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FACTS ABOUT CRIPPLED CHILDREN 1944 U. S. DEPARTMENT O F LA B O R CH ILD REN ’S BUREAU PUBLICATION 293 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Contents Page How many crippled children are there?................. ............................................... What are the causes o f crippling conditions?................................. ...................... What progress has been made by public agencies for care and treatment?........ How does the Federal Government help finance the program ?.. ....................... How are the services administered?..................................................................... What services are included in a State program?................................................... What services are provided?..................................................................... ............ How does a child obtain care?............................................................... »................ What provisions are there for education?............................... .............................. What provisions are there for vocational training?. . ....................................... .. What measures are taken to prevent crippling conditions?.................................. How do public and private agencies cooperate?................................................ . State agencies administering services for crippled children.................................. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis ' 1 1 2 & 4 4 9 9 9 10 10 11 12 Facts About Crippled Children Federal aid to the States for services for crippled children authorized in the Social Security Act (approved August 14, 1935, and amended August 10, 1939), has made possible the development of a Nation-wide program o f medical, surgical, and aftercare services for the physical restoration and social readjustment o f crippled children. The conduct o f this program is bringing to light information not here tofore available for all the States ahout the numbers and location o f crippled children, the causes o f crippling conditions, the care such chil dren need, and the costs o f care. How Many Crippled Children Are There? Since the passage o f the Social Security Act, registers for crippled children have been established by each official State agency administer ing these services. The registers o f crippled children in the 48 States, Alaska, the District o f Columbia, Hawaii, and Puerto Rico on June 30, 1944, included the names o f 373,177 crippled children. The children registered are those under 21 years o f age who are living in the State or Territory and who are suffering from crippling conditions as determined by the diagnosis o f a licensed physician under the definition given in the State or Territorial law or regulation. Included are children under care or awaiting care by the official crippled children’s agency or under other public or private auspices. The number o f crippled children on State registers increases as the States develop more effective methods o f locating crippled children and broaden the types o f crippling conditions covered. W hat Are the Causes o f Crippling Conditions? Information received in a special report from State agencies regarding the crippled children on State registers indicated that 97 percent of the children so registered were suffering from orthopedic or plastic conditions, and 3 percent were suffering from other types o f crippling conditions. Among the major causes o f crippling, as shown by State registers, are infantile paralysis, congenital defects, birth injuries, accidents, rickets, osteomyelitis, and bone and joint tuberculosis. It is recognized that there are many other types o f crippling conditions among children for which little or no provision for care has been made, such as disabilities arising from impaired vision, impaired hearing, and diabetes. A begin618551°—45 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 1 2 ning has been made in the provision o f care for children with rheumatic fever or heart dise&se.1 Except for certain congenital defects the causes of crippling or the crippled conditions which result are to some degree preventable. In the majority o f cases proper treatment given in tune will result in physical restoration or will materially reduce the child’s handicap. W hat Progress Has Been Made by Public Agencies for Care and Treatment? Over a number o f years notable work for crippled children has been carried on by private organizations, both in providing direct services for crippled children and in urging appropriations from public funds for the extension o f such services. The first public hospital devoted to the care of crippled children was established in Minnesota in 1897. The first State law that made pro vision for services on a State-wide basis was enacted in Ohio in 1919. By 1934, 35 States had made some provision for funds for the care of crippled children, although in several o f these