University of the State of New York Bulletin Entered as second-class matter August 2, 1913, at the Post Office at Albany, N. Y., under the act of August 24, 1912. Acceptance for mailing at special rate of postage provided for in section 1103, act of October 3, 1917, authorized July 19, 1918 Published Fortnightly a ee SS a eS A a No. 869 ALBANY, N. Y. February 1, 1927 g rye D ‘M4 Bud hoBEP -HEALTH EDUCATION IN NINE SCHOOL SYSTEMS OF NEW YORK STATE i ANETTE M, PHELAN | THE LIBRARY GF THE SEP 1 7 4999 UNIVERSITY OF ILLINOIS i % ALBANY THE UNIVERSITY OF THE STATE OF NEW YORK PRESS 1926 G198r-N26-1 10(5190): THE UNIVERSITY OF THE STATE OF NEW YORK Regents of the University With years when terms expire 1934 CHEsTER S. Lorp M.A., LL.D., Chancellor - - Brooklyn 1936 ADELBERT Moot LL.D., Vice Chancellor - - ~- Buffalo 1927 ALBERT VANDER VEER M.D., M.A., Ph.D., LL.D. Albany 1937 Cuarces B. ALEXANDER M.A. ebay, Tie Litt D. - - - - - - - - - - - = - Tuxedo 1928 WaLTER Guest Kettoce B.A., LL.D.- - - - Ogdensburg 1932 James Byrne B.A., LL.B., LL.D. - - - - - New York 1931 Tuomas J. Mancan M.A., LL.D. - - - - - Binghamton 1933 Wittiam J. WALLIN M. A. - - - - - - Yonkers 1935 Wittram Bonpy M.A., LL.B., Ph.D., D. C. L. - New York 1930 Wittram P. BAKER B.L., ites D. - - - - - Syracuse 1929 Ropert W. Hicpre M.A.- - - -.- - - - Jamaica 1938 Rotanp B. Woopwarp B.A. - - - - - - - Rochester President of the University and Commissioner of Education FRANK P. Graves Ph.D., Litt. D., L.H.D., LL.D. Deputy Commissioner Avucustus S. Downinc M.A., Pd.D., L.H.D., LL.D. Counsel ERNEST E. Cote LL.B. Assistant Commissioner for Higher and Professional Education JAMEs SuLtivan M.A., Ph.D. Assistant Commissioner for Secondary Education Georce M. Wirey M.A., Pd.D., LL.D. Assistant Commissioner for Elementary Education J. Cayce Morrison M.A., Ph.D. Director of State Library James I. Wyer M.L.S., Pd.D. Director of Science and State Museum CHARLES C,-ADAMS M.S. 4Ph.D oleae Directors of Divisions Administration, LLoyp L. CHENEy B.A. Archives and History, ALEXANDER C, Frick M.A., Litt. D., Ph.D. Attendance, Examinations and Inspections, AVERY W. SKINNER B.A., Pd.D. Finance, CLARK W. HALLIDAY Law, Irwin Esmonp Ph.B., LL.B. Library Extension, ASA Wynxoop M.A., M.L.S. School Buildings and Grounds, FRANK H. Woop M.A. Visual Instruction, ALFRED W. ABpraAms Ph.B. Vocational and Extension Education, Lewis A. Witson D.Sc = NYE x (2 “Mh. § 69-37) University of the State of New York Bulletin Entered as second-class matter August 2, 1913, at the Post Office at Albany, Y., under the act of August 24, 1912. Acceptance for mailing at special rate of postage provided for in section 1103, act of October 3, 1917, authorized July 19, 1918 Published Fortnightly No. 869 ALBANY ,“NF¥: February 1, 1927 HEALTH EDUCATION IN NINE SCHOOL SYSTEMS OF NEW YORK STATE BY ANETTE M. PHELAN GENERAL VIEW This paper is a report of observations of health education in the public schools of nine communities of New York State made between November 30 and December 18, 1925. . The State Department of Education selected the cities and made arrangements for the visits. The places visited were Binghamton, Johnson City, Elmira, Ithaca, Jamestown, Rochester, Syracuse, Utica and Schenectady. Purpose The purpose of the visits was to discover where good work in health education was in progress; of what the work consisted; where the emphasis was being placed; how the work was adminis- tered and supervised; and what factors were contributing to its success. The?Plan?'? « The plan followed in the observations included: 1 Conferences with administrative and supervisory officers and teachers to understand the school policy regarding health education. 2 A view of school buildings and grounds for impressions as to adequacy, ventilation, cleanliness, facilities for play, etc. 3 A view of the medical, dental, nursing and clinical service to ascertain tendencies toward thoroughness, educational values and effectiveness in follow-up work. 4 Conferences with the person or persons responsible for health education organization to understand the point of view, the objec- tives and the relation of the health education program to the rest of the work in the school. + THE UNIVERSITY OF THE STATE OF NEW YORK 5 Classroom visits to learn the teacher-pupil relationship, the emphasis in health teaching, the methods used, etc. 6 Tests given to the low fifth grade to secure a sample of health knowledge at the command of the children of the grade, and the habits and attitudes developed. Explanation of Terms For the sake of clearness in this report, let it be understood that when the terms “ health service,” “health education” and “ physical education” are used, the distinction between them is that made by Thomas D. Wood M.D., adviser in health education, Teachers Col- lege, Columbia University. Doctor Wood explains the terms as follows: 1 Health service includes the various protective measures to be conducted by the school for the conservation and improvement of the health of the pupils. These measures and procedures do not primarily involve the knowledge, responsibility, or activity of pupils themselves. a Health examinations. These include the monthly weighing of school children, and other factors required for the periodic health examination which should be made for every pupil at least once