- 7 U 3 3 IV id LIBRARY OF CONGRESS 020 730 342 2 F EDUCATION DEPARTMENT OF EDUCATION THE CITY OF NEW YORK SIXTEENTH ANNUAL REPORT OF THE CITY SUPERINTENDENT OF SCHOOLS 1913-1914 REPORTS ON DEFECTIVE CHILDREN MENTAL DEFECTIVES THE ANAEMIC THE TUBERCULOUS THE BLIND THE DEAF AND DUMB THE CRIPPLED VISITING TEACHERS PRESENTED TO THE BOARD OF EDUCATION DECEMBER 9, 1914 Q ,£: & *°KS • a \ TABLE OF CONTENTS ^ PAGE Letter op Transmittal 4 Report on Ungraded (Mentally Atypical) Classes. 7-31 Advisory Council 7 Type of medical examination 8-9 Segregation of types of atypical children 10 Existing administrative staff inadequate 11-15 Difficulty in establishing ungraded classes 16 Number and distribution of ungraded classes and register of pupils. . 16 Schools proposing children for ungraded classes 17 Insufficient clerical staff 18-19 Laboratory 19 Visiting teachers 19-20 Visiting teachers' report of work 21-27 Survey of results of ungraded class training 28-31 Summary of recommendations 31 Report on Open-air Classes 32-54 Classes for tuberculous children 32-33 Advantages of schooling for tuberculous children 33-34 Effect of cold air on tuberculous children 34-35 Statistics 36 Schools having anaemic classes 37 Temperature of classrooms 38 Kind and situation of open-air classrooms 38-39 Proper equipments of rooms and clothing of children 39-40 Results of these classes on physical condition 40-41 Permanency of results 41-42 Need for more anaemic classes 42 Statistics 43-45 Open-window classes for normal children 46-48 Teachers' reports on such classes 48-49 Suggestions for management of open-window classes 50-53 Problems of ventilation 53-54 X 1(5 r x Si "5 |4 3 PAGBS Classes for Blind Children 55-62 Reference to death of Miss Gertrude E. Bingham 55 Statistics 55-56 Classes in elementary schools 56 Pupils in high schools 56-58 Work in printing office for the blind 58 Vocational training in connection with blind pupils in our classes . . 58-60 Physical training — Athletics 60 Lectures for blind children in American Museum of Natural History 62 Eye examinations at clinic 62 Glasses for children with defective vision 62 School for the Deaf 63-71 Statistics 63-64 Origin and distribution of deafness 64-66 Physical care of the deaf 66-68 The mental side W. . .68-69 Industrial work for the deaf 69-70 The graduates of the school 70-71 Need of a new building 71 The voice 71 Classes for Crippled Children 73-75 Statistics 73 East Side Free School Association for Crippled Children 74 Association for the Aid of Crippled Children 74 Industrial work 74 Proposed inspection of classes for crippled children 75 Report on Visiting Teachers 78-84 General purpose and metnod of work 78 Summary of cases treated 79 Conditions investigated 79 Conditions found 79 Action taken 79 Outcome of investigation 80 Agencies that co-operated with the visiting teachers 80 A few significant cases 80-81 Testimony of principals 81-84 Testimony of district superintendents 84 LETTER OF TRANSMITTAL. New York, July 20, 1914. To the Board of Education: Ladies and Gentlemen: I have the honor to present in this pamphlet the reports of our school work for defective children — the mentally defective, the anemic, the tuberculous, the blind, the deaf and dumb, and the crippled. A feature of the report prepared by Miss Elizabeth E. Farrell, Inspector of Ungraded Classes (classes for mentally defective children), is the account of the work of two visiting teachers, appointed for the first time last year. Another interesting feature is a survey of the after life of 86 atypical boys and 38 atypical girls who left the ungraded classes after a training of three or four years. The survey shows that 54 per cent of these children are now engaged in some kind of remunerative employment. Miss Farrell shows very clearly the necessity for more labora- tory and office space to conduct the examination of children alleged to be mentally defective, of more physicians to examine them, of more visiting teachers to discover life histories and to bring the home into co-operation with the school, of more trained teachers to train these unfortunate children when they are gath- ered into classrooms, and of more classrooms in which to grade them in accordance with the degree of defect. Dr. I. Ogden Woodruff, who for three years, without remuner- ation, inspected and reported upon open-air classes, became, during the year, a salaried officer of the Board of Education, with special assignment to the supervision of all open-air classes. His report will be found valuable, not only because of his clear account of what was accomplished during the year in our three kinds of open- air classes — classes for the tuberculous, classes for the anaemic, which care for children who are subnormal physically, and open- window classes for normal children, — but more particularly for his demonstration of the permanence of the good effects produced by open-air classes and his suggestions to principals and teachers for the management of open- window classes for normal pupils. A study of this report would scarcely fail to impress your Board with the propriety — if not the necessity— of largely increasing the facilities for teaching in the open air. The Report on Classes for the Blind shows that substantial progress is being made in the work of teaching the blind. The suggestion that a special teacher of music, to train blind children endowed with the musical gift, be appointed, is worthy of careful consideration. | The need of a new building in which to carry on the beneficent work of teaching the deaf to speak and to understand what others say by reading their lips, and to provide increased opportunity for vocational training, is ably set forth by Miss Carrie W. Kearns, Principal of the School for the Deaf. Superintendent Edson, who reports on the classes for crippled children, shows the necessity of gathering these classes into cen- trally located and specially equipped buildings. Because of the intimate connection between the work of visit- ing teachers and the school \. jrk of mentally and physically defective children (thoiign the work of the visiting teacher is not by any means limited to such children) , I publish in this pamphlet Superintendent ICdson's account of the work accomplished by visiting teachers. Eight 'Visiting teachers were appointed during the year. Their work Has been carefully watched. Mr. Edson's report is extremely valuable, because of its summary of the testimony to the worth of Ahis work borne by district superintendents and principals. I sjmcerely trust that this testimony will lead to a very great en- 6 largement of the corps of visiting teachers. In a small city or village, where the population is fairly homogeneous, where all teachers live near their work, and where the schools are not crowded, necessary visiting at homes may be done by the regular staff of teachers. Such is not the case, however, in a city of the dimensions of New York, or even a city much smaller. In a community in which teachers frequently live at a great distance from their schools, in which the teacher, at the close of the day's work is worn out by the management of crowded classes, and in which a very large proportion of the parents do not speak English, the work of visiting homes becomes a special function. Many of our principals and teachers, particularly the kindergarten teachers, do much visiting at homes. Nor should this work be discontinued. The conscientious teacher will always find work of this kind to do. But there are so many cases in which, in order to bring about due correlation between the work of the school and the work of the home, so much time and so much energy and so much sympathy are required, that the class teacher cannot possibly bring about the desired results. Her reserves of time, energy, and sympathy are not sufficient. For such cases the visiting teacher becomes a necessity. I urgently recommend that the force of visiting teachers be increased from eight to twenty-five. Respectfully yours, WM. H. MAXWELL, Cit> Cuoerintendent of Schools \ MENTAL DEFECTIVES Report on Work of Ungraded Classes (From Report of Miss Elizabeth E. Farrell, Inspector of Ungraded Classes) ADVISORY COUNCIL The most significant thing in the history of the ungraded class movement in New York City is the acceptance during the last year by the Department of Education of the services of public- spirited men and women to serve in the capacity of advisers to the Department of Ungraded Classes. In offering their services to the city, the Council set forth as its objects: 1. — To work out a type of examination for children who are backward in their school work. 2. — To formulate public opinion with regard to adequate institutional pro- vision for such children as need it. 3. — To recommend such legal protection for children entering industry from ungraded classes as seems desirable. 