AB N U A l' R E"P O R^T S ' 'o F THE b U P E K 1 I^i i ii i"^ i^' li « i •O- F ■-: S CM 0.0' L S , 1^9 1 8 '■ 1 9 2 Qass. Book. ^BOARD OF EDUCATION. .,^^,,^.^^3,,^^ THE CITY oFnEW YORK (city) ANNUAL REPORT OF THE SUPERINTENDENT OF SCHOOLS 1918-1919-1920 Reports on Special Classes MENTAL DEFECTIVES THE CRIPPLED OPEN AIR CLASSES INDUSTRIAL AND THE BLIND AND SIGHT PLACEMENT WORK CONSERVATION THE CARDIAC THE DEAF ' SPEECH IMPROVEMENT TRUANT AND PROBATIONARY SCHOOLS VISITING TEACHERS PRESENTED TO THE BOARD OF EDUCATION DECEMBER 22, 1920 TWENTIETH TWENTY-FIRST TWENTY-SECOND ANNUAL REPORTS ^f^c ] A-0 -5^ %^'. LIBRARY OF CONGRESS -'~£tVE" JUN11192t poouMEHTs ki. Vision TABLE OF CONTENTS PAGE Letter of Transmittal, 7 Ungraded Classes 20 Selection of children for examination ][[[ 20 A study to establish facts ..V.. 21 Children's Court cases ' 22 Mental surveys 22 Psychiatric examinations 24 Visiting teachers 26 Social service chart 28 Statistical summary 29 The problem " ' 3Q Recommendations " 39 Open-air Classes 3]^ Dr. Baker's report 3I Classrooms 3I General regulations ' 3I Feeding 32 Home conditions ^2 Rest period ^^ Supervisor ^^ Progress of work ^ ^^ Statistics 34 Improvement of children 35 Scholarship record 35 Medical supervision : .---. . .- 36 Results of work . . ; . 7. ;';'. 35 Summer vacation 37 Conclusions S7 Miss Smith's report 38 Out-door classes 38 Type of classroom .• 39 Classroom equipment 39 Personal equipment 39 Number and types of out-door classes 41 New classes 43 Open-air classes 43 Type of case 44 Location of classrooms 44 Vetitilation and temperature 45 Classroom equipment 45 Personal equipment 45 Rest period and diet 47 Cleaning personal equipment 47 Hospital record cards 50 Number of classes SO Open window classes 51 Location 52 Structure 52 Ventilation and temperature 52 Type of case 52 Recommendations 53 Prophylactic Treatment 55 Type of case 55 PAGE Working group and control group 55 Clinic records 56 Diet 56 Physical defects 57 Dental inspection 57 Rate of incidence of tuberculosis 58 Results 58 Pretuberculous children in the public schools 59 Summary 60 The Blind and Sight Conservation Classes 61 Distribution of classes 61 Eye clinics 62 Production of textbooks 63 After school records 64 Manual work 64 War activities 65 Function of the sight conservation classes 65 Recommendations 66 Miss Smith's report 68 Specialized physical training 68 Sight conservation classes 71 Hygiene suggestions 12> Classroom equipment 12) Summary 74 Dr. Beals' report 75 The work 75 Candidates for sight conservation classes 76 Progressive myopia 11 The lens of the eye' 78 Need of glasses 79 Need of propaganda 80 Refraction 80 Ungraded children 81 Handicap to normal children 81 Results 82 Whitman's views 83 The Deaf 85 Growth of the school 85 The semi-deaf 85 Objections to attendance at P. S. 47 86 Advantages obtained 87 Statistics 88 Nationalities in the school 89 Classroom work 89 Test for standards 90 The physical side 90 The alumni association 91 Trade work 91 Graduates 92 Improvements 92 Miss Smith's report 93 Physical care' and specialized physical training 93 Facilities and equipment needed 98 Another teacher needed 98 Summary 98 PAGE Crippled Children Iqq Mrs. Scheider's survey 100 Classes and register 100 Classes in hospitals and convalescent homes 101 The course of study 101 Retardation 102 . Transportation 102 Causes of disability 102 Noon day meals 104 Prevocational training 104 Character of the work .". . . 105 Recommendations 106 Conclusion 107 Miss Smith's report 110 History 110 Growth 110 Type of special classes Ill Special classes in public schools Ill Classrooms and equipment 113 Transportation 113 Day school 1 13 Hospital classes 115 Home instruction for helpless cripples 117 Assignment of teachers 118 Volunteer visiting teachers 121 Results and inductions of poliomyelitis 122 Summary 124 Industrial and Placement Work 125 Controlling purpose 125 Aim 125 Adjustment of time schedule 126 Work in School for the' Deaf 127 Teachers' training classes 128 Cardiacs 129 Miss Smith's report 129 Formation of classes 129 Type of case 129 Hospital record card 130 Co-operation bodies 131 Admission and discharge 131 Classroom temperature 131 Feeding in school 132 Morning hygietie inspection 132 Daily medical inspection • 133 School care 133 School curriculum 134 Routine school day 134 After school recreation 135 Tentative program for Saturday and Sunday 136 Chart for general observation 136 Results 137 Recommendations 138 Principal Marks' report 139 Organization of classes in P. S. 64, Manhattan 139 Classification 139 PAGE Mothers' meetings 140 Thoroughness of maintenance 141 Mrs. Scheider's report 142 Organization of classes as annex to P. S. 75, Man 142 Enrollment 142 Food 142 Program 143 Results 143 Table of attendance 144 Principal Smith's report 145 Organization of class in Lenox Hill Settlement 145 Clinics 145 Food 145 Rest 146 Recreation 146 Co-operating agencies 146 Speech Improvement 147 Teachers employed 147 Work in evening and summer schools 147 Clinics 148 Army work 149 Syllabus on foreign accent 149 Re'commendations 150 Parental and Truant Schools 151 Buildings 151 Physical and medical examination 151 Daily life 152 Grade work 152 Activities and products 153 Recommendations 155 Commitments 156 Value of productions 157 The Manhattan school 158 Probationary Schools 1^9 Organization 159 Causes of truancy and delinquency 161 Physical defe'cts 162 School lunch 164 Garden 166 Afternoon recreation centre 166 S. P. C. C. annex 166 Shop work 167 Business methods 168 Academic subjects 168 Suggestions 169 Visiting Teachers I'O Function and requirements I'O Assignment and supervision I'O Visiting teachers' individual report 171 Visiting teachers' monthly report 1'^ Maladjustments in scholarship 174 Conduct and prevention of truancy 177 Children kept in school 1' 9 Americanization 180 Suggestions 1°1 LETTER OF TRANSMITTAL July 12, 1920. TO THE BOARD OF EDUCATION. Ladies and Gentlemen: I submit herewith the report of Associate Superintendent Ed- son, dealing with special classes. The report also deals with the work of truant and probationary schools, and the work of visit- ing teachers. Perhaps the most characteristic advance in school administra- tion during recent years has been the rejection of the assumption that all children are practically alike in physical and mental equipment, and also that children with marked physical defects of sight, hearing or limb have no place in the public schools. Un- der the older belief, children of widely different abilities were grouped together in unit classes, with the result that physical and mental defectives were very frequently laggards because of their inability to take advantage of the instruction offered. The child with defective vision, the stammerer, the cardiac, and the mental defective were placed in severe scholastic competition with prac- tically normal children. The net result of their failure was not only extreme personal discouragement and loss of self-esteem and self-confidence, but also considerable expense to the city, because of the fact that such children were repeaters in the grades. The proper classification and segregation of such children was there- fore desirable, not only from a humanitarian, but also from an economical standpoint. I am sure that in the future we face an expansion of this type of service, because increased diagnostic skill will make it possible and also imperative that children be grouped in accordance with their physical and mental ability, so that unfair demands will not be made upon them, and also so that they can derive the maximum benefit from the educational facilities offered. While the present emphasis is upon the care of the subnormal type of child grouped 8 in so-called ungraded classes, it is equally certain that in the fu- ture grading of our children we will have to make definite pro- vision for the superior type of child. As I have already stated in discussing this problem, a desirable type of school organization where grade registers are sufficiently large to permit such group- ing, is one in which the total group in a given grade is sorted out into class units of precocious, average, and subnormal children in terms of native ability as well as scholarship. Pupils grouped in this way, if handled by skillful teachers, are happy and contented because they are working within their normal limits of ability. As the result of such grouping, the teacher, if allowed to adjust the course of study to the needs of the pupils, can do much more effective work than is possible in a class composed of pupils of markedly uneven attainments. It is too radical to urge that chil- dren properly grouped and working through a course of study adapted to their ability, would never be left back in the grades? Is it not true that the percentage of holdovers and leftbacks is at least a partial index of the crudity of school management and our ignorance of childhood? Indeed, the development of a finer classification of our chil- dren implies the extension of the ungraded class system far be- yond its present limits, and also other groupings that the present ungraded system does not include. Children of a precocious type are entitled to just as much consideration as those of a subnormal type. We have made an excellent start, but a very limited one, in the mastery of the entire problem. Probably no type of class or child makes a stronger appeal to the general public than the ones with which this report deals. The various partial reports show with considerable detail the pro- visions made for the blind child, who formerly groped around his home, making no progress and developing all kinds of unfortu- nate mannerisms ; for the deaf child, who either remained at home or struggled ineffectively in the classroom ; for the child afflicted with a cardiac lesion who formerly was compelled to comply with all the exacting demands made with reference to dis- missals, gymnastics, book work, despite his disability ; for the crippled, who either remained at home after infantile paralysis had afflicted him, or who struggled manfully in a school room equipped with furniture which was totally unsuited to accommo- date him; for the speech defective, whose stuttering and stam- mering made him an object of pity or ridicule, both in his school and in his social environment ; and for the mental defective, whose inability to respond as a member of a normal class begat nagging, which in turn eventually drove the child to truancy. Backward indeed would be any educational program that did not include within its benevolent scope ample provision for such types of handicapped children. A careful consideration of the problem of the exceptional child convinces me that there will always be need of a system of par- ental and probationary schools to handle those children who, either because of bad habits resulting from defective mentality or from unfortunate social environment, or the combined influence of both, are so vicious or unsocial in their behavior that it is necessary to place them under more or less restraint in order that they may not contaminate decent children, and in order that, through proper care and instruction, they shall be, trained in habits of hygienic living and orderly behavior. The proper execution of this plan would involve the establishment throughout the city, in definite relation to the needs of the school population, a system of proba- tionary schools in which, through compulsory attendance rigidly enforced, longer hours, a varied school curriculum including pre- vocational training and such coercive measures under wise limita- tion as may be deemed necessary, these exceptional pupils would be trained so that after a reasonable period they could be returned to the average public school. The initial step in this matter has been taken, and the gradual development of such a system of schools is one for which financial provision should be made just as soon as it is possible to relieve existing congestion, and thus make certain buildings available for this purpose. The problem of the visiting teachers, especially their salary status, is one that has aroused a good deal of heated discussion, much of the difference of opinion growing out of the lack of definition of the function of the visiting teacher. Some go so far as to claim that the title is a misnomer because little if anv teach- ing is done bv the so-called visiting teacher. Others claim that such work is a very essential part of their daily routine, and go 10 so far as to claim that the person serving in such capacity should be a highly qualified teacher with training in social work, and should be paid as great a salary as a teacher holding a promotion license. If we were to concede the truth of this contention, it would seem to be reasonable to claim that the visiting teacher should be recruited from the teaching staff, and that she should hold a basic grade license and also a promotion license. I am inclined to believe that the truth of the matter is that the so-called visiting teacher is primarily an adjuster of certain social situations, and is entitled neither to the status nor to the salary of teachers who have, as the result of competitive examination, gained basic teaching licenses, and who daily face the exacting routine of classroom instruction. As social adjusters, the visiting teachers' most valuable service will no doubt always be rendered in the case of adolescent girls in unfortunate environments. It is conceded that our present visiting teachers operating in this par- ticular field have done remarkably fine work, and have filled a real gap in our educational service. Whether or not visiting teachers, as a group, shall be made an integral part of the Bureau of Attendance and Child Welfare is a mooted question, and will be decided in the light of experience. In conclusion, I wish to take this opportunity to extend to the Board of Education my sincere appreciation of the intelligent in- terest in these special classes that has been the basis of an insis- tent demand on the part of the Board that these activities receive adequate financial support. Very truly yours, WILLIAM L. ETTINGER, Superintendent of Schools. 11 DR. WILLIAM L. ETTINGER, Superintendent of Schools. Dear Sir : I submit herewith reports for the past three years on special classes in our pubHc schools, including the education and training of mental defectives; of the blind, deaf, and crippled children; of children having speech defects ; of children in the truant and pro- bationary schools ; and reports of the visiting teachers. MENTAL DEFECTIVES Miss Farrell, Inspector of Ungraded Classes, calls special at- tention to one of the great problems in school administration — the proper identification and treatment of children of low or re- tarded mentality. The results of the mental surveys of men in the army disclosed the fact that of the 1,726,(X)0 men examined, five-tenths per cent were reported for discharge because of mental inferiority, six-tenths per cent were assigned to development battalions in order to be carefully observed and be given a pre- liminary training for use in the army, and 3 per cent were found to be under 10 years' mental age. The facts disclosed have ex- cited much discussion among educators of this country, and, as a result, increased attention is sure to be given to the education and training of children of low mentality. The extent of the problem may be seen from the estimate made by two of the best authorities in this country, Dr. Walter E. Fernald and Dr. Louis M. Terman, who estimate that 2 per cent of the population are of low mentality. On this basis, 14,760 children in the schools of this city should be in ungraded classes, only about 28 per cent of whom are now in such classes. The recent tests given men, applying or drafted into service in the army, gave a much higher percentage than 2 per cent. The prob- lem is a large one and calls for a liberal appropriation. One phase of the work, brought to our attention in this report, is the fact that 222 elementary school principals in control of 321,- 900 children, approximately, neglected to report any children for psychological and psychiatric examination. The school principals 12 sympathetic in the matter of individual differences, reported from 1 to 5 per cent for examination. Miss Farrell recommends that all cases of truant and incorrigible children be subjected to a mental examination before any disposition of their case is made. In any consideration of the problem of the education and training of children of low mentality, attention is called to the fact that the Lockwood law of 1917, which went into effect in 1918, requires the education of children with retarded mental de- velopment. The passage of this law, making compulsory special education for mentally retarded children, imposes a burden and a responsibility upon the school authorities of this city. One of the most serious problems in connection with the edu- cation and training of children of low mentality is the inability to secure properly trained teachers for the work. Many teachers are unwilling to be assigned to such classes, and many others are poorly prepared to give these children the training they need. The lack of preparation is especially evident in lines of manual work, the very field in which all the teachers should be strong. OPEN AIR CLASSES Dr. S. Josephine Baker, Director of the Bureau of Child Hygiene, submits a brief summary of the work carried on by the Board of Health in connection with open air classes. One notice- able result of this work was found in the average gain in weight of children in the open air classes. This gain was more than eight and a half pounds, and it was noticed that the lower the temperature, the greater the gain, due largely, no doubt, to the fact that the appetite is markedly increased in cold weather. The school progress of children in open air classes was found to be very satisfactory. Dr. Baker asserts, "It has been conclu- sively proven that children who are subnormal physically, when afforded an opportunity to receive fresh air, light, and food, to have their physical defects, which retard growth and development, corrected, and to live under proper hygienic conditions, can be re- stored to at least normal physical condition." Miss Smith. Assistant Director of Physical Training, presents a report on the outcome of the results obtained through open air 13 treatment of cases of incipient tuberculosis, and of those predis- posed to respiratory diseases. She considers the type of open air classes, the location and structure of classrooms and equipment needed, the value of lunch service for these children, the hospital and physical training records called for, and the prophylactic treatment of pre-tuberculous children in the Stuyvesant clinic. The work carried on in the three types of fresh air classes — the open window, the open air, and the classes of children affected with tuberculosis — is proving a Godsend to thousands of children in our schools. The open window classes call for no additional equipment. The ventilating system is cut off from the rooms so that the circulation of fresh air is through the open windows. The children are allowed to wear their outer wraps as desired, and the temperature is not allowed to go below 50°. The open air classes have, or should have, sunny rooms, in- dividual study chairs, cots for an hour's rest during the day, sleeping bags, sweaters, caps and mittens, and a warm noon lunch. The classes for tuberculous children are located at sanatoriums^ on the roofs of hospitals, or on abandoned ferry boats. These classes receive daily medical treatment, a warm noon lunch, two mid-session lunches, and opportunity for rest. There are today 110 open air classes — 57 in A^anhattan, 8 in the Bronx, 34 in Brooklyn, 10 in Queens, and one in Richmond. There is an imperative demand for a large increase in the number, but the increase cannot be made unless proper equipment can be provided. In fact, 37 of the classes already organized are in need of suitable equipment, in whole or in part. If funds and rooms were available we could organize to advantage 100 new classes. There are at present 25 out-door classes of tuberculous chil- dren in sanatoriums, hospitals, and on abandoned ferry boats, as annexes to nearby public schools, 17 in Manhattan, 4 in Brook- lyn, and 4 in Richmond. These children receive food and careful medical treatment. The reports are very illuminating and suggestive. Their rec- ommendations, as to the organization and conduct of open air 14 classes and the treatment of pre-tuberculous children are worthy of thoughtful consideration. Money and effort given to the bet- terment of these physically handicapped children are well spent. THE BLIND AND SIGHT CONSERVATION CLASSES Miss Moscrip, Inspector of Classes for the Blind, in her re- view of the work of the year in the treatment of blind and near blind children, presents an excellent view of the work accom- plished. She emphasizes the value of the eye clinic under Dr. Beals of the Board of Health, and calls special attention to the function of the sight conservation classes that are doing such ad- mirable work in saving the eyesight of so many children. The scarcity of suitable textbooks with enlarged type, and the great expense and labor involved in preparing these textbooks, are a great handicap to the work. The expense of transportation of the blind children and their guides to and from school is a necessary part of the education of these children, as many of them are obliged to travel long dis- tances to school where a class has been organized. There are at present 300 cases on file in the office of the In- spector awaiting assignment to sight conservation classes. Teachers and equiprhent for these children with defective eyesight are very much needed. Miss Smith calls attention to the value of specialized physical training of the blind from the segregated group toward the nor- mal through association with children in normal classes. She points out the fact that the blind and near-blind children are phys- ically able to take part in most of the physical training exercises of physically normal children, and she recommends that large, sunny, and well ventilated classrooms be provided for all blind and sight conservation classes in public schools. Dr. Beals makes a very interesting summary of the work of the eye clinic in P. S. 30, Manhattan. He examines the eyes of all candidates and assigns these children to blind, sight conserva- tion, or normal classes. He makes a full diagnosis and prognosis of each case, and outlines the kind and quality of work that may 15 be permitted for each child, and he suggests improvements in the conditions found, be it disease or refractive error. Some of the results obtained are very remarkable and very encouraging. THE DEAF Miss Kearns, principal of the School for the Deaf, presents the objections raised and the advantages obtained by attendance at a special school for the deaf ; statistics on the present condition of the school and the nationalities represented; the classroom work and tests for standards. The great need of the school is a suitable building, and the Board of Education has included a request for such building and site in the next appropriation. It is to be hoped that this build- ing will be erected in the near future, as the school is in great need of better accommodations. The work in the School for the Deaf, and the results attained, are deserving of the highest praise. This school is ranked as one of the best in the country. Miss Smith, in her report, emphasizes the need of special at- tention to be given to the health of physically handicapped children as the essential basis of their school life. She sta'tes that over 66 per cent of thei children in the School for the Deaf have become deaf through serious illness, and that as a consequence their vitaHty has become impaired. She urges that during the growing periods of these children they be given adequate physical training in order to overcome their physical deficiencies. THE CRIPPLED Mrs. Scheider, principal of Public School 75, Manhattan, was assigned at the opening of the spring term' to make a survey of the work carried on in the 78 classes of crippled children in the public schools of the city. She visited these classes two or three times during the term, and her conclusions are embodied in the report submitted. Mrs. Scheider calls attention to the need and value of proper physical training, including motor transportation of crippled chil- 16 dren to and from school and to and from hospitals, to the need of suitable food at noon, inchiding a glass of milk during the morn- ing and afternoon sessions, to the need of suitable braces, massage and electrical treatment, to a close co-operation between the home, the school, and the hospital, and to proper medical and surgical treatment. She makes a plea for the best possible educational advantage for all, a unified control, the standardization of forms of organization and methods, and a study of openings in industry for these children. In order to secure better results, it is clearly evident that there should be a great centralization of these classes, motor transporta- tion for all, greater attention given to curative gymnastics, and a proper and thorough industrial training given to all in order that they may readily engage in some useful and self-supporting em- ployment. Miss Smith, in her report, considers the four types of special classes for crippled children — special classes in various schools, a day school for crippled children, hospital classes, and home in- struction for helpless crippled children. The assignment of teach- ers to the homes of helpless cripples for instruction in elementary school subjects and in lines of industrial training is proving a Godsend to many children who would otherwise be entirely neg- lected. The three points that stand out most prominently in these reports are the need of : 1. A greater concentration of classes 2. Motor transportation 3. An extension of the plan to provide teachers for helpless cripples at their homes. The expense for the education and training of crippled chil- dren looms large, but the problem is a big one. A recent survey made by a representative committee of physicians and specialists indicates that there are in this city about 36,000 cripples ; that about 50 per cent are under 16 years of age; that 63 per cent be- came cripples before reaching the age of 16; that nearly one-half of the cases discovered by a field canvass were not being treated ; that there are approximately in the city, 1,000 cases of poliomye- 17 litis, Potts' disease, and tuberculosis of the joints, not yet diag- nosed; that there are about 3,700 cases with these diseases that have been diagnosed but have ceased to attend clinics; and that over 50 per cent of cripples are not known to any agency. INDUSTRIAL WORK Miss Ronzone, special teacher in charge of the industrial and placement work of physically handicapped children, urges as the controlling purpose of her work the preparation of these children for useful employment in the trades. She states that it is the mission of the teacher to study the peculiar handicap and individ« ual tendency of each child in order to find occupational possibili- ties, and thus aid the child to be self-supporting and self- respecting. CARDIACS For the past two years, an experiment has been tried in the organization and conduct of classes of children having pro- nounced cardiac trouble, and during the past year very consider able emphasis has been given to the problem by the active co- operation of a committee of the Public Education Association and of the physicians in nearby hospitals. The special equip- ment provided, the examination of children by specialists, ihe daily routine of examination, work, rest, food, recreation are found in the accompanying report. The classes already organ- ized are made annexes to Public Schools 64, 70, 75, 168, 192, Manhattan, and Public School 34, Brooklyn. Other classes will soon be formed as suitable rooms can be found. The results so far secured are in the highest degree encouraging. SPEECH IMPROVEMENT Dr. Martin, Director of Speech Improvement, in his report of progress during the past year, gives a very encouraging statement of the work in his department. With his 26 special teachers at his clinics, he is able to render an excellent account of the service he is rendering to many young people of this city having speech defects. Three of his teachers rendered very acceptable service in army work. 18 Dr. Martin recommends that a central school be selected in each borough, at which acute cases of stammering may be iso- lated from other children. The idea appears to be an excellent one, as more time and effort could there be given to cases in need of prolonged and intensive treatment. In order to have the work properly carried on in all of the schools of the city, there should be a very considerable increase in the number of special teachers of speech improvement, at least one for each group of three or four schools, and five or six for the high schools and training schools. TRUANTS The principals and teachers in charge of the parental, truant, and probationary schools present interesting reports of the work of these schools during the past year. The Parental School, accommodating about 225 boys, is located on a farm of 107 acres, and the Brooklyn Truant School, accommodating about 120 boys, is located on a site comprising 14 acres, so that the boys in these two institutions get considerable outdoor Ufe and experience. The Manhattan Truant School, accommodating about 50 boys, is located in a brick building on East 21st Street, with no oppor- tunity for the boys committed there to get out-door work and exercise. The Parental School takes the older boys, while the Brooklyn and Manhattan Schools take the younger boys and transfer many to^ the Parental School from time to time as oppor- tunity offers and occasion demands. Provision has been made in the budget for 1920 for the erection and equipment of additional cottages at the Parental School, a cottage-home for the superintendent, an infirmary, a suitable barn and hennery. When these additions are completed, the Brooklyn and Manhattan schools can be closed and the property turned over to the city. The expense of the needed additions to the Parental School will thus be small, if anything, and the education and training of truants will be immeasurably improved, as well as a very considerable reduction in expense of management eflfected. ■ 19 The three probationary schools are serving a most excellent purpose in checking truancy and in leading boys to appreciate the advantages of an education. There should be a dozen such schools in this city. The need is great. A committee of the Teachers' Council submitted to the Board of Education last June a report urging the establishment of more probationary schools. The report closed with the following statement : The greatest waste occurring in school administration is that which arises when a school is compelled to retain among its pupils exceptional children whose physical, mental or moral condition is such that an ex- cess of time and energy must be continually bestowed upon them to the detriment of normal pupils, in order to secure the proper social and scholastic classroom environment in which instruction can be fittingly carried on, VISITING TEACHERS The six visiting teachers have continued their good work. They have had the assistance of four teachers of German on special assignment. The work is so important and so far-reach- ing that I feel justified in making a special plea for an increase in the number of such teachers. The visiting teacher is the co-operating agency between the school and home. Her work is to secure the hearty interest and support of parents in the schools, and thus in the most effective way to prevent truancy. She is one of the potent agencies in making good citizens ; she assists backward children to gain a promotion ;, she assists in making home adjustments so that children may be prompt and regular in attendance at school : she is a tremendous force in preventing children from becoming delinquents and criminals. The call from principals for the assignment of visiting teachers to their schools is loud and insistent. We could make good use of one in each of the 48 school districts. The accompanying reports are submitted for your careful and sympathetic consideration. Respectfully submitted, ANDREW W. EDSON, Associate Superintendent. 