not only as individuals and families but also as groups and as a community as a whole. This community work is being done in various ways, such as the development of Little Mothers' clubs, classes in home hygiene and care of the sick, health leagues and other classes and clubs, baby weeks, exhibits at county fairs, health parades and other public group activities. Undertakings of this kind tend to establish in the counties and the community as a whole a popular understanding of the need for health and for the development of public health nursing.

We find that our nurses must be not only technicians in public health nursing, but organizers and leaders as well. They must not work alone as highly trained specialists, but must learn to work with and make use of the untrained people of their communities. The organization of the people around the nurse's work is one of her most important duties. These problems of organization are new ones for the majority of our nurses, in the solving of which they need much guidance. We are trying to provide this guidance through maintaining a strong staff of supervising nurses, through group conferences originated and convened by the Red Cross or by the State Bureau of Public Health Nursing, through long distance guidance from our division offices, and through the assistance of the National Organization for Public Health Nursing, which is one of our staunchest friends and supporters.

We are not looking forward to much expansion of our work during the coming year. Our service is already a large one and needs all of our attention to strengthen and improve it. We feel keenly our responsibility for the soundness of every service we have created. We want each one of our services to be in flourishing condition, a distinct asset to the community, well understood and believed in by the people of the community before it is turned over to the public authorities. Eventually the great majority of the services started by the Red Cross will become public services maintained by the local or state government. It is our duty to see that these services are strong and vigorous and of high standard when they are turned over to public control.

We are very much interested in the progress our states are making toward the public assumption of responsibility for the maintenance and direction of public health nursing. A goodly number of our states now have bureaus or divisions of public health nursing in the State Department of Health, with which we are closely working and in which we strongly believe. We are also glad to see that public officials are becoming more broad-minded in their understanding of public health nursing as a public function and are beginning to see the propriety and importance of including in a state program nursing care and the social aspects of public health nursing as well as the narrowly preventive aspects such as the control of communicable diseases. The day is not far distant and has already come in some localities when public health nursing conducted by public authorities will be as broad and fi as is that now being carried on under private control.

One interesting problem which we find ourselves runni

raised by the fact that it seems necessary to have several differe
in our counties in order to accomplish the essential social tasks.

need a public health nurse, a home demonstration agent, a nutrition special
worker, and possibly a recreation specialist as the least number required to m
most pressing social needs. Our county tax budge

to maintain all these workers. Which ones shall we

or three? Are we to look forward to further specia

I

HEALTH

of the workers needed in the county, or can we work toward fewer y few more broadly educated so that they need not be confined to se I have no solution to this problem and am simply throwing it out a

consideration which we shall have to face before long.

bu

In closing I want to say that we in the Red Cross Public Hea feel that we are most fortunate because we are still in the pioneer stage a We are having all the pleasure that comes from creative work, problems and arriving at new solutions, from feeling our way and was methods as we go. Throughout this creative period especially we d social workers and doctors in thinking over and arriving at solutions to cu arrive at our goal, which is undoubtedly a common goal, more speedily a You, too, are undoubtedly struggling with the same kind of new w and in better condition if we do some of our working and thinking tog beg we try to solve our problems without consultation. It speaks well for not interest and cordiality of feeling that public health nursing in its relation tha work is being discussed in no less than three different sessions of this core life are glad to have had this privilege and shall do our best to make it a ma

cementing our friendship more firmly and lastingly.

SOCIAL SIGNIFICANCE OF CHILD HEALTH WORK

fail

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we

dise Th Com

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and

A. THE PSYCHOLOGY OF HEALTH HABITS
J. Mace Andress, Child Health Organization of America, Boston
cance. Even the man in the street would consider the matter undebatable.
This audience does not need to be convinced that health is of fundamentals of E
numerous books on educational philosophy we have considered physical devel ther
we have responded to a considerable extent as if we were unconscious of their exist
as one of the trinity of educational aims. Notwithstanding our beliefs and our t
seldom shown much interest in the health of its pupils. Parents and teachers
Our traditional school has emphasized reading, writing, and arithmetic, b tions
expected the children to improve in arithmetic and in morals possibly, but they
seldom expected that they would really improve in their health, yet this is the b

of success and happiness in life. With the possible exception of innate intelli
it is the most valuable capital of any individual. In some respects it is even