4. — To advise with regard to types and methods of training for atypical chil- dren in the public schools. The Advisory Council is made up of experienced alienists, neurologists, educators, sociologists, and psychologists, as follows: L. Pierce Clark, M.D. Mrs. Wesley C. Mitchell Charles L. Dana, M.D. Frederick Peterson, M.D. Stephen Pierce Duggan, Ph.D. James Putnam, M.D. August Hoch, M.D. Bernard Sachs, M.D. Eleanor Hope Johnson Israel Strauss, M.D. Mrs. Florence Kelley Lillian D. Wald Foster Kennedy, M.D. Elizabeth E. Farrell, Secretary Adolf Meyer, M.D. Their conspicuous contribution to the work in the schools during the past year has been twofold. In conference with the regular staff, a type of examination has been worked out which is in accord with the best traditions in this work. They have taken an aggressive part in initiating legislation affecting the mentally deficient throughout the State. They have advocated publicly and privately the passage of a bill giving the Governor authority to appoint a Commission of five persons to investigate present provision for the care of the mentally deficient in this State and to outline a program for its improvement. TYPE OF MEDICAL EXAMINATION The type of medical examination was worked out after certain neurologists of the Advisory Council had given at least one after- noon a week in this office for the purpose of seeing certain selected cases referred by the examiners on the regular staff. Attention should be given to the detail which characterizes these examina- tions. We are not satisfied with examination by one person, with the results of one test, such as the Binet-Simon test, but each case is studied and tested by different individuals. In every difficult case as many as four examiners try to analyze the mind not only on its intellectual side but on the emotional and on the volitional as well. To understand a case thoroughly we must not rely entirely upon laboratory tests. They must be supplemented by records of social and economic efficiency. This necessitates, therefore, the consideration of the following groups of data: 1 —Record of school achievement; 2 — Record of home and envi- ronmental conditions; 3 — Record of neurological and psycholog- ical examination; 4 — Record of personality study. TYPE OF EXAMINATION AND RECORD Case I. The study is based upon a boy, aged fourteen years, who is totally unable to make any progress in the ordinary book work of his school. He cannot spell the simplest words, such as "girl" or "desk," and does not know the three times table in multiplication. His sense training in the school is but fair. He was especially quick to respond to commands in all physical training. His handwriting was shaky and much of his industrial 9 training was accompanied by trembling movements. He speaks well. His reading and arithmetic are equal to a boy's of seven years. The amount of general information is fair. His power of attention and memory is good. In the ungraded class he does good manual labor. The family history is negative, and throws no light on the causes of his mental defect. An inquiry into the personal history is negative aside from an attack of scarlet fever at three years of age. A year after the fever, which was moderately severe, he had two or three peculiar faint turns which pointed to a certain type of epileptic fits, but nothing similar to them has occurred since. He is a robust, fine looking, bright boy, with no apparent physical or nervous disorder. Careful test shows his intellectual development to be that of a boy of seven years. He stands in great terror of his father and the teachers, who think he is lazy and unwilling to learn. At home, he reads his lessons over and over again before the father comes home at night so that the father will not hear his mistakes and scold him, but he continues to make mistakes in spite of all efforts. The main examination shows that he has a good disposition. He went through all the manual and motor tests easily and well. It was &mnd that ever since the attack of scarlet fever at three years, he has been sluggish and indifferent to any kind of work requiring visual memory. He has always been poorest in spelling. His motor cleverness and ability to handle and understand mechanical work is well shown in an incident of last summer, while in the country on a vacation. He wanted to take two broken bicycles apart and make one good one out of the remnants; after days of labor and constructive adaptation he succeeded in accomplishing the task, in spite of receiving advice that it could not be done. It is found that he has gradually become a timid type of boy who never plays freely or naturally with other children and always prefers to be alone. He is interested in electrical work and attends to the electric bells in his home, and in fact does all the repair jobs about the house. He is employed by the teachers in his school at all sorts of work. His very lack of getting on at school seems to have engendered a shyness, timidity, and feeling of inadequacy and doubt, which in turn are slowly shutting him out of daily friendly contact with the outside world. He is becoming morose and solitary in habits. What the boy himself has to say is as follows: "I don't know why I can't get on at school; I can't spell nor write nor do arithmetic. I can do any sort of hand work; I seem to understand that by nature, but I can't carry anything in my mind. I mean I can't see a thing in the shop window and go home and make any part of the toy or machine by having just seen it in the shop. I want to be an electrician, but realize I must know more about books if I am to do any good work in life. If I could get an education through my hands it would be easy." 10 SEGREGATION OF TYPES OF ATYPICAL CHILDREN It will not be understood that an examination such as that detailed above is given to every child who is proposed for an ungraded class. The obvious case of mental defect is easy to detect. The borderline cases, the nervous children, in which group are found those afflicted with hysteria, habit spasms, fears, epilepsies, the timid, shy, depressed, the excitable types, the delinquent and the truant, call for all phases of physical and mental testing in order that their reactions and the depth and breadth of their personalities may be somewhat laid bare. The children in this second group present some of the most serious problems in community life. On every hand researches are being made into the causes of vagrancy, .crime, pauperism and the diseases of social life, but in all of these researches it is a product, a result that is dealt with. The research student in penology, like the alienist, must view in retrospect the individual's life, and reconstruct, if possible, the early youth and childhood of the person who is a pauper, a criminal, or a mental wreck. Even if it were possible to reconstruct accurately the past of these unfortunate individuals, the greatest difficulty is still ahead of the worker. A cure, a reformation is to be effected. This means that the individual must be re-educated, re-formed; his habits and instincts and interests must be re-established and in the right way. To do this in adult life is almost an impossible task. If the tendencies had been detected while