HV 3011 M5C6 UC-NRLF $B 3flE lEti SURVEY of CRIPPLES IN NEW YORK CITY UNDER THE AUSPICES OF A SPECIAL COMMITTEE ON SURVEY OF CRIPPLES HENRY C. WRIGHT DIRECTOR OF SURVEY */(//. C/P7. 3 J93J ^ OF THE ^JNIVERSITY PRINTED AND DISTRIBUTED BY THE NEW YORK COMMITTEE ON AFTER CARE ~~ OF INFANTILE PARALYSIS CASES NEW YORK CITY OCTOBER, 1920 Ew:^w:m':'- V" V ^ SURVEY OF CRIPPLES IN NEW YORK CITY Undertaken hy A COMMITTEE ON SURVEY With the Compliments of Ihe New York Committee on After Care of Infantile Paralysis Cases Dr. S. S. Goldwater Mr. Douglas McMurtrie Mr. William Church Osborn Mr. James H. Perkins Dr. Thomas J. Riley Dr. Jacques Rushmore Mrs. John S. Sheppard Henry C. Wright, Director of Survey mmm^l ^H "^' 1 1 ^F^X^^^^^^^B m> ^^E^^^^^^l ^mt' ^SB^^I f A ^^Sj^^^I^^^^^H ^ -^ SURVEY OF CRIPPLES IN NEW YORK CITY Undertaken by A COMMITTEE ON SURVEY OF CRIPPLES Mr. Thomas S. McLane, Chairman Mr. Alexander M. White, Treasurer Mrs. Henry B. Barnes Dr. E. H. Lewinski-Corwin Dr. Andrew W. Edson Dr. Virgil P. Gibney Dr. S. S. Goldwater Mr. Douglas McMurtrie Mr. William Church Osborn Mr. James H. Perkins Dr. Thomas J. Riley Dr. Jacques Rushmore Mrs. John S. Sheppard Henry C. Wright, Director of Survey April 21, 1920 To the Committee on Survey of the Conference on Cripples Under your authorization and direction I began a survey of cripples in New York City on November I, 1919. I am herewith submitting my report, with recommendations. Respectfully submitted, Henry C. Wright Director HV30U CONTENTS PAGE Introduction 5 Summary of Recommendations 7 Some Significant Findings 10 Detailed Statement with Regard to Recommendations 12 Arguments in Support of Recommendations 21 Field Canvass 32 Education for Cripples 61 Social Agencies 68 Hospital and Clinic Care 77 Orthopedic Beds in Hospitals of New York City and Vicinity 87 Out- Patient Service 88 Convalescing and Custodial Care 99 794371 INTRODUCTION This survey was inaugurated by the representatives of 41 organizations, associations, and hospitals in Greater New York engaged in work for cripples, at a conference on April 4, 1919, which was the result of the efforts of the New York Committee on After Care of Infantile Paralysis Cases. The expenses were met by contributions from certain of these agencies and a liberal gift from the Rockefeller Foundation. The responsibility for the after care of the survivors of the 191 6 Infantile Paralysis epidemic in New York City has since that time been vested in the above named Committee, representing all the agencies interested in these children. This Committee had pro- vided a system of follow-up, including necessary financing, transportation, home care, etc., which proved so beneficial in its results on the thousands of cases recorded that the committee early in 191 9 resolved to learn whether all the city's needy crip- ples were being cared for, and if not, to what extent the need was unmet. The Survey was made under the direction of Mr. Henry C. Wright, of the Hospital and Institutional Bureau of Consulta- tion. The aim was to ascertain the number of persons crippled in New York by different causes, and the nature of care and treat- ment being given them, with the chief emphasis on the causes which produce cripples. Instead of surveying the entire city, which would have been a very large task, six typical districts, having an aggregate population of 110,000 people, were selected. In these districts a house-to-house canvass was made. Where cripples were found whose cases had not been diagnosed at a recognized clinic or hospital, an orthopedic surgeon was sent to the home to make a full diagnosis. The statistics of causes and classifications thus obtained are reasonably accurate. In addi- tion to the field canvass, the work of all organizations, hospitals, and institutions dealing with cripples was examined to determine its character and scope. 5 INTRODUCTION This report is published by the New York Committee on After Care of Infantile Paralysis Cases, from whom additional copies can be obtained for $i.oo postpaid, by addressing the Director, Mr. Robert Stuart, at 69 Schermerhorn Street, Brooklyn, New York. Thomas J. Riley T SUMMARY OF RECOMMENDATIONS O REDUCE factors which produce cripples, and to render cripples so far as possible self supporting, it is necessary to perform at least the following functions : (a) Elementary and secondary education. (b) Prevocational training. (c) Vocational guidance. (d) Medical and surgical treatment. (e) Convalescing care. (/) Custodial care. (g) Social service. (h) Home treatment. {i) Summer outings. (j) Vocational training. (k) Placement in employment. (/) Work in home. (m) Braces and appliances. The foregoing functions are not listed in chronological sequence, since several of these functions would necessarily be carried on simultaneously, such as elementary and secondary education, medical and surgical treatment, and social service. Educational guidance, for instance, with children just leaving high school or elementary school, would probably take place through different organizations than vocational guidance for adults. In addition to work with potential and actual cripples, every effort should be made to prevent crippling sickness and accident. Such work involves legislative measures, and will be carried on by various organizations which do not deal directly with the problem of the cripple. SURVEY OF CRIPPLES IN NEW YORK CITY Recommendations AS TO THE DISTRIBUTION OF THE FOREGOING FUNCTIONS TO ASSOCIATIONS, SCHOOLS, HOSPITALS AND CLINICS I That there be created a central organization covering the city, to perform the following functions: 1 . The keeping of identifying records of all cripples in the city. 2. Through the school Census Bureau, or through direct effort, the registration of all cripples and potential cripples of all ages. 3. To be responsible for the operation of a transportation sys- tem, and the 1g termination as to what cases shall be transported. 4. Advise as to the fields in which various organizations can operate without overlapping. 5. Advise as to additional facilities needed, such as beds, schools, shops, etc. 6. Cooperation with city departments to the end that trans- portation be furnished, begging cripples be referred to the ap- propriate training and placement agencies, and needed census information be registered. 7. Approval of the distribution to various agencies of a joint fund for cripples. Manhattan, Bronx and Richmond II The Association for the Aid of Crippled Children to be re- sponsible, directly and indirectly, for the performance of the functions listed above under (a) to {i) , as follows : (a) Elementary and secondary education. {h) Prevocational training. {c) Vocational guidance. {d) Medical and surgical treatment. {e) Convalescing care. (/) Custodial care. {g) Social service. {h) Home treatment. {i) Summer outings. 8 SUMMARY OF RECOMMENDATIONS III The Federation of Associations for Cripples and the Institute for Crippled and Disabled Men to cooperate in the performance of the functions listed above under (J) to (w), as follows: (j) Vocational training. (k) Placement in employment. (/) Work in home. (m) Braces and appliances. Brooklyn and Queens IV The Committee on Crippled Children of the Brooklyn Bureau of Charities to act as agent of the central organization, and also undertake responsibility for the performance of the functions listed above under (j) to (w) , as follows : (j) Vocational training. (k) Placement in employment. (/) Work in home. (m) Braces and appliances. V The Visiting Nurse Association of Brooklyn to be responsible, directly and indirectly, for the performance of the functions listed above under (a) to (i), as follows: (a) Elementary and secondary education. (b) Prevocational training. (c) Vocational guidance. (d) Medical and surgical treatment. (e) Convalescing care. (/) Custodial care. (g) Social service. (h) Home treatment. (i) Summer outings. VI That joint financing of at least the five organizations herein- before mentioned be provided for. 9 SOME SIGNIFICANT FINDINGS 1. That there are about 36,000 cripples in the city. 2. That of all cripples, about 50 per cent are under 16 years of age ; that about 63 per cent became crippled before reaching the age of 16 years. 3. That nearly one-half of the cases discovered by the field canvass were not being treated ; that there are in the city prob- WHAT IS THE CRIPPUNG PERIOD OP LIFE? FINDINGS IN 727 CASES ably about 1000 cases of poliomyelitis. Potts' disease and tuber- culosis of the joints not yet diagnosed ; that there are about 3700 cases with these diseases that have been diagnosed but have 10 SOME SIGNIFICANT FINDINGS ceased to attend clinics ; that over 50 per cent of cripples are not known to any agency. 4. That very few cripples attend high school. 5. That there are enough operative beds and sufficient clinical facilities, but insufficient number of convalescent and custodial beds. 6. That in the social work for cripples there are portions of the field uncovered, and at the same time somewhat vague limits assigned to the work of various agencies. II DETAILED STATEMENT WITH REGARD TO RECOMMENDATIONS, AND ARGUMENTS IN THEIR SUPPORT The Problem of the Cripple Elementary and Secondary Education ELEMENTARY and secondary education is more important, if possible, for cripples than for a normal child. If a normal child be not educated, he at least can perform manual labor, and always be in a position to sell his services. A cripple must render a limited and specialized service which, in almost all cases, combines and requires a large element of intelligent application. Many cripples can perform little or no physical labor, but are unrestricted in work requiring knowledge and intelligence. A person crippled because of the loss of one or both legs can render as good service as a bookkeeper, stenographer, typist, and in various other occupations, as a person who is not thus handi- capped. An education and vocational training are needed as a preparation. Elementary and secondary education should be conducted so far as possible by the Department of Education of the city, even in hospitals and custodial homes. In general, the function is reasonably well performed for the child residing at home. The educational processes are less satisfactory in hospitals and homes. Prevocational Training The average child can be allowed to come to maturity without much advice as to his vocation, with little danger but that he will choose a vocation reasonably well adapted to his ability and capacity. A cripple, on the other hand, is much more limited in his choice, and is not likely to be informed as to the vocations or the processes wherein he can be serviceable regardless of his handicap. It is important, therefore, that he be thrown in touch with those who are familiar with the kind of things that can be 12 DETAILED STATEMENT WITH REGARD TO RECOMMENDATIONS done by those handicapped by one or more of the great variety of handicaps produced by disease or modern commerce and in- dustry. The advice and instruction in connection with prevoca- tional training should be adjusted to the vocation which is sub- sequently to be chosen. This function is but partially performed at the present time, and warrants fuller consideration and development on the part of the Department of Education. Vocational Guidance Many crippled persons will not, or cannot, for a variety of reasons, avail themselves of any particular training for a voca- tion. It is important that they be advised as to the type of things which they can most readily perform without specialized training. There is a tendency on the part of some philanthropic citizens to organize movements to train children to make artificial flow- ers, beads, etc., and to offer to crippled children this work, with- out informing them of other trades and vocations, thus limiting their choice to the one or two things presented. Such a pro- cedure must necessarily at times force upon children a vocation for which they are ill fitted, and deter them from entering into work for which they have ability and talent. These processes will naturally take place in connection with the Department of Education, with the Association for the Aid of Crippled Children cooperating, for children going directly from the public schools to work. For those taking a subsequent vocational training, and for adults, the guidance should be carried on by an organization or organizations doing vocational training. Medical and Surgical Treatment Fortunately, New York City is reasonably well equipped with orthopedic hospitals and clinics, served by competent surgeons. A person who attends these hospitals or clinics is likely to receive intelligent and adequate treatment and care. Of hospitals de- voted exclusively to orthopedic work, there are 6 within the city limits, and a state institution at West Haverstraw. In these 7 institutions there are, or shortly will be, 928 beds. There are orthopedic services in 10 general hospitals within the city 13 SURVEY OF CRIPPLES IN NEW YORK CITY limits, and i in territory accessible to the city, jointly providing 350 beds, making a total of 1278 operative beds. Of this num- ber, 816 are in Manhattan, 207 in Brooklyn and 255 in the vicinity of New York, available for both Manhattan and Brooklyn. The hospitals take cognizance only of the cases that come to their doors. They are not financed or organized to discover and treat the cripple who does not voluntarily seek their aid. That there are a large number of such cripples in New York City is shown by the survey. Estimating on the basis of the number of cases found in the districts surveyed, there are probably in New York City about 1600 crippled children under 15 years of age who have not been to aclinic or hospital for diagnosis, and 6500 who have attended but have discontinued such visitation and have not returned within a period of six months or longer. Of those over 15, there are about 7000 that fall within these two classes. These are all remediable or curable, and in addition to these, there are probably fully 6300 cases of rickets which would be much benefited by medical and surgical attention. Details of the foregoing statistics will be found in the body of the Report. It is reasonably clear that there is no need of additional opera- tive beds in New York City taken as a whole. Inasmuch as a larger proportion of the operative beds are in Manhattan, it is probable that additional operative beds are needed in Brooklyn. Even with the small number available in Brooklyn, there is still a question whether or not additional operative beds be needed, provided more convalescing beds should be made available, and a system of after-care be provided in the home. The comparative results of the long term and short term stay cases in the operative hospitals are well illustrated by an exam- ination of end results of cases discharged from two hospitals in Brooklyn. In one of these hospitals 77 patients were operated upon and discharged to their homes after an average stay of 12 days. Of these operations there were 12 types. A corresponding number of patients were operated on in another leading Brooklyn hospital, covering 9 types of operations. These children re- mained in that hospital on an average 52 days. All of these cases, discharged from both hospitals, subsequently returned to their respective clinics for examination. The surgeon who was in charge of the cases in the hospital where the children remained 14 DETAILED STATEMENT WITH REGARD TO RECOMMENDATIONS the shorter term states that on their return to the hospital for re-examination he found that their early discharge was entirely satisfactory, as far as results were concerned. The conclusion might be drawn from the foregoing statement that it would be feasible to discharge orthopedic cases operated upon within a period of two weeks, and that as good end results would be obtained as though they were kept in the hospital for a period of at least 7 weeks. This probably is a fair conclusion as applied to the majority of cases, but there are other factors to take into consideration in addition to the end results. Under the conditions in which most New York families live, it is difficult to care for sickness in the home. To the extent that patients discharged after a period of two weeks still remain bed patients in their homes, they are a burden upon that home. It is strongly urged by some that a hospital is much more than a place in which operations are performed ; that it is an institution designed not only to care for the needs of the patient, but also to relieve the home of the burden brought about by sickness. In other words, as to whether or not a patient needs to be cared for in a hospital may be more a social than a medical question, and the decision must be left in most cases with social agents. This decision in- volves an investigation and determination in each case as to whether or not the burden can be cared for in the home. It seems reasonably clear that patients can remain in the operative hospital a much shorter time than they now remain, if two agen- cies are provided first, an adequate social agency to examine the homes and to supervise patients in the homes where they can be sent, and second, convalescing hospitals to be used for such cases as cannot wisely be sent home. Neither of these agencies is adequate in New York City at the present time. Convalescing Care Convalescence, generally speaking, may be considered, on an average, to begin two weeks after an operation. In general, such convalescence takes place in the hospital where the operation is performed, owing to the fact that there are comparatively few convalescing beds. There are but 4 institutions devoted to con- valescing care. One is operated by the New York Orthopaedic Hospital at White Plains, New York, two by the City of New 15 SURVEY OF CRIPPLES IN NEW YORK CITY York (one at Neponsit Beach and the other a portion of Sea View Hospital), and the remaining one is operated by an independent board in a private residence at Yonkers. The combined con- valescing capacity of these 4 places is 273. On an average, a convalescing case needs attention for a period of at least ten weeks, which ratio would mean that there should be five con- valescent beds to each operative bed, a requirement of 6400 con- valescent beds for the 1278 operative beds. This number would be reduced in proportion to the number of cases that could be sent directly from the operative hospital to their homes. Un- fortunately, in New York City a large proportion of such homes are in tenement houses, where it is difficult to care for a convales- cent orthopedic case for a long period of time. It is difficult to determine the number of convalescent beds actually needed. It is obvious, however, that 6400 are not needed, which the present operative beds could fill. The problem is to provide convalescent beds as pressure develops on the operative beds. It is reasonable to estimate that at least 500 additional convalescent beds are needed at present. Such convalescent beds as are provided should be within easy reach of New York City. Custodial Care Many children and adults are crippled to a degree that renders it impossible for them to care for themselves. In many cases where they are not sufficiently crippled to make it impossible to care for their personal needs, they are yet unable to follow any occupation that would make them self supporting. The families in some such cases are able to care for cripples in their homes. There are many others, however, which, owing to family condi- tions, must be cared for in institutions. These are the so-called custodial cases. There is no hope of their recovery or material improvement, and they must be maintained at the expense of the public or of contributors. At the present time there are 7 institutions in or adjacent to New York City, with 563 beds, caring for custodial cases. There is always a long and increasing waiting list for these few beds; particularly is there a need for an institution that will care for the feeble-minded cripple. The number of custodial beds should be markedly increased. 