A. OMNIBUS USED FOR TRANSPORTING CRIPPLED CHILDREN, NEW YORK.

times women but more often men. In several cases police officers have been employed. When the attendant is a woman the driver is expected to help to carry the larger children. In New York City the 28 stages furnished by the city have men attendants. The stages provided by the Association for the Aid of Crippled Children are accompanied by women nurses. The special teacher in charge of physically handicapped children urges the superiority of women attendants. She says:

The contract (to supply stage service paid for by the city) should also require the presence of a woman attendant in the stage instead of men or boys. In stages having women attendants results have been very satisfactory in the improved conduct of the children during transportation, in securing home care for the children, and in improved attendance. It would be a valuable addition to the home inspection if nurses from the board of health could be assigned to this work.

The use of men as attendants has thus far been in most cases a matter of convenience. Patrolmen have been assigned to this work in cities where children are transported in police-patrol wagons because this could be done without the expense of extra employees.

FOOD.

The second large item of expense in separate classes for cripples is the food served free or for very small payments. Hot lunches are usually given to the children at noon, consisting of a hot soup or stew, bread, cocoa, or milk, and a simple pudding. One or more vegetables are sometimes added. In many classes milk or milk and crackers are served when the children reach school or in the middle of the morning. In Chicago, Cleveland, Detroit, and Baltimore the food is furnished entirely free by the city. In New York and Philadelphia the bulk of the expense is met by private contributions, and the children make small payments if they are able to do so. For example, in Public School 107, in New York, soup was served for 3 cents, and sandwiches, cookies, cocoa, milk, etc., for 1 cent each. The children there are required to take the soup before they are allowed to have sweets. In some schools, where cripples buy food in the regular school lunch rooms used by all children in the building, the crippled children are served first.

A special study of the school lunch menu for crippled children in the public schools in New York was made in 1915-16. It was found that the children ate too much white bread, white crackers, and macaroni, and too many sweets. A change in the menu was urged, in order to include more food containing the mineral elements which are needed by all children, but especially by those cripples who have bone tuberculosis.

Nourishing food is part of a public school's provision of conditions which foster the physical well-being of children in the cripples' classes.

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FRESH AIR.

Fresh air is another element which is desirable for all children, but of especial importance for children who have been ill and who need to gain as much strength as they can from every source. Any visitor to classrooms for crippled children will note that the air is purer than in most public-school rooms for normal children. This is especially true in schools which are supervised or visited by physicians, because they generally order open windows. The air in a number of classrooms visited seemed as pure as that out of doors, even during cold weather. This result was attributed to open windows rather than to a system of indirect ventilation. During the winter a plentiful supply of steam is furnished in most of the schools where the windows are kept open, and the children are expected to wear their outdoor wraps on the coldest days.

Outdoor classrooms.-None of the public day schools for cripples have special rooms or buildings designed for the use of outdoor classes. Several of the residential institutions conduct outdoor classes in special rooms whose arrangement may be mentioned here as of possible suggestive value for public schools. At the Massachusetts Hospital school outdoor classes are held on open platforms adjoining the school building, which forms the only solid wall. On the other three sides there is a tight board railing about 3 feet in height, with pillars at intervals which are connected overhead to the main building by rods, over which an awning can be drawn. The children sit in collapsible boxlike chairs with very high backs extending to the floor behind their feet, and with winged pieces of board at each side to break the wind. Very warm clothing, knit caps, and heavy blankets are provided.

The first specially designed building for outdoor school work for crippled children was completed about 1914 at the Industrial School for Crippled and Deformed Children in Boston. This building, erected at a cost of $15,000, has a substantial roof and one brick wall; the other three sides have steel pillars covered with concrete, between which there are sliding glass partitions. In order to obtain ventilation without a draft through the room, the roof is built in monitor form with movable windows in two sections. The seats used are similar in general design to those at the Massachusetts Hospital school. There are also half a dozen canvas cots which stand along the sunny southern side of the building and are used during rest periods.

A simpler outdoor school building was built at about the same time at the Sewickley Fresh-Air Home, near Pittsburgh. This building is roofed, but has no walls; glass partitions are used in winter.

