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pupils to whom the regular grades act as an intellectual hobble skirt, spoiling their natural gait perhaps for life. These special classes are good for the pupils requiring special treatment, but their greatest benefit is in releasing the teacher's time for the benefit of the normal pupils.

We must have summer schools, because children grow in summer as well as in winter, and should have their mental diet supplied all the year round. The diet must of course be the right one and fitted to the season of the year. The three lower grades should have their afternoons outdoors, not in the schoolroom, partly that they may be free from the demoralizing influence of heavy pressure work, even more that the teacher may have time in the afternoons to take them, two or three at a time, and find out what they really need.

We must look at the home, not as a boarding house, but chiefly for its spiritual contribution to health. When by promiscuous school feeding we break down the responsibility of the home, we have injured the child even in his physical health more than all we can do for him would ever atone.

Finally, school hygiene is race hygiene. Childhood is the time for effective treatment of physical defects, and the school is the one place where every individual can be reached.

D. SOME IMPORTANT FACTORS PREVENTING NORMAL GROWTH AND
DEVELOPMENT IN SCHOOL LIFE.

D. P. Macmillan,
Director of child study in the public tchooU, Chicago, III.

There are many children who are hygienically handicapped from the beginning of life. First, the chain of heritage is weakened in some links, and, of course, this goes back to unhygienic conditions and influences. Parents for ninny generations back have not known the first principles of right living, in which, though few have been willfully perverse, many were innocently ignorant. Children come into the world with incipient nervous disorders, which environmental factors early transform into overstimulated or understimulated nervous systems. Again, diseases in early years are found to be associated in the child's life with unhygienic states. Right living, through proper surroundings and teachings, will ultimately make the so-called "inevitable children's diseases" a mere matter of curious history in child hygiene. Further, among these must be classed accidents to the child's health and person, although indeed one advantage is often apparent in that very frequently these at once arrest the attention of parents and guardians to at least remediable and recoverable cases. Any discussion must take into account the desirability of considering cleanliness of family life, adequate and appropriate clothing for all kinds of activities, as well as purity or impurity of the air breathed in cramped and darkened home quarters; but above all we must begin with diet, rest periods, and educative muscular activity.

Most potent, because it is the most vital, constant, and controllable factor during the periods of infancy and childhood, is the dietary of the child. The food provided may not be sufficient, and this reaches out to social economics; it may not be properly balanced and adapted to growth needs in general or in particular to the needs of the individual child's system; it may be irregularly partaken, and this is dependent to a large degree upon the habits of the home; it may be poorly selected food, cheap, old, decayed, and is very frequently unhygienically cooked. Finally, as so often occurs, the children are not educated to eat properly.

Xext to improper food in all its parts as a deterrent of normal growth must be recorded the factor of irregular, inadequate, or disturbed sleep. According to our experience, this does not apply to the poor and needy or the lower section, financially considered, of the fairly comfortable social strata of a metropolitan school population, as frequently as to the children of the comfortable and well to do. With the latter not infrequently late hours, social gatherings, and excessive indulgence through the day cause nervous exhaustions, the injurious effects of which continue to show themselves well along into the adolescent period, and are often wrongly blamed on the school regime. All this indicates the necessity for popular education to reach back into the early and later home life of children, not only indirectly, but directty in some positive ways.

Further, the clean, well-clothed, and properly fed young generation, provided with fresh air and adequate sleep, is still poorly furnished for a life of efficiency if the remaining vital factor affecting normal development is not assured—namely, educative muscular activity. Educators are just awakening to the vital significance of this for our present generation as a hygienic consideration of primal importance, and every physical and mental test and measurement bears out the suspicion of our first inspections and observations. Free and directed plays and games and ordered regular exercise in municipal playgrounds, social centers, and school yards, merely point the need and the way to begin early and adequately to round out the physical and mental hygiene of the child in educative muscular activity.

These factors, which operate as handicaps to normal development in infancy and early childhood, continue their prejudicial influence with cumulative power in school life, and our attention is most often called to their after-effects, such as physical disorders, physical defects and their correlates, mental dullness, incorrigibility, and even juvenile crime. All departures from normal of this character are merely symptoms of these underlying conditions of hygienic living which are outraged, neglected, or inadequately provided for.

Defective eyesight and hearing, difficulties in breathing, hypertrophied tonsils and adenoid tissue, decayed and painful teeth, all noncommunicable defects and contagious diseases of every sort have come to be considered as preventives or deterrents to normal growth and development of school children. Defects of the senses of sight and heal ing, to which appeal is largely made in schoolroom activities, are considered by some to be the primary causes of delay or derangement of normal development, and it must be admitted that they delimit the number and quality of sense impressions as well as contribute to the formation of injurious habits in schoolroom arts, especially in younger children, but they are by no means such potent deterrents as the deeper lying derangements, which we may group somewhat roughly as nervous exhaustions and constitutional disorders. In looking over the records of the first 7,200 cases of exceptional that readily came to hand in our files, it was found that only 8 per cent are schoolroom problems because of defective vision, and a little over 0 per cent of the total number require either special care or training because of defective hearing, whereas over 40 per cent of the total number are nervously depleted, ill-nourished, weakened in power of resistance, uneducated in the fundamental bodily activities of their years, apathetic in voluntary initiative, and lacking in bodily control.

