With the entrance into school, a new life begins for the child. The open air life must of necessity give way to the requirements of school time. The harmless, untrammeled play must. in a similar manner, he repressed; and opposed to the unrestricted hours arc the method, dis cipline, and restraint of the school. It is " sit still and pay attention!" Here arise new conditions for the young child, conditions which are entirely different from the earlier ones, and which cannot possibly he without influence upon its body and mind. These changes in the entire scheme of the child's life, and the possible evils resulting therefrom, must not be blamed altogether upon the school, as the disturbance of all the usual relations is necessary and natural. The agitation aroused in the young organism. by the requirements and new impressions of school life can best he allayed by instituting a healthy routine.
During this period the physician must be especially careful to ward off the injuries which school influences may produce upon the health of the child. Among the poorer classes, the school physician now takes the place of the family physician in the supervision of the child's health; but, although the duty of watching over the physical and mental welfare of the child during school years is obligatory upon the school physician, it should none the less remain, at least in part, the duty also of the fam ily physician. Both must be careful that children who are physically or mentally backward, whether from chronic diseases (rachitis, anxinia, scrofula) or otherwise, should be closely observed upon entering school, to determine whether or not they are able to keep pace with normal children of their own age. Should it be decided that they arc not up to this standard, they should at once he placed in a lower grade, not only in justice to themselves, but also in the interest of their class mates. This period should then be devoted to so caring for the health of the child that it may finally reach normal development. Serious defects or illnesses (deafness, blindness, imbecility, epilepsy, tuberculosis) require special schools or institutions. It is exceedingly important. also, that the sight and hearing. of the child be carefully tested before its admission to school, so that any abnormalities may he neutralized or corrected by giving the child a most advantageous position (toward the front of the room) in the class room.
After school life has begun, it is essential to see that the injurious effects of the new conditions (sitting still, impure air, close attention, fear, mental overstrain) are reduced to a minimum. The harmful
effect of daily attendance at school shows sooner or later; but it is prin cipally apparent among the very young, or delicate, nervous, or anemic children. The general term applied to this condition is "school sickness." its manifestations are varied and numerous, being sometimes one, sometimes another, of the following symptoms, or sometimes a combi nation of several: headache, lassitude, anorexia, insomnia, irritability, nervousness, severe ann mnia, and hysteria. This condition is, without doubt, a sequel to the alteration in the child's mode of living. Even if the physician is unable to prevent this condition in all cases, he is at least in a position to see that no serious injury results therefrom. If the hygienic arrangements of the school are satisfactory, much will have been accomplished. Large, airy rooms, with the best facilities for ventilation, should be insisted upon, not only in the public school, but in private schools as well.
The floors of the school room should he smooth, and oiled to pre vent the collection of dust. The temperature should be between and 20° C. (61°-6S° r.) and should he regulated according to the indi cations of a thermometer. The best method of heating is by means of the hot-water system. The benches should not be too near the radiator and should be so placed that the light, from windows as broad and high as possible, falls upon them from the left. Artificial light should be used as little as possible. Proper school benches are of the utmost impor tance. In addition to these requirements in regard to the building. the physician should be consulted with reference to the amount of school work, the number of school hours, the recesses, the distribution of vaca tion periods, etc. if all these conditions, and such others as may arise, are hygienically attended to in turn, most causes of the harmful effects of school life will have been removed. The general practitioner, as well as the school physician, may accomplish much in this respect. Let us hope that in future the physician will be consulted upon the question of removing from the school certain sick children (especially those suffer ing from tuberculosis) whose presence is a menace to the other scholars, thus attaining a distinct advance in the prophylaxis of diseases occurring during school years. In like the physicians should be permitted to formulate new rules as to when a child may return to school after recovering from an infectious disease, or when a member of its family is suffering from such a disease.