REËDUCATION OF THE DISABLED
In all probability not one person in a hundred ever heard the word
"reëducation" before reading the very recent newspaper accounts of
the government's plans as announced by Surgeon-general Gorgas for
rehabilitating and reëducating the disabled soldiers. We have been in
the habit of seeing blinded and crippled men selling lead pencils at
street corners, and we have given our pity and our penny. We have seen
the wonderful rugs woven by the blind (assisted in the designing and
setting up by people who could see), and we have bought them, impelled
by a sympathetic interest in a charitable cause. We have heard some
exceptional person, who has overcome tremendous physical disabilities,
describe her methods of studying college subjects and competing
successfully with those who are unhandicapped, and we have said "How
wonderful!" and stopped thinking at that point.
As a nation we have failed in our duty to make the physically
handicapped economically self-supporting and normally strong. It is
an educational problem as great as, if not greater than, that of
assisting the mental defective.
Only within two years have the vocational schools of our country
even thought of instructing their pupils in the general principles
of safety. Only since workingmen's compensation laws and industrial
insurance have come into the foreground in legislative halls have
public men considered the appalling need for "safety-first" instruction
in factories and in technical schools.
For the duration of the war our thought of safety appliances for
industrial life in peaceful times sinks into the background, and we
think only of devices for preventing suffocation by poisonous gases,
of means of withstanding liquid fire, of deflectors for bullets
and camouflage for marching troops. But notwithstanding all these
precautions, the inevitable results of war are before us.
The multitude of men who have been injured in the present war is out
of all proportion to the number injured in any war with which history
or experience makes us acquainted, and the fitting of them to be
economically self-supporting is a task of stupendous proportions. For
the problem of the support of these men cannot be met entirely by
pensions; even if this were possible, the man would thus become a dead
weight for the rest of the country to carry, an unenviable position
from all points of view. In the case of the professional man, he may,
even if handicapped, carry on his work; but the man with a trade, when
maimed or blinded, must be taught some other vocation or be provided
with some mechanical substitute for his loss in legs or arms and often
with special tools and other apparatus which will enable him to carry
on his former occupation or a new one. It will not be possible to place
all these men as ticket sellers, news vendors, gatemen, and in other
positions hitherto appropriate for the industrially disabled; and our
vocational schools, the medical profession, and the national government
must coöperate in a study of the reëducation of injured soldiers with
the aim of putting them on the pay roll.
On July 31, 1917, announcement was made through the press of the United
States that a government system for the rehabilitation and reëducation
of men disabled in the fighting abroad would be made an adjunct of the
proposed scheme for the federal insurance of soldiers and sailors, and
that the plans for the rehabilitation of these men would probably, like
those in Canada, be modeled after the systems in use in France and
England. It is, of course, part of the government's duty to provide for
the future of men crippled in its service. It is not the province of
the several philanthropic agencies which in the past have commendably
endeavored to care for the blind and the crippled by teaching them the
handiworks of weaving, brush-making, etc. The work must be done on a
sound and scientific basis, and be adjusted to economic conditions on a
vast scale such as no philanthropic society can hope to maintain; that
is, it must not be relief work, it must be governmental constructive
work in reëducation which shall teach the disabled man how to overcome
the disadvantage of his infirmity in reëntering the industrial world.
To learn the extent of what may be done in this work of rehabilitation,
England, Canada, and the United States look to France,--to the
municipal vocational-training school for soldiers at Lyons known as
L'École Joffre and the many schools patterned after it in other cities;
to the Institution of St. Maurice, at Paris, which has been established
by the French government to be a model for other institutions; to
the Laboratory of Research on Vocational Work, in Paris, directed by
Dr. Jules Amar; and to the Anglo-Belgian hospitals, especially that
at Vernon. It has been announced that the United States will pattern
its training school after the Institution of St. Maurice, which is a
clearing house of experiments and research for the continent.
There are also in France, as in England and Canada, convalescent
homes for disabled soldiers,--many of which are supported by private
benevolence,--where trades are taught. At the Institute of Les Amis
des Soldats Aveugles, in the suburbs of Paris, the blind soldiers are
taught the trades of basket-making, bootmaking, brush-making, netting,
harness-making, and bookbinding, the course taking about six months
before the pupils become proficient. The institution runs its own
printing establishment for literature in Braille (the print for the
blind). The blind are peculiarly incapacitated, and the occupations
open to them are consequently limited. Private benevolence has done
much to lessen their economic misfortune, and the government must
do more. Some French doctors believe that tobacco manufacturing and
matchmaking are adapted to the blind because of their well-known
delicacy of touch; many hospitals are giving them lessons in the art of
massage, for the same reason, believing that the blind man can qualify
for this employment in a few months. The work, however, is still in the
experimental stage. But the most progressive work in France has been
done in the municipal and government training schools in equipping the
maimed and crippled for work, and it is this of which this chapter will
treat.
