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22.

23.

Extent of school health services, by agency responsible for
administration and for financing, in cities with population
of 2,500 or more, by regions: 1950..

Number and percent of school systems reporting personnel
available for school health services, and by region and city
population group....

24. Number and percent of school systems reporting number of
medical examinations required of each pupil enrolled in
school, including preschool, by region and city population
group

25.

Extent to which elementary school children are accompanied
by one or more parents at the medical examinations, by
region and city population group-

26. Extent of established methods whereby teachers may refer
children with suspected defects or health problems, by
region and city population group-

27. Number and percent of school systems reporting number of dental examinations required of each pupil enrolled in school, including preschool, by region and city population group__ 28. Number and percent of school systems reporting personnel who make school dental examinations, by region and city population group....

29.

30.

Extent of follow-through by the school to see that children
obtain dental supervision and care, by region and city
population group..

Extent to which sodium fluoride treatment of teeth is available to school children, by region and city population group. 31. Extent to which school nursing is provided, by type of service and by region and city population group

QUESTIONNAIRES

First: Survey of School Health Services..
Second: Survey of School Health Services - -

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V

FOREWORD

IN RESPONSE to increasing interest in the school health program, the Office of Education, since 1930, has made studies at regular 10year intervals of the school health services of our Nation. This study is the third one in the series to be reported.

The study, undertaken in cooperation with the Public Health Service of the Federal Security Agency and the American Medical Association, shows the present status of many phases of school health services in cities having a population of 2,500 or more in Continental United States. Certain trends are also indicated.

Dr. Cyrus H. Maxwell, formerly Chief of Administration of School and College Health Services, Office of Education, originated the study. Dr. Kilander who has carried the report to completion has been assisted in the preparation of the statistical data by Albert Pelley, Research Assistant.

The report should be of special interest to school administrators, school health service personnel, public health officials, medical and dental societies, parent-teacher associations, and many other individual groups.

WAYNE O. REED

Assistant Commissioner

Division of State and Local School
Systems

GALEN JONES
Director

Instruction, Organization, and
Services Branch

Health

Services

in

City

Schools

A

SCHOOL HEALTH PROGRAM is usually thought of as comprising three broad areas: (1) health education, including both separate and integrated instruction; (2) healthful school environment, including both physical and social aspects; and (3) school health services.

The study reported here deals with the school health service area of the school health program. Presented is certain information of a statistocal nature regarding health services in school systems of the 3,430 cities in Continental United States with populations of 2,500 and above.

The findings in this study indicate that considerable increase has occurred since the last previous study in the number of school systems having health services and in the scope of their school health programs. The study also shows that much still needs to be done in the United States if all our 30,000,000 school children are to have adequate school health service programs.

Historical Background of
School Health Programs

Certain significant landmarks in the growth of the school health programs prior to 1900 are here presented. 1

In 1872, a "sanitary superintendent" was employed by the Board of Education in Elmira, N. Y., because of the "alarming prevalence of smallpox."

In 1894, 50 "medical visitors" were appointed in Boston. These physicians visited the schools daily and examined "all children thought by their teachers to be ailing."

1 James F. Rogers. Health Services in City Schools. Washington, U. S. Government Printing Office, 1942. p. 1-2. (Federal Security Agency, U. S. Office of Education, Biennial Survey of Education in the United States, 1938-40, Vol. I, Ch. 5)

New York City followed the example of Boston in 1897 by the appointment of 134 medical inspectors.

In 1902, the first staff of school nurses was appointed in New York City.

In 1899, the State of Connecticut required the examination of all school children by teachers for defects of vision and, by 1905, many school physicians had become interested in the search for these and other physical faults. Laws in this field are now on the statutes of nearly all States. Since 1900, the development of the school health service has been rapid as compared with that of prior years.

Survey of School Health Programs

The first Nation-wide survey of school health programs, including school health services, was made in 1922. Periodically since that time additional studies have been made. These studies are here briefly listed and described.

1922: The Joint Committee on Health Problems in Education of the National Education Association and the American Medical Association issued a report 2 on certain phases of the school health service program.

1923: A survey 3 was made by the Bureau of Education, Department of Interior, to "determine present efforts and ways and means put forth for health work in schools." It included cities of all sizes and dealt with health services, physical education, and health education.

1930: A survey 4 was conducted by the Office of Education, Department of the Interior, in response to a request from the Committee on the School Child of the White House Conference on Child Health and Protection. The study dealt with "a series of questions in regard to what is being done by special means toward the conservation and promotion of the health of children." The questionnaires went to superintendents in cities over 2,500 population and to county school superintendents.

1940: The Office of Education, Federal Security Agency, made a survey 5 of school health services. The study concerned various phases of the health services, similar to the study in 1930, but cities with a population of less than 10,000 were not included.

Health Services in City Schools. Report of Joint Committee on Health Problems in Education of the National Education Association and the American Medical Association. Washington, The National Education Association, 1922.

James F. Rogers and Frank M. Phillips. Progress and Prospect in School Health Work. Washington, Bureau of Education, Department of Interior, 1925.

James F. Rogers. School Health Activities in 1930. Washington, U. S. Government Printing Office, 1931. U. S. Office of Education, (Pamphlet No. 21.)

James F. Rogers. Health Services in City Schools. Op. cit.

In addition to these earlier studies of school health services, several related and supplementary reports have appeared in recent years, as follows:

1947: The Academy of Pediatrics study of child health services. 6 Certain aspects of school health services were included in the comprehensive nation-wide study of child health services. This study was carried out by the Academy with the cooperation of the Public Health Service and the Children's Bureau of the Federal Security Agency. Each of the 3,000 counties in the United States was included in the survey.

1947: A status study 7 was made by the Office of Education of the State administration of school health, physical education, and recreation.

1949: A study 8 was conducted by the National Education Association of personnel and relationships in school health, physical education, and recreation in cities over 2,500 population.

1950: A study was made of physician participation in school health service programs by the American Medical Association. A questionnaire was directed to all local medical societies in the 48 states, the District of Columbia, and the Territories in order to determine the extent of medical society interest and physician participation in the school health program. The study was made in cooperation with the Office of Education.

1950: A report 10 was prepared by the Office of Education, in cocoperation with the American School Health Association, of the organization of health instruction in the secondary schools.

Survey Procedures

The information presented in this report has been obtained through two questionnaires. The first one was mailed out during the school year 1949-50, and the second one, during the school year 1950-51. To simplify the use of dates in the report, the year 1950 is used as the reference date. The first questionnaire On the first questionnaire, information was requested as to whether a school system had school health services avail

• The Commonwealth Fund. Child Health Services and Pediatric Education. New York, The Commonwealth Fund, 1949.

7 Frank S. Stafford. State Administration of School Health, Physical Education, and Recreation. Washington, U.S. Government Printing Office, 1947. (Federal Security Agency, Office of Education, Bulletin 1947, No. 13.) Personnel and Relationships in School Health, Physical Education, and Recreation. Research Bulletin, October 1950. Washington, D. C., The National Education Association.

• Fred V. Hein and Donald A. Dukelow.

The American Medical Association, 1950.

Physician Participation in School Health Services. Chicago,

10 H. F. Kilander. Health Instruction in the Secondary Schools: An Inquiry into Its Organization and Administration. Washington, U. S. Government Printing Office, 1951. (Federal Security Agency, Office of Education, Pamphlet No. 110.)

212792-52-2

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