Form 54. 
Commonwealth of Pennsylvania 
DEPARTMENT OF HEALTH 
DIVISION OF SCHOOL HEALTH 
Instructions to Teachers 
HARRISBURG, PA.: 
1920 Form 54 
Commonwealth of Pennsylvania 
DEPARTMENT OF HEALTH, 
DIVISION OF SCHOOL HEALTH 
Instructions to Teachers 
HARRISBURG, PA.: 
1920 2 COMMONWEALTH OF PENNSYLVANIA 
DEPARTMENT OF HEALTH 
DIVISION OF SCHOOL HEALTH 
Instructions to Teachers 
Intelligent cooperation on the part of school teachers and public 
health officials is extremely important for the well-being of the school 
child. In order that teachers may be thoroughly familiar with their 
duties as provided for by law and that they may be of greater assis- 
tance to the State Department of Health in its efforts to control com- 
municable diseases and to better the health of the school child, these 
instructions have been prepared. 
In order to comply with the School Code (Section 1505), it be- 
comes your duty to send the reports of the Medical Inspection of all 
pupils of your school needing medical, dental, ocular, or surgical 
care to the parents or guardians of such pupils. 
The Teachers Follow-up Report, Form 51-B, contains the names of 
pupils for whom treatment is recommended. Notices relating to the 
individual pupil are enclosed. These you will kindly seal and hand 
to the respective pupils with instructions to deliver to their parents 
or guardians. 
Under the heading "Affection" on the Follow-up Report, Form 
51-B, are enumerated the defects for which treatment has been rec- 
ommended. Form 51-B is to be kept by you throughout your school 
term, during which time you will please keep these pupils under 
careful observation, inquiring whether treatment has been procured 
to remedy the defects, recording "Yes" in the proper column or 
columns for "Medical," "Dental," or "Ocular" treatment, and under 
"Tonsils" or "Adenoids" if they have been removed. "CL" should 
be entered in the "Dental" Column for teeth regularly cleansed, 
without other dental treatment. If vision was affected and glasses 
have been fitted, enter "Glasses" in the "Ocular" column. If treat- 
ment for a defect is promised,, enter "Prom." in the proper column. 
If a pupil has received no attention whatever for defects reported, 
write "None" in the first or "Medical" column, leaving other columns 
blank. 
Under "Results Noticed" briefly state whether the pupil is im- 
proved, greatly improved, unimproved, or worse. 
The data required to answer questions 2 to 7 on this report should 
be obtained from time to time through your recitations on the sub- 
ject of Hygiene and should include all pupils in your school or grade. 
NOTE: The instructions on this page apply only to teachers in 
Fourth Class School Districts. 
3 4 
Considerable tact must be used to get correct answers and at the 
same time impress upon the pupils the value of dental care, open 
windows, and abstinence from-the use of all stimulants. 
Ten days before the close of your school term or not later than 
June 1st,-should your term extend beyond that date,-mail the re- 
port to the Department of Health with the required items carefully 
recorded. Do not fail to return the report even though no pupil has 
received treatment-stamped return envelope is enclosed for this pur- 
pose. 
If you have occasion to write to the Department, always mention 
township or borough and county in which you are teaching. 
Additional duties of school teachers may conveniently be divided 
into those that are imposed upon them by law and those which they 
should assume in the great work of creating a more perfect environ- 
ment in wThich the school child may develop. 
PUBLIC HEALTH LAWS AFFECTING TEACHERS. 
1. Reporting Retarded School Children. Section 1413 of the 
School Code as amended July 24, 1919, requires that "Teachers shall 
secure information and report to the medical inspector of the school 
district on or before the fifteenth of October of each year, every child 
within said district between the' ages of eight (8) and sixteen (16) 
who is gravely retarded in his or her school work or who because of 
exceptional physical or mental condition is not being properly edu- 
cated and trained." 
The teacher should prepare a list of retarded children and submit 
the same to the medical inspector when he visits the school. For the 
information of subsequent teachers it is best to prepare the list at the 
end of the school year. When the school reopens it will be a simple 
matter, even for a new teacher, to formulate an accurate list of the 
retarded children. 
2. Reporting Symptoms of Disease and Excluding Pupils from 
School. Section 9. That every teacher, principal, superintendent, or 
other person or persons in charge of any public, private, parochial, 
Sunday, or other school, having in any such school any child or per- 
son showing an unusual rash or skin eruption, or complaining of sore- 
ness in the throat, or having symptoms of whooping-cough, or any 
disease of the eye, shall immediately exclude such child or other per- 
son from the schools, pending the action of the health authorities, 
and shall report such fact to the health officer of the city, borough or 
township, giving the name and residence of such child or other per- 
son. Act of July 17, 1919. 
3. Readmission of Pupils to School on Certificate from Health 
Authorities, Registration of Pupils, Inspection of School Register. 
Section 10. No child or other person, excluded from any school by 
the provisions of this act (Sects. 7 & 8, See Table) shall be readmitted 
thereto unless he or she, or some person on his or her behalf, shall 
furnish to the principal, superintendent, or teacher, or other person in 
charge of said school, a certificate setting forth that the conditions 
for such readmission prescribed by this act have been complied with; 5 
which certificate shall be signed by a person to be designated for that 
purpose, in cities, boroughs, and townships of the first class, by the 
health authorities thereof, exclusively; and in townships of the sec- 
ond class, and cities, boroughs, and townships of the first class, not 
having boards of health or bodies acting as such, by the State Depart- 
ment of Health; and the registry of all public, private, parochial, 
Sunday, and other schools shall exhibit the names and residences of 
all children and persons excluded therefrom or readmitted thereto, 
agreeably to the provisions of this or any other Act of Assembly; and 
said register shall be open at all times to the inspection of the city, 
borough, or township authorities and the State Department of 
Health, and their respective officers and agents. Act of July 17, 
1919. 
