of the house unless accompanied by some one. We took him to the curative workshop and put him at the desk and he found himself through his fingers. Now, I want to emphasize that; he found himself through his fingers. That stunned brain had to direct his fingers to work and by that constant function, directing those fingers, that automatic thing that he was used to doing brought him back. He salvaged himself.

Here is our curative workshop in West Forty-first Street. There is one man in this shop whose case I want to recite. He had a spinal lesion. He had a hunchback, and tuberculosis of the spine, most extreme case of this kind I have ever seen, but it illustrates my point, I think, exceptionally well. I was called to a suburban hospital to see him about 12 years ago. I found he had been paralyzed and in bed for five years. He had had many specialists to see him and they had said it was a hopeless case. He was paralyzed from the waist down, and his nerves had degenerated and he couldn't carry on. Well, I recommended operating upon him and making a bone graft from part of his shin. We operated and it resulted that in a little less than a year he was walking again.

Here is a man who had been hospitalized for five years. Every bit of initiative that he had had almost been destroyed at the end of that time. About 17 years have elapsed since I operated on him, and I had lost track of him entirely. When this curative workshop was opened he was one of the first to apply. He had tried several times during the last 10 years to get back into industry, but each time had found an unsympathetic foreman. He was a man who looked more or less emaciated and wasted. When he saw the announcement of this curative workshop he said to his sister, who was always his guiding angel, "Well, that is my chance." And so he went to the shop and began to work. He didn't know I was connected with it, by the way. The second day I went into the shop I found him there. Now, he had been in the great hospitals in the city of New York, shifting from one to another, for 10 years, and nothing had been done to get this man back to work. The little curative workshop was the means. He did so well that he soon rose to the position of subforeman, then foreman, and after that we were unable to hold him any longer because he was able to get larger wages than we could possibly give him, and to-day he is employed and earning very good wages.

By this picture I want to emphasize that the management of artificial legs is something that must be treated and handled differently from any method that has been followed in the past. It is a perfect. shame to select some artificial limb maker and trust the whole matter to him. I am speaking of my own profession. That is too often

the case. The medical man will say to the disabled man, "Go to A. B. C., they are very good limb makers, and let them make you a limb," and then never think of the case again. The disabled man should be watched and encouraged. If he has limited motion or stiff hip, it will be difficult wearing the limb. He may have a sensitive stump. Sometimes there are spicules of bone. I could show you a hundred lantern slides of these spicules of bone that are just as sharp as needles and are apt to occur on the ends of bones and stumps.

I show this picture for the purpose of discussing the length of graft that can be made. I have often been asked how much bone can be restored. The answer is that you can restore just as much bone as the length of the longest bone in the body. There is no limitation. The tibia is the best one to get bone from, and you can restore to the full length of the tibia. Unfortunately, the bones are no longer than the tibia. Here is a small graft. The next one will show how it proliferates. It is remarkable how nature does this for us. This is that same little graft, but see how it has proliferated. If we put in a graft the size of a lead pencil the mechanical demands upon that bone where the graft is put causes that bone to increase in size to take care of the demands placed upon it. If a graft is put in and it is too large, and that practically never happens, it will become smaller. Our bodies are wonderfully planned. We are not supposed to carry any excessive bone anywhere.

Here is a case where the curative workshop idea was most important. This was where we used our workshop and its entire organization to the limit. This man had four fingers missing. He had nothing to oppose the thumb to. It was a question of building up a finger for him. We did it in a synthetic way. We took a piece of flesh, skin, and underlying soft tissues here from the side of the thorax and made a bloodless finger for him. We took two pieces of his tibia and put them in there as the bone of the finger. Here it is with the two grafts grown together four years afterwards.

This is a picture of the man feeding himself. This is a poor lantern slide, but the next, I think, will show him in a better way. The man can use that hand; he can hold the newspaper and his knife and fork and hold heavier tools. It is stationary, of course, but he is able to oppose his thumb against it.

In reference to the development of the curative workshop I want to acknowledge the very active cooperation in our shop in New York City of the rehabilitation service of New York State. Doctor Little and Mr. Elton have been most kind in being of help, and the shop practically could not have been possible if it had not been for their

very great cooperation. It is a great source of satisfaction to me and I think to everybody concerned with it.

(At this point a motion picture was shown of a bone-graft operation that had been performed by Doctor Albee.)

Question. I am wondering how your supervision and training in the curative workshop is obtained. Do you depend on one foreman to handle the different kinds of work, or do you have experts in different lines come in?

Doctor ALBEE. In the curative workshop in the industrial work we have not specialized in the industrial work as we did in the Army. During the war period everything was at our beck and call. We had every kind of an expert we wanted, but here we can't have them thus far. We have got to work along simpler lines. Of course, the first consideration is therapy-it is treatment. And then when it merges off into education there is an unknown point many times in these cases, but the thing I want to appeal to you about is to get them in the shop as a curative thing. Of course, we haven't the finances to broaden out and have the wide educational features.