States the appropriations were so small that only a few children could be cared for. In relatively few States was it possible to conduct a State-wide program providing diagnosis, medical and surgical care, hospitalization, and aftercare services for any substantial number o f crippled children. On August 14, 1935, the Social Security Act became a law and author ized Federal grants to the States for services for crippled children to be ad ministered by the Children’s Bureau o f the United States Department of Labor. The first Federal appropriation for this purpose made funds available for grants to the States on February 1, 1936, and the States then began to submit State plans as required in requesting Federal grants. By June 30, 1937, all the States, Alaska, Hawaii, and the District of Columbia had legislation authorizing an official State agency to carry on a program for the care o f crippled children. In the 8-year period since February 1, 1936, services for crippled children, under the provisions of the Social Security Act, have been established in every State, the District o f Columbia, Alaska, Hawaii, and Puerto Rico. Children’s Bureau Publication No. 258, which is available upon request, 1 The following Children’s Bureau publications deal with the subject of rheumatic fever: State Programs for Care o f Children With Rheumatic Fever Under the Social Security A ct, title Y , part 2. 1943. Some Facts About Rheumatic Fever. 1943. The Virginia Program for Children With Rheumatic Fever. Reprint from The Child (January) 1942. Social Planning for Children With Rheumatic Heart Disease. Reprint From The Child (January) 1941. Proceedings o f Conference on Rheumatic Fever. 1944. (In press.) https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 3 describes in detail the development o f the crippled children’s program and the progress made in each State in extending and improving its services. How Does the Federal Government Help Finance the Program? The Social Security Act, title V, part 2, as amended (1939) authorizes the appropriation annually o f $3,870,000 for Federal grants to the States to help them "extend and improve (especially in rural areas and in areas suffering from severe economic distress) * * * services for locating crippled children, and for providing medical, surgical, corrective, and other services and care, and facilities for diagnosis, hospitalization, and aftercare, for children who are crippled or who are suffering from condi tions which lead to crippling.” Grants are made to the States upon approval by the Chief o f the Children’s Bureau of State plans for such services. Under the terms o f the act as amended the sum o f $20,000 is allotted by the Secretary o f Labor to each State (total $1,040,000), and the sum o f $1,830,000 is allotted on the basis o f the need in each State after the number o f crippled children in need o f care and the costs of furnishing care have been taken into consideration. These amounts (total $2,870,000) are available for expenditure for services for crippled children under approved State plans when matched by State funds. The remaining amount ($1,000,000), first authorized under a 1939 amendment, is avail able for grants to the States without the requirement for matching by State funds. It is allotted by the Secretary o f Labor according to the financial need o f each State for assistance in carrying out its State plan after taking into consideration the number o f crippled children in the State who need care and the cost o f furnishing services to them. This fund makes possible the provision o f services for additional children in States with limited financial resources; expansion of the program to include other types o f crippling conditions, such as rheumatic heart disease; and provision for emergencies, such as epidemics o f infantile paralysis. Since February 1, 1936, the amount o f Federal funds paid to the States for services for crippled children during each fiscal year has been as follows: Fiscal year: 1 9 3 6 .................... $732,492.33 1937 ......................................................... 2,01 1938 .............................................................................................. 2,691,869.82 1939 ................................................................... 2,997,914 1940 ..................................................................... 3,378,985. 1941 ...................................................................... ........................... 3,919,837.04 1942.'................................................................................. 4,053,292.08 1943............................................................. 