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A hard cold for 10 days, spas

modic cough, whooping tenth to fortieth day, thick nasal discharge, vomiting, nosebleed. Rarely, ifever, carried

in clothing. Chill, fever, vomiting, more

sudden onset and slower recovery than common colds; contagious. Usually send home children with fresh sudden sneezing colds; if not sent home, children with colds should be seated in front row.

Note.- Many eye diseases are contagious; do not take risks: beware of towels and handkerchiefs. Parasitic, bald patches on scalp, scabby patches on body. Recommend that a physician be consulted. Parasitic, rough, scabby sores,

especially when skin has been broken; beware of towels. Recommend that a physician

be consulted. Recommend three applications

of lard and sulphur, or crude petroleum, soap suds following: fine comb with vinegar

for nits. Parasitic, itching sores on

wrists, back of hand, and between fingers. Recommend applications of lard and sul. phur, or crude petroleum. “Loss of appetite, weakness, languor, listlessness,

are among the early signs. Pal. lor, marked anaemia, loss of weight, excessive emaciation, the

presence of enlarged glands in the neck, are indications that there is something wrong. If in addition to this there is a cough, with or without sputum, the child should most certainly be examined by a physician.”

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Incubation is the time between exposure and first symptoms. Invasion is from first symptoms to eruption or marked disease.

Please notify the superintendent and school physician in writing of all known cases of tuberculosis, epilepsy, St. Vitus dance,

and eczema. In center schools require a certificate from the superintendent or a physician in all cases of peeling hands. Colds and influenza are probably contagious. Exclude pupils with sore throat until cured or until they bring a certificate. Look out for second crop of measles in school eight days after the first outbreak.

Pupils exposed to mumps or whooping cough may attend school provided watch is kept for symptoms.

Pupils exposed to diseases "carried in clothing" may not attend school until after the days of quarantino as above, without a physician's certificate. Approved by East St. Louis board of health, July, 1911.

GREENSBURG, IND. BLAND, Curtis. Report of diphtheria epidemic in Greensburg (Ind.) during the

months of September and October, 1911. Indiana. State board of health. Monthly bulletin, 14: 147-49, December 1911.

“Out of a total of 872 cultures taken from grade and high-school pupils, September 30–October 6, 1911, 288, or 33 per cent, came back positive. This high percentage of 'carriers' ... and the large number of contacts under quarantine ... made us feel justified in keeping the schools closed."

All parts of the town were found to be about equally infested with “carriers.” Without doubt the street carnival, held by the Eagles from September 11 to 16, inclusive, had served to distribute the diphtheria bacilli.

As soon as positive reports were received the “carriers" were quarantined. Eventually, 260 homes were quarantined, containing about 1,200 persons, and this in a town of 6,000. Out of 400 “carriers" found only 4 developed clinical symptoms of the disease.

Conclusions:

“1. To fight successfully an epidemic of diphtheria 'carriers' must be found and ... with contact cases must be isolated. 2. A bacteriological examination of the throat must be made in order to discover the 'carriers.' This makes absolutely necessary the maintenance of a bacteriological laboratory of the State board of health. 3. That antitoxin bears the same relation to clinical diphtheria that water does to fire. If the antitoxin is used in time and in sufficient quantities ... in the first 24 hours of the disease, the death rate is practically nil and there are no persistent bad after effects of the disease."

NEW YORK, N. Y.

BAKER, Sara Josephine. Inspection for the detection of cases of contagious

diseases. In her The Division of child hygiene of the Department of health of the city of New York. 1912. p. 64–70. tables. insert. illus.

1. Each nurse visits each school in her charge before 10 o'clock each morning and inspects in a room set apart for this purpose all children referred by the teachers. 2. Children manifesting any signs or symptoms of an acute contagious nature, such as smallpox, diphtheria, scarlet sever, measles, chickenpox, whooping-cough or mumps, are referred by the nurse to the principal. Cultures are taken in every case of sore throat. If the child is not suffering from a contagious disease, it is notified to return to school and is given an official certificate to that effect. If a confirmatory diagnosis of contagious disease is made the patient is isolated, the apartment placarded with a notice of the character of the disease, and the case immediately reported to the division of contagious diseases, which thereafter assumes supervision and control. 3. Children affected with a contagious eye or skin disease are given a notice to take home to their

parents. HERRMANN, Charles. The prevention of the spread of contagious diseases in

public schools. Internationales archiv für schulhygiene, 6: 1-15, October 1909. forms. tables.

