(1920) Survey of Cripples in New York City

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SURVEY of CRIPPLES
IN
NEW YORK CITY

UNDER THE AUSPICES OF A
SPECIAL COMMITTEE ON SURVEY

OF CRIPPLES
HENRY C. WRIGHT
DIRECTOR OF SURVEY
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^ OF THE
^JNIVERSITY
PRINTED AND DISTRIBUTED BY

THE ~~NEW YORK COMMITTEE ON AFTER CARE
OF INFANTILE PARALYSIS CASES
NEW YORK CITY
OCTOBER, 1920
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SURVEY OF CRIPPLES
IN
NEW YORK CITY
Undertaken hy
A COMMITTEE ON SURVEY
With the Compliments of

Ihe New York Committee on After Care of Infantile Paralysis Cases
Dr. S. S. Goldwater
Mr. Douglas McMurtrie
Mr. William Church Osborn
Mr. James H. Perkins
Dr. Thomas J. Riley
Dr. Jacques Rushmore
Mrs. John S. Sheppard
Henry C. Wright,
Director of Survey
SURVEY OF CRIPPLES
IN
NEW YORK CITY
Undertaken by
A COMMITTEE ON SURVEY
OF CRIPPLES
Mr. Thomas S. McLane, Chairman
Mr. Alexander M. White, Treasurer
Mrs. Henry B. Barnes
Dr. E. H. Lewinski-Corwin
Dr. Andrew W. Edson
Dr. Virgil P. Gibney
Dr. S. S. Goldwater
Mr. Douglas McMurtrie
Mr. William Church Osborn
Mr. James H. Perkins
Dr. Thomas J. Riley
Dr. Jacques Rushmore
Mrs. John S. Sheppard
Henry C. Wright,
Director of Survey
April 21, 1920
To the Committee on Survey
of the Conference on Cripples
Under your authorization and direction I began a survey of
New York City on November I, 1919. I am herewith
cripples in
submitting my report, with recommendations.
Respectfully submitted,
Henry C. Wright
Director
HV30U
CONTENTS
PAGE
Introduction 5
Summary of Recommendations 7
Some Significant Findings 10
Detailed Statement with Regard to Recommendations 12
Arguments in Support of Recommendations 21
Field Canvass 32
Education for Cripples 61
Social Agencies 68
Hospital and Clinic Care 77
Orthopedic Beds in Hospitals of New York City and Vicinity 87
Out- Patient Service 88
Convalescing and Custodial Care 99
794371
INTRODUCTION
This survey was inaugurated by the representatives of 41
organizations, associations, and hospitals in Greater New York
engaged in work for cripples, at a conference on April 4, 1919,
which was the result of the efforts of the New York Committee
on After Care of Infantile Paralysis Cases. The expenses were
met by contributions from certain of these agencies and a liberal
gift from the Rockefeller Foundation.
The responsibility for the after care of the survivors of the 191 6
Infantile Paralysis epidemic in New York City has since that time
been vested in the above named Committee, representing all the
agencies interested in these children. This Committee had pro-
vided a system of follow-up, including necessary financing,
transportation, home care, etc., which proved so beneficial in its
results on the thousands of cases recorded that the committee
early in 191 9 resolved to learn whether all the city's needy crip-
ples were being cared for, and if not, to what extent the need was
unmet.
The Survey was made under the direction of Mr. Henry C.
Wright, of the Hospital and Institutional Bureau of Consulta-
tion. The aim was to ascertain the number of persons crippled
in New York by different causes, and the nature of care and treat-
ment being given them, with the chief emphasis on the causes
which produce cripples. Instead of surveying the entire city,
which would have been a very large task, six typical districts,
having an aggregate population of 110,000 people, were selected.
In these districts a house-to-house canvass was made. Where
cripples were found whose cases had not been diagnosed at a
recognized clinic or hospital, an orthopedic surgeon was sent to
the home to make a full diagnosis. The statistics of causes and
classifications thus obtained are reasonably accurate. In addi-
tion to the field canvass, the work of all organizations, hospitals,
and institutions dealing with cripples was examined to determine
its character and scope.
5
INTRODUCTION
This report is published by the New York Committee on After

Care of Infantile Paralysis Cases, from whom additional copies
can be obtained for $i.oo postpaid, by addressing the Director,
Mr. Robert Stuart, at 69 Schermerhorn Street, Brooklyn, New
York.
Thomas J. Riley
SUMMARY OF RECOMMENDATIONS
O REDUCE factors which produce and to render
T
cripples,
cripples so far as possible self supporting, it is necessary
to perform at least the following functions :
(a) Elementary and secondary education.

(b) Prevocational training.
(c) Vocational guidance.
(d) Medical and surgical treatment.
(e) Convalescing care.
(/) Custodial care.
(g) Social service.
(h) Home treatment.
{i) Summer outings.
(j) Vocational training.
(k) Placement in employment.
(/) Work in home.
(m) Braces and appliances.
The foregoing functions are not listed in chronological sequence,

since several of these functions would necessarily be carried on
simultaneously, such as elementary and secondary education,
medical and surgical treatment, and social service. Educational
guidance, for instance, with children just leaving high school or
elementary school, would probably take place through different
organizations than vocational guidance for adults.
In addition to work with potential and actual cripples, every
effort should be made to prevent crippling sickness and accident.
Such work involves legislative measures, and will be carried on
by various organizations which do not deal directly with the
problem of the cripple.
SURVEY OF CRIPPLES IN NEW YORK CITY
Recommendations
AS TO THE DISTRIBUTION OF THE FOREGOING FUNCTIONS TO
ASSOCIATIONS, SCHOOLS, HOSPITALS AND CLINICS
I
That there be created a central organization covering the

city, to perform the following functions:
1. The keeping of identifying records of all cripples in the city.
2. Through the school Census Bureau, or through direct effort,
the registration ofall cripples and potential cripples of all ages.
3. To be
responsible for the operation of a transportation sys-
tem, and the 1g termination as to what cases shall be transported.

4. Advise as to the fields in which various organizations can
operate without overlapping.
5. Advise as to additional facilities needed, such as beds,
schools, shops, etc.
6. Cooperation with city departments to the end that trans-
portation be furnished, begging cripples be referred to the ap-
propriate training and placement agencies, and needed census
information be registered.
7. Approval of the distribution to various agencies of a joint
fund for cripples.
Manhattan, Bronx and Richmond

II
The Association for the Aid of Crippled Children to be re-

sponsible, directly and indirectly, for the performance of the
functions listed above under (a) to {i) ,
as follows :

{h) Prevocational training.
{c) Vocational guidance.
{d) Medical and surgical treatment.
{e) Convalescing care.
(/) Custodial care.
{g) Social service.
{h) Home treatment.
{i) Summer outings.
8
SUMMARY OF RECOMMENDATIONS
III
The Federation of Associations for Cripples and the Institute

for Crippled and Disabled Men to cooperate in the performance
of the functions listed above under (J) to (w), as follows:

(/) Work in home.
Brooklyn and Queens

IV
The Committee on Crippled Children of the Brooklyn Bureau
of Charities to act as agent of the central organization, and also
undertake responsibility for the performance of the functions
listed above under (j) to (w) ,
as follows :

(/) Work in home.
V
The Visiting Nurse Association of Brooklyn to be responsible,
directly and indirectly, for the performance of the functions
listed above under (a) to (i), as follows:
(b) Prevocational training.
(c) Vocational guidance.
(d) Medical and surgical treatment.
(e) Convalescing care.
(/) Custodial care.
(g) Social service.
(h) Home treatment.
(i) Summer outings.
VI
That joint financing of at least the five organizations herein-
before mentioned be provided for.
9
SOME SIGNIFICANT FINDINGS
1.That there are about 36,000 cripples in the city.
2.That of all cripples, about 50 per cent are under 16 years
of age that about 63 per cent became crippled before reaching
;
the age of 16 years.

3. That nearly one-half of the cases discovered by the field
canvass were not being treated ;

that there are in the city prob-
WHAT THE CRIPPUNG

IS
PERIOD OP LIFE?
FINDINGS IN 727 CASES
ably about 1000 cases of poliomyelitis. Potts' disease and tuber-

culosis of the joints not yet diagnosed that there are about 3700
;
cases with these diseases that have been diagnosed but have
10
SOME SIGNIFICANT FINDINGS
ceased to attend clinics ;

that over 50 per cent of cripples are not
known to any agency.
4. That very few cripples attend high school.
5. That there are enough operative beds and sufficient clinical
facilities, but insufficient number of convalescent and custodial

beds.
6. in the social work for cripples there are portions of the
That
fielduncovered, and at the same time somewhat vague limits
assigned to the work of various agencies.
II
DETAILED STATEMENT WITH REGARD TO
RECOMMENDATIONS, AND ARGUMENTS
IN THEIR SUPPORT
The Problem of the Cripple
Elementary and Secondary Education

and secondary education is more important,
ifpossible, for cripples than for a normal child. If a normal
ELEMENTARY
child be not educated, he at least can perform manual labor,
and always be in a position to sell his services. A cripple must
render a limited and specialized service which, in almost all cases,
combines and requires a large element of intelligent application.
Many cripples can perform little or no physical labor, but are
unrestricted in work requiring knowledge and intelligence. A
person crippled because of the loss of one or both legs can render
as good service as a bookkeeper, stenographer, typist, and in
various other occupations, as a person who is not thus handi-
capped. An education and vocational training are needed as a
preparation.
Elementary and secondary education should be conducted so
far as possible by the Department of Education of the city, even
in hospitals and custodial homes. In general, the function is
reasonably well performed for the child residing at home. The
educational processes are less satisfactory in hospitals and homes.
Prevocational Training
The average child can be allowed to come to maturity without
much advice as to his vocation, with little danger but that he
will choose a vocation reasonably well adapted to his ability and
capacity. A cripple, on the other hand, is much more limited in
his choice, and is not likely to be informed as to the vocations or
the processes wherein he can be serviceable regardless of his
handicap. It is important, therefore, that he be thrown in touch
with those who are familiar with the kind of things that can be
12
DETAILED STATEMENT WITH REGARD TO RECOMMENDATIONS
done by those handicapped by one or more of the great variety

of handicaps produced by disease or modern commerce and in-
dustry. The advice and instruction in connection with prevoca-
tional training should be adjusted to the vocation which is sub-
sequently to be chosen.
This function is but partially performed at the present time,
and warrants fuller consideration and development on the part
of the Department of Education.
Vocational Guidance
Many crippled persons will not, or cannot, for a variety of
reasons, avail themselves of
any particular training for a voca-
tion. important that they be advised as to the type of
It is
things which they can most readily perform without specialized

training.
There is a tendency on the part of some philanthropic citizens
to organize movements to train children to make artificial flow-
ers, beads, etc., and to offer to crippled children this work, with-
out informing them of other trades and vocations, thus limiting
their choice to the one or two things presented. Such a pro-
cedure must necessarily at times force upon children a vocation
for which they are ill fitted, and deter them from entering into
work for which they have ability and talent.
These processes will naturally take place in connection with
the Department of Education, with the Association for the Aid
of Crippled Children cooperating, for children going directly
from the public schools to work. For those taking a subsequent
vocational training, and for adults, the guidance should be carried
on by an organization or organizations doing vocational training.
Medical and Surgical Treatment

Fortunately, New York City is reasonably well equipped with
orthopedic hospitals and clinics, served by competent surgeons.
A person who attends these hospitals or clinics is likely to receive
intelligent and adequate treatment and care. Of hospitals de-
voted exclusively to orthopedic work, there are 6 within the
city limits, and a state institution at West Haverstraw. In
these 7 institutions there are, or shortly will be, 928 beds. There
are orthopedic services in 10 general hospitals within the city
13
limits, and i in territory accessible to the city, jointly providing

350 beds, making a total of 1278 operative beds. Of this num-
ber, 816 are in Manhattan, 207 in Brooklyn and 255 in the vicinity
of New York, available for both Manhattan and Brooklyn.
The hospitals take cognizance only of the cases that come to
their doors. They are not financed or organized to discover and
treat the cripple who does not voluntarily seek their aid. That
there are a large number of such cripples in New York City is
shown by the survey. Estimating on the basis of the number of
cases found in the districts surveyed, there are probably in New
York City about 1600 crippled children under 15 years of age
who have not been to aclinic or hospital for diagnosis, and 6500 who
have attended but have discontinued such visitation and have
not returned within a period of six months or longer. Of those
over 15, there are about 7000 that fall within these two classes.
These are all remediable or curable, and in addition to these,
there are probably fully 6300 cases of rickets which would be
much benefited by medical and surgical attention. Details of
the foregoing statistics will be found in the body of the Report.
It is reasonably clear that there is no need of additional opera-
tive beds in New York City taken as a whole. Inasmuch as a
larger proportion of the operative beds are in Manhattan, it is
probable that additional operative beds are needed in Brooklyn.
Even with the small number available in Brooklyn, there is still
a question whether or not additional operative beds be needed,
provided more convalescing beds should be made available, and
a system of after-care be provided in the home.
The comparative results of the long term and short term stay
cases in the operative hospitals are well illustrated by an exam-
ination of end results of cases discharged from two hospitals in
Brooklyn. In one of these hospitals 77 patients were operated
upon and discharged to their homes after an average stay of 12
days. Of these operations there were 12 types. A corresponding
number of patients were operated on in another leading Brooklyn
hospital, covering 9 types of operations. These children re-
mained in that hospital on an average 52 days. All of these
cases, discharged from both hospitals, subsequently returned to
their respective clinics for examination. The surgeon who was in
charge of the cases in the hospital where the children remained
14
the shorter term states that on their return to the hospital for
re-examination he found that their early discharge was entirely
satisfactory, as far as results were concerned.
The conclusion might be drawn from the foregoing statement
that it would befeasible to discharge orthopedic cases operated
upon within a period of two weeks, and that as good end results
would be obtained as though they were kept in the hospital for a
period of at least 7 weeks. This probably is a fair conclusion as

applied to the majority of cases, but there are other factors to
take into consideration in addition to the end results. Under
the conditions in which most New York families live, it is difficult
to care for sickness in the home. To the extent that patients

discharged after a period of two weeks still remain bed patients
in their homes, they are a burden upon that home. It is strongly
urged by some that a hospital is much more than a place in which

operations are performed that it is an institution designed not
;
only to care for the needs of the patient, but also to relieve the
home of the burden brought about by sickness. In other words,
as to whether or not a patient needs to be cared for in a hospital
may be more a social than a medical question, and the decision
must be left in most cases with social agents. This decision in-
volves an investigation and determination in each case as to
whether or not the burden can be cared for in the home. It
seems reasonably clear that patients can remain in the operative
hospital a much shorter time than they now remain, if two agen-
cies are provided first, an adequate social agency to examine
the homes and to supervise patients in the homes where they can
be sent, and second, convalescing hospitals to be used for such
cases as cannot wisely be sent home. Neither of these agencies
is adequate in New York City at the present time.
Convalescing Care
Convalescence, generally speaking, may be considered, on an
average, to begin two weeks after an operation. In general, such
convalescence takes place in the hospital where the operation is
performed, owing to the fact that there are comparatively few
convalescing beds. There are but 4 institutions devoted to con-
valescing care. One is operated by the New York Orthopaedic
Hospital at White Plains, New York, two by the City of New
15
York (one at Neponsit Beach and the other a portion of Sea View
Hospital), and the remaining one is operated by an independent
board in a private residence at Yonkers. The combined con-
valescing capacity of these 4 places is 273. On an average, a
convalescing case needs attention for a period of at least ten
weeks, which ratio would mean that there should be five con-
valescent beds to each operative bed, a requirement of 6400 con-
valescent beds for the 1278 operative beds. This number would
be reduced in proportion to the number of cases that could be
sent directly from the operative hospital to their homes. Un-
fortunately, in New York City a large proportion of such homes
are in tenement houses, where it is difficult to care for a convales-
cent orthopedic case for a long period of time. It is difficult to
determine the number of convalescent beds actually needed. It
is obvious, however, that 6400 are not needed, which the present
operative beds could fill. The problem is to provide convalescent

beds as pressure develops on the operative beds. It is reasonable
to estimate that at least 500 additional convalescent beds are
needed at present. Such convalescent beds as are provided
should be within easy reach of New York City.
Custodial Care
Many children and adults are crippled to a degree that renders
it impossible for them to care for themselves. In many cases
where they are not sufficiently crippled to make it impossible to
care for their personal needs, they are yet unable to follow any
occupation that would make them self supporting. The families
in some such cases are able to care for cripples in their homes.
There are many others, however, which, owing to family condi-
tions, must be cared for in institutions. These are the so-called
custodial cases. There is no hope of their recovery or material
improvement, and they must be maintained at the expense of
the public or of contributors.
At the present time there are 7 institutions in or adjacent to
New York City, with 563 beds, caring for custodial cases. There
isalways a long and increasing waiting list for these few beds;
particularly is there a need for an institution that will care for
the feeble-minded cripple. The number of custodial beds should
be markedly increased.
16
detailed statement with regard to recommendations
Social Service
Social service in connection with orthopedic cases is carried
on by hospitals only in connection with patients that have been
discharged after operations, and workers are provided by ii hos-
pitals. The majority of cases discharged receive no social service
or after-care. The clinic cases are cared for by the Association
for the Aid of Crippled Children in Manhattan, Bronx and Rich-
mond, and by the Visiting Nurse Association in Brooklyn. These
Associations, however, are not able with their present staffs to
care for more than a portion of the cases that need attention.
The kind of service rendered by such visitors is, instruction to
parents as to the care of the patients, and the watching of the
case to see when it is advisable for it to return to the hospital or
clinic for examination, to see that the child receives an education
and secures advice with regard to future occupation. Without
such work many cripples would not go to clinics, or, having gone,
would not return at periods indicated by the examining surgeon.
They might neglect their education, so important to cripples,
and, failing to appreciate their limitations, might select occupa-
tions at which they would be able to earn but a very meager
living.
Home Treatment
Home treatment is of recent development. It was first tried in
connection with the work at Long Island College Hospital and
Brooklyn Hospital at the time of the epidemic of infantile paraly-
sis in191 6. After cases were examined at the clinic or in the home
by an orthopedic surgeon, orthopedic nurses or masseurs were
sent to the homes of the patients, and continued treatment under
the advice and direction of the orthopedic surgeon. At periods
indicated by the surgeon the patient was to return to the clinic
for examination. In this manner about 427 cases were cared for
in their homes. The results of this method of treatment have
been satisfactory to the surgeons in those hospitals, and they
highly recommend the extension of this type of service. Where
home treatment was not used it was, and still is, necessary to
transport cases from their homes to clinics. At the present time
there are 22 buses devoted to this purpose, 10 operated by the
City of New York, 5 by the New York Committee on After-Care
2
17
of Infantile Paralysis Cases, and 7 by the Brooklyn Bureau of