16 detailed statement with regard to recommendations Social Service Social service in connection with orthopedic cases is carried on by hospitals only in connection with patients that have been discharged after operations, and workers are provided by ii hos- pitals. The majority of cases discharged receive no social service or after-care. The clinic cases are cared for by the Association for the Aid of Crippled Children in Manhattan, Bronx and Rich- mond, and by the Visiting Nurse Association in Brooklyn. These Associations, however, are not able with their present staffs to care for more than a portion of the cases that need attention. The kind of service rendered by such visitors is, instruction to parents as to the care of the patients, and the watching of the case to see when it is advisable for it to return to the hospital or clinic for examination, to see that the child receives an education and secures advice with regard to future occupation. Without such work many cripples would not go to clinics, or, having gone, would not return at periods indicated by the examining surgeon. They might neglect their education, so important to cripples, and, failing to appreciate their limitations, might select occupa- tions at which they would be able to earn but a very meager living. Home Treatment Home treatment is of recent development. It was first tried in connection with the work at Long Island College Hospital and Brooklyn Hospital at the time of the epidemic of infantile paraly- sis in 191 6. After cases were examined at the clinic or in the home by an orthopedic surgeon, orthopedic nurses or masseurs were sent to the homes of the patients, and continued treatment under the advice and direction of the orthopedic surgeon. At periods indicated by the surgeon the patient was to return to the clinic for examination. In this manner about 427 cases were cared for in their homes. The results of this method of treatment have been satisfactory to the surgeons in those hospitals, and they highly recommend the extension of this type of service. Where home treatment was not used it was, and still is, necessary to transport cases from their homes to clinics. At the present time there are 22 buses devoted to this purpose, 10 operated by the City of New York, 5 by the New York Committee on After-Care 2 17 SURVEY OF CRIPPLES IN NEW YORK CITY of Infantile Paralysis Cases, and 7 by the Brooklyn Bureau of Charities. There are a number of cases, however, that cannot be taken to the clinics by relatives or friends ; cannot be transported with the available buses, and are not being treated in the homes. To furnish adequate transportation for all needing it, if no home care is furnished, would require an expenditure of not less than $150,000 annually. If, however, the system of home care be ex- tended to all cases that can be cared for in the home, and trans- portation be used to transport cases to clinics only for re-examina- tion not oftener than six to eight weeks, the transportation for the entire city could be adequately cared for with six to eight buses. The home treatment under this system would require more ortho- pedic nurses and masseurs. It has been found by the Visiting Nurse Association of Brooklyn that one nurse can care for 40 cases of infantile paralysis in their homes. When it is taken into con- sideration that a fair proportion of cases that need home treat- ment would require treatment less often than infantile paralysis cases, it seems probable that 30 nurses and masseurs could care for all cases in the homes in New York City. This system of home treatment, combined with less frequent transportation, seems highly desirable from the standpoint of economy and efficiency. The combined transportation and home treatment cost would not exceed one-third of the cost of operating an adequate trans- portation system. Summer Outings Summer outings are provided by a number of associations and groups of people to both well and sick children. These outings are much more needed by cripples, owing to the fact that they are confined to their locality and restricted in their ability to get about. Every encouragement should be given to groups to ex- tend this service. The work, however, should be so coordinated as not to overlap and duplicate other services rendered. Vocational Training Inasmuch as the things which a cripple can do are quite limited as compared with the multitude of things which can be performed by the normal person, it is necessary to establish and provide for education in trades which are best suited and adjusted to the 18 DETAILED STATEMENT WITH REGARD TO RECOMMENDATIONS variety of handicapped conditions. The world war has added much to our knowledge along these lines, and that knowledge should be carried over into peace time in connection with the problem of preparing for self support those crippled by disease or industry. This function is performed to some extent by the Department of Education, especially in the training of girls. Much less is done for boys. It is not clear how far nor to what extent the Department of Education should attempt to teach vocations through public schools, more especially in that it is dealing with the young and immature, when the capabilities and desires are not clear. It may be advisable to lay additional stress upon pre- vocational training, with the expectation that vocational training will be conducted in separate establishments organized particu- larly to carry on that function. There may come a time, after private enterprise has experimented and developed methods and standards, when it may be advisable for the city and state to as- sume such functions. Too much emphasis cannot be laid upon the necessity for voca- tional training. Many cripples now enter the almshouses or beg upon the streets who could readily support themselves with proper training, appropriate to their particular handicap. The type of institution to carry on this work needs to be much more specialized than the ordinary vocational shop. It must have officers thoroughly versed in trades or processes that can be carried on by the different kinds of handicapped persons, and also in manufacturing and trade conditions using such processes. For this reason it is highly desirable that such vocational training be carried on by an organization devoting itself exclusively to this line of work. Placement in Employment It is difficult for a crippled person to obtain employment, par- ticularly at times when there is a surplus of labor. If there are two persons applying for a job, one physically normal and the other physically handicapped, the employer will usually accept the physically able person. For this reason it is especially im- portant that there be an adequate service for placing in employ- ment persons who are not able to compete with the physically 19 SURVEY OF CRIPPLES IN NEW YORK CITY normal. The ordinary employment agency will give little or no heed to the physically handicapped. It requires an agency de- voting its attention exclusively to this class to produce good placements. The Institute for Crippled and Disabled Men oper- ates a bureau for this purpose, with very commendable results. Funds should be provided to increase the number of employees and to enlarge the scope of the service. Proportionately, it re- quires a much larger staff to place handicapped than normal per- sons, owing to the fact that employers must be visited and shown that if work is properly selected and adjusted to a handicapped person he can be as serviceable as a person without handicap. The Association for the Crippled and Disabled of Cleveland, Ohio, operates a bureau for this purpose in connection with a municipal employment bureau, and it is sufficiently staffed to handle all persons referred to it. There is no organization in Brooklyn conducting such a service. Work in the Home Many cripples cannot use transportation lines, and so cannot travel from their residence to an industry or trade. Such persons, however, can be employed in their homes if suitable employment can be carried to them. The Federation of Associations for Cripples has been operating such a service very successfully. Owing to an insufficient staff, it is able to provide work only for a limited number of shut-ins. Many hundreds of crippled persons in New York City could be self supporting in their own homes if this Bureau had sufficient funds adequately to conduct this service. There is no work of this character carried on in Brooklyn. Braces and Appliances But 5 hospitals in the city have shops wherein braces and ap- pliances are made. All other hospitals and clinics secure such appliances as they use from private agencies. The making of braces and appliances is a good vocation. It would seem feasible and desirable that this vocation be taught to cripples, and the product of the students' work be used to supply the needs of the hospitals and clinics that are now obliged to purchase braces and appliances. This instruction work could 20 ARGUMENTS IN SUPPORT OF RECOMMENDATIONS well be experimented with in the shops operated by the Institute for Crippled and Disabled Men. In addition to braces and appliances for cripples, this shop could well manufacture all splints and other appliances now used in hospitals in connection with fractures. The treatment of fractures during the war has clearly demonstrated that the old method of casts can be advantageously supplanted by the method of splints and a suspension by harness of the injured member. By this process, healing and uniting is more rapid, and the muscles are left in normal function and condition, which permits of much more rapid convalescence, shortening the period in the hospital. There is no shop manufacturing these appliances. It is probable that cripples, if trained in the vocational shops, could readily per- form all processes necessary in their manufacture. Arguments in Support of Recommendations Central Organization It IS recommended that a central organization be created to perform certain services hereinbefore outlined. Until the Federa- tion of Associations for Cripples was organized in 191 2, there was no coordinated effort in connection with the problem of cripples. This association consisted of representatives of the following hospitals, institutions and organizations: Association for the Aid of Crippled Children, Association of Public School Teachers of Crippled Children of the City of New York, Blythedale Home for Convalescent Tubercular Crippled Chil- dren, Brearley League Industrial Classes for Cripples, Brooklyn Association for Improving the Condition of the Poor, Brooklyn Bureau of Charities, Brooklyn Home for Blind, Crippled and Defective Children, Children's Aid Society, Crippled Children's Driving Fund, Crippled Children's East Side Free School, Harlem Day Home and School for Crippled Children, Hospital for Deformities and Joint Diseases, 21 SURVEY OF CRIPPLES IN NEW YORK CITY New York State Branch of the Shut-In Society, WilHam H. Davis Free Industrial School, Ladies' Auxiliary of the Orthopedic Ward of the Post Gradu- ate Hospital, New York Philanthropic League in Aid of Crippled Children, Institute for Crippled and Disabled Men, The After-Care Home for Crippled Children. This list comprises but a proportion of the hospitals and agen- cies dealing with cripples, and is itself a federation in but a limited sense. Its function has been primarily to discuss questions com- mon to the associations represented in the Federation, and it was not organized to handle the broader questions relating to cripples, nor has it attempted to deal with them. During the infantile paralysis epidemic of 1 91 6 it became apparent that some central organization was needed to handle some of the common problems of the thousands of children afflicted with that disease. The New York Committee on After-Care of Infantile Paralysis Cases was organized, and proceeded at once to discover, through all available records and sources of information, children who had become partially or wholly paralyzed by infantile paral- ysis. With this record in hand, the Committee endeavored to see that each child had proper and adequate medical and surgical attention; that braces and appliances were furnished; that transportation was supplied to carry the patient from the home to the clinic, and where needed that new clinics were organized, and existing facilities enlarged. It is a noteworthy result that of the 6575 surviving children afflicted by infantile paralysis, the number of cases of deformity is almost negligible. Had this work not been done, there would have been hundreds of hopelessly deformed children in the city to-day. The After-Care Committee, however, has cared only for infantile paralysis cases of the epidemic of 191 6. There are being produced year by year additional cripples caused by infantile paralysis and by bone tuberculosis, spastic paralysis, birth paral- ysis, spinal meningitis, arthritis, osteomyelitis, rickets, and accidents. A portion of these cases seek the advice of private physicians; some go to clinics and hospitals, but many in the ag- gregate, as shown by the field canvass of the survey, do not seek or receive attention or treatment. Their ailment is not cared for 22 ARGUMENTS IN SUPPORT OF RECOMMENDATIONS at its inception, and as a result, serious handicapping deformity in many cases results. Some agency should be responsible for seeing that such cases are discovered at the inception of their affliction and properly treated. This function is not covered, as heretofore stated, by the After-Care Committee, nor is it covered by the Federation of Associations for Cripples. The parents of cripples, conceiving the idea that their child is not improving as rapidly as it ought, sometimes shift from a clinic to a private physician, or from one clinic to another, or drop treatment altogether. In case treatment is dropped, and par- ticularly if in the meantime the family moves, at the present time there is no centralized record or means of following up or redis- covering such a case. As is well known, there is a great deal of moving from place to place in New York City, from location to location in the same Borough, and from one Borough to another. A process of treatment or education may be started in one loca- tion, and when a family moves to another, all processes may be discontinued. Transportation is needed in connection with many hundreds of cases. At the present time there are being transported to clinics about 950 cases, and the service is inadequate. The cost of an adequate service, as heretofore stated, is almost prohibitive. A system of home treatment is needed to simplify the process and reduce the cost. Some agency is needed to operate transporta- tion, to select the cases that are to be transported, and to induce clinics to accept the home treatment method as a substitute for transportation. To attempt to operate a transportation system without some agency to select the cases to be transported would be very inefficient in results. The parents of nearly all crippled children are glad to avail themselves of transportation, and if such appeals were to be handled by the drivers of buses, the number of cases transported would so increase as to make the transportation problem so large as to be inoperable. At the present time the only measure of need for increase of facilities is the pressure upon particular clinics or hospitals. There is no other basis of determining needs than the judgment of the managers of such hospitals or clinics, based upon applica- tions. It is easily possible that when the number of applications at a particular place indicates that there is need for additional 23 SURVEY OF CRIPPLES IN NEW YORK CITY facilities, the facilities should not be located at the place where the applications are made, but should be located elsewhere, and there is no centralized authority to express a judgment on such a matter. There is at the present time no one to answer the ques- tion, when, where and how many custodial beds are needed. Many applications are made to clinics for braces and appliances by parents who are not able to pay for them. The clinics have insufficient funds, and no agency is in the field to inform the public as to the need for such expenditures, except the individual agencies to which application is made. As a result, many crippled children needing braces or appliances must needs do without them, with resulting increase of their deformity and a lessening of their capacity. Many cripples attempt to earn a living by begging upon the street. The number varies according to the watchfulness of the Police Department. There seems to be need of some organiza- tion that will cooperate with the Police Department to the end that all begging cripples shall be referred to an agency that will study each case, give them vocational training and place them in a position where they can earn a living. Unless there be some central organization to perform this function, it cannot be ex- pected that the Police Department will at all times exert the effort necessary to direct these begging cripples to the proper agency and to see that they are kept from the streets. The Census Bureau connected with the Department of Edu- cation would seem to be the appropriate agency for collecting in- formation with regard to cripples. The Bureau cannot perform this service, however, without additional funds, and such funds are not likely to be provided unless the City authorities can be convinced that such work is necessary and advisable. Unless there be some body of citizens that can demonstrate the necessity for and will urge needful appropriations, this work will not be initiated and carried on. It has been suggested that these problems, which do not fall within the province of any particular association, hospital or clinic, might be handled by a conference or a federation composed of representatives of associations, hospitals and clinics, such con- ference or association to meet from time to time, but not to have an office or staff. It is difficult to see how the functions enumer- 24 ARGUMENTS IN SUPPORT OF RECOMMENDATIONS ated above could be performed by a conference without an office or staff. The representatives of associations, hospitals and clinics would undoubtedly be officers whose time is almost wholly occu- pied by their duties in connection with their organizations. They could not be expected to render much service outside of their official duties. The functions referred to cannot be performed without constant attention and oversight, and such service would be inadequately performed except through a paid staff devoting its entire time and attention to its affairs. There may be a fear on the part of some that a central organi- zation might interfere to some extent with the operation of a hospital or clinic. This probably is true to a certain extent, but it is highly improbable that any restraining influence would be exercised except to refuse to send patients to clinics that were not giving reasonably satisfactory service. If there should be any indication of prejudice or preference on the part of the staff of such a central organization, the managing board undoubtedly could, with little difficulty, rectify matters. It might be argued that the problem of the cripple is not so great as the problem of tuberculosis, or of venereal diseases, or maternity care, or home nursing, for all of which funds are solic- ited ; and that none of these functions is as adequately supported as it should be, and in view of that fact, this inadequate support should not be divided by stressing an appeal for cripples. There is some foundation for such an argument, and no one is wise enough to state at any particular time what proportion of public funds or private contributions should be devoted to various activities. This much may be said, however, in support of the claim that the cripple problem should be more adequately han- dled : it is a compassable problem and is not hidden and subtle in its forms, as is tuberculosis, and is not nearly so prevalent. It can always be recognized and its causes are quite as subject to control as are the causes of tuberculosis; and though the various causes producing cripples do not so frequently, or in so large a proportion, cause death as does tuberculosis, nevertheless, they produce distress and dependency, and a mental anguish that lasts for a lifetime. Moreover, it is comparatively a newly recognized problem, and one that is especially appealing to the public, and funds could probably be secured for a more efficient 25 SURVEY OF CRIPPLES IN NEW YORK CITY handling from sources which do not so readily give to other health and social activities. The problem of cripples seems one worthy of effort, and being a comparatively simple and small problem, sufficient effort adequately to handle it. The central organization recommended could be operated with a budget of $10,000 to $15,000. It would seem advisable to have a controlling board composed of representative men and women not necessarily officially connected with agencies dealing with cripples, but with an interest and sympathy in the problem. The Hospital Sunday Fund and the King Edward Hospital Fund, both of London, have successfully operated for many years with boards whose members are not connected with hospitals. There are distinct advantages in this arrangement, inasmuch as such a board represents the contributing public and the public needing hospital care. Such a board, sympathetic with the problem, with broad vision, and without prejudice, can be trusted to deal fairly with all hospitals and clinics. There are several ways in which such a board could be created and perpetuated. The following methods are suggested for con- sideration : 1. That the existing Committee on Survey appoint such a board, with power to create and define a membership, which would annually thereafter elect members to fill vacancies. 