The only index to community conditions prejudicial to health that will make known the child of the well-to-do who needs attention is the record of physical examination. No other means to-day exists by which the state can, in a recognized and acceptable way, discover the failure of these well-to-do parents to protect their children's health and take steps to teach and, if necessary, to compel the parents to substitute living conditions that benefit for conditions that injure the child.

Among the important health rights that deserve more emphasis is the right to be healthy though not "poor." A child's lungs may be weak, breathing capacity one third below normal, weight and nutrition deficient, and yet that child cannot contract tuberculosis unless directly exposed to the germs of that disease. But such a child can contract chronic hunger, can in a hundred ways pay the penalty for being pampered or otherwise neglected. Physical examination is needed to find every child that has too little vitality, no zest for play, little resistance, even though sent to a private school and kept away from dirt and contagion.

The New York Committee on the Physical Welfare of School Children visited fourteen hundred homes of children found to have one or more of the physical defects shown on the above card. While they found that low incomes have more than their proper share of defects and of unsanitary living conditions, yet they saw emphatically also that low incomes do not monopolize physical defects and unsanitary living conditions. Many families having $20, $30, $40 a week gave their children neither medical nor dental care. The share each income had in unfavorable conditions is shown by the summary in the following table.

Table VII

Showing Per Cent Share of Physical Defects of Children, Unfavorable Housing Conditions, and Child Mortality found among each Family-income Group

 Weekly Family Income
$0-10$10-15$16-19$20-25$25-29$30 and over$100
%%%%%%%
Proportion to total families  8.432.715.223.8  3.915.6100
Physical defects:       
Malnutrition13.843.412.417.9  3.4  9.  "
Enlarged glands  8.637.414.622.6  3.613.2"
Defective breathing  9.632.315.524.4  2.815.4"
Bad teeth  8.132.215.324.5  4.815.1"
Defective vision  8.234.616.522.1  1.417.3"
Unfavorable housing conditions:       
Dark rooms  8.235.418.118.4  3.815.9"
Closed air shaft  6.930.218.926.4  3.219.6"
No baths10.138.516.519.7  4.410.8"
Paying over 25% rent  8.627.621.714.7...27.6"
Child Mortality:       
Families losing children10.335.514.720.5  5.413.6"
Families losing no children  6.430.115.726.9  2.418.6"
Children dead11.736.213.120.8  6.112.1"
Infants dying from intestinal diseases  8.937.618.318.8  4.  12.4"
Children working  4.219.513.230.311.521.3"

The index should be read in all grades from kindergarten to high school and college.

Last winter the chairman of the Committee on the Physical Welfare of School Children was invited to speak of physical examination before an association of high-school principals. He began by saying, "This question does not concern you as directly as it does the grammar-school principals, but you can help secure funds to help their pupils." One after another the high-school principals present told—one of his own daughter, another of his honor girls, a third of his honor boys—the same story of neglected headaches due to eye strain, breakdowns due to undiscovered underfeeding, underexercise, or overwork. Are we coming to the time when the state will step in to prevent any boy or girl in high school, college, or professional school from earning academic honors at the expense of health? Harmful conditions within schoolrooms and on school grounds will not be neglected where pupils, teachers, school and family physicians, and parents set about to find and to remove the causes of physical defects.