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FLORIDA'S
SCHOOL HEALTH PROGRAM
FLORIDA PROGRAM FOR IMPROVEMENT OF SCHOOLS
BULLETIN NO. 4
Revised Edition
1943
WAENT OF EDUCATION,
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Published jointly by
FLORIDA STATE DEPARTMENT OF EDUCATION
TALLAHASSEE, FLORIDA
and
FLORIDA STATE BOARD OF HEALTH
JACKSONVILLE, FLORIDA
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FLORIDA'S SCHOOL HEALTH PROGRAM
1
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Prepared in Collaboration with
THE CHILD HEALTH COMMITTEE
of the
FLORIDA MEDICAL ASSOCIATION
and Other Interested Agencies
FLORIDA'S
SCHOOL HEALTH PROGRAM
=LORIDA PROGRAM FOR IMPROVEMENT OF SCHOOLS
BULLETIN NO. 4
Revised Edition
1943
MW EOf it'AT1N4*p
'01's n vn 1 t i i
Published jointly by
FLORIDA STATE DEPARTMENT OF
TALLAHASSEE, FLORIDA
EDUCATION
FLORIDA STATE BOARD OF HEALTH
JACKSONVILLE, FLORIDA
THE PURPOSES OF THIS BULLETIN
1. To set forth the responsibility of the, school for the improve-
ment of the health of the pupils and ultimately of he'ilth
conditions in the state.
2. To outline the scope of the school health program in order
that every school may advance, in a balanced way toward
the solution of Florida's health problems.
3. To give guidance to teachers in their methods of planning
for daily school living, for the improvement of health status
of pupils, and for more effective health instruction programs.
4. To relate, more adequately the school health program to the
health programs and health activities of the local health
unit and other organizations.
FOREWORD.
It is almost platitudinous to say that health is of fundamen-
tal importance to all society and to each individual in it, and
that all private and public agencies should work cooperatively
toward achieving that goal. Yet all too frequently the first is
not realized and the second is not done.
Our State should be particularly prideful that such coopera-
tion in developing a plan for the school health program has been
attained. Some features perhaps are not in agreement with what
any one individual might like and all phases will undoubtedly
be improved as work under the plan progresses. The significant
factor is that we now have a plan upon which we have agreed
and that, knowing the extent of our responsibilities, as well as
the places where we encroach upon the responsibilities and work
of others, we are all in a position to make our utmost contribu-
tion to the program in the place where that contribution will be
most effective.
COLIN ENGLISH
State Siperi tendent of Public Instruction
If we are to have a population composed of individuals who
understand the basic facts about health and disease so clearly
hat they will continue throughout life to protect their own health
and the health of the community, we must begin health instruc-
tion in the primary grades and continue it throughout the entire
school course.
The publication of the first edition of "Plans for Florida's
school Health Program" was a noteworthy achievement. The
Application of the program in our schools, our local health de-
artments and local communities has proceeded steadily since
he publication of the bulletin. This second edition outlines cer-
ain revisions and improvements which have developed from
the practical application of the school program plan.
I recommend this bulletin to all health officers and their
staff as a practical guide in planning their school health service
program in cooperation with the school authorities.
HENRY HANSON, M. D.
Florida State Health Officer
PREFACE TO FIRST EDITION
In order that all who are interested in an improved health
program for Florida schools might have an opportunity to assist
in planning that program, State Superintendent of Public In-
struction Colin English called a special two weeks' conference
beginning on August 14, 1939, for the purpose of developing the
program. A general invitation was issued to all, and a special
invitation was sent to the chairmen of all organized groups hav-
ing a special interest in the program. The announcement was
made far enough in advance to allow study of special materials
which were prepared in advance for the purpose of giving direc-
tion to the conference.
The response to the invitations indicated extreme interest
on the part of all, and a thoroughly representative group assem-
bled for the first two days of the conference. During this time
all aspects of the problem were discussed, and many suggestions
were made for inclusion in the written plans. Using these sug-
gestions as a background, a sub-committee continued the work
thus begun and put into definite written form the principles
established in the discussions. The actual time consumed in
this writing was nine days, and at the end of this period the
large group reassembled to discuss what had been written and
to make suggestions for changes. The product of all these inter-
changes of ideas is this bulletin, which is the first step in a con-
certed attempt to improve the health program in the schools.
It should be thoroughly understood that it is only the first
step. The plan must be translated into action while it is being,
at the same time, continually improved. Supplementary bulletins
amplifying various aspects of the program, particularly that
dealing with health instruction, must be developed. With a con-
tinuous united effort on a program which all understand, how-
ever, great advancement will be made.
Acknowledgements are due to all who have had a part in de-
veloping the plan or who may assist in its interpretation. To
those who participated in the conference and gave freely of their
time, energy, and ideas, special appreciation is due. Those who
were present for all or the greater part of the conference were:
Miss Fannie Shaw of the Georgia State Department of Health
and member of the Joint Committee on Health Problems in Edu-
cation of the National Education Association and the American
Medical Association; Dr. G. F. Amyot, Administrative Associate
of the American Public Health Association; Miss Ruth E. Hen-
person, Educational Assistant to the National Director of Amer-
ican Junior Red Cross; Miss Alice Miller, Lecturer, University
of Texas; Dr. Garland Weidner, Assistant City Health Officer
of Atlanta, Georgia; Mrs. Elizabeth Bohnenberger, Director of
Health Education, Florida State Board of Health; Miss Katherine
Montgomery, Director of Health and Physical Education, and
Miss Grace Fox, Instructor in Health and Physical Education,
Florida State College for Women; Dr. E. Benton Salt, Director
of Health and Physical Education, University of Florida; Mr.
B. K. Stevens, Instructor of Physical Education, P. K. Yonge
School; Mr. J. L. Graham, Director of School Plant Planning
Service, State Department of Education; Mr. G. F. Catlett, Direc-
tor of Engineering, Florida State Board of Health; Mr. Joe Hall,
Conference Director, Consultant in Health and Physical Educa-
tion, State Department of Education.
Those who participated during the first two and last days
of the conference were: Dr. A. B. McCreary, State Health Of-
ficer, Jacksonville; Mr. Colin English, State Superintendent of
Public Instruction; Dr. Luther W. Holloway, Representative of
the Florida Medical Association; Mrs. May Pynchon, Executive
Secretary of the Florida Tuberculosis and Health Association;
Mrs. Inez Nelson, R.N., President of the Florida State Nurses
Association; Mrs. Malcolm McClellan, President of the Florida
Congress of Parents and Teachers; Mr. John P. Ingle, St., Chair-
man of the State-Wide Public Health Committee; Miss Sara
Ferguson, Chairman of the Classroom Teachers Association;
Mr. Lafayette Golden, Secretary of the Florida High School Ath-
letic Association; Dr. J. C. Dickenson, Dr. John Norton Moore,
and Dr. J. Maxey Dell, Jr., Representatives of the Florida Radio-
logical Society; Mr. J. S. Rickards, Executive Secretary of the
Florida Education Association; Mr. Nash Higgins, Director of
Health and Physical Education, University of Tampa; Dr. Jay
Pearson, Secretary, University of Miami; Mrs. J. Ralston Wells,
President of the Florida Federation of Women's Clubs; Mr. M.
W. Carothers, Director of Instruction, State Department of Edu-
cation; Dr. Lloyd N. Harlow, Director of the Bureau of Dental
Health and Representative of the Florida Dental Society; Dr.
Dan N. Cone, Director of Epidemiology, State Board of Health;
Dr. F. V. Chappell, Director of Maternal and Child Health, State
Board of Health; Miss Ruth E. Mettinger, R.N., Director of
Public Health Nursing, State Board of Health; Miss Jean Hen-
derson, Director of Public Relations, State Board of Health; Mrs.
Gordon Ira, State Health Chairman of the Florida Federation of
Women's Clubs; Mrs. R. C. Williamson, Chairman of the Alachua
County Health Council; Mr. M. K. Adams, Instructor in Health
and Physical Education, University of Tampa; Miss Ruth Mof-
viii PREFACE TO FIRST EDITION
fatt, Instructor in Health and Physical Education, University of
Tampa; Dr. D. H. Turner, Field Director, Dental Department,
State Board of Health; Miss Lalla Mary Goggans, R.N., State
Consultant for County Health Departments, State Board of
Health; Dr. A. J. Logie, Director of Division of Tuberculosis
Control, State Board of Health; Mr. Fred Gehan, Chairman,
Elementary Principals' Association; Mrs. Howard Dial, Seventh
Vice-President and Health Director of the Florida Congress of
Parents and Teachers; Miss Anna Mae Sikes, Extension Nutri-
tionist, Florida State College for Women; Mrs. Dora Skipper,
Member of the State Courses of Study Committee, Florida State
College for Women; Dr. Ruth Connor, Acting Supervisor of Home
Economics Education, State Department of Education; Miss
Ella Faye Price, Secretary.
Special acknowledgement is given to the Florida Tuberculosis
and Health Association, whose financial contributions made the
conference possible, and to Mr. James Edward Rogers, Secretary
of the National Society of Directors of Health and Physical Edu-
cation, who was of great assistance in developing the original
idea and outline.
JOE HALL
Conference Director, Consultant in Health and
Physical Education, State Department of Health
PREFACE TO SECOND EDITION
By May, 1942, the 5,000 copies of the original bulletin had
been distributed, and demand for additional copies made a new
printing necessary. Changed conditions in national life brought
on by the war and changed ideas of the ways in which the health
program can best function made it desirable to alter certain
portions of the bulletin before making the reprint. Consequently,
during the spring and summer of 1942 a group of health educa-
tion leaders gave special attention to writing the revised edition.
None of the changes in the revised edition are revolutionary
in nature. Instead they are the natural improvement in practice
which evaluated experience brings. Minor revisions are made
all the way through the bulletin, but chief major alterations are
in the recommended plan for health instruction given in Chap-
ter V.
PREFACE TO SECOND EDITION
In the preparation of the revised bulletin, individuals spent
a great deal of time in preparing their respective parts. One
entire week, August 3-8, 1942, was spent at the Florida State
College for Women, Tallahassee, in exchanging ideas. Those par-
ticipating in the conference and in the actual writing of the
bulletin were: Katherine Montgomery, Director of Physical Edu-
cation, Fannie B. Shaw, Associate Professor of Health Education,
and Grace Fox, Instructor in Health and Physical Education,
Florida State College for Women, Tallahassee; Mrs. Elizabeth
Fretwell, Director of Health Education, Mrs. Elsie Withey, Con-
sultant in Health Education, and Dr. E. F. Hoffman, Acting
Director of the Bureau of Epidemiology, State Board of Health,
Jacksonville; John Permenter, Consultant in Narcotics and
Health Education, and Joe Hall, Consultant in Physical and
Health Education, State Department of Education, Tallahassee.
Subsequent to this conference much individual work was done,
particularly by Miss Shaw and Mrs. Withey.
After the original materials had been completed, they were
mimeographed in tentative form and sent to all those who par-
ticipated in the preparation of the first edition of the bulletin,
to all members of the Florida Defense Council Physical Fitness
Advisory Committee, to all county health officials, and to other
selected individuals. They were requested to submit their sug-
gestions for correction. Alterations were made in line with the
suggestions received, and the bulletin was printed.
JOE HALL
Consultant in Physical and Health Education
State Department of Education
Tallahassee, Florida
ELIZABETH FRETWELL
Director of Health Education
State Board of Health
Jacksonville, Florida
x TABLE OF CONTENTS
CONTENTS
page
FOREWORD ....................------------------------------------------ v
CHAPTER ONE: Philosophy and Principles....-----.....-.....------... ---------.. 3
Introductory Statem ent ............................. ...................... ........ 3
Florida's H health Problem s............. ........................................... 5
Point of View in Health Education ..................................... ..... 7
Chart: Scope of School Health Program ............................ 8
Health Education Terms Defined............................................. 9
CHAPTER TWO: Special Administrative Considerations.....-.... 13
Materials for Interpreting the School Health Program....... 13
Relationship of School and Community Health Programs... 15
Organizing the School Curriculum for Proper
Attention to Health Instruction............... ............................ 16
Allocation of R esponsibilities.................................. .............. 20
Home, School, and Community Cooperation .. ............... 22
CHAPTER THREE: Healthful School Living......---...........------------ 27
Physical Environm ent of the School................ ....................... 27
Organization of a Healthful School Day................................. ...... 34
Pupil-Teacher Relationships ............................ ............. :...... 35
CHAPTER FOUR: Health Service ......----------------.. .- ---------. 41
Prevention and Control of Communicable Disease. ......... 42
H health E xam nations ................................................................... 45
Teacher and Employee Health Record Form.... ............ 46
Preliminary Procedures ........... ....... ...... .. 50
Exam nation Procedures ... .... ...... ................................ .. 58
Pupil H health Record Form ................ ................. .. 59
C orrection of D efects................................................................... 68
Guidance of Handicapped Children. ................. 68
First Aid for School A accidents ............................ ................... 73
CHAPTER FIVE: Health Instruction ...---------- 77
Determining What To Teach ......................... ............. 79
Suggestions Concerning Graduation.................... 83
Choice and Use of Methods and Materials.............................. 89
Criteria for Selecting Pupil Activities..................... ............. 89
Suggested Types of Pupil Activities. .......... ............................ 91
Areas of Health Subject Matter for Teachers ......... ...... 92
Teaching Materials: State-Adopted Textbooks .............. 102
TABLE OF CONTENTS xi
CHAPTER SIX: Sources of Materials .............. ............... 107
Criteria for Selection of M materials .... ...... ...... ..... ....... 107
National Agencies Which Distribute Lists of
Publications in Health Education ................ ................. 108
Florida State Agencies Which Distribute Health
E education M materials .. ... .. .... .. ........... ........ .................. 108
Health Education Textbooks for Teachers................... .............. 108
Health Textbooks for Pupils .. .... .... ..... 110
F ilm L ists .................... ... . .. .. ... ............. ..... ... ......... 114
CHAPTER SEVEN: Evaluating the School Health Education Program 131
Improvement of Health Status of Children..... ....... ............... 131
Improvement of the Environment in Which
C children L ive at School . ....... ..... ......... .... ................ 131
Educational Outcomes in Terms of Habits,
Attitudes, and K nowledges ............. ....... ........ ...... 132
Health Tests, Health Appraisal Forms, and Checklists ....... ..... 133
APPENDIX: Laws Relating To School Health ........ .......... .......... 137
CONTINUING PRODUCTION OF CURRICULUM BULLETINS
FLORIDA PROGRAM FOR IMPROVEMENT OF SCHOOLS
Series Beginning 1938
S" No. 4 Florida's School Health Program (1943, Revised)
; No. 21 Source Materials for Physical Education in Elementary
No. 9 Schools (1941)
A Guide to Improved a No. 22K Teaching Actions and Effects of Alcohol and other Nar-
Practice in Florida rn cotics (1941)
Schools (1940) No. 26 Arithmetic in the Elementary School (1942)
No. 27 State-Adopted Library Books for Florida Schools (1942)
No. 1 Guide to Exploratory Work (1938)*
No. 4 Florida's School Health Program (1943, Revised)
No. 23 No. 5 Source Materials for Physical Education in Secondary
Ways to Better Avenues of Under- Schools (1942, Revised)
Instruction in standing, A bulle- No. 11 Business Education (1940)
Florida Schools tin for Parents and "' No. 12 Industrial Arts (1940)
(1939) Lay Groups (1940) ^ No. 22K Teaching Actions and Effects of Alcohol and Other Nar-
W. cotics (1941)
Jo No. 25 Home Economics Books and Other Source Materials (1941)
g No. 27 State-Adopted Library Books for Florida Schools (1942)
W No. 28 Social Studies in the Secondary School (1942)
--, No. 29 Everyday Living, Grades 7 and 8 (1942)
No. 40 Mathematics Essentials (12th Grade Pupil Text) (1942)
No. 10 No. 41 Background Material in War Mathematics (for Teachers)
A Guide to a Functional (1942)
Program in the Secondary No. 42 Teacher's Manual for War Emergency Physics Course
School (1940)
Technology Series:
Book 1 General Mechanics (1940)
*Now out ot Print. Book 2 Engines (1942)
Book 3 Aeronautics (1942)
THE PRODUCTION OF CURRICULUM BULLETINS
IN THE FLORIDA PROGRAM FOR
IMPROVEMENT OF SCHOOLS
AN EXPLANATION OF THE DIAGRAM
The diagram on the preceding page has been designed to aid
teachers in seeing the continuity and relationship existing among
the various instructional bulletins which have been produced in
the Florida Program for Improvement of Schools during the
past several years. It is important to note the fact that the pro-
gram has been one of continuous development and that consid-
erable effort has been exercised in order to maintain consistency.
The importance of Ways to Better Instruction in Florida Schools,
which contains the basic principles for the development of the
series of bulletins, should not be overlooked. The two basic
bulletins for elementary and secondary schools are essential to
any intelligent application or use of the many source materials
bulletins which are to follow. The importance of Avenues of
Understanding, a bulletin for parents and lay groups, will be
evident to all those interested in improving education in the
state. It will be noted that in some cases the bulletins containing
source materials are equally applicable to the elementary and
secondary school. In such cases, the titles have been duplicated
in the diagram. The reader should give attention to the footnotes
which are included with the diagram, since they give important
information concerning whether or not the materials are now
available. Additional materials are being planned in both the
elementary and secondary field, but definite announcement con-
cerning them cannot be made at this time.
THE RELATIONSHIP OF THIS BULLETIN TO OTHERS IN THE SERIES
This bulletin contains material other than that which would
be strictly called curriculum material. Chapter V, however, has
definite bearing on the program of studies. The other chapters
are administrative in nature, but all deal with the experiences
the child should receive in the school. Through a careful study
of the contents, the administrator can fit the health program
Properly into the total school program.
PHILOSOPHY AND PRINCIPLES
CHAPTER ONE
PHILOSOPHY AND PRINCIPLES
INTRODUCTORY STATEMENT
In recent years "Health Education" has assumed a much
broader significance than its original interpretation implied. It
embraces all the activities directed toward the attainment and
maintenance of an optimum state of health from the pre-natal
stage through adulthood. It is known that one's state of health
varies in accordance with inheritance; immunity or susceptibility
to disease; home, school, and community environment; and daily
regimen of living. The school is faced with the responsibility
of taking the child as he is at the age of six and inculcating in
him desirable health practices, giving such knowledge as will
rationalize everyday healthful living and creating favorable at-
titudes which will eventually lead the individual to assume
responsibility for the well-being of himself and others-to make
one self-directing in health activities which will enrich, rather
than deteriorate life. With the expansion of the concept of the
health program there appear today several very definite basic
understandings:
1. Health education is a way of living, as well as a subject to
be taught, and is, therefore, concerned with the interaction
of the individual and his environment from the beginning
to the end of his life.
2. Health education is essentially a program of activity in
which progress is expressed in terms of desirable reactions
and practices in health situations.
3. Health education is concerned with the development of the
whole child, physically, mentally, socially, and emotionally.
4. Health education is a sharing program in which the school,
home and community have definite responsibilities for es-
tablishing and maintaining coordination.
5. Health education must be compatible with and contribute
to the aims of general education.
6. Health education must recognize and provide for individual
differences.
4 FLORIDA'S SCHOOL HEALTH PROGRAM
7. School health education, through a program based on child
felt needs and interests and achieved through purposeful
activities, aims to develop concepts and practices in better
living.
8. Health experiences must give satisfaction to the individual
to be of practical and lasting value.
9. Since health is an integrative process, every teacher is re-
sponsible for presenting favorable health concepts in re-
spect to:
(a) Her personal appearance, manner, voice, and personality.
(b) The emotional tone of her classroom and her handling of each
daily health situation that arises.
10. School health education aims to guide the child to meet
reality squarely and wisely to the end that he faces the
important factors in his adjustment situations, such as:
(a) Facing adverse situations.
(b) Seeing all sides of his problems.
(c) Questioning "why" in the quest for truth.
11. Health education aimns to guide the child in becoming in-
creasingly self-directing as he adjusts to new and unpre-
dictable health situations and develops values which enable
him to place "first things first."
12. The school health education program should be flexible and
should cooperate with and aid in guiding community health
activities.
13. Health education must permeate the entire school structure
to provide for the healthful school living of all individuals
concerned through:
(a) A wholesome physical environment.
