try. To this end an advisory committee composed of prominent physicians who have had practical experience in issuing certificates permitting children to work was appointed at the close of the Washington Child Welfare Conference in 1919. These physicians have contributed their expert advice in formulating minimum physical requirements for children entering industry.

The work of the Social Service Division, which is concerned with children in need of special care-the dependent, defective, and delinquent-necessarily touches upon the problems of physical and mental health. There have always been many points of contrast between this division and the Hygiene Division, and joint studies by the two divisions are contemplated.

It is not the intention in this brief résumé of the health activities of the Children's Bureau to stress unduly the health side of the Bureau's work. The aim has been to illustrate the advantage of all possible and necessary co-operation between medical and social fields.

Preventive medicine affords a common meeting ground for the medical and social sciences, both aiming at effective education. It presents a field so vast that the contribution of each is necessary in the co-ordination of scientific methods and the popularization of their practical results, thus making for individual and community intelligence and efficient service.

physical condition, after having their tonsils or adenoids removed. Malnutrition, they say, is generally the secondary result of handicap of some kind which the clinic can remove. They believe that if sufficient food is available, the choice of articles which enter into the diet is a matter of relatively slight importance. We believe that this view can survive only in the minds of those whose knowledge of modern research in nutrition is archaic.

On the other hand among our visitors are not a few who feel that almost the antithesis of this view is really the sound one. They have been occupied in teaching boys and girls of school age what to eat and how much to rest, and, without any surgical treatment, numerous children under their observations have resumed growth, and have developed a health appearance, even though harboring large tonsils, or carrying other handicaps to health. These workers remark upon the extent to which a properly nourished child can tolerate poisoning through infected tonsils or absessed teeth, and still maintain its normal rate of growth. There is much evidence that this is true, but this fact does not serve as an argument against the clinic.

There are many cases of children showing all signs of malnutrition who have had at least a diet sufficiently good to have enabled others in the family to grow in an apparently normal manner. Such cases can only be accounted for on the basis that there is some other factor which is primarily responsible for their poor condition. In most cases the children of this group have been injured by one or more of the contagious diseases of childhood and have not been able to overcome their handicap. There seems much reason to believe that throat and nose infections are in most instances the sequel to such injury in infancy or early childhood. Where a pathological condition has definitely developed the rational thing to do is to introduce surgical treatment where it has a prospect of success. Only those who take a narrow view of the subject would be inclined to deduce from such evidence that attention to diet is a matter of relatively little importance in such cases.

Everyone now accepts the view that there are fundamental similarities in the physiological processes of man and the lower animals. Almost all that we know abort human physiology is based upon deductions from experimental results obtained wi animals. In a comparable degree we have derived our knowledge of the principle nutrition. There are several diseases of man which are directly caused by speci faults in the diet. These can be produced experimentally in animals, and their natur and causes are well understood. Animals require the same foodstuffs for their maintenance and growth as does the human species. We have in recent years gained a most remarkable amount of knowledge of the extent and manner in which a properly selected diet can promote health. Few are familiar with the result reason that they are new, and that they have appeared in which it was not easy to study with sufficient care to mast as absurd for anyone, whatever his technical attainments in to form an independent judgment as to the bearing of food is for one who has no detailed knowledge in any field to as comparable to an expert in that field.

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Space will not permit more than a few passing remarks on the subject of our discussion here, but a certain feature of the problem looms up larger and larger as our experience becomes more extensive, that is, that irrespective of the agency which operates to improve the physical condition of our children, the work which is being done with the child of school age is essentially a salvaging operation. We may remove a focus of infection, free it from difficult breathing, repair its teeth, or teach it personal hygiene, but we are at best but repairing, for temporary service and temporary relief, a damaged human being. By the time a child has reached school age it is already past the time when anything but fundamental in establishing a vigorous constitution can be done. We can add many years to its life in many cases, and increase comfort and happiness, and make it a more useful citizen, and this reward is sufficient to warrant all the effort which we can expend upon it. The extent to which we shall meet with success will depend in great measure on inherited vitality.