The government institution of St. Maurice follows the lead of the
now famous L'École Joffre, which in turn learned much from a school
at Charleroi, maintained before the war for victims of industrial
accidents. L'École Joffre was the pioneer which has blazed the way for
the technical instruction of the wounded. It was founded under the
direction of the city of Lyons, with the mayor of the city, Edouard
Herriot, most active in the undertaking, and Maurice Barrès to spread
its fame with winged words. To house it, an old disused château in a
populous part of the city was put in order late in 1914, and early
in 1915 the men discharged from the hospital and pronounced suitable
for training entered upon their course of instruction. The first one
hundred cases received were restricted to those disabled but cured of
wounds, the partially paralyzed, and those recovered from amputation.
To direct the technical work, Monsieur Basèque, a professor in the
industrial-accident school at Charleroi, was chosen. The success of
the school was immediate, and by September another was opened in the
outskirts of the city to accommodate 80 men.
Naturally, at first, experiments were made, and the experience of
L'École Joffre is most valuable to us. Three schemes were inaugurated:
one, called _placement à domicile_, where an allowance was made the
man, who was to live in his own home while he entered a workshop to
learn a craft of some sort; another, _la mode de l'externat_, where
the man pupil lived at his home or in lodgings while attending classes
daily, receiving at the school at noon a canteen meal in order to save
the time which would otherwise be taken in going home; and a third, _le
régime de l'internat_, where he lived in the institution as a pupil
in a boarding school. Experience developed that this last method was
the only one which might be adopted with any assurance of success,
the others subjecting the men to possible discouragement, through the
jealousy shown by other shop workers, the necessarily slow progress,
the inequality of pay, the varying degrees of instruction, and
insufficient supervision. Canada too, after investigation, has found
that the men throughout their training must live at the school and be
under supervision, in order to avoid discouragement and the forming
of bad habits of idleness and alcoholism, and to insure continuity of
interest in their work.
The condition of entrance to L'École Joffre in Lyons is that the man
must be pronounced permanently unfit for military service. Next he
is examined to ascertain his fitness for industrial work, a matter
determined by his freedom from disease, his previous work, his general
education and ability, the employment preferred, and the occupations
open. Whenever possible, the man is kept in his former employment.
This principle is sound economically and psychologically, and must
be adhered to in our schools. The employments for which training is
given are bookkeeping, shorthand and typewriting, paper-stitching,
bookbinding, toymaking, shoemaking, woodworking and drafting,
tailoring, wood carving, gardening, and machine adjusting. Office work
offers special opportunity to the one-handed and the crippled, as
stenography and typewriting do to the blind. The course with commercial
subjects, it was found, had to be carefully restricted, for many
without sufficient education wished to take it up, and there was danger
of sending too many men into occupations already well supplied with
competent workers.
L'École Joffre is a municipal undertaking, a free school, the men
pupils paying no board or tuition. It is in a measure subsidized, for
the school receives from the Ministry of War a grant of 3 francs 50
centimes for each pupil for each day's attendance. The other funds to
support the school are provided in various ways--popular subscriptions
and grants by provincial organizations and other official bodies. As
for the men themselves, they do not, while in training, receive the
government pension of 1 franc 70 centimes a day, but the school makes
each man an allowance of 1 franc 25 centimes a day from its own funds,
so far as they permit of such liberality.
The work done by the city of Lyons has been followed in many
localities,--Bourges, Bordeaux, Marseille, Rouen, and others, in most
cases endowed by the municipalities. At Bourges additional classes are
held in silver-engraving, hair-dressing, and locksmith work.
In the similar school in Marseille, tinsmiths, foundry workers,
jewelers, and metal workers are trained. At Cluses, in 1915, seventy
partially disabled men were serving an apprenticeship in clock-making.
This is sitting work, but it demands the possession of one hand and at
least two fingers on the other, and an exceptionally good eye, so it is
not so generally taught as other trades. At Cluny a course of training
has been established for the former workmen who wish to become master
workmen and designers; that is, the school specializes in training
those whose ability is above the average.
