Wealth Guide For - Teachers In School Health Work · Community Health

Wealth Guide For - Teachers In School Health Work

Item

Title: Wealth Guide For - Teachers
In School Health Work
extracted text: SAD-RF-CH-2.10

Weaffih Mie Far Teachers

m Sehasli E fo-aiSth Work

SCHOOL HEALTH PROGRAMME

M. G. D. Ki. HOSPITAL,
Kangazha, Kottsayaxxx, Ke ml a,.

PREFACE
It is estimated that one-fifth of the country’s population is
comprised of school going children. Hence health care of this
group assumes paramount importance.
Although school health
service is considered important among the national priorities in
health, this service is largely unavailable for want of resources
both in personnel and in kind. It is impracticable for a country
like ours to- have a system in which we have physicians to take
direct responsibility for the care of school children.
The role of teachers in health care of the community
is increasingly being recognised- They certainly can share part
of the responsibility in school health work. Based on this philo
sophy, the community health department of M. G. D. M. Hospital
has launched a new system of school health work involving teachers
in the various levels of health care delivery to pupils. This publi
cation is intended as a guide for our teachers who arc so graciously
involved in this new venture.

M. G. D. M. Hospital
Kangazha.

Dr. M. V. Joseph md> dch.
Pediatrician and
Community Health Co-ordinator

CONTENTS

SECTION I

Page

IfJSVnUCTlOfJ AUD STA3DIHG orders

1

Section I

— Instruction and Standing Orders.

Section H

— Simple Dental Care

Section HI

— Prevention of Malnutrition in
School Children

Section IV

— Immunivation and Prevention of
Communicable Disease

15

Appendix I

— School Formulary

17

Appendix 11

— Lab. Test by Teachers

(a)

io
„

„

13

18

HOW TO RECOGNISE A SICK CHILD?
i

The teacher is in a unique position to carry out ‘daily
/inspection’ of children as he is familiar with children and can
detect changes in the child’s appearance or behaviour that suggest
'illness. The following clues will help the teacher in suspecting
that the child is ill(I) Child is less active is irritable and
fretful and not attentive in the class
(2) His an unusually
flushed face.
(3) Has red or watery eyes. (4) Has rashes or
spots on the body or face (5) Has a running nose, or sneezing
(6) Complains of sore throat
'(7) Complains of car-ache
(8) Has a rigid neck (9) Has swelling over the face and other
:regidns eg. Mumps, Dental abscess.
Then what do you do?

!

/

I
J

Inspect child closely to assess the seriousness of the child’s
problem, Take a history as to the duration and severity of the
symptoms. Try to assess if the child’s condition is serious enough
to send for medical aid. Decide if the child has any one of the
communicable diseases such as mumps, chicken pox, which are
highly infectious; if so, the child should be removed from the school
environment as early as possible.
(b) COMMON SYMPTOM'S AND THEIR MANAGEMENT
Fever
Is a common symptom of many diseases especially the infec
tious diseases such as chicken pox, measles,' mumps etc: Record
the temperature. If the fever is high (over 161"—102"F) child needs
to be sent to the doctor immediately. Look for rashes or spots on the
body or face; look for swelling on face and check angle of the jaw
for mumps- Examine throat for inflamed tonsils. If the child has
none of the above symptoms and is otherwise vVell^ symptomatic
treatment with antipyretics (Aspirin) may be tried for 1 or 2 days.
Jf the fever persists after 2 days, send the child to doctor.

5

2
Cough and Cold
If the child has got cough and cold with not much of
fever or respiratory difficulty, he maybe treated for a short period
with a cough syrup.
If child is not well after 48-72 hours or
develops difficulty in breathing or any other serious symptom, he
should be referred to the doctor.
ACHES AND PAINS

vomiting along with pain in abdomen which starts at the umblicus
(Navel) and is associated with vomiting and fever. Give the child
a few doses of carminative mixture •} oz. three time day (diluted)
for 1 or 2 days. If the symptom persists, send the child to the
doctor.
Vomiting

Any child who has serious vomiting (more than one or two
bouts) should be sent to the doctor.