(b) The organization of a healthful school day.
(c) The establishment of teacher-pupil relationships which insure a
favorable social and emotional tone in classroom situations.
14. The health service program should serve as the basis for
the educational guidance of the child and should function in:
(a) Determining the health status of the child.
(b) Enlisting the cooperation of the child in health protection and
maintenance.
(c) Notifying parents concerning the health status of the child.
(d) Controlling the spread of disease.
(e) Securing the correction of remediable defects.
(f) Promoting community responsibilities in respect to health serv-
ices.
15. The health education program should provide experiences
which aid the individual to evaluate community health serv-
ices to the end that he will select effectively his own med-
ical service.
PHILOSOPHY AND PRINCIPLES 5
16. The health instruction program aims to provide sound
knowledge, develop desirable attitudes, and establish effec-
tive practices through providing the child with learning
experiences based upon the child's needs, as determined by:
(a) A study of the physical, mental, social, and emotional needs
common to all children as related to the individual child.
(b) A study of the child's health status.
(c) State and community health problems.
(d) Community environmental problems as indicated by vital sta-
tistics.
(e) Social and economic factors.
(f) The interests of the child.
(g) The vocational possibilities of the child.
17. The sum effect of the coordinated health education program,
all factors working together, results in an individual able
to correlate his experiences to the end that his personality
is effectively integrated.
FLORIDA'S HEALTH PROBLEMS
Latest statistics (1941) indicate that at least one-third of
the deaths occurring among Florida people resulted from dis-
eases or. conditions either wholly or partially preventable. Many
thousands more were ill from various preventable causes, cre-
ating an economic burden on the citizens of every county because
of inability to earn a living for themselves or their families.
Any and all measures taken to improve this situation will react
favorably upon econonric as well as health conditions in Florida.
Any program of health instruction in the school should be
planned on a basis of the definite needs as indicated by the vital
statistics records concerning specific locations. Listed below are
some of Florida's major health problems.
Hookworm. Approximately 35 % of the rural white popula-
tion of Florida is infested with hookworm and in some counties
this infestation is as high as 70"; The disease is particularly
prevalent among pre-school and school children.
Malaria. Malaria is an economic disease in many areas of
Florida. It is present to a degree of economic import in prac-
tically all counties west of the Suwan.nee River and all counties
bordering the Gulf of Mexico as far south as Hillsborough. De-
pending upon the period of the cycle of the disease, and malaria
is cyclic in its appearance, mortality rates in Flo'ida from ma-
laria have varied during the last ten years from 28.1 per 10,00)
to 0.5 and actual deaths from 445 in 1934 to 85 in 1941. It is
dangerous to estimate the numbers of persons considered to be
sick with the disease by computing these from the numbers of
deaths annually, but it can be stated that the rate for sickness
is many, many times that for death.
FLORIDA'S SCHOOL HEALTH PROGRAM
Malaria is characterized as a debilitating disease and this
is a truth. Death may be its end result, but incapacity to con-
duct normal life and perform normal duties is the price it
exacts from those suffering with it.
Syphilis and Gonorrhea. The rate of prevalence of the ve-
nereal diseases in Florida is among the highest in the United
States. Three-fourths of these infections occur in persons under
30 years of age, and one-fourth in persons under 20 years of
age. It was found that 15.9% of the men examined for selective
service through August, 1941, in Florida were found positive for
syphilis; 40.6% of the Negroes examined were positive, while
the percentage was 5.3% for the white men. Education of
young people as to the dangers of these diseases is particularly
important for this reason.
Gonorrhea and other venereal diseases are also important
causes of disdLiiity and economic loss. Gonorrhea is known to
occur many times more frequently than syphilis. The use of
modern drugs makes the cure of gonorrhea relatively easy as
compared to older methods of treatment.
Tuberculosis. In 1941, 927 persons died of tuberculosis in
Florida. In this same year it is estimated that there were at
least 7,000 cases of this disease, many of which were unknown
or unrecognized. If every case of pulmonary tuberculosis could
be detected in the minimal stage, there probably would be less
than 100 deaths a year.
Pneumonia. In 1941, 900 Florida people died of pneumonia.
The disease is particularly prevalent among children in the age
group 5 to 14 years and in Florida it is the fifth leading cause
of death in this school age group. By diagnosing pneumonia
early and starting treatment with sulfanilamides, the death
rate from pneumonia would be dramatically decreased.
Infant Mortality. In Florida 1,812 infants, one year of age
and under died during the year 1941. Most of these deaths were
due to causes which are preventable.
Maternal Mortality. For a number of years the death rate
of mothers dying from childbirth was higher in Florida than
in any other state in the union. In 1940 the Florida maternal
death rate was second from highest among the forty-eight states.
At least 40% of these lives could have been saved by the ap-
plication of known public health principles.
Diarrhea and Enteritis. In 1941, diarrhea and enteritis were
responsible for 273 deaths, of which 145 were children under
two years of age. Diarrhea and enteritis are definitely pre-
ventable diseases.
PHILOSOPHY AND PRINCIPLES 7
Pellagra. This is a disease associated with inadequate and
unbalanced diet and more commonly found among the indigent
and low-income groups. In Florida pellagra accounted for 59
deaths in 1941.
Typhoid. Twenty-four persons died in Florida from typhoid
in 1941. Typhoid is a definitely preventable disease.
Typhus Fever. There were 14 deaths and 196 cases of typhus
reported in Florida for the year 1941.
Accidents (all kinds). Florida citizens numbering 1,733 died
from accidental causes in 1941.
Dental Diseases. Of the men in Florida between the ages of
21-36 examined by Selective Service, 27,c were rejected because
of dental defects. This number was far greater than for any
other cause of rejection. A survey of the Florida school children
showed 76%, or over 304,000 to have dental caries, which if
not given early attention will eventually result in infection and
the loss of the teeth. The loss of these teeth can be prevented.
Each of these diseases and conditions is largely preventable
through the application of known public health and medical
principles. There are many other health problems requiring con-
sideration and study, such as care in the pre-natal and maternal
periods, the infant and pre-school child, preventive dentistry,
nutrition, milk and food supervision, sewage disposal and hous-
ing. The study of such problems in Florida schools will be of
utmost importance in their eventual solution.
POINT OF VIEW IN HEALTH EDUCATION
Health education, to be effective in providing for the growth
and development of the individual child, must be compatible with
and must contribute to the program of general education. Bonser
states: "It is my philosophy that the purpose of life, health,
and education are one. The end and aim of all are growth and
enrichment of human experience."
The method in health, as in education, is learning through
experience. Interest plays a large part. The needs of children
form the basis for the curriculum. The school may be thought
of as a community in which children must have facilities to live
adequately during the school hours-individual lives, yet lives
which are harmoniously adjusted to the group with which they
associate. The curriculum is conceived, not in terms of subject-
matter only, but as experiences making up the life process-a
succession of experiences built around real situations and mo-
tivated by the purposes of those being taught.
This point of view necessitates cooperative and careful plan-
SCOPE OF THE SCHOOL HEALTH EDUCATION PROGRAM
The chart here given is designated to picture all the aspects of the school program. The meanings of the terms used and the way in which varloau
parts of the program are carried out are indicated in other parts of the bulletin.
HEALTHFUL SCHOOL LIVING
A. Ph3s:cal Environment of the School
1. Site adequate and free from health haz-
ards
2. Building hygienically constructed and
equipped with regard to health functions
such as:
a. Heating and ventilation
b. Water supply
c. Sewage disposal
d. Toilet rooms
e. Lighting
f. Seating
g. Lunchrooms
h. Facilities for play
i. Teaches' rest rooms
j. Special health rooms
3. Maintenance of sanitary school grounds
and building: Operations for sweeping,
dusting, scrubbing, cleaning
II. Organization of a Healthful School Day
1. Safe and comfortable transportation
2. Length of school day and class periods
:;. Mental and physical activities alternated
4. Supervised study at school minimum
home study
C. Pupil-Teacher Relationships
1. Social and emotional tone of the class-
room
2. Avoidance of strain, noise, and excite-
3. Provision for success and the avoidance
of failure
-1. provisionss for individual difference-s
S. VWholesomne piersonlity of teachers cou-
tli'u tes I o l :i fu ii f l siv u.
HEALTH SERVICE
A. Prevention and Control of Communicable
Disease
1. Daily observations by parent
2. Daily observations by bus driver
3. Daily observations by teacher
4. Teacher services in:
a. Isolation and transportation of sick
children
b. Knowledge of communicable disease in
the area
c. Avoidance of infection through proper
use of facilities and sound school reg-
ulations
5. Immunizations
It. Health Examinations
1. For teachers and employees
2. For school children
Preliminary procedures:
a. Arranging for examinations
b. Preparing the child
c. Inviting parents
d. Preparing records
e. Recording preliminary information
f. Preliminary testing
g. Providing an examination room
The health examination
a. General procedures
b. IDental examinations
c. Other examinations: re-exanminations,
major athletes, lpre-school and trans-
fer students' examinations
C. Correction of Defects
1. Parents' prrsonce at txanmination
Homne visits by the nurse
:;. Health instruction based on texanmination
findings
Teacher conf-rences
*. Use of comniounity resouiirce
I). Guidance of Handicapped Children
I'. Virst Aid for School Accidents
HEALTH INSTRUCTION
A. Determining What To Teach, based on:
1. Health examination findings
2. Children's health practices
3. Iome health practices
4. Characti istics of children at specific age levels
5. Local school health conditions
i. Previous health learning
7. Student interests
8. Leads from other subjects
!). tAea.th and safety hazards in the local community
10. State health problems
11. Current health events
12. Basic physiological needs
B. Suggestions Concerning Gradation
1. Grades 1-3; emphasis on practices and attitudes based
on daily experiences of children
2. Grades 4-(: emphasis on the reasons for health practices
3. Grades 7-8: emphasis on the problems of everyday liv-
ing, personal adjustments to school and home
4. Grades 9-10: emphasis on biological aspects of health-
ful living
5. Grades 11-12: emphasis on community, state, and na-
tional health problems, personal health problems of
social, vocational, and civic life
('. Choice and Use of Methods and Materials
1. Criteria for selecting and conducting pupil activities
2. Types of pupil activities
I). Areas of Health Subject Matter for Teachers: Defining
health. Living healthfully at school, Having a health ex-
amination, Correcting defects. Developing physical fit-
less, Eating effectively, Eliminating wastes, Controlling
communicable disease, Understanding the human body,
Protecting the sense organs, Developing effective person-
ality, Improving personal appearance, Playing happily,
Using leisure time constructively, Budgeting time and en-
ergy. Avoiding fatigue, Understanding alcohol and other
narcotics, Living safely. Choosing professional health serv-
ices wisely, Becoming employable, Working cooperatively
Swith others, Educating for parenthood, Improving home
living, Improving community health conditions, Using
community health resources, Understanding Florida's
health problems.
EI. Teaching 3Materials:
State-AdoIpt id T'xtbook.
SOME HEALTH EDUCATION TERMS DEFINED*
Health is that quality of life that enables one to live most and serve best. The concept of health needs enrichment. Too often
health is considered to be merely the absence of disease.
Health Education is the sum of experiences which favorably influence habits, attitudes, and knowledge relating to individual,
community, and racial health. Health Education is not to be thought of merely as a subject to be taught. It includes the
many activities which make up the total health program, not only in the school, but in the home and the community.
Healthful School Living is a term that designates the provision of a wholesome environment, the organization of a healthful
school day, and the establishment of sound teacher-pupil relationships, all of which insure a safe and hygienic school situation
favorable to the best development and living of pupils and teachers. Children learn through living healthfully at school each day.
The physical environment, a schedule without tensions, and a classroom with favorable social and emotional tone are all import-
ant factors in the health education program.
Health Service comprises all those procedures designed to determine the health status of the child, to enlist his cooperation
in health protection and maintenance, to inform parents of defects that may be present, to prevent diseases, and to correct rem-
ediable defects. Every phase of the health service program should be rendered in such an educationally sound manner that
parents and children will become self-directing in the improvement and maintenance of their own health.
Health Examination is that phase of health service which seeks, through examination and personal conference by physicians,
dentists, and other qualified specialists, to determine the physical, mental, and emotional health of an individual.
Health Instruction is that organization of learning experiences directed toward the development of favorable health knowl-
edge, attitudes and practices. Health Instruction is the function of the classroom teacher in the elementary school and the
teacher of health in the secondary school.
* Adapted from thI Terminology Committee Report, Health Education Section. American Physical Education Association, Journal of Health and Physical Edu-
cation, December. 1934.
10 FLORIDA'S SCHOOL HEALTH PROGRAM
ning by school, home, and community. Only as the health needs
of children become evident to parents, school administrators,
and teachers and are related to all facilities in the community
will the school health program function as a primary objective
of education.
The teacher is the strategic person in the guidance of the
children in healthful living throughout school life and in the
maintenance of healthful conditions in the school environment.
It is essential that teachers exemplify healthful practices in daily
living. A broad knowledge of scientific facts underlying personal
and community health is imperative. In developing a functional
school program it is necessary for the teacher to be thoroughly
familiar with: (1) the health problems existing in the school,
in the home, and in the community; and (2) the health assets
and facilities existing in the home, school, and community which
may be used in solving the problems.
In planning local school health education programs, the fol-
lowing considerations should be observed:
1. In every community many groups are interested in child
health-parents, private physicians, dentists, departments of
public health, voluntary health organizations, welfare and
social agencies, teachers, parent-teacher groups, women's
clubs, and other civic organizations.
2. Health education is a sharing program. No single professional
or special group can claim a monopoly of interest or responsi-
bility for the health of the children of the state. Improved
child health and improved health conditions in the state will
result, not from the program of one group or one organization,
but will come from the harmonious planning and working
together of all groups in Florida.
3. There is a decided trend toward breaking down the line of
demarcation between school health education and public
health education. Each is dependent upon the other. The
school program is hampered unless the public health program
has functioned in its maternal and child hygiene, dental and
communicable disease control programs. On the other hand,
the success of the public health program is greatly augmented
if the public school turns out pupils who are prepared, through
definite health education programs, to take their places of
leadership in home and community.
4. Health has been a primary objective of education for many
years. To realize this objective, Florida schools have a definite
responsibility in planning for the coordination of health ex-
periences in the home, school, and community in such a way
as to influence favorably practices, attitudes, and knowledge.
SPECIAL ADMINISTRATIVE CONSIDERATIONS
CHAPTER TWO
SPECIAL ADMINISTRATIVE CONSIDERATIONS
This chapter is addressed especially to administrators, wheth-
er they be school principals, county superintendents, county
health officers, or lay persons insofar as school work is concerned,
who are interested in the school health program. In order that
the program may function efficiently, it is necessary that these
individuals understand it thoroughly and realize fully exactly
where special responsibilities lie. In the development of this total
school health program a number of administrative guides, in-
structional materials, and other aids have been provided. A dis-
cussion of how these are to be used brings out most of the
aspects of the program.
MATERIALS FOR INTERPRETING THE SCHOOL HEALTH PROGRAM
The basic administrative guide is a pamphlet, "Florida's
Physical Fitness Guide"1, prepared by numerous state-wide
organizations under the auspices of the Florida Defense Council
and published jointly by the State Department of Education and
the State Board of Health. This pamphlet presents eight points
which are essential to the health of the individual and makes
numerous suggestions as to how each of these points may be
carried out. In its brief pages, however, suggestions could not
be sufficiently detailed to give adequate help to the individual
attempting to conduct the program. Consequently, supplement-
ary aids for each of the eight points were necessary.
In presenting these eight points essential to health, it is
understood that they are applicable both to in-school and out-of-
school persons. It is fully realized, however, that in the admin-
istration of the program the techniques for the in-school and
out-of-school groups necessarily vary a great deal. The State
Defense Council recognized this when it appointed separate phys-
ical fitness directors for each of these groups. The following
pages give the plan which is being followed in carrying out the
in-school health and physical fitness program.
Three of the points-health examinations, correction of de-
fects, and control of communicable diseases-are grouped to-
14 FLORIDA'S SCHOOL HEALTH PROGRAM
gether under the general heading, "Health Service," and are
given more complete discussion in Chapter Four of this bulletin.
By reading this chapter carefully, the administrator will be in
a position to organize school health service so that it will operate
effectively. School officials and health officials have a definite
responsibility for meeting together and planning for the most
effective way to administer health examinations. They must
bear in mind that the examinations should be as thorough as
possible and should be so conducted as to develop favorable
attitudes and whole hearted cooperation on the part of the
child. This means that the school administrator and the teacher
should prepare the pupils psychologically to receive the health
examinations and the follow-up teaching should insure that the
experience has been emotionally and educationally satisfactory.
The importance of health examinations of school personnel can-
not be overestimated. Procedures are given in Chapter Four.
Two other points good environmental conditions and mental
and emotional preparedness-are given fuller attention in Chap-
ter III, "Healthful School Living". Nutrition is discussed in a
number of sections in this bulletin in order to emphasize its
importance in a complete health program (pages 32, 34, 61, 73,
94-95, 120, 132). Administrators should give particular attention
to nutrition as it is related to the school lunch program. Health
examinations should include a physician's diagnosis of nutri-
tional status. Definite nutrition instruction should be provided
for all pupils, both boys and girls, in every grade. It is recom-
mended that time-allotment equivalent to at least one regular
class period per week should be devoted to nutrition instruction
in each grade. This provision should preferably take the form
of a six weeks' unit on nutrition each year. Home economics
teachers, whenever possible, should be consulted in the plan-
ning for the .nutrition instruction program.
The physical activity program is given full treatment in two
bulletins-one for the elementary school and the other for the
secondary school. The elementary bulletin of 365 pages is en-
titled "Source Materials for Physical Education in Elementary
Schools"; the secondary bulletin of 415 pages is entitled "Source
Materials for Physical Education in Secondary Schools." Chapter
II in each of these bulletins is entitled "Administrative Standards
and Policies". A complete discussion of the best organization of
the school for an adequate physical education program and the
way in which the administrator functions in the operation of
this program is given.
Health Instruction, the eighth point in the complete program
for health and physical fitness, is discussed in Chapter Five of
this bulletin. It is readily recognized, however, that many sup-
plementary aids are necessary for a complete presentation of
SPECIAL ADMINISTRATIVE CONSIDERATIONS 15
the health instruction program. Chapter Five lists the textbooks
which should be provided, supplementary materials which should
go into the classroom, plans for organizing and scheduling classes,
and other points which are helpful to the administrator in the
organization of his program of studies.
The diagram on page 17 summarizes the foregoing pages
and shows where detailed suggestions may be received for carry-
ing out each phase of the total health and physical fitness
program.
OTHER AIDS
In addition to the written materials available, other types of
aids will be of great help if properly utilized. Visual aids from
the General Extension Division of the University of Florida,
and from the Florida State Board of Health, regular health
courses at institutions of higher learning, and the special health
education laboratory being developed at the Florida State Col-
lege for Women will be most valuable.
RELATIONSHIP OF SCHOOL AND
COMMUNITY HEALTH PROGRAMS
All who understand the full significance of health are i.n com-
plete agreement that the school health program is only a part
of the total health program which must be concerned with the
community as a whole. Important as immunization of school
children is, for example, infant and pre-school immunizations are
far more important. Likewise, many other health procedures as-
sume greater significance for the pre-natal, infant, and pre-school
child than for the school child himself.
The school as an agency for community development, there-
fore, will wish to give its assistance first to providing for a total
community health program, and second to establishing its proper
relationship as a part of that total program. One important
step in the development of the community health program is
securing adequate public health services. This may take the
form of establishing a full-time county health unit for the
county, or, where population does not justify this procedure,
combining two or more counties to form a health unit, or even
of organizing a considerable number of counties into a district
under the direction of the State Board of Health. This public
agency will be able to meet the needs of school health services
(see Chapter Four), and should bridge the gap between un-
16 FLORIDA'S SCHOOL HEALTH PROGRAM
recognized need of medical attention on the part of the individual
and the help which the private physician and the dentist may
give to him. With public health services established, the great-
est responsibility of the school, insofar as professional health
service is concerned, will be to make it possible for this agency
to function effectively in the school program. There are, how-
ever, certain aspects of health service which are school respon-
sibilities regardless of the method by which professional health
services are rendered.