It must be remembered that in French provinces there are many more hand
processes in use than in the United States. Joinery and carpentry,
for example, employ tools to make parts which in this country are
turned out in factories. The industrial difference is evident in some
of the photographs of the rehabilitated French workmen who are shown
ingeniously at work with artificial "hands and arms" on processes
for which there is no field here. Many French soldiers, too, find
employment in toy making, a real industry for France and Germany, but
one which is unlikely to be developed here to any extent. In America
we must fit our disabled men to tend machines, and not make the
blunder of preparing men for operations which are out of date in our
standardized machine industries. In a very moving little book, "Les
jeunes filles françaises et la guerre" (Jules Combarieu, Paris, 1916),
we read of a man who was employed in a joinery establishment after
suffering the amputation of both hands. His left arm was furnished
with a leather glove to which was adapted an ingenious instrument for
holding nails. His right arm was fitted with another glove arrangement
to which a hammer was attached. With the left he took the nails; and
with the right he pounded them into a piece of wood. Marvelous as
the achievement may be, in America this workman would belong to the
class for whom special relief workshops must be maintained. Work in
reëducation must naturally be adapted to the demands of the vicinity;
the French towns of Nancy, Clermont, and Montpellier have not the
industrial conditions of Pittsburgh, Worcester, or Birmingham.
In Paris the model government institution of St. Maurice contains both
a convalescent hospital and a training school for discharged patients.
It has the advantage over L'École Joffre of uniting hospital and
school, giving an opportunity of combining physical with industrial
reëducation. It is therefore possible to have at St. Maurice, under
the direction of Dr. Bourillon, physiotherapy by massage, electricity,
medical gymnastics, and mechanotherapy, which prepare the man for his
reëducation. Dr. Bourillon affirms that this preliminary medical care
reduces the effort which the patient must make to learn and exercise a
trade.
The French government also maintains at Paris the Laboratoire des
Recherches sur le Travail Professionel,--an establishment for the
scientific examination of wounded men, particularly to ascertain the
percentage of their disability in the labor market. The question of
how many disabled men are capable of reëducation is one not rigidly
determined. There are, of course, some hopeless cases which will have
to be entirely dependent on the government for their support, whether
by pension or other means under discussion. But the figures of Dr.
Jules Amar, director of this laboratory of industrial research, a man
who has devised mechanical apparatus for developing the capacities of
injured limbs, show that of the maimed cases which have come under his
observation at least 80 per cent are capable of vocational reëducation.
Of this proportion 45 per cent succeed in earning normal salaries after
a training including some specializing; 20 per cent are partially
restored to normal wage earning; while the remaining 15 per cent can
only obtain work in shops maintained especially for the disabled, such
as a toymaking studio. Of the reëducation of this 80 per cent Dr.
Amar says: "It is a question of science and method; it demands the
organization of training schools.... It unites medical and technical
knowledge to the end that artificial limbs shall be adapted to satisfy
physical and vocational capabilities. The proportion of men dependent
upon relief is then reduced; and one must endeavor, without ceasing, to
diminish it."[6]
The method in the Paris schools is scientific. "In the training
schools," he continues, "the object of the instruction is to
supplement the diminished physical capacity of the disabled man with
a greater knowledge of his trade, superior technical instruction, or
better vocational adjustment."
[6] Special Bulletin of Military Hospitals Commission, Canada, April,
1916.
The first responsibility falls on the medical examiner. To reëquip
the maimed physically, an indispensable prosthesis (an addition of an
artificial part to supply the missing member of the body) is made,
the _dynamical_ prosthesis--not the kind which _replaces_ the member,
but that which reëstablishes or repairs the _functions_. What the
wounded man needs is not an admirable imitation of the missing arm or
leg, ingenious and often fragile appliances, but a practical working
tool,--a socket into which a variety of tools can be fitted.
Next, in the laboratory of the school an analysis of the workman's
movements is made in relation to their regularity, direction, speed,
and according to the force they expend. The measure of the man's
physical incapacity is deduced from impressions gathered in this
analysis, and from it the method of training must be devised. Furnished
with his card of qualifications, the man passes from the hospital
laboratory to the workshop, where experts instruct him in theory and
practice. The first thing to determine is whether a man cannot perform
the operations of his former trade. In many cases a man imagines that
the disability caused by amputation of fingers, hand, or arm makes him
unfit for the work he did previous to the war. But where the school
is attached to a hospital and the man's disability can be accurately
known, the union of medical skill and technical instruction makes it
possible to restore him to usefulness with the minimum of effort and
waste.
Dr. Amar recommends for special relief work for the 15 per cent who
are not capable of any great degree of reëducation, shops which will
execute orders for easily manufactured articles, involving such
processes as light cooperage, stamping, plaiting, toymaking,--work such
as is offered at the shop in Rue de la Durance, Paris.
