CANTON.

CABOT, Arthur Tracy, School inspection in small towns. In American school hygiene association. Proceedings, 1911. Springfield, Mass., American physical education review, 1911. p. 40-43.

Also in Boston medical and surgical journal, 164: 633-34, May 4, 1911.

The town's appropriation being too small for payment for systematic medical inspection, at a town meeting in 1908, a school nurse appropriation of $500 was made, a trained nurse to begin at the opening of the next school year. The work, which also included the parochial school, was found to be so satisfactory that for the year following, $950 was appropriated.

The nurse looks after 900 children; makes examinations at beginning of year, keeping card record; keeps record of any illness they have; children with any infirmity of eyes, ears, throat or general condition, are referred to their physicians; children requiring specialist's aid are taken by her to a public clinic in Boston. She gives hygiene talks in the schools, and visits the homes. "We have found the work of the school nurse thoroughly satisfactory in giving the town what seems adequate inspection and control of contagious disease."

The neighboring town of Norwood adopted same system; Milton, planning the same.

WELLESLEY.

CANAVAN, Myrtelle M. Medical data of the examination of 2,333 supposedly normal adult young women. In American school hygiene association. Proceedings, 1912. Springfield [Mass.] American physical education review, 1912. p. 76-91. tables. record blanks.

The physical examination system of Wellesley college; data covering examinations from 1906 to 1911; average age of students, 19 years.

While 17 per cent had had throat operations, and 15 per cent of these, for removal of tonsils or adenoids, tonsils were found enlarged in 28 per cent.

Unusual lesions for the most part are stigmata of degeneration, 24 different sorts.

WORCESTER.

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

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

1906.

“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 are by no means complete and many of the record cards show normal vision when serious defects are really present. . . . There is no test card for astigmatism. . . .

"In the fifth grade only 34 per cent had 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 cent 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 average number per pupil should be so high; that is eight in the first grade and nearly four in the ninth grade. . . .

"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:

Physical defects discovered (May 1, 1910, to December 1, 1910.)

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, 30.501 children were examined by the medical school inspectors; 3,499 excluded for contagious diseases; 818 cases of tonsilitis; 12, of scarlet fever. Physical defects were found in 2,118 pupils: Of these 598 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, attended to 234 children.

MARTINDALE, W. C. How Detroit cares for her backward children. Psychological 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 superv hor."

82883°-13-6

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; if parents are unable to provide the needed medical attention, the principal reports the case to the child study committee; upon note from the seeretary 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 cases; 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. Seventy-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 systematic examinations has been strikingly shown in the medical department. For the last four or five years 3 to 6 cases of tuberculosis have been discovered 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 seven 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; 11 per cent of anemia; 6 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."

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. One physician employed to give three hours each day from 9 to 12 to the schools and to maintain office hours 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' supervision. "Our experience strengthens the conviction that it 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, drinking 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 to the parents or guardians of pupils lacking in cleanliness or needing treatment; he shall be authorized to exclude 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 as 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.

343

170

243

182

669

482

203

144

270

103

118

25

9

8

20

2,000

220

MISSOURI.

St. Louis. Board of education. Department of school hygiene. In its 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 its 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.

"If a 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 until 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 reexamined 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 disease 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; în 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 buildings in the city quarantined in 1910-11 than in 1909-10; in 1910-11 there were 35,659 more inspections