n 609 U6 Public ' Health UC-NRLF B 3 T30 2^3 Y LIBKAHY U. S. DEPARTMENT OF LABOR JAMES J. DAVIS. Secretary CHILDREN'S BUREAU GRACE ABBOTT. Chief PHYSICAL STATUS OF PRESCHOOL CHILDREN GARY. IND. BY ANNA E.)RUDE. M. D. ^ Bureau Publication No. 1 1 1 V\ mm i[' WASHINGTON GOVERNMENT PRINTING OFFICE 1922 U. S. DEPARTMENT OF LABOR JAMES J. DAVIS. Secretary CHILDREN'S BUREAU GRACE ABBOTT. Chief PHYSICAL STATUS OF PRESCHOOL CHILDREN GARY, IND. BY ANNA E. RUDE. M. D. •55 Bureau Publication No. 1 1 1 WASHINGTON GOVERNMENT PRINTING OFHCE 1922 /\ CONTENTS. Page. Letter of transmittal 9 Introduction 11-13 Scope of study 12 Staff 12 Methods and standards used 13-26 General method of conducting examinations 14 Physical examination record form used 15 Instructions accompanying physical examination schedule 18 Measuring and weighing 21-23 Height '... 21 Weight 22 Vision testing 23 Hearing testing 24 Indications for recommending removal of tonsils and adenoids 25 Physical findings 27-62 Introduction 27 Findings in general 28 Height and weight 32 Nutrition 36 Anemia 39 Vaccination 40 Head 41 Eyes 42 Ears 44 Mouth 44-45 Teeth 44 Other mouth defects 45 Nasopharynx 45-62 Adenoids 46 Symptoms suggesting adenoids 47 Tonsils 48 Lymph glands 51 Lungs 55 Heart 55 Skin 55 Abdomen 56 Bony and muscular systems 57-61 Bony defects of rachitic origin 58 Postural defects 59 Arch measurements 60 Nervous system 61 Mental condition 62 Genitalia 62 500585 ' 4 CONTENTS, Page. Appendixes 63-83 Appendix A. — General tables on ph.ysical findings of the preschool child. . 65 Appendix I>. —Results of physical examinations of children under '1 years of age 75-83 Source of material 75 Findings in general 75 Height and weight 77 Nutrition 77 Anemia 78 Vaccination 78 Head 78 Eyes 78 Ears 79 Mouth 79 Nasopharynx 79-80 Tonsils 80 Adenoids 80 (xlands 80 Heart 81 Lungs 81 Skin 81 Abdomen 81 Bony and muscular system 82 Arch measurements 83 Mental condition 83 Genitalia 83 TEXT TABLES. Page. Table I. Age and sex; children from 2 to 7 years of age given physical examination 27 II. Prevalence of defects, by sex; children 2 to 7 years of age given physical examination 28 III. Number of defects, by age and sex; children 2 to 7 years of age given physical examination 30 IV. Average heights and weights, by sex and age; white children 7 years of age and under given physical examination 36 V. Grade of nutrition, by age and sex ; children 2 to 7 years of age given physical examination 38 VI. Grade of nutrition, by color and nationality of mother; children 2 to 7 years of age given physical examination 39 VII. Grade of nutrition, by earnings of chief breadwinner; children 2 to 7 years of age given physical examination 39 VIII. Vaccination, by age and sex; children 2 to 7 years of age given physical examination 40 IX. Vaccination, time of vaccination, and entrance in school, by color and nationality of mother ; children 2 to 7 years of age given physical examination 41 X. Defect of \asion, by age; children 2 to 7 years of age given physical examination 42 XI. Vision, by sex and eye disease or other defect; children 2 to 7 years of age given physical examination 43 XII. Eye disease or defect other than of vision, by color and nation- ality of mother; children 2 to 7 years of age given physical examination 43 XIII. Decayed teeth, by age and sex; children 2 to 7 years of age given physical examination 44 XIV. Naso-pharyngeal defect, by age and sex; children 2 to 7 years of age given physical examination 45 XV. Adenoid condition, by age and sex; children 2 to 7 years of age given physical examination 46 XVI. Condition of tonsils, by age and sex; children 2 to 7 years of age given physical examination 49 XVII. Prevalence of diseased tonsils, by presence of decayed teeth; children 2 to 7 years of age given physical examination 51 XVIII. Condition of glands, by age and sex; children 2 to 7 years of age given physical examination 52 XIX. Condition of cervical glands, by condition of tonsils and teeth; children 2 to 7 years of age given physical examination 53 XX. Condition of glands, by color and nationality of mother; children 2 to 7 years of age given physical examination 54 XXT. Distended abdomen, by age and sex; children 2 to 7 years of age given physical examination 56 XXII. Defect of bony and muscular system, by age and sex; children 2 to 7 years of age given physical examination 57 XXIII. Postural defects, by age and sex; children 2 to 7 years of age given physical examination 60 5 6 PHYSICAL STATUS OF PRESCHOOI. ( HII.DREN. APPENDIX TABLES. Page. Appendix A — General tables 65-73 Tablk 1 . Prevalence of defects, by sex; children 2 to 7 years of age given j)hysical examination 65 2. Specified defects, by age and sex; children 2 to 7 years of age given physical examination 65 3. Specified defects, by color and nationality of mother; children 2 to 7 years of age given physical examination 67 4. Specified defects, by earnings of chief bread \vinner; children 2 to 7 years of age given physical examination 67 5. Per cent of children ^\'ith specified defects, by deviation from average weight for height; children 2 to 7 years of age given physical examination 67 6. Specified skin diseases, by age and sex ; children 2 to 7 years of age given physical examination 68 7. Condition of specified glands, by sex; children 2 to 7 years of age given physical examination 69 8. Specified defects of bony and muscular system, by age and sex; children 2 to 7 years of age given physical examination 70 9. Relation of weight to height, by age and sex; children 2 to 7 years of age given physical examination 70 10. Relation of weight to height, by color and nationality of mother; children 2 to 7 years of age given physical exami- nation 71 11. Prevalence of specified defects, by deviation from a^'erage weight for height; children 2 to 7 years of age given physical examination 72 12. Annual earnings of chief breadwinner, by color and nativity of mother; children 2 to 7 years of age given physical ex- amination 73 Appendix B: Table I. Number of defects, by age and sex; children under 2 years of age given physical examination 75 II. Prevalence of disease or defects, by sex; children under 2" years of age given physical examination 76 III. Grade of nutrition, by age and sex; children under 2 years of age given physical examination 77 IV. De\dation from average weight for height, by age and sex; children under 2 years of age given physical examination . . 78 V. Nasopharyngeal defects, by age and sex; children under 2 years of age given physical examination 79 VI. Condition of tonsils, by age; children under 2 years of age given physical examination 80 VII. Condition of glands, by age and sex; children under 2 years of age given physical examination 81 VIII. Rickets, by age and sex; children under 2 years of age given physical examination 82 IX. Rickets, by condition of tonsils; children under 2 years of age given physical examination 82 X. Condition of glands, by presence of rickets; children under 2 years of age given physical examination S3 XI. Comparison of the prevalence of defects in children under 2 years of age and children 2 to 7 years of age given phy- sical examination 83 ILLUSTEATIONS. 7 CHARTS. L Page. f Chart I. Average heights of boys from birth to six years of age; Children's Year, Gary, (iary and Health Conferences combined, and Crum 32 II. Average heights of girls from birth to six years of age; Children's Year, Gary, Gary and Health Conferences comlnned, and Crum \ 33 III. Average weights of boys from l)irth to six years of age; Children's Year, Gary, Gary and Health Conferences combined, and Crum 34 IV. Average weights of girls from birth to six years of age; Children's Year, Gary, Gary and Health Conferences combined, and Crum 35 V. Per cent of children having one or more defects, from birth to six years of age 84 ILLUSTRATIONS. Page. Measuring Faces 22 Measuring square Faces 22 Measuring strip Faces 22 Weighing in scoop scale Follows 22 Weighing on beam scale Follows 22 Vision testing Faces 23 Healing testing Faces 23 LETTER OF TRANSMITTAL. U. S. Department of Labor, Children's Bureau, WasUngton, April 29, 1922. Sir : There is transmitted herewith a report on the Physical Status of Preschool Children, Gary, Ind., by Dr. Anna E. Rude, director of the child hygiene division of the Children's Bureau. The investiga- tion on which the report is based was planned by Dr. Grace Meigs Crowder, formerly director of the child hygiene division of the bureau. All the field work of the investigation was in charge of Doctor Rude, and the material has been organized by her with the assistance of Caroline Legg. Respectfully submitted. Grace Abbott, Chief. Hon. James J. Davis, Secretary of Labor. PHYSICAL STATUS OF PRESCHOOL CHILDREN, GARY, IND. INTRODUCTION. In coimection with the social and economic study of infant mor- tality and the preschool child in Gary, Ind., made in 1918 by the United States Children's Bureau, an investigation to determine the physical condition of the children was conducted by the hygiene division of the bureau. In all, 4,348 individual examinations of children under 7 years of age were made during the six-month period extending from April to October. The splendid interest and hearty cooperation of the Gary school authorities made possible the systematic examination of practically all children under 7 years of age who were attending the kindergartens and primary grades in all the public schools and in three parochial schools. The school examinations occupied the first three months of the investigation, following which the examinations were conducted in cliildren's health conferences. The first conference center was in a vacant store in the center of the business district on the North Side of Gary. The conference rooms were open from 9 o'clock in the morning until 4.30 o'clock in the afternoon every day except Satur- day and Sunday. Children were examined by appointment onl3^ The second conference or consultation center was opened for the last two months of the study on the South Side of the city, where a large proportion of the foreign population lived. In order to stimulate interest in the health conferences and instruct the public as to their general purpose, the cooperation of the Gary Cliildren's Year Committee of the Council of National Defense was enlisted. This committee secured active interest and cooperation from the mayor, the women's organizations, the men's clubs, and the school authorities, and conducted a poster contest on the subject of child care in the Gary schools. Two men's organizations, the commercial club and the chamber of commerce, donated $75 for prizes in the form of thrift and war-savings stamps. An exhibition of posters from all the school grades in a do\\Ti-to\\Ti shop window, prior to the awarding of the prizes, helped to arouse 11 12 PHYSTCAIi STATUS -OF PRESCHOOL CHILDREN. interest' and attract attention to the forthcoming conferences, where a large collection of posters was finally displayed. Another feature of the conferences which attracted considerable attention was the exhibit of small models which included a bed properly prepared for a mother at confinement, baskets and cribs for the baby, the necessary bath equipment, utensils for preparing food and Pasteurizing milk, an iceless refrigerator, play pens, simple and cheap homemade screens, etc. There were also models of infants' clothes, and paper patterns from which the mothers might cut dupli- cates if they so desired. Simple meals for the preschool child were shown in a glass case, and the values of pai'ticular kinds of food were explained by a nurse. Children's Bureau publications dealing with prenatal care and the care of infants and young children were dis- played, and given free to persons desiring them. Much interest was evinced in these exhibits, and in the wall charts which pictured various phases of child care with warnings and suggestions to mothers. SCOPE OF STUDY. Tabulations were made of the records of 3,125 children whose ages ranged from 2 to 7 years ,^ and of 994 infants under 2 years of age. The data relating to the latter are presented in Appendix B, but the descriptions of methods include those used in the examinations both of infants and of older children. In both age groups the distribution by sex was fairly even. The older group included 1,555 boys and 1,570 girls. It was possible to make certain correlations for this group with items on the family schedules which were taken for all of these children in the general study of children of preschool age made by the Children's Bureau.^ STAFF. The regular working staff consisted of three physicians, two nurses, and four clerical assistants. A specialist from Chicago was engaged for one day a week to examine all children who had been found upon examination to have eye, ear, nose, or throat defects. These special examinations were discontinued after the conferences were begun, owing to the fact that the majority of the examinations in the conferences were of infants and the comparative infrequency of these defects in infancy made the services of the specialist seem unwarranted. During the examinations in the schools, the school nurses were loaned to the Children's Bureau staff for almost full-time assistance. 1 Included in this group were 220 cliildren who had passed their seventh birthdays between the date of beginning the study and the date of the physical examination. Since the majorit y of these 220 children were stiUless than 7h years of age, and since data concerning them apjjeared in the family schedules wliich had been taken and had already been incorporated in other reports on the Gary investigation, tliey have been included in all discussions where ages are not distinguished; but where ages are distinguished this group is not separately discussed. 2 Children of Preschool Age in Garj', Ind. (In press.) METHODS AND STANDAKDS USED. 13 They determined from the school register what children were eUgible for examination, notified parents as to date and time of examination, invited them to be present, and brought the chiklren in turn to the examination room. The interest of the parents was most encourag- ing; in several of the school districts approximately 75 per cent of the mothers were present for the examinations. The nurses also helped with the undressing and dressing processes.. During the entire study they rendered valuable assistance by following up cases reported by the physicians as in need of special attention. One nurse acted as interpreter, such service being indispensable during the conference on the South Side of Gary, where the families of the foreign-bom predominated. A list of the defects noted upon examination was transcribed on the school physical examination card for a permanent school record, a duplicate of which was sent by the school authorities to the parents. METHODS AND STANDARDS USED. The chief value of this report on the physical condition of the preschool child in a typical industrial center lies, perhaps, not so much in the data gathered as in the presentation of the methods and standards used in the study. The dearth of definite information regarding the physical condition of the preschool child is noteworthy; the data obtained in this investigation are offered as the result of uniformly careful examinations. The usual lack of uniformit}^ in methods of examination, record forms, etc., makes for apparent unreliability in data, and this has a tendency to lower rather than to raise standards. It is doubtful if any physical examination record form or method of examination would meet with universal approval. The methods and standards used in this study are not offered as ideal; but since there is a generally recognized need for standardiza- tion in all phases of child-welfare work, the plan has been given in detail in the hope that the report may serve to some extent as a handbook for similar scientific investigations as well as for the less technical popular health activities of both private and Governmental organizations. In order that data gathered in this study might conform to the standard of exactness required in making statistical tabulations, it was necessary to plan definite standards for recording observations. The difficulties involved are readily recognizable, since much of the information secured through ordinary physical examinations shows variation, according to the individual examiner's judgment. While such data may be sufficiently accurate for clinical purposes, they do not have the degree of conciseness and uniformity necessary for statistical tabulations. 14 PHYSICAL, STATUS OF PRESCHOOL CHILDREX. GENERAL METHOD OF CONDUCTING EXAMINATIONS. The following general procedure was adhered to almost mthout exception throughout the six months devoted to the physical examina- tions recorded in this study. The child was first given the vision and hearing tests, in a room speciall}^ set aside for the purpose. This was done first in order to eliminate the possibility of any nervous strain after subjection to the physical examination. It was most important in testing eyes and ears to gain the child's undivided attention, for if it was at all strained or unnatural the results were necessarily less accurate. Moreover, by subjecting him at the start to an active rather than a passive examina- tion, i. e., to one in which his own faculties were exercised, the child's cooperation and confidence were secured for the more trying ordeal of a complete physical examination. The details of the ^dsion and hearing tests and the method of grading will be described subse- quentl}^.^ After the tests of sight and hearing were completed the child was directed to a dressing room and completely undressed by a nurse or parent; separate rooms were provided for boys and girls. As soon as the clothing was removed the child's body was covered with a clean square of flannelette fastened around the trunk and falling to the knees, and the height and weight were taken. This was done either at one end of the large room in which the examinations were made or in a smaller separate room, according to available facilities. After the record of height and weight was made the child was ready for the doctor. The physical examination was strictly private, each physician having a curtained booth about 8 by 10 feet. The examining table was covered with a clean white sheet and provided with all necessary equipment for making a thorough physical test, including stethoscope, thermometer, tongue blades, culture tubes and slides, standard tape measures and rulers, paper towels, facilities for sterilizing instruments, and celluloid toys which were used to divert the attention of ^^ounger children during the more trying parts of the examination. A clerical assistant at one end of the table recorded the details of the examina- tion as dictated by the doctor, and noted such facts as date of birth, age at entering school, grade attained, and history of previous ill- nesses. A record of height and weight, vision and hearing grades, and defects found, if any, together with suggestions concerning their correction and dietary advice applicable to the individual child, were given to the mother before she left the conference rooms. 3 See pp. 23 and 24. METHODS AXD STANDARDS USED. 15 PHYSICAL EXAMINATION RECORD FORM USED. A physical examination record form was prepared from which statistical data could easily be transcribed. Wliile to the average physician this form may appear unnecessarily detailed for practical use, experience has shown that the system of establishing uniform standards and then requiring every item to be checked is probabl}^ the only means of insuring sufficiently accurate and detailed informa- tion in routine physical examinations. The practicability of this particular record form has been tested by use both in this study and in subsequent work. Some of the items could well be omitted, and the form could be made practical for continued use only by providing space for the records of repeated examinations on the reverse side of the card. The general arrange- ment, however, has proved satisfactory and practical from a statis- tical standpoint. 