2. That such a board be elected by representatives from asso- ciations, hospitals and clinics. It would be necessary to establish a basis for representation, and such a basis is suggested below: Each of the following to be entitled to send two delegates to a meeting at which board members would be elected : (a) Hospitals having 25 or more orthopedic beds ; (b) Clinics not associated with hospitals having the above- mentioned number of beds, but having a registration of 100 or more active orthopedic cases; (c) Associations or organizations dealing with cripples, having an annual budget of $5000 or more. 3. The board to be created, and subsequent vacancies filled, by the following organizations, each of which does not directly deal with cripples, but is fundamentally interested in the cripple problem : 26 ARGUMENTS IN SUPPORT OF RECOMMENDATIONS Manhattan Brooklyn Charity Organization Society Brooklyn Bureau of Charities Assn. for Improving the Condition Assn. for Improving the Condition of the Poor of the Poor St. Vincent de Paul Society St. Vincent de Paul Society Children's Aid Society Brooklyn Children's Aid Society Federation of Jewish Charities Federation of Jewish Charities At Large Public Education Society of the City of New York Academy of Medicine The Board of Managers, when created to appoint two Councils, one composed of officials or executives of associations, hospitals and clinics dealing with cripples, and the other composed of orthopedic surgeons. The Federation of Associations for Cripples could well be used as a basis for the Council to be composed of representatives of associations. The Board also to create an Executive Committee composed partly from its own membership and partly from the membership of each of the Councils. Manhattan, Bronx and Richmond It is recommended that the Association for the Aid of Crippled Children undertake in Manhattan, Bronx and Richmond, certain functions hereinbefore listed . This is a well-organized association , founded in 1899. It has an office force consisting of a secretary and two clerks, and a field force of twelve nurses. At the present time this association, through its nurses, looks up all cripple cases referred to it by other associations or individuals, and sees that such cases receive medical or surgical care ; also that they receive education through the public schools or otherwise. It recom- mends cases for transportation to the After-Care Committee, and furnishes milk for cripple cases at six public schools. They follow up children having left or finished the public school classes, and where possible secure technical training for them, or see that they are placed in some occupation. This is the only association in the district doing this class of work on a large scale. It seems appropriate that it should not only continue to do this work, but should be sufficiently staffed thoroughly to cover the entire district of Manhattan, Bronx and 27 SURVEY OF CRIPPLES IN NEW YORK CITY Richmond. In addition to the work it is now carrying on, it is recommended that it undertake home treatment through ortho- pedic nurses and masseurs. It is further recommended that it extend its work to adult cripples, so that it will be the only associa- tion performing the functions described for all classes of cripples, of whatever age. If it undertakes this work, it would employ the necessary number of orthopedic nurses and masseurs and under- take the home treatment in connection with all cripple cases need- ing such treatment, subject to the direction, as to the nature of the treatment, of the surgeon in charge of each case. It would recommend also, to the central organization having in charge transportation, the period at which each case would be returned to its respective clinic. Thus, being in touch with all field work in connection with cripples, except home employment, it would recommend to the central organization when additional facilities seem to be needed. The central organization then would make a study to determine where such facilities should be provided. It would keep all detailed records with regard to cripples, and transmit to the central organization the name and identifying information with regard to each case. It would utilize all existing facilities for education public and private schools for children, and the Institute for Crippled and Disabled Men for adults. It would report to the central organization lack of educational and transportation facilities. It would then be the function of the central organization to endeavor to induce the city to meet the needs. To carry out the program of work assigned to this Association, if all cripple cases are cared for, would require i8 nurses to cover the territory not now covered, and 15 orthopedic nurses and masseurs in case home treatment is undertaken. In addition, one supervisor would be needed. At the present time it would be wise to employ all the social service nurses needed, and but a portion of the orthopedic nurses to initiate the work. As the number of orthopedic nurses is increased, the number of social service nurses could be somewhat decreased, owing to the fact that the orthopedic nurses would incidentally do some social service work. It is recommended that the Federation of Associations for Cripples and the Institute for Crippled and Disabled Men arrive 28 ARGUMENTS IN SUPPORT OF RECOMMENDATIONS at some basis of cooperation. At the present time the chief work carried on by the Federation is home employment, where it carries work of various descriptions to the homes of cripples. This work is carried to about 200 homes. The work is well done, but owing to limited finances, the Federation can do but a small portion of the work of that character needing to be done. The Institute in the main performs two functions: first, the training of crippled men in vocations, and second, the placing of such and others that apply, in positions. Both of these functions are well performed. They do not, however, work with women cripples, nor does any existing association. It seems highly desirable that this Associa- tion become the one recognized employment agency for all cripples, male and female, and that it be recognized as the one well-equipped place in which all may receive training for a voca- tion. The Association for the Aid of Crippled Children would refer all cases needing employment or home work to these joint Associations. All hospitals and clinics having crippled cases which have not fallen under the care of the Association for the Aid of Crippled Children would likewise refer their cases for training and placement. The New York City Homes (alms- houses) would also refer a portion of their applicants for admis- sion to these Associations, in the hope that they could be placed in some selected employment, and thereby maintain themselves and not become public charges. For some time it has been apparent to the Institute for Crippled and Disabled Men that dormitory facilities are needed in com- bination with the vocational shop, for cripples who are conva- lescing, for such as cannot use transportation lines, and for those who come from outside New York City. The demand upon the Institute is such as clearly to indicate that there is need for such dormitory facilities. In addition, the Institute needs clinical facilities to pass judgment upon men who apply to the Institute for training, as to their physical condition and limitations. Not infrequently a crippled man who comes to the Institute needs to continue his attendance upon a clinic. It would seem to be desirable if a hospital and clinic, such as the Clinic for Functional Re-Education of Disabled Soldiers, Sailors and Civilians, could combine its facilities with a vocational shop such as that operated by the Institute for Crippled and Disabled Men. Could this be 29 SURVEY OF CRIPPLES IN NEW YORK CITY done, crippled men coming to the hospital and clinic could begin pre-vocational work as soon as they were able to move about, and much before they were in condition to be discharged from the hospital and clinic. On the other hand, the Institute would find clinical facilities at hand in the same building. Such a combined institution would make it possible for all of the hospitals of New York City to transfer amputation and ununited fracture cases to this combined hospital and vocational shop for their period of convalescence and subsequent training. No general hospital has in beds at any one time a sufficient number of such cases to warrant the organization of a staff for occupational, pre-voca- tional and vocational work with these cases. If, however, all such cases, soon after operation, were transferred to a specialized hos- pital as indicated above, it would make a large group, and each would be receiving the care and training advisable and necessary. It would seem highly desirable that consideration be given to the possibility of creating an institution of the character indicated. Brooklyn and Queens It is recommended that the Committee on Crippled Children of the Brooklyn Bureau of Charities act as agent for and perform the work of the central organization for Brooklyn and Queens, and also assume the same functions assigned in Manhattan, Bronx and Richmond to the Federation of Associations for Crip- ples and the Institute for Crippled and Disabled Men. This Committee of the Brooklyn Bureau of Charities is the most appropriate body to carry out these functions, inasmuch as it is now doing all that is being done along these lines in Brooklyn. The functions of carrying work to the homes of cripples and the placing of cripples in employment are not being performed in Brooklyn. These functions would be new to this Committee, but they are functions which have been neglected owing to a lack of finances rather than to any lack of appreciation of their need. The budget necessary to carry on this expanded work probably could be best estimated by assuming that it would approximate the proposed budgets of the Federation of Associations for Crip- ples and the Institute for Crippled and Disabled Men. It is recommended that the Visiting Nurse Association carry on for Brooklyn and Queens the work assigned to the Association for 30 ARGUMENTS IN SUPPORT OF RECOMMENDATIONS the Aid of Crippled Children in Manhattan, Bronx and Rich- mond. The Visiting Nurse Association is at the present time carrying on a portion of the functions listed. It has been looking after cripples in the same manner as the Manhattan Association, and in addition has been carrying on home treatment, a new function recommended for the Manhattan Association. Its work, how- ever, has been quite limited owing to a lack of finances, and to do the work recommended would require a budget equal to the pro- posed budget of the Association for the Aid of Crippled Children. General Statement There are a number of minor associations, described in the body of the Report, doing a variety of and excellent work for cripples. The work on the part of these smaller organizations need not be discontinued or lessened, but it seems highly desirable that they should clear, through one of the associations heretofore recom- mended, so that the work done for cripples will not overlap, and also that there shall be no portion of the field uncovered. This can be assured if each association in the city dealing with cripples will seek a cooperative understanding with one of the associations recommended, viz., the central organization, and, in Manhattan, the Association for the Aid of Crippled Children and the Institute for Crippled and Disabled Men, and in Brooklyn the Committee on Crippled Children of the Brooklyn Bureau of Charities and the Visiting Nurse Association. These five organizations then would not only perform the work assigned to them, but would also attempt to secure the cooperative agreement indicated above. 31 FIELD CANVASS THE scope of the investigation as recommended to and adopted by the Survey Committee was as follows: I. All institutions, departments and associations caring for cripples, to be examined, to determine (a) Adequacy of physical plant and equipment. (b) Number of cases handled. (c) Follow-up method. {d) Records. (e) Character of work. (/) Staff. (g) Transportation facilities. (h) How far dependent on: i. Public funds. 2. Voluntary contributions. (i) Custodial care. 2. A house-to-house canvass to be made of typical districts, to determine (a) Number of cripples. (b) Cause and degree of crippled condition. (c) To WHAT EXTENT REMEDIAL. (d) Educational facilities available, and to what EXTENT used. (e) Occupation if at work. (/) Financial status of cripples. (g) To what extent preventable. 3. All literature throwing light upon the problem in hand to be examined and reported upon. 4. The findings to be summarized in recommendations covering at least the following points: (a) Staff, records, system and transportation used by each institution, department and association as indicated by the data gathered. (b) When certain functions are not now, or seem not likely to be , well performed , recommendations for a system which is designed to supplement and correct the shortcomings. In preparation for the survey of New York City all available literature dealing with the number and classification of cripples 32 FIELD CANVASS was examined. Two noteworthy surveys have been made, namely, in the city of Birmingham, England, during the year 1910 (in- corporated in a report of 52 pages divided into two reports of 38 and 14 pages respectively) ; and a survey of cripples was made in Cleveland, Ohio, from October, 1915, to October, I9i6,the find- ings of which are incorporated in a report of 227 pages, published in 1916. In formulating the program for the Birmingham survey the following definition of "cripple" was adopted: "A person whose (muscular) movements are so far restricted by accident or disease as to affect his capacity for self support." The Cleveland survey adopted the following definition as its basis for classifica- tion : Persons **who are handicapped because they lack the normal use of skeleton or skeletal muscles." The definition formulated as a basis for the survey in New York City was as follows: "Those handicapped by some limited or distorted use of muscles, joints, or skeletal members." It seemed advisable to the Committee to stress the causes which produce crippled conditions, especially the crippled conditions of children, feeling that if these phases of the crippled problems could be better handled, the effect upon the number of cripples would be much greater than an attempt to correct crippled con- ditions already produced or to vocationally train cripples. Ac- cordingly stress was laid on accurate classifications on the basis of the causes which produced the crippled condition. This in- volved accurate diagnoses. It seems advisable to arrive at an estimate of the number of cripples of various classifications in New York City, and to ac- complish this purpose thoroughly to canvass house by house in typical districts. Accordingly six districts were selected, having a combined population of about 1 10,000. These districts were as follows: three in Manhattan; one on the East Side embraced within Stanton, Ludlow, Delancey, and Chrystie Streets; one in Greenwich Village bounded by Broome, Thompson, Bleeker, Hancock, Congress, King, MacDougal, Spring, and Sullivan Streets; one in Harlem bounded by 130th to 135th and from 8th Ave. to Lenox Ave. One district in the Bronx bounded by St. Paul's Place, Crotona Park So., Clinton Ave., Boston Road, 1 68th St., Fulton Ave., 167th St., Webster Ave. Two districts in Brooklyn included the Red Hook District bounded by Degraw, 3 33 SURVEY OF CRIPPLES IN NEW YORK CITY Henry, Carroll, Hamilton, and East River; also a section in Williamsburg included between McKibben, Graham Ave., Ten Eyck, and Bushwick Ave. The districts selected were typical as to housing, density of population, and standards of living. Greenwich Village district consists of old-law tenements occupied by a population almost completely Italian. Delancey Street comprises older tenements occupied by both Jewish and Italian families. Harlem district contains old and new law tenements of the better class occupied by colored and American families. Bronx district, larger in ex- tent, contains tenements and apartment houses, which are occu- pied largely by American born families of various nationalities; in many of these houses children are not permitted. Williams- burg comprises old and new law tenements and one-family houses occupied by Germans of American birth, Jewish and Italian families. The Red Hook District is a typical water-front section, consisting of old private houses which have been altered into tenements, without janitors, and occupied by Italian families. Experimenting was done to determine the most effective method of discovering cripples in their homes. A limited area in these districts was canvassed family by family, then inquiry was made of janitors or housekeepers as to their knowledge of cripples in the same families that had been canvassed. It was found that on the whole, fuller information was secured through janitors and housekeepers than when the individual families were visited. The family often refused or neglected to give information with regard to a crippled member, whereas the janitors and housekeepers readily gave such information. The method finally adopted was a combination of the two. Where intelligent, alert janitors or housekeepers were found, their word was taken with regard to the location of cripples in the building; where none such were found, each family was canvassed. The canvasser attempted to locate the cripples, and recorded full information only in connection with cases of amputation, where the crippled condition could not be a matter of doubt. All other cases were reported to the Survey office and were subse- quently visited by an inspector who secured full information with regard to the cripple. This information was recorded on the fol- lowing card : 34 CO 2^ Q 2: ^ MS 06 WW wo w< o 00 O w w > > PQ Oi CU (X, I I I w w 13 w Pi w w < < Q Q O ^w> W J 5w Sw So !< IS 35 Q W a u < o C o < J J ^ S < >-* Q ^ > m^ J p w :J S Pi < J o < o g ph u ;^ si w O (A w ma d mm Q ^^ ^ ID O J Pi z < o fe f^ ^ ^ y> a o tD o Q hJ ^ Ci -. H ^ -J w Q w o P cu 5 2 p=^ o cu < ^ J a p K ^ w w Q i Www W p> tH J w ^ w o ^ w ^ *^ > n Z Z J-! < w > o ? ^ 2 ^< < f^ d S fc w S ^ ? H CM <: Si: z > fii 1^ < w H < *0 r^ 00 Ov Q W H O w J w CO >" u m Z Q J w o s J Pi < w z z o 8 5 t/) o 36 FIELD CANVASS The diagnoses of cases which had been in attendance at a clinic were accepted from the cHnic if obtainable. All cases where the diagnoses could not be secured through a recognized clinic were diagnosed by sending a competent orthopedic surgeon to their own homes. By this method it is probable that the diagnoses and the classifications of cripples incorporated in the report are rea- sonably accurate. The following instructions were issued to each canvasser lo- cating cripples : Instructions for Canvassers for the New York Survey of Cripples General Instructions It shall be the duty of the Canvasser to locate the cripples in the blocks or districts selected by the Committee. She shall obtain the following data : Name, sex, age, color, civil condition, name of family with whom the cripple lives on the date of the visit, the street address, and name of Borough. She shall set down the name of the hospital or clinic at which the cripple has been registered. If the person is crippled by the amputation of a member only, the canvasser will proceed to secure all the information required to complete the schedule card provided. A card shall be made for each cripple found, and the cards made out each day shall be filed at the office on the morning of the fol- lowing day. A count should be made of the number of families covered each day, and filed together with the cards for that day. How TO Proceed I. State briefly, to the person who answers your knock, that you are taking a census of persons injured by accident or dis- ease. 'Tn discussing the work of this committee in the field you will make use of the term 'cripple' as little as possible. Instead of inquiring whether there is a cripple in the household you will use another form of inquiry. Likewise when making inquiries of the janitor or another you will ask whether there is anyone in 37 SURVEY OF CRIPPLES IN NEW YORK CITY the building who has anything the matter with their arms, legs, or back which affects their walk or the use of their arms or legs." 2. After stating the purpose of your visit, state that the pur- pose is to find out who and where the handicapped persons are, in order that they may receive medical attention if necessary, or to secure for them training that will fit them for a suitable occu- pation. 3. Make sure that the family understands you are not giving financial assistance. 4. State that no names will be used, and all information will be held confidential. 5. Do not secure information from a child. 6. Do not use a child as interpreter unless no adult is available. Be sure that the child understands your questions. Usually a neighbor will interpret. 7. If there be doubt as to whether or not a person should be considered a cripple, take the usual information, and make a note regarding the case. If the person is of extremely low grade mentally, make a note to that effect. 8. Should any person interviewed refuse information, make a note of the address. 9. Become familiar with the charitable or social agencies of the district in which you work, in order to direct to the proper agency those who ask you forj help on their family problems. Consult these agencies as to their knowledge of cripples in the district. 