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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 natures 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 liands infected. Facilities for washing the liands 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 coining 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?





Boston, Mass.—The division of child hj'giene is concerned with the physical welfare of every child in Boston from the time of conception up to the age of 16 years. The work of this division is classified into three subdivisions, as follows: (1) Prenatal and postnatal; (2) medical inspection of schools; (3) physical examination «f licensed minors.

Physical examination of school children for the year 1912-13 showed the following results:

Total number of pupils examined 121,832

Totnl number of pupils without defects 52.499

Total number of pupils with defects 69,333

The defects noted were: Mental deficiency, 391: defective nasal breathing, 9,174; hypertrophied tonsils, 24,720; defective teeth, 00,709; defective palate, 300; cervical glands, 11,370; pulmonary disease—tuberculous 66, nonttiberculous 1,165; cardiac disease, 2,796; nervous disease, 303; orthopedic defect—tuberculous 103, nonttiberculous 3,1.54; skin disease, 3,768; rickets, 644: malnutrition, 2,620.

Buffalo, IV. Y.—Medical school inspection in Buffalo is divided into four general divisions: (1) Prevention of communicable diseases; (2) detection and removal of physical defects; (3) child psychophysiology; (4) sanitary condition of the school buildings and environments. 94

The following is a resume of some of the work:

Report of medical school examiner, year IS1Z.

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Cincinnati, Ohio.—The bureau of medical inspection and relief is organized with the following officers: Chief school inspector, with a salary of $1,800; 16 district physicians, 11 on full time and 5 on part time, to whom a total salary of $18,275 is paid: 14 school nurses, $10,920; 1 chief dental inspector, $1,500: 4 dental operators (part time), $2,000; 2 clinical assistants, $1,100: 1 clerk, infectious diseases, $1,000; 1 clerk, tuberculosis records, $S00; fumigator, $900: 1 chief medical inspector and assistant health officer, $2,750. Their functions are: School inspection, medical relief of the poor, surveillance of infectious diseases.

The hours of medical inspection are 9-12 a. m., 2-3 p. m. Twentytwo public schools and 35 parochial schools, a total of 57, have medical inspection only, without the school nurse. In 43 public schools and 12 parochial, a total of 55 schools, both doctors and nurses are employed. The average number of pupils for each nurse is 2.350.

During the period from September 10, 1912 to June 19, 1913, the

school doctor handled the following cases:

Excluded on account of Infection disease or contact 113

Inspected after 4 days' absence 6, 331

Examined but not needing treatment 13, 537

Received for treatment 14. 679

Total number of examinations of children 35. 57$

Tn the same period the school nurses' activities were as follows:

Number of cases referred to nurses 8. 874

Treated by family physician 1.985

Treated by clinics and hospitals 2.002

Pediculosis and minor cases treated by nurses 2, 811

13011"—13 7

Cases refused treatment and pending 1,076

School treatments given 8,053

Home visits 4. 731

"The nurse is the connecting link between school and home." A survey of 36,438 pupils in public schools, April 21 to June 6, 1913, showed:

Number. Per cent.

Tuberculous 84 0,23

Pretuberculous 505 1.38

Anemic simply 1.030 2.83

Total anemic 1, 61!> 4.44

Mentally retarded 657 1. 80

This is urged as an argument for (1) more open-air schools and low-temperature rooms: (2) new school for mentally deficient children.

Among defects diagnosed by school physician were: Defective vision, 2,135: diseases of the eye, 298. Of these, 1,092. or 44.9 per cent, were corrected by glasses and treatment. Hypertrophied tonsils, 2,692 cases noted, operative, 642; medical, 650, a total of 1.292. or 48 per cent treated. Defective teeth, exclusive of dental inspection, 1,754; cases finished. 1.002, or 57 per cent. Medical and surgical miscellaneous, 1,996; treated, 1,501, or 75 per cent. Children inoculated against smallpox. September 10. 1912, to June 19, 1913, 4.686; of these 97.3 per cent were successful, 52 were unsuccessful, and 76 unknown.

Detroit, Mich.—Results of medical inspection of schools, September, 1912, to June, 1913:

Number of pupils examined 95.542

Number of pupils excluded 4, 752

Number of pupils vaccinated 6,400

Number of defects found 0, 002

Nurses' visits to homes 7.081

Nurses' visits to schools 4.193

Nurses' visits to dispensaries 432

Total visits 11. 700

Attendance at school clinics 27. 22S

Children treated at home 252

Children treated at dispensaries 1.03S

Instruction to mothers 5, 34S

Eight nurses were employed at a total expense of $4,800, and 33 doctors ($11,500), or a total cost of $16,350.

Jacksonville. Fla.—Medical inspection of school children in Jacksonville, Fla., showed that 77.1 per cent of all the children examined were defective in one or more particulars. The following arc the

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