Charities. There are a number of cases, however, that cannot be
taken to the clinics by relatives or friends cannot be transported
;
with the available buses, and are not being treated in the homes.
To furnish adequate transportation for all needing it, if no home
care is furnished, would require an expenditure of not less than
$150,000 annually. If, however, the system of home care be ex-
tended to all cases that can be cared for in the home, and trans-
portation be used to transport cases to clinics only for re-examina-
tion not oftener than six to eight weeks, the transportation for the
entire city could be adequately cared for with six to eight buses.
The home treatment under this system would require more ortho-
pedic nurses and masseurs. It has been found by the Visiting
Nurse Association of Brooklyn that one nurse can care for 40 cases
of infantile paralysis in their homes. When it is taken into con-
sideration that a fair proportion of cases that need home treat-
ment would require treatment less often than infantile paralysis
cases, it seems probable that 30 nurses and masseurs could care
for all cases in the homes in New York City. This system of home
treatment, combined with less frequent transportation, seems

highly desirable from the standpoint of economy and efficiency.
The combined transportation and home treatment cost would
not exceed one-third of the cost of operating an adequate trans-
portation system.
Summer Outings
Summer outings are provided by a number of associations and
groups of people to both well and sick children. These outings
are much more needed by cripples, owing to the fact that they
are confined to their locality and restricted in their ability to get
about. Every encouragement should be given to groups to ex-
tend this service. The work, however, should be so coordinated
as not to overlap and duplicate other services rendered.
Vocational Training
Inasmuch as the things which a cripple can do are quite limited
as compared with the multitude of things which can be performed
by the normal person, it is necessary to establish and provide for
education in trades which are best suited and adjusted to the
18
variety of handicapped conditions. The world war has added

much to our knowledge along these lines, and that knowledge
should be carried over into peace time in connection with the
problem of preparing for self support those crippled by disease or
industry.
This function is performed to some extent by the Department
of Education, especially in the training of girls. Much less is
done for boys. It is not clear how far nor to what extent the
Department of Education should attempt to teach vocations
through public schools, more especially in that it is dealing with
the young and immature, when the capabilities and desires are
not clear. It may be advisable to lay additional stress upon pre-
vocational training, with the expectation that vocational training
will be conducted in separate establishments organized particu-
larly to carry on that function. There may come a time, after

private enterprise has experimented and developed methods and
standards, when it may be advisable for the city and state to as-
sume such functions.
Too much emphasis cannot be laid upon the necessity for voca-
tional training. Many cripples now enter the almshouses or beg
upon the streets who could readily support themselves with
proper training, appropriate to their particular handicap. The
type of institution to carry on this work needs to be much more
specialized than the ordinary vocational shop. It must have
officers thoroughly versed in trades or processes that can be
carried on by the different kinds of handicapped persons, and
also in manufacturing and trade conditions using such processes.
For this reason it is highly desirable that such vocational training
be carried on by an organization devoting itself exclusively to
this line of work.
Placement in Employment
a crippled person to obtain employment, par-
It is difficult for
ticularly at times when

there is a surplus of labor. If there are
two persons applying for a job, one physically normal and the
other physically handicapped, the employer will usually accept
the physically able person. For this reason it is especially im-
portant that there be an adequate service for placing in employ-
ment persons who are not able to compete with the physically
19
normal. The ordinary employment agency will give little or no

heed to the physically handicapped. It requires an agency de-
voting its attention exclusively to this class to produce good
placements. The Institute for Crippled and Disabled Men oper-
ates a bureau for this purpose, with very commendable results.
Funds should be provided to increase the number of employees
and to enlarge the scope of the service. Proportionately, it re-
quires a much larger staff to place handicapped than normal per-

sons, owing to the fact that employers must be visited and shown
that if work is properly selected and adjusted to a handicapped
person he can be as serviceable as a person without handicap.
The Association for the Crippled and Disabled of Cleveland,
Ohio, operates a bureau for this purpose in connection with a
municipal employment bureau, and it is sufficiently staffed to
handle all persons referred to it. There is no organization in
Brooklyn conducting such a service.
Work in the Home

Many cripples cannot use transportation lines, and so cannot
travel from their residence to an industry or trade. Such persons,
however, can be employed in their homes if suitable employment
can be carried to them. The Federation of Associations for
Cripples has been operating such a service very successfully.
Owing to an insufficient staff, it is able to provide work only for a
limited number of shut-ins. Many hundreds of crippled persons
in New York City could be self supporting in their own homes
if this Bureau had sufficient funds adequately to conduct this
service.
There is no work of this character carried on in Brooklyn.
Braces and Appliances

But 5 hospitals in the city have shops wherein braces and ap-
pliances are made. All other hospitals and clinics secure such
appliances as they use from private agencies.
The making of braces and appliances is a good vocation. It
would seem feasible and desirable that this vocation be taught to
cripples, and the product of the students' work be used to supply
the needs of the hospitals and clinics that are now obliged to
purchase braces and appliances. This instruction work could
20
ARGUMENTS IN SUPPORT OF RECOMMENDATIONS
well be experimented with in the shops operated by the Institute

for Crippled and Disabled Men.
In addition to braces and appliances for cripples, this shop
could well manufacture all splints and other appliances now used
in hospitals in connection with fractures. The treatment of
fractures during the war has clearly demonstrated that the old
method of casts can be advantageously supplanted by the method
of splints and a suspension by harness of the injured member. By
this process, healing and uniting is more rapid, and the muscles
areleft in normal function and condition, which permits of much
more rapid convalescence, shortening the period in the hospital.

There is no shop manufacturing these appliances. It is probable
that cripples, if trained in the vocational shops, could
readily per-
form all processes necessary in their manufacture.
Arguments in Support of Recommendations

Central Organization
It IS recommended that a central organization be created to
perform certain services hereinbefore outlined. Until the Federa-
tion of Associations for Cripples was organized in 191 2, there was
no coordinated effort in connection with the problem of cripples.
This association consisted of representatives of the following
hospitals, institutions and organizations:
Association for the Aid of Crippled Children,
Association of Public School Teachers of Crippled Children of
the City of New York,
Blythedale Home for Convalescent Tubercular Crippled Chil-
dren,
Brearley League Industrial Classes for Cripples,
Brooklyn Association for Improving the Condition of the Poor,
Brooklyn Bureau of Charities,
Brooklyn Home for Blind, Crippled and Defective Children,
Children's Aid Society,
Crippled Children's Driving Fund,
Crippled Children's East Side Free School,
Harlem Day Home and School for Crippled Children,
Hospital for Deformities and Joint Diseases,
21
New York State Branch of the Shut-In Society,

WilHam H. Davis Free Industrial School,
Ladies' Auxiliary of the Orthopedic Ward of the Post Gradu-
ate Hospital,
New York Philanthropic League in Aid of Crippled Children,
Institute for Crippled and Disabled Men,
The After-Care Home for Crippled Children.
This comprises but a proportion of the hospitals and agen-
list
cies dealing with cripples, and is itself a federation in but a limited

sense. Its function has been primarily to discuss questions com-
mon to the associations represented in the Federation, and it
was not organized to handle the broader questions relating to
cripples, nor has itattempted to deal with them. During the
infantile paralysis epidemic of 1 91 6 it became apparent that
some central organization was needed to handle some of the
common problems of the thousands of children afflicted with that
disease. The New York Committee on After-Care of Infantile
Paralysis Cases was organized, and proceeded at once to discover,

through all available records and sources of information, children
who had become partially or wholly paralyzed by infantile paral-
ysis. With hand, the Committee endeavored to

this record in
see that each child had proper and adequate medical and surgical
attention; that braces and appliances were furnished; that
transportation was supplied to carry the patient from the home
to the clinic, and where needed that new clinics were organized,
and existing facilities enlarged.
a noteworthy result that of the 6575 surviving children
It is
afflicted by infantile paralysis, the number of cases of deformity
is almost negligible. Had this work not been done, there would
have been hundreds of hopelessly deformed children in the city
to-day. The After-Care Committee, however, has cared only for
infantile paralysis cases of the epidemic of 191 6. There are being
produced year by year additional cripples caused by infantile

paralysis and by bone tuberculosis, spastic paralysis, birth paral-
ysis, spinal meningitis, arthritis, osteomyelitis, rickets, and
accidents. A portion of these cases seek the advice of private
physicians; some go to clinics and hospitals, but many in the ag-
gregate, as shown by the field canvass of the survey, do not seek
or receive attention or treatment. Their ailment is not cared for
22
at inception, and as a result, serious handicapping deformity

its
in many cases results. Some agency should be responsible for

seeing that such cases are discovered at the inception of their
afflictionand properly treated. This function is not covered, as
heretofore stated, by the After-Care Committee, nor is it covered
by the Federation of Associations for Cripples.
The parents of cripples, conceiving the idea that their child is
not improving as rapidly as it ought, sometimes shift from a clinic

to a private physician, or from one clinic to another, or drop
treatment altogether. In case treatment is dropped, and par-
ticularly if in the meantime the family moves, at the present time
there is no centralized record or means of following up or redis-
covering such a case. As is well known, there is a great deal of

moving from place to place in New York City, from location to
location in the same Borough, and from one Borough to another.
A process of treatment or education may be started in one loca-
tion, and when a family moves to another, all processes may be
discontinued.
Transportation is needed in connection with many hundreds
of cases. At the present time there are being transported to
clinics about 950 cases, and the service is inadequate. The cost
of an adequate service, as heretofore stated, is almost prohibitive.
A system of home treatment is needed to simplify the process and
reduce the cost. Some agency is needed to operate transporta-
tion, to select the cases that are to be transported, and to induce
clinics to accept the home treatment method as a substitute for
transportation. To attempt to operate a transportation system

without some agency to select the cases to be transported would
be very inefficient in results. The parents of nearly all crippled
children are glad to avail themselves of transportation, and if
such appeals were to be handled by the drivers of buses, the
number of cases transported would so increase as to make the
transportation problem so large as to be inoperable.
At the present time the only measure of need for increase of
facilities is the pressure upon particular clinics or hospitals.
There is no other basis of determining needs than the judgment
of the managers of such hospitals or clinics, based upon applica-
tions. It is easily possible that when the number of applications
at a particular place indicates that there is need for additional
23
facilities,the facilities should not be located at the place where

the applications are made, but should be located elsewhere, and
there is no centralized authority to express a judgment on such a
matter. There is at the present time no one to answer the ques-
tion, when, where and how many custodial beds are needed.
Many applications are made to clinics for braces and appliances
by parents who are not able to pay for them. The clinics have
insufficient funds, and no agency is in the field to inform the
public as to the need for such expenditures, except the individual

agencies to which application is made. As a result, many crippled
children needing braces or appliances must needs do without
them, with resulting increase of their deformity and a lessening
of their capacity.
Many cripples attempt to earn a living by begging upon the
street. The number varies according to the watchfulness of the
Police Department. There seems to be need of some organiza-
tion that will cooperate with the Police Department to the end
that begging cripples shall be referred to an agency that will
all
study each case, give them vocational training and place them
in a position where they can earn a living. Unless there be some
central organization to perform this function, it cannot be ex-
pected that the Police Department will at all times exert the
effort necessary to direct these begging cripples to the proper
agency and to see that they are kept from the streets.
The Census Bureau connected with the Department of Edu-
cation would seem to be the appropriate agency for collecting in-
formation with regard to cripples. The Bureau cannot perform
this service,however, without additional funds, and such funds
are not likely to be provided unless the City authorities can be
convinced that such work is necessary and advisable. Unless
there be some body of citizens that can demonstrate the necessity
for and will urge needful appropriations, this work will not be
initiated and carried on.
It has been suggested that these problems, which do not fall
within the province of any particular association, hospital or
clinic, might be handled by a conference or a federation composed
of representatives of associations, hospitals and clinics, such con-
ference or association to meet from time to time, but not to have
an office or staff. It is difficult to see how the functions enumer-
24
ated above could be performed by a conference without an office

or staff. The
representatives of associations, hospitals and clinics
would undoubtedly be officers whose time is almost wholly occu-
pied by their duties in connection with their organizations. They
could not be expected to render much service outside of their
official duties. The functions referred to cannot be performed
without constant attention and oversight, and such service would
be inadequately performed except through a paid staff devoting
its entire time and attention to its affairs.
There may be a fear on the part of some that a central organi-

zation might interfere to some extent with the operation of a
hospital or clinic. This probably is true to a certain extent, but
it is highly improbable that any restraining influence would be
exercised except to refuse to send patients to clinics that were

not giving reasonably satisfactory service. If there should be
any indication of prejudice or preference on the part of the staff
of such a central organization, the managing board undoubtedly
could, with little difficulty, rectify matters.
might be argued that the problem of the cripple is not so
It
great as the problem of tuberculosis, or of venereal diseases, or

maternity care, or home nursing, for all of which funds are solic-
ited and that none of these functions is as adequately supported
;
as it should be, and in view of that fact, this inadequate support

should not be divided by stressing an appeal for cripples. There
is some foundation for such an argument, and no one is wise
enough to state at any particular time what proportion of public

funds or private contributions should be devoted to various
activities. This much may be said, however, in support of the
claim that the cripple problem should be more adequately han-
dled it is a compassable problem and is not hidden and subtle
:
in its forms, as is tuberculosis, and

is not nearly so prevalent.
It can always be recognized and causes are quite as subject

its
to control as are the causes of tuberculosis; and though the

various causes producing cripples do not so frequently, or in so
large a proportion, cause death as does tuberculosis, nevertheless,
they produce distress and dependency, and a mental anguish
that lasts for a lifetime. Moreover, it is comparatively a newly
recognized problem, and one that is especially appealing to the
public, and funds could probably be secured for a more efficient
25
handling from sources which do not so readily give to other health

and social activities. The problem of cripples seems one worthy
of effort, and being a comparatively simple and small problem,
sufficient effort adequately to handle it.
The central organization recommended could be operated with

a budget of $10,000 to $15,000. It would seem advisable to have
a controlling board composed of representative men and women
not necessarily officially connected with agencies dealing with
cripples, but with an interest and sympathy in the problem. The
Hospital Sunday Fund and the King Edward Hospital Fund,
both of London, have successfully operated for many years with
boards whose members are not connected with hospitals. There
are distinct advantages in this arrangement, inasmuch as such a
board represents the contributing public and the public needing
hospital care. Such a board, sympathetic with the problem, with
broad vision, and without prejudice, can be trusted to deal fairly
with all hospitals and clinics.
There are several ways in which such a board could be created
and perpetuated. The following methods are suggested for con-
sideration :
1. That the existing Committee on Survey appoint such a

board, with power to create and define a membership, which
would annually thereafter elect members to fill vacancies.
2. That such a board be elected by representatives from asso-
ciations, hospitals and clinics. It would be necessary to establish

a basis for representation, and such a basis is suggested below:
Each of the following to be entitled to send two delegates to a
meeting at which board members would be elected :
(a) Hospitals having 25 or more orthopedic beds ;
(b) Clinics not associated with hospitals having the above-

mentioned number of beds, but having a registration of 100 or
more active orthopedic cases;
(c) Associations or organizations dealing with cripples, having
an annual budget of $5000 or more.
3. The board to be created, and subsequent vacancies filled, by
the following organizations, each of which does not directly deal
with cripples, but is fundamentally interested in the cripple
problem :
26
Manhattan Brooklyn
Charity Organization Society Brooklyn Bureau of Charities
Assn. for Improving the Condition Assn. for Improving the Condition
of the Poor of the Poor
St. Vincent de Paul Society St. Vincent de Paul Society
Children's Aid Society Brooklyn Children's Aid Society
Federation of Jewish Charities Federation of Jewish Charities
At Large
Public Education Society of the City of New York
Academy of Medicine
The Board of Managers, when created to appoint two Councils,

