well intentioned and in many instances splendid citizens, namely; Christian Scientists, antivivisectionists and antivaccinationists. The League of Medical Freedom has taken desperate measures to defeat the application of advanced medical science as applied to school supervision.

A number of American States have passed laws within recent years permitting medical inspection of schools in all districts. Many municipalities have made medical inspection mandatory. The Commonwealth of Pennsylvania, during 1911, in the adoption of a new School Code, set a new standard for medical inspection, making it mandatory in districts of the first and second class, that is, in districts having a population of 500,000 or more and in districts having from 30,000 to 500,000 respectively. Had it not been for the activity of the League of Medical Freedom, mandatory medical supervision would also have been provided for districts of the third and fourth class, that is, municipalities with a population of 5,000 to 30,000 and municipalities of rural sections having a population of 5,000 or less, respectively.

In the same Code it is provided that school children shall be inspected at least once each school year by physicians having at least two years experience in the practice of medicine and that these physicians shall make the sanitary inspection of school grounds and school buildings; provision is made for the teaching of physiology and hygiene, including reference to alcoholic drinks and especial reference to tuberculosis and its prevention, to all pupils of all grades. The Code also provides for the establishing of open air schools and schools for the anæmic and tubercular and for the exclusion from school of those having tuberculosis of the lungs, whether a pupil, teacher, janitor, or other employee.

Activities of the League of Medical Freedom. The activities of the League of Medical Freedom and their followers during the passage of the School Code brought about some modified action on the mandatory provision referring to districts of the third and fourth class, an optional clause being inserted giving School Boards the right to decline (by resolution) medical inspection of schools in third class .districts before the first day of August of each school year, and in fourth class districts before the first day of July.

The activity of this League did not end with having the optional clause inserted in the Act, but, as many of you know, they extended their campaign to the school authorities in every municipality in the United States having medical inspection or contemplating taking it up. In Pennsylvania prior to the printing and circulation of the new School Code in 1911, their literature was sent to the Secretaries in the various districts, many of whom were readily deceived by their

claims and two-thirds of the rural (fourth class), districts schools were deprived of medical inspection and supervision during the first school year. The eyes of the public seem to have been soon opened, however, so that for the second school year, instead of two-thirds of the districts having elected not to have medical inspection, only about one-third of the districts passed such resolution and more than four-fifths of all of the pupils in the public schools of the Commonwealth received the advantages of medical inspection. Careful sanitary inspection of school premises was carried out by Health Officers of the Department in fourth class districts where medical inspection was refused. The provisions of the School Code for the teaching of applied physiology and hygiene were, of course, carried out everywhere.

During the summer of 1913, the same activity was continued by the League of Medical Freedom, letters, literature, and blank forms being sent to the school directors, and yet with no opposition to this campaign put forth by the Department of Health, 362 additional school districts declined to pass resolutions against medical inspection, and a total of 1,831 school districts was inspected during the third year of the work.

Your Committee believes that the Conference of State and Provincial Boards of Health might consider taking definite action to offset the irrational teachings of this League and should counteract the efforts of these medical pretenders where their influence is greatest. Constructive Program. Your Committee is of the opinion that medical supervision of schools should be the joint responsibility of public Health Officers and educators. The functions of the former should be devoted to those problems which only persons trained in medical and sanitary science can solve. The functions of the latter should be in the administration of correctional measures other than medical, suggested by the investigations and advice of the former. To this end supervision may be considered under five subjects.

(1) Inspection and correction of remediable defects in pupils, this to include an examination of the pupil's eyes, ears, nose, mouth, throat, superficial lymphatic glands, gross deformities, general nutrition, and evidences of disturbances of the nervous system, such as epilepsy, chorea, and tic.

(2) The prevention of communicable disease. The underlying principle is to protect public health and to this end the services. of the inspector are to diagnose the disease and to take measures to detect carriers.

(3) Segregation in special schools of tubercular, mentally defective, and incorrigible pupils. The segregation of tubercular pupils is a demonstrated success in many municipalities throughout

America and the improvement in those of poor nutrition demonstrates its importance. The legislature which excludes from schools children known to have tuberculosis should also provide for their education. Special classes of schools for the mentally retarded and the defective are no longer in the experimental stage. Where necessary or practicable schools of these classes should be organized.

(4) The recognition of faulty position or postural habits or mental or physical fatigue in relation to study and recreation periods, of faulty kinds and sizes of types in text books, all should be made by one familiar with the individual needs of the pupil and should be based upon a well founded knowledge of anatomical relations and of normal and pathological physiology.

(5) Sanitation of school buildings and school grounds. We are of the opinion that medical supervision should extend to the sanitary inspection of the school buildings and grounds, and should include the problems of air space, lighting, ventilation and heat, water supply, ground drainage and sewage disposal. It should also include the arrangement of the play grounds and outside points of sewage disposal in so far as they influence the moral tone of the pupil.

In such a systematic supervision of schools the Medical Examiner occupies the position of investigator and adviser. It should be his duty to notify the health authorities of the existence of communicable diseases; to exclude carriers, to advise school authorities of the defects found in pupils and premises and to outline the corrective measures to be taken not only in relation to the individual pupil but to the pupils as a class. The duties of the school authorities should be purely administrative and should be made effectual and economical by closer cooperation with the Medical Officer.

