Pi 1"'!'^ 1 1 ' ill i llhi,i'"ii|i' i 1 1 I I ALBERT R. MANN LIBRARY New York State Colleges OF Agriculture and Home Economics Cornell University Cornell University Library RD 731.S68 Care and education of crippled cliildren 3 1924 003 455 551 Cornell University Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924003455551 House of St. Giles the Cripple United We Stand. (See page i68) RUSSELL SAGE FOUNDATION CARE AND EDUCATION OF CRIPPLED CHILDREN IN THE UNITED STATES By EDITH (reeves') ^le^Luxux' SPECIAL AGENT DEPARTMENT OF CHILD-HELPING ' RUSSELL SAGE FOUNDATION INTRODUCTION By HASTINGS H. HART, LL.D. DIRECTOR DEPARTMENT OF CHILD-HELPING NEW YORK SURVEY ASSOCIATES, INC. MCMXI V Copyright, 191 4, by The Russell Sage Foundation PRESS OF WM. F. FELL CO. PHILADELPHIA DEDICATED TO THE BRAVE LITTLE PEOPLE Photo by Jessie Tarbox Beats Foot Race — The Start PREFACE THIS volume is intended to serve as a handbook for the use of those who are interested in the care of crippled children. It undertakes to give concrete information respecting 37 hospitals, convalescent institutions, and asylum homes whose work is so standardized as to permit of statistical treatment, and to give a brief outline of about the same number of institutions, schools, and societies which devote only a part of their effort and resources to crippled children, or whose work is less definitely de- veloped and standardized. The rapid growth of work for crippled children since 1891 indicates an increasing recognition of the need, and the facts here given suggest the ways in which that need is to be met. It is hoped that the book will be especially useful to those who are considering the question of organizing work for crippled children. To this end the work is freely illustrated by plans and photographs, accompanied by comparative statistics of the cost of lands and buildings and the expenditures for maintenance. Especial attention is called to the work of the state institu- tions for crippled children in Massachusetts, New York, Minne- sota, and Nebraska. These are the only institutions which are meeting adequately the needs of children in rural communities. It is doubtful whether the needs of these children can be met in any other way, and it is a significant fact that the states of Illinois and Ohio are contemplating the establishment of similar state institutions. In the Introduction and in the descriptions of particular in- stitutions the effort has been made to bring out the spirit of courage and optimism which animates the crippled children themselves and all who work for them. In particular, too high praise cannot be given to the orthopedic surgeons whose technical skill and personal devotion have furnished the basis for all effective efforts in behalf of crippled children. The Department of Child-Helping of the Russell Sage Foun- dation will take pleasure in answering inquiries for information not covered by this volume. ni TABLE OF CONTENTS PAGE Preface .... iii List of Illustrations vii List of Tables xi Introduction .... i I. The Scope of the Study 17 II. Physical Care of Crippled Children 28 III. Special Provisions for the Education of Crippled Chil- dren .... .... -49 IV. Hand Work and Vocational Training .... 62 V. Statistics .... . 91 VI. Detailed Description of Institutions . -141 Appendix . . 205 Index . . ... 237 LIST OF ILLUSTRATIONS Connecticut Newington page Virginia T. Smith Home for Incurables 185 Illinois Chicago "Happy Haven," Summer Camp at Twin Lakes, Indiana • '5 May wood Home for Disabled Children Miss Kittie Smith Carpentering ... 65 Miss Kittie Smith Embroidering . . . 64 Miss Kittie Smith Typewriting ... -65 Miss Kittie Smith with a Pupil ... . . 64 West Chicago Convalescent Home for Destitute Crippled Children ... 54 Outdoor Life .... 54 School Room -55 Sewing Class ■ ■ 5 5 Maine Portland Children's Hospital 140 First Floor Plan 143 Roof Garden 140 Maryland Baltimore Children's Hospital School . . 91 Sleeping Porch and Sun Parlor, in the Rear . . .91 Kernan Hospital and Industrial School for Crippled Children . 90 A Brave Soldier .... 24 A Weaver ... 42 Class in Basketry ... 42 Outdoor Sleeping Porch .... ... 42 Massachusetts Boston Industrial School for Crippled and Deformed Children Cane Seating. 49 Manual Training 49 Canton Massachusetts Hospital School Administration Building 8 vii LIST OF ILLUSTRATIONS PAGE Baseball Team 59 Covered Walk .43 Dormitories 43 Girls' Sewing Room 62 Infirmary Floor Plan . .161 Outdoor Class 9 Rotunda, Hospital Building ... . 9 Sleeping Ward 9 Two-story "Monitor Roof" Cottage .... 162 Two-story Monitor Roof Cottage, Cross Section . . .163 Wood-working Room ... .... 62 Hyde Park New England Peabody Home for Crippled Children . . 7 Coasting 7 Cooking Class .... . . 63 Industrial Room 63 School Room -63 Sleeping Porch in Stormy Weather . . .7 Minnesota Phalen Park State Hospital and School for Crippled Children . . . .166 Boys' Ward .... .... 166 School Room ... ... . . 166 Nebraska Lincoln Nebraska Orthopedic Hospital An Outing . -14 New Jersey Englewood Daisy Fields Home and Hospital for Crippled Children . . 72 Cooking Class ... 72 Newark Home for Crippled Children . . . ... 141 Orange New Jersey Orthopaedic Hospital and Dispensary Master of His Fate 14 New York Buffalo Crippled Children's Home 185 Coney Island Sea Breeze Hospital Outdoor Sleeping Porch . . 167 The Sun Bath ("Heliotherapy") 167 Garden City, Long Island House of St. Giles the Cripple Play Hour .... 82 viii LIST OF ILLUSTRATIONS PAGB Surgical Pavilion 91 Surgical Pavilion, Interior 82 United We Stand Frontispiece New York City Association for the Aid of Crippled Children School Omnibus 48 Crippled Children's East Side Free School Adult Cripples' Workroom 49 Foot Race — The Start Dedication Outdoor Sewing Class at Summer Home, Oakhurst, N. J. 37 Playground at Summer Home, Oakhurst, N. J. . 37 Hospital for Deformities and Joint Diseases 149 Outdoor Sleeping . 148 Special Gymnastics Before a Mirror . . -36 Hospital for the Ruptured and Crippled ... 6 First Floor Plan ... . -151 Fourth Floor Plan .... .... 152 Fifth Floor Plan ... 153 Sixth Floor Plan . . 150 New York Orthopaedic Dispensary and Hospital Dispensary . . . . . . . 155 Orthopedic Gymnastics .... 36 Outdoor Clinic 155 Public Schools Special Classes for Crippled Children Adjustable Chair and Desk 48 Trade School of the Hospital of Hope for Crippled Men Class in Making of Rattan Furniture 75 Port Jefferson, Long Island St. Charles Hospital for Crippled Children 83 "Seeking a Shrine " — A Legend of a Crippled Child . . 83 Sleeping Porch . ... 83 Victor Over Pain . 24 Southampton, Long Island Summer Home for Crippled Children (Conducted by the Post- Graduate Hospital of New York) 33 A Hike . i5 Milk Between Meals 33 The School . . . 33 West Haverstraw State Hospital for Crippled Children . .... 28 Outdoor Sleeping in Winter ... ... 29 Outdoor Sleeping Shack, Exterior . . . . 29 Outdoor Sleeping Shack, Interior . .... 29 Solarium 28 White Plains Country Branch New York Orthopaedic Hospital .... 2 A Cubicle 32 ix LIST OF ILLUSTRATIONS PAGE Bungalow Built by the Boys 32 Class Room 3 Graduates' Reunion ... 3 Staff Living Room 32 Ready for Surgeon's Weekly Inspection 3 Ohio Cleveland Holy Cross House Gardening 25 Public School Class 48 Rainbow Cottage and Lakeside Hospital "Reconstructing the Carter Twins" 73 Pennsylvania Allentown Good Shepherd Home Friendly Visitors 154 Philadelphia Home of the Merciful Saviour for Crippled Children "Play Ball!". ... 59 House of St. Michael and All Angels The Nursery 73 Widener Memorial School 16 Entrance 17 Front View ... . 17 Rear View ... . . ....17 First Floor Plan . . . . . 176-177 Second Floor Plan 178-179 Third Floor Plan . . 180 Pittsburgh Industrial Home for Crippled Children Sleeping Pavilions ... 184 Surgical Building Floor Plan .... . . 184 Washington Seattle Children's Orthopedic Hospital Outdoor Sleeping (All weathers) 148 Out-Patient Department .... . . 154 School for Children in Bed . . . . . 58 LIST OF TABLES TABLE PAGE I A. Sources of support, capacity, children in care, and employes in 10 hospitals io8 I B. Sources of support, capacity, children in care, and employes in 14 convalescent hospitals or homes ... .109 I C. Sources of support, capacity, children in care, and employes in 13 asylum homes no II A. Floor space per child in 9 hospitals 112 1 1 B. Floor space per child in 1 2 convalescent hospitals or homes . 114 II C. Floor space per child in 12 asylum homes. . 1 16 III A. Cost of plant per capita in 7 hospitals 1 18 III B. Cost of plant per capita in 1 2 convalescent hospitals or homes 119 inc. Cost of plant per capita in 1 1 asylum homes . . . .120 IV A. Annual current expense per capita in 9 hospitals . .121 I V B. Annual current expense per capita in 13 convalescent hospitals or homes ... 1 22 IV C. Annual current expense per capita in 12 asylum homes . .124 V. Sourcesof the income of 35 institutions . . . . 125 VIA. Rulesof admission and discharge in 10 hospitals . . 128-129 VI B. Rules of admission and discharge in 14 convalescent hospitals or homes ... .... 130-131 VIC. Rulesof admission and discharge in 13 asylum homes . 132-133 VII. Children attending school : grade, work. Teachers, sessions, and equipment, in 37 institutions . . . . .134 VIII. Hand work and vocational work in 37 institutions . . . 137 IX. Dispensary work of the 9 institutions having dispensaries . 140 SPECIAL TABLES — MATERIAL NOT FOUND IN GENERAL TABLES A. Causes of physical disability of 721 crippled children. Bir- mingham, England, 191 1 21 B. Public school provision for crippled children in four cities, in the school year 1912-1913 56 C. Working ability of 1,001 cripples 16 years of age or more. Birmingham, England, 1911 . . . -67 D. Self-support among 1,001 cripples 16 years of age or more. Birmingham, England, 191 1 68 E. Working ability of 69'^ cripples under 16 years of age who were not at work. Birmingham, England, 191 1 .... 68 F. Ratio of public funds received to the current expenses of 35 in- stitutions ... 103 G. Public funds; sources and amounts for one year in 17 institu- tions 104 H. Costof plant in the Widener Memorial School .... 182 I. Current expenses for one year in the Widener Memorial School 182 J. Square feet of floor space per child in the Widener Memorial School 183 XI CARE AND EDUCATION OF CRIPPLED CHILDREN IN THE UNITED STATES INTRODUCTION By Hastings H. Hart, LL.D. Director of the Department of Child-Helping of the Russell Sage Foundation TH E study of the work for crippled children in the United States which is here reported has extended over a period of more than two years. It was conducted by Miss Edith Reeves, a graduate of the University of South Dakota and Radcliffe College, who had two years' previous experience, under the Women's Educational and Industrial Union of Boston, in research work on labor laws affecting women and children in Massachusetts. 1 1 was at first proposed to study primarily the matter of vocational training of crippled children, but it soon appeared that in order to consider the vocational work intelligently, it would be necessary to under- stand fully the institutional work. New institutions for crippled children are being created every year, but heretofore the founders of such institutions have had no comprehensive source of information with regard to their con- struction and management. It is hoped that this report, with its illustrations, plans of buildings, and statistical tables, will afford valuable assistance in such undertakings. No comprehensive study of American institutions for crippled children has heretofore been made.* Efforts in behalf of crippled children include surgical work in hospitals and dispensaries, care during convalescence in insti- tutions,t asylum care for incurable and protracted cases, instruc- tion in institutional schools and day schools; also industrial and * In a recent pamphlet Douglas C. McMurtrie has treated the subject in- telligently, but briefly. See McMurtrie, Douglas C: The Care of Crippled Chil- dren in the United States. New York, 1912. Published by the author. t A small amount of visiting nursing service for cripples is carried on in con- nection with certain dispensaries. CARE OF CRIPPLED CHILDREN vocational training in institutions and special schools. The present study covers all of these lines of work except where carried on in orthopedic wards in general hospitals or in homes for incur- able adults which contain some crippled children. Most hospitals do more or less orthopedic work; some of the larger ones have special orthopedic wards; but hospitals as a rule deal with com- paratively few orthopedic cases and treat them in the regular surgical wards. In making this study Miss Reeves has visited nearly all of the institutions described.* The statistics cover 37 institutions — 10 orthopedic hospitals, 14 convalescent hospitals or homes, and 13 asylum homes. The united capacity of the 37 institutions is about 2,500 children.! Some of these institutions maintain summer homes whose work and expenses are included with those of the main institution. For convenience of study Miss Reeves has divided the insti- tutions for crippled children into hospitals, convalescent hospitals or homes, and asylum homes. It is impossible, however, to make a definite line of division. Some of the hospitals and all of the asylum homes provide a certain amount of convalescent care; some of the convalescent hospitals or homes do operative surgery. The endeavor has been to classify the institutions according to that feature of the work which seemed to be most prominent. There are several organizations doing work for cripples living in their own homes, of which the Association for the Aid of Crippled Chil- dren and the Crippled Children's Driving Fund of New York, reach by far the greatest number of children. The foregoing include all of the institutions in the United * The one at Seattle was visited by a special agent. t Miss Reeves studied 27 additional institutions which are not included in the statistical report. These 27 institutions include the following: I nstitutions which preferred not to furnish statistical information . 2 Hospitals for children in which orthopedic work constituted a minor feature 5 Convalescent hospitals or homes in which the work for crippled children constituted a minor feature 4 Asylum homes in which the work for crippled children constituted a minor feature 2 Summerhomesnotconnected with the above 37 institutions . . 8 Private schools for crippled children (including one for adults) . . 6 An account of the 27 additional institutions will be found in the Appendix. 2 Graduates' Reunion Class Room Ready for Surgeon's Weekly Inspection. (See page 172) Country Branch New York Orthopaedic Hospital, White Plains INTRODUCTION States, as far as we are informed, which are devoted to the care of crippled children. The statistical report does not include classes in public schools for crippled children. Such classes we find as follows: In New York City, 39; Chicago, 7; Cleveland, 4; and Detroit, i; total, 51 classes. A UNIQUE SPIRIT The most impressive result of this study has been the reve- lation of the extraordinary spirit which animates the inmates, the caretakers, the nurses, the teachers, the superintendents, the surgeons, and the donors of institutions for crippled children. This unique and potent spirit characterizes nearly all of these in- stitutions; orthopedic hospitals, convalescent hospitals, and asylum homes alike. It is the same spirit which pervades many institu- tions for the deaf and blind. The children manifest a cheerfulness, courage, and enthu- siasm which are a standing rebuke to pessimism. The New York Association for Improving the Condition of the Poor has circulated tens of thousands of pictures of " Smiling Joe, " strapped day and night to a board, in the most constrained position, yet exuberant with life, spirit, and jollity. Smiling Joe is a fair exemplar of hundreds of crippled children. To witness a game of baseball in which every player wears a brace or carries a crutch, and to see the life and enthusiasm which animate the game, is a revelation. Little children, pale, worn, and thin, and handicapped by disease or deformity, are found in school, proud of their ability to keep fully abreast of children in the public schools. The win- dows of their school rooms are wide open, or they may be found in blanket suits studying on outside porches in midwinter, earnest, happy, and progressive. Many of these children are eager to measure up to the accomplishments of normal children and be- come self-supporting, independent citizens. The nurses, teachers, and caretakers generally foster and encourage the brave spirit of their little wards. They constantly encourage a spirit of self- help, striving to develop initiative and independence among the children. In many of these institutions, cripples, young or old, carry on the work of the house and sometimes assume large responsi- 3 CARE OF CRIPPLED CHILDREN bilities. One of the most active and efficient nurses in the New York Hospital for the Ruptured and Crippled has never walked a step but goes about in a wheel chair, and many of the employes are cripples. In the Country Branch of the New York Orthopaedic Hospital the house physician, a surgeon of unusual skill, is crippled. In the Home for Disabled Children at Maywood, Illinois, the teacher, who was the founder of the institution, is an armless girl who can do with her feet most of the things which ordinary people do with their hands, including the use of a telephone and of car- penter's tools, and can even comb her own hair. The superintendents of the institutions are, almost without exception, men and women of large vision and inspiring purpose. The fine spirit which has been noted among the subordinate em- ployes is due partly to the skill of the superintendents in selecting them and partly to the inspiration which has been caught by the subordinates from their chiefs. The surgical directors of these institutions include the lead- ing orthopedic surgeons of the United States, who command high fees; but they give their time and skill to the children of the poor without pecuniary reward and with the same cheerfulness and fidelity as to the children of the rich. They have not been con- tent with the exercise of their skill in the operating room but, al- most to a man, they are addressing themselves to the problems of convalescent care, restoration to health, and the vocational need. The donors have caught the spirit of the movement and have not only poured out their wealth with a free hand, but have given their personal interest to the work. The late George D. Widener was practically superintendent of the splendid Widener Memorial School at Philadelphia. He directed its operations personally and paid the bills month by month. Miss Emily A. Watson has not only built the beautiful country home of the New York Orthopaedic Hospital at White Plains, supporting it entirely from her own re- sources, but she frequently visits it and keeps in personal touch with the children. The Chicago Home for Destitute Crippled Children is a hospital carried on by a group of wellknown Chicago women, who have not only performed the duties of trustees, but have personally solicited the funds for the building and mainte- nance of the hospital. They have even kept the accounts and paid 4 INTRODUCTION the bills and have now built a beautiful and well equipped country home. Even in the state institutions for crippled children there has been an absence of the partisan political control which has blighted so many state institutions, and the same spirit of altruism has almost invariably prevailed. For example, the Minnesota State Hospital had its origin in the sympathetic heart of a crippled girl, who, almost alone, secured the initial legislation. The surgical director has given his services for sixteen years without remuner- ation. The authorities of the St. Paul City and County Hospital have lent the facilities of that institution to the state at a merely nominal compensation. In Massachusetts a bill was introduced in both houses of the legislature for the establishment of a state institution for crippled children. The bill was reported back un- favorably by the committees of both the House and the Senate; nevertheless, the bill passed both houses and was signed by the governor. The governor appointed a commission which studied the care of crippled children at home and abroad, abandoned the traditions of both hospitals and asylums, and built an admirable state hospital school. It is fair to say that the credit for this unique spirit in insti- tutions for crippled children is due chiefly to the unselfish devotion of the orthopedic surgeons who lead the movement. Their spirit does not differ in kind from that of their brethren in other hospitals and other lines of medico-philanthropic work. But this particular field offers a peculiar opportunity for the development and mani- festation of altruism in its highest perfection. The patients are under care for a longer period than those in other hospitals and thfe results are notable because of the special handicap. DEVELOPMENT OF INSTITUTIONS The development of institutions for crippled children has been very gradual. In this report we have listed 37 institutions, in 13 states, as follows: Maine, i; Massachusetts, 2 ; Connecticut, i; New York, 12; New Jersey, 3; Pennsylvania, 6; Maryland, 2; Ohio, i; Illinois, 4; Michigan, i; Minnesota, 2; Nebraska, i; Washington, i. Of the 37 institutions, 10 are found in the two cities of New York and Philadelphia. 5 CARE OF CRIPPLED CHILDREN The year of opening the first institution for crippled children in each of the 13 states was as follows: (i) New York, 1863; (2) Pennsylvania, 1877; (3) New Jersey, 1891; (4) Illinois, 1892; (5) Massachusetts, 1894: (6) Maryland, 1895; (7) Connecticut, 1896; (8) Minnesota, 1897; (9) Ohio, 1903; (10) Nebraska, 1905; (11) Washington, 1907; (12) Michigan, 1907; (13) Maine, 1908. In the twenty-eight years from 1863 to 1890, only five insti- tutions were established, all in two cities: two in New York City and three in Philadelphia. In the ten years from 1891 to 1900, 12 institutions were established. In the eleven years from 1902 to 1 91 2, 20 institutions were established. ARCHITECTURE AND COST OF LEADING INSTITUTIONS The most complete and perfect orthopedic hospital in the United States is the new structure of the Hospital for the Rup- tured and Crippled, in East Forty-second Street, near the new Grand Central terminal, in New York City, built in 1912. It lacks nothing that could be desired in provision for the treatment and care of crippled children. Although it occupies a small piece of ground in the heart of a congested district it has a wonderful aspect of largeness and freedom. From the upper porches there is a fine view of the river. The wards are spacious and sunny; beautiful dining rooms and school rooms for children have been provided to break the monotony of ward life. Adjacent to each ward is an outdoor porch with an amount of space nearly equal to that of the ward itself. The architect has preserved the artistic proportions and re- lations of the building without sacrificing any of the requirements of efficient administration or scientific surgery. The leading examples of combined hospitals and convales- cent homes are the Massachusetts Hospital School at Canton and the Widener Memorial School at Philadelphia. Of these, the Massachusetts Hospital School presents the more useful type, for the reason that the Widener School has a monumental charac- ter which led to a more elaborate style of architecture and equip- ment than would be desirable in an ordinary institution. The Massachusetts Hospital School provides for 250 children at a cost per bed for building and equipment of only $1,105 as against an 6 Main Building Coasting Sleeping Porch in Stormy Weather. (See page i8q) New England Peabody Home for Crippled Children, Hyde Park, IVlass. INTRODUCTION average of )? 1,294 for similar institutions, and the per capita cost of care is only ^291 per child as against an average of $348 for the institutions of this class. Yet the institution meets the require- ments of the best modern standards in all respects. An admirable feature is found in the Minnesota State Hospi- tal and School and also in the Massachusetts Hospital School, whereby the children live entirely on the ground floor and the buildings are so constructed as to allow the easiest possible in- gress and egress for children on crutches or wheel chairs. This arrangement greatly facilitates outdoor life. Examples of strictly convalescent homes are the country branch of the New York Orthopaedic Hospital at White Plains, the Minnesota State Hospital and School at Phalen Park, and the Convalescent Home for Crippled Children at West Chicago, Illinois. These are all new institutions, built expressly for the purpose for which they are used. All three of these institutions should be studied by those who contemplate similar plants, as each of them has points of special excellence and each can be improved upon in some ways. Of the 1 3 asylum homes only five have buildings which were erected for the purpose, the others occupying buildings originally designed as residences. Of the five, the two which probably come nearest to the ideal are the House of the Annunciation for Crippled and Incurable Children in New York City, and the New England Peabody Home for Crippled Children at Hyde Park, Massachusetts. STATE HOSPITALS FOR CRIPPLED CHILDREN When the first state hospital for crippled children was es- tablished in Minnesota in 1897, it found its precedent in the Illi- nois State Eye and Ear Infirmary, established many years ago, strictly as a preventive institution, to give treatment to children suffering from diseases of the eyes and ears. It was recognized that while crippled children living in large cities like St. Paul and Minneapolis stand a good chance of relief in hospitals, there are multitudes of crippled children living on farms and in villages, en- tirely beyond the reach of orthopedic surgeons. Their parents have no knowledge of orthopedic surgery and no means of meeting 7 CARE OF CRIPPLED CHILDREN the expense of surgical treatment if they had the knowledge. These children live lives of suffering and grow up hopelessly handi- capped. The Minnesota State Hospital brought the highest surgical skill and the most efficient hospital care within the reach of every crippled child in the entire state, and in the sixteen years since the hospital was established not only its human but its economic value has been amply indicated. Hundreds of children who would otherwise have become a permanent burden either upon their friends or upon the community at large, have been cured and have been fitted to become independent citizens. The state institu- tions of Massachusetts and Nebraska also have demonstrated their usefulness. The New York State Hospital has been overshadowed by the numerous private institutions for crippled children in and around New York City, but it covers a most important field which is not reached by the private institutions. The institutions of New York City do very little for crippled children in the rural districts and it is the office of the State Hospital to provide for their needs. The spirit of the hospital is admirable, and it has already justified its creation. It has been handicapped by lack of sufficient appropriations, but it will doubtless serve a beneficent purpose for the children of the rural communities as soon as the legislature shall provide adequate means. We have no hesitation in advocating the creation of a state hospital for crippled children in every state in the Union. In no other way can the multitudes of crippled children outside of the large cities be reached. The need of such hospitals is greatest, however, in those states where there are few, if any, competent orthopedic surgeons. Such surgeons are found only in the large cities because smaller cities do not have a sufficient number of cases to afford a livelihood to competent men. Our study shows that there are no institutions for crippled children west of Omaha except in Seattle, and none south of Balti- more. Some orthopedic work is done in general hospitals of the South and West, in cities like Charleston, Atlanta, New Orleans, Galveston, Los Angeles, and San Francisco, but that work leaves the rural districts untouched. 8 Rotunda, Hospital Building Sleeping Ward Outdoor Class. (See page i6i) Massachusetts Hospital School, Canton, Massachusetts INTRODUCTION It is not only necessary to establish state hospitals but to institute systematic social service for crippled children who are dismissed from general hospitals or who are now in almshouses, orphan asylums and in families. In many cases parents refrain from seeking surgical help for their children because of an ignorant horror of surgery and hospitals. Such cases can be reached only by the patient efforts of physicians and social workers to remove these apprehensions. There are large numbers of crippled chil- dren in rural communities who will never receive proper care un- less they are sought out and taken to a suitable institution. STATISTICAL INFORMATION Particular attention is called to Chapter V, Statistics, together with the nine statistical tables at its close.* This infor- mation is intended for those who are carrying on institutions for crippled children and especially for those who contemplate the establishment or enlargement of such institutions. The average number of children cared for during the year recorded was: in the lo hospitals, 662 children; in the 14 conva- lescent hospitals or homes, 945 children; and in the 13 asylum homes, 361 children — a total of 1,968. The number of employes was 847, which was one for every 2.3 children. The ratio of children to employes was, in the hos- pitals, 2.0 children to each employe; in the convalescent hospitals or homes, 2.4; in the asylum homes, 3.1. It requires twice as many employes in proportion to the number of children to care for crippled children as it does to care for dependent or delinquent children in institutions. Many of these employes are trained nurses or other specially trained people, necessitating the pay- ment of a high scale of wages. Owing to the fact that most of these institutions are new and are in process of evolution, the physical plants consist in many cases of residences or other buildings which were originally erected for some other purpose. But, as we have seen, new and admir- able buildings have been erected for six or eight institutions. * See pp. 91-140. 9 CARE OF CRIPPLED CHILDREN Ground plans of some of the more important buildings are pre- sented herewith.* The occupation of buildings not erected for use as children's hospitals or homes explains the great diversity in the amount of floor space available for different purposes in different institutions; but the averages approximate closely to the accepted standards of space needed for similar institutions. The provision for the ac- commodation of employes in most of the institutions for crippled children is much less adequate than in the institutions for de- pendent and delinquent children. This is an important matter, because in order to do their best work employes must have ample opportunity for rest and recuperation. It should receive careful attention in all planning for future institutions. The cost of the plants for crippled children has varied widely, thus far, because of the undeveloped condition of most of the institutions. The cost of land and buildings and equipment ranges all the way from $300 to $5,200 per bed; but it is possible to discover reasonable standards. The cost of hospitals per capita is more than twice that of the convalescent hospitals or homes and two and one-half times that of the asylum homes. The new convalescent hospitals or homes have cost as follows: West Chicago (Illinois) Convalescent Home $1,800 per bed Massachusetts Hospital School, Canton . j! 1,1 00 per bed Minnesota State Hospital and School, Pha- len Park J>i, 135 per bed Country Branch of the New York Ortho- paedic Hospital, White Plains . . $3,230 per bed Pittsburgh Industrial Home for Crippled Children $2,200 per bed A satisfactory convalescent hospital school or an asylum home for 100 to 200 children need not cost more than $1,200 to * The study of institutions for crippled children brings out clearly the fact that, while a modern plant of fireproof buildings constructed with reference to maintaining sanitary conditions and arranged to facilitate convenient and eco- nomical operation is exceedingly desirable, nevertheless, admirable work can be done and excellent results accomplished with a very imperfect plant if there is efficient administration. For example, the New York Orthopaedic Hospital is doing hospital and dispensary work of the highest order in a row of tenement houses constructed without any reference to the purpose for which they are now employed. 10 INTRODUCTION $1,500 per bed, though a cost of ? 1,800 to $2,000 per bed is not necessarily extravagant. The asylum homes are all small. The Virginia T. Smith Home for Incurables at Newington, Connecticut, is the only one yet established which has a capacity of more than 50 children. It is desirable that the asylum homes should continue to be small. It is significant that those now in existence provide for a united capacity of only 409 children as against 1,219 in the convalescent hospitals or homes and 846 in the hospitals for crippled children. The asylum homes ought to accommodate only children who are homeless, whose own homes are entirely unsuitable, or whose con- dition makes necessary the asylum care. The experience of the child-placing societies proves that a considerable portion of the homeless crippled children can be successfully placed in good family homes where they can lead happy and normal lives; but there are many cases of infantile paralysis, syphilitic children, and so forth, where the placing-out method is inapplicable. The statistics show that the care of crippled children is necessarily expensive. The lowest rate per capita in the hospitals is $233 per year, but that is in an institution with a very inade- quate force of employes. The average rate per capita is $570 per year. The lowest rate in the convalescent hospitals or homes is $153 per year, but that again is in an institution with an inade- quate force. The average in convalescent hospitals or homes is $348 per year (nearly $1 .00 per day). The lowest rate in the asy- lum homes is $184 per year; the average, $267 per year. THE VOCATIONAL PROBLEM The vocational problem of the crippled child is both more and less complicated than we had been led to expect. It is more complicated than we had anticipated because of the necessity of considering not only the individual bent of each child who is to earn a living for himself under a handicap, but also of considering his individual limitations. It is possible to select certain pursuits which are adapted to persons of limited strength, persons who are unable to work standing, or persons whose phys- ical deformity makes them sensitive as to the observation of others. Excellent schools have been established for special vocational II CARE OF CRIPPLED CHILDREN training of crippled children, and these schools have selected a few trades like the jeweler's trade, wood carving, printing, and so forth, which are adapted to persons of limited strength who can not stand on their feet; but it has been found that only a few crippled children are willing to avail themselves of this highly specialized instruction, and notwithstanding earnest efforts, and the decided success of some of the pupils, each one of these vo- cational schools reports that it has been unable to find pupils to avail themselves of some of the opportunities that are open. On the other hand, the vocational problem is being very greatly simplified by the rapid advances made in orthopedic treat- ment. The urgent importance of applying orthopedic treatment in the earliest stages of the disease is being emphasized, and as a result there has been a great diminution of the average age of children in some of the best orthopedic hospitals. The aim now is to get the child very young and to cure him and restore him to his natural environment before he is old enough to receive any vocational training whatever. The child being restored to health, even though he may be somewhat lame, is able to work out his own vocational problem. At the Country Branch of the New York Orthopaedic Hospital, for example, the vocational brace shop which was being carried on enthusiastically three years ago is closed, for the reason that the boys in the school at the present time are too young to be taught that kind of work. It is our hope to undertake a study of vocational training of crippled children as follows : First, to study in detail such special vocational training as is now being given in institutions for crippled children. Second, to study the work of the small number of vocational schools which are designed for crippled children. Third, to study the history of a large number of cripples who have been under treatment in hospitals or convalescent homes for crippled children during the past ten or fifteen years and to ascertain how the vocational problem had been met in actual ex- perience. In this way we hope to discover to what extent special vocational training is required for crippled children and how best to apply such training to their needs. 12 INTRODUCTION FUTURE OF THE MOVEMENT The future of the movement in behalf of crippled children is clearly indicated by what has already been done. The useful- ness of the work has been demonstrated, not only as a means of abating a vast amount of cruel and needless human suffering, but also as an economic measure to preserve to the community a great number of useful and effective individuals who would otherwise become hopelessly dependent. Miss Reeves has recognized five different forms of work for crippled children: orthopedic hospitals, convalescent hospitals or homes, asylum homes, dispensaries, and special day schools. It appears from her study that the strictly hospital needs of crip- pled children have been more nearly met than the needs for the other forms of work mentioned. We shall continue to establish private orthopedic hospitals because they appeal legitimately to the generous instincts of wealthy men and women, and because they afford such oppor- tunity as can not otherwise be given to develop and produce the spirit of courage, hopefulness, and self-reliance which has charac- terized these institutions. We shall continue to build convalescent homes for cripples, in the country, at the seashore, or in the mountains, chiefly as auxiliaries to orthopedic hospitals. We shall do this because ex- perience has shown that the period of convalescence in orthopedic cases, especially those involving tuberculosis of the bones, is a slow process. We are learning that it is a cruelty to give a child the benefit of the skill of the orthopedic surgeon and then leave it to relapse into its former condition for lack of proper care and food. We are learning that convalescence can be much better promoted in the country branch than within hospital wards. Con- valescent homes have already been established in connection with several of the orthopedic hospitals and still others are proposed. It is a significant fact that the New York Hospital for the Ruptured and Crippled and the New York Hospital for Deformi- ties and Joint Diseases are both planning the establishment of convalescent branches in the country. From an economic standpoint the convalescent home can be 13 CARE OF CRIPPLED CHILDREN maintained at a less cost; it will shorten the period of convales- cence and increase the number of permanent cures. The study indicates that convalescence is promoted by dealing with the chil- dren in small groups and in small cottages; also that special educational facilities must be provided, as a rule, because of the long period often necessary for the entire cure of bone tuberculosis. In a paper read in 1909 by Dr. Newton M. Shaffer, formeriy surgeon-in-chief to the New York State Hospital for the Care of Crippled and Deformed Children, he said: "The bringing together of a large number of children, especially this class, should be dis- couraged. The family of destitute, crippled and deformed chil- dren in hospital or school life should not exceed, in my judgment, more than 30 or 40, and great care should be exercised in the selection of those in control." We shall continue to build asylum homes for a limited num- ber of homeless crippled children and children of the poor who are manifestly incurable; but we shall jealously guard the brave and independent spirit of these children and carefully avoid creating the spirit of dependence or pauperism. Thus far nearly all of these asylum homes have kept the children in small groups where they have lived in dwelling houses under conditions closely approxi- mating those of the ordinary family. This admirable practice should be maintained. The massing of large numbers of children in institutions and dormitories is injurious even for those who are normal, but it is especially undesirable for crippled children, who can not thrive in crowds. We shall continue to develop state hospital schools and state convalescent homes for crippled children, following the ex- ample of Minnesota, New York, Massachusetts, and Nebraska. Preliminary legislation for such institutions has been adopted in Ohio and Illinois. Michigan and Wisconsin are caring for a small number of cripples in their state homes for dependent children. No other plan has been developed which meets the needs of the rural crippled child, and no other plan seems likely to provide care for crippled children in those states which have no large city to afford practice for high grade orthopedic surgeons. This is especially true in the great western states where most of the people live in scattered towns not large enough to have an 14 Master of His Fate. (See page 148) New Jersey Orthopaedic Hospital and Dispensary, Orange, New Jersey An Outing. (See page 146) Nebraska Orthopedic Hospital, Lincoln, Nebraska INTRODUCTION orthopedic surgeon, or in farming districts, remote from the centers of population, because supervision by surgeons and trained nurses can be secured only by residence in the institution, both for oper- ative treatment and for subsequent convalescence, with school opportunities. Massachusetts and Minnesota have demon- strated the practicability of furnishing the best care and treat- ment in a state institution at a moderate cost both for equipment and administration, avoiding institutionalism or mischievous partisanship. We shall continue to maintain dispensary service, in connec- tion with the orthopedic hospitals, for such children as can receive proper care in their own homes; but, as far as possible, we shall seek for such children the benefit of the orthopedic hospital and the convalescent homes, because of the difficulty of securing effi- cient execution of the surgeon's orders in private families, even among fairly intelligent people. The efficiency of dispensary ser- vice will be greatly improved by the development of the best possible social service and visiting nursing service in connection with the dispensary. It is a difficult social problem to secure in the home of poor parents even the minimum of comfort, fresh air, nutritious food and cleanliness which are required for successful convalescence of a child with bone tuberculosis or infant paralysis; but an efficient trained nurse may accomplish much through appeals to the affec- tion of parents and through judicious assistance to secure proper food. Parents can thus be encouraged and stimulated to follow more faithfully the directions of the surgeon, and unfavorable or unsanitary conditions in the child's home can be corrected; or, if that can not be done, the parents may be induced to send the child to the hospital. We shall continue to maintain special schools for crippled children inrthe great cities as a necessary corollary to the dispensary system. These schools will include special omnibus service, out- door school rooms, luncheon service with special diet prescribed by the physician, and separate play places to protect the children from accident, injury, and annoyance. Close medical supervision will be an essential feature of such schools. 15 CARE OF CRIPPLED CHILDREN We shall develop in every state a plan whereby crippled children shall be discovered in the earliest stages of their disease, in order that the disease may be more readily cured. The best hospitals are using every means to reach the children while they are small and to keep them under care long enough to eradicate disease and in every possible case to fit them for self-support. ' This work will always be expensive because of the necessity for roomy, well equipped buildings, and a generous diet, including butter, eggs, and milk. The helplessness of the inmates necessi- tates a large staff of reliable and trained employes. But the com- munity will cheerfully meet the expense because of the beneficent results attained in the relief of little children from suffering and their development into useful citizens. We shall emphasize, more and more, as the work develops, the fact that a crippled child, like any other child, is not simply an isolated "case" for surgical treatment or a "special problem" educationally, but is also a human being. His development toward the standards of normal living is possible only if he is con- sidered as a member of a family and part of the community as a whole. The Association for the Aid of Crippled Children of New York has done pioneer work in the propagation of the idea that organizations working for crippled children must have not only standards of physical and educational care, but social standards as well. The service of such organizations is not only in the work they themselves do directly, but in their power of forcing upon the attention of the surgical world and of all other persons working for cripples, the essential fact that the development of a crippled child, as of any child, must be regarded as a whole, including physical, mental, and also moral and social growth. The Russell Sage Foundation will cheerfully furnish specific information to anyone who is contemplating the development of any form of work for crippled children. i6 Hnlrancc Front View 1 , » Wym-f ^ss^il^ 1 ^ — ^si^Sres^ 1^ ^M ^4nvi^Bppi if Sr. V \.I^\T^ hHHIIH 1 1 ■* ,-*n-'g»^S?'^ 1 1 iJjJii^l^i^miWMMlWlM^illill^-^^B Rear View WiDENi;u Memorial School, Philadelphia. (See page 173) CHAPTER I THE SCOPE OF THE STUDY IT was originally proposed that this study should cover only the educational work for crippled children in the United States, with special attention to existing opportunities for vo- cational training,* but the scope of the study has been extended to cover also all phases of the physical care of the children, except technical questions of surgical and medical treatment. Articles concerning many individual institutions and, in a few cases, discussions covering all the institutions in very brief fashion, have appeared in medical journals and occasionally in magazines or newspapers with wider circulation. Some of these articles have been reprinted as pamphlets. Valuable accounts of institutions, especially those in foreign countries, have been written by Douglas C. McMurtrie of New York, who has published an extensive bibliography on the whole subject of the care of crippled children, covering books and articles in many languages.f But no publication which has thus far appeared treats comprehensively all phases of work for crippled children in the United States, based upon detailed information from all the institutions. In securing material for this handbook, each of the 37 in- stitutions scheduled has been visited; most of them have been visited several times. Many of the surgeons, superintendents, teachers, and other employes, have given liberally of their time and attention, placing every possible fact of interest concerning their work at the writer's disposal. * For the purposes of this handbook, we have accepted the definition of vocational training approved by the board of managers of the National Society for the Promotion of Industrial Education, in February, 1913, as follows: "Vocational training includes all forms of specialized education, the controlling purposes of which are to fit for useful occupations." t McMurtrie, Douglas C: Bibliography of the Education and Care of Crippled Children: A Manual and Guide to the Literature Relating to Cripples, together with an Analytical Index. Published by the author, New York, 19 13. 2 17 CARE OF CRIPPLED CHILDREN CENSUS OF CRIPPLES This intensive study reveals a large number of organizations working exclusively for crippled children in the more densely pop- ulated sections of the United States, and a smaller number in parts of the country not so thickly settled. In the course of the investi- gation we have received many inquiries as to how far existing or- ganizations of various kinds meet the present needs of crippled children. There have been a number of inquiries which included requests for estimates of the number of crippled children in the United States or in a given section. We are able to say that many of the institutions report waiting lists and that the officers of most institutions say that they refuse applicants frequently, usually for lack of space or of money for maintenance of a greater number. But we have no authentic information upon which to base an esti- mate of the total number of crippled children or crippled adults in the United States. Table I, pages 108-1 11, shows the number of children now cared for in all of the 37 institutions for crippled chil- dren here listed,* but there was no way to secure the number of crippled children cared for in summer homes or in orthopedic wards of general hospitals, or the number not receiving care through any institution. A small number of physicians and others much interested in the subject have for years advocated including physical defor- mities among personal items taken by census officers. Germany and England record the number of crippled or deformed people in those countries. Sir John Byers is quoted as saying that there are half a million cripples in Germany, and that the census of England classes over 400,000 as deformed.f The number of crippled children under fifteen in Germany was given by Herr Professor Lange, the distinguished orthopedic surgeon from Munich, in the course of a speech at the Industrial School for Crippled and Deformed Children in Boston in 1910, as 98,263. If the num- ber of crippled children in the United States bore the same pro- * Children attending private day schools and special public school classes for cripples are not included in the tables because many of them come from institu- tions for cripples. t Slainte, the Journal of the Women's National Health Association of Ireland, May, 19 10, p. 96. 18 SCOPE OF THE STUDY portion to the general population as in Germany, we should have about 133,000 crippled children under fourteen years of age. But there seems to be no way of determining whether our proportion of crippled children is higher or lower than that of Germany, and we shall continue to hear estimates varying from 50,000 to 250,000 or more, until a census enumeration gives an exact figure.