B. THE SCHOOL AND VITAL STATISTICS.

FRANKLIN C. GRAM, M. D.,

Chief of the Bureau of Vital Statistics, Department of Health, Buffalo, N. Y.

At first thought it might seem that the school and vital statistics are antitheses and their points of contact about as opposite as the two poles. The same might have been said about medical school inspection only a few years ago. In an age of progress the dead languages give way to technical education and the philosophy of unknown quantities to manual training. Granting this, you will ask, Where will the study of vital statistics fit into the school curriculum?

It needed no argument to make room for the art of bookkeeping. Even the unintelligent recognized the necessity of a knowledge by which, in his crude way, he might measure his financial loss or gain during a given period. Vital statistics is the bookkeeping of a community. It shows the assets as well as the liabilities. It does more. It forms a permanent record of every individual from the beginning to the end of life.

If we teach our children that certain diseases, such as measles and whooping cough, which have been regarded as blessed essentials of childhood, and which our mothers were wont to invite by contact in order to have them over with as early in life as possible, are not essential but more fatal than dreaded pestilence, then we assist them in retaining a normal constitution and possibly prevent them from filling an early grave.

The reduction of infant mortality has long ceased to be a subject of philanthropy or of public spirited benevolence. It is a recognized duty of the State. The State can do nothing without the cooperation of its citizens, and unless its citizens can be made to understand a condition there can be no cooperation, because it then becomes a matter of law and not of duty.

To a proper study of these things it is essential to have some knowledge of morbidity and mortality conditions. It is necessary to know the number of births in a community in order to compare it with the number of deaths. Vital statistics show at what period of life the lowest and highest mortality rates exist, the causes which produce death at later periods, and this again leads to the study of prevention. Connected with this study is a natural inquiry into the causation of disease, and while such study still presents many obstacles to the untutored mind, yet it is within the range of possibility.

Nor is such study without profit to pupils before they reach high school or college. It is particularly valuable before that stage is reached, because during this period of life many of the contagious diseases occur which cut short a promising career or leave the individual burdened with an infirmity for life.

The study of vital statistics is entitled to a place in schools on the following grounds: (1) It leads to an inquiry into morbidity and mortality conditions of the home locality; (2) it forms a basis for comparison with what such conditions ought to be; (3) it assists in the study of prevention of disease and in the knowledge of public health; (4) it is an essential adjunct to medical school inspection and school nursing; (5) a knowledge of health and disease forms the bulwark of nations; (6) youth is the best period in life for beginning to acquire such knowledge.

C. ACCIDENT PREVENTION AS RELATING TO CHILD WELFARE.

MARCUS A. Dow,

General Safety Agent, New York Central Lines.

Remarkable results have been obtained in the actual reduction of industrial accidents through the education of industrial workers along the lines of safety, in many instances large plants or railroads showing decreases ranging from 10 to 40 per cent in casualties in one year. In a very brief period the plan of systematic education of industrial workers in accident prevention has proved effective and successful. Why should it not be just as successful if applied in schools? The great need for a concerted, well-defined plan of teaching school children" safety," "prudence," and "carefulness" is apparent when the great number of lives sacrificed annually is considered.

The railroads do not begin to furnish all the accidents that result in serious or fatal injury to children and others. The dangers that beset the child in daily life are numerous and varied. Matches and bonfires, the automobile, the street cars, vehicles drawn by horses, and many other things contribute to the huge list of deaths and injuries to children from accident causes.

In New York City alone there were 226 children killed and 479 seriously injured while playing in the city streets during the year 1912. In the States of New York and New Jersey during the same year there were 164 children under 16 years of age killed by being struck or run over by automobiles and 935 injured from the same cause. There were 77 killed and 171 injured by trolley cars and 110 killed and 249 injured by wagons, a total of 351 children under 16 years of age killed and 1,355 injured in one year in only two States of the Union on account of being struck or run over by vehicles while playing upon or crossing public streets or highways.

D. INTESTINAL PARASITES AND THE RURAL SCHOOL.

JOHN A. FERRELL, M. D.,

Rockefeller Sanitary Commission, Washington, D. C.

