Reprinted. Russell Sage foundation. Department of child hygiene. No. 41.

The interrelation of physical defects as discovered by medical inspection, and retardation of school children as found in statistical studies of Camden, N. J., New York City, and Philadelphia.

"In the two Philadelphia examinations the percentage of defectiveness among 'exempt' and 'nonexempt' children is very similar. The Camden investigation showed very little difference as regards vision and hearing between retarded children and those of normal age. The New York examinations showed that the retarded children have on the whole fewer defects than those of normal age, but it goes farther than this. It establishes the important principle that, except in the cases of vision, older children have fewer defects, and . . . that when children who are badly retarded are compared with normal children and very bright children in the same age groups so that the diminishing of defects through advancing age does not enter as a factor, the children rated as 'dull' are found to have somewhat higher percentages of each sort of defect than the normal and bright children. Here again defective vision must be excepted.

'Physical defectiveness does have a bearing on the progress of children, but . . . physical defects constitue a cause, not the cause of retardation."

CLAPP, Raymond G. How can our physical examinations be made more effective? Hygiene and physical education, 1 : 76–78, 370-72, April, June 1909.

"I have come to the conclusion that a medical examination should be required annually of every college student; that medical consultation and advice should be free to all students; that the health of the general student body should be protected by the early determination and proper control of all cases of venereal disease, tuberculosis, and other infectious diseases; that each student should be carefully watched to see that he does not impair his health by overwork; that there should be practically no medical or surgical treatment given which will arouse outside antagonism; and that all this supervision should be made by the department of physical education."

Conference on "Diseases among school children, and the remedy."

and surgical journal, 166 : 621-27, April 25, 1912.

Boston medical

Diseases of the mouth, throat, and chest, by Richard C. Cabot; Malnutrition, by George S. C. Badger; Diseases of the skin, by C. Morton Smith; Orthopedic defects and rickets, by Joel E. Goldthwait; Nervous and mental disorders in the schools, by Arthur Willard Fairbanks.

From Sep

Conditions in Boston: Approximately 4,000 school children suffering from malnutrition. tember 13 to December 31, complete physical examinations were made in the schools, and 11,691 children with skin diseases were found.

Papers read under the auspices of the Boston association for the relief and control of tuberculosis, January 31, 1912.

COPLAN, M. Medical inspection of our public schools.

August 1911.

Pediatrics, 23: 465-74,

References: p. 473-74. Also in Ohio medical journal, 7: 443-47, September 1911. Emphasizes the need for the proper teaching of sex hygiene in the public schools. "The medical inspector should be one of the instructors, or have the supervising of the instruction of the hygiene of the sex in the public school. The medical inspector should instruct the boys and the nurse the girls." CORNELL, Walter Stewart. Health and medical inspection of school children Philadelphia, F. A. Davis co., publishers, 1912. illus. figs.

tables. 8°.

CONTENTS. I. Medical inspection. II. Hygiene. III. Defects and diseases (the eye; the nose and throat; the ear; the teeth; the nervous system; mental deficiency; the skeleton; nutrition; the skin; speech; infectious diseases; prevalence of defects and diseases).

"The aim is to present a practical exposition of the work of medical inspection, born of the examination of some 35,000 children, and to give to physicians and teachers a survey of medical practice as it relates to children of school age. A review of the work of medical inspection in different localities is not attempted." (Preface)

DAVISON, Alvin. Medical inspection of schools.

57: 471-75, May 1909.

Pennsylvania school journal,

Reprinted in Pennsylvania State educational association. Department of city and borough super intendents. Proceedings, 1909. p. 13-16.

Statistical résumé of work and defectives found.

"The benefits, then, to be derived from the medical inspection of school children are a saving of many thousands of dollars spent in instructing backward pupils, the prevention of much sickness and suffering, the warding off of a considerable amount of early death, and the remedying of numerous defects in childhood which are certain to limit the usefulness of the future citizen, and in a considerable number of instances make him an object of charity, and sometimes even a criminal.