* The opposition to the census enumeration of cripples in the United States comes in part from those who do not believe it neces- sary to know the exact number so long as they know that there are more than present agencies can receive. In other words, it is argued that the additional cost of including this item in the census enumeration would not be warranted because the ascertaining of the number of cripples would merely corroborate what we know already — that there are enough to keep the present agencies for their care very busy and to warrant the development of any new institutions likely to be established in the near future. DEFINITION AND CLASSIFICATION It is also said that a census enumeration would be of doubtful value until after all the surgeons and others interested had agreed upon a sufficiently exact definition of the word "cripple" for the guidance of census enumerators who possess no knowledge of orthopedics. The most practicable definition which we have discovered is that employed by the education committee of Birmingham, England, whose special subcommittee of inquiry concerning physically defective adults and children took a com- plete census of the cripples in Birmingham in 191 i.f For the purpose of this census a cripple was defined as: "A person whose (muscular) movements are so far restricted by accident or disease as to affect his capacity for self-support. " It seems easily probable that census enumerators without medical knowledge could classify people as cripples according to this non-technical but admirably usable definition. Such an enumeration would, of course, have * Dr. H. Winnett Orr, superintendent and assistant surgeon at the Nebraska Orthopedic Hospital, estimates the number of crippled children and adults in the United States as 259,000. (See American Journal of Carejor Cripples, Vol. I, No. 1 , page 43.) t See also Chapter IV, pp. 67-69. 19 CARE OF CRIPPLED CHILDREN but a limited value if only the information required by this defi- nition were secured. There is far greater value in any census made and interpreted by surgeons who understand the different causes of crippled conditions (as was the census in Birmingham), because the physical necessities and educational possibilities of children crippled from different causes vary so widely. The broadest division of cripples is into two classes — maimed and diseased. The children maimed as a result of infantile par- alysis, because of congenital deformities, or through accident, pre- sent a problem very different from that of the large number of children who have bone tuberculosis. Children who have become deformed through rickets resemble the first class in that their sur- gical treatment usually comes after the disease is no longer active, and in the fact that they can safely be permitted to move about as freely as they are able; but, in common with the tuberculous chil- dren, they need general building up of their strength in order to prevent the return of the difficulty. Any information showing the relative proportion of different types of cripples would be highly valuable in indicating for what types of cases there is most liberal provision in existing institu- tions. But it is obviously as impossible to tell what proportion of the crippled children in the United States are deformed from various causes, or diseases, as it is to tell what is the total number of crippled children in the country. The hospital records which show the classification of cases are suggestive but not final on this point, because it is probable that some kinds of cases seek hospital attention more quickly than others. It would be necessary to combine the medical statistics of many orthopedic hospitals in order to secure proportions between the different kinds of cases which would be likely to come at all close to the proportions ex- isting throughout the country, because individual hospitals are apt to receive the kinds of cases for whose treatment they are especially known. The Birmingham census, already mentioned, is the only statement of which we know of cases taken from the general population and not from the records of particular hospitals. Among 72 1 crippled children under sixteen for whose cases the surgeons in charge had secured particulars, the proportion crippled from each specified cause is shown in the following table: 20 SCOPE OF THE STUDY TABLE A. — CAUSES OF PHYSICAL DISABILITY OF 72 1 CRIPPLED CHILDREN. BIRMINGHAM, ENGLAND, I9II (Not included in general statistical tables.) Cause Tubercular disease Infantile paralysis Rickets . Congenital deformity Apoplexy Birth palsy Accident. Scoliosis . Scattering Total . TREATMENT AND AFTER-CARE The term "cripple" includes cases with such widely varying needs that the institutions for cripples are of several different types. It may be said in general that the crippled children who are maimed or deformed but have no active disease need, first, operative measures which will give them the greatest use of their muscles or make the deformed limbs as nearly straight as possible. After recovery from operations they can in many cases return to their homes, if they go frequently to dispensaries for the adjust- ment of braces and appliances. These are the children whom it often seems best to educate through day schools for cripples. But children who have had rickets and all those with bone tuberculosis need to live for a considerable time where the general living con- ditions as to food, air, and sun are the best. These children form the largest proportion of the number cared for in convalescent hos- pitals, usually located in the country. There are a limited number of incurable cases cared for per- manently in asylum homes. Very few of these cases were hopelessly deformed at birth or otherwise really incurable; most of the so- called "incurables," except a small proportion of badly paralyzed cases, are children who were not treated in time but who, if they 21 CARE OF CRIPPLED CHILDREN had been brought to a surgeon's attention when their difficulty was first discovered, could have been greatly benefited and ulti- mately enabled to care for themselves to such an extent that resi- dence in an institution would not have been necessary. That the family home is the best place for well children is now generally recognized. But crippled children are conceded to be a special class, requiring in many cases surgical operations and in most cases very close physical supervision for months, often years. It is admitted to be inevitable that operative cases must go to the hospital; but there is not general agreement as to what should be done with children well enough to leave the hospital who still need careful attention for a long period. Some surgeons insist that parents can not be trusted to adjust a child's brace or even to bring him to the dispensary at the time ordered by the doctor. Some go so far as to say that the treatment of joint tuberculosis through a dispensary benefits the patient very little, and that such cases must always be looked after in convalescent hospitals with the constant oversight of nurses and physicians. Some of the asylum homes covered by this study provide a degree of medical care which is believed to be greater than the children would re- ceive if they were in family homes. Children may be placed in such homes from the same motives which cause others to be sent to convalescent hospitals. Children who do not require special medical attention are often placed in the asylum homes chiefly because the persons in- terested do not know what else to do with them. They believe that places can not be found for crippled children in family homes because they are less attractive to look upon than other children. While not denying the probable truth of this contention in some cases, we must state our belief that a considerable number of the children not requiring medical care who are now in asylum homes for cripples might be placed with families. The New York Home for Destitute Crippled Children was closed as an asylum home for crippled children in the spring of 191 3. The building is now used by the Children's Aid Society of New York as a temporary receiving home for children who come into its care. Of the 20 crippled children in the home at the time of the change in its work 19, or all but one, were placed by agents of the Children's Aid 22 SCOPE OF THE STUDY Society within one month in homes of relatives. Most of the children will probably live in surroundings much less attractive than those furnished by the home, but the change seems a com- mendable one. It would be well if other asylum homes would consider carefully the character of the cases they admit and re- fuse those not genuinely in need of institutional care. This would leave more openings for children who need such care. Many people interested in work for crippled children, whose viewpoint is not strictly technical, object to sending children to any institution for a period which may extend to five or six years, be- cause children who live so long in an institution atmosphere will become "institutionalized." This objection is somewhat met by the rejoinder that crippled children in family homes are not usually treated as other members of the family are; that they are petted, or in some cases neglected and despised, if they live at home. When this is true, the child has certainly never known the normal family atmosphere; and it is possible that his relation to other people would be more natural in an institution where the other children are also crippled and no one receives either dispro- portionate kindness or unkindness. The psychological question as to whether cripples would better associate chiefly with other cripples or in part with normal children is argued strongly on both sides. Some would keep crippled children segregated so that they may not be too sensitive in regard to their disabilities or hurt by seeing sound children do things they can not do. Other people be- lieve that segregated cripples always become abnormal in their point of view; that they need contact with others who associate more actively in the life of the world. It is not intended to give in this handbook final answer to these difficult questions. It is our conclusion that both systems of organization in the care of convalescent crippled children are needed, especially in very large centers of population. Some chil- dren should be kept in convalescent hospitals or homes, prefer- ably in the country, throughout their period of convalescence. Others may quite safely live at home, being cared for physically through a dispensary, and may attend day school classes, either public or private. Each of the larger cities in America should have day school classes for crippled children who are disabled but 23 CARE OF CRIPPLED CHILDREN not diseased, and also for some of those who are still diseased, as with bone tuberculosis, but who have fairly good homes and parents with enough intelligence to follow the instructions of a visiting nurse. Four sets of facts must be clearly comprehended in choosing between these alternatives for each individual child: First, What is the physical condition of the child who is being considered? The nature of his physical difficulty and the degree to which he needs supervision by surgeons and nurses are the most vital points. On this question the surgeon's decision must be taken as final and it seems undeniable that a great number of children with bone tuberculosis can be cured as rapidly as pos- sible only with continuous supervision in a convalescent hospital. Second, What kind of a home has the child, and what kind of care will he receive if he does not go to an institution? This depends upon housing conditions, the sort of food the child will get at home, and the probable intelligence of his parents in carry- ing out the doctor's orders about fresh air and other conditions necessary for the child's health, as well as upon faithful visits to the dispensary. Third, What degree of physical supervision will the child have if he remains at home instead of going to an institution? The existence of an efficient system of visiting nursing in connec- tion with the hospital to which the child is taken is the neces- sary prerequisite for successful dispensary work. When there are visiting nurses many children may stay at home who would other- wise need to go to a convalescent hospital. Fourth, What are the standards of the institution to which the child may be sent? Those who fear that residence in an insti- tution for cripples would unfit the child to make his way in the world as well as if he stayed in a family home, ought to consider with care certain definite points. The number of children in the entire institution should be learned; if there is a cottage system, the number of children in each cottage, the number of beds in each, and the amount of space between them; how many sit at each table in the dining room and whether the chairs, dishes, and utensils create a homelike atmosphere; whether or not there is uniform dress. These details are not given as absolute criteria 24 Victor Over Pain. (See page 169) St- Charles Hospital for Crippled Children, Port Jefferson, L. I. A Brave Soldier. (Seepage 159) Kernan Hospital and Industrial School for Crippled Children, Baltimore Gardening Holy Cross House, Cleveland, Ohio. (See page 197) •'A Hike" Summer Home for Crippled (Children (Conducted by Post-Gradunte Hospital of New York), Southampton, Long Island. (See page 222) SCOPE OF THE STUDY as to the quality of the institution, but are suggestive pointers. The vital element is not dependent alone or chiefly upon these material details, for it is the personality of the employes which after all determines the elusive thing called "atmosphere. " Some of the hospitals gave the visitor an impression of greater homelike- ness than did some of the places called "homes." The succeeding chapters will give in some detail the resources and methods applied by all these different agencies for the physical care, the education, and the vocational training of crippled children. The work of residential institutions and non-residential agencies is treated in the chapter on Physical Care; the public school classes and educational work in residential institutions are discussed in the chapter on Education; the work of the private day schools in the academic education of crippled children is also covered in the chapter on Education, their voca- tional training, in the chapter on that subject. The names and locations of the residential institutions work- ing exclusively for cripples and open all the year, and certain gen- eral facts concerning the nature of their work, are shown in the tables.* ylt will be seen that the majority of the institutions are in or near the great centers of population — New York, Chicago, Boston, and Philadelphia. The smaller number of institutions in other states are usually in or near the largest city. A striking fact regarding the geographical location of the institutions is the absence of any institution for cripples, so far as we can learn, farther south than Baltimore, and the fact that the Children's Orthopedic Hospital in Seattle, Washington, is the only one farther west than Lincoln, Nebraska. Of the 37 institutions, we have, as has been stated, classed lo as hospitals,, 14 as convalescent hospitals or homes, and 13 as asylum homes. This classification is not borne out by the names of all of the institutions. Some of the early hospitals were or- ganized many years ago as homes for crippled children, and the old titles have been retained since the institutions developed into hospitals. A number could easily be classed in either of two of the three groups. It has been necessary, therefore, to put each insti- tution into the group whose general type it most nearly resembled. * See pp. 108-140. 25 CARE OF CRIPPLED CHILDREN The characteristics which have controlled the assignment into the several groups may be broadly stated as follows: Hospitals are of necessity located in large cities, and have about the same average number of patients as the convalescent hospitals or homes, but considerably more than the asylum homes. They are served by orthopedic specialists and have operating suites where all kinds of orthopedic operations may be performed. The patients receive care according to hospital standards during conva- lescence, with attention from nurses, some of whom are graduate nurses. There is no restriction as to color in any of the institu- tions we have classed as hospitals. The age limits for admission and discharge are usually more flexible than in the other institu- tions; the period of stay is considerably shorter. School work is usually but little developed. Most of the convalescent hospitals or homes are located in suburban or country localities. They sometimes have operating rooms of their own, but more often receive cases after operations at hospitals in the city. There are fewer surgeons and nurses in proportion to the number of children. About half of the institu- tions take white children only. The age limits for admission are more definite and there are fewer opportunities for children under three or four years of age. The most striking difference between the convalescent and the regular hospitals is the longer period of stay permitted in the convalescent hospitals. It is usual to keep each child as long as he needs the care offered, up to a period of several years, and sometimes even after his cure is completed, for purposes of education in the schools which are usually connected with convalescent hospitals. Asylum homes for the custodial care of children crippled permanently or likely to be so for long periods are usually in resi- dential sections of cities or in suburbs. They are much smaller than any of the other institutions and offer only a minimum of special medical care. The children are sent to hospitals for operative treatment. The homes themselves sometimes have one gradu- ate nurse, sometimes none. Seven out of 1 3 take only white chil- dren, and there is but one asylum home for colored children only. Age limits resemble those in the convalescent hospitals or homes. There is a tendency to avoid taking infants under two or three 26 SCOPE OF THE STUDY years because of the special care they require. The large majority of the asylum homes have no rule as to the age limit of discharge and the children are commonly kept as long as they need a home, even in some cases for months or years after their physical cure has been completed and they have ceased to be crippled children. Some of these institutions send children to public schools; in other cases there is a school in the institution. 27 CHAPTER II PHYSICAL CARE OF CRIPPLED CHILDREN ALL efforts in behalf of crippled children must be based upon sound policies of surgical treatment and general physical L. care, which aim to cure the diseases and correct the de- formities of the children whenever that is possible, and to return them to conditions of living on a plane with those of children who have not been crippled. It is equally true that for the crippled children whose handicaps can not be entirely removed, the first aim should be the elimination, in as large a measure as possible, of the difficulties which set them apart from children who have no physical defects. SURGICAL CARE The surgeon, in larger cities usually an orthopedic specialist, is sought first in the effort to help any crippled child. The surgeon's operative skill and his knowledge of the measures needed in the physical care of crippled children before and after operations and in cases requiring no operations, including the use of many kinds of mechanical appliances, like braces and plaster jackets, furnish the necessary foundation for all other work for crippled children. Most of the residential institutions for the care of crippled children owe their inception to the desire of some orthopedic sur- geon to furnish better opportunities to crippled children who are unable to pay for treatment. In most of the institutions visited the surgeons give their services without remuneration. It is true that the number of cases in a large free hospital affords an opportunity to keep in constant touch with all kinds of orthopedic work which few private practices furnish; also that connection with a well-known hospital adds to asurgeon's prestige and often brings him private patients. But in most cases the material re- turn to the surgeon probably by no means balances the large 28 Main Hospital Building Solarium. (See page 170) State Hospital for Crippled Children, West Haverstraw, New York Outdoor Sleeping Shack, Exterior OutJorjr Sleeping Shack, interior Outdoor Sleeping in Winter. (See page 170) SiATt Hospital for Crippled Children, West Haverstraw, New '>'ork PHYSICAL CARE amount of time which he takes for free work. The writer desires to record with emphasis the impression that orthopedic surgeons in the institutions covered by this study take a deep interest in giving of their best skill to work for poor children, and in many cases sacrifice their own material interests in order to meet the appeal of cases which must be treated without compensation. An increasing number of people are beginning to believe that it is not desirable nor right to expect surgeons to give their ser- vices freely to institutions doing charity work. The surgeon-in- chief at the New York State Hospital, who is also superintendent, and the surgeon-in-chief and assistant surgeon at the Nebraska State Hospital, the latter also its superintendent, receive yearly salaries. In several of the large city hospitals the more important members of the surgical staff are salaried. One of the convalescent hospitals, located so far in the country that the surgeon's weekly visit requires a full day of his time, gives him a yearly salary. In most of these cases the amount received by the surgeons probably does not equal that which they could earn in the same time by private practice, but the payment of some definite salary is believed by many people to be a step in the right direction. Each of the hospitals visited has a medical staff which in- cludes orthopedic specialists who examine applicants for admis- sion, perform operations in the operating suite in the hospital, and visit the wards frequently to watch the progress of the cases. If the hospital has a dispensary the surgeons are present on all days when the dispensary is open, to see new applicants for hospital care and to examine convalescent patients who live at home and are brought to the dispensary, usually by their parents. All the hospitals are fully equipped with modern operating rooms, and, in most cases, with X-ray apparatus and laboratory equipment. Four of the hospitals have brace shops where ap- pliances of all kinds are made in large quantities.* All the convalescent hospitals or homes, with the exception of the Van Leuven Browne Hospital School, Detroit, have ortho- * They are the Home for Destitute Crippled Children in Chicago; the Chil- dren's Hospital in Portland, Maine; the New York Orthopsedic Hospital, and the Hospital for the Ruptured and Crippled in New York. The Nebraska Orthopedic Hospital and the Children's Orthopedic Hospital in Seattle have new brace shops with equipment which will be increased later. 29 CARE OF CRIPPLED CHILDREN pedic surgeons who visit tiie institutions at frequent intervals. In the majority of cases the surgeon has a weekly visiting day and spends at least an hour at the institution. At the Kernan Hos- pital School, Baltimore, the surgeon-in-chief, who is also superin- tendent, pays almost daily visits. During these visits the surgeon always examines the case most recently operated upon and is con- sulted by resident doctors and nurses concerning children needing special attention. At the Country Branch of the New York Or- thopaedic Hospital, White Plains, all of the children file past the surgeon-in-chief at each of his weekly visits, and he examines a certain proportion carefully each time that he comes. The careful examination of a limited number is usual in other places, but the cheerful procession of a hundred children who are greeted by the surgeon-in-chief personally and their general progress noted, is unique with the institution at White Plains. The surgeons sometimes examine applicants at the con- valescent hospital, sometimes at the city hospital of which the convalescent hospital is a branch, and occasionally in their own offices if it is more convenient for the applicant to come there when the convalescent hospital is located at some distance in the country. Eight of the 14 convalescent hospitals or homes have oper- ating suites and full hospital equipment, often including X-ray apparatus, and many operations are performed at the institutions themselves. Minor operations only are performed at the Van Leuven Browne Hospital School, Detroit. The other convales- cent hospitals which have no operating equipment receive only children who have already been operated upon in hospitals, and cases not requiring operations. Only three of the eight conval- escent hospitals mentioned as having operating suites do all their own operative work; namely, the New York State Hospital at West Haverstraw, the Sea Breeze Hospital at Coney Island, New York, and the St. Charles Hospital at Port Jefferson, New York. Many of the children sent to the Massachusetts Hospital School at Canton have already received surgical attention at the Children's Hospital in Boston. Children who go to the Widener Memorial School are sometimes operated upon at the Hospital of the University of Pennsylvania, Philadelphia, whose chief orthopedic 30 PHYSICAL CARE surgeon is surgeon-in-chief at the Widener Memorial School. Opera- tions for the House of St. Giles the Cripple, Garden City, New York, are sometimes performed at Brooklyn hospitals. In rare instances children from the Kernan Hospital School, Baltimore, have re- ceived their operative treatment at the University of Maryland Hospital, and the new Children's Hospital School near Baltimore may send cases occasionally for operations at the Johns Hopkins Hospital. In these cases the surgeon-in-chief is connected with both institutions. Operations upon children who later go to the convalescent hospital are sometimes performed at the city hospital for the advantage of medical students. Braces used for children at the convalescent hospitals or homes are usually made at the brace shops of city hospitals. The Widener Memorial School at Philadelphia has its own brace shop. The Country Branch of the New York Orthopaedic Hospital has a fully equipped shop which is not now used, the braces for the patients being made at the city branch of the institution.* Some of the asylum homes have orthopedic surgeons who pay regular visits at long intervals; in others routine visits are paid by a general practicing physician and the orthopedist is called upon when needed. None of the asylum homes have operating suites with complete equipment. Minor operations only are per- formed at the Home of the Merciful Saviour in Philadelphia, the New England Peabody Home, Hyde Park, Massachusetts, and the Home for Incurables, Newington, Connecticut. Major op- erations upon children from these homes and all operations upon children from the other lo asylum homes are performed in city hospitals. Usually all operations for one asylum home are done at the same city hospital, generally at the one with which the ortho- pedic surgeon for that home is connected. Seven of the convalescent hospitals or homes have resident physicians: the Kernan Hospital School near Baltimore, the Children's Hospital School in Baltimore, the Massachusetts Hos- pital School, the St. Charles Hospital at Port Jefferson, New York, the New York State Hospital, the Country Branch of the New * Miss Charlotte C. Barnwell, of Baltimore, Maryland, has for more than thirty-five years made removable jackets of plaster of paris in her own home for incurable crippled children. This is a personal beneficence. 3> CARE OF CRIPPLED CHILDREN York Orthopaedic Hospital, and the Widener Memorial School, Philadelphia. Only one of the asylum homes — the Home for Disabled Children at Maywood, Illinois, has a resident physician. NURSING STAFF All of the hospitals employ graduate nurses ranging in num- ber from one to seven. The convalescent hospitals have gradu- ate nurses, ranging in number from one to five, except the St. Charles Hospital at Port Jefferson, New York, the Country Branch of the New York Orthopaedic Hospital at White Plains, and the Van Leuven Browne Hospital School, Detroit. The two first mentioned institutions have resident physicians, and their nurses receive training in orthopedic nursing at the institution, although there is as yet no formally organized training school granting dip- lomas. Fourof the asylum homes have graduate nurses; namely, the New England Peabody Home at Hyde Park, Massachusetts; the Daisy Fields Home, Englewood, New Jersey; Holy Cross House, Cleveland, Ohio; and the Home of the Merciful Saviour, Philadelphia. There were two graduate nurses at Holy Cross House when this study was made, and one in each of the other three institutions mentioned. In addition to the graduate nurses, all of the hospitals and convalescent hospitals and many of the asylum homes have other nurses with some special knowledge of the needs of orthopedic cases. In three of the institutions nurses in training in general hospitals of the same city come to the orthopedic hospital for limited periods, usually three months, in order to secure a knowl- edge of orthopedic nursing. Nurses at the Home for Destitute Crippled Children in Chicago come from the Presbyterian Hos- pital; those at the Children's Hospital School in Baltimore come from the Church Home and Infirmary; those at the Children's Orthopedic Hospital in Seattle come from one of the general hos- pitals in the city. Two of the hospitals have formal training schools for nurses, granting diplomas which make the holders eligible to register as graduate nurses. A two-years' course is offered at the Nebraska State Hospital at Lincoln where there are 1 1 pupil nurses. At the Children's Hospital in Portland, Maine, 22 pupil nurses are 32 Bungalow Built by the Boj's A Cubicle Staff L.iving Room. (See page rya) Country Branch New York Okthop/edic Hosi'Ital, White Plains Milk Between Meals The School SuMMF.K H(jMi-; FOR Crip['i.i-.d CuiLiiRtN. (See page 222) (Conducted by the Post-Graduotc Hospital of New York), Southampton, L. I. PHYSICAL CARE registered for a three-years' course, of which two years and a half are spent at the hospital itself and six months at Bellevue Hos- pital in New York, where the nurses undertake work for which there is not opportunity at the hospital in Portland. The Kernan Hospital School in Baltimore has a training school for nurse maids, with eight pupils taking a one-year course. The nursing training for the Sisters in charge of the St. Charles Hospital at Port Jeffer- son, New York, is now in process of formal organization and may result in the organization of a training school. In the hospitals and many of the convalescent hospitals there are nurses or nurse maids on duty all night, who spend most of their time in or near the wards used by children needing the closest attention. CARE OUTSIDE THE INSTITUTIONS The medical and nursing care of the children not in resi- dential institutions represents many degrees of effectiveness. In the day schools for crippled children there is usually a nurse who watches over the physical condition of the children during school hours, and in some cases goes to their homes. The nurses in pri- vate schools are paid by the society maintaining each school; other private organizations, like the Association for the Aid of Crippled Children in New York City, and the Sunbeam Circle in Cleveland, Ohio, furnish the nurses who go to public schools where there are special classes for crippled children. The Crippled Children's East Side Free School and the school maintained by Miss Spence's School Society, both in New York, have one pro- vision not elsewhere found; an orthopedic surgeon holds weekly clinics at the school and the children have braces adjusted, plaster jackets applied, and all surgical work other than actual operations done at the school.* But the most important provisions for medical supervision of crippled children not living in institutions are the dispensary services in eight out of the ten orthopedic hospitals studied and in one of the convalescent hospitals, which has a separate dis- pensary building in the city. Table IXf gives details of the work * For detailed statements concerning the medical attention given in different day schools, see the chapter on Education. t See p. 140. 3 33 CARE OF CRIPPLED CHILDREN of the nine dispensaries. The table shows a total of 34,392 different out-patients who visited the nine dispensaries as against 4,901 patients cared for as residents in the entire 37 institutions we have tabulated. The conclusion is obvious that when so very great a majority of crippled children receive medical attention through dispensaries, the importance of high standards in out- patient work can not be overestimated. There are, of course, no concrete facts according to which the efficiency of medical care through dispensary service, as com- pared with that in residential institutions, can be estimated by a person without medical knowledge. But we record here the state- ment made by many different surgeons, that while dispensary care may be adequate for some cases, especially for those that do not have active disease, it can be safely substituted for institutional care only when the child is actually brought to the dispensary as frequently as the doctor orders, and when his directions for care at home are carefully followed. This is most necessary in cases of children with active tuberculosis of the bone. Many surgeons consider it impossible to treat a case of hip tuberculosis satisfac- torily in a dispensary on the ground that the parents can not be trained to exercise the constant vigilance necessary to keep the brace properly adjusted. The best aid. to effective dispensary service is a staff of vis- iting nurses who follow the children into their homes, see to it that each child comes to the dispensary at the time ordered, visit the children at home between dispensary visits in order to adjust braces, apply surgical dressings, and, most important of all, edu- cate the mother so that she may be able to supplement the care given by surgeons and nurses through as intelligent co- operation as possible. Of the nine institutions with dispensaries, five had recorded no visits paid to the homes of out-patients by visiting nurses during the year studied. Some cases from the Children's Hospital at Portland, Maine, are visited in their homes by an agent of the Maine Children's Committee, who has not had medical training but who is accustomed to examine general living conditions in homes where children are placed by the com- mittee. Some visits to homes of out-patients are paid by the nurse in charge of the out-patient department of the Children's 34 PHYSICAL CARE Orthopedic Hospital at Seattle, Washington. Only three out of the nine institutions recorded a number of visits paid to homes by visiting nurses which was con^mensurate with the size of the dispensary service; namely, the New York Orthopaedic Dispensary and Hospital, the New Jersey Orthopaedic Hospital and Dispen- sary, and the Kernan Hospital and Industrial School in Baltimore. The system of supervision of dispensary cases developed at the New York Orthopaedic Dispensary and Hospital is specially noteworthy since it has no parallel at any of the other large or- thopedic hospitals. During the year 191 2, four visiting nurses, of whom two were graduate nurses and two non-graduate nurses with special knowledge of the treatment of orthopedic cases, and one social service visitor without medical training, paid a total of 8,498 visits to homes of patients; and 7,020 visits were paid by surgeons connected with the hospital. There was, thus, a total of 15,518 visits to patients' homes as against 27, 140 visits paid by the patients themselves to the dispensary. The exceptional thoroughness of the following-up of cases treated by this institution is evident from the fact that it is also the only one of the three large ortho- pedic hospitals in New York which has a convalescent hospital in the country for the long-time care of post-operative cases. Several hospitals not covered by our tabulations are worthy of study for their provision of supervision for dispensary cases. Lakeside Hospital in Cleveland, Ohio, and Rainbow Cottage, a country convalescent hospital affiliated with Lakeside, employ an experienced graduate nurse who follows up all of their cases and goes, also, for three days each week in the school year, to the spe- cial public school for crippled children. This nurse is thus able to follow the same children from their first appearance at the hospital for operative care, through their convalescence and return to the measure of health which permits their attending school. The Hos- pital of the University of Pennsylvania has a social service depart- ment in charge of a college graduate without nursing training which includes, as one of the staff, a graduate nurse who visits the homes of orthopedic cases. The Post-Graduate Hospital in New York City has a graduate visiting nurse who, during the winter, gives her whole time to patients coming to the orthopedic clinic; during the summer months the same nurse acts as superintendent 35 CARE OF CRIPPLED CHILDREN of a summer convalescent home where some of the cases which she has followed during the year are taken for the summer. The Johns Hopkins Hospital in Baltimore has a social service director and assistant, but as a rule the orthopedic cases are left to the visiting nurse for that department, in order to avoid, if possible, sending more than one visitor to the same home. The Children's Hospital in Boston, Massachusetts, has a social service depart- ment in charge of one of its graduates who received additional training at the Boston School for Social Workers. She has several pupil nurses as assistants. PHYSICAL CULTURE AND GYMNASTICS In addition to the medical staff there are in many institu- tions, especially in the hospitals, masseurs and masseuses who give treatments to paralyzed children. Physical exercises are also given, sometimes under the direction of the people who give massage, sometimes by special teachers of corrective gymnastics. Five of the hospitals, or half of the number, namely, the Home for Destitute Crippled Children in Chicago, the Children's Hospital in Portland, Maine, and the three orthopedic hospitals in New York— the New York Orthopaedic, the Hospital for the Ruptured and Crippled, and the Hospital for Deformities and Joint Dis- eases — have special gymnastic apparatus for use in this work. The two convalescent hospitals in Baltimore have equipment for special gymnastics; the Widener Memorial School has the most complete equipment of any institution we have scheduled. Three other convalescent hospitals — the Massachusetts Hospital School, the New York State Hospital, and the country branch of the Minnesota State Hospital — have a few pieces of special ap- paratus. There is a small equipment at the Holy Cross House in Cleveland, one of the asylum homes. Of the institutions visited but not scheduled, the Hospital of the University of Pennsylvania in Philadelphia has a completely equipped gymnasium, and the work is in charge of a specialist in teaching corrective gymnastics who has had long experience in the work. Some of the teachers of special gymnastics are graduates of schools of gymnastics, where they have taken courses to fit them- selves to teach crippled children for whom special apparatus must 36 Orthopedic Gymnastics. (Seepage 155) New York Orthopaedic Dispensary and Hospital, New York City Special Gymnastics Before a Mirror. (See page 149) Hospital for Deformities and Joint Diseases, New York City Playground Outdoor Sewing Class Ckiit'Llu Children's East Side Free School oe New York, Summer Home, Oakhurst, New Jersey. (See page 228} PHYSICAL CARE be used and who must be allowed to undertake only the sort of exercises approved in advance by the surgeon. Most of the children who come to these gymnastic classes either have paralysis in some degree or have lateral curvature of the spine. For the paralysis cases the better equipped gymnasia provide a great va- riety of motor-driven machines for the exercise of different parts of the body. Apparatus, usually of a simpler sort, is used for stretching exercises by children with lateral curvature. The fol- lowing is a statement of the very complete equipment for special gymnastics at the Widener Memorial School: Apparatus for Special Gymnastics in the Widener Memorial School, Philadelphia, Pennsylvania* 2 swinging rings with mattresses below them. I seat swing. 1 swing with 2 rods for seats. 2 large and i small punching bags. I jumping chair with springs. 1 vibrating machine with places for 3 feet or arms. 4 foot machines "for going round and round." I quarter circle for back exercises with a chest weight. 1 climbing rack. 2 hand machines with different sorts of wooden handles to be twisted. I English back board. 3 other pieces of apparatus for back exercises. I stretcher for head and neck. I trolley for walking exercises (used for children with paralysis of the legs). 1 jumping board and revolving rod (child holds on to the rod), 6 sets of pulley exercises attached to the wall. 2 straw couches for use in massage (i low; i high). I plinth. I wooden gun. A large number of dumb-bells, Indian clubs and wands. Physical exercises without apparatus are often given by teachers in the day scTiool classes for crippled children, and teachers of physical culture are sent to several of the asylum homes * Non-technical terms have been used in this list as far as possible. 37 CARE OF CRIPPLED CHILDREN for crippled children in New York City by the People's University Extension Society. Several years ago there was a lively discussion among surgeons and teachers working for crippled children as to the desirability of physical exercises in the public school classes for crippled children in New York. There is difference of opinion still, but the majority of those interested in the discussion have agreed that the question is one which should be settled individually for each child; that most crippled children can do some physical exercises without danger of overstrain or the retarding of their physical cure, but that the nature of the exercises desirable for each child should be indicated by his surgeon. The record card supplied by the Department of Education of the City of New York for each crippled child includes spaces in which the child's physician may indicate in general how much and what kind of exercise the child should have, and indicate specifically the exercises he should not take and those which would most benefit him. PHYSICAL CONDITIONS IN RESIDENTIAL INSTITUTIONS In addition to the special equipment and trained employes provided by all of the organizations working for crippled children, there are in the residential institutions many provisions for general physical care such as are necessary for normal as well as for crip- pled children. All children need abundant nourishing food, ap- propriate clothing, the opportunity to breathe pure air both by day and by night, protection from infectious diseases, and an at- mosphere of cheerfulness. All these elements are found in many family homes and in many institutions for dependent children who are not crippled, but we believe that it may safely be said that the institutions for crippled children have a higher average standard as to the provision of healthful conditions than do institutions where the children are not under medical supervision. There is great difference between orthopedic surgeons as to the degree of their interest in the general living conditions affect- ing their patients; nurses are not always so devoted to the cause of fresh air as might be desired. However, it is our conclusion, based upon an acquaintance with all the institutions for crippled children in the United States, that the presence of an absolute standard of efficiency in one direction, that is, medical and surgical care, has 38 PHYSICAL CARE brought the interesting result of raising the standard of the institu- tions at almost all other points. It is generally true that the insti- tutions where surgical and medical provision is most complete are likely to provide most effectively the general health conditions mentioned, with the exception in some cases of the homelike at- mosphere, which is, of course, most noticeable in the small asylum homes with the least provision for medical care. The majority of surgeons, nurses, teachers, and other spe- cialists working for crippled children have a sufficiently broad view of the interests of those children to prompt a degree of atten- tion to elements in their care which lie outside the special field belonging to each group of officers. Even the occasional visits of a surgeon to an asylum home may have an appreciable effect in encouraging good housekeeping, because the surgeon expects to find hospital standards of cleanliness. Dietary Much information has been collected concerning the dietary in the institutions visited, most of the records covering in detail the menus for a week or more. The meals of the children, officers, and servants are separately stated for the larger institutions, where the food served to the three groups of people varies. There is universal insistence by the surgeons upon an abundance of simple and nourishing food, especially for the children recovering from rickets and those who have or have had bone tuberculosis. Special diets are prescribed for certain children in the hospitals; this is done in rare cases, also, in convalescent hospitals. Some of the institutions have a regular order for the main dishes served at meals, which is changed at intervals. For example, the meats served at dinner at the Children's Hospital in Portland, Maine, run according to a list for two weeks; at the end of the second week the list for the first week is again followed, and so on. In most cases the order of appearance for each dish is not perfectly regular, except for the children whose diet has been especially pre- scribed. In convalescent hospitals and especially in the asylum homes, where efforts are made to make the atmosphere as much like that of an ordinary household as possible, and where the period of stay is longer than in the hospitals, the children have no more 39 CARE OF CRIPPLED CHILDREN idea in advance what will be served at any meal than they would have in most homes. Some of the smaller institutions are unable for financial reasons to furnish as liberal quantities of milk and eggs as they desire to the children; but in most of the institutions eggs and milk are very liberally used, and in many cases as much milk is given as the children can be induced to drink. Milk and egg- nogs are often served between meals, especially for the tuberculous children. At the Sewickley Fresh Air Home, Sewickley, Penn- sylvania, all the children who will drink it so often have milk at each of the three meals, in the middle of the afternoon, and at night just before they go to bed; they have fruit juice in the mid- dle of the morning. The menu lists show the usual breakfast to include cereal — most often oatmeal — ^with milk, bread or toast, milk to drink, and sometimes eggs. For dinner, which is everywhere served at noon, there is usually meat (beef and lamb are most used, with chicken for Sundays and holidays), potatoes, one and sometimes two other vegetables, and a simple dessert, very often bread or rice pudding. Supper is a very simple meal in practically all the institutions; it usually includes only bread and butter, milk or cocoa, stewed fruit, with the infrequent addition of eggs or some other one sub- stantial dish. It will be seen that the meals do not differ greatly from those provided for children in many households. They are usually planned by the matron or housekeeper, with general supervision by the doctor, who prescribes special diets. In a few institutions, including both the New York Orthopaedic Hospital and its country branch at White Plains, the housekeeper is a trained dietitian. Clothing, Air, and Sunlight Where the institution has facilities for outdoor living on porches, the children have specially warm clothing for wear by day or night. The special equipment for outdoor schools is mentioned in the chapter on Education. The children who sleep out of doors wear, in the coldest weather, hoods and mittens; they have a large number of very warm blankets and sometimes sleep in sleeping bags. Aside from these special provisions, in some institutions the 40 PHYSICAL CARE children who are able to be dressed during the day wear clothing provided by the parents or friends of the child. In other cases clothing is furnished entirely by the institution. At some places the parents supply as much suitable clothing as they are able to buy and the institution furnishes other needed articles. Where clothing is furnished from the children's homes it is usually disin- fected before it is used in the institution. On the ground of pos- sible infection, some of the institutions refuse to accept clothing even when the parents are willing to furnish it. In none of the institutions was there an altogether uniform dress, although the checked aprons of the girls, and the dark blue blouses of the boys in a few of the institutions where garments are secured in large numbers by the institution itself, or given by guilds of women who sew, presented little variety in appearance. Many of the officers in the different institutions called special at- tention to the fact that there was no uniform dress, and in some cases variety was sought as much as possible. Most of the insti- tutions have lockers or other provision for the garments of the different children and each child has his own clothing. In a few places underclothing and garments for everyday wear are arranged by sizes only, when the clean garments return from the laundry, and the individual children do not always receive the same cloth- ing. Fresh air and nourishing food are the two elements conceded to be necessary for upbuilding the strength of tuberculous children, and highly desirable for other children as well. Eleven* of the institutions studied have provisions for outdoor sleeping for a part or all of the children. At the New York State Hospital at West Haverstraw, and at the Van Leuven Browne Hospital School in Detroit, there is provision for outdoor sleeping in shacks. The New York State Hospital has also one pavilion more substan- tially built but with windows on all sides, which affords the equi- valent of outdoor sleeping. The Home for Destitute Crippled Children in Chicago has 30 beds on a flat glass-covered roof, with skylights which can be dropped so that excellent ventilation is se- cured. The Industrial Home for Crippled Children in Pittsburgh * Since this study was made, St. Charles Hospital at Port Jefferson, New York, has provided outdoor sleeping space for 28 children. 