the personality was still plastic enough to permit of change, we might have prevented that which it is difficult if not impossible to cure. Examinations such as have been indicated above have yielded results. It is proposed to individualize ungraded classes, to put into a given class those children whose needs are similar. An endeavor will be made to have teachers informed as to the char- acteristic phases of the work in these special classes. They will know the children best. They will be encouraged to study the instinctive life of the child as it develops, to analyze the com- ponent parts of the individual's personality, to determine the 11 formative traits or trends of character, in order that educational changes or environmental changes may be made as seem necessary. EXISTING ADMINISTRATIVE STAFF INADEQUATE The additions to the administrative staff were made in Sep- tember, 1913. It is to be regretted, however, that the requests granted at that time for additional help were those made some three years ago. They were based on the amount of work turned into this office during 1910-1911. It is needless to say that the acquisitions were entirely inadequate to the amount of work to be done in 1914. Therefore it becomes necessary again to call attention to the fact that additional physicians, inspectors and social workers are urgently needed at once to do the work of the department. In no place is the inadequacy of our staff so evident as in the conduct of clinics for the examination of children who are not obviously defective. Their examination demands special equip- ment and apparatus, quiet and time to do the work. It is im- perative that more such clinics should be held. Instead of having only two central places of examination, there should be at least one such place in each borough. While the work has been done at four central clinics a week during the past year, it is hoped that we shall be able to devote each afternoon in the week and Saturday morning to the examination of these higher types of variant mentality. Elementary school principals, the permanent census bureau and child welfare agencies proposed 4,739 children for examination. This is the largest number to be referred in any one year. It seems to confirm what has long been felt that as soon as the number of workers is at all commensurate, the amount of work to be done is increasingly in evidence. Of this number a total of 2,956 were examined. The difference between the number proposed and the number actually examined is very great. It is to be explained, however, by the fact that Dr. Smart has been absent for several months because of serious personal illness. 12 RE-EXAMINATION It is again necessary to report that the re-examination of all children in ungraded classes has been impossible. That the regular school grades might not be too seriously burdened by the presence in them of slow and defective children, the policy has been to do the new work whenever possible. The children in the ungraded classes have been neglected. It would be hard to exaggerate the necessity of regular re-examinations of these children. Their im- provement is to come, if at all, with improved physical, hygienic, and educational treatment and training. 13 B A = No. Cases Reported. B= " " Examined. C= " " Not Examined. D= " " Approved. E= " " Not Approved. 14 A / 1.— Medical staff in 1906. \ 2. — No children proposed in 1906. „ / 1.— Medical staff in 1914. \ 2. — No. children proposed in 1914. 15 Year Number Reported Number Examined Not Examined. 1912-1913 3430 1791 1639 1913-1914 4739 2956 1783 B 2 A* = No. Cases Proposed 1912-13. A2= « « Examined 1912-13. Bi= ■ " Proposed 1913-14. B 2 = « « Examined 1913-14. 16 DIFFICULTY IN ESTABLISHING UNGRADED CLASSES In organizing ungraded classes one of the greatest difficulties is in finding a suitable room. In a given month during the spring term just ended, the district superintendents of schools throughout the city reported approximately one thousand children examined and approved for ungraded class work but not in such classes. A similar survey of available rooms in school buildings, or in annexes to the same, evidenced the inability to organize additional classes unless property could be rented for the purpose. It seems de- sirable to have money set aside for this purpose. I beg to recom- mend that ten thousand dollars, for the rental of rooms in which ungraded classes may be organized, be included in the school budget for 1915. NUMBER AND DISTRIBUTION OF UNGRADED CLASSES To this date 192 ungraded classes have been authorized by the Board of Superintendents. Of this number 184 were in actual operation during the whole or part of the school year just closed. The remaining eight classes will be organized in September, 1914. The distribution of ungraded classes by boroughs is as follows: UNGRADED CLASSES 1914 Classes June 30 after promotion Addi- tional classes auth- orized forSept. Total classes auth- orized Reg- ister June 30 1914 June 30, 1914 Borough Teachers Vacan- cies For classes to be orga- nized Manhattan... The Bronx. . . Brooklyn .... Queens Richmond. . . 92 14 64 16 3 4 1 *2 92 18 65 17 3 1,496 223 1,002 201 50 67 13 43 15 3 25 1 21 1 4 1 1 Total 189 6 195 2,972 141 48 6 *1 class discontinued. 17 SCHOOLS PROPOSING CHILDREN FOR UNGRADED CLASSES As has been done in former years, school principals were asked to report children whom they thought to be in need of ungraded class work. This request was made in the following way: " To Principals of Elementary Schools, Ladies and Gentlemen: I am sending you under separate cover application forms for the examina- tion of children whom you propose for ungraded class work. (These children should be brought immediately to the attention of the school doctor and the school nurse for care and treatment.) I suggest that you give your personal attention to the conspicuously backward children; those obviously mentally defective; those three years behind in their school work; those who are apparently unable to learn to read; those who have very deficient number sense; those who are truants; those who seem incorrigible and noticeably irritable and nervous. In judging the above points allowance should be made for the child's lack of educational opportunities. It is proposed to examine the children in accordance with the following schedule : SCHEDULE September, 1913 June, 1914 DISTRICTS September 6, 8, 13, 14 February October 1, 2, 11, 16, 23, 25, 32, 37, 41, 43, 45 March November 4, 7, 15, 18, 19, 24, 28, 34, 39, 46 April December 3, 9, 10, 12, 20, 26, 27, 33, 36, 38 May January 5, 17, 21, 22, 29, 30, 31, 35, 40, 42, 44 June Because of the great pressure of work only such children will be examined as have been reported to this office at least ten days (10 days) prior to the first day of the month indicated for the different districts. It is imperative that the parent or some responsible person be present at the examination, which will be held in a school building to be determined later. I take pleasure in informing you that clinics for the examination of chil- dren are held each week in the Manhattan office on Thursday afternoon and Saturday morning and in the Brooklyn office Tuesday afternoon and Saturday morning. In order that unnecessary hardship to parents may be avoided, it is essential that appointments be made for children who are to be examined. Respectfully, WILLIAM H; MAXWELL, City Superintendent of Schools." 