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WORCESTER. EMERY, George E. Medical inspection in two Worcester schoole. Pedagogical seminary, 17: 111-18, March 1910. tables.

"Fifteen inspectors were appointed in Worcester by the board of health and began work in October,

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"Our duties were to inspect such children as were referred to us by the teachers, and make weekly reports of such inspection.

"October of this year (1909) blanks were furnished by the board . . . and a systematic inspection of all the pupils was begun The tests for sight and hearing are conducted by the teachers, but . . . they ** bg no means complete and many of the record cards show normal vision when serious defects are really preænt. ... There is no test card for astigmatism.

“In the fifth grade only 34 per cent bad enlarged glands. In the sixth grade 80 per cent ... and for the whole school 55 per cent. ... The general nutrition of the pupils is ... 63 per cent good, 32 per Dent medium and only 4 per cent poor.

"I was not surprised that a large number should have poor teeth; but I was surprised that the averse number per pupil should be so high; that is eight in the first grade and nearly four in the ninth pade. ..

* The school nurse should be the link between the school and the home, but in Worcester that link is missing. The district nurses do help but . . . can give but little time to this work."

MICHIGAN. Grand Rapids. Board of health and Poor commissioners. Report of School examiner. In their Annual reports, year ending March 31, 1911. tables.

Inspection for physical defects was ordered discontinued by the board of health, on December 6, 1910,
and inspection is now made for contagious diseases only.
The following is a report of work from May 1, 1910 to April 1, 1911:

Contagious diseases discovered.
Itch..
W booping cough.
Mrasies
Typhoid fever.
Bezirt fever,
German measles.
Churkenpox.
Smallpoi.
Total.

Physical defects discovered (May 1, 1910, 10 December 1, 1910.)
Glandular
Nortois
Sumarb
Hernia
Dertive tooth
Deformito.
Hypertrophind tonsils
Ear trouble.
Adenoids
Suin trouble

Total....
The total number vaccinated was 245. The acting school examiner is Leland H. Gilleland.
KIEFER, Guy L. Medical inspection of school children. Dental summary, 31:
264-68, April 1911.

In Detroit, 50,501 children were examined by the medical school inspectors; 3,499 excluded for contaguru diseases; 518 cases of tonsilitis; 12, of scarlet fever. Physical defects were found in 2,118 pupils: of the 998 had defective eyesight; 204, diseased eyes; 136, defective hearing; 906, enlarged tonsils or adenoids, or both, and 210 had defective teeth.

Beginning October 23, 1909, to May 7, 1910, the Detroit district dental society, in its free dental clinic, strades to 234 children. MARTINDALE, W. C. How Detroit cares for her backward children. Peychological clinic, 6: 125–30, October 15, 1912.

"In the fall of 1910 the department of special education was organized and the nine special rooms, the school for cripples and schools for stammerers, were placed under the direct supervision of the general Eupervisor."

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Binet-Simon tests are used to determine the mentality. If no results follow notification to parents, the school principal calls upon the regular school physician to make a physical examination of the child, to ascertain if the backwardness be due to defective vision, defective hearing, adenoids, enlarged tonsils, or nervousness. The principal reports result to parents; il parents are unable to provide the needed medical attention, the principal reports the case to the child study committee; upon note from the secretary of the committee, Detroit's best specialists give free assistance to the children. Where children can not afford spectacles, they are provided through fund set aside by the Detroit teachers' association.

Since September, 1911, 215 pupils have been tested for defective vision and provided with glasses.

After the child's physical defects have been remedied, if his mental condition still remains unchanged, the Binet examiner, appointed by the board of education. then visits the school and gives him the Binet test. The special physician, appointed by the board of health to work under the direction of the board of education, visits the school and makes a physical examination of the child. “The statement of the parent as given in the report sent to the secretary of the child study committee by the principal, together with the child's school history, reports of the Binet examiner and of the school physician are then passed upon by the child study committee.

"In the cases of low grade children whom the committee thinks it advisable to exclude, a second examination is made . by one of the mental specialists of the child study committee consultation staff ... and usually results in the exclusion of the child. ... Since September, 1911, 488 cases have been

examined. The committee recommended 190 of this number to the special rooms." MAY, George A. The result of one thousand nose and throat examinations. American physical education review, 14: 636-44, December 1909.

