and treatment of this class of cases. For your further information I would also state that through the personal influence of Senator W. G. Harding, of Marion, O., an act was passed during the last hours of the extraordinary session of the Ohio Legislature creating a commission of five members with an appropriation of one thousand dollars to investigate the needs and requirements and to consider the advisability of establishing a State institution for the care and treatment of crippled children. This commission to report at the next meeting of the Legislature.

To aid these committees in a proper understanding of the matter, it is their desire to obtain all the evidence possible and to receive such suggestions as will assist them in a perfect development of plans supplying all of the needs and requirements. With this end in view, I trust that you may give the subject attention to the extent of thorough discussion and if in your final opinion the plans presented merit your support, that you may recommend them as a society.

In presenting the subject I assume that you all agree that this class of patients demands much that can not be afforded by the general practitioner and because of this there is no class of cases which are so compromising to professional reputation, so unsatisfactory to treat and so unfortunate in their outcome.

This assump

sist nature in reclaiming itself. This may come in the form of some apparatus to be applied to the afflicted member, some mechanical device to be employed in the treatment of the body or in the particular need of some trained assistant to afford manipulations which can not be supplied by the physician himself. The extent to which these requirements present is very great and they carry with them demands which are not justified and can not be borne by the family physician.

The rapid progress made in the development of adjuncts to the practice of orthopedics has evolved much in the form of mechanical apparatus, hydropathic and electropathic means and manipulative measures which can not be supplied by any form of home treatment because of their great expense in production and operation and yet a lack of these means causes the crippled and deformed to go untreated, or if treated at all, in a most unsatisfactory manner to both physician and patient.

As to the insufficiency of length of time devoted to treatment, experience teaches that most cases of deformity are compelled by the expense of maintenance to desist treatment before nature has had sufficient time to make the necessary repair. As you all know the majority of cases of cripples and deformities are due largely to constitutional disturbances, and the general nutritive functions of the body are so greatly impaired that much time is needed to replenish and renew the vital force essential to restoration, thereby requiring a protracted line of treatment, anything short of which will not answer. In most cases a few days, a few weeks, or even a few months will not suffice; nothing but years of persistent effort, patient care and scientifically directed treatments will bring about a cure and in some cases nothing but partial relief can be accomplished. Where individuals are poor, and this class is very large, they must necessarily fail to receive the benefits they deserve without aid from outside sources.

On the other hand, from the length of time needed for treatment, the child's

schooling is so interfered with, his mental training so interrupted that it becomes necessary to discontinue treatments before the full benefits have been attained. Thus the matter of means and the need of education deprive many a crippled child of physical improvement which would be possible otherwise.

We therefore find entering into the proposition of the proper care and treatment of crippled and deformed children two fundamental principles. One dealing with the physical side of the being and having to do with his physical development, the other dealing with his mental side and having to do with his education.

To illustrate: Let us consider a well developed case of Lateral Curvature of the Spine complicated by rotation manifesting all the symptoms and presenting all the conditions common to this trouble. In such a case we have one which is necessarily very protracted in its final outcome and there are many special conditions to be met and many special requirements necessary to meet them. This is one of the cases which, without constant, persistent, daily treatment for months at a time, must necessarily go on to the worst of deformity with the most serious of complications and finally to utter helplessness which brings about a condition not only of chronic invalidism, but of dependency as well.

If such a case is to receive the benefit it may receive, special apparatus for support is demanded, special forms of manipulative treatment are required and many extraordinary measures must be adopted which can not be supplied at home. To exemplify: Let us suppose that this case is a female twelve years of age, the average age at which this disorder presents; that the length of time necessary to her recovery-if recovery is possible-is at least three years. Three years lost out of the schooling at this time of life means irreparable loss.

To prevent this, I propose that the institution in which this patient be treated supply a course of education of a practical kind that will prepare this child for

some vocation in life adapted to her special needs. The course that this line of instruction should take should be determined by the possible results of treatment, her adaptability and natural talent. In one case this might lead along lines of art work, of needle work, of music, of literature or of science, or what is more useful than all, domesticity. With proper instructors the educational demands could be supplied while the physical treatments were being continued. The patient could be educated while being treated.

Suppose the case were a boy of the same age, with a corresponding physical condition. In this case the educational part of the treatment could be along the lines of mechanics, physics, any of the sciences or trades, horticulture, agriculture, etc., etc., any of which could be conducted to meet the special demands of the individual, always considering the handicap of his infirmity and the possibility that he might not become strong enough to follow other than a special vocation.

