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majority of medical students obtain no systematic training whatever .. , since, according to Flexner's report, half or more of the medical schools require less than a good high school course for admission. ...

"Medical students who undertake the work in pedagogy as prospective school inspectors or school physicians should undertake the extra training either in a graduate year or elect a minimum during the senior year of the medical course. ...

"2. Appropriate courses in education should be offered prospective school nurses.

"3. The college student who desires to become a specialist in school hygiene or a public sanitarian may omit the regular medical course and proceed from the bachelor's degree to the doctor of philosophy in hygiene or to the new degree of doctor of public health ... candidates for the bachelor of arts in education should be permitted to follow hygiene as a major subject, extending through at least three years. . . . In the courses in hygiene, preventive medicine, physiology and psychiatry, the medical department may be utilized. ...

"4. In the study of the school problems of elimination, retardation, repeating, and of the exceptional child, the department of education should lead. The educational laboratory and pathological clinic, an adjunct to the laboratory of psychology, is one point for concentration of effort upon these problems,

by cooperation of psychologist, physician, sociologist, and teacher." KOBER, George M. Hygiene and dietetics. American academy of medicine. Bulletin, 11: 779–86, December 1910.

Outlines lectures for a course intended to give to students such knowledge "as may enable them to differentiate between wholesome articles of food and drink. ... The examination of air in rooms, the velocity, condition and quality of air currents are considered. . . . The organic analyses of water and its various forms of pollution, together with the examination of soils."

Under "List of lectures” are: The alcohol and tobacco question. Importance of good teeth. House sanitation. Lighting. Hygiene of schools-Medical inspection of school children and the prevention

of permanent disabilities in childhood. Social and moral prophylaxis. LANKFORD, J. S. The public school and the prevention of tuberculosis. Texas State journal of medicine, 5: 403-405, March 1910.


"A careful study of tuberculosis should be made a part of the curriculum of every school, beginning at the fourth grade and extending through the grammar school. ...

“First. It is the duty of the officials to see that buildings are located on amplo grounds and in airy places, so far as possible; that the premises are kept clean and sanitary; that the buildings are arranged to the best advantage for heating, lighting and ventilation, that extremes may be avoided; that seats are adjustable and that everything is done to protect children from disease and to promote good health and development. The course of study ... should be ... lightened; the mental strain should be relieved and more attention given to the physical side of life. . .

“Second in importance is the health and preparation of the teacher. She must be free from tuberculosis ... (and) must be deeply impressed that the prevention of tuberculosis stands first in any system of education. . . . She should have a keen insight into the general condition of her pupils, as well as a wide scope of information concerning illness. . . . She should urge that every practice promoting general health in school life is carried out.

“Third. Practical courses of instruction should follow this equipment.” PALMER, George Thomas. The short-comings of municipal public health administration. American city, 5: 64-68, August 1911.

“In but seven of the (44 Illinois] cities have the health officers been permitted to serve sufficiently long to become thoroughly conversant with the sanitary requirements of the city or to work out sanitary and public health reforms. In 15 cities changes have been made every two years, and in six ... every

year.” ROSENAU, Milton Joseph. The department of preventive medicine and hygiene

and the new degree of doctor of public health. Boston medical and surgical journal, 166: 886–87, June 13, 1912.

Course authorized by the faculty of medicine on June 22, 1910, by Harvard university president and fellows, leading to the degree Dr. P. H.

“While candidates for the degree of doctor of public health are advised first to take the medical courses, the medical degree is not a prerequisite. Those who desire to specialize in sanitary engineering, sanitary architecture, sanitary chemistry, vital statistics or other branches of public health work may receive the degree after four years of work following the bachelor's degree. ... In any case a minimum of one year of residence is required.”

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Flexner, Abraham. Medical education in the United States and Canada; a Report ... New York City (* 1910 346 p. maps. tables. 8°. (Carnegie foundation for the advancement of teaching. Bullo tin, no. 1)

RUCKER, William Colby. The making of a health officer. California State journal of medicine, 9: 155–56, April 1911.

The course to be "offered by the Oakland (California) college of medicine will cover one year and ... will include general and personal hygiene, sanitary engineering, especial stress being laid on the collection, storage, purification and delivery of water, and the collection, purification and disposal of sewage; theoretical plumbing; sanitary architecture; sanitary law, bacteriology, parasitology including medical entomology, sanitary chemistry and food inspection.

Discussion: p. 156-58. SHIPLEY, Alfred E. Training for public health. New York medical journal, 93: 985–87, May 20, 1911.

