the teachers, 13,854 all told. Full directions for making a test of eyesight and of hearing, and for inspecting and reporting upon the condition of the mouth, throat, and teeth accompany each set of cards. Whenever a defect is discovered it is properly recorded and the parent of the child is notified . . . and advised to consult a physician. A full record is kept at the school, and duplicates are sent to the health department. These examinations are to be made during school hours and the district superintendents are to be held responsible to see that teachers carry out the printed instructions."

SHAWAN, Jacob Albright. School activities in relation to children's eyes. See Appendix B.

STANDISH, Myles. Should the examination of the eyes of school children be conducted by the teacher or the school physician? In American school hygiene association. Proceedings, 1911. Springfield, Mass., American physical education review, 1911. p. 98-101.

Also in American physical education review, 16: 243-46, April 1911. of school children be conducted by the teacher or the school physician?

Title: Should the examination

"The examination by the school physician if limited to the card-letter test would be of very little more value than where it is conducted by the teacher. . . . If the doctor's examination is to be better than the teacher's, it must be conducted with belladonna in the eyes to prevent accommodation. Such an examination... has no certain relationship to the question in hand, viz, Are the child's eyes exerting a deleterious effect upon the child's school life?

"If then neither the examination with the test-letter card, nor an accurate scientific examination. is to be relied upon as indicating what children should be advised to use glasses, to what shall we look for the most important factor in this decision? In no other direction than to the symptoms." WHITE, Daniel W. and Treibly, Charles E. A brochure on trachoma. Ophthalmic record, 21: 223-51, May 1912. figs.

Bibliography: p. 251.

"A comparative estimate of the number of known cases of trachoma amongst the Indians of Oklahoma could safely be placed at 60,000 to 70,000, or about 60 to 70 per cent of the entire population (Indian) of the State. It can also be safely estimated that from 60 to 80 per cent of the Indian population of the United States have trachoma.

During December, 1910, there were over 600 examinations made of eyes of the pupils at the United States Indian school at Carlisle, Pa. Of this number, there were 414 cases free of trachoma, 37 suspicious cases, and 149 known cases of trachoma. Males under 10 are more susceptible than females. Females over 10 have shown more susceptibility than males. This has been found to be the case in all Indian schools.

IN REPRESENTATIVE LOCALITIES AND INSTITUTIONS.

ARIZONA.

MARTIN, Alice. A year's work at the Eye hospital of the United States Indian school, Phoenix, Arizona. Southern California practitioner, 25: 410-12, September 1910. tables.

There were 444 boys, and 390 girls examined. The following table shows the results obtained:

The number of pupils suffering from complications was 17. Two hundred and sixty-five operations were performed on boys; 269 on girls. Of the total number of boys and girls in the school, 75 per cent had trachoma.

CALIFORNIA.

REINHARDT, G. F. The Infirmary and the Department of hygiene. In California. University. Biennial report of the President 1908-1910. Berkeley, The University press, 1910. p. 125-29. (University of California bulletin, 3d ser. vol. IV, no. 4, January 1911)

Tabulation of the eye conditions of 850 students; eye-examination, 1909-10, has become a part of the regular physical examination given to all matriculants at the university.

From the above table it will be seen that only 22 per cent of the students examined were normal.

CONNECTICUT.

Bristol. Board of school visitors. Eye test. In its Annual report, year ending July 14, 1911. p. xxix. table.

"Once in three years the eyes of the pupils in the public schools are tested according to directions furnished by the Connecticut board of education."

MASSACHUSETTS.

COUES, William Pearce. The results of the clinical throat examination of 212 school children. Boston medical and surgical journal, 162: 215, February 17, 1910. The children examined were in 4 different buildings and 6 different rooms. The ages were from 6 to 15 years. About 50 per cent were native born, a large percentage being girls. Of the 212 children, 153, or over 72 per cent, showed marked chronic tonsillar hypertrophy-so marked in a number of cases that the tonsils practically met in the central line. Of the whole number examined, 103, or about 50 per cent, showed markedly carious teeth. Of the whole number, 141, or 66 per cent, showed enlarged submaxillary glands.

Of the 153 children with chronic hypertrophic tonsils, 90, or 58.8 per cent, showed marked dental caries; 120, or 77 per cent, exhibited marked enlargement of the submaxillary glands.

"In the large percentage of chronic tonsil cases. . . three factors act to a large extent as predisposing causes: 1. Poor home surroundings; lack of fresh air and sunlight. 2. Improper and insufficient food and neglect of the teeth. 3. The wretchedly unhygienic conditions existing in some of our public schools."

Fall River. School committee. Medical inspection [1907-1911] In its Annual school report, 1911. p. 15-18. table.

"The most important occurrence of the year in this line was the establishment of free clinics at the Union Hospital."

Massachusetts. State board of health. Directions for testing sight and hearing (in accordance with Chap. 502, Acts of 1906, as amended by Chap. 257, Acts of 1910)

"1. Tests will be made as early in the school year as possible, preferably in September.

"2. Made under the most favorable conditions, as nearly as possible under the same conditions, preferably in well lighted rooms, in the early part of the day.

"3. Testing done by the teacher of the class, and supervised by the principal to see that the conditions of the test are as uniform as possible for the different classes.

