USA > Massachusetts > Norfolk County > Quincy > Inaugural address of the mayor, with the annual report of the officers of the city of Quincy for the year 1937 > Part 10
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All forms
Typhoid Fever
Whooping Cough
1877-1881
251
165
7.7
27.9
325
36.8
8.
1882-1886
77
143
3.5
38.9
323
50.
5.1
1887-1891
158
181
15.9
6.7
254
57.3
12.5
1892-1896
82
174
3.2
15.
262
42.2
11.8
1897-1901
34.5
155
11.5
1.8
208
24.3
17.
1902-1906
41.6
121
9.4
4.4
184
12.6
19.5
1907-1911
17.5
126
5.5
12.
153
8.
6.9
1912-1916
14.3
57
7.3
9.8
151
5.2
11.4
1917-1921
16.2
35
5.7
5.
135
2.1
11.2
1922-1926
7.5
10.3
3.6
2.4
89
.3
6.6
1927-1931
2.6
7
3.2
5.6
65
.6
4.2
1932-1936
.8
3.7
1.0
2.1
50
.3
3.2
1937
.0
6.3
.0
.0
47.8
.0
0.
TABLE 6. Average annual infant death rate and still birth rates per 1,000 live births in Quincy, Mass., for five year periods, 1902-1936 and the rates for 1937 alone.
Period
Infants under one month
Infants one month to one year
Infants under one year
Still births
1902-1906
38.8
66.2
105
30.6
1907-1911
43.4
63.6
107
36.
1912-1916
42.8
43.4
86.2
33.4
1917-1921
35.7
36.1
71.8
35.6
1922-1926
32.6
24.7
57.3
34.3
1927-1931
32.7
25.5
58.2
29.
1932-1936
28.9
15.0
43.9
25.
1937
19.5
12.5
32.
21.9
TABLE 6 Reportable Diseases by Months, 1937
Disease
Jan.
Feb.
Mar.
Apr.
May
June
July
Aug.
Sept.
Oct.
Nov.
Dec.
Total
Anterior poliomyelitis
62
42
82
49
22
20
3
1
0
5
60
72
418
Chickenpox
8
4
13
10
28
23
11
17
16
9
9
14
162
Dog bite
1
0
2
2
1
0
0
1
0
0
0
0
7
Epidemic Cerebro-Spinal Meningitis
2
0
0
2
7
5
0
0
0
0
0
0
16
German Measles
5
19
12
24
9
5
2
2
1
13
3
11
106
Lobar pneumonia.
0
0
0
0
0
0
0
0
1
0
0
0
1
Malaria.
5
1
13
63
98
96
35
4
0
0
1
3
319
Measles
14
6
15
4
0
0
2
0
0
0
0
1
42
Mumps.
0
0
0
0
1
3
0
0
0
0
0
0
4
Para Typhoid Fever
44
46
40
30
37
18
7
0
5
20
52
92
391
Scarlet fever
0
0
1
0
0
1
0
0
0
0
0
0
2
Septic Sore Throat
0
0
0
0
0
0
0
0
1
0
0
0
1
Superative Conjunctivitis
0
0
1
0
0
0
0
0
0
0
0
0
1
Trachoma
0
0
0
1
0
0
0
0
0
0
0
1
2
Trichinosis
8
9
1
5
8
12
10
2
7
2
1
6
71
Tuberculosis, pulmonary
0
7
1
0
1
0
0
0
1
1
0
0
11
Tuberculosis, hilum
0
0
0
0
0
1
0
0
0
0
0
0
1
Tuberculosis, other forms.
0
0
0
1
0
0
1
1
0
0
0
0
3
Typhoid fever.