"If medical inspection is to prevail it should be made as efficient as possible. With the results of the experience of others, the opinion must be upheld that both kinds of inspection should be undertaken,

the one for the detection of contagious diseases, the other for physical defects. The work relative to contagious diseases should either be related to or under the direction of the board of health, while the physical examination should be directed by the school authorities."

DIXON, Samuel C. The object to be obtained by the medical inspection of school children. Harrisburg, Pa. [1910] 9 p. 8°. (Pennsylvania health bulletin, no. 8, February 1910)

Résumé of medical inspection in various cities:

"The first day that medical inspection went into effect in New York, 140 children were found to be ill with dangerous contagious diseases, contagious skin diseases, or parasites.

"In Boston during the first four months, 5,825 pupils were found to be sick, of whom 1,035 needed to be sent immediately home. Of these, 286 were capable of spreading the disease from which they were suffering.... The New York report for the year 1905 presents the following: Number of [examinations of] children, 16,285,435; children excluded, 1 18,844."

"In the annual report for 1905 of the board of health of Philadelphia the number of pupils referred to inspectors by principals for examination, 74,524; the number of individual examinations was 141,303; the number excluded from school was 7,598; the number of pupils found to be requiring medical care, but not needing to be excluded from school, was 27,481.

"In the city of Chicago, during a period of four months, 233 schools were visited with the result that 1,417 cases of diphtheria and 306 cases of scarlet fever were discovered in actual attendance on school.

"In the city of New York trachoma was known to prevail. The report showed that 17 per cent of all the school children were suffering from this affection and it was found necessary to open a special hospital for the treatment of this disease alone in the year 1903."

The number of cases treated by operation was 4,337; treated without operation, 11,599.

"In 1900 the deaths from [diphtheria] in the United States were 16,475, the great majority of whom were school children. In Chicago, medical inspection was instituted in 1900. During the year preceding 3,931 cases of that disease had occurred, of which 843 were fatal. During 1900 the number of cases fell to 3,303, a decrease of 628, and the number of deaths was reduced to 797.

"One most important result of inspection is the discovery of unreported cases of contagious disease at the homes. In Chicago 744 cases of diphtheria discovered in schools brought to light 2,619 cases at home, while 231 cases of scarlet fever discovered by the school inspectors disclosed 745 cases at home. "In Terre Haute, Ind., out of 491 children examined 125 were found defective in hearing, and yet only 3 had been so recognized by their teachers.

"In the year 1906, out of 9,258 deaths from pulmonary tuberculosis in this State [Pennsylvania], 1,456 were of persons under 20. Of children over five and under nine, 39 died of that disease, of those between nine and fourteen, 166, and of those between fourteen and nineteen, 784.

"The investigations of our county medical inspectors and health officers [in Pennsylvania] soon developed the fact that throughout our rural districts the excellent laws which the legislators had provided for the construction and management of schools in the interest of the protection of the health of our school children" were not observed, and in 1908 the department inaugurated a system of sanitary inspection of school buildings through its health officers.

"On careful deliberation it has been decided therefore to place the supervision of the whole system of school inspection in the hands of the county medical inspectors, including both sanitary inspection of buildings and grounds, and medical examination of the children . . . and only physicians are to be entrusted with it.

"The reports of inspection are made on score cards. One of these is marked 'Sanitary Inspection,' the other 'Physical record. On the first is recorded the sanitary condition of the schoolrooms, grounds and outbuildings including provisions for light, heat, ventilation, water supply, and sanitary conveniences. On the second the age and sex of the pupil, the condition of sight, hearing respiration, skin, teeth, cervical glands, contagious diseases, pulmonary tuberculosis, and deformities." DOWLING, Oscar. Value of medical inspection for schools and school children. In Southern commercial congress. Proceedings, Third annual convention, 1911. p. 334-50.

A general résumé of statistical information from various medical inspection reports of leading American cities.

