Care and education of crippled children in the United States, by Edith Reeves. Introd. by Hastings H. Hart.
Solenberger, Edith Gertrude Reeves, 1886-

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Page  [unnumbered] ,9"0- ~ -r, ( "-:: "'rLc4?e" t RUSSELL SAGE FOUNDATION CARE AND EDUCATION OF CRIPPLED CHILDREN IN THE UNITED STATES BY EDITH REEVES 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. MCMXIV

Page  [unnumbered] Copyright, 1914, by THE RUSSELL SAGE FOUNDATION PRESS OF WM. F. FELL CO. PHILADELPHIA

Page  I DEDICATED TO THE BRAVE LITTLE PEOPLE Photo by Jessie Tarbox Beals FOOT RACE-THE START

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Page  III PREFACE HIS 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 developed 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 institutions for crippled children in Massachusetts, New York, Minnesota, 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 institutions 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 Foundation will take pleasure in answering inquiries for information not covered by this volume. iii 276944

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Page  V TABLE OF CONTENTS PREFACE LIST OF ILLUSTRATIONS LIST OF TABLES. PAGE iii vii xi X1 Introduction. I. The Scope of the Study II. Physical Care of Crippled Children III. Special Provisions for the Education of C dren IV. Hand Work and Vocational Training V. Statistics VI. Detailed Description of Institutions APPENDIX INDEX I., I 17 28.rippled Chil49 *.. 62 91 141. 205 237 v

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Page  VII LIST OF ILLUSTRATIONS CONNECTICUT Newington PAGE Virginia T. Smith Home for Incurables.. 85 ILLINOIS Chicago "Happy Haven," Summer Camp at Twin Lakes, Indiana. 15 Maywood 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........... 55 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

Page  VIII LIST OF ILLUSTRATIONS PAGE Baseball Team.....59 Covered Walk.....43 Dormitories......43 Girls' Sewing Room.... 62 Infirmary Floor Plan....... 16I Outdoor Class... 9 Rotunda, Hospital Building.. 9 Sleeping Ward.......... 9 Two-story "Monitor Roof" Cottage..162 Two-story Monitor Roof Cottage, Cross Section.. 63 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..66 Boys' Ward......66 School Room......66 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....41 Orange New Jersey Orthopaedic Hospital and Dispensary Master of His Fate.... I4 NEW YORK Buffalo Crippled Children's Home.. 85 Coney Island Sea Breeze Hospital Outdoor Sleeping Porch...67 The Sun Bath ("Heliotherapy").... 67 Garden City, Long Island House of St. Giles the Cripple Play Hour.....82 viii

Page  IX LIST OF ILLUSTRATIONS PAGE Surgical Pavilion. Surgical Pavilion, Interior... 2 United We Stand. Frontispiec 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..........48 Special Gymnastics Before a Mirror.... 36 Hospital for the Ruptured and Crippled..... 6 First Floor Plan..... I51 Fourth Floor Plan.........52 Fifth Floor Plan...153 Sixth Floor Plan... 50 New York Orthopaedic Dispensary and Hospital Dispensary.. 5 5 Orthopedic Gymnastics... 36 Outdoor Clinic....55 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 PostGraduate Hospital of New York)... 33 A Hike.....25 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

Page  X LIST OF ILLUSTRATIONS Bungalow Built by the Boys.. Class Room. Graduates' Reunion Staff Living Room Ready for Surgeon's Weekly Inspection. OHIO Cleveland Holy Cross House Gardening Public School Class Rainbow Cottage and Lakeside Hospital "Reconstructing the Carter Twins" PAGE 32 3 3. 32. 3 PENNSYLVANIA Allentown Good Shepherd Home Friendly' Visitors. Philadelphia Home of the Merciful Saviour for Crippled Children "Play Ball!". House of St. Michael and All Angels The Nursery. Widener Memorial School. Entrance Front View. Rear View First Floor Plan. Second Floor Plan Third Floor Plan. 25 48 73. 154 59 73 16 17 17 17 176-177. 178-179. i8o Pittsburgh Industrial Home for Crippled Children Sleeping Pavilions. Surgical Building Floor Plan WASHINGTON Seattle Children's Orthopedic Hospital Outdoor Sleeping (All weathers) Out-Patient Department. School for Children in Bed.....184 ~... 184. 148......154 ~.... 58 x

Page  XI LIST OF TABLES TABLE PAGE I A. Sources of support, capacity, children in care, and employes in o1 hospitals.. Io8 I B. Sources of support, capacity, children in care, and employes in 14 convalescent hospitals or homes.og I C. Sources of support, capacity, children in care, and employes in 13 asylum homes..... o 11 A. Floor space per child in 9 hospitals......12 II B. Floor space per child in I2 convalescent hospitals or homes. 114 II C. Floor space per child in 12 asylum homes.... 6 III A. Cost of plant per capita in 7 hospitals.. 18 III B. Cost of plant per capita in 12 convalescent hospitals or homes I19 III C. Cost of plant per capita in X I asylum homes... 20 IV A. Annual current expense per capita in 9 hospitals... 121 IV B. Annual current expense per capita in 13 convalescent hospitals or homes. 122 IV C. Annual current expense per capita in 12 asylum homes.. 124 V. Sources of the income of 35 institutions... 125 VI A. Rules of admission and discharge in io hospitals. 128-129 VI B. Rules of admission and discharge in 14 convalescent hospitals or homes..130-131 VI C. Rules of 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. Birmingham, England, 19l.. 21 B. Public school provision for crippled children in four cities, in the school year 1912-1913.. 56 C. Working ability of I,ooI cripples 16 years of age or more. Birmingham, England, 19 67 D. Self-support among I,ooI cripples 16 years of age or more. Birmingham, England, 911... 68 E. Wotking ability of 697 cripples under 16 years of age who were not at work. Birmingham, England, 1911... 68 F. Ratio of public funds received to the current expenses of 35 institutions.........03 G. Public funds; sources and amounts for one year in 17 institutions..104 H. Cost of plant in the Widener Memorial School.. 82 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

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Page  XIII 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 HE 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 laborlaws affecting women and children in Massachusetts. It 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 understand 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 construction 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 institutions,t asylum care for incurable and protracted cases, instruction in institutional schools and day schools; also industrial and * In a recent pamphlet Douglas C. McMurtrie has treated the subject intelligently, but briefly. See McMurtrie, Douglas C.: The Care of Crippled Children in the United States. New York, I912. Published by the author. t A small amount of visiting nursing service for cripples is carried on in connection with certain dispensaries. I I

Page  XIV 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 incurable 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 comparatively few orthopedic cases and treat them in the regular surgical wards. B In making this study Miss Reeves has visited nearly all of the institutions described.* The statistics cover 37 institutions-io orthopedic hospitals, 14 convalescent hospitals or homes, and 13 asylum homes. The united capacity of the 37 institutions is about 2,500 children.t 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 institutions 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 Children 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: Institutions 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 Summer homes not connected 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

Page  1 COUNTRY BRANCH NEW YORK ORTHOPfEDIC HOSPITAL, White Plains. (See page 172)

Page  2 a i LA) di6"i Ili'Ps I^ i~ it I i I B~I, ffi, ~', rgi Graduates' Reunion Class Room Keady tor burgeon's Weekly Inspection. (See page 172) COUNTRY BRANCH NEW YORK ORTHOP/EDIC HOSPITAL, White Plains

Page  3 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 revelation 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 institutions; orthopedic hospitals, convalescent hospitals, and asylum homes alike. It is the same spirit which pervades many institutions for the deaf and blind. The children manifest a cheerfulness, courage, and enthusiasm 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 windows 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 become 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 selfhelp, 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 responsi3

Page  4 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 armlessgirl 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 carpenter'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 employes 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 leading 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 content with the exercise of their skill in the operating room but, almost 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 resources, 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 maintenance of the hospital. They have even kept the accounts and paid 4,

Page  5 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 remuneration. 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 unfavorably 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 institutions 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 manifestation of altruism in its highest perfection. The patients are under care for a longer period than those in other hospitals and the 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, io are found in the two cities of New York and Philadelphia. 5

Page  6 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, I894; (6) Maryland, 1895; (7) Connecticut, 1896; (8) Minnesota, 1897; (9) Ohio, 1903; (o1) Nebraska, 19o5; ( i) Washington, 1907; (12) Michigan, 1907; (13) Maine, 1908. In the twenty-eight years from 1863 to 1890, only five institutions 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 I902 to 1912, 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 Ruptured 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 relations of the building without sacrificing any of the requirements of efficient administration or scientific surgery. The leading examples of combined hospitals and convalescent 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 character which led to a more elaborate style of architecture and equipment 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,I05 as against an 6

Page  [unnumbered] HOSPITAL FOR THE RUPTURED AND CRIPPLED, New York City. (See page 151)

Page  [unnumbered] 1 I i- - I, X t, - '~ ~ aa, $k~ A - T~: 4k ~,... 4: _ Main Building Coasting Sleeping Porch in Stormy Weather. (See page 189) NEW ENGLAND PEABODY HOME FOR CRIPPLED CHILDREN, Hyde Park, Mass.

Page  7 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 requirements of the best modern standards in all respects. An admirable feature is found in the Minnesota State Hospital 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 ingress 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 13 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 established in Minnesota in 1897, it found its precedent in the Illinois 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, entirely beyond the reach of orthopedic surgeons. Their parents have no knowledge of orthopedic surgery and no means of meeting 7

Page  8 CARE OF CRIPPLED CHILDREN the expense of surgical treatment if they had the knowledge. These children live lives of suffering and grow up hopelessly handicapped. 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 institutions 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 Baltimore. 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

Page  [unnumbered] ADMINISTRATION BUILDING, MASSACHUSETTS HOSPITAL SCHOOL, Canton, Massachusetts. (See page 161)

Page  [unnumbered] Rotunda, Hospital Building Sleeping Ward Outdoor Class. (See page 161) MASSACHUSETTS HOSPITAL SCHOOL, Canton, Massachusetts

Page  9 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 children in rural communities who will never receive proper care unless 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 information 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 convalescent 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 hospitals, 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 payment 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 admirable buildings have been erected for six or eight institutions. * See pp. 91-I40. 9

Page  10 CARE OF CRIPPLED CHILDREN Ground plans of some of the more important buildings are presented 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 accommodation of employes in most of the institutions for crippled children is much less adequate than in the institutions for dependent 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 $5,2oo 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. $i,ioo per bed Minnesota State Hospital and School, Phalen Park....... $, 135 per bed Country Branch of the New York Orthopaedic Hospital, White Plains. $3,230 per bed Pittsburgh Industrial Home for Crippled Children... $2,2oo per bed A satisfactory convalescent hospital school or an asylum home for Ioo to 200 children need not cost more than $I,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 economical 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

Page  11 INTRODUCTION $1,500 per bed, though a cost of $I,8oo 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 condition 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 inadequate 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 inadequate force. The average in convalescent hospitals or homes is $348 per year (nearly $i.oo per day). The lowest rate in the asylum 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 physical deformity makes them sensitive as to the observation of others. Excellent schools have been established for special vocational II

Page  12 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 vocational 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 treatment. 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 experience. 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

Page  13 Missing~~~0

Page  14 0 0 ~~ 0

Page  15 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 operative treatment and for subsequent convalescence, with school opportunities. Massachusetts and Minnesota have demonstrated the practicability of furnishing the best care and treatment 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 connection 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 efficient execution of the surgeon's orders in private families, even among fairly intelligent people. The efficiency of dispensary service 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 affection 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 in the great cities as a necessary corollary to the dispensary system. These schools will include special omnibus service, outdoor 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. I 5

Page  16 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 necessitates a large staff of reliable and trained employes. But the community 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 considered 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

Page  [unnumbered] WIDENER MEMORIAL SCHOOL, Philadelphia. (See page 173)

Page  [unnumbered] ...Entrance Entrance Front View Rear View WIDENER MEMORIAL SCHOOL, Philadelphia. (See page 173)

Page  17 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 vocational 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.t 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 institutions 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, 1913. 2 17

Page  18 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 populated sections of the United States, and a smaller number in parts of the country not so thickly settled. In the course of the investigation we have received many inquiries as to how far existing organizations 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 estimate of the total number of crippled children or crippled adults in the United States. Table I, pages o&-I I I, shows the number of children now cared for in all of the 37 institutions for crippled children 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 deformities 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.t 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 Childrenin Boston in Ig91, as 98,263. If the number 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 institutions for cripples.. f Slainte, the Journal of the Women's National Health Association of Ireland, May, g19o, p. 96.

Page  19 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 necessary 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 complete census of the cripples in Birmingham in I91.t 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. (SeeAmerican Journal of Carefor Cripples, Vol. I, No. I, page 43.) t See also Chapter IV, pp. 67-69. 19

Page  20 CARE OF CRIPPLED CHILDREN but a limited value if only the information required by this definition 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 paralysis, because of congenital deformities, or through accident, present 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 surgical 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 children, 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 institutions. 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 existing 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 721 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

Page  21 SCOPE OF THE STUDY TABLE A.-CAUSES OF PHYSICAL DISABILITY OF 721 CRIPPLED CHILDREN. BIRMINGHAM, ENGLAND, 1911 (Not included in general statistical tables.) Cripples Cause Number Per cent Tubercular disease.... 285 39.5 Infantile paralysis....... 175 24.3 Rickets..... 73 '1o. Congenital deformity.... 71 9.8 Apoplexy..... 33 4.6 Birth palsy.... 25 3.5 Accident......... 25 3.5 Scoliosis.......... 13 1.8 Scattering..... 21 2.9 Total..... 721 100oo.o TREATMENT AND AFTER-CARE I tThe 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 adjustment 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 ~pds and all those with bone tuberculosis need to live for a considerable time where the general living conditions as to food, air, and sun are the best. These children form the largest proportion of the number cared for in convalescent hospitals, usually located in the country. There are a limited number of incurable cases cared for permanently in asylum homes. Very few of these cases were hopelessly deformed at birth or otherwise really incurable; most of the socalled "incurables," except a small proportion of badly paralyzed cases, are children who were not treated in time but who, if they 21

Page  22 CARE OF CRIPPLED CHILDREN had been brought to a surgeon's attention when their difficulty was first discovered, could have been greatly benefited and ultimately enabled to care for themselves to such an extent that residence 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 receive 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 interested 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 1913. 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

Page  23 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 commendable one. It would be well if other asylum homes would consider carefully the character of the cases they admit and refuse 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, because 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 disproportionate 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 believe 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 children should be kept in convalescent hospitals or homes, preferably 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

Page  24 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 possible 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 carrying out the doctor's orders about fresh air and other conditions necessary for the child' 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 connection with the hospital to which the child is taken is the necessary prerequisite for successful dispensary work. When there are visiting nurses many children may stay at home who would otherwise 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 institution 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

Page  [unnumbered] ~'X I",S > \! b VICTOR OVER PAIN. (See page 169) St Charles Hospital for Crippled Children, Port Jefferson, L. I. A BRAVE SOLDIER. (See page I59) Kernan Hospital and Industrial School for Crippled Children, Baltimore

Page  [unnumbered] GARDENING Holy Cross House, Cleveland, Ohio. (See page 197) "A HIKE" Summer Home for Crippled Children (Conducted by Post-Graduate Hospital of New York), Southampton, Long Island. (See page 222)

Page  25 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 homelikeness 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 vocational training, in the chapter on that subject. The names and locations of the residential institutions working exclusively for cripples and open all the year, and certain general facts concerning the nature of their work, are shown in the tables.* It 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 o1 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 organized 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 institution into the group whose general type it most nearly resembled. * See pp. 0o8-140. 25

Page  26 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 convalescence, with attention from nurses, some of whom are graduate nurses. There is no restriction as to color in any of the institutions we have classed as hospitals. The age limits for admission and discharge are usually more flexible than in the other institutions; 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 institutions 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 residential 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 graduate nurse, sometimes none. Seven out of 13 take only white children, 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

Page  27 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

Page  28 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 care, which aim to cure the diseases and correct the deformities 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 surgeon 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 return to the surgeon probably by no means balances the large 28

Page  [unnumbered] Main Hospital Building Solarium. (See page I70) STATE HOSPITAL FOR CRIPPLED CHILDREN, West Haverstraw, New York

Page  [unnumbered] Outdoor Sleeping Shack, Exterior Outdoor Sleeping Shack, Interior Outdoor Sleeping in Winter. (See page 170) STATE HOSPITAL FOR CRIPPLED CHILDREN, West Haverstraw, New York

Page  29 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 services freely to institutions doing charity work. The surgeon-inchief 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 includes orthopedic specialists who examine applicants for admission, 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 appliances 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 Children's Hospital in Portland, Maine; the New York Orthopedic 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

Page  30 CARE OF CRIPPLED CHILDREN pedic surgeons who visit the 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 Hospital School, Baltimore, the surgeon-in-chief, who is also superintendent, pays almost daily visits. During these visits the surgeon always examines the case most recently operated upon and is consulted by resident doctors and nurses concerning children needing special attention. At the Country Branch of the New York Orthopaedic 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 convalescent 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 operating 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 convalescent 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 convalescent 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

Page  31 PHYSICAL CARE surgeon is surgeon-in-chief at the Widener Memorial School. Operations 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 received 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 performed 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 operations upon children from these homes and all operations upon children from the other IO 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 orthopedic 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 Hospital 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. 31

Page  32 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 number from one to seven. The convalescerft hospitals have graduate 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 diplomas. Four of 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 knowledge of orthopedic nursing. Nurses at the Home for Destitute Crippled Children in Chicago come from the Presbyterian Hospital; 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 hospitals 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 11 pupil nurses. At the Children's Hospital in Portland, Maine, 22 pupil nurses are 32

Page  [unnumbered] Bungalow Built by the Boys A Cubicle Staff Living Room. (See page 172) COUNTRY BRANCH NEW YORK ORTHOPEDIC HOSPITAL, White Plains

Page  [unnumbered] Milk Between Meals gS... I.. S_ _. The School SUMMER HOME FOR CRIPPLED CHILDREN. (See page 222) (Conducted by the Post-Graduate Hospital of New York), Southampton, L. I.

Page  33 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 Hospital 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 Jefferson, 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 residential 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 private 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 provision 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 dispensary building in the city. Table IXt 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

Page  34 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 outpatient work can not be overestimated. There are, of course, no concrete facts according to which the efficiency of medical care through dispensary service, as compared with that in residential institutions, can be estimated by a person without medical knowledge. But we record here the statement 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 satisfactorily 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 visiting 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, educate the mother so that she may be able to supplement the care given by surgeons and nurses through as intelligent cooperation 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 committee. Some visits to homes of out-patients are paid by the nurse in charge of the out-patient department of the Children's 34

Page  35 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 commensurate with the size of the dispensary service; namely, the New York Orthopaedic Dispensary and Hospital, the New Jersey Orthopaedic Hospital and Dispensary, 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 orthopedic hospitals. During the year I912, 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 I5,518 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 orthopedic 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 special 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 Hospital of the University of Pennsylvania has a social service department 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

Page  36 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 department 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 institutions, 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 Diseases-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 yost 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 apparatus. 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 themselves to teach crippled children for whom special apparatus must 36

Page  [unnumbered] ORTHOPEDIC GYMNASTICS. (See page 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

Page  [unnumbered] Playground Outdoor Sewlng Class CRIPPLED CHILDREN'S EAST SIDE FREE SCHOOL OF NEW YORK, SUMMER HOME, Oakhurst, New Jersey. (See page 228)

Page  37 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 variety 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 following 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. I swing with 2 rods for seats. 2 large and I small punching bags. I jumping chair with springs. I 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. I 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). I 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 school 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

Page  38 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 crippled children. All children need abundant nourishing food, appropriate clothing, the opportunity to breathe pure air both by day and by night, protection from infectious diseases, and an atmosphere 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 affecting 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

Page  39 PHYSICAL CARE brought the interesting result of raising the standard of the institutions at almost all other points. It is generally true that the institutions 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 atmosphere, 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 specialists working for crippled children have a sufficiently broad view of the interests of those children to prompt a degree of attention 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 prescribed. 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

Page  40 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 eggnogs are often served between meals, especially for the tuberculous children. At the Sewickley Fresh Air Home, Sewickley, Pennsylvania, 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 middle of the morning. The menu lists show the usual breakfast to include cerealmost 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 substantial 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 Orthopedic 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

Page  41 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 disinfected before it is used in the institution. On the ground of possible 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 attention to the fact that there was no uniform dress, and in some cases variety was sought as much as possible. Most of the institutions 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 clothing. 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 substantially built but with windows on all sides, which affords the equivalent 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 secured. 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

Page  42 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 Orthopedic Hospital, the Hospital for Deformities and Joint Diseases in New York, the Convalescent Home at West Chicago, the Children'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, particularly the Widener Memorial School at Philadelphia, which have cross ventilation from many windows, provide ventilation so perfect 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 glassenclosed 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 example; they represent nearly as great a space as that occupied by the indoor rooms used by hospital patients. The other institutions whose buildings provide special outdoor space are the Children'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, Illinois, 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 hs providing outdoor space have windows so arranged that they can be completely closed in case of storm. If these windows 42

Page  [unnumbered] Outdoor Sleeping Porch Class in Basketry A Weaver KERNAN HOSPITAL AND INDUSTRIAL SCHOOL FOR CRIPPLED CHILDREN, Baltimore, Maryland. (See page 159)

Page  [unnumbered] Dormitories Covered Walk. (See page 161) MASSACHUSETTS HOSPITAL SCHOOL, Canton, Massachusetts

Page  43 PHYSICAL CARE are not kept open the children may not secure "outdoor" air so effectively as in an ordinary ward with many windows which provide 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 because its windows are kept open throughout the year. At the meeting of the Federation of Associations for Cripples in New York City in April, 1913, there was a discussion of outdoor 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 children'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 factor 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 children, during the hot months. Some surgeons believe that there is special benefit for tuberculous 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 surgeons 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

Page  44 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 unprecedented 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 hospital 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 dis44

Page  45 PHYSICAL CARE eases; and when cases do appear, to prevent the spread of the disease. Seven of the institutions* isolate newly admitted children, usually for two weeks, to prevent the introduction of infectious or contagious diseases. The clothing worn by children when they enter is sometimes destroyed; sometimes it is disinfected 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 forbidden 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 preventing the occurrence of infectious diseases. But the possibility 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 quarantine. This hospital has limited space because of its heavy dispensary service, which is to be transferred later to a new dispensary building. Cases of serious contagion here or in any other orthopedic hospital located in a large city can be sent at once to a special contagious hospital if the quarantine facilities at the institution 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 Massachusetts Hospital School at Canton, the country branch of the Minnesota State Hospital School at Phalen Park, the Crippled Children's Home at Buffalo, the New York State Hospital at West Haverstraw, the Industrial Home for Crippled Children at Pittsburgh, and the Widener Memorial School at Philadelphia. 45

Page  46 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 Orthopaedic Hospital are on the top floor and can be reached by an outside 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 isolation 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 distance 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 construction, 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 quarantine two different diseases at the same time. The Massachusetts Hospital School at Canton has various 46

Page  47 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 description 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 direcriy 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 provisions 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 Hospital in White Plains, there are separate wards, with baths, reserved 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 outside 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 buildings of Sea Breeze, the summer home, would be used in winter. At the Kernan Hospital School, Baltimore, a tent is used for isolation in summer; there is no space in the building reserved for isolation in winter. It has already been noted that special precautions 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 epidemic affected the surgical cases. The Van Leuven Browne Hospital School has no provision for isolation. Only one of the asylum homes, the Home for Incurables at 47

Page  48 CARE OF CRIPPLED CHILDREN Newington, Connecticut, has a separate building used only for isolation and quarantine. Two of the institutions, the New England 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, without 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 element 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 noticeable deformities have learned bitterness, but the smaller children still in the institutions are almost uniformly cheerful. The doctors, 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, 1913: "Contentment and happiness of these little ones play no small part in their cure and recovery." 48

Page  [unnumbered] SCHOOL OMNIBUS. (See page 57) Association for the Aid of Crippled Children, New York City ADJUSTABLE CHAIR AND DESK. (See page 57) Special Classes for Crippled Children, New York City Schools PUBLIC SCHOOL CLASS. (See page 58) Cleveland, Ohio

Page  [unnumbered] Cane beating Manual Training. (See page 226) INDUSTRIAL SCHOOL FOR CRIPPLED AND DEFORMED CHILDREN, Boston, Mass. Adult Cripples' Workroom. (See page 228) CRIPPLED CHILDREN'S EAST SIDE FREE SCHOOL, New York City

Page  49 CHAPTER III SPECIAL PROVISIONS FOR THE EDUCATION OF CRIPPLED CHILDREN HE educational needs of most crippled children can not be met in regular school classes attended by healthy children. This fact has been recognized in recent years, and in consequence special classes for cripples have been opened in public and private day schools and in many residential institutions. Some of the problems which must be solved in the education of crippled children are produced by the fact that both curable and incurable crippled children are usually taught in the same special classes. A large proportion of crippled children can be cured or so far helped that in the course of time they will be able to re-enter regular classes in the public schools. Many of these temporarily crippled children find in the special classes a much needed opportunity to " keep up" with their school work in so far as their physical condition permits. But there are also considerable numbers of crippled children whose cure is impossible, or possible only after years of treatment. These children need a complete system of education which will develop such powers as they possess. The teacher of crippled children has to deal with some who are familiar with public school routine and have much the same point of view as the normal pupils, together with a large number who have never been able to attend the regular schools or to associate freely with other children. It is not intended to suggest that crippled children can be divided accurately into the two groups mentioned. The crippled child may differ greatly or to only a slight extent from the normal, sound child of his own age in general strength and in point of view; and the graduations are numerous between: for example, a boy who has been a vigorous urchin until he lost a leg in a trolley accident at twelve or fourteen and, on the other hand, a child who has been paralyzed from the age 4 49

Page  50 CARE OF CRIPPLED CHILDREN of three or four, or one who has been fighting to overcome bone tuberculosis since an early age. It is important that every teacher of crippled children should have an elementary knowledge of the different physical difficulties which have caused them to become crippled, and that she should know in the case of each individual child how long he has been in a handicapped condition, and in what degree his life has differed from that of a normal child up to the time when he entered her class. To meet the educational needs of all sorts of crippled children there are in the United States special school classes organized under two different systems: those connected with residential institutions, and day schools, public or private, attended by children who live in their own homes. There are notable variations in educational work under different systems of organization which will be discussed later in this chapter, but the better schools of both types are similar in most of their detailed provisions for the safety and comfort of the children. SCHOOL ROOM EQUIPMENT School rooms are located on the ground floor, wherever possible, and the more modern buildings have large elevators. Fireescapes are provided with more care than in ordinary school buildings. Stairways have broad treads, at easy distances; thresholds over which a child with crutches or a brace might stumble are usually absent altogether. Where the school can afford such provision strips of rubber or cork are laid on hall floors and stairs, and similar material is sometimes used for covering entire floors of gymnasiums and play rooms. In one or two buildings there are hand rails along the walls at low levels, by which paralyzed children or others who can not walk well help themselves along. Toilets and lavatories are conveniently located. The water-closets are either of varying heights or all so low as to be convenient for the smaller children and those who are most crippled. In the school rooms adjustable seats and desks are frequently provided. Sometimes the seats are so constructed that one or both sides can be dropped, in case the child using the seat has one or both legs held straight by a brace or plaster; while the backs can be adjusted at any angle and the seat raised and lowered at 50

Page  51 SPECIAL PROVISIONS FOR EDUCATION will. The desks which go with these elaborate seats are also adjustable as to height, and the top of the desk may be moved backward and forward. This special equipment is somewhat expensive. One set costs usually from $17 to $19. Other schools use desks and seats which can be adjusted as to height, and seats with one central support instead of two side supports, so that there may be more room for a child whose legs are encumbered by apparatus. Many teachers believe that these partially adjustable desks and seats are entirely satisfactory for the greater number of crippled children, and that half a dozen of the more costly drop-seats is a sufficient number in the average school room. At the Massachusetts Hospital School the desks and seats are not fastened to the floor because it has been found that a child is sometimes able to take a more comfortable position through a slight change in the position of the desk or seat. There are some teachers who are entirely satisfied with ordinary non-adjustable desks and seats like those used in most public school rooms. They say that the children take positions which they find comfortable, and that the ordinary equipment is quite satisfactory when seats and desks of varying heights are provided, so that each child may have the size to which he can best adapt himself. In many of the residential institutions large tables and ordinary chairs are used in place of school seats and desks. This is true not only in a number of small asylum homes with limited funds, and in hospitals where most of the children are bed cases and it is not thought worth while to spend money for school equipment of the ordinary sort, but also in a few institutions like the Nebraska State Hospital and the country branch of the Minnesota State Hospital. These state institutions have well organized schools, but they use tables and chairs not only for the sake of economy but because they are regarded as satisfactory. For children who must sit in wheel chairs, lapboards are provided at the Children's House of the Home for Incurables, Philadelphia. In each case the board is so adjusted that it is about as high above the child's lap as a desk would be. Aside from these details of architecture and equipment, two special provisions, always necessary in connection with day schools for crippled children, are among the largest items of expense in 51

