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First; it should be thoroughly understood that the decision as to whether a pupil
is to participate - so far as his physical condition is concerned — should rest
wholly in the hands of the school physician or of the physician who is Director of
the health service,

Second; the physical examination given should be thorough enough so that it will
really give definite scientific information about the physical condition of the
candidate, An examination including-only a hurried listening to heart sounds,
plus a quick examination for hernia is a farce as an agency tor protecting the
youngster,

What organs bear the chief load in strenuous athletic competition? At the head
of the list most physicians would place the circulatory organs. The tests should
include then a careful examination of the valve sounds and of the size of the
heart, Closely correlated to these is the blood pressure, Apparently the rise
in blood pressure is the earliest sign of circulatory strain, The opinions of
life insurance medical examiners, of Dr. Greenleaf, and of Drs. Robinson and
Bruccr, to name only a few, indicate that not more than 120 over 80 indicates a
circulatory system that may safely be subjected to athletic stress, This does not |
necessarily mean that all those having a blood pressure higher than this should
be barred from competition, It does mean, however, that they should be watched
with great care - i.e., frequently re-examined - and those showing bad effects
from the activity should be removed from competition. Closely related to these
heart and blood pressure tests are the cardiac functional tests, one of the most
interesting being that devised by George Meylan, M.D. This simple test notes the
difference in pulse rate in the recumbent position and that in the standing
position, Of this change, Dr. J. H. McCurdy says: "This test compares the lying
and standing pulse, a variability of more than 20 beats in changing from the lying
to the standing position representing at least doubtful condition.! Such cases
should not be permitted to participate until and unless careful correction of
fatigue and other basic conditions brings about a more nearly normal reaction to
the test.

The presence of hernia should - in the vast majority of cases - bar a pupil from
competition in such a vigorous sport as basketball. Not only is the activity
great, but the postures in throwing tend to put great strain on the abdominal
muscles,

The kidneys also have to carry an extra heavy load when physical activity is great.
This is shown by the fact that a considerable portion of competitors show a marked
increase in urinary albumin after severe exercise, The pupil whose urine
habitually, when on normal diet, shows pathological amounts of albumin should
probably be kept out of violent physical activity. Doubtful cases should be kept
under observation, by means of repeated urinalyses.

A noticeable percentage of adolescents have an undiagnosed diabetes. The urinary
examination should include, therefore, a test for sugar. Not all those showing
increased sugar excretion are pathological, but such cases should be examined re-—
peatedly. Of course, those found to be true diabetics should be kept out of the -—
for them — too vigorous physical activities of such a game as basketball,

Closely tied up with these other indices of physical condition is the factor of
weight. Seemingly underweight is aot in itself a reason of rejection. The
seriously underweight pupil will be eliminated anyhow in most cases by the process
of competition, :