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The writer was astonished to find, in conducting the investigation preliminary to the preparation of this report, that institutions and organizations less than ten miles apart were utterly unaware of the existence of neighbor groups working to solve their problem. The desirability of interchange of information; the necessity of avoiding ineffective, and sometimes conflicting, activity; the desirability of entirely fulfilling the needs of the crippled child, rather than holding before him a mirage and then failing completely to fulfill the promise thereby presented; and finally, the necessity of a policing group which also is able to stimulate activity wherever needed: -- all these justify state and national organizations, whose object is to accomplish these purposes, specifically for the crippled child problem, and for this problem only. It is to be hoped that the International group and its member societies will accomplish that purpose.

PART II

A SURVEY OF AMERICA FACIILITIES TO CARE FOR, CURE AND EDUCATE CRIPPLED CHILDREN

CHAPTER IX.

A STATISTICAL STUDY

We are told that Rome was not built in a day. The movement to aid crippled children, however, has certainly undergone phenomenal growth. So rapidly have these efforts spread in the decade which has elapsed since Miss Reeves produced her study of existing facilities, that a thoroughly accurate survey of all existing facilities has become practically impossible. When the Bureau of Information of the International Society for Crippled Children entered upon this task, the problem seemed to be a simple one to solve. Philanthropic agencies, local social groups, and known institutions were solicited for information. It seemed only a question of time until all correlated data would be accumulated.

Experience proved that this would not, and could not, transpire New agencies seemed to be organized over night. Older organizations or associations would send partial answers to questions submitted. We would discover that institutions would expand bed capacities without informing us of the change in data. Perhaps the chief difficulty in correlating the data received was in the location of general hospitals providing orthopedic services. Notwithstanding all of these impediments to accuracy and completeness, the author has been able to provide a fairly comprehensive list of agencies and institutions. Although we present herewith a tabulated statement of our finings, readers are earnestly requested to call our attention to omissions and corrections. In turn we wish to emphasize, not the statistical details which are admittedly incomplete, but the general indications which may be interpreted.

The Directory of active agencies printed in Part IV includes the following activities in the United States of America:

40 special associations active in this work.

92 orthopedic hospitals and general hospitals with orthopedic services, providing 5,381 beds for crippled children.

6 additional orthopedic hospitals, the bed capacity of which was not ascertained.

45 additional general hospitals providing orthopedic services but reporting no limited bed capacity for juvenile cases.

41 convalescent homes, convalescent hospitals, and special sanatoria provided with 2,449 beds for crippled children.

4 additional convalescent institutions reporting no limited bed capacity for crippled children.

15 summer homes and camps. Six of these have reported a total bed capacity of 239 crippled children. No information could be obtained concerning the capacity of the others.

18 custodial institutions, fourteen of which reported a bed capacity of 656. Four reported no bed capacity.

82 special state and city public schools and private day schools are provided with facilities for the education of 6,225 children. 162 classes are enumerated in 40 of these institutions.

5 additional schools provided with special classes, data concerning which has not been obtainable.

36 general tuberculosis sanatoria and hospitals reported a total bed capacity of 4,120 with 453 beds devoted especially to the care of crippled children.

7 other general tuberculosis sanatoria with a total bed capacity of 506 reported that they were caring for crippled children, but gave no figures as to the number of these cases.

Thus, 382 special institutions and organizations were discovered in this survey. Undoubtedly there are numerous other general sanatoria and general hospitals providing for the care of crippled children in this country. Their omission is due to failure to respond to questionnaires, or to failure of neighbor agencies to report their existence and activities. We may conclude from these figures, first, that existing facilities for convalescent care of juvenile orthopedic patients are inadequate. There are over twice as many beds available for operation and acute treatment as there are for convalescent observation and care. We may interpret, second, that any survey or local statistics relative to the frequency of "surgical" tuberculosis probably will be lower than the actual percentage, inasmuch as a considerable number of special institutions are devoted partially or exclusively to caring for all forms of the disease. The figures indicate that existing special educational facilities are caring for less than two per cent of the crippled children of the United States. An examination of the tables on pages 70 and 71 will demonstrate that activities to aid crippled children are largely concentrated in the central eastern coast states. There remains a great opportunity for missionary work in the territories west of the Mississippi River.