ance to do all of this work, and much of it has to be done in New York City. We have been allowed by the Salary Classification Commission a shoemaker and brace repairer, but are unable to obtain a candidate for the position at the salary which has been allowed.

Indirectly the war will be a benefit to crippled children. One of the chief barriers to expansion in this work has been the very general pessimistic view as to the economic value of saving the life of a child who must be a permanent cripple, or of trying to lessen invalidism if it is beyond our power to make the invalid perfectly whole. The work which will be done by our reconstruction hospitals will familiarize the public with the possibilities of so repairing a cripple that he can lead as useful a life as any of his fellow citizens. From the statistics obtained from the experience of our allies, it has been determined that for 1,000,000 men we shall need in France 35,000 beds for cases classed under orthopedic surgery. Over here the government will build about fifteen reconstruction hospitals to hold 7,000 to 10,000 patients each. Thus it may be seen that the maimed adult will soon be a common sight.

It might be of interest to compare the work of a Reconstruction Hospital and the work of this hospital. Both have for their chief function the providing of special surgical skill, called orthopedic surgery, but here the comparison ends. Instead of a stump of a leg which we must repair for the application of an artificial leg, we have a useless leg, or a leg which is diseased and which if neglected, will be deformed or take the patient's life. Furthermore, orthopedic surgery for children differs from the orthopedic surgery for adults in that with children, advantage should be taken of the assistance time can give, while with adults this assistance must be sacrificed frequently for a quicker but less perfect result. Sacrifice of joints or even limbs must be made rather than risk harm to the mental and general physical condition of the patient by prolonged treatment. The Reconstruction Hospital treats adults who have been taken from some line of work in which they had become more or less skillful and to which they must, if possible, be returned. Failing in that they must be repaired sufficiently to undertake some other work. Here we treat children only. We have no special work for which we must try to fit them. Most of our patients are too young to make a vocational school of value in our work. We can, however, so train their minds and hands that they will have a less limited choice as to their life-work when the time comes for such a decision.

We have always discountenanced exploiting the cripple. There are cases in which charity seems to be necessary all through life, but usually the patient can be made independent. We have on our pay roll as a laborer, a young man who need never fear that he cannot always make a living. Both legs were paralyzed when he came to us and he could not stand or walk; now he can carry a ladder and his bucket of paint to a building, put up the ladder, mount it and paint, without any assistance. We heard of an English officer who early in the war lost his arm at the shoulder. He is now wearing an artificial arm and is back at the front. He asks favors of no one, can run his own car through London's traffic, remove and replace tires, and is quite independent in every way.

Persons who have given attention to management of hospitals may be interested in knowing some factors which we believe have been of no little importance in obtaining the home atmosphere which is invariably remarked upon by our visitors. We do not dress the children alike. This helps to make each of them an individual and not merely one of a number. Personal tastes are studied by teachers, nurses and waitresses, and cultivated so far as possible. Interest in the patients, in their physical improvement and in their little lives, on the part of any employee, is encouraged. New employees, who by their previous training have been institutionalized, and those who do not "fit in" with the existing order of things, are not retained. To be satisfactory in any position an employee in this institution must have a natural love for children, a desire to serve, patience with unremediable conditions which may make for slight discomforts, and must be unselfish. It is surprising with how little friction such a staff works. The physician, the steward, the matron, the head nurse and the teachers are held responsible for their departments, and are ready to assist one another when necessary and possible. The personal interest and pride in what we are able to do is not limited to the heads of departments, but is felt by each one rendering any service whatsoever.

Our library now contains 1,147 volumes. It is constantly used and is valued by the older patients. All the books were donated and the donors may be satisfied that their gifts have been appreciated. We need, however, more books for both boys and girls from six to fourteen years of age.

The expense of maintaining this hospital is $1.10 per capita per day. This list includes all items of maintenance, such as salaries, food, light, heat, clothing, equipment, general supplies, medical and

surgical supplies and apparatus, including braces, which vary in price from $10 to $85. In fact, this includes every conceivable item of expense except that of construction and rental, or cost of property. The State owns this property, and the buildings are paid for out of special appropriations which are not taken into consideration in computing our per capita. These figures are excedingly low in comparison with those of other hospitals, yet efficiency is not impaired, and although close economy has been practiced, it has not been to the injury of our patients. The up-keep of the hospital has been excellent. Repairs and replacements are made promptly.

Received for special appropriations.

Received for deficiency appropriations.

Received for maintenance appropriations.

Received from all other sources, bank balances.

Balance on hand July 1, 1916...