10. Tell the family in which you have located a cripple that another person will call to get more detailed information. The cards from the canvassers were mailed each night to the office, where they were numbered and given to an experienced investigator, whose duty it was to visit the home of the cripple and to fill out the entire schedule. This method saved consider- able time, as the investigator was not required to make visits except to certain specified addresses. In checking the nature of condition she consulted the records of any clinic in which the patient had been treated, or the records of any association for cripples to which the cripple was known. Later, when these 38 FIELD CANVASS sources of information had been exhausted, the Committee en- gaged Dr. Herbert C. Fett, attending surgeon at the Throop Avenue Children's Orthopedic Hospital, and assistant at the Polhemus CHnic, to make examinations of the cripples in their own homes with regard to whom no clinical diagnosis had been secured. No census figures, except those of the 1910 census, are avail- able, therefore the canvassers were instructed to set down on their daily reports the total number of persons covered and also the total number of families. According to this estimate the total number of persons covered in the canvass was 106,092; the total number of cripples found after all doubtful cases were elimi- nated was 727, this gives the ratio, by rate per thousand, of 6.9. The rate per thousand in the Cleveland survey, which was a house to house enumeration of the whole city, was 6.2. In the Massachusetts State census of 1905, which included lame, maimed, and deformed, the rate per thousand was 5.7. The Birmingham, England, survey of 1910 in which the particulars were obtained by circularizing the clergy, the surgeons, the orthopedic hospitals, the C.O.S., the City Aid Society, the Guardi- ans, the Police Society, and the Women's Settlement, showed the ratio to be 2 per thousand. In applying this ratio to estimate the total number of cripples in the city, the Committee deducted from the population, according to the census of 1910, in Man- hattan all of the district north of 63d St. and west of 8th Ave. the total population thus deducted was 446,004; in Brooklyn, the population of the well-to-do classes was likewise deducted to the number of 165,344; ^^ the Bronx 10 percent of the total population was deducted ; in Queens and Richmond 20 per cent of the total population was deducted. The arithmetical rate of increase as used by the Department of Health of the City of New York was applied to the remaining territory, and the cripples estimated as shown by the following table : 39 SURVEY OF CRIPPLES IN NEW YORK CITY NUMBER OF CRIPPLES IN NEW YORK CITY Calculated from Estimated Population for iq2o, Excluding Residence Districts of the Well-to-do Classes Popula- tion 1910 Per cent deducted Popula- tion deducted 1910 cen- sus of remainder 1920 es- timate of remainder Estimate of cripples Manhattan . Bronx Brooklyn . . . Queens Richmond . 2,341,699 435.843 1,644,218 286,806 86,369 19.04 10 10.06 20 20 446,004 43.584 165,344 57.361 17,274 1,895.695 392,259 1,478,874 229,445 69,095 2,279,627 602,310 1,905,007 335.605 84,447 15.729 4,156 13,144 2,316 583 Total for the City . . 4.794.935 729.567 4,065,368 5,206,996 35,928* * These figures were compiled before the U. S. Census report for 1920 was issued. It was issued previous to the printing of the report and indicates that the estimates for Manhattan and Brooklyn were somewhat in error. The total for the city, however, is sufficiently near the estimate to render it inad- visable to modify the ratio of cripples to the total population. The number of cripples found in the selected districts canvassed was 727; of these 515 cases were in Manhattan and the Bronx, and 212 in Brooklyn. Since the Committee decided to stress the causes which pro- duced the crippled conditions, especially the crippled conditions of children, the schedule cards representing the cases were studied as to places where treated. The following tabulation shows places where treated of the Manhattan cases. It will be noted in this table that 252 cases or 49 per cent of the total number were not receiving treatment, and of this number somewhat over one- half were under the age of 16 years. A similar tabulation was made of the 212 cases found in Brook- lyn districts as follows. It will be noted in this table that 98 cases or 46 per cent of the total number were not being treated. In Brooklyn as in Manhattan over half of the cases not being treated were children. 40 FIELD CANVASS CASES IN MANHATTAN DISTRICT Distributed as to age and place where treated 515 cases Private Doctor '. , Ruptured and Crippled N. Y. Orthopedic Mt. Sinai Post Graduate Neurological , Broad Street Hospital Gouveneur Hospital City Hospital East Side Free School Stuyvesant Polyclinic N. Y. Hospital Deformities and Joint Diseases Metropolitan Port Jefferson Bellevue St. Mary's St. Vincent's Brooklyn White Plains Staten Island Harlem Fordham Army Hospital - Flower Hospital 5th Ave. Milk Station Lincoln Hospital Jewish Hospital Blackwell's Island Presbyterian Lebanon 59th St. Hospital Montefiore Vanderbilt St. Francis Sub-total Not treated: Amputation Rachitis Traumatic Pyogenic Tuberculous Polio Arthritis Congenital Syphilis Other Conditions Unknown Sub-total Cured: Amputation Traumatic Congenital Sub-total Total 41 Under 15 20 18 23 2 6 4 II I 4 7 4 2 4 I 2 I I 4 3 I 2 129 87 3 2 17 2 16 6 4 137 275 16-45 Over 45 39 I I 30 I 3 7 2 6 12 2 65 23 I 24 128 30 46 21 2 2 I 9 _3_ 15 I 50 16 112 SURVEY OF CRIPPLES IN NEW YORK CITY CASES IN BROOKLYN DISTRICTS Distributed as to age and place where treated 212 cases Private Doctors R. and C N. Y. Orthopedic Bellevue Brooklyn White Plains Army Hospital Blackwell's Island St. Catherine's Throop Ave Sea View Kings Co Greenpoint Hospital L. I. College Hospital Visiting Nurse Assn. (Bk.) Sub-total Not treated: Rachitis Traumatic Pyogenic Tuberculous Poliomyelitis Congenital Other Conditions Unknown Syphilis Sub-total Cured: Amputation Traumatic Sub-total Total Under 15 I 10 I I 18 I 30 I I 13 10 3 50 58 III 16-45 20 I 30 14 2 26 ^ 16 72 Over 45 7 29 These figures may be compared with the results of the survey made in 1913 and 1914 in the Yorkville district and the Cherry Hill district of Manhattan by the Association for the Aid of Crippled Children. In Yorkville 32.7 per cent of the total number of cases found had not received previous treatment, while in the Cherry Hill section 82.4 per cent of the children found were not being treated. The low percentage of untreated children in the 42 FIELD CANVASS Yorkville district might be attributed to the work of the four orthopedic chnics adjacent to this section. 1 1 8 CRIPPLES NOT PREVIOUSLY DL\(3N0SED OR TREATED Poor Prognosis V///^ P^ir Prognosis I Sood Protasis PROGNOSIS SHOWN BY DIAONOSIS IN THEIFL OWN HOMES The cases examined in their homes by Dr. Herbert C. Fett were, of course, chiefly cases that had received no previous exam- ination or treatment. The tabulation of these cases as to the diagnoses and prognoses made is as follows : 43 SURVEY OF CRIPPLES IN NEW YORK CITY CASES NOT HERETOFORE DIAGNOSED OR TREATED, SUBSEQUENTLY DIAGNOSED IN THEIR HOMES Distributed as to diagnosis and prognosis Prognoses Poor Fair Good Good with braces and diet Good with operation Total Poliomyelitis . . Rachitis Pott's disease . Tubercular hip Hemiplegia . . . Meningitis .... Arthritis Congenital Traumatic .... Scoliosis No deformity . ID I 5 I 3 2 I 4 5 4 2 I I 9 2 I I 13 23 I I 17 59 3 I 9 I 5 4 2 4 13 Total 27 12 27 23 29 ii8 CASES NOT TREATED WITHIN SIX MONTHS PREVIOUS TO SURVEY Distributed by Clinical Diagnosis and Prognosis 247 cases Total estimated population, New York Dists., 75,000; Brooklyn Dists., 32,000 Poor Fair Good Total New York Brook- lyn New York Brook- lyn New York Brook- lyn New York Brook- lyn Total Poliomyelitis... Pott's disease . . Tubercular hip . Tb. of other joints Pyogenic Arthritis Congenital Scoliosis Paralysis Traumatic Mental One-year no appliance Amputation . . . 8 I 5 12 10 3 19 16 4 4 I 2 3 I 7 20 3 8 3 I 2 8 I 3 30 5 II 4 2 5 I 18 3 I 3 3 5 I I 2 I I '4 31 4 II 4 6 14 21 4 22 51 4 5 16 I 6 4 I 8 4 I 29 47 5 17 4 10 15 29 8 4 5 Total 78 18 84 42 15 10 177 70 247 Note: Rickets and amputations performed over one year ago and cases over 60 are omitted from this table. Among the New York cases were 37 un- treated cases of rickets with a fair prognosis and 62 with a good prognosis. In Brooklyn were 30 untreated cases, all with good prognoses. 44 FIELD CANVASS The foregoing tables are two of the most significant resulting from the survey. The first shows an analysis of Ii8 cases not heretofore diagnosed or treated; the second, an analysis of 247 cases heretofore diagnosed and treated but not having visited a clinic or hospital within six months previous to the survey. It will be noted in the two tables combined there were of poliomye- litis, Pott's disease, tuberculosis of the joints, 94 cases, which indi- PROGNOSIS OF 247 CRIPPLES NOT TREATED CURING SIX MONTHS PREVIOUS TO SURVEY Tair JPro^nosJs 1 Good "Prognosis cates that in the city as a whole there are 4700 cases of these diseases, of which number somewhat over 1000 have not been diagnosed, and the remainder have been diagnosed but ceased to attend clinics. A closer analysis of the table indicates that of the 118 cases recently diagnosed in their homes, all but 27 showed fair or good 45 SURVEY OF CRIPPLES IN NEW YORK CITY prognoses, while of the 247 that had ceased to attend dinics, less than 100 showed poor prognoses. These figures would indicate that in the entire city there are probably over 3000 cripples whose prognosis is good who either have not been diagnosed or have been diagnosed and have ceased to attend clinics. ALL CASES Distributed as to age and causes Diagnosis 15 and under 16 to 45 Over 45 All ages Per cent Tuberculous 25 3 3 152 105 22 7 47 18 4 6 3 4 I 14 2 88 39 10 28 5 3 4 18 I 5 57 23 I 26 3 34 10 25 153 120 7 167 69 58 72 12 4-7 1.3 3.4 21.0 Pyogenic Arthritis Rachitis Poliomyelitis 16.5 i.o Syphilis Traumatic 23.0 8 Amputation Congenital Other conditions Unknown . . . 9-9 17 Total 336 200 141 727 100,0 The above table, when compared with the results found in the Birmingham, England, and in the Cleveland, Ohio, surveys, shows a lower percentage of tuberculosis cases. This is borne out by the testimony of orthopedic surgeons and by various hospitals in the City of New York, who unite in saying that the number of tuberculosis cases appearing at the clinics is annually decreasing, attributable to preventive and curative measures taken, and the education of the families as to the benefits of treatment in this disease. The highest percentages of poliomyelitis and rachitis show a greater number to be under 15, while of the traumatic or accident cases, the greater number is found above 16 years of age. Congenital conditions, however, were found largely among chil- dren, chiefly because adults apparently do not survive, and this explanation probably can be extended to the other ailments of poliomyelitis and rachitis. 46 FIELD CANVASS Of the 727 cases found, 454 are recorded as having attended a clinic at some time, and of this number 116, or 25%, changed their 727 CASES DISTRIBUTED AS TO NATURE OF CONDITION J^i^tires Indicate Percenis^es clinic one or more times. These 116 cases have been tabulated as to reasons for the change as follows : In the following table, where the patient was transferred by the doctor, the change was made for a special reason, such as removal to such a distance from the clinic that regular treatment could not be had. 47 SURVEY OF CRIPPLES IN NEW YORK CITY CASES CHANGING CLINICS ONE OR MORE TIMES Distributed as to reason for change Changed once Changed twice No reason 2 I 12 30 29 9 4 I I 7 3 Did not want operation Did not like treatment 6 Transferred by doctor 4 4 Advice of friends Advice of private doctor Advice of social worker 2 Advice of teacher Advice of policeman . . To get transportation ... 96 20 Another distribution of all cases was made for various ages and the sexes as follows : ALL CASES Distributed as to percentage age and sex All ages Under 5 Rachitic. . . . Non-rachitic Rachitic . . . . Non-rachitic 10-15 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Over 60 Unknown Male Female To No. Per cent No. Per cent No. 407 100 320 100 727 661 29/ 23.3 50) 24/ 23.1 Ii6\ 53/ 19 1 18] 37] 46 27-5 42 28.8 88 47 J 32 J 79 J 23 1 23 1 46] 17 14 31 28 9 37 22 32.9 14 30.3 36 18 9 27 14 17 31 12 J II J 23 J II ) 13/ 5-9 ::} 6.9 l\] 1} 10.3 'D 10.9 1} Per cent 23.2 28.1 31.8 6.3 10.6 48 FIELD CANVASS It will be noted that a little over one-half of the total are under 15 and that the bulk of the remainder are under 50 years of age. This would indicate that of the 35,928 cripples previously re- ferred to, about 8000 are under five, about 10,000 are between five and fifteen years of age, and the remainder are adolescents or adults. K> 35%- ^ 30%- o 8 25%- 20%- 15 %- C 10%- ft. 5%r 727 CASES DISTRIBUTED AS TO PERCENTAGE OF AGE AND SEX i I AGE UNDER GROUP 5 rf i i ' i m ^ 5-15 15-50 50-60 OVER. 60 MAUfi PEMALfi 49 SURVEY OF CRIPPLES IN NEW YORK CITY An analysis of the large number of cripples among children is shown in the following tabulation giving age of onset for the principal causes of disability : ALL CASES Distributed as to age of onset for principal causes of disability Causes of Disability All Tubercu- lous No. 34 Per cent 100 Infantile Paralysis No. 120 Per cent lOO Traumatic No. 167 Per cent 100 Other Conditions No. 406 Per cent 100 Totals No. 727 Per cent 100 Birth-4. 5-9--- 10-14. 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60 and over, Not stated . . 88.2 11.8 98-3 17 23 1 \\\ 16 13 14 10 6 9 5 9 16 12 27.5 47-3 8.4 9.6 7.2 238 14 10 12 12 15 15 10 6 10 8 16 22 18 64.6 19.7 5-9 5-4 4.4 374 53 29 25 29 28 29 21 13 20 13 25 38 30 62.7 22.7 5-2 5.2 4.2 50 FIELD CANVASS ALL CASES DISTRIBUTED AS TO AGE OF ONSET FOR PRINCIPAL CAUSES OF DISABILIX^ 400 350 ABOVE IS yAJ?S FR(M BIRTH 7X) /4 YEARS 300 250- It, O EGO 150 too 50 3 120 JSZ TUBEPCULOUS INFANTILE TRAUMATIC OTHER PARALYSIS CONDITIONS 51 SURVEY OF CRIPPLES IN NEW YORK CITY 456 CASES DISTRIBUTED AS TO AGE OF ONSET FOR PRINCIPAL CAUSES OF DISABILITY Z60 240- 2Z0- 200- 160 ^o 120 100 I 5; 80 eo m^ 46 262 mzL TUBERCULOUS INFANTILE TRAUMATIC OTHER PARALYSIS CONDITICNS JProm Birth to J'our Years ofA^e ' Pive-tvNine - - - Ten -to Fourteen It will be noted that tuberculosis and poliomyelitis occurred in nearly all of the cases before the age of sixteen, while in the traumatic cases only about one-fourth of the total number occur before the age of sixteen. 52 FIELD CANVASS ALL CASES Distributed as to education, age and sex Ages 6-16 17 and over Male Female Male Female No. Per cent No. Per cent No. Per cent No. Per cent No education Common School Com. Sch. (Sp. Class) . . High School 7 70 15 I 8 I 6.9 68.7 14.7 .9 7-9 9 8 54 19 2 2 8 I 8.5 57.5 20.2 2.1 2.1 8.5 I.I 32 146 4 8 I I 16.7 76.1 2.1 4.1 5 .5 28 99 I 4 I 6 20.2 71.2 .7 2.9 .7 Special Sch. for Cripples Home teaching: Public Private. . . Not stated 4.3 Total 102 lOO.O 94 lOO.O 192 1 00.0 139 lOO.O All ages No education Common School . . . Com. Sch. (Special) High School Special Sch. for Cripples. . Home teaching; Public Private Not stated Total Male No. 39 216 15 5 8 9 I I 294 Per cent 13.3 73.5 5.1 1.7 2.7 31 .3 .3 lOO.O Female No. 36 153 20 6 3 8 233 Per cent 154 65.7 8.6 2.6 1-3 3.4 3.0 lOO.O Totals No. 75 369 35 II II 17 527 Per cent 14.2 70.0 6.7 2.1 2.1 31 .2 1-5 lOO.O Comparing the cases under sixteen years with those over it will be noted that the special education for adults was not apparent, but 53 SURVEY OF CRIPPLES IN NEW YORK CITY that among children 90 per cent of the males and 85 per cent of the females of the families receive either common school, special school education, or instruction in the schools for cripples. It will be noted that very few attend high school and special schools. ALL CASES DISTRIBUTED AS TO EDUCATION The study of all crippled children from 5 to 15 years of age, classified as to school attendance, is shown below: ALL CRIPPLED CHILDREN FROM FIVE TO FIFTEEN YEARS OF AGE Classified by age and school attendance Crippled children from five to fifteen years Age at time of survey Total School attendance Public school Regular classes Public school Special c asses Special schools for cripples Not attending All ages 204 127 24 10 43 '5-6 23 28 20 22 20 15 16 19 22 19 7 13 16 17 12 II II II 16 13 2 I 4 2 2 5 5 3 I 2 2 I I I 2 16 6-7 12 7-8 I 8-0 3 Q 10 3 10 II I II-I2 2 12-13 1-1-14 I I I4.-I; 3 54 FIELD CANVASS It will be noted that 21 per cent of these children were not attending school. This percentage apparently would be higher if the district on the East Side, which is very close to the Crippled Children's East Side Free School, had been excluded. In this district but one child was found who was not attending any public institution. PERCENTAGE OF CRIPPLES (5-15YEARS)ATTENDING SCHOOL Considerable difficulty was encountered in comparing economic conditions before and after disability. Later conditions, due to the war, have so affected the wages that in some cases a man who was formerly a skilled mechanic is now earning more money in a manual unskilled task than he formerly earned in his trade. The degree of support, however, is shown in the following table: ALL CASES OVER Distributed as to [5 YEARS OF AGE degree of support ' Total Per cent Male Per cent Female Per cent Dependent Partially self-sup- p)orting 96 45 200 28 13 59 43 27 127 22 14 64 53 18 73 37 12 Self-supporting .... 51 341 100 197 100 144 100 55 SURVEY OF CRIPPLES IN NEW YORK CITY It will be noted of the 341 cases over 15 years of age only 59 per cent were entirely self-supporting, while 28 per cent were wholly dependent. DEPENDENCY AMONG CRIPPLES OVER 15 YEARS OF AGE Wholly Dependent Partial Jy SelT- Supporting Entirely SeiT- Supporting 341 CASES The degree of self-support as shown by this survey is slightly higher than that found in Cleveland, as is shown in the table of comparatives : COMPARATIVE PERCENTAGES OF DEGREE OF SUPPORT Total Males Females New York Cleve- land New York Cleve- land New York Cleve- land Dependent Partially self-sup- porting Per cent 100 28 13 59 Per cent 100 44 3 53 Per cent 100 22 14 64 Per cent 100 40 2 58 Per cent 100 37 12 51 Per cent 100 50 4 Self-supporting .... 46 56 FIELD CANVASS It will be noted that the New York survey shows a higher percentage of both males and females to be self-supporting while those wholly dependent are less in New York than in Cleveland. This disparity may be due to a difference in judgment as to the classification of a cripple as dependent or partially self-supporting since Cleveland shows a lower percentage to be partially able to support themselves. It will be of interest to compare the percentages of the many causes of disability found in the City of New York with those of Cleveland, Ohio, and Birmingham, England: COMPARATIVE PERCENTAGES OF MAIN CAUSES OF DISABILITY City of New York Cleveland, 0. Birmingham, Eng. Under i6 Over 16 Under 16 Over 16 Under 16 Over 16 All causes 100 6.4 .8 .8 39-3 27.3 5.9 1.8 I2.I I.O 4.7 100 2.4 2.1 6.5 .3 4.4 2.1 42.5 18.2 3-2 2.3 15-8 100 15 41 9 16 3 16 100 44 52.4 4.7 38.5 100 39-5 I.I .3 12.2 24-3 3.5 17.9 1.2 100 Tuberculosis Pyogenic .... 24.9 7.0 3.5 1.8 Arthritic .... Rachitis . Poliomyelitis Syphilis .... 10.9 5-0 16.2 4.0 19.7 7.0 Traumatic Amputation Congenital Unclassified Other conditions.. . It will be noted that Cleveland showed 41 per cent of cases under 16 years of age to have been due to poliomyelitis, whereas in New York the percentage was but 27.3. The higher percentage in Cleveland is due to the fact that the New York survey included rachitis in the table, in order to get a comparison with Birming- ham, England, which was not included in the Cleveland table. If this disease be excluded from the table and the percentages re- figured. New York would show 44 per cent of poliomyelitis. It will be noted, also, that Cleveland shows 15 per cent of tuberculosis, whereas New York shows but 6.4 per cent. If the New York table be refigured with rachitis omitted, the tuber- culosis percentage would be 10.7 per cent, still materially lower than that in Cleveland. The Birmingham percentage for tuber- 57 SURVEY OF CRIPPLES IN NEW YORK CITY culosis is 39.5, over six times the ratio found in New York, whereas for those over 16 years of age, Birmingham's percentage was 24.9 as compared with 2.6 per cent in New York City, which shows a still greater difference. Birmingham showed 12.2 per cent of rachitis as against 39.3 per cent in New York. It is difficult to say whether conditions are worse in New York than in Birmingham, or whether the dis- parity in percentage is due rather to the method of securing data in Birmingham, a method which would be much less likely to discover rachitis than the method used in New York. This latter explanation will probably account for the lower percentage in Birmingham. Agencies Interested in the Care of Cripples In order to learn what social agencies had been interested in the cases discovered, inquiry books were secured from the Social Service Exchange of New York and the Confidential Social Ser- vice Exchange of Brooklyn. Inquiries were sent to these exchanges for all cases discovered in the field. The results of these inquiries showed that 515 cases in the Manhattan and the Bronx were found registered or unregistered as follows: cases in MANHATTAN AND BRONX Distributed as to agencies with which registered Registered with Number United Hebrew Charities 24 Crippled Children's East Side Free School 11 Fed. of Ass'ns for Cripples 21 Red Cross Home Service 24 Jewish Big Brothers 2 Dept. Public Charities 8 Dept. of Health, Corlears 2 N. Y. Post Graduate 4 A. I. C. P 20 Assn. for Aid of Crippled Children 75 Red Cross Institute 2 Probation Dept., Children's Court 4 Jewish Big Sisters 3 Skin and Cancer Hospital i Randall's Island 2 University Settlement i Henry St. Settlement i N. Y. Dispensary 7 Italian Hospital i Beth Israel Hospital i N. Y. Eye and Ear Infirmary i C. O. S 22 58 FIELD CANVASS Registered with Number Richmond Hill Home 1 1 Washington Clinic, Dept. of Health 6 Maternity Center Ass'n 5 Children's Aid Society 4 Spring St. Neighborhood House 3 N. Y. Orthopedic S. S 3 Infants' Milk Sta 2 Salvation Army 4 Fordham Hosp N. Y. Child Labor Commission N. Y. Diet Kitchen Ass'n Spring St. Church R. &C. S. S Clearing House for Mentally Defective Manhattan Trade School Judson Memorial Church Metropolitan Hospital Dept. of Education, Bureau of Attendance Bellevue S. S Assn. of Catholic Charities Protestant Big Sisters Vanderbilt Clinic Bureau of Domestic Relations 3 Board of Child Welfare , 5 Public Education Ass'n 2 St. Phillip's Church i Save a Home