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"These statistics of school children are exceedingly significant, from various points of view:

*First. These children are growing up under a severe physical handicap. If they do not undergo medical treatment, not only will this handicap be appreciable in deaths due directly to hookworm infection, but this infection will so reduce their vitality that they will more readily fall a prey to other diseases, such as tuberculosis, pneumonia, malaria, etc.

" Second. Their physical development is of necessity inhibited, and many of them may reach maturity stunted in their growth.

“Third. Children in this condition can not possibly be expected fully to assimilate the education which is being given to them, and as a result the money being spent on education is not giving to these tovas full returns. . .

"Fourth. Not only these three counties but all other parts of the South visited by winter tourists should awaken promptly to the self-evident fact that the danger is present that such tourists will soon svoid those rural portions of the South in which the soil pollution is so extensive as to lead to 55.9 per cnt hookworm infection among the school children. ...

"At least five of the teachers in the schools visited showed clear and pronounced effects of hookworm infection."

GEORGIA. Atlanta. Board of education. Department of medical inspection. In its Report, January 1912. p. 231-32.

Signed: Robert G. Stephens, M. D.

Medical inspection established in Atlanta, winter of 1909. Force, to date, consists of chief cxaminer, one white assistant, one colored, four white nurses and one colored.

"Method pursued is that of routine examination. A school is visited daily by an examiner and nurse antil each child in that school has received a physical examination." Defects are noted on individual cards. "If the defect is remediable a notice card is sent to the parents suggesting that dental or medical attention be given. ...

"Out of 5,838 recommended for treatment in 1910-1911, 50.9 per cent received treatment, but in order to get this number treated the nurses made 4,814 visits to homes.

"Schools examined for the first time furnish in every instance from 60 to 94 per cent of the children defective." Augusta and Richmond County, Georgia. (Board of education] Medical inspection of schools. In its Annual report, 1910. p. 22–23; 111.

** During the past year we have had a very satisfactory experiment with ... district nurse visitation and inspection at the John Milledge school. The district nurse of the fifth ward has attended that school for two or three hours each week, has visited all the grades, and has had referred to her all suspected cases of disorder or disease. She then refers the cases to the regular physician of the city, or to specialists. ...

"There is also a movement on the part of the board (of education) to engage the cooperation of the board of health by which ... at least one nurse and one physician shall be especially set apart for school inspection ... as a part of the regular work of the board of health by which a complete system

of medical inspection can be inaugurated for all the schools." FORT, A. G. Examination of county school children. Medical association of Georgia. Journal, 2:7, May 1912. table.

"The combined results of the inspection of three rural counties in Georgia are as follows:

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"In the inspection of the sanitary surroundings of 59 of these schools, we found 17 privies only, and all of these poorly constructed. Is it any wonder then that 1,668 gave clinical evidence of hookworm Infection and microscopical examination revealed that an average of 74.7 per cent of the suspects were

Injected" PORT, A. G. (Hookworm disease among Georgia school children] American

school board journal, 43: 39, October 1911.

Defectives among the children of Stewart, Webster and Tift counties, Georgia.

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Savannah and County of Chatham. (Board of education) Health and sanitation. In its Annual report, year ending June 30th, 1910. p. 16–18.

“Whenever in the judgment of the principal a pupil of the public schools needs medical treatment . . he shall notify the parent or guardian. ... Such pupil shall not be permitted to continue in attendance upon the public schools until a certificate from the attending physician shall have been presented to the principal.”

This plan has been in operation since January 1, 1910. Cases reported, 191. [Stephens, Robert G.) Medical inspection of school children. In Georgia educa

tional association. Proceedings and addresses, 1911. Atlanta, Ga., Bennett printing house. p. 65–73.

General résumé, by the medical examiner of schools, Atlanta, Ga.

"Out of a group of 2,375 examined in Atlanta in 1909, 1,452 were defective, or 61.1 per cent; out of 2,166 in Atlanta examined in fall of 1910, 1,653 or 76.2 per cent were defective."

Defects: Atlanta, 1910.
Nutrition..
Anaemia
Glands.
Heart..
Skin..
Nervous.
Teeth..

1,372 Tonsils

375 Adenoids.

257 Eyes..

189 Lungs..

Two medical inspectors and four nurses work under control of board of education. Two weeks are allowed to elapse following notification to parents of defects, after which time a nurse visits the home of each defective child who has not returned a card signed by physician or dentist.

50

28 192 11 42 6

IDAHO.

