"12. An effort should be made to so modify the present system of employing and supervising janitors of school buildings that the principal of each school should have full authority over and responsibility for the work of the janitor."

New York City. City superintendent of schools.

Medical examination of school children. In his Annual report, year ending July 31, 1911. p. 154–57. tables.

"Only 287,871, or considerably less than one-half of the total number of pupils in average daily attend ance were examined at all. Of the 299,184 defects found, only 152,941 are reported as remedied.

"As I have frequently pointed out in former reports, the medical service rendered to the department of health is inadequate. The figures given above sustain this assertion. Only about one-fourth of the children in the schools derive substantial benefit from this service. The facts fully warrant me in again recommending that legislation be sought to enable the board of education to organize its own bureau of child hygiene. . . . Physicians employed by your board should be constantly on hand to advise regarding the school training of children suffering from physical defects, particularly nervous disorders and those resulting from malnutrition, and also with regard to the direction which the education even of normal children should take. The advice of a competent physician as to the physical ability of a boy or girl to accomplish any particular line of school work or to undertake the preparation for vocational work... would be of incalculable value to parents, pupils, and teachers." SCHENCK, Herbert Dana. Medical inspection in schools and its status in New York State. North American journal of homoeopathy, 58: 644–51, October 1910. "Of the 48 cities in the State outside of Greater New York, 31 sent in answers. Buffalo is the only city of the first class. In the second class are 7 cities, Albany, Rochester, Schenectady, Syracuse, Troy, Utica, and Yonkers, all but Syracuse reporting. Albany made so meager a report . . . it cannot be reckoned with, on most questions. Of the other 40 cities having less than 50,000 inhabitants each, comprising cities of the third class, 24 answered the 30 questions sent out by the [American School Hygiene Association] Of these 17 cities reported 383 schools under supervision. . . . Twelve of these cities have an organized system of medical inspection and in 9 the inspection is made for both contagious diseases and physical and hygienic defects, while in 2 others the vision alone is tested. In 2 others, contagious diseases are the only things for which an inspection is made; 12 cities follow up both cases of contagious diseases and of physical defects . . . and 6 more follow up only . . . contagious disease. In 10 cities it is reported that from 80 to 100 per cent are treated by reputable physicians. The inspection does not average more than one visit per week in most cities. . . .

"In 7 cities the parochial and private schools are also inspected for contagious diseases, and in several places for physical defects.

"In four places the inspector is required to visit the houses to find out the cause of absence. . . .

"In 6 cities the books are fumigated once or twice a year... In 14 of the cities the books and other materials of children ill with contagious diseases or in families where there have been contagious diseases are destroyed and in 14 they are disinfected. . . .

"Eight cities provide one or more nurses. . . . In 5 cities they perform the duties of a medical inspector in a limited way. In three cities the teachers are expected to do this. In seven cities a permanent [record of the] physical condition of the child is kept; 15 report none.

"The school authorities in 20 of these cities say that medical inspection has improved the hygienic condition of the schools, the efficiency of the children and the attendance. There are none reporting against it."

Summary:

"1. In no sphere has preventive medicine a better field than in correcting the physical and hygienic defects of school children, which are largely undiscovered until school life begins.

"2. The most economical, comprehensive and complete inspection must include examinations by the teachers, by medical inspectors and by nurses in 'follow up' work.

"3. Efficiency and cooperation will be better secured by having physicians employed by the boards of education examine for physical and hygienic defects as well as contagious diseases. As soon as the latter are excluded from school they should fall under the jurisdiction of the board of health.

"4. In New York State medical inspection is rapidly extending and widening its sphere. . . .

"5. As physicians and citizens it is incumbent upon every member to urge the necessity of comprehensive and accurate medical inspection for defects that impede progress as well as diseases which endanger others."

SHAFER, George H. School medical inspection in New York City. Pedagogical seminary, 18: 303-14, September 1911.

Cases of major contagious diseases are at once excluded. The inspector immediately telephones the name and address to the borough office of the division of contagious diseases, and duplicates this by a notice through the mail and again includes the case in his daily report. The division of contagious diseases at once sends a diagnostician, except in case of diphtheria or pulmonary tuberculosis. If the diagnosis is confirmed the case remains under the control of the division of contagious diseases.