18 The response to this letter is as follows : Number of Elementary Schools 505 Number of schools that did report 326 Number of schools that did not report 179 Total 505 CLERICAL STAFF The conditions which prevailed last year and which were presented in the last annual report still obtain with regard to the clerical staff. A large part of the work is done by sustitute teachers without any special preparation in office work. This means that they must be trained by their daily work. It also 19 means that the daily work is never accomplished within the day. There is always much more to be done than can possibly be accom- plished with the staff as it exists at present. LABORATORY It is discouraging to report again that nothing has been done in the matter of providing adequate laboratory room. One of the physicians, as well as the social workers, has been obliged to use any desk which at the time might be unused. He has had no place to call his own, no possible way of taking care of his ma- terials and supplies. Such an arrangement does not make for efficiency. That it should be continued seems incredible. VISITING TEACHERS For the first time in the history of any school system in this country, if not in the world, visiting teachers, whose function is that of social workers, have been officially licensed to do for the children what the best teachers in smaller and less complex com- munities have always done. We have learned that if this service is left undone, it is at a great cost to the children and ultimately to the State. The hospital learned some years ago that its ex- pensive care was made more expensive when recovery was delayed because of certain conditions in the home which caused worry to the sick person; while others in need of convalescent care did not receive it if left to themselves. The consequence was they were often forced to return to the hospital for a more or less prolonged stay. The condition in the school is similar, particularly with those children who are slow and retarded. To know that they need glasses and to do nothing further is to be willing to repeat the expensive work of the school; to bring a slow and retarded child for a physical and mental examination without submitting definite information of his environmental setting and of his family and personal developmental history is to waste the time of several people, deny the child his best opportunity, and by so doing waste public funds. The story of this new factor in public education is told by the visiting teachers, Miss Brown and Miss Culp, in their report of the year's work, which I take pleasure in submitting. * 20 Q Q u. _j-«0 < cQ U ^ U- ^ U (0 3 Z o T OD^bZo ° (0 • O I- S 0- u rn (0 Lit! (0 up ^2 p h z z U UJ (0 K- 5^ z o > Q U J DC f li >- a _j h u (0 L) h < i u o & -I cO cO => < k u - o o $Z Jp O ry y er o 5 u - u. u. o o y a? t £h o <° y -J guJ!0<> (V D 3 -J ^ DO tO^^ ^^ 4 its 21 VISITING TEACHERS REPORT OF WORK The work is old, as old as the public schools. At first it was done by the teachers; often with more kindness than judgment, visiting here, teaching there things not written in books, giving often from a slender purse. Later, volunteer visitors from churches and clubs made occasional appearance in school, and sometimes straightened difficulties in the homes. Then, as the philanthropic societies grew up, the principals and teachers came to refer their children to them, and social workers went to the homes from the societies. Then the educational societies took up the work and as need arose have loaned skilled workers year by year to organize and practice a maximum of good with a minimum of confusion; and now the regularly appointed visiting teacher — is she not part of the logical development of the school? All stages of social service still exist, but unevenly. Visiting teachers have come to fill the gaps where social work is not done, and to relieve those principals, who, possessing the shepherd spirit, know only too well how much time, energy and money are spent in referring, conferring and visiting, and realize that this should be the work of one person with training, skill and time to work for results. Why should the workers be attached to schools? Be- cause we know the children, and we know each child's brothers and sisters, mothers, families — some for months, some for years. Because, though we can co-operate with other organizations, we cannot direct them. "Co-opera- tion" is a great slogan, but it does not mean asking somebody else to do the work. 1. The children 2. The parents 3. The principals and teachers 4. The Department of Ungraded Classes 5. The Department of Education 6. The co-operating agencies Each call naturally involves some benefit to all six bodies of people, but the degrees vary in each case. For instance, if the visiting teacher visits the public library to find a list of suitable reading for a high-grade mental defective, the class teacher is not as likely to reap immediate and general satis- faction therefrom as if the visiting teacher were conducting a child with a discharging ear to the dispensary, or urging a careless mother to send her child to school clean; yet all are good visits. In the same way the mother does not see the particular benefit to her in an unexpected call from a stranger who questions her on the subject of convulsions over and done with ten years ago, but the doctor who examines the child does. Then when Jenny knows more history than the teacher thought or when the mother learns that by proper care her boy may escape epileptic attacks, the purpose of our work begins to be appreciated. WE SERVE 22 Special cases needing adjustment. The adjustment of special cases seems to take up most of our time. For instance, the truants who have to be coaxed in the home or on the street corner day after day; the cases of home guardian- ship so bad that children disappear for days; the guiding of children to insti- tutions and persuading parents to let them stay. For example: John Kennedy, a low grade defective, was kept home on the (verbal) advice of a doctor who said he has brain tumor and a weak heart. The visiting teacher went to the home and in the course of conversation found that the doctor's treatment consists of very expensive pills and "plenty of fresh air and exercise." The fresh air was acquired on the father's vegetable cart and the exercise consisted of carrying loads of potatoes to the top floors of tenements. Armed with this information the visiting teacher telephoned the doctor, who had seen the boy but twice. Would he advise institutional care? Yes. Did he know the work of the ungraded classes? No. He thought the boy was in a 4B grade. After this conversation the doctor and visiting teacher advised in harmony as follows : 1. Permanent Custodial care, or 2. Ungraded class every day, and 3. No peddling of vegetables under threat of the Child Labor Committee. Investigation of homes preliminary to the doctor's examination. Children examined in school for the ungraded classes and at the office clinics are not always accompanied by a parent, hence the family history is not available for the doctor's information. Also it is quite true that the mothers are more apt to be truthful and explicit at their own firesides than they are among strangers in the office. It is often necessary to interview members of the family, school teachers, and family physicians before all the information needed for a com- plete understanding of the child's mental and physical condition can be obtained. Following up the doctor's recommendations. Home visits are necessary to follow up the examining physician's recommendation. It is necessary to analyze the child's environmental conditions, hereditary influences and tem- peramental tendencies, as a basis for treatment. For instance, in a case of malnutrition we must find the cause in order to correct it. Is the child's- condition due to lack of food, poor food, poor cooking, hasty meals, impaired digestion, too much candy, decayed teeth, or adenoids? In the case of a. choreic child, is chorea due to previous illness, fright, cruel or drunken parents,, late hours, excitement, over-stimulation by coffee, eye defect? We must know the child and the whole family very well before we can hope to accom- plish much. When the school nurses have these same children on their records, we work with them. Only workers who have watched the same chil- dren for years know the difficulties of maintaining a standard of good health. As yet we can deal only with the more immediate cases, but as every child examined does not enter an ungraded class, here is a chance for excellent co- 23 operation with the visiting teachers of the Public Education Association. Provided