Examinations made at the Waterman gymnasium, University of Michigan.

There were found in 1,000 students, mostly freshmen, 157 deviated septa; nasal spurs and ridges, 398; adenoids large, 36, moderate, 145; chronic tonsilitis, 4; lacunar, 8; chronic tonsillar inflammation with hypertrophy, 191 casas; symptoms of frequent nasal bleeding, 170; 85 without accountable etiology; simple chronic rhinitis, 54 cases; atrophic rhinitis, 12; larynx, acute inflammatory conditions, 105. Eighty-three complained of more or less chronic hoarseness. There were 38 hay fever cases. Sev. enty-six gave a history of some nose and throat operation.

The main object of the paper is to point out the necessity of an examination of this character. The ideal time for such would be the childhood period. WARTHIN, Aldred Scott. Thy physical health of the University. Michigan alumnus, 16: 70–73, November 1909.

The University of Michigan.

“At the beginning of the present college year the department of medicine and surgery adopted methods tending towards a better physical knowledge of the medical students particularly with reference to the occurrence of tuberculosis. Each medical student is to report once a semester to the department of internal medicine for an examination. ... The need for such systema, ic examinations has been strik. ingly shown in the medical department. For the last four or five years 3 to 6 cases of tuberculosis have been discoverod annually in the junior and senior medical classes-about 4 per cent of the class on an average. ... Very few cases are discovered in the freshman or sophomore years. ...

"Out of 200 women examined in the gymnasium) the examiner discovered 8 suspicious cases, 6 of which gave positive evidence of incipient tuberculosis."

MINNESOTA.

MINNEAPOLIS.

Minneapolis. Board of education. Report of the Supervisor of hygiene and

physical training. In its Annual report, year ending June 30, 1911, p. 89-94 (98)

Signed: Charles H. Keene, M. D.

January 1, 1911, a system of medical inspection was Inaugurated, conducted by seven physicians and se ven nurses. During the five months medical inspection has been in operation, 19,082 inspections made, 7,102 being physical examinations. Of these, 72 per cent were found defective; most common defect, hypertrophied tonsil, 35 per cent of those examined having this defect; 32 per cent, defective teeth; 28 per cent, adenoids; 24 per cent, enlarged glands; 18 per cent, defective vision; 114 per cent of anemia; 64 per cent, malnutrition; 3,873 cases have been treated, "who would not otherwise have received treatment."

ST. PAUL.

MEYERDING, E. A. School health. St. Paul medical journal, 14: 246–55, May 1912.

General summary. Medical inspection in St. Paul, p. 248–250, 253. Page 253 contrasts conditions between two schools; one among a foreign-born and laboring-class population and the other one of the best from a social standpoint."

Hill school (good social class).

Harrison
school
(labor
class).

Requiring dental attention
Marutrition
Cookeanliness.
Skin disease.

Per cent. Per cent. 40

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1 Less than,

St. Paul. Board of school inspectors. Medical inspection. In its Annual reports, school years ending June 9, 1909, and June 10, 1910. p. 57–59. illus.

Department of medical inspection established along lines outlined by the superintendent of schools. Ode physician employed to give three hours each day from 9 to 12 to the schools and to maintain office bours from 9 to 12 on Saturdays at the school board rooms. He began his work with one nurse assistant and later three nurses were assigned. Medical inspection entirely under the school authorities' superFiSign. "Our experience strengthens the conviction that should always be so. ...

* The medical inspector shall make recommendations on matters affecting the physical environment of children such as the building lot, the drainage, heating, plumbing, ventilating, water supply, drinkng facilities, sweeping, scrubbing, use of disinfectants, deodorizing, fumigating, etc.

" He shall go from building to building and shall make systematic examination of all pupils in the elementary schools reported to him by teachers and principals and such other pupils as may appear to him physically defective.

" He shall be accompanied and assisted in all his work by a school nurse who shall record all findings, and report to parents. The medical inspector shall not be permitted to give any treatment to children except temporary assistance, or in cases of emergency. ... The medical inspector shall also send notice lo the parents or guardians of pupils lacking in cleanliness or needing treatment; he shall be authorized to esclude pupils. ...