Describes the method in New York City. The medical inspector visits each school every morning between 9 and 10 o'clock and examines: “1. Those pupils presenting any indication of contagious disease. 2. Those pupils previously excluded on account of contagious disease, who have returned. 3. Those pupils who have been absent for 3 or more days on account of sickness. Every morning each principal receives a list of all the cases of contagious disease which have been reported on the previous day. This

list is sent to every classroom." New York (City) Association of tuberculosis clinics. Significant features. In its Fourth annual report, 1911. p. 18-19, 35 (table).

In 1910 there were under observation 500 children. In January, 1911, there were 1,243 children under observation, an increase of 149 per cent. In addition, there were treated during the year 4,272 new cases and 1,293 old, making in all a total of 6,808 children treated, an increase of 2,103, or 45 per cent over the number treated in 1910. The establishment of additional children's classes is strongly urged.

PHILADELPHIA, PA.

ROACH, Walter W. The role of the school in the spread of scarlet fever. A lesson

from one school in Philadelphia. American Journal of public health, 2: 450–51, June 1912. diagram. map.

Reprinted.
Epidemic in the T. M. Pierce public school.

First case reported January, 1912; 6 cases followed in February. “There was no classroom inspection during this time, the school doctor under the rule calling each morning at the principal's office to examine

children referred to him by the teachers, who in the last analysis were the only medical inspectors in the classrooms, with the whole system depending upon their ability to primarily detect disease.

“The 'carriers' were undoubtedly in the school, hidden and unrecognized. Twelve more cases followed in March and ... when the medical man began classroom inspections he picked up 7 cases in the school desquamating. If it had been a neighborhood epidemic, other cases would unquestionably have occurred among pupils attending the Walton and Belview Schools, but the cases point to one focus. The Pierce school building was fumigated, inspectors stationed at each entrance and the 1,400 pupils carefully examined. Suspicious ones were refused admission and investigated. ... The whole situation was cleared up in a short time.”

PROVIDENCE, R. I.

CHAPIN, Charles Value. The spread of scarlet fever and diphtheria in schools. American journal of public hygiene, 20: 813–17, November 1910. tables.

For the purpose of studying the incidence of these diseases in schools in Providence, R. I., sets of cards are kept--one set for scarlet fever and one set for diphtheria, with a card for each school. A table on page 816 shows the age distribution of the reported cases of scarlet fever and diphtheria in Providence for 21 years. The amount of disease increases until the first year of school attendance when it begins to fall off.

“While it appears to be true that the diseases under consideration rarely spread in schools, and that the schools are safer than the streets ... it is probable that the rules in regard to the school attendance of children from families where these diseases exist, are in most of our cities, amply sufficient to prevent extension from reported cases. Disinfection of the school is, generally speaking, a useless procedure. The trouble comes not from the recognized cases but from the missed cases' and healthy 'carriers.' .

“The common drinking cup must go. The use of the slate encourages carelessness with the saliva. The roller towel is almost as bad as the common drinking cup. . . . The use of modeling clay and sand, and much other kindergarten work, encourages personal uncleanliness. . . . II, however, the child is taught to wash its hands, and wipe them on its own towel, before touching the clay, and to keep the fingers out of the mouth while modeling he will learn that it is wrong to inflict his own saliva on another. By such teaching the spread of contagious diseases in school may be made even less than it is."

VALPARAISO, IND. NESBIT, Otis B. Books as carriers of scarlet fever. American medical association. Journal, 59: 1526-28, October 26, 1912. table.

