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65.6 per cent of all examined were boys and 67.4 per cent of all assigned for treatment were boys.

“The problem is a good one, and fraught with serious consequences if public sentiment is not aroused to the magnitude of the increase in defective mentality, and if some definite legislation is not speedily enacted along the line of eugenics."

NORTH CAROLINA.

FERRELL, John A. Report. Status of hookworm disease in North Carolina.

In North Carolina. State board of health. Thirteenth biennial report, 1909–1910. Raleigh, N. C., Edwards & Broughton printing co., 1911. p. 53–55.

of more than 600 North Carolina college students examined for hookworm disease, residents of 50 counties, one-third were found to be infected. Probably one-fourth of the rural population are infected, the highest infection percentage being among school children.

The plan of campaign is as follows: 1. The State will be divided into 16 or 18 sanitary districts. 2. Five practical physicians of experience will be appointed as field agents. They will devote their entire time to the campaign against hookworm disease. 3. Each field agent will be assigned to a sanitary district. He will be expected to cooperate with the doctors, teachers and all other forces which may lend a helping hand toward making the facts and methods for eradication, common knowledge. Wher. ever practicable examinations will be made free.”

A conservative estimate gives the annual loss occasioned by hookworm disease, in the State appropriation for public schools, as $187,500. HAYWOOD, Hubert, jr. Results of the examination and treatment for hookworm

disease of the pupils at the State blind school for the white. In North Carolina. State board of health. Bulletin, 26: 175–78, August 1911.

Out of 172 pupils examined, 83 were infected with hookworm disease; about 56 per cent of the boys and about 42 per cent of the girls, with one or two exceptions all being from country districts, largely

from farms; not a single case from a city or town where there was a sanitary sewerage system. RANKIN, W. 8. What County boards of health are doing. In North Carolina. State board of health. Bulletin, 26: 334-43, January 1912.

Board of health rules:

“That all children attending schools shall be vaccinated or be excluded from school after January 1, 1912. (See Exhibit A.)

“That the county superintendent of health shall be provided with a suitable stereopticon lantern and a full collection of lantern slides, and that he shall give illustrated lectures in all of the public schools of the county on important phases of sanitation.

“That the teachers in the public schools shall examine the children for the common physical defects, and report on suitable blank forms furnished them by the county superintendent of health. Probably defective children shall be examined by the county superintendent of health, who shall notify the parent of the condition of the child and of the proper course to pursue to secure the necessary treatment. (Sce Exhibits B, C, and D.)

“That the public school teacher shall report to the county superintendent of health all absences from school on a post card furnished them by the said superintendent. (See Guilford County Exhibit E.)

"That the county superintendent of health shall notify the teachers of public schools of the presence of infectious diseases in the families that have children attending their school. (See Exhibit F). ... (He) shall visit and make examination of all school buildings and grounds during the school vacation every year; . . . shall keep a record on file in his office showing the physical condition, recommendations, and effects of treatment of defective school children that have been referred to him by the teacher."

(See Exhibit G.) STROSNIDER, C. F. The frequency of hookworm infection among the whites as

compared with the negroes. In North Carolina. State board of health. Bulletin, 26: 167–69, August 1911. table.

In the examination of 3,429 school children, 2,092 of whom aro whites and 1,337 negrocs, 34 per cent of the whites are infected against 15 per cent among the negroes. The infection among the rural whites is three times as frequent as among the semi-rural and thoso whose homes have sewer connection; and the rural negroes were found five times as commonly infected as were those in the large towns. The percentage was always lower, excepting one case, among the negroes.

The infection was found to be higher among mulattoes than among full-blooded Africans.

NORTH DAKOTA. North Dakota. State board of health. [The medical inspection of school children in North Dakota] Its Bulletin, 4: 3-5, September 1911. (Caption: Back to school)

Section 236 of the 1911 session laws reads as follows:

"The board of any school corporation may employ one or more physicians as medical inspector of schools. It shall be the duty of the medical inspector to examine, at least once annually, all children enrolled in the public schools of the district, except those who present a certificate of health from a licensed physician, and to make out suitable records for each child, one copy of which shall be filed with the county or city superintendent of schools. Notice of physical defects of abnormal or diseased children shall be sent to the parents, with recommendations for the parent's guidance in conserving the child's health. The medical inspector shall co-operate with the state, county, and township boards of health in dealing with contagious and infectious diseases and to secure medical treatment for indigent children. It shall be the duty of the county and city superintendents of schools to co-operate with school boards in promoting medical inspection. He may arrange schools by groups, especially in the rural districts, for the purpose of inspection, and shall advise school boards with a view to securing the most efficient and economical administration of this law. The school board or board of education shall furnish all blanks and other needed supplies for this purpose."

