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-1- Jacob Sobel, M. D., Franklin B. Van Ward, M. D., and Walter I. Galland, M. D., The Lorenz Clinics at the Department of Health of New York City, Monthly Bulletin of the Department of Health of New York City, Vol. XII, No. 5, May, 1922.

1. A physician in charge.
2. A technical orthopedist.
3. An associate orthopedist.
4. A consulting neurologist.
5. Supervising inspectors and medical inspectors.
6. The secretary of the physician in charge.
7. A supervising nurse.
8. Six trained nurses.
9. Four stenographers.
10. Two trained orderlies.

Ninety preliminary clinics, twenty-nine Lorenz clinics, and six operative clinics were attended by 6,376 cripples of all ages. The most significant result of this work was the instantaneous and wide-spread enthusiasm which it produced. More than one-sixth of all of the cripples in the city had undergone examination, and newspaper publicity had brought their condition to the attention of thousands of citizens who had never given thought to this movement before. As a result, hundreds of neglected crippled children and adults received necessary attention.

Acute Hospital Care.

The child has been thoroughly examined by expert clinicians. The cause of his deformity has been diagnosed, and the time for treatment is at hand. Unfortunately, at this point our pathway divides, and two avenues arouse the perplexing question as to which is the more expedient, the general hospital or the special orthopedic institution. The number of the latter continues to grow, and every new building aggravates the controversy. The advocates of the special hospital maintain that:

(1) Orthopedic and general surgery are definitely and necessarily divided and that the general hospitals too often make them one function.

(2) Nursing and care for orthopedic cases must be specialized beyond the capabilities of the general hospital. The general nurse does not understand the uses of the Bradford frame, or other details of special care for crippled children.

(3) The management of a general hospital is not interested in orthopedic cases. They are anxious to have "blood and thunder surgery cases,"-1- and find the routine orthopedic care monotonous.

-1- Gillette, A. J., State Hospital for Deformed and Crippled Children Would Be Advantage, American Journal of Orthopedic Surgery, XIV, 259-264, May, 1916.

(4) Many of the beds in general hospitals are endowed by philanthropists who are anxious to have them annually available for as large a number of patients as possible. They complain of the long term occupancy necessary for orthopedic cases.

(5) Orthopedic cases seem to "develop" when there is a orthopedic hospital to treat them. The advertising value of such an institution is significant in locating cases for which treatment is necessary.

(6) An orthopedic hospital is better fitted financially for research and scientific advancement in this field than is the general hospital.

The International Society for Crippled Children and its affiliated organizations stand definitely against the erection of further special institutions. They point out that:

(1) The general hospital with special orthopedic services has a better balanced medical staff, which will care for all defects of the crippled child. There are generally complicating conditions correlated with the orthopedic defects, with which the general physician is best able to cope.

(2) The orthopedic hospitals with complete operative facilities are not economical. They are generally erected in direct competition with existing orthopedic services and result in several partially filled institutions attempting to do the same work. New orthopedic facilities in general hospitals can be provided less expensively than new orthopedic hospitals.

(3) The operative facilities of the orthopedic hospital are not used to their maximum possibilities. The average hospital period per patient in three Shriners' institutions up to April 1924, was ninety-five and seven-tenths (95.7) days. There were, on that date, three hundred and fifty-six children on the waiting lists at Portland, "The Twin Cities," and San Francisco. With this infinitely slow turn-over (which, by the way, is rapid compared to some institutions), operative facilities lie idle much of the time. The Minneapolis institution had performed only one hundred and seventy-five operatons -sic- since its opening (March 1923).

The International Society favors the orthopedic service in the general hospital, with affiliated convalescent homes receiving patients for the recuperative period. Approximately eight efficient convalescent buildings can be constructed for the price of one orthopedic hospital, and patients can be moved through the general hospital in as little as fourteen days.-1-

-1- Patients at the Elyria Memorial Hospital are moved to the Gates (convalescent) after an average 16-day period.