Headache:
,r
diarrhoea
Mild headache of short duration associated with a running'
Simple diarrhoea (loose, frequent, excessive bowel move
nose and bodyache is caused by influenza. These children can be
ments), resulting from dietary indiscretion, change of food or water,
treated symptomatically for short periods with cough syrup and
or from fatigue or tension, usually subsides in 12 to 48 hours.
analgesics such as aspirin. Headache is often caused by stress or
Relief is best accomplished by refraining from food for the first 18
strain, tension, sleeplessness etc. These cases can be treated with
to 28 hours. Because the body is dehydrated, replacement of fluids
rest and analgesics such as aspirin. But if headache is persistent
is important. Give the patient weak tea, lime juice, salted or salty
or recurrent, medical help shall be sought. Headache can be a
broth every hour or after every bowel movement. Liquids should be
symptom of severe brain disease such as inening its or, encephalitis,
tepid (not hot, not cold). Rest in bed may hasten recovery. When
orbrain tumour if it is associated with vomiting. If any child who
I bowel movements have ceased for 18 hours, begin feeding the patient
has headache and also has of vomiting, shall be sent to the doctor
alight, bland diet—bread, kanji, well cooked rice, butter milk and
immediately.
liquids as above. Avoid spicy foods and do not use laxatives. If
Tooth-ache:
diarrhoea persists, consult the doctor. Severe diarrhoea with a
For temporary relief of tooth-ache, clean the cavity with a
large number of watery stools can be serious and the child should
swab of cotton wool on a toothpick: then pack the cavity with
be hospitalised.
■a bit of sterile cotton wool dipped in oil of cloves. Be careful
not to drip the oil on the gums or tongue; it burns. If the pain
(c) EMERGENCIES AND FIRST AID
comes not from a cavity but from some part of the gums or jaw,
First aid for emergencies arc given in alphabetical order
hold a hot-water bottle to the face on the side that aches. Aspirin
‘ for easy reference.
may help to relieve pain temporarily. Send the pupil to a dentist
Bites—Animal
if pain persists.
Earache:
If foreign body or discharge is not found, give aspirin.
' Refer to the doctor if the child is not better after a period of
observation.

Wash the wound immediately under running tap water to
flush out the animal’s saliva. Then wash the wound for five minutes
with a gauze dressing and plenty of soap and water. Rinse thoro
ughly with running water and cover with a dressing. Consult a
doctor immediately.

Abdominal pain
May be caused by diet upsets, dyspesia or gaseous disten
sion of stomach, but could also be caused by serious disease such
as appendicitis. Suspect appendicitis if the child complains of.

| Bleeding—Severe
Get the child to lie down to prevent fainting. To stop the
bleeding, press a sterile gauze dressing or a clean handkerchief,

firmly over the wound with your whole hand- If the dressing
becomes saturated with blood, lay a fresh dressing directly over
the saturated one and continune pressure- If bleeding from an arm
or
leg cannot be stopped by direct pressure over the wound, try
or Teg
shutting off circulation in the artery supplying the blood by pressing
'
’. Apply a tourniquet.,
firmly against it with the palm of your hand.
to drink,' this
or tie with a handkerchief. Not
IL. to
L give- things
'
—Cdag t„..
the. bones
under an aestheria
may result in delay in setting
____ ___
which requires that
th... the
.1----stomach should be fully empty above the
wound. Release the tourniquet after 10 minutes. If the bleeding.
continues, send child to hospital after reappling it. When the
bleeding has stopped, bandage the dressings in place firmly, but
not so tightly that you can't feel the pulse below or beyond the.
wound. Send the pupil to a doctor-

not give fluids to drink, this may result in delay in setting the bones
under anaesthesia which requires that the stomach should be fuliy
empty-.'*'
Broken Neck or Back