"He shall give such instructions to principals and teachers as will make them familiar with the more conspicuous symptoms of physical and mental deficiency, to the end that they may suggest only those who are really abnormal to the inspector for examination. He shall give instruction to teachers, respecting vision and hearing tests, and on such matters relating to the physical inspection of children

will promise the assistance and cooperation of teachers and principals in the work of his department.” During the school year 1909-10, a systematic examination of 3,265 found 2,088 behind grade; 28 per cent of them backward in studies because of physical conditions The following is a summary of the work of two nurses:

Total. Rooms inspected...

343 Contagious diseases discovered. Carnmunicable diseases (not contagious). Surgical dressings and treatments. Pediculosis. (Cured, 442.) Taken to dispensary or doctor..

482 Delative vision, attention received. Detective vision, glasses secured.

144 Defective pose and throat, attention received. Defective nose and throat, operated upon.. Malnutrition. Enlarged cervical glands.. Pulmonary diseases, attention received. Tubercular diseases, attention received. Beart disease, attention received. Tmeth, use of brush taught...

2,000 Teeth, alleation received.

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MISSOURI.

St. Louis. Board of education. Department of school hygiene. In ils Annual report, 1909. p. 176-88.

History of the St. Louis department of school hygiene. Work to begin opening of school year, Sep. tember, 1909.

The supervisor of hygiene is required to be a skilled physician. He must devote his entire time to the work of the department. The inspectors must be graduates of medical colleges of recognized standing, and devote themselves to this work for ten months in each year. They must during all school hours be engaged in their investigations in the school buildings, and during the school term use such further time as shall be required for making the necessary examinations and reports. Supervisor and inspectors must not treat any case of physical defect or disease that has been discovered by them while engaged in the work of the department. The work must be conducted under such further regulations as may be prescribed by the superintendent of instruction with the approval of the board of education. Bacteriological laboratory to be opened in board of education, or in some school building, and to be equipped

with necessary instruments and supplies. St. Louis. Board of education. Department of school hygiene. In ils Annual report, 1910. p. 199-213; 314-16. tables.

The school year of 1909–10 saw the first actual work of the department of hygiene. A supervisor and five inspectors were authorized by the board of education on February 9, 1909.

“When the inspector arrives at a school, he at once notifies the principal, who, in turn, through a monitor, informs the teachers that the inspector has arrived and he is ready to care for reported cases.

“The teacher having previously filled out the teacher's diagnosis card, Form 11-C[form follows), sends the child with this card to the inspector. The inspector makes his examination and enters his diagnosis on this card and fills out, in duplicate, Form 11-A [form follows! He instructs the child to deliver the card ... to the parent or guardian.

“Ila child is found to be suffering from a contagious or infectious disease, he is at once excluded and the city health department is notified on the form ... [form follows). This terminates the relation of the department of hygiene with the child urtil he or she is ready to reenter school, at which time the health department notifies us ... that quarantine restrictions have been raised. The child is reex. amined by the inspector of hygiene.

“In case of ... physical defect, the diagnosis card (Form 11-C) is set back a certain number of days in a follow-up file and at that time the pupil is reexamined and his condition . . . entered upon the card.

“The cases of noncommunicable disease are handled in the same manner as the cases of physical defects except where ... a menace to the other children. The pupil suffering from such a discase is excluded until, in the opinion of the inspector, he may properly return to school."

Each school in the city has an emergency surgical chest. For absence of three days, the teacher reports to the inspector of hygiene for her school; he tabulates all the reports from the same school and reports them to the health department, filing a duplicate with department of hygiene. On receipt, the health department district inspectors visit the homes of children so reported and report back, to the principal and inspector, the cause of the child's absence; the case is followed up by the attendance department, if the cause is other than illness. The health department makes a daily report to the department of hygiene of all contagious diseases reported to it. During the summer of 1909 a record of all such cases was kept by the supervisor of hygiene, and a letter was sent to the infected homes and to the principal of the school in the district in which these homes were located, requiring the children to be examined by the assistant health commissioner, or by the department of hygiene, before admission to school. Principals were directed to refuse admission unless the child brings a certificate from one of the two examining officers. The inspector makes thorough examination of all suspected contact cases for contagious diseases and these are under daily inspection. All children are examined in a school where scarlet fever has been found, the case is at once excluded, health department and the building commissioner are notified, and fumigation is made after school dismissal (p. 205-209).

