APPENDIX I 



nose or throat, or as the result of unhappy home conditions, irregular 

 habits, want of proper sleep, lack of suitable food, bad hygienic condi- 

 tions, etc. Great care must always be used in order not to confound 

 cases of permanent mental deficiency with cases of temporary back- 

 wardness in school work, due to the causes mentioned above, or those 

 described under the head of excessive nervous fatigue. 



In some cases, where the existence of mental defect is in doubt, 

 accurate information is usually to be obtained in the early history of 

 the child. The time of first "taking notice," the time of recognition 

 of the mother, that of beginning to sit up, to creep, to stand, to walk 

 and to talk should be learned. Marked delay in development in these 

 respects is usually found in all pronounced cases of mental deficiency. 



It may be found useful to require teachers to refer at stated intervals 

 to the medical inspectors for examination all children who, without 

 obvious cause, such as absence or ill health, show themselves unable to 

 keep up in their school work, who are unable to fix their attention, or 

 are incorrigible, though it does not follow that all such cases have 

 either physical or mental defects. 



SCHOOL HYGIENE 



The school physician should notice the ventilating, lighting and 

 heating of the rooms, and the location of the source of water supply with 

 reference to possible pollution. In case pollution of the water supply is 

 suspected, application should be made to the State Board of Health 

 for an examination of the water. The general cleanliness of the school- 

 room is of importance, and the admission of sunlight when possible is 

 desirable. 



The Closets. The school physician, accompanied by the janitor 

 of the school, should inspect the toilet rooms, to see if the floors are clean 

 and dry, that the bowls of the closets are properly emptied and kept 

 clean. (If outhouses are used, a large supply of earth will aid in keeping 

 the place in a sanitary condition.) A few simple directions as to the 

 cleanliness of the room should be posted in the closets. 



Cups. The use of one drinking cup for a number of children is to 

 be condemned, as tending to spread the infectious diseases from child to 

 child. The so-called hygienic drinking fountain, now in more or less 

 general use in progressive cities and towns, is to be recommended where 

 running water is available. If there is no running water, each child 

 should use his own cup. 



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