Many of these cases become from lack of treatment and from want of education life long dependencies, while on the other hand if they were properly prepared they could at least be self-supporting and by the time their physical trouble was overcome, they would be in the line of promotion to other and better things. The same rules that are applicable to the cases just cited are just as applicable to hundreds of similar cases.

As you all know many of the cases of cripples and deformity have capabilities. which if they are especially educated and encouraged in proper directions will give them prestige and position, independence and self-support.

Usually these are precocious children, who, if they had the opportunity of education, improvement and development along lines of natural endowment, might become leaders in the world, in any event they may at least be made independent.

A few years ago, I had a patient afflicted with hip joint disease in the third stage, a bright little girl ten years old when coming under treatment. On my first

acquaintance with her she had been confined twenty-one months to her bed and she was still far from well. During the course of treatment which followed, I dis covered in her a marked talent for drawing. This I encouraged as much as her condition would allow. After her convalescence had been sufficiently established I advised that she be put under special instructions to develop the talents which she manifested. This was accordingly followed out and to-day she is capable of supporting herself, an invalid mother and a father who had failed in business. But for her help all of these would have necessarily become dependencies.

This is but one of many similar experiences I have had in my practice of orthopedics. And I feel sure any of you can recall similar cases to which the principles I advocate would be just as applicable.

It is difficult, indeed, to present the subject of the care and treatment of crippled and deformed children even to a society of medical gentlemen as fully as its magnitude merits, because there are no records to which to refer whereby a perfect knowledge of the number of such cases now existing can be procured; for even Uncle Sam with all his generosity has not recognized crippled and deformed children to the extent of even giving them a statistical standing, much less to afford for them places of succor and relief.

In the great State of Ohio there has not been until very recently a single public institution devoted to the care and treatment of this class of individuals and yet they are so numerous that there is no community, however small, but that has its quota. In fact, there are but few families, as you know, in which there is not some member who is so unfortunate as to have a crooked back, a club foot, a paralyzed limb, a diseased joint, a hare lip or some other mark of the ravages of disease or of nature's incompetency.

Out of Ohio's population it is safe to estimate that there are at least ten thousand charitable and semi-charitable crippled and deformed children. Of this

number, under favorable means, fifty per cent. are curable, twenty-five per cent. more could be materially benefited and all could by the plan I propose at least be made self-dependent. Ohio supplies, through her charities, homes for the indigent poor, for the orphans and homeless, for the blind and idiotic, for the epileptics, for the depraved and degenerate, for the insane and the imbecile, for the feeble and the aged, for the deaf and dumb, but not one thing for her crippled and deformed; not one thing for a class of individuals who are ordinarily of good habits with perfect faculties and inclinations, but who have absolutely nothing to help them; not one thing for a class of people who are the worst of outcasts, because they have desires and ambitions, because they have possibilities and natural endowment, because they have special requirements and needs, but no means of supplying them.

I simply offer these facts in passing as evidence of neglect, both State and private, of this great army of afflicted citizens, with the hope that the suggestions may pave the way to the supplying of a State institution so broad in its policies and so wide in its range that it may be justified in the claim that it is the greatest of Ohio's charities.

An institution to meet all of the demands of this class of cases must be arranged for the care and education as well as for the treatment of its inmates, it must be considered from a different standpoint than most of the private or public institutions of the country. It should combine all the elments of a well directed home, of a scientifically arranged hospital, of a school and polytechnic institute with administrative management so thorough and complete as to compare with the very best of our public institutions.

To the end of perfect organization and completeness of detail, I should have as the central part of the plan an Administration Department, the name of which implies its purpose. In connection with this I would propose a Physical Department in which would be administered everything known to modern science in

the way of treatment, including special departments for the administration of hydropathic, electropathic, and manipulative treatments, together with essential mechanical and physical culture means adapted to the special requirements of the cases under treatment.

In this same department I should arrange for the training in health culture principles, including diet, hygiene, sanitation, etc., etc., conducting a line of research and enforcing a course of instruction which would accrue to the benefit of all, always bearing in mind the possibilities of each case.

Unfortunately many orthopedic cases are not curabie even under the most favorable circumstances and conditions. This, as you will all agree, constitutes one of the greatest reasons for the adoption of the educational plan in connection with the institution which has for its purpose the welfare of its beneficiaries. There are few cases but can at least be greatly benefited physically, there are none but that may be the better prepared for self help and usefulness if they are cared for in a properly managed and equipped institution, with an eye to their general betterment.

No matter how badly distorted a body may be, how helpless it may seem, there is always some compensating characteristic which if sought out and improved may help the individual to a life with some purpose and some practical good.