4. Penalty for Violations. Section 26. ****** * 
* * * * * Any physician, undertaker, teacher of a public 
school, principal of a school, superintendent of a Sunday school, sex- 
ton, janitor, parent, or guardian, or any other person or persons, who 
shall fail, neglect, or refuse to comply with, or who shall violate, any 
of the provisions of this act, shall, for every such offense, upon con- 
viction thereof in a summary proceeding before any magistrate or 
justice of the peace of the county wherein said offense was com- 
mitted, be sentenced to pay a fine of not less than twenty ($20) 
dollars or more than one hundred ($100) dollars, to be paid to the 
use of said county, and costs of prosecution, or to be imprisoned in 
the county jail for a period of not less than ten or more than thirty 
days, or both, at the discretion of the court. Act of July 17, 1919. 
VACCINATION. The Vaccination Law and the Rules and Reg- 
ulations of the Department of Health are quoted in full for the infor- 
mation of the inspector. 
THE VACCINATION LAW. 
Section 12. It shall be the duty of all school directors, superin- 
tendents, principals, or other persons in charge of any public, private, 
parochial or other school, to refuse the admission of any child to any 
of said schools under their charge or supervision, except upon a cer- 
tificate signed by a physician, setting forth that such child has been 
vaccinated and that a subsequent examination reveals a resulting 
cicatrix indicating successful vaccination, or that vaccination has 
been performed according to the rules and regulations promulgated 
by the Commissioner of Health, with the sanction and advice of the 
Advisory Board of the Department of Health, or that it has 
previously had smallpox. All certificates of vaccination shall be 
issued in accordance with the rules and regulations promulgated by 
the Commissioner of Health with the sanction and advice of the 
Advisory Board of the Department of Health. Act of June 5th, 1919. 
THE RULES AND REGULATIONS CONCERNING 
VACCINATION. 
"Inspection and Certification. Eight to fifteen days after vaccina- 
tion the vaccinating physician shall inspect the site and if a typical 
vesicle has appeared shall issue a certificate of successful vaccination. 
Under no other circumstances shall he issue such certificate. 6 
All certificates of successful vaccination shall be in the form pre- 
scribed by the Commissioner of Health and shall state that the 
vaccination site was thus inspected subsequent to vaccination and 
found to indicate successful vaccination. (Form 75.) 
Certificates confirming previous successful vaccination as shown 
by cicatrix or of previous smallpox as shown by cicatrix, may be 
issued by legally qualified physicians on forms prescribed by the 
Commissioner of Health. (Forms 76 and 77.) 
The Department of Health will countenance the admission to 
school of a child during the eight to fifteen day period which must 
elapse between the time of vaccination and the issuance of a cer- 
tificate of successful vaccination. 
If, at the expiration of this period, the child fails to submit a cer- 
tificate of successful vaccination, said child must be excluded imme- 
diately from school; provided that, if a second vaccination is made at 
once, the pupil may remain in school until a second period of from 
eight to fifteen days has expired whereupon exclusion will be en- 
forced unless a certificate of successful vaccination is submitted to 
the school authorities, or unless a temporary certificate of vaccina- 
tion is submitted to the school authorities. 
Temporary Certificates in reference to vaccination shall be issued 
only by the County Medical Director, his authorized deputy or the 
medical officer of a borough or city Board of Health, each for his 
respective community. 
Unsuccessful Vaccinations. When a school child has been twice 
unsuccessfully vaccinated within a period of three months he may 
be admitted to school after being again vaccinated, free of charge? 
by or in the presence of the County Medical Director, his authorized 
deputy or the medical officer of a borough or city Board of Health. 
A temporary certificate (Form 75-A) will be issued by said officer 
and it may be countersigned by the attending physician. Said cer- 
tificate will admit the child to school for a period of one year only. 
If success results from this third vaccination a regular certificate 
of successful vaccination shall be issued by the officer who issues 
the temporary certificate, after a typical vesicle or a typical cicatrix 
has appeared. 
Alleged Physical Unfitness for Vaccination. When the family 
physician claims that physical conditions contraindicating vaccina- 
tion exist in the school child, the County Medical Director, his au- 
thorized deputy or the medical officer of a borough or city with an 
organized Board of Health shall examine the child resident therein 
and decide whether physical unfitness for vaccination exists. If pos- 
sible the said family physician shall be present at the examination. 
If vaccination is deemed inadvisable a temporary certificate con- 
spicuously marked "Good for Current School Year Only" and 
authorizing the admission of the child to school for this period shall 
be issued and signed by the said officer. This authorization will 
admit the child to school for but one year, after which he shall be 
vaccinated or excluded from school. 
Re-Issuance of Temporary Certificates of Vaccination. When a 
temporary certificate of vaccination has become invalid by virtue of 
the expiration of the current school year, the school child holding 7 
said certificate must again be vaccinated, free of charge, by or in the 
presence of the County Medical Director, his authorized deputy or 
the Medical Officer of a Board of Health. Said officer shall then 
issue a new temporary certificate (Form 75-A) good for the following 
current school year, only. The certificate may be countersigned by 
the attending physician. 
Lost Certificate. The School Medical Examiner or the family 
physician may issue to any school child who has no certificate of 
vaccination but who has been successfully vaccinated a certificate 
upon Form 76, after examination and determination that a clearly 
defined vaccination scar exists. If sufficient evidence of previous 
smallpox exists he may similarly certify upon Form 77. Such cer- 
tificate will be accepted by principals or teachers in lieu of a certifi- 
cate of vaccination." 