"4. Children wearing glasses will be tested with the glasses, and if found normal will be so recorded. "5. Examine all children, but record as defective only those whose vision is 20/40 or less, in either eye. "6. Report to the State board of education the whole number of children examined and the number found defective according to the standard given in No. 5."

MISSOURI.

SNEED, C. M. A report upon medical inspection in the Jefferson City public schools. Missouri school journal, 25: 535-39, December 1908. tables.

An examination of the eyes, ears, throat and nose conditions of 1,000 white children and 100 negro children.

Normal.

Defective in vision.

White...
Negro.

635
81

365 19

A comparison was made between the percentage of defects found in the 116 examined in the high school and in 147 in the lower grades. The children of the high school showed visual defects in 40.51 per cent, while the children of the lower grades 29.43 per cent. Other defects were found in the 1,000 white and 100 negro children, as exhibited in the following table:

There were 551 cards of warning issued to pupils for the various defects found-74 out of the 423, or 17 per cent, who reported having received cards, had consulted a physician.

This study, differently arranged and credited to Dr. Sneed and Guy Montrose Whipple, is also in Psychological clinic, 2: 234-38, January 15, 1909. The following table is from the latter publication:

TAUSSIG, Albert E. An investigation as to the prevalence of visual and aural defects among the public school children of St. Louis County, Mo. Interstate medical journal, 16: 721-31, November 1909. tables.

Also in Psychological clinic, 3: 149-60, November 15, 1909. Title: "The prevalence of visual and aural defects," etc.

Two thousand children were examined, about 30.6 per cent of whom had vision that was below normal in one or both eyes. A little over 14 per cent showed vision that was less than two-thirds of the normal in both eyes, children with vision less than half the normal in both eyes being a little less than 3 per cent of the total number examined.

Defective sight and hearing of public-school children (tables combined).

Conclusions derived from data of the children examined:

"1. Unrecognized or at least untreated defects of vision and hearing are nearly as common in our suburban communities as in large cities. Both call urgently for systematic medical inspection.

"2. Unrecognized adenoids, so extreme as to cause serious interference. . . were not found to be very common. In nearly 1 per cent of the children, however, the adenoids imperatively demanded operation...

"3. Defective vision seems a little commoner among girls and defective hearing among boys. . . . "4. In other communities a progressive increase in the prevalence of impaired vision was noted as the children grew older, whereas in St. Louis County the reverse was found to be true, both as regards slight and grave defects. . . . It does not, however, furnish an argument against inspection. . . . The fact that one-third of the children with spectacles wore unsuitable glasses is also suggestive in this respect. "5. Our data show that to a certain, though not very great extent, the children with impaired vision or hearing progress more slowly in their school work than their normal fellow students. The evil effects of unrecognized physical defects go, however, far deeper than this. . . . Adequate medical school inspection would lead to the recognition and to a great extent, to the correction of such defects.

"6. The marked divergence between the data obtained in different cities, or, in the same city, by different investigators, indicates the need for greater uniformity in methods of tabulating these statistics. . . . For statistical purposes it is important for the investigator to state just where he draws the line between defective and normal. As regards vision, hearing and adenoids, a division into slight and serious defects is to be recommended.

"7. In estimating the value of medical inspection of school children . . . the greatest benefit to be derived from inspection consists in the early recognition of contagious diseases and the prevention of school epidemics."

NEW HAMPSHIRE.

Manchester. School committee. [Medical inspection of elementary school children] In its Report, year ending December 31, 1909. p. 17-18.

Teachers annually test the eyes and ears, records being preserved.

Of these 1,852 pupils found defective in vision and hearing, 823 are over age for their grades and 491 have failed one or more times to be advanced with their classes.

NEW YORK.

DRESBACH, M. Examinations of the eyes of college students. Medical record, 82: 190-95, August 3, 1912.

References: p. 195.

Cornell University. Examination of 3,326 enrolled men, and 360 examinations of women.

Percentage with symptoms of eye strain (no glasses worn) approximately

27

3 or 4

40

15

6

4

30

40

25

22

2

1 case.

Several cases.

Defects of 155 students from rural districts, attending for 12 weeks only.

Per cent.

40

50

10

Hyperopic astigmatism.

Myopic astigmatism.
Unclassified..

A questionnaire was sent out, and replies received from 105 institutions of learning, with the following results: Not requiring eye examinations, 22. Among these were 3 prominent schools of technology, 2 well known schools for women, and 1 great university. In about a dozen only is an eye specialist engaged. In 17 institutions estimates of students needing glasses ranged from 10 to nearly 100 per cent, the latter figure being from a Government school, "where, it is stated, practically every student wears glasses before he finishes his course."

SCHENCK, Herbert Dana. [Inspection in New York State of the eyes, ears, noses, and throats of public-school children] In National education association of the United States. Department of superintendence. Proceedings, 1909. Published by the association, 1909. p. 117–19.

"No systematic effort. . . for an annual record of the condition of the sight, hearing, and nasal operations has been made by even the most progressive cities [of New York State]. At a conference

of the health officers in the fall of 1906 .. a plan, essentially that in vogue for ten years in Connecticut, for four years in Vermont, and for the last two years in Massachusetts, where the examinations are compulsory, was adopted."