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examination of athletes, and supplementary examinations for special students and special occasions. This study deals primarily with the medical examination required of all students.

Information was requested on the questionnaire in regard to the number of examinations required of all pupils and the years in which such examinations are given. The questionnaire did not provide for information as to whether the required examination is given by school physicians in the school or by private physicians in their offices.

Since parents should have an important role in the periodic examination to assure a more adequate follow-through on the correction of remedial defects, and for other reasons, information was also requested about the presence of parents at the examination and at school conferences to discuss the examination. These and related topics are here presented.

Number of Medical Examinations Per Pupil

A considerable variation in the number of medical examinations required of all pupils in the elementary and secondary years exists between cities, States and regions. Some authorities believe that annual or biennial examinations are needed, whereas others consider that less frequent examinations are desirable, particularly if they are more thorough. The question of availability of medical personnel is a determining factor in the frequency of examinations given in the public schools.

A summary of this subject for the Nation is presented in Table 9.

Table 24 gives similar information by regions and city size. These tables, and the discussion which follows, only concern the medical examination required of each pupil. A large percentage of the schools reporting that they have "no" required examination do indicate that (1) examinations are "offered" but not "required," and (2) that special examinations are given to athletes and others. These special examinations are also given in many of the cities which have the required examinations for all pupils.

United States. The information for all cities reporting is, in percent, as follows: no medical examination required, 17.0; 1 examination, 18.0; 2 examinations, 7.9; 3-4 examinations, 21.6; 5-6 examinations, 16.4; 7-8 examinations, 5.0; 9-10 examinations, 1.6; 11-12 examinations, 4.0; and 13-14 examinations, 8.5.

Seventeen percent of the school systems report that they require 8 to 14 medical examinations. Many of these systems are actually reporting that they have examinations annually, since some of them do not have school beyond the eighth grade. Those cities reporting 13 to 14 examinations give one before the child enters kindergarten and annually thereafter.

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Table 9.-Percent of school systems reporting varying numbers of medical examinations required of each pupil enrolled in school, including personnel

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The cities in Group IV represent a 50 percent sampling. Therefore, in order to weight Group IV correctly when computing the percentages in totals for "United States," the number of cities in each column of Group IV has first been doubled. This procedure has also been followed with other tables related to the second questionnaire when determining the final percentages for geographical regions and for the United States.

City population groups.-Groups I and II have approximately the same ranking frequency plans for medical examinations. The rank for the plans most often reported, with percent shown, is as follows:

Group I-3-4 examinations (38.1); 5-6 examinations (20.3); no examination (17.8); 1 examination (6.0); and 13-14 examinations (5.9). Group II.-3-4 examinations (30.3); 5-6 examinations (19.0); no examination (12.8); 13-14 examinations (10.4); and 1 examination (10.0). Group III.-5-6 examinations (20.0); 3-4 examinations (19.4); 1 examination (15.3); no examination (13.0); and 13-14 examinations (11.5). Group IV.-1 examination (20.9); 3-4 examinations (20.2); no examination (19.0); 5-6 examinations (14.4); and 2 examinations (8.2).

Of the 250 cities which reported that they required no examination, 15 were in Group I; 27 in Group II; 73 in Group III; and 135 in Group IV. Of the 260 cities reporting that they required only 1 examination, 5 were in Group 1; 21 in Group II; 86 in Group III; and 148 in Group IV.

Regions.-Middle Atlantic reports the highest number of examinations per pupil with all except two cities requiring at least three examinations. Ranking first is the 5-6 examination plan and second, the 13-14 examination plan.

Information for the other regions, with the plan ranking first, is as follows: New England, 5-6 examination plan; East North Central and East South Central, 3-4 examination plan; West North Central, South Atlantic and Pacific, one examination plan; and West South Central and Mountain,"no" examination plan.

The regions reporting the highest percentages of their cities with no required examination are: Mountain (40.0); West South Central (35.3); West North Central (27.3); and Pacific (23.2).

Grades in Which Required Medical
Examinations are Given

The 80 percent of the 1,556 cities which reported that they required one or more medical examinations of each pupil also indicated the grade or grades in which the examinations were most frequently given. Pertinent information on this subject follows:

One examination.-Of the 260 cities reporting that they required only one medical examination, 121 indicated that it was given as a preschool examination; 39 reported it as given in the kindergarten; and 87 stated first grade. The remaining 13 cities gave the examination in other grades.

