"Better Off in School"

School Medical Inspection as a Public Health Strategy During the 1918-1919 Influenza Pandemic in the United States

Most city schools across the United States reacted to the 1918 flu epidemic by closing their schools for weeks, even months in the fall and winter when the pandemic raged. Three cities, however, diverged from that dominant pattern—New York, Chicago, and New Haven, Conn.—where officials widely held the belief that students were better off in school than playing unsupervised elsewhere.

These case studies of how schools in three cities handled the flu epidemic of 1918 offer instruction for today’s public health practitioners, educators and policy-makers as we face the threat of H1N1 or other pandemics. Among the lessons:

  • Public schools presented an opportunity to implement public health strategies and intensify the school hygiene movement that had been established over the past several decades.
  • Nurses were instrumental in ensuring that medical inspections ran well in schools.
  • Well-designed communication systems kept teachers, nurses, physicians and city health leaders informed with daily reports. In the Progressive era, school nurses had expanded their roles to include surveying health conditions of students and families in their homes. When infected students were sent home they were visited by nurses who instructed family members about proper procedures for isolation and self-care.