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FOREWARD

By FRANKLIN D. ROOSEVELT

FOLLOWING is the Annual Report of the Georgia Warm Springs Foundation for the fiscal year ended September 30, 1940, and a description, necessarily brief, of its activities during the last thirteen years.

In my opinion it would be a mistake to think of the Foundation as just a hospital. It is all of that and more. During a pioneering period it has conducted many activities and dealt with many problems that do not confront a hospital in its customary routine.

The conception of the Foundation at Warm Springs was an experiment in treating by hydrotherapy individuals who had been handicapped as a result of infantile paralysis, and in caring for them under certain psychological, climatic and geographical conditions not always present in the usual hospitalization of such patients. Such an institution really required building from the very base and necessitated at the same time maintaining a flexibility that would enable it to conform to any changes in the scientific care of the after-effects of infantile paralysis.

The Foundation has unquestionably done much good for individual cases, but it has been working to the end that it might also be able to discover something of value for those thousands of cases which, of course, it cannot care for. Needless to say, such a hope takes time and unlimited patience, but with the new facilities recently installed at the Foundation, it will be enabled, while caring for the individual cases to the limit of its capacity, to devote more of its time to the broader aspects of the after-effects of this disease for the benefit of all afflicted by it.

Apart from the purely medical phase of the work of the Foundation, its very existence during the last thirteen years has aroused to an unbelievable extent in this country, and even abroad, a public recognition of the havoc caused by this disease and the necessity of making every effort to bring it under control. As set forth in this Report, all of this imposed upon the Foundation at Warm Springs obligations and activities throughout the whole country which it had to assume and which, to the extent possible, it was glad to undertake.

With the creation of the National Foundation for Infantile Paralysis in 1938, the purpose of which is to unify, direct and coordinate the fight against this disease in all its phases, the Foundation at Warm Springs was able to concentrate its efforts directly on the medical problems involved in the after-effects of the disease.

Franklin D. Roosevelt

"The Spirit of Warm Springs"

THE GEORGIA WARM SPRINGS FOUNDATION is essentially a medical institution for the treatment of the after-effects of infantile paralysis. For this reason, medical care and treatment is paramount and takes precedence over all other factors. The Foundation, however, does recognize that the medical regimen is most effective when supplemented by high morale.

The Foundation is unusually fortunate in providing a physical environment totally different from that usually associated with an institution of this kind. With these geographical advantages, the Foundation has stressed and fostered the building of as normal a social life as is possible.

That this has been accomplished to a great extent is witnessed by the spirit of cheer, optimism and good fellowship among the patients, whether they be on stretchers, in hospital beds, in wheel chairs, or on crutches. The average visitor finds it difficult to understand how the patients can achieve and maintain such a splendid mental attitude of encouragement. If it were not for the braces, crutches and wheel chairs, one would not think from observing the happy faces and listening to the good-natured conversation and laughter that these were any but able-bodied people indulging in a rest cure. Such an accomplishment could not succeed were it not encouraged by the entire personnel of the Foundation.

Table of Contents

OFFICERS

President FRANKLIN D. ROOSEVELT
Vice-President KEITH MORGAN
Vice-President and Treasurer BASIL O'CONNOR
Vice-President HENRY POPE
Vice-President and Secretary RAYMOND H. TALOR
Assistant Treasurer LOUIS C. HAUGHEY
Assistant Treasurer J. BRUCE WILLIAMS
Assistant Secretary FRED BOTTS
Assistant Secretary WILLIAM F. SNYDER

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EXECUTIVE COMMITTEE

BASIL O'CONNOR, Chairman
CASON J. CALLOWAY
CHARLES ENGELHARD
JEREMIAH MILBANK
FRANKLIN D. ROOSEVELT

BOARD OF TRUSTEES

CASON J. CALLOWAY La Grange, Georgia
CHARLES ENGELHARD, President, Hanovia Chemical & Manufacturing Co. New York City
JOHN C. HEGEMAN, President, Hegeman-Harris Co, Inc New York City
SAMUEL H. KRESS, Chairman of the Board, S H Kress & Co. New York City
LEIGHTON MCCARTHY, Chairman of the Board, The Canada Life Assurance Company Toronto, Canada
JEREMIAH MILBANK New York City
JAMES A. MOFFETT, Chairman of the Board, California Texas Oil Co., Ltd. New York City
KEITH MORGAN New York City
BASIL O'CONNOR, Lawyer New York City
HENRY POPE, President, Bear Brand Hosiery Chicago, Illinois
FRANKLIN D. ROOSEVELT Washington, D. C.
CATOR WOOLFORD Atlanta, Georgia

