II. THE SCHOOL NURSE.

Buffalo, N. Y.-School nurses in 1912 made 1,703 school visits and 2.014 home visits, of which 600 were to contagious and 1,414 to noncontagious cases. Total inspections were 19.411.

Treatment or instruction was given as follows: Pediculosis, 1,364 cases; ringworm. 40; favus, 13; scabies, 184; impetigo, 470; skin, 1,201; eyes, 1,398; ears, 564; vaccinations, 379; miscellaneous, 2,381; dispensary, 43.

Philadelphia, Pa.-The bureau of health of Philadelphia shows the direct value of the school nurse service by comparing conditions with and without nurses. A saving of nearly five days is obtained on every case of contagious disease by means of the school nurse service. The statistics show that the average number of days lost by school children when the schools are without school nurse service is 5.06458. The average number of days lost when the schools have nurse service is found to be 0.34268. Lack of nurse service is therefore responsible for 4.72191 days of preventable loss. Multiplying 4.72191 (preventable) loss (average days) by 16,884 cases of minor contagious diseases handled by school nurses gives 79,725 total days of school time saved to these school pupils through nurse service. The per capita cost of education in Philadelphia is 183 cents, so that $9,122.05 is saved to the educational system through this one branch alone of the school nurses' activity. The total cost of school nurse service from February, 1912, to June, 1913, was $25,760. The nurses were employed in the congested districts of the city.

Another proof of the importance of the school nurse is found in the follow-up results. Irrespective of social grade, more physical defects are corrected with nurse than without. Four groups were studied: In group white, native, social grade A, 43 per cent of defects were corrected with nurse, as compared with 36 per cent when no nurse was employed. In group white, grade B, 50 per cent were corrected with a nurse, and 43 per cent without. In white, grade C, 50 per cent were corrected when a nurse was employed, whereas only 18 per cent were corrected when there was no nurse. In colored, grade C, 63 per cent of defects noted were corrected with the nurse, as against 22 per cent without a nurse.

Rochester, N. Y.-School nurses in Rochester paid 1,269 visits to homes; took 853 cases to dispensaries and hospitals; cared for 1.906 defects; found 306 defects of eyes; 461 of ears, nose, and throat; 273 of teeth; 267 skin diseases; 413 miscellaneous defects.

III. ORAL HYGIENE.

Connecticut.-In Hartford there are free dental clinics for school children supported by the Hartford dental society. In Waterbury there are two dental inspectors, salary $600, paid by the city. In Bridgeport the city appropriates $500 for the dental clinic of the Bridgeport dental society. New London has a dental clinic equipped by the board of education and maintained by the New London dental society. Other Connecticut towns report as follows: Stratfordexamination by an individual dentist, but no town appropriation; New Britain-examination of the children by the New Britain dental society; Greenwich-clinic established by the United Workers; New Haven-room secured in a school building for a privately supported clinic; Meriden-school children examined by the Meriden dental society, but no appropriation.

Kentucky.-Dental inspection and clinics in 17 communities throughout the State.

New York.-The State department of health is conducting an active oral hygiene campaign by means of elaborate exhibit material, which includes a model clinic.

Pennsylvania.-Thirteen free dental dispensaries are in operation. Besides the 5 in Philadelphia, there are 2 each at Pittsburgh and Wilkes-Barre, and 1 in each of the following cities: Scranton, Philipsburg, Reading, Chester.

Boston, Mass.-The Forsyth Dental Infirmary, Boston's answer to the oral hygiene problem, is to be opened in 1914. Its work will be to care for the mouth conditions of all the children of Greater Boston up to 16 years of age. Attention will be given to adenoids, hair lip, tonsils in short, the whole subject of mouth, nose, and throat. Follow-up work will be done by the school nurse and social secretary. Patients will be required to return to the infirmary three or four times a year for examination, treatment, and advice. The institution will have facilities for 64 chairs, with room for 44 additional; each chair having a capacity of 12 patients per 8-hour day, or a total capacity of 768 patients daily. There will be a lecture room for public lectures on hygiene and oral prophylaxis.

Cincinnati, Ohio.-Mouth hygiene is supervised in Cincinnati through a cooperative arrangement between the Cincinnati dental society and the board of health. The board of health provides 1 chief dental inspector, 4 dental operators, and 2 clinical assistants. The dental society furnishes 56 dental inspectors and 39 lay volunteers. The number of children examined in different years was: 920 in 1909; 4.594 in 1910; 8,432 in 1911; and 12,660 in 1912.