Question. Couldn't you get volunteer instructors? I should think this would appeal to a great many people, and that they would be glad to devote time in the evening, or something of that sort, training these people.

Doctor ALBEE. I think they will. You see, it needs publicity. The psychology of it needs to be impressed upon p.ople. I feel as you do, that when we do get it impressed upon the public there will not be any difficulty in securing this help. I feel there will be many kindly disposed people who will come forward and lend their time and money to the movement.

Chairman ELTON. We are certainly indebted to Doctor Albee for what he has presented, and for his splendid talk.

The meeting is now adjourned.

FIFTH SESSION

THURSDAY, OCTOBER 1, 1925, 2 p. M.

Chairman: W, F. FAULKES, Supervisor or Rehabilitation,

Wisconsin

Chairman FAULKES. The first speaker this afternoon was scheduled originally on this morning's program, but our time was limited. However, he consented to remain over for this afternoon's session. He has had very successful experience as an industrial surgeon. The industrial surgeon comes very close to the rehabilitation worker, especially in working out a rehabilitation program for the man who is injured in employment. I am very glad now to call on Doctor Schram of the Fairbanks-Morse Co., of Beloit, Wis.

THE RELATION OF THE INDUSTRIAL SURGEON TO REHABILITATION

Dr. C. F. N. SCHRAM, Fairbanks-Morse Co., Beloit, Wis.

The relation of the industrial surgeon to rehabilitation is unique. No other one agency has quite as broad a field of service in rehabilitation as does the physician in industry. The usual use of the word "rehabilitation" refers only to the things or services which individuals, agencies, and society in general may do or render, in order that other individuals, who have suffered an injury and are handicapped by that injury, may again fill their place in society by earning a good living.

The physician in industry is peculiarly situated in that he does not have to narrow his viewpoint down to the usual conception. He can do much more than wait until after the individual has handicaps before his usefulness begins. In fact, if he is going to live up to the ideals of a true physician, and I can put it even more plainly, if he is going to hold his own in modern industrial medicine, which he has chosen as his field, he will have to do more than work on the corrective side of industrial rehabilitation. He must also consider the medical, the surgical, and the preventive aspects, and I have so divided this subject.

First, as to the medical: Does rehabilitation have a field here? You are met here with the National Safety Congress, and the city of Cleveland is trying for, and we, its visitors, are thinking about what? Safety? No. Cleveland is out to establish a record in acci

dent prevention and we, its visitors, are thinking accident prevention. I'll wager that the medical wards and rooms in the hospitals in Cleveland are and will have just as many patients this week as last week, and next week will be the same. Does the employee, with one arm need rehabilitation? How about the young man entering our shop to-day with a bad heart, a low kidney function? Disease brought the latter conditions about, and let me assert that the industrial physician who does not recognize the medical aspects of rehabilitation is not on his toes. There are to-day applying for employment nearly 20 times as many handicapped by disease as there are applying who are handicapped by accident. The only men that I recall rejecting for employment because of a physical handicap resulting from an accident, were men who had lost an eye and who applied for foundry work; and these are quite rare. But men with a heart trouble, men with very poor teeth, men with very poor vision, men with diabetes, and men with high blood pressure are being put to work in industry to-day and, comparatively speaking, there has been no thought of rehabilitation in these medical cases. In those industries where there is a preemployment health examination for placement in that industry, and where as a result of that examination the applicant is told in ordinary English what his defects are and advised as to their correction and treatment, we have medical rehabilitation. I do not know just what the percentage is of industries or firms who require a preemployment-health examination, nor do I know what per cent of the gainfully employed get an annual health examination, but let me hazard a guess that this percentage is small in both cases. Of course there is much medical rehabilitation work done by the general practitioner in medicine, and in a preventive way the Public Health Service, both national and local, can well claim much credit, but the physician in industry who is not putting on a health examination and who is not assisting to place the men handicapped by disease has not a vision of the possibilities of such a reclamation service.

Surgical: What has been said of the medical rehabilitation is true of surgical rehabilitation. Just as good medical treatment prevents the need of later refitting to usefulness, so does good surgery accomplish the same thing. The first-aid department that cares for the minor injury so as to avoid crippling infection, takes care of the eye and saves vision, is certainly doing good surgical rehabilitation work. The physician in industry, whose work in fracture cases is approximating good anatomical results and getting good functional results, is a mighty factor in real surgical rehabilitation. I know that it is wonderful what can be done by surgery in assisting crippled men back to some degree of comfort and to less limited usefulness. It