20 UNGRADED CLASSES Elizabeth E. Farrell, Inspector. SELECTION OF CHILDREN FOR PSYCHOLOGICAL AND PSYCHIATRIC EXAMINATION In a previous report it was recommended that a method be devised which will make practically certain the identification of all mentally defective children in the schools. Tiiey should be known early in their school careers in order that habits of tru- ancy in some children may not develop, that conduct disorders may, in part, be prevented, and that educational opportunity, commensurate with their needs and capacities, may be provided. Because of the significance for school administrators of the men- tal examination of men in the army, this recommendation is repeated. Mentally defective children are not identified by all school principals, notwithstanding the Superintendent has in- dicated certain t}pes of children who should be the objects of their study and for whom they should exhaust the resources pro- vided. Some of his suggestions are as follows: 1. Children who may be mentally defective: a. Children who have gross conduct disorders — truants : those who seem to be incorrigible ; those who seem to show criminal tendencies ; those who are habitually ab- sent from school even for a half day at a time ; those who have "tantrums." b. Children who seem nervous — those who cry easily ; those who are easily frightened ; those who constantly move about ; choreic children ; those who have unusual anxieties ; epileptics. c. Children who seem psychopathic — those who do not play ; those who play with children much younger than themselves ; those who are over-conscientious, hyper- sensitive ; those who avoid companionship ; those who are irritable ; those who have shown a marked change in disposition. ^1 d. Children whose progress is unsatisfactory — those who show defeci in general information about the home, the school and the street environment; those who show marked muscular inco-ordination ; those who show de- fect in judgment, foresight, language, suggestibility. 2. Children who are obviously mentally defective: The weakness of this method is obvious. It leaves to chance and to opinion the selection of children for examination. During this school year 222 elementary school principals in control of a school population of approximately 321,900 neglected to report children for psychological and psychiatric examination. The percentage of children reported by elementary school principals who are intelligent and sympathetic in the matter of individual differences varies from 0.1 per cent in some schools to 5 per cent in others. The presence in all schools of children who need this service is demonstrable in two ways — mental surveys made else- where have determined the incidence of mental abnormality in school children; agencies other than the school in contact with certain children have sought mental examination for them. Agencies like the Bureau of Attendance, the Red Cross, the Children's Court, physicians, are some of those at whose request we have examined children this year. Thirty-four of the 222 public schools from which children were not reported for mental examination this year had on their registers children whose ex- amination was asked by one or more of the agencies named. A STUDY TO ESTABLISH FACTS The Bureau of Attendance reported for examination this school year, 1,188 children who, after repeated warning by the attendance officers, persisted in their truancy and were called with their parents for a hearing before the Bureau of Attend- ance. An intensive study* of 608 such children was made in order to establish some facts as to the mental status of truants. * The Mental Status of Truants, by Louise E. Poull. 22 The study shows the distribution of intelligence quotients as fol- lows: Intelligence Quotient *' Total 40 50 60 70 80 90 100 110 120 to to to to to to to to to 49 59 69 79 89 99 109 119 140 Number of Children 3 16 76 170 176 77 81 9 608 From a study of the age and grade distribution it is apparent that 75 per cent of these truants are retarded from one to nine years in their school attainment ; that 44 per cent are of such mental calibre that it is extremely improbable that their mental development will ever exceed that of a child of 12 years of age. children's court cases A study of the records ( September, 1918 — May, 1919, in- clusive) of the Manhattan Children's Court, shows that 200 public school children were diagnosed as mentally defective by the psychiatrist of the court. Seventy-three of them had previ- ously been diagnosed by this office. f The distribution of intelligence quotients for this group is as follows : Intelligence Quotient Unknown Total 30 40 50 60 70 80 to to to to to to 39 49 59 69 79 89 Number of Children 1 12 61 81 38 1 6 200 The work of these two agencies indicates that the school is far from discharging its duty with regard to its poorly endowed children. It is futile to continue the present method. A more objective and scientific one must be devised. MENTAL SURVEYS Surveys of large numbers of school children indicate that about 2 per cent are mentally defective. Terman says4 "What ever intelligence tests have been made in any considerable * An intelligence quotient below 80 indicates mental abnormality. t Of this number 11 were referred to the court by this department. $The Measurement of Intelligence. Lewis M. Terman. 23 number in the schools, they have shown that not far from 2 per cent of the children enrolled have a grade of intelligence which, however long they live, will never develop beyond the level which is normal to the average child of 11 or 12 years. The large majority of these belong to the moron grade." Apply this per- centage to the total register of 222 schools from which no chil- dren were reported by the school principals this year, and it is apparent that 6438 children have been neglected. The results of the mental survey of men in the army are now available. This survey was undertaken because the army was thought of as a place for highly specialized educational training. The specific problem was to place the recruit where he could give the best service and where his training could be most economically and efficiently obtained. "It is obvious that efficient and economical training can be given only when the intellectual power, degree of nervous stability and the degree of self-control of individuals are known. One million seven hundred and twenty-six thou- sand were given psychological examinations with a view to deter- mining these elements in their makeup. Of this number, 7749 (0.5 per cent) were reported for discharge because of mental inferiority; 9871 (0.6 per cent) were assigned to development battalions in order that they might be carefully observed and given preliminary training to discover, if possible, ways of using them in the army. "During this same period of six months, there were reported 4744 men with mental age ratings below seven years ; 7762 be- tween seven and eight years ; 14,566 between eight and nine years ; 18,581 between nine and 10 years. This gives a total of 45,653 (3 per cent) men under 10 years' mental age."* The simplification of methods of discipline and a decrease in the number of offenders came as a by-product of the mental ex- amination of recruits. The army experience shows that men with low intellectual power, when in squads or companies in which men of high intellectual power were present, chose to appear stubborn rather than stupid. When this fact was estab- lished, extreme or persistent violators of military rules were not * Major Robert M. Yerkes in Psychological Reviezv, March, 1919. 24 punished until the results of mental examination were available. This experience is similar to that common in ungraded classes. It will be true in all classes when individual mental differences determine school classification. The great majority of the men examined in the army are products of the public schools of this country. It is fair to assume that their school life could have been more efficient and more economical if their mental status had been known. Judged by the results of tests in the army, we have in the public schools of this city, 22,200 children who will never develop beyond the mental age of 10 years. Apply the more conservative percentage of Terman and we have 14,800 children who will never reach the mental development of the normal adult. There are ifl ungraded classes at present, 4126 children. PSYCHIATRIC AND PSYCHOLOGICAL EXAMINATION From the data, both practical and theoretical, submitted here, it is obvious that we are not identifying all the mentally defective children in the schools. This failure is due to the inherent weaknesses in the present method of selecting children for ex- amination. This method is based on subjective data. The new method must be based on objective, scientifically determined facts. A satisfactory method must be based on the following principles : It must eliminate chance and surmise in the selection of children for examination ; it must be practicable from the point of view of time and of expense; it must eliminate emotional factors in the selection of children; it must insure that every school shall know the extent of its problem of mental ab- normality. With this in mind, we have, during this school year, inaug- urated a new method of selecting children for special education. A mental survey of two public schools was made. All of the children were measured in order that the school attainment, the intellectual power and the emotional control of each child might be known. This was made possible by the generosity and scien- tific interest of Professor W. A. McCall and of Professor Leta S. Hollingworth of Teachers' College; and by friends of the 25 children who provided funds for additional psychological, statis- tical and clerical help. The results show that one child in three is classified according to his ability to do school work. The fol- lowing statements will serve as illustrations : Measured by the Thorndike Reading Scale, it was found that the best pupil in the 3A class made the same score in reading as the poorest pupil in the 8A class ; there was every degree of overlapping of reading ability between these two extremes. Measured by the Trabue Completion Language Scale, the four best pupils in the 4B class made exactly the same scores as the three poorest pupils in the lOB class. The best speller in the 3A class could spell the same number of words of the Ayres Scale as the poorest speller in the 8A class. Measured by the Woody- McCall Mixed Fundamentals in Arithmetic, the best pupil in the 3A class made a higher score than the poorest 8B pupil. Eigh- teen (3 per cent) of the group were found to be mentally defec- tive. Eleven of these were wasting their time, as well as the time of the other children in their classes, and of the teachers, in grades from 5B to 9A. This fact was unknown previous to the survey. Sixty were children of borderline intelligence. As well as these stupid children, the survey revealed the fact that eight children were of superior intelligence, while 14 were far above the average. A table, showing the reclassification of the SB class "on the basis of ability to do school work," is given be- low, and will serve to illustrate what was found throughout the school: ^^3LE RECLASSIFICATION OF 8- -B GRADE. Assigned to : No. Children Ungraded 1 Special 2 7a 1 8a 7 8b 7 9a 3(1 ps3'chopathic) 9b 2 lib 3 12b 1 27 AGE RANGE 12j4 TO 17 YEARS. 26 REPORT OF VISITING TEACHERS The time of the social service staff is divided approximately as follows : Visits Clinics Records Statistics Interviews VISITS Visiting occupies about one-half the time. The usual object of visiting the home is to ascertain what the conditions are and to endeavor to correct or modify any influences which are ad- verse to the child's welfare. Sometimes the chief purpose of the call is to talk with the mother on some special subject. School visits are made to talk over with principal or teacher the special problem of the child. Miscellaneous visits include calls at hospitals, Children's Court, relief agencies, and so forth. Of all the cases visited, 53 per cent were visited once, 22.5 per cent twice, and 24.5 per cent three times or more. Visits are made at all hours of the day, whenever the family can be found at home. Sometimes the call must be made in the even- ing, at the lunch hour, or on Sunday. The total number of visits made was 1217. Of these 711 were home visits, 186 were visits to schools, and 320 were miscel- laneous.* CLINICS The work of the visiting teacher at climes consists first of taking from the parent who accompanies each child, a careful *The figures represent the work of the school year, May and June work being estimated on the averages of the previous eight months. 27 history of the early life, and of the hereditary and environmental influences; secondly, in talking with the parent at the end of the examination and summing up the recommendations made. Many parents who bring their children for examination have never heard of an ungraded class. The purpose of ungraded classes must be explained in order to secure the parents' co-op- eration. Recommendations for physical care must be talked over, and the parent told where to go for the treatment indicated. A careful interview at the time of the parent's visit to the office frequently makes a home visit unnecessary. Two hundred and eighty-seven clinics of one-half day each were held in the department, each of which was attended by one or more of the visiting teachers. RECORDS Full and accurate reports of all visits are made. Even interviews and telephone calls must be recorded in order that the file of each child may be complete. The records of each case, therefore, show exactly what has been done to date. STATISTICS The social work is, as occasion arises, put into statistical form. Sometimes it is desirable to present the data graphically. We regret that more time cannot be given to this part of the work, for the wealth of material in the files of the department would be of great scientific value, if it could be prepared for reference. INTERVIEWS Aside from the talks at the clinics, the visiting teachers give much time to interviews in the office. Relations, teachers, social workers, and sometimes the children themselves, come for ad- vice and information. 28 The relation of the social service to the rest of the depart- ment is shown in the accompanying chart : SOCIAL SERVICE SOURCES TYPES SCHOOLS RELATIVES SOCIAL AGENCIES CHILDREN'S COURT ETC DEPARTMENT OF UNGRADED CLASSES AGENCIES The number of new cases cared for was 410. Of these 272 were boys and 138 were girls. In addition, 112 after-care cases were visited, the majority of these requiring only one call. More attention has been given to the correction of physical defects than ever before. It is hoped that many children pro- posed for ungraded class work may be able to maintain them- selves in the grades if physical handicaps are overcome. We attempt to provide social and recreational facilities for these difficult children in order to aid them to their fullest moral development. From September to May, 29 children w^ere sent to institu- tions for the feeble-minded. These w^ere either so unstable as to be a menace to society, or of such low grade mentality that they could not well be cared for at home. 29 Through the generous co-operation of such agencies as the Society for the Prevention of Cruelty to Children, charitable or- ganizations, Children's Court, hospitals and settlements, we have been able to accomplish more than could otherwise have been possible. The 5000 children annually referred to this department can- not be cared for adequately by only three visiting teachers. Many psychopathic children are examined. These require the most watchful care, and with our present staff can be given but little attention. Many cases referred to hospitals and social agencies cannot be followed up as they should be to make sure that recommendations are carried out. Time is required for more intensive work with individuals. After-care work, which is so necessary for the mentally defective, is hardly touched upon. In order that the social service of the department may at- tempt to cope with the demands made upon it, at least two ad- ditional visiting teachers are urgently needed. TABLE STATISTICAL SUMMARY ANALYSIS OF 1672 NEW CLASSES SEEN BY PSYCHIATRISTS 1919-1920 Ungraded Not Ungraded Total Total Age.. 5-8 8-12 12-16 Age.. S-8 8-12 12-16 Sex.. B. G. B. G. B. G. B. G. Sex.. B G. B. G. E.G. B. G. Man. 16 23 176 96 149 93 341212 Man. 40 22 13867 47 41 225 130 Bronx 6 5 28 17 20 6 54 28 Bronx 8 3 33 6 13 1 54 10 Bklyn 28 7 119 54 81 39 228 100 Bklyn 23 9 90 22 32 2 145 33 Qu'ns 1 14 10 9 13 24 23 Qu'ns 3 2 18 3 2 3 23 8 Richd 11 6 8 11 18 9 Rich'd 3 1 12 4 3 Total 665 372 451 184 Grand total 1037 635 30 TABLE STATISTICAL SUMMARY OF NERVOUS AND MENTAL DISORDERS Disease . Constitutional T3^„: Functional r, u i.u- it -i Glandular Brain Psychopathic Epilepsy /-,, • Psychoses t f • v Dysfunction Total Organic •' Inferiority -^ 37 28 25 33 19 142 THE PROBLEM 800,000 public school children 22,200 who should be in ungraded classes 4,126 children now in ungraded classes For every 200 school children approximately 5 are in need of ungraded class work. At present only 1 of these is cared for in an ungraded class. RECOM MENDATIONS The work which has been carried on this year dictates the following recommendations : 1. The position of education psychologist should be author- ized in the office of the inspector of ungraded classes. 2. Two additional clerical positions should be authorized. 3. Two additional visiting teachers with training and experi- ence in psychiatric social service should be provided to continue the work which the American Red Cross has begun in connec- tion with this office, and which is concerned with children of school age who cannot attend school because of the degree and complexity of the defects from which they sufifer. 4. Following tiie army procedure cases of gross misconduct which do not yield to ordinary measures of school discipline should have a mental examination before any disposition is made. 5. Provision should be made for the examination of all tru- ant children. 31 OPEN-AIR CLASSES S. Josephine Baker, M. D., D. P. H. Director, Bureau of Child Hygiene. I beg to submit the following report of the work performed by the Bureau of Child Hygiene of the Department of Health during the school year 1918-1919, in connection with the open-air classes of the public schools. The number of open-air classes has been increased to 110 during the year. Though many more classes are needed and desired, so few satisfactory rooms are available that the increase must be slow until an ample number of suitable classrooms can be procured. CLASSROOMS The present location of classrooms can be divided intO' three general groups : first, the public parks ; second, on roofs of pub- lic school buildings and other buildings ; and third, in classrooms in public schools. ^ The best location for these classes is in the school building, particularly if the customary structural changes have been made. Such classrooms answer all the requirements demanded for this work, and have none of the short-comings of the other two groups. They are cheaper and easier to maintain, require less equipment for the children, weather conditions do not interfere with the class routine, and therefore the work can be carried out properly every day. GENERAL REGULATIONS The nurses and teachers strive to have the parents procure proper medical treatment for their children. Because of these efforts, very rarely does a parent refuse or fail tO' have his child placed under proper medical care. Unfortunately, the facili- ties for providing medical care were greatly reduced this year, and many children were not able to receive the attention they so anxiously sought and desired before the close of the school year. However, arrangements have been made to care for many of these children at the various hospitals during the Summer va- cation period. 32 Great efforts are being made by the nurses and teachers to have the parents carry out, at home, similar routine to that con- ducted at the school. This is particularly emphasized as re- quired on the days when there are no school sessions. The parents are instructed to have their children observe the rest periods, and to provide their children with extra feeding on these days. We have been able to demonstrate that many of the children who failed to progress satisfactorily, improved readily and rapidly after the above routine was established at home. The parents have been urged to carry out this routine during the Summer, as it is hoped to prevent these children re- turning to school in the Fall with a great loss in health, which has been the unfortunate experience of the past. FEEDING Extra feeding has been provided in all the classes. In the Boroughs of Brooklyn and Queens, all deficits have been met by the Tuberculosis Committees of those Boroughs. In Manhat- tan and the Bronx many of the open-air classes were unable to procure funds from the usual sources, and the teachers were urged to have the cliildren bring food from home for their extra feeding period. This plan met with great success, and fre- quently the children would bring their own food from home and eat a liberal portion. The results show that this method of feeding is equal to any other plan, provided the children respond to the request and ])ring the proper food, as they did this year. Some of the teachers have found that there was more actual gain with this method than when the school provided the food. HOME CONDITIONS The nurses and teachers have paid a great deal of attention to the home conditions. On their visits to the homes, they strive to have proper hygienic conditions established, particularly for the pupils of their classes. To overcome all the obstacles they find in the homes entails a great deal of social service work for the nurses and teachers. This they have done willingly, and they have come to realize that this is a very important phase 33 of the work. Though a great deal has been accomphshed dar- ing the past year, the greater part of the work is still to be done, as funds have been very limited. REST PERIOD The morning rest period has continued to give the good re- sults previously noted. Though there are still a few teachers who find the afternoon rest period of equal value, the vast ma- jority now definitely state that the children benefit more, both from the pedagogical and the health points of view, with the morning rest period, and that it is superior in every way. The parents are urged to have their children observe a short rest period before the evening meal. SUPERVISOR The Supervising Inspector of Open-Air Classes and the med- ical inspectors gave talks to the parents on subjects that relate to the important factors that assist in bringing these children to normal physical condition. The nurses, too, attended parents' meetings and frequently gave talks on subjects brought to t'leir attention when visiting the homes. The teachers assisted at these meetings and co-operated in instructirg the parents, in getting the children under treatment, in correcting hom^ cond"- tions, and in general social service work. The Supervising Inspector of Open-Air Classes, in conjunc- tion with the Department of Physical Training, gave the teachers of these classes a course of lectures designed to promote a bet- ter understanding of this work, and to assist them in carryi^-g it out intelligently. PROGRESS OF THE WORK The amount of work performed by the Bureau of Child Hygiene during the school year 1918-1919 is shown in the tables that follow. The work was interfered with to a slight extent by the influenza epidemic, as many pupils and some teachers were absent at that time, 34 WORK IN OPEN-AIR CLASSES — STATISTICS 1918-19 Number of schools with open-air classes 78 Number of open-air classes 110 Register of classes 2,705 Number of pupils examined 3,388 Boys 1,423 Girls 1,%S Number found with defective vision 451 Glasses obtained 372 Number found with defective hearing 36 Treated 27 Number found with defective teeth 1,811 Treated 1,134 Number found with defective nasal breathing 396 Treated (operation) 161 Number found with hypertrophied tonsils 478 Treated (operation) 201 Number found with defective nutrition 2,855 Improved in open-air classes 2,618 Number found with cardiac disease 96 Treated 96 Number found with pulmonary disease 72 Treated 67 Number found with orthopedic defects 86 Treated 86 Number found with nervous affections 31 Treated 31 Total number of children discharged from classes 683 Total number of pre-tubercular children 628 Total number who gained 3,151 Total number who did not gain 214 Total number who lost 23 WORK OF MEDICAL INSPECTORS Inspections 743 Regular physical examinations 3,688 Re-examinations 9,674 WORK OF NURSES Contagious Diseases : Inspections 45,167 Instructions and treatments 12,344 35 Physical defects : Instructions at school 12,545 School consultations with parents 1,612 Cases terminated 926 Visits : For contagious diseases 394 For p'hysical defects 4,639 To dispensaries 241 To lectures 237 IMPROVEMENT OF CHILDREN The method of weighing- the children has improved and is now uniform, so that the data is accurate. No child is consid- ered to have improved unless a gain of at least half a pound a month is made. , The average gain during the year was more than eight and a half pounds. Those who had not made a normal average gain were studied by the medical inspectors to ascertain the cause of the failure to gain. In most instances this was remedied and a gain quickly established. The children show a proportionate gain according to t'l^e temperature — the lower the temperature, the greater the gain. This seems to prove that it is not only fresh air, but also a low temperature that is required to procure a rapid gain in weight. This appears to be due to the fact that the appetite is remarkably increased during cold weather. With the first signs of Spring, the children fail to gain as rapidly, and one can readily deter- mine that their appetites immediately decrease. This is an ob- servation that has always been noted by those closely following this work. SCHOLARSHIP RECORD The school progress of the children in the open-air classes is perhaps best demonstrated by the following table, the data for which was supplied by the teachers of the open-air classes : Grades advanced Progress as compared to previous record More than Less than More At More one grade One grade one grade rapidly same rate slowly 277 28^ 309 840 2^520 ^ 36 MEDICAL SUPERVISION The medical supervision was conducted in the same manner as last year. The inspectors and nurses were given a course of instruction by the Supervising Inspector of Open-Air Classes. The work was conducted more uniformly and with more intelli- gence after their experience of a few years with this work. The waiting lists were maintained in every school so that vacancies could be filled at once and full registers maintained throughout the entire year. Discharges from open-air classes are made at the mid-term promotion time and at the opening of school in September, be- cause it has been found that the children, on their return to school in September, are frequently not in as good physical con- dition as they were in June, when the schools closed. In such cases, many who were fit for discharge from the open-air classes in June must be re-admitted in September. This procedure has worked so satisfactorily that it is being continued this year. RESULTS OF WORK Last year a report was submitted of 367 children who were followed up after discharge from open-air chsses. These chil- dren were followed up again this year, and it has been found that every one of them has continued to remain in good phys'cil condition, able to carry out the work of his or her regular grade. This year 683 children were discharged from the open-air classes as fit to proceed in a regular class. Of this number it has been possible to follow up 491 to the end of this school yeir. with the following results : Cases Discharged from Open-Air Classes Gained Remained Lost Scholarship weight same weight weight improved Same Worse 417 2 116 311 0~ It has not been necessary to return a single child, discharged during the year, to an open-air class because of loss in weight Z7 or because the physical condition became so bad that they were unable tO' carry out successfully the work in a regular class. SUMMER VACATION The Association for Improving the Condition of the Poor cared for 500 boys of the open-air classes at their Simmer camp at Southfield, N. Y., during the Summer of 1918, and 528 during the Summer of 1919. They are to do the same again this Sum- mer for a like number of boys. Those who had this splendid opportunity all showed the benefits of their stay in the country. The Tuberculosis Committee of the Boroughs of Brooklyn and Queens opened a camp on Long Island, and cares for 75 girls of their Boroughs, all selected from the open-air classes, during the Summer of 1918, and 125 girls during the Summer of 1919. CONCLUSIONS It has now been conclusively proven that children who are subnormal physically, when afforded an opportunity to receive fresh air, light, food, to have their physical defects which retard growth and development corrected, and to live under proper hygienic conditions, can be restored to at least normal condition. Besides, during this time, they can receive proper education. One of the most satisfactory results procured in this work is that so many of the children continue to follow out the instruc- tions given them while in these classes, and that the older ones are able to institute similar conditions in their homes, to the ad- vantage of the rest of the family. This is proved by the fact that there is never any difficulty in having a sister or a brother of a former member of any open-air class, willingly, even anxiously, enrolled in one of these classes. All members of the Bureau of Child Hygiene whose work brings them in touch with the Open-Air Classes takes this oppor- tunity to express their thanks for the hearty co-operation of t^:e principals and teachers, the various committees on prevention of tuberculosis and their respective supervisors, who follow up this work so closely. 38 OUTDOOR, OPEN-AIR AND OPEN-WINDOW CLASSES Adela J. Smith, Assistant Director of Physical Training. OUTDOOR CLASSES Open-air schools and open-window classrooms in the public school organization are the outcome of the beneficial results ob- tained through open-air treatment of respiratory diseases, par- ticularly pulmonary tuberculosis. Educational hygienists and physicians have been influenced thereby to adopt similar meth- ods for the health, care and treatment of school children, who, by reason of tuberculous affections, poor nutrition and other de- bilitating conditions, make little progress ph} sically and mentally in the environment of the indoor type of classroom. Among the 800,000 children attending the public schools of the City of New York, there are thousands of physically handi- capped children. These include children aft'ected with pul- monary tuberculosis, bone, skin and glandular tuberculosis, and also pretuberculous children, i. e., those exposed daily to tuber- culosis in their homes. Besides these, there are hundreds of crippled children, anaemic, mal-nutrition and cardiac cases. Experience has shown that these children cannot attend the regular classes in public schools, with profit. Through experi- mental study, it has been found beneficial to care for their com- fort, health and school progress, through definite methods of segregation, in special classrooms, and to provide suitable per- sonal and classroom equipment and a relaxed curriculum. Owing to the various types of physical defects, and the dif- ferent method of treatment, these children cannot be grouped in one type of classroom. The segregation of the various groups of physically handicapped children in the public schools of the City of New York, for open-air treatment and physical care, has been arranged according to the type of case. Three types of classrooms are used — outdoor, open-air, and open-win- dow rooms. 