Fund, Evening Mail 2 Vocational Guidance Bureau, P. S. No. 119 2 Diet Kitchen, Tuck's Branch i Tuberculous Hosp. Adm. Bureau i Harlem Hosp. Tub. Clinic i Women's Hosp. S. S I Lenox Hill Hosp. S. S i N. Y. Milk Committee 2 Jefferson Clinic i Lebanon Hosp. S. S 2 Dept. of Health, Tremont Clinic 3 Division of Midwives and Foundlings i City Hospital i Montefiore Home S. S i Widows and Mothers Fund 2 Not registered 326 It will be noted that the highest number known to any agency were registered with the Association for the Aid of Crippled Children. The agencies which had the next highest number were the United Hebrew Charities and the Red Cross Home Service, also the Federation of Associations for Cripples. In- quiries were made of the other agencies where each case was registered ; it developed the fact that in most cases the agencies were not interested in the cripples found by the survey, but in some other member of the family. It will be especially noted that 326 cases were not registered with any agency. Of the 212 cases in Brooklyn referred to the Confidential Social 59 SURVEY OF CRIPPLES IN NEW YORK CITY Service Exchange the following were found to be registered or unregistered : CASES IN BROOKLYN Distributed as to agencies they are registered with Number United Jewish Aid Society 5 Baby Health Sta i Department of Health i N. Y. American Baby Hospital i District Nursing Com., General Dept 13 District Nursing Com., Orth. Dept 20 B. of C. Committee on Crippled Children 13 S. P. C. C 3 American Red Cross i Dept. of Public Charities. i State Industrial Commission 3 Kings County Hosp. S. S 2 Civilian Relief 3 Manhattan Trade School i R. & C. Dental Clinic i Brooklyn Hospital S. S i Little Italy House i L. I. College Clinic i Red Hook Health Centre i Unregistered 150 Of the foregoing cases, 150 were not registered with any agency. Out of the 727 cases found, 476 were not registered with any agency. T^ROPORTION OP 727 CASES NOT KNOWN TO ANY AGENCY MANHATTAN AN'D BRONX SROOKLVN ] Csses Registered Ca^es Not Re^sterecf 60 T EDUCATION FOR CRIPPLES Public Schools HE Department of Education in the City of New York maintains 89 special classes in 36 public schools of four boroughs : Borough Public schools Classes Manhattan 16 46 Bronx 4 II Brooklyn 14 30 Queens 2 2 Information as to pronounced cripples is secured by the Bureau of Census, Department of Education. Each attendance officer is required to cover his district annually. On the cards used is a blank space in which is to be entered any defect discovered by a physician. If such appears on the card, it is sent to Miss A. J. Smith at the office of the Department of Education. Informa- tion as to children under five is likewise taken, but is incomplete and not tabulated, due to the lack of staff. The special classes are under the direction of Miss Carolina G. Ronzone,who is respon- sible to Dr. Andrew W. Edson. Admission to such classes, also the transportation, is arranged by Miss Smith, who, under the supervision of Dr. Aldinger, is in charge of the Physical Training of handicapped children. Wherever possible, Miss Smith ar- ranges three groups: Tuberculosis bone and joint cases, non- tuberculosis cases, and mental defectives, planning the work so as to meet the needs of each child so far as possible. The industrial training in these classes is given by the teachers assigned the classes for cripples, under the supervision of Miss Carolina G. Ronzone, who gives them special training in prin- ciples in the pre-vocational work taught in these classes. Miss Ronzone is acquainted with the fundamentals of all the industries which she has charge of in the pre-vocational work and aims to stress the fundamentals rather than having the boys and girls make finished products in class. Fifteen hundred and forty-five children are registered in the cripple classes. Of these 416, or 27 61 SURVEY OF CRIPPLES IN NEW YORK CITY per cent, are tuberculous, 66i , or 43 per cent, are post-polio, 29, or 2 per cent, are cardiac cases, and the remainder are miscellaneous cripples. None are admitted to these classes who would be unable to get about in a crowd of normal children. Transportation is furnished all children who attend classes for cripples. Children who are totally disabled and therefore shut-ins may receive home teaching. This feature of the teaching service, however, has not as yet been developed satisfactorily to the department, owing to a lack of funds. At present about 200 children are taught in their own homes while 100 others are on a waiting list with no teachers available. The latter children are receiving no education. Class Rooms The class rooms for cripples are not equally suitable for the work to be carried on since some are in old buildings and others in new. Of the 24 classes visited, one-half were on the ground floor and the others were one flight up. With the exception of one room all of the class rooms were fairly well lighted, but in few cases were the windows so arranged as to give cross ventilation. In II of the 24 visited the attendance exceeded the seating capacity of the rooms. Special equipment is furnished for 20 children per class, but in some rooms the excess needing such equipment reaches as high as ten, and plain wooden chairs were used to meet the deficiency of special furniture. In some of the schools visited classes were maintained for tuberculous cases, but no open air classes were held for these cases. Nursing Service In schools located in districts where the Association for the Aid of Crippled Children has nurses the children of the classes for cripples are given the benefit of this service ; in others the Depart- ment of Health nurses visit to some extent. Lunches The Philanthropic League furnishes school lunches for six cripple classes in P.S. No. 27 in Manhattan and furnishes milk in P.S. No. 32 and No. 10 in the Bronx. The Association for the Aid of Crippled Children furnishes milk for P.S. Nos. 6, 30, 44, 69, and 32A, and in cooperation with the foregoing League in P.S. No. 70. 62 EDUCATION FOR CRIPPLES Curriculum There is considerable retardation due to irregularity of attend- ance. As the teachers are required to keep the children up to the standards, this makes it very difficult. The amount of pre-voca- tional work is not as great as it should be. Some teachers claim that the children are mentally alert and normal, others say that they are feeble-minded and subnormal. These opinions are, of course, not based on diagnosis, but doubtless have considerable effect upon the attitude of the teachers toward the pupils. In the classes visited, the pre-vocational work for girls was found to be well developed, but for boys it was sometimes entirely lacking. In class rooms for tuberculous cases, the children are provided with cots and folding chairs. After lunch each child lies down for one hour covered with warm blankets. During this time all windows are kept open. In addition, at other times the teacher assigns five minute rest periods at her own discretion. CHILDREN ATTENDING PUBLIC SCHOOL CLASSES FOR CRIPPLES Distributed as to age and nature of condition Nature of condition Under 7 7-12 12-16 16 and over Age unknown No. Total per cent Tuberculous Poliomyelitis. . . . Traumatic Amputation Congenital Paralysis Hip-joint disease . Rachitis Heart disease Other diseases . . . Unclassified 24 14 5 I 5 I I 5 12 170 259 4 10 14 25 9 II 5 19 42 152 313 12 II 21 22 8 23 22 58 50 43 I 3 4 20 4 I I 18 30 'I 2 2 I 8 17 416 661 24 % 81 37 25 29 66 135 26.9 42.8 1.6 1.6 3.0 5.2 2.4 1.6 1.9 n Total 68 44 568 36.8 675 43.7 150 9-7 84 5-4 1545 Per cent lOO.O Compiled from the record cards on file at the Bureau of Physical Educa- tion at the Department of Education. 63 survey of cripples in new york city Private Schools East Side Free School The Crippled Children's East Side Free School, 157 Henry St., should be regarded as a private school, although the staff, con- sisting of principal and 7 teachers, is provided by the Board of Education. Two vocational teachers, one for industrial art and one for cooking, are provided by the institution. Two nurses, four maids, a cook, and a handy-man are also employed by the institution. The building has four floors, basement, and enclosed roof. In addition to the class rooms there are a dispensary, re- ception room, and also work rooms. The capacity of the institu- tion is 200. All of the day pupils are transported by five buses, three belonging to the Board of Education, and two to the insti- tution. The teachers generally are of a high type and the work in the class rooms compares favorably with that of neighboring public schools. Industrial work includes cooking, fancy flower making, novelty and favor making, plain and fancy sewing. All of this work is graded in easy stages from the kindergarten up. The work room is conducted for girls who have graduated from the eighth grade. The present enrollment consists of 25, five of whom are working at home on the piece work basis, and of the remaining 20, five are receiving eight dollars a week, five from fifteen to eighteen dollars, and six receive twelve dollars a week. The work consists of fine lingerie made to order. The work is now self-supporting. Rhinelander School The Rhinelander School for Cripples, 350 East 28th St., is a day school maintained by the Children's Aid Society. The school occupies an old type school building, with light and airy class rooms. The nurse looks after the physical care of the children and in cooperation with the nurses of the Association for the Aid of Crippled Children does the follow-up work in their homes. The tuberculosis bone and joint cases are segregated in an open air class room and the children of this class are supplied with special outdoor clothing. These children receive three meals a day in the school, and the other pupils are given a hot luncheon. The teachers are not licensed from the Department of Educa- 64 EDUCATION FOR CRIPPLES tion. Grade work is carried on up to 6B. The academic work is carried on in the morning. Luncheon is served at 12, and at 12 130 such children as need treatment are taken to the New York Orthopaedic. In the afternoon the children are trained in pre- vocational work: drawing, woodwork, knitting, and sewing. During the summer the children are given a vacation at the summer home of the association at Bath Beach. William H. Davis Memorial School The William H. Davis Memorial Free School for Cripples, 471 West 57th St., accepts crippled children of poor parents be- tween the ages of five and fourteen. The capacity of the school is 50. Three academic teachers, not licensed by the Board of Education, give academic instruction. Dressmaking, fine sewing, wood carving, brass work, tool leather work, and cobbling are also taught. The class rooms are poorly ventilated and unattrac- tively furnished, the desks and seats being of the non-adjustable type. As soon as the children are fourteen years of age they discontinue school attendance and obtain working papers. All children, with the consent of their parents, leave on June ist for the summer home the Lulu Thorley Lyons Home at Claver- neck, N. Y., and remain until October ist. During that time they have one hour a day school work and continue their manual training. Education in Hospitals and Homes Education in custodial institutions and hospitals has been dis- cussed in connection with those institutions. Upon the whole the instruction in vocational and pre-vocational subjects is deficient. Institute for Crippled and Disabled Men The Institute for Crippled and Disabled Men, loi East 23rd Street, is the only organization devoting itself to the vocational training of handicapped men. It was organized by the American Red Cross during the war, and continued under its supervision until December, 19 19, when it was reorganized under its present name, with a separate charter. Mr. Douglas C. McMurtrie was responsible for its initiation and general activity. Dr. J. C. Faries is now Director. 5 65 SURVEY OF CRIPPLES IN NEW YORK CITY The Institute has two primary functions, first, to train all crippled men applying for training for a vocation; second, to place in positions crippled men who apply for employment, in- cluding such men as it trains in its shops. To carry out this work it has two bureaus, one for the education of men and the other for placement. It also has a third bureau for field work, which keeps in touch with hospitals and directs men to the Institute, and also keeps in touch with the men as they work in the Institute, to see that they attend clinics for advice, and that their families are cared for, if need be. The In- stitute also cooperates with the Federation of Associations for Cripples, whose office is in the same building, in its work of carry- ing employment to the homes of cripples. In this connection, the truck operated by the Institute is used to carry materials to the residences of cripples doing home work. When a person applies to the Institute for vocational training, he is examined by Dr. Faries for the purpose of determining his aptitude and taste for class instruction. The Director then per- sonally advises him as to the vocation or vocations for which he would best be suited considering his handicap. In the educational department instruction is given in the manufacture of artificial limbs, oxy-acetylene welding, printing, typewriter repairing, enameling, nickel plating, moving picture projecting, and jewelry making. In this educational department about three hundred men have been enrolled since the beginning of the work, and of these, i lo have been placed in the vocation for which they were trained in the shop. The employment bureau of the Institute is at the service of any crippled man needing employment. The bureau gets in touch with employers, to learn where crippled men can best be used, and then attempts to fit the man to the place, and after he has been placed, to keep in touch with him to see that his placement is the proper adjustment for him. During 191 9 there were 828 requests from employers for employees, and there were 3627 visits of applicants to the office seeking employment. Of these, 2342 were referred to positions. The number actually placed was 896. The Institute is doing excellent work, but its work could be 66 EDUCATION FOR CRIPPLES several times enlarged if all the institutions and associations and City departments dealing with cripples would cooperate with the Institute in referring men to it for training and placement. The Institute does not train or place women, nor is this work done elsewhere except in a limited degree through one or two other associations that are operated primarily as aids to patients leaving hospitals. Such work is very much needed. Some work is done in connection with the Department of Edu- cation in the placing of crippled pupils leaving the schools. The Institute occupies a very important place, and should become so thoroughly known and recognized that through its ministrations no cripple need beg or be partially or wholly de- pendent because untrained for a vocation. 67 SOCIAL AGENCIES New York Committee on After Care of Infantile Paralysis Cases THE New York Committee on After Care of Infantile Paralysis Cases was organized on the request of Dr. Haven Emerson, Commissioner of Health, who was charged with the care of several thousand children suffering from the epidemic of poliomyelitis in the fall of 191 6. This Committee consisted of representatives from various associations, who elected a Board of Trustees to take charge of funds which were turned over to it by Commissioner Emerson. Dr. Thomas J. Riley was elected Chairman of the Committee and has remained such since its or- ganization. At the close of the epidemic the After Care Commit- tee had assumed charge of 6575 children who had been afflicted during and survived the epidemic. It was apparent at once that these children needed clinical treatment, and a large proportion of them needed transportation from their homes to clinics. Accord- ingly, one of the first and most pressing problems of the Committee was to provide transportation. This was secured partly through the City of New York, partly through other agencies, and partly by the operation of buses directly by the Committee. The Committee kept complete record of each child at its office : by whom treated; prognosis; progress, and followed the child to see that treatment was continued. In addition, the Committee purchased through clinics many braces and appliances where parents were not able to defray the expense of such devices. The results of the care of children afflicted with infantile paral- ysis during that epidemic have been very gratifying. Almost no deformities due to neglect have resulted among the thousands of children afflicted. Toward these good results the After Care Committee has contributed a large share. The After Care Committee, operating buses, has been con- stantly appealed to to carry children who have been paralyzed by other epidemics than that of 1916, or handicapped by other 68 SOCIAL AGENCIES diseases, such as spastic paralysis, birth paralysis, spinal menin- gitis, arthritis, osteomyelitis, rachitis, or by accident. It has found it necessary from time to time to yield to these appeals, and to transport cases other than those for which the Committee was originally created. These appeals to the Committee for trans- portation have made very clear the constant and pressing need for aid to various classes of cripples. The Committee, in addition to its transportation work and the demand for braces and appliances, has contributed funds for the employment of orthopedic nurses. During the year 1919, through its funds, 74,069 home visits were made by orthopedic nurses. The total cost of appliances, home visitation, supervision and transportation during the year was $53,116.63. One of the things impressed upon the staff of the After Care Committee is the fact that not infrequently parents will grow discouraged be- cause the treatment in a particular clinic does not show favorable results more rapidly, and will cease to take the child to the clinic, and in the meantime, move their residence, so that without some central record and follow-up system, the child would cease to have any medical treatment and care. With the follow-up system of the After Care Committee, however, such discouragement or occasional neglect on the part of parents seldom results in injury to the child. The need for the After Care was clearly demonstrated by the results of its work during and subsequent to the epidemic of 1916. The demands made on it by children crippled at other times than in 191 6 and by other diseases than infantile paralysis, make it apparent that some central organization is needful to keep track of the children of moving parents, and to supervise transportation and perform certain other functions not readily performed by an association which has not city-wide interests. Association for the Aid of Crippled Children 1 HE Association for the Aid of Crippled Children was organized to provide systematic home nursing care for children of all ages, physically or mentally handicapped. Their field is divided into twelve districts, to each of which is assigned a field nurse whose duty it is to look after the welfare of over two hundred cripples 69 SURVEY OF CRIPPLES IN NEW YORK CITY each. Four of these districts are in the Bronx and eight are in Manhattan. Every nurse, except those in the Bronx, who are under a Deputy-Supervisor, is at the main office of the Associa- tion once a week in conference with the supervisor or members of the executive committee. The Association receives cases under sixteen years of age from the various welfare agencies who do not deal directly with cripples, and also by house-to-house surveys by which they aim to secure information as to all cripples. All kinds of social work are performed with the exception of mate- rial relief, although there is an emergency fund which may be drawn upon for this purpose. Braces and special shoes are pro- vided and kept in repair when the parents are unable to pay. The Association has arranged for nurses to visit milk stations at which on stated days they see cases in need of orthopedic care, also regul ar visitation is made upon the schools for cripples in the Department of Education and in fact all follow-up work and most of the vocational activities in this school are done by the nurses from the Association for the Aid of Crippled Children. From January 22nd to June 5th, 191 9, the Association fur- nished 5105 quarts of milk to these crippled classes at a total cost of $716.22, of which they had reimbursement of $217.29. This milk was distributed to the following public schools : P.S. Nos. 6, 30, 70, 44, 69 and 32A. Christmas boxes and candy are also distributed by the Association in these schools. The work of this Association shows a continuous increase in the number of crippled children under its care. The work done is constructive, although the important aim, whether it be physical, economic, or educational, is a work that requires long-continued and untiring effort. The Association has no nurses in the following districts : that part of Manhattan south of 59th St., east of West Broadway and Sixth Avenue, that part north of 59th St. and west of Fifth Ave- nue; that part of the Bronx north of the south line of Crotona Park. Mrs. Edgar S. Auchincloss is President of the Association; T. S. McLane, Treasurer; Miss M. L. Barker, Secretary; Mrs. Henry B. Barnes, Chairman of the Executive Committee; Miss Genevive Wilson, Secretary of the Executive Committee, and also supervisor of the nurses. 