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Questions frequently are raised concerning the number of crippled children in the United States, and their frequency per thousand population. Various estimates have been made to this ratio, some of them being the following:

(1) The Birmingham (England) cripple estimate of 1911: 5.7 per thousand population.

(2) The New York City Special Committee which conducted the 1919 survey estimated the number of cripples at 6.9 per thousand population. 52% of these were under sixteen years of age.

(3) The Cleveland, Ohio, survey of 1916 estimated a ratio of 6.2 cripples per thousand. Only 22% of these were children.

(4) The Massachusetts census of 1905 recorded 5.7 cripples per thousand of population.

(5) The Toronto, Canada, survey of 1923 reported 2.16 crippled children per thousand of population.

Except in the Cleveland survey, most estimates suggest that about fifty per cent of all cripples are children under sixteen years of age. Assuming this ratio to be correct, we find the following ratios of juvenile cripples to population:

On the basis of these figures, there are approximately 4,256,300 crippled children in the world; 342,500 in North America; and 264,276 in the United States. While the ratio seems to be fairly constant, it must be borne in mind that conditions in various localities will alter the proportion according to frequency of epidemics, efficiency of public health agencies, or other similar circumstances.

CHAPTER X

A STUDY BY LOCALITIES

In endeavoring to survey efforts to aid crippled children throughout the United States and Canada, two questions must be kept in mind: first, the question of how well localities which are characterized by concentrated populations are provided with facilities to cure, care for, and educate crippled children; and second, how well crippled children of isolated communities are cared for. The fact that cities in many states are widely scattered and of small population may explain why facilities for the care and education of crippled children have developed more slowly than those in the more densely populated areas, but it does not to any degree reduce the problem. Rather this situation should be a stimulus to more concentrated activity.

No attempt is made, either in this chapter, or in the directory, to list all of the general hospital orthopedic wards or services in the United States. That would be a stupendous task, and never would be completed or up-to-date. Orthopedic services in general hospitals have been listed and referred to: first, if they demonstrate a particular arrangement of facilities provided for by legislation (as for example, in Ohio); second, if they happened to be called to our attention in the course of the survey; or third, if they are the sole agencies for the solution of the problem of a particular area.

Because these general hospital facilities are not all known, it will be impossible to state the exact relation of hospital beds to population in every locality. Were this possible, it still would be necessary to demonstrate the fact that the proportion of crippled children to the entire population in every area, at the same time, remained constant. We know that this cannot possibly be true. Epidemic and other environmental conditions will lower or raise this proportion periodically. This study therefore will be confined to a general demonstration of existing methods of solving the problem of the crippled child in the various states or groups of states, and a general estimate of the degree to which existing agencies are competent. All population figures refer to the Census of 1920.

THE UNITED STATES OF AMERICA

The Northwestern Coast Area

Two orthopedic centers, Portland, Oregon, and Seattle Washington, are provided with the only facilities for aiding crippled children of this group of states. In addition to the Portland Shriners' Hospital with fifty beds, care is provided for crippled children at the University of Oregon Medical School under a legislative act which states that juvenile courts may commit indigent children to that institution for medical or surgical treatment. Due to a lack of facilities, a lack of local interest, and the long distances which the child must travel, only a very few patients have been treated under the terms of this act. In addition, the University has had some difficulty collecting from the counties, as is prescribed by the legislation. The situation will be relieved somewhat by the erection of a seventy-bed children's hospital, provided for in a legacy left to the University by the late Mr. F. S. Doehrnbecher. The Children's Orthopedic Hospital, of Seattle, is a center for Washington. Idaho is forced to send patients to one of these two cities. There can be no question that many children in this wide area are suffering for want of readily available facilities.