The end attained by such investigations and administration will not be limited to the education of the child but will extend to the education of the parents. One of the great ends attained by the Kindergarten method is the lesson carried home to the mother by the child. For this reason we believe the teaching and enforcement of personal and school hygiene to the child to be one of the effectual methods of teaching its advantages to the parents.

We further believe that pedagogists should constantly be urged to keep in mind that it is their duty to help build a perfect human tabernacle; that they should continually keep before them the thought that education is but the adornment of the tabernacle and is most valuable only when developed in a good physique.

With the exception of segregation or exclusion of those suffering with communicable diseases, the power exercised by health and school authorities is purely recommendatory. Under a representative form of government it is obvious that close supervision cannot be man

datory, hence, it is recommended that the meaning and importance of defects found in the pupil should be interpreted to the parents in a terse note of advice.

We beg leave to recommend that methods for the collection and compilation of statistics should be made uniform by using standardized forms similar to those now in use in Kansas, Vermont, and Pennsylvania. We would further recommend that standardized forms should be designed to secure statistics of the results obtained for each pupil through records which should follow the pupil from year to year. The uniform adoption of some such method will furnish a basis for accurately estimating the value of medical inspection.

In its proper place will be found the report of the State Registrar. An inspection of his tables reveals many interesting vital statistics of the past year.

The sickness of the year, in so far as it presents itself in the reports of communicable diseases, shows certain striking changes. The total number of such cases dropped to something over 140,000. For the years 1906 to 1912 the reported cases had ranged between 70,864 and 141,739 with an annual average of 113,933. In 1913 the number jumped up to 195,015 largely due to a very marked increase in measles. The drop this year is also largely due to the pronounced decrease in the number of cases of measles, this disease being less common than in any year since 1907. As compared with 1913 the decline in measles is over 66,000 cases, or nearly seventytwo per cent. of the cases reported for 1913. On the other hand a very striking increase of German measles is noted, the cases being 5,912, or much more than twice the 2,575 of 1913. Here there is probably some confusion as to distinguishing scarlet fever from this disease. Chicken pox, mumps, and whooping cough each went up twenty-five to thirty per cent. The cases of whooping cough far exceeded the record since our statistics began. For scarlet fever the report is much greater than any we have had and exceeded that of 1913 by eleven per cent. Pneumonia showed a drop of eleven per cent. but it is doubtful if this disease be reported with any completeness. There is a notable decline in the reports of typhoid fever-nearly thirty per cent. from those of a year ago. The cases are fewer than in any year of our series being less than one-third of those reported in 1906 (really thirty-one per cent.).

The deaths of the year numbered 114,832. The population of Pennsylvania is estimated as 8,246,018 which gives a death rate of 13.9 for every thousand. The decrease from 1913 by cases is 3,163 but

but on the basis of the death rate of 1913 the decrease from the expected deaths would be 4,735.

The decrease shows itself in all the groups of the International Classification except diseases of the circulatory system (of which nearly three-fourth is heart disease) and malformations. The puerperal diseases also show a very slight increase of mortality.

Particularly gratifying is the drop in the deaths attributed to typhoid fever which reached the lowest figures known in the statistics of Pennsylvania.

This is also true of diphtheria although the decline is less marked. Practically all the gain in diphtheria was for patients under ten. The remarkable decline in the prevalence of measles showed itself quite as markedly in the mortality from this disease. Notwithstanding this drop the fatality of measles was somewhat higher, assuming the cases to be as fully reported as in other years. Of the children reported as having measles slightly over two in every hundred died, and no one knows how many more were enfeebled and thus prepared to fall a prey to other diseases. This is the disease which many think "every child should have." In scarlet fever the fatality was also exceptionally low although there were nearly two thousand more cases than a year ago, but here also death is by no means the only damage done by the disease. In whooping cought the death rate fell slightly.

The mortality from tuberculosis showed a slight increase over last year but still remained lower than for any other year of the series covered by our records.

Deaths from cancer and other malignant tumors numbered 5,997 or 102.4 per cent. of those of 1913. The rate of increase is less than it has been since 1911 when the rate was only a little over the percentage increase of population. The 143 cases by which 1914 exceeded 1913 are more than covered by those charged to the buccal cavity, breast, and skin which one is tempted to suppose might have been early recognized and accessible to operation.

As to births the reports do not awaken apprehension regarding a falling rate. In fact the rate of each thousand of the population went up from 25.7 to 26.6, and was the highest of our records. For the years 1906-1913 the birth rate has ranged between 23.4 and 26.5 with an average of a trifle over 25.4. In 1914 there were born in Pennsylvania 219,542 living children, of which 113,180 were boys and 106,362 girls, or 106.4 to 100, a slightly smaller proportion of boys than last year. The twin births rose from 2,149 to 2,409, and there was one set of triplets more than in 1913. The number of illegitimate children fell to 4,001, a drop of 487, more than a tenth.

The marriage contract received the personal attention of 67,567 couples during the year, thirteen per cent. of them choosing June