1. MONTHLY EXAMINATION.

One hundred and ten institutions report that the attending physician examines at least once a month the buildings throughout as to their sanitary condition, and the physical condition of each child. The examination of children varies greatly in method. In large institutions the inmates may be sent to the office one by one on an appointed day or days. In other places, the physician sees them all much more frequently.

Non-compliance varies from "examinations made, but not so often as once a month," to instances where "the doctor never comes unless he is sent for to attend a sick child." As the written report presupposes the examination, objections and difficulties are noted under the next heading.

2. MONTHLY MEDICAL REPORTS.

Reference to the appended tables shows that 55 of the 148 institutions included in this examination fail to comply, or comply only partially, with that provision of the Public Health Law requiring reports of the attending physicians' examinations of buildings and inmates to be filed each month with the board of managers and with the local board of health. "Ignorance of the law" on the part of institution officers, attending physicians and local health boards was found in great part the cause of this failure. In some cases the supply of report forms had run out, and a new official was at a loss how to secure more. About half the remaining institutions had been filing these reports only since 1900. Many of those not complying at the time the inquiry was made have since begun doing so. The loss of valuable data occasioned by the attitude of some local health boards, who considered the matter entirely "perfunctory," will be referred to again in another portion of this report.

Opinions of attending physicians. It was occasionally objected that as the attending physicians-men at the head of their profession and exceedingly busy-gave their services without compensation, they could not be asked to do the writing entailed, or even be called to the institution once each month if no child

were ill. The physicians themselves when conversed with almost unanimously expressed themselves convinced that, aside from the obvious wisdom of a thorough examination each month such as the law contemplates, such a record, far from being "another piece of red-tapeism," would be of great scientific value. Suggestions given by them for enhancing the value of such records will be discussed later in this report. Some declared themselves too busy to attend to the matter, but said the reporis ought to be made and suggested the wisdom of detailing a younger or less busy man to the work.

Recommendations.-- Recommendations made" are seldom on the blanks provided in the report form for that purpose. The great majority of physicians make them orally, or if of a nature requiring special action by the governing board, in a separate and formal communication to that body. "Not complying," therefore, means that recommendations have not been made, either orally or in writing, and may be modified by the explanation made in numerous instances that "none were necessary."

3. INVESTIGATION BY LOCAL HEALTH BOARDS. In very few instances were there records of "complaints." The figures given in Table I. under this heading refer rather to whether or no general sanitary inspections are made by the local board.

DORMITORY REQUIREMENTS.

"Section 215. Beds, ventilation.—(1) The beds in every dormitory in such institution shall be separated by a passageway of not less than two feet in width, and so arranged that under each the air shall freely circulate and there shall be adequate ventilation of each bed, and such dormitory shall be furnished with such means of ventilation as the local board of health shall prescribe. (2) In every dormitory six hundred cubic feet of air space shall be provided and allowed for each bed or occupant, (3) and no more beds or occupants shall be permitted than are thus provided for, unless free and adequate means of ventilation exist approved by the local board of health, and a special permit in writing therefor be granted by such board, specifying the number of beds or cubic air space which shall under special circumstances be allowed, which permit shall be kept conspicuously posted in such dormitory. (4) The physician of the institution shall immediately notify in writing the local board of health and the board of managers or directors of the institution of any violation of any provision of this section."

1. LATERAL SPACING.

Referring again to Table I., it will be seen that 63 institutions observe the proper spacing in all dormitories, 66 in part of the dormitories, and 19 have all beds too closely crowded. Of the latter 16 are in the Eastern District (with 10 in New York city), and three in the Western District.

In a few instances dormitories would admit of the proper distance between beds with a different arrangement. In one institution where beds were properly spaced elsewhere those in the nursery dormitory were shoved side to side in rows of six or eight, and the largest or quietest of the children were placed in the end beds "to keep the others from rolling out."

Floor crowding.-Numerous dormitories have permits for a larger number of beds than could be placed in the room were they "separated by a passageway of not less than two feet in width." It is to be noted in connection with this fact that the provision for permits for an increased number of beds refers only to the lessening of the cubic space per bed, while no au thority is given for floor crowding.

2. AIR SPACE.

Of the 148 institutions 9 have dormitories allowing 600 cubic feet or more of air space for each occupant. Ten others have less than the required amount in some dormitories, but the high ceilings or larger space in others make the average 600 cubic feet or more. The subjoined tables (Table II. and Summary) show the amount of air space per capita in institutions in dif ferent parts of the State.

A discussion of the apparent effect of these conditions on the health of the inmates will be found in Part III. of this report.

3. POSTING OF PERMITS.

Where non-compliance in posting of permits was not due to ignorance of the law it was found that perhaps more difficulty has been experienced by institutions in securing proper permits from the local health boards than in complying with any other provision of these sections.

The borough of Manhattan has had for years a printed form, giving dimensions and otherwise identifying the dormitory for which the permit is intended. In other boroughs permits posted previous to the unification under the laws of 1899 are usually of the "blanket " variety, giving on one sheet the number of beds allowed in each dormitory, but with no dimensions. Frequently but one such permit is provided, and that is in a hall, not "kept conspicuously posted in such dormitory." These blanket permits were found in many institutions outside of New York city, in both districts. Occasionally they were of so ancient a date that remodeling or rearrangement had made them wholly inapplicable to present conditions. In other places pen or typewritten permits were provided for each dormitory, but without dimensions or other means of determining for which particular dormitory each was meant. After a housecleaning these might be pretty thoroughly confused. It actually happened that some rooms showed permission for more beds than could possibly have been placed on the floor. This was true also in one institution (with unusually high ceilings) where it was apparently the custom of the local board of health to divide the number of cubic feet by 300 and grant beds accordingly, regardless of floor space.

Lack of proper forms.-Printed forms similar to those now provided for New York city have been recently furnished by the city of Troy. Some institutions report having made repeated requests for permits, but "nothing done about it." Officers of some of these and other local boards when interviewed requested instruction as to the proper form. In some of the cities of the Western District the local health boards were not aware that they had the right of examining dormitories and granting such permits. In one city was found an institution having instead of a permit a framed statement from the health department to the effect that there was no reason why a permit should not be granted. Two others had in several of the dormitories a neatly framed compliment from the town health officer, with no reference either to the number of beds or to dimensions.

A help to uniformity and accuracy in this matter would be a printed form specifying essential details, and like the monthly medical report and physicians' examination certificates, to be obtained from the Albany office on request. A form embodying such necessary features will be found at the conclusion of this report.

4. NOTIFICATION BY PHYSICIAN.

In most instances of non-compliance, the attending physician's attention was called to the last clause of section 215.