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 wor thy 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 contagious 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 children 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."

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 reports 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.

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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."