Page  52 CARE OF CRIPPLED CHILDREN such schools; namely, the buses which bring the children to school in the morning and take them home at night, usually accompanied by a nurse or other caretaker, and the food served free or for very small payments at most of the day schools. Hot lunches are usually given to the children at noon so that an additional trip home will not be necessary; and in many classes milk and crackers are served in the morning and afternoon. CURRICULUM The curriculum in classes for crippled children is always modeled after that in regular school classes, and it is usually the ambition of a teacher of crippled children to be able to say that the children who leave her classes after they are cured, re-enter regular public school classes in the grades which would have been theirs if they had remained perfectly well. The special classes for cripples are almost always smaller than the regular classes, and each child receives, therefore, closer attention. (The teachers believe it is this higher degree of individual attention which counter- 2. balances the time lost by crippled children owing to illness and operations.) /'~" The hours of the sessions are usually somewhat shorter than those for children who are not crippled. In the public school,.' classes and in the private day schools the crippled children usually stay from 9 o'clock until half past two or three, with an hour's intermission for lunch: In the three hospitals Where school classes are highly organized, in most of the convalescent hospitals or homes, and in one of the residential homes, the school hours approximate those in public school classes for crippled children. In the other residential institutions the hours are shorter. Very commonly classes are held from 9 until 12 only, on five days a week. At two of the hospitals where the teaching is very informal, the hours are still shorter. In one case the teacher gives three hours on each of two afternoons for class work and the same amount of time on two other afternoons for teaching bed patients; at the other hospital a volunteer teacher spends about two hours and a half in the morning, two or three times a week, with the bed patients. Table VII (pages 134-136) shows the hours of school work 52

Page  53 SPECIAL PROVISIONS FOR EDUCATION in each institution. It will be seen that they range from the short sessions mentioned for some of the hospitals to full public school hours, and that the amount of time is longer in proportion to the emphasis placed upon educational work as distinguished from surgical treatment. / Furthermore, there is considerably more variety and elasticity of schedule in the special classes for crippled children than in regular public school classes. The children are permitted to leave their work and lie down for short periods, sometimes in a separate rest room provided for the purpose, sometimes on a couch in a corner of the school room. In some schools these rest periods are ordered at scheduled intervals by a surgeon, nurse, or teacher. The class work usually includes rather more frequent change from one subject to another and more hand work than is usual in regular classes. Some of the residential institutions aim to secure more flexibility in the grading of pupils and in their promotion than is believed to be possible under a public school system. The report of the Massachusetts Hospital School for I912 states on page I6: " Promotions are made freely from group to group at any time during the year when a pupil shows evidence of ability to do the work of the class next above him." Any visitor to class rooms for crippled children will note that the air is purer than in most public school rooms for normal children. This is especially true in schools which are supervised or visited by physicians, because they generally order open windows. The air in a number of class rooms visited seemed as pure as that out of doors, even during cold weather. This result was always attributed to open windows, never to a system of indirect ventilation. During the winter a plentiful supply of steam is furnished in most of the schools where the windows are kept open, and the children are expected to wear their outdoor wraps on the coldest days. Three of the institutions have rooms especially designed for the conducting of outdoor classes. At the Massachusetts Hospital School the outdoor classes are held on open platforms adjoining the school building, which forms the only solid wall. On the other three sides there is a tight board railing about 3 feet in height, with pillars at intervals which are connected overhead to the main 53

Page  54 CARE OF CRIPPLED CHILDREN building by rods, over which an awning can be drawn. The children sit in collapsible box-like chairs with very high backs which extend to the floor behind their feet, and with winged pieces at each side to break the wind. Very warm clothing, knit caps, and heavy blankets are provided. The first specially designed building for outdoor school work for crippled children has recently been completed at the Industrial School for Crippled and Deformed Children in Boston. This building, erected at a cost of about $15,000, represents at present the acme of attainment in the erection of special school buildings for tuberculous children. The building has a substantial roof and one brick wall; the other three sides have simply steel pillars covered with concrete, between which there are sliding glass partitions. In order to secure ventilation without a direct draft through the room, the roof is built in monitor form with movable windows in two sections. The seats used are similar in general design to those at the Massachusetts Hospital School. There are also half a dozen canvas cots which stand along the sunny southern side of the building and are used for rest periods. A simpler outdoor school building has just been completed at the Sewickley Fresh Air Home near Pittsburgh. The building is roofed but has no walls; glass partitions will be put in later. These are the only institutions where school classes are held out of doors throughout the year, but mention should be made of the excellent arrangement at Sea Breeze Hospital, Coney Island, for outdoor teaching during about half the year. From early spring until quite late in the fall, the school classes there are held in a tent with wooden floor and board walls about 3 feet high. The walls are completed above that height by screens and canvas which may be dropped in case of rain. At the New York State Hospital at West Haverstraw and at Holy Cross House, Cleveland, Ohio, school classes are held in buildings which were formerly barns and are so loosely constructed that the outdoor school ideal has been in some measure attained without special planning. The classes at the New York State Hospital move into a warm room in the administration building during the coldest weather. The report for 1912, page 20, states: "We are not provided with the necessary equipment, such as blanket clothing, for 54

Page  [unnumbered] Main Building Outdoor Life. (See page 157) CONVALESCENT HOMIE FOR DESTITUTE CRIPPLED CHILDREN, West Chicago, I11.

Page  [unnumbered] School Room Sewing Class. (See page 157) CONVALESCENT HOME FOR DESTITUTE CRIPPLED CHILDREN, West Chicago, Ill.

Page  55 SPECIAL PROVISIONS FOR EDUCATION carrying on an outdoor school in freezing temperature, but hope to be able to do so next year." The Crippled Children's Home in Buffalo has an unused barn which could be transformed into a school with semi-outdoor class rooms. Table VII (pages 134-136) presents in detail the points to which reference is made in this chapter, including the number of pupils in the various residential schools; the number of desks of different types; the number of teachers supplied respectively by the city and by the institution itself; the hours of the sessions, and so forth. Certain general differences in the educational work provided by institutions of the various types may be noted. School work in hospitals is always incidental to the physical care of the children and is often undertaken because a small amount of study amuses the children and is thought by the doctors to facilitate their cure by occupying their attention, rather than because much educational advance is expected. Three of the hospitals provide no instruction; only three have formally organized classes with special school rooms. In the remaining hospitals there is bedside teaching with individual attention to each child. In the state hospitals of Minnesota and Nebraska, where there are organized schools, the teachers also give individual instruction to the children who are in bed and unable to come to the class rooms. Uppatients from the Hospital for Deformities and Joint Diseases in New York are sometimes sent to the nearest public school. A few patients from the Home for Destitute Crippled Children in Chicago have attended the Spalding School for Crippled Children (public), located on land adjoining the site of the hospital. In convalescent hospitals or homes the situation is very different, because most of the children are out of bed and able to attend school regularly. Most of the patients remain for longer periods of time, and a greater proportion than in hospitals are able to do serious school work. Each of these institutions has a school of its own. One convalescent home-the Industrial Home for Crippled Children in Pittsburgh-which has a school of its own, sends some of the children who are able to walk to a nearby public school, because the superintendent desires to broaden their outlook as much as possible. 55

Page  56 CARE OF CRIPPLED CHILDREN The school arrangements in the asylum homes are determined by several factors. Five of the smaller homes do no educational work themselves but send the children to public school classes; sometimes to special classes for crippled children, sometimes to regular classes. This is usually done for reasons of economy, especially in small homes where there are not many children of school age. The superintendents and managers of some of the homes prefer to send the children to public school classes, as they believe it desirable for them to have some contact with the world outside the institution. In the majority of cases schools maintained in institutions are supported by the institutions themselves, but in two of the hospitals, three of the convalescent hospitals, and one of the asylum homes, the teachers are furnished by the board of education of the city in which the institution is located. PUBLIC SCHOOL CLASSES FOR CRIPPLES Public school classes for crippled children have been organized in New York, Chicago, Cleveland, and Detroit, and the opening of similar classes in Philadelphia* is under discussion. The following is a statement in outline of the work of the classes in the four cities mentioned: TABLE B.-PUBLIC SCHOOL PROVISION FOR CRIPPLED CHILDREN IN FOUR CITIES, IN THE SCHOOL YEAR 1912-19I3 (Not included in general statistical tables.) Children Average Annual City Classes renrol daily at- iTeachers bonus paid......__________________.ltendance teachers Chicago, Ill... 7 199 135 7 $200 Cleveland, 0... 4 88 77 5 Detroit, Mich... I 44 4o0 3 200 New York, N.Y.. 39 657a 569 39 100 Total.. 51 988 821 54 a "On register." In New York City there are 39 classes, distributed throughout the city, with usually not more than two or three in a single * In September, 1913, a class was opened in Philadelphia, with accommodations for about 25 children. Baltimore established classes in 1913. 56

Page  57 SPECIAL PROVISIONS FOR EDUCATION school building. Twenty is the maximum number allowed in a single class for crippled children and the average "on register" in the classes closely approaches this limit. Twelve is the minimum number with which a class may be organized. The teachers receive a bonus of $1oo per year over the amount which they would receive if they were doing similar work with children not crippled. This bonus is the same as that paid to teachers of the blind and deaf. Sessions are one hour shorter than those of the majority of the school classes; that is, from 9 until 2, instead of 9 until 3. Hot lunches are sold to the children in the public schools. In Public School 107, for example, soup is served for three cents, and sandwiches, cookies, cups of cocoa, and so forth, for one cent each. Children are required to take the soup before they are allowed to have sweets. In some places the children in the special classes for cripples are served first. About one-third of the buses used for transporting the children and the caretakers who accompany them are furnished by the board of education. The remainder are paid for from private sources, through the Association for the Aid of Crippled Children which furnishes nurses to accompany the buses to the schools. The city of Chicago maintains special classes for crippled children in two sections of the city. On the west side the Spalding School, an excellent new building, thoroughly modern, is given over entirely to classes for crippled children. There are five class rooms in addition to a play room, surgical dressing room, rest room, gymnasium, and so forth, all on the first floor. Five teachers are employed, and about Ioo children are registered in the school in the winter. Thirty-four children attended a morning session during the summer of 191 I. The hours are from 9 to I I, and 12:30 to 2. Most of the desks and seats are of the special adjustable type. A nurse comes to the school every day to look after the physical needs of the children. The large Fallon School on the south side of Chicago has reserved on the first floor two class rooms and a play room, kitchen, dining room, toilet rooms, and so forth, for the exclusive use of crippled children. Desks and seats are adjustable only as to height. Two teachers are employed and the average number of children is 45. The session lasts from 9 until 2:45 during the winter. 57

Page  58 CARE OF CRIPPLED CHILDREN In 191 1, 32 children attended summer classes from the time when the public schools closed until July 27th. The summer session lasts only from 9 until 12. The work for crippled children connected with public schools in Chicago is financed entirely by the board of education. A bonus of $200 per year is paid the teachers. Hot lunches and transportation by buses are furnished to the children. At present seven buses are used to carry children to and from the Spalding School, and three buses to carry those who attend classes at the Fallon School. A police officer is detailed to accompany each bus on its rounds, night and morning. In Cleveland, classes for crippled children in connection with the public schools are conducted in a one-story wooden building in a large yard at the rear of the Wilson School, one of the largest public schools in the city. There are class rooms, a dining room, kitchen, and surgical dressing room. Desks and seats are adjustable as to height; one central pivot supports both a desk and a seat. A principal, grade teachers, and one kindergarten teacher are employed.,They receive no extra pay. A visiting nurse is furnished jointly by Rainbow Cottage, a country convalescent children's hospital, and Lakeside Hospital. Buses for the transportation of children, and hot lunches, are provided by the Sunbeam Circle, an organization of women. The average attendance is 77. In Detroit, class rooms are reserved for crippled children on a lower floor of the Clinton School building. The total number of children enrolled is 44, the average daily attendance is 40. Only 15 crippled children are allowed in one of the special classes, while in ordinary school classes in Detroit the number of children is usually determined by the seating capacity of the room and in most cases runs from 45 to 48. The three teachers of crippled children are paid $2oo a year more than teachers doing similar work with children who are not crippled. The hours of the session are the same as those in other school classes during the spring and fall; but from November until April the classes for cripples begin an hour later in the morning, so that the children need not leave their homes so early during the cold weather. A nurse is provided,by the city. She helps the children to and from the carriages and 58

Page  [unnumbered] SCHOOL FOR CHILDREN IN BED Children's Orthopedic Hospital, Seattle, Washington (See page 156)

Page  [unnumbered] BASEBALL TEAM. (See page i61) Massachusetts Hospital School, Canton, Massachusetts PLAY BALL! (See page 199) Home of the Merciful Saviour for Crippled Children, Philadelphia

Page  59 SPECIAL PROVISIONS FOR EDUCATION assists in the serving of luncheon at noon and milk at other hours during the day. PRIVATE DAY SCHOOLS In New York City there are four private day schools for crippled children. The Crippled Children's East Side Free School in New York is a private organization owning its property and financing all phases of its work except the actual grade teaching, for which teachers and equipment are furnished by the city board of education. The class rooms can accommodate about 200 children, and the number registered is never below the full capacity. There are 163 desks and chairs of the special adjustable variety and 33 ordinary kindergarten chairs. All grades from the kindergarten through the eighth grade are included. Classes are held on regular public school days from 9 until 2:30, with an hour's intermission for luncheon. The teaching resembles that in other public schools. It is worthy of note that the windows are kept open and the air is good at all seasons of the year. A visiting orthopedic surgeon holds weekly clinics at the school. An assistant surgeon and a trained nurse assist in the adjustment of braces, application of plaster dressings, and other treatments. For important operations the children are sent to various hospitals. Under the supervision of a staff of nurse maids, all the children have baths twice each week. There were 9,703 baths recorded in the last school year, and 450 visits were paid to the homes of the children. A summer home at Oakhurst, New Jersey, houses 106 children at a time during July and August. Each child's stay varies from two to eight weeks. The important part of the school's work represented by industrial classes will be discussed in Chapter IV. An open-air class for children with bone tuberculosis is maintained by the alumnae of Miss Spence's School on one deck of a boat belonging to Bellevue Hospital, which is moored near the foot of East Twenty-sixth Street. The average attendance is 20. The teacher and school supplies are furnished by the board of education. Miss Spence's School Society supplies the omnibus, special chairs for outdoor use, warm wraps, and meals, including milk and eggs served when the children reach the boat in the morning and 59

Page  60 CARE OF CRIPPLED CHILDREN at 4 o'clock in the afternoon, and a hot dinner at noon. A visiting orthopedic surgeon holds weekly clinics on the boat and a trained nurse is in constant attendance. There are two private schools for crippled children in New York which have no relation to the board of education. The William H. Davis Free Industrial School for Crippled Children offers kindergarten work and instruction through the eighth grade in addition to industrial work. The school pays for two teachers and furnishes all supplies. The children are at the school from 9 until 4. A wagonette owned by the school makes the rounds for the children who can not walk. The driver carries the children to and from the wagon when necessary and a nurse rides with them. A hot dinner is served free to all the children at noon. The desks and seats are not adjustable. This school has a summer home at Claverack, New York. The industrial work will be covered in Chapter IV. The Rhinelander Industrial School for Crippled Children is an interesting combination of private activities. The industrial classes will be discussed in Chapter IV. The Children's Aid Society of New York is responsible for the maintenance of the building and for the payment of the teachers who give instruction in the grade classes. The building is somewhat old-fashioned and has no elevator. For this reason the classes are arranged on a unique basis. The children able to climb stairs easily are assigned to the second floor, the others remain on the first floor. The two grade class rooms are much like country schools; each includes work in all the eight grades and there is no attempt to grade the children as exactly as in most public schools. Academic classes are held every forenoon except Saturday, from 9 until 12. The children are taken to the school and returned to their homes by buses furnished through a private gift. In Boston, the Industrial School for Crippled and Deformed Children has done pioneer work in the cause of education for crippled children both in grade branches and in industrial classes, and has maintained its leadership in both. The main building is modern in every particular, with all the special equipment needed for the safety and comfort of crippled children. Its class rooms contain ioo desks and seats of the special adjustable 60

Page  61 SPECIAL PROVISIONS FOR EDUCATION sort. Each desk is adjusted at the beginning of the year, under the supervision of the doctor in charge, for the particular child who is to use it. The capacity of the school has recently been increased by the erection of a building for an outdoor class room, which is a model structure for its purpose. The equipment, which is equal to that in the best public schools, includes slate blackboards, maps, kindergarten materials, and so forth. The curriculum closely resembles that of graded public schools, and many observers of the school believe that its teaching standard is above that in most public schools. A nurse is in constant attendance and visits the homes of the children on Saturdays and during the summer months. Visiting physicians watch over the physical condition of the children, and the nurse carries out their directions, seeing also that the children go frequently to the various dispensaries at which they are being treated. This school has a long waiting list, and considerable time occasionally elapses before a vacancy permits the admission of new applicants.

Page  62 CHAPTER IV HAND WORK AND VOCATIONAL TRAINING HE most recent feature in the development of special educational provisions for crippled children is occupational training. Simple housework and sewing have been part of the life of most residential homes for cripples since their establishment, and some of the special industrial schools are older than most of the hospitals. Yet, for reasons that can readily be understood, this phase of educational training has been in most communities the last to receive special attention. It is generally true that in each city the orthopedic hospitals, or orthopedic wards in general hospitals, have brought their work to a high standard of surgical and medical efficiency as the necessary first step in providing for cripples and children likely to become cripples if not given surgical attention. The next step has been the establishment of schools for convalescents in residential institutions and of special day schools for cripples who live at home. It has usually been only after the pressing needs for surgical attention, convalescent care, and education in the simple academic branches have been met in some degree in a community that the question of vocational training for crippled children and young people has received serious consideration. The same arguments which are advanced for the occupational or vocational training of healthy children apply also to crippled children. There is difference of opinion as to the age at which any child's preparation for wage-earning should begin, but most educators agree that this special training promises to every child a better chance of a good "start in life" and more rapid advancement than would be possible if he had no preliminary training. When the child is a cripple, certain other considerations enter: E' First, the simpler forms of industrial work, as well as grade 62

Page  63 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 A discussion of the treatment of crippled children which appears in the English Charity Organisation Review for September, 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-consciousness 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 sufficient 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. V 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. JThis 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 training can be judged only by comparing those who are trained with untrained children who are also crippled. When crippled 63

Page  64 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 between the measure of success they do attain and entire dependence. SUITABILITY OF OCCUPATIONS CHOSEN " It is more necessary to recognize the indefiniteness 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 children with some kinds of physical handicaps are quite impracticable 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 occupation 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 employment 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 extraordinary 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 deprived of both arms as the result of either accident or disease is comparatively small. The cases seen during the progress of the 64

Page  [unnumbered] Miss KITTIE SMITH EMBROIDERING MISS KITTIE SMITH WITH A PUPIL Home for Disabled Children, Maywood, Illinois. (See pages 64 and 188)

Page  [unnumbered] MISS KITTIE SMITH CARPENTERING Miss KITTIE SMITH TYPEWRITING Home for Disabled Children, Maywood, Illinois. (See pages 64 and 188)

Page  65 HAND WORK AND VOCATIONAL TRAINING study have usually been children so far paralyzed that no industrial 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, telegraph 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 conspicuous 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 institutions 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

Page  66 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 without 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. A Institutions about to open new classes for vocational training 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 representatives 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 reference 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

Page  67 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 I. In this city of 500,000 people were found I,ooI cripples over sixteen years of age and i,oo6 under sixteen years of age. The report of this census printed in October, 19I I, 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 I,ooI cripples sixteen years of age or more is shown by the following table: TABLE C.-WORKING ABILITY OF 1,001 CRIPPLES 16 YEARS OF AGE OR MORE. BIRMINGHAM, ENGLAND, 191 I (Not included in general statistical tables.) Cripples Status Number Per cent Able to go to work under ordinary conditions. 214 21.4 Able to attend a central workshop.... 145 14.5 Able to do remunerative work at home... I l. I Unable to do any remunerative work.. 5 3.0 Total..........,O l oo.o * Report of a Special Sub-committee of Inquiry Concerning Physically Defective Adults and Children to the City of Birmingham Education Committee, 1911. 67

Page  68 CARE OF CRIPPLED CHILDREN The following table shows the measure of self-support attained by cripples sixteen years of age or more: TABLE D.-SELF-SUPPORT AMONG I,001 CRIPPLES I6 YEARS OF AGE OR MORE. BIRMINGHAM, ENGLAND, 191 I (Not included in general statistical tables.) Cripples Status Number Per cent Self-supporting.... 176 17.6 Not self-supporting but did not require help.. 156 15.6 Not self-supporting and did not require help at time of census, but might be expected to need it later. 144 14.4 Not self-supporting and required help.... 19 19.1 Being maintained in charitable institutions.. 334 333 Total 1,001 1,oo.o 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, 191 I (Not included in general statistical tables.) Cripples Status Number Per cent Likely to be able to go to work under ordinary conditions.. 230 33.0 Likely to be able to attend a central workshop. 191 27.4 Likely to be able to do remunerative work at home. 42 6.o Likely to be unable to4o any remunerative work. 57 8.2 Future capacity could not be estimated.. 177 25.4 Total...... 697 loo.o 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

Page  69 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 I 1 (reasonable remuneration being given in both cases for work done); " (3) Financial assistance were given to 191 (the amount required varying from about 2 shillings to 5 or 6 shillings per week)." A second report of this committee, dated March 29, 1912, recommends that the first need be met by the establishment of a workshop for crippled girls where they may learn general needlework, 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 undertaken 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 institution 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 training 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

Page  70 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 generalization may be accepted as true for all parts of the country.4As 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 suggestions 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-I 36, which gives details concerning the academic school work, includes also the number of teachers giving 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 training 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 include children who do housework, except the older girls at the House of St. Michael and All Angels in Philadelphia. The children 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

Page  71 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 facilities for teaching some occupations for which they have at present no pupils of the right age or otherwise fitted. For example, at several of the residential institutions, including the New York State Hospital at West Haverstraw, typewriting and stenography have occasionally been taught by the secretary or bookkeeper 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 sewing 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 occupational work is taught in formal classes by special teachers, but much of the training received by children in residential institutions grows out of the daily life of the institution. INFORMAL VOCATIONAL TRAINING IN INSTITUTIONS The children very often help with the domestic work. In 13 of the 37 institutions * they receive sufficient training in housework 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 71

Page  72 CARE OF CRIPPLED CHILDREN homes. In six of these institutions-named first in the footnotethe work is planned in advance, and each child is assigned to definite 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 caring for younger children. But the effort to use the routine domestic work of an institution 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 training is by grouping children in small cottages, each cottage being a complete domestic unit in which the cooking, baking, table service, and sleeping are managed on the same plan as in an ordinary household. Such cottages should contain not more than 15 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

Page  [unnumbered] The Cooking Class Main Building and Yard. (See page 19o) DAISY FIELDS HOME AND HOSPITAL FOR CRIPPLED CHILDREN, Englewood, N. J.

Page  [unnumbered] 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, Philadelphia

Page  73 HAND WORK AND VOCATIONAL TRAINING The institution has a steam laundry and the most modern housekeeping equipment for its other buildings; but experience with ultra-modern machinery would be of littl, use to girls who go afterward into cheap or moderate priced ap'rtments or houses in the country districts. At the House of St. /Michael and All Angels in Philadelphia the young colored girls receive similarly comprehensive 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 household linen in good order. In the larger institutions, one or more seamstresses are employed. In some of the smaller ones a seamstress 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 children 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 Hospital 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

Page  74 CARE OF CRIPPLED CHILDREN library. Stenography and typewriting are taught at the Kernan Hospital in Baltimore and the St. Charles Hospital in Port Jefferson, 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 offer excellent opportunity 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 Orthopedic 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, expect to develop later various kinds of farm work, including dairying, 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

Page  [unnumbered]

Page  [unnumbered] Courtesy of American Journal of Core for Cripples CLASS IN MAKING OF RATTAN FURNITURE, TRADE SCHOOL OF THE HOSPITAL OF HOPE FOR CRIPPLED MEN. (See p. 231) =11~~~~~~~~~~~~~~~Cuts of _-Izta Jo|ms ofCr f Cip CLA* 1 IN _111O AtNFRNTR.TAESHOLO H OPTLOFHP O RPLD E.(e.2

Page  75 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 furniture 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 especially 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 Ioo 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 engineering 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

Page  76 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 carpenter 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 engaged the boy to take charge of the heating apparatus by night; 76

Page  77 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 anywhere 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. LOther 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 supplement what parents give for their children. Nevertheless the educational motive is never forgotten. The pupils receive thorough 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

Page  78 CARE OF CRIPPLED CHILDREN Less Advanced Class Monday Plain sewing 12X hours Tuesday Mending I hour Knitting X hour Wednesday Mending i hour Crocheting X hour Thursday Plain sewing I hour Crocheting Y hour Friday Plain sewing I hour Knitting X hour Advanced Class Monday Cutting I hour Plain sewing I hour Tuesday Mending I hour Knitting I hour Wednesday Mending I hour Crocheting I hour Thursday Cutting I hour Plain sewing i hour Friday Plain sewing I 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, chaircaning, and the making of small fancy articles; third, direct training for self-support in occupations which offer reasonable opportunities for crippled children to earn their living after they leave the institution. The different grades of hand work will be discussed briefly in the order mentioned. 78

Page  79 HAND WORK AND VOCATIONAL TRAINING Many of the children lay the foundation for later industrial training in kindergarten classes. Fifteen of the residential institutions 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, kindergarten 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 institutions 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 sewing which may be regarded as genuine preparation for self-support will be discussed, with other methods of direct occupational training, 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 procurable, 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 burntwood articles, brass candle shades, and bead chains are also relatively 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

Page  80 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 purchaser 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 children 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 kindergarten 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 raffia. 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 position 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

Page  81 HAND WORK AND VOCATIONAL TRAINING ORGANIZED TRAINING FOR SELF-SUPPORT The hand work which we have placed in a third class includes 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 regularly organized cooking classes for the girls in four residential institutions 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 comparatively 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 Crippled and Deformed Children New York City Crippled Children's East Side Free School Rhinelander School William H. Davis Free Industrial School for Crippled Children Sewing, embroidering, cooking, advanced kindergarten work, manual training, basketry, cobbling, chair-caning, printing, proofreading Hand and machine sewing, embroidering Sewing, embroidering, jewelry making Sewing, embroidering, leather tooling, burnt wood work, wood carving * See page 73. The House of St. Michael and All Angels has trained several colored girls successfully for domestic service. 6 8i

Page  82 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 $45 a dozen. The different schools have attained fame for different 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, boudoir 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 covered 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 otherwise 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

Page  [unnumbered] Surgical Pavilion, Interior The Play Hour. (See page 168) HOUSE OF ST. GILES THE CRIPPLE, Garden City, Long Island

Page  [unnumbered] "Seeking a Shrine." (A Legend of a Crippled C Sleeping Porch Main Building. (See page 169) ST. CHARLES HOSPITAL FOR CRIPPLED CHILDREN, Port Jefferson, Long Island

Page  83 HAND WORK AND VOCATIONAL TRAINING For girls who have completed the eighth grade, there is opportunity 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 hemstitching, embroidery, cross-stitching and the making of dolls' and children's clothes. Two boys are learning the rudiments of tailoring. 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 embroidery have been taught in a few institutions. At the Kernan Hospital 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 children 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 beautifully 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

Page  84 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 commercial 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 difficulty 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 VIII, 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

Page  85 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 advanced 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 $5.oo 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 equipment as between $4,000 and $4,500. It includes five presses and cases of type, a paper cutter, a wire-stitching machine, and a looseleaf 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 work85

Page  86 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 $1oo in 91 I, 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 v 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 children 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 Annunciation 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

Page  87 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 various ways. In all the residential institutions many of the articles made by the children are used in the buildings. This is true not only 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 Massachusetts 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 considerable 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, 1913. Half a dozen of the residential institutions have also made articles for sale, but the receipts have not represented any noticeable 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 Baltimore. One hundred dollars was realized in one year. One-third of the amount for each article is given to the children; from the 87

Page  88 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 Merciful 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 teachers' 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

Page  89 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 vocational 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 conditions 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 different types of cripples to perform the various kinds of tasks imposed by the given occupations has not been determined. It is obvious that studies for the purpose of securing information about employment conditions are needed for the guidance of young people, whether they are crippled or not. Such studies must usually be within a limited range of territory, sometimes 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 furnishes a basis for a program of vocational training. The pamphlets 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 institutions for cripples by showing the relative advantages of the different 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 different 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

Page  90 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 initiative 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

Page  [unnumbered] " ~s a X'rh** `._~e,_* Q " jk 9 a.A./ 4 -WL KERNAN HOSPITAL AND INDUSTRIAL SCHOOL FOR CRIPPLED CHILDREN, Baltimore. (See page 159)

Page  [unnumbered] Main Building. Sleeping Porch and Sun Parlor in the Kear CHILDREN'S HOSPITAL SCHOOL, Baltimore. (See page 158) -* 'MN J *,,- '!, "., ^ ~ i*.~d ^ *^1 ": o-w -^ 1 * ^ ia.u v ~ i 2 i ^ EnW s hw rig gY~" iy;~'+;$ Surgical Pavilion HOUSE OF ST. GIIES THE CRIPPLE, Garden City, L. I. (See page 168)

Page  91 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 possible. 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 referred to the tables themselves for details. CAPACITY AND NUMBER OF CHILDREN IN CARE DURING YEAR IN 37 INSTITUTIONS (Summarized from Table I, pp. io8- i i) Average Total number G roup of ins s Beds for chil- number of of children dren children in care in care during year during year lo Hospitals.. 846 662 3,064 14 Convalescent hospitals or homes... 1,219 945 1,391 13 Asylum homes... 409 361 446 37 Institutions 2,474 1,968 4,901 Average number children in care per institution Group of institutions Minimum Maximum Average Io Hospitals... o 192 66 14 Convalescent hospitals or homes.. 25 229 68 13 Asylum homes... 6 87 28 37 Institutions.... 6 229 53 91

Page  92 CARE OF CRIPPLED CHILDREN The total capacity of the o 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 I00 to 250. The capacities of the 10 hospitals are as follows: 16, 50, 56, 57, 65, 70, 70, 1oo, I12, and 25; average, 85. The total capacity of the 14 convalescent hospitals or homes is 1,219. They cared for 1,391 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 Hospital 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, 6o, 60, 75, 85, 1oo, 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 ioo. 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 ioo. The capacities of the 13 asylum homes are as follows: 6, 12, i8, 20, 20, 25, 30, 30, 30, 33, 35, 50, and oo; average, 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 i,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

Page  93 STATISTICS RATIO OF CHILDREN TO EMPLOYES IN 36 INSTITUTIONS (Summarized from Table I, pp. 0o8-1 I) Average number of Group of institutions chilnnare Employes during year 9 Hospitalsa... 599 319 14 Convalescent hospitals or homes... 945 400 13 Asylum homes....... 361 117 36 Institutions... 1,905 836 Ratio of children to employes Group of institutions Minimum Maximum Average 9 Hospitalsa.. 1.6 3.2 1.9 14 Convalescent hospitals or homes.... 1.2 6.1 2.4 13 Asylum homes... 2.0 6.0 3.1 36 Institutions.... 1.2 6. 2.3 a Not including Minnesota State Hospital, which uses the unreckoned services of employes of the St. Paul City and County Hospital. The residential institutions have 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

Page  94 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, i.8, 1.8, 2.1, 2.1, 2.6, and 3.2; average, 1.9. The total number of employes in the 14 convalescent hospitals 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 employe for every 1.2 children. At the other extreme, the St. Charles Hospital at Port Jefferson, New York, has one employe for every 6. I 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, i.8, 1.9, 2.3, 2.4, 2.7, 2.8, 3.I, 3.2, 3.5, 3.5, and 6.1; average, 2.4. The 13 asylum homes have a total of 117 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 employe 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.o; 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.o. 94

Page  95 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 increase in employes makes an increase in expense of food, furnishings, 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 sleeping, 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 institutions 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 a (Summarized from Table II, pp. 112-117) Square feet of floor space per child for Group of institutions Mselno A.Childre EmployesMiscellaneous All Children Employes p purposes purposes 9 Hospitals... l 55 148 314 12 Convalescent hospitals or homes.... 17 38 98 253 12 Asylum homes... 151 41 137 329 33 Institutions... 121 44 122 287 a For institutions omitted see notes to Table I, pp. 13, 115, 117. 95

Page  96 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 Children 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 Congregate Institutions,"* a description of 50 typical institutions for dependent 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 children 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 5o 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 delinquent 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 Committee, 9Igo. 96

Page  [unnumbered] Wood-working Room Girls' Sewing Room. (See page 16i) MASSACHUSETTS HOSPITAL SCHOOL, Canton, Massachusetts

Page  [unnumbered] Cooking Class School Room Industrial Room. (See page 189) NEW ENGLAND PEABODY HOME FOR CRIPPLED CHILDREN, Hyde Park, Mass.