-

If the child cannot' move his fingers readily, or if there is
tingling or numbness round his shoulders, his neck may be broken.
but not his •feet
or* toes,
|
~If he can move his fingers
U
w •. V
IO vj j or
\J X if
111he has
!z ingling or numbness'in his legs; br pain when he. tries
___ to
.j move
nis back dr ■ neck, his back-may be broken.' Loosen clothing round
neck and waist; Cover' tbc:child;and'summon a doctor or ambu-...
lance. Don't move the child for examination. Don't lift his
head to give him water. Don’t let him try to move. The spinal
cord extends down through the neck and back vertebrae, and any
Bones—Fractures
pressure or movement may cause damage to the spinal cord and
result in Paralysis.
While waiting for the doctor,, keep the .patient warm,, and-. ■
treat for shock if necessary. 1If the broken bone protrudes, through--•><
the skin and there is severe bleeding, stop the bleeding, but do not-.iBurns - Chemical
Make no attempt, to clean . .
attempt to push the bone back in place
the wound. Wait for medical aid. . If no doctor is available and'
Sluice the burnedarea thoroughly with water to dilute and
the pupil must be moved to receive medical aid , dress the-wound usd I
remove/the chemical.' Then treat as you would a comparable heat’.
ifan'y. The fracture should be immobilised with splints to prevent i .i
burn.-' If an 'eye is burned by a'chemical, sluice the eye gently •
further damage. For spiints, use anything that will keep the broken
but thoroughly with sterile water or with a saline solution. .
bonds from moving; newspapers or magazines for arms, I boards for:
Cover the eye with a sterile dressing and consult a doctor
legs. Make the splints long enough to reach beyond the joints
immediatelyabove and below the fracture site.
If the limb must be straightened before splints can be
[ Burns and Scalds - Minor
t ■
applied, support the limb with a hand on either side of the fracture •
Run cold tap water over the burn to reduce the pain. Wash
site while someone gently eases it into a position as nearly
your hands thoroughly before touching the burn, If the skin is
natural as possible. Pad improvised splints with cotton wool or
i not blistered, smooth on petroleum jelly and edver the burn
clean rags and tie them snugly (but not too tightly) in place with
bandages, belts, ties or strips of clothing. Body splinting may > ' ; with several dressings, one on top of the other. If the skin is
also be used: a fractured forearm against the chest for instance,.;,: i blistered, cover the burn with sterile dressings, to
to vprevent contaor an injured leg against the sound one. Splinting is done merely . -... ■ j mination. Don’t apply ointment, oil or antiseptic.. Don’t break' ’’
to immobilize the fractured limb. If possible, don't splint and dan't-i j or drain the blisters.
move the patient at all. If the fracture is in the back, neck, pelvis
or skull, don’t attempt to move the patient. Don’t assume that no '
Caution: Minor (superficial) burns or scalds may be danger
bones arc broken merely because the child can move the injured
ous if large areas are involved. Send the pupil for Medical
joint or limb. To avoid complications, get a doctor promptly. Do- ■ • attention.

6
Convulsions (Fits)
In convulsive spasms the child’s lips turn blue, his eyes roll
upwards, his head is thrown back, his body is jerked by uncon
trollable spasms. Don’t try to restrain convulsive movement.
Place the child on the floor, and turn his head to one side to allow
saliva to drain- Move furniture so that he cannot injure himself.
Put a rolled handkerchief between his teeth to keep him from
biting his tongue. If he is feverish, place cool, wet cloth on his
forehead and sponge his body with cold water. When the spasms
subside, make him as confortablc as possible. Convulsions do not
usually last more thana few minutes. If the pupil is not known
to have had convulsions in the past, send the child for urgent
hospitalisation.

Cuts, Scratches, Abrasions
1.' .To minimize the possibility of infection, wash your
hands thoroughly before treating any wound. Using sterile gauze,
clean the skin round the wound with soap and running tapwater.
To avoid contamination wash away from the wound, not towards it.
2- When the area round the wound is clean, wash the wound
itself with soap and running tap water for five minutes, using-a
fresh piece of gauze for each swabbing. Clean out all dirt and
debris. :-If it is necessary to use tweezers to remove debris, boil
them first for ten minutes or sterilize them in the flame of a spirit
lamp
s’ t .-ing sUrife gauze, apply mild antiseptic to the wound
and the skin surrounding it.
4. When the antiseptic is dry, cover the wound with sterile
gauze held in place by bandage or adhesive tape.
5. Watch carefully for the signs of infection - which may
not appear, for several days: (a) a reddened, hot, painful area
surrounding the wound; (b) red streaks radiating from the wound
up the arm or leg: (c) swelling round the wound, accompanied
by shivering or feverishness. If infection appears, see a doctor
at once.
6. Remember that there is always danger of tetanus (lockjaw)
in any wound; in deep, extensive or dirty wounds, the threat is
Serious. If the child has been previously immunized with tetanus

’ toxoid (triple vaccine) and immunity has been maintained with refresher in jections, toxoid given by a doctor at the time of injury
will provide protection- But, if the child has not been immunized
' previously, toxoid cannot give immunity fast enough, and the
doctor will then administer antitoxin. (Antitoxin gives temporary
but not lasting immunity) Antitoxin should be followed by a
course of 3 tetanus toxoid injections first al mg with the ATS,
then 2nd after 6 weeks and 3rd 6 months after the first
ly-. shot.
1
:

