DOCUMENTS DEPT. REPORT OF PROCEEDINGS OF THE FIRST NATIONAL CONFERENCE ON VOCATIONAL REHABILITATION OF PERSONS DISABLED IN INDUSTRY OR OTHERWISE St. Louis, Mo., May 15, 16, 17, 1922 ISSUED BY THE FEDERAL BOARD FOR VOCATIONAL EDUCATION WASHINGTON, D. C. WASHINGTON: GOVERNMENT PRINTING OPFIOE. 1922. DOCUMENTS OEPT. FEDERAL BOARD FOR VOCATIONAL EDUCATION. MEMBERS. HERBERT C. HOOVER, Secretary of Commerce. HENRY G. WALLACE, Secretary of Agriculture. JOHN J. TIGERT, Commissioner of Education. JAMES J. DAVIS, Chairman, Secretary of Labor. HARRY L. FIDLER, Vice Chairman, Labor. , EDWARD T. FRANKS, Manufacture and Commerce. CALVIN F. MC!NTOSH, Agriculture. EXECUTIVE STAFF. J. C. WRIGHT, Director. C. H. LANE, Chief, FRANK CUSHMAN, Chief, Agricultural Education Service. Industrial Education Service. ANNA E. RICHARDSON, Chief, Home Economics Education Service. JOHN AUBEL KRATZ, Chief, EARL W. BARNHART, Chief, Vocational Rehabilitation Division, Commercial Education Service. JOHN CUMMINGS, Editor and Statistician. 2 CERTIFICATE: By order of the Director of the Federal Board for Vocational Education the matter contained herein is published as administrative information and is required for the proper transaction of the oublic business. DCPT. CONTENTS. Page. Foreword 5 List of persons in attendance at the conference 7 GENERAL MEETING, MAY 15, 2 P. M. Address of welcome 12 A national program of vocational rehabilitation 16 Reciprocity among States in vocational rehabilitation work 20 General discussion 22 Rehabilitation of persons with type disabilities 25 General discussion 28 GROUP MEETING, MAY 16, 9 A. M. Rehabilitation in the field of agriculture 31 General discussion 41 GROUP MEETING, MAY 16, 10.30 A. M. Securing cooperation of industrial management in the employment of the disabled 46 General discussion 59 GENERAL MEETING, MAY 1% 2 P. M. Social and economic significance of vocational rehabilitation 62 Responsibility of industrial management in vocational rehabilitation 70 General discussion 74 The worker's interest in rehabilitation 76 GROUP MEETING, MAY 17, 9 A. M. Cooperation by other State departments in rehabilitation work 80 General discussion 91 GROUP MEETING, MAY 17, 10.30 A. M. Cooperation by private agencies in rehabilitation work 93 General discussion 109 GENERAL MEETING, MAY 17, 2 P. M. Proposed investigations to be undertaken by the Federal and State boards 115 General discussion '. 122 Problems of future legislation 128 General discussion . . 129 Available bulletins of the Federal board for vocational education 136, 775859 FOREWORD. The following pages contain a report of the proceedings of the First National Conference on Vocational Rehabilitation of Persons Injured in Industry or Otherwise, held at St. Louis, May 15, 16, and 17, 1922, under the auspices of the Division of Vocational Rehabili- tation of the Federal Board for Vocational Education. The con- ference was called by the Federal Board in response to the sugges- tion of many State directors and supervisors of vocational rehabilita- tion, for the purpose of pooling experience and discussing topics of vital concern to all, at a stage in the work where it was very much needed. A national conference was called this year in preference to the former regional conferences for the reason that it was felt that vastly more would be gained through the contact of a larger number of State directors and supervisors, as well as others in allied fields of work, than was possible at the regional conferences. It was the opinion of many who were present that this result had been fully accomplished. J. C. WRIGHT, Director. List of Persons in Attendance at the Conference. ANDERSON, CLAUDE H., Special Agent, Vocational Rehabilitation Federal Board for Vocational Education, Washington, D. C. ANDERSON, MARY, Director, Women's Bureau, Department of Labor, Washington, D. C. BAKER, Mrs. MARY SANFORD, Assistant Supervisor, Industrial Rehabilitation, State Department of Education, Jackson, Miss. BLACK, MILLARD A., Special Agent, Vocational Rehabilitation, Federal Board for Vocational Education, Washington, D. C. BOUGH, ALICE K., Federal Board for Vocational Education, Washington, D. C. BRACKETT, E. E., Principal, University of Nebraska Trades School, Lincoln, Nebr. BRILES, CHAS. W., State Director for Vocational Education, Oklahoma City, Okla. BUESCHEN, MAY DAVIS, St. Louis, Mo. BURTON, HENRY F., Assistant State Supervisor, Industrial Rehabilitation, Indian- apolis, Ind. CANGNEY, DORIS M., Secretary, Industrial Department, Social Service Federation of Ohio, Toledo, Ohio. CARTER, HAZEL M., Employment Worker, St. Louis, Mo. CHAMBERLAIN, MARY L., Social Worker, Washington University Dispensary, St. Louis, Mo. CLAYTON, FRANK J., Special Agent, Vocational Rehabilitation, Federal Board for Vocational Education, Washington, D. C. CONNERY, JULIA M., Principal, Central Institute for Deaf, St. Louis, Mo. CONNOR, DAISY M., Assistant Secretary, Missouri Association for the Blind, St. Louis, Mo. COPP, TRACY, Special Agent, Vocational Rehabilitation, Federal Board for Vocational Education, Washington, D. C. CUMMINGS, H. B., Special Agent, Vocational Rehabilitation, Federal Board for Voca- tional Education, Washington, D. C. DALLAS, HERBERT A., Supervisor of Rehabilitation, Boston, Mass. DAVIS, LILLIAN H., Field Agent, Industrial Rehabilitation, St. Louis, Mo. FAULKES, W. F., State Supervisor, Industrial Rehabilitation, State Department, Madison, Wis. FERGUSON, SHIRLEY, Chapter Correspondent, Southwestern Division, A. R. C., St. Louis, Mo. FISCHEL, MRS. WASHINGTON E., Federation of Women's Clubs, St. Louis, Mo. FULMER, C. A., State Director of Vocational Rehabilitation, Lincoln, Nebr. GRANT, WILLIS W., Supervisor, Industrial Rehabilitation, State Capitol, Des Moines, Iowa. GUILD, A. A., Superintendent, Social Service Federation, Toledo, Ohio. GUSTAFSON, LEWIS, Superintendent, Rankin School, St. Louis, Mo. HANGER, J. E., President, Hanger Artificial Limb Co., St. Louis, Mo. HARVEY, H. V., Assistant Supervisor of Rehabilitation, Milwaukee, Wis. HAWKINS, HILDRED M., Special Agent, Women's Bureau, Department of Labor, Washington, D. C. HENRY, LLOYD A., Agent, Civilian Rehabilitation, Helena, Mont. HOLT, IDA V., Student Nurse, W. U. T. L. O., St. Louis, Mo. 8 VOCATIONAL REHABILITATION. HORTQN, GEO. E., Rehabilitation Agent, Idaho State Board for Vocational Educa- tion, Boise, Idaho. HUBBABD, F. J., State Director, Vocational Rehabilitation, Jackson, Miss. JENNISON, KATHLEEN B., Special Agent, United States. Women's Bureau, Depart- ment of Labor, Washington, D. C. JEWELL, J. R., Assistant State Supervisor, Industrial Rehabilitation, Department of Vocational Education, Lincoln, Nebr. JOB, LEONARD B., State Supervisor, Vocational Rehabilitation, Indianapolis, Ind. JONES, VALLE, Stenographer, D. P. Kane Co., St. Louis, Mo. KELLEY, MAY, Social Worker, Washington University Dispensary, St. Louis, Mo. KEOUGH, FREDERIC W., Associate Editor, "Industry," Washington, D. C. KLINEFELTER, EUGENIA L., Medical Social Worker, Washington University Social Service, St. Louis, Mo. KRATZ, JOHN AUBEL, Chief, Vocational Rehabilitation Division, Federal Board for Vocational Education, Washington, D. C. KREYLING, DAVID, Secretary-Treasurer, Central Trades and Labor Union, St. Louis, Mo. KTJNZ, BEN G., Representative Safety Department, American Car & Foundry Co., St. Louis, Mo. LAIN, F. M., D. P. Kane & Co., St. Louis, Mo. LAND, FORT E., Supervisor of Rehabilitation, State Capitol, Atlanta, Ga. LANE, MAY ROGERS, SpecialJAgent, United States Women's Bureau, Department of Labor, Washington, D. C. LAPP, DR. JOHN A., The Nation's Health, Chicago, 111. LE Bow, C. M., Field Agent, Industrial Rehabilitation, Kansas City, Mo. LISON, MARGUERITE, Director, Division of Industrial Rehabilitation, Pierre, S. Dak. MCCLELLAN, LUCIA, Deputy Industrial Inspector, St. Louis, Mo. MCCULLOUGH, Mrs. FLORENCE, Social Worker, Washington University Dispensary St. Louis, Mo. McPiKE, JOSEPHINE, ChapterDorrespondent, A. R. C., St. Louis, Mo. MANGOLD, GEORGE B., Missouri School of Social Work, Misssouri State University, St. Louis, Mo. MANNING, CAROLINE, Industrial Assistant, United States Department of Labor, Washington, D. C. MARTIN, H. G., Acting Supervisor of Industrial Rehabilitation, New Orleans, La. MEYER, ERVINE, Field Officer, Industrial Rehabilitation, St. Louis, Mo. MOORE, JOHN T., Chief Clerk, Medical Department, State Compensation Department, Charleston, W. Va. MOORE, MARGARET, Case Correspondent, Southwestern Division, A. R. C., St. Louis, Mo. MOORE, Mrs. PHILIP N., President, National Council of Women, St. Louis, Mo. MOORE, W. J., Secretary, Commission for Blind, Oklahoma City, Okla. MORRIS, IRENE, Social Worker, Washington University Dispensary, St. Louis, Mo. MORRISON, A. H., Mechanical Arts H. S., Boston, Mass. MOYER-WING ALICE CURTICE, Industrial Inspection Department, St. Louis, Mo. NOOTER, MARIE, Social Service (Medical) Red Cross U. S. V. H. No. 35, St. Louis, Mo. OTT, LEE, State Compensation Commissioner, Charleston, W. Va. PAYTON, Susanne A., Chapter Case Correspondent, S. W. Division, A. R. C., St. Louis, Mo. RAMEY, MARGARET, Supervisor, Case Correspondence, S. W. Division, A. R. C., St. Louis, Mo. REAVIS, GEO. W., Assistant Director, Rehabilitation, Jefferson City, Mo. RENARD, BLANCH, Assistant Director, Community Council, St. Louis, Mo. VOCATIONAL, REHABILITATION. 9 RIDDLE, S. S., Chief, Bureau of Rehabilitation, Pennsylvania Department of Labor and Industry, Harrisburg, Pa. ROCKEY, D. W., Supervisor, Industrial Rehabilitation, Santa Fe, N. Mex. SAYLOR, CHARLES HENRY, Acting Supervisor, Industrial Rehabilitation, Springfield, 111. SCHNEIDER, ERNEST L., State Supervisor of Industrial Rehabilitation, Missouri State Department of Education, Jefferson City, Mo. SCHOLZ, HELEN C., Medical Social Work, A. R. C., St. Louis, Mo. SCHOPMEYER, C. H., Assistant in Agricultural Education, S. R. S., United States Department of Agriculture, Washington, D. C. SCHWAB, MRS. S. I., Missouri Association for Occupational Therapy, St. Louis, Mo. SHANNON, MAY, Secretary-Treasurer, Bindery Women's Union No. 55, St. Louis, Mo. SHAW, JOHN C., Special Agent, Industrial Rehabilitation, Wheeling, West Virginia. SHAW, W. F., Supervisor, Civilian Rehabilitation, Columbus, Ohio. SMALL, R. O., Director of Vocational Rehabilitation, Department of Education, Bos- ton, Mass. SNORTUM, KENNETH O., Assistant Director of Reeducation, Minnesota State De- partment of Education, St. Paul, Minn. % SONNENSCHEIN, ALICE, American Red Cross, St. Louis, Mo. SPRAGGON, MRS. SARAH, State Superintendent, Women's Free Employment Depart- ment, St. Louis, Mo. SPITZ, JOSEPH, Deputy Commissioner, Rehabilitation Commission and State De- partment of Labor, Newark, N. J. STANTON, H. L., Supervisor of Industrial Rehabilitation, Raleigh, N. C. STRUCK, F. THEODORE, Assistant Director, Vocational Education, State Department of Public Instruction, Harrisburg, Pa. SULLIVAN, OSCAR M., State Department of Education, Director of Reeducation, St. Paul, Minn. THOMPSON, L. LUCILE, St. Louis, Mo. WALKER, LOUISE, Assistant Director, Medical Social Service, A. R. C., St. Louis, Mo. WARD, M. H., Representing Illinois Manufacturers Association, East Side Manu- facturers Association, Granite City, 111. WHEELER, MARY L., Orthopedic Social Worker, Barnes Hospital, St. Louis, Mo. WHITE, CATHERINE E., S. W. Division, A. R. C., St. Louis, Mo. WHITE, ROBT. H., Director of Civilian Rehabilitation, Nashville, Tenn. WILFLEY, 0. S., Medical Officer, U. S. V. B., St. Louis, Mo. WOODRUFF, C. N., Detroit Rehabilitation Office, Department of Public Instruction,. Detroit, Mich. WOODS, SAM E., Supervisor, Industrial Rehabilitation, Jackson, Miss. WORTH, W. E., Assistant Manager, Industrial Relations Department, International Harvester Co., Chicago, 111. WRIGHT, J. G., Director, Federal Board for Vocational Education, Washington, D. C. YOUNG, FAITH, Statistician, S. W. Division, A. R. C., St. Louis, Mo. FIRST NATIONAL CONFERENCE ON VOCATIONAL REHABILITATION OF PERSONS DISABLED IN INDUSTRY OR OTHERWISE May 15, 16. 17, 1922. ST. LOUIS. MO. GENERAL MEETING. MAY 15 2 P. M. CHAIRMAN: Mr. JOHN AUBEL KRATZ, Chief, Vocational Rehabilitation Division, Federal Board for Vocational Education. Chairman KRATZ. It affords me great pleasure that I have the honor of opening what is really the First National Conference on Vocational Rehabilitation. Last fall we held three regional confer- ences in Philadelphia, St. Paul, and Salt Lake City. These were very well attended. To-day we begin our first national conference. In beginning I want to say that there is every justification for calling this meeting. Although the Federal Board has called it, the matter was initiated with State officials, who by correspondence and in per- sonal interview said they thought this would be an appropriate time for State workers to convene to discuss matters of interest and to pool our information and experiences, to get together and meet each other, and, above all, to consider matters of first importance in our work. We have been engaged in the work of industrial rehabilita- tion I should say vocational rehabilitation, because the work is not confined to industry and I like to think that although we have been going only a year and a half we have accomplished much which we have handed on to the States. If you will study the program, you will see just what we hope to do. We believe that we shall all go away much better in thought, vision, enthusiasm, and capacity to do our work. There are very few States not represented. It would be very difficult to get repre- sentatives from all of the 34 cooperating States here. Local diffi- culties in connection with travel prevent complete representation. 