16 PHYSlC-y:. STATUS OF PRESCHOOL CHILDREN. CQ 5i o CO o !Z OS < Q CO W CO 6 Zm 5 .> CO • • << • m • ^^ S 1 C-3 ^•z ;?; (M S =n i = ^^ ^ .2 -csa.. ^ /I, a; Qj 2 ^ ^ uo a) -3 — ^ c . . C 0^ (i -■c S ?^ C "e a3 ^ CO T}i 10 *5l id I 5"c « ;::^ (1, •^ £ 5: O s^ !i^ 03 s: p ^^ ^ . . . W<2. 5C t-^ : E-g§g"-35-S g|ZH^OQ h^ Cl ■* IC CO <* C^ C^ COM ZZ222ZZ zzzzzzz zzzzzzz J^ ^ ^ ,1^ ^ ^ ^ 2ZZZZZZ 1^ pn j^ pH pH JH ^ w 03 C3 t; S^ 2 •~ 5 'S =^ -S t: a> • x s t .^ Z C3 §'5^';3 , 1- 8 •; ^■!z "is ^■§.3 la c3 o_ :fz5 S"iSg z g ..Z :- ..22 g 2 M^ S >. _r !- - 03 ~^ t. p3-p^rsr";r Wg cp; 3Z". -T3 ?* 9 — "" is &•< fe t:^ ^ .2 > c £-- o ffiSZ| • ^ u oi 3 '^u . . ■7- « o 0) 3 Hal •a&.^ C3 O 3 p. a;" os.o'ots'S' Z 3 S i ^ z-s a 03 m 03 t-i a) fiji d Z «-. E-l c R S 5 2 2S.5-'5 [KHOJ QHOOaH NOIXVNIKVXa IVDISAHJ] METHODS AND STANDARDS USED. 1? [record form — REVERSE.] Genitalia: 79. Male: pre])uce adherent, contracted, normal. 80. Female: vaginal discharge, N. Mental Condition: 81. (a) Normal, N. (b) Defect app. (spec). (c) Abnormality susp. (spec.) 82. Laboratory Findings: 83. Previous Illness: (a) Contagious; (b) Respiratory: (c) Digestive: (d) Other: 84. Bad Habits: 85. Summary of Defects and Diseases: 86. Recommendations: 108178°— 22 2 18 PHYSICAL STATUS OF PRESCHOOL CHILDRE^^T. INSTRUCTIONS ACCOMPANYING PHYSICAL EXAMINATION SCHEDULE. Every question on the schedule must be checked. If abnormal, check this word or the condition listed; if normal, check N, meaning "No" or not abnormal. Care should be taken that the check is in the letter or word intended. Carelessness in checking means inac- curacy in tabulations, and schedules with omissions deplete the total base or are thrown out. General. (5)" WEIGHT. To be taken without clothes. (6) HEIGHT. To be taken without shoes. Measuring board to be brought down until horizontal part just touches child's head firmly while perpendicular part is pressed against the wall. Most mistakes are made in reading; therefore measurements to be taken twice, once before and once after exami- nation, and entry made on record after the second measurement. (7) ANEMIA. To be determined by inspection of color of mucous membranes, especially conjunctivae. (8) NUTRITION.^ "Excellent" indicates a condition superior to "good." "Good" is to be checked if the child's weight is within a 10 per cent deviation below average weight for height. "Poor" to be checked when weight is below 10 per cent deviation from average weight for height and when supervision is required. "Very poor" to be checked where weight is more than 10 per cent below average weight for height and medical treatment is required. "Poor" or "very poor" is always to be noted under Summary and Recom- mendations. (9) TEMPERATURE. To be taken onlv if symptoms indicate. (10) VACCINATED. Unless the mothei- is with the child it may not be possible to ascertain the age at which he was vaccinated for smallpox, but it may be learned from the teacher whether or not it was done before he entered school. Head. (11) SIZE. If abnormal, the fronto-occipital circumference is to be measured wnth tape and the measurement recorded. (12) SHAPE. If abnormal, "square head," "hydrocephalic," "oxycephalic," or " scaphocephalic " may be specified. (13) ABNORMAL CONDITION. Here may be noted abnormal conditions of scalp, features, hair, etc. Eyes. (17) VISION. To be tested by one person, using "illiterate" chart." All cases of defective vision to be listed and referred for con- sultation with specialist. (20) OTHER ABNORMALITIES. Such conditions as nystag- mus, etc., to be noted here and every case to be listed for consultation with the specialist. * Figures refer to items on record form. 6 See page 36. 6 For details of vision testing, see page 23. methods and standards used. 19 Ears. (22) HEARING. To be tested by one person, using ''whispered voice. "^ If hearing is defective or there is any discharge, the chikl is to be listed and referred to the specialist for examination for ceru- men, retracted drums, and adenoids. Mouth. (27) MALOCCLUSION. Includes any condition causing an abnormal bite. (29) OTHER ABNORMAI^ITIES. Here should be noted general conditions of cleanliness and types of teeth, such as syphilitic, rachitic, and those devoid of enamel, abnormal condition of gums and mucous membranes, badly coated tongue, offensive breath, etc. Nasopharynx. Children with colds are to be excluded from examination until well. (30) MOUTH BREATHING. To be tested by closing the mouth to see if child breathes easilv through nostrils. (32) NASAL OBSTRUCTION. To be tested by closing each nostril in turn to see if child breathes easily through the open nostril. (34) TONSILS.^ ''Rem." means removed; ''Enlarged" indi- cates moderate enlargement; "Greatly enlarged" are those nearly filling the throat; ''Diseased" tonsils are those shovv^ing (1) cheesy plugs, (2) localized injections of the surrounding vessels. All posi- tive entries in Nos. 30 to 36, inclusive, are to be listed and referred to specialist for absolute diagnosis. (35) OTHER ABNORMALITIES. Here may be noted any mal- formations such as harelip, cleft palate, bifid uvula, etc. All abnormal conditions of the nasopharynx to be listed and referred to the spe- cialist for absolute diagnosis. Glands. (37) "ENLARGED" glands are those over i inch in diameter; "Greatly enlarged" glands are those 1 inch in diameter or over. In looking for the infection associated with enlarged glands, look among other causes for bites on the body and if present, examine clothing for pediculosis and the head for nits. (37-g) OTHER— SPECIFY. Includes thyroid, etc. Heart. (38) HEART. Enlargement to be determined by axillary border and apex beat if latter is below the fourth or fifth interspace and outside the mammary line. Lungs. Percuss the paravertebral regions and listen with the stethoscope over the bases and the paravertebral regions. (41) OTHER DEFECTS. Asymmetry, abnormal shape, poor development, etc. 7 For details of hparing testing, see pago 24. * For details on indications for recommending removal of tonsils and adenoids, see page 50, 20 physical status of preschool children. Skin. (51). OTHER CONDITIONS. May be included general condition of the skin such as cleanliness, rough, dry, clammy; also birthmarks, furunculosis, urticaria, etc. Abdomen. (54) LIVER. Is ''enlarged" if more than 1 inch below border of ribs. Specify in inches. (55) SPLEEN. Is "enlarged" if palpable; ''moderately en- larged" if 1 inch below border of ribs; "greatly enlarged" if felt as tumor mass in abdomen. (57) OTHER DEFECTS. Note should be made of distension due to tympanites as in rickets, or ascites, etc., and measurements taken at a level of the umbilicus, if greatly enlarged from any cause. Boxy ani> Muscular System. (68) FLAT-FOOT. Child to be examined standing in stocking feet or barefoot, and height of arch recorded in inches. This is to be measured with ruler held perpendicularly from floor to tubercle of scaphoid bone, which is the top of the arch. Observe child's walking and record position of feet, i. e., toes straight ahead, toes in, toes out. (71) ARTHRITIS. If present, try to get a history of previous infections. (73) OTHER DEFECTS. Note flabbiness of muscles, clubbed fingers, tuberculous bone affections, etc. Record here also in every case whether or not pronation of feet is present, i. e., rotation of the axis of the foot. Nervous System. (77) OTHER DEFECTS. Note to be made of extreme nervous- I16SS ©tc MENTAL CONDITION. Note to be made of sluggish or active mentality and confer with teacher if questionable. Laboratory Findings. In this space may be recorded results of urinalysis, cultures or smears, from reports furnished by the Gary Board of Health labora- tory. Previous Illness. This information may be obtained only in case the mother accom- panies the child and can make apparently reliable statements. (83-d) OTHER. General diseases such as rheumatism, malaria, intestinal parasites, etc. Bad Habits. (84) Such as finger sucking, masturbation, nail biting, perverted appetites, enuresis, etc. Information probably can be obtained only from mother or teacher. methods and standards used. 21 Summary ov Defects and Diseases. To inclii(l(> all checked (lefccts found in general examination. Recommendations. These are to be such as will correct or improve defects found by referring to specialists — correction of habits, dietary and general hygienic advice. MEASURING AND WEIGHING. In an attempt to secure accurate figures on standing height and nude weight, these measurements were taken largely by one specially instructed person in order to eliminate, so far as possible, personal variations. Each measurement was made twice, once before the physical examination and once after, the second figure serving as a check on the previous one. Height. The measuring apparatus consisted of two pieces as follows: (1) A blue-print paper measuring scale." The scale was prepared from a standardized meter stick secured from the United States Bureau of Standards, a draftsman making the tracing from which blue prints could be obtained. The strips of paper were 72 inches long and 3 inches wide, with a scale divided into |-inch units. The inch lines extended across the paper and the half-inch lines were J inch in length. The strips were pasted on a smooth pine board which could be attached perpendicularly to the floor, thus insuring a standard position which is impossible in the ordinary room due to wainscoting and sheathing. For the examination of infants too young to stand, the measuring strip was pasted directly on the examination table, and a board 4 by 6 inches was fastened perpen- dicularly to the end of the table for a headrest. (2) Square. This second essential part of the measuring apparatus was a plane to slide down over the measuring scale, when reading the height. It consisted of two pieces of wood, each 6 inches long, 4 inches broad, and ^ inch thick, fastened together at a right angle. A crossbar on the inside served as a handle and further strengthened the apparatus, which simulated a book end with a crossbar. The measurement of standing height was made by having the child stand erect, arms hanging naturally at sides, heels together, back and the back of the head (the eyes in a horizontal plane) against the board to which the measuring scale was attached. The "book end," as the square was sometimes called, was brought down firmly on the top of the head and the reading taken. The 4-inch width of 9 This type of scale was prepared after consultation with Dr. A. Hrdlicka, anthropologist of the Smith- sonian Institution. 22 PHYSICAL STATUS OF PRESOHOOL CHILDREN. the measuring apparatus was a definite advantage in that the inch hues across tlie printed scale insured an accurate horizontal position of the square because it must not only touch the top of the head firmly but also be parallel to the longer lines across the scale. The reclining length of infants was taken by pushing the square firmly against the soles of the feet, which were held at right angles to the table. Weight. For weighing children who could stand, an upright beam scale was used. Infants were weighed on a grocer's scoop scale with a very heavy base, to which the scoop was securely riveted. All weights were taken without clothes. The flannelette square used as a protection for the child as he came from the dressing room was removed and held in front of him by the mother or nurse as a screen while the weight was taken. So far as possible, the weighing was done by one nurse who had been^specially instructed in the importance of accuracy in adjusting the balance of the scale several times daily and reading the record of weight with the beam hori- zontal or at mid-balance. After the physical examination the child was reweighed, and the second reading was checked up with the original figures before entry was made on the record form. The height and weight table used as a standard was that prepared by the Children's Bureau for the weighing and measuring test during the Children's Year campaign, the averages for children at birth and for boys at 3 months having been taken from Dr. L. Emmett Holt's figures from original observation; those for children aged 6 to 48 months, from the antlii'opometric table compiled by F. S. Crum; and those for children aged 5 to 7 years, inclusive, from Bowditch. Since all the children included in this study were weighed without clothing and the Bowditch figures included weight of clothing, it was necessary to deduct from the latter the average weight of clothes (Bowditch's averages.)^** In order to economize time as well as to eliminate possible errors through hasty computation, this table was adapted for the use of the examining physicians, weights being shown in haK-year periods, decimal or fractional pounds being changed to ounces and decimal inches to fractional inches. Weights 10 per cent below the accepted averages were also computed and arranged in a column parallel to the corresponding averages. The saving of time, the elimination of the possible chances of mathematical error, and the uniformity of method made possible are obvious. The adapted table is here given, since it offers some practical suggestions, although its form could be more conveniently arranged. »o See The Diseases of Infancy and Childhood, by L. Emmett Holt, M. D., p. 19. New York, 1916. = IZ- MEASURING ^ — 5 ^—4- == — 3 m^' — I MEASURING SQUARE. 22— i MEASURING STRIP. Scale I inch equals 1 inch. jXTJCaUM-' s 3i€» csxc: axe arr? ~ :n WEIGHING IN SCOOP SCALE. 22—3 WEIGHING ON BEAM SCALE. VISION TESTING. HEARING TESTING. METHODS AND STANDARDS USED. 23 Heights and weights of hoys. Heights and weights of girls. Height. "Weight. 10 per cent below average. Average. Inches. 20i 23J 26i 2"i 271 2Si 28i 29 291 291 30J 30J 31i aif SIJ 32i 321 32i 33i 33f 33| 34 34J 34J 35i 35* 35| 35J 36 36i 36J 36i 37J 371 37i 37i 38i 381 381 38i 381 39 39 39J 39§ 41f 42f 43| 44| 45f 461 47| 48| 49f SOJ 51J Lbs. Oz. 6 13 11 11 16 3 17 3 17 12 18 5 18 13 19 4 19 11 20 9 20 11 21 4 21 11 22 1 22 3 22 15 26 26 9 27 7 27 9 27 9 28 28 11 29 29 29 2 29 13 30 2 30 4 30 6 30 6 30 13 31 1 31 4 32 3 32 5 33 6 34 7 36 5 38 2 39 10 41 43 3 45 5 47 12 50 2 51 15 53 10 Lbs. Oz. 7 9 13 18 19 2 19 12 20 6 20 14 21 6 21 14 22 14 23 23 10 24 2 24 8 24 10 25 8 25 12 25 12 26 14 27 27 2 27 14 28 4 29 29 2 29 4 29 8 30 8 30 10 30 10 31 2 31 14 32 4 32 4 32 6 33 2 33 8 33 10 33 12 33 12 34 4 34 8 34 12 35 12 35 14 Age. Birth 3 months. . 6 months. . 7 months.. 8 months . 9 months. . 10 months. 11 months. 12 months. 13 months- 14 months. 15 months. 16 months. 17 months. 18 months 19 months. 20 months. 21 months. 22 months. 23 months. 24 mouths. 25 months. 26 months. 27 months. 28 months. 29 months. 30 months. 31 mouths. 32 months. 33 months. 34 months. 35 months., 36 months. 37 months. 38 months. 39 months. 40 months. 41 months. 42 months. 43 months. 44 months. 45 months. 46 months. 47 months. 48 months. 55 11 57 11 59 9 4i years . 5 years . . 5 J years . 6 years . . 6 J years . 7 years . . 7J years . 8 years. . 8§ years. 9 years . . 9i years. 10 years . Height. Inches. 20i 25i 26* 27 271 27J 28J 281 291 29i m 30J 30| 31J 31i 32 32} 321 321 33f 334 331 331 341 34J 341 35J 351 35| 36i 36i 36J 36| 37 37i 37i 37J 38 38i 38i 38i 3St m 39 40J 41i 42| 431 «i 45i 46| 471 48J 49f 50| 51i Weight. 10 per cent below average. Lbs. Oz. 6 8 i5 'i 15 10 16 7 17 3 17 9 18 2 18 11 18 14 19 7 19 11 20 6 20 9 21 1 21 6 21 11 22 .4 22 12 23 1 23 12 24 3 24 8 24 8 25 25 25 7 25 14 Average. 27 11 27 14 28 7 28 13 29 29 4 29 8 29 11 29 15 31 13 33 3 34 13 36 7 38 39 8 41 10 43 8 45 15 48 3 50 3 52 1 Lbs. Oz. 7 3 16 12 17 6 20 12 21 21 10 21 14 22 10 22 14 23 6 23 12 24 2 24 12 25 4 25 10 26 6 26 14 27 4 27 4 27 12 27 12 28 4 28 12 29 30 12 31 31 10 32 32 4 32 8 32 12 33 33 4 33 8 33 8 33 12 35 6 36 14 38 11 40 8 42 4 44 46 4 55 12 57 14 VISION TESTING. The "illiterate" chart was the one used for testing the vision of these children, most of whom were too young to know the alphabet. This chart consists of eight rows of letter E's, gradually diminishing in size and turned in four different positions. The child was given a 24 PHYSICAL STATUS OF PRESCHOOL CHILDREX. pasteboard letter E and instructed how to turn it to correspond to the position of the particuhir letter in the cliart at which the nurse pointed. The child's own fingers could also be used to indicate the position of the fingers of the E. At the side of each row of letters there was a number which indicated the distance in feet at which the letter should be read by a normal eye. The large letter at the top should be read at a distance of 200 feet: the other rows at 100, 65, 50, 39, 25, 20, and 15 feet. The cMld was placed at a distance of 20 feet from the chart. If he could then turn his letter correctly to correspond to the letters on the 20-foot line, he was given a grade of %%. If he could not see that line but could see the large line above, he was given a grade of f 5 , the numerator of the fraction being always the distance between the chart and the child, and the denominator indicating the line which the child could see. A child who received a grade of |^ saw only two- thii'ds of what he should see; one who received |^ saw only two-fifths of what, he should see. Every child whose vision grade was ?r% or less was referred to an eye specialist. If a child's vision was so poor that at a distance of 20 feet from the chart he could not see the top letter, which should have been visible at 200 feet, he was moved toward the chart until he could see it, and the distance between him and the chart was then measured. For instance, a child might receive a grade of -^. Vision graded ^ was considered ''slightly defective" and not necessarily requiring glasses, but when a child received such a grade the mother was advised to keep his vision under observation; vision graded ^% or worse was tabulated as "seriously defective" and requiring glasses. Important details to be observed in testing vision by this method are: 1. Have the child stand 20 feet away from the chart. 2. Always test the right eye first. 3. Use a card to cover one eye while testing the other, being careful not to press on the covered eye. 4. Use a bright-colored pointer, such as a red penholder. 5. Do not point to the same letter consecutively, since that tends to puzzle the child. 6. Place the pointer directly under the letter, being careful not to touch the letter at any point. 7. Do not spend a great length of time on the larger letters. If you are couA-inced that the child sees them readily, pass on to the lower lines before the child grows tired or loses interest. 