safe and efficient operation, unless an appropriation was available of $25,000 for initial expenditure and $12,500 for annual maintenance. It was also suggested by Dr. Leake that whether or not the manufacture of diphtheria antitoxin was undertaken by the State, the number of distributing centers of this product in the State should be increased to about 600, so as to make supplies available for all communities. SCHOOL HYGIENE. Studies in school hygiene formerly undertaken by the service in cooperation with local health authorities and boards of education have been extended and conducted in a more intensive manner during the past year. There is increasing necessity for the application of scientific medical and sanitary knowledge to the administration of the public schools in the interests of efficiency and health. This necessity is especially apparent in many rural communities, where effort has been improperly directed and much money unwisely expended for want of the necessary knowledge of the hygienic requirements of school life. The purposes of sanitary and medical surveys, from the publichealth standpoint, are to collect data for the standardization of the requirements of school hygiene; to collect mental and physical data over wide areas of the country which may be of value in establishing mental and physical standards for the youth of the Nation; to stimulate interest in sanitary surveys of schools; to instruct local health and school authorities wherever needed in the methods of making sanitary and medical surveys of schools and in the utilization of the knowledge gained thereby for economic educational advancement, instruction in personal hygiene, and the betterment of community health. SANITARY SURVEY OF RURAL SCHOOLS IN PORTER COUNTY, IND. On request of the State and local health authorities, Surg. Taliaferro Clark, Passed Asst. Surg. G. L. Collins, and Asst. Surg. W. L. Treadway were directed to make a sanitary and medical survey of rural school buildings and school children in Porter County, Ind. This survey was begun February 11, 1915, and lasted until May 10, 1915. During this survey exhaustive studies were made of the hygiene of 75 rural schools, due attention being paid to the construction and location of school buildings, their heating and ventilating facilities, water supply, toilet facilities, and playgrounds. Numerous classroom observations were made, which included air examination, classroom temperatures, daylight illumination, type and arrangement of school desks, blackboards, location of windows, composition and color of walls and ceilings, position and arrangement of doors, and all other conditions which might affect the efficiency and health of school children. Medical and mental examinations were made of 2,488 school children, of whom 1,254 were boys and 1,234 girls. The results of these studies, together with the recommendations based thereon, will be published in a forthcoming report. SANITARY SURVEY OF THE NATIONAL TRAINING SCHOOL FOR BOYS, WASHINGTON, D. C. In accordance with a resolution adopted on September 5, 1914, by the Committee on Expenditures in the Department of Justice of the House of Representatives, Surg. Taliaferro Clark and Passed Asst. Surg. E. H. Mullan were directed to make a sanitary survey of the National Training School for Boys, including a physical and mental examination of the inmates. The National Training School for Boys is an institution situated in the District of Columbia, the trustees of which are appointed by the President. Its classes consist of persons not over 17 years of age committed by Federal courts and the district and juvenile courts of the District of Columbia. During the investigation in September and October, 1914, the sanitary condition of the buildings and grounds were carefully studied and 361 boys examined. As a result of the physical examinations the following defects were discovered: Defective vision in 25.2 per cent of the boys examined, defective hearing in 5 per cent, defective speech in 3 per cent, defective teeth in 43.3 per cent, enlarged tonsils in 3.3 per cent, adenoids in 1.9 per cent, glandular enlargement in 39 per cent, and spinal curvature in 12.4 per cent. In addition, 16.9 per cent of the boys examined had less than 85 per cent hemoglobin. The mental examination showed 20 cases afflicted with mental disease or mental defect and 16 suspicious cases, the percentage of mental defectives being lower than that reported in other reformatory institutions. Faults in sanitary construction were noted in certain of the buildings, especially in regard to lighting and fire protection, the equipment and arrangement of the school rooms, location of dining room, kitchen, and pantry, screening against flies, etc. Specific recommendations were made in the report submitted to the Committee on Expenditures in the Department of Justice for the remedying of the defects observed, especially in regard to the construction of a new building for the reception of newly