11 12 VOCATIONAL REHABILITATION. Several States, however, have come in good numbers, and there are as many as three or four delegates from some of them. We have with us also persons from allied fields, such as compensation, social service, and the like. I am sure more will come later. It has been very gratifying to hear from so many people regarding attendance at our conference, and a number of persons have expressed regret that they could not come. I wish to call your attention to the registration desk in the rear of the room. We want everyone to register, so we may know who you are and what activity you represent. In room 110 the Hanger Artificial Limb Co. has an exhibit of arti- ficial arms and appliances. This exhibit will be kept open through- out the conference. I do not want to let this opportunity go by without calling atten- tion to the splendid cooperation that the State folks in Missouri have given to make our stay here pleasant and agreeable. They have done everything to make this meeting go, and to them will be due in large part the fine success that I am sure this meeting will have. It is with much regret that I can not introduce to you Mr. Sam A. Baker, superintendent of schools of Missouri. He has sent in his stead Mr. George Reavis, who will now speak to us. ADDRESS OF WELCOME. Mr. GEOGE W. REAVIS, Assistant Superintendent of Schools, Missouri. Mr. Chairman, ladies and gentlemen, when I visited the battle fields of Gettysburg they took us up on a hill where the big guns were located in that conflict, and then they took us down and showed us where the little guns were located, and ever since that time I have reserved the high places for the big guns, because I am only a little gun and like to stand down on the level. Missouri and those in charge of the vocational rehabilitation work are immensely and earnestly in sympathy with the movement. We in Missouri have not done as much as some of the other States in the Union, and it seems fitting to-day, the birthday of our State work, because we are 1 year old, that we should have this convention of workers meet here to discuss with us, to work out plans, to put them in operation, and to make our work better as the years go on. Your chairman said that I was to deliver the address of welcome. This is my maiden attempt at delivering an address of welcome, but let me say you are just as welcome in Missouri as the flowers in May, and after you have had your sessions here and after you have closed up your work I hope that you will look on this as a successful meeting, and I hope that you will want to come back again to old Missouri; so VOCATIONAL REHABILITATION. 13 I want to extend to you right now an invitation to make this place your meeting place next year. You are engaged in a new work. In our country nothing like it has been attempted before. We are taking in this State and in this Nation the taxes of all the people the millionaires and the washer- women and we are taking that money and using it for the purpose of rehabilitating handicapped people, putting them back on the payroll, so they may again know what it is to be upstanding men and women and not be a charge upon the community. It is up to us whether or not we shall be good stewards in this work, or fritter away the taxes of the people and not show good results. We are living in a very interesting and important age. We are living among a seething, surging mass of humanity where each one is trying to get together enough to feed his family. There are many hazardous positions and occupations, many dangerous jobs that somebody must do. It is up to you to give light to the individual, down-hearted and discouraged, who sees nothing but darkness ahead. It may be up to you to inspire that individual to take heart and try again to assure him that there is a new day, that there will come an oppor- tunity in the future to make good. So it is up to you to sit as com- forters in a home of sorrow, to work with the people, not to work with the millionaires who have two good hands and two good eyes and two good legs. That is not your preference; you are to work with the unfortunate class, in vocational or industrial rehabilitation, to put them back again take the fellow that is down and out and put him back on the pay roll again. How is this to be done ? I believe that to be a good field agent one must be as wise as Solomon, one must be as big as his job. We have had a few cases in Missouri where the agent has taken the disabled person, carefully investigated the case, put him in training where he has responsibility, and, in the language of the street, he has "made good," he appreciates the effort of the people, of society, in his behalf. We find another class of folks; you can pick them up and help them, minister to them, and you will wake up to find them in jail. Then you have that class which seems to be very difficult to work with. How are we going to help the pencil and shoe-string sellers, and the fellows who do not want to do anything ? How are we going to inspire them to do anything that is worth while ? I think that it is absolutely necessary that the field agent or supervisor supervise. Super, you hear that word often; superman, beyond the ordinary man. If you measure up to the meaning of the term "superman," you have the ability to go out and by patient toil and energy to work out something that the other fellows of us here could not do. It is neces- 14 VOCATIONAL REHABILITATION. sary that you secure the cooperation of all the agencies around about or in the State, and so it seems to me that the silver thread of cooper- ation and the golden cord of inspiration must characterize you in your work, and it seems to me that the successful supervisor, or successful field agent, is the one who is going to tie together as best he can all the cooperating agencies and get them to work together and put these unfortunates back on the pay roll so that they may look the whole world in the face, and though handicapped they may feel "I am master of my fate and captain of my soul, and I can make good, and I will make good." That is a hard task, and I know you will get dis- couraged when you see a few people in whom you have put a lot of confidence heedless of your efforts. You become discouraged and say " What is the use ? " But remember that there are still enough folks in the world who will appreciate your efforts. Somewhere in this big city there is an unfortunate man or woman, boy or girl, of employable age, who is longing for the very help that you, cooperating with the National Government and the State government and the city govern- ment, are able and ready to give. When you can find that individual who is just longing and you can see the mist come into the eye and you can see the devoted wife take out her handkerchief, you have an avenue of approach and you can help that person in some way. I am going to leave it to persons who are mightier than I to speak of the ways and means of securing cooperation of the various fra- ternal organizations, but I believe that through the B. P. O. E.'s, the Masonic clubs, Rotary clubs, Kiwanis clubs, and other organizations we can work out a scheme of cooperation and can tie them together and can work out a uniform plan so that what is being done in one State can be done in all the other States where the Federal Board is giving aid and money. We ought to have a uniform system of work- ing out plans that will be most effective, just as we have in the voca- tional education. In conclusion, I hope that you will have a good meeting. I hope that you will feel when you go back to your States that you have been helped, that you have just a little better grasp of the situation, and you feel like doing just a little more next year than you did last year, in order that somebody somewhere may be helped and lifted from the condition where he is to a life of usefulness to himself and the community. We live in a dynamic world. We do not live in a static world. May we improve as the work goes on. With future conferences like this we will know how to go on. Chairman KRATZ. Paraphrasing the words of a famous statesman, this is a conference of the States, by the States, and for the States. The Federal Board has called this conference, but it is your conference. The Federal Board is taking very little part. The staff are here ready to meet you in between times and to discuss the problems you VOCATIONAL [REHABILITATION. 15 may have and to be of general assistance. I would now like to have a roll call of the States. (The chairman hereupon called the roll of States, to which repre- sentatives present responded as follows:) Georgia: FORT E. LAND. Idaho: GEO. E. HORTON. Illinois: CHAS. HENRY SAYLOR. Indiana: LEONARD B. JOB. HENRY F. BURTON. Iowa: WILLIS W. GRANT. Louisiana: H. G. MARTIN. Massachusetts: R. O. SMALL. HERBERT A. DALLAS. Michigan: C. N. WOODRUFF. Minnesota: OSCAR M. SULLIVAN. KENNETH 0. SNORTUM. Missouri: GEORGE W. REAVIS. EARNEST L. SCHNEIDER. DR. C. W. LsBow. ERVINE MEYER. LILLIAN H. DAVIS. Mississippi: F. J. HUBBARD. SAM E. WOODS. MRS. MARY S. BAKER. Montana: Lloyd A. HENRY. Nebraska: C. A. FULMER. J. R. JEWELL. New Jersey: JOSEPH SPITZ. North Carolina: H. L. STANTON. New Mexico: D. W. ROCKEY. Ohio: W. F. SHAW. Pennsylvania: F. THEODORE STRUCK. S. S. RIDDLE. South Dakota: MARGUERITE LISON. Tennessee: ROBERT H. WHITE. West Virginia: JOHN C. SHAW. LEE OTT, State compensation com- missioner. JOHN F. MOORE. Wisconsin: W. F. FAULKES. H. V. HARVEY. Oklahoma: CHAS. W. B RILES. Chairman KRATZ. Mr. Fidler, who was to have been the next speaker on this afternoon's program, is unable to be here. We have with us, however, Mr. J. C. Wright, the new Director of the Federal Board for Vocational Education. It is not necessary for me to introduce Mr. Wright to this audience. I am sure you know him. Mr. WRIGHT. Mr. Chairman, ladies and gentlemen, I wish to say to you that it is with much regret that Mr. Fidler, vice chairman of the board, is not able to be here this afternoon, because of other busi- ness. Mr. Fidler has asked me to read his paper. 16 VOCATIONAL REHABILITATION. A NATIONAL PROGRAM OF VOCATIONAL REHABILITATION. H. L. FIDLER, Vice Chairman, Federal Board for Voca- tional Education. I am especially happy at the opportunity of participating in this conference. Let me say that the vocational rehabilitation move- ment has a deep personal as well as public meaning to me. It touches a subject which has been the background of my own life. It is only a few years ago that I stepped down from a locomotive cab over here on the Pennsylvania Road. Among the wage-working class I had spent all the formative years of my life. And if there was any one impression which I took away with me from my work- ing experience it was the tremendous need among workers of just such an agency as we are here to-day to promote it was the need of vocational rehabilitation. The most piteous memories which I carry of my old railroad coworkers are the memories of the broken, crippled victims of industrial accidents, so numerous in our ranks. And the greatest responsibility which I feel as a member of the Federal Board for Vocational Education is the responsibility to use all my powers to perfect this great rehabilitation agency to the point where no injured worker in America need suffer in the future for the want of reemployment. Truly remarkable has been the progress of vocational rehabili- tation during the last 24 months. Two years ago the vocational rehabilitation of persons disabled in industry or otherwise on a national basis was only a project. Be- fore June 2, 1920, only three or four States were engaged in any public program of restoring disabled workers to remunerative em- ployment. To-day 34 States are engaged in this task in cooperation with the Federal Government. The others are fast falling in line. Not even the most visionary optimist would have foretold such an expansion in two brief years. In several of the 14 noncooperating States the legislatures have not had an opportunity to pass upon an acceptance act. In two or three of them certain technical adjustments will be made making cooperation with us possible. Already in others there has been aroused a sentiment for the work which will crystalize into action at the next meeting of the legislatures. The effect of example and accomplishment in surrounding States can not be long withstood in nonrehabilitation States. But let us contemplate for a moment on what has been done to date in the 34 States cooperating. A conception of its present magnitude may be gained from the fact that the administrative staff in these States numbers 125 persons. This number means much more, however, when we realize that this staff has many VOCATIONAL REHABILITATION. 