Returning the Disabled Soldier to economic Independence
It is surprising how very recent has been the development of the work of rehabilitating the disabled man. Up to ten years ago absolutely nothing had been done in that direction, and while the cripple received monetary compensation of one kind or another in the past, nothing was done to put him back on his own feet or to deal with him in a constructive manner. The only obligation acknowledged to the disabled soldier in the past has been the pay- ment of a pension—which has not always been a help to the man in the long run. It has been a necessary provision, of course, but it did not go far enough. It was never enough to support a man, on the assumption that he was totally disabled, and has acted more or less as a subsidy which has not proven an encouragement for him to go out and earn his own living. We have dealt practically in the same way with disabled industrial workers. We have, even under the most enlightened legislation, compensated him for his disability in the form of* a money pension and left him idle and without any means of getting back to usefulness. This is also, I am glad to say, in the process of change. The first school for the disabled adult was established in 1908 in Belgium, at Charleroi, and was practically the only school in existence up to the opening of the present war. During the first couple of weeks of hostilities that school was swept out of existence by the German invasion. The next move was made in Lyons, France, in December, 1914. That institution was the fore runner of all the other schools, of which there are now over one hundred in France alone. The work has been taken up by practically every other nation, it being realized that the only real compensation to the disabled man is to put him back again where he can be useful, where he can be productive, and in a position where he can be happy and contented. Now when we talk about rehabilitating the disabled soldier. The Annals op the American Academy when we talk about taking a man who has lost an arm or a leg, or who has lost two legs, and sending him out to earn his own living sigain so that he will be able to earn as much as he did before, it *does not sound plausible. The usual reaction will be: "That's all very well to talk about but can it be done? " I think I can demon- strate the logic of it by a couple of simple examples. Let us sup- pose that a man comes back_frpm the front with both legs off. That is a serious handicap and he would ordinarily be classified under any pension scale as totally disabled, laid aside forever. Presume, however, that we take that man and teach him linotype operating, a job at which he will be seated all day long and which requires the use of only the head and the hands. Can that man turn out as good a day's work as the able-bodied worker next to him? There is absolutely no reason why he cannot. Let us pre- sume that we have a man with only one arm, and that again is a serious handicap, because the arm cases are infinitely more difficult, generally speaking, than the leg cases, particularly in the case of manual workers. Let us suppose that we put that man in a furniture factory at a job as striper, that is, a man who takes the chairs after they have been painted and puts the stripes down the legs, or wherever the design calls for them. If you take a man with two hands and put him at that job he would probably keep one hand in his pocket because he will not have to use it. Is a man with one arm at all handicapped when placed at work of that character? I was struck the other day when reading a document describing the work for the blind at one of the centers in Europe to learn that they had found successful employment for the blind in a clock fac- tory at the job of testing out the gongs—spiral pieces of tempered wire, upon which the hours are sounded. One of the jobs is testing these gongs, listening to the tone, and then adjusting the gauge at the end to make the tone right. The blind are used almost exclu- sively for this work and perform it as well or better than sighted workers could do. In finding jobs for the handicapped, we look at the disabled man's capabilities rather than at his disabilities, and if we look long enough and carefully enough we will find many jobs for which the individual disability does not disqualify. If men are trained and put in those jobs they will, of course, succeed. This is, however, not as easy as it sounds. It requires long and painstaking work. Disabled Soldiebs and Economic Independence the most successful mechanism for discovering possible jobs is what is known as the industrial survey, with special reference to the placement of the handicapped. Such surveys were undertaken first in a very informal way in Great Britain, where committees studied certain trades and published statements of what opportu- nities there were in those trades for disabled men. Canada then took up the work and has done a most thorough and intensive job. The Invalided Soldiers' Commission has surveyed industry after industry, listing every process in the fields covered with relation to men with all types of handicap—leg cases, arm cases, blindness, deafness and the like. Work of this character brings easily within range of the placement officer or vocational adviser a large number of jobs, which can be sifted down in relation to any individual case. Some will be found exceptionally favorable, others medium, and so forth, and there will be discovered many processes that could not be known of unless some such large scale operation were carried out. What is the course of the disabled man from the battlefield on which he is wounded, back to self-support? He passes through the mechanism of the medical corps at the front, through the clearing stations and base hospitals, and when it becomes evident that he is no longer needed for military service and can no longer be useful for duty at the front, or that he will be laid up for a considerable period of time, he is invalided home. He passes here through the recon- struction hospital, which differs from the ordinary hospital, in lay- man's parlance, only in the more intensive treatment given. He is retained just as long as he profits by treatment, and the endeavor is to restore the man to the best physical shape possible. While he is in the hospital, in