a year. Health examinations should include attention to the physical, mental, emotional and personality health of pupils. b Correction of remediable health defects. Some of these defects may be corrected in the elementary school, such as (1) certain conditions of malnutrition; (2) functional defects of posture and other orthopedic defects; (3) defective mental and emotional habits. The more serious health defects, requiring medical and surgcial treatment, must be given attention outside of the school. c Daily health inspection. This part of health service is to dis- cover whether the child is in good enough health to be in school that day, and to determine whether the pupil shows signs of health disturbance indicating the possibility of his conveying to other pupils some form of communicable disease. Daily health inspection should be differentiated from daily health habit inspection. d School sanitation. This is concerned with the school plant and its surroundings in construction, equipment and maintenance. . é€ First aid and safety f Immunization of school children against infectious and com- mwunicable diseases. It is recognized today that protection of. chil- dren by isolation, quarantine and forms of immunization against communicable diseases are as important for the life and health of HEALTH EDUCATION IN NINE SCHOOL SYSTEMS 5 the child as the entire range of personal health habits and other phases of personal hygiene. g The hygiene of instruction h Health of teachers, janitors or custodians, and other school officials and employees 2 Health education is the sum of experiences in school and elsewhere which favorably influence habits, attitudes and knowledge, relating to individual, community and racial health. 3 Physical education includes the fundamental psycho-motor activities, or the big brain-muscle activities, which are valuable in the growth and development of the child in the preschool age, as well as in the period of elementary instruction. Physical education is the contribution made to the complete edu- cation of the child in the preparation for life by the fundamental big brain-muscle activities including play, games, athletics, gymnas- tics, dancing, pantomime, dramatic activities, swimming, hiking, camping, scouting activities and similar programs. Physical education also logically and practically should recognize and include general life activities, practical work, industrial or social service activities, such as gardening, farming, housekeeping etc., if they are big brain-muscle activities and if they are healthful and educative. From the distinction pointed out by Doctor Wood, it will be seen that the direct responsibility for health service rests with the highly trained specialist group of doctors, dentists and nurses on one hand, and on the other upon the school administration. Both groups are concerned with the problem of providing an environment for the child and promoting a condition of the child favorable to health. It must also be evident that the responsibility for the health education of the child rests with the classroom teacher, acting either on her own initiative, without assistance or support from principal or supervisor, or working in accordance with an accepted plan for the individual school or the school system, with assistance of prin- cipal, supervisor or special subject matter teacher, or all. It will be seen, furthermore, that the responsibility for physical education rests with another group of trained specialists in a posi- tion to render a specific type of health service, and upon whom rests the same obligation for observing the principles of hygiene of instruction as rests upon every other teacher of the child. In hygiene of instruction are included : 6 THE UNIVERSITY OF THE STATE OF NEW YORK 1 An atmosphere created by the teacher in the classroom, favor- able to enjoyment of work, vigorous effort culminating in success, and respect for personality and development of initiative. 2 A daily program furnishing a balance of mental and physical activity and frequent periods of relaxation. 3 Stimulating tasks suitable to the capacity of the child and in which there is a reasonable opportunity for success, with an adequate pian for attack and freedom to express personality in executing the plan. 4 Opportunities for the child to exercise his powers, physical, mental and social, without overstimulation or strain. 5 Equipment and materials such as books, charts etc., selected with a view of safeguarding the child from strain or other conditions unfavorable to health. General Information Policy of the administration and its influence on the health education program. On the whole the reaction of the school administration toward health education was friendly. In a small percentage of cases the attitude was one of tolerance. Frequently the confusion of the terms “ health education,’ “ health service ” and “ physical education” in the minds of the administrative officers was apparent, and a corresponding vagueness regarding the activi- ties within these three fields. Where this was found, there was a general tendency to consider the attention accorded health service or physical education adequate to meet the health needs of the child. When this view extended to principal and classroom teacher, its influence was frequently evident in a lack of