visited. In each institution note was made under each of the several specifications. The figures in the appended tables (Table I.) show that the degree of compliance is greatest in institutions receiving commitments from New York city and least in the scattering institutions of the Western district.

Where lack of compliance has not been due to ignorance of the law, or to a misunderstanding of its provisions, certain difficulties have been cited by officials, or objections have been urged by them. These will be considered under the various sections.

EXAMINATIONS AND QUARANTINE OF NEWCOMERS.

“Section 213. Examinations and quarantine of children admitted to institutions for orphans, destitute or vagrant children or juvenile delinquents.-Every institution in this state, incorporated for the express purpose of receiving or caring for orphan, vagrant or destitute children or juvenile delinquents, except hospitals, (1) shall have attached thereto a regular physician of its selection duly licensed under the laws of the state and in good professional standing, whose name and address shall be kept posted conspicuously within such institution near its main entrance. The words 'juvenile delinquents' here used shall include all children whose commitment to an institution is authorized by the penal code. (2) The officer of every such institution upon receiving a child therein, by commitment or otherwise, shall, before admitting it to contact with the other inmates, cause it to be examined by such physician (3) and a written certificate to be given by him, stating whether the child has diphtheria, scarlet fever, measles, whooping-cough or any other contagious or infectious disease, especially of the eyes and skin, which might be communicated to other inmates and specifying the physical and mental condition of the child, the presence of any indication of hereditary or other constitutional disease, and any deformity or abnormal condition found upon the examination to exist. No child shall be so admitted until such certificate shall have been furnished, (4) which shall be filed with the commitment or other papers on record in the case, by the officers of the institution, (5) who shall, on receiving such child, place it in strict quarantine thereafter from the other inmates, until discharged from such quarantine by such physician, (6) who shall thereupon indorse upon the certificate the length of quarantine and the date of discharge therefrom."

(The six provisions are indicated by figures for convenience.)

1. ATTENDING PHYSICIAN.

A regular physician is employed in every instance. In 30 institutions, the name and address were not posted. In 27 others either the name was posted with no address, or name and address were not "within such institution near its main entrance."

2. PHYSICIAN'S EXAMINATION.

But 17 institutions admit children without examination by a physician. Eleven others do so under "special circumstances," or when the child and its previous surroundings are personally known to the admitting officer, who has then considered it unnecessary to call the physician before his regular visiting time. If the physician lives at some distance from the institution, and a strict quarantine is observed until the child is examined, the spirit of this provision is not violated; but instances of exposure occurring without the knowledge of the child's own mother, or infection having been introduced from this source against all likelihood, serve to emphasize the necessity for literal compliance with the law.

3. PHYSICIAN'S CERTIFICATE.

The law enumerates certain specifications which must be stated in the certificate furnished at the child's admission. A large number of institutions make use of the form furnished by the State Board of Charities, or have similar printed forms specially prepared for their own use. Certain of the commitment papers in use have a certificate form printed thereon. Those of Erie county and those on Department of Charities commitments of the borough of Manhattan have no place for indicating "length of quarantine and date of discharge therefrom."

Certificates, when written out by the physician, usually state only that the child is "all right," or "may be admitted." The use of certificates of this character, or of an oral statement of fitness, defeats the purpose of the law, viz.: to preserve a com plete official certificate of the child's condition at the time of admission to institution life.

H

Mental condition.-Two objections given by officials to stating "mental condition" have weight. (a) In the case of young infants it is practically impossible to be determined. (b) Older children may appear actually stupid through excessive shyness and homesickness, and afterwards prove to be normal, while others, seemingly quick and bright under the stimulus of novelty, are found later to lack memory and power of attention to a degree of feeble-mindedness. This difficulty may be met by waiting, in cases of reasonable doubt, and inserting the item a few weeks later.

4. FILING OF CERTIFICATES.

The wording of the law apparently has in view a system by which the "commitment or other papers on record" in each case shall be kept together for ready access. That 57 institutions do not file the certificates with the commitment papers is partly due to the fact that some officers commit children by lists, or in some cases orally. There is no such explanation, however, for the fact that only 49 institutions comply with the law in the matter of filing the certificates with the "other papers." (See Table I., 5 (a) and (b).)