Another institution whose methods are similar to those employed at St.
Maurice and by Dr. Amar is the Anglo-Belgian Military Institute, at
Port Villez, Vernon, under the technical director Major Haccourt. It
accommodates over 800 men, and is self-supporting, the land where it is
situated having been originally covered with forests, the sale of which
financed the undertaking at first. Forty-three trades are taught here,
and a large farm is maintained on which horses wounded in war are cared
for and made useful. The workshops provide for commercial courses,
telegraphy, wall-paper designing, the manufacture of motor vehicles
and electrical machinery of all kinds, plumbing and tinsmithing,
rabbit and poultry farming, fur curing and dyeing, etc. The shops
make fuse boxes for munitions, and various army supplies. At Vernon
the men pupils are regarded as still in the Belgian army, receiving
military pay; they have no option as to entrance, since they are under
military discipline, but enter as soon as they are discharged from
the Anglo-Belgian hospital at Rouen. In this school the services of
the best professors in different trades are obtained without trouble,
for the director can requisition any man in the Belgian army for any
required purpose. Before the war Belgium had a large proportion of
highly trained workmen; and with compulsory reëducation and military
discipline the operation of this institution is much simplified.
In working out plans for reëducation in the United States we must
have in mind certain principles. There is the necessity of making our
training thorough. Our problem will be not to find employment for
the period of the war, during which there is a constant demand for
workers, but to train the disabled for an occupation in which they
can hold a place after the temporary shortage of labor created by the
war conditions is over. It is obvious that if the men are incompetent
and ill-prepared for their work, they will be weeded out as soon as
skilled men are available. Their work is barred from that demanding
manual strength; nor can it hope to belong to that highly specialized
kind which would demand an arduous and elaborate training. But there
is a wide range of semiskilled occupations where a handicapped man
can earn more than if he should enter after a long course of training
the highly skilled trade where he would meet the competition of the
physically normal.
There are at least three kinds of disabilities our schools will have to
deal with. First, there is the man who has lost his right arm. This man
must, whenever possible, be taught to use his left hand in his trade,
although it is sometimes easier to learn a new process than to change
right-hand to left-hand methods in the old operation. In carpentry,
turning, and machine trades, however, the one-armed man may continue to
be employed, and our vocational schools should incorporate courses in
left-hand training. Here also we find another need: there must be built
for the disabled _left-hand machines_.
Next there is the case of the man who must be instructed in an allied
trade because his former one is pronounced by medical examination and
the tests of mechanotherapy to be impossible. And last there is the
case of the man whose injury makes necessary the fitting of delicately
adjusted prosthesis and a course of expert training before he can
become a wage earner.
Our chief difficulty in our work of reëducation will be to secure the
right kind of teaching force, and it is clear that our government must
establish schools to train our technical instructors how to adapt their
knowledge of trade teaching to the kind of work demanded in giving
instruction to the physically disabled. The selection of the proper
type of teacher is vital to the success of any scheme of reëducation.
The ideal instructor must not only know his trade but be able to suit
his methods to the individual case so as to get the best response from
each man under his direction. At present it seems as if there would be
no way of training instructors except by sending chosen trade teachers
to St. Maurice to study the French methods, that they may return to
this country properly equipped to select and instruct others, until
such time as a government school of the right type is well established
in this country.
As for the schools themselves, they must be undertaken by the
government, even if additional hospitals and laboratories for research
are maintained by private benevolence and bequest, for there should
be no limit to the funds available for carrying on this work of the
economic rehabilitation of the men injured in the service of the
country, and it must keep pace with the progressive work in France and
elsewhere. Branch schools in municipalities may be organized under
government control and subsidized by federal money. Some of our trade
and vocational schools and their equipment may be taken over by the
government for this purpose. Our trade and technical schools must
also include courses in training teachers for this special work, the
course to be supplemented by a special preparation prescribed by the
government.
In Canada the Military Hospitals Commission has made a careful study of
the French and Anglo-Belgian treatment in the restoration of disabled
soldiers, and has equipped the Central Military Convalescent Hospital
at Toronto with the mechano-apparatus similar to that used in France
by Dr. Amar and Dr. Bourillon. Profiting by their observation of the
foreign hospital schools, they have determined to consider the men
in training as still in hospital and under military rule, for in
Europe there is absolute unanimity of opinion that the influence of
convalescent homes and benevolent support is bad, conducive to lax
discipline and idleness. Canada has agreed that the earning power
subsequently acquired by a pensioner in training will not lessen his
pension. To pass upon the cases eligible for reëducation, Canada has
a board of three: a member of the Provincial Advisory Committee, a
vocational officer, and a medical man, thus combining with technical
and medical aid advice in the industrial choice and placement of the
man pupil.