These are the only institutions where school classes can be held out of doors throughout the year, but mention should be made of the

From early spring held in a tent with

excellent arrangement at Sea Breeze Hospital at Coney Island, N. Y., for outdoor teaching during about half the year. until late in the fall the school classes there are wooden floor and board walls about 3 feet high. The walls are completed above that height by screens and canvas which may be dropped in case of rain.

Outdoor classes v. open windows. The importance of fresh air for crippled children, especially for those with bone tuberculosis, can not be overemphasized. But there are differences of opinion as to the best methods for obtaining the fresh air. At the meeting of the Federation of Associations for Cripples in New York City in April, 1913, there was a discussion of outdoor schoolrooms and schoolrooms where windows are kept open in winter, which brought out sharp differences of opinion as to whether or not cold temperatures have a bad effect upon the children's physical condition. Many of the physicians seemed to agree that cold in itself was never harmful if the children were warmly dressed and had plenty of good food. But many physicians advise a reasonable degree of warmth in schoolrooms, especially those used by crippled children who have bone tuberculosis, and advocate schoolrooms with plenty of window space rather than outdoor rooms where little or no heat is provided. Better progress is usually made educationally when the children are warm enough to avoid the need of heavy wraps and are able to use their hands for writing.

It must not be forgotten that the effect upon the children's health can not be foretold from a knowledge of the mere facilities for securing fresh air unless one knows also how those facilities are used. An apparently old-fashioned building may be well ventilated if the individual teachers see to it that windows are lowered from the top and raised from the bottom in sufficient measure to obtain a good supply of fresh air. On the other hand, a room with the most approved movable walls will not have good air if these be not removed during the school sessions. The Crippled Children's East Side Free School of New York is noteworthy among day schools because its windows are actually kept open throughout the year. The fresh air and the nourishing food which are desirable for all children have been discussed here because they are specially needed by crippled children. These children need also much special attention for their health which is not necessary for other children.

SURGICAL AND MEDICAL SUPERVISION.

Most of the crippled children attending public school classes for cripples are or should be under the supervision of an orthopedic surgeon; they should report frequently at the hospital dispensary, where their surgeon can examine them. The relation of the school

to the surgical and medical treatment of the crippled children varies widely in the different cities.

At one extreme, the Crippled Children's East Side Free School in New York, at the expense of a private organization, offers to the children taught by public-school teachers in that building practically all phases of surgical and medical care for their orthopedic difficulties except operations requiring an anesthetic. A visiting orthopedic surgeon holds weekly clinics at the school building, where an assistant surgeon and a trained nurse assist him in the adjustment of braces, application of plaster dressings, and other treatments. Under the supervision of a staff of nurse maids, all the children have baths at the school twice each week. There were 9,703 baths recorded for one school year, and 450 visits were paid to the homes of the children.

Philadelphia.-At the other extreme, the public school classes in Philadelphia have no orthopedic surgeons of their own and no nurses with special orthopedic training. This does not mean that the children in the Philadelphia classes are less well looked after from a medical point of view than those in other public schools. The difference is simply one of organization. Philadelphia is noted for its many fine hospitals, and the schools cooperate with the social service departments in the various hospitals. The school nurse has general supervision of the cripples, as of other children, and a matron is provided in each school where there are cripples to superintend the serving of their lunches and to act as attendant for children who can not go from one room to another without some help.

In all the six cities with public school classes for cripples, the children are either inspected by an orthopedic surgeon at the school or urged to attend the hospital dispensaries. A nurse or matron is sometimes present in the classroom all the time that the children are there; in other schools a trained nurse with special knowledge of orthopedics gives part of her time to work at the school and part of her time to visiting the children in their homes. Special gymnastic exercises adapted to crippled children are given in most of the classes, sometimes by the class teachers and sometimes by special teachers of gymnastics. There are so many differences between the detailed methods used in different cities that we shall state here briefly the system of medical supervision in each city.

New York. The City of New York has had since 1907 a special supervising teacher assigned to the classes for cripples by the director of physical training for the public schools of the city. Under her supervision the grade teachers have learned to watch carefully the health of their pupils. The physical activities of every child in the special classes for cripples are limited carefully in accordance with the recommendations of special hospital record cards kept at the