lated and sparse. It was not until 1840 that Rhode Island passed legislation to make education compulsory, and other states soon followed (Means, 1975).

School health professionals often state that the ''modern school health era" began in 1850 (Pigg, 1992). In that year, the Sanitary Commission of Massachusetts, headed by Lemuel Shattuck, produced a report that had a significant impact on school health and has become a classic in the field of public health. Shattuck served as a teacher in Detroit and as a member of the school committee in Concord, Massachusetts, where he helped reorganize the public school system. His background led to school programs receiving major attention as a means to promote public health and prevent disease (Means, 1975). The report states the following:

Every child should be taught early in life, that, to preserve his own life and his own health and the lives and health of others, is one of the most important and constantly abiding duties. By obeying certain laws or performing certain acts, his life and health may be preserved; by disobedience, or performing certain other acts, they will both be destroyed. By knowing and avoiding the causes of disease, disease itself will be avoided, and he may enjoy health and live; by ignorance of these causes and exposure to them, he may contract disease, ruin his health, and die. Everything connected with wealth, happiness and long life depends upon health; and even the great duties of morals and religion are performed more acceptably in a healthy than a sickly condition.

Soon after the release of the Shattuck report, the medical and public health sectors began to recognize the role that schools could play in controlling communicable disease with their "captive audience" of children and young people. For example, even though a vaccine had been developed years earlier, smallpox continued to strike well into the latter half of the nineteenth century, due to the constant influx of new immigrants and the mobility of the population. When New York City was faced with an outbreak of smallpox in the 1860s, no mechanism was in place to provide free vaccinations to those who needed them, so the Board of Health turned to the schools. Education officials agreed to permit inspection of school children to determine whether or not they had been vaccinated, and in 1870, smallpox vaccination became a prerequisite to school attendance (Duffy, 1974).

Although the schools of this period had the potential to confront and control communicable disease, no doubt they also contributed to the spread of disease. In the late 1860s and early 1870s, the New York City Board of Health instituted a program of sanitary inspections of all public school twice a year. These inspections revealed a filthy environment and excessive crowding. Modern plumbing was nonexistent, and schools were sometimes overrun by rats. Frequently, more than 100 students occupied



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