committed boys, improving the lighting and fire-protection system of certain buildings, remodeling of toilets, screening, improving of playgrounds, providing the inmates with a well-balanced diet, removal of insane and epileptic cases, and employment of a medical psychologist to eliminate mental defectives and classify the school work according to mental age. MENTAL EXAMINATION OF INMATES, NATIONAL JUNIOR REPUBLIC, ANNAPOLIS JUNCTION, MD. As stated in the last annual report (p. 68), a physical and mental examination was made by Surg. Taliaferro Clark of the boys of the National Junior Republic, at Annapolis Junction, Md., in May, 1914. At the request of the superintendent of this institution a mental examination of the boys admitted to the institution since the survey of last year was made by the same officer in June, 1915. In the course of this examination, completed June 15, 1915, 27 boys were examined mentally, among whom were found 8 mentally 70 PUBLIC HEALTH SERVICE. defective, 1 constitutionally inferior, and 27 backward. The mental defectives constituted 29.6 per cent of the total examined, a percentage closely approximating that found in correctional institutions. During the year a number of boys were received from various correctional institutions, which in large measure accounts for the high percentage of mental defectives found at the time of this examination. Primarily the republic is not intended for the reception of boys of this type. However, owing to the fact that a large number of delinquent and incorrigible children are mentally defective to a greater or less degree, it would be difficult to refuse admission to all mental defectives and at the same time continue the purposes for which the institution was founded. As the result of this and previous inspections of this institution, recommendations were made by Dr. Clark for rigid physical examination and careful determination of the mental age of every child accepted by the republic, reorganization of the teaching staff to include preceptors especially skilled in the training of backward and mentally defective children, and the replacement of at least two of the present cottages by modern dormitories. MENTAL EXAMINATIONS OF SCHOOL CHILDREN IN WESTCHESTER COUNTY, N. Y. The commission to investigate provision for the mentally deficient in the State of New York requested the cooperation of the service in making a survey of Westchester County, N. Y., to determine the number of mentally defective persons residing therein. In accordance with this request, Passed Asst. Surg. E. H. Mullan was detailed on October 31, 1914, to cooperate with the commission in its investigations. The plans of the commission contemplated at first a study of the number of mentally defective persons in Westchester County, the conditions under which they live, and the relation which mental deficiency bears in that county to education, poverty, delinquency, and other social problems. In view, however, of the fact that the report of the commission to the legislature had to be completed before February 10, 1915, it was deemed advisable for Dr. Mullan to limit his work to making a mental examination of the children in a typical school in Yonkers, Westchester County, N. Y. Dr. Mullan's studies were continued from November 19, 1914, to January 19, 1915. The school selected, after conference with the superintendent of schools, had a registration of 1,205 pupils. A mental examination of 1,136 of these children actually attending school was made, using for the purpose tests similar to those employed in the examination of immigrant children at Ellis Island, N. Y. The results of the examinations showed 9 feeble-minded, 11 suspicious cases of mental deficiency, and 2 cases suspicious of epilepsy. The proportion of feeble-minded to the total number examined was therefore almost 8 to 1,000, and if the suspicious cases are included 18 to 1,000. It was regarded as certain by the investigator that some of the suspicious cases would later be shown to be positive cases of mental deficiency, and that others would in turn show improvement of intellectual PUBLIC HEALTH SERVICE. 71 power. Nine of the above-mentioned cases of feeble-mindedness were found to have been born in the United States, the paternal parent in six cases being American born and in four cases foreign born. A similar examination was made of 176 children in a parochial school in the same county. This examination resulted in finding five feeble-minded and one suspicious case. The collection of data relating to sanitary environment, economic status, and other factors having a bearing on the presence of mental defects in the area investigated devolved on others associated in the work of the commission. The technical examination of school children as conducted to determine mental status is time consuming but considered of great importance. By this means can the value of present tests be judged. Furthermore, improved tests may be developed and data collected which