Chapter IX: 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.