Health units which are established will not fulfill the purpose
for which they are created unless trained and capable personnel
are employed. The school should lend its influence to insist that
this be done. The school and the health unit should constantly
keep in mind the idea that one of the chief objects of the work
of the health unit is to assist in developing an interest in and
an understanding of the health benefits which may be obtained
from a capable family physician.
The principles stated in this section apply to both dental and
medical services. For full information on procedures to be fol-
lowed in establishing local health units and concerning the serv-
ices which they can render, write to the State Board of Health,
Jacksonville, Florida.
ORGANIZING THE SCHOOL CURRICULUM FOR
PROPER ATTENTION TO HEALTH INSTRUCTION
(See Appendix pages 138, Section 231.09 (1).) The organiza-
tion of the program of studies so that proper attention may be
given to health instruction presents a special problem to school
principals. "Some educators feel that health instruction in sec-
ondary schools can be presented entirely through the integration
of health material with science courses, with home economics,
with physical education and other subjects in the curriculum. It
is the consensus of many, however, that such presentations have
not proved satisfactory because of the divided responsibility,
because many important topics may be omitted with this type
of arrangement, and because at times teachers have been asked
to teach health material when inadequately prepared for such
work".2
One reason for difficulties is found in the confusion of the
terms "health instruction" and "physical education." Some health
instruction may rightfully be done in physical education classes,
just as it may be done in other classes. In order to insure ade-
AVAILABLE MATERIALS FOR FLORIDA'S SCHOOL HEALTH PROGRAM
Health and Physical Fitness Guide
(Basic Administrative Pamphlet)
Bulletin 4, "Florida's School Health Program," 7. Nutrition Program
containing suggestions for Home Economics P
1. Mental and Emotional Preparedness
2. Wholesome Environment
3. Control of Communicable Disease
4. Correction of Defects
5. Health Examinations
I
Under Direction of
personnel
I
Short Unit Courses in Nutrition (in
mimeographed form)
Bulletin 5, "Source Materials for
Physical Education in Secondary
Schools"
6. Health Instruction
S For Teachers
00
0 "I I -
u H *i 0
I S c
= 0. = "E
'a0 l -
0 0 S. 0.(r
"- > na
::D^
c rz
Bulletin 22K, "Plans for Teaching the Effects of Alcohol and Other Narcotics"
Malaria
Hookworm
Pellagra
Typhus
Tuberculosis
Venereal Diseases
*In process of dievelopiiiment
For Pupils
8. Physical Activity Program
Bulletin 21, "Source Materials for
Physical Education in Elementary
Schools"
FLORIDA'S SCHOOL HEALTH PROGRAM
quate coverage of the field, however, special health instruction
classes and teachers must be 'designated. Some schools in the
past have attempted to meet this need by scheduling physical
education four days a week and health instruction one day. In
general this plan for health instruction has proved rather un-
satisfactory. It is difficult, if not impossible, to carry on a con-
tinuous effective, interesting program in classes meeting only
one time a week, as students regard such classes as being of
only minor importance, and satisfactory classrooms are seldom
provided for classes meeting only once a week.
Even if one class a week were satisfactory, increased atten-
tion to physical education will make scheduling in conjunction
with health education extremely difficult. The State Board of
Education has recommended daily physical education classes
wherever possible with at least thirty minutes daily in grades
1-6 and has required at least 180 minutes per week in grades 7-12.
In adjusting school health instruction to the new program
of studies, an amount of time equivalent to that allotted under
the old organization should be set aside for emphasis on health
education. Plans for organizing this program are presented in
Chapter Five of this bulletin (see pages 83-88), in the "Physical
Fitness Guide", and in the bulletin, "Programs of Study in Flor-
ida Secondary Schools".
Grades 1-3 (see pages 84-85). In the first three grades em-
phasis should be placed on establishing desirable health practices
and attitudes, utilizing the everyday living experiences of the
child. Such instruction should occur at any time during the
school day when the need arises and should be integrated with
other studies when effective learning is stimulated thereby.
Health concepts and practices can be favorably motivated by
well-selected stories and dramatizations.
Grades 4-6 (see page 85). "If the teaching method is through
the large unit plan, care should be exercised to see that the pos-
sibilities for developing health meanings and attitudes are uti-
lized in connection with units having leads in this direction and
that there are occasional units with health as the central theme.
If subject matter lines are drawn, however, definite periods for
health instruction should be provided and special efforts should
be made to show relationships to other fields, such as science, or
social studies, etc. Emphasis should be placed, not only on
health practices and on the development of skills, but also upon
beginning the study of the how and why of these practices and
skills.
SPECIAL ADMINISTRATIVE CONSIDERATIONS 19
Grades 7-8 (see page 86). "It is highly desirable in these
grades to combine the health instruction with a modification of
the home economics and science courses usually taught in these
grades to provide for all boys and girls two full year courses
devoted to science, health, and home living problems. The teach-
ers in each of these areas should collaborate in planning the es-
sential and related learning experiences in these fields to insure
the richer treatment of basic problems and the elimination of
inadvisable duplication".3 The "Programs of Study in Florida
Secondary Schools" bulletin recommends a unified course for
grades 7 and 8. The State Department of Education Bulletin
29, "Everyday Living", gives detailed suggestions for teaching
this course. "When this plan is impossible, 70-90 periods (one
semester or the equivalent during the two years) should be
devoted to health instruction. When the program is organized
in this way, one full semester course during the two years, meet-
ing five times a week, is preferable to a course meeting once
each week for every semester during the two years.
Grades 9-10 (see page 86. "Health instruction should occupy
the center of emphasis for the equivalent of one semester (70-90
periods) during the two years. If all students take biology, this
course can be reorganized so that it includes biology and health.
If some students take general science instead of biology, that
course can be reorganized to include science and health. In either
event, health texts . should be used in the course. If neither
of these plans is feasible, a full semester course during the two
years, meeting five times a week, is preferable to a course meet-
ing once each week for every semester during the two years.
Grades 11-12 (see page 88). "There should be the same alloca-
tion of time as in grades 9-10 The most satisfactory plan
would be the organization of a full semester, one-half unit course
for these grades. The plan of approach should involve a study
of human relationships and social problems, including the struc-
ture and function of the human body as it relates to economic
and social efficiency. Emphasis should be placed upon a more
detailed study of the importance of health in solving problems
of general social significance. Credit should be granted on the
same basis as any other classroom subject; that is, the one
semester should carry one-half unit of credit. The Standard or
Junior Red Cross First Aid course should be given as a part of
this work. If it is impossible to organize the one-half unit course,
the subject matter content should be carefully distributed among
such courses as social studies, science, physical education. Regu-
lar health textbooks should be used wherever health subject
matter is assigned."'
20 FLORIDA'S SCHOOL HEALTH PROGRAM
College Courses. There is also need for the inclusion of health
instruction as a part of the regular college program for all stu-
dents. Courses which are offered for this purpose will -naturally
deal with health problems which are of special interest to stu-
dents of college age. A two semester hour course in personal
health problems and a two semester hour course in community
health problems will be adequate only if the general training
provided by the high school program has been adequate. Many
colleges may wish to combine these two courses to make one
four semester hour course.
Teacher Education. In addition to the courses in personal
and community health which all college students should take,
those who are going into education work should have additional
preparation in the use of material adapted to the age level of
the group of students which they plan to teach. In the elemen-
tary school this may be a two semester hour course in health
education in the elementary school.
The health teaching in the secondary school should be done
by those who have had the preparation required for certification
in health education (12 semester hours). These hours could
well include the three courses described above and in addition a
course in health education in the secondary school, a course in
the administration of health education, and a course in physical
education. It should be understood that those devoting their
full time to this work should wish to secure far more training
than this minimum suggestion.
ALLOCATION OF RESPONSIBILITIES
(See Appendix pages 137-139, Sections 230.23 (10) ; 230.33 (8)
(15); 231.40; 232.03). The school administrator is responsible
for planning all phases of the school program so that the school
may make the greatest possible contribution to health. He is
also responsible for supervising to the end that all plans are
fully carried out. This responsibility includes the relationship
of the school to public health agencies, as well as all details of
the program within the school. The points which should receive
attention are clearly indicated in this bulletin. The administrator
should be thoroughly familiar with its contents. He will find it
helpful to utilize individuals and committees from his faculty
in meeting these responsibilities. The training of the adminis-
trator should be at least equivalent to that of the elementary
school teacher indicated in the preceding section of this chapter.
SPECIAL ADMINISTRATIVE CONSIDERATIONS 21
The Classroom Teacher: A general principle to be observed
by the classroom teacher is that he should assume his share of
the responsibility for all phases of the school health program
in addition; to health instruction. The training necessary for
this is indicated in the preceding section of this chapter.
The survey of the American Public Health Association states:
"The teacher should play a definite part in the school health
program and should be trained and encouraged to undertake
health services, such as rendering first aid, teaching first aid,
testing eyesight and hearing, and observing children for signs
of communicable disease and other conditions affecting health.
The teacher should also be sufficiently interested in the health
of the pupils to study their health records and to present to the
health authorities any problems which may be related to health".5
Health Teachers and Health Supervisors: In addition to the
health training which all teachers have, the health teacher and
health supervisor should have a college major in the field of
health education. The duties of this teacher and supervisor will
be to teach the special health subjects in the curriculum and to
assist the administrator in organizing and coordinating the total
school health program.
The Health Officer From the Local Health Unit: "A full-time,
thoroughly trained, and otherwise well-qualified health officer
can assist in organizing school health services and take an active
part in the health examination of children" . He together . .
"with his modern health organization. . the public health nurse
and sanitarians . can assist in communicable disease control,
environmental sanitation, and the supervision of the health of
the children".r
The Public Health Nurse from the Local Health Unit: "The
public health nurse is not a certified teacher and should not be
expected to teach in the schools, nor should she spend too much
of her time in the schools. She is the most important link be-
tween the school, the home, and the community. It is a waste
of taxpayers' money and an imposition on an already over-crowd-
ed health service to require public health nurses to remain in
the schools waiting to give first aid. It may be necessary for
public health nurses to instruct teachers in first aid who, in turn,
should teach this as a subject to the pupils, utilizing the oppor-
tunities of rendering first aid as a demonstration. To conduct
independent school health nursing service is not in conformity
with modern public health thought and principles".7
FLORIDA'S SCHOOL HEALTH PROGRAM
". . Health conditions of school children reflect the condi-
tions of the home and community as a whole. A school child
with bad teeth, with hookworm, who is malnourished, or who
shows other defects and health deficiencies, is merely a sample
from a home where those conditions are likely to exist in some
or all of the other children".8
It is the duty of the public health .nurse to act as health coun-
selor in all situations of this kind. In maintaining this relation-
ship and advising the parents regarding corrections of conditions
in the home and in giving professional guidance to teachers, she
will find her chief work.
The Sanitary Officer from the Local Health Unit: The sani-
tary officer provided in all local health units is trained in the
principles and practices of environmental sanitation. Like the
nurse, he is not a teacher and should not be expected to teach.
He should be used for advice and consultation with the principal
in regard to school sanitation and essential rules of conduct neces-
sary to be observed by pupils for proper use of sanitary facilities.
He should also act as consultant and advisor to janitors and
other school employees entrusted with the operation and main-
tenance of the school plant.
Other Personnel (see Appendix, page 141, Section 234.02):
Janitors, bus drivers, school secretaries, lunchroom directors,
and other school personnel occupy a most important place in the
complete health program. Special health training of the type
most essential for their respective work should be provided and
required. Since the employment of these individuals is almost
entirely subject to regulation of county boards of public instruc-
tion, these boards should assume the initiative in establishing
health training and other requirements for these personnel.
HOME, SCHOOL, AND COMMUNITY COOPERATION
(See Appendix pages 138, 140, Sections 230.33 (15) ; 232.31;
232.32): The planning and functioning of the school health
program depend upon the coordination of all health facilities in
home, school, and community and the cooperative efforts of all
available health personnel.
The classification of children as pre-natal, infant, pre-school,
or school children is merely convenient terminology. Obviously it
is the same child moving imperceptibly, to himself at least,
through those various stages. The child's life is a continuous
process and cannot be divided into isolated compartments. Like-
wise, the child is not divided into compartments to receive the
SPECIAL ADMINISTRATIVE CONSIDERATIONS 23
services which various organizations may give to him. The child
needs a coordinated health program, regardless of whether the
elements come from one or a dozen different sources. It is
essential, therefore, that all agencies and individuals function-
ing in the health program have the same concepts and under-
standings of that program.
Parents, of course, have the greatest interest in seeing their
children grow into strong men and women. They have first
responsibility in furnishing a home, food, clothing, medical care,
and for habit formation. They do not always know the health
needs of children, nor are they always financially able to provide
essential needs, but fundamentally they are interested, and
they need the help of professionally trained personnel such as
doctors and dentists who are interested in preventing disease
and correcting defects of children.
The State Board of Health and the local health units are in-
terested in providing for children communicable disease control
measures, pure food and water, sewage disposal and other en-
vironmental safeguards.
Voluntary health organizations, community welfare and other
social agencies are interested in child health activities because
they see the relationship between good health and one's ability
to live fully. They know that sickness and poverty go hand in
hand.
Teachers are interested in the well-being of their pupils be-
cause health contributes largely to learning. They accept the
responsibility for providing a healthful place to live in school,
for certain health services, and for developing habits, attitudes,
and knowledge which prepare children to assume responsibility
for their own health.
Civic clubs, women's clubs, and parent-teacher groups are
interested in and contribute definitely to programs for improv-
ing the health of children. Any services which they undertake
should be developed with the idea that they will become a part
of the work of official agencies as soon as the community realizes
the need. Special contributions which they make will result in
the most practical good if they are made directly to an official
agency or if the service rendered is under the guidance of the
official agency.
24 FLORIDA'S SCHOOL HEALTH PROGRAM
Progressive groups of this kind welcome opportunity to parti-
cipate in a program of improved community health and are anxi-
ous to be utilized in this endeavor. Those who are charged with
the responsibilities for the health program are remiss in their
duties if they fail to acquaint these organizations with the most
effective ways in which they can contribute to the program.
1When this pamphlet is reprinted it will be called "Florida's Health and Physical Fit-
ness Guide."
2"Joint Report on Suggested School Policies" by the American Medical Association and
National Education Association.
$"Physical Fitness Guide", State Department of Education and State Board of Health,
May, 1942. page 18.
41bid., page 19.
5"The Health Situation in Florida", Report of the American Public Health Association,
1939, page 53.
6lbid., pages 52-53.
7Ibid., page 53.
aIbid., page 52.
HEALTHFUL SCHOOL LIVING
CHAPTER THREE
HEALTHFUL SCHOOL LIVING
DEFINITION
Healthful School Living is a term that designates.the pro-
vision of a wholesome environment, the organization of a health-
ful school day, and the establishment of such teacher-pupil re-
lationships as give a safe and sanitary school favorable to the
best development and living of pupils and teachers.
PHYSICAL ENVIRONMENT
The ideals of every person are influenced by lawns, trees and
beautiful buildings. The public school plant is the people's in-
vestment for the future. It, therefore, should be made an example
for home improvement. It should be developed so that it will be
artistic and esthetic. School children represent a cross-section
of community home life and of the health problems existing in
the community. The construction of the school building, insofar
as environmental sanitation has to do with the transmission of
disease is, therefore, of utmost importance from the standpoint
of public health. The school administration is responsible for
providing a hygienic physical environment, while classroom
teachers are responsible for the best educational use of the
(environment.
SITE
(See Appendix pages 138, 141, 142, 143, Section 230.23
(11b) ; 232.36; 232.37; 235.20; 235.21; 235.22)
Before acquiring a school site, the county board should
determine the location of elementary, junior high, and
senior high schools for the county, as prescribed in Chap-
'ter IX, Article 2, Sections 916 and 917 of the Florida
School Code. Each school site should contain a minimum
,of two acres for a one-teacher school. At least one acre
,-should be added to this minimum size of the site for every
fifty pupils enrolled in the school after the first fifty
pupils, and until the enrollment reaches five hundred
,pMupils.
FLORIDA'S SCHOOL HEALTH PROGRAM
Each site should be well drained, reasonably free from
mud, and the soil adapted to landscaping as well as to
playground purposes. Insofar as practicable, the school
site should not adjoin the right of way of any railway, or
through highway, and should not be adjacent to any fac-
tory or other property from which noises, odors, or other
disturbances would be likely to interfere with the school
program.
The site should be accessible from every direction
and to all parts of the area to be served. Attention should
be given to any special services for which provision has
been made in the building, and which may be intended
for those living beyond the limits of the local attendance
area.
Sites should be located with due regard to traffic, the
the availability of bus lines, paved roads, as developed at
the time of the selection, as well as the possibility of
future traffic problems. It is important from a public
health standpoint in selecting a site that locations be
avoided where the drainage is such that disease carrying
mosquitoes would be a problem, or in the vicinity of slum
sections or where the surrounding sanitation is below the
best standards existing in the community. Where a public
sewerage system is .not available, the site should be select-
ed with a view to the proper disposal of waste materials.
BUILDING
(See Appendix pages 137, 141, 142, 143, Sections 230.23
(11) ; 232.36; 232.37; 235.13; 235.14; 235.24; 235.06(2) )
Insofar as possible in erecting one story schools, materials
should be used which are available and adaptable to that par-
ticular section. In the erection of school buildings of two stories,
fire resistive materials should be used in the construction of
stairways and halls. Due regard should be given to the size of
corridors, and stairways should be provided in conformity with
the recommendations of the National Board of Fire Under-
writers. Buildings of three or more stories should be entirely
fire proof in order to prevent the danger of panics. In buildings
already erected of two or more stories, well constructed fire
escapes should be provided where the number of stairways does
not meet the standards as prescribed by the National Board
of Fire Underwriters.
The principals, teachers, and janitors should, in conformance
with state laws and regulations, at the beginning of each school
year agree on rules which should govern the fire drills, and
HEALTHFUL SCHOOL LIVING 29
these drills should take place at least once a month at a different
period of the day in each case.
Fire extinguishers should be provided in schools according
to the provisions of the School Code, and the operation of an
extinguisher should be demonstrated at the beginning of school
terms as part of the fire drill instruction. All exit doors should
be hung so as to swing out and should be provided with hard-
ware which may be opened by pressure from the inside at all
times.
Heating and Ventilating: The condition of school room air, particularly
its temperature, has a direct bearing upon learning and upon the incidence
of certain diseases. There must be a circulation of air, and for the class-
room the temperature of this air should not be less than 68 degrees or
more than 72 degrees. The most suitable method of ventilation under
Florida conditions is the window inlet ceiling exhaust system. Windows
should be of such a type that at least 50% of their area may be opened
at one time. Standard classrooms should be provided with two window
deflectors to protect pupils from currents of cold air.
For small schools where central heating plants are not feasible, the
jacketed stove furnishes the best means of providing heat and ventilation.
This consists of a stove that is enclosed in a metal cylinder opened at the
top and bottom. A fresh air duct runs from the outside of the building
and is terminated beneath the jacket. Cold air is drawn up between the
jacket and the stove, is warmed, and is discharged above to go out into
the room. Some of the room air which has become cold and fallen to floor
level is also drawn into the jacket and rewarmed. Air change is insured
by means of an exhaust duct with an opening at floor level. The exhaust
duct connects with the chimney, or better still encloses the chimney. The
chimney keeps the temperature of the exhausted air sufficiently high so
that a good upward draft is insured. Dampers should be provided in both
the inlet and exhaust ducts so that the amount of air entering the school
can be regulated. For a schoolroom 22' x 30' with a ceiling of 12' the
jacketed stove used should have a fire pot diameter of at least 18" at the
low end of the stove door.
Water Supply: The drinking water used in schools is of the very
greatest importance from a health standpoint. Where a public water sup-
ply is available, schools must always connect with this. There should be
no other source of supply available to the children. The safety of public
water supply is insured by state and municipal regulations.
A most important problem is presented where no public water supply
is available. If it is necessary to develop a private water supply for the
school, it should be from a drilled well, sunk so that the water is derived
from deep seated sources and surface and ground water prevented from
entrance into the well. Such wells should be constructed in accordance
With the regulations of the State Board of Health. School water supplied
from private sources should have periodic bacteriological laboratory ex-
aminations. This examination may be made by application to the local
health officer, or if there is no local health officer, to the State Board
of Health. In connection with the distribution of water, the use of com-
mon drinking cups is unlawful and most dangerous as disease may be
spread in this way. Where running water is available in the school, sani-
tary drinking fountains should be installed in the ratio of one to every
100 pupils, but not less than two to each school.