one composed of officials or executives of associations, hospitals
and clinics dealing with cripples, and the other composed of
orthopedic surgeons. The Federation of Associations for Cripples
could well be used as a basis for the Council to be composed of
representatives of associations. The Board also to create an
Executive Committee composed partly from its own membership
and partly from the membership of each of the Councils.
Manhattan, Bronx and Richmond

recommended that the Association for the Aid of Crippled
It is
Children undertake in Manhattan, Bronx and Richmond, certain
functions hereinbefore listed . This is a well-organized association ,
founded in 1899. It has an office force consisting of a secretary

and two clerks, and a field force of twelve nurses. At the present
time this association, through its nurses, looks up all cripple cases
referred to it by other associations or individuals, and sees that
such cases receive medical or surgical care also that they receive
;
education through the public schools or otherwise. It recom-

mends cases for transportation to the After-Care Committee, and
furnishes milk for cripple cases at six public schools. They follow
up children having left or finished the public school classes, and
where possible secure technical training for them, or see that they
are placed in some occupation.
This is the only association in the district doing this class of
work on a large scale. It seems appropriate that it should not
only continue to do this work, but should be sufficiently staffed
thoroughly to cover the entire district of Manhattan, Bronx and
27
Richmond. In addition to the work it is now carrying on, it is

recommended that it undertake home treatment through ortho-
pedic nurses and masseurs. It is further recommended that it
extend its work to adult cripples, so that it will be the only associa-
tion performing the functions described for all classes of cripples, of
whatever age. If it undertakes this work, it would employ the
necessary number of orthopedic nurses and masseurs and under-
take the home treatment in connection with all cripple cases need-
ing such treatment, subject to the direction, as to the nature
of the treatment, of the surgeon in charge of each case. It would
recommend also, to the central organization
having in charge
transportation, the period at which each case would be returned
to its respective clinic.
Thus, being in touch with all field work in connection with
cripples, except home employment, it would recommend to the
central organization when additional facilities seem to be needed.
The central organization then would make a study to determine
where such facilities should be provided.
It would keep all detailed records with regard to cripples, and
transmit to the central organization the name and identifying
information with regard to each case. It would utilize all existing
facilities for education public and private schools for children,
and the Institute for Crippled and Disabled Men for adults. It
would report to the central organization lack of educational and
transportation facilities. It would then be the function of the
central organization to endeavor to induce the city to meet the
needs.
To carry out the program of work assigned to this Association,
if all cripple cases are cared for, would require i8 nurses to cover
the territory not now covered, and 15 orthopedic nurses and
masseurs in case home treatment is undertaken. In addition, one
supervisor would be needed. At the present time it would be wise

to employ all the social service nurses needed, and but a portion
of the orthopedic nurses to initiate the work. As the number of
orthopedic nurses is increased, the number of social service
nurses could be somewhat decreased, owing to the fact that the
orthopedic nurses would incidentally do some social service work.
It is recommended that the Federation of Associations for
Cripples and the Institute for Crippled and Disabled Men arrive
28
at some At the present time the chief work

basis of cooperation.
carried on by the Federationhome employment, where it carries
is
work of various descriptions to the homes of cripples. This work

is carried to about 200 homes. The work is well done, but owing
to limited finances, the Federation can do but a small portion of
the work of that character needing to be done. The Institute
in themain performs two functions: first, the training of crippled
men in vocations,and second, the placing of such and others that
apply, in positions. Both of these functions are well performed.
They do not, however, work with women cripples, nor does any
existing association. It seems highly desirable that this Associa-
tion become the one recognized employment agency for all
cripples,male and female, and that it be recognized as the one
well-equipped place in which all may receive training for a voca-
tion. The Association for the Aid of Crippled Children would
refer all cases needing employment or home work to these joint
Associations. All hospitals and clinics having crippled cases
which have not fallen under the care of the Association for the
Aid of Crippled Children would likewise refer their cases for
training and placement. The New York City Homes (alms-
houses) would also refer a portion of their applicants for admis-
hope that they could be placed
sion to these Associations, in the
insome selected employment, and thereby maintain themselves
and not become public charges.
For some time it has been apparent to the Institute for Crippled
and Disabled Men that dormitory facilities are needed in com-
bination with the vocational shop, for cripples who are conva-
lescing, for such as cannot use transportation lines, and for those
who come from outside New York City. The demand upon the
Institute is such as clearly to indicate that there need for such
is
dormitory facilities. In addition, the Institute needs clinical

facilities to pass judgment upon men who apply to the Institute
for training, as to their physical condition and limitations. Not
infrequently a crippled man who comes to the Institute needs to
continue his attendance upon a clinic. It would seem to be
desirableif a hospital and clinic, such as the Clinic for Functional
Re-Education of Disabled Soldiers, Sailors and Civilians, could

combine its facilities with a vocational shop such as that operated
by the Institute for Crippled and Disabled Men. Could this be
29
done, crippled men coming to the hospital and clinic could begin
pre-vocational work as soon as they were able to move about, and
much before they were in condition to be discharged from the
hospital and clinic. On the other hand, the Institute would find
hand in the same building. Such a combined
clinical facilities at
institution would make it possible for all of the hospitals of New
York City to transfer amputation and ununited fracture cases to
this combined hospital and vocational shop for their period of
convalescence and subsequent training. No general hospital has
in beds at any one time a sufficient number of such cases to
warrant the organization of a staff for occupational, pre-voca-
tional and vocational work with these cases. If, however, all such
cases, soon after operation, were transferred to a specialized hos-
pital as indicated above, it would make a large group, and each
would be receiving the care and training advisable and necessary.
It would seem highly desirable that consideration be given to the
possibility of creating an institution of the character indicated.
Brooklyn and Queens

recommended that the Committee on Crippled Children
It is
of the Brooklyn Bureau of Charities act as agent for and perform
the work of the central organization for Brooklyn and Queens,
and also assume the same functions assigned in Manhattan,
Bronx and Richmond to the Federation of Associations for Crip-
ples and the Institute for Crippled and Disabled Men.
This Committee of the Brooklyn Bureau of Charities is the
most appropriate body to carry out these functions, inasmuch as
it is now doing all
that is being done along these lines in Brooklyn.
The functions of carrying work to the homes of cripples and the
placing of cripples in employment are not being performed in
Brooklyn. These functions would be new to this Committee, but
they are functions which have been neglected owing to a lack of
finances rather than to any lack of appreciation of their need.
The budget necessary to carry on this expanded work probably
could be best estimated by assuming that it would approximate
the proposed budgets of the Federation of Associations for Crip-
ples for Crippled and Disabled Men.
and the Institute
It is recommended that the Visiting Nurse Association carry on
for Brooklyn and Queens the work assigned to the Association for
30
the Aid of Crippled Children in Manhattan, Bronx and Rich-

mond.
The Visiting Nurse Association is at the present time carrying
on a portion of the functions listed. It has been looking after
cripples in the same manner as the Manhattan Association, and
in addition has been carrying on home treatment, a new function
recommended for the Manhattan Association. Its work, how-
ever, has been quite limited owing to a lack of finances, and to do
the work recommended would require a budget equal to the pro-
posed budget of the Association for the Aid of Crippled Children.
General Statement
There are a number of minor associations, described in the body
of the Report, doing a variety of and excellent work for cripples.
The work on the part of these smaller organizations need not be
discontinued or lessened, but it seems highly desirable that they
should clear, through one of the associations heretofore recom-
mended, so that the work done for cripples will not overlap, and
also that there shall be no portion of the field uncovered. This
can be assured if each association in the city dealing with cripples
will seek a cooperative understanding with one of the associations
recommended, viz., the central organization, and, in Manhattan,

the Association for the Aid of Crippled Children and the Institute
for Crippled and Disabled Men, and in Brooklyn the Committee
on Crippled Children of the Brooklyn Bureau of Charities and
the Visiting Nurse Association. These five organizations then
would not only perform the work assigned to them, but would
also attempt to secure the cooperative agreement indicated above.
31
FIELD CANVASS
scope of the investigation as recommended to and
adopted by the Survey Committee was as follows:
THE I. All institutions, departments and associations caring
for cripples, to be examined, to determine

(a) Adequacy of physical plant and equipment.
(b) Number of cases handled.
(c) Follow-up method.

{d) Records.
(e) Character of work.
(/) Staff.
(g) Transportation facilities.
(h) How far dependent on: i. Public funds.
2. Voluntary contributions.
(i) Custodial care.
2. A house-to-house canvass to be made of typical districts, to
determine
(a) Number of cripples.
(b) Cause and degree of crippled condition.
(c) To WHAT EXTENT REMEDIAL.
(d) Educational facilities available, and to what
EXTENT used.
(e) Occupation if at work.
(/) Financial status of cripples.

(g) To what extent preventable.
3. All literaturethrowing light upon the problem in hand to
be examined and reported upon.
4. The findings to be summarized in recommendations covering
at least the following points:
(a) Staff, records, system and transportation used by each
institution, department and association as indicated by
the data gathered.
(b) When certain functions are not now, or seem not likely
to be well performed
, ,
recommendations for a system which
designed to supplement and correct the shortcomings.
is
In preparation for the survey of New York City all available

literature dealing with the number and classification of cripples
32
FIELD CANVASS
was examined. Two noteworthy surveys have been made, namely,

in the city of Birmingham, England, during the year 1910 (in-
corporated in a report of 52 pages divided into two reports of 38

and 14 pages respectively) and a survey of cripples was made in
;
Cleveland, Ohio, from October, 1915, to October, I9i6,the find-

ings of which are incorporated in a report of 227 pages, published
in 1916. In formulating the program for the Birmingham survey
the following definition of "cripple" was adopted: "A person
whose (muscular) movements are so by accident or
far restricted
disease as to affect his capacity for self support." The Cleveland
survey adopted the following definition as its basis for classifica-
tion : Persons **who are handicapped because they lack the normal
use of skeleton or skeletal muscles." The definition formulated as
a basis for the survey in New York City was as follows: "Those
handicapped by some limited or distorted use of muscles, joints,
or skeletal members."
It seemed advisable to the Committee to stress the causes which
produce crippled conditions, especially the crippled conditions of

children, feeling that if these phases of the crippled problems
could be better handled, the effect upon the number of cripples
would be much greater than an attempt to correct crippled con-
ditions already produced or to vocationally train cripples. Ac-
cordingly stress was laid on accurate classifications on the basis
of the causes which produced the crippled condition. This in-
volved accurate diagnoses.
It seems advisable to arrive at an estimate of the number of
cripples of various classifications in New York City, and to ac-

complish this purpose thoroughly to canvass house by house in
typical districts. Accordingly six districts were selected, having
a combined population of about 1 10,000. These districts were as
follows: three in Manhattan; one on the East Side embraced
within Stanton, Ludlow, Delancey, and Chrystie Streets; one in
Greenwich Village bounded by Broome, Thompson, Bleeker,
Hancock, Congress, King, MacDougal, Spring, and Sullivan
Streets; one in Harlem bounded by 130th to 135th and from 8th
Ave. to Lenox Ave. One district in the Bronx bounded by St.
Paul's Place, Crotona Park So., Clinton Ave., Boston Road,
1 68th St., Fulton Ave.,
167th St., Webster Ave. Two districts in
Brooklyn included the Red Hook District bounded by Degraw,
3 33
Henry, Carroll, Hamilton, and East River; also a section in

Williamsburg included between McKibben, Graham Ave., Ten
Eyck, and Bushwick Ave.
The districts selected were typical as to housing, density of
population, and standards of living. Greenwich Village district
consists of old-law tenements occupied by a population almost
completely Italian. Delancey Street comprises older tenements
occupied by both Jewish and Italian families. Harlem district
contains old and new law tenements of the better class occupied
by colored and American families. Bronx district, larger in ex-
tent, contains tenements and apartment houses, which are occu-
pied largely by American born families of various nationalities;
in manyof these houses children are not permitted. Williams-
burg comprises old and new law tenements and one-family houses
occupied by Germans of American birth, Jewish and Italian
families. The Red Hook District is a typical water-front section,
consisting of old private houses which have been altered into
tenements, without janitors, and occupied by Italian families.
Experimenting was done to determine the most effective
method of discovering cripples in their homes. A limited area in
these districts was canvassed family by family, then inquiry was
made of janitors or housekeepers as to their knowledge of cripples
in the same families that had been canvassed. It was found that
on the whole, fuller information was secured through janitors and
housekeepers than when the individual families were visited. The

family often refused or neglected to give information with regard
to a crippled member, whereas the janitors and housekeepers
readily gave such information. The method finally adopted was
a combination of the two. Where intelligent, alert janitors or
housekeepers were found, their word was taken with regard to
the location of cripples in the building; where none such were
found, each family was canvassed.
The canvasser attempted to locate the cripples, and recorded
full information only in connection with cases of amputation,
where the crippled condition could not be a matter of doubt. All

other cases were reported to the Survey office and were subse-
quently visited by an inspector who secured full information with
regard to the cripple. This information was recorded on the fol-
lowing card :
34
MS
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<
FIELD CANVASS
The diagnoses of cases which had been in attendance at a clinic

were accepted from the cHnic if obtainable. All cases where the
diagnoses could not be secured through a recognized clinic were
diagnosed by sending a competent orthopedic surgeon to their
own homes. By this method it is probable that the diagnoses and
the classifications of cripples incorporated in the report are rea-
sonably accurate.
The following instructions were issued to each canvasser lo-
cating cripples :
Instructions for Canvassers for the New York Survey of

Cripples
General Instructions
It shall be the duty of the Canvasser to locate the cripples in
the blocks or districts selected by the Committee. She shall
obtain the following data :
Name, sex, age, color, civil condition, name of family with whom
the cripple lives on the date of the visit, the street address, and name
of Borough. She shall set down the name of the hospital or clinic
at which the cripple has been registered.
the person is
If member only,
crippled by the amputation of a
the canvasser will proceed to secure all the information required
to complete the schedule card provided.
A card shall be made for each cripple found, and the cards made
out each day shall be filed at the office on the morning of the fol-
lowing day. A count should be made of the number of families
covered each day, and filed together with the cards for that day.
How TO Proceed
State briefly, to the person who answers your knock, that
I.
you are taking a census of persons injured by accident or dis-

ease.
'Tn discussing the work of this committee in the field you will
make use of the term 'cripple' as little as possible. Instead of
inquiring whether there is a cripple in the household you will use
another form of inquiry. Likewise when making inquiries of
the janitor or another you will ask whether there is anyone in
37
the building who has anything the matter with their arms,
legs, or back which affects their walk or the use of their arms
or legs."
2. After stating the purpose of your visit, state that the pur-
pose to find out who and where the handicapped persons are,
is
in order that they may receive medical attention if necessary, or

to secure for them training that will fit them for a suitable occu-
pation.
3. Make sure that the family understands you are not giving
financial assistance.
4. State that no names will be used, and all information will be

held confidential.
5. Do not secure information from a child.
6. Do not use a child as interpreter unless no adult is available.
Be sure that the child understands your questions. Usually a
neighbor will interpret.
7. If there be doubt as to whether or not a person should be

considered a cripple, take the usual information, and make a
note regarding the case. If the person is of extremely low grade
mentally, make a note to that effect.
8. Should any person interviewed refuse information, make a
note of the address.