3 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 4 How Are the Services Administered? The crippled children’s program and the maternal and child-health program (also included under provisions o f the Social Security Act) are administered by the Children’s Bureau in its Division o f Health Services, with a medical director in charge and with medical, medical-social, and public-health-nursing staff to give consultant service to the State agencies in formulating their plans and carrying on their services for crippled children. A part-time orthopedic consultant is available when needed. The annual plan for services for crippled children, submitted by each State crippled children’s agency to the Chief o f the Children s Bureau, embodies the State’s request for the Federal aid offered, explaining how the funds will be used in accordance with the requirements o f the Social Security Act. I f the State plan is in conformity with the requirements, the Chief o f the Children’s Bureau approves the plan, and the Secretary o f Labor certifies to the Secretary o f the Treasury the payments to be made to the State for services for crippled children. The Children’s Bureau receives quarterly reports on the registration o f crippled children and services rendered to crippled children in the States. These reports are summarized and are issued annually for the United States as a whole. Special studies to promote the efficient adminis tration o f the program are also made by the States and by the Children’s Bureau. An advisory committee on services for crippled children, appointed by the Secretary o f Labor, assists the Children’s Bureau in the development o f policies affecting the administration o f title V, part 2, o f the Social Security Act. The advisory committee on services for crippled children is composed o f orthopedic surgeons, pediatricians, nurses, medical-social workers, physical-therapy technicians, and others experienced in the care o f crippled children and in the administration o f services for their benefit. Its recommendations and those o f the State and Territorial health officers are o f great assistance in the development o f State programs. W hat Services Are Included in a State Program? A summary o f the State plans in operation for the fiscal year ending June 30, 1944, shows the program administered in 29 States by the department o f health, in 10 by the department o f welfare, in 5 by a crippled children’s commission, in 5 by the department o f education, and in 3 by State university medical school or hospital. Federal funds for crippled children’s services have made possible the development o f State-wide programs where they did not previously exist and the extension and improvement o f programs already being adminis tered by other public and private agencies and organizations. The State programs vary widely, since each State has been guided in developing its program by its own needs and resources. A State plan usually provides for a State administrative staff, including https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 5 one or more physicians, public-health nurses, physical-therapy technicians, and medical-social workers. Local physicians, public-health nurses, social workers, school officials, and members o f community groups aid in locating crippled children and report them to the State crippled children’s agencies. The State agency employs qualified orthopedic surgeons and pediatricians to conduct diagnostic and treatment clinics. When a child needs more extensive treatment than can be provided at the clinic, the State agency arranges for his care by an orthopedic surgeon and other physicians at an approved hospital and pays for these services. The State agency arranges for aftercare services needed to complete the child’s physical restoration and social readjustment. At the present time many orthopedic surgeons and other physicians who formerly participated in the State services for crippled children are now serving in the armed forces. This has necessitated certain changes in State programs with regard to location and frequency o f clinics, hospitals used, and number o f physicians and surgeons engaged in providing diag nostic and treatment services. In some instances children in need o f care cannot be furnished with the necessary medical, nursing, or physiotherapy services so promptly as formerly. In order to care for those most urgently in need o f such services special consideration is given to those children with crippling conditions requiring prompt attention which, if neglected for any considerable period, would have a detrimental effect upon the welfare o f the child. The various war agencies concerned with rationing and priorities o f materials have consistently given careful consideration to the special needs o f crippled children, particularly as these needs apply to the use of metal for braces, purchase o f special shoes, and the rationing of gasoline for transporting the children to clinics for treatment. Safeguards have been provided that will permit continuation o f the essential services to this group during the present National emergency. The program o f services that every State aims to provide through the crippled children’s agency established under State law includes the follow ing features: 1. Locating all crippled children. 