sounds dramatic as we tell about it, and, thank God, we can do it, but did you ever stop to think that many, many of these cases would never have been, had good surgery been practiced immediately following the injury or good surgical advice been given and followed in the treatment of human ailments.

Some one once said that prevention is better than cure, and here is the big field of the physician in industry. That is his whole job, if he will only see it. He works with the safety department in the eliminating of accident, and every accident is a possible case which later may need rehabilitation. He is working hard on the reduction of sickness, because every sickness case may produce a real handicap. In the preemployment health examination he lays the cards all down; he tells the applicant all that he finds wrong; he advises as to any corrections and then he follows it up and sees that his advice is followed. In some cases pressure to make an employee see the light is essential, and if this is necessary the physician in industry should use it. Any move that tends toward educating the gainfully employed in the prevention of sickness or injury lends itself to the physician in industry.

I once had the pleasure of listening to an address by a man from Middletown, Ohio, and he emphasized very strongly that we should never take the economic urge away from anyone. In industry the physician is continually preaching that it is good economy to stay well, and every patient kept well reduces by just that much the possibilities of having to refit that man or woman for useful work.

The usefulness of the physician in industry need not be limited to the shop. If he is the right kind, his fellow employees will consult him about medical problems in the home, and no one can ever take from the physician in industry the sense of appreciation and gratitude that comes from a fellow workman when we have solved a real medical or surgical problem in the home.

The physicians of this country have it in their power to cause the resignations of about 90 per cent of those employed in rehabilitation agencies or commissions. The reason we have not done this is that we have been so busy taking care of the sick and injured that we did not have time to think of keeping men healthy. Then, too, physicians are paid, when paid, to care for the sick, to do operations, to reduce fractures, but no one pays the physician in private practice to keep him well. I say no one.

Mr. Vauclaim, of the Baldwin Locomotive Works, does it, but his case was, or is, so rare that it was a valuable news item at the time the contract was made. The exception is the physician in industry. He is paid to keep people from getting sick or injured, and the nearer he approximates this condition the less he has to do and the more

he is paid. I know that some physicians object strenuously to anything but a fee basis of pay, and I once heard a real good-yes, an excellent surgeon say that the fee basis was the only basis on which a real man, a real physician, would work. But I would like to ask how anyone would suggest paying for the reduction of the lost time from sickness from nine days per man per year to three days per man per year, on a fee basis, or the assisting in reducing of lost time from accidents 75 per cent. Possibly some may inquire what this reduction in time lost has to do with rehabilitation, and my answer is that the only reason for this conference is because there is need for it. Men and women need rehabilitation and why? Because they have been sick or injured, and the more these two causes for lost time are reduced the less need there will be for such conferences, and may God speed the day when the need is no more.

As to the corrective work which the industrial physician can do and is doing, he is an essential connecting link between the agency working to rehabilitate any given individual and the accomplishment of that purpose; often he is both the agency and the connecting link. He discovers the handicap at the preemployment health examination, and the employee's boss, the employee, and the industrial physician work together to rehabilitate and make a real producer. The aid of the family physician, solicited by the physician in industry, is very often an important factor in this process. Most men and women who, when they are physically able to begin their occupational training, following their sickness, injury, or operation, still need care by a physician. In fact, we are realizing more and more that a busy hand does much in the convalescence of patients because it keeps the mind busy, and the earlier we can get patients started to do something the better off they are. If we could only keep the mind occupied in a positive way, in future planning, and not in retrospective self-pity, we could accomplish heaps more. But when the time comes for the actual shopwork for the convalescent, a cheerful, hopeful physician who can actually see that the desired training is given, and that the patient is not overworked, and that he is advanced as he learns, can not be superseded by anyone.

The corrective rehabilitation work, as far as medicine and surgery go, belongs largely with the specialist. The industrial physician aids in the care as soon as the patient is able to work by assisting in the placing of that man in the shop, office, or mill, and seeing that he is not transferred to work which does not fit in with his reeducation. When we try to apply occupational therapy to the man who has just had a long sojourn in the hospital, or to the man who finally wakes up to the fact that he has never before fitted his job, that he is broke, that the world does not owe him a living, but that it is expecting him to forget the past and go to work, the task is not easy, but I know

of no one better fitted to cope with such a situation than a real physician in industry. He can make complete that which the specialist began.

I am wondering if many more men would not have completed. their rehabilitation training if there had been a real physician in the industry where they were being reeducated. Industries certainly have taken many men at the request of the rehabilitation agencies, but I feel that an appreciable number have not come up to expectations in their training, and I know that the physician in industry can do much to remedy that.

But the message I wish to leave with you is one of prevention rather than treatment; one of avoidance rather than correction. In order to accomplish this much will have to be done in accident prevention and sickness prevention.