70 SOCIAL AGENCIES Brooklyn Bureau of Charities Committee on Crippled Children Previous to May, 191 9, the Committee on Crippled Children had assisted the orthopedic clinic in Long Island College Hos- pital and in the Brooklyn Hospital. This included the provision of nurses, the conduct of the after-care, and social service work, also the transportation of all cases not included in the city trans- portation service. In addition to this the committee provided transportation for all other cases which for various reasons had not been included in the city service, but were attending other clinics, such as the clinic of the 'Jewish Hospital, the Throop Avenue Dispensary, and some under the care of the Visiting Nurse Association. In May, 1919, due to the policy of the Brooklyn Bureau of Charities that such work, having been initiated by the Bureau, should be carried on independently by other agencies, the various hospitals and dispensaries undertook the continuation of the work under their own administration. Since 1910, the orthopedic work in Long Island College Hos- pital and in Brooklyn Hospital has been in part maintained by the income from the Fox Fund, which was given to the Associa- tion for Improving the Condition of the Poor and to the Brooklyn Bureau of Charities for work among cripples. In the main, the funds in the charge of the A. I. C. P. are given to the Long Island College Hospital. The Brooklyn Bureau of Charities contributes chiefly to the work in the Brooklyn Hospital. The Visiting Nurse Association, which was part of the Com- mittee on Crippled Children previous to last May, continues social service and home treatment work for the orthopedic de- partment of the Long Island College Hospital and home treat- ment work for the Brooklyn Hospital. At present the Committee on Crippled Children acts as a Federation on work for cripples. Most clinics and associations in Brooklyn are represented. The Committee on Crippled Children has had an active part in handling the transportation of cripples in Brooklyn for some years, and since 191 6 has been responsible for the arrangement of 71 SURVEY OF CRIPPLES IN NEW YORK CITY all transportation to clinics. Furthermore, it has assumed charge of all social service work for cripples except that of the medical social service which is performed by the Visiting Nurse Associa- tion. It arranges for admission to classes for cripples, and where no employment work has been undertaken it has offered some vocational training. The Visiting Nurse Association of Brooklyn The Visiting Nurse Association of Brooklyn, located at 80 Schermerhorn St., Brooklyn, was incorporated as an independent organization on May 14th, 1919. Previous to that time, since 1901, it has been a department of the Brooklyn Bureau of Chari- ties, known as the District Nursing Association. By representa- tion on the Committee on Crippled Children it continues to main- tain a connection with that Society. On the staff of the Visiting Nurse Association are an average of fifty graduate nurses, including the superintendent. Miss Eliza- beth Stringer, an assistant superintendent, a general field super- visor, and a registrar. Each of the ten districts is under the direc- tion of a supervisor. The orthopedic department, which is the part of the organiza- tion of special interest in a study of the care of cripples, is under the direction of Miss Katherine Edwards, assisted by ten other graduate nurses. The work of the orthopedic department includes social service and home treatments. The relation of the Association to the clinics varies. In the Long Island College Hospital the Association provides a nurse six days a week in the Orthopedic Clinic, ostensibly for the purpose of being on hand to secure the physician's advice in regard to home treatment of individual cases, but practically the Visiting Nurse actually takes the place of a clinic nurse for infantile paralysis cases. She prepares the child for treatment, takes the physicians' dictation, and is present throughout the entire examination and treatment. The social service work includes such service for the orthopedic department of the Long Island College Hospital. This includes follow-up and after-care work, but is distinctly medical social service. No relief is given and cases requiring family rehabilita- 72 SOCIAL AGENCIES tion and adjustment are referred to the Brooklyn Bureau of Char- ities. The home treatment work includes massage, muscle training, corrective work and other treatment on the advice of the physi- cian. Cases receiving this treatment are brought to the clinic on an average of every two months for re-examination. The major- ity of cases in this group are poliomyelitis cases. Of the 375 under care at the present time, 278 are patients of the Long Island Col- lege Hospital and 87 of the Brooklyn Hospital. The following report for the month of October, 1919, indicates the present scope of the Orthopedic Department : No. of cases under care Oct. ist 979 Aided during current month, new 15, old 4 19 Total number under care 998 No. terminated during month 8 Home treatments 1.451 No. social service visits 534 No. visits to social agencies 14 Total treatments and visits If99i Individual children receiving home treatment 316 No. patients under care Nov. ist 990 Fees from patients $216.33 No financial report for the orthopedic department for the past fiscal year is available as the work was financed entirely by the Brooklyn Bureau of Charities. The cost per visit based on total operating expenses has been computed at $0.60. This charge is made per treatment when the family is in position to pay. Otherwise the rate is graduated from nothing up to $0.50 according to the family's ability to pay. No charges are made for any visits in which treatments are not given. Employment Bureaus for Cripples 1 HERE are oin New York City four agencies that may be said to specialize in employment for cripples : (i) The Employment Bureau of the Institute for Crippled and Disabled Men; (2) The Employment Bureau for the Handi- capped of the Hospital Social Service Association; (3) The Supervisor of Home Work of the Federation of Associations for Cripples; (4) The Industrial Classes for Cripples in the Depart- ment of Education directed by Miss Ronzone. 73 SURVEY OF CRIPPLES IN NEW YORK CITY I. The Employment Bureau of the Institute for Crippled AND Disabled Men The above Bureau, under the supervision of Miss Gertrude R. Stein, occupies a large room on the second floor of the Institute. This Bureau handles men only. It is the outgrowth of the Bureau for Cripples which was established in 191 6 in cooperation with the Hudson Guild. Applicants for work are referred to the Employ- ment Bureau through newspaper publicity, through employment bureaus, charitable societies and hospitals, and others come through cripples who have themselves been placed. The work of this Bureau is curtailed somewhat by the hard and fast rule that none but orthopedic cases are registered. A very intelligent effort is made to study the capability of the applicant and his adaptability temperamentally and otherwise to the kind of work at which he may be able to succeed. Health considerations are likewise given due weight, and considerable effort has been made to educate employers who are now pre- judiced against cripples. The kind of positions secured and the handicapped conditions are shown in a comparative statement of the weekly reports of the Institute for Crippled and Disabled Men, the Handicapped Department of the Hospital Social Service Association of New York and the Association for the Crippled and Disabled in Cleveland, which will be placed at the end of this section of the report. 2. Employment Bureau for the Handicapped 405 Lexington Avenue The Hospital Social Service Association established in 1912 operates a special Department, known as the Employment Bu- reau for the Handicapped, which undertakes the placement of both men and women in industries. It includes surgical, medical, nervous and mental cases which are referred to it by the Social Service departments of various hospitals having membership in the Social Service Association. About 20 per cent of the appli- cants come within the scope of this survey, indicating that its service to the disabled is somewhat similar to that which is fur- nished by the Employment Bureau of the Institute for Disabled Men. While no complete statement concerning the whole num- 74 SOCIAL AGENCIES ber of applicants and placements for the last year is available, the following statement with regard to cardiac cases is interesting : CARDIACS FROM JUNE QTH TO FEBRUARY 29TH, I920 Applicants 305 Placed 161 Still in position 117 Lost track of by hospital, moved, etc 30 Died 6 Too feeble to work 16 There is no doubt that the Bureau takes a large place in solving the problem of the handicapped in the City of New York. The work of the Bureau is in charge of Mrs. John S. Sheppard, Chairman, Mrs. William Woodward, Secretary, and Mrs. Ida M. Duggan, Director. Due to the fact that this Bureau accepts ap- plicants handicapped in every way, the field of its efforts is con- siderably broadened. 3. Home Work of the Federation of Associations for Cripples Miss McCleery of the Federation of Associations for Cripples obtains home employment for males and females of all ages. This requires considerable field work, as nothing can be sent to homes which have not been previously inspected. In fact the Associa- tion certifies to the Bureau of Licenses as to the cleanliness of the home before licenses are issued. The character of the home work obtained has been addressing envelopes, fringe knotting and other fringe work, painting toys, painting ribbons, glove finishing and the manufacture of neckwear. There are now 198 cripples re- ceiving work through this source. 4. Placement Work for Crippled Children in the Public Schools Miss Carolina G. Ronzone, Director of the Industrial Work in the Department of Education, places children from these classes in various industries with which she has established relations. Having planned her course of study to train the children in the lower grades to use their fingers and tools correctly, to understand the manipulating of materials, to measure properly, she gets in touch with employers and satisfies them that these handicapped 75 SURVEY OF CRIPPLES IN NEW YORK CITY children are fitted to meet the demands of their establishments. The children who have been placed by Miss Ronzone in the flower-making industry, are working on the finer grades of flowers and earning good salaries In Cleveland, Ohio, the Association for Crippled and Disabled operates an Employment Bureau for the Handicapped. This Bureau has its desk in the office of the State Employment Bureau, and in addition to cases referred to it direct, receives applicants who have applied to the State Employment Bureau. No such cooperative arrangement has been made with other employment bureaus by the special employment bureaus in New York. A comparison of the weekly reports of the three Bureaus mentioned above who place applicants in various industries is shown below : COMPARATIVE TABLE OF APPLICATIONS AND PLACEMENTS IN ONE WEEK BY HANDICAP BUREAUS OF HOSPITAL SOCIAL SERVICE ASSOCIATION, INSTITUTE FOR CRIPPLED AND DISABLED MEN, AND CLEVELAND ASSOCIATION FOR CRIPPLED AND DISABLED Applicants New. . . Old ... . Placed . . Hospital Social Service Association 73 34 39 33 Institute for Crippled and Disabled men 87 19 68 26 Cleveland Association 26 14 12 13 The Bureau for the Handicapped in Cleveland accepts all kinds of cases, including heart, old age and tubercular disabilities, and the success of the work performed by the Employment Bureau for the Handicapped of the Association for Crippled and Disabled would indicate that a similar plan might be followed in employ- ment bureaus in the City of New York. There is no bureau in Brooklyn with the same functions as the bureaus making placements in the City of New York, although the hospitals of Brooklyn stand in need of services similar to those of the City of New York. 76 HOSPITAL AND CLINIC CARE THE Survey made examination of all hospitals in and about New York City providing orthopedic beds, primarily for the purpose of determining their capacity and the degree to which the capacity is at present used. The number of beds found is shown in a separate table on page 87. It will be noted that there are in specialized orthopedic hospitals in and adjacent to New York City 928 beds. Of this number, 673 are in Man- hattan, and but 55 are in Brooklyn; in addition 50 beds are available for Brooklyn at Port Jefferson, Long Island. Of the total orthopedic beds in specialized and general hospitals there are or shortly will be 1278. These are all operative beds. In addition to the active operative beds, there are 375 beds available for convalescent patients, making a total of 1651 beds available for cripples undergoing treatment. Manhattan and the Bronx New York Orthopaedic Hospital 1 HE New York Orthopaedic Hospital occupies a modern six- story and basement fire-proof building constructed about 191 5. The first floor is used for administrative offices, out-patient de- partment, and gymnasium. The second floor is used to house the female hospital helpers, and the third floor is the nurses' quar- ters. The ward units and other hospital facilities occupy the three upper floors of the hospital. There are ten beds for male adults, ten beds for female adults, twenty beds for boys from five to six- teen, twenty beds for girls from five to sixteen, and thirty- two beds for children under five, making a total of ninety-two. This hospital is very generally and favorably thought of by the parents of the children found in the districts canvassed. Many cases are referred there by the friends of the patients, and there is usually a long waiting list at this hospital for that reason. 77 SURVEY OF CRIPPLES IN NEW YORK CITY The chief-surgeon is Dr. Russell Hibbs, and the superintendent is Miss Theodora S. Root. School instruction, pre-vocational training, and nursery ac- commodations are provided for the children. The Visiting Nurses* Department employs twelve nurses for follow-up work on patients of the hospital and dispensary, and to visit the homes of cases discharged from the Country Branch at White Plains. The Hospital for the Relief of the Ruptured and Crippled The Hospital for the Relief of the Ruptured and Crippled is a five-story and basement fire-proof building at 321 East 42nd Street. The first floor is devoted to the administrative offices and the dispensary. The second floor is given entirely to living quar- ters of the superintendent, staff, graduate nurses, and female help. The third, fourth and fifth floors are devoted to the ward units, operating rooms, school rooms, patients' dining room, and recreation rooms. It provides forty beds for female adults, nine- teen beds for male adults, eighty-one beds for female children, and eighty-one beds for male children, making a total of two hundred and twenty-one. This hospital is very well and favorably known to the parents, and cripples found in the districts surveyed have gone to the hospital upon the advice of neighbors and friends. This hospital has a very strong medical staff. Dr. Virgil P. Gibney is chief surgeon, and Mr. Joseph D. Flick is superin- tendent. School instruction, pre-vocational training and nursery accom- modations are provided for the children. It has no branch for convalescents, but the social service de- partment renders valuable service in finding places for conval- escent patients. Dispensary and Hospital for Deformities and Joint Diseases The Hospital for the Deformities and Joint Diseases, 1924 Madison Avenue, corner of 123rd St., has a total capacity of 102 beds; children 41, female adults 21, male adults 22, private rooms 18. This hospital has almost as great a reputation among the people who came within the scope of this survey as the two hos- 78 HOSPITAL AND CLINIC CARE pitals mentioned previously. The hospital has plans under way to build a new plant with 360 beds which will make it one of the largest orthopedic hospitals in the world. The beds will be dis- tributed as follows: children under 10, 120; children from 10 to 13, 40; male adults, 40; female adults, 60; private rooms, 100. The physician and surgeon-in-chief is Dr. Henry W. Frauen- thal. Mr. Charles Diehl is superintendent of the hospital. School instruction, pre- vocational training, and nursery ac- commodations are provided for the children. Mt. Sinai Hospital Mt. Sinai Hospital, at looth St. and Fifth Ave., is a 500 bed general hospital. Dr. S. S. Goldwater is superintendent. It maintains no beds for orthopedic cases, but plans, however, for the enlargement of the hospital so as to provide 20 beds for these cases. Lenox Hill Hospital Lenox Hill Hospital, located at 112 East 77th Street, is a gen- eral hospital of 519 beds. This hospital does not set aside any beds for orthopedic service, but Dr. Charles Hope Jaeger is per- mitted one bed for operative treatment. Louis Kortum is super- intendent of the hospital. New York Hospital New York Hospital, located at 8 West i6th St., is a general hospital of 270 beds. This hospital does not set aside any ortho- pedic wards, but allows orthopedic cases to be cared for in its surgical ward. Dr. Thomas Howell is the superintendent of the hospital. St. Luke's Hospital St. Luke's Hospital, located at Broadway and 114th St., is a general hospital of 400 beds. Reverend George F. Clover is superintendent of the hospital. St. Luke's Hospital maintains two wards for orthopedic cases : one for nine girls under the age of twelve, and one for nine boys under the age of twelve. Two beds are provided for adults. Dr. T. Halstead Myers is the chief attending orthopedic surgeon. No educational activities are 79 SURVEY OF CRIPPLES IN NEW YORK CITY provided in the orthopedic service, as the Board of Education is unwilling to provide bedside instruction. A social service worker follows up all cases discharged from the hospital. New York Post Graduate Medical School and Hospital New York Post Graduate Hospital, at 303 East 20th Street, is a general hospital of 405 beds. It has a ward of 28 beds for ortho- pedic cases. Dr. Fred H. Albee is the chief surgeon of this ser- vice. Mr. Alexander H. Candlish is the superintendent of the hospital. Bellevue and Allied Hospitals There are no beds set aside for the care of orthopedic cases in Bellevue or its Allied hospitals. Orthopedic services are main- tained at Bellevue, Harlem, and at Fordham Hospitals, and pro- vision is made for the treatment of such cases in the wards of these hospitals. In 191 7 orthopedic cases were treated in these three hospitals as follows : Bellevue Harlem Fordham Pott's Disease ... 52 34 22 600 131 215 8 I 76 27 38 I Rickets 4 4 57 IQ Arthritis Pyogenic Congenital Other conditions 26 1054 150 III In Bellevue the chief of the orthopedic service is Dr. Reginald H. Sayre; in Harlem the service is in charge of Dr. Henry Scott; in Fordham, Dr. S. W. Boorstein is the chief surgeon. City and Metropolitan Hospitals The Department of Public Charities provides orthopedic ser- vices for children in both the City and the Metropolitan Hospitals. No orthopedic beds are set aside in the City Hospital, but 20 beds are available for this use. Dr. Fuld is the orthopedic surgeon. 