8. Always try the letters which are easiest for the child to see, and if the light is better on one side of the chart, as for instance when a lamp is used, point to the brightest letters. HEARING TESTING. In the hearing test the child stood 20 feet away from the nurse who made the examinations, \\dth his head turned so that his right ear was toward her and with his finger in his left ear. The " whispered METHODS AND STANDARDS USED. 25 voice" was used — simple numbers and phrases whispered on tlie exhalation of a breath, 66 or any other number ending in 6 being avoided. After the right ear was tested the child was faced about and the left ear was tested in the same manner. The repetition of the number or phrase heard indicated the child's ability to hear. The advantage of having the same person' conduct all the hearing tests is self-evident, since individual variations in pitch of voice, enunciation, etc., in a number of examiners might result in imeven grading. A cliild standing 20 feet away from the nurse and repeating cor- rectly the whispered words, received a grade of |^. If the child had defective hearing, the nurse advanced slowly toward him until he could hear what she was saying. The gi'ade was then determined by measuring the distance between the child and the nurse. For instance, a child might receive a grade of ^. All cases of defective hearing were referred to a specialist. In the tabulations, hearing was entered as "slightly defective" if the grade was between ^ and ^, and "seriously defective" if it was less than ^, INDICATIONS FOR RECOMMENDLXG REMOVAL OF TONSILS AND ADENOIDS. A difficult point in the consideration of naso-pharyngeal defects in children is the decision as to what cases shall be listed as having enlarged tonsils and adenoids. The fact that standards for deter- mining this have varied greatly among different examiners is proved by the greatly varying percentages of this defect recorded by differ- ent medical school inspectors. Specialists differ greatly in their estimate of what are enlarged tonsils and what forms an indication for their removal. Tliis obvious difference in standards is largely due to the fact that hyperplasia of lymphoid tissue is physiological in young children, and that normal tonsils are proportionately larger in children than in adults. In this study it was, in the first place, found necessary for statistical purposes to determine definite standards for making the entries on the record form; it was also necessary that each of the symptoms present be definitely outlined before removal of tonsils was recom- mended. From the standards which follow it is evident that a very conservative point of view was taken in making recommendations for removal of tonsils or adenoids. Difficulties, of course, arise in deciding whether removal of tonsils and adenoids is indicated, when examining a group of children from many of whom no history can be obtained. The history of previous attacks of tonsilhtis, and of habitual mouth breathing and snoring at night, are important factors in making the decision. In doubtful cases where no history could be obtained, no recommendation for 26 PHYSICAL STATUS OF PRESCHOOL CHILDREN. removal of tonsils and adenoids was made; but it was recommended that the child be examined again by a tln-oat speciahst, and the throat conditions watched. The following was the basis on which recommendations were made for the removal of (1) tonsils, (2) adenoids, or (3) tonsils and adenoids. 1. Indications for removal of tonsils: ( «) Greatly enlarged tonsils, practically filling the throat and making breathing difficult; or (6) Moderately enlarged tonsils with repeated attacks of tonsillitis, ioui' or five a year; or (c) Moderately enlarged tonsils with a severe systemic infection, siich as heart, joints, etc. ; or (d) Greatly enlarged submaxillar%' glands, together with moderately enlarged tonsils. (e) Diseased tonsils; i. e., showing cheesy plugs. Where moderately enlarged tonsils were found but the above positive indications were not present, no recommendations ior removal were made. 2. Indications for removal of adenoids: (a) IMarked mouth breathing with adenoid facies, in a])sence of other causes of nasal obstiiiction. (&) History of habitual snoring and mouth breathing at night (only to be obtained where the mother was present at the examination i. (c) Chronic nasal discharge \vith marked excoriation of the lip (simple colds excluded 1. (d) Marked retraction of the ear drums. (e) Soft palate standing off from the posterior wall of the phar^iix. 3. Indications for removal of tonsils and adenoids: The indications here would be a combination of those of (1) and (2). A digital examination for adenoids was not undertaken in making these examinations, as it was not considered feasible. In all cases where a child was examined to see whether an operation for the removal of tonsils and adenoids was indicated, or whether the case should merely be watched, an examination of the drum membrane was made. Mouth breathing not of marked degree (i. e., that which has not caused any facial deformity and that of a child who breathes through his nose during the examination, even though he has been observed to breathe through his mouth when not self-conscious) w^as not con- sidered an indication for removal of. adenoids. The recommenda- tion in these cases was that the child be watched and that a speciahst be consulted again if the mouth breathing continued. PHYSICAL FINDINGS. INTRODUCTION. The term ''preschool," while literally referring to the years of life prior to school attendance, necessarily applies to a period of variable length, inasmuch as school entrance ages in different sections of the country range from 5 to 8 years. Clinically, early childhood has long been divided into two periods, viz., infancy, the first two years of life, and the preschool age, from 2 to 6 or 7 years. In this study the term ''preschool" covered the period 2 to 6 years inclusive." A very considerable proportion, about 50 per cent, of all the chil- dren of preschool age in Gary were given physical examinations. The proportions of different ages who had physical examinations varied from approximately one-third of the children 3 years of age to about two-thirds of the 6-year-old children. Nearly one-half (1,544) of the 3,125 children of this group given physical examinations were attending kindergarten or primary grades, and the examinations were made in their respective schools. The remaining 1,581 children were attendants at the health confer- ences.^^ A singularly even distribution by sex is noticed in the entire group as well as at each age. Table I. — Age and sex; children from 2 to 7 years of age given physical examination. Age. All ages... 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under 6. C years, mider 7 7 years, under 8. Both sexes. 549 667 6S2 220 Bovs. 261 251 274 337 334 Girls. 1,570 250 245 275 330 348 122 To what extent the social and economic environment of these children affected their physical condition would be difficult to deter- mine; but a consideration of the nationality and income of parents in relation to physical conditions offers interesting data. 11 For explanation of inclusion see Note 1, page 12. "Seepage 11. 27 28 PHYSICAL STATICS OF PRESCHOOL CHILDREN. Children of foreign-born white mothers constituted 60.7 per cent of the cliihh'en in this study. The principal nationalities represented were Serbo-Croatian, Slovjik, Polish, Magyar, Italian, Gerniaii, and Lithuanian. (See General Table 10, p. 72.) Family incomes were tabulated in groups ranging from those below $650 to those of $2,2.50 and over. Practically two-thirds of all the children of foreign-born white parentage belonged to the lower in- come groups, i. e., those under $1,450. (See General Table 12, p. 73.) FINDINGS IN GENERAL. Table II gives an enumeration of the kinds of defects found and their distribution according to sex. The boys on the whole showed a slightly higher percentage having defects than the girls, 96.9 com- pared with 93.6. The large proportion of boys with genital defects (47.1 per cent) unquestionably accounts largely for this variation be- tween the sexes, although dominance in defects of the nasopharynx, bony and muscular systems, and glands also helped to swell the higher percentage for boys. Table II. — Prevalence of defects, by sex; children examination. to 7 years of age given physical Disease or defeft. Num- ber. Total. Without defects Witti disease or defect. Oeneral: Underweight (10 per cent and over) . Anemia Head Abnormal shape Open f ontaneUe Craniotabes 149 2,976 Eyes. Vision defective Diseases and defects other than of vision Conjunctivitis Blepharitis Stye Corneal ulcer Ptosis Corneal opacities Strabismus Ears. Hearing defective. . . . Acute otorrhea Chronic otorrhea Retracted ear drums . Mouth Decayed teeth Malocclusion Gum abscess 303 2^3 163 151 13 2 1 890 738 245 78 70 28 1 13 11 76 <295 25 3 22 258 2,091 2,021 343 101 Per cent. 4.8 95.2 9.7 7.8 5.2 4.8 .4 .1 28.5 2 36.1 7.8 2.5 2.2 .9 (') .4 .4 2.4 9.4 5 1.4 .1 .7 6 8.3 66.9 64.7 11.0 3.2 Boys. Num- ber. 1,507 140 113 105 102 5 1 437 355 127 42 38 16 1 7 7 33 171 14 2 15 148 1,043 1,007 163 53 Per cent. 3.1 96.9 9.0 7.3 6.8 6.6 .3 .1 28.1 235.6 8.2 2.7 2.4 1.0 .1 .5 .5 .21 11.0 f' 1.6 .1 1.0 6 9.5 67.1 64.8 10.5 3.4 Girls. Num- ber. 1,570 101 1,469 163 130 58 49 8 1 453 383 118 36 32 12 6 4 43 124 11 1 7 110 1,048 1,014 180 48 Per cent. 100.0 6.4 93.6 10.4 8.3 3.7 3.1 .5 .1 28.9 2 36.6 7.5 2.3 2.0 .8 .4 .3 2.7 7.9 6 1.2 .1 .4 6 7.0 66.8 64.6 11.5 3.1 1 In 1,081 cases, vision was not tested; hence this number does not include all possible cases of defective vision. 2 Per cent based on 2,044 cases tested, 998 boys and 1,046 girls, s Less than one-tenth of 1 per cent. < In 1,279 cases, hearing was not tested; hence this number does not include all possible cases of defective hearing. 6 Per cent based on 1,846 cases tested, 901 boys and 945 girls. 6 A minimum statement — not all children were examined for this defect. PHYSICAL FINDINGS. 29 Table II. — Prevalence of defects, by sex; children 2 to 7 years oj age given physical examination — Concluded . Disease or defects. With disease or defect — Continued. Naso-pharynx Defective tonsils Adenoids (definite) Adenoids suspected Mouth lireathing Nasal discharge High-arch jialate Nasal obstruction Glands: . Enlarged or greatlj' enlarged. Occipital glands Sulnnaxillary glands Cervical glands Axillary glands Inguinal glands Thyroid glands Heart Heart disease Questionable heart disease. . . Lungs Lung disease Questionable lung disease Skin Eczema Acne Pediculosis Impetigo Infected sores Ringworm Scabies Scars Abdomen Distended abdomen Enlarged liver Hernia Bony and muscular system Beaded ribs Pigeon breast Harrison's groove Enlarged epiphyses Round shoulders Winged scapulse ScoUosis Lordosis Kyphosis Knock-knee Bowlegs Clubfeet Arthritis - Paralysis Nervous system Speech defect Tic Chorea Other nervous disease Very nervous or restless MentaUty Defect apparent Defect suspected GenitaUa, male Prepucial defects Other defects Genitalia, female: Vaginal discharge Both sexes. Num- ber. 2,157 1,620 1,050 207 1,232 299 1,027 1,194 2 704 241 15 51 60 99 14 85 32 11 21 318 80 1 145 8 67 29 9 165 464 423 11 47 1,308 31 53 175 209 ia3 452 57 16 1 194 300 4 3 5 75 54 8 1 4 12 37 19 18 Per cent. 69.0 52.0 33.6 6.6 39.4 9.6 32.9 38.2 29.1 .1 22.5 7.7 .5 1.6 1.9 3.2 .4 2.7 1.0 .4 .7 10.2 2.6 (') 4.6 .3 2.1 .9 .3 5.3 14.8 13.5 .4 1.5 41.9 1.0 1.7 5.6 6.7 3.3 14.5 1.8 . 5 (') 6.2 9.6 .1 .1 .2 2.4 1.7 Boys. (1) .1 .4 1.2 .6 .6 Num- ber. 1,118 836 570 106 670 157 535 651 489 1 3.83 143 12 38 21 39 21 6 15 137 49 1 35 3 35 18 5 97 234 214 5 24 709 15 38 112 146 62 238 27 10 1 92 193 3 2 4 42 28 5 1 3 7 26 12 14 732 719 22 Per cent. 71.9 53.8 36.7 6.8 43.1 10.1 34.4 4L9 31.4 .1 24.6 9.2 .8 2.4 1.4 3.1 .6 2.5 1.4 .4 1.0 8.8 3.2 .1 2.3 .2 2.3 1.2 .3 6.2 15.0 13.8 .3 1.5 45.6 1.0 2.4 7.2 9.4 4.0 15.3 1.7 .6 .1 .5.9 12.4 .2 .1 .3 2.7 1.8 .3 .1 .2 .5 .7 .8 .9 47.1 46.2 1.4 Girls. 1. Num- ber. 1,039 790 480 101 562 142 492 543 419 1 321 98 3 13 39 51 5 46 11 5 6 181 31 110 5 32 11 4 68 230 209 6 23 599 16 15 63 63 41 214 30 102 107 1 1 1 33 26 3 Per cent. 66.2 50.3 30.6 6.4 35.8 9.0 31.3 34.6 26.7 .1 20.4 6.2 .2 .8 2.5 3.2 .3 2.9 .7 .3 .4 11.5 2.0 7.0 .3 2.0 .7 .3 4.3 14.6 13.3 .4 1.5 38.2 1.0 1.0 4.0 4.0 2.6 13.6 1.9 .4 6.5 6.8 .1 .1 .1 2.1 1.7 .2 1 Less than one- tenth of 1 per cent. The actual number of children without physical defects was found to be only 4.8 p)er cent of those examined — 149 out of 3,125. The girls, of whom 6.4 per cent were without defect, made a more fa- 30 PHYSICAL STATUS OF PRESCHOOL CHILDREl^J". vorable showing than the boys, with only 3.1 per cent free from defect. Boys also had the larger number of defects per individual, 44.8 per cent having 5 or more, as compared with 31.2 per cent of . the girls. The average number of defects per child, based on all those who had defects, was 4.2 for both sexes, 4.5 for boys, and 3.8 for girls. This average for the different age groups was as follows : For the 2-year-olds, 2.7; for the 3-year-olds, 3.1; and for the 4-, 5-, and 6-year-olds, 3.5, 4.8, and 5, respectively. The proportion with no defects decreased from 15.1 per cent at 2 years to 0.3 per cent at 6 years. Table III. — Number of defects, by age and sex; children 2 to 7 years of age given physical examination. Total 2 years, 3 years, 4 years, 5 years, 6 vears, 7 vears, children. under 3. under 4. under 5. uiider 6. under 7. under 8. Number of de- Per Per Per Per Per Per Per fects, and sex. cent cent cent cent cent cent cent Num- dis- Num- dis- Num- dis- Num- dis- Num- dis- Num- dis- Num- dis- ber. tri- bu- ber. tri- bu- ber. tri- bu- ber. tri- bu- ber. tri- bu- ber. Iri- bu- ber. tri- bu tion. tion. tion. tion. tion. tion. tion. Both sexes . 3,125 100.0 511 100.0 496 100.0 549 100.0 6r,7 100.0 682 100.0 220 100.0 With defects . . . 2,976 9.5.2 4.-!4 84.9 455 91.3 531 96. 7 660 99.0 680 99.7 218 99.1 Less than 5. 1, 789 .57.2 37 ^ 73. 361 72.8 352 1 64. 1 324 48.6 286 41.9 93 42.3 1 332 10. 6 125 24. 5 84 16.9 48 8.7 38 5.7 27 4.0 10 4.5 2 440 14.1 116 22.7 111 22.4 70 12.8 66 9.9 60 8.8 17 7.7 3 537 17.2 85 16.6 96 19.4 131 2.3.9 95 14.2 98 14.4 32 14.5 4 480 1.5. 4 47 9.2 70 14.1 103 18.8 125 18.7 101 14.8 34 15. 5 5to0 1,123 35.9 60 11.7 90 18.1 172 31.3 311 46.6 372 54. 5 lis fili.a 5 426 1.3.6 31 6.1 56 11.3 59 10.7 124 18.6 122 17.9 34 1.5.5 6 316 10.1 16 .3.1 18 ,3.6 63 11.5 79 11.8 96 14.1 44 20.0 7 196 6.3 6 1.2 9 1.8 32 5.8 47 7.0 84 12.3 IS 8.2 8 123 3.9 3 .6 4 .8 10 1.8 43 6.4 48 7.0 15 6.8 9 62 2.0 4 .8 3 .6 8 1.5 18 2.7 22 .3.2 7 3.2 10 to 15 64 2.0 1 2 2 .4 7 1.3 25 3.7 22 3.2 7 3.2 10 30 21 8 3 1 1 1.0 .7 .3 1 .2 1 3 2 .2 .5 .4 8 13 3 1 L2 1.9 .4 .1 16 1 3 2 2.3 .1 .4 .3 4 2 1.8 11. 2 .4 .9 12 13. .1 (') 0) 14 1 .2 15 1 5 Without defects 149 4.8 77 15.1 43 8.7 18 .3.3 7 1.0 2 .3 2 .9 Boys 1,555 100.0 261 100.0 251 100.0 274 100.0 337 100.0 334 100.0 98 100.0 With defects . . . 1,507 96.9 235 90.0 237 94.4 269 98.2 335 99.4 333 99.7 98 100.0 Less than 5. 810 52.1 194 74.3 174 69. 3 156 56.9 133 39.5 117 35.0 36 36.7 1 136 8.7 57 21.8 32 12.7 17 6.2 15 4.5 9 2.7 6 6.1 2 181 11.6 57 21.8 59 23.5 26 9.5 18 5.3 18 .5.4 3 .3.1 3 242 1.5.6 45 17.2 44 17.5 61 22.3 39 11.6 40 12.0 13 13.3 4 251 16.1 35 13.4 .39 15.5 52 19.0 61 18.1 .50 15.0 14 14.3 5to9 652 41.9 41 15.7 61 24.3 108 39.4 184 64.6 202 60.5 .56 ,57.1 5 Zii 15.0 19 7.3 34 13.5 36 13. 1 65 19.3 63 18.9 16 16.3 6 184 11.8 12 4.6 16 6.4 .36 13. 1 49 14.5 47 14.1 24 24.5 7 121 7.8 4 1.5 4 1.6 24 8.8 31 9.2 50 15.0 8 8.2 8 74 4.8 2 .8 4 1.0 8 2.9 26 7.7 28 8.4 6 6.1 9 40 2.6 4 1.5 3 1.2 4 1.5 13 3.9 14 4.2 9 2.0 10 to 15 45 21 15 5 2 1 1 48 2.9 1.4 1.0 .3 .1 .1 .1 3.1 2 .8 5 1 2 1 1.8 .4 .7 .4 18 5 10 2 1 5.3 1.5 3.0 .6 .3 14 11 4.2 3. 3 4 1 6.1 10 4 1 11 ^ .8 1.0 12 i .6 .3 13 14 1 .4 15 1 1.0 Without defects 26 10.0 14 5.6 5 1.8 2 .6 1 .3 Girls 1.570 100.0 250 100.0 245 100.0 275 100.0 .330 100.0 348 100.0 122 100.0 1 Less than one-tenth of 1 per cent. PHYSICAL, FINDINGS. 31 Table III. — Number of defects, by age and sex; children 2 to 7 years of age given physi- cal examination — Concluded. Total 2 years, 3 years, 4 years, 5 years. 6 years. 7 years. . children. under 3. imder 4. under 5. under 6. under 7. under 8. Number of de- Per Per Per Per Per Per Per fects, and sex. cent cent cent cent cent cent cent Num- dis- Num- dis- Num- dis- Num- dis- Num- dis- Nimi- dis- Num- dis- ber. tri- hu- ber. tri- bu- ber. tri- bu- ber. tri- bu- ber. tri- bu- ber. tri- bu- ber. tri- bu- tion. tion. tion. tion. tion. tion. tion. With defects . . . 1,469 93.6 199 79.6 216 88.2 262 95.3 325 98.5 347 99.7 120 98.4 Less than 5. 979 62.4 179 71.6 187 76.3 196 71.3 191 57.9 169 48.6 57 46.7 1 196 12.5 68 27.2 52 21.2 31 11.3 23 7.0 18 5.2 4 3.3 2 259 16.5 59 23. 6 52 21.2 44 16.(1 48 14.5 42 12.1 14 11.5 3 295 18.8 40 16.0 52 21.2 70 25.5 56 17.0 58 16.7 19 15.6 i 229 14.6 12 4.8 31 12.7 51 18.5 64 19.4 51 14.7 20 16.4 5to9 471 30.0 19 7.6 29 11.8 64 23.3 127 38.5 170 48.8 62 50.8 5 193 12.3 12 4.8 22 9.0 23 8.4 59 17.9 59 17.0 18 14.8 6 132 8.4 4 1.6 2 .8 27 9.8 30 9.1 49 14.1 20 16.4 7 75 4.8 2 .8 5 2.0 8 2.9 16 4.8 34 9.8 10 8.2 8 49 22 19 9 6 3 1 101 3.1 1.4 1.2 :2 .2 .1 6.4 1 .4 2 4 2 .7 1.5 .7 17 5 7 3 3 1 5.2 1.5 2 1 .9 .9 .3 20 8 8 5 1 1 1 1 5.7 2.3 2.3 1.4 .3 .3 .3 .3 9 5 1 7 4 9 4.1 10 to 15 1 1 .4 .4 8 10 .. .. 11 1 1 .4 .4 1 8 12 . 13 Without defects 51 20.4 29 11.8 13 4.7 5 1.5 2 1.6 Correlations with nationality showed that children ot foreign-bom white parentage had slightly more defects than those of native white parentage. The proportion without defect was higher among children of native white mothers than among those of the other nationality groups — 6.8 per cent as compared with only 3.6 per cent among the children of foreign-born white mothers and 2.8 per cent among the colored cliildren. Among the foreign nationalities represented in the study the Polish had the largest proportion without defects, 5.4 per cent, the Magyar came next with 4, then the Slovak with 3.5 per cent, the Itahan with 3.2 per cent, the German with 2.9 per cent, the Lithuanian with 2.4 per cent, and the Serbo-Croatian with only 1.6 per cent free from defects. The average number of defects per individual child among the childi-en w^ho had one or more defects varied in a similar manner; it was lowest, 3.8, for the children of native white mothers, next for the children of foreign-born white mothers, averaging 4.3, and highest, 4.6. for the colored cliildren. Among the foreign nationalities, the Polish had the best record, with only 3.8 defects to a child; the German were next, with 4.1; the Italian followed, with 4.3; the Slovak and Lithuanian, each with 4.4, the Serbo-Croatian, with 4.5; and the Magyar, w4th 4.6. The proportion of children without defects varied also according to fathers' earnings. Thus in families where the fathers earned $2,250 and over the percentage of children without defects was 6.6, as com- pared with a percentage of only 3.9 in families where the fathers earned less than $1,050. 32 PHYSICAL STATUS OF PRESCHOOL CHILDREN. A discussion of the findings in detail follows, the items covered by the examination appearing in the same order as on the record form. HEIGHT AND WEIGHT. The average heights and weights of Gary boys and girls 7 years of age and under, according to age, are recorded in Table IV. As has Chart I. Average heights of boys from birth to 6 years of age; Children's year, Gary, Gary and health conferences combined, and Cnun. Inches. 50 - ^-. :■-'■'■''' ■:^^' . ^^ tff"'''''''^ ^^ - -'*' ,^ ''^^' *^^ ^;^ ;>--•- ^ f" f^*^ t^TM ^ Zr> /" / IS 24 Months 6 12 Children's year Gary health conferences Gary and other health conferences Crum 36 48 54 60 66 72 already been stated, these figures represent the results of stripped examinations, in which measurements were made uniformly and were carefully verified. These figures are lower tlu'oughout than Crum's and Bowditch's, which were used as standards at the exami- nations, and also lower than the averages obtained from the figures submitted by doctors and nurses in all parts of the country during the Children's Year campaign. PHYSICAL, BINDINGS. 33 In explanation of these differences it may be noted that Doctor Crum's figures were based upon children weighed and measured at baby health conferences and baby contests, in many of wliich prizes were given for the most perfect physical development. The children brought to these conferences and contests undoubtedly included many who were taller and heavier than the average. The Children's Year figures were based on a sample of slightly over 1 per cent of the CiiAET II. Average height of girls from birth to 6 years of age; Children's year, Gary, Gary and health conferences combined, and Crum. Inches. 50 30 20 10 ^' -^ ■f^' ^ ^•*"' ^---"' ,>"■'''' m*' / y <;^ 5 18 24 Months 6 12 Children's years Gary health conferences Gary and other health conferences Orum 30 36 42 48 54 60 66 72 total number of cliildren under 6 years of age in the country, who were weighed and measured in the course of the Childi'en's Year weighing and measuring campaign. Though the campaign was designed to reach all classes of the population, the sample included in the tabulation may have been slightly biased, since the California children, who were foimd to be somewhat taller and heavier than 108178°— 22 ^3 34 PHYSICAL STATUS OF PRESCHOOL CHILDREX. children in other parts of the country, were more largely represented in the group tabulated than in the total population under 6 years of age. The Gary heights and weights, however, as already stated, were based upon a very large proportion of the children in the city luider 6 years of age, and there was therefore less chance for these averages to be influenced by any biased selections. Chart in. Average weights of boys from birth to fi years of age; Children's year, Gary, Gary and health conferences combined, and Crum. Pounds. 