Cleveland, Ohio.-In 1910-11 Cleveland was the scene of the national mouth-hygiene campaign. The National Dental Association supplied equipment for clinics, a trained nurse and finances for the Marion School class. The Ohio State Dental Association paid for the printing and furnished the use of a stereopticon. The Cleveland dental society furnished the examining clinicians and lecturers. Rooms were furnished by the Cleveland board of education, by the library, and by St. Alexis Hospital. The campaign had for its object:

To bring to the attention of the people, by means of dental inspection of an adequate number of children, the universal need of dental service; to show by means of clinics that there is a great demand for dental service by indigent children; to present to the people by means of lectures the great value of mouth hygiene in the general welfare of the child; to show by means of the Marion School class the results possible to be obtained from an ideal method of instruction in the care and use of the mouth, accompanied by the correction of the faulty oral condition.

As a result of this campaign, 20,861 pupils were examined. The mouths of 97 per cent were found faulty. The six clinics were operated for a total of 334 half-days; 372 patients were treated; 2,217 operations were performed; and 49 lectures were delivered at the various school auditoriums to parents of the older grade pupils.

From a school of 846 pupils there were selected 40 children presenting the most faulty oral conditions, 27 of whom acquiesced in the plan, followed instruction, and took the tests. The children were

each given a toothbrush, tooth powder, and a drinking glass. A dental nurse trained them to clean properly the teeth and mouth and visited their homes to see that the instructions were carried out. The children were given special instruction in the use of the mouth in the home and by specimen meals in school. The faulty oral conditions were corrected in the clinics. Psychological tests under an expert demonstrated the mental as well as physical improvement due to remedying bad mouth conditions.

Detroit, Mich.-An appropriation of $5,000 was allowed for dental inspection and clinics from September 1, 1912 to July 1, 1913. Four dentists examined 50,000 pupils; 12,000 patients were treated in five clinics; and there were 40 lantern-slide lectures in school.

For the year 1913-14, $8,000 has been appropriated. There will be six inspectors and seven clinics, and twice as many lectures on mouth hygiene as last year.

Los Angeles, Cal.-The board of education has now taken over the dental clinic formerly maintained by the Los Angeles parent-teacher association and the county dental society. During the past year (1912-13) there were two full-time operators; 1,434 patients were treated.

Philadelphia, Pa.-The city maintains a complete system of dental inspection and clinics as a separate division under the bureau of health. The work was organized in the fall of 1910 on a volunteer basis, and remained so for one year, the city supplying the offices in city hall and equipment for three chairs and one nurse. In January, 1912, eight paid dentists were engaged. In February, 1912, the first school branch opened. In December, 1912, four additional assistants and one chief were engaged, and in 1913 two additional school branches were opened. The appropriation for 1913 provides as follows:

Twelve operators, each serving three hours per day, at $700_
Equipment for two schools__.

Maintenance

Nurse at central office....

Chief of division_.

$8.400

1.200

500

800

2,500

The school board at present bears no expense except plumbing and electric current.

The work of one of the clinics from January 1 to June 30, 1913:

Girard College has a department of dental surgery, recently organized, which has for its sole object and aim the care of the teeth of the boys in Girard College. The department is under the care of a dentist in chief, two assistant dentists, and a clerical and mechanical assistant, all of whom are employed full time.

Rochester, N. Y.-A free dental clinic, claimed to be the first in the world, was established in Rochester more than 25 years ago. It was closed after two years for lack of support. The first American school dental dispensary was established in Rochester in 1905 by the Rochester Dental Society. Dental dispensaries are now operated in schools Nos. 26, 12, and 14. In 1912, 2,104 patients were treated, involving 11,137 operations. The total cost was $2,461.16, or $1.12 for each child.

Toronto, Canada.-Lee School, of Toronto, claims the distinction of having pupils absolutely without a carious tooth or an unclean mouth. The pupils are all from the Girls' Home, where daily care of the teeth is part of the routine.

Relation of dental hygiene to mental efficiency.-Dr. J. E. W. Wallin has measured with selected test materials the increased mental efficiency of children whose oral defects have been remedied. In memorizing 3-place digits there was an average gain in those under observation of 19 per cent in efficiency; in the spontaneous association test the average efficiency gain was 42 per cent; in adding 1-place digits, 35 per cent; in the antonym test, 129 per cent; and in the test of canceling a's there was an average gain due to dental improvement of 60 per cent.

IV. OPEN-AIR SCHOOLS.

Horace Mann School, New York, N. Y.-Two third-grade classes, as similar as it was possible to have them, were compared for a period of six months. One class was an outdoor class, the other a regular indoor class. The two classes were compared in respect both to physical improvement and mental improvement, with the following results:

Physical improvement,