"Training for public health service involves the preparation of physicians and of nurses. . . . Such & course should include:

“Hygiene studied from public, semipublic, and personal standpoints. Public hygiene includes municipal, State, and Federal hygiene. . . . State hygiene attends to the health affairs of towns and rural communities. . . . Municipal hygiene . . . will require the services of a vast number of medical men. ...

Consideration must be given to sewage, garbage, cleanliness of streets, water supply, food supply, sanitation of dwellings, including ventilation, lighting and plumbing, air pollution, transmissible diseases, and child hygiene.

“School hygiene is developing very rapidly, its phases already being so many that it should have the entire time service of medical men.

“In the proper consideration, therefore, of the many problems arising in the field of preventive medicine, social, industrial, economic, and medical factors must be given their due proportions." SMALL, Willard S. School hygiene in the training of teachers: The organizing

principle. In American school hygiene association. Proceedings, 1910. Springfield (Mass.) American physical education review, 1910. p. 124–31.

Also in American physical education review, 15: 586–92, November 1910; and in Atlantic educational journal, 6: 5-6, 40, September 1910.

“Health as an end in education requires that the various factors of the school life and environment shall be adequately understood. “The three factors I have chosen as illustrative examples, would be acknowledged ..

... as of essential importance.

“1. Ventilation. The point of attack is the relation between air and life. This should be a matter of intimate knowledge on the part of teachers. As a matter of fact, this relation is little understood. ...

2. Eye hygiene. ... The development of the eye must be understood. The specific strains and degenerations to which each important part is liable must be made clear. ... The principles of lighting ... the vicious effects of improper position; the dangers of too prolonged near work and of home study; improper methods in writing. Above all, it is essential that there should be a thorough study of the hygiene of reading and definition of the hygienic requirements for text books.

“3. Physical defects. . . . The statistics of retardation show relatively little retardation associated with visual defects, whereas the common defects ...e. g., adenoids, enlarged tonsils, are attended by a relatively large amount of retardation. The same is true of defective hearing. . . . Such defects inevitably mean retardation and perversion of development in the ordinary school environment. Teachers in training should study the more important physical defects—their physiological character, their specific effects upon psycho-physical development, their relations to school practices and condi

tions, and their remedies or alleviations." STEWART, Elsa. Sex hygiene. 9 p. 8°. (Cheney, Washington, Department of school hygiene. Bulletin H., no. 1, Sept. 27, 1911)

The Washington State board of education passed resolution, in January 1911, making sex hygiene a part of the curriculum of the State normal schools.

The course was first given at the Cheney State normal, summer session 1911. Frequent bulletins are to be sent out, detailing the plan and progress of the work.

The course is concerned first with the primary principles of biology, (Q) protoplasm, (6) life, (c) the cell theory, (d) germ cells and their life cycle; 2d, the evolution of sex; 3d, human reproduction present ing the (a) anatomical and (b) physiological phases briefly, (c) embryological development touching upon prenatal influences, (a) birth; 4th, the phenomena of adolescence physical and psychical, the boy and girl problem and its solution, adolescent reading and amusements; 5th, the pathology of sex onanism among school children, causation and treatment, social diseases and the social evil. This phase of the subject will be treated briefly ... 6th, sociological aspects of sex, (a) recognized social conventions, what they are for and their meaning, (b) the nature and obligations of the family and the sancity of the home, (c) the centripetal tendencies of family life against the centrifugal tendencies of industrial life, (d) studies of the theories of inheritance and environment, (e) eugenics, () infant mortality, causes and preventions, (q) race suicide and the duties of educators in the preservation of the nice."

TERMAN, Lewis M. Professional training for child hygiene. Popular science monthly, 80: 289-97, March 1912.

“The situation may be summed up in a sentence: The physician's training does not qualify him for the mong sided task of adapting the program and environment of the school to the health and growth needs of the pupil. The main purpose of this article is to suggest tentatively. some of the more important lines of professional preparation necessary for those who are to work in any field of child hygiene in the public schools.

“Educational hygiene has four chief aspects: (1) 'Medical Inspection,' including routine examinations for physical defects and consequent follow-up service; (2) supervision of physical training, including free play, gymnastics, and athletic sports; and (3) child psychology, including clinical work with mentally and morally atypical children, the hygiene of instruction, etc.; (4) researches in school heating, lighting, ventilation, seating, sanitation and other externals affecting the health of the child. Each of these divisions has of course its logical subdivisions but as only the vory largest cities could employ a more specialized staff than this scheme calls for it is unnecessary to carry the classification further. On the other hand, the majority of school health officers will probably for some years to come have to serve more or less in all these capacities. Assuming, however, the four separate lines of specialization above designated let us examine the general and special courses of study which would be necessary for their successful pursuit.

