by the State, county, or city as a public-health nurse and in 12 by some other organization than the department of education or health. From these returns there is either a full or part-time nurse in 80 per cent of these schools, but the percentage will vary greatly by States.

A "special health supervisor" is reported by 46 (9 per cent) of these cities, 40 of whom are employed by the board of education, 4 by the "city," one by the board of health, and one by the Red Cross. Elsewhere the nurse is usually reported as in general charge of the health work.

In 381 cities (75 per cent) there is a physical-education director employed, in 350 by the school board, in 12 by the "city," in 5 by the county, in 4 by the county and State, and in the rest by other combinations of agencies.

Health Examinations

In 499 cities "the teachers inspect pupils daily for signs of communicable disease," and it is to be hoped that they know what these signs are. In all but two of these cities the pupils with such signs are promptly isolated and sent home, which statement is too good to be true.

All but 20 of these communities report the weighing and measuring of pupils, but 47 do not report how often this is done. In 6 it is done weekly; in 223 monthly; in 98 less often, but more than twice a year; in 96 twice a year; in 45 yearly; and in 2 every two years. In 184 the teacher does the weighing and measuring, in 177 the nurse, in 84 the nurse and teacher, in 11 the physician, in 6 the nurse and physician. In 10 there is some other combination of examiners, and 40 superintendents make no report.

Regarding a general medical examination 87 make no report and in 51 communities there is no such examination (a total of 27 per cent). In 73 per cent there are such examinations.

In 300 cities (59 per cent) this examination is given yearly, and in 40 twice a year. In 15 it is given every two years. In 220 the examination is made by a physician, in 42 by a nurse, in 66 by the physician and nurse.

In 456 cities (90 per cent) the eyes of the pupils are examined. In 354 this is done yearly; in 49 twice a year; in 11 every two years (a total of about 80 per cent). Eight report "irregularly" and the rest do not specify. In 177 this examination is made by a nurse, in 164 by a physician, in 35 by a teacher, and in the remainder by 2 or more of these persons.

The examination of hearing is reported by about as many superintendents, given as frequently as for vision and usually by the same. examiners.

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The examination of the teeth is reported by eight more cities than those which mention the examination of vision. In 335 this is done yearly, in 72 twice a year, in 7 more frequently, in 10 monthly. parently eyes, ears, and teeth are examined in about the same schools and at the same time in most of them). Examination by a dentist is mentioned in 131 and by a nurse and dentist in 13. Evidently the service of a dentist, for at least examinations, is available in about 25 per cent of these cities.

For "follow-up work" in securing treatment of defects all but 68 mention some agent or agents. In 276 this is the nurse alone, in 27 the teacher, in 34 the doctor. More than one of these persons is mentioned in the remainder. The parent-teacher association is referred to in three reports.

General clinics for examination and treatment of pupils are reported as available in 164 cities (32 per cent). Of these 27 are traveling clinics, 137 are free, and 29 are pay clinics. Twenty-five are maintained by boards of education, 25 by some private agency, 19 by hospitals, 18 by city health departments, 17 by county health departments, 23 by the State department of health, 11 by physicians, 4 by nurses, 1 by a university, and 1 by a church.

Eye clinics are available in 98 cities. Thirteen are traveling clinics. In 25 there is a charge. Only 18 are supported by the schools. Dental clinics are reported by 197 cities (39 per cent). It is quite probable that many of these are included in the "general clinics." Of these dental clinics 39 are traveling. In 70 there is a charge for some or all children. Seventy-seven (40 per cent) are supported by the board of education (the law requires the establishment of such clinics in some States).

Mental Hygiene

"Psychological clinics" are reported by 98 cities (nearly 20 per cent). In 42 these are traveling clinics (most of them conducted by a State department). A charge is reported in 11 clinics; 37 are under the jurisdiction of the State; 12 under local education authorities; 3 under local health authorities; 8 are conducted by county authorities; 6 by universities; 7 by hospitals; 5 by private agencies; 4 by "research agencies"; 16 by local medical associations; 1 by a judge, and 1 by a church.

"Other" clinics are reported by 91 cities, and this probably refers to nose and throat clinics. Of these 37 are traveling clinics, about the same number as of dental clinics.

Physical Education

In 467 cities (90 per cent) a "regular time is set apart in the curriculum for physical education." (This is required by law in 36 States.)

In 23.2 per cent of schools (not cities) there is a gymnasium. In 88.3 there is a playground and in 29 per cent there is a play room (possibly many of these were included also under gymnasiums).

Noon Lunch

In 23 per cent of schools (58 per cent of cities) a noon lunch is provided (a large percentage considering the size of these communities unless they include children from surrounding territory).

In 141 cities this is supervised by the teacher, in 69 by the homeeconomics department, in 25 there is a cafeteria, in 4 a dietitian has charge, in 7 the Parent-Teacher Association; in 2 the janitor, and in 1 a nurse.

Health Education

Health education is given in 506 of these cities; in 250 such instruction is reported for all grades (the surprisingly high percentage of 50). In the remainder such teaching seldom extends beyond the eighth grade. In many it is not begun until the second, third, fourth, fifth, sixth, seventh, or even the eighth grade.

In 357 an attempt is made to correlate hygiene with other subjects, and in 36 "some" correlation is reported.

