renovated are tagged showing the name of manufacturer and source of materials used. Similar laws are in effect in other States and cities, but it is believed that this does not have much public health significance. It is one of those items which is assigned to the bureau of sanitation for enforcement and must be continued because the industry desires it. In all fairness, the tag placed on mattresses manufactured from sterilized second-hand material should state the fact that the materials are sterilized. However, the tag gives the name and address of the persons who disinfected the mattress and the date of the disinfection. The measure seems to be designed to promote the sale of new mattresses. Podiatry establishments.—By an act of Congress in 1918 the practice of podiatry (chiropody) was made unlawful unless the person practicing had passed an examination given by the health officer to determine his fitness. The enforcement of the act was assigned to the bureau of sanitation. This has no place in the work of this bureau. It should be assigned to the commission on medical licensure or some similar agency. Fowls and birds.—In the Preble report it is stated that "The burden of controlling nuisances arising in connection with the keeping of fowl and other birds within the District appears to be delegated to the health officer either through the courtesy or diplomacy of the police authorities." This activity is clearly a function of the police authority and should be delegated to that department. DISCUSSION It seems rather evident that, in the interests of efficiency and economy, the bureau of sanitary inspection and the bureau of food inspection should be included in a division of sanitation, headed by a public health engineer, in order to provide engineering supervision and advice which neither bureau now enjoys. In view of the extraneous activities which must be carried out with a force of inspectors hardly sufficient to carry on the work normally falling to a well-organized health department, it becomes evident that either the extraneous activities should be dropped or the number of inspectors should be increased. When one considers that few of the inspectors are qualified by special training, and that the average age of the inspectors is high, the need for additional competent inspectors becomes apparent. Four inspectors devote all their time to extraneous activities, the 8-hour female labor law, and the mattress inspection law. The time of four or five other inspectors was devoted to activities which kept them from regular inspector's duties, such as attending Public Health Service seminars, details to nursing service, and to office duties, etc. In order that the full quota of inspectors can be made available for field duty, eight additional inspectors are needed. In fairness to property owners, housewives, and the public generally, field inspectors should be in uniform. It would definitely and promptly identify inspectors, facilitate their work, make for better public relations, and generally increase the efficiency of the force. Such procedure is in line with good health department practice in large cities. Securing abatement of nuisances on properties whose owners are indigent, absent, or refractory should be made possible by new legislation and not made dependent upon the annual appropriation of a revolving fund. It is believed that the inclusion of the bureaus of sanitary inspection and milk and food inspection in a division of sanitation would be advantageous. Therefore, the following plan for the organization of such a division is presented and the personnel for staffing the new division is suggested in the following: Division of sanitation PROPOSED ORGANIZATION A. Bureau of public health engineering: 1. Sanitary inspection section: (a) Complaints; (b) Routine and special inspection. 2. Housing section: (a) House-to-house inspection. 3. Plumbing inspection section. 4. Industrial hygiene section: (a) Industrial; (b) Accident prevention. 5. Extraneous activities section: (a) 8-Hour law; (b) Mattress law; (c) Podiatry; (d) Fowls and birds. B. Bureau of milk and food inspection: 1. Milk inspection section: (a) Dairy; (b) Pasteurization plant; (c) Ice cream. 2. Food inspection section: (a) Pure food law; (b) Restaurants. 1 Supervision of these activities should be placed in some other department. PROPOSED PERSONNEL 1 director of division_ 1 assistant director, bureau of public health engineering_ $5, 600 4, 600 1 assistant director, bureau of milk and food inspection_. 7 chief inspectors at $2,600_. 3, 800 19, 600 By J. O. DEAN, Passed Assistant Surgeon, United States Public Health Service Recommendations.-The following recommendations are made: 1. That more adequate office space be provided for the work of the bureau of school medical inspection. 2. That a closer working relationship be established between the board of education and the health department to bring about unification of interest in the school health program. This may be promoted by regular conferences between school authorities, medical inspectors, and school nurses, upon which occasions the objectives, procedures, and problems should be discussed. 3. That there be more frequent and detailed field observations of the work of medical inspectors and nurses for the purpose of insuring a uniform quality of work. It is desirable that the position of assistant director be filled in order that proper supervision may be given to school medical inspection services. 4. That school medical inspection be extended to all private and parochial schools. 