0
6
7
2
1
2
0
4
6
5
2
0
35
Venereal Disease-Gonorrhea
0
5
5
5
3
2
6
11
3
3
4
0
47
Venereal Disease-Syphilis
36
39
40
48
28
32
6
7
2
4
0
4
246
Whooping cough
0
0
0
0
0
0
1
7
2
1
0
0
11
REPORT OF DEPARTMENT OF HEALTH
173
174
CITY OF QUINCY
TABLE 7. Reportable diseases by Wards, 1937.
Wards
Disease
1
2
3
4
5
6
Total
Anterior poliomyelitis.
4
3
0
0 64
44
85
418
Dogbite
50
14
12
16
35
35
162
Epidemic Cerebro-Spinal Meningitis
1
2
1
1
0
2
7
German Measles
2
0
0
2
7
5
16
Lobar pneumonia.
26
22
17
11
16
14
106
Malaria
0
0
1
0
0
0
1
Measles.
72
28
41
18
85
75
319
Mumps.
5
4
1
4
17
11
42
Para-Typhoid Fever
1
0
1
0
1
1
4
Scarlet Fever.
54
15
8
14
100
200
391
Septic Sore Throat
0
0
0
0
1
1
2
Superative Conjunctivitis
0
0
0
0
1
0
1
Trachoma
0
1
0
0
0
0
1
Trichinosis
1
0
0
0
0
1
2
Tuberculosis, pulmonary
13
10
9
18
10
11
71
Tuberculosis, hilum
2
7
0
1
0
1
11
Tuberculosis, other forms.
0
0
0
0
0
1
1
Typhoid Fever
0
0
1
2
0
0
3
Whooping Cough
63
39
21
18
61
44
246
2
2
11
Chickenpox.
153
36
36
TABLE 8 Comparative Morbidity-1928-1937
Disease
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
Actinomycosis.
1
8
13
24
2
9
1
23
1
11
Anterior poliomyelitis
196
62
106
64
134
278
278
157
34
418
Chickenpox.
0
0
0
1
2
Conjunctivitis.
19
18
7
9
26
25
12
1
1
0
Diphtheria.
22
40
39
71
62
78
178
214
155
162
Dog bite.
0
0
0
0
0
1
0
Dysentery, amebic.
0
0
0
0
0
0
1
1
0
0
Dysentery, bacillary.
0
0
0
4
1
1
5
0
0
0
Encephalitis lethargica
0
0
0
0
0
0
0
0
1
0
Hookworm
37
83
8
23
4
4
Influenza*
49
47
51
38
38
54
34
40
41
106
Lobar Pneumonia
1
0
1
0
0
0
1
0
1
1
Malaria.
1855
99
771
207
106
55
1963
124
1177
319
Measles.
2
2
1
78
65
167
20
30
500
564
0
Mumps
0
1
1
0
0
2
0
0
0
0
Rabies.
8
8
78
6
6
12
12
4114
29
16
Rubella ..
241
268
343
322
211
547
221
270
189
391
2
Scarlet Fever
4
0
5
3
2
7
3
1
0
0
Septic sore throat.
1
0
0
0
0
0
0
0
0
0
Smallpox.
0
0
0
0
0
0
0
1
0
1
Tetanus
1
0
0
0
1
0
1
0
0
2
Trachoma.
0
0
0
0
0
0
0
83
42
71
Trichinosis
73
68
96
84
58
67
Tuberculosis, pulmonary.
106
24
47
32
16
20
117
Tuberculosis, other forms **
0
4
3
3
Typhoid Fever
0
0
0
0
0
0
0
1
1
0
Undulant Fever.
91
170
88
94
70
158
207
95
95
246
REPORT OF DEPARTMENT OF HEALTH
*Not reportable since 1933.
** Includes hilum tuberculosis.
175
Whooping Cough.
1
0
0
0
0
0
0
0
0
0
1
0
0
0
0
1
0
7
2
1
1
1
2
42
Meningococcus meningitis
6
1
0
Ophthalmia neonatorum ..
0
0
1
0
0
0
0
63
20
13
12
2
3
4
3
3
3
0
0
..