9. Become familiar with the charitable or social agencies of
the district in which you work, in order to direct to the proper
agency those who ask you forj help on their family problems.
Consult these agencies as to their knowledge of cripples in the
district.
10. Tell the family in which you have located a cripple that
another person will call to get more detailed information.
The cards from the canvassers were mailed each night to the
office, where they were numbered and given to an experienced
investigator, whose duty it was to visit the home of the cripple
and to fill out the entire schedule. This method saved consider-
able time, as the investigator was not required to make visits
except to certain specified addresses. In checking the nature of
condition she consulted the records of any clinic in which the
patient had been treated, or the records of any association for
cripples to which the cripple was known. Later, when these
38
FIELD CANVASS
sources of information had been exhausted, the Committee en-

gaged Dr. Herbert C. Fett, attending surgeon at the Throop
Avenue Children's Orthopedic Hospital, and assistant at the
Polhemus CHnic, to make examinations of the cripples in their
own homes with regard to whom no clinical diagnosis had been
secured.
No census figures, except those of the 1910 census, are avail-
able, therefore the canvassers were instructed to set down on
their daily reports the total number of persons covered and also
the total number of families. According to this estimate the
total number of persons covered in the canvass was 106,092; the
total number of cripples found after all doubtful cases were elimi-
nated was 727, this gives the ratio, by rate per thousand, of 6.9.
The rate per thousand in the Cleveland survey, which was a
house to house enumeration of the whole city, was 6.2. In the
Massachusetts State census of 1905, which included lame,
maimed, and deformed, the rate per thousand was 5.7. The
Birmingham, England, survey of 1910 in which the particulars
were obtained by circularizing the clergy, the surgeons, the
orthopedic hospitals, the C.O.S., the City Aid Society, the Guardi-
ans, the Police Society, and the Women's Settlement, showed the
ratio to be 2 per thousand. In applying this ratio to estimate the
total number of cripples in the city, the Committee deducted
from the population, according to the census of 1910, in Man-
hattan all of the district north of 63d St. and west of 8th Ave.
the total population thus deducted was 446,004; in Brooklyn,

the population of the well-to-do classes was likewise deducted
to the number of 165,344; ^^ the Bronx 10 percent of the total
population was deducted in Queens and Richmond 20 per cent

;
of the total population was deducted. The arithmetical rate of

by the Department of Health of the City of New
increase as used
York was applied to the remaining territory, and the cripples
estimated as shown by the following table :
39
NUMBER OF CRIPPLES IN NEW YORK CITY

Calculated from Estimated Population for iq2o, Excluding Residence Districts
of the Well-to-do Classes
FIELD CANVASS
CASES IN MANHATTAN DISTRICT

Distributed as to age and place where treated
515 cases
Under 15 16-45 Over 45
Private Doctor '. , 20 30
Ruptured and Crippled 18
N. Y. Orthopedic 23
Mt. Sinai 2
Post Graduate 6
Neurological ,
4
Broad Street Hospital
Gouveneur Hospital
City Hospital
East Side Free School II
Stuyvesant Polyclinic I
N. Y. Hospital 4
Deformities and Joint Diseases 7
Metropolitan 4
Port Jefferson 2
Bellevue 4
St. Mary's I
St. Vincent's 2
Brooklyn I
White Plains I
Staten Island
Harlem 4
Fordham 3
Army Hospital -
Flower Hospital I
5th Ave. Milk Station 2

Lincoln Hospital
Jewish Hospital
Blackwell's Island
Presbyterian
Lebanon
59th St. Hospital
Montefiore
Vanderbilt
St. Francis
Sub-total 129 39 46
Not treated: Amputation I
Rachitis 87 I
Traumatic 3 30 21
Pyogenic I 2
Tuberculous 2 3 2
Polio 17 7
Arthritis 2 2
Congenital 16 6
Syphilis I
Other Conditions 6 12 9
Unknown 4 2 _3_
Sub-total 137 65 50
Cured: Amputation 23 15
Traumatic I I
Congenital
Sub-total 24 16
Total 275 128 112
41
CASES IN BROOKLYN DISTRICTS

Distributed as to age and place where treated
212 cases
Under 15 16-45 Over 45
Private Doctors 20
R. and C I
N. Y. Orthopedic
Bellevue
Brooklyn
White Plains
Army Hospital
Blackwell's Island
St. Catherine's I
Throop Ave 10
Sea View I
Kings Co
Greenpoint Hospital I
L. I.
College Hospital 18
Visiting Nurse Assn. (Bk.) I
Sub-total 50 30
Not treated:
Rachitis 30
Traumatic I
Pyogenic
Tuberculous I
Poliomyelitis 13
Congenital 10
Other Conditions 3
Unknown
Syphilis
Sub-total 58 26
Cured:
Amputation 14 ^
Traumatic 2
Sub-total 16 7
Total III 72 29
These figures be compared with the results of the survey

may
made in 1913 and 1914 in the Yorkville district and the Cherry
Hill district of Manhattan by the Association for the Aid of
Crippled Children. In Yorkville 32.7 per cent of the total number
of cases found had not received previous treatment, while in the
Cherry Hill section 82.4 per cent of the children found were not
being treated. The low percentage of untreated children in the
42
FIELD CANVASS
Yorkville district might be attributed to the work of the four

orthopedic chnics adjacent to this section.
8 CRIPPLES NOT
1 1
PREVIOUSLY DL\(3N0SED
OR TREATED
Poor Prognosis
V///^ Pîr Prognosis

I
Sood Protasis
PROGNOSIS SHOWN BY DIAONOSIS IN

THEIFL OWN HOMES
The cases examined in their homes by Dr. Herbert C. Fett

were, of course, chiefly cases that had received no previous exam-
ination or treatment. The tabulation of these cases as to the
diagnoses and prognoses made is as follows :
43
CASES NOT HERETOFORE DIAGNOSED OR TREATED, SUBSEQUENTLY

DIAGNOSED IN THEIR HOMES
Distributed as to diagnosis and prognosis
FIELD CANVASS
The foregoing tables are two of the most significant resulting

from the survey. The first shows an analysis of Ii8 cases not
heretofore diagnosed or treated; the second, an analysis of 247
cases heretofore diagnosed and treated but not having visited a
clinic or hospital within six months previous to the survey. It
will be noted in the two tables combined there were of poliomye-
litis, Pott's disease, tuberculosis of the joints, 94 cases, which indi-
PROGNOSIS OF 247 CRIPPLES

NOT TREATED CURING SIX
MONTHS PREVIOUS TO SURVEY
Tair JPro^nosJs
1 Good "Prognosis
cates that in the city as a whole there are 4700 cases of these
diseases, of which number somewhat over 1000 have not been
diagnosed, and the remainder have been diagnosed but ceased to
attend clinics.
A closer analysis of the table indicates that of the 118 cases
recently diagnosed in their homes, all but 27 showed fair or good
45
prognoses, while of the 247 that had ceased to attend dinics, less
than 100 showed poor prognoses. These figures would indicate
that in the entire city there are probably over 3000 cripples whose
prognosis is good who either have not been diagnosed or have
been diagnosed and have ceased to attend clinics.
ALL CASES
Distributed as to age and causes
Diagnosis
FIELD CANVASS
Of the 727 cases found, 454 are recorded as having attended a

some time, and of this number 116, or 25%, changed their
clinic at
727 CASES DISTRIBUTED

AS TO NATURE OF CONDITION
Indicate Percenisês
Jî^tires
clinic one or more times. These 116 cases have been tabulated
as to reasons for the change as follows :
In the following table, where the patient was transferred by

the doctor, the change was made for a special reason, such as
removal to such a distance from the clinic that regular treatment
could not be had.
47
CASES CHANGING CLINICS ONE OR MORE TIMES

Distributed as to reason for change
FIELD CANVASS
It will be noted that a little over one-half of the total are under
15 and that the bulk of the remainder are under 50 years of age.
This would indicate that of the 35,928 cripples previously re-
ferred to, about 8000 are under five, about 10,000 are between
five and fifteen years of age, and the remainder are adolescents or
adults.
727 CASES DISTRIBUTED

AS TO PERCENTAGE
OF AGE AND SEX
K>
35%-
ô 30%-
8 '
25%-
rf
20%- i
15 %- i
C 10%- i
ft.
5%r
I i
m ^
AGE UNDER 5-15 15-50 50-60 OVER.
GROUP 5 60
MAUfi PEMALfi
49
An analysis of the large number of cripples among children is

shown in the following tabulation giving age of onset for the
principal causes of disability :
ALL CASES
Distributed as to age of onset for principal causes of disability
Causes of Tubercu- Infantile Other

Traumatic Totals
Disability lous Paralysis Conditions
Per Per Per Per Per

No. No. No. No. No.
cent cent cent cent cent
All
34 100 120 lOO 167 100 406 100 727 100
Birth-4. 23 1 238 374

5-9--- 88.2 98-3 27.5 14 64.6 53 62.7
10-14. \\\ 10 29
15-19 12 25
20-24 16 12 29
25-29 13 15 28
30-34 11.8 17 14 47-3 15 19.7 29 22.7
35-39 10 10 21
40-44 6 6 13
45-49 9 10 20
50-54 5 8 13
8.4 16 5-9 5-2
55-59 9 25
60 and over, 16 9.6 22 5-4 38 5.2
Not stated . . 12 7.2 18 4.4 30 4.2
50
FIELD CANVASS
ALL CASES DISTRIBUTED AS

TO AGE OF ONSET FOR PRINCIPAL
CAUSES OF DISABILIX^
400
350
ABOVE IS yAJ?S
FR(M BIRTH 7X) /4 YEARS
300
250-
It,
O EGO
JSZ
150
120
too
50
3
TUBEPCULOUS INFANTILE TRAUMATIC OTHER

PARALYSIS CONDITIONS
51
456 CASES DISTRIBUTED AS TO

AGE OF ONSET FOR PRINCIPAL
CAUSES OF DISABILITY
262
Z60
240-
2Z0-
200-
160
ô
120 m^
100
I
5; 80
eo
46
mzL
TUBERCULOUS INFANTILE TRAUMATIC OTHER

PARALYSIS CONDITICNS
JProm Birth to J'our Years

ofAê
' - - -
Pive-tvNine
Ten -to Fourteen
be noted that tuberculosis and poliomyelitis occurred in

It will
nearly of the cases before the age of sixteen, while in the

all
traumatic cases only about one-fourth of the total number occur

before the age of sixteen.
52
FIELD CANVASS
ALL CASES
Distributed as to education, age and sex
that among children 90 per cent of the males and 85 per cent of
the females of the families receive either common school, special
school education, or instruction in the schools for cripples. It
willbe noted that very few attend high school and special schools.
ALL CASES DISTRIBUTED AS TO

EDUCATION
The study of all crippled children from 5 to 15 years of age,

classified as to school attendance, is shown below:
ALL CRIPPLED CHILDREN FROM FIVE TO FIFTEEN YEARS OF AGE

Classified by age and school attendance
FIELD CANVASS
It will be noted that 21 per cent of these children were not

attending school. This percentage apparently would be higher
if the district on the East Side, which is very close to the Crippled
Children's East Side Free School, had been excluded. In this

district but one child was found who was not attending any public
institution.
PERCENTAGE OF CRIPPLES
(5-15YEARS)ATTENDING SCHOOL
Considerable difficulty was encountered in comparing economic

conditions before and after disability. Later conditions, due to
the war, have so affected the wages that in some cases a man who
was formerly a skilled mechanic is now earning more money in a
manual unskilled task than he formerly earned in his trade. The
degree of support, however, is shown in the following table:
ALL CASES OVER
Distributed as to
It willbe noted of the 341 cases over 15 years of age only 59

per cent were entirely self-supporting, while 28 per cent were
wholly dependent.
DEPENDENCY AMONG CRIPPLES

OVER 15 YEARS OF AGE
Wholly Dependent
PartialJy SelT-
Supporting
Entirely SeiT- Supporting
341 CASES
The degree of self-support as shown by this survey is slightly
higher than that found in Cleveland, as is shown in the table of
comparatives :
COMPARATIVE PERCENTAGES OF DEGREE OF SUPPORT

FIELD CANVASS
It will be noted that the New York survey shows a higher

percentage of both males and females to be self-supporting while
those wholly dependent are less in New York than in Cleveland.
This disparity may be due to a difference in judgment as to the
classification of a cripple as dependent or partially self-supporting
since Cleveland shows a lower percentage to be partially able to
support themselves.
It will be of interest to compare the percentages of the many
causes of disability found in the City of New York with those of
Cleveland, Ohio, and Birmingham, England:
COMPARATIVE PERCENTAGES OF MAIN CAUSES OF DISABILITY
culosis is found in New York, whereas

39.5, over six times the ratio
over 16 years of age, Birmingham's percentage was 24.9
for those
as compared with 2.6 per cent in New York City, which shows a
still greater difference.
Birmingham showed 12.2 per cent of rachitis as against 39.3
per cent in New York. It is difficult to say whether conditions
are worse in New York than in Birmingham, or whether the dis-
parity in percentage is due rather to the method of securing data

in Birmingham, a method which would be much less likely to
discover rachitis than the method used in New York. This latter
explanation will probably account for the lower percentage in
Birmingham.
Agencies Interested in the Care of Cripples

In order to learn what social agencies had been interested in
the cases discovered, inquiry books were secured from the Social
Service Exchange of New York and the Confidential Social Ser-
vice Exchange of Brooklyn. Inquiries were sent to these exchanges
for all cases discovered in the field. The results of these inquiries
showed that 515 cases in the Manhattan and the Bronx were
found registered or unregistered as follows:
cases in MANHATTAN AND BRONX

Distributed as to agencies with which registered
Registered with Number
United Hebrew Charities 24
Crippled Children's East Side Free School 11
Fed. of Ass'ns for Cripples 21
Red Cross Home Service 24
Jewish Big Brothers 2
Dept. Public Charities 8
Dept. of Health, Corlears 2
N. Y. Post Graduate 4
A. I. C. P 20
Assn. for Aid of Crippled Children 75
Red Cross Institute 2
Probation Dept., Children's Court 4
Jewish Big Sisters 3
Skin and Cancer Hospital i
Randall's Island 2
University Settlement i
Henry St. Settlement i
N. Y. Dispensary 7
Italian Hospital i
Beth Israel Hospital i
N. Y. Eye and Ear Infirmary i
C. O. S 22
58
FIELD CANVASS
Registered with Number

Richmond Hill Home 1 1
Washington Clinic, Dept. of Health 6

Maternity Center Ass'n 5
Children's Aid Society 4
Spring Neighborhood House
St. 3
N. Y. Orthopedic S. S 3
Infants' Milk Sta 2
Salvation Army 4
Fordham Hosp
N. Y. Child Labor Commission
N. Y. Diet Kitchen Ass'n
Spring St. Church
R. &C. S. S
Clearing House for Mentally Defective
Manhattan Trade School
Judson Memorial Church
Metropolitan Hospital
Dept. of Education, Bureau of Attendance
Bellevue S. S
Assn. of Catholic Charities
Protestant Big Sisters
Vanderbilt Clinic
Bureau of Domestic Relations 3
Board of Child Welfare ,
5
Public Education Ass'n 2
St. Phillip's Church i
Save a HomeFund, Evening Mail 2
Vocational Guidance Bureau, P. S. No. 119 2
Diet Kitchen, Tuck's Branch i
Tuberculous Hosp. Adm. Bureau i
Harlem Hosp. Tub. Clinic i
Women's Hosp. S. S I
Lenox Hill Hosp. S. S i
N. Y. Milk Committee 2
Jefferson Clinic i
Lebanon Hosp. S S. 2
Dept. of Health, Tremont Clinic 3
Division of Midwives and Foundlings i
City Hospital i
Montefiore Home S. S i
Widows and Mothers Fund 2
Not registered 326
It will be noted that the highest number known to any agency
were registered with the Association for the Aid of Crippled
Children. The agencies which had the next highest number
were the United Hebrew Charities and the Red Cross Home
Service, also the Federation of Associations for Cripples. In-
quiries were made of the other agencies where each case was
registered it developed the fact that in most cases the agencies
;
were not interested in the cripples found by the survey, but in

some other member of the family. It will be especially noted
that 326 cases were not registered with any agency.
Of the 212 cases in Brooklyn referred to the Confidential Social
59
Service Exchange the following were found to be registered or

unregistered :
CASES IN BROOKLYN
Distributed as to agencies they are registered with
Number
United Jewish Aid Society 5
Baby Health Sta i
Department of Health i
N. Y. American Baby Hospital i
District Nursing Com., General Dept 13

District Nursing Com., Orth. Dept 20
B. of C. Committee on Crippled Children 13
S. P. C. C 3
American Red Cross i
Dept. of Public Charities. i
State Industrial Commission 3

Kings County Hosp. S. S 2
Civilian Relief 3
Manhattan Trade School i
R. &
C. Dental Clinic i
Brooklyn Hospital S. S i
Little Italy House i
L. I. College Clinic i
Red Hook Health Centre i
Unregistered 150
Of the foregoing cases, 150 were not registered with any agency.
Out of the 727 cases found, 476 were not registered with any agency.
T^ROPORTION OP 727 CASES

NOT KNOWN TO ANY AGENCY
MANHATTAN
AN'D BRONX SROOKLVN
]
Csses Registered
Caês Not Re^sterecf
60
EDUCATION FOR CRIPPLES
Public Schools
HE of Education in the City of New York
T Borough
Department
maintains 89 special classes in 36 public schools of four
boroughs :
Public schools Classes

Manhattan 16 46
Bronx 4 II
Brooklyn 14 30
Queens 2 2
Information as to pronounced cripples is secured by the Bureau

of Census, Department of Education. Each attendance officer
is required to cover his district annually. On the cards used is a
blank space in which is to be entered any defect discovered by a
physician. If such appears on the card, it is sent to Miss A. J.
Smith at the the Department of Education. Informa-
office of
tion as to children under five is likewise taken, but is incomplete
and not tabulated, due to the lack of staff. The special classes are
under the direction of Miss Carolina G. Ronzone,who is respon-
sible to Dr. Andrew W. Edson. Admission to such classes, also
the transportation, is arranged by Miss Smith, who, under the
supervision of Dr. Aldinger, is in charge of the Physical Training
of handicapped children. Wherever possible, Miss Smith ar-
ranges three groups: Tuberculosis bone and joint cases, non-
tuberculosis cases, and mental defectives, planning the work so
as to meet the needsof each child so far as possible.
The
industrial training in these classes is given by the teachers
assigned the classes for cripples, under the supervision of Miss
Carolina G. Ronzone, who gives them special training in prin-
ciples in the pre-vocational work taught in these classes. Miss
Ronzone is acquainted with the fundamentals of all the industries
which she has charge of in the pre-vocational work and aims to
stress the fundamentals rather than having the boys and girls
make Fifteen hundred and forty-five
finished products in class.
children are registered in the cripple classes. Of these 416, or 27
61
per cent, are tuberculous, 66i or 43 per cent, are post-polio, 29, or
,
2 per cent, are cardiac cases, and the remainder are miscellaneous
cripples. None are admitted to these classes who would be unable
to get about in a crowd of normal children. Transportation is
furnished all children who attend classes for cripples. Children
who are totally disabled and therefore shut-ins may receive home
teaching. This feature of the teaching service, however, has not
as yet been developed satisfactorily to the department, owing to a
lack of funds. At present about 200 children are taught in their
own homes while 100 others are on a waiting list with no teachers
available. The latter children are receiving no education.
Class Rooms
The class rooms for cripples are not equally suitable for the
work to be carried on since some are in old buildings and others
in new. Of the 24 classes visited, one-half were on the ground
floor and the others were one flight up. With the exception of
one room all of the class rooms were fairly well lighted, but in few
cases were the windows so arranged as to give cross ventilation.
In II of the 24 visited the attendance exceeded the seating capacity
of the rooms. Special equipment is furnished for 20 children per
class, but in some rooms the excess needing such equipment
reaches as high as ten, and plain wooden chairs were used to meet
the deficiency of special furniture. In some of the schools visited
classes were maintained for tuberculous cases, but no open air
classes were held for these cases.
Nursing Service
In schools located in districts where the Association for the
Aid of Crippled Children has nurses the children of the classes for
cripples are given the benefit of this service in others the Depart-
;
ment of Health nurses visit to some extent.

