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(4) General hospitals will provide efficient and competent orthopedic services in proportion to the degree to which money is made available for this purpose. In Ohio, North Dakota, and other states providing a source of funds for general hospital treatment, the difficulty of disinterested managements has been eliminated. Unfortunately, in past years, these institutions lacked appropriations to handle orthopedic cases.

(5) Perhaps the greatest argument against the orthopedic hospital lies in its inability to solve the problem of the crippled child throughout the entire state. It is financially impossible to construct special institutions in enough centers to make facilities available for a very large proportion of the children of a state. The result of this situation is that large sums of money are spent in building central orthopedic hospitals and no funds remain to provide acute or convalescent services for most of the children in isolated communities. Only a relatively small number of parents bring their families to a distant city for the extended period of time necessary to orthopedic treatment.

Generally speaking, the Ohio plan is gaining ascendancy throughout the country. The argument for orthopedic hospitals carries more weight in central large communities, such as New York City and Chicago, than in farming states where distances to central institutions are too great to make the latter very effective in solving the problem. In New York City, orthopedic hospitals are probably thoroughly justified, sharing medical staffs with the great general institutions, sending their patients to New Jersey and up-state convalescent homes for the post-operative period, and helping to solve the distinct problem of this great concentrated community. In Ohio and similar states, such institutions would only compete with the established general hospitals, and consume funds which would otherwise be used for much needed convalescent facilities. Whether by special institutions or general hospitals, acute orthopedic work generally should be done in carefully selected centers. Ohio has ten of these chosen because of the presence of competent orthopedists, because they are centrally located for a particular group of counties, and because general environmental conditions, climate, and resources, are favorable. The availability of the orthopedic surgeon is a matter of great importance. He "acts as a mechanic to the human machine; he deals with its poise and movement; it is a part of his work to keep the axis true and the movement free in each of its joints; he watches and balances the output of power from the muscle groups and its transference through the tendons, and must see to the correct initiation and control of the movements of the limbs through motor and sensory nerves."-2- The general physician is often the ogre of normal children. To crippled children, the orthopedist is a Messiah. They welcome him with delight and suffer under treatment with unbelievable fortitude. It is within his power to reconstruct them in the image of their normal playmates and they appreciate whatever he does for them.

-2- G.R. Girdlestone, The Care and Cure of Crippled Children, Part I, p. 30.

There are three types of orthopedic services: those operated by the state, as in Minnesota, Iowa, Nebraska, New York, North Carolina, Massachusetts, Wisconsin, and West Virginia; those operated privately, but supplied with patients by state agencies, as in Ohio, Indiana, North Dakota, Michigan, Pennsylvania, Virginia, and Illinois; and those operated and supplied by private agencies, such as the Shriners' Hospitals, orthopedic services in general hospitals throughout the country, and special children's or general orthopedic hospitals.

A special committee on Minimum Requirements for an Orthopedic Hospital, recently appointed by the Ohio Hospital Association, listed the following basic essentials for an orthopedic service:-1-

-1- The Crippled Child. Vol. II, No. 4, p. 4, (April, 1924), and Vol. II, No. 6, p. 10 (July-August, 1924). Committee Consisted of C. H. Pelton, M. D., Chairman, B. G. Chollett, M. D, and B. W. Stewart.

1. Separate wards for children.

2. Specially prepared orthopedic surgeon on hospital staff, or admitted to practice in the hospital.

3. Special nursing service.

4. Operating room.

5. X-Ray and other laboratory facilities.