41 CARE OF CRIPPLED CHILDREN has two pavilions with 14 beds each, which have cross ventilation from windows which take up practically the entire wall space. There are porches for outdoor sleeping at the Nebraska Ortho- pedic Hospital, the Hospital for Deformities and Joint Diseases in New York, the Convalescent Home at West Chicago, the Chil- dren's Hospital, and the Kernan Hospital School in Baltimore, the Home for Incurables at Newington, Connecticut, and the New England Peabody Home at Hyde Park, Massachusetts. The dormitories at the Massachusetts Hospital School with their monitor roofs, and the wards in some institutions, particu- larly the Widener Memorial School at Philadelphia, which have cross ventilation from many windows, provide ventilation so per- fect that sleeping porches are not considered necessary. Thirteen of the institutions have special rooms for use by day which are entirely or almost entirely open to the outdoor air. Sometimes they are flat roofs without covering; sometimes there is a covering overhead but no walls; sometimes the rooms are glass- enclosed with windows which can be dropped except at times of storm, so that there is no interference with the currents of air. The great porches and roof space at the new Hospital for the Ruptured and Crippled in New York are the most striking ex- ample; they represent nearly as great a space as that occupied by the indoor rooms used by hospital patients. The other institu- tions whose buildings provide special outdoor space are the Chil- dren's Hospital in Portland, Maine, the New York Orthopaedic Hospital, the Country Branch at White Plains, the Children's Hospital at Baltimore, the House of St. Giles at Garden City, New York, St. Charles Hospital at Port Jefferson, New York, the Home for Incurables at Newington, Connecticut, the Home for Disabled Children at Maywood, llHnois, the Crippled Children's Home at Buffalo, Holy Cross House at Cleveland, the Widener Memorial School in Philadelphia, and the House of St. Michael in Philadelphia. It must not be forgotten that results can not be foretold from a knowledge of the mere facilities for securing fresh air unless one knows, also, how those facilities are used. Some of the porches listed as providing outdoor space have windows so arranged that they can be completely closed in case of storm. If these windows 42 Outdoor Sleeping Porch Class in Basketry A Weaver Kernan Hospital and Industrial School for Crirpled Children, Baltimore, Maryland. (See page 1 59) Dormitories Covered Walk. (See page '6i) Massachusetts Hospital School, Canton, Massachusetts PHYSICAL CARE are not kept open the children may not secure "outdoor" air so effectively as in an ordinary ward with many windows which pro- vide cross ventilation, if those windows are always kept open. The Hospital for Deformities and Joint Diseases in New York has a children's ward whose windows had not been closed during five years previous to our visit. The Crippled Children's East Side Free School of New York is noteworthy among day schools be- cause its windows are kept open throughout the year. At the meeting of the Federation of Associations for Cripples in New York City in April, 191 3, there was a discussion of out- door school rooms and school rooms where windows are kept open in winter, which brought out sharp differences of opinion as to whether or not cold temperatures have a bad effect upon the chil- dren's physical condition. Most of the surgeons seemed to agree that cold in itself was never harmful if the child were warmly dressed and had plenty of good food. This has been found to be the attitude of other surgeons met in the course of the study. The search for pure air as one of the necessary elements for the strengthening of tuberculous children has been the chief fac- tor in causing some city institutions to move to country locations or to establish country branches. Others which have not changed the location of their plant send as many as possible of their patients to fresh air homes, or to special summer homes for crippled chil- dren, during the hot months. Some surgeons believe that there is special benefit for tubercu- lous children in sea air. Sea Breeze Hospital was established at Coney Island, New York, because of this belief, and its medical officers think that the results prove the great advantage of the seashore as a site for these institutions. Several summer homes for crippled children have been located near the sea. At all these places the majority of the children bathe in the ocean. Some sur- geons believe that the salt water is useful in hastening the healing of tuberculous sinuses. At the summer branch of the Providence (Rhode Island) Hospital, children who are kept on Bradford frames are put upon a special frame, carried to the beach, and dipped into the water. More recently there has been considerable discussion of the value of sunshine for sick children, especially tuberculous children. 43 CARE OF CRIPPLED CHILDREN In several places in Europe, particularly in Switzerland, children with tuberculous sinuses are exposed to the direct rays of the sun, and the surgeons state that the sinuses have healed with unpre- cedented rapidity. This method of treatment is in constant use at Sea Breeze Hospital, and has also been used at the summer branch of the Providence Hospital and by the orthopedic surgeons at the Allegheny General Hospital in Pittsburgh. Sometimes the rays of the sun are focused upon the sinuses by the use of glass. This sun treatment, or heliotherapy, is recommended chiefly by surgeons interested in the cure of active bone tuberculosis. The value of sunlight for all children cared for in the in- stitutions we have studied is recognized by some of the officers, as shown particularly in the establishment of country institutions where children have abundant opportunity to play out of doors in the sun, and where the buildings usually admit more sunlight than is possible in the city hospitals. The most concrete statement of the value of sunlight for crippled children which we have heard was that made by Dr. Henry Frauenthal, surgeon-in-chief of the Hospital for Deformities and Joint Diseases in New York, at a meeting of the Federation of Associations for Cripples in New York. He said that the progress made by patients in his hos- pital who slept in a dormitory the windows of which were never closed but which received little sunlight, was distinctly less rapid than that of other patients sleeping on a porch adjoining this dormitory which admits the sun for many hours every day. Rest forms a part of the treatment of many of the children in the institutions. This is true not only of those whose surgical treatment requires that some joint be kept immobile, and who are sometimes kept for considerable periods in a fixed position upon a frame or in bed with an extension, but, also, of other patients who regain strength more rapidly when they have long regular hours of sleep, including, in many institutions, a rest hour after dinner. Provisions for Quarantine In institutions for crippled children, as in other institutions where considerable numbers of children are gathered together, it is highly important to prevent the occurrence of infectious dis- 44 PHYSICAL CARE eases; and when cases do appear, to prevent the spread of the disease. Seven of the institutions* isolate newly admitted chil- dren, usually for two weeks, to prevent the introduction of in- fectious or contagious diseases. The clothing worn by children when they enter is sometimes destroyed; sometimes it is disin- fected lest it carry germs. The other possible source of infection, besides newly admitted patients, is found in the visits of the patients' relatives and friends. The officers of institutions have learned especially to fear the visits of small children, who are likely to bring germs of measles, whooping cough, or scarlet fever. In a few cases, especially at the Kernan Hospital School, Baltimore, small children are for- bidden to visit in the wards. At the same institution adults who visit in the wards are required to wear linen ulsters furnished by the institution, which completely cover their clothing. Many of the institutions have been very successful in pre- venting the occurrence of infectious diseases. But the possi- bility is recognized as always present, and most of the institutions plan to care for such cases apart from the other children, when necessary. All the hospitals except the Hospital for Deformities and Joint Diseases, in New York, have some provision for quar- antine. This hospital has limited space because of its heavy dis- pensary service, which is to be transferred later to a new dispensary building. Cases of serious contagion here or in any other ortho- pedic hospital located in a large city can be sent at once to a special contagious hospital if the quarantine facilities at the institu- tion where the disease was discovered are not adequate. The city branch of the Minnesota State Hospital, for instance, located on the grounds of the St. Paul City and County Hospital, can send cases requiring quarantine to the building of that hospital for contagious diseases. Three of the hospitals reserve one or more small wards with adjoining bathrooms for use only in cases of infectious disease. These are the Home for Destitute Crippled Children in Chicago, * The Home for Crippled Children at Newark, New Jersey, the Massachu- setts Hospital School at Canton, the country branch of the Minnesota State Hos- pital School at Phalen Park, the Crippled Children's Home at Buffalo, the New York State Hospital at West Haverstraw, the Industrial Home for Crippled Chil- dren at Pittsburgh, and the Widener Memorial School at Philadelphia. 45 CARE OF CRIPPLED CHILDREN the Children's Hospital in Portland, Maine, and the New York Orthopaedic Hospital. All have separate outside entrances. The isolation rooms at the Chicago institution are in the basement; those in Portland are over the kitchen wing of the hospital, are reached by an outside fire-escape, and can not be entered from any other part of the building; the rooms used at the New York Ortho- paedic Hospital are on the top floor and can be reached by an out- side fire-escape. The five other hospitals have definite space for isolation which, however, is used for other purposes when there are no cases needing quarantine. At four of the hospitals, namely, the Nebraska Orthopedic Hospital, the Home for Crippled Children at Newark, New Jersey, the New Jersey Orthopaedic Hospital at Orange, and the Children's Orthopedic Hospital at Seattle, this is due to pressure for space. The Hospital for the Ruptured and Crippled in New York has ample space for all purposes in its new building, and it is therefore of special interest to note that the iso- lation ward on the top floor is not to be closed to other uses except when in actual use for quarantine. The large solarium is used by all the patients, and the other rooms which can be completely shut off for isolation will be used for other purposes if necessary. Careful isolation provision for contagious cases is in some ways more important in convalescent homes than it is in hospitals. The former are often located in the country, at a considerable dis- tance from special contagious hospitals, and contagion is likely to travel more rapidly because more patients are out of bed and they mingle together more freely. Five of the 14 convalescent homes have provisions for isolation in separate buildings. A small wooden building, constructed especially for the purpose, is used at the New York State Hospital. The Widener Memorial School and the Home for Convalescent Crippled Children at West Chicago have fireproof buildings of the most modern construc- tion, for use only for isolation and quarantine. Each of these buildings and the surgical building at the Industrial Home for Crippled Children at Pittsburgh, which is built of wood but has thoroughly modern equipment, can be divided into two sections entirely separated from each other, in case it is necessary to quar- antine two different diseases at the same time. The Massachusetts Hospital School at Canton has various 46 PHYSICAL CARE facilities for quarantine. Single cases have usually been housed in temporary movable houses of which the school has at present three; the number could be indefinitely increased. (For descrip- tion of these houses see Chapter VI, page 164.) The surgical building, or infirmary, has rooms for isolation of suspected cases so situated that, if the disease develops, the child's bed can be moved directly out onto a porch, whence he is taken to one of the little contagion houses, without passing through any other room in the surgical building. In the rare event of an epidemic which includes many cases, like a "siege" of measles in the summer of 1913, the cottage for older boys can be used as a quarantine. The Sewickley (Pennsylvania) Fresh Air Home has pro- visions for isolation in a small ward, with bathroom near. There is no separate outside entrance. At the Children's Hospital School in Baltimore, St. Charles Hospital at Port Jefferson, New York, and the Country Branch of the New York Orthopaedic Hos- pital in White Plains, there are separate wards, with baths, re- served for use only in case of infectious disease. The especially careful arrangement for the bringing of food into the quarantine ward and the return of dishes to the kitchen, at White Plains, is described in Chapter VI, page 172. The country branch of the Minnesota State Hospital at Phalen Park has four rooms on the ground floor, each containing a bowl and toilet and having an out- side entrance. Some of these rooms are used for ordinary cases when there is no infection, but it is possible to isolate four kinds of cases separately. At Sea Breeze Hospital, Coney Island, a tent is used for isolation in summer; rooms in the unused build- ings of Sea Breeze, the summer home, would be used in winter. At the Kernan Hospital School, Baltimore, a tent is used for isola- tion in summer; there is no space in the building reserved for isolation in winter. It has already been noted that special precau- tions are taken at this institution to prevent the introduction of infectious disease. The House of St. Giles the Cripple at Garden City, New York, reserves no space for isolation, but the surgical building would make an excellent quarantine building if the epi- demic affected the surgical cases. The Van Leuven Browne Hos- pital School has no provision for isolation. Only one of the asylum homes, the Home for Incurables at 47 CARE OF CRIPPLED CHILDREN Newington, Connecticut, has a separate building used only for isolation and quarantine. Two of the institutions, the New Eng- land Peabody Home at Hyde Park, Massachusetts, and the Home of the Merciful Saviour in Philadelphia, have isolation suites with baths, which are used only for their special purposes. Five of the asylum homes have one room each which is reserved for quarantine. At the New York Home for Destitute Crippled Children, the House of the Annunciation in New York, and the Children's House of the Home for Incurables in Philadelphia, there is simply a ward, with- out special bathroom; at the Daisy Fields Home at Englewood, New Jersey, and the House of St. Michael in Philadelphia, nearby bathrooms ordinarily used by employes could be set aside for use only by the quarantined persons. At the Crippled Children's Home in Buffalo and at the Darrach Home in New York, there is a room which would serve for quarantine if necessary. Many material provisions for the physical care of children in the institutions have been listed in this chapter as contributing to their physical improvement. There is also an intangible ele- ment which has an importance that can not be overestimated. An atmosphere of cheerful good humor is prevalent in the great majority of the institutions visited during the preparation of this study. Many of the people who work constantly with crippled children have commented upon the fact that the great majority of those who are not suffering actual pain seem always happy. Some of the older children who go out into the world with notice- able deformities have learned bitterness, but the smaller children still in the institutions are almost uniformly cheerful. The doc- tors, nurses, and other employes who help to create this atmosphere, do it in part because they feel a human sympathy with their small charges. But many doctors say that this pleasant atmosphere is necessary for the best physical progress of the children. Dr. Charlton Wallace, who is orthopedic surgeon to the St. Charles Hospital at Port Jefferson, New York, the Crippled Children's East Side Free School, in New York, and the school maintained by Miss Spence's School Society, in New York, states in an article on Surgical Tuberculosis and Its Treatment, printed in the Journal of Outdoor Life for March, 191 3: "Contentment and happiness of these httle ones play no small part in their cure and recovery." 48 School Omnibus. (See page 57) Association for tlie Aid of Crippled Children, New York City "*™bs__ m ^n. <^B \ ' M "'^ A^ PhAMOLi^ lloAih i-OK CuippLRi) (^HiLDKiN, Hyde Park, Mass. HAND WORK AND VOCATIONAL TRAINING class work, have been used chiefly for the sake of arousing an interest in definite work of any sort which makes the child an easier object of care and perhaps indirectly facilitates physical cure. A discussion of the treatment of crippled children which appears in the English Charity Organisation Review for Septem- ber, 1909, includes a strong statement by Warrington Haward ending with the following sentences: " If these young people can feel they are doing some useful work— and especially if they are exercising some developed talent or skill — they are at once raised to a much happier plane of life, and their work acts as a tonic both to mind and body. One useful result is that their attention is diverted from their ailments and incapacity, and this helps to neutralize the painful self-conscious- ness which often aggravates their sufferings." Just as the young crippled child, the special burden in his home, goes to school much as other children do, and there gains a new outlook upon life, so the cripple of wage-earning age takes great strides toward a normal point of view when he finds himself actually doing useful work. Our humanitarian interest is suf- ficient reason for encouraging cripples who can not become entirely self-supporting, or even earn anything worth mentioning, to have their small share in the work of the world because such work may partially bridge the gap between them and the outer world, and so increase their happiness. Second, some people urge the occupational training of crippled children because they desire to lift from the charitable public part of the present burden of supporting cripples. It is believed that many crippled children who would otherwise be entirely dependent can be taught occupations by which they can earn part of their own support. This introduces an element very different from anything met in the course of industrial training for well children. The success of such training for normal children is judged according to the ability of the trained pupils to take better positions and advance more rapidly than the untrained. The benefit of industrial train- ing can be judged only by comparing those who are trained with untrained children who are also crippled. When crippled 63 CARE OF CRIPPLED CHILDREN children who would otherwise fail as producers are able to earn part or all of their own living after special training, the value of that training must in many cases be judged by the difference be- tween the measure of success they do attain and entire dependence. SUITABILITY OF OCCUPATIONS CHOSEN It is more necessary to recognize the indefmiteness of the word "cripple" in discussing industrial training than in discussing any other phase of the care of crippled children, except, of course, technical matters of surgery. Trades which are suitable for chil- dren with some kinds of physical handicaps are quite imprac- ticable for those who are crippled in other ways. The physical condition and possibilities as well as the mental aptitude of each individual child must be studied before deciding for what occupa- tion he shall be trained. In choosing the occupation, the first question is: Can this particular child do this work? It may be said in general that there are many occupations open to cripples whose hands are in good condition, and also that the loss or disablement of one arm is by no means a barrier to choice among a considerable number of employments. The child who has lost both hands or arms or has been deprived of their use presents the hardest problem. No school has been found in the course of this study where any effort has been made to plan em- ployment for an armless child. Miss Kittie Smith, of the Home for Disabled Children in Chicago, who lost both arms at the age of nine years, is a remarkable example of what perseverance and intelligence can accomplish in training the feet to do an extraordi- nary number of things for which most people would suppose hands to be essential. Miss Smith runs a typewriter, does very good sewing and embroidery, draws with more than average skill, and makes pieces of furniture which require the use of a saw, hammer, and other tools. Such accomplishments must be regarded as possible, however, only in those cases in which the loss of arms and the consequent beginning of unusual efforts with the feet occur when the child is very young. Fortunately, the number of crippled children who are de- prived of both arms as the result of either accident or disease is comparatively small. The cases seen during the progress of the 64 c 2 z U = E \5\ HAND WORK AND VOCATIONAL TRAINING study have usually been children so far paralyzed that no indus- trial training was possible. However, one boy who had lost both arms in a trolley accident was brought to our attention and efforts were made to find an opening for him as a test of the possibilities for such cases, but no place could be found. For instance, tele- graph operating was seriously considered. It is not taught in any of the New York institutions for cripples, but the educational director of the school of telegraphy at the East Side Young Men's Christian Association came to the conclusion that the boy could operate the key by wearing some simple apparatus attached to one of his stumps. But on expert advice, it was decided that such training would be useless because the boy would almost certainly be unable to hold a position in competition with others not so afflicted. He could do only the mechanical things- which his appliance made possible and for which he had been especially trained. An employer prefers people who can, if necessary, be called upon in an emergency to do work apart from their usual duties. Furthermore, an armless person who wears any conspicu- ous piece of apparatus could not work without annoyance in places where this feature of his appearance would be noticeable. Special artificial arms have been tried by many people with varying degrees of success. They are so costly, however, that it would usually be impossible to secure them for the poor children who attend the schools with which this study deals. It is not our purpose to pass judgment upon the practicability of artificial arms because we have made no study of the subject. As stated before, it concerns very few, indeed, of the children in the institu- tions covered. The need of exhaustive preliminary study before opening trade classes is open to question. It is interesting to note that the most recently organized trade school for cripples, the Trade School of the Hospital of Hope for the Injured and Crippled, established by Dr. Jaeger in New York in 1912, has opened five classes for the teaching of skilled handicrafts with the assumption that there are a sufficient number of crippled men able to learn the different kinds of work. The assumption has been justified by the gradually increasing number in each class. This experimental method of organizing classes in subjects which are clearly suited to some 5 65 CARE OF CRIPPLED CHILDREN kinds of cripples, and teaching those who come, without waiting to determine with scientific accuracy whether or not the particular trades offered are the best ones, has the merit of time saving in the beginning of this much needed work. However, this school and several of the other trade classes are running with an attendance considerably below their capacity. The Rhinelander School class in jewelry making, for example, has only two-thirds as many boys as the managers desire, in spite of the skilled teaching offered with- out cost and the success of boys who have been graduated in securing positions. Various methods have been adopted in efforts to increase the number of pupils in these two schools. Efforts to induce individual surgeons or officers in orthopedic institutions and dispensaries to furnish names of possible candidates have been unsuccessful. This lack of success may be due partly to the necessary requirement that pupils in Dr. Jaeger's school must work faithfully, without wages, for several months, while the jewelry class of the Rhinelander School requires an apprenticeship of two years. Institutions about to open new classes for vocational train- ing of crippled children should know, if possible, what proportion of the crippled children likely to enter the classes represent each of the different types of handicapped conditions. Hospital records show the medical and surgical diagnosis of each case treated, but, as stated in Chapter I, it would be necessary to combine the records of many hospitals to obtain this information. Only where very complete records are kept of both hospital and dispensary cases and after an exhaustive study of these records could the representa- tives of the trade schools learn how to classify the cases according to ability or inability to stand or walk for definite periods, to take particular positions, or to exert muscular effort in the definite directions required by some kinds of mechanical work. If such a classification of hospital cases could be made, with special refer- ence to the dispensary cases fourteen or sixteen years of age or older, the founders of trade classes could tell with considerable exactness what trades they should teach. Most of the children in the institutions visited have the use of one or both arms, and it should be noted that by far the greater 66 HAND WORK AND VOCATIONAL TRAINING number of occupations mentioned in this chapter are those in which most of the work can be done while the worker is seated. CENSUS OF CRIPPLES IN BIRMINGHAM, ENGLAND No comprehensive census of crippled children has been taken in any state or community in the United States. The one attempt to secure a complete and scientifically analyzed census of the cripples of a community, not only from hospital records but from many other sources, including school records and those of many charitable organizations, is the census of cripples in Birmingham, England,* already mentioned in Chapter 1 . In this city of 500,000 people were found 1,001 cripples over sixteen years of age and 1 ,006 under sixteen years of age. The report of this census printed in October, 191 1, is worthy of study by any city in America where even a rough estimate of the number of cripples is to be made. The cripples over sixteen and under sixteen, respectively, were divided by the special committee of inquiry, which included a number of surgeons; first, according to the medical or other causes of their physical difficulties, then according to their ability to work. As already stated in Chapter I, a cripple was defined as: "A person whose (muscular) movements are so far restricted by accident or disease as to affect his capacity for self-support." The working ability of the 1,001 cripples sixteen years of age or more is shown by the following table: TABLE C. — WORKING ABILITY OF 1,00! CRIPPLES l6 YEARS OF AGE OR MORE. BIRMINGHAM, ENGLAND, 191 I (Not included in general statistical tables.) Status Cripples Number Per cent Able to go to work under ordinary conditions Able to attend a central workshop .... Able to do remunerative work at home . Unable to do any remunerative work 214 '45 III 531 21.4 145 II. I 53.0 Total 1,001 1 00.0 * Report of a Special Sub-committee of Inquiry Concerning Physically De- fective Adults and Children to the City of Birmingham Education Committee, 191 1. 67 CARE OF CRIPPLED CHILDREN The following table shows the measure of self-support at- tained by cripples sixteen years of age or more: TABLE D. SELF-SUPPORT AMONG I.OOI CRIPPLES l6 YEARS OF AGE OR MORE. BIRMINGHAM, ENGLAND, IQI I (Not included in general statistical tables.) Cripples Number Per cent Self-supporting Not self-supporting but did not require help Not self-supporting and did not require help at time of census, but might be expected to need it ater Not self-supporting and required help .... Being maintained in charitable institutions ■ 76 156 144 191 334 .7.6 15.6 ■44 19. 1 33-3 Total 1,001 1 00.0 The following table indicates the working capacity of 697 cripples under sixteen years of age who were not at work: TABLE E. WORKING ABILITY OF 697 CRIPPLES UNDER 16 YEARS OF AGE WHO WERE NOT AT WORK. BIRMINGHAM, ENGLAND, I9I I (Not included in general statistical tables.) Status Cripples Number Per cent Likely to be able to go to work under ordinary con- ditions Likely to be able to attend a central workshop Likely to be able to do remunerative work at home . Likely to be unable to do any remunerative work . Future capacity could not be estimated . 230 191 42 57 '77 33.0 27-4 6.0 8.2 25.4 Total 697 1 00.0 The printed report of this census does not take up in detail degrees of handicap suffered by the different individuals, how many are unable to stand, unable to walk, and so forth, but it is 68 HAND WORK AND VOCATIONAL TRAINING probable that the original records would give much information of this kind. The committee stated as its conclusion that "all the cripples in the city" [at that time] "not including the 334 cases in the workhouses and infirmaries, would be properly provided for" [though with a very low estimate of the amount necessary for subsistence] "if " (i) A Central Workshop were provided for 145; " (2) Work were provided at home for in (reasonable re- muneration being given in both cases for work done) ; "(3) Financial assistance were given to 191 (the amount re- quired varying from about 2 shillings to 5 or 6 shillings per week)." A second report of this committee, dated March 29, 191 2, recommends that the first need be met by the establishment of a workshop for crippled girls where they may learn general needle- work, embroidery, millinery, and tailoring, and receive wages for their work; also a central workshop for cripples of both sexes doing printing and bookbinding. WILL THE OCCUPATION BE PROFITABLE? The suitability of any occupation for a particular crippled child is not the only point which must be carefully decided. There is a second question which has been until recently too little considered; namely. Is this the most profitable occupation which this crippled child can enter? Certain manual occupations have become traditional in institutions. Basketry, chair-caning, and the making of fancy articles for sale at bazaars have been under- taken as obviously suitable for children unable to do more active work. The fact that it is hard to secure steady employment or reasonably good wages by making such articles outside the insti- tution and away from the possibility of a "charity" demand for the things made, has been too often forgotten. But the present study has revealed the general development of discontent with these traditional occupations as the sole kind of industrial train- ing offered. We have been surprised and greatly interested to find how frequently superintendents and teachers express their desire to branch out into more "practical" lines of industrial teaching, or their satisfaction over having been able to do so. 69 CARE OF CRIPPLED CHILDREN The relative merits of different trades from this point of view is in part a local problem, and the choice of trades to be taught in industrial schools should be made with a knowledge of the demand for workers in those trades in the community, the wages paid, and the opportunities for advancement as compared with those in other occupations. However, one broad general- ization may be accepted as true for all parts of the country. As far as possible, skilled occupations should be taught to cripples. Many cripples can not expect to compete in quantity of output with the work of perfectly sound people, and they should be led to enter occupations where the competition is in the direction of quality. This does not mean that skilled handicrafts should be taught when no market can be found for the goods produced. But serious efforts should be made to find such a market or to teach cripples clerical or other occupations requiring skill, before it is decided to teach them only the easily learned occupations in which competition is heavy and wages low. Some detailed sug- gestions as to particular occupations which might be more largely introduced into trade schools for cripples will be made at the end of this chapter, after a discussion of the occupations now taught in the various institutions. OCCUPATIONS TAUGHT IN 37 INSTITUTIONS Table VI I, on pages 134-136, which gives details concerning the academic school work, includes also the number of teachers giv- ing hand work, the number of pupils in hand work and domestic science classes, and the number receiving vocational training. In the latter column have been placed only the numbers of children who are giving a considerable portion of their time to direct train- ing for some occupation in which it is expected that they will be wholly or partially self-supporting. The large numbers in the column headed "hand work and domestic sciences" do not in- clude children who do housework, except the older girls at the House of St. Michael and All Angels in Philadelphia. The chil- dren who do garden work are not counted because this work has not yet progressed far beyond nature study. Several of the institutions located in the country expect ultimately to train some of their children to be market gardeners. 70 HAND WORK AND VOCATIONAL TRAINING Table VIII, pages 137-139, shows the kinds of hand work and vocational training now taught in all the institutions for crippled children. All kinds of hand work except kindergarten processes have been included. The kindergarten work is also included for four institutions where it has been carried to a point beyond what is usual in kindergartens. The tabulations do not show the fact that in several instances the institutions have fa- cilities for teaching some occupations for which they have at present no pupils of the right age or otherwise fitted. For ex- ample, at several of the residential institutions, including the New York State Hospital at West Haverstraw, typewriting and sten- ography have occasionally been taught by the secretary or book- keeper of the institution, usually to one or two pupils at a time. The managers of the Country Branch of the New York Orthopaedic Hospital find that most of the children are now cured and sent home before they are old enough to receive industrial training and have, therefore, curtailed their vocational work. It will be seen from the tables that only two of the ten hospitals have any hand work or vocational training. Both the Hospital for the Ruptured and Crippled in New York and the State Orthopedic Hospital in Lincoln, Nebraska, provide liberally for simple hand work, and the latter is unique among institutions classed as hospitals because of its introduction of several kinds of occupational training. Most of the asylum homes teach simple housework and sewing, but occupational training apart from sew- ing has been very little developed. The bulk of the occupational training of crippled children in America is done by convalescent hospitals or homes and by private day schools. Some of this oc- cupational work is taught in formal classes by special teachers, but much of the training received by children in residential insti- tutions grows out of the daily life of the institution. INFORMAL VOCATIONAL TRAINING IN INSTITUTIONS The children very often help with the domestic work. In 1 3 of the 37 institutions * they receive sufficient training in house- work to be of distinct service when they go back to their own * State Orthopedic Hospital, Lincoln, Nebraska; State Hospital for Crippled Children, Phalen Park, Minnesota; Country Branch of New York Orthopaedic 7> CARE OF CRIPPLED CHILDREN homes. In six of these institutions — named first in the footnote — the work is planned in advance, and each child is assigned to defi- nite tasks usually listed and posted in the dining room. The tasks are changed at several of the institutions at regular weekly or monthly intervals, and in others irregularly. The work done by the children usually includes dish wiping, the arranging of tables, dusting, light sweeping, the making of beds, and care of their own possessions. Very often the older girls assist in dressing and car- ing for younger children. But the effort to use the routine domestic work of an insti- tution for purposes of vocational training is usually disappointing, especially where the children are assembled in large groups, where the cooking is done in large quantities by steam, where the dishes are washed by machinery, and the dining room is cared for on system. It is very difficult to reproduce the home conditions under which ordinary housekeeping is done. The only way in which institution work can be made efficient for vocational train- ing is by grouping children in small cottages, each cottage being a complete domestic unit in which the cooking, baking, table ser- vice, and sleeping are managed on the same plan as in an ordin- ary household. Such cottages should contain not more than 1 3 children. At the Massachusetts Hospital School the older girls spend the last year or two of their residence at the school in a special cottage where they are under the direction of a house mother, but without the assistance of servants. The girls attend to all the housekeeping. The cottage has purposely been made very simple and the girls learn to do work by methods which they can follow later in their own homes. They use a wood or coal range for cooking, wash in set tubs, dry their clothes on lines put up on the rear porch, and iron with an ironing board between two chairs, quite as they might in a small household with few conveniences. Hospital, White Plains, New York; Daisy Fields Home, Englewood, New Jersey; Holy Cross House, Cleveland, Ohio; Home of the Merciful Saviour, Philadelphia, Pennsylvania; Convalescent Home for Crippled Children, West Chicago, Illinois; Home for Disabled Children, Maywood, Illinois; House of St. Giles the Cripple, Garden City, New York; Home for Destitute Crippled Children, New York City; Darrach Home, New York City; New England Peabody Home, Hyde Park, Massachusetts; Home for Incurables, Newington, Connecticut. 72 The Cooking Class Main Building and Yard. (Seepage iqo) Daisy Fields Home and Hospital for Crippled Children, Englewood, N. J. As Admitted (See page 216) As Discharged Reconstructing THE Carter Twins Rainbow Cottage and Lakeside Hospital, Cleveland, Ohio The Nursery. (See page 200) House of St. Michael and All Angels, Philadelphi; HAND WORK AND VOCATIONAL TRAINING The institution has a steam laundry and the most modern house- keeping equipment for its other buildings; but experience with ultra-modern machinery would be of little use to girls who go after- ward into cheap or moderate priced apartments or houses in the country districts. At the House of St. Michael and All Angels in Philadelphia the young colored girls receive similarly compre- hensive training in housework and some of them have left to take positions in domestic service. In all the residential institutions, a great deal of sewing is necessary in order to keep the children's clothes and the house- hold linen in good order. In the larger institutions, one or more seamstresses are employed. In some of the smaller ones a seam- stress comes in occasionally by the day. The older girls in the institutions usually help with the mending and sometimes with the making of simple garments for themselves and other children. It will be seen that sewing is taught in a greater number of institutions than any other hand work; that is, in 22 out of the 37 residential institutions. The amount of time given to the work and the degree of skill which the children develop vary greatly. With sewing, as with other domestic work in which the children have a part, the emphasis in some institutions is put upon the desire to have the children help out with the necessary work in order to reduce expenses by decreasing the number of servants. In other institutions more attention is paid to seeing that the chil- dren learn as much as possible. Institutions which have classes in sewing meeting at regular hours will be mentioned later. Of the homes where sewing is done informally, the House of St. Giles the Cripple and the Home of the Merciful Saviour have daily meetings of the older girls who do sewing of considerable variety under the direction of a seamstress. In a smaller number of institutions, other kinds of work have grown naturally from the opportunities offered by the varied life of the institution. Several of the children at the Nebraska Hos- pital School have been taught enough of cataloguing and general library work to arrange and manage the institution's library. The children at the State Hospital in West Haverstraw, New York, had at one time some share in the cataloguing of their 73 CARE OF CRIPPLED CHILDREN library. Stenography and typewriting are taught at the Kernan Hospital in Baltimore and the St. Charles Hospital in Port Jef- ferson, New York. As stated before, there are several other institutions where the secretary or bookkeeper has sometimes given similar instruction to pupils who were interested. Institutions located in the country oifer excellent oppor- tunity for the training of children in gardening and various kinds of farming. At present the Home for Incurables in Connecticut, the Sewickley Fresh Air Home in Pennsylvania, the Daisy Fields Home at Englewood, New Jersey, the Country Branch of the New York Orthopaedic Hospital at White Plains, and the State Ortho- pedic Hospital of Nebraska have gardening classes. At the home in Connecticut, gardening is taught by a special teacher engaged for the summer. At the other places, the gardener or farmer for the institution teaches the children. Only the Massachusetts Hospital School has thus far given actual instruction in farming other than gardening; but several of the country and suburban institutions, notably the Kernan Hospital School and Children's Hospital School in Baltimore, the Convalescent Home in West Chicago, and the Minnesota State Hospital at Phalen Park, ex- pect to develop later various kinds of farm work, including dairy- ing, the raising of chickens, squabs, and ducks, the care of horses, and the use of implements in general farming, in addition to the raising of vegetables and flowers for the market. All of these outdoor occupations are especially advantageous for children who have had bone tuberculosis and need to continue life in the open air for a long time. It is not possible, of course, for those who are badly crippled to assume much responsibility in farm work; however, boys who limp in walking but have strong arms are able to do a great many kinds of farm work on specialized farms such as are usually found near eastern cities. There would be fewer openings for crippled boys on extensive western farms where grain is raised on a large scale and most of the work is done by heavy machinery which requires the efficient use of both hands and both feet. Chair-caning, the making of simple furniture, and cobbling are usually taught in formal classes and will be mentioned again later in this chapter, but it should be noted in passing that these 74 HAND WORK AND VOCATIONAL TRAINING kinds of hand work may develop also in a residential institution because the children who learn to do such work can repair furni- ture in the institution and keep their own shoes in good condition. Brace making has been much discussed as a possible source of livelihood for crippled boys, but it is not now taught in any of the institutions. It may be offered at the Widener Memorial School and the Nebraska State Hospital later when there are older boys in sufficient numbers to furnish pupils for this as for the other trades already taught. OCCUPATIONAL TRAINING AT TWO NOTABLE INSTITUTIONS Two of the largest and best equipped institutions are espe- cially notable for the comprehensive fashion in which they have turned all the resources of the institution into possible avenues of vocational training for the children in their care. The Widener Memorial School in Philadelphia has a capacity of loo children; the Massachusetts Hospital School located in the country near Canton has a capacity of 250 children. In each institution so large a staff of employes is necessary in caring for the buildings and grounds and otherwise continuing the general work of the institution that opportunity is afforded to the older boys and girls to turn naturally to the kinds of work which most appeal to them. At the Widener Memorial School one of the older girls is securing excellent training as a teacher under the direction of the principal of the institution school. The girl has charge of certain classes and is receiving training not unlike what she would receive in practice courses at a normal school. Another girl is learning the care of hospital wards and something about elementary nursing. Cooking is taught by the institution chef. Stationary engineer- ing and practical carpentry are taught respectively by the school's engineer and carpenter. Most of the industrial work at the Massachusetts Hospital School is not learned through formal courses, but in much the same natural fashion that boys on a farm and girls who work in their mother's kitchen "pick up" information. The children are given the run of the place and are allowed within reason to follow the various employes necessary for so large an institution. It is the desire of the superintendent that the natural inclination of the 75 CARE OF CRIPPLED CHILDREN children shall be observed and that when a child shows special interest in some one kind of work, he shall, if possible, be given a chance to learn to do that work. It is found that some boys "hang round" the barn and are chiefly interested in the horses, goats, oxen, pigs, and chickens. At present four boys are regularly helping the farmer. Others are more attracted by the engine house. The painter and car- penter receive their share also of interested attention. Three boys are now working at carpentry. Ten boys are learning cobbling. They do all the repairing of shoes for the inmates of the institution; they also make pretty good shoes on simple lines, especially moccasins. Three boys are now working at printing. They print laundry lists, library catalogues, and other forms used in the institution. The most interesting case of a boy's development along the line of his natural interests is that of a young fellow, now eighteen years old, who has twisted legs and must use crutches when he walks at all rapidly. His general health is good and his arms are strong. Three years ago, when he came to the Hospital School, he was an unmanageable boy, considered a "hard case." The superintendent, Dr. John E. Fish, "tamed" him in the shortest way possible, through discovering work which would interest and occupy him. The boy's fondness for "hanging round" the door of the power house was observed. He was allowed to go inside, to throw on a shovelful of coal occasionally, later to read the meters, and then gradually to make himself more and more useful to the engineer. He was made to feel that this was a privilege and none of the other boys was allowed the same freedom in the power house. Finally, the engineer took him to the State House in Boston and he successfully passed the state examination for a third class fireman's license. Later, he secured a second class license. Then Dr. Fish began to seek a job for the boy, who is fully able to earn his living. Much difficulty was found in the prejudice of employers against having a crippled person work with machinery, and of fellow-workmen who thought such a boy might not do his full share of the work. But at last an owner of a small tannery en- gaged the boy to take charge of the heating apparatus by night; 76 HAND WORK AND VOCATIONAL TRAINING he works alone and it is hard to see how his twisted legs can trouble the esthetic sense of anybody. Dr. Fish says that at least 50 boys are laying foundations for useful lives in the future in this way. A boy with traumatic flat feet, sixteen years old, who is unable to advance beyond the eighth grade in school, has become very skilful in the farm and grounds division under the direction of the head farmer. He will be discharged in a short time to do similar work about a country place. Another boy, of about the same mentality, has recovered from a tuberculous knee. He is now a strong, well developed young man who is looking forward to a responsible position on a nearby country place. He has the reputation of having the best groomed horse and the brightest harness and wagon seen any- where round. The head farmer is also teaching him to operate an automobile. There is less variety in the openings for girls. In the cottage for older girls at the Massachusetts Hospital School all branches of housekeeping are taught. Some of the girls may later work in the steam laundry which does the major part of the laundry work for the institution. Other opportunities for the girls seem limited thus far to sewing. The sewing classes are formally organized; one head seamstress and her assistant spend all their time in the sewing room. But it should be remembered that the work is closely interwoven with the actual needs of the institution, and the point of view of girls who learn sewing there must be quite different from that of girls who learn fine sewing and embroidery in most of the other institutions which have formal sewing classes. Their teaching is more or less incidental to the distinctly heavy work of replenishing the stock of clothing needed to sup- plement what parents give for their children. Nevertheless the educational motive is never forgotten. The pupils receive thor- ough instruction in both hand and machine sewing. There are five power machines and some of the girls have learned to operate them. The following schedule shows work done by the two groups of girls who are learning sewing: 77 CARE OF CRIPPLED CHILDREN Less Advanced Class Advanced Class Monday Monday Plain sewing lyi hours Cutting i hour Plain sewing i hour Tuesday Tuesday Mending i hour Mending i hour Knitting }4 hour Knitting i hour Wednesday Wednesday Mending i hour Mending i hour Crocheting }4 hour Crocheting i hour Thursday Thursday Plain sewing i hour Cutting i hour Crocheting }4 hour Plain sewing i hour Friday Friday Plain sewing i hour Plain sewing i hour Knitting }4 hour Lace-making i hour The all-round nature of their training is evident from this schedule. The advanced pupils are not confined to plain work altogether; some pretty though simple embroidered towels, knitted slippers in gay colors, and other small articles, are made. All the products of the sewing room are used in the institution, or given by the girls to their relatives and friends. At present there are 12 girls in the less advanced class, and two are doing advanced work in sewing. ORGANIZED TEACHING PRELIMINARY TO VOCATIONAL TRAINING The informal but effective teaching which grows out of the life of a large residential institution is seen at its best in the larger convalescent hospitals. Formal classes in occupational training, meeting at definite hours and receiving instruction from special teachers who usually give all their time to teaching, are most highly developed in the private day schools, although excellent work of this kind is done at several of the residential institutions. Three grades of hand work can be distinguished : first, elementary kindergarten or manual training work; second, basketry, chair- caning, and the making of small fancy articles; third, direct train- ing for self-support in occupations which offer reasonable oppor- tunities for crippled children to earn their living after they leave the institution. The different grades of hand work will be dis- cussed briefly in the order mentioned. 