17 times its own number of assistants. A great army of helpers is re- cruited through cooperation with other State departments, such as Workmen's Compensation, Education, Health, Labor, Welfare, and with numerous social agencies, to say nothing of the medical profession, and men of business, as well as cooperating individuals. For example, one State with a staff of only five members has set up cooperative relations with over 60 municipalities. Almost every week information comes to us from the States that some new relationship has been established, making for a better and more extended service. Looking at accomplishments from another angle, we see in the* period from July 1, 1921, to November 15, 1921, an increase in the live roll of the States of 240 per cent. Although exact figures will not be available, before the close of the present fiscal year, we believe by July 1, the live roll will number fifteen or sixteen thousand cases. Figuring on a basis of from four to five months of service to each case, there will have been assisted during the present fiscal year almost 50,000 disabled persons in the 34 cooperating States. I hesitate to make an estimate of what the live roll of cases at the end of the year 1924 will be, but judging from the past accomplishments and taking into consideration the momentum that will come by way of increased experience and development of new methods, the number of disabled persons assisted by the States during the year 1924 will approximate 90,000 cases. Vocational rehabilitation is decidedly on the map, and by the close of the year 1924, the end of the experimental period assigned by Congress, it is my opinion that vocational rehabilitation will be as important a national and a State movement as is vocational education or any other movement of social progress and welfare. I would also like to say in passing that the strength of the oca- tional rehabilitation movement lies in its appeal to all industrial groups. It is not a mooted program. It is an unchallenged program, to which capital as well as labor can give hearty support. It enjoys the pleasant singularity of being one of those few movements in which the employers and employees can unite their enthusiasm, for it touches the cord of humanity which lies in everyone. This meeting at which we are now in attendance is the first session of the fir's t national conference of vocational rehabilitation workers and representatives from a number of cooperating agencies. To-day and for the next two days we are to make rehabilitation history. What we accomplish here will, I trust, in no small way affect the future of the great social program in which we are engaged. We have come together from every section of this great United States to discuss ways and means of promoting and advancing the work of the 1476522 2 18 VOCATIONAL REHABILITATION. reclamation of the disabled. The conservation of the Nation's man- power in this time of stress is a matter of no small concern. To-day the thought of the great minds of industry is pointed toward great production with little waste. This is, of course, a worthy purpose, but coupled with it should be the desire to accomplish large pro- duction with a minimum hazard and injury to labor, and a maximum of return to them in safety, physical comfort, and happiness. I am convinced that to this high purpose and endeavor the move- ment of vocational rehabilitation will make a very substantial con- tribution. It would be entirely out of place for me to attempt to convince this audience that more and better education will be the cure of many of our social ills. The training of young men and women, and of older men and women for that matter, to use their hands in the skilled trades and occupations of our modern industrial world will go far to build safe and sure foundation for a social structure that will endure. But although the wheels of industry are being made to turn more safely, and although the compensation laws of our country are gradually being made more comprehensive and beneficial, disabling accidents will always be with us, and workmen's compensation will always be inadequate. Of a necessity the movements of safety, accident prevention, insurance, and compensation will always need to be supplemented by a program of restoration to industry through the media of expert advisement, skillful guidance, and efficient coopera- tion by a rehabilitation service. The program has been launched. We are here to pool our informa- tion, exchange our experiences, and to develop new plans and methods for furthering this great national program of vocational rehabilitation in which we are engaged. It is the hope of my Board that your conference will accomplish big results. Mr. WRIGHT. As I sat here this afternoon and listened to what has already been said I could not help but think of some of the phases of your program that are likejbhe program of improving foremanship. You might well adopt a slogan and let that slogan be " save the man." Down in the coal mines of our coal-mining districts the men are required to examine their working places continuously to note if these places are safe. We think of mining as a hazardous occupation. It is. We must think of the men working down there as men to be protected and saved. When you get a group of foremen together and ask whether it is worth while to save the man, to save even a man who, because some act of his own has been careless, has caused an accident resulting in an injury to human life, those foremen will tell you that they are responsible for trying to save the man in ev( every VOCATIONAL REHABILITATION. 19 case. If the man has been careless, the question is what shall be done with him shall he be fired, or shall he be counseled and re- tained in the service. Even as a matter of business economy, to save expense on account of labor turnover, it is not an exception but the rule for foremen in positions of that sort to say that they are responsible for saving the man first, and that they will not fire him, except when they can not find a way to overcome his habit of care- lessness. If the man through his own carelessness has suffered a physical disability, he still possesses potential value as a skilled workman or as an executive, or is capable in some line according to the capacity in which he has been working. He still possesses that potential value, and the question is, Is the man worth saving ? We say, "yes." From the standpoint of a comprehensive national program, it seems to me that your particular program can well be set up in three or four stages, comprising the stages we found it necessary to go through in the preliminaries of vocational education. The National Society for the Promotion of Vocational Education, together with conferences that were held in various parts of the country where groups of 10, 20, or 30 people got together, established a certain philosophy and set up certain principles which in five years of ad- ministration of the Smith-Hughes Act we have found little occasion to change. Those principles had to do with objectives what we were trying to do, what was the purpose of vocational education, how were we going to set up a program. The question of schools, of teacher training, and all the problems hi industrial, agricultural, and home-economics education were involved. This social under- taking called for the establishment of various programs, the prepara- tion of State plans, and the organization of schools within the States. The passage of the vocational rehabilitation act, however, pre- sented a somewhat different situation, in that nobody, or at most very few, had proceeded to study the problems with which you are con- fronted in a similar way. You are pioneers. You are beginning at the beginning. While it is true that certain of the States have had experience in compensation, nevertheless, in my opinion the under- taking is yet to be established upon a basis of agreed-upon and well- founded principles. And that is the problem you are up against. The act sets up certain requirements, and after these requirements are met, the State plans provided, etc., it becomes somebody's responsi- bility to find out where these people are who need rehabilitating. You must locate your cases, and then these vocationally disabled persons must be placed in positions where you believe they will be rehabilitated. tYou may disagree with me, but I believe that is about where you e to-day. You have gone through the stage of how to get a State 20 VOCATIONAL REHABILITATION. to cooperate, how to set up a State plan, how organizations can be provided in the State to administer and cooperate, and you know how to locate cases throughout the State and get them placed in some sort of occupation in which it is believed they can be retrained. The real problem is giving them the training which fits them for the occupation for which you wish to train them, so that they become full-fledged wage earners. A man is placed down in a coal mine as a substation operator placed there perhaps because he has one arm missing and because the employer reserves that sort of place for handi- 1 capped men. If the man has no knowledge of, for example, electricity, he may need a considerable amount of help, attention, and training in order that his fellow workmen or the foreman may not look upon him as a person in a position reserved for unfortunates, or as a recipient of charity. I should like to see that man placed in a position where he can hold his head up among his fellow men, so that the fact that he has only one arm will make him no different from his co workers. That is the problem that we have before us to-day. Chairman KRATZ. Mr. Coman, of California, will not be here this afternoon, and Mr. Job, of Indiana, has kindly consented to speak to us on " Reciprocity among States in vocational rehabilitation." RECIPROCITY AMONG STATES IN VOCATIONAL REHABILITATION WORK. LEONARD B. JOB, State Supervisor Vocational Rehabilitation, Indianapolis, Ind. I came down here with the impression that Mr. Coman, of Cali- fornia, would tell you all about reciprocity between States and that I might be called upon to supplement his address by a few remarks concerning local conditions in Indiana. Mr. Kratz wired me a few days ago, asking if I would say something about reciprocity at this conference. I had no idea that I was to play any important part in this performance and am, therefore, wholly unprepared. I can only hope to raise a few points which, I believe, are worthy of discussion at this tune. I hope those present will consider these points and discuss them at length. 1. Probably the first and most important way in which States can help each other is by investigating cases. It often happens that citizens of one State are injured in another State. They come under the rehabilitation service of their home State, but the rehabilitation workers find it impossible to travel in other States to make the neces- sary investigation. Just as frequently disabled persons wander from their home State in search of employment or for other reasons. When they hear of the rehabilitation service they wish to return VOCATIONAL REHABILITATION. 21 home and take advantage of the opportunity. This affords an excel- lent chance for the States to get together in this work. 2. The question of medical examination has already come up in Indiana. A man injured in Michigan came to Indiana to work. He made application for training in Michigan. A medical examination was required. I secured the examination and forwarded the report to the supervisor in Michigan. The cost of the examination was borne by the Indiana division. A working relation of this sort between States is of great aid. It costs but little and is of real value. 3. New cases coming to the supervisor in one State often belong to other States. Such cases can easily be referred to the State in which they belong. Such service has a great possibility. 4. A fourth point which is of great importance is that of broad- casting infonnation concerning desirable training opportunities. Some of the men present were in soldier rehabilitation work and have some knowledge of the training opportunities in other States. All of you, however, do not have this information and often need information concerning possibilities in some lines of work. If it is at all possible we should train our people in our own State. This is not always possible. We have no place in Indiana where we can secure training in watchmaking. We therefore send our people to Bradley Institute at Peoria, 111. Training opportunities which are especially good should be widely advertised by the State service, because some States are much more fortunate than others in the variety of training institutions and of industrial plants. In Indiana we have a shoe repair shop which conducts a, course in shoe repair work. The course covers from six to eight weeks. I know of places which devote from one to three years in teaching the trade. It is not at all necessary to take such a long period. It can be done in eight weeks or less. Men so trained can get jobs paying at least $20 per week. It has been done in Indiana. 5. A fifth point which I would like to have discussed is that of having rehabilitation agents in other States follow up cases in training. We have men in training in two of our neighboring States. It is obvious that we can not follow up these people personally. There are in training in Indiana to-day men from three other States. We are gladly following up these men and making reports to the proper supervisor. It entails no extra work as we have some of our men in the same institution. It is my opinion that this can be made a very valuable service. If Mr. Shaw, of Ohio, sends a man to the Dodge Institute of Telegraphy, at Valparaiso, Ind., he can send me the man's name and I will gladly supervise the case. He should keep me informed of the man's withdrawal, however, if he leaves the school before training is completed. Such machinery is very simple, and the results should be worth while. 