Health Guide For Teachers in School Health Work

Item

Title
Health Guide For Teachers
in School Health Work
extracted text
Health Guide For Teachers
in School Health Work

SCHOOL HEALTH PROGRAMME

M. 6. D. M. HOSPITAL,
Kangazha, Kottayam, Kerala.

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COMMUNITY HEALTH CELL
326, V Main, I Block
Koramungala

PREFACE Bangalore-560034
India

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It is estimated that one-fifth of the country’s population is
/comprised of school going children. Hence health care of this
youp assumes paramount importance. Although school health
* ervice is considered important among the national priorities in
■' health, this service is largely unavailable for want of resources
coth in personnel and in kind. It is impracticable for a country
> ke ours to have a system in which we have physicians to take
rect responsibility for the care of school childly

The role of teachers irk health care of the community
'increasingly being recognised-) TheyXcertainly can share part
f the responsibility in school health work. Based on this philo. ophy, the community health department of M. G. D. M. Hospital
* ias 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 are so graciously
(involved in this new venture.
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Vs-’iS
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: M. G. D. M. Hospital
; Kangazha.

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

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CONTENTS

Section I

— Instruction and Standing Orders.

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Section II

— Simple Dental Care

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Section III

— Prevention of Malnutrition in
School Children

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— Immunivation and Prevention of
Communicable Disease

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Appendix I

— School Formulary

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Appendix II

— Lab. Test by Teachers

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Section IV

CC/7 /rs-'
COMMUNITY HEALTH CELL
47/1. 'First Fleer; St. Marks Road.
Bangalore - 560 001.

SECTION I

INSTRUCTION AND STANDING ORDERS
(a)

HOW TO RECOGNISE A SICK CHILD ?

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(1) Child is less active is irritable and
fretful and not attentive in the class
(2) Has 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
regions eg. Mumps, Dental abscess.
Then what do you do?

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 SYMPTOMS 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 101°—102nF) 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 well, symptomatic
treatment with antipyretics (Aspirin) may be tried for 1 or 2 days.
If the fever persists after 2 days, send the child to doctor,

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Cough aud 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

Headache:
Mild headache of short duration associated with a running
nose and bodyache is caused by influenza. These children can be
treated symptomatically for short periods with cough syrup and
analgesics such as aspirin. Headache is often caused by stress or
strain, tension, sleeplessness etc. These cases can be treated with
rest and analgesics such as aspirin. But if headache is persistent
or recurrent, medical help shall be sought. Headache can be a
symptom of severe brain disease such as inening its or, encephalitis,
or brain tumour if it is associated with vomiting. If any child who
has headache and also has of vomiting, shall be sent to the doctor
immediately.

Tooth-ache:
For temporary relief of tooth-ache, clean the cavity with a
swab of cotton wool on a toothpick; then pack the cavity with
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
comes not from a cavity but from some part of the gums or jaw,
hold a hot-water bottle to the face on the side that aches. Aspirin
may help to relieve pain temporarily. Send the pupil to a dentist
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.
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

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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.

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Diarrhoea
Simple diarrhoea (loose, frequent, excessive bowel movements), resulting from dietary indiscretion, change of food or water,
or from fatigue or tension, usually subsides in 12 to 48 hours.
Relief is best accomplished by refraining from food for the first 18
to 28 hours. Because the body is dehydrated, replacement of fluids
is important. Give the patient weak tea, lime juice, salted or salty
broth every hour or after every bowel movement. Liquids should be
tepid (not hot, not cold). Rest in bed may hasten recovery. When
bowel movements have ceased for 18 hours, begin feeding the patient
alight, bland diet—bread, kauji, well cooked rice, butter milk and
liquids as above.
Avoid spicy foods and do not use laxatives. If
diarrhoea persists, consult the doctor. Severe diarrhoea with a
large number of watery stools can be serious and the child should
be hospitalised.

(c)

EMERGENCIES AND FIRST AID

First aid for emergencies arc given in alphabetical order
for easy reference.

W

Bites—Animal
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.