78 HAND WORK AND VOCATIONAL TRAINING Many of the children lay the foundation for later industrial training in kindergarten classes. Fifteen of the residential in- stitutions have such classes. The children learn to cut paper, make small articles from cardboard, weave mats with strips of paper or yarn, and sometimes to make mats from raffia. In four of the residential institutions and one of the day schools, kinder- garten work is carried further than in most kindergartens, and some of the children have learned to make rather good baskets, boxes covered with cretonne, and similar articles. Courses in manual training or sloyd are offered in eight of the residential in- stitutions and one of the day schools. In these classes boys learn the use of tools in making articles from wood. Sometimes small book holders or other articles are made; but the chief aim of the work is not the making of articles but the teaching of principles and the training of the boys' minds and hands. In most of the institutions the first kinds of work usually taught by which the children may later earn money are sewing, basketry, and chair-caning. Sewing is taught in almost three times as many institutions as any other one subject, but much of it has only a slight vocational bearing. Many of the girls in asylum homes do mending and very simple sewing continuously, and there is no opportunity for them to advance very far beyond the stage which they reach soon after beginning the work. The sew- ing which may be regarded as genuine preparation for self-support will be discussed, with other methods of direct occupational train- ing, later in this chapter. The making of baskets and caning of chairs have become traditional occupations for people who must do sedentary work, especially for the blind. These kinds of work have been introduced into a number of institutions for crippled children because the children could learn to do the work easily, and because the kindergarten teacher or someone else, easily pro- curable, could usually give sufficient instruction in these subjects, when the teaching of other handicrafts would have required the employment of a special teacher. The making of simple burnt- wood articles, brass candle shades, and bead chains are also rela- tively simple processes which can usually be taught by the grade or manual training teacher. All these branches of hand work are pedagogically useful as 79 CARE OF CRIPPLED CHILDREN further means of training beyond kindergarten work and sloyd. It is also true that money is received for these articles when sold at Christmas bazaars or other fairs. But it is almost unavoidable that the demand should be influenced by the desire of the pur- chaser to help the institution. The writer has yet to learn of any crippled child, taught in an institution to make these articles, who has been able to earn any large proportion of his living expenses continuously by any of these methods when he has left the school and attempted to do the work on his own responsibility. We believe that it is well to begin industrial training for crippled chil- dren with precisely these kinds of hand work, but there should always be an ultimate aim to lead as many children as possible into the kinds of work which are more profitable when put on a strictly commercial basis, and not to depend upon the selling of articles to people who buy because of their sympathy for cripples. The institution which has most clearly and logically worked out the usefulness of these hand processes of a semi-vocational value is the Widener Memorial School. Apart from its training of children under direction of various employes which has already been discussed with the informal education of other convalescent hospitals, the Widener School has planned its hand work according to a careful and comprehensive program. It begins with kinder- garten processes and leads through sloyd and simple woodwork for boys and basketry for girls to complete training for particular trades in special classes. Each boy has four years of sloyd work and each girl is in the basketry class for three years. In this class the girls also do some work with beads and brass. They have sometimes designed boxes which the boys have made up in their wood-working classes. The boys' classes have stenciled cushions which the girls have later embroidered with raifia. The classes meet each week for sessions of from two to five hours. All of this hand work is regarded as desirable as a preliminary training in the use of the hands and as a possible source of income in after years. While such work seldom provides an adult with a sufficient source of livelihood, a cripple who loses his regular posi- tion or is temporarily confined to his home, could earn some money by these methods and might at any time add to his regular income by doing such work at odd hours. 80 HAND WORK AND VOCATIONAL TRAINING ORGANIZED TRAINING FOR SELF-SUPPORT The hand work which we have placed in a third class in- cludes many different occupations in which it is expected that crippled children trained in the institution will be able to earn all or part of their own support. It has already been stated that most of the training in domestic science is incidental to helping with the housework in residential institutions. But there are regu- larly organized cooking classes for the girls in four residential in- stitutions and at the Industrial School for Crippled Children at Boston. The usual aim in teaching crippled girls cooking or other domestic science is to prepare them for some usefulness in the homes of their parents when they leave the institution, or, in some cases, for work in homes of their own after marriage. It is com- paratively seldom that domestic service is advocated for crippled girls, because it is usually assumed that not many of them are sufficiently strong or agile to do general housework.* There seems to be no reason why a girl whose general health is good should be debarred from domestic service because of a limp or other slight defect, but she can probably secure a position as nurse maid or mother's helper more easily than a place as general servant. VOCATIONAL TRAINING IN PRIVATE DAY SCHOOLS We have found only four private day schools which carry on vocational training. Their work is summarized in the following statement : Private Day Schools Giving Vocational Training Massachusetts, Boston Industrial School for Crip- Sewing, embroidering, cooking, pled and Deformed Child- advanced kindergarten work, ren manual training, basketry, cobbling, chair-caning, print- New York City ing, proofreading Crippled Children's East Hand and machine sewing, em- Side Free School broidering Rhinelander School Sewing, embroidering, jewelry making William H. Davis Free In- Sewing, embroidering, leather dustrial School for Crip- tooling, burnt wood work, pled Children wood carving * See page 73. The House of St. Michael and AH Angels has trained sev- eral colored girls successfully for domestic service. 6 8l CARE OF CRIPPLED CHILDREN All of these four day schools with industrial training teach most, if not all, of the girls in sewing and embroidery classes. At the Industrial School for Crippled and Deformed Children in Boston, the Crippled Children's East Side Free, School, and the Rhinelander School in New York, plain sewing, fancy stitches of many kinds, and the making of complete garments are taught. A smaller number of girls at the William H. Davis Free Industrial School for Crippled Children make articles such as small aprons, pincushions, bags, and so forth, for sale at their fairs. Many of the girls have learned to do very beautiful work and the products bring good prices. Three schools have made hand-embroidered towels with considerable success. At the Rhinelander School towels with borders of Swedish drawn work have been sold for as much as I45 a dozen. The different schools have attained fame for dif- ferent kinds of work. At the Crippled Children's East Side Free School beautiful initial embroidery is done. Many elaborate trousseau sets have been made for special orders. The girls do all the sewing on these garments by hand, including putting in lace insertion and making very fine tucks. The school makes also all kinds of aprons, bou- doir caps, and women's undergarments. Machine sewing has recently been introduced and inexpensive aprons of gingham and other material are cut and made by the children. The needle trades classes have been successful as to quality of the work done, the demand for the articles, and the proportion of their cost cov- ered by the receipts. The sewing classes have an enrollment of 26. All of the workers receive regular wages and give their full time to the work. They are brought to the school by a bus and are given a hot meal at noon. Two boys have been included in the embroidery class, and it is hoped that boys may profit by the opportunity to do machine sewing. The school has not other- wise succeeded in finding a successful subject for the trade training of boys. At the Boston school the girls receive regular instruction in sewing, under special teachers, and are graded according to age and capacity from the third to the eighth grammar grade. They do fairly advanced work, including the making of simple dresses. 82 Surgical Pavilion, Interior The Play Hour. (See page 168) House of St. Giles the Cripple, Garden City, Long Island "Seeking a Shrine." (A Legend of a Crippled Child) '^^ «^^'*^' j»p MMMMIwteMMtMl il l**(l«rtS w Sleeping Porch Main liuilding. (See page i6i-)J St. Charles Hospital For<. Crippled Children, Port Jefferson, Long Island HAND WORK AND VOCATIONAL TRAINING For girls who have completed the eighth grade, there is oppor- tunity to work in the sewing room all the time and receive wages. At the time of the writer's visit three girls were sewing continuously. The school is known especially for its cross-stitch embroidery on napkins, towels, and other table and bed linen, and for small children's dresses and rompers. The usual line of pincushions and other fancy articles may be seen, but in general the articles made are examples of careful plain sewing and unelaborate trimming. The St. Charles Hospital for Crippled Children at Port Jefferson, New York, is the only one of the residential institutions which has classes whose members sew continuously all day. Three girls do both plain sewing and fancy work, including hem- stitching, embroidery, cross-stitching and the making of dolls' and children's clothes. Two boys are learning the rudiments of tailor- ing. They have made several small suits for the younger children and white coats for the doctors. The children are very useful in helping with the necessary sewing of the institution, but each girl has opportunity to learn all the different stitches. SPECIAL HANDICRAFTS Other handicrafts than sewing, fancy stitches, and embroid- ery have been taught in a few institutions. At the Kernan Hos- pital School in Baltimore some of the girls in the sewing class have learned to make lace. At the Widener School and the New York State Hospital at Haverstraw, a good deal of stenciling is done. At West Haverstraw designs are transferred by wood blocking. The success of the teacher at West Haverstraw in teaching chil- dren to make their own designs is especially notable. The Kernan Hospital School has a small loom and some creditable work in rug weaving has been done. At the Widener School, the Kernan Hospital School, and the William H. Davis Free School (a day school) the children have made articles of burnt wood. Leather tooling for pillow and table covers and chair upholstery is beauti- fully done at the William H. Davis Free School. The teacher of all their work in leather and wood is a former pupil of the school, still slightly crippled. He has artistic ability in making designs and considerable skill in execution. He and two or three of the older boys produce many elaborate tooled pieces of leather. 83 CARE OF CRIPPLED CHILDREN At the Rhinelander School in New York there is a jewelry class for boys, taught by an expert jeweler who was formerly employed in a high grade shop. The capacity of the class is about 14, and there are usually from eight to 12 members. The boys work on a two years' apprenticeship basis. They pay no tuition and receive no pay for their work except for occasional pieces made to order, upon which they may work after the short hours of the session, which are from nine to three. The boys are taught both the making by hand of artistic pieces and the processes which they need to know in order to secure positions in a regular com- mercial jewelry shop. There is a belief on the part of those in charge of the class that it would not be wise to teach "arts and crafts" processes only, because often a boy would earn less through selling hand-made pieces than he would when working for wages at machine work in a jewelry factory. The members of the Brearley League, which maintains the industrial classes at the Rhinelander, have had considerable difficulty in finding enough boys for the jewelry class. Their diificulty in finding pupils has already been discussed. Some boys are not eligible because their hands are not adapted to the fine details of jewelry making; others lack the good eyesight which is required for admission to the class. Of the three kinds of clerical work given in Table VI 11, proofreading is taught at the Industrial School for Crippled and Deformed Children in Boston. Library work, stenography and typewriting have already been mentioned as carried on informally in residential institutions. MECHANICAL TRADES There have been several successful efforts to teach crippled children mechanical trades. Stationary engineering and practical carpentry at the Massachusetts School and the Widener School have already been mentioned. Very elementary carpentry work is done by some of the children at the Hospital for the Ruptured and Crippled in New York. Simple furniture making is taught by industrial teachers in three of the residential institutions: namely, the Phalen Park section of the Minnesota State Hospital, at the New York State Hospital, and the Industrial Home for 84 HAND WORK AND VOCATIONAL TRAINING Crippled Children in Pittsburgh. At Phalen Park, Minnesota, book and magazine holders are made; at West Haverstraw, New York, some of the children have made very good wooden toys and a few tabarets and telephone stands. The work is farther ad- vanced at the Pittsburgh Home, and six of the boys have done sufficiently advanced work in the making of magazine holders, boxes to hold shoe-blacking outfits, and small tables, so that it could be called vocational. They have made a number of work tables resembling camp stools, with tops divided into two parts joined by hinges so that they can be closed when one wishes to move the table. These tables are covered with cretonne and have large pockets underneath. They have sold readily at J5.00 each. The manual training courses at the Boston school consist chiefly of sloyd work, but the pupils have made excellent wooden toys and some small pieces of furniture. The most elaborate woodwork is done at the William H. Davis Free Industrial School. Wood carving in varied patterns designed by the teacher, a former student in the school, is done with the help of two or three of the older boys now in the school. Elementary bookbinding and repairing are taught at the Nebraska Orthopedic Hospital. The children work chiefly on the books in the library of the institution which need repairing, under a non-resident teacher. The equipment includes a stamping press, two sewing benches, a card cutter, and necessary supplies. Eight girls and two boys are in the class. The same teacher has three boys studying printing. The Industrial School at Boston has a printing plant which compares very favorably as to its equipment and the quality of work turned out with commercial establishments of high standing. Eight boys and three young women give their entire time to the work in the shop. The plant is in charge of an experienced printer who is not himself a cripple. He estimates the value of the equip- ment as between $4,000 and $4,500. It includes five presses and cases of type, a paper cutter, a wire-stitching machine, and a loose- leaf binder. In this shop, as in other departments of the Boston school, children who are still in the grades come for brief sessions. At the time of the writer's visit four grade pupils were coming every day for from one to two hours. The atmosphere of the work- 85 CARE OF CRIPPLED CHILDREN shop is altogether businesslike; but the printer does not lose sight of the main educational purpose and beginners receive sufficient attention. The employes who give their entire time to printing work from 9 to 5. Another hour is sometimes added in rush seasons, but the usual day is seven hours, an hour less than the eight-hour limit set by the printers' union. The possibility for special consideration for workers below the normal in a shop where ordinary cripples are employed is interestingly illustrated in the case of a boy who is not as strong as the others. He rests from II to 12 every day and leaves at 4 instead of 5. Much of the work done by the plant is in the filling of small private orders, but they receive larger commercial contracts occasionally. They have printed the magazine of the Boston Girls' Latin School. The shop turns into the treasury of the school each year a small amount over and above its own expenses for materials and wages, but, of course, with no account for rent, heat, or light. Mention should be made of the chair-caning and basketry work at the Boston school because it is conducted successfully on a commercial basis. This department netted the school $100 in 191 1, after paying for its own material and wages. Cobbling has been taught at the Boston school, but no shop for commercial work has been developed. FINE ARTS Of the fine arts, only music has been taught in institutions for crippled children as a possible direction for vocational training. Simple class work in music and drawing for children in the grades has not been included in our tables. At four of the institutions music lessons are given to many of the children. Individual chil- dren in other institutions have sometimes received music lessons because of special ability. Many piano lessons are given at the Massachusetts Hospital School and at the House of the Annuncia- tion in New York. At the Widener School a music teacher is busy giving individual piano lessons for three and a half hours on two different days in the week. The boys of the school are organized into two bands, with a visiting band master and opportunities to learn to play any of the instruments. Music is regarded at the Widener School not only as a cultural asset but as a possible 86 HAND WORK AND VOCATIONAL TRAINING source of income to the children after they leave the institution. Music is taught at the Virginia T. Smith Home for Incurables at Newington, Connecticut. DISPOSAL OF THE ARTICLES The articles made in the institutions are disposed of in va- rious ways. In all the residential institutions many of the articles made by the children are used in the buildings. This is true not onlj^ of the products of the sewing rooms but of other miscellaneous articles. For example, some of the children at the Widener School have re-caned chairs used in the institution; baskets made by the children are used in the offices of the Kernan Hospital School; at Phalen Park, Minnesota, the children have made leather napkin rings for all the residents of the institution; at the Massachusetts Hospital School large numbers of moccasins have been made and the boys are required to wear them while indoors. The printing at the Nebraska State Hospital and the Massachu- setts Hospital School includes various kinds of blank forms needed in the institutions. All four of the private day schools which have industrial classes make goods to order. Three of the schools, the Industrial School in Boston, the Crippled Children's East Side Free School, and the William H. Davis Free School in New York, receive a con- siderable share of their income from fairs at which all the different products of the schools are sold. The Boston school rented part of a small store on Boylston Street for four weeks before Christmas and very profitable sales resulted. The two schools mentioned in New York have held sales on their own initiative in hotels, and have also sold goods at booths during general exhibitions like the Woman's Industrial Exhibition held at the Grand Central Palace in February, 191 3. Half a dozen of the residential institutions have also made articles for sale, but the receipts have not represented any notice- able proportion of the cost of maintaining industrial teaching. The Kernan Hospital School has held no fairs in its own name but has sent articles to bazaars and to the Women's Exchange in Balti- more. One hundred dollars was realized in one year. One-third of the amount for each article is given to the children; from the 87 CARE OF CRIPPLED CHILDREN remaining two-thirds materials are paid for and any balance is used by the institution for purchasing some needed piece of equipment for the school work. Fairs have been held at Christmas time at the Widener Memorial School. Two hundred dollars' worth of articles made by the children was sold last year. One-fourth of the selling price was returned to the school to pay for materials, and three-fourths of the amount was entered in the bank accounts of the children who made the articles. At Christmas time and during Lent, articles of needlework are offered for sale at the Home of the Merci- ful Saviour in Philadelphia. The children have given to foreign missions the money realized for articles sold during Lent. At the Industrial Home in Pittsburgh, the Peabody Home in Hyde Park, Massachusetts, the Home for Incurables in Philadelphia, the Convalescent Home for Destitute Crippled Children in Chicago, and formerly at the House of St. Giles the Cripple, now in Garden City, fairs or teas have been held occasionally in the institution, at which the work of the children was offered for sale. Articles have occasionally been made for sale, upon order, at the New York State Hospital. Realizing money through the sale of goods is always a minor object in the maintenance of occupational classes. In those day schools where the young people who work all day receive wages, the sales sometimes cover the wages and the cost of materials, but the surplus after these payments are made never equals the teach- ers' salaries, rent, heat, light, and other expenditures. It should be remembered also that the sale of goods under the name of a charitable institution usually does not test in any degree the actual market value of the products, or show whether or not the crippled young people will be able to secure similar prices by making the same things outside of the institution. CONCLUSIONS This study reveals the wide variety of pursuits by which many of the institutions are preparing cripples to earn a part or all of their own support. The opinion is practically unanimous that needle trades, including plain sewing, embroidery, and possibly millinery, solve the problem of wage-earning for large numbers 88 HAND WORK AND VOCATIONAL TRAINING of crippled girls. There is also general agreement that manual training, in addition to its other advantages, helps to fit crippled boys, as well as other boys, for later work which has direct voca- tional bearing. But no one occupation or group of occupations is regarded as so universally practicable for crippled boys as the needle trades are for crippled girls. Only a few institutions have tried any one of the other occupations, and there is much difference of opinion as to the respective merits of the various occupations mentioned in this chapter. It is not our purpose to advocate here the general acceptance of any one of the occupations under discussion, because, first, the conditions of employment in given occupations as to health condi- tions of the places of work, hours, wages, and prospects of advance have not been studied in sufficient detail, even for industries as a whole, still less for a specific locality; second, the ability of dif- ferent types of cripples to perform the various kinds of tasks im- posed by the given occupations has not been determined. It is obvious that studies for the purpose of securing in- formation about employment conditions are needed for the guid- ance of young people, whether they are crippled or not. Such studies must usually be within a limited range of territory, some- times one state, often only a single city, in order to have the fullest value. People who are interested in the vocational training and guidance of crippled children should keep closely in touch with every movement whose aim it is to secure information which fur- nishes a basis for a program of vocational training. The pam- phlets on particular kinds of employment issued by the Women's Educational and Industrial Union of Boston are excellent examples of such local studies. All general information on the subject helps to simplify the choice of occupations to be taught in institu- tions for cripples by showing the relative advantages of the dif- ferent occupations for any young person. For cripples who remain in any degree handicapped, we need, in addition, knowledge of the particular kinds of work for which each type of cripple is not incapacitated by his physical defect. Studies of this sort made in difi'erent localities would furnish a basis of generalization as to how far specific handicaps prove a hindrance or make work possible in a given occupation. Machine 89 CARE OF CRIPPLED CHILDREN work in a factory should be undertaken by a cripple only after he is sure that neither the ordinary movements he must perform, nor those necessary in case of accident, require physical effort of which he is not capable. The experience of cripples graduated from special schools, and the success or failure of individual cripples who have entered different occupations on their own in- itiative without coming from an institution, would, if gathered together, furnish practical information as to the degree to which certain physical defects hinder or prevent success in different kinds of work.* So long as the two kinds of information mentioned are not available we do not feel prepared to recommend specific trades as better than others for introduction into schools for cripples. If a crippled child has sufficient ability and if necessary funds can be secured for his education in one of the professions where the work is chiefly mental, his problem becomes an easy one; but these cases are rare. For those who lack special mental ability, or for whom it is not possible to secure the money necessary for the undertaking of long years of training, the best opportunities seem to be in the direction of skilled handicrafts, including needle trades of all kinds, commercial engraving, mechanical drawing, the making of articles from wood, reed or metal, printing, cobbling, manicuring, and photography. * A list of graduates from the Industrial School for Crippled and Deformed Children in Boston, with the wages they are earning and the cause of crippling in each case, is given in the Appendix, p. 235. 90 "*'^lp'g^ Main Building. Sleeping Porch and Sun Parlor in the Rear Children's Hospital School, Baltimore. (See page 158) '*"->-^'-' ' ■, ■,* t"^^^'- j} "is^-^ ^^1'^:^^.-^- ^ J^ry^f^"-' "*^-^ii!^ Surgical Pavilion Housh OF St. Gii.F-S thf Crippi.k, Garden City, L. I. (See page 168) CHAPTER V STATISTICS STATISTICAL information with reference to the institutions for crippled children has been gathered with great care and an effort has been made to standardize it as nearly as pos- sible. This has been a difficult task because of the difference in methods of bookkeeping and because of the lack of any standard as to building equipment; nevertheless, it will be seen that the results are very significant.- SUMMARIES OF STATISTICAL TABLES In discussing the statistics of the institutions for crippled children summaries have been prepared in order to bring out the most salient and significant facts in outline. The reader is re- ferred to the tables themselves for details. CAPACITY AND NUMBER OF CHILDREN IN CARE DURING YEAR IN 37 INSTITUTIONS (Summarized from Table I, pp. 108-1 ii) Group of institutions Beds for chil- dren Average number of children in care during year Total number of children in care during year 10 Hospitals .... 14 Convalescent hospitals or homes .... 13 Asylum homes 846 1,219 409 662 945 361 3,064 1,391 446 37 Institutions 2.474 1,968 4,901 Group of institutions Average numbe r children in care per institution Minimum Maximum Average 10 Hospitals .... 14 Convalescent hospitals or homes .... 13 Asylum homes 10 ■ 1 192 229 87 66 68 28 37 Institutions .... 6 229 53 91 CARE OF CRIPPLED CHILDREN The total capacity of the lo hospitals is 846. They cared for 3,064 children during the year, with an average of 662, which was 78 per cent of the capacity, leaving an average of one-fifth of the beds unoccupied during the year. They range in size from the New Jersey Orthopaedic Hospital at Orange with 16 beds, to the Hospital for the Ruptured and Crippled in New York with 250 beds. There are four with a capacity of 16 to 57; three with a capacity of 65 to 70, and three with a capacity of 100 to 250. The capacities of the 10 hospitals are as follows: 16, 50, 56, 57, 65, 70, 70, 100, 112, and 250; average, 85. The total capacity of the 14 convalescent hospitals or homes is 1 ,2 1 9. They cared for i ,391 children during the year, an average of 945, which was 78 per cent of the capacity, leaving an average of over one-fifth of the beds unoccupied during the year. They range in size from the Van Leuven Browne School at Detroit, with a capacity of 30 and an average of 25, to the Massachusetts Hos- pital School with a capacity of 250 and an average of 229. There are five with a capacity of 50 or less; five with a capacity of 55 to 85; three with a capacity of 100 to 200, and one with a capacity of 250. The capacities of the 14 convalescent hospitals or homes are as follows: 30, 32, 42, 50, 50, 55, 60, 60, 75, 85, 100, 130, 200, and 250; average, 87. The total capacity of the 13 asylum homes is 409. They cared for 446 children during the year, an average of 361, which was 88 per cent of the capacity, leaving an average of one-eighth of the beds unoccupied during the year. They range in size from " Happy Haven " in Chicago, with a capacity of six, to the Virginia T. Smith Home at Newington, Connecticut, with a capacity of 100. There are five with a capacity of 20 or less; four with a capacity of from 25 to 30; three with a capacity of 33 to 50, and one with a capacity of 100. The capacities of the 13 asylum homes are as follows: 6, 12, 18, 20, 20, 25, 30, 30, 30, 33, 35, 50, and 100; aver- age, 31. The 37 institutions combined have a capacity of 2,474. They cared for 4,901 different children during the year, with an average of 1,968, which was 80 per cent of their total capacity, which would leave an average of one-fifth of the beds unoccupied during the year. 92 STATISTICS RATIO OF CHILDREN TO EMPLOYES IN 36 INSTITUTIONS (Summarized from Table I, pp. 108-ni) Group of institutions 9 Hospitals a. .... 14 Convalescent hospitals or homes 13 Asylum homes . j . . 36 Institutions .... Average number of children in care during year 1.905 Employes 836 Group of institutions Ratio of children to employes Minimum Maximum Average 9 Hospitals a . . . . 14 Convalescent hospitals or homes .... 13 Asylum homes . 1.6 1.2 2.0 3.2 6.1 6.0 1-9 2.4 3> 36 Institutions .... 1.2 6.1 2-3 a Not including Minnesota State Hospital, which uses the unreckoned ser- vices of employes of the St. Paul City and County Hospital. The residential institutions liave a large number of employes, skilled and unskilled, in addition to the surgeons who perform operations and exercise a general oversight over the treatment of the children. The total number of employes in the nine hospitals is 319, or one employe to every 1.9 children. The number ranges from one employe to 1.6 children at the New York Orthopaedic Hospital and the Hospital for Deformities and Joint Diseases in New York City, to 3.2 children for each employe in the Home for Crippled Children at Newark, New Jersey. The average would be raised to one employe for every 2.0 children if we included the city branch of the Minnesota State Hospital, which is credited with only one employe for 5.7 children, a number which is explained by the fact that only employes working exclusively with crippled 93 CARE OF CRIPPLED CHILDREN children are counted, although a number of other employes in the St. Paul City and County Hospital, with which the state hospital is connected, do work for the crippled children as well as for the other patients in the hospital. The number of children for each employe in nine hospitals is as follows: 1.6, 1.6, 1.7, 1.8, 1.8, 2.1, 2.1, 2.6, and 3.2; average, 1.9. The total number of employes in the 14 convalescent hos- pitals or homes is 400, or one to every 2.4 children. There is a wider range between the different institutions in this group than is the case with the hospitals. The most liberal provision is at the Widener Memorial School at Philadelphia, where there is one em- ploye for every i .2 children. At the other extreme, the St. Charles Hospital at Port Jefferson, New York, has one employe for every 6. 1 children.* Nine of the convalescent hospitals have 2.3 or more children to each employe. The number of children for each employe in 14 convalescent hospitals or homes is as follows: 1.2, 1.4, 1.7, 1.8, 1.9, 2.3, 2.4, 2.7, 2.8, 3.1, 3.2, 3.5, 3.5, and 6.1; average, 2.4. The 1 3 asylum homes have a total of 1 1 7 employes, or an average of one to 3.1 children. The ratio is extremely varied, as in the case of the convalescent hospitals. The six children at " Happy Haven," in Chicago, are all cared for by one person. The most liberal provision is at the Children's House of the Home for Incurables in Philadelphia, where there is one employe to each 2.0 children. Only four of the asylum homes have less than three; children to each employe. The number of children for each em- ploye in 13 asylum homes is as follows: 2.0, 2.1, 2.6, 2.8, 3.0, 3.1, 3.3, 3.6, 3.6, 4.0, 4.2, 5.5, 6.0; average, 3.1. It will be seen that the proportionate number of employes is greatest in the hospitals, where most of the patients are in bed and closer attention is necessary. The convalescent hospitals have more employes than the asylum homes, partly because they approach more nearly to hospital standards of physical care and liberal educational provisions, partly because their incomes are more liberal. It requires more than twice as many employes in proportion * This includes only employes who devote most of their time to cripples. If the work of persons giving all of their time for cripples were included, the ratio of children to employes would probably be 4.0 or 5.0. 94 STATISTICS to the number of children to care for crippled children as it does to care for dependent or delinquent children in institutions. Many of these employes are trained nurses or other persons of special training, necessitating a high scale of wages. The relative in- crease in employes makes an increase in expense of food, furnish- ings, fuel, upkeep, and so forth, all of which contributes to the unavoidable increase of current expenses as compared with those of institutions intended for well children. FLOOR SPACE IN INSTITUTIONS FOR CRIPPLED CHILDREN Table II is a comparison of the floor space available for different purposes in institutions for crippled children. With proper ventilation and sanitary equipment, and with an abundance of porch space for outdoor living and outdoor sleep- ing, the question of cubical space per child becomes a secondary consideration. The height of stories will vary with the ideas of the individual architect and with the requirements of different climates. As a rule, higher stories will be built in southern climates than in northern climates. In modern hospitals, dormitories and children's wards are usually arranged with windows on three sides, or, at least, with cross ventilation. The floor space used for different purposes in the 33 institu- tions for which definite and comparable figures are available has been reduced to per capitas. At first glance there would seem to be no standards whatever; but when we come to consider averages we find that they do not vary much from the averages of other well planned institutions. They may be summarized as follows : FLOOR SPACE PER CHILD IN 33 INSTITUTIONS* (Summarized from Table II, pp. 11 2- 117) Group of institutions Square feet of floor space per child for Children Employes Miscellaneous purposes All purposes 9 Hospitals .... 12 Convalescent hospitals or homes .... 12 Asylum homes . III 117 '51 55 38 4' 148 98 137 3'4 253 329 33 Institutions 121 44 122 287 * For institutions omitted see notes to Table II, pp. 1 13, 115, 1 17. 95 CARE OF CRIPPLED CHILDREN There is a wide diversity in the amount of floor space per child in different institutions, ranging all the way from io6 square feet for all purposes in the St. Charles Hospital for Crippled Chil- dren at Port Jefferson, New York, to 526 square feet in the Country Branch of the New York Orthopaedic Hospital at White Plains. Nevertheless, when we take an average of all the 33 institutions, we find a standard which agrees remarkably with that of other well organized institutions for children. In " Cottage and Congre- gate Institutions,"* a description of 50 typical institutions for de- pendent and delinquent children, it was shown that the average floor space for all purposes in the 50 institutions was 257 square feet per child. The average for the 33 institutions for crippled children, as above stated, is 287 square feet per child, for all purposes. The average floor space for the personal use of the chil- dren in the 50 cottage and. congregate institutions was 128 feet. The average floor space for the personal use of children in the 33 institutions for crippled children, as shown above, is 121 square feet per child. The difference might easily be accounted for by the fact that many of the crippled children are bed cases and there is, therefore, less need of sitting room space and dining room space than in institutions for normal children. The floor space for dormitories varies from 28 to 88 square feet per bed, averaging 53 square feet. The average dormitory floor space in the 50 cottage and congregate institutions was 44 square feet per child. In nearly all of the institutions studied the dormitories have abundant ventilation, and 13 out of 33 have outdoor sleeping porches for a number of the children. The floor space, therefore, is adequate in most of them. Referring to the summary on page 97: when the institutions for crippled children which are now housed in old residences come to be located in adequate modern buildings, the amount of space required will probably correspond even more closely with that in the cottage and congregate institutions for dependent and delin- quent children than it now does. It is to be expected that, in practical experience, the average space employed in institutions * Hart, Hastings H.: Cottage and Congregate Institutions for Children. Russell Sage Foundation Publication. New York, Charities Publication Com- mittee, 19 10. 96 STATISTICS conducted by competent and experienced people will approximate closely the amount actually necessary. Some institutions may use too little space on account of poverty; others may use too much, because of bad planning; but in the end reasonable stand- ards will be found, as has already been done in the case of the institutions for dependent and delinquent children. DORMITORY FLOOR SPACE PER CHILD IN 33 INSTITUTIONS » (Summarized from Table II, pp. 1 12-1 17) Group of institutions Square feet of floor space per child for dormitories Indoor Outdoor Total 9 Hospitals .... 12 Convalescent hospitals or homes .... 12 Asylum homes . 54 40 54 5 7 5 59 47 59 33 Institutions 47 6 53 Square feet of floor space per child for dormitories Group of institutions Minimum Maximum Average 9 Hospitals .... 12 Convalescent hospitals or homes .... 12 Asylum homes . 49 28b 40 85 87 88 59 47 59 33 Institutions 28b 88 53 ^ For institutions omitted see notes to Table 1 1 , pp. 113, 115, 117. b This minimum of floor space for dormitories was in St. Charles' Hospital for Crippled Children, but their dormitory space has since been increased to about 32 square feet per bed. There is one respect in which the provision made by the institutions for crippled children is much less liberal, as has been mentioned, than that made by the cottage and congregate insti- tutions for dependent and delinquent children; namely, in the provision of space for the accommodation of officers and employes. 7 97 CARE OF CRIPPLED CHILDREN In the 50 cottage and congregate institutions, provision is made for 2,206 employes with an average of 264 square feet of floor space for each. In the 33 institutions for crippled children provision is made for 600 officers and employes at the rate of only 1 66 square feet for each. The rate for the hospitals is 170 feet; for the con- valescent hospitals or homes, 160 feet; and for the asylum homes, 168 feet for each employe, including dormitories, sitting rooms, baths, toilets, closets, and so forth. It is exceedingly important that people who are called upon to perform such responsible and exacting duties as those required for inmates of this class should have such accommodations for sleeping and recuperation as will keep them in good condition for their work. It is very difficult to keep high grade employes unless such accommodations are provided, and this matter should be care- fully watched in plans for future institutions. COST OF PLANT Table III is a comparison of the cost of plants of the different institutions for crippled children. The statement on page 99 summarizes the cost of plant per child in 30 institutions. At first sight there would seem to be a hopeless variation, for the cost of lands, buildings, and equipment per bed ranges all the way from $302 to $5,190 per bed; but on examining the averages some fairly definite standards are indicated. In the summary of Table III, referred to above, the seven hospitals show an average cost of $2,747 per bed. This high rate for cost of plant is partly due to the cost of land, which averages $617 per bed. It is partly due to the equipment which is necessary to any well ordered hospital, and is partly due to the fact that a number of the hospitals have considerable space de- voted to dispensary work for out-patients. The 12 convalescent homes, for which data are available, show an average cost of $1,294 per bed, less than half that of the hospitals. This lower cost is partly due to the fact that the con- valescent homes are located on country sites where the cost of land is insignificant. It is partly due to the fact that several of these homes are inadequately housed, and when they shall have built 98 STATISTICS adequate homes the average cost will probably reach $i,6oo or $i,8oo per bed. COST OF PLANT PER CHILD IN 30 INSTITUTIONS = (Summarized from Table 111, pp. 1 18-120) 7 Hospitals 12 Con- valescent homes II Asylum homes . 39 Institu- tions Beds for children .... 690 1,077 373 2,140 Total cost of lands, buildings, and equipment . $1,895,400 $1,393,300 $404,600 $3,693,300 Cost per bed Lands and buildings Surgical and gymnastic equip- ment Furniture and educational equipment .... Miscel aneous items 1(2,599 49 87 12 $1,155 18 104 '7 $1,013 8 55 9 ?i,595 26 91 ■4 Total .... $2,747 $1,294 $1,085 $1,726 Cost of plant per child per institution Group of institutions Minimum Maximum Average 7 Hospitals .... 12 Convalescent hospitals or homes . 1 1 Asylum homes $920 302 453 $5,190 3,232 2,739 ■ $2,747 1,294 1,085 30 Institutions .... $302 $5,190 $1,726 a Based on capacity; including cost of lands, buildings, and equipment. For institutions omitted see notes to Table 111, pp. 118, 119, 120. The II asylum homes show an average cost of $1,085 per bed. Asylum homes cost less than convalescent homes because their buildings are of a simpler character. It is probable, how- ever, that when these asylum homes are adequately housed the difference in cost in favor of the asylum homes will not be great. The per capita cost of asylum homes as they now stand is less 99 CARE OF CRIPPLED CHILDREN than that of the average cottage institution for healthy orphan children; whereas it ought to be probably a little more. Owing to the wide range of cost and the great difference in size and quality of buildings, study of individual institutions as shown in the statistical tables is necessary for an intelligent com- parison. The cost of land averages $617 per bed for the seven hospitals which are located in cities where property is expensive, and only $165 per bed for 16 convalescent homes and asylum homes which are located, usually, in the country, where land is cheap. The cost of lands and buildings together is shown to be jj52,599 per bed for seven hospitals; $1,155 pc bed for 12 con- valescent hospitals or homes, and $1,013 for 11 asylum homes. The cost of furniture, equipment, and miscellaneous items is $148 per bed for the seven hospitals; $139 per bed for the 12 con- valescent hospitals or homes, and $72 per bed for the 1 1 asylum homes. CURRENT EXPENSES Table IV exhibits the annual current expense per child for 34 institutions, three being omitted because the figures are not comparable. The amounts expended are as given on page loi. The proper care of crippled children is necessarily very ex- pensive. They need airy dormitories with good beds, spacious sitting rooms, and comfortable surroundings, in order to build up their frail bodies; they need an abundance of good food, milk, cream, butter, eggs, fresh vegetables, meats, and fresh fruit. They need skilled nursing, and a large amount of help is required be- cause the children themselves are able to render but little service. Gymnastic apparatus and expensive braces add materially to the expense. The total cost per child is as follows: In the hospitals, $570; in the convalescent homes, $348; and in the asylum homes, $267; the average for all classes being $406, or $1.11 per day. This expenditure seems large, but is not extravagant. It repre- sents the actual cost of the proper care of such children, and it brings direct returns in the restoration of children to health and self-dependence. 100 STATISTICS CURRENT EXPENSE IN 34 INSTITUTIONS » (Summarized from Table IV, pp. 121-124) Group of institutions Average number of children in care during year Current expense 9 Hospitals 13 Convalescent hospitals or homes . 12 Asylum homes 599 849 355 $341,450 295,295 94.853 34 Institutions 1,803 $73 ".598 Group of institutions Current expense per child Minimum Maximum Average 9 Hospitals .... 13 Convalescent hospitals or homes 12 Asylum homes . f233 153 184 553 431 S570 348 267 34 Institutions $153 $977 f4o6 * Based on average number of children. For institutions omitted see notes to Table IV, pp. 121, 123, 124. The corresponding expense for normal dependent children in cottage institutions ranges from $159 to J272 yearly per child, averaging ^196. The compensation of employes forms a large part of the ex- pense. It runs as follows: SALARIES AND WAGES PER CHILD IN 34 INSTITUTIONS* (Summarized from Table IV, pp. 121-124) Group of institutions 9 Hospitals .... 13 Convalescent hospitals or homes .... 12 Asylum homes . 34 Institutions . Salaries and wages per child Minimum 57 40 $40 Maximum 265 1 84 $528 Average 141 90 $164 » For institutions omitted see notes to Table IV, pp. 121, 123, 124. lOI CARE OF CRIPPLED CHILDREN The ratio of children to each employe in the hospitals is 1.9;* in the convalescent homes, 2.4; in the asylum homes, 3.1. These employes must be competent people of high grade and they command good wages. The average cost for food in these institutions is about 20 cents per day, or $1.41 per week, for each person fed, including children and employes. This is a very moderate rate considering the kind of food which is necessary for these children. FOOD COST PER PERSON FED PER YEAR AND PER DAY IN 34 IN- STITUTIONS^ (Summarized from Tables II and IV, pp. 1 12-1 17 and 121-124) 9 Hospitals 13 Con- valescent homes 12 Asylum homes , 3^ Institu- tions Average number of children in care . . ... Average number of resident employes .... 599 251 849 261 355 93 1,803 605 Total number of persons fed . 850 1,110 448 2,408 Total cost of food for year Cost of food per person per year Cost of food per person per day $66,665 78.43 .215 |8o,6o5 72.62 •199 $29,737 66.38 .182 $177,007 73-5 ■ .201 * For institutions omitted see notes to Tables II and IV, pp. 1 13, 1 15, 117, and 121, 123, 124. SOURCES OF INCOME Table V shows the sources of income of 35 institutions, the figures for two institutions not being comparable. The summary on page 103 indicates income from four different sources. Public funds form one-third of the income of the hospitals, nearly one-half of the income of the convalescent homes, and only one-seventh of the income of the asylum homes. Donations form nearly one-third of the income of the hospitals, one-fourth of the income of the convalescent homes, and nearly three-fifths of the income of the asylum homes. One-fifth of the income of the * Not including Minnesota State Hospital, which uses the unreckoned ser- vices of employes of the St. Paul City and County Hospital. 102 STATISTICS 35 institutions comes from invested funds, ranging from i8 per cent for the hospitals to 23 per cent for the convalescent homes. SOURCES OF INCOME OF 35 INSTITUTIONS* (Summarized from Table V, pp. 125-127) Per cent of income from Group of institutions Public funds Invested funds Pay patients Dona- tions All sources 9 Hospitals .... 14 Convalescent hospitals or homes 12 Asylum homes 33 47 14 18 23 21 18 5 3 3> 100 100 100 35 Institutions .... 