Cases of tuberculosis are referred for treatment to the family physician, or to the department of health clinic and a special report is made to the chief of the division of child hygiene.

A few weeks after school opens in the fall, a general routine inspection of all children is made by the medical inspector. This routine is made at the beginning of each term, and is repeated by the nurse at least once a month.

Contagious diseases are designated according to a certain code as follows: (1) Diphtheria, (2) pediculosis, (3) tonsilitis, (4) pediculosis,1 (5) acute conjunctivitis, (6) pediculosis,1 (7) trachoma, (8) pediculosis,1 (9) scarlet fever, (10) measles, (11) varicella, (12) pertussis, (13) mumps, (14) scabies, (15) ringworm, (16) impetigo, (17) favus, (18) molluscum contagiosum, (19) acute coryza.

When the physician diagnoses a case he calls out the code number, and the teacher puts down the name of the child with the code number.

There are three classes of physical examinations. 1. Routine physicals. 2. Work paper physicals. 3. Physicals for athletics.

Each morning as soon as the inspector has made his tour of inspections, he stops at one of his schools to make regular physical examinations. These cover the following points: Defective vision, defective hearing, defective nasal breathing, hypertrophied tonsils, tuberculous lymphnodes, pulmonary disease, cardiac disease, chorea, orthopaedic defects, malnutrition, defective teeth, defective palate. A measurement of height is also made.

The examinations are made in the following order: First the children entering school for the first time. Second, beginning with children of the lower grades and proceeding to the higher grades in regular order.

SMART, Isabelle Thompson.

Examination of subnormal children. Women's

medical journal, 22: 57-59, March 1912.

"Medical examination of school children should be included in every city, town and district in the State, and the special examination of all children thought to be mentally backward or deficient should be in evidence everywhere.”

Gives some statistics gathered in the course of the author's medical work, 1910-11, as special examiner of the mentally unfit in the public schools of Greater New York.

Of one group, numbering 2,500, there were 204 who needed actual hospital care. There were 627 requiring general medical care; and 90 cases in such poor physical condition as to make an outdoor class imperative. There were 145 cases of epilepsy, the major number of them of the more serious form known as grandmal; 947 cases of masturbation; 946 cases of speech defect; cases needing dental care, 1,560. "The eye defects," says the writer, "were appalling, and ranged . . . all the way from a simple, slight strabismus to congential cataract of both eyes and tuberculosis of the eyeball. . . . I found 1,608 children suffering from aural defects; [and] 1,716 cases who had adenoids, or enlarged tonsils. Eightyone children had chorea, or St. Vitus Dance, while there were 876 cases showing various other forms of nervous diseases. In addition there were 446 hearts in a pathologic state...

...

...

"Is it any wonder that such children are seldom promoted; that they are reported as nervous and irritable; that they are with difficulty controlled, and that so many of them become truant?"

SMART, Isabelle Thompson and MACY, Mary S. On the medical examination of children reported as mentally defective in the public schools. Pediatrics, 23: 665-71, November 1911. tables. charts.

Reprinted.

Data collected in the course of routine examination of 6,245 school children in the public elementary schools of New York City. The children were all backward.

Eye defects..

Ear diseases or deaf.

Defective teeth..

Tonsils alone enlarged.

Result of examination of 6,245 backward children in New York City.

Adenoids alone enlarged.

Tonsils and adenoids.

Speech defects.

Epilepsy.

Chorea.

Other neuroses..

Tubercular suspects.

Cardiac weakness..

Nutritional disorders.

68.7

1 The repetition of Pediculosis "was originally intended to shield the pupil. In the examination the pupils file past the physician who calls out the code number to the teacher or nurse as the diagnosis is made. Any one of the four numbers was recorded as pediculosis." (Letter of author, U. S. Bu. educa., Div. sch. hyg.)

65.6 per cent of all examined were boys and 67.4 per cent of all assigned for treatment were boys. "The problem is a good one, and fraught with serious consequences if public sentiment is not aroused to the magnitude of the increase in defective mentality, and if some definite legislation is not speedily enacted along the line of eugenics."

NORTH CAROLINA.

FERRELL, John A. Report. Status of hookworm disease in North Carolina. In North Carolina. State board of health. Thirteenth biennial report, 1909-1910.