appreciation of the principles of hygiene of instruction and a failure to utilize classroom situations to develop in the child a sense of responsibility for pro- moting his own health and the health of others. It was indeed gratifying to find that a few of the superintendents had been thinking the problem through and had arrived at the con- clusion that health education can not be dismissed with the allotment of a 30-minute period a week to formal instruction in health knowl- edge, but because of its significance in the intellectual and social life of the child it must, to be effective, permeate the whole school program, showing itself as health values in the various classroom activities. Where these superintendents have been able to instil in their supervisors, principals and teachers an appreciation of this con- ception of health education, its influence was felt alike in a greater HEALTH EDUCATION IN NINE SCHOOL SYSTEMS i respect for hygiene of instruction, a fuller utilization of subject matter and all classroom activities for developing attitudes and habits favorable to health. Buildings and grounds. Overcrowding was evident in only two of the school buildings visited. As a result or a corollary of the overcrowding, the sanitary conditions were also undesirable. On the whole, the buildings. were conveniently located, well-lighted and clean. Many of them were vacuum cleaned. ‘The facilities for good ventilation were apparently in use in most of the schools. The visits were made in December during warm rainy weather. ‘This may have accounted for the fact that while most of the classrooms posted temperature readings four times a day, the readings hovered about 70 degrees. It should be borne in mind that one of the important recommendations of the New York State Commission on Ventilation was that the temperature of the school room be not allowed to rise above 68 degrees. Playgrounds were provided at or near most of the schools. Because of the damp weather, or for some other equally good reason, all the play periods visited were devoted to plays and games indoors. Most of the programs provided for relaxation periods. Those observed usually were devoted to setting up drills. Status of health education in the elementary schools. New York requires by law that 30 minutes a week be devoted to health teaching in the elementary school. The law is interpreted literally in many of the school systems, and a 30-minute period a week is frequently the full amount of time given the subject. Too fre- quently the situation was met by the teacher devoting 30 minutes once a week to formal instruction in health knowledge, including a little anatomy, a little physiology, some well-meant advice on what ene should or should not do, and a description of evils resulting from doing the wrong thing. A woeful lack of good materials of instruction in health was apparent, for these lessons were often overrunning with negative teaching and included too many scientific inaccuracies. In many of the lessons observed there was a sincere effort to make the teaching carry over into habits for the pufpose largely of meeting future needs. Some desirable situations and tendencies observed. 1 A pro- gram of school athletics planned for the entire high school, and participation in it by the majority of the pupils. 2 Several attempts to make controlled studies of methods of health education. 8 THE UNIVERSITY OF THE STATE OF NEW YORK 3 A director of the elementary school together with a committee of classroom teachers and specialists making a study of opportunities for correlation of health education with other subjects of the elemen- tary school. 4 A primary supervisor working on an integrated course of study including health education in the kindergarten and first grade. 5 An elementary school teacher, who had been in service over a quarter of a century, doing some splendid work on correlation of health education with other school subjects. 6 A growing recognition of the constructive value of the service of the classroom teacher in the program of health education. 7 Among certain groups of principals and teachers, a growing recognition of the need for something more than formal instruc- tion in health knowledge, if the elementary school is to meet its responsibilities towards health education. 8 A growing recognition, by people working in the schools, of the importance to any school health program of the health standards of the community and the facilities for health education offered by that community. 9 A supervisor of junior high school together with the junior high school principals at work upon a program for the promotion of the physical, mental and social health of the junior high school pupils. 10 A tendency among medical examiners and school principals to express dissatisfaction with anything less than a thorough physical examination followed by effective work in removal of physical defects. 11 An appreciation among some of the medical examiners of the increased educational possibilities of the physical examination when the parent or classroom teacher is present. : 12 Interest of many classroom teachers in a better understanding ot the health condition of the pupils in their care. © 13 Interest of many classroom teachers in improving the char- acter and widening the scope of their own knowledge of health education. 