Part 27

It must never be forgotten that intelligence and will are factors of the first importance, so that however little intellectual capacity the disabled man may have, he is bound to profit by his passage through the school of re-education in learning to read and write if he is illiterate--this is more frequent than is usually believed--or to improve his knowledge if he has already had some instruction. It is, in fact, by brain work that many learn to replace their physical defect. Let us take, for example, a disabled bricklayer. If he is intelligent and is given a helping hand in the shape of the necessary instruction, he may become a builder on his own account in a small way when he knows how to make plans, work out estimates and keep accounts.

This is not a Utopian fancy. In the small towns and villages there are many owners of businesses such as masons, decorators, joiners, etc., workmen who cannot spell, but who are intelligent, have business minds and a gift for overseeing, who have given up the trowel and will build you a house as well as, or often better than, many "architects." It is with similar aims to these in view that a bricklayer should be re-educated when it is judged that his intellectual capacity is sufficiently great.

Where there is no intelligence education can do little. There are in civil life innumerable "casual labourers" with limbs intact who have never been able to learn a regular trade and who earn a miserable livelihood by doing what "turns up." Their situation becomes serious when they lose some of their physical capacity. They can, however, be rescued, particularly by encouraging them to become agricultural labourers. It is indeed especially agricultural labourers who should be urged to return to the land, and those mechanics who will be unable to work in a factory for the future should also be encouraged to take up this work. One reason for this is that the workman's arm--especially if it has not been too much elaborated--is useful for the execution of a considerable variety of work on the land. It is unnecessary to speak of cases of amputation below the knee, since their usefulness on the land may be taken for granted.

In the country as a matter of fact a man never dies of hunger; and this cannot be said of the town. Apart from actual cultivation of the land, which is in part impossible for the maimed, there are numerous and important occupations of which a town dweller would not think. It is when he goes to the centre of re-education in agricultural work, first of all to view it and then to work, that the disabled man takes note of what he can or cannot do, and of the work in connection with agriculture which is open to him, such as poultry rearing or bee keeping.

This applies to other employments than agriculture.

Apart from his actual trade which the workman can no longer ply with a sufficient return for his labour, he may be able to work at one or two of the accessory employments which would not of themselves bring him in a living but which would yield a satisfactory supplementary income.

In certain re-education centres there seems to be a marked predilection for crafts in which the apprenticeship is short and the installation costs little, though these are in fact the characteristics of those trades which give the labourer a poor return, that is to say, time-work in a large or small workshop.

At the beginning of the war an attempt was made to show that there would never be enough tinkers, sabot makers, shoemakers, or saddlers in the country. It is quite a false idea that a disabled man can gain a living at one of these crafts in a village. It is true that he can do so if, working as an agricultural labourer, he can act as a barber in his spare time, and is capable of executing small jobs, especially repairs, which the villagers would readily give to him rather than have to go several miles to get them done. When the disabled man has this additional work in his hands he will gradually be able to ascertain whether the needs of the countryside and his own personal capacity are compatible with its development. In that case, however, he will be, in fact, a small proprietor buying his own tools and materials and fixing a retail price. But the great majority of workmen have no notion of such calculations and such organisation as are indispensable when a man runs a business even if he is alone. It follows, therefore, that the education of his mental, and especially his commercial, faculties must be considered, and it must be ascertained whether the man is likely to profit by such education. It is useless to install in a hamlet a shoemaker who is incapable of working except as an assistant, and in the town at the actual factories the prospects are poor.

Moreover, conditions of life in the disabled man's native place must be considered as a matter of importance. A man from the Mediterranean country has no idea beyond the cultivation of meadows, and one from Picardy none beyond the making of cane baskets for packing flowers.

Judgment is difficult, and in order that the choice may be exercised as reasonably as possible, the careful collaboration of the patient, the doctor and the managers of the workshops is essential. We repeat that this is one of the principal objects for which the centres of re-education are useful. There are some efficient men, we know, who without asking anything of anybody find quickly and unerringly the exact work that suits them. There is no need of anxiety in such cases.

A certain metal worker from the invaded area suffering from pseudarthrosis of the shoulder, whose wound we were treating, sent for his wife, and they began to rear geese. We know two cases of amputation of the right arm, an operative at an aeroplane works and a worker in stucco, who during their stay at hospital and before they had been supplied with artificial limbs, had taught themselves, the one technical design the other ornamental design. Both of them, as soon as they were discharged, have been taken on by their former masters, who no doubt were fully conscious that they were thus combining a good deed with good business. To come to a decision of any value, however, cases of this sort must not be taken as a criterion, for they are in fact exceptional. The majority of the men are in need of guidance.

The procedure employed at the Belgian centre of re-education at Port-Villerz consists in allowing the patient to frequent the workshops at will for a few days, during which time he sees what is going on and is not slow to make his choice, which it appears rarely needs to be amended.

We have dealt chiefly with the conditions which are suitable for the re-education of a man who has lost an upper limb, or, speaking more generally, is disabled in one arm, for whom resumption of work in a workshop will often be out of the question. The question is easier of solution for the lower limb. Cases of amputation of the leg can work standing, if supplied with an artificial limb, at practically any trade. Cases of amputation of the thigh have numerous manual occupations open to them in which they sit for at least part of the time. It must be understood, however, that these professions which require skill can, as a rule, only be learnt in well-equipped workshops at the price of a fairly long apprenticeship. Two or three years are necessary to make a good mechanic, a good watchmaker, glass cutter, etc. This should not deter us in the case of fairly young men. The difficulty is to organise special workshops, often with a complicated equipment, where the maimed man can at least pick up the rudiments of the work, for it is not to be thought of that he can remain there during the whole time occupied in a complete training.

In conclusion, we should like to draw attention to the law of 1831, which regulates the distribution of pensions by means of groups classified according as the loss is of two limbs or of one. No distinction is made with regard to the seat of the amputation. But a man who has lost both legs and has been suitably equipped with artificial limbs can earn a fair wage, whereas a man who has lost both arms is completely disabled so that he cannot even wash or dress himself. Among the amputation cases the difference is also considerable in the lower limb, between amputation through the leg and through the thigh, and even more in the upper limb, between an amputation retaining the movements of the elbow and one in which they are lost. There is, moreover, a great difference in the quality of stumps and the consequent utility of the artificial limb. It is of course impossible to allow with mathematical precision for all degrees of disablement, but the several general distinctions which we have enumerated could be taken into consideration without difficulty.

INDEX

American chuck, 122

Angle at which foot is set, 34, 49

Appliances for use instead of hand, 108 with mobile joint, 123 with universal joint, 126

Artificial hand, 96 spring grip thumb, 97 automatic thumb, 98 Beaufort thumb, 99 for commercial travellers, 102 automatic fingers, 105

Bearing points, 6 upon ischium, 13 upon condyles of femur, 62 upon tuberosities of tibia, 67 upon end of leg stump, 77

Bouget, 145, 151

Bonreau's appliances, 112 function of the artificial hand, 117 hook and ring, 124 length of artificial forearm, 118

Braces for suspension of artificial leg, 24 with extending sling, 43 for amputation below knee, 73

Brunet's grip, 107

Brushmaker's hook, 119

Camus, Jean, 147

Cardan joint, 126

Chauffeur's bell, 125