36 20 10 34 100 a For institutions omitted see notes to Table V, p. 127. •> Including 6 per cent from miscellaneous sources. The following table shows the ratio of the income from public funds to the total current expenses of the institution. TABLE F. — RATIO OF PUBLIC FUNDS RECEIVED TO THE CURRENT EXPENSES OF 35 INSTITUTIONS » (Not included in the general statistical tables) Total current expenses Public funds Group of institutions Amount Per cent of cur- rent expense 10 Hospitals 13 Convalescent hospitals or homes 12 Asylum homes . i5355,393*' 295,395 94.853 §102,034 145,124 15,956 28.7 16.8 35 Institutions $745,54' $263,114 35-3 a Not including the Widener Memorial School, Philadelphia, nor Happy Haven, Chicago. See Table IV, p. 127. •> This figure includes $13,943, the expenditure of the St. Paul State Hos- pital not included in Table IV. It will be observed that out of ^746,000 expended for the support of 35 institutions for crippled children, 35 per cent came 103 CARE OF CRIPPLED CHILDREN from public funds. The convalescent hospitals or homes received 49 per cent of their support from public funds. This larger ratio is due to the fact that the convalescent hospitals or homes include the state institutions of Massachusetts, New York, and Minne- sota, which are supported entirely by public funds. The indica- tions are that there will be a steady increase of institutions for crippled children maintained entirely by public funds. Five of the 37 institutions are state institutions, maintained by state appropriations and controlled by state boards of trustees : two in Minnesota, and one each in Massachusetts, Nebraska, and New York. The remaining 32 institutions are controlled and ad- ministered by private boards of trustees, though some of them are subject to public inspection under the laws of the states in which they are located. The number of institutions receiving money from the public treasury was 1 7, as follows : TABLE G. PUBLIC FUNDS; SOURCES AND AMOUNTS FOR ONE YEAR IN 17 INSTITUTIONS (Not included in the general statistical tables) Hospital Public funds Sources Amount for one year Maine Portland Children's Hospital Minnesota St. Paul State Hospital (state institution) * Nebraska Lincoln Nebraska Orthopedic Hospital (state institution) New Jersey Newark Home for Crippled Children New York New York City Hospital for Deformities and Joint Dis- eases Hospital for the Ruptured and Crippled . State State State City City City $10,000 13.943 45,060 2,500 7.730 22,801 Total ... $102,034 ^ Conducted in connection with St. Paul City and County Hospital. 104 STATISTICS TABLE G. — PUBLIC FUNDS; SOURCES AND AMOUNTS FOR ONE YEAR IN I7 INSTI- TUTIONS — (Continued) Public funds Convalescent hospital or home Sources Amount for one year Maryland Baltimore Children's Hospital School State fe.750 Kernan Hospital and Industrial School State 5,000 for Crippled Children .... City 4,240 Massachusetts Canton Massachusetts Hospital School (state insti- Cities tution) and towns 64,958 Minnesota Phalen Park, St. Paul State Hospital and School for Crippled Children (state institution) . State 11,398 New York Garden City House of St. Giles the Cripple . Cities 6,495 Port Jefferson St. Charles Hospital for Crippled Chil- City dren and county 19,294 West Haverstraw State Hospital for Crippled Children (state institution) State 24,437 Pennsylvania Pittsburgh Industrial Home for Crippled Children State 5,000 Sewickley Sewickley Fresh Air Home .... State 552 Total 1145,124 Public funds Asylum home Sources Amount for one year Connecticut Newington Virginia T. Smith Home for Incurables New York Buffalo Crippled Children's Home . State and cities Erie County fi3,345 2,611 Total .... ... Ji 5.956 Grand total $263,114 105 CARE OF CRIPPLED CHILDREN Each state institution takes only children who are residents of the state in question, and institutions receiving public grants usually give preference to children from the state or city from which money is received. ADMISSION AND DISCHARGE Table VI* is a summary of the rules of admission and discharge. Most of the institutions are liberal in the kinds of cases admitted, with the exception of cases of tuberculosis of the lungs, which the majority of them reject. Many of the con- valescent and asylum homes exclude the feeble-minded, and a few exclude epileptics. The length of stay both in the hospitals and the convalescent hospitals or homes for crippled children is much longer than in ordinary hospitals and convalescent homes, because the conva- lescence is so slow. It runs into months and years instead of days and weeks. A most encouraging feature is that 1 5 out of 37 institutions maintain some helpful supervision of their patients after discharge. The ages of admission run low. There is an increasing recog- nition of the importance of early help in order to accomplish a permanent cure. No one of the 10 hospitals has any restrictions as to color. Of the remaining 27 institutions, 12 receive white children only, one receives colored children, and 14 do not draw the color line. All of the 37 institutions receive free patients. In nine in- stitutions all the beds are free; in 23 others the beds are usually free. Seventeen out of 37 institutions have no geographical re- strictions as to admission. SCHOOL STATISTICS Table VII t covers school statistics, sessions, and equip- ments. Schools are maintained by seven hospitals, all of the 14 convalescent homes and eight of the asylum homes; that is, in 29 out of 37 institutions. As to vocational training, it is difficult to decide in some cases whether the work taught should be classed as vocational training *See pp. 128-133. t See pp. 134-136. 106 STATISTICS or not, but it is probably fair to say that "vocational training" is undertaken in one hospital, five convalescent homes, and one asylum home. Four additional convalescent homes propose to introduce vocational training. Teachers are supplied by the public school authorities for seven out of 29 schools. Special desks are used in only two schools out of 29. Desks adjustable as to height are used in nine schools. Non-adjustable desks are used in eight schools, while ordinary tables and chairs are used in 1 5 schools. Four schools use more than one kind of furniture for school purposes. HAND WORK Table VIIl* gives details of instruction in handwork and vocational work. Eight hospitals and one convalescent home attempt none. In 10 of the remaining 28 institutions only sewing and simple housework are taught (with gardening in three cases). This means that these children receive no training in domestic science or vocational work beyond what can be given in the ordi- nary domestic routine in the institutions, which is ordinarily very little because the cooking and the service are not like that of an ordinary household. DISPENSARIES Table IXf gives a bare outline of the work done for cripples by nine hospital dispensaries located in seven cities. It appears from this table that about one-third of the dispensary work re- ported by the nine hospitals was done by one institution — the •Hospital for the Ruptured and Crippled, New York City. We hesitated to accept these figures, but on second inquiry they were confirmed by the records of the institution. Of the nine dispensaries, five are open six days in the week; one, four; one, three; and two, two days a week. Six are open two hours per day; one for one and one-half; one for three and one-half, and one varies from one to two hours. Only three report systematic visits to homes of out-patients. This part of the work should by all means be developed. There is a great difference in the average number of visits paid to the dispensaries by each out-patient in a year, ranging from two to 14. The average daily attendance ranges from nine to 147. *Seepp. 137-139. tSeep. 140. 107 CARE OF CRIPPLED CHILDREN TABLE I A.— SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 10 HOSPITALS Aver- Total Beds age num- ber of num- ber of Ratio of Statistics Hospital Sources of support for chil- chil- dren chil- dren Em- ployes chil- dren for year ending » dren in care during year in care during year to em- ployes Illinois Chicago Home for Destitute Crippled Chil- dren . Private 112 87 151 34 2.6 Sept. 30, 1911 Maine Portland Children's Hospital Public and private 6S 57 255 33 1.7 Dec. I, 1912 Minnesota St. Paul State Hospital State 70 63 155 II' 5.7' July 31, 1911 Nebraska Lincoln Nebraska Ortho- pedic Hospital State 100 70 153 40 1.8 Dec. 31, 1911 New Jersey Newark Home for Crippled Children . 1 Public and private S6 45 242 14 » 3.2 Dec. 31. 191 1 Orange New Jersey Ortho- paedic Hospital and Dispensary Private i6 10 34 S' 2.1k Dec. I, 1912 New York New York City Hospital for De- formities and Joint Diseases Public and private 57 49 od 333 31' 1.6 Oct. 31, 1912 Hospital for the Ruptured and Crippled >> Public and private 250 192 ^ I,l85« 109' I.S Sept. 30, 191 2 New York Ortho- paedic Dispen- sary and Hos- pital . . Private 70 62 462 40 1 1.6 Sept. 30, 191 2 Washington Seattle Children's Ortho- pedic Hospital Private so 27 94 13 2.1 Feb. r, 1913 Total . . . 846 6621 3.064 330 2.0 • In all of the tables, statistics for each hospital are given for the most recent year for which information was available. •> Capacity refers to new plant, completed 1913, other figures to old plant. ' Including adults', average number of children, about 27. d The average number of inmates for the New York Hospital for Deformities and Joint Diseases includes about 22 women, that for the New York Hospital for the Ruptured and Crip- pled about 20 women. The ratios of inmates to employes for these two institutions and for the group are probably not affected by this. " Including 189 women. ' Administration work done by employes of St. Paul City and County Hospital not in- cluded. If included, it would probably reduce the ratio of children to employes to 4.0 or perhaps to 3.0. ' Not including laundress, part time. ■" Not including clerk, laundress, and furnace man, part time. ' Not including 20 dispensary employes. 1 Not including 33 dispensary employes. '' Figured on exact average, 10.4 inmates. 108 STATISTICS TABLE I B.— SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 14 CONVALESCENT HOSPITALS OR HOMES Aver- age Ratio Beds num- Chil- of Convalescent hospital or Sources of for ber of dren Em- chil- Statistics home support chil- dren chil- dren in care during year in care during year ployes dren to em- ployes for year ending ■ Illinois West Chicago Convalescent Home for Destitute Crippled Chil- dren . Private 60 40 60 17 2.4 July 10, 1912 Maryland Baltimore Children's Hospital School . . Public and private SO 30 84I 16 1.9 Apr. 30, 19 1 3 Kernan Hospital and Industrial School for Crip- pled Children Public and private 55 53 190 38 1.4 June I, 1912 Massachusetts Canton Massachusetts Hos- pital School Michigan Detroit State 250 229 264 65 3-5 Nov. 30, 1912 VanLeuven Browne Hospital School Private 30 25 48 8 3.1 Mar. 31, 1913 Minnesota Phalen Park, St. Paul State Hospital and School for Crip- pled Children . State 60 38 69 12 3.2 Jan. 31, 1913 New Yoek < Coney Island Sea Breeze Hospital Private 42 42 53 25 1.7 Sept. 30, igi2 Garden City House of St. Giles the Cripple . Public and private 85 45 80 13 3-5 Sept. 30, 1911 Port Jefferson St. Charles Hospital for Crippled Childrenb. . Public and private 200" II0« 130° 18 • 6.1 • Jan. I, 1913 West Haverstraw State Hospital for Crippled ChU- dren . State 75 61 82 27 2.3 Sept. 30, 1912 White Plains Country Branch New YorlE Or- thopaedic Hos- pital . . Private 130 104 132 57 1.8 Sept. 30, 1912 Pennsylvania Philadelphia Widener Memorial School . . Private 100 96 96 78 1.2 July 29, 1912 Pittsburgh Industrial Home for Crippled Children . Public and private 50 45 50 16 2.8 Apr. 30, 1911 Sewickley Sewlcliley Fresh Air Home Private 32 27 53 10 2.7 Dec. I, 1911 Total 1,219 945 1,391 400 2.4 * In all of the tables, statistics for each convalescent hospital or home are given for the most recent year for which information was available. b Department of Brooklyn Home for Blind, Crippled, and Defective Children. " Figures refer to cripples only. ^ Not including seven readmissions. ^ Includes only employes who devote most of their time to cripples. If all work for cripples were included, the ratio of children to employes would probably be 4.0 or 5.0. 109 CARE OF CRIPPLED CHILDREN TABLE I C— SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 13 ASYLUM HOMES Aver- age num- Chil- dren in care during Ratio Asylum home Sources of support Beds for chil- dren ber of chil- dren in care Em- ployes of chil- dren to em- ployes Statistics for year ending • during year year Connecticut Newington Virginia T.Smith Home for In- curables Public and private 100 87 IIS 28 3.1 Oct. I, ipii Illinois Chicago Happy Haven Private (South Side Crippled Children's Aid So- ciety) 6 6 6 Id 6.0 Maywood Home for Disabled Children Private (National Children's Home So- ciety) 12 ZI II 4° 2.8 June IS, 1912 Massachusetts Hyde Park New England Pea- body Home for Crippled Children Private 30 30 38, 14 2.1 Oct. 1, 1910 New Jersey Englewood Daisy Fields Home and Hospital for Crippled Children . Private i8 l8 23 S' 3.6 Apr. i, 1913 New York Buffalo Crippled Chil- dren's Home Public and private 35 22 36 4 5-5 Oct. 1, 1912 New York City Darrach Home . Private 20 l8 22 5 3.6 Jan. i, 1911 House of the An- nunciation for Crippled andlncurable Children Private 30 30 31 10 3.0 Sept. 30. 191 1 New York Home for Destitute Crippled Children b . Private 25 20 • 22 « 5" 4.0 Oct. 16, 191 2 Ohio Cleveland Holy Cross House Private 20 Ig 28 7 2.6 Sept. i, 19H N. B. For footnotes see page in. no STATISTICS TABLE I C. — SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 1} ASYLUM HOMES — (Continued) Asylum hom^ Sources of support Beds for chU- dren Aver- age num- ber of chU- dren in care during year ChU- dren in care during year Em- ployes Ratio of chU- dren to em- ployes Statistics for year ending Pennsylvania Philadelphia Children's House of the Home for Incurables Home of the Mer- ciful Saviour for Crippled Children House of St. Michael (and All Angels . Private Private Private (Episcopal Sisters of St. Mar- garet) 33 SO 30 26 SO 2S 32 45 37 13 IS 61> 2.0 3-3 4.2 Apr. IS, 191 1 Oct. 31, 1911 Sept. 1, 1912 Total . . . 409 361 446 117 3.1 ■ In all of the tables, statistics for each asylum home are given for the most recent year for which information was available. ti Institution closed since this study was made. « Estimated. "* Home conducted by one volunteer worker; occasional outside help. ■ Not including man and laundress, part time. ' Not including seamstress, gardener, and furnace man, part time. ' Not including laundress, part time. '' Not including two laundresses and furnace man, part time. Ill 3 «».a- g H a as. ■*-^Q0 .0 o no\ 'M ^ -5« a S ><-S4i£.2' < o Z O Qi u 0. u < (/D O o 03 < Hull's, SO w Q, CO ^ d a mU ut: OS SB aa mZkUU ^ O C8 Q'S B C> li O £• ^a i s-cs wOkquu '?: : is nu^ ca o-i Qflo 5 o 3 1 12 f*3 10 10 0»t^« 0000 w r-00 Vi n ^ n M M . OOO fO M to H H MO : : HI C4 H 00 H ^ low N 0» . , HI M H M . . s M H N % 00 HI fO 1 ro J* 10 H »o»oo s fO t* 00 DO M : :%" 3 ^ 000 . 00 H a M ^ H 0\ . ft -* ^ Hi & : : Oi S5 ■^ . 10 N t^OO WoiO N H W PON 00 00 . . 00 •g •^ HI wi fO W . ^1 Ht M M 10 . HI HI 10 . r. r- 00 S 5 , ifl-* H 32 5 M 00 i fO ro 00 Tfr-io a^r»vO « ro . HI a « for- Ht HI 10 For employes Sitting rooms Dining rooma Bed rooms Baths and toilets 1 •3 1 For general purposes Offices and reception rooms . Kitchens Laundries Store rooms HaUs Porches " Miscellaneous . . ... 1 "(3 For special purposes Medical and surgical rooms . Gymnasium — corrective .... Brace shop 1 0, hi 3 1 I. ca ' u 3 ¥ o, .a; 'Si's at! u «g .as a iSsil 2Ju 2=5-2 gg K-y O m 4J p. S J M 13 O Ji ^u ■- KB m5 M MB s.SsfoSao.s :! Tl a> ►.; «3 1'" ►^ *J (Q'm a — M S 3 ^s; s- ^1 e ii, ■a'" «.a .d c d « g-S2 le of the te y Hospital ng. not m use 5.3 "_-g •asssssss ■SU'T^'C « « a _.CiHiI;[Jd^o . ^.o ■>. - .a ., ^ H3 UJ S o Oi O < [- o a: H Z U u LU J < > z o u z X u u U o to o o CO < f- •a o H CO o ^r-« o « t* o o H Ot*M H H H Pennsyl- vania Sewickley, Sewickley Fresh Air Home n n a a woo . . I-I O M U) e O P. FO - « to HI Pennsyl- vania Pitts- burgh, Industrial Home for Crippled Children o WON M\0 m w ro H«0 M W M M to M w New York White Plains, Country Branch, New York Ortho- paedic Hospital o M for-oO MOO Ooo Ch to to S New York West Haver- straw, State Hospital for Crip- pled Chil- dren .gg-r-jjWHO S :"g : •g in New York Port Jefferson, St. Charles Hospital for Crip- pled Chil- dren" o 8 . OO 00 N O Ol". « M TT S New York Garden City, House of St. Giles the Cripple V) GO « . . N Minne- sota Plialen Park, St. Paul, State Hospital and School for Crip- pled Chil- dren J , Ococo N>o .« o It N O Michigan Detroit, Van Leuven Browne Hospital School % H\OQ0 . IfliflM . . CA . Oi s Massa- chusetts Canton, Massa- chusetts Hospital School'' o : : : s; Mary- land Baltimore, Keman Hospital and In- dustrial School for Crippled ChUdren V) ■a V5 .eo . 00 M Mary- land Baltimore, Children's Hospital School O . . »* . N "O "'. ■* ^ OtO> . 00 Illinois West Chi- cago, Con- valescent Home for Destitute Crippled Children s fO ■* r» .nui looo M « . W H »o 00 r? 00 3 1 Square Feet of Floor Space, Per Bed For children Indoor Day and play rooms . Dormitories and wards School rooms — ^general School rooms — ^industrial . Dining rooms Baths and toilets . Clothes rooms Isolation rooms 1 Outdoor Day and play rooms . Dormitories and wards School rooms .... H I 114 «*M^ CO ooo r»^o»>nfO « N M a o . . o fO to w 1 O lO N S W M W N . s r*) . . ro O (O o> 00 H ^ N H «U1 H n . . ro n % to H 3 H s H O lO H H .00 rflw ■^SETeJ^^iS '^ g Oi . . Oi w M 00 M to .HON H H a a (0 O o H H H C4 C4 H 00 M H >H M o M . . w lO M CO M OO H . . FON M t* K t*0 . . Si « . . to o H 00 C4 H w H ; ro . . fO CO 00 S 3 inoo woo Noo w ■^H . lO to o NO H 00 M M 00 H «0 rOO -it . N HI M N fjro . 2 to H ro o ro HI . rf)(*it^ H H M ^ H o t: 1 CO 5 fO w CO ro M M « . . (O to to 00 HI For employes Sitting rooms Dining rooms Bed rooms Baths and toilets . (0 1 1 For gCMcroJ purposes Offices and reception rooms . Kitchens .... Laundries .... Store rooms .... Halls Porches'* Miscellaneous 1 1 For special purposes Medical and surgical rooms . Gymnasium — corrective Brace shop .... a 1 •3 1 1 1 n £ . si s ■§ *- Pi . u s trf n M o S s C^ O Ol as e m ft V C . S rtO CO ** Q S 0,8 u S S M > .SugSJoiS ago. O fljjj 41— ™ ^ P ..'O ft, « 3 ' i| 0.S "0, o.>. B.O a; n •o 3 H - H ij a d ft -G 3 c 4* ts S^.S«|.^'3.S-o.-SagS-a ■2-1-o?SS-3 6gS.2gj;o rt M B u go fl o.S SjS o s "5 1 0> ■* P- ■* in OkO o M lO H M M H lOli^M tH H a 00 .a a ■ ■ Oi 00 1 ^ Sg^-a u S3 I, ■Si o TfO Oi . o> ^ fO t* : : : • o H a H CO Ui S o X S 3 s N m ^ P- ro w (vj . H>0 « M Hf M tH ; ; M M 5 r-io . . ro»n« »o s < z 10 o CO O . , O t»P0O» & : : M Q J X o Millie in M ^ . . HI w u u < a; 8 00 .10 .00 rcoi ^ 00 M ||^^- sill, II W ■^M IN W W H 00 t>Oi ^ 00 1 (J H g 00 . . 00 vO H < i2 o^- 5*°: :"':'°& : t-l H H M o o M 5 W lO . o M 1 u XI & ^ B9g-i55tf ^ is ■ Si . Ml & 1 16 M (*S ^ N O , C4 ■* ooooo r-00 ^00 OlUlOOOO M ^ M ■* M . Q .O Ovt>- n H N sOOO lO W3 fO N . HI N ^« . aa s cog's « s c a g Ill's « 1 ^■2 ° g ^ d to 0) O "^ b V to S T 8 a.S *i3| a , o 'o~S>' a ■s Iff U >i o 1 a a o 0) H s PQ a fc> rt o O h ° & 53, a a p . 'R'O a •d 01 .8 m flJ rt . S rt.S S C-S .-• li (U V V V o ".S 117 M U ** S§ o « o « m o « r- W O Tf n <*i . Ov n ■ lO t- « I-- M 00 .2 -M ■ o Surgical and gym- nastic equipmen S ro «o w ■* « -*. q hi ■o •o CO V) O H WOO t^ a O O M a CO a o H rt IN N H M N N^ ■>* o .fS t* w» o o o o o o o o D) 4J o o o o o o o o P e q q q r- moo "t -.2 M w -(f eo ■«? t^ H in (4 A O « Oi «o O Oi M 5* H W_ HI °°- ,0 Q w. w H M o£ Ua V U N m O O t- o o O m'O H vO O to in lo ifl o. TJrS H H N vO Ejg cq o T) . •a "d • 4J ad ^ a . . ^ fl] d rt g .si' 1 .8 .S •« -3 ■ K stitute ital pedicH 2 e & .ii ■a edC Defo ses le R oped •a S. 1 1 a S5; fi 1 INOIS Chicago Home for Children INE Portland Children's H BRASKA Lincoln Nebraska On w Jersey Newark Home for Cri w York New York City Hospital fo: Joint Di Hospital for Crippled SHINGTON Seattle Children's O ^ S S Z Z g $ >>3j ^ O u'gl J3 in J ■ d i« 3> ^^.^ •o a" 2'So)« s. »>.'Ba lis I lig'S's I -. d.^ b ^- "__-.tJ M a ijS as ^ 52 8 b 2 ■s "«>2 -a d-g-aS I > OJ u o ^ iFtl i S'«"--aogS t aZ &I =2 ^■g to g te s «.o o S.8 mil III S"" 3 <0 O g rill •a ao 8§ 73 a .2 u wo T3r3 la's ■3 •9 8 -S S IJ >. .■§ '"■2 ■S8 .- -o o a « I ^1 S 9 ■ " 1« -s-sl dj a -^ M V o •o fta-g,. - -S Jig's t-i nt CO a -3 EO ill h n e v a o. CO a av^B I 5 o ^^ 8 •a -g gcq |« 2s4 Is •2g> •? a £ .'-' o ■; H P fl ft as SS tu S o a: § D J >< < < H < o oi u i- Z < a. u. O O o u .J < ■3 3 2 §■§1^ S Sac's g.S « 3 S) 35.9 2-| (Ol3 Sg 10 s ^ V. OS §? «a ■3 M^ s 'g.sS .a„-S a>3 « 01 2 ■US s Si" I u a sd8 [33 Mrt as 2 ^ W TO - -.2 S s3 " •Sag" S-gTJ'-n Ol >. CO a a 1 = ^3 mi 3 o "■S.9 't^ DiA e -e M .a 0-- 120 » o S 1 "3 9^ o ^ DO ro 'J- in r* i> H o 2Si Q. 00 o (O ro a o* *o t- =2. r* ^ « N 00 00 m Oi ^ m 1 "i "SSS ■H III r» Ot ■* M ■^ H iH ro o « o NO ro in H « t* ro M o •o cd •-•9"=a [/3 o ^ )H 00 tn t- 00 t* 00 00 < •q a Mg. ^ u> c* -* ■* •* M ro m V cd M 0. w H HI ^ s gg oi (/2 O 'S Ifl 00 o. H O Ol HI m z h & ti« M M N • m HI o ro CN i2 p« Z ■a g M bo < 1 o M in ■«1- H M , E 8 U Jl < u oi •3-2S o o r- „ Oi H * O ro 2 a. s d bj] .s ■o ■* M ro mm t- m u en Z A u •|g o M o M O r* fo 00 M M w> M ro lO o m M o DO HI 0. X P o £" «» H HI N H HI H HI u H 10 z S m « H M H O fO « 00 o W fO O 00 00 in m ■^ M to ■* H tH H ro (O w m n N 1"^ w» ** oi o O 00 o O ON ro r* O CO M r» o m 00 00 DO m u M ■* o -* n. 00 r- m °i "t < Z z ^ V^ ■s ? d Ch 3 ■§" S" M M t Average number of children in care during year t^ r- o in o •a e 2 c N t* o» DO Vi r» ■* M ■* a « N Oi < > tH m w I • u • , u L 0) .-rt . U I . y . < 1 5. 1 I I If 1 |- 5 ■ 3 2 ' l'. S. 11 51 ry . . . City al for Deformitie id Joint Diseases al for the Rupturei id Crippled . York Orthopaedi ispensary and Hoa tal . B oi Sb 1^ i 9 1-1 z o w York New York Hospit an Hospit an New Di pi' .SHINGTON Seattle Childri Hi ■3 3 < M .? ii S » 2 t, & •a o, 3 3 (9 CO V u 5S So n u H 2a OS B S OIIM s o flj tn . o O ?'g a)^^ b > in V P, £_^HH KHHhh =t 'S9 2 « u .tj o iH » S: a jfifti: ££||Sjoa •OS "3 "-o 1-^ S « S °^Sgg Qta ca *j ™ ^H j> ^ lu Id a o g' u'ei u •3 a, o p,3.B „ B SS.Hu^3a3 121 d lli O to n M ro o O O 0» N (4 M ^ M Oi WJ o H a r* o tn rt M M lO « H fO « N H ^ m cn HwS w> U 4J % O ^ a to E o 0> 00 m Tf w m w M oi 9! •* ro « -* o ro m ro lo ■^ o sl* m M c« -J < WJ M O r- Oi lO 00 m M 00 00 H •O fl uo. M N ■* H M fO U Cd >H Oi «4 cu s gg Ul O X 2 (- ■| O tH fO in t^ Ov Oi O O C4 s z •y 6« u is pi! u a (/3 A u w w .J § ifl O 00 M m O ■^ rQ < > 1 M M M z 't u u ^ o u i; f<^ b 'oJ'd^ lO " -* 00 w 00 3 d M M ") M w in PO ta «ia d* z < >S lO -er ■* O 5 lO >0 o r- r- fn ol II ro O l-t H 00 « t* CO -^t a < ia,« u oi Ui .§„s o 00 t^ o OV o <*■ O t- 00 m cu ?^ bfl ^ 00 Oi O l-l ro Oi »0 t* o M Ht M M « M C4 on l"*^ «>» Z sill o ■* o »o o 00 in ^ f*3 't in cu o a O O n o» N (*) l-t O in X f*5 o" oo" vn 00_ fo tt o t- m H ro » ■* UJ H M o •^ N M M « m Z 1^2 S'C S o O rO o. lO 00 w m o M ■* (^ -* M m w « « ■^ ■* H \0 o ^p-s^^ « H H _J < D z z t 03 > 03 < a 1 1 lii ..III - o-n-o J" SBC C Oi 1 ■ s a . MS f Is 5^ & li. II -=g l« ^ ^^ Sila 11 tU^ Sig K^ %i J < < H S [d d S c ? % s z 122 ^ ^ 1 -a 5 1 M , V) 00 H Ok C4 00 N M CO 00 l> N M M IH *1» o m M M in t^ Ok •"t 00 Pennsylvania Pittsburgh Industrial Home for Crip- pled Children . SewicHey Sewickley Fresh Air Home •3 i2 ■s o B g 2 3 d a S a ■& Ss ** lb a ^Sjs 01 '^ u a ■a §.s^ U 01 <^ ^ CO S'fl I §11 -a t^«S .2 ■» »._ It o B V >. .a ■a o '-3 em" I 53 a § p. .So a j; ^ o - .. - "US ^ u V a a ■s .S gig* w o S aJ ri Ti V IH £ tJ B ^ d s d d d 123 -5. u 5 S S a- .3-0 3 S >3 9 !^S ■S B o ■= to a ii 1 3 u •d a a ■c u ■ft y a a s *^ o I z 3 o •a •c u ,U IS P S M ui • r«s S S I a. e o M J3 S J3 U B o W W 2 1 S oia-SM 3g •"3 •23 .go an S5 •.!|Q h g u "<: i a^ o i?-§sl ■^ O ^^ One social service worker recently engaged Through dispen- sary and staff of S visiting nurses Through dispen- sary and visiting nurse 2}/i to 11 = Any under 21 d Any under i6 2 to i8; a few adults All Boys i)4 to i6; girls iH up All Age limit for dis- charge ! to 14 and adult women « Any under z6 No rule No rule No rule No rule Boys i6; girls no rule No rule No rule No rule No rule Sexes received Both Both Both Both Both Both Both Both Both Both Color re- striction None None None None None None None None None None Financial terms Usually free; maxi- mum charge $$ a week <> Medical service free; patients pay for braces; board often free; maximum charge $1 a day Free Free Usually free; a few pay Si to Sio a week Usually free; maxi- mum charge $s a week Usually paid for by relatives or city; some free; some private cases About 6o per cent paid by city; 20 per cent free and 20 per cent pay 94 per cent free; occasional pay- ments J4-S7 a week Usually free; maxi- mum charge Jio a week Geographical restrictions and preferences Intended for resi- dents of Illinois. Rule not strictly followed In-patients must be residents of Maine. Out- patients no re- strictions Minnesota chil- dren only Must have been resident in Ne- braska one year None Preference given to New Jersey children None None None None d Charter permits taking of adults, e All ages treated in dispensary. 129 TABLE VI B.— RULES OF ADMISSION AND DISCHARGE Kinds of orthopedic Physical and mental Usual period of Convalescent hospital or home cases taken and restrictions and stay in in- preferred preferences stitution Illinois West Chicago Convalescent Home for Desti- tute Crippled Children . Curable cases; no Backward children At least until cured bed patients at received, but none present obviously feeble- Maryland minded; no lung Baltimore tuberculosis Children's Hospital School Cases likely to be Lung tuberculosis Until benefited as cured or distinctly and feeble-minded- much as possible improved ness excluded *■ Baltimore Kernan Hospital and Indus- trial School for Crippled Children .... All kinds Backward children Plan to keep until received, but none as much benefited obviously feeble- as possible" Massachusetts minded; no lung Canton tuberculosis Massachusetts Hospital School AU kinds Feeble-minded and Until benefited as epileptic cases ex- much as possible Michigan cluded Detroit Van Leuven Browne Hospital School .... All kinds >> None As long as they need a home Minnesota Phalen Park, St. Paul State Hospital and School for Crippled Children . All kinds Lung tuberculosis Until benefited as and feeble-minded- much as possible ' ness excluded New York Coney Island Sea Breeze Hospital . Tuberculosis of bones Because of great Until benefited as and glands only. demand seldom much as possible Preference to bone take feeble-minded Garden City House of St. Giles the Cripple . tuberculosis or chronic cases All kinds Very few feeble- Until benefited as minded cases; no much as possible, new ones will be or as long as they Port Jefferson taken need a home St. Charles Hospital for Crip- pled Children* . All kinds None •* Until benefited as much as possible, or as long as they need a home West Haverstraw State Hospital for Crippled Children .... All kinds Feeble-minded cases As long as in need not often taken of convalescent White Plains care Country Branch New York Orthopaedic Hospital Curable cases; espe- Lung tuberculosis Until cured and cially bone tuber- excluded probability of re- Pennsylvania culosis lapse is past Philadelphia Widener Memorial School Permanent cripples, Accept only those Until 1 8 to 21 for yet not absolutely likely to become purpose of indus- helpless partially self-sup- porting. No lung tuberculosis, feeble-minded or trial training Pittsburgh backward children Industrial Home for Crippled Children .... All kinds Preference to those At least until bene- likely to profit by fited as much as industrial training. possible; occasion- No lung tubercu- ally longer for losis, no feeble- purposes of educa- Sewickley mindedness tion Sewickley Fresh Air Home All kinds Children with lung Until benefited as tuberculosis or much as possible markedly feeble- minded or epilep- tic, excluded " Department of Brooklyn Home for Blind, Crippled, and Defective Children. *■ Occasional non-orthopedic cases. » Occasional exceptions as to feeble-minded. <■ Feeble-minded children segregated. • This policy is not fully carried out because of demand for beds. ' May decide to keep for industrial training when organized. > Expect to employ visitor. •■ Most institutions which have no formal system of after care keep in touch with many discharged children through correspondence and visits of the children to the institution. 130 IN 14 CONVALESCENT HOSPITALS OR HOMES After care and visitation Ages received Age limit for dis- charge Sexes received Color re- striction Financial terms Geographical restrictions and preferences New institution; policy not defi- nitely decided 4 to 14 No rule Both None Free Cases transferred from Home for Destitute Crip- pled Children, Chicago Preference given to Maryland chil- dren None" 3 to 10 13 Both White only Usually free; max- imum charge $^ a week Through dispen- sary and staff of 3 visiting nurses Up to about i6 Undecided Both White onlyp Usually free; max- imum charge S14 a week Preference given to Maryland chil- dren None" Sto IS No rule Both None State, cities or towns. Parents pay $4 a week if able Must be residents of Massachusetts None' 3 years up ' No rule Both White only Usually free; max- imum charge $s a week None None" 5 to 17 ' Undecided Both None Free Minnesota children only Visits by agents of the Association for Improving the Condition of the Poor None" 2 to 12 Up to i6 No rule . . Both Both None None Usually free Usually paid for by city None None Visits by agent of Catholic Orplian Asylum Society No rule k No rule Both No rule City cases at $.40 a day, others free or payment small Most children from Brooldyn; none from Man- hattan; a few from other states None" 4 to i6 ' No rule' Both None Free; parents furnish clothing if able Must be resident of New York State one year None; if necessary would be super- vised by nurses of city branch " Plan boarding home for dis- who are partially self-supporting 3 years up k 4 to 10 " No rule 21 Both Both None White only Usually free. A few pay some- thing Free None Preference first to residents of Phil- adelphia; second, Pennsylvania out- side of Philadel- phia; third, any other states None" 3 to 12 " No rule Both No rule; no col- ored chil- dren yet taken Usually free; max- imum charge $1 a day Pennsylvania chil- dren only None" 3 to 12 ' No rule Both White only Free No rule; so far, all but one from Pennsylvania ' Occasional exceptions. ' Occasionally under five. ' Probably would not take boys over 12 years. ' Occasionally receive children under four years. "> All children must be indentured to the institution until 21. » Occasionally receive children over 1 2 years. ° If children remain after 16 they become "helpers" and may stay indefinitely. P Colored children treated at city dispensary. •31 TABLE VI C— RULES OF ADMISSION AND Asylum home Kinds of orthopedic cases taken and preferred Physical and mental restrictions and preferences Usual period of stay in in- stitution Connecticut Newington Virginia T. Smith Home for Incurables Illinois Chicago Happy Haven Maywood Home for Disabled Children Massachusetts Hyde Park New England Peabody Home for Crippled Children New Jersey Englewood Daisy Fields Home and Hos- pital for Crippled Children New York Buffalo Crippled Children's Home New York City Darrach Home House of the Annunciation for Crippled and Incurable Children New York Home for Destitute Crippled Children » . Ohio Cleveland Holy Cross House Pennsylvania Philadelphia Children's House of the Home for Incurables Home of the Merciful Saviour for Crippled Children House of St. Michael and All Angels .... All kinds No children unable to attend public school classes for cripples Cases not requiring surgical treatment All kinds Curable cases, able to walk All kinds All except helpless All except menin- gitis; no long-time bed cases Cases not requiring surgical care or nursing All kinds All kinds of incur- able cases All kinds AH kinds Lung tuberculosis excluded ° Until benefited as much as possible: longer if they need a home Lung tuberculosis As long as they need excluded a home Feeble-minded, deaf and blind cases and those with lung tuberculosis , excluded Lung tuberculosis and feeble-minded- ness excluded Lung tuberculosis and f eeble-minded- ness excluded Children with lung tuberculosis or markedly feeble- minded or epilep- tic excluded Lung tuberculosis excluded Children with lung tuberculosis,** epi- lepsy, St. Vitus' dance or syphilis excluded Lung tuberculosis and feeble-minded- ness excluded Children with lung tube rcu 1 osis , known to be feeble- minded, or requir- ing special diets, excluded Children with lung tuberculosis or feeble-minded or epileptic excluded Lung tuberculosis and feeble-minded- ness excluded Lung tuberculosis and feeble-minded- ness excluded Until self-supporting or a good home is found Until benefited as much as possible; or . until self-sup- porting if they have not good homes Until benefited as much as possible; longer if they need a home Until benefited as much as possible; longer if they need a home As long as they need a home As long as they need a home Until age limit if they need a home As long as they need a home * Most cases perma- nent ; transferred to adult depart- ment at various ages Girls as long as they need a home. In- curable boys trans- ferred to institu- tions for adults at about i6 Boys must leave at 10. Aim to place girls at service at about 1 8 » Institution closed since this study was made. ° Plan to take no feeble-minded cases. d Possible exceptions in cases under four years, slightly affected. e Do not plan to keep adult cases. 132 ^ Some exceptions. DISCHARGE IN 13 ASYLUM HOMES After care and visitation Ages received Age limit for dis- cliarge received Color re- striction Financial terms Geographic restrictions and preferences By agents of Con- necticut Chil- dren's Aid So- ciety None* By agents of Chil- dren's Home So- ciety None' None' By members of a visiting commit- tee, who also co-operate with other agencies None' None' None' None' None' None' None' 2 years up s School age No infants. None over 8 To 12 3 to 10 Up to about i6 3 to 12 ii 4 to i6 ■■ 3 to 14 No rule Up to 12 2}^ to6 No rule No rule No rule No rule Boys, 14, girls, no rule No rule No rule No rule ' Usually 17 No rule No rule No rule Boys, 10, girls, usually iS Both Both Both Both Both Both Both Girls only Both Both Both Both Both None None None None White only None White only White only White only White only White only White only Colored only State pays $3 a week for one- half; a few free. Relatives or towns pay some- thing for others, usually {i a week Usually free; i pays $4 a week Usually free; par- ents may con- tribute to home Usually free; maxi- mum charge $3 a week Usually free; a few pay small amounts Usually free; per capita rate for county cases Usually free; : few pay a little Connecticut chil- dren except in rare instances None Free Free Usually free Usually free ; maxi- mum charge $7 a week Usually free; a few pay small amounts Usually free; few pay $i week None New England chil- dren None' None None None None Preference to Cleveland chil- dren; some from other cities and states First, Philadelphia, second, Pennsyl- vania, and third, other states Preference to Penn- sylvania children others taken None ' Most institutions which have no formal system of after care keep in touch with many discharged children through correspondence and visits of the children to the institution. s Adults not taken. t Occasionally under four. ' Usually leave at i6. ' Receive mostly New York City children •33 1/5 z o D t/} Z t^ m Z H Z s £: a u Q Z < 1/5" Z o on t/3 u t/> ui ai u X U < u H Qi O Q < ai o o O X u 1/3 o z 5 z UJ h- H < Z u Di Q (J 09 < Tables and chairs used S S .ss S > >, »* >< s 4^-^ 0) OX a B S 5 §3*" .2? bO •a 1 1, aj P^ 1 <.l-ss| •a a n m Vi lO o O •a s . . f*j g s Pi ^ 1 « ro f!Npo ■ ro iiiilli^ c* • • M • £ ^ ^1 a-g>.^ • •O • M S s& w-a " H ^•n asi ^■s >>i.2 N |s "^■°|i T3 bO 1 r- : :g : : a 3 lis fl « ^ll g *-3| •i d !>BS •= * g a S -* ■ fO ■ 1 3 o w w (OH « 3 a H "^ o (0 M a-S o o lO V)N lO « M i. c M fl-S-g o o • o • w e ►^5(3 N :5M >. i "l ■ . > >4 >4 fO H M vO « o lO o ■* o « ^ M to CH lO H o o M ' -* lO Ifl m U) ifl lO «5 W Ifl to « lO to lO "' : : ? 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J3 O < I CtC t"* o 1^ &' ,M 15 O > 2 St) 3.9 £ o a a 3= o.2< gfe.H gss rt S o o IUJ3 o O ■gUKK ■o.S •§1 'p Eg ,„•§" Hi £■« B 2 " T)J3 3 3-" O 5.SS| B-« 9.S at OS s ■" B e m ■>, nj nj 139 Visits to homes of out- patients in year i M 1 i 1^ oo "2 § 1 2 M ZZ U Z 1st s: ::?; N H ci a ti t-t ro t o o tn o O O O O lO 5 °.s fn ro i-t H w M(*S PO o z plisS •a "? q P4 ifl q o ct q % « M i> lO ■•i- ft X o ^ in 0+* , a ■a s -. i H i4 a a)-* . o TT O 00 a rfO t^ O ■% c* H E Oi H 00 t* w t^ o ■*? z w H C4 H M o\ u ^ K c« m W ■* 00 •* O OO °a s S DO (*) o Ov 00 0>0 ■* ro •S O 41 4J "2 00 r; M H 0.0 H t^ O :^ „§ 1.&5 oi i? 1^ g 1 ^ fO t^ r- O r-w O ■* < cT fO 4 /M H w O" CI oi < "3 • 'c ' i ■•§ • • < J3 1 1 5 a a u .a .J 3 1 i |6 1 1 1 1- 03 < 1 1 Kg •& OB «-lg- « H " ^g |la| s o < u H •< d a s 15 Z g: 2l 140 Main Buildino Roof Garden Children's Hospital, Portland, Maine. (See page 142) CHAPTER VI DETAILED DESCRIPTION OF INSTITUTIONS A. HOSPITALS* ILLINOIS Home for Destitute Crippled Children, 1653 Park Avenue, Chicago Incorporated: 1892. Superintendent: Miss M. O. Stewart. Orthopedic surgeon : John Lincoln Porter, M.D. Class: Hospital. Average number of children : 87. Capacity: 112. Plant: Brick buildings, not all fireproof. Iron fire-escapes with very wide platforms at window levels; children carried to windows dur- ing frequent fire drills. Admission: Two and a half to eleven years; chiefly residents of Illinois. No feeble-minded or epileptic; no tuberculosis of the lungs. Discharge: At twelve years, or after dispensary care can be safely substituted. Facilities for care of children : Affiliation with Rush IVIedical College. Superintendent resident in the Home. Four graduate nurses, one of whom is head night nurse; nurses in training come from Presby- terian Hospital for periods of service here in order to secure training in orthopedic nursing. Full hospital equipment; operating room; special gymnasium; brace shop; separate isolation ward; sleeping facilities for 30 children, on roof enclosed in glass; large dispensary service. School: None. Hand work and vocational training: None. Cost of property: ? 103 ,000. Year's expenditure per capita: i?28o. *The population statistics of some hospitals include a small number of adults. In the text, these are included in "average number of children"; in the tables the number of adults is given in footnotes. 141 CARE OF CRIPPLED CHILDREN Comment : The name is misleading. The work of the home is purely that of a hospital. Nearly all the children are bed cases and the average stay in the hospital is short. Convalescent cases are sent to the Convalescent Home for Destitute Crippled Children in West Chicago. This hospital, of good standing in the surgical world, is notable for its lack of modern business methods on certain points. The record of expenditures for each year is printed in the report according to the following method: "January, Sundry Cash Items .... February, Sundry Cash Items .... March, Sundry Cash Items . . . ." and so forth. It is possible to tell how much is spent during each month, but there is no statement as to how much of the money is spent specific- ally for salaries, for provisions, and for other important items. This is the only orthopedic hospital which prints no detailed finan- cial statement. MAINE Children's Hospital, Portland Date of opening: 1908. Superintendent: Miss Edith Soule. Orthopedic surgeon: Edville G. Abbott, M.D. Class: Hospital. Average number of children: 57. Capacity: 65. Plant: Three city lots. Old mansion used by nurses; adjoining modern building, of similar architectural design, used for hospital. The latter is so nearly fireproof that no insurance is carried. Walls of brick, with steel lath inside; all floors of terrazzo; slate treads on stairs; fire doors to nurses' home and shutting off elevator shaft; other doors of wood and opaque glass. Second stairway; outside escape from isolation ward only. Stairs do not run around elevator. Painted walls. Admission: Infants to twenty-one years; in-patients must be resi- dents of Maine; cases with lung tuberculosis sometimes taken and isolated; feeble-minded are taken, all that is possible is done for their orthopedic difficulties, then they are sent to State Home for Feeble- minded. In emergencies only, a few infants who were not ortho- pedic cases have been taken. Discharge: After dispensary care can be safely substituted; average stay 97 days. 142 DESCRIPTION OF INSTITUTIONS 143 CARE OF CRIPPLED CHILDREN Facilities for care of children: Medical staff includes orthopedic specialists; superintendent and superintendent of nurses are graduate nurses; 22 nurses in training, whose course includes two and one-half years in this hospital and six months at Bellevue Hospital in New York. Night nurse and engineer on duty all night. Full hospital equipment. All kinds of orthopedic opera- tions performed. Well equipped gymnasium for special gym- nastics. Isolation ward over kitchen, accessible only by outside iron stairs, includes two wards, nurses' room, bath, diet kitchen, serving room, store room. Brace shop in basement where work for the hospital is done; also private orders; brace makers work inde- pendently, not on salary. Large dispensary service daily. Ex- cellent sun room on roof for use by day, surrounded by unenclosed promenade with green awnings. Thresholds absent; very large elevator. After care through agent of Maine Children's Com- mittee. School: None. Hand work and vocational training: None. Cost of property: j! 12 1,000. Year's expenditure per capita: $464. Comment : Well equipped modern building, has every facility for hospital care, including wards with many windows and outdoor space for use by day, though no outdoor sleeping space. Note- worthy arrangement of examination rooms in the dispensary for fullest use of surgeon's time; entrance into each examining room directly from waiting room, also door from examining room to a dressing room, and exit thence directly to waiting room. Most cases are bed patients whose stay is relatively short; no need is felt for a dining room or other general space for patients except the sun room and promenade on the roof. The atmosphere of the institution is very cheerful and friendly. About one-third of the expenses are paid from the State treasury. MINNESOTA State Hospital for Indigent Crippled and Deformed Children, St. Paul (Maintained by the state of Minnesota) Date of opening: 1897. Superintendent: None. (Superintendent of St. Paul City and County Hospital, Arthur B. Ancker, M.D.) 144 DESCRIPTION OF INSTITUTIONS Orthopedic surgeon : Arthur J. Gillette, M.D. Class: Hospital. Average number of children : 63. Capacity: 70. Plant: Brick building, part of St. Paul City and County Hospital. Two stairways; painted walls; floors of bare wood. Admission: Up to sixteen years; Minnesota children only; no re- strictions as to kinds of cases. Discharge: After they no longer need strictly hospital care; usually when able to be cared for equally well at country branch at Phalen Park. Average stay before opening of country branch, about one year. Facilities for care of children : Special medical staff, including ortho- pedic specialists; also the facilities of a large general hospital as to its operating rooms, wards for isolation of contagious diseases; resident physicians, interne, and nurses. Graduate head nurse works only with crippled children. Each interne spends with them one month of his year's residence; nurses in training remain from six weeks to two months each. Tent in yard for outdoor sleeping in summer. Outdoor playground with swings. Night nurse (in training). Thresholds absent. School: Non-resident teacher; graded school. Non-adjustable desks and seats. Bedside teaching also. Hand work and vocational training: None. Cost of property : No property owned; cases cared for in one building of St. Paul City and County Hospital used for orthopedic cases. Year's expenditure per capita: j?22i.* Comment: The children come here for operations and post-operative care. If there is room at the country branch in Phalen Park they are sent there for convalescence and further education, including industrial training. At the city hospital the care of the crippled children is of the same high standard as the whole work of the hos- pital. The building is not new but serves its purpose well, and the playground and tent for sleeping out of doors are important fea- tures. High grade of nurses and other employes may be more easily possible because of connection with the city hospital. The atmosphere is cheerful and the children seem very happy. The institution stands high in public favor through the state. * Low rate is due to the fact that children are cared for under contract by the St. Paul City and County Hospital at a rate which is less than actual cost in the state hospital and school for the same children at Phalen Park. 145 CARE OF CRIPPLED CHILDREN NEBRASKA Nebraska Orthopedic Hospital, Lincoln (Maintained by the state of Nebraska) Date of opening: 1905. Superintendent: H. Winnett Orr, M.D. Orthopedic surgeon: J. P. Lord, M.D. Class: Hospital, with educational facilities. Average number of children : 70. Capacity: 100. Plant: City lots with large outdoor play space. Two large brick buildings, not new, also laundry building. Much wood in interior of buildings; fire would spread rapidly. Painted walls, bare floors of wood. Provisions for escape are fair; spiral enclosed fire- escape; fire drills. Admission: From two to eighteen years; must be residents of Ne- braska. No restriction as to kinds of cases. Discharge: After hospital care is no longer needed; plan to emphasize educational work and occupational training and to keep many chil- dren until they have learned to support themselves. Average stay of first 500 patients, 250 days. Facilities for care of children: Operating suites and X-ray machine. Visiting surgeon-in-chief and assistant surgeon are orthopedic specialists. Assistant surgeon is also superintendent and resides in institution. Head nurse and assistant are graduate nurses; training school with two years' course has 1 1 pupil nurses; all high school graduates. Masseuse, night watchman, two night nurses. Special ward used by older girls could serve for isolation. Elevator enclosed; thresholds absent; two inclines; solarium ward furnishes practically outdoor sleeping for limited number. School: Graded school with two experienced teachers. Tables and chairs used. School is open twelve months in the year. Hand work and vocational training: Sewing, cooking, simple house- work, elementary bookbinding and repairing, cataloguing and gen- eral library work, printing, gardening. Specially trained teacher of domestic science (resident) ; special non-resident teacher of book- binding and printing. Cost of property : $94,000. Year's expenditure per capita: $638. Comment: This hospital is doing work on a comprehensive scale, covering operations and convalescent care. Educational work, including occupational training, receives more emphasis than in any of the other institutions we have classed as hospitals. All 146 DESCRIPTION OF INSTITUTIONS this work is carried on by a staff of employes whose enthusiasm seems unlimited, and with thoroughly creditable results, in spite of the serious handicap presented by out-of-date buildings. The risk of fire is considerable. The institution merits a modern plant, which should include a small separate cottage for isolation of con- tagious diseases, and, if possible, two small cottages, one for the older boys and one for the older girls. NEW JERSEY Home for Crippled Children, Clinton and Fifth Avenues, Newark Date of opening: 1891. Superintendent: Miss Emma IVIueller. Orthopedic surgeon: Sidney A. Twinch, M.D. Class: Hospital. Average number of children : 45. Capacity: 56. Plant: City lots; modern brick building has dispensary and some wards, and old residence has other wards and employes' rooms. Walls calcimined or painted; floors of wood, unpolished. Stairs have slate steps in dispensary building. One fire-escape on old building. Admission: No age limit; both infants and adults have been taken; lung tuberculosis and feeble-minded cases not desired, but some- times taken. Discharge: As soon as can be transferred to dispensary; great de- mand for beds. Facilities for care of children: Operating room. Medical staff, including orthopedic specialists; superintendent and head nurse are graduate nurses; training school with one-year course has five nurses in training; masseuse. Excellent outdoor sleeping facilities for 20 on porches. Epidemics have been rare; then most cases sent to City Hospital. Measles and whooping cough isolated here in one ward and children are isolated upon admission, but no special ward is kept solely for this use. Elevator in dispensary building. Large dispensary service two days a week. Children often sent in summer to fresh air home at Westfield, which has no official connection with this hospital. School: None. Hand work and vocational training: None. Cost of property: $63,700. Year's expenditure per capita: $233. Comment: The name is no longer accurate, for the institution has •47 CARE OF CRIPPLED CHILDREN hospital facilities, and children come for operations and post- operative care. Most patients are bed cases and there is no dining room or day room for children. The pressure for beds and large dispensary service suggests the need of both a larger city plant and a country convalescent home open all the year. In spite of the strictly hospital nature of their surroundings the children seem happy and many efforts are made to entertain them. NEW JERSEY New Jersey Orthopaedic Hospital and Dispensary, 148 Scotland Street, Orange Date of opening: 1903. Superintendent: Miss Emma McGall. Orthopedic surgeon : Robert E. Humphries, M.D. Class: Hospital. Average number of children : 10.4. Capacity: 16. Plant: About one acre of land with wooden residence for hospital; dispensary in office on Main Street; both rented. Hospital has second stairway. Roof reached easily. Walls papered except in operating room where painted; floors of bare wood. Admission: From one and a half years; no boys over sixteen; no lung tuberculosis; preference to New Jersey children. Discharge: After dispensary care can be safely substituted; average stay three months. Boys not kept after sixteen. Facilities for care of children: Operating room. Visiting surgeon- in-chief is orthopedic specialist. Superintendent and two nurses are all graduate nurses. No special isolation rooms, but there are several small wards and one of them could be used for isolation. Small children are not admitted to the wards as visitors because it is thought that they are more likely than adults to bring con- tagion; efforts are also made to discourage parents from bringing with them to dispensary children who are not patients. Visiting nurse from Visiting Nurse Association gives half her time to cases from this hospital. School : Non-resident teacher daily. Tables and chairs used for the few children able to be out of bed. Largely individual instruction. Hand work and vocational training: None. Cost of property: Plant rented. Aggregate cost of surgical equip- ment and furniture, $2,345. Surgical equipment per capita, $j. Furniture per capita, $140. Year's expenditure per capita: $894. 