Record of Vaccinations. A permanent record of vaccination cer- 
tificates shall be kept, preferably on school card record system or 
permanent school register, entering thereon the name of the child, 
date of successful vaccination, and name of the vaccinating phy- 
sician. This record will thus be at hand for use by succeeding 
teachers. Certificates of new pupils entering from year to year 
should be entered on this list. • 
Blank vaccination certificates, Form 75, and Forms 76 and 77 will 
be furnished to physicians upon application to the State Depart- 
ment of Health. 
The purpose of the sections of law above quoted is to control the 
spread of disease in our schools. Whenever we can detect a com- 
municable disease in its early stage and separate the child having 
this disease from its associates in school and out of school, we are 
able to prevent the transmission of the disease to others. The secret 
of success lies in the early detection of such diseases. 
The State Department of Health must rely on the teachers of 
this Commonwealth to pick out those pupils suspected of developing 
communicable diseases. Where a school nurse or school inspector 
is in daily attendance such agents will assume this duty, but there 
are few schools, as yet, in which we find continuous medical 
service. 
Many teachers feel at a loss in aiding the health authorities because 
of a lack of knowledge concerning communicable diseases. The fol- 
lowing facts are tabulated in a way that will make it easy for you to 
know the signs that usher in the commoner diseases of childhood 
and to know how these infections are transmitted from the sick to 
the well. 
THE CONTROL OF COMMUNICABLE DISEASES. 8 
Disease 
Early Signs and Symptoms 
Method of Transmit- 
ting the Disease 
Remarks 
Chicken Pox 
Often the first sign of this 
disease is a rash which 
appears on all parts of 
the body. The rash con- 
sists of small pimples 
which become filled with 
fluid. Eater crusts de- 
velop and the scabs 
which form drop off in 
about fourteen days. The 
rash comes out on differ- 
ent days so that finally 
one finds pimples, vesi- 
cles and crusts on the 
same skin area. 
Probably by the dis- 
charges from the skin 
lesion as well as the 
secretions from the 
nose and mouth. 
This disease Is usual- 
ly mild in charac- 
ter. It is important 
because often con- 
fused with small- 
pox. 
Cerebro-spinal 
Meningitis 
Usually sudden in onset 
with high fever, severe 
headache and stiffness of 
the neck. 
Through the secretions 
from the nose or 
mouth of a person 
' sick with the disease 
or who carries the 
germs about In his 
nose or mouth without 
being sick himself 
(designated as a car- 
rier) . 
Many of these cases 
are due to carriers 
and this fact makes 
its control very dif- 
ficult. 
Diphtheria 
■ Onset of the disease is us- 
ually gradual--the child 
complaining of headache, 
apathy, aching through- 
out the body, a little 
chilliness and moderate 
fever. The most pro- 
nounced symptom will be 
sore throat. In certain 
cases there will be a 
bloody discharge from the 
nose. 
Through the secretions 
from the nose and 
mouth from a child 
suffering from the dis- 
ease or from a car- 
rier of the germs. 
This is one of our 
most dangerous dis- 
eases because It is 
not only likely to 
kill but may leave 
serious after effects. 
When one case of 
diphtheria occurs in 
a school room ex- 
clude every child 
who develops a sore 
throat. Second at- 
tacks of the dis- 
ease frequently oc- 
cur. 
Measles 
Begins abruptly with chilli- 
ness, fever and cold in 
the head (running nose, 
inflamed and watery 
eyes and sneezing). On 
the fourth day the rash 
usually appears-first be- 
hind the ears, on the 
forehead and on the face; 
it then spreads over the 
entire body. 
Through the secretions 
from the nose and 
mouth of persons suf- 
fering from the dis- 
ease or by means of 
objects which have 
been soiled by these 
discharges from the 
infected person. 
A highly contagious 
disease - frequent 
serious after ef- 
fects. Indirectly 
causes more deaths 
than either diph- 
theria or scarlet 
fever. Most con- 
tagious during the 
three days prior to 
the rash. 
German Measles 
The onset Is usually mild 
though abrupt. The rash 
is often the first sign 
noted; it consists of 
small, discrete, rosy red, 
elevations. Rash may re- 
semble that of measles 
or Scarlet Fever. Sore 
throat occurs with fre- 
quency. 
Through the secretions 
from the nose and 
mouth of persons suf- 
fering from the dis- 
ease. 
This infection is sel- 
dom dangerous. It 
is important be- 
cause It may be 
confused with scar- 
let fever. 
Mumps 
Onset characterized by mod- 
erate fever, pain at the 
angle of the jaw and 
within a day or two 
marked swelling of the 
parotid gland, on one or 
both sides. 
Through the secretions 
from the nose and 
mouth of the person 
suffering from the dis- 
ease. 
Highly Infectious dis- 
ease. 9 
Disease 
Early Signs and Symptoms 
Method of Transmit- 
ting the Disease 
Remarks 
Smallpox 
Onset is usually sudden 
with severe chills, high 
fever, headache, muscular 
pains and vomiting. 
About the third day the 
rash appears and the dis- 
comfort of the patient 
lessens temporarily. 
Through the ■ secretions 
from the nose, mouth 
and skin lesions of the 
patient. These dis- 
charges may be car- 
ried directly or indi- 
rectly. 
Very highly Infec- 
tious. The disease 
is serious not only 
because it may 
cause death but be- 
cause of the dis- 
figurement which 
results from It. 
Successful vaccina- 
tion protects one 
from the disease. 
Universal vaccina- 
tion means no 
smallpox. 
Scarlet Fever 
Onset usually sudden with 
nausea, vomiting, high 
fever and sore throat. 