54
2
0
176
CITY OF QUINCY
JANUARY 1, 1938.
RICHARD M. ASH, M.D.
Health Commissioner.
Dear Sir :-
Through your foresight, the Quincy Health Department con- ducted a very thorough and profitable survey of all cases listed as Tuberculosis in the files of the Quincy Tuberculosis Dispensary. This was done under the supervision of State Board of Health, and by their personnel, working in conjunction with the Quincy Health Department.
As a result of this splendid survey, 142 cases were removed (as well and arrested cases) from the active files. Of course these cases were removed only after a painstaking physical examination and X-ray findings. Also due to the survey, many W.P.A. nurses and clerks were furnished many remunerative pay checks, working under the supervision of Miss Russell the Dispensary Tuberculosis Nurse. These nurses put in their time, getting case histories in the field, and transporting patients for examination.
As a result of this survey, our files are now up-to-date, and we can feel our case statistics represent a more accurate picture of the current story of Tuberculosis in Quincy.
Previously many cases were carried on yearly in our list, simply because the original diagnosis took place in Quincy, and have since been dead-wood in our files. Now this is all corrected, and Quincy, together with a few other cities in the State, has joined the ranks of the select in furnishing real truth when rendering vital statis- tics in Tuberculosis. The survey was a progressive act, and you deserve great credit in bringing the State Board of Health to Quincy, for this purpose. As in business, so in health, inventories from time to time, bring out the facts and stimulate the personnel to achieve greater success in their work. The success of this survey was also remarkable because it happened in a week of terrific heat, and yet, the patients, some over 70 years of age, came willingly to the clinic. This naturally reflects great credit to the nurses getting the preliminary information, and convincing the patients that the City Health Department was about to furnish them a real check-up of their present lung condition. Their im- mediate response and cooperation were ample evidence of their appreciation and also equally pleasing to the Health Department.
"Tuberculosis Statistics for 1937"
The story of Tuberculosis for 1937 showed a slight annual in- crease over previous years. Hard times, poor housing and in- adequate family income, were probably responsible for the result- ing malnutrition and subsequent increase of Tuberculosis.
Rigid follow-up work of discovery of new cases, and thorough examination of contacts, offset this increase. When discovered, the active Pulmonary Tuberculosis cases should be first hospital- ized. If these cases respond and their sputum becomes negative, either through gas treatment or operation, they might then be al- lowed to go home and come back periodically to the hospital for "refills".
177
REPORT OF DEPARTMENT OF HEALTH
Only this sort of treatment is safe for the patients, the family, and the community. The so-called home treatment, without hos- pitalization, is neither good medicine nor good medical ethics and should be discouraged in our city. Quincy has spent much money in fighting Tuberculosis and has reached high standards in its intent to control the disease. Home treatment alone, lowers this standard, especially in these days of lower family income and poor housing, and should be discouraged.
"Children's Clinic"
Starting with the idea that education is the outstanding factor in controlling Tuberculosis, many Tuberculosis authorities think the children's clinic is, by far, the greatest single factor in the fight.
Here you meet the disease in the non-contagious stage. The time element, in control, is not so important at this age, and through this clinic the adult members of the family and the children's parents, are more easily contacted and their cooperation obtained. Usually parents are far more solicitous of their children's health, than their own. Hence, in these clinics, tuberculosis propaganda and education is easily disseminated and disease control, as well as prevention, is taught the entire family.
As the family is the community unit, one can readily see how you can thus make an entire city health conscious, and Tuber- culosis control can more intelligently be carried out.
In our city we have such a children's clinic at our Tuberculosis Dispensary and we are particularly proud of its record. Our af- filiation with our own preventorium camp, the hospital at Lakeville, the two State children's preventoria and certain private welfare rest homes, put us in a preferred position, to offer a lot of educa- tion and help along the idea of Tuberculosis control. Having been connected with the clinic in Quincy since its origin, I have natu- rally seen and have been pleased with its progress. I am thoroughly convinced that this city has been well repaid in health dividends and should be congratulated for its foresight for furnishing the financial aid.
