Historians who have examined physical education (PE) have rarely related PE to its wider social context. This article considers the development of PE in elementary schools in England and Wales between 1907 and 1939, and locates PE within the wider history of the School Medical Service. From 1907, local authorities appointed specialist staff, acquired playing fields, and sent their teachers on short vacation courses, while at a policy level the Chief Medical Officer, Sir George Newman, came to regard PE as a component of preventive medicine. In the interwar period, PE was greatly influenced by voluntary organizations, and by the physical training schemes set up by the continental dictatorships, and this culminated in the Physical Training and Recreation Act of 1937. However PE also illustrated many of the weaknesses of the School Medical Service, including striking regional variations in its provisions, and in the 1930s the emphasis on PE contrasted with the relative neglect of malnutrition. The article concludes by suggesting that the contrast between Sir George Newman's ambitious plans for PE as a branch of preventive medicine, and provision in most local authorities, illustrated the great gulf that could exist between rhetoric and reality.