carried on by private associations of different kinds and so has borne for many the taint of charity, has been a distinct handicap to its spread.) The schools, moreover, have the confidence of all the people and in most families the word of the school is law. Therefore, much time and waste of effort are eliminated if we secure the schools as the medium for health education and training. Second, it is a great advantage to have health education an integral part of the regular curriculum in the schools, rather than have it super-imposed by special teachers from the outside. The child then recognizes health in its proper relation to his other activities. Up to the present time, of course, health has been the last consideration of even those schools where it has been included at all-academic standing always being the prime consideration. Many educators, however, are now realizing that if schools training is primarily a preparation for life, then training in health and food habits must be given first recognition in the school curriculum as the basis of any successful and efficient career. Many are, moreover, convinced that a perfectly well child is a much more teachable child than the half sick, physically handicapped, undernourished, and consequently apathetic and dull child. Third, another advantage is the possibility of using the forces already in the schools as a means of health education; that is, the medical inspection department, the physical education service, the domestic science department, the open-air schoolroom and the school luncheon, all of which may be made to contribute to the child's health program. Fourth, with very little adjustment, it is also possible to introduce the health angle into almost every study; to connect sources of food supply with geography; quantities of foods, caloric value, etc., a part of mathematics in all grades; to make health posters part of the art work; to make gains in weight and an improvement in health and food habits a definite test of the practical value of the lessons in hygiene, physiology, biology, etc.; to use the physical education department as a means of securing the corrective exercises, posture changes, and the rest and relaxation needed, as well as the gymnastics now provided; and to so order the school luncheon that it is a source of education in food values and in the choice of correct and well balanced meals. All of the methods, moreover, in the use of dramatization, stories, and graphic presentation that have made teaching of other subjects so successful can be very naturally brought to bear on the promotion of health lessons throughout the schools. Fifth, another advantage is the fact that most schools form a natural community center where the parent-teacher associations or meetings of citizens generally may be made the means of interesting the public in this new point of view towards health. All this work in the schools may be done with very little extra expense to the school system, if educators and the public once feel the vital necessity for including health education in the curriculum. Knowing, as we do now, that at least one-third of our school children are seriously underweight and that many more are suffering to some extent from physical defects, from bad food and health habits, there can be no question that our problem is a very large one. It may, however, be divided into two sections: first, the need for health education and actual training in health and food habits for every normal child; and second, the intensive special treatment which must be given to all of the children who are physically handicapped in any degree, or who are so much underweight that they need special care and instruction to bring them up to normal. Under the first section, general health education, I think the best work has perhaps been done in the public schools of Kansas City under the direction of Dr. Fred M. Berger, of the Physical Education Department, and Miss Maud A. Brown, director of hygiene. This health service has included the weighing and measuring of every child in 87 schools and their classification into three groups, as follows: those children up to average weight for height and over; those children 1 to 10 per cent underweight for height; those more than 10 per cent underweight for height. (Our experience in Chicago would lead us to suggest that the second group be made to include only those who are from 1 to 7 per cent underweight and the third group include all those 7 per cent or more underweight, since the child who is 7 per cent underweight, if not given care speedily, will join the 10 per cent group.) The Kansas City schools have adopted a clever device of giving individual tags of white to the children who are average weight and above, to those in the second group a blue tag, and to these the third, or seriously underweight group, a red tag. This leads the groups to be easily distinguished and points immediately to the children who are in need of special care. The teachers were interested in the plan and co-operated warmly: 83 out of 87 schools instituted a milk service for which the children paid, with very few exceptions; all kinds of games and posters were used in the promotion of health; and the teachers, under Miss Brown's guidance, found a thousand ways to make the subject of health interesting. As a result of this work the percentage of underweight in the schools was very definitely lowered. The children were also given instruction in food values, and the noon lunches were used to promote this study. Miss Brown spent a week in one school after the other, giving intensive lessons in