With the cooperation of Gertrude E. Hodgman,
Assistant Professor of Nursing, Yale School of Nursing.

1. Essential Elements in a Community Program for Orthopedics. In recent years we have come to a new appreciation of the importance of bodily mechanics as a factor in health, -an importance which demands for orthopedics and posture training an essential place in the community health program.

The essentials in such a program are four in number; hospital care for pronounced orthopedic defects with the necessary adjunct of occupational therapy; clinic service for less extreme deviations from normal and for aftercare; nursing follow-up, which in this field is of such peculiar importance since treatment must often be so long continued; and training of the normal or nearly normal individual in good postural habits as a preventive of later deterioration.

Hospital care for orthopedic cases is provided by the three hospitals. Financial aid is furnished by the Crippled Children's Aid Society to patients in the Grace and St. Raphael's Hospitals; and this organization also supports ten beds for after-care at the Children's Community Center. Clinic service is rendered by the New Haven Dispensary and by the physicians of the Crippled Children's Aid Society; and nursing service, for the latter clinics only, by the Crippled Children's Aid Society. The Visiting Nurse Association has no special provision for expert orthopedic care. Posture work and vocational training as carried on in the public schools has been discussed in a pre- ceding chapter. The New Haven Normal School of Gymnastics exerts a valuable educational influence in this general field.

The services of the hospitals, the Dispensary and the Crippled Children's Aid Society must be discussed some- what more in detail.

2. Hospital Service. Both the New Haven and Grace Hospitals have excellent special orthopedic services and at St. Raphael's many orthopedic cases are treated in the course of regular surgical practice. The service at the New Haven Hospital is in charge of Dr. W. M. Phelps and in the year July 1926-June 1927 cared for 657 cases. The service at Grace Hospital is in charge of Dr. R. J. Cook and Dr. C. W. Henze and in 1926 cared for 384 cases.

3. Clinic Service. The outpatient service at the New Haven Dispensary is an unusually complete one, including one muscle-training class under Dr. W. M. Phelps, two general orthopedic clinics under Dr. Phelps and Dr. M. K. Lindsay, a fracture clinic under Dr. Lindsay, two foot clinics under Dr. D. J. Morton, a posture clinic under Dr, Phelps and three weekly physiotherapy clinics. The registration for these clinics in the month of December 1927 was as follows: physiotherapy, 156; orthopedic, 136; muscle- training, 82; heliotherapy, 44; posture, 40; fracture, 19; foot, 15; total, 492. The growth of this admirable clinic service is a cause for great satisfaction.

4. The Crippled Children's Aid Society. The principal agency in this field is the Crippled Children's Aid Society (Mrs. John R. Demarest, President). For thirteen years this organization has performed an exceedingly useful function in providing material aid and nursing follow-up for orthopedic cases.

This society was organized in 1914 by a group of ladies interested in the relief of crippled children by affording them material assistance, by providing medical and surgical services, by supplying necessary orthopedic appliances, and such further means of hygienic and social uplift as may tend to remove the handicap to children's welfare and happiness which their unfortunate position has imposed.

The first nurse of this organization was employed through an arrangement with the V. N. A. for part time work. Later, a full time nurse separate from the V. N. A. was appointed. At the present time one full time nurse and one half time nurse, who is studying physiotherapy, in preparation for full time work with the Association, are employed.

The organization consists of a Men's Board of Trustees, a Board of Physicians (Dr. Carl W. Henze, Dr. Leonard W. Bacon and Dr. Raynham Townshend) and an all Woman's Board of Directors. The standing committees are: Case 'Work, Education, Service, Nursing, Children's Equipment, Entertainment-indicative of the broad scope of interest and work of the Society.

The Society had in 1926 receipts of $16,998.80, of which $14,600 came from the Community Chest, $512.00 from annual dues, $197.50 in collections from patients and the rest from various miscellaneous sources. Expenditures amounted to $16,996.08, distributed as follows:

The bulk of the expense under the first item mentioned is for the support of ten beds at the Children's Community Center, for which the Society pays $10 a bed per week, for the care of rickets, post-operative and similar cases. Thirty-seven orthopedic cases were thus cared for in 1926. The staff of the society includes besides an office secretary the two nurses, Miss Pansy V. Besom and her assistant.

Operative cases are all sent to Grace Hospital and Clinic service (twice a week) is generously provided without charge by Drs. C. W. Henze and L. W. Bacon. Physiotherapy cases are similarly handled by Dr. H. E. Stewart and Miss Margaret O'Neil; and the new nurse is studying physiotherapy with Dr. Stewart in order to prepare herself for giving nursing treatments. Miss Besom and her assistant take the children to the physicians for treatment and do follow-up in the homes. One hundred and sixty children were carried in 1926 and 3,014 calls made by the nurses, while 3,688 days of care were given to 25 children at the Community Center.

The opening by the Board of Education of a special class in vocational training for crippled children at the Zunder School last year was largely due to the initiative of the society. More extended provision of this kind is urgently needed.

The Crippled Children's Aid Society performs admirable work in enlisting and focusing attention upon a vital problem in the field of public health. As we shall point out, however, the scope of its influence might profitably be widened.

5. Summary and Recommendations. It would appear that hospital and clinic facilities for the care of orthopedic cases are ample in New Haven.

The nursing service and material relief provided by the Crippled Children's Aid Society is excellent in plan and quality. It seems unfortunate, however, that its facilities should be available, as appears to be the case, only to the patients of three individual physicians. The New Haven Dispensary, which is another member of the Chest and which maintains an excellent orthopedic clinic, receives no service from the organization. It would seem eminently proper that the nursing service of the Society and its funds for material relief should be made available for all qualified orthopedists in the community.

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