In numerous instances the practice of filing physicians' certificates (on separate forms) by themselves is adhered to because of the frequent handling of the commitment papers required by the rules of the Department of Charities. In Brooklyn several institutions formerly filed them as specified in section 213, but have changed to the other method "since the Comptroller requires each child's commitment with each month's bill."

The envelope system of record keeping has been found by some institutions a practical solution of these difficulties, and is worthy of general adoption.

5. QUARANTINE AT ENTRANCE.

One-third of the entire number of institutions (see Table I.) failed to comply, or complied but partially, with the law requir ing each child to be placed in " strict quarantine from the other inmates, until discharged from such quarantine by such physi

cian." Two or three institutions having separate cottages available for the purpose do not quarantine newcomers, as they consider it "useless when the children are so well known," or else on account of the added expense of heat and service.

Lack of facilities.-The reasons most frequently assigned for non-compliance, however, are lack of suitable room, and an insufficient number of attendants. Where the only institution in a community is taxed to the extent of its capacity in caring for children who cannot well be sent elsewhere, the problem of place is a real one. It is not infrequently the case that this added source of danger of introduction of contagion is coupled with lack of suitable means of isolation in the event of the outbreak of any infectious disease. The probability of one case causing an epidemic is thus increased.

Various methods.-Where additional building is possible, a plan that has been found to work satisfactorily and that offers the advantage of economy is as follows: A detached cottage or an attached wing with separate outside access is fitted with bath, toilet, attendants' room and means of heating water or food. Here newly admitted children are quarantined. If contagion occurs, admissions are suspended, and the quarantine is available for isolation. Another method, rarely pursued, is to board the child for the observation period in some reliable home near enough the institution for supervision, and where there are no children. When this can be done for the price paid the institution for maintenance, it meets the difficulty of increased cost for an additional attendant.

Infants not quarantined.-Some institutions which care for infants maintain no quarantine for babies less than six months old when admitted. Most of these little ones have been since birth under medical supervision, either in the hospital or in the maternity department of the institution, but some have not been. The serious results which may follow the admission to the babies' ward of one child who has been exposed to any conta gious or infectious disease are a strong argument for the provi sion of facilities for the quarantine of children of all ages.

Loneliness in quarantine.-It has been urged that the isolation of a child (especially when through fewness of attendants it must be left much alone in the quarantine room), at the time when it is lonely and strange and often miserably homesick, is a species of cruelty. "Besides, a new child demands and gets more attention than those that are wonted to the institution life, and there is plenty of opportunity for observation." To this it may be said that boarding out in the right kind of a home should insure the child's happiness, while the risk to other chil dren from possible contagion is too great not to be avoided.

Quarantining truants.-One really knotty problem is that of quarantining children committed for truancy. "They must go to school; that is what they are sent here for, and we cannot give them a special teacher or a separate classroom," said one perplexed official. Truants are usually among the oldest of the inmates at an institution, and are less likely themselves to develop contagion. For this reason physicians seem customarily to depend for protection upon examination and thorough disinfection in bathing and clothing, and so shorten the quarantine to a day or two.

MONTHLY EXAMINATIONS AND REPORTS.

'Section 214. Monthly examination of inmates and reports.—Such physician shall at least once a month (1) thoroughly examine and inspect the entire institution, and (2) report in writing, in such form as may be approved by the State Board of Health, to the board of managers or directors of the institution, and to the local board of the district or place where the institution is situated, its condition, especially as to its plumbing, sinks, water-closets, urinals, privies, dormitories, the physical condition of the children, the existence of any contagious or infectious disease, particularly of the eyes or skin, their food, clothing and cleanliness, and whether the officers of the institution have provided proper and sufficient nurses, orderlies, and other attendants of proper capacity to attend to such children, to secure to them due and proper care and attention as to their personal cleanliness and health, with such recommendations for the improvement thereof as he may deem proper. (3) Such boards of health shall immediately investigate any complaint against the management of the institution or of the existence of anything therein dangerous to life or health, and, if proven to be well founded, shall cause the evil to be remedied without delay."