Sewage Disposal: The most satisfactory method of disposing of school
30 FLORIDA'S SCHOOL HEALTH PROGRAM
sewage is by connection with a municipal sewerage system, and such con-
nection should always be made where possible.
Where there is no municipal system, special facilities must be ar-
ranged. A septic tank must be provided for water flush toilet systems.
Except in very large schools, the septic tank effluent can be disposed of
by a tile pipe drainage field laid in trenches of crushed stone or cinders.
The difficulty is in getting septic tanks properly designed and adequate in
capacity and in getting sufficient drain tile properly installed. For this
reason, such installations cease to function in a short time, and sewage
bubbles up from the ground and stands on the surface. This makes a very
dangerous condition. The specifications given in State Board of Health
Bulletin, "Sewage Disposal for the Home", may be used for the small
school, not exceeding 200 pupils. This bulletin also explains the funda-
mental principles involved. For larger schools the. State Board of Health
will send a representative for investigation and will furnish specific plans
for any school.
In very small rural schools where water under pressure is not avail-
able it will be necessary to construct sanitary privies. The State Board
of Health Bulletin, "The Sanitary Pit Privy", covers specifications for
privy sanitation very completely. Special designs for larger multiple priv-
ies to meet the need of schools can be furnished. Where a privy must be
used, it is most important that it be so constructed that excreta will not
contaminate the soil, will not be accessible to animals, that it will be abso-
lutely fly-tight, and that it be well vented so as not to produce odors.
Toilet Rooms: Wherever possible indoor flush toilets should be pro-
vided for public schools. At least one toilet room for each sex should be
required on each floor, and entrances to them should be well separated.
They should be easily accessible from playgrounds and classrooms. Wher-
ever possible, cross ventilation should be provided in these rooms, and as
many of them as possible located on sides which will receive direct sun-
light some time during the day. The floors of toilet rooms should be of
some non-absorbent material; tile should be used whenever possible. The
walls should be of a material which will enable the custodians to take
soap and water and wash them at least as high as six feet from the floor.
The toilet room should be provided with a drain, and the floor shaped so
that the custodian may take a hose and flush the toilet floor. Toilet rooms
should not be located in basements and should be provided with 20% win-
dow glazing as compared with the floor area. Toilets should be so located
and screened that the inside is not visible from a corridor when pupils are
passing in and out of the room. Doors should be provided for toilet stalls
which will stand open when not in use.
TOILET FIXTURES SHOULD BE PROVIDED AS FOLLOWS:
Elementary School
Boys' Toilet Seats........................................................ .....One for each 40 boys
Boys' U rinals ............................... ............. ........................ One for each 30 boys
Girls' Toilet Seats ................... ..............O............................ One for each 25 girls
High School
Boys' Toi'et Seats............. ................................On...... e for each 50 boys
Boys' U rinals .................................... ................................ One for each 40 boys
( irls' Toilet Seats .......................... ....................................One for each 30 girls
For primary children the height of the toilet seats should not be over
10"; for the elementary school children, the height should be 12"; and for
high school children, 14". Separate toilet rooms are desirable features for
the kindergarten and primary children. Pedestal type urinals are highly
satisfactory for use in the public schools and urinal troughs should not be
used.
HEALTHFUL SCHOOL LIVING 31
Handwashing facilities are very essential in any school. There should
be one lavatory for every eighty pupils and at least two for each school.
Ample soap and paper towel facilities and mirrors are also essential. Lava-
tories for elementary grades should not be over 25" in height and not over
30" for high school children.
Lighting: The natural and artificial lighting of classrooms plays an
important part in the health of school children. The intense use of the
eyes in school work demands that illumination be adequate at all times.
Most school authorities, doctors, and illumination engineers have agreed
that about ten-foot candles of illumination are adequate for most school
purposes. A classroom of approximately 20'x30'x12' can be naturally
lighted if the glazing in the room amounts to 20 per cent of the floor
area and the glazing is properly placed. The windows should be within
six inches of the ceiling, placed on one side of the room so that light is
received over the pupil's left shoulder, and should be approximately 42"
above the floor. The preferred fenestration is east and west. Such a facing
enables a classroom to receive the benefit of the sun's rays during a part
of the day, and from experiments it has been proved that such facing
of the windows has the least amount of desk interference from the sun
during the course of the school day. If movable seats are used, care should
be exercised to see that no pupil faces the light for an extended period.
Shades are necessary to control the light which varies during the day.
The double-hung shade hung in the middle of the window enables the
teacher to lower or raise shades readily, and in this manner she can ef-
fectively control desk interference from the sunshine. They should be of
enough density to avoid glare on working surfaces. Care should be taken
to see that objects outside of the school, such as trees and tall buildings,
do not affect the amount of light in the building. The interior finish of
the classroom materially affects the illumination. It is necessary that
a paint schedule be worked out carefully. As a usual thing, walls of buff,
or light green with the ceiling white, or very light cream and dadoes of
darker color, as a dark tan, have coefficients of reflection which will help
to control the light so that there will be no glare. Ceilings should be
painted with a material which gives 75 to 80 per cent reflection, upper
walls about 50 to 60 per cent, and dadoes not more than 30 per cent.
Artificial lighting is essential not only for night work, but to insure
sufficient illumination during winter months. Lighting units should be
placed to eliminate shadows. As a rule, six outlets about 18" from the
ceiling with semi-indirect equipment will light a classroom satisfactorily.
It is necessary to keep in mind that fixtures should be cleaned at regular
intervals, and the classroom painted at regular intervals or the number
of foot candles of light furnished will vary considerably. Foot candle
meters can be secured through the Florida Power and Light Company to
be used in measuring the intensity and distribution of light.
Seating: From a health standpoint, one of the most important single
pieces of school furniture is the school seat. Seats may be classified in
three general classes. The fixed seat and desk is most commonly used,
but it is probably the least desirable. Movable seats are excellent for
modern teaching techniques, but may be as injurious to the children's
posture as the fixed type. The table and chair arrangement for primary
grades offers a very nice working situation and is being used more ex-
tensively in the higher grades.
In general movable furnishings are more desirable than fixed ones
in the school room, because with such furniture the room may be used
as a play room, or the chairs may readily be removed and made accessible
inl other areas. Some of the common faults of school seating are: seats
are too high and deep for the pupils; desks are too close or too far away
from the pupils; desks and seats, though adjustable, are not often adjusted
to pupils' needs. Some standards for seating are: the seat is too high if
32 FLORIDA'S SCHOOL HEALTH PROGRAM
there is pressure on the thighs and the feet are not resting on the floor,
and too deep if it does not permit the pupil to sit back in the seat.
Practically all standards can be met by use of the adjustable seat.
Interest and skill, however, are necessary to secure the proper adjustments.
The following sizes of desks are recommended by Dr. H. E. Bennett in his
book, "School Posture and Seating."*
1 I _I SEAT NUMBER
GRADE 6 5 4 3 2 1
I 90% 10%
II 50 j 50______________________________
IV__ 35 40 10%__________
VII 25 50 25%
VIII __10 40 50
High
School 25 40 35%
Lunchrooms: A lunchroom is essential to every public school. It should
be located where it can receive a maximum of sunlight and air and at
the same time must be easily accessible to all. It should be so located as
to eliminate the spread of cooking odors. About ten square feet should
be provided per pupil exclusive of service space. A homelike appearance
should be sought and every effort should be utilized in securing a minimum
amount of noise. The lunch counter should be of sufficient length to enable
rapid service. The facilities provided will depend on the financial ability
of the community and on the size of the school. For large schools, the
following items should be provided: counter, steam table, ice cream packer,
bread and sandwich table, tray and silver rack, cashier stand, cocoa urn,
milk and cream cooler, water cooler, guide rail or partitions, dish trucks,
soiled dish trays, kitchen, storage space and main dining room. Battleship
linoleum affords an excellent floor surface. Tables should be provided that
can be washed and should be about 74" long and 30" wide.
Teachers' Rest Rooms: In the larger schools, comfortable rest rooms
should be provided for the teaching staff. Teachers' rest rooms should be
as attractively furnished as possible and should be well lighted, heated, and
ventilated. Handwashing and toilet facilities and supplies should be pro-
vided and maintained. A mirror, comfortable chairs, a bed or cot with a
pillow and blanket, several small desks or tables, lamps and other needed
furnishings should insure comfort and restfulness of the rooms.
Special Health Rooms: Every school should be interested in good
health standards and, in order to make the highest accomplishments pos-
sible, it should provide every available health facility. The health room
should be located adjacent to the administration unit and should be pro-
vided with artificial and natural lighting, nurses' room, medical clinic,
waiting room, first aid equipment, and an isolation room for ill pupils
waiting transportation home. Fresh linens should be supplied for each
occupant of the beds in these rooms.
* Bennett, H. E., School Posture and Seating, Ginn and Company, Atlanta, 1928.
HEALTHFUL SCHOOL LIVING 33
MAINTENANCE OF A SANITARY ENVIRONMENT
(See Appendix page 138, Section 230.23(11) (c))
The duties of the custodian should be to keep the building clean and
sanitary. He should do all sweeping, washing, dusting, cleaning rooms,
and watering grass. When necessary he should keep the grounds in good
condition and do other custodial work as specified from time to time.
Administrators should set up work schedules to be performed by the cus-
todian, determine standards of service, and the volume of work which a
custodian should be given. A complete list of the duties and activities of
the custodial staff should be outlined and the teachers and custodians should
have copies of these duties, so that they may effectively co-operate with
one another in the discharge of their duties.
If a person has an appreciation of cleanliness, and has also the ability
to impart this to others, it will manifest itself in clean, well kept, com-
fortable, sanitary school buildings. Well kept, sanitary buildings require
more manpower than those in which little work is done and which are
allowed to remain dirty and insanitary. The time has come when the re-
sponsibility for a sanitary school building cannot be entrusted to ignorant,
untrained personnel. Housekeeping no longer means the wielding of a
corn broom and a feather duster and slopping soap suds on dirty floors.
Intelligence in the proper direction is necessary if the building is to be
sanitary. A custodian needs to possess traits which would tend to classify
him as a paragon. He should be economical with supplies and utilities and
should be a good sanitarian. He must keep the school building, fixtures,
furniture and equipment in such a state of cleanliness as to avoid the
possibility of illness among the children housed in the building.
Administrators must not expect custodians to do the impossible. They
must see that they are properly provided with good equipment, and must
furnish proper directions for maintenance of the school plant. The follow-
ing is a suggested list of the frequency of the cleaning operations that
should be performed by the custodian in a school building.
OPERATION IDEAL
Sweeping:
Classrooms and other rooms ............................ .................. Dally
Corridors and stairs................. ............................. ...... ... ............ Twice daily
Under radiators ......................................................................... ......................... W weekly
Dusting:
F furniture .................................................................................................... ......................... D aily
W oodw ork .............. ................................ ........... .................................................W weekly
W alls and Ceiling......................... ....... .......... .....................3 times per year
W all pictures and window shades..........................................................3 times per year
R adiator tops ................................................................................ ............... ........... W weekly
Between radiator sections ............................................................................................ Yearly
Scrubbing and Mopping:
Classrooms ............... ... ............... .....3 times per year
Rest room s ..... ......... ......................................................... 3 tim es per year
Corridors ............................................................................................. ....3 tim es per year
Stairs ......................... ............ ....... ............. .............................. .. ........... W weekly
Domestic Science Room s........................................................................................ W weekly
E entrances ............................................... ............... ................................................ W weekly
Offices and kindergartens................-.................-...................................................W weekly
Cleaning:
Furniture and woodwork. ......... .............................. times per year
Windows (outside).............................-. ...... 3 times per year
Windows (inside)............... .............................................. .. tim Weekly
Inside door lasside) ........................................... ........ ....................... .........Tw ice w weekly
cupboard glass ......................................... ............... .. ...... Twice weekly
Tolet room floors .........................................T twice daily
Toilet bowlsom floors ............................................................................................... Twice Daily
U rinals ................................................. ............ ............................ D aily
Blackboards ............... ......... ................ ............... .............................Daily
E raisers ..............................................................................................................................W weekly
Rem oval of sawdust and shavings .......................................... .................................. Daily
Rem oval of garbage..................................................... ..... ................ ........... Daily
Hand rails and door knobs....................................................... .............................................. Daily
34 FLORIDA'S SCHOOL HEALTH PROGRAM
ORGANIZATION OF A HEALTHFUL SCHOOL DAY
(See Appendix pages 137, 141, Sections 227.121 (18) ;230.23 (10);
234.02)
The responsibility of the school for the health of the child
begins when the school bus picks him up in the morning. This
hour of leaving for school should not be early enough to inter-
fere with a wholesome, warm breakfast. The bus should not
be overcrowded, and pupils with communicable diseases should
not be allowed to enter the bus. The bus driver should be selected
on the basis of good moral character, good vision, and hearing;
he should be able-bodied, free from communicable disease, men-
tally alert, and not a user of alcoholic beverages or narcotics.
The condition of the bus should insure a safe and comfortable
ride to school.
Pupils who arrive at school early or are obliged to wait for
a late bus should be comfortably sheltered and supervised by
members of the teaching staff.
The length of the school day is definitely specified in the
Florida School Code, Section 227.12(18), page 137. As is shown
there, the length of the school day varies to meet the needs of
children at different stages of physiological and psychological
development and should be organized to prevent undue fatigue.
A balance between work and play and rest should be maintained.
The daily schedule should allow time for recess, relaxation and
play, and lunch periods. Care should be taken that curricular
or extra-curricular activities be assigned according to the
strength and energy of pupils. Regular physical education periods
should be observed in accordance with plans indicated in the
State Department of Education bulletin on physical education.
The activities at this time should be so planned and organized
that every child has a desire and an opportunity for safe, vigor-
ous and educational play suited to his age and physical status.
Definite and adequate time should be allotted to the lunch
period. This plan will vary according to the situation. A longer
period will be required when pupils go home to lunch. A school
lunchroom where hot, nutritious food is prepared and served
under the supervision of the school authorities is essential for
the health of the pupils. Special provision should be made for
those children who bring their lunches to eat healthfully at
school. The school lunchroom is a laboratory where children
learn what to eat and how to eat. No carbonated drinks, tea, or
coffe should be served in the school lunchroom. Pasteurized milk
should be served when at all possible. No candy should be served
or sold in the school or on the school premises. The school has
the same responsibility to educate appetites as minds.
HEALTHFUL SCHOOL LIVING 35
Rest and relaxation periods should be interspersed in the
daily schedule when the pupils need relief from sustained effort.
Windows should be opened and pupils allowed to participate in
relaxation activities chosen according to their immediate needs.
Change of work results in relaxation and avoidance of strain.
Social activities which serve to amuse and relieve the monotony
are desirable.
In order that a maximum amount of work may be done with
the accumulation of a minimum amount of fatigue, it is recom-
mended that school subjects requiring close mental work should
alternate, when possible, with subjects requiring motor activity.
There is a definite trend today to spend more time on assign-
ment and preparation of lessons and less time on formal recita-
tions. Guidance of children in establishing effective study tech-
niques requires supervised study periods.
No home work should be assigned in the elementary grades.
A limited amount, and such work as can be accomplished with
satisfaction at home, may be assigned in the secondary grades.
The danger of cumulative fatigue, interference with sleep and
play, eye strain, and posture has been recognized as a menace to
health. Suggestions regarding budgeting time and effective home
study may encourage high school students to improve or make
the best possible use of study conditions in the home.
A minimum amount of after-school activities should be plan-
ned by the school. Evening school activities should be rare and
so planned that there will be no interference with sleep. It is
recognized today that parents and children need more family
association. Home duties and responsibilities are desirable and
educationally worthwhile for children.
PUPIL-TEACHER RELATIONSHIPS
If the school accepts the responsibility for the development
of the whole child, the classroom environment in which he lives
must be conducive to his physical, mental, social, and emotional
growth. Wrong habits and improper emotional reactions formed
early in school life condition present and future achievement.
Environment includes more than the physical plant and sanitary
features of the school building. It goes further than arranging
a daily schedule. The social and emotional tone of the classroom
provide atmosphere for mental, social and emotional, as well as
physical well-being. The classroom experience should be so guid-
ed as to eliminate fears in children and to develop in them self
confidence, self respect, and self direction. Fear is frequently
responsible for numerous types of abnormal behavior, such as
jealousy, types of delinquency, lying and cheating.
36 FLORIDA'S SCHOOL HEALTH PROGRAM
Success and failure establish certain attitudes in children that
largely determine future success. Continual failure leads to des-
pair, continual success without effort to over-confidence. The
teacher should plan for experiences which give opportunities in
which every child may experience genuine success reasonably
often. Likewise he should plan work which will challenge the
ability of brighter students to the level of their capacity. Knowl-
edge of success favors learning. The mental effect of failure
tends to destroy self confidence. The well-informed teacher will
be able to plan for the personality development of all his pupils.
Classroom discipline promotes or retards personality develop-
ment. It should be remembered that faulty vision, defective
hearing, imperfect elimination, lack of nourishing food, illness,
insanitary surroundings and unfavorable conditions at home
affect the behavior of children. Punishment that fails to recog-
nize all such factors violates all principles of child development.
Corporal punishment, depriving the child of necessary recreation,
standing him in the corner, using fear or sarcasm as a motive
for actions, are methods of discipline which often result in per-
sonality problems of a very serious and long standing nature.
Harsh disciplinary measures undoubtedly produce a non-cooper-
ative attitude in children. On the other hand, indulgence and a
lack of control often develop an anti-social outlook. Between these
extremes, an understanding teacher working with his class may
set up standards of behavior which lead to self direction and
control in maintaining acceptable
The rush and tensions of modern life are being felt even in
the classroom. Overcrowded programs and faulty work habits
lead to unplanned and purposeless living. Fatigue and strain may
be observed i.n the average group of pupils. Restlessness is often
mistaken for surplus energy and children are permitted, if not
forced, to extend themselves beyond their ability. The under-
standing teacher plans for democratic experiences based on the
interests and abilities of his group. Working together on mutu-
ally interesting problems often takes care of unruly behavior
and makes possible wholesome, stimulating effort of the entire
group. Even the non-cooperative child is susceptible to group
approval.
Children are no more alike in mental ability than in physical
appearance. They vary in strength, endurance, resistance to dis-
ease, likes and dislikes, visual and auditory acuity, intelligence,
memory power, educability. The well-trained teacher will under-
stand this and plan his classroom experiences according to the
principles of individual differences. Only through such a proced-
ure can the health of children be adequately protected.
HEALTHFUL SCHOOL LIVING
Informal instruction adjusts itself well to the principle of
individual differences. One child excels in one line of work; an-
other can make an equally satisfying contribution in another
activity. A low I.Q. does not always indicate failure, nor does
a high I.Q. insure success. When tasks are assigned on the basis
of interest and ability, rather than the next chapter, children will
begin to live and learn functionally at school.
Parents often hold pupils to a standard of high grades above
their ability. The teacher grades rigidly and children frequently
cheat or become emotionally upset in facing such situations. Re-
wards, honor rolls, and prizes for achievement and attendance
may give satisfaction to a few outstanding children, but many
more suffer as a result of such faulty educational procedures.
The teacher is the key person in the health program in the
classroom. He should personify health in personal appearance
and daily living. Children are his imitators. They reflect his
enthusiasm, his health practices, his voice, his philosophy of
living, as well as his neatness of appearance. The teacher's re-
sponsibility is great. He largely molds the lives of his pupils.
HEALTH SERVICE
CHAPTER FOUR
HEALTH SERVICE
DEFINITION
Health Service comprises all those procedures designed to
determine the health status of the child, to enlist his coopera-
tion in health protections and maintenance, to inform parents
of defects that may be present, to prevent disease, and to correct
remediable defects. All school health services are included in
the program primarily because of their educational value. Every
service should be rendered in a way that parents and children
become self-directing in accepting the responsibility for main-
taining their own health.
INTRODUCTORY STATEMENT
Children should be as fit physically, mentally, and emotion-
ally as possible if they are to profit by their school experiences.
