mental survey of the children. Cases requiring special study and observation are sent to the state psychopathic hospital. The major surgery except that performed by the throat specialist or the home physician's emergency work is done at the state hospital. at Iowa City. During serious epidemic diseases we feel free to call in the state epidemiologist for advice and assistance in tracing the source of contagion. A local dentist is employed to care for children's teeth. A resident trained nurse is in constant attendance and immediately on the appearance of symptoms or elevation of temperature indicating the possibility of contagion, isolates the patient in the hospital until the physician passes judgment on the case. On their entrance to the home the children are immediately given a thorough bath and an entire change of clothing is provided. They are then kept under observation for several days in order to determine their general make-up and to become acquainted with their new surroundings. A far more efficient and thorough method would be the immediate segregation and isolation from all contact with other children in a separate building or hospital until proper classification of the mental and physical condition could be determined and all danger of contagion eliminated. Later they are brought before the physician where a thorough examination is made and necessary immunizing tests given. It is regretted that so many of the children committed to the home are unaccompanied by medical records. And many of those who have them are found very deficient in respect to their family and past history, thus requiring us to get our information from the child which is very unreliable especially in respect to any syphilitic or tuberculosis taint. A clinical record is filled out and filed alphabetically giving the number, date of entrance, when examined, and by whom, name, age, weight, height, and grade in school, general appearance, facial expression, muscular and mental development and the condition of the skin. After this general physical and mental examination is made any abnormalities are noted and recommendations made for their correction. Every child is vaccinated unless a recent scar is shown. The Schick test is administered and if a positive re-action is observed after a three days' observation permanent immunization is rendered by the injection of toxin antitoxin at three stated periods of seven days apart. Sputum and Wassermann analyses are made when the symptoms indicate the necessity. A complete clinical record is kept of each child and filed alphabetically, to which is added from time to time any hospital record or operative procedure which may have ensued. A monthly register of the weight and height is also kept. A pleasing phase of our work has been the hearty cooperation and assistance of the state psychiatrist and epidemiologist and Dr. Royal French of Marshalltown, eye, ear, nose and throat specialist. In September 1921, L. G. Lowery of the state psychopathic hospital was invited to make a survey of the mental condition of the children at the home. After a careful study in which three separate visits were made an analysis of 141 children examined showed that fifty-five per cent could be considered to have a normal mentality, six per cent psychopathic personality, nine per cent retarded mental development and thirty per cent feebleminded or approximately forty-five per cent subnormal mentally. This no doubt may appear to be a high percentage of deficients but when we consider the number who come from neglected homes, the low intelligence of the parents, the lack of control and discipline of those committed to the Home, the percentage is not unduly high. With a background of a survey of this character the physician and specialist can render more adequate medical service to those needing it. Training and study should be suited to the mental capacity of each individual child rather than to force him beyond his ability to assimilate. It would seem to us the proper time to determine whether a child is normal or subnormal is before he is committed to the Home. An examination of the child by a mental expert through an order of the court would assist greatly in overcoming this. During recent years the prevention of disease has become more and more a factor in the economic and social growth of society. The impetus given to the movement through the results obtained in the recent war, have so impressed themselves on the medical profession and society in general that it is not so much now to cure but to prevent the formation of disease. The results obtained in our work at the Juvenile Home have been most gratifying, especially since the introduction of the Schick method of immunizing for diphtheria. Prior to the introduction of this method we were seldom without a number of cases of diphtheria in the hospital. New children continually brought the disease to us. From the institution of the Home up to last October we had over forty cases of diphtheria. At that time we tested the children and employes with the Schick method and found thirty-five who showed positive re-action. They were immunized with the toxinantitoxin. Since then we have followed this method with all of the new entrants as they come in the Home and have had no case develop since that time, although there has been a severe epidemic in the community during the past winter. An epidemic of scarlet fever presented a number of very interesting features. The physician and nurse picked up several cases of rash appearing on the buttocks and outer side of thighs with no other symptoms that would warrant a diagnosis of scarlet fever. None were bed cases. They were isolated as a precaution but due to the fact that there was no desquamation and the symptoms were so slight the children were let out of quarantine from seventeen to twenty-one