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-3- Richard Aldrich. Verdi: Rigoletto. Essay on the Story. New York, 1902.

-4- Michel de Montaigne. Essays, Vol. III. 1588. Translated by Cotton, London, 1811.

The essay, published in 1588, does not so much as suggest humanitarian kindness toward the deformed. In the sixteenth century, Luther advised that a rachitic baby be thrown into the river.-5-

-5- H. Hare. A Study of Handicapped Children, p.6.

After a "moral holiday" of six centuries, the initial law providing for some care of cripples was passed in England during the reign of Queen Elizabeth (1601). The first Poor Relief Act included cripples among those offered asylum care. It was not until two hundred and thirty years later that an institution exclusively for the care of crippled children was at last founded. "The Royal Bavarian School and Home for Crippled Children," a convalescent home, was opened in Munich by Johan Nepimak in 1832. This institution was taken over by the Bavarian authorities in 1844, and has since been operated by the state. From this beginning, the movement spread throughout Germany, France, England, Switzerland, and Italy, in the order named. In 1872 the first effort toward the industrial education of crippled children was instituted by Pastor Hans Knudson, who founded an industrial school in Copenhagen, Denmark.

In the United States, the Hospital for the Ruptured and Crippled was opened in New York City in 1863. Three years later the New York Orthopedic Hospital and Dispensary entered upon the same work. In Philadelphia, the Home of the Merciful Saviour, established in 1884, was the first American Home to care for crippled children. The pioneer school for crippled children was the Industrial School for Crippled and Deformed Children, established in 1893, for the purpose of making Boston cripples self-supporting.

Although the movement had made considerable progress, the infantile paralysis epidemic of 1916 demonstrated clearly that facilities were as yet entirely inadequate. During the past eight years, nation-wide efforts of various fraternal and social organizations have increased greatly the number of convalescent homes, state hospitals, clinics and sanatoria. Writing in 1912, Mr. Douglas C. McMurtrie, for many years the leader in rehabilitation of cripples, remarked: "From a national stand-point, however, the situation is most unsatisfactory, all institutions being grouped around four or five cities. The gravest defect is that immense sections, notably in the West and South, are without any provision whatever."-1-

-1- The Care of Crippled Children in the United States.

While there are still vast sections of this country in which there is little or no provision for the care and education of crippled children, twelve years have brought an extensive development in this work, and a significant improvement in the situation. In the course of this volume we shall see how the Shrine, hundreds of Rotary, Kiwanis, Elks, and other clubs became interested. In the more densely populated states adequate facilities are rapidly being developed; and the widespread interest in the movement promises well for future development in less populous areas.

CHAPTER III

HOW CHILDREN BECOME CRIPPLED

Medieval folk-lore informs us that two itinerant knights once chanced to meet at a crossroad. Suspended from a tree at the intersection, a splendid shield marked the domain of a third knight, a noble who was famous for deeds of valor. The travelers exchanged friendly greetings and introduced themselves. In the course of time the conversation turned to a discussion of the owner of the great shield above them.

"I like the effect of the white design on a black background," exclaimed the first knight.

"I beg your pardon," said his companion, "but it is black on a white background."

"Sir, you contradict me! A black background, I say."

"White!"

"Black!"

Therewith the knights drew their swords, each to punish the other for his impertinence. After a frightful duel, one was about to wound mortally his vanquished companion when a gust of wind reversed the great shield and showed it to be of opposite color combinations, one side being black on white and the other white on black.

"Truth," says William James, "is always 'in so far forth.'" It depends on the position of the observer. So, in the question of how children become crippled, we find two positions: that of the sociologist, who emphasizes fundamental environmental conditions, and that of the physician, who presents the immediate clinical diagnosis. We further ascertain that among the physicians there is a wide diversity of opinion as to what constitutes the most frequent crippling cause.

In this chapter, it is our aim to examine those immediate physical conditions which cause children to be physically handicapped. We do not pretend to interpret these phenomena from a medical point of view; but it is necessary for the sociological scholar of this philanthropic movement to have some slight acquaintance with the major types of crippling diseases and their comparative frequency. This, too, must be "in so far forth."