addition to medical and surgical care, he is constantly under treatment of another character. In the first place he is there getting occupational therapy—something that will keep the mind active, something to drive away the tedium of idleness and keep him from thinking about himself, something that gets him again interested in life. Occupational work of a very simple nature is sometimes carried on at the bedsides or in the wards and serves the double purpose of interesting him and being of per- manent value. For example, if a man who is in business in a small way can be interested while in the hospital in learning some of the principles of accounting, it will enable him when he goes out, to run his business better, and yet at the same time serve the therapeutic The Annals of the American Academy purpose in view. It will leave him at the end of the treatment with some definite asset as a result of his stay in the hospital. One of the first necessities is to overcome the natural discour- agement which comes when an able-bodied man—and the men of our forces are more than able-bodied; they are the pick of the coun- try—when you take, a man like that and strike him down from such full physical power and make him, as he thinks, a cripple for life, it is a very desperate experience. Our injustice to the disabled man in the past has made it even more of a despair than it should be, for he often happens to know of the man who used to work next to him in the factory and who lost an arm. .Where is that man now? Well, the superintendent thought he would be good, and made a messenger's job for him. He is getting $12.00 a week now whereas- he used to earn $30.00. The soldier also knows another man who was injured in the factory. What is he doing? Selling pencils on the main street. And so he could go on, practically without excep- tion, thinking of case after case where disability meant practical hopelessness. That is what he visualizes as the future for himself, and in first dealing with him you have to grant that the deduction is theoretically correct and then simply endeavor to tell him that things have changed, that the matter is seen in a wiser way, and that much better provision is being made by the government to deal with his situation. At the earliest moment, men of high ealiber should be brought in close, friendly, and confidential touch with the disabled man, to show him what there is ahead, and lead him to begin to think about his own plans. Now, when he has once gotten a little spirit back, when his ambition is aroused again and he begins to think he can do some- thing, the next necessity is to find what he shall do, and that neces- sitates what is known in some of the countries as a vocational survey. We have found, let us presume, through industrial surveys and other means what jobs are possible to the disabled. We are asked again and again, and I suppose everybody who is interested in this work has been asked the same question: What are the jobs for the one-armed man, what are the jobs for the one-legged man? For answer we must say that there are none. Experience has shown that for five hundred one-armed men there are probably four hun- dred different jobs that they might most profitably fill, and the chief criterion that has been found effective in determining the Disabled Soldiers and Economic Independence choice is the past experience of the man. You are dealing with a man—not with a boy who is making his first vocational choice. You are dealing with an adult who has had actual experience in jobs. That experience should not be wasted, but every effort made to conserve it. The principle may be illustrated by two superficial examples. Let us presume that we have a railroad hand, a brake- man, who has come home from the front with a leg off or a foot off. That is not a serious handicap in some senses but it would at least prevent him from hopping on and off freight cars. What are you going to train that man for? If you have found printing a good job for a man with a leg off, would you train that man to be a printer? The answer would be most decidedly negative, because such a course would waste all his past railroad experience. On the other hand, he might be trained to be a competent telegrapher and sent back to the railroad he worked for in the past. We can then say, "Here is John Jackson. He has worked for you for a number of years and you know him to be reputable, sober and steady. Although he. cannot go back to his old job, he has been trained to be a competent telegrapher, and perhaps you can put him in the train despatcher's office or in a switch-tower on the road." The minute he gets that job all his past experience as to rolling-stock, time schedules, and railroad practice in general immediately comes into play, and is saved rather than thrown away. The organization of re-education has varied in the different belligerent countries. In France the first school was started by a municipality, and other schools, in sequence, by an employer's asso- ciation, a department, or state, a charitable organization, a trade union, and various other organizations. In fact, there exist today schools under almost every type of administration. The result is that the work varies widely. If you go to one city you will find the courses of a certain length, and if you go to another city you will, find that they are only half as long—or twice as long. The result is that the advantages of the French soldier largely depend on how lucky he was in picking out a place of residence before the war. This is in some ways unfortunate and gives men in some localities a better chance than the men in others. The type of work varies tremendously, the standards being different in prac- tically every school. The French saw the difficulty of this and have founded a National Office for War Cripples. That office endeavors The Annals of the American Academy to standardize the work but it has no real authority except in the control it exerts in the award of subsidies to some school. The office requests the schools to standardize, and sends out questionnaires, but does not get much further than that. England's experience holds for us a lesson by which we have profited. In this work of re-educating the disabled, England found1 herself in no worse situation than any other country, although with- out any provision