The only index to community conditions prejudicial to health that will make known the child of the well-to-do who needs attention is the record of physical examination. No other means to-day exists by which the state can, in a recognized and acceptable way, discover the failure of these well-to-do parents to protect their children's health and take steps to teach and, if necessary, to compel the parents to substitute living conditions that benefit for conditions that injure the child.
Among the important health rights that deserve more emphasis is the right to be healthy though not "poor." A child's lungs may be weak, breathing capacity one third below normal, weight and nutrition deficient, and yet that child cannot contract tuberculosis unless directly exposed to the germs of that disease. But such a child can contract chronic hunger, can in a hundred ways pay the penalty for being pampered or otherwise neglected. Physical examination is needed to find every child that has too little vitality, no zest for play, little resistance, even though sent to a private school and kept away from dirt and contagion.
The New York Committee on the Physical Welfare of School Children visited fourteen hundred homes of children found to have one or more of the physical defects shown on the above card. While they found that low incomes have more than their proper share of defects and of unsanitary living conditions, yet they saw emphatically also that low incomes do not monopolize physical defects and unsanitary living conditions. Many families having $20, $30, $40 a week gave their children neither medical nor dental care. The share each income had in unfavorable conditions is shown by the summary in the following table.
Table VII
Showing Per Cent Share of Physical Defects of Children,
Unfavorable Housing Conditions, and Child Mortality
found among each Family-income Group
| Weekly Family Income | |||||||
| $0-10 | $10-15 | $16-19 | $20-25 | $25-29 | $30 and over | $100 | |
| % | % | % | % | % | % | % | |
| Proportion to total families | 8.4 | 32.7 | 15.2 | 23.8 | 3.9 | 15.6 | 100 |
| Physical defects: | |||||||
| Malnutrition | 13.8 | 43.4 | 12.4 | 17.9 | 3.4 | 9. | " |
| Enlarged glands | 8.6 | 37.4 | 14.6 | 22.6 | 3.6 | 13.2 | " |
| Defective breathing | 9.6 | 32.3 | 15.5 | 24.4 | 2.8 | 15.4 | " |
| Bad teeth | 8.1 | 32.2 | 15.3 | 24.5 | 4.8 | 15.1 | " |
| Defective vision | 8.2 | 34.6 | 16.5 | 22.1 | 1.4 | 17.3 | " |
| Unfavorable housing conditions: | |||||||
| Dark rooms | 8.2 | 35.4 | 18.1 | 18.4 | 3.8 | 15.9 | " |
| Closed air shaft | 6.9 | 30.2 | 18.9 | 26.4 | 3.2 | 19.6 | " |
| No baths | 10.1 | 38.5 | 16.5 | 19.7 | 4.4 | 10.8 | " |
| Paying over 25% rent | 8.6 | 27.6 | 21.7 | 14.7 | ... | 27.6 | " |
| Child Mortality: | |||||||
| Families losing children | 10.3 | 35.5 | 14.7 | 20.5 | 5.4 | 13.6 | " |
| Families losing no children | 6.4 | 30.1 | 15.7 | 26.9 | 2.4 | 18.6 | " |
| Children dead | 11.7 | 36.2 | 13.1 | 20.8 | 6.1 | 12.1 | " |
| Infants dying from intestinal diseases | 8.9 | 37.6 | 18.3 | 18.8 | 4. | 12.4 | " |
| Children working | 4.2 | 19.5 | 13.2 | 30.3 | 11.5 | 21.3 | " |
The index should be read in all grades from kindergarten to high school and college.
Last winter the chairman of the Committee on the Physical Welfare of School Children was invited to speak of physical examination before an association of high-school principals. He began by saying, "This question does not concern you as directly as it does the grammar-school principals, but you can help secure funds to help their pupils." One after another the high-school principals present told—one of his own daughter, another of his honor girls, a third of his honor boys—the same story of neglected headaches due to eye strain, breakdowns due to undiscovered underfeeding, underexercise, or overwork. Are we coming to the time when the state will step in to prevent any boy or girl in high school, college, or professional school from earning academic honors at the expense of health? Harmful conditions within schoolrooms and on school grounds will not be neglected where pupils, teachers, school and family physicians, and parents set about to find and to remove the causes of physical defects.
Disease centers outside of school buildings quickly register themselves in the schoolroom and in the person of a child who is paying the penalty for living in contact with a disease center. If a child sleeps in a dark, ill-ventilated, crowded room, the result will show in his eyes and complexion; if he has too little to eat or the wrong thing to eat, he will be underweight and undersized; if his nutrition is inadequate and his food improper, he is apt to have eye trouble, adenoids, and enlarged tonsils. He may have defective lung capacity, due to improper breathing, too little exercise in the fresh air, too little food. Existence of physical defects throws little light on income at home, but conclusively shows lack of attention or of understanding. Several days' absence of a child from school leads, in every well-regulated school, to a visit to the child's home or to a letter or card asking that the absence be explained. Even newly arrived immigrants have learned the necessity and the advantage of writing the teacher an "excuse" when their children are absent. Furthermore, neighbors' children are apt to learn by friendly inquiry what the teacher may not have learned by official inquiry, why their playmate is no longer on the street or at the school desk. While physicians are sometimes willing to violate the law that compels notification of infection, rarely would a physician fail to caution an infected family against an indiscriminate mingling with neighbors. Whether the family physician is careless or not, the explanation of the absence which is demanded by the school would give also announcement of any danger that might exist in the home where the child is ill.
If it be said that in hundreds of thousands of cases the child labor law is violated and that therefore school examination is not an index to the poverty or neglect occasioning such child labor, it should be remembered that the best physical test is the child's presence at school. The first step in thorough physical examination is a thorough school census,—the counting of every child of school age. Moreover, a relatively small number of children who violate the child labor law are the only members of the family who ought to be in school. Younger children furnish the index and occasion the visit that should discover the violation of law.