;

Fainting

Place the person on his bac.k, head low. Loosen tight cloth
ing, apply cold cloth to his face and forehead, allow him to inhale
aromatic spirits of ammonia.
When he revives, give him hot
coffee ortea. I f the fainting lasts more than a minute or two, keep
5 the patient covered warmly and summon a doctor. Fainting may
be caused by fatigue, hunger, sudden emotional shock, a poorly
;■ ventilated room, etc. The patient’s breathing is usually weak,
■ pulse feeble, fr.ee pale and the forehead covered with beads of
; perspiration. Iflhe pupil merely feels faint, make him sit in a
chair, bending forward, with his head between his legs
! and lower than his knees, and tell him to breathe deeply.
1

i Head Injury — Fracture, Concussion
Suspect head injury in any traffic accident, fall or other
^incident of violence. Symptoms: child dazed or unconscious, bleed
ing from mouth, nose or ears; pulse rapid but weak; pupils of eyes
/unequel in size, paralysis of one or more extremities: headache
’or dizziness. Or the child may appear quite normal and have a
: momentary loss of consciousness or a lack of memory of the event
■.causing the injury - only to lapse into unconsciousness later. Keep
’the patient lying down and covered for warmth until the doctor
icomes. Even though the blow may not have brought about unconsiciousness, there is always danger of brain haemorrhage and serious
(trouble later- Lying quietly lessens the chance of haemorrhage.
pf the patient’s face is flushed and if you’re sure his neck or spine
lis not fractured raise his head and shoulders on a small pillow
'or jacket. If his face is pale, don’t raise his head. If you must
move him, keep the patient lying flat while doing so,' If he is

8

S

j

s

unconscious or choking, turn his body and head gently to ,-the
side so that blood or mucus can-drain from the.corner of his
mouth. If his scalp is bleeding, place a sterile dressing
' lightly over the wound, without pressure, and bandage
it into place (Pressure may pu'h bone fragments into the
brain).
Do not permit the child to sit up or walk about. Don’t leave
him unattended. Get medical aid at once. .Keep him lying down
' and completely quiet until help comes. If he is unconscious do .not
attempt to give him anything by mouth.

5 If the poison is a strong acid (such as carbolic) or alkali
(like, ammonia) or paraffin or petrol, do not induce vomiting.
Instead attempt to dilute and neutralize the poison. Neu
tralize acids with two tcaspoonfuls of magnesia to a glass of
water. Neutralize alkalis with a teaspoonful of lemon juice
or vineear to a glass of water. Give several glassfuls, but :
not enough to cause vomiting. Then give a glass of milk or
four egg whites. If the poison is paraffin, petrol or similar
solvent, merely administer four or five glasses of water. Get
the child to a doctor or hospital. Always keep the container
of poison to show to the doctor.

Nose Bleed
Puncture Wounds
Make the patient sit quietly, with the head thrown . forward,
1 Gently squeeze or'‘milk” the wound, to encourage bleeding.
and press the nostrils together for five minutes. This may cause a
(Punctures that arc caused by nails, wires, needles, pins or
clot to form over the ruptured blood vessels. If this fails, pack each
any olher penetrating objects tend to “’seal in’’ contami
nation)
■ bleeding nostril with a plug of sterile gauze, leaving one end of each
2 Wash your hands and then clean up the wound and apply an
plug outside so that it can be removed from the nostril easily. Get
the patient to lie down, with his head elevated, and place a cold wet
antiseptic.
t
3 Cover the wound loosely with a sterile dressing. Apply cold
towel across his face. Slight nose bleeds often occur spontaneously,
compresses.
particularly in children. In event of persistent nose bleed, consult a f
4 Take the pupil to a doctor. The doctor will clean the wound,
doctor.
opening it further if necessary, and will administer a re
Poisoning by Mouth
fresher injection of tetanus toxoid or an injection of tetanus
antitoxin if necessary. The chance of child getting tetanus
Contact the doctor immediately. Tell him what the suspected
is high with puncture wounds.
poison is and follow his instructions.
2 If you can’t get medical advice, dilute the poison in the : Shock— How to treat it
stomach by giving the child several glasses of milk or water '
auI 1Ous injury (bleeding wound, fracture, major burns),
In any serious
Save the vomitus in a bottle for examination.
'. always expect shock and act to lessen it. Symptoms: the skin is
Symptoms:
3 If the poison is known to be a strong acid or alkali — if the. jPalc, cold, clammy; the pulse is rapid: it.
breathing
shallow, rapid or
child’s mouth is burned, you can assume it's one or the other , irregular: the injured person is frightened, restless, apprehensive.
or
paraffin or
petrol, proceed to.step
5.
or if
nrnnr.ffin
nrnMrnl
tn
S Ifitisn
If U t. ’t, W it
n |1
1’ Keep the patient lying down W i th head a t a lower level than
is unknown, induce the child to vomit by sticking yourthe feet.
fingers in to his throat or by giving him several glasses- off
2 Loosen his clothing.
warm water containing one tablespoonful of. salt, per glass. ’
3 Keep him lightly covered, but do not cause sweating. Don't
Keep his head low and turned to one side so that.he won’t :
apply hca t, such as a heating pad or hot-water bottle. The
inhale any vomit.
object is to conserve body heat, not to overheat the patient.
4 After the child has vomited, administer several more glasses,?
4 In the case of head or chest injuries, raise the patient’s bead
of milk (two to four) or the whites of four raw eggs mixed ]
and shoulders on pillows or rolled up coats so that his head
with a glass of milkj

