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"Now gentlemen, I congratulate you in this job, but you can't make a bigger mistake than to make this an organization of bachelors. If the women are not with you, you are going to let slip by you a whole lot. I have worked along these lines about fifty years. I find the co-operation of men and women in work for little children very essential, and you can't afford to go it alone. You wouldn't think of establishing a hospital and putting in it none but men nurses. You can't do it. The same holds true with regard to the organization. I am sure you are going to want the women."-1-

-1- Hastings H. Hart, The Restoration of the Crippled Child. The Crippled Child, p. 5, Dec. 1923

Since the presentation of the speech quoted above, an agreement has been reached between the Shrine Hospital Committee and the International Society whereby several of the members of the former organization are representative on the Advisory Board of the latter. Many Rotary Clubs have arranged for the co-operation of wives in the crippled children activities. Most of the present work of this organization is directed toward more complete national co-ordination.

Intra-state, the co-ordination has been achieved to varying degrees of completion. The Illinois Society for Crippled Children, in a recently published program, planned to enlist the co-operation of all interested organizations, namely, the Illinois Department of Health, the Russell Sage Foundation, the Rockefeller Institute, the American Institute of Orthopedic Surgeons, the American Hospital Association, the National Education Association, the National Welfare Association, the American Red Cross, the American Legion, (for assistance in securing beneficial legislation), the Knights of Columbus (for the same purpose), and the Shrine. Representatives of the Shrine, the State Department of Health, and the Illinois Society met in Chicago in 1923 and planned the following program:

1. The State Department of Health will concentrate on prevention.

2. The Shrine will concentrate on providing hospital beds for the "operative" and convalescent patients.

3. The Illinois Society will turn its attention to the ambulatory patients.

4. All three will co-operate in securing expedient legislation.-1-

-1- From an address by Dr. E. H. Marshall of the Illinois Society for Crippled Children.

In contrast may be cited a conference of orthopedic surgeons held in Harrisburg, Pennsylvania, March 24, 1924, under the auspices of the State Department of Welfare. An excellent group of suggestions was proposed, but no means was provided for putting them into operation. Accordingly, a second conference was held in the Senate Caucus Room, two months later. The meeting discussed the application of the Ohio plan in Pennsylvania, the function of the various professions and active social groups in completing this movement, the need of hospital beds in that state, and the necessity of avoiding pauperization. The group appointed a committee to meet monthly and formulate a program to be adopted by another conference to be called in December, 1924. The co-ordinated activities of Pennsylvania are now rapidly reaching efficiency and bringing that state to a place of leadership in the movement to aid crippled children.

When the first burst of Rotary enthusiasm brought Ohio into crippled child activities, co-ordination was sadly lacking. Clinics were held without public health nurse assistance or direction, and children were committed in wholesale lots to hospitals which were not ready to care for them. Family physicians were deprived of one pay case after another by free clinicians who examined children, diagnosed cases, and sent them to free remedial facilities regardless of whether they were able to pay or not. Had this in-co-ordinated activity continued, something similar to state medicine would have superseded private practice in Ohio, and all impetus for medical and surgical development would have disappeared.

Through the efforts of the Ohio Society for Crippled Children and the State Department of Health this disorganized and dangerous practice was first checked and finally corrected, until, at present, Ohio state departments and local social groups are working in harmony and handling the problem effectively. The co-operation of clinical facilities with family physicians cannot be too strongly urged. In the first place, the family doctor is in the best position to aid in arriving at a correct diagnosis of the case. In the second place, inasmuch as the medical profession as a group has rendered, without charge, unlimited social service in caring for destitute cases everywhere, it is only fair that indiscriminate free facilities should not deprive physicians of patients who can pay for their services. No physician should object to a second and assisting diagnosis of either free or pay patients. From the very beginning, however, the family physician should be consulted, and given the opportunity of caring for all of those patients who can remunerate him for his services. A third reason for such co-operation is the desirability of making free services available for as many indigent patients as possible, and not depriving them of these opportunities by using funds for less needy persons.