homes before she was placed by a social agency in a genuine foster mother's care. She learned to sew beautifully. Buoyant with pride, she showed some embroidery to her own languid, alimony-supported mother. "Well," said the mother, "it may be all right, but I think Betty can get by without learning to sew."

Is "getting by" a test of success? Assuredly we expect something more of our delinquent girls. We would like them to achieve the expression of a normal personality, which includes, according to Dr. Rosanoff, inhibition, emotional stability, rational control (a guiding line), and durability.

Let us look at two cases from a small institution, El Retiro, an adjustment or opportunity school for wards of the court. One case, Belle, represents an institution failure followed by community success; the other, Ruth, an institutional record of success ending in apparent collapse outside.

Belle was normal in intelligence and health. In the school she was listless, dirty, unpunctual, slack about work and personal hygiene, discontented, and insolent. After ten months she was removed as an unfit subject. Today she has a four-year achievement of outstanding community success. She is a competent wife and mother. She is a leader in social affairs. Her essential attribute is feminine charm and affection. She is frivolous, as so many clever young women ✓ are. With Belle the institution never emphasized the right things. All her personality attributes were penalized. There was no incentive. The world outside accepted her as she was.

Ruth was handicapped by an inferior physique and three years' mental retardation. Within the school she was obedient, trustworthy, taking the regulations seriously, acquiesing in the program and the standards of behavior, following all suggestions promptly and cheerfully. She graduated with the highest possible number of credits after eighteen months. Ruth has a four-year record of community failure. She is still obedient and acquiescent, but to the standards of an antisocial group. She evades the police because she conforms to certain exterior respectabilities, but she lives an idle, dissolute life. She is still cheerful and courteous. With Ruth the institution followed the line of least resistance: it developed no new possibilities. Perhaps the result could not have been different, but the keynote of her failure was already struck in the school, and could have been observed; it undoubtedly lay in her acquiescence.

The test of success is found in the ability of the girl to maintain responses and attitudes in the outside world of sufficient stability to withstand the innumerable onslaughts of antisocial groups and individuals. This can come about only if she believes in the fundamental righteousness of the standards she is taught in the school, and if she has not developed antagonism toward her teachers.

A study of riots and infractions of discipline in institutions is instructive. Usually correctional schools maintain discipline houses or rooms. In one state school, with a population of 320, the inmates of a discipline house were studied.

In five months eighty girls had been punished by terms of confinement ranging from three to ninety days. Forty-three girls had been previously punished five times; twenty-one, four times; eleven, three times; and the remaining five were in the discipline house for the first time. An analysis of the offenses showed the following: laziness, grouch, insolence, petty disobedience, forbidden communications, notes to other girls, thefts of candy, food, or cigarettes, and running away.

The atmosphere of this school was reeking with settled, deep antagonism to authority. The conditions under which this antagonism had developed were petty. Senseless routine, galling, unnecessary restrictions, trivial rebukes for trivial offenses, deepening into rebellion. The difficulty lay in the fallacy so common to institutions, the special institution fallacy which attributes to a single cause, that of delinquency, all the normal traits of human nature. Viola is sent to a state school because of theft. The institution program is not outlined to "cure" theft (to bring about a highly complex emotional readjustment). But within the institution Viola is punished because she always twitches her left shoulder when her matron speaks to her. The matron has an Intelligence Quotient of about 82, and Viola an Intelligence Quotient of 115, so the matron rather rightly maintains that Viola has a superior attitude. When Viola entered the institution she was frightened and a little sorry. Now, after nine months of "discipline" she is hard-boiled and bitterly rebellious.

The institution that likes to consider itself successful must ask itself, Do wev meet the complex needs of adolescence so completely that none are restricted from the group and none develop permanent feelings of antagonism to authority?

What is a practical test of success outside? If this were a just world, it would undoubtedly be keeping out of jails and institutions, that is, there would be no more repeaters supported at public expense. Judged by these moderate standards no juvenile institution reports fewer than 60 to 80 per cent of successful cases. In some state schools ninety out of every one hundred make good.

But this is not a just world. Some are returned to custody for minor violations: going to dance halls, losing jobs, running charge accounts, smoking cigarettes; others live within the letter of the law, and lie, cheat, are disloyal to comrades and indifferent to the suffering of others, and "get by."

We should remember that some of our girls on probation or parole endure struggles beyond anything demanded of the rest of us.

Elsie, aged seventeen, with an Intelligence Quotient of 80, an insane father, and drunken mother, went to work for a cleaning establishment at $16 per week after a period of ten months' training in a correctional school. She regularly paid $4 a week for the board of her baby. One night, on the way home from work, she was summoned to the receiving hospital where her nineteen-yearold brother was dying of gun shot wounds inflicted by the police in a raid. She arranged for the funeral, bore part of the expense, and conducted everything

herself. Later her mother died on the street, literally in the gutter, after a spree. Undaunted, Elsie carried on the stern business of running her own affairs. In two years there were reported of her only three minor violations: she went to a dance with a forbidden companion, again she stayed out till two in the morning, and she bought a white fur coat costing $60 on the instalment plan. She is now in an office earning $19 per week. It is instructive to note that she was given opportunity to make trials and errors without being crushed. Our girls have little discretion. As Morley observes, "in order to attain discretion, one must have destroyed innocence.

The ultimate success of a large proportion of our wards should fill us with humility. It is they who have attained durability, and a guiding line, in the face of handicaps and failure which is often beyond our utmost reach. We should recognize that many who do not achieve a worldly success, who fail in their adjustment to our sordid city streets, have attained those priceless virtues, tolerance, good will, and the will to struggle.