"To begin with, it would seem that the time requirement could not reasonably be placed below soven years in addition to a four year high school course. This corresponds to the usual allotment for the doctorate of philosophy and to that for the doctorate of medicine in our sixteen best medical schools. Using the seven-year basis for our calculation, the course falls naturally into three divisions. The first three years would be given to regular college work in which the elements of physics, chemistry, biology, physiology, psychology, paidology, sociology and at least one modern language would be taught. The next three years would be ample time in which to give all that is needful for the school health officer out of the present medical curriculum, besides leaving a fair margin for collateral work in psychology, paid. ology, and the technical aspects of education. The last year would be reserved for carefully supervised clinical practise in the public schools. Proof of ability to read both French and German should be required a year before the end of the course, for most of the important researches in school hygiene are in these languages.

"Physicians will of course object to the time allotment for the second division. How, they will ask, can you condense a medical course into three years, to say nothing of a margin to be left for psychology and paidology? The answer is more in terms of elimination than of condensation. Pharmacology, materia medica and therapeutios can be discarded in a lump, with a consequent saving of a full half year. Doing the same for the obstetrics, gynecology and most of the surgery effects a further saving of three-quarters of a year. This makes a year and a quarter off the present medical course. Further, for the purpose here in question, minor savings could be effected in several subjects, as, for example, anatomy, in which the minimum of 400 hours required by the best medical schools could here be taken for the maximum. Finally, the additional year of clinical experience in the schools would take the place of most of the usual courses in the hospital and dispensary, so that almost half of the second three years would be left for psychology, paidology, education, sociology, school hygiene, gymnastic sports, etc., the amount of each being dependent upon tho student's choice among the four special lines abovo named: medical inspection, clinical child psychology, physical training and school sanitation. Throughout the course time would be saved and effectiveness promoted by never losing sight of the professional nature of the courses. Physiology, pathology and bacteriology, as well as psychology and sociology, would have to be taught in their relations to the ultimate work to be done, not as so many unitary and complete sciences. Even the first three years ought to be conscious of the professional end.

“A school health officer, the product of such a school, would be of far greater service to education than is the usual school physician and would probably be worth more to society in the long run than a dozen well-trained practitioners. At least one such specialist in child hygiene is needed for every 2,000 school children. California needs 200, the United States at least 7,000. What university will be the

first to undertake their production?" WHIPPLE, Guy Montrose. The instruction of teachers in school hygiene. Pedagogical seminary, 17: 44-50, March 1910.

Status of the teaching of school hygiene to teachers: Course outlines; time needed. WINSLOW, Charles Edward Amory. The rôle of the visiting nurse in the campaign for public health. American journal of nursing, 11: 909–20, August 1911.

Establishment and value of school-nurse work; and the service in homes, teaching "public health.”

"Most hospital training schools are not prepared to meet these new needs. ... It is absurd to attempt to train the nurses . . . for the public health campaign by a course which involves two or three hours a week of theory and 50 or 60 hours in the wards, not hours of clinical instruction, but for the most part & routine of unenlightening and exhausting manual work. ...

“The instructive visiting nurse in the public health campaign ... must have a sound grasp of the blologiral principles which underlie her work so that she ought to have as good a grounding as the medical man in the fundamentals of physiology and bacteriology and hygiene; and ... she must be

quainted with the broad outlines of sanitation and sociology. ... We máy emphasize as necessary

the provision of special graduate instruction for nurses specializing in these various lines.” WITMER, Lightner. Clinical psychology and the professional training of teachers

(and others interested in child welfare) In his The special class for backward children. . . Philadelphia, The Psychological clinic press, 1911. p. 262–75.

See also under the teaching of health and hygiene. Meylan, George L. Report of the committee,



AYRES, Leonard P. Salaries of medical inspectors in America and in England.

Journal of education, 70: 149-50, August 19, 1909. [GULICK, Luther Halsey] Salaries of medical inspectors. Pedagogical seminary, 19: 225–27, June 1912. chart v.

