ciency upon early recognition and prompt action. Anything short of daily inspection of all schools is a very poor protection against acute infectious diseases. The plan which brings before the school physician each morning, every child suspected of acute illness, is the only one that can receive the approval of intelligent sanitarians. The instant dismissal of the child to his home, and the more searching investigation of the case in the home, either by the family physician or the inspector of the health authorities, is probably the most practical way of dealing with the cases of acute infectious disease. Chronic infections, also, must be followed beyond the schoolroom, either through the family physician or the health authorities, or, where it exists, by the staff of school nurses. Something must be done beyond the mere declaration that the child is unfit to attend school if medical inspection is to command the confidence of a practical people.

Acute illness not contagious in character should also be passed upon by the school physician to the extent of deciding whether the interests of the patient demand his exclusion from school. In these cases there is the greatest need for a good understanding between the school physician and the practitioner under whose care the child should properly come.

Chronic diseases and deformities, congenital or acquired, may require more careful investigation, but they allow of more time. Before going into any case minutely the school physician will properly satisfy himself as to whether the disease or fault of development is receiving intelligent attention from some other member of our profession, and if such be the case he should refrain from any investigation of it, except in conjunction with that colleague.

In many chronic cases the school physician should perform another very important function. Through him the practitioner in charge of the case should be able to secure that modification of school routine which the interests of his patient require. Sometimes it will be a matter of special light or seating, or hours of work in the school; sometimes the arrangement for a special course of physical training or the modification of the course of school instruction to meet the needs of the particular child. But

through the school physician we can expect that more and more the individual peculiarties of the scholar shall receive recognition, in the tasks he is put to for the purpose of drawing out and developing his powers. In this direction there is opportunity for original scientific work of great importance. Progressive educators feel keenly that popular machine methods of instruction are defective, and look to those who best understand physiologic and pathologic processes for guidance and help in their attempts at improvement.

Defects of sight and hearing which directly hamper the child in its school work, and which are liable to arise or increase during school life, should be systematically sought for, at least once a year, among all pupils. The return of a child to the schoolroom, after exclusion for illness of any sort, should be the occasion for careful examination, which may reveal recently acquired defects of these special senses, but such defects may arise quite apart from illness that would interrupt school attendance.

Even the school physician who may be quite unfitted to give instruction in hygiene, may be able to offer helpful criticism of the teaching of hygiene that goes on in the school. On this account such teaching should be at least partly under his supervision if he does not take a more active part in it.

There can be no doubt that the medical inspection of schools, like other special work in medicine, will be best done by a distinct class of practitioners who devote their whole time to this and similar work. To have it in the hands of those who are in no way professional rivals will avoid the friction and opposition almost certain to arise where a physician also in private practice is called upon, in his capacity of school physician, to form a medical opinion regarding patients of a fellow practitioner.

This kind of complete specialization is greatly to be desired and in the main aimed at. But in a period of development and transition the most desirable cannot always be attained. In some places it will be possible to have the functions of school physician and health officer combined in one who has withdrawn from private practice. But where a competent school physician can only be found among those actively engaged in practice, one should be chosen largely because he has the respect and confidence of

his colleagues, and an unaggressive temper that will help to secure that co-operation which is absolutely essential to the best results.

Special training for the duties of school physician will begin, as has already been indicated, with a complete course in a standard medical college. To this must be added a certain number of years, say three, of general medical practice. We cannot conceive of any other way of acquiring, at the present time, that diagnostic skill which is the first essential in medical inspection of schools. Beyond this there must be a pretty thorough course in hygiene, both personal and public hygiene, including some practical skill in bacteriology.

Courses of the kind required already exist in connection with some of our larger universities and medical schools, although these require some further development before they will fully meet the needs of the school physician. To this should be added a good practical course on physical training, such as is now given in a few of our best institutions, and which should be offered in every one of them claiming the title of college or university.

The current literature of this special department of medicine is already considerable. The appended bibliography includes chiefly the titles of papers that have appeared in English since January 1, 1903. The periodical literature appearing in French and German is in some respects more extensive and more important. Those who can avail themselves of it will find it brought together in the Index Medicus chiefly under the headings: Hygiene of Person and Hygiene of Schools. In the near future the work of the school physician will doubtless become the subject of special text-books.

BIBLIOGRAPHY.

Andrew, F.: " 'Paper in Opposition to the Introduction of Military Drill into Public Schools," J. State Med., London, 1904, 12, B 1-83.

Baker, L. K.: “Sanitary Legislation Affecting Schools," Cleveland Med. J., 1903, 2, 571-575.

Bancroft, Jessie H.: "The Place of Automatism in Gymnastic Exercises," Am. Phys. Educat. Rev., Brooklyn, 1903, 8, 218-231.

Berry, F. May D.: "The Education of Physically Defective Children under the London School Board," Lancet, 1903, 2, 17-29.

Beszant, Miss S. B.: "The Teaching of Hygiene," J. San. Inst., London, 1903-4, 24, 788-797.

Boyd, J. J.: "School Notification of Infectious Disease," Public Health, London, 1903-4, 16, 94–98.

"Brief Statement of the Results Obtained by the Commission of the British Dental Association Appointed to Investigate the Condition of the Teeth of School Children,” British Dental J., London, 1903, 24, 809–816.

Bracken, C. W.: “Practical Hygiene in Elementary Schools," J. State Med., London, 1903, 11, 314-325.

Bronner, A.: "On the Importance of Examining the Eyes and Ears of all Children, Not Only Those of the Board Schools," J. San. Inst., London, 190, 1, 189-198.

Bryce, P. H.: "The Ethical Value of Education in Preventive Medicine," Canad. J. Med. and Scin., Toronto, 1903, 12, 1–9.