148 Outdoor Sleeping. (See page 149) Hospital for Deformities and Joint Diseases, New York City Outdoor Sleeping (All weathers). (See page 156) Children's Orthopedic Hospital, Seattle, Washington DESCRIPTION OF INSTITUTIONS Comment: This little institution combines hospital care with an atmosphere which is very homelike and cheerful. It deserves a modern plant where the fire danger would be less and isolation facilities better, and where modern finish would make it easier for the employes to maintain the high standard of cleanliness which they now achieve even in an old building. NEW YORK Hospital for Deformities and Joint Diseases, 1915-19 Madison Avenue, New York City Date of opening: 1906. Class: Hospital. Surgeon-in-chief and superintendent: Henry W. Frauenthal, M. D. Average number of children : 49. Capacity: 57. Plant: Several old brick residences thrown together. New dis- pensary building planned. Because buildings are far from fire- proof, special precautions are taken to prevent fire and to provide easy exit. Fire doors between buildings. Iron outside stairways with wide platforms carefully railed. Extinguishers filled twice a year, marked with date of last filling. Painted walls; floors covered with asbestolith in wards, linoleum in office. Admission: All ages; no lung tuberculosis. Discharge: After dispensary care can be safely substituted; average stay about six months. Facilities for care of children : Visiting medical staff, including ortho- pedic specialists; superintendent and three nurses are graduate nurses; seven other nurses, some of whom have been trained at the Hospital for the Ruptured and Crippled in New York and the New ■ York Orthopaedic Hospital; 26 masseurs and masseuses in clinic. Operating room. X-ray, Zander room, massage and special gym- nastics. Outdoor sleeping for nine children on iron balconies. Indoor children's ward has not had windows closed for five years. Thresholds absent or very low. No elevator. Night watchman who goes through buildings every half hour, and three night nurses. Fire drills twice each week. No special isolation ward. Plan to start visiting nursing. Large dispensary service daily. School : None. A few children able to go have been sent to a nearby public school. Hand work and vocational training: None. Cost of property: ^104,500. Year's expenditure per capita: ■49 CARE OF CRIPPLED CHILDREN Comment: The buildings face a park and there is freer access for light and air than is the case in most city hospitals which are not in specially constructed buildings. The heavy demand for beds could be better met by the hospital if it had a branch for convales- cent cases in the country. The hospital has a ward for adult men and one for adult women, and several small private rooms, in addi- tion to the ward and sleeping porch for children. New York Hospital for the Ruptured and Crippled Sixth Floor Plan. (See page 1 54) J 50 DESCRIPTION OF INSTITUTIONS NEW YORK Hospital of the New York Society for the Relief of the Rup- tured AND Crippled, 321 East 42d Street, New York City Date of opening: 1863. Superintendent: Mr. Oliver H. Bartine. Orthopedic surgeon: Virgil P. Gibney, M.D. Class: Hospital. York and Sawyer, ArchitecU New York Hospital for the Ruptured and Crippled First Floor Plan. {For Elevation see p. 6) 151 CARE OF CRIPPLED CHILDREN Average number of children : 192. Capacity: 250. Plant: City lot 200 by 200 feet. Brick building (erected 19 12) is of modern fireproof construction; two enclosed staircases separated fOR.-rvTVM UTLN^ION New York Hospital for the Ruptured and Crippled Fourth Floor Plan from corridors by fireproof doors; also an enclosed emergency staircase and two fire-escapes. Two passenger elevators enclosed, large enough to carry stretchers, also freight elevator. Machinery in laundry includes both sterilizing washer and dry sterilizer. 152 DESCRIPTION OF INSTITUTIONS Kitchen with tile floor and modern cooking apparatus. Dispensary on first floor with tile floor and sanitary base. IVIarble partitions in orthopedic examination rooms form 12 booths for children; rVTVf^t LITIHAION B V I I. D I N G New York Hospital for the Ruptured and Crippled Fifth Floor Plan small separate rooms for adults. Record room with fireproof vault. Second floor is a low story with rooms for employes, one wing for superintendent and internes, one for matron and graduate nurses, one for housekeeper and nurses who are not graduates. 153 CARE OF CRIPPLED CHILDREN Four ward units on third floor (one for adult women); three on fourth floor. On fifth floor, large room decorated very attractively with friezes showing flowers and animals, is used for kindergarten, dining room at noon, play room and special entertainments. Ward for men on this floor. IVlost sanitary and enduring material used in finishing the building throughout; terrazzo floors in corridors and dining rooms; buff tile in wards, white tile in quiet rooms and toilet rooms; cement in employes' rooms; wood in offices, gym- nasium, and school rooms. Admission: From four years up; special wards for adult men and women. Discharge: After dispensary care can be safely substituted; average stay sixty-five days. Facilities for care of children : Visiting medical staff, including large number of orthopedic specialists. Two operating rooms, one of them a large amphitheater with 50 seats; X-ray department, also rooms for electrotherapy and hydrotherapy, as well as massage, special gymnastics, and work with Zander apparatus. Seven grad- uate nurses, i o not graduated but experienced in orthopedic nursing; two night watchmen. Fire drills. Brace shop; solarium and day porches. Sixth floor has large solarium with small adjoining rooms for use as isolation ward in case of need. Will not be set aside for isolation until need arises. Very large roof space, some covered, some uncovered, for use by day. One social service worker en- gaged recently. Large dispensary service daily. Three elevators; thresholds absent. At the exercises held for the formal opening of the new building, both the president of the board and the surgeon- in-chief expressed the hope that the next step might be the estab- lishment of a country branch for the care of convalescent cases. Children from this hospital have been sent to several summer institutions in the country not officially connected with the hospital. School: Graded, with seven non-resident teachers and 132 pupils. Institution selects teachers and city board of education pays $15 per year for each pupil, on basis of average number computed from total days of attendance. Tables and chairs used. Hand work and vocational training: Sewing, chair-caning (basketry in summer), elementary carpentry, taught by teacher from People's University Extension Society. Cost of property: $1,298,000. Year's expenditure per capita: J567. Comment: This modern fireproof building represents the acme of 154 ■"^P* 1 |:J^ |/-^\|:.->,'^. ■:, ■' ';4 bo C- uo 2 u, '^ o feii^l iilt:li---i^'' ' """■■■-.-aii>'''""""" ■ f^$ I^F *^^mfe^^ .., n ,«»t-,.«W.»M«aMM ■liiMiiltf^B a: X UJ T3 C rS The Dispensary Outdoor Clinic. (Seepage 155) Ntw York Oi 35 •7 Total for special purposes 52 Total for all purposes 772' » It is to be noted that not all the employes sleep in the institution. b Libraries used as day rooms. <: Vocational training also given in rooms used for other purposes. d Not including covered passageways between buildings, 57 square feet per bed, or outdoor space for children. « For corresponding figures, see Table II B, pp. 1 14-115. 183 CARE OF CRIPPLED CHILDREN PENNSYLVANIA Industrial Home for Crippled Children, Pittsburgh Date of opening: 1902. Superintendent: Rev. Lyman Mevis. Orthopedic surgeon: James O. Wallace, M.D. Class: Convalescent hospital and industrial school. Average number of children : 45. Capacity: 50. Plant: City lots 160 by 200 feet and 145 by 160 feet. Main building of brick, three stories; isolation and infirmary building of wood, one story. Walls painted, then varnished; floors bare wood in most rooms, cement in pavilions for outdoor sleeping, special com- position in infirmary. Admission: From three to twelve years; no rule as to color, but only white children yet taken; Pennsylvania children only. No lung tuberculosis; no feeble-minded; preference to those likely to profit by industrial training. Discharge: No rule. Remain until benefited as much as possible, occasionally longer for purposes of education. Facilities for care of children: Operations performed elsewhere, usually at Allegheny General Hospital or Children's Hospital. Visiting orthopedic surgeons; graduate nurse. Two pavilions con- nected with main building furnish equivalent of outdoor sleep- ing for 28 children — usually those with bone tuberculosis. Each child entering is kept two weeks in isolation building. In case of two kinds of infection this building can be divided into two parts, each with two small wards, nurses' room and bath; one diet kitchen. Masseuse comes every afternoon. Gymnastic exercises taught occasionally by stenographer. Children able to do so, often dance in school room after supper. Outdoor playgrounds. Large in- door play room, also exceptionally good library in another room. Thresholds very low or absent; two inclines at rear of building. School: Grade teaching. Desks and seats adjustable as to height. Some children able to walk well are sent to public school in order to secure contact with children other than those in the institution. Hand work and vocational training: Sewing, basketry, manual training, furniture making, music. Music by grade teacher; other subjects by special non-resident teacher. Cost of property: $1 10,000. Year's expenditure per capita: {5333. Comment: All phases of work here are worth studying; the build- ings are altogether adequate for care of convalescent cases and the 184 Sleeping Pavilions Co rtflioo ft _^ — I — -7 ^^ p- ' -/t-fe »- 11 /^ /o'-t"x ft'-t' l-o'-o'w.cs. Cov£fi£" T'oncn. Floor Plan, Surgical Building Industrial Home for Crippled Children, Pittsburgh, Pa. (See page 184) Play Pavilion, School House, and Gikls' House Virginia T. Smith Home for Incurables, Newington, Conn. (See page i86) Cripplld Ciiildken's Home, Buffalo, New York. (See page 191) DESCRIPTION OF INSTITUTIONS equipment is modern; two well constructed pavilions with 14 beds each for outdoor sleeping cost ^2,900. Infirmary building well arranged. Educational and industrial work good. The spirit of the house is that of a well ordered and very happy home, with little suggestion of the fact that it is an institution. PENNSYLVANIA Sewickley Fresh Air Home, Sewickley Date of opening: 1897, ^s Fresh Air Home; since 1909 has done orthopedic work only and has been open throughout the year. Superintendent: Miss Anna M. Flakenstein. Orthopedic surgeon: James O. Wallace, M.D. Class: Convalescent hospital. Average number of children: 27. Capacity: 32. Plant: 50 acres of land, of which 30 acres are woodland. Gardens supply large share of vegetables. Farmer lives on place in separate house. Main building of wood in style of a residence; separate small wooden cottage for several boys and caretaker used in sum- mer. Fire-escape; tank and pumping station; hose ready to attach to spigots all over house. Painted walls, bare varnished floors. Admission: From three to twelve years; no geographic restriction, but thus far all but one child from Pennsylvania; no lung tuber- culosis; no markedly feeble-minded or epileptic. Discharge: After benefited as much as possible. Facilities for care of children : Operations performed at the Allegheny General Hospital; room here for surgical dressings; orthopedic surgeon pays weekly visits; superintendent and one other nurse are graduate nurses. Six double-decker beds and one ordinary bed for children are on a sleeping porch. Isolation in a small ward with bathroom near, no separate outside entrance. Very complete provision for amusement of the children. Indoor play room, much outdoor play space with tent, summer house, small merry-go-round, and swings. Thresholds absent. School : Simple branches taught daily by visiting volunteer, in special outdoor school building. Hand work and vocational training: Sewing, basketry, manual training; gardening taught by another visiting volunteer teacher. Cost of property: $22,000. Year's expenditure per capita: fegi. Comment: This small convalescent hospital has an excellent loca- tion and buildings which serve their purpose well. Outdoor sleep- 185 CARE OF CRIPPLED CHILDREN ing space for a still larger number of the children could be used to advantage. It is possible that in rare cases more complete isola- tion would be desirable than the present isolation ward affords. The dietary is especially good, with very liberal use of milk and eggs. Milk is served at every meal, in the middle of the afternoon and at night, before the children go to bed; they have fruit juice in the middle of the forenoon. C. ASYLUM HOMES Remark: Four asylum homes, the Darrach Home, House of the Annunciation, and the New York Home for Destitute Crippled Children in New York City, and the Home of the Merciful Saviour in Philadelphia, have summer homes, which are excluded from the figures for cost of plant, in order that they may be comparable with other institutions in the group. The current expense figures of these four institutions include the cost of operating the summer homes, as the main institutions are closed for the summer. CONNECTICUT Virginia T. Smith Home for Incurables, Newington (Maintained by the Children's Aid Society of Connecticut) Date of opening: 1896. Secretary of Children's Aid Society: Miss Josephine Griswold, 60-61 Brown-Thomson Building, Hartford, Connecticut. Orthopedic surgeon : J. E. Root, M.D. Class: Asylum home. Average number of children : 87. Capacity: 100. Plant : 65 acres, of which 40 are cultivated. Farmer lives in original farm house. Other buildings (all wooden): girls' house; boys' house; school house; isolation building. Paint and plaster walls; bare floors. Admission: Not under two years; no lung tuberculosis; plan to take no feeble-minded cases. Practically all children from Connecticut. Colored children taken. Discharge: No limit to stay. Many improved children have been sent home; a small number have been placed in family homes. Facilities for care of children: Children sent to hospitals in Hartford for major operations; minor operations and dressings done at home by visiting physicians. One experienced (not graduate) nurse. Isolation in separate building. Preliminary visits to homes and after care through agents of Connecticut Children's Aid Society. 186 DESCRIPTION OF INSTITUTIONS Some of the children go in summer to "Playridge," a summer home for dependent children at the seashore maintained by Children's Aid Society. Thresholds low or absent. Incline to school house entrance. Elevator in boys' cottage. School: Two teachers; separate school building. Full eight grade course; unusually close resemblance to school for well children. Non-adjustable desks. Hand work and vocational training: Simple housework, manual training, gardening, music. Cost of property: 5^56,000. Year's expenditure per capita: J5213. Comment : Custodial care on the cottage plan is provided for cripples of all kinds. Unrestricted outdoor play space; woods; hills. A few incurable adults still remain, but it is not planned to take others or to admit feeble-minded cases in future. ILLINOIS " Happy Haven," 3445 Vernon Avenue, Chicago Date of opening: 1908. Superintendent: Miss Florence E. Prouty. Orthopedic surgeon : None. Class: Asylum home. Average number of children : 6. Capacity: 6. Plant: A city apartment on the first floor with a small rear porch and a back yard. The children go for the summer to a camp for crippled children at Twin Lakes, Indiana. Admission : Must be of school age and able to attend special public school classes for cripples; no lung tuberculosis. No other re- strictions; both boys and girls, white and colored. Discharge: Stay as long as they need a home. Facilities for care of children: Very simple. Children sent to a hospital if necessary. Miss Prouty consulted an orthopedic sur- geon to learn elementary points in the physical care of children. School : All children are taken by bus to special classes for cripples at Fallon School (public). Hand work and vocational training: Nothing except simple house- work. Cost of property: None. Year's expenditure per capita: All expenses met by Miss Prouty, with slight aid as to clothing from South Side Crippled Children's Aid Society. 187 CARE OF CRIPPLED CHILDREN Comment: Miss Prouty has been a teacher of crippled children in the public schools of Chicago for about twelve years. She has taken six crippled children into her own home because in each case the child was left in need of a home through the death of parents or other disaster. In most cases Miss Prouty has believed the chil- dren not eligible to any existing institution. She takes the chil- dren with her to school and they have hot dinners there on school days. All other meals are prepared by Miss Prouty, with a little help from the children. The only outside assistance comes from the weekly visits of a scrubwoman. Summer Home, Twin Lakes, Indiana For several summers, beginning in 1909, Miss Florence Prouty of "Happy Haven " has taken the five or six children for whom she was caring and as many more as possible, to spend several weeks in the country. Crippled children are referred to this camp by residents of Hull House. Two police officers from Chicago are sent along by the city, to give such assistance as is needed in lifting the children about. In the summer of 1910, 42 children lived in seven tents at Twin Lakes, Indiana. Since then a rough pavilion has been completed, in which most of the children sleep. It has partial partitions giving the effect of several rooms, but not interfering with the circulation of air. A farmer has agreed to the permanent rental of this acre of land for the nominal charge of $1.00 per year. Miss Prouty and several mothers of the children have prepared the meals. They hope to have money enough in future seasons to hire a cook. One older person, usually the mother of one of the children, sleeps in each tent. ILLINOIS Home for Disabled Children, 902 South Eighth Avenue, Maywood Date of opening: 1909. Superintendent: Martha M. Crofut, M.D. Asylum home: Maintained by Children's Home and Aid Society of Illinois. Average number of children : 11. Capacity: 12. Plant : A substantial residence set in beautiful grounds, 262 by 294 feet. Admission : Limited to cases not requiring surgical care, but disabled permanently or for a long time. No lung tuberculosis, no feeble- minded, deaf or blind. Discharge: After children no longer need the special care offered. 188 DESCRIPTION OF INSTITUTIONS Facilities for care of children: Superintendent a physician; home vithin three-quarters of an hour by train from Chicago; cases needing surgical attention taken to Home for Destitute Crippled Children in Chicago. Especially large outdoor play space; sand pile. School: In institution (ungraded) conducted by armless teacher; simple branches. Hand work and vocational training: None, except simple housework. Cost of property: J 1 1,400. Year's expenditure per capita: $305. Comment: A place less institutional can not be imagined. The life is like that in any pleasant home. It is planned that not more than a dozen children shall ever live in the house. If there are more cases needing care it is hoped that other small cottages, probably of fireproof construction, can be built within the large grounds upon which the present house stands. MASSACHUSETTS New England Peabody Home for Crippled Children, Hyde Park Date of opening: 1894. Superintendent: Miss Clara M. Thurston. Orthopedic surgeon: Robert W. Lovett, M.D. Class: Asylum home with some provision for convalescent care. Average number of children : 30. Capacity: 30. Plant: Suburban property. Wooden building resembles large resi- dence. Very careful provision for escape in case of fire; well of brick from top floor to ground contains wooden stairway with iron hand rail, entered from each floor, exit directly out of doors. Linoleum used to cover many floors. Admission: Not over twelve years; New England children. No lung tuberculosis; no feeble-minded. Discharge: After benefited as much as possible, or after able to be self-supporting, if they have not good homes to which they may return. Facilities for care of children: Most operations at the Children's Hospital, Boston; minor operations and dressings at home by visiting surgeon; graduate nurse; isolation ward with three beds and bath on third floor can be reached by fire-escape well. Seven- teen beds in outdoor sleeping rooms or porches. School: Grade classes. Adjustable desks. Hand work and vocational training: Sewing, cooking, simple house- work, basketry, chair-caning, manual training. Special teacher. 189 CARE OF CRIPPLED CHILDREN Cost of property: !?37,ooo. Year's expenditure per capita: j!342. Comment: Excellent combination of good physical care, even for cases requiring considerable medical attention, with a very pleasant home life. Play room with open fire furnishes social center; only defect is fact that this room, like the sun parlor, gets no sun for a considerable part of the day. Interesting effort to keep children long enough to give them real help. Parents are required to sign agreement to leave child in the home for at least two years. This is not legally binding but it has a decided moral effect. NEW JERSEY Daisy Fields Home and Hospital for Crippled Children, Engle- wood Date of opening: 1893. Superintendent: Miss Angeline L. Staples. Orthopedic surgeon: Henry Ling Taylor, JVl.D. Asylum home: With facilities for convalescent hospital care. Average number of children: 18. Capacity: 18. Plant: Wooden residence with three floors; steam heat; gas; un- guarded windows for ventilation; outside wooden stairway; ex- tinguishers; painted walls; maple floors in dormitories and bath- rooms. Gates at head of stairs on each level to prevent accident. No children's rooms above second floor. Admission: Between three and ten years. Only curable cases, able to walk; no feeble-minded; no tuberculosis of the lungs. Discharge: Boys leave at fourteen ; girls stay until benefited as much as possible, longer if they need a home. Facilities for care of children: Superintendent is a graduate nurse; children sent to Post-Graduate Hospital in New York if they need surgical attention; play house; large outdoor space. Isolation in two rooms which can be shut off from rest of house, with fire-escape for direct entrance from outside. Superintendent's bathroom can be used by isolated persons. School: In institution; simple branches only. Hand work and vocational training: Gardening and simple house- work. Cost of property: $15,000. Year's expenditure per capita: $431. Comment: The most noticeable feature is the combination of the small numbers and long period of residence which make the place much like a family home, with adequate physical supervision for 190 DESCRIPTION OF INSTITUTIONS children who are not bed cases but who still need to be carefully watched. There is much closer attention to strictly medical care than in most asylum homes, and the institution could, in that re- spect, be classed with the convalescent hospitals. The atmos- phere is most cheerful and the children seem very contented. NEW YORK Crippled Children's Home, 487 Niagara Street, Buffalo Date of opening: 1910. Superintendent: Mrs. Elizabeth Saylor. Orthopedic surgeons: (Attending) Prescott Le Breton, M.D., Ward Plummer, M.D. Class : Asylum home. Average number of children : 22. Capacity: 35. Plant: Wooden residence, somewhat altered to fit special needs of the institution. Still further provision of baths and toilets needed. Satisfactory fire-escape; extinguishers; bare floors; thresholds absent. Good barn at rear of property could be used for school building. Admission: Up to about sixteen years; no lung tuberculosis; no epileptics or markedly feeble-minded. Colored children taken. Discharge: After being benefited as much as possible, longer if they need a home. Facilities for care of children : Matron is experienced in care of chil- dren and a practical nurse; visiting physicians; no operations. No special isolation ward, but children are isolated in one of the wards for two weeks after admission. Visiting committee goes to homes, also co-operates with other agencies. School: None. Hand work and vocational training: Sewing, advanced kindergarten work by volunteer teachers. Cost of property: $21,000. Year's expenditure per capita: ?i84. Comment: The pleasantly homelike atmosphere results in part from the matron's personality, but also in large measure from the earnest and sympathetic interest of the women oflTicers who keep in close personal touch with all phases of the work. NEW YORK Darrach Home for Crippled Children, i 18 West 104th Street, New York City Date of opening: 1899. 191 CARE OF CRIPPLED CHILDREN Superintendent: Mrs. J. K. Mott. Orthopedic surgeon : Arthur H. Cilley, M.D. Class: Asylum home. Average number of children : i8. Capacity: 20. Plant: City house of brownstone; no front yard; very small back yard. Children play on uncovered roof over rear extension of building. Summer home at Pelham Bay Park, New York. Admission: From three to twelve years; no lung tuberculosis; no bed patients or helpless cases; none requiring close medical or physical attention. Discharge: Remain as long as they need a home. Facilities for care of children: Matron a housemother without nurse's training. A physician, general practitioner, examines each child before admission to be sure there is no infectious disease. He ex- amines all children upon their return from summer home in the fall; orthopedic surgeon sees children if necessary. A maid's room on top floor where no children sleep would be used for isolation if necessary; separate outside entrance possible by using fire-escape. Enclosed elevator. School: None. Hand work and vocational training: Simple housework; sewing taught by teacher sent one afternoon each week for an hour by People's University Extension Society. Cost of property : $30,500. Year's expenditure per capita: $218. Comment: This is primarily a home for children requiring little surgical attention. The atmosphere is genuinely homelike and the children seem very happy in spite of the small opportunity for out- door life. They are much refreshed by their long season in the country, and one wonders if it would not be better to keep them in the country all of the year if that could be made practicable. Summer Home, Pelham Bay Park, New York The children from the Darrach Home are housed for the summer in an old residence provided by the City of New York. It would be hard to find a more ideal location. The house over- looks Pelham Bay, and the occupants have a good private bathing beach. The children go in bathing every day, and many of them are able to swim. There is heavily wooded vacant space about the house. The building is of wood and stone. Since extensive repairs in the summer of 191 1 it is in good condition. The floors are bare; 192 DESCRIPTION OF INSTITUTIONS the plumbing is good, with bathroom for boys on the first floor and for girls on the second floor (used also by the officers and maids). At the time the institution was visited there were i8 children — nine boys and nine girls. There is abundant room for a larger number. One boy, eighteen years of age, who is employed in the city, has been commuting from the Adee House this summer. He now earns $20 a week at some mechanical profession. There is a matron, assistant matron, a cook, and a laundress. For two hours each afternoon during the summer a sort of school session is held. The older children teach the younger children in three groups. The children do some domestic work. They take care of their own sleeping rooms, but have nothing to do with the kitchen. The children have weeded and finally brought to the house the vegetables which they have grown. At the time the institution was visited the older boys were play- ing a spirited game of baseball with two ablebodied youngsters. NEW YORK House of the Annunciation for Crippled and Incurable Chil- dren, Broadway and 156th Street, New York City Date of opening: 1892. Superintendent: The iVIother Superior of the Sisters of the Annuncia- tion. Orthopedic surgeon : T. Halsted Myers, IVI.D. (Consulting.) Class: Asylum home. Average number of children: 30. Capacity: 30. Plant: Brick building on lot 100 by 100 feet. Thoroughly modern in finish and equipment. Careful precautions against fire; walls and partitions of brick; steel girders; wood trim covered with metal in parts of house most used by children; wire glass in doors; electric gongs; good outside stairway for escape. House telephone system. Tile and wood floors; walls of hard plaster, some painted, some calcimined. Slate treads on stairs. Unusually complete and well planned system of closets. Summer home at Wilton, Connecticut, with good buildings. Admission: White girls only; four to sixteen years; no long-time bed cases; no meningitis, lung tuberculosis, epilepsy, St. Vitus' dance, or syphilis^ Discharge: Remain as long as they need a home. IVlany of the chil- 13 193 CARE OF CRIPPLED CHILDREN dren stay in the home for a long time, and the number admitted each year is very small. Facilities for care of children: Operations at St. Luke's Hospital. Consulting orthopedic surgeon and visiting physician. The chil- dren do not have individual clothing except as parents furnish it, but they do not wear uniforms. They have no bureaus but have individual space in the bathrooms for their toilet articles. Some Sisters sleep within reach of dormitories. Thresholds absent, or very low; stairs have very wide, easy rises and two platforms be- tween first and second story. ChapeK chairs for children are of different heights. Gallery for those unable to walk, to which wheeled chairs can be conveniently moved. No elevator, but dumb-waiter is so large and strong that it is sometimes used for moving children. Isolation ward with two beds. School: Academic work is given for an hour daily by one of the Sisters, in addition to religious instruction. Hand work and vocational training: Sewing, basketry, advanced kindergarten work, music taught by teachers from People's Uni- versity Extension Society. Cost of property: 5^156,000. Year's expenditure per capita: $214. Comment : This is the Mother House of the Sisters of the Annuncia- tion, B. V. M., as well as a home for the crippled and incurable children in their charge. The dormitories with their immaculate beds, glass-topped tables, and white screens, resemble small wards in a hospital, although hospital care is not offered. There is a good library of children's books. All the rooms have copies of famous religious paintings, and the reception room and the Sisters' sitting room have beautiful pictures of considerable value, in- cluding two original Italian paintings. Summer Home, Wilton, Connecticut (Opened at Stamford, Connecticut, in 1895) The surgical work is under Dr. Myers, of Saint Luke's Hospital. The county physician has agreed to serve them if necessary while they are in Connecticut, but there has been no illness. The most notable point concerning the cases received is the fact that paralyzed and feeble-minded children are received readily, as well as those who have only tuberculous bone troubles. The report for the year ending September 30, 1909, shows eight cases of paralysis out of 19 patients. Dr. Myers, the orthopedic surgeon summarizes each case. He specifically mentions poor mental 194 DESCRIPTION OF INSTITUTIONS development on the part of five out of the 23 children treated during the year. There were 28 children present at the time the home was visited; capacity 30. The summer home is located on a tract of 16 acres. The former residence has been finished as a home for the Sisters. The old garage was moved up to the house and transformed into a chapel. An excellent modern building for the use of the children has been erected. The Mother Superior, who founded the insti- tution, supervised every detail of the construction and remodeling. The whole plant reflects her careful planning. The floors are all of hardwood — polished oak or hard pine. There are no thresholds in this building except at the outside doors. A small, steep incline is built at the rear of the house. It is meant for the use of wheel chairs. An attic playroom and a large porch give play space. There are three dormitories of 10 beds each. The rooms are absolutely bare except for the beds, which are of white enamel. A tiny cottage of two rooms at some distance to the rear of the other buildings is intended for the use of clergy or other visitors. It would make an excellent isolation cottage in case of need. The three tables in the children's dining room are covered with oilcloth. The children's dishes are of granite ware. All the children who are able to do so help in the light housework. A few girls have learned to cook by staying after most of the chil- dren leave in the fall, or by coming in advance of the others in the spring. There is no formal teaching from books during the summer. Someone comes to teach them songs. A Sister helps them with mending, embroidery, basket making, and bead work. A number of these children are mentally defective and some are too young to do useful hand work. Apparently, little effort is made to fit the children to earn their own living independently. NEW YORK New York Home for Destitute Crippled Children, 141 West 6ist Street, New York City Date of opening: 1904. Superintendent: Mrs. McCarthy. Orthopedic surgeon: (visiting physician) Egerton S. Jackson, M.D. Class: Asylum home. Average number of children: 20. Capacity: 25. 195 CARE OF CRIPPLED CHILDREN Plant: City house of brownstone. No outdoor play space. Iron fire-escape. Reception rooms are fully furnished, but for sanitary reasons rooms used by children have less furniture, bare floors with rugs, and painted walls. Summer home with good wooden house at Patchogue, New York. Admission: Three to fourteen years; cases not requiring surgical care or nursing. No lung tuberculosis; no feeble-minded. Discharge: After a home is no longer needed, usually when not over seventeen years. Officers help those who leave to find employ- ment. Facilities for care of children: Operations usually at Hospital for the Ruptured and Crippled; consulting orthopedic surgeons and visiting house physicians. Simple gymnastic exercises by teacher from People's University Extension Society. One small ward, without bath, for isolation. Rubber treads on stairs. School: None. Hand work and vocational training: Sewing, simple housework. Cost of property: $21,500. Year's expenditure per capita: $207. Comment : This home was transferred to the Children's Aid Society of New York in the spring of 1913 and will be used as a receiving shelter for well children whom they plan to place in family homes. The work for cripples will be continued by the society at its day school for crippled children, the Rhinelander School in East 8ist Street. When the transfer was made 18 of the 19 crippled children in the New York home were placed with relatives within a month, by agents of the Children's Aid Society. The home has been in- cluded in this study because its work continued through most of the time during which this study was in progress. It was a pleasant home, with a very friendly atmosphere. Summer Home, Patchogue, New York This summer home was opened in 1908, in a former residence located on about two acres of ground. A small fresh-water lake lies a few yards beyond the boundary. The majority of the children move about with very nearly the facility of perfectly sound children. There are none who stay in bed; none with abscesses. Most of them come to this home from the Hospital for the Ruptured and Crippled where all surgical work for the home is done. The home accommodates 18 children. A few more could be taken by crowding in additional beds. 196 DESCRIPTION OF INSTITUTIONS Most of the children sleep in a large dormitory on the second floor. Four of the older boys have a separate room. There is also a separate room for the older girls. There are only two maids at the country home. All the laundry work is sent out. The children eat at two long tables covered with white oilcloth. They use porcelain dishes, but enameled cups. There is no uniformity in the children's dress. No school work of any sort is maintained. The children do a little domestic work. OHIO Holy Cross House, 5609 Whittier Avenue, Cleveland Date of opening: 1903. Sister-in-charge: Sister Edith Constance, C. T. Orthopedic surgeons: S. W. Kelley, M.D., Gordon Morrill, M.D. Class: Asylum home. Average number of children : 1 8. Capacity : 20. Plant : Two old residences, connected, on land 80 by 180 feet. About two-thirds of the land is used as a playground. Painted walls and floors. No special precautions against fire. More bathroom fa- cilities desirable. Admission: Preference to Cleveland children, but others have been taken; no lung tuberculosis; none known to be feeble-minded; none requiring special diets. Discharge: No limit as to stay; remain as long as they need a home. Facilities for care of children: Operations at St. Luke's Hospital; visiting surgeon and physician. Matron and one nurse are gradu- ate nurses. Thresholds absent. Incline to back yard (play- ground). School: Maintained by city board of education in old barn at rear of property. Grade class work and simple kindergarten processes by same teacher. Desks adjustable as to height. Hand work and vocational training: Simple housework. Cost of property: $1 1,600. Year's expenditure per capita: J282. Comment: This is a cheerful, homelike place, where the children seem very happy. The buildings are inferior but the interior of the house is kept clean and cheerful. The management of the house has recently been placed in the hands of the Sisters of the Com- munity of the Transfiguration, and it has been made a diocesan institution of the Episcopal Church. Since the affiliation with St. 197 CARE OF CRIPPLED CHILDREN Luke's Hospital, it is believed that convalescent cases will be taken requiring more medical and surgical attention than was necessary for the chronic or incurable cases. PENNSYLVANIA Children's House of the Home for Incurables, South 48th Street and Gray's Ferry Road, Philadelphia Date of opening: 1877. Superintendent: Miss Jane R. Kelly. Orthopedic surgeon: John Speese, M.D. Class: Asylum home. Average number of children: 26. Capacity: 33. Plant: Modern connected buildings on grounds of large institution for adults. Boys' house fireproof; second stairway enclosed; extinguishers; occasional fire drills; alarm. Bare floors, painted walls. Admission: Not over twelve years; all kinds of incurable crippled children; no lung tuberculosis; no feeble-minded or epileptics. Preference to Philadelphia cases, then to those from other parts of Pennsylvania. Discharge: Cases are transferred to adult department at various ages. A very few cases have improved unexpectedly and been sent to their own homes, and one case to the Widener Memorial School. Facilities for the care of children: Operations at hospitals; most cases do not require close surgical supervision. Night nurse maid. Each child has a small room of his or her own, most of them on first floor level. Cork carpets in halls; thresholds absent. Cov- ered corridor to play house. One room for isolation. School: Grade work. Some non-adjustable desks. Some children in wheel chairs. Hand work and vocational training: Sewing and manual training. Visiting teacher. Cost of property : $90,400. Year's expenditure per capita: $393. Comment: This is the only home exclusively for incurable crippled children in America. It fills a pressing need in Philadelphia and is an example of the type of small institution needed for incurable cases in every section. Special care is taken to conserve the indi- viduality of the children through separate rooms and individual possessions of every sort. This is especially important since the 198 DESCRIPTION OF INSTITUTION.S children stay permanently. The atmosphere is thoroughly cheer- ful. PENNSYLVANIA Home of the Merciful Saviour for Crippled Children, 4400 Balti- more Avenue, Philadelphia Date of opening: 1882. Superintendent: Miss Rosanna Pattee. Orthopedic surgeon: Charles H. Frazier, M.D. Assistant: Frank Dickson, M.D. Class: Asylum home. Averagenumber of children: 50. Capacity: 50. Plant: About 15 acres of land; a group of connected stone buildings with central heating plant; girls' house; boys' house; surgical building; school building; chapel. Painted walls; floors bare or covered with linoleum. Tile in bathrooms. Alarm; iron fire-escape. Summer home at Avon-by-the-Sea. Admission: From two and a half to six years; preference to Pennsyl- vania children; no lung tuberculosis; no feeble-minded. Discharge: Girls stay as long as they need a home. Incurable boys have been transferred to institutions for adults at about sixteen. Facilities for care of children: Operating room for minor operations; major operations at University Hospital. One graduate nurse, who sleeps in room opposite ward used by children needing closest attention. One other attendant trained for one year at a children's hospital. Bed cases moved into sun parlor from ward for the day. Diet kitchen. In most cases only two or three children in each sleeping room. Thresholds absent. Incline, to back yard. Rub- ber floor covering in center of surgical ward and some halls. Ele- vator. Two rooms and bath for isolation. School : Grade classes. Non-adjustable desks. Hand work and vocational training: Sewing and simple housework. Officers have helped older children to find positions. Cost of property: $97,000. Year's expenditure per capita: $326. Comment: A pleasant home with strong religious influences. The abundant space would permit care of larger number, but homelike atmosphere would doubtless be less striking if number were in- creased. Summer Home, Avon-by-the-Sea, New Jersey Date of opening: i888. 199 CARE OF CRIPPLED CHILDREN The summer home is a large wooden building with a full height basement, three stories, and an attic which could be used for sleep- ing purposes. It stands among pine trees and has vacant space in the rear. It has the largest porches seen on any summer home for crippled children. In spite of this porch space none of the children sleep outdoors. There are several beds at one end of the second-story porch, used during the day by the few children who must stay in bed. The interior is simply but comfortably furnished. Three large rooms on the first floor are used for general sitting room, a boys' play room, and a play room and sewing room for the girls. In the dining room are several small tables with white tablecloths and porcelain dishes for the older children. The tables for the smaller children are covered with oilcloth and furnished with enameled dishes. The most noticeable feature here as at the city plant is that the children sleep in small rooms with one or two beds and have abundant provision for their personal belongings. The floors are of hardwood, with no covering. The walls are of painted plaster. There are no fire-escapes, but the extensive porches would make it very easy to remove the children from the building in case of fire. PENNSYLVANIA House of St. IVIichael and All Angels, North 43rd and Wallace Streets, Philadelphia (Under the Sisters of St. Margaret) Date of opening: 1887. Superintendent : The Sister in charge. Orthopedic surgeon: Walter G. Elmer, iVl.D. Class: Asylum home. Average number of children : 25. Capacity: 30. Plant : Wooden residence with good back yard. Bare floors; painted walls in rooms used by children. Summer home at Sea Isle City, New Jersey. Admission: Colored children only; not under two years; no lung tuberculosis; no feeble-minded. Discharge: Boys at ten; girls usually about eighteen. Facilities for care of children: Operations performed at University Hospital by one of the orthopedic surgeons there, who is the surgeon for this home. Small ward kept as infirmary; bath near. Fire- escape could be used as separate outside entrance. Sun room over 200 DESCRIPTION OF INSTITUTIONS porch used by smallest children during the day in winter; large back yard provides play space in summer; part of it covered. School: None. Sometimes two or three children unable to go to public school have been taught by one of the Sisters. Hand work and vocational training: Sewing and complete course in housekeeping for girls. Cost of property: $13,600. Year's expenditure per capita: JSiSg. Comment: This is the only institution exclusively for colored crip- pled children in America. Similar places providing care for longer time than a hospital can offer are much needed in other communi- ties where there is a large Negro population. The building and equipment are very simple, but the interior is kept up to the hospital standard of cleanliness, and the atmosphere is very cheerful. Summer Home, Sea Isle City, New Jersey In 1911 the trustees purchased a house and grounds for a sum- mer home at Sea Isle City, Cape May, at a cost of $3,000, and ex- pended $1,200 additional, making a total of $4,200. The summer home is a commodious building with large porches. The building is large enough to accommodate the entire population of the house in Philadelphia which is closed during the summer months. 201 APPENDIX APPENDIX DESCRIPTIONS OF INSTITUTIONS NOT INCLUDED IN THE TABULATED LIST Supplemented by List of Occupations of Graduates of Industrial School for Crippled and Deformed Children, Boston, Massachusetts Name of Institution Massachusetts Boston Children's Hospital Reasons for not Listing Hospital A general hospital for children (about one-fourth orthopedic cases) New York Randall's Island New York City Children's A general hospital for children Hospital (Department of (orthopedic wards only) Public Charities) New York City Seton Hospital (Nazareth Branch for Women and Chil- dren) Pennsylvania Philadelphia Philadelphia Orthopaedic Hos- pital and Infirmary for Nervous Diseases Wisconsin Milwaukee Children's Free Hospital A general hospital for children (about one-third orthopedic cases) Tuberculosis hospital (about 15 per cent crippled children) (About one-third orthopedic cases) Convalescent Hospitals or Homes Massachusetts Wellesley Hills Convalescent Home of the A general convalescent home (about (Boston) Children's Hospital • one-third crippled children) 205 CARE OF CRIPPLED CHILDREN Name of Institution New Jersey Atlantic City Children's Sea-Shore House New York Chappaqua Convalescent Children's Home of the New York Children's Aid Society Rochester Country Convalescent Hos- pital White Plains St. Agnes Hospital for Crippled and Atypical Children Ohio Cleveland Rainbow Cottage (affiliated with Lakeside Hospital) Reasons for not Listing A general convalescent home (about one-fifth crippled children) A general convalescent home (about one-third crippled children) A strictly private institution. Owner preferred not to furnish statistical information Receives mentally deficient and crippled children (about 75 beds for cripples). Sisters preferred not to furnish statistical data; 128 or- thopedic cases in 1910 A general convalescent home (about one-half crippled children) Asylum Homes New York New York City House of the Holy Com- Receives women and children forter for Incurables (about one-fifth cripples) Pennsylvania AUentown Good Shepherd Home for Receives cripples, infants, depend- Crippled Orphans ent children and old people (about one-third cripples) Summer Homes New Jersey Westfield Children's Country Home Summer care only New York Arverne Seaside Home for Crippled Summer care only Children 206 APPENDIX Name of Institution Reasons for not Listing Hawthorne Blythedale (Convalescent Summer institution, when visited. Home for Tuberculous Crip- Since opened all the year round pled Children) Bath Beach Haxtun Cottage at the Summer care only Children's Summer Home of the New York Children's Aid Society Sheepshead Bay Summer Home for Crippled Summer care only Children Southampton Summer Home for Crippled Summer care only Children (maintained by the Post-Graduate Hospital, New York City) Tarrytown-on-the-Hudson Robin's Nest Summer care only Rhode Island North Kingston Crawford Allen Memorial Summer care only Hospital (Branch of Rhode Island Hospital) Day Schools Massachusetts Boston Industrial School for Day care only, without board Crippled and Deformed Children New York Nev*; York City Crippled Children's East Side Day care only, without board Free School Miss Spence's School Society Day care only, without board Rhinelander Industrial School Day care only, without board for Crippled Children 207 CARE OF CRIPPLED CHILDREN Name of Institution Reasons for not Listing Trade School of the Hos- Vocational school. Deals with pu- pital of Hope for the In- pils over i6 years of age jured and Crippled William H. Davis Free In- Day care only, without board dustrial School for Crippled Children INSTITUTIONS NOT INCLUDED IN THE TABULATED LIST HOSPITALS MASSACHUSETTS Children's Hospital, Huntington Avenue, Boston Date of opening: 1869. Superintendent: Sister Caroline, of the Sisters of St. Margaret. Orthopedic surgeon : Robert W. Lovett, M.D. About one-fourth of the beds are usually occupied by orthopedic cases, one-fourth by other surgical cases, and one-half by medical cases. The department for out-patients has four different services. The surgical service, which includes orthopedic cases, receives out- patients on four days a week, from 2 until 4 p. m. Out of 26,500 visits paid to the dispensary during 1912, 8,319 were by orthopedic cases other than lateral curvature, and 3,303 by lateral curvature cases. The average number of patients cared for in the year ending December 28, 1912, was 69. This hospital is soon to move to a new building with modern equipment, located near the Harvard Medical School. There are two gymnastic clinics with an average attendance of about 21 in the clinic for scoliosis and 19 in the clinic for paralysis. Sessions are held on three afternoons and on Saturday morning, and most of the patients are expected to come every time. In some cases exercises are prescribed which the patients may do at home, reporting once in two weeks. A list of exercises, numbered in the order in which they are to be given, is furnished each patient by the director of the work. There is a waiting list of 100. An attendance chart is kept and patients who do not come regularly are dropped. The work is in charge of seniors from the Sargent School of Gymnastics. A social service department is in charge of a graduate nurse of this hospital, who received special training at the Boston School for Social Workers. She has several pupil nurses as assistants. 208 APPENDIX Many other graduates of this training school hold responsible positions as superintendents and head nurses in children's hospitals and country institutions. Arrangements with general hospitals in Boston permit the nurses in training at the Children's Hospital to study adult nursing for three or four months. The applications for admission to the school exceed the number of vacancies. The hospital maintains a brace shop where appliances are sold at cost to patients unable to pay more. The social service depart- ment has organized a fund for the purchase of braces for cases unable to pay even the cost price. Appliances are also sold to other hospitals and for surgeons' private cases, at an advance over the cost price. NEW YORK New York City Children's Hospital (Department of Public Charities), Randall's Island Established: 1837. Superintendent: Mrs. M. C. Dunphy. Orthopedic surgeon: (for normal children) Charles Ogilvy, M.D. This general hospital for children does not separate the orthopedic cases from the regular surgical cases. At the time of the visit in 1913 there were about 70 orthopedic cases; some were new and others had been there for a long time. There is no fixed capacity; all cases sent are admitted. The wards for surgical cases, where all orthopedic cases are cared for, are located in a separate building from the one in which chronic cases are cared for. They are in a one-story brick building, with unscreened windows on all sides. The building is old and lacks many features commonly found in modern hospitals. Near this building are shacks, occupied during the day in pleasant weather by surgical cases. Children between the ages of two and sixteen are admitted. Examinations are made at the city dispensary and all cases except those of lung tuberculosis are taken; the feeble-minded are segre- gated. The hospital plans to discharge the children before they are six- teen, but sometimes they have to be kept longer. The social worker tries to find homes for them, return them to friends or place them m other institutions. There is a surgical building where all operations are performed and isolation buildings for various contagious diseases. The ortho- pedic cases are all housed on the first floor. 