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U. S. DEPARTMENT OF LABOR
JA M E S J. D A V IS . Secretary
CHILDREN’S BUREAU
G R A C E A ß B O T T . ChjeL
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PHYSICAL STANDARDS FOR WORKING CHILDREN
PRELIMINARY REPORT OF THE COMMITTEE APPOINTED
BY THE CHILDREN’S BUREAU OF THE U. S. DEPARTMENT
OF LABOR TO FORM ULATE STANDARDS OF NORMAL
DEVELOPMENT AND SOUND HEALTH FOR THE USE OF
PHYSICIANS IN EXAMINING CHILDREN ENTERING EM
PLOYMENT AND CHILDREN AT WORK
Bureau Publication No. 79
(Appendix revised to include legislation up to August 15. 1926)
W ASH IN G TO N
G O V E R N M E N T PR IN T IN G OFFICE
1926
7
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SINGLE COPIES OF THIS PUBLICATION MAY BE
OBTAINED FREE UPON APPLICATION TO THE
CHILDREN’ S BU R E A U .
ADDITIONAL COPIES MAY
BE PROCURED FROM THE SUPERINTENDENT OF
DOCUMENTS, GOVERNMENT PRINTING OFFICE,
WASHINGTON, D . Ç
at'
10 C E N T S P E E C O P Y
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CONTENTS.
4
-« : ■
Page.
Letter of transmittal.........................
vn
Foreword.........................
2-5
1
Types of legislation........................................................................................ . ............
Standards of administration................................................................ ....................
3
Committee on physical standards...................................... ...............................
4
Prelim inary report of the committee on physical standards............ .................... 7-15
General recommendations................................... ...................................................... 7_10
Age minimum for entrance into industry......................................................
7
Physical minimum for entrance into industry.............................................
7
Physical examinations for children entering industry...............................
7
7
Reexaminations for children changing occupations............. ......................
Periodical reexaminations for all working children...................................
8
Centralized control of methods of examination............................... ............
8
Desirability of physical examinations of children during school and
preschool period............................ ..................................................................
8
Need of study b y local administrative and medical officers of occupa
tions in which children are employed and of their effect upon health.
8
Need of authoritative scientific investigation...............................................
9
Certain tentative minimum standards obtainable from results of
scientific research already available............................................. ............
10
Minimum standards of physical fitness for children entering and working
in industry.................................................................................................... ............10 -12
Standards of normal development.... ..............................................................
10
Standards of sound health and physical fitness for employment............
10
Points to be covered and methods to be employed in physical examina
tions............................................................................................................................. 12-15
Items for in q u iry.......................................................................................... ..
12
Use of previous examination records...............................................................
14
Record card and instructions for use of examining physician.................
14
Record of physical examination for employment certificate..................Face
14
Instructions to physicians for filling in records of physical examinations of
14
children applying for employment certificates............................. ..........Face
Appendix: Laws relating to physical requirements for employment.................... 17-24
Examinations before child goes to work.................................................................
17
Reexaminations.................................
21-22
Reexamination when child changes employers. . . ! . . . ...............................
21
Periodical reexaminations..................................................................... / . ___
21
Reexamination required through issuance of temporary certificates.. .
22
Administrative provisions.......................
22-24
Issuing officers....................................................................................
22
Power to prescribe forms and standards..................................................
24
Revocation of employment certificates............................
24
MAP.
Legal requirements for physical examinations of children going to work—
August 15,1926........................................
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Ss?i7 l'i.-C;. X ‘ S fe'îiîVf-,
L E T T E R O F T R A N S M IT T A L ,
U . S . D ^P A R T M E n I’
OF
L A B o fi,
Children ’ s B ureau ,
Washington, August 15, 1926.
Si r : I transmit herewith the report on Physical Standards for
Working Children with the appendix revised to include 1925 and
1926 legislation. At a session of the Children’s Bureau Conferences
on Standards of Child Welfare the bureau was requested to appoint
a committee to formulate definite standards of normal development
and sound health for the use of physicians in examining children
applying for work permits. The following physicians consented to
serve on the committee and this report, first published in 1921, was
made possible through their cooperation:
Dr. George P. Barth, director of school hygiene, city health depart
ment, Milwaukee, Wis., chairman.
Dr. Emma M. Appel, employment-certificate department, Chicago
Board of Education.
Dr. S. Josephine Baker, chief, bureau of child hygiene, department
o f health, New Y ork City.
Dr. Taliaferro Clark, representing the United States Public Health
'i£M. Service.
Dr. C. Ward Crampton, dean, Normal School of Physical Educa
tion, Battle Creek, Mich.
Dr. D. L. Edsall, dean, Harvard Medical School.
Dr. George W . Goler, health officer, Rochester, N. Y.
Dr. Harry Linenthal, industrial clinic, Massachusetts General PIospital, Boston,. Mass.
Dr. H. H. Mitchell, representing the National Child Labor Com
mittee.
Dr. Anna E. Rude, director, hygiene division, United States Chil
dren’s Bureau.
Dr. Thomas B. Wood, chairman of committee on health problems
and education, Columbia University.
Miss E. N. Matthews, director of the industrial division of the
Children’s Bureau, acted as secretary to the committee.
Since the publication of the third edition a number of legislative
changes have been made in various State laws fixing physical
standards for working children. The foreword and the appendix
have therefore been" revised so as to bring up to date all the state| ments relating to legal requirements.
P* .
Respectfully submitted.
Grace A bbott, Chief.
Hon. James J. D avis ,
Secretary o f Labor.
v
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L E G A L R EQ U IR EM EN TS FO R P H Y SIC A L EXAMINATIONS
O F C H ILO R EN GOING TO W ORK
fl9 26 legisl ation included so far as available August 1,1926}
(Examinations forregu lar employment certificates. Exam!nations to determine age not included)
I. . I Examination, -'mandatory
Issuing officer has power
to require examination
■ No provision
£ Exam ination mandatory in Milwaukee by order of Wisconsin Industrial CoVnmission.
jj Exem ptions in certain cases on w ritten objection of parent.
A Exam ination within 6 m onths previous by authorized medical officer may be accept
ed as su b stitu te.
O No provision for employment certifica tes a p p lica b le to general occu pations.
P No regular em ploym ent certifica te req u ired for child over minimum age (15)j
physical exa m in a tion m an datory fo r"p o v e rty ” perm it (12-15)..
• E ffective July 1,1927.
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PHYSICAL STANDARDS FOR WORKING CHILDREN.
FO R E W O R D .
'i
The child who goes to work between 14 and 18 years of age is in
need of special protection if he is to arrive at maturity with good
health and a vigorous and well-developed body. During these years
he is passing through the most critical period of his physical develop
ment, when his body must meet the unusual demands of rapid
growth and physiological readjustment. If at the same time he is
subjected to the mental and physical strain of occupational life,
the burden upon his immature physique is a double one, and special
precautions are necessary if normal growth and development are not
to be endangered. Prohibiting the employment of children in certain
occupations generally recognized as injurious to health is an important
but obviously limited means of affording. protection. Raising the
minimum age for entrance upon any employment offers only a
partial solution of the problem. A tendency to keep children out
of industry until they are at least 16 years of age is becoming apparent
in child labor laws, but even with 16 years as a minimum age, large
numbers of young persons will continue to go to work before their
physical growth is completed and will stand in need of protection if
they are to reach normal development. An effective means of pro
tecting the health of children at work lies in the adoption of standards
of physical fitness which all children entering employment are
required by law to meet.
TYPES OF LEGISLATION.
The first attempts to protect the health of employed children
through direct legal provisions took the form of laws giving factory
inspectors or other law-enforcing officials power to require physical
examinations of children found at work who appeared to be physically
unfit for employment. Illinois, Michigan, Minnesota, New Jersey,
and New York were among the States enacting legislation of this
type. A number of these early laws are still on the statute books,
and a few States have in recent years passed laws of the same type,1
but generally powers of this kind are not so exercised as to protect
any considerable number of children from the strain of too early or
inappropriate labor. This is due not only to the inherent weakness
i See Appendix, pp. 21-22.