food values and health habits to each grade, using a number of very ingenious divices to carry the lessons graphically to the children. Under the second section, the children needing intensive care, we should find the Kansas City classification very convenient to start with, because all children 7 per cent or more underweight for height, or the "red" card group, should if possible be placed in nutrition classes. The nutrition, or health, class, developed according to the methods of Dr. William R. P. Emerson, of Boston, has, I believe, been the best scheme so far devised for bringing the underweight child up to normal health and vigor. The work is based on the five reasons for malnutrition, which, according to Dr. Emerson, are: physical defects, lack of home control, over-fatigue, insufficient food and improper food habits, and a faulty health habits. The nutrition class forms the best method of bringing the parents in touch with the school and uniting the forces which may best be co-ordinated for the child's benefit; that is, the home, the school, the physician, the nurse, and the child's own interest. Experience with nutrition classes in Chicago has shown us that it is possible to interest the children very keenly in their own health program; that with a proper physical examination for every child and provisions for proper food and rest, and with education of the parents, it is possible to get children well in their own homes in a comparatively short space of time, without a very great amount of machinery or prohibitive expense. It has been shown that the school makes the very best center for this nutrition work, because the parents come to regard it as an integral part of the school program, and the health class takes its place in the child's mind in the proper relationship with all his other lessons and is at least of equal value with them. If we are to have all our children well, it is absolutely necessary to focus attention upon the underweight, malnourished group, as sick children. They cannot be treated as the normal up-to-weight children are, either in the home or the school program, and special modifications of both must be made for their benefit. These underweight children become frequently the victims of tuberculosis and other contagious diseases, to which they fall prey very readily; they form the group that was rejected in the army examinations and are those who go through life handicapped with poor health and physical defects. If this group is definitely taken care of and their defects removed, and all children given education in health habits and food values, there will be every reason to believe that the next generation will go far ahead of this one in resistance to disease and will develop much greater efficiency in carrying on the business of life. C. THE MODERN HEALTH CRUSADE AND THE NUTRITION MOVEMENT Charles M. De Forest, Modern Health Crusade Executive, National Tuberculosis Association, New York City No health agencies could more cordially welcome a systematic campaign against malnutrition than the anti-tuberculosis associations. Tuberculosis workers are prone to class all malnourished children as “pre-tuberculous.” Just as the tuberculosis associations have labored for open-air schools, with rest periods and lunches, they are promoting weighing and measuring and nutrition classes and clinics. Tuberculosis campaigners wish to multiphy the means of prevention, relief, and cure for adults, but that is not the strategy on which they ultimately depend. It was expressed the other day by a Montana reporter: "If you want to put this health thing across, you must catch the kids." The Modern Health Crusade launched by the National Tuberculosis Association is a drag net for catching the kids for health. In the last four years more than six million Crusaders have enlisted in a new chivalry, to become squires, knights, and knights banneret through health feats. In reality the Crusade is a system of teaching health by the actual practice of hygiene. It has been adopted by thousands of schools because it does not stop with teaching truths but secures action and imparts habits. The Crusaders' feats are real ordeals. They do week after week daily health chores that are abominated by the average boy or girl. The charms of health knighthood motivate the Crusader to faithful performance of the chores when no end of admonishing would. The weakness of health instruction in the past and under many present syst is that it lacks motivation to action and to continued action. Physiology and writers believe that "the truth shall make you free," but most of them have the necessary corollary, "Yes, but only if you act on it." Faulty as is our knowledge of health laws, it is enough to lengthen life if we apply it. The great lack is will to apply. The problem of volition 'Lantern slides were shown of nutrition classes and work under Dr. Emerson Elizabeth McCormick Memorial Fund in Chicago, under the Tuberculosis A and other cities where similar work is being conducted. urgent than medical research. Children do not need more knowledge of calories and vitamines. What they need is a rule of thumb, the formula boiled down from the Latin terms of scientists, and an everlasting will to apply. Many interesting and valuable stunts such as clowns and knighting ceremonies have been introduced. They supply children with the interest that must precede the will to act. And these stunts get action-for a while. But without follow-up, stunts are ephemeral. The much overlooked law of habit formation requires continuity of action. The desideratum is good health habits, and there