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Washington, January 1, 1913. Sir: In the older Greek education one-half of the school day was regularly spent by the Greek boys in exercises and games designed to make them strong and also to teach them the mental significance of sound health. During the middle ages this high ideal of soundness and sanity was lost, and even looked upon as spiritually dangerous.

There is emerging to-day a new health consciousness. We now know that diseases are not providentially sent, but are the results of natural forces which man may overcome. We know, too, even better than the Greeks, that physical soundness and mental sanity are vitally related. Hence, we realize that mental progress demands physical progress.

Medical inspection of school children has for its chief purpose the early discovery of physical defects or disease, so that such defects may be corrected in early life, or that contagion may be reduced to a minimum. No educational movement in modern times has had vital relations to the children, to the homes they represent, and to the Nation, than medical inspection of school children and the general hygienic movement it typifies.

The work began in this country less than 20 years ago, but we are now in the midst of the most rapid development of this part of the public educational service. Information is eagerly sought from all parts of the country.

The manuscript hereby transmitted, entitled “Annotated Bibliography of Medical Inspection and Health Supervision of School Children in the United States for the Years 1909–1912,” was compiled in the Division of School Hygiene and Sanitation of this bureau. It is a digest of the chief literature on this subject published in America during the past four years, and will be very helpful, especially to school and health officers. I therefore recommend its publication as a bulletin of the Bureau of Education. Very respectfully,





ALLEN, Arch Turner. The school and physical welfare of the child. In North

Carolina association of city public-school superintendents and principals. · Proceedings, 1911. Raleigh, Edwards & Broughton pri co., 1911. p. 19–27.

"It is the business of the school to see that the physical surroundings of the child comply in every detail with the laws of healthful living. The room should be large; the air space ample; the ventilation continuous; the light free from shadows and properly directed; the sittings accommodated to the child's size and not to the grade; the water pure and of the right temperature, and sanitary arrangements for using it; the toilets clean; the playgrounds large and dry; and plenty of time to use them

“The school is under urgent obligations legally as well as morally to see that it does not become a distributing center for contagious diseases.

“When we consider what medical inspection will do for the schools, its cost becomes a legitimate school expenditure. It is just as much so as the salary of the teacher.

“The three essential things in this inspection are the following:
“1. To know the health records of the community.
"2. To know as far as possible the physical condition of the children who attend school.

"3. To follow up this knowledge by having as many of them treated as we can find a means for, and to use these health records in every helpful way possible.” American medical association. Report of committee on administrative methods

of physical examination of school children. Its Journal, 57: 1750–51, November 25, 1911.

Signed: Ernest B. Hoag, M. D. and Everett C. Beach, M. D.

Recommends: That city and county boards of education should secure the services of trained medical inspectors sufficient in number to instruct all elementary school teachers in making preliminary physical examinations or health surveys; that city boards of education maintain departments of medical inspection, the heads of such departments to be medically trained men; that the cities be divided into districts with a medical inspector in charge of each district.

That each child be given a physical examination each year, preferably at the beginning.

That this examination be sushciently thorough to detect defects that interfere, or are liable to interfere, with the health, growth, and development of the child, such examinations to include the examination of the eye, ear, mouth, nose, throat, teeth, heart, lungs, thorax, shoulders, spine, hips, inguinal region, feet, nutrition, mentality, and nervous system.

That the preliminary examination in the elementary schools be made by the teacher or nurse and in the high schools by the director of physical education or one of his assistants.

That the supplementary physical examination be made in the elementary schools by the trained medical inspector, and in the high schools by the director of physical education if he be medically trained; otherwise by the medical inspector; that a careful record be kept of the results of the preliminary and supplementary examinations to include only such data as would be of future use to the teacher or director

That these records be kept by the teacher and passed on with the promotion slip. a duplicate being retained in the office of the health inspector.

That whenever feasible the physical examination be conducted preferably by examiners, employed by and under the direction of the board of education. When this is not feasible the appointee of the board of health should be approved by the board of education.

That a greater effort be made to establish hearty cooperation between the school physician, the ceacher, the family physician, the home, and the free dispensaries in following up and in securing the correction of physical defects.

