This historical study carefully examines the processes that led to the care of crippled children in Virginia between 1910 and 1935. The efforts of the maturing professions, philanthropists, lay persons and government programs shaped the care of children in the state. In the early years of the twentieth century the primary cripplers of children were tuberculosis of the bone and joint, congenital malformations and accidents, while later in the period polio became the primary threat to the physical integrity of children. This study aims to unravel the complex social, economic, and political climate of that time, and rediscover the professional knowledge and values that drew attention to this population and set the stage for developments in their care. Virginia, a segregated society during these years, serves as a case study and provides an example of a southern state with a large rural population along with two urban centers. Between 1910 and 1935, the state greatly enhanced its public health, welfare and education programs. The Federal Social Security Act, which had specific provisions for crippled children, provides the end point for the study. Examples from other locations throughout the country provide a counterpoint to the care model that emerged in Virginia.

Crippled children's care emerged in Virginia in the second decade of the 20^th century in conjunction with the introduction to the Richmond area of orthopedic surgery as a specialty, the success of visiting nursing in the identification and provision of care for poor urban children and the promotion of health for all Virginians by the State Health Department. It is no surprise that the initial efforts were successful in urban environments, as they were in New York twenty years earlier. Fundamental differences in rural and urban populations, racial tensions and compromises, and progressive ideas as they developed in a southern state are discussed. Tuberculosis as a crippler of children is employed as an example of orthopedic care. The study illustrates two waves of US crippled children's programs that roughly corresponded to the prevalence of two crippling diseases, tuberculosis and polio. Poverty became a defining qualification for state supported care.