I LB2S23 ■;!; \',/ | S III ill ,;l : ■ ;:::;.!" # ill lr ffi m.. !! II li| 1 M i, f;i ^cui Hark i>tate (^allege af Agriculture At OJocnell UninerattB llthaca, N. ? . IGthrant ADJUSTING THE SCHOOL WORkT ' TO THE CHILD Results of A Survey of Three Baltimore Schools BY CHARLES B. THOMPSON, M.D. Executive Secretary Mental Hygiene Society of Maryland LB 2823.B C 1°9 r! j-4' UniVers »V Library Publication No. 3 THE MENTAL HYGIENE SOCIETY OF MARYLAND Member of The Alliance of Charitable and Social Agencies 31 1 W. Monument St., Baltimore This report was read at a meeting of the School Board of Baltimore May 28, 1919 ADJUSTING THE SCHOOL WORK TO THE CHILD Results of A Survey of Three Baltimore Schools By CHARLES B. THOMPSON, M. D. Executive Secretary Mental Hygiene Society of Maryland This is a partial Survey of Three Baltimore Public Schools from the point of view of mental examinations, showing the conditions which presumably exist in all the schools of the city. This survey was made by the Mental Hygiene Society through the cooperation of the Health Department and with the permission of the School Board, and independent of any other organization or federation concerned with the school problem. REASONS FOR MAKING THE SURVEY. We, the Mental Hygiene Society, are interested particularly in the development of children of average intelligence, and those brighter than average. And where we take up the problem of the subnormal child, it is chiefly as he impedes the development of those of normal or above average intelligence. And for this reason: Mental Hygiene means prevention of mental disorders, and mental disorders are largely the result of conditions under which people develop from infancy onwards — not only physical conditions of nourishment, shelter and physical exercise, but especially the mental or psycho- logical conditions; in other words, the opportunities for the develop- ment of the individual. Now it has many times been pointed out that the proper place to begin Mental Hygiene or preventive or constructive work of this sort is in the schools. Here the conditions surrounding the individual are more or less regular; that is, the situation remains generally the same from day to day, and hence can be well computed. Here also the individual is under continual observation, and the conditions are more or less under control. Mental difficulties can be detected in their incipient stages, and the adjustments made at the proper time. 1 It has also been a well-known fact for years that subnormal children are scattered through the schools, and that they present one of our educational problems. This has come to our notice particu- larly in this way: For the past six years, that is, since the Mental Hygiene Society has been established, there have been brought to its offices for mental examination several hundreds of children who are doing poor work in the public schools, many of them also causing difficulty through their misconduct, both in and out of school. The majority of these children were found on examination to be sub- normal mentally, for the most part to the very marked degree which we call feebleminded. Hence it gradually appeared that it would be a valuable piece of constructive work to ascertain how their presence in the school classes concerned the normal children, to make a survey of one or more city schools, find the percentage of these actually subnormal children, and gain some idea of their total number in the school population; to block in, as it were, the problem they create. In other words, to what extent are these subnormal children now clog- ging the machinery of the schools, and impeding the development of the otherwise normal children. For the permission to make this survey, and especially for the privilege of presenting this report before their meeting, I wish to express to the School Board my most sincere thanks. I will also take this opportunity of thanking Dr. John D. Blake, Commis- sioner of the Department of Health, for his thorough cooperation in making the practical arrangements in the schools, and for the kind assistance of the school nurses; also, to the principals of the three schools visited who gave me their very kind cooperation. THREE SCHOOLS SELECTED— SCHOOLS Nos. 55, 16 AND 13. The data in this survey were to be collected most conservatively, so the schools were very carefully selected. We determined to con- fine our survey to schools composed as far as possible of American- born white children. We would avoid the schools composed of foreign-born children because with them the language difficulty would forestall any accuracy in estimating their mentality. We would avoid the negro schools because the great racial difference between the intelligence of negro children and that of white children renders such data applicable only to other negro schools. More- over, no accurate scale for measurement of the negro intelligence has as yet been established. Finally, we wanted representative schools, that is, schools of an average number of backward children, so that it would not be pos- (^1732.6 sible to say afterwards that our figures were not generally applicable because we had selected a particularly low standard school, or on the contrary, a school from a district of particularly high intelli- gence level. Data gathered in one or more representative schools of American-born white children would be possible of the widest appli- cation. The following are the three schools which we selected: School No. 55 is located in Hampden, at the corner of Thirty- eighth Street and Chestnut Avenue, just about at the western border of Wyman's Park. School No. 16 is at the corner of Harford and Ashland Avenues, in East