No one, save the physician and the sanitary policeman, stands in more intimate relation to the public health than the teacher. There is, however, a difference. The work of the physician looks to the correction of the past errors of the individual; the sanitarian looks after the present health of the community, while the teacher building on the broad ground of a better knowledge of sanitary matters works for the future, both of the individual and of the community. My own experience as a teacher is too limited to permit me to speak with authority on hygiene as a pedagogical matter, and I shall content myself with discussing it as a purely practical matter, affecting the present health of the teacher and his pupils. This is a subject which is only just now coming to be generally understood. The larger cities are providing medical inspectors, who examine children sent to them by the teachers, especially those who seem to be ill or who have returned after an absence of more than one day. These physicians do not treat the sick pupils, but simply say whether they may safely remain for the rest of the day. These inspectors do the work which must in small places be left undone, or else be done by the teacher. So far as I know there has been no effort as yet made to educate the teacher so that he could do it. Naturally, in the limits of a single paper, such as this is, it is possible only to indicate

broadly the lines which such knowledge must follow, and the teacher must fill this in, either by reading or by consultation with his family physician.

The teacher who is worthy of his high calling aims at the formation of character and the making of good citizens. Now, that citizen who is not sound and well is not so valuable to the state and the nation as the man or woman who is equally endowed mentally and morally, but is stronger physically. Hence, the teacher, who is paid by the state to build its future citizens, must have as his ideal the old Roman one of a sound mind in a sound body. Guiding, directing and moulding as the teacher does, during the whole formative period of the child's life, he has many opportunities to make or mar the child's future

Some of these opportunities at least are physical, and in some cases life or death may hang upon vigilance or neglect. To use the most obvious illustration, many infectious diseases, through ignorance or carelessness on the part of parents, find a way into the school room. The ability on the part of the teacher to detect such a condition may save many of his pupils or himself from severe or even fatal infection, which may follow from contact with any case, however mild, of the common infectious diseases.

Passing this class of cases for a few moments, there is a type of child that is

known to every experienced teacher. This is the dull or stupid pupil. He seems to be defective mentally. The countenance is often surly or frowning. The mouth is open and the lower lip thick and hanging. Frequently he is slow of speech and slower still to respond when spoken to. He may or may not be bad in his deportment, but he is undeniably slow about learning. Such a condition is remediable under skilled hands. It is not the teacher's province to cure such a case, but simply to point out that there may be a cure. Several things may be the matter with the boy.

First. He may really be defective in brain and nerve structure, in which case individual teaching adapted specially to the needs of the child must solve the problem as far as possible.

Second. There may be some difficulty with the organs of special sense, either the eye or ear being defective.

Third. And very frequently, especially with those who have an impediment or huskiness in speaking, the pharynx is filled up by a morbid growth, preventing breathing through the nose and in some. instances compressing the vessels supplying the brain.

Taking up the eye more in detail, I shall assume that your school physiologies have taught you the structure of the eye, and shall not dwell on it. The principal anatomical defects of the eye are farsight, in which the eyeball is short and the light rays are brought to a focus behind the retina; near-sight, in which the rays of light are brought to a focus in front of the retina; astigmatism, in which the lens or cornea is differently curved in different meridians and consequently never focusses properly; muscular troubles, which are due to unequal pull on the part of the muscles which move the eyeball, and consequent straining to make them pull evenly.

Near-sight almost never causes headache, but the other forms of eye trouble usually do. Any of them may cause indistinct vision and consequent apparent stupidity. I have heard one of the most distinguished surgeons in a neighboring state say that he was always rated as a

fool in school, and he believed it. He never could see the blackboard with sufficient distinctness to know what he was expected to do, and it was not until he fell into the hands of a competent oculist that he realized that he was not a fool, but only had bad eyes. The symptoms of eyetrouble are headache, especially in the forehead; rubbing the eyes frequently; redness of the margins of the lids; and inability to see clearly. These need not all be present, but with serious trouble most will be. Testing for eye troubles with test type is done by hanging the card of tests in a good light at a distance of twenty feet, preferably. The pupil should be able to read that type which is marked D twenty, or D fifteen if his distance is only fifteen feet.

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You may construct these type for yourself by cutting from a newspaper or having printed for you, plain Roman capital letters five-sixteenths of an inch in height for a distance of twenty feet, and exactly one-fourth of an inch for fifteen feet. These letters should not form words. Anything invidious in this or other tests may be avoided by having other children tested at the same time. The tests should be made with each eye separately, using a paper to screen the other eye, as the pressure of the hand is disturbing to the after testing of the second eye.

Tests for astigmatism may be improvised by drawing a number of concentric circles on the board, being careful to have the lines equidistant and of equal distinctness. Another test may be made by drawing a circle and filling it almost solid with lines carefully drawn, all passing from side to side through the center. Both of these may be made more practical by writing the hours around the circumference as on the dial of a clock.

To use the test the pupil should sit at twenty feet and use each eye separately. To the non-astigmatic eye the circles will look uniform, even though the individual radii or concentric circles can not be distinguished; but to the astigmatic eye the diagrams will be divided into sectors, two of which will be distinct and two blurred. Some tact is necessary in using this test, because children like to answer whatever

they think you expect. The tests for muscular trouble are difficult and require special apparatus.

