As laymen become more intelligent regarding their own bodies and healthy living, it grows harder and harder for quacks and incompetents to mislead and exploit them. Better than any possible outside safeguard is hygienic living. Fortunately, we can all learn the simple tests of environment and of living necessary to the selection of physicians, dentists, and opticians, or other "architects of health" whose efficiency and integrity are beyond question.

PART IV. OFFICIAL MACHINERY

FOR ENFORCING HEALTH

RIGHTS

CHAPTER XXVII

DEPARTMENTS OF SCHOOL HYGIENE

The term "school hygiene " generally suggests no other school than the public school. State laws say nothing about compulsory hygiene in military academies, ladies' seminaries, or other preparatory and finishing schools. Yet when one thinks of it, one must conclude that the right to health and to healthful school environment cannot equitably be confined to the children whose tuition is given at public expense. There is a better way to check "swollen" fortunes than by ruining the health of "fortune's children." The waste and danger of slow-minded, noticeably inefficient children are no less when parents are rich than when parents are poor. There is no justification for neglecting the health of children in parochial schools, in private schools for the well-to-do or rich, or in commercial schools for the ambitious youth of lower income strata. Nor has the commercial, parochial, private school, or college, any clearer right than the public school to injure or to fail to promote pupils' health. So far as school hygiene is advisable, so far as it is right to make hygiene compulsory, its personal and social benefits should be shared by children of school age without regard to income, and its laws should be enforced by all teachers, principals, and officers that have

to do with school. In presenting a programme for school hygiene this chapter refers to the hygiene taught, the hygiene practiced, the hygiene not taught, and the hygiene not practiced in buildings and on grounds where children and youth are at school, whether these children are in kindergarten or high school, in reformatory or military academy, in charitable school, or in finishing and preparing center for society's juniors.

The question of the local, state, and national machinery by which proper standards of school hygiene shall be made effective will be taken up after we have considered individual steps in a comprehensive programme for school hygiene.

1. Thorough physical examination of all candidates for teachers' positions and periodic reëxamination of accepted

teachers.

Teachers would be grateful to be told in time their own physical needs and the relations of their vitality to the vitality of their pupils. Are your teachers examined? Do they know the laws of health and the signs of child health? Are they permitted to continue in schoolrooms after tuberculosis is discovered? Are normal graduates given physical tests before being permitted to teach and before being permitted to give four years to preparation for teaching?

2. Thorough physical examination of every single child in every single school upon entering and periodically during school life.

We believe a vast number of things that "ain't so" about the health of country children as compared with city children, of private-school children as compared with publicschool children. Where do we find more degenerate men, physically and morally, than in so-called "American settlements," where, for generations, children have had all outdoors to play in, except when in homes and schoolhouses that are seldom cleansed and seldom ventilated? Open

mouths and closed minds clog the "little red schoolhouse"; there headaches do not suggest eye strain; there deafness and running ears are frankly attributed to scarlet fever which everybody must have with all the other "catching" diseases, the earlier the better; there colds begin in December and run until March, to the serious injury of attendance and promotion records; there bone tuberculosis is called "knee trouble" or "spine trouble in the family "; there boys like my little friend Fred count the bottles of codliver oil they take to cure adenoids that could be removed in two minutes.

The index to community life and community living conditions should be read in the country, not only for the country's sake, but also for the sake of the city whose milk and water, poisoned in the country, cause thousands of deaths annually, besides annual sick bills exceeding many times over the Russell Sage and Carnegie Foundations, which we rightly call munificent. Reading the index of private schools and colleges is important for their children and youth, but still more important for the community upon which unbridled passion, inability to work or to spend properly, inconsequential thinking, mediæval ideals of caste, etc., can inflict greater injuries than can typhoid fever or cholera.

The physical record of each child should be kept from date of entrance to date of leaving school, showing condition at successive examinations, absence because of illness, etc.

3. Thorough physical examination of children when leaving school, or when passing compulsory school age, as a condition to" working papers" and to" coming out."

To give working papers to children seriously handicapped by physical defects is to buy future industrial trouble, hospital and poorhouse bills. A boy with adenoids, a girl with eye trouble, should not be permitted to begin the fight for self-support without at least being clearly shown that the

correction of these defects will increase their earning power. At present a schoolgirl with incipient tuberculosis, or predisposed to that disease, can get working papers, go to a hammock or tobacco factory, work long hours, breathe bushels of dust, deplete her vitality, spread tuberculosis among her co-workers and home associates, infect a tenement, and all this without any help or advice or any protection from society until she is too sick to work and her physician notifies the health department that she is a danger center. We may disagree about society's right to control a child's act after the defects are discovered, but who will question society's duty to tell that child and her parents the truth about her physical needs before it accepts her labor or permits her to enter society"?

4. Supervision by physicians of hygiene practiced in schoolrooms and on playgrounds.

Superintendent Maxwell, of New York City, and other educational leaders urge teachers to do their utmost to learn the physical conditions and home environment of the individual child, and to fit school treatment to the individual possibilities and handicaps. But experience proves conclusively that try as they will, teachers and principals have neither the special knowledge nor the time to acquire the special knowledge requisite to use the facts disclosed by the physical examination of school children. Physicians and nurses are needed, not so much for treating children, as for teaching children, parents, teachers, family and dispensary physicians.

Private schools have visiting physicians who may be consulted; they need physicians to supervise, with power to examine or to require certificates of examination. The Committee on the Physical Welfare of School Children found that when a visitor was detailed for that purpose it was easy to secure the cooperation of parents, teachers, family physicians, dispensaries, school boards, and