Baltimore. School No. 13 is at the corner, of McElderry and Patterson Park Avenue, in a good section of East Baltimore. Like each of the two above, it contains an average number of children not keeping up with their classes. All three are representative, coeducational schools of American- born children. The same facts were found in all three, and, I may say, in another school not in this city where I have made a similar survey. METHOD OF SELECTING AND EXAMINING THE CHILDREN. To make certain that we would find the children of low intel- ligence, we examined only the children in those schools who were reported to us by the teacher as being "backward"; that is, children who did not measure up to the practical test of doing their school work. In each case a report from the teacher came with the child, with as far as possible a note as to the child's disposition, behavior, and home environment. Each child was examined separately, and under the most favorable conditions of quiet and privacy. A full Binet-Simon or Yerkes test of each child's mentality was made, and a general and detailed observation made of the child during the examination — his particular method of reacting, ability to grasp explanations, capacity for reasoning, and memory. The data were compiled most carefully, and there is this ad- vantage that all examinations were made by one person who has had for several years special training in this work. This means that the standards employed were as uniform as it is possible to obtain. The child was given the benefit of every doubt in his answers, so that the subnormal children have been, if anything, over-rated. Wherever a child has been labeled as below average, this has been conclusively proved. A separate case record and folder have been given to each child in the private record files at our offices. The names of the children and the data of each case have been gathered into confidential master lists, and then further coordinated into tables. It might be explained here that in applying a classification to all children in a school, it will be found that the ascent of intelli- gence level from idiocy, or nearly zero, through the subnormal, to the normal and above normal to the geniuses, is gradual. That is, there is no definite line of demarcation between children who can be classed as very subnormal or feebleminded on the one hand, and children of normal intelligence on the other. The place where this line is drawn will determine to a certain extent the percentage of subnormal children found; but in this survey an effort has been made to place the line, if anything, at a very conservative point. As mentioned before, we wanted our evidence to be unassailable. It will be noted in our tables that some of the children who were selected by the teachers as not doing good work were found to be of normal mentality. The delayed progress was found to be due to physical defects, disadvantageous living condition, or other causes. This is mentioned here to show that the diagnosis of "Mentally Subnormal" was applied only in proof-positive cases. The school nurses made many home visits to corroborate our findings and to observe and improve home conditions. They also took special children to dispensaries for examination and for treat- ment, and to secure proper glasses. A summary of each of our examinations was written on the "health card" for each pupil which is kept in the files of the school, in order that this data might be at the disposal of the teachers for future reference. And I may say that a number of teachers have already volunteered the information that the written estimate of the student from this viewpoint was most helpful in the subsequent placing and instruction of the pupil . FINDINGS. There were 172 children examined in School No. 55 as not doing average work in their classes. They group themselves as follows: Very subnormal. .37, or 3M% 1 j ^ of the total school papa- _ ,- , , ' _^ C lation; scattered through all six Retarded 88, or 7% ^ grades. Normal 6 Above average 41 There were only 20 children examined in School No. 16, dis- tributed as follows: Very subnormal 13 Retarded 6 Normal 1 After beginning work here we found the school had no grade higher than the fourth. Although this limitation of the school makes the data unsatisfactory, they are valuable in that the fact was estab- lished that the feebleminded and retarded children are thrown together with the normal, above normal and with the finely-grained children in the Kindergarten, and in the fourth grade. In the first, second and third grades they are separated off in lower sections of the class. There were 76 children examined in School No. 13, resolving themselves into the following groups: Tr , , „„ ( 3.6% total school population Very subnormal 36 j through ^ , ower gradeg Retarded 27 Normal 13 CAUSES OF LACK OF PROGRESS. 1. MENTAL RETARDATION. There are a certain group of children whom we describe as being a little "slow" — just a little below the average, but nevertheless below the average to an unmistakable degree. They are often well behaved, affectionate, and very attractive children, and the only difference they present from normal children is that their minds are not so active ; they comprehend less readily, remember less completely, and utilize their knowledge to a less extent than does a normal child. But here we have the advantage that they are somewhat educable, and here they contrast with the class that follows, namely, the feebleminded. The mentally retarded can learn something, though slowly, and never as much as the normal child. They fall one or two years behind their proper grades, and pick up something in earlier grades, say up to the fourth, but never as much as the average child. After the fourth they learn less and less from the usual cur- riculum, finally acquiring almost nothing in the sixth, seventh and eighth grades. 