Infection by intestinal parasites is world-wide in its distribution. It is most prevalent in the tropical and semitropical countries, where it is a problem of great magnitude. As a factor affecting the life and the health of the people, their physical and mental development, and their material welfare, its importance has not been generally appreciated. In fact, it has not been particularly emphasized by many of our medical colleges and of course not by the physicians they graduated. Yet in the light of the revelations made during the past three or four years by the Rockefeller Sanitary Commission, working in conjunction with boards of health of 11 Southern States, there should be great reform generally in the methods for acquainting both students of medicine and the laity with the essential facts pertaining to this form of infection.

Types of parasites.-During the three and one-half years prior to July 1, 1913, the health agencies above referred to made 665,581 microscopic examinations of specimens of feces for parasitic ova for 665,581 persons; of these 329,578 were found to have hookworm infection and were treated. Private physicians have treated and reported 162,305 additional persons, giving, with those treated by the health agencies, a total of 491,833 treated persons. The hookworm is by far the most common and most important of the intestinal parasites. In 326 counties of the South, infection surveys for hookworm disease have been made. Each survey is based on the microscopic examination of a minimum of 200 country children taken at random, ages 6 and 18 years, inclusive. These surveys indicate that in different counties, varying with their geographical location, the hookworm infection ranges from 1 per cent to as high as 80 or 90 per cent of those examined.

In many localities 80 to 100 per cent of the school children have been found to have the disease and to have made only 50 per cent of the progress made by normal healthy children. In other localities. entire families heavily infected have had their systems so undermined that they were swept away completely, either directly by hookworm disease or by intercurrent diseases like tuberculosis, pneumonia, or typhoid fever, which easily overwhelm the devitalized bodies of hookworm subjects. Routine examinations for a series of graded schools have shown hookworm infection three times more prevalent in the backward sections than in the advance sections for the various grades.

The school in the rural section affords the greatest medium for the spread of the infection. Suppose we take a certain school district in which by chance no infection exists. Now let the son and daughter of Mr. Smith visit Mr. Jones, who lives in a district where there is much hookworm disease. While there, fruit of some kind is picked up from the ground by the Smiths and eaten, and perhaps in going barefooted "ground itch," the beginning of skin infection, is contracted. The visit over, the Smiths return home. Having no sanitary privy on their premises, the soil around their house is soon polluted, so that one by one the whole Smith family becomes infected in varying degrees of severity. Fall comes, and the neighborhood school opens. The Smith children may by this time be a little pale and puny from the disease, but they start to school. The school may be in a progressive neighborhood; it may be painted and furnished with patent desks, and perhaps it has secured a creditable library. Good heaters have been provided, the light comes from the rear and over the left shoulders of the pupils. Perhaps there is a driven well to supply water, but there will be no individual drinking cups, and this is not the worst of it. No privy has been provided; but why should there be? The pupils, not having one at home, do not think of having one at school, especially since the woods and undergrowth are near the schoolhouse. The girls, by custom, conceal themselves when answering nature's call in the woods on the east side and the boys on the west. The Smith children do not know they are infected. They use the common hiding grounds with the other children. Soon the whole school grounds are so heavily polluted that on damp days every pupil who goes around barefooted will contract "ground itch." and, moreover, those who play ball. marbles, mumble-the-peg, etc.. get their hands infected. Facilities for washing the hands are not available; so at lunch time they handle their food with soiled hands which are likely to be contaminated. In this way the pupils at school become infected. In a comparatively short time the premises around the homes of all the school children are polluted, and you have a change which anemia produces coming over the community. Progress of the children in the school is retarded; the daily attendance is poor; the health of the community is below normal; the crops are not so well cultivated; and there is a general backward tendency. The houses are not so well provided for or kept. The whole community is sick and doesn't know it. The economic loss is tremendous. Delay in establishing control of infection spread by such filthy habits is criminal, once the facts are known. The victims are ignorant of the facts. Teaching them is a duty of every informed citizen, board of health, and physician; yet these agencies are not sufficient to reach the masses.

The common schools through the school children can reach practically every home. Hence, an important part of this work should be directed to the teaching of sanitation, dealing particularly with parasitic intestinal infection and other infections spread by soil pollution. The school should be an institution where methods are taught for saving and preserving the child, for making him a healthy educable child, one who will bless the State with the highest type of citizenship. May we not hasten a reform which will make the school a place where the teachings of sanitation are put into practice and not a center for exchanging and spreading all kinds of filth-borne diseases?