50 40 30 20 y ^ ,*^'* .■_^> ■J'' fJJ'^' y^ i^'' •^ ^^x' A / Months 6 12 18 24 30 36 Childi'en'syear Gary health conferences Gary and other health conferences Crum 42 oi 60 66 72 On the other hand, the Gary averages are for children in a group in which the nationality composition varies considerably from that in the country as a whole. About three-fifths of the childi-en under 7 years of age in Gary had roreign-born mothers, as compared with only about one-fourth in the country as a whole. The principal foreign nationalities represented were the Slavic groups — including PHYSICAL FINDINGS. 35 Polish, Serbo-Croatian, and Slovak — and the Magyar, the Italian, and the German. Of these, the Italians are of markedly shorter stature than the British stocks which form the principal element in the native white population, and the Poles and Serbs are somewhat shorter, wliile the Germans are of very nearly the same stature as the British stocks. ^^ The special nationality composition of the Chakt I\'. Average weights of girls from birth to 6 years of age; Children's year, Gary, Gary and health conferences combined, and Crum. Pounds. 5n -c= r^"' .^' --'^^.jr*' ,. - . 5 years, under 6. 6 years, under 7 . 7 years, under 8 . Boys 2 years, under 3 . 3 years, under 4. 4 years, under 5. 5 years, under 6. 6 years, under 7. 7 years, under 8. Girls 2 years, under 3 . 3 years, under 4. 4 years, under 5 . 5 years, under 6 . 6 years, under 7. 7 years, under 8. Total chil- dren. 511 496 549 667 682 220 1,555 261 251 274 337 334 1,570 250 245 275 330 348 122 Grade of nutrition. Excelllent. Num- ber. 71 S8 100 126 142 53 259 Per pent. 18.6 13.9 17.7 18.2 18.9 20.8 24.1 16.7 13.4 16.7 15.3 16.9 18. C 21.4 20.4 14.4 18.8 21.1 20.9 23.0 26.2 Good. Num- ber. 2,242 355 349 393 497 492 156 1,156 183 ISO 204 264 252 73 Per cent. 71.7 69.5 70.4 71.6 74.5 72.1 70.9 74.3 70.1 71.7 74.5 78.3 75.4 74.5 1,086 69.2 172 169 189 233 240 83 69.0 68.7 70.6 69.0 68.0 Poor. Num- ber. Per cent. 15.9 11.5 9.8 6.1 5.9 3.6 15.3 11.2 9.9 4.7 5.1 2.0 16.4 11.8 9.8 7.6 6.6 4.9 Very poor. Num- Per ber. cent. 0.7 .8 .4 .4 .4 1.'2 1.4 1.1 .4 .4 .4 .4 .4 .9 1.4 Classified according to nationality, the well nourished showed an equal distribution among children of native and of foreign-born white parentage, although the former group had a slightly higher per cent of " excellently" nourished — 20.9 as against 17. The highest per cent of "excellently nourished" in any nationality appeared in the Lithu- anians (28.9), and the highest per cent of poorly nourished appeared in the Germans (15.1) . Colored children showed an average condition regarding nutrition. The higher income groups contained 20.5 per cent excellently nour- ished children and 9.4 per cent poorly nourished. The lower income groups contained 16.7 per cent excellently nourished and 10 per cent poorly nourished — indicating that higher family incomes do not nec- essarily imply more intelligent feeding and care. PHYSICAL FINDINGS. 39 Table VI. — Grade of nutrition, by color and nationality of mother; children 2 to 7 years of age given physical examination. Total chil- dren. Grade of lutrition. Color and nationality of mother. Excellenl. Good. Poor. Very poor. Num- ber. Per cent.i Num- ber. Per cent.i Num- ber. Per cent.i Num- ber. Per cent.i Total 3,125 580 18.6 2,242 71.7 281 9.0 22 0.7 White 3,047 1,151 1,896 321 313 224 176 157 139 S3 483 71 7 563 240 323 58 36 29 34 33 27 24 82 15 2 18.5 20.9 17.0 18.1 11.5 12 9 19.3 21.0 19.4 28.9 17.0 21.1 2,188 797 1,.391 235 243 172 131 115 91 53 351 49 5 71.8 69.2 73.4 73.2 77.6 76.8 74.4 73.2 65.5 63.9 72.7 69.0 274 106 168 26 29 21 11 9 20 6 46 7 9.0 9.2 8.9 8.1 9.3 9.4 6.3 5.7 14.4 7.2 9.5 9.9 22 8 14 2 5 2 .7 .7 .7 Serbo-Croatian 6 Slovak 1.6 Polish .9 Magyar German 1 .7 Lithuanian All other 4 .8 Not reported 1 Not shown where base is less than 50. Table VII. — Grade of nutrition, by earnings of chief breadwinner; children 2 to 7 years of age given physical examination. Earnings of chief breadwinner. Total chil- drin. Grade of nutrition. Excellent. Num- ber. Per cent. Good. Num- ber. Per cent. Poor. Num- ber. Per cent. Very poor. Num- ber. Per cent. Total Under $050 $650-8849 $850-$l,049 $l,0o0-$l,249 $1,250-$1,449 $1,450-$1,849 $1,850-82,249 $2,250 and over No chief breadwinner and no earnings Not reported 580 18.6 71.7 9.0 110 240 412 491 456 613 262 .303 58 180 11 36 .56 94 88 121 53 68 11 42 10.0 15.0 13.6 19.1 19.3 19.7 20.2 22.4 19.0 2S.3 179 317 342 326 430 183 212 42 122 80.9 74.6 76.9 69.7 71.5 70.1 69.8 70.0 72.4 67.8 8.2 8.3 8.3 10.8 8.6 9.8 9.2 7.3 8.6 8.3 22 .9 2.1 1.2 .4 .7 .3 ANEMIA. Obviously, mere inspection of the mucous membranes for pallor furnishes no accurate guide as to the degree of anemia; but in this type of study blood examinations are not feasible. However, the results here recorded coincide somewhat closely with those of more accurate clinical methods. Nearly 8 per cent of the group were considered anemic. There was very slight difference in this respect between boys and girls, but pallor was more common in the older children. In both sexes a very notable increase in the percentage of pale children appeared after 40 PHYSICAL STATUS OF PRESCHOOL CHILDREN. the fifth year, and a marked increase during the seventh year, when 16,7 per cent showed unusual pallor. The percentage of anemic children was slightly liigher among the children of foreign-born parentage (8.G) than among those of native white parentage (6.2). The colored children showed the highest percentage (11.3). Children in the families of income groups below $1,450 showed a slightly higher percentage of anemia (8.4) than children in the families of the groups where earnings were SI, 450 and over (6.5). While pallor is generally considered a fairly constant sign in malnu- trition, in this study only 13.9 per cent of the most seriously under- weight children were considered anemic. VACCINATION. Unless the mother was with the child, no history as to age or success of smallpox vaccination was obtainable, and the presence of a scar was the evidence on which vaccination was checked. Table VIIL- ■ Vaccination, by age and sex; children 2 to examination. years of age given physical Age and sex. Total children. Vaccinated. Number. Per cent Not vaccinated. Number. Per cent. Not reported whecher vacci- nated. Both sexes 2 years, under 3. 3 years, under 4 . 4 years, under 5. 5 years, under 6. 6 years, under?. 7 years, under 8. Boys 2 years, under 3. 3 years, under 4 . 4 years, under 5. 5 years, under 6 . 6 years, under 7. 7 years, under 8 . Girls 2 years, under 3. 3 years, imder 4 . 4 years, under .'> . 5 years, under 6 . 6 years, imder 7 . 7 years, under 8. 3,125 511 496 .549 667 682 220 1,555 261 251 274 337 «34 1,570 250 245 275 330 348 122 762 44 75 111 195 253 84 368 23 34 48 101 126 36 394 21 41 63 94 127 48 24.4 8.6 15.1 20.2 29.2 37.1 38.2 23.7 467 421 436 470 428 136 1,184 8.8 13.5 17.5 30.0 37.7 36.7 2.5.1 238 217 225 234 208 62 1,174 8.4 16.7 22.9 28.5 36.5 39.3 229 204 211 236 220 74 75.5 91.4 84.9 79.4 70.5 62.8 61.8 76.1 91.2 86.5 82.1 69.4 62.3 63.3 74.8 91.6 83.3 76.7 71.5 63.2 60.7 Of all the children examined, only 24.4 per cent had been vacci- nated. Early vaccination, i. e., by 1 year of age, appears not to have been the rule, for only 8.6 per cent of the children between 2 and 3 years of age had been vaccinated. The percentage increased with each year of age, however, and reached 37.1 by the seventh year, indicating that the school-entrance requirement was the principal PHYSICAL FINDINGS. 41 factor influencing vaccination. About one-sixth (14.6 per cent) of the 1,581 cliildren who had not entered scliool had been vaccinated, while of the 1,544 attending school more than one-third (34.4 per cent) liad been vaccinated. Table IX. — Vaccination, time of vaccination, and entrance in school, by color and nationality of mother; children 2 to 7 years of age given physical examination. Children of - Vaccination, time of vaccination, and Total children. Native white mothers. Foreign-born white mothers. Negro mothers. Moth- ers whose na- Num- ber. Per cent dis- tribu- tion. Num- ber. Per cent dis- tribu- tion. Num- ber. Per cent dis tribu- tion. Num- ber. Per cent dis- tribu- tion. tion- ality was not re- port- ed. Total 3,125 100.0 1, 1.51 100.0 1,896 100.0 71 100.0 7 Not vet in school 1 581 .t(1. fi 596 56 540 51.8 4.9 46.9 949 175 772 2 947 374 99 33 242 570 3 50.1 9.2 40.7 .1 49.9 19.7 5.2 1.7 12.8 30.1 .2 32 45.1 4 Vaccinated 231 1,348 2 1,544 531 142 71 318 1,010 3 7.4 43.1 .1 49.4 17.0 4.5 2.3 10.2 32.3 .1 Not vaccinated. . . . . 32 45.1 4 Not reported In school . . 555 149 40 36 73 406 48.2 12.9 3.5 3.1 6.3 35.3 39 7 2 2 3 32 54.9 9.9 2.8 2.8 4.2 45.1 3 1 Before entering school After entering school 1 Not vaccinated . . 2 Vaccination not reported A comparison by nationality shows that 28.9 per cent of the chil- dren of foreign-born white mothers and 17.8 per cent of those of native white mothers had been vaccinated. It was impossible to get entirely accurate figures as to how many of the school children were vaccinated before and after entering school, on account of the large number of cases in which no report on this subject was made. However, an analysis of the few cases where an answer to this question was obtained revealed the fact that among 132 children of foreign-born white parentage, tliree times as many were vaccinated before entering school as after entering, 99 as compared with 33; while among 76 children of native white parentage, almost as many were vaccinated after entering school as before entering, 36 as compared with 40. The fact that in the mother countries people are accustomed to compulsory vaccination probably accounts for the greater frequency and earlier ages of vaccination among the children of foreign-born parentage. HEAD. While anthropometric head measurements were not made in this study, observations were recorded as to apparent abnormalities in size in 76 cases. More than twice as many boys as girls had abnor- mally shaped heads, the square or rachitic head being the most preva- 42 PHYSTCAI. STATUS OF PRESCHOOL CHILDREN. lent type. Open fontanelles ranging in diameter from 1 centimeter to 2^ centimeters persisted in 13 children in this group, of whom one was past 8 years of age. EYES. It was possible to test vision in only about two-thirds (2,044 cases) of the children who were given physical examinations, since only the exceptional child under 3 years of age comprehended the test at all and only a very small number (124) of children under 4 years did so. Out of the 2,044 children given vision tests, slightly more than one-third (36.1 per cent) showed defective sight of varying degree, with apparently no significant relation to age, although the fifth year showed a slightly higher per cent than any of the others (39) . Table X. — Defect of vision, by age; children 2tol years of age given physical examination. Total children. 2 years, under 3.1 3 years, 4 years, under 4. under 5. 5 years, under 6. 6 years, under 7. 7 years, under 8. Defect of vision. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Nimi- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Total 3, 125 511 496 549 667 6S2 220 Vision tested Vision normal Vision defective. . . Both slightly de- 2,044 1,306 738 461 108 76 29 61 3 1,0S1 100.0 63.9 36.1 22.6 5.3 3.7 1.4 3.0 .1 4 3 1 1 124 85 39 29 3 3 100.0 68.5 31.5 23.4 2.4 2.4 403 248 155 101 IS 20 4 12 "146' 100.0 61.5 38.5 25.1 4.5 5.0 1.0 3.0 631 385 246 163 32 22 6 22 1 100.0 Gl.O 39.0 25.8 5.1 3.5 1.0 3.5 .2 663 414 249 142 44 27 16 19 100.0 62.4 37.6 21.4 6.6 4.1 2.4 1 Q 219 171 48 25 11 4 3 5 100.0 78.1 21.9 11.4 Both seriously defective One normal, one sUghtly defec- tive 5.0 1.8 One normal, one seriously de- fective 1.4 One slightly de- fective, other seriously de- fective. "sof 3 1 372 2.4 .8 2.3 Blind in one or both eyes Vision not tested 1 -2 36 19 1 I Per cent distribution not shown where base is less than 50. The degree of visual abnormality varied from slight defect of one eye to serious defect of one or both, and even blindness. In 108 cases vision was seriously defective in both eyes and the need for glasses imperative, as shown by the test and corroborated by the specialist. Of these children, only 10 per cent were wearing glasses; the other 90 per cent were not even cognizant of the need for them. Strabismus was found m 2.4 per cent of all the children, but cor- rective glasses for this defect were being worn by only about one- seventh of the children Avith this defect. While fewer boys (33) than girls (43) had strabismus, it is worthy of comment that of the 11 children having strabismus and wearing glasses only 1 was a boy. PHYSICAL FINDINGS. 43 E_ye diseases and defects other than those of vision were found in 7.8 per cent of all the children; but twice as large a proportion of those with poor vision (12.6 per ami) as of those with normal vision (6.4 per cent) had other eye defects or diseases. Table XI. — Vision, by sr.r and eye diseuite or other defect; children 2 to 7 years of age given physical examination. Vision and sex. Total children. With eye disease or defect other than vision. Without eye disease. Number. Percent. 3,125 245 7.8 2,880 Vision tested . 2,044 1,306 738 1,081 1,555 177 84 93 68 127 8.7 6.4 12.6 6.3 8.2 1,867 1,222 645 1,013 1,428 998 643 355 557 1,570 91 46 45 36 118 9.1 7.2 12.7 6.5 7.5 907 Normal 697 310 521 Girls 1,452 Vision tested 1,046 663 383 524 86 38 48 32 8.2 5.7 12.5 6.1 960 Normal 625 335 492 On the whole, slight difference was found between the eye con- ditions of the children of native and of foreign-born white parentage. Among the latter, the highest percentage with defective vision was found among the children of Italian parentage. The colored children, although few in number, were freer from eye defects than any other group of children, only 1 out of 71 (1.4 per cent) having eye defect. Table XII. — Eye disease or defect other than of vision, by color and nationality of mother; children 2 to 7 years of age given physical examination. Color and nationality of mother. Total children. With eye disease or defect other than of vision. Nimiber. Per cent Without eye disease. Total. White Native Foreign-born Serbo-Croatian . Slovak PoUsh Magyar Italian German Lithuanian AH other Negro Not reported 3,125 3,047 1,151 1,896 321 313 224 176 157 139 83 483 71 7 245 244 86 158 27 32 n 17 19 11 4 35 1 7.8 8.0 7.5 8.3 8.4 10.2 5.8 9.7 12.1 7.9 4.8 7.2 1.4 2,880 2,803 1,065 1,738 294 281 211 159 138 128 79 448 70 7 44 PHYSICAL STATUS OF PRESCHOOL CHILDREN. EARS. It was not possible to test successfully as many children for hear- ing as for ^dsion, as sufficiently quiet quarters could not always be obtained. The total number examined was about 200 less than the number tested for vision. The total number of cases of defective hearing, including slight and serious defect of one or both ears, was only 25, or 1.4 per cent of those examined. Aside from defective hearing, the other ear defects noted were 25 cases of otorrhea and 258 cases of retracted ear drums. MOUTH. Teeth. The most conspicuous single defect in the entire preschool group was carious teeth. This condition was found in 64.7 per cent of the children examined, the percentages increasing from 21.1 in the 2- to 3-year-old children to 87. 7 in the 6- to 7-year-olds. In the entire group, 83 children had decayed permanent teeth. Table XIII. — Decayed teetJi, 6y age and sex; children 2 to examination. years of age given physical Total chil- dren. With decayed teeth. Age and sex decayed teeth. Total. Temporary only. Temporary and permanent. Permanent only. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Both sexes 3,125 1 104 .^=;. 3 2,021 64.7 1,938 r2.o 80 2.6 3 0.1 2 years, under 3 511 49P 549 607 6S2 220 1,555 403 278 185 134 84 20 548 78.9 56.0 33.7 20.1 12.3 9.1 35.2 108 218 364 533 598 200 1,007 21.1 44.0 66. 3 79.9 87.7 90.9 64.8 108 218 363 520 555 174 976 21.1 44.0 66. 1 78.0 81.4 79.1 62.8 ... i 3 years, under 4 4 years, under 5 1 13 41 25 .2 1.9 6.0 11.4 6 years, under 7 2 1 .3 7 years, under 8 Boys 31 2.0 2G1 251 274 337 334 98 1,570 204 136 92 64 41 11 556 78.2 54.2 33.6 19.0 12.3 11.2 35.4 57 115 182 273 293 87 1,014 21.8 45.8 66. 4 81.0 87.7 88.8 64.6 57 115 181 266 279 78 962 21.8 45.8 66. 1 78.9 83.5 79.6 61.3 3 years, under 4 . 4 years, under 5 1 .4 7 14 9 49 2.1 4.2 9.2 3.1 7 yearS; under 8 Girls 3 .2 2 years, under 3 250 245 275 330 348 122 199 142 93 70 43 9 79.6 58.0 33.8 21.2 12.4 7.4 51 103 182 2G0 305 113 20.4 42.0 6(i. 2 78.8 87.6 92.6 51 103 182 254 276 96 20.4 42.0 oi,;. 2 77.0 79.3 78.7 6 27 16 1.8 7.8 13.1 6 years, under 7 2 1 .6 .8 Information regarding previous dental attention showed that only 3.2 per cent had had any teeth filled, such a very small proportion at once indicating ignorance regarding the importance of dental attention for temporary teeth. One child under 3 years of age had a PHYSICAL. FINDINGS. 45 filled tooth, but 108 between 2 and 3 years had decayed teeth which had not been filled. The lack of dental care was almost as serious among the older children, 95 per cent of those between 6 and 7 with decayed teeth having received no attention whatever. Other mouth defects. Gum abscesses and malocclusion were the other most frequent mouth defects, 3.2 per cent showing the former and 11 per cent the latter defect. Malocclusion showed only slight variations by sex, but a decided increase with age, especially marked after the fifth year. This defect was found to occur approximately three times as often among children with positive diagnosis of adenoids as among others. NASOPHARYNX. Defects of the nasopharynx were the most common type of defect noted in this preschool group, occurring in 69 per cent of all cases, while the defects of the mouth claimed second place with 66.9 per cent. On the whole there was a slightly higher per cent of boys with nasopharyngeal defects than of girls, 71.9 and 66.2 per cent, respec- tively. The highest per cent of nasopharyngeal defects for both sexes (78.1 per cent) appeared in the sixth year. Table XIV. — Nasopharyngeal defect, by age and sex; children 2 to 7 years of age given physical examination. Total children. 2 years, under 3.^3 years, under 4. 1 4 years, under 5 Nasopharyngeal defect, and sex. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Both sexes 3,125 100.0 511 100.0 496 100.0 549 100.0 With nasophai'viigeal defect 2,157 711 342 915 179 10 968 1,555 69.0 22.8 10.9 29.3 5.7 .3 31.0 100.0 250 154 19 49 27 1 261 261 48.9 30.1 3.7 9.6 5.3 .2 51.1 100.O 312 165 34 89 23 1 184 251 62.9 33.3 6.9 17.9 4.6 .2 37.1 100.0 395 165 54 154 21 1 154 274 71.9 30.1 Adenoids only 9.8 Defective tonsils with adenoids. . . High-arch palate onlv 28.1 3.8 Other nasopliaryngeal defect Without nasopharyngeal defect .2 28.1 loao With nasopharyngeal defect 1,118 348 188 488 91 3 437 1,570 71.9 22.4 12.1 31.4 5.9 .2 28.1 100.0 135 79 10 31 15 51.7 30.3 3.8 11.9 5.7 166 83 20 49 13 1 85 245 66.1 33.1 8.0 19.5 5.2 .4 33.9 100.0 199 81 27 82 9 72.6 29.6 Adenoids only 9.9 Defective tonsils with adenoids. . . High-arch palate only 29.9 3.3 other nasopharyngeal defect Without nasopharyngeal defect Girls 126 250 48.3 100.0 75 275 27.4 100.0 With nasopharyngeal defect . 1,039 363 154 427 88 7 5:jl 66.2 23.1 9.8 27.2 5.6 .4 33.8 115 75 9 18 12 1 135 46.0 30.0 3.6 7.2 4.8 .4 54.0 146 82 14 40 10 59.6 33.5 5.7 16.3 4.1 196 84 27 72 12 1 71.3 Defective tonsils only 30.5 Adenoids only 9.8 Defective tonsils with adenoids. . . 