• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 Foreword
 Introduction
 Table of Contents
 School health program
 Planning and organizing a school...
 Healthful school living
 School health services
 Health instruction
 Finding and using resources
 Directions for using the Snellen...
 Natural lighting for classroom...
 Communicable diseases in schoo...
 School record MCH 304
 Laws relating to school health
 Back Cover














Group Title: Bulletin - Florida State Department of Education ; no. 4D
Title: A program of health services for Florida Schools
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00067258/00001
 Material Information
Title: A program of health services for Florida Schools Florida program for improvement of schools
Series Title: Its Bulletin
Physical Description: 85 p. : forms. ; 23 cm.
Language: English
Creator: Florida -- Dept. of Education
Publisher: s.n.
Place of Publication: Tallahassee
Publication Date: 1953
 Subjects
Subject: School hygiene -- Florida   ( lcsh )
Genre: government publication (state, provincial, terriorial, dependent)   ( marcgt )
non-fiction   ( marcgt )
 Notes
Statement of Responsibility: Sponsored jointly by Florida State Dept. of Education and Florida State Board of Health.
Funding: Bulletin (Florida. State Dept. of Education) ;
 Record Information
Bibliographic ID: UF00067258
Volume ID: VID00001
Source Institution: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 07843953
lccn - a 55009466

Table of Contents
    Front Cover
        Front Cover 1
        Front Cover 2
    Title Page
        Title Page 1
    Foreword
        Foreword 1
        Foreword 2
    Introduction
        Introduction 1
        Introduction 2
        Introduction 3
    Table of Contents
        Table of Contents 1
    School health program
        Page 1
        Page 2
        Page 3
    Planning and organizing a school health program
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
    Healthful school living
        Page 9
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
    School health services
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
        Page 31
        Page 32
        Page 33
        Page 34
    Health instruction
        Page 35
        Page 36
        Page 37
        Page 38
        Page 39
        Page 40
        Page 41
        Page 42
        Page 43
        Page 44
        Page 45
        Page 46
        Page 47
        Page 48
        Page 49
        Page 50
        Page 51
        Page 52
        Page 53
        Page 54
        Page 55
    Finding and using resources
        Page 56
        Page 57
        Page 58
        Page 59
    Directions for using the Snellen vision test
        Page 60
    Natural lighting for classrooms
        Page 61
        Page 62
        Page 63
        Page 64
    Communicable diseases in schools
        Page 65
        Page 66
        Page 67
        Page 68
        Page 69
        Page 70
        Page 71
        Page 72
    School record MCH 304
        Page 73
        Page 74
        Page 75
        Page 76
        Page 77
    Laws relating to school health
        Page 78
        Page 79
        Page 80
        Page 81
        Page 82
        Page 83
        Page 84
        Page 85
    Back Cover
        Back Cover
Full Text





















UNIVERSITY

OF FLORIDA

LIBRARIES


I











A Program of HEALTH SERVICES

for Florida Schools

Florida Program for Improvement of Schools

BULLETIN No. 4D

JULY, 1953
















Sponsored Jointly By


FLORIDA STATE DEPARTMENT OF EDUCATION
THOMAS D. BAILEY, State Superintendent
TALLAHASSEE, FLORIDA
and
FLORIDA STATE BOARD OF HEALTH
WILSON T. SOWDER, State Health Officer
JACKSONVILLE, FLORIDA







-p-^







FOREWORD

The Florida Department of Education in cooperation with
the State Board of Health has published this bulletin for the
information and guidance of all who have responsibilities for
pupil health.

Health education and health services are public service areas
in which school personnel may have a significant part not only
in providing healthful pupil surroundings, but also in encour-
aging desirable pupil health practices and normal emotional
adjustments.

The importance of the school health program cannot be over-
emphasized. Properly conceived and intelligently implemented,
the school health program may do much to assure strong healthy
bodies and emotionally stable young people; failure to provide
such a program may well contribute to the physical and func-
tional inadequacy of our people.

Each teacher, supervisor, principal, county superintendent
and others who are charged with duties and obligations in
the education of children are in key positions to contribute. It
is our hope that this bulletin will prove to be of help in plan-
ning the health programs for schools and communities all over
Florida.
THOMAS D. BAILEY
Superintendent of Public Instruction















The efforts of the professions primarily concerned with the
improvement of health, the prevention of disease, and the pro-
longation of life obtain their maximum benefit when applied to
a citizenry which already has considerable knowledge of basic
health principles. The interests of health departments and de-
partments of education meet because of their common concern
with the health of children of school age. However, there is a
greater area of common interest due to the need for instruction
of children in basic facts which will enable them to live healthy
and happy lives in a clean and wholesome environment. In some
areas of the world, modern medical and sanitary science is
helpless in the face of ignorance and superstition in the general
population.
It is the aim of this bulletin to aid the teachers in the public
schools to further the enlightenment of our children so that suc-
ceeding generations will not only be more receptive to the prac-
tice of all that is known in the field of health, but will demand
its full application.
WILSON T. SOWDER
State Health Officer










INTRODUCTION

In the fall of 1950, a meeting, jointly sponsored by the State
Department of Education and the State Board of Health, was
called at the George Washington Hotel in Jacksonville on No-
vember 13-17 for the purpose of developing a bulletin to re-
place Bulletin 4. Bulletin 4, published jointly by the State De-
partment of Education and the State Board of Health, entitled
"Florida's School Health Program" was revised and reprinted
in 1943. Since copies of Bulletin 4 were no longer available and
because of a need for revision of the bulletin, Hon. Thomas D.
Bailey, State Superintendent of Public Instruction, and Dr. Wil-
son Sowder, State Health Officer, jointly issued a call to a
group interested in health services and health education, repre-
senting not only the State Department of Education and the
State Board of Health but other agencies in Florida, including
a representative segment of public school personnel.

Dr. Charles C. Wilson, Professor of Education and Public
Health, Yale University, was secured through the joint coop-
eration of the State Department of Education, the State Board
of Health, and the Florida Tuberculosis and Health Association,
as a consultant for the meeting. The following attended:


Name
Claud Andrews
George F. Baker
J. E. Bevis
Doris Bilger
J. M. Bistowish
Carolyn C. Blair
T. J. Bleier
George S. Bote
James H. Bunch
Clara Capron
Frances Champion
Clethoa Clark
H. W. Craig
O. A. DePree
Katie Sue Echols
Florence Ehlers
George J. Emanuele
James A. Espy
M. M. Ferguson
Virginia Flanigan


Position
Director of Vocational Rehabilitation, State Depart-
ment of Education
Health Educator, State Board of Health
Supervisor of Negro Education, Broward County
School Lunch Specialist, State Dept. of Education
Health Officer, Leon County Health Department
Orthopedic Nursing, Crippled Children's Commission
Supervisor of Health and Physical Education, Dade
County Schools
Typhus Control Specialist, State Board of Health
Lawyer, Jacksonville
General Supervisor, Palm Beach County Schools
State Supervisor, Home Economics Education, State
Department of Education
Supervisor, Physical Education, Edward Waters
College
Executive Director, Florida Chapter, National Society
for Crippled Children
Dean, Florida Normal and Industrial College
Consultant, Narcotics Education, State Department of
Education
Nursing Consultant, State Board of Health
Director, Prevention of Blindness, Council for Blind
Dean, Edward Waters College
Coordinator of Certification Service, State Depart-
ment of Educaton
Health Coordinator, Alachua County










Anne H. Franz
Robert Gates

Frank Hall
Lilly Harmon
Dora Hicks
Ethyl Holloway
E. P. Jones
Mary L. Jones
Sara Krentzman Srygley
Lucy Lang

Ruth Laxton
Johanna Sogaard
Rosa Long
Sara Macnamara
W. H. Marshall

Helen McKey
L. L. McLucas

Ruth Mettinger

Gertrude Mooney
O. A. Moore

Sam H. Moorer

Marjorie Morrison
B. J. Nelms
H. A. Nevel

Ann C. Nicholson
L. L. Parks

Thomas B. Phinizy
Edna F. Prince
R. W. Puryear
May Pynchon

E. G. Raborn

Cleo Rainwater
Frances E. M. Read

Elizabeth Reed
Charlotte S. Ripke
S. R. Roberson

John A. Rudd
Fred Safay
Mildred Scott
Louise Smith
Wilson T. Sowder
D. K. Stanley

T. Q. Srygley

Charlotte Steinhans

William Thiel
lona Tillman
Claudius J. Walker
Walburg S. Wayne


American Cancer Society, State Executive Committee
Consultant, Education for Exceptional Children, State
Department of Education
Director, Alaclrua County Health Department
Director of Nurses, Dade County Health Department
Assoc. Prof. of Health Education, Univ. of Florida
District Home Demonstration Agent
Bethune-Cookman College
Health Educator, Tuberculosis and Health Association
School of Library Service, Florida State University
Asst. Supervisor, Home Economics Education, State
Department of Education
Diabetic Consultant, State Board of Health
Nurse Consultant, State Board of Health
Head, Dept. of Education, Edward Waters College
Field Secretary, Fla. Tuberculosis and Health Assn.
General Consultant in Instruction, State Department
of Education
Mental Health Consultant, State Board of Health
Supervisor, Health and Physical Education, Duval
County Schools
Director, Division of Public Health Nursing, State
Board of Health
Assoc. Professor, University of Miami
Asst. Professor, Physical Education, Florida A. & M.
College
Director, Division of Instructional Field Service, State
Department of Education
Nutrition Consultant, State Board of Health
Principal, Leon High School
Asst. Director, Bureau of Preventable Diseases, State
Board of Health
General Supervisor, Gadsden County Schools
Director, Bureau of Preventable Diseases, State Board
of Health
Professor of Health Education, Florida State Univ.
Field Secretary, Fla. Tuberculosis and Health Assn.
President, Florida Normal and Industrial College
Executive Secretary, Florida Tuberculosis and Health
Association
General Consultant in Instruction, State Department
of Education
Demonstration School, Florida State University
Director, Maternal and Child Health, State Board of
Health
Director of Health Information, State Board of Health
Public Health Nurse, Holmes County
Instructor, Health Education, Florida Normal & In-
dustrial College
Executive Secretary, Florida Heart Association
Sanitation Consultant, State Board of Health
Health Officer Consultant, State Board of Health
Head, Dept. of Health Education, Fla. State Univ.
State Health Officer, State Board of Health
Dean, College of Health & Physical Education, Uni-
versity of Florida
Director, Division of Instruction, State Department
of Education
Consultant in Elementary Education, State Depart-
ment of Education
Division of Diabetes Control State Board of Health
Kirby Smith Junior High School
Sanitarian, State Board of Health
Supervisor of Nurses, Escambia County Health Dept.








Ferne H. Wilden Nurse Consultant, State Board of Health
D. E. Williams Supervisor of Negro Education, State Department of
Education
Charles C. Wilson Professor of Education & Public Health, Yale Univ.
Harry Wood Supervisor, Vocational Agriculture, State Department
of Education

The committee worked as a group and also subdivided into
small groups, each group being responsible for the production
of a portion of the total report. Every person who attended the
meeting worked on a subcommittee. The reports of the various
subcommittees were submitted to the committee of the whole
and content of each report was discussed and evaluated. A small
editing committee composed of Miss Louise Smith, State De-
partment of Education; Miss Elizabeth Reed, State Board of
Health; and Mrs. Ann Nicholson, General Supervisor for Gads-
den County Schools, was appointed for the purpose of receiving
the subcommittee reports which were to be fully written before
they were turned in to the editing committee.
After each subcommittee had turned in its report, the com-
mittee met and decided that the work of completing the bulletin
should be carried on primarily by Miss Louise Smith. After Miss
Smith resigned from the State Department of Education to
teach at Florida State University she was succeeded by Mr.
Zollie Maynard who was given major responsibility for the
production of the publication. At this stage of the work Dr.
James Wardlaw of the State Board of Health gave invaluable
assistance.
The materials in the publication have been revised in the light
of the reactions and criticisms of all members of the committee
and of the Committee Consultant, Dr. Charles Wilson, and have
been evaluated by members of the State Department of Educa-
tion and the State Board of Health. Mr. T. George Walker of
the Florida Department of Education has done much of the
editorial work on the manuscript.
A large part of the credit for development of the material
presented in the bulletin must go to the Kellogg Foundation.
This foundation made possible a pilot project which greatly
influenced the methods and ideas as they are recorded. The
project also provided a testing ground and assured the practi-
cality of the information.









TABLE OF CONTENTS
Page
F orew ord .......................................................... .......................... ii
Introduction ..................................................... ......................... iv
I. School Health Program ....................................... ......... 1
Desirable Trends in the School Health Program........ 2
II. Planning and Organizing a School Health Program........ 4
Initiating the School Health Program........................ 4
Organization of the County School Health
Planning Committee .............................................. 6
III. Healthful School Living ..................................... ........... 9
School Sites ................................................. ........... 9
Sewage Disposal ......................................... .......... ... 10
School Building ........................................... .......... ... 11
Sanitation ................................... ............... ....... ..... 15
Safety ................................................... ....................... 16
IV. School Health Services ...................................... ........... 19
Health Appraisal ......................................... ........... .. 19
Protection Against Communicable and
Infectious Disease ............................................. 27
Emergency Care Following Accidents and
Sudden Illness ...................................... ........... 29
The Follow-up Program ............................................. 31
Health Counseling and Guidance ............................ 32
School Food Service ................................... ........... 33
V. Health Instruction ............................................. .......... 35
Suggestions Concerning Gradation .......................... 44
Evaluation in the Health Education Program ............ 50
VI. Finding and Using Resources .............................................. 56
Suggested Community Activities and Field
Trip Possibilities ................................................... 57
Selection of Resources ................................................. 58
A ppendix ....................................................................................... 60
Directions for Using the Snellen Vision Test ........... 60
Natural Lighting for Classrooms .............................. 61
Communicable Diseases in Schools .......................... 65
School Record Form MCH 304 .................................... 73
Laws Relating to School Health ................................ 78









Chapter I


SCHOOL HEALTH PROGRAM

The current school health programs which are provided for
the youth of Florida show that an extended period of develop-
ment has taken place. Records show that the programs have
advanced gradually but significantly in procedures and tech-
niques. Parent groups, professional groups, and community or-
ganizations have contributed to this growth, but the need for
more adequate school health programs parallel the advance-
ments made in medical and public health sciences and the
changing health problems of the community.
Florida people accept the challenge of planning and pro-
viding for improved programs of school health. The State De-
partment of Education, the State Board of Health, and volun-
tary health agencies cooperate in promoting and providing
services for sound programs of school and community health.
Their mutual contributions of energy, materials, and continuous
understanding will play a major role in helping to establish
adequate school health programs and in helping to improve
those programs already in existence.
The legal responsibility for school health services is vested
primarily in the State Board of Health but the program is im-
plemented through its affiliated county health departments.
The responsibility for health education rests primarily with
the State Department of Education through the local school
units. A healthy school environment is the responsibility of
the local school board, with consultation available from the
local health department. It is with these facts in mind that this
bulletin has been prepared.
This bulletin is written for all who are concerned with the
health of the school child. Although the information it con-
tains will be used primarily by classroom teachers, other school
personnel, and public health personnel, it should be remem-
bered that the primary responsibility for the child's health
remains with the parent. The work of the public school and
public health personnel is to supplement and assist the parents.
It is hoped that the presentation of suggested procedures in
the multiple aspects of the program will help to clarify and con-
tribute to mutual understanding on the part of all concerned.







HEALTH SERVICES FOR FLORIDA SCHOOLS


Desirable Trends in the School Health Program
Some important recent trends in school health in school sys-
tems over the nation point the way toward increasingly effec-
tive school health programs throughout the state. Some of
these trends are as follows:
A. More and more children are concerned with their own
health problems and heads of households are taking the
initiative in providing health examinations. Moreover, the
family physicians and dentists who make the examina-
tions usually are willing to assist the schools in comple-
tion of health records.
B. In recent years there has been a growing awareness of
the need for more thorough physical examinations and
for careful and continuous screening of all children by
the classroom teacher. It should be noted here, perhaps,
that the presence of the parents at physical examinations
of elementary school pupils is considered essential.
C. Parent responsibility is continually kept in the forefront
throughout all phases of the school health service pro-
gram. The attitude is that of assisting parents in caring
for their children rather than substitution for the parents'
responsibility.
D. Teachers have a better understanding of their relation-
ship to pupil health. They are able to observe and classify
behaviour which reflects a need for specialized attention
in the classroom or for medical or dental examination and
therapy.
E. The mental and emotional needs of children are becoming
better known through studies relating to child growth and
development and teachers generally are better able to ap-
ply in the classrooms and with individual pupils the find-
ings of recent research in that field.
F. The organization of comprehensive courses in specialized
health education in secondary schools is of greater fre-
quency than ever before.
G. Accurate, up-to-date, cumulative health records available
to the school and to the health department are considered
essential, and of benefit to the entire health program.
H. The importance of teacher-nurse conferences, teacher-







SCHOOL HEALTH PROGRAM 3

nurse-parent conferences and any combination of these
now generally is recognized.
I. Increasingly there is a follow-up of the health examina-
tion and screening test in order to secure early correction
for health problems. There is general agreement that many
health problems of children can be solved only through
the cooperative efforts of pupils, parents, schools, and
local health organizations.
In harmony with these trends, adequate standards for school
health programs should be developed. Certainly, school health
experiences must be of practical and lasting value to the indi-
vidual and must enable him to select his own medical services
wisely and effectively. Constant revision of health programs
and procedures must be made in the light of changing com-
munity needs and in the light of new knowledge and new de-
velopments in the many health sciences.









Chapter II
PLANNING AND ORGANIZING A SCHOOL
HEALTH PROGRAM
A certain amount of organization is necessary to assure the
success of any important undertaking. This is especially true
when the project involves individuals and organizations that do
not operate within the same administrative framework. It is the
purpose of this chapter very briefly to outline a plan for or-
ganizing the county in order to develop an efficient and com-
plete program of school health services. This plan should be
considered a guide that must be adjusted to local conditions.
Suggestions are made for both the county-wide organization and
the individual school-community organization.