STAFF AT WARM SPRINGS

MEDICAL DEPARTMENT

Chief Surgeon C.E. IRWIN, M.D.
Assistant to Chief Surgeon STUART RAPER, M.D.
General Physician J.A. JOHNSON, M.D.
Superintendent of Nurses MAMIE CLEGG, R.N.
Operating Room Nurse JUDY MORGAN, R.N.
Anesthetist ANITA C. BENTEEN, R.N.
X-Ray Technician JUDY MORGAN, R.N.
Corsetiere MRS, J.O. CALDWELL
Superintendent of Physical Therapy ALICE LOU PLASTRIDGE
Superintendent of Physical Therapy GENEVIEVE COLLINS

ADMINISTRATIVE OFFICE

Comptroller LOUIS C. HAUGHEY
Accountant J. BRUCE WILLIAMS

ADMISSIONS OFFICE

Registrar FRED BOTTS

SCHOOL AND OCCUPATIONAL THERAPY DEPARTMENT

Director of School ROBERT HOGG, M.A..
Director of Occupational Therapy Department JEANETTE NEAL

Brief History and Purpose

ACCORDING to historical records, the first white settlers pushed westward from the east coast of Georgia, reaching the warm springs shortly after 1825. Until the early 1840's, Warm Springs was a post tavern on the military highway leading to Columbus, Georgia.

The comparatively cool climate and the remarkable pool of warm water soon made the place a favorite summer resort. People from the coastal plain, the hot lowlands, sought the cool breezes of Warm Springs, and it became a noted carriage resort for the well-to-do people of that area.

In the early days, the warm water of the pool was piped into a number of small tanks or bathing tubs, and those who visited at the Meriwether Inn (demolished in 1934 to make way for Georgia Hall) bathed in these separate tiny pools.

Comparing the old Meriwether Inn, formerly used as a hotel, with Georgia Hall which replaced it (photographs of which appear elsewhere in this Report) will give a visual idea of the trend of progress at the Foundation since its organization.

Until the advent of the automobile, guests of Warm Springs were driven in state in a de luxe stage coach over a six mile scenic route from the railroad station to the Inn, although the station was but a half mile away by direct route.

As the automobile gradually came into favor and people could travel greater distances more rapidly, Warm Springs as a resort declined in popularity. It was a rather neglected resort, in fact, when in 1924 the possibilities of the natural facilities at Warm Springs, Georgia, for the hydro therapeutic treatment of the after-effects of infantile paralysis were brought to the attention of the Honorable Franklin D. Roosevelt who himself had been a victim of this disease.

Warm Springs has the natural advantages of climate, pleasant environment and an abundant supply of pure spring water, heated by nature to almost 90o F. as it flows from a depth of about 1500 feet at an almost constant rate of 800 gallons per minute and of such a quality that no enervation results from remaining for considerable periods in pools filled with this water. The water possesses no magical curative properties, neither does it have any particular medicinal qualities.

In the Spring of 1926, through the efforts of Mr. Roosevelt, experimental work under expert supervision was begun when 23 patients were placed under observation for periods of from 5 to 17 weeks. All seemed to make some improvement.

Under the guidance of Mr. Roosevelt, the Georgia Warm Springs Foundation was organized in 1927 as a non-stock, non-profit organization to develop an institution at Warm Springs, Georgia, to render service to those physically handicapped by infantile paralysis. The purpose of the service was two-fold:

First, to use the natural facilities of Warm Springs and the skill of an able, carefully selected professional staff for the direct aid of patients;

Second, to pass on to hospitals and the medical profession of the country any useful observations or special methods of proven merit resulting from this specialized work and which might be suitable for practical application elsewhere.

Both phases of the work are national in scope. Since the establishment of the Foundation, patients from every state in the United States, the Canadian Provinces, Argentina, Cuba, England, Germany, Hawaiian Islands, Honduras, Korea, Mexico, Philippine Islands, Puerto Rico and Venezuela have been in residence at Warm Springs for varying periods.

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Initially, the pool of natural warm water located at the Foundation furnished the facilities for treatment and it continues to serve a specific purpose in the treatment of those patients for whom hydrotherapy is indicated. As the work at the Foundation progressed, however, conditions made it necessary to broaden the field and scope of treatment and to supplement hydrotherapy with additional methods, as all problems did not lend themselves to the efficacy of a single regime.