there were somebody to gather in reports from the co-operating visiting teachers, who almost in every instance know the families before the children are proposed for ungraded classes, then the recommendations of the children not admitted to Ungraded Glasses, could be returned to the original visiting teacher, while the advice to those admitted could be followed up by the visiting teacher attached to this office. Following up children discharged from school. We try to trace children who have left ungraded classes, especially those who are discharged at sixteen years. This is work requiring much patience and inspiration. On the desk beside this report lies a letter from the Charity Organization Society promising one more glass eye to Tom Dunn, to equip him for seeking work, and beneath it lies a list of "Boys Wanted," cut out of a newspaper ready to send to another boy's mother. All of these cases prove the need of constant supervision; and in all our visiting we must be constantly urging the parents to their responsibility to- ward their mentally defective children. This education of the parents, which is one of the first principles of our work, should be a field for a much jvider propaganda. Every child who has left the ungraded class to go to work would probably be working more efficiently and making more money under sympathetic "after care." A sort of continued oversight until their needs are demonstrated and met would help, beyond a doubt. Following up cases reported by the Census Bureau. Children reported by the permanent census bureau who have not been brought to this office on request must be looked up by the visiting teacher. These are our saddest cases. They do not often prove to be children who would be helped by un- graded class work, but they frequently need institutional and sometimes medical care. For example: Little Dennis Kelley, the son of a bankrupt saloon keeper, was reported to the office of Classes for the Blind. The visitor from that office reported him to us as a mental defective, and our visiting teacher guessed him a hopeless idiot, nearly blind, with tuberculosis of the knee. While there was money, Dennis had had doctors; when the money went the treatment ceased. The father and mother loving him more than the other five children, kept him at home in three dark rooms. They could not bear to take this little child to the hurried doctors of dispensaries, even if he could have stood the strain of visiting three different clinics. Dennis is now in a beautiful country hospital growing larger and stronger. His parents, devout Catholics, trust him entirely to the Sisters there, while the other five children have more of their mother's care, more room and less danger of infection. Such cases belong to the lower border of the ungraded class. It is hard to convince the parents that no amount of school work could improve the child's mind and still harder to persuade them that institutional care is best. 24 Social survey of classes or groups of children. The efficacy of visiting in routine a whole group or class of children depends largely upon the amount and quality of visiting done by the teacher of the ungraded class. Some very good teachers do not seem to feel responsible for their scholars after school hours, some feel the responsibility, but lack the social spirit. Others without visible effort can build up in the families of their pupils a very real spirit of gratitude and loyalty to the ungraded class. This is what the visiting teacher must supply in the groups where the teacher has not done so; but it takes far more time than we have as yet been able to devote to this particular work. Ideally there should be visiting teachers for all these branches of work. There should also, we think, be a social worker at the office clinics, with plenty of time to receive the parents and children, somebody who has attended other clinics and knows the horrors of the tedious but necessary waiting. Children waiting for a psychological examination should be occupied, and we feel sure the results obtained would justify the employment of a visiting teacher for this purpose. As to the co-operation we have received, by individuals and for individuals, it has been very efficient and generous. We thank most heartily all social and settlement workers, nurses and volunteer visitors who have contributed largely to the successful results of our work, and we hope that we may be of mutual help to each other in the future. We recommend for the future: enough workers to do for all ungraded class children what has been done for a relatively few selected cases this year. 25 ^ 3 Jg.r»b.Tal I- K»o ;«^ JW ( & ~- J^a f^ • he^ c/^K J-loSjoiTo-t . -VowJ at W. 1 1- C * i- 'e. u ^S.«o..- W»»b'.ro.i . u VunSu« JJoSb.15-1 ■ JWosb.-fo.! L.^coli s.f.ra.1 ^06 O «- *-y W y- 26 COMBINED STATISTICAL REPORT OF TWO VISITING TEACHERS— UNGRADED CLASSES No. of Classes from Which Children were Visited Ungraded Not Ungraded Total Manhattan Bronx Queens 75 12 30 9 28 1 16 1 103 13 46 10 Richmond Total 126 46 172 Sum Total. No. of school children visited No. of children not in school visited. Total children visited 172 529 70 No. of home visits , Visits of co-operation (to schools, churches, settlements, etc.) , 599 1,058 697 Total visits 1,755 Children taken to clinics and hospitals . No. of visits to clinics and hospitals . . . 42 78 27 VISITS TO EACH CHILP CP r n 0) I O < H 0) > A) n < Co H 03 - N Cu •£ 0\ ff) s o> u> - N OJ 4> 01 (J) S CP ro o K> N^o^iN^3 N 0> ^ 01 (P 6 O OJ O o 01 o o 3 o o o o o o o 5 o o o 9 5> o 3 o o o ro O t\) O ro OJ O IS) O en o o 3 8 28 SURVEY OF THE RESULTS OF UNGRADED CLASS WORK It is the last mentioned field of activity, the social survey, which the visiting teacher may well develop. Her function as a Social Surveyor of the careers of those children who have left the ungraded classes at sixteen years, to enter industry, will be of the utmost importance in determining a rational program for the care of backward and defective individuals. As far as I know, there is nowhere a body of facts of this type upon which action may be based. There are persons who inform us on every occasion that the class of undesirable citizens is largely recruited from the group of backward and defective. Such talk is very largely guess work. The most definite piece of work of this kind which deals with present day verifiable facts was directed by Miss Walsh, my associate. Because of its obvious value and its pregnant meaning for the future, I bring it to your attention. CAEEERS OF 124 BOYS AND GIRLS DISCHARGED FROM UNGRADED CLASSES In an effort to find out what becomes of those children who at sixteen years of age leave the ungraded classes, a study of eighty-six boys and thirty- eight girls has been made. Children are placed in ungraded classes after examination and certification by a physician and psychologist as being unable because of mental defect to profit by the work in the regular graded school. When children are discharged from an ungraded class a prognosis is made by the examiners. The children considered here have been out of school from one to six years; the average length of time being two years. The classes they attended were among those organized in 1906 when the department of ungraded classes was formed. The reason for choosing these older classes is obvious. More children have been discharged from them, and they have been for a longer time out in the world. The children here considered rep- resent the total number discharged on becoming sixteen years of age from these ungraded classes. P. S. — Lower East Side, Manhattan 8 children P. S— Upper " " " 9 P. S— Lower " " " 8 P. S.— Upper " " " 9 P. S.— Lower " " " 12 P. S.