Fortunately nearly every crippled and deformed individual is possessed of good mental faculties. They are of good habits, ambitious and willing. Natural qualifications, compared with many of those under the care of the State, rank them as vastly superior and more capable, and for this reason, if for no other, they are more justly entitled to the aid the State can afford.

To the end of meeting all the demands of the care and treatment of the crippled and deformed I would therefore suggest a polytechnic and manual training department, having for its special purpose the

preparation of the crippled and deformed for such vocations in life as would best supply their individual requirements and be most suitable for their life work and personal support.

cases.

This department should be so planned as to have for one of its chief purposes, the manufacture of such apparatus, machinery and devices as would be useful in the practical treatment of all orthopedic None should be more capable of devising ways and means than those who are afflicted and if the patients themselves had the means at their command they surely could greatly improve much of the apparatus which is necessary in their treatment. This would afford not only range for their ingenuity, but it would as well give experience in the trades and sciences which would be helpful to all so inclined.

In this same department many of the other trades and sciences could be supplied for both males and females. In fact, there should be established a manual training school reaching from a kindergarten to a completed education. From the simplest vocations to the most extensive preparations whereby the instructors and teachers for the future operation of the institution could be constituted.

This would be possible and practicable within a short time simply by the qualification and employment of the incurable patients and would afford for a number of those without hope of permanent recovery, employment which would be most useful and helpful.

I have thought out much of detail which owing to limitation of time I can not present now, but I hope the general ideas I have expressed may be sufficient to enlist your support to the end of obtaining your influence in creating a public sentiment in behalf of this class of individuals and of directing the attention of your county and senatorial representatives to the real situation as regards the present condition of this class of individuals and the great need of a public institution for their care and treatment.

HINTS IN THE EDUCATION OF CHILDREN, BASED UPON THE ANATOMY AND PHYSIOLOGY OF THE NERVOUS SYSTEM.

By W. H. Bigler, A. M., M. D., Philadelphia, Pa. Before proceeding to a consideration of the main subject of this paper it will be necessary to advance two preliminary propositions which form the foundation upon which the views to be expressed are based.

In the first place, in addition to numerous phenomena which collectively amount to convincing evidence of the fact, we are taught by our own consciousness that in us there is a something the Ego-which is distinct and apart from the material physical body, itself not material, not confined or restricted to any portion of our anatomical frame, but of the essential nature of which we are, and at present must remain, ignorant, owing to the solely material means at our command for acquiring knowledge.

Secondly, although this Ego is separate and distinct from the body, the body, and more particularly the nervous system, is the only means and the sole instrument by which it can manifest its existence and activity, and upon the integrity and normal constitution of which it is dependent for its own adequate expression. A prisoner at present, it is brought into contact with the external material world only mediately through the senses. Through these alone can it acquire a knowledge of its surroundings, and through the stimuli afforded by these alone can it be aroused to an activity, which again is manifested only mediately, through the physical body as responsive to these stimuli. This mutual action and reaction is a fundamental principle according to which all education, physical, moral and mental must be directed. The mind may be sound but if the body be not the same we may not know it.

Reasoning from analogy we must believe that the ego, although undergoing no essential change, is still destined to unfold its capabilities and powers. This it can only do, in the present stage of its existence, under the influence exerted

upon it from without, by the environment of its containing body. We see thus how necessary to the proper unfolding of the ego, to the changing its potential into kinetic energies, is the soundness and the integrity of the body, particularly of the nervous system, and how important it is for all who have to do with education, be it of the child or of the adult, to have clearly defined views as to the laws according to which they must act if they would have success. These laws are not in the last instance psychological but physiological; they are not mental but histological. The mind can only be reached through its instrument, the central nervous system, and in its molecular structure we must look for the explanation of the modes of mental activity. By seeking to modify this structure in ways shortly to be spoken of, even without knowing precisely how it is effected, we cause the outward expression of the ego to correspond with these modifications, since it has no other means of expression. The soul of a Mozart, or of a Beethoven, expressed itself through the medium of the body of the musician and the poor little tinkling spinet or harpsichord, but how different would have been the expression of the same ideas of the same soul through a Steinway or a Chickering Grand! Let a musician attempt to give voice to his inspirations on an instrument out of tune, how utterly must he fail. Tune the instrument, and the same effort of the same mind will produce an expression adequate to the conception. What must be the horrors of a sane mind in an insane body!

We will now present some facts in regard to the anatomy and physiology of the nervous system, upon which may be founded certain basal principles to be applied to the education of the young.

The nervous system is composed of a mass of separate nerve cells (neurons), connected throughout its whole extent by their contiguity not continuity. The neurons each possess at least one branch, the neuraxon, or axis cylinder, with its collaterals, both efferent in character, and protoplasmic prolongations, the dendrons,