On the second day the 
rash appears first on the 
neck and chest, which 
consists of a multitude 
of minute bright red 
points, set in a diffusely 
ted slightly swollen skin. 
Some cases have sore 
throat without the rash. 
Through the discharges 
from the nose and 
mouth and the dis- 
charges which may 
come from the ears 
and cervical glands. 
The scales of the skin 
may transmit the dis- 
ease. 
A dangerous disease 
because of the 
number of deaths it 
produces and the 
after effects. When 
the disease occurs 
in a school room all 
children with a 
sore throat should 
be excluded. 
Poliomyelitis 
(Infantile Par. 
alysis) 
The onset is abrupt with 
fever, headache and vom- 
iting. Within twenty- 
four hours paralysis of 
one or more of the limbs 
may develop. 
Uncertain - probably 
through discharges 
from the nose and 
mouth. 
Most highly commu- 
nicable in the early 
stages. 
Whooping-cough 
Begins slowly with cold in 
the head and cough which 
gradually becomes more 
intense and accompanied 
by the characteristic 
whoop. Vomiting fre- 
1 quently accompanies par- 
| oxysms of whooping. 
Through the discharges 
from the nose and 
mouth. 
The after effects are 
often severe and 
cause great general 
debility. The most 
infectious period of 
this disease Is In 
the early stages 
even before the 
whoop appears. If 
a child vomits after 
coughing it prob- 
1 ably has whooping- 
cough. 
When you have made yourself familiar with the early signs of the 
common communicable diseases you are in a position to be of unusual 
service to your community. It is an advantage to the community to 
keep your school open, not only from the pedagogic standpoint, but 
also from the sanitary standpoint. It is easier to combat and control 
an epidemic of diphtheria, for instance, if supervision of the children 
is maintained through the school than if the school be closed and the 
pupils allowed to go about without the slightest regulation. It is 
necessary to exclude pupils from school if they show the earliest 
signs of disease; if these children be permitted to attend school until 
the disease is well advanced they will have been in contact with many 
other pupils during the most infectious period of the disease. It is 
highly important, therefore, that you comply with the law and ex- 10 
elude such children from school as soon as you recognize suspicious 
symptoms. A pupil who develops a cough, sore throat, running nose, 
rash, or who looks sick, should have his temperature and pulse taken. 
The normal temperature is ninety-eight and two-tenths degrees Fahr- 
enheit and the pulse rate, which varies somewhat with age, is, for 
age seven, between eighty-five and ninety and for age fourteen, be- 
tween eighty and eighty-five. Children whose temperature rises above 
ninety-nine and two-tenths degrees and whose pulse rate goes above 
one hundred should be excluded from school and referred to the fam- 
ily physician. Not only should you exclude the child from school, 
but you should at once notify the Health Officer of the district that 
you suspect a communicable disease and he will take the proper 
steps to have a diagnosis made and if necessary establish quarantine. 
The following TECHNIC FOR THE CONTROL OF COM- 
MUNICABLE DISEASES in the school, is based on the laws of the 
Commonwealth, already quoted. This technic presumes that there 
is neither school physician nor school nurse to supervise and direct 
the work. 
In the typical 4th class school district there are t^ree individuals 
who share responsibility in controlling communicable diseases, the 
parent, the teacher and the truant officer. Their respective duties are 
outlined below: 
I. PARENTS. No parent or guardian of a school child shall 
permit said child to go to school who is showing such symptoms of 
disease as are enumerated below: 
1. Rash. 
2. Sore Throat. 
3. Eyes red and running. 
4. Cough. 
5. "Running" nose. 
6. Acutely swollen glands of neck, 
7. Fever. 
8. Drowsiness. 
9. Fretfulness and irritability. 
10. Chills. 
11. Vomiting. 
(Copies of this technic may be procured, in limited numbers, for 
distribution to parents. They should be distributed as early in the 
year as possible.) 
II. TEACHER. 
1. Make a rapid daily inspection of all pupils for the purpose of 
discovering illness, as well as neatness and cleanliness. 
This inspection should be made immediately after school is as- 
sembled. 11 
B. Exclude pupils who show signs of illness such as noted 
below: 
1. Unusual rash or skin eruption. 
May indicate presence of Scarlet Fever. 
Measles. 
German Measles. 
Chicken Pox. 
Smallpox. 
Ring Worm. 
Scabies (Itch). 
Impetigo Contagiosa. 
2. Complaining of sore throat. 
May indicate presence of Diphtheria. 
Scarlet Fever. 
Measles. ' 
Tonsillitis. 
3. Redness or discharge of the eyes. 
May indicate presence of Measles. 
German Measles. 
Pink Eye. 
Trachoma (Granular eye 
lids). 
4. "Running" nose. 
May indicate presence of Measles. 
Diphtheria. 
Scarlet Fever. 
Influenza. 
"Cold." 
5. Cough, frequent, spasmodic or with a whoop. 
May indicate presence of Whooping Cough. 
Tuberculosis. 
Measles. 
"Cold." 
C. Notify the local Health Officer of any exclusion on account 
of sickness. 
D. Re-admit pupils absent because of a communicable disease 
only upon certificate by the Constituted Health Authority (the 
Health Officer) setting forth that they are non-infectious. 
E. Prevent faults in the operation of the school plant. Such 
faults lower pupils' resistance to disease. 
1. Cleanliness-School room, cloak room, desks, black 
boards, etc. 
2. Ventilation-Make use of windows-Open widely before 
school assembles, after each recitation, during every 
period devoted to physical education and at recess. Make 
use of window boards at all times. (See diagram). 12 
'Pre^pz-CT iye. 