Initiating the School Health Program
Each school community should establish a Health Council.
The size of this council will be influenced by the size of the
school and the community that the school serves. Each county
should establish a County School Health Planning Committee
including community, school, and county health unit representa-
tives. The committee should have representation from both of-
ficial and voluntary health agencies.
The County School Health Planning Committee will provide
the type of organization needed to bring about desired results.
Cooperative planning is the keynote for the continuous, har-
monious working together of personnel of the schools, county
health department, and voluntary and professional agencies.
All recognize that the total health of the child in his life sit-
uation is the paramount objective of any school health program.
No complete school health planning can be successfully carried
out without the support, understanding, and active participa-
tion of both the school and county health organization. The
committee may be composed of a cross-section of persons in the
community, who, by the nature of their professional duties, are
interested in health problems; for example, representatives of
the schools, the county health department staff, county, medical
and dental societies, social welfare agencies, and other public
and voluntary agencies interested in and concerned with health.
This type of organization can be most helpful in securing con-
certed action.







PLANNING AND ORGANIZING


If efforts to plan and organize a successful school health pro-
gram are to be realized, some one person must be charged with
the responsibility of coordinating all efforts toward this end.
Ideally, the health coordinator should be a school person with
special training and experience in health work. This person
should possess the quality of leadership and the "know-how"
necessary to keep the County School Health Planning Committee
aware of immediate and long-range problems and should keep
abreast of successful practices used in other communities. In his
hands should rest definite responsibility for the total school
health program and for cooperation with and coordination of
the school health program with all other agencies interested
in and vitally concerned with community and school health.
The county superintendent of schools and the county health
officer should take initial steps in setting up such a committee.
The superintendent should select school representatives to meet
with the county health officer and his staff and together they
should select a health coordinator. In many counties it may not
be possible to employ a person whose full responsibility will be
to serve as a county school health coordinator. In such cases,
this responsibility should be delegated to someone who is al-
ready employed by the school or someone may be employed
who is competent to perform other duties in the county school
office in addition to those of county health coordinator. Some
counties have used their county supervisor of physical educa-
tion, health, and safety, as the county school health coordinator.
Throughout the entire undertaking it should be recognized
that the schools and the county health departments are governed
by certain legal restrictions and established policies and pro-
cedures. These restrictions should be thoroughly understood by
both groups so that each organization can supplement and com-
plement the work of the other. The County Health Planning
Committee should formulate policies and develop a plan of ac-
tion and agenda for it. If, in the course of its work, existing
regulations, policies, and procedures seem not to be in the best
interest of the health and education of the children or in con-
flict with best recommended, practices, it may be considered
advisable to seek change.
Each school community should form a Health Council to pro-
vide a simple, orderly, and convenient organization for deter-
mining wise school policies for immediate and long-range needs.







HEALTH SERVICES FOR FLORIDA SCHOOLS


Each school community should designate a member of the fac-
ulty other than the principal as school health coordinator. This
person should serve as chairman of the School-Community
Health Council which will function along the lines of a con-
tinuing committee within the individual school organization.
The amount of responsibility that this work would involve will
vary, depending on the size of the schools. The committee may
simply be composed of a teacher, a parent, and the public health
nurse. The committee, through its chairman, should cooperate
with the County School Health Planning Committee. Even
though the principal may delegate responsibility to his school
health coordinator, he should realize that the school health
program will become an effective instrument for solution of
health problems in the school and community only to the extent
that he visualizes their importance and encourages the de-
velopment of sound health practices among his faculty, the
student body, and the community. The principal, himself, must
first be convinced of the value of a complete health program.
His interest and enthusiasm is the chief force behind the entire
program. The encouraging results achieved by other schools as
well as the obvious need for such a program in every school,
should inspire him to action.

Organization of the County School Health
Planning Committee
The suggestions listed below may to some extent duplicate
what is said in other parts of the chapter. They are presented
here with the purpose of simplifying and clarifying the steps
that are necessary.
A. The county superintendent and the county health officer
should meet and select a county health coordinator. The
coordinator should be a person who is selected with due
consideration as to his training and experience in public
school health, and for his leadership and administrative
ability. He should be well informed on all state and local
school health laws and the policies of public school au-
thorities and health officials. It is also imperative that
he keep himself, as well as the County School Health
Planning Committee, informed on all problems pertinent
to the work and activities of this committee.
B. Under the supervision of the school health coordinator,







PLANNING AND ORGANIZING


a survey may be made of the immediate school health
needs. This should be done before the committee is for-
mally organized, in order that its purposes and scope may
be more clearly identified. Obviously, school and health
unit personnel will necessarily assist in this survey.
C. After the survey has been completed, the school health
coordinator should be authorized to take the lead in or-
ganizing the County School Health Planning Committee.
Caution should be exercised against allowing the com-
mittee membership to become too large and thereby de-
crease its effectiveness. It is suggested that the member-
ship of the County School Health Planning Committee
may be composed of the following individuals and repre-
sentatives of the following organizations: County super-
intendent of schools, county health officer, public health
supervising nurse, county school health coordinator, a
school lunch supervisor, a librarian, and the general su-
pervisor or director of instruction. In addition to these
individuals, representatives of the following organizations
may be included: County Medical Society, Dental Society,
Parent-Teacher Association, welfare agencies, School Prin-
cipals Association, Classroom Teachers Association, and
voluntary agencies interested in health.
D. Based upon the needs as indicated by the survey, responsi-
bilities should be delegated to committees in order that
work may be begun on the most urgent projects. The
following is a list of projects that are likely to present
themselves to the Council:
1. Organization of Health Councils in school communi-
ties. As has been indicated previously, for small
schools this committee may be composed of a teacher,
a parent, and a public health nurse. The suggested
membership of these councils is very similar to that
of the County Health Planning Committee. Member-
ship may be selected from the following: Principal,
health coordinator for the school, deans, public health
nurse serving the school, teachers of physical educa-
tion, science, homemaking, classroom teacher repre-
sentatives, guidance specialists, librarian, school lunch
manager, head custodian, students representing the
Student Council or student body, representatives of







HEALTH SERVICES FOR FLORIDA SCHOOLS


Parent-Teacher Association or other voluntary agen-
cies closely associated with the work of the individual
school.
2. Survey of community health agencies operating in
the county and the services rendered by them. The
result should be better understanding and use of
these services of volunteer health agencies, such as
the Tuberculosis and Health Association.
3. Cooperation with special education projects.
4. The installation and use of a system of accurate and
up-to-date cumulative health records.
5. Integration of the health education program with the
general school curriculum.
6. Planning and equipping health clinics in schools.
7. Studying the causes of accidents and developing a
plan for the prevention of accidents.
8. The interpretation and application of school and
health laws to school health problems.
9. Improvement of library material on the subject of
health.
10. Arrangements for excuse of students from school ac-
tivities because of individual health problems and en-
couragement of activities suitable for students faced
with health problems.
11. Provision for in-service education for teachers and
other school and health personnel.
12. Establishment of training courses for custodial per-
sonnel.
13. Coordination of the school health service program
with other community health programs. This is par-
ticularly important in the connection of the correc-
tion of physical defects found among school children.
14. Arrangements for a continuous evaluation of the work
of the planning committee and the total school health
program.









Chapter III
HEALTHFUL SCHOOL LIVING

The ideals of every person are influenced by his surroundings,
therefore the public school plant is the people's investment in
the future. It should be made an example for home and com-
munity improvement, and should be developed and maintained
so that it is artistic and beautiful. School children represent a
cross-section of the home life of the community, therefore among
them will be found the same health problems that exist in the
community. The construction of the school building, in so far
as environmental sanitation is related to the transmission of
disease and the physical and mental well-being of pupils, is of
utmost importance from the standpoint of public health. The
school administration is responsible for providing a healthful
physical environment and administrators and classroom teach-
ers are responsible for the best educational use of the environ-
ment.
School Sites
Each site should be well drained and reasonably free from
mud. The soil should be adapted to landscaping as well as play-
ground purposes. Insofar as practical, the school site should not
adjoin the right-of-way of any railroad or through highway,
and should not be adjacent to any factory or other property
from which noises, odors, or other disturbances would be likely
to interfere with the school program.
The site should be accessible to all parts of the population
areas to be served. The school site should be suitable for special
areas which represent needs of the school, such as bus loading
areas, lunch department service areas, and other special area
requirements.
The recommended standard as to the size of the school site
for elementary schools is five acres, high schools five to ten
acres, and senior high schools ten to twenty acres. This recom-
mended standard should be considered as a minimum.
Sites should be located with due regard to traffic, the avail-
ability of bus lines, paved roads, and the possibility of future
traffic problems. Moreover, it is important from the public
health standpoint to select a site which is properly drained so







HEALTH SERVICES FOR FLORIDA SCHOOLS


that mosquitoes cannot breed and to by-pass other sections in
which slum sections or the surrounding sanitation is below the
best standards existing in the community. If a public sewerage
system is not available, the site should be selected with a view
to the proper disposal of waste material.
LANDSCAPING
One phase of a wholesome environment that must not be over-
looked in planning a school site in that of beautification. A
spacious lawn, shrubs, and trees should be provided in front
of or around the building. Shrubs and trees should be spaced
and kept trimmed in order that they will not obstruct the
source of natural light from any window area.
PLAYGROUNDS
The playground should be so graded, surfaced, and drained as
to permit the greatest possible utilization. A well managed sod
should be maintained at all times on grass areas. Regular
cutting, sprinkling, fertilizing, and seeding are vital factors in
good maintenance. Courts and diamonds should be constructed
to provide for a variety of activities in a well-balanced play
program. All playground equipment should be so located that
the children will be safeguarded from moving parts. The equip-
ment should be set in substantial foundations for maximum
safety and should be inspected at regular intervals.

Sewage Disposal
The most satisfactory method of disposing of school sewage
is by connection with a municipal sewerage system. If there is
no municipal system, special facilities must be arranged.
The specifications for the septic tank given in Chapter V
of the Florida State Sanitary Code may be used for small
schools not exceeding 100 pupils. For larger schools, the sewage
disposal installation should be designed by a registered sani-
tary engineer and plans submitted to the Florida State Board
of Health for approval prior to construction. In all cases, the
advice of the State Board of Health or the County Health De-
partment should be secured on the method of disposal of the
effluent from the septic tank and the quantity of drain tile,
where such is used.







HEALTHFUL SCHOOL LIVING


School Building
School architecture now emphasizes the needs of children.
The trend today is toward one-story buildings. Because of this
trend, better schools are available for pupil, teacher, parent,
and community.
Insofar as possible in erecting schools, materials should be
used which are available in and adaptable to the needs of the
section in which the school is located. The building should con-
form to the requirements of the National Board of Fire Under-
writers as to the use of fire resistant materials and Sections
235.24-235.33, Florida Statutes, 1949. In buildings already
erected of two or more stories, well constructed fire escapes
should be provided where the number of stairways do not meet
the standards as prescribed by the National Board of Fire Un-
derwriters and Section 235.26 (21a), Florida Statutes, 1949.
The building should be of rat-proof construction in accord-
ance with requirements set forth in Chapter XXIV, Florida
State Sanitary Code. The foundation, walls, and chimneys should
be kept in good repair.
WATER SUPPLY
Facilities for water supply for all schools should be con-
structed, operated, and maintained in accordance with the
regulations of the State Board of Health, Chapter XXIV, Flor-
ida State Sanitary Code. The drinking water used in schools
is of the greatest importance from a health standpoint. If a
public water supply is available, the school must connect with
it. The safety of public water supplies is insured by state and
municipal regulations and watchfulness. If it is necessary to
develop a private water supply for the school, it should be from
a drilled well from which water is derived from deep seated
sources.
Surface and shallow ground water should be prevented from
entering the well. School water not coming from a municipal
supply should have periodic bacteriological laboratory exami-
nations. These examinations may be arranged by application to
the county or state health officers.
The use of common drinking cups is unlawful. Where running
water is available to the school, sanitary slant-jet drinking
fountains should be installed in the ratio of 1 to every 100
pupils, but not less than two for each school. One fountain







HEALTH SERVICES FOR FLORIDA SCHOOLS


should be inside, and one, outside. Each fountain should be
supplied with water under at least twenty pounds pressure.
Drinking fountains should not be attached or connected to
the lavatories because of crowding and possible contamina-
tion of the fountain by splashing and dripping.
CLASSROOMS
The temperature in classrooms is important at all times. Ef-
fort should be made to maintain consistent, comfortable room
temperature. A favorable range is considered between 68 and
72 degrees Fahrenheit. The question of humidity requires spe-
cial attention so that warm, fresh air will not be excessively
dry. Air which becomes excessively moist will likewise create
an unfavorable health situation within the classroom. An im-
portant part of classroom equipment should be a thermometer
placed on an inside wall, eye level height of children who are
seated in their chairs or desks.
Ventilation must serve a number of purposes and comply with
a number of conditions before it can be considered satisfactory:
1. It must bring in fresh air from outside in order to dilute and
remove the products of respiration. 2. It must maintain the air
within the room at a proper temperature and humidity and
further must keep the. air of the room in gentle and continuous
motion. 3. It must remove the gases, odors, bacteria, dust, and
other substance that contaminate the air of enclosed spaces.
The mandates of satisfactory ventilation are usually fulfilled
if the air is kept cool with only slight fluctuations in tempera-
ture and free from odors. Either fan gravity or window gravity
ventilation will give satisfactory results if properly designed,
installed, and operated, but the window gravity method is far
more promising.
The lighting of classrooms is of concern to the physical well-
being of the children not only as an educational but also as a
health factor. As in temperature, either excessive or inadequate
amounts of light are unsatisfactory to the desirable learning
situation.
Appropriate tinting of classroom walls when planned in con-
junction with lighting fixtures can provide an economic saving
in the amount of light necessary within any given classroom.
Where necessary to control direct sunlight, double shades origi-
nating in the center of the window and capable of being pulled
both up and down are suggested as desirable.







HEALTHFUL SCHOOL LIVING


All classroom equipment such as chalkboards, woodwork, and
furniture should be considered in the total problem of provid-
ing a desirable learning situation. The use of the green chalk-
board has been found to be helpful in providing better lighting
conditions within the classroom. Other classroom equipment
should receive concern for the part that it plays in properly
lighting the classroom.
It is important that glare be eliminated and light be evenly
distributed throughout the entire room. Between twenty to
thirty foot candle power of light properly controlled will, in
most cases, meet the needs of the children. This is a highly
technical subject and the installation of lighting requires the
services of a specialist. The importance of washing windows and
light fixtures and keeping them free of obstruction should not
be overlooked (for additional material on classroom lighting
see page 61, Appendix).
SPECIAL SERVICE ROOMS
Health Suite. Wherever possible, rooms should be desig-
nated for the many health services which require special ac-
commodations within the school plan. These rooms should be
located away from the noisy areas of the schools, such as gym-
nasiums, shops, etc., and preferably joining the administrative
unit. Where only one room can be established for the use of
health personnel, it must necessarily serve as a clinic room for
teacher-nurse conferences, administration of first aid, exami-
nations, and for isolation of youngsters who are suspected of
having contagious diseases. Where more room can be arranged
for health purposes, separate rooms for clinic purposes and
isolation should be maintained. Lavatory and toilet facilities
should be easily accessible.
Minimum equipment within the health suite should be a cot,
sink, cabinet space for first-aid supplies, a table and chairs,
sanitary waste container, and scales. Other highly desirable
pieces of equipment for such a health room would be a two
compartment sink with a closed cabinet, additional tables and
chairs, a sterilizer, a file for records, screens for isolation pur-
poses, a footstool, bulletin boards, and a desk for the health per-
sonnel. A quantity of laundered sheets and pillow cases should
be on hand for the cots in order that fresh linen may be avail-
able for each use.







14': HEALTH SERVICES FOR FLORIDA SCHOOLS

Planned space with suitable connections of water and electric-
ity should be made for mobile x-ray, dental, or other health units.
Teachers' Lounge. It is essential that provisions be made
for the health and emotional well-being of the teachers. In doing
this, it is recommended that a teachers' lounge be provided. Such
a room is for the use of professional personnel for rest and re--
laxation during unscheduled periods. Policies appropriate to
the community should be maintained by the group using this
room. The room should be large enough to provide for chairs,
sofa, bookcases, magazine racks, and space for personal be-
longings of the professional staff. There should be toilet fa-
cilities provided as a part of the teachers' lounge.
School Lunch Departments. A school lunch department is
essential to every school. It should be located on the first floor
and accessible to a service driveway, the rest of the school build-
ing, and to the public for evening and vacation use without
opening the entire school. The required capacity of lunch facili-
ties is based on the school enrollment. The necessary space in
new buildings can be determined accurately only by making
a functional layout.
School lunch buildings should conform to the standards set
forth in Chapter IX of the Florida State Sanitary Code and
Sanitation and Safety Manual.
The type, size, and amount of kitchen equipment will depend
upon the number served. As a minimum for a small depart-
ment, a kitchen should include a heavy duty range, a three
compartment sink with adjoining soiled and clean dish space, a
cook's table, a refrigerator, a serving counter, and a water
heater capable of maintaining a water temperature of at least
120 degrees F. at all times when utensils are being washed. If
the hot water method of sanitation is used, a hot water heater
capable of a constant supply of water of at least 170 degrees F.
is required. "Planning and Equipping School Lunch Rooms"
tabulates sizes and kinds of equipment needed for various sizes
of departments. This bulletin was reprinted in 1948 by the Pro-
duction and Marketing Administration of the U. S. Department
of Agriculture. It also contains a good check list for evaluating
school lunch layouts.
Gymnasium. In the construction of a gymnasium, we should
be mindful of the fact that the sole purpose of this building is







HEALTHFUL SCHOOL LIVING


not for the entertainment of the public but rather as an aid for
the carrying on of a balanced health, physical education, and
recreational program. Therefore, the floor area should be ex-
tensive enough to meet the needs of a highly enriched program.
Shower, drying, and dressing rooms should be of ample size
and quality to both meet state recommendations and provide
realistic educational health experiences.
Toilet Room. Whenever possible, indoor flush toilets should
be provided for public schools. At least one toilet room for each
sex should be required on each floor and the entrance to them
should be well separated and clearly marked. In number, toilet
facilities should be as listed below:
Elementary School: Ideal Number Sanitary Code Requirements
Boys Toilet Seats one for each forty boys one for each seventy-five boys
Boys Urinals one for each thirty boys one for each thirty boys
Girls Toilet Seats one for each twenty-five girls one for each thirty-five girls
High School:
Boys Toilet Seats one for each fifty boys one for each seventy-five boys
Boys Urinals one for each thirty boys one for each thirty boys
Girls Toilet Seats one for each thirty girls one for each forty-five girls
Toilets should be easily accessible from playgrounds and class-
rooms. Toilet rooms should be so located within the building as
to provide cross ventilation and a maximum of direct sunlight
within the room.
Handwashing facilities are essentials in all schools. Each
toilet room should contain one lavatory for every forty pupils
and at least two for each school. Soap and paper towels are
essentials. Mirrors are very desirable. Lavatories for elementary
grades should not be over twenty-five inches in height and not
over thirty inches for the upper grades.
A janitor's sink should be provided near each toilet room so
that the custodial officers will have a place to wash out their
mops and rags.