Many cases presented themselves for treatment within a few weeks after the acute onset and their condition on admission demanded prolonged rest in bed with medical and nursing care and other facilities which had to be installed at the Foundation. Care had to be exercised to prevent, deformities while improvement in muscle power was taking place. Many patients had well defined deformities on admission which needed correction before any type of physical therapy could be of value. In some instances this could be accomplished by braces or a series of corrective plaster casts, and in advanced cases surgical intervention was sometimes necessary. All these phases of treatment and many others have been added during the life of the Foundation, resulting in what might be called a more individualized type of treatment than it was originally possible to give.

With the completion of the Medical Building in 1939, still greater progress has been possible along advanced lines of treatment.

Location

THE FOUNDATION is located at Warm Springs in west-central Georgia in Meriwether County on the slopes and summit of Pine Mountain at an altitude of from 1000 to 1200 feet. It is about 75 miles southwest of Atlanta, 6 miles from Manchester and 39 miles from Columbus. It is on the route of the Southern Railway and may be reached by railroad connections with that city or by motor over concrete highways. There is a commercial airport about 6 miles from Atlanta in the direction of Warm Springs.

Physical Equipment

THE FOUNDATION is a complete community in itself, maintaining its own water supply from the famous warm springs, a sewage disposal system, miles of improved road -- all located in a tract of land over 1800 acres, most of which is in a natural state of forestation. On this site are the following buildings:

THE MEDICAL BUILDING completed in 1939 is a three-story, fireproof structure housing the numerous necessary activities of the Medical Department. The third floor has accommodations for 40 patients, consisting of single and double rooms, and wards for younger children. These facilities are used for operative cases, and for convalescent patients who require nursing attention following an acute attack. The second floor contains an air-conditioned operating suite equipped for orthopedic surgery, an emergency room, an x-ray room, a laboratory, a library, examination rooms and ample office space for the medical staff. One section of the ground floor is devoted to the nurses' living quarters; the remainder of that floor housing the drug room, plaster room, appliance shop, photographic studio and the physiotherapy department. All floors are connected by an automatic elevator.

The NORMAN WILSON MEMORIAL INFIRMARY adjoining the Medical Building, is used for those patients who, while allowed a certain amount of activity, still require close nursing supervision and cannot be classified as ambulatory.

Those patients who have reached the ambulatory stage are housed in two fireproof buildings:

BUILDERS HALL, donated by a construction firm and a group of material and supply contractors, housing 17 patients in single and double rooms and --

KRESS HALL, donated by Samuel H., Rush H., and the late Claude W. Kress, located about one hundred feet from Georgia Hall. The upper floor of Kress Hall is used as an adult dormitory, and the lower floor is used by very young children.

GEORGIA HALL, built with funds donated by the people of the State of Georgia, provides a community dining room, kitchen, a gathering place for music and games, reception and information desk, and administration offices.

The SCHOOL AND OCCUPATIONAL THERAPY BUILDING completed in 1939, was the gift of Mrs. S. Pinkney Tuck. This is a one-story building, containing properly equipped rooms for occupational therapy and for class teaching, as well as several smaller rooms for individual tutoring. It also houses a collection of books which comprises a very complete reference library for use of the pupils of the school, as well as a number of books for general reading by patients and staff.

A fully equipped BRACE SHOP where the braces and other apparatus used by the patients are made and directly fitted, is located near the Infirmary.

The Foundation has its own non-sectarian CHAPEL which was the donation principally of Miss Georgia M. Wilkins. An organ, the gift of Mr. and Mrs. James B. McHutchinson, and a bell contributed by Dr. and Mrs. G. H. Huntington, greatly enhance the utility of this building.

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Situated directly under the bluff on which the Medical Building is located, and in close proximity to the warm springs, are the TREATMENT POOLS. The glass enclosed pool was donated by Mr. and Mrs. Edsel B. Ford. The pools and their accessory buildings have provisions for physical therapy in warm water, and heliotherapy.

The Foundation has several houses and cottages which are used for the staff and a few small housekeeping cottages which are for rental to the families and friends of patients who may be visiting them.

There are a number of privately owned housekeeping cottages, several of which may be rented by visitors desiring that type of accommodation when making an extended stay at the Foundation.

Situated near Georgia Hall is THE PLAYHOUSE, donated by the Hon. Frank C. Walker and the late Michael E. Comerford, where motion pictures are shown three times a week, the films being contributed by the various motion picture companies. It is also used for amateur theatricals and general assemblies.