DRESSLAR, Fletcher Bascom. The duty of the State in the medical inspection of schools; results which the public may rightfully expect. In National education association. Journal of proceedings and addresses, 1912. Published by the association, 1912; and in U. S. Bureau of education. Current educational topics no. 3. p. 5-13. (Bulletin no. 24, 1912)

1 See New York City. City superintendent of schools. Seventh annual report July 31, 1905. p. 502. (Report of Dr. Thomas Darlington, commissioner of health)

year ending

Recent books on medical inspection of school children: p. 13.

Medical inspection must include the following points:

"1. It ought to serve as an efficient means of preventing the spread of contagious diseases. This will necessitate a careful examination of all children, especially at the beginning of the school terms, in order both to exclude children who are suffering from contagious or parasitic diseases and those 'carriers' who are a menace to others, even though they themselves show no decided effects of the diseases they are capable of disseminating.

"2. Medical inspection ought to emphasize in a decided way the especial significance of hygienic conditions in schools; it is far more important to furnish conditions which promote the health and development of well children than it is to make special efforts to care for those who are sick or defective, especially where these defects have been largely induced through neglect.

"3. Health officers must know more about education, more about the hygiene of teaching, more about the normal demands of child life; they must possess more ability to work with teachers and the people for the general welfare of the community. A large majority of physicians, those who would not hesitate to undertake the work of supervising the health interests centered in our public schools, are wholly unfit for the place because they know next to nothing of the ideals and methods of modern education, and they are ignorant of their own ignorance. The best results can not obtain under such conditions.

"4. We need doctors of health, who will be more delighted in exhibiting a large list of healthy, welldeveloped children than a long list of those who are physically defective and diseased; they must be able to see defects and diagnose correctly, but their chief emphasis should be in preventive measures." FERRELL, John A. The medical inspection of schools and school children. North Carolina. State board of health. Bulletin, 27: 91-110, June 1912. illus. tables.

map.

Reprinted as Public school health bulletin no. 4. Raleigh, Issued from office of superintendent of public instruction of North Carolina, 1912.

In the following résumé of medical inspection and its needs, Dr. Ferrell dwells chiefly upon the need for sanitation and the wide prevalence of hookworm disease in North Carolina. "We know," he writes, "that the disease prevails in 99 of the 100 counties of the State. In determining its frequency by counties we microscopically examine not less than 200 rural school children ages 6 and 18, inclusive taken at random in each county. The surveys are complete in 29 counties and partially complete in other counties to a degree sufficient to justify the map.

"Can we neglect to have the simple examination made and the treatment administered; knowing that by it more than one-fourth of all our girls and boys are being stunted in their bodies, dulled in their minds, robbed of their vitality, rendered backward in their work, and started on a road which will lead them to death, invalidism, or perhaps to prisons?"

GIVENS, Amos J. The prevention of nervous and mental diseases through medical inspection of schools. North American journal of homoeopathy, 26: 291-301, May 1911.

Reprinted. Stamford, Conn., 1911.

The need is for immediate action, in order that medical supervision shall go "as far beyond the detection of physical defects as that detection is an advance beyond the mere search for contagious and infectious diseases. An extension which shall secure for children from all classes of society the beneficent determination of temperamental and constitutional conditions, of mental capacity, of the soundness or unsoundness of the nervous system-an estimation and valuation by the medical inspector not only as a pathologist, but also as a psychologist."

GULICK, Luther Halsey. The importance of medical inspection of schools. School progress (Trenton) 1: 20-23, December 1909.

Each school district should have an inspector. The cleanliness, ventilation, water supply, closet, the accumulation of dust, the examination of children's eyes, throats, noses, ears, and skin, their general physical make-up, should be gone into. The inspector should have authority to exclude from school, and to take such steps as he judges necessary to prevent spread of communicable diseases.