Sanitation
The primary responsibility for the maintenance for a clean
and sanitary school plant rests upon the custodial staff. How-
ever, it should be borne in mind that the school administrator
is responsible for all actions and conditions taking place or
existing within the school.
The responsibility for a sanitary school building cannot be







HEALTH SERVICES FOR FLORIDA SCHOOLS


entrusted to untrained personnel. Satisfactory housekeeping
means much more than the simple action of the corn broom and
the feather duster. Intelligence and proper training in satisfac-
tory methods are necessary if the building is to be sanitary.
The custodian should be economical with supplies and utilities.
He must keep the school building, fixtures, furniture, and
equipment in such a state of cleanliness as to avoid the possi-
bility of illness of children housed in the building.
Insect and rodent control in and around the school is an im-
portant part of sanitation. The services of the County Health
Department may be necessary for control measures beyond the
immediate environs of the school. This service may be obtained
on application to the county health officers. The teaching staff
can render assistance to the custodial staff by helping children
establish good habits of housekeeping throughout the day. Ad-
ministrators should set up work schedules for the custodians
and standards of cleanliness to be maintained. A complete list
of duties and activities of the custodial staff should be outlined.

Safety
School administrators in Florida are constantly on the alert
to make their schools as responsive to the needs of youth as
possible. They conclude that time and space will not permit the
full realization of all youth's needs, but those which relate to
survival values must be emphasized in a fundamental manner.
The high accident toll is testimony of the failure of man to
adjust his life to the hazardous environment in which he now
must live. In 1948, accidents in Florida took the highest toll of
life in ages one to forty-four, causing 40.6% of the deaths of
all causes in the fifteen to twenty-four year age group. What
profited all other learning if one has not learned to stay alive
Too much emphasis cannot be placed on the necessity for a
safe environment for boys and girls from the time they leave
home in the morning until they return in the evening.
School Safety Patrol. School boys, and sometimes girls, are
used in many schools to assist children across dangerous street
intersections. The boys should not direct traffic from the street
but work from the curb with flags. The flags should be placed
on poles which the boys can extend into the street to stop
traffic when children are ready to cross the street. Time should








HEALTHFUL SCHOOL LIVING


be given to the proper training of the school boy patrols so that
they will be effective in their work and cause a minimum of
slow-up in traffic. The student body should realize the impor-
tance of the work of the patrol and follow their directions.
Safety Zones. Attention should be given to provide stop
signs, designated safety zones, and police patrol during con-
gested periods. A hazard often overlooked by the school ad-
ministration is that caused by the lack of sidewalks. It is the
responsibility of the administration to work cooperatively with
city and county officials to work out details which will pro-
vide the necessary facilities needed for children who walk to
and from school.
Fire Protection. In the construction and maintenance of any
new school building and in the maintenance of any existing
school building, special attention should be given to protection
and safeguards from fire hazards. Any and all school buildings,
two or more stories in height, which do not have fireproof or
fire resistant stairways and corridors and adequate exits should
be provided with at least one adequate and easily accessible fire
escape for each 250 pupils enrolled in the school (Section 235.26,
Florida Statutes, 1951).
Any school plant with six or more classrooms not protected
by the services of a public fire department must be provided
with chemical fire extinguishers approved by the National
Board of Fire Underwriters and conforming to Subsection 21b,
Section 235.26, Florida Statutes, 1951. Fire extinguishers should
be prominently exposed to view and always accessible. The prin-
cipal of each school should see that each extinguisher is re-
charged annually.
There should be a place in a hall or corridor of each school
plant, an alarm consisting of a bell or gong, arranged or equip-
ped so as to be found at least at one convenient station or place
upon each floor and of sufficient size and volume of tone to
be distinctly heard in each room when sounded (Subsection
21c, Section 235.26, Florida Statutes, 1951).
Inspection. It is the responsibility of the school administra-
tion to secure an inspection of the site, building, and equip-
ment regularly in order to ascertain and, if remedial, to cor-
rect all hazards. The county health officers may be called on
to perform this service.








18 HEALTH SERVICES FOR FLORIDA SCHOOLS

Supervision of Play Activity. At all times that children are
on the school grounds, adequate supervision must be provided.
It is very important that proper organization and supervision
of play activities before school, during free periods, and after
school be recognized as a definite responsibility. A physical edu-
cation period should provide instruction as to the safe use of
facilities located on the school grounds.









Chapter IV
SCHOOL HEALTH SERVICES

The strength or weakness of the program of school health
services depends to a great extent on the general understand-
ing, interest, and cooperation of everyone concerned with the
program. A cooperative group consisting -of those responsible
for and those benefiting from the school health program should
be represented on the school health planning committee. Such
a group can efficiently implement an effective school health
program which will improve the health of the student body.
The county school board and local health department each
have a legal responsibility for the school health program while
the physicians and dentists of the community together with
voluntary and other official agencies also have an interest and
concern with the program.

Health Appraisal
PURPOSES OF HEALTH APPRAISAL
A. To provide accurate information for the teacher, nurse,
parent, or other interested person respecting the child's
physical or emotional well being.
B. To identify the child who needs treatment or referral to
physician, dentist or other agency and/or individual to
accomplish correction of defect.
C. To identify the children with non-remedial defects who
need an adapted program, e.g., epilepsy, speech defect,
cerebral palsy and heart disease. (For further information
see Bulletin No. 55, "Developing a Program for Educa-
tion of Exceptional Children in Florida.")
MEDICAL EXAMINATIONS
A. Pre-examination suggestions
1. Screening should be conducted by the teacher and nurse
if deemed necessary prior to the physician's medical
examination. The medical examination should be given
only after a teacher-nurse conference regarding the
findings of the preliminary screening.
2. Sufficient preparation should be made so that the
examination will be an educational health experience
for the child.








HEALTH SERVICES FOR FLORIDA SCHOOLS

3. The parent should be notified in writing by the teacher
of the day, time, and place of the examination of the
child, and should be requested to be present during the
examination.
4. If the parent is not present at the time of the examina-
tion and defects are found, notice for referral should
be prepared by the health department, and be sent to
the parent.
B. Examination of entrants and transfers
All children entering a school for the first time (in the
first or any other grade) should be examined. It is pre-
ferable that this be done by a private physician and
dentist and a record of the findings entered on the school
health record (MCH 304). When necessary, the examina-
tion may be done by the school physician.
C. Examination of the child referred as a result of teacher
screening and teacher-nurse conferences.
1. Experience has demonstrated that medical examina-
tions are most fruitful when the student has been
specifically referred to the physician because parent,
teacher, or nurse suspected that something was wrong.
Such examinations should always take precedent over
routine examinations.
2. Provision should be made for the medical examination
of students who show signs or symptoms of disease,
defect or disorder, failure to grow as expected or ap-
pear to have a health basis for failure to make antici-
pated school progress.
3. The policy in Florida is to encourage parents to place
children under continuous medical and dental super-
vision from birth, preferably under the care of a pri-
vate physician or dentist. It is recommended, there-
fore, that these examinations be performed by the
private physician and dentist rather than the health
department except in cases of medical indigency.
D. Periodic examination
"During the school years pupils should have a minimum of
four examinations. One at the time of entry into school, one
in the intermediate state, one at the beginning of adoles-








SCHOOL HEALTH SERVICES


cence, and one before leaving school. Pupils who have seri-
ous defects or abnormalities, who have suffered from seri-
ous or repeated illnesses or who engage in vigorous athletic
programs, require more frequent examinations. The phy-
sician is the best judge of the need for repeated examina-
tions and of the frequency with with they should be given.
Additional examinations, even annual examinations, may
be arranged if money, time, and personnel permit, but the
quality of medical procedures and judgment should not
be sacrificed to a desire for frequent and complete cover-
age of the entire school. Medical examinations should be
sufficiently painstaking and comprehensive to command
medical respect, sufficiently informative to guide school
personnel in the proper counseling of the student and
sufficiently personalized to form a desirable educational
experience." (Suggested School Health Policy, American
Medical Association, pages 28-29.)
E. Dental examination
1. Children should be prepared in advance for dental
examination and treatment in order to allay fear and
in order to create an atmosphere so that the situation
may be used as an educational experience. This should
be done regardless of whether the child is examined
or treated by his family dentist or local clinic facilities.
2. Conference with the nurse regarding special care for
children with speech defects or marked malocclusions.
3. Teachers should follow up the examination to encour-
age dental corrections and to determine if corrective
dental service has been received after dental exami-
nation.
SPECIAL TESTING AND HEALTH SCREENING
A. Pre-school examinations
1. The school should conduct a survey of pre-school chil-
dren to find those who will be entering school the fol-
lowing year. Whenever possible, a survey should be
made of younger children two and three years of age,
also.
2. Encourage parents to have children examined by their
private physician and dentists well in advance of school
opening so that defects may be corrected before the








HEALTH SERVICES FOR FLORIDA SCHOOLS


children enter school. Findings of these examinations
should be entered on the school health record.
3. Develop interest and assistance of the PTA and other
appropriate groups in encouraging parents to get chil-
dren under early continuous medical supervision.
B. Screening of school children
1. Screening may be defined as a selected process of
health appraisal to determine the children who need
further attention or examination and includes all pro-
cedures short of a complete physical examination used
to determine the health situation of children. Periodic
screening of children is primarily the responsibility of
teachers. Each teacher personally should screen all
children in his class.
Screening by the teacher has a multiple purpose. It
not only notes apparent physical defects which need
correction but it also helps the teacher to understand
the child more completely. Screening may serve to
guide the teacher in making any indicated adjust-
ments to help the child.
2. Procedures for screening
a. Height and weight-variations are to be referred to
if a child fails to gain over a period of three months.
This condition should be looked on as only an indi-
cation that the child may have a health problem.
These referrals should be made to the public health
nurse. It is hoped that many teachers will investi-
gate the possibility of using the American Medical
Association and National Education Association
Physical Growth Record or the Wetzel Grid. In
order that height and weight measurements may
be reliable, an adequate number of beam type
scales should be provided, at least one in each
school.
Periodic weighing of all children should take place
at least annually. It is advisable that elementary
school children (because of rapid growth and
changes at these ages) be weighed and measured
at least three times a year or every three months.
During the growth period a child should show some








SCHOOL HEALTH SERVICES


gain in weight and height each year. When these
factors are measured, the teacher should record
them on health record (MCH 304) noting the date.
If the teacher observes that a child is not making
some gain or if a child appears too much under-
weight or overweight (making allowance for
normal average limits), an investigation should be
initiated to discover the causes.
b. Vision-every child's visual acuity should be tested
at least once a year. Some schools of the State of
Florida have access to the Massachusetts Vision
Test or telebinocular through their local health de-
partment and most schools use the Snellen Chart.
This simple test along with other observations will
help the teacher to discover defects in vision and
will indicate children who should have visual or
medical attention.
The teacher should record any symptoms of eye-
straining noted:
(1) Thrusting head forward
(2) Tilting head
(3) Eyes watering
(4) Frowning or scowling
(5) Closing one eye during test when both eyes are
tested together
(6) Excessive blinking
Directions for the use of the Snellen Eye Chart are
to be found in the appendix.
c. Hearing-early knowledge of defective hearing is
very important.
The more common means for detecting hearing
problems are:
(1) General observation, such as turning the head,
in-attention, and failure to follow directions
(2) The whisper test or
(3) The coin click test.
The child may lose a considerable amount of hear-
ing ability without being aware of the loss and
hence fail to seek medical aid until too late.
The problem is one of prevention, examination,







HEALTH SERVICES FOR FLORIDA SCHOOLS


diagnosis, treatment, and rehabilitation. Obviously,
the school must play an important role in solving
the problems of speech defects, retardation, in-
feriority complexes, and emotional maladjustments
resulting from defective hearing.
DAILY OBSERVATION BY TEACHER
A. Conditions which may indicate visual disturbances
1. Crust on lids and lashes
2. Red eyelids
3. Styes
4. Swollen lids
5. Watery eyes
6. Apparent lack of coordinating eye movement
7. Behavior of the child such as
a. Attempting to brush away blur
b. Blinking continually or frequently while reading
c. Showing signs of nervousness, irritability when
doing close work, frequently crying or having fits
of temper
d. Holding book far away from face when reading or
holding book too close when reading
e. Holding body tense when looking at a distant ob-
ject or squinting to see the blackboard
f. Showing inattention to wall charts, maps, or black-
board lessons
g. Showing inattention in reading lesson
h. Reading only at brief periods without stopping
i. Rubbing eyes frequently
j. Puckering face
k. Thrusting head at unusual angle
1. Complaining of frequent headaches
m. Poor alignment in penmanship
n. Reversal tendencies in reading
o. Confusion in reading and spelling such as "o" and
"a", "e" and "c", "n" and "m", "n" and "r",
"f" and "t".
p. Making apparent guesses for a quick recognition
of parts of words in easy reading materials.
B. The teacher should refer those children with symptoms
of eye defects to the nurse who can provide additional







SCHOOL HEALTH SERVICES


examinations or arrange for the child to be examined by
an ophthalmologist.
C. Symptoms often associated with hearing difficulties
1. Discharging ears
2. Earache
3. Turning head to hear
4. Asking others to repeat the conversation
5. Inattentiveness
6. Excessive noisiness
7. Inability to repeat accurately things heard
D. Teacher screening for possible teeth defects. Children
having the following should be referred to the public
health nurse for further examination.
1. Loose first teeth
2. Decayed teeth in either temporary or permanent teeth
3. Highly reddened, irritated, bleeding gums
4. Any sore in mouth that does not heal in two weeks
5. Permanent teeth out of alignment
6. Speech defects
7. Broken down tooth roots
8. Repeated absence from school because of toothache
9. Poor mouth hygiene
E. Indications of throat disorders. Children having any of
the following should be referred for further examination
to the public health nurse.
1. Repeated attacks of sore throat
2. Earache or discharging ears
3. Obvious chronic mouth breathing
4. Visible enlarged glands in the neck
F. Teacher screening for developing posture problems
The teacher should watch children for slumping and
careless habits of walking, standing and sitting. Children
with abnormal posture habits should be referred to the
public nurse.
G. Teacher screening for nutritional problems
It is desirable that teachers learn to recognize signs and
symptoms of malnutrition, so they can be alert to problems
existing in the classroom. Changing eating habits is .a
slow process, but children's habits can be improved. Be-
cause of this fact it is felt that nutrition should be an
integral part of the school curriculum.








HEALTH SERVICES FOR FLORIDA SCHOOLS


H. Teachers should refer children for further examination if
any of the following are noted:
1. Abnormal nervousness or irritability
2. Repeated absence because of sickness
3. Evidence of abnormal fatigue
4. Infections of scalp or skin
5. Lack of general cleanliness
6. Chronic or continual withdrawal from the group
7. Retarded mental or physical development
SCHOOL HEALTH RECORDS (MCH 304)
A. In planning the health appraisal part of a school pro-
gram, the need for records becomes apparent. School
health record (MCH 304) approved jointly by the State
Board of Health and the State Department of Education
is recommended. (See Appendix)
B. School health records should be filed and kept in the
school at all times. It is advisable that the school health
records be kept in a permanent file in the classroom so
that the teacher can have convenient access to the records
and make daily or continuous observations or notations
whenever something significant occurs.
C. No records should be removed from the school. The rec-
ords should be transferred with the child's cumulative
folder when he transfers from one grade to another or
to a different school.
D. These records are confidential, permanent, and a part of
the individual's personal history and should, therefore,
be given the strictest of care. The teacher, the principal,
the public health nurse, parents, the health officer and
through him the private physician are the only persons
who should have access to these records. Other persons
desiring access to these health records should obtain per-
mission from both the county superintendent of schools
and the county health officer.
E. The principal's responsibility in record keeping
1. The principal should obtain a supply of health record
forms (MCH 304) for the school by requisitioning them
from the local health department.
2. The principal is responsible for permanent filing and
preservation of health records of all children in the








SCHOOL HEALTH SERVICES


school. He should attempt to obtain health records of
all transfer pupils.
3. The principal should encourage and guide teachers re-
garding the keeping and filing of health records.
F. The teacher's responsibility in record keeping
1. The teacher should see that the health record is filed
and kept up to date.
2. The teacher should initiate a record for every new
child, filling in information and data such as family
history and immunization history on page 1 of School
Health Record (MCH 304). This is done for pre-school
children or children entering school for the first time.
3. On page 2 of Health Record (MCH 304) the teacher
should record the findings of the screening test which
she administers. Parents, or in some cases high school
students, may assist the teacher with recording.
4. Significant illness or injury should be recorded for each
pupil as it occurs.
5. School health records should be made available to the
public nurse so that she can enter thereon pertinent
information gained during the followup.
Protection Against Communicable and Infectious Disease
EXCLUSION AND READMISSION POLICIES
A. It is possible to endanger the health of the school child
through overemphasizing school attendance, therefore
school policy should not set too great a value on perfect
attendance. Parents should be encouraged to make care-
ful observation of their children before sending them to
school in order to help prevent sending a child who might
be in the first stages of a communicable disease.
B. Exclusion of sick pupils
1. The teacher is responsible for recognizing any child
who shows any sign or symptoms of illness, and for
referring the child to the principal, nurse or proper
authority for exclusion from school. The cases of com-
municable diseases should be reported immediately to
the county health department.
2. The teacher should be continuously alert to note any
child who deviates from his normal health and be-
havior. The teacher should take particular care in ob-







HEALTH SERVICES FOR FLORIDA SCHOOLS


serving children for early signs of a communicable
disease.
3. It is an approved State policy that no treatment shall
be given by the teachers with the exception of first
aid for injuries. (If, in certain locations, exceptions
for minor and specific procedures are made, these
must have the approval of the local medical society,
county health officer, and school authorities.)
4. Any child considered by the teacher to be sick should
be isolated-placed apart from all other children until
arrangements can be made to send the child home. A
sick child's parents are responsible for taking care of
him and should be notified immediately.
5. According to Florida law, a school child who has been
ill of a communicable disease shall in no case be al-
lowed to return to school except on the written per-
mission of the full-time county health officer or other
reputable physician licensed to practice in the State
of Florida (Section 232.35).
6. Signs and symptoms of communicable diseases may be
obtained from the Florida State Board of Health Com-
municable Diseases Wall Chart previously mentioned
which should be in every elementary school classroom
and in the principal's office of each high school. These
wall charts may be secured from the local health unit.
7. Personnel of the county health department should keep
the school authorities informed about incidence of
communicable disease, furnish information and as-
sistance when requested by schools, and guide the
schools in raising health standards, thereby reducing
disease incidence in the community.
ISOLATION AT SCHOOL
Children who are suspected of having a communicable dis-
ease should be isolated until arrangements are made for
the parents to accept the responsibility.
IMMUNIZATION AND VACCINATION
A. The school is responsible for the distribution and collec-
tion of permit slips for immunizations given in the schools.
B. School personnel also assist in selection of children need-
ing immunization. The following recommendations are
made by the State Board of Health:








SCHOOL HEALTH SERVICES


1. It is recommended that- diphtheria-whooping cough-
tetanus immunizations be given to children beginning
at two months of age up to five years of age. A booster
injection should be given about one year later and
then again three years later if this combination is used.
2. Smallpox vaccination should take place within the
first year of life and preferably after the diphtheria-
whooping cough-tetanus combination has been com-
pleted. A booster smallpox immunization should be
given every three or four years and on exposure to
the disease.
3. Tetanus or lockjaw toxoid is advisable in combination
with the diphtheria and whooping cough as stated-
above. However, it may be given beginning at about
two months of age up to any age and a booster dose
one year later and then a booster dose every three
or four years and after an injury such as a nail
puncture.
4. Typhoid immunization is not necessarily recommended
routinely except in epidemic areas and upon exposure.
After the first series of injections have been received,
a booster injection should be given every three years.
5. The immunization of diphtheria, whooping cough and
tetanus may be administered in a combination or they
may be given individually. The combination injection
is just as effective and surely less painful to the child.