Page  97 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 standards 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 INSTITUTIONSa (Summarized from Table II, pp. 112-117) Square feet of floor space per child for dormitories Group of institutions Indoor Outdoor Total 9 Hospitals.. 54 5 59 12 Convalescent hospitals or homes.... 40 7 47 12 Asylum homes... 54 5 59 33 Institutions.. 47 6 53 Square feet of floor space per child for dormitories Group of institutions Minimum Maximum Average 9 Hospitals... 49 85 59 12 Convalescent hospitals or homes... 28b 87 47 12 Asylum homes... 40 88 59 33 Institutions... 28b 88 53 a For institutions omitted see notes to Table II, pp. 13, 115, 17. 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 institutions for dependent and delinquent children; namely, in the provision of space for the accommodation of officers and employes. 7 97

Page  98 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 I66 square feet for each. The rate forthe hospitals is 170 feet; for the convalescent hospitals or homes, 16o 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 carefully 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 devoted 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 convalescent 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

Page  99 STATISTICS adequate homes the average cost will probably reach $i,6oo or $1,800 per bed. COST OF PLANT PER CHILD IN 30 INSTITUTIONSa (Summarized from Table III, pp. 118-120) 12 Con- II 30 oit7 valescent Asylum InstituHospitals homes homes 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. $2,599 $i,i55 $1,013 $1,595 Surgical and gymnastic equipment. 49 i8 8 26 Furniture and educational equipment.. 87 104 55 91 Miscellaneous items.12 17 9 14 Total.... $2,747 $1,294 $1,o85 $1,726 Cost of plant per child per institution Group of institutions Minimum Maximum Average 7 Hospitals.... $920 $5,190 $2,747 12 Convalescent hospitals or homes.... 302 3,232 1,294 II Asylum homes... 453 2,739 1,085 30 Institutions... $302 $5, 90 $1,726 a Based on capacity; including cost of lands, buildings, and equipment. For institutions omitted see notes to Table III, pp. I18, 119, 120. The II asylum homes show an average cost of $I,085 per bed. Asylum homes cost less than convalescent homes because their buildings are of a simpler character. It is probable, however, 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

Page  100 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 comparison. 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 $2,599 per bed for seven hospitals; $I,155 per bed for I2 convalescent hospitals or homes, and $1,013 for I I asylum homes. The cost of furniture, equipment, and miscellaneous items is $148 per bed for the seven hospitals; $139 per bed for the 12 convalescent hospitals or homes, and $72 per bed for the 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 ioi. The proper care of crippled children is necessarily very expensive. 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 because 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 represents 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. I00

Page  101 STATISTICS CURRENT EXPENSE IN 34 INSTITUTIONS a (Summarized from Table IV, pp. 121-124) Average number Group of institutions of children in Current expense care during year 9 Hospitals... 599 $341,450 13 Convalescent hospitals or homes..849 295,295 12 Asylum homes..... 355 94,853 34 Institutions.. 1,803 $731,598 Current expense per child Group of institutions Minimum Maximum Average 9 Hospitals.. $233 $977 $570 13 Convalescent hospitals or homes... 153 553 348 12 Asylum homes.. 184 431 267 34 Institutions... $i53 $977 $406 a 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 $1I59 to $272 yearly per child, averaging $196. The compensation of employes forms a large part of the expense. It runs as follows: SALARIES AND WAGES PER CHILD IN 34 INSTITUTIONSa (Summarized from Table IV, pp. 121-124) Salaries and wages per child Group of institutions Minimum Maximum Average 9 Hospitals.. $8I $528 $241 13 Convalescent hospitals or homes... 57 265 141 12 Asylum homes... 40 184 90 34 Institutions.... $40 $528 $164 a For institutions omitted see notes to Table IV, pp. 121, 123, 124. IOI

Page  102 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 INSTITUTION S a (Summarized from Tables II and IV, pp. 112-117 and 121-124) 13 Con- 12 34. valescent Asylum InstituHospitals homes homes tions Average number of children in care.... 599 849 355 1,803 Average number of resident employes.... 251 261 93 605 Total number of persons fed. 850 I, 1o 448 2,408 Total cost of food for year. $66,665 $80,605 $29,737 $177,007 Cost of food per person per year 78.43 72.62 66.38 73.51 Cost of food per person per day.215.199.182.201 a For institutions omitted see notes to Tables II and IV, pp. 113, 115, 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 services of employes of the St. Paul City and County Hospital. 102

Page  103 STATISTICS 35 institutions comes from invested funds, ranging from 18 per cent for the hospitals to 23 per cent for the convalescent homes. SOURCES OF INCOME OF 35 INSTITUTIONSa (Summarized from Table V, pp. 125-127) Per cent of income from Group of institutions Public Invested Pay Dona- All funds funds patients tions sources 9 Hospitals.. 33 18 i8 31 1o 14 Convalescent hospitals or homes.. 47 23 5 25 0oo 12 Asylum homes. 14 21 3 62b 100 35 Institutions... 36 20 10 34 0oo a For institutions omitted see notes to Table V, p. 127. b 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 INSTITUTIONSa (Not included in the general statistical tables) Public funds Total current Group of institutions Total Amount Per centof curexpenses Amount Per cent of current expense o1 Hospitals. $3 55,393b $102,034 28.7 13 Convalescent hospitals or homes... 295,295 145,124 49.1 12 Asylum homes.. 94,853 15,956 16.8 35 Institutions... $745,541 $263,114 35.3 a Not including the Widener Memorial School, Philadelphia, nor Happy Haven, Chicago. See Table IV, p. 127. b This figure includes $13,943, the expenditure of the St. Paul State Hospital not included in Table IV. It will be observed that out of $746,ooo expended for the support of 35 institutions for crippled children, 35 per cent came 103

Page  104 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 Minnesota, which are supported entirely by public funds. The indications 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 administered 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 17, as follows: TABLE G.-PUBLIC FUNDS; SOURCES AND AMOUNTS FOR ONE YEAR IN 17 INSTITUTIONS (Not included in the general statistical tables) Public funds Hospital Hospitas Amount for Sources one year one year MAINE Portland Children's Hospital.. State $0o,ooo MINNESOTA St. Paul State Hospital (state institution)a. State 13,943 NEBRASKA Lincoln Nebraska Orthopedic Hospital (state institution).... State 45,060 NEW JERSEY Newark Home for Crippled Children... City 2,500 NEW YORK New York City Hospital for Deformities and Joint Diseases. City 7,730 Hospital for the Ruptured and Crippled City 22,801 Total...... $102,034 a Conducted in connection with St. Paul City and County Hospital. 104

Page  105 STATISTICS TABLE G.-PUBLIC FUNDS; SOURCES AND AMOUNTS FOR ONE YEAR IN 17 INSTITUTIONS-(Continued) Public funds Convalescent hospital or home Amount for Sources one year one year MARYLAND Baltimore Children's Hospital School..State $3,750 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..... $145,124 Public funds Asylum home Sources Amount for one year CONNECTICUT Newington State and Virginia T. Smith Home for Incurables cities $13,345 NEW YORK Buffalo Crippled Children's Home.... Erie County 2,61I Total........ $15,956 Grand total..... $263,1 14 105

Page  106 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 convalescent 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 convalescence is so slow. It runs into months and years instead of days and weeks. A most encouraging feature is that 15 out of 37 institutions maintain some helpful supervision of their patients after discharge. The ages of admission run low. There is an increasing recognition of the importance of early help in order to accomplish a permanent cure. No one of the Io 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 institutions all the beds are free; in 23 others the beds are usually free. Seventeen out of 37 institutions have no geographical restrictions as to admission. SCHOOL STATISTICS Table VIlt covers school statistics, sessions, and equipments. 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. 1o6

Page  107 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 15 schools. Four schools use more than one kind of furniture for school purposes. HAND WORK Table VIII* gives details of instruction in hand work and vocational work. Eight hospitals and one convalescent home attempt none. In io 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 ordinary 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 IXt 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 reported 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. *See pp. 137-139. tSee p. 140. 107

Page  108 CARE OF CRIPPLED CHILDREN TABLE I A.-SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 10 HOSPITALS A - Total num- num- Ratio Beds berof ber of of Statistics Hospital Sources of for chil- chil- Em- chil- forSyear support chil- dren dren ployes dren ending a dren in care in care to emduring during ployes year year ILLINOIS Chicago Home for Destitute Crippled Children. MAINE Portland Children's Hospital MINNESOTA St. Paul State Hospital NEBRASKA Lincoln Nebraska Orthopedic Hospital NEW JERSEY Newark Home for Crippled Children. Orange New Jersey Orthopaedic Hospital and Dispensary NEW YORK New York City Hospital for Deformities and Joint Diseases Hospital for the Ruptured and Crippled b New York Orthopaedic Dispensary and Hospital WASHINGTON Seattle Children's Orthopedic Hospital Private Public and private State State Public and private Private Public and private Public and private Private Private 112 65 70 I00 56 87 57 63 70 45 10 49 d 192 d 62 27 151 255 I55 153 242 34 333 I,185 462 94 34 33 II f 40 I4 z 5 h 31I 109 J 40 13 2.6 1.7 5.7 f 1.8 3.2 Sept. 30, I9II Dec. I, 1912 July 31, 19II Dec. 31, 1911 Dec. 31, 19II 2.1 k Dec. I, 1912 57 250 70 50 1.6 1.8 1.6 2.1 Oct. 31, 1912 Sept. 30, 1912 Sept. 30, I9I2 Feb. I, 1913 Total..846 662 d 3,064 330 2.0 a In all of the tables, statistics for each hospital are given for the most recent year for which information was available. b Capacity refers to new plant, completed I913, other figures to old plant. o 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 Crippled about 20 women. The ratios of inmates to employes for these two institutions and for the group are probably not affected by this. e Including I89 women. f Administration work done by employes of St. Paul City and County Hospital not included. If included, it would probably reduce the ratio of children to employes to 4.0 or perhaps to 3.0. z Not including laundress, part time. b Not including clerk, laundress, and furnace man, part time. Not including 20 dispensary employes. Not including 33 dispensary employes. k Figured on exact average, I0.4 inmates. 108

Page  109 STATISTICS TABLE I B.-SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 14 CONVALESCENT HOSPITALS OR HOMES Average Ratio Beds num- Chil- of Convalescent hospital or Sources of for ber of dren Em- chil- Statistics home support chil- chil- incareployes dren for year dren dren during to em- ending in care year ployes during year ILLINOIS West Chicago Convalescent Home for Destitute Crippled Children. MARYLAND Baltimore Children's Hospital School Kernan Hospital and Industrial School for Crippled Children MASSACHUSETTS Canton Massachusetts Hospital School MICHIGAN Detroit VanLeuven Browne Hospital School MINNESOTA Phalen Park, St. Paul State Hospital and School for Crip. pled Children. NEW YORK Coney Island Sea Breeze Hospital Garden City House of St. Giles the Cripple Port Jefferson St. Charles Hospital for Crippled Childrenb. West Haverstraw State Hospital for Crippled Children. White Plains Country Branch New York Orthopaedic Hospital PENNSYLVANIA Philadelphia Widener Memorial School Pittsburgh Industrial Home for Crippled Children Sewickley Sewickley Fresh Air Home Private Public and private Public and private State Private State Private Public and private Public and private State Private Private Public and private Private 60 50 55 250 30 60 42 85 200C 75 130 I00 40 30 53 229 25 38 42 45 IIo C 61 104 96 45 27 6o 84d I90 264 48 69 53 80 I30C 82 132 96 17 38 65 8 I2 25 13 8 e 27 57 78 2.4 I.9 I.4 3-5 3.I 3.2 1.7 3.5 6.I e 2.3 I.8 1.2 July 10, I9I2 Apr. 30, I913 June I, 1912 Nov. 30, I912 Mar. 31, 1913 Jan. 31, 1913 Sept. 30, 1912 Sept. 30, 1911 Jan. I, I913 Sept. 30, I912 Sept. 30, I912 July 29, I912 50 32 50 2.8 Apr. 30, 9I I 53 IO 2.7 Dec. I, II9I _A_~~~~~~~~~~ I. Total..,219 945,39I 400 2.4 a 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. o Figures refer to cripples only. d Not including seven readmissions. e 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

Page  110 CARE OF CRIPPLED CHILDREN TABLE I C.-SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 13 ASYLUM HOMES Average Chilnum- dren Ratio Sources of Beds ber of in Em- of chil- Statistics Asylum home for chil- dren for year Support chl- dren care ployes oem- ending Virginia T. Smith Home for Incurables. Public and private 100oo 87 115 28 3.I Oct. I, 191II ILLINOIS Chicago Happy Haven. Private 6 6 6 Id 6.o (South Side Crippled Children's Aid Society) Maywood Home for Disabled Children. Private 12 II II 4 2.8 June 5, I9I2 (National Children's Home Society) MASSACHUSETTS Hyde Park New England Peabody Home for Crippled C eChildren Private 3 30 38 4 2.1 Oct.,s I90 NEW JERSEY Englewood Daisy Fields Home and Hospital for Crippled Children. Private I I 23 5 4 3.6 Apr. I, 1913 NEW YORK Buffalo Crippled Children's Home Public and private 35 22 36 4 5.S Oct. I, 1912 New York City Darrach Home. Private 20 IS 22 5 3.6 Jan. I, 1911 House of the Annunciation for Crippled andlIncurable Children. Private 30 30 31 1o 3.0 Sept.30, 191 New York Home for Destitute Crippled Children. Private 25 20 232 5. 40 Oct. 6, I9I2 OHIO C rleveland Holy Cross House Private 20 i8 28 7 2.6 Sept., 1911. For footnotes see page for Crippled II0

Page  111 STATISTICS TABLE I C.-SOURCES OF SUPPORT, CAPACITY, CHILDREN IN CARE, AND EMPLOYES IN 13 ASYLUM HOMES-(Continued) Average num- Chil- Ratio Beds her of dren of Statistics Asylum home Sources of for chil- in Em- chil- for year support chil- dren care ployes dren ending dren in care during to emduring year ployes year PENNSYLVANIA Philadelphia Children's House of the Home for Incurables Private 33 26 32 13 2.0 Apr. 15, 19I1 Home of the Merciful Saviour for Crippled Children. Private 5o 5o 45 i5 3.3 Oct. 31, 1911 House of St. Michael 'and All Angels. Private 30 25 37 6h 4.2 Sept. I, 1912 (Episcopal Sisters of St. Margaret) ~~~l................ l Total. 409 36 446 11 7 3.1 a In all of the tables, statistics for each asylum home are given for the most recent year for which information was available. b Institution closed since this study was made. c Estimated. d Home conducted by one volunteer worker; occasional outside help. e Not including man and laundress, part time. f Not including seamstress, gardener, and furnace man, part time. s Not including laundress, part time. h Not including two laundresses and furnace man, part time. III

Page  112 TABLE II A.-FLOOR SPACE PER CHILD IN 9 HOSPITALSa NEW YORK NEW YORK NEW YORK ILLINOIS NEW JERSEY New York New York New York WASHINGTON Chicago, Lincoln, Newark, Orange, City, os- City, Hos- City, New Seattle, Destitute Children' Nebraska Home for Newperse pital for pital for YorkO- Children's Total aOrthopedic Crippled ' edic Deformities the Rup- thopaedic Crippled Hospital Orthopedic Crippled Ho pitaland Defrmiie the Rup- Dispensary Orthopedic Children Hospital Children sp n and Joint tured and Hospital ChiLdren ~Dispensary Diseases Crippled b and Hospital Beds for children 112 65 1oo 56 i6 57 250 70 50 776 SQUARE FEET OF FLOOR SPACE, PER BED For children Indoor Day and play rooms 6.. 5 *.. ih 6.1.. 4 Dormitories and wards 44 80 39 52 62 52 54 64 63 54 School rooms —general.14 16 D i.. 8 School rooms —industrial Dining rooms.......C 7.... 4 9.. 6 Baths and toilets.... 7 5 9 9 6 5 15 5 12 10 Clothes rooms..... oo 7 3 2 i 3 4 3 3 Isolation rooms.... 18 12.... 9 1.. 3 13m.. 9 Total 75 97 8r 64 90 58 12I io6 78 94 Outdoor Day and play rooms.... 60... 20 6m.. 12 Dormitories and wards.... d.. 13.... 22 5 School rooms...... Total 13 60 o.. 13 20 6 22 17 Total for children.... 88 157 91 64 90 71 141 I12 Ioo III

Page  113 For employes Sitting rooms. Dining rooms. Bed rooms. Baths and toilets 8 4 37 5 I0 35 14 9 58 7 5 32.o. 19 6I 4 4o 3 6 6 32 9 12 5 48 6 10 I8 3 4 6 38 7 Total for employes.... 54 59 74 37 84 43 53 71 31 55 For general purposes Offices and reception rooms... 9 9 10 7..9 10 6 9 Kitchens.. 4 8 6 8 4 9 7 5 I4 7 Laundries.... 7 13 15 31 6 I3 I1 I3 12 Store rooms...6 47 138 47 13 28 12 14 20 Halls........ 32 87 55 32 54 27 83 29 6I 58 Porchese...3.... 20.. 1I k.... 6 Miscellaneous....... 2 I.... 3.... Total for general purposes... 61 164 I01 87 146 64 i56 67 1o8 113 - For special purposes - Medical and surgical rooms -J Gymnasium-corrective. Brace shop. I2 e I3 7 43 e i8 20 15 2 8.o. 19 oo@.o. I0 8.o. 25 e 5 9 i6 10 22 27 e.. 20 e 7 8 Total for special purposes... 32 8117 8 19 8 39 48 27 35 Total for all purposes.... 235 461 283 196 339 196 389b 298 266 314 Beds for employes.....29 33 34 14 4 24 70 31 12 251 Square feet of floor space, for employes' use, per employe...... 207 117 219 146 335 103 188 i6o 128 I70 a Data are presented for nine of the ten hospitals. The Minnesota State Hospital is not comparable as to floor space with the other institutions in the group, as it is operated as a part of the St. Paul City and County Hospital and the employes live outside the department for cripples. b Figures refer to new building. e See, also, outdoor space for children. d An equal amount of space not in use. e Not including estimated proportion of medical and surgical space for dispensary patients. (See Table IX.) f Used also for industrial teaching. g Roof garden over entire building not used because of defects. h Dining room serves also as diet kitchen and play room. i Fire-escape balconies used for outdoor sleeping. i Including wards for adults, 13 square feet per bed. l Not including uncovered roof space-26 square feet per bed. I School rooms, equipped and used as play rooms. m Isolation rooms include outdoor day rooms-6 square feet per bed.

Page  114 TABLE II B.-FLOOR SPACE PER CHILD IN 12 CONVALESCENT HOSPITALS OR HOMESa ILLINOIS West Chicago, Convalescent Home for Destitute Crippled Children MARYLAND Baltimore, Children's Hospital School MARYLAND Baltimore, Kernan Hospital and Industrial School for Crippled Children MASSACHUSETTS Canton, Massachusetts Hospital Schoolb MICHIGAN Detroit,Van j Leuven Browne Hospital School MINNESOTA Phalen Park, St.IPaul, State Hospital and School for Crippled Children NEW YORK Garden City, House of St. Giles the Cripple NEW YORK Port Jefferson, St. Charles Hospital for Crippled Children a NEW iYORK West Haverstraw, State Hospital for Crippled Children NEW YORK White Plains, Country Branch, New York Orthopaedic Hospital PENNSYLVANIA Pittsburgh, Industrial Home for Crippled Children PENNSYLVANIA Sewickley, Sewickley Fresh Air Home Total Beds for children. 6o 50 55 250 30 60 75 130 50 32 I,077 I7 |:^:.1, I I.-I - I I I I I 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 Total 13 24 7 13 5 l8 7 12 6 4 29 34 II 4 5 I 12 44 24 II 6 I! 21 36 8 5 5 2 77 6o 8 8 12 6 8 5 35 20 4 6 2 i 72 28 8 2 6 9 2 55 I9 14 7 13 5 I 10 69 23 77 I8 41 28 30 8 9 234 I2 6o 12 21 16 15 I 53 190 I5D 38 II 9 I 5 79 55 99 102 8 40 14 7 12 10 2 7 100 9 7 I 17 117 Outdoor Day and play rooms Dormitories and wards School rooms. Total. 13 I3 98 9 39< 48 77 9 2 4 A 26 26e 55 *. TR 31~ 3.. 0 27.. P 27 27 58 2I7 137 73 99 86 102 74 59 95 289 Total for children

Page  115 For employes Sitting rooms Dining rooms Bed rooms Baths and toilets. 4 27 6 3 43 7 7 70 4 3 3 33 4 5 19 I 13 2 I 3 12 2 I 10 2 8 13 2 I 6 46 6 5 6 3I 6 3.. 2 3 4 3 4 Total for employes.. 37 1 53 8 43 25 15 8 1I3 23 69 48 3 38 37~ ~ ~ ~. ~ 2"" ~ x3-""~2 For general purposes Offices and reception rooms. Kitchens Laundries Store rooms Halls Porches. Miscellaneous 14 5 5 38 35 17 2 I2 12 AI 21 12 I6 2. R 5 8 5 38 22 28 I 13 9 20 2 11 I 4 o.. 3 7 7 7 26 5 5 3 12 17 4 4 I 16 5 4 41 30 17 34 7 Total for general purposes Ii6 105 36 I07 59 50 6 3 4~~~~~~~~~~~~~~~~ I 4 12 17 23 9 18 3 86 9 9 12 6 48 70 7 152 i6 3 21 15 35 51 5 4 134 3 9 5 19 27 28 21 o09 3 3 6 8 7 24 29 15 3 92 6 6 For special purposes Medical and surgical rooms. Gymnasium-corrective Brace shop Total for special purposes 3 3 II II 9g 4 13 4 I.o. 3 3 3 3 2 2 3m 3m 9 i6 3 _5 Total forall purposes. 254 246 303 254 173 I70 155 io6 213 526 402 302 253 Beds for employes.. r 36 6 8 3 36 1 8 47 I5 9 256 Square feet of floor space, for employes' use, per employe.. 48 203 I24 i8I 94 84 1l8 242 95 19i I60 187 i6o.~~~~~~~~~~9 841822 9 9 6 8. a Data are presented for 12 of the I4 convalescent hospitals or homes. The Widener Memorial School, Philadelphia, and Sea Breeze Hospital, Coney Island, New York, are not comparable as to floor space, with other institutions in the group. (See Chapter VI, pp. I83 and I67.) b An assembly hall and a boys' cottage erected since this study was made are not included either in the figures for capacity or in the figures for floor space. c Department of Brooklyn Home for Blind, Crippled, and Defective Children. d See, also, outdoor space for children. e Lockers in dressing rooms attached to outdoor sleeping porches. f Including indoor dressing room space, 9 square feet per bed. g Not including estimated proportion of medical and surgical space used for dispensary patients. (See Table IX.) h Used also for industrial teaching. i In emergency surgical building could be used. i Dormitories contain lockers. k Since this study was made, a part of the roof space has been fitted up for outdoor sleeping for 28 children. 1 Not including space occupied by six employes who sleep in dormitories for children. m Since this study was made, the space for medical and surgical purposes has been practically doubled by converting all but one of sleeping rooms for employes into medical and surgical rooms. Sisters now sleep in another building. a Play and school room combined. o Covered pavilions and porches. P Porches, 15 square feet per bed, used for sleeping in summer, included in play space. q Including only that portion of attic space estimated to be actually used by employes. Additional attic space 3i square feet per bed.

Page  116 TABLE II C.-FLOOR SPACE PER CHILD IN 12 ASYLUM HOMESa I I I I I. a CONNECTICUT Newington, Virginia T. Smith Home for Incurables ILLINOIS Chicago, Happy Haven 6 ILLINOIS Maywood, Home for Disabled Children 12 MASSACHUSETTS Hyde Park, New England Peabody Home for Crippled Children NEW JERSEY Englewood, Daisy Fields Home and Hospital for Crippled Children NEW YORK Buffalo, Crippled Children's Home NEW YORK New York City, Darrach Home NEW YORK New York City, New York Home for Destitute Crippled Children b OHIO Cleveland, Holy Cross House PENNSYLVANIA Philadelphia, Children's House of the Home for Incurables VANIA Philadelphia, Home of the Merciful Saviour for Crippled "I 1j-n PENNSYLVANIA Philadelphia, House of St. Michael and All Angels Beds for children. I00 30 i8 35 20 25 20 33 50 _~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 30 Total 379 I9 54 17 4 15 9 6 I6 SQUARE FEET OF FLOOR SPACE, PER BED For children C0' Indoor Day and play rooms Dormitories and wards School rooms-general. School rooms-industrial Dining rooms Baths and toilets. Clothes rooms Isolation rooms I3 54 22 9 I2 6 24 8I d 45..f '6 29.. 45 76 g 21 I4 3 II 41 I9 22 26 I2 6 17 55 I9 i8 13 9 14 7 40 7 3 4 o.. 28 60 20 7 3 91 17 45 '3 5 12 5 12 63 24 7 I3 II 3.o. 27 7I 14 14 i6 8.o. 54 56 29 29 I4 3 47 I 556 e 12 I 4 I I Total..... 147 6 159 154 128 6i 127 97 133 150 232 78 140 Outdoor Day and play rooms.... 8 28.. I 27k.. II... 9 h 5 Dormitories and wards. 5.47 i' 5 School rooms........ 9.......... I.. Total..... 6.. 8 84.. I 27., I.. * 9 II Total for children.. 153 i6i I67 238 I28 62 I54 97 144 I50 232 87 | I51

Page  117 For employes Sitting rooms..... 6......... Dining rooms.. 4... 28..... 4 i2 Bedrooms 30.. d 4 46 39 17 22 22 30 5648 30 Baths and toilets 3 4. 9 i Total for employes.. 39.. 41 56 7 7 22 23 30 6553 42 For general purposes. Offices and reception rooms 6.. i6 8 i 15 20 30 22 9 I7 8 Kitchens.. 8 40 20 II 13 3 25 o10 6 15 14 6 Laundries.... 15.. 20 II 9.. 4 13 8 20 i8 Storerooms.... 25 6 I5 19 16 22 15 I 49 58 36 7 Halls..... 43 19 37 64 71 20 55 39 35 14I 73 8 Porcheso. 22 37 67 19 25........ 24 I 14 Miscellaneous..... 8 _ ____ 13 8 Total for general purposes 119 I02 175 140 I49 71 I25 94 125 255 274 69 For special purposes Medical and surgical rooms....... 9 4 7.... i8 2 5 Gymnasium-corrective............ 0. Brace shop.........:3 Total for special purposes...... 9 4 7.... 28 2 5 Total for all purposes. 311 263 383 443 352 157 291 214 327 472 464 98 I 4 34 2 41 12 II I3 26 53 I5 3 133 3 I 4 329 93 Beds for employes... 22 4 0 5 4 4 4 7 1~~~~~~~~ iI 25 6 Square feet of floor space, for employes' use, per employe.. 180. 20 i66 255 154 20 I44 86 194 177 208 i68 a Data are presented for 12 of the 13 asylum homes. The House of the Annunciation, New York City, is part of the Mother House of the Sisters of the Annunciation, and the floor space for cripples can not be separately determined. b Institution closed since this study was made. o See, also, outdoor space for children. d Day room serves also as employes' sleeping room. e Children go out to school. f Dining room and kitchen combined. g Used also as play room. h Covered play pavilion. Including indoor dressing-room space, 17 square feet per bed. i Isolation room used as employes' bedroom when not needed for isolation purposes. k Roof playground. I Dining room and study combined. m Estimated.

