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-1- This institution includes a 90-acre farm which supplies fresh vegetables daily.

For normal children these activities are a matter of course, a part of their routine experience. For crippled children they are generally a new privilege, one of many unprecedented opportunities. Some of the children at the Prince Crossing institution are Boy Scouts. Another group has organized an orchestra. An excellent library has available the best juvenile literature. The children learn to dance and weekly parties are enthusiastically anticipated.

Closely akin to the convalescent homes are the institutions limited to specified diseases. The Reconstruction Home for Infantile Paralysis, in Ithaca, New York, is one of the very few institutions which exclusively care for otherwise normal children, suffering from the effects of poliomyelitis. A similar home in Elmira, New York, limits itself largely to rachitic and poliomyelitic children. In addition to these, there are special sanatoria for bone and joint tuberculous children, and general sanatoria, admitting this class of patients.

Sanatoria are special institutions caring for patients afflicted with tuberculosis.-2- They are of three types:-3-

-2- To be distinguished from the "sanitarium," an institution for mental and nervous diseases. Originaly, these two words were interchangeable. The distinction was made through the influence of the National Tuberculosis Association.

-3- From the Tuberculosis Directory of the National Assoxiation, 1923, p.4.

"1. Public institutions -- including state, county, and municipal. These are, in most instances, for local patients only.

"2. Private institutions -- operated by a non-official board by an individual for commercial purposes and open to patients from any locality.

"3. Semi-private institutions -- operated by a non-official and supported partly by private contributions or endowments, partly by fees of patients, and in some cases, partly by public funds. In most instances, admission of patients is restricted to certain groups of localities, or is otherwise limited."

Earlier studies of efforts to aid crippled children failed to take into account the large number of these patients under care in the special tuberculosis institutions. Agencies to check this disease had aroused a national interest at least fifteen years before the movement to aid crippled children had gained an extensive following. The National Tuberculosis Association was founded in 1904, and was itself a merger of several national groups. The extensive preventative, clinical, and curative endeavors which resulted from the efforts of this group had brought under sanatorium care hundreds of children, crippled by the progress of bone or joint tuberculosis. Although the development of convalescent homes has transferred some of this responsibility to special orthopedic agencies, there are still a number of these patients in sanatoria and other tuberculosis institutions.

Efforts to check the progress of "surgical" tuberculosis have been more successful than most of the other branches of orthopedic work. The J. N. Adam Memorial Hospital at Perrysburg, New York, reports the following results in the treatment of "surgical" tuberculosis during a period of seven years:-1-

-1- 1913-1929. See Annual Reports.

Of 638 cases committed to hospitals or sanatoria by the Ohio Department of Public Welfare during a period of three years, the following results were achieved:

The lower percentage of successful cures in Ohio may be explained by a lack of special facilities and the inland situation of the state. The North American Sanitarium-2- in Ventnor, Atlantic City, New Jersey, reports an average of 86% of its patients cured or greatly improved.

-2- Named before the distinction of terminology was established.

In addition to salt water bathing facilities, the "heliotherapy,' or sun treatment, has been found to produce remarkable results. This work was begun at Dr. Rollier's sanatorium the Swiss Alps in 1903. It was introduced into this country the J. N. Adam Memorial Hospital by Dr. John Pryor. It consists of exposure of the diseased part to sunlight for periods increasing from five minutes three times a day, to five, six, or seven hour periods. The exact results which take place are not understood, but there have been observed an increase in the pigmentation of the skin, a growth of hair, a general metabolism, a decrease in the number of respirations, with the increase in the depth of the individual respiration, a fall of blood pressure, and a stimulation of the nervous system indicating an improved general condition and a stronger resistance. It is important that this treatment should be given with judgment, over-exposure or personal idiosyncrasy may result in sunstroke, rising temperature, cardiac palpitation, insomnia, or nervousness.-3-