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, Elizabeth 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 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 I 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 and other cities where similar work is being conducted.