at all. The work did not start early. A great, many of the disabled soldiers in the first year of the war were dis- charged, at a time when there were only two charitable institution» to which they could turn. These two did their best to meet the situation, but it was a bigger job than any charitable organization, ever undertook before, and they were not able to handle the situa- tion. The government stepped in and formed a statutory com- mittee and gave that committee some funds, expecting further funds to be supplied by the charitably disposed public. But the British public did not consent to this and said to Parliament, "This is a national job. The soldier disabled in .the service of Britain should certainly be taken care of at the expense of the nation." That was where the job belonged. So in the third year of the war the whole work—pensions, medical treatment after dis- charge, re-education, placement—was turned over to the Ministry of Pensions and is now under one single administration. The only country that saw the job from the first as a national responsibility was Canada, and I think it is a very great and lasting credit to our northern neighbors that they did so. Practically from the beginning of the war, no Canadian soldier has had to be in any way dependent on charity or philanthropy. In conclusion I want to point out the importance of two other factors upon which I did not touch before. You may have re-edu- cation, you may have schools, you may have hospitals, and they may be the best in the world, and yet the work is not going to suc- ceed unless there are operative two human factors: first, the spirit and ambition and enthusiasm on the part of the man himself; and second, the understanding of the subject and the support of the program by the public at large. We are amazed as this work goes on at finding all over the country cripples who, in spite of every disadvantage against them, in spite of the public attitude, in spite of no means of help at hand, Disabled Soldiers and Economic Independence have made good and have overcome their obstacles. The help of those cripples is a great service in dealing with other disabled men because they can do more than anyone else to demonstrate what can be accomplished and to cheer the men along. There are also ways of bringing this kind of enthusiasm and this kind of encouragement to disabled soldiers. One thing that the Surgeon General of the Army has done is to prepare a series of films showing success- ful American cripples. This series of films-is to be shown in mili- tary hospitals abroad and will provide a very graphic demonstration to a man who has been disabled that he is not down and out. Another feature is the publication of a "cheer up" book, which ¦contains the autobiographies of successful cripples. In Germany they have used, with good success, a book under the title of "The Will Prevails." The Surgeon General's office is getting out a magazine called "Carry On," the object of which is inspirational—to give medical men, nurses, and all others concerned some idea of the pur- pose and character of the reconstruction work. Dealing with the cripple himself is, perhaps, the easiest end of the problem, because if we do the work well and put real people into the game, he will take care of himself. The American is not ¦easily downed and if you give him half a show he will " come across" - with his end of the job. But to enlist the support of the public is a much more difficult thing. The public has not done much but injure the cripple in the past. If we train men and send them out into the community, with the public reacting to disabled men as it has in the past, the whole effort will be near a failure. This cannot be emphasized too clearly. The family of the disabled man gives him no constructive help. The employer has always been willing to give the cripple charity but not willing to give him a job. The public at large has thought its duty to disabled men in general was discharged by offering them alms, or its duty to the disabled soldier largely fulfilled by entertainment. One thing which will come home to us is the damage that is going to be done some disabled soldiers, through using them in a liberty loan campaign and other drives of a similar nature, to serve as object lessons, make speeches, and the like. The public may be in need of that kind of appeal, but it is certainly going to do the disabled men themselves no end of injury and it is going to the Annans oe the American Acacemy be years before those men "wH reeow» from the eifeeta of feeing made popular heroes in that way. It is doing just the kind of thing that the people who are work- ing with cripple? are trying sedulously to avoid. We had a young Canadian come in to see us a little while ago. He was a disabled man who had been brought to this country by the Eed Cross, and who had been going around making speeches. He came in to get employment and when he was asked what kind of work he wanted he said, "A job in some kind of propaganda." He did not want a trade employment or regular work but he wanted to go around, be in the public eye, and make speeches. I need not emphasize how injurious it is to have many of the ladies think that their duty to the disabled soldier is to entertain him at pink teas and in an un- wise and inappropriate way. That again sets the man back. To entertain a man is easy but to give real thought to what you should do for him is hard. It is a public duty which we cannot impress too strongly, that every reaction, every influence on the returned disabled soldier shall be constructive, and help to build up charac- ter rather than aid in any way in breaking it down. That is the last link of the chain and that is something that the government or any other agency cannot provide. The public will decide whether the work of rehabilitating disabled American soldiers is going to be a complete success. We know from the demonstrated results what can be accom- plished. In the words of one European writer, "there are no more cripples," and the literal truth of this statement is in process of demonstration. There may be physical cripples, but certainly with the best provision and the best help of everybody concerned there need be no social and economic cripples consequent on the engage- ment of American forces in the defence of civilization.