teachers in the schools report for examination when requested by the superintendent's office. Sirth—--Especial examination is given to exceptional children. Seventh-School buildings are inspected by the staff. Eighth Follow-up-work is carried on by the staff, by principals and teachers of the schools. The following is a summary of examinations of Los Angeles city schools:

1,112 to be watched by teachers and examined further if pupil's health or school work indicates further examination.

Number defective in hearing......
Notices sent to parents....

862

175

Most of the defective hearing is due to adenoids and diseased tonsils and lack of care of the nose and throat. For this reason special notices of defective hearing were not sent to parents where the cause was otherwise clearly indicated.

652 to be watched by teachers and reëxamined if defective hearing or lowered vitality indicate such examination.

Report of physical examinations of pupils, selected by teachers and examiners, because the need of examination was indicated by poor health, lowered vitality, or poor school work-all pupils undergoing the physical examination by examining staff. Notices sent to parents in almost all cases.

The above pupils were pupils especially selected from different buildings, or pupils of ungraded rooms, or of the special schools, or of the deaf school, or office examinations.

Total number examined for the year, 7,776.

Report of defective growth and vitality and school work accompanying these defective pupils is hard to make. It is mostly measured by the number of repeaters in the schools, by considerable sickness and disease, and by more or less inefficiency and degeneracy.

Sooner or later the main data which enter into the intelligent handling of pupils must depend to a greater or less degree upon physiological age, the physical and mental endurance of children and youths; the character and kind of work should be adjusted primarily to physiological, not chronological age.

82883-13-5

OAKLAND.

Oakland. [Superintendent of schools] The Department of health development and sanitation. In his Annual report, 1909-1910. p. 61-64. (Director, N. K. Foster) "It was impossible to examine every child; hence only those who were defective enough to be observed by the teacher were examined." Number examined, 1,965; not tabulated, 97.

PAYNE, I. D. [The Palo Alto, California, elementary school children: Physical defects and grade retardation] Psychological clinic, 5: 145-47, October 15, 1911. tables.

Of 467 enrolled, 110 reported as having no physical defect.

"Among the 38 children retarded two or more years there are only three who have no reported physical defects. . . . Four are confirmed cigarette smokers. . . . Twenty-six have one or more serious physical defects."

PASADENA.

HOAG, Ernest Bryant. Some new problems in school hygiene. In American school hygiene association. Proceedings, 1912. Springfield [Mass.] American physical education review, 1912. p. 205-208.

In the schools of Pasadena, California.

"The plan consists or two parts or features: 1. A scheme for a partial health survey to be made by the pupils themselves. 2. A scheme for a more extensive health survey on the part of the teachers. "The questions given . . . in the sixth, seventh and eighth grades with a general summary of the answers: 1. Have you ever had much sickness? Yes, 88. 2. Are you feeling we now? No, 9. 3. Do you eat lunch every day? No, 8. 4. Do you eat lunch at school? Yes, 79. 5. Do you drink coffee? Yes, 128. 6. Do you drink tea? Yes, 125. 7. Do you have a ventilated bedroom (open window)? Yes, 263. 8. Have you ever been to a dentist? No, 71. 9. Do you ever use a toothbrush? No, 53. 10. Do your eyes smart in school? Yes, 57. 11. Do they trouble you in any other way? Yes, 71. 12. Can you read writing on the black board easily from your seat? No, 39. 13. Do you often have headache? Yes, 65. 14. Do you notice any blurring of the print? Yes, 50. 15. Do you have earache? Yes, 38. 16. Can you hear the teacher easily? No, 60. 17. Do you tire easily? Yes, 82. 18. Do you work any out of school hours? Yes, 122 (Average 14 hours per day). 19. How much do you study at home? (Average 40 minutes.) 20. Do you take regular exercise? Yes, 238. "Total number of pupils questioned, 270. Average age of pupils in eighth grade, 15 years. Average age of pupils in seventh grade, 14 years Average age of pupils in sixth grade, 141⁄2 years.” Pasadena. [Board of education] Report of medical examiner. report, year ending June 30, 1910. p. 36-38, 41. table. p. 41.

Signed: R. C. Olmstead, M. D.

In its Annual

"Practically every child in the kindergarten and grades receives a physical examination. All high school students receive attention when necessary."

COLORADO.

BATES, Mary Elizabeth. The Colorado method for the examination and care of public school children. In [American academy of medicine] Conservation of school children. Being the papers and discussions of a Conference at Lehigh university, April 3 and 4, 1912 . . . Easton, Pa., Printed for the American academy of medicine, 1912. p. 216-37.