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

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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
shutting off circulation in the artery supplying the blood by pressing
firmly against it with the palm of your hand. Apply a tourniquet
or tie with a handkerchief.
Not to give things to drink, this
may result in delay in setting the bones under an aestherla
which requires that the 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-

Bones—Fractures
While waiting for the doctor, keep the patient warm, and
treat for shock if necessary.
If the broken bone protrudes through
the skin and (here is severe bleeding, stop the bleeding, but do not
attempt to push the bone back in place- Make no attempt to clean
the wound. Wait for medical aid. If no doctor is available and
the pupil mubt be moved to receive medical aid, dress the wound
if any. The fracture should be immobilised with splints to prevent
further damage. For splints, use anything that will keep the broken
bones from moving; newspapers or magazines for arms, I boards for
legs. Make the splints long enough to reach beyond the joints
above and below the fracture site.
If the limb must be straightened before splints can be
applied, support the limb with a hand on either side of the fracture
site while someone gently eases it into a position as nearly
natural as possible. Pad improvised splints with cotton wool or
clean rags and tie them snugly (but not too tightly) in place with
bandages, belts, ties or strips of clothing. Body splinting may
also be used: a fractured forearm against the chest for instance,
or an injured leg against the sound one. Splinting is done merely
to immobilize the fractured limb. If possible, don’t splint and dan't
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
bones arc broken merely because the child can move the injured
joint or limb. To avoid complications, get a doctor promptly. Do

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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.
If he can move his fingers but not his feet or toes, or if he has
tingling or numbness in his legs, or pain when he tries to move
his back or neck, his back may be broken. Loosen clothing round
neck and waist. Cover the 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 aud back vertebrae, and any
pressure or movement may cause damage to the spinal cord and
result in Paralysis.

Burns - Chemical

Sluice the burned area thoroughly with water to dilute and
remove the chemical. Then treat as you would a comparable heat
burn. If an eye is burned by a chemical, sluice the eye gently
but thoroughly with sterile water or with a saline solution.
Cover the eye with a sterile dressing and consult a doctor
immediatelyBurns and Scalds — Minor
Run cold tap water over the burn to reduce the pain. Wash
your hands thoroughly before touching the burn, If the skin is
not blistered, smooth on petroleum jelly and cover the burn
with several dressings, one on top of the other. If the skin is
blistered, cover the burn with sterile dressings, to prevent conta­
mination. Don’t apply ointment, oil or antiseptic. Don’t break
ordrain the blisters.
Caution: Minor (superficial) burns or scalds may be danger­
ous if large areas are involved. Send the pupil for Medical

attention.

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Convulsions (Fits)
In convulsive spasms tbc 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 movementPlace 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 bis body with cold water. When the spasms
subside, make him as confortable as possible. Convulsions do not
usually last more than a 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
lamp3- Using sterile 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, sec 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

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toxoid (triple vaccine) and immunity has been maintained with re­
fresher injections, 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 jng with the ATS,
then 2nd after 6 weeks and 3rd 6 months after the first
shot.
Fainting

Place the person on his back, 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 or tea. If the fainting lasts more than a minute or two, keep
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, face pale and the forehead covered with beads of
perspiration. If the 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.

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
comes. Even though the blow may not have brought about uncons­
ciousness, there is always danger of brain haemorrhage and serious
trouble later- Lying quietly lessens the chance of haemorrhage.
If the patient’s face is flushed and if you're sure his neck or spine
is 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 fiat while doing so.
If he is

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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.
Nose Bleed
Make the patient sit quietly, with the head thrown forward,
and press the nostrils together for five minutes. This may cause a
clot to form over the ruptured blood vessels. If this fails, pack each
bleeding nostril with a plug of sterile gauze, leaving one end of each
plug outside so that it can be removed from the nosti il easily. Get
the patient to lie down, with his head elevated, and place a cold wet
towel across his face. Slight nose bleeds often occur spontaneously,
particularly in children. In event of persistent nose bleed, consult a
doctor.

Poisoning by Mouth
Contact the doctor immediately. Tell him what the suspected
poison is and follow his instructions.
2 If you can’t get medical advice, dilute the poison in the
stomach by giving the child several glasses of milk or water
Save the vomitus in a bottle for examination.
3 If the poison is known to be a strong acid or alkali — if the
child’s mouth is burned, you can assume it’s one or the other
or paraffin or petrol, proceed to step 5. If it is n’t, or if it
is unknown, induce the child to vomit by sticking your
fingers in to his throat or by giving him several glasses of
warm water containing one tablcspoonful of salt per glass.
Keep his head low and turned to one side so that he won’t
inhale any vomit.
4 After the child has vomited, administer several more glasses
of milk (two to four) or the whites of four raw eggs mixed
with a glass of milk1

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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 teaspoonfuls of magnesia to a glass of
water. Neutralize alkalis with a teaspoonful of lemon juice
or vinegar 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.

