of the yard, or, if the play space is limited for the number of pupils involved, it is better not to plant them at all.

MEDICAL INSPECTION AND NURSES IN SCHOOLS. Fully 60 per cent of the children in our schools are said to be more or less handicapped by physical defects or physical conditions which could easily be detected and as easily remedied. Wm. H. Allen, in his "Physics and Health," says that 95 per cent of the pupils examined during a single term in St. Paul showed one or more physical defects and that 68 per cent required medical or surgical treatment. In Pasadena, out of 275 pupils questioned, 71 had never been to a dentist, 53 had never used a tooth-brush, 25 slept in rooms with the windows all shut, 88 had much sickness, 57 had trouble with their eyes, 38 often had earache, 60 were seldom able to hear what the teacher said, and 82 usually grew very tired in school. Out of 275,000 pupils examined during a period of two years in New York, 72 per cent showed the need of treatment for one or more physical defects, and these were children of the rich and well-to-do as well as of the poor. There were defects of the eyes, of the nose and throat, of the teeth, of hearing, of the scalp and skin, as well as such as arose from incorrect postures, from sleeping in crowded and ill-ventilated rooms, from having too little or too much to eat or from eating wrong things, and from bad habits of work and study. Principals and teachers do not have sufficiently expert knowledge for the detection of all such defects, although they can discover many of the worst cases and should be trained to do so, especially in places where medical supervision by experts is not easily secured. But the physician and the nurse are needed in the schools for additional reasons. Not only is a physician more competent to examine for physical defects and conditions, but he is also needed to discover and exclude cases of contagious disease and to see that both in the school and in the home teachers and pupils work under sanitary conditions. And he should be authorized not only to report upon health conditions but to insist upon his recommendations receiving every possible attention. During the late war between Russia and Japan, the one supreme authority in the Japanese campaign was the army-surgeon. And his

authority and care proved to be a large factor in the Japanese aggressiveness and endurance. But the nurse is also needed to assist the physician and to see that his instructions are carried out by following the child, when necessary, into its home. A tactful, sympathetic nurse can often accomplish in her "follow-up" work in the home a transformation of conditions in behalf of the child. The physician should arrange to give systematic instruction to both teachers and parents on subjects of health and sanitation. This instruction should take the form of practical talks free from all abstruse terms and explanations. The nurse, aside from the assistance she renders the physician in his work, can be of great service to girls at the age of puberty and in treating many of the minor ailments and accidents which arise in every large school.

Besides being in accord with the growing conception of the value of human life, medical inspection is of great economic value. It requires on the average 9 years for the child with enlarged adenoids to complete an 8 years' course of study. As a result he wastes a year of time and is usually less well prepared than a child who can breathe normally. Besides, if his schooling is costing $25 per year, this amount, in his case, is lost to the school system where he is educated by the extra year required. In a large city with a number of such cases in the schools, it would be possible to pay for the most effective medical supervision and still have money left out of the funds saved by the prompt removal of all the physical handicaps that prolong the period required to complete the course of study. And this takes no account whatever of the waste of time and efficiency fastened upon these pupils by these physical defects. Nor does it consider the great loss to the State through the lowered return in effective citizenship that it thus gets from these young people. Adenoid nasal obstruction necessitates breathing through the mouth, and is responsible, according to medical authorities, for such serious handicaps as chronic nasal catarrh; chronic inflammation of the middle ear, which leads to defective hearing; malformation of the rose, palate, and upper jaw; chronic sore throat; and tends toward flat chest, stoop shoulders, indigestion from swallowing mucus, Door nutrition, and

many of the nervous disorders arising from reflex irritation. This is a long array of serious charges to lay against a defect that almost invariably yields to treatment, or is easily remedied by a very simple surgical operation. As mental dulness is a natural result of such physical handicaps, removal or satisfactory treatment of adenoids is always followed by an improvement in the intellectual and moral development of the child. But adenoids are only one of the many physical defects that demand the attention of the school and its medical expert. The effects of decay of the teeth are now known to be more serious than most parents realize. In lowering of the general health through the imperfect mastication that follows the loss or decay of a number of teeth, in the increased danger from putrid and germ-laden food that tends to collect in the cavities of decaying teeth and to be swallowed with the other food, and in general defective mouth conditions in children, the necessity of care of the teeth is readily seen. The medical inspector, however, more than justifies any reasonable expenditure for his services in the way he is able to avoid the spread of contagious diseases. In this way it is possible for him to save much suffering and many precious lives. And, incidentally, he is avoiding the necessity of much absence through sickness, and thus again economizing in the period required for completing the

course.