39 TYPE OF CLASSROOM LOCATION AND STRUCTURE These special classrooms are situated outdoors and, in large cities, may be located on ferryboats and piers, in parks and on hospital roofs. Elevators should be provided when the roofs of buildings are utilized. Outdoor classrooms are partially protected from weather conditions by a roof, but the sides of the room are open. Provision should be made for a heated indoor warming room and lunch room. This should be located on the same floor, to eliminate stair climbing. Careful consideration of the dietary of physically handi- capped children, both at school and at home, is of prime impor- tance, and necessitates the co-operation of the teacher with the school nurse for home visits. CLASSROOM EQUIPMENT Movable chairs should replace fixed desks and seats. For tuberculous children, a specially constructed chair is recom- mended. These children are handicapped by a serious disease which is active, and they have, therefore, less strength to resist fatigue than any other group under open-air treatment. PERSONAL EQUIPMENT For the personal equipment, certain essential garments and coverings are recommended. This equipment includes a wind- proof outer garment with hood attachment, or an Eskimo coat — an outfit easily washed, and therefore sanitary. Over the shoes a foot covering is worn in extremely cold weather. This con- sists of sitting-out canvas-covered felt knee boots with felt in- soles. This covering is warm and well ventilated, in contrast to the rubber arctics sometimes worn, which make the feet cold and damp by causing excessive perspiration. Bloomers should be provided for additional warmth, if nec- essary. These are worn by the boys over their school clothing, and by the girls under the dress skirt. Sweaters, coats, caps 40 41 and mittens should be provided by the parents, since these are articles of clothing commonly in use by all. An army blanket should be used on very cold days, or when the child is sleeping. It is hygienic because it is easily cleaned. NUMBER AND TYPES OF OUTDOOR CLASSES Outdoor classes have been formed in the five boroughs of the City of New York, as annexes to the nearest public schools. Seven hundred and sixteen tuberculous children are now registered in 28 classes. These outdoor schools are classified as : Day Camps Home Hospital Schools Hospital Open-Air Classes Sanitarium Open-Air Schools In the Day Camp Schools, the children spend the entire day at the school, and return to their homes late in the afternoon. The classrooms are located upon ferryboats and piers, and ii parks. The Home Hospital School is a unit consisting of apartment homes of tuberculous families. The children of these families are practically isolated through hygienic measures. The out- door classrooms are located upon the roofs of the Home Hospi- tals. The day is spent out-doors, and at night, this open-air treatment is continued by means of spec'ally constructed bed rooms. The food is prepared by an expert, and supplied to all the families, through a central kitchen in the hospital. The Hospital Open-Air Classes have been planned for tuber- culous children who require medical and surgical care in hospi- tals. These children attend these out-door classes during the day, and remain at the hospital until cured. The classrooms are located on the roofs and balconies of the various city hos- pitals. 42 The Sanitarium Open-Air School receives children in the early stages of tuberculosis. They are sick children, and are, therefore, allowed to have only a limited number of hours for mental work or physical activities. Borough Manhattan . Brooklyn . . . DAY CAMPS P. S. No. of Classes Register , 12 Annex 151 Annex . 17 Annex Totals 4 3 3 10 108 87 97 292 Location Ferryboat "Camp Hud- dleston,'" ft. Jackson St. Ferryboat "Camp Mid- dletown," ft. E. 91st St. Ferryboat "Camp Ruth- erford," ft. of Broadway HOME HOSPITAL CLASSES Manhattan 158 4 96 78th St. and John Jay Pk. HOSPITAL OUTDOOR CLASSES Manhattan . . , . . 141 Annex 2 59 52 Annex 1 14 Bronx , . . 30 Annex 2 45 Queens . . . 58 Annex 1 35 Richmond . . . . . 30 Annex 4 88 Totals 10 241 Roof, Vanderbilt Clinic House of Rest, Inwood St. Joseph's Hospital 143d St. near Brook Ave. St. Anthony's Hospital, Woodhaven Sea View Hospital, New Dorp, S. I. Manhattan SANITARIUM OPEN-AIR SCHOOL 14 Annex 4 87 N. Y. Municipal San't'm, Otisville, N. Y. 43 NEW CLASSES The need for additional out-door classes for the care of tu- berculous children of school age is indicated by the statistics which have been compiled from the recent records of various cities. A summary of the conservative estimates of chief medical officers shows that 1 per cent are affected by tuberculosis of easily recognized forms. This estimate would indicate that 8,000 children of school age in the City of New York are tuberculous. The New York Board of Health has estimated that there are also from 4,000 to 5,000 children under 15 years of age suffering from non-pulmon- ary forms of tuberculosis. This indicated that there are hun- dreds of tuberculous children of school age who requii^e school care and treatment similar to that provided through the various types of out-door classes of the public schools. At the request of the Superintendent of the Day Camp "Rutherford," an additional class has been recommended for this annex, to accommodate the tuberculous children waiting for admission to out-door classes. At present there are nearly 100 children in outdoor classrooms at this Day Camp. The formation of these new classes should be the beginning of a movement for the extension of out-door classes throughout the City of New York in connection with the public school sys- tem. It should continue until every tuberculous child is under open-air treatment combined with medical and school care, in order that these unfortunate children may have every chance for an education under the best hygienic conditions. OPEN-AIR CLASSES Open-air classes were established in public schools at the re- quest of the Anti-Tuberculosis Associations, in order that pre- tuberculous children might build up their resistance to disease through prophylactic measures, and also be removed from the danger of infection during the day. 44 TYPE OF CASE Three special groups of physically handicapped children should be included under the type of case selected under this classification. The first group includes the pretuberculors children, that is, those exposed daily to tuberculosis in their homes, and also those suffering from gland and skin tuberculosis. The second group includes children in an arrested stage of pulmonary tuberculosis. The third group includes the so-ca'.led "anaemic" or malnutrition cases. While experience has shown that all these groups have been benefitted by open-air treatment in fresh air classes, nevertheless, when accommodations are limited, preference should be given to the pretuberculous group and the arrested cases, as the more seriously handicapped children. Fresh air classes in public schools were established primarily for pretuberculous children as a prophylactic measure in the crusade against tuberculosis. Malnutrition and anaemic cases, without a tuberculous history, should not be segregated with this other type of case or arrested cases of tuberculosis, as this means a needless exposure of physically unfit children to tuberculous infection. Recent experiments in the public schools of New York have shown that anaemic and mal-nutrition cases have been placed in open-window classes with much benefit, and since there is prac- tically no expense associated with this type of open-air treat- ment, all malnutrition cases without a tuberculous history should be assigned to such special classes. LOCATION OF CLASSROOMS The open-air classroom should be an indoor room, located not higher than one flight, in buildings without elevators, in or- der to eliminate excessive stair climbing for physically handi- capped children. The classroom should be a corner room, preferably, in order that direct ventilation may be obtained even in stormy weather. 45 It should have a southeasterly or southwesterly exposure, so that sunshine may be had practically all day for warmth and as a germicide. The window frames of the classroom should be fitted with horizontally hung, pivoted, sectional windows. By means of this type of window, adequate fresh air can be admitted, without producing drafts, and even in stormy or windy weather, the windows may remain open without discomfort to the children. VENTILATION AND TEMPERATURE Direct ventilation is used, and heat should be available drr- ing the months when artificial heat is used. Care should be exercised to prevent the temperature from exceeding 50° F., or going below 40° F, CLASSROOM EQUIPMENT Movable, adjustable desk-chairs should be used in fresh air classrooms. This type of furniture can be moved to one side of the room, and space is thus provided for the cots during the rest period. Furthermore, sufficient space may be obtained for specialized physical training, without climbing stairs to the gym- nasium or playground. This is an important consideration in the prophylactic treatment of pretuberculous children. The desk chair should be adjustable, so that when the chil- dren are clothed in additional garments for warmth, they may still be seated with comfort, and in a manner to encourage good posture. This is essential to the health of the child. The char- acteristic posture of the pretuberculous child — as the accompany- ing photographs show — is one with chest depressed, head drooped and scapulas and waist prominent. Therefore, part of the treatment of this type is to improve his chest expansion and chest capacity, in order to strengthen his lungs, and to encourage a strong, erect posture. PERSONAL EQUIPMENT The same type of personal equipment recommended for use in out-door classes should be used by the pretuberculous chil- dren in open air classes.- An equipment lighter in weight rnay 46 47 be used, because the room temperature is higher. The wind- proof outer garment and the sitting-out boots are, therefore, un- necessary. Leggings made of blanket material, similar to that used for the Esquimo suits, may be used in extremely cold weather. REST PERIOD AND DIET Methods similar to those outlined for children in out-door classes should be observed in regulating the diet and rest period for those in the fresh air classes. Pretuberculous children are suffering from conditions which require rest during the day. They are liable to prolonged fa- tigue periods in the afternoon, and because of their tendency to tuberculosis, there is the possibility of an afternoon temperature. The rest period should follow the noonday meal in order to tide over this danger time in preference to having either mental or physical exertion. Furthermore, in special cases, the rest period after lunch can be prolonged for several hours, especially for children running an afternoon temperature, until the physical condition improves. This rest is often impossible to obtain at home. The temperatures of all children in fresh air classes should be taken as a basis for the time and amount of rest each child should have daily, CLEANING PERSONAL EQUIPMENT ■Considerable difficulty has been experienced in fresh air classes in keeping sleeping bags clean and sanitary. Vacuum cleaning and beating have been tried, and while this removes the dust, it does not kill vermin. Furthermore, it does not clean the soiled portions of the bags, nor remove the danger of infec- tion when used bags are assigned to other children. By way of experiment last term, a set of bags were thoroiighly beaten, brushed and washed with warm water and soap. This produced a clean, sanitary bag at a reasonable cost. All the personal equipment this year were cleaned in this manner and stored in mothalene until the winter term. 48 RETURN TO OFFICE OF DIRECTOR OF PHYSICAL TRAINING 157 East 67th Street. New York City < « o z I o e^ w Q o 2 g < a. (fi O X m u o z z < y 55 5h X a. O u, tfi z o p •< Q bJ s o u u iti a & >> a m u 8 X 49 PL, be 3w tt a < O I :z o i^ O m < U o CL, 2 3 ^ 0/ tr. p o -a M-t C u >, X3 y ■c dj O; 11 o M-) O -a O >, c a ■'^ 15 's 33- tn ci3 ;_, n o o C ^-' JS _>^ 'Z ^ aj 3 o O a e .y "5 u 1-. c c -5 C t a; u (/; 1 ^ -^ 01 m (. rt (LI '_5 '^ a, PU u H 68 PHYSICAL TRAINING FOR THE BLIND Adela J. Smith^ Assistant Director of Physical Training SPECIALIZED PHYSICAL TRAINING When the special classes for the blind were organized, the supervision of the physical training- and hygiene was assigned to the Department of Physical Training. This special attention to the physical welfare of these handicapped children, has proved to be an extremely important factor in the education of the blind in public schools. Aside from the physical benefits of health, strength and endurance, the association of the blind with normal children in their games, dances and other physical activities, has had a psychological effort of the utmost value in their normal mental development. Through a new system of specialized physical training, based upon their physical handicap, the blind children are first taught as a segregated group through special methods and devices, to re- spond to directions for physical activities. Each child is en- couraged to do this through his own interpretation and defects of posture, position or direction are corrected by the teacher only after independent effort on the part of each child. It is necessary first to break up old habits and encourage the blind child to re-act normally to his surroundings. The slow, groping, shuffling walk of the blind must be overcome and changed to an alert, light lively step with good posture. Event- ually he must also be taught to run and skip. Other character- istic idiosyncrasies must be corrected also. Many devices have been invented, and special methods of instruction used for obtaining this motor response. For in- stance, rope guides are used as a device in teaching the blind to improve their speed of locomotion and length of step. These ropes are stretched tightly around the exercise space at a height of three feet above the floor and several feet from the walls to avoid contact. Bells are attached to the rope at the corners of the roped space, to indicate the places for turning while walking. The blind children are first taught to walk, then march, run and skip in this enclosed space beside the rope for a guide. 69 70 HH '^ 71 At first, the children walk around the space encouraged through constant grasp of the guide rope with the hand ex- tended from the side. Then the normal walking step is taught, still with the children grasping the rope while walking. Later this exercise is taken in the normal walking position with the hands at the sides, and contact is maintained by touching the guide rope with the side of the arm. Finally, the children gain sufficient confidence to walk in a brisk, alert manner, and the guide rope is touched only occasionally and eventually not at all. The children are then ready tO' attempt marching to music, and even running and skipping. Contest running and roller skating are taught through this same method, but guide handles are used to protect the hands from the friction of the rope as it passes through the hand rap- idly. Courage, confidence and skillful body control is taught through the use of apparatus, such as the athletic slide, flying rings and pull up bar. Similarly, special training through other devices is given in each group of physical activities, and the blind children are gradually lead away from the segregated group through their proficiency in the physical activities of normal children. They are taught to improve their posture and their walk, to respond with alertness and accuracy, and tO' inhibit and control their movements. Through this special training, they have gained in endurance and become intelligent about the rules of games, athletics, and folk dancing. SIGHT CONSERVATION CLASSES Children handicapped by greatly impaired, defective or par- tial vision are assigned to these classes. They are physically able to take part in most of the physical training of physically normal children, but require in addition, special attention for certain characteristic physical defects. The impaired eyesight of this group has caused marked physical deterioration. Poor posture is characteristic, and this has resulted in depressed chests, prominent scapulae with marked impairment of lung capacity and strength. 72 7Z In most instances, this is a long standing condition induced by the children trying to force their impaired vision to do the work in regular classes. It is extremely difficult to overcome these physical defects by means of exercises with normal children. Besides this form of physical training, therefore, special exercises must be pre- scribed for both classroom and home use, in order to improve the physical condition of these children. HYGIENE SUGGESTIONS Several of the rooms now used by classes for the blind and sight conservation classes are not suitable for classrooms. Th;se rooms were not designed originally for such use, and are, there- fore, poorly lighted, badly ventilated, and in very cold weather, insufficiently heated. The quality of the air in a classroom is dependent upon an abundance of sunlight. One of the essentials in the care of physically handicapped children is a large, sunny, well ventilated classroom, especially since most of these children are physically impaired as a result of serious illiiess, and have therefore fee'jle constitutions. Furthermore, it must be considered that these children have the same classroom throughout their school life, while normal children change theirs each term. For this reason, it is impor- tant to consider the location and type of classroom. CLASSROOM EQUIPMENT Owing to their inferior physical condition resulting from their handicap, blind children suffer more from improper seating and other adverse school conditions than normal children. Furthermore, in each classroom there are children of various ages. The furniture, therefore, should have not only a w'de range of adjustment, but should be also of various sizes. Both desks and seats should be adjustable horizontally and vertically and should have a central support instead of two side supports to reduce the danger of tripping the blind child during his use 74 of the classroom. This would add much to the health and comfort of these handicapped children. A sanitary iron cot, with a canvas stretcher pillow and blanket, should be included in the classroom equipment, so that tired or sick children may rest. Sheets and pillow slips should be provided also, to keep the cots in a sanitary condition. I would, therefore, respectfully recommend that the class- rooms for the blind and the sight conservation classes may be equipped with three sizes of adjustable desks and seats, with central supports, a cot and supplies for its use. SUMMARY To aid in the health care of the blind cliildren in the public schools, it is respectfully recommended that : 1. Large, sunny, well ventilated classrooms be provided for all classes for the blind and for sight conservation classes. 2. That a complete classroom equipment may be provided including three sizes of adjustable desks and seats, cot and supplies for its use. 75 SIGHT CONSERVATION WORK IN THE PUBLIC SCHOOLS M. B. Beals, M. D., Supervising Oculist, Bureau of Child Hygiene, Department of Health, City of New York. THE WORK The sight conservation work in the public schools is to pro- vide conditions under which the partially sighted children may study without injury to the eyes, and to provide supervision and treatment by an oculist of the Bureau of Child Hygiene. The equipment for these classes consists of special large print, proper light, raised maps, adjustable desks and individual assistance by the teacher, who prepares all the work in a large, easily read copy, which permits the partly sighted child to keep pace with its normal grade without further loss of vision. Constant supervision and treatment is given by the oculist of the Bureau of Child Hygiene, Department of Health, who ex- amines the eyes of all candidates and assigns the child to a blind, sight conservation or normal class. He makes a full diagnosis and prognosis, and outlines the kind and quantity of work that may be permitted for each individual child. He also strives to improve the conditions found by the indicated treatment, be it disease or refractive error. Each child suffering from any eye disease or refractive error is instructed to go to his private oculist for treatment if financi- ally able, but in the great majority of children in these classes this is not the case, in which event, if the parents consent, the child is treated at the Child Hygiene Special Clinics for these classes. The oculist care of these classes have been under the Bureau of Child Hygiene, Department of Health, for about two years, with most gratifying results in a large number of cases, greatly assisted by the hearty co-operation of the Inspector of the blind and sight conservation classes, and her splendid corps of teachers. 7(^ Some highly practical results have been obtained since the Bureau of Child Hygiene took over this work, results that would not have been obtained if the Board of Health had not taken this work over. We now have 699 active cases under our medical supervision, but not all placed in sight conservation classes as yet, due to the widely scattered locations of these classes, the result of trying to cover all of greater New York with but 30 classes. One thousand one hundred and fourteen cases with vision of 20/50 or worse have been sent to the special clinic for sight con- servation cases as candidates for sight conservation classes, of which 639 have been terminated cured and 475, while still under treatment, have improved to such a degree that they have been assigned to normal classes. Of those cases in the sight conservation classes, Z}» have been terminated cured, and 34, though still under treatment, have so improved that they have been reassigned to normal classes. There are at present 99 children in the Ijlind classes. These children had nearly all been through the usual routine of medical school inspection, but due to defects somewhere in the system, either in the original vision test, follow up work, or lack of co-operation by principals and teachers, due in most cases to a lack of thorough understanding of the importance of this work, there had been failure to get them under proper treat- ment. CANDIDATES FOR SIGHT CONSERVATION CLASSES All children with a vision in the better type of 20/50 or worse are candidates for sight conservation classes. If the oculist cannot improve this vision the child may be assigned to the sight conservation class. \i the vision is improved to better than 20/50 by glasses or treatment, the oculist will decide if sight conservation work would be beneficial. In many cases of pro- 77 gressive myopia the vision can be improved with glasses to a greater degree than 20/50 or even normal vision, 20/20, and yet the sight conservation methods of school instruction is very beneficial. A final recommendation should be obtained from the oculist in charge of the cases as to the use of eyes to be permitted in each case, with full instructions as to glasses and revisits to oculist, as by this method only can most children be kept under most favorable conditions. By far the most common cause of loss of vision of the chil- dren of the sight conservation classes is progressive myopia. PROGRESSIVE MYOPIA Progressive myopia is a subject that the general practitioner and the school teacher should be far more familiar with than .many now are. They should be sufficiently familiar with this subject to be able to explain intelUgently to parents and children why the myopic eye needs so much more careful and constant attention than other forms of refractive errors. Myopia or near sight is a misleading name. It should be poor far sight. The vision is simply nearly normal at the near point and very poor or not at all at the distance. The principal cause of myopia, and practically the only one that the non-spe- cialist need consider, is the bulging of the posterior or back wall of the eyeball, which causes the retina or receiving structure of the eye, lining the inner surface of the wall of the eyeball, to be moved back beyond the point of focus of parallel rays of light passing through the lens of the eye at the aperture called the pupil when the lens is at rest. To produce a focus of these parallel or distance rays of light on the retina, which is necessary for vision, the lens must be changed in shape by the constant action of small muscle fibers within the eye called the ciliary muscles. Nearly every one is famihar with the change in the shape of the bones of the face, nose and mouth by the steady pressure 78 produced by mouth breathing in cases of adenoids in children. If this is possible with the bony structures, how much more easy is it to appreciate how the soft structure of the eye can be changed in shape by the constant pressure such as exists in the myopia eye from this constant action of these muscles in the near sighted eye of the growing child. THE LENS OF THE EVE The lens of the eye is a gelatinous strrcture contained in a capsule, and its curve and thickness is changed by the action of these muscles to bring the rays of light from varying distances to a focus on the retina. In myopia it is necessary to flatten the lens to reduce its curve to produce this focus, and to do this, these muscle fibers are constantly pulling from the edge of the lens to the side wall of the eye, producing a constant drag on these walls, which is the source of a great deal of injury to the eyes, principally the increase in the bulging of the back of the eye, due to stretching of the weakened wall of the eye, but also other injury as a varying amount of separation of the retina from the optic nerve, detachment of the retina from the wall of the eyeball and hemorrhage in the retina. We can now see why myopia is progressive and why myopia of any marked degrees is called progressive myopia. A great amount of this injury can be prevented by proper treatment and control if this treatment and control is started early in child life and continued and maintained d'ring that period when the tis- sues are developing. It is here that the sight conservation class is of inestimable value in co-operating with the oculist in saving these near sighted children from this irreparable injury to their vision. The constant strain of the near sighted eye can be relieved by wearing glasses if the glasses are properly fitted, combined with the proper use of the eyes, but it is only by the co-operation 79 of the family ph3^sician, teachers, social workers and school nurses that the parents and children can be educated up to the point of giving these eyes the proper and sufficiently sustained care. It should be clearly explained to parents that every myopic or near sighted eye has developed a chronic contraction of those small muscles within the eye. This is called a spasm of the ciliary muscles. This is why it is necessary to use a mydriatic, popularly known as "drops," in the eyes to relieve the chronic contraction or spasm of this muscle to allow the lens of the eye to resume its natural curve at rest, so that the glasses may be fitted properly for the lens in its real curve, and not to the altered curve produced by the spasm. NEED OF GLASSES This will also emphasize the necessity of having the near sighted child fitted with glasses by the experienced oculist and not by an optician. The optician is not permitted to use "drops" by law, because he is not qualified to do so, and no near sighted eye in childhood can be fitted accurately without these drops, and also explain that the proper fitting of glasses to near sighted eyes calls for the highest skill of the experienced oculist, which, of course, is not possessed by the optician. The progressive nature of this condition is the reason that these eyes should be refitted under drops with glasses at least once a year, as it is important to prevent all strain on the yield- ing wall of the eyeball that would be caused by even a small change in the eye. After the proper glasses are procured, they must be worn at all times for the same reason. Those having control of children of school age should know the importance of proper light and the harm done by working the growing eye in improper light. The starting of near sight in a normal eye is undoubtedly very often caused by the eye strain necessary to read and study in a poor light. 80 The question of light receives but scant consideration in our schools. I have seen many classrooms lighted very badly by gas on all days but the very brightest. No more favorable setting could well be imagined for the de- velopment of myopia, elepherities, headaches and all that long list of neuroses caused by eye strain in the growing child. NEED OF PROPAGANDA It is necessary to do a great deal of educational and propa- ganda work with the authorities in the Department of Education before we shall be able to correct these defects in our schools and guard against repetitions in new buildings. Many of our schools used for night schools are not provided with proper lighting equipment, and the work done in these schools by the pupils un- der this poor illuminating is producing the same bad results as in the poorly lighted day schools. REFRACTION A large part of the good results of the work of sight conser- vation clinic is obtained by skillful refraction, which is the fitting of glasses. Refraction of the partly sighted child, the mentally defective, backward or very young child, requires the highest skill of the experienced oculist, and is wholly beyond the skill of the oculist of little experience or the optician. This work calls for the constant use of Skiascopy or the Shadow Test, by which the measurement of the refraction of the eye is made without any assistance from the child as in these classes of children, the child can be of but very doubtful assist- ance to the oculist. After years of practice, a high degree of accuracy is obtained by this method of refraction. A great deal of harm may be done to defective eyes by their use, and harm may be done to the physical well being of the child from eye strain producing reflex nervous symptoms. 81 UNGRADED CHILDREN Out of 132 ungraded or mentally defective children whom I refracted, and for whom the glasses were procured, 24 were found to be nomial mentally after relieving their eye strain, and giving them vision, and more than 65 per cent showed decided mental improvement and many showing physical improvement. One little girl, for example, nine years of age, always in an un- graded class, had never been able to read or write and of such a vicious temper that constant care was necessary to prevent her from injuring other children of her class. She also> suffered from severe nervous symptoms of a choreic nature. Within two months after I refracted her and she began wearing glasses, a most remarkable change occurred. She made rapid progress in reading and writing and all other branches of work done by this class, but the most striking change occurred in her nervous sys- tem. From a vicious, dangerous child she changed to a happy, lovable little girl, and her pronounced symptoms disappeared. In about six months this child lost her glasses, and was without glasses for about two months. During this period the child re- lapsed completely. Again she would not or could not read or write. It was impossible to get any mental concentration. She became again vicious and all neurotic symptoms returned. At last the glasses were again procured, and the picture again re- versed itself in its entirety as on the first occasion, furnishing one of the most striking examples of the profound effect of eye strain on both the mental and physical development. HANDICAP TO NORMAL CHILDREN On the child of normal mentality, defective vision is a great handicap as is shown in every large school or group of schools. In a group of 400 habitual left back children found in a large New York school, I found more than 100 had decided refractive errors, and I prescribed glasses for about 110—100 of these chil- dren procured these glasses, and in less than three months some 82 very pleasing results were obtained. Out of 100, more than 90 of these left backs passed the regular school examination, many skipping classes, and one boy, far behind his grade for age, skipped five grades on this examination. Of the 10 who did not have their prescription filled for the glasses which I had pre- scribed, only one was promoted. In the same school we had the walls of a small room nearly covered with test papers, showing the startling improvement ma-de in writing, drawing and arithme- tic in remarkably short periods, of children of all ages, after correction of refractive errors. RESULTS I wish to report some very pleasing and unusual results ob- tained in the treatment of corneal opacities by the negative gal- vanic electricity. Those of the medical profession who are not specializing in eye work may not be familiar with these conditions or know how difficult it is to produce any appreciable results from any treat- ment of these old cases which have passed beyond the acute stage. Especially is this true in the general eye clinics, where, in the great majority of cases, nothing is even attempted. At our child hygiene eye clinic at Public School No. 30, Man- hattan, about one year ago we installed a small wall cabinet for the purpose of administering negative galvanism to these very unfortunate cases, and have produced decided improvement in vision in a number of cases. The treatment is necessarily a slow and long continued procedure, but in many cases surprising im- provement in vision will be obtained if the treatment is persist- ently given for 10 to 12 months, once or twice a week. The following are results in treatment of school children in the sight conservation classes: We have 27 cases under treatment. Case 1. A girl with old corneal opacities of both eyes and a vision of 20/70 in both eyes, with glasses, had improved after 31 83 treatments so much that her vision is now 20/20 in both eyes with glasses. Case 2. A boy with corneal opacities in both eyes, with a vision of O. U. 20/200, and no improvement from glasses, had had but 12 treatments, and his vision has improved to O. U. 23/40. Case 3. A boy had a vision of 20/100 caused by corneal opacities, had received Z7 treatments and now has a vision of 20/40 and has been promoted twice. Case 4. A boy had a vision of 4/200, due to very dense corneal opacities. After 10 treatments his vision has improved to 20/200. Another activity has been the treatment of tuberculo kera- titis with tuberculines and vaccines furnished by the Department of Health. This is being done at eye clinics of the Bureau of Child Hygiene in Public School No. 21 and Public School No. 65 — 38 school children have been treated. All have been im- proved, some most markedly. All cases presenting themselves were first given the Von Pirquet Test, and only those were treated who responded to this test. WHITMAN S VIEWS Lloyd B. Whitman's articles of September, 1915, in "Archives of Ophthalmology," takes not only the sordid view of this subject which I express, but also the higher appreciation of its impor- tance as follows : "Economically, the conservation of vision can be rated almost as high as the conservation of life, from some standpoints higher, for, when dead, as man imposes no burden upon the public. Not so with the blind, who must be housed, clothed and fed. As they are not producers, we must add what they would have contributed toward the national wealth had they been able to work. Another source of loss is in the public schools. To children with faulty eyes, school work is a pain 84 and a burden. They are always behind their classes, an exasper- ation to their teachers, a discouragement to themselves. Unless relieved and rendered fit for study, they are regarded as mentally deficient and become disheartened. Then, at the age of 14, they are apt to be taken from school and put to work, for which they are unequipped, and the State again loses ; loses money, loses a valuable worker or thinker, loses a useful citizen, and perhaps gains a rogue to support, because of the neglect of an examina- tion of the eyes and proper treatment." 