injured employees undergoing vocational rehabilitation. Organized labor of New York State gave enthusiastic support to these projects, and the New York State Federation of Labor issued a statement to its numerous affiliations announcing the creation of a bureau of rehabilitation in the State department of education in cooperation with the State departments of labor and of health, and continuing as follows:

The proper handling of those who have been handicapped in life by a disabling accident or disease has been one of the most difficult problems concerning every community. There are thousands of men and women who have possibilities of entering into gainful employment if there were only some agency which could intelligently study their physical handicaps and discover the most advantageous ways for them to direct their energies. A deformity or injury which might totally incapacitate them from remunerative occupation in one line of work, might prove to be no handicap at all if they were employed in some other occupation. When it is known that there are from 50,000 to 60,000 compensation cases yearly in New York State resulting in approximately 3,000 amputations, it is clearly seen that nearly every labor union has at some time or other members who have been injured in the pursuit of their trade so that they could no longer continue the same kind of work, yet who, with a little intelligent training or guidance, could be made competent and efficient workers at some other trade or occupation.

Our amended law is based on sound economic and humanitarian grounds. The State, the community, the family, and the individual all suffer when a person ceases or is unable to fill a remunerative occupation. The loss in earning capacity may bring severe physical and mental suffering to the handicapped person and his whole family. By restoring such persons quickly to gainful labor the deteriorating effects of idleness are avoided and a quicker recovery of body and mind is accomplished. Physically handicapped persons eligible for vocational retraining should make application to the bureau of rehabilitation as early as possible after receiving an injury that may incapacitate. They may make this application through the medium of their union or any other agency. The officers of the New York State Federation of Labor will exert their utmost efforts to have the appropriations for this most essential work increased during the coming year. We urge all local unions to cooperate with this new bureau and to appoint committees to advise and assist members who may be incapacitated from following their old occupations to learn some new trade or occupation and thus return to self-supporting.

What organized labor of New York State did in 1920 and has continued to do in promoting vocational rehabilitation of the injured is simply illustrative of similar activities throughout our country. We find in the proceedings of the 1919 convention of the American Federation of Labor a report from its executive council that every effort had been made at the session of Congress just ended to secure the enactment of an act supplementing the Federal law of 1918 providing for vocational rehabilitation of our returned soldiers by extending its scope to include civilians. These efforts had failed, however, and the report concluded with these words:

The work of reeducating and refitting into industry of the many cripples made by accidents in industry is of vital importance to labor, and we recom

mend that full support of the American Federation of Labor be given to this

measure.

The recommendation of the executive council was adopted by unanimous vote of the convention, and in the following session of Congress the Federal civilian vocational rehabilitation act was passed and approved. With the active cooperation of the labor organizations during the past five years State after State has accepted the provisions of the Federal law, until with the acceptance this year by Colorado, New Hampshire, and Oklahoma a total of 39 States is now operating under the act. In New York State this year we liberalized the maintenance allowance for trainees, and last year Congress extended the scope and tenure of the original act by continuing the dollar-for-dollar financial aid to States until 1930. When that year has arrived it is to be devoutly hoped that every State will willingly undertake all necessary expenditures to continue solely as a State obligation a system of human salvation that will have completely proved its worth to society.

To demonstrate that worthiness is the task in hand. The way to success is not a path of roses. It is an adventure in trial and error, despite the gainful results that have so encouraged the spread of the system. No set of regulations to which all may conform with advantage can yet be formulated. No cases are exactly alike, as one may discover by studying the cases so far compiled and published; but they are an illuminating index of the perplexities that can arise. There are mental as well as physical adaptations to be considered. Those not actually engaged in the rehabilitation and replacement work can rarely give constructive counsel. Organized labor has sufficiently demonstrated its first-hand and continuing sincere interest in rehabilitation to be permitted to offer suggestions and will do so feeling that they will be accepted, whether of value or not, as made solely for the welfare of the workers undergoing training and for the ultimate success of the rehabilitation program.

With this understanding, we urge attention upon some phases of retraining. Workers with head injuries should not be introduced to noisy workshops, as the discomfort set up discourages and defeats retraining. Persons with injuries that involve derangement of the nerves should be separated and given special study to discover if the condition is persistent. We have good reason to believe that many doctors, acting for insurance companies, declare an injured worker of this type to be completely cured of the very ailment of which he most complains. As the nature of one's injury most frequently indicates the new occupation he may be fitted for, it is well to be positive just what the injury actually is, especially as injuries are not always on the surface. Replacement should be fortified against following

the lines of easiest resistance in securing employment for trainees so as to avoid any particular occupation being too representative of rehabilitated workers. It should also be kept in mind that in several occupations positions easy to fill are reserved for those who grow old and less active in the same employment; no effort should be made to preempt these positions of superannuation. The standard to be achieved in retraining and replacement should be that the worker enters an occupation on equality with those already there. We believe that the rehabilitation and replacement staffs accept this standard and are most willing to honor it with strict observance, and we announce it now mainly for the purpose of warning those that may undertake to direct the channels of training and placement without having actual connection with the work or being responsible for the results. The American worker is self-reliant and proud of his capacity to cope with his fellows on even ground, and he will resent bitterly if his injured condition, no fault of his, and perhaps the penalty for devotion to his job, is taken advantage of to attempt to place him anywhere on a lower plane than that of equality. He who seeks to do so, ignorantly or otherwise, is no friend of civilian or of soldier rehabilitation.