Lunches
The Philanthropic League furnishes school lunches for six
cripple classes in P.S. No. 27 in Manhattan and furnishes milk in
P.S. No. 32 and No. 10 in the Bronx. The Association for the
Aid of Crippled Children furnishes milk for P.S. Nos. 6, 30, 44, 69,
and 32A, and in cooperation with the foregoing League in P.S.
No. 70.
62
Curriculum
There is considerable retardation due to irregularity of attend-
ance. As the teachers are required to keep the children up to the
standards, this makes it very difficult. The amount of pre-voca-
tional work is not as great as it should be. Some teachers claim
that the children are mentally alert and normal, others say that
they are feeble-minded and subnormal. These opinions are, of
course, not based on diagnosis, but doubtless have considerable
effect upon the attitude of the teachers toward the pupils. In
the classes visited, the pre-vocational work for girls was found
to be well developed, but for boys it was sometimes entirely
lacking.
In classrooms for tuberculous cases, the children are provided
with cots and folding chairs. After lunch each child lies down for
one hour covered with warm blankets. During this time all
windows are kept open. In addition, at other times the teacher
assigns five minute rest periods at her own discretion.
CHILDREN ATTENDING PUBLIC SCHOOL CLASSES FOR CRIPPLES

Distributed as to age and nature of condition
Nature of
condition
survey of cripples in new york city
Private Schools
East Side Free School
The Crippled Children's East Side Free School, 157 Henry St.,
should be regarded as a private school, although the staff, con-
sisting of principal and 7 teachers, is provided by the Board of
Education. Two vocational teachers, one for industrial art and
one for cooking, are provided by the institution. Two nurses,
four maids, a cook, and a handy-man are also employed by the
institution. The building has four floors, basement, and enclosed
roof. In addition to the class rooms there are a dispensary, re-
ception room, and also work rooms. The capacity of the institu-
tion is 200. All of the day pupils are transported by five buses,
three belonging to the Board of Education, and two to the insti-
tution. The teachers generally are of a high type and the work
in the classrooms compares favorably with that of neighboring
public schools. Industrial work includes cooking, fancy flower
making, novelty and favor making, plain and fancy sewing. All
of this work is graded in easy stages from the kindergarten up.
The work room is conducted for girls who have graduated from
the eighth grade. The present enrollment consists of 25, five of
whom are working at home on the piece work basis, and of the
remaining 20, five are receiving eight dollars a week, five from
fifteen to eighteen dollars, and six receive twelve dollars a week.
The work consists of fine lingerie made to order. The work is
now self-supporting.
Rhinelander School
The Rhinelander School for Cripples, 350 East 28th St., is a
day school maintained by the Children's Aid Society. The school
occupies an old type school building, with light and airy class
rooms. The nurse looks after the physical care of the children
and in cooperation with the nurses of the Association for the
Aid of Crippled Children does the follow-up work in their homes.
The tuberculosis bone and joint cases are segregated in an open
air class room and the children of this class are supplied with
special outdoor clothing. These children receive three meals a

day in the school, and the other pupils are given a hot luncheon.
The teachers are not licensed from the Department of Educa-
64
tion. Grade work is carried on up to 6B. The academic work is

carried on in the morning. Luncheon is served at 12, and at 12 130
such children as need treatment are taken to the New York
Orthopaedic. In the afternoon the children are trained in pre-
vocational work: drawing, woodwork, knitting, and sewing.
During the summer the children are given a vacation at the
summer home of the association at Bath Beach.
William H. Davis Memorial School

The William H. Davis Memorial Free School for Cripples,
471 West 57th St., accepts crippled children of poor parents be-
tween the ages of five and fourteen. The capacity of the school
is 50. Three academic teachers, not licensed by the Board of
Education, give academic instruction. Dressmaking, fine sewing,
wood carving, brass work, tool leather work, and cobbling are also
taught. The class rooms are poorly ventilated and unattrac-
tively furnished, the desks and seats being of the non-adjustable
type. As soon
as the children are fourteen years of age they
discontinue school attendance and obtain working papers. All
children, with the consent of their parents, leave on June ist for
the summer home the Lulu Thorley Lyons Home at Claver-
neck, N. Y., and remain until October ist. During that time
they have one hour a day school work and continue their manual
training.
Education in Hospitals and Homes

Education in custodial institutions and hospitals has been dis-
cussed in connection with those institutions. Upon the whole the
instruction in vocational and pre-vocational subjects is deficient.
Institute for Crippled and Disabled Men

The Institute for Crippled and Disabled Men, loi East 23rd
Street, is the only organization devoting itself to the vocational
training of handicapped men. It was organized by the American
Red Cross during the war, and continued under its supervision
until December, 19 19, when
was reorganized under its present
it
name, with a separate charter. Mr. Douglas C. McMurtrie was

responsible for its initiation and general activity. Dr. J. C.
Faries is now Director.
5 65
The Institute has two primary functions, first, to train all

crippled men applying for training for a vocation; second, to
place in positions crippled men who apply for employment, in-
cluding such men as it trains in its shops.

To carry out this work it has two bureaus, one for the education
of men and the other for placement. It also has a third bureau
for fieldwork, which keeps in touch with hospitals and directs
men and also keeps in touch with the men as
to the Institute,
they work in the Institute, to see that they attend clinics for
advice, and that their families are cared for, if need be. The In-
stitute also cooperates with the Federation of Associations for
Cripples, whose office is inthe same building, in its work of carry-

ing employment to the homes of cripples. In this connection,
the truck operated by the Institute is used to carry materials to
the residences of cripples doing home work.
When a person applies to the Institute for vocational training,
he examined by Dr. Faries for the purpose of determining his
is
aptitude and taste for class instruction. The Director then per-
sonally advises him as to the vocation or vocations for which he
would best be suited considering his handicap. In the educational
department instruction is given in the manufacture of artificial
limbs, oxy-acetylene welding, printing, typewriter repairing,
enameling, nickel plating, moving picture projecting, and jewelry
making.
In this educational department about three hundred men have
been enrolled since the beginning of the work, and of these, i lo
have been placed in the vocation for which they were trained in
the shop.
The employment bureau of the Institute is at the service of any
crippled man
needing employment. The bureau gets in touch
with employers, to learn where crippled men can best be used,
and then attempts to fit the man to the place, and after he has
been placed, to keep in touch with him to see that his placement
is the proper adjustment for him. During 191 9 there were 828
requests from employers for employees, and there were 3627
visits of applicants to the office seeking employment. Of these,
2342 were referred to positions. The number actually placed was
896.
The Institute is doing excellent work, but its work could be
66
several times enlarged if all the institutions and associations and

City departments dealing with cripples would cooperate with the
Institute in referring men to it for training and placement.
The Institute does not train or place women, nor is this work
done elsewhere except in a limited degree through one or two
other associations that are operated primarily as aids to patients
leaving hospitals. Such work is very much needed.
Some work is done in connection with the Department of Edu-
cation in the placing of crippled pupils leaving the schools.
The Institute occupies a very important place, and should
become so thoroughly known and recognized that through its
ministrations no cripple need beg or be partially or wholly de-
pendent because untrained for a vocation.
67
SOCIAL AGENCIES
New York Committee on After Care of Infantile Paralysis
Cases
New York Committee on After Care of Infantile
was organized on the request of Dr. Haven
Paralysis Cases
THE Emerson, Commissioner of Health, who was charged with
the care of several thousand children suffering from the epidemic
of poliomyelitis in the fall of 191 6. This Committee consisted of
representatives from various associations, who elected a Board
of Trustees to take charge of funds which were turned over to it
by Commissioner Emerson. Dr. Thomas J. Riley was elected
Chairman of the Committee and has remained such since its or-
ganization. At the close of the epidemic the After Care Commit-
tee had assumed charge of 6575 children who had been afflicted
during and survived the epidemic. It was apparent at once that
these children needed clinical treatment, and a large proportion of
them needed transportation from their homes to clinics. Accord-
ingly, one of the first and most pressing problems of the Committee
was to provide transportation. This was secured partly through
the City of New York, partly through other agencies, and partly
by the operation of buses directly by the Committee.
The Committee kept complete record of each child at its office :
by whom treated; prognosis; progress, and followed the child to

see that treatment was continued. In addition, the Committee
purchased through clinics many braces and appliances where
parents were not able to defray the expense of such devices.
The results of the care of children afflicted with infantile paral-
ysis during that epidemic have been very gratifying. Almost no
deformities due to neglect have resulted among the thousands of
children afflicted. Toward these good results the After Care
Committee has contributed a large share.
The After Care Committee, operating buses, has been con-
stantly appealed to to carry children who have been paralyzed
by other epidemics than that of 1916, or handicapped by other
68
SOCIAL AGENCIES
diseases, such as spastic paralysis, birth paralysis, spinal menin-

gitis, arthritis, osteomyelitis, rachitis, or by accident. It has
found it necessary from time to time to yield to these appeals,
and to transport cases other than those for which the Committee
was originally created. These appeals to the Committee for trans-
portation have made very clear the constant and pressing need
for aid to various classes of cripples.
The Committee, in addition to its transportation work and the
demand and appliances, has contributed funds for the
for braces
employment of orthopedic nurses. During the year 1919,

through its funds, 74,069 home visits were made by orthopedic
nurses. The total cost of appliances, home visitation, supervision
and transportation during the year was $53,116.63. One of the
things impressed upon the staff of the After Care Committee is
the fact that not infrequently parents will grow discouraged be-
cause the treatment in a particular clinic does not show favorable
results more rapidly, and will cease to take the child to the clinic,
and in the meantime, move their residence, so that without some
central record and follow-up system, the child would cease to have
any medical treatment and care. With the follow-up system of
the After Care Committee, however, such discouragement or
occasional neglect on the part of parents seldom results in injury
to the child.
The need Care was clearly demonstrated by the
for the After
work during and subsequent to the epidemic of 1916.
results of its
The demands made on it by children crippled at other times than
in 191 6 and by other diseases than infantile paralysis, make it
apparent that some central organization is needful to keep track

of the children of moving parents, and to supervise transportation
and perform certain other functions not readily performed by an
association which has not city-wide interests.
Association for the Aid of Crippled Children

1 HE Association for the Aid of Crippled Children was organized
to provide systematic home nursing care for children of all ages,
physically or mentally handicapped. Their field is divided into
twelve districts, to each of which is assigned a field nurse whose
duty it is to look after the welfare of over two hundred cripples
69
each. Four of these districts are in the Bronx and eight are in
Manhattan. Every nurse, except those in the Bronx, who are
under a Deputy-Supervisor, is at the main office of the Associa-
tion once a week in conference with the supervisor or members
of the executive committee. The Association receives cases
under sixteen years of age from the various welfare agencies who
do not deal directly with cripples, and also by house-to-house
surveys by which they aim to secure information as to all cripples.
All kinds of social work are performed with the exception of mate-
rial relief, although there is an emergency fund which may be
drawn upon for this purpose. Braces and special shoes are pro-
vided and kept in repair when the parents are unable to pay.
The Association has arranged for nurses to visit milk stations
at which on stated days they see cases in need of orthopedic care,
also regul ar visitation is made upon the schools for cripples in the
Department of Education and in fact all follow-upwork and most
of the vocational activities in this school are done by the nurses
from the Association for the Aid of Crippled Children.
From January 22nd to June 5th, 191 9, the Association fur-
nished 5105 quarts of milk to these crippled classes at a total
cost of $716.22, of which they had reimbursement of $217.29.
This milk was distributed to the following public schools P.S. :
Nos. 6, 30, 70, 44, 69 and 32A. Christmas boxes and candy are
also distributedby the Association in these schools.
The work of this Association shows a continuous increase in
the number of crippled children under its care. The work done is
constructive, although the important aim, whether it be physical,
economic, or educational, is a work that requires long-continued
and untiring effort.
The Association has no nurses in the following districts that :
part of Manhattan south of 59th St., east of West Broadway and

Sixth Avenue, that part north of 59th St. and west of Fifth Ave-
nue; that part of the Bronx north of the south line of Crotona
Park.
Mrs. Edgar S. Auchincloss is President of the Association;
T. S.McLane, Treasurer; Miss M. L. Barker, Secretary; Mrs.
Henry B. Barnes, Chairman of the Executive Committee; Miss
Genevive Wilson, Secretary of the Executive Committee, and
also supervisor of the nurses.
70
SOCIAL AGENCIES
Brooklyn Bureau of Charities

Committee on Crippled Children
Previous to May, 191 9, the Committee on Crippled Children
had assisted the orthopedic clinic in Long Island College Hos-
pital and in the Brooklyn Hospital. This included the provision
of nurses, the conduct of the after-care, and social service work,
also the transportation of all cases not included in the city trans-
portation service. In addition to this the committee provided
transportation for all other cases which for various reasons had
not been included in the city service, but were attending other
clinics, such as the clinic of the 'Jewish Hospital, the Throop
Avenue Dispensary, and some under the care of the Visiting
Nurse Association.
In May, 1919, due to the policy of the Brooklyn Bureau of
Charities that such work, having been initiated by the Bureau,
should be carried on independently by other agencies, the various
hospitals and dispensaries undertook the continuation of the
work under their own administration.
work in Long Island College Hos-
Since 1910, the orthopedic
pital and in Brooklyn Hospital has been in part maintained by
the income from the Fox Fund, which was given to the Associa-
tion for Improving the Condition of the Poor and to the Brooklyn
Bureau of Charities for work among cripples. In the main, the
funds in the charge of the A. I. C. P. are given to the Long Island
College Hospital. The Brooklyn Bureau of Charities contributes
chiefly to the work
in the Brooklyn Hospital.
TheVisiting Nurse Association, which was part of the Com-
mittee on Crippled Children previous to last May, continues
social service and home treatment work for the orthopedic de-
partment of the Long Island College Hospital and home treat-

ment work for the Brooklyn Hospital.
At present the Committee on Crippled Children acts as a
Federation on work for cripples. Most clinics and associations
in Brooklyn are represented.
The Committee on Crippled Children has had an active part
in handling the transportation of cripples in Brooklyn for some
years, and since 191 6 has been responsible for the arrangement of
71
all transportation to clinics. Furthermore, it has assumed charge

of all social service work for cripples except that of the medical
social service which is performed by the Visiting Nurse Associa-
tion. arranges for admission to classes for cripples, and where
It
no employment work has been undertaken it has offered some
vocational training.
The Visiting Nurse Association of Brooklyn

The Visiting Nurse Association of Brooklyn, located at 80
Schermerhorn St., Brooklyn, was incorporated as an independent
organization on May 14th, 1919. Previous to that time, since
1901, it has been a department of the Brooklyn Bureau of Chari-
ties, known as the District Nursing Association. By representa-
tion on the Committee on Crippled Children it continues to main-
tain a connection with that Society.
On the staff of the Visiting Nurse Association are an average of
fifty graduate nurses, including the superintendent. Miss Eliza-
beth Stringer, an assistant superintendent, a general field super-
visor, and a registrar. Each of the ten districts is under the direc-
tion of a supervisor.
The orthopedic department, which is the part of the organiza-
tion of special interest in a study of the care of cripples, is under
the direction of Miss Katherine Edwards, assisted by ten other
graduate nurses.
The work of the orthopedic department includes social service
and home treatments. The relation of the Association to the
clinics varies. In the Long Island College Hospital the Association
provides a nurse six days a week in the Orthopedic Clinic, ostensibly

for the purpose of being on hand to secure the physician's advice
in regard to home treatment of individual cases, but practically
the Visiting Nurse actually takes the place of a clinic nurse for
infantile paralysis cases. She prepares the child for treatment,
takes the physicians' dictation, and is present throughout the
entire examination and treatment.
The social service work includes such service for the orthopedic
department of the Long Island College Hospital. This includes
follow-up and after-care work, but is distinctly medical social
service. No relief is given and cases requiring family rehabilita-
72
SOCIAL AGENCIES
tion and adjustment are referred to the Brooklyn Bureau of Char-

ities.
The home treatment work includes massage, muscle training,

corrective work and other treatment on the advice of the physi-
cian. Cases receiving this treatment are brought to the clinic on
an average of every two months for re-examination. The major-
ity of cases in this group are poliomyelitis cases. Of the 375 under
care at the present time, 278 are patients of the Long Island Col-
lege Hospital and 87 of the Brooklyn Hospital.
The following report for the month of October, 1919, indicates
the present scope of the Orthopedic Department :
No. of cases under care Oct. ist 979