85 SCHOOL FOR THE DEAF, P. S. 47, MANHATTAN. Carrie W. Kearns^ Principal I have the honor to submit the following report of the work done in the School for the Deaf for the years 1918-1919-1920. The many disturbing influences which entered into our work during this time made it difficult to realize all that we had planned to do. The influenza, the great amount of absence among the teachers, the lack of substitutes, and the frequent holidays, all tended to disturb our routine. However, we believe that the school has steadily improved, and that the close of this year shows better results than we have ever had. GROWTH OF THE SCHOOL Our register is 300. In comparison with other schools for the deaf throughout the country, this is a good number. The largest institution in the country has an enrollment of a little more than 600. It is a State institution. We graduate about 15 children each year and a number of other older children go to work, but our numbers show no net loss. The greatest gain is in our kindergarten and first year classes, and this is the right place for growth. THE SEMI-DEAF I believe there are still a number of children in our regular schools who are losing their promotions and are being considered dullards, but who really fail to hear half of what is said in the classroom. These children are not conscious that they do not hear everything. They are shy and quiet. Their parents are loath to admit they are hard of hearing, and their teachers do not recognize that this is the trouble. In one case, this year, we had one little girl here almost a year before the mother admitted that she had another older child who did not hear much, and this admission came only after the principal of the school which the child was attending sent word to us about her. Many parents seem to think there is some disgrace attending deafness. They will not send the child to a school for the deaf. 86 Principals often listen to these parents, and from mistaken kind- ness allow the child to remain in the school, to drag along with this big handicap. The consequence is that the child is constantly at a tension. He is trying to hear all day, and he becomes nerv- ous and irritable. He never has more than "b" on his report card, and he often fails to be promoted. The probabilities are that he will never be graduated. OBJECTIONS RAISED TO ATTENDANCE AT PUBLIC SCHOOL NO. 47 What are the objections to coming here? 1. It is a school apart, with a dreadful name— the School for the Deaf — 2. The child has some hearing, so he may hear the harsh voice of the congenital child. 3. He may see some child using "signs.'' 4. He will have to travel so far to school, and the carfare is too great an expense. ANSWER TO THESE OBJECTIONS 1. It is a school for the deaf. We do not feel aversion to wearing glasses nor to the use of a crutch. Why should we try to hide deafness ? Deafness is a big handi- cap, but, if it is there, why not meet the situation and be glad that there is a school for such children? 2. He will perhaps hear the voices of children who speak badly. However, the voices of the children are better than they used to be, and so far as possible, we put the children who have some hearing in classes by them- selves. This is always done in speech work. We hope to plan for this in our new building. 3. As we are a public school, we must accept all children who apply for admission, unless they are mentally de- fective. Some of these come from schools where they have been allowed to use signs. Naturally they will continue to use them until they realize that the sentiment of the school is entirely against it. These "signers" 87 are few in number, and the child with partial hearing need not bother with them. 4. After several years of trying separate classes in other boroughs, I find that deaf children need most careful grading, because of their big handicap of lack of lan- guage. Separate classes admit of very little grading. Children varying in ages get into one class. It is im- possible to do justice to all of them. This year all the children have been taught in the central school. We now have no scattered classes. The gain for the chil- dren has been marked. The children travel safely; they learn to' be independent and self-reliant — two very useful lessons. There is also a responsibility for the parent here. If a parent has a deaf child, it is the duty of the parent to make some home arrangements that the child may attend school with the least hardship. Free transportation is provided for all who cannot afford to pay carfare. ADVANTAGES OBTAINED BY ATTENDANCE AT THIS SCHOOL Now, as to the gain in sending a child here : In the first place, every child who comes here is carefully examined by our aurist and tested by the principal and teacher to determine the amount of deafness, etc. Sometimes, in order to be perfectly sure, a child remains with us a week, joins in the work of the class, sometimes of several classes, in order to test his hearing. He is never admitted if he shozus he has enough hearing to remain in a regular school. He is sent back with a note, telling the results of the test, and offering any recommenda- tions that may be deemed necessary. If any medical treatment can help him, the parent is advised what to do. But in many in- stances the child has not so much hearing as the parent thinks, and the deafness is progressive. It is better for that child to enter this school. If he is old enough to understand, he is told of his handicap, and of how he can overcome it by learning to read the lips and by being in a small class. Our classes have registers of 10 and 12. Here there is time for the teacher to repeat and explain several times. Everything is done to encourage the child. What is the result ? The child finds his balance, his nervousness disappears, he realizes that he can be an "A" pupil, he stays to be graduated, and he goes out from the school with confidence in himself. We have 60 such children in the school now. For the sake of such children, it would seem wise to call the attention of the principals to the need of examining all dull chil- dren to ascertain the amount of hearing they have. A child should not be allowed to grow dull because he does not hear. This should also be brought to the attention of the parents at Parents" Meetings. Misplaced sympathy should not interfere with the child's best interests. In the case of children too poor to pay for transportation, the city pays the carfare. STATISTICS The following statistics give an idea of the make-up of the school: Number of children on register, April 25, 1920. . . .290 AMOUNT OF DEAFNESS. Totally deaf 152 Can distinguish sounds 110 Can hear words at close range 28 AGE AT WHICH CHILDREN BECOME DEAF. Number born deaf 132 Number deaf before 3 years of age 11 Number deaf before 6 years of age 39 Number deaf after 6 years of age 36 Number who gradually become deaf 6 CAUSES OF DEAFNESS. Congenital 132 Brain fever 2 Spinal Meningitis 45 Diphtheria 5 Scarlet fever 20 Convulsions 4 Measles 11 Whooping-cough 4 Abscesses 10 Mastoid 2 Catarrh 19 Typhoid fever Colds 7 Marasmus Influenza 1 Rheumatism Fright 4 Tubercular Pneumonia 4 Kicked by horse Infantile Paralysis 3 Run over by auto Falls 4 Unknown 7 89 NATIONALITIES IN THE SCHOOL The following nationalities are represented in the school : English, Irish, Scotch, Swedish, Norwegian, Danish, German, Austrian, Hungarian, Bohemian, Russian, Polish, Galician, Rou- manian, Armenian, Italian and French. We have one child whose parents came from the West Indies, and two whose par- ents came from Malta. They are brother and sister. All the children in this school are loyal Americans. They have done their bit. In the Third Liberty Loan, they sold $17,500 worth of bonds ; in the Fourth they sold $40,000 worth ; and in the Fifth they sold more than the equivalent of a bond for every child in the school, which amounted to $43,900 worth. They adopted a French child, and are still paying for her support. They asked for a deaf child, and little Marie, a deaf child, was given them for adoption. They have her picture. During the years 1918- 1919, they made and sent abroad the following: Babies' and children's garments ; 316 Bags for hospitals 224 Pillows and pillow cases 30 each Quilts 18 Dolls, made and dressed 39 Forty-three children pledged as Victory Boys and Girls, and every other pupil became a Victory Junior. In the Fifth Vic- tory Loan, they sold 298 bonds, which is equivalent to a bond for every child on register. In 1919-1920 they contributed $46 for the Near East Relief. Teachers and pupils gave $86 for the children and teachers of the School for the Deaf in Budapest. They are also giving their birthday money for the Serbians. CLASS ROOM WORK The great number of little children who have come into our kindergarten and first year classes is very encouraging. The earlier we can start them to speak and to read the lips and to grasp words and ideas, the better. It is a matter of congratu- lation that the work in this part of the school is now in excellent shape, so that from the kindergarten through the third year, the 90 progress is steady and gratifying. This is due to the fine plan- ning of my assistant, Miss D. F. Kaufifman, and to the committee of teachers who worked out a language story for each week of the term, this story embodying a language principle which is made the basic work for the week. They have published these stories in book form, and the book has met a ready sale in schools for the deaf throughout the country. TESTS FOR STANDARDS In the Spring of 1919, the school took the tests in general intelligence and in school work, planned by Dr. Rudolph Pintner of the Ohio State University, in an attempt to get minimum standards for judging the ability of deaf children at various ages. He examined about 2500 deaf children throughout the country, and from their answers arranged a percentile for each year, so that it may be possible to judge the general intelligence and work of the deaf child according to his age. In his answer, enclosing the returns of our school, he writes : "In this grade (the highest year in the school — 8B and 8A) we note that the median percentile in the mental tests is 71 and in the educational test 89. This would seem to indicate that these classes are doing educationally much better than is usually found in schools for the deaf." Later, in the same letter, he says in regard to results of all the classes taking the tests (from 8B through 2A) : "As com- pared with other deaf schools, you would seem' to be accomplish- ing more than is usually accomplished." We are glad to have this assurance that we are working along right lines. THE PHYSICAL SIDE The physical care of our children has, as usual, been carefully looked after by our three physicians — our aurist, our oculist and our general practitioner. Every new pupil who applies for ad- mission is examined, also every child reported by the teacher as in poor condition, or specially noted at physical training time as needing attention. Not only have they had an examination, but they have had special treatment at hospitals where our doc- 91 tors have made special arrangements, and in the case of dis- charging ears, etc., our nurse has been here every day to give treatment. Through the kindness of friends, we still have 13 quarts of milk at 10 o'clock for undernourished children, and our school luncheons, served by our Board of Education, have been particularly good. We were obliged to raise the price one cent, so that now it costs six cents per child. One hundred and ninety children have been examined by our physicians ; 56 have received special treatment. THE ALUMNI ASSOCIATION Our Alumni Association has met regularly on Sunday after- noons, once a month. This gives a fine opportunity to keep in touch with our boys and girls who have left school. We know where they are working, what they find to be the difficulties in the world, and how we can aid them and encourage them. TRADE WORK In response to a questionnaire concerning the work of former pupils sent out once each year, we have the following returns for this year : Number of answers received 104 Number in hearing high schools 3 Number in college 1 Number working (boys, 51 ; girls, 2)7) 88 Number remaining at home 8 Number married 4 Number out of work 3 Average wages per week (boys, $15.26; girls, $12.19) Average length of time in one place (boys, 1 year, 5 months; girls, 1 year, 7 months) Number who have saved money 50 Number who have Liberty Bonds 32 Our Industrial Department has had a busy year, especially the millinery and the printing classes. They are busy with or- ders the year round. We still have no trouble in placing our children, and frequently I have more requests for children to work than I can fill. The teachers in this department deserve a special word of praise. 92 In 1915 the average wages per week of our workers was $7.15; in 1919 it was $15.16 for the boys and $12.44 for the girls. We still meet the problem of the pupil who will not "stick" at a job and the one who wants big money at once. But they are fewer than they used to be. It is only by personal touch we overcome this. Very often we receive a letter in which a pupil tells of his dissatisfaction, but adds: "I shall stick until I hear from you. Please give me some good advice." Then we realize the power of the school and the teacher, GRADUATES Seven pupils were graduated in February, 1919, and another seven in June, 1919. In February, 1920, nine were graduated. One of the June graduates entered a high school for hearing pupils in the Fall. She has done splendid work. Another, a congenitally deaf boy, entered De Witt Clinton High School in February, 1920. He, too, is doing very well. The others are working and succeeding, too. The total number of graduates since June, 1911, the date of our first graduation, is 96. IMPROVEMENTS HERE AND TO COME The installation of electric lighting throughout our building has been a great blessing, removing so much of the eye strain of the past, and taking away the depressing feeling of dark days. The one other great blessing of the year is the promise of a new building. This is included in the list of new buildings for which our Board is asking. We hope that we shall realize this very soon. We feel that much of the absence of teachers is due to nervous break-downs caused by teaching in "double rooms" — that is, one small room divided by home-made screens and made to accommodate two classes all day long. We hope to accomplish greater results in our special work — ^^better reading of the lips, better speech, and a bigger, broader grasp of lan- guage. We want to make these children as normal as we pos- sibly can, so that they may measure up to the standards of their hearing companions. 93 PHYSICAL TRAINING FOR THE DEAF Adela J. Smith, Assistant Director of Physical Training. PHYSICAL CARE AND SPECIALIZED PHYSICAL TRAINING The health care of physically handicapped children is the essential basis of their school life. The amount and kind of school work which these children may do must be adjusted, therefore, to the efforts which they are physically able to make. For this reason, therefore, more time has been given to spe- cialized physical training- and hygiene for the deaf than to any other study, except the multiform subject of English, even before the enactment of the Welsh Law. It must be considered that over 66 per cent of the children attending the School for the Deaf have become deaf through serious illness. As a consequence, their vitality has become im- paired by the disease causing their handicap. Even congenitally deaf children, aside from their heritage, are inferior to normal children, owing to their limited facilities for exercise at home. City streets and play spaces are dangerous playgrounds for phys- ically handicapped children. The school, therefore, must pro- vide ample facilities for systematic physical training and ade- quate play space for the younger children. No amount of subsequent training can eradicate the idiosyn- cracies and defects of physical development of the deaf child, where, during the growing periods, there has been inadequate physical education. These characteristic physical deficiencies must be overcome by special devices and methods of instruction. There is a noticeable defect in their power of equilibrium which produces a characteristic shuffling walk. In running, jumping and skipping there is still greater difficulty in maintain- ing balance, and the foot is used flat upon the ground in a man- ner quite distinctive from the light, graceful, tripping step of the normal child. Poor posture is another marked defect of deaf children, re- sulting not only from an inferior physical condition, but also 94 CO W CO w >^ w W Q Q < 95^ from the poor poise of the body, induced by their impaired sense of balance in walking. Besides this attention to the improvement of the physical de- velopment of the deaf, definite special training must be given to correlate methods of speech instruction with those of physical education. The deaf lack a sense of rhythm and rhythmic continuity of movement both in action and speech. Therefore, great stress has been placed by the Department of Physical Training upon the teaching of rhythm' to all deaf children, through folk danc- ing, marching, mimetic and other rhythmic exercises. Further- more, deaf children have no speech values. For this reason it has been found necessary to formulate various original methods and devices of teaching to produce rhythmic motion and thought in deaf children. This has been successfully applied through specialized physical training. The underlying method of instruction is a simple basic prin- ciple — that of touch vibration and muscular action. First there is an interpretation by the deaf children, of vibration values, through the sense of touch by use of a piano or stringed instru- ment. Then these time values are expressed in rhythmic mo- tion, first through the training of great muscle groups of the body and then the application of this training, through the use of the finer muscles of speech, to express the same rhythm and continuity of motion produced mentally through the larger muscle groups. It has long been possible to teach the deaf to articulate sylla- bles and combinations of syllables forming words and sentence construction. The efforts, however, to secure time value in speech, showing the relative rest counts given to the comma, semi-colon and period, and the natural rhythmic phrasing of con- nected and continuous speech has been a more recent study. The experiments in this work, through the Depar'tiiient of Physical Training, have been conducted by correlating the meth- ods of teaching the various rhythmic values in physical training with those for speech values. For a time, this work was con- 96 97 ducted in connection with the physical training period. Experi- ence has shown, however, that rhythmic training for speech values, while taught through the same basic principles underly- ing the development of rhythmic physical exercises, must be con- ducted at a separate time so that the physiological results of the physical training period might not be lost. Eventually, how- ever, rhythmic speech exercises would be utilized in the games and folk dances, when these have become perfected. For this reason, it would be of great benefit to the deaf chil- dren to have a special teacher of speech rhythms assigned to this school under the training of the Department of Physical Train- ing, in order that the same methods of rhythmic training might be correlated for speech and exercise and eventually tone pro- duction. This training would be in addition to the class and speech training each deaf child receives for the production of proper enunciation and articulation of syllables, words and sentences which would be the basis for this advanced work. Special apparatus for this work should be provided through an equipment for teaching relative vibration values. A grand piano, which gives better vibration for study than an upright piano, is needed, and a drum, and also several string instruments, such as a 'cello, violin and banjo, should be included in this equipment. This training in speech values and the modulations of tone and power of voice would be of the utmost value to the deaf child in his contact with the world outside his school, in aiding him to relieve the monotony and uniform emphasis commonly noted in the speech of the deaf, and which renders it so difficult for those not familiar with it, to understand. I am completing now, a system of time values, through touch vibration correlated with rhythmic exercises, to effect the trans- position of physical exercises to speech, and of motion to con- tinuity of speech, which are based upon my studies at the School for the Deaf. Thus a natural physical basis for speech instruction and even tone production can be established, which will be valuable in teaching speech and tone values to deaf children. 98 FACILITIES AND EQUIPMENT FOR SPECIALIZED PHYSICAL TRAINING Special equipment and adequate space for physical education are essential in order to conduct this specialized training for deaf children. The crowded condition of the old school, poor lighting, lack of a gymnasium and limited play space have been a great draw- back to the development of this work and its application. One of the main considerations, therefore, in the planning and construction of the new school, should be the provision of adequate facilities and special equipment for the physical educa- tion of handicapped children. TEACHER NEEDED An additional special teacher of physical training is needed. The rapid increase in the number and types of special classes for physically handicapped children has resulted in a decrease in the amount of time allowed heretofore to the School for the Deaf for the special instruction and supervision of physical training and hygiene. This has been detrimental to the progress of the work, for the special methods of instruction and device work require adequate time for continual supervision. Furthermore, new teachers assigned to this school must be instructed in this special work. SUMMARY It is respectfully recommended, in the interest of the physical welfare of the children attending the School for the Deaf, that: 1. The new school be provided with a large, light, sunny gymnasium, out-door playground and school garden, a roof playground, fresh air classroom and lunch room and kitchen. 2. The administration of the lunch room and kitchen be under the joint supervision of the Department of Do- mestic Science and the Department of Physical Training and Educational Hygiene. 99 3. Special playground and gymnasium equipment be sup- plied for specialized physical training of the deaf. 4. Special equipment be provided for the teaching of rel- ative vibration values in connection with rhythmic speech training and rhythmic physical training. 5. Elevator service be supplied for the use of cardiac cases, pretuberculous children and other physically handi- capped children assigned to the school for industrial training. 6. Classrooms and the assembly room be equipped with movable adjustable furniture in order to provide great- er space for classroom activities and physical training, greater freedom for class activities for deaf children and accommodations for group work, thus rendering but one classroom equipment necessary. This equip- ment should include a sanitary cot screen, air pillows, blankets, sheets and pillow slips. 7. A teacher of speech rhythms may be assigned to this school for the purpose of providing rhythmic speech training in accord with rhythmic physical training, also an additional special teacher of physical training for physically handicapped children in order that the time assigned for special instruction and supervision of phys- ical training and hygiene in this school may be not de- creased. 8. A special equipment may be provided for the teaching of relative vibration values in connection with rhythmic speech training and rhythmic physical training. 100 A SURVEY OF CLASSES OF CRIPPLED CHILDREN Mrs. Henrietta Rinaldo Scheider, Principal of P. S. 75, Manhattan. This survey, made under the direction of the Board of Su- perintendents during the Spring term of 1919, describes existing conditions and makes recommendations for the improvement and extension of the education and training of crippled children. CLASSES AND REGISTER The number of classes and register of pupils by boroughs is found in the following table : Borough Schools No. of Classes Register Manhattan 14 41 in Brooklyn 13 29 571 The Bronx 3 8 163 Total 30 78 1471 KINDERGARTEN CLASSES FOR CRIPPLES Borough No. of Classes No. of Pupils Manhattan 2 40 Brooklyn " 2 41 Total ■ 4 81 PUPILS IN SCHOOLS AND HOSPITALS AS ANNEXES TO NEARBY SCHOOLS WHO HAVE BONE TUBERCULOSIS Borough No. of Classes No. of Pupils Manhattan 6 110 Brooklyn 6 113 Total 12 223 UNGRADED MENTALLY DEFECTIVE CRIPPLES Borough No. of Classes No. of Pupils Brooklyn 1 23 101 CLASSES IN HOSPITALS AND CONVALESCENT HOMES The following classes of crippled children are located in hos- pitals, the pupils being- patients of the hospital : No. of No. of Borough School Hospital Classes Pupils Manhattan 14 Bellevue 17 103 Deformities and Joint Diseases 22 192 Blythedale Home 16 102 Blythedale Home 17 Brooklyn 91 Kings County 22 91 Kings County 19 91 House of St. Giles 16 29 L. I. College 20 The Bronx 8 Montefiore Home 19 9 168 In these classes education is of secondary importance to the hospital care. The hospital authorities attest that since the pa- tients became pupils they have become better patients. This is due to the teacher's influence and to the improved mental attitude that comes from interested occupation. THE COURSE OF STUDY The regular course of study outlined by the Board of Super- intendents for the eight grades of the elementary school is fol- lowed as far as prevailing conditions in particular instances per- mit. The factors that determine the amount of work that can be done during any school day or school term are the following : 1. The shorter school day. ■ 2. Frequent periods for rest, relaxation and treatment. 3. Grading of classes, with not less than two grades to a class, excepting kindergarten, and frequently with all grades from lA through 8B. 4. The pupil's physical condition. Principals necessarily allow great latitude in the interpreta- tion of the course of study for these classes. Instruction is given to individual pupils or to groups of pupils owing to the 102 miscellaneous grading of classes. Promotions are made freely from group to group at any time during the year when pupils show evidence of ability to do the work of the grade above. The interests of these children are limited ; they cannot play freely with other children. Their brightest hours are the hours at school. They are earnest and persevering. They are so happy to be at school, many of them after a long period in hospitals, that they apply themselves with delight to their school tasks. They are encouraged to forget their handicap and to develop a healthy attitude of mind toward work, study and play. RETARDATION One would expect to find educational progress of crippled children much slower than that of other children because of the short school day and irregular attendance. TRANSPORTATION The Board of Education supplies 27 stages, 16 auto buses and two automobiles (capacity four and six children) to convey chil- dren to and from school. Stages and auto buses make one or two trips each per school as required by the number of pupils. Stages and buses have capacities varying from 15 to 25 children. CAUSES OF DISABILITY The principal causes of disability are found to be infantile paralysis, tuberculous joints, accident and congenital. The other diseases are progressive muscular dystrophy and spastic paraly- sis, scoliosis, osteomyelitis, meningitis, rachitis and arthritis. It is important that every teacher of crippled children should have an elementary knowledge of the different physical disabilities which have caused the children to become crippled. When children affected by infantile paralysis come to school they have no active disease. They can be safely urged to study and they are able to do excellent work. In many classes pupils having poliomeylitis, bone tuberculosis and other disabilities, are grouped together. In some few 103 104 classes of kindergarten and elementary grades, bone tuberculosis cases have been segregated. NOON DAY MEALS It is to be noted that all classes in hospitals are served with milk twice daily in addition to the hot luncheon. Proper nourishment contributes to the cure, and co-operation with social or welfare agencies for a milk supply should be arranged until such time as the Board of Education can assume the responsibil- ity. The classes in Public School 75, Manhattan, are the only ones outside of the hospital classes supplied with milk both morning and afternoon. They owe this excellent physical care to the East Side Crippled Children's Association. Many schools are visited weekly or bi-monthly by nurses who confer with the children's teachers and take the children to hospitals for treatment. The East Side Crippled Children's Free School Association provides a well-balanced nourishing noon meal, nicely served in a large, fully equipped dining room, to the classes of Public School 75, Manhattan, free of cost to the children. It also serves milk, bread and peanut butter, or bread and jelly, during the morning session and before dismissal in the afternoon. Principals and teachers agree that where children enjoy a mid-day meal their physical condition responds more readily to treatment. They have more endurance both physically and mentally from proper feeding. One principal reports a marked improvement in the mental and physical tone of the children within a short period of two months after the arrangements for feeding were made. PREVOCATIONAL TRAINING INDUSTRIAL ART COURSE The course in industrial art is one means of fitting crippled children for working life. The industrial art course for girls includes instruction in millinery, making ornaments for hats and dresses, and bead work, French flower making, and cotillion and dinner favors. The course for boys includes instruction in full 105 blockj half block and spur lettering as a foundation for sign printing and architectural drawing. Box making, case making, modeling, plaster work and pottery are important elements of the course, but have been necessarily omitted during the past term because of the high cost and shortage of material. Trade technique is insisted upon. Graduates report that the skill ac- quired in these classes has been of invaluable help in their daily work. A valuable part of this trade training is the placement of pupils in suitable positions upon the completion of the course. This has been successfully done by the special teacher assigned to industrial art instruction and placement work. Industrial Art Instruction was given during the current term in the following schools : Manhattan— Public Schools 27, 30, 44, 46, 54, 68, 69, 70, 75, 104, 192; Brooklyn— Public Schools 15, 26, 30, 34, 107, 162; The Bronx — Public School 8, Total number of pupils, 1,022. Total number of schools, 18. The best results in industrial art instruction are shown in Manhattan, Public Schools 68, 69 and 75 ; Brooklyn Public Schools 34 and 162. In each of these schools the principal has departmentalized the work and placed it in charge of one teacher. Each teacher in charge has devoted time outside of school hours in fitting her- self for this work. CHARACTER OF THE WORK The teacher of crippled children has to deal with a far more complicated situation than the teacher in an ordinary class. Each of her pupils is likely to vary greatly from time to time in energy and capacity, according to his physical condition. There is more variation between different pupils than between a similar num- ber of ordinary children. A large number of crippled children have never been able to attend school regularly or to associate freely with other children. The great variation in the children's condition and previous experience affects not only their instruc- tion, but their discipline. Some crippled children have been over-indulged, and must be taught to make independent effort. 