2. Providing skilled diagnostic services by qualified surgeons and physicians at State clinics located in permanent centers or held periodically in other centers so as to be accessible to all parts of the State. 3. Maintaining a State register o f all crippled children in the State. 4. Selecting properly equipped hospitals, convalescent homes, and foster homes throughout the State and providing for the care of crippled children at such hospitals and homes. 5. Providing skilled medical, surgical, nursing, medical-social, and physical-therapy services for children in hospitals, convales cent homes, and foster homes. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis FEDERAL GRANTS TO STATES FOR CRIPPLED CHILDREN’ S SERVICES UNDER THE SOCIAL SECURITY ACT [Title V, part 2, o f the Social Security A ct, as amended] Federal Funds Available and Federal Funds . Requested as o f March 15, 1944, in State Plans Approved by the Chief o f the Children’s RllPAQll T A I* tlia TTiannl Vnn« T o tal State 1 Federal funds available for fiscal year 1944 1 United States. Alabama...................... Alaska......................... Arizona........................ Arkansas..................... California.................... Colorado..................... Connecticut................ Delaware..................... District o f Columbia. Florida........................ Georgia........................ Hawaii......................... Idaho........................... Illinois..................... .. Indiana....................... Io w a ......................... . K ansas....................... Kentucky.................... Louisiana.................... M aine.......................... Maryland. .................. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis ‘ 5,142,389.75 97,281.49 74,046.40 44,099.10 80,136.69 168.145.61 55,168.33 98,033.22 66,775.73 81,298.39 72,833.82 133,639.77 54,062.91 55.786.61 152,823.20 81,756.81 125, 865. 46 67, 608. 27 94, 237. 42 102, 471. 03 48, 018. 20 91, 257. 48 ------T _ _ _ _ _ _ _ _O A 1 AA Fund A (matching required) Fund B (matching not required) Requests for Federal Requests for Federal Requests for Federal funds approved for Federal funds available funds approved for Federal funds available funds approved for for fiscal year 1944 for fiscal year 1944 fiscal year 1944 fiscal year 1944 fiscal year 1944 4,437,542.54 97,281.49 32,027.29 44,099.10 80,136.69 166,072.00 55,168.33 92,729.61 9,301.00 81,298.39 72,833.82 133,639.77 53,887.07 46.385.00 152,823.20 78.260.00 125, 865. 46 59, 826. 00 94, 237. 42 102, 471. 03 48, 018. 20 91, 257. 48 8 3,779,610.16 74.936.00 63,038.11 35.022.65 61,681.14 97,005.59 32.696.00 67,808.68 61,944.78 29,669.23 54.877.01 115,855.18 45.274.66 31,170.00 128,822.68 66,337.77 71, 267. 63 47, 513. 77 72, 788. 47 88, 078. 72 33, 507. 64 58, 248. 02 3,215,359.98 74.936.00 21.019.00 35,022.65 61,681.14 95.667.00 32.696.00 62,505.07 6,298.00 29,669.23 54.877.01 115,855.18 45,098.82 31.170.00 128,822.68 63.620.00 71, 267. 63 43, 920. 00 72, 788. 47 88, 078. 72 33, 507. 64 58, 248. 02 1,362,779.59 22,345.49 11,008.29 9,076.45 18,455.55 71,140.02 22,472.33 30,224.54 4,830.95 51,629.16 17,956.81 17,784.59 8,788.25 24,616.61 24,000.52 15,419.04 54, 579. 83 20, 094. 50 21, 448. 95 14, 392. 31 14. 510. 56 33, 009. 46 1,222,182.56 22,345.49 11,008.29 9,076.45 18,455.55 70.405.00 22,472.33 30,224.54 3,003.00 51,629.16 17,956.81 17,784.59 8,788.25 15.215.00 24,000.52 14.640.00 54, 597. 83 15, 906. 00 21, 448. 95 14, 392. 31 14, 510. 56 33, 009. 46 Massachusetts............................ Michigan................... ................ M innesota................................. M ississippi................................. M issouri..................................... M ontana..................................... Nebraska..................................... N evada....................................... New Hampshire......................... New Jersey................................. New M exico............................... North Carolina......................... North D akota........................... O hio............................................ Oklahoma................................... Oregon........................................ Pennsylvania............................. Puerto R ico................................ Rhode Island............................. South Carolina.......................... South Dakota............................ Tennessee................................... Texas.......................................... Utah........................................... Vermont..................................... Virginia....................................... Washington ......................... West Virginia............................. W isconsin................................... W yoming.................................... 100, 753. 07 148, 383. 43 145, 291. 10 90, 735. 15 95, 898. 36 47, 835. 92 69, 814 16 69, 045. 76 69, 879. 95 153, 935. 13 42, 967. 29 248 112. 79 112, 108. 06 46, 001. 