14 209 CARE OF CRIPPLED CHILDREN A regular public school is attended by all the children who are well enough to go. The courses cover regular grades and there is some industrial work, which is done out of doors when this seems best. The children are carried to and from the school in carts and wagons. Those who can not walk are carried to the carts by male attendants. Seton Hospital, Spuyten Duyvil Parkway, New York City (In charge of the Sisters of Mercy) Date of opening: 1895. Superintendent of the hospital: Sister Frances Ignatius. Superintendent of Nazareth Branch for Women and Children: Sister Mary James. Orthopedic surgeon: Russell A. Hibbs, M.D. Seton Hospital is a large institution for the care of tuberculosis cases, of both sexes and all ages. This hospital meets a special need by receiving considerable numbers of children who have both bone and lung tuberculosis, cases not usually welcomed by ortho- pedic wards in general hospitals or by orthopedic hospitals. The majority of the patients are men with tuberculosis of the lungs. During the year ending December 31, 191 1, 783 men were cared for and 516 patients were treated in the Nazareth Branch for Women and Children. Seventy-eight of the children were classed as orthopedic cases. The children are housed in wooden buildings, including one sub- stantial building used almost entirely for orthopedic cases. The sleeping pavilions have steam heat connections, and are made warm in winter for dressing and undressing by closing the windows for half an hour both in the morning and at night. Some of the chil- dren sleep in tents or under awnings attached to the pavilions, when weather permits. All the rooms have abundant provision for the entrance of air and sunlight. Floors are bare, except for strips of rubber matting and of linoleum. Bathrooms have com- position floors. All walls are painted. The thresholds are low. The pressure of applicants who are lung cases is greater than that of orthopedic cases. Each child who is well enough goes to school for two hours each day. One of the Sisters is the teacher; she has 60 pupils in all and the classes usually range from kindergarten to 4A. The children are graded as accurately as possible. Many of them have attended school irregularly before coming to the hospital. 210 APPENDIX PENNSYLVANIA Philadelphia ORTHOPiEoic Hospital and Infirmary for Nervous Diseases, 17th and Summer Streets, Philadelphia Date of opening: 1868. Superintendent : Miss Margaret S. Wilson. Surgeon: G. G. Davis, M.D. This hospital has 126 beds, of which 86 are in wards and 40 are in private rooms. Of the 698 patients treated during the year ending December 31, 1911, 442 were in wards and of these 280 were free cases. Of the total number of cases 205 were chiefly orthopedic. There is a large dispensary service which recorded 7,646 visits of surgical cases and 15,016 visits of nervous cases. A large propor- tion of these visits were for massage and electrical treatments. The orthopedic clinics are held three days a week, with a different surgeon in charge on each of the three days. There is a training school for nurses with 32 registered. A special class for massage and electricity is held with 13 pupils. This city hospital, with full modern equipment, has not been scheduled because the work is not exclusively for orthopedic cases. WISCONSIN Children's Free Hospital, Milwaukee Date of opening: 1894. Superintendent: Gertrude I. McKee, R.N. This hospital has 65 beds, of which at least 20 are usually oc- cupied by orthopedic cases. Operations are performed by general surgeons. The building is a former residence so transformed that hospital standards of sanitation are met. CONVALESCENT HOSPITALS OR HOMES MASSACHUSETTS Convalescent Home of the Boston Children's Hospital, Wellesley Hills Date of opening: 1874. Head nurse and housekeeper: Miss Gertrude J. Davidson. This convalescent home for children discharged from the Boston Children's Hospital is supervised by the same Sisters of St. Mar- garet who have charge of the city hospital, and by the same medical staff. All kinds of convalescent cases are sent to the country branch; one-half the beds are kept for medical cases, one-half for all kinds of surgical cases, among which the orthopedic cases form so large a majority that they usually constitute about one-third 211 CARE OF CRIPPLED CHILDREN of all the children in the institution. There are no bed cases, but several of the children lie on cots all day. The average number cared for was 56 in 19 12. The home has 90 beds. The main building is of brick with a second story used for employes only; it is connected by corridors with one-story wooden buildings which contain the children's dormitories, and a large and very well lighted play room where the children spend much of their time. The buildings are planned with as careful consideration of the easy movement of the children and their rapid transfer from the building in case of fire, as though only crippled children were residents. There are no thresholds and strips of rubber are laid on floors in the halls. Although the children live entirely on the first-floor level and could be taken out of the build- ing quickly in case of need, there are fire extinguishers, standpipes and hose. There is a separate ward with bath for contagious diseases, also an infirmary with two beds. The interior finish of the buildings has been planned with about the same degree of reference to sani- tary details which is usual in the convalescent hospitals we have scheduled. Some floors are of a special red composition; those of the wards are of bare hardwood; all walls are painted; doors are flat. Clothing worn by the children is supplied by the institution; that which they wear when they come is not used again until they are sent home. There are three visits a week by doctors from the city hospital. A kindergarten teacher comes every afternoon except Saturday, and supervises the children's play. NEW JERSEY Children's Sea-Shore House, Atlantic City Date of opening: 1872. President of Board of Managers: William H. Bennett, M.D. Orthopedic surgeons: William Jackson Merrill, M.D., Frank D. Dickson, M.D. This seaside convalescent home has a department for sick infants with their mothers, one for children under twelve without their mothers, one for older girls, and a camp for older boys. The entire capacity is for more than 400. The institution is housed in modern wooden buildings on the cottage plan. Some of the cottages are open only in summer, but the wards for children include 70 beds set apart throughout the year for cases of tuberculosis of bones and glands. There is no discrimination as to color. While many of 212 APPENDIX the patients coming to the institution, especially in summer, re- main for brief periods, usually not more than ten days, the cases of bone and gland tuberculosis are allowed to remain for many weeks. Out of i8o of these cases during the year 191 1, many stayed for several months and three for the entire year. It receives orthopedic cases from many general hospitals in Philadelphia, especially the Hospital of the University of Penn- sylvania, and in large degree fills the place of convalescent branches connected with the city hospitals. NEW YORK Convalescent Children's Home, Chappaqua Opened in 1908 under the auspices of the Children's Aid Society. Superintendent: JVlrs. Marion H. Withycomb. This institution is a home for convalescent children from New York City. In the year ending September 30, 191 2, it had an average daily attendance of 116. About 40 crippled children are usually included. They are cared for in rooms planned for their special comfort, with thresholds omitted. Some come for short periods only, in fresh air parties; others are allowed to stay some- what longer, but the home does not attempt to provide for very long-time convalescent cases. The home has its own physicians who are called upon whenever needed, but most of the crippled children who come to Chappaqua have been in attendance at some dispensary in the city under the care of a surgeon. In such cases the home sends a nurse to New York with the patient when the surgeon requires it, and the chil- dren continue treatment under the same specialist who originally had charge of their cases. Country Convalescent Hospital, Rochester (Privately maintained) Date of opening: Opened for summer of 1908 and continuously since the summer of 1909. Orthopedic surgeon : Ralph R. Fitch, M.D. This small convalescent hospital near Rochester is financed entirely by Dr. and Mrs. Ralph R. Fitch. Dr. Fitch is an ortho- pedic surgeon. He sends to this small institution some of his poorer patients whose homes do not afford conditions proper for con- valescence. The parents are encouraged to make small payments, if they are able to do so, because it is thought better that they 213 CARE OF CRIPPLED CHILDREN should not feel the element of charity in the work done for their children any more than can be helped. Very few are able to pay anything, and the maximum amount is seldom more than one or two dollars per week for any child. Many of the cases have bone tuberculosis. The building used is a transformed barn on grounds belonging to Dr. Fitch. The building has been completely refinished with narrow boards for wall coverings, bare floors, hot-water heat and modern plumbing. It is worthy of study by anyone desiring to build a simple but adequate country place for a small number of crippled children, where the utmost use is made of the space avail- able, and where arrangements for fresh-air sleeping are of the best. The children's beds stand on a porch 12 feet wide which extends along two sides of the house. The porch has a solid wooden railing between 3 and 4 feet in height and is screened above that level. There are windows which drop in sections into the wooden railing. They are raised in case of storm and on the coldest days in winter, at night, and in the morning while the children dress and undress. The heating arrangements are so good that the porch can be made reasonably warm within fifteen minutes after the windows are closed. In addition to this porch the first floor has a big living room with fireplace, a kitchen, bathroom and linen closet. There are rooms on the second floor for the two graduate nurses and the cook. The children are kept for unlimited periods. The institu- tion has only 10 beds and many more could be filled; neverthe- less, the children admitted are always kept until their cure is entirely completed. Several of the children have been contin- uous residents since the opening for all-the-year work in 1909. By this plan the fruits of the beneficent work of the hospital are as- sured to its patients. The provisions for physical care of the children could hardly be bettered; the only added advantage they would have in a larger convalescent hospital would be in educational directions. A teacher has sometimes come for several hours a day during the sum- mer, but it has not been possible to arrange for teaching in winter because the institution is too far away from any school to secure the part time of a teacher, and the number of children old enough and well enough to give much attention to school work is too small to warrant engaging a teacher for her entire time. The homelike atmosphere which might be expected with the small number of children cared for is fully realized. 214 APPENDIX St. Agnes Hospital for Crippled and Atypical Children, White Plains (In charge of the Sisters of St. Francis) Date of opening: 1908. Superintendent: Mother M. Catherine. Orthopedic surgeon: Francis E. Butler, M.D. All kinds of orthopedic cases are taken. This hospital cared for 128 orthopedic cases during the year ending January i, 191 1, in addition to a large number of atypical, or mentally deficient children (the exact number of the latter is not given in the printed report). It has a well equipped operating room and is prepared to give full hospital treatment. The institution has 16 acres of land, of which 12 acres are culti- vated as gardens; the remaining space is used for lawns and a play- ground. The main building, school building, and cottage most used by the cripples are of brick, partly fireproof. Other build- ings, including an isolation cottage, a laundry building with second- floor rooms for quarantine purposes, the manual training shop and the carpentry shop are of wood. There is an iron fire-escape of special merit at the rear of the main building; it is 6 feet broad, railed, has corrugated steps to the ground and a metal roof. Exits are on the level of each floor from a porch. This outside stairway is commonly used by the children in going to upper floors of this building. JMost of the bed cases are in the main building, but 60 of the crippled children sleep in a special cottage with two stories. It has a special enclosed stairway, but no fire-escapes. Most of the cases are sent by the Department of Public Charities. There is a visiting orthopedic surgeon and a staff of consultants; some of the Sisters have been trained as nurses. There is a graded school with separate classes for crippled and atypical children. During the year ending January i, 191 1, there were 150 children of both types in attendance. There were two classes for cripples and two for atypical children in addition to a kindergarten. Sessions were held from 9 until 1 1 : 30, and from i until 3 : 30, every day except Saturday. A great deal of hand work is done In all of the classes, including sewing and kindergarten processes. Singing and drawing lessons are also given. Most of the vocational training has grown out of the life of the hospital. The girls learn sewing and all kinds of housework. At the time of our visit five or six girls spent a good deal of time in general housework and four met daily, at the close of the school session, to sew. Many of the atypical children do 215 CARE OF CRIPPLED CHILDREN small tasks about the institution, but few of the cripples are able to help. A class in basketry is taught by one of the Sisters for an hour each week; 12 children attend, including some of those who are crippled and some of the atypical children. Manual training classes are taught by one of the Sisters. Twelve boys are divided between two classes. They take manual training for two years, then begin practical work with the institution's carpenter. Six of the older boys have been working with him in the construction of a bungalow to be used by some of the children. Two boys work in the engine room and two with the farmer. The per capita rate paid by the city for the care of the children covers a large share, though not all, of the cost of operating the hospital. OHIO Rainbow Cottage (Affiliated with Lakeside Hospital), Cleveland Date of opening: i8go. Superintendent of nurses: Miss Arvilla Patton. Visiting surgeon: Gordon N. Morrill, M.D. Out of 233 cases treated during the year ending December 31, 191 1, 130 are surgical cases, most of them orthopedic. The med- ical cases include children with heart disease and chorea, and convalescents from typhoid fever or other long illnesses. If the older girls who come for two-week periods are not counted, the average stay is somewhat over two months, but a few cases have stayed much longer, even two years. This convalescent country hospital can accommodate 62 patients in summer; the capacity of the buildings which are fitted for use in winter is 26. The cottage is located about 10 miles from the center of Cleveland, in a section which is becoming suburban in character. The institution owns 10 acres of land, including a large pine grove. Fruit trees and grape vines make large contributions to the food supply. There is a main building, a play house with a small stage, and a third house containing a large dining room and kitchen, all of wood. A small building for quarantine of contagious diseases was burned shortly before the institution was visited. The floors in the hall and play room are covered with cork carpeting which costs about the same as hardwood flooring. It is preferred because it can be washed or varnished easily and because the children's braces do not harm it. Walls are painted; in the sun room the walls are ceiled with wood, 216 APPENDIX and there is wooden wainscoting halfway up the walls of some other rooms; bathrooms are finished with tile. There is a separate tent where the children come to wash their hands in running water after they have been playing out of doors. A pipe is run horizontally above a large trough at such a height that the children can easily reach the many faucets. Inclines facilitate the movement of the children in and out of the building. A tent ac- commodates eight older girls who come for two weeks each. None of the other children sleep out of doors, but many of them have second beds in an outdoor pavilion to which they are carried for the day. There is one sun room with two beds. The work done has gradually changed from fresh air work to con- valescent hospital care with consulting and visiting surgeons and physicians, an interne who is a fourth year student at Western Reserve Medical College, a graduate nurse, a night nurse, and a corps of nurse maids who are taking a one year's course of training. Operations are done at Lakeside Hospital, but there is a surgical dressing room at Rainbow Cottage and cases requiring close medi- cal care are taken. The cottage shares with Lakeside Hospital the services of a visiting nurse who keeps closely in touch with the children after they return to their homes. The Benjamin Rose Foundation con- tributes $5,000 a year for the orthopedic work at Rainbow Cottage. A kindergarten teacher does informal teaching for five hours a day, five days in the week. ASYLUM HOMES NEW YORK House of the Holy Comforter for Incurables, 139th Street and Riverside Drive, New York City Incorporated: 1880. Superintendent: Miss M. R. Swarr. This is a free home for incurables who are without means or friends who can support and care for them, or who can not be re- ceived in homes or hospitals. The better class of Protestant women and female children are taken, and there is a trial period of three months. The capacity of the home is about 80. Most of the cases are adults and in 19 12 there were only about 15 children out of 78 inmates. These children were crippled and from four to eighteen years of age. 217 CARE OF CRIPPLED CHILDREN The house is a large one, with a big dining room on the first floor and a school room on the second floor. There is one teacher and the children are not graded. There is a table instead of desks. A little sewing is the only branch of industrial work taught. A few children have been placed in positions, but most of them go back to their homes or are sent to other institutions. PENNSYLVANIA Good Shepherd Home (for Crippled Orphans, Infant Orphans, Destitute Children, Old People, and Aged or Disabled Ministers), Allentown Date of opening: 1908. Superintendent : Rev. John H. Raker. This home cares for 4 1 children and seven old people. Fifteen of the children are crippled. There is no surgical attention, but the children receive careful and affectionate treatment. This home undertakes to care for five different classes of depend- ents or defectives, not more than two of which belong together. It also undertakes to carry on a nurses' training school, and to conduct a placing agency — all on an income of about $5,000 per year. The per capita expense is only J?i40 per inmate: too little for the classes cared for. A fine spirit pervades the home. SUJVIMER HOMES NEW JERSEY Children's Country Home, Westfield Date of opening: 1892. Superintendent: Mrs. Emily Schwartz. This country home is open from the first of June to October. It began as a place for fresh air parties of children from New York. The capacity is 25 and there are seldom any vacancies. About 50 different children are cared for each season. All classes of chil- dren who need convalescent country care are taken, including chil- dren with nervous troubles. An increasing proportion, however, are orthopedic cases from the Home for Destitute Crippled Children in Newark. The building is beautifully located in wooded country, about two miles from the railroad station. There are 10 acres of land, in- cluding a garden which furnishes all of the vegetables. The wooden house, originally a residence, has been enlarged and renovated. The floors are of bare hardwood; walls are calcimined except 218 APPENDIX in dining room and wards, where they are of narrow boards. The house is heated by furnace and lighted by kerosene lamps. There is a windmill with large water tank, and connection for hose on each floor of the building; outside wooden stairs with rails lead to the ground from both dormitory wings. The sleeping arrangements are good. A special feature is the provision for outdoor sleeping for the children in one dormitory, which has a screened piazza 3 feet wide on each side. There are 1 1 windows and a bed stands against each one. The beds have casters which run easily in narrow strips of board nailed to the floor. They are run part way out of the window so that the child's head is out of doors while he sleeps. It is only in case of storm that the beds are moved inside and windows lowered. For some archi- tectural reason the second large dormitory could not be built in similar fashion, but the 19 windows furnish almost solid walls, of glass and cross ventilation is possible, which secures a close ap- proach to outdoor sleeping. Most of the children are in these two dormitories. Three smaller rooms have three or four beds each. The rooms for the matron and her assistants are placed near those of the children. There is a covered play pavilion in the yard; also a basement play room with cement floor, at the ground level, and a toilet near it. The length of stay, formerly two weeks, has been extended to six or eight weeks and sometimes for the entire summer. The fmancial resources of the home do not permit its being kept open for the entire year. The children are not expected to help with the housework. In the matron's opinion they do not stay long enough to learn much by helping, and they are expected to play out of doors whenever the weather permits. The children's lives are very happy. NEW YORK Seaside Home for Crippled Children, 4 Summerfield Avenue, Arverne Date of opening: 1912. President: Miss Evelyn M. Goldsmith. This is a summer home. It takes many pupils from the special classes for crippled children in the New York public schools and some children who have been in hospitals. The house is open from the last of June until early in September. Two hundred different children were received in the summer of 1912, for minimum periods of two weeks, extending in many cases to four or six weeks. About 219 CARE OF CRIPPLED CHILDREN 1 5 of the children remained throughout the summer. The presi- dent estimated that 400 different children would be cared for during the summer of 1913. It is possible for the house to accommodate 50 at a time. The application card has a place for the physician's name and other statements, including his recommendation as to whether or not the child is to have sea baths. Except in the cases of children whose physicians prohibit ocean bathing, the children go into the water daily. Considerable emphasis is placed upon abundant and nourishing food, including eggs and milk. The milk is served in the morning and afternoon as well as at meals. Some of the children are learning to do manicuring and have made money by receiving patrons on the porch of the summer home; others have earned money by developing photographs for summer residents. It is hoped that some of the children may be able to keep on with the work they have learned to do during the summer. One girl now has a position as manicurist in a department store. Blythedale (Convalescent Home for Tuberculous Crippled Chil- dren), Hawthorne Date of opening: June, 1904. In 19 12 was open for whole year. Matron: Miss E. M. Crysbe. Orthopedic surgeon: F. H. Albee, M.D. This country convalescent institution at the time this study was made was open only in summer. In 19 12 and 191 3 it was kept open during the winter, and should henceforth be classed with the institutions in our scheduled group of convalescent hospitals and homes. It is maintained by the Visiting Guild for Crippled Chil- dren of the Ethical Culture Society of New York. None of the children are bed cases, but convalescent tuberculosis cases requiring some degree of medical supervision can be taken because the matron and the nurse are both graduate nurses. The capacity is 35, and 32 children were cared for during the first winter. The home occupies a wooden building designed and built for the purpose, on an elevation which affords good circulation of air and beautiful views of the wooded hills. There are four acres of land, including a large vegetable garden where the children do a good deal of work. The floors in the house are bare except for the big rug in the living room; all walls are painted. The surgical dressing room has composition flooring. The house is heated by steam and has its own water system. The children sleep in four dormitories, two for boys at one end of the building and two for 220 APPENDIX girls at the other. The matron's room and the nurse's room are also at opposite ends of the building, near the different dormitories. An isolation room on the second floor can be connected with the bathroom on that floor, if necessary. All other rooms for the chil- dren are on the first floor. There are unrestricted outdoor play space and a large porch, part of which is enclosed in glass and used as a sun room in winter. There is a living room which has a large stone fireplace, a piano, phonograph, and library of children's books. There is another fireplace in the cheerful dining room. Both boys and girls between the ages of four and sixteen are admitted; most of them have been patients at the Post-Graduate Hospital with which the surgeon for this home is connected. Nourishing food is furnished in abundance, especially eggs and milk. The children have milk in the forenoon and in the afternoon, as well as at meals. The parents are asked to furnish shoes; other clothing is supplied by the institution. Abundant provision is made for the entertainment of the chil- dren. A resident kindergarten teacher amuses them and does elementary teaching. JVIost of the children take care of their own beds and some of the older girls do their own ironing. Some girls who have worked in the Crippled Children's East Side Free School and have learned to do embroidery, make articles which are later sold at the school. Haxtun Cottage at the Children's Summer Home, Bath Beach (Maintained by the Children's Aid Society of New York) Date of opening: 1888. Superintendent: Charles R. Fry. This cottage is one of a group belonging to a summer home to which the Children's Aid Society of New York sends children in parties for periods of one or two weeks. It is located near the sea- shore. One wooden building with 16 beds is reserved for crippled girls between the ages of three and fifteen. They come in parties of 16 and remain for two weeks. Most of them have been patients at the Hospital for the Ruptured and Crippled in New York City. The children to be sent are chosen by the hospital; no cases needing to stay in bed are admitted. The house has painted walls; the dormitory floor is of bare wood and linoleum is used on the floor of the dining room, which serves also as the children's general living room. Escape in case of fire would be easy by a porch which runs the entire length of the dormi- 221 CARE OF CRIPPLED CHILDREN tory. Nearly every bed in the dormitory can be seen from a room occupied by one of the nurses. The employes at this cottage include only two graduate nurses and a housekeeper. The food is brought over from the general kitchen, reheated on a gas stove if necessary, and served in the din- ing room of the cottage. Summer Home for Crippled Children, 2425 Ocean Avenue, Sheeps- head Bay Date of opening : 1 9 1 1 . Parties of crippled children are received at the home of Mrs. Harrison Gray Lamson at Sheepshead Bay, throughout the sum- mer. Girls come in one party, boys in the next, and each group of nine remains for two weeks. Mrs. Lamson wishes to provide these summer outings especially for children who, for some reason, are not eligible for admission to institutions receiving other crippled children. Children very much deformed are not refused, but those requiring medical care can not be taken. Some of the children are students in the public schools with which Mrs. Lamson was formerly connected as a teacher. The children sleep in a wooden pavilion 15 feet square, with screens occupying about half the wall space. On two sides the screened sections are covered with awning curtains. They ordi- narily eat at a table in the kitchen of the residence; on Sunday evenings they are invited for supper with Mr. and Mrs. Lamson in the dining room. All the work in connection with the children is done by Mrs. Lamson and her two maids. The children help pick vegetables in the garden; it is planned later to have the first parties come early enough to learn something about planting seeds. A considerable share of the cost of this work has been met by Mrs. Lamson; but there have been some contributions and other sums have been raised by social occasions, including a bazaar. Summer Home for Crippled Children, Southampton (Maintained by the Post-Graduate Hospital, New York) Date of opening: 1904. Superintendent: Miss Frances M. Melvin. This summer home cares for 30 convalescent orthopedic cases from the Post-Graduate Hospital of New York. The home is located on a slight rise of land about three miles from Southampton. There is a large two-story wooden cottage of 222 APPENDIX modified bungalow style and a separate building with one large room 1 8 by 30 feet, which is used as play room and school room. These specially planned modern buildings are connected by a covered passageway. The walls are painted and floors are hardwood, bare and unpolished. The residence building has a great deal of porch space, most of it screened. About half of the children, including all those with tuberculous abscesses, sleep on out-of-door porches. The children take special pleasure in their sunny and attractive play room. The children are usually between the ages of four and fourteen. There is wide variation in their physical condition. There are usually four or five that might be termed hospital cases, including children on Bradford frames, but the large majority of the children are not bed cases. The institution receives cases requiring some medical supervision. The home is open from the first of June until the first of October and the same children stay throughout this period. The superintendent is a graduate nurse who has had extended experience with orthopedic cases. During the winter the superin- tendent acts as visiting nurse for the orthopedic ward in the Post- Graduate Hospital, and her cases include the children for whom she cared during the summer. There is a cook stove in the play room which is used by one of the maids in giving cooking lessons to the older girls. After such lessons they serve tea themselves and eat the food they have pre- pared. Each older girl takes care of three beds and has also special charge of one smaller child. The children sweep and dust the play room and keep it in order. They are not dressed in uniform. A teacher who has taught in special classes for crippled children in day schools in New York stays at the home throughout the five months when it is open. During the summer she gives kinder- garten instruction including much simple hand work. In the month of September the school is organized with classes from the kindergarten to grade 6A. The work is then made to conform as closely as possible to that in the public schools in order that the children who go to school may continue with their regular classes when they return to the city in October. The atmosphere of this home is one of comfort and good humor. Robin's Nest, Tarrytown-on-the-Hudson Date of opening: 1891. Superintendent: Miss A. B.Abbott. 223 CARE OF CRIPPLED CHILDREN This summer home for convalescent crippled children is an inde- pendent organization, but all its cases come from the Hospital for the Ruptured and Crippled in New York. For more than twenty years it has been open from the first of May until the first of December, and parties of 22 children are taken for two months each, so that three groups are received each season. Alternate parties are made up exclusively of girls and of boys. No bed cases are taken, but many of the children have tuberculous abscesses which are dressed by the graduate nurse. There are occasional visits by a surgeon from the Hospital for the Ruptured and Crippled and a local physician comes when needed. The building is a former residence with about an acre of land. There are vegetable gardens in which the children work. The building has been refinished for its present purpose, with painted walls and composition floors in the surgical dressing room and some of the bathrooms. Pails of water are kept on the different floors for use in case of fire. Fire drills, with two canvas chutes, are held occasionally. The children sleep in several small dormitories. The nurse's room is opposite the largest dormitory, which has 1 1 beds. Some- times two of the youngest children sleep in the nurse maid's room. Liberal provision has been made for both physical care and amuse- ment of the children. A small section of the porch has been made into a sun parlor where the children play often on cool or rainy days. The yard has big wooden swings and abundant space for games. There are three dining rooms: one for the officers, one for twelve of the older children, and one for the younger children. The table service is more like that in a comfortable home than in the majority of the other institutions visited; white tablecloths and pretty dishes are used. There is a staff of nine employes. No expense limit is set in the procuring of nourishing and appetizing food. Between 25 and 30 quarts of milk are used daily. The children drink it at meals, and milk, buttermilk, or beef tea is served at 10 in the morning and at 3 in the afternoon. One of the managers furnishes the uniforms worn by all of the children. Boys wear blue overalls and the girls wear gingham dresses which are identical in cut and material. The garments come in sizes from one to seven, and there is no attempt to keep individual garments for the same children. This is the only detail at the Robin's Nest which suggests the life ordinarily associated 224 APPENDIX with institutions. In some other directions more than ordinary attention is paid to providing a non-institutional background. A trained kindergarten teacher instructs the children in ele- mentary branches and supervises their play. The kindergarten classes are held in a large room with many windows, which is also an indoor play room. The children do a great deal of hand work beyond the grade ordinarily done by kindergarten pupils. The girls sew a great deal; they have made simple aprons and sunbonnets, as well as fancy bags and cases for toilet articles. The boys make trays and lamp shades of brass. All of the children draw and cut out pictures of the birds they see on the grounds and of the flowers growing within reach of the home; these and other pictures are colored with water colors. The children have done some clay modeling and simple work with reed and raffia. Articles have been sold on rare occa- sions, but the children have taken home or back to the hospital ward most of the things they have made. RHODE ISLAND Crawford Allen Memorial Hospital, North Kingston (Branch of Rhode Island Hospital) Date of opening: 1907. Superintendent: John M. Peters, M. D. This country institution takes children from the Rhode Island Hospital in Providence. It is not exclusively for crippled children but they are usually in the majority. At the time of our visit there were 36 orthopedic cases among the 43 children. The proportion differs between the orthopedic and medical cases for the whole season because many of the medical cases remain for only a few weeks, while most of the crippled children stay for the entire six months during which the institution is open. Some of the children return to the hospital in Providence, others go to their homes where they are watched by visiting nurses from the hospital. About two-thirds of the children are bed cases. The institution owns 106 acres of land which, except for a large vegetable garden, are not commercially used. The children sleep in a three-story brick building, a former residence, which also fur- nishes space for rooms of employes and a general kitchen. But the children eat and live for the entire day in a pavilion close to the seashore, at a considerable distance from the other building. This wooden pavilion, which cost about i?5,ooo, has one very large room used as dining room and living room, a kitchen and toilet rooms, 15 225 CARE OF CRIPPLED CHILDREN a porch used as an outdoor school room, and a large uncovered plat- form on which the children unable to leave their cots lie for the greater part of the day. It is possible that at some time in the future shacks or pavilions for sleeping will be built near the water, so that it will not be necessary to move the children so great a dis- tance each night and morning. The superintendent is a graduate nurse. There are two other graduate nurses and four nurses in training from the Rhode Island Hospital who rotate every two months. Although the officers would like to give more of the nurses opportunity to work for part of the summer in the country, this is not done because frequent changes in personnel mean loss to the children whose individual needs can not be learned until the nurses have been for a little time at the institution. Whenever the water is at a temperature of 70 degrees or more, sea baths are taken by all the children, including those with open sinuses and without regard to what sort of apparatus they wear. Plaster jackets are made in such a way that they can easily be taken off. Children whose treatment requires their being strapped to a frame are put onto a special frame before being dipped into the water. If the temperature of the water is between 65 and 70 de- grees, the bed cases are not given baths but the up-children are allowed to go in if they desire, and most of them do so. For a short period each sunny day the cases with open sinuses lie almost unclothed in the sun. The sun bath may not be more than five minutes for the first few days but it is gradually lengthened. A teacher, who is a normal school graduate and has taught for four years, has charge of the school which does work extending through the sixth grade. Thirty of the children are able to do school work and the teacher finds that she can grade them fairly accurately. Those in cots wheel themselves or are wheeled by the other children to the school porch in time for their classes. DAY SCHOOLS MASSACHUSETTS Industrial School for Crippled and Deformed Children, 241 St. Botolph Street, Boston Date of opening: 1894. Superintendent: Miss Mary M. Perry. Chairman medical committee: E. G. Brackett, M.D. This institution is a private day school with both grade classes 226 APPENDIX and vocational classes. The average number of children in the grades for the year ending April i, 191 2, was 90. The average number in the industrial department was 29. It has a capacity for 100 grade pupils and 50 industrial pupils. There is a waiting list. The school has one large building for general use and a special building for outdoor grade classes. Both are thoroughly modern in construction, finished with the utmost concern for sanitation and convenience, and fully equipped. There is a large elevator with the shaft entirely enclosed, a second stairway with iron steps, enclosed in a brick wall, also iron stairs attached to the outside of building. Thresholds are absent. Although the building is of fireproof construction, two extinguishers are kept on each floor. The building is heated by steam and lighted by electricity. Win- dows are kept open for ventilation although a system of heated flues is provided. There are transoms over all doors. Toilet and bathrooms are provided; the toilets provided are of varied heights. The floors are of hardwood, bare, finished in such a way that they are easily kept clean, and the walls are painted. The new build- ing for outdoor school work is the first building in America espe- cially designed for the outdoor teaching of crippled children. It represents at present the acme of attainment in the erection of special school buildings for tuberculous children. The cost was about $15,000. The building has a substantial roof and one brick wall. The other three sides have steel pillars covered with con- crete, between which there are sliding glass partitions. The roof is built in monitor form with movable wmdows in two sections. Crippled and deformed children who do not require residential care in institutions and who are physically and mentally able to do school work are admitted. There are occasional pupils who use wheel chairs. Most of the pupils are out-patients of hospitals. Feeble-minded children and those with tuberculosis of the lungs are not taken. All pupils must be residents of Boston. Each child entering the school is examined by the physician serving at that time. The children usually continue in this school until they are so far cured that they can go to public schools not for crippled children, or if they are not cured, until they have finished the eight grammar grades. Some of those who complete the eight grades remain to do industrial work in the shops. The school exercises the most careful supervision over the physi- cal condition of all its pupils. A nurse who is a graduate of the training school of the Children's Hospital of Boston gives her entire 227 CARE OF CRIPPLED CHILDREN time to the physical care of the children during school hours and visits them in their homes on Saturdays; and every day through- out the summer vacation. No operations are performed at the school, but there is a special room for medical treatment with sterilizers and simple surgical equipment. The nurse gives nasal douches, looks after discharging ears or cut fingers, and does other minor dressings in this room. She also goes through the school rooms each morning and inspects the apparatus worn by the chil- dren to see if everything is properly adjusted. There are two rest rooms, one with three beds for girls and one with three beds for boys. The children who are unable to remain in their seats as long' as the others are sent for rest at regular times. The nurse loosens their apparatus before they lie down and readjusts it when the rest peridd is over. She has charge of the distribution of clothes sent in by outsiders for the children. She keeps card records of the children's medical diagnoses, filled out by the doctors. A separate record is kept of the condition of the child's eyes and ears. Still another record catalogue has been begun which shows the home surroundings of each child, by what church the family has been aided, and so forth. The school keeps in touch with the Associated Charities of Boston. Special gymnastic trainmg is given by a gymnastic teacher. She keeps a record of the height and weight of all the children. The medical service for the school is supplied by physicians on the medical committee, each one of whom serves for a period of one month. The physician on duty visits the school regularly once a week and other times on call. The nurse sees to it that each child reports at the out-patient department with which he is registered and supervises also the children's visits to the Harvard Dental Clinic where free dental service is given. Articles made are sold upon order and at occasional fairs. For full accounts of the educational and industrial work, see chapters III and IV. Cost of property: $190,000. Year's expenditure per capita: $153. NEW YORK Crippled Children's East Side Free School, 155-9 Henry Street, New York City Date of opening: 1900. Superintendent: Miss S. Saal. Orthopedic surgeon : Charlton M. Wallace, IVl.D. The aims of this school are thus stated in its last report: "To 228 APPENDIX improve the children's physical condition, to train them to become self-supporting, and to provide them with work." The school was organized in 1900. The work was carried on at several different addresses before the opening of the excellent build- ing erected by the Emanuel Lehman Foundation. This modem building is worthy of study by those interested in the erection of special day schools for cripples. It is fireproof in construction. There is a large enclosed elevator around which the main stairs ascend. There is an outside iron stairway, railed, for use as a fire-escape. All doors have transoms and the outside windows are kept open throughout the year, so that the ventilation is excellent. The roof is used as play space after school hours and on Saturdays. Teachers and equipment for academic work are provided by the board of education of New York City. The city's contribution in- cludes special adjustable desks and seats in all the class rooms except the kindergarten. The curriculum, text books, and methods are identical with those employed in other special public school classes for cripples in the city, and the standards are very little, if any, different from those in public school classes for children who are not crippled. The average number in the school classes is 190. All other expenses are met by the private corporation which owns the property. The children are brought to school in omnibuses, given hot dinners, and bread and milk each morning and afternoon, and baths twice a week. One distinctive feature of the school is its weekly clinic, in charge of the orthopedic surgeon. Dr. Charlton IVl. Wallace. The medical rooms give ample provision for examination of the children, appli- cation of plaster of Paris dressings and braces, massage and electri- cal treatments, and the inspection of eyes, ears, and teeth. In addition to the visiting orthopedic surgeon there are an assistant surgeon, a graduate nurse, and three other experienced nurses. The school accepts the entire physical supervision of the crippled children under its care, except when they need actual hospital treatment. They do not attend other clinics at hospitals. The effort to find occupations in which crippled children may be- come self-supporting has resulted in the establishment of a sewing workroom where all kinds of stitches are taught and complete garments of many kinds are made. Twenty-six girls give their entire time to sewing in this shop and are paid regular wages. Most of the work is done to fill orders. The school has also con- tributed some of its products to sales. 