— " West " " 20 P. S— " East " " 7 ■p cj a a a a n P. S— " " " " 9 P. S — Bronx 10 P. S. — Ridgewood Section, Brooklyn 12 P. S— Brooklyn 13 Total 124 29 The teachers of these classes were asked to submit a list of the names of children who had been discharged on reaching sixteen years of age. They were asked also to furnish any authentic information, not "reliable hearsay," covering the following points: kind of employment, number of jobs held, wages, number of arrests, commitment to penal institu- tions, number of marriages, number of children, and number of deaths. This information was checked up and augmented during the last two months by the visiting teachers from this department. In most of the cases volunteer social workers had done follow-up work in years past. There were, then, two reports on all the cases considered, and on many three. The facts brought out by the study of these 124 cases are as follows: Working 54% Cared for at home (some helping) 25% In institutions 8.8% No information 8.9% Dead 2.3% Arrested 5% 30 The occupations include for the girls, millinery, making of linings, factory work, laundry work, etc.; for the boys, truck driving, delivering groceries, wood turning, tailoring, etc. The findings in this study, as far as the proportion of those who are working is concerned, agree with those referred to in a paper by Wm. A. Polglase, M. D., Medical Superintendent of the Home for Feeble-minded in Lapeer, Michigan. He says, " It has been shown that more than 50% of the adults of the higher grades of the men- tally defective who have been under training from childhood are capable of doing, under intelligent supervision, a sufficient amount of work to pay for the actual cost of their support, whether in an institution or at home." K. Richter (Leipzig) , says : " Would that our master mechanics could be brought to understand that pupils sent out from our auxiliary schools (schools for mental defectives) are not nearly as incompetent as people are wont to believe; in truth they are often more capable in practical affairs than boys from the country and elsewhere. The work of training auxiliary school apprentices pays if the master does not leave the matter entirely in hands of his assistants, but looks after the boys personally and bestows the necessary patience, kindness, and oversight upon them." He has suggested a plan of following the pupils who have left the auxiliary schools. Every six years a set of questions is sent out to such of these former pupils as can be found. They seek infor- mation, especially concerning the person's ability to earn a living. Huxley says that life is not alone a "survival of the fittest," but a " fitting of as many as possible to survive." How best may these handicapped children be helped to survive after they have been sent from the ungraded classes out into the world to earn a living? Many who have gone out have demonstrated that they are worth while. How much more they might have accomplished and how much easier their way might have been if a system of "watch-care" could have been theirs after leaving the classes. There would be a most specific value in some scheme of after supervision. For this more visiting teachers are urgently needed. Two might well spend all their time in helping 31 to conserve these products of the ungraded classes. Some one has said the mental defectives are those who, like slag, have fallen out of nature's mould as waste material. The scientific treatment of waste material is its utilization for the best interests of the community. We should have during the year 1915 eight additional visiting teachers in order to make this statistical and social survey on a scale which is warranted by the results of this first year of social service in the public schools. SUMMARY OF RECOMMENDATIONS The recommendations herein set forth may be summarized as follows: 1. The immediate demands of the Department of Ungraded Classes are: (a) The appointment of at least four physicians, experts in nervous and mental diseases. This would in all probability make certain the examination of all children proposed by elementary school principals; the re-examination of all children in ungraded classes; and an intensive study and survey of one school district. (b) The appointment of four assistant inspectors of ungraded classes. (c) The appointment of eight additional visiting teachers in order that all children may have what only a few selected cases during this year have been given; that a social survey may be made of all children who have left ungraded classes. (d) Adequate provision for clerical help. Suitable office space sufficient to meet the urgent demands of the educational clinics. 32 REPORT ON OPEN AIR CLASSES Mr. William H. Maxwell, City Superintendent of Schools, Dear Sir: I present the following report on open air classes for the year 1913-14: The open air classes this year have been of three types, classes for children with tuberculosis; the so-called "anemic" classes, which care for children who are subnormal physically or who are likely to contract tuberculosis through exposure; and the open window classes for normal children. Each of these groups differs distinctly in its organization, its aims and in the lines along which it is conducted. CLASSES FOR TUBERCULOUS CHILDREN Under this heading are included those classes for children with pulmonary tuberculosis only, as the open air classes for children with bone and joint tuberculosis belong more properly to the classes for crippled children. I feel very strongly that while it is no sense necessary, or even desirable, that classes for crippled children should be put under the supervision of the physician in charge of the open air classes, it is most desirable that these children should receive their instruction in open window classes. A large pro- portion of these children are crippled as a result of previous bone and joint tuberculosis — -in some classes as many as 40% — and all of them because of their physical handicap, get a minimum amount of out-of-doors. NUMBER OF CASES The classes for tuberculous children during the past school year cared for 860* cases. These children are ones who are being *This does not represent the actual number of children, as owing to trans- fers and readmissions there is some duplication. Probably the actual num- ber of children is about 15% lower than this. 33 treated for pulmonary tuberculosis either at Otisville, the Munici- pal Sanitorium for tuberculosis, or the House of Rest, or at one of the day camps for tuberculosis in the city. They are situated in the following locations: Otisville Sanitorium Annex of P. S. 14 Manhattan House of Rest, Inwood " " " 52 " Ferry Boat, Southfield " " " 14 * " " Westfield " " " 12 « Middletown " " " 51 " " " Rutherford " " " Brooklyn Vanderbilt Clinic Roof " " " 141 Manhattan East River Homes " " " 158 " These classes are conducted entirely out of doors. The children on the day camps are in the open air eight hours daily, and at Otisville and the House of Rest open air treatment is prac- tically continuous 24 hours a day. In all cases the childrln are under the direct medical supervision and charge of the nurses and physicians connected with the camp or sanitorium. They are on a high calory diet in practically all cases, and a special equipment is provided, consisting of a cot or bed for the rest hour, and clothing, consisting of sleeping bags, sweaters, overshoes, mittens, coats and caps. The exact type of equipment varies somewhat with each day camp or sanitorium, and is provided either by the institution where the day camp is operated, or, as is the case in most instances, by a private "auxiliary" or committee. ADVANTAGES OF SCHOOLING FOR TUBERCULOUS CHILDREN The Board of Education provides only the classroom furnish- ings and teachers, and receives the children for as many hours daily as in the opinion of the attending physician their physical condition permits. These classes, however, are extremely im- portant elements in the care of these tuberculous children. When day camps were first started, it was extremely difficult to get the parents to send the children to the camp during the school year. As few of the children had tubercle bacilli in their sputum, only a limited number could be excluded from school and 34 the treatment would have had to be given up just as the children were beginning to make satisfactory progress. The children them- selves were