OtCTJON 
Window Jwi Attaculp Jta MlJOejming UmcpWirn Good Anp Ruiy Amp 
Mlthop Or Attach Window Vintilatoe, U^iN6 A&oaw Oil Glw 3hilld.' 13 
3. Lighting-Window shades to be kept in working order. 
Keep rolled up unless direct sun light strikes pupils' 
eyes. (See diagram). 
4. Temperature-Keep at 68° Fahr. 
5. Distribution of water-Eliminate common drinking cups. 
F. Prevent faults in personal hygiene of pupils. 
1. Hands and nails-Have ample provision for washing and 
have them kept clean. Wash before lunch and after 
going to toilet. 
2. Face and hair-Keep clean and well groomed. 
3. Pencils, pens, etc.-Individual and keep out of mouth and 
nose. 
4. Coughing and sneezing-Shield nose and mouth with 
handkerchief or piece of paper. 
5. Spitting-Absolutely prohibited in or about school build- 
ing. 
III. TRUANT OFFICER. 
Investigate promptly all cases of absenteeism of three days dura- 
tion. When sickness is found to be the cause of absenteeism notify 
the Health Officer so that the proper investigation may be made 
by the health authorities. 
DUTIES OF TEACHERS THAT SHOULD BE ASSUMED. 
HEALTH EDUCATION. It is to be hoped that school teachers 
will have such an appreciation of the role they may play in the 
whole problem of school health that they will not only carry out 
these measures which the Acts of Assembly have made obligatory, 
but that they will also inaugurate additional work which will tend 
to further safeguard the well-being of the pupils. There is no phase 
of our work more important than the teaching of the fundamental 
principles of health. In former times the school curriculum was 
formulated for the sole purpose of developing the mental and moral 
side of the child; the modern conception has added instruction which 
is directed towards the physical well-being of the pupil. It is not 
to be expected that the teachers in our public school system will 
have a detailed knowledge of the entire subject, of hygiene, but it is 
reasonable to expect them to know and appreciate the simple prin- 
ciples of this science and to expect them to inculcate the same in 
the minds of the children coming under their direction. A good 
deal of enthusiasm and much practical knowledge may be imparted 
if the teacher will adopt some such simple method as the following: 
Appoint one of the pupils to be Health Officer of the school for a 
week at a time. The Health Officer is held responsible for the sani- 
tation of the school room-he is instructed to report on cleanliness, 
ventilation, temperature and light. Such unhygienic conditions as 
are reported will be corrected by the Health Officer or the Sanitary 
Committee, should one be appointed. Personal cleanliness is al- 
most sure to accompany environmental cleanliness. The teacher 14 
who succeeds in creating an interest in the cleanliness of the class- 
room will have little difficulty in spreading knowledge about per- 
sonal cleanliness. Remember that clean hands and face entitle the 
pupil to a good rating quite as much as a satisfactory recitation in 
Geography, etc. 
Unless a course in health education is already prescribed, the 
teacher would do well to institute a course, following some good 
text book such as the following: 
Gulick Hygiene Series, Jewett. 
5 vol. Ginn Co. 
Health Series, O'Shea and Kellogg 
4 vol. Macmillan. 
Healthy Living, Winslow. 
2 vol. Merrill. 
There are certain organizations such as the Junior Red Cross, 
Modern Health Crusade and Little Mother's Leagues which have 
entered the school for the purpose of developing in the children a 
health conscience and making health knowledge a dynamic force in 
their lives. All these organizations serve a very useful purpose and 
their operations should be so coordinated with the course in health 
education as to supplement and amplify it. 
The President of the American Medical Association, Surgeon 
General Braisted of the United States Navy, in his address before 
this organization dwelled on the subject of health education in a 
very sane and telling way. So appropriate are his remarks to our 
subject that we are quoting a number of paragraphs. 
"I submit that the nation's health is a national concern, that it 
underlies all industrial and business effort; that it is the fundamental 
element in successful competition with rival nations, whether under 
the slow and prolonged strain of commercial contests or the sudden 
and imperious demands of armed conflict; that if we look ahead, as 
true love of country compels us to do, and estimate the trend of 
future events, we must acknowledge that physical vigor will, in a 
large measure, decide our complete development and permanent 
possession of the land which oui' forefathers won for us. 
"I think that up to the present we have been guilty of a cardinal 
error in seeking wholly to proselyte the adult; oui' preaching has 
been to people enslaved by the chains of lifelong habits. We have 
advised men with damaged hearts and kidneys and blood vessels to 
eat and drink and smoke less; to take moderate exercise; to learn to 
relax and play; to avoid undue excitement so that they might spin 
out the thread of life by a few years. We have appealed to high 
school, college and university students to abjure tobacco and alcohol; 
have held up personal purity as something of supreme importance, 
given instruction about venereal diseases, instituted courses in per- 
sonal hygiene that perhaps conveyed to them for the first time in 
their lives some rudimentary knowledge of their own bodies. In 
all this we have overlooked two things. The man of middle life 
cannot make over his depraved body and replace wornout organs. 
If he stops work he dies for lack of occupation. 15 
"In the second place, we forget the pitiless logic of youth. The 
lad or maiden who has for five, ten or fifteen years been goaded to 
study grammar, mathematics, languages; on whom there has been 
exerted insistent pressure to acquire mental attainments, cannot 
easily be persuaded later on that a subject kept in the background 
or displaced in favor of something else is the one of paramount im- 
portance. We cannot expect the young to believe that hygiene, 
physiology and health are matters of prime importance; that their 
parents and teachers really esteem them such, when everything else 
has come ahead of these subjects. The children are right, because 
we do put first what we esteem to be first. They infallibly consider 
that health teachers are mere faddists and reformers, and that it is 
more vital to the gratification of their ambitions and their success 
in life to know the length of the Amazon and to be able to give 
the ordei' in which different politicians have occupied the White 
House than to understand the oxygenation of the blood or the nature 
of a reflex movement. 