Emergency Care Following Accidents and Sudden Illness
SUGGESTED GENERAL POLICY
A. Simple first aid and emergency medical care is the re-
sponsibility of the school personnel. The principal or a
member of the school staff trained in first aid should be
designated to care for the more serious accidents. Minor
first aid, such as for scratches and abrasions, should be
administered. It is recommended that every teacher be
informed on standard first aid methods and procedures.
B. Every accident which is treated, no matter how trivial,
should be recorded. The school staff should have a stated
policy providing for notification of parents and of the
further procedures to be followed.
C. Each child's cumulative record folder should include in-







HEALTH SERVICES FOR FLORIDA SCHOOLS


formation relative to the name, address, and telephone
number of the local family physician and a second choice
for emergency purposes. For those pupils whose parents
are not available and who have no family physician, the
record should show to which physician or hospital the
child should be moved. Written permission from the par-
ents should be filed in order to implement the above.
TRANSPORTATION OF SICK CHILDREN
A. The principal should arrange with one or more respon-
sible adults to transport sick children from the school to
the home or hospital in cases where it is impossible for
the parents to come for the child. This particular problem
has been met in some communities by cooperation with
local civic organizations, although the ultimate respon-
sibility remains with the principal.
B. If the child is in such state that he may not be moved
safely, medical care and treatment should be secured and
costs should be defrayed under established policies for
such emergencies.
THE FIRST AID KIT
A. First aid kits should be readily available (but inaccessible
to elementary school children) in adequate numbers.
B. In the elementary school one kit will ordinarily be ade-
quate for each three hundred pupils.
C. In the larger schools first aid kits should be easily ac-
cessible during such activities as strenuous athletics and
conveniently located with respect to the boiler room, the
kitchen, laboratory classrooms, and the gymnasium.
D. An instruction sheet showing approved procedures of first
aid should be posted in each first aid kit.
E. Each accident should be used as a teaching opportunity
in the interests of safety.
F. Suggested guides for first aid procedures and contents of
the kit are available from the Metropolitan Insurance
Company (free), John Hancock Insurance Company
(free), Red Cross Instruction Book (minimal price).
G. Suggested equipment for the first aid kit or cabinet
1. Tincture green soap
2. An antiseptic such as tincture merthiolate








SCHOOL HEALTH SERVICES


3. Aromatic spirits of ammonia
4. An ointment for first degree burns, such as vaseline
5. Oil of cloves
6. Band-aid (1 inch)
7. Gauze bandage (2 inch)
8. Adhesive (1/2 inch and 2 inch)
9. Absorbent cotton
10. Applicators
11. Scissors
12. Toothpicks
13. Triangular Bandages
14. Thermometer
15. Small basin
16. Splints, plastic or wood
17. Table salt
18. Baking soda
19. Safety pins
20. Glass
21. Spoons

The Follow-up Program
POINT OF VIEW
A. The purposes of a school health program should be to
eliminate and prevent defects as well as maintain and
promote good health. The follow-up is most important be-
cause many corrections will not be obtained by the parents
unless there is sufficient follow-up. It should be remem-
bered also, that weakness in follow-up is one of the major
reasons that a school health program is not successful.
B. The facilities and resources available in a community
must be completely known before a plan can be organized
for a follow-up program, and the problems peculiar to
the local community must be understood by the health
officer.
C. The health officer with the school health planning com-
mittee should establish the plan and cooperate with the
private physician. The entire program and especially the
part of obtaining correction of the defects should be un-
derstood by the private physicians and have approval of
the local medical society.







HEALTH SERVICES FOR FLORIDA SCHOOLS


PROCEDURES
A. The scope of the follow-up program includes all those
processes and procedures which are employed to follow
the child to obtain the desired corrections and treatment.
Everyone concerned with school health has a necessary
role in the follow-up.
1. The public health nurse, because of her close associa-
tion to the family and relationship to the school, com-
munity, and health workers, has a major part in the
follow-up work.
2. The individual teacher, because of his close association
with the child and parent, also has a necessary role in
the follow-up procedures.
B. Because of their relation to physical and mental develop-
ment, remediable defects should be corrected early in the
life of the child. Children with nonremediable defects
should be helped to understand their limitations and to
develop their optimum potentialities.
C. Follow-up must be continuous and active with the child,
family, and community until the desired treatments or
corrections are completed.
D. Proper procedure for obtaining family-aid services should
be familiar and understood by county superintendents,
principals, and teachers as well as personnel of the county
health department. (See chart on page 34.)
E. Parent interest in obtaining corrections should be stimu-
lated.
F. Report should be made to the county health department
regarding correction.
G. Report should be made by the county health department
to the school of defects corrected.
H. There should be cooperation with the nurse in selection
of cases of follow-up by the nurse.

Health Counseling and Guidance
Health counseling and guidance may be considered as an
interchange of ideas between two or more people to formulate
a plan, whether it is for guiding a child's normal development
or for solving a specific and immediate health problem of a
child.








SCHOOL HEALTH SERVICES


VALUABLE CHANNELS FOR COUNSELING
A. Teacher-nurse conferences
B. Teacher-nurse-parent conferences
C. Teacher-child conferences
D. Nurse-child conferences
E. Teacher-physician-parent conferences
F. Home visiting by nurse, teachers, and other health workers
G. Parent-community organizations conferences
OPPORTUNITIES FOR HEALTH COUNSELING
Valuable and effective health counseling may be done at the
time of the physical examination or during the conduction of
special testing and health screening. However, health counseling
is not limited and should be considered as a continuous construc-
tive procedure. Health counseling is an important factor in guid-
ing not only the child who needs attention but also the average
or normal child in his growth and development of health.

School Food Service
One of the most important health services of the school is the
provision of nutritionally adequate food for all children in the
school.
The lunch served should provide one-third to one-half of the
child's nutritive requirements for the day. If breakfasts are
known to be inadequate or deficiencies are apparent, more than
one-third of the child's nutritive requirements for the day should
be provided by the school lunch.
Food and beverages served in the schools should be only those
which contribute both to the nutritional needs of the child and
to the development of desirable food habits.









Health Services
Available through Personnel Services Materials
Local Chapter



Organization 0 Explanation of
SNotations







American Cancer Society,
Florida Division, Inc......... X X ...... X X ...... X ...... X X X ...... X X X X X

Division of Vocational Rehab- (1) Transparent Over-
ilitation, State Department lay Process to be used
of Education ............... X X X X (1) X X X X X X X ...... ............ X X ...... with Lecture

Florida Council for the Blind... X () X X X ...... ..... X X X X X X X ...... ...... X ...... (1) In cooperation with
other agencies

Florida Crippled Children's
Commission................ X X X X X ...... ...... .. .. ........................ .. ... ............

Florida State Board of Health. X X ...... X ...... ...... X X X X X X ...... ...... X X (1) X (2) (1) Rarely; (2) Rarely


Florida Tuberculosis a
Health Assn......


National Foundation for Infan-
tile Paralysis, Florida North
and South Offices.......... :

National Society for Crippled
Children and Adults, Florida
Chapter.................... X


X(1) ...... ...... X X ......


X X X X X X IX ............ X


(1) In cooperation with
X local health unit

(1) Films deposited with
I! tateBoardof Health
University of Florida
X Florida State Univ.

(1) for cerebral palby
(2) for professional
...... workers










Chapter V
HEALTH INSTRUCTION

Health education is both a continuous process and an end
result. "Health education is the process of providing learning
experiences for the purpose of influencing knowledge, attitudes,
or conduct relating to individual, community, or world health."
... and it is "the sum of experiences which favorably influence
practices, attitudes, and knowledge relating to health."'
WE LEARN WHAT WE LIVE
Health education in school, like every other aspect of learning,
is a product of experiences. The individual patterns of behavior,
healthful and unhealthful, are influenced by many forces. What-
ever the source and whatever the worth of the innumerable
health suggestions the child receives, it is only as he makes
them a part of his own behavior that he gains health knowledge,
that he changes his attitudes, and is prompted to healthful con-
duct.
The child lives in one continuous environment so far as grow-
ing and learning is concerned. Teachers, parents, and physicians
sometimes act in isolation from each other with disregard for
the child's environment outside their immediate concern. All
who help to provide and to control the complete environment
of the child must work on a common front in health education.
Teachers are justified and obligated to concern themselves with
home conditions. Those who work primarily in the various com-
minity social and civic agencies in the interest of health must
concern themselves with what goes on in schools and in indi-
vidual family homes. Concerted and coordinated educational ef-
fort is required if the total environment exerts a consistent,
wholesome, and unified influence on growing children.
HOME, SCHOOL, AND COMMUNITY MUST
WORK TOGETHER FOR HEALTH
The health program of the school should supplement and
re-enforce the health efforts of the home and should be closely
coordinated with all the community efforts to provide healthful
learning experiences. The influence of the home, the parents,
and the surrounding environments is of tremendous importance

* NEA, Joint Committee on Health Problems in Education of the NEA and
the AMA, Health Education, p. 4.







HEALTH SERVICES FOR FLORIDA SCHOOLS


in cultivating desirable concepts of health behavior. The things
learned in the home and in the community will be carried by
the child in his contacts with other children and groups.
Home health education is the first learning experience in
health that the child receives. The health knowledge of parents
is strongly influenced by outside factors in the environment
and health information received from many varied sources, both
reliable and unreliable. Many homes today are influenced by
the traditional information and misinformation handed down
from generation by grandparents and their parents. The motion
picture at the commercial theatre, radio and television in the
home, public exhibits, newspapers, magazines, and other media
of communication with the public are all channels through which
health education takes place. Public services and commercial
enterprises within the community also exert influence upon the
health behavior of parents and their children. These influences
do not solve the problems of health; they do create interest,
stimulate thinking and sometimes lead to action. It is important
that these influences are recognized and that both children and
their parents are educated to choose wisely and weigh carefully
the information they allow to influence their health behaviors.
When formal education is ended, the effect of the community
in which a person lives invariably influences his health practices.
Health education is an action program concerned with real
people living in real situations. Recognizing health problems in
the school, home, or community, finding solutions for them and
carrying through with a program of action to change the unde-
sirable conditions, actions, and beliefs are all valuable learning
experiences constituting health education-both the processes
engaged in and the end results they cause.
RELATIONSHIP OF HEALTH EDUCATION TO
THE TOTAL SCHOOL HEALTH PROGRAM
The total school program includes all of the school sponsored
provisions, experiences, activities designed to protect, improve,
and promote the health and well-being of children. Health edu-
cation of the child must be a planned part of the aspect of the
school health program in order that the understandings and
practices of healthful growing and living may result.
Teaching for health should be integrated into every learning
experience the child has. Health is in itself one of the primary
goals of education whether formal or informal; therefore, all







HEALTH INSTRUCTION


educators, the entire school personnel, and every area of the
curriculum are in some measure educating for health. A fully
developed and well integrated school health program is com-
plex and involves the participation of many individuals who
must work harmoniously toward common goals. The entire
school atmosphere must evidence efforts to attain agreed upon
objectives for the health of every child. Accomplishments in
relating health education to the whole of the school health pro-
gram are seen when a child gains respect for and develops a
sense of responsibility in improving himself and his environment.
A child cannot grow or develop or learn at his optimum ca-
pacity if he is not fully nourished, if he has a remediable defect
or if he fails to live in harmony with society and emotional ad-
justments. He cannot be taught with such waste of effort and
useless expenditure of energy. He cannot be interested, happy,
and free from misguided concepts of himself, his associates and
his environment unless adequate consideration is given to his
health education.
THE SCHOOL SETTING
Learning experiences in health education are provided partly
through attention to the school environment. The cleanliness
and sanitation of the toilet facilities, water supply, school
grounds, and school lunch department have a direct influence
on the student's outlook in such matters and his assumption of
responsibility in helping to keep them clean. Improvement and
repair of the school plant, buildings and grounds, interior deco-
rations, and the provision of supply are all effective channels
through which health education is directed. An important edu-
cation procedure in the school is the arrangement of seating in
the classrooms so that available natural light is used to the best
advantage. Artificial light should be provided when needed.
Pupils may learn to make the classroom an example of healthful
living with proper attention to such factors as lighting, glare,
seating, ventilation, and cleanliness including the intelligent use
and maintenance of toilet facilities. The methods used in the
instructional program and the day to day living of the students
are influencing factors of the pupils' understanding of healthful
behavior.
THE LENGTH OF SCHOOL DAY
The frequency and length of rest periods and the adaptation
of individual pupil program to physical and mental capacities







HEALTH SERVICES FOR FLORIDA SCHOOLS


are factors which must receive careful consideration in pro-
viding for the health education and needs of children. The ef-
fects of the total curriculum on the total health of the pupils are
significant in the health education planning.
THE SCHOOL LUNCH PROGRAM
The school lunch department is another phase of the total
health program that provides many educational opportunities
for improving the health of pupils. Eating is an important event
in a child's day and the dining room at the school is where the
child eats his meal while away from home. The school lunch
program provides opportunity for the child to eat adequate
lunches at school. He practices regularly the habit of washing
his hands before lunch; he learns to enjoy friendly association
with his classmates during unhurried lunch periods; he learns
many combinations of foods which are most valuable to health,
and is taught to cultivate tastes for new foods. The school lunch
program and study of the food habits of the pupils, offers many
possibilities for enriching the curriculum and for teaching func-
tional health education.
The nutrition problems listed below should serve as a chal-
lenge to classroom teachers:
A. Poor nutrition as judged by the physician
B. Dental caries
C. Inadequate intake of milk, fruits, and vegetables
D. Underweight
E. Breakfast and supper omission
F. Frequent consumption of soft drinks and candy
G. Poor food habits and food waste
MAKING THE HEALTH SERVICES EDUCATIVE EXPERIENCES
Health education can help children to understand the mean-
ing and to appreciate value of adequate medical and dental
examinations and inspections, communicable disease controls
and other activities. Children should be made to feel that they
are a part of the health examination and must recognize results
from it. If it is a functional health experience, the effectiveness
of health examination, the correction of physical defects, the
control of communicable diseases-all promote accomplishments
of better personal and social health when they are integral parts
of the program of health education and when they are recognized
as laboratory experiences in health education. Children should
learn to appraise their strengths and weaknesses. They should
use community resources for the correction of remediable de-
fects and they should secure protection against communicable







HEALTH INSTRUCTION


diseases. One of the most important phases of health education
is the personal counsel and health guidance that children should
receive concerning their health problems and health practices.
This counsel and guidance is the cooperative job of the school
physician and dentist, private physician and dentist, public
health nurse, parent, teacher, and other school personnel.
Teachers and health personnel must explain the procedure of
health services if children gain real meaning. and receive sig-
nificant educational values from them. These experiences in
schools today give unique opportunities for health education
that creates favorable, friendly and cooperative attitudes to-
ward health maintenance and improvement. The health services
provided in the school health program are treated fully in
Chapter IV.
There are problems in the healthful development of boys and
girls that must be solved through teacher and pupil planning
and that are based on the interest and needs of children as they
are discovered by teacher observation and pupil expression.
These experiences in health education should be directed toward
helping each child gain an understanding of the many factors
which influence health and of the ways in which individuals or
groups may use these factors to improve health.
DETERMINING WHAT TO TEACH
Sound health education is the obligation of every teacher at
every grade level in the elementary school. Before a teacher can
plan an educational program for children he must have an
adequate understanding of each child's health needs and in-
terest. There may be variations in the growth and development
processes of the child and there may be defects or inadequacies
that cause health problems. There are health problems stem-
ming from environmental conditions-in classrooms, in the gen-
eral school environment, in the home, or in the community.
There are health problems that may arise from everyday living
practices of the children.
The teacher is in a strategic position to notice the day to day
variation of the child's health, as he works, plays, and associ-
ates with others, for he maintains almost unbroken contact
with his pupils during the school day; however, no one teacher
or no one person alone can be expected to find all of the many
and varied problems in health that exist among children. Only
through cooperative findings and cooperative planning can
these health problems be found and solved.