22 VOCATIONAL REHABILITATION. 6. The cost of service rendered persons from other States might well claim our attention for a moment. It is my opinion that supervision or follow up and cost of medical examination can well be met by the State in which the work is done or the examination secured. Tuition costs should, of course, be met by the State in which the man claims residence. From the Federal viewpoint I can see no reason for objection to any agreement reached between States, as the main point is that the Federal dollar be matched. It makes no difference whether it is a Hoosier dollar or a Buckeye dollar. I have enumerated six phases of rehabilitation work and have attempted to sketch, very briefly, the manner in which States can render service to each other. I shall be glad to hear an expression from other State supervisors on these points or any other wa} T s in which a State may be of service to its neighbors. GENERAL DISCUSSION. Mr. REAVIS. What does the gentleman from Indiana think of cor- respondence schools ? Mr. JOB. I do not wish to take a stand on the question of corre- spondence courses. I use them, I subscribe to several of them, but I will say that in only a small percentage of cases do the results justify the costs. Mr. WRIGHT. There was a question raised about which I would like to know more. In his statement about doing the work of another State I should like to know the mechanics of that. If a man who lives in Indiana moves to Ohio, do you give him training, or do you mean that the Ohio people do this for you, if you reim- burse them ? Mr. JOB. In Indiana the cost of training has been borne by the State sending the man to Indiana. We have sent men outside the State and we have paid the cost. As to the question of a man in- jured in Indiana and moved to Ohio when trained under the Indiana law, if that man thinks he will some day come back to Indiana and live, I would not hesitate to give him training in Ohio under the supervision of Mr. Shaw and pay for his training out of Indiana funds. If he had been injured in Indiana five years ago and moved to Ohio, I would consider that Mr. Shaw's problem and not mine. He has been out of the State long enough to be considered a resident of the other State. We do not consider the question whether the man received his injury in Indiana. If a man has sustained an in- jury in Indiana, we will train him. We will pay the cost of the train- ing, no matter where he was injured. If he was injured in another State, came to Indiana for six months, wanted to go back to his home VOCATIONAL REHABILITATION. 23 State, I would be inclined to feel that that is not our job. Have I answered your question ? Mr. WRIGHT. I think you have. I am raising certain questions for the purpose of discussion. Each State assumes the responsibility for taking care of the people who are living or residing in the State. What is everybody's job is nobody's job, and perhaps you feel that this fellow who was hurt in Indiana and goes to Ohio should be retrained in Ohio and that is Mr. Shaw's job, and Mr. Shaw might feel that this was Mr. Job's. Is there any ground for common understanding ? Mr. FAULKES. Would not that be largely defined by the State law? In Wisconsin "any physically handicapped person who has been domiciled within the State for one year or more, or who resides in the State and shall so reside at the time of becoming physically handicapped, may apply' to the board for advice and assistance relative to his rehabilitation." I had a very worthy case, a man with two legs cut off, but because of the provision of our act we can not help him. As I was listening to Mr. Job, I thought it would be a very nice thing if we had a digest from the Federal Board of all the State acts. We would then know how far each State could go. Chairman KRATZ. I wish to state in response to the suggestion of Mr. Faulkes that such a bulletin is about to be undertaken by the Federal Board. With regard to the whole question of eligibility, the matter is decided in the last analysis in accordance with the provisions of the State law. For instance, if your State act pro- vides that you can not rehabilitate a man unless he is a citizen of your State, or unless he has been a resident of your State for, say, six months or a year, then you must be guided by the act. Mr. SULLIVAN. Regarding State acts, it would be valuable to us if we had a digest or statement of the laws of each State. How long does a man have to reside in a State before he becomes a charge on the State ? We have had that arise in Minnesota. We undertook a case a month or two ago, attempted to rehabilitate this man, and we had the local charity associations camping on our trail, because they claimed we were encouraging a person to stay in Minnesota and thus become a charge upon the State. That becomes a question of con- siderable importance, especially where you are going to organize maintenance. These people will want to know are you encouraging the man to become rehabilitated or are you encouraging some one to become a public charge ? That should all be considered how long a time must a person have resided in a State before he becomes a charge on that State ? Mr. WHITE. I was just going to suggest that the Federal Board get that digest as to requirements for eligibility in the various States and pool that information and submit it to the States. You will 24 VOCATIONAL REHABILITATION. find 34 laws, 34 different requirements of eligibility. In Tennessee a person must have resided in the State for one year in order to get rehabilitation training. Mr. RE A vis. Is that requirement for voting or eligibility ? Mr. WHITE. Eligibility. If a boy has lived in Tennessee for one year. It has nothing to do with suffrage. Chairman KRATZ. Has Mr. Riddle anything to say ? Mr. RIDDLE. I would like to speak on the residence point. Our rehabilitation act does not set up residence requirements. Our State constitution does define conditions of citizenship. In the case of rehabilitation., however, we look into the applicant's intentions as to residence. A man's family is located in Virginia; he temporarily comes into Pennsylvania. Where he has always worked we presume he is going again. On the other hand, we have had men from for- eign countries come into our State, but they are going to remain. Any person who has been in the State and has indicated his inten- tion to remain, provided, of course, we are satisfied Pennsylvania will be his permanent home, is entitled to rehabilitation. A lot of common sense is necessary, and you will have a lot of twilight-zone cases and will have to stretch things a bit and view the legislation in its broadest interpretation. If we get it standardized, we are going to get into difficult straits. We can not overcome definite legisla- tion entirely; we ought not to set up standards to interpret legisla- tion. In Pennsylvania the State legislature restricts us more in its (State's) expenditures than in the case of Federal expenditures. Chairman KRATZ. I am going to appoint a committee to consider these questions. Here is a man who has started rehabilitation in the State of Indiana, and for some good and feasible reason, not some idiosyncrasy, he needs to go to another State and take up rehabilitation. If that State had set out in its plans the requirements for eligibility, that man would have to w T ait until he met the State requirements. I am going to ask Messrs. White, Sullivan, and Job to put on paper for some future meeting some statements they think the Federal Board ought to' take up at this conference. Does that meet with the approval of this body ? Mr. WRIGHT. In this connection I think it would help the Federal Board if this committee would make the specific suggestion that a digest of State laws be made. Chairman KRATZ. Has anyone a specific question he would like to ask? Mr. JOB. Along the line of the interpretation of the law and the resident requirements, I do not want to give the impression that we have laid down any rules regarding the length of residence. The length of residence is not mentioned in our law. The State board of education has } r et to make its first ruling with regard to the inter- dof Her- VOCATIONAL REHABILITATION. 25 pretation of our law. We have no ruling of any kind from the attorney general or the State board of education. They have left it to those in charge to do what is best for the cause in order to put the job over. Chairman KRATZ. The next speaker on the program is Mr. S. S. Riddle, who will discuss " Rehabilitation of persons with type dis- abilities." REHABILITATION OF PERSONS WITH TYPE DISABILITIES. Mr. S. S. RIDDLE, Chief, Bureau of Rehabilitation, Depart- ment of Labor and Industry, Pennsylvania. After I had read over the subject assigned to me, to tell the truth, I reached the conclusion that I had little to say on type disabilities. Experience of the Pennsylvania Bureau of Rehabilitation tends to show that it is difficult to consider specific task lists of employment possibilities in connection with specific types of disabilities. For instance, we have vision defects, arm and leg amputations, internal injuries, injuries without limitation. As one able-bodied person may be a better skater than another able-bodied person, just so may one disabled person without one hand or two hands be per- fectly eligible for a certain type of employment for which another person with the same disability exactly could not even be considered. Each rehabilitation case presents its own physical, economic, train- ing, and employment problem, and must be considered individually in the light of all factors affecting it for complete success of a rehabil- itation program. Mr. Delfino, one of our blind cooperating agents, has said that a blind man could do anything but paint a picture. There are certain limitations that are, of course, imposed upon all disabilities. There are far more important factors involved in rehabili- tation than the actual type of disabilities. Some of these factors are age, education, mental capacity, physical capability, courage, will power, ambition, the possibilities of employment in the neighborhood where the person is going to live, domestic responsibility, and accom- panying economic pressure. There are all sorts of problems which almost prevent their being classified under types. A year ago I was very strong for surveys that told us for instance what one-armed men could do in shoe factories. They are of value. I think, however, that it is best to show what happens in the case. We try in Pennsyl- vania, so far as possible, to meet the disabled persons on their own ground. We try to get them enthused. We try to meet them on a common level. We try to appeal to them in a matter of fact way. We try to get all of them to realize as well as they can what lies before them and to make the best of what ability they have in the work that seems, in the light of all circumstances, best suited to them. 26 VOCATIONAL REHABILITATION. In order that you may see what we in Pennsylvania have done for different kinds of cases, I am going to cite a number of cases, of which I have photographs here. A charge of powder being tamped in a hole in a clay mine in central Pennsylvania in July, 1917, exploded and not only destroyed the sight of - , a sturdy American, 27 years of age, but changed his whole future. He had quit high school when 17 years of ag&, gone to work as a railroad fireman, and later entered the mines. To-day he is a licensed insurance salesman, established in a city in central Pennsyl- vania, after receiving, through the assistance of the Pennsylvania Bureau of Rehabilitation, one year of instruction in an institute for the blind and another year in intensive study of insurance at the Wharton School of the University of Pennsylvania under direct instruction of Prof. S. S. Huebner, a national authority on insurance. A heavy bolt falling from the superstructure of a merchant ship in course of construction on the ways of a Pennsylvania shipyard not only fractured the skull of - , 29 years of age, a naturalized American, Montenegrin born, but after three years was a direct result of this man's holding a responsible position with a large com- mercial organization in Pennsylvania a position which is an avenue to greater work in which his knowledge of a number of European languages in addition to English will be a great asset. Two years of intensive study in a commercial school, based upon his elementary education in his native language, accomplished the final result with the aid of the bureau of rehabilitation. When an industrial accident caused the amputation of the left leg of - , an 18-year old boy in a Pennsylvania city, he tried a num- ber of tasks with indifferent success, registered with the Pennsylvania Bureau of Rehabilitation, was placed in employment training with a large baking company in a task which he found suitable and con- genial, and to-day is a regularly qualified and salaried employee at a skilled task in a large bakery. One of the ropes snubbing a barge at a Pittsburgh wharf on the Allegheny Rivei; in 1918 caught the right leg of - , a 19-year old " wharf hand," crushing the leg so that it had to be amputated. The boy was provided with an artificial leg by the Pennsylvania Bureau of Rehabilitation, put into commercial school for a time, and later at his insistent request given training in barbering. He is to-day a qualified and successful workman in his new task. Two young women in the same central Pennsylvania city lost their right hands while operating presses in industrial establishments. They have each been trained for clerical work, and to-day are in more congenial and remunerative employment, with better future prospects, than before they were injured. * VOCATIONAL REHABILITATION. 