5 These children retard the progress of the other children, too. The teacher is continually led into trying to teach the child the usual course, and is continually wasting time and wearing out her efficiency. It is true that they often fall in the B, or lower division of a grade, but the bright children also often pass through this division. It is very destructive to any habits of attention and ready thinking which they, the bright children, have acquired to have to listen to the recitation of these mentally retarded children. It is unfair to the normal children to have to wait for them. Yet these children very often show great interest and proficiency along certain lines. They seem to have an aptitude for such things as carpentry and simple machine-shop work, which often more than makes up for their lack of success in more abstract subjects; and eventually enter some trade of this kind as a life work. But this trade has to be learned after school years, if it is mastered at all. It must be picked up in a haphazard way at great cost in time and skill to the individual. If this could be taught in school, several years would be saved, and the community would receive better artisans, since they have this interest in mechanical subjects, and since they acquire but little from their last several years at school. These chil- dren are many of them capable of making their living under proper training. Without this, however, many of them will be dependent. It would seem best, then, that these retarded children be given a mechanical training at least during part of the day, for instance, throughout their last three or four years in school. Since they have not the capacity to learn what we are giving them, let us give them something they can grasp, and which at the same time will be an advantage to them, and hence to the community. The teaching would be much more efficient in every respect. As teachers have many times explained to me, it is easy and gratifying to teach the normal children the regular work; it is equally easy and pleasant to teach the slower children what they can learn. But trying to teach these slower, below average children what they can not learn is an impossibility, and is not fair either to themselves or to the other children. There are 88 such retarded children in School No. 55. There are 27 of them in School No. 13 of whom we know conclusively. There are more mentally retarded children in School No. 13 of whom we know, but who were not examined and hence not officially reported here because the survey had to be discontinued that this report might be presented before the School Board. And these mentally retarded children are scattered through all the grades up to and including 6-A grade. 2. FEEBLEMINDEDNESS— Inherent Lack of Capacity. The feebleminded children are mentally so slow, and are so far below the average, that their defect is as a rule obvious even to an untrained person. They are not responsible for their lack of progress inasmuch as they suffer from lack of mental development. They are quite unable to learn anything. These make the "oversize" children. A child of 13, for instance, with a mentality of a 9-year-old child, will often be found in the third grade with the other 9-y ear-old chil- dren. They are difficult to keep in order, and many of them, in fact, were reported as presenting a chronic conduct difficulty. They not only learn nothing themselves, but hold up the education of the other children. One of these feebleminded in a class will retard that class to a measurable degree; the teacher is obliged to try to teach him, and this takes much of her time; he is continually interfering with the ether children, and otherwise misbehaving, thus taking the teacher's time. Then, lastly and most important, he bullies the other children unmercifully. A boy of 12 in the second grade, with the unpleasant disposition of the aggressive feebleminded, can make life miserable for many of the other boys and girls in the class, who, being far younger, are much smaller and weaker. Your finely-grained girl or boy is classed right in with these feebleminded, potential criminals. Sometimes filthy in mind and body, they are a millstone about the necks of the other pupils. Let me quote a case: The Story oj Henry. Henry has been in the fourth grade for 23^ years. He is now 14 years old. He is lazy, quarrels with the other children, is slovenly, frequently plays truant, and is a cigarette addict. He seems unable to learn except very, very little, and will forget this little by the next day. He openly masturbates in every class in which he is placed. It would take at least an hour of the teacher's time each day, devoted to this boy alone, to teach him to acquire anything at all. In addition to this, because he is quarrelsome and continually misbehaving, a great deal of the teacher's attention is taken up keeping him in order, thus diminishing the attention she can give to the general class teaching. The emotional strain to the teacher of trying to keep him from interfering with the other children, and trying to make this boy learn when it is impossible for him to do so, is tremendous. There is but one result: The teacher's efficiency as a teacher is reduced, and this means reduced progress for the normal children — the majority of the class. Further Trouble Caused by the Feebleminded. Some further idea of the character of these feebleminded children may be had from the fact that a large percentage of the children, who out of school