Page  118 TABLE III A.-COST OF PLANT PER CAPITA IN 7 HOSPITALSa Per capita cost b for Hospital Beds for Total cost Buildings Surgical Furniture Total per Bchildren lof plant (including and gym- and educa- Miscel- apita t b Land heating ap- nastic tional equip- laneous paratus and equipment ment items machinery) ILLINOIS Chicago Home for Destitute Crippled Children... 112 $103,000 $268 d $594 $I3 $45.. $920 MAINE Portland Children's Hospital...65 I2,00o 205 I,41o 76 123 $48 i,862 NEBRASKA Lincoln Nebraska Orthopedic Hospital 0. o94,000 120 660 45 15.. 940 O NEW JERSEY Newark Home for Crippled Children. 56 63,700 I91 866 54 27.. I,138 NEW YORK New York City Hospital for Deformities and Joint Diseases.. 57 104,500 28 1,425 e 92 35.. i,833 Hospital for the Ruptured and Crippled... 250 1,297,600o I,296 3,732 44 97 21 5,190 WASHINGTON Seattle Children's Orthopedic Hospital. 50 III,600 400 I,6io 60 162.. 2,232. l.......... Total..690 $,895,4oo $617 $1,982 $49 $87 $2 $2,747 a Data as to cost of plant are presented for seven of the Io hospitals. The Minnesota State Hospital is operated as part of the St. Paul City and County Hospital to which the state pays a fixed sum for each child, in addition to the salary of a teacher, and furnishes the educational and medical supplies. (See Chapter VI, p. 145.) The New Jersey Orthopaedic Hospital and Dispensary occupies a rented plant. (See Chapter VI, p. I48.) The plant of the New York Orthopsedic Dispensary and Hospital is too old for figures of cost to have significance. (See Chapter VI, p. 156.) b Based on number of beds for children. a Figures refer to new building. d Including original building which is used for hospital purposes. e Including alterations, costing $312 per capita.

Page  119 TABLE III B.-COST OF PLANT PER CAPITA IN 12 CONVALESCENT HOSPITALS OR HOMESa Per capita cost b for Convalescent hospital or home Beds for Total cost Building Surgical Furniture ice Total per children of (including Surgical Furniture Miscel- Total per children of plant Land heating ap- and gym- and educa- laneous capita cost b paratus and nastic tional equip- items machinery) equipment ment ILLINOIS West Chicago Convalescent Home for Destitute MARYLAND Crippled Children. 60 $108,o $ 96 $I,287 $33 g $217 $67 $,800oo Baltimore Children's Hospital School 50 72,350 360,00 50 37 447 School for Crippled Children 55 84,250 I,473 I8 41.,532 MASSACHUSETTS Canton Massachusetts Hospital School 250 276,200 68 904 14 77 42 I.I05 MICHIGAN Detroit Van Leuven Browne Hospital School. 30 Io,400.. 275. 72.. 347 MINNESOTA Phalen Park, St. Paul State Hospital and School for NEW YORK Crippled Children... 60 68,ioo I91 d 850 9 75 Io 1,135 Garden City House of St. Giles the Cripple 85 25,700 21 e 26 7 48.. 302 Port Jefferson St. Charles Hospital for Crippled Children... 200 Ii8,700C 53 507 5 25 4 594 West Haverstraw State Hospital for Crippled Children...... 75 77,6oo 267 564 4I I32 31 1,035 White Plains Country Branch New York Orthopadic Hospital... I30 420,200 98 2,780 29 325.. 3,232 PENNSYLVANIA Pittsburgh Industrial Home for Crippled Children.. 50 110,100 670 r,372 20 140.. 2,202 Sewickley Sewickley Fresh Air Home.. 32 21,700 156 469 3 44 6 678 Total. 0., I77 $1,393,300 $140 $1,OI5 $18 $104 $17 $1,294 a Data as to cost of plant are presented for I2 of the 14 convalescent hospitals or homes. The Widener Memorial School, Philadelphia, is not comparable with other institutions in the group. (See Chapter VI, p. I82.) Sea Breeze Hospital is a part of the institution known as Sea Breeze, and cost of plant can not be accurately determined. (See Chapter VI, p. i67.) b Based on number of beds for children. c Department of the Brooklyn Home for Blind, Crippled, and Defective Children; figures relate only to department for cripples; expenses pro rata for department of cripples, based on statement for the entire institution. d Land donated. Including original building. Includin I ncluding. reclining and wheel chairs. h Not including furniture donated. Including live stock and farm equipment. J Not including consumable supplies worth $36 per capita.

Page  120 TABLE III C.-COST OF PLANT PER CAPITA IN 11 ASYLUM HOMESa Per capita cost b for Buildings Asylum home |Beds for Total cost (including Surgical Furniture Miscel- Total per children of plant Land heating ap and gym- and educa- laneous capita cost b paratus and nastic tional equip- items machinery) equipment ment CONNECTICUT Newington Virginia T. Smith Home for Incurables.... 100 $56,400 $6i $435 $2 $31 $35 $564 ILLINOIS Maywood Home for Disabled Children. 12,400 514 430.. 6. 950 MASSACHUSETTS Hyde Park New England Peabody Home for Crippled Children... 30 36,600 205 e 878 20 117.. 1,220 NEW JERSEY Englewood Daisy Fields Home and Hospital for Crippled Children.. 8 14,700..f 734 8 75.. 817 NEW YORK 0 Buffalo 0 Crippled Children's Home.. 35 2I,o00 314 228.. 61. 603 New York City Darrach Home. 20 30,500..f 1,475.. 50.. 1,525 New York Home for Destitute Crippled Children d 25 21,500.. f 820. 40. 86o OHIO Cleveland Holy Cross House.... 20 z1,600.. f 500 g 28 52 1.. 580 PENNSYLVANIA Philadelphia Children's House of the Home for Incurables. 33 90,400.. 2,669 h.. 70. 2,739 Home of the Merciful Saviour for Crippled Children a 50 96,800 480 1,360 30 66 i. 1,936 House of St. Michael and All Angels..... 30 3,600 83 317. ~ 53.. 453 Total...... 373 $404,600 $50 863 $8 $55 $9 I $,o85 a Data as to cost of plant are presented for ii of the 13 asylum homes. Happy Haven, Chicago, Illinois, is an individual philanthropy conducted by Miss Prouty in her private apartment and is not comparable with other institutions in the group. (See Chapter VI, p. 187.) The House of the Annunciation for Crippled and Incurable Children, because of the extraordinary value of its land, is not fairly comparable with the other institutions of the group. b Based on number of beds for children. a Has summer home which is excluded from the figures for cost of plant, in order that institution may be comparable with other institutions in the group. d Institution closed since the study was made. e Not including small amount of land donated. f Included under buildings. B Including land. b Children's department located on grounds of institution for adults. i Estimated.

Page  121 TABLE IV A.-ANNUAL CURRENT EXPENSE PER CAPITA IN 9 HOSPITALS a Average Per capita cost b for number of Total Total Hospital children current Medical per capita in care expense Salaries Provi- Fuel Clothing and Miscel- t b during for year and sions and and Repairs surgical laneous year wages light bedding supplies items ILLINOIS Chicago Home for Destitute Crippled Children c. MAINE Portland Children's Hospital NEBRASKA Lincoln Nebraska Orthopedic Hospital NEW JERSEY Newark Home for Crippled Children Orange New Jersey Orthopaedic -^~ ~ Hospital and Dispensary NEW YORK New York City Hospital for Deformities and Joint Diseases Hospital for the Ruptured and Crippled New York Orthopaedic Dispensary and Hospital. WASHINGTON Seattle Children's Orthopedic Hospital $50 87 $24,380 57 26,420 $138 61i 70 45 10 49 d I92 e 62 27 I 44,678 I82 Io,470 8I 9,300 f 350 121 130 51 206 157 II3 I68 b 81 $30 60i 47 21 39 5I 54 70 53 $IO $5 ISi 119 21 45 $20 34 51 28 145 I47 48 I17 38 $58 $27 69 64 31 '54 f 121 71 33 66 $62 $280 464 638 233 894 895 567 977 481 $570 43,850 353 108,782 g 245 I6 I7 50 I9 60,583 528 236 12,987 Total...599 $14 7 $35 11 $341,450 $241 $III $49 s Data are presented for nine of the Io hospitals. The Minnesota State Hospital is operated as a part of the St. Paul City and County Hospital, to which the state pays a fixed sum for each child, in addition to the salary of a teacher, and furnishes the educational and medical supplies. b Based on average number of children in care. c The report of the institution gave salaries as $12,000; other expenses undistributed. The distribution of current expenses is estimated by the editor. d Including adults; average number of children about 27. e Including a few women. f Including rent and building repairs, $IIo per capita. Expense per capita is figured on exact average of children in care, 10.4. g Figures given refer to old plant. h Including house supplies. i Including water and power. J Including "hospital repairs and replacements," $14 per capita.

Page  122 TABLE IV B. ANNUAL CURRENT EXPENSE PER CAPITA IN 13 CONVALESCENT HOSPITALS OR HOMESa Convalescent hospital or home Average number of children in care during year Total current expense for year Salaries and wages ILLINOIS West Chicago Convalescent Home for Destitute Crippled Children. MARYLAND Baltimore Children's Hospital School Kernan Hospital and Industrial School for Crippled Children MASSACHUSETTS Canton Massachusetts Hospital fS, School MICHIGAN Detroit Van Leuven Browne Hospital School MINNESOTA Phalen Park, St. Paul State Hospital and School for Crippled Children d NEW YooRK Coney Island Sea Breeze Hospital Garden City House of St. Giles the Cripple Port Jefferson St. Charles Hospital for Crippled Children West Haverstraw State Hospital for Crippled Children White Plains Country Branch NewYork Orthopaedic Hospital 40 30 53 229 25 $I3,200 $140 Per capita cost b for 10,394 88 28,200 197 66,565 I20 Provisions $75 134 I04 80 44 65 176 86 47 97 I63 Fuel and light $35 35 52 24 I8 52 43 22 9 25 38 Clothing and bedding $I5 I6 3,836 69 38 42 45 IIO 61 Io4 11,398 21,425 I3,034 19,713 24,504 57,455 8.. g 5 i6 14 3 Repairs $IO I3 5 7 9 9 Io IO 10 2 20 Medical and surgical supplies $15 21 46 7 9 5 8 15 12 38i Is Miscellaneous items $40 | $330 451 1 291 Total per capita cost b 234 90 57 178 265 4 62 k 35 51 31 59 49 39 128 346 532 I53 300 5Io 290 I79 I 402 552

Page  123 PENNSYLVANIA Pittsburgh Industrial Home for Crippled Children Sewickley Sewickley Fresh Air Home 45 27 15,003 io,568 I28 $17 $I4I 86 III $95 22 12 $28 19 22 $8 25 48 h $11 17 $IS 36 333 8i 391 $50 $348 Total. 849 1 $295,295 a Data are presented for 13 of the 14 convalescent hospitals or homes. The Widener Memorial School, Philadelphia, is not comparable with the other institutions in the group. (See Chapter VI, p. 181.) b Based on average number of children in care. c Distribution estimated by the editor. d Figures pro-rated on basis of information for six months. e Including ice. f Clothing only. a Bedding included in miscellaneous. h Including improvements. i Including braces. i Including farm and grounds, $I5 per capita. k Including bedding. i See note "c," Table III B.

Page  124 TABLE IV C.-ANNUAL CURRENT EXPENSE PER CAPITA IN 12 ASYLUM HOMES a Average Per capita cost b for number of Total - Asylum home in care epense Salaries Proi- Fuel Clothing and Miscel- per capita during for year and sions and and Repairs surgical laneous cost b year wages light bedding supplies items CONNECTICUT Newington Virginia T. Smith Home for Incurables. 87 $18,564 $74 $43 $20 $II $8.. $47 $213 ILLINOIS Maywood Home for Disabled Children.... I 3,356 I41 63 32 i7 3.. 49 305 MASSACHUSETTS Hyde Park New England Peabody Home for Crippled Children.. 30 10,251 I34 I24 25 1.. $14 33 342 NEw JERSEY Englewood Daisy Fields Home and Hospital for Crippled Children... 7,759 84 125 27 i8 I6 II 50 431 NEW YORK Buffalo - Crippled Children's h1 Home.... 22 4,049 65 58 17 9 5 I5 15 I84 -I New York City Darrach Home.. 8 3,920 77 83 I2 7 14. 25 2I8 House of the Annunciation for Crippled and Incurable Children. 30 6,428 40 82 26 3 5 2 56 214 New York Home for Destitute Crippled Children d... 20 4,138 79 8 75 g IO B 2 24.. I7 207 OHIO Cleveland Holy Cross House.. 18 5,080 90 142 I9 5 5 4 7 282 PENNSYLVANIA Philadelphia Children's House of the Home for Incurables 26 10,277 102 I26 I9 21 III..f 6 395 Home of the Merciful Saviour for Crippled Childrene.. 50 16,32 I 13 92 26 26 i8 13 38 326 House of St. Michael and All Angels.. 25 4,719 49 87 19 2 II 3 8 89 Total. 355 $94,853 $90 $84 $21 $I2 $21 $5 $34 $267 a Data are presented for 12 of the 13 asylum homes. Happy Haven, Chicago, Illinois, is an individual philanthropy conducted by Miss Prouty in her private apartment and is not comparable with other institutions in the group. (See Chapter VI, p. I87.) b Based on average number of children in care. o Has summer home, the current expenses of which are included, as the main institution is closed for the summer. d Institution closed since this study was made. e Including water and sewer. f Fuel and medical and surgical supplies of the children's department not separated from the department for adults in the accounts of the institution. g Estimated.

Page  125 TABLE V-SOURCES OF THE INCOME OF 35 INSTITUTIONSa Per cent of income from Institution HOSPITAL MAINE Portland Children's Hospital MINNESOTA St. Paul State Hospital NEBRASKA Lincoln D> Nebraska Orthopedic Hospital NEW JERSEY Newark Home for Crippled Children Orange New Jersey Orthopaedic Hospital and Dispensary NEW YORK New York City Hospital for Deformities and Joint Diseases. Hospital for the Ruptured and Crippled New York Orthopedic Dispensary and Hospital WASHINGTON Seattle Children's Orthopedic Hospital 33 100 99 22 18 26 3 14 I2 7 33 41 3 30 14 30 25 14 35 50 36 79 52 I6 45 62 I00 I00 I00 100 100 100 I00 100 I00 I I I- I,I Total..... 33 8 I8 31.00 l Data are presented for nine of the xo hospitals, for all of the 14 convalescent hospitals or homes, and for 12 of the I3 asylum homes. The Home for Destitute Crippled Children, Chicago, was unable to furnish an itemized statement.

Page  126 TABLE V.-SOURCES OF THE INCOME OF 35 INSTITUTIONS (Continued) a Per cent of income from Institution Public Invested Pay Miscella- All funds funds patients Donations neous sources sources CONVALESCENT HOSPITAL OR HOME ILLINOIS West Chicago Convalescent Home for Destitute Crippled Children..... 51 2 47.. 1oo MARYLAND Baltimore Children's Hospital School... 27 I 14 58. oo Kernan Hospital and Industrial School for Crippled Children.. 27 14 58.. oo MASSACHUSETTS Canton Massachusetts Hospital School......... IOO....... IO MICHIGAN - Detroit ~o Van Leuven Browne Hospital School.... 24 76.. 0oo C' MINNESOTA Phalen Park, St. Paul State Hospital and School for Crippled Children. ioo.. o...... Ioo NEW YORK Coney Island Sea Breeze Hospital.. 36 d 3 6ie. oo Garden City House of St. Giles the Cripple... 45 8 I 46.. Ioo Port Jefferson St. Charles Hospital for Crippled Children b. 76.. 3 20 I Ioo West Haverstraw State Hospital for Crippled Children.. oo White Plains Country Branch New York Orthopaedic Hospital.. 87 7 6.. Ioo PENNSYLVANIA Philadelphia Widener Memorial School.... Ioo...... 0oo Pittsburgh Industrial Home for Crippled Children.... 39 20 8 32 I Sewickley Sewickley Fresh Air Home...... 7.. 89 I Ioo Totals.47 23 5 2... 2 I 00. ~ ~~ 4 5 o

Page  127 ASYLUM HOME CONNECTICUT Newington Virginia T. Smith Home for Incurables.....75 2 o1 13.. I 1 ILLINOIS Maywood Home for Disabled Children...... 4 78 18 o10 MASSACHUSETTS Hyde Park New England Peabody Home for Crippled Children... 29 I 45 25 Ioo NEW JERSEY Englewood Daisy Fields Home and Hospital for Crippled Children.... 3 o. 97. 00 NEW YORK Buffalo Crippled Children's Home.... 41.. 2 57 I00 New York City Darrach Home.......5 95. io House of the Annunciation for Crippled and Incurable Children. 99 I I00 New York Home for Destitute Crippled Children.... 50 3 47.. I00 OHIO Cleveland Holy Cross House........ 6 93 I I00 PENNSYLVANIA Philadelphia Children's House of the Home for Incurables.. 44. 40 i6 100 Home of the Merciful Saviour for Crippled Children6.. 38.. o00 House of St. Michael and All Angels... 44 2 44. I00 Total. 14 21 3 56 6 1o00 a Data are presented for nine of the io hospitals, for all 14 convalescent hospitals or homes, and for 12 of the 13 asylum homes. The Home for Destitute Crippled Children, Chicago, was unable to furnish an itemized statement. The work of Happy Haven, Chicago, is carried on in her own apartment and financed by Miss Florence Prouty. Figures as to income are not available. Because of exceptional features of the Widener Memorial School, figures for that institution have been omitted in computing the percentages for the group. (See Chapter VI, p. i8i.) b Department of the Brooklyn Home for Blind, Crippled, and Defective Children; figures relate only to department for cripples; income pro rata for cripples based on statement for entire institution. e Institution closed since this study was made. d Interest on building fund. e Fifty per cent of the total income from reserve fund of Association for Improving the Condition of the Poor.

Page  128 TABLE VI A.-RULES OF ADMISSION Kinds of orthopedic Physical and mental Usual period of Hospital cases taken and restrictions and stay in inpreferred preferences stitution I~ ~ I. ILLINOIS Chicago Home for Destitute Crippled Children.. MAINE Portland Children's Hospital. MINNESOTA St. Paul State Hospital. NEBRASKA Lincoln 'Nebraska Orthopedic Hospital NEW JERSEY Newark Home for Crippled Children. Orange New Jersey Orthopaedic Hospital and Dispensary NEW YORK New York City Hospital for Deformities and Joint Diseases Hospital for the Ruptured and Crippled New York Orthopaedic Dispensary and Hospital WASHINGTON Seattle Children's Orthopedic Hospital All kinds All kinds All kinds All kinds All kinds All kinds All kinds All kinds All kinds All kinds Feeble - mindedness, epilepsy, and lung tuberculosis excluded None; cases of lung tuberculosis isolated None None Lung tuberculosis and feeble-minded cases not desired; sometimes taken Lung tuberculosis excluded Lung tuberculosis excluded None Lung tuberculosis excluded Lung tuberculosis excluded Until dispensary care can be safely substituted Until dispensary care can be safely substituted; average 97 days As long as benefited by hospital care; average one year As long as benefited by hospital care; average 250 days a Transfer as soon as possible to dispensary; great demand for beds Until dispensary care can be safely substituted; average 3 months Until dispensary care can be safely substituted; average 6 months Until dispensary care can be safely substituted; average 65 days Until dispensary care can be safely substituted; average 50 days Until dispensary care can be safely substituted; average 44 days s Aim to develop educational work and keep children until self-supporting. b Plan to start visiting nursing. ~ Some exceptions. 128

Page  129 AND DISCHARGE IN 10 HOSPITALS After care and Ages for di- exes Color re- Financial Geographical visitation received received striction terms resrcnsn charge preferences I__: Through dispensary only Through dispensary and systematic visits by one agent of Maine Children's Committee None None Through dispensary only Through dispensary and systematic visits by one nurse (half time) Through dispensary only b One social service worker recently engaged Through dispensary and staff of 5 visiting nurses Through dispensary and visiting nurse 2' to 11 a ] [2 ~ Any under 21 d Any under 16 2 to IS; a few adults All iBoys IX to 16; girls I Y up All 4 up 2 to 14 and adult womene Any under I6 No rule No rule No rule No rule Both Both Both Both Both Both Both Both Both Both L None None None None None None None None None None Usually free; maximum charge $5 a week o Medical service free; patients pay for braces; board often free; maximum charge $i a day Free Free Usually free; a few pay $i to $Io a week Usually free; maximum charge $5 a week Usually paid for by relatives or city; some free; some private cases About 60 per cent paid by city; 20 per cent free and 20 per cent pay 94 per cent free; occasional payments $4-$7 a week Usually free; maximum charge $io a week 1 Intended for residents of Illinois. Rule not strictly followed In-patients must be residents of Maine. Outpatients no restrictions Minnesota children only Must have been resident in Nebraska one year None Preference given to New Jersey children None None None None Boys i6; girls no rule No rule No rule No rule No rule i I d Charter permits taking of adults. e All ages treated in dispensary. I29 9

Page  130 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 inpreferred preferences stitution ILLINOIS West Chicago Convalescent Home for Destitute Crippled Children MARYLAND Baltimore Children's Hospital School Baltimore Kernan Hospital and Industrial School for Crippled Children MASSACHUSETTS Canton Massachusetts Hospital School MICHIGAN Detroit Van Leuven Browne Hospital School. MINNESOTA Phalen Park, St. Paul State Hospital and School for Crippled Children NEW YORK Coney Island Sea Breeze Hospital. Garden City House of St. Giles the Cripple. Port Jefferson St. Charles Hospital for Crippled Children. West Haverstraw State Hospital for Crippled Children White Plains Country Branch New York Orthopaedic Hospital PENNSYLVANIA Philadelphia Widener Memorial School Pittsburgh Industrial Home for Crippled Children Sewickley Sewickley Fresh Air Home Curable cases; no bed patients at present Cases likely to be cured or distinctly improved All kinds All kinds All kinds b All kinds Tuberculosis of bones and glands only. Preference to bone tuberculosis All kinds All kinds All kinds Curable cases; especially bone tuberculosis Permanent cripples, yet not absolutely helpless All kinds All kinds Backward children received, but none obviously feebleminded; no lung tuberculosis Lung tuberculosis and feeble-mindedness excluded o Backward children received, but none obviously feebleminded; no lung tuberculosis Feeble-minded and epileptic cases excluded None Lung tuberculosis and feeble-mindedness excluded Because of great demand seldom take feeble-minded or chronic cases Very few feebleminded cases; no new ones will be taken None d Feeble-minded cases not often taken Lung tuberculosis excluded Accept only those likely to become partially self-supporting. No lung tuberculosis, feeble-minded or backward children Preference to those likely to profit by industrial training. No lung tuberculosis. no feeblemindedness Children with lung tuberculosis or markedly feeble. minded or epileptic, excluded I At least until cured Until benefited as much as possible Plan to keep until as much benefited as possibles Until benefited as much as possible As long as they need a home Until benefited as much as possible ( Until benefited as much as possible Until benefited as much as possible, or as long as they need a home Until benefited as much as possible, or as long as they need a home As long as in need of convalescent care Until cured and probability of relapse is past Until I8 to 21 for purpose of industrial training At least until benefited as much as possible; occasionally longer for purposes of education Until benefited as much as possible. I * Department of Brooklyn Home for Blind, Crippled, and Defective Children. b Occasional non-orthopedic cases. o Occasional exceptions as to feeble-minded. d Feeble-minded children segregated. * This policy is not fully carried out because of demand for beds. f May decide to keep for industrial training when organized. * Expect to employ visitor. h 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

Page  131 IN 14 CONVALESCENT HOSPITALS OR HOMES Age limit Geographical After care and Ages for dis- Sexes Color re- Financial restrictions and visitation received charge received striction terms preferences _~~~~~~~~cag prfeene New institution; policy not definitely decided None g Through dispensary and staff of 3 visiting nurses None b None h None h Visits by agents of the Association for Improving the Condition of the Poor None h Visits by agent of Catholic Orphan Asylum Society None h None; if necessary would be supervised by nurses of city branch h Plan boarding home for discharged children who are partially self-supporting None h None h i I 4 to 14 3 to IO Up to about i6 5 to IS 3 years up' 5 to r7 2 to 12 Up to i6 No rule k 4 to I61 3 years up 4 to 10 m 3 to I2n 3 to I2 i No rule '3 Undecided No rule No rule Undecided No rule 0 No rule No rule L No rule 2I No rule No rule Both Both Both Both Both Both Both Both Both Both Both Both Both Both None White only White only P None White only None None None No rule None None White only No rule; no colored children yet taken White only Free Usually free; maximum charge $7 a week Usually free; maximum charge $ I4 a week State, cities or towns. Parents pay $4 a week if able Usually free; maximum charge $5 a week Free Usually free Usually paid for by city City cases at $.40 a day, others free or payment small Free; parents furnish clothing if able Usually free. A few pay something Free Usually free; maximum charge $i a day Free Cases transferred from Home for Destitute Crippled Children, Chicago Preference given to Maryland children Preference given to Maryland children Must be residents of Massachusetts None Minnesota children only None None Most children from Brooklyn; none from Manhattan; a few from other states Must be resident of New York State one year None Preference first to residents of Philadelphia; second, Pennsylvaniaoutside of Philadelphia; third, any other states Pennsylvania children only No rule; so far, all but one from Pennsylvania Cases transferred from Home for Destitute Crippled Children, Chicago Preference given to Maryland children Preference given to Maryland children Must be residents of Massachusetts None Minnesota children only None None Most children from Brooklyn; none from Manhattan; a few from other states Must be resident of New York State one year None Preference first to residents of Philadelphia; second, Pennsylvania outside of Philadelphia; third, any other states Pennsylvania children only No rule; so far, all but one from Pennsylvania I I i Occasional exceptions, i Occasionally under five. k Probably would not take boys over 12 years. 1 Occasionally receive children under four years. m All children must be indentured to the institution until 21. n Occasionally receive children over 2 years. o If children remain after I6 they become "helpers" and may stay indefinitely. P Colored children treated at city dispensary. i 13I

Page  132 TABLE VI C.-RULES OF ADMISSION AND Kinds of orthopedic Physical and mental Usual period of Asylum home cases taken and restrictions and stay in inpreferred preferences 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 Hospital 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 a 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 cases b All except meningitis; no long-time bed cases Cases not requiring surgical care or nursing All kinds All kinds of incurable cases All kinds All kinds Lung tuberculosis excluded ~ Lung tuberculosis excluded Feeble-minded, deaf and blind cases and those with lung tuberculosis, excluded Lung tuberculosis and feeble-mindedness excluded Lung tuberculosis and feeble-mindedness excluded Children with lung tuberculosis or markedly feebleminded or epileptic excluded Lung tuberculosis excluded Children with lung tuberculosis,d epilepsy, St. Vitus' dance or syphilis excluded Lung tuberculosis and feeble-mindedness excluded Children with lung tuberculosis, known to be feebleminded, or requiring special diets, excluded Children with lung tuberculosis or feeble-minded or epileptic excluded Lung tuberculosis and feeble-mindedness excluded Lung tuberculosis and feeble-mindedness excluded Until benefited as much as possible; longer if they need a home As long as they need a home Until self-supporting or a good home is found Until benefited as much as possible; or until self-supporting 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 e Most cases permanent; transferred to adult department at various ages Girls as long as they need a home. Incurable boys transferred to institutions for adults at about I6 Boys must leave at 10. Aim to place girls at service at about I8 b Some exceptions. a Institution closed since this study was made. c 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