14 Interest of many classroom teachers in materials of instruction on health education adapted to the elementary school. Tests. Health Knowledge. One objective of the study of health education in the State was to obtain a sample of the health knowledge at the command of the children in the elementary school. The Gates-Strang Health Knowledge Test, Form I, for grades 3 to 12, was used. This test consists of 64 items of health knowl- HEALTH EDUCATION IN NINE SCHOOL SYSTEMS 9 edge. Each item is so expressed that the child is obliged to select the most reliable statement from among five. The following sample will illustrate the test: We should have fresh air eae all the time Pe. in daytime but not at night ied at night but not in daytime Bt ake especially in summer La when we begin to get a headache The child is instructed to read all five answers and then place a check on the dotted line preceding the one best answer. The number of right answers constitutes the child’s score. The low fifth grade was selected as the place in the elementary school in which the health knowledge would be sampled. ‘The test was given to 223 children in seven classes. In cities where the director of health education had made plans for using the identical test later on, the test was omitted. The principals, the teachers and the children were interested and gave evidence of a fine spirit of cooperation. On the whole, children appeared to enjoy the test. One hundred sixty-one children, or 72 per cent of the number tested, made scores equal to or above 31, the actual mean score for the low fifth grade as determined by the authors of the test. The top 5 per cent of the children had scores ranging from 48 to 51]. The scores of the bottom 5 per cent ranged from 15 to 22. The accompanying graph shows the distribution of scores. Sixty-four is a perfect score for the twelfth grade. The children’s reactions to separate items of health knowledge were then observed. Assuming according to elementary school practice that when 75 per cent of a class gave the correct answer to any specific item, the knowledge tested was at the command of the class as a whole, one might infer that the low fifth grades tested knew 25 of the 64 items of the test. The knowledge incorporated in these items and assumed to be at the command of the low fifth grades may be summarized as follows: 1 ea a and growth a Children should eat at regular times. b Children should sit down at the table and eat slowly. c Pale, thin children should eat milk, bread and butter, and spinach. d Hot cereal is a good food for breakfast. e Milk is a most important food for children. f Orange juice is a healthful drink for children. THE UNIVERSITY OF THE STATE OF NEW YORK No. of scores 4o oe Sb 34 32 So 28 2b 24 22 20 18 Actual ~ W- *3- 29- 31- ¥§- 39- B- 47- sc ores cee Oia 26 380 34 38 4h 46 Scores made in Gates-Strang Health Knowledge Tests in the low fifth grades of six cities of New York State Highest possible score, 64 Number of children tested, 223 HEALTH EDUCATION IN NINE SCHOOL SYSTEMS ll 2 Sanitation and care of food a Food should be protected from flies because they carry germs. b Cooked meat and vegetables should be covered and kept in a cool place. 3 Control of communicable disease a There is less danger of giving a cold to someone else if the face is covered when one sneezes or coughs. 4 Fresh air a The best way to get fresh air is to go outdoors in the sunshine. 5 Sleep a Long hours of sleep keep children well. b Best way to sleep is under light warm covers with the window open top and bottom. 6 Safety a Children should learn to swim in order to prevent acci- dents in the water. b In games, children should be careful not to trip or hit each other. , 7 First aid a When a child gets a cinder in his eye, it is best to have it taken out by someone who knows how. S Posture a A good way to learn to sit well is to select chairs and desks at school of just the right size and shape. 9 Clothing a In the morning clothing should be selected for its suita- bility to the weather. b Loose clothing is best. 10 Emotional a When a child gets a low mark at school, it is a good thing to ask teacher’s advice and follow it. b It is a good thing to feel happy and comfortable at meal time. 11 Care of the teeth a Everyone should visit a dentist twice a year. 12 Care of the eyesight a When a child needs glasses he should have an eye doctor fit them to his eyes. It is hardly safe to assume that all low fifth grades have the foregoing knowledge at their command. In fact, the variation in 12 THE UNIVERSITY OF THE STATE OF NEW YORK the degree to which any item might be said to be mastered was very marked between the individual schools. In one school the knowledge of one individual item might be at the command of 100 per cent of the children, while in another school only 53 per cent of the class might know it. This variation between schools was found to exist to even a greater degree with reference to the items of health knowledge at the com- mand of less than 75 per cent of the group as a whole. For example: 81 per cent of the children in one school knew that a child should drink from four to eight glasses of water daily, while only 37 per cent of the children in another school had that item of knowledge at their command. On some of the items which we have been led to believe a child of the low fifth grade should know, however, all the grades made low scores. One of these items is that the best temperature for a room in which one is sitting reading is between 65 and 68 degrees. Another item which one might have supposed to be at the command of the fifth grade and on which all schools consistently made a low score, is that the best exercise for fourth grade girls and boys is active and outdoor play. It is not the purpose of this paper to determine what health knowl- edge should or should not be taught in the elementary school pre- ceding the high fifth grade, but merely to leave, in passing, the question of whether it might not be desirable that the health knowl- edge be selected in the light of the child’s health needs during the period and on the basis of the value of the knowledge in developing habits and attitudes which tend to meet those needs. Testing habits and attitudes. An attempt was made to test a few of the health habits and attitudes recognized as desirable in children ~ of the elementary school. They were tested by questions which the children themselves answered. Some of the questions were fairly direct while some were so phrased, especially in the attitude test, as to make two opposing appeals to the child. These experimental tests were used for the first time during the study. The fact that their validity and reliability had not been established makes them of less value in actually testing the habits and attitudes of the children. Rewording many of the questions would make them more valid. Perhaps some should be omitted entirely. The results, however, are interesting, and may be taken for what they are worth. To forestall a tendency to overestimation among HEALTH EDUCATION IN NINE SCHOOL SYSTEMS 13 those who might be actuated by a desire to make a good showing, the children were requested to leave all identifying marks off their papers. The children undertook the test with a fine spirit and the results are indicative of cooperation and a desire to answer honestly. Of the 12 habits tested, the children claimed practice in varying degree. The figure following the statement of each habit indicates the percentage of children tested claiming the practice of that special habit. 1 Reading with the light falling on the page from the left or ‘from behind. 87 per cent This habit was tested by the question: Whenever I am reading, I sit so the light falls on my book pees from behind me ape from my left side cca I do not notice direction 2 Covering the face with a handkerchief when about to sneeze. Tested by: 79 per cent Whenever I feel like sneezing in school rem I cover my face with my handkerchief et I turn around eee I just sneeze 3 Eating a regular full breakfast including cereal and milk. Tested by: 78 per cent During the past week I have eaten a full breakfast including cereal and milk. ye. if I get up in time tis when I felt hungry eras every morning 4 Being in bed 10 hours each night. 75 per cent Tested by: Last night I was in bed a aS five hours eae from seven to nine hours PS aetae ten hours 5 Brushing the teeth daily. 73 per cent Tested by: I brush my teeth thoroughly “PBs once or twice a week nap not at all eee: more than once a day 14 THE UNIVERSITY OF THE STATE OF NEW YORK 6 Settling difficulties over playground injuries without quar- relling. 71 per cent Tested by: When a playmate hurts me without meaning to sete I settle it without a quarrel seatee I tell the teacher sie I go home and think about it 7 Playing outdoors two hours a day. 65 per cent Tested by: During the past week I have played out of doors pikes not at all eee all day long ee about two hours a day 8 Drinking at least three glasses of milk daily. Tested by: 64 per cent In last three meals I drank altogether elles three glasses of milk es no milk badge one glass of milk 9 Eating at least three kinds of vegetables a day. Tested by: 61 per cent In the last three meals I have eaten Beale more than ten different kinds of vegetables ee three or more kinds of vegetables aac no vegetable but potatoes 10 Regular daily bowel movement. 61 per cent Tested by: During the past week my bowels have moved bxcasere once in a while are Wik regularly every day rok Me three times a day 11 Safeguarding other children from his cold. 60 per cent Tested by: The last time I had a cold rete I went to school Sees I stayed away from other children live I played in the yard with some children who came to see me HEALTH EDUCATION IN NINE SCHOOL SYSTEMS 15 12 Sleeping with bedroom window open. wide open, 49 per cent opened at least an inch or two, 80 per cent Tested by: Every night last week I slept with my bedroom window eet wide open 2 A closed ee raised an inch or two If the results of the tests are indicative of the status of these particular habits in the low fifth grade, it would appear that the children in this grade get the proper amount of sleep for children of that age; that they are in the habit of eating breakfast in the morning, and including cereal and milk in the breakfast; that they try to protect others when they sneeze in school; and that they take the precaution when reading to sit so that direction of the light is correct. The questions that arise are: In the light of the child’s health needs What habits are desirable? Which ones are the whole or partial responsibility of the school ? What opportunities does the school offer for their formation? What knowledge is essential to strengthen the habits already formed or to rationalize the formation of other desirable ones ? The test on attitudes followed that on habits with the following results : 98 per cent of the children showed a sense of responsibility for protecting themselves and others from food known to be unclean, as indicated by disposal of a cookie accidentally dropped on the floor. 