We no longer think of the child as being sent to school for the
purpose of merely learning subject matter. He is sent to school
to learn how to live, and school experiences today are designed
to teach or demonstrate the best standards of everyday living.
In the life struggle for self betterment it is the expressed or
unexpressed desire of any parent that his children learn to live
fuller, richer, healthier, and happier lives than he was able to
live. With this inherent desire our forebears established the
institutions of learning, hoping that their children, their chil-
dren's children, and the children of the less informed and eco-
nomically handicapped might learn better how to live.
It is as true today as then that ignorance or economic insuf-
ficiency results in a lack of interest in the early training and
care of the infant and pre-school child, so that children enter
school unable to adjust themselves to the ever increasing phys-
ical, social and economic demands set up by our modern school
standards. Because of this, many children enter school with
definite problems, many of which continue throughout their
school life, and many of which need more attention than is given
them in the home.
Today the school health service, set up as a part of the gen-
eral community health service, is initiated and provided as part
FLORIDA'S SCHOOL HEALTH PROGRAM
of an educational demonstration in healthful living. It is closely
related to the program of health instruction and to the main-
tenance of healthful school environment. It should be so related
to the school curriculum that health is practiced in the everyday
living of boys and girls both at home and at school.
The object of health service is not only to perform a needed
service but to impress on the child the necessity of forming cer-
tain practices and attitudes that he can retain throughout life
to protect health. There must be real understanding and sincere
cooperation between the personnel of both school and health de-
partment services. The health department should not be asked
to perform services in the schools that should be undertaken by
the educational personnel. The weighing and measuring of chil-
dren, the testing of hearing and sight, the rendering of first aid,
morning observations and any other routine needs are within
the capabilities of a teacher. These activities should be used as
demonstrations to supplement the teaching of health in the
schools.
The school health service is the combined responsibility of
the school authorities, the family physician, the parent-teacher
association, and the health authorities. This responsibility in-
cludes not only the school child, but progressively the pre-natal,
natal, post-natal, infant and pre-school care of the child.
PREVENTION AND CONTROL OF COMMUNICABLE DISEASES
(See Appendix pages 140, 141, Sections 232.33-.34-.35)
Children are compelled by law to attend school; therefore it
is imperative that the school and health authorities insure a
healthful school environment. Communicable diseases, i.e., dis-
eases which can be spread from one person to another, are fre-
quently brought into the schools and transmitted to other school
children. Therefore, measures which prevent children in the
early stages of communicable diseases from entering school are
an important part of communicable disease control. School pre-
ventive measures include:
1. Daily observation of the child by the parents before he leaves
for school in the morning. Any child showing symptoms of
the common cold, such as sneezing, coughing, running nose,
flushed face, and headache, should be kept at home. A child
who suddenly develops a headache, chill, a vomiting spell, or
any other signs of illness should be kept at home. Average
daily attendance should not be stressed to the extent that
the health of children is endangered.
HEALTH SERVICE 43
2. Observation of children by the bus driver as they enter the
bus each morning. Bus drivers should know the early, ob-
vious signs of communicable diseases and should observe the
children carefully as they board the bus in the morning. Any
child exhibiting such symptoms should be encouraged to re-
turn home immediately.
3. Observation of the children by the teacher on arrival at
school. The teacher should observe every child carefully for
signs of communicable disease on arrival at school. Play-
ground supervisors who conduct before-school programs can
by similar observations frequently prevent ill children from
entering the classroom in the morning.
4. Teacher services in:
a. ISOLATION OF SICK PUPILS: Any child thought by the teacher
to be ill should be isolated-placed apart from all other children-
until arrangements can be made to send him home. The sick child's
parents, who are responsible for taking care of him, should be noti-
fied immediately. The teacher should not take the responsibility of
calling the family physician unless he has definite authority from
the parents. The teacher should make the child comfortable and
report to his principal for instructions concerning the removal of
the sick child from school.
b.. TRANSPORTATION OF SICK CHILDREN: Provisions should be
made in every school for the transportation of sick children to their
homes. Parents should take this responsibility, but if they cannot
be reached or have no means of transportation, some other arrange-
ment must be made. A transportation committee of the parent-
teacher association or other interested local organizations can be
utilized. The person who transports an ill child should not be one
who has small children at home to whom the disease might be
transmitted. Health unit personnel should not be expected to take
children home, nor to a physician, unless all other means have
been exhausted.
c. KNOWLEDGE OF COMMUNICABLE DISEASE IN THE AREA:
Every teacher should know, and be informed by health unit person-
nel, of the presence of communicable diseases in the area. He should
familiarize himself with the signs and symptoms of these diseases
so that he can make skillful morning observations of the children.
Current information relative to communicable diseases should be
furnished the teacher by the local health unit.
d. AVOIDANCE OF INFECTION: There are many opportunities in
the school for preventing the spread of infections from undetected
early cases or carriers of communicable disease. The teacher
should study the health practices in the school as they relate to
the spread of communicable disease. He should establish preventive
practices in the school and should incorporate them into his teach-
ing. The following points will aid in preventing the spread of
infection:
Frequent hand-washing, particularly before eating and after
using the toilet. A child should be taught to keep his finger-
44 FLORIDA'S SCHOOL HEALTH PROGRAM
nails trimmed and his fingers clean, and to keep his fingers
and other objects out of his mouth and nose. The school should
provide water, soap, and individual paper towels. In small
schools these facilities can be provided if the ingenuity of both
teacher and pupils is used. Time should be allotted and definite
plans made for handwashing before lunch.
Proper use of clean handkerchiefs. Every child should carry a
clean handkerchief, or tissue, and should be taught to cover his
mouth and nose when he coughs or sneezes in order to protect
other children.
Sanitary drinking fountains or individual cups. The common cup
should not be used under any circumstances. Where sanitary
drinking fountains are not available, individual paper drinking
cups should be used. Specifications for the approved sanitary
drinking fountain can be obtained from the local health unit or
from the State Board of Health. Children should be carefully
guided in the proper use of drinking facilities.
Communicable disease chart. A communicable disease chart,
containing a list and description of signs and symptoms of
communicable diseases is published by the State Board of Health
and can be obtained in any quantities from the local health unit
or the State Board of Health. The chart should be placed on
the wall of every classroom at a height convenient for both
teacher and pupils. It should be studied frequently and referred
to whenever a communicable disease is prevalent in the com-
munity.
Readmission after illness from communicable disease. A child
who has been absent from school because of a communicable
disease should be readmitted only after obtaining a certificate
from the health unit or family physician recommending that the
child be readmitted.
Cleanliness of the school. The school should be clean at all times,
but especially when a communicable disease is prevalent in the
community. Soap and water, properly used, are the generally
recognized means of removing micro-organisms which may have
been deposited by carriers of communicable disease on desks and
other school equipment.
5. Immunizations: All children, before they reach the age of
one year, should be immunized against certain communicable
diseases by the family physician. Immunizations should be
those of vaccination against smallpox, injections of diphtheria
toxoid against diphtheria, and-if and where necessary-
immunization against typhoid fever. Where these immuniza-
tions have not been done, for economic or other reasons, public
health authorities and the local medical society should be
consulted concerning an immunization program for all school
children. Even when definite immunization programs are not
in progress, teachers and county nurses should be active in
conducting conferences with parents concerning the immun-
ization of individual children. The following are the recom-
mended immunization policies:
HEALTH SERVICE 45
a. Vaccination against small pox: Should be obtained normally at any
time between 3 to 12 months of age, and at any age during an
epidemic. It should be repeated before entrance into school and
repeated thereafter every five to seven years.
b. Immunization against diphtheria: Should occur first at 9 months
of age, again from 4 to 6 weeks later, and again before entering
school. If the family wishes, a Schick test may be requested before
the toxoid is administered.
c. Immunization against typhoid fever: Should be obtained at any age
during an epidemic or catastrophe, or when the individual has con-
tact with a known carrier. It should be obtained routinely after
two years of age in areas in which typhoid is prevalent, or sanita-
tion facilities are so poor as to be conducive to typhoid. The State
Board of Health recommends that 3 initial injections be given,
to be followed annually by 1 injection of the vaccine.
HEALTH EXAMINATIONS
(See Appendix pages 137, 140, 141, 142, Sections 230.23(8)
(f) ; 232.29; 232.30; 232.31; 232.32; 234.05; 234.02)
1. Health examinations for teachers and all school employees.
Teachers and all school personnel, including clerks, janitors,
bus drivers, cafeteria workers and others who are in any
way in contact with the school children should be thoroughly
examined at least annually. Every member who is now in
the school system who has not had a chest X-ray within the
last year, and all newly entering personnel, should be X-
rayed before entering a new term of service. All school per-
sonnel should then have periodic chest X-rays as deemed feas-
ible by the local School Board. A special record form (see
page 46) should be kept for each member of the personnel.
The examination may be performed by private physicians,
provided the official record form is used. Records of personnel
examinations should be confidential, filed in the health de-
partme.nt, and available only to the school authorities when
teachers or others have failed or refused to comply with in-
structions and are endangering the health of the pupils. On
the completion of the examination the teacher should be given
a certificate by the health unit showing the completion of
the examination and the filing of the form with the full-time
health unit. This certificate should be tendered to the school
authorities by the teacher. In counties without "full-time
health service, personnel examination records should be sent
to the State Board of Health which will issue certificates.
46 FLORIDA'S SCHOOL HEALTH PROGRAM
FLORIDA STATE BOARD OF HEALTH
FLORIDA STATE DEPARTMENT OF EDUCATION
RECOMMENDED
SCHOOL EMPLOYEES' PHYSICAL EXAMINATION FORM
This record is to be, completed and sent with X-ray and all laboratory
reports to
(county health department) (address)
PART I
N am e...................................... ..................... .... Sex................... R ace ... ............
Place of birth................ ...... .................. Age......
Permanent address .. .. ...........-- -- -............. ...............................
County in which examinee will be employed...................................................
HISTORY
Contagious diseases:
Scarlet fever.................Diphtheria.............Pertussis ...........
Measles ........-- ...............Smallpox .............Poliomyelitis ... .....
Typhoid Fever................. Venereal disease...... ................
Other serious illness......
Immunization history: Smallpox: Date...... Result......Typhoid: Date .
Diphtheria: Date...... Schick test: Date .... Result....
PHYSICAL EXAMINATION
General appearance ................................................ ......................--
Head: Ears: Hearing Rt............/20 L............/20
Eyes: Vision Rt 20/............ L 20/......With glasses Rt 20/.... L20/....
N ose:...................................................
M outh: Teeth..................... ............. Gum s............... ...- ...--
Tonsils ..................-- ............. ... Pharynx................................
Neck: Thyroid ........................................ Lymph nodes.... -----...........
Chest: Heart location..................... Rhythm.................. Sounds...............
Blood pressure Systolic ......................... Diastolic-..........--
Abdomen: Herniae................... Tumors................ Appendix...........
Extrem ities .......................... ............................................... .................. ...
Nervous system: Reflexes-Superficial .......................... Deep...............
Cranial nerves.........-.. ...... ---- -
Remarks on defects not sufficiently described above: Mental aberrations,
etc. ........ .. ................. ...................................... .... ....... .......
LABORATORY*
K ah n ..... ..................... ....... ..............................................................
Other: Stool, urinalysis, hbg., etc. (if indicated) ................. ................
*Laboratory report including Kahn MUST be attached and forwarded with
this record.
HEALTH SERVICE 47
PART 1 (Continued)
CHEST
History of chest diseases (Asthma, Bronchitis, Emphysema, etc.)..............
Tuberculosis
F am ily history....... ........................... ....... ....................... ... .... .........
P personal history............................................. ...............................................
Physical examination
Physical signs .................... ........ ...... ... ... ........ .............
Clinical m anifestations......... .................................................... .............
Do you recommend acceptance with minor physical defects ?.........------
Are defects being treated ?...................... If rejection is recommended specify
cause ................................................................................................. ...... -..........--- ...
....cause.. .. ........... ......................... .................................M D .
.................................. ...M.D.
(date) (examining physician)
(address)
PART 2
X-RAY*
Film : D ate taken...................... ...................Place .................................... ....
Interpretation........... ............................ ........
(date) (roengenologist)
I certify that the X-ray film submitted herewith is the X-ray of the
chest of the examinee named on this physical examination form and was
taken on........ ..........................................
(date)
............ ............................ .................... ........ M D .
(date) (examining physician)
.............................. .... M D .
(health officer)
(county health dept.)
*X-ray film MUST have been taken within three months of date of
contract. X-ray film with all laboratory reports must be sent to the
county health department for approval and record. X-ray films will
be filed for future reference. All information will be treated con-
fidentially.
FLORIDA'S SCHOOL HEALTH PROGRAM
(See Appendix page 140, Sections 232.29; 232.30-.31-.32)
2. Health examinations for school children. The local full time
health unit is the agency which should organize and be re-
sponsible for the health examination of school children. In
counties without full time health services the school authori-
ties are responsible for securing the advice and assistance of
the local medical and dental societies, the State Board of
Health, and the State Department of Education for planning
and conducting the examinations.
In all health examinations the attitude of the examining phys-
ician is of utmost importance in gaining the confidence of the
child and in making the examination worthwhile. The teach-
er's thorough understanding of the purposes, procedures, and
findings of the health examinations of his pupils is necessary
to insure that educational outcomes result. Children should
be taught and urged to have annual health examinations by
private physicians in addition to the school health exam-
inations.
The availability of examining personnel as related to the total
number of children needing examinations in a given school
or locality will help determine which children should be ex-
examined and at what intervals these examinations should
be conducted. Three general types of programs are in prac-
tice today:
(a) the annual examination of all pupils
(b) the routine examination of children in certain grades at
intervals of two or three years
(c) the examination of groups of children selected by a
screening process from each or any grade level
The third method named, which provides for the examina-
tion of selected groups, is recommended as the most practical
because it enables a greater percentage of professional time
and services to be devoted to the most needy children. When
mass examinations are attempted the limitations on the num-
ber and time of medical personnel too often necessitate mere-
ly a rapid cursory inspection of children rather than an ade-
quate health examination. Such inspections are of very lim-
ited value to either the children, the parents, or the teachers.
A program which provides for the adequate examination of
carefully selected groups will also serve better to balance the
total community health program. The amount of time spent
on school health examinations should not be out of proportion
to the time spent on other community health programs in the
light of results possible of achievement.
HEALTH SERVICE 49
Today it is recommended that the classroom teacher make a
preliminary or "screening" survey, as well as systematic con-
tinuous observations of the pupils to be sure that no signifi-
cant symptoms go unnoticed. The value of the teacher's
participation in the selection of children needing a physician's
examination should not be underestimated. In addition to
alleviating conditions where the examination of all children
is either impossible or not advisable, this plan presents ex-
cellent opportunities for sound health instruction concerning
the importance of building and maintaining favorable health
status.
The exact procedure to be followed by the teacher in conduct-
ing a preliminary survey should be carefully explained and
demonstrated by the public health nurse or the examining
physician. The survey should be conducted as a demonstration
to the children of some of the procedures used in a properly
conducted health examination. The teacher's screening pro-
cess is not medical. It should never be accompanied by diag-
nosis, advice, or treatment. But through the demonstration
of certain phases of a health examination the teacher cannot
only select the children most in need of medical examination
but can guide all of the children to become more self-directing
in their observations of their own deviations from normal.
Generally the teacher will conduct the survey to include the
"Preliminary Procedures" described on page 54 (weighing,
measuring, testing vision and hearing as well as to observe
for general cleanliness, posture, skin eruptions, marked over
or under weight, or other deviations from normal indicated
by the nurse or physician for teacher observation). The con-
tinuous daily observations, unobtrusively yet systematically
and thoroughly done, should be recorded on the child's health
record form as should the results of the demonstration sur-
vey. Health and behavior symptoms indicated by the teacher
help to furnish information valuable to the examining physi-
cian and also help the teacher in selecting children most
needy of further examination. All of these observations as
well as survey findings may form a nucleus for class discus-
sions in the evaluation of related everyday health practices.
A nurse-teacher conference should follow the completion
of the observations so that the nurse may aid and check
the teacher in her selection of children to be examined fur-
ther. The number of children to be examined from each
grade on each examination day will depend upon the schedule
for examinations as planned by the examining physician and
FLORIDA'S SCHOOL HEALTH PROGRAM
the school administrator. Priority in the matter of receiving
attention should be given to the children with the greatest
immediate needs. The selection should be based on evaluations
which take into account the physical, mental, emotional, and
social problems of each child.
The persistence, if not the presence, of most physical defects
is largely the result of lack of knowledge on the part of the
family concerning either the needs for medical care or the
methods for securing such care for the child. Such lack of
knowledge can be corrected only through the direct teaching
of the future parents who are our present school children.
This can best be done by adequately trained teachers in the
public schools. Care should be exercised in following the
recommendation that all children secure a periodic health
examination from their family physicians in addition to
school health examinations. Unless sound health instruction
accompanies school health examinations children and parents
may come to rely upon the school and the medical examining
personnel for all of their medical advice. Directing persons
solely to school or health department medical staffs can pre-
vent children from gaining the experience and knowledge of
how best to use the existing medical facilities of the com-
munity. This is essential to the future assumption of indi-
vidual and family responsibility for medical care. Children
should be taught to be self-directing in securing health serv-
ices rather than to rely upon sources which are withdrawn
from them when they leave school. Health instruction which
is properly coordinated with school health service should
result in an understanding of the values of personal and
family physicians and of all available health services in the
community as well as a.n understanding of how to obtain the
proper health services under various conditions.
PRELIMINARY PROCEDURES
(a) ARRANGING FOR EXAMINATIONS. The county nurse
or a member of the health unit personnel should consult
with the school administrator to plan details of the
health examinations such as the time, the number and
groups of children to be examined, invitations to parents,
the preparation of the examining room, the distribution
to teachers of the record forms and instructions for the
preliminary testing and recording. When this has not
HEALTH SERVICE 51
been done, or in counties where there is no full-time
health unit, the school authorities should be responsible
for initiating arrangements with the agencies which will
be cooperating with the school health examination pro-
gram. These arrangements should be made sufficiently
in advance of the examinations to enable teachers and
school administrators to perform the important prelim-
inary procedures as completely and effectively as pos-
sible.
(b) PREPARING THE CHILD. The school child should be
prepared psychologically by the teacher to desire the
health examination and to realize its importance. This
can be accomplished through class discussion concerning
the examination and its relationship to everyday health-
ful living and the prevention of disease. To develop
favorable pupil interests, attitudes, and understandings
concerning health examinations the teacher should be
familiar with the procedures to be used in examining
and should be prepared to use this knowledge in effective
teaching. Teachers can prepare themselves in securing
essential background understandings through studying
the health examination record forms (page 59), review-
ing and adapting the suggestions for using health ex-
amination records in health instruction as described on
pages 78, 79, 80, 93, and through studying the general ex-
amination procedures described in this chapter on pages
61-67. Conferences with previous teachers concerning
past examination results and former health problems, as
well as consultations with the nurse, the parent and the
examining physician, should disclose to the teacher the
more specific nature of the local examinations to be
given and indicate the probable reactions and attitudes
of his specific pupils to these examinations. With such
preparation, the teacher should be able to judge the most
effective ways and means for preparing his pupils for
their next health examination.
(c) INVITING PARENTS TO ATTEND THE EXAMINA-
TION. If the school situation permits, particularly in
elementary schools, it is very desirable that the parents
be present at the health examination to discuss the find-
ings with the physician and to hear his recommendations
first hand. After consultations with the examining physi-
cian, school authorities should be responsible for inviting
parents to these examinations where their attendance
52 FLORIDA'S SCHOOL HEALTH PROGRAM
is possible. A very simple statement should be made to
invite parents, giving them details concerning the time
and place for the examination and stating simply the
reasons why their attendance is important. Some such
statement as the following might be used:
"You are cordially invited to participate in your
child's periodic school health examination which will
be held at (place) on (date). Your child's examination
will be much more beneficial if at least one of his
parents is present because it will enable you to talk
with the physician and reach a fuller understanding
of your child's health status and the physician's rec-
ommendations."