Aided during current month, new 15, old 4 19
Total number under care 998
No. terminated during month 8
Home treatments 1.451
No. social service visits 534
No. visits to social agencies 14
Total treatments and visits If99i
Individual children receiving home treatment 316
No. patients under care Nov. ist 990
Fees from patients $216.33
No financial report for the orthopedic department for the past

fiscal year is available as the work was financed entirely by the
Brooklyn Bureau of Charities.
The cost per visit based on total operating expenses has been
computed at $0.60. This charge is made per treatment when the
family is in position to pay. Otherwise the rate is graduated from
nothing up to $0.50 according to the family's ability to pay. No
charges are made for any visits in which treatments are not given.
Employment Bureaus for Cripples

1 HERE are oin New York City four agencies that may be said to
specialize in
employment for cripples :
(i) The Employment Bureau of the Institute for Crippled and

Disabled Men; (2) The Employment Bureau for the Handi-
capped of the Hospital Social Service Association; (3) The
Supervisor of Home Work of the Federation of Associations for
Cripples; (4) The Industrial Classes for Cripples in the Depart-
ment of Education directed by Miss Ronzone.
73
I. The Employment Bureau of the Institute for Crippled

AND Disabled Men
The above Bureau, under the supervision of Miss Gertrude R.
room on the second floor of the Institute.
Stein, occupies a large
This Bureau handles men only. It is the outgrowth of the Bureau
which was established in 191 6 in cooperation with the
for Cripples
Hudson Guild. Applicants for work are referred to the Employ-
ment Bureau through newspaper publicity, through employment
bureaus, charitable societies and hospitals, and others come
through cripples who have themselves been placed.
The work of thisBureau is curtailed somewhat by the hard
and fast rule that none but orthopedic cases are registered.
A very intelligent effort is made
to study the capability of the
applicant and his adaptability temperamentally and otherwise
to the kind of work at which he may be able to succeed. Health
considerations are likewise given due weight, and considerable
efforthas been made to educate employers who are now pre-
judiced against cripples. The kind of positions secured and the
handicapped conditions are shown in a comparative statement
of the weekly reports of the Institute for Crippled and Disabled
Men, the Handicapped Department of the Hospital Social Service
Association of New York and the Association for the Crippled
and Disabled in Cleveland, which will be placed at the end of this
section of the report.
2. Employment Bureau for the Handicapped

405 Lexington Avenue
The HospitalSocial Service Association established in 1912
operates a special Department, known as the Employment Bu-
reau for the Handicapped, which undertakes the placement of
both men and women in industries. It includes surgical, medical,
nervous and mental cases which are referred to it by the Social
Service departments of various hospitals having membership in
the Social Service Association. About 20 per cent of the appli-
cants come within the scope of this survey, indicating that its
service to the disabled somewhat similar to that which is fur-
is
nished by the Employment Bureau of the Institute for Disabled

Men. While no complete statement concerning the whole num-
74
SOCIAL AGENCIES
ber of applicants and placements for the last year is available,

the following statement with regard to cardiac cases is interesting :
CARDIACS FROM JUNE QTH TO FEBRUARY 29TH, I920

Applicants 305
Placed 161
Still in position 117
Lost track of by hospital, moved, etc 30
Died 6
Too feeble to work 16
There is no doubt that the Bureau takes a large place in solving

the problem of the handicapped in the City of New York.
The work of the Bureau is in charge of Mrs. John S. Sheppard,
Chairman, Mrs. William Woodward, Secretary, and Mrs. Ida M.
Duggan, Director. Due to the fact that this Bureau accepts ap-
plicants handicapped in every way, the field of its efforts is con-
siderably broadened.
3. Home Work of the Federation of Associations for

Cripples
Miss McCleery of the Federation of Associations for Cripples
obtains home employment for males and females of all ages. This
requires considerable field work, as nothing can be sent to homes
which have not been previously inspected. In fact the Associa-
tion certifies to the Bureau of Licenses as to the cleanliness of the
home before licenses are issued. The character of the home work
obtained has been addressing envelopes, fringe knotting and other
fringe work, painting toys, painting ribbons, glove finishing and
the manufacture of neckwear. There are now 198 cripples re-
ceiving work through this source.
4. Placement Work for Crippled Children in the Public

Schools
Miss Carolina G. Ronzone, Director of the Industrial Work in
the Department of Education, places children from these classes
in various industries with which she has established relations.
Having planned her course of study to train the children in the

lower grades to use their fingers and tools correctly, to understand
the manipulating of materials, to measure properly, she gets in
touch with employers and satisfies them that these handicapped
75
children are fitted to meet the demands of their establishments.

The children who have been
placed by Miss Ronzone in the
flower-making industry, are working on the finer grades of flowers
and earning good salaries
In Cleveland, Ohio, the Association for Crippled and Disabled

operates an Employment Bureau for the Handicapped. This
Bureau has its desk in the office of the State Employment Bureau,
and in addition to cases referred to it direct, receives applicants
who have Employment Bureau. No such
applied to the State
cooperative arrangement has been made with other employment
bureaus by the special employment bureaus in New York. A
comparison of the weekly reports of the three Bureaus mentioned
above who place applicants in various industries is shown below :
COMPARATIVE TABLE OF APPLICATIONS AND PLACEMENTS IN ONE

WEEK BY HANDICAP BUREAUS OF HOSPITAL SOCIAL SERVICE
ASSOCIATION, INSTITUTE FOR CRIPPLED AND DISABLED
MEN, AND CLEVELAND ASSOCIATION FOR CRIPPLED
AND DISABLED
Hospital Institute for

Cleveland
Social Service Crippled and Association
Association Disabled men
Applicants 73 87 26
New. . .
34 19 14
Old ... .
39 68 12
Placed . .
33 26 13
The Bureau for the Handicapped in Cleveland accepts all kinds

of cases, including heart, old age and tubercular disabilities, and
the success of the work performed by the Employment Bureau
for the Handicapped of the Association for Crippled and Disabled
would indicate that a similar plan might be followed in employ-
ment bureaus in the York.
City of New
There is no bureau in Brooklyn with the same functions as the
bureaus making placements in the City of New York, although
the hospitals of Brooklyn stand in need of services similar to those
of the City of New York.
76
HOSPITAL AND CLINIC CARE
Survey made examination of all hospitals in and about
New YorkCity providing orthopedic beds, primarily for
THE the purpose of determining their capacity and the degree
to which the capacity is at present used. The number of beds
found is shown in a separate table on page 87. It will be noted
that there are in specialized orthopedic hospitals in and adjacent
to New York City 928 beds. Of this number, 673 are in Man-
hattan, and but 55 are in Brooklyn; in addition 50 beds are
available for Brooklyn at Port Jefferson, Long Island. Of the
total orthopedic beds in specialized and general hospitals there
are or shortly will be 1278. These are all operative beds.
In addition to the active operative beds, there are 375 beds
available for convalescent patients, making a total of 1651 beds
available for cripples undergoing treatment.
Manhattan and the Bronx

New York Orthopaedic Hospital
1 HE New York Orthopaedic Hospital occupies a modern six-
story and basement fire-proof building constructed about 191 5.

The first floor is used for administrative offices, out-patient de-
partment, and gymnasium. The second floor is used to house
the female hospital helpers, and the third floor is the nurses' quar-
ters.
The ward units and other hospital facilities occupy the three
upper floors of the hospital. There are ten beds for male adults,
ten beds for female adults,
twenty beds for boys from five to six-
teen, twenty beds for girls from five to sixteen, and thirty- two
beds for children under five, making a total of ninety-two. This
hospital is very generally and favorably thought of by the parents
of the children found in the districts canvassed. Many cases are
referred there by the friends of the patients, and there is usually
a long waiting list at this hospital for that reason.
77
The chief-surgeon is Dr. Russell Hibbs, and the superintendent

is Miss Theodora S. Root.
School instruction, pre-vocational training, and nursery ac-
commodations are provided for the children.
The Visiting Nurses* Department employs twelve nurses for
follow-up work on patients of the hospital and dispensary, and
to visit the homes of cases discharged from the Country Branch
at White Plains.
The Hospital for the Relief of the Ruptured and Crippled

The Hospital for the Relief of the Ruptured and Crippled is a
five-story and basement fire-proof building at 321 East 42nd
Street. The first floor is devoted to the administrative offices and
the dispensary. The second floor is given entirely to living quar-
ters of the superintendent, staff, graduate nurses, and female
help. The third, fourth and fifth floors are devoted to the ward
units, operating rooms, school rooms, patients' dining room, and
recreation rooms. It provides forty beds for female adults, nine-
teen beds for male adults, eighty-one beds for female children, and
eighty-one beds for male children, making a total of two hundred
and twenty-one. This hospital is very well and favorably known
to the parents, and cripples found in the districts surveyed have
gone to the hospital upon the advice of neighbors and friends.
This hospital has a very strong medical staff. Dr. Virgil P.
Gibney is chief surgeon, and Mr. Joseph D. Flick is superin-
tendent.
School instruction, pre-vocational training and nursery accom-
modations are provided for the children.
It has no branch for convalescents, but the social service de-
partment renders valuable service in finding places for conval-

escent patients.
Dispensary and Hospital for Deformities and Joint

Diseases
The Hospital for the Deformities and Joint Diseases, 1924
Madison Avenue, corner of 123rd St., has a total capacity of 102
beds; children 41, female adults 21, male adults 22, private rooms
18. This hospital has almost as great a reputation among the
people who came within the scope of this survey as the two hos-
78
pitals mentioned previously. The hospital has plans under way

to build a new plant with 360 beds which will make it one of the
largest orthopedic hospitals in the world. The beds will be dis-
tributed as follows: children under 10, 120; children from 10
to 13, 40; male adults, 40; female adults, 60; private rooms, 100.
The physician and surgeon-in-chief is Dr. Henry W. Frauen-
thal. Mr. Charles Diehl is superintendent of the hospital.
School instruction, pre- vocational training, and nursery ac-
commodations are provided for the children.
Mt. Sinai Hospital

Mt. Sinai Hospital, at looth St. and Fifth Ave., is a 500 bed
general hospital. Dr. S. S. Goldwater is superintendent. It
maintains no beds for orthopedic cases, but plans, however, for
the enlargement of the hospital so as to provide 20 beds for these
cases.
Lenox Hill Hospital

Lenox Hill Hospital, located at 112 East 77th Street, is a gen-
eral hospital of 519 beds. This hospital does not set aside any
beds for orthopedic service, but Dr. Charles Hope Jaeger is per-
mitted one bed for operative treatment. Louis Kortum is super-
intendent of the hospital.
New York Hospital

New York Hospital, located at 8 West i6th St., is a general
hospital of 270 beds. This hospital does not set aside any ortho-
pedic wards, but allows orthopedic cases to be cared for in its
surgical ward. Dr. Thomas Howell is the superintendent of the
hospital.
St. Luke's Hospital

St. Luke's Hospital, located at Broadway and 114th St., is a
general hospital of 400 beds. Reverend George F. Clover is
superintendent of the hospital. St. Luke's Hospital maintains
two wards for orthopedic cases one for nine girls under the age
:
of twelve, and one for nine boys under the age of twelve. Two
beds are provided for adults. Dr. T. Halstead Myers is the chief
attending orthopedic surgeon. No educational activities are
79
provided in the orthopedic service, as the Board of Education is
unwilling to provide bedside instruction.

A social service worker follows up all cases discharged from the
hospital.
New York Post Graduate Medical School and Hospital

New York Post Graduate Hospital, at 303 East 20th Street, is
a general hospital of 405 beds. It has a ward of 28 beds for ortho-
pedic cases. Dr. Fred H. Albee is the chief surgeon of this ser-
vice. Mr. Alexander H. Candlish is the superintendent of the
hospital.
Bellevue and Allied Hospitals
There are no beds set aside for the care of orthopedic cases in
Bellevue or its Allied hospitals. Orthopedic services are main-
tained at Bellevue, Harlem, and at Fordham Hospitals, and pro-
vision is made for the treatment of such cases in the wards of
these hospitals. In 191 7 orthopedic cases were treated in these

three hospitals as follows :
In the Metropolitan, 40 beds in the children's pavilion are used

as an orthopedic ward and are in charge of Dr. Anson H. Bingham.
Laura Franklin Free Hospital for Children

The Laura Franklin Memorial Children's Hospital has a
capacity of 67 free beds which are for the use of acute or chronic
curable cases. Considerably more than one-half of its beds are
devoted to the care of cripples, in fact, the entire work of the
hospital embraces the care of cripples and of nose and throat
conditions.
This hospital is a philanthropy of the Delano family and is
provided with almost sufficient endowment to carry on the work.
The balance is obtained from the members of the Delano family.
The president is Warren Delano, Jr.; Treasurer, Frederick D.
Hitch secretary, T. Delano Weeks. The orthopedic surgeon in
;
charge is Dr. Anson H. Bingham, the general surgeon is Dr.

George W. Roberts. Frances L. Lurkins is superintendent.
Lebanon Hospital
Lebanon Hospital, located at Westchester and Caldwell Ave-
nues, Bronx, is a general hospital of 196 beds. George E. Halpern
is superintendent. Lebanon Hospital does not have any ortho-
pedic ward, but admits operative cases to its surgical beds. The
orthopedic work is in charge of Dr. S. Kleinberg.
Brooklyn and Queens

Brooklyn Hospital
Brooklyn Hospital, located at Raymond St. and DeKalb
Avenue, a general hospital of 286 beds. This hospital divides
is
its service for cripples between the

orthopedic, the pediatric, and
surgical. In the orthopedic ward are ten beds, in the pediatric
19, and in the surgical 58. Dr. Walter Truslow is the leading
orthopedic surgeon. Dr. W. G. Nealley is superintendent.
Long Island College Hospital

Long Island College Hospital, located at Henry, Pacific, and
Amity Streets, is a general hospital of 614 beds. This hospital
provides two hospital wards, with a capacity of 30 beds each, for
6 81
orthopedic cases. These wards are also used for convalescents.

There are two roof pavilions for this work, each pavilion being
a complete unit, including kitchen and bath-room, making a total
of 90 beds. The roof wards are so arranged that they are either
enclosed or entirely open. In addition to the beds in the roof
ward 10 beds are provided in the general wards. The head of the
orthopedic service is Dr. Jacques C. Rushmore; Dr. Richard E.
Shaw is superintendent of the hospital.
Throop Avenue Children's Hospital and Dispensary

The Throop Avenue Children's Hospital and Dispensary, 470
Throop Avenue, has 18 beds for operative cases. This is not
sufficient to take care of the hospital cases from its out-patient
department, but Dr. Herbert C. Fett, the chief surgeon, being
also connected with the Long Island College Hospital, is able to
make use of some of the beds available there.
House of St. Giles, the Cripple

The House of St. Giles is a new hospital on Brooklyn Avenue
and President St., Brooklyn. This hospital has a capacity of 47
beds, part of which may be used for adults. Dr. B. B. Mosher is
the chief surgeon. Miss Anne F. Hasbrouck is the superintendent.
Kings County Hospital of Brooklyn

Kings County Hospital, Clarkson and Albany Avenues, Brook-
lyn,is a general hospital of 1209 beds operated by the Depart-
ment of Public Charities of the City of New York. Dr. M. B.