are brought before the juvenile court, are feeble- minded. Nearly all the juvenile repeaters are feebleminded; also a large percentage of those so persistent in crime that they are sent to reformatories, are feebleminded. Having become adults, the men form the indigents, tramps, alcoholics and repeater criminals; the women become prostitutes, unmarried mothers, usually with several feebleminded children, and, like the men, chronic paupers, alcoholics and vagrants. Our School Situation. Now, as children, these feebleminded were found to be scattered through every grade up to and including the sixth in School No. 55, and were classed with the normal children in Kindergarten and the fourth grade in School No. 16, as far as the school goes. In School No. 13 they were distributed through all the grades up to the sixth. The same fact was found in the Annapolis Grammar School, where I made a similar survey. I found feebleminded children as high as the sixth grade while making some examinations in a Highlandtown school. In other words, it is probably only fair to state that in practically every school in this city these feebleminded are scattered through the five or six lower grades. Now what does this signify? Speaking in the interests of the normal child again, it is the first six years of school that are the most important for the acquiring of habits of concentration and the development of interest. And nothing will take the interest from a class of normal children, or develop habits of inattention in them more quickly than having a feebleminded child therein. In no other place in life are we classed with the feebleminded and forced to put up with their tyrannies and their interference. Thirty-seven children of this type, scattered through the six lower grades of a school for normal children, diminish to a tremendous extent the efficiency of the school. And these thirty-seven children are of such inferior mentality that they are incapable of ever main- taining themselves. There were 37 in School No. 55, that is, 3.08% of the total population of that school; there were 36 in School No. 13—3.6% of the total school population. The two classes mentioned above — the retarded taken together with the feebleminded, formed 10% of the total school population of School No. 55, the one school in which their numbers were fully computed. Since the schools here reported are representative public schools, and hence facts found in them may fairly be considered to exist in all the schools, and since feebleminded and retarded children have been found to be similarly present on investigation in the schools of other cities, Washington, Philadelphia, New York, Boston and Cincinnati, it seems only reasonable to conclude that we are dealing with conditions that are common to all public schools. To generalize from the above data: On the above basis there are upwards of 2,000 feebleminded children scattered through the schools of the city. There are some 8,000 of both feebleminded and retarded chil- dren in the schools of this city, at a conservative estimate. These figures vary somewhat in each school, but the main fact remains, that these two classes of children with inferior mentality, both those who are uneducable and those who are educable, are present in a very considerable number in every school. And they are scattered through all the lower six grades of the schools, form- ing not only a very serious hindrance to teaching the other children, but also a problem from the point of view of their own instruction. That one fact is all we need consider in regard to these figures, and renders negligible any slight variation in percentages. 3. PHYSICAL DEFECTS OR DISADVANTAGEOUS LIVING CONDITIONS. There were a number of children with normal mentality who were prevented from doing good work because of unusual conditions, viz : Caffeine Psychosis — Overstimulation with Coffee. Quite a number of children were reported as being very restless, and being unable to apply their attention for more than one or two minutes at a time, yet seemingly quite bright. The symptoms sug- gested overstimulation of some sort. To quote a case: A little girl of six was reported as being silent, slow and doing little work. When examined she was found to be small and nervous, continually stroking her neck and unbuttoning and buttoning her waist. This child of six was found on investigation to be drinking eight cups of coffee a day ! She was so excitable as a result that her attention could not be retained for longer than half a minute at a time. Another, a boy of 14, seemed to have a general inability to con- centrate. He wandered aimlessly about the room and annoyed the other children by talking to them. The boy was bright — of almost adult intelligence. He said that he was "nervous." His inattention was explained when he stated that he had been drinking nine cups of coffee a day, taking five cups for breakfast. A census in one school of a third grade class showed that 41 children of nine years of age were drinking 74 cups of coffee and 19 cups of tea a day. The principal immediately instituted a crusade to reduce this tea and coffee drinking, substituting for it the use of cocoa and milk. Poor Habits of Rest. A number of children worked all the time outside of school, one boy working in a store until 11 o'clock at night. Others were deliberately sent by parents to "movies" every night. Others had no place at home to study, a large family living in a few small rooms, rendering impossible the quiet and privacy necessary for study. Infected Tonsils and Adenoids. The danger from enlarged tonsils and adenoids is that the en- largement or swelling means that they are infected, and that from them constant poison is being poured into the blood. This causes reduced vitality, and hence reduced mental activity. Removal of tonsils and adenoids has been very much overdone in past years, perhaps. Many cases operated on showed no improvement because they were of inherently inferior mentality. But we have all known, however, of certain definite children, possibly in our own families, who have showed very wonderful improvement after this operation. So children with enlarged tonsils and adenoids should have the bene- fit of the doubt, and be given the advantage of having this source of poisoning removed. 