Arrangements can be made with parents and with
the physician for the examination of all school members
of one family on the same day so that parents need not
make several trips. If parents cannot be present the
public health nurse should visit the home as soon as
possible to communicate the results of the examination
to the parents. The public health nurse should act as
intermediary between the home and the private physi-
cian and dentist, or between the home and the agen-
cies cooperating in the correction of defects. The school
health examination, through this foll--,;-up service by
the public health nurse, can be an important part of the
whole family and community health program. Teachers
should be responsible for assisting the nurse in this fol-
low-up work in their conferences with parents concern-
ing the child's school progress.
(d) PREPARING AND KEEPING RECORDS. A uniform
examination record for each child should be used. There
should be two copies of each child's record, one to be
kept on file in the school and one to be placed in the
health department file. Teachers should be responsible
for filling in certain information on both forms, depend-
ing upon school regulations. The official record form,
shown on page 59, can be obtained in sufficient quantities
from the local health unit or from the State Board of
Health. The school copy of these records can be made on
the Florida Cumulative Guidance Records, the recom-
mended folder for pupil records used in most schools,
or duplicate copies of the official forms can be kept on
file in the school. The official record forms should be
secured in sufficient time prior to health examinations
HEALTH SERVICE 53
so that teachers can fill in the preliminary information
and conduct the preliminary testing. If records are not
kept properly and continuously, they are of little use
and are a waste of time and energy. The classroom
teacher should be responsible for having the records of
his pupils up to date on both the school forms and on
the official forms prior to the examinations. For children
in departmentalized grades the home room teacher or
a teacher appointed by the administrator should be re-
sponsible for preparing and keeping the records for a
specific group and should be responsible for the prelim-
inary testing and other preliminary procedures.
At the time of the examination the official record
forms should be filled in carefully by the physician or by
the public health nurse under the physician's instruc-
tions. After the physician or nurse has discussed the
health of each child with the teacher, a copy of the re-
cord should be made on the school form by the teacher.
These records should be easily accessible to the teacher or
the teacher should make his own notations concerning
the health problems of each child for his own use. The
original record should be kept in the full time county
health unit to be used by the public health nurse for
follow-up home visits. Any further entries made on
either copy should be transferred to the other by the
nurse or teacher at periodic intervals. The confidential
nature of health examinations should be observed at
all times.
(e) RECORDING PRELIMINARY INFORMATION. In
checking to see that the record forms are in readiness
before the health examination date the teacher should
be sure that the following information, needed by the
physicians has been filled in on the forms as completely
as possible:
(1) The previous history of the family and child. (Names, addresses,
age, date and place of birth, etc. as requested on the top of the
examination form shown on page 59).
(2) Record of illnesses, particularly communicable diseases. (See the
blank spaces under "Disease Experience" on the sample record
form. Any information not already supplied by previous notations
should be secured from the parents or nurse.)
(3) Results of previous examinations. The nurse should be consulted
concerning any lack of recording of previous examinations. This
also includes the recording of the date and results of "Immuniza-
tions and Clinical Tests" as shown on the sample record form.
54 FLORIDA'S SCHOOL HEALTH PROGRAM
(4) Observations by the teacher. On the back of the record forms
under "Notes on Clinic, Conference, and Field Visits", the teacher
should record at any time observations that would be helpful to
the physician in better understanding the child. Pertinent observa-
tions which have been made on the school cumulative guidance
records concerning the child should be transferred to the health
examination record form. These should be recorded under the
column headed "Notes", and the teacher's signature under the
column headed "Worker". Such teacher observations as follows
should be recorded:
(a) Academic progress.
(b) Social behavior.
(c) Health practices and attitudes.
(d) Physical or mental abnormalities.
(5) Observations made by parents should be recorded by the teacher,
public health nurse, or physician.
(f) PRELIMINARY TESTING. The teacher should be re-
sponsible for the weighing, measuring, the testing of
sight and hearing of his pupils, and for recording results
on the record form prior to the regular health exam-
ination by the physician. All teachers can learn to per-
form these simple procedures. When teachers conduct
these preliminary tests time is saved for the physician
or nurse to spend on items demanding more professional
attention. This also provides the teacher with additional
opportunities for valuable demonstrations in health
teaching.
(1) Weighing and measuring. Pupils should be weighed and measured
at school at least every three months and immediately before the
health examination. This procedure should be used as a teaching
experience. Weight and measurement are not sufficient criteria
for the determination of the nutritional status of the child, but
must be utilized with other factors, which include the total health
examination as well as an understanding of the physical char-
acteristics of the parents. The important feature about weighing
and measuring is to show progressive, orderly increases in weight
and growth. Standard weight is no longer considered a measure
of health, and deviations should not be emphasized by the teacher
or the parents. This should be explained by the family physician
or the health authorities.
HEALTH SERVICE 55
For weighing and measuring it is advisable for the child to have
all heavy extra clothing and shoes removed. Conditions should
be as similar as possible to those of the previous weighing and
measuring. Children should wear approximately the same amount
of clothing and should be weighed at approximately the same
time of day as at the last weighing. The scales should be checked
frequently for balance during examinations and the weight should
be recorded to the nearest quarter of a pound.
If the scales are not equipped for measuring height, a tape measure
can be used. It should be accurately tacked to a straight wall.
The end of a chalk box or a book may be placed against the tape
on the wall and as a child stands in front of the tape the box should
be lowered easily until it rests upon the head of the child. The
child being measured should stand facing straight ahead so that
his head is not tilted backward or up. Height should be recorded
to the nearest quarter of an inch.
(2) Testing hearing and sight: The classroom teacher controls in
many ways the child's school progress, school adjustments, and
social-emotional development which are decidedly influenced by
his ability to see and hear. Therefore, it is especially important
that teachers conduct the testing of sight and hearing. Further-
more, the teacher is responsible for making adjustments for chil-
dren with visual or hearing defects as well as for motivating the
correction or alleviation of such physical handicaps.
Several testing methods are described below. The teacher should
consult the health unit personnel, however, concerning the testing
method preferred for recording on the regular health examination
record form.
HEARING TESTS
The 4A audiometer is the most reliable test for determining
the extent of hearing loss. It is highly recommended for
school use and should be the means used for testing hear-
ing whenever possible. It is advisable for either the county
school system or the county health unit to purchase an
audiometer to be used by all schools in the county although
this is difficult because of the present limited supply.
Where audiometers are available they should be shared as
widely as possible and teachers should learn how to use
them. Since there are few audiometers available for school
use in Florida at present, however, several other less accu-
rate testing methods can be used to determine at least
which children appear in need of further attention.
56 FLORIDA'S SCHOOL HEALTH PROGRAM
The Whisper Text: The normal child should be able
to hear a whispered voice at 20 feet distance. A fairly
loud whisper, not a stage whisper, and clearly enun-
ciated words, should be used in testing and should be
kept as uniform as possible. A quiet room is needed.
Any outside or extraneous noises should be at a mini-
mum at the time of testing. The child should hold one
ear closed so that one ear is tested at a time. Simple
directions which the child can easily comprehend,
such as "walk forward," "turn right," "repeat these
numbers or words" should be whispered from 20 feet
distance. If the child cannot hear, the teacher should
move up one foot at a time and repeat the direction
until the child can hear. If he hears at 20 feet the ear
being tested can be recorded at 20/20, if he hears only
at 16 feet, the score is 16/20. The same procedure is
used for testing the other ear. The accuracy of this
test, of course, is dependent upon the uniformity of
conditions present, such as the presence of other
sounds, the volume of whisper, the accuracy of the
distance. The teacher should attempt to have condi-
tions as uniform as possible for each test.
The Watch Test: Even less accurate than the whisper
test, this test involves using a watch, preferably of
medium size and quietness. The distance of the watch
from the ear will vary in establishing the "norm" in
respect to the loudness of the watch used. Naturally
the same watch should be used for examining all class
members. The teacher should hold the watch in the
palm of his hand and stand behind the child being ex-
amined. The child should close one ear while the other
is being tested. Starting at about arm's length from
the ear (depending upon the loudness of the watch)
the teacher gradually moves closer until the child in-
dicates he can hear the watch tick. The distance of
the watch from the ear may be roughly measured.
Testing all members of the class with the same watch
and same procedure will help the teacher to judge
normal or possibly impaired hearing. Retesting will
be necessary, but at least doubtful cases can be
determined.
VISION TESTS
The Snellen Eye Charts are most commonly used and the
most readily available school means for testing vision. It
should be remembered, however, that these charts are used
primarily for testing visual acuity, and that a number of
eye defects may be present which the Snellen Eye Charts
do not reveal. Many authorities recommend the use of the
HEALTH SERVICE 57
telebinocular in addition to the Snellen Eye Charts because
these instruments, when properly used and interpreted, will
indicate other visual defects. Telebinoculars, like audiom-
eters, are not numerous in Florida for general school use,
however, while the Snellen Charts can easily be secured
through local health departments or the State Board of
Health. These charts should not be kept on display con-
stantly, but should be placed properly for use only during
the eye testing periods. Window cards (cards with centers
cut out to approximately the size of various letters) should
be used in vision testing as they help to eliminate the memo-
rization of the chart by the children.
In using the Snellen Eye Charts it should be remembered
that they do not indicate the degree of farsightedness which
may exist, nor the presence or seriousness of astigmatism
or color blindness, nor the coordination and efficiency of the
two eyes working together.
A child may have a 20/20 or normal vision rating on the
Snellen charts and still have a vision defect which may be
serious. The teacher, therefore, in addition to using this test
as part of the health examination, should be constantly
alert for observable signs of eye trouble, such as:
Complaints of frequent headaches, burning eyes, sties, in-
flamed or crusted eyelids.
Blinking, brushing hair away from the eyes, rubbing the
eyes.
Holding reading materials very close or very far from the
eyes.
Shutting one eye or screwing up the face when looking at
objects or when reading.
Stopping frequently to look up when reading.
Inattention to wall charts, maps or backboard displays.
Although these signs do not necessarily indicate eye dis-
orders, they do indicate that the condition of the child's eyes
should be carefully considered as a possible cause of such
conditions.
In routine vision testing, the Snellen charts will help in the
discovery of children who may need to have further atten-
tion given to their eyes. Either the Snellen letter chart, the
Snellen "E" chart, or the combination chart should be avail-
able in schools for testing purposes. On these charts each
line of letters or "E's" is labeled as the 100 foot, 70 foot,
60 foot line, and so on. The chart should be hung where it
receives good light, at least 10 foot candles, but not in a
glaring light. The child should be seated 20 feet from the
chart. One eye should be tested at a time by covering the
other eye with a card. The child should be asked to name
aloud certain letters or to indicate with his hand the direc-
58 FLORIDA'S SCHOOL HEALTH PROGRAM
tion of the three lines on the "E"s. The line which he is last
able to read correctly is the foot line to be used in scoring.
If he can read correctly the "20 foot line" but makes an
error in the "15 foot line," his vision is considered at 20/20.
Normal vision is considered as 20/20, which means that the
child with normal vision should be able to read the 20 foot
line at 20 feet distance. If, however, he is able to read only
the line that should be seen at 30 feet, and makes a mistake
on the 20 foot line, his vision would be recorded as 20/30.
If no line below the 40 foot line can be read at 20 feet, it is
recorded as 20/40. Although a score of 20/40 is considered
indicative of faulty vision, any child whose record shows
that less than normal vision is present in either eye should
be referred to the examining physician or to a competent
ophthalmologist for complete examination. Variations in the
use of these charts may be recommended and explained by
health unit personnel. Such variations may involve marking
off the floor at different distances so the child can move up
until he is able to read a certain line correctly. Different
fractions are then used in recording. The advice of the exam-
ing personnel should be followed.
(g) PROVIDING AN EXAMINATION ROOM. If possible,
proper clinic rooms should be available in every school.
If such a room is not available a temporary space, well-
lighted and sufficiently large to provide privacy for the
examination of each child, should be provided by school
authorities. The examining room should be supplied at
least with the following: a desk, chairs, tables, sheets
and paper towels. Someone to serve as a clerk or recorder
should be provided. School authorities should consult
with the examining personnel when other preliminary
arrangements are being made to determine the quantity
of such supplies and the nature of other supplies that
may be needed. These should be ready and i.n the exam-
ining room before examination time.
THE HEALTH EXAMINATION
(See Appendix page 137, Section 230.23 (8) (f))
The attitude of the children at the time of the examination
is a good test of the teacher's preliminary health instruction and
psychological preparation of the children. Interested, unworried,
and cooperative attitudes should be manifested rather than
those of over-excitement or fear. The teacher's previous under-
standing and teaching concerning the following general exami.na-
tion procedures as well as his familiarity with the purposes and
items to be examined will have helped to achieve this. Items
SCHOOL HEALTH EXAMINATION RECORD FORM
COLOR W C SEx M F
NAME OF FATHER
DATE OC BIRTH PLACE OF BIRTH
GRADE SCHOOL | I
AVE DATE
HEIGHT- WEIGHT I
NUTRITIONS I
ORTHOPEDIC I
SK:N AND SCALP
NOSE i I \
TEETH. TEMPORARY I \
THROAT
HEART
V IS Io N W IT H O U
PARENT PRESENT I ______________I
IMMUNIZATIONS AND CLINICAL TESTS
II I-
I i
I . l I- _
I-_____l
I __i
I I
I
DISEASE EXPERIENCE
DATE RESULT DATE & RESULT DATE RESULTj DATE DATE DATE I DATE
TYPHIOI FEVER TYPoT.. FEVER I OTITIS ME AI I I
DIPHTHERIA I U51MEASLFS U I _
STAIRS SCARR FEUSR
S....... ,-WHOPING COUA I i
DATE EXAMINER'S NOTES SIGNIFICANT FACTS IN HISTORY, PHYSICIAN S ORDERS
SCHOOL RECORD FLORIDA STATE BOARD OF HEALTH
C. H. W. 3
ADDRESS (I)_
MoTHER
;1
NOTES ON CLINIC. CONFERENCE, AND FIELD VISITS
CONDITIONS UNDER
DATE FOOs REST MEDICAL OR DENTAL NOTES WOTE
TREATMENT
CODE: Os-ATiaFACORO; 1, 2. 3-LIOrHTL.. MODRATL. MARKEDLY UNSATIrFACTORAY X-NEDS MEDICAL ATTNTON; A DAsXH -
INFORMATIONS OTAINED. OO-CORRECTION
HEALTH SERVICE 61
are listed on the' record form (page 59). The teacher should
inquire in advance concerning the specific procedures to be used
with his group and should have taught the importance and pur-
poses of each. This can be done most efficiently by the teacher's
demonstration of the health examination and the procedures
which will be used. Much valuable instruction should accompany
this demonstration and it should serve as a good review of points
studied in previous class discussions.
(a) GENERAL EXAMINATION PROCEDURES: At the time
of the examination the health record forms, properly pre-
pared, any advisable educational literature, and the physi-
cian's examining equipment should be placed on convenient
tables or desks. Physicians will naturally vary in the pro-
cedures followed in their examination for the different
items listed on the record forms. The description given
here presents a general picture of the nature of a school
health examination. Physicians will also vary in the methods
they desire used in recording their findings. The following
included suggestions for recording examination results may
serve as examples for the information of teachers attempt-
ing to better understand the total examination procedures.
The explanation of the code used for recording can be noted
on the sample record on page 60.
(1) Nutrition Examination: Accurate measurements of malnutrition
cannot be nmade easily, yet the physician can state whether' a par-
ticular child appears to be in need of additional attention in respect
to his nutritional status. The height and weight of the child are noted
and an appraisal made of his general physical development and
growth. The use of height and weight in determining nutritional
status should not be overemphasized. Individual variations of dif-
ferent bodily types should be taken into account. Muscle tonus, tex-
ture of the skin, lustre of the eyes, color of eyelids, and appearance
of the hair may be noted in making this appraisal. If suggestions
of nutritional anemia are present a hemoglobin rating should be taken.
The values of a well rounded diet and the associated need of plenty
of sleep to promote growth can be explained. The relationship be-
tween nutrition, exercise and good posture can be explained.
In recording the nutritional status of each child the following
code may be used:
0-Satisfactory
1-Some slight evidence of temporary loss of normal fat.
2X-Definite loss of fat, muscle tone, and distinct evidence of malnutrition.
3X-Marked evidence of abnormal nutrition, needing immediate attention.
62 FLORIDA'S SCHOOL HEALTH PROGRAM
(2) Orthopedic and Posture Examination: During the course of the
examination the presence of orthopedic defects will be noted. Children
with orthopedic defects will be referred to their private physicians to
discuss examination and treatment at an orthopedic clinic if necessary.
Postural defects, when noted, should be explained in respect to
their possible causes, such as poor nutrition, lack of proper exercise
resulting in poor muscular tone, and mental attitudes and fatigue.
The extent of the defects noted may be coded in the appropriate
space as follows:
Orthopedic:
0-Satisfactory.
1-Slight impairment which will be evidenced by stooped shoulders, flat
feet and postural defects of an orthopedic nature.
2X-Any impairment of a moderate nature which could be improved either
by treatment or operation.
3X-This would include such things as more serious postural defects. spInal
curvatures, high shoulders, hunch back, limping and post paralysis
impairments.
Posture:
For recording postural defects other than those of an orthopedic nature:
0-Satisfactory.
]-Slight impairment as evidenced by flat feet, stooped shoulders or other
defects due to faulty nutrition, lack of exercise mental attitudes or
fatigue.
2X-Fau.ty posture of a moderate functional nature, such as drop shoulders,
functional lordosis (hollow back) or scoliosis (lateral curvature of the
spine), which could be improved by corrective exercises, improved nu-
trition, proper attitudes and increased rest.
3X-In this class would come the worst cases of children with functional
postural defects.
(3) Skin and Scalp Examination: The texture and consistency of the
hair and the contour of the head will be noted. Presence or absence
of abnormal growths, prominences of the head, and the presence or
absence of pediculi or nits in the hair may be note.d.
The general cleanliness of the skin and scalp, and the presence
of skin eruptions will be noted. Signs of scabies or impetigo should
be checked very carefully.
The following outline should be used for recording various ob-
servations made under "Skin and Scalp" (See Health Examination
forms):
0-Satisfactory. No eruption. Clear skin. Clear scalp.
1-Slight eruption of minor nature.
2X-Moderate degree of eruption or scratch mark on the back of the hands
and between fingers. Ulcerated areas more or less oozing or, covered
with a scab on face, margin of hair, or on legs or other parts of
the body.
3X-Marked degree of eruption of the character designated above. Sipeci;tl
note if pediculi are present.
(4) Ear Examination: The physician will examine the external ear
for abnormalities such as eczema, discharge, foreign bodies, and for
general cleanliness. The ears may be examined next with an otoscope.
The otoscope is nothing more than a flash light attached to a funnel
in such a way that the light passes from the mouth of the funnel
to its outlet at the small end, producing a concentrated spot of light.
A magnifying glass is fastened over the large end of the funnel. The
instrument can be explained to the child. With this instrument the
physician examines for abnormal wax or other foreign bodies which
may be obstructing the external ear. He also notes the appearance
of the ear membrane (ear drum). By this observation he is able to
determine the presence or absence of infection in the middle ear. The
HEALTH SERVICE 63
results of the child's preliminary hearing test as recorded on the
examination form should be noted and checked by the physician and
appropriate advice given to the parent.
For recording ear examination findings the following code may
be used:
0-Satisfactory.
1-Slight eruption or uncleanliness.
2X-Evident obstruction such as hard wax and removable foreign body;
moderate degree of eczema or moderate ear involvement.
3X-Marked obstruction requiring operative removal; middle ear involvement
with running ear and eczema.
(5) Eye Examination: The eyes will be observed for conjunctivitis
(redness or inflammation), "pink eye", swelling and granulation of
the lids. The physician may test the muscular action of the eye
muscles and note any squinting, blinking, nystagmus (jerky motion)
or strabismus (cross eyes). The child's record is consulted for the
vision test reading, and if an abnormal finding is noted this is ex-
plained and recommendations made.
The physician's findings on eye examinations should be recorded
as follows:
0-Satisfactory.
1-Slight variation from normal.
2X-Moderate redness or inflammation, swelling or granulation of the lids.
3X-Marked conjunctivitis, "pink eye", strabisms, nystagmus. eye injury
or other abnormalities.
(6) Nose Examination: The physician will examine the nose for con-
genital defects, obstructions such as deviated septums, foreign bodies,
polyps (grape-like growth of tissues), congested mucous membranes,
abnormal discharges and enlarged adenoids.