1
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PH YSICAL STANDARDS FOR W O RKIN G CHILDREN.
of a mere permissive regulation, but also to the fact that the un
fitness of a child for his work is seldom so apparent as to force itself
upon the attention of an official— usually n ot a physician—whose
inspection duties often cover far more than the child-labor provisions
of the law. The next form of legal provision permitted the cer
tificate-issuing officer to require a child who did not appear to be in
fit physical condition for work to be examined by a physician before
he could secure an employment certificate. Eight States 2 and the
District of Columbia now have permissive laws of this type, and
though in a few instances they may be so enforced as to require
practically every child going to work to be passed upon by a physi
cian, they have the serious disadvantage of depending for their
effectiveness upon the degree of interest evidenced b y each one of
a large number of enforcing officials, who are in most States prac
tically unsupervised by any central authority and who in many cases
do not realize the importance of this phase of their work.
The mandatory requirement of a physical examination for every
child securing an employment certificate, now found in the laws of
25 States,2 represents the third step in the development of the legal
protection of the health of working children. In some of these States
the child must be examined with reference to the particular kind
of work which he is to do and must obtain a new certificate of physi
cal fitness whenever he goes from one employer to another. But a
child fitted for one occupation may be transferred b y his first employer
to an entirely different kind of work for whidh he is not at all fitted,
and he may stay with his first employer until he passes the certificate
age. It is thus obvious that even requiring a certificate of physical
fitness for the issuance of every employment certificate and a new
employment certificate every time a child changes employers does
not give an opportunity for adequate and uniform health supervision
of employed children.
One State only (Virginia3) has as yet advanced to the next stage—
examination of every working child at regular intervals during the
years when he is peculiarly susceptible to the strains of industry in
order to determine whether the work at which he is engaged is
injuring him or interfering with his growth.4 The laws of 15 States,8
s See Appendix, pp. 17-20. In one of these States, the law does not go into effect until July 1, 1927.
3 See Appendix, p . 21.
4A n exceptionally good opportunity for putting into effect an adequate program of health supervision
of working children is furnished by the compulsory continuation-school laws now in force in 27 States,
which keep still under the control of the school authorities children who have left the all-day schools to
enter industry b y requiring them to spend a certain number of their working hours in classes specially
provided for them. These States are Arizona, California, Connecticut, Delaware, Florida, Illinois, Indiana,
Iowa, K entucky, Massachusetts, M ichigan, Missouri, M ontana, N ebraska, N evada, N ew Jersey, N ew
Mexico^ N ew York, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, U tah, Washington, W est Vir
ginia, and Wisconsin. A ll except seven have provisions requiring schools to be established and children
to attend under certain specified conditions. These seven are Indiana, where loeal school authorities m ay
establish schools and require attendance; and Connecticut, Illinois, Kentucky, Ohio, Tennessee, and
Washington, where certain groups of children m ust attend if schools are established, but there are no com
pulsory provisions for establishment.
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PH YSIC AL STANDARDS FOR W O RKIN G CHILDREN.
3
moreover, still make no provision at all for a physical examination
even when the child first goes to work.
The most comprehensive type of law now found requires that a
child be of normal development, in sound health, and physically
qualified for the occupation in which he is to engage, and stipulates
that the examination shall be made and the certificate of physical
fitness granted b y a physician who is officially connected with some
public department, usually the public-school system or the board of
health, but in some cases the department enforcing the child-labor
laws. In order that the physician may judge the child’s fitness
for his intended work, the latter is required to bring a promise of
employment signed by the prospective employer and stating the occu
pation in which he is to be engaged.
STANDARDS OF ADMINISTRATION.
y
/'
.
Even where provisions which might go far toward protecting the
health of employed children are found on the statute books, inade
quate appropriations and a failure to recognize the importance of
the physical requirement are responsible for inadequate administra
tion. The first examination is in many cases hurried and superficial
rather than thorough. Reexaminations when the child goes from
one employer to another, required under the laws of a few States
and possible, at least, in most of the States where the first examination is mandatory,5 are either omitted or only perfunctorily given.
In States where the law is permissive, issuing officers seldom take full
advantage of their power to require examinations.
The procedure followed in making physical examinations of
children applying for employment certificates is usually determined
by the policy of each individual issuing office, but in a few States,
among which are Alabama, California, Connecticut, Delaware, Illinois,
Indiana, Maryland, New York, Pennsylvania, and Virginia, a uni
form blank fdr recording the results of the examination is in use.6
These forms, which are prescribed b y the State board responsible
for the enforcement of the child labor law, specify the points which
should be covered by the physician’s examination, and in some States
they are supplemented by detailed instructions. In certain cities
the local officials in charge of issuing certificates have devised special
forms and have attempted to develop standard methods of procedure.
One of the most usual forms of physician’s certificate does not
furnish in any sense a record of the examination, since it con
tains merely the bare statement required by law that the child has
been examined and has been found in sufficiently sound health and
physically fit for the work which he intends to do. Among the
forms which do attempt to furnish a record of the results of the
5 See Appendix, p . 21.
8 In Massachusetts the State department of labor and industries has drafted and printed a blank record
form and recommends its use b y local issuing officers, to w hom copies are supplied upon request.
10687°—26----- 2
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PHYSICAL. STANDARDS FOR W O RKIN G CHILDREN.
examination, wide variation in details is found. Some require
entries of only a few of tlie outstanding facts about the child s physical
condition, under such items as: Ears, eyes, teeth, throat, chest
development, height, weight, vaccinated, malnutrition, heart action.
Others go into great detail as to the points to be covered b y the
examination, in effect instructing the physician as to exactly what
indications he should look for, and what methods he should use in
examining each child. Such a form serves the double purpose of
preserving a record of the child’s physical condition and of insuring
at least a certain degree of thoroughness as well as of uniformity
where any conscientious attempt is made to make the practice con
form to that obviously demanded b y the record blank.
Even where directions are issued and forms are used, the examina
tions in practice vary widely. No form can be more than a guide
and a reminder; its use can not make certain that a child will be
thoroughly or scientifically examined, but a form which is properly
arranged and adequate for its purpose greatly increases the proba
bility of such examinations.
The object of the physical examination is obviously to prevent
children from going to work in unsuitable occupations, or from
going to work at all if they are not in a fit condition to do so. The
key to its actual value to the child, therefore, is found in the standards set for the granting of a certificate of physical fitness. This
standard varies probably fully as much as the standard of the exam
inations themselves, becoming more exacting the more thorough the
examination. As would be expected, the more definite standards
are found in o f f i c e s where specially devised record.forms are used
these forms, in fact, being in many cases accompanied b y detailed
instructions as to the defects for which certificates must be perma
nently refused or temporarily refused until such defects are corrected.
COMMITTEE ON PHYSICAL STANDARDS.
The difficulties in the way of adequate enforcement of the physical
provisions of child labor laws are recognized as due to a large extent
to the lack of definite standards and of uniformity in procedure.
“ Sound health” and “ normal development” are not defined in the
laws, and physical fitness for a specific occupation can not be deter
mined unless precise and definite knowledge of occupations and
their effect on the growth of the body and on the health of the child
is available.
A t the Children’s Bureau Conferences on Standards of Child W elf are
(May and June, 1919) considerable attention was devoted to the
subject of physical standards,7 and the following physical minimum
i Standards of Child W elfare, A Report of the Children’ s Bureau Conferences M ay and Jupe, 1919,
p p 85-97.
U . S. Children’s Bureau Publication N o . 60.
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PH YSICAL STANDARDS FOR W O RKIN G CHILDREN.
5
was adopted as a part of the minimum standards for children entering
employment.8
A child shall not Be allowed to go to work until he has had a physical examination
by a public-school physician or other medical officer especially appointed for that
purpose b y the agency charged with the enforcement of the law, and has been found
to be of normal development for a child of his age and physically fit for the work at
which he is to be employed.
There shall be annual physical examinations of all working children who are under
18 years of age.
Acting on a proposal made by members of the Conference who
realized that such a standard could not be adequately applied until
it was more carefully defined, the Children’s Bureau appointed a
committee of physicians whose task it was to formulate definite
standards of normal development and physical fitness for the use
of medical examiners in making physical examinations of children
applying for employment-certificates, and also of working children.
Following its first meeting in January, 1920, the committee pre
pared a preliminary report and a tentative record form, which
were sent for criticism and suggestions to State labor officials, local
certificate-issuing officers, examining physicians, and others interested
in physical standards for working children. The record form was
also tried out in several cities. In the light of suggestions and criti
cisms received from these sources, this preliminary report was revised
at the second meeting of the committee, January, 1921, and sub
mitted to the Children’s Bureau. It is expected that from time to
time the report will be revised to embody the results of further scien
tific research and practical experience in this field.