Realizing that reëducation is a new idea to most soldiers and, indeed,
to the public generally, Canada has put forth a propaganda of making
popular the training courses. A bulletin has been posted conspicuously
in public buildings and a printed card circulated bearing the same
information, "What Every Disabled Soldier Should Know." Aside from
encouragement and directions of where to obtain help, etc., we find the
following:
That his strength and earning capacity will be restored in the
highest degree possible.
That if his disability prevents him from returning to his old
work, he will receive free training for a new occupation.
That full consideration is given to his own capacity and
desires when a new occupation has to be chosen.
That neither his treatment nor his training nor his
transportation will cost him a cent.
That his maintenance and his family's will be paid for during
his training and for a month after.
That his home province has a special commission to assist him
in finding employment on discharge.
To further the publicity of the work in Canada, moving-picture films
have been prepared, systematically illustrating the treatment and
reëducation of wounded soldiers in England, France, and Canada, and
showing their progress up to the stage of final recovery. These films
have been shown in hundreds of theaters throughout the Dominion.
It is encouraging that occasionally in France and Canada the vocational
training in connection with hospitals places a man in a better position
financially than before. The following examples are given out by the
Canadian Military Hospitals Commission and are testimonials of the
possibilities of rehabilitation.
Letter received is from an ex-private in the 13th Battalion.
Before enlistment he was getting $12 a week as driver on a city
milk round. "I always had a liking for drawing," he says, "and I
felt that if I ever had the chance I would take up a course in
mechanical drawing." This opportunity came to him at one of the
commission's convalescent hospitals. After six weeks' application
to the work there, he was able to secure an appointment beginning
with $75 a month, with good prospects of advance.
A locomotive fireman had enlisted, was severely wounded, and
had to have his left arm amputated. Under the commission's scheme
of reëducation, which is offered to all men incapacitated for their
former work by service, he received special training in telegraphy
and railway routine. As a result he secured an appointment as
station agent and dispatcher at $110 a month.
In England the high sheriff of Lancashire has formulated a scheme for
listing the employments open to the disabled. First, the employer is
asked, whenever possible, to give the returned soldier his old job.
Next, certain employments are listed as being within the powers of
partially disabled men, and with the help of labor exchanges and of
other agencies, these are reserved for them.
It is for the economic interest of the State to make possible the
employment of the disabled. The amount of a pension is not the measure
of the cost of the pensioner. The nation cannot afford to let any human
power go to waste or lie idle. To reëquip the maimed is to make him
partly forget his infirmity,--an indispensable mental advantage. France
is now discussing whether reëducation of one form or another shall be
compulsory, as in the Anglo-Belgian hospital. "But obligatory or not,"
says A. L. Bittard,[7] "the industrial reëducation must be above all
a national work. We should regard it as a debt owed to the wounded
and as an effective preparation for the future of the nation.... The
State alone is capable of giving all the mutilated the maximum equality
of treatment, where private initiative would be totally incapable of
realizing the minimum."
[7] A. L. Bittard, Les Écoles de Blessés. Paris, 1916.
The war simply makes the question of reëducating and rehabilitating the
disabled a striking one. But we must not forget that the problem of the
injured is always with us. It may not be amiss to point out that 54,001
men and women were actually killed in the United States during the year
1913. This means one killed every ten minutes. Over 2,000,000 men and
women are injured in the industries in the United States each year.
This means one injured every sixteen seconds. The economic loss from
accidental deaths and injuries is nearly $500,000,000 annually, and the
loss from preventable accidents and diseases would more than pay the
cost of maintaining all the public schools in the United States. These
are appalling figures.
At present the great fear of every boy who goes to war and of every
sister and mother of such a boy is that he may go through life maimed
and dependent. But we never think of the ever-present danger to these
boys of being handicapped physically by merely going to work; and yet
there are more persons so disabled through accidents in industrial life
in normal times than are disabled by war.
When our boys come back from the war, physically disabled, and through
the government work in rehabilitation and reëducation are made
self-supporting and self-respecting members of society, we shall
begin to appreciate that we have been extremely negligent in the past
in limiting our efforts to help the crippled and blinded to the good
offices of charity and philanthropy. It is a public matter. It is a
problem of education. It is an opportunity for service for the teachers
of vocational training, for the experts in vocational guidance and
direction, for the directors of placement and employment bureaus, and
for the designers of special tools and machines for the handicapped.
It is an immediate problem in this time of war; it is even more
significant in time of peace.