26.2 4.4 other nasopharyngeal defect Without nasopharyngeal defect .4 99 40.4 79 28.7 46 PHYSICAL STATUS OF PRESCHOOL CHILDREN. Table XIV. — Nasopharyngeal defect, hy age and sex; children physical exam ination — Concluded . to 7 years of age given Nasopliaryngeal defect, and sex. Both sexes . 5years,under6. Per Num- cent ber. distri- bution. 667 With nasopharjTigeal defect j 521 111 97 268 42 ,5 Without nasopharyngeal defect ' 1-16 Defective tonsUs only. Adenoids only Defective tonsils with adenoids. High-arch palate only Other nasopharyngeal defect. Boys. 100.0 6 years, under 7. Num- ber. 6S2 Per cent distri- bution. 7 years, under 8. Num- ber. 100.0 220 Per cent distri- bution. 100.0 78.1 16.6 14.0 39.9 6.3 .7 21.9 100.0 517 82 106 283 44 2 165 With nasopharyngeal defect 274 Defective tonsils only Adenoids only Defective tonsils with adenoids High-arch palate only Other nasopharjnigeal defect Without nasopharyngeal defect Girls. 45 53 153 22 1 63 330 81.3 13.4 15.7 45.4 6.5 .3 18.7 100.0 With nasopharyngeal defect - - 247 Defective tonsils only j 66 Adenoids only i 44 Defective tonsils with adenoids j 113 High-arch palate only ' 20 Other nasophar>-ngeal defect ! 4 With nasopha^}^lgeal defect I 83 74.8 20.0 13.3 34.2 6.1 1.2 25.2 268 40 62 143 22 1 66 348 249 42- 44 140 22 1 75.8 12.0 15.5 41.5 6.5 .3 24.2 100.0 80.2 12.0 18.6 42.8 6.6 .3 19.8 100.0 71.6 12.1 12.6 40.2 6.3 .3 28.4 162 34 32 74 22 58 73.6 15.5 14.5 33.6 10.0 26.4 100.0 22 122 77.6 20.4 16.3 30.6 10.2 22.4 100.0 70.5 11.5 13.1 36.1 9.8 29.5 Adenoids. Adenoids were definitely diagnosed in one-third (33.6 per cent) of all cliildren examined, while an additional 6.6 per cent were con- sidered as probably having adenoids, this being indicated by the presence of one or more suggestive signs, viz., mouth breathing, nasal discharge vdih excoriation of the nares, high-arch palate, adenoid facies, etc. Table XV.— Adenoid condition, by age and sexj children 2tol years of age given physical examination. Total children. 2 years, under 3. 3 years, under 4. 4years,undcr5. Adenoid condition, and sex. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Both sexes 3,125 100.0 511 100. 496 100.0 549 100.0 1,050 33.6 207 6. 6 1,868 59.8 1,555 100.0 34 34 443 261 6.7 6.7 86.7 100.0 76 47 373 251 15.3 9.5 75.2 100.0 164 44 341 274 29.9 s.o 62.1 Boys 100.0 570 36.7 18 6.9 23 8.8 220 84.3 250 100.0 42 27 1S2 245 16.7 10.8 72.5 100.0 S8 21 IGo 275 32.1 106 879 1,570 6.8 56.5 100.0 >. / 60.2 Girls 100.0 480 101 989 30.6 6.4 63.0 16 11 223 6.4 4.4 89.2 34 20 191 13.9 8.2 78.0 76 23 170 27.6 With adenoids (suspected i &4 64.0 PHYSICAL FINDINGS. 47 Table XV. — Adenoid condition, by age and sex; children 2 to 7 years of age given physical examination — Concluded . Adenoid condition, and sex. Both sexes With adenoids (definite) . . With adenoids (suspected) Without adenoids Boys With adenoids (definite) . . With adenoids (suspected) Without adenoids Girls With adenoids (definite) . . With adenoids (suspected) Without adenoids 5 years, under 6. Num- ber. 315 48 304 337 187 19 131 128 29 173 Per cent distri- bution. 100.0 47.2 7.2 45.6 100. 55.5 5.6 38.9 100.0 6 years, under 7. Num- ber. 361 28 293 191 14 129 348 170 14 164 Per cent distri- bution. 52.9 4.1 43.0 57.2 4.2 38.6 100.0 48.9 4.0 47.1 7 years, under 8. Num- ber. 220 100 6 114 Per cent distri. button. 100.0 45.5 2.7 51.8 100.0 44.9 2.0 5.3.1 4.'5.9 3.3 .50.8 Adenoids were more prevalent among boys, throughout all the pre- school years. Only 6.7 per cent of the children under 3 years of age had adenoids definitely diagnosed and an equal number had "sus- pected" ones. The number of cases of positively diagnosed adenoids increased with age, reaching a maximum of 52.9 during the seventh year, while the maximum in "suspected" cases was reached during the fourth year. Whether adenoids are often present in younger children, and, if present, whether they are of such slow growth that their effects are not manifested by symptoms until the sixth or seventh year, is a question inviting further observation and scientific investi- gation. Only insignificant differences in the prevalence of adenoids betw^een the children of native and of foreign-born white mothers were found, the percentages being 34.3 and 33.8, respectively. The highest per cent of adenoids (41) was found in the children of German parentage, the lowest per cent (19.7) in the colored children. Symptoms suggesting adenoids. (a) Mouth hreatliing.—Oi the entire group of children examined, 39.4 per cent were mouth breathers. Mouth breathing proved a remarkably constant symptom of adenoids, being present in 99.6 per cent of the cases. Only four cases of adenoids in which the child was apparently not a mouth breather were recorded and in six cases mouth breathing persisted after the removal of adenoids. It became a more pronounced habit or defect wdth age; 12.7 per cent of the children 2 to 3 years of age, and 56.2 per cent of those 6 to 7 years of age were moutli breathers. This symptom or defect was more common among boys, showing 43.1 per cent as compared with 35.8 per cent among girls. 48 PHYSICAL STATUS OF PRESCHOOL CHH,DREX. Malocclusion and high-arch palate apparently had a direct relation to mouth breathing, since 62.4 per cent of the children with malocclu- sion and 65.4 per cent of those with high-arch palate were mouth breathers. (b) A^asal discharge. — Nine and six tenths per cent of all children had what was considered a chronic nasal discharge, 10.1 per cent of the boys and 9 per cent of the girls. (c) A'asal obstruction. — Thirtj'-eight and two-tenths per cent of the children showed nasal obstruction. Of the cases of malocclusion 59.8 per cent showed nasal obstruction, as compared with 35.5 per cent of those without malocclusion. id) High-arch palaie. — According to the observations of the examiners, practically one-third of all the children, 1,027 out of 3,125, sho\ved high-arch palate. This condition prevailed in more than half (57.4 per cent) of the cases of malocclusion, and in a still higher percentage (59.5) of the positive cases of adenoids. (e) Ear drums. — Retracted drums, which were considered a cor- roborative sign of adenoids, were found in 258 of the cases examined by the specialist. This is probably an understatement, since not all children were observed by the specialist. In 94.6 per cent of the cliildren with retracted drums, adenoids were also found. Hearing appears to have been only slightly impaired by retracted di'ums either with or without adenoids, since it was found to be defective in only 8, or 3.5 per cent, of the 231 cases of retracted ear drums in which hearmg was tested, as compared with 1 per cent in the rest of the group. (/) Adenoid facits. — So-called typical adenoid facies were observed in slightly more than one- third (37.2 per cent) of the children having adenoids. This symptom was more common in boys and showed an increase with age to the seventh year. Tonsils. A little less than half (45.4 per cent) of the total number of children examined had tonsils which would generally be considered normal, since they showed no enlargement or evidence of disease. More than half (56.3 per cent) the children vdth. abnormal tonsils also had adenoids. Of the entire group 2.5 per cent, or 1 in 40, gave a history of having had tonsils removed. Slight enlargement of the tonsils was far more common than other tonsillar affections, being found in slightlj^ more than one-third (34.9 per cent) of the children. The maximum of simple enlargement, which increased in prevalence with each year of age, was reached during the fifth year, and thereafter a steady and even decrease was shown. Possibly these findings suggest that enlargement without disease may be merely a hyperplasia of lymphoid tissue, normal at this period of life. PHYSICAL. FINDINGS. 49 Table XVI. — Condition of tonsils, by age and sex; children 2 to 7 years of age given physical examination. Condition of tonsils, and sex. Total children. Num- ber. Both sexes 3, 125 Tonsils: Normal Defective Enlarged only Greatly enlarged only Diseased Enlarged Greatly enlarged . Not enlarged Removed Boys. Tonsils: Normal Defective Enlarged only Greatly enlaiged only. Diseased Enlarged Greatly enlarged . . Not enlarged Removed 1,420 1,626 1,091 129 406 266 134 6 79 1,555 Girls. Tonsils: Normal Defective Enlarged only Greatly enlarged only. Diseased .". Enlarged Greatly enlarged. Not enlarged Removed 671 836 574 61 201 132 65 4 48 749 790 517 68 205 134 69 2 31 Per cent distri- bution. 2 years, under 3. Num- 45.4 52.0 34.9 4.1 13.0 8.5 4.3 .2 2.5 100.0 I 261 308 203 188 5 10 5 5 43.2 53.8 36.9 3.9 12.9 8.5 4.2 .3 3.1 100.0 151 110 101 3 6 3 3 250 Per cent distri- bution. 100.0 60.3 39.7 36.8 1.0 2.0 1.0 1.0 57.9 42.1 38.7 1.1 2.3 1.1 1.1 100.0 3 years, under 4, Num- ber. 237 254 211 10 33 21 12 5 251 115 132 110 5 17 10 7 4 245 Per cent distri- bution. 4 years, under 5. Num- ber. 549 47.8 51.2 42.5 2.0 6.7 4.2 2.4 1.0 100.0 223 319 244 20 55 31 23 1 7 45.8 52.6 43.8 2.0 6.8 4.0 2.8 1.6 100.0 108 163 126 8 29 16 12 1 3 275 47.7 50.3 32.9 4.3 13.1 8.5 4.4 .1 2.0 157 93 87 2 4 2 2 62.8 37.2 34.8 122 122 101 5 16 11 5 49.8 49.8 41.2 2.0 6.5 4.5 2.0 115 156 118 12 26 15 11 Per cent distri- bution. 40.6 58. 1 44.4 3.6 10.0 5.6 4.2 .2 1.3 100.0 39.4 59.5 46.0 2.9 10.6 5.8 4.4 .4 1.1 100.0 41.8 56.7 42.9 4.4 9.5 5.5 4.0 1.5 Condition of tonsils, and sex. Both sexes. Tonsils: Normal Defective Enlarged only Greatly enlarged only . Diseased Enlarged Greatly enlarged . . Not enlarged Removed Boys.... Tonsils: Normal . Defective . 5 years, under 6. Num- ber. Per cent distri- bution, 667 263 377 221 42 114 78 34 2 27 100.0 39.4 56.5 33.1 6.3 17.1 11.7 5.1 .3 4.0 100.0 123 i 198 Enlarged only 112 " ! 27 59 41 16 2 16 Greatly enlarged only . Diseased Enlarged Greatly enlarged. . Not enlarged Removed 36.5 58. 8 33.2 8.0 17.5 12.2 4.7 .6 4.7 6 years, under 7. Num- ber. 285 365 176 39 150 99 49 2 32 132 183 98 15 70 49 21 Per cent distri- bution. 100.0 41.8 53.5 25.8 5.7 22.0 14.5 7.2 .3 4.7 100.0 39.5 54.8 29.3 4.5 21.0 14.7 6.3 5.7 7 years, under 8. Num- ber. 104 108 51 13 44 32 11 1 Per cent distri- bution. 47.3 49.1 23.2 5.9 20.0 14.5 5.0 .5 3.6 100.0 42.9 51.0 27.6 3.1 20.4 13.3 6.1 1.0 6.1 108178' 50 PHYSICAL STATUS OF PRESCHOOL CHILDREjST. Table XVI. — Condition of tonsils, by age and sex; children 2 to 7 years oj age given physical examination — Concluded. Condition of tonsils, and sex. 5 years, under 6. Num- ber. Per cent distri- bution. 6 years, under?. Num- ber. Percent distri- bution. 7 years, under 8. Num- ber. Percent distri- bution. Girls. Tonsils: Normal Defective Enlarged only Greatly enlarged only . Diseased Enlarged Greatly enlarged . . Not enlarged Removed 330 100.0 100.0 140 179 109 15 55 37 18 42.4 54.2 33.0 4.5 16.7 11.2 5.5 3.3 153 182 78 24 80 50 28 2 13 44.0 52.3 22.4 6.9' 23.0 14.4 S.O .6 3.7 50.8 47.5 19.7 8.2 19.7 15.6 4.1 1.6 Greatly enlarged tonsils, i. e., those nearly filling the throat, were found in only 8.4 per cent of the children; in one-half these cases the tonsils were also diseased. This degree of enlargement also showed definite increase with age. TonsUs considered ''diseased" were found in 13 per cent of all the children in the group and showed a steady increase from 2 per cent in the 2- to 3-year group to 22 per cent in the 6- to 7-year group. Practically all "diseased'' tonsils showed some enlargement; in only six cases were the tonsils recorded as "diseased" but not "en- larged." Approximately two-thirds of the "diseased" tonsils were associated ^dtli slight enlargement, the other third being recorded as "greatly enlarged." The standards adopted in this study for the recommendation of the removal of tonsils ^'^ compelled a rather conservative viewpoint, but in spite of this it was considered ])y the specialist that removal was required in 39.3 per cent of the 1,626 cases of tonsillar defect. Parents were instructed to keep the throats of the remaining number under observation. Removal was recommended more commonly among the older chil- dren, the percentages based upon total number of children having de- fective tonsils ranging from 6.9 at 2 to 3 years, to 61.9 at 6 to 7 years. Removal of both tonsils and adenoids was recommended in 57.3 per cent of the cases in which both conditions were present. Re- moval of tonsils alone was necessary in but 7.1 per cent of all cases of defective tonsils. Table XVII indicates a definite relation between diseased tonsils and age, but apparently shows little relation between decayed teeth and diseased tonsils. " See p. 25, PHYSICAL FINDINGS. 51 Table XVII. — Prevalence of diseased tonsils, by presence of decayed teeth; children 2 to 7 years of age given physical examination. Age. Children without decayed teeth. Total. With diseased tonsils. Number. Per cent Children with decayed teeth. Total. With diseased tonsils. Number. Per cent.i 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under 6 6 years, under 7 7 years, under 8 403 278 185 134 84 20 2.0 5.8 8.1 19.4 21.4 108 218 364 533 598 200 2 17 40 88 132 42 1.9 7.8 11.0 16.5 22.1 1 Not shown where base is less than 50. There appeared to be no striking difference in the condition of the tonsils of the children of native and foreign-born white parentage; defective tonsils were found in 51.5 per cent of the latter as against 53.2 per cent of the former. The highest per cent found in any na- tionality group was 57.9 in the Serbo-Croatians, while the lowest per cent (47.9) was found among the colored children. Correlations with earnings did not even suggest that the children of well-to-do parents had fewer tonsillar defects than those of poorer families, except that a larger per cent in the higher income groups had had tonsils removed. GLANDS. The condition of the superficial external lymphatic glands as to size and associated infection is shown in Table XVIII. Since a certain degree of swelling and hyperplasia is considered normal during early childhood, only glands described as "enlarged" or "greatly enlarged" were in this study considered as defects. However, in 17.6 per cent of the children glands were not even "palpable," and for this reason further observation seems necessary to determine w^hether or not palpability should be considered normal even at this period of life. 52 PHYSICAL STATUS OF PRESCHOOL CHBLDREIT, Table XVIII. — Condition of glands, by age and sex; children 2 to 7 years of age given physical examination. Total children. 2 years under 3. 3 years under 4. 4 years under 5. Condition of glands, and sex. Num- ber. Percent distri- bution. Num- ber. Per cent distri- bution. Nimi- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Both sexes 3,125 100.0 511 100.0 496 100.0 549 100.0 Glands: Nonpalpable Palpable Enlarged or greatly enlarged Without associated infection . With associated infection Boys 550 1,667 908 143 765 1,555 17.6 53.3 29.1 4.6 24.5 100.0 195 250 66 26 40 261 38.2 48.9 12.9 5.1 7.8 100.0 131 289 76 17 59 251 26.4 58.3 15.3 3.4 11.9 100.0 87 312 150 20 1.30 274 15.8 56.8 27.3 3.6 23.7 100.0 Glands: 260 806 489 74 415 1,570 16.7 51.8 31.4 4.8 26.7 100.0 99 131 31 12 19 250 37.9 50.2 11.9 4.6 7.3 100.0 68 128 45 11 34 245 27.1 55.0 17.9 4.4 13.5 100.0 32 160 82 11 71 275 11.7 Palpable Enlarged or greatly enlarged > Without associated infection. With associated infection Girls 58.4 29.9 4.0 25.9 100.0 Glands: Nonpalpable Palpable Enlarged or greatly enlarged Without associated infection. With associated infection 290 861 419 69 350 18.5 54.8 26.7 4.4 22.3 96 119 35 14 21 38.4 47.6 14.0 5.6 8.4 63 151 31 6 25 25.7 61.6 12.7 2.4 10.2 55 152 68 9 59 20.0 55.3 24.7 3.3 21.5 sex. 5 years under 6. 6 years under 7. 7 years under 8. Condition of glands, and Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Both sexes 667 100.0 682 100.0 220 100.0 Glands: Nonpalpable 71 346 250 34 216 337 10.6 51.9 37.5 5.1 32.4 100.0 47 370 265 28 237 334 6.9 54.3 38.9 4.1 34.8 100.0 19 100 101 18 83 98 8.6 45.5 Enlarged or greatly enlarged Without associated infection. With associated infection 45.9 8.2 37.7 Boys 100.0 Glands: Nonpalpable Palpable Enlarged or greatly enlarged Without associated infection. 36 165 136 17 119 330 10.7 49.0 40.4 5.0 35.3 100.0 18 168 148 13 135 348 5.4 50.3 44.3 3.9 40.4 100.0 7 44 47 10 37 122 7.1 44.9 48.0 10.2 With associated infection 37.8 Girls 100.0 Glands: Nonpalpable Palpable 35 181 114 17 97 10.6 54.8 34.5 5.2 29.4 29 202 117 15 102 8.3 58.0 33.6 4.3 29.3 12 56 54 8 46 9.8 45.9 Enlarged or greatly enlarged Without associated infection. With associated infection 44.3 6.6 37.7 PHYSICAL FINDINGS. 53 Table XIX. — Condition of cervical glands, by condition of tonsils and teeth; children 2 to 7 iiears of age given physical examination. Total chil- dren. Condition of cervical glands. Condition of tonsils and teeth. Nonpalpa- Palpable. Enlarged. Greatly en- larged. Num- ber. Per cent. Num- ber. Per cent. Num- Per ber. ! cent. i Num- ber. Per cent. Total 3,125 898 28.7 1,986 03.6 233 7.5 8 3 With decayed teeth or diseased ton- sils Decayed teetli Diseased tonsils 2,106 1,700 85 321 1,019 476 407 24 45 422 22.6 23.9 28. 2 14.0 41.4 1,438 1,155 56 227 548 68. 3 67.9 65.9 70.7 53.8 186 133 5 48 47 8.8 7.8 5.9 15.0 4.6 6 5 .3 .3 Both Without decayed teeth or diseased tonsils 1 2 .3 .2 The highest per cent of '• palpable " glands (58.3) was found among children in their fourth year. This was a considerable increase over the 48.9 per cent found among children in their third year. Only a slight diminution in palpability was noticeable in the succeeding age groups. Definite "enlargement," sufficient to be considered pathological, was observed in 29.1 per cent of the cases; and all but about 15.7 per cent of this number showed an associated infection causing the en- largement. "Enlarged" glands, with or without associated infection — while present in nearly 13 per cent at 2 to 3 years of age — show^ed num- bers steadily increasing with age, and no tendency to diminution even during the seventh year. As vdth most other defects, there was a slightly higher per cent in boys. The submaxillary and cervical glands were by far the most com- monly "enlarged," and showed associated infection more frequently than any other group. While not so many children had "palpable" submaxillary glands (43 per cent) as had "palpable" cervical glands (63.6 per cent), a larger number — nearly tliree times as many — had "enlarged" submaxillary glands (20.9 per cent) than had "enlarged" cervical glands (7.5 per cent) . A very definite form of infection, such as decayed teeth or diseased tonsils, was associated with 84.3 per cent of the cases of "enlarged" glands. In 14 per cent of the children with both decayed teeth and diseased tonsils, the cervical glands w^ere not even "palpable;" and 21.2 per cent of the children with these defects had "nonpalpable" submaxil- lary glands. Inguinal glands were "palpable" in 1,028 children, or 32.9 per cent of all those included in the study, and "enlarged" in 49 children — 36 boys and 13 girls. No associated infection was reported with any condition of this group of glands. 