The diseases of the eye other than the ones named, which concern the teacher, are granulated lids and running sore eyes. Both of these diseases are contagious, the first being slightly so, and the second. eminently so. Either may cause loss of sight, and the pupil should be so warned. Granulated lids are also indicative of defective health in other respects, because it is very rarely indeed found in people of any age who are otherwise vigorous. No child whose eyes are discharging should be admitted to the schoolroom, since the disease is almost sure to spread through the school and to leave many permanently injured eyes in its track.

The tests for deafness are easily improvised and applied. The most convenient is the watch. The child is blindfolded and holds the ear not under observation closed with one hand. The experimenter then moves the watch back and forth until the exact distance where the watch can barely be heard, is found.

It should occasionally be taken away entirely and the child asked whether it still hears, in order to have a check on the answers given. Both with this and the following test, a number of observations should be made with different children to obtain a standard for the particular instrument you are using.

A tuning fork is very convenient, and is specially desirable because its vibrations can be damped at any time with the fingers, or indeed it need not be vibrating at all during the check tests.

There is one form of ear trouble which is regarded in a kind of superstitious way by many people; it is thought to be dangerous to stop a running ear.

This arises from the fact that sudden suppression of the external discharge is a frequent symptom of the invasion of deeper structures, such as the formation of a brain abscess. A chronically suppurating ear is so dangerous a matter that no life insurance company will take a risk on such a life. Should the teacher notice a pupil who wears cotton habitually in the ear it is his duty to warn him of the

danger, and if met by the old superstition I have mentioned to stamp it as absolutely false.

There are various throat troubles which the teacher should learn to diagnose, sometimes for the good of the affected pupil, and sometimes for the good of the school. These troubles may be reduced. to one head-obstruction of the upper respiratory tract. This may be caused by enlargement of the tonsils, which may easily be seen at the sides of the throat near the base of the tongue; by enlargement of the third tonsil which lies at the back of the pharynx and above the soft palate; by tumors of the pharynx, and by tumors or catarrhal swelling within the nostrils.

The symptoms are very similar; mouthbreathing and a general lack of life are the first things the teacher will notice, but there may be hoarseness or huskiness of the voice, the child talking as though he had something in his mouth. There may be drowsiness; I personally knew one case where the child could not be kept awake in school. These persons are usually slender and not well nourished and are not good students.

Out of this condition grow deafness, deformities of the face and chest and susceptibility to all infectious diseases, especially those of the chest, such as bronchitis, pneumonia and consumption.

To examine the throat, the pupil should stand facing a good light, and hold the tongue down with his forefinger. The teacher should notice particularly the tongue, tonsils and back of the pharynx. The earliest symptoms of almost all the infectious diseases are first seen in the mouth. The eruption of measles shows as red irregular patches with a bluish white center on the inside of the cheeks. Scarlet fever shows as a bright inflammation of the pharynx. Diphtheria is a dirty white. membrane covering the soft palate, tonsils, or pharynx, partly or entirely. Tonsilitis may be known by the dark red angry looking tonsils, sometimes with white specks.

While the teacher can hardly be expected to diagnose such cases like a specialist in children's diseases, if he bears

in mind the one maxim, to allow no child in the school who has a severe cough or a sore throat, he will save the health of his pupils, and in many cases his own. In addition to the diseases I have just named, the teacher would by this rule exclude infectious colds, influenza or "grippe," and whooping cough.

After examination of the throat, the teacher may test the potency of the nostrils by having the pupil close each in turn, and breath gently. It is easy to see whether there is stoppage or catarrhal trouble, and if it seems to be severe, the pupil should be recommended to see his family physician.

Returning to the infectious diseases, no pupil who has had either measles, scarlet fever, or so-called scarlatina, which is merely Latin for scarlet fever, should be permitted to return to school without a certificate of disinfection of the house, and after all "peeling off" of the skin has stopped.

It would be a wise rule if school boards everywhere required a certificate of successful vaccination before admitting a pupil to the school. The opponents of vaccination do not realize that only a century and a quarter ago, one person in every seven died of smallpox and that this had been so from time immemorial; they do not realize that of those who recovered, the disease took awful toll in the way of blindness, deafness, hideous scarring of the face and terrible deformities. They do not realize that hygiene and cleanliness do little to protect against infection, and that of those who, unvaccinated, take the disease, we are unable to save any larger proportion than a hundred years ago. they do realize, there is no word in the English language strong enough to condemn their captious opposition to a procedure which by modern methods is absolutely harmless and void of all bad after effects. There is no question that vaccination has saved the world more suffering than any other hygienic procedure ever invented or discovered, and that the bad effects ascribed to it by its enemies have been due to inoculation with contaminating bacteria, either from dirty hands or instruments.

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There are also certain parasitic skin. diseases, affecting chiefly the scalp and the hands, which do not require any description to diagnose correctly and which should not be tolerated for an instant in the schoolroom.

For the following report showing the methods of inspection and results in Chicago, I am indebted to my former teacher Dr. W. S. Christopher, professor of children's diseases in the Chicago Polyclinic and a member of the board of education of that city:

In January, 1900, fifty medical inspectors of schools were assigned to work under the jurisdiction of this department and technical direction of the department of health. From January 8 to April 15, 1900, the result of their work in protecting the health of pupils at the various schools was as follows:

Total number of examinations....76,805 Contagious diseases detected and

excluded ..

4,539 The emergency corps of inspectors on duty from April 17 to June 1, 1900, conducted sixty additional examinations and excluded thirty-five children from school. for cause. The detailed report of exclusions of contagious diseases at school is as follows: