250 NATURE STUDY REVIEW [7:9— Dec, 1911 



a really remarkable showing - , when one considers how recently 

 this procedure was generally regarded as an experiment or a 

 fad. The plan was first tried in 1890. Eleven cities had 

 adopted it by 1900 ; 55 by 1905, and 443 by 1911 : 214, or about 

 one half, include in this system of inspection such thorough- 

 going, complete examination as would reveal physical defects 

 and organic diseases, including tuberculosis. 



Special children's clinics have been established in a num- 

 ber of cities in connection with free dispensaries, where certain 

 hours or days are set aside solely for the examination of chil- 

 dren. The clinic for children, as distinguished from the general 

 clinic, has been deemed advisable because diagnosis in chil- 

 dren, especially of tuberculosis, is distinctly a specialty and, 

 furthermore, there is a marked difference in treatment. There 

 are 25 or 30 dispensaries in the country that are conducting 

 special children's clinics and the majority of these are in New 

 York City. Most of them have a special staff of physicians 

 for this kind of work. 



In some cities, where there is no system of medical in- 

 spection of the school children by physicians, a special nurse or 

 nurses have been provided to examine the children for defects, 

 and upon the detection of defects to refer the children to the 

 family physician for diagnosis, or to the district physician, if 

 there be no family doctor. The school nurse, through her 

 training and experience, will frequently suspect that a child 

 has tuberculosis and will see to it that the diagnosis is made. 



TREATMENT. 



Should a child on examination be found to have open tu- 

 berculosis, that is, to have advanced disease and be for that 

 reason, a menace to his classmates, he is excluded from the 

 school and is, wherever possible, removed to a sanatorium or 

 tuberculosis hospital. Fortunately, open cases of tuberculosis 

 among children of school age are not frequent. The majority 

 of cases diagnosed as tuberculosis are those in which the 

 disease is present in the bones, joints or glands, or if pulmon- 

 ary, is in the incipient stage. It is to these cases that most at- 

 tention is being directed with reference to treatment. 



The Association for Improving the Condition of the Poor 

 of New York City has maintained for a number of years at 

 Seabreeze, near Coney Island, an institution for the treatment 

 of tuberculosis of the bones and joints. Such remarkable re- 

 sults have been secured that it has become well known all over 



