percentage of defects treated in children of parents in better circumstances and of an average higher level of education is not materially different, if at times not smaller, than in children of the poorer sections of the city: in this connection it must be noted that the per cent, of children with defects other than teeth was much lower in the well-to-do section than in any of the three other sections; (second) that full and harmonious cooperation between the teaching staff and the medical corps is an element of extreme import in the efficacy of the work. In some instances, especially in cases of defects with reference to which a great deal of popular education has been undertaken, it is evidently possible to attain one hundred per cent, of treatments when the cooperation of the principal and teachers is genuine and wholehearted; (third) that the proximity to the school of a well-equipped and efficient dispensary tends to increase the usefulness and efficiency of the work of the medical school inspectors; (fourth) that in the case of children's ailments, parents, even of the poorer classes, resort in fifty per cent, of cases to the services of private physicians; (fifth) that over thirty per cent, of reported treatments of school children by private physicians and dispensaries do not result in cure or improvement; and (sixth) that teeth are of all the largest and most neglected class of children's defects.
Should a comprehensive study on the lines suggested in this paper bear out the above cited conclusions a thorough revision of the underlying theory and methods of our medical school inspection should be undertaken and serious attention given to the institution and organization of school clinics where efficient, competent and prompt work would be done.
School clinics are being tried in various parts of the country and abroad. In New York City we have dental, nose and throat, and contagious eye diseases clinics for children, maintained by the Department of Health. The number of these clinics is small and their location is not planned to meet the peculiar needs of certain sections. The only therapeutic work done in schools of New York City is by nurses who treat minor skin and eye troubles like scabies, ringworm, favus, impetigo and conjunctivitis. This measure alone has decreased the number of school exclusions from 57,665 children in 1903 to 3,361 in 1911, but what is more important than mere school attendance, it has effected positive cure in thousands of cases.
It is my personal opinion and belief that school clinics, if adopted on a broader scale, should be established if not in every school, then in schools centrally located, so that children from other schools in the vicinity could easily reach them. The clinic districts should not be made too large, that the evils of overcrowding may be avoided and the children not subjected to waiting long and many hours. The treatment in school clinics for those who need it and are unable for one reason or another to