Puncture Wounds
1 Gently squeeze or '‘milk” the wound, to encourage bleeding.
(Punctures that arc caused by nails, wires, needles, pins or
any other penetrating objects tend to “seal in’* contami­
nation)
2 Wash your hands and then clean up the wound and apply an
antiseptic.
3 Cover the wound loosely with a sterile dressing. Apply cold
compresses.
4 Take the pupil to a doctor. The doctor will clean the wound,
opening it further if necessary, and will administer a re­
fresher injection of tetanus toxoid or an injection of tetanus
1 antitoxin if necessary. The chance of child getting tetanus
is high with puncture wounds.
Shock — How to treat it
In any serious injury (bleeding wound, fracture, major burns),
always expect shock and act to lessen it. Symptoms: the skin is
pale, cold, clammy; the pulse is rapid: breathing shallow, rapid or
irregular: the injured person is frightened, restless, apprehensive.
1 Keep the patient lying down with head at a lower level than
the feet.
2 Loosen his clothing.
3 Keep him lightly covered, but do not cause sweating. Don't
apply heat, such as a heating pad or hot-waterbottle.
The
object is to conserve body heat, not to overheat the patient.
4 In the case of head or chest injuries, raise the patient’s head
and shoulders on pillows or rolled up coats so that his head
COMMUNITY HEALTH
CELLJ
326, V Main. 1 Block
Koram- rg-’a
Ban^ ' O1*-t6j034

India

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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 h im 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 CARE
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. Bacteria] action on this

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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
will 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.
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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 arc quite sure which tooth is causing the pain it maybe
extracted by the dental surgeon.
Keeping the Teeth clean:
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
Qi 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.

When to brush (he Teeth.
After breakfast in the merning. It is no good brushing
them before breakfast because you soon make them dirty again when
you eat. Before you go to bed at night. It is important that you
sleep with a clean mouth. If possible, after the midday meal also.
Method of cleaning Teeth.
Always start on the gum above or below the teeth and brush
away from the gums over the teeth. When all the teeth have been
cleaned like this, brush the tops. Ensure that each surface of each
tooth has been brushed at least ten times. This is not always easy,
especially at (he back of the mouth, and it will require practice.
After a short time however, it will become easier but should take at
least two minutes. After brushing, the mouth should be thoroughly
rinsed with water three times to wash away all the food that has
been cleaned off the teeth.
Foods that are bad for the Teeth.
These are ones which stick to the teeth and most of them
contain a lot of sugar, such foods being cakes, biscuits and sweetsIf these foods are to be eaten they should be taken with meals
because the teeth decay starts half an hour after sweet foods have
been in the mouth. If these foods are eaten between meals then the
teeth will obviously be decaying for a longer time.

Foods that are good for the Teeth.
These are those vegetables and fruits which are firm and
fibrous and which have to be chewed hard; pineapple, mangoes,
coconut, apple. It is a good idea to eat foods like this at the end
of each meal.
DISEASES OF THE GUMS
Gingivities.
This is the name given to inflammation of the gums. The
pupil complains of soreness and bieeding of the gums. It is usually
caused by food being left around and between the teeth. If the
patient does not keep his mouth clean this condition gets worse and
spreads down towards the root, destroying the fibres attaching the

13
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
teeth that are not kept clean) which is most often seen behind the
lower front teeth
Treatment.
If there is tartar present this should be removed (scaling) with
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.
Brushing the teeth properly prevents food resting on the gums and
the inflammation (gingivitis) should subside.
Acute Ulcerative Gingivitis.
This disease is not so widespread as simple gingivities but is
also found in people who do not keep their mouths clean. It is often
seen in young malnourished adolascent school children-

Signs.
Ulcers are seen along the margins of the gums, being next to
one tooth or several- The mouth is very sore, and because of this
the pupil may not wish to eat- The ulcers which may have a white
covering, bleed easily and the patient’s breath has a characteristic
smell. Sometimes the patient feels generally unwell and may have a
slight temperature.
Treatment.
Carefully apply a strong antiseptic on a very small piece of
cotton wool to the ulcers. Do this once a day.
Tell the child to
keep the mouth clean. If it is too sore to use a brush, cotton wool
or even a damp cloth may be used to wash the teeth. Rinsing the
mouth with warm salt water after meals is also helpful. As soon as
possible correct brushing with a toothbrush should be started. It is
also important to ensure that the patient is having a balanced diet.
Section HI