restless and felt keenly the loss of their education and the lack of definite mental work. Moreover the attendance was irregular as there was nothing to hold the children regularly be- yond the realization (one can imagine the extent of that in child- hood) that it was for their own welfare. Now the children come regularly. Attendance has improved; they are happy and con- tented and the parents satisfied. Moreover the classes are of distinct economic value. A child, on account of its illness, will lose very little of its education. While in general the rate of progress is not so fast as in the regular classes, yet, as the percentage of promotions in the table at the end of the section shows, enough progress is made to prevent most of the children from losing much ground; and to enable them to qualify as wage earners within but a short time of that at which they would normally, had they kept their health and continued in the regular classes. The importance of this is realized on re- calling that in the families of these children, frequently one wage earner is already incapacitated because of this disease. As most of discharged patients fall into the groups of either apparently cured, arrested, or apparently arrested cases, the results are of very distinct value. The experience of most physicians who have had charge of day camps is that only a small percentage of cases in childhood relapse, during the school age at any rate (our experience has not yet extended over a period sufficiently long to enable us to know how permanently the resistance of these children has been raised). This means that for a period of some years (let us hope that in most cases it is for life), these children are " cured" of a disease, which, in most of them, if left to itself, would probably have gone on to a slowly progressive and fatal termination. EFFECT OF COLD AIR The classrooms of these children are kept at out-door tem- perature and the cold is not tempered by any heating. A glance 35 at the temperature for the winter months in the classrooms on some of the day camps and at the Otisville Sanatorium shows that the children received not only fresh air, but almost frozen air for some months for their treatment. Day Camp Temperatures December January February March Av. Min. Av. Min. Av. Min. Av. Min. Otisville 31.6 16 23.4 1 17.3 1 30.4 17 Rutherford 28 20 33 4 25 16 25 19 Westfield 35 21 31 3 24 34 18 Southfield 44 33 32 15 40 21 49 30 Interestingly enough these months are those of their greatest improvement. While this would not justify a statement that fresh air is a valuable therapeutic agent in direct proportion to the lowness of its temperature, yet it is a fact that in tuberculosis cool and cold weather raises both the blood pressure, which is abnormally lowered by the tuberculous poison, and also the re- sistance of the individual; while hot weather, especially when associated with considerable humidity, lowers the general condi- tion of the patient. The knowledge of this fact has been made use of during the past two summers, and a number of these tuber- culous children have been taken to summer camps in the mountains. One of the most successful of these summer camps has been organized, and is being conducted, through the assistance of interested private individuals, by one of the teachers of the classes for tuberculous children, and here she takes care during the sum- mer vacation of the youngsters she teaches in the winter time. The improvement in the children in the summer is very gratifying, and from being a time of the year when they barely held their own or slipped backward a little, it is now a period of great gain. 36 Sanitorium or Day Camp Register 6-30-13 . Discharged Admitted Register 6-30-14. Length of stay : Came once 2— 29 days 30 days and over. Reasons for discharge : To work To school To sanitorium or hos- pital To other day camps. . . Too sick to attend. . . . Not tuberculous Other causes Statistical Tables Tuberculous Classes Otisville Any garden (?) Sewing, weaving, can- ing, etc No. hrs. daily in school Any exceptions No. hrs. daily in camp. Length of rest hour. . . Per cent, attendance school days Seven days a week. . . Summer vacation. . . . Per cent, promotions: 6-30-13 1-31-14 6-30-14 89 83 80 86 3 80 82 1 Yes Yes 4 No 24 Varies 98 100 90 68 House of Rest Ruther- ford 14 82 74 66 72(?) 1 4 69 4 46 7 2 2 13 No Yes 31 Yes 8 H 83. 76 81 85 83 82 South- field 37 42 40 35 15 8 19 24 14 1 3 Yes Yes 3 Yes 8 li West- field 73 56 80 46 57 47 36 8 50 21 25 1 10 Yes Yes 4 No 9 1 81 78 61 65 70 70 Van- derbilt Roof East River Homes 49 80 70 39 10 20 50 2 13 17 1 5 8 34 Yes Yes 3-4 No 8 2 85 80 85 80 67 62 25 26 41 40 1 39 24 1 1 Yes Yes 5 No i 60 92 89 84 37 ANEMIC CLASSES In the classes for tuberculous children we saw a type of class which was associated with an enterprise whose aims were curative. The anemic class stands for both prevention and cure — prevention of the disease which the classes for tuberculous children were orga- nized to aid in combating, and as an aid in restoring to health those children whose physical condition seems distinctly below the normal standard. At the close of this year there are 39 anemic classes connected with the following schools : SCHOOLS HAVING ANEMIC CLASSES Manhattan 12, 17, 21, 33 (2 classes), 51 (2 classes), 61, 65B, 84, ^9, 92, 95, 107, 110, 179, 192. Brooklyn 5, 8, 30, 34, 85, 91, 150, 162 (3 classes), 168, 173 (2 classes), 174, 175. Bronx 4, 45, 46. Queens 7, 90, 92. Richmond 13. These classes are situated, with one or two exceptions, on school property and the classes are under the medical supervision of a physician officially connected with the educational system. The classes are limited to 25 children, and in a number of cases the register is held somewhat lower. This is deemed necessary, on account of the educational difficulties connected with teaching so many grades. Most of these classes are indoors, in classrooms of more than average size, which have the windows pivoted. Some have roofs or balconies in connection with them which may be used in favor- able weather. Three or four have only out-door classrooms, and have to find some makeshift quarters when the weather is too severe or stormy to permit being out-of-doors. This is occasionally necessary, as the present equipment does not protect adequately against severe cold. Moreover when children come to school in 38 wet clothing, as they sometimes do in a cold winter rain, it is not possible to have them sit out in the raw atmosphere in their wet clothes. TEMPERATURE OF CLASS ROOMS Some heat is permitted in the class rooms when necessary to overcome unduly low temperature or excessive dampness. There is a distinctly rational use for it in the latter condition, as cold moist air radiates body heat much quicker than cold dry air. Thus a temperature of 32 degrees F. with much moisture will chill a child much more quickly than one of 20 to 25 degrees with little moisture. The temperature rarely goes below 35 to 30 degrees F. in these class rooms. KIND AND SITUATION OF OPEN AIR CLASS ROOMS A general tendency throughout the country seems to be to place anemic children entirely out of doors. With the changeable climate of New York City, and the extremely raw weather in winter, I am distinctly in favor of keeping the classes within build- ings. Apart from that, to get an out-door or roof structure of sufficient rigidity to insure any permanency or stability requires a very considerable expenditure. Even then it is difficult so to construct such shelters as to render them satisfactory in both cold and warm weather, and in New York City we have, during the school year, extremes in temperature. In the cold weather it is desirable to have a shelter so arranged as to permit the sides being adjusted to keep out all wind, with the top so constructed that it may roll back completely, thus allowing a maximum of sunshine on the children and a minimum of air movement. Such a con- dition approaches the ideal for cold weather. On the other hand, in warm weather the sides need to be raised as