27 A young man, 19 years of age, lost both legs while working as a brakeman on the railroad in July, 1919. The bureau of rehabilitation assisted him by training in a commercial school, and he is now working as a clerk for a large car manufacturing company in Pennsylvania, at a salary of $80 a month, and is happy in his work, and his employer is well pleased with him. This } 7 oung man, 24 years of age, lost his left leg and sustained injuries to two fingers on his left hand in a mine accident. He was entered by the bureau of rehabilitation in a school of telegraph}^, and is now back with the same coal company where he was injured. We have another case where the man suffered the loss of a leg, and is successfully working as superintendent of a building. He finds little difficulty in performing the most unusual tasks in his work, although his right leg was amputated above the knee. In Wilkes-Barre we have had considerable success with getting a couple of young blind men to learn to walk around by themselves to sell brushes. Those small sales made considerable success. With broom making we have had little success. You take the individual who is going to live at home, install a broom-making machine, and you have the proposition of selling. We have one man making baskets. We have established a direct line of communication between him and a department store. There has been very little op in his sales; he has marketed through that channel. A young man came back from France without a scratch. He entered an industrial establishment upon his return and met with an industrial accident which caused the loss of his left hand. He is being trained in a commercial school for clerical work. This man came to us and we asked him what he would like to do. He said he would like to be a baker. He was cleaning the dough mixer one day and through his failure to shut off the power before cleaning the machine, he lost two of the fingers of his left hand. He attempted to get compensation for the loss of these fingers, but the compensation commission said that inasmuch as he was not receiving a wage at the time of his accident he was not eligible for compensa- tion. He was in the capacity of a student. There was no possibility of paying compensation to that boy. Now, then, whenever we put people in training without salary we make some provision for the wage of the injured person, no matter how small, so that in the event of a second injury we can secure compensation for the disabled person. (Here Mr. Riddle exhibited pictures of a number of other cases showing what has been done in Pennsylvania for persons with differ- ent kinds of disabilities.) Hundreds of just as energetic and ambitious disabled persons have been trained or are now being trained in Pennsylvania in many lines of work suitable in each case to the disability of the injured person. 28 VOCATIONAL REHABILITATION. A few of the many tasks for which such persons have been trained and are being trained are accountancy, automobile mechanics, bak- ing, barbering, basket making, bookkeeping, card writing and engrossing, carpet weaving, chair caning, clerking of various kinds, drafting, electricity, embalming and funeral directing, insurance selling, jewelry manufacturing and watch repairing, mine fire bossing, motion-picture operating, piano tuning, selling, shoe repairing, school teaching, stenography, telegraphy, commercial and wireless telegraphy, traffic managing, and welding and brazing, in addition to many skilled tasks peculiar to the various industrial works. We have had a variety of experiences. We have had all types. Our one object is to make the rehabilitation facilities available so as- to render to all the utmost service. Chairman KRATZ. Mr. Schneider has an announcement to make. Mr. SCHNEIDER. Mr. Hanger, of the Artificial Limb Co. here, has said through his representative that he would be glad to have 3, 4, 5,. or 6 persons here wearing artificial appliances. Mr. Kratz said if you desire the Hanger artificial appliances to be shown we will have several persons up here to-morrow afternoon and have both men and women. GENERAL DISCUSSION. Chairman KRATZ. Speaking of type disabilities, we all know by experience that certain types are fairly easy to handle. The eye cases and the arm amputations do give considerable concern, and I was just wondering whether or not w r e might bring up some of these types. In our further meetings we will naturally bring up case histories. Nothing so stimulates the rehabilitation agent's imagina- tion as a statement of what has been done in a case. Do not give all the spectaculr cases, give us some of the ones you didn't solve. Mr. DALLAS. I want to have the question about employment training with maintenance paid to the disabled trainee by the rehabili- tation agency in lieu of any salary from the employer made clear. Even though the rehabilitation bureau maintains the disabled worker in training from its appropriation, would it have been possible to have the employer pay such worker $1 per week so that such worker may get full workmen's compensation if he be injured ? Mr. RIDDLE. That procedure would be of no great benefit because such disabled worker sustaining another injury in his employment would receive in Pennsylvania compensation of only $1 per week. The workmen's compensation act of Pennsylvania provides that compensation shall not be more than $12 per week nor less than $6 per week, with the further proviso that if at the tune of injury the employee receives wages of less than $6 per week, then he shall receive the full amount of such wages per week as compensation. VOCATIONAL, REHABILITATION. 29 Therefore a disabled trainee receiving $1 per week as wages would receive $1 per week as compensation in Pennsylvania if sustaining an injury during training with maintenance coming from the reha- bilitation agency and a nominal wage of $1 per week coming from the employer. It is my impression that such conditions prevail gener- ally in other States. Mr. DALLAS. In our State it would be 66 f per cent. Mr. RIDDLE. In Pennsylvania our every effort is to keep living maintenance payments from the rehabilitation appropriation to a minimum so far as it can be accomplished without working hardship on a disabled trainee during his training course. On the bureau's regular placement training forms providing for maintenance the question is asked, does the employer agree to start trainee on his pay roll at the rate of $1 per week or more after four weeks' proba- tionary period in training, with the amount of pay per week from the employer gradually increasing and, consequently, diminishing in like amount per week the pay from the bureau of rehabilitation, until at the end of the 20-week period the registrant is entirely off the bureau of rehabilitation's pay roll and on the employer's pay roll. The maximum living maintenance that in any case may be paid under the Pennsylvania rehabilitation act to a disabled trainee is $15 per week. In all cases the amount of payment to a disabled trainee, including school costs or maintenance, is not necessarily the maximum but is in accurate amount the difference by which the trainee's estimated weekly expenses during training exceeds such trainee's weekly income during training. The Pennsylvania bureau has very few trainees getting maintenance in lieu of wages in employment training. Mr. DALLAS. You do not think it possible to cover the amount in training completely so far as compensation is concerned ? Mr. RIDDLE. I do not see legally how a disabled person in training sustaining injury during such training could receive compensation from a rehabilitation agency, and if the employer was paying such trainee no wage, it is very doubtful if such trainee could legally obtain compensation from such employer and, further, if the em- ployer was paying the trainee in Pennsylvania an amount of less than $6 per week, compensation would merely be the amount of wage that the employer was actually paying the disabled trainee. Before a disabled trainee is entered by the Pennsylvania Bureau of Rehabili- tation in an employer's establishment, with living maintenance during such training coming from the bureau of rehabilitation and no wage from the employer, it is made absolutely clear to such disabled trainee that it is the belief of the bureau of rehabilitation that such trainee is entered in such employment training as a student, and that, so long as he does not receive a wage from the employer, the relation 30 VOCATIONAL REHABILITATION. of master and servant does not exist and, consequently, he is not entitled to workmen's compensation payments in the event that he should be injured during the time that he is in such training and receiving no wage from the establishment. In fact, in addition to the explanation, such trainee in Pennsylvania signs a definite form of the bureau of rehabilitation, acknowledging such condition. That acknowledgment is based on the fact that, as a general proposition , workmen's compensation insurance protectio'n is afforded employers and paid to injured employees, or the dependents of employees killed, by the premium paid by the employer on his pay roll amount classified by hazards and, consequently, during the period in which the establishment pays the trainee no salary it pays no premium to any insurance carrier for such trainee, and therefore such trainee is not, so far as compensation payments are concerned, an employee of the establishment in which such prospective trainee desires to receive training. Mr. LAND. Would there be any objection in letting the employer pay the man the wage and you reimburse the employer ? Mr. RIDDLE. Yes; because under the Pennsylvania rehabilitation act the bureau may provide maintenance costs for a physically handicapped person in training, and such payments could not be made to the employer for maintenance costs if they were later to be paid by the employer to the person. Such payments should be made to the person. Mr. FAULKES. The commissioner of Wisconsin has ruled that every person is on the pay roll. Mr. RIDDLE. The Pennsylvania Commission originally made a similar ruling, but difficulties later arose regarding the insurance premiums and payments. Mr. FAULKES. In Wisconsin we have the apprenticeship law. Mr. CUMMINGS. Inasmuch as we have a compensation man here, Mr. Ott, of West Virginia, I would like to suggest that he give his opinion of this matter. Mr. OTT. I have nothing particular to add only to say that I think as Mr. Riddle. Our situation in West Virginia is the same as Pennsvlvania. GROUP MEETING. MAY 16 9 A. M. CHAIRMAN F. J. HUBBARD, Director of Vocational Rehabili- tation, Mississippi. Chairman HUBBARD. The first speaker for our morning's program is Mr. Lloyd A. Henry, of Montana, who will speak on the topic "Rehabilitation in the field of agriculture." REHABILITATION IN THE FIELD OF AGRICULTURE. LLOYD A. HENRY, Civilian Rehabilitation Agent, Montana. I notice that my topic for discussion this morning is " Rehabilita- tion in the field of agriculture." I prefer to choose for my text the possibilities of training disabled persons in agriculture under civilian rehabilitation. I wish to say in the beginning that I am a hard- headed farmer from Montana, out in the wild and wooly West where rehabilitation agents are not supposed to make speeches, but where real men are cow-punchers where, when they are not breaking bucking bronchos, they are fighting Indians and shooting buffalo for a pastime. Whenever I attempt to give a talk I feel like my friend Bill did when he rode a range steer across an irrigation ditch. Bill and I were riding across the range one Sunday morning and Bill said to me: "I can ride any range cattle on the ranch." Bill was dressed in his Sunday-go-to-meeting clothes. When we came to a corral where there were some wild ones, I picked out one I thought he couldn't ride. He got on then went up the gulch, down the range, and toward the irrigating ditch. Bill held tight until they reached the ditch, but as the steer leaped into the ditch Bill fell head first into the water. The water was very low and consisted mostly of mud. When poor Bill came up for air you couldn't see him for mud. So I expect that I will be thrown several times before I am through. Rehabilitation has come to mean the training of disabled persons in work that they are interested in and work that they can follow after their training is completed. Agricultural rehabilitation does not differ materially from any other kind of rehabilitation. There are a few fundamental principles which I would like very much to 31 32 VOCATIONAL REHABILITATION. give you at this time for your consideration, and which I believe underlies all rehabilitation work : 1. The desire for training must come from the disabled persons. 