106 Others have been neglected and must be encouraged to overcome their shyness and timidity. A special course in sewing is given in Public School 75, Man- hattan. The aim of this work is to prepare pupils for self-sup- port by means of fine art in the needle craft. This especially fine course in sewing is being given to the classes of crippled children to articulate the elementary training in sewing with the work room maintained by the East Side Crippled Children's Free School Association, occupying quarters in the same building with the classes at 157 Henry Street. This work room provides employment in the needle arts for girls and women. It is al- most self-supporting, but is subsidized sufficiently to permit of perfect industrial conditions. Both work rooms have been in existence for years, and are rendering splendid service by pro- viding employment for those who are too badly crippled to com- pete in the open market. COOKING Instruction in cooking is given to crippled children in the following schools : Manhattan Public Schools— 27, 44, 68 and 75 ; Brooklyn Pub- lic Schools — 26 and 35. RECOM MENDATIONS To realize the intellectual, physical and industrial aim of the work, provision should be made for each phase of the problem as indicated in the following outline: (a) To insure the best physical condition he is capable of attaining requires provision for physical care and physical education. Physical care calls for — 1. Transportation to and from school in comfort. 2. Transportation to and from hospitals for treatment. 3. Nourishment — the noon hour luncheon and morning and after- noon supply of milk. 4. Nursing — adjustment of braces, massage and electric treatments to be given as indicated by the orthopedist in charge of the child. 107 5. Co-operation established between the hospital, the school and the home by means of nurses' visits. 6. Medical and surgical treatment. Regular attendance at clinic and dispensary. The best physical education calls for — 1. Curative exercises under the direction of a trained specialist. 2. Opportunities for the enjoyment of free play, within the limits of the child's physical disability, in large, open, sunny playgrounds. (b) To insure the best education he is able to assimilate calls for— 1. Complete elementary school training. 2. Special high school training for those whose physical condition does not permit them to attend regular high school classes. 3. Adequate elementary trade training. 4. Post-graduate industrial classes for those unable to attend regular classes of trade or technical schools. (c) To insure the best job he is competent to undertake demands — 1. Adequate provision for trade training. 2. Placement in industry of those not too badly disabled to compete in the open labor market. 3. Specially provided working conditions and employment for those not fitted to enter into ordinary business competition. 4. The extension of the advantages of the industrial art instruction, to the home bound cripple. 5. Work for the home bound cripple articulating with the above instruction. CONCLUSION My survey of the classes for crippled children reveals a wide difference among the respective classes in the advantages for physical, intellectual and industrial education. Some enjoy a maximum of advantages. Others have little that justifies us in calling them special classes. 108 To equalize educational advantages, providing the best for all classes, I recommend: 1. Unified control of these classes to bring about — (a) A plan which will find all the crippled children who ought to be receiving the attention of one or more of these agencies ; out-patient, social, educational, vocational, and transportation service. (b) A system of continuous record to prevent overlooking and overlapping. (c) A system to meet all transportation needs of crippled children to schools, to clinics, to work. (d) A system of follow up care on the discharge of cripples from hospitals, from schools, from employment. 2. The standardization of forms of organization and methods of teaching cripples. 3. Study of openings in industry as a basis for selection of trade training of different localities. 109 110 CRIPPLED CHILDREN Adela J. Smith, Assistant Director of Physical Education. HISTORY New York was the first city in the L^nited States to provide special classes for crippled children in public schools. For 14 years the Department of Education has conducted these classes so that these physically handicapped children might receive the same educational advantages as other children, and at the same time have the protection provided through a special class with technical supervision of their physical deficiencies. Further- more, this segregation has relieved the larger school organization of the responsibility of handicapped children. This care of physically handicapped children through one of the city organizations, now the Association for the Aid of Crip- pled Children, began in 1899 in one of the school buildings off the Children's Aid Society. Seven years later, the success of - this undertaking led to the formation of the first special class for crippled children in Public School 104, Manhattan. In that same year, the classes of crippled children under the caje of the Ladies' Auxiliary of the Lehman Foundation were arai^ed to Public School 147, Manhattan, with a total register of approxi-. mately 138 crippled children. Gradually the classes of cripples conducted through private philanthropy have l^ecome a pe'rma-' nent feature of the public school system. GROWTH ^ ^f Classes have been formed in Manhattan, Brooklyn, the Bronx'; and Queens. Two thousand and forty-nine crippled children- are now registered in 96 special classes in 42 public schools and hospital annexes in four boroughs of the City of New York. The 1916 poliomyelitis epidemic has added a long Htt to the crippled children, who will need special school/'accommodations and transportation in New York. -S' ., In reviewing the summary of the 6,294 cases reported by the New York Committee for the Care of Paralysis^.Cases^;l',92r crippled children will require special school care. The youngest Ill children of this group will be of school age in 1921. At this time, this list of poliomyelitis cases will have more than doubled the 1916 registration in classes for crippled children. TYPE OF SPECIAL CLASSES When special classes in public schools, and transportation, were provided, it seemed that the educational needs of crippled children had been met. As this movement progressed, howevei-, it became evident that a large number of crippled children under treatment in hospitals were receiving no education. Further- more, an ever-increasing list of helpless crippled children was reported. All these children were too greatly handicapped to permit their attendance in special classes in public schools. Many of these children could neither read nor write. To meet the urgent pleas for educational facilities for these two groups of crippled children, special classes were formed in hospitals as annexes to the nearest' public schools. Visiting teachers were provided also this year for the instruction of help-f less crippled children, in academic subjects and occupational train- ing in their home to bring these "shut in children" in touch with the outside world. ;-{ The type of school care for crippled children associated with the public school system of the City of New York is arranged, therefore, in accordance with the type of case as follows : SPECIAL CLASSES IN PUBLIC SCHOOLS The placing of special classes for crippled children in public schools was the result of a demand for a school atmosphere for this segregated group, as nearly as possible like that of normal children, while providing protection and technical supervision of their physical defects. This movement voiced the sentiments of both parents and children more than any other activity that has been established in recent years, for physically handicapped chil- dren. They want to do the things which other children do; they want to study the same lessons, play similar games, and go to the same schools. In placing these classes in public schools, therefore, the crippled children feel that they are as much a part of that school system as their more fortunate brothers jind sisters, 112 113 CLASSROOMS AND EQUIPMENT The special classrooms selected for the use of crippled chil- dren are near an exit and the playground, and are located upon the ground floor, to eliminate excessive stair-climbing for physi- cally handicapped children. Preferably, corner rooms are chosen, with either a southeasterly or southwesterly exposure so that sunshine may be obtained for practically all the school day, and direct ventilation, even during stormy weather. %, These rooms are equipped with special adjustable furniture' suitable for the care and comfort of cripples. TRANSPORTATION Transportation is provided for crippled children who are physically unable to walk short distances to school or to use the street cars. The stage districts are so regulated that no child travels in a school stage more than 45 minutes, in each trip. INSTRUCTION The course of study, especially for nontuberculous crippled children, is similar to that for pupils in regular classes, although more time is allowed for preparatory work in industrial training. The amount and kind of mental and physical work which each child is permitted to do is based upon the recommendations made on the hospital record cards by the speciahst treating each child. DAY SCHOOL FOR CRIPPLED CHILDREN There is at present one day school for crippled children con- nected with the pubhc school system. It has U classes with a registration of 200. This school is the Crippled Children's East Side Free School— Public School 75, Manhattan. The teachers of academic instruction and specialized physical training, and supervisors, are assigned through the public school system. The special classroom equipment, school supphes and rent are provided also by the Department of Education. The advanced instruction in industrial training and the work shop are conducted by the Board of Directors of the Lehman Foundation, through which fund other running expenses of the school are paid. Through this foundation free medical treat- 8 114 115 ment, nurses' services and baths are dispensed in the school cHnic. Morning and afternoon lunches and an excellent dinner are served daily to the children without cost. Furthermore, sum- mer vacations are arranged by the Directors for all the children at the summer home of this school. This type of school for crippled children is particularly adapted to the congested part of the city where the work of prac- tically all of the parents and older members of the family keeps them from home all day. Owing to these conditions, the chil- dren are unable to receive systematic treatment at the City clinics where most of the other orthopedic cases are treated, and it is therefore provided during the school day at the school clinic. Transportation is provided, mainly by the Department of Education, although two stages are supplied through the Lehman Foundation for the pupils in the work shop and some of the grade pupils. HOSPITAL CLASSES These classes were organized for the school care of crippled children who are under treatment in hospitals for two months or longer. Many of these children, especially the cases of bone tuberculosis, remain in hospitals for years, and in consequence, have been without systematic school training before such special classes were organized. Formerly these children had such in- struction and amusement only as occasional visitors were willing to give. Later, through private philanthropy, several classes were established for the ambulatory cases in some of the hospi- tals. The success of this experiment has resulted in the estab- lishment of special classes in hospitals under public school super- vision, at the request of the hospital superintendents and ortho- pedic surgeons. These classes include the ambulatory cases mainly. The bed cases receive individual instruction. In some hospitals, helpless crippled children and the severe cases resulting from the 1916 poliomyelitis epidemic are admitted to these classes from the out-patient department, because they still require such frequent hospital care that school attendance is otherwise impossible. Furthermore, these children are profit- ably occupied while waiting for their turn for trea;tment. 116 117 The hospital authorities and surgeons are much pleased with the results of this movement for providing education facilities for crippled children in hospitals. The interest and pleasure which the children take in their daily occupation has reacted favorably upon them physically. Many of the surgeons have stated that the time of treatment in many instances has been re- duced because of this mental reaction upon the physical condi- tion of the child. Furthermore, the parents are more willing to have their children remain at the hospital until treatment is completed, for neither children nor parents are worried over their school progress, which heretofore was necessarily inter- rupted by long periods of absence from school. HELPLESS CRIPPLED CHILDREN In May, 1915, at a conference with the directors of the Fed- eration of Association for Cripples, it was found possible to se- cure their co-operation with the Department of Physical Train- ing in providing visiting teachers by way of an experimental study for the instruction of helpless crippled children in their homes. As a result of this conference, one teacher was appointed im- mediately, and the following term several volunteer teachers of- fered their services for instruction in both elementary school subjects and industrial work. Records show that by December, 1916, 26 helpless crippled children under 16 years of age were under instruction through the services of volunteer teachers. Forty-five volunteer teachers and one paid supervising teacher were employed during the period from December, 1916, to March, 1918. The teachers visited the children usually twice each week, and reports were rendered every two weeks concerning the progress of each child. Books and supplies were received from the nearest public school. This experimental study showed most satisfactory results. The home visits proved to be a source of great pleasure and profit to the children, and furthermore, the anxiety of parents concern- ing the education of these helpless crippled children was greatly relieved. 118 The practical results of this experiment caused the parents of other helpless cripples to make persistent pleas for the extension of this work. During 1918, 92 helpless crippled children re- ceived home instruction in both elementary subjects and indus- trial work for varying periods through the services of volunteer visiting teachers. By December, 1918, 125 crippled children of school age, with normal minds, were listed for the services of volunteer visiting teachers, because their physical condition made it impossible to transport them to school. When the summary of the statistics of the recent poliomyelitis epidemic showed as a pitiful result 270 helpless crippled children, 35 of school age, 29 of kindergarten age, and 206 of five years or younger, it became evident that the number of children requiring home instruction would increase each year. ASSIGNMENT OF PUBLIC SCHOOL TEACHERS This work had now outgrown its experimental stage, and it was evident that the time had come when the instruction of these children should be carried on by the Board of Education as the most systematic and continuous way of providing an elementary school education, and also' industrial training. Consequently, a report was made upon this experimental study with recommenda- tions for the employment of substitute teachers under the super- vision of the Department of Education. This report and recom- mendation was approved by the Board of Education in December, 1918. These recommendations included: 1. The employment of twenty substitute teachers to give instruction in the elementary school subjects and in industrial work. 2. These teachers to receive technical training in hygiene and methods of instruction of crippled children through the Department of Physical Training. 3. Books and supplies to be furnished from nearby schools when re- quested by the visiting teacher and indorsed by the district superintendent in charge of the schools. 4. A record of the condition of each child receiving instruction, the work carried on, and the progress made to be recorded at the close of each month. 5. The co-operation of the Federation of Association for Cripples to be continued in order that volunteer service be secured whenever it was deemed advisable. 119 6. A canvass to be made for all cases of helpless crippled children of school age. It is worthy of note that the report was presented in such a convincing manner that it was approved by the Board of Educa- tion, and in February, 1919, 20 visiting teachers were assigned for service as home teachers for the instruction of helpless crippled children. PLAN OF WORK During the term from February to June, 1919, 20 visiting teachers were assigned to this special instruction. By June, 1919, 160 children were receiving home instruction and 265 cases had been investigated. These teachers gave instruction in ele- mentary school subjects three times a week for one and one-half hour each visit for every pupil, and thus full time teachers working six days per week instructed eight children. In June, 1919, there was an extensive waiting list of helpless childen, including cripples, severe cardiac cases and epileptics requiring the service of visiting teachers. Additional funds for this work was required and granted in the Budget of 1920. In January, 1920, 36 visiting teachers were appointed. Of these, 18 were after-school visiting teachers from nearby schools, who were assigned to helpless children residing in outlying dis- tricts at some distance from a visiting teacher's circuit, and also to helpless cripples who were preparing to graduate. Each after-school teacher gave instruction for four afternoons each week. Books and supplies were obtained through the district super- intendent in charge of the nearest school having a class of crippled children, in which the helpless crippled child was regis- tered as a member of that class. After the first visit to the home of each child by the visiting teacher, a report of this visit was made and a copy forwarded to the Department of Physical Training. This included a tentative examination of the mental attainment of the child, and also a record of his physical disability, medical and surgical treatment, name of hospitals attended and physicians giving treatment. The child, if able to profit by home instruction, was then reported for registration on the roll of the nearest school. As a result of 120 this first visit, the child was graded and the plan of work for each child for the month was outlined in accordance with the grade in which he was registered in the school. Careful adjust- ment of this plan of work for the month was made by the visiting teacher through visits to this school in conference with the prin- cipal and class teacher of crippled children. In cases of the serious illness of one of these children or in instances of quarantine in contagious diseases, the visiting teacher, after notifying the Department of Physical Training for investigation gave the time of this child as additional service to the other pupils on her assignment until the sick child was physi- cally able to continue his studies. When children were sent to the hospital for an operation or prolonged treatment, a new assignment was made to the visiting teacher from children on the waiting list. In cases where the hospital treatment extended over more than three or four weeks, the child was either ad- mitted to a class for crippled children in the hospital, or, if the hospital had no such accommodations, the visiting teacher was reassigned to the instruction of the child in the hospital upon the recommendation of the physician in charge. In June, as an experimental study, examinations similar in character to those conducted by the principals in the school in which each child was registered, were given by the visiting teachers and used as a basis for promotion. As a result of this plan, two helpless crippled boys completed the work of the eighth year and passed the examination of the principals and district superintendents in a satisfactory manner. All the other chil- dren, with the exception of those who were admitted to hospitals or were convalescing from operations or diseases, were advanced to the next grade in June, 1919. A number of the children were so interested and anxious to progress in their school work, that they covered the work of two grades by June. In February, 1920, two more helpless boys graduated, and in June, 1920, an- other will have completed eighth -year work satisfactorily. Two of these boys are now receiving home instruction in typewriting and stenography, and shortly will be able to earn their living through their own efforts. 121 This procedure has given great satisfaction to both parents and children, for they feel that these helpless crippled children have at last become associated with other children in their educa- tion and school training. PHYSICAL RECORDS The history and records of the physical disability causing the handicap, were obtained from the parents of each helpless crippled child listed for the services of a visiting teacher. Each case was carefully investigated by the Department of Physical Training, with the efficient aid of the Federation of Association for Cripples, and where either medical or surgical treatment was needed, this was instituted. Over 260 cases of helpless crippled children were investigated last term, and hundreds of parents were interviewed. In many instances, parents had become com- pletely discouraged by what appeared to them to be a hopeless situation. Superintendents of hospitals, surgeons of orthopedic clinics and other children's specialists were ccmsulted and inter- ested to co-operate in the treatment of these children. As a re- sult, 19 helpless crippled children were so improved physically that they were able to attend classes for cripples or other classes. VOLUNTEER VISITING TEACHERS The services of the volunteer visiting teachers, supplied through the Federation of Associations for Cripples, were re- tained for instruction in industrial work, hand training and recre- ation. The visits of these teachers alternated with those of the public school visiting teachers. Some of these volunteer teachers were experienced workers in trades and industrial arts, and after a busy day gave their time to the instruction of these helpless children. Recreation is planned also by the volunteer visiting teachers through their own efiforts and by interesting influential friends. Automobile rides are arranged, trips to Coney Island and the parks, entertainments and picnics, visits to museums and even the moving picture shows have entered the lives of these home bound children, giving untold happiness to them. 122 CRIPPLED CHILDREN RESULTS OF POLIOMYELITIS EPIDEMIC — 1916 The results of the 1917 survey of the New York Committee on the After-Care of Infantile Paralysis, of the children affected by this epidemic, have been summarized in the following tabula- tion under age headings, in order that an estimate might be made of the number of special classes that would be required. 94 cases between the ages of 10 and 15 years in 1916. 56 cases between the ages of 9 and 10 years in 1916. 178 cases between the ages of 8 and 9 years in 1916. 127 cases between the ages of 7 and 8 years in 1916. 160 cases between the ages of 6 and 7 years in 1916. 245 cases between the ages of 5 and 6 years in 1916. 412 cases between the ages of 4 and 5 years in 1916. 693 cases between the ages of 3 and 4 years in 1916. 1,098 cases between the ages of 2 and 3 years in 1916. 1,398 cases of the age of 2 years in 1916. 793 cases of the age of 1 year in 1916. 192 cases under 1 year of age in 1916. Fromi this it is evident that 860 children of school age were under treatment in 1916, to which may be added 412 children of kindergarten age, or 1272 crippled children. To this must be added, in 1918, 1105 crippl'ed children who are now of school age, and 1098 children of kindergarten age, making 1905 children of elementary school age and 1098 children of kindergarten age, or a total of 3003 children. To this record should be added 200 cases not Hsted in this tabulation, and found to be without treat- ment, later. Through systematic and special hospital care and treatment during the two years from 1916 to 1918, some of these children have been cured and others aided, so that although somewhat dis- abled, they may attend regular classes in public schools. In order to ascertain the present physical disability of each child listed in the survey of 1917, a complete inspection of each case was made from June to October, 1918, through the helpful co-operation of the New York Committee on After-Care of Paralysis, Dr. Frederic Splint, Director. 123 The following summary of this comprehensive survey indi- cates the number of crippled children v^ho must have special school accommodations in 1918 and 1919. DEDUCTIONS Of the total number of 6256 cases of children afflicted with poliomyelitis during the epidemic, and reported in this recent sur- vey, the following school care is indicated for the children of kindergarten and school age. Not counting the 910 cases in which the ages were not given, approximately : 418 cured cases of school age, and 258 cured cases of kindergarten age, could be referred to regular classes in the public schools. 418 cases with slight disability of school age, and 258 cases of kindergarten age, could be referred for accom- modation in regular classes in a public school, with a letter to the principal requesting a report of progress in case the child could not stand the physical strain of reg- ular class work. 434 cases of severe disability of school age, and 307 cases of kindergarten age, should be registered in classes of crippled children. 44 helpless cripples of school age, and 36 helpless cripples of kindergarten age, should be regis- tered in hospital classes or provided with visiting teachers. To this number must be added 125 cases of helpless cripples who received home instruction during the past year, or 205 cases. There are, therefore, 418 crippled children of school age and 258 crippled children of kindergarten age in the five boroughs, or a total of 676 cases requiring transportation and school care in special classes in the public schools. To this must be added 80 helpless cripples, who will be accommodated in hospital classes or who require a visiting teacher, or a total of 756 crippled chil- dren. This is equivalent to a register of 35 special classes, and will require approximately 20 stages for transportation. At one sudden, unfortunate blow, therefore, the number of children 124 requiring special school accommodation has been increased by nearly 64 per cent, of the registration of May, 1918. It will be 1922 before all the cripples of the 1916 epidemic are accommo- dated in special classes. SUMMARY For the physical welfare of crippled children under public school supervision, permit me to respectfully recommend that : 1. Thirty-two visiting teachers be provided for the home instruction of helpless crippled children during the school year. 2. Transportation for crippled children in public school classes, including accommodations for such service to hospitals to encourage systematic and continuous treat- ment ; and to secondary and vocational schools for spe- cial schools for special training. 3. An eligible list be prepared of teachers of classes of cripples with a schedule equivalent to that of a promo- tion license, and that special training for assignment to special classes be required. 4. Special provision be made for playgrounds and teachers for all crippled children in hospitals, clinics and conval- escent homes for the summer vacation. 5. Another special teacher of physical training be assigned to assist in the instruction of physically handicapped children. 