10
is ten inches higher than the feet- If the patient develops
difficulty in breathing, lower the head as in Step. 1.
5 If the patient is conscious and thirsty, give him plain water
(neither hot nor very cold), a few sips at a time. Do not
give water if the patient is nauseated, or if he has a deep

abdominal wound.
6 Shock due to loss of blood volume requires urgent hospital
attention for blood transfusion.
Swallowed Objects
Small round objects (beads, buttons, coins, marbles) swallo- (
wed by children usually pass uneventfully through the intestines and
are eliminated. Do not give cathartics, laxatives or bulky foods—
give just the normal diet. If there is pain, consult a doctor. For
several days, strain stool through muslin to determine whether object
is eliminated. Sharp or straight objects (hair-pins, open safety
pins, bones) are dangerous, and if the ehild has swallowed any one
of them, immediately send the pupil to the hospital.

Throat ■— Something Caught in.
Encourage the victim to cough up the object. Do not probe
with your fingers; probing is less effective than coughing and may
push the object deeper. If coughing doesn’t work, hold him head
down and slap him hard on the back between the shoulder blades or
make him bend head-down, or lay him across something head-down>
and slap him hard between the shoulder blades. If the substance
cannot be dislodged, send for a doctor or ambulance.
SECTION II
SIMPLE DENTAL CAKE
Function of the Teeth.
Food must be broken into small pieces in the mouth so that It
can be swallowed easily, and to enable further digestion in the
stomach. It is, therefore, important that the teeth are well cared
for as well as the gums around them so that they have a good chance

of being kept healthy.

Dental Decay — How Dental Decay starts.
After each meal, food particles may remain in the cracks on
the top of the teeth, or between the teeth. Bacterial action on this

li
food make an acid which dissolves the enamel of the tooth. A small
hole therefore forms which will get bigger unless something is done
about it. At this stage a dentist can remove the decayed part of the
tooth and do a filling. If this treatment is not carried out the hole
" wi|l get bigger and as it gets nearer the nerve pain will be felt.
Symptoms of Decay.
The pain will only be felt with hot, cold, sweet and acid foods
at first, but later it will be felt all the time and will be severe. If
the tooth is left untreated the decay will kill it and then an abscess
may form. An abscess is an infection round the end of the root
which has reached there from the decay in the crown of the tooth.
The symptoms of an abscess arc:
1 The tooth hurts when it is knocked gently.
2 There may be some swelling in the mouth next to the tooth.
3 The whole side of the face may be swollen.

Treatment:
If there is any swelling near the bad tooth it is usually advi
sable to give a course of antibiotics. When the swelling has subsided
the tooth should be removed as soon as possible. If the extraction is
not done, the swelling and pain will recur. If there is no swelling
and you are quite sure which tooth is causing the pain it maybe
extracted by the dental surgeon.
Keeping the Teeth cleau:
Dental decay and gum disease are caused by food resting on
the teeth and gums, so when a pupil comes with bad teeth or gums it
is important to teach him how to keep them clean so that he will not
have trouble in the future. Often gingivities can be completely
cured by cleaning the teeth and gums correctly. Instruction in
cleaning the teeth is for everyone, not only for those who already
have dental disease- Prevention is better than cure. Teach those
who do not have gum disease so they are less likely to get it.