229 CARE OF CRIPPLED CHILDREN For the year 19 13 the receipts from the workrooms were ^6,400, of which $4,450 was returned to the woriters for wages, and the re- mainder covered expenditures for materials and other supplies. The receipts did not cover the salary of the director who serves as both business manager and teacher of sewing. It has been found much harder to find profitable employment for boys. Bookbinding was tried and given up. At present several boys are doing machine operating on aprons and at different times two or three have under- taken embroidery. During the summer months a home for crippled children is maintained by this school at Oakhurst, New Jersey. One hundred and six children can be housed there at one time and each child is able to stay from two to eight weeks, according to his need of coun- try life. The children remaining in the city are regularly visited by a nurse engaged for the purpose, and the system of baths and treatments are continued during the summer at the school building. The value of the city property owned by the institution is over $180,000. The property at Oakhurst, New Jersey, is worth $25,- 000. The total operating expense for the year ending November 30, 191 2, was $32,000. Miss Spence's School Society, Foot of East 26th Street, New York City Date of opening: 1902. President: Miss Amy Ellis. Orthopedic surgeon: Charlton M. Wallace, M.D. This society maintained classes for crippled children at the Henrietta Industrial School of the New York Children's Aid Society for eight years. In September, 1909, this work was given up and a school for crippled children was organized on a ferry boat belonging to Bellevue Hospital and anchored in the East River close to the hospital grounds. Dr. Charlton M. Wallace holds weekly orthopedic clinics on the boat and a trained nurse is in constant attendance. A teacher and school supplies are furnished by the board of education of New York. The alumnae of Miss Spence's School supply an omnibus for transporting the children, special chairs for outdoor use, warm wraps and meals, including milk and eggs served when the children reach the boat in the morning and at 4 o'clock in the afternoon, and a hot dinner at noon. The average number of children is 20. All kinds of orthopedic cases are taken. The children admitted 230 APPENDIX must be able to gain something from school work. Kindergarten processes are taught but there is no vocational training. The chil- dren come on Saturdays also for rest and play although no classes are held. There are enclosed rooms for eating, for use during the weekly clinics, and so forth. But the children spend practically all of their time out of doors, on the deck, except in very extreme weather. The expenditure made by Miss Spence's School Society for the year ending March i, 1910, was $3,967, or about !?i8o per child. Rhinelander Industrial School for Crippled Children, 350 East 80th Street, New York City Date of opening: 1890. Superintendent of grade classes: Miss Katherine R. Stackpole. Orthopedic surgeon: Brainerd H. Whitbeck, M.D. Special classes for crippled children were opened by the Chil- dren's Aid Society in a building erected by the Misses Rhinelander in 1890. The average daily attendance in the grade classes for the year ending September 30, 1913, was 114. Manual training and trade classes are maintained by the Brearley League. . The average number registered in manual training classes was 62; 21 children over fourteen years of age, most of them graduates of the eighth grade, give their entire time to work in trade classes. The class for girls does sewing, embroidery, and dressmaking; for boys a jewelry class is maintained. For further account of the educational and vocational work, see chapters on Education and Vocational Training. A trained nurse is employed and an ortho- pedic surgeon, Dr. Brainerd H. Whitbeck, visits the children at the school. Those who are unable to walk are brought to the school by omnibus. Trade School of the Hospital of Hope for the Injured and Crippled, i 59th Street and Mott Ave., the Bronx, New York City Date of opening: 1912. Director: Charles Jaeger, M.D. This trade school for adult men was organized in September, 1912, by Dr. Charles Jaeger, orthopedic surgeon of the German Hospital of New York. He has been interested for many years in artistic hand work; has done work with water colors and made hand-wrought jewelry. The school admits only males between sixteen and thirty-five years of age. There are accommodations 231 CARE OF CRIPPLED CHILDREN for 50. Those maimed by accident are preferred to those crip- pled through disease. The school is maintained by a single phil- anthropist for the present; whether or not he will provide for it permanently is not yet known. It is expected that modern buildings for the housing of this trade school and for a hospital with which it is to be connected will be built later on land not far from the old residence leased at present for the trade school. The present building stands on high ground and is surrounded by an entire block of land. The workrooms are large, airy, and well lighted, with exceptionally high ceilings. All instruction and a substantial dinner at noon are furnished free. Work rooms have been opened and skilled teachers employed in each of the following five branches: The making of reed articles, metal work, mechanical drawing, engraving, and woodwork. The reed working department is in charge of a foreman who was previously employed by one of the best manufactories of reed articles. All sorts of reed furniture are made, including large willow chairs, small rockers for children, baskets from interesting German designs, foot stools, and large vases for holding flowers with long stems. Old chairs are repaired and provided with new seats. Tabarets, revolving book cases and magazine holders have been made in the woodworking department. In the metal working room one may see brass bowls of very beautiful designs in various stages of development. It is believed by Dr. Jaeger that there is a good opening for the making of special designs in smaller varieties of hardware, particularly for country homes in the old English and other special styles of architecture, where the door locks and other small metal pieces must accord with the interior finishings of the house. Some locks and panel pieces have already been made in the shop. The teachers of metal work and mechanical drawing each come for only half a day. An expert engraver is teaching one man to engrave initial letters, monograms, and so forth. A sixth room contains a large loom for the weaving of silk neck- ties. Opportunity to learn this trade and the weaving of artistic rugs will be offered later if a suificient number of men make appli- cation for it. The director desires that all this work shall be on an entirely practical basis, although none of the articles are as yet offered for sale. Articles made in the workshop are kept as evidence of the 232 APPENDIX kind of work produced by the institution. The chairs will be used in furnishing the house. It is expected that each man who enters will stay not more than from three to six months, because it is believed that that amount of time will be sufficient to teach him some work by which he can earn his living. Pupils leaving the school will be assisted in securing positions. One of the men now working with reed and woodwork is nearly ready to open a shop of his own. He has many friends. It is believed that his shop will soon have so much business that it will be possible for him to employ some of the others who have learned these trades in the school. It is possible that a regular workshop will develop later and if this is the case it is hoped that its products may earn possibly 40 per cent of the running expense of the institution. The remainder must be supplied by private charity. William H. Davis Free Industrial School for Crippled Children, 471 West 57th Street, New York City Date of opening: 1899. Superintendent: Mrs. E. Bullard. Chairman, Medical Board: James Porter Fiske, M.D. The chairman of the medical board. Dr. James Porter Fiske, ex- amines each child before it is admitted to the school. He also examines all the children before they go to the country home at Claverack for the summer. Children with all kinds of orthopedic difficulties are taken. No feeble-minded cases are desired. There are no fixed age limits but the children usually enter the kinder- garten when not less than four years old. It is expected that they will stay until they have finished the eighth grade. They may remain after that in the sewing and wood carving classes, if they choose. This school is entirely private and receives no aid from the city board of education. The grade work is divided between two teachers: one has the kindergarten and primary grades, the other has the later grammar grades. Ordinary school seats, not ad- justable, are used. The program is not so definitely fixed as in the public schools. A sewing teacher and a manual training teacher, who was formerly a pupil in the school, are employed. Articles made are sold at fairs. The children have been paid a portion of the proceeds. There are usually four or five older girls and one or two older boys who give a large share of their time to industrial work. Elaborate and beautiful wood carving and leather 233 CARE OF CRIPPLED CHILDREN tooling is done by a crippled young man who has been in the school for more than twelve years, first as a pupil, then as teacher. Two or three of the other boys are able to do creditable work under his direction. In the sewing class the girls make some plain garments and many fancy articles for sale at the fairs. The children are brought to the school by a wagonette with an experienced attendant. They are given a hot dinner without charge. From the time the school closes in June until the first of October, the children are kept at the Lulu Thorley Lyons Home for Crip- pled and Delicate Children at Claverack, New York. According to the last report, printed in June, 1909, the average number in the city day school was 50 and the cost per day was 78 cents for each child. About 85 per cent of the cost of the manual training department, including the payments made to the children, was covered by sale of work at harvest festivals. The average number of children in the country home is given also as 50 and the average cost per day as 69 cents for each child. The financial statements printed in the report are admirably detailed and clear, but their value would be much greater if they were presented annually. The statements for the printed report for 1909 covered a period of three years and two months. ORTHOPEDIC WARDS IN GENERAL HOSPITALS Special orthopedic wards are maintained by a number of general hospitals. Among those specially noteworthy are the Lakeside Hospital, Cleveland, Ohio; the Hospital of the University of Penn- sylvania, Philadelphia; the New York Post-Graduate Hospital in New York City; the University Hospital of the University of Michigan, at Ann Arbor; the Johns Hopkins Hospital at Balti- more, and the Sanatorium for Hebrew Children of the City of New York, at Rockaway Park, Long Island. The St. Louis Chil- dren's Hospital and the Washington University Medical Hospital have special orthopedic wards with dispensary service. ASSOCIATIONS FOR THE AID OF CRIPPLES We have not attempted to study the societies which aid cripples. Among the societies of this class are three in New York City: The Association of Public School Teachers of Crippled Children; the Federation of Associations for Cripples; the Association for the Aid of Crippled Children; and in St. Louis is found the Tiny Tim Fund. 234 APPENDIX OCCUPATIONS AND WEEKLY EARNINGS OF GRADUATES Industrial School for Crippled and Deformed Children, Boston, Massachusetts In the course of the general survey of work for crippled children a list of former students of the Industrial School for Crippled and Deformed Children in Boston, and their present occupations, have been secured. They are printed herewith because they have some suggestive value. A detailed study of the subject should include for each employed cripple an exact statement concerning his physical ability and disability. (Information given in response to letters in March, 1910, by graduates from the school) store Occupations Monotype casting operator Lunch cart tender Manufacturing jeweler Cashier .... Printer of cards Bookkeeper Town weigher . In charge of sample department for manufacturer's agent Compositor Office girl Sales girl in department Sales girl Printer Office girl Secretary Stenographer Printer Clerk . Stenographer Shank-tacking operative factory . Press feeder Power machine operative (on un derwear) (Piece work) Telephone operator Office worker, department store Stenographer .... Stenographer .... Bookkeeper .... Fruit and vegetable dealer . Electrical apprentice Sorter of nails .... Curtain maker Chamber worker and seamstress in shoe Weekly earnings $20.00 20.00 20.00 17.00 15.00 14.00 13.50 12.00 12.00 12.00 10.00 10.00 10.00 10.00 9.00 9.00 9.00 8.00 8.00 7.00 7.00 7.00 6.50 6.00 6.00 6.00 6.00 5.00 4.50 4.50 3.00 1.50 Physical difficulty Amputation of leg Amputation of leg Hip disease Hip disease Tumor albus Hip disease Hip disease Hip disease Hip disease Spinal curvature Spinal curvature Pott's disease Pott's disease Hip disease Spinal curvature Hip disease Cured hip case Pott's disease Hip disease Hip disease Lumbar caries Amputation of ankle Hip disease Lateral curvature Hip disease Hip disease Coxa Vfira of hip Pott's disease Tuberculosis of knee Lateral curvature Amputation of leg Lateral curvature 235 INDEX INDEX Abbott, Edville G., M. D., 142 Admission and Discharge: age and color restrictions, 106 Aid AssoaATiONS: in New York City, 234; Tiny Tim Fund, St. Louis, 234 Albee, F. H., M. D., 220 Ancker, Arthur B., M. D., 144 Architecture and Cost: ground-floor school rooms, fire-escapes, and ele- vators, 50; Hospital for Ruptured and Crippled, New York City, 6; leading institutions, 6, 7 Artificial Arms: special devices costly, 6s Association for Aid of Crippled Children: New York City, 234; aid given in own homes, 2; buses furnished by, for cripples to attend public schools, 57; nurses for pub- lic school classes, 33; propaganda of work, 16 Association of Public School Teach- ers OF Crippled Children: New York City, aid society, 234 Asylum Homes, 186-201; admission and discharge, rules of. Table VI C, 132-133; average cost, per bed, 99, 1 20; capacities of, and number of children treated during year, 92, 1x6; characteristics of, and pur- poses, 26, 27; child-placing so- cieties and homeless cripples, 11; Children's Aid Society, New York City, placing children from, 22, 23; Children's House of the Home for Incurables, Philadelphia, descrip- tion of, 198, 199; Crippled Chil- dren's Home, Buffalo, N. Y., de- scription of, 191; Daisy Fields Home and Hospital for Crippled Children, Englewood, N. J., de- scription of, 190, 191; Darrach Asylum Homes (condnued) Home for Crippled Children, New York City, description of, 191-193; for homeless children, 11; general descriptions of institutions, 206; Good Shepherd Home, Allen- town, Pa., description of, 218; Happy Haven, Chicago, 92, de- scription of, 187, 188; Holy Cross House, Cleveland, Ohio, descrip- tion of, 197, 198; Home for Dis- abled Children, Maywood, III., description of, 188, 189; Home of the Merciful Saviour for Crippled Children, Philadelphia, description of, 199, 200; House of the Annun- ciation for Crippled and Incurable Children, 7, description of, 193- 195; House of the Holy Comforter for Incurables, New York City, de- scription of, 217, 218; House of St. Michael and All Angels, Philadel- phia, description of, 200-201; in- curable cases in, 21; institutions having summer homes, 186; New England Peabody Home for Crip- pled Children, Hyde Park, Mass., description of, 189, 190; New York Home for Destitute Crippled Chil- dren, New York City, description of, 195-197; number of employes, 94; quarantine and isolation not general, 47, 48; school arrangements in, 56; statistics of annual expenses per capita. Table IV C, 124; sta- tistics of capacity. Table I C, no; statistics of children in care. Table I C, no; statistics of cost of plant. Table III C, 120; statistics of em- ployes. Table I C, no; statistics of floor space per child. Table II C, 116; statistics of sources of support, TableIC, no; summer homes, cur- rent expenses, 186; Virginia T. Smith Home for Incurables, New- ington. Conn., description of, 186, 187 239 INDEX Baee, William S., M. D., 158 Bartine, Ouver H., 151 Bellevue Hospital: New York City, training for nurses, 33 Benjamin Rose Foundation, 217 Birmingham, England: census of cripples in 1911, 19-21, 67-68 Blythedale: (convalescent home) Hawthorne, N. Y., description of, 220, 221 Brace Shops: adjuncts to hospitals, 29,31 Brackett, E. G., M. D., 226 Bradford, Edward H., M. D., 161 Bradford Frames: Providence Hospi- tal and sea bathing, 43 Burr, Charles H., 155, 172 Butler, Francis E., M. D., 215 Byers, Sir John: census of cripples in Germany and England, 18 Census or Cripples: Birmingham, England, in 1911, 19-21, 67-68; no authentic census in United States, 19; organizations for relief of cripples in United States, 18-19; proportion of, in United States and Germany, 19, 20; records of crip- pled and deformed in England and Germany, 18-20; self-support, in England, 67-69 Cheerfulness: characteristic of crip- pled children in institutions, 48; value of, as a curative influence, 47 Chicago: outline of public school classes, 56-58; public school classes, number of, 3. See also Home for Destitute Crippled Children Children's Aid Society op New York: disposition of children, 22, 23 Children's Country Home: West- field, N. J., description of, 218, 219 Children's Free Hospital: Milwau- kee, description of, 211 Children's Hospital: Boston, de- scription of, 208, 209; social ser- vice department, 36 Children's Hospital: Portland, Maine, description of, 142-144; dietary for, 39; infectious disease wards, 46; Maine Children's Com- mittee, 34; outdoor space, 42; physical culture and gymnastics, 36; training school for nurses, 32; visiting nurses and out-patients, 34 Children's Hospital School: Balti- more, description of, 158, 159; nurses from Church Home and In- firmary, 32; outdoor sleeping porches, 42 ; resident physicians of, 3 1 ; wards for infectious diseases, 47 Children's House of the Home for Incurables: Philadelphia, asylum home, 51; description of, ig8, 199; number of employes, 94; school room equipment, 51; ward for in- fectious diseases, 48 Children's Orthopedic Hospital: Seattle, Wash., description of, 156, 157; nurses from general hospi- tal, 32; out-patients and visiting nurses, 34, 35 Children's Sea-Shore House: At- lantic City, N. J., description of, 212, 213 CiLLEY, Arthur H., M. D., 192 Classification of Cripples: com- mittee on education, Birmingham, England, 19-20; maimed and dis- eased, 20; relative proportion of types, 20 Clinics: Crippled Children's East Side Free School, New York City, 33; Miss Spence's School Society, New York City, 33 Clothing, Air, Sunlight: country lo- cations for tuberculous children, 43 ; Home for Destitute Crippled Chil- dren, outdoor sleeping, 41; insti- tutional provisions for, 40-44; New York State Hospital, West Haverstraw, outdoor sleeping, 41; outdoor living and school classes, institutions which provide, 40-44; outdoor space, special provision for, 42; Sea Breeze Hospital, Coney Island, N. Y., 43, 44; uniform dress in institutions, 41; Van Leuven Browne Hospital School, Detroit, outdoor sleeping, 41 240 INDEX Connecticut: Virginia T. Smith Home for Incurables, Newington, II, 31, 42, 48, 92, description of, 186-187 Convalescent Chiidren's Home: Chappaqua, N. Y.; description of, 213 Convalescent Homes: admission and discharge, rules of. Table VI B, 130-131; advantages of , in cost and permanent cures, 14; auxiliaries to orthopedic hospitals, 13; average cost, per bed, 98, 119; capacity of, 14, and number of children cared for during year, 92, 114-115; characteristics of , and purposes, 26; Children's Hospital School, Balti- more, description of, 158, 159; Children's Sea-Shore House, At- lantic City, N. J., description of, 212, 213; Convalescent Children's Home, Chappaqua, N. Y., descrip- tion of, 213; Convalescent Home for Destitute Crippled Children, Chicago, 157, 158; Convalescent Home of Boston Children's Hospi- tal, description of, 211, 212; cost of land for, 100; Country Branch and Industrial School of New York Orthopaedic Hospital and Dis- pensary, 172, 173; Country Con- valescent Hospital, Rochester, N. Y., description of, 213-214; ex- amples of, 7; general descriptions of institutions, 205, 206; House of St. Giles the Cripple, Garden City, N. Y., description of, 168-169; Industrial Home for Crippled Children, Pittsburgh, description of, 184, 18s; isolation and infec- tious diseases, 46, 47; Kernan Hospital School, Baltimore, de- scription of, 159-161; Massachu- setts Hospital School, description of, 161-165; Minnesota State Hospital and School, description of, 166, 167; number of employes, 94; quarantine provisions for, 46, 47; Rainbow Cottage, Cleveland, Ohio, description of, 216, 217; St. Agnes Hospital for Crippled and Atypical Children, White Plains, N. Y., description of, 215; St. Charles Hospital for Crippled Children, Port Jefferson, N. Y., description '■ of, 169-170, number of employes, 16 24 Convalescent Homes {continued) 94; Sea Breeze Hospital, New York, description of, 167, 168; school work, more extensive than in hos- pitals, 55; Sewickley Fresh Air Home, Sewickley, Pa., description of, 185, 186; State Hospital for Care of Crippled and Deformed Children, West Haverstraw, N. Y., 170-172; statistics of annual ex- pense per capita, Table IV B, 122; statistics of capacity. Table I B, 109; statistics of children in care, Table I B, 109; statistics of cost of plant. Table III B, 119; statis- tics of employes. Table I B, 109; statistics of floor space per child. Table II B , 114; statistics of sources of support. Table IB, 109; types of special excellence, 7; Van Leuven Browne School, Detroit, capacity of, 92, description of, 165; Widener Memorial School for Crippled Chil- dren, Philadelphia, description of, 173-183, number of employes, 94 Convalescent Home for Destitute Crippled Children: West Chi- cago, description of, 157-158; out- door sleeping porches, 42; strictly convalescent institution, 7 Convalescent Home of Boston Chil- dren's Hospital: description of, 211, 212 Cost of Plants: a comparison of, 98; average for asylum homes, per bed, 99-100, 120; average for con- valescent homes, per bed, 98, 119; average for hospitals, per bed, 118; equipment, furniture, and miscel- laneous, 100; lands and buildings, 100 "Cottage and Congregate Institu- tions": floor space of institutions, 96 Country Branch Homes: convales- cence best promoted in, 13 Country Branch of New York Or- thopedic Hospital: cripples as- sume work, 4; description of, 7, 172-173; floor space of, 96; resi- dent physicians of, 31; separate wards for infectious diseases, 47; special outdoor space, 42 I INDEX Country Branch Minnesota State Hospital: physical culture and gymnastics, 36; quarantine ward of, 47. See aJso Minnesota Country Convalescent Hospital: Rochester, N. Y., description of, 213-214 Country Institutions: trades taught in formal classes, 74-75 Crawford Allen Memorial Hospi- tal: North Kingston, R. I., de- scription of, 225, 226 Crippled Children's Driving Fund: aid given in own homes, 2 Crippled Children's East Side Free School: New York City, descrip- tion of, 59, 228-230; fresh air pro- vided, 43; sewing classes and embroidery, 82; weekly clinics and surgical work, 33 • Crippled Children's Home: Buffalo, N. Y., description of, 191; special outdoor space, 42 Crofut, Martha M., M. D., 188 Current Expenses: annual, for hos- pitals, convalescent and asylum homes, 100-102, 121-124; per child, in asylum homes, 100, 124; per child, in convalescent homes, 100, 122; per child, in hospitals, 100, 121 Curriculum: hours of sessions, 52-53; similar to regular schools, 52 Daisy Fields Home and Hospital for Crippled Children: Englewood, N. J., description of, 190, 191; grad- uate nurses employed, 32 Darrach Home for Crippled Chil- dren: New York City, description of, 191-193 Davis, G. G., M. D., 173, 211 Day Schools: classesneeded, 21,23,24; descriptions of, 207, 208, 226-234; Crippled Children's East Side Free School, New York City, descrip- tion of, 228-230; Industrial School for Crippled and Deformed Chil- dren, Boston, description of, 226- DAY Schools (continued) 228; Miss Spence's School Society, New York City, description of, 230, 231; nurses and physical care, 33; Rhinelander Industrial School, New York City, description of, 231; Trade School of the Hospital of Hope, New York City, descrip- tion of, 231-233; William H. Davis Free Industrial School, New York City, description of, 233, 234 Department of Education: New York City, record cards and physi- cal cultiure, 38 Dickson, Frank, M. D., 199, 212 Dietary: food costs, per person fed, 102; New York Orthopaedic Dis- pensary and Hospital, trained diet- itian, 40; Sewickley Fresh Air Home, Sewickley, Pa., 40; special, nourishing food essential, 39 Dispensaries: eflSciency of service, 15, 33-36; Hospital for Ruptured and Crippled, work done by, 107; in hospitals and convalescent homes, 33-36; Lakeside Hospital, Cleve- land, Ohio, visiting nurses, 35; New York Orthopasdic Dispensary and Hospital, system of supervision, 35; number in seven cities, 107; out-patients and daily attendance, 107; out-patients and visiting nurses, 34-36, 140; special schools a corollary of, 15; statistics of work in nine institutions. Table IX, 140; when open, 107 Eagleson, James B., M. D., 156 Education: buses for school children, 52; Chicago public school classes, S6> 57) 58; Cleveland public school classes, 56, 58; Crippled Children's East Side Free School, New York City, 59; curriculum parallel to regular schools, 52; Detroit public sdbiool classes, 56, 58; . differences in school work, 55-56; Industrial School for Crippled and Deformed, Boston, special building, 54; Mas- sachusetts Hospital School, out- door classes and equipment, 51, 53, 54; Miss Spence's School Society, class on steamer deck, 59, 60; New 242 INDEX Education {continued) York City public school classes, 56-57; outdoor school classes a healthful factor, 53-55; Philadel- phia, public school classes opened, 19131 56; problems to be met for curable and incurable cripples, 49- 50; public and private pay schools, 49-61; scope of school work in hos- pital, convalescent, and asylum homes, 55-56; Sea Breeze Hospi- tal, Coney Island, outdoor teach- ing, 54; Sewickley Fresh Air Home, outdoor school, 54; summer school at Oakhurst, N. J., subsidi- ary of East Side Free School, 59 Elmer, Walter G., M. D., 200 Employes: cheerful spirit of, 3, 4; crippled, aid in institutional work, 3. 4. 48 England: census of Birmingham, in 1911, 67-68; census report of de- formed, 18-20; report of census conmiittee on workshops for crip- ples, 68-69 Fassett, Frep J., M. D., 156 Federation or Associations for Cripples: New York City, aid society, 234; outdoor school rooms in winter discussed, 43; statement by Dr. Henry Frauenthal, on bene- fits of sunlight, 44 Fine Arts: music taught in many in- stitutions, 86-87 Fish, John E., M. D., 161 FisKE, James Porter, M. D., 233 Fitch, Ralph R., M. D., 213 Food Costs: per person fed, 102, 121 Frauenthal, Henry W., M. D., 44, 149 Frazier, Charles H., M. D., 199 Gardening: advantageous for tubercu- losis cases, 74; country institu- tions which teach, 74; Massachu- setts Hospital School, farm work and gardening, 74 Germany: Professor Lange, of Munich, and number of crippled children. Germany {continued) 18, 19; Sir John Byers and census of cripples, 18 Gibney, Virgil P., M. D., 151 Gillette, Arthur J., M. D., 145, 166 Good Shepherd Home: Allentown, Pa., description of, 218 Gymnastics: special teachers and ap- paratus, 36-37 Hand Work in 37 Institutions: sta- tistics. Table VIII, 137 Happy Haven: Chicago, capacity of, 92; description of, 187, 188; num- ber of employes, 94 Haxtun Cottage: Bath Beach, N. Y., description of, 221, 222 Heliotherapy: benefits derived from, in bone tuberculosis, 43, 44; con- stant use of, at Sea Breeze Hospital, New York, 44; use of, at Provi- dence Hospital, for tuberculosis, 44 Hibbs, Russell a., M. D., 155, 172, 210 Holy Cross House: Cleveland, Ohio, description of, 197, 198; graduate nurses employed, 32; physical cul- ture and gymnastics, 36; school classes, where held, 54; special out- door space, 42 Home por Crippled Children: New- ark, N. J., description of, 147, 148; number of employes, 93 Home por Destitute Crippled Chil- dren: Chicago, description, 4, 5, 141, 142; infectious disease wards, 45; nurses from Presbyterian Hos- pital, 32; outdoor sleeping, 41; physical cultmre and gymnastics, 36 Home for Disabled Children: May- wood, 111., description of, 188, 189; founder of and teacher, a cripple. Miss Kittle Smith, a wonderful ex- ample of vocational training, 4, 64; special outdoor space, 42 Home por Incurables: Newington, Conn., 186, 187; minor operations performed, 31; outdoor sleeping porches, 42; quarantine and iso- lation building, 48; special outdoor space, 42 243 INDEX Home op the Merciful Saviour por Crippled Children: Philadel- phia, description of, 199, 200; grad- uate nurses of, 32; isolation suites for infectious diseases, 48; minor operations performed, 31; sewing done informally, 73 Hospitals: admission and discharge, rules of. Table VI A, 128-129; aver- age cost per bed, 98, 118; charac- teristics of, and purposes, 26; Chil- dren's Free Hospital, Milwaukee, description of, 211; Children's Hospital, Boston, description of, 208, 209; Children's Hospital, Portland, Maine, description of, 142-144; Children's Orthopedic Hospital, Seattle, Wash., 156, 157; cost of land for, 100; descriptions of, 141-157; difference between general and convalescent, 26 ; floor space per child, Table II A, 112; general descriptions of institutions, 205; Home for Crippled Children, Newark, N. J., 147, 148; Home for Destitute Crippled Children, Chi- cago, description of, 141, 142; Hos- pital for Deformities and Joint Diseases, New York City, descrip- tion of, 149, 150; Hospital for the Ruptured and Crippled, New York City, capacity of, 92, description of, 151-iss; Nebraska Orthopedic Hospital, description of, 146, 147; New Jersey Orthopaedic Hospital and Dispensary, 92, description of, 148, 149; New York City Chil- dren's Hospital, description of, 209, 210; New York Orthopaedic Dispensary and Hospital, 155, 156; number of employes, 93-94; or- thopedic wards in, 234; Phila- delphia Orthopaedic Hospital and Infirmary for Nervous Diseases, description of, 211; school work different from that in convalescent homes, SS! Seton Hospital, New York City, description of, 210; State Hospital for Indigent, Crip- pled, and Deformed Children, St. Paul, description of, 144-145; sta- tistics of annual expense per cap- ita. Table IV A, 121; statistics of capacity. Table I A, 108; statistics of children in care. Table I A, 108; statistics of cost of plant. Table Hospitals (continued) , III A, 118; statistics of employes, Table I A, 108; statistics of floor space per child. Table II A, 112; statistics of sources of support. Table I A, 108; total capacities of, 10, and number of children cared for during year, 92 Hospital for Deformities and Joint Diseases: New York City, de- scription of, 149, 150; number of employes, 93; outdoor sleeping porches, 42, 43; physical culture and gymnastics, 36; plarming country branch, 13 Hospital for the Ruptured and Crippled: New York City, capac- ity of, 92; description of, 151-155; dispensary work, scope of, 107; extensive outdoor space, 42; most complete in United States, 6; phy- sical culture and gynijiastics, 36; plarming country branch, 13; spacious isolation ward, 46; vo- cational training provided, 4, 71 Hospital of University op Pennsyl- vania: Philadelphia, complete gymnasium, specialist teacher, 36; orthopedic wards in, 234; social service department of, 35 House of Holy Comforter for In- curables: New York City, de- scription of, 217, 218 House op St. Giles the Cripple: Garden City, N. Y., description of, 168, 169; sewing done inform- ^liXi 73) special outdoor space, 42 House of St. Michael and All An- gels: Philadelphia, description of , 200-201; domestic training, 73; special outdoor space, 42 House op the Annunciation for Crippled and Incurable Chil- dren: New York City, descrip- tion of, 193-195; example of asy- lum home, 7; ward for infectious diseases, 48 Humphries, Robert E., M. D., 148 Hutchins, James H., M. D., 167 244 INDEX Illinois: Convalescent Home for Crippled Children, 7, description of, 157-158, special outdoor space, 42; Happy Haven, Chicago, 92, 94, description of, 187-188; Home for Destitute Crippled Children, Chi- cago, 4, 5, 32, 36, 41, 45, 141-142; Home for Disabled Children, May- wood, 4, 42, 64; Illinois State Eye and Ear Infirmary, a preventive institution, 7; public school classes in Chicago, 3, 56-58 Illustrations: list of, ix Income: public funds, donations, and invested funds as bases, 102-105; public funds for current expenses, 102-104; sources of, for institu- tions, 102; sources of, statistics for 35 institutions. Table V, 125 Industrial Home for Crippled Chil- dren: Pittsburgh, description of, 184, 18s Industrial School for Crippled and Deformed Children: Boston, 60-61, 81-82, description of, 226- 228; occupations and earnings, 235 ; printing plant a profitable enter- prise, 85-86; special outdoor school building, description of, 54 Infection: quarantine to prevent, 45- 48 Institutions: absence of political con- trol, s; architecture and cost, 6, 7, 118-120; character of employes, 3- 5; classification of, 2, 25; cripples aided in their own homes, 2; cur- rent expenses, 100-102, 121-124; date of opening in 13 states, 6; ex- penses per capita, 11; first Ameri- can study of construction and management, i ; five forms of work recognized by Miss Reeves, 13; floor space per child, 95, 98, 112- 116; gradual development of, 5; hospital rates per capita, com- pared with convalescent and asylum homes, 11; majority near large cities, 25; number and capacities of, 2, 5; physical conditions in, 38-39; protracted care and objec- tions to, 23; spirit which animates the work, 3-5; surgical and hy- gienic standards, 38-39; work as- sumed by cripples, 3 245 Jackson, Egerton S., M. D., 195 Jaeger, Charles, M. D., 231 Johns Hopkins Hospital: Baltimore, orthopedic wards in, 234; social service department of, 36 Kelley, S. W., M. D., 197 Kernan Hospital School: Baltimore, description of, 159-161; isolation tent for quarantine, 47; measures to prevent infection, 45; nurse maids' training school, 33 ; outdoor sleeping porches, 42; stenography and typewriting taught, 74; super- intendent and resident physicians of, 30, 31 Kindergarten Work: and vocational training, 71, 78, 79, 80, 81 Lakeside Hospital: Cleveland, dis- pensary cases and visiting nurses, 35; orthopedic wards in, 234 Lange, Professor: number of crippled children in Germany, 18, 19 Le Breton, Prescott, M. D., 191 Little, Margaret, 157 Lord, J. P., M. D., 146 Lovett, Robert W., M. D., 161, 189, 208 McMurtrie, Douglas C: bibliography on care of crippled children, 17; pamphlet on care of crippled chil- dren in America, i Maine: Children's Hospital, Portland, 32, 33, 34, 36, 39, 42, 46, 142-144 Maryland: Children's Hospital School, Baltimore, 31, 32, 42, 158-159; Kernan Hospital School, Balti- more, 33, 42, 45, 74, 83, 87, 159- 161; Johns Hopkins Hospital, Baltimore, 36, 234 Massachusetts: bill for state institu- tion, 5; Children's Hospital, Bos- ton, 30, 36, 208-209, 211-212; Industrial School for Crippled and Deformed Children, Boston, 54, 60, 81, 82, 85, 87, 226-228, 235; INDEX Massachusetts {corUinrnd) Massachusetts Hospital School, 7S~77> 16I7 i^s; New England Peabody Home, Hyde Park, 31,32, 42, 189-190; state institutions, one, 104 Massachusetts Hospital School: Canton, 6, 7, 42, 51, 86; description of, 161-165; capacity of, for occu- pational training, 75; features of outdoor school classes, 53-54; interesting developments in occu- pational training, 77; natural ap- titude a guide for occupational work, 76; physical culture and gjrnmastics, 36; quarantine and isolation rooms, 46, 47; resident physicians of, 31; report as to grading in school classes, 53; school equipment, 51; special domestic training, 72-73; vocational work for girls, 77 Mechanical Trades: Industrial School, Boston, printing plant made profitable, 85-86; institutions where taught, 84-86; William H. Davis Industrial School, wood- working and wood carving, 85 Mebkill, William Jackson, M. D., • 212 Mevis, Lyman, Rev., 184 Michigan: Van Leuven Browne Hos- pital School, Detroit, description of, 165; outdoor sleeping, 41 Minnesota: Minnesota State Hos- pital, St. Paul, 144, 145; first state hospital, in 1897, 7; Minnesota State Hospital and School, Phalen Park, 7, 36, 45, 166, 167; mechan- ical trades taught, 84, 85; St. Paul City and County Hospital, 5 ; school classes in hospitals, 55; state institutions, two, 104 Minnesota State Hospital: St. Paul, description of, 144-145; hospital for contagious diseases and quar- antine, 45; number of employes, 93; origin of, 5; skill and efficiency of surgeons, 8 Minor Operations: where performed, 30,31 Miss Spence.'s School Society: New York City, description of, 230, 231; open-air classes on steamer, 59, 60; weekly clinics and surgical work, 33 Morrill, Gordon N., M. D., 197, 216 Mosher, Burr Burton, M. D., 168 Myers, T. Halstead, M. D., 193 Nebraska : Nebraska Orthopedic Hos- pital, Lincoln, 29, 32, 71; cata- loguing and library work taught, 73; description of, 146-147; outdoor sleeping porches, 42; salaried surgeon-in-chief, 29; school classes in hospital, 55; state institution, 104; training school for nurses, 32 New England Peabody Home: Hyde Park, Mass., description of, 189- 190; graduate nurses employed, 32 isolation for infectious diseases, 48: minor operations performed, 31 outdoor sleeping porches, 42 New Jersey: Children's Country Home, Westfield, description of, 218-219; Children's Sea-Shore House, Atlantic City; 212-213; Daisy Fields Home, Englewood, 32, description of, 190-191; Home for Crippled Children, Newark, 93, description of, 147-148; New Jersey Orthopaedic Hospital, Orange, 92 New Jersey Orthopaedic Hospital: Orange, capacity of, 92; descrip- tion of, 148-149 New York: Association for Aid of Crippled Children, New York City, 2, 33; Association for Improving Condition of the Poor, 3; Bellevue Hospital, New York City, training for nurses, 33; Blythedale Con- valescent Home, Hawthorne, de- scription of, 220-221; Children's Aid Society, 22, 23; Convalescent Children's Home, Chappaqua, de- scription of, 213; Country Branch New York Orthopaedic Hospital, 31, 42, donor of, 4, floor space, 96, description of, 172-173; Country Convalescent Hospital, Rochester, description of, 213-214; Crippled Children's Driving Fund, New 246 INDEX New York (conlinued) York City, 2; Crippled Children's East Side Free School, New York City, 33, 43, description of, 228- 230; Crippled Children's Home, Bufialo, 42, description of, 191; Darrach Home for Crippled Chil- dren, 191-192, summer home, 192- 193; Dr. Henry FraUenthal dis- cusses heliotherapy, 44; East Side Free School, New York City, 82, 87; Federation of Associations for Cripples, April, 1913, 43; Haxtun Cottage, Bath Beach, description of, 221-222; Home for Destitute Crippled Children, 195-196, sum- mer home, 196-197; Hospital for Deformities and Joint Diseases, New York City, 13, 36, 42, 43, 93, description of, 149-150; Hospital for Ruptured and Crippled, 4, 6, 36, 42, 46, 71, 84, 92, 107, descrip- tion of, 151-155; House of St. Giles the Cripple, Garden City, N. Y., 42, description of, 168-169; House of the Annunciation, 7, 86, description of, 193-194, summer home, 194-195; House of the Holy Comforter for Incurables, 217-218; Miss Spence's School Society, 33, description of, 230-231; New York City Children's Hospital, descrip- tion of, 209-210; New York Ortho- paedic Dispensary and Hospital, New York City, 35, 36, 40, 42, 93, description of, 155-156; New York State Hospital, West Haverstraw, 8, 36, 41, 71, 83, description of, 170-172; isolation for contagious diseases, 46; Post-Graduate Hospi- tal, New York City, 35; public school classes, outline of work, 56, 57; Rhinelander Industrial School, 60, 84, description of, 231; Robin's Nest, Tarrytown-on-Hudson, de- scription of, 223-225; St. Agnes Hospital, White Plains, 215-216; St. Charles Hospital, Port Jeffer- son, 31, 33, 42, 74, 83, 94, 96, de- scription of, 169-170; Sea Breeze Hospital, Coney Island, 43, 44, 54; description of, 167-168; Seaside Home, Arveme, description of, 219-220; Summer Home for Crip- pled Children, Sheepshead Bay, description of, 222; Simimer Home for Crippled Children, Southamp- New York (continued) ton, 222-223; Trade School of Hospital of Hope, New York City, 65, description of, 231-233; two institutions established in New York City between 1863 and 1890, 6; William H. Davis Free Indus- trial School, industrial and kin- dergarten work, 60, 85, 87, de- scription of, 233-234 New York Association for Improving THE Condition of the Poor: "Smiling Joe," 3 New York City Children's Hospi- tal: description of, 209, 210 New York Home for Destitute Crippled Children: New York City, 22, 48, description of, 195- 197 New York Hospital for Deformi- ties AND Joint Diseases: New York City. See Hospital New York Hospital for Ruptured AND Crippled: New York City. See Hospital New York Orthopedic Hospital: New York City, description of, 155-156; housekeeper a trained dietitian, 40; number of employes, 93; physical culture and gymnas- tics, 36; record of visiting nurses, 35; special outdoor space, 42 New York Post-Graduate Hospi- tal: orthopedic wards in, 234 New York State Hospital: West Ha- verstraw, 170-172; outdoor school classes, reportfor 1912, 54, 55; out- door sleeping pavilion, 41 ; physical culture and gymnastics, 36 ; resident physicians of, 31; salaried surgeon- in-chief, 29; special field the rural districts, 8; stenography and type- writing taught, 71 Nurses: Association for Aid of Crippled Children, New York City, provides public school nurses, 33; Bellevue Hospital, New York City, training, 33; Children's Hospital, Portland, Maine, 32, 33; Children's Ortho- pedic Hospital, Seattle, Wash., out-patients visited, 34, 35; dis- pensaries and out-patients, 34-36; employed in convalescent homes, 247 INDEX Ntirses (continued) 32; for day and private schools, 33 ; Hospital of University of Penn- sylvania, 35; in asylum homes, 32; in hospitals, 32; institutional train- ing for, 32, 33; Keman Hospital School, Baltimore, training for nurse maids, 33; Lakeside Hospital, Cleveland, Ohio, public school ser- vice, 35; Nebraska State Hospi- tal, training school for, 32; New York Orthopaedic Dispensary and Hospital, visiting nurses, 35; Post- Graduate Hospital, New York City, 35-36; Simbeam Circle, Cleveland, provides pubUc school nurses, 33; training school at St. Charles Hospital, Port Jefferson, N. Y., 33 Ntjtt, John Joseph, M. D., 171 OcctTPATiONS AND EARNINGS: Indus- trial School for Crippled and De- formed Children, Boston, 235 Ogilvy, Charles, M. D., 209 Omo: Holy Cross House, Cleveland, 32, 36, 42, description of, 197-198; Lakeside Hospital, Cleveland, 35; public school dasses in Cleveland, 3 ; public school work, 56, 58; Rain- bow Cottage, Cleveland, 35, de- scription of, 216-217; Sunbeam Circle, Cleveland, 33, 58 minor, where performed, Operations 30,31 Ore, H. Winnett, M. D., 146 Orthopedic Hospitals: continue es- tablishment of, 13 ; dispensary ser- vice in, 15 Orthopedic Wards: in general hospi- tals, 234 Outdoor Schools: discussion of, by Federation of Associations for Cripples, 1913, 43; efficacy of, 53-55; Industrial School for Crip- pled and Deformed Children, 54; Massachusetts Hospital School, classes and equipment, 53, 54; Sea Breeze Hospital, Coney Island, special plan for, 54; Sewickley Fresh Air Home, 54 248 Outdoor Sleeping: hospitals which provide, 41-44; Industrial Home for Crippled Children, Pittsburgh, sleeping pavilions, 41-42 Out-patients: Children's Orthopedic Hospital, Seattle, Wash., visiting nurses, 34, 35; dispensaries and visiting nurses, 34-36 Paralysis: gymnastic classes and spe- cial equipment, 37 Pennsylvania: Children's House of the Home for Incurables, Phila- delphia, 7, 51, 94; description of, 198; estabUshment of three institu- tions in Philadelphia between 1863 and 1890, 6; Good Shepherd Home, Allentown, description of, 218; Home of the Merciful Saviour, Philadelphia, 31, 32, description of, 199; House of St. Michael and All Angels, 42, 70, 73, description of, 200-201; Hospital of Univer- sity of Pennsylvania, 35, 36; In- dustrial Home for Crippled Chil- dren, Pittsburgh, 41-42, 55, de- scription of, 184-185; Philadelphia Orthopaedic Hospital and Infirm- ary, description of, 211; Sewickley Fresh Air Home, 40, 54, descrip- tion of, 185-186; Widener Mem- orial School, Philadelphia, 4, 6, 30, 31. 32, 36, 37, 42, 46, 75, 80, 83, 86, 87, 88, 94, description of, 173-183 People's University Extension So- ciety: physical culture teachers sent to asylum homes, 37, 38 Peters, John M., M. D., 225 Philadelphia ORTHOPiEDic Hospital and Infirmary for Nervous Dis- eases: description of, 211 Physical Care: charity work and sur- geons, 28-29; modern equipment in hospitals, 29-30; outdoor sleeping, hospitals which provide, 41-44; surgical care and appliances, 28-32; visiting surgeons to hospitals and homes, 29-30 Physical Culture: Children's Hos- pital, Portland, Maine, special gymnastic apparatus, 36; Country Branch Minnesota State Hospital, Phalen Park, 36; Department of INDEX Physical Cultuei; {continued) Education, New York City. 38; Holy Cross House, Cleveland, Ohio, 36; Home for Destitute Crippled Children, Chicago, 36; Hospital for Deformities and Joint Diseases, New York City, 36; Hos- pital for Ruptured and Crippled, New York City, 36; Hospital of University of Pennsylvania, com- plete gymnasium, 36; Massachu- setts Hospital School, Canton, 36; New York Orthopsedic Dispensary and Hospital, New York City, 36; New York State Hospital, special apparatus, 36; opinions as to de- sirability in public schools, 38; People's University Extension So- ciety, teachers for, 37, 38; Widener Memorial School, equipment, 36, 37 PLtruMER, Ward, M. D., 191 Porter, John Lincoln, M. D., 141 Post-Graduate Hospital: New York City, services of visiting nurse, 35- 36 Private Day Schools: number in New York City, 59-61 Protracted Institutional Care: ob- jections to, 23 Prouty, Florence E., Miss, 187 Public Schools: buses and nurses. New York City, 57; Chicago board of education finances work, 58; four in Cleveland, 3; hot lunches served cripples, 52; Industrial Home for Crippled Children, Pitts- burgh, Pa., 5s; in New York City, 3; one in Detroit, 3; outline of work in Chicago, 56, 58; outline of work in Cleveland, 56, 58; outUne of work in Detroit, 56, 58; outline of work in New York City, 56, 57; organized in four cities, 56-58; seven in Chicago, 3; special equip- ment of classes, 49-58; teachers receive extra salary in Chicago, Detroit, and New York, not in Cleveland, 56-59 Quarantine: facilities for, in asylum homes, 47, 48; Hospital for Rup- tured and Crippled, New York City, 46; infections isolated, 44- QuARANTiNE (continued) 47; infectious disease wards in Children's Hospital, Portland, Maine, 46; isolation provisions for asylum homes, 47, 48; Massa- chusetts Hospital School, special isolation provisions, 46, 47; Min- nesota State Hospital, isolation of contagious diseases, 45; special provisions for, in convalescent homes, 46, 47; Widener Memorial School, fireproof isolation build- ings, 46 Rainbow Cottage: country home of Lakeside Hospital, Cleveland, Ohio, 35; description of, 216, 217 Raker, John H., Rev., 218 Rhinelander Industrial School: de- scription of, 231; financed by Chil- dren's Aid Society, 60; jewelry making class and apprenticeship, 66; jewelry class taught by expert, 84 Rhode Island: Crawford Allen Mem- orial Hospital, North Kingston, description of, 225-226; Summer Branch Providence Hospital, sea bathing for children on frames, 43 Ridlon, John, M. D., 157 Robin's Nest: Tarrytown, N. Y., de- scription of, 223-225 Root, J. E., M. D., 186 St. Agnes Hospital for Crippled and Atypical Children: White Plains, N. Y., description of, 215-216 St. Charles Hospital: Port Jefferson, N. Y., 42, description of, 169-170; floor space of, 96; organizing train- ing school, 33; resident physicians of, 31; separate wards for infec- tious diseases, 47; sewing classes, 83 St. Louis Children's Hospital: or- thopedic wards with dispensary service, 234 St. Paul City and County Hospital: state use of, 5 249 INDEX Sanatoeium foe Hebrew Children: Rockaway Park, N. Y., orthopedic wards in, 234 Schools for Cripples: ground-floor rooms and equipment, 50-51 Schools in 37 Institutions: adjust- able seats and desks, 50-51; statis- tics of attendance, grade work. Table VII, 134; statistics of teach- ers, sessions, equipment. Table VII, 134; teachers and equipment, vocational training, 106-107 Sea Breeze Hospital: Coney Island, N. Y., description of, 167, 168; heliotherapy for tuberculous si- nuses, 44; isolation for infectious diseases, 47 ; outdoor school classes, 54; sea air and salt water benefits, 43 Seaside Home for Crippled Chil- dren: Arveme, N. Y., description of, 219, 220 Seton Hospital: New York City, de- scription of, 210 Sewickley Fresh Air Home: Pitts- burgh, description of, 185, i85; dietary for, 40; isolation for infec- tious diseases, 47; outdoor school building, S4 Shaffer, Dr. Newton M. : advocates cottage plan for crippled and de- formed, 14 Shafor, H. a., M. D., 165 Sharples, Casper W., M. D., 156 Smith, Miss Kittle: armless founder and teacher of Home for Disabled Children, Maywood, Illinois, 4, 64 Social Service: Children's Hospital, Boston, 36; department at Johns Hopkins Hospital, 36; visiting nurses and auxiliaries for, 33-36 Soutter, Robert, M. D., 161 Special Handicrafts: institutions which teach, 83-84 Speese, John, M. D., 198 State Hospitals: advocated, 14; first established in Minnesota in 1897, 7; need of, in rural districts, 8; social service needed to reach crip- ples in rural districts, 9 State Hospital for Care of Crippled and Deformed Children: West Haverstraw, N. Y., description of, 170-172 State Hospital for Indigent Crip- pled AND Deformed Children: St. Paul, description of, 144-145, 166-168 State Institutions: maintenance and control, 104, 106 Statistical Intormation: children cared for during year, 9; compara- tive cost of hospitals, convalescent homes, and asyliun homes, 10; cost of hospitals per capita, 10; cost of land, and buildings and equipment, 10; number of em- ployes, 9; summaries of, 91-107; Tables I to IX, 108-140 Statistical Tables: list of , xiii Summer Home for Crippled Chil- dren: Sheepshead Bay, N. Y., de- scription of, 222 Summer Homes: Blythedale, Haw- thorne, N. Y., description of, 220, 221; Children's Country Home, Westfield, N. J., description of, 218,219; Crawford Allen Memorial Hospital, North Kingston, R. I., description of, 225, 226; Darrach Home, Pelham Bay Park, N. Y., description of, 192, 193; descrip- tions of, 206-207, 218-226; Happy Haven, Twin Lakes, Indiana, description of, 188; Haxttm Cottage, Bath Beach, N. Y., de- scription of, 221, 222; Home of the Merciful Saviour, simimer branch, Avon-by-the-Sea, N. J., de- scription of, 199, 200; House of the Annunciation, summer home, de- scription of, 194, 195; New York Home for Destitute, summer branch, description of, 196, 197; Robin's Nest, Tarrytown, N. Y., description of, 223-225; Seaside Home for Crippled Children, Ar- veme, N. Y., description of, 219, 220; Summer Home for Crippled Children, Southampton, N. Y., description of, 222, 223 Sunbeam Circle: Cleveland, Ohio, nurses for public school classes, 33, S8 2tO INDEX Tayior, Henry Ling, M. D., igo Taylor, R. Tunstall, M. D., 159 Thorndike, Augustus, M. D., 161 Tiny Tim Fund: St. Louis, aid society, 234 Trade School op the Hospital of Hope for Injured and Crippled: established by Dr. Jaeger in New York, a success, 65-66; description of, 231-233 Treatment and After-care: consid- erations in placing cripples, 24, 25; convalescent hospitals for joint tu- berculosis, 22; day schools and convalescent hospitals needed, 21; different types of institutions neces- sary, 21 ; medical care and asylum homes, 22; segregation of crippled children, 23 Tuberculosis of the Bones: conva- lescent hospitals preferred, 22; country locations and pure air, 43 ; dispensaries and visiting nurses, 34; healing sinuses by salt water, 43; hehotherapy recommended, 44; liv- ing conditions for, and convalescent homes, 21; open-air school on steamer deck for Miss Spence's class, S9, 60; rejection of cases in many institutions, 106; Sea Breeze Hospital at Coney Island, New York, 43; value of sxmshine on si- nuses, 43-44 TwiNCH, Sidney A., M. D., 147 University Hospital of University of Michigan: orthopedic wards in, 234 Van Leuven Browne School: De- troit, capacity of, 92; description of, 165; minor operations only, 30; outdoor sleeping, 41 Virginia T. Smith Home for Incur- ables: Newington, Conn., ca- pacity of, II, 92; description of, 31, 42, 48, 186, 187 Vocational Training: accomplish- ments of cripples, 64-65; adapta- tion of pursuits, 11-12; benefit de- rived as wage-earners, 63 ; capacity Vocational Training {continued) of Widener Memorial School for occupational training, 75; classifi- cation of, in schools, 106; consider- ations of, iniegard to cripples, 62- 63; developments at Massachu- setts Hospital School, 77; discus- sion of, in English review, in 1909, 63; disposal of articles made in in- stitutions, 87-88; hand work and domestic science, 107; informal training in domestic work, 71-73; Keman Hospital School, stenog- raphy and typewriting taught, 74; kindergarten work the basis of, 71, 78, 79, 80, 81; manual training or sloyd, 79; Massachusetts Hospital School's classes for girls, 77-78; spe- cial, for boys, 75 ; mechanical trades, and institutions which teach, 84-86; Nebraska Hospital School, library work, 73; needlework a profitable trade for classes, 88-89; occupa- tions open to cripples, 64; occupa- tions taught in 37 institutions, 70- 75; occupations taught in asylum homes, 71; organized teaching pre- liminary to, 78-80; orthopedic treatment in early stages is empha- sized, 12; plans of study, 12; pri- vate day schools having vocational classes, 81-82; profitable occupa- tions a factor, 69-70; provision for, inschoolsandhomes,62-63; respec- tive merits of different occupations, 89; St. Charles Hospital, stenog- raphy and typewriting taught, 74; schools and trades offered, 11-12; self-support the aim, 81; sewing taught in 22 of 37 institutions, 73; skilled handicrafts a local problem, 70; skilled handicrafts offer best opportunities, 90; suitabiUty of oc- cupations, 64; Trade School of the Hospital of Hope for Injured and Crippled, established by Dr. Jae- ger, 65-66; trade classes based on hospital records, 66; trade schools and attendance, 65-66; Women's Educational and Industrial Union, Boston, pamphlets on local studies, 89 Wallace, Charlton M., M. D., 48, 169, 228, 230 Wallace, James O., M. D., 184, 185 251 INDEX Washington: Children's Orthopedic Hospital, Seattle, 32, 34, 35, de- scription of, 156-157 Washington Untvejisity Medical Hospital: orthopedic wards with dispensary ser\'ice, 234 Watson, Emily A.: donor Country Home New York Orthopaedic Hos- pital, 4 Whitbeck, Brainerd H., M. D., 231 WiDENER Memorial School: hospital and convalescent home, 6; com- plete gymnastic equipment, 36-37; description of, 173-183; George D. Widener, 4; isolation buildings fireproof, 46; kindergarten and successive classes for special train- ing, 80; music taught as means of Widener Memorial School (con- tinued) self-support, 86-87; resident physi- cians of, 31; statistics of, 182-183; vocational training, capacity of school, 75 William H. Davis Free Industrial School: New York City, descrip- tion of, 233, 234; kindergarten and industrial work, 60; summer home at Claverack, New York, 60, 234 Willis, Park Weed, M. 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