For this examination the physician will probably use a sterilized
nasal speculum. This is a flexible instrument with funnel like dividers
at the end to spread open the nasal passage.
The physician's findings should be recorded as follows:
0-Satisfactory.
1-Slight choryza (watery discharge due to upper respiratory cold) or
slight deviation of septum (division between nasal passages) producing
little obstruction.
2X-Moderate obsl auction due io deviated seiotuml, foreign bodies, polyps.
congested mlucous membranes, ahnormlal discharges, (enlarged adenoids,
or symltonos of sillus involvement.
3X-M irkied comlttions ;is described in 2X.
(7) Mouth, Teeth and Throat Examination: In examining the mouth,.
teeth and throat the child's color and general physical state are taken
into account.
For the purpose of examining the mouth and throat a tongue
blade is used. The tongue depressor is used to push the inner surface
of the mouth away from the gums so that the condition of the teeth
and the gums may be observed. The gums will be observed for pallor,
inflammation and oral hygiene, and for the presence or absence of
congenital abnormalities such as cleft palate or harelip. The teeth
will be observed for faulty development, occlusion and caries.
NOTI: The physician's dental inspection will he more or less casual.
Attention should be given to temporary teeth even though they are coming
out to make way for the permanent teeth, as a neglected temporary tooth
will make trouble for the permanent one. Attention should be given par-
ticularly to the sixth year molars which are permanent teeth. (See Dental
Examinations on page till.)
64 FLORIDA'S SCHOOL HEALTH PROGRAM
The tongue depressor is also used to hold down the tongue while
the throat is being examined. The throat is observed for defective
utensils, naso-pharyngeal drainage, edema engorgementt of the mu-
cous membrane of the nasal pharynx), obstruction of the nasal
pharynx, enlargement of the tonsils or adenoids.
The following codes may be used in recording the findings:
Conditions of the mouth:
0-Satisfactory.
1-Slight evidence of mouth breathing (may be temporary condition due
to acute cold), slight high-arched palate (a condition which may be
the result of mouth breathing which has been allowed to continue too
long without attAntinn).
2X-Unmistakable evidence of mouth breathing, but the condition has not
progressed to such an extent as to cause a permanent facial distortion.
Note anemia of gums or poor oral hygiene.
3X-Marked evidence of mouth breathing. Cannot breathe through nose.
Mouth breathing has progressed so as to cause a permanent facial dis-
tortion.
NOTE: Make a special note of the presence of cleft palate or harelip
and marked gingivitis (inflammation of the gums). (A cleft palate is where
nasal and mouth cavities are united through a cleft in the palate. Any
degree of cleft palate and harelip is apt to interfere with speech.)
Conditions of the throat:
0-Satisfactory.
1-Slight inflammation.
2X-Moderate inflammation and enlargement of tonsils and adenoids w:th
naso-pharyngeal drip.
3X-Marked degree of conditions noted In 2X.
Condition of teeth:
(The same code is used for both temporary and permanent teeth)
0-Satisfactory. Teeth clean and no evidence of decay.
1-Slight defect. Teeth unclean or slight pit cavities in the temporary
teeth.
2X-Moderate defect. Teeth with heavy green stain or badly broken down
cavities in the permanent teeth.
3X-Urgent condition in either temporary or permanent teeth which have
abscesses in the gums near their root.
(8) Glands Examination: This portion of the examination refers par-
ticularly to the anterior glands in the forepart of the neck, but there
are similar small aggregations of adenoid tissue located in various
parts of the body such as at the back of the neck, under the armpits,
and in the groin. The anterior glands of the neck which are located
in the angle of the jaw with the neck are connected with similar
adenoid tissue of the tonsils and mouth region. The ones behind the
neck receive the lymphatic draininge from the scalp. The anterior
glands may become inflamed and enlarged from an acute sore throat,
acute tonsilitis, chronic enlarged tonsils, infected adenoids, infected
sinuses or abscessed teeth, for in all these conditions the infected
areas drain into the same region of the neck. They may also become
enlarged through serious diseases of the glands themselves.
The following code may be used with particular reference to
anterior glands in the forepart of the neck. Involvement of other
glands in the body should be recorded as a special note.
0-Satisfactory. No visible evidence of abnormalities.
1-Slight enlargement, size of a shelled peanut, detected by the phys;ciani'
feeling the region with the fingers.
2X-Moderate enlargement, size of a small lima bean.
3X-Marked enlargement, size of a small acorn or larger. Special note If
gland is discharging.
HEALTH SERVICE 65
(9) Thyroid Examination: The thyroid gland is a gland of internal
secretion and is closely linked with other glands of internal secretion.
Any abnormality of this gland may become part of an abnormal en-
docrine (glands of internal secretion) symptom complex. The normal
thyroid is so small it cannot be easily seen or felt. Where abnor-
malities of the thyroid are found their nature and relationship to
the other glands of internal secretion in the body should be explained.
The following code should be used for recording abnormalities:
0-Satisfactory. No enlargement.
1-Slight enlargement.
2X-Moderate enlargement accompanied by slight nervousness, loss of
weight and increased heart rate.
3X-Greatly enlarged and disfigured, particularly accompanied by nervous-
ness, loss of weight, bulging of the eyes, rapid heart and flushing
of the face.
(10) Heart and Lungs Examination: For heart and lungs examination
the children should be stripped to the waist if feasible. The exam-
ination is conducted for the most part with the use of a stethoscope.
The stethoscope is an instrument consisting of a funnel shaped piece
of metal attached to two long rubber tubes connected with ear pieces
which are placed in the physician's ears. The bell shaped portion of
the stethoscope funnel is held close to the chest at different points
in the front or the back. This instrument magnifies the sound in the
chest. It is through these variations in sound that the physician is
able to interpret normal from abnormal chest conditions. The chest
will be examined for abnormal density and breath sounds character-
istic of certain abnormal conditions. Albnormality of the chest should
be checked by X-ray.
The heart of the child is checked for irregularity of rate or
rhythm and for the presence of murmurs, before and after exercise.
Positive heart findings should not be over-emphasized but should be
explained as being questionably of functional or organic nature. Rec-
ommended further observations will reveal the significance of any
such findings.
Code for the heart:
O-Satisfactory.
1-Sl:ght observation, probably transient.
2X--Heart murmur, questionably functional or organic in nature.
3X-Enlarged heart. Marked palpitation. Murmur. Decidedly organic.
A 3X condition will be characterized frequently by shortness of breath
when at play or in climbing stairs, or by sudden flushing of the face.
The type of murmur, whether systolic or diastolic, may be recorded in a
special note.
Code for the lungs:
O-Satisfactory.
1-Slight observation, probably transient.
2X-Lung findings associated with the history of persistent coughing over an
extended period of time and associated with constant loss of weight,
or a history of tuberculosis In the child's family.
3X-Marked chest findings associated with history of acute upper res-
piratory infection or a history as outlined in 2X.
(11) Emotional Status: The emotional status of a child in relationship
to the scholastic accomplishment should be considered. The intelli-
gence quotient of the child should be taken into consideration. When
facilities are available, children with average intelligence, but with
marked evidence of maladjustments, should be referred to a child
guidance clinic.
Abnormalities of personality and adjustment may be recorded in
the additional space on the health record, using the general code to
show the degree of maladjustment and a special note as to the type
of abnormality.
66 FLORIDA'S SCHOOL HEALTH PROGRAM
(12) Immunization History: If the child's record shows that he has
not been vaccinated consistently for smallpox or immunized for diph-
theria, the need to bring these up to date will be emphasized. Parents
and children who fail to become vaccinated are susceptible and fre-
quently contract the disease on exposure. The fact that rapid trans-
portation contributes to the increased possibility of exposure to com-
municable diseases should be brought out.
(12) Hookworm Infestation: Signs and symptoms of hookworm in-
festation, if present, will be noted along with the general examination.
If previous tests do not confirm these findings subsequent tests should
be requested. A record of tests that have been taken should be found
under the "Immunization and clinical tests" section of the health
record form. The nature of the disease and its relationship to sanita-
tion and the measures necessary to rid the child of the infestation
may be explained.
(b) DENTAL EXAMINATIONS: The condition of a child's teeth
has a direct bearing upon his entire health status and should be
considered a definite part of the school health examination.
Arrangements for the dental examination of school children
should be made by the school authorities in cooperation with
the local dental society and the health authorities. Dental ex-
aminations should be made by a dentist. Where no dentist is
available, however, a dental hygienist or a physician may
make inspection. The examiner should present at least the
basic facts about teeth in respect to the dental defects that
are observed. At all times the necessity of early and continu-
ous? dental care by the dentist should be stressed so that teeth
may be saved and infections prevented. Defects found should
be recorded on the health examination form as are other ex-
amination results. Dental inspections or examinations are
not of real value unless followed by corrective programs. As-
sistance in establishing a dental corrective program, either in
the private dentist's office or in the dental clinic, should be a
part of every school health program. The teacher and the
nurse should be responsible for instigating and assisting with
dental follow-up work as a part of their follow-up of other
examination results. Where regular dental examinations are
not made frequently enough, both the teacher and nurse
should plan and conduct the inspection which will screen out
the most urgent dental defects and lead these children to
sources for further examination.
(c) OTHER EXAMINATIONS:
1.) Examinations should be made of all students taking part
in major athletics at the beginning of the practice season
for each major sport. The examination should be made
by the team physician in cooperation with the full-time
health unit.
HEALTH SERVICE 67
2.) At least annual re-examinations should be made of every
child in whom major defects are found, to ascertain from
time to time the progress of the child.
3.) Many preventable defects develop during the pre-natal,
infant, and pre-school periods. Obviously the periodic ex-
aminations made during these periods should aid in bring-
ing to the school a child in better physical and mental
conditions. Immunizations should be given during the
first year of life as a part of these examinations. Summer
round-up examinations have been made because of the
lack of adequate facilities for periodic examinations dur-
ing the pre-school period of the child's life. Where ade-
quate pre-natal, infant,,and pre-school services are avail-
able there should be no need for the summer round-up.
Where these are not available it is advisable to examine
early in the spring those pupils who intend to enter school
for the first time in the fall. Thus any defects found may
be corrected before school opens.
4.) Transfer students. All transfer students should be exam-
ined upon entrance unless there is an accompanying rec-
ord of a recent adequate examination in the former
school. Health records should be transferred when the
pupil changes schools.
3. Educational significance of health examinations: The accu-
rate recording of examination results, the completion of the
teacher's copy or the school copy of the record form, and the
consultations with the nurse or examining physician are the
teacher's first responsibilities in the important follow-up
work after the health examinations. Teachers should review
the chapter on Health Instruction for more detailed sugges-
tions on the use of health examination findings in the health
teaching program. The teacher's actual follow-up work, in-
volving individual conferences with specific children, their
parents, and the nurse, should not be forgotten any more
than should the more general use of the examination in
health teaching. The importance of both the preliminary
procedures and the most effective use of examination results
cannot be over-emphasized. Unless the educational purposes
and possibilities are well utilized, the value of the health ex-
amination is at a minimum and the educational results may
even be negative. The parents, the nurse, the teacher, the
school authorities, the health unit, and other community
agencies should cooperate closely in making health exam-
inations and the correction of defects most sound and edu-
cationally significant.
FLORIDA'S SCHOOL HEALTH PROGRAM
CORRECTION OF DEFECTS
Periodic health examinations are of little value unless the
defects found are corrected. It is the parents' responsibility
to arrange for the adequate treatment of the child. Where the
parents are unable to pay for this service other means should
be sought, but utilized only with the consent of the parents.
The correction of defects can be facilitated by:
1. The presence of the parents at the health examination: A
form detailing the definite defects i.n readily understandable
terms should be presented to the parents at the termination
of the examination. When the parents are not present this
form should be taken to the home by the public health nurse
and carefully explained.
2. The home visits made by the public health .nurse to advise
the parents and to assist them in obtaining corrections.
3. The utilization of the health examination findings in the
health instruction program in the school.
4. The teachers' follow-up work through conferences with pu-
pils and parents concerned with corrections.
5. For parents unable to pay, the full utilization of community
resources, which should be carefully studied by the health
authorities to assist in providing for the correction of defects.
Welfare agencies should be consulted concerning the degree
of indigency before help is given.
THE GUIDANCE OF HANDICAPPED CHILDREN
(See Appendix pages 137, 139, Sections 230.23(8) (e);
232.06(1))
School authorities are responsible for providing adequate in-
struction for all children who are compelled by law to attend
school. This includes the provision for such individualized in-
struction as may be necessitated by the presence of handicapped
children in school. Children with orthopedic, visual, speech,
hearing, heart, neurological, or certain mental abnormalities pre-
sent problems in many schools. Special attention must be given
to adjusting instruction so that the needs of these children are
as adequately met as possible. There are two schools of thought
concerning the provision of special facilities for handicapped
school children. One group of school administrators believes that
special schools should be built and staffed for the care and
teaching of children with the various types of handicaps. Under
this type of administration, children are segregated from their
playmates who are not handicapped, and often make greater
progress during their school experience than would be possible
in an average school.
HEALTH SERVICE
A second group believes that special schools are necessary
for a very limited number of handicapped children and that
the average school can be adapted to the care and instruction
of most of the handicapped children who are not bed patients
and who are able to reach the school through transportation
facilities afforded by the school authorities.. It is recognized,
of course, that there still remains a large group of children who
are home bound and who will require care and instruction in
their homes. The establishment of special schools and special
instructors for children handicapped with various types of con-
ditions tends to set them apart from contacts with normal chil-
dren which makes it difficult for these children to adjust them-
selves to society when they have completed their education. The
group of administrators which believes in attempting to adapt
the average school, in so far as is possible, to the needs of all
children has made considerable headway in recent years along
these lines.
It is assumed that each child shall have a proper inspection
by the teacher on entering school and at frequent intervals
thereafter. In addition, it is assumed that children with obvious
or specific defects shall have a proper examination by a qualified
physician who will be expected to indicate the special care that
the child should have in order to proceed with his education.
Unless a thorough physical examination is given to these chil-
dren, it would not be possible for the teacher to appreciate the
handicap of the child and the special precautions which should
be observed for him during the period he is attending school.
The major responsibility for the guidance and instruction of
handicapped children falls upon the classroom teacher. These
children need social and emotional guidance as well as indi-
vidualized care in respect to their specific deviation from normal.
For this reason handicapped children should not be set apart
from the normal social group but should be helped in finding a
satisfactory place among the total group. On the other hand,
the type of attention paid to the handicapped child should not
be of such nature or extent that the progress of the rest of
the class is delayed. The teacher will need a thorough under-
standing of the children needing this type of guidance and a
knowledge of the nature and degree of the specific handicaps
involved. It is suggested that the teacher have one or several
conferences with the medical specialist caring for each handi-
capped child. By observing carefully the opportunities for favor-
able seating arrangements in respect to comfort, light, and
sound; for individualized study programs; for extra conferences;
for assigning responsibilities through which such children can
70 FLORIDA'S SCHOOL HEALTH PROGRAM
experience real success and through other devices, the skillful
teacher can assist handicapped children to achieve satisfaction
and growth as members of the total class group.
Extreme cases present difficulties, of course, and all com-
munity resources should be utilized in securing the proper as-
sistance for these children. There are several suggestions given
below, however, which may aid the teacher in the classroom
guidance of handicapped children attending regular school:
1. Orthopedic Defects. The child with an orthopedic defect (one
with a disability of the arm, leg, or spine involving some
motor handicap) often has difficulty in -negotiating the
stairs or in going to the toilet after he has reached school.
Teachers and principals can assist this child by arranging
to have him assisted or carried upstairs or to the toilet. The
seats in the school room are designed for the use of children
with normal physical development. Slight modifications, such
as the addition of a box for the feet, a higher or lower seat,
a homemade adjustment'of the back, a support for the leg,
or legs, or for a semi-reclining position, will make the child
comfortable and permit him to participate in the school pro-
gram without pain or discomfort.
School children can be cruel in their attitude toward
crippled children, although they are ordinarily not inclined to
do so. With proper direction and stimulation, the average
normal school child will accept a handicapped child as an
equal and will go out of his way to assist him.
Without a tendency to segregate the child and deny him
the pleasure of social contacts, it goes without saying that
every attempt should be made to have children with ortho-
pedic handicaps examined by qualified private orthopedic
surgeons or by the surgeons employed by the Florida Crip-
pled Children's Commission, in order to see whether or not
anything can be done to correct the disability. Infantile
paralysis still continues to be an important if not a major
cause of handicap in children of school age. The neglect of
a child with long standing poliomyelitis usually results in a
disability due to weak or overstretched muscles that should
have been supported by appropriate bracing and appliances.
The longer the condition is neglected the greater the degree
of disability. It is important, therefore, that slight orthopedic
disabilities should be recognized as promptly as possible and
appropriate measures taken to protect the child from a sub-
sequent handicap that inevitably develops.
2. Visual Defects. Visual defects constitute one of the most fre-
quent forms of handicapping conditions among school chil-
HEALTH SERVICE
dren. The proper use of the standard Snellen test chart should
be made by the teacher and other signs of visual disturbance
observed carefully. The teacher should do everything possible
to see that children with suspected visual disturbances are re-
ported to the nurse or examining physician or that such chil-
dren secure a thorough examination by a competent ophthal-
mologist.
The type of school lighting has a profound influence on
the ability of children to read and follow instructions on the
ordinary blackboard. The Florida Council for the Blind is
issuing a special pamphlet on school lighting, which should
be secured by administrators and teachers.
In addition to these methods of proper school lighting,
the average school principal and teacher can improve condi-
tions in the room by proper adjustment of the blinds, the
position of the seats, and frequent cleaning of the walls and
the globes surrounding the source of light. Lighting engi-
neers point out that the efficiency of light rapidly decreases
when the bulb or globe becomes dirty. Arrangements should,
therefore, be made for systematic and regular washing of
bulbs and globes. (See page 31 for standards on classroom
lighting.)
3. Speech Defects. Defects of speech also constitute an import-
ant difficulty with many school children. Stammering, stut-
tering, and lisping are quite common speech defects among
school children. It is unfortunate that this type of child
often becomes the object of imitation or ridicule by other
children. The strenuous attempt of the child to overcome
his difficulty often aggravates his condition. It is only
through the careful guidance of the teacher that the child is
protected against ridicule and is taught the fundamentals of
good speech. There are a number of text books on this sub-
ject that should be helpful to teachers with these problems.
In addition, there is at the University of Florida a Division
of Speech Correction which will give helpful advice.
4. Hearing Defects. Unrecognized hearing defects are a fre-
quent cause for an apparent inability of a child to learn rap-
idly, because he does not hear the teacher. In the same man-
ner as with visual difficulties, these children should be tested
by the teacher, as described on page 55, to be followed, when-
ever possible, by a physical examination by a qualified phy-
sician. All too frequently, the lack of ability to hear is caused
by impacted wax or foreign bodies in the ear canal. Other
conditions which cause partial deafness are frequent head
colds, chronic middle ear disease, and enlarged adenoids.
Obviously such conditions should receive treatment at the
FLORIDA'S SCHOOL HEALTH PROGRAM
earliest opportunity. As has been suggested concerning vis-
ual defects, children who do not hear well should be seated
in the schoolroom towards the front so that they can hear
the teacher more distinctly.
5. Heart Defects. It is more difficult perhaps for the teacher
to recognize conditions which may indicate heart defects and
the teacher should never attempt to classify or diagnose
cases as such. A child that has blue lips, cyanosed finger
nails, puffy ankles, and who is short of breath on exertion
should be immediately referred to a physician for a complete
examination. Children who participate in strenuous athletic
events should be given an additional heart examination be-
fore the practice period for the sport begins, as irreparable
damage can be done to a diseased heart through such activ-
ity. If, after an examination by a physician it is considered
that the child with a heart condition is able to attend school,
provision should be made for him to lie down for a rest pe-
riod sometime during the day. ,Many schools have been able
to improvise folding cots for this purpose, or to use canvas
inclining chairs. Such children's programs of exercise should
be carefully planned and supervised.