All of the buildings used by patients, including the cottages, are provided with ramps. There are no door sills. Hallways are furnished with guard-rails, and walls and pillars are splayed at the bottom as a protection against damage by wheel chairs. Doors are provided with metal bands so that wheel chairs can be pushed against them to open them. Rooms are equipped with various .hand-rails and other devices so that patients can move about easily. There are parking places for wheel chairs, and places where crutches can be left conveniently. Thus, many of the patients, by means of wheel chairs, move about the buildings and grounds entirely without the aid of an attendant.

Physical Therapy Post-Graduate School

THIS SCHOOL which will open at the Foundation in July, 1941, will furnish technical education to physiotherapy technicians in the care of poliomyelitis patients. Located at Warm Springs, it will provide a unique opportunity for the post-graduate student to observe and study those methods of treatment now in use with infantile paralysis patients. More important, perhaps, is the fact that it will serve as a research laboratory where new techniques can be developed to advance and improve the present knowledge in the field of after-care.

Here will come physiotherapists, some without any experience with infantile paralysis cases but all graduates of schools approved by the Council on Medical Education of The American Medical Association. The subjects offered will be those approved by the Council and they will be taught by a Director who is a qualified orthopedic surgeon or physical therapist.

This project has been made possible by a grant of funds from The National Foundation for Infantile Paralysis whose medical advisers realized the soundness of such a program of education.

Thus will Warm Springs soon he able to send forth well-trained graduates for work in their home states, not only with infantile paralysis patients, but also those whose crippling after-effects are of such nature that they may respond favorably to physiotherapy techniques.

Medical Department

by DR. C. E. IRWIN, Chief Surgeon

THE METHODS of treating residual paralysis and deformities following an attack of anterior poliomyelitis (infantile paralysis) as employed at the Georgia Warm Springs Foundation today are essentially no different in principle from those of other orthopedic institutions throughout the country. Pathology of the disease and fundamental orthopedic principles form the basis of treatment for every patient.

The Georgia Warm Springs Foundation is probably best known for its past work in hydrotherapy, particularly exercise in a medium of warm water. In its beginning some thirteen years ago, this was a justifiable recognition, since supervised exercise in a pool of naturally warm water constituted the chief and almost the only method of treatment. From this single plan of treatment there has been a gradual evolution to our present-day system which, as a whole, bears little similarity to that employed in the earlier days.

A complete physical examination is made of every patient on admission. The entire body has been subjected to a severe shock and physiologically altered as a result of the poliomyelitis attack. Faulty elimination, loss of weight, anorexia and anemia are only a few of the abnormal conditions found on examination. The institution of appropriate treatment for these conditions is essential and increases the patient's response to the prescribed orthopedic measures.

Orthopedic examinations must be thorough. Complete muscle tests are an important part of the examination and form a basis on which the indicated method of treatment is founded. Without an accurate muscle analysis, the surgeon cannot possibly outline an intelligent treatment program. These initial examinations are made by a trained technician who is an experienced physical therapist. The chance of error is lessened if, in making comparative tests, each subsequent examination is made by the same technician. Routine x-rays of the spine and pelvis, with the patient in sitting and supine positions, enable the physician to detect many cases of early scoliosis which would otherwise be overlooked. Treatment of the poliomyelitis patient, particularly one who is severely handicapped, cannot be done satisfactorily by any one individual. The treatment program, in the majority of cases, requires a trained organization which includes orthopedic service, the services of an internist, orthopedic nursing, physical therapy, brace maker, and adequate physical facilities designed for the handicapped patient. All these departments must be coordinated to bring about that degree of improvement which is possible to obtain ultimately for the patient.

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The various types of treatment now given at the Foundation are corrective surgery; conservative correction of deformities by plaster casts; immobilization during early convalescence by plaster, plaster and removable splints, or removable splints; all of which are followed at some time by underwater physical therapy. In addition, the supplementary types of treatment available are hydrotherapy, heliotherapy, massage, paraffin baths, occupational therapy and walking exercises. All these forms are not indicated for any one individual, but from them appropriate treatment is available for each case.

For growing children protective apparatus is provided by plaster of Paris casts in preference to removable splints. Since concentration is necessary for proper localization, young children cannot cooperate in a treatment program of specialized exercises. Casts are removed every few weeks to allow muscle re-checks and new ones applied with the parts in the position the results of the muscle analysis and deforming tendencies require. For the adult patient, with certain distribution of muscle weakness, complete immobilization during early convalescence gives better results. For example, shoulder girdle weakness and weakness behind the thigh and in the calf respond much better to this conservative form of therapy.