No salary, 75; $1 to $100, 47; $101 to $200, 50; $201 to $300, 44; $301 to $400, 25; $401 to $500, 24; $501 to $600, 18; $601 to $700, 2; $701 to $800, 12; $801 to $900, 6; $901 to $1,000, 13; $1,001 to $1,500, 18; $1,501 to

$2,500, 7; $3,501 to $4,000, 3. Fee according to service, 19. From article by Louis B. Blan. GULICK, Luther Halsey and AYERS, Leonard P. laries medic inspec

tors and the number of pupils per inspector. In their Medical inspection of schools. New York, Charities publication committee, 1908. p. 1, 23, 139–49. table. Statistical.

Facts in regard to medical inspection in seventeen cities.

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Boston, Mass. Brockton, Mass. Camden, N. J. Chelsea, Mass.. Detroit, Mich... Lawrence, Mass. Montclair, N.J. Newark, N.J.. New Haven, Conn. New York, N. Y.. Paterson, N. J... Seattle, Wash. Somerville, Mass. Springfield, Mass Woonsocket, R. I.. Worcester, Mass..

86, 839 7, 781 9, 718 6,047 37, 757 7,539 2,503 38,562

18, 135 523,084 15, 238 16,174 11, 166 10, 605

1,085 1,111 9, 718 2,015 1,398 7, 147

625 2,410 3,627 3, 151 5,168



200 2,400




* 1,200
11, 200
3 600


. 179 .247 .099 .175 . 201 .487 . 165 .066 .380



1,400 2,400

600 6,750 1,500 1, 220 6,400

199, 200




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50 200

300 3,000

6 15

477 1,218

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1 One.
1 Two.

3 Ten. TERMAN, Lewis M. [Salaries of California school physicians) Psychological clinic, 5: 58, May 15, 1911.

Pay of school health officer varies from $100 to $3,600 per year. Half-time workers (excluding nurses) receive from $400 to $1,600, full-time workers from $1,500 to $3,600. Two of the smaller cities pay the physician for each individual pupil, 50 cents in one case, $1 in the other.




Birmingham public schools. [Superintendent) Report of Medical director. In his Annual report, 1911. p. 27–37. illus.

Signed: James S. McLester, M. D.

Each teacher keeps upon her desk blank cards (fig. 1) upon which she notes anything unusual she detects in a child; when these cards are filled, she gives them to the principal who keeps them until the next visit of the medical director, who in a room set apart for the purpose, examines all those pupils

whose record cards have been given him. Communication with attached return postal is sent the parent explaining case and advising that physician be consulted, or the child taken for free treatment to the dispensary at the Hillman hospital; parent is requested to take this notification to the physician or hospital as case may be, and a reply from the physician is to be written upon the return postal card. This reply is noted on the child's original card, which is then filed in an index system. In cases where no physician's reply is received, the nurse visits the child's home, and her data are added on the record card, before its final filing.

Study of 10 elementary white schools (enrollment of 5,343) was begun in March 1911. Results — I. Temporarily subnormal, 192. II. Permanently subnormal: (1) Morons, 33; (2) imbeciles, 10; (3) idiots, 4. III. Truant and incorrigible class: (1) Defective mentality, 16; (2) fair mentality, 51. IV. Epileptic class, 4. V. Physically defective: (1) Physical trouble, temporary or permanent, 347; (2) the blind, 3; (3) the deaf-mute, 0.

In the Paul Hayne school a dental clinic cares for the defective teeth. Central high school has an emergency hospital (see picture. p. 28).

Samples of cards used by the department of medical inspection, p. 35-36.


(LOPER, John D.] Medical inspection of school children. Made by competent physician, employed by the board of education.

Letter, signed John D. Loper, superintendent, to U. S. Bureau of education, Division of school hygiene.

If child is found to have any infectious or contagious disease, he is sent home with a notice to parent stating the case and asking that he be given treatment by physician of their own choice; readmitted to school only upon certificate of school physician. “About 8 per cent of our pupils have trachoma. Eighty per cent of the children 80 affected are among our Mexican population and fully 90 per cent of these children have no means of securing treatment. Hence, our greatest problem in this connection is to provide some means by which our indigent children may be treated for this disease."


California. University. Statistics of the infirmary. Medical examination of

new students, 1908–9, 1909–10. In Biennial report of the President, 1908–1910. Berkeley, The University press, 1910. p. 329-61 (tables only)

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Chest deformity..
Ears, defective.
Eyes, defective.
Feet, weak arches.
Heart, abnormal.
Lungs, abnormal.
Nose, diseased..

Right lower.
Left lower.

Skin, diseased.

Antero-posterior curve.

Lateral curve.
Teeth, poor..
Throat, diseased.
Thyroid, enlarged.
General condition:

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26 243 419 85 18

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