Conclusion

In 281 cities the superintendents find their present plan of health work satisfactory. In 59 cities things go fairly well, in 155 the results are not satisfactory, and 22 make no comment.

Lack of funds, lack of personnel, and lack of time are the chief complaints. One superintendent remarks "not organized and conducted through upper grades," which might have been said by a very large number. "Defects not taken care of" is another comment. It is evident that most superintendents know about what should be done but are hampered in securing the means. There is little complaint of lack of cooperation from the homes except as regards financial needs.

Communities from 2,500 to 5,000 Population

According to the census of 1920 there were 1,320 communities with a population of from 2,500 to 5,000. Replies to our questions were received from 1,007 of these places (76 per cent).

The total schools reported was 7,431 and the total pupils 1,076,701. There were 2,292 one-room schools or more than one in three of the schools reported. These occur chiefly in New England where the town is equivalent to the township of other sections of the country. Inclusive of 1-room schools there were, on the average, about 150 pupils per building.

Personnel

Twenty-one of these communities have a full-time medical inspector, 17 of whom are employed by the board of education. The remainder are employed by the county, city, or State and probably give only part of their time to the schools.

A part-time medical inspector is reported by 431 superintendents, 230 of whom (56 per cent) are employed by the board of education; 59 are county, 53 city, 45 State, and 11 district health officers. The Parent-Teacher Association employs one. Eight physicians give their services without charge.

In 299 communities (29 per cent) there is a full-time nurse. In 231 she is employed by the board of education and probably devotes all her time to the schools. In 345 (34 per cent) there is a part-time nurse (a total of 63 per cent of schools with nurses). In 106 communities these are hired by the school board, in 89 they are county nurses, in 35 they are city nurses, in 22 Red Cross nurses, etc.

Fifty-one (5 per cent) superintendents report a "special health supervisor," 49 of whom are employed by the board of education. In 545 (54 per cent) there is a physical-education director, 481 of whom are employed by the local board of education, six by the county, 16 by the district, 28 by the city or town, etc.

Health Examinations

According to these reports from 826 superintendents their teachers. are daily on the alert for signs of communicable disease and an even larger number, 903, state that pupils with such diseases are promptly isolated. This is all too good to be true.

In 900 of these communities pupils are weighed and measured. In 8 they are weighed weekly, in 348 monthly; in 178 less often but more than twice a year, in 182 twice a year; in 136 yearly, in 5 every 2 years, in 1 every 4 years. In 70 per cent therefore the children are weighed at least twice a year. In 349 this is done by the teacher, in 305 by nurses, in 138 by nurse and teacher.

A general medical examination is given yearly in 533 (53 per cent) of these communities. In about 500 it is given by a physician.

In 864 (86 per cent) the eyes of the pupils are examined. In 747 this is done yearly or oftener.

In 298 it is done by nurses, in 128 by teachers, in 221 by a physician. (It is somewhat puzzling that these figures for examinations by physicians do not equal or exceed those for general medical examinations). In 829 the hearing of pupils is examined. The frequency and the examiners are about the same as for vision.

In 847 localities the teeth are examined, in 596 places yearly, in 102 twice a year, in 11 monthly. The examinations are made by a dentist in 204 of these schools (20 per cent of all); by a nurse, dentist, or doc

tor in 68; and by a dentist and doctor in 13. In all a dentist is mentioned by 285 (28.5 per cent) of the superintendents answering the questionnaire.

A general clinic is available for examination or treatment of children. in 282 towns. In 111 it is a traveling clinic, and 223 are free clinics. Only 34 of these are under the direction of boards of education. Fifty-two are maintained by county health departments, 49 by State departments, 24 by local hospitals, 10 by nurses, 7 by physicians, 5 by Parent-Teacher Associations, etc.

The eye clinics reported are 136, of which 98 are traveling clinics. (Probably these also diagnose or treat nose and throat conditions.) These are all free. Only 14 of these are under the jurisdiction of departments of education.

In 305 towns (35 per cent) there is a dental clinic, of which 189 are traveling and 183 are free. These are under the department of education in 69 communities; 33 are supported by private agencies (dentists?), 40 by dentists, 11 by the Red Cross, etc.

Mental Hygiene

"Psychological clinics" are reported by 126 superintendents (12.5 per cent). These are traveling clinics in 75 instances and 63 are under the direction of the State. Seven are county clinics; 6 university clinics; 3 research clinics, and 10 others are maintained by private. associations. There is no charge in 104 of these clinics.

One hundred and forty-three "other" clinics are reported, 59 of which are traveling clinics. Doubtless these are mostly nose and throat clinics, and do not wholly duplicate the clinics already mentioned.

Health Education

Health education is reported by 973 superintendents (97 per cent). In about 50 per cent of schools it is given in all grades. Some degree of correlation of hygiene with other subjects is made in 58 per cent. Noon lunch.-There is provision for a noon lunch in 1,980, or 26 per cent of these schools. In 442 of the school districts this is supervised by the teacher, in 123 by the home-economics teacher, in 18 by the Parent-Teacher Association, in 3 by a dietitian, in 2 by janitors, and in 2 by a nurse, etc.

Physical Education

In 812 towns a regular time is set apart in the curriculum for "physical education." A gymnasium is reported in 15 per cent of schools (probably mostly high schools). Nineteen per cent have play Playgrounds are reported for 90 per cent of the schools.

rooms.