2. Mental and physical rehabilitation must precede the training. For example a man froze his hands so severely that he had to have the fingers on both hands amputated. His friends paid for his maintenance and the nurses at the hospital fed and dressed him. Everybody told him that he would never be able to work again. He really believed it. He stayed at the hospital for over two years. The civilian rehabilitation department surveyed his case and he was taken to Minneapolis to the Minneapolis Artificial Limb Co. where he was fitted with double hooks. The man who showed him how to use the appliances was a man who has lost both arms and both legs. The fact that this man who went to the factory and saw other men working who had worse disabilities than he made him know that he could work. Now our man can do any work that any of us with two arms can do. 3. Give the man or woman the work that he or she is interested in and the work that they can follow after their training is completed. Men are mechanical or they are not. They are agricultural, industrial, commercial, or musical, or they are not. If you try to make a farmer out of a mechanic, you will probably waste his time and your money. The person who is not interested in the work that he is doing is the man who is generally injured while working. At one time I was working for the Ford Tractor Factory, at Dearborn, Mich., and was going through the plant. A worker on one of the machines put his hand over to shut off his machine, and not looking put it in a gear and cut his hand off. This man was exceedingly uninterested in his work and gave it little thought. The only way to have a man inter- ested in his work and show progress is to give him work that he is interested in. When I speak of work that anyone is interested in I am reminded of a story. Tom and Dick were college students and they were both taking a course in psychology called " Wisdom." One morning both boys were going up to take an examination. Dick said to Tom, "How is it that you manage to get by so easily with the work?" Tom said, " You listen to what I tell the professor when I go in and you tell him the same thing and you will get by all right." Tom went in and said, "Say, Prof., there is a lot about this work that I don't understand." "You needn't worry, Tom, about that, you know all there is to be known about this work." u Oh, not yet, Professor, but I expect to when I finish your course." Dick went in and said: "Good morning, Professor. There is a lot I don't knoi about psychology." "I know it," said the professor, "and what is more, you will never learn it. I shouldn't have let you stay in the VOCATIONAL REHABILITATION. 33 course. You are a fool." "Oh, not yet, Professor, but I expect to be one before I finish your course." Tom was interested in psychol- ogy, Dick was not. 4. When a trainee enters institutional, placement, or combined training, if he does' not hit the ball, drop him. Make it a business proposition. I want to cite to you a few cases that are in agricultural training in Montana. 1 . A Montana rancher, who had the misfortune to lose his sight as the result of an accidental dynamite-cap explosion several years ago, had his case surveyed, and he was placed in our special adult School for the Blind at Boulder, Mont. He is being taught academic sub- jects, reading of the Braille. In two months' time he had done more work than the average blind student does in two years. He is also given commercial work and is now able to write his own letters on a typewriter. He will finish in June and will start a workshop in his home, where he will be self-supporting. 2. Another rancher, whose right side became paralyzed and who was not able -to work on his ranch, is taking work in a commercial college in left-hand penmanship, bookkeeping, English, and arithme- tic. He expects to start a business of his own when he finishes. But you say that this is not agricultural rehabilitation. You are training men away from the farm. Let me give you a few cases that are being trained on the farm : 3. An ex-service man lost his hand in the A. C. M. Smelter working on a sampling mill. He is receiving placement training on a poultry farm. He is now receiving wages and his board and room at the place, and will be given charge of the poultry farm in the fall. 4. Another ex-service man lost his hand in a sawmill. He is now getting combined training at the horticultural department at the Montana Agricultural College. Another year it is expected that he will be made foreman of all the workmen in the department and receive $100 per month. He is now getting $70 per month for his services. 5. Another case is that of a man who lost both arms below the elbow in a railroad accident. He was on the county poor farm for seven years. He was placed on a poultry farm and has been there for about nine months. The foreman says that he is the best man that he ever had to work for him. Some time ago this foreman went to Helena to the State poultry show and left the armless man in charge of the flock of 1,500 pure-bred white leghorns. He fed the birds, trap nested, gathered the eggs, and kept the fires going in the feed houses where the feed was cooked for the poultry. When the 1476T 22 :-{ 34 VOCATIONAL REHABILITATION. foreman returned he said that everything was in very good condition. These are only a few cases of those training in agriculture. The State Sanitarium for Tuberculosis has many arrested cases that will be trained in poultry work, beekeeping, orcharding, truck gardening, and horticulture. This will prevent them from going back to the hospital for further treatment. We are also training the adult cases who are being discharged from the State Orthopedic Hospital, State School for the Blind, and Industrial School for Boys. Placement training will be given our trainees at the State college and their substations throughout the State. Let me call to your atten- tion another phase of rehabilitation that is under way in the State of Montana. The A. C. M. Co. has several hundred men on its pension list, and these are men who have been disabled in the mines and smelters. Some of the pensioners are past the age of rehabilita- tion. These men are drawing from the treasury of the company thousands and thousands of dollars annually for their pensions and disabilities. They receive from $20 per month up to as high as $100 per month compensation from the company. We are proposing to start a poultry colony to take care of the men who have been diasbled in the mines and smelters. The company is to establish a central plant to train these men, and as they become competent in poultry work to build them a home and provide them with a unit of poultry of one thousand to fifteen hundred bird capacity. These men will be given an opportunity to buy these units at cost on a long-term payment basis, or they can rent them from the company. The rehabilitation part of the program is to provide the working plan, and the A. C. M. Co. will furnish the money. We have another agricultural rehabilitation scheme which is being worked out in Montana. It is a plan I believe should be put in operation in every other State that is, the rehabilitation of the county farms. But you say that the majority of these people are too old for training and that they do not have a vocational handicap. If they did not have a vocational handicap they would not be in the county farm. When we were surveying the case of one of our arm- less men we found that the county had expended $3,500 for his main- tenance and that he had spent seven years in idleness on the county poor farm. If he had stayed there and lived to the age of 60, the county would have been obliged to spend some $15,000 more for his keep. We placed this young man on a poultry farm and to-day he is making steady progress along this line. While w^e were surveying his case we were surprised to find that there were many things that these men at the Missoula County farm could do to make themselves happier people and derive benefits for the county by making its farm more nearly self -supporting. We found one man who had consid- erable experience in poultry husbandry. He was given charge of VOCATIONAL REHABILITATION. 35 the poultry flock. He sold off the old flock of Rhode Island Reds and with the money bought back pure-bred White Leghorns. He remodeled, painted, and put new ventilators in the old poultry plant. Heretofore they received very few eggs from the poultry of the farm. They have gotten eggs the past winter. In February they got 31 dozen, March 81 dozen, and in April over 200 dozen from a 100-bird plant. This man is training another one of the men on the farm to take care of the birds, and when he has become sufficiently well acquainted with the work of poultry raising the present foreman will be placed on a commercial egg farm where he will be self- supporting. Another 'man was found to have had a great deal of experience in shoe repairing. He was furnished a shoe-repairing outfit and is now doing all the shoe and harness repairing for the farm. He is also repairing the shoes that the county auditor receives for distribution for the poor of the county. He receives half of what the county formerly paid the commercial shoe repair man for his work. He, too, is training a man to do the work and will be placed in a shoe shop where he will be self-supporting. Another man was found employ- ment in a mission in western Montana where he received his board and room and $15 OP $20 per month for his work. Another man is raising bulbs and flowers. An old cabinet maker is teaching the men who are unable to leave the ward how to make toys which are turned into profit for the men. Knitting machines and carpet looms will be added to the shop to give employment to the men and women of the farms to keep them busy and enable them to earn some money to help make them self-supporting. The plan is to give these people something to do and help make the county farm more nearly self- supporting. This rehabilitation work on the farm has awakened the community and they are providing the people with entertainments and motion pictures and are planning several band concerts at the farm for these people. When you stop to consider the enormous expense of the upkeep of the county farms of just one State and the number of unhappy people that live on these farms, I think that you will agree with me that this rehabilitation of county farms is one big problem of the State that can be solved through agricultural rehabilitation. Chairman HUBBARD. We have a second speaker who will continue the discussion. WILLIS \V. GRANT, Supervisor, Industrial Rehabilitation, Iowa. I wish I might boast to you of the wonderful things we have done in agriculture, and pour into your eager ears the magic formula of how it was done. Surely a State with a billion dollar annual agricul- X 36 VOCATIONAL REHABILITATION. tural product, with the lowest percentage of illiteracy, and with one out of every four, of the total population last year attending some kind of school will have something of interest to report about rehabili- tation in agriculture. But we have been able to do very little along the line of agricultural projects since this program started. I am glad to discuss the situation frankly. Lest you mistake this for a sorrowful admission of guilt and ineffi- ciency, I want to quote a statement which I consider rather remark- able. A man was in my office recently who is an employee of the War Veterans' Bureau and in charge of farm rehabilitation projects in 12 Iowa counties. He stated to me .that while about 50 per cent of the enlistments in this section were from farm occupations, less than 20 per cent of the disabled veterans were taking vocational training in agricultural lines, and even after three and one-half years since the armistice he had only 8 men in the 12 counties actually placed on farm projects. When you consider the wonderful training facilities in agriculture offered in soldier rehabilitation, together with subsistence money available for six months after the project begins, we surely shall have to look elsewhere than to the rehabilitation agency for the cause of this situation. I searched for statistics concerning free employment service to find the trend of employment passing through the Iowa State-Federal Employment Bureau. Here are some figures compiled for the year ending June 30, 1920. Offices were maintained by that bureau for only part of that year in 15 cities, so that the total numbers are not significant. Out of a total of 26,850 men placed during the year there were only 7,483 placed in occupations even suggesting agricul- ture and but 6,709 as farm hands, gardeners, and in dairying. Of the 8,711 women placed but 156 were located on farms. The employ- ment service in such an agricultural State as Iowa at a time when farm labor was in demand and well paid placed about one-fifth of its people in agricultural occupations. Rather early in the history of our service we prepared a circular letter and addressed it to every farm bureau county agent in the State. It was an appeal to them to supply us with the names of prospective cases. I understand the Federal Board has circulated copies of Bulletin No. 72 in this State. Syndicated news material \vas sent out at the time the work started. One case only was reported by a county agent, and lie had made a previous personal application. We have the names of some agricultural prospects, but they did not come through any agency interested in farm welfare. I visited a county poor farm after reading the experience of one of our neighbor States, but did not find any prospective cases. Of course, we have not combed the State, but the fact remains that we have about 210 listed cases and not over half a dozen directly concerned in agriculture. VOCATIONAL REHABILITATION. 