125 INDUSTRIAL AND PLACEMENT WORK FOR PHYS- ICALLY HANDICAPPED CHILDREN Carolina G. Ronzone PURPOSE The purpose in this work is the preparation of boys and girls for useful employment in the trades, according to their handicap. As the greater percentage of them leave school at the age of 15 or 16, the work planned for them is kept closely allied to the fundamentals of the trades they anticipate entering. Elementary school children cannot become skilled workers, and experience proves that the foreman has his own methods and would rather carry the children on to skill in his own way. This not only re- lieves the school authorities of expensive equipment, but it places within reach of education a means of insuring, with ,very little expense, the apprenticeship for the child. The work of the teacher is to study carefully each peculiar handicap and individual tendency, to find the occupational possi- bilities, the methods used in the trades, and then to educate the child. AIM The elementary work aims to train the children to use their fingers and tools correctly in handling material, working entirely from nature. It develops form, color, trade processes by free- hand cutting and making of objects. It also trains the eye in correct proportion and teaches perspective. The details learned in the elementary grades of making fruits, vegetables and flowers ; bead charts, millinery charts, elementary construction and model- ing lead to the following trades : Cotillion favors, dinner favors. French flowers, satin flowers — used in millinery. Needlework — relating to silk novelties. Millinery— which includes all processes from the making of the frame to the finished product and the renovation of old hats. Beading, fringing, tassel making. This course correlates with the sewing department. A girl who can sew and also make these accessories to a dress is a valuable acquisition in a work room. 126 Lettering. This course embraces the formation of different type let- ters as full block, half block, spur block, which are all built ac- cording to different ratios by the aid of mechanical instruments, T, square, angle, etc., and leads to the detail work in an architect's and designer's office and to ornamental glass sign painting. Later the scale of these letters is lowered by the eye and gold leaf and other mediums are used to decorate them. This course correlates with printing and shop work. , Elementary Construction— which teaches the processes of cornering- out, scoring, setting-up, stripping or covering, and the correct ma- nipulation of the mediums employed, as paste and glue. Typewriting and Machine Calculating. This work correlates with the academic branches and is given to boys and girls who do not care to handle industrial work. Weaving, Basketry, Brushes, Chair-caning. This type of work should be set apart for the blind, mentally de- fective, and those so badly handicapped that this is all they can do. The best trades are now open to the deaf, crippled and other handicapped children offering training and a splendid future. ADJUSTMENT OF TIME SCHEDULE An adjustment should be made in the time schedule so as to give these children more time for hand work, for as it now stands the major part is given to the academic subjects. This adjust- ment is necessary in order to meet the needs of the boys and girls entering the trades at the early age of 15 and 16. It would be a good plan to give the children entering the trades six months of intensive training in their special trade before graduation. For those who are preparing for office work, telegraphy, typewriting, machine calculating, filing, etc., it would be well to give extra work in academic training. Where there are four or five classes of handicapped children in a school, a special industrial room is advised with one teacher in charge of the work. This plan is in operation at Public School 69, Public School 75, Manhattan, and Public School 34, Brook- lyn, and the results for the current year demonstrate the value of it over all other methods. Each class receives 40 minutes' in- struction daily, and while the teacher in charge is in the shop, the academic work is being taught to her class by the teacher of the class, which is in the shop. This plan is also in operation in the School for the Deaf. 127 Handicapped children are now receiving industrial training in the School for the Deaf, eleven schools for cripples in A^Ianhattan, six in Brooklyn, and one in the Bronx. This year two schools for cripples, twO' for tuberculous, one for anemic children in open air class, and one for blind have been added in Manhattan and the Bronx and four for cripples in Brooklyn, making a total of seven- teen schools in Manhattan and ten schools in Brooklyn. Eventu- ally the work will be extended to the other schools where there are classes for handicapped children. Only three schools for crippled children have an extra room to give to industrial work, and they are equipped as follows : Four tables, twelve regular chairs, ten small chairs, eight stools. In schools not having special industrial rooms the work is carried on in the regular class rooms. WORK AT THE SCHOOL, FOR THE DEAF The work of educating the handicapped child for the trades was first begun in New York City at the School for the Deaf. In the beginning it seemed a hopeless task, but with the loyal co- operation of heads of educational departments, representative business men, and medical specialists, these children have won their fight for independence, and have victoriously entered the ranks of the industrial world. The placement work is steadily growing. The demand for the deaf as workers in the trades is greater than the supply, and statistics show that it is a rare case for one to make a change of position within the year. There were 22 graduates in February and June, 1918, 14 in February and June, 1919, and 16 in February and June, 1920, making a total of 52 in 1918-1919-1920. Two entered high school and the remainder entered the trades of printing, glass signs, mil- linery, French flowers and power-machine operating. Investiga- tion shows that all graduates of this and former years are em- ployed and earning good salaries — minimum $8 and maximum $30 per week. The placement of the crippled child is mainly conducted through the various organizations interested in the after care of 128 cripples. All graduates thus far have either entered high school or have been placed in the trades. There were 21 graduates in February and June, 1918, 21 in February and June, 1919, and 75 in February and June, 1920, making a total of 117 in 1918-1919- 1920. Wider opportunities will present themselves, but the place- ment record up to date proves that all physically handicapped children trained under the right conditions will make good. Heads of firms have become so interested that an association of business men now co-operate in furthering the trade interest of the handicapped. The sale of the product of handicapped chil- dren while they are in school is not encouraged, but the use of the actual materials is employed as far as possible to give them real trade experience. In this we have the co-operation of the trades people who are willing to send the working materials to the schools- Many handicapped children whose parents have asked for their release have been retained in school to graduate by finding for them afternoon and Saturday employment. Business men in Greenpoint, Brooklyn, are to open a room in which to employ those children who cannot travel far, and firms will send their work to them. In some of the hospitals where the public school work is now being carried on, the doctors and nurses have become interested and are asking that a training class for nurses be organized so that they may give the work to the adult cripple in the wards. TRAINING CLASS FOR TEACHERS There is no special corps of industrial teachers to assist in this work. It has been the work of the one special teacher in charge of this work to instruct the classroom teacher, and for this pur- pose a training class has been voluntarily carried on at the School for the Deaf. 129 REPORT ON SPECIAL CLASSES FOR CARDIAC CASES Adela J. Smith, Assistant Director of Physical Training Frances Cohen, M. D., Assistant Director of Educational Hygiene FORMATION OF CLASSES The formation of special classes for cardiac cases in the public schools of the City of New York was due to the evident need for group segregation and special hygienic care for children afflicted with severe cardiac disturbances. These classes were formed, as an experiment, to accommodate the numerous cardiac cases re- ported by principals who, in the administration of their school activities, found it necessary to provide special protection for this type of physically handicapped children, who were unable to keep pace with the normal children in regular classes. Surveys were made in various schools, and all the children were examined by medical inspectors, and records were made of children suffering from cardiac disturbances. Later, these cases were referred to special cardiac clinics in hospitals selected for this purpose, and here detailed re-examinations by the cardiac specialists in these clinics were made. TYPE OF CASE Through these examinations, a selective type case was ob- tained, for which special school care was recommended. The group selected for this care included well-marked cases of organic heart disease. No cases of so-called functional heart disturbances were included. This selective type of cardiac case, generally Class III, con- stituted the policy behind the formation of special classes for cardiacs in public schools. It was found to be advisable to have each case selected in this manner, associated with the special car- diac clinic in the school district in which this special class was formed, in order that frequent examinations by the cardiac spe- cialist could be made as the basis for the kind and amount of school work the child might undertake, and also that he might be under the supervision of the nurse associated with the clinic. 130 HOSPITAL RECORD CARD The following is a copy of the hospital record card. The form is based upon the one used so successfully in the care of crippled children in special classes in the public schools. DEPARTMENT OF EDUCATION THE HOSPITAL RECORD CARD- CITY OF NEW YORK CARDIAC Name Last First Date of Birth Address Floor Name of teacher School Borough Date entered Grade RECOMMENDATIONS FOR PHYSICAL TRAINING Check Exercises Indicated Gymnastics Breathing exercises -or improvmg posture For alert response — control For physiological (circulatory) results lass Room — Seat Games Recreative Elxercises (Cla f Adapted Playground Games Quiet Games Exercises Contra Indicated Should the child rest (prone) in schoo ? Yes No How long ? RETURN TO OFFICE OF DIRECTOR OF PHYSICAL TRAINING, Last First Name Date 157 East 67th St., N. Y. C. Hospital Physician Diagnosis Cardiac Classificahon (Class I. II. III. IV. V.) Check (V) type of case in columq. I. Organic (Sympts. of Insufficiency— never evident) IV. "Possible" Cardiac disease (Doubtful Murmurs: Mainly functional, possibly organic) II. Organic ( _pa,t. not present) III. Organic ( -present ) V. Potential (Predisposing history) Should the child be in a hospital ? Yes. No. If not, is he physically able to attend school ? Yes. No. Should he be in a special class for cardiacs ? Yes. No. Should he be permitted to climb stairs ? Yes. No. No. of flights Physical Defects. Def. Vision Yes. No. Def. Hearing Yes. No. Discharging Ears Yes. No. Def. Teeth Yes No. Def. Nasal Breathing Yes. No. Chr. Nasal Discharge Yes. No. Hypertrophied Tonsils Yes. No. Nutrition Grading I - 2 - 3 - 4 Pulmonary Def. Yes. No . Chorea Yes. No. Code : Nutrition Grading I Excellent. 2 Good- 3 Fair. 4 Poor, 131 The method of classifying the various types of cardiac disease and the degree of disabihty are in accord with the diagnostic scheme adopted by the Association for the Prevention and Relief of Cardiac Disease. The school attendance and the amount and kind of school ac- tivity permitted each child is varied in accordance with the recom- mendations made by the cardiac speciahst, as shown by the records on this card from month to month. This medical record is later transcribed by the Department of Physical Training in terms ap- plicable to the school care of the child, for the use of the class teacher. CO-OPERATION BODIES Experimental classes were organized in 1918 in Public School 168, Manhattan, in conjunction with the special cardiac clinic in the Dispensary of the Mt. Sinai Hospital, and in the Educational Alliance— Public School 75 Annex— which is associated with the cardiac clinic of the Beth Israel Hospital. These two clinics represent two of those established under the recommendation and auspices of the Association for the Preven- tion and Relief of Cardiac Disease in zoning the city for the relief of cardiac cases. ADMISSION AND DISCHARGE OF CARDIAC CASES The administrative procedure governing the admission and discharge of children assigned to these special cardiac classes is based upon the recommendations made by the cardiac specialist upon the hospital record card of each child. Frequent re-exam- inations are made by the physician of the clinic as a basis for the continued school care. CLASSROOM — TEMPERATURE VENTILATION It has been found necessary to select suitable classrooms for the special school care of cardiac cases. These rooms should be preferably upon the ground floor, or not higher than one flight of stairs, and should have plenty of sunlight and fresh air. A corner room with a southeastern or southwestern exposure is, therefore, desirable. The room should be located near an exit and within easy access to the playground, 132 The temperature of these rooms should not be lower than 60° F. during the season when artificial heat is required, and at this time the children should be warmly clad, even to the extent of wearing sweaters, mittens, caps, and if necessary, leggings, in or- der to prevent circulatory disturbances by prolonged lowering of body temperature. FEEDING IN SCHOOL From observation, it has been found an advantage to supply the midday meal at school in preference to having the children walk to their homes at noon time, especially during inclement weather. Special care has been taken to supply a well-balanced diet, eliminating free sugar, with a minimum of meat, meat broths and fluids. Three meals a day, about four or five hours apart, have been recommended with no lunches between meals except a hot drink on cold days after the afternoon recreation period. A rest period is provided during the school day after the noon meal. DAILY MORNING HYGIENE INSPECTION A comprehensive morning inspection of the children is made daily by the teachers in charge of these special classes. Emphasis is placed upon any sign that would indicate an increase in cardiac disturbance, such as unusual rapidity of pulse, or of respiration, flushed face, extreme pallor, labored breathing, blue lips and fingers, profuse perspiration and general weakness or languor. In addition to observing signs of illness, a careful inspection is made of each child from the standpoint of cleanliness and kind and amount of clothing worn. It is especially important that these children should be provided with warm underwear during the winter months, so that they do not sufifer from circulatory disturb- ance resulting from prolonged cold. The teachers ascertain if these conditions are fulfilled. Emphasis is' placed upon the importance of good mouth hygiene, sufficient number of hours of sleep at home, the quality and quantity of food, and the general home hygiene and care. The teachers are assisted in the health care of these children by the nurse assigned for home visits, through the special cardiac clinics. 133 DAILY MEDICAL INSPECTION Besides the general and special morning inspection, the nurse associated with the cardiac clinic should take the temperature of each child twice a day, at 9.00 A. M. and at 3.00 P. M., to serve as a guide for the school care during the day and for the after school recreation period. A study of body temperature was made in two classes on vari- ous groups of children for a period of a month each in order to ascertain primarily whether children afflicted with organic heart disease are subject to abnormal fluctuations of temperature. The records of the temperature charts obtained from these observa- tions show, beyond a doubt, that a large number of children suf- fering from heart disease run an abnormal temperature. It is significant that in a study of 15 cases, all organic heart cases had an abnormal temperature, and that 80 per cent of the cases showed an elevation of temperature more than 50 per cent of the time, while the congenital case had temperature a very short time. The fact, therefore, that these children, aside from having a mechanical physical defect, are also constantly subject to fever as a result of an infection of the heart, indicates the necessity for a modification of their school curriculum, which must be provided through special classes. The physical strain induced by these chil- dren attempting to keep pace with normal children in regular classes is, therefore, not only an aggravation of their cardiac con- dition, but eventually prevents them from attending school. SCHOOL CARE This study of body temperature has been made the basis for the school care of severe cardiac cases admitted to these special classes in the public schools. A child with a temperature of 100° F. or more is not allowed to attend school. If the temperature is discovered after the child is in school, his class work is suspended and the child is permitted to rest in school for the remainder of the school day. He is not allowed to return to the class room until his temperature is normal. The name of the child and the degree of temperature should be reported at once by the teacher to the principal of the school. 134 The nurse associated with the cardiac clinic reports the condition to the parents and to the doctor in charge of the special cardiac clinic to which the child is attached, and arranges for the child to have care at home in bed until such time as he may be free from temperature for 24 hours, when he may return to school. The nurse in charge of the case calls upon the child daily at his home, and if he cannot have proper care at home, he is re- ferred, with the consent of his parents, for bed care at the hospi- tal affiliated with the special cardiac clinic. In case the child is ab- sent from school, the nurse investigates the cause of the first day's absence, in order that a record may be kept and treatment in- stituted. SCHOOL CURRICULUM From experimental observation it is apparent that certain modifications in the course of study are necessary to prevent strain and overwork. While it may not be necessary to change to any great extent the content of the various courses of study, it is es- sential that these children should be permitted to take a longer time to complete the same amount of work accomplished by 'nor- mal children. Even though their school life may be lengthened by this additional time, it will prevent worrying about examinations and similar causes of school strain. The curriculum should be so arranged as to include short morning periods of mental application, followed by rest or a quiet recreative period, and short periods of physical training adapted to the physical condition of each child. Furthermore, provision should be made in the afternoon periods for vocational training suitable to the strength and physical condition of the children, in order that they may become self-supporting in a measure after their school training has been completed. Many of these children will probably not live to adult life. This ability to do light indus- trial work would keep them happily engaged during the hours of enforced invalidism. ROUTINE SCHOOL DAY The following routine school day has been suggested for ex- perimental study: 135 i TIME — ^ACTIVITIES 8.30-9— Arrival. 9-9.15 — Rest and reclining chairs. Observations to determine pulse rate, temperature and other physical conditions. 9.15-10.15 — School program. *10.15-10.35 — Recess and recreative exercises. 10.35-12.15 — School program. **12.15-12.45— Lunch period. 12.45-1.45 — Rest period for all children in reclining chairs. 1.45-3 — School program, including specialized physical train- ing exercises. These special exercises are for selected groups ar- ranged in accordance with the recommendations for physical ex- ercises provided by the cardiac specialist in charge of each child. AFTER SCHOOL RECREATION PERIOD 3-3.15 — Rest in reclining chairs for observation to determine pulse rate, temperature and other physical conditions in relation to the amount of school work done during the school day and as a guide for after school recreation activities. 3.15-4.15 — After school recreation period. Outdoor in pleas- ant weather. ***4. 15-4.30 — Quiet games for all children. Hot drink in cold weather, or glass of milk and graham cracker before dismissal. * Note — It is suggested to omit mid-morning lunch in order that the parents may be encouraged to provide the children with a suitable break- fast before coming to school. It has been recommended that a period of about four to five hours should be observed between meals. ** In connection with feeding in school there should be a proper cor- relation between the type and quantity of food supplied at that hour with the type and amount supplied at home. This should be accomplished through the co-operation of the Social Service Department of each car- diac clinic after consulting with the physician in charge. Suggestions to parents concerning proper diet should be made by the Social Service Nurse. ***Note — It is a question whether it is advisable for these children to have any food between meals. Experiments have shown that 4 to 5 hours' intermission between meals with no lunches during that time has given very satisfactory results. 136 4.45-5 — Walk home for exercise. Children unable to walk use trolley car or bus service where possible. Dismissal in winter at an earlier time, because of the shorter daylight hours. 5.30 — Indoors. Dinner not later than 6. After dinner, quiet occupation. In bed before 7 o'clock. TENTATIVE PROGRAM SUGGESTED FOR SATURDAY AND SUNDAY In bed until 10 A. M. Co-operation should be encouraged in the home to keep the children in bed until 10 A. M., and then to continue the following program if possible. 10-12 — Quiet recreation. 12.00— Dinner. In bed until 2 P. M. Quiet play until 4.30. 5 P. M. — At home. Dinner before 6. In bed before 7 P. M. CHART FOR GENERAL, OBSERVATION The following chart for use in cardiac clinics has been sug- gested for trial and further report by a committee of physicians in charge of these special clinics : 1. Name 2. Age 3. Number of children in family 4. Kind of control at home : Good : Fair : Poor : 5. Number of times in bed or in hospital for heart conditions : Before observation After observation 6. Approximate duration of disease in months or years 7. Etiology : 8. Diagnosis : *9. Hypertrophy or not 10. Irregularity 11. Average pulse rate at rest 12. Pulse rate immediately after jumping with both feet 10 times 13. Pulse rate three minutes after having jumped with both feet 10 times 14. Weight every week * By Hypertrophy we designate easily demonstrable enlargement of the heart. 137 15. Hsemoglobin taken once a month 16. Lungs: Rales: Dullness: Dyspnea: 17. Liver — palpable: not palpable: 18. Spleen— palpable : not palpable: 19. Morbidity — days absent from school during term 1. Days in bed — cause of absence 2. Days in sanitarium — cause of absence 3. Days in hospital — cause of absence We thought it advisable that the children admitted to the car- diac classes should fit into Class III of the classification adopted by the Association of Cardiac Clinics, namely, "Patients with or- ganic heart disease at the time of observation who have symptoms of cardiac insufficiency following ordinary exertion." It might be preferred to have cases of mitral stenosis or aortic insufficiency given the preference, the class to consist only of girls. The class for experiment is to be limited to 25. RESULTS Certain definite results have been obtained through this experi- mental study which indicates that these special classes for cardi- opathic children have proved of great benefit. A study of the school attendance of various groups of cardiac cases showed, in general, a better record of attendance after segregation than at any previous period. The less severe cases whose records of attendance in regular classes were marked by long and frequent periods of absence, showed an attendance whereby the majority were able to complete the relaxed curricu- lum of the term while the more severe cases, who were unable to attend schools before segregation, showed good attendance and marked progress in their studies. The comparison of the attendance records of a group of car- diac cases shows a total of 492 days' absence before segregation and only 132 days after admission to a special class for one school year. Individual records are even more interesting. One child had a record of 89 days of absence during the school year, before admission to a special class, and but 12 days after admission; an- other child reduced his absences from 88 days to 24 and others showed a gain of 25 to 69 days. 138 An extremely interesting report has been made of the hospital record of the children associated with the cardiac clinic of the Lenox Hill Hospital. Last year, 20 children from this clinic re- quired treatment in the hospital for various periods. Since these children have been attending school in a special class for cardiacs with a supervised school day from 9.00 to 5.00, not one case has required hospital care other than two cases who contracted pneu- monia. Every child in this group of 25 in the special class at Public School 70 Annex, with the exception of one very serious congeni- tal case of heart disease, has gained in weight since segregation, some children gaining over a pound a month. Furthermore, the anxiety of the parents concerning the educa- tion of their children, was relieved, and the children themselves received not only mental and physical benefit through this special school, but also much pleasure. This is well illustrated by the re- mark of a little girl, who, after her first day at school, said: "This is the first time I have ever been in school. It is the happiest day of my life." RECOMM-ENDATIONS As a result of the experimental study for the special school care for cardiac cases, it is respectfully recommended that : 1. Special classes for severe cardiac cases be formed in each cardiac clinic zone thfough the selective method herein outlined in co-operation with the treatment recommended by the cardiac specialists of these various clinics. 2. Suitable classroom and personal equipment be provided for the classes now organized and for all additional spe- cial classes for cardiacs. 3. Transportation be arranged for selected cases in each class. 139 CARDIAC CLASSES Louis Marks, Principal P. S. 64, Manhattan ORGANIZATION Because of several favorable conditions, the experiment of organizing the classes of cardiac children was tried at Public School 64, Manhattan, in the Children's Aid Society Building at 8th Street and Avenue B. This is the center of a district ranging from 14th Street to Delancey Street, and from the river front to Third Avenue, making a hub of 17 schools in this area. Dr. Halsey of the Post-Graduate Hospital was in immediate charge of the examination of children for these classes, and was assisted by a staff of four associated physicians from the same hospital and two nurses from the Henry Street Settlement. The result of the examination showed about 150 children with heart disease. These children were classified according to the method adopted by the Association of Cardiac Clinics. Of these groups, I and n showed evidence of heart disease, but were without symptoms when examined. Group IV were children who had some finding on examination which was not of serious importance. Group III showed symptoms of heart weakness on slight or moderate exertions. It was only this group which was selected for the cardiac classes. The school had its formal opening on February 2, 1920, in the rooms of the Tompkins Square Building of the Children's Aid Society. Twenty-nine of the 77 Group III children were regis- tered. By February 27 there were 58. By the middle of March 75 children were on register and thus the three classes were full. CLASSIFICATION Pupils who were classified as belonging to Groups I, II, IV, and a few of Group III who have remained in attendance in the regular classes of other schools of the district, are kept under ob- servation by means of a follow-up card. About 400 of these chil- dren are kept under supervision of the doctors. Once a month the nurse goes to the schools of the district, taking cards with her. The principal of each school has recorded on the card the number of school days of the month and the number of times absent of 140 each of these children. This insures close watching of each case. If any unusual symptom is noted, a re-examination of that child is made by the doctor. This record affords an opportunity for comparison between the children in the special cardiac classes and those in regular classes. The whole group of children are re-examined from time to time by Dr. Halsey and his associates to re-determine the condition of each child and what changes, if any, should be made in the treatment. The records and complete data concerning the physi- cal condition are carefully kept up to date, and there is a cross- index system. The principal of Public School 64 has the super- vision of the educational part of the program. At present the three classes at Public School 64 are graded as follows: Cardiac I — 25 children (boys and girls), lA to 3B; Car- diac II — 25 children (boys and girls), 4A to 6A; Cardiac III — 25 children (boys and girls), 6B to 8A. There are three regular teachers in charge of these classes until 3 o'clock. At 3 P. M. three teachers of recreational activities take charge and remain with the children until 5 P. M. In fine weather an hour is spent in the park which is in front of the school. It is planned to in- troduce the elements of domestic science and manual training dur- ing the two hours before home-going. MOTHERS MEETINGS Once a month a mothers' meeting is held in the school so that the home may learn of the care and welfare of the children. The first meeting of this kind was held February 11, 1920, with 40 mothers, two elder brothers and one father present. Mr. Marks and Dr. Halsey spoke concerning the educational and physical side of the work. Following the meeting they talked with the mothers individually. During the summer vacation some of the children will be sent to the country for rest and recreation. In addition to this there will be a summer vacation playground maintained under the De- partment of Recreational Activities. The Children's Aid Society will furnish a daily luncheon and a nurse. 141 THOROUGHNESS OF MAINTENANCE It may be of interest to note the exceptional thoroughness with which these classes are maintained. Every one of the 75 children has received the Wassermann test besides the most care- ful re-examinations from time to time. Besides this, each child has received a careful individual intelligence test — the Terman, Sanford Revision of the |Binet Simon. Dr. Halsey hopes to make a final detailed report based upon his observations and statistical records. When this is completed it is certain that very definite conclusions will be drawn which will furnish a reliable contribution to the problem of cardiac children in our elementary schools. ■ 142 CARDIAC CLASSES Mrs. Henrietta Renaldo Scheider, Principal P. S. 75, Manhattan ORGANIZATION OF CLASSES Through the co-operation of the Board of Education with the Beth Israel Hospital, the Social Service Department of the hospi- tal and the Cardiac Clinic, there have been established two classes for children suffering with cardiac conditions. These children are considered too ill to attend the regular classes of the public schools, but not ill enough to be confined entirely to their homes. During the two years and a half since their organization, 28 boys and 32 girls have been enrolled. During the same period 19 boys and 26 girls have been discharged from the register. The causes for discharge are as follows : Condition improved, children recommended for return to regular grades 23 Moved out of district 14 Graduated 2 Too ill to attend school 4 Over school age 1 Died 1 45 ENROLLMENT The present enrollment of 50 pupils in two classes shows children suffering from the following cardiac conditions : Boys Girls Total Aortic and mitral insufficiency 4 4 Mitral insufficiency 8 23 31 Double mitral insufficiency 1 5 6 Stenosis 3 3 6 Congenital 2 2 Weakness, resultant from anemic condition 10 1 19 31 50 FOOD Good wholesome food and plenty of it is extremely important to keep up resistance to disease. It is useless to expect an under- 143 nourished patient to respond to medical treatment. To meet this need, the children are served with a hot luncheon at noon, and milk and bread and butter during the morning and afternoon ses- sions. A typical luncheon menu is as follows: A thick soup, either cereal or vegetable, meat and potatoes, bread and dessert, either stewed fruit or a nutritious pudding. PROGRAM During the summer months a roof school is conducted on the roof of the Beth Israel Hospital. Here the children rest and play trom nme to five. Nourishment is supplied by the hospital. In this way the children are kept ofif the street and under supervision. Girls improve more quickly than boys for the reason that girls are more easily controlled than boys and submit more readily to re- strictions. As the foregoing emphasis upon the physical care of cardiac children indicates, our aim is to regard the child first as a patient and then as a pupil. RESULTS The results obtained in two and a half years have justified the undertaking. All the children under treatment show an improved physical condition. They sleep better, eat more and with better appetite, and show an appreciable gain in weight. Their interest in school life has been re-awakened and they are making steady progress in their studies. Their attendance at school is more reg- ular. Eleven children who have been in the cardiac class for one term lost only 55 days by absence during this period. The same children lost 265 days by absence during the one term preceding their admission to the cardiac class. In other words there was an average gain of 19 days per child for one school term. These facts speak for themselves. The following table shows the gain in attendance of pupils in the two cardiac classes ; 144 Term Ending June 30, 1920 Between Between Between Between 1 term 1 and 2 2 and 3 3 and 4 4 and 5 or less terms terms terms terms 1. Number of pupils in car- diac classes 11 9 7 6 17 2. Total number of days of absence of these pupils for equivalent periods in regular classes, preced- ing admission to special (cardiac class) 265 436 500 387 1533 3. Total number of days of absence of these pupils from cardiac class with- in these periods 55 168 167 137 833 4. Total number of days gained in attendance in cardiac class 210 268 333 250 700 5. Average gain in attend- ance as pupils in cardiac class 19 30 48 42 41 145 CARDIAC CLASSES Abraham Smith, Principal Public School 70, Manhattan ORGANIZATION The class was organized on September 22, 1919. The pupils were drawn from nearby schools. The tentative register was made up by special recommendation from principals. Every child underwent a careful clinical examination at the hands of Dr. Bopp, Cardiac Specialist of Lenox Hill Hospital. Only children with marked organic lesions were accepted. Original register — -18. Present register — 24; 9 girls, 15 boys. CLINICS Clinics are held on Wednesdays and Fridays from 2 to 4 p. m. at the Lenox Hill Hospital. Each week every pupil is carefully examined as to his general condition and to the state of his heart. His progress is noted and recorded, and recommendations made for his future treatment. Records of every case are kept on spe- cial clinic cards. The child's general condition and progress de- termines the frequency of his visits to the clinic. Debilitated children are sent to the country to recuperate. Records of the temperature, pulse and respiration of the children are taken twice a day, and furnish a ready index to their cardiac condition. The deviation from the normal in these records shows the degree of acuteness of the cardiac malady. FOOD Twelve quarts of milk are sent to the class daily by the Board of Education Lunch Service. At 10 A. M. a light lunch is served consisting of a cup of milk and a graham cracker. Dinner is served at noon by the Lenox Hill Settlement for which a charge of five cents is made. The food is plain, wholesome and nutri- tious, and the Settlement deserves great credit for this most un- usual service. • 10 146 REST PERIOD The children play a little after their noon meal, and then he down in the steamer chairs for 40 minutes. The room is well ventilated and darkened, and absolute quiet is observed. On the first occasion of using the chairs, eight children slept during most of the 40 minutes. The next day 16 out of the 19 present slept most of the time. RECREATION AFTER 3 P. M. The children stay daily till 4.30 in charge of special recreation teachers. They are divided in three groups according to their degree of health. They play either sitting games, quiet games or games of moderate activity, according to the group they are in. The main purpose of the recreation period is to keep the children off the streets where in emulation of physically normal children they might speedily undo the benefits of many weeks of careful treatment. CO-OPERATING AGENCIES The Lenox Hill Settlement, the Lenox Hill Hospital, with the affiliated Jacobi Hospital for Children, and its excellent Social Service Department, deserve a great deal of credit for their ef- fective co-operation in all work and experimentation. 