5. That routine "complete" physical examinations be replaced by examinations made on the basis of need as observed by parents, principals, teachers, nurses, doctors, and others. Such examinations should include a history of the child's progress in school, past and present illnesses, a review of home environment, and other pertinent information directing attention to the child's physical and mental well being. 6. That standards be established to define physical defects in need of medical attention. 7. That a regular schedule of school visiting be followed by school medical inspectors, arrivals at schools being reported to principals and head masters. Regular conferences between school physician and principals regarding children to be examined and corrective measures to be instituted, now infrequent, should be increased. 8. That sanitary' inspections of school buildings be made by representatives of the bureau of sanitary inspection, preferably under the direction of a sanitary engineer. 9. That cafeterias in schools be supervised by a nutritionist or the department of home economics in the board of education. Only that portion of child health supervision embraced by the health program for public schools is considered here.1 The purpose of a school health program is to bring medical knowledge into contact with the mass of children in order to secure information which will aid the school in dealing intelligently with the individual child. It is also intended to benefit the immediate and future health of the child. It is important to all concerned that organization and procedure be such that the end sought shall be achieved, and achieved with the least possible entry of futile or trivial activity. Accomplishment of this purpose requires, as a first essential, well trained and proficient personnel supplementing the work of each other in an integrated program. School physicians should have an adequate understanding of child growth and development, of educational psychology, teaching principles, and of school administration. Teachers and principals must be health-minded and acquainted with the principles by which early physical impairments and departures from health are detected. They must understand how physical, emotional, and social factors are related to the well-being of the child. With this as a concept of a school health program the District school health program has been examined. DESCRIPTION OF SERVICE General organization. The "Preble Survey" of 1927 and the "Health and Hospital Survey" of 1929 have given a general description of organization and services of the school health program. Now, as formerly, health services in the school are rendered jointly by the health department and the board of education. Health instruction and physical education directed by well trained directors of physical education and health afford the board of education its principal means of participating in the health program, while the health department makes its contribution through medical, dental, and nursing services. The elements of the program conducted by the health department are provided through the work of two bureaus-the bureau of school medical inspection, and the bureau of nursing. Services rendered in the school program are qualitatively the same as in 1929. The major changes have been those of organization within the health department. Since 1929, 10 nurses doing follow-up work have been transferred from the bureau of school medical inspection to a generalized public-health nursing service administered by 1 It is believed that the health of the school child might well be considered in connection with maternal, infant, and preschool hygiene, thus insuring continuous interest in the subject from a time before the child is born until he passes from the supervision of the school system. It has already been suggested, under the heading of organization, that the health of the school child be one of the chief concerns of the proposed division of individual hygiene. a new bureau—the bureau of nursing. Follow-up work is now done as part of the work of 38 nurses whose other duties include work in the fields of maternity, infancy, and preschool hygiene, and communicable disease control. Also since 1929 there has been an increase in the number of physicians, dentists, and dental hygienists within the bureau of school medical inspection. Part of this increase was for the purpose of extending school medical inspection to the parochial schools, but the appropriation from which salaries are to be paid limited the services to public schools. The positions and salaries in this bureau are shown in table 1. The position of assistant director is unfilled, partly because it was only recently created and partly because a qualified individual has not been obtained. A physiotherapist, whose salary is paid by the bureau of maternal and child hygiene, is assigned to the school medical inspection work to supplement the services of its two workers of the same type. No additions other than the filling of the assistant director's position are now planned. TABLE 1.-Positions, duties, and salaries of personnel (including those engaged in dental hygiene) of bureau of school medical inspection of the Health Department of the District of Columbia in 1938 Doctors and dentists working in the schools are part-time employees otherwise engaged in private practice. The doctors, officially known as medical inspectors, are employed 3 hours daily for 6 days a week. The qualifications required for the position of medical inspector are graduation from a reputable medical school, 3 years' experience in the practice of medicine, and licensure in the District of Columbia. No special knowledge of school medical inspection work is required, |