removed without the preliminary of convincing the parents as to the advantages of the operation was merely a demand for the "right to knowledge," which is never overlooked with impunity. Reluctance to permit operation on a young child, and the natural shrinking of a parent at seeing a child under the surgeon's knife, require the teacher or school physician or nurse to answer fully the usual questions of the hesitant mother and father.

I. Is the operation necessary? Will the child not outgrow its adenoids? Usually the adenoid growths atrophy or dry up after the age of puberty. Adenoids are not uncommon in adults, however. The surgeon general of the army reports that during the year 1905, out of 3004 operations on officers and enlisted men in service, there were 225 operations on the nose, mouth, and pharynx, 103 of which were operations for adenoids and enlarged or hypertrophied tonsils. Allowing the child to "outgrow" adenoids may mean not only that he is being subjected to infection. chronically but that his body is allowed to be permanently deformed and his health endangered. Beginning at the age of the second'dentition, the bones of jaw, nose, throat, and chest are undergoing important changes - nasal occlusion. Adenoids left to atrophy - if large enough to cause mouth breathing may mean atrophy of this developing process, permanent disfiguration of face, and permanent deformity of chest and lungs.

2. Will the growth recur? In a few cases it does recur; frequently either because it was not desirable to make a complete removal of the adenoid tissue or because the surgeon was careless. If the growths do recur, then they must be removed again.

3. Is the operation a dangerous one?

4. Is an anæsthetic necessary?

5. Will the operation cure the child of all its troubles? These questions are best answered by the process and

results of an "adenoid party," which was given especially for the benefit of this book, every step and symptom of which were carefully studied.

The seven children pictured here were discovered by their school physician to have moderately large adenoid growths,- one boy having enlarged tonsils also.

The picture on page 46 was taken by flash light at 2.30 P.M., January 15, 1908. At 3 P.M. the principal escorted these children into the operating room at Vanderbilt Clinic. The doctor examined the throat and nose of each child,

entered the name and age of each, together with his diagnosis, on a clinic card, sending each child into the next room after examination. He then called the first boy and explained that it would hurt, but that it would be over in a minute. The principal stood by and told him to be brave and remember the five cents he could have for ice cream afterwards. The clinic nurse tied a large towel about him and put him in her lap; with one hand she held his clasped hands, while the other held his head back. The doctor then took the little instrument - the curette and pushed it up back of the soft palate, and with one twist

brought out the offending spongy lump. The boy's head was immediately held over a basin of running water. He was so occupied with spitting out the blood that rushed down to choke him that he hadn't time to cry before the acute pain had ceased. The rush of cool air through his nostrils was such a pleasurable sensation that he smiled as the school nurse escorted him out into the hall to wait for his companions. At 3.30 P.M. all seven children were out in the hall, all seven mouths were closed, and all seven faces were clothed with the sleepy, peaceful expression that comes with rest from the prolonged labor of trying to get enough air. At 3.45 P.M. they had been all reëxamined by the doctor, and a few tag ends were picked out of the nasopharynx of one child. At 4 P.M. the "party" had returned to the Children's Aid Society's school and to the ice cream that follows each adenoid party.

It is worth while to tell mothers stories of the "marvelous improvement in school progress of those children whose brains have been poisoned and starved by the accursed adenoid growths, and how their bodies fairly bloom when the mysterious and awful incubus is removed," to use the words of one school principal. It is worth while to show them "before" and "after" pictures, and "before" and "after" children, and "before" and "after" school marks.

CHAPTER VI

CATCHING DISEASES, COLDS, DISEASED GLANDS

Deadly fevers, the plague, black death, cholera, malaria, smallpox, taught mankind invaluable lessons. Millions of human beings died before the mind of man devoted itself to preventing the diseases for which no sure cure had been found. Efforts to conquer these diseases were tardy because men were taught that some unseen power was punishing men and governments for their sins. The difference between the old and the new way is shown powerfully by a painting in the Liverpool Gallery entitled "The Plague." A mediæval village is strewn with the dead and dying. Bloated, spotted faces look into the eyes of ghouls as laces and jewelry are torn from bodies not yet cold. In the foreground a muscular giant, paragon of conscious virtue, clad like John the Baptist and Bible in hand, finds his way among his plague-stricken fellow-townsmen, urging them to turn from their sins. Modern efficiency learns of the first outbreak of the plague, isolates the patient, kills rats and their fleas which spread the disease, thoroughly cleanses or destroys, if necessary, all infected clothing, bedding, floors, and walls, and makes it possible for us to go on living for each other with a better chance of "bringing forth fruits worthy for repentance."

Where boards of health make it compulsory to report cases of sickness due to contagion, health records are a reliable index to "catching" diseases. But now that the chief infection is the kind that afflicts children, we can read the index before the outbreak that calls in a physician to diagnose the case. School examination shows which

children have defects that welcome and encourage disease germs. It points to homes that cultivate germs, and consequently menace other homes. To locate children who have enlarged tonsils may prevent a diphtheria epidemic. To detect in September those who are undernourished, who have bad teeth, and who breathe through the mouth will help forecast winter's outbreaks of scarlet fever and measles. One dollar spent at this season in examination for soil hospitable to disease germs may save fifty dollars otherwise necessary for inspection and cure of contagious diseases.

It is harder at first to interest a community in medical examination than in medical inspection, because we are all afraid of "catching" diseases, while few of us know how they originate and how they can be prevented by correcting the unfavorable conditions which physical examination of school children will bring to light.

Courses in germ sociology are therefore of prime necessity. How do germs act? On what do they live? Why do they move from place to place? What causes them to become extinct? With few exceptions, germs migrate for the same reason as man,—search for food, love of conquest, and love of adventure. When there is plenty of food they multiply rapidly. Full of life, overflowing with vitality, they move out for new worlds to conquer. Like human beings, they will do their best to get away from a country that provides a scanty food supply. Like men and women, they starve if they cannot eat. Like boys and girls, they avoid enemies; the weak give way to the strong, the slow to the swift, the devitalized to the vitalized.

Human sociology imprisons, puts to death, deprives of opportunity to do evil, or reforms those who murder, steal, or slander. Germ sociology teaches us to do the same with injurious germs. We imprison them, we take away their food supply, we kill them outright, or we starve them slowly. They have a peculiar diet, being especially