much as possible to permit a maximum air movement, and even under such conditions, if a double roof with an intervening air space is not present, the temperature is apt to become very high under the shelter. It is difficult to construct a type of shelter which will satis- factorily meet both of these requirements. One made of canvas 39 may be constructed which will give moderate satisfaction in sum- mer. In winter, however, too much air can get through the joints on windy days, and besides there is danger, if the weather turns cold after a heavy rain, of the canvas freezing and being ripped into shreds if a high wind follows. This has been the fate of one or two such structures already in use, in the storms of last winter. One other objection to roof structure, and in my mind a serious one, is the physical strain to which the children are subjected when the class is put on the roof of the school building. To reach the roof of one of the newer school buildings necessitates a climb of five or six flights of stairs. This climb has to be made twice daily by the children in the anemic classes so situated. The anemic classes contain children from the lower grades as well as the upper, and they are children in poor physical condition. I think the expenditure of effort needed to climb these stairs is distinctly undesirable. % In addition, the placing of any children with cardiac disease in classes so situated is absolutely contraindicated. Personally, I am more in favor of a class situated on about the third floor in a corner room with preferably an easterly and southerly exposure. This gives a maximum of sunlight in winter and the heat and glare of the sun in hot weather can be tempered by shades. Of course, it is desirable in placing a class on the third floor to be assured that the buildings opposite are not so high as to cut off the sunlight during some of the winter months when the sun's angle with the horizon is rather small. PROPER EQUIPMENT OF ROOMS AND CLOTHING OF CHILDREN Besides, as stated before, the present equipment does not pro- tect adequately against very low temperature, and one that would do so is too expensive. To protect children properly against extreme cold or wind, two features are necessary in the equipment which are lacking in that of the anemic classes in the public schools. The first of these is a coat or sweater of some warm material which is a good non-conductor. One of the best materials for these gar- ments is angora wool. It combines the minimum of weight with 40 • the maximum of warmth. As it is loosely woven it is desirable to provide over it a garment of closely woven kahki-like material which is so made as to be practically wind-proof. Garments such as these are in use in some of the open-air classes in the private schools in New York City, and have proved satisfactory. The cost of these is about $8.00 greater than that of the present equip- ment, and as the angora sweaters are all wool they require an ex- pensive method of cleaning to prevent matting and shrinkage. The equipment as supplied by the Board of Education, together with the approximate cost of each article, is as follows : Moulthrop chairs, at $5 .50 each Folding cots at 2 .00 " Sleeping bags, at 4 .50 " Sweaters, at 1 .25 " Caps, at 25 " Overshoes, at 2 .25 a pair Mittens, at 20 " $15.95 RESULTS ON PHYSICAL CONDITION The effect of these classes on the physical condition of the chil- dren has already been set forth in the detailed reports of the care- ful studies made during the past three years, and has been incor- porated in your annual reports of 1911-12-13. A few points, however, are worthy of mention outside of the data contained in the appended table. One of these is the slight influence of feeding this year on the gain in weight. In Manhattan, in six classes where feeding was given, the average gain was 2.7 lbs., while the average gain in eight where no feeding was given was 3.3 lbs. The schools in all the other bor- oughs gave feeding, with the exception of P. S. No. 4, in the Bronx, but the average of these schools which did not include a substantial lunch, but merely milk, cocoa, crackers, etc., was 2.9 lbs. In the other five schools, four in Brooklyn and one in Richmond, where a substantial lunch was given in addition, the average gain was 5.8 lbs. The following menu, however, which was used at P. S. No. 41 150, Brooklyn, is much greater than could be introduced into fresh air classes in general. 10 A. M., cereal with milk and sugar or cocoa with crackers. 12 Noon, thick soup with meat, fish or eggs. Cocoa, bread. Sometimes fruit. 2:15 P. M., milk with crackers. The daily cost is about 123^ cents per capita, of which the chil- dren pay only about y z . In Richmond the Parents Association of P. S. No. 13 contributed $400 last year for food and clothing for these children. In Manhattan the feeding was practically self supporting. In general, the results this year seem to bear out the impression our previous studies gave us that the addition of milk and crackers or some light form of nourishment in the morn- ing or afternoon, or both, seems to have but little effect upon the general progress of these children, and not very much up<5H the weight. The improvement in scholarship is also very encouraging. Many children made normal progress who previously had failed. Over 50 advanced more rapidly than the normal rate, though no attempt was made to goad the children to additional effort, and children are always encouraged to rest whenever they feel tired. Of course it is difficult to determine how much of the improvement in scholarship is due to gain in health and ability to concentrate and work, and how much is due to the additional individual atten- tion these pupils may receive. The average attendance of these classes is excellent, considering that these are children whose physical conditions renders them more likely than the majority of those in school to contract illness. In most cases the attendance approximates closely to that of the school as a whole. PERMANENCY OF RESULTS Of necessity it occurs at times to all of us who are working in any branch of public health service, to wonder whether what we 42 accomplish is really worth the effort expended, and whether our results are anything more than temporary. The endeavor to get some data on this question, led me to gather together those children whom I could, who had been dis- charged from the anemic class at P. S. No. 21, Manhattan, where, on account of the length of time the class had been in operation, I could get the greatest number of cases. Thirty-five of these discharged cases were still in the school. They had been out of the class from one to three years. Superficial examination showed nearly all of them to be in good physical condition. Their color was good and they carried themselves as if they had plenty of reserve energy and good physical tone. Examination showed that they had gained on an average of 16 pounds in weight since leaving the class, and that their average hemoglobin was 90 per cent. Compare this with 72 to 77 per cent., the averages of the class on admission. Their hemoglobin had increased on an average of 7.8 per cent. Only eight out of thirty-five had lost in hemoglobin, and of these in six cases it was only from 1 to 5 per cent. Only eight showed a hemoglobin below 85 per cent, and none below 81 per cent. In a word, the findings encouragingly lead us to the conclusion that we are engaged in a work that is of distinct benefit to the children, and one in which the results, so far as can be determined from a very limited number of cases, show a surprising degree of permanency. NEED FOR MORE ANEMIC CLASSES The need for additional classes for anemic children is great, especially in certain localities. This is particularly true of that great section of the East Side in Manhattan, from Delancey Street, north, to the Harlem River, and bounded on the east by the Bowery and Third Avenue. In this immense and over-crowded area there is only one anemic class. 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