HEALTH SERVICES FOR FLORIDA SCHOOLS


The school health program consists of finding the existing
health problems of children, planning the solution on the basis
of accurate information and solving the problems in terms of
action. The individual teacher is responsible for planning with
her pupils the specific health experiences necessary to solve the
existing problems. They may need to call upon the participation
of other school personnel, upon parents or other members of the
immediate family, the private physician, the public health per-
sonnel, or other community organizations interested in solving
health problems.
Any outline of suggested health problems should be used by
the teacher only as a guide to possible needs which may be over-
looked. The existing needs and interests of the children are
basic in determining what to teach. So long as a health problem
exists it has a place in the curriculum at any grade level. Many
problems may become school-wide in appeal and may involve
participation of all pupils according to their capacities and
levels of understanding. The teacher and pupil should study
themselves, their school, and their community in the light of
the following guide in determining what the learning experi-
ences should be.
1. What are the social, emotional, mental, and physical char-
acteristics of children at specific age levels?
The teacher should understand the characteristics expected
of children at the age levels of his pupils in respect to physical
growth, social development, emotional stability and mental ca-
pacity. The degree to which specific children deviate from
known and expected characteristics of their age group will in-
dicate needs for adjustments. An understanding of children
at specific age level will also assist the teacher to determine
the types of approach, the motivation and the methods most
likely to be effective with specific groups.
2. How do health situations in the local school furnish leads
to needed health education?
The total school environment as it deviates favorably or un-
favorably from healthful school living standards has decided
influence upon the health education of children. It is the teach-
er's responsibility to understand the school environmental
forces affecting his pupils and to guide their adjustment in
this environment so that sound educational experiences result.







HEALTH INSTRUCTION


A study of the local school environment as suggested in Chapter
III, "Healthful School Living," page 9 of this bulletin, should
suggest many teaching and learning opportunities. The school
lunch department, for example, should certainly be used as a
laboratory for health education or else it has no place in a
public, tax supported educational institution. The type of room
in which children eat, the kinds of foods provided, and the chil-
dren's food practices all provide excellent channels through
which needs in health education are determined. Many phases
of the school environment should be similarly studied by the
teacher in order to find other health problems that need to be
solved.
3. What are the observable health and safety practices of
particular children in specific situations?
The classroom teacher is the best person to judge the rela-
tive importance and needs for health education based on the
actual practices of the children in respect to handwashing, use
of toilet facilities, food handling, pupil practices in getting to
and from school, practices at play and rest, and many others.
Observation, informal discussion and conferences with other
teachers, parents, and other persons responsible for the health
guidance of children are the teacher's means for determining
needed health education on the basis of the present practices of
the children.
4. What major student interests are related to needed health
education?
Recognition of vital pupil interest not only guides the teacher
in selecting what to teach but will indicate the most effective
motivation to be used in teaching. Current student interest
may be centered around play activities, after school boy or girl
scout activities, hobbies, a special event in the life of the child
or his family or others. More general interest may be centered
around the desire for growth or being accepted by the group
or around the desire for success. The degree to which health
experiences are closely related to vitally felt pupil interest
will influence the degree to which health experiences are signifi-
cant to children.
5. What are the children's needs as related to the basic
health needs of all persons?
Health needs of man have been described as nutrition, exer-








HEALTH SERVICES FOR FLORIDA SCHOOLS


cise, rest, safety, mental hygiene, and protection from infection
or defect. A study of pupil's problems in meeting these basic
needs in their own lives will reveal the specific nature of certain
learning experiences needed by pupils.
6. 7What are the findings of the health examination?
The actual health status of each child can best be determined
through studying medical examination records and discussing
the findings for needs with the examining physician or the
public health nurse. The teacher should make and keep confi-
dentially his own record of these findings for each child which
provides the first and most important determinant of the child's
needs. If visual defects or malnutrition, for example, are dis-
closed by the health examination to be serious problems with
specific problems with specific children, health education should
provide the knowledge and develop the practices which solve
the problems.
7. What are the health practices in the homes of children?
Through informal discussion with the children, use of simple
pupil questionnaires, home visits, and conferences with the
nurse, the teacher can determine many of the home health
practices which greatly influence the health practices of the
children. The nature of these home practices should help to
guide in the type of health education experiences that teachers
and pupils plan.
8. What have been the previous health learning experiences
of the children?
Conferences with previous teachers, a study of students'
records, administration of health knowledge tests, and pupils'
self-inventory, and other similar procedure should indicate to
the teacher the previous health experiences of her pupils. An
inquiry should be made concerning methods and emphasis previ-
ously employed. The result of previous education should be both
observed and tested. Such study should reveal rather definitely
the needs for certain emphasis, for a change or continuance of
certain methods and for the introduction of new experiences
based upon previous learning.
9. What pupil experiences in other study areas provide lead
for needed health education?
The opportunities for emphasizing and enriching health teach-







HEALTH INSTRUCTION


ing through the leads from other study areas should not be
overlooked. In planning, the teacher will know in advance when
these opportunities are likely to arise. The teacher should be
prepared to seek definite health outcomes as well as outcomes
related to other areas. Health outcomes do not result "inci-
dentally" and they require definite teaching as do all educa-
tional ends. The actual health needs of the group rather than
merely the presence of opportunities for correlation should de-
termine the emphasis and the amount of time to be given to
the health contribution of other subjects.
10. What are the health and safety hazards in the local com-
munity?
The teacher's knowledge of the health and safety problems
in the local community will indicate definite health education
needed by the children who are influenced by these hazards.
Local statistics concerning the prevalence of certain diseases,
the causes of accidents, the safety of water, milk, and food
supply, the measures employed for communicable disease con-
trol, and the possible presence of malaria mosquito breeding
ponds or of unsanitary privies should be understood by the
teacher so that the choice of health education experiences is
based upon existing rather than assumed need. A visit of in-
quiry to the local health department or to other official or vol-
untary agencies should disclose to the teacher facts about these
problems. Education based upon these problems should give
emphasis to the pupil's relationships to the conditions found.
11. What current health events or problems indicate leads
for needed health education?
A local epidemic, a current accident, present or seasonal
drives, programs of health organization, a school health prob-
lem being emphasized at the time, and others, provide excellent
opportunities for health teaching. Some of these events can be
foreseen in advance by the teacher who should be prepared to
use the heightened student interest and enthusiasm to the best
educational advantage. Although pre-planning is often impossi-
ble, the teacher who is constantly aware of the most important
health education needed by his pupils will be prepared to use
current opportunities as they arise as most effective "teach-
able moments".








HEALTH SERVICES FOR FLORIDA SCHOOLS


12. What do statistics reveal concerning the most important
health problems in the State?
The most recent statistics should be secured through the local
county health unit. A study of the reasons for the existence of
these major health problems in Florida will point to many spe-
cific knowledge, attitudes, and practices that Florida children
should develop. The specific locality, the specific teaching sit-
uation and the specific need, age level, and characteristics of
the pupils will help the teacher to determine the degree to
which each of these Florida problems is important to his own
group. For example, elementary school children might study
the control of the most important communicable diseases among
younger children while the study of tuberculosis prevention
should be more appropriate for high school children. The local
prevalence of hookworm would make the study of this problem
more important in some sections than in others.
13. How should health education be related to the persistent
problems of all children as indicated in the general pro-
gram of education for elementary grades described in
Bulletin 97?
Since the guidance of health experiences is an integral part
of the program of general education for Florida's elementary
schools, a study of Bulletin 9 should indicate further to the
teacher certain health problems related to the general teaching
plans. The program of education described in Bulletin 9 should
indicate further to the teacher certain health problems related
to the general teaching plans. This program is based upon ex-
panding interest of children and provides a plan for gradation
which will be helpful to the teacher in relating specific health
problems to the general education.

Suggestions Concerning Gradation
Suggestions for organizing the health experiences of the vari-
ous grade levels are outlined in this section. It is by no means
the intention of this bulletin to set up a pattern for adoption in
schools. On the contrary, the plan and description of activities
presented here are offered as an illustration of methods and
as a guide to selection. While much of the experience in the

* A Guide to improved Practices in the Elementary School. Bulletin 9, State De-
partment of Education, 1940.








HEALTH INSTRUCTION


schools of one county may be utilized in the schools of other
counties, the educational program in detail is effective only
when it is planned for the immediate local community. Health
education, including the gradation of health experiences, meth-
ods employed, and materials used, should be consistent with the
local program of curriculum organization and the general edu-
cational policies of the school.
The desired learning experiences in health for each grade
level should include emphasis on different phases of child
growth at each particular level. Health education will be more
interesting and effective for both teacher and pupil when they
select from these experiences for each level:
1. Those which will improve general health.
2. Those habits and actions which are prompted by the child's
response to his environment-social and physical-and in
which he needs to be guided in order to cultivate them.
3. Those interests in personal appearance which may make
the child more responsible for self care.
4. Those protections which should be afforded the child and
those which he can provide for himself.
5. Those experiences which encourage the child to broaden
his interests, appreciations, and patricipations in living
more healthfully.
The teacher and the pupil together devise the means for ac-
complishing the desired health experiences. It is not enough
to practice health habits because of being checked: it is false
emphasis to accomplish desired habits and actions because of
being told to act or because of being afraid of punishment; it
is inadequate to present learning situations and hope that chil-
dren are broadening interests, appreciations, and participation
in a wider variety of activities; it is unfair to neglect any child
by not affording him the maximum protection due him, and by
not showing him ways in which he can protect himself; and it
is wasted opportunity when a child is not encouraged to be
critical of his own personal appearance, and to be interested in
improving it. Health experiences which are planned to accom-
plish desired results must be based upon helping the child to see
his improvement in general health, to benefit from his increased
efficiency, and to allow him to see the responsibility he can
assume and how self-efficient he can be.








HEALTH SERVICES FOR FLORIDA SCHOOLS


KINDERGARTEN-PRIMARY LEVEL
Emphasis in health education at the kindergarten-primary
level is placed upon establishing positive health practices. Im-
pressions gained by children at this age level often remain
through life. Health experiences should center around every-
day living experiences. Effective teaching will provide for the
cultivation of self-responsibilities commensurate with the ability
to practice the health habits encouraged. Practically everything
that goes on during the day concerns the child's health educa-
tion, and the alert teacher will use these experiences wisely in
guiding the healthful behavior of the child in response to ad-
justments in his changing environment.
At this early level, it is necessary for the child to recognize
immediate results from his health practices. The habits which
he learns to practice must be easily and pleasurably accom-
plished. He must be surrounded by evidence proving the worth
of the habits which he is encouraged to cultivate. This evidence
includes the appearance and behavior of his teachers and his
parents as well as the healthful environment with which he
should be surrounded.
IN THE ELEMENTARY SCHOOLS
In elementary schools if the general program of studies fol-
lows the plan of Bulletin No. 9, A Guide to Improved Practices
in the Elementary School, teachers will be familiar with the
guide offered therein for the gradation of health education
through integration with the "persistent problems" of children.
The specific health problems of particular groups will vary,
but the teacher should be able to adapt most of the needed
health instruction according to the "persistent problems" of
the various grade levels. If this is impossible the teacher should
direct the needed health experience of his pupils in addition to
providing the general program of studies. The following De-
partment of Education bulletins may provide further sugges-
tions in organizing the health experiences of elementary chil-
dren:
Bulletin 9A, Planning Programs of Study in Florida Elementary Schools
*Bulletin 30, Social Studies in the Elementary Schools
*Bulletin 21, Soir'ce Materials for Physical Education in the Elementary
School
*Bulletin 84, tEl. i ,", t'". Ih, Language Arts
Bulletin 33A, Grovu',,,r T'I,,'rnl, School Lunch Experiences
*Bulletin 4D, Health Education--Kindergarten Through Sixth Grade
Bulletin 5, A Guide to Teaching Physical Education in the Secondary
Schools
Out of print.







HEALTH INSTRUCTION


Sometimes the departmentalization of study in the secondary
schools causes a serious decline in health education at this level.
The guidance of health practices, assumed to be every school
teacher's responsibility, may become no one's responsibility.
Children who have been closely guided in healthful practices
in the elementary school should have this guidance continued
throughout the high school years, since they have not reached
a level of maturity at which they can be wisely and totally self-
directed in all their practices. Otherwise, much that has been
gained earlier in elementary schools may be lost when health
education is not provided at the secondary level.
The health practices and understandings of the secondary
level are based upon many problems faced by children for the
first time. These adolescents find themselves with an almost
new body that is reaching adult proportions and maturations.
These changes present many perplexing and interesting prob-
lems of adjustment to them. The healthful growth of these boys
and girls cannot be left to chance. They need to seek health in-
formation, and they need guidance and direction in making
wise choices.
The responsibilities for the direction and orderly sequence
of health education in the secondary schools should be placed
upon teachers who are specially trained and prepared for the
work. Teachers in secondary schools should make more decided
efforts to understand, to discuss, to decide, and to plan to-
gether the standards and procedures which should be empha-
sized by all of them concerning the pupils' development.
At this point it may be well to consider several suggestions
for the gradation of planned health education during definite
periods of the school day for the various levels of the secondary
schools.
IN JUNIOR HIGH SCHOOLS
lt is recommended that Everyday Living, State Department
of Education Bulletin 29, serve as a guide for health education
in grades 7 and 8. Bulletin 29 gives specific suggestions to
teachers in offering daily a special course in health education.
Approaches to the course are made through the life problems
involved in the student's adjustment to his school environment
and friends, to his home, and to his community. Personal health
problems are given emphasis as they are related to scientific







HEALTH SERVICES FOR FLORIDA SCHOOLS


concepts, to personal and home living practices, and to the im-
provement of local community living.
If in grades 7 and 8, separate courses are offered, one semester
in science and one semester in health are recommended. In
schools developing integrated or core programs, health should
be included in the core, provided the teacher is competent in
the area of health education. Where the core teacher is not
competent in health education, either the plan outlined in Bulle-
tin 29 or the suggested separate one-semester courses in science
or health should be offered.
Health education in the 9th grade should be offered through
a general science course and in homemaking education unless
it is included in the core program.
IN SENIOR HIGH SCHOOLS
For grade 10, it is recommended that health be emphasized
in biology courses. In grades 11 and 12, it is necessary to ex-
pand the opportunities for health education. Two alternative
procedures for doing this are: (1) providing a special course
in health education, and (2) integrating experiences in health
education into the existing structure of the curriculum. What-
ever procedure the school chooses to use, it is recommended
that a balanced program be provided which would include for
all students experiences in such problem areas as: (1) making
the most of yourself, (2) understanding habit forming drugs
and alcohol, (3) understanding ourselves, (4) growing into ma-
turity, (5) outwitting disease hazards, (6) controlling the en-
vironment to protect health, (7) assuming individual responsi-
bility for group health, (8) learning to drive, (9) eating ade-
quate meals.
These problem areas are presented as resource units in Effec-
tive Living, Bulletin 4B of the State Department of Education.
Many schools will, no doubt, desire to require a course in
"Effective Living" for graduation from high school, as soon
as administrative provisions will allow. If it is offered as a
separate course, it is recommended that one unit of credit
toward graduation be granted. When taught as a separate
course, it should be taught by carefully selected teachers whose
specialized training in health education, and whose personality,
skill and experience fit them for this work. If a trained teacher
in health education is not available, it may be necessary to use,
temporarily, a teacher who is interested in health and who has








HEALTH INSTRUCTION


been trained in homemaking, science, physical education, or
related health areas. Public health nurses may teach health if
they are also trained as teachers. Detailed plans are given in
Bulletin 4B for selection of problems and experiences in de-
veloping improvement and service units with students. Much
information is provided through resource units and sources of
materials that are suggested in Bulletin 4B.
When not taught as a separate course, the problem area listed
above should be allotted to already existing courses in the school.
The faculty should decide cooperatively where they should be
allocated. Competencies of the teachers and appropriateness of
subject matter should be important considerations in deciding
on the allocation of units. Decisions should be made as to what
content in already existing courses should be omitted in order
to make room for the study of these health problems.
Regardless of the plan used in the individual schools, addi-
tional emphasis on health education should be accomplished
through the inclusion of problems of community health in the
social studies. Courses in homemaking education should give
considerable emphasis to health problems related to the home.
Physical education activities afford a natural setting for health
guidance of pupils, and provide a real need for the practice of
sanitation measures in the physical education plan, and health-
ful practices accompanying the participation in activities. All
teachers should make use of specialists and resource persons
available.
IN JUNIOR COLLEGE
Education in health is an essential part of any college cur-
riculum. At least four of the eleven objectives of general edu-
cation, as set forth in the recent report of the President's Com-
mission on Higher Education,* are devoted to the related learn-
ings and practices in education:
... To understand the common phenomenon in one's physical environment,
to apply habits of scientific thought to both personal and civic problems, and
to appreciate the implications of scientific discoveries for human welfare.
"To attain a satisfactory emotional and social adjustment.
"To maintain and improve his own health and to cooperate actively and in-
telligently in solving community health problems.
"To acquire the knowledge and attitudes basic to a satisfying family life...."
* President's Commission on Higher Education, Higher Education for American
Democracy, Volume I, "Establishing the Goals," pp. 50-58, U.S. Government
Printing Office, Washington 25 D. C., Dec. 1947. 103 pp. 400.








HEALTH SERVICES FOR FLORIDA SCHOOLS


Personal and community hygiene needs should include a pro-
gram of general education of the first and second years of col-
lege. The objectives of this basic health course should be:
1. To provide a body of information concerning the function-
ing of all parts of the human body under varied conditions:
the beneficial and detrimental factors of the environment,
their effects upon the body, and ways in which these fac-
tors may be used for health improvement.
2. To induce behavior which will assist the individual stu-
dent to attain and to maintain optimum health-mental,
physical, and social.
3. To develop attitudes and understandings which will lead
the student to cooperate with community and group pro-
grams for health protection and improvement.
The recommendations of the Third National Conference on
Health in Colleges* are in complete accord with these provisions.
The health education of the general college student of the junior
college level should include consideration for the health problems
of nutrition, family living, mental hygiene, effects of external
factors on the body, control of disease and infection, other major
health problems, significance of the periodic health examination,
and community organization and evaluation of health activities.

Evaluation in the Health Education Program
The evaluation of educational programs in the field of health
is difficult. The scope and quality of a program does not al-
ways indicate the results. Different communities have different
problems and need different health emphases. A standard of
perfect practices would be difficult to determine. Education is
not an easy job; dictation and prescription are much easier.
Pupil progress and school improvement are slow and hard to
measure in specific, tangible ways. Home and community
changes may be more slow and more difficult to measure. The
results of health education are cumulative and evaluation is
a continuing part of the health education program.
It is profitable for a school and community to study what it
is doing in the light of what could be done, and to evaluate its

Third National Conference on Health in College, A Health Program for Col-
leges, "Health Education for All College Students," pp. 43-47. National Tuber-
culosis Association, 1790 Broadway, New York 19, N. Y. May 1947. 152 pp.