The last legislature passed the following law;

"Each local board of health, at least once every thirty days, in such manner as it shall direct, cause to be adequately disinfected each school house, within its jurisdiction; provided this act shall not apply to school houses during vacation; provided, that except in case of emergency, the disinfection of school bouses shall be made after school on Friday afternoon or on Saturday."

*Summing matters up we would respectfully recommend for the consideration of school boards all this time the following: 1. Medical inspection of schools. 2. Where this is not practical, engaging teachers who are competent to recognize the ordinary contagious diseases as well as the common physical defects. 3. That the attention of parents be directed to such physical defects as may be detected and suggestions mad, as to how they may be remedied. 4. Provide adequate sanitary accommodations for al pupils. 5. Abolish the common drinking cup. 6. Prohibit spitting.”

Seeme: p. 6-7, October 1911.
"The last legislature passed a law making monthly disinfection compulsory. ...

"In the opinion of Attorney General Miller this law is null and void on account of a discrepancy between the title and the body of the bill. He says:

sil have traced the course of this measure through the legislature and find that it was several times amended and that, as finally passed, the title of the bill covered sufficiently the subject matter embraced within the body of the bill. It appears therefore that an error was made in the enrollment of the bill, so that wbeo submitted to the governor for his signature it was a different measure than when passed by the legislature.'

"From this you will note that the legislature was right and that the bill fails through a technical cbertal error."

OHIO.

AYRES, S. C. Civic medical inspection of school children, with special refer

EDCES to diseases of the eye, ear and throat. Journal of ophthalmology and otolaryngology, 6:1-6, January 1912.

General; and Cincinnati, Ohio, in particular.

"The work done by the school nurses has been of the greatest benefit. Three nurses ... had supersition of 13 schools. The following figures will give you some idea of what they did in 1910:

“They made 1,425 visits to the schools, and inspected 3,676 cases. They gave 1,191 treatments at the homes of the children, and 7,900 at the schools, and made 11,434 reinspections. They held 1,455

consultations with the parents." Cincinnati. [Board of education Medical inspection. In its Report of the public schools, school year ending August 31, 1911. p. 84-88. tables.

Under "supervision of the department of health by the district physicians. Primarily, its aim is the ... detection of infectious and contagious diseases ... School inspection includes also the detection of those physical defects which interfere with the child's ability to do his school work. .

"One hundred and two public and parochial schools were included in school hygiene, and in the congested districts 5 nurses were employed to look after the physical welfare of the children in 21 schools. ...

“Three additional purses were appointed for the present year. A daily notice is sent to every school in the city by the board of health, giving information concerning all the children of the city who are Excluded for contagious diseases, and also a list of those who are permitted to return." Total number of medical inspections for 1911, 11,811.

82888° -13_7

Diphtheria exclusions.
Scarlet fever exclusions.
Measles exclusions.
Mumps exclusions.
Chickenpox exclusions.
Whooping cough exclusions.
Impetigo contagiosa exclusions
Tinea exclusions...
Scabies exclusions
Pediculosis exclusions.
Other diseases exclusions.

Total excluded....
Examined but not excluded, 1,374.

8 67 11 75 143 21 56 28 76 256 298

1,039

314

Recommended for treatment. Defective eyesight...

800 Diseases of the eyes..

303 Defective hearing.

115 Otitis media.

84 Hypert. tonsils.

864 Adenoids..

318 Eczema..

266 Other skin diseases. Tonsilitis.

510 Other diseases.

1,577 Total........

5,151 Examined but not recommended for treatment, 4,854. Total number examined, 24,229.

Defects of the eye, ear, nose, throat, in children of five public schools in congested districts: Total examined.

2, 437 Defects of vision (33.36 per cent).

813 Defects of ear, nose, and throat (64.13 per cent)..

1,563 Dental inspections have been held for three years; 14,886 school children have been examined, of whom 12,205, or 90 per cent, required dental attention Inspections are carried on by volunteers from the Cincinnati Dental Society. A permanent lecture committee addresses mothers' clubs, school children, and other organizations desiring its services.

In September, 1910, a free dental clinic was established in one of the school buildings; expense of operating the clinic about $2,000 for every 1,000 children.