Jones is the superintendent.
Kings County Hospital provides in all fifty-two beds for ortho-
pedic cases: fifteen for male adults, fifteen beds for female adults.
In the children's pavilion a ward of twenty-two beds is provided
for the children's orthopedic service.
The orthopedic clinic, held on Friday, is attended by former
patients of the hospital.
Jewish Hospital of Brooklyn

The Jewish Hospital of Brooklyn, located at Classon and St.
Mark's Avenues, has a capacity of about 300 beds, and its dis-
82
pensary includes an orthopedic clinic. This clinic gives approxi-

mately 400 treatments monthly and gives after-care to about 60
cases of infantile paralysis. The follow-up work of this clinic is
done by Miss Dichter, the nurse in charge of the orthopedic
clinic. We have been unsuccessful in securing information with
regard to the work of this clinic.
Jamaica Hospital
Jamaica Hospital, located on New York Avenue, Jamaica, is a
general hospital of 55 beds.
None of the beds of this hospital are set aside for orthopedic
cases, but Dr. H. C. Courten, surgeon-in-chief of the orthopedic
clinic, is allowed sufficient beds to take care of the operative cases
from his clinic. Miss Rose Saffeir is superintendent of the hos-
pital.
Neponsit Beach Hospital for Children

The Neponsit Beach Hospital, Mohawk St., Rockaway Beach,
contains 125 beds for tuberculous joint cases. The attending
surgeon is Dr. Brainerd H. Whitbeck. Miss Josephine T. W.
Brass is superintendent. This is a branch of Bellevue and Allied
Hospitals.
The building with equipment was constructed by the Asso-
its
ciation for the Improvement of the Condition of the Poor of New

York City and was transferred by them to the city department of
Bellevue and Allied Hospitals. It is a four-story brick building
of the ordinary institutional type, with porches facing the beach
at the front of the right and left wings, and enclosed porches
of similar construction within the quadrangle formed by the two
wings. These enclosed porches are devoted to school use, and to
provide open air class rooms for the children. The census on the
day of our visit was 100, and Dr. Whitbeck, who is the attending
surgeon, stated that recently he had offered the vacancies to pa-
tients of severalBrooklyn hospitals whom he thought might wish
to take advantage of them. The follow-up work of the Bellevue
and Allied Hospitals social service departments does not extend
to the children of this hospital and the follow-up work of these
patients is, therefore, left to the Department of Education, to
whom notice is sent of all discharged cases.
83
Adjacent to New York City

New York State Hospital for Crippled and Deformed
Children, West Haverstraw, N. Y.
Plant
The institution occupies a tract of 48^/2 acres. The original
building was a private house, and is now used for the staff and
the girls. On the first floor is the staff dining room and sitting
room, a dining room and sitting room for the girls. On the second
floor are the staff rooms, a clothing room, and a sewing room.
This building is approached by sloping boardwalks, making an
easy access for children with wheel chairs or on crutches. The
hospital building is a two-story and attic brick structure. On
the first floor is a ward containing 40 beds, a kitchen, and other
service rooms. The second floor is similar in plan with the ex-
ception that the service rooms above are used for operating, anes-
thesia, and X-ray. The boys are housed in the U-shaped frame
building. An old barn has been divided into two rooms which
are used for class rooms or industrial operations.
Admissions
Although this is a hospital for curable cases only, it shows a
tendency to give part of its beds to cases needing custodial care,
since many of the children remain at the institution for four or
five years, and the average stay has been computed at one year
and nine months. This is in spite of the fact that Dr. John Joseph
Nutt, the admitting officer, has restricted the admissions to hos-
pital cases, and 475 children have been refused admission, partly
on the grounds of ineligibility. Fifteen of the 171 children are
from 15 to 18 years of age. Seven discharged patients are on the
hospital payroll.
Education
This phase of the institution's work is not so high a standard
as the medical work. Two
teachers are supplied, one for aca-
demic work and one for vocational work. The staff is not ade-
quate for the instruction of 171 children, especially since about
one-half of the children require bedside instruction. Until last
84
summer a man had charge of carpentry work, but since his death
no one has been put in his place. One vocational teacher is trying
to make the best of very poor conditions by teaching basketry
and stenciling. Typewriting is taught by the secretary of the
superintendent in spare time. Four children in the institution
are taking music lessons at the expense of their parents.
After-Car e
of the discharged have been followed up and of
About one-half
these the information gathered shows that they are employed
at the following occupations: in government factories, federal
shipyards, manufacturing industries, as stenographers, teleg-
raphers, bookkeepers, clerks, cashiers, teachers, journalists,
painters, carpenters, farmers, and laborers.
Brooklyn Home for the Blind, Crippled, and Defective

Children, Port Jefferson, L. I.
The Brooklyn Home for Blind, Crippled, and Defective Chil-
dren was established thirteen years ago to provide a place for the
blind, crippled, and defective children of the Brooklyn Roman
Catholic parishes.
Plant
The institution is divided into two distinct parts, the defective
being in a different part of the grounds from the blind and crip-
pled, who are located in St. Charles Hospital, which has a capacity
of 262 beds. The grounds consist of eleven acres overlooking Long
Island Sound. While this institution
is equipped with complete
facilities for carrying on the work

an active hospital service,
of
it is to a great degree custodial, inasmuch as a large number of
its inmates are being given care intended to build them up before
receiving treatment, or after-care following an operation. At
least twenty-five per cent of the cases are of the after-care type
and a considerable percentage are receiving building-up treat-
ment preliminary to operation.
Admissions
There is a waiting list of fifteen to twenty continually at the
office of the Roman Catholic Orphan Asylum Society, whose
secretary is the admitting officer of this institution.
85
Administration
The head of the institution is Mother Theresa. She and forty-
six Sisters do all the work of the institution.Each Sister has been
specially trained for her task. Each teacher has been trained in
some industrial specialty for which she is responsible in the edu-
cational work. Each nursing Sister has been trained in a recog-
nized hospital.
Education
The course of instruction reaches from Kindergarten through
High School. The graduating class includes about twenty boys
and girls.
Advanced After graduating from the eighth grade two courses
:
are open, the academic and the commercial. Four are following
the academic and i6 are enrolled in the commercial. The com-
mercial course includes shorthand, French, English, typewriting,
telegraphy, and the use of the dictaphone.
Special: Music, Art, and fancy work are given important
places. Twelve children are being instructed on the piano, 40
receive violin lessons, 6 receive lessons on the 'cello, 6 on the
organ, and 7 on the drums. Special aptitude is sought and voca-
tional work is taught beside the commercial course. Pre-voca-
tional work is taught in plain sewing for the girls.
86
ORTHOPEDIC BEDS IN HOSPITALS OF NEW
YORK CITY AND VICINITY
OUT-PATIENT SERVICE
FAR the greater part of the remedial work done for
done in out-patient of hospitals,
BY cripples is departments
or in independent out-patient clinics. In the hospitals
and clinics, with the exception of those noted below, records were
both deficient and defective, and it was with great difficulty that
the proper information could be secured as to the histories of the
patients.
Manhattan
New York Orthopedic Dispensary and Hospital
This hospital emphasizes out-patient treatment for cripples.
The Out-Patient Department occupies the large rotunda which
forms the central pavilion of the hospital. The department is
open every day except Sundays and holidays, from 1 130 to 3 P. M.
All new cases are referred to the Visiting Nurse Department,
whose duty it is to assist in the follow-up work to see that the
instructions of the doctor are carried out and that the patients
appear regularly at the clinic for treatment. The records in this
hospital are fully In the 15 months ending
and accurately kept.
December 31st, 191 8, this out-patient department treated 6176
new cases from the City of New York; 875 of these were flat foot,
which were not regarded as cripples coming within the scope of
this survey; it also treated 1205 new cases from other cities.
Braces and orthopedic shoes are furnished at a reduced price to
patients.
New York Society for the Relief of the Ruptured and

Crippled
The Out-Patient Department of the New York Society for the
Relief of theRuptured and Crippled conducts one of the largest
out-patient departments in the city. The social service depart-
ment comes in close contact with all dispensary cases and is thus
enabled to do the necessary work which might otherwise be over-
looked. No follow-up system, however, is in use, it being the
88
OUT-PATIENT SERVICE
policy of the hospital to leave continued attendance to the initia-

tive of the patient. A
commendable feature of the social service
department is the assistance in sending patients to convalescent
homes. The hospital does not operate a separate convalescent
home, which is one of its great needs. The project has not been
undertaken because the requirements demand an institution of
considerable size. In the 12 months ending Sept. 30th, 1919,
9843 new orthopedic cases were treated, 2844 of which were flat
foot, which have not been regarded as a crippled condition coming
within the scope of this survey. This hospital draws patients
from a wide area outside of New York City, as does the New
York Orthopaedic Hospital. Braces and appliances are furnished
at reduced prices to patients.
Dispensary and Hospital for Deformities and Joint

Diseases
The Out-Patient Department of this hospital is its greatest
activity. During the year ending November, 191 8, 10,957 new
cases received treatment and 92,875 treatments were given. The
plans for a new hospital provide for a dispensary of double the
capacity of the present one.
The present dispensary is a six-story building fitted with all
approved equipment and apparatus for orthopedic treatment.

Social service work consists in visiting all cases who have been
absent from clinic one month or more, to determine the condition
of the patient and advise as to further treatment. Braces and
appliances to the value of $265.75 were given to patients during
the year ending November, 1919.
Dr. Henry W. Frauenthal gives personal attention to the
dispensary work on Mondays, Wednesdays, and Fridays, and Dr.
Herman Frauenthal is in charge on Tuesdays, Thursdays, and
Saturdays.
New York Hospital
The Out-Patient Department of the New York Hospital con-
ducts an orthopedic clinic daily. In this out-patient department
about 50 cases of poliomyelitis are receiving continued treatment.
The orthopedic wôrk is so closely connected with the other
phases of surgical treatment that it is impossible to more than
approximate the number of crippled cases handled. The records
7 89
indicate, however, that about 30 orthopedic cases are treated.

The facihties of the hospital are sufficient to give out-patient care
to not more than 100 patients, each one of whom
would receive
three treatments a week. The follow-up work of these cases is
done by the social service department in cooperation with the

Association for the Aid of Crippled Children, the home visits
being made by the Association.
Mount Sinai Hospital

In order to obtain an accurate knowledge of the work the
Mount Sinai Hospital is doing for cripples, it is necessary to make
a study of all the departments. Such an examination, covering a
period of two weeks in January, produced a list of 56 new cases,
the kind most frequently treated in orthopedic departments of
hospitals.The total number of treatments given during the year
ending December, 1918, was, orthopedic 2997, poliomyelitis 2678.
During this period there were 147 1 new cases. There are at
present 32 poliomyelitis cases under care. The facilities of this
out-patient department would be sufficient to care for approxi-
mately 100 patients receiving three treatments a week. The
social service work of this clinicis the responsibility of Mrs. Bauer,
the orthopedic nurse, who follows up the cases during the hours
that she is not engaged in the clinic work. These children are also
visited in their homes by the nurses of the Association for the Aid
of Crippled Children. The hospital has remitted one-half of the
cost of braces whenever necessary, the other half being met by
other agencies.
St. Luke's Hospital
The orthopedic clinic is held in the out-patient department
of St. Luke's Hospital between i :30 and 2 130 three days a week.
One of these days is devoted exclusively to the treatment of cases
of the 1916 epidemic of poliomyelitis. Two masseurs give massage
treatment to these cases; one masseur, employed by the hospital,
treats the patients of the other two clinics and gives corrective
exercises to those needing such treatment. This hospital has no
country branch and the social service nurses for the orthopedic
cases state that there is great difficulty in securing any summer
outings for crippled children. The orthopedic clinic of St.
Luke's Hospital has about one hundred cases.
90
out-patient service
Bellevue Hospital
Bellevue Hospital operates a clinic for poliomyelitis in which
are registered 58 cases who attend the clinic twice a week, one
group on Tuesdays and Thursdays the other group on Mondays
;
and Fridays. On Saturday morninga clinic is held for a group

of eleven school children. There
no orthopedic clinic operated
is
by the hospital except this one, but an orthopedic clinic under

the direction of Dr. Reginald Say re is conducted by the New
York University and Bellevue Hospital Medical College.
FoRDHAM Hospital
The orthopedic clinic is conducted in the out-patient depart-
ment by Dr. Samuel Boorstein. This a large tent
clinic is held in
which has been in use since the 191 6 epidemic of poliomyelitis.
It is fairly satisfactory, being of sufficient size and equipped with
steam heat. Although our examination was made on a very cold,
windy day, the tent was quite warm. Special mention should be
made of the care with which the records of the orthopedic depart-
ment are kept. The files are always up to date and at the end
of each year the records are tabulated. During the year 19 19, 385
new cases were registered, and 4095 treatments were given. The
social service work of the orthopedic cases is left to the social
service department of the hospital. The children of the polio
clinic are followed up through the Association for the Aid of
Crippled Children. The orthopedic clinic of Fordham Hospital
has a capacity of about 100 cases.
Harlem Hospital
The orthopedic Harlem Hospital is small, due to the
clinic of
fact that there is little by the orthopedic service
after-care given
to surgical cases. The equipment is somewhat meager. The
follow-up work is done on the advice of the physician, and only
surgical cases are followed up. The clinic of Harlem Hospital is
able to accommodate about 25 cases.
Cornell University Clinic

The orthopedic clinic of Cornell University Medical College,
at 28th St. and First Avenue, under the charge of Dr. Arthur
is
H. Cilley, the chief surgeon. The average daily attendance is

91
from 15 to 20 and 19 poliomyelitis cases from the epidemic of

1916 are treated three times a week. The clinic cares for ap-
proximately 100 cases. No social service work is done by the
clinic. In cases of necessity, home treatments are given by a
masseur.
Lebanon Hospital
The Lebanon Hospital conducts an orthopedic clinic in its
out-patient department daily. In addition, a clinic is held for
poliomyelitis, which is under separate control. The surgeon-in-
chief is Dr. S. Kleinberg. This clinic cares for about 20 polio
cases and the orthopedic clinic takes care of a large number of
cases of rickets and other deformities.
Vanderbilt Clinic
Vanderbilt Clinic, 60th St. and Amsterdam Avenue, does not
operate a separate orthopedic clinic; however, the orthopedic
department of the Neurological Clinic under the charge of Dr.
Jaeger cares for 20 cases of 191 6 polio cases. Other orthopedic
cases at this clinic would be referred to the New York Hospital.
Neurological Institute
The Neurological Institute, 149-51 East 67th Street, gives
dispensary treatment to a large number of cases that would be
included in our definition of cripples. A report for the year
ending Nov., 1919, indicates that there were treated 831 cases of
bone, joint, and muscle; 37 hemiplegia; and 28 poliomyelitis.
In some of these cases the crippling defect is a result of a nerve
derangement, although there is no history of other nerve insta-
bility.
West Side Dispensary
The West Side Dispensary and Hospital, 328 West 42nd Street,
conducts an orthopedic clinic, in which are treated 12 poliomye-
litis cases. The average number of patients in the dispensary
per year is about 600. There is no follow-up work for these
cases. The total capacity of the orthopedic clinic is 25.
Stuyvesant Polyclinic
Stuyvesant Polyclinic, located at 137 Second Avenue, gives
treatment regularly to 17 cases of poliomyelitis. This is practi-
cally the capacity of the clinic.
92
out-patient service
Clinic for Functional Re-education of Disabled Soldiers,

Sailors, and Civilians
The Clinic for Functional Re-education at 4 Livingston
Place operates a clinic with a daily attendance of 120; the total
number of patients receiving treatment at the close of February,
1920, 322. Clinic hours are from 9-5 daily; 9-12 on Sat-
was
urday; 7-9 P.M. on Mondays, Wednesdays, and Fridays. This
gives an opportunity for patients to be treated without inter-
ference with other duties and without the necessity of waiting
for any great length of time. The from the
clinic receives cases
U. Government,
S. accident insurance companies, railroad and
industrial corporations, and social agencies. There is a social
service worker whose duty it is to cooperate with the other agen-
cies interested in the patients. Little follow-up work is needed
but considerable is done in the rehabilitation of patients.
The clinic was established July 15, 191 8, and complete records
of cases have been kept since then. The following figures show
the scope of the work:
Totals to
Radiographs taken
Operations
Hospital days
Treatments by departments
Electrotherapy
Thermotherapy
Massage
Mechanotherapy
Miscellaneous
shall be left to the medical authorities of the institution. A com-

plete physical examination is made, including teeth, eyes, nose,
skin, scalp, heart, lungs, and posture defects. The teeth are re-
examined and put in condition once a year. Braces and appli-
ances are supplied on a part-pay basis graded as to ability to pay.
All patients admitted to the school must be able to walk. Trans-
portation is furnished to and from their homes.
Within the last three years 35 children have been graduated
from the eighth grade, and out of a class of 11 last year 7 or 8 are
now attending high school. Four former graduates are attending
night school in which they are taking business courses.
There is a work room, or industrial department, in connection
with the school. Articles are manufactured in this work room
which are sold. This work room is now entirely self-supporting.
Eight girls in work room are transported to the school by the
the
school buses. Four former pupils are in such condition that travel
to work is impossible, and work has been furnished to these per-
sons in their own homes. Miss Howard, head of the work room,
systematically looks after the employment of her former pupils.
A summer home at Oakhurst is operated by the school. It has
a capacity of 126. Those needing a long term in the country are
kept there 10 weeks, which is almost the whole of the vacation.
Others are allowed five weeks. Every one enrolled in the school
is given a summer outing at this home.
Brooklyn
PoLHEMus Clinic
PoLHEMUS Clinic, at the corner of Henry and Amity Streets,
Brooklyn, operated in connection with the Long Island College
is
Hospital. The orthopedic dispensary is conducted on the

second floor of this building. Five rooms are devoted entirely to
orthopedic work, and three of these rooms are also used for other
clinics. Two are devoted to examinations; one for fitting casts;
one for records ;and two for poliomyelitis only. In the dispensary
from October i, 1918, to Sept. 30, 1919, the number of cases
treated was as follows:
Total number of patients treated 853

Total number of treatments given 9.771
Average number of treatments per patient 11
94
OUT-PATIENT SERVICE
The clinic includes a physical training class for corrective exer-

cises. A brace shop is also operated.
The social service work of the orthopedic
department is
handled chiefly by Two hundred
the District Nursing Service.
and seventy-five children attending the Polhemus Clinic receive
home treatment by the nurses of this organization. They are
brought to the clinic on an average of every two months for re-
examination. The social service department of the Long Island
College Hospital cares for the cripples on their discharge from
the medical and surgical wards of the hospital. This constitutes
in Brooklyn one-half of the cases. The social service referred 12
men to the Red Cross Institute for re-education during the past
year. This clinic is now about up to capacity since it would be
undesirable to have a larger orthopedic service in a general hos-
pital of this size.
Brooklyn Hospital Out-Patient Department

The dispensary building of the Brooklyn Hospital is a two-
story building of twenty rooms on each floor. In the center is
an open gallery. There are waiting rooms on each floor with a
total capacity of about 300. Of the twenty rooms on the first
floor, three are used for an orthopedic clinic; one for examina-
tions and treatment room one as an office and record room and
; ;
one as an examining room for adults, and baking for those cases
requiring it. These rooms are small. The basement rooms of
the dispensary are also given over to orthopedic work. There
isa gymnasium equipped with four treatment tables and certain
gymnastic apparatus. Three rooms in the basement are used for
plaster work and brace shop. The orthopedic clinic is open
daily from 10-12. The dispensary records show a total of 4471
treated during year ending April 30th, 191 9; of these 4034 were
children and 437 adults. The orthopedic clinic has a daily aver-
age of 60 children and five adults. These figures indicate that
about one-fourth of the dispensary work is devoted to ortho-
pedic work for crippled cases, which is approximately the capa-
city of the clinic. The social service and follow-up work of the
orthopedic department is looked after by the social service depart-
ment of the hospital. Due to the other demands upon this service
the follow-up work of this department has not been adequate.
95
survey of cripples in new york city
Throop Avenue Children's Orthopedic Hospital and