80 HOSPITAL AND CLINIC CARE In the Metropolitan, 40 beds in the children's pavilion are used as an orthopedic ward and are in charge of Dr. Anson H. Bingham. Laura Franklin Free Hospital for Children The Laura Franklin Memorial Children's Hospital has a capacity of 67 free beds which are for the use of acute or chronic curable cases. Considerably more than one-half of its beds are devoted to the care of cripples, in fact, the entire work of the hospital embraces the care of cripples and of nose and throat conditions. This hospital is a philanthropy of the Delano family and is provided with almost sufficient endowment to carry on the work. The balance is obtained from the members of the Delano family. The president is Warren Delano, Jr.; Treasurer, Frederick D. Hitch ; secretary, T. Delano Weeks. The orthopedic surgeon in charge is Dr. Anson H. Bingham, the general surgeon is Dr. George W. Roberts. Frances L. Lurkins is superintendent. Lebanon Hospital Lebanon Hospital, located at Westchester and Caldwell Ave- nues, Bronx, is a general hospital of 196 beds. George E. Halpern is superintendent. Lebanon Hospital does not have any ortho- pedic ward, but admits operative cases to its surgical beds. The orthopedic work is in charge of Dr. S. Kleinberg. Brooklyn and Queens Brooklyn Hospital Brooklyn Hospital, located at Raymond St. and DeKalb Avenue, is a general hospital of 286 beds. This hospital divides its service for cripples between the orthopedic, the pediatric, and surgical. In the orthopedic ward are ten beds, in the pediatric 19, and in the surgical 58. Dr. Walter Truslow is the leading orthopedic surgeon. Dr. W. G. Nealley is superintendent. Long Island College Hospital Long Island College Hospital, located at Henry, Pacific, and Amity Streets, is a general hospital of 614 beds. This hospital provides two hospital wards, with a capacity of 30 beds each, for 6 81 SURVEY OF CRIPPLES IN NEW YORK CITY orthopedic cases. These wards are also used for convalescents. There are two roof pavilions for this work, each pavilion being a complete unit, including kitchen and bath-room, making a total of 90 beds. The roof wards are so arranged that they are either enclosed or entirely open. In addition to the beds in the roof ward 10 beds are provided in the general wards. The head of the orthopedic service is Dr. Jacques C. Rushmore; Dr. Richard E. Shaw is superintendent of the hospital. Throop Avenue Children's Hospital and Dispensary The Throop Avenue Children's Hospital and Dispensary, 470 Throop Avenue, has 18 beds for operative cases. This is not sufficient to take care of the hospital cases from its out-patient department, but Dr. Herbert C. Fett, the chief surgeon, being also connected with the Long Island College Hospital, is able to make use of some of the beds available there. House of St. Giles, the Cripple The House of St. Giles is a new hospital on Brooklyn Avenue and President St., Brooklyn. This hospital has a capacity of 47 beds, part of which may be used for adults. Dr. B. B. Mosher is the chief surgeon. Miss Anne F. Hasbrouck is the superintendent. Kings County Hospital of Brooklyn Kings County Hospital, Clarkson and Albany Avenues, Brook- lyn, is a general hospital of 1209 beds operated by the Depart- ment of Public Charities of the City of New York. Dr. M. B. Jones is the superintendent. Kings County Hospital provides in all fifty-two beds for ortho- pedic cases: fifteen for male adults, fifteen beds for female adults. In the children's pavilion a ward of twenty-two beds is provided for the children's orthopedic service. The orthopedic clinic, held on Friday, is attended by former patients of the hospital. Jewish Hospital of Brooklyn The Jewish Hospital of Brooklyn, located at Classon and St. Mark's Avenues, has a capacity of about 300 beds, and its dis- 82 HOSPITAL AND CLINIC CARE pensary includes an orthopedic clinic. This clinic gives approxi- mately 400 treatments monthly and gives after-care to about 60 cases of infantile paralysis. The follow-up work of this clinic is done by Miss Dichter, the nurse in charge of the orthopedic clinic. We have been unsuccessful in securing information with regard to the work of this clinic. Jamaica Hospital Jamaica Hospital, located on New York Avenue, Jamaica, is a general hospital of 55 beds. None of the beds of this hospital are set aside for orthopedic cases, but Dr. H. C. Courten, surgeon-in-chief of the orthopedic clinic, is allowed sufficient beds to take care of the operative cases from his clinic. Miss Rose Saffeir is superintendent of the hos- pital. Neponsit Beach Hospital for Children The Neponsit Beach Hospital, Mohawk St., Rockaway Beach, contains 125 beds for tuberculous joint cases. The attending surgeon is Dr. Brainerd H. Whitbeck. Miss Josephine T. W. Brass is superintendent. This is a branch of Bellevue and Allied Hospitals. The building with its equipment was constructed by the Asso- ciation for the Improvement of the Condition of the Poor of New York City and was transferred by them to the city department of Bellevue and Allied Hospitals. It is a four-story brick building of the ordinary institutional type, with porches facing the beach at the front of the right and left wings, and enclosed porches of similar construction within the quadrangle formed by the two wings. These enclosed porches are devoted to school use, and to provide open air class rooms for the children. The census on the day of our visit was 100, and Dr. Whitbeck, who is the attending surgeon, stated that recently he had offered the vacancies to pa- tients of several Brooklyn hospitals whom he thought might wish to take advantage of them. The follow-up work of the Bellevue and Allied Hospitals social service departments does not extend to the children of this hospital and the follow-up work of these patients is, therefore, left to the Department of Education, to whom notice is sent of all discharged cases. 83 SURVEY OF CRIPPLES IN NEW YORK CITY Adjacent to New York City New York State Hospital for Crippled and Deformed Children, West Haverstraw, N. Y. Plant The institution occupies a tract of 48^/2 acres. The original building was a private house, and is now used for the staff and the girls. On the first floor is the staff dining room and sitting room, a dining room and sitting room for the girls. On the second floor are the staff rooms, a clothing room, and a sewing room. This building is approached by sloping boardwalks, making an easy access for children with wheel chairs or on crutches. The hospital building is a two-story and attic brick structure. On the first floor is a ward containing 40 beds, a kitchen, and other service rooms. The second floor is similar in plan with the ex- ception that the service rooms above are used for operating, anes- thesia, and X-ray. The boys are housed in the U-shaped frame building. An old barn has been divided into two rooms which are used for class rooms or industrial operations. Admissions Although this is a hospital for curable cases only, it shows a tendency to give part of its beds to cases needing custodial care, since many of the children remain at the institution for four or five years, and the average stay has been computed at one year and nine months. This is in spite of the fact that Dr. John Joseph Nutt, the admitting officer, has restricted the admissions to hos- pital cases, and 475 children have been refused admission, partly on the grounds of ineligibility. Fifteen of the 171 children are from 15 to 18 years of age. Seven discharged patients are on the hospital payroll. Education This phase of the institution's work is not so high a standard as the medical work. Two teachers are supplied, one for aca- demic work and one for vocational work. The staff is not ade- quate for the instruction of 171 children, especially since about one-half of the children require bedside instruction. Until last 84 HOSPITAL AND CLINIC CARE summer a man had charge of carpentry work, but since his death no one has been put in his place. One vocational teacher is trying to make the best of very poor conditions by teaching basketry and stenciling. Typewriting is taught by the secretary of the superintendent in spare time. Four children in the institution are taking music lessons at the expense of their parents. After-Car e About one-half of the discharged have been followed up and of these the information gathered shows that they are employed at the following occupations: in government factories, federal shipyards, manufacturing industries, as stenographers, teleg- raphers, bookkeepers, clerks, cashiers, teachers, journalists, painters, carpenters, farmers, and laborers. Brooklyn Home for the Blind, Crippled, and Defective Children, Port Jefferson, L. I. The Brooklyn Home for Blind, Crippled, and Defective Chil- dren was established thirteen years ago to provide a place for the blind, crippled, and defective children of the Brooklyn Roman Catholic parishes. Plant The institution is divided into two distinct parts, the defective being in a different part of the grounds from the blind and crip- pled, who are located in St. Charles Hospital, which has a capacity of 262 beds. The grounds consist of eleven acres overlooking Long Island Sound. While this institution is equipped with complete facilities for carrying on the work of an active hospital service, it is to a great degree custodial, inasmuch as a large number of its inmates are being given care intended to build them up before receiving treatment, or after-care following an operation. At least twenty-five per cent of the cases are of the after-care type and a considerable percentage are receiving building-up treat- ment preliminary to operation. Admissions There is a waiting list of fifteen to twenty continually at the office of the Roman Catholic Orphan Asylum Society, whose secretary is the admitting officer of this institution. 85 SURVEY OF CRIPPLES IN NEW YORK CITY Administration The head of the institution is Mother Theresa. She and forty- six Sisters do all the work of the institution. Each Sister has been specially trained for her task. Each teacher has been trained in some industrial specialty for which she is responsible in the edu- cational work. Each nursing Sister has been trained in a recog- nized hospital. Education The course of instruction reaches from Kindergarten through High School. The graduating class includes about twenty boys and girls. Advanced : After graduating from the eighth grade two courses are open, the academic and the commercial. Four are following the academic and i6 are enrolled in the commercial. The com- mercial course includes shorthand, French, English, typewriting, telegraphy, and the use of the dictaphone. Special: Music, Art, and fancy work are given important places. Twelve children are being instructed on the piano, 40 receive violin lessons, 6 receive lessons on the 'cello, 6 on the organ, and 7 on the drums. Special aptitude is sought and voca- tional work is taught beside the commercial course. Pre-voca- tional work is taught in plain sewing for the girls. 86 ORTHOPEDIC BEDS IN HOSPITALS OF NEW YORK CITY AND VICINITY Present capacity operative Addition under in- struction operative Convalescent treatment *Hosp. for Ruptured and Crippled .... *New York Orthopaedic 221 92 102 28 35 20 40 538 10 90 8 47 52 207 40 15 50 150 255 1,000 258 20 278 278 134 *Hosp. for Deformities and Joint Dis- eases Post Graduate Laura Franklin Memorial St. Luke's Metropolitan Mt. Sinai Sub-total Brooklyn Brooklyn Hospital L. I. College Hospital *Throop Avenue Hospital .... *House of St. Giles Kings County Hospital Sub-total Queens Neponsit Hospital . . . 80 Richmond Sea View Hospital .... 35 100 24 Vicinity of New York *St. Charles Hosp., Port Jefferson. . . New York State Hosp. for Cripples After-care Home for Cripples Sub-total Total 373 *Strictly orthopedic hospitals. 87 OUT-PATIENT SERVICE BY FAR the greater part of the remedial work done for cripples is done in out-patient departments of hospitals, or in independent out-patient clinics. In the hospitals and clinics, with the exception of those noted below, records were both deficient and defective, and it was with great difficulty that the proper information could be secured as to the histories of the patients. Manhattan New York Orthopedic Dispensary and Hospital This hospital emphasizes out-patient treatment for cripples. The Out-Patient Department occupies the large rotunda which forms the central pavilion of the hospital. The department is open every day except Sundays and holidays, from 1 130 to 3 P. M. All new cases are referred to the Visiting Nurse Department, whose duty it is to assist in the follow-up work to see that the instructions of the doctor are carried out and that the patients appear regularly at the clinic for treatment. The records in this hospital are fully and accurately kept. In the 15 months ending December 31st, 191 8, this out-patient department treated 6176 new cases from the City of New York; 875 of these were flat foot, which were not regarded as cripples coming within the scope of this survey; it also treated 1205 new cases from other cities. Braces and orthopedic shoes are furnished at a reduced price to patients. New York Society for the Relief of the Ruptured and Crippled The Out-Patient Department of the New York Society for the Relief of the Ruptured and Crippled conducts one of the largest out-patient departments in the city. The social service depart- ment comes in close contact with all dispensary cases and is thus enabled to do the necessary work which might otherwise be over- looked. No follow-up system, however, is in use, it being the 88 OUT-PATIENT SERVICE policy of the hospital to leave continued attendance to the initia- tive of the patient. A commendable feature of the social service department is the assistance in sending patients to convalescent homes. The hospital does not operate a separate convalescent home, which is one of its great needs. The project has not been undertaken because the requirements demand an institution of considerable size. In the 12 months ending Sept. 30th, 1919, 9843 new orthopedic cases were treated, 2844 of which were flat foot, which have not been regarded as a crippled condition coming within the scope of this survey. This hospital draws patients from a wide area outside of New York City, as does the New York Orthopaedic Hospital. Braces and appliances are furnished at reduced prices to patients. Dispensary and Hospital for Deformities and Joint Diseases The Out-Patient Department of this hospital is its greatest activity. During the year ending November, 191 8, 10,957 new cases received treatment and 92,875 treatments were given. The plans for a new hospital provide for a dispensary of double the capacity of the present one. The present dispensary is a six-story building fitted with all approved equipment and apparatus for orthopedic treatment. Social service work consists in visiting all cases who have been absent from clinic one month or more, to determine the condition of the patient and advise as to further treatment. Braces and appliances to the value of $265.75 were given to patients during the year ending November, 1919. Dr. Henry W. Frauenthal gives personal attention to the dispensary work on Mondays, Wednesdays, and Fridays, and Dr. Herman Frauenthal is in charge on Tuesdays, Thursdays, and Saturdays. New York Hospital The Out-Patient Department of the New York Hospital con- ducts an orthopedic clinic daily. In this out-patient department about 50 cases of poliomyelitis are receiving continued treatment. The orthopedic w^ork is so closely connected with the other phases of surgical treatment that it is impossible to more than approximate the number of crippled cases handled. The records 7 89 SURVEY OF CRIPPLES IN NEW YORK CITY indicate, however, that about 30 orthopedic cases are treated. The facihties of the hospital are sufficient to give out-patient care to not more than 100 patients, each one of whom would receive three treatments a week. The follow-up work of these cases is done by the social service department in cooperation with the Association for the Aid of Crippled Children, the home visits being made by the Association. Mount Sinai Hospital In order to obtain an accurate knowledge of the work the Mount Sinai Hospital is doing for cripples, it is necessary to make a study of all the departments. Such an examination, covering a period of two weeks in January, produced a list of 56 new cases, the kind most frequently treated in orthopedic departments of hospitals. The total number of treatments given during the year ending December, 1918, was, orthopedic 2997, poliomyelitis 2678. During this period there were 147 1 new cases. There are at present 32 poliomyelitis cases under care. The facilities of this out-patient department would be sufficient to care for approxi- mately 100 patients receiving three treatments a week. The social service work of this clinicis the responsibility of Mrs. Bauer, the orthopedic nurse, who follows up the cases during the hours that she is not engaged in the clinic work. These children are also visited in their homes by the nurses of the Association for the Aid of Crippled Children. The hospital has remitted one-half of the cost of braces whenever necessary, the other half being met by other agencies. St. Luke's Hospital The orthopedic clinic is held in the out-patient department of St. Luke's Hospital between i :30 and 2 130 three days a week. One of these days is devoted exclusively to the treatment of cases of the 1916 epidemic of poliomyelitis. Two masseurs give massage treatment to these cases; one masseur, employed by the hospital, treats the patients of the other two clinics and gives corrective exercises to those needing such treatment. This hospital has no country branch and the social service nurses for the orthopedic cases state that there is great difficulty in securing any summer outings for crippled children. The orthopedic clinic of St. Luke's Hospital has about one hundred cases. 90 out-patient service Bellevue Hospital Bellevue Hospital operates a clinic for poliomyelitis in which are registered 58 cases who attend the clinic twice a week, one group on Tuesdays and Thursdays ; the other group on Mondays and Fridays. On Saturday morning a clinic is held for a group of eleven school children. There is no orthopedic clinic operated by the hospital except this one, but an orthopedic clinic under the direction of Dr. Reginald Say re is conducted by the New York University and Bellevue Hospital Medical College. FoRDHAM Hospital The orthopedic clinic is conducted in the out-patient depart- ment by Dr. Samuel Boorstein. This clinic is held in a large tent which has been in use since the 191 6 epidemic of poliomyelitis. It is fairly satisfactory, being of sufficient size and equipped with steam heat. Although our examination was made on a very cold, windy day, the tent was quite warm. Special mention should be made of the care with which the records of the orthopedic depart- ment are kept. The files are always up to date and at the end of each year the records are tabulated. During the year 19 19, 385 new cases were registered, and 4095 treatments were given. The social service work of the orthopedic cases is left to the social service department of the hospital. The children of the polio clinic are followed up through the Association for the Aid of Crippled Children. The orthopedic clinic of Fordham Hospital has a capacity of about 100 cases. Harlem Hospital The orthopedic clinic of Harlem Hospital is small, due to the fact that there is little after-care given by the orthopedic service to surgical cases. The equipment is somewhat meager. The follow-up work is done on the advice of the physician, and only surgical cases are followed up. The clinic of Harlem Hospital is able to accommodate about 25 cases. Cornell University Clinic The orthopedic clinic of Cornell University Medical College, at 28th St. and First Avenue, is under the charge of Dr. Arthur H. Cilley, the chief surgeon. The average daily attendance is 91 SURVEY OF CRIPPLES IN NEW YORK CITY from 15 to 20 and 19 poliomyelitis cases from the epidemic of 1916 are treated three times a week. The clinic cares for ap- proximately 100 cases. No social service work is done by the clinic. In cases of necessity, home treatments are given by a masseur. Lebanon Hospital The Lebanon Hospital conducts an orthopedic clinic in its out-patient department daily. In addition, a clinic is held for poliomyelitis, which is under separate control. The surgeon-in- chief is Dr. S. Kleinberg. This clinic cares for about 20 polio cases and the orthopedic clinic takes care of a large number of cases of rickets and other deformities. Vanderbilt Clinic Vanderbilt Clinic, 60th St. and Amsterdam Avenue, does not operate a separate orthopedic clinic; however, the orthopedic department of the Neurological Clinic under the charge of Dr. Jaeger cares for 20 cases of 191 6 polio cases. Other orthopedic cases at this clinic would be referred to the New York Hospital. Neurological Institute The Neurological Institute, 149-51 East 67th Street, gives dispensary treatment to a large number of cases that would be included in our definition of cripples. A report for the year ending Nov., 1919, indicates that there were treated 831 cases of bone, joint, and muscle; 37 hemiplegia; and 28 poliomyelitis. In some of these cases the crippling defect is a result of a nerve derangement, although there is no history of other nerve insta- bility. West Side Dispensary The West Side Dispensary and Hospital, 328 West 42nd Street, conducts an orthopedic clinic, in which are treated 12 poliomye- litis cases. The average number of patients in the dispensary per year is about 600. There is no follow-up work for these cases. The total capacity of the orthopedic clinic is 25. Stuyvesant Polyclinic Stuyvesant Polyclinic, located at 137 Second Avenue, gives treatment regularly to 17 cases of poliomyelitis. This is practi- cally the capacity of the clinic. 