"Oui' primary schools have received not a little attention lately; 
they are better built and have better lighting and ventilation than in 
the past. We examine the pupils for enlarged tonsils, bad teeth 
and granulated lids. We are instituting various commendable re- 
forms, which should be continued and expanded, but they all belong 
to what might be called an extrinsic method of procedure. We must 
have something intrinsic and we must get possession of the child 
himself, affect his inner consciousness, modify his personality and 
give his life a definite bent, so that he will progressively and in- 
creasingly contribute by his own efforts to secure and preserve the 
health indispensable for the fullest use of the opportunities of high 
school, college and university." 
EXERCISE. The physical condition of a school child determines, 
in no small degree, its mental capability. It is a wanton waste of 
public money, teacher's time and pupil's health to attempt to cram 
the minds of those physically incapable. The institution of simple 
but regular and uniform methods of exercise may be made of in- 
comparable value to the school child. Exercise increases the blood 
flow, brings an added supply of oxygen and food to the body cells 
and carries off waste products; thus creating in the tissues more 
natural conditions. Those exercises which tend to increase the lung 
capacity, establish and maintain correct posture and cause con- 
traction and expansion of the various muscles of the body will de- 
velop the school .child's physique. When you carry out exercises 
of any kind it is preferable to do so in the open air. If this is im- 
practicable, a free circulation of air should be maintained in the 
room by opening all the windows. A five minute period of recess 
should be instituted each hour for the purpose of carrying out a few 
calisthenic exercises. 
Because of the difficulty which many teachers encounter in at- 
tempting to select exercises, a list is presented below. These ex- 
ercises have been selected particularly because of their influence 
upon posture. (See "Posture of School Children," Bancroft-Macmil- 
lan Co.) 16 
Incorrect posture (weak, 
slouching or fatigue posture). 
The neck, trunk and legs form 
a xlgzag line. 
Correct posture (strong, 
healthful, beautiful and ef- 
ficient). The neck, trunk and 
legs form a straight, vertical 
line. 
Exaggerated posture (rigid, 
ugly, and incorrect). This 
posture can be held only for a 
short time with great effort. 
TYPES OF POSTURE. 
(From Wall Chart issued by the American Posture League, Inc.) 
Before beginning systematic exercise the teacher must know how 
to judge good posture or erect carriage. The simplest means of 
measuring posture is by the vertical line test. Hold a window pole 
at the side of the pupil-if the long axis of the body is a perfectly 
vertical line and if the long axis of the head and neck is in the same 
vertical line, good posture may be said to exist. The vertical line 
tests tell us of the entire body except the shoulders. The shoulder 
blades should be flat upon the back; if they are drawn outward and 
forward, the condition of round shoulders results. 
At the beginning of each exercise period, the order, Attention! 
should be given by the teacher, at which command each pupil as- 
sumes the erect posture in conformity with the vertical line test. 
During the course of the various exercises the normal relationship 
between head, neck, body and legs should be maintained in so far 
as the exercises will permit. 17 
Exercise I. 
Position: Fingers on shoulders, elbows pointing front. 
(Keep fingers in same position during entire ex- 
ercise). 
Movement: Lift elbows and describe semicircles at the sides, 
moving them upward, backward and downward. 
Then swing elbow directly to the front again. 
Execute by count of 1. 
Repeat 4 times and increase to 10. 
Exercise II. 
Position: Hands on hips (thumbs to the rear). 
Movement: 1. Relax head and drop it backward. 
2. Lift head upward and draw chin strongly in- 
ward (as though making a double chin). 
Execute by count of 2. 
Repeat-4 to 10 times. 
Exercise HI. 
Position: Hands on hips holding'head firmly in good posi- 
tion. 
Movement: 1. Bend trunk forward from the hips not the 
waist. 
2. Rise to erect posture. 
Execute by count of 2. 
Repeat-4 to 10 times. 
Exercise IV. 
Position: Hands on hips holding head and upper part of 
trunk firmly in correct relation to each other. 
Movement: 1. Bend trunk sidewise at waist line. Do not 
twist shoulders nor shift position of feet. 
Pause a moment each time in upright position. 
Execute by count of 2. 
Repeat-4 to 10 times. 
Exercise V. 
Position: Hands on hips, erect posture. 
Movement: 1. Rise on toes (maintain this position). 
2. Bend knees to an acute angle keeping trunk 
and head erect. 
3. Rise to erect position and stretch knees to 
their utmost. 
4. Lower heels to floor. 
Execute by count of 4. 
Repeat-4 times, gradually increase to 10. 18 
Exercise VI. 
Position: Hands on hips. 
Movement: 1. Inspiration-slow and deep. 
2. Expiration-slow and complete. 
Execute by count of 2. 
Repeat-8 to 10 times after every other exercise. 
RECORD OF PHYSICAL AND MENTAL DEVELOPMENT. 
It has been found by experience that a school record which accom- 
panies a child through his school life is of unusual value to sub- 
sequent teachers, as well as to principals and superintendents. A 
physical record of each school child which will also follow the child 
through his school life, has been shown to be of like importance. 
Form 92 was devised to meet the needs of teachers who desire to 
have both the school record and the physical record of each child in 
a convenient form, capable of meeting the needs of pedagogy as well 
as health. 