10 Impairment of Vision. Near-sightedness, astigmatism, squint — these cause certain defi- nite obstacles to the proper performance of school work which will no longer be present when the schools get their adequate medical inspection, including that of eyes, ears, nose and throat. 4. NERVOUSNESS OF ONE KIND OR ANOTHER WHICH CAN BE OB- VIATED BY USE OF SMALL GROUPS OR CLASSES. (a) Hypersensitive or Diffident Children. There are certain children who are too diffident, too retiring to answer up before a large class, particularly where they are apt to receive jeers from the defective children. These children are some- times brighter than the average, but are quite lost out in the usual class of 40 or 50 pupils. (b) Nervous, excitable children whose attention holds but two or three minutes at a time, but is then intense. (c) Those whose concentration naturally is not intense, but who can grasp the work if their attention is held, as is possible in a smaller group. These may possibly belong to the slightly below average group. (d) Epileptics with characteristic moody, irritable dispositions, who are often unable to learn. 5. INTELLIGENCE HIGHER THAN NORMAL. In the course of the survey another fact appeared, and which is, perhaps, the most interesting one of all. It has been found, I have since learned, by other investigators working in other cities: Among the children referred as not doing even average work in the school classes, there was a certain percentage of children whose mentality was, as a matter of fact, above normal for their age. The same fact held with them as with several normal children who were not doing average work. The routine curriculum of the school held no interest for them. It has been demonstrated that bright children have such vivid interests and such a natural acquisitiveness for facts, that if per- mitted to develop along lines of their own interest, they will out- strip children in ordinary lines of education. This does not mean forcing the children, no one is in favor of that. But it means rather not hampering them and holding them back at every step to wait for the other children to stumble along. Hence a special class, giving freer rein to these children, is indispensable. 11 6. NORMAL INTELLIGENCE. It appeared that some normal children were held back by lack of interest in the school curriculum, in addition to (a) untreated physical defects, such as near-sightedness or deafness, and (b) the presence of the feebleminded and mentally retarded throughout the classes. The school did not fit their lives closely enough. A child will do addition and subtraction and multiplication when buying at a store, hardly realizing what he is doing. A boy will learn to com- pute baseball batting averages with a mathematical facility that would bring joy to a teacher's heart. As a matter of fact, this prob- lem was utilized in the Cincinnati schools. Children will spend hours at a world's fair or a large museum, or over pictures, studying the customs of other countries, who will in school hate the conventional geography. All of which might suggest to us effective methods of arousing the children's interest, such as have been already success- fully tried out. We can make our teaching of practical subjects more alive, more close to the children, more practical. And in addi- tion, they should have shorter periods and more complete recreational facilities. Bad Behavior Shows Need for Recreation. A number of children were referred to me because of continual bad conduct. Some of these were of very subnormal mentality and hence irresponsible, as was mentioned before. This is another reason for separating them into special classes. But another type of occasional though not infrequent misbe- havior comes from the fact that we are not providing adequate outlet for the physical energy of the pupils. A normally healthy, vigorous child is so constructed that he must have a fairly frequent expenditure of muscular energy. An adult can quietly listen to a lecture for an hour or perhaps an hour and a half, but a child can not keep still that long. He is not yet so coordinated that his energy can be directed into purely mental activity for the same period. He is so constructed that use of his muscles becomes imperative long before. Half an hour is the most that can be expected and twenty min- utes is probably a much more comfortable period for him. A few minutes then in the open air, a dash around a running track, a jump or two, and your previously restless, misbehaving because high- spirited child becomes again an interested pupil. 