is no short cut to habit. There must be repetition. The central fact in the Modern Health Crusade is not its stunts but the repetition of hygienic duties day after day for 15 or 30 weeks, and in many schools year after year. The Crusade creates and sustains interest so that will keeps functioning and repetition leads to habit. The purpose of this paper is not an exposition of the Modern Health Crusade. By a postcard you may secure the manual from the National Tuberculosis Association at New York, or from any of the 48 state associations. The purpose is to emphasize certain principles important both to the specialized nutritionist and to the more general worker in child health. The problem of health is twofold: both to escape the causes of disease and to build up strength for life's work, and to resist those causes of disease which are not escaped. There are so many of these causes and so many factors on which strength depends, that the problem is like that of a besieged city. Watch must be maintained against every form of attack, and the defense must be strong at every point. He who would live long and strong should remember Babylon, thick-walled but entered through the bed of a deflected river. It is no wonder that most men overlook some approach of the enemy, or weak spot in the walls, for so much medical advice stresses one factor to the apparent scorn of others. Following one line of advice, our attention is so given to avoiding infectious contacts that our neglected resistance is sure to break down under degenerative disease if not from the germs that get by us. One popular book full of practical advice on diet and digestion gives the impression that, with these right, infectious germs may be ignored; in fact, considered friends. A set of health rules for children, recently published, omits washing hands before meals, keeping infectious things out of the mouth, good posture, and other essentials. There is danger lest nutrition workers let their achings be one-sided. It is accordingly most gratifying to see nutrition ize the need of allaround health training. Bad posture bloc are needed by the malnourished. "Vigor of the pamphlets of the Child Health Orga If anyone believes that the health cam weight up to normal, his attention should be This is not cited to contend th underweight. The nutrition propaganda of Emerson is directed both against overweight and underweight, and emphasizes the need of removing various physical defects. The citation is made to illustrate the necessity of attention to many health factors, and not to a regimen limited to securing normal weight. The health rules inculcated by the Modern Health Crusade include not only food, air, exercise, rest, and posture, but exclusion of infection, cleanliness, healthful thinking, and co-operation for public health. Observe how nearly complete a code for child health is presented by the Crusade chores and explanatory notes. It should be remembered that every Crusader makes a mark of at least 75 per cent in the performance of chores repeated week after week. The following are from the record or score card for intermediate grades. 1. I washed my hands before each meal today. NOTE: You should wash your hands before handling any food prepared for eating. Soap should be used. 2. I washed my face, ears, and neck, and I cleaned my fingernails. 3. I kept fingers, pencils, and everything likely to be unclean or injurious out of my mouth and nose. Keep from your mouth anything bitten or placed in mouth by another person, and any cup, spoon, etc., used, since washing, by another person. Wash all raw, unpeeled fruits before eating. 4. I brushed my teeth thoroughly after breakfast and after the evening meal. Brush teeth up and down, both the front and back surfaces. Brush the biting surfaces. Brush after every meal, if possible, and rinse. (It is wise to use dental floss daily.) 5. I took ten or more slow, deep breaths of fresh air. I protected others if I spit, coughed, or sneezed. If you cough or sneeze, turn aside and cover mouth and nose with handkerchief. 6. I played outdoors or with windows open more than thirty minutes. I tried hard to sit and stand straight. The play required for this chore should give general muscular exercise. If you are as much as one-twelfth underweight, you should rest quietly at least thirty minutes in the daytime, and not play hard. Stand "tall." Lying down, be "long." Leaning forward, bend at the hips, not at the waist. 7. I was in bed ten hours or more last night, and kept my windows open. Boys and girls thirteen to sixteen years of age may perform this chore by nine hours in bed, but ten hours is better. Those under ten years should sleep eleven hours at least. 8. I drank four glasses of water, drinking some before each meal, and drank no tea, coffee, nor any injurious drinks. You may count drinking any time after one meal as "before" the next, except that d "before breakfast" must be in the morning, preferably at getting-up time. Have four or mo times. 9. I tried to eat slowly and only wholesome food including milk, vegetables, fruit. I went regular time. You should drink-slowly-two glasses of unskimmed milk daily. cereals, coarse breads, and vegetables like onions, turnips, and spinach. 10. I tried hard to keep neat; to be cheerful, straightforward, and cleanothers. 11. I took a full bath on each day of the week that is checked. Eat oatmeal or wh Is it any wonder that the Modern Health Crusade has prove malnutrition? For the average child, gain in weight and stren index of his progress in the Crusade, no less than his acc d; and to be helpf Boys should ht in und |