Experience at the Foundation makes it apparent that exercise in the medium of warm water is required at some time during the treatment program of every patient and, at the indicated time, can bring about results impossible to obtain otherwise. Following prolonged immobilization, warm water is an excellent medium in which to increase joint motion without added discomfort. This is true whether the patient has been immobilized to provide physiological rest during early convalescence or to hold a part in proper position following operative procedures. Exercise and movement in the medium of warm water is less difficult for the patient and is the most satisfactory method by which activity can be increased from the point of complete rest to whatever degree of active independence it will be possible to obtain for the patient at the end of the prescribed treatment program.

Orthopedic appliances for the poliomyelitis patient demand careful attention to details. Fine workmanship is of no value if the appliance does not fit or properly support the part. To facilitate mobility during the first stage of weight bearing, the durability of a brace oftentimes must be sacrificed to possibly a more fragile but lighter weight material. Splints of various types, which are applied to provide rest during convalescence, must be positive, yet so designed that they can be easily removed to allow daily massage, exercises, or other forms of treatment. For a great number of patients, walking braces are permanent equipment and become almost a part of the individual. An inch added to the length or the setting back of the knee a few degrees may determine whether the patient can or cannot walk with the support. These appliances cannot be supplied from a distance but must actually be built on the patient. The several necessary fittings during construction may be done by the brace maker, but in every case the final inspection, before the patient attempts weight bearing, should be made by the attending physician.

During the latter part of the prescribed treatment program, every effort is made to fortify the individual with sufficient endurance to fit him again into an environment of normal associates. He is taught to get up and down from a sitting position without assistance, to get in and out of bed, and otherwise take care of his personal needs. In so far as possible he is trained to do all of the normal activities of everyday life with as little assistance as possible. Thus not only is the individual made more independent but the necessity of his depending on an attendant or some member of the family is reduced.

In upper extremity involvement, various types of handicrafts are valuable in teaching coordination and the finer movements characteristic of the hand. This type of exercise is applicable to those cases where there is generalized weakness or in postoperative cases where certain transplants have been done about the fingers and thumb. The prescribed program consists of leather work, weaving on hand looms, sewing, knitting, crocheting, and other work that requires intrinsic muscle activity.

Surgery in the after-treatment of poliomyelitis provides probably the most effective means of improving disabilities resulting from residual paralysis imbalance and ensuing deformities. The surgeon must know just to what extent the operation on the given part will help the individual as a whole. Any operation, regardless of the skill with which it is performed on a given part, has been ill-advised if this improved part proves of no value to the patient. Experience at the Foundation indicates that it seems preferable to delay operative procedures until at least eighteen months have elapsed from the time of the acute onset. There are exceptions to this rule, however. For example, surgical correction of contractures is done earlier if they are preventing the functioning of opposing muscle groups, disrupting weight bearing lines, or are otherwise causing undue strain on adjacent parts of the skeleton.

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One must remember that the recovery of an extensively damaged muscle is never complete if some of its representative nerve cells in the spinal cord have been destroyed. Likewise, one may say the future potential strength of the muscle can be measured by the number of representative neurons remaining intact. No one type of treatment is suited to these neuromuscular units that remain. Each case is an individual problem and must be treated as such. The after-care of the poliomyelitis patient in all its phases has not been standardized. Treatment varies from complete physiological rest over prolonged periods to exercises in a medium of warm water as early after the acute attack as the physical status of the patient will allow. There is no positive evidence that one method has a decided advantage over the other. Unfortunately there are no "controls." It is impossible to say what improvement a given individual would have made had he been treated by a different method or methods.

With the completion of the hospital building at Warm Springs in August of 1939, the Medical Department for the first time in the history of the institution was provided with a unit in which every phase of treatment of the poliomyelitis patient could be applied and studied under one roof. The one exception is the work carried on in the main hydrotherapy pool which is located at a convenient distance from the hospital. Patients residing in the hospital for whom hydrotherapy is indicated can be transported to and from the pool in a manner consistent with the care their particular involvement requires. For example, no early convalescent patients are allowed to sit up. They are transported to and from the pool on specially designed frames. The hospital is designed in particular for the treatment of infantile paralysis. It is so arranged and equipped that a maximum number of patients can be thoroughly supervised and cared for with the greatest efficiency. It is possible to have every early convalescent patient seen every day by designated members of the physical therapy department. This makes it possible to detect early deformities, apparatus that might not fit properly, and give attention to the minute details which are so important in the treatment of poliomyelitis. Patients can be carried in their own beds down to a lower level to an appliance shop for fitting of all apparatus and at this one fitting the minor adjustments which are necessary can be made with the least inconvenience and discomfort to the patient.