78 140,692.48 114,230.23 40,032.26 196,836.17 83,702.26 87,626.85 96,977.19 37,592.59 110,484.94 179,848.27 71,012.88 68,016.63 98,396.68 97,051.21 70,937.21 130,492.98 69,790.96 100, 753. 07 148, 024. 52 145, 291. 10 90, 057. 99 95, 771. 26 34, 829. 00 69, 814. 16 9, 799. 00 27, 004. 56 153, 935. 13 35, 234. 00 206, 543. 23 112, 108. 06 46, 001. 78 140,692.48 114,230.23 40,029.00 176,437.91 83,702.26 44,890.00 96,627.19 37,196.16 89,613.08 162,464.00 66,860.63 21,425.00 92,139.00 64,760.00 63,380.00 130,492.98 19,817.41 88, 601. 06 91,141. 82 65, 678. 35 61, 982. 36 71, 979. 40 36, 216. 61 42, 496. 86 61, 657. 10 63, 330. 30 127, 018. 85 36, 997. 29 248,112. 79 91, 476. 29 40, 006. 39 111,454.05 60,797.87 32,779.36 174,139.32 67,900.90 58,148.39 56,864.21 29,362.63 84,108.08 121,546.27 34,341.56 62,207.80 52,621.09 46,928.31 55,965.91 82,938.00 63,773.55 88, 601. 06 90, 782. 91 65, 678. 35 61, 305. 20 71, 852. 30 28, 536. 00 42, 496. 86 7, 000. 00 20, 454. 91 127, 018. 85 29, 264 00 206, 543. 23 9i; 476. 29 40, 006. 39 111,454.05 60,797.87 32,779.00 159,668.91 67,900.90 24,290.00 56,514.21 28,966.20 75,822.08 115,548.00 33,343.15 16,900.00 50,775.00 34,840.00 51,258.00 82,938.00 13,800.00 12,152. 01 57, 241. 61 79, 612. 75 28, 752. 79 23, 918. 96 11, 619. 31 27, 317. 30 7, 388. 66 6, 549. 65 26, 916. 28 5, 670. 00 12,152. 01 57, 241. 61 79, 612. 75 28, 752. 79 23, 918. 96 6, 293. 00 27, 317. 30 2, 799. 00 6, 549. 65 26, 916. 28 5, 970. 00 20, 631. 77 5, 995. 39 29,238.43 53,432.36 7,252.90 22,696.85 15,801.36 29,478.46 40,112.98 8,229.96 26,376.86 58,302.00 36,671.32 5,808.83 45,775.59 50,122.90 14,971.30 47,554.98 6,017.41 20, 631. 77 5, 995. 39 29,238.43 53.432.36 7.252.00 16.769.00 15.801.36 20.600.00 40.112.98 8,229.96 13.791.00 46.916.00 33,517.48 4.525.00 41.364.00 29.920.00 . 12 122.00 47.554.98 6,017.41 1 The term "State” includes the District o f Columbia, Alaska, Hawaii, and Puerto Rico. _ ■ „ * Includes, in addition to the allotment for fiscal year 1944, any balance o f Federal funds in the State July 1, 1943, and the unrequested 1942 and 1943 allotments available for budgeting for the fiscal year 1944. 1 Includes $119,493.66 fund A reserved for later apportionment. * Includes $43,066.41 fund B reserved for later apportionment. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 6. Providing medical, nursing, medical-social, and physical-therapy services at home for crippled children who are not in need of hospitalization or who have been returned home following hospital or convalescent care. 7. Cooperating with other agencies in arranging for education and vocational training for crippled children. 8. Cooperating with professional groups, with private organizations, and with public and private agencies in providing services for crippled children. 9. Coordinating State and local services for the care o f crippled children. Since January 1, 1940, several State agencies have inaugurated services for children suffering from rheumatic fever and heart disease. These services are usually confined to an area within the State where adequate facilities and services are available for the diagnosis, treatment, and super vision o f children accepted for care. Such programs had been approved, by January 1944, in 17 States (California, Connecticut, the District o f Columbia, Idaho, Iowa, Maine, Maryland, Michigan, Minnesota, Ne braska, Oklahoma, Rhode Island, South Carolina, Utah, Virginia, Wash ington, and Wisconsin). Additional informational bulletins d escrib in g the State rheumatic-fever programs are available and may be obtained upon request from the Children’s Bureau, U. S. Department o f Labor, Washington, D . C. In accordance with a 1939 amendment to the Social Security Act, State crippled children’s agencies have been required, since January 1,1940, to provide in their State plans for the employment o f all personnel on a merit basis, either under a State civil-service system, where such exists, or under a merit-system plan o f personnel administration established by State executive action. Recommendations o f national professional organizations and standards set b y national examining boards with regard to essential qualifications for surgeons and other professional personnel are being used by State agencies as guides in establishing requirements for the selection o f the members o f the State staff and o f those to whom children are to be sent for treatment. M ost o f the State crippled children’s agencies have the assistance of advisory committees representing the professional groups concerned in the program, the agencies experienced in providing care for crippled children, and the organizations actively concerned with obtaining care for crippled children. Such committees advise with regard to standards for personnel and for hospital and convalescent facilities and with regard to the extension and improvement o f the services under the program. Surgical and medical fees and hospital costs and rates are reviewed by the State agencies, with the assistance o f their advisory committees, in arriving at an equitable hasis o f payment. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 9 W hat Services Are Provided? During the year ended June 30, 1944, the following services for crippled children were reported by State agencies: Visits for medical service to diagnostic and treatment clin ics...................... Children under care in hospitals 1. . ............................................................... Days’ care provided in hospitals........................................................... Children under care in convalescent homes 1................................... Days’ care provided in convalescent homes.................. Children under care in foster homes 1....................................... Days’ care provided in foster homes. . . .............. ......................; ................. Visits by public-health nurses.......................................................................... Visits by physical therapists.......................................................... .............. ; Children given medical-social service.............................................................. Children referred for vocational rehabilitation............................. , ............... 183,086 31,428 1,228,158 5,660 444,776 1,190 92,438 158,661 176,744 21,841 5,952 1Including réadmissions. How Does a Child Obtain Care? The parents or friends o f a crippled child needing care that his family cannot provide report the child’s name to the State crippled children’s agency. Children needing care are also reported to the State agency by local physicians, public-health nurses, social workers, school officials, and other individuals or groups who are helping to locate crippled children. As soon as possible after receiving the name of a crippled child, the State agency arranges for diagnosis o f the child’s condition at a crippled children’s clinic. If hospitalization is necessary, the State agency arranges for the child’s admission to an approved hospital as near home as possible where medical and surgical treatment is proyided as needed. Payment for medical and surgical treatment and for hospital and convalescent care is made by the State crippled children’s agency. After the child leaves the hospital, medical treatment and other aftercare services are provided as needed in a convalescent home, a foster home, or the child’s own home. The purpose o f the crippled children’s program for each child served is to attain for him the maximum physical restoration possible and to aid him in adjusting to life at home and in the neighborhood and in taking advantage o f opportunities for education and vocational training. W hat Provisions Are There for Education? Some States through their departments o f education provide the funds necessary to cover the costs o f special education for crippled children. Such costs include, for example, transportation o f the children to school, special equipment to aid children in surmounting their handicaps or to be used in their physical training, teachers specially trained to work with crippled children, and teaching service for crippled children in hospitals or at home. In many States crippled children’s agencies are working in cooperation with State departments o f education to obtain additional services that are greatly needed. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 W hat Provisions Are There for Vocational Training? When the children reach the age o f 16 years, vocational training is made available from funds provided jointly by the State and Federal Govern ments for the vocational rehabilitation o f the physically disabled. Through cooperative arrangements provision is also made in a number o f States for vocational guidance to crippled children who are under the age at which they may be accepted for training by the State vocational-rehabilitation service. Vocational-rehabilitation services in all the States will be expanded under the provisions of the Barden-LaFollette Vocational Rehabilitation Act, approved July 6, 1943, which is planned to meet the needs o f phys ically disabled civilians o f employable age. The Federal grants to the States for vocational rehabilitation are administered by the Federal Security Agency through the Office o f Vocational Rehabilitation, and in the States the vocational-rehabilitation service is associated with the State department o f education. Under the Barden-LaFollette Act, in addition to vocational education and training, corrective medical services and hospital care may now be provided for eligible individuals o f employ able age, some o f whom will be under 21 years o f age. In order to avoid the duplication o f services already available to crippled youths under State crippled children’s programs, the Federal Office o f Vocational Rehabilitation and the Division o f Health Services o f the Children’ s Bureau have agreed jointly on the policy that State vocational-rehabilitation services shall refer to the State crippled chil