Page  133 DISCHARGE IN 13 ASYLUM HOMES After care and Ages Age limit Sexes Color re- Financial Geographic foiato eeve car dis rcve restrictions and visitation received charge received striction terms preferences _Ica I i I By agents of Connecticut Children's Aid Society None f By agents of Children's Home Society None None By members of a visiting committee, 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 o1 Up to about I6 3 to I2b 4to I6h 3 to 14 No rule Up to I2 2% to 6 2 years up No rule No rule No rule No rule Boys, I4, girls, no rule No rule No rule No rule i Usually I7 No rule No rule No rule Boys, 1o, 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 onehalf; a few free. Relatives or towns pay something for others, usually $I a week Usually free; I pays $4 a week Usually free; parents may contribute to home Usually free; maximum charge $3 a week Usually free; a few pay small amounts Usually free; per capita rate for county cases Usually free; a few pay a little Free Free Usually free Usually free; maximum charge $7 a week Usually free; a few pay small amounts Usually free; a few pay $i a week I Connecticut children except in rare instances None None New England children None 1 None None None None Preference to Cleveland children; some from other cities and states First, Philadelphia, second, Pennsylvania, and third, other states Preference to Pennsylvania children others taken None Connecticut children except in rare instances None None New England children Nonei None None None None Preference to Cleveland children; some from other cities and states First, Philadelphia, second, Pennsylvania, and third, other states Preference to Pennsylvania children others taken None _ 8 I I f 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. g Adults not taken. h Occasionally under four. i Usually leave at 16. J Receive mostly New York City children 133

Page  134 TABLE VII.-CHILDREN ATTENDING SCHOOL: GRADE, WORK. TEACHERS, SESSIONS, AND EQUIPMENT, IN 37 INSTITUTIONS Children in classes Teachers School sessions Seating equipment Institution In kindergarten and grades In a Total kinder- In Total garten In hand work and vocational training classes In In hand k onal Total anddo- trainmestic. - science " For kindergarten and grades Supplied SUpled by plied insti- by tution city For hand work and vocational training Hours per day A.-M. P.M. 2 2 dd Days per week Desks and seats - Tables Ad- Not and just- adjust- chadrs Special able able used as to as to height height HOSPITAL ILLINOIS Chicago Home for Destitute Crippled Children. w MAINE v. Portland Children's Hospital. MINNESOTA St. Paul State Hospital. NEBRASKA Lincoln Nebraska Orthopedic Hospital NEW JERSEY Newark Home for Crippled Children. Orange New Jersey Orthopaedic Hospital and Dispensary NEW YORK New York City Hospital for Deformities and Joint Diseases Hospital for the Ruptured and Crippled New York Orthopaedic Dispensary and Hospital WASHINGTON Seattle Children's Orthopedic Hospital 20 6 40 13 29 70 5 92 I5 I2 29 90o II 15 132 25 25 24 39' I3.o. 37 39 1 2 I I I I I.I.6 I ii.. 2 23 3 I. 3 I 3 3 2 3 5 f 5 5 2 or 3 5 4 5.S 22 Yes Yes Yes Yes Yes

Page  135 CONVALESCENT HOSPITAL OR HOME ILLINOIS West Chicago Convalescent Home for Destitute Crippled Children 7 26 33 7. 1.. 7 I.. I4-2 I-2 5.. 35 MARYLAND Baltimore Children's Hospital School.. 19 9 30..P 30 I I 3.. 5 o Io Kernan Hospital and Industrial School for Crippled Children.... I 6 17 2...... I 5.. 24 MASSACHUSETTS Canton Massachusetts Hospital School.... 27 136 63 62 i5 77 3 I 3 1 5.. S 50.. Yes MICHIGAN Detroit Van Leuven Browne Hospital School..... 10I.... x 3 2 5 ggY.. Yes MINNESOTA Phalen Park, St. Paul State Hospital and School for Crippled Children 38 38 42 k..P 42 I I 3 I dd 5.... Yes NEw YORK Coney Island Sea Breeze Hospital..... 31 42 2I3.. 13.. 2 3 1 5.... 23 Yes Garden City House of St. Giles the Cripple.... 14 46 60 8 I 9 2.... 3 2 5... 21 Port Jefferson St. Charles Hospital for Crippled Children 82 82 3 7 Io 3.. I 3 21 5... 62 West Haverstraw State Hospital for Crippled Children 46 46 45 4 49 I. I 3 2 5.... i6 White Plains Country Branch New York Orthopaedic Hospital 97 97 40 m 40 4. i 2 aa i 5 i i6 PENNSYLVANIA Philadelphia Widener Memorial School...4 92 96 36 19 55 2 3 b bb 5 40 57 Pittsburgh Industrial Home for Crippled Children 23..h 23 9 20.. 3C 2 5.. 2 Sewickley Sewickley Fresh Air Home.... 14 2 26 22'.. 22 I8.. Ir 2 I s...... Yes If children are able they go out to special public school classes for cripples. g Includes some children doing work of kindergarten grade. h A few older children attend regular public school classes. i Including 12 children between six and one-half and nine years doing hand work more advanced than kindergarten work. i Most of the work is of kindergarten grade. k Including 22 doing hand work of kindergarten grade. 1 Including 15 doing hand work of kindergarten grade. m Not including 35 children doing elementary gardening. ' Estimated. P Vocational training planned. q Not including 17 children taking daily gardening lessons in summer. r Volunteer. E Nurse. u Institution selects teacher, city pays per capita rate ($IS per year for each pupil) for maintenance of school. v Furnished by People's University Extension Society, New York. w Furnished by Playground Association, Baltimore. y Kindergarten class two and one-half hours in morning only. ' For children below the fifth grade. aa Some simple hand work has been taught by volunteer academic teacher outside of hours stated bb Hours vary for different grades; total for grades, 12 to 16 hours per week: for kindergarten about three and one-half hours per week. c" Younger children two hours in morning only. dd Mornings only, in summer. ee For children in fifth to eighth grades inclusive. fI Five mornings and three afternoons; mornings only, in summer. s " Public school hours "; two hours only in afternoon.

Page  136 TABLE VII.-CHILDREN ATTENDING SCHOOL: BY GRADE, WORK. TEACHERS, SESSIONS, AND EQUIPMENT, IN 37 INSTITUTIONS (Continued) Children in classes Teachers School sessions Seating equipment In hand work and In kindergarten and vocational training For kindergar-, For Hours per day Desks and seats grades classes ten and grades hand Institution - work Tables In and Days and hnand In Supvc-per Ad- Not a In Idweek just- adjust- used inder- ades Total ndd tional Total by ied tiona A.M. P.M. Special able able garten train insti- y inas to as to sinciitution height height ASYLUM HOME CONNECTICUT Newington Virginia T. Smith Home for Incurables ILLINOIS Chicago Happy Haven b Maywood Home for Disabled Children MASSACHUSETTS Jw Hyde Park New England Peabody Home for Crippled Children NEW JERSEY Englewood Daisy Fields Home and Hospital for Crippled Children NEW YORK Buffalo Crippled Children's Home o New York City Darrach Home d House of the Annunciation for Crippled and Incurable Children New York Home for Destitute Crippled Children e 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 f Yes 2 2 6 55 4 I9 57 6 25 45. 17 g 17 27 13 28 36 27 I3 28 42 27 17 8 27~ 28 5.. 45 27 2 I I I I 3" IY2-3 IIY-24 17.... 8.. I.. I.. 27 I.. I v I I. 2-3 0-2 28 2.. I 3 5 I1... 3 Y2 6 2 2 3 I I IY 5 5 5 5 5 5 5 5 *. 1 79 24 Yes Yes 8 Yes 28 Yes 13 b Children go out to special public school classes for cripples. o Children go out to regular public school classes; hand work taught by volunteer teachers. d Children go out to school, some to regular public school classes, others to special classes for cripples. e Children go out to regular public school classes. Institution closed since this study was made. g Includes some children doing work of kindergarten grade. f Most of the children go out to regular public school classes; two taught by one of the Sisters. o Class in simple hand work once a week. t Not including one older girl who teaches in kindergarten class. v Furnished by People's University Extension Society, New York. x Including gardening teacher employed in spring and summer only.

Page  137 TABLE VIII.-HAND WORK AND VOCATIONAL WORK IN 37 INSTITUTIONS Institution Hand work and vocational work HOSPITAL ILLINOIS Chicago Home for Destitute Crippled Children MAINE Portland Children's Hospital. MINNESOTA St. Paul State Hospital.. NEBRASKA W Lincoln Nebraska Orthopedic Hospital NEW JERSEY Newark Home for Crippled Children. Orange New Jersey Orthopaedic Hospital and Dispensary NEW YORK New York City Hospital for Deformities and Joint Diseases Hospital for the Ruptured and Crippled New York Orthopaedic Dispensary and Hospital WASHINGTON Seattle Children's Orthopedic Hospital None None None Sewing, cooking, simple housework, b elementary bookbinding and repairing; cataloguing and general library work, printing, gardening None None None Sewing, chair-caning (basketry in summer), elementary carpentry None I None b By simple housework is meant the ordinary domestic work of the house, not instruction by domestic science teachers.

Page  138 TABLE VIII.-HAND WORK AND VOCATIONAL WORK IN 37 INSTITUTIONS-(CONTINUED) Institution Hand work and vocational work CONVALESCENT HOSPITAL OR HOME ILLINOIS West Chicago Convalescent Home for Destitute Crippled Children MARYLAND Baltimore Children's Hospital School Kernan Hospital and Industrial School for Crippled Children. MASSACHUSETTS Canton Massachusetts Hospital School MICHIGAN Detroit Van Leuven Browne Hospital School MINNESOTA 00 Phalen Park, St. Paul State Hospital and School for Crippled Children NEw YORK Coney Island Sea Breeze Hospital. Garden City House of St. Giles the Cripple Port Jefferson St. Charles Hospital for Crippled Children West Haverstraw State Hospital for Crippled Children White Plains Country Branch New York Orthopaedic Hospital PENNSYLVANIA Philadelphia Widener Memorial School Pittsburgh Industrial Home for Crippled Children Sewickley Sewickley Fresh Air Home Sewing, simple housework,b gardening o Advanced kindergarten work, basketry, chair-caning d Sewing, lace making, rug weaving, basketry, chair-caning, burnt woodwork, stenography and typewriting Sewing, complete course in housekeeping, manual training, practical carpentry, printing, cobbling, farming, stationary engineering, music None Sewing, simple housework,b manual training, furniture making d Some sewing and basketry, advanced kindergarten work Sewing, simple housework b Sewing, tailoring, stenography and typewriting Sewing, stenciling and wood blocking, furniture making Sewing, cooking, simple housework,b gardening Sewing, cooking, elementary nursing and general work in wards, basketry, stenciling, chair-caning, burnt woodwork, manual training, practical carpentry, engraving, cobbling, stationary engineering, teaching, music Sewing, basketry, manual training, furniture making, music Sewing, basketry, manual training, gardening

Page  139 ASYLUM HOME CONNECTICUT Newington The 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 Hospital for Crippled Children NEW YORK Buffalo ~D 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 a 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 Simple housework,b manual training, gardening, music Simple housework b Simple housework b Sewing, cooking, simple housework,b basketry, chair-caning, manual training Simple housework,b gardening Sewing, advanced kindergarten work Sewing, simple housework b Sewing, basketry, advanced kindergarten work, music Sewing, simple houseworkb Simple housework b Sewing, manual training Sewing, simple housework b Sewing, complete course in housekeeping a Institution closed since this study was made. b By simple housework is meant the ordinary domestic work of the house, not instruction by domestic science teachers. e Plan to teach all branches of housework and several branches of farmwork, including dairying. d Plan to teach farm industries.

Page  140 TABLE IX.-DISPENSARY WORK OF THE 9 INSTITUTIONS HAVING DISPENSARIES a Institution b Square feet of floor space used for dispensary purposes Visits by outpatients in year o Average daily attendance of outpatients Number of different out-patients in year ILLINOIS Chicago Home for Destitute Crippled Children MAINE Portland Children's Hospital MARYLAND Baltimore Kernan Hospital and Industrial School for Crippled Children.. NEW JERSEY Newark Home for Crippled Children 0 Orange New Jersey Orthopaedic Hospital and YORK Dispensary NEW YORK New York City Hospital for Deformities and Joint Diseases Hospital for the Ruptured and Crippled New York Orthopaedic Dispensary and Hospital.... WASHINGTON Hospital Seattle Children's Orthopedic Hospital. 2,054 3,023 4,117 I,237 1,200 1,977 Io,I65 2,559 724 2,587 8,935 1,701 2,797 I,784 9d 29 II 28 I7 710 d 664 250 e 538 399 3 414 22,000 f 6,417 250 Average number of visits by each outpatient in year 2.2 d I3.5 7.0 5.2 4-5 10.0 2.0 f 4.2 3.0 Dispensary open Days Days Hours in year per per week day 304 6 I 306 6 IS 150 0OI 103 304 304 304 51 3 2 2 6 6 6 4 3% 2 2 2 2 2 I to 2 Visits to homes of outpatients in year None 930 None I,I37 None None I5,5i8 b None 33,998 44,604 27,140 738 112 147 89 I4 a Statistics are given for the most recent year for which information was available. b Eight of the o1 hospitals and one of the 14 convalescent hospitals or homes have dispensaries. c Including visits for massage and corrective gymnastics. d Not including patients coming for massage and corrective gymnastics only. e New cases. f Estimated. a Children's homes are visited by agents of Maine Children's Committee. h Including 7,020 visits by surgeons and 8,498 visits by four visiting nurses and one social service worker.

Page  [unnumbered] .,, >.- I I I II@ Main Buildings Roof Garden CHILDREN'S HOSPITAL, Portland, Maine. (See page 142)

Page  [unnumbered] L. I Y HOME FOR CRIPPLED CHILDREN, Newark, New Jersey. (See page 147)

Page  141 CHAPTER VI DETAILED DESCRIPTION OF INSTITUTIONS A. HOSPITALS* ILLINOIS HOME FOR DESTITUTE CRIPPLED CHILDREN, 1653 Park Avenue, Chicago Incorporated: I892. 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 during 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 Medical College. Superintendent resident in the Home. Four graduate nurses, one of whom is head night nurse; nurses in training come from Presbyterian 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: $280. *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. I41

Page  142 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 specifically for salaries, for provisions, and for other important items. This is the only orthopedic hospital which prints no detailed financial 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 residents 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 Feebleminded. In emergencies only, a few infants who were not orthopedic cases have been taken. Discharge: After dispensary care can be safely substituted; average stay 97 days. 142

Page  143 DESCRIPTION OF INSTITUTIONS I 0 w z z 'U; U-r. a '43

Page  144 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 operations performed. Well equipped gymnasium for special gymnastics. 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 independently, not on salary. Large dispensary service daily. Excellent 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 Committee. School: None. Hand work and vocational training: None. Cost of property: $121,000. 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. Noteworthy 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

Page  145 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 restrictions 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 orthopedic 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: $221.* 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 hospital. The building is not new but serves its purpose well, and the playground and tent for sleeping out of doors are important features. 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. 10 145

Page  146 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: ioo. 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 fireescape; fire drills. Admission: From two to eighteen years; must be residents of Nebraska. 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 children 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 i 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 housework, elementary bookbinding and repairing, cataloguing and general library work, printing, gardening. Specially trained teacher of domestic science (resident); special non-resident teacher of bookbinding and printing. Cost of property: $94,ooo. 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

Page  147 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 contagious 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: I89I. Superintendent: Miss Emma Mueller. 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 sometimes taken. Discharge: As soon as can be transferred to dispensary; great demand 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 147

Page  148 CARE OF CRIPPLED CHILDREN hospital facilities, and children come for operations and postoperative 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 surgeonin-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 contagion; 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 equipment and furniture, $2,345. Surgical equipment per capita, $7. Furniture per capita, $140. Year's expenditure per capita: $894. 148

Page  [unnumbered] 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 *.*...., ', *

Page  [unnumbered] - ~~~~~~~~~~~~~~~~~~~l-l W - 'i -~~ -J I as ~~~~~~ -, "LHOSP1TAL FOR DEFORMITIES AND JOINT DISEASES, New York City. (See page 149'

Page  149 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 dispensary building planned. Because buildings are far from fireproof, 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 orthopedic 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 gymnastics. 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: $895. 149

Page  150 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 convalescent cases in the country. The hospital has a ward for adult men and one for adult women, and several small private rooms, in addition to the ward and sleeping porch for children. NEW YORK HOSPITAL FOR THE RUPTURED AND CRIPPLED Sixth Floor Plan. (See page 154) I5o

Page  151 DESCRIPTION OF INSTITUTIONS NEW YORK HOSPITAL OF THE NEW YORK SOCIETY FOR THE RELIEF OF THE RupTURED 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. I i................... ill E I I - - It - 1110111111111b ELECTM - 1"j& bArIN4 - - m 9$6711716 &OL 11 3EL'CIC. DEJODWAY OOED PREPARAMTNCNCWAIT1 DELIVEPY PLATFOIRJE MILEEPCC 1.1 PATENT RO NY NACIVM N ZANDM.EOOM FUU01 AD 11; L Mr3-r. XI VIINAr '6 9 CIVIO I = OP-THOPIDIC DEPT 175ECI I MKOT PHY W(rX T ELET.RRZLKAPHY XI z HIET,0F WAITING 1,00 LINIC TOILET 5UP NA L L 5 UK, 0 UCLPTION P Box I I 01 FL. Z3 ENTR.ANC 100-m 1140 MIN, Lato I N C HILF WAITING POOM U m r -, r - rI 17 -rr17 - W - - -- ---- DUVOECWAY York and Sawyer, Architects NEW YORK HOSPITrAL FOR TrHE RUPTURED AND CRIPPLED First Floor Plan. (For Elevation see p. 6) 151

Page  152 CARE OF CRIPPLED CHILDREN Average number of children: I92. Capacity: 250. Plant: City lot 200 by 200 feet. Brick building (erected 1912) is of modern fireproof construction; two enclosed staircases separated z _ s-'UL LU i U UUUUUUU U1- n uuuuuuu n "ltf* L - 1I I l C I223lR~oAj I22] N_ _ _ __ 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

Page  153 DESCRIPTION OF INSTITUTIONS Kitchen with tile floor and modern cooking apparatus. Dispensary on first floor with tile floor and sanitary base. Marble partitions in orthopedic examination rooms form 12 booths for children; 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

Page  154 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. Most 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, gymnasium, 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 graduate nurses, 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 engaged 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 surgeonin-chief expressed the hope that the next step might be the establishment 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: $567. Comment: This modern fireproof building represents the acme of 154

Page  [unnumbered] OUT-PATIENT DEPARTMENT. (See page 156) Children's Orthopedic Hospital, Seattle, Washington FRIENDLY VISIIORS. (See page 218) Good Shepherd Home, Allentown, Pennsylvania

Page  [unnumbered] The Dispensary Outdoor Clinic. (See page 155) NEW YORK ORTHOPAEDIC DISPENSARY AND HOSPITAL, New York City

Page  155 DESCRIPTION OF INSTITUTIONS achievement in orthopedic hospital construction in America. Here and at the Widener Memorial School in Philadelphia, the best materials known have been used and the latest equipment installed at every point. NEW YORK NEW YORK ORTHOPEDIC DISPENSARY AND HOSPITAL, 126 East 59th Street, New York City Date of opening: 1866. Superintendent: Mr. Charles H. Burr. Orthopedic surgeon: Russell A. Hibbs, M.D. Class: Hospital. Average number of children: 62. Capacity: 70. Plant: Four old brick and stone residences on city lots, connected to form one building. The section which contains wards for the children has been made partly fireproof and can be shut off from remainder of building by metal doors. Another similar house for nurses' home. Iron outside stairways with large platforms at front and rear of hospital and rear of nurses' home. Painted walls; bare wooden floors. Admission: From two years up; no boys over fourteen; adult women taken; no lung tuberculosis; no markedly feeble-minded cases, because they need special care. Discharge: After dispensary care, or care in Country Branch at White Plains can be safely substituted; average stay fifty days. Facilities for care of children: Operating suite with X-ray machine; medical staff including orthopedic specialists, two resident physicians; superintendent of nurses and two other hospital nurses are graduate nurses; other nurses trained for orthopedic nursing in the hospital, though there is no formal training school. Well equipped corrective gymnasium; two trained gymnastic teachers and two masseuses. Night watchman. Automatic elevator, enclosed, not near any stairway. Thresholds absent in parts of building most used by children. No day rooms for children. Preliminary visits and after care through five visitors, two of whom are graduate nurses, one a social service worker and two nurses of experience with orthopedic cases; last year 8,498 visits paid to homes by visiting nurses and 7,020 visits by surgeons of the hospital. Large brace shop makes appliances which are rented at cost, or free if patient is unable to pay. Large dispensary service daily. Each patient is cared for throughout treatment by the same surgeon. 155

Page  156 CARE OF CRIPPLED CHILDREN School: Non-resident teacher spends two afternoons with children able to be up and sit at tables, and two afternoons with bed patients. Instruction largely individual, with little class work. Hand work and vocational training: None. Cost of property: Plant too old for figures of cost to have significance. Planning new building. Present property has market value of about $ 15o,ooo. Year's expenditure per capita: $977. Comment: Children come here for examination, operations and postoperative treatment, after which they are either transferred to the Country Branch and Industrial School at White Plains, or cared for through the dispensary. The exceptional thoroughness with which cases are "followed up" is worthy of study. Although the hospital treats great numbers of patients in the course of a year, the aim of the institution is consistently toward quality, not quantity, of work; that is, the final cure of each case accepted, or as near an approach to cure as the nature of the case makes possible. Cases sent to the Country Branch are kept there not only until all improvement which seems possible has been attained, but until it is believed that the danger of relapse is past. All convalescent cases cared for through the dispensary are visited in their homes by nurses and if necessary by the surgeons, and strong efforts are made to secure regular attendance at the dispensary. The staff in the hospital itself is hampered by old-fashioned buildings. Plans are being made for the erection of new buildings on another site, with ioo hospital beds and large dispensary space. WASHINGTON CHILDREN'S ORTHOPEDIC HOSPITAL, 2107 Warren Avenue, Seattle Date of opening: 1907. Superintendent: Miss Lillian Carter. Orthopedic surgeons: Casper W. Sharples, M.D., Fred J. Fassett, M.D., Park Weed Willis, M.D., James B. Eagleson, M.D. Average number of children: 27. Capacity: 50. Plant: City lots with thoroughly modern building planned with view to future enlargement; walls of reinforced concrete; refrigerating plant extending through all floors to diet kitchens. Steam laundry with modern machinery. Two enclosed inside stairways; outside steel stairway, railed, used constantly by helpers. Yates system of fire protection. Standpipe and hose. Drinking fountains. Hard plaster walls; cement floors, some covered with battleship linoleum, some with special composition. 156

Page  157 DESCRIPTION OF INSTITUTIONS Admission: Up to sixteen years; no lung tuberculosis. Discharge: After dispensary care can be safely substituted; average stay forty-four days. Facilities for care of children: Operating suite including X-ray machine. Visiting medical staff, including orthopedic specialists; four senior surgeons, each with an assistant, visit all clinics at hospital on three months' service, and for one day each week during other nine months so that each surgeon may continue supervision of cases which have come to him. Three rooms for private patients who pay hospital for care. Superintendent, surgical nurse, and nurse in out-patient department are graduate nurses; five pupil nurses from other hospitals in the city who spend three months of their senior year here. Isolation in receiving room in basement or in room ordinarily in use by maid; very few cases have required isolation. Thresholds absent. Semi-outdoor sleeping in wards where windows are never closed and the air seems identical in quality with that out of doors. Nurse in out-patient department pays preliminary visits to homes of patients and supervises cases discharged. School: Grade teacher from city board of education. Students from kindergarten training school come for one week each to teach the kindergarten. Many pupils in bed. Others use tables and chairs. Classes all held in wards. Hand work and vocational training: None. Cost of property: $I I,6oo. Year's expenditure per capita: $481. Comment: The building was erected after visits by officers and employes to many leading orthopedic institutions in the East, and shows both the adoption of good ideas learned elsewhere and ability to adapt these ideas to meet the special needs of this hospital. B. CONVALESCENT HOSPITALS OR HOMES ILLINOIS CONVALESCENT HOME FOR DESTITUTE CRIPPLED CHILDREN, R. F. D. No. 2, West Chicago Date of opening: 19 1. Superintendent: Miss Margaret Little. Orthopedic surgeon (consulting): John Ridlon, M.D. Class: Convalescent hospital. Average number of children: 40. Capacity: 60. 157

Page  158 CARE OF CRIPPLED CHILDREN Plant: Excellent. Farm of 96 acres, run by farmer living in original farm house. All other buildings of cement, fireproof; main building, isolation, also school building in process of erection. Modern interior finish and equipment. Tile, cement, and maple floors; enamel and painted walls; cork matting on halls. Unusually pleasant servants' quarters: for men in basement with good light, for maids on third floor. Complete precautions against fire include tank, hydrants, extinguishers; fire-escapes tested twice each week. Drills planned. Admission: Four to fourteen years. Cases from Home for Destitute Crippled Children in Chicago. Curable cases; seldom bed cases. No lung tuberculosis; no obviously feeble-minded. Colored children admitted. Discharge: After cure. Average stay expected to be long. Facilities for care of children: Superintendent a graduate nurse; visiting surgeons and physicians. Admirable isolation building where cases of two diseases can be separately isolated. Outdoor sleeping porches for children; also first floor porch for daytime naps. Unrestricted outdoor play space; children watched when out of doors by nurse maid. Lavatories on first floor for day use. School: Taught by experienced teacher formerly at Spalding School for Cripples in Chicago. Desks adjustable as to height. Hand work and vocational training: Sewing, simple housework, gardening. Plan to teach all branches of housework and many kinds of farm work, including dairying. Cost of property: Io8,ooo. Year's expenditure per capita: $330. Comment: Plant and equipment are admirable and worthy of study by anyone interested in building a small convalescent hospital or home on thoroughly modern lines. MARYLAND CHILDREN'S HOSPITAL SCHOOL, Green Spring Avenue, Baltimore,/' Date of opening: 1912. Superintendent of nurses: Miss M. E. Kinsey. Orthopedic surgeon: William S. Baer, M.D. (medical director.) Class: Convalescent hospital. Average number of children: 30. Capacity: 50. Plant: 17 acres on outskirts of Baltimore. Modern building of reinforced concrete faced with marble. Floors of cement and tile construction; walls fireproof in sections used by children; linoleum on hall floors. Outside stairways. Cement walls, to be painted. 158

Page  159 DESCRIPTION OF INSTITUTIONS Admission: From three to ten years; preference to Maryland children; cases likely to be cured or distinctly improved; no lung tuberculosis; no feeble-minded. Discharge: After being benefited as much as possible, up to thirteen years. Facilities for care of children: Staff of visiting surgeons and physicians, including specialists of many kinds. Institution will ultimately take all other kinds of children's cases as well as orthopedic cases. Operating room; some major operations done at Johns Hopkins Hospital. Superintendent a graduate nurse. Other nurses for periods of three months from Church Home and Infirmary where they are in training. Special gymnasium. Isolation ward and bath. Children isolated only if disease develops, not upon entrance. All the children sleep on two outdoor sleeping porches separated by glass-walled office for night nurse; glass-enclosed porch for play during day. Unlimited outdoor space. Play tent 20 by 24 feet. Elevator; thresholds absent, or very low; incline from porch. School: Teacher for grade subjects supplied by city board of education. Ten adjustable and ten special desks. Hand work and vocational training: Advanced kindergarten work, basketry, chair-caning taught by teacher from Playground Association, half of whose salary is paid by the Hospital School. Plan to teach farming and dairying later. Cost of property: $72,000. Year's expenditure per capita: $346. Comment: A building worthy of study by people planning to build a small hospital, as to modern construction in general and especially as to the arrangement of sleeping porches. Much thought spent on details of equipment. Each child's small possessions kept in flat cloth bag strapped at foot of his bed, instead of gathered bag hung over bed post as in many other places; large screens in dressing rooms have attached to the inside a hook for each child, where night garments hang by day and day garments by night. MARYLAND JAMES LAWRENCE KERNAN HOSPITAL AND INDUSTRIAL SCHOOL OF MARYLAND FOR CRIPPLED CHILDREN, Hillside, near Baltimore Date of opening: 1895. Superintendent and surgeon-in-chief: R. Tunstall Taylor, M.D. Class: Convalescent hospital. 159