As education has begun once more to come into her own by including bodily features, and all that belong thereto, so hygiene, or the science of well-being, must always be thought of in terms of the mind as well as of the body. And as we ascend in the scale of human values and cultural sensitivity, hygienic education demands the exclusion of all morbidities, self-consciousness, false motives, fears, envies, angers, all emotional neuroses, all disordered attentional habits, all deranged associational processes, every clogged or explosive act of will and inconsistency in thinking, until the best functioning of mind as well as body is the common attainment of our children.

E. NOTES ON THE HEALTH OF SCHOOL CHILDREN.

S. Adolphub Knopf, M. D.,
Xeic York Postgraduate Medical School and Hospital.

The site for a school building should be on elevated ground, and as far as possible removed from traffic, dust, and noise. The building should be sanitary, well lighted, and attractive outside as well as inside.

The janitor of a public, parochial, or private school should be a practical sanitarian. Daily cleansing or disinfection, when necessary, of classrooms should be obligatory.

The toilet and washing facilities for children should be sanitarily perfect.

The rural school should not be less sanitary, less well equipped, nor less well managed than the public schools of a city.

The more open-air schools we can have, the more outdoor instruction in kindergarten, public schools, and colleges, the greater will be the physical vigor and strength of the pupils.

If we wish effectually to prevent and stamp out tuberculosis in children, the open-air school must become the rule, the indoor classroom the exception.

If there is not ample room for playgrounds and separate openair classes, the schoolhouse should have a garden, playground, recreation room, and some open-air classes on the roof.

Let us send the child to the open-air, or fresh-air, school before its tonsils or adenoids are enlarged as a result of overwork indoors and fighting off dust and infection.

If the indoor classroom must be used, the temperature and moisture should be properly regulated with the aid of the thermometer and the hygrometer, and the air kept in motion with the aid of a fan. These three devices should be as essential to the equipment of an indoor classroom as is the blackboard.

Practical breathing exercises, judiciously taught, should form a part of the daily curriculum.

Outdoor singing, outdoor recitation, botanical and geological excursions, practical lessons in horticulture or in farming, should be introduced as often as the curriculum will permitInculcate the love for open-air life into the child at school and it will become a fresh-air apostle at home.

So long as we permit child labor in factory, workshop, cannery, field, mine, or home, so long shall we have physically, mentally, and morally defective citizens.

The well-known methods of daily medical inspection of all school children to exclude those afflicted with acute or chronic infectious, general or local diseases, should be supplemented by a thorough physical and mental examination of every pupil by the school physician on admission, and annual or semiannual reexaminations for tuberculosis, heart disease, insidious nervous afflictions, etc. A careful record of the physical and mental condition of the child should be kept and the result of each physical and mental examination recorded. Teachers and all school employees who come in close contact with the children should likewise be examined on admission and submit to periodical reexaminations.

The tuberculous or predisposed, the mentally defective, delinquent, or backward children should have separate schools, or at least be placed in separate classes.

A goodly number of the seemingly delinquent, defective, and backward children are of syphilitic origin, and before classing them permanently with the defectives a Wassermann test should be applied, and if positive, antisyphilitic treatment should be inaugurated.

The hopelessly feeble-minded and defective child should be rendered sterile before puberty.

Health lessons and simple instructions in the prevention of disease, such as tuberculosis for example, can easily be imparted to even the youngest child.

Lessons in mental alertness, in what to do in hours of danger, such as the event of fire in school or at home, or a panic from whatever cause, and instruction in first aid to the injured, are to my mind as essential as any health lessons.

In case of epidemics of diphtheria preventive injections of antitoxin should be given to all children exposed. When parents object to this procedure, their children should be excluded from school until the epidemic has ceased.

In case of typhoid epidemics antityphoid vaccination should be used.

Every large community should have a special outdoor or fresh-air classroom for children afflicted with whooping cough.

"While all hindrances to the proper physical and mental development of the pupil should be remedied, such as adenoids and enlarged tonsils, polypi, or a deviated septum, defective eyesight, hearing, or defective teeth, orthodontal treatment for the correction of irregular teeth should not be neglected. The same should hold good for the treatment of any remediable unesthetic appearance in the child.

The school curriculum should be so arranged that the mental strain shall not react unfavorably on the physical and moral constitution of the child.

Sanitary fountains furnishing good, cool water should form part of the equipment of every school, and the drinking of plenty of such water should be encouraged.

No public school should be considered well equipped without its swimming tank of running water; no curriculum complete without swimming lessons.

Gymnastics, calisthenics, esthetic and graceful dances, and rational athletics should be taught to the boys and girls at school. These exercises will benefit the child's physique and give it a healthy and happy frame of mind.

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