PREVENTION OF MALNUTRITION IN SCHOOLCHILDREN
Protein and Calorie Malnutrition.
Child will be under-weight with stunted growth. (Weight
and Height of children should be recorded annually and checked
against the standard chart provided). Advise cheap sources of
protein — Pulses should be advised to be eaten every day with rice;

14

ground-nut is a good source of protein, which is easily aval'able
and cheap.
Deficiency Vitamin A.
Deficiency of this Vitamin affects eyes and vision. Careful
examination of the eyes with reveal deficiency of this vitamin. Keep
eye open for 30 seconds and look fordr^nees of conjunctive (white
portion). Also look for irregular white patches on this area (Bitot's
spots). These arc early e\ idence for Vit- A deficiency and also
many complaints of night blindness i. e. inability to see in dim
light. In advanced case of Vit. A deficiency the cornea will be
affected with dryness or ulceration. If the cornea is affected, send
the child to hospital immediately. Early cases of Vit. A deficiencies
can be treated with A t D Cap. given daily for 1 or 2 months or
Vit. A concentrate 1 dose or fish liver may also be used. Child shall
be instructed to cat plenty of green vegetables such as ‘cheera* to
get good amounts of Vit Ain diet.
Vit. C Deficiency.
Children with Vit. C deficiency will have unhealthy and
bleeding gums. They should be asked to take fruits like ‘oranges
and goosebery and fresh vegetables’. Vit.C tablets also may be
given for short periodsDeficiency of Vit. B Complex.

Will be manifested by soreness of mouth and tongue, .fissure
of the angle of the mouth etc. Parboiled rice should be advised and
also fresh vegetables. B coinplcxlablcts could be given for a period
of 1 or 2 months.
Iron Deficiency anemia.
Children with iron deficiency anemia will look pale, and in
attentive in class and will be backward in studies. The nail and
conjuctive will look pale. In doubtful case Hb. estimation should
be done.
If Hb- (Haemoglobin) less than 10 gmu/o iron
should bo given in the form of tablets. Dosage 2—3 tablets a
day for 2 or 3 months. Children should be asked to consume a
diet rich in iron such as green leafy vegetables such as cabagc,
chccra ele. Jaggery taken instead of sugar will provide good
amount of iron. Children with severe anemia (Hb. less 5 gmu/o)
shall be hospitalised. Stool examination for hook worm should be
done in all severe cases.

15
SECTION IV

IMMUNISATION AND PREVENTION OF COMMUNICABLE DISEASE
Small pox Vaccination
If the child is not vaccinated at the time of school admission,
advise vaccination- Revaccination is to be done once in 3 years.
This vaccination prevents small pox. Following the vaccination,
some pupils may develop excoriation and ulceration at vaccination
site.
This does not require any special treatment.
However
boric powder may be applied locally to reduce the inflamationNo other dressings or medicaments are to be applied. If any other
untoward reaction develops, it should be reported to the school
physician.
i
B. C. G.
Inspect children for vaccination scar at school entry (small
puckered scar on the shoulder). If not vaccinated, arrange vacci­
nation with school team. Revaccinate 5 years after the primary­
vaccination
B.C.G. helps to prevent tuberculosis and is?
believed to be of some value in preventing leprosy.
Dipthreia, Tetanus Vaccination
At the time of school admission, find out if the child has
received Triple Antigen and polio vaccine. If the child has not
received them, make a note and arrange immunisation with school
health team- 2 doses at 6 weeks interval will suffice. Booster dose>
of toxoid to be repeated every five years.
Polio vaccination
Can be given to the children who have not received them but
polio being commin only in younger children, it may not be
very necessary.
' Prevention of Spread of Communicable Disease
I
Above mentioned immunization help to prevent certain..
diseases in individual children. Sometimes these diseases spread very
rapidly and become epidemic. Cross infections occur very commonly
In school. So teachers hive a role in the prevention of spread of
communicable diseases. This will be possible by early case detec^tion and isolation and imposing quarantine for cases and their
contacts. The following table will give the sign symptoms isola­
tion and quarantine period of some common communicable diseases.

