ear
period--twice during the eight years of school life--special emphasis
be laid upon the discovery and cure of each of the more important
defects. How this emphasis should be distributed is a matter best
decided by the staff in conference. It might be found advisable to
adopt a plan whereby special attention is given to teeth, adenoids,
tonsils, and glands in the lower grades; posture and heart in the
upper grades; and eyes, hearing, lungs, and nutrition straight through
the grades. Whatever plan is adopted must be the result of study,
consultation, and experiment, in an endeavor to find the most
economical investment of effort on the part of nurses and doctors in
terms of results gained.

[Illustration: Columns are proportionate in height to the per cent of
physical defects corrected each year for five school years.]

Speech defects are very common among children. At first they yield
readily to treatment, but if allowed to continue through the
adolescent period the habit becomes fixed so that trying to cure it is
a difficult and often fruitless task. Judging from the experience of
other cities, about 200 boys and 800 girls in the Cleveland public
school system are suffering from some form of speech defect. There are
few fields in which the medical inspection department has such an
opportunity for effective work and in which so little has been done.
Effort should be made to locate these children, and form them into
groups for daily training, under the direction of a teacher specially
prepared to handle speech cases.

UNIFORM PROCEDURE

In the fall of 1914, the medical staff conducted a survey of its own
efficiency. A committee prepared questions concerning procedure, and
secured answers from each member of the staff. These answers were
compared and discussed in staff meetings and uniform rules were
finally adopted for examinations and recording.

In line with this, the staff somewhat earlier prepared rules for
reporting defects so that all records may be compiled on the same
basis. This standardization of work is an especially noteworthy
feature of the Cleveland system, and should furnish valuable
suggestions to medical inspection departments of other cities. A few
of the rules adopted by the staff will serve to indicate the nature of
their work:

_Teeth_--Report decayed first or second teeth, and reddened
and inflamed gums. Do not report loose first teeth.

_Tonsils_--Report cases wit