There is one condition in the Cleveland school system which rises like a mighty barrier against the possibility of completely fulfilling any such program of health education as that outlined in the 10 planks of the preceding platform. This is the fundamental fact that the Cleveland school authorities have not yet conceived of health work as being an integral part of education.

In this city the work of the Board of Education is divided into three main departments. These are the executive department, the educational department, and the department of the clerk. The executive department is under the leadership of the director of schools and it deals with the business activities of the Board. The educational department is under the superintendent of schools and deals with teaching.

Under this organization the activities carried on by the Board of Education must be assigned to one or another of the departments and this entails in most cases arriving at a decision as to whether the work in question is predominantly of an educational nature or of a business nature. In dealing with health work in the public schools, the Board of Education rendered its decision both ways. It decided that provision for health in education was a series of business transactions and so it placed medical inspection in the executive department under the leadership of the director. It also decided that provision for education in health was a teaching problem and so it placed physical education and training in physiology and hygiene under the direction of the superintendent of schools.

Despite its decision that provision for health in education is a business matter, while provision for education in health is a teaching matter, the Board realized that some sort of unity was essential if the different sides of the work were carried forward efficiently. They met this situation by employing a competent director of health work and giving him an official dual personality. As the official held responsible for health in education, he is the director of medical inspection and is subordinate to the director of schools. As the official responsible for education in health, he is an assistant superintendent and is responsible to the superintendent of schools. In one capacity he is appointed by the superintendent and receives a portion of his salary from educational funds. In his other capacity he is appointed by the director of schools and paid from business appropriations. As an employee of the educational department, he is appointed for a term of one year, but as an employee of the business department, he is on the civil service list with an indeterminate period of employment.

In his educational capacity, he may arrange for the organization of basketball teams for this is held to be a matter of physical education, but in order to have a basketball game actually played at any time outside of regular school hours, he must get the permission of the director, for this is held to be a business transaction.

Instruction in infant hygiene is given to the girls in the upper grades. Part of the teaching is done by the regular teachers, the rest by the nurses of the medical inspection department. When the instruction is given by the teachers, it is considered an educational activity and is under the supervision of the superintendent; when the same class is taught by the nurse, it is considered a business transaction and is under the authority of the director.

As chief medical inspector, representing the business department, this official discovers a feeble-minded child whom he wishes to transfer to a special class. Since the transfer of this child is an educational problem, he reports the matter to the assistant superintendent in charge of the district. Since the medical inspector is also an assistant superintendent, these two men are co-ordinate educational officials. The assistant superintendent of the district reports the requested transfer to the city superintendent who deals with the matter as an educational problem and issues an order to the chief medical inspector in his capacity as assistant superintendent in charge of physical education to make the transfer.

This whole situation, which arises from assigning some phases of the health work to the business department and other phases to the educational department, has not given rise to as many or as serious difficulties as might well be expected. This relative freedom from trouble and friction is an impressive tribute to the unremitting tactfulness of the officials most directly concerned. The chief medical inspector is a conspicuous example of a man defying holy writ by successfully serving two masters.

Health work in Cleveland public schools is on a higher plane than in most other cities. Its present accomplishments have carried it further than similar work has gone elsewhere. Its future possibilities are unusually bright because the early stages of development have been successfully passed. The one thing that we may be sure of is that this future development will tend toward an ever closer relationship and more intimate intermingling of the activities which make for health in education and those which are directed toward education in health. Each new development and each forward step renders a separation of the work into educational and business activities progressively difficult.

To discover decayed teeth and to teach children to care for their teeth are intimately related matters and their separation is bound to be theoretical and not real. To attempt to separate the testing of vision from teaching concerning the conservation of vision is to lose an opportunity for the most effective sort of instruction. Similarly, if one scrutinizes all of the 10 items that have been suggested as indicating the health activities which Cleveland should continue to develop in its public schools, he can hardly fail to appreciate the utter impossibility of successfully dividing the work into certain activities which shall be educational and certain other activities which shall be business. Sooner or later the theory that this can be done will be destroyed by the logic of events, for health work in our public schools is constantly becoming a more intimate and integral part of the every-day education of all the children.

Sooner or later serious difficulties are bound to arise from an administratively unsound arrangement in which a school official in charge of a most important division of work is responsible to two entirely independent chiefs. The opportunities for honest but irreconcilable conflict of views are so numerous that they will surely arise in time. One chief may favor vaccination and the other be opposed to it on principle. One may deem it the duty of the schools to have the doctors and nurses give instruction in sex hygiene while the other may be utterly against anything of the sort. One may hold that the only useful physical exercise is that gained through games and athletics, while the other may favor formal gymnastics. One may believe in school gardens, and the other deem them a waste of time and money. One may believe that courses in infant hygiene should be provided for the girls in the upper grammar grades, while the other may hold that such instruction should be reserved for continuation classes for young women.

All of these are matters on which educational authorities are sharply divided in opinion and there are many more of the same nature. The present director of schools, the present superintendent of schools, and the present chief medical inspector have so far worked successfully under the present arrangement of divided duties and responsibilities, but a reorganization along sounder administrative lines should be made before, instead of after, serious trouble arises. Eventually, if not now, Cleveland must realize that health work in education must be placed under the direction of the city's highest educational official who is the city superintendent of schools.