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HYDE, George E. Medical inspection of schools. Northwest medicine, D. B. 3:

340-43, December 1911.

Rule V, of the State board of health of Idaho, requires the county physician to "report, on or about September 1 of each year, the sanitary condition of the public schools of the county in which he resides."

The author receiving permission to examine the school children in his home town, Rexburg, "to see if the findings of inspection in other parts of the county could be bourne out” by his personal investigation. Teachers tested the eyes with Snellen's chart, took records of heights and weights, ages, grades, number of years attending school, and history of contagious diseases; Dr. Hyde examining the ears, nose, throat, and teeth.

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Deafness..
Adenoids.
Hypertrophied tonsils
Yuld eye defect:

Ranging from 20/30 to 20/40.....
Ranging 2050 to 6/200..

(31 of these pupils had headaches on reading; 12 had change of posture at

desk in order to be able to write their lessons; 11 could not see the lesson

written on the blackboard, from where they sat in their room.)
Defective teeth (of these, 25 per cent'in very bad condition)..
Mitral regurgitation (histories of rheumatisin in 4 cases)....
No discoverable defects in..

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*These results ... show that the children in this western country have not nearly the same number of playsical defects among them as examination shows exists among the schools of the East."

ILLINOIS.

115 125 58

34

259 66 12 13 469 276

Chicago. Board of education. Department of child-study and educational

research. Child-study and educational research. In its Report of the Superintendent of schools for the year ending June 30, 1912. p. 44-50. table.

From Report of directors, D. P. MacMillan.

“Of the whole number of children, 2,095, examined during the year ... with the exception of truants mod incorrigibles ... the maximum number, 469, falls in that group which is made up of children with nervous disorders, particular physical defects or general constitutional depletion. In the majority of cases they proved to be extremely backward pupils.”

Children examined from July 1, 1911, to June 30, 1912.
Blind or defective vision...
Ikeaf or defective hearing.
Crippled....
Truants and incorrigibles, at office.
Triants and incorrigibles, parental school.

466
Bubnormals..
Delective in speech (persistent cases only).
Tuberculous (not including anaemics).
Epileptics (most aggravated cases only).
Children with constitutional depletion or nervous disorders or specific physical defects.

Special cases: Unusually bright children, moral delinquents, mental aberrants. Chicago. Department of health. Bureau of contagious diseases. Medical school inspection. In its Report, 1907–1910. p. 22–33, 39. tables. chart. forms.

"For the supervision of approximately 400,000 school pupils in the public and parochial schools the city employs 100 medical health officers and 41 nurses, all of whom secure their appointments by competitive civil service examinations. For administrative purposes 5 medical health officers are selected to supervise without extra pay, the other 95; and 2 nurses, one receiving $15 per month more than the others supervise the other 39. The city is divided into 95 districts, to each of which is assigned a medical health officer, whose duty it is to inspect the pupils in the schools of the district. In addition, be bas control and supervision of all contagious diseases in the territory to which he is assigned. ...

"The medical health officer makes daily visits to each school assigned him, commencing work at 9a, m. At the beginning of the term he makes a rapid inspection of all pupils to determine if any bear evidence of a contagious disease.

* For this preliminary inspection the health officer visits each room, stands with his back to a window, and has all pupils in the room file past him. ... The pupil ... exposes to view palms of hands and wrists; with the fingers of one hand pulls down the eyelid, exposing the conjunctiva; opens the mouth and puts out the tongue. This hurried inspection is made by the physician without touching the papil. ... After the completion of this preliminary inspection ... the regular forenoon inspection is taken up.

" Inspections and examinations at high schools are done only on request or ... emergency. Parocbial schools desiring ... have the same service as the public schools. Inspection for contagious disease in parochial schools is enforced. In making physical examinations, we begin with the pupils in highest grade, completing one school before beginning ‘physicals' in another.

**The daily routine is as follows:

"Inspection is first made for contagious diseases, after which ten or more physical examinations are made.

* Tibe health officers request principals to have all pupils in readiness for inspection who have been streat four consecutive days ...

“All children to be examined are sent to a room by themselves. ... Inspection is made with reler. ence to communicable diseases and vaccinal status of pupils.

“Pupils with marked defects needing immediate attention . . . referred by the principal, teacher or nurse, are examined without delay. If agreeable to the principal, Friday is (the) . . . day for sucb emergency examinations.

"Health officers are forbidden to make any suggestions as to the treatment or management of pupils who are sick. This command is imperative.

