In New York City one child in ninety-one already examined has had the form of nervous disease known as St. Vitus's Dance, or chorea. So prone are we to overlook moderate evils and moderate needs that the child with aggravated St. Vitus's Dance is apt to be cured sooner than the child who is just "nervous." Teachers cannot know whether twitching eyes, emotional storms, constant motion of the fingers or feet are due to chorea, to malnutrition, to eye strain, or to habits acquired in babyhood or early childhood and continued for the advantage that accrues when discipline impends. Many a child treasures as his chief asset in time of trouble the ability to lose his temper, to have a "fit," to exhibit nervousness that frightens parent, teacher, or playmate, incites their pity, and wards off punishment. The school examination will settle once for all whether the trouble can be cured. The family physician will explain what steps to take.

Tests of Malnutrition

We Americans were first interested in the physical examination of school children by exaggerated estimates of the number of children who are underfed. As fast as figures were obtained for eye defects, breathing defects, bad teeth, some one was ready to declare that these were results of underfeeding. Hence the conclusion: give children at least one meal a day at school. Scientific men began to set us straight and to give undernourishment a technical meaning,—soft bones, flabby tissue, under size, anæmia. While too little food might cause this condition, it was also explained that too much food of the wrong sort, or even food of the right sort eaten irregularly or hurriedly or poisoned by bad teeth, might also cause undernourishment, including the extreme type known as malnutrition. In extreme instances the symptoms enable an observant teacher who has learned to distinguish between the pretty hair ribbon and clean collar and the sunken, pale, or hectic cheek and lusterless eyes to detect the cause. But as with eyes and nose, an unhealthy condition of nourishment may exist long before outward symptoms are noticeable. Therefore the value of the periodic searching examination by the school physician.

Same Age, Same School, Different Nutrition

Bone Tuberculosis; Orthopedic Tests

Only recently have we laymen learned that knee trouble, clubfoot, ankle sores, spine and hip troubles, scrofula, running sores at joints, etc., are not hereditary and inevitable, but are rather the direct result of carelessness on the part of adult consumptives. These conditions in school are indices of homes and houses where tuberculosis is or has been active, and of health boards that are or have been inactive in checking the white plague. Early examination may disclose the small lump on the child's spine,—which one mother diagnosed as inherited "round shoulders,"—and save a child from being a humpback for life. Moreover, the examination of the crippled child's brothers and sisters will often show the beginnings of pulmonary tuberculosis.

A Grievous Penalty For Neglect By Adult Consumptives

Enlarged Glands—Tuberculosis

In almost every class are one or more children who are proud of small or big lumps under one or more jaws. Only physicians can find very small lumps. Many family doctors will say, "Oh, he will outgrow those," or "Those lumps will be absorbed." Like most other evils that we "outgrow" or that pass away, these lumps shriek not to be neglected. They mean interference with nourishment and prevent proper action of the lymphatic system, as adenoids prevent free breathing. Even when not actually infected with tubercle bacilli, they are fertile soil for the production of these germs. If detected early, they point to home conditions and personal habits that can be easily corrected. In New York one child in four has these enlarged glands. If the same proportion prevails in other parts of the United States, there are 5,400,000 children whose strength is being needlessly drained, many of whom, if neglected, will need repeated operations.

Model Of America'S First Hospital For Seashore Fresh-Air Treatment Of Nonpulmonary Tuberculosis In Children To Be Erected At Rockaway Beach, New York City