8.Minimum Standards for Child Welfare Adopted b y the Washington and Regional Conferences on Child
Welfare, Î919, p p . 3-5. U . S. Children's Bureau Publication N o. 62.
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PR E L IM IN A R Y REPO R T O F T H E C O M M IT T E E O N PH YSICAL
STA N D A R D S FOR W O R K IN G C H ILD R E N .
GENERAL RECOMMENDATIONS.
1. Age minimum for entrance into industry.
The minimum age for the entrance of children into industry should
be not younger than sixteen years. Since it is recognized that the
physiological and psychological readjustments incident to pubescence
(which in the vast majority of cases are not completed until the six
teenth year) determine a period of general instability which makes
great and special demands upon the vitality of the child, it is of
paramount importance that he should be protected during this period
from the physical and nervous strain which entrance into indus
try inevitably entails. The committee recognizes the fact that pubes
cence may occur early or may be very greatly delayed, and is con
vinced that the longer it is delayed the stronger is the indication of a
physical stage during which it is highly inappropriate to subject the
child to the strains of industry.
2 . Physical minimum for entrance into industry.
No child between the ages of sixteen and eighteen should be per
mitted to go to work who is not of normal development for his age,
of sound health and physically fit for the work at which he is to be
employed.
3. Physical examinations for children entering industry.
The physical fitness of children entering industry should be deter
mined by means of a thorough physical examination conducted by a
public medical officer appointed for this purpose. Where possible
all examinations should be made without clothing. Before such a
physical examination is made, the child should present a definite
promise of employment in writing from his intended employer, stat
ing the specific occupation at which he is to be employed.
4 . Reexaminations for children changing occupations.
The employment certificate should not be given to the child, but
sent by mail to the employer. When a child leaves the specific em
ployment for which the certificate was issued, the employer should
return the permit to the issuing officer by mail. With each change of
employer another examination should be made before the child is
again permitted to work, the mode of procedure to be the same as in
the issuance of the original permit. Wb.en a child is transferred to any
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PH YSICAL STANDARDS FOR W ORKING CHILDREN.
occupation in the same establishment differing in its physical demand's
and hazards from those common to the occupation for which the per
mit has been issued, this must be communicated by the employer to
the issuing officer in writing, and a new physical examination of the
child made and a new certificate issued.
5 . Periodical reexaminations for all working children.
All employed children up to the age of eighteen should have at least
one yearly physical examination, to be made by a public medical
officer appointed for this purpose. Whenever in the judgment of the
medical examiner more frequent examinations are desirable, the child
should be ordered to report at stated intervals for this purpose.
These examinations should take place in the certificate-issuing office,
in the continuation school, or in the establishment in which the child
is employed.
6. Centralized control of m ethods of examination.
In order to insure uniformity in methods of examination in each
State the State labor or other department administering the child
labor law should have authority to make rules and regulations relar
tive to methods of examination and qualifications of examining physi
cians, to prescribe record forms, and to require reports with reference
to examinations made. Each such department should employ one
or more physicians qualified in industrial hygiene, who shall be author
ized and required to supervise the work of the local examining physi
cians.
7. Desirability o f physical examinations of children during school and
preschool period.
Many of the physical defects found in children applying for work
permits could easily have been discovered and cured, or prevented
altogether, b y proper examination and treatment during the child’s
school life, or even earlier. The committee therefore urges the neces
sity for the provision of adequate facilities for medical examination
and treatment of all children of school and preschool age.
8 . N eed o f study by local administrative and medical officers of occu
pations in which children are employed and o f their effect upon
health.
Occupations in which children are likely to be employed should be
made the subject of special study for the purpose of ascertaining
their physical requirements and their effect upon the health and
development of the growing child. The examining physician should
be authorized and required to visit periodically industrial establish
ments and to familiarize himself with conditions of employment and
with the various health hazards of industry.
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PH YSICAL STANDARDS FOR W ORKING CHILDREN.
9.
A
i
9
Need of authoritative scientific investigation.
The committee recognizes the impossibility of formulating definite
physical standards for children in industry which will he complete
and finally authoritative without a great deal of further scientific
study of the effect of different kinds of work upon the health and
physique of the adolescent child.
Research is especially needed with reference t o :
a. The rate of growth and development of children employed in
different occupations and industries as compared with
children not in industry.
b. Morbidity among children employed in different occupations
and industries as compared with children not in industry.
c. Mortality among children employed in different occupations
and industries as compared with children not in industry.
d. Fatigue in children employed in different occupations and
industries.
e. Effect of employment in specific occupations at different
stages of physiological development upon the growth and
health of—
(1) Normal children.
(2) Children with certain physical defects (such as compen
sated cardiac disease or with orthopedic defects) or
with a personal or family history indicating predispo
sition'to certain diseases.
f. Effect of employment in specific occupations upon the men
strual function and pelvic organs of adolescent girls and
young women.
g . Types of work desirable for:
(1) Children and young persons with some mental defect
who, nevertheless, are able to fulfill the educational
requirements necessary to obtain an employment
certificate.*
(2) Children and young persons who are suffering from
certain physical handicaps, such as the partially dis
abled child and the child with seriously impaired
vision or hearing.
h. Industries and occupations in which children are customarily
employed with special reference to health hazards.
N o t e . —Material for at least the greater number of such studies might effectively
and economically be secured from the records of examinations made in the public
schools and in connection with the issuance of employment certificates in States
where reexaminations are required. It is, therefore, urged that all such examinations
be scientifically and thoroughly made and that methods and record forms be standard
ized so as to be statistically comparable.
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Federal Reserve Bank of St. Louis
10
PH YSICAL STANDARDS FOR WORKING CHILDREN.
10. Certain tentative minimum standards obtainable from results of
scientific research already available.
While recognizing the necessity of further study, the committee is
of the opinion that the results of scientific research already available,
together with the experience acquired in the administration of laws
prescribing physical requirements for admission to industry, permit
the recommendation at the present tune of certain tentative mini
mum standards. The acceptance of these standards will aid mate
rially in safeguarding the physical welfare of the child obliged to enter
industry before reaching his full development.
MINIMUM STANDARDS OF PHYSICAL FITNESS FOR CHILDREN ENTERING
AND WORKING IN INDUSTRY.
1. Standards o f normal development.
a. Certificates should be refused to children who do not come
up to the following minimum standards of height and weight
for specified age, which are based on the most reliable ex
perience and present-day practice.
(Since at the present
time children under 16 may be legally employed in a con
siderable number of States, minimum standards of height
and weight are furnished for children 14 and 15, as well as 16,
years of age.)
Age.
W eight
(in clothing).1
Height.
14
15
16
80 pounds.
85 pounds.
90 pounds.
58 inches.
58 inches.
59 inches.
1 W h en children are weighed without
•clothing, not more than 5 pounds should
be allowed for clothing.
In exceptional cases, a child who falls below the prescribed
minimum of height or weight may, however, be granted a
certificate if, after examination by two physicians, it is found
that this condition is a family or a racial characteristic, and
that he is free from any other defects which would justify
the refusal of the certificate.
b. Certificates should be refused to children who do not show
unmistakable signs of puberty.
2 . Standards o f sound health and physical fitness for employment.
a. Certificates should be refused to all children who have the
following defects:
(1) Cardiac disease, with broken compensation.
(2) Pulmonary tuberculosis or other evidence of serious
pulmonary disease.
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PHYSICAL STANDARDS FOR WORKING CHILDREN.
11
(3) Active glandular tuberculosis.
(4) Active tuberculous or syphilitic disease of joints or
bones.
(5) Total blindness. (Unless no further educational facili
ties can be provided for such children.)
(6) Total deafness. (Unless no further educational facili
ties can be provided for such children.)
(7) Trachoma.
(8) Chorea.
(9) Syphilides.
(10) Hyperthyroidism.
(11) Acute or subacute nephritis.
(12) Hookworm.
All children who are refused employment certificates because of
physical defects as noted under “ a” should be referred to some
appropriate person or agency for whatever medical or other
assistance they need.
b. Certificates should be refused to all children pending correc
tion of all serious remediable defects, such as:
(1) Defective vision'subject to correction b y glasses.
(2) Contagious eye and skin diseases.
(3) Defective teeth : extraction or prophylactic care needed.
(4) Malnutrition requiring supervision or medical atten
tion and not under treatment.
(5) Untreated inguinal or femoral hernia.
(6) Diseased tonsils.
