A student nibbles thoughtfully on his pencil as he thinks in class.

Public Health Rhymes, 1918

By Elizabeth Mullen ~

A student nibbles thoughtfully on his pencil as he thinks in class.

Germs that float upon the air
Are sure to settle everywhere;
They’ll be on pencil and on pen,
And even on our fingers ten.

To write our lessons it is true
We use our hands and pencils too;
Let’s keep them from our lips and tongues,
So germs won’t get into our lungs.

This April marks the 25th anniversary of National Poetry Month, an event celebrating and exploring the role of poetry in American life and culture. The intersection of health and poetry is wide and varied;  Health First Reader for Happy, Healthy Children, a charming booklet of “public health rhymes,” is just one of the many poetic works in the historical collections of the National Library of Medicine.

Children jump rope, hold hoops, and play on swings and seesaws.
Health First Reader for Happy, Healthy Children, 1918
National Library of Medicine #101579401

The Anti-Tuberculosis League of Kenton County, Kentucky produced Health First Reader in 1918, at the end of the Progressive Era, and distributed copies of it free to K-3 school children.  The secretary of the League, William S. Groom, wrote and illustrated the booklet and the 1918 Bulletin of the National Tuberculosis Association featured it as a “…contribution to the cause of  health promotion and disease prevention in childhood which has already made a distinct impression and which is bound to have a widely leavening influence.”

The Progressive Era saw wide-ranging social policy changes, many focused on improving the lives of children including movements toward universal education and health measures in educational institutions. President Woodrow Wilson designated 1918 as Children’s Year to support these efforts.  Public institutions, particularly schools, played a key role in health education campaigns. Indeed, even when the 1918 flu closed schools, some urban schools stayed open, being thought more healthy than the homes of the students. In the same vein, public health nurses visited schools and worked in poor and immigrant communities around the country to improve child health particularly around tuberculosis and mortality rates.

A nurse stands at the front of a class of boys and girls.The focus of the Reader is public health and the importance of forming healthy hygiene habits in early childhood. The Health and Sanitation Through the Public Schools of Kentucky, ca. 1918, which includes the Reader, at the end of the text, provided schools with information about why the booklet had been developed and how it could be used.  The school is recognized as an important site for community health education as “…education of the child at school often reaches back into the home and results in the improvement of sanitation and hygienic conditions in the home with less difficulty than direct efforts toward the education of parents.” The instructive (or cautionary) illustrations on each page show bright three-color scenes of happy children behaving in healthy ways (or unhappy children who were not so wise), while the serious message is couched in rhymes—”…have the children commit the verses to memory and encourage them to recite them to their parents at home“—an effective pedagogical tool.

The 17-page booklet, about six inches high, features colorful drawings and two stanzas on each page. Lessons emphasize cleanliness, fresh air, proper clothing, and what not to share (food, dishes, towels, and sneezes).

The Reader begins by introducing a nurse to the classroom and enjoining the children to heed her authoritative advice.  Several cautionary tales are included: of Fred’s cold after he “…got wet up to his knees,” the toothache of the little boy who “…hated his toothbrush so,” and the “foolish little chap” who “would not wear his cap or coat… now he has a bad sore throat.”

The booklet instructs and advises students to listen to the advice of the nurse and their teachers but also asserts significant independence and agency by the student. “A sleeping-porch can oft be made / By handy boy with parent’s aid / But if there’s none, then move your bed / With open window near your head.”

A boy reclines outdoors in the sun and breezes.Near the end, a lovely backyard scene depicts a boy reclining on a lounge on a wide lawn with a table of refreshments by his side. “Of all the doctors in this town / Not one can reach such high renown / As Doctors Sunlight, Rest, Good Food / And Doctor Fresh Air, too is good.”  How achievable this daydream might have been for the students (or how frustrating to look at while being kept to their reading primer) we can only speculate.

The Reader closes with an illustration of a band of soldiers marching under an American flag and followed by an ambulance bearing a red cross.  With the ongoing U.S. involvement in World War I, a major concern of the military medical corps was screening recruits to ensure they were “fit.”  This large scale screening discovered a worrying array of health issues and fostered concern about the health of the general population. The patriotic image linked community health to the war effort and reinforces the discipline of the “rules of health they must obey” and the civic duties of maintaining personal and public health.

World War One soldiers march in ranks under an american flag followed by an ambulance.

The National Library of Medicine’s copy of the pamphlet is annotated in ink throughout with critical commentary by an unknown hand.  The text is carefully considered and evaluated, with remarks like “pretty good,” “bad rhyme,” “how could a child judge,” and “will not prevent a boy to do likewise.”

Handwritten notes on the back of a booklet.Comments such as “what is pure food” “no [tooth] powder mentioned,” “usually no nurse visiting school,” and “throwing out chest out of date” provide additional critique.  And a final list on the back states that the pamphlet makes no mention of “Pure Water, Safe Milk, House Dust, or Tobacco,” common elements of public health guidance in the 1920s. Whatever purpose the evaluator had in mind for this booklet, they seem to have felt it needed significant improvement. Nevertheless, the power of poetry to teach healthy habits is timeless.

Photo of Elizabeth Mullen outside in front of a building.Elizabeth A. Mullen is Manager of Web Development and Social Media in the History of Medicine Division at the National Library of Medicine.


  1. Outside my window, I saw a little birdie named Enza so I opened the window and in flew Enza.

  2. There are still some people that semi-believe some of those poems present. I am 72 and still hear the phrase “You’ll catch your death out in that weather.” on occasion. This was a very interesting column.

    ~V Wood

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