54 PHYSICAL STATUS OF PRESCHOOL CHILDPvEX, Twenty-one boys and 39 girls were found to have thyroid enlarge- ment, a condition unusual for children of these ages, although fairly common at later ages in the Great Lakes region. Apparentl}^ little significance can be attached to the findings in regard to the other gland groups. Occipital glands were ''palpable'' in only 21 cases (0.7 per cent) and ''enlarged" in only 2. The axillary group of glands were "palpable" in 3.2 per cent of the cases, and enlarged in only 0.4 per cent. "Palpable" epitrochlear glands were reported in 2 boys. Correlations to determine any existing relations between the condition of the glands and other physical factors were made. There appeared to be no connection between glandular enlargement and underweight; in fact, a higher percentage (20.1) of those 10 per cent or more undei-weight had normal glands than of those of average or above average weight (17.6). Similarly, a higher percentage (29.1) of "enlarged" glands was found in children of average weight, or above, than in those 10 per cent or more below average (27.4 per cent). Of 243 pale or anemic children, 133 (54.7 per cent) had "palpable" glands and 98 (40.3 per cent) had "enlarged" glands. Glandular defects showed more striking difference according to nationality than did other defects, being found in 32.5 per cent of the children of foreign-born parentage and in only 23.5 per cent of those of native parentage. The highest percentage having glandular defects (47) was found among the Lithuanians. Table XX. — Condition of glands, by color and nationality of mother; children 2 to 7 years of age given physical examination. Total chil- dren. Condition of glands. Non- palpable. Palpable. Enlarged or greatly enlarged. Color and nationality of mother. Total. With associated infection. Without associated infection. Num- ber. Per cent.i Num- ber. Per cent.' Num- ber. Per cent.i Num- ber. Per cent.i Num- ber. Per cent.i Total 3,125 3,047 1,151 1,896 321 313 224 176 157 139 83 483 71 7 550 544 254 290 39 52 37 18 16 17.6 17.9 22.1 15.3 12.1 16.6 16.5 10.2 10.2 1,667 1,617 627 990 168 160 113 102 94 74 37 242 46 4 53.3 53.1 54.5 52.2 52.3 51.1 50.4 58.0 59.9 53.2 44.6 50.1 64.8 908 8S6 270 616 114 101 74 66 47 39 39 146 20 2 29.1 29.1 23.5 32.5 35.5 32.3 33.0 31.8 29.9 28.1 47.0 30.2 28.2 765 752 236 516 96 92 60 44 32 34 32 126 12 24.5 24.7 20.5 27.2 29.9 29.4 26.8 25.0 20.4 24.5 38.6 26.1 16.9 143 134 34 100 18 9 14 12 15 5 7 20 8 1 4.6 ^^^lite Native 4.4 3.0 5.3 Serbo-Croatian Slovak .5.6 2.9 Polish. . 6.3 Magyar Italian . .. 6.8 9.6 26 18. 7 7 8.4 95 19. 7 5 7.0 3.6 Lithuanian. 8.4 All other 4.1 Negro 11.3 Not reported. . . . 1 ....;. 1 Not .shown where base is less than 50. PHYSICAL FINDINGS. 55 Colored children showed a higher per cent of "palpable" glands than any other racial group; a per cent of "defective" glands midway between those of the children of foreign-born white parentage and of native white parentage; and a decided lack of "associated infection" with all degrees of enlargement. LUNGS. A comparatively small number of children showed symptoms of respiratory disease. Positive diagnoses on one examination were possible in only 11 cases (0.4 per cent), the majority of these being bronchitis. An additional 21 cases (0.7 per cent) were considered suspicious, and were referred for medical supervision." A slightly higher percentage (18.8) of diseased tonsils was found in children with lung disease (definite and suspected) than in those without such disease (12.9 per cent). HEART. A positive diagnosis of organic heart disease was possible in only 14 cases, or 0.4 per cent of all. A group of 85 cases (2.7 per cent) were reported as "suspected heart disease" and requiring observation, since it was impossible to make a definite diagnosis on only one examination. Functional murmurs without other heart s3^mptoms were reported in 68 cases (2.2 per cent). Onl}^ 2 cases of functional murmur were reported as early as the third year, but the number steadily increased with age, reaching 25 during the seventh year. SKIN. Under this subject were included not only definite skin diseases but pediculosis as well. This latter condition far exceeded all other skin affections, being found in 4.6 per cent of all the children. Pediculosis was three times as frequent among girls as among boys, and its preva- lence increased steadily with age, so that by far the larger number of cases was found among children over 5 years of age. The number of cases of pediculosis of the body was practically negligible. Of the skin diseases, eczema was most common, occurring in 80 cases (2.6 per cent). There were also 67 cases of infected sores; 29 of ringworm, chiefly of scalp and face; 9 cases of scabies; and 8 cases of impetigo. With the exception of infected sores and ringworm these diseases were more commonly found in the later ages, i. e., those over 5 years. - Under "other conditions " were listed scars, with their causes when these could be ascertained. A surprisingly large number, 165, or 5.3 per cent, were found to have scars of one kind or another. "Un- reported causes " was recorded for the majority, but the most common- ly reported causes were bums (26.7 per cent) and operations (15.2 per cent). Doubtless many of the scars, the causes of which were unreported, were in fact the result of burns or other accidents. 56 PHYSICAL STATUS OF PRESCHOOL CHILDREN. Abnormal skin conditions were more common in the older children, 14.1 per cent in the seventh year or later as compared with 4.9 per cent during the third year. No marked relation was shown between underweight and abnormal skin condition, but malnutrition, plus skin defects, was found to be accompanied by a high per cent of anemia. The increase in skin defects was from zero among the ''excellent" to 21.6 per cent among the ''good, " 27.3 per cent among the "poor, " and 60 per cent among the "very poor." Children of foreign-bom mothers were more commonly subject to abnormal skin conditions than those of native parents, the percent- ages being 13.2 and 4.9, respectively. The groups in which the per- centage of this defect most nearly approached that of the native white group were the German, with 5.8 per cent; and the Polish, with 7.1 per cent; a maximum of 22.9 per cent was reached among the Italian and the Lithuanian. Correlations with incomes show definitely that the children of the more prosperous families were freer from abnormal skin conditions than those in the lower-income groups ; the percentage of children in whom such conditions were found decreased from 16.4 among families where the father earned less than S850 to only 5.6 in the group where the fathers earned S2,250 or more. Low standards of living, including lack of bathing facilities, ignorance as to proper care and habits of the body and proper food, etc., prevailed to a greater degree among the families of the low-income groups. ABDOMEN. Abdominal distension was most frequently observed in the younger children, being present in 19.8 per cent of those in their third year of age. A gradual decrease in the prevalence of this defect was notice- able in each succeeding age group. This condition was evenly dis- tributed according to sex. Distended abdomen was more commonly observed in children with rachitic defects (23.1 per cent) than in nonrachitic children (11 per cent) . Table XXI. — Distended abdomen, by age and sex; children 2 to 7 years of age given physical examination. Age and sex . ; Total children. Both sexes 3, 125 2 years, under 3 511 3 years, under 4 496 4 years, under 5 549 5 years, under 6 667 6 years, under 7 682 7 years, under 8 , 220 With distended abdomen. Number. Per cent, 423 101 75 70 77 74 26 13.5 Without distend- ed abdo- men. 2,702 19.8 410 15.1 421 12.8 479 11.5 590 10.9 608 11.8 194 PHYSICAL FINDINGS. 57 Table XXI. — Distended abdomen, by age and sex; children 2 to 7 years of age given physical examination — Concluded. Age and sex . Boys 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under G 6 years, under 7 7 years, under 8 Girls 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under 6 6 years, under 7 7 years, under 8 Total children. 261 251 274 337 334 1,570 250 245 275 330 348 122 With distended abdomen. Number. Per cent 50 35 40 42 32 15 209 13.8 19.2 13.9 14.6 12.5 9.6 15.3 13.3 20.4 16.3 10.9 10.6 12.1 9.0 Without distend- ed abdo- men. 1,341 211 216 234 295 302 83 1,361 199 205 245 295 306 111 Of the children of average weight or above, 19.5 per cent had abdominal defect, while smaller percentages — 11.4, 10.5, and 12.5 — of the children in the underweight groups showed this defect. There were 11 cases of enlarged liver — 0.4 per cent of all exam- ined — and none of enlarged spleen. Hernias were found in 47 cases, 36 umbilical and 11 inguinal, only 1 of the latter variety being in a girl. Four boys had operations for this condition. BONY AND MUSCULAR SYSTEMS. A simple enumeration of bony and muscular defects is given in General Table 7, page 69. One defect of the bony and muscular system appeared in 41.9 per cent of the children. Distribution of these defects by age showed a gradual increase from 24.9 per cent in the third year to 56.2 per cent in the seventh year. Table XXII. — Defects of bony and muscular system, by age and sex; children 2 to 7 years of age given physical examination. Age and sex. Total children. With defects of bony and mus- cular system. Number. Per cent. Without defects of bony and mus- cular system. Both sexes 2 years, under 3 . 3 years, under 4. 4 years, under 5. 5 years, under 6 . 6 years, under 7 . 7 years, under 8 . Boys 2 years, under 3 . 3 years, under 4. 4 years, under 5 . 3,125 1,308 511 496 549 667 682 220 1,555 127 144 204 324 383 126 709 261 251 274 68 76 111 41.9 24.9 29.0 37.2 48.6 56.2 57.3 45.6 26.1 30.3 40.5 384 352 345 343 299 94 193 175 163 58 PHYSICAL STATUS OF PRESCHOOL CHILDREN. Table XXII. — Defects of bony and muscular system, by age and sex; children 2 to 7 years of age given physical examination — Concluded. Age and sex. 5 years, under fl . 6 years, under 7. 7 years, under 8 . Girls Total children. 337 334 1,570 2 years, under 3 . 3 years, under 4 . 4 years, under 5. 5 years, under 6 . 6 years, under 7. 7 years, imder 8 . 250 245 275 330 348 122 With defects of bony and mus- cular system. Number. Per cent 183 208 63 59 68 93 141 175 63 54.3 62.3 64.3 38.2 23.6 27.8 33.8 42.7 50.3 51.6 Without delects of bony and mus- cular system. 154 126 35 971 191 177 182 189 173 69 On the whole, the percentage of boys (45.6) with defects of the bony and muscular systems, exceeded that of girls (38.2). In general, the incidence of these defects in the various weight groups was not sufficiently uniform to suggest any definite correlation with weight. (See general Table 5, p. 68.) Bony defects of rachitic origin. Since a large number of the bony defects were considered to be of rachitic origin, tabulations based on this causative factor were made. Bony defects tabulated as ^'unquestionably" the result of rickets were: Beaded ribs, Harrison's groove, enlarged epiphyses, pigeon breast, craniotabes, and lumbar kyphosis if it was accompanied by one of the group of '^ probable signs" of rickets such as large square head or open fontanelle after 18 months of age. Bowlegs or knock- knees were considered as merely additional evidence of rickets and, unless other rachitic signs appeared with them, were disregarded. In combination with lumbar kyphosis they were called unquestion- able signs of rickets. Three hundred and eighty-eight children (12.4 per cent) were con- sidered as having defects definitely the result of rickets, while an additional 79 children (2.5 per cent) had defects ''probably of rachitic origin," bringing the total of those having defects possibly due to early rickets to 14.9 per cent. Rickets is usually conceded to be a disease of infancy, the symp- toms of which disappear early under proper dietary and hygienic conditions; hence the prevalence and persistence of these excessively high percentages probably due to rickets lead to the inference that the corrective measures of diet, hygiene, and environment had not entered into the lives of this preschool group. This conclusion is perhaps further substantiated by the fact that these defects showed PHYSICAL FINDINGS. 59 no tendency to diminish, even in the older children, but increased steadily. Correlations between bony defects of rachitic origin and the con- dition of the teeth showed a higher per cent (75.2) of decayed teeth in the children with such bony defects than in those without (62.8). Slightly more than half (54.2 per cent) of the children with rachitic bone defects were found to have defective tonsils as compared with 51.7 per cent of children without such defects. Children without rachitic bone defects had a much higher per cent of nonpalpable lymphatic glands (19.4 per cent) than those with such defects (7.3 per cent) . The prevalence of rachitic defects was greater among the children of foreign-born white pa,rentage (17.7 per cent) than among those of native white parentage (10.4 per cent). Of the former, the Serbo- Croatians had the highest per cent (22.1 per cent). Contrary to the general impression, the colored children, although a small group, showed only 14.1 per cent with rachitic defects, a per cent slightly less than the average for the entire group (14.9 per cent). While rachitic defects appeared to be slightly associated with underweight, their incidence increased only from 13.1 per cent in the ''above average" group to 18.8 per cent in the group most seriously underweight. (See general Table 5, p. 68.) On the other hand, only 12.2 per cent of the children with rachitic defects as compared with 9.3 per cent of the nonrachitic showed 10 per cent or more deviation from average weight for height. Postural defects. Included in this group were the defects due to lack of muscular development, namely, romid shoulders, winged scapulae, scoliosis and lordosis, and, when not associated with rickets, bowlegs and knock-loiees. The total number of children with one or more postural defects was 793, or 25.4 per cent of all those examined. In children 6 to 7 years of age the number increased to over one-third of the total. This at first appears to be an excessively high percentage; but to what extent the conditions may be interpreted as actual defects is perhaps debatable, considering that between the ages of 2 and 6 years muscular development is poor and muscle tonus practically lacking. This characteristic lack of muscular development probably explains in part the frequency of winged scapulae in this study. The percent- age of children having this defect was 14.5 for the whole group, and was noticeably higher after the fourth year. The increase in scoliosis appeared more prominently after the fifth year. Postural defects, on the whole, appeared to bear some relation to underweight; for 28.7 per cent of the children 10 per cent or more 60 PHYSICAL STATUS OF PRESCHOOL CHrLDREN". below average weight for height had one or more postural defects, as contrasted with 20.4 per cent of those whose weight was average or above. Table XXIII. — Postural defects, by age and sex; children 2 to 7 years of age given physical examination. Age and sex. Both sexes. 2 years, under 3. . 3 years, under 4.. 4 years, under 5.. 5 years, under 6.. 6 years, under 7. . 7 years, under 8. . Total children. 511 496 549 667 6S2 220 Boys. 2 years, under 3. 3 years, under 4. 4 years, under 5. 5 years, under 6. 6 years, under 7. 7 years, under 8. Girls 2 years, under 3. 3 years, under 4. 4 years, under 5. 5 years, under 6. 6 years, under 7 . 7 years, under 8 . 261 251 274 337 334 250 215 275 330 348 122 With postural de- fects. Number. Per cent 56 68 117 220 255 77 418 30 40 56 125 131 36 375 25.4 11.0 13.7 21.3 33.0 37.4 35.0 26.9 11.5 15.9 20.4 37.1 39.2 36.7 23.9 26 2S 61 95 124 41 10.4 11.4 22.2 28.8 35.6 33.6 Without postural defects. 2,332 455 428 432 447 427 143 1,137 231 211 218 212 203 62 1,195 224 217 214 235 224 Si Among the colored the percentage of postural defects was very high — 52.1; among the children of native white parentage it was 21.8, and among those of foreign-born white parentage it was 26.6. The influence of environment and living standards upon develop- ment as reflected in faulty posture is sihown by the incidence of the highest per cent of postural defects in the lower wage group; this per cent was 27.6 in families whose incomes were less than SI, 450, as contrasted with 22.1 per cent in families whose incomes were $1,450 or over. (See General table 4, p. 67.) Arch measurements. Since there appeared to be no standard for grading flat foot, and since anatomical data regarding arches in children's feet were notably lacking, the suggestion of a prominent orthopedist that the study include a measurement of the height of the arches in children was carried out. (See instructions, p. 20.) The results are herewith given without any attempt at interpretation, since obviously other and more detailed investigations on the subject must follow before the material in this report can be evaluated. PHYSICAL FINDINGS. 61 Measurements were made on 3,064 children, and in only 65 cases were the arch heights found to be unequal in the two feet. In com- puting median arch measurements these 65 cases were discarded. The accompanying table gives median arch measurements ac- cording to sex and age: Median arch measurements. Age. 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under 6 6 years, under 7 7 years, under S Both sexes. Inches. Boys. Inches. ., Inches Girls. The increase in arch height with age probably parallels the mus- cular development in the feet, which apparently increases with use. Careful observations were made and recorded as to the relation of the axes of the foot and leg while the child was walking. Of all the children 81.3 per cent had what is commonly known as the " straight" type of foot, i. e., they toed straight ahead, the axes of the foot and leg making a right angle; 10.3 per cent were of the '4nflared" type with the foot deflected in; while 6.9 per cent were the "outflared" type with the foot deflected out. Correlations between the position of the foot and the median height of the arch indicate that the deflections in and out increased with the height of the arch, as the accompanying figures show: Median arch measurements. Age. Inflare. Outflare. Straight foot. 2 years, under 3 3 years, under 4, 4 years, under 5. 5 years, under 6 6 years, under 7 7 years, under 8 Inches. Inches. Inches. NERVOUS SYSTEM. The prevalence of defects of the nervous system is shown in General Table 1.^^ Of the entire group, nervous defects were noted in 75 children — only 2.4 per cent. Individual defects were too few to be of definite value statistically, and the clinical findings are equally valueless without a more detailed and thorough examination than was possible in this study. isSeep.65. 62 PHYSICAL STATUS OF PRESCHOOL CHILDREN. Functional speech defects were noted in 1.7 per cent of the children, practically equally distributed according to sex. They were chiefly stammering, stuttering, and lisping, with a few cases of poor articu- lation. MENTAL CONDITION. No mental tests were conducted in connection with this study. If the observations of the examining physicians or nurses led to even a suspicion of abnormality, the observations were supplemented by information gained from the teacher, the mother, or the school physician who conducted mental tests. Nineteen apparent mental defectives and 18 suspected cases came under the observation of the physicians during the course of the study. GENITALIA. An astonishingly high per cent of genital defects was found in boys, due almost entirely to adherent or contracted prepuce, there bemg 437 cases (28.1 per cent) of the former and 289 (18.6 per cent) of the latter. There were recorded only 22 cases (1.4 per cent) of other abnormalities of the genitalia than of the prepuce. The data from this study are submitted merely as the results of careful routine physical examinations based upon somewhat stand- ardized methods. No attempt has been made to draw conclusions, since the findings point very definitely to the need for further consecutive study of the child before correlations between existing physical defects and their possible causes may be determined. Studies of racial, economic, and envu'onmental factors, breast feeding, growth, intercurrent dis- eases, diet, sleep, and recreation, correlated with the objective findings of periodic physical examinations covering the period from birth to school age, would undoubtedly add a great deal to the present knowledge of the physical development of the child and the factors which modify it. Such studies would also in time afford a means of evaluating present efforts in the field of child hygiene. APPENDIXES. 63 APPENDIX A. GENERAL TABLES ON PHYSICAL FINDINGS OF THE PRESCHOOL CHILD. Table 1.