(7) Defective nasal breathing requiring correction and not
under treatment.
(8) Discharging ears not under treatment.
(9) Orthopedic defects not under treatment.
(10) Intestinal parasites (other than hookworm) not under
treatment.
All children who are temporarily refused employment cer
tificates because of the existence of physical defects as outlined
under “ b ” should be referred to the care of a public medical
officer, school physician, family physician, or school nurse,
who should make every effort to see that the necessary medical
treatment or other care is secured for the child. As soon as such
treatment has been completed, or the defect has been corrected,
the issuance of the employment certificate may be recommended.
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12
PH YSICAL STANDARDS FOR WORKING CHILDREN.
c» Provisional certificates for a period, of not more tlian three
months may he issued on recommendation of the medical
examiner under the following conditions:
(1) Where treatment has been started but not completed,
in such cases as:
(a) Defective teeth.
(b) Malnutrition.
(c) Orthopedic defects.
(d) Defective nasal breathing.
(e) Discharging ears.
(f) Intestinal parasites (other than hookworm).
(2) Partial blindness.
(3) Partial deafness.
(4) Other defects (not specified under “ a ” and “ b ” ) which
in the opinion of the medical examiner require super
vision.
Children receiving provisional certificates shall be reexamined
at the expiration of the provisional certificate, or at such inter
vals as the examining physician may deem necessary. If in
the opinion of the examining physician every conscientious effort
. has not been made to correct the defect during the provisional
period, no new certificate shall be issued until correction has
been obtained.
d. All children who, because of their physical condition, or
because of their family or previous history, show a tendency
to weakness or disease of any organ should be excluded from
occupations which would tend to aggravate that tendency.
POINTS TO BE COVERED AND METHODS TO BE EMPLOYED IN PHYSICAL
EXAMINATIONS.
1. Item s for inquiry.
a. Information with reference to the following items should be
recorded upon the examination record blank b y the issu
ing officer or his clerk before the child is sent to the
physician for examination:
(1) Age.
(2) Sex.
(3) Color.
(4) Nationality of father.
(5) Nationality of mother.
(6) Intended employer.
(7) Industry.
(8) Occupation.
(9) Grade completed.
(10) Child’s previous industrial history.
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PH YSICAL STANDARDS FOR W O RKIN G CHILDREN.
13
The examining physician should inquire into and record the
condition found with reference to the following items:
(1) Significant family history (medical).
(2) Previous illnesses.
(a) Scarlet fever.
(b) Diphtheria.
(c) Infantile paralysis.
(d) Asthma.
(e) Bronchitis, chronic.
(f) Pneumonia.
(g) Pleurisy with effusion.
(h) Chorea.
(i) Epilepsy.
(j) Rheumatism.
(k) Frequent sore throats.
(l) Operations.
(m) Vaccination (against smallpox).
(n) Hospital or dispensary care.
(3) Physical examination—
(a) General physical condition—
Height in inches and fractions.
Weight in pounds and fractions.
Nutrition.
Anemia.
Evidence of puberty.
Menses (sp. abnormalities).
(b) Skin—
Parasitic diseases.
Other diseases.
(c) Eyes—
Vision.
Diseases.
(d) Ears—
Hearing.
Diseases.
(e) Mouth—
Dental caries.
Gingivitis.
(f) Nasopharynx—
Nasal obstruction.
Tonsils— enlarged— diseased
(g) Glands—
Enlarged.
Infected.
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54
PH YSICAL STANDARDS FOR W ORKING CHILDREN,
(3)
Physical examination— Continued.
(h) Thyroid—
Goiter, simple— exophthalmic.
(i) Chest—
Deformities.
(j) Lungs—
Abnormal breath sounds.
Abnormal dullness.
Rales.
Respiratory disease.
(k) Heart—
Apex-interspace.
Sounds.
Murmurs.
Pulse rate.
Heart disease.
(1) Abdomen—
Hernia, truss— operation.
Intestinal parasites.
(m) Orthopedic defects.
(n) Nervous system—
Chorea.
Other abnormalities.
(o) Kidneys—
Disease.
(p) Diabetes.
In making reexaminations, physicians should cover the same points
as in the first examination, and in addition should note in detail any
changes in physical condition, either improvement or defect, and all
diseases or operations the child may have had in the interval between
the two examinations.
2 . U se o f previous examination records.
Records of examinations made by school medical officers during the
child’s school period should when practicable be made available to
physicians making examinations of applicants for work permits.
3. Record card and instructions for use o f examining physician.
For the purpose of securing uniformity in administration and in
statistical analysis, the committee recommends the use of a uniform
record card in all States where the law provides for a certificate of
physical fitness for children entering employment.
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Federal Reserve Bank of St. Louis
RECORD OF PHYSICAL EXAMINATION FOR EMPLOYMENT CERTIFICATE.
Reserve for
Statistical
Use
STATE:
C IT Y O R T O W N :
1. N A M E :
2. A D D .:
----- f-----1W A T K T N A L m
1
: 7." Father:—
Sym. Sym .
10. P R E V I O U S I L L N E S S E S :
3. D A T E O F B I R T H : Y .
M.
D.
4. S E X : M .
F.
C O L .: W .
C.
O th (sp.)
6. G R ¿
TrsnU V TE TC A N TTFA M n7rTnN TO R Y'lTiIf^(51 T:—
■!. Mother:
Scarlet Fever— Diphtheria— Infantile Paralysis— Asthma— Bronchitis, chronic— Pneumonia— Pleurisy with effusion— Chorea— Epilepsy— Rheumatism— Frequent Sore ThroatsVaccinated (smallpox)— Operations (sp.)
Hospital or Dispensary Care (sp.)
Reexaminations
Original
Examination
First
Second
J
Third
11. IntendedJob(N o.onInd.Record)
First
Second
Y . N . Tr. Op.
Y .N .T r .O p .
Y .N .T r .O p .
Third
37. Rales (sp.)
12. Date of Examination
Y.
M.
D.
Y.
M.
D.
Y.
M.
D.
Y .íjlj
D.
13. Date of Birth
Y.
M.
D.
Y.
M.
D.
Y.
M.
D.
y .l
d
m
,
.
14. Age
38. Resp. Disease (sp.)
H E A R T : 39. Apex Interspace
40. Sounds
G EN. P H Y S. CONDITION:
41. Murmurs (sp.)
15. Height
in.
in.
in.
in.
16. W eight
(cl. N .)
(cl. N .)
(cl. N .)
(cl. N .)
E . G . F . P.
E . G . F . P.
E . (1 F . P.
17. Nutrition
Reexaminations
Original
Examinati >n J
E.
G.
F.
P.
42. Pulse Rate
43. Heart Disease (sp.)
ABDOM EN: 44. Hernia
18. Anemia
45. Intestinal Parasites (sp.)
19. Evidence of Puberty
46. ORTHOPEDIC DEFECTS (sp.)
Y .N .T r .
20. Menses (sp. abnorm.)
S K IN : 21. Parasitic Diseases (sp.)
NERVOUS SY ST EM : 47. Chorea (sp.)
22. Other Diseases (sp.)
48. Other abnormalities (sp.)
E Y E S : 23. Vision
R.
L.
R.
L.
R.
L.
R.
L.
24. Diseases (sp.)
R.
L.
R.
L.
R.
L.
R.
L.
E A R S: 25. Hearing
R.
L.
R.
L.
R.
L.
R.
L.
51. M E N TA LIT Y:
26. Disease (sp.)
R.
L.
R.
L.
R.
L.
R.
L.
52. RECOM M ENDATIONS:
49. K ID N E Y S : Disease (sp.)
,
50. D IA B E T E S :
M OUTH: 27. Dental Caries
(a) Unconditional Issue
28. Gingivitis
(b) Refusal (sp. cause)
N A SO P H A R Y N X : 29 N a. obstr.
30. Tonsils
(c) Refusal tem p. (sp. cause)
enl.-dis.
enl.-dis.
enl.-dis.
enl.-dis.
(d) Provisional Issue (sp. cause)
G LANDS: 31. Enlarged (sp.)
53. TR EATM ENT RECOMMENDED:
32. Infected (sp.) ~
33. Thyroid: Goiter “
54. CERT. RECOM. AFTE R COR. D E F .:
simple-exoph.
simple-exoph. simple-exoph. simple-exoph.
55. R EM AR K S:
CHEST: 34. Deformities (sp.)