At the time of the medical inspector's examination Forms 92 
should be in front of the teacher so that the findings of the inspector 
may be entered on the proper cards. On Form 92 there is a line 
for each year of the child's school life so that finally this card repre- 
sents a complete report of his physical development. Not only de- 
fects appear on the record but also treatments which have been 
secured and the results of treatment. It is important for each 
teacher to have a correct understanding of what has gone before in 
both the mental and physical side of the child's development and this 
record fulfills this need. Along the right hand edge of the card, 
physical record side, there are spaces to list the contagious diseases 
which the child may have had, or which he develops while at 
school. Correct information of this kind is invaluable to the Health 
Officer or teacher in times of a threatened epidemic. For instance, 
if a case of measles breaks out in your school of forty pupils and 
you find, by referring to their physical record cards, that thirty of 
these children have already had measles, your attention may be 
devoted wholly to the remaining nine-who may be susceptible and 
you will carefully observe these nine children for the early symptoms 
of the disease in question. The number of ways in which such a 
card is useful are many; we have mentioned only a few for the pur- 
pose of illustration. The Department of Health will supply Forms 92 
to all districts of the fourth class which will express a desire to 
adopt them. When a pupil finally leaves school this Form 92 
should be forwarded to the central office of the State Department 
of Health, to be used for statistical purposes. 
CARE OF THE TEETH. From the examination of thousands of 
school children throughout the State and the country at large, it has 
been fouhd that defects of the teeth are more prevalent than those of 
any other part of the body. Beginning with the first grade, it is 
highly desirable to inaugurate tooth brush drills for all the children. 
The following instructions outline an excellent method for cleaning 19 
the teeth. This method is well adapted for class work and may 
be carried out in the form of a drill. The purpose of this drill is 
to teach the children how to remove food from all the surfaces of 
all the teeth. This is accomplished 1, by brushing, 2, by using floss 
silk between the teeth. All drills are to be carried out with the dry 
brush. Use no water and no powder in school. 
(a) Outside surface. Place the tooth brush inside left cheek and 
on upper gums, and nearly close the teeth together. Make the brush 
go backward and downward to lower gums, then slightly forward 
and upward until it has traveled a complete circle. This circular 
motion should be done rapidly so that the gums will be stimulated 
and the teeth cleansed of food. Keep up fast circular motion and 
brush all the teeth on the left side as well as all the front teeth. Do 
not brush the teeth and gums crosswise. 
Now brush the right side with the same circular motion, or re- 
versing the circle if found more convenient. Brush long enough to 
thoroughly stimulate the gums and cleanse the teeth, going back 
and forth over all the surfaces several times. 
(b) Inside surfaces of upper teeth. With the bristles of the 
brush pointing outward and the end of the thumb on the back of 
the handle, brush the inside gums and surfaces of the teeth with a 
fast in-and-out stroke, reaching back on the gums as far as you 
can go. 
(c) Inside surfaces of lower teeth and gums. Hold the handle 
of the tooth brush in your closed hand with the thumb lying across 
the back of the handle and brush the gums and teeth with an 
in-and-out stroke, using chiefly the tuft end or toe of the brush. 
Reach back in the mouth on the gums below the last tooth on both 
sides and brush with a fast, light, in-and-out stroke. Tip the handle 
of the brush up in brushing the gums of the lower front teeth. 
(d) Tops of teeth or grinding surfaces. Lastly, brush the teeth 
with an in-and-out stroke on the surfaces on which you chew, as the 
food must be removed from the grooves or fissures of the molars. 
BRUSHING. 
RULES TO REMEMBER. 
1. Brush at least twice a day; before breakfast and before 
going to bed. Use a good dental cream or powder for home 
use. The teeth must be clean and free from food before 
going to bed as most of the decay takes place while sleep- 
ing. 
2. Brush two minutes each time; two minutes by the clock. 
It takes two minutes of brushing to properly stimulate the 
gums and thoroughly cleanse the teeth. Be sure to brush 
the gums. 
3. Do not use pressure with the brush. A fast, light stroke is 
the best. A brush should never be worn out by having its 
bristles flattened and spread out. 20 
4. Never allow any one to use your brush. Disease germs 
may be easily carried from one mouth to another, readily 
causing sickness. 
5. Candies, sugar, crackers, cake, pastry, bread, will all decay 
the teeth if allowed to remain on their surfaces. 
FLOSS SILK. Four fifths of the decay of teeth takes place on 
the surfaces on which you chew. There is but one way which is 
effective in removing the food from between the teeth and that is 
with a piece of floss silk. 
Use a section of floss about twelve inches long. Hold one end 
between the thumb and first finger of the left hand and wrap the 
floss twice around the end of the first finger. Do the same with 
the thumb and first finger of the right hand. Now by using the com- 
bination of the ends of the thumbs and second fingers the floss may 
be carried into the mouth and forced carefully between all the 
teeth. Rub it back and forth against the surfaces of each tooth to 
loosen and remove the food and to cleanse these surfaces. After a 
little practice one can floss all the surfaces between the teeth in a 
minute's time. 
GROWTH AND DEVELOPMENT OF THE SCHOOL CHILD. 
The Department of Health wishes to see every pupil in the public 
schools develop in a normal manner. A monthly record of weights 
is the surest way to determine this. Each school should be supplied 
with scales and the teacher or volunteer worker should see to it that 
all the pupils are regularly weighed and that a record of the weights 
is made. School districts may furnish scales or they may be obtained 
through welfare organizations. Weight varies with age and height. 
The Department of Health will furnish, on request, tables which 
give the correct weight for each age and height. Pupils will be 
interested to learn whether they are above, below or of normal 
weight. Parents will be anxious to know whether their child is 
undernourished. If he is losing weight or fails to gain weight, he is 
or soon will be undernourished. Proper food, properly eaten and 
good health habits are essential to the cure of undernourishment. 