What to use for Brushing.
A small toothbrush, and toothpaste (dental cream) are the
best means, but a stick (chewed at one end to make a brush) is quite
good if it is used correctly. Common salt may be used on the stick
Qr brush instead of toothpaste. Charcoal powder (umikkari) has

been found to be of no value. Constant use will damage the enamel.
Its action is only that of a polishing agent.

tooth to the jaw. As this continues, the tooth begins to get loose
and painful, and eventually it may be necessary to extract it- The
condition is made worse by tartar (a hard substance which sticks to
When to -brush the Teeth.
teeth that are not kept clean) which is most often seen behind the
After breakfast in the morning. It is no. good brushing
■ lower front teeththem before breakfast because you soon make them d irty again when ;• Treatment.
you eat. Before you go to bed at night. It is important that you
If there is tartar present this should be removed (scaling) with
sleep with a clean mouth. If possible,, after the midday meal also.
a special instrument. When this has been done, or if tartar is not
present, the pat ient should be taught how to brush the teeth correctly.
Method of cleaning Teeth.
■
Brushing the teeth properly prevents food resting on the gums and
Always start on the gum above or below the teeth and brush
the inflammation (gingivitis) should subside.
away from the gums over the teeth. When all the teeth have been
Acute Ulcerative Gingivitis.
cleaned like this, brush the tops. Ensure that each surface of each
This disease is not so widespread as simple gingivities but is
tooth
least ten times. This is not always easy,
LWIU has been
Uvvu brushed at
— ------------especially at the back of the mouth, and it will require practice i also found in people who do not keep their mouths clean. It is often
seen in young malnourished adolascent school children--------- it
easier
take at
After a short time however,
i. will
.’become
------ * -u
—M but should
<»
the mouth should be thoroughly
Signs.
least two minutes, iAfter
___ brushing,
_
rinsed with water three times to wash away all the food that has
Ulcers are seen along the margins of the gums, being next to
one tooth or severalseveral. The mouth is very sore, and because of this
been cleaned off the teeth.
the
pupil
may
not wish to eat. The. ulcers which may have a white
IFoods that are bad for the Teeth.
covering, bleed easily and the patient’s breath has a characteristic
I
and
most
of
them
These are ones which stick to the teeth
smell. Sometimes the patient feels generally unwell and may have a
contain a lot of sugar, such foods being cakes, biscuits and sweetsslight temperature.
If these foods are to be eaten they should be taken with meals
Treatment.
because the teeth decay starts half an hour after sweet foods have
then
the
Carefully apply a strong antiseptic on a very small piece of
been in the mouth. If these foods are eaten between meals
cotton
woo] to the ulcers. Do this once a day.
Tell the child to
teeth will obviously be decaying for a longer time.
keep the mouth clean. If it is too sore to use a brush, cotton wool
Foods that are good for the Teeth.or even a damp cloth may be used to wash the teeth. Rinsing the
These are those vegetables and fruits which are firm and | mouth with warm salt water after meals is also helpful. As soon as
fibrous and which have to be chewed hard: pineapple, mangoes, | possible correct brushing with a toothbrush should be started. It is
coconut, apple. It is a good idea to eat foods like this at the end j also important to ensure that the patient is having a balanced diet.
of each meal.
Section III
DISEASES OF THE GUMS
PREVENTION OF MALNUTRITION IN SCHOOLCHILDREN
Gingivities.
This is the name given'to inflammation of the gums. The !■ Protein and Calorie Malnutrition.
pupil complains of soreness and bleeding of the gums. It is usually !
Child will be under-weight with stunted growth. (Weight
caused by food being left around and between the teeth. If the and Height of children should be recorded annually and checked
patient does not keep his mouth clean this condition gets worse and against the standard chart provided). Advise cheap sources of
spreads down towards the root, destroying the fibres attaching the protein—Pulses should be advised to be eaten every day with rice;