LUNGS: 35. A b n .b rth . sounds (sp.)
36". Abnormal dullness (sp.)
Examining Physician:
Employer
K ind and No.
of Certif.
Duration of Employment
Industry
Occupation
Address
Date
Begun
Date
Ended
Length
Y.
Remarks
M.
T
U . S. Department of Labor, Children’ s Bureau, Committee on Physical Standards for Working Children.
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Federal Reserve Bank of St. Louis
I . D . 1920— 8.
10687°—26.
(Face p. 14.)
N o . 1.
¿u f vi ?i r,
I •..!«>.>
II
ifxp
r-.au' r.a.u
A
.. , .
Mí , . '
¡»Äs
. Pm->j
•i'iilWl
M
i *
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Federal Reserve Bank of St. Louis
INSTRUCTIONS TO PHYSICIANS FOR FILLING IN RECORDS OF PHYSICAL EXAMINATIONS
OF CHILDREN APPLYING FOR EMPLOYMENT CERTIFICATES.
Answers to items 1-8 and 11-14, inclusive, and name and address
of intended employer, industry, and occupation, and all required
information relative to preceding employment, if any, should be filled
in by the issuing officer or his clerk before the child is sent to the 'physician
for examination.
In filling out record blank check (x/) where defect or abnormality
is found, and dash (— ) where condition is normal. Where item is
marked (sp.) specify defect or condition indicated.
2. Add.—Address.
3. Y . M. D.—Enter year, month, and day.
5. Col.—Color.
6. Gr.—Grade. Enter grade completed.
9. Note only significant defects or diseases, such as tuberculosis, insanity, etc.
Specify member of fam ily affected and whether living or dead.
10. After “ operations” —Note (1) nature of operation; (2) date. After “ Hospital
or dispensary care ” note (1) name of hospital or dispensary; (2) nature of defect or illness
for which treatment given; and (3) period of care (i. e., dates of beginning and ending).
11. In the case of all original examinations and of all reexaminations of children
changing employment, the issuing officer or clerk should enter the number of the job
for which certificate is desired, as indicated on the Industrial Record. In the case of
periodical reexaminations or reexaminations of children to whom certificates have
been temporarily refused pending correction of defect, or who have been working on
provisional certificates, and who are not intending to change their employment, one
of the following symbols should be entered as indicated:
P er.: Regular Periodical Reexamination of all working children required b y law
or administrative ruling.
P rov.: Reexamination of child working on provisional certificate.
Cor.: Reexamination of child temporarily refused certificate pending correction of
defects.
N o t e .—
In the case of children temporarily refused certificates, whose defects
are corrected or treatment commenced within a short time after the initial examina
tion and where in consequence no complete reexamination is necessary, no record
of reexamination need be entered except under 54.
12. 13. Y . M. 1).—Enter year, month, and day.
14. Enter age in termb of years, months, and days.
15. Height.—To be entered to nearest quarter inch, and should always be measured
without shoes.
16. Weight.—To be entered to the nearest quarter pound, and should always be
taken without coat and shoes, preferably without clothing. I t should always he indicated
on the record card whether children were weighed with or without clothing. (If clothed,
check cl.; if stripped, check N.)
N o t e .—Where
girls are examined without clothing, the examination should be
made b y a woman physician or nurse, or in the presence of a nurse or of the girl’s
mother, or woman guardian or relative.
1 7 . Nutrition. — To be determined b y such factors as muscle tone, the color of the
skin and mucous membranes, and the relation to each other of height, weight, and age.
Check on record card condition indicated, as follows: E —excellent, G—good, F — f air
requiring supervision), P—poor (requiring medical attention).
18.
A nem ia .—If suspected because of pallor of mucous membranes (especially
conjunctiva), laboratory tests should be made and results recorded. Presence of
anemia should be noted only where determined by such tests.
21. Shin. —Parasitic diseases. Here note pediculosis, scabies, etc.
22. Skin. — Other diseases. Here note eczema, impetigo, etc.
23. Vision.—A separate examination and record of the visual acuity of each eye
should be made, the Snellen test card being used. A bility to read the twenty-foot line
at a distance of twenty feet to be considered perfect and recorded as 20/20. Record in
fractions, the numerator indicating the distance between chart and child, denominator
indicating line read by the child. (Figures shown at side of chart.) If child is unable
to read any of the letters correctly at twenty feet, move him toward the chart until he
can see the top letters, and measure distance between him and the chart and record as
test. If child is wearing glasses, the test to be made both with glasses on and with glasses
off. A child with vision of 20/30 or less in either eye should be referred to an oculist.
25. H earing .—Each ear to be tested separately, using the whispered voice at a
distance of twenty feet. Child should stand with ear being tested toward examiner,
and other ear covered or external canal occluded. If hearing is defective, the examiner
should advance slowly toward the child until he can hear the whispered voice—measure
distance between examiner and child, and record in fractions, 20/20 being normal.
Inability to hear the whispered voice at ten feet or less should be considered defective
hearing and should be referred to a specialist.
29. Nasopharynx. —Na. obstr.—Nasal obstruction.
30. Tonsils.—Enlarged—diseased. Visual examination of the throat to be made
with the use of an individual wooden tongue depressor, a separate one to be used for
each examination. Check conditions found.
31. Glands.—Enlarged. Specify as cervical, axillary, inguinal, etc.
34. Chest.—Examination of the chest should always be made on the bare skin.
35. Lungs. —To be examined b y percussion and ausculation, and use of stethoscope.
A ny abnormal condition found to be specified.
A hn. brth. sounds .—Abnormal breath sounds.
39. Heart.— T o be examined with stethoscope.
43. Heart disease.—Specify variety of organic disease and compensation.
44. Hernia (Yes—No—Truss—Operation).—Presence or absence to be determined
by questioning and physical examination where suspected. Check whether found
or not, whether truss worn, and whether or not child needs operation.
45. Intestinal parasites.—Examination of the stool to be made when hookworm
or other intestinal parasites are suspected, and results recorded.
46. Orthopedic defects.—General inspection of the body to be made. A ll defects,
including impaired mobility or defects of posture must be specified. Necessary measure
ments to be made when indicated b y abnormal findings.
49. Kidneys.—Urine analysis to be made if kidney disease is suspected, and the
results recorded.
50. Diabetes.—Urine analysis to be made if diabetes is suspected, and results
recorded.
51. Mentality.—Special examination to be made b y psychiatrist if mental defect
or disease suspected, and results recorded.
52. Recommendations.—Check as indicated and specify physical defect causing
recommendation of refusal or of provisional certificate.
54. Certificate recommended after correction o f defect.—Enter date of recommendation.
55. Remarks.—Note here any unrecorded items which the examining physician
recommends for consideration at the time of reexamination, also any diseases and
operations or changes in physical condition not elsewhere recorded which child m ay
have had since the last examination.
U. S. DEPARTMENT OF LABOR,
CHILDREN’S BUREAU,
Committee on Physical Standards for W orking Children.
10687°— 26.
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Federal Reserve Bank of St. Louis
(Pace p. 14.)
N o . 2.
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Federal Reserve Bank of St. Louis
PHYSICAL STANDARDS FOR W ORKING CHILDREN.
15
Three forms of record card were tentatively approved by members
of the committee, as follows :
a. Form 1 providing on the face of the card for a record of the
first examination only. Space on back of original form
may be used for records of reexaminations. (5 by 8 card.)
b. Form 2 providing on the face of the card for a record of the
original examination and three reexaminations. (8 by 10
card.)
c. Form 3 providing for a record of the original examination and
three reexaminations, similar in detail to Form 2, except
that both sides of the blank are used, making possible a
smaller sized card. (5 by 8 card.)
It was finally agreed by the majority of the committee that Form 2
appeared to offer the smallest number of difficulties in administration
and that it should therefore be the form printed in this preliminary
report and thus made available for general distribution. Unprinted
copies of Forms 1 and 3 have been submitted by the committee to the
Children’s Bureau, with the suggestion that they be made available
to any interested persons upon request.9
9 State and city officials and other interested persons m ay obtain copies of these forms upon applica
tion to the Children's Bureau, U . S . Departm ent of Labor, W ashington, D . C . Forms similar to Form
3 are in use in Indiana and in Wisconsin (physical examination m andatory in Milwaukee only), and
i
sample
copies, if desired, m ay be obtained upon application to the State industrial board of Indiana or
1the State industrial commission of W isconsin.