The friends and exponents of this new program of regeneration have a duty to perform that is worth the doing-that is, to spread the news of the encouraging results that have already been gained in this field of human endeavor. Tell of the plans and their purpose. Bring the hopeful tidings to those who, imprisoned in their own false sense of irreparable disability, are giving up the fight. Attack the mental condition that surely follows the loss of a member of the body by recital of the many verified instances where such a loss has been the key to a fuller and richer life through vocational retraining. Help to chase away the clouds that settle down on the disabled, and let the light of these truths in to console and inspire them to walk erect and take a new and probably a better grip on fortune. Preach that the rehabilitation work is the social hand of his fellow humans stretched out to him in respect and confidence, and not in charity; that he has paid for it as his share in the expenses of Government. Restore his belief in himself and you have gotten him half-way on the road to assured independence again.

"Man's inhumanity to man " may have "made countless thousands mourn," but the humanity of the rehabilitation service throughout our Nation has made many thousands rejoice. Let us so fill the future with such rejoicing that mourning voices will not rise from the lips of those denied self-sustaining places in the industries of America in whose service ranks they have suffered.

Adjournment.

83530-26-7

FOURTH SESSION

THURSDAY, OCTOBER 1, 1925, 10 a. M.

Chairman: FREDERIC G. ELTON, District Director, Rehabilita

tion Bureau, New York City District

Chairman ELTON. We are a little late in starting this morning a program which brings before us something that all of us in rehabilitation are beginning to realize, namely, that rehabilitation is much more than the problem of placement, or placement involving training. It is a program for an individual that includes medical or surgical treatment, the restoration of confidence and grit, the selection of and preparation for suitable work in which the disability will not prove a handicap, and, throughout the whole program, advice and guidance that will coordinate all these factors.

By no means unimportant is a consideration of the needs and possibilities of the individual in the light of his ability, environment, and mentality. The services rendered by the doctor, the nurse, the social service worker, the occupational therapist, the instructor, and the rehabilitation adviser, all coordinated and correlated in the realization of a definite aim, placement, make possible a complete and satisfactory rehabilitation.

Upon the work of the surgeon or doctor, in many cases, largely depends the success of our final objective.

The restoration of confidence and the advice and encouragement that must continue throughout the whole program can be called a form of social service, and we all realize the very important part that this service plays in the reconstruction of a disabled person.

The vocational advice and guidance which has been a part of the program brings us to the placement of the injured person in industry. Placement sometimes involves training. Training, however, must be considered as only a means toward the end, and not one of the outstanding features of the restoration program.

The first speaker of the morning is a man who is very conversant with the social aspect of our work. I take pleasure in introducing to you Dr. John A. Lapp, whom we all know. Doctor Lapp.

86

SOCIAL ASPECTS OF CIVILIAN REHABILITATION

Dr. JOHN A. LAPP, National Catholic Welfare Conference,
Chicago, Ill.

Mr. Chairman, ladies, and gentlemen: The opportunity to speak to the people engaged in rehabilitation is one that I prize very much. Having had a hand in the beginning of the national vocational movement, having seen that vocational movement expand beyond the training of the normal individual, to the training of handicapped people, I have taken something of pride in the participation which I have had in the whole movement.

I am not so sure, as a social worker, that I would put the medical aspects of this work first as the chairman did. I rather think the first aspect of this work is as arranged on the program, the social aspects of civilian rehabilitation, for to a considerable degree the work is dependent upon the analysis which the social worker makes of the situation.

I don't know that we realize the extent to which we are subject. to the very serious disasters of life, although they are prominent in our presence at all times. I don't suppose we reflect enough upon the causes which break men down and cause the necessity for rehabilitation. If we could view the map of life continuously and keep before us the causes of disaster, I am sure that our people generally would have a clearer idea of the remedies that we ought to have in this work for the problems of poverty, the problems of destitution, and the problems of rehabilitation.

I wish we might review a body of infants, and repeat the review every 10 years, and see what has happened to them, and what have been the causes that have broken them down, if they have been broken down, or have injured them or harmed them in any way. As we went along in each 10-year period we would see clearly that the causes of breakdown are causes which are social causes, and generally are causes which are beyond the control of the individual. But the chief ones that we should find as the causes for breakdown socially would be accidents, sickness, unemployment or underemployment, and old age. And all of these would have a very direct reference to our program of rehabilitation.

A very considerable portion of our people are in poverty or im destitution, or are in very serious distress, because of the results of accidents. A still larger part, generally stated as seven times as many, are in destitution or in poverty or in handicapped situations because of sickness. And a very, very large number are in distress because of their inability to earn a living, their lack of skill, their lack of training, their lack of ability to deliver something that is worth buying. And of course, much distress comes in old age when