Conclusions:

“1. If books act as carriers, it is only immediately after being contaminated with the discharges of the patient; yet this investigation has failed to reveal a single instance of this kind. 2. Books that have been used by scarlet fever patients do not long contain the infection in such a way as to transmit the disease to man. 3. Any book which has been handled by a scarlet fever patient should be burned or fumigated.”

Regarding epidemic of scarlet fever Valparaiso Ind. September 1908- June 1911, during which time “there were 400 cases, of which only 255 were reported to the city board of health, 145 were not reported and most of them were not subjected to quarantine regulations. Beginning in February, 1911, a special study of the epidemic was begun."

MEDICAL INSPECTION OF THE EYES, EARS, NOSE, AND

THROAT.

GENERAL REFERENCES.

ALLEN, William Harvey. Eye strain. In his Civics and health. Boston (etc.) Ginn and company (*1909) p. 72–82. illus.

“For some time to come eye tests will find eye troubles by the wholesale in every industrial and social class, in country as well as city schools. In 415 New York villages 48.7 per cent of school children had

defects of vision—this without testing children under 7-while 11.3 per cent had sore eyes.” ALLPORT, Frank. The examination of children's eyes, ears and throats. American school board journal, 41: 2, November 1910.

“This is a field that can be efficiently covered by the teacher, for ... sufficient data will have been obtained to enable him or her to know that the child has passed either a satisfactory examination, or has some defect. ... Examination consists in the ascertaining of a few simple facts as follows:

"1. Does the pupil habitually suffer from inflamed lids or eyes? 2. Does the pupil fail to read a majority of the letters in the No. XX line of the Snellen's test type with either eye? 3. Do the eyes

and head babitually grow heavy and painful after study? 4. Does the pupil appear to be cross-eyed? 5. Does the pupil complain of earache in either ear? 6. Does pus or a foul odor proceed from either ear? 7. Does the pupil fail to hear an ordinary voice at 20 feet, in a quiet room, with either ear? 8. Is the pupil frequently subject to colds in the head' and discharges from the nose and throat? 9. Is the pupil an habitual ‘mouth breather?' If an affirmative answer is found to any of these questions, the

pupil should be given a printed card of warning to be handed to the parent." ALLPORT, Frank. The eyes and ears of school children. Medicine, 12: 258–68, April 1906.

Also in Vermont medical monthly, June 15, 1906; in Pediatrics, 18: 465-81, August 1906; in Internationales archiv für schulhygiene, 3:20–36, October 1906; and in American school hygiene association. Proceedings of the first, second, and third congresses. Published November, 1910. Springfield (Mass.) American physical education review, 1910, p. 218-31.

Read at third congress, 190"Reprinted.

"In order to facilitate the work and bring it more fully before the profession. I secured at the New Orleans meeting of the American medical association the passage of the following resolution, both in the ophthalmological section and the house of delegates:

“Whereas the value of perfect sight and hearing is not fully appreciated by educators, and neglect of the delicate organs of vision and hearing often leads to disease of these structures, therefore, be it

Resolved, That it is the sense of the American medical association that measures be taken by boards of health, boards of education, and school authorities, and, where possible, legislation be secured looking to the examination of the eyes and ears of all school children, that disease in its incipiency may be discovered and corrected.

“Since then these resolutions have been adopted by the Mississippi valley medical association and by the State medical societies of the following States: Minnesota, Colorado, Illinois, Montana, New York, Indiana, North Dakota, Rhode Island, Alabama, Michigan, Utah, South Dakota, Delaware, California, Massachusetts, Arizona, West Virginia, Kentucky, Louisiana, Nebraska, and Washington.

“The resolutions have also been adopted by the American public health association, by the State and provincial boards of health of North America and by the State boards of health of the following States: Kansas, Minnesota, Colorado, Wisconsin, North Carolina, Vermont, Illinois, Montana, New York, Indiana, Connecticut, Ohio, North Dakota, Rhode Island, Alabama, Pennsylvania, Maine, New Hampshire, Michigan and Utah. The resolutions have also been adopted by the State boards of education of the following States: Texas, Kansas, Minnesota, Colorado, Wisconsin, North Carolina, Vermont and Connecticut. Four State legislatures, Connecticut, Vermont, Colorado and Massachusetts, have incorporated this movement in a public law...