37 Let us analyze this situation and search for the cause of so few agricultural cases. 1. In spite of the general outcry, the Iowa farmer is fundamentally prosperous. A school inspector told me of his experience in talking with a one-armed farmer boy who was about to graduate from high school. He explained the rehabilitation service and urged the boy to get in touch with us. "Oh, no," he said; ''father owns a large farm and I expect to inherit another from my uncle, so I think I will be able to get along." Generally, if there is a cripple in a farmer's family, he or she can live and live comfortably. I have in mind one pitiable case of a renter who became paralyzed below the hips because a hay stacker fell on him. He lost all he had and was sold off the farm. We enlisted the sympathy of the community. The last I knew he was living in a comfortable house in town supplied by a relative and never suffered for lack of food. So far as I can find out his is the only such case in the county, which has raised thousands of dollars for Red Cross funds. We shall gladly help him to some home em- ployment, if he is still with us when the chiropractor is through with him. But that case would never have been reported to us from that community because they are so able and willing to take care of their own. It came through State hospital service. 2. There is a growing exodus from the farm. Only last week a member of the faculty of the college of agriculture in an address before the county school superintendents quoted some figures in support of this statement that there was an alarming exodus of young people from rural occupations. A questionnaire was sent to the graduating pupils of the outstanding consolidated schools asking them what they had chosen for their life work. The replies indicated that 80 per cent of these have chosen vocations that are distinctly urban. A survey of the graduates of the consolidated schools shows that within 18 months after graduation 30 per cent have not returned to their farm homes. He further states that while there is now only an exodus from the farms to the town, in former years there was a countercurrent of people drifting from town to agriculture. This countercurrent has practically ceased. You will be interested to note his reasons for this condition. He gave four. 1. Misdirected education. 2. Social disadvantages. 3. The apparent difference in conditions of labor. 4. Difficulty of starting on a farm. There is a growing tendency in this State for the present land- owners to enlarge their holdings. These people are looking forward to the time when they can move to town and live in comfort, making 38 VOCATIONAL REHABILITATION. little effort to enjoy life as they go. Their children are growing up under conditions of hardship not at all in keeping with the family fortunes. A county superintendent told me of a recent health survey of his children where they found 50 per cent of the first thousand under weight. They sell the cream and butter and feed the skim milk to the children and hogs. In this State of butter and eggs, 33 per cent of the children are underweight. Now I am not an alarmist. Neither am I ashamed of the great and glorious State in which I was born, with her wonderful resources and intelligent citizens. Many minds are focused on this problem. Many efforts are being made to better the conditions of rural life and happy indeed is the lot of the prosperous owner of Iowa land. But the conditions I have noted have their influence on the natural choice of disabled persons who are facing the problem of their future vocation. The farmer is an individualist and not easily interested in social welfare work. We have seen the rise and fall of cooperative enter- prises. Even when these enterprises have given promise of financial reward they have been hard to promote and still harder to keep together. Much more difficult then is the problem of getting a general sentiment to promote the welfare of the community or of that part of the community which we hope to serve. 3. Farm occupations are not generally suited to disabled persons. Now, this is a mere generality. I know a man who is suffering from a tubercular back, with complete paralysis of the legs. He told me he plowed corn most of the season for his brother-in-law. I also know a blind man, who is not able to count fingers 2 feet from his face, who makes his living as a woodsman. He claims he can fell a tree within 4 inches of the spot he selects, although he can not see the lowest branches. The determination that stops at nothing if applied to farm projects will make a hopeless cripple a successful farmer. But it is rare, indeed, to find a person so determined to be a farmer these days. I know this paper is going to provoke discussion. At least, I hope it will, for otherwise I should never have consented to stand before you to discuss this phase of rehabilitation. I am now going to add fuel to the fires of your indignation by saying that I do not believe there will ever be very many cases of bona fide rehabilitation in agriculture. When I was doing vocational advisement for the Federal Board at the Norfolk Naval Hospital, a large number of disabled marines and sailors passed through my hands. We were under orders at the time to influence as many toward farm occupations as possible. These men were mostly recruited in the Middle West, and the answers to my suggestions along farm lines will not be reproduced here. They VOCATIONAL REHABILITATION. 39 simply would not consider it. I know I am seriously in need of more light on this subject, and I would like to ask " Just how much of a field is there for a disabled man in agriculture ?" Right away some one cries out, " Poultry is a good field." I accept that as a good thing in some cases. In order to see a man actually starting in this line, I went with my Veterans' Bureau friend to visit one of his " projects." He was getting nicely started and had 600 baby chicks, 2 brooder houses, and 1 henhouse, in which he was living. He was about to erect his house to live in. He had no money, but had gone in debt to get started. As the proposition stood he was $2,000 in debt. But remember he is drawing $115 per month sub- sistence money, and if he and his wife pull through a couple of years without serious illness, he will probably pay out. But here is the point I want to make. His present disability is a technicality, a mere matter of record. And, besides that, he was a good carpenter to begin with, and the type of man it takes to make a good carpenter. I doubt if most of you would have accepted him as a civilian rehabili- tation case having a " physical defect or infirmity." Occasionally a well-trained man can start in the chicken business on credit and win out, but it is more likely to be an ex-carpenter than a disabled farm hand who does this. In looking over the various monographs and leaflets which have come to my desk I have not discovered a great number of suggested occupations within the field of agriculture that would be adapted to the disabled farm laborer. We must carefully distinguish between the problem of finding the proper opportunities for the son of a moderately well-to-do farmer who has some of the family resources to help him and the farm laborer who has earned his living by hard labor and now finds him- self unable to make a living that way. The young farmer's son has a world of possibilities before him. The other man, generally handi- capped by family cares, faces a limited field. We have several of the first group in training and not one of these expecting to return to farming. The second group constitutes the problem of rehabilita- tion in agriculture. One solution of this difficulty which is in keeping with the general principle to build on former experiences will be to find the oppor- tunities in the small towns and villages. A great deal of the industry in these towns is in catering to the needs of the farmers. Their familiarity with these needs and their acquaintances among the farmers become an asset which the towns people readily recognize. Organized cooperation will generally be lacking, and the rehabilita- tion agent will find this disappointing and time consuming. Our experience indicates that each town has an individuality. In one place the county superintendent of schools has given most effective 40 VOCATIONAL REHABILITATION. assistance. In other places this official can not be interested, but some Red Cross worker lends a hand. After all, the rural as well as the urban problem seems to be to get the interest and confidence of as many persons as possible. Patience and persistence will bring results. Here especially we find local cooperation essential. If places are to be found for these unfortunates it will only be with the aid of local sympathy. The suggestion that unless the man is able to get to work he will become a county charge meets with little or no response. It is a discouraging process without much prospect that this social effort will bring any general results. We have a disabled man taking the animal husbandry course at the State Agricultural College at Ames. But listen to the job objective. He is a farmer boy and a bright one, but he is taking this course preliminary to taking up the work of a farm bureau county agent. I think he will make a good one. A real dirt farmer is one of our star cases. He lost his left hand in a corn shredder and was living on a small farm. The products of his farm, with a few cows, bees, and fruit, are not sufficient to make him a living now that he can not hire out to his neighbors. He is a superior type of man and took several months to make his decision. Jlemember, he was all located to work out the bee, fruit, and poultn^ combination. He has been active in cooperative work in his county, and was frequently delegate to State conventions. After careful consideration he asked for a business college course, including short- hand, in order that he might qualify as a paid secretary or agent in some of the farmers' cooperative business organizations now being projected. 4. The financial depression has made it necessary for many owners who have been living in town on the rental from their farms to return to their farms. The crippled owner of an Iowa farm is not a subject for rehabilitation and the child of such a family will be diffi- cult to locate anywhere but with the parents. The financial situa- tion, which as you know has delayed many of our rehabilitation cases, has had especial influence in making it difficult for a person to start in agriculture. In one of our cases mentioned elsewhere we made a determined effort to keep the man on his rented farm. In normal times we should have succeeded, but along Vith his neigh- bors the man did not make enough to see him through the year. The landlord himself, facing a curtailed income, was forced to move back to his homestead and farm his own land, and the disabled man was dispossessed. You all know the condition of farm credits and the hopelessness of trying to obtain a loan to help start a disabled man as a renter. In this case the question of training him did not enter, for the man was formerly a skillful and successful farmer. VOCATIONAL REHABILITATION. 