The newly awakened interest in health and the organization of the Child Hea
fundamental than intelligence, for without health intelligence may cease to functi

Council are indications that ere the end of another decade we as a
that children in going to school shall conserve and retain their health.

people shall dem

when Horace Mann was instrumental in introducing physiology into the curriculum The first efforts looking forward to the health of the school child was in 1 It was a crude attempt lacking in vision and psychological and pedagogical insight

littl

acqu

Modern preventive medicine as we know it today had not begun. There was
on a science of hygiene. The definite knowledge possessed was in the realm of anatomy
consequently the first books for children dealt with anatomical facts which the children
were supposed to commit to memory religiously. Some of these books contain extracts

caref

of th Succe

parer etc.

to co estim

most which and q

and s

sonal

the so

T

child

the county, profitably go into Life. From a book published in 1884 I take the following

d so that they

pemblem and an

QUESTIONS ON THE NOSE

a. have to face be is the nose? In the middle of the face.

the parts of the nose.

that we in the ice is the tip of the nose? At the end of the nose.

mate because we are sve is the bridge of the nose? At the top of the nose between the eyes.

ure that comes b

re is the cartilage? In the middle of the inside of the nose.

hat use is the nose? To smell and breathe through.

sevations, from t are the nostrils? The openings inside of the nose.

this creative peut

hat use are the nostrils? To let the air into and out the opening back of the mouth.

ng over and amme subject-matter in our textbooks has changed considerably since those days, with the ch of it is still antiquated in its content. Unfortunately teachers are still medy a command with the idea that facts mean power, regardless of the facts. We have just me of our to realize as a result of the newer behavioristic psychology that it is action, consultation anere knowledge of facts, that counts. There is a general consensus of opinion Pubic heate teaching of hygiene in our public schools has failed to touch the emotional tree different the child and to inspire appropriate action. In a word it has been a colossal shall do our be. Our most enlightened efforts now are directed toward getting children to those habits of action that make for health.

lastingly,

It is only recently that we made the discovery that growth is an index to health. the child's business to grow. If he fails to gain in height and increase in weight CHILD now that something is wrong. Either he has some physical impediment such as

sed tonsils and adenoids, or he is not practicing the rules of healthy living. HEALTH Eough the weighing and measuring of children we have a rough test of health parable to the tests recently developed for school subjects. Realizing the imporration of Amra ce of this discovery the Child Health Organization and the United States Bureau at health is ducation are now carrying on a spectacular campaign to get scales in every school the matter med to have all children weighed and measured. The desire to gain in weight normally Insidered prefore becomes a powerful incentive in habit formation. Instead of fostering the ing our besquisition of facts we are now intent on forming habits.

Habits take time, a long time, to form. They are formed through many repetiand tons, and interesting repetitions. This means that training the child necessitates arents areful supervision over him for a considerable length of time. This is the opportunity possit the teacher. It is through vigilance and ingenuity that we shall eventually win hyet access. But the teacher cannot win the battle alone. She needs the support of the of narent, school physician, school nurse, physical director, domestic science teacher, cts tc. There is one goal-the health of the child-and all these different forces need to combine to win success. At the present time each of these forces is likely to underhe Chestimate and disregard the other.

le shi

This great movement in the health training of children is in harmony with our most progressive educational thought today, which is emphasizing subject-matter which will meet the practical needs of everyday life, the formation of health habits and qualities of intelligence and character such as initiative, self-control, self-reliance, is and social consciousness. Health habits should be linked up with social ideals. Per#sonal efficiency is not wholly a matter of personal advantage. It is for the sake of the social group.

The possibilities of health teaching as a social leaven are tremendous. Every child carries the message "How to live" back into the home, and so affects matters

seraining a fies, sitation warzowing, etc. If we can inspire in the children of today deals foran minimum vial standards they will in adult life insist on nding how "hings for themselves and aerially for their children. This is the gal of was wice wority of the people in helping themselves to better social

conditions.

Bery whool whyer has its pesiar psychology. Health teaching has its informationa, ade da nanit site. We try in all our schools to grade instruction what it will stifferent and increasingly fitficalt in each grade. This is not possible nra arata trencamet see children need to begin to practice all the funda menta arata in the aderaren wir grade, and that training needs to continue through uil the trades of the school. The center of all this training is to teach every boy and bet the thing he ought to be taught when he needs it. If this plan were followed from the dergarten through the high school we would have a product in heuth at the end of the whoot period that we could be proud of. While the funda menta, narata nat are to be attacked will remain the same through all the grades, the information to be presented must be varied from grade to grade so as to grip the imagination and emotions of the child and give him further insight and appreciation.

The last low or fore years have witnessed remarkable activity in health teaching. There is no head of teaching that has nown such initiative, inventiveness, and origi wanty. ht da eat it has succeeded to a remarkable extent in enlisting the child's emchana and activities through the various methods of play. Let me illustrate the old and new method of teaching by concrete examples. Miss M. says: "Children, we are going to talk today about eating vegetables. Each of you may imagine that you are a vegetable and tell me a story about yourself." Mary gets up at the end of the class and says: "I am a great green head of lettuce. I live out under the blue axy. The ram falls upon me and keeps me clean. The sun shines and keeps me dean. Vat me and you will have a good complexion." John says: "I am a big red best. I have roots that go down deep into the ground. In the ground there is iron. The iron goes into the beet. Eat me and you will be strong."

Miss O, says to her class: "We shall have a lesson on vegetables today. Please remember everything I say, for I shall ask you about it. First of all let us talk about lettuce, Lettuce is good because it helps to give you a good complexion. Beet contains iron and will help to make you strong."

The next day she says to Mary: "What can you say about the value of lettuce ?" etc.,

It is evident as to which lesson is interesting to children and gets them

right attitude to begin to practice a habit.

It is my conviction that every class should be a health class. If health is popular in every grade, made fashionable throughout the school, I believe we shal able to train the vast majority of the children to be healthy. number of cases, however, that will not yield to regular in we need to have in our school systems special health clas nutrition clinics which distresses the lay mind) where m methods may be used to get results. The special health clu beginning of this movement but at the end, but it should even in probably every school system. It is just here that the or outside of the school may assist in establishing such classes. Th

thropic organization is its ability to eliminate itself and make itself unnecessary. One of your opportunities is to demonstrate to the public the value of such a special health class until such time as the school is ready to incorporate it as its own.

B. WHAT STATE DIVISIONS OF CHILD HYGIENE ARE DOING TO PROMOTE CHILD HEALTH

Ada E. Schweitzer, M.D., Director, Division of Infant and Child Hygiene, Indiana State Board of Health, Indianapolis

Child hygiene divisions in the states have multiplied in the last three years. Two outstanding causes may be assigned for the growing interest in child health; first, the need of early correction of defects as shown by the somewhat astounding results of the draft examinations and, second, the nation-wide interest in child health aroused by the Children's Year program.

The number of states having divisions of child hygiene in 1918 was eight. By 1921 the number had increased to thirty-eight.

The majority of these divisions are under the supervision of state boards of health. Other agencies which have partial supervision and which furnish partial financial support are departments of education, the United States Public Health Service, state and national public health associations, the American Child Hygiene Association, the Public Health Nursing Association, pediatric societies, the Red Cross, the Federal Children's Bureau, and the Anti-tuberculosis Association. In many states community aid is given to projects initiated and fostered by state divisions of child hygiene.

In some states public health nursing is being developed as a division of the child hygiene bureau, in other states as an independent division.

A general purpose and plan of work is common to all states. Each seems to have adopted certain minimum standards of care for mothers and children, and each is trying to educate the general public and to secure the establishment of its standards in all the communities under its jurisdiction. The working plan of the older divisions especially that of New York state, is the basis of that of many other states. On the other hand, several states have developed original plans that are worthy of consideration. These will be commented on by subjects.