Steady growth and increase in the body weight constitute most important indices to the rate of progress being made by a child. Hence if a child fails to gain normally something always is wrong,

and an examination is required to discover the trouble.

It is earnestly to be hoped that the time is near when all teachers, before receiving teaching certificates, will be required to possess training in testing eyesight, hearing, and mental deficiency besides being grounded in school hygiene and the recognition of the more usual communicable diseases.

Nothing is more certain than that in the teacher we have an agent, hitherto neglected, who, if properly utilized, is susceptible, in the highest degree, of improving the health of school children. This is especially true in the case of rural schools, where the communities are small, the school the usual center of culture and information, and the influence of the teacher extensible to the home.

It is plain from the foregoing that we are increasing the requirements and qualifications of a profession which is already loaded to capacity with work. If, then, as Prof. William James puts it, we are going to require the teacher to “energize upon a higher plane," the school authorities in turn must do something for the teacher. This "something" means that the teacher should be better paid and have smaller classes. The reduction in the average size of classes will be a most important step in advance, for it will signify that the pupil is no longer a mere name to the teacher, but an individual differentiated plainly in the teacher's mind from his classmates, thus insuring much closer observation and consideration of his various aptitudes and requirements.

The results of the general entry of teachers as effectives in the army of health crusaders are certain to be of the happiest order so far as the community at large is concerned.

The School Physician.

If we increase the qualifications demanded of teachers from a health standpoint, what shall we say of the school physician? In this country at present the school physician, usually a busy practitioner or a young man just starting out to conquer a place in his profession, is paid a small salary for the part of his time devoted to medical inspection of schools. Owing to the newness of public-health work in general he does not, as a rule, approach his duties with the proper viewpoint. His idea of doctoring is to treat disease, not to prevent it. He is deficient in consequence in that breadth of mental


which must characterize all who work in the great preventive field of medicine.

The school physician should be primarily a man of wide general qualifications, with insight into human nature and its psychologs.


He should be a keen observer, an acute and accurate diagnostician, mules

& progressive sanịtarian, especially with respect to school hygiene and the psychology of education. It goes without saying that he

should be thoroughly familiar with communicable diseases and the We necessary technic of bacteriologic and laboratory diagnosis; with all

details of school architecture, equipment, and the like; with disindefie: fection, lighting, heating, sanitation, and, in a word, with all the itin 2 minutiæ which would increase his efficiency in this particular phase

of professional activity. In addition to all this, he must be a patient, rebran enthusiastic, forceful man, devoting all his time to this work. It is se evident that such a man must receive and is fully worth adequate bilet compensation. The money spent, however, in paying men of this Moc caliber will be returned manifold in benefits to the State.

His duties would consist in a preliminary examination of all school children at the beginning of the school year. The object of his primary examination would not be so much a complete survey of the child's physical condition as to establish the general physical status, the freedom from communicable disease of any kind, including communicable disease of the eyes, such as trachoma, and to

determine the presence of satisfactory protection against smallpox po by vaccination.

Before the close of the school year each child in his district is to y receive a careful physical examination, the results of which are made

å matter of permanent and accurate record. Children found to hare defective vision or hearing by the teacher's test are carefully examined by the school physician, and the exact nature and extent of the defect determined.

In addition to this the doctor makes mental examination of children, when necessary, in order to determine the grade of any mental deficiency which may be present, and makes recommendations, in the case of such retarded pupils, as to the special classes in which they should be placed.

Moreover, the school physician is not satisfied with the scope of his duties merely in relation to the child. He examines physically all teachers and school employees, thus insuring that only those free from communicable disease come in contact with the children.

Besides these duties the school physician is the sanitarian of the school buildings and grounds. His supervision includes the architecture of school buildings, school equipment, lighting, heating, ventilation

, cleaning, sewerage and water supplies, playgrounds, disinfection, and the like. He also frames such sanitary regulations as are Decessary in order to maintain the school and its environment constantly in a sanitary condition, and their condition is checked by frequent inspections.

He should, moreover, instruct teachers in matters pertaining to school hygiene and the health of their pupils.

It is seen from the foregoing that no easy job is outlined for the school physician, and it is equally evident that men who fulfill these qualifications will be great powers for good in any community.

The School Nurse. Wherever employed school authorities have been enthusiastic in praise of the good accomplished by school nurses. One at least should be in daily attendance at each school. They attend to minor injuries and diseases, collect children to be examined by the school physician from the various classrooms, assist in keeping records, follow up children in their homes to ascertain the causes for absence, urge parents to have corrected physical defects reported in their children, discover what home conditions require correction in the case of children not progressing satisfactorily from a physical or mental standpoint, and the like.

The school nurse is a most valuable agent for extending the educational sphere of the school into the home. She has made herself indispensable wherever introduced.

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The School Clinic.

The apparatus for the medical supervision of schools that has just been outlined will undoubtedly detect defects and diseases in pupils, watch over their health during school hours, and greatly improve the sanitation of school buildings and grounds, besides insuring a healthy teaching staff and school personnel.

But of what avail is it to detect a defective or diseased condition in children unless the defect is remedied or the disease cured? While the experience varies in different localities, even under the most favorable conditions, when defects in children are brought to the parents' attention a large percentage of such defects and diseases are allowed to exert their baneful influence unchecked, often leading to permanent physical handicaps and, in the case of such diseases as ringworm or trachoma, to the exclusion of children from school for long periods.

Adenoid growths, enlarged tonsils, and defective teeth form another class of defects which parents are prone to neglect, even after attention has been called to their existence, through ignorance of their effects, until the damage wrought is irretrievable. When the parents try to heed advice given for the correction of physical defects and are too poor to employ a physician for the purpose, the cry goes up

that hospitals and dispensaries, already overcrowded beyond their capacity, have their facilities further clogged by the crowds of school children applying for relief. Again the time consumed in waiting their

return in such crowded institutions is apt to discourage well-meaning

parents and their children so that the defect remains uncorrected.

The obvious answer is the establishment of clinics solely for school children. Such clinics are specially adapted for the treatment of defects and diseases peculiar to school life. The treatment afforded is prompt and efficient, and, wherever they have been established, the results have been brilliant and of lasting utility.

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The Country School. O.

What of the country school ? It may well be urged that, while the

kind of medical supervision just outlined is suited for the densely en populated urban community, rich in funds, what can be done to fur

nish medical supervision in the country where the funds are scanty and the schools small and separated by great distances!

Everything that applies to medical school inspection in cities apsi plies with even greater force in the country, and the need also is

greater. Inspection of many of our rural schools has revealed insaniingetary conditions in need of immediate correction. In the hookworm

States whole schools are found infected with the disorder and, indeed, in this country, rural sanitation to-day is a problem presenting a virs gin field.

In answer one may suggest that the qualifications in hygiene and sanitation of teachers be raised as previously described, and that, wherever practicable, school nurses be attached to rural communities, The medical inspection may be performed, as is the case in England, by traveling medical school inspectors, employed by the State, with good salaries and travel allowances. The services of local physicians can be enlisted, provided they pass some form of State examination as to their special qualifications. The correction of visual and dental desects, together with such other conditions as require expert or special treatment, can be effected by means of traveling school clinics which visit localities where the reports of the medical school inspectors show their services to be needed.

In conclusion it may be said that, in common with all new probJems, that of the medical inspection of schools needs working out and the future is filled with rich promises of good to be accomplished, The main point which we have for congratulation is that its potentialities are now beginning to be fully recognized, and it remains the duty of all who can to extend, so far as in them lies, the field of its appliv (stion.

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