Two examinations. Of all the cities reporting, 122 indicated that they required two examinations of each pupil during his years in school. Of the 244 examination grades reported by these cities, 37 are given as preschool examinations; 35 in kindergarten; 69 in first grade; 56 in grades 2-6; 38 in grades 7-9; and 9 in grades 10-12.

Three examinations.-There were 196 cities reporting three required examinations of all pupils. Of the 588 examination grades involved, 30 are preschool; 35 in kindergarten; 142 in first grade; 166 in grades 2-6; 176 in grades 7-9; and 39 in grades 10-12.

Four or more examinations.-In instances where four or more examinations are required, there tended to be a spacing between the years so as to cover preschool, lower elementray grades, intermediate elementary grades, upper elementary or junior high school grades, senior high school grades, and a terminal examination. The examinations tended to be given more frequently in preschool, kindergarten and first grade than in any other comparable period. The senior high school years were next in frequency, with grades 2-6 being lowest. Many of the schools which reported 4-6 examinations gave the last one in the tenth or eleventh grade rather than in the twelfth grade.

Parents Present at Medical Examinations in Elementary Schools

When parents are present at a medical examination, it is more likely that they will understand their child's condition and needs. Consequently, there is a greater possibility that there will be a follow-through to see that remedial defects are corrected. Table 10 gives data in regard to the frequency with which parents are present at medical examina

Table 10.-Percent of school systems reporting various extents to which elementary school children are accompanied by one or both parents at medical examination

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1 To be read as follows: 14.2 percent of the school systems reporting indicate that no elementary school children are "accompanied by one or both parents at the initial entrance examination."

tions in the elementary school. Table 25 indicates corresponding information by regions and groups.

At initial examination.-For the United States as a whole, 52.9 percent of the cities report that the elementary school children are accompanied by one or more parents at 50 to 100 percent of the intitial medical examinations. Additional statistics are: 6.8 percent of the cities indicate that parents are present at 15 to 49 percent of the examinations; 6.6 percent at 5-14 percent of the examinations; 19.5 percent at less than 5 percent of the examinations; and 14.2 percent report that no parents are present at the initial medical examination.

The extent to which parents are present does not vary much by city population groups; the range for cities reporting 50-100 percent of examination with parents present is from 51.2 percent for Group I to 56.9 percent for Group II. The range for "no parents present" is from 7.1 percent of the cities in Group I to 15.5 percent in Group IV.

At subsequent examinations.-Parents are much less likely to accompany children at subsequent medical examinations in the elementary schools. Only 9.3 percent of cities report parents present at 50-100 percent of the examinations. The largest number of cities-56.1 percent-report that this practice occurs in less than 5 percent of the examinations. There are 14.2 percent of the cities which report that no parents accompany the children at the examination.

By city groups, there are no important variations from the national percentages. Group I has a slightly higher percentage of cities reporting that parents accompany children at the subsequent examinations. For cities reporting "no parents present," the range is from 7.1 percent for Group I to 15.5 percent for Group IV.

The questionnaire did not provide for information about parents accompanying children attending the secondary schools. In general, the practice there is even less common than that indicated for the elementary school.

Parent Conferences in Regard to Examinations

A conference held with the parent either at the time of the medical examination or shortly afterwards, to plan for the follow-through to secure medical or other care, is recommended by school health authorities. The school person at such a conference may be a teacher, the principal, or a representative of the school health service. This procedure, similar to having a parent present at the medical examination, may help to assure that there is a follow-through. The extent to which such conferences are held is indicated in Table 11.

Table 11.-Percent of school systems reporting varying extents to which the school holds a conference with a parent following a medical examination of the child to plan for the follow-through

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For the United States, 43.8 percent of the cities report that such conferences are held "regularly" with parents. Another 41.1 percent report that such conferences are held "only for special cases." Only 2.3 percent indicate that the conferences are "seldom" held; and 12.8 percent state that there are "no provisions" for parent conferences.

Such parent conferences are held regularly in 67.9 percent of the cities in Group I; in 59.7 percent in Group II; in 46.7 percent in Group III; and in 38.8 percent in Group IV.

The statistics for cities reporting "no provision" for such conferences are as follows: Group I, 7.1 percent; Group II, 8.5 percent; Group III, 8.5 percent; and Group IV, 15.5 percent.

The percentages for "only special cases" are: Group I, 25.0 percent; Group II, 31.8 percent; Group III, 44.0 percent; and Group IV, 42.2 percent. Few cities list "seldom" as an answer.

Clothing in the Medical Examination

The extent to which clothing is removed during a medical examination is one guide to the quality of the examination. The questionnaire provided for the recording of the various practices in the removal of

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