B

HEALTH CELL

326, V Main, I Block
Koram„nga|a
Ban9alore-560034
India

INFECTIONS DISEASES

Disease

Suggestions for quarantine regulations
Signs&Symptoms
Patient is released from isolation
Susceptible contacts may reand may return to school_______________ enter school.______
fever

On recovery and after 2 or 3
successive negative cultures:
each from nose and throat:
taken after cessation of anti­
microbial therapy and at
intervals of not less than 24
hours.
On recovery: at least 8 or 9
days (5 days after appearance
of rash)

Diphtheria

Throat pain,

Measles

High fever, cough, cold,
red eyes, red spots on the
face

Smallpox

Fever, bodyachc,
tions on the face

Chickenpox

Fever, headache, bodyachc,
eruptions on the body and
extremities

On recovery and after dis­
appearance of scabs and
crusts: usually 3 to 6 weeks.
On recovery and when crusts
have formed; not sooner than
7 days after on set.

Whooping
cough
(Pertussis)
Mumps

Cold, paroxysmal cough
with whoop and vomiting

Not before 3 weeks after on
set of typical paroxysms

Fever, headache, swelling
in the jaws
Fever,
loss of apetite,
yellow urine, vomiting

When swelling has dis­
appearedAfter first week of illness.

Infectious
Hepatitis

erup­

When two or more successive
cultures of nose and throat
are negative, or not for at
least 7 days after last exposure

Exclusion from school is of
no practical value; when prac­
ticed, at least 14 days must
elapse after last exposure
16 days after successful vacci­
nation

Exclusion from school is of
no practical value: when prac­
ticed, at least 21 days must
elapse after exposure14 days after exposure if clini­
cally well
No restriction

No restriction

17
Appendix I

School Formulary
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)

Tablets
Aspirin

—

I rom

—

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

B. Complex

—

A & D Capsules

—

MultiVitamin

—

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

| 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

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

Local applications
Benzyl Benzoate

—

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

18
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.

Calamine lotion

—

Ointment
Furacin ointment

—

For infected skin wounds or other lesions.

Whitefield ointment—

For treatment of superficial fungal infec­
tions of the skin such as ring worm.

Sulfa acetamide eye
drops (LOCULA)—

For red eyes,
Trachoma.

(con junclivitics)

and

Appendix II

LABORATORY TESTS BY TEACHERS

Haemoglobin estimation
Finger tip is cleaned thoroughly with spirit and is dried with
a piece of cotton. The finger is held with a very gentle pressure on
the sides. The needle is sharply plunged to a depth of 3 mm. deep.
The pressure is released and blood is allowed to flow freely. The
blood should be collected in the pippette within one minute.

PROCEDURE
Sahli Method

Place N/10 hydrochloric acid in the tube up to the lowest mark
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 wait
for 10 minutes and allow the brown colour to develop. Then dilute
the solution with distilled water drop by drop; tips the colour
matches with the glass plates of the comparator. Matching should
be done in good sun-light. The reading is then taken, from the
markings on the tube. (N/10 Hcl can be made by adding 1 ml. of
con. Hcl. with 99ml. of distilled water).

Urine Examination
Urine sugar test (Benedicts test)
Take 5 ml- of benedicts qualitative reagent and to it add ‘8’
drops of urine and boil for 3 to 5 minutes and note the colour of
solution.

20
Albumin test (sulphosalicylic acid test)
To 2 ml. of clear urine add an equal volume of 3-/. sulphosalicylic acid and allowed to stand for 10 minutes.
No albumin
No cloudiness
—
Cloudiness against a black
Trace amount of albumin.
back ground
—
Cloudiness with granules and
Moderate amount of albumin
definite fioculation
—
Cloudiness with floculation
—
Large amount of albumin

Motion examination for parasites
Take a small amount of faecal matter on the end of a narrow
stick and make a thin emulsion in a drop of normal saline
placed on a glass slide and put a cover slip over it. The thickness
of the preparation should be such that one should be able to
see fine prints through it and examine the slide under a micro­
scope. Identity the parasites from the diagrams given below:

References
1. Text Book of Preventive and Social Medicine by J. E. Park
and K- Park; Published by Banarsidas Bhanot Jaipur, 1976.
2. Simple Dental care for rural hospitals by David J. Halestrap,
Published by The Medical Missionary Association, London,1970
3. Text-Book of Pediatrics by Nelson, Vaughan and Mckay.
Published by W. B. Sanuders Company. Philadelphia, 1975.
4. Hand Book of First—Aid-Reader’s Digest Publication.
5. Hand Book of Medical Laboratory Technology. Published
by the Staff of the department of clinical pathology and
Blood Bank of the Christian Medical College and Hospital,
Vellore, Tamil Nadu.
COMMJN1TY HEALTH
£IS
47/1. (First Floor) St. Mai^s Ro
Bangalore - 560 00V
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