Public health education must be spread more than ever through every agency. The medical men of the future must be trained to sickness prevention rather than sickness treatment. Quack schools and diploma mills must be abolished. People must learn that while medicine and surgery are not exact sciences, yet the recognized medical schools of highest requirements are teaching the best known methods of preventing illness and of treating the sick and injured. Lastly, industry must see that illness is a waste, just as they say that injury was a waste, and then it will be given an impetus that will do much to allow it to catch up with accident prevention, and the two, sickness prevention and accident prevention, bearing the banner of universal safety will go hand in hand up the world's pathway proclaiming a message of strong, healthy, vigorous manhood and womanhood, free from the effects of physical injury.

Chairman FAULKES. The committee that arranged the program for this afternoon thought it would be well to bring before you for discussion the future of the national program of civilian rehabilitation from the Federal as well as the State point of view. The first speaker on this subject, representing the Federal Government, will be Mr. John Aubel Kratz, Chief of the Civilian Vocational Rehabilitation Division, of the Federal Board for Vocational Education. Mr. Kratz.

THE FUTURE OF THE NATIONAL PROGRAM: FEDERAL AID AND

ADMINISTRATION

JOHN AUBEL KRATZ, Chief, Civilian Vocational Rehabilitation
Division, Federal Board for Vocational Education

From at least one point of view it would have been much better had a State rather than a Federal man been selected to discuss the topic assigned to me. Although the subject of Federal aid is not necessarily "taboo" for those of us who are connected with the

Federal Board for Vocational Education, we find it convenient for obvious reasons not to go too far in committing ourselves officially upon the question. Consequently, I have not come before you with the intention of making a case for Federal aid in the promotion of civilian vocational rehabilitation. I suppose most every State official here this afternoon, who has a responsibility for the administration of a State rehabilitation program, knows something of the degree to which grants in aid to the States are effective in the general promotion of the work. In addition, I do not think that you would be inclined to disagree with me, should I make the statement, that successful operation of Federal aid in civilian rehabilitation, or in any other form of aided work, depends very largely upon the extent to which the State, partners in the enterprise, realize and meet their responsibilities in the joint undertaking. I am confident that whatever success has been accomplished in the present rehabilitation program, which has been in operation since 1920, has been due to the attitude of our State partners as exhibited in their fine understanding of our problems and objectives, in their splendid willingness to cooperate with us, and finally in their high efficiency in having been able to put into effect locally many of their ideals in principles and standards of practical administration.

From another aspect of this question you can easily see why it is not difficult for us to ascertain our responsibilities as a Federal board of administration. As long as Federal aid will be available to the States for the promotion of rehabilitation of the disabled civilians, our board will continue to have certain very definite responsibilities of administration. There are numerous features of this phase of our administrative function which are rather uninteresting or even distasteful to us. We have other things to do which are far more stimulating, engaging, and seemingly far more productive. Since the beginning of our work we have scrupulously endeavored at all times to steer a middle course. On the other hand, in the determination of our policies and standards we have been most careful, on the one hand, not to embarrass the State program by making it too limited or restricted in scope, while on the other hand we have been just as zealous in our efforts to safeguard the use of Federal funds and the interests of the National Government. This will continue to be our policy.

While on this question I can not refrain from pausing long enough to call your attention to conditions which obtained during the first half of the last fiscal year. During this time, for reasons of which you are aware, Federal rehabilitation funds were not available, and in a number of the States even their own funds could not be used because of the unavailablity of Federal funds, this restriction being due either to provision by legislation or opinion by the State's at

torney general. It is needless for me to say that this condition embarrassed the programs, reducing their general effectiveness and volume of service given. At the time, the States simply were not position financially, at least, to carry the whole load them

selves.

Another observation I should like to make upon this matter of Federal aid, is that whether it will continue, will depend, of course, upon the States. This is not a new and startling piece of information to you. If needed, and if strongly enough desired by the States, Federal aid in civilian rehabilitation will most surely be continued.

In so far as the future of our national program is concerned, we, as a Federal agency, have still much to do in the way of promotional service and research. To begin with, nine States are still " without the fold." Although prospects for getting most of these are good, some of them still remain either in a state of ignorance of the needs, disinterestedness in the program, or unwillingness to undertake this much-needed form of State service. The best we can do is to continue to try to show them the light.

On the service side, I am happy to say that the States continue to desire the services of the Federal agency. They ask repeatedly for help, and we have more calls for service then we can meet in view of limited staff and funds for administration.

As to the third phase of our work, it is certainly safe to say that the surface has hardly been scratched. We have done little in the field of research for two simple reasons. In the first years of our existence there was practically nothing to "research," and during the last year or two our other responsibilities have pressed so heavily that we have been able to do but little. The situation in this respect is improving rapidly. One member of our staff is just beginning a study of employment training in all of its phases. During the next six or eight months he will devote all of his time to the investigation. In addition, each of the remaining members of the staff, including myself, will be carrying on in connection with his general work, some form of investigational activity. Thus, we shall be in a position in the next year to make considerable contribution to the general program of rehabilitation in so far as our research function is concerned.

Finally, considering the promotional phase of our program, I betray no confidences when I say to you that in our responsibility for improving the general character of the work and for establishing desirable minimum standards in the States, we have still very much to do. To be specific would be embarrassing both to you and to me, to say nothing of being indiscreet and impolite, so I hurry to the next topic.