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Federal Reserve Bank of St. Louis
A P P E N D IX
L A W S R E L A T IN G TO P H Y S IC A L R E Q U IR E M E N T S FO R E M P L O Y
M E N T OF CHILDREN.
[1926 legislation included so far as available August 15,1926.]
EXAM INATIONS BEFORE CHILD GOES TO W O RK .
The following summary shows the requirements for the issuance of
regular employment certificates only, special permits, such as those
granted on account of poverty, being omitted. Since an employment
certificate is not always required for all occupations in which a child
may legally be engaged, these requirements may not by any means
afiect all children entering industry. Examinations to determine age
are not considered here.
L e g a l R e q u ir e m e n t s f o r P h y s ic a l E x a m in a t io n s of C h il d r e n G o in g to W o r k .
State.
A labam a.
Arizona.
Requirement of
examination.
M andatory.
.d o .
A r k a n sa s...
[N o provision].
California..
M andatory___
Colorado___
[N o provision].
Connecticut
M an d atory__
Delaware.
-d o .
Examining physician.
C ounty health officer or
public-school physi
cian, or, in counties in
which there are no
such health officers or
physicians, a regu
larly licensed physi
cian authorized in
writing b y the chair
man of the county
board of health.
Medical officer of board
o r d e p a rtm e n t of
health, or physician
appointed b y school
committee.
Physician appointed b y
school board or other
public medical officer.
Physician certifies to -
2. Sound health.
3. Physical fitness for intended work.i
1. Norm al development.
!. (Sufficiently sound health and phys;
ical fitness for intended work .i
2.
---
3. Physical fitness for intended work.i
Physician designated b y
State board of educa
tion.
Physician
designated
b y labor commission.
Sufficiently sound health and phys
ical fitness for intended work.i
[ Certificate shall also indicate kind
of work suited to the child, and no
em ployment certificate is to be
granted unless it appears to the
issuing officer that its issuance is
for the best interests of the child.]
---
'
3. Physical fitness for intended work.i
D ist. of C o lu m b ia ..
Optional ».
[None specified (choice
apparently left to issu
ing officer.)]
1. Norm al development.
2. Sound health.
3. Physical fitness for intended work.*
Florida_____________ ______do.*
Medical officer of board
or d e p a r t m e n t o f
health or the county
physician.
1. Normal development.
2. Sound health.
3. Physical fitness for intended work.*
Georgia.
M andatory
- « ---------------—..
(0 .
I d a h o ...
[No provision].
N ote .^—See footnotes on p. 20.
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Federal Reserve Bank of St. Louis
17
18
P H Y S IC A L
L egal
R e q u ir e m e n t s
State.
Illinois.
STANDARDS
for
P h y s ic a l
W ork—
Requirement of
examination.
M andatory.
FOR
W O R K IN G
E x a m in a t io n s
C H IL D R E N .
of
Ch il d r e n
G o in g
to
Continued.
Physician certifies to -
Examining physician.
Physician appointed b y
municipal health de
partment, or b y board
of education or other
local school authority.
1. —
2. -----
3. Physical fitness for intended work,1
Indiana.
M an d a to ry 1
School health officer or
public-health officer.
1. Normal physical and mental devel
opment.
2. Sound health.
3. Physical fitness for intended work.1
Iow a.
M andatory.
Medical inspector of
schools or physician
appointed b y board
of education.
1. Norm al development.
2. (Sufficiently sound health and phys3.1 ical fitness for intended work.1
K ansas___
[N o provision].
K entucky.
M andatory___
Public-health officer or
physician appointed
b y board of education.
1. Normal development.
2. Good health.
3. Physical fitness for intended work.1
Louisiana.
Mandatory. (In
effect July 1,
1927.)
Parish health officer or
public-school
physi
cian.
2.
M ain e.
Optional2---------
School p h y s i c i a n or
m e d i c a l o f f i c e r of
board of health.
1 . Norm al development.
2. (Sufficiently sound health and phys3.
\ ical fitness for intended work.6
M arylan d .
Mandatory.
Physician appointed by
issuing officer.7
1. N orm al development.
2. (Sufficiently sound health and phys3.1 ical fitness for intended work.1
-d o .
School or family ph y
sician or physician ap
pointed b y school com
mittee.
^./Sufficiently soufid health and phys3.1 ical fitness for intended work.1
M ichigan.
Optional A
Medical officer of board
or d e p a r t m e n t o f
health.
1. Norm al development.
2. Sound health.
3. Physical fitness for intended work.1
M innesota.
M andatory.
Physician designated by
school board.
1. Norm al development.
2, /Sufficiently sound health and phys3.1 ical fitness for intended work.1
Mississippi.
[N o provision] .
M issouri___
M and atory___
M ontan a.
[N o provision].
Nebraska.
O ptional2_____
N evad a-- ..................
[N o provision]_
New H am psh ire...
M andatory___
Massachusetts.
N ew Jersey— _____
_do.
Reputable physician. . .
1 .----- —
3. Physical fitness for intended work.*
1 .-----
2. Good physical and mental health.
3. Ability to perform labor without
injury to health or mental develop
m ent.9
Physician provided b y
State department of
labor.
1. Normal development.
2. Sound health.
3. Physical fitness for intended work.3
Medical officer of board
of health or physician
designated b y school
board.
1. Normal development.
2.
/Sufficiently sound health and phys3.1 ical fitness for intended work.1
Medical inspector em
ployed b y board of
education.
1. Normal development.
0 (Sufficiently sound health and physical fitness for any occupation in
[ which child m ay legally engage.
....................
(•)■
N ew M exico.
Optional A ..
(9)
N ew Y o r k ...
M and atory.
Medical officer desig
nated b y local board
of health.
1. Normal development.
2. Sound health.
3 .
--------------------1
North Carolina.
____ do.10____
Health officer or prac
ticing physician.
2. -----
N ote,— See footnotes on p. 20.
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Federal Reserve Bank of St. Louis
1 . -----3. Physical fitness for intended work.1
P H Y S IC A L
■Le g a l
R e q u ir e m e n t s
State.
STAN D ARDS
for
Requirement of
examination.
North Dakota u .
[N o provision].
Ohio________
M andatory___
O klahom a___
O ptional;
P h y s ic a l
W ork—
FOR
W O R K IN G
E x a m in a t io n s
C H IL D R E N .
of
C h il d r e n
1 9
G o in g
to
Continued.
Examining physician.
Physician certifies to—
School physician, dis
trict health commis
sioner, or physician
designated b y either.
3. Physical fitness for any occupation
m which child m ay legally engage5
1. —— '
Medical officer of board
or
department
of
health.
3. Physical fitness for intended work.2
2.«---
Oregon_______
-d o *_
[None specified (choice
apparently left to issuing officer).]
1. Normal development.
2. Sound health.
3. Physical fitness for intended work.1
Pennsylvania.
M andatory.
Physician “ approved*’
b y board of school
directors.
2 . -----3. Physical fitness for intended work ,1
Rhode Island..
.d o .
South Carolina,
[N o provision].
South D a k o t a ..
-------do_________
Tennessee...........
Mandatory
Texas____
W>.............
U ta h ____
[N o provision],
In Providence either of 2
physicians appointed
by
State
commis
sioner of education;
elsewhere physician to
whom child is sent b y
issuing officer.
1-. — . _
2 (Sufficiently sound health and phys3 1 ical fitness for any occupation in
•l
which he m ay legally engage.1
Public-health officer or
public-school medical
medical inspector.12
1. Good physical development.12
2. Sound health.1»
3. Physical fitness for intended work.1
Public-health or school
physician.
1. Normal development.
2. Sound health.
3. Physical fitness for intended work.1,
Verm ont.
— ,-do.,_______
Virginia..
M andatory___
W ash in gton ...
[N o provision].
W est Virginia.
M a n d a to ry .. _
Wisconsin:
Outside
M il
waukee.
Medical inspect or
of
schools
or
publichealth officer.
1. Norm al development.
2. Sound health.
3. Physical fitness for intended work.1
Optional *_____
[None specified (choice
apparently left to is
suing officer).]
[Issuing officer * m ay refuse to grant
work permit to child who seems
“ physically unable t o perform the
labor” at which ho “ m ay be em
ployed,” or if best interests of child
will be served b y such refusal.]1
M ilw aukee_____
W yom in g.
M andatory.
[N o provision 12]_
N ote.—See footnotes on p. 20.