Dispensary
The Out-Patient by the Throop Avenue Chil-
service furnished
dren's Hospital and Dispensary was begun in 191 6 to meet the
demand for the after-care of children affected by the epidemic of
poliomyelitis. It was established by funds raised through the
New York American and up to the present year was known as the
New York American Baby Hospital. It occupies a two-story and
attic building at 470 Throop Avenue, owned by the Brooklyn Asso-
ciation for the Improvement of the Condition of the Poor. The
location is desirable because of its proximity to a large area seri-
ously affected by the epidemic, and also because it is some distance
removed from the other clinics in the borough. The entire build-
ing, except for one room, which is a ward of eight beds, is devoted
to the out-patient work. The clinic is equipped with every ortho-
pedic device needful. Especial mention should be made of the
manner in which the records are kept. All cases are completely
indexed and all clinical and social facts are fully recorded.
This clinic is limited to children only, and continuously treats
about 350 cases. Of these :
Poliomyelitis 310
Other paralyses 12
Tubercular conditions 9
Congenital conditions 6
Rickets 6
Scoliosis 6
Fracture i
The follow-up work of this clinic is now being conducted by

means of postals, which is said to be fairly successful. About
one-half of the patients attending this clinic are transported, as
the children of the 19 16 epidemic are now becoming heavy and
transportation requirement is probably greater. Street car trans-
portation is a considerable problem and frequent transfers on the
system result in much waiting on the corner, and the danger of
frostbite to paralyzed limbs is said to be greater than to normal
limbs.
House of St. Giles, The Cripple
In the out-patient department of the House of St. Giles, the
orthopedic clinic is conducted by Dr. Burr Burton Mosher.
96
OUT-PATIENT SERVICE
During the year 191 8, 176 new orthopedic cases were treated,
and the total attendance was 1441. In this department there is a
professional masseuse and a masseur in constant attendance who
give treatment to these cases and likewise to resident cases. The
total number of treatments given during the year was 2227.
Queens
Jamaica Hospital Out-Patient Department
1 he only institution in Queens County which offers orthopedic
service to cripples is the Jamaica Hospital, located on New York

Avenue, Jamaica, L. I. The orthopedic work is carried on by
Dr. Henry C. Courten. This clinic was opened after the epidemic
of poliomyelitis in 1916. At that time 190 post-polio cases were
registered. The clinic is held Tuesdays, Thursdays, and Satur-
days between twelve and four p.m. Three masseurs are engaged ;
one on full time is in charge of the clinic. While the clinic is not
in operation one is engaged in giving home treatments to cases
who are unable to come to the clinic. The average daily attend-
ance at the clinic is sixteen.
The number treated during the last year:
Children 156
Number treated during year 4,902
Home treatments 600
Number transported to and from clinic 4902
All of the cases cared for in this clinic are transported or treated
in their own homes. Miss Rose Saffeir is the superintendent of
this hospital.
Capacity of Out-Patient Departments

I he capacity of most out-patient clinics for cripples may be
stated accurately. The capacity, however, of the out-patient

departments of the New York Orthopaedic Hospital, the Hospital
for the Ruptured and Crippled, and the Hospital for Deformi-
ties and Joint Diseases cannot be accurately stated. Facilities
are capable of extension to meet any emergency, and it would,
therefore, be impossible in stating the facilities of the out-patient
departments of the City to place any limit upon the number of
97
patients which these three departments can accommodate. The

facihties for out-patient services of New York City are listed as
follows :
MANHATTAN
New York Orthopaedic Unlimited
Ruptured and Crippled Unlimited
Deformities and Joints Unlimited
New York Hospital loo
Mt. Sinai . lOO
St. Luke's ICO
Bellevue lOO
Fordham lOO
Harlem 25
Cornell 100
Lebanon 50
Vanderbilt 25
Neurological 100
West Side Dispensary 25
Stuyvesant Polyclinic 20
Clinic for Functional Re-education 250
BROOKLYN
Polhemus Clinic 200
Brooklyn Hospital 100
Throop Avenue Dispensary 400
House of St. Giles 25
QUEENS
Jamaica 25
98
CONVALESCING AND CUSTODIAL CARE
Country Branch of the New York Orthopedic Hospital
Country Branch of the New York Orthopaedic Hos-
White Plains, New York, has 134 beds for after-
THE pital, at
care and treatment of patients from the New York Ortho-
paedic Dispensary and Hospital in New York City.
The hospital building consists of three pavilions, each two
stories high, connected by glass enclosed galleries or cloisters.
Its approaches are easy, adapted to the use of cripples. The
children live in the end pavilions, or wings, which are fire-proof.
Separate cubicles in some of the wards give privacy to the patients
and add to the homelike spirit of the institution. The grounds
comprise twelve acres.
Curable cases only are admitted, a large number of which are
usually of bone tuberculosis. Cases are admitted only through
the dispensary or hospital in New York City, and are kept as long
as deemed necessary to prevent possibility of relapse. The homes
to which the children are discharged are supervised by the social
service department of the hospital.
This country branch, the first of its kind to be developed, is
still the only institution operated by an orthopedic service to
give extensive convalescent care to patients discharged from the

hospital or dispensary.
A
graded school is maintained with a curriculum comparable
with that of public schools. Special school equipment is pro-
vided.
The After-Care Home for Cripples, 142 Bruce Avenue,

YONKERS
The After-Care Home for Cripples, 142 Bruce Avenue, Yonk-
conducted by a Board of Managers, of which Mrs. Joseph
ers, is
E. Heimendinger is President. Miss Katherine Huther, formerly
connected with the New York State Hospital for Crippled Chil-
dren, is Superintendent. Dr. Leo Mayer is chief surgeon, and
99
decides upon all admissions to the Home. Wassermann and

Schick tests are given by him before admission.
The Home occupies a two-story frame cottage located on a
hillside street. It is approached by stone steps leading up to the
porch. This porch is enclosed and extends on the front or west

side of the house and halfway around the south side.
The Home has 24 beds,which are occupied at all times.
all of
About one-half pay a small amount for their care.
of the patients
Besides the Superintendent, there are two nurses who give
treatment and muscle training as directed by Dr. Mayer. A
teacher gives academic instruction three hours a day. Besides
these there are a cook and two housemaids.
The income from the patients is small. The expenses are met
by donations of the members and by an annual benefit which is
conducted by a committee of the Board. The Home owns no
property except the household equipment, which is moved each
year to the Long Branch Home and is returned in the fall.
Blythedale Home
Blythedale Home, located at Tarry town Road, Hawthorne, is
a development of the Visiting Guild for Crippled Children. The
original object of this Guild was to furnish teachers for the chil-
dren in their own homes. At first they provided a summer home,
but in 191 3 the Board of Trustees decided to make a permanent
home for children. The institution is non-sectarian, and is gov-
erned by a Board of Trustees, which has 22 members. It is sup-
ported by voluntary contributions, by the Federation of Jewish
Philanthropic Societies, and is, in part, subsidized by the City of
New York. The Superintendent is Miss E. M. Crysler. The
main building of the institution is a two-story frame cottage with
two enclosed porches and an annex for school purposes. The
totalbed capacity is 44.
The institution admits girls sixteen, and boys from
from four to
four to ten. Before admission must be examined by Dr.
all cases
Barrie of the Hospital for Ruptured and Crippled. Although it is
provided that only tuberculous bone cases should be admitted, ex-
ceptions are sometimes made. Children are usually referred by the
Post Graduate, Mt. Sinai, St. Luke's, Bellevue, New York, Lenox
Hill Hospitals and the Hospital for the Ruptured and Crippled.
100
A well balanced diet consisting of meat, vegetables, milk, and

eggs given to the children. A milk allowance of one quart per
is
day for each child is given. Treatment at the Home is conserva-

tive, but minor operations are being performed by Dr. Barrie in
the institution.
Two teachers are assigned by the Department of Education
of the City of New York. Regular grade work is carried on, and
one of these teachers, who completed a special course in pre-
vocational work, now teaches basketry and embroidery.
The home each child to be discharged is investigated by the
of
Association for the Aid of Crippled Children. Employment is
often obtained through Miss Ronsone. Miss Cirysle/, the nta ti-pll,
keeps in touch with the former charges by correspondence.
Darrach Home for Crippled Children

The Darrach Home for Crippled Children, at Ii8 West 104th
New York City, is governed by a Board of Trustees of
Street,
nine members, of which Mrs. W. L. Bauer is President. It is
supported by voluntary contributions, and interest on invest-

ments and fees for board. Miss J. K. O'Leary is the matron in
charge of the institution.
The institution occupies a three-story, attic and basement stone
building. It has a capacity of sixteen, and the census on the day
of our visit was eleven. Fees of from five to eight dollars a month
are paid for the less needy children. Dr. Stanley Brady, the
attending surgeon, examines all children before admission. Only
children of school age are accepted, most of whom are post-polio
cases and are taken to the clinic by their mothers or by nurses.
A teacher for corrective gymnastics from the People's University
Extension Society gives instruction one day a week.
The children are taken to special classes of the public school by
buses of the Board of Education and receive the instruction pro-
vided in these classes.
No provisions are made for after-care, except that on reaching
the age of sixteen, efforts are made to place the children in suitable
employment through the co-operation of the Board of Directors.
From June 30th to October ist, children of the institution are
maintained at the summer home, Groton, Conn.
lOI
MONTEFIORE HOME
The Montefiore Home Hospital, located at Gun Hill Road near
Jerome Avenue, New York City, is a modern plant having a
capacity of about 500, supported by the Federation of Jewish
Philanthropic Societies, legacies, voluntary contributions, and
to some extent by a city subsidy. It is governed by a Board of
Trustees of 30 members. Siegfried Wachsmann is the Director
of the institution.
Of the total census of 476, 66 adults are suffering from diseases
of the boê ad joints; and in the department for children there
are about twenty children, some of whom are post-polio cases,
others having tuberculous bones or spine conditions.
The institution has the most modern facilities for electro-
therapy, hydrotherapy, and mechanotherapy. It has one of the

finest equipments in its Zander room.
The Department of Education assigns one teacher to the in-
stitution. The school room is equipped with adjustable desks
and seats. Besides instruction in general grade subjects, the
teacher instructs the children in raffia work, basketry, embroi-
dery, and sewing. No children are assigned to the occupational
department of the institution.
The activities of the occupational department are aimed more
toward occupational therapy than to pre-vocational or vocational
training. The occupations taught are the making of braided or
woven rugs, loom weaving, wood work, toy making, needlework,
chair caning, card-board construction, basketry, drawing, and
lettering. About fifty patients are under the supervision of this
department.
The social service department of the Home, operating with the
United Hebrew Charities and other organizations, obtains em-
ployment for the discharged patients. Some of the patients have
been employed by the hospital; for some peddler's licenses are
obtained and stands are purchased.
House of the Annunciation

The House of the Annunciation for Crippled Children, located
at Broadway and 155th Street, is conducted by Protestant Epis-
copal Sisters of the Annunciation of the Blessed Virgin Mary,
102
and is supported by legacies, voluntary contributions, and the
board of patients. Its object is to give care to incurable and

crippled girls between the ages of four and sixteen. Nineteen of
the twenty-four cases at the institution at the time of our visit
were cripples.
The institution occupies a fairly modern four-story and base-
ment brick building. On the first floor are the office, chapel, li-
brary, etc. On the second floor are one ward, school room, dining
room, music room, and surgical dressing room. On the third floor
and the fourth are two other wards and rooms for the staff and
the help.
The institution owns sixteen acres of land at Wilton, Conn.,
where a summer home for children is operated.
Dr. T. Halstead Myers is the director of the orthopedic ser-

vice. Operative cases are taken from St. Luke's and attended by
Dr. Myers. Children are usually referred to the institution by
Sisters or by ministers who work among the poor.
The institution does not have a school operated by the Board
of Education, but the nurse, who is a teacher, gives instruction
in reading, writing, and arithmetic, also sewing and embroidery.
The regular school curriculum is not followed nor are pre-voca-
tional subjects taught.
Children who can work are assigned tasks such as dusting,
and announcing callers.
polishing brass,
There are no after-care activities. However, the Mother
Superior takes a personal interest in the children and makes efforts
to provide employment in family homes, either at housework or
looking after children.
House of St. Giles, The Cripple

Garden City, L. I.
The House of St. Giles, the Cripple, on the outskirts of Garden
City a country home for cripples, operated by the Brooklyn
is
hospital of the same name. The institution has a capacity of

fifty. The grounds are spacious and afford room to grow garden
products. The children are provided with fresh vegetables, and
sufficient chickens are kept to provide fresh eggs. The house at
Garden City, while attractive in appearance, is an old dwelling
to which additions have been made, affording ward space and
103
enclosed porches.. It is the intention to build a new institution

on this site with a capacity of 125.
Children are admitted through the hospital in Brooklyn, or
by commitment by Poor Law officers of the City of New York or
Nassau County.
The school isunder the supervision of the Board of Education
of the City of New York. It is an annex to Public School No.
34, Queens. One teacher is provided by the Board of Education
and an assistant is assigned by the institution. Regular grade
work is given, and some pre-vocational work. Only about one-
half of the children of the institution are of school age.
There is no systematic follow-up work by this institution, but
the superintendent. Miss Anne Hasbrouck, takes a continuous
interest in her former charges and is of great assistance in locating
them properly and making plans for their welfare.
St. Agnes Hosx ital. White Plains, New York

St. Agnes Hospital for Crippled and Atypical Children is
located at White Plains, New York. The institution is main-
tained by the Order of Sisters of St. Francis, and is supported by
public funds and voluntary contributions. Most of the children
are committed by the Poor Law Officers of New York City and
Westchester County. Sister Mary Frances is the superintendent.
The hospital has 225 beds for children of both sexes between the
ages of two and sixteen.
The plant consists of sixteen acres in land on which is the main
building. In this the children and staff are housed. There are
also separate buildings, one for the powerhouse and the other for
an open air play-house.
The orthopedic surgeon is Dr. Francis Butler.
chief Dr.
Butler examines the children after they are received at the insti-
tution and performs all operations. During 191 9, 46 operations
were performed.
Four class rooms are provided for school work which is con-
tinued up to the sixth grade. Most of the children are retarded,
reaching the fifth grade at fourteen or fifteen years of age. Four
Sisters are employed as teachers. No kindergarten work for the
younger children is maintained. No pre-vocational training is
provided, but it is the intention to give carpentry to the boys.

104
-3
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UNIVERSITY OF CALIFORNIA LIBRARY

This book is DUE on the last date stamped below.
Ijte:25 cents on first day overdue
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(1920) Survey of Cripples in New York City

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UC-NRLF

NEW YORK CITY

SPECIAL COMMITTEE ON SURVEY

PRINTED AND DISTRIBUTED BY

With the Compliments of

This report is published by the New York Committee on After

(a) Elementary and secondary education.

The foregoing functions are not listed in chronological sequence,

That there be created a central organization covering the

tem, and the 1g termination as to what cases shall be transported.

Manhattan, Bronx and Richmond

The Association for the Aid of Crippled Children to be re-

(a) Elementary and secondary education.

The Federation of Associations for Cripples and the Institute

(j) Vocational training.

(k) Placement in employment.

Brooklyn and Queens

(j) Vocational training.

the age of 16 years.

canvass were not being treated ;

WHAT THE CRIPPUNG

ably about 1000 cases of poliomyelitis. Potts' disease and tuber-

ceased to attend clinics ;

facilities, but insufficient number of convalescent and custodial

Elementary and Secondary Education

done by those handicapped by one or more of the great variety

things which they can most readily perform without specialized

Medical and Surgical Treatment

limits, and i in territory accessible to the city, jointly providing

period of at least 7 weeks. This probably is a fair conclusion as

to care for sickness in the home. To the extent that patients

urged by some that a hospital is much more than a place in which

operative beds could fill. The problem is to provide convalescent

of Infantile Paralysis Cases, and 7 by the Brooklyn Bureau of

treatment, combined with less frequent transportation, seems

variety of handicapped conditions. The world war has added

larly to carry on that function. There may come a time, after

ticularly at times when

normal. The ordinary employment agency will give little or no

quires a much larger staff to place handicapped than normal per-

Work in the Home

Braces and Appliances

well be experimented with in the shops operated by the Institute

more rapid convalescence, shortening the period in the hospital.

Arguments in Support of Recommendations

New York State Branch of the Shut-In Society,

cies dealing with cripples, and is itself a federation in but a limited

Paralysis Cases was organized, and proceeded at once to discover,

ysis. With hand, the Committee endeavored to

produced year by year additional cripples caused by infantile

at inception, and as a result, serious handicapping deformity

in many cases results. Some agency should be responsible for

not improving as rapidly as it ought, sometimes shift from a clinic

covering such a case. As is well known, there is a great deal of

transportation. To attempt to operate a transportation system

facilities,the facilities should not be located at the place where

public as to the need for such expenditures, except the individual

ated above could be performed by a conference without an office

There may be a fear on the part of some that a central organi-

exercised except to refuse to send patients to clinics that were