Page  160 CARE OF CRIPPLED CHILDREN Average number of children: 53. Capacity: 55. Plant: A beautiful estate of 63 acres, known as Radnor Park, reached from Baltimore by trolley in about an hour. Exceptionally beautiful grounds. Old mansion house of stone, very well built, successfully adapted to institution's needs. Painted walls; bare floors. Two movable canvas chutes for escape in case of fire. Fire drills held. Wooden farm house used by nurses. Lodge and rooms over stable for colored servants. Vegetables and fodder raised; milk from cows belonging to institution; chickens, squabs, and hogs are raised. Admission: Up to sixteen years; preference to Maryland children; no lung tuberculosis. Backward children admitted, but none who are obviously feeble-minded. Discharge: After being benefited as much as possible; age limit undecided. Facilities for care of children: Surgeon-in-chief, an orthopedic specialist, pays almost daily visits; two resident physicians; superintendent of nurses, and three other graduate nurses; eight nurse maids in training. Operating room; small equipment for special gymnastics. Outdoor sleeping accommodations for 17 children on large porch. Tent used for isolation; special care to prevent introduction of infectious diseases; strict rules as to visitors, who are required to wear linen dusters if they enter wards. Children's elevator enclosed in terra cotta. Thresholds very low. Night nurse and two ward maids on duty, and orderly subject to call. Marble slabs for baths in addition to tubs. After-care through dispensary in Baltimore and three visiting nurses. School: Two teachers divide grade and hand work. One is supplied by city board of education, one by the institution. Desks adjustable as to height. Hand work and vocational training: Sewing, lace making, rug weaving, basketry, chair-caning, burnt wood work, stenography and typewriting. Cost of property: $84,00o. Year's expenditure per capita: $532. Comment: A notable example of the possibility of adapting substantial old houses with large rooms for hospital uses. The administrative system has been carefully worked out. A small printed pamphlet of "rules and regulations" is given to each new employe. The cheerful atmosphere and esprit de corps clearly evident here are important in a country institution where the emI60

Page  161 DESCRIPTION OF INSTITUTIONS ployes spend most of their leisure time, as well as working hours, together. MASSACHUSETTS MASSACHUSETTS HOSPITAL SCHOOL, Canton (Built and maintained by the Commonwealth of Massachusetts) Date of opening: 1907. Chairman board of trustees: Edward H. Bradford, M.D. Superintendent: John E. Fish, M.D. S. W. Mead, Architect MASSACHUSETTS HOSPITAL SCHOOL Infirmary Floor Plan Orthopedic surgeons: Robert W. Lovett, M.D., Augustus Thorndike, M.D., Robert Soutter, M.D. Class: Convalescent hospital. Average number of children: 229. Capacity: 250. Plant: 65 acres of land, of which 20 are cultivated by farmer and helpers, and 35 acres are heavily wooded. Administration building, power house, and assembly hall of brick; two dormitory buildings, older girls' cottage, industrial building, hospital building, and barns of wood. Modern interior finish and equipment. Walls of hard plaster painted; floors of bare wood in most rooms, of special It 166

Page  162 ELI 1 62

Page  163 DESCRIPTION OF INSTITUTIONS compositions in operating room and in many toilet rooms. Iron fire-escapes on main building where employees sleep on upper floors. Admission: From five to fifteen years; must be residents of Massachusetts; no feeble-minded or epileptic. No color restriction. Cross section through living room MASSACHUSETTS HOSPITAL SCHOOL Cross Section of Two-story Monitor Roof Cottage, Showing Unique False Roof and Ceiling Ventilation Transoms in Both Stories, Which Prevent Drafts and Defy Storms Discharge: After being benefited as much as possible. May remain somewhat longer for educational reasons. Facilities for care of children: Visiting medical staff, including orthopedic specialists. Superintendent is a physician; assistant physi163

Page  164 CARE OF CRIPPLED CHILDREN cian; three graduate nurses; 15 nurse maids and four men attendants. Night watchman; night nurse maids. Separate hospital building for bed cases, with operating room, which contains a glass-enclosed space within which operations are performed. A few pieces of special gymnastic equipment in an "exercise room." Isolation facilities include small portable shacks for use when there are a few cases of contagious disease; each has a main room io by 12 feet, a kitchen annex 7.5 by 7.5 feet, and a small screened veranda, which cost $205: earth closets disinfected with chloride of lime. The hospital building has isolation rooms used for newly admitted children and for suspected cases of infectious disease. Building is so constructed that child can be moved directly from either isolation ward to porch, thence to a quarantine shack, without passing through any hall or other room. The newly constructed boys' cottage was used for isolation, considerable space being necessary during epidemic of measles. Children's dormitories in cottages with monitor roofs which provide perfect ventilation; new cottage for older boys, two stories, has monitor arrangement for each story after original design. Unrestricted outdoor space for play and work. Woods and lake; baseball ground. Assembly hall contains theater and library. Older boys and girls live in separate cottages in small groups where life resembles that of large family. No elevators necessary, since children live entirely on first floor level; thresholds absent; inclines unnecessary since buildings are almost at ground level. School: Graded school with principal and two other teachers. Two of the three class rooms are out of doors. Adjustable desks, also tables. Hand work and vocational training: Sewing, complete course in housekeeping, manual training, practical carpentry, printing, cobbling, farming, stationary engineering, music. High development of "apprenticeship system" of vocational training. Cost of property: $276,000. Year's expenditure per capita: $291. Comment: This is the largest institution for crippled children in America; well housed, well equipped, and conducted according to an administrative system which has been most carefully worked out. In spite of the large number of children, there is but a minimum of institutionalism. The life of the older girls and older boys, in simple cottages where a small number live after the fashion of a large family, is noteworthy. The results achieved through 164

Page  165 DESCRIPTION OF INSTITUTIONS vocational training evolved from the daily life of a large institution are most strikingly seen here and at the Widener Memorial School. MICHIGAN VAN LEUVEN BROWNE HOSPITAL SCHOOL, 31-33 Kenilworth Avenue, Detroit Date of opening: 1907. Superintendent: Miss Laura E. O'Neill. Orthopedic surgeon: None. Visiting physician, H. A. Shafor, M.D. Class: Classed with convalescent hospitals, but in many respects has close resemblance to asylum home. Average number of children: 25. Capacity: 3o. Plant: Double house of brick on two city lots. Two stairways. There is a fire-engine house near. The firemen have been over the institution and know where to find the children in case of fire. This does not cancel need of fire-escapes, which would decrease the risk for children in wards on second floor. Floors painted; walls have paint over paper except in one dormitory where paper was scraped off before walls were painted. Admission: From three years; all kinds of cases, including a few blind children and well children in need of a home. Discharge: After they no longer need a home. Facilities for care of children: No hospital connections. Four visiting physicians, two of them osteopathic. President, who lives in institution, has been crippled since childhood, from tuberculosis of the spine. Three nurse maids without previous training. There is a surgical dressing room but dressings are usually done in wards. All the children are taught danger of infection from dressings worn by those with abscesses. Winter play room with good light. Thresholds absent; incline, to back yard. Shacks in this yard provide sleeping places for all the children from May until cold weather comes in the autumn. Sand pile, swings. School: Simple branches taught by resident German teacher, in English and German. Tables and chairs. Hand work and vocational training: None. Cost of property: $10,400. Year's expenditure per capita: $153. Comment: The life in this small home is much like that of a large family; there is little to suggest an institution except the number of beds in the sleeping rooms. The children are very much attached to all the people who care for them and good humor prevails. 165

Page  166 CARE OF CRIPPLED CHILDREN MINNESOTA MINNESOTA STATE HOSPITAL AND SCHOOL FOR INDIGENT CRIPPLED AND DEFORMED CHILDREN (Country Branch), Phalen Park (Maintained by the state of Minnesota) Date of opening: 19o0. Matron: Miss Marie D. Hoppe. Orthopedic surgeon: Arthur J. Gillette, M.D. Class: Convalescent hospital. Average number of children: 38. Capacity: 60. Plant: 23 acres of land; fireproof building of cement and terra cotta, with completely modern equipment. Painted walls; floors of special composition throughout first floor. No fire-escapes, children all on first floor; fire drills held. Servants' rooms above kitchen wing, with no access to rooms of other employes, which are over central part of building. Building can be enlarged by adding wings at rear. Admission: From five to seventeen years; Minnesota children only; no color restriction; no lung tuberculosis; no feeble-minded. Cases come from city branch in St. Paul. Discharge: After being benefited as much as possible; age limit undecided. Facilities for care of children: Visiting medical staff, including orthopedic specialists; matron and head nurse are graduate nurses. Operations in city of St. Paul. Surgical dressing room. Children sleep in two long dormitories from which beds can be rolled out on to cement terraces on either side. Many doors give cross ventilation almost equivalent to outdoor sleeping. Sun parlors for day use. Unrestricted outdoor play space. Night attendant. Four small isolation rooms with bowl and toilet in each; each with separate outside entrance. Each child isolated for a week upon admission. One piece of gymnastic stretching apparatus for correction of lateral curvature in surgical dressing room. No elevator necessary since children live entirely on ground floor level. Thresholds absent. School: Taught by non-resident teacher, work in all grammar grades offered. Tables and chairs. Hand work and vocational training: Sewing, simple housework, manual training, and furniture making. Teaching of elementary housework is especially thorough. Special teacher gives entire time to hand work. Plan to develop farm industry. Cost of property: $68,ooo. i66

Page  [unnumbered] Main Building School Room Boys' Ward STATE HOSPITAL AND SCHOOL FOR CRIPPLED CHILDREN, Phalen Park, Minn. (See page 166)

Page  [unnumbered] The Sun Bath (" Heliotherapy") '44nt,. Outdoor Sleeping Porch SEA BREEZE HOSPITAL, Coney Island, New York. (See page 167)

Page  167 DESCRIPTION OF INSTITUTIONS Year's expenditure per capita: $300. Comment: This building deserves special study as to its general construction and as to arrangement, especially the dormitories and school rooms which are open to sun and air on three sides. A good foundation has been laid for thorough education, which will include more and more vocational training if enough children need to stay until they reach an age when they are ready for it. NEW YORK SEA BREEZE HOSPITAL, Surf Avenue and 29th Street, Coney Island (Maintained by The New York Association For Improving the Condition of the Poor) Date of opening: 1904. Superintendent: Miss Josephine T. W. Brass. Orthopedic surgeon: James H. Hutchins, M.D. Class: Grouped with convalescent hospitals because of location and long stay of patients. Otherwise resembles institutions classed as hospitals. Average number of children: 42. Capacity: 42. Plant: Wooden building on grounds of Sea Breeze, a fresh air home used in summer for mothers and children from New York. Orthopedic cases only in this building; open all the year. Painted walls; bare floors, unpolished. Buildings of Sea Breeze used in winter for hospital purposes if needed. Some hospital employes sleep there in summer also. Outside iron stairway to ground, corrugated treads; fire alarm. Admission: From two to twelve years; no color restriction; tuberculosis of bones and glands only; preference to bone cases. Seldom take feeble-minded or cases likely to derive but little benefit. Discharge: After being benefited as much as possible. Facilities for care of children: Weekly visits from surgeon-in-chief, an orthopedic specialist; two graduate and three "practical" nurses. All orthopedic operations performed in operating room. Sun baths with exposure of sinuses to sun and air. Admirable ventilation of dormitories with many windows provides practical equivalent for outdoor sleeping. Big porches with beds where bed cases stay all day. Building on beach, sea bathing for many children. Isolation in tent in summer; in winter, in unused buildings of Sea Breeze. After-care through agents of the New York Association for Improving the Condition of the Poor. School: In summer, tent with wooden floor, lower part of the walls 167

Page  168 CARE OF CRIPPLED CHILDREN of wood, and canvas above; in dining room in winter. Teacher furnished by New York City board of education. Non-adjustable desks and tables. Hand work and vocational training: Some sewing and basketry; advanced kindergarten work taught by kindergarten teacher furnished by city board of education. Cost of property: Not separated from Sea Breeze. Year's expenditure per capita: $5 IO. Comment: A hospital on the seashore with every possible advantage in respect to sun and fresh air needed in the cure of tuberculous children. The wooden building would burn readily, but there is good provision for escape in case of fire from parts of building used for children. Permanent buildings for this hospital will be erected at Rockaway Park. NEW YORK HOUSE OF ST. GILES THE CRIPPLE, Garden City, Long Island Date of opening: 1891. Superintendent: Miss Regina Morgan. Orthopedic surgeon: Burr Burton Mosher, M.D. Class: Convalescent hospital. Average number of children: 45. Capacity: 85. Plant: Nearly four acres of land; cows and chickens kept. Group of wooden buildings; former residence used as main building includes chapel, girls' dormitories and employes' rooms; boys' dormitory building; school house; building for surgical cases. Roof ventilation in boys' dormitory and surgical building; somewhat similar result in main building because windows in attic are kept open. Second stairway; fire drills; iron fire-escapes. Most children sleep on first floor level. Admission: Up to sixteen years. Very few feeble-minded cases; no new ones will be taken. No color restriction. Discharge: After being benefited as much as possible, unless they still need a home. At sixteen, children still needing care or having no homes remain indefinitely as helpers. Facilities for care of children: Visiting medical staff, including orthopedic surgeons. Some operations in Brooklyn hospitals but many in simple operating room at the institution. Two graduate nurses; night nurse. Surgical building could be used for isolation. Unrestricted outdoor play space. Some officer always visits a child's home before he is sent back to it after a stay at the institution. 168

Page  169 DESCRIPTION OF INSTITUTIONS School: Two teachers; graded school; non-adjustable desks and seats. Older children often sent outside institution to high school. Hand work and vocational training: Sewing, simple housework. Cost of property: $26,000. Year's expenditure per capita: $290. Comment: The work of this institution is unusually comprehensive in that it offers hospital care for both operative and convalescent cases in the surgical building, and at the same time furnishes a long time or even permanent home with school for children who have no good homes to which they may be sent after as much as possible has been done for them surgically. The system of "helpers" is unique: each child remaining after sixteen is paid $2.50 a month and does such work as he can in the institution. The small money payments are believed to lessen the children's sense of dependence. The atmosphere is homelike, and the children who have been residents for a considerable time have a strong feeling of loyalty to the home. NEW YORK ST. CHARLES HOSPITAL FOR CRIPPLED CHILDREN, Port Jefferson, Long Island (Under the Daughters of Wisdom) Date of opening: 1907. Superintendent: Mother Teresa. Orthopedic surgeon: Charlton M. Wallace, M.D. Class: Convalescent hospital. Average number of children: I Io. Capacity: 200. Plant: 21 acres of land, of which 12 are cultivated. Large congregate building of terra cotta brick covered with cement. Modern finish, with utmost care as to sanitary provisions, including plaster walls, floors of cement blocks, bubble fountains, high bathtubs. Cross ventilation in dormitories of 60 beds each. Separate laundry building with modern equipment. Building fireproof; most doors of metal. Fire-escapes considered unnecessary. Admission: Through Roman Catholic Orphan Asylum Society in Brooklyn. No rule as to color; most children from Brooklyn. Discharge: After being benefited as much as possible, unless they still need a home. Facilities for care of children: Operations in institution's operating suite, thoroughly modern, including X-ray machine. Surgeon-inchief, orthopedic specialist, pays weekly visits; resident physician; 169

Page  170 CARE OF CRIPPLED CHILDREN some of the Sisters have had nursing training and experience; two Sisters sleep in each of the three large dormitories. Small solarium. Isolation for colds or other slight ailments in two small wards in hospital building. Serious infectious cases isolated in separate wooden house, generally in use for defective children; two sections which can be completely separated. Preliminary visit to every applicant's home and after care through agents of Catholic Orphan Asylum Society, Brooklyn. Large play room over laundry will be built later. Uncovered roofs of two porches furnish limited sunny space for outdoor use in winter as well as summer. Unrestricted playground space out of doors. Swings. Enclosed elevator; thresholds absent; stairs have unusually easy treads covered with rubber. School: Graded school with Sisters as teachers. Larger school rooms would be an advantage. Non-adjustable desks and seats. Hand work and vocational training: Sewing, tailoring, stenography and typewriting. Five of the children now give all day to sewing; some of them attend special school classes held in the evening. Cost of property: $ I19,000. Year's expenditure per capita: $179. Comment: This hospital is part of a larger institution, the Brooklyn Home for Blind, Crippled, and Defective Children. The hospital is located at a considerable distance from the buildings used for defective children and except in administration is like a separate institution. Provision for crippled children is offered on a very comprehensive basis, including all phases of hospital care, also asylum care and education for incurable cases without good homes. The building may be regarded as a model according to most, if not all, hospital standards. In spite of the present limited indoor play space and the large numbers cared for in a congregate building, the kindness and faithful care of the Sisters have their result in a cheerful atmosphere. If the older children could be in small cottages, it would seem that the large building might well be kept filled with cases needing hospital care and having less need of homelike surroundings than those who are not in bed by day. NEW YORK STATE HOSPITAL FOR THE CARE OF CRIPPLED AND DEFORMED CHILDREN, West Haverstraw (Maintained by the state of New York) Date of opening: 19oo. 170

Page  171 DESCRIPTION OF INSTITUTIONS Superintendent and orthopedic surgeon: John Joseph Nutt, M.D. Class: Convalescent hospital. Average number of children: 61. Capacity: 75. Plant: 48 acres of land, including large garden which supplies a good proportion of the vegetables used, orchard and pasture for live stock. Main building is a wooden residence, in Georgian style, beautifully situated; has three stairways, iron stairway outside, enclosed in iron screening; isolation building, solarium (dormitory building), barn used as school building for greater part of year, and shack (dormitory) also of wood. Fire drills held every two weeks. Much need of more space, especially for employes, many of whom have to live outside. Painted walls, bare floors, linoleum in center of wards. Admission: From four to sixteen years; no color restriction; only children resident in New York state; feeble-minded not often taken. Discharge: After patients are no longer in need of convalescent care. Facilities for care of children: Consultant medical staff of surgeons and physicians in cities throughout state. If applicant lives near one of these cities, he is asked to go to the consultant there, who forwards opinion of the case to the hospital. Surgeon-in-chief, who is also superintendent, is an orthopedic specialist; resident physician; graduate nurse. Operating room where all operations are performed. Some non-resident patients come for dressings and brace adjustment. Night watchman and night nurse. Isolation in separate building. New cases are isolated upon admission. A few pieces of special gymnastic apparatus for correction of lateral curvature. No indoor play room, but abundant outdoor space. Two inclines at rear of main building, one from barn used for school classes. School: Graded school. Resident teacher. Non-adjustable desks and seats. Hand work and vocational training: Sewing, stenciling, and wood blocking; furniture making taught by special resident teacher. Cost of property: $78,000. Year's expenditure per capita: $402. Comment: This hospital has an excellent location but needs a modern plant. The isolation building serves its purpose well, and the small solarium and shack furnish excellent facilities for outdoor sleeping for a limited number of children; the others sleep in wards in the main building, which do not furnish as good an opportunity for the entrance of light and air. It is difficult to keep a building which is 171

Page  172 CARE OF CRIPPLED CHILDREN not modern in its interior finish up to hospital standards of cleanliness. The space for employes is limited in the extreme; many of them live outside the institution and provision for those who do reside in the hospital is inadequate. The spirit of the institution is one of cheerful endeavor to do a great deal of work in crowded quarters. There is little "institutional" atmosphere, and the children seem happy and very much at home. NEW YORK COUNTRY BRANCH AND INDUSTRIAL SCHOOL OF THE NEW YORK ORTHOPEDIC DISPENSARY AND HOSPITAL, White Plains Date of opening: I904. Superintendent: Mr. Charles H. Burr. Orthopedic surgeon: Russell A. Hibbs, M.D. Class: Convalescent hospital. Average number of children: o14. Capacity: 130. Plant: 12 acres of land. Large brick building; superintendent's cottage of wood; separate power house; small greenhouse. Garden. Main building has painted walls, bare floors for children. Finish and equipment modern, including tile floors and marble partitions in toilet rooms. Wings where children live, fireproof; fire-escapes for employes. Admission: From three years up; no color restriction; curable cases only; large proportion of cases of bone tuberculosis. Parents sign statement agreeing to leave child in institution as long as surgeon-in-chief deems necessary for child's health, not legally binding but effective in many cases. Discharge: After cured and probability of relapse passed. Facilities for care of children: Operations at the New York Orthopaedic Hospital in the city; surgical dressing room here. Surgeonin-chief, orthopedic specialist, pays weekly visits, reviews all the children, and examines carefully a limited number at each visit. Resident physician; no graduate nurses. Night watchman; two night nurses. Isolation ward with 13 beds and bathroom. Food is brought to this ward through passageway with two doors. Dishes used are washed in the ward, dipped into carbolated water, returned wet to kitchen to be washed again there. Cooking under direction of housekeeper who is expert dietitian. Separate cubicles built within some of the wards do not hinder good circulation of air, yet give children separate rooms. Automatic elevator in central section of building, chiefly for employes. Rubber mats 172

Page  173 DESCRIPTION OF INSTITUTIONS one yard wide run full length of sun corridors. Homes visited before children are accepted, and children supervised after leaving, if necessary, by visiting nurses of city branch. School: Graded school with principal and other teachers. Work is comparable at practically all points with that in the best public schools; modern methods and equipment throughout. Desks adjustable as to height. Hand work and vocational training: Sewing, cooking, simple housework, gardening. Manual training curtailed because there are now few boys old enough to take it. Cost of property: $420,000. Year's expenditure per capita: $552. Comment: This Country Branch of a city hospital is one of the pioneer developments in the direction of unhurried care for convalescent crippled children in country surroundings, after they have received surgical attention in the city. It is well housed and equipped, and administered according to a system which secures efficiency in the work of employes with as little consciousness as possible on the part of the children of the necessary rules. There is a surprising degree of homelikeness for so large an institution, due in part to the cubicle arrangement which gives many of the children separate sleeping rooms, but due even more to the high character of the employes and their skill in creating a friendly relation to the children, which keeps them happy and permits the development of individuality without impairing good discipline. PENNSYLVANIA WIDENER MEMORIAL SCHOOL FOR CRIPPLED CHILDREN, North Broad Street and Olney Avenue, Philadelphia Date of opening: I906. Matron and chief nurse: Miss F. Isbell Doolittle. Orthopedic surgeon: G. G. Davis, M.D. Class: Convalescent hospital and industrial school. Average number of children: 96. Capacity: Ioo. Plant: 30 acres of land in a suburban residence district; o1 acres in vegetable gardens, 20 for buildings, ornamental grounds, playgrounds, and woodland. A high brick fence with wrought-iron gates bounds the front of the property. The school is approached through wide stretches of landscape gardening as beautiful as those on a country estate. The buildings are of uniform colonial architecture, constructed of red brick, trimmed with 173

Page  174 CARE OF CRIPPLED CHILDREN white. There is a large central administration and hospital building, flanked by four smaller buildings and connected with them by glass-enclosed passageways which are heated in winter. The isolation building, head gardener's cottage, engineer's cottage, and stables with rooms for some men employes, are apart from this central group. The main hospital building has kitchen, storage rooms, and sleeping rooms for maids in the basement. The first floor includes reception and office rooms, examining rooms, dentist's room, lavatories, the children's dining room and gymnasium. The second floor has two wards with adjoining sun parlors each accommodating 34. One of these wards is for boys, one for girls. Between them are smaller wards for acute or post-operative cases, surgical dressing room, lavatories, and linen closets. On the third floor there is a surgical suite comparable with those in the most completely modern general hospitals, including etherizing room, operating room, recovery room, sterilizing room, two rooms for X-ray photographic work, a special room for examination of the eye, ear, nose, and throat, surgeon's lavatory and dressing room, and storage rooms. One hundred and five operations were performed during the two years covered by the last printed report. The cottage for the older girls, and the one for the older boys, of similar design, include in each case library, dining and play rooms, a dormitory with 12 beds and Io individual rooms for children, and an office and a suite of living rooms for the house mother or house father. Another cottage is the school building, with two grade class rooms and a kindergarten room used also for hand work classes. The fourth cottage serves as residence for the physician, superintendent, and nurses. There are separate cottages for the chief engineer and head gardener, and rooms over the stable for colored men employes. The isolation building can be divided into two parts, each with examination room, ward and bath for children, nurses' room and bath and kitchen. It is used for isolation of infectious diseases and for isolation of children just admitted. A chapel has recently been erected near the central group of buildings in which services are conducted every Sunday. All interior finish in the buildings is of the most endurifig and beautiful materials. Painted walls in most rooms; tile in operating rooms; five-foot tile wainscoting in baths and lavatories, diet kitchens, wards; white marble wainscoting in reception hall. Tile floors in operating suite, baths and lavatories, diet kitchens; granolithic floors in kitchen; marble in reception hall; other floors 174

Page  175 DESCRIPTION OF INSTITUTIONS of bare wood. Equipment of every sort is modern and complete. Fire risk is at a minimum. Reinforced concrete walls. Outside railed iron fire-escapes, unusually wide. A summer home at Longport, New Jersey, has been recently built. It is a large bungalow in the shape of a hollow square with interior court and occupies a block of land on Atlantic Avenue, facing the ocean. Admission: Four to ten years; preference to residents of Philadelphia first, then to those in the rest of Pennsylvania. Children must be permanently crippled, yet not absolutely helpless; no lung tuberculosis; no feeble-minded or backward children. Only those capable of becoming at least partially self-supporting are accepted. Parents or guardians must sign an indenture binding child over to the trustees of the institution until he shall reach his majority. Children are admitted in groups at widely separated intervals, in order to make as infrequent as possible the concentration of effort necessary to prevent danger of possible infection to the children already in the institution. Discharge: After they reach the age of twenty-one, perhaps at eighteen, if ready to begin wage-earning. Facilities for care of children: Visiting medical staff including orthopedic specialists; superintendent, head nurse, two other day nurses and one night nurse, all graduate nurses; day attendants, one for night duty; house father for boys' cottage; house mother for girls' cottage; night watchman. Wards with cross ventilation from many windows and adjoining solaria. Fully equipped gymnasium for special corrective gymnastics which are taught by expert instructor who is also in charge of that work at the University of Pennsylvania Hospital; spends seven and a half hours each week here. Thresholds absent. Elevator in main building large enough for a bed; also elevator in each of the two cottages for older children. Abundant space for all purposes, including sitting rooms and libraries in children's cottages. Outdoor playgrounds for tennis, baseball, and other games. Boarding home on grounds of institution planned for discharged children who are partially selfsupporting. They will pay to the school for board such sums (not to exceed the cost) as they are able to pay from their earnings. School: Kindergarten taught by non-resident hand work teacher. Graded school with two non-resident teachers. Forty special desks and seats and 57 adjustable as to height only. Curriculum and examinations cover standards set for public schools of Philadelphia. 175

Page  176 Tc9AP WIDENER MEMORIAL SCHOOL First Floor Plan (South Half) (See pages 16 and 17) 176

Page  177 Horace Trumbauer, Architect FOR CRIPPLED CHILDREN First Floor Plan (North Half) (See pages 16 and 17) 12 177

Page  178 * * 'f M f It WIDENER MEMORIAL SCHOOL Second Floor Plan (South Half) 178

Page  179 * a Gnaw ~'~ ~ FOR CRIPPLED CHILDREN Second Floor Plan (North Half) 179

Page  180 WIDENER MEMORIAL SCHOOL FOR CRIPPLED CHILDREN Third Floor Plan

Page  181 DESCRIPTION OF INSTITUTIONS WIDENER MEMORIAL SCHOOL (Continued) Hand work and vocational training: Sewing, cooking, elementary nursing and general work in wards, basketry, stenciling, chaircaning, burnt woodwork, manual training, practical carpentry, engraving, cobbling, stationary engineering, teaching, music. Special teachers are engaged whenever necessary; other employes also give vocational training informally in many directions. New subjects are undertaken as soon as any of the children are ready for them, and the range of choice will be practically unlimited. Cost of property: $1,132,000, not including stable or cottages for engineer and gardener, or summer home at Longport. Year's expenditure per capita: $1,115. Comment: The Widener Memorial School was founded by Mr. P. A. B. Widener as a memorial to his wife and his eldest son. Since the loss of another son, Mr. George D. Widener, and a grandson, Henry Elkins Widener, by the sinking of the Titanic, Mr. Widener and other members of the family have regarded the institution, to which Mr. George D. Widener in particular had given close personal attention, more fully as a family memorial. The purpose of the founder has included the creation of a memorial whose architectural reserve and harmony of line make it an artistic contribution to the whole community. The large expenditure incurred in establishing so magnificent a plant and in providing so ample an endowment covers not only liberal provision for all phases of the care of Ioo crippled children, but the maintenance of an institution which must always be considered as partly memorial in character. For this reason it is fairly comparable as to the size of the buildings, the cost of property or yearly expenses, with few if any of the other institutions studied. It has therefore been decided not to include such figures for this school, which have been kindly furnished in full, in the comparative tables, but to add them at the end of this general account of the institution. The school is maintained from the income of a trust of $4,000,000 created by Mr. P. A. B. Widener in May, I912. Any surplus income unexpended will be added to the trust until it has reached $5,ooo,ooo. The trust will never exceed that amount, for further surplus income is to be expended for other charitable objects determined by the trustees, who are at present Mr. Widener, his son, and grandson. The charter grants power to increase the number of trustees, and it is planned to add in the near future persons outside 181