147 SPEECH IMPROVEMENT Frederick Martin, Director The report of the progress of the Department of Speech Im- provement Progress during the year 1919-1920. Twenty-six teachers are now devoting their entire time to the work of speech improvement. Classes for the correction of speech defects, stammering, stuttermg, Hsping, acute defective phona- tion and acute foreign accent are conducted in 78 day elementary schools, in five evening schools and in five summer schools. This does not include all the work being- done, as there are also the clinics and the work of many teachers, trained at the clinics, who devote their spare periods to the correction of acute cases of speech defects in their schools. The work in the day elementary schools for the past year, con- sisting of stammering, stuttering, lisping, acute defective phona- tion and acute foreign accent, was conducted according to the fol- lowing schedules : MANHATTAN No. of Pupils Not Teacher Schools Classes Reg. Treated Cor. Impr.Impr. Dooling, A. M 9,17,94 120 4,145 212 101 111 Dowd, J...110, 147, 188B, 188G 200 7,476 312 94 118 Gavin, M 11,32,67 82 2,958 179 79 98 2 Gilroy, M. C 43, 54, 157 138 6,097 192 78 109 5 Gregory, G 5, lOB, lOP 151 6,127 224 10 212 2 Gross, C 22, 88, 131 103 3,870 154 59 94 1 Kiely, K 24,57,119 177 7,062 186 83 95 8 McCord, E 51,58,84 107 3,870 223 97 126 McNally,E.H. 87,93,141,165,179 182 7,211 375 192 183 Moore, E. H 27, 40, 61 144 5,641 302 109 186 9 O'Connor, A 20,83,109 178 6,700 288 148 140 Pray, S 53,151,158 158 6,386 161 65 96 Secor, M 2, 65, 114M 181 6,825 215 102 109 4 Youmans, F 115 58 1,894 51 21 30 BRONX Youmans, F 47,53 124 4,125 124 46 78 148 BROOKLYN Birmingham, A. I.. 35,93,149 172 6,884 184 55 122 7 Douris, E. F 20B, 70, 179 136 5,111 248 156 88 4 Dybynska, J Z2, 78, 29B 88 3,534 173 46 127 Greene, E 25,79,162 111 4,492 116 39 67 5 Murtha, L 13, 46, 58B 88 3,686 223 72> 150 1 Prusslin, 1 168, 50, 166 100 4,966 166 81 77 10 Seebeck, G 41,109 97 5,628 170 79 83 4 QUEENS Farrell, E 20,21,23,31,41 66 2,434 188 87 101 Milne, K 4,83,6 149 6,340 259 146 112 1 Shelsey, C 11,92,89 92 3,380 462 211 238 13 RICHMOND— NONE Pastel, E. — Recently from U. S. Army assigned to office. O'Conncll, C. — Recently from U. S. Army absent for health. The work in the Evening Schools is conducted according to the follow- ing schedule : Manhattan— 27. 32, 93, 103. Bronx — 54. The work in the Stimincr Schools is conducted according to the follow- ing schedule : Manhattan— 27, 186. Bronx — 54. Brooklyn— 50. Queens — 85. The work in the Clinics is conducted according to the following schedule : Manhattan— C. C. N. Y., Hunter College, 157 East 67th Street, Cornell Medical, Summer at C. C. N. Y. Brooklyn — Brooklyn Training School. Queens — Bryant High School, Jamaica T. S. These clinics have been conducted without any additional ex- pense to the city because the teachers have volunteered their ser- vices without compensation. As director I have supervised the 26 teachers of the speech improvement by visiting the schools and observing the work of the teachers ; by observing and criticising the work of the teachers in the clinics ; by verifying cards sent to the ofifice by the teachers for cases under instruction. 149 The speech improvement work done by the speech improve- ment teachers has been of infinite value in the correction of sUght cases and as a preventive measure. The foreign accent syllabus has proven to be a practical aid for both class teacher and speech improvement teacher. The speech improvement work is essential as follow-up work for cases of stammering and lisping corrected in special groups. This follow-up work has been planned according to two divi- sions : the work done as a result of conference by class teacher and speech improvement teacher ; the work done as a result of conference of parents and speech improvement teachers. The teachers of speech improvement have co-operated with principals and class teachers of their schools by holding confer- ences ; by devoting auxiliary periods to assisting teachers with dif- ficult cases ; by visiting classes and giving desired assistance to class teachers ; by conferring with teachers in regard to follow- up work for pupils in speech correction classes ; by holding dis- trict conferences. ARMY WORK Three of the specially trained teachers in our clinics — Cather- ine V. O'Connell, Esta V. Pastel and Mary K. Thornton, have devoted 18 months to army work. They were selected by the sur- geon-general of the United States Army to organize the work of the correction of speech defects in soldiers who have suffered im- pairment of speech organs or suffered from "shell-shock." Their work has been highly praised by Colonel Richardson and Lieu- tenant-Colonel Blair of the reconstruction units. SYLLABUS ON FOREIGN ACCENT In connection with the present movement for the Americaniza- tion of the foreigner, many cities are now employing the syllabus on foreign accent, prepared by this department and adopted by the Board of Superintendents. This pamphlet is not only intended as a definite manual for the correction of foreign accent, so preva- lent in some sections of our city, but it is also a guide to the teach- ers in correcting general imperfect phonation. If the drills and vocal gymnastics contained in this pamphlet are practised daily. 150 in conjunction with the "two-minute setting-up drills," an ap- preciable improvement in the pupils' voices will soon be noted and a marked change in their articulation. RECOMMENDATION A central school in each borough, where acute cases of stam- mering may be isolated from all other students, should be selected. This will give the sufiferer the opportunity and incentive to devote a very considerable portion of his time to a study of his speech. Cases would be kept here for periods varying from a month to a year, until entirely corrected. 151 PARENTAL AND BROOKLYN TRUANT SCHOOLS John S. Fitzpatrick, Principal BUILDINGS The New York Parental School is located in Flushing on a farm of 107 acres. There are at present five building's, three dou- ble cottages provide accommodations for 216 boys. The power house contains the light, the heat and the ice plants, the bakery, the kitchen and the laundry. In the administration building are six classrooms, the auditorium, the gymnasium and the following shops : shoe, printing, plumbing, carpenter, tailor and wood work- ing. The latter building and the power house are connected by a subway, through which entrance is obtained to each cottage. Through the subway the meals are conveyed by means of trucks carrying thermos utensils. At the Brooklyn Truant School, Jamaica Avenue and Enfield Street, there are about 14 acres of land. The buildings are old and beyond repair. The buildings and the equipment are unsuited to the care of truants. PHYSICAL AND MEDICAL EXAMINATION The day the boy enters the school he is given a thorough phys- ical examination, first by the resident school nurse and then by the visiting physician. A careful record is kept of the physical condition of each boy. If necessary a course of treatment is pre- scribed, special attention being given to diet, medication, physical training and out-door life. Minor operations are performed when necessary at the local hospitals, and boys are also treated there for eye and teeth trouble. The proof of the physical fitness of the boys was manifest dur- ing the last two epidemics of influenza which visited every part of the United States. Owing to the previous clean, regular living and rigid quarantine at once established at the outbreak, not one boy in the Parental or the Brooklyn Truant School developed in- fluenza. 152 DAILY LIFE The daily life of the boys at the Parental School is one of in- tense activity. The bugle sounds reveille at 6 A. M. In 20 min- utes every boy has had a shower bath and is ready for the day's work. Breakfast is served at 7.00. From 7.45 the boys enjoy free play until the call to assemble for military drill on the campus at 8.15. After drill the boys fall-in to march to school and shops. From 9 A. M. until 4 P. M., excepting the dinner interim, 12 to 1, they are divided into alternating groups, A and B. A group is in the classrooms three hours in the morning and B group in the shops and vice-versa in the afternoon. GRADE WORK Truants are committed from many different schools in the five boroughs. They are admitted to the same grade they attended in the elementary school. The pupils are grouped by each class by subjects, and in each subject according to ability. The teachers ascertain the knowledge each boy has in each subject and this knowledge is used as the basis of the new work. One of the chief aims of the schools is to have the boy feel that he is among those who understand him and are trying to teach and help him to have confidence in his own ability. Having once established this condi- tion, the teacher is able to inculcate new habits, namely, appli- cation, industry, honesty, politeness and obedience. At first they are given work they are well able to do, so they gradually become interested and apply themselves and their progress is marked. The school as a whole is grouped as follows : (a) Pupils who,- when paroled, are to return to the elementary schools. (b) Pupils eligible for emplojanent certificates. (c) Pupils over age and below grade. (d) Pupils who may graduate. The grade work is also planned to meet the above conditions. Forty-three boys were graduated from' the Parental School since September, 1917. Regular elementary school diplomas were accorded and the boys are designated as graduates of Public School 70, Queens. 153 ACTIVITIES AND PRODUCTS PRINTING Upper grade boys are assigned to- the printing shop in two groups of 12 to 15 boys each. The boys and one instructor do from $3,000 to $5,600 worth of work each year for the Board of Education. The printing class is noted for the excellent quality of the work done and the promptness with which orders are filled. THE BAND The reputation of the band rivals that of the printing class. The band is self-supporting". During the past three years it has furnished music for Liberty Loan drives, the Red Cross, draft send-ofifs, welcome home receptions and the June festivals of the public school kindergartens. From both the printing class and the band, boys are assured of good positions. THE TAILOR SHOP Winter and summer uniforms, gray and olive drab respective- ly, are supplied for use in the Parental School. The uniforms are made by the school tailor, assisted by assigned boys. In the shop boys are taught to mend and care for their outer garments. THE SHOE SHOP The work done in the shoe shop is of great value ; not only does it teach the boys a useful and economic trade, but shoes which have apparently gone beyond repair are torn apart, the worn parts thrown aside, good pieces substituted, and very good shoes finally derived. WOODWORK The value of manual training is exemplified by the interest and proficiency shown by the boys in the manufacture of models for furniture, household implements, toys, airplanes, etc. REPAIRS Most of the repairs in and about the building are done by the plumber and the carpenter, assisted by selected groups of boys. 154 THE LAUNDRY All the laundry work for the Parental, the Brooklyn and the Manhattan Truant Schools, the Board of Education and several departments is done at the Parental School. THE BAKERY The Parental School bakery not only makes its own bread and pastry, but also supplies the Brooklyn and the Manhattan Truant Schools. THE FARM Sixty-five acres of the school property are cultivated. Enough vegetables are raised to feed the employees and the boys at the Parental and the Manhattan Truant Schools throughout the year. All the boys participate in some form of farm work under the supervision of experienced farmers. The anemic type of boy is assigned permanently to farming of the lighter kind during his commitment. The plentiful supply of fresh green vegetables in their diet aids materially in the physical upbuilding of the boys. PHYSICAL TRAINING During the past two years there has been a resident physical training instructor at the Parental School which accounts for the manifest improvement in the carriage, posture and general health of the boys. The work consists of military training, formal gym- nastics, athletics, free play and organized games. Selected boys are drilled for exhibition work for assemblies and entertainments. A World Meet is held each year. Inter-cottage series are played in baseball, basketball and hockey. Baseball and basketball games are played with teams from local elementary schools. LECTURES Lectures, motion pictures and entertainments are given Sat- urday evenings. Plays are loaned by the leading film companies. RELIGION Representatives of the local Jewish. Catholic and Protestant religions visit the schools regularly to instruct the boys of their respective denominations. ISS THE BROOKLYN TRUANT SCHOOL The younger truants are sent to the Brooklyn school. They attend school five hours daily. The classes are small and the grade work is excellent. The manual activities are limited due to the equipment. The boys receive instruction in woodworking and basketry. Small groups of boys help on the farm and on the lawns. Special attention is given to physical training. Since April, 1917, the Brooklyn Truant School has been in charge of Mr. W.-Tully Bascom, who has rendered excellent ser- vice. RECOMMENDATIONS 1. That the Brooklyn Truant School be closed and the prop- erty turned back to the city. 2. That money should be appropriated and the contracts awarded for the erection of the following buildings at the Parental School for which plans have already been drawn: cottages to accommodate 300 boys, a home for the principal whose apartments now occupy much needed space in the administration building, an infirmary, a barn, a hog pen and a hennery. 3. That boys should be kept in the Parental School at least eight months. 4. That the following boys should be sent to the Parental School : (a) All truants in the seventh and eighth grades. (b) All truants fourteen years old and older. (c) All candidates for employment certificates. 5. That the following boys should not be sent to the Parental School: (a) All truants under twelve years old. (b) All truants below the 5A grade. 6. That the minimum commitment age to any truant school should be nine years. The following tabulation shows the boroughs and the number of the different schools from which the 220 boys in the New York Parental School and the 120 boys in the Brooklyn Truant School, June 30, 1919, were received : 156 Parental School Borough No. of Schools Manhattan 47 The Bronx 13 Brooklyn 54 Queens 10 Private 9 Brooklyn Truant Manhattan 28 The Bronx 7 Brooklyn 41 Queens 7 Private 4 No. of Boys 82 21 89 19 9 49 7 49 10 5 COMMITMENTS The number of truants committed to (1) the New York Par- ental School, (2) the Brooklyn Truant School, during the school years 1918-19 and 1919-20, is shown by the following table : Number of children in school, July 1 Number first committed di- rectly, between July and June 30: By director. Bureau of Attendance By Court 22 Number returned on broken parole from July 1 to June 30 Number returned from other truant" schools Number returned from hos- pitals Total number received.. Number paroles from July 1 to June 30 Number discharged from July 1 to June 30 Number transferred to other schools (1) 1918-19 214 1919-20 207 (2) 1918-19 1919-20 132 116 173 246 123 136 ■195 15—261 16—139 12—148 34 7i 63 43 171 130 103 51 20 5 1 1 634 676 438 359 269 336 198 184 71 53 32 12 58 56 71 38 207 229 11 6 12 12 206 215 ?18-1S (2) • 1919-20 20 1 5 322 116 239 120 157 (1) 1918-19 1919-20 Number transferred to N. Y. Catholic Protectory 7 7 Number transferred to hos- pitals 22 6 Total Number on register July 1 . . Number graduated, January. Number graduated, June.... Average daily attendance. . 206 215 118 119 Value of the Productions 1918 1919 Laundry $13,782.87 $20,277.61 Bakery 12,970.68 14,249.75 Farm 8,648.84 9,211.26 Tailor 2,000.00 2,344.00 Plumbing 656.40 1,033.85 Printing 5,601.75 4,605.25 Carpenter 1,794.25 1,684.83 Shoe Shop 2,054.43 2,086.05 Ice Plant 2,500.00 Engineer .' 600,00 650.00 Total $48,109.22 $58,642.60 158 MANHATTAN TRUANT SCHOOL Mary K. Leonard, Matron -Superintendent The activities of the Manhattan Truant School, which is of mixed grades, are divided into common branches, grades lA through 6B, shop work and physical training. The subjects taught in common branches embrace arithmetic, history, reading, spelHng, grammar, composition, Hterature, pen- manship and geography, two teachers dividing these subjects be- tween them. In the shop, under the direction of one teacher, the following articles are made by the boys, viz. : Morris chairs, tabourettes, knife boxes, letter boxes, picture frames, pen trays, bread boards, sleeve boards, etc. In addition, basketry, chair caning, free hand drawing, lettering, sketching and sign painting are taught. One hour and a half daily is given to physical training with apparatus work and military drill, this under the supervision of a physical training teacher. Physical examinations are conducted at various intervals. We aim to make the health, cleanliness and hygiene of the children im- portant factors in their care, and we have been fortunate during the year 1919-1920 in having no cases of illness in the school. The number of admissions during the period July 1, 1919, to May 31, 1920, were 316 boys. The maximum capacity of the school at any one time, however, is only about 50 or 52. The commitment of a boy for violation of the Compulsory Education law is for two years, but the duration of his stay at this school is usually limited to five months, after which he is paroled, provided his conduct and progress warrants it. 159 REPORT ON PROpATIONA*RY SCHOOLS 1918-1819-1920 P. S. 120, Manhattan, Olive M. Jones, Principal P. S. 61, Brooklyn, Lucille Nicol, Teacher-in-Charge P. S. iT 1 Manhattan, Hazen Chatfield, Teacher-in-Charge ORGANIZATION The probationary schools are organized for the purpose of taking care of truants, deHnquents, over age and backward pupils as v^ell as those who, for some special reason, the principals or district superintendents consider are in need of special help. Public School 120, Manhattan, and Public School 61, Brook- lyn, admit about 300 boys within a year. Public School VJ , Man- hattan, was organized February 5, 1919, and it is impossible to say how many boys it can accommodate annually. When the school was organized six teachers were appointed, and boys were transferred from other schools by special order of the district su- perintendent. They were admitted a few at a time, so that each one might be tested and his needs studied. Retarded boys were given every opportunity to catch up in their grade work. Public School 120, Manhattan, takes boys from the district below 14th Street. Public School 61, Brooklyn, takes boys from nine districts and 69 schools. Public School 37, Manhattan, takes boys from Districts 10 and 11. One of the difficulties of these schools are the constant changes — admissions and discharges occurring daily. Discharges are usually given for the following reasons : Labor certificates. Over age. Returned to schools. Committed to institutions. Physically incapacitated (very few). Out of city (removal). Suspense list (boys who run away and cannot be located by Bureau of Attendance). Graduates. In reference to the above, Miss Jones, Public School 120, re- ports that the two years, 1918-1920, have been unquestionably the 160 most difficult years in the history of the school. The number of applications for admission has been greater than ever before, and the boys have been harder to manage. They presented many new and more difficult problems than even those we had to face in the first years of the school. The parents were even more difficult than the children to deal with, and in very few instances did the parents give willing co-operation except in cases where the boys had been in school for a long time. The ease with which boys obtained employment and the unusual sums of money they could earn made the task of keeping them in school almost impossible. Another difficulty which complicated the problem in Public School 120, was the discontinuance of the evening session. It was impossible to find additional teachers to do this work, and ex- perience has demonstrated that the teachers serving during the day cannot successfully do the evening work as well. In conse- quence, we lost our hold on the boys at night. In previous years they had been accustomed to coming to the school tO' read, study, work up in the subjects in which they were backward, and play. Lacking this opportunity, they went to the moving picture houses, to poolrooms, and became the prey of gangsters of whom there has been recently a larger number than in a number of years be- fore in this neighborhood. Miss Nicol, Public School 61, reports that during the time covered by this report. 27 boys graduated. Of these graduates, 12 were discharged and went to work; 15 entered junior high school, vocational school or high school ; seven are still there, the other eight having left and gone to work. The number of boys sent to institutions from Public School 61 has shown a decrease each year, although the register of the school has shown an increase. In 1918 (the year of the war) 21 boys out of 213 (9 per cent) were committed to corrective in- stitutions. In 1919, out of 305 boys, only 10 (3 per cent) had to be committed to institutions. September, 1919. to date, eight boys out of 286, 29 (10 per cent) had to be sent away. Since most of the boys sent here are "on their way to institutions" we note with pride the decrease. It is clearly evident that laws are badly needed fixing the re- sponsibility of the parent. The desire to shift responsibility and 161 get rid of the boy until he is able to earn his own living should be more carefully investigated. In the desire to "make money,'' especially since the war, children are given little or no super- vision. CAUSES OF TRUANCY AND DELINQUENCY From a careful study made of causes of truancy and delin- quency in Public School 61, through the reports of the visiting teacher, the following facts have been gathered : Causes — Lack of parental control, 45 per cent; incorrigibility, 3 per cent ; truancy, 7 per cent ; over age and unwilling to be in class with younger boys, 9 per cent; frequent change of residence and school, 12 per cent ; hoys whose principals claim are motor- minded and who need special individual attention, 3 per cent. These causes overlap and it is difficult to make a line of demarca- tion. Sometimes several causes apply to the same case. Where truancy and incorrigibility have been cited as causes, it refers to cases where parents have co-operated with us and failed. The 21 per cent delinquency is largely due to lack of parental control and bad associates. A study of nationalities in Public School 61 shows the follow- ing : Russian, Polish (Jewish) .58 per cent; Italian, 24 per cent ; colored, .06 per cent ; American, .039 per cent ; German, .037 per cent; Irish, .02 per cent; Polish (Catholics), .015 per cent; French, .006 per cent. Public School 120 reports that 83 per cent of the boys need physical care. The difficulty is not with the securing of the ex- aminations or the diagnoses. The trouble is in securing the care and treatment after diagnosis is made. Furthermore, the physical care should be given years before there is any question of the boy's physical condition upon his work in school, his securing of an employment certificate or his success in employment. One of the greatest needs for probationary school work is the enactment of some law making compulsory upon the parent the consent to necessary medical care and of some law making provision for the school to secure such care. 11 162 PHYSICAL DEFECTS HEALTH HYGIENE In Public School 37, Manhattan, by special arrangement with the Board of Health, Dr. Hyams made a careful physical exam- ination of each entrant. The summary follows : DEFECTS General defects 130 boys Vision 55 Hearing 13 Nasal breathing 29 Hyp. tonsils 29 Malnutrition 89 Cardiac 10 Orthopedic 7 . Nervous diseases 5 Defective teeth 109 Total number of defects 346 Total number examined 216 The foregoing tabulation reveals an appalling degree of physi- cal deterioration. It is quite obvious that these various ailments furnish an excuse for absence if not a real reason for truancy. Poor vision, malnutrition and defective teeth are positive handi- caps which account for retardation, irritability and bad conduct. These defects can only be remedied with the greatest difficulty. The boys are ashamed to wear glasses, they choose their own food and they fear the dentist. Little is accomplished by appeals to the home. In most cases the boys defy their parents, and are more obedient in school than out of it. Parents have no time to take their children to after-school clinics. When sent alone the boys often get into trouble and are kept waiting until the last. Whenever there is assurance that a boy will follow directions he is given a pass to visit the clinic during school hours. At times it has been necessary to send a teacher with them or escort them in person. Public School 61 reports that the self-respect of the boys has been increased by the emphasis placed upon personal cleanliness. A system of daily inspection has been introduced with ratings, and the boys show a decided improvement. Clean faces and hands, clean shirtwaists, neckties and polished shoes have given the boys a changed appearance. 163 164 The school nurse reports that every boy in the school has been examined by the doctor upon his first visit after the admission of the boy. With very few exceptions, those suffering from hy- pertrophied tonsils, adenoids, eye, ear or nasal defects and de- fective teeth are either under treatment or have had their defects remedied. A dentist (a member of the Local School Board) has given our boys in very needy cases prompt and effective treat- ment. The teacher of physical training reports an average gain in height of two and three-cjuarter inches, an increase in weight of approximately five pounds, and an improvement in posture of 30 per cent. SCHOOL LUNCH Another problem with which the probationary schools have to contend is the lunch problem. The boys in these schools usually live too far away to permit them tO' go home to lunch. No boys in Public School 120 or Public School 61 go home at noon, and only a few in Public School Z7 . Each school handles the problem to meet its individual needs. In Public School 120 the lunch problem has been carried on in four ways: (1) By a teacher sent by the director of cooking, giving the boys helpfully illustrated talks on food value. (2) By the teacher in charge of the physical training in the school who measured and weighed the boys and led them to see the re- lation between their physical condition and their eating habits. (3) By the teachers in charge of the lunch service, who co-op- erated with the two teachers just mentioned, supervised the quan- tity and kind of food and induced the boys to eat more nutritive food. (4) Communications to parents in regard to needs of the boys. The teachers report a greatly increased demand for foods containing milk and clear milk foods which they would scarcely touch previously. In Public School 61 a canteen run by the boys was inaugurated in September, 1918. The boys have developed splendid business ability. They not only sell the things, but buy the supplies. They furnish, at a nominal cost, milk, cocoa (in cold weather), fruit in season, crackers, sandwiches (tongue, ham, corned beef, cheese). Theyjcook the ham and tongue theniselves. The following things 165 are cooked and prepared by the boys : Soup, buckwheat cakes, pancakes, beans, apple fritters, banana fritters, frankfurters, spaghetti, French toast, stewed prunes, apricots, etc. Candy is no longer sold. There is no demand for it. Cooked fruits seem to take its place. The menu changes daily. Each boy who joins the canteen (those who run it) invests $1.50. The average sales have increased from $4.50 per day to $7.75. Dividends are paid at the end of each term. The boys keep account of their expenses and income and receive much practical training in cooking and business methods. They have bought their own cooking utensils, furnished a new table with iron stands, and presented a set of silk Allied flags to the school. In Public School 7)7 a lunch service was inaugurated in Decem- ber, 1919, to provide those boys who live at a distance of ten blocks or more and to make an attempt to reduce malnutrition. Hot cocoa and crackers were served to each boy who was able to pay 5c. for them. A seat at the table was also provided for each boy who brought his own lunch. In March, through the co-opera- tion of the Park Community Council, the serving of regular lunches was begun. Soup or cocoa, sandwiches and dessert are furnished daily for 10c. per person. From 50 to 100 boys avail themselves daily of this privilege. Parents of underfed boys were urged to pay 50c. per week for tickets. The results are encourag- ing. The chairman of the Food Committee of the Park Com- munity Council, purchases all food, hires and pays the cook, and aids in preparing the lunches. A teacher sells the tickets, super- vises the setting of the tables, and looks after the school property. The lunch service is not self-sustaining. SCHOOL BANK Public School 61 has a school bank, the report of which is as follows : The bank was organized December 7, 1916. Amount deposited since organization $595.18 Amount deposited September, 1919, to date 125.21 Balance in bank 154.29 There are 134 active accounts. The books, drafts, and all material for the bank are printed by the boys. The accounts are kept by the boys. 166 GARDEN Public School 61 has a garden in a vacant lot adjoining the school but not school property. It has been in operation five years. In the spring of 1919 peas were planted and in a year when peas failed the crop was 68 quarts. During the summer of 1919 the garden was kept up. It was considered one of the best gardens in Broolclyn and was visited until November. The crop yielded 132 quarts of beans, 20 bunches of radishes, 200 ears of corn. The boys also took care of the lawn. Asters were planted and added much to the appearance of the school. The garden will be continued this spring and through the summer. AFTERNOON RECREATION CENTERS Each of the schools has an afternoon recreation center. The one in Public School Z7 was discontinued owing to the small attendance. This was due to the fact that so many boys work after school and live at a distance from the school. In Public School 61 the attendance of the boys was not variable, as many of them worked, but as it was the only center, boys from neigh- boring schools came in and thus increased the attendance and interest. There is every reason to believe that these boys are subjected to unusual temptations after school hours — smoking, gambling, and illegal employment, and that competitive games would be helpful. It is a difficult problem as attendance is not compulsory. S. p. C. C. ANNEX The institutional classes in S. P. C. C. are an annex to Public School ZT . There are five classes. The rooms are small, the registers fluctuate, organized class instruction is carried on with great difficulty. In June, 1919, the roof playground was in use under the direction of an afternoon recreation center teacher. The girls had two afternoons a week, boys three. Funds for this were denied in 1920. Inasmuch as these children are denied their freedom twenty-four hours a day, it is not unreasonable to de- mand that they be given every opportunity to play in the open air. Since organized play is necessary for their protection and safety on a crowded roof playground a trained recreation center teacher should be put at their disposal every afternoon. 