12 This brings us to the fact, however, that the recreational facili- ties in many of our city schools are as yet quite undeveloped. The schools have only small yards which must accommodate hundreds of children, and afford little pleasure in any case. Not even at recess time, nor in the periods before and after school can a child have much play or fun from his school yard. Children take naturally to grassy fields and activity thereon. They have also a spirit of play, a desire for fun, which must be taken into account and pro- vided for. For outdoor play means health, and health means better work by the pupil, and hence greater efficiency for the school. This is only a partial survey, as we stated at the beginning. It should also include all the other children in each school mentioned; and eventually all the other schools in the city. There may be many other children than those listed as actually doing poor work, who could be doing much better, and with no greater effort than at present. This is possible through a closer adjustment between the schools and the children along lines some- what similar to those already pointed out, but which only a further survey of the normal children would disclose. Table 1. SCHOOL No. 55. GRADE AND DIAGNOSIS OF CHILDREN EXAMINED. Showing that Feebleminded and Mentally Retarded Children Are in Each of the First Six Grades. DIAGNOSIS Kg. 1 1-A 1 1-B 8 2-A 1 2-B 5 SCI 3-A 2 iO( 3-B 3 )L 4-A 2 GR, 4-B 10 ^D] 5-4 3 3 S-B 6-A 6-B 1 7-A 8-B Mentally Defective (Feebleminded) Mentally Retarded 5 11 20 4 17 3 7 3 11 1 2 2 2 Normal Intelligence 3 6' 13 13 1 1 2 1 1 Above Average Intelligence 1 3 1 1 Physically Handicapped 4 7 7 1 10 4 1 5 1 1 1 13 Table 2. SCHOOL No. 16. GRADE AND DIAGNOSIS OF CHILDREN EXAMINED. This school only goes to the fourth grade, and therefore the data are incomplete. The feebleminded and mentally re- tarded children were found in every grade. DIAGNOSIS KG. SCHO 1st OL Gl 2nd U.DE 3rd 4th Mentally Defective 1 5 5 1 1 (Feebleminded) Mentally Retarded 1 1 3 1 Normal Intelligence 1 Physically Handicapped 2 4 3 3 Table 3. SCHOOL No. 13. GRADE AND DIAGNOSIS OF CHILDREN EXAMINED. The Feebleminded Are in All Grades Up to the Sixth. The Mentally Retarded Are in All Six Lower Grades. DIAGNOSIS 1-A 1-B 2-A S 2-B CH( 3-A 301 3-B , G 4-A RA) 4-B 3E 5-A 5-B 6-A G-B Mentally Defective 3 6 2 2 4 9 3 1 4 (Feebleminded) Mentally Retarded 9 2 3 2 3 2 4 1 1 2 Normal Intelligence 2 2 3 3 1 1 1 2 Physically Handicapped 1 2 2 1 1 1 14 SUMMARY. In the three representative schools mentioned, the "slow" or retarded and also the feebleminded children are scattered through all the lower five or six grades. There is reason to believe that this is the case in all the public schools of the city. THE FEEBLEMINDED form a little over 3% of the school population in the two schools in which this was computed. THE "SLOW" OR RETARDED form about 7% of the school population in the one school in which their total number was com- puted. Both of these classes together form about 10% of the school population. They are not being properly trained and they hold back the remaining 90%, which is an obvious injustice. In the course of the survey it developed, as has since been found to be the case in other cities, that a certain number of normal and also children above normal in intelligence, were not doing even average work because the present routine curriculum was unin- teresting to them. A certain number of children are being hindered by untreated medical conditions, and also by improper habits of resting and living. RECOMMENDATIONS. These must necessarily be stated only in broad terms, and as principles, leaving the working out and adjustment of the details for a later conference. 1. There should be special classes for the "slow" children to give each of them an opportunity to develop his particular capacity. It is not fair to them that they have to remain in the regular classes at work which will never be of service to them. Nor should they be made to hold back the other children. 2. For the sake of the normal children, the feebleminded chil- dren should be in special classes off to themselves. Whatever the state may do or may not do in regard to taking care of the feeble- 15 minded, it is not fair to the normal children to have to put up any longer with the disadvantages caused by the presence of these indi- viduals in their classes. 3. It has been shown that many of the children who are brighter than normal, as well as many of the normal children, are not doing even average work, because the present school work does not interest them. They should have the advantage of smaller classes, more live studies and shorter periods. 4. The more finely-grained and the nervous children should be in smaller classes with more individual attention and instruction. 5. A complete medical inspection of each child, not only of the heart, lungs and the digestive system, but also of the eyes, ears, nose and throat, should be a frequent and regular part of the school care of each child. 6. There should be a large playground with thoughtfully directed recreational facilities for each school. 7. This survey has conclusively proved that it is practical, that it deals with facts which can be practically applied so as to result in a direct extension of the efficiency of the schools. It might be interesting to note that already three more school principals have requested that we make a similar survey of their schools. Hence we would recommend that a permanent clinic or board be established in the schools to be run by specially trained men of the highest standing which will continue and extend this type of work to the other classes and other schools throughout the city, and attain for each girl and boy the greatest^opportunity for develop- ment which the schools can create. It was determined by motion at the time of the reading of this report that a conference of the School Board be held in the near future with the Mental Hygiene Society for the consideration and practical application of these recommendations. 16 Date Due Jim3'?M *! Library Bureau Cat. No. 1137 H mM III' It Hi '■' ■,:r;i«»:i:; I.:: I 11 'III 1 !'■ ; lis: llllll HI ii : ;-:::