All progressive cities now provide these clinics and they are con- sidered essential in Tuberculosis control. It is nice to know that Quincy was a pioneer in this work and is now rated among the highest doing this sort of work.
"Norfolk Camp Preventorium"
A very important part of our work in the children's clinic, at the Dispensary on Saturday mornings during the year, is the selec- tion of the list of deserving children for "Camp Norfolk". This list, when finally determined, furnishes some forty to fifty children for an intensive eight weeks' stay at the camp. The camp training and health education often spelled the difference between health and tuberculosis in these children. The knowledge they bring back to their own families also aids materially in our fight to control Tuberculosis.
The cost of the camp is furnished jointly by an annual appropria- tion of $2000 by the City Council and by an additional $1000 from the Tuberculosis Seal Sale at Christmas. This financial support is very worthy and should be continued. It is preventive work and as in all health projects, prevention is more desirable than control, and it is also cheaper from a tax standpoint.
178
CITY OF QUINCY
During 1937, we had the usual good results from Camp Norfolk. A large group of "below par" children entered the camp in July and returned as perfect health specimens about the first of Sep- tember. The project's only drawback was that more children wish to go than we could afford to send. However, we suppose this will always be true, for in most worth while projects the demand is usually greater than the supply.
Sincerely yours, CORNELIUS J. LYNCH, M.D. Dispensary Physician.
179
REPORT OF DEPARTMENT OF HEALTH
REPORT OF THE TUBERCULOSIS DISPENSARY NURSES
RICHARD M. ASH, M.D. Health Commissioner.
QUINCY, MASSACHUSETTS.
Dear Dr. Ash :-
We herewith submit to you our annual report for the year end- ing December 31, 1937.
Number of new tuberculosis cases reported Pulmonary
70
Hilum
11
Other forms 1
Disposition of new tuberculosis cases:
Admitted to Norfolk County Hospital 43
At home working or under own physician 6
Admittel to Veteran's Hospital, Rutland 3
Admitted to Rutland Sanatorium 1
Transferred to Italy
1
Transferred to Georgia
1
Transferred to Maine
1
Admitted to Lakeville State Sanatorium from Norfolk County Hospital (spine) 1
Admitted to Channing Home, Boston
1
Died at home
3
Died at Veteran's Hospital 2
Diagnosis revoked 2
Disposition of new hilum cases:
Admitted to North Reading State Sanatorium 8
Transferred to New York to live 1
Attending dispensary for check up, but sent to Norfolk County Preventorium for eight weeks during the Summer 2
Disposition of new other forms:
Admitted to Lakeville Sanatorium
1
"Norfolk County Hospital"
Cases discharged during the year
66
Conditions of patients on discharge:
Arrested pulmonary
16
Indefinite leave of absence to report back to hospital for "refills" 20
Dead 20
Non T. B. 1
Left against advice "Quiescent"
1
Left against advice "Improved" 1
Non T. B. "lung abscess" healed 1
Bronchiectasis-unimproved 2
Pulmonary Fibrosis-Hypertension-improved 1
Carcinoma of Bronchus-left-unimproved 1
Silicosis-improved-negative for T. B. 1
Silicosis-Arthritis (Deformans) 1
Cases discharged from leave of absence to arrested pulmonary 4
Cases discharged from Norfolk County Hospital and read- mitted during the year 8
Pneumonia 1
From leave of absence 3
Was arrested pulmonary but became active 3
Left against advice and was readmitted 1
82
180
CITY OF QUINCY
"North Reading State Sanatorium"
Cases admitted during the year 11
Cases discharged during the year 13
Number of cases at Sanatorium at end of year Condition of cases on discharge:
5
Arrested Hilum and in good condition 12
Arrested Hilum and in fair condition (kidney condi- tion) 1
One discharge to Boston Children's Friend Society for placement in foster home.