"Growth is more necessary than education. There is not a school board in America that systematically weighs and measures its children to ascertain whether or not they are growing normally, and if not to readjust the mental task to meet these physiological conditions; the courses of study are constructed without the guidance of any data based on any careful investigation of these vital matters. We must develop within our boards of education power to see that the fundamental principle of human life-health-is properly guarded. Until these things are done it will be impossible to contribute anything of permanent value to physical development."

GULICK, Luther Halsey and AYRES, Leonard Porter. Medical inspection of schools. [4th ed., rev.] New York, Survey associates, inc., 1913. 224 p. illus. 8. (Russell Sage foundation)

Bibliography: p. 203-206.

Text of earlier book has been entirely rewritten, and material and forms brought down to date. GULICK, Luther Halsey and AYRES, Leonard Porter. Medical inspection of schools. [4th ed., rev. and reprinted, January 1913] New York, Survey associates etc., 1913. 224 p. illus. tables. charts. map. 8°.

Bibliography: p. 203–206.

Fer capita costs and salaries, p. 101-13 (places by name). Legal provisions, p. 165–80. Inspection by physicians for contagious diseases costs about 10 cents per child per year; for contagious diseases and examinations for detection of physical defects average about 25 cents per child per year; where school nurses are employed, the average cost is about 30 cents per child per year. In cities having relatively efficient systems, the number of defective pupils receiving remedial treatment as a result of the examinations is from about 10 to 50 per cent.

At the beginning of year 1911, there were 415 school nurses employed in 102 municipalities. In 1912, Minnesota, Massachusetts, Pennsylvania, Rhode Island, New Jersey, West Virginia, Louisiana. Colorado, Utah, and the District of Columbia had mandatory medical inspection laws; California, Washington, North Dakota, Indiana, Ohio, Virginia, New York, Connecticut, Vermont, and Maine had permissive laws, and the remaining States had no laws. Dental inspection is carried on in nearly 200 cities.

HARTMAN, Lawton M. The problem of the public school from the medical point of view: The studies and their effects on the nervous system. Pennsylvania medical journal, 13: 581-88, May 1910. tables.

The author gives a general résumé of various writers' work and findings, substantially as follows: 1. That the subject of nervous diseases among the school children has, up to this time, not received sufficient attention by the inspectors of any prevailing systems of medical inspection of the public schools; that this subject is being recognized as of the utmost importance from the standpoint of the physical and mental development of the country's youth.

2. That there is now no definite knowledge of the part played by any particular study or group of studies or any school occupation in the development of nervous affections among the school children. 3. That there is a large and varied group of nervous manifestations, shown as definite and distinct alterations from the normal mental and physical state, occurring among school children.

4. That before the age of puberty overwork at school is of much less importance as a factor in the causation of nervous disorders.

5. That after the age of puberty, especially among girls, overwork at school plays a much more definite part in producing affections of the nervous system.

6. That the importance of medical inspection of the schools is becoming universally recognized. 7. That proper and broader legislation should be urged for the legal support of more general, more accurate and more powerful medical inspection of schools.

8. That more general establishment of child-study departments should be strongly encouraged and urged.

9. That there should be greater cooperation between educators and physicians for maintaining a better standard of health among the school children.

10. That the individual management of those pupils who may be affected with some nervous disorders is the only rational way of providing for the proper and continued education and supervision of the health of the school youth.

HERBST, H. Herbert. Medical oversight of public schools. Pennsylvania medical journal, 13: 592-602, May 1910.

Bibliography: p. 602.

General résumé of reports made.

HILL, David Spence. First measures needed for child welfare upon the part of municipal and educational authorities in the South. Southern medical journal, n. s., 3: 99–104, January 1911.

1. The compulsory medical inspection of all school children and schoolhouses.

2. Bureaus of research.

"These two fundamental measures would not produce an immediate cure-all for the sins against the children. But adopted, they might mean the application of the scientific method to the root of some of our troubles; the health, efficiency, and happiness of millions of children in the South."