“Besides this the tests are being placed in operation ... in hundreds of schools in America where they are not required by school authorities.

“Let me then ask you, and through you all boards of health and education, all legislatures, and all who are interested in the physical and moral welfare of our children, do you believe that bad vision and hearing constitute an important barrier to the reasonable and easy acquirement of an education? Do you believe that a vast number of children are thus embarrassed? Do you believe that a great benefit to the children, to society at large and mankind in general, would be effected if such physical defects could be detected and relieved? Do you believe that some such plan as I have proposed would be in. strumental in largely relieving such defects. Do you believe such a plan to be practical, unobjectionable and inexpensive? ... Then may I ask you still another question: Why do you not take up this work

and carry it through?” ALLPORT, Frank. A plea for the systematic annual and universal examination

of school children's eyes, noses, and throats. In National education association of the United States. Department of superintendence. Proceedings, 1909. Published by the association, 1909. p. 112-16. Discussion:

p.

117-119 (Herbert Dana Schenck- New York State conditions regarding examinations) Also in National education association of the United States. Journal of proceedings and addresses, 1909. p. 266-270; in Ilygiene and physical education, 1: 228-33, May 1909; in Psychological clinic, 3: 67–70, May 15, 1909; and in Journal of the Minnesota State medical association and Northwestern lancet, 29:347–50, August 15, 1909.

“About 50,000 American children are annually removed from school on account of physical inability to continue at work. . . . About 8,000,000 school children suffer from some eye defect, and about 8,000,000

from some ear, nose, or throat defect." AYRES, S. C. Civic medical inspection of school children, with special reference

to diseases of the eye, ear, and throat. Journal of ophthalmology and oto-laryngology, 6:1-6, January 1911.

Also in Lancet-clinic (Cincinnati) 106: 652–54, December 23, 1911.

Brief historical references; and the work in Cincinnati, of medical inspectors (26 physicians) and the three school nurses who have supervision of 13 schools.

CHEATLE, Arthur H. The ears, nose, and throat of school children. In Kelynack,

T. N., ed. Medical examination of schools and scholars . . . 1910. p. 179-91. tables.

Table given by Dr. Thomas Barr, of Glasgow, who was the first to draw attention to the subject in Great Britain. Shows the various results obtained by skilled observers in different countries up to September, 1889.

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1 Who had reached school age.
• Having ears in some way affected.

: Ages 3-16. Adenoids present in 434 children; 57 had permanent perforation of drum of ear. NOTE:-Use in conjunction with this table, the table of Dr. Taussig, Psychological clinic, 3: 152, Nov. 15, 1909. CORNELL, Walter Stewart. The prevalence of eye defects in school children]

In his Health and medical inspection of school children ... 1912. p. 578–84. tables.

Bibliography on the eyes: p. 584.

Containg data showing the progressive increase of myopia through the higher grades. Statistics of Boston and Philadelphia schools, University of Pennsylvania, and the German city schools. CORNELL, Walter Stewart. The prevalence of eyestrain in children. Monthly cyclopaedia and medical bulletin, 1: 114–19, March 1908. tables.

Reprinted.

The reports of examinations of the eyes of school children in Philadelphia, New York, Boston, London (England) compared. CORNELL, Walter Stewart. Prevalence of nose and throat defects and defective

hearing. In his Health and medical inspection of school children . . . 1912. p. 584–90.

tables. fig. From review of about 6,000 children, the following table may be formed:

Table showing prevalence of nasal obstruction.

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“Probably from the local irritation of ill-ventilated rooms, and partly from the flabby tissues resulting from poor food, the children of the slums suffer from nose and throat defects in at least twice the pre

portion of the children of the better classes." New York (State) Department of health. Eye, ear, throat, and teeth examinations in schools. Its Monthly bulletin, n. 8. 7: 70–71, March 1912.

"In rural districts it is not feasible as yet to employ physicians to make the inspection, but ... the department of health has sent out the necessary test cards and report blanks for distribution among

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