Prior to the completion of the hospital, all surgery was done in an affiliated hospital some 75 miles distant from Warm Springs. Now there is a complete operating suite in which all operations can be performed under the most favorable conditions, and the postoperative care which is so important can be closely supervised. Physical facilities have been provided whereby all the necessary parts of an orthopedic organization can work in a coordinated manner to give the best care possible for the poliomyelitis patient.

Procedure for Admission of a Patient

AN APPLICATION for the admission of a patient, accompanied by a complete medical case history from the attending physician, should be directed to the office of the Registrar. Thereafter the Chief Surgeon and his staff review the case history and determine the applicant's medical acceptability. If the applicant is acceptable, arrangements are made by the Registrar for the admission of the patient.

Cost of Treatment

Over 50% of the patients are Aid cases, the others paying a moderate rate which does not defray actual cost. (1) There are no patients at Warm Springs from whom any profit is derived.

Railroads extend the courtesy of one-half the regular fare to Aid patients and one person accompanying them. Application for this special rate can be made to the railroad agent from whom the ticket is purchased through a special form furnished by the Registrar.

Generally the cost of medical attention and maintenance, depending somewhat on the type of accommodations, is as follows:

Medical: There is an initial examination of every patient on arrival, comprising three separate functions: a general examination by a physician, muscle examination by a trained physiotherapist, and orthopedic examination by an orthopedic surgeon. The fee is determined by the extent of these examinations, but is usually $25 for all three.

Rates: There are two basic rates for Pay patients, which include medical supervision, physical therapy treatment in the pools, service of all attendants, walking instructions, etc., and complete maintenance. The present rates are $42 per week for patients living in the hospital and infirmary who require full hospital care; and $39 per week for those patients who are ambulatory and need less nursing care. However, such patients are always supervised by a registered nurse.

NOTE: These rates do not include such extra items as orthopedic appliances (braces, shoes, corsets, plaster casts, etc.), surgical fees, use of operating room, and anesthesia.

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The rate for Pay out-patients which includes all the services above, but with the exception of room and board, is $22 per week.

Trained Private Attendants: Trained private attendants may be engaged by patients needing or desiring them. Room and board for such attendants can be obtained from the Foundation for $20 per week. Salaries in addition to maintenance for female attendants range from $40 to $50 per month, and for male attendants from $50 to $75 per month.

Housekeeping Cottages: For families wishing to establish a temporary home on the Foundation grounds, a number of cottages are available fully equipped for either light or full housekeeping. Rental rates range from a minimum of $50 per month, upward.

Educational Facilities

MRS. S. PINKNEY TUCK very generously donated the funds for the construction of a school and occupational therapy building including equipment, furnishings and library, and for the maintenance of the school, including teachers' salaries, for a trial period of ten years, with the understanding that if during that time the school demonstrated its usefulness and future need, adequate provision would be made for its continued maintenance by way of endowment.

The school opened in May, 1939, and is under the supervision of a Director who has done graduate work in Education and holds a Master of Arts degree. He is assisted by two full-time teachers, each of whom is well trained and experienced in her field, one having specialized in elementary school work from kindergarten through the eighth grade, and the other in high school subjects. There is also a teacher of commercial subjects who acts as librarian. Additional teachers are brought in for part-time work as their services are required.

The purpose of the school is to help patients maintain the scholastic level of their group in their home schools whenever their physical condition permits. After a consultation with the Medical Department to determine how much work the patient is able to do, a curriculum and schedule which will give the greatest coverage and thoroughness are worked out for each individual. Wherever possible, the principal of the patient's home school is consulted, and in many cases the same textbooks and syllabi which are used at the home schools are followed.

Most of the pupils in the elementary grades are taught in classes, as it is thought that the competition offered in group activities has a salutary effect. In the high school, the work consists almost wholly of private or semi-private instruction. Examinations are given every four or six weeks varying with the individual case, and progress reports are sent to parents.

Pupils who are able to walk or operate wheel chairs go to the school building for their work, but those who are confined to their beds are visited by the teachers in the Infirmary or the Medical Building.