"Lakeville State Sanatorium"
Cases admitted during the year 1
Cases discharged during the year
3
Condition on discharge:
T. B. spine-arrested-"Cast on" 1
Bilateral orchitis-unimproved-left against advice 2
Number of cases at sanatorium at end of year 4
"Deaths"
Number of deaths reported during the year 36
At home 7
At Norfolk County Hospital 19
At Veteran's Hospital-Rutland 1
At Chelsea Naval Hospital-"Pneumonia" 1
At Chelsea Naval Hospital-Pul. T. B. Carcinoma 1
At Quincy City Hospital-Pul. T. B. Carcinoma 7
"Adult Clinic"
Attendance 303
New cases added to clinic register 71
Number of contact examinations made 119
Number of sputum examinations made 285
Cases X-rayed at Norfolk County Hospital 226
"Children's Clinic"
Attendance 1213
New cases added to the clinic register 219
Number of contact examinations made 486
Mantoux Tests done 182
Number of children admitted to the Norfolk Preven-
torium for eight weeks during the summer months ..
52
Vaccinations done 10
Cases referred to Family Welfare for social service needs 8
Cases referred for T & A operations 22
Tuberculosis Survey Conducted in Cooperation With the State Department of Public Health During the Summer of 1937
181
REPORT OF DEPARTMENT OF HEALTH
"Summary"
Total number of cases listed in Quincy
917
Removed from the list as not active tuberculosis (Definite transfers and not on the file)
142
Actual number of cases left
775
Examined or under definite supervision 535
Per cent examined or under definite supervision 69
Questionable supervision-no reports available 46
Per cent without reports 5.9
Refusals, unlocated, absent (to be revisited) 194
Percent on active list not checked 25
Relief work was done by both nurses during the year. Mrs. Gifford is doing part-time parochial school work and part-time tuberculosis work. The nurses gave lectures with "moving picture films" on their work to the senior class at the Quincy City Hospital. Practically all patients going for X-ray were transported every Tuesday morning to the Norfolk County Hospital by us, and we follow the patient thru this examination, giving histories, etc. As a rule, we escort the patients to the hospital when being ad- mitted to Norfolk County Hospital, Lakeville Sanatorium, and North Reading State Sanatorium. We are conducting two clinics for tuberculosis diagnosis each week. On July 1st, when the children went to the Norfolk Health Camp, private citizens loaned their cars to help transport these children to the camp, as did the other nurses in the department.
Respectfully submitted,
GERTRUDE T. RUSSELL, R.N. HAZEL R. GIFFORD, R.N. Dispensary Nurses.
182
CITY OF QUINCY
REPORT OF CHILD WELFARE CLINIC
JANUARY 1, 1938.
DR. RICHARD M. ASH, Health Commissioner.
QUINCY, MASSACHUSETTS.
Dear Dr. Ash :-
After an interval of ten years I again took up the duties of Child Welfare Physician beginning January 1, 1937.
It is my impression that during this ten year interval, infant mortality has practically reached an irreducible minimum-pro- vided we exclude the neo-natal deaths in the first month of life. There were no deaths from nutritional disturbances among those babies registered at the clinics. The efficiency of any well baby clinic can be criticized if there are many deaths from nutritional diseases.
It has been my policy to see each registered baby as often as a physician would usually see them in private practice. There has been no prescribing done at any clinic.
The purpose of the preschool clinic does not-as yet-seem to be appreciated by the public. There is a tendency to use the clinic for diagnosis and treatment. It has been our policy to refer all suitable cases from the Preschool Clinic to the Habit Clinic.
I wish to express my appreciation of the faithful work of the Child Welfare Nurses-Mrs. McLennan and Mrs. Fowler.
I also wish to thank you for your complete cooperation.