Raleigh, N. C., Edwards & Broughton printing co., 1911. p. 53-55.

Of more than 600 North Carolina college students examined for hookworm disease, residents of 50 counties, one-third were found to be infected. Probably one-fourth of the rural population are infected, the highest infection percentage being among school children.

2.

The plan of campaign is as follows: 1. The State will be divided into 16 or 18 sanitary districts. Five practical physicians of experience will be appointed as field agents. They will devote their entire time to the campaign against hookworm disease. 3. Each field agent will be assigned to a sanitary district. He will be expected to cooperate with the doctors, teachers and "all other forces which may lend a helping hand toward making the facts and methods for eradication, common knowledge. Wherever practicable examinations will be made free."

A conservative estimate gives the annual loss occasioned by hookworm disease, in the State appropriation for public schools, as $187,500.

HAYWOOD, Hubert, jr. Results of the examination and treatment for hookworm disease of the pupils at the State blind school for the white. In North Carolina. State board of health. Bulletin, 26: 175-78, August 1911.

Out of 172 pupils examined, 83 were infected with hookworm disease; about 56 per cent of the boys and about 42 per cent of the girls, with one or two exceptions all being from country districts, largely from farms; not a single case from a city or town where there was a sanitary sewerage system.

RANKIN, W. S. What County boards of health are doing. In North Carolina. State board of health. Bulletin, 26: 334-43, January 1912.

Board of health rules:

"That all children attending schools shall be vaccinated or be excluded from school after January 1, 1912. (See Exhibit A.)

"That the county superintendent of health shall be provided with a suitable stereopticon lantern and a full collection of lantern slides, and that he shall give illustrated lectures in all of the public schools of the county on important phases of sanitation.

"That the teachers in the public schools shall examine the children for the common physical defects, and report on suitable blank forms furnished them by the county superintendent of health. Probably defective children shall be examined by the county superintendent of health, who shall notify the parent of the condition of the child and of the proper course to pursue to secure the necessary treatment. (See Exhibits B, C, and D.)

"That the public school teacher shall report to the county superintendent of health all absences from school on a post card furnished them by the said superintendent. (See Guilford County Exhibit E.) "That the county superintendent of health shall notify the teachers of public schools of the presence of infectious diseases in the families that have children attending their school. (See Exhibit F). . . . [He] shall visit and make examination of all school buildings and grounds during the school vacation every year; ... shall keep a record on file in his office showing the physical condition, recommendations, and effects of treatment of defective school children that have been referred to him by the teacher." (See Exhibit G.)

STROSNIDER, C. F. The frequency of hookworm infection among the whites as compared with the negroes. In North Carolina. State board of health. Bulletin, 26: 167-69, August 1911. table.

In the examination of 3,429 school children, 2,092 of whom are whites and 1,337 negroes, 34 per cent of the whites are infected against 15 per cent among the negroes. The infection among the rural whites is three times as frequent as among the semi-rural and those whose homes have sewer connection; and the rural negroes were found five times as commonly infected as were those in the large towns. The percentage was always lower, excepting one case, among the negroes.

The infection was found to be higher among mulattoes than among full-blooded Africans.

NORTH DAKOTA.

North Dakota. State board of health. [The medical inspection of school children in North Dakota] Its Bulletin, 4: 3–5, September 1911. (Caption: Back to school)

Section 236 of the 1911 session laws reads as follows:

"The board of any school corporation may employ one or more physicians as medical inspector of schools. It shall be the duty of the medical inspector to examine, at least once annually, all children enrolled in the public schools of the district, except those who present a certificate of health from a licensed physician, and to make out suitable records for each child, one copy of which shall be filed with the county or city superintendent of schools. Notice of physical defects of abnormal or diseased children shall be sent to the parents, with recommendations for the parent's guidance in conserving the child's health. The medical inspector shall co-operate with the state, county, and township boards of health in dealing with contagious and infectious diseases and to secure medical treatment for indigent children. It shall be the duty of the county and city superintendents of schools to co-operate with school boards in promoting medical inspection. He may arrange schools by groups, especially in the rural districts, for the purpose of inspection, and shall advise school boards with a view to securing the most efficient and economical administration of this law. The school board or board of education shall furnish all blanks and other needed supplies for this purpose."