- -Prc valence of defects, by sex; children examination. to 7 years of age given physical Summary of defects. Total Without defects With defects Underweight (10 per cent and over) . . Anemia Head defects Eye defects Defective vision Other defect Ear defects Defective hearing Other defect Mouth defects Nasopharyngeal defects Enlarged glands Heart defects Lung defects Abnormal skin condition Abdominal defects Defects of bony and muscular system Bony defects of rachitic origin Postural defects Defects of nervous system Defects of mentality Defects of genitalia Both sexes. Num- ber. 3,125 149 2,976 303 243 163 1890 738 2-15 •48 25 25 2,091 2, 157 908 99 32 318 464 1,308 467 793 75 37 769 Per cent distri- bution. 100.0 4.8 95.2 9.7 7.8 5.2 28.5 2 36.1 7.8 1.5 <1.4 .8 66.9 69.0 29.1 3.2 1.0 10.2 14.8 41.9 14.9 25.4 2.4 1.2 24.6 Boys. Num- ber. 1,555 48 1,507 140 113 105 437 355 127 30 14 17 1,043 1,118 489 48 21 137 234 709 304 418 42 26 732 Per cent distri- bution. 100.0 3.1 %.9 9.0 7.3 6.8 28.1 '35.6 8.2 1.9 n.6 1.1 67.1 71.9 31.4 3.1 1.4 8.8 15.0 45.6 19.5 26.9 2.7 1.7 47.1 Girls. Num- ber. 1,570 101 1,469 163 130 58 453 383 118 18 11 8 1,048 1,039 419 51 11 181 230 599 163 375 33 11 37 Per cent distri- bution. 100.0 6.4 93.6 10.4 8.3 3.7 28. 9 '36.6 7.5 1.1 ♦1.2 .5 66.8 66.2 26.7 3.2 .7 11.5 14.6 38.2 10.4 23.9 2.1 .7 2.4 1 In 1,081 cases vision was not tested; hence this number does not include all possible cases of defective vision. 2 Per cent based on 2,044 cases tested, 998 boys and 1,046 girls. ' In 1,279 cases hearing was not tested; hence this number does not include all possible cases of defective hearing. ■• Per cent based on 1,846 cases tested, 901 boys and 945 girls. Table 2.— Specified defects, by age and sex; children 2 to 7 years of age given physical examination. Age and sex. Both sexes 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under 6 6 years, under 7 7 years, under 8 108178°— 22 5 Total chil- dren. With anemia. Num- ber 3,125 511 496 549 667 682 220 243 5 3 21 67 114 33 Under- weight (10 per cent and over). Per Num- cent. ber. 1.0 .6 3.8 10.0 16.7 15.0 Per cent. 9.7 16.6 11.9 10.2 6.6 7.0 5.0 With decayed teeth. Num- ber. 2,021 108 218 364 533 59S 200 Per cent. 64.7 21.1 44.0 66.3 79.9 87.7 90.9 With defective tonsils. Num- ber. 1,626 203 254 319 377 365 108 Per cent. 52.0 39.7 51.2 58.1 56.5 53.5 49.1 With adenoids, positive and suspected. Num- ber 1, 257 68 123 208 363 389 106 65 Per cent. 40.2 13.3 24.8 37.9 54.4 57.0 48.2 66 PHYSICAL STATUS OF PRESCHOOL CHmDREN. Table 2. — Specified defects, by age and sex; children 2 to 7 years of age given physical examination — Concluded . Age and sex. Total chil- dren. "With anemia. Num- ber. Per cent. Under weight (10 per cent and over). Num- ber. With decayed teeth. Per Num- cent. ber Per cent. With decayed tonsils. With adenoids, positive and suspected. Numi ber. Per Num- cent. ber Per cent. Boys 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under 6 6 years, under 7 7 years, under 8 Girls 2 years, under 3 3 years, under 4 4 years, under 5 5 years, under 6 6 years, under 7 7 years, under 8 7.3 64.8 836 53.8 43.5 261 251 274 337 334 98 1,570 2 1 10 32 53 15 130 .4 3.6 9.5 15.9 15.3 8.3 43 29 28 16 20 4 163 16.5 11.6 10.2 4.7 6.0 4.1 10.4 250 245 275 330 348 122 1.2 .8 4.0 10.6 17.5 14.8 16.8 12.2 10.2 8.5 8.0 5.7 57 115 1S2 273 293 87 1,014 21.8 45.8 66.4 81.0 87.7 88.8 64.6 110 132 163 198 183 50 42.1 52.6 59.5 58.8 54.8 51.0 50.3 41 69 109 206 205 46 581 15.7 27.5 39.8 61.1 61.4 46.9 37.0 51 103 1S2 260 305 113 20.4 42.0 66.2 78.8 87.6 92.6 93 122 156 179 182 58 37.2 49.8 56.7 54.2 52.3 47.5 27 54 99 157 184 60 10.8 22.0 36.0 47.6 52.9 49.2 Age and sex. With enlarged glands. Num- ber. Per cent. With abnormal skin condition . With bony and muscular defects. Total. Num- ber. Per cent. Num- ber. Per cent. Of rachitic origin. Num- ber. Per cent. Postural. Nmn- ber. Per cent. Both sexes 2 years, under 3 . 3 years, under 4 . 4 years, under 5. 5 years, under 6 . 6 years, under 7 . 7 years, under 8. . Boys 2 years, under 3 . 3 years, under 4 . 4 j-ears, under 5 . 5 years, under 6 . 6 years, under 7 . 7 years, under 8. Girls 2 years, under 3 . 3 years, under 4 . 4 years, under 5 . 5 years, under 6. 6 years, under 7 . 7 years, under 8 . 29.1 318 10.2 1,308 41.9 14.9 793 25.4 66 76 150 250 265 101 12.9 15.3 27.3 37.5 38.9 45.9 31.4 25 27 50 80 96 40 137 4.9 5.4 9.1 12.0 14.1 18.2 127 144 204 324 383 126 708 24.9 29.0 37.2 48.6 56.2 57.3 4.5.6 54 42 73 106 148 44 304 10.6 8.5 13.3 1.5.9 21.7 20.0 19.5 56 68 117 220 255 77 418 11.0 13.7 21.3 33.0 37.4 35.0 26.9 31 45 82 136 148 47 419 11.9 17.9 29.9 40.4 44.3 48.0 26.7 11 16 23 38 32 17 181 4.2 6.4 8.4 11.3 9.6 17.3 11.5 68 76 111 183 208 63 599 26.1 30.3 40.5 54.3 62.3 64.3 38.2 163 12.6 8.8 17.5 22.3 29.3 2&6 10.4 30 40 56 125 131 36 375 11.5 15.9 20.4 37.1 39.2 36.7 23.9 35 31 68 114 117 54 14.0 12.7 24.7 34.5 33.6 44.3 5.6 4.5 9.8 12.7 18.4 18.9 59 68 93 141 176 63 23.6 27.8 33.8 42.7 50.3 51.6 8.4 8.2 9.1 9.4 14.4 13.1 26 28 61 95 124 41 10.4 11.4 22.2 28.8 3.5.6 33.6 GENERAL TABLES. 67 Table 3. — Specified defects, by color and nationality of mother; children 2 to 7 years of age given physical examination. Total chil- dren. Children of— Defect. Native white mothers. Foreign-born white mothers. Negro mothers. Moth- ers whose na- Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. tional- ity was not re- port- ed.! Total 3,125 100.0 1,151 100.0 1,896 100.0 71 100.0 7 Anemia 243 303 245 1,626 1,257 908 318 467 793 7.8 9.7 7.8 52.0 40.2 29.1 10.2 14.9 25.4 71 114 86 612 473 270 56 120 251 6.2 9.9 7.5 53.2 41.1 23.5 4.9 10.4 21.8 164 182 158 976 761 616 '250 336 505 8.6 9.6 8.3 51.5 40.1 32.5 13.2 17.7 26.6 8 7 1 34 22 20 12 10 37 11.3 9.9 1.4 47.9 31.0 28.2 16.9 14.1 52.1 Underweight (10 per cent and over)... Eye disease or defect other than of 4 Adenoids (definite and suspected) Enlarged glands 1 2 Abnormal skin condition Bony defects of rachitic origin 1 1 Per cent not shown where base is less than 50. Table 4.- -Specified defects, by earnings of chief breadwinner; children 2 to 7 years of age given physical examination. Earnings of chief breadwinner. Defect. dren. Under $1,450. S 1,450 and over. Not re- ported. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Total 3,125 100.0 1,767 100.0 1,178 100.0 180 100.0 Anemia 243 303 245 1,626 1,257 908 318 467 793 7.8 9.7 7.8 52.0 40.2 29.1 10.2 14.9 25.4 149 176 141 938 714 533 214 296 487 8.4 10.0 8.0 53.1 40.4 30.2 12.1 16.8 27.6 76 111 87 602 476 322 80 149 260 6.5 9.4 7.4 51.1 40.4 27.3 6.8 12.6 22.1 18 16 17 86 67 53 24 22 46 10.0 8.9 Eye disease or defect other than of vision Defective tonsils 9.4 47.8 Adenoids (definite and suspected) 37.2 Enlarged glands 29.4 Abnormal skin condition 13. 3 Bony defects of rachitic origin 12.2 Postural defects 25.6 68 PHYSICAL, STATUS OF PRESCHOOL CHILDREN. Table 5. — Per cent of children with specified defects, by deviation from average weight for height; children 2 to 7 years of age given physical examination. Defect. Total children Relation of weight to height. and above. Below average. Less than 7 per cent. 7 per cent, less than 10. 10 per cent and over. Total Anemia Eye disease Decayed teeth Naso-pharyngeal defects Defective tonsils, no adenoids — Adenoids, no defective tonsils. . . Defective tonsOs and adenoids. . . Diseased tonsils Other Enlarged glands Abdominal defects Defects of bony and muscular system Bony defects of rachitic origin. . . Postural defects 100.0 100.0 100.0 7.8 5.0 64.7 69.0 22.8 11.0 29.3 13.0 6.0 29.1 14.8 41.9 14.9 25.4 5.5 4.4 66.7 70.5 23.1 11.8 30.4 13.0 5.2 29.1 19.5 37.6 13.1 20.4 7.9 5.4 66.9 70.0 21.9 11.8 29.4 13.0 6.9 29.1 11.4 45.2 16.2 28.6 100.0 10.8 6.2 61.0 64.1 21.4 9.0 28.2 15.2 5.6 30.3 10.5 42.1 14.2 30.7 100.0 13.9 5.0 51. 2 04.0 26.1 6.6 25.1 10.9 6.3 27.4 12.5 47.2 18.8 28.7 Table 6. — Specified skin diseases, by age and sex; children 2 to 7 years of age given physical examination. Age and sex. Both sexes 2 years, under 3., 3 years, under 4.. 4 years, imder5.. 5 years, under 6.. 6 years, under 7. . 7 years, under 8.. Boys 2 years, imderS.. 3 years, imder4.. 4 years, under 5. . 5 years, under 6.. 6 years, under 7. . 7 years, under 8.. Girls 2 years, under 3. . 3 years, under 4.. 4 years, under 5.. 5 years, iuider6.. 6 years, under 7. . 7 years, under 8. . Total chil- dren 3,125 511 496 549 667 682 220 1,555 261 251 274 337 334 1,570 250 245 275 330 348 122 Children with- Eczema. Num- ber. Per cent. Pediculosis. Num- ber. 2.6 145 4.6 Per cent. Impetigo. Num- ber 49 1.2 .4 2.9 3.1 4.0 3.6 3.2 3.3 3.9 5.7 4.1 2.0 2.5 2.4 2.3 3.3 1 1 3 15 5 10 110 .4 1.2 2.2 6.0 8.2 13.2 2.3 .4 .4 1.1 4.5 1.5 10.'2 7.0 .4 2.0 3.3 7.6 14.7 15.6 Per cent. 0.3 Infected sores. Num- ber. Per cent. 67 2.1 32 2.2 2.2 3.1 1.8 1.8 1.8 2.3 2.3 2.4 2.9 1.8 1.8 3.1 2.0 2.0 3.3 1.8 1.7 Ringworm. Num- ber. 29 Per cent, 1.0 1.2 .5 1.0 .4 2.4 .7 .9 1.2 2.0 1.6 .4 1.2 Scabies. Num- ber Per cent. GEISTEEAL TABLES.' 69 1 •M c 5 H |OiOi .-< -< to |COCO .r- OS^ c 5 ', '■3 1 § 5 a a OS §^.2 s i s ■ S 3 oi 5 a> § I 8 i J g^ 5 mc^ § i S w g o 1 10 5 10 0^ ^^ 5~ n h" i-T T T^ a, i c a--^^ c > « IM -"I" ■<>< .-1 c 5 (^ 10 t^ to -^ 1-1 --l c 3 OSOIN— l,-l !>> . §i3.2 § S" ■ ■ ■ > lOcO 1 ?■ 8"^ ■ ■ ■ c a "Si So c^ J ||223«-- > 00 ira -< tH .-H rH ) 00iOr-lr-( c 3 jHtgWC.^ g a ;§^ > ■* S "3 o c r co" ,-r ^- "S.i d c > t^ to lO .-H ■<(< to M c > 00 00 CO 10 ■* Tl CO c > to ,-1 ,-1 00 CO --H rt J3 ^^ c >-. O g ocgt^^^ • s I S'S"-^'^ 1 5 g2«5 -uj • f 03 o^ .Six? 1^1 1 £ qM a^ (N oo«ecocoooor-4t- r^ if^ r- r* CO 1-H lO ; sssss^ e^ t -o 3 £ TtlOS "-H f-H ■*C3l 3 i-^ f 1 -'■■ " >. "S.J, d c T»i o OJ "5 •* to --lu: c > N W 00 lO CO OS C^ t^ c > t* 03 i-t "3 to CO CO gi3.2 j^^o^rf^- -^ 1 S??j?^'-'S'^ '-^ s ; Slsss-"^"-^' '-'■ ^43 H 60 1^1 a^ u- CO "O ■* t^ t>. o CO I- lOtOCO CO c iii^s^ ^ XJ "" Cs t^ Ttl lO -l* O lO ■* IT t- N ^ aS ococo to ir iC 02 12; -^ c "-'-''' " ■" S.i d c CO t*^H c 010^-H c toco-< rt rt j^- •&l SS 2 |3| ^ ■ ■ 5 $-• • • 1 § ■ ■ S.2 ,S; bjQ i^ ^ N — IM-Hrt ir QOtO-H'-l c ^U^f-4 ,_( O °" c ON 1? s- & s g^ e^ oo"' - -*- M o ■o fl 03 i5 "H d d d a d a s ■a o 1 •2 8 •2g ^5 d-j3 at |.a 11 is •2| £.3 dv3 •s-g . ■s-g ■3'g . a-r3 ■'-' 03 1.2 ■§13 "S ,2 T) § « 03 TO '0 03 03 3 § "2 = ■§ 8 §''S i .2 8a.2 8 a s « ^ C3 tn 03 M 03 H w C3 ■ 3 • w « e M 03 o jq o'3'H S 3 s OS o3 1 70 PHYSICAL, STATUS OF PRESCHOOL CHILDEEN. s s •« g 5cg 1-^ 12:'^ cOt^ t- tC tC o O 00 00 C t^ 'C -fC 00 0(N CO CO 5 Tt< Tj< t- lO CO Cl Tii -xji CO oi ifi lO ui ^COOOOOlN (N - -f OS -^ 00 l-H T-1 CO iC 00 (N o r^ ■<** "^ ri CO cot^os 1-1 ci OC OS -.^H UO CO ui iri 06 o -^ CD T-H .— — I ?<1 i-H O rt<00o0CO ■ O "^ •^'^f t^Tj* ! C- CO 1-1 CO O CO CD l>- '^ CSOOOSIN i-< 00 00 CO CO CO i-( CD ■ Ci CO LO CO -^ CM C^l t^ O 00 1-H Ttt -^ i-O CO CM 00' iC w O ^ ^ CM^ TT CO --* •<*♦ rr CO CO' LO CO »o CM 00 ''t^ O 10 -* O •<*< rt^ CO ^ CO OC "»J< »MCMCOt^i.O00 CO t^t^— '0<— it^ ^ t-l CM CO -^ r-H CM^OOOCMCM OS coooui »oo6 CO lO CM OS 00 O CM t-H CM t-H f-H 1-1 ^CO 06 OS CO CO 1-^ OS CM 1-H 1-1 00 1-t CMCOCM Tt< X T}< t>. CM OS ^CM—tOi'^CD 00 CM COOS '^ O ^H i-it^ COCO CMCO^OS^OO 00 00 O OS OS i-O '■^COCMCM CMCMi-iCOOCO ^ T-H 00 -^J^ 1-1 000 o o Or-- CM CM -^ CO CD 10 OcOcDCMOSCM O lOco COOS OS 00 •'J* CO OS 00 --< CO 00 CO 00 00 00 OS OS CM CM iC CO CO OC O: i-H CO OS b- CM CM lOCO -^ »0 JN, t^ Tj< 1-4 t^ f* OOO'^COtJ* GC 'cm ' 'i-J LO ^ CM O »-( ^-^ d .-( COOS r* CM o 1— < 01 ^ CO «!; CM to Tji ic CO CO CM ^ ■^ 'Tfi t^ yrf 00 O CD ».o r— CO cc OS t^ CM CM CM CO CO »-': ^ •n' t^ CO rf^ CM CO '^USOt* cc rt c3 ^ c3 ^ c3 CM CO '«J' 10 CDt O D C/ c; © Q> -3 --; X! -TS TJ T3 C C3 S ^ C G s .tii © ® 05 Q) d c c a 1 >! X >. >. >. >. o o a> o ffi o CS C3 ffl o cot- GENERAL TABLES. 71 Table 9. — Relation of weight to height, by age and sex; children 2 to 7 years of age given physical examination. Relation of weight to height and sex. Both sexes Weight for height: Average and above Below average Less than 7 per cent . . 7 per cent, less than 10 10 per cent and over . . Boys Weight for height: Average and above Below average Less than 7 per cent. . . 7 per cent, less than 10. 10 per cent and over. . . Girls Weight for height: Average and above Below average Less than 7 per cent. . . 7 per cent, less than 10. 10 per cent and over. . . Total children. Num- ber. 3,125 1,319 1,806 1,180 323 303 1,555 618 937 627 170 140 1,570 701 869 553 153 163 Per cent distri- bution 42.2 57.8 37.8 10.3 9.7 100.0 39.7 60.3 40.3 10.9 9.0 100.0 44.6 55.4 35.2 9.7 10.4 2 years, under 3. Num- ber. 511 188 323 172 66 95 166 91 32 43 250 93 157 81 34 42 Per cent distri- bution 100.0 36.8 63.2 33.7 12.9 16.6 100.0 36.4 63.6 34.9 12.3 16.5 100.0 37.2 62.8 32.4 13.6 16.8 3 years, under 4. Num- ber. 194 302 184 59 59 251 Per cent distri- bution. loao 39.1 60.9 37.1 11.9 11.9 100.0 94 37.5 157 62.5 95 37.8 33 13.1 29 n.6 245 100.0 100 40.8 145 59.2 S9 36.3 26 10.6 30 12.2 4 years, under 5. Num- ber. Per cent distri- bution. 100. 223 326 222 48 56 274 175 119 28 28 275 124 151 103 20 28 40.6 59.4 40.4 8.7 10.2 100.0 36.1 63.9 43.4 10.2 10.2 100.0 45.1 54.9 37.5 7.3 10.2 Relation of weight to height and sex. 5 years, under 6. Num- ber. Per cent distri- bution 6 years, mider 7. 7 years, under 8. Num- ber. Per cent distri- bution. Num- ber. Per cent distri- bution. Both sexes - 667 100.0 100.0 Weight for height: Average and above Below average Less than 7 per cent 7 per cent, less than 10. 10 per cent and over Boys. 284 383 277 62 44 337 42.6 57.4 41.5 9.3 6.6 100.0 320 362 239 75 48 334 Weight for height: Average and above 135 Below average 202 Less than 7 per cent 152 7 per cent, less than 10 j 34 10 per cent and over | 16 Gu-ls. Weight for height: Average and above Below average Less than 7 per cent 7 per cent, less than 10. 10 per cent and over 330 149 181 125 28 28 40.1 59.9 45.1 10.1 4.7 100.0 147 187 132 35 20 45.2 54.8 37.9 8.5 8.5 173 175 107 40 28 46.9 53.1 35.0 11.0 ,7.0 100.0 44.0 56.0 39.5 10.5 6.0 100.0 49.7 50.3 30.7 11.5 8.0 110 110 50.0 50.0 39.1 5.9 5.0 100.0 48 50 38 8 4 122 49.0 51.0 38.8 8.2 4.1 100.0 50.8 49.2 39.3 4.1 5.7 72 PHYSICAL STATUS OF PRESCHOOL CHILDREN. Table 10. — Relation of weight to height, by color and nationality of vwther; children 2 to 7 years of age given -physical examination. Color and nationality of mother. Total chil- dren. Relation of weight to height. Average and above Be'ow average. Total. Num- ber. Per cent.i Num- ber. Per cent.i Less than 7 per cent. Num- ber. Per cent.i 7 per cent, less than 10. Num- ber. Per cent. 10 per cent and over. Num- ber. Per cent.' Total. 3,125 1,319 42.2 1,806 57.8 1,180 37.8 323 10.3 303 9.7 White Native , Foreign-born , Serbo-Croatian. Slovak , Polish Magj'ar Italian German Lithuanian All other Negro Not reported 3,047 1,284 42.1 1,763 1,151 466 40.5 685 1,896 818 43.1 1,078 321 144 44.9 177 313 102 32.6 211 224 90 40.2 134 176 76 43.2 100 157 89 56.7 68 139 58 41.7 81 83 47 56.6 36 483 212 43.9 271 71 33 46.5 38 7 2 5 57.9 59.5 56.9 55.1 67.4 59.8 56.8 43.3 58.3 43.4 56.1 53.5 1,150 439 711 121 137 89 66 52 49 22 175 26 4 37.7 38.1 37.5 37.7 43.8 39.7 37.5 33.1 35.3 26.5 36.2 36.6 317 132 185 28 40 22 23 7 11 8 46 5 1 10.4 11.5 9.8 8.7 12.8 9.8 13.1 4.5 7.9 9.6 9.5 7.0 296 114 182 28 34 23 11 9 21 6 50 7 9.7 9.9 9.6 8.7 10.9 10.3 6.3 5.7 15.1 7.2 10.4 1 Not shown where base is less than 50. Table 11. — Prevalence of specified defects, by deviation from average weight for height; children 2 to 7 years of age given physical examination. Deviation from aver- age weight for height. I Total i chil- dren. With decayed teeth. With adenoids. With diseased tonsils. With postural defects. With bony defects of rachitic origin. With anemia. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Total 3,125 2,021 64.7 1,050 33.6 406 13.0 885 28.3 467 14.9 243 7.8 4i pounds or more below average 3i and 4 pounds be- low average 3 pounds below aver- 84 99 110 126 177 188 255 241 270 234 259 217 185 146 119 159 207 49 51 68 69 72 100 126 158 154 185 144 160 135 114 96 80 114 153 42 60.7 68.7 62.7 57.1 56.5 67.0 62.0 63.9 68.5 61.5 61.8 62.2 61.6 65.8 67.2 71.7 73.9 85.7 31 35 37 33 55 56 74 85 88 84 93 70 59 51 41 53 89 16 36.9 35.4 33.6 26.2 31.1 29.8 29.0 35.3 32.6 35.9 35.9 32.3 31.9 34.9 34.5 33.3 43.0 32.7 12 19 20 23 10 22 32 39 30 22 32 25 19 18 21 23 28 11 14.3 19.2 18.2 18.3 5.6 11.7 12.5 16.2 11.1 9.4 12.4 11.5 10.3 12.3 17.6 14.5 13.5 22.4 33 30 41 37 50 59 79 73 71 62 70 51 46 40 37 39 53 14 39.3 30.3 37.3 29.4 28.2 31.4 31.0 30.3 26.3 26.5 27.0 23.5 24.9 27.4 31.1 24.5 25.6 28.6 17 23 19 19 20 32 42 43 39 26 40 36 28 17 16 21 20 9 20.2 23.2 17.3 15.1 11.3 17.0 16.5 17.8 14.4 11.1 15.4 16.6 15.1 11.6 13.4 13.2 9.7 18.4 20 15 17 16 15 21 17 16 14 13 18 13 10 10 6 4 14 4 23.8 15.2 15.5 2i pounds below 12.7 2 pounds below aver- 8.5 IJ pounds below 11.2 1 pound below aver- 6.7 J poimd below aver- 6.6 5.2 i pound above aver- age 5.6 1 pound above aver- 6.9 U pounds above 6.0 2 pounds above aver- age. . 5.4 2J poimds above 6.8 3 pounds above aver- age 5.0 3J and 4 pounds above average 4J pounds or more above average Not classified 2.5 6.8 8.2 1 In tills table, the average weights for height of the Children's Year series were taken as standard. See Statures and Weights of Children under Six Years of Age, Children's Bureau Publication No. 87, p. 29. GENERAL TABLES, 73 Tablf. 12. — Annual earnings of chief breaduinner, by color and nativity of mother; children S to 7 years of age given physical examination. Annual earnings of chief breadwinner. Total 3.125 '100.0 '3,047 100.0 Total children. Color and nati\-itv of mother. Total. Xative. Num- ber. Per cent dis- tribu- tion. Per i ber. 'tribu- 1 I tion. Under S650 $650-$849 $850-81.049 Sl,050-$1,249 $1,25(>-$1,449 $1,450-81,849 $1,850-82,249 $2,250 and over No chief breadwinner and earnings Not reported 110 240 412 491 456 613 262 303 58 180 3.5 13^2 15.7 14.6 19.6 8.4 9.7 1.9 102 229 396 477 448 606 259 300 57 173 3.3 7.5 13.0 15.7 14.7 19.9 8.5 9.8 1.9 5.7 Num- ber. Per cent dis- tribu- tion. 1,151 100.0 19 34 69 146 154 313 151 194 19 52 1.7 3.0 6.0 12.7 13.4 27.2 13.1 16.9 1.7 4.5 Foreign born. Num- ber. I Per cent dis- . tribu- I tion. 1.896 100.0 83 195 327 331 294 293 108 106 38 121 4.4 10.3 17.2 17.5 15.5 15.5 5.7 2.0 6.4 Negro. Num- ber. Per cent dis- tribu- tion. 11.3 15.5 21.1 19.7 11.3 8.5 1.4 1.4 1.4 S.5 Not re- port- ed.! 1 Per cent distribution not shown where base is less than 50. APPENDIX B. RESULTS OF PHYSICAL EXAMINATIONS OF CHILDREN UNDER TWO YEARS OF AGE. Source of material. During the conferences held in connection with this study, exami- nations were made of 994 infants, the same standards being observed in making the physical examinations and tabulations as were used in the preschool group. Since rather interesting differences in the incidence of defects in the two age groups were found, a brief state- ment of the results is liere appended. Findings in general. Of the entire group of 994 infants, 28.3 per cent were found to have no defects; less than half (40.2 per cent) of those under 6 months of age were without defect. More boys than girls showed defects, as only 12 per cent of the former were without defect in contrast to 46.4 per cent of the latter. Table I. — Number of defects, by age and sex; children under 2 years of age given physical examination. Total children. Under 6 months. 6 months, under 1 year. 1 year, under IJ years. IJ years, under 2 years. Number of defects, and sex. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. 994 100.0 214 100.0 278 100.0 245 100.0 257 100.0 With defects 713 676 318 205 114 39 34 3 281 524 71.7 68.0 32.0 20.6 11.5 .S.9 3.4 .3 28.3 100.0 128 128 87 31 6 4 59.8 59.8 40.7 14.5 2.8 L9 182 179 104 52 18 5 3 65.5 64.4 37.4 18.7 6.5 1.8 1.1 191 180 69 61 39 11 11 78.0 73.5 28.2 24.9 15.9 4.5 4.5 212 189 58 61 51 19 20 3 45 137 82.5 Less than 5 73.5 1 22.6 2 23.7 3 19.8 4 7.4 5to9 . 7 8 10 to 14 1.2 Without defects 86 113 40.2 100.0 96 146 34.5 100.0 54 128 22.0 100.0 17.5 Boys 100.0 With defects.. 461 435 188 137 81 29 24 2 63 470 88.0 83.0 35.9 26.1 15.5 5.5 4.6 .4 12.0 100.0 96 96 61 26 6 3 85.0 85.0 54.0 23.0 5.3 2.7 127 125 65 41 14 5 2 87.0 85.6 44.5 28.1 9.6 3.4 1.4 115 106 35 36 28 7 9 89.9 82.8 27.3 28.1 21.9 5.5 7.0 123 108 27 34 33 14 13 2 14 120 89.8 78.8 1.. 19.7 2 24.8 3... 24.1 4 10.2 5to9... 