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Federal Reserve Bank of St. Louis
Physician of city health
department, or any
other competent ph y
sician of general prac
tice.
2 . -----3. Ruling of State industrial commis
sion requires from physician “ a
detailed statement, based upon a
physical examination, showing the
condition” of the health of the
child, and no work permit is issued
unless child is shown to be phys
ically fit for em ployment.1
20
L egal
P H Y S IC A L
R e q u ir e m e n t s
STAN D AR DS
for
FOR
W O R K IN G
P h y s ic a l E x a m in a t io n s
W o r k — C o n tin u e d .
C H IL D R E N .
of
C h il d r e n
G o in g
to
FOOTNOTES.
i Presentation of promise of employment required for issuance of employment certificate. [In certain t
States this requirement is not specified in the law but m ay be implied from the following facts. -Michigan .
Certificate is to be returned to issuing officer upon termination of employment. Minnesota— Issuing
officer’s m onthly report to State industrial commission m ust show name of employer and nature o f work
child is to do, and em ployment certificate is returned to issuing officer upon termination of employment.
New Jersey — Em ployer m ust notify issuing officer o f nature o f child s em ployment within 2 days after
employing child, and certificate is returned to issuing officer upon termination o f em ployment.] In N ew
Hampshire this requirement isprescribed b y the State board o f education, in North Carolina b y the State
child-welfare commission, and in Oregon b y the State board of inspectors of child labor.
»Because issuing officer’s power to require an examination b y a physician is implied from the fact that
the law requires him to certify to child’s physical condition (District of Columbia and Oregon) ; because
issuing officer m ust certify to child’s physical condition and is specifically empowered to require examina
tion b y physician (Florida, Michigan, and Nebraska) ; because issuing officer m ust be satisfied as to
fi+nocc opri io omnnwftrftd to rftcmire examination b y physician f OkUihovui) y Decause
BCCXJU
3uu^uwii
—IPI-------- ------JJudgment
would b e served b y such refusal” ( Wisconsin).
i Promise of employment not required b y law. (B u t where child m ust be physically fit for intended
work it m ight be implied that the issuing officer m ay demand formal notice of the work child is to do.)
; The employment certificate m ust show that child is physically fit to follow the em ployment sought
(promise orem ploym ent is required). State department of commerce and labor holds that examination
b y physician is compulsory. Rulings of board state that for examination of children a public-health or
public-school physician m ust be given preference; i f neither of such physicians is available, the superin
tendent of schools w ill designate a physician to make the examination,
¡Law exempts from requirement, upon written objection of parent, child who has been exempted from
physical examination while attending school (parent’s written objection required for latter exemption
also.)
¡T h e law does not specifically require a promise of employment, but the forms prescribed b y the State
commissioner of labor for the use of employment certificate issuing officers include a form for promise of
employment. Also since child m ust be physically fit for intended work it might be implied that the
issuing officer m ay demand formal notice of the work the child is to do.
7 state Board of Labor and Statistics issues employment certificates in Baltimore; State board and local
school superintendents or their deputies have coordinate authority outside Baltimore.
8Promise of employment not specifically required b y law , but certificate permits child “ to work at the
occupation therein to be designated,” and issuing officer must be satisfied work is not dangerous nor
injurious.
‘ Satisfactory proof must be furnished to certificate-issuing officer that the work is not dangerous to child
or injurious to his health, and application for employment certificate m ust show that child is in good physical
health.
.
M Examination within six months previous b y authorized medical officer m ay be accepted as substitute.
» In North Dakota the law makes no provision for a physical examination when a child first goes to work,
but states that upon termination o f the employment a new employment certificate shall be issued only
“ upon presentation b y the child of a new promise of employment and a new certificate o f physical fitness.
The issuing officer m ay revoke child’s certificate whenever it shall appear that the physical welfare o f the
child would be best served b y such revocation, but the law does not specify that a physical examination
shall be required as a basis for revocation.
m Law passed later at same session states that child must present certificate from reputable physician or
health officer showing physical fitness for intended work.
18 N o regular em ployment certificate required for child above minim um age (15); physical examination
mandatory for “ poverty” permit, which m ay be issued to child between 12 and 15 years of age under certain
conditions.
u state industrial commission or person appointed b y it.
« N o legal provisions for employment certificates applicable to general occupations.
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P H Y S IC A L
STANDARDS
FOR
W O R K IN G
C H IL D R E N .
21
R E E X A M IN A T IO N S .
R eexam ination when child changes em ployers.
In Delaware; Illinois, Maryland, Ohio, Pennsylvania, and Vir
ginia the law specifically requires a child to be reexamined b y a
physician whenever he goes from one employer to another. The
Maryland, Pennsylvania, and Virginia laws provide further that the
employment certificate shall he valid only for the specific occupa
tion for which it is issued,1 and in Ohio a child whose complete physi
cal ability to engage in any legal occupation can not be vouched for
may be granted a limited certificate good only in the occupation
designated by the physician. But since in these States the employer
is not obligated to return the certificate to the issuing office when he
puts the child at another kind of work, this limitation of the cer
tificate to a single occupation in a single establishment is practically
unenforceable. Although the express requirement of a reexamina
tion when changing from one employer to another is not found in the
laws of any o f the 19 remaining States which make the first examina
tion mandatory, there is reasonable ground for believing this to be
implied wherever the law, in addition to requiring a child to be
physically fit for the work he intends to do before he can obtain an
employment certificate, makes him secure a new promise of employ
ment and a new certificate for each new employer.2 In any case an
opportunity is offered for a reexamination wherever the child must
come back to the issuing office for an employment certificate ibefore
' egoes to work for a new employer (whether he gets a hew certificate
or merely his old one reissued), and this he is obliged to do in all the
States where the original examination is mandatory, except in Mis
souri,1 New York,3 Worth Carolina, and Tennessee, and in at least
three of the States (Michigan; Oregon, and Wisconsin) where the
examination is optional.
Periodical reexam inations.
Only one State, Virginia, as yet specifically provides for periodical
physical examinations of children who have entered upon employ
ment. In that State the employment certificate becomes invalid
after 12 months from its date of issuance unless a new certificate of
physical fitness, like the one required when the employment certifi
cate was first issued, is filed with the issuing officer. In Missouri
such a periodical examination might be required, since the employ
ment certificate becomes invalid at the end of three months, and an
extension (for the same period) is conditional upon a satisfactory
showing on the part of the child that he % in good health. Under
the New Mexico law the application for the employment certificate
must show that the child is m good physical health and the certificate
must be renewed at the end o fsix months, such renewal being condi
tional upon “ satisfactory showing that the child is in good health.”
In 9 States, moreover (Illinois, Indiana, Louisiana, Maine, Minne
sota, New Hampshire, New York, Ohio, and Oklahoma), the factory
1 In Missouri there is no statement-about reexamination when child changes from one employer to
another or from one occupation to another, h u t the certificate permits child “ to work at the occupation
therein to be designated,’ ’ and certificate-issuing officer m ust be satisfied work is not dangerous nor
injurious. (See also under “ Periodical reexaminations” and footnote 11 on page 26.)
a These requirements ore found in all the mandatory States, except Missouri (see footnote 1), N ew Jersey,
N ew York, North Carolina, Rhode Island, and Tennessee.
s In N ew York the law specifically states that thochild shall be entitled to a new certificate upon return
of the old certificate and presentation of a new promise of employment.
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22
P H Y S IC A L
STANDARDS
FOR
W O R K IN G
C H IL D R E N .
inspector or some other State official enforcing the labor law is
authorized to require a child found at work to secure a certificate of
physical fitness from a physician in order to continue in employment.
In most of these States this demand may be made only in case a
child seems physically unfit for the employment at which he is
engaged, but m Indiana and New York children must submit to such
an examination whenever required to do so by the enforcing official,
and in Louisiana the provision applies only to children apparently
“ under legal age.” Besides these 9 States, 3 others (Alabama, Mas
sachusetts, and Mississippi) have laws of this general type.4 In
Alabama the inspectors of the .child-welfare department, which en
forces the child labor law, must remove from an establishment any
child with an infectious, contagious, or communicable disease, or
whose physical condition makes his continuing at work hazardous to
himself. In Massachusetts inspectors of the State board of labor
and industries are directed b y law to inform themselves concerning
the health of minors employed in factories in their districts, and,
whenever they think it advisable or necessary, to call the ill health
or physical unfitness o f any minor to the attention of his parent, his
employer, and the State board. In Mississippi county health officers
must inspect manufacturing establishments and report to the sheriff
any child whose physical condition incapacitates him to perform the
work required of him, the sheriff being required thereupon to remove
the child from the establishment. Tne Rhode Island law empowers
the State board o f health to declare any particular occupation in
jurious or hazardous for any particular minor under 16, whereupon^
it shall be unlawful for that minor to be so employed.