“Beginning November 1, each year, medical officers vaccinate free of charge any child or pupil who may apply to them for vaccination: . vaccinate no child without the consent of parent or guardian.

“ Health officers carry with them the following supplies Circulars on Prevention of consumption; The vaccination creed: special circulars on each of the infectious diseases, and warning slips to distribute and post in public places; wood spatulas for tongue depressors (Each tongue depressor is used only once and then burned); culture media and outfits for Widal test.”

The blanks follow in the order in which they are used: Family history; physical record; medical inspection of schools exclusion; non-exclusion notification of abnormal condition; health officer's daily report; card for child to take to physician and return to school nurse; health officer's monthly report.

A summary of the reports of the school medical inspectors of the Department of Health, of Chicago. for the year 1909, gives the following statistics: of the total number of children examined, 123,897 (51 per cent) were defective.

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East St. Louis. Board of education. Retardation. In its Annual report, 1910–11. p. 34-46. tables (Grades 1-12)

“Of 534 puplis marked to repeat the work of next term," 48 suffered from physical defects; 44, menta! defects.

In all white schools, pupils, 6,842; over age, 676, or 39 per cent. In all colored schools, pupils, 1,082; over age, 714, or 69 per cent. HEDGER, Caroline. Physical examination of below-grade children. Winois medical journal, 15: 433-39, April 1909. tables.

Examination of 208 (125 boys; 83 girls) below-grade public school children in Chicago.

Boys.

Girls.

Cervical glands....
Goitre...
Hypertrophied tonsil.
Irregular pulse...
Hemic murmurs.
Transmitted apical murmurs.
Lateral curvature.
Negative lungs.
Suspicious lung findings.
Positive lung findings.
Cough.
Pediculosis.
Bad teeth..
Tea and coffee.

Per cent. Per cent.

89.6 95.1
23.2 25.3
55.2
23.2 19
50. 4 36.1
11,2 10.8
20

39.7 41.6 43.3 10

43.3 18.4

13.4 8

19 40

72.3 25.6 25.2 99.1 100

Quincy. (Board of education] Medical inspection. In its Annual report of the

public schools, school year ending June 30, 1911. p. 31–38. tables. Total number inspected..

3,018 Defective.. Witb defective eyes.

1, 191

284 With defective hearing.

87 Wrb throat defects.

770 With nasal defects..

336 With defective teeth.

292 With malnutrition.

5 With nervous trouble.

23 With kidney trouble.

2 Physicians assigned to the various schools, for the inspection, at a joint meeting of the committee of the Adams County medical society and the board of education. Signed by Committee of board of education, and Superintendent of city schools Edward G. Bauman.

KENTUCKY.

HANCOCK, D. O. School sanitation. Kentucky medical journal, 9: 724–26, October 1, 1911.

Proposes a "Health committee for each school, composed of four members, the teacher, a physician, and a woman and a man who are each patrons of the school. ...

"That this committee have immediate charge of health matters in the school and district; that it be organized, president, secretary and medical inspector; that it have meetings once each month and oftener is needed; that it keep records of its doings; ... that this committee see to it that the schoolhouse is properly constructed and kept; that conditions are such as will insure the comfort and health of teachers and pupils; that contagious diseases are immediately controlled; that infectious diseases are Dot carried to the school.

* There is a useless and criminal sacrifice of time, comfort, health and life in our schools which should Dot exist. ... The remedy is immediate supervision by those who are on the field and who have personal interest at stake.”

Following this address of Dr. Hancock before the Henderson county teachers' Institute, August 24, 1911, e resolution was adopted:

* Resolved, That the county superintendent of schools is hereby requested by the institute to appoint a health committee as suggested by the paper of Dr. Hancock, in each school district in Henderson County; that the teacher and trustee of each school are hereby requested to organize the committee thus appointed and to assist it in doing the work contemplated; that the county superintendent have printed a list of these committees for use in organizing for school sanitation."

LOUISIANA.

New Orleans. Superintendent of schools. [Report of the] Department of hygiene. In his Annual report, 1910-1911. p. 85–142. tables.

Reported as defective by grammar and primary grade teachers, 2,339 pupils; and 85 kindergarten papile.

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From September 26 to June 16, the total was: Scarletina..

231 Diphtheria..

145 Measies..

660 Smallpox...

12 Among ponquarantinable exclusions were: Impetigo..

57 Seebies.

215 Pediculosis

197 Lezera (chronic).......

27 Applicants for teachers' positions and pupils entering normal school required to stand a physical examination

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