9.5 10tol4 1.5 Without defects 17 101 15.0 100.0 19 132 13.0 100.0 13 117 10.2 100.0 10.2 Girls 100.0 With defects 252 241 130 68 33 10 10 1 218 53.6 51.3 27.7 14.5 7.0 2.1 2.1 .2 46.4 32 32 26 5 31.7 31.7 25.7 5.0 65 54 39 11 4 41.7 40.9 29.5 8.3 3.0 76 74 34 25 11 4 2 65.0 63.2 29.1 21.4 9.4 3.4 1.7 89 81 31 27 18 5 7 1 31 74.2 Less than 5 67.5 1 25.8 2 22.5 3 15.0 4 1 1.0 4.2 5to9... 1 .8 5.8 10 .8 Without defects 69 68.3 77 58.3 41 35.0 25.8 75 76 PHYSICAL STATUS OF PRESCHOOL CHILDREN. An analysis of the kinds of defects as given in Table II shows a fairly even distribution as to sex except in defects of the genitalia, where a marked difference between boys and girls occurs. Table II. — Prevalence of disease or defects, by sex; children under 2 years of age given physical examination. Disease or defect. Total. AVithoiit defect With disease or defect General: Underweight (10 per cent and over) Anemia Head Abnormal shape . . '. Open fontanel (children 1^ to 2 years of a| Eyes: Diseases and defects other than of vision. Conjunctivitis Blepharitis Stye Ptosis Corneal opacities Strabismus Blindness (one eye) Ears Acute otorrhea... Chronic otorrhea. Mouth Decayed teeth . . . Malocclusion . . . . Xaso-pharynx Defective tonsils Adenoids (definite) Adenoids (suspected) Glands: Enlarged or greatly enlarged Submaxillary Cervical . . . ." Axillary Inguinal Heart Heart disease (I uestionable heart disease Lungs Lung disease Questionable lung disease Skin Eczema Impetigo Infected sores Ringworm Scars Abdomen Distended abdomen Enlarged liver Hernia Bony and muscular system Beaded ribs Pigeon breast Harrison's groove Enlarged epiphyses Roimd shoulders Winged seapul--p Lordosis Knock-knee Bowlegs Clubfeet Arthritis Paralysis Mentality Defect apparent Defec t suspected Genitalia: Boys Prepucialdefects Defects other than those of prepuce. Genitaha: Girls: Vaginal discharge Both sexes. Num- ber. 2S1 713 262 22 172 25 49 23 3 2 1 2 2 13 1 8 2 6 26 16 12 225 182 22 31 38 16 22 1 5 3 1 2 26 14 2 10 1 2 150 121 1 as 135 11 2 10 8 3 1 4 1 121 2 2 1 7 Per cent. 28.3 71.7 26.4 2.2 17.3 2.5 4.9 2.3 .3 .2 .1 .2 .2 1.3 .1 .8 .2 .6 2.6 1.6 1.2 22.6 18.3 2.2 3.1 3.8 1.0 2.2 .1 .5 .3 .1 .2 .9 .4 .5 2.6 1.4 .2 1.0 .1 .2 15.1 12.2 .1 3.8 13.6 1.1 .2 1.0 .8 .3 .1 .4 .1 12.2 .2 .2 .1 .7 .2 .5 Boys. Num- ber. 524 63 461 152 13 6 15 10 5 129 101 17 17 23 9 14 1 2 2 1 1 7 4 3 14 7 2 5 1 1 71 56 1 19 81 7 2 8 5 2 1 3 1 72 1 2 1 4 2 2 374 371 7 Per cent. 12.0 88.0 29.0 2.5 17.0 3.1 4.8 2.7 1.5 1.0 1.0 2.9 1.9 1.0 24.6 19.3 3.2 3.2 4.4 1.7 2.7 .2 .4 .4 .2 .2 1.3 .8 .6 2.7 1.3 .4 1.0 .2 .2 13.5 10.7 .2 3.6 15.5 1.3 .4 1.5 1.0 .4 .2 .6 .2 13.7 .2 .4 .2 .8 .4 .4 71.4 70.8 1.3 Num- ber. EXAMINATIOlSr OF CHILDREN UNDER TWO YEARS OF AGE. 77 Irrespective of age, the average number of defects of all infants examined was 2.2 for boys and 1.9 for girls. The incidence of defects according to age increased steadily in both sexes from 6 months to 2 years, but the rate of increase was much higher in girls. For instance, 85 per cent of the boys under 6 months of age had defects, in contrast to 31.7 per cent of the girls; while at 2 years of age the defects had increased to 89.8 per cent and 74.2 per cent for boys and girls respectively. Height and weight. The average heights and weights of all white infants are recorded by months in Text Table IV. As in the case of the preschool child, these averages are somewhat lower throughout than those used as standards in the examinations. Nutrition. More than a quarter (26.4 per cent) of all children under 2 years of age were more than 10 per cent below average weight for height, in contrast with 9.7 per cent of the children 2 to 7 years of age. This marked difference, in the two homogeneous groups classified by age, rather suggests that a range greater than 10 per cent below average weight for height would be a fairer standard during infancy. The age group, 6 months to 1 year, showed the highest per cent (14) graded "excellent" as to nutrition, and the higher age group, 1 to H years, had the highest per cent (35.9) underweight. In fact, the proportion of childi'en 10 per cent or more below the average weight for height increased steadily with age up to 18 months; but in the 6 month period following, a decidedly better condition was apparent, only 21 per cent of these children being 10 per cent or more underweight. Table III. — Grade of nutntion, by age and sex; children under 2 years of age given physical examination. Age and sex. Both sexes Under 6 months 6 months, under 1 year 1 year, under U years. . U' years, under 2" years. Boys Under 6 months 6 months, under 1 year 1 year, under 1| years., li years, under 2 years. Girls Under 6 months 6 months, under 1 year 1 year, under U years.. li years, under 2 years. Total chil- dren. Grade of nutrition. Excellent Good. Poor. Very poor. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. Num- ber. Per cent. 994 94 9.5 638 64.2 242 24.3 20 2.0 214 27S 245 257 524 10 39 20 25 61 4.7 14.0 8.2 9.7 11.6 159 164 137 178 311 74.3 59.0 55.9 69.3 59.4 38 72 S5 47 141 17.8 25.9 34.7 18.3 26.9 7 3 3 7 11 3.3 1.1 1.2 2.7 2.1 113 146 128 137 470 6 28 12 15 33 5.3 19.2 9.4 10.9 7.0 79 75 65 92 327 69.9 51.4 50.8 67.2 69.6 24 41 50 26 101 21.2 28.1 39.1 19.0 21.5 4 2 1 4 9 3.5 1.4 .8 2.9 1.9 101 132 117 120 4 11 8 10 4.0 8.3 6.8 8.3 80 89 72 86 79.2 67.4 61.5 71.7 14 31 35 21 13.9 23.5 29.9 17.5 3 1 2 3 3.0 .8 1.7 2.5 78 PHYSICAL, STATUS OF PRESCHOOL. CHILDREN". A table showing the amount of deviation from average weight for height in children under 2 years of age is given for purposes of com- parison with the preschool group. Table IV. — Deviation from average weight for height, by age and sex; children xcnder 2 years of age given physical examination. Deviation from average weight for height. Both sexes . Average and above Below average Less than 7 per cent 7 per cent, less than 10. . 10 per cent and over Total children. Num- ber. 994 307 6S7 279 146 262 Boys. Average and above Below average Less than 7 per cent 7 per cent, less than 10. 10 per cent and over Girls. Average and above Below average Less than 7 per cant 7 per cent, less than 10. 10 per cent and over 165 359 139 68 152 470 142 328 140 78 110 Per cent dis- tribu- tion. 100.0 30.9 69.1 28.1 14.7 26.4 100.0 31.5 68.5 26.5 13.0 29.0 100.0 30.2 69.8 29.8 16.6 23.4 Under 6 months. Num- ber. 214 96 118 49 24 45 42 71 29 14 28 101 Per cent dis- tribu- tion. 100.0 44.9 55.1 22.9 11.2 21.0 100.0 37.2 62.8 25.7 12.4 24.8 100.0 53.5 46.5 19.8 9.9 16.8 6 months, less than 1 year Num- ber. 278 86 192 73 44 75 Per cent dis- tribu- tion. 100.0 30.9 69.1 26.3 15.8 27.0 100.0 1 year, less than l\ years. Num- ber. 245 57 188 63 37 34.9 65.1 19.9 15.8 29.5 100.0 26.5 73.5 33.3 15.9 24.2 100 34 15 51 Per cent dis- tribu- tion. 100.0 11 years, less than 2 years. Num- ber. 257 23.3 76.7 25.7 15.1 35.9 100.0 21.9 78.1 26.6 11.7 39.8 100.0 189 94 41 54 ai.8 75.2 24.8 18.8 31.6 Per cent dis- tribu- tion. 100.0 26.5 73.5 36.6 16.0 21.0 100.0 32.1 67.9 34.3 11.7 21.9 100.0 20.0 80.0 39.2 20.8 20.0 Anemia. Of the children under 2 years of age, only 2.2 per cent showed suf- ficient pallor to be considered anemic. Pallor increased with age, as did the number of defects, and was more common in boys than in girls. The percentage was also higher in underweight children. Vaccmation. Only 24, or 2.4 per cent, of the children under 2 years of age had been vaccinated. Head. Measurements showed only 13 heads of abnormal size, 7 small and 6 large, in the 994 children of this age group, a percentage of 1.3. Special attention was given to the palpation of fontanels. Four cases of completely closed fontanels were noted in infants under 6 months, and 15 in the period 6 months to 1 year. There were 49 cases of open fontanel in infants between 18 months and 2 years of age. Eyes. Obviously, it was impossible to obtain data regarding vision in this group; but 23 mfants, or 2.3 per cent, showed eye defects, the pro- EXAMINATIOlSr OF CHILDEEX UNDER TWO YEARS OF AGE. 79 portion steadily increasing with age from 0.9 per cent among infants under 6 months to 3.1 per cent among those 1^ to 2 years of age. Ears. Ear defects m this group of infants were confined to 8 cases of otorrhea. Mouth. A careful examination of the mouths revealed little of significance beyond the fact that only 5 infants, or 2.3 per cent of those under 6 months of age, had one or more teeth, while 11.2 per cent had com- pleted teething under 2 years of age. Sixteen infants (2.4 per cent) 18 months of age or over had decayed teeth, and 12 cases (1.2 per cent) of malocclusion were found. Nasopharynx. The most common defects of infancy, as of the preschool age, were those of the nasopharynx, although these defects were about one- third as prevalent in infancy as in the preschool period. Boys slightly predominated in all types of nasopharyngeal defects, show- ing 24.6 per cent in contrast to 20.4 per cent among the girls. The incidence of nasopharyngeal defects among infants under 6 months of age was noticeably slight, but a marked and gradual increase in the number of defects with age was found. Table V. — Nasopharyngeal dejects, by age and sex; children vnder 2 years of age given 2)hysical examination . Age and sex. Total chil- dren. With mouth breathing. Num- ber. Per cent. With high- arch palate. Num- ber. Per cent. With defec- tive tonsils. Num- ber. Per cent. With ade- noids. Num- ber. Per cent. Both sexes Under 6 months 6 months, under 1 year 1 year, under IJ years.. IJ years, under 2 years. Boys Under 6 months 6 months, under 1 year 1 year, under U years.. IJ years, under 2 years. Girls Under 6 months 6 months, under 1 year 1 year, under li years.. 1§ years, under 2 years. 214 278 245 257 113 146 128 137 101 132 117 120 5.5 30 3.0 18.3 3.6 7.8 10.1 .5 2.2 4.5 4.7 3.1 4.7 10.8 24.5 31.9 19.3 4.8 8.6 11.7 2.7 4.7 3.6 3.0 4.4 11.0 25.0 35.0 17.2 2.3 6.8 8.3 1.5 4.3 5.8 5.0 10.6 23.9 28.3 53 4.0 6.9 9.7 6.5 5.5 8.6 10.9 4.0 2.3 5.1 8.3 80 PHYSICAI. STATUS OF PRESCHOOL CHILDREN. Mouth breathing mcreased from 3.6 per cent in the 6 months to 1 year period to 10.1 per cent in the 18 months to 2 years period. High-arch palate showed a gradual development after 6 months of age, the majority of cases being pronounced enough for recording only after 1 year of age. Tonsils. — Enlargement of tonsils increased with age from 4.7 per cent under 6 months to 31.9 per cent from 18 months to 2 years. To what extent the so-recorded '' enlarged tonsils" may have been a normal hj^erplasia of lymphoid tissue needs to be verified by further observations; but only 1 infant in the group was considered to have greatly enlarged' tonsils and only 1 had diseased tonsils. Removal of tonsils was advised in onl}^ 4 cases of the 182 defective, 3 of these being accompanied by adenoids. ^ Adenoids. — The prevalence of adenoids increased with age, even during the period of infancy. Adenoids were definitely diagnosed in 22 cases (2.2 per cent), and sjmiptoms such as mouth breathing and high-arch palate led to a diagnosis of "suspected or probable" ade- noids in 31 cases (3.1 per cent); thus the number of infants having definite or probable adenoids amounted to 5.3 per cent. Removal of adenoids was recommended in a total of 9 cases, 6 being combmed with defective tonsils. Only 1 case of adenoids requiring removal was found in a child under 1 year of age. Glands. In 66 per cent of the entire group of infants the glands were not even "palpable," and only 3.8 per cent had actually "enlarged" glands. Table YI. — Condition of tonMls, by age; children under 2 years of age given physical examination. ' Total children. Under 6 montlis. 6 months, under 1 year. 1 year, under IJ years. IJ years,under 2 years. Condition of tonsils. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- lui- tion. Num- ber. Per cent distri- bu- tion. Num- ber. Per cent distri- bu- tion. Total 994 100.0 214 100.0 278 ,100.0 245 100.0 257 100.0 811 1 182 180 1 1 81.6 .1 18.3 18.1 .1 .1 204 95.3 248 89.2 185 75.5 174 1 82 81 1 67.7 Removed, not defective .4 10 10 4.7 4.7 30 29 10.8 10.4 60 60 24.5 24.5 31.9 Enlarfted onl v 31.5 Great ly enlarged only Diseased and enlarged .4 1 .4 That the size of the glands gradually but markedly increased with age is shown by the percentage "palpable," as follows: 7.9 per cent under 6 months, 25.5 per cent from 6 months to a year, 38.4 per cent from 1 year to 18 months, and 45.9 per cent from 18 months to 2 years. EXAMINATION OF CHILDREN UNDER TWO YEARS OF AGE. 81 Table VII. — Condition of glands, by age and sex; children under 2 years of age given physical examination. Total children. Under 6 months. 6 months, un- der 1 year. 1 year, under li years. ih years, un- der 2 years. CcHiditlon of glands, and sex. Num- ber. Per cent dis- tribu- tion. Num- ber. Per cent dis- tribu- tion. Num- ber. Per cent dis- tribu- tion. Num- ber. Per cent dis- tribu- tion. Num- ber. Per cent dis- tribu- tion. Both sexes 994 100.0 214 100.0 278 100.0 245 100.0 257 100.0 Glands: Normal 656 300 38 21 17 524 66.0 30.2 3.8 2.1 1.7 100.0 195 17 2 1 1 113 91.1 7.9 .9 .5 .5 100.0 206 71 1 74.1 25.5 .4 141 94 10 2 8 128 57.6 38.4 4.1 .8 3.3 100.0 114 118 25 18 7 137 44.4 Palpable 45.9 Enlarged and greatly en- larged 9.7 With associated infec- 7.0 Without associated in- fection 1 146 .4 100.0 2.7 Boys 100.0 Glands: Normal 325 176 23 12 11 470 62.0 33.6 4.4 2.3 2.1 100.0 101 11 1 89.4 9.7 .9 104 41 1 71.2 28.1 .7 67 55 6 1 5 117 .52.3 43.0 4.7 .8 3.9 100.0 53 69 15 11 4 120 38.7 Palpable 50.4 Enlarged and greatly en- larged 10.9 With associated infec- 8.0 Without associated in- fection 1 101 .9 100.0 1 132 .7 100.0 2.9 Girls 100.0 Glands: 331 124 15 9 6 70.4 26.4 3.2 1.9 1.3 94 6 1 1 93.1 5.9 1.0 1.0 102 30 77.3 22.7 74 39 4 1 3 63.2 33.3 3.4 .9 2.6 61 49 10 3 50.8 Palpable 40.8 Enlarged and greatly en- S.3 With associated infec- tion 5 8 Without associated in- 2.5 Heart. Only one case of positive organic cardiac disease and two question- able cases were found in the total of 994 infants. Lungs. The slight incidence of respiratory disease in this group of infants is interesting, as shown by only four positive diagnoses and five questionable cases. Skin. A comparatively small percentage of infants showed any abnormal skin condition — only 26, or 2.6 per cent. Abdomen. Distended abdomen was found in 121 cases, or 12.2 per cent, this condition being slightly more prevalent among girls. The presence of hernia was noted in 3.8 per cent of the group. In both sex groups umbilical hernias predominated. Inguinal hernia was observed in 7 cases, of which 6 were boys. The largest number of hernise by age was fomid in the 18 months to 2 years groups. Enlarged liver occurred in the case of one boy. 108178°— 22 6 82 PHYSICAL STATUS OF PRESCHOOL CHILDREN, Bony and muscular system. Positive signs ^ upon which definite diagnoses of rickets were based were found in 22 cases (2.2 per cent). Fifty-three additional cases having one or more suggestive signs were recorded "probably rachitic." ^ No cases were noted in the group under 6 months of age; 7 of the children classified as rachitic were between 6 months and 1 year, 9 were between 1 year and 1^ years, and 59 (78.7 per cent of all those with rickets) were over 18 months. Of the rachitic children 12.1 per cent had defective tonsils, as compared with 6.6 per cent of those showmg no evidence of rickets. Table VIII. — Rickets, by age and sex; children under 2 years of age given physical examination. , ,, Age and sex. ITotal ctuldren. With rickets. Num- ber. Per cent. With probable rickets. Without rickets. Num- ber. Per cent. Num- ber. Per cent. Both sexes. 994 5.3 919 92.5 Under 6 months 6 months, under 1 year. 1 year, under 1 J years . . IJ years, under 2 years.. Boys. Under 6 months 6 months, under 1 year. 1 year, under IJ years. . IJ years, under 2 years.. Girls. 214 278 245 257 524 1.4 2.4 4.7 27 113 146 128 137 470 2.1 3.1 5.1 1.7 26 1.1 1.2 18.3 5.2 1.4 .8 17.5 5.5 Under 6 months 6 months, under 1 j'ear. 1 year, under IJ years. . IJ years, under 2 years.. 101 132 117 120 1.7 4.2 1.7 19.2 214 I 271 I 236 I 198 [ 483 100.0 97.5 %.3 77.0 92.2 113 141 123 I 106 436 100.0 96.6 96.1 77.4 92.8 101 130 113 92 100.0 98.5 96.6 76.7 Table IX. — Rickets, by condition of tonsils; children under 2 years of age given physical examination. Condition of tonsils. Total children. With rickets. With probable rickets. Without rickets. Nimi- ber. Per cent .1 Num- ber. Per cent.i Num- ber. Per cent.i Total 994 22 2.2 53 5.3 919 92.5 811 1 182 180 1 16 2.0 1 37 4.6 758 1 160 158 1 1 93.0 6 6 3.3 i 16 3.3 ! 16 8.8 8.9 87.9 Enlarged only 87.8 1 ' Not shown where base is less than 50. Of the rachitic children 10.7 per cent showed "enlarged" glands, 38.7 per cent "palpable" glands, 50.7 per cent nonpalpable glands, as compared with 3.3 per cent, 29.5 per cent, and 67.2 per cent, respectivelj^, of the nonrachitic children. ' For signs, see page 58. ' See page 5S. EXAMINATION OF CHILDREN UNDER TWO YEARS OF AGE. 83 Table X. — Condition of glands, by presence of rickets; children under 2 years of age given physical examination. Condition of glands. Total Normal Palpable Enlarged and greatly enlarged. . With associated infection Without associated infection Total children. Num- ber. 656 300 38 21 17 Per cent distri- bution. 100.0 66.0 30.2 3.8 2.1 1.7 With rickets or proballe rickets. Num- ber. Per cent distri- bution. 100.0 50.7 38.7 10.7 2.7 8.0 With With prob- rick- I able ets. I rick- 1 ets. Without rickets. Num- ber. 618 271 30 19 11 Per cent distri- bution. 100.0 67.2 29.5 3.3 2.1 1.2 Bowlegs were more common among the boys than among the girls, 13.7 of the boys and 10.4 per cent of the ghls bemg thus deformed. All other rachitic signs were also more noticeable in the boys than in the girls. Arch measurements. Arch measurements were taken on 552 infants and the median height was found to be the same, | inch, up to 18 months, but increased to f inch in infants from 18 months to 2 j^ears. Mental condition. Two cases of apparent and five cases of suspected mental defectives were noted during the course of the study. Genitalia. A very large per cent of defects of genitalia, chiefly contracted or adherent prepuce, was found among boys — 71.4. A summary of defects found in children under 2 years of age, as compared with those found in the preschool group, is here given. Table XI, — Comparison of the prevalence of defects in children under 2 years of age and children 2 to 7 years of age given physical examination. Summary of defects. » Children under 2 years of age. Number. Per cent Children 2 to 7 years of age. Number. Per cent Total. Underweight (10 per cent and over) Anemia Head defects Eye diseases and defects other than of vision. Ear defects other than of hearing Mouth defects Naso-pharyngeal defects Enlarged glands Feart defects Lung defects Abnormal skin condition Abdominal defects Bony and muscular defects 262 22 172 23 8 26 225 38 3 9 26 150 135 100.0 26.4 2.2 17.3 2.3 .8 2.6 22.6 3.8 .3 .9 2.6 15.1 13.6 3,125 303 243 163 245 25 2,091 2,157 908 99 32 318 464 1,308 100.0 9.7 7.8 5.2 7.8 .8 66.9 69.0 29.1 3.2 1.0 10.2 14.8 41.9 1 For specific defects see Text Table II, p. 29, and Appendix Table II, p. 76. 84 PHYSICAL STATUS OF PRESCHOOL CHILDREN, Chart V. Per cent of children having one or more defects, from birth to G years of age. Per cent 100 80 50 30 Months Boys . Girls - ^^ ::::^ y'' x^ / / ^ / / / / 1 1 1 1 / I 1 1 1 / / / / / / / / / / / / / 36 60 ADDITIONAL COPIES OF THIS PUBLICATION MAT BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE ■WASHINGTON, D. C. AT 15 CENTS PER COPY V THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW AN INITIAL FINE OF 25 CENTS WILL BE ASSESSED FOR FAILURE TO RETURN THIS BOOK ON THE DATE DUE. THE PENALTY 1 WILL INCREASE TO 50 CENTS ON THE FOURTH DAY AND TO $1.00 ON THE SEVENTH DAY OVERDUE. -1 Wf^ ?i]^^^\[^^ ^ fl^f]^^'"'^^ LD 21-100m-12,'43 (8796s) 14 DAY USE RETURN TO DESK FROM WHICH BORROWED This book is due on the last date stamped below, or on the date to which renewed. Renewed books are subjert to immediate recall. Tel. No. 642-2511 LD 21-32m-3,'74 General Library (R7057sl0)476 — A-32 University of California Berkeley I U.C. BERKELEY LIBRARIES ca5T3flsa7i