Truly yours,
EDMUND B. FITZGERALD, M.D. Child Welfare Physician.
REPORT OF DEPARTMENT OF HEALTH
183
REPORT OF CHILD WELFARE NURSES
JANUARY 1, 1938.
DR. RICHARD M. ASH,
Health Commissioner.
Report of Child Welfare Nurses for the year ending December 31, 1937.
Total clinic registration during year 1351
Total clinic registration active December 31st 997
Total new registrations during year 729
Total preschool registrations (1937) 145
Preschool clinic 99
Orthopedic clinic 46
Registered over 6 years in Orthopedic clinic
24
Total clinic attendance 6494
Removed from file for reasons given below
354
Deaths
4
2 Bronchopneumonia
1 Cerebrospinal meningitis
1 Otitis media
Inactive 8 months and over
Entered school
Returned to institutions
Moved from city
Number of clinics held
282
Well baby
261
Preschool
11
Orthopedic
10
Clinics Held
Day
Station
Attendance Examined
New
Monday
South Quincy
1354
1063
104
Monday
Woodward (preschool)
131
117
60
Tuesday
Wollaston
868
702
89
Tuesday
Houghs Neck
461
351
57
Wednesday
Quincy Point
1231
914
102
Thursday
Woodward
994
884
91
Thursday
Squantum
89
89
7
Thursday
Woodward (Orthopedic)
179
163
69
Friday
Atlantic
1187
908
150
6494
5191
729
Houghs Neck clinic is held twice a month, Preschool, Squantum and Orthopedic clinics are held once a month, and all others are held weekly.
184
CITY OF QUINCY
Clinic Registration
Active Dec. 31st Inactive 8 months Reg. in 1937
South Quincy
149
72
221
Wollaston
118
48
166
Houghs Neck
67
40
107
Woodward
135
35
170
Preschool
99
4
103
Orthopedic
107
19
126
Quincy Point
158
40
198
Atlantic
145
78
223
Squantum
19
18
37
Totals
997
354
1351
Boarding homes registered
16
Boarding homes not registered
9
Children now in boarding homes
54
Boarding home inspections
231
Temporary homes found for
14
Number of visits made to babies under 1 year
2333
Number of visits made to babies between 1 & 2 years
1490
Number of visits to preschool group
598
Number of visits to boarding homes
231
Assisted at T.A.T. clinics and relieved other nurses.
Total number visits made
4652
All children not immunized for contagious diseases referred to family doctor.
Referred to local M.D. by clinic or nurse
157
Referred to clinic or private dentist
30
Referred to Habit clinic
31
We extend our sincere thanks to Dr. E. B. FitzGerald and Dr. F. Costanza for their kindness to us and for their valued assistance.
We also thank the Wollaston Women's Club members for their assistance, and to our friend and volunteer worker for six years at the Atlantic clinic, Miss Alice G. Thompson, our deepest apprecia- tion.
Respectfully submitted,
NETTIE D. FOWLER, R.N., MARY MARR McLENNAN, R.N., Child Welfare Nurses.
Clinic
REPORT OF DEPARTMENT OF HEALTH
185
REPORT OF ORTHOPEDIC CLINIC
FEBRUARY 28. 1938. Department of Health,
DOCTOR RICHARD ASH, Health Commissioner,
QUINCY, MASSACHUSETTS.
Dear Doctor Ash:
Enclosed is my report of eleven Orthopedic Clinics attended by me.
With kindest regards, I am
Sincerely yours, JOHN L. DOHERTY. JLD: MY
Report of Orthopedic Clinic
The following is a report of eleven clinics attended by Dr. John L. Doherty from January, 1937 to December 1937 inclusive:
163 children were examined-seventy-four were new admissions and eighty-nine were follow up examinations.
Classification of Conditions Found in New Patients
Pronated feet
32
Knock knees 10
Bow legs
5
Faulty posture
5
Flat feet 21
Spastic paralysis
0
Obstetrical paralysis
1
Recurvatum of knees
0
74
Eighty-nine children reported for follow up examination.
