MEDICAL INSPECTION OF SCHOOLS 



frequent brushing. Children should be prevented from eating crackers 

 and candy between meals, and when possible the teeth should be cleaned 

 after eating. Inspection of the teeth by a dentist should be made at 

 least once in six months. 



NERVOUS TROUBLES AND MENTAL DEFECTS 



Teachers and medical inspectors of the schools should investigate 

 children who show certain physical and mental symptoms. Especially 

 should they take notice of the presence of these symptoms in a child 

 who did not formerly show them. The most important of these are the 

 following: 



I. Restlessness and inability to stand or sit quietly, in a previously 

 quiet child, especially if to this is added irritability of temper and loss 

 of self-control, as shown by crying for trifles, or inability to keep the 

 attention fixed. 



There may also be present quick, twitching movements of the mus- 

 cles of the trunk, face, and especially of the hands, fingers, arms or'legs. 

 If severe, these may cause the child to drop things, render its work awk- 

 ward, or interfere with buttoning the clothes, writing or drawing. Such 

 children are often scolded for being inattentive or careless. 



These symptoms are the slighter ones of chorea (St. Vitus' dance). 

 With these should not be confounded other forms of twitching of mus- 

 cles, such as the blinking of the eyelids, the slower twitching movements 

 of the face or shoulders, or other parts of the body, often called habit 

 spasms, which may be due to defects of vision, adenoid growths or other 

 reflex causes. These latter cases do not usually need to be withdrawn 

 from school work, though often requiring treatment; while the former 

 class should be removed from school at once, both for the child's sake 

 and to prevent an epidemic of imitative movements, such as sometimes 

 occurs. 



1 1 . Another class of symptoms requiring investigation are repeated 

 faintings, especially if the child's lips become blue; attacks, often only 

 momentary, in which the child stares fixedly and does not reply to ques- 

 tions, or in which he suddenly stops speaking or whatever he is doing, and 

 is unaware of what is going on about him. These lapses of consciousness 

 may be accompanied also by rolling up of the eyes, drooling, or unusual 

 movements of the lips, and often appear like a "choking" attack. 



Sudden attacks of senseless movements of various sorts, such as 

 twisting and pulling at the clothes or handkerchief, fumbling aimlessly 

 at the desk, especially if there is no recollection afterwards of what was 

 done, are often another expression of the same conditions. 



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