Page  182 CARE OF CRIPPLED CHILDREN the family, prominent citizens who are interested in the development of work for crippled children. TABLE H.-COST OF PLANT IN THE WIDENER MEMORIAL SCHOOL Cost Lands............. $400,000 Buildings (including heating apparatus and machinery) a... 709,910 Surgical and gymnastic equipment........ 7,508 Furniture and educational equipment..... 14,1o9 Total............... I$, 131,527 a Not including stable or cottages for engineer and gardeners. TABLE I.-CURRENT EXPENSES FOR ONE YEAR IN THE WIDENER MEMORIAL SCHOOL a Expense Salaries and wages $42,795 Provisions........ 32,605 Fuel and light...... 8,663b Clothing and bedding...... 4,699 Repairs..... 2,126 Medical and surgical supplies...... 1,968 Miscellaneous expenses..... 2,016 Care of grounds......... 3,506 Shop expenses....... 8,663 Total........ $17,041 a Figures for the year ending July 29, 1912. The average number of children in care in the year ending July 29, 1912, was 96. bThe equipment of the institution includes a power house. 182

Page  183 DESCRIPTION OF INSTITUTIONS TABLE J.-SQUARE FEET OF FLOOR SPACE PER CHILD IN THE WIDENER MEMORIAL SCHOOL Square feet Floor space per child FOR CHILDREN Indoor Day and play rooms...... 6 b Dormitories and wards......... 73 School rooms-general.......... 34 School rooms-industrial..... 8 c Dining rooms...... 33 Baths and toilets...... 24 Clothes rooms............. I Isolation rooms. 28 Total..... 207 Outdoor Day and play rooms. 24 Total....... 24 Total for children..... 231 FOR EMPLOYESa Sitting rooms.............. 15 Dining rooms............. 13 Bed rooms.. 62 Baths and toilets. 18 Total for officers.o..... 8 FOR GENERAL PURPOSES Offices and reception rooms..... 15 Kitchens....... 38 Laundry....... 33 Store rooms....... 107 Halls........ 115 Porches...... 28 d Miscellaneous purposes...45 Total for general purposes....381 FOR SPECIAL PURPOSES Medical and surgical rooms..... 35 Gymnasium (corrective)..... 17 Brace shop....... Total for special purposes.....52 Total for all purposes..... 772 e a It is to be noted that not all the employes sleep in the institution. b Libraries used as day rooms. c 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. e For corresponding figures, see Table II B, pp. 1 14-I 15. 183

Page  184 CARE OF CRIPPLED CHILDREN PENNSYLVANIA INDUSTRIAL HOME FOR CRIPPLED CHILDREN, Pittsburgh Date of opening: 1902. Superintendent: Rev. Lyman Mevis. Orthopedic surgeon: James 0. 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 composition 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 connected with main building furnish equivalent of outdoor sleeping 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 indoor 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: $i I o,ooo. Year's expenditure per capita: $333. Comment: All phases of work here are worth studying; the buildings are altogether adequate for care of convalescent cases and the 184

Page  [unnumbered] Sleeping Pavilions Floor Plan, Surgical Building INDUSTRIAL HOME FOR CRIPPLED CHILDREN, Pittsburgh, Pa. (See page 184)

Page  [unnumbered] PLAY PAVILION, SCHOOL HOUSE, AND GIRLS' HOUSE Virginia T. Smith Home for Incurables, Newington, Conn. (See page 186) CRIPPLED CHILDREN'S HOME, Buffalo, New York. (See page 19I)

Page  185 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: I897, as Fresh Air Home; since 9gog 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 summer. 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 tuberculosis; 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: $391. Comment: This small convalescent hospital has an excellent location and buildings which serve their purpose well. Outdoor sleepI85

Page  186 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 isolation would be desirable than the present isolation ward affords. ~/ Wf ~ 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 L-,(- Qmiddle of the forenoon. /i~ atC. 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: I896. 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: Ioo. 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

Page  187 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: $56,ooo. Year's expenditure per capita: $213. 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: 90o8. 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 restrictions; 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 surgeon 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 housework. 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

Page  188 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 children not eligible to any existing institution. She takes the children 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 I910, 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 $I.oo 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: I. 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 feebleminded, deaf or blind. Discharge: After children no longer need the special care offered. 188

Page  189 DESCRIPTION OF INSTITUTIONS Facilities for care of children: Superintendent a physician; home within 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: $11,400. 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 residence. 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. Seventeen beds in outdoor sleeping rooms or porches. School: Grade classes. Adjustable desks. Hand work and vocational training: Sewing, cooking, simple housework, basketry, chair-caning, manual training. Special teacher. 189

Page  190 CARE OF CRIPPLED CHILDREN Cost of property: $37,000. Year's expenditure per capita: $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, Englewood Date of opening: I893. Superintendent: Miss Angeline L. Staples. Orthopedic surgeon: Henry Ling Taylor, M.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; unguarded windows for ventilation; outside wooden stairway; extinguishers; painted walls; maple floors in dormitories and bathrooms. 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 housework. Cost of property: $ 15,ooo. Year's expenditure per capita: $43. 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

Page  191 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 respect, be classed with the convalescent hospitals. The atmosphere is most cheerful and the children seem very contented. NEW YORK CRIPPLED CHILDREN'S HOME, 487 Niagara Street, Buffalo Date of opening: I91o. 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 children 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: $184. 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 officers who keep in close personal touch with all phases of the work. NEW YORK DARRACH HOME FOR CRIPPLED CHILDREN, I 8 West Io4th Street, New York City Date of opening: 1899. 191

Page  192 CARE OF CRIPPLED CHILDREN Superintendent: Mrs. J. K. Mott. Orthopedic surgeon: Arthur H. Cilley, M.D. Class: Asylum home. Average number of children: 18. 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 examines 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 outdoor 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 overlooks 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 1911 it is in good condition. The floors are bare; 192

Page  193 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 18 childrennine 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 playing a spirited game of baseball with two ablebodied youngsters. NEW YORK HOUSE OF THE ANNUNCIATION FOR CRIPPLED AND INCURABLE CHILDREN, Broadway and 156th Street, New York City Date of opening: I892. Superintendent: The Mother Superior of the Sisters of the Annunciation. Orthopedic surgeon: T. Halsted Myers, M.D. (Consulting.) Class: Asylum home. Average number of children: 30. Capacity: 30. Plant: Brick building on lot IOO by Ioo 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. Many of the chil13 193

Page  194 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 children 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 between first and second story. Chapel 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 University Extension Society. Cost of property: $156,ooo. Year's expenditure per capita: $214. Comment: This is the Mother House of the Sisters of the Annunciation, 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, including 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, 19og, shows eight cases of paralysis out of 19 patients. Dr. Myers, the orthopedic surgeon summarizes each case. He specifically mentions poor mental 194

Page  195 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 i6 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 institution, 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 io 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 children 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, I41 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

Page  196 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 employment. 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 I913 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 included 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. I96

Page  197 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: I903. 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: 18. 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 facilities 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 graduate nurses. Thresholds absent. Incline to back yard (playground). 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: $I 1,6oo. Year's expenditure per capita: $282. 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 Community of the Transfiguration, and it has been made a diocesan institution of the Episcopal Church. Since the affiliation with St. 197

Page  198 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: I877. 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. Covered 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: $395. 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 individuality of the children through separate rooms and individual possessions of every sort. This is especially important since the 198

Page  199 DESCRIPTION OF INSTITUTIONS children stay permanently. The atmosphere is thoroughly cheerful. PENNSYLVANIA HOME OF THE MERCIFUL SAVIOUR FOR CRIPPLED CHILDREN, 4400 Baltimore 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. Average number 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 Pennsylvania 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. Rubber floor covering in center of surgical ward and some halls. Elevator. 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 increased. SUMMER HOME, Avon-by-the-Sea, New Jersey Date of opening: I888. I99

Page  200 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 sleeping 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. MICHAEL 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, M.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. Fireescape could be used as separate outside entrance. Sun room over 200

Page  201 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: $189. Comment: This is the only institution exclusively for colored crippled children in America. Similar places providing care for longer time than a hospital can offer are much needed in other communities 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 summer home at Sea Isle City, Cape May, at a cost of $3,ooo, and expended $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. f 7 201

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Page  203 APPENDIX

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Page  205 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 Reasons for not Listing HOSPITAL MASSACHUSETTS Boston Children's Hospital NEW YORK Randall's Island New York City Children's Hospital (Department of Public Charities) New York City Seton Hospital (Nazareth Branch for Women and Children) PENNSYLVANIA Philadelphia Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases WISCONSIN Milwaukee Children's Free Hospital A general hospital for children (about one-fourth orthopedic cases) A general hospital for children (orthopedic wards only) Tuberculosis hospital (about 15 per cent crippled children) (About one-third orthopedic cases) A general hospital for 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

Page  206 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 Hospital 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 orthopedic cases in I90o A general convalescent home (about one-half crippled children) ASYLUM HOMES NEW YORK New York City House of the Holy Comforter for Incurables PENNSYLVANIA Allentown Good Shepherd Home for Crippled Orphans Receives women and children (about one-fifth cripples) Receives cripples, infants, dependent 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

Page  207 APPENDIX Name of Institution Hawthorne Blythedale (Convalescent Home for Tuberculous Crippled Children) Bath Beach Haxtun Cottage at the Children's Summer Home of the New York Children's Aid Society Sheepshead Bay Summer Home for Crippled Children Southampton Summer Home for Crippled Children (maintained by the Post-Graduate Hospital, New York City) Tarrytown-on-the-Hudson Robin's Nest RHODE ISLAND North Kingston Crawford Allen Memorial Hospital (Branch of Rhode Island Hospital) Reasons for not Listing Summer institution, when visited. Since opened all the year round Summer care only Summer care only Summer care only Summer care only Summer care only DAY SCHOOLS MASSACHUSETTS Boston Industrial Crippled Children School for and Deformed Day care only, without board NEW YORK New York City Crippled Children's East Side Free School Miss Spence's School Society Rhinelander Industrial School for Crippled Children Day care only, without board Day care only, without board Day care only, without board 207

Page  208 CARE OF CRIPPLED CHILDREN Name of Institution Reasons for not Listing Trade School of the Hos- Vocational school. Deals with pupital of Hope for the In- pils over 16 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 outpatients 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 Ioo. 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

Page  209 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 department 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 segregated. The hospital plans to discharge the children before they are sixteen, but sometimes they have to be kept longer. The social worker tries to find homes for them, return them to friends or place them in other institutions. There is a surgical building where all operations are performed and isolation buildings for various contagious diseases. The orthopedic cases are all housed on the first floor. 14 209

Page  210 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 orthopedic 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, 19 11, 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 substantial 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 children 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 composition 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 6o 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

Page  211 APPENDIX PENNSYLVANIA PHILADELPHIA ORTHOPEDIC HOSPITAL AND INFIRMARY FOR NERVOUS DISEASES, 17th and Summer Streets, Philadelphia Date of opening: I868. Superintendent: Miss Margaret S. Wilson. Surgeon: G. G. Davis, M.D. This hospital has I26 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 proportion 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 occupied 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: I874. 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. Margaret 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

Page  212 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 1912. The home has go 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 building 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 sanitary 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

Page  213 APPENDIX the patients coming to the institution, especially in summer, remain 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 18o of these cases during the year 191 I, 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 Pennsylvania, 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: Mrs. Marion H. Withycomb. This institution is a home for convalescent children from New York City. In the year ending September 30, 1912, it had an average daily attendance of 16. 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 somewhat 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 children 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 I909. 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 orthopedic surgeon. He sends to this small institution some of his poorer patients whose homes do not afford conditions proper for convalescence. The parents are encouraged to make small payments, if they are able to do so, because it is thought better that they 213

Page  214 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 available, 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 institution has only o1 beds and many more could be filled; nevertheless, the children admitted are always kept until their cure is entirely completed. Several of the children have been continuous residents since the opening for all-the-year work in 1909. By this plan the fruits of the beneficent work of the hospital are assured 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 summer, 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

Page  215 APPENDIX ST. AGNES HOSPITAL FOR CRIPPLED AND ATYPICAL CHILDREN, White Plains (In charge of the Sisters of St. Francis) Date of opening: 19o8. 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, 19 I, 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 cultivated as gardens; the remaining space is used for lawns and a playground. The main building, school building, and cottage most used by the cripples are of brick, partly fireproof. Other buildings, including an isolation cottage, a laundry building with secondfloor 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. Most 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 I, 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 II:30, and from 1 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

Page  216 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: 1890. Superintendent of nurses: Miss Arvilla Patton. Visiting surgeon: Gordon N. Morrill, M.D. Out of 233 cases treated during the year ending December 31, 1911, 130 are surgical cases, most of them orthopedic. The medical 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 lo miles from the center of Cleveland, in a section which is becoming suburban in character. The institution owns Io 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

Page  217 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 accommodates 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 convalescent 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 medical 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 contributes $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, I39th Street and Riverside Drive, New York City Incorporated: I88o. 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 received 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 1912 there were only about I5 children out of 78 inmates. These children were crippled and from four to eighteen years of age. 217

Page  218 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 41 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 dependents 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,ooo per year. The per capita expense is only $140 per inmate: too little for the classes cared for. A fine spirit pervades the home. SUMMER 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 children who need convalescent country care are taken, including children 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 io acres of land, including 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

Page  219 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 I I 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 architectural reason the second large dormitory could not be built in similar fashion, but the I9 windows furnish almost solid walls of glass and cross ventilation is possible, which secures a close approach 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 financial 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

Page  220 CARE OF CRIPPLED CHILDREN 15 of the children remained throughout the summer. The president 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 Children), Hawthorne Date of opening: June, 19o4. In 1912 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 I912 and 1913 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 Children 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

Page  221 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 children 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 children. A resident kindergarten teacher amuses them and does elementary teaching. Most 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 seashore. One wooden building with 16 beds is reserved for crippled girls between the ages of three and fifteen. They come in parties of I6 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 dormi221

Page  222 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 dining room of the cottage. SUMMER HOME FOR CRIPPLED CHILDREN, 2425 Ocean Avenue, Sheepshead Bay Date of opening: 19I 1. Parties of crippled children are received at the home of Mrs. Harrison Gray Lamsvn at Sheepshead Bay, throughout the summer. Girls come i A 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 ordinarily 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

Page  223 APPENDIX modified bungalow style and a separate building with one large room 18 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 superintendent acts as visiting nurse for the orthopedic ward in the PostGraduate 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 prepared. 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 kindergarten 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

Page  224 CARE OF CRIPPLED CHILDREN This summer home for convalescent crippled children is an independent 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 I beds. Sometimes two of the youngest children sleep in the nurse maid's room. Liberal provision has been made for both physical care and amusement 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 o1 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

Page  225 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 elementary 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 occasions, 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 o06 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 furnishes 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 $5,000, has one very large room used as dining room and living room, a kitchen and toilet rooms, 15 225

Page  226 CARE OF CRIPPLED CHILDREN a porch used as an outdoor school room, and a large uncovered platform 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 distance 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 degrees, 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

Page  227 APPENDIX and vocational classes. The average number of children in the grades for the year ending April I, 1912, was go. The average number in the industrial department was 29. It has a capacity for ioo 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. Windows 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 building for outdoor school work is the first building in America especially 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 $1 5,000. The building has a substantial roof and one brick wall. The other three sides have steel pillars covered with concrete, between which there are sliding glass partitions. The roof is built in monitor form with movable windows 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 physical 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

Page  228 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 throughout 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 children 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 period 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 training 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,ooo. 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, M.D. The aims of this school are thus stated in its last report: "To 228

Page  229 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 900o. The work was carried on at several different addresses before the opening of the excellent building 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 includes 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 19o. 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 M. Wallace. The medical rooms give ample provision for examination of the children, application of plaster of Paris dressings and braces, massage and electrical 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 become 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 contributed some of its products to sales. 229

Page  230 CARE OF CRIPPLED CHILDREN For the year 1913 the receipts from the workrooms were $6,400, of which $4,450 was returned to the workers for wages, and the remainder 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 undertaken 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 country 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 $i80,ooo. The property at Oakhurst, New Jersey, is worth $25,ooo. The total operating expense for the year ending November 30, 1912, 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

Page  231 APPENDIX must be able to gain something from school work. Kindergarten processes are taught but there is no vocational training. The children 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, g19o, was $3,967, or about $i8o per child. RHINELANDER INDUSTRIAL SCHOOL FOR CRIPPLED CHILDREN, 350 East 8oth 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 Children'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 orthopedic 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, I59th 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

Page  232 CARE OF CRIPPLED CHILDREN for 50. Those maimed by accident are preferred to those crippled through disease. The school is maintained by a single philanthropist 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 neckties. Opportunity to learn this trade and the weaving of artistic rugs will be offered later if a sufficient number of men make application 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

Page  233 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, examines 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 kindergarten 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 adjustable, 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

Page  234 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 Cripoled and Delicate Children at Claverack, New York. According the last report, printed in June, 19o9, 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 9gog 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 Pennsylvania, 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 Baltimore, and the Sanatorium for Hebrew Children of the City of New York, at Rockaway Park, Long Island. The St. Louis Children'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

Page  235 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, 191o, by graduates from the school) Occupations Weekly earnings Monotype casting operator.. $20.00 Lunch cart tender... 20.00 Manufacturing jeweler. 20.00 Cashier....17.00 Printer of cards.. 15.00 Bookkeeper..... 14.00 Town weigher..13.50 In charge of sample department for manufacturer's agent.. 12.00 Compositor..... 12.00 Office girl... 12.00 Sales girl in department store 10o.oo Sales girl...1000oo Printer... 10.00 Office girl...10.00 Secretary....9.oo Stenographer... 9.00 Printer....9.oo Clerk.... 8.oo Stenographer. 8.oo Shank-tacking operative in shoe factory....7.00 Press feeder...7.00 Power machine operative (on underwear) (Piece work). 7.00 Telephone operator. 6.50 Office worker, department store 6.oo Stenographer...6.oo Stenographer...6.oo Bookkeeper...6.oo Fruit and vegetable dealer.5.00 Electrical apprentice... 4.50 Sorter of nails....4.50 Curtain maker... 3.00 Chamber worker and seamstress. 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 vara of hip Pott's disease Tuberculosis of knee Lateral curvature Amputation of leg Lateral curvature 235

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Page  237 INDEX

Page  238

Page  239 INDEX ABBOTT, EDVILLE G., M. D., I42 ADMISSION AND DISCHARGE; age and color restrictions, Io6 AID ASSOCIATIONS: 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 elevators, 50; Hospital for Ruptured and Crippled, New York City, 6; leading institutions, 6, 7 ARTIFICIAL ARMS: special devices costly, 65 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 public school classes, 33; propaganda of work, 16 ASYLUM HOMES (continued) Home for Crippled Children, New York City, description of, I9I-I93; for homeless children, II; general descriptions of institutions, 206; Good Shepherd Home, Allentown, Pa., description of, 218; Happy Haven, Chicago, 92, description of, 187, i88; Holy Cross House, Cleveland, Ohio, description of, I97, I98; Home for Disabled Children, Maywood, Ill., description of, i88, I89; Home of the Merciful Saviour for Crippled Children, Philadelphia, description of, 199, 2oo; House of the Annunciation for Crippled and Incurable Children, 7, description of, I93 -I95; House of the Holy Comforter for Incurables, New York City, description of, 217, 218; House of St. Michael and All Angels, Philadelphia, description of, 200-201; incurable cases in, 21; institutions having summer homes, I86; New England Peabody Home for Crippled Children, Hyde Park, Mass., description of, I89, 190; New York Home for Destitute Crippled Children, 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, I24; statistics of capacity, Table I C, i o; statistics of children in care, Table I C, IIo; statistics of cost of plant, Table III C, I20; statistics of employes, Table I C, IIo; statistics of floor space per child, Table II C, 116; statistics of sources of support, Table I C, Io; summer homes, current expenses, I86; Virginia T. Smith Home for Incurables, Newington, Conn., description of, i86, 187 ASSOCIATION OF PUBLIC SCHOOL TEACHERS OF CRIPPLED CHILDREN: New York City, aid society, 234 ASYLUM HOMES, i86-201; admission and discharge, rules of, Table VI C, 132-I33; average cost, per bed, 99, 20o; capacities of, and number of children treated during year, 92, 116; characteristics of, and purposes, 26, 27; child-placing societies and homeless cripples, II; Children's Aid Society, New York City, placing children from, 22, 23; Children's House of the Home for Incurables, Philadelphia, description of, I98, I99; Crippled Children's Home, Buffalo, N. Y., description of, 191; Daisy Fields Home and Hospital for Crippled Children, Englewood, N. J., description of, I90, I9I; Darrach 23

Page  240 INDEX BAER, WILLIAM S., M. D., I58 BARTINE, OLIVER H., I51 BELLEVUE HOSPITAL: New York City, training for nurses, 33 BENJAMIN ROSE FOUNDATION, 217 BIRMINGHAM, ENGLAND: census of cripples in 191I, 19-2I, 67-68 BLYTHEDALE: (convalescent home) Hawthorne, N. Y., description of, 220, 221 BRACE SHOPS: adjuncts to hospitals, 29, 3I BRACKETT, E. G., M. D., 226 BRADFORD, EDWARD H., M. D., I6I BRADFORD FRAMES: Providence Hospital 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, i8 CENSUS OF CRIPPLES: Birmingham, England, in 19II, 19-2I, 67-68; no authentic census in United States, I9; organizations for relief of cripples in United States, I8-I9; proportion of, in United States and Germany, 19, 20; records of crippled and deformed in England and Germany, I8-20; self-support, in England, 67-69 CHEERFULNESS: characteristic of crippled 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 OF NEW YORK: disposition of children, 22, 23 CHILDREN'S COUNTRY HOME: Westfield, N. J., description of, 218, 219 CHILDREN'S FREE HOSPITAL: Milwaukee, description of, 21I CHILDREN'S HOSPITAL: Boston, description of, 208, 209; social service department, 36 CHILDREN'S HOSPITAL: Portland, Maine, description of, 142-144; dietary for, 39; infectious disease wards, 46; Maine Children's Committee, 34; outdoor space, 42; physical culture and gymnastics, 36; training school for nurses, 32; visiting nurses and out-patients, 34 CHILDREN'S HOSPITAL SCHOOL: Baltimore, description of, 158, 159; nurses from Church Home and Infirmary, 32; outdoor sleeping porches, 42; resident physicians of, 31; wards for infectious diseases, 47 CHILDREN'S HOUSE OF THE HOME FOR INCURABLES: Philadelphia, asylum home, 51; description of, I98, 199; number of employes, 94; school room equipment, 51; ward for infectious diseases, 48 CHILDREN'S ORTHOPEDIC HOSPITAL: Seattle, Wash., description of, I56, I57; nurses from general hospital, 32; out-patients and visiting nurses, 34, 35 CHILDREN'S SEA-SHORE HOUSE: Atlantic City, N. J., description of, 212, 213 CILLEY, ARTHUR H., M. D., I92 CLASSIFICATION OF CRIPPLES: committee on education, Birmingham, England, I9-20; maimed and diseased, 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 locations for tuberculous children, 43; Home for Destitute Crippled Children, outdoor sleeping, 41; institutional 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

Page  241 INDEX CONNECTICUT: Virginia T. Smith Home for Incurables, Newington, II, 31, 42, 48, 92, description of, I86-I87 CONVALESCENT CHILDREN'S HOME: Chappaqua, N. Y.; description of, 213 CONVALESCENT HOMES: admission and discharge, rules of, Table VI B, 13o-I3I; advantages of, in cost and permanent cures, I4; auxiliaries to orthopedic hospitals, I3; average cost, per bed, 98, II9; capacity of, 14, and number of children cared for during year, 92, 114-II5; characteristics of, and purposes, 26; Children's Hospital School, Baltimore, description of, 158, 159; Children's Sea-Shore House, Atlantic City, N. J., description of, 212, 213; Convalescent Children's Home, Chappaqua, N. Y., description of, 213; Convalescent Home for Destitute Crippled Children, Chicago, I57, I58; Convalescent Home of Boston Children's Hospital, description of, 211, 212; cost of land for, ioo; Country Branch and Industrial School of New York Orthopaedic Hospital and Dispensary, 172, 173; Country Convalescent Hospital, Rochester, N. Y., description of, 213-214; examples of, 7; general descriptions of institutions, 205, 206; House of St. Giles the Cripple, Garden City, N. Y., description of, I68-I69; Industrial Home for Crippled Children, Pittsburgh, description of, 184, I85; isolation and infectious diseases, 46, 47; Kernan Hospital School, Baltimore, description of, I59-161; Massachusetts Hospital School, description of, I6I-i65; Minnesota State Hospital and School, description of, i66, 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 A of, I69-170, number of employes, 16 2 CONVALESCENT HOMES (continued) 94; Sea Breeze Hospital, New York, description of, 167, i68; school work, more extensive than in hospitals, 55; Sewickley Fresh Air Home, Sewickley, Pa., description of, I85, i86; State Hospital for Care of Crippled and Deformed Children, West Haverstraw, N. Y., I70-I72; statistics of annual expense per capita, Table IV B, 122; statistics of capacity, Table I B, Io9; statistics of children in care, Table I B, Io9; statistics of cost of plant, Table III B, II9; statistics of employes, Table I B, Io9; statistics of floor space per child, Table II B, 114; statistics of sources of support, Table I B, iog; types of special excellence, 7; Van Leuven Browne School, Detroit, capacity of, 92, description of, I65; Widener Memorial School for Crippled Children, Philadelphia, description of, 173-183, number of employes, 94 CONVALESCENT HOME FOR DESTITUTE CRIPPLED CHILDREN: West Chicago, description of, 157-158; outdoor sleeping porches, 42; strictly convalescent institution, 7 CONVALESCENT HOME OF BOSTON CHILDREN'S HOSPITAL: description of, 211, 212 COST OF PLANTS: a comparison of, 98; average for asylum homes, per bed, 99-Ioo, 120; average for convalescent homes, per bed, 98, II9; average for hospitals, per bed, I 8; equipment, furniture, and miscellaneous, ioo; lands and buildings, I00 "COTTAGE AND CONGREGATE INSTITUTIONS": floor space of institutions, 96 COUNTRY BRANCH HOMES: convalescence best promoted in, 13 COUNTRY BRANCH OF NEW YORK ORTHOP~EDIC HOSPITAL: cripples assume work, 4; description of, 7, I72-I73; floor space of, 96; resident physicians of, 31; separate wards for infectious diseases, 47; special outdoor space, 42 41

Page  242 INDEX COUNTRY BRANCH MINNESOTA STATE HOSPITAL: physical culture and gymnastics, 36; quarantine ward of, 47. See also Minnesota COUNTRY CONVALESCENT HOSPITAL: Rochester, N. Y., description of, 213-214 COUNTRY INSTITUTIONS: trades taught in formal classes, 74-75 CRAwFORD ALLEN MEMORIAL HOSPITAL: North Kingston, R. I., description of, 225, 226 CRIPPLED CHILDREN'S DRIVING FUND: aid given in own homes, 2 CRIPPLED CHILDREN'S EAST SIDE FREE SCHOOL: New York City, description of, 59, 228-230; fresh air provided, 43; sewing classes and embroidery, 82; weekly clinics and surgical work, 33 CRIPPLED CHILDREN'S HOME: Buffalo, N. Y., description of, I9I; special outdoor space, 42 CROFUT, MARTHA M., M. D., I88 CURRENT EXPENSES: annual, for hospitals, convalescent and asylum homes, 100-102, 121-124; per child, in asylum homes, Ioo, I24; per child, in convalescent homes, Ioo, 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, 90o, I9I; graduate nurses employed, 32 DARRACH HOME FOR CRIPPLED CHILDREN: New York City, description of, 19I-I93 DAVIS, G. G., M. D., I73, 2II DAY SCHOOLS: classes needed, 21, 23, 24; descriptions of, 207, 2o8, 226-234; Crippled Children's East Side Free School, New York City, description of, 228-230; Industrial School for Crippled and Deformed Children, Boston, description of, 226 -24 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, description 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 physical culture, 38 DICKSON, FRANK, M. D., 199, 212 DIETARY: food costs, per person fed, I02; New York Orthopledic Dispensary and Hospital, trained dietitian, 40; Sewickley Fresh Air Home, Sewickley, Pa., 40; special, nourishing food essential, 39 DISPENSARIES: efficiency of service, 15, 33-36; Hospital for Ruptured and Crippled, work done by, Io7; in hospitals and convalescent homes, 33-36; Lakeside Hospital, Cleveland, Ohio, visiting nurses, 35; New York Orthopaedic Dispensary and Hospital, system of supervision, 35; number in seven cities, 107; out-patients and daily attendance, o07; out-patients and visiting nurses, 34-36, I40; special schools a corollary of, I5; statistics of work in nine institutions, Table IX, I4o; when open, I07 EAGLESON, JAMES B., M. D., I56 EDUCATION: buses for school children, 52; Chicago public school classes, 56, 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 school classes, 56, 58; differences in school work, 55-56; Industrial School for Crippled and Deformed, Boston, special building, 54; Massachusetts Hospital School, outdoor classes and equipment, 51, 53, 54; Miss Spence's School Society, class on steamer deck, 59, 60; New