will throw light on the problems of handling and training mental defects. APPARENT RELATION OF SANITARY ENVIRONMENT TO SCHOOL PROGRESS. Advancement in school grades. A study of 2,166 white children (1,062 boys and 1,104 girls) by Prof. C. W. Stiles in one city has shown the interesting fact that if the children are classified according to the presence or absence of a privy or of sewer connection (but no privy) at their homes the following results are obtained: The girls averaged 80 per cent of the advancement in school grades to which they were entitled on the legal basis of entering school at 6 years of age and on the supposition that they were entitled to advance one grade each year thereafter. The boys averaged 78 per cent of the advancement to which they were entitled theoretically. Children who live at sewered homes seem to advance more rapidly than children who live at homes provided with privies. A group of 814 girls from sewered homes advanced 84 per cent, as compared with 72 per cent advancement in a group of 240 girls who lived at homes provided with privies; and a group of 772 boys from sewered homes advanced 81 per cent, as compared with 68 per cent advancement in a group of 194 boys who live at homes provided with privies. It would thus appear that the sanitation (in respect to excreta disposal) may be taken as basis for classification of two groups of school children who show different degrees of school advancement. While the type of sanitation is one factor that influences schoolgrade retardation, since more diseases of certain types will naturally occur under poorer than under better sanitary conditions, there must be taken into consideration certain other factors that play important rôles in the results obtained, for instance, general economic conditions, home influences, etc. Memory span. In both boys and girls there was in general a gradual increase in the memory span from the youngest (6 years old) group to the oldest (17 years old) group, but this increase was not regular for each successive year, for in the boys the 10-year-old group stood ahead of the 11-year-old group, and the 12-year-old group stood ahead of the 13-year-old group, while in the girls the 9-year-old group excelled the 10-year-old group, and the 13-yearold group excelled the 14- and the 15-year old groups. The conclusion would seem justified that there was no essential difference brought out between the memory spans of the two sexes, and that while there was in general a gradual increase in the span from younger to older children this increase did not exhibit itself in absolutely exact ratio to age. It seems reasonable to expect the following memory spans in the city schools for white children in the locality under consideration: Children 6 and 7 years old__. Children 8 to 13 years old, inclusive__ Numbers. 5 6 7 Dividing the children into sanitary groups, it was found that out of 24 comparisons 14 groups from sewered homes and 10 groups from privy homes held first place. SANITARY SURVEY OF SCHOOLS IN MANATEE COUNTY, FLA. In connection with an investigation of the prevalence of trachoma among the school children of Manatee County, Fla., made by Surg. J. A. Nydegger at the request of the State Board of Health of Florida, a sanitary survey of the schools in that county was also undertaken. This survey lasted from March 13 to March 26, 1915, and included (1) a medical examination of school children, with special reference to the occurrence of contagious and infectious diseases and physical and mental defects; (2) a sanitary inspection of school buildings, outhouses, water supply, excreta disposal, grounds, etc. In all, Dr. Nydegger inspected 25 schools and examined 1,684 children. Eleven of the schools were rural and the rest urban. Most of the rural schools were, however, closed at the time of the visit. Address on public-health subjects were delivered at all the schools visited. It was found that 26 per cent of the children examined had defective teeth, 16.2 per cent enlarged tonsils, 13.4 per cent adenoids, 12.4 per cent anemia, while hookworm disease was prevalent to a moderate extent. Nine cases of apparent mental defectiveness were also detected and 1 case of ringworm.1 In regard to sanitary conditions in general, as exemplified by methods of sewage disposal, water supply, ventilation, etc., 1 of the schools could be classified as excellent, 8 as good, 7 as fair, and 9 as decidedly bad. As a rule there was noticed a marked improvement in all the schools recently constructed in regard to lighting, heating, ventilation, location, sanitary arrangements, and general equipment. The complete report of Dr. Nydegger's investigation has been published as Supplement No. 25 to the Public Health Reports. NEED FOR IMPROVEMENT IN RURAL SCHOOLS. As surveys of sanitary conditions in rural sections are being made by the service it becomes more and more apparent that organized health work in schools has so far been largely confined to cities. It 1 See also p. 39. |