96 per cent showed an unwillingness to drink water not known to be pure, indicated by reaction to a hypothetical situation involving a hike, thirst, a creek. 90 per cent showed a preference for a breakfast of oatmeal, prunes, toast and milk to one including beefsteak, potatoes or waffles, bacon and coffee. 87 per cent indicated a preference for milk in a hypothetical party where a choice of tea, coffee or milk was given. 80 per cent indicated an unwillingness to sleep in a room with a closed window in a hypothetical case involving staying all 16 THE UNIVERSITY OF THE STATE OF NEW YORK night with a friend who failed to open the window. This agrees with the group that raised the bedroom window at least an inch or two. 79 per cent indicated a sense of responsibility for safeguarding themselves from communicable disease by staying away from a playmate with measles. 78 per cent indicated an unwillingness to postpone the regular morning bowel movement even at the risk of being late for school. This is interesting in the light of the fact that only 61 per cent claimed the habit of a regular daily movement. Though 75 per cent of the children claimed to have been in bed 10 hours the night before the test was given, only 35 per cent of them would have gone to bed if they had been given a chance to see Charlie Chaplin in the “ Gold Rush ”’ instead. The preference for a good breakfast seems to agree with the habit of eating one, but the 87 per cent preference for milk does not show to any pronounced degree in the milk drinking habit. HEALTH EDUCATION IN NINE SCHOOL SYSTEMS 17 coe SPECIFIC INFORMATION REGARDING INDIVIDUAL SCHOOL SYSTEMS Ithaca Organization and Distribution of Responsibility The work is in process of organization under a health education committee comprised of a member of the board of education, the administrative officers of the school, all the workers directly interested in health activities and the special teachers. Those actively concerned about the health work are the school physician, who is also health officer for the city; a full-time dentist and a dental hygienist and two nurses. ‘The health education work is under the supervision of the director of physical education and his two assistants. Health § ervice Health inspection. The health inspection made by the school physician is annual. Five minutes are given to each child. The child’s blouse is opened at the neck, but not removed. The parents and teachers are not present. The records are kept in the school in care of the principal. They are available to teachers, and contain a complete inventory of defects and corrections. Reports are sent to parents and to the physical education department. Follow-up. ‘The follow-up work after the inspection is done usually by mail because the supervising nurse considers the number of nurses inadequate for personal follow-up in addition to other services expected of them. Dental corrections occur more frequently than others. The school has a dental clinic, a memorial to John Rumsey. All cases needing attention are cared for here. Control of communicable disease. 1 Diphtheria. By Decem- ber 1, 1925, 1979 of the 3575 children enrolled in the school had been immunized against diphtheria. 2 Vaccination against smallpox is required of all pupils. 3 Parents and teachers are furnished with leaflet on symptoms of contagious diseases. a 4 Children are excluded on suspicion by the principal, and all children who have been so excluded, or who have been sick or absent because some one in the home has been sick, are readmitted to school by the school physician. Special study. With the cooperation of the local medical association, a study was made during the year 1924-25 of the 18 THE UNIVERSITY OF THE STATE OF NEW YORK prevalence of enlarged thyroids in the school. Results showed the condition in 52 per cent of the girls and 26 per cent of boys. There were 3155 children examined. A treatment clinic is planned for this. Johnson City Organization and Distribution of Responsibility The health work in Johnson City is organized for health service mainly, and is under the supervision of the school nurse. The school physician, on half time for examination purposes, is also half-time health officer for the city. The school system also has a full-time dental hygienist and provides clerical assistance for the nurse. Health Service Health inspection. The health inspection is made on school entrance and in grades 3 and 5. It is made by the school physician. Five minutes are given to the inspection of each child who is not stripped. A thorough examination is given to suspicious cases. The parents are seldom present during the examination. Some- times the teachers are present. The records are kept in the nurse’s office in each school, are available to the teacher, and contain a com- plete inventory of defects, also a record of corrections made.