The last legislature passed the following law:

"Each local board of health, at least once every thirty days, in such manner as it shall direct, cause to be adequately disinfected each school house, within its jurisdiction; provided this act shall not apply to school houses during vacation; provided, that except in case of emergency, the disinfection of school houses shall be made after school on Friday afternoon or on Saturday."

"Summing matters up we would respectfully recommend for the consideration of school boards all this time the following: 1. Medical inspection of schools. 2. Where this is not practical, engaging teachers who are competent to recognize the ordinary contagious diseases as well as the common physical defects. 3. That the attention of parents be directed to such physical defects as may be detected and suggestions mad› as to how they may be remedied. 4. Provide adequate sanitary accommodations for all pupils. 5. Abolish the common drinking cup. 6. Prohibit spitting."

See same: p. 6-7, October 1911.

"The last legislature passed a law making monthly disinfection compulsory...

"In the opinion of Attorney General Miller this law is null and void on account of a discrepancy between the title and the body of the bill. He says:

"I have traced the course of this measure through the legislature and find that it was several times amended and that, as finally passed, the title of the bill covered sufficiently the subject matter embraced within the body of the bill. It appears therefore that an error was made in the enrollment of the bill, so that when submitted to the governor for his signature it was a different measure than when passed by the legislature.'

"From this you will note that the legislature was right and that the bill fails through a technical clerical error."

OHIO.

AYRES, S. C. Civic medical inspection of school children, with special references to diseases of the eye, ear and throat. Journal of ophthalmology and otolaryngology, 6: 1-6, January 1912.

General; and Cincinnati, Ohio, in particular.

had super

"The work done by the school nurses has been of the greatest benefit. Three nurses . . . vision of 13 schools. The following figures will give you some idea of what they did in 1910: "They made 1,425 visits to the schools, and inspected 3,676 cases. They gave 1,191 treatments at the homes of the children, and 7,900 at the schools, and made 11,434 reinspections. They held 1,455 consultations with the parents."

Cincinnati. [Board of education] Medical inspection. In its Report of the public schools, school year ending August 31, 1911. p. 84-88. tables.

Under "supervision of the department of health by the district physicians. Primarily, its aim is the... detection of infectious and contagious diseases. . . School inspection includes also the detection of those physical defects which interfere with the child's ability to do his school work.

"One hundred and two public and parochial schools were included in school hygiene, and in the congested districts 5 nurses were employed to look after the physical welfare of the children in 21 schools. . . .

"Three additional nurses were appointed for the present year. A daily notice is sent to every school in the city by the board of health, giving information concerning all the children of the city who are excluded for contagious diseases, and also a list of those who are permitted to return." Total number of medical inspections for 1911, 11,811.

82883-137

Examined but not recommended for treatment, 4,854. Total number examined, 24,229. Defects of the eye, ear, nose, throat, in children of five public schools in congested districts: Total examined.

Defects of vision (33.36 per cent).

Defects of ear, nose, and throat (64.13 per cent).

2,437 813

1,563

Dental inspections have been held for three years; 14,886 school children have been examined, of whom 12,205, or 90 per cent, required dental attention Inspections are carried on by volunteers from the Cincinnati Dental Society. A permanent lecture committee addresses mothers' clubs, school children, and other organizations desiring its services.

In September, 1910, a free dental clinic was established in one of the school buildings; expense of operating the clinic about $2,000 for every 1,000 children.

"The most notable innovation is the so-called 'experimental class,' which is being conducted at the sixth district school-certain psychological, physical, sociological, and dental tests instituted; behavior attendance, scholarship, etc., recorded, and dental treatment given-the object being to demonstrate that through proper hygienic mouth conditions, scholarship, attendance, behavior, manner, etc., will be radically improved, thereby saving the municipality in actual money more than the cost of maintaining proper conditions. At the end of the year these tests will be repeated... This is the first time that this experiment has been attempted with an entire classroom and the results should be of great scientific importance."

Cleveland. Board of education. Second annual report of the Division of medical inspection of schools, Cleveland, 1911-1912. 8 p. tables. 8°.

Number of cases fully corrected during the year 1911-1912 was 3,580, as compared with 1,793 for 1910-11. "Of the corrected cases, approximately two-thirds of the number were repeaters, presumably by reason of correctable defects."