92 out-patient service Clinic for Functional Re-education of Disabled Soldiers, Sailors, and Civilians The Clinic for Functional Re-education at 4 Livingston Place operates a clinic with a daily attendance of 120; the total number of patients receiving treatment at the close of February, 1920, was 322. Clinic hours are from 9-5 daily; 9-12 on Sat- urday; 7-9 P.M. on Mondays, Wednesdays, and Fridays. This gives an opportunity for patients to be treated without inter- ference with other duties and without the necessity of waiting for any great length of time. The clinic receives cases from the U. S. Government, accident insurance companies, railroad and industrial corporations, and social agencies. There is a social service worker whose duty it is to cooperate with the other agen- cies interested in the patients. Little follow-up work is needed but considerable is done in the rehabilitation of patients. The clinic was established July 15, 191 8, and complete records of cases have been kept since then. The following figures show the scope of the work: Radiographs taken Operations Hospital days Treatments by departments Electrotherapy Thermotherapy Massage Mechanotherapy Miscellaneous Totals to During Average Jan. 31 Feb. per mo. 2,228 184 124 331 16 18 21,704 1,081 1,206 11,301 772 628 21,338 1,336 1,185 30,665 2,477 1,704 15,202 876 844 463 60 26 89,634 6,638 4,980 Totals to Feb. 29 2,412 347 22,785 12,072 22,674 33,142 16,078 523 96,272 East Side Free School for Cripples The East Side Free School for Cripples, 157 Henry Street, has a capacity for 200 children, and the enrollment at the present time is 215. It operates a clinic for the care of these children, and in fact, it is the desire of the authorities of the school that when a child enrolls in the school, the entire physical care of the case 93 SURVEY OF CRIPPLES IN NEW YORK CITY shall be left to the medical authorities of the institution. A com- plete physical examination is made, including teeth, eyes, nose, skin, scalp, heart, lungs, and posture defects. The teeth are re- examined and put in condition once a year. Braces and appli- ances are supplied on a part-pay basis graded as to ability to pay. All patients admitted to the school must be able to walk. Trans- portation is furnished to and from their homes. Within the last three years 35 children have been graduated from the eighth grade, and out of a class of 11 last year 7 or 8 are now attending high school. Four former graduates are attending night school in which they are taking business courses. There is a work room, or industrial department, in connection with the school. Articles are manufactured in this work room which are sold. This work room is now entirely self-supporting. Eight girls in the work room are transported to the school by the school buses. Four former pupils are in such condition that travel to work is impossible, and work has been furnished to these per- sons in their own homes. Miss Howard, head of the work room, systematically looks after the employment of her former pupils. A summer home at Oakhurst is operated by the school. It has a capacity of 126. Those needing a long term in the country are kept there 10 weeks, which is almost the whole of the vacation. Others are allowed five weeks. Every one enrolled in the school is given a summer outing at this home. Brooklyn PoLHEMus Clinic PoLHEMUS Clinic, at the corner of Henry and Amity Streets, Brooklyn, is operated in connection with the Long Island College Hospital. The orthopedic dispensary is conducted on the second floor of this building. Five rooms are devoted entirely to orthopedic work, and three of these rooms are also used for other clinics. Two are devoted to examinations; one for fitting casts; one for records ; and two for poliomyelitis only. In the dispensary from October i, 1918, to Sept. 30, 1919, the number of cases treated was as follows: Total number of patients treated 853 Total number of treatments given 9.771 Average number of treatments per patient 11 94 OUT-PATIENT SERVICE The clinic includes a physical training class for corrective exer- cises. A brace shop is also operated. The social service work of the orthopedic department is handled chiefly by the District Nursing Service. Two hundred and seventy-five children attending the Polhemus Clinic receive home treatment by the nurses of this organization. They are brought to the clinic on an average of every two months for re- examination. The social service department of the Long Island College Hospital cares for the cripples on their discharge from the medical and surgical wards of the hospital. This constitutes in Brooklyn one-half of the cases. The social service referred 12 men to the Red Cross Institute for re-education during the past year. This clinic is now about up to capacity since it would be undesirable to have a larger orthopedic service in a general hos- pital of this size. Brooklyn Hospital Out-Patient Department The dispensary building of the Brooklyn Hospital is a two- story building of twenty rooms on each floor. In the center is an open gallery. There are waiting rooms on each floor with a total capacity of about 300. Of the twenty rooms on the first floor, three are used for an orthopedic clinic; one for examina- tions and treatment room ; one as an office and record room ; and one as an examining room for adults, and baking for those cases requiring it. These rooms are small. The basement rooms of the dispensary are also given over to orthopedic work. There is a gymnasium equipped with four treatment tables and certain gymnastic apparatus. Three rooms in the basement are used for plaster work and brace shop. The orthopedic clinic is open daily from 10-12. The dispensary records show a total of 4471 treated during year ending April 30th, 191 9; of these 4034 were children and 437 adults. The orthopedic clinic has a daily aver- age of 60 children and five adults. These figures indicate that about one-fourth of the dispensary work is devoted to ortho- pedic work for crippled cases, which is approximately the capa- city of the clinic. The social service and follow-up work of the orthopedic department is looked after by the social service depart- ment of the hospital. Due to the other demands upon this service the follow-up work of this department has not been adequate. 95 survey of cripples in new york city Throop Avenue Children's Orthopedic Hospital and Dispensary The Out-Patient service furnished by the Throop Avenue Chil- dren's Hospital and Dispensary was begun in 191 6 to meet the demand for the after-care of children affected by the epidemic of poliomyelitis. It was established by funds raised through the New York American and up to the present year was known as the New York American Baby Hospital. It occupies a two-story and attic building at 470 Throop Avenue, owned by the Brooklyn Asso- ciation for the Improvement of the Condition of the Poor. The location is desirable because of its proximity to a large area seri- ously affected by the epidemic, and also because it is some distance removed from the other clinics in the borough. The entire build- ing, except for one room, which is a ward of eight beds, is devoted to the out-patient work. The clinic is equipped with every ortho- pedic device needful. Especial mention should be made of the manner in which the records are kept. All cases are completely indexed and all clinical and social facts are fully recorded. This clinic is limited to children only, and continuously treats about 350 cases. Of these : Poliomyelitis 310 Other paralyses 12 Tubercular conditions 9 Congenital conditions 6 Rickets 6 Scoliosis 6 Fracture i The follow-up work of this clinic is now being conducted by means of postals, which is said to be fairly successful. About one-half of the patients attending this clinic are transported, as the children of the 19 16 epidemic are now becoming heavy and transportation requirement is probably greater. Street car trans- portation is a considerable problem and frequent transfers on the system result in much waiting on the corner, and the danger of frostbite to paralyzed limbs is said to be greater than to normal limbs. House of St. Giles, The Cripple In the out-patient department of the House of St. Giles, the orthopedic clinic is conducted by Dr. Burr Burton Mosher. 96 OUT-PATIENT SERVICE During the year 191 8, 176 new orthopedic cases were treated, and the total attendance was 1441. In this department there is a professional masseuse and a masseur in constant attendance who give treatment to these cases and likewise to resident cases. The total number of treatments given during the year was 2227. Queens Jamaica Hospital Out-Patient Department 1 he only institution in Queens County which offers orthopedic service to cripples is the Jamaica Hospital, located on New York Avenue, Jamaica, L. I. The orthopedic work is carried on by Dr. Henry C. Courten. This clinic was opened after the epidemic of poliomyelitis in 1916. At that time 190 post-polio cases were registered. The clinic is held Tuesdays, Thursdays, and Satur- days between twelve and four p.m. Three masseurs are engaged ; one on full time is in charge of the clinic. While the clinic is not in operation one is engaged in giving home treatments to cases who are unable to come to the clinic. The average daily attend- ance at the clinic is sixteen. The number treated during the last year: Children 156 Number treated during year 4,902 Home treatments 600 Number transported to and from clinic 4902 All of the cases cared for in this clinic are transported or treated in their own homes. Miss Rose Saffeir is the superintendent of this hospital. Capacity of Out-Patient Departments I he capacity of most out-patient clinics for cripples may be stated accurately. The capacity, however, of the out-patient departments of the New York Orthopaedic Hospital, the Hospital for the Ruptured and Crippled, and the Hospital for Deformi- ties and Joint Diseases cannot be accurately stated. Facilities are capable of extension to meet any emergency, and it would, therefore, be impossible in stating the facilities of the out-patient departments of the City to place any limit upon the number of 97 SURVEY OF CRIPPLES IN NEW YORK CITY patients which these three departments can accommodate. The facihties for out-patient services of New York City are listed as follows : MANHATTAN New York Orthopaedic Unlimited Ruptured and Crippled Unlimited Deformities and Joints Unlimited New York Hospital loo Mt. Sinai . lOO St. Luke's ICO Bellevue lOO Fordham lOO Harlem 25 Cornell 100 Lebanon 50 Vanderbilt 25 Neurological 100 West Side Dispensary 25 Stuyvesant Polyclinic 20 Clinic for Functional Re-education 250 BROOKLYN Polhemus Clinic 200 Brooklyn Hospital 100 Throop Avenue Dispensary 400 House of St. Giles 25 QUEENS Jamaica 25 98 CONVALESCING AND CUSTODIAL CARE Country Branch of the New York Orthopedic Hospital THE Country Branch of the New York Orthopaedic Hos- pital, at White Plains, New York, has 134 beds for after- care and treatment of patients from the New York Ortho- paedic Dispensary and Hospital in New York City. The hospital building consists of three pavilions, each two stories high, connected by glass enclosed galleries or cloisters. Its approaches are easy, adapted to the use of cripples. The children live in the end pavilions, or wings, which are fire-proof. Separate cubicles in some of the wards give privacy to the patients and add to the homelike spirit of the institution. The grounds comprise twelve acres. Curable cases only are admitted, a large number of which are usually of bone tuberculosis. Cases are admitted only through the dispensary or hospital in New York City, and are kept as long as deemed necessary to prevent possibility of relapse. The homes to which the children are discharged are supervised by the social service department of the hospital. This country branch, the first of its kind to be developed, is still the only institution operated by an orthopedic service to give extensive convalescent care to patients discharged from the hospital or dispensary. A graded school is maintained with a curriculum comparable with that of public schools. Special school equipment is pro- vided. The After-Care Home for Cripples, 142 Bruce Avenue, YONKERS The After-Care Home for Cripples, 142 Bruce Avenue, Yonk- ers, is conducted by a Board of Managers, of which Mrs. Joseph E. Heimendinger is President. Miss Katherine Huther, formerly connected with the New York State Hospital for Crippled Chil- dren, is Superintendent. Dr. Leo Mayer is chief surgeon, and 99 SURVEY OF CRIPPLES IN NEW YORK CITY decides upon all admissions to the Home. Wassermann and Schick tests are given by him before admission. The Home occupies a two-story frame cottage located on a hillside street. It is approached by stone steps leading up to the porch. This porch is enclosed and extends on the front or west side of the house and half way around the south side. The Home has 24 beds, all of which are occupied at all times. About one-half of the patients pay a small amount for their care. Besides the Superintendent, there are two nurses who give treatment and muscle training as directed by Dr. Mayer. A teacher gives academic instruction three hours a day. Besides these there are a cook and two housemaids. The income from the patients is small. The expenses are met by donations of the members and by an annual benefit which is conducted by a committee of the Board. The Home owns no property except the household equipment, which is moved each year to the Long Branch Home and is returned in the fall. Blythedale Home Blythedale Home, located at Tarry town Road, Hawthorne, is a development of the Visiting Guild for Crippled Children. The original object of this Guild was to furnish teachers for the chil- dren in their own homes. At first they provided a summer home, but in 191 3 the Board of Trustees decided to make a permanent home for children. The institution is non-sectarian, and is gov- erned by a Board of Trustees, which has 22 members. It is sup- ported by voluntary contributions, by the Federation of Jewish Philanthropic Societies, and is, in part, subsidized by the City of New York. The Superintendent is Miss E. M. Crysler. The main building of the institution is a two-story frame cottage with two enclosed porches and an annex for school purposes. The total bed capacity is 44. The institution admits girls from four to sixteen, and boys from four to ten. Before admission all cases must be examined by Dr. Barrie of the Hospital for Ruptured and Crippled. Although it is provided that only tuberculous bone cases should be admitted, ex- ceptions are sometimes made. Children are usually referred by the Post Graduate, Mt. Sinai, St. Luke's, Bellevue, New York, Lenox Hill Hospitals and the Hospital for the Ruptured and Crippled. 100 CONVALESCING AND CUSTODIAL CARE A well balanced diet consisting of meat, vegetables, milk, and eggs is given to the children. A milk allowance of one quart per day for each child is given. Treatment at the Home is conserva- tive, but minor operations are being performed by Dr. Barrie in the institution. Two teachers are assigned by the Department of Education of the City of New York. Regular grade work is carried on, and one of these teachers, who completed a special course in pre- vocational work, now teaches basketry and embroidery. The home of each child to be discharged is investigated by the Association for the Aid of Crippled Children. Employment is often obtained through Miss Ronsone. Miss Cirysle/, the nta ti-pll, keeps in touch with the former charges by correspondence. Darrach Home for Crippled Children The Darrach Home for Crippled Children, at Ii8 West 104th Street, New York City, is governed by a Board of Trustees of nine members, of which Mrs. W. L. Bauer is President. It is supported by voluntary contributions, and interest on invest- ments and fees for board. Miss J. K. O'Leary is the matron in charge of the institution. The institution occupies a three-story, attic and basement stone building. It has a capacity of sixteen, and the census on the day of our visit was eleven. Fees of from five to eight dollars a month are paid for the less needy children. Dr. Stanley Brady, the attending surgeon, examines all children before admission. Only children of school age are accepted, most of whom are post-polio cases and are taken to the clinic by their mothers or by nurses. A teacher for corrective gymnastics from the People's University Extension Society gives instruction one day a week. The children are taken to special classes of the public school by buses of the Board of Education and receive the instruction pro- vided in these classes. No provisions are made for after-care, except that on reaching the age of sixteen, efforts are made to place the children in suitable employment through the co-operation of the Board of Directors. From June 30th to October ist, children of the institution are maintained at the summer home, Groton, Conn. lOI SURVEY OF CRIPPLES IN NEW YORK CITY MONTEFIORE HOME The Montefiore Home Hospital, located at Gun Hill Road near Jerome Avenue, New York City, is a modern plant having a capacity of about 500, supported by the Federation of Jewish Philanthropic Societies, legacies, voluntary contributions, and to some extent by a city subsidy. It is governed by a Board of Trustees of 30 members. Siegfried Wachsmann is the Director of the institution. Of the total census of 476, 66 adults are suffering from diseases of the bo^e ad joints; and in the department for children there are about twenty children, some of whom are post-polio cases, others having tuberculous bones or spine conditions. The institution has the most modern facilities for electro- therapy, hydrotherapy, and mechanotherapy. It has one of the finest equipments in its Zander room. The Department of Education assigns one teacher to the in- stitution. The school room is equipped with adjustable desks and seats. Besides instruction in general grade subjects, the teacher instructs the children in raffia work, basketry, embroi- dery, and sewing. No children are assigned to the occupational department of the institution. The activities of the occupational department are aimed more toward occupational therapy than to pre-vocational or vocational training. The occupations taught are the making of braided or woven rugs, loom weaving, wood work, toy making, needlework, chair caning, card-board construction, basketry, drawing, and lettering. About fifty patients are under the supervision of this department. The social service department of the Home, operating with the United Hebrew Charities and other organizations, obtains em- ployment for the discharged patients. Some of the patients have been employed by the hospital; for some peddler's licenses are obtained and stands are purchased. House of the Annunciation The House of the Annunciation for Crippled Children, located at Broadway and 155th Street, is conducted by Protestant Epis- copal Sisters of the Annunciation of the Blessed Virgin Mary, 102 CONVALESCING AND CUSTODIAL CARE and is supported by legacies, voluntary contributions, and the board of patients. Its object is to give care to incurable and crippled girls between the ages of four and sixteen. Nineteen of the twenty-four cases at the institution at the time of our visit were cripples. The institution occupies a fairly modern four-story and base- ment brick building. On the first floor are the office, chapel, li- brary, etc. On the second floor are one ward, school room, dining room, music room, and surgical dressing room. On the third floor and the fourth are two other wards and rooms for the staff and the help. The institution owns sixteen acres of land at Wilton, Conn., where a summer home for children is operated. Dr. T. Halstead Myers is the director of the orthopedic ser- vice. Operative cases are taken from St. Luke's and attended by Dr. Myers. Children are usually referred to the institution by Sisters or by ministers who work among the poor. The institution does not have a school operated by the Board of Education, but the nurse, who is a teacher, gives instruction in reading, writing, and arithmetic, also sewing and embroidery. The regular school curriculum is not followed nor are pre-voca- tional subjects taught. Children who can work are assigned tasks such as dusting, polishing brass, and announcing callers. There are no after-care activities. However, the Mother Superior takes a personal interest in the children and makes efforts to provide employment in family homes, either at housework or looking after children. House of St. Giles, The Cripple Garden City, L. I. The House of St. Giles, the Cripple, on the outskirts of Garden City is a country home for cripples, operated by the Brooklyn hospital of the same name. The institution has a capacity of fifty. The grounds are spacious and afford room to grow garden products. The children are provided with fresh vegetables, and sufficient chickens are kept to provide fresh eggs. The house at Garden City, while attractive in appearance, is an old dwelling to which additions have been made, affording ward space and 103 SURVEY OF CRIPPLES IN NEW YORK CITY enclosed porches.. It is the intention to build a new institution on this site with a capacity of 125. Children are admitted through the hospital in Brooklyn, or by commitment by Poor Law officers of the City of New York or Nassau County. The school is under the supervision of the Board of Education of the City of New York. It is an annex to Public School No. 34, Queens. One teacher is provided by the Board of Education and an assistant is assigned by the institution. Regular grade work is given, and some pre-vocational work. Only about one- half of the children of the institution are of school age. There is no systematic follow-up work by this institution, but the superintendent. Miss Anne Hasbrouck, takes a continuous interest in her former charges and is of great assistance in locating them properly and making plans for their welfare. St. Agnes Hosx ital. White Plains, New York St. Agnes Hospital for Crippled and Atypical Children is located at White Plains, New York. The institution is main- tained by the Order of Sisters of St. Francis, and is supported by public funds and voluntary contributions. Most of the children are committed by the Poor Law Officers of New York City and Westchester County. Sister Mary Frances is the superintendent. The hospital has 225 beds for children of both sexes between the ages of two and sixteen. The plant consists of sixteen acres in land on which is the main building. In this the children and staff are housed. There are also separate buildings, one for the powerhouse and the other for an open air play-house. The chief orthopedic surgeon is Dr. Francis Butler. Dr. Butler examines the children after they are received at the insti- tution and performs all operations. During 191 9, 46 operations were performed. Four class rooms are provided for school work which is con- tinued up to the sixth grade. Most of the children are retarded, reaching the fifth grade at fourteen or fifteen years of age. Four Sisters are employed as teachers. No kindergarten work for the younger children is maintained. No pre-vocational training is provided, but it is the intention to give carpentry to the boys. 104 -3 fil UNIVERSITY OF CALIFORNIA LIBRARY This book is DUE on the last date stamped below. Ijte: 25 cents on first day overdue ^^c 50 cents on fourth day overdue iOne dollar on seventh day overdue. m\l 3 1947 liOM a^ '^'' *290cf55PL OCTl 5 1955 '.. ldQ^o1^,1"!oi BECDLD 0C 2816)4120 l471.5PMj.^ ^ ik -i^; rs-