Reprinted.

Requires teacher or principal in every public school, or county superintendent, during the first month of each school year, to test the sight, hearing and breathing of all pupils under his charge; examinations to be made without using drugs or instruments, or coming in contact with said child; and shall keep a record and make written report of such examinations to the State superintendent of public instruction as he may require. Every teacher shall report the mental, moral and physical defectiveness of any child under his supervision, to the principal or county superintendent.

[CALLICOTTE, William Riley] Physical examination required first month [of each school year] Colorado school journal, 27: 25–27, September 1911.

Colorado law:

"It shall be unlawful for any person having the care or custody of any child willfully to cause or permit the life of such child to be endangered, or the health of such child to be injured, or willfully to cause or permit such child to be placed in such a situation that its life or health may be endangered, or in any other manner injure such child."

For violation of this act, a fine of $100 or a three-months imprisonment may be imposed. It is the duty of county and city superintendents to enforce the law for physical examinations and report tho results to the Superintendent of public instruction.

Colorado. State superintendent of public instruction. Physical examination [of school children] In her Report, 1909-1910. Denver, Colorado, The SmithBrooks printing co., State printers, 1910. p. 14-17.

Law enacted by the Seventeenth General Assembly.

In 54 counties complying with the law, 92,427 were examined; 41,546 were found defective, physically, mentally or morally to a degree sufficient to warrant reporting their condition. Defects in sight in 26,978, hearing in 6,155, breathing in 8,045, and other unclassified defects, 21,825. There were 3,071 mental defectives and 746 moral defectives.

WIXSON, Helen Marsh. Health of school-children. In National association for the study and prevention of tuberculosis. Transactions, 1911. Philadelphia, Pa., Press of Wm. F. Fell company, 1911. p. 95-101.

"It is time for us to have a little sane legislation regarding physical examinations in the schoolstime for us to relieve overburdened teachers by giving this work to specialists and trained nurses, and and while about it, why not set up a minimum standard of clothing, cleanliness, nutrition, and education, and if the standard is not maintained by the child, make the parents responsible?"

[COMPILER'S NOTE.-Since medical inspection and care are for those school children whose parents are not able financially or educationally to do these necessary things for these children, how could a "standard" be compelled? Why not say, rather, "make the municipality or State that is able, do these things"]

CONNECTICUT.

GOODENOUGH, Edward Winchester. Some problems connected with the medical inspection in schools. In Connecticut State medical society. Proceedings, 1911. Published by the Society. p. 203-13. table.

In Waterbury, Conn.

Up to 1910, Waterbury had no permanent records of school inspection, either for department of education or department of health.

"My first duty was to observe the heating, ventilation and sanitation of the different school buildings...

"I have attempted to inspect all the children up to and including the fifth grade each month; inspect the grammar grades in some manner each term. . . .

to

"The Waterbury dental society has done . . . an enormous amount of work in tabulating the condition of the children's teeth."

Discussion: p. 214-221.

New Haven. Board of education. Medical inspection. In its Annual report, year ending December 31st, 1910. p. 37-39.

Five school physicians and three school nurses.

Main effort of the physicians is to prevent the development of contagious disease. Whenever a pupil in school appears to the teacher to have symptoms of a contagious disease, the principal immediately summons the school physician. School physicians do not prescribe in any case.

SLOAN, Thomas G. The medical supervision of school children in South Manchester, Conn. Medical record, 82: 339-42, August 24, 1912. tables.

In the fall of 1906, out of over 1,600 school children, 72 were found to be a year or more behind grade, 51 whose backwardness could not be explained; on examination, 50 of the 51 had one or more defects. In 1907, 1,437 were examined for eye defects, and 91 were found needing treatment. In 1908, 204 were examined for nose and throat troubles, 126 found needing operations or treatment. In January 1910, a special examination was made of 1,564 pupils, all who were at that time in attendance; results as follows: Number examined...

1,564

295

113

73

71

62

44

39

15

4

16

In October 1911, 1,739 children were examined and defects found as follows:

Adenoids, tonsils and teeth.

Teeth and markedly enlarged cervical glands.

Enlarged cervical glands.

Miscellaneous.....

The medical inspector is in his office at the school, with the school nurse in attendance at 10 a. m., two mornings a week. All children the teachers think need attention are sent to him. No child he sends home is permitted to attend school until seen by medical examiner.