Page  243 INDEX EDUCATION (continued) York City public school classes, 56-57; outdoor school classes a healthful factor, 53-55; Philadelphia, public school classes opened, I9I3, 56; problems to be met for curable and incurable cripples, 49 -50; public and private pay schools, 49-61; scope of school work in hospital, convalescent, and asylum homes, 55-56; Sea Breeze Hospital, Coney Island, outdoor teaching, 54; Sewickley Fresh Air Home, outdoor school. 54; summer school at Oakhurst, N. J., subsidiary 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 I9II, 67-68; census report of deformed, 18-20; report of census committee on workshops for cripples, 68-69 FASSETT, FRED J., M. D., I56 FEDERATION OF ASSOCIATIONS FOR CRIPPLES: New York City, aid society, 234; outdoor school rooms in winter discussed, 43; statement by Dr. Henry Frauenthal, on benefits of sunlight, 44 FINE ARTS: music taught in many institutions, 86-87 FISH, JOHN E., M. D., 161 FISKE, JAMES PORTER, M. D., 233 FITCH, RALPH R., M. D., 2I3 FOOD COSTS: per person fed, I02, 12 FRAUENTHAL, HENRY W., M. D., 44, 149 FRAZIER, CHARLES H., M. D., I99 GARDENING: advantageous for tuberculosis cases, 74; country institutions which teach, 74; Massachusetts Hospital School, farm work and gardening, 74 GERMANY: Professor Lange, of Munich, and number of crippled children, GERMANY (continued) 18, I9; Sir John Byers and census of cripples, i8 GIBNEY, VIRGIL P., M. D., 151 GILLETTE, ARTHUR J., M. D., 145, i66 GOOD SHEPHERD HOME: Allentown, Pa., description of, 218 GYMNASTICS: special teachers and apparatus, 36-37 HAND WORK IN 37 INSTITUTIONS: statistics, Table VIII, 137 HAPPY HAVEN: Chicago, capacity of, 92; description of, 187, I88; number of employes, 94 HAXTUN COTTAGE: Bath Beach, N. Y., description of, 221, 222 HELIOTHERAPY: benefits derived from, in bone tuberculosis, 43, 44; constant use of, at Sea Breeze Hospital, New York, 44; use of, at Providence Hospital, for tuberculosis, 44 HIBBS, RUSSELL A., M. D., 55, 172, 2Io HOLY CROSS HOUSE: Cleveland, Ohio, description of, I97, 198; graduate nurses employed, 32; physical culture and gymnastics, 36; school classes, where held, 54; special outdoor space, 42 HOME FOR CRIPPLED CHILDREN: Newark, N. J., description of, 147, I48; number of employes, 93 HOME FOR DESTITUTE CRIPPLED CHILDREN: Chicago, description, 4, 5, I41, I42; infectious disease wards, 45; nurses from Presbyterian Hospital, 32; outdoor sleeping, 41; physical culture and gymnastics, 36 HOME FOR DISABLED CHILDREN: Maywood, Ill., description of, I88, I89; founder of and teacher, a cripple, Miss Kittie Smith, a wonderful example of vocational training, 4, 64; special outdoor space, 42 HOME FOR INCURABLES: Newington, Conn., i86, i87; minor operations performed, 31; outdoor sleeping porches, 42; quarantine and isolation building, 48; special outdoor space, 42 243

Page  244 INDEX HOME OP THE MERCIFUL SAVIOUR FOR CRIPPLED CHILDREN: Philadelphia, description of, I99, 200; graduate 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; average cost per bed, 98, 118; characteristics of, and purposes, 26; Children's Free Hospital, Milwaukee, description of, 2II; 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, Ioo; descriptions of, I41-I57; 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., I47, I48; Home for Destitute Crippled Children, Chicago, description of, I4I, I42; Hospital for Deformities and Joint Diseases, New York City, description of, 149, I50; Hospital for the Ruptured and Crippled, New York City, capacity of, 92, description of, 151-I55; Nebraska Orthopedic Hospital, description of, I46, I47; New Jersey Orthopaedic Hospital and Dispensary, 92, description of, 148, I49; New York City Children's Hospital, description of, 209, 2io; New York Orthopeedic Dispensary and Hospital, 155, I56; number of employes, 93-94; orthopedic wards in, 234; Philadelphia Orthopaedic Hospital and Infirmary for Nervous Diseases, description of, 2II; school work different from that in convalescent homes, 55; Seton Hospital, New York City, description of, 2Io; State Hospital for Indigent, Crippled, and Deformed Children, St. Paul, description of, 144-145; statistics of annual expense per capita, Table IV A, 121; statistics of capacity, Table I A, io8; statistics of children in care, Table I A, io8; statistics of cost of plant, Table HOSPITALS (continued) III A, ii8; statistics of employes, Table I A, io8; statistics of floor space per child, Table II A, II2; statistics of sources of support, Table I A, Io8; total capacities of, 10, and number of children cared for during year, 92 HOSPITAL FOR DEFORMITIES AND JOINT DISEASES: New York City, description of, I49, 150; number of employes, 93; outdoor sleeping porches, 42, 43; physical culture and gymnastics, 36; planning country branch, 13 HOSPITAL FOR THE RUPTURED AND CRIPPLED: New York City, capacity of, 92; description of, I5I-155; dispensary work, scope of, Io7; extensive outdoor space, 42; most complete in United States, 6; physical culture and gymnastics, 36; planning country branch, 13; spacious isolation ward, 46; vocational training provided, 4, 7I HOSPITAL OF UNIVERSITY OF PENNSYLVANIA: Philadelphia, complete gymnasium, specialist teacher, 36; orthopedic wards in, 234; social service department of, 35 HOUSE OF HOLY COMFORTER FOR INCURABLES: New York City, description of, 217, 218 HOUSE OF ST. GILES THE CRIPPLE: Garden City, N. Y., description of, i68, 169; sewing done informally, 73; special outdoor space, 42 HOUSE OF ST. MICHAEL AND ALL ANGELS: Philadelphia, description of, 200-20I; domestic training, 73; special outdoor space, 42 HOUSE OF THE ANNUNCIATION FOR CRIPPLED AND INCURABLE CHILDREN: New York City, description of, I93-I95; example of asylum home, 7; ward for infectious diseases, 48 HUMPHRIES, ROBERT E., M. D., 148 HUTCHINS, JAMES H., M. D., I67 244

Page  245 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, Chicago, 4, 5, 32, 36, 41, 45, I4I-I42; Home for Disabled Children, Maywood, 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, I02-105; public funds for current expenses, 102-104; sources of, for institutions, 102; sources of, statistics for 35 institutions, Table V, 125 INDUSTRIAL HOME FOR CRIPPLED CHILDREN: Pittsburgh, description of, I84, I85 INDUSTRIAL SCHOOL FOR CRIPPLED AND DEFORMED CHILDREN: Boston, 6o-6i, 81-82, description of, 226 -228; occupations and earnings, 235; printing plant a profitable enterprise, 85-86; special outdoor school building, description of, 54 INFECTION: quarantine to prevent, 45 -48 INSTITUTIONS: absence of political control, 5; architecture and cost, 6, 7, II8-20o; character of employes, 3 -5; classification of, 2, 25; cripples aided in their own homes, 2; current expenses, IO-I02, I2I —I24; date of opening in 13 states, 6; expenses per capita, II; first American study of construction and management, i; five forms of work recognized by Miss Reeves, 13; floor space per child, 95, 98, II2 -II6; gradual development of, 5; hospital rates per capita, compared with convalescent and asylum homes, II; majority near large cities, 25; number and capacities of, 2, 5; physical conditions in, 38-39; protracted care and objections to, 23; spirit which animates the work, 3-5; surgical and hygienic standards, 38-39; work assumed by cripples, 3 JACKSON, EGERTON S., M. D., I95 JAEGER, CHARLES, M. D., 231 JOHNS HOPKINS HOSPITAL: Baltimore, orthopedic wards in, 234; social service department of, 36 KELLEY, S. W., M. D., I97 KERNAN HOSPITAL SCHOOL: Baltimore, description of, I59-16I; isolation tent for quarantine, 47; measures to prevent infection, 45; nurse maids' training school, 33; outdoor sleeping porches, 42; stenography and typewriting taught, 74; superintendent and resident physicians of, 30, 3I KINDERGARTEN WORK: and vocational training, 71, 78, 79, 8o, 8i LAKESIDE HOSPITAL: Cleveland, dispensary cases and visiting nurses, 35; orthopedic wards in, 234 LANGE, PROFESSOR: number of crippled children in Germany, I8, 19 LE BRETON, PRESCOTT, M. D., I9I LITTLE, MARGARET, 157 LoRD, J. P., M. D., 146 LOVETT, ROBERT W., M. D., I6I, 189, 208 MCMURTRIE, DOUGLAS C.: bibliography on care of crippled children, I7; pamphlet on care of crippled children in America, I MAINE: Children's Hospital, Portland, 32, 33, 34, 36, 39, 42, 46, I42-I44 MARYLAND: Children's Hospital School, Baltimore, 31, 32, 42, 158-I59; Kernan Hospital School, Baltimore, 33, 42, 45, 74, 83, 87, I59 -I6I; Johns Hopkins Hospital, Baltimore, 36, 234 MASSACHUSETTS: bill for state institution, 5; Children's Hospital, Boston, 30, 36, 208-209, 211-212; Industrial School for Crippled and Deformed Children, Boston, 54, 60, 8i, 82, 85, 87, 226-228, 235; 245

Page  246 INDEX MASSACHUSETTS (continued) Massachusetts Hospital School, 75-77, i6i, I65; New England Peabody Home, Hyde Park, 31, 32, 42, I89-190; state institutions, one, 104 MASSACHUSETTS HOSPITAL SCHOOL: Canton, 6, 7, 42, 51, 86; description of, i6i-i65; capacity of, for occupational training, 75; features of outdoor school classes, 53-54; interesting developments in occupational training, 77; natural aptitude a guide for occupational work, 76; physical culture and gymnastics, 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, woodworking and wood carving, 85 MERRILL, WILLIAM JACKSON, M. D., 212 MEVIS, LYMAN, REV., I84 MICHIGAN: Van Leuven Browne Hospital School, Detroit, description of, 165; outdoor sleeping, 4I MINNESOTA: Minnesota State Hospital, St. Paul, 144, I45; first state hospital, in I897, 7; Minnesota State Hospital and School, Phalen Park, 7, 36, 45, i66, 167; mechanical 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, I44-I45; hospital for contagious diseases and quarantine, 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., I97, 2I6 MOSHER, BURR BURTON, M. D., 168 MYERS, T. HALSTEAD, M. D., I93 NEBRASKA: Nebraska Orthopedic Hospital, Lincoln, 29, 32, 71; cataloguing and library work taught, 73; description of, I46-I47; outdoor sleeping porches, 42; salaried surgeon-in-chief, 29; school classes in hospital, 55; state institution, o14; training school for nurses, 32 NEW ENGLAND PEABODY HOME: Hyde Park, Mass., description of, 189 -I9o; 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, 2I8-219; Children's Sea-Shore House, Atlantic City, 212-213; Daisy Fields Home, Englewood, 32, description of, 90o-191; Home for Crippled Children, Newark, 93, description of, 147-I48; New Jersey Orthopaedic Hospital, Orange, 92 NEW JERSEY ORTHOPAEDIC HOSPITAL: Orange, capacity of, 92; description 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 Convalescent Home, Hawthorne, description of, 220-221; Children's Aid Society, 22, 23; Convalescent Children's Home, Chappaqua, description 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

Page  247 INDEX NEW YORK (continued) York City, 2; Crippled Children's East Side Free School, New York City, 33, 43, description of, 228 -230; Crippled Children's Home, Buffalo, 42, description of, 191; Darrach Home for Crippled Children, 19I-I92, summer home, 192 -193; Dr. Henry Frauenthal discusses heliotherapy, 44; East Side Free School, New York City, 82, 87; Federation of Associations for Cripples, April, I913, 43; Haxtun Cottage, Bath Beach, description of, 221-222; Home for Destitute Crippled Children, I95-I96, summer home, I96-I97; 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, description of, 151-155; House of St. Giles the Cripple, Garden City, N. Y., 42, description of, I68-I69; House of the Annunciation, 7, 86, description of, I93-I94, summer home, 194-195; House of the Holy Comforter for Incurables, 2I7-2I8; Miss Spence's School Society, 33, description of, 230-231; New York City Children's Hospital, description of, 209-20o; New York Orthopiedic Dispensary and Hospital, New York City, 35, 36, 40, 42, 93, description of, I55-156; New York State Hospital, West Haverstraw, 8, 36, 41, 71, 83, description of, 170-172; isolation for contagious diseases, 46; Post-Graduate Hospital, 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, description of, 223-225; St. Agnes Hospital, White Plains, 215-216; St. Charles Hospital, Port Jefferson, 31, 33, 42, 74, 83, 94, 96, description of, 169-170; Sea Breeze Hospital, Coney Island, 43, 44, 54; description of, 167-168; Seaside Home, Arverne, description of, 219-220; Summer Home for Crippled Children, Sheepshead Bay, description of, 222; Summer 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 I863 and I89o, 6; William H. Davis Free Industrial School, industrial and kindergarten work, 60, 85, 87, description of, 233-234 NEW YORK ASSOCIATION FOR IMPROVING THE CONDITION OF THE POOR: "Smiling Joe," 3 NEW YORK CITY CHILDREN'S HOSPITAL: description of, 209, 210 NEW YORK HOME FOR DESTITUTE CRIPPLED CHILDREN: New York City, 22, 48, description of, 195 -I97 NEW YORK HOSPITAL FOR DEFORMITIES AND JOINT DISEASES: New York City. See Hospital NEW YORK HOSPITAL FOR RUPTURED AND CRIPPLED: New York City. See Hospital NEW YORK ORTHOPADIC HOSPITAL: New York City, description of, 155-I56; housekeeper a trained dietitian, 40; number of employes, 93; physical culture and gymnastics, 36; record of visiting nurses, 35; special outdoor space, 42 NEW YORK POST-GRADUATE HOSPITAL: orthopedic wards in, 234 NEW YORK STATE HOSPITAL: West Haverstraw, I70-172; outdoor school classes, report for 1912, 54, 55; outdoor sleeping pavilion, 41; physical culture and gymnastics, 36; resident physicians of, 31; salaried surgeonin-chief, 29; special field the rural districts, 8; stenography and typewriting 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 Orthopedic Hospital, Seattle, Wash., out-patients visited, 34, 35; dispensaries and out-patients, 34-36; employed in convalescent homes, 247

Page  248 INDEX NURSES (continued) 32; for day and private schools, 33; Hospital of University of Pennsylvania, 35; in asylum homes, 32; in hospitals, 32; institutional training for, 32, 33; Kernan Hospital School, Baltimore, training for nurse maids, 33; Lakeside Hospital, Cleveland, Ohio, public school service, 35; Nebraska State Hospital, training school for, 32; New York Orthopaedic Dispensary and Hospital, visiting nurses, 35; PostGraduate Hospital, New York City, 35-36; Sunbeam Circle, Cleveland, provides public school nurses, 33; training school at St. Charles Hospital, Port Jefferson, N. Y., 33 NUTT, JOHN JOSEPH, M. D., 171 OCCUPATIONS AND EARNINGS: Industrial School for Crippled and Deformed Children, Boston, 235 OGILVY, CHARLES, M. D., 209 OHIO: Holy Cross House, Cleveland, 32, 36, 42, description of, I97-I98; Lakeside Hospital, Cleveland, 35; public school classes in Cleveland, 3; public school work, 56, 58; Rainbow Cottage, Cleveland, 35, description of, 216-217; Sunbeam Circle, Cleveland, 33, 58 OPERATIONS: minor, where performed, 30, 3I ORR, H. WINNETT, M. D., 146 ORTHOPEDIC HOSPITALS: continue establishment of, 13; dispensary service in, I5 ORTHOPEDIC WARDS: in general hospitals, 234 OUTDOOR SCHOOLS: discussion of, by Federation of Associations for Cripples, I913, 43; efficacy of, 53-55; Industrial School for Crippled 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 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 special equipment, 37 PENNSYLVANIA: Children's House of the Home for Incurables, Philadelphia, 7, 51, 94; description of, 198; establishment of three institutions in Philadelphia between 1863 and I890, 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 University of Pennsylvania, 35, 36; Industrial Home for Crippled Children, Pittsburgh, 41-42, 55, description of, 184-185; Philadelphia Orthopaedic Hospital and Infirmary, description of, 211; Sewickley Fresh Air Home, 40, 54, description of, i85-I86; Widener Memorial School, Philadelphia, 4, 6, 30, 3I, 32, 36, 37, 42, 46, 75, 8o, 83, 86, 87, 88, 94, description of, 173-183 PEOPLE'S UNIVERSITY EXTENSION SOCIETY: physical culture teachers sent to asylum homes, 37, 38 PETERS, JOHN M., M. D., 225 PHILADELPHIA ORTHOPEDIC HOSPITAL AND INFIRMARY FOR NERVOUS DISEASES: description of, 211 PHYSICAL CARE: charity work and surgeons, 28-29; modem 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 Hospital, Portland, Maine, special gymnastic apparatus, 36; Country Branch Minnesota State Hospital, Phalen Park, 36; Department of 248

Page  249 INDEX PHYSICAL CULTURE (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; Hospital for Ruptured and Crippled, New York City, 36; Hospital of University of Pennsylvania, complete gymnasium, 36; Massachusetts Hospital School, Canton, 36; New York Orthopaedic Dispensary and Hospital, New York City, 36; New York State Hospital, special apparatus, 36; opinions as to desirability in public schools, 38; People's University Extension Society, teachers for, 37, 38; Widener Memorial School, equipment, 36, 37 PLUMMER, WARD, M. D., 19I PORTER, JOHN LINCOLN, M. D., 14I POST-GRADUATE HOSPITAL: New York City, services of visiting nurse, 35 -36 PRIVATE DAY SCHOOLS: number in New York City, 59-6I PROTRACTED INSTITUTIONAL CARE: objections to, 23 PROUTY, FLORENCE E., MISS, I87 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, Pittsburgh, Pa., 55; in New York City, 3; one in Detroit, 3; outline of work in Chicago, 56, 58; outline of work in Cleveland, 56, 58; outline 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 equipment 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 Ruptured 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; Massachusetts Hospital School, special isolation provisions, 46, 47; Minnesota State Hospital, isolation of contagious diseases, 45; special provisions for, in convalescent homes, 46, 47; Widener Memorial School, fireproof isolation buildings, 46 RAINBow COTTAGE: country home of Lakeside Hospital, Cleveland, Ohio, 35; description of, 216, 217 RAKER, JOHN H., REV., 218 RHINELANDER INDUSTRIAL SCHOOL: description of, 231; financed by Children's Aid Society, 60; jewelry making class and apprenticeship, 66; jewelry class taught by expert, 84 RHODE ISLAND: Crawford Allen Memorial 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., description of, 2 23-225 ROOT, J. E., M. D., I86 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, I69-I70; floor space of, 96; organizing training school, 33; resident physicians of, 31; separate wards for infectious diseases, 47; sewing classes, 83 ST. LOUIS CHILDREN'S HOSPITAL: orthopedic wards with dispensary service, 234 ST. PAUL CITY AND COUNTY HOSPITAL: state use of, 5 249

Page  250 INDEX SANATORIUM FOR HEBREW CHILDREN: Rockaway Park, N. Y., orthopedic wards in, 234 SCHOOLS FOR CRIPPLES: ground-floor rooms and equipment, 50-5I SCHOOLS IN 37 INSTITUTIONS: adjustable seats and desks, 50-51; statistics of attendance, grade work, Table VII, 134; statistics of teachers, sessions, equipment, Table VII, I34; teachers and equipment, vocational training, o16-107 SEA BREEZE HOSPITAL: Coney Island, N. Y., description of, 167, i68; heliotherapy for tuberculous sinuses, 44; isolation for infectious diseases, 47; outdoor school classes, 54; sea air and salt water benefits, 43 SEASIDE HOME FOR CRIPPLED CHILDREN: Arverne, N. Y., description of, 219, 220 SETON HOSPITAL: New York City, description of, 210 SEWICKLEY FRESH AIR HOME: Pittsburgh, description of, x85, I86; dietary for, 4o; isolation for infectious diseases, 47; outdoor school building, 54 SHAFFER, DR. NEWTON M.: advocates cottage plan for crippled and deformed, I4 SHAFOR, H. A., M. D., I65 SHARPLES, CASPER W., M. D., I56 SMITH, MISS KITTIE: 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., i61 SPECIAL HANDICRAFTS: institutions which teach, 83-84 SPEESE, JOHN, M. D., I98 STATE HOSPITALS: advocated, 14; first established in Minnesota in 1897, 7; need of, in rural districts, 8; social service needed to reach cripples in rural districts, 9 STATE HOSPITAL FOR CARE OF CRIPPLED AND DEFORMED CHILDREN: West Haverstraw, N. Y., description of, I70-I72 STATE HOSPITAL FOR INDIGENT CRIPPLED AND DEFORMED CHILDREN: St. Paul, description of, 144-145, i66-I68 STATE INSTITUTIONS: maintenance and control, 104, io6 STASTSTICAL INFORMATION: children cared for during year, 9; comparative cost of hospitals, convalescent homes, and asylum homes, io; cost of hospitals per capita, io; cost of land, and buildings and equipment, o1; number of employes, 9; summaries of, 9I-107; Tables I to IX, Io8-140 STATISTICAL TABLES: list of, xiii SUMMER HOME FOR CRIPPLED CHILDREN: Sheepshead Bay, N. Y., description of, 222 SUMMER HOMES: Blythedale, Hawthorne, N. Y., description of, 220, 221; Children's Country Home, Westfield, N. J., description of, 218, 219; Crawford Alien Memorial Hospital, North Kingston, R. I., description of, 225, 226; Darrach Home, Pelham Bay Park, N. Y., description of, 192, 193; descriptions of, 206-207, 218-226; Happy Haven, Twin Lakes, Indiana, description of, I88; Haxtun Cottage, Bath Beach, N. Y., description of, 221, 222; Home of the Merciful Saviour, summer branch, Avon-by-the-Sea, N. J., description of, 199, 2oo; House of the Annunciation, summer home, description of, I94, I95; 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, Arverne, 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, 58 250

Page  251 INDEX TAYLOR, HENRY LING, M. D., 190 TAYLOR, R. TUNSTALL, M. D., I59 THORNDIKE, AUGUSTUS, M. D., I6I TINY Tir FUND: St. Louis, aid society, 234 TRADE SCHOOL OF 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: considerations in placing cripples, 24, 25; convalescent hospitals for joint tuberculosis, 22; day schools and convalescent hospitals needed, 21; different types of institutions necessary, 21; medical care and asylum homes, 22; segregation of crippled children, 23 TUBERCULOSIS OF THE BONES: convalescent hospitals preferred, 22; country locations and pure air, 43; dispensaries and visiting nurses, 34; healing sinuses by salt water, 43; heliotherapy recommended, 44; living conditions for, and convalescent homes, 21; open-air school on steamer deck for Miss Spence's class, 59, 60; rejection of cases in many institutions, Io6; Sea Breeze Hospital at Coney Island, New York, 43; value of sunshine on sinuses, 43-44 TWINCH, SIDNEy A., M. D., I47 UNIVERSITY HOSPITAL OF UNIVERSITY OF MICHIGAN: orthopedic wards in, 234 VAN LEUVEN BROWNE SCHOOL: Detroit, capacity of, 92; description of, I65; minor operations only, 3o; outdoor sleeping, 41 VIRGINIA T. SMITH HOME FOR INCURABLES: Newington, Conn., capacity of, II, 92; description of, 31, 42, 48, I86, I87 VOCATIONAL TRAINING: accomplishments of cripples, 64-65; adaptation of pursuits, I-I2; benefit derived as wage-earners, 63; capacity VOCATIONAL TRAINING (continued) of Widener Memorial School for occupational training, 75; classification of, in schools, xo6; considerations of, in regard to cripples, 62 -63; developments at Massachusetts Hospital School, 77; discussion of, in English review, in 1909, 63; disposal of articles made in institutions, 87-88; hand work and domestic science, 107; informal training in domestic work, 71-73; Kernan Hospital School, stenography and typewriting taught, 74; kindergarten work the basis of, 71, 78, 79, 8o, 8I; manual training or sloyd, 79; Massachusetts Hospital School's classes for girls, 77-78; special, 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; occupations open to cripples, 64; occupations taught in 37 institutions, 70 -75; occupations taught in asylum homes, 71; organized teaching preliminary to, 78-80; orthopedic treatment in early stages is emphasized, 12; plans of study, I2; private day schools having vocational classes, 81-82; profitable occupations a factor, 69-70; provision for, in schools and homes, 62-63; respective merits of different occupations, 89; St. Charles Hospital, stenography and typewriting taught, 74; schools and trades offered, II-I2; self-support the aim, 8i; sewing taught in 22 of 37 institutions, 73; skilled handicrafts a local problem, 70; skilled handicrafts offer best opportunities, go; suitability of occupations, 64; Trade School of the Hospital of Hope for Injured and Crippled, established by Dr. Jaeger, 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, I69, 228, 230 WALLACE, JAMES 0., M. D., 184, I85 251

Page  252 INDEX WASHINGTON: Children's Orthopedic Hospital, Seattle, 32, 34, 35, description of, 156-157 WASHINGTON UNIVERSITY MEDICAL HOSPITAL: orthopedic wards with dispensary service, 234 WATSON, EMILY A.: donor Country Home New York Orthopaedic Hospital, 4 WHITBECK, BRAINERD H., M. D., 231 WIDENER MEMORIAL SCHOOL: hospital and convalescent home, 6; complete gymnastic equipment, 36-37; description of, 173-183; George D. Widener, 4; isolation buildings fireproof, 46; kindergarten and successive classes for special training, 80; music taught as means of WIDENER MEMORIAL SCHOOL (continued) self-support, 86-87; resident physicians of, 31; statistics of, 182-i83; vocational training, capacity of school, 75 WILLIAM H. DAVIS FREE INDUSTRIAL SCHOOL: New York City, description of, 233, 234; kindergarten and industrial work, 60; summer home at Claverack, New York, 60, 234 WILLIS, PARK WEED, M. D., 156 WISCONSIN: Children's Free Hospital, Milwaukee, description of, 21I WITHYCOMB, MARION H., MRS., 213 WOMEN'S EDUCATIONAL AND INDUSTRIAL UNION: Boston, vocational training explained in pamphlets, 89 APP 1! 1915 252

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Page  [unnumbered] i - RUSSELL SAGE FOUNDATION PUBLICATIONS l CORRECTION AND PREVENTION. Four volumes prepared for the Eighth International Prison Congress. Edited by Charles Richmond Henderson, LL.D. 8vo. Price per set, express prepaid, $10; per volume, $2.50 net. PRISON REFORM. By Chas. R. Henderson, F. B. Sanborn, F. H. Wines and Others. And CRIMINAL LAW IN THE UNITED STATES. By Eugene Smith. IIIMs. 326 pages. Postpaid, $2.67. PENAL AND REFORMATORY INSTITUTIONS. By Sixteen Leading Authorities. Illus. 358 pages. Postpaid, $2.70. PREVENTIVE AGENCIES AND METHODS. By Charles Richmond Henderson, Ph.D. 454 pages. Postpaid, $2.68. PREVENTIVE TREATMENT OF NEGLECTED CHILDREN. By Hastings H. Hart, LL.D. With special papers by leading authorities. Illus. 430 pages. Postpaid, $2.70. JUVENILE COURT LAWS IN THE UNITED STATES SUMMARIZED. Edited by Hastings H. Hart, LL.D. 8vo. 160 pages. Postpaid, $1.60. CIVIC BIBLIOGRAPHY FOR GREATER NEW YORK. Edited by James Bronson Reynolds, for the New York Research Council. 8vo. 312 pages. Postpaid, $1.50. HANDBOOK OF SETTLEMENTS. Edited by Robert A. Woods and Albert J. Kennedy. 8vo. 342 pages. Cloth, postpaid, $1.50. Paper, postpaid, $0.75. CARRYING OUT THE CITY PLAN. By Flavel Shurtleff. In collaboration with Frederick Law Olmsted. I2mo, 362 pages. Postpaid, $2.00. THE CARE AND EDUCATION OF CRIPPLED CHILDREN IN THE UNITED STATES. By Edith Reeves. IIlus. 8vo. 264 pages. Postpaid, $2.00. RECENTLY PUBLISHED by Survey Associates, Inc. OUR SLAVIC FELLOW CITIZENS. By Emily Greene Balch. Part I. Slavic Emigration at Its Source. Part II. Slavic Immigrants in the United States. 8vo. 550 pages. 48 full-page illustrations. Postpaid, $2.50. THE SPIRIT OF SOCIAL WORK. By Edward T. Devine. Nine Addresses. 12mo. 244 pages. 3d edition. Postpaid, $1.00. SOCIAL FORCES. By Edward T. Devine, Associate Editor The SurOvey; Director, New York School of Philanthropy; Professor of Social Economy, Columbia University. 12mo. 226 pages. 3d edition. Postpaid, $1.00, VISITING NURSING IN THE UNITED STATES. By Yssabella Waters, of the Nurses' Settlement, New York. 8vo, 367 pages. 2d edition. Postpaid, $1.25, FIFTY YEARS OF PRISON SERVICE. An Autobiography. By Zebulon R. Brockway. Ilus. 12mo. 450 pages. Postpaid, $2.00. SURVEY ASSOCIATES, INC. PUBLISHERS FOR THE RUSSELL SAGE FOUNDATION 105 EAST 22d STREET, NEW YORK I -

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