6. Neurological Defects. Neurological defects as distinguished
from me-ntal defects are more difficult to handle in the aver-
age school room. The acceptability of these children for the
average school will depend largely on the type of the diffi-
culty and the ability of the child to compensate in carrying
on the regular activities of the school. Although there are
a number of conditions such as spastic paralysis that are
closely allied to orthopedic defects for which no operation
appears to benefit the child, there are, in addition, a num-
ber of minor neurological conditions such as habit spasms
and tics that are associated with behavior disturbances and
an inferiority complex. Where these exist, the understanding
teacher in cooperation with the examining physician can ac-
complish a great deal in adapting a child to the normal school
routine.
7. Certain Mental Defects. The child with an obvious and out-
standing mental defect as shown by a careful psychological
and physical examination should not be allowed to attend
the public school. In the border line cases, the child fre-
quently becomes the object of ridicule from other children
unless an understanding teacher directs the normal pupils
to 'special consideration of the child's disabilities. Insuffi-
cient provision is usually made for special instruction for
these children, and it is particularly important that they
HEALTH SERVICE 73
should not be urged to attempt mental processes far beyond
their ability to comprehend.
8. General Debility and Anemia. General debility and anemia
is a condition too frequently found in school children to neg-
lect special attention by teachers. The incidence of intesti-
nal parasitic infestation in school children throughout the
state, especially in Northwest Florida, is so high that a spe-
cial effort should be made to have the stools of all school
children examined at regular intervals and plans made for
appropriate treatment through the school authorities. The
State Board of Health provides a laboratory service to the
schools, without charge, and medication for treatment on
request. The health record of each school child should in-
clude a definite statement at frequent intervals regarding
this matter. It is just as important as the routine record
of immunizations. A continuous drive should be carried
on in all schools to urge the construction of sanitary privies
for each home. In some schools manual training departments
have used the construction of model privies as a project for
pupils. It is only by a coordinated and continuous drive by
all educational personnel and health authorities that progress
can be made in the control and eradication of intestinal
parasitic infections. Similarly, frequent studies should be
made on the actual food each child eats in order to deter-
mine the type of instruction on food and food .habits to be
taught in the schools.
FIRST AID FOR SCHOOL ACCIDENTS
1. Responsibility: It is expected that schools will do everything
possible to prevent accidents in school buildings and grounds
through the elimination of dangerous or imperfect equip-
ment, through alert supervision, the observance of other
safety procedures, and through safety education.
In case of accident or sudden illness, first aid for ordi-
nary injuries is the responsibility of the teacher. The ideal
is that every teacher should be prepared adequately through
the Red Cross Standard Course in First Aid. Classes for such
training usually can be arranged through the local Red Cross
Chapter. If this is not feasible, the Red Cross National Head-
quarters in Washington, D. C., can advise concerning the
nearest authorized instructor. If all teachers in a school
cannot have such training, at least one should be so prepared.
It is advisable that one teacher in each school be qualified
by the Red Cross as an Instructor in First Aid.
74 FLORIDA'S SCHOOL HEALTH PROGRAM
2. Facilities: There should be a first aid cabinet or kit in every
room; the minimum should be at least one in every school, in
a place accessible to all. There should be a clinic room or
rest room, or in one-room schools, a first aid corner of a
cloakroom where emergency cases can be treated. Every
school bus should be equipped with a first aid kit and bus
drivers should be trained in first aid care. Wherever a Red
Cross Highway First Aid sign is displayed, trained personnel
is available.
3. Limitation of Treatment: A teacher trained in first aid
will know what should not be done as well as what should be
done. In cases of sickness, a teacher should not give medi-
cines except under a physician's direction. A teacher should
never diagnose any illness nor any accident.
4. Notification of School Authorities: When an accident or ill-
ness occurs the teacher should notify the school administra-
tor as soon as possible so that he is familiar with what has
happened in case inquiries are directed to him.
5. Notifying Parents: As soon as possible after an accident or
the onset of sickness, the school should notify the parents,
turning over to them the responsibility for deciding on fur-
ther arrangements for a child's transportation home.
6. Disposition of the Pupil: Before or after first aid has been
administered, a pupil who needs to be removed from school
should be kept quiet and away from a crowd until a physi-
cian, an ambulance, or the parents reach the school. Ordi-
narily the pupil should .not be sent home alone or accom-
panied only by another pupil.
7. Accident Record Form: An account of the accident should
be written on an accident record form. In cases of accidents
which may prove serious, the names and addresses of wit-
nesses and a signed statement as to what they observed
should be taken at the time of the accident.
8. Educational Aspects: The need of administering first aid
provides a learning situation which should be utilized in class
discussion as to how the accident happened, how it could
be prevented next time, how it was taken care of. First aid
care to prevent infection can be related to general science
and health instruction. The care for shock, bleeding, and
broken bones, can be related to the study of the structure
and functions of the body. Making equipment for an emer-
gency room or corner may be a problem for the shop, indus-
trial arts, or home economics classes.
HEALTH INSTRUCTION
CHAPTER FIVE
HEALTH INSTRUCTION
DEFINITION
"Health Instruction is that organization of learning experi-
ences directed toward the development of favorable health knowl-
ledges, attitudes, and practices." Every teacher in the school
has a function in the health instruction program, although at
different school levels certain teachers will assume major re-
sponsibilities. Every teacher, therefore, should be familiar with
the health education program of the school so that his health
teaching contributes toward the aims of the total school pro-
gram. Health teaching is in part a problem of recognizing teach-
ing situations as they arise and using these situations to best
educational advantage at the time and place they occur.
INTRODUCTORY STATEMENT
Health should be taught in each school according to the gen-
eral plan of instruction used in teaching other areas of learning.
If an integrated plan of general instruction is used, there are
many excellent opportunities for integration in health teaching.
If the school follows the plan of dividing the day into subject
periods, a definite period for health instruction should be pro-
vided. Just as is true with all teaching, health content should
be scientifically accurate, and the teaching methods education-
ally sound. Especially in the field of health there are many
dangers that faulty information may lead to the development of
erroneous attitudes and practices unless teachers are thorough-
ly prepared and use accurate and scientific sources of informa-
tion.
Health education has been described as a way of living as
well as a subject to be taught. Health instruction, therefore,
should develop from and improve the quality of the life experi-
ences of the child. Since the school provides only one part of
the total experiences of the child, health instruction must be
concerned with home and community influences and must seek
to relate the child's understandings, attitudes, and practices with
his everyday living in home, school, and community. The child's
78 FLORIDA'S SCHOOL HEALTH PROGRAM
actual health needs should be basic in determining what to teach,
and health instruction should result in such modifications of the
child's health practices as will lead to the solution of his health
problems and improve his adjustments to problems of everyday
living. Health instruction should help to enable the child to live
a fuller, happier, and more satisfying life. It should guide him
to become self-directing in his daily living. To be effective,
therefore, health instruction must be concerned with the insepa-
rable physical, social, emotional, and mental reactions and inter-
actions of the whole child.
As a part of the total program of health education, health
instruction is definitely related to both the health service and
the healthful school living phases of the program. Not only do
the health services and the school living practices provide bases
for determining what to teach but the effectiveness and edu-
cational values of both of these programs are dependent upon
the methods, procedures, and content of the health instruction
program. The first and most important responsibility of the
health instruction program lies i.n the educational significance
,it offers to the health service program and to the program of
healthful school living.
The values and outcomes of health examinations, morning
observations, school measures for preventing and controlling
communicable diseases, and other health services will be decid-
edly limited unless the children are soundly motivated and
taught through the health instruction program to derive lasting
benefit from these services. It is the teacher's responsibility
to prepare his pupils so that they appreciate and cooperate with
health examinations. This necessitates the teacher's understand-
ing of the nature and purposes of health examinations as basic
to his responsibility for developing favorable pupil understand-
ings and attitudes relative to health examinations. If the find-
ings and results of health examinations and other health services
are not considered fundamental in the planning of health in-
struction, the total school health program may fail to achieve
its educational aims for improving the health status and the
healthful living practices of children.
Procedures related to healthful school living will likewise
have only narrow and limited value unless given direct educa-
tional and instructional interpretation. School living situations
cannot be soundly improved nor profitably utilized unless pupils
are guided in the correct use and care of the school building, its
equipment and supplies; unless pupils are taught how to live ef-
fectively throughout a hygienically planned school day; nor un-
less their learning experiences include participation in classroom
activities where the social and emotional tone is conducive to
HEALTH INSTRUCTION 79
happy living. Children learn more, perhaps, from their e.nviron-
fent and from the adjustments they make to it than from what
is actually taught in the classroom. The teacher must consider
the problems of school living, therefore, as most important in-
structional situations and should guide the child in his adjust-
ments to his school environment so that he progressively con-
tributes to the improvement of healthful school living.
It should be clear, consequently, that although there are
specific problems which may be more directly related to one
than to another of the three phases of school health education,
all phases are definitely inter-related. School or health depart-
ment personnel who are concerned with the school health pro-
gram and who lack an understanding of the inter-relationships
between all three phases of school health education will be per-
forming only a limited function and service at best.
DETERMINING WHAT TO TEACH
The individual teacher is faced with the important responsi-
bility of deciding which specific health experiences should be
provided for his specific pupils. Understanding that existing
needs and interests of the children should be basic in determin-
ing what to teach, the teacher should also realize that any pre-
scribed outline of health teaching content can never serve as a
sound starting point. Such prescribed outlines cannot present
accurately the comparative importance of health problems
among specific children. Outlines of suggested problems should
be considered as merely "suggested", and should be used by the
teacher only as a check on possible needs which may have been
overlooked.
There are several definite and specific guides the teacher
can follow in determining what to teach. It should be remem-
gered that for every grade level in the school sound health in-
struction will begin at the present level of the children and pro-
gress as far as possible toward desired and needed outcomes.
The basic task of the teacher, therefore, is the discovery of the
present level of his children in respect to their health status,
practices, attitudes, and knowledge. So long as a health prob-
lem still exists it has its place in the curriculum at any grade
level until the problem is satisfactorily solved. The teacher
should study his pupils, his school and teaching situation, and
his community in the light of the following guides to determine
what to teach:
1. What are the findings of the health examinations? The
actual health status of each child can best be determined through
conferences with the examining physician or the public health
80 FLORIDA'S SCHOOL HEALTH PROGRAM
nurse concerning the health examination findings. The teacher
should make and keep confidentially his own record of these
findings, which provide the first and most important determin-
ant of what needs to be taught. If dental defects or malnutri-
tion, for example, are disclosed by the health examinations to
be serious problems with specific children, health instruction
should provide the knowledge and develop the attitudes which
lead to the solution of these problems.
2. What are the observable health and safety practices of
specific children in specific situations? The classroom teacher
is the best person to judge the relative needs for health instruc-
tion based on the actual practices of the children in respect to
hand-washing, the use of toilet facilities, the selection of food,
pupil practices in getting to and from school, practices at play
and rest, and many others. Alert observation, informal discus-
sion, and conferences with other teachers and parents are the
teacher's means for determining needed health instruction on
the basis of the present practices of the children.
3. What are the health practices in the homes of the chil-
dren? Through informal discussions with the children, home
visits, and conferences with the nurse, the teacher can deter-
mine many of the home health practices which greatly influence
the health practices of the children. The nature of these home
practices should guide the teacher in the type of health instruc-
tion to plan for the children.
4. What are the social, emotional, mental, and physical
characteristics of children at specific age levels? The teacher
should understand the characteristics to be expected of chil-
dren at the age level of his pupils in respect to physical growth,
social development, emotional stability, and mental capacity. The
degree to which specific children deviate from known and ex-
pected characteristics of their age group will indicate needs for
adjustments. Understanding children at specific age levels will
also assist the teacher to determine the types of approach, the
motivation, and the methods most likely to be effective with
specific groups.
5. What are the children's needs as related to the basic phy-
siological needs of all persons? Basic physiological needs of man
have been described as the needs for air, water, food, sleep, rest,
sunshine, exercise, and elimination. A study of the pupils'
problems in meeting these basic needs in their own lives will
reveal the specific nature of certain learning experiences needed
by the pupils. What are the pupil's problems related to air,
to food, to sleep, to exercise, to elimination?
6. How do health situations in the local school furnish leads
to needed health instruction? The total school environment as
HEALTH INSTRUCTION 81
it deviates favorably or unfavorably from healthful school liv-
ing standards has decided influence upon the health and educa-
tion of children. It is the teacher's responsibility to understand
the school environmental forces affecting his pupils and to guide
their adjustments to this environment so that sound educa-
tional experiences result. A study of the local school environ-
ment as suggested in the chapter devoted to "Healthful School
Living," page 27, should suggest many teaching opportunities.
The school lunch room, for example, should certainly be used as
a laboratory for health teaching or else it has no place in a pub-
lic tax-supported educational institution. The type of lunch
room in which specific children eat, the kinds of food provided
for their selection, and the children's food selection practices all
provide excellent leads to health instruction. Many other phases
of the school environment should be similarly studied by the
teacher who wonders what health instruction is needed.
7. What have been the previous health learning experiences
of the children? Conferences with previous teachers, a study of
student records, the administration of health knowledge tests,
and other similar procedures should indicate to the teacher the
previous health instruction experienced by his pupils. An in-
quiry should be made concerning methods and emphases previ-
ously employed. The results of previous teaching should be
both observed and tested. Such study should reveal rather defi-
nitely the needs for certain re-emphases, for a change or con-
tinuance of certain methods and for the introduction of new ex-
periences based upon previous learning.
8. What major student interests are related to needed health
instruction? An alert recognition of vital pupil interests .not only
guides the teacher in selecting what to teach but will indicate
the most effective motivation to be used in teaching. Current
student interest may be centered around sand-lot play activities
after school, football spectatorship, Boy or Girl Scout activities,
hobbies, reading, or others. More general interests may be
centered around the desire for growth, for being accepted by the
group, or around the desire for success. The degree to which
health experiences are closely related to vitally felt pupil inter-
ests will influence the degree to which health experiences are
significant to children.
9. What pupil experiences in other study areas provide
leads for needed health instruction? The opportunities for em-
phasizing and enriching health teaching through the leads from
other study areas should .not be overlooked. In planning, the
teacher will know in advance when these opportunities are likely
to arise. The teacher should be prepared to seek definite health
outcomes as well as outcomes related to other areas. Health
82 FLORIDA'S SCHOOL HEALTH PROGRAM
outcomes do not result "incidentally" and they require just as
definite teaching as do other educational ends. The actual
health needs of the group, rather than merely the presence of
opportunities for correlation, should determine the emphases
and the amount of time to be given to the health contributions
of other subjects.
10. How should health instruction be related to the persis-
tent problems of all children as indicated in the general pro-
gram of instruction for elementary grades described in Bulletin
No. 9?* Since the guidance of health experiences is an integral
part of the general instruction program for Florida's elemen-
tary schools, a study of Bulletin No. 9 should indicate further
to the teacher certain health problems related to the general
teaching plan. The program of instruction described in Bulle-
tin No. 9 is based upon the expanding interests of children and
provides a plan for gradation which will be helpful to the teacher
in relating specific health problems to general instruction.
11. What are the health and safety hazards in the local com-
munity? The teacher's knowledge of the most important health
and safety problems in the local community will indicate defi-
nite health instruction needed by the children who are influenced
by these hazards. Local statistics concerning the prevalence
of certain diseases; the causes of accidents; the safety of the
water, milk, and food supply; the measures employed for com-
municable disease control; and the possible presence of malaria
mosquito breeding ponds or of insanitary privies should be
understood by the teacher so that the choice of teaching con-
tent is based upon factual rather than assumed needs. A visit
of inquiry to the local health department or to other local offi-
cial agencies should disclose to the teacher facts about these
problems. Instruction based upon these problems should give
emphasis to the pupil's relationships to the conditions found.
12. What do statistics reveal concerning the most important
health problems in the State? A general description of Florida's
major health problems is given on page 3 of this Bulletin. A
more detailed description may be found in "The Health Situa-
tion in Florida" which can be secured through the State Board
of Health. The most recent statistics should be secured through
the local health unit or the State Board of Health. A study of
the reasons for the existence of these major health problems in
Florida will point to many specific knowledge, attitudes, and
practices that Florida children should develop. The specific lo-
cality, the specific teaching situation, and the specific needs,
age level, and characteristics of the pupils will help the teacher
to determine the degree to which each of these Florida problems
" A Guide to Improved Practices in the Elementary School. Bulletin No. 9. State Depart-
ment of Education, Tallahassee. 1940.
HEALTH INSTRUCTION
is important to his own group. For example, elementary school
children might study the control of the most important com-
municable diseases among younger children while the study of
tuberculosis prevention would be more appropriate for high
school children. The local prevalence of hookworm would make
the study of this problem more important in some sections than
in others.
13. What current health events or problems indicate leads
for needed health instruction? A local epidemic, a current acci-
dent, present or seasonal drives and programs of health organi-
zations, a school health problem being emphasized at the time,
the national drive for physical fitness, a very recent classroom
event, and others, provide excellent opportunities for health
teaching. Some of these events can be foreseen in advance by
the teacher, who should be prepared to use the heightened stu-
dent interest and enthusiasm to best educational advantage.
Although pre-planning is often impossible, the teacher who is
constantly aware of the most important health instruction need-
ed by his pupils will be prepared to use current opportunities
as they arise as most effective "teachable moments."
SUGGESTIONS CONCERNING GRADATION
Health Instruction, including the gradation of content, meth-
ods, and materials, should be consistent with the local program
of curriculum organization and the general instruction policies
of the school. The specific content to be taught in any partic-
ular grade should not be determined by any super-imposed out-
line from remote sources but should be clear to the teacher who
follows the guides described in the section, "Determining What
To Teach." The presentation of content so determined should
then be planned so that it is consistent with the school's general
instructional program. Several general policies concerning the
conduct of health instruction on the various grade levels are
suggested below:
IN THE ELEMENTARY SCHOOL
In schools where the general program of studies follows the
plan of Bulletin No. 9, A Guide to Improved Practices in the Ele-
mentary School, teachers will be familiar with the guides offered
therein for the gradation of health instruction through in-
tegration with the "persistent problems" of children, basic to the
plan of Bulletin No. 9. The specific health problems of partic-
ular groups will vary, but the teacher should be able to adapt
most of the needed health instruction according to the emphasis
given to the "persistent problems" on the various grade levels.
If this is impossible, direct teaching should be done toward the
solution of health problems not adaptable to the plan. Regard-
84 FLORIDA'S SCHOOL HEALTH PROGRAM
less of whether the plan of Bulletin No. 9 or another plan of
general instruction is used, the following suggestions for teach-
ers of various grade levels should be generally applicable in
nearly all elementary school situations:
(1). In Grades One, Two, and Three: (See page 18) Health
instruction in grades one, two, and three should be centered chief-
ly around the every-day living experiences of the child as he
comes to school, lives with others in the classroom, as he selects
and eats his lunch, as he engages in play activities, and as he
participates in rest and relaxation periods, and the many other
daily practices. Definite and effective teaching should occur
whenever these situations or needs arise. Practically every-
thing that goes on during the day concerns the child's health
education and the alert teacher will use these daily experiences
wisely in guiding the child's behavior as he learns to adjust to
changing situations.
It is of great importance that the classroom environment be
conducive to health and happiness. Positive, joyous, happy ap-
proaches should be stressed while those which may be conducive
to fears or anxieties should be avoided. Basic guidance in many
of the little daily experiences is frequently provided by merely
a well-timed word of approval, a thought-provoking question, a
bit of information given to individual pupils, a thoughtful and
careful answer to a question. Small group or class discussions
can also be conducted so that improved practices are motivated
by the attitudes developed. This guidance can often be supple-
mented with health stories or pictures which should be closely
related to the health practice or attitude being discussed or ex-
perienced. Direct group health instruction should be given when
emphasis is. needed. Special emphasis at these grade levels
should be placed upon the development of desirable practices
and attitudes rather than placing too much stress on health
knowledge. Health information that is presented should be
within the child's scope of understanding and should be imparted
for the chief purpose of improving specific attitudes and prac-
tices.
In the first three grades it is recommended that health read-
ers should be used rather than textbooks. Several textbooks
can be used advisedly with third grade groups provided they are
used as references for the solution of health problems which
have arisen from child experiences. Textbooks here, as gener-
ally throughout the elementary school, should not be used as the
point of departure for page by page study. Health stories select-
ed should involve dramatic episodes and the subjects and plots
should be closely related to the experiences of the children
rather than more far away or remote subjects. Often the dis-
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