167 SHOP WORK Shop work is carried on in all three schools. Public School 120 and Public School 61 each have one shop, while Public School Zy has two. The difficulty encountered is to furnish varied models within the intelligence of these boys. The older boys make furniture and articles for use in their homes. Manual training is quite a feature in Public School 61 where it is co-ordinated with the work of the shop and drawing and design. This work is practically self-supporting as most of the things made in it are made to order, the boys furnishing the labor and the people interested in the school, the materials. This has given the boys practical, business training in that the boys not only made the things but delivered them, made out bills, receipted these and filed the receipts for delivery. The principal's office has been fitted by the boys with settees, copper book ends, letter rack and pen tray, runners (stencilled) screens, couch cover, costumer, umbrella stand. The activities include upholstery, bead work, metal work, weav- ing, cobbling, book binding, tray making, reed and raffia, cretonne novelties, etc., etc., stencilling, sign printing and poster making. The drawing and design has been more practical than ever. Tin cracker boxes from the canteen (not returnable) were painted with designs and made fine cake boxes. Designs were made for book ends. Stencils were made for curtains and run- ners and signs and posters made for fairs and neighborhood events. Public School 120 made a number of articles for the Red Cross and for former pupils of the school in the Army and Navy. The usual Christmas gifts were made and sent to Beth Israel Hospital and Gouverneur Hospital. PRINTING Public School 61 has a small printing press, the gift of one of the teachers. On this the boys have printed programs for the schools in the neighborhood and for various club affairs, tickets, small booklets and pamphlets, and various circulars for associa- tions. In addition to this the boys have printed all the cards for use in the school and various things for the district superinten- 168 dent. During the past two years 242 jobs have been turned out on the press. Public School yj has the press and printing equipment for- merly in Public School 30, the Bronx. It has been in use since December, but the press, which is made to run by motor, has not yet been completely installed. It cannot be used. SHEET METAL SHOP Public School Z7 is equipped with a sheet metal shop. It has been in operation since November. Up to the present time the gas stoves have not been connected. A temporary arrangement had to be made. BUSINESS METHODS A brief course designed to prepare the boys for work is in every school. Public School })7 has typewriters for this course. In Public School 120 this was begun in 1909. It was designed to fit the boy for his first "job" and make possible his advance- ment. Poster making and sign printing are included. The signs are used in the neighborhood by small stores and push cart workers. In Public School 61 it is used to supplement arithmetic and English and includes sign printing, business letters, bills, receipts, checks, inventories, money orders, telegrams, etc. The canteen and bank add much to the practicality of the work in Public School 61. Here, too, the boys are receiving, checking, and distributing supplies as part of this training. 10,000 circulars and 50,000 booklets and circulars were folded and placed in en- velopes for E. N. Y. Savings Bank. This community service is helpful in gaining the respect of the neighborhood for the school. ACADEMIC SUBJECTS English, arithmetic, history, geography, civics, etc., are also included in the curriculum; arithmetic is a very difficult subject for these boys. History and civics are featured because of the need for it with boys who have little respect for law and order. The teaching of history in Public School 61 has been made more interesting by means of a radiopticon. This was purchased from the Wertheim $100 prize which was won for selling W. S. S. 169 The boys also subscribe to Current Events. The radiopticon also proves of value in geography, as well as the Geographic News Bulletin which we receive monthly from Washington. The boys compete for a history medal yearly, the Daughters of the Revolu- tion giving the topic. Civics was especially emphasized in Public School 120 by assembly talks by the principal and invited guests, in addition to extra time given to it by every teacher. PHYSICAL TRAINING Special attention is given to this in all the schools for the train- ing in attention, inhibition and response. Many of these boys do not know how to play a fair game. This training is essential and is of great moral value in a school of this type. VISITING TEACHER Public School 61 has a visiting teacher furnished by the Alli- ance of Women's Clubs of Brooklyn. She has proved very help- ful in reporting home conditions, getting help when necessary and following up the boys after they leave. SUGGESTIONS The buildings in which the probationary schools are located are all old and unsanitary. Public School 120 is the poorest of the three. This school needs additional shops and gymnasium space, and either a new and enlarged building or an addition built to the present building. Public School 61 is handicapped by the size of the building. The printing press which was sent from Public School 23 is still there as funds for its removal are not available. Typewriters are needed for the business course. The report from that school asks for a more liberal supply of funds for supplies. Psycho- logical tests would prove very helpful but the prices are pro- hibitive with the present allotment of money. Public School 37 requests shower baths. A request is made here also for individual psychological tests. Every boy admitted to these schools should be examined physi- cally and mentally. It is only in this way that the problem can be intelligently attacked. 170 VISITING TEACHERS FUNCTION AND REQUIREMENTS An interpreter has to understand two languages ; so the visit- ing teacher, with her two-fold function of interpreting the school to the home and the home to the school must have had the train- ing and experience of both teacher and social worker. Having met the classroom problem, she is able to explain to the parent the child's school difficulties. Through her experience- in social work, she is able to grasp and adjust the needs of the home. Thus she brings about the double co-operation of the home and school for the benefit of the child. The requirements for visiting teachers are: Either (a) (1) Graduation from high school or an equivalent education, and five years' experience as visiting teacher approved by the Board of Examiners, or (b) (1) Graduation from an approved college, or from an ap- proved normal or training school, and (2) at least one year of successful experience in teaching, and (3) one year of pro- fessional training in social work including case work satisfac- tory to the Board of Examiners, or two years of experience as visiting teacher under supervision approved by the Board of Examiners, or two years of social case work under super- vision approved by the Board of Examiners. These requirements represent a minimum only. Many cases of children and parents present problems of mental maladjust- ment, so that it is highly desirable, if not indispensable, that the visiting teacher have some understanding of psychiatry or psycho- analysis. Abundant tact, child study, and knowledge of human nature will contribue largely to her success. ASSIGNMENT AND SUPERVISION Each visiting teacher is under the supervision of a district superintendent, who assigns her to schools in his districts. The six visiting teachers are assigned as follows : 171 Jessie L. Louderback to P. S. 15, 36, 61, 64, 188G, Manhattan. Margaret A. McGroarty to P. S. 78, 102, 159, Manhattan. Kathryne E. Manley to P. S. 109, 149, 165, 173, Brooklyn. Dorothy Brown Knote to P. S. 40, 60, 82, 124, 172, Brooklyn. Cornelia L. Swinnerton to P. S. 3, 30, 43, The Bronx. Christine Schaefer (resigned Dec, 1919) to P. S. 5, 32, 45, The Bronx. Former teachers of German assigned temporarily as visiting teachers. Flora Goos to P. S. 18, 27, 59, Manhattan. Pauline G. Margolies to P. S. 30, 109, 121, 150, 151, Manhattan. Emilie Nida to schools in Districts 8 and 13, Manhattan. Louise Larsen to P. S. 1, 72, 83, 86, 89, Queens. Average number of case's for year by each visiting teacher 675 Average number of calls at homes for year 1200 Average number of miscellaneous calls fnr year 270 Each visiting teacher has a schedule of definite times and days for calling at her several schools, arranged to suit her locality. Upon calling at a school she receives new cases from the principal or assistant to principal. A sample of the record card used is •reproduced here. Name of child - Residence._. Reported by _ VISITING TEACHER'S REPORT Bor..... P. S Grade Case No.. Date of Birth Place School Record When admitted..,. Effort Proficient in. Deficient in. Conduct Absence. „ Grades repeated.... Heauth Recoiu) Personal History. Out of School Activities Home Conditions ..Father's Name _ Occupatic ..Mother's Name.„ - Occupatic ..Other Children..-.. .Ages 172 VISITING teacher's Special Difficdlties REPORT — Continued Agencies InteHested " Action Taken D»™ __ - - . Result ' ■ , Vitilivg Teacher. She confers with the classroom teacher over the child's special difficulties for in order to present the matter effectively to the parent she must have a detailed record. Frequently she inter- views the child also in school. All important action taken is recorded on the card with the date of entry, and when not in use this card is filed in the school. After interviewing parents at home or in the shop, or in the evenings when necessary, the visiting teacher reports back to the principal and teacher whatever may help them in understanding the child. She may also think best to interest or consult social agencies in the matter. A case is followed up till an adjustment is made, but in the stress of work, revisiting has to be a matter of discretion. A monthly report, a sample of which is here reproduced, is sent in duplicate to Associate Superintendent Edson and to the Dis- trict Superintendent. An annual detailed report is also sub- mitted. 173 DEPARTMENT OF EDUCATION THE CITY OF NEW YORK MONTHLY REPORT OF VISITING TEACHER Borough District Schools Month I. Scope of Work. Number of cases held over from preceding month.... Number of new cases Number of cases closed Number of cases reopened Number of visits to homes Number of homes visited twice Number of homes visited more than twice Number of miscellaneous visits II. Classification of Causes. Irregular attendance Lateness Poor scholarship Home conditions Poverty Health Conduct III. Preventive and Helpful Agencies. Mothers' clubs .| ........ Charity organizations Hospitals Society for Prevention of Cruelty to Children Department of Health Children's Court Other organizations IV. Interesting Cases (two or more cases in some detail on attached sheets). V. Comments. (Signed) Visiting Teacher. Address Date 19 Borough (Signed) District Superintendent. This blank to be sent in duplicate, at the close of each month, to the District Superintendent, who will forward one copy to Associate Superin- tendent Edson. 174 SUMMARY OF ANNUAL REPORTS Cases referred to the visiting teachers may be explained under the following groups : Poor scholarship, which includes children who are deficient in lessons, repeating grades or in danger of doing so, or suspected of feeblemindedness. Conduct, which means not incidental misbehavior but that which is unusual or peculiar, or misconduct which might become habitual ; conduct out of school causing complaint or suspicion of morals. Home conditions, which require investigation for neglect, poverty, misfortune, morals, cruelty, improper guardian- ship, lack of co-operation with the school, etc. Attendance, especially those children asking for working papers, or children graduating who should be allowed to attend high school. Lateness and intermittent attendance due to home conditions which require special adjustments or advice with parents. Health, which means special physical defects, not nurses' cases, but children requiring special diagnosis at a clinic, or a class for the physically handicapped ; also neurotic, tem- peramental, and mentally peculiar children. As most of the cases this year have come under the first four headings, these will be taken up in some detail. MALADJUSTMENTS IN SCHOLARSHIP Children deficient in lessons or repeating grades are often so analyzed and adjusted that thereafter they make normal progress. Some children are deprived of time to study by working after school in the parent's shop, or illegally for a merchant, or are doing "beadwork, or finishing" at home till late hours. The visit- ing teacher shows the parent how to manage without the child's assistance, or if there is financial strain, she secures relief. She points out to the parent the harm he is doing the child, and her 175 suggestions are usually accepted, for the parent naturally wishes to do the best for his child. The child who fails may be deceiving his parents about his class standing, or he may state that he receives no report card or has no home work. Many parents do not understand the ratings and believe the false interpretation of the child. The visiting teacher when bringing the child's failure to the attention of the parent also shows him how to avoid such ignorance in the future, and how to keep in touch with the child's progress. Many studious children prepare their home work, but have such lax methods of study that they dawdle for hours over les- sons that should consume an hour. They may have poor habits of attention or concentration, or study in the midst of family chatter and confusion. The visiting teacher suggests better meth- ods of study, regular hours for work, and greater concentration, so that the child not only forms good habits, but has time for recreation, helping mother, and sufficient sleep. The visiting teacher finds many children who, through dis- couragement from their inability to keep up with the class, have formed the habit of failure. A special disability may have caused the child to lose interest. Personal influence, motivation, locating the cause of failure and pointing a remedy, obtaining a little ex- tra help at the critical time, are all means used by the visiting teacher. Older brothers and sisters, big Sisters, or the teacher, when she has a spare moment, will help the visiting teacher on such a problem. ILLUSTRATIONS Willis was an over age backward boy who never prepared lessons and was always in trouble. He told his teacher he had to work on a delivery wagon after school because his family was poor. The mother told the visiting teacher they were poor; but not satisfied that the economic pressure was so great, the visiting teacher called at an hour when the father was at home. He told her willingly how much he earned, and how anxious he was to have all his children graduate from school. Willis did not have to work, but had given his father the im- pression that he had no home study. We stopped his illegal employ- ment, and had him prepare home work. The school had a different attitude toward Willis, and his conduct and scholarship improved. 176 Pauline was not only deficient herself but was jeopardizing the dis- cipline and progress of the 8B class. She would exclaim, "I can't write," or "I can't do arithmetic," or "I can't sew, I just can't!" and she seemed firmly to believe in her own impotency. I called at her home to get light on this hysterical condition. The mother was almost blind, and Pauline was evidently overwrought by study and housework. I suggested simplified housekeeping and other changes that would tend to keep her from a breakdown. But from the mother I drew out the fact that the child had a presentiment she would not graduate, and dreamed and talked of failure in her sleep. Knowing that she had natural ability I reassured her by promising to talk over her difficulties with the teacher. The teacher showed her how to overcome her diffi- culties. The "can'ts" vanished, she began to improve, and graduated with her class with no recurrence of the hysteria. The visiting teacher takes advantage of mental tests in deciding what recommendations to make for the child who is not getting along. She takes into account besides the intelligence, the history, environment, age, and emotional tendencies of the child. Children are often recommended for the Manhattan Trade School, or vo- cational training, examination for ungraded class, or rapid ad- vancement. The following is an illustration : William, ten years old, was a special case given to me by the district superintendent in December. He had been one year, nine months in 4A owing to one thing or another. He had broken some glass and was therefore a court case. He had just been expelled from school for furious outbursts of temper. I gave him a psychological test and found he had an intelligent quotient of 140. With this information I accompanied him to the Children's Court, and when the judge asked me for my recommendations, I suggested that he be tried out in a 5A. Therefore the judge sentenced him to harder intellectual work, and suggested he be tried out as I had recommended. William was then entered at a new school in 4B-5A rapid advance- ment Terman class in January and at the end of April it was very in- teresting to me to learn that he had been elected class president by his classmates in spite of his ragged elbows, and that at a Trabue writing test as well as in geography and arithmetic he excelled all other chil- dren in this selected bright group. His mother is so delighted with the change in her boy that in spite of her poverty she gladly puts up his lunch and gives him his daily carfare. He has consistently main- tained the high record for scholarship and deportment that he gained the first day the change was made. The visiting teacher in the new school took up the work where I left it. 177 CONDUCT AND PREVENTIOTST OF TRUANCY The bad conduct of many children is traceable to faulty home training or no consistent training. The visiting teacher, in show- ing the parent better methods, also helps to prevent the recurrence of trouble with the younger children. Faulty hygiene, congenital neurosis, association with a neurotic or high-tempered member of the family may afifect the child's disposition. Physical and psychological examinations throw light on obscure cases. The visiting teacher does preventive work with children who show a tendency to do wrong or associate with evil companions. The class teacher discovers such tendencies of the mother appeals to the school for help. The visiting teacher obtains a change of occupation or interest, suitable recreation, directed reading, but above all personal influence and careful follow-up work are needed. The time so spent is well repaid in child saving. She may ask Big Brothers and Sisters to assist. Extreme cases are referred to the S. P. C. C, whose help has been most effective in ridding the neighborhood of evil influences and bad characters. ILLUSTRATIONS Jacob, 13 years old, in 8A, was reported as "D" in conduct, can do his work but is making little effort." Mother had been sent for with- out success, and so the child was referred to the visiting teacher. When the mother heard the reason for the call, she exclaimed, "I know all about him! I can't help it. He's just a bad boy; send him away. I don't care." I encouraged her to tell me her troubles. She was not well ; business was not prosperous and she had helped her husband in the store as much as her health would allow, and the boy had been unintentionally neglected. He was getting no ethical training because he refused to remain at home and receive his lessons from the Rabbi. He had lost a book from the library which had to be paid for, con- sequently he was forbidden to read. Being naturally fond of reading he spent all the pennies he could save on "Nick Carter," as these books could be' procured second hand for a few cents. He was not allowed to join the Boy Scouts as "they could probably take him for a soldier." Altogether everything he liked seemed to be prohibited. After school he went to his father's shop to help. When everyone else was asleep he withdrew his books from their hiding place and read; consequently in school the next day he was not a promising pupil. 12 178 The mother accepted most graciously the changes in treatment sug- gested by the visiting teacher. She promised to allow the boy to join the Boy Scouts, and to draw books from the library. The teacher gladly suggested a list of books that would help with his studies. He had "A" next month and was promoted that term. There was no fur- ther complaint. Frequently the mother insisted the advice was worth a hundred dollars to her, as she had been most discouraged and des- perate. In a congested part of the city, Lucy was losing her interest in les- sons and coming late to the afternoon session, offering as excuse that "mother was sick," but her classmates whispered to the teaclier that she was talking to boys on the .'■treet. The visiting teacher learned from the bed-ridden mother that Luc\' had changed since coming under the influence of a playmate, Elsie. Lucy's father was insane, and her brother an invalid, and from this dreary home-atmosphere Lucy es- caped at 3 P. M. to go no one knew whither till she came home at 11 P. M. The visiting teacher saw the necessity of getting acquainted with Elsie, and went to her school. Elsie had an enviable record for re- peating grades, half days' absence, and poor conduct. The visiting teacher took this record to her home and questioned the parents. They were aware that Elsie had been left back and that sometimes she had been absent from home as well as from school ; but they had been unable to find out where she spent her time. The visiting teacher was not content with her explanation that she went "no place," and finally, by careful probing based on a study of the record card showing at what date she began to go wrong, got the information she was seeking. She sent for the Children's Society, and shortly they had under arrest the man who had lured Elsie and her friends to his rooms for no good purpose. He was convicted and sent to jail for "impairing the morals of youth." The visiting teacher kept these children under her care, looking out for their recreation and companionship as well as for their les- sons. Lucy became at once, when her friendship with Elsie was broken, a better student at school. Her mother lived to see her become again her faithful nurse and housekeeper. Elsie, because her habits of de- linquency were stronger, needed careful supervision at home and school. But the home co-operation was secured and she goes "no place" now that is not accounted for. Her interest in school is aroused so thai she is making progress. Her character is developing slowly, good points long dormant showing in her changed attitude. 179 HOME CONDITIONS The home presents many problems — from the well-meaning but inefficient mother, whose lack of system makes her "need Jennie to^ give her a hand" in the morning, and so Jennie is late ; or who says she "puts Johnnie on clean every day," but he comes with torn blouse and grimmy ears ; to the hard-working parent of ten children who has no time to differentiate the train- ing for one individualistic child, and wonders when she "gives him more licks than any of the others," he is still her one black sheep. Patiently the visiting teacher shows both mother and child the better way. Other parents leave the street to train the child. Poverty, step-parents, parents who disagree, one parent who is sick, or unfaithful, or mentally incompetent, are all problems which the visiting teacher meets. She gets in touch with relief societies, domestic relations courts, tuberculosis and mental hygiene clinics, clubs, social service departments of hospi- tals, convalescent homes, nurseries, etc., who co-operate with her in helping the family and the child. James' whole appearance showed neglect ; he came unkempt, un- washed, his clothes filthy and ragged. He was frequently absent or late. I found that the father had left home, but was contributing to the support of his family. I sought him out at his store, and told him that if, as he claimed, the mother was unfit to bring up his four chil- dren, then it was his duty to see to their moral and social training. James did better for a few days, then began to fall back, and I called again. Hearing more rumors about the mother I reported the case to the Children's Society, and meanwhile continued my work with the boy. He improved rapidly and will be promoted. The Children's Society report that the parents are now reconciled, and are giving adequate care to their children. CHILDREN KEPT IN SCHOOL Many children apply for working papers when there is no economic need. The child may be discouraged over failure in class, or lured by the high wage paid a friend. The parent may not see the ultimate advantage of education over present earning power. The visiting teacher is usually able to keep these children in school, and even when there is poverty, may secure a scholar- ship or enlist the help of relatives. 180 Some bright children graduate without signing for high school. Their parents frequently have the wrong impression of high school, or know nothing of the advantages open to those who have had secondary and college education. The visiting teacher's call brings a new vision. Grace had not reported for the 9A, and I found her at home helping her mother do embroidery to support the three younger children. The father was sick in the country. The mother consented to send her back to school when I explained the advantages of education, and the consequences of illegal employment. Grace attended regularly till she reached 9B. This time I found her doing crochet beading to pay the rent, for mother had been taken ill, and the father was now sick at home. Through a friend of the school $100 was contributed for the family. With the rent paid, and both parents under a physician's care, Grace finished her commercial course, happy in her fulfilled desire for an education. When the principal discovered a child with a perfect school record seeking working papers, and referred her to me that I might go and plead for a maximum of education, I rejoiced in the chance to seek out the child's father, even on a hot, dusty evening ; and I think that the man, awakened from sleep after a hard day's work, did not regret my call as we mapped out the girl's future. She is remaining in school. AMERICANIZATION Most of the visiting teachers work in neighborhoods largely foreign, where parents cling to their traditional customs and lan- guage, and believe their children should go to work at 12 or 14, the same as they did in the old world. Promptly at 3 P. M. a task is awaiting many of these little ones, or household drudgery begins, the parent considering that he has done his full share in giving up his child from 9 to 3. He looks upon education for his daughter as a waste for "she will marry'' and then he will have "no good of her." The visiting teacher has to convince him that his child is a bigger asset than the estimate put on her trivial earnings. The foreign parent complains of his "bad American children" for whom he blames "the country.'' The school child has far out- striped the father and mother in developing in this "free land." and the visitins: teacher must show the latter how to conserve 181 his parental authority. She encourages him to enter into the life of his child, to talk about the things that interest the child, his books, lessons, companions, game, and athletics; — on which the foreigner looks with suspicion. She shows him American ideals of democracy and leads him to live — not for his children but with his children. Thus she is not only helping the school to as- similate the child, but is aiding in the making of better Americans. SUGGESTIONS The visiting teacher is seriously handicapped by the lack of a room which she can call her own. Records should be kept where they may be consulted and properly filed, but the best the crowded school buildings afford are make-shift spaces which consume the time and energy of the visiting teacher. Children's affairs are of too intimate a nature to discuss in halls or assembly rooms. It is to be hoped that in the new buildings to be erected, some acces- sible room will be designed for the visiting teacher where she may file records, and interview children and social workers. The visiting teacher should be a neighborhood asset for a group of schools not too remote from one another for her to keep in touch with all. She cannot adequately attend to more than two or three schools — depending on the size. All visiting teachers agree that sporadic cases referred from many schools cannot be properly followed up, and are therefore an expenditure of visiting teacher's time with a disproportionate amount of gain and of discouragement to the worker. The attempt to adjust oneself to the demands of too many schools — with their varied systems and ideals — is an overwhelming demand on the nervous system of the visiting teacher. Travelling for five days a week through filthy tenements, fres- coed with vulgar expressions as far up as juvenile fingers can reach, conversing for many hours a day with difficult parents over elusive problems, often missing the noon rest to catch a parent at dinner time — all done for the sake of the children whose changed outlook on life makes every effort worth the while — this is the work of the visiting teacher. 182 She comes as a mutual help to school and home, and is needed in our congested districts as much by the good to keep them good as by the bad to reform them. The poor widow of an American citizen may need only to be told where to apply for a pension, or the invalid father of an exceptionally bright child shown the way to give his son a high school education. Therefore it is highly desirable that the visiting teacher be not associated wholly with "bad children" or used as a "scare." To the visiting teacher there is no "incorrigible child," yet she recognizes as perhaps no one else in the school work, the necessity for early recognition and referring of cases to her, to the end that she may conserve the child, and the time and energy of the teacher and the visiting teacher; and the partial elimina- tion at least of the "repeater" and the juvenile offender. With visiting teachers in all the schools all the deficient children could be analyzed and the difficult children adjusted, and none lost by transfer. -^ "333 BROOKLYN EAGLE PRESS LIBRARY OF CONGRESS 020 730 295 8