“The most notable innovation is the so-called 'experimental class,' which is being conducted at the sixth district school-certain psychological, physical, sociological, and dental tests instituted; behavior attendance, scholarship, etc., recorded, and dental treatment given-the object being to demonstrate that through proper hygienic mouth conditions, scholarship, attendance, behavior, manner, etc., will be radically improved, thereby saving the municipality in actual money more than the cost of maintaining proper conditions. At the end of the year these tests will be repeated. ... This is the first time that this experiment has been attempted with an entire classroom and the results should be of

great scientific importance." Cleveland. Board of education. Second annual report of the Division of medical inspection of schools, Cleveland, 1911-1912. 8 p. tables. 8°.

Number of cases fully corrected during the year 1911-1912 was 3,580, as compared with 1,793 for 1910-11. “Of the corrected cases, approximately two-thirds of the number were repeaters, presumably by reason of correctable defects."

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Report of medical inspection of backward, defective, and mentally defective children of the

public schools of Cleveland, Ohio.

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Total number examined...
Total number of feeble-minded.
Total number of feeble-minded and border-line cases
Number now in special classes..
Number now in boys' school.

1,281

469 750 302 131

Cleveland. Superintendent of schools. Medical and dental inspection. In his Annual report, 1909. p. 70–72. table (results in two contrasted schools)

Examination of 30,000 children in grades III to VII, year 1906–7, by the Department of physical training, with respect to condition of eyes, ears, nose, and teeth.

In one school in “congested" district contrasted with results in “East End" school.

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In March, 1909, of 36,403 children examined, the teeth were found to be defective of 27,918.

Though the Cleveland schools have never enjoyed a complete system of medical inspection, the department of health, through its ward physicians, protect the schools from infectious diseases. . . . In addition, under the general direction of the school physicians, there have heen located in schools in foreign districts, six school dispensaries, five of these being established this year. . . . At ea is stationed

a school nurse; ... a new feature of this year." Cleveland chamber of commerce. Report of the Municipal sanitation committee on medical inspection in the schools. 10 p. 8o.

Approved by the Cleveland chamber of commerce, February 23d, 1909.

Historical sketch, and argument for medical inspection based on Superintendent's report for Cleveland schools, 1907: “That the schools are suffering a great economic and moral waste. ... 8,595 children, 13.3 per cent of last year's enrollment, were three or more years behind their grade. At the estimated tuition cost of $26 per enrolled pupil per year, this number represents a dead loss per annum of $223,470. It is estimated that less than one-tenth of this sum will provide an adequate system of medical supervision. If such a system resulted in the saving of only one grade to not more than one in ten of these

backward children each year, it would prevent a greater waste than it would cost.” MCHENRY, Junius H. Medical school inspection in Cleveland. Cleveland medical journal, 8: 338-46, June 1909.

Also in Ohio State medical journal, 6: 641-45, December 15, 1910., Title: Medical inspection of schools.

In March 1906, the board of health appointed 26 physicians to attend the indigent sick and to inspect the public and parochial schools. The ward physicians organized themselves into the Cleveland medi cal school inspectors association; redistributed assignments of schools, effective in 1907.

Each inspector visits each of his schools daily. During school session, monthly meetings are held by the inspectors and representative medical men and specialists, to discuss conditions and present addresses.

Cleveland has installed a system which, I believe, does not exist in other cities, namely school dispensaries. These are situated in the congested foreign element districts of the city. Two such dispensaries are now used and others are being equipped. It is the intention of the board of education to establish others ... where they are most needed. A graduate nurse of the visiting nurses association is in charge ... and is under the instructions of the school inspector. ... After school hours the nurses are required to visit those children who were absent, on account of exclusion. . . . As a result 90 per cent of the children that otherwise would have been excluded, are enabled to continue in attendance ... without exposing any of the associated children to the dangers of infection."

Treatment is given at these dispensaries for emergency cases only. A card system is in operation, “intended to follow the child through its school life and the information is confidential for the boards

of health and education," regarding the home and health conditions found in investigation. WALLIN, John Edward Wallace. Medical and dental inspection in the Cleveland schools. Psychological clinic, 4: 93–108, June 15, 1910.

Bibliography: p. 108.

Between the school nurse and the dispensary of one school alone, 1,871 days in school were saved for children who otherwise would have been excluded. “As a result of this hygienic and medical work the attendance records have reached unprecedented heights in these irregular stations."

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