Although the patients are handicapped physically, they are not handicapped mentally, and every endeavor is made to keep standards at least as high as those of the pupils' home schools, always being guided, however, by the reports of the Medical Department on the amount of work that each individual pupil is physically able to do, and being careful not to interfere with the regimen set for the patients by the Medical Department.

The Occupational Therapy Department is under the supervision of a Director and trained occupational therapy assistant. While, of course, most of the training is done in the school building, work is also taken to those patients who are unable to move about. The primary purpose of this Department is to provide beneficial exercises for certain muscular weaknesses under the direction of the Medical Department, but it also provides entertainment and amusement for the entire Foundation family. The occupational equipment includes a metal working room, many types of weaving looms, sewing machines, pottery kiln, and provides facility for almost any handicraft hobby except heavy carpenter work.

General Statistics
1934-1940

IN GENERAL, the statistics given are for a period beginning in 1934, when funds were received from the first Celebration of the President's Birthday. All statistics are based on a calendar year period prior to October 1, 1939, when a fiscal year ending September 3oth was adopted.

I. CAPACITY

The number of patients that can be cared for at any one time by the Foundation is about 105.

The accommodations are approximately as follows:

II. NUMBER OF PATIENTS IN RESIDENCE

III. OUT-PATIENT CLINIC VISITS

IV. FINANCIAL CLASSIFICATION OF PATIENTS

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V. OPERATIONS PERFORMED BY FOUNDATION BY SURGEONS

NOTE: This total of 595 procedures were performed on a total of 501 patients during the period.

VI. TOTAL PATIENTS TREATED 1935 THROUGH 1940, INCLUDING FINANCIAL CLASSIFICATIONS AND GEOGRAPHICAL DISTRIBUTION

Annual Statistics for Year 1940

I. NUMBER OF PATIENTS IN RESIDENCE

II. MONTHLY REGISTRATIONS AND DISMISSALS

III. AVERAGE NUMBER OF PATIENTS, PER DAY
80.9

IV. AVERAGE LENGTH OF STAY OF PATIENTS
3 months

V. CLASSIFICATION OF PATIENTS AT TIME OF ADMISSION ACCORDING TO PARTS AFFECTED

VI. DURATION OF ATTACK AT TIME OF ADMISSION

VII. AGE GROUP OF PATIENTS IN RESIDENCE

VIII. AGE AT DATE OF ATTACK

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IX. BRACES AND OTHER APPLIANCES MADE IN BRACE SHOP

X. CORSETS MADE

XI. CASTS MADE

XII. X-RAYS MADE

XIII. PHYSICAL THERAPY DEPARTMENT

XIV. PATIENTS' AID

During the fiscal year 1940, there were treated at the Foundation, 296 patients, who received 29,097 hospital days' care. Of that number, 184 patients, or 62.16%, required financial assistance. These Aid patients received 20,389 hospital days' care, or 70.07% of the total hospital days' care.

XV. TOTAL PATIENTS TREATED INCLUDING FINANCIAL CLASSIFICATION AND GEOGRAPHICAL DISTRIBUTION

1940

Georgia Warm Springs Foundation and The National Foundation for Infantile Paralysis, Inc.

SOME CONFUSION has arisen in the minds of the public as to the relationship between Georgia Warm Springs Foundation, founded in 1927, and The National Foundation for Infantile Paralysis, Inc., organized in 1938.

These two Foundations are entirely separate and distinct.

It was because of the experience gained from the work done at Georgia Warm Springs Foundation that the National Foundation was created. The occasion and the reason for organizing The National Foundation for Infantile Paralysis, Inc., cannot be better described than it was by President Roosevelt in a statement which he made on September 23, 1937, sponsoring the creation of the National Foundation, which reads as follows:

"My own personal experience in the work that we have been doing at the Georgia Warm Springs Foundation for over ten years, leads me to the very definite conclusion that the best results in attempting to eradicate this disease cannot be secured by approaching the problem through any single one of its aspects, whether that be preventive studies in the laboratory, emergency work during epidemics, or after-treatment. For over ten years at the Foundation at Warm Springs, Georgia, we have devoted our effort almost entirely to the study of improved treatment of the after-effects of the illness. During these years other agencies, which we have from time to time assisted, have devoted their energies to other phases of the fight. I firmly believe that the time has now arrived when the whole attack on this plague should be led and directed, though not controlled, by one national body. And it is for this purpose that a new national foundation for infantile paralysis is being created.