See also Report, 1911, p. 141-150 (Regulations and work of the six school nurses added to the department of school hygiene, and cards).

NEW JERSEY.

HOLMES, George J. Educational hygiene and prophylaxis. New Jersey. Journal of the medical society, 9: 223–31, October 1912.

Newark requires the medical inspector “to devote two hours each day, the hours of service to be at the convenience of the school authorities."

Cost to run the department of medical inspection in 1909–10 was 31 cents per pupil; in 1910-11, 41 cents per capita. The increased cost was justified by results: Forty thousand fewer days were lost by quarantine in 1910–11 than in the previous year, and a decrease of 50 per cent in the number of buildlngs in the city quarantined in 1910–11 than in 1909-10; in 1910–11 there were 35,659 more inspections

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made by the department, with 843 fewer exclusions, and the 15,625 more physical examinations show a Den in amount of work and character of same.

"During 1910–11, 24,310 physical examinations were performed—614 per cent of this number were fant to have one or more defects and 383 per cent were found normal. "Chief among the defects are:

Per cent. Erlerged glands.. [hause vision.

20 [relative hearing.. Defectire nasal breathing..

7 Delective teeth,

47 Lovgod tonsils. Atenids...

12 Mentality (percentage based on number found defective).

*Were I asked to establish medical inspection in a city ... I would employ first of all, sufficient tuned nurses to carry on the major part of the work. The only part of medical inspection that cansot be conducted by nurses trained in school work is the examination of the heart and lungs.

"I sould have these nurses under the direction of a trained physician who should be expected to derote the entire day, from 9 to 5, to school work. Medical inspection should not be carried on in public

sebecois as a necessary evil, but as an indispensable benefit.” LAMSON, William J. The medical inspection of schools. Medical society of New Jersey. Journal, 7: 569–72, April 1911. tables. form.

Duties of a medical inspector, as adopted by the New Jersey State board of education, October 5, 1909, are as follows:

*1 He shall use the same skill in examining pupils as he would in the case of private patients.

*2. He shall arrange his visits to the school to suit the convenience of the school authorities and his own private work. He shall respond to emergency calls as quickly as possible.

49. He shall make regular inspections: (a) In rural districts at each school at least twice a month; (b) to villages and small towns at least once a week; (c) in towns and cities at least three times a week, add in crowded cities daily.

"4. At the commencernent of each school year he shall make a thorough physical examination of each Ball, and record his findings on cards assigned for this purpose: (a) Eyes, for farsightedness or nearSIELKUNss, color blindness, squint and roughly for astigmatism, also the condition of the eyelids; (6) cars, for seuleness of hearing, adenoids, discharge; (e) throat, for enlarged tonsils, adenoids, nasal debortuities or discharges; (d) teeth, condition and care; (e) deformities, spine, limbs, etc.; () skin, eruption, condition of scalp; (g) when practicable measurements, height, weight and chest measures; examinstion of heart and lungs.

"5. He sball exclude cases of contagious diseases, and send a written statement of conditions found. 6. He shall from time to time examine into the sanitary conditions of all schools in his district. 47. Any special work, such as frequent extra visits, vaccination or fumigation, shall be arranged for by motual agreement between the board of education and the inspector.” MACDONALD, Joseph, jr. The object and intent of medical inspection of school children. New Jersey. Journal of the medical society, 9: 231-34, October 1912.

To be accomplished-

"First. By the appointment of a State medical school inspector as a member of the State board of odocation.

" Second. By the preparation of uniform blanks by the State board covering individual record cards for yearly examination; recommendation cards for treatment and exclusion cards for infectious or communicable diseases.

* Thind By requiring that duplicate reports shall be sent by the school inspectors to the school boards they are serving, and to the State board at Trenton; thus with other essential details ... a most important department could be built up that would prove not only a great saving in expense to the commu. nity, now expended in carrying along physically deficient pupils, but would give us a stronger race of well and women physically and mentally.".

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