There is one other question in this subject fundamental to the whole plan of health in struction which must be considered. The question is frequently raised as to whether the work which has been done in the schools under the name of medical inspection, physical ex amination, etc., should be under the direction of the health authorities or the school au thorities. At first thought it may be desirable to have matters which relate to health under the health authorities. The primary pur pose of this phase of work in the public schools is now being accomplished through the schools to provide better educational advancement for all the children in attendance upon the schools. It is unfortunate that the terminology used in dealing with this subject at the outset was more of a medical character than an educational character. This was due to the fact that the work was first undertaken, as above stated, for the purpose of checking epidemics, etc. In the large cities where this work was first undertaken it was through the health depart ment and in some of such cities the health authorities still continue to supervise such work. The whole trend of thought during the last 10 years, however, and the general policy pursued throughout the country have been to place health instruction under the school authorities and not the health authori ties. About 87 per cent of all the work done in this country in relation to the health of chil dren in the schools is directly under the super vision of the school authorities. The United States Commissioner of Education'in his annual report in 1915 said: . .
"Two gratifying tendencies appear in recent legislative and administrative dealing with medical inspection: The broadening of the scope of medical inspection and the recog nition of the educational department as the proper admin istrative authority. They are interdependent." Very recently, by an act of Congress, the control of the health work of the schools of the city of Washington was transferred from the board of health of that city to the board of education. In Boston, the second city in the United States to begin this work, the health authorities were responsible for its supervision. Recently the work in that city was transferred from the health department of the city to the board of education.
It is only recently that the educational forces of the country as well as the people generally have begun to appreciate the service which may be rendered in the improvement of our economic and social conditions by provid ing thorough and scientific health instruction for every child in the country. The subject of health instruction has not been seriously considered as one of the great problems in the administration of the schools which should be attacked by the State itself. Provision has generally been made for the instruction in physiology and hygiene, in sanitation, etc. Medical inspection has been provided in most of the cities and in rural schools. Open-air schools have been established in several of the cities. Physical training has recently come into prominence. Oral hygiene has received only scant attention and the undernourished child has been considered occasionally. Under State authority all of these various phases of health instruction should be co-ordinated and a general program prepared and carried out in detail by all the schools of the State so that the physical development of every child shall receive the same definite consideration that has for years been given to the intellectual de velopment of the child.
A child has no discretion in this country as to whether or not he shall attend school. Neither have the parents of a child discretion in this matter. The American States have very generally declared under mandatory statutes that the interests of the country demand that every boy and girl from 6 to 14 years of age shall be in attendance upon instruction. If suitable instruction is not provided for a child by his parents either at home or in a private school, such child must attend the public school. The State has, therefore, stretched out its strong arm of authority and declared that every child must be in attendance upon school for a certain number of days each year and generally for a period of eight years. If the State imposes this obligation upon the child, is there not the obligation upon the State to see that such child is properly safeguarded in his physical development as well as in his intel lectual development? The results obtained in all parts of the country through medical inspection, the inves tigations made by leading foundations and other authorities show that more than 50 per cent of all the children enrolled in the schools are below normal physical standards. If all those having defective eyes and defective teeth were included, the percentage would be much larger. The annual report of the War De partment for the year 1916 shows that approxi mately 133,000 men of military age applied during that year for admission to the United States army. These men may naturally be presumed to have been in good physical condi tion. They were young men of the best physi cal type to be found in the country. They were required, in accordance with army regu lations, to undergo a rigid physical examina-. tion prescribed by the government. Approxi mately 22,000 of these men were ultimately ac cepted for service in the army and 111,000 were rejected. If the physical standards pre scribed by the government for admission to the army before we entered the World War had been strictly adhered to in creating the army for service in France, less than one-third of the enrolled men would have been accepted. Thousands of young men were not admitted to the service until they had received treatment and in many cases operations had been per formed to cure physical defects from which they were suffering. After this remedial treat ment these men were admitted to the service. There are also thousands of boys and. girls to school who have physical defects which inter fere with their physical and intellectual de velopment. The great function of the school is so to train and develop boys and girls that when they enter into the activities of the social, commercial and industrial life of the nation they shall possess the best equipment possible for efficient service in their own behalf and in behalf of society in general. One of the greatest assets which a girl or boy may possess when leaving school to become a worker and earner is a sound, healthy body. It is as much the function of the school to teach a boy how to care for his body and to see that proper treatment is provided for physi cal defects which interfere with his normal growth and development or with his progress in school work as it is to teach such boy how to read and to cultivate in him a desire for whole some literature. It is for this reason that several of the States have, within the last few years, enacted laws requiring medical inspection and laws requiring physical training in all the schools of the State.