HEALTH INSTRUCTION


goals and procedures in terms of best practices. A measurement
of results and accomplishments is helpful even though it is not
precise or exact. This sort of progress evaluation, or record of
results and accomplishments, should be recorded by those in
whom the improvements are sought, and by whom the improve-
ments are made. Periodic reports of progress should be at-
tempted each year. A systematic record of progress is helpful
to any school and community in evaluating what has been done
and in determining what needs to be done.
An evaluation of health education should be made in terms
of the objectives sought in the local situation. It is the process
by which we can find out the advancement that is being made
toward the attainment of program objectives. Since the health
education program seeks to bring about various improvements
in pupil health behavior, and in the home, school, and com-
munity, evaluation should be in terms of these objectives. A
re-statement of objectives will be necessary as the health edu-
cation develops. Program plans and evaluation procedures must
change to conform to the changing objectives.
Several aspects of evaluation are necessary in order that a
health education program may continue to be effective:
1. Evaluation must show where emphasis needs to be placed,
pointing out conditions that have been improved and those
which need further attention and give direction to the
program of health education.
2. Evaluation shows the strengths and weaknesses in the
development of the program, pointing out the worthwhile
and the ineffective techniques and procedures according to
accepted practice and existing conditions.
3. Evaluation is indicative of the progress made by pupils
with respect to improvement in health behavior.
4. Evaluation gives information that is significant to health
councils and groups in curriculum planning, and aids them
in determining program content and methods.
5. Evaluation gives data that is valuable in proving the
worth of health education to those who participate in its
development, to administrators of education and of public
health, and to the community at large.
There are many types of evaluation activities that may be
employed. The following suggestions may be helpful in plan-







HEALTH SERVICES FOR FLORIDA SCHOOLS


ning and developing a program of evaluation in health edu-
cation.
1. Teacher observation. This is the most widely used of
any of the means of evaluation. The ease with which it
may be handled leads to its wide use. Records may be kept
by jotting down the conditions observed, or a check list
may be developed during the year.
2. Interviews. Personal interviews with children and with
their parents may reveal information that is helpful in
determining progress in health education. It is important
that records of such interviews be dated and kept with
the teacher's other pupil-information.
3. Checklist of questionnaires. These may be selected from
available forms already developed, or they may be de-
veloped by the teacher and pupils, together. They may
include health attitudes, interest, knowledge, or health
practices. A self-appraisal inventory may be designed for
pupil use. Such a pupil self-inventory may be made at
regular intervals in order to determine improvements
made.
4. Records and reports. Health examination records, rec-
ords of attendance, causes of absences, and anecdotal rec-
ords are significant in attempting to evaluate the effec-
tiveness of health education.
5. Surveys and appraisals. Standard appraisal forms for the
total health education program are not available at the
present time. It is suggested that a school may develop
its own forms to fit the local situation. Careful care must
be exercised in determining the scope of activities in the
attempt to survey and appraise, and available guides in-
dicating the provisions of adequate school health pro-
grams should be studied carefully.
6. Photographs and motion pictures. Both still pictures and
motion pictures are being utilized as a means of recording
developing programs of health education. They provide
interesting and appealing evidence of improvements made
and further improvements added.
7. Pupils' work booklets. Notations in work books may
give evidence of understanding in health concepts. The
day by day accounts found in pupil diaries may also re-







HEALTH INSTRUCTION


veal progress in health. Health knowledge may be oral
or written and test only health problems. It must be re-
membered that health knowledge accumulated does not
necessarily indicate health improvement made.
8. Related studies and health literature. Recent emphasis
on program planning through evaluation procedures ap-
ply to the total school health program and produce many
excellent suggestions for improvement in health educa-
tion. These references should be made available in school
libraries.
IN-SERVICE EDUCATION
The development of school-community health projects requires
joint planning and joint action. In-service education should be
planned intelligently and as carefully as pre-service education.
The in-service program in health education should be de-
veloped cooperatively by college, state, and local departments
of education and public health. It is an important responsi-
bility of teacher-education institutions to lend support to in-
service personnel in helping them to keep abreast of new de-
velopments and to become increasingly effective on the job.
Such relationships in the field also help college staffs to grow
professionally.
Well-qualified, skilled leadership in health education is neces-
sary to bring about cooperative action among school administra-
tors, classroom teachers, health educators, public health nurses,
other public health personnel, students, parents, and lay citi-
zens. Health education leaders should be selected because they
are qualified and interested in health education. Health is one
of the most difficult fields in which to teach, for new discov-
eries and new applications require constant new learning on
the part of all.
Many teachers in the field today are not well informed in
health facts, school health responsibilities, or educational op-
portunities in hygiene. An adequate and continuing program
of in-service education is the only practical solution; it should
include all school personnel.
Highly competent personnel should be used in the in-service
education program. Imaginative and inspirational leadership in
necessary consultation services should be sought as needed.
New problems, new inspirations, and new concepts can be







HEALTH SERVICES FOR FLORIDA SCHOOLS


brought to life continuously and should always be built around
practical application in the local school and community.
Through in-service education a school and community will ac-
complish greater understanding on the part of all community
groups having contributions to make to school health efforts.
The personnel for whom in-service education in health is
planned will include various groups and combinations of groups
in addition to teachers, according to the immediate problem and
the specific need. Those who may be included in in-service edu-
cation for health are:
Administrators
Supervisors
Teachers
School lunch personnel
Custodial and maintenance staff
School bus drivers
Librarians
Medical and nursing supervisory staff
Recreational and coaching staff
Staff of various official and voluntary organizations contrib-
uting to health and welfare
Civic organizations, including PTA, etc.
The vehicles of in-service education are many and varied.
Workshop experiences or work conferences may be held by
local groups for the purpose of attacking school-community
health problems. One, two, or three-day meetings, or a series
of evening meetings are suggested according to the local com-
munity needs and patterns of work.
The development of joint planning groups in neighborhoods,
towns, counties, states, and the nation demonstrate a most se-
lective type of in-service education. These organizations are of
various kinds and may be in the form of school health councils
or committees, or in the form of broader community councils.
The group participating may include health departments, school
systems, voluntary health agencies, welfare organizations, medi-
cal societies, professional organizations, youth groups, and con-
sumers of health service like labor, business, agriculture, and
civic groups. The planning group needs to represent the local
people and the discussion must include people who have spe-
cific knowledge of health programs and problems.







HEALTH INSTRUCTION 55

Tie State Department of Education, the State Board of
Health, and the voluntary health agencies are generous in the
amount of consultant services given to workshops and work
conferences, when additional assistance is needed.
The colleges and universities are pleased to furnish.the con-
sultant services of the health educators on their faculties when
local communities request them and as on-campus responsibili-
ties will permit. This consultant service may occur through
conference with school administrators, nurses, and teachers, or
it may be given by participation in a series of work meetings.
City and county workshops or pre- and post-school planning
sessions offer excellent opportunities for in-service education.
Night classes or Saturday classes in health education and sum-
mer course offerings at the colleges and universities may in-
clude courses especially designed to meet the needs of in-
service personnel. School and public libraries and the State Li-
brary in Tallahassee offer excellent sources for materials.









Chapter VI
FINDING AND USING RESOURCES

In every community there are people, places, and things
which may be used to make health education an effective ex-
perience. Children learn from all they see, hear, or do, whether
this experience is planned or just happens. Their attitudes and
concepts, which are basic to health practices, will be determined
by their total experiences.
People are an important resource for health instruction. The
child, himself, his abilities, his participation, his interests, and
his attitudes help to determine the learning situation for him-
self and his associates. The teacher brings her experience to
the classroom and may become a valuable resource. Other
people in the community, specialists, parents, and community
leaders may be used to encourage young people to understand
the community in which they live, its problems, its needs, and
its organization for making improvement possible. In this way,
boys and girls have opportunities to grow in active citizenship
and to develop an understanding of their possibilities in de-
veloping a healthful and safe community for all the people.
Books, magazines, newspapers, films, film strips, charts, radio
and television, still pictures, and models offer rich possibili-
ties for expanding the experiences of boys and girls. Carefully
chosen materials, properly used, can broaden understandings,
offer accurate scientific information, and motivate an interest
in problem solving. The use of a variety of media of communi-
cation can keep the learning situation fresh and interesting to
the young people.
Places, too, should be considered in choosing desirable in-
structional materials. A visit to the county health unit may
offer children a better opportunity to understand the services
and role of this agency than printed material or lectures. A
field trip to the local hospital, dairy, school lunch kitchen, or
welfare department might motivate an interest in reading,
seeing motion pictures and having discussion about such im-
portant community services. The entire community is resource
in which children are learning health attitudes and under-
standings, good or bad. A list of suggested field trips and
community activities are presented below.








FINDING AND USING RESOURCES


Every school library should provide a central index of the
people, places, and things available for teaching and learning.
Teachers, librarians, and children should contribute informa-
tion for this card file, classified by subject and by author when
feasible. The detailed suggestions for making such a file may
be found in The Library Manual, (Florida School Bulletin, De-
cember 1943), published by the Florida State Department of
Education.

Some Suggested Community Activities and
Field Trip Possibilities
Bakeries
City or school incinerators
Community and commercial canning plants
Custodial and correctional institutes
Dairies and creameries
Day homes or special schools for children
Dental clinics
Experiment stations
Family service agencies
Federal Housing Authorities
Fire Department
First aid rooms
Food freezing plants
Grocery stores
Health departments
Health laboratories
Hospitals
Laundries
Manufacturing plants
Nursery schools
Police departments
Restaurants
School busses
School lunch departments
School playgrounds
Home garbage disposal
Home lighting
Home food preservation and storage
Home water supply
Home safety
Home gardening
Sewage disposal plants
Utility companies
Vegetable and meat packing plants
Water works
Welfare departments
In many communities, particularly in the rural areas, field
experiences may be limited to the direction of home projects.
Each school community should develop its own list of suggested
field trips and community activities. This should be well-
balanced to include personal, home, school, and community
health experiences.








HEALTH SERVICES FOR FLORIDA SCHOOLS


Selection of Resources

Having discovered the problems needing instructional em-
phasis, the teacher is concerned with selecting the best ways
and means for accomplishing the desired results. The very
nature and extent of the problems themselves will also point
to the best resources to be employed. Important factors to be
considered are: (1) The child, his knowledge, background,
needs, and interests; (2) the teaching situation, its type, occa-
sion, and time limits; (3) the specific outcomes desired in
terms of understanding attitudes and practices.
SOURCES OF PRINTED MATERIALS
Each county health department has numerous pamphlets on
various health subjects, in some instances suitable for both
teachers and students.
A list entitled "Sources for Pamphlets, Reprints and Radio
Scripts," can be obtained by writing to the Library, Florida
State Board of Health, Jacksonville.
Listed below are samples of sources of materials which in-
clude health materials. These are only samples and should not
be considered a complete list.
"The Library's Picture Collection," subscription books, bulletins, October, 1946.
Basic Book Collection for Elementary School. American Library Assoc., 1951.
Basic Book Collections for Junor High. American Library Assoc., 1950.
Basic Book Collection for High School. American Library Assoc., 1952.
Educators Index to Free Materials. Educator's Progress Service, Randolph,
Wis.
Elementary Teachers Guide to Free Curriculum Materials. Educator's Progress
Service, Randoph, Wis.
Free and Inexpensive Learning Materials. Nashville, Tennessee: Division of
Surveys and Field Services, George Peabody College for Teachers, 1950.
Martin, Laura. Magazines for School Libraries. H. W. Wilson Company, 1946.
Miller, Bruce, Sources of Free and Inexpensive Teaching Aids: A Source List.
Ontario, California.
Recommended Library Books for Florida Schools. Florida State Department
of Education, Bulletin 22A, 1948.
Subject Index to Readers. Chicago: American Library Association.
U. S. Government Publications Monthly Catalog. Washington: Government
Printing Office.
Vertical Files Service Catalog. H. W. Wilson Company.
SOURCES OF AUDIO-VISUAL MATERIALS
Blue-Book of 16 mm films: Twenty-fourth Annual Edition. Chicago, Educa-
tional Screen.
Educational Film Guide. New York: H. W. Wilson Company.
Educator's Guide to Free Film. Randolph, Wisconsin: Educator's Progress
League, 1946.
Evaluation Projects. New York: Educational Film Libraries.
Educational Radio and Transcription Exchange Catalog. Federal Radio Com-
mission.
Film Strip Guide. New York: H. W. Wilson Company.









FINDING AND USING RESOURCES 59

Health Films Catalog. New York: Educational Film Library Association.
Heimers, Lili. Health Education for All Ages. New Jersey, New Jersey State
Teachers College, 1944.
New Tools for Learning Catalog. New York: New Tools for Learning.
U. S. Library of Congress. Motion Picture Division. Guide to U. S. Govern-
ment Motion Pictures. Washington: Government Printing Office.
SOURCES OF TEACHER HELP IN USING LIBRARY MATERIALS
Film Tactics. Two Reels (22 minutes) 16 mm., Sound. Castle Films.
How to Teach With Films. Two Reels (20 minutes) 16 mm., Sound, Cathedral
Film Inc.
Kinney, L. and Dresden, K. Better Learning Through Current Materials.
Tips on Slide Films. Jim Dandy Products.
Using the Classroom Film. Columbus, Ohio: The Junior Town Meeting League.
Walraven, Margaret K. and Paul-Quest, Alfred. Library Guidance for Teach-
ers, Wiley, 1941.
Walraven, Margaret K. and Paul-Quest, Alfred. Teaching Through the Ele-
mentary School Library. New York: H. W. Wilson Company, 1948.









Appendix


DIRECTIONS FOR USING THE SNELLEN VISION TEST
When requested, the nurse will demonstrate to the teacher
the procedure of this test.
1. If a child wears glasses, test only with glasses.
2. Test both eyes together, then the right, then the left.
3. With children suspected of impaired vision, begin at the
top of the chart. With other children, begin with the 50-
foot line and proceed with test to include the 20-foot line.
4. Keep unused portion of line covered, using a "window
card." Expose one symbol at a time.
5. A young child indicates with his hand which way the "E"
points; older child may prefer to state directions.
6. Move promptly and rhythmically from one symbol to
another at a speed with which the child seems to keep
pace easily.
7. Show one vertical symbol and one which is horizontal on
a line, and move to the next line. In the last line read
correctly or in 20-foot line use all four symbols. Reading
three out of four symbols is usually considered evidence
that the child sees the line satisfactorily.
8. Record vision of each eye. Record as though it were a
fraction. (This should not be interpreted as percentage
of vision. 20/30 visual acuity does not indicate 2/3 of
normal vision.)
In routine vision testing, the Snellen Chart should be hung
where it receives good light, but not in a glaring light. The
child should be twenty feet from the chart so that eyes are at
a level with chart.
The teacher should record any symptoms of eye straining
noted during the testing, such as:
Thrusting head forward
Tilting head
Eyes watering
Frowning or scowling
Closing one eye during test when both eyes are tested together
Excessive blinking







APPENDIX


NATURAL LIGHTING FOR CLASSROOMS*
Uniformity of brightness has a very important bearing on
the usefulness of light as well as the quantity of light. Bright-
ness ratios in a field of vision in excess of 10 to 1 have been
found to cause fatigue, eye strain, and other disorders. Authori-
ties in the field of lighting and vision have arrived at the
conclusion that the goal for brightness ratios in any given
field of vision should be less than 5 to 1 and preferably 3 to 1.
The useful natural light must include the light rays so dif-
fused as to provide light in both the horizontal and vertical
planes since the child is expected to see clearly in three di-
mensions. Great improvement has been achieved in utilizing
the uniform high brightness available from natural daylight
by redecorating classrooms. The steps that are described are
not necessarily the most practical ones for new construction
but rather were devised for correcting existing defects in previ-
ously constructed buildings.
A. Ceiling. The classroom ceiling and upper portion of the
walls, that is down about 24 inches or to the picture molding,
if present, should be finished with a white flat paint with a
light reflectivity of 85% or higher. Pipes or other structures
near the ceiling should be painted with the high light reflectivity
flat paint to assure a uniform appearance. If the ceiling is dark
due to dust or smoke, it will be necessary to clean the surface
before painting. The application of two or more coats will be
required to prevent streaking and spotting if the ceiling has
been painted a dark color previously.
B. Walls. The classroom walls down to the chalk rail or
window ledge level should be finished with a light tinted flat
paint with a high factor of light reflectivity but less than the
ceiling which forms a light dome. Inasmuch as the inside wall
or the wall opposite the windows will receive the greatest
amount of natural light, this wall should be treated to reflect
slightly less light than the other walls. The use of a higher
reflectivity on the front, window, and back walls than on the
inside wall will result in a more nearly uniform appearance.
The inside wall down to the window ledge or chalk rail level
should be treated with a flat paint to reflect 70% of the light.
The other three walls should be treated to the same level with
* Developed by the Texas State Department of Health.