HINES, Linnaeus Neal. A study in retardation. In American school hygiene association. Proceedings, 1912. Springfield [Mass.] American physical education review, 1912. p. 53-56.

Also in Journal of education, 75: 460-61, April 25, 1912.

An investigation of retardation in the Crawfordsville, Ind., schools, conducted with 1,229 grade pupils as the subjects; of these 605 boys and 624 girls, 114 boys and 93 girls came under the retarded classification.

Physical causes, general bad health, anæmia, etc..

Lacking mental ability to do the minimum amount of work required..
Home and outside environment..

In the

Of the 1,229 children, "887 belonged to the good health class and 342 to the poor health class. same body of pupils, only 207 are retarded, and of the retarded pupils, only 63 belong to the poor health class. The poor health pupils constitute 27.8 per cent of the entire number, 1,229 or 27.2 per cent of the nonretarded pupils come in the poor health class and . . . only 30.4 per cent of the retarded pupils are in the poor health classification. Of the nonretarded pupils, 279 are in poor health or need medical attention. The term 'poor health' [includes] poor eyesight, defective hearing, or other similar troubles. "It may be safely stated that from 70 to 80 per cent of school children have some defect. "What, then, can be done about the matter. Employ school doctors and school nurses, Improve the home conditions where possible, better the conditions in the schoolroom and on the playground. . . . If every pupil did his work in the open air all the time, if the school gave him a bath whenever he needed it, if the school kept him properly fed, if the school through the doctor and the nurse sought to remedy his defects, conditions would be changed for the better. . . . The demand is insistent that the school shall take up this burden for society. The school will answer the call by assuming a responsibility for the physical welfare of the child as well as for his mental and moral welfare." HOAG, Ernest Bryant. The teacher's relation to health supervision in schools. American academy of medicine. Bulletin, 13: 127-34, June 1912.

Reprinted in American academy of medicine. Conservation of school children.

"(1) Every teacher before certification should be obliged to give evidence of practical elementary knowledge of the functions of the body.

"(2) Every such teacher should be obliged to give evidence of practical knowledge of those ordinary physical defects of children in the schools, which interfere with school progress.

"(3) Every normal school and teachers' college should provide adequate instruction in the lines indicated above. Very few of them now do so, although when questioned most of them answer in the affirmative, regarding certain traditional courses in biology and physiology as covering the requirement, a supposition which the facts prove almost entirely unwarranted.

"(4) Teachers who are without experience in child hygiene but who are already certificated, should be instructed by properly qualified specialists in this subject.

"(5) Physical educators must receive this special training in addition to that which they ordinarily acquire in their courses and with it their efforts will prove particularly valuable in this new sort of health supervision."

The writer gives an outline for the health grading of the school child, to be made by the teacher at the beginning of the term. It embodies the following general heads: (a) General appearance; (b) mental conditions; (e) nervous conditions; (d) teeth; (e) nose and throat; (f) ears; (g) eyes; (h) communicable diseases of the skin; (i) eruptive diseases.

"When the outline is properly filled out," says Mr. Hoag, "the teachers will be surprised with the information it develops on points often unsuspected. As a preliminary test before the arrival of the school medical officer or nurse, it will furnish invaluable aid."

Medical and physical examination of school children.
Quarterly publications, 12: 558-65, June 1911.

HOFFMAN, Frederick L. American statistical association. tables.

"It would pay the community to reduce absence and retardation to a minimum by intelligent medical and physical inspection of school children and to employ methods of sanitary control. . . . We require to know the amount of floor space per pupil as well as the amount of cubic space. . . . We require more accurate and conclusive statistics on the question as to whether there is a direct relationship between school attendance and epidemic outbreaks of acute infectious diseases. . . . We require to know more definitely the actual temperature and air conditions in schoolrooms during the winter months. . . . We need better mortality statistics of children at school, thoroughly analyzed according to causes and circumstances to determine the extent to which deaths from diphtheria, scarlet fever, and whooping cough are directly traceable to school infection."