In 1910-11 South Manchester suffered from a long-lasting epidemic of scarlet fever, starting before the opening of schools in the fall. The time lost by ill children amounted to 3,696 days; excluded children, 4,394 days. Total cost of time lost, about $2,500; with medical inspection cost, etc., and cost to families, total about $15,000. Open-air school was opened January 25, 1911.

Therapeutic value of medical inspection of school children. American medical association. Journal, 55: 596-99, August 13, 1910. tables.

Presents three view-points of the relation of the child to the matter in hand: "(1) Has the child, while in attendance at school, any need of medical supervision? (2) The relation of the child to the community at large. (3) The consideration of the child as an individual" (Kenna, W. Matthew. Regarding medical inspection of school children in New Haven. Table of results, also included in the excerpt given at length in this article).

Table of results of examination of 400 school children, New Haven, Conn. "A" denotes defect present, not requiring treatment; "B," treatment advisable; "C," treatment imperative:

These statistics "have not before been announced," states the writer.

DISTRICT OF COLUMBIA.

MACATEE, H. C. School laggards. Some comments on the local situation. Washington medical annals, 10: 149-59, June 1911. tables (from Ayres, L. P.)

Reprinted.

Conclusions:

"1. The public schools here exhibit the same problems of retardation and elimination as do those of other cities.

"2. The schools here are no better adapted to the average child with the average health history than are those in other cities.

"3. Educators should modify the school course so as to allow for the factor of illness; physicians should endeavor to restore children to the schools as soon as possible so as to avoid elimination from age and grade disparity.

"4. Special schools have been established here for the care of incorrigible and mentally defective children; other special ungraded schools ought to be established to care for normal children during temporary retardation, in order that they may be restored to their grades, and for physically defective children so as to adapt the schooling to the capacity of each child. Such schools should perform the same relative function in the schools as the convalescent hospital is designed to subserve in the care of the sick.

"5. The problems of retardation carry new things for the physician engaged in work among children to know.

"6. Adequate medical inspection is essential to the reduction of retardation in healthy children and in physically defective ones.

"*7. Medical inspection as now provided is inadequate.

"8. School nurses are indispensable for the best results of medical inspection.

"9. Congress is not willing to give to this city what is everywhere recognized as an essential weapon against retardation of school children, having at the last session reduced the medical inspection service and having failed to provide for school nurses.

"10. The Dillingham bill providing for the establishment and maintenance of a laboratory for the study of defectives in the District of Columbia should be enacted, both for its broad general purposes and also for the proper study and classification of defective school children.

"11. Retardation is in part brought about by repeated failures to succeed and thus may be a causative factor in the neurasthenias and psychasthenias so frequent in American life. The problem should engage the attention of physicians."

FLORIDA.

BYRD, Hiram. Medical inspection of schools. In Florida. State board of health. Annual report, 1911. Deland, Florida, The E. O. Painter printing co., 1912. p. 331-41. (State board of health of Florida. Publication 96, June 1912) Largely, the extent of hookworm disease in Florida and the need for medical inspection as a factor in its eradication.

"Let us pause here long enough to see if we can get the full import of this one disease.

"White people suffer from it more than negroes.

"Children suffer from it more than adults.

"The rural population suffers from it more than the urban.

"Our inquiry will be then to determine the cost in dollars and cents that hookworm disease entails upon our rural white children.

"Fifty-five per cent of our people are white. Seventy per cent of our people live in the country. Therefore 28 per cent of our white school children live in the country.

"A canvass was made by the State board of health covering 6,000 rural school children and it was found that 52 per cent of them were hookworm sufferers.

"From which it is seen that 15 per cent of the total school children of the State are suffering from hookworms.

The extent to which the sufferer's vitality is lowered varies. But it can be measured with a fair degree of accuracy by the color of the blood. That is to say, rich, healthy, deep red blood is indexed at 100. The hookworm sufferer's blood becomes pale and watery in proportion to his infection. And as the infection gets worse and worse the color index of the blood runs down and down, 90, 80, 60, and even to 20 per cent of the normal. Perhaps an average color would be 70 per cent. But, to be especially conservative, we will assume that it is not so low as that. We will assume that it is 80 per cent. That means that the sufferer is off 20 per cent in strength, 20 per cent in intellectual energy, 20 per cent in power of learning.

-Now if 15 per cent of our school children are off 20 per cent in power of development, that lowers the whole power of development of the school children of the State by 3 per cent.