addition, they gave 775 toothbrush drills, and 19,406 individual or class health talks to the pupils of the public schools during the year.

The School Nurse

The value of the school nurse is one feature of medical inspection of schools about which there is no division of opinion. Her services have abundantly demonstrated their utility, and her employment has quite passed the experimental stage. The introduction of the trained nurse into the service of education has been rapid, and few school innovations have met with such widespread support and enthusiastic approval.

The reason for this is that the school nurse supplies the motive force which makes medical inspection effective. The school physician's discovery of defects and diseases is of little use if the result is only the entering of the fact on the record card or the exclusion of the child from school. The notice sent to parents telling of the child's condition and advising that the family physician be consulted, represents wasted effort if the parents fail to realize the import of the notification or if there be no family physician to consult. If the physical examination has for its only result the entering of words upon record cards, then pediculosis and tuberculosis are of precisely equal importance. The nurse avoids such ineffective lost motions by converting them into efficient functioning through assisting the physician in his examinations, personally following up the cases to insure remedial action, and educating teachers, children, and parents in practical applied hygiene.

Some idea of the work of the school nurses in Cleveland may be gained from the following record of what one nurse did during one day while the survey was in progress. It represents a typical day's work for a typical nurse and is not especially unusual.

8:30 a. m.

Home call to get permission to take child to school headquarters for mental examination.

Called at Case-Woodland School to examine child with sore throat.

Took a child home to have mother clean her up.

Called at Harmon School.

Treated 10 cases of impetigo, three of toothache, two of ringworm.

Took two children home to be cleaned up.

Inspected 50 children.

Gave health talk.

Tried to locate a boy who is to attend partial blind class at Harmon School.

Found boy was transferred from Harmon School to Marion School last year.

Called at Marion School but found no trace of boy.

Called at address to which child was supposed to have moved; no such number.

Called at Kennard School to see if Miss O'Neill remembered him at Marion School; found no trace of him.

Called at two homes in regard to enlarged tonsils and defective vision.

1:15 p. m.

Mayflower School: boy with sprained ankle, soaked in hot water, strapped with adhesive.

Treated four cases of impetigo, one cut finger, opened two boils.

Conference with mother at school.

Instructed her in case of child's discharging ear.

Inspected 62 children.

Called at two homes to secure treatment for defective teeth.

Advised mother to send children to Marion Dental Clinic.

To sum up the case for the school nurse: She is the teacher of the parents, the pupils, the teachers, and the family in applied practical hygiene. Her work prevents loss of time on the part of the pupils and vastly reduces the number of exclusions for contagious diseases. She cures minor ailments in the school and clinic and furnishes efficient aid in emergencies. She gives practical demonstrations in the home of required treatments, often discovering there the source of the trouble, which, if undiscovered, would render useless the work of the medical inspector in the school. The school nurse is the most efficient possible link between the school and the home. Her work is immensely important in its direct results and far-reaching in its indirect influences. Among foreign populations she is a very potent force for Americanization.

Cleveland's Dispensaries

Cleveland has 86 school dispensaries, or what are usually termed "physicians' offices." These are rooms about 20 feet long by 15 feet wide, located in the basement or on the first floor of the school building, well lighted, and painted in white or light colors. Usually they contain one or two small white enamel tables, several chairs, a wash basin with running water, a white enamel pail for waste materials, wooden tongue depressors, eye charts, a medical cabinet filled with instruments and supplies, filing boxes, and printed forms. In 37 of the elementary schools, shower baths are provided as part of the equipment of the building.

Cleveland's dispensaries are well equipped.

Cleveland's dispensaries are of exceptionally high grade. In every case lighting, ventilation, and equipment are good. Many of the rooms are large enough for conferences and hygiene talks, and in at least one school—East Madison—the dispensary is used with desirable psychological effect for the regular meetings of the Mothers' Club. The excellence of Cleveland's school dispensaries has contributed in no small measure to the efficiency of the medical service, and money spent in this way has been a wise investment. It is probably true that Cleveland's dispensaries are of better grade than those of any other large city in the United States.

Columns are proportionate in height to the number of children given physical examinations each year for five school years. Portion in black indicates number having physical defects. The figures above the columns show how many thousands of children were examined and how many found defective in each year.

These dispensaries have proved of the greatest value in rendering the physical examinations of the children more effective and efficient. This work is very different from that which relates to the detection of contagious diseases. The latter is primarily a protective measure and looks mainly to the immediate safeguarding of the health of the community. The former aims at securing physical soundness and vitality and looks far into the future.

The physical examinations conducted in these dispensaries have shown conclusively that a large percentage of the Cleveland children—like those of all other cities—suffer from defective vision to the extent of requiring an oculist's care if they are to do their work properly, and if permanent injury to their eyes is to be avoided. More than this, a considerable proportion of the children are so seriously defective in hearing that their school work suffers severely. Most important of all, only a small minority of these defects of sight and hearing are