Because of the difficulty of establishing effective medical inspection in rural and semi-rural districts, teachers should be trained, even more carefully than in the cities, to detect from the appearance and action of the pupil the presence of defects or of contagious disease. The attention of parents and of the local physician can then be called to each case. In larger school centres nurses can perform this service, although even then the value of the teacher who knows and is quick to see is very great. Some States now require such training for all their teachers. An important part of all such supervision of the health of pupils is the way in which parents are notified and the care with which every case is followed until proper action is taken by them. Strange to say, some parents are so indifferent, or so mercenary, or so imbued with a false sense of

their rights as against the rights of their children that they resent such vigilance upon the part of the school. Although an injudicious or over-zealous medical inspector or teacher is sometimes at fault, parents in general, especially when they understand, welcome such careful oversight of the health of their children. However, no medical inspector, nurse, or teacher should get into the habit of seeing disease everywhere and in everything. It pays to be looking for good health, even if it has to be visioned beyond the physical defect or disease.

HEALTH INSTRUCTION.-There is one main purpose in all of the health instruction in the schools, and that is, the development of intelligent habits of health. A healthy mind in a healthy body has been a favorite phrase in the mouths of educators for many years; but it is only within recent times that the demand has grown insistent that health instruction shall result in actual health activities, that disease shall be prevented as well as cured, and that the incomplete or even imperfect work of nature shall have all possible assistance. It is claimed that 40 per cent of the deaths among children are due to preventable disease,—diseases whose causes are traceable to ignorance and neglect. Of those who are saved, many are unable to cope with their more robust fellows, or have physical habits or organic affections that seriously handicap them for either success or the full enjoyment of life. The school therefore has clearly two duties to perform. One is to assist in preventing physical defects and disease; the other is to assist in furnishing the information and training that will help to make and keep the body well and strong. One is to furnish health information and training to the child while it is in the school; the other is to assume a helpful attitude in regard to its health while it is in the home, as well as while it is in the school. The former instructs the child, the latter safeguards the instruction and the child. The former requires well-selected facts and a strong appeal; the latter, tact and true interest in the welfare of the child. But the school has also a third duty to perform, and that is, to point out and assist in remedying physical defects by giving the home all necessary information and assistance, and the

child the kind of instruction which will make him intelligent and persistent in helping himself in their remedy.

Effective health instruction is one of the most important duties of the school. Not only is there an imperative need of convincing the community that without sanitary school buildings, ample provision for recreation, and thorough health supervision satisfactory educational results cannot be obtained, but there is even greater need of enlightening the school to the fact that, without the health instruction that produces well-informed, well-trained pupils, the most promising citizens cannot be produced. Instruction that tends to promote in the pupil the physical efficiency, the longevity, the joy coming from vigorous physical life, also promotes the intellectual work and is sure to exert a far-reaching influence on the spiritual life. Proper physical training in the school not only furnishes information which fosters the habits of health that tend strongly toward success, but it also interests the individual in the promotion of the health of the community in which he lives. And this social side of health teaching should be far-reaching in its influence and results. When tested by its actual results, the health teaching in the schools has not been encouraging. This has no doubt been due to: (1) an imperfect or incomplete study of the psychology of the subject; (2) to a poor selection of material for the work; (3) to mistakes in method; and (4) to imperfect preparation and the lack of interest on the part of teachers.

1. Psychology of Health Instruction.-Like in morality the personal equation enters so largely into the health instruction that it is not always easy to predict final results. It is comparatively easy to appeal to the pupil's memory of facts, but often exceedingly difficult to get him to assimilate these facts in a way that will make them control his life activities. Nor is it usually wise to attempt to connect didactic moral instruction with the teaching of physiological facts. The child's own observation will so often seem to contradict the teacher's ethical aim that confidence in the instruction will be undermined. The pupil is usually quick to sense a hygienic situation which is forced for the purpose of conveying a moral lesson, and takes little vital interest in material which is artificial and not closely allied