dren’s agencies all patients under 21 years o f age who have crippling condi tions for which diagnostic and treatment services may he provided under the crippled children’s program. There will be joint planning by the State crippled children’s agencies and the State vocational-rehabilita tion agencies for physical restoration and for the vocational education and training o f individual crippled children who are o f employable age and who demonstrate vocational aptitudes and physical and mental capacities for specific types o f training in selected trades and crafts. W hat Measures Are Taken T o Prevent Crippling Conditions? An important feature o f a crippled children’s program is the effort to reduce the chances that children will be crippled and to provide prompt care for all children suffering from disease or injury that may result in physical handicap. Individual and community effort is important in the prevention o f physical handicaps. Parents must he instructed how to guard children against accidents and disease. Children must be taught how to avoid accidents. Better obstetric care for mothers will reduce birth injuries and crippling due to syphilis. Cod-fiver oil and adequate exposure to sunlight will largely prevent and cure rickets. The use o f pasteurized https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 11 milk from cows free from tuberculosis and the protection o f children against exposure to active cases o f tuberculosis are factors in preventing bone and joint tuberculosis. Periodic medical supervision o f children, especially in the preschool period, will reveal injuries and incipient disease at a stage when treatment can he most effective. Precautions to protect children against accidents in the home and on the farm and safety campaigns to prevent highway and other accidents will reduce the number o f children injured and crippled. With Federal and State funds now available it is possible for the State crippled children’s agencies, during epidemics of infantile paralysis, encephalitis, or meningitis, for example, to provide immediate diagnosis and treatment so as to prevent or reduce the physical handicap that may follow the disease. As the State crippled children’s agencies accumulate experience, they are in an increasingly better position to inform parents, physicians, nurses, and others who care for children o f the ways to prevent the conditions that bring to children the danger o f physical handicap. How Do Public and Private Agencies Cooperate? Many private organizations and individuals are maintaining hospitals and are raising funds to provide care for crippled children. In some States in which sufficient State appropriations have not yet been made, private funds have been made fully available for public use under the supervision o f the State crippled children’s agency in order that the State may receive its entire allotment o f Federal funds for which matching is required. There is continuous cooperation between the private groups and agencies interested in crippled children and the officials administering the State crippled children’s programs. Citizens’ groups are active in locating crippled children, in helping to arrange for and conduct crippled children’s clinics, and in providing transportation for crippled children to the clinics and to hospitals. In arranging for the care o f crippled children the State agencies make use o f private as well as public hospitals and convalescent homes. Private groups frequently provide supple mentary equipment and recreational supplies during the convalescent or aftercare period. The most important contribution o f private groups, including pro fessional associations, is their continuing interest in the improvement in the quality o f care made available for crippled children. Their rep resentatives on the State advisory committees and on the advisory committee for the Federal Children’s Bureau share in formulating standards for the selection o f surgeons and other professional personnel and for the approval o f hospitals, convalescent homes, and foster homes to which crippled children are to be sent. The interest and understanding o f private groups are frequently responsible for improvement in public and private facilities used for the care o f crippled children. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis State Agencies Administering Services for Crippled Children Alabama......... State Department o f Education, Division o f Vocational Education, Montgomery. Alaska............. Territorial Department o f Health, Division o f Maternal and Child Health and Crippled Children, Juneau. Arizona........... State Department of Social Security and Welfare, Division for Crippled Children, Phoenix. Arkansas......... State Department of Public Welfare, Crippled Children’s Division, Little Rock. California State Department o f Public Health, Crippled Children’s Services, San Francisco. Colorado......... State Division o f Public Health, Division o f Crippled Children, Denver., Connecticut. . . State Department o f Health, Bureau o f Child Hygiene, Division o f Crippled Children, Hartford. Delaware. . . . . State Board o f Health, Services for Crippled Children, Dover. D i s t r i c t o f Health Department o f the District o f Columbia, Bureau Columbia. o f Maternal and Child Welfare, Washington. Florida............ Crippled Children’s Commission, Tallahassee. Georgia........... State Department o f Public Welfare, Crippled Children’s Division, Atlanta. Hawaii............. Territorial Board o f Health, Bureau o f Crippled Children, Honolulu. Idaho.............. State Department o f Public Health, Bureau o f Maternal and Child Health and Crippled Children, Boise. Illinois............. University o f Illinois, Division of Services for Crippled Children, Springfield. Indiana........... State Department o f Public Welfare, Services for Crippled Children, Indianapolis. Iow a................ State Board o f Education, Crippled Children’s Services, Iowa City. Kansas............. Crippled-Children Commission, Wichita. Kentucky......... State Department o f Health, Crippled-Children Com mission, Louisville. 12 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 13 Louisiana.................State Board o f Health, Division of Preventive Medicine, Division o f Crippled Children’s Serv ices, New Orleans. M aine....................... State Department o f Health and Welfare, Bureau o f Health, Division o f Medical Service, Augusta. Maryland................. State Department o f Health, Service for Crippled Children, Baltimore. Massachusetts.........State Department o f Public Health, Services for Crippled Children, Boston. Michigan................. Crippled-Children Commission, Lansing. Minnesota............... State Department o f Social Security, Division o f Social Welfare, Bureau for Crippled Children, St. Paul. Mississippi...............State Board for Vocational Education, Crippled Children’s Services, Jackson. Missouri................... University o f Missouri, State' Crippled Children’s Service, Columbia. M ontana.................. State Board o f Health, Division o f Crippled Chil dren, Helena. Nebraska................. State Board o f Control, Division o f Child Welfare and Services for Crippled Children, Lincoln. Nevada.................... State Department o f Health, Division of Maternal and Child Health and Crippled Children Services, Reno. New Hampshire. . . . State Board o f Health, Division o f Maternal and Child Health and Crippled Children’s Services, Concord. New Jersey.............. Crippled Children’s Commission, Trenton. New M exico............ State Department o f Public Welfare, Division o f Crippled Children’s Services, Santa Fe. New Y ork ............ . State Department o f Health, Division o f Ortho pedics, Albany. North Carolina. . . . State Board o f Health, Division for Crippled Chil dren, Raleigh. North D akota.........Public-Welfare Board o f North Dakota, Division o f Child Welfare, Bismarck. O hio..........................State Department o f Public Welfare, Division o f Social Administration, Services for Crippled Children, Columbus. Oklahoma.......... .. Commission for Crippled Children, Oklahoma City. Oregon. .................... University of Oregon Medical School, Division o f Crippled Children, Portland. Pennsylvania...........State Department of Health, Crippled Children’s Service, Harrisburg. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 14 Puerto R ic o ........... . Insular Department o f Health, Bureau o f Infant Hygiene, Bureau for Services for Crippled Chil dren, San Juan. Rhode Island........ . State Department o f Health, Crippled Children’s Division, Providence. South Carolina. . . . State Board o f Health, Division o f Crippled Chil dren, Columbia. South Dakota. . . . . State Board o f Health, Division o f Crippled Children, Pierre. Tennessee.............. . State Department o f Public Health, Services for Crippled Children, Nashville. Texas...................... . State Department o f Education, Division o f Crippled Children, Austin. U tah....................... . State Department o f Health, Crippled Children’s Service, Salt Lake City. Vermont................. . State Department o f Public Health, Crippled Children’s Division, Burlington. Virginia.................. . State Department o f Health, Crippled Children’s Bureau, Richmond. Washington........... . State Department of Health, Division of Maternal and Child Hygiene and Crippled Children’s Serv ices, Seattle. West Virginia........ . State Department o f Public Assistance, Division of Crippled Children, Charleston. Wisconsin.. .......... . State Department o f Public Instruction, Bureau for Handicapped Children, Crippled Children’s D ivi sion, Madison. Wyoming. . *........ . State Department o f Public Health, Division for Crippled Children, Cheyenne. UNITED STATES GOVERNMENT PRIN TING OFFICE WASHINGTON 25, D . C. 1945 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis
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