R eexam ination required through issuance o f tem porary certificates.
In Connecticut, Delaware, and Pennsylvania the law expressly
permits the physician, whenever he deems it advisable, to issue a
certificate of physical fitness good only for a limited period, at the
end of which the minor must return to the issuing office and submit
to reexamination in order to be allowed to continue in employment.
In practice such temporary certificates are issued in some States even
where this express provision of the law is not found.
A D M IN IS T R A T IV E
P R O V IS IO N S .
Issuing officers.
In 30 States and the District of Columbia the issuance of employ
ment certificates is placed by law in the hands of local public-school
officials,5 usually the superintendent of schools or some person desig
nated by him. These States are: Alabama, Arizona, California, Dela
ware,6 District of Columbia, Florida, Georgia, Illinois, Indiana,7 Iowa,
Kentucky, Maine, Massachusetts, Michigan, Minnesota, Missouri,
Montana, Nebraska, New Jersey, New Mexico, New York,8 North
4In Wisconsin the State industrial commission, and in North Dakota the issuing officer, m ay revoke
the employment certificate whenever it appears that the child’s physical welfare would be best served by
such revocation, but the law does not specify that a physical examination shall be required as a basis for
revocation.
» N o t including N ew Hampshire, where local public-school authorities issue certificates but are under
the supervision and control of the State board of education.
.
8 Outside special school districts, State superintendent of public instruction or his deputy is issuing officer.
7 Where school superintendents deputize other persons as issuing officers, the approval of the State
board of attendance is required.
8 Where school superintendents deputize other persons as issuing officers, it must be done in accordance
with the regulations of the State commissioner of education. The number of issuing officers is limited to
not more than one for each quarter million or fraction thereof in each city or school district.
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PHYSICAL STANDARDS FOR WORKING CHILDREN.
23
Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota,
Tennessee, Utah, Virginia, and West Virginia. Three other States,
while permitting local public-school officials or their appointees to
issue certificates, give equal powers to some other person: Arkansas/
State commissioner o f labor andstatistics; Colorado, superintendent or
principal o f a parochial school; and Kansas, judge o f a juvenile court.
In one other State, Louisiana, theeertificate is issued b y the city factory
inspector in New Orleans, elsewhere b y the school authorities.
States in which the issuance of certificates is centralized to a greater
or less degree through being placed under direct control of some
State authority10are: Connecticut, where the State board of educa
tion has entire control of issuance; Maryland, where the State board
of labor and statistics must issue certificates in Baltimore and m ay
issue them in other parts of the State;11 New Hampshire, where local
school officials issue certificates, but the State board o f education,
through its power to enforce the certificate law and to appoint the
school^ superintendents, who are the issuing officers, has the work
under its control ; North Carolina, where the State child-welfare com
mission, which enforces the child labor law, appoints the issuing offi
cers and prescribes the conditions under which certificates shall be
granted; Oregon, where the State board of inspectors o f child labor
either itself issues or appoints the issuing officers and directs the work ;
South Carolina, where the State commissioner of agriculture, com
merce, and industries issues “ permits” based upon the parents’ affi
davits, which are obtained b y the employer and forwarded* to him;
Vermont, where the commissioner of industries alone is citipowered-to
grant certificates; and Wisconsin, where the industrial Commission
issues certificates in Milwaukee and appoints the issuing officers and
supervises their ■work: throughout the State.
In Nevada and Washington the continuation-school laws call for
permits from the school officials, and the labor laws require also
permits from a judge— in Nevada a judge o f the district court o f the
county and in Washington a superior court judge. In Texas the only
working papers issued are temporary permits granted by county
judges to children permitted to be employed Under the legal working
age (15) on account of poverty. In Mississippi and Idaho there is
no issuing officer” strictly speaking; in the former State the only
paper required is an affidavit from the parent and in the latter the
employer must keep an “ age record ” oi children between 14 and 16
years of age employed. In Wyoming no provision is made b y law
lor work permits for general occupations.
U
Power to prescribe form s and standards.
One of the first steps toward standardizing physical examinations
is the use of a uniform record blank. In the following 16 States
some official or board is given specific authority to formulate and
? tate commissioner of labor and statistics» who has power to make rales and
seeure satisfactory evidence of age, rs that employment certificates are to be issued b y the
MT“ ,^ ml^ 10T? eL i)i ll? L j y j * ® W S f o r w a r d e d to him .by the school authorities'.
pakota the State board of administration m ust exercise supervision over the administrati<
w ^ v w J « L eP pl£ ym ^ L £ ertlfl,cate , aw • In Virginia the State commissioner of labor must supervise the
V i
°® 5 ^ rs and m ake rales and regulations for carrying out the.purposes of the act. (See
also footnote & for provision m Arkansas.)
K
11 Local school superintendents have coordinate authority outside Baltimore.
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24
PHYSICAL STANDARDS FOR WORKING CHILDREN.
furnish the preliminary forms necessary for issuing employment
certificates, including record forms for physical examinations, though
the law is not always clear as to whether the use o f these forms is
compulsory:12 Alabama, California, Connecticut, Delaware, Indiana,
Iowa, Kentucky, Maine, Maryland, Massachusetts, New Hampshire,
New Jersey, New York, North Carolina, Virginia, and West Virginia.
In California, Connecticut, Iowa, Kentucky, New Hampshire, and
New Jersey this power is given to the State board o f education; in
Indiana to the State industrial board in cooperation with the State
board of attendance; in New York to the State commissioner of
education, subject, in the case of the record o f the physical examina
tion, to the approval o f the State commissioner of health; and m the
other eight States to the State board or official enforcing the child
labor law. In Massachusetts the State board o f education is to be
consulted and the form must be approved b y the attorney general.
In Maine also the attorney general must approve the form. In States
where the issuance o f certificates is under direct control of some State
authority this power to prescribe forms might be implied even when it
is not specifically given in the law. In addition, the Alabama law
provides that proof of the child’s physical fitness shall be based upon
standards prescribed b y the State board of health. The blanks and
forms for the physical examination shall be approved b y the State
board of health.
Revocation o f em ploym ent certificates.
In the following 13 States the State board or official charged with
the enforcement o f the child labor law is authorized to revoke certifi
cates improperly issued:13 Alabama, Arkansas, California,14 Georgia,
Indiana,14 Kansas, Maine, Missouri,15 New Jersey,15 North Carolina,
Rhode Island, West Virginia, and Wisconsin. In North Carolina the
agents o f the State child-welfare commission may revoke certificates
issued on false evidence o f age and m ay suspend the certificate when
ever a condition is found that will injure the health or morals o f a
child or endanger his physical safety, pending the action of the com
mission. In New Mexico the bureau o f child welfare, which enforces
the employment certificate law, may cancel any permit “ for cause
with the concurrence o f the issuing officer. In Wisconsin this power
extends also to cases where the physical or moral welfare o f the child
would be best served b y such revocation. The power to require a
child who appears physically unfit for the work he is doing to~be ex
amined b y a physician, found in the laws o f a number o f States,
carries with it the right to cancel the employment certificate if the
physician’s report is not satisfactory. In States where the issuance
of certificates is under direct control of some State authority the power
of revocation might be implied even when not specified in the law.
12 In M aryland the law states that the preliminary forms necessary for the issuance of the certificate need
not be those prescribed b y the State board if they state fully the facts called for b y the statute.
is In Kentucky and Louisiana also powers of revocation are given to State labor officials but are limitea
to cases where the child is under legal age (Kentucky) or where the certificate was obtained through fraud
° r i ^ l ^ C ^ i t o m ^ the State Superintendent of public instruction and in Indiana the State board of attendan^G
In &M is s ^ r i^ fie 'c e rtiflo a te ^ a y * b e revoked " fo r cause.” In N ew Jersey the ori^ P * | P ^ r;?
which certificates are granted are sent to the State department of labor, which examines them and notihea
the comradssioner of eduTatton of any cases where the certificate appears to have
The latter has power to direct the board of education of the district where the certificate was issued to
cancel the certificate, and the district board m ust cancel the same if so directed.
o
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