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"As I have said, the general purpose of the new foundation will be to lead, direct, and unify the fight on every phase of this sickness. It will make every effort to ensure that every responsible research agency in this country is adequately financed to carry on investigations into the cause of infantile paralysis and the methods by which it may be prevented. It will endeavor to eliminate much of the needless after-effect of this disease -- wreckage caused by the failure to make early and accurate diagnosis of its presence.

We all know that improper care during the acute stage of the disease, and the use of antiquated treatment, or downright neglect of any treatment, are the cause of thousands of crippled, twisted, powerless bodies now. Much can be done along these lines right now.

The new foundation will carry on a broad-gauged educational campaign, prepared under expert medical supervision, and this will be placed within the reach of the doctors and the hospitals of the country. The practicing physician is in reality the front line fighter of the sickness, and there is much existing valuable knowledge that should be disseminated to him.

"And then there is also the tremendous problem as to what is to be done with those hundreds of thousands already ruined by the after-effects of this affliction. To investigate, to study, to develop every medical possibility of enabling those so afflicted to become economically independent in their local communities will be one of the chief aims of the new foundation."

The Georgia Warm Springs Foundation has conducted an institution at Warm Springs since 1927 for the treatment of children and adults who are suffering from the after-effects of infantile paralysis.

The National Foundation for Infantile Paralysis, Inc., attacks the whole problem of infantile paralysis through virus research, nutritional research, after-effects research, epidemic aid and study, and education.

Since 1937, Georgia Warm Springs Foundation has received no part of the proceeds of any Birthday Celebration. Since that time, and with the consent of the Georgia Warm Springs Foundation, the fund-raising activities for victims of infantile paralysis through the medium of Birthday Celebrations have been in the hands of the National Foundation. The Board of Trustees of the National Foundation appropriated in the year ended September 30, 1940 the sum of $175,000 to enable Georgia Warm Springs Foundation to meet its operating costs.

The following tabulation shows the net receipts of all the Celebrations of President Roosevelt's Birthdays from 1934 to 1940, inclusive, and the distribution thereof:

CELEBRATIONS OF PRESIDENT ROOSEVELT'S BIRTHDAYS

Statement of net Receipts from 1934 to 1940, inclusive, showing distribution thereof.

Finances

THE GEORGIA WARM SPRINGS FOUNDATION from 1927 to 1934 met its annual operating costs in excess of its income chiefly with contributions from individuals and charitable organizations.

In 1934, the net proceeds of the first Celebration of the Honorable Franklin D. Roosevelt's Birthday were given to Georgia Warm Springs Foundation for the benefit of the victims of the after-effects of infantile paralysis.

In 1935 it received no part of the proceeds of the Celebration held that year.

In 1936 and 1937 the Foundation received 30% of the proceeds, 70% being retained in the various communities where raised to be used locally for the aid of sufferers from poliomyelitis.

In 1938, all of the net proceeds of the Birthday Celebration were given to the National Foundation for Infantile Paralysis.

Since 1938, 50% of the net proceeds of all Birthday Celebrations has been left in the counties where raised and the remaining 50% has gone to the National Foundation for Infantile Paralysis.

HASKINS & SELLS CERTIFIED PUBLIC ACCOUNTANTS 22 EAST 40TH STREET NEW YORK

Accountants' Certificate

GEORGIA WARM SPRINGS FOUNDATION:

We have examined the balance sheet of Georgia Warm Springs Foundation, a New York corporation, as of September 30, 1940 and the related statement of fund reserves for the year ended that date (including the operations of its subsidiary, Meriwether Reserve, Inc. to April 30, 1940 the effective date of its dissolution), have reviewed the system of internal control and the accounting procedures of the Foundation, and have examined or tested its accounting records and other supporting evidence by methods and to the extent we deemed appropriate.

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In our opinion, the accompanying balance sheet and related statement of fund reserves present fairly the financial condition of the Foundation at September 30, 1940 and the results of operations for the year ended that date (including Meriwether Reserve, Inc. for the period indicated above) in conformity with generally accepted accounting principles, and on a basis consistent with that followed in the preceding year.

HASKINS & SELLS

November 28, 1940.

GEORGIA WARM SPRINGS FOUNDATION Balance Sheet, September 30, 1940

ASSETS

LIABILITIES

GEORGIA WARM SPRINGS FOUNDATION
Statement of Fund Reserves
For the Year Ended September 50, 1940

NOTE: This statement includes the operations of Meriwether Reserve, Inc. for the seven months ended April 30, 1940, as of which date the dissolution of that corporation was made effective and its operations taken over directly by Georgia Warm Springs Foundation.