186
CITY OF QUINCY
QUINCY HABIT CLINIC STATISTICS, 1937
JANUARY 28, 1938.
RICHARD M. ASH, M.D. Health Commissioner. CITY HALL QUINCY, MASSACHUSETTS.
MY DEAR DOCTOR ASH:
You will please find enclosed the annual report of the Quincy Habit Clinic for the year 1937.
In the event that this report is too lengthy to practically fit in with the rest of your report, please feel free to delete or abstract it in any way you think best.
Thank you for the cooperation which your department has given us during the past year.
Sincerely yours,
OLIVE A. COOPER, M.D., Assistant to Director.
OAC: MF
Enc.
Boys
Girls
Total
Total number of clinics held
-
-
44
Total number of cases carried
148
64
212
School age-161-pre-school age-51
Total number of new cases
97
48
145
School age-108-pre-school age-37
Total number of old cases
51
16
67
School age-53-pre-school age-14
Total number of visits by children
656
232
888
Sources from Which Cases Were Referred
Schools
84
Relatives and friends
23
Health agencies 20
Physicians
6
Children's agencies
4
Family agencies
3
Clinic staff
3
Community education
2
Churches
0
Total Number of New Cases 145
187
REPORT OF DEPARTMENT OF HEALTH
QUINCY HABIT CLINIC
Annual Report-1937
During the year 1937, there has been little deviation from the program of the Quincy Habit Clinic as outlined in our last report- in the main, the general organization, methods of study and treat- ment previously described have been followed. The two major objectives have been clinical and educational. We have been able to maintain in the clinical program a high therapeutic standard throughout the year. We have also continued to fulfill an ever- increasing request for community education.
The clinic has always stressed quality rather than quantity as one of its goals. Treatment of the individual child has been our uppermost objective, and we have painstakingly avoided any pro- cedure that tended to defeat that objective or adulterate the serv- ice in any way. While not being disposed to limit our intake of cases, we have endeavored to keep the number accepted for in- tensive treatment consistent with adequate therapeutic results. A clinic maintaining such aims and standards cannot undertake to study intensively all of the cases referred-to do so would not only reduce the clinic's opportunity to deal with the increasing referral of cases, but would also impede progress in those cases where service is most needed. Therefore, it becomes necessary to practice a reasonable amount of selection in accepting cases for prolonged study and treatment. This selection is not made on any arbitrary basis, nor by avoiding any opportunity to contribute to the most difficult cases when it is deemed practicable to do so. Rather the selection is made on the basis of whether a child will be benefited by the specialized type of service we have to offer, and whether the treatment is going to be a prudent expenditure. Every case referred is accepted for appraisal at least, if not for detailed study and treatment. Even in those cases where a com- plete clinic service would seem to be impractical (either from the patient's standpoint or from that of the clinic), a consultation service is always rendered in which the appraisal of the case is given to the referring agency, with recommendations made as to the most practical disposition of the case.
Because such frequent inquiries are made both by correspon- dence and by personal visits from interested persons regarding clinic service, a brief résumé of the clinic's mode of operation would seem indicated at this time. Children are referred to the clinic from various sources and for multiple reasons-behavior problems manifest either in the home or outside; personality deviations sufficient to interfere with social and scholastic adjust- ment; various neurotic traits; educational disabilities in the form of inability to read, difficulty in concentration, application, etc .; and lastly, problems of delinquency. The variety of problems and situations brought before the clinic necessitates a comprehensive method of study. This is outlined briefly in the following descrip- tion of clinic routine.
The clinic procedure is devised on the assumption that a child who presents difficulty in the home, school, or other contacts, or manifests symptoms or signs of disturbance in the course of physi- cal and mental development requires a thorough investigation in order to determine the real sources of his difficulty. The full study
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