i

15
14

ground-nut is a good source of protein, which is easily available

SECTION IV

IMMUNISATION AND PREVENTION OF COMMUNICABLE DISEASE

and cheap.
Small pox Vaccination
Deficiency Vitamin A.
t
If the child is not vaccinated at the time of school admission,
Deficiency of this Vitamin affects eyes and vision. Carelul
examination of the eyes with reveal deficiency of this v Ham in. Keep K advise vaccination- Revaccination is to' be done once in 3 years.
This vaccination prevents small pox. Following the vaccination,
eye open for 30 seconds and look fordrynees of conJuncUve i <W^‘®
some pupils may develop excoriation and ulceration at vaccination
portion). Also look for irregular white patches on this aiea (Bitot s
i site..
This does not require any special
However
soots') These are early evidence for Vit- A deficiency an
-*------ treatment.
many complaints of night blindness i.e. inability to see in dm^ boric powder may be applied locally, to reduce the iinflamation.
In advanced case of Vit. A deficiency the cornea will ’ be t r^o
* o other dressings or medicaments are to be applied.
aoDlied. If any other
affected with dryness or ulceration. If the cornea is affected, send untoward reaction develops, it should be reported to the school
the child to hospital immediately. Early cases of Vit. A deficiencies physician.
can be treated with A I D Cap. given daily for 1 or 2 months or B. C. G.
Vit A concentrate 1 dose or fish liver may also be used. Child shall >
Inspect children for vaccination scarat. school entry (small
be instructed to eat plenty of green vegetables such as cheera to i puckered scar on the shoulder). If not vaccinated, arrange vacci—
nation with school team. Revaccinate 5 years after the primary
get good amounts of Vit Ain diet.
;
vaccination
B. C. G. helps to prevent tuberculosis and is
Vit. C Deficiency.
Children with Vit. C deficiency will have unhealthy and r believed to be of some value in preventing
■
= leprosy.
bleeding gums. They should be asked to take fruits like ‘oranges. Pta Tetanus Vaccination
. and goosebcry and fresh vegetables’. Vit. C tablets also may c
le t'meof school admission, find out if the child has
given for short periodsLec-ived th-m ° A"tlSen and poil° vaccine- If the child has not
Deficiency of Vit. 13 Complex.
’health team" 2 do’seq nt7“t- arra°ge immaa'sation with school
Will be manifested by soreness of mouth and tongue,- fissureHof toxoid fo be
‘
s 'nterva‘^11 suffice. Booster dose
of the angle of the mouth etc. Parboiled nee should be ad v.scd and.
ry hve years. .
also fresh vegetables. B complextablets could be given for a period^
Can be given to the ch'H
. ,
of 1 or 2 months.
.^lio bein« common
h ’
"
reCeived ,hem but
Iron Deficiency anemia.
. 'Very necessary
"
Ch‘'dren’ U
Children with iron deficiency anem.a will look pale, a“d
Prevention of Snreml of cnn.
• ,>
attentive in class and will be backward in studies. The nail and.
pread of Communicable Disease
conjuctive will look pale. In doubtful case Hb estimation> should^
A
help to prevent certain
be done.
If Hb- (Haemoglobin) less than 10 gm / iro'
children. Sometimes these diseases spread very
should be given in the form of tablets. Dosage 2-3 tablets a
Y
econie epidemic. Cross infections occur very commonly
day for 2 or 3 months. Children should be asked to consume
So
have a role in the prevention of spread of
d’cUic'b
This will be possible by ea'rly
diJt
rich in iron such as green leafy vegetables such as ccabagegjmunicable
aaba8ew
b diseases.
®as«- Tins
early case deteccbccra etc. Jaggery taken instead of sugar will provide good,
iso ation and imposing quarantine for cases and their
amount of iron. Children with severe anemia (lib. less 5 gm/£
•
te folio wing table will give the sign symptoms isolashall be hospitalised. Stool examination for hook worm should b
• quarantine period of some common communicable diseases,

done in all severe cases.

17
Appendix I

School Formulary
Tablets
Aspirin

Dosage, uses and side effects
Aches and pain, fever. One tablet 3 or 4
times a day to be taken after meals.
(not to give on empty stomach)

Irom

For treatment of iron deficiency. 2 or 3
tablets daily after meals, to be give for 2
or 3 months.

B. Complex

One tablet twice daily for 1 or 2 months.
For children with signs of B. Complex de
ficiency such as sore tongue and angle of
mouth etc.

A & D Capsules

One or two capsules daily for one or two
months for children with signs of Vit. A
deficiency such as night blindness, dryness
of conjunctive etc.