Interesting pamphlets on "Nutrition" and "Nutrition classes" are 
published by the Bureau of Education, Department of the Interior, 
Washington, D. C., by the Child Health Organization, 156 Fifth 
Avenue, New York, and by the Department of Agricultural Ex- 
tension, Pennsylvania State College. A request directed to these 
organizations will bring literature of great value to those who intend 
to do something to help solve the problem of the malnourished 
children. 
PUPIL HEALTH OFFICER. 
In previous sections, mention has been made of the Pupil Health 
Officer. It is desirable to. emphasize the potential possibilities that 
are in this office. The busy, over-worked teacher must learn to make EXCLUSION FROM 
school 
(Public, private, parochial, 
Sunday and other school). 
MINIMUM 
QUARANTINE 
PERIOD 
DISEASE 
'Medical Inspectors required to issue 
morbidity report to Health Officer. 
REMOVAL FROM INFECTED 
PREMISES 
Contacts who remove from infected house- 
hold after a disinfecting bath and putting 
on disinfected clothing may, under the fol- 
lowing conditions, be 
ADMITTED TO SCHOOL. 
CONTACTS 
(Unafflicted chil- 
dren in same 
household.) 
PATIENT 
Until lifting of quarantine and thorough disinfection of premises. 
(Children known to have had whooping cough may be permitted to continue 
school attendance during quarantine period for whooping cough.) 
Until recovery, lifting of quarantine and thorough 
disinfection of premises. 
Du ring 
Illness. 
'Whooping Cough.t 
After fourteen (14) days, (a) 
'Cerebrospinal Meningitis (epidemic) 
(Cerebrospinal fever, spotted fever). 
After seven (7) days. 
'Relapsing fever. 
After ten (10) days. 
16 days. 
16 days. 
16 days. 
16 days. 
'Chicken Pox. 
'Measles.! 
'German Measles.! 
'Mumps. 
Move to premises occupied only by adults or 
adults and immune children. Fourteen (14) 
days later admit to school. If immune by 
virtue of a former attack may be admitted 
to school next day. 
21 days, 
(b) 
'Diphtheria 
Diphtheritic and membranous croup, 
putrid sore throaty 
Move to premises occupied only by adults- 
antitoxin administered. Admit to school 
after five days. 
30 days. 
'Smallpox. 
(Variola, varioloid). 
Not permitted to remove from quarantined 
premises. 
10 days after lift- 
ing of quarantine 
and disinfection of 
premises. 
30 days. 
♦Scarlet Fever 
(Scarlatina, scarlet rash).^ 
Move to premises occupied only by adults or 
adults and immune children. Fourteen (14) 
days later admit to school. If immune may 
be admitted to school next day. 
21 days. 
'Anterior Poliomyelitis (acute) 
(Infantile paralysis). 
After fourteen (14) days. 
Exclusion X»f unafflicted children in same 
household not required. 
Until recovery or final disinfection. 
During 
Illness. 
♦Typhoid Fever. 
Premises not quarantined. 
♦Tuberculosis of Lungs (active) 
(See Sec. 1509 School Code). 
♦Erysipelas.! 
'Uncinariasis (Hook Worm disease). 
♦Scabies (Itch).^ 
♦Impetigo Contagiosa (Pustular Inflam. 
of skin).^ 
♦Trachoma (Granular eye lids).f 
Acute Conjunctivitis (Pink eye).^ 
Tonsillitis.! 
Ringworm (Tinea circinata).! 
Head Lice. 
Body Lice. 
Favus (Crustaceous skin disease).f 
♦Lupus (Tuberculosis of the skin).^ 
(a) In case of Whooping Cough children who, by virtue of a former attack, are immune may attend school from quarantined premises, 
(b) Provided, "That if antitoxin has been used for curative purposes for the patient and for the immunizing of all of the inmates of the 
premises and two negative bacteriological cultures have been secured from the diseased area of each patient on the premises for 
two consecutive days, the minimum period of quarantine may be 14 days." 
(f) Teachers or Principals required to report symptoms of disease. See Sec. 9, Act of July 17, 1919, on p. 4 of this manual. 
COMMUNICABLE DISEASES REQUIRING EXCLUSION FROM SCHOOL 21 
use of her pupils by developing self instruction. Not infrequently 
instruction can be combined with service. This is especially true 
in health work. 
Every pupil should at one time or another be appointed to serve 
as Pupil Health Officer. The teacher must determine what duties 
shall be assigned to this officer. As an aid thereto, the following 
suggestions are made: 
1. A weekly report from Pupil Health Officer to teacher. 
2. Daily inspection to determine: 
a-Cleanliness of class-room, floors, walls, desks, seats, etc. 
b-Cleanliness of cloak-rooms, halls, school yard, etc. 
c-Cleanliness of the toilets or privy. 
d-Temperature of room (Read thermometer at least twice a 
day, same hours daily). 
e-Whether ways are provided for adding water vapor to the 
air and if so, how much water per pupil is evaporated daily. 
f-How many times have the windows been thrown widely open 
and the school thoroughly aired. 
Teachers should feel free to discuss with the Department of 
Health, difficult problems that arise in school health. 
REFERENCE BOOKS FOR TEACHERS. 
Games for the Playground, Home, School and Gymnasium. Jessie 
H. Bancroft. Macmillan Co. 
Health Education in Rural Schools. J. M. Andress. Houghton 
Mifflin Co. 
How to Live. Fisher & Fisher. Funk & Wagnails. 
The Hygiene of the School Child. L. M. Terman. Houghton 
Mifflin Co. 
The Posture of School Children. Jessie H. Bancroft. Macmillan Co. 
Preventable Diseases. Woods Hutchinson. Houghton Mifflin Co. 
School Hygiene. F. B. Dresslar. Macmillan Co. 
The Teacher's Health. L. M. Terman. Houghton Mifflin Co. 22