STATE PROGRAMS FOR CRIPPLED CHILDREN

Harry H. Howett, Executive Secretary, International Society
for Crippled Children, Elyria, Ohio

Minnesota. From the historical standpoint, Minnesota deserves first place among the states providing for crippled children at public expense. As early as 1896, Dr. Arthur J. Gillette, an orthopedic surgeon, and others aroused the public to the duty of the state to the crippled child.

The first appropriation amounted to $10,000 for two years. The state university provided care for about seventy crippled children in the St. Paul City and County Hospital. In 1910 a county branch of this state hospital was organized for convalescent cases and opened its doors the next year at Phalen Park, with a capacity for about sixty patients. Thus, at the beginning, Minnesota had in reality two state institutions.

Since 1913 these institutions have been merged into one and the capacity has been increased from 130 to 210, the capital invested from $68,000 to over $420,000 for real estate and personal property, and the per capita cost from $300 to over $700. The expenditure for the year ending June 30, 1924, including construction, improvements, equipment, repairs and replacements, current expense, etc., was $213,013.04. The average population is 200, with as many more on a waiting list. Only indigent patients are admitted, but the out-patient department, which is conducted by one paid employee and many volunteers, has contact with some 2,000 children. It is important to note that the superintendent, in her report to the state board of control, in 1924, estimated the additional needs of the institution at $274,000.

A great part of the high-grade professional medical service of the staff of

thirty-five doctors is rendered freely to the children and the state. At present there is an orthopedic nurses' training school in connection with the state hospital, an elementary and advanced course of study in the hospital school, and provisions for vocational training.

Within the state there are about fourteen private institutions which have some cases of children with surgical tuberculosis, a unit of the Shriners' chain of orthopedic hospitals, and an endowed school and convalescent hospital in connection with the state university.

In 1921 the state enacted a law which established classes for crippled children in the public schools. Boards of education which organize such classes are paid from a state subsidy, not to exceed $250 per pupil for a full school year's attendance.

Ohio.-The Ohio plan has three distinct periods of development covering a period of about twenty years. The first consisted in the enlargement of the administrative, co-operative and supervisory powers of the state departments of welfare, health and education. This development made it certain that the state institution was not needed in Ohio, and it never will be built.

The second period was from 1911 to 1921, when laws which took root from the principles laid down by the White House Conference called by President Roosevelt in 1909 were passed, providing that the state should plan to care for dependent children without additional institutions.

During the past four years the third period has brought forth additional laws and private organizations inspired by Edgar F. Allen, president of the Ohio and International societies for crippled children, which ordained a remarkable cooperative movement that is bringing to the crippled child his birthright of opportunity.

It finds crippled children unofficially through surveys and officially by school enumerators who are required by law to give special information to county auditors and to the state department of education regarding crippled children from one to twenty-one years of age. Expert diagnoses are made by approved and selected orthopedic surgeons in all parts of the state, especially in rural sections, in diagnostic conferences or clinics organized and supervised by the state department of health.

Parents, guardians, local nurses, Rotarians, teachers, health commissioners, welfare workers, and state nurses follow up the clinics and see that the existing facilities are brought to the children or the children to the facilities, as the cases respectively require. Many children are taken care of privately and the rest are taken to the juvenile court for commitment to the division of charities in the state department of public welfare, or to special schools for education, or given the benefit of trained field service or home care and instruction, depending upon their several circumstances and conditions.

The state division of charities is responsible by law, through its orthopedic nurses, for the care, relief, and education of committed crippled children. It

contracts with individuals, approves institutions and hospitals, pays the bills, which are then charged back to the counties from which the children are committed, and supervises the children, in their own homes or wherever they may be, as long as the commitments last. This division has a rotating fund of about $53,000, which is protected by the attorney-general of the state, whose duty it is to collect from counties which allow their bills to become delinquent. The juvenile court collects partial payments from parents and guardians.

Education is, in a way, the most important part of the program, because it applies to all crippled children who are not feebleminded, while the surgical operation applies to only about 20 per cent of them. Therefore it is arranged so that crippled children come within the provisions of the compulsory school law.

Local school boards, with the permission of the state director of education, may provide home teaching, special classes, special schools, or pay for the board, tuition, or transportation of crippled children when necessary. The state department of education, besides furnishing a state subsidy for the education of crippled children not to exceed $300 per pupil per year, maintains a bureau to supervise special education, and a division of civilian rehabilitation for cripples over fifteen years of age.

Last available statistics show that 91 clinics have attracted 4,300 cases. Up to April 1, 1925, the state department of public welfare accepted 1,092 commitments. There are now 50 special classes and schools in 17 different cities, 7 of which are located in hospitals or convalescent institutions, and 95 home teaching cases in 35 different communities. The enrolment for special education varies, but is about 850 pupils. The annual per capita cost in the welfare department is approximately $300, and in the educational department, for excess costs, about $250. Including duplicates, the three state departments are in touch with more than 6,000 crippled children.

Iowa. One of the states following the general principle found in the Minnesota plan, that deserves special attention because of the amount of work which has been accomplished in medical care for crippled children, is Iowa. The chief difference from the Minnesota program is that the care and relief is given at the orthopedic division of the general hospital at the state university.

As in Ohio, juvenile courts may commit "any legal resident of Iowa, residing in the county where the complaint is filed" to the university hospital. While any adult may file a complaint, a specific duty to do so is placed by law upon "physicians, public health nurses, members of boards of supervisors and township trustees, overseers of the poor, sheriffs, policemen, and public school teachers." Patients may be treated who are not committed, and the hospital authorities "shall collect from the person or persons liable." Patients may be treated also outside of the hospital.

There is no direct information at hand to tell how much money is spent on children with orthopedic difficulties, except that statistics show there were 1,576