recognize that our underlying principles must be altered and actual conditions met more satisfactorily than by mere observation and noticing of defects.
Medical inspection of school children is in its infancy. Before a satisfactory method will be worked out many experiments must be tried out and many careful inquiries made. The present fragmentary study was undertaken on behalf of the public health, hospital and budget committee of the New York Academy of Medicine to demonstrate a method of testing the value of certain elements entering into the effectiveness of our medical school work, in order to determine whether school clinics are a practical necessity. Matters pertaining to the health of the school children of the City of New York are confided to the care of a dual authority—that of the Department of Education and the Department of Health. The sanitary care of schools, the instruction in physical training and personal hygiene, the segregation of backward and mentally defective children, are entrusted to the Department of Education; all the other elements of the medical school inspection are under the control of the Department of Health.
There are instances where the work of the two departments overlaps; there are instances where the two departments collide. There are opportunities for mutual dissatisfaction and irritation, which at times engender ill-feeling and refusal to cooperate on the part of individuals. We shall eventually come to the point, it seems to me, when we shall have to decide on some definite policy of procedure, which will eliminate any possibility of friction. We should like, therefore, to know precisely to what extent the full and complete cooperation of the teaching staff with the medical corps is to be counted on as a factor in bringing the efficiency of our school medical work to the highest possible pitch. Then, we have a great many dispensaries in the City of New York, varying in size and efficiency. The knowledge of the extent to which the proximity of a large and well-equipped dispensary affects our problem is also essential before a definite policy is adopted. Thirdly, we harbor within our city limits population composed of various races, of various degrees of intelligence and education and differing in economic status. We should like to know to what extent these factors enter into our problem.
Recognizing the importance of these elements, we have selected four schools in the Borough of Manhattan: One on the lower east side, in a section whose population is composed almost entirely of Russian, Austrian and other Jews, and where the cooperation of the school authorities with the health officers is known to be excellent. Then, another school amidst a mixed population—foreign to a great extent, where the interest of the principal in the work of the health department's officials was known to be slight. A third school was selected, again in a Jewish quarter, but in another section of the city, near a large and efficient dis-
