circumferences, vital capacity, and grip, as given by Camerer, Monti, Lange, Gundobin and Steinhaus, advises the following measurements as minima for entering school children:

1. The height should be at least 115 cm.

2. The weight should be at least 20 kg.

3. The chest circumference should be at least 53 cm.

4. Children on entering school should have all four of the six-year molars. This should be required of both sexes.

5. Standards should be the same at this age for boys and girls, although for girls a little less may be permitted regarding height and weight.

Bone development at this age, as shown by Roentgenograms* is as follows:

Times of Appearance of Epiphyses: Ulna-lower epiphysis, fifth to seventh year; phalanges (ossific center of second row) fourth to seventh year: all bones of the wrist are present, but only the os magnum and unciform are well developed.

By the end of the sixth year all epiphyseal centers have appeared except:

Humerus lower epiphysis, trochlea, external epicondyle.

Ulna-upper epiphysis.

Femur-trochanter minor.

Completion of the obturator foramen.

Union of the ischium and ilium.

Ossification of the cartilage of the acetabulum.

For exhaustive Anthropometric Studies see Hŕdlička, Ales., Anthropometry, American Journal of Anthropology, Vol. ii, Nos. 1, 2, 3, 4 and Vol. iii, No. 1.

The marvelous physical development of young children progresses without setback until the period between 7 and 10 years. Practically all tables of weight and height show a slight relative falling off at this time. With this occurs the second dentition with a concomitant loss of chewing surface and liability to toothache. There is also a change in the circulatory system. The heart becomes relatively smaller than the blood vessels, and there is a resulting tendency to heart weakness and fatigue.†

E. M. Hartwell's tables on the specific intensity of life show that in girls from the ages of eight to nine, and for boys from the ages of 9 to 10, there is a lessened rate of rapidity of increase in immunity. This period should be borne in mind in planning school curricula, as will be seen under the Hygiene of Instruction.‡

*Rotch, "Living Anatomy and Pathology."

† Gundobin, "Besonderheiten des Kindesalters," p. 124.

Physical Training, Its Function and Place in Education, American Physical Education Review, Vol. ii (1897), pp. 133–151. (See pages 407, 408 and 420.)

EXAMINATION FOR THE DETECTION OF NON-CONTAGIOUS PHYSICAL DEFECTS

Physical examinations may be conducted in two ways:

1. The customary public school method is the examination of an average of 10 children each day in a different school. In the City of New York all children entering school for the first time are examined as early as possible; thereafter special cases are examined who have been detected by the medical inspector, or referred by the school nurse, or teacher; finally the rest of the children are examined grade by grade. Every child should be weighed and measured at least at the beginning of each term, and every child should have a thorough physical examination at least once in two years. These examinations are made preferably by the medical inspector. If the community can not afford a medical inspector, an especially qualified nurse or school hygienist may conduct them.

2. In private schools and in those public schools of small communities that can afford it, it is desirable to make all physical examinations during the first two weeks of school before the strenuous activities of physical education begin. This entails an additional temporary force, and in most communities is not practicable. This method is very desirable, however, and if possible should be conducted along the following lines. Ten days before the opening of school, notices of the medical examination should be sent to the parents, making definite appointments and urging them to be present with their children. They are informed that the appointment may be changed if the one designated is inconvenient, providing it is requested before a date designated. In the case of new pupils a health blank is sent with the notification, which solicits information regarding the pupil's health condition during the preceding year and summer vacation, his past communicable, other serious disease and operation history, his present hygienic home conditions, including habits of sleeping, eating, out-door exercise, home study and routine, social and cultural activities not directly connected with the school, his vacation environment, and other miscellaneous information which may have a bearing on his health. These blanks are filled in by the parents and returned to the medical officer by each pupil as he comes for examination. They are kept on file in the health folders of the pupils.

The force required for the conduct of physical examinations is: An office secretary.

Trained physical education workers.

(a) Anthropometric measurements, which include nutrition estimates and observations.

(b) Examination of postural defects and advice for corrective home work.

Physicians.

(a) One who makes the tests for hemoglobin, examines eyes and ears, and takes temperature, pulse and blood pressure records.

(b) Two who complete the examinations of those pupils who are allotted to them. The examiners look at and record the general nutritional condition and conditions of the nose, tonsils, teeth, thyroid, glands, heart, lungs, abdomen, spine; for tuberculosis and other organic changes; they examine skin, extremities, reflexes, genitalia-if necessary-and the length of the legs.

As the examinations are concluded, the office secretary collects the examination records.

Number of Examinations per Day.-With this force from 40 to 45 pupils can be examined during school hours.

Equipment of Room Space for Examinations.-A large room is desirable, which can be sectioned off by screens such as are used for the stage settings of the assembly hall, if such are available. Smaller screens make good dressing rooms. There should be separate spaces for weighing and measuring, equipped with a desk or table, scales, height measuring apparatus, tape measures, and calipers. The space allotted to the examiner of posture should be fitted with a long mirror, a table, and two chairs. The space occupied by the physician detailed to what may be called laboratory work should be in a separate room where it is quiet. She should be provided with Snellen's charts, a watch, a reliable, recently tested blood-pressure instrument, preferably one which can be quickly manipulated-such as the Tycos or Federaland apparatus for testing hemoglobin. It is well known that the Tallquist scale is not very reliable, but it is doubtful if a Dare could be used in such rapid work unless one person were delegated to the task. The other two physicians will require only the stethoscope, tape line for leg measurements, an examining table, two stools and a chair.

Costume for Examinations.As the public school does not permit the removal of enough clothing to place the stethoscope directly on the skin of the chest, and it is impossible to make accurate heart and lung diagnosis without doing so, the matter should be constantly and tactfully agitated until parents are educated to see the importance of the procedure. Even after their coöperation is assured it will be well to begin this more thorough type of work with boys. As soon as the advantage of sound medical work can be demonstrated, the parents will demand the same thoroughness for their daughters. Under present conditions girls should always be guarded from unnecessary exposure, they should retain their knitted underwear, shoes and stockings, and should be provided with a long straight strip of outing flannel with a hole in the middle for the head. The shoes should be unfastened, ready for rapid removal. In most private schools the physical education directors of boys advise the removal of all clothing during the medical examination.

The health examination card of many cities provides a space for a record of the social condition of the families from which the children This is very desirable in many instances, and can be procured by the nurse when she is making "follow-up" calls (note p. 916).

come.

It will be seen by Table 13 that there is considerable difference in the estimation of the inspectors of different cities. Rapeer estimates roughly that one-third of all school children have no defects, one-third have decayed teeth, and one-third have other serious defects. This is doubtless a low estimate. Rural children and defective children have a much higher percentage, as may be seen by reference to the last two columns. The figures of the work certificate group are based on the examination of 100 boys and girls over 14 years of age examined at the Orthogenic Institute of Rush Medical College, Chicago. The large number of defects found in this group is due to a general lowered