The opportune time to attain the maximum benefits of proper nutrition is in prenatal life and early infancy, and more effort should be directed toward education of mothers concerning the benefits to be derived by their children as the results of right living on their part. Before the teeth are erupted their enamel is already formed. If it fails to form a satisfactory union in the places where it meets as it extends away from the primary centers of enamel formation on the cusps, no amount of care and scrubbing will serve to preserve the tooth. The time when the teeth are forming is a critical one in the life of the child, and the secret of preventive dentistry lies here, in proper diet of the mother during this period. This goes far back of the school clinic and of the age at which other agencies are attempting to reach the child and teach him health habits. Once the teeth are formed they cannot be improved in any marked degree, but we are in possession of information which would gradually bring us back to the condition of satisfactory dentition enjoyed by our ancestors.

In conclusion, therefore, we would call attention again to the types of diets which succeed in the nutrition of man and of animals. They are the strictly carnivorous type, in which practically all parts of the animal are eaten; the type so common in parts of the Orient, viz., that in which the leafy vegetables, such as spinach, cabbage, lettuce, turnip tops, beet tops, and other leaves, find a prominent place in the diet; and lastly the diet such as we use in America, containing liberal amounts of milk and other dairy products. The trouble is we do not consume enough of the protective foods, milk and the leafy vegetables. These are so constituted as to correct the faults in a cereal, legume seed, tuber, and meat diet such as is so common in our country today. The sooner we carry this information to every child in the land and send him home with this message to his mother, the sooner will we have started on the right road toward better health and better physical development.

B. WHERE SHOULD NUTRITION SERVICE NEXT BE CENTERED, IN THE SCHOOL OR IN THE CHILD'S OWN FAMILY?

Mrs. Ira Couch Wood, Director, Elisabeth McCormick Memorial Fund, Chicago

Under ideal conditions every child should be so protected by intelligent home care, or by enlightened community interest, that he is physically prepared to begin his school career at six years of age. This would mean preliminary education in

health habits, and removal of all physical defects, and food habits so well established that he could stand the strain of school life.

The ideal is so far from realization that there is almost nothing done at the present time for the preschool-age child. The task of educating the parents is a colossal one, and there is neither enough money nor enough machinery to undertake this task at public expense.

Infant welfare stations and child health centers are growing, but are still inadequate to meet the need of the children in the preschool-age period. Extension of child health centers and the creation of new machinery to meet this need would take such a length of time and amount of money as to be impractical at the present time, and moreover public opinion is not yet educated to the point of providing adequate community support for medical and health service.

Therefore, we are forced to use the piece of machinery at hand which is best adapted to an educational purpose; that is, the schools. On them most children must depend for the correction of physical defects which are hampering their progress and for the training in health and food habits essential to their well-being. We have, moreover, already made a beginning of health work in many cities and towns through the medical inspection department of the schools which often provide physicians and nurses for the service of the children.

From the new point of view of training in health habits as a fundamental in all education, it will be necessary, however, to extend and broaden this medical inspection service, and to so educate the physicians and the nurses now engaged in school inspection that they will see in their offices something more than the prevention of contagion, and will realize that what will be demanded of them in the near future is nothing less than a complete program of health for every child. In this enlarging vision of health service in the schools, a more definite co-ordination must also be worked out between the teaching staff, the physical education department, the home economics department, and the medical inspection department, so that all these forces may work harmoniously together to lay the firm foundations of health for every school child. To secure the practice of this enlarged conception of health education in its vital relation to the schools, it will be necessary to present the program adequately at all normal schools, colleges, medical and nursing schools, and departments of home economics and physical education, so that young men and women in their most impressionable student period may have the instruction which will prepare them to act as leaders in the new health crusade.

General propaganda of all kinds and through all mediums must also be carried on vigorously so that the public at large may require of its representatives on boards of education such a conviction of the value of health education as will lead them to demand the carrying forward of this program for the benefit of all children in the school systems. Any procedure adopted by the school board spreads of course to all of the school officers, so that the conversion of people at the head of the school systems to the new point of view in health education would eventually carry with it all of the active forces of the schools.

The definite advantages of having health education carried on in the schools are: First, the schools are supported by taxation, making them instruments for the service of all the people as distinguished from any philanthropic effort, however fine. (The fact that up to the present time health teaching has been almost entirely