days after being discovered. One of the older girls was allowed to wait on table on the twentyfirst day. Within a week a number of severe cases began to develop and before the epidemic was controlled thirty-six had the disease in a severe form. The state epidemiologist was called in and traced seventeen cases from this one girl. With a rigid quarantine from twenty-eight to forty-five days or until desquamation had entirely ceased we were able to control it so that there has been no case in the Home for a period of about three months. This again emphasizes the necessity for careful observation and prompt isolation of those presenting symptoms of possible contagion. It has been our fortune to have but two deaths in the Home since its establishment in 1920. One a child with a temperature of 106 with double pneumonia and meningeal complications when he arrived at the institution; the other paralysis of heart following diphtheria. In the preparation of this paper I have aimed to make the medical service meet the needs of a large Home rather than a hospital. The equipment of a hospital with laboratory and X-ray department would be more elaborate and expensive than is required to meet the present needs of the Home. Two hospital rooms of ten-bed capacity, one for contagious and one for non-contagious diseases with an ordinary operating outfit with necessary drugs constitute our equipment. To summarize a plan for the adequate medical service of a children's State Home should be: First: A thorough mental and physical examination of the child before commitment to the Home by order of court. Special attention being given to the family history and psychopathic findings, medical record to accompany each child. Second: On admission to the Home segregation and quarantine in separate buildings, preferably hospital, until such time as a proper classification of mental and physcal condition is observed and danger of spreading contagion has passed. Third: Complete medical examination as soon as the child becomes used to the environment of the Home with the administration of various immunizing agents, as smallpox vaccine, Schick test, Wassermann and sputum analyses, when symptoms or history point to the possibility of a hereditary taint. Fourth: The early correction of any abnormal condition which might inhibit the mental or physical growth with especial reference to proper fitting of glasses, removal of tonsils and adenoids, and correction of deformities. Fifth: Monthly record of weight and height with instruction for supplemental feeding to those over ten per cent below weight for height, rest and limitation of physical exercise. Sixth: Systematic instruction in hygiene with particular reference to personal cleanliness and regular habits, Seventh: Isolation from contact with other children at onset of acute febrile conditions, sore throat or appearance of any rash until seen and diagnosed by physician. Eighth: Daily observation by physician or competent nurse, preferably in morning before school, of any colds, sore eyes, constipation, etc, with the administration of the suitable remedy to give relief. Ninth: Frequent inspection of hygienic and sanitary surroundings with special attention to the housing, water, food and sewage disposal. We believe that these children, the majority of whom would have gravitated to the criminal class if left in their environment will pay to the state many times as an economic asset the cost of providing them with a comfortable home surrounded with Christian influence, the inculcation of a clean moral life, sound body and mind, making them useful members of society with a hopeful outlook on life. WARDS OF THE STATE. J. W. Kintzinger, Judge of District Court, Dubuque, Iowa. A child born in lawful wedlock is the greatest gift the Creator can bestow on his creatures. The family is the bulwark of society. In carrying out the divine plan, God ordained that the parents are the natural guardians of their offspring. Ordinarily speaking, no law of the state is required to implant in the hearts of parents feelings of love and sympathy for the little ones placed in their care. In the home, center all the tender sentiments of the human heart. Parents, realizing the great responsibility thrust upon them, make innumerable sacrifices for their children when they are unable to help themselves. In the average home the state is seldom called upon to control or direct parental activity. However, due to unhappy marriages, poverty, vice, divorce, and other causes, the state, being the parent of the people, is forced to step in and say, "Thou Shalt Not", and take from the parents the little ones entrusted to their care. It is fitting indeed that in this centennial year of the writing of "Home Sweet Home", consideration should be given to the children whom the state has made its wards, with a view of determining whether or not it is makng for them a real home, to take the place of the home John Howard Payne had in mind when he wrote: Mid pleasures and palaces, though we may roam, A charm from the skies seems to hallow us there, Which, seek through the world, is ne'er met with else where. Home, home, sweet, sweet home, There's no place like home, There's no place like home. This, Parents are the natural guardians of their children. however, is not an absolute right. As long as parents furnish nurture, care, education, and reasonably good home surroundings considering their station in life, the state will not interfere with that right. From time immemorial the state, acting through its courts of chancery, has ever safeguarded the interests of children. It looks with a jealous eye to their wellbeing. Presumptively, the parents have the right to direct their education and their upbringing, but let the parent become recreant in his duty, then the state, under the doctrine of parens patriae, exer |