41 Now this condition is temporary and is already passing, but it will be many years before the lure of the cities will attract so many substantial farmers. I look for the movement for better homes and schools, for labor-saving devices in the home, and better rural social life to result in permanent establishment of many of them. But I can not see in that movement much prospect of the easy access to independent farming for the man without means, even if he is not suffering from physical disability. Our experience may be unique, but my observation leads me to the conclusion that rehabilitation in the midwestern agricultural States will not differ materially from that in the rest of the country. The majority of the prospective cases will not come from the farms and will not find their greatest opportunities for reemployment there. The last report of the industrial commissioner gives a total number of accidents reported for the year ending June 30, 1920, as 14,437, from which is excluded not only farmers but "all workmen and em- ployers engaged in threshing, corn shredding, corn selling, and other employments intimately related to agricultural pursuits." A settled agricultural State has many trades and industries and other fields for employment outside of agriculture. Our cities look small com- pared with St. Louis, our factories appear insignificant compared with those of the great industrial centers, but did you ever stop to think how many of these smaller cities with their smaller industries there are ? Only 44 per cent of our population live on farms, and many of these are supported by labor in town. I quote Wallaces' Farmer: "It is exceedingly doubtful if more than one-third of the people of the United States and 40 per cent of the people of Iowa can be called genuine farmers." There are 60 per cent then who are not concerned in agriculture. I present this rather negative paper without apology. You must not infer that we are ultraconservative or inactive. It is not in- tended as a report of the various types of rehabilitation service which we have rendered. Many States here represented have had experi- ences in this field, and I wish to present the situation as I see it for their discussion. There is nothing final in such a new movement as we represent, and this is surely not the last word on this subject. I hope you will discuss it and criticize every statement here. We all need the very widest viewpoint on every phase of this difficult but fascinating service which we are attempting to render to mankind. GENERAL DISCUSSION. Mr. MARTIN. Are you undertaking the rehabilitation of people who happen to be in agriculture ? Mr. GRANT. I think we are. It consists largely of overcoming physical handicaps. Physical handicaps in my experience are not 42 VOCATIONAL REHABILITATION. minor handicaps. One of the greatest handicaps is that of the man who has been in the wrong vocation from the beginning. Men who are natural-born agriculturists, mechanics, bookkeepers, etc., who become handicapped will not in a large number of cases listen to you. They are able, having been naturally adapted to these vocations, to see their own possibilities. The question we ask is, What was the man's original vocation ? There are a great many boys born on the farm, who have always lived on a farm, and received their injury on a farm. They have come to the city. In all our work we try not to put a man back, but to find where he should have been in the first place. Looking into our cities, we find that a great many handi- capped men in the city were born on a farm. A man who has lost his sight in a shop should be rehabilitated for mechanical work, if mechanically inclined. Mr. HENRY. A man is mechanical or not, industrial or not, or musical or not. If you are going to try to train a man for mechanical work who is interested in music, you are going to fail. So many of us here are misfits, not in our right line. If a man is interested in farming, give him farming; if interested in mechanical work, give him mechanical work, if his disability will allow. Another point is that we have put as many men on the farm as we have in the city. I think I understand the agricultural situation pretty well. I still maintain that there are many disabled men on the farm who should be on the farm, and there are a lot disabled in the cities who should be on the farm. Mr. SNORTUM. It seems to me that there is something to be said in the matter of background. I have met a number of people in need of rehabilitation who have been interesting to me because of an agricultural background. These people have been engaged in various pursuits or trades, perhaps in a commercial firm, or in some other field of work, and I found that they are or have been engaged some time or other, especially in youth, in farming, and I have seen how valuable this background is in perhaps bringing them back to the farm. I do not mean that in the sense of exploitation, but, perhaps, to reawaken something they might have cherished when young. Here is an opportunity. Perhaps that background is only a very general one, but it seems to me that it should be capital- ized. That is the kind of thing I am interested in, the cases we meet in our city who have gone into other phases than agriculture and who might be brought back to agriculture. Mr. GUILD. I want to ask Mr. Henry a question. Have you used the women in the county farms ? Mr. HENRY. We have the women knitting stockings, we are intro- ducing a knitting machine, which they can use. VOCATIONAL REHABILITATION. 43 Mr. GUILD. Because they are in the county farm, do you feel you are able to use the money provided for this work in rehabilitating them; that is, do you take it for granted because they are there that they are handicapped ? Mr. HENRY. I maintain that if they did not have a vocational handi- cap they would not be on the county farm. I ask the county com- missioners to provide all this equipment; all we provide is just the scheme. The same is true of the Anaconda Iron Works. Mr. FAULKES. We have to contend with the agricultural situation. Wisconsin is a dairying State. They are doing what is called regis- tering work; that is, cow testing. We have tried out two cases; one case is a fellow who had 10 years' experience on the farm, and because he had only one arm it was difficult for him to get a position on the farm because he was a laborer. We tried him out as one of these fellows who go around testing. This fellow is on his sixth job and we have testimonials, and they say he- is good as or better than some fellows who have two hands. That is what we are doing in Wisconsin. They are earning from $90 to $140 a month. On poultry raising I agree a good deal with Mr. Henry with regard to poultry raising in agriculture. We like to take a man who has had some agricultural background. He has to know something about the farm end of the work, I think. We have two fellows who are very successful, who are making their living now on poultry. We have an instructor in the University of Wisconsin giving them some fine points of the work. I believe that there is a big opportunity for, the use of handicapped persons who are willing to make a return. One of these men has sixth or seventh grade education. We trained him in five weeks and he is making good. He is employed by the county cow-testing association, under the agricultural association of the State. Mr. WHITE. I want to ask the gentleman from Montana about knitting machines. The reason I am asking that question is that there is a woman down in Tennessee born without any limbs. I have been thinking of getting her into training, operating one of these machines. I have written to the Gayheart Knitting Machine Co., of Clarefield, Pa., and the Auto Knitting Machine Co., of Buffalo, N. Y. In reply- ing they sent a lot of literature and the usual flock of letters and a guaranty to buy all products. When I tried to enter into a formal agreement they did not reply to my letters. Mr. GRANT. I had the same experience. Mr. WHITE. I had my wife write to them and they sent her a lot of literature, also. What I want to get is their agreement to buy the products of this woman. She lives up in the mountains of Tennessee and has positively no way of marketing her goods. 44 VOCATIONAL REHABILITATION. Mr. FULMER. I have a sister out in our State who has a little leisure time. She bought a knitting machine and she has had no difficulty in selling her wares. We have a young man using the Auto Knitter and we have had correspondence with the Gayheart Co., and they offered to send the machine to us. This discussion is interesting to me. Mr. LAND. Have they purchased her wares ? Mr. FULMER. It is not difficult to get them to sell the machine. She can knit enough hosiery, she can not get out and market her products. When I tried to pin them to buy them, no reply. Mr. SPITZ. I might add something to the discussion regarding the Auto knitting machine. We had a man come to our commission, blind in one eye. He 'asked us to find out if the Auto knitting machine was as advertised. We have a very fine working agreement with New York and Pennsylvania, and Mr. Elton, of New York, volunteered to have a personal investigation made. This investiga- tion was made by an agent in Rochester, the home of the knitting machine, right on the ground. I would suggest that if any of the members of this conference desire any information in this connec- tion, Mr. Elton would be just as glad to hand it to you as he was to us. Mr. GRANT. How about the Gayheart people ? Mr. FULMER. We have not entered into this proposition, but before doing that I wrote to Director Wilson, of New York, and he came back with the same statement that Mr. Spitz has just made. Mr. SHAW. We have had experience with the Auto Knitting Machine Co. The first proposition by the Gayheart people was to give me 10 per cent on all the sales. We have had three purchases in Cin- cinnati. We have had one success out of three tries. The Auto Knitting Machine will pay and the Gayheart will pay $1.50 per dozen pairs. The literature is all what it promises. You are going to find a discouraged spirit. If there is a market for the product, or if there is some agency that will market the product, you are all right, but if you have to rely on the individual you are going to meet with failure. We gave it an honest, fair trial. We watched each of them and we do not believe in it. Mr. LAND. May I ask Mr. Grant what success he has had in market- ing the products of the looms, that is, rugs ? Any market for hand- woven rugs ? Mr. GRANT. Very successful project in Sioux City. We have very good cooperation with the welfare bureau and it was through them that we worked out the proposition of rug weaving. This man I spoke of was a Syrian. We got him the training, got him the loom, and he has made as high as eight rugs in a day. That man and his family were going to be a burden on the welfare bureau. This winter VOCATIONAL REHABILITATION. 45 they told me that they had given them no family relief, excepting perhaps one ton of coal, so that the family was entirely removed from dependency. This man buys his materials, makes his rugs mornings and evenings, and in the middle of the day hurries out and sells them. He has made his success on plain rug weaving and has sold many of them among the Syrians in his community. Question. What is his disability ( Mr. GRANT. Blindness. Mr. HENRY. We have not many pictures, but by July we hope to have pictures of some of our trainees in agriculture. Mr. SCHNEIDER. I think a very great deal of our work in agricul- ture resolves itself to the ingenuity of the field agent. Bee culture is a good avenue to which we could turn certain cases for rehabili- tation. I am strong for Mr. Henry's chickens in Montana, but there is another form of agriculture that we employ in Missouri; that is, capon production. We tried it with a man 60 years of age, with both legs off below the knees. He is taking training with a man en- gaged in that work nows With fruit, there are also suggestions open there. I think that summing the two up and leaving it to the in- genuity of the field agent, much can be done for the disabled men in the field of agriculture. GROUP MEETING. MAY 16, 10.30 A. M. CHAIRMAN: R. 0. SMALL, Director of Vocational Rehabilitation, Massachusetts. Chairman SMALL. The first speaker on this morning's program is Mr. Joseph Spitz, deputy commissioner of rehabilitation, New Jersey. Mr. SPITZ. My chief, Col. Lewis T. Bryant, was to have been with you this morning, but was unable to get here. I bring you his best wishes for the success of your meeting. He has given me his paper to read. SECURING COOPERATION OF INDUSTRIAL MANAGEMENT IN THE EMPLOYMENT OF THE DISABLED. LEWIS T. BRYANT, Commissioner of Labor, New ^eisfc^. (Read by Mr. SPITZ.) A comprehensive rehabilitation law enacted in the State of New Jersey in 1919 designates that the statute shall be enforced by a commission at present comprised of Dr. Fred H. Albee as chairman, Mr. Peter Campbell, president of the Nairn Linoleum Works, repre- senting employers, and Mr. Gregory Adlon, representing the workers of the State. The ex ofncio members of the commission are Mr. Burdette I. Lewis, commissioner of institutions and agencies; Mr. John E. Enright, commissioner of education, and Col. Lewis T. Bryant, commissioner of labor. The active member representing the New Jersey State Department of Education is Dr. Wesley A. O'Leary, assistant commissioner of education and vocational director of our State schools. The New Jersey rehabilitation law was enacted by legislation and approved by the governor on April 10, 1919. Upon organization of the commission, it was the consensus of opinion of its members that the work would best function by co-- ordinating its activities with the work of the State department of labor, in which department is lodged the responsibility of the con- duct of the workmen's compensation bureau, as well as that of 46 VOCATIONAL REHABILITATION. 47 factory supervision and the Federal-State and municipal employ- ment system. A representative of the rehabilitation division is detailed at all compensation centers. Likewise a rehabilitation vocational ex- aminer is active in the employment offices, being accorded the fullest degree of cooperation to obtain opportunities for placement training in industrial establishments for such handicaps as are registered in his district. Labor Department units, comprising headquarters for work- men's compensation hearings, employment service, factory inspec- tion direction, and rehabilitation clinics have been instituted in the following cities of our State: Newark, Jersey City, Camden, Trenton, and Paterson. While New Jersey ranks as the sixth industrial State of the Union, it is appreciated that geographically it makes itself responsive to close contact and supervision for those desirous of being accorded the advantages of physical as well as vocational rehabilitation. Through the cooperation of the State commