good health is the basis for wealth, happiness, and long life and that all children should be taught that preserving their health and the health of others is one of their most important duties. Knowledge leads to good health, while ignorance leads to poor health and disease.

Between the late 1800s and 1950, many social concerns and public health issues focused on the role of schools in promoting and maintaining health. In the 1890s, schools in Boston and Philadelphia were early pioneers in establishing cooperative programs with philanthropic organizations to provide school lunches to fight malnutrition. The era of “medical inspection” in schools started at the end of the nineteenth century in response to problems of urbanization and immigration. In 1894, 50 “medical visitors” were appointed in Boston to visit schools and examine children thought to be “ailing.” By 1897, Chicago, Philadelphia, and New York had all started comparable programs, and most of the participating medical personnel provided their services without compensation. The success of these early programs developed into more formalized medical inspection. In 1899, Connecticut made examination of school children for visual defects compulsory. In 1902, New York City provided for the routine inspection of all students to detect contagious eye and skin diseases and employed school nurses to help their families seek and follow through with treatment. In 1906, Massachusetts made medical inspection compulsory in all public schools and this ushered in broad-based programs of medical inspections in which school nurses and physicians participated. By 1911, there were 102 cities employing cadres of school nurses. In 1913, New York City alone had 176 school nurses. A great deal of the nurses' time was spent in home visits to families with children who had been excluded from school because of illness or infection, encouraging these families to have their children treated and returned to school. During this period the prevalence of tuberculosis in the United States also had a dramatic impact on school health with the development and spread of “open-air classrooms” in all major cities under the supervision of both medical and educational personnel.

One of the most influential groups in the development of school health was the Joint Committee on Health Problems and Education, which was jointly sponsored by the American Medical Association (AMA) and the National Education Association (NEA). Prior to 1920, the committee published the report Minimum Health Requirements for Rural Schools. Their 1927 paper Health Supervision and Medical Inspection of Schools strongly promoted the emerging concept of coordination among the medical services, the physical education, and the health education programs in schools.

Early in the 1920s, the AMA/NEA Joint Committee on Health Problems and Education reported the results of a nationwide survey on the status of health education in 341 city schools. The findings are particularly interesting

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