Burnell, T.: "The Teaching of Hygiene in Elementary Schools," J. State Med., London, 1903, 11, 326–330.

"Discussion in Applied Hygiene for School Teachers," J. San. Inst., London, 1903, 24, 27-40.

Ehinger, C. E., "Physical Examination in Normal Schools and Public Schools," Am. Phys. Educat. Rev., Brooklyn, 1903, 8, 237-244.

Emerson, Florence G.: "Medical School Inspection in Greater New York," Brooklyn Med. J., May, 1904.

Foster, B.: "Some Problems of Preventive Medicine,” Am. Med., Philadelphia, 1903, 5, 422–466.

Great Britain. Royal Commission on Physical Training. (Scotland). Report of the . . 2 V., London, 1903. Neil & Co., 199, p. 1 diag. 648 p. 101.

Groff, G. G.: "Physiology vs. Hygiene in Our Public Schools," This Bulletin (Easton, Pa.), 1902-3, 6, 370–374.

Hall, G. S.: "Child Study at Clark University, an Impending New Step," Am. J. Psychol., Worcester, 1903, 14, 96–106.

Hancock, H. Irving: "Japanese Physical Training," New York and London, 1904. G. P. Putnam's Sons. 19 + 171 pp., 12 plates.

Hay, M.: "Notification of Measles and Whooping Cough," Public Health, London, 1902-3, 15, 382-397.

Hermann, C.: "The Present Method of Medical School Inspection in Greater New York," N. Y. Med. J., 1903, 27, 401-403.

Jackson, E.: "Testing of Vision in the Public Schools," Colorado Med., Denver, 1903-4, 1, 97-102.

Johnson, H. P.: "Medical School Inspection in the City of New York," Tr. M. Soc. of N. Y., Albany, 1903, pp. 183-189.

Knott, J.: “Brain Fag, and Its Effects on the Health,” N. Y. Med. J., 1903, 78, 986-989.

Little, A.: "Care of the Eyes of the Children Attending Elementary Schools," J. San. Inst., London, 1903-4, 24, 814-824.

Lloyd, R. J.: "The Education of Physically and Mentally Defective Children," Westminister Rev., London, 1903, 159, 662-674.

Lydston, G. F.: "Briefs on Physical Training,” Am. Med., Philadelphia, 1903, 5, 300, 342, 383, 419, 463.

Mackenzie, W. L.: "Medical Inspection of Schools and School Children, with Special Reference to the Royal Commission on Physical Training,” County and Municip. Rec., Glasgow and Edinburgh, 1903, 1, 486.

Macpherson, J. D.: "Popular Medical Education, Its Aid in Limiting the Spread of Disease," Buffalo Med. J., 1902–3, 42, 709-722.

Moore, S. G.: "The Advantages To Be Gained by the Teaching of the Elements of Hygiene in Schools," J. State Med., London, 1903, 11, 309–313. Nesbitt, D. M.: "Warming and Ventilating of Public Schools," J. San. Inst., London, 1903-4, 24, 825–833; 3 plans, Idiag.

Newsholme, A.: "School Hygiene, the Laws of Health in Relation to School Life." New Ed. London, 1903. S. Sonnenschien & Co., Vol. VI, pp. 12 + 311.

Newton, R. C.: "Some Practical Suggestions on Physical Education in the Public Schools," Med. News, New York, 1903, 83, 1115-1117.

Powers, L. M.: "Some Observations Made on the Inspection of Schools," S. California Pract., Los Angeles, 1903, 18, 292–297.

Putnam, Helen C.: "The Desirable Organization for a Department of Hygiene in Public Schools," This Bulletin (Easton, Pa.), 1902–3, 6, 378–386. Richards, H.: "The Education Bill, and the Sanitary Control of Schools," Med. Mag., London, 1903, 12, 77-82.

Richards, H. M.: "The Sanitary Control of Schools with Reference to the Education Bill," Public Health, London, 1902-3, 15, 121-136. "Some of the Medical Problems of Public Elementary Schools," J. San. Inst., London, 1903-4, 24, 775-782.

Robertson, J. C.: "The Introduction of Military Drill into Public Schools," J. State Med., London, 1904, 12, 75-80.

Rothwell, Annie: Hygiene in Elementary Schools, and Its Bearing in Home Life," J. San. Inst., London, 1903-4, 24, 773.

Savage, W. B.: "Physical Education, Past and Present," Am. Phys. Educat. Rev., Brooklyn, 1903, 8, 209–217.

Schmidt, H. F.: "School Hygiene and the Need of Medical Supervision in All Our Schools, N. Y. State Med. J., New York, 1904, 4, 24-28. Sedgwick, W. T., and Hough, T.: “What Training in Physiology and Hygiene May We Reasonably Expect in the Public Schools?" Science, New York and Lancaster, Pa., 1903, n. s., 18, 333-360.

Sheard, C.: "Infectious Diseases among School Children, Can. Lancet, Toronto, 1903-4, 37, 621-625.

Sherer, J. W.: "School Hygiene of the Eye," St. Louis Cour. of Med., 1903, 29, 369-379.

Smith, Alice M.: "A Study of School Hygiene, Development of Children and Preventive Medicine," Am. Med., Philadelphia, 1903, 6, 743.

Somers, B. S.: " The Medical Inspection of Schools; A Problem in Preventive Medicine," Med. News, Jan. 17, 1903.

Swain, R. L.: "The Brain of Children and Some Suggestions from the Standpoint of the Physician as to How It Should Be Regarded by the Teacher," Am. Med., Philadelphia, 1903, 6, 950-955.