Muiti Vitamin

One or two tablets daily for general debi
lity and Vitamin deficiency states.

Mixtures
Cough syrup

—

One or two teaspoon 3 times daily for 2
or 3 days for children with common cold,
cough etc.

Carminative mixture—

j oz. of diluted mixture (1:4) 3 times
daily for one or two days, For children
who complain of miln paid abdomen,
colics.

Kaolin mixture

A oz. 3 times daily for one or two days
for children who complain of mild
diarrhoea.

Local applications
Benzyl Benzoate
d

o -•
w p <
CT r-* <“* CT

(25-/• solution) For treatment of scabies
and pediculosis. Tobe applied all over
the body except head and face after a

18

Calamine lotion
Ointment
Furacin ointment —
White field'ointment—

Sulfa acetamide eye
drops (LOCULA)—

bath at night to be repeated morning and
bed time for 2 days and take bath after
that- Treatment may have to be carried
out for other members of the family and
contacts.
For itching and urticaria. To be applied
locally.
\

■

For infected skin wounds or other lesions.
For treatment of superficial fungal infec
tions of the skin such as ring worm.

For red eyes,
Trachoma.

(conjunct ivities)

and
.?/ TOK

WITM

Tos£

PipPer re

Urine Examination
Urine sugar test (Benedicts test)
Appendix II
Take 5 ml- ofbenedicts qualitative reagent and to it add ‘8’
LABORATORY TESTS BY TEACHERS
drops of urine and boil for 3 to 5 minutes
—
3 to 5 minutes and note the colour of
solution.
Haemoglobin estimation
Blue colour (no sugar)
Green
* —
s.
— Negative
Finger tip is cleaned thoroughly with spirit and is dried with; Yellow colour
small amount of sugar (0-5./•)
colour 1 ..—,
a piece of cotton. The finger is held with a very gentle pressure on£i Orange colour j Moderate
! amount of sugar
■the sides. The needle is sharply plunged to a depth of 3 mm. deep.5 Red colour
(1.5-/.)
Large amount of sugar
The pressure is released and blood is allowed to flow freely. They
(2-1./.
blood should be collected in the pippette within one minute.

PROCEDURE
Sahli Method

I
I

Place N/10 hydrochloric acid in the tube up to the lowest mart
Blood is down into the pippette up to the 20 mark, and transferred
in to the tube and mixed well. The tube is shaken well and waitfor 10 minutes and allow the brown colour to develop. Then dilute
the solution with distilled water drop by drop; tipe the coloujj
matches with the glass plates of the comparator. Matching should
be done in good sun-light. • The reading is then taken, from th;
markings on the tube.' (N/10 Hcl can be made by adding 1 ml. 4
con. Hcl. with 99ml. of distilled water).

I

20
Albumin test (sulphosalicylic acid t ■st)
1
To 2 ml. of clear urine add a i equal volume of 3-/. sulpho;
salicylic acid and allowed to stand for 10 minutes.
No cloudiness
—
No albumin
I
Cloudiness against a black
I
back ground
—
Trace amount of albumin, j
Cloudiness with granules and
definite floculation
—
Moderate amount of albumifj
Cloudiness with floculation
—
Large amount of albumin j
Motion examination for parasites
Take a small amount of fa
matter on the end of a narrov
stick and make a thin emulsion in a drop of normal salin;
placed on a glass slide and put a cover slip over it. The thicknes
of the preparation should be such that one should be able tc
see fine prints through it and examine the slide under a micro;
scope. Identity the parasites from the diagrams given below:

ROUND- IVOW

OVUM

HOOK-WORM

OVUM

yjHtP -WORM

Ol/t
I

References
1.

2.
3.
4.
5.

Text Book of Preventive and Social Medicine by J. E. Park
and K- Park; Published by Banarsidas Bhanot Jaipur, 1976. il
Simple Dental care for rural hospitals by David J. Halestraps
Published by The Medical Missionary Association, London,I97C
Text?Book of Pediatrics by Nelson, Vaughan and Mckayh
Published by W. B. Sanuders Company. Philadelphia, 1975. ?
Hand Book of First—Aid-Reader’s- Digest Publication.
;■
Hand Book of Medical Laboratory Technology. Published
by the Staff of the department of clinical pathology an4
Blood Bank of the Christian Medical College and Hospital;
Vellore, Tamil Nadu.
I

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