American. medical association. Report of committee on medical inspection of schools. Its Journal, 57: 1751-57, November 25, 1911.

Chairman, George L. Leslie.
“Two divisions of this field of work are advisable:

"4: Untier the control and direction of boards of education—that part of the work essential for the intelligent-Fiandling of pupils and students throughout their period of educational training; and for the maintenance of hygienic environment and hygienic activity-the field of educational hygiene.

“B+ ‘Under the control and direction of boards of health-that part of the field of work concerned with the care and control of contagious and infectious diseases as a part of the field of public health.



“1. The establishment of biennial, annual, and, when necessary, more frequent skilled physical and developmental examinations of pupils and students by a staff of experts. The establishment of initial examination of pupils by the teaching force of the schools, as far as the teaching force is qualified, prior to the skilled examinations by experts.

“2. By effective action, based on the data of these examinations, to secure (a) the correction of physical anomalies and thus remove the growth-barriers of children and youths, and (b) whenever possible and practicable, to adjust educational activities to meet the requirements of physical and mental health, growth and development, and thus establish a special field of education for the maintenance of continuous health and development supervision of pupils and students.

“3. To maintain a scientific and systematic study of mental retardation and mental deviation of pupils and students by skilled examination, and whenever possible and practicable, by skilled training in special schools.

“4. To establish skilled physical and health examinations of candidates for teachers' positions prior to their election to determine vital fitness for their work, and thereafter to maintain continuous supervision of health and efficiency to teachers as related to the work of the schools.

“5. (a) To organize and supervise courses of technical instruction in hygiene for pupils, students and teachers, in the means of conservation of physical and mental health, growth and development; in the means of correction and prevention of defects, disease and degeneracy; (b) whenever necessary for efficiency, to give practical and technical instruction to the teaching force of the schools, while engaged in teaching, in the initial physical and developmental examination of pupils; and in the skilled physical and developmental and psychoclinical examination of exceptional pupils, abnormal and supernormal.

“6. To establish and maintain well-equipped medical anthropometric and psychoclinical laboratories in the public schools which shall afford opportunity and equipment,

“(a) for sufficiently skilful medical, anthropometric and psychoclinical examination of exceptional pupils and of all pupils requiring special examination.

(6) for such technical training of teachers in the laboratory and experimental phases of educational work, connected with the physical and mental examination of pupils, in clinical psychology and in experimental pedagogy as is essential for the intelligent handling of pupils.

"(c) for essential work in hygiene and sanitation.

"7. To exercise expert sanitary supervision in the planning and maintenance of school buildings and grounds.

"8. To bring about the establishment of dental and medical clinics for pupils whose parents are finan. cially unable to provide essential medical and dental aid.

"9. Whenever possible and practicable, to cooperate with State, county, and city health officers in the detection of and reporting of contagious diseases.

"10. Each department of educational hygiene to constitute a bureau of practical investigation and research in educational hygiene, and as such to cooperate with State bureaus of educational hygiene whose functions will or ought to be the organization and supervision of State-wide work and investigation in this special field of education-looking forward to the establishment also of a national bureau of educational hygiene.

"An approrimate grouping of pupils.—Based on the data of physical and developmental examinations which ought to follow the examination of pupils and students. 1. Those for whom medical and dental aid is essential. 2. Those whose respiratory or circulatory systems are defective or are poorly developed, for whom a larger amount of out of door life and physical activity is essential, or other modification of school activities necessary. 3. Those whose nervous systems are defective or poorly developed and who require an unusual amount of out of door life, physical activity, special care and skilled training. 4. The segregation of pupils requiring an unusual amount of physical activity for possible mental growth-both sexes. 5. Segregation of pupils of truancy and criminal tendencies or otherwise showing more or less degeneracy, and assignment to special schools with special training. 6. Segregation of mentally defective pupils and assignment to special schools. 7. The segregation of supernormal pupils and assignment to special schools. 8. As far as practicable, the grouping of pupils in accordance with development age.

“In this program, school nurses are assistants to the staff. Their field work is essentially as follows:

"To assist members of the staff in the skilled examination of pupils and otherwise as assistance is needed; to assist teachers in making preliminary surveys of their pupils and in giving initial examina

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