HEALTH SERVICES FOR FLORIDA SCHOOLS


a paint which is flat and will reflect 75% of the light striking
the surface.
C. Wainscoting. The portion of the walls below the win-
dows or chalk rail level is known as the wainscoting and should
be treated differently from the upper portion of the wall since
this area is bounded by the floor which, of necessity, will be
darker. In order to provide the minimum contrast or light re-
flectivity in any visual field the wainscoting should be treated
with a flat tinted paint which will reflect less light than the
upper wall surface and more light than the floor. It is de-
sirable to achieve a light reflectivity about half way between
that of the bounding surfaces which in most instances will
mean a light reflectivity of 50% to 55%. Since this area is
readily accessible to soiling, it may be necessary to coat the
wainscoting with a water wax which will produce a washable
protective coating, but not a glossy surface.
D. Floor. In most old schools the floors have been treated
with some type of oil to keep down dust which results in a very
dark finish. In order to lighten the floor, it is necessary to re-
cover the natural wood color which may require bleaching to
remove oil or other stains. The bleaching and cleaning process
may be accomplished with soap and water scrubbing in some
instances, while the more difficult floors will require the use
of strong alkali or naphtha. In all cases the floor should be
thoroughly cleaned and the natural wood finish recovered. The
light finish can be preserved and protected by the use of a
clear varnish followed by a non-gloss wax, or by the use of
clear floor filler. It has been found that a properly finished
light floor will require but very little, if any more, maintenance
than an oiled floor, and it is more sanitary and attractive. Most
floors with the natural wood color preserved will have a 20%
to 30% light reflectivity.
E. Woodwork and Trim. The woodwork or trim of the
room needs to be considered if a uniform light distribution is
to be provided. On these surfaces, as on all others, the gloss
finish is to be avoided as an anti-glare measure by using flat
paint and in locations such as door jambs, window ledges, etc.,
which are subject to extensive soiling, a water wax or other
non-gloss wax can be used to provide a washable protective
coating. A harmonizing flat paint with a light reflectivity of







APPENDIX


50% to 55% should be used except for the baseboard which
may have a slightly lower reflectivity if desired.
F. Chalkboards. The modern methods of teaching utilize
only a small chalkboard for teacher demonstration, thus elimi-
nating the need for extensive chalkboards often found in older
school buildings. In most instances, a chalkboard which covers
about half of the width of the room placed on the front wall
will prove adequate. To supplement this board it has been found
advisable to provide tackboard for bulletins and display pur-
poses, usually one on each side of the chalkboard. The tack-
boards should have a harmonizing finish with about 30% light
reflectivity. In rooms that have greater expanses of chalkboard
than is desired it will be necessary to cover existing boards so
that they oan be finished in the same manner as the remainder
of the respective wall surfaces. Excess chalkboards can be cov-
ered with a building board or removed, and the space finished
in like manner to the wall.
G. Fenestration and Shading. The importance of the treat-
ment of windows can not be overemphasized, if maximum
uniform brightness is to be accomplished. The window open-
ings should be treated in such a manner as to allow the ad-
mittance of as much usable light as possible, yet preventing
high contrast of brightness or glare.
The natural light which enters should be diffused and re-
flected in order to supply the greatest uniform distribution of
light over the room. One way of achieving this goal is to
provide a diffuser for the upper part of the windows which
will reflect part of the light to the ceiling and allow part of the
light to pass through in a diffused state thus eliminating high
glare spots. The use of a diffuser on the upper sash of the win-
dows eliminates the need for shades or blinds on this portion
of the window. The diffusers should be constructed of a white
matte material, such as muslin, bleached domestic, fiber glass
cloth, etc. The diffuser should be mounted in such a manner as
to blot out direct vision of the upper sash from any work loca-
tion in the room, and reflect the light to the ceiling with a mini-
mum of light loss. To achieve the desired results, the diffuser
should be mounted in a manner that slopes the reflecting sur-
face toward the interior of the room at an angle of about 35
degrees. The lower portion of the window or vision strip can







HEALTH SERVICES FOR FLORIDA SCHOOLS


be shaded to prevent glare; however, windows located on the
north side of the building generally will not require shading.
H. Furniture. The room furniture such as desks, chairs,
and tables can best be finished in natural wood color with a
resultant light reflectivity of about 30% except in the case of
very light woods which may reflect as high as 40% of the light
striking the surface. In the event that the natural surface does
not produce a sufficiently uniform light surface, it may be ad-
visable to paint the surfaces with a light color such as plati-
num or blond with light reflectivity of 40% and providing the
surfaces with a flat finish to prevent glare. The desk and table
surfaces are of great importance due to the extensive periods
that these surfaces are in the child's immediate field of vision.
While the goal is to achieve a light reflectivity within a visual
field with contrasts of not greater ratios than 3 to 1, it is also
advisable to keep the actual task, book, and work with higher
light reflectivities than the surroundings of the immediate
area. The supporting parts of the furniture should be lightened
to the natural wood color or painted with a light flat paint
which will harmonize with the room generally.
I. Seating Arrangements. To provide the best working light
in the school child's visual field with a minimum of shadows,
the seating arrangements should be altered with each desk,
given individual consideration and not located in straight rows
paralleling the side walls. Each desk should be turned away
from the leading edge of the front window at an angle of 50
degrees. A child seated at a desk rotated in this manner normally
will not have any direct sky light on the eyes, will have the
maximum amount of light on the working or desk surface, and
will have a minimum body shadow on the desk. The desk tops
should be tilted at an angle of 20 degrees with the horizontal
to conform with a point of minimum stress as worked out by
body mechanics. No desk should be placed in front of the front
window mullion or behind the back window mullion.
In order to obtain the variations in the light reflectivities
of the painted surfaces, it will be necessary to let-down the
colored paint with white paint. The paint dealer will be able
to supply the required information regarding the percentages
of various paints that are needed to obtain the desired light
reflecting surfaces.








APPENDIX


Seating is one of the most important single problems in the
school from the standpoint of health. For general purposes, in
most schools, it is found that the chair and table type is the
most desirable, as it is possible to rearrange this equipment for
many different types of groups or activities or move the furni-
ture out of the room to make way for an area of diversified
activity.
The furniture should be of the proper size or adjustable so
that when a child is seated his feet are able to rest on the floor
without the knees coming into contact with the bottom of the
desk. Frequent adjustment of all seating equipment should be
made in keeping with the changing needs of the children.

COMMUNICABLE, DISEASES IN SCHOOLS
DEFINITIONS
Case--or patient-is a person or animal who shows signs and
symptoms of sickness due to a specific infection.
Communicable Disease-An illness due to an infectious agent
or its toxic products which is transmitted directly or indirectly
to a well person from an affected person, animal, or other
organism.
Period of Communicability-is considered as the period in-
volved from date of first exposure to an infection until the in-
fecting micro-organism is no longer present as revealed by ex-
aminations of the patient.
Contact-A "contact" is any person or animal known to
have been in such association with an infected person or animal
as to have been presumably exposed to infection.
Contamination-Contamination of a surface (wound) article
(handkerchief or eating utensil) or substance (water or milk
or food) means the presence of disease producing agents on it
or in it.
Immune Person-An immune person is one who possesses or
is able to produce sufficient specific response to protect him
from illness following contact with the causative agent of the
disease. Immunity is relative and an ordinarily effective pro-
tection may be overwhelmed by an excessive dose of the infec-
tious agent.
Immunization-The induction or introduction of specific pro-
tection in a susceptible person or animal.







HEALTH SERVICES FOR FLORIDA SCHOOLS


Incubation Period-The time interval between the infection
of a susceptible person or animal and the appearance of signs
or symptoms of the disease.
Infection-The entry and multiplication of the particular dis-
ease agents in the body of man or animal. The presence of
living infectious agents on exterior surfaces of the body or upon
articles of human use, as apparel or toilet article is not infection,
but soiling of such surfaces and articles. The term "infection"
should not be used to describe conditions or inanimate matter
such as soil, water, sewage, milk, or food, which are described
under the term "contamination."
Isolation-The separation for the period of communicability
of infected persons from other persons, in such places and under
such conditions as will prevent the direct or indirect convey-
ance of the infectious agent from infected persons to other
persons who are susceptible or who may spread the disease to
others. (This applies also to animals.)
Lesion-An injury, a wound; a "sore."
Mucous Membrane-The lining of cavities and canals com-
municating with the air (such as nose, mouth, throat, etc.).
Quarantine-The limitation of freedom of movement of such
persons or animals as have been exposed to a communicable
disease, for a period of time equal to the longest usual incuba-
tion period of the disease, in such manner as to prevent effec-
tive contact with those not so exposed.
Segregation-Is the separation for special consideration, con-
trol, or observation of some part of a group of persons from
others, to facilitate the control of communicable disease.

Diseases
CHICKEN POX
Identification-Usually begins with a slight fever and mild
constitutional symptoms, followed several days later by eruption
or rash of vesicles ("raised pimples" which become filled with
clear fluid). Scabs form later.
Incubation Period-Two to three weeks, commonly about 14
days.
Period of Communicability-About 1 day before to 6 days
after the appearance of the first crop of vesicles, or rash.
Source of Infection-The infectious agent is present in the








APPENDIX


lesions (sores) of the skin and presumably in the respiratory
tract.
Mode of Transmission-Directly from person to person, in-
directly through articles freshly soiled by discharge from the
skin and mucous membranes.
Method of Control-Exclusion from school, for the period of
communicability, and avoidance of contact with non-immune
persons. Other children in the family may attend school but
are to be closely observed by the teacher and excluded immedi-
ately at the first sign of illness
COMMON COLD
Identification-A highly infectious acute affection of the
upper respiratory tract, usually accompanied by a slight rise
in temperature and chilly sensations on the first day.
Incubation Period-Probably between 12 and 72 hours.
Period of Communicability--Probably limited to the early
stages of the disease.
Source of Infection-Discharges from nose and mouth of in-
fected persons.
Mode of Transmission-Droplets from nose and mouth through
coughing, sneezing, and explosive manner of speech, especially
within short range.
Method of Control-(a) Personal hygiene such as covering
mouth when coughing and sneezing; (b) disposal of nose and
mouth secretions; (c) an infected person should avoid exposure
to others, especially children.
Note: The early stages of many communicable diseases, such as measles,
diphtheria, scarlet fever, poliomyelitis and others, are frequently mistaken for
a "common cold."
DIPHTHERIA
Identification-Early signs and symptoms are fever and sore
throat, with white or grayish patches on the throat, palate, and
tonsils. (The early signs are often mistakenly confused with
tonsillitis.)
Incubation Period-Usually 2 to 5 days.
Period of Communicability-Exists until causative organism
disappears from the nose and throat. This usually is 2 to-4 weeks
or less.
Source of Infection-Discharges from nose and throat of in-
fected persons. : i:







HEALTH SERVICES FOR FLORIDA SCHOOLS


Mode of Transmission-(a) Association with an infected per-
son, (b) articles soiled with discharges of infected person, (c)
milk (and other foods) have served to transmit the disease.
Method of Control-Immunization of all children against
diphtheria. It should be emphasized that immunization is the
only effective control measure against diphtheria.
Recommended: Every child be immunized when 2 to 6 months of age; re-
inforcing doses will be necessary during pre-school and school ages. Isola-
tion from school until two negative nose and throat cultures (taken 24 hours
apart) are obtained, or isolation for at least 14 days. All children having
close contact with the patient should stay at home until all persons of the
household have been determined to be no longer carriers.
GERMAN MEASLES (RUBELLA)
Identification-Characterized by a rash; there may be a slight
fever, inflamed eyes or sore throat. This disease usually occurs
in epidemics.
Incubation Period-10 to 21 days, usually about 18 days.
Period of Communicability-Approximately the first week.
Mode of Transmission-By association with the patient or
with articles freshly soiled with discharges from nose and
throat of patient.
Method of Control-The child should be excluded from school
for 7 days from the beginning of the disease.
IMPETIGO CONTAGIOSA
Identification-An infection of the skin appearing as watery
sores which later form loose scales or crusts; commonly found
on hands and faces and sometimes over the body. Sores may
spread to appear in patches.
Incubation Period-2 to 5 days.
Period of Communicability-While lesions (sores) remain un-
healed.
Source of Infection-Lesions (sores) on skin of infected per-
son and discharges from nose and throat.
Mode of Transmission-Contact with discharges of the skin
lesions (sores) or articles recently soiled by these discharges.
The infection may spread from place to place on the patient's
body by scratching.
Method of Control-Personal cleanliness, particularly the
avoidance of common use of toilet articles among children;
prompt treatment of other infections of skin pediculosis,
scabies, parasitic infections; infected children should be ex-








APPENDIX


eluded from school until sores are healed; children under treat-
ment and observing necessary precautions may attend school
upon advice of the health officer.
MEASLES RUBEOLAA MORBILLI)
Identification-Early signs and symptoms are similar to those
of a bad cold, with sore throat, red watery eyes, runny nose and
fever. Red rash or blotches appear a few days later.
Incubation Period-About 10 days from date of exposure to
onset of fever; 13 to 15 days to appearance of rash; may be but
not usually longer or shorter.
Period of Communicability-Usually from 4 days before to 5
days after appearance of rash.
Source of Infection-Secretions from nose and throat of an
infected individual.
Mode of Transmission-By droplets (from nose and throat);
or by articles freshly soiled by an individual.
Method of Control-Exclusion from school during period of
communicability; during epidemics-daily examinations of ex-
posed children for signs of "colds" or any elevation in tempera-
ture; if the date of the only exposure is reasonably certain, an
exposed susceptible child may be allowed to attend school for
the first 7 days of the incubation period.
Note: One of the most easily transmitted of communicable diseases; compli-
cations following an attack of measles are common, especially in cases who
do not observe proper bed rest and medical care. Complications include pneu-
monia, loss of vision or hearing; it is important that exposed children under
3 years of age and other children by advice of physician, be protected by
temporarily immunizing, by use of immune globulin.
MUMPS
Identification-Usually begins with slight fever and some-
times nausea. Later painful swelling appears about the angle
of the jaw, in front of the ear.
Incubation Period-12 to 26 days, usually 18.
Period of Communicability-Probably beginning at least 2
days before development of any distinctive symptoms of sick-
ness and lasting as long as there is swelling of the glands about
the angle of the jaw.
Source of Infection-Saliva of infected person.
Mode of Transmission-By droplets from nose and throat of
infected individual, and by articles freshly soiled with saliva
of infected individual.







HEALTH SERVICES FOR FLORIDA SCHOOLS


Method of Control-Exclusion from school until swelling
subsides.
PEDIOULOSIS
Identification-Early signs and symptoms are irritation and
itching of scalp. Pediculosis or lice are light gray insects that
lay eggs or "nits" in the hair.
Incubation Period-The eggs or "nits" usually hatch in ap-
proximately a week.
Period of Communicability-As long as live lice remain on
the person or clothing or until the eggs (or nits) in hair and
clothing have been destroyed.
Source of Infection-Infected persons or their personal be-
longings, particularly body clothing.
Method of Control-Direct inspection of the head, body, and
clothing. Personal hygiene and home hygiene are.sufficient to
prevent infection. Education in the value of bodily cleanliness
by use of hot water and soap. Use of insecticide at appropriate
intervals. Exclusion from school as long as lice or nits are on
individual. During treatment child may attend school if head
is covered with a closely fitted skull cap.
POLIOMYELITIS
Identification- (Only a small proportion of infected persons
are sufficiently sick to be recognized.) Frequently begins with
slight fever, headache, "stomach ache," and general discomfort.
Incubation Period-Usually 7 to 14 days, sometimes 3 to 35
days.
Period of Communicability-Period of greatest communica-
bility is apparently covered by the late part of the incubation
period and the first week of acute illness.
Source of Infection-Discharge from nose and throat of in-
fected person, faces of infected persons and frequently of those
not suffering from a clinically recognized attack.
Mode of Transmission-Close association with infected per-
sons accounts for a large portion of cases.
Method of Control-Isolation of infected person for one week
from date of onset or for duration of the fever, if longer. Iso-
lation in bed of all children- with fever pending diagnosis.
Avoidance of excessive physical strain (violent exercise) in
children during an epidemic, or in case of known exposure








APPENDIX


Avoidance of unnecessary traveling or visiting during epi-
demic periods. In certain conditions quarantine measures may
be advisable upon advice of the health officer.
RINGWORM (DERMATOPHYTOSIS)
Identification-Ringworm of scalp tineaa capitis) usually ap-
pears on scalp as round scaly patches with short broken-off
hair; but may appear anywhere on the body. Ringworm of
body and feet-scaly patches, cracks between the toes, peel-
ing blotches of skin.
Incubation Period-Undetermined.
Period of Communicability-As long as causative agent is
present in the lesions. Ringworm is spread by wearing con-
taminated clothing, or by contacting the scales or hairs from
the lesion. Transmission of the infection occurs readily in home
contacts or in recreational pursuits, particularly those indoors.
Source of Infection-Lesions on body of infected person, arti-
cle of clothing of infected person.
Mode of Transmission-Skin to skin contact with lesions of
infected person, and by clothing, towels, etc., soiled with scales
or hair from such lesions.
Method of Control-Infected children should be excluded from
school until recovery. Isolated and separate classrooms for edu-
cation of children with this infection may be necessary. Inspec-
tion of children under 15 years of age at regular intervals. Use
of filtered ultra-violet light. Education of personal cleanliness.
Children under treatment and observing necessary precautions
may attend school upon advice of the health officer.
SCABIES
Identification-Usually appears as small, scattered red spots
which cause itching; frequently located in webs of fingers,
about wrists, and areas of thighs and arms where skin is thin.
Incubation Period-Merely the length of time for the itch
mite to burrow into the skin and lay eggs; the itching may
occur within 24 to 48 hours.
Period of Communicability-Until the itch mite and eggs are
destroyed.
Source of Infection-Persons having itch mite.
Mode of Transmission-Contact with infected person, or
through towels, underclothing, gloves, bedding, etc. of such
person.







HEALTH SERVICES FOR FLORIDA SCHOOLS


Method of Control-Personal hygiene and cleanliness. Chil-
dren should be excluded from school until adequately treated.
SMALLPOX (VARIOLA)
Identification-Onset is apt to be sudden with fever, head-
ache, and backache. Rash usually a few days later.
Incubation Period-7 to 16 days.
Period of Communicability-From first symptoms to disap-
pearance of all scabs and crusts.
Source of Infection-Lesions (sores) of the mucous mem-
branes and skin (rash) of infected person.
Mode of Transmission-By contact with infected person, or
articles and clothing soiled by such person.
Method of Control-General vaccination in early infancy. Re-
vaccination at appropriate intervals. Vaccination of entire popu-
lation when disease appears in severe form. Strict quarantine
and isolation regulations are enforced.
STREPTOCOCCAL INFECTIONS-SCARLET FEVER,
STREPTOCOCCAL SORE THROAT, TONSILLITIS
Identification-Scarlet fever in streptococcal sore throat, in
which the infecting organism is capable of producing a rash.
Onset often begins with headache, sore throat, fever, and some-
times vomiting. The fine, unraised red rash appears evenly on
the body.
Incubation Period-2 to 5 days.
Period of Communicability-Until discharges (such as nose
and ears) are free of the infection.
Source of Infection-Discharge of nose and throat of infected
person, and articles soiled by these discharges.
Mode of Transmission-Contact with infected person, or arti-
cles soiled by such person; coughing, sneezing; floor dust, bed
clothing, personal clothing, handkerchiefs. Contaminated milk
and other foods have accounted for some outbreaks.
Method of Control-Approved milk supply (pasteurized
milk). Exclusion from school of infected persons for not less
than 14 days from onset of sickness, or until complications sub-
side. Daily inspection for one week of all children exposed or
potentially exposed. Segregation of persons with evidence of
upper respiratory infections.








APPENDIX


WHOOPING COUGH
Identification-Often begins as a "cold" with sneezing and
coughing. From a few days to 2 weeks later the "whoop" may
begin.
Incubation Period-Usually 7 to 10 days, sometimes longer.
Period of Communicability--Particularly communicable in
early stages. Communicable stage extends from 7 days after
exposure to 3 weeks after onset of typical "whoop."
Sources of Infection-Discharges from nose and throat of in-
fected person.
Mode of Transmission-By contacts with infected person and
articles soiled by droplets from nose and throat of such indi-
vidual.
Method of Control-General immunization of infants at 2 to
6 months of age. All susceptible children under 5 years of age
should be immunized. Exclusion from school of infected person
for 3 weeks after the appearance of "whoop." Non-immune
children will be excluded from school for 8 weeks after last
exposure to a recognized case.

SCHOOL RECORD MCH 304
The sample form shown in the next four pages is School Rec-
ord form MCH 304. This form was developed jointly by the
State Board of Health and the State Department of Education.
It is approved and recommended for uniform use throughout
the public schools of Florida. It is intended that this record
be kept in the child's permanent record folder and be passed
on from grade to grade and school to school.













HEALTH SERVICES FOR FLORIDA SCHOOLS









OATE INDEXED


ir. ddl. cOLOR-- S-- CHOOL
FATHER'S NME
MOTHER'S NAME


DATE OF BIRTH BIRTI REGISTERED:
SIGNIFICANT HISTORY:


YES- NO- PLACE OF BIRTH


IA UNIZATIONS CLINICAL & LAB TESTS )SEASE EXPERIENCE
DATE DATE DATE DATE DATE DATE TYPE RESULT DISEASE YEAR
TYPHOID
SMALLPOX
OIPHTHERIA-ERRTUSSIS-TETANUS
DIPHTHERIA
PERTUSSIS
TETANUS
GRADE: SCHOOL
AGE: DATE
NUTRITION ____
ORTHOPEDIC____
SKIN & SCALP ____
EARS
EYES ______
NOSE __ ____
AOUTH & THROAT -
TEETH
GLANDS -
HEART ____ __ __
LNGS
LIGEH / _________/________ __


OTHER -
PARENT PRESENT
PHYSICIAN
DATE SIGNIFICANT FACTS AND PHYSICIANS' NOTES (WORKER SHOULD INITIAL EACH ENTRY)




















CODE: 0 *.t*.r efri I, 2, 3 IllabtAltr. y d.er.t*, r*N*ely RwtNrltcryri "*.d AVtr.lon:;
1 rrterNIos: 00 co.,,.N..
Record aprmved by State Oseprtment of Education nd State board of Health SCHOOL RECORD CH 304S


N t r ....


---













APPENDIX


TYPE OF
VISIT SERVICES RENDERED, HOCE VISITATION & PARENT CONFERENCES
DATE INFORMATION SECURED, ADVICE GIVEN, PLAN FOR CORRECTION
& o (WORKER SHOULD INITIAL EACH ENTRY)











TESTS GIVEN BY TEACHER


HEIGHT
E IDAT

VISION W/O GLASSES R L L R L R L L R R L R L R L R L
VIS'ONu'TH GLASSES R L L R L R L R L L L L R L R L L
HEARING R L L R L R L L L R L R L R
TEACHER'S OBSERVATION DURING SCHOOL YEAR
TEACHER'S NAHM OR INITIAL
GRADE WIEN OBSERVED
FREQUENT STYES,CRUSTED LIDS, INFL.

EYES FREQUENT HEADACHES
SQUINTS AT BLACKBOARD AND BOKE
EARACHES AND DISCHARGING EARS
EARS -
FAILS TO HEAR QUESTIONS
NOSE & PERSISTENT MOUTH BREATHER
THROAT FREQUENT SORE THROAT OR COLDS
MOUTH OBVIOUS NEED FOR CARE
SKIN & SPIN ERUPTIONS
,SCALP PEDICULOSIS
NENSTRUAL DISORDERS
TIES EASILY
G POOR uJSCEULAR COORDINATION
CONDITION
BAD POSTURE
APPEARANCE --- -
SPEECH DEFECT

NERVOUSNESS-OR RESTLESSNESS

BEHAVIOR SHYNESS
NAIL BITING
TOO LITTLE GROUP PARTICIPATION
HEALTH LACK OF EMITINRAL CONTROL
HABITS EXCESSIVE USE OF TOILET
POOR FOOD HABITS
DAYS
FOR

CCOE: 6 s2tltfertor! 1, 2, 3 Sutlls ly. wod.tIr.Dl. mritkd*r .. tltr.tori X -x .ee. sAtteltlu
l Inform.to; 00 C.rec.tion.










HEALTH SERVICES FOR FLORIDA SCHOOLS


DATE NOTES (WORKER SHOULD INITIAL EACH ENTRY)











APPENDIX


DATE NCTES (WORKER SHOULD INITIAL EACH ENTRY)







HEALTH SERVICES FOR FLORIDA SCHOOLS


LAWS RELATING TO SCHOOL HEALTH
The following sections from the Florida School Code are
those pertinent to the health of the school child, the teacher
and other personnel, and the school environment. (For com-
plete code see Florida School Code, Title XV, Statutes, 1951.)
SECTION 227.12
(18) School Day-A school day for any group of pupils is
that portion of the day in which school is actually in session
and shall comprise not less than five net hours and not less
than six hours including intermissions for all grades above
the third; not less than four net hours for the first three
grades; and not less than three net hours in kindergarten
and nursery school grades: Provided that the minimum length
of the school day herein specified may be decreased not to
exceed one net hour under regulations of the state board.
SECTION 230.23
Powers and Duties of County Board.-The county board act-
ing as a board shall exercise all powers and perform all duties
listed below:
(8) (e) Provide for Education of Special Groups.-Pro-
vide, insofar as practicable, for special facilities for
classes for backward, defective, truant, or incorrigible
children of school age and for part-time or night school
or classes for adolescents and adults, including illiterate
and groups needing Americanism, and, when desirable
and practicable, to provide for the education of children
below the first grade level in nursery school or kinder-
garten classes.
(f) Health Examination and Treatments.-Provide for
all children of school age in the county to have periodic
physical and dental examinations and, insofar as prac-
ticable, arrange and cooperate with other organizations
for the prompt treatment of all pupils who are in need
of remedial and preventive treatment; provided, that
except in emergencies pupils may be given remedial or
preventive treatment only on. written consent of the
parent.
(10) Transportation of Pupils.-Make provision for the
transportation of pupils to the public schools or school activi-
ties they are required or expected to attend: and adopt








APPENDIX


the necessary rules and regulations to insure safety, economy,
and efficiency in the operation of all busses, as prescribed
in Section 234, hereof.
(11) School Plant.-Approve plans after considering any
recommendations which may have been submitted by the
trustees of the districts concerned, for locating, planning,
constructing, sanitation, insuring, maintaining, protecting and
condemning school property as prescribed in Section 235 and
as follows:
(b) Sites, building, and equipment.--Select and pur-
chase school sites, playgrounds, and recreational areas
located at centers at which schools are to be constructed
and of adequate size to meet the needs of pupils to be
accommodated; provided that the trustees of any dis-
trict shall have authority to refuse, on the grounds of
excessive cost or improper location; ... to expand exist-
ing sites; ... to insure that all plans and specifications
for buildings provide adequately for the safety and
well-being of pupils....
(c) Maintenance and upkeep of school plant.-Provide
adequately for the proper maintenance and upkeep of
school plants, so that children may attend school with-
out sanitary or physical hazards and to provide for the
necessary heat, lights, water, power and other supplies
and utilities necessary for the operation of the schools.
(e) Condemnation of buildings.-Condemn and pro-
hibit the use for public school purposes of any building
which can be shown for sanitary or other reasons to be
no longer suitable for such use, and when any building
is condemned by any state or other government agency
as authorized in Section 235, to see that it is no longer
used for school purposes.
SECTION 230.33
Duties and Responsibilities of County Superintendent.-The
county superintendent shall exercise all powers and perform all
duties listed below; provided, that in so doing he shall advise
and counsel with the county board:
(8) Child welfare.-Recommend plans to the County Board
for the proper accounting for all children of school age, for
the attendance and control of pupils at school, for the proper








HEALTH SERVICES FOR FLORIDA SCHOOLS


attention to health, safety, and other matters which will best
promote the welfare of children in the following fields, as
prescribed in Section 232:
(15) Cooperation with other agencies.-Recommend plans
for cooperating with and on the basis of approved plans to
cooperate with federal, state, county and municipal agencies
in the enforcement of laws and regulations.
SECTION 231.09
(1) Teaching.-Teach efficiently and faithfully, using the
books and materials required, following the prescribed courses
of study, and employing approved methods of instruction, the
following: the true effects of alcohols and intoxicating
liquors and beverages and narcotics upon the human body
and mind, state and county officials shall furnish and put
into execution a system and method of teaching the true ef-
fects of alcohol and narcotics on the human body and mind,
provide the necessary textbooks, literature, equipment, and
directions, see that such subjects are efficiently taught by
means of pictures, charts, oral instruction, and lectures and
other approved methods, and require such reports as are
deemed necessary to show the work which is being covered
and the results being accomplished, and provided further,
that any child whose parent shall present to the school prin-
cipal a signed statement that the teaching of disease, its
symptoms, development and treatment, and the viewing of
pictures or motion pictures of such subjects conflict with the
religious teachings of their church, shall be exempt from
such instruction, and no child so exempt shall be penalized
by reason of such exemption.
SECTION 231.40
Sick Leave.-Any member of the instructional staff employed
in the public schools of the State who is unable to perform his
duty in the school because of illness, or because of illness or
death of father, mother, brother, sister, husband, wife, or child,
and consequently has to be absent from his work shall be granted
leave of absence for sickness by the county superintendent, or
by someone designated in writing by him to do so.
SECTION 232.03
Evidence of Date of Birth Required.-Before admitting a
child to the first grade, the principal shall require evidence








APPENDIX


that the child has attained the age at which he should be ad-
mitted in accordance with the provisions of Section 232.01. The
county superintendent or attendance assistant may require evi-
dence of the age of any child whom he believes to be within
the limits of compulsory attendance as provided for in Sections
232.01-232.19.
SECTION 232.06
(1) Physical and Mental Disability.-Children whose phys-
ical or mental condition is such as to prevent or render inad-
visable their attendance at school or application to study; pro-
vided, that before issuing a certificate for physical or mental
disability, the county superintendent shall require the submis-
sion of a statement from the county health officer, if a licensed
physician, in counties having such an officer, and in other
counties from a licensed practicing physician designated by
the county board, certifying that the child is physically o0
mentally incapacitated for school attendance; provided further
that children who are handicapped by deafness or blindness fs
to be unable to make satisfactory progress in the public school
shall attend the Florida State School for the Deaf and t e
Blind or some other institution within or without the st-te
in which equivalent instruction is offered, the rating of su
instruction to be determined by the state superintendent un
regulations prescribed by the state board; and provided furt!,
that if any child is so seriously crippled as to make imposip ,,i
or inadvisable his or her attendance at a regular public school
the county superintendent shall attempt to make arrangements
for such child to attend a public or other school for cripple !
children.
SECTION 232.29
Physical and Mental Examination.-The state board of edu-
cation and the state board of health shall jointly prescribe uni-
form forms, rules and regulations, and, through their executive
officers shall arrange for the examination at appropriate in-
tervals of each child attending the public schools of the state
for the purpose of discovering, reporting and promoting treat-
ment of mental and physical defects that require medical or
surgical treatment for the proper development of each child.
SECTION 232.30
Medical Examination of School Children Under Supervision
of State Board of Health.-Subject to these rules and regula-







HEALTH SERVICES FOR FLORIDA SCHOOLS


tions the state board of health shall have supervision over all
matter pertaining to the medical examination of school chil-
dren in Florida, with such duties and powers as are prescribed
by law pertaining to public health, and all school children shall
be examined as to their physical condition at appropriate in-
tervals. Any work done by health authorities, provided, how-
ever, that any child shall be exempt from medical or physical
examination, or medical or surgical treatment, upon written re-
quest of the parent or guardian of such child who objects to
the examination and/or treatment on religious grounds, and
provided further that the laws, rules and regulations relating
to contagious or communicable diseases and sanitary matters
shall not be violated.
SECTION 232.31
County Boards and Health Authorities to Cooperate.-County
boards of public instruction and county health authorities shall
cooperate in providing and arranging for periodic medical ex-
aminations of all school children under regulations of the state
board of education and the state board of health.
SECTION 232.32
County Health Units: Cooperation With.-In counties in
which county health units have been provided and are in active
operation it shall be the duty of the county board, and the
county superintendent shall cooperate with said units in all
matters having to do with the health andiwelfare of school chil-
dren provided, that if the periodic medical inspection of school
children is a part of the program of a county health unit such
medical inspection shall be considered as meeting the require-
ments for a medical inspection as set forth in this chapter.
SECTION 232.33
Child Ill at School.-If a child becomes ill while at school the
teacher or principal shall segregate such child from other chil-
dren until such time as he can be removed to his home.
SECTION 232.34
Procedure During Epidemics.-In case of an epidemic of a
communicable disease among the pupils of a school, the county
superintendent shall observe such measures as are advisable by
the full-time county health officer who shall act in accordance
with rules and regulations prescribed by the state board of
health. In case there is no full-time county health officer, the








APPENDIX


county superintendent shall act on the advice of a physician
designated by the county board, which physician shall act in
accordance with rules and regulations prescribed by the state
board of health regarding control of communicable diseases.
SECTION 232.35
Admittance of Child After Illness With Communicable Dis-
ease.-A school child who has been ill of a communicable dis-
ease shall in no case be allowed to return to school except on
the written permission of the full-time county health officer or
other reputable physician licensed to practice in the State of
Florida.
SECTION 232.36
Sanitation of Schools: State Regulations.-The state board
of education and the state board of health shall jointly adopt
and promulgate all needful rules and regulations having to do
with sanitation of school buildings, grounds, shops, cafeterias,
toilets, school busses, laboratories, rest rooms, first aid rooms,
and all rooms or places in which pupils congregate in pursuit
of the school duties or activities.
SECTION 232.37
Duties of County Boards With Reference to Sanitation.-The
county board shall see that all state rules and regulations hav-
ing to do with sanitation of the schools under their control
are enforced; provided that additional rules and regulations
not in conflict with the state rules and regulations may be
adopted by the county board and enforced through the county
superintendent.
SECTION 234.02
Safety and Health of Pupils.-Maximum regard for safety
and adequate protection of health shall be primary requirements
which must be observed by county boards in routing busses,
appointing drivers, and providing and operating equipment.
SECTION 234.05
Examining Physicians.-Each county board shall designate
a physician or physicians to examine and report the physical
condition of bus drivers and driver applicants in accordance
with regulations of the state board and procedure prescribed by
the state superintendent.
SECTION 235.06
(2) Condemnation by State Department or State Board of








HEALTH SERVICES FOR FLORIDA SCHOOLS


Health.-An inspection of any school property may be made
by the state department or by the state board of health, either
of which may order the property to be withdrawn from school
use until undesirable conditions are corrected; provided, that
the state board of health shall notify the state superintendent
of any such action taken by it.
SECTION 235.13
Fire Precaution.-A principal or teacher in charge of a school
shall see that all teachers, janitors, and any and all school em-
ployees under his direction take proper precautions in handling
or storing of waste papers, kerosene lamps, oiled dusting cloths,
and any and all inflammable articles and to endeavor to see that
pupils exercise all necessary precautions. All closets, cabinets,
attics, basements, storage spaces, and any places within or
under the building where supplies are kept or where waste
paper or other materials may accumulate shall be regularly
checked by the principal and county superintendent and any
improper conditions shall be remedied.
SECTION 235.14
Fire Drills.-The state superintendent shall formulate and
prescribe regulations and instructions for fire drills for all the
public schools of the State of Florida, and each principal or
teacher in charge of each such school shall be provided with
a. copy of such regulations and instructions; and each such per-
son shall see that fire drills for his school are held at least
twice each semester and that all teachers and pupils of the
school are properly instructed regarding such regulations and
instructions.
SECTION 235.20
Site Must Be Adequate.-Each new site selected shall be ade-
quate in size to meet the needs of the school to be served. As
far as practicable, any present sites which are not adequate
shall be increased to conform to minimum standards for new
sites. Each school site shall contain a minimum of two acres
for a one-teacher school. At least one acre shall be added to
this minimum size of the site for each fifty pupils enrolled in
the school after the first fifty pupils and until the enrollment
reaches five hundred pupils; provided that this requirement
may be waived in the discretion of the state superintendent
under regulations of the state board when any county board












APPENDIX


files evidence showing that a school site of that size is im-
practicable in any given situation.
SECTION 235.21
Other Minimum Standards to be Met.-It shall be the respon-
sibility of the county superintendent to recommend to the
county board for purchase and of the county board to pur-
chase school sites in accordance with the provisions of Section
230 which meet standards prescribed below and such supple-
mentary standards as may be prescribed by the state board to
promote the educational interests of the children. Each site
shall be well drained, reasonably free from mud, and the soil
shall be adapted to landscaping as well as to playground pur-
poses. Insofar as practicable, the school site shall not adjoin a
right of way of any railroad or any through highway and shall
not be adjacent to any factory or other property from which
noise, odors, or other disturbances would be likely to interfere
with the school program.
SECTION 235.24
New Buildings Must Meet Minimum Standards.-In order to
provide for the sanitary, safe, and economical construction and
maintenance of public school plants, toilets and physical equip-
ment, and in order to promote the physical welfare and safety
of the school children of the state, any building hereafter con-
structed for public school purposes in any county in this state
shall meet all minimum standards prescribed by law or by rules
and regulations of the state board of education, and in addition,
all minimum standards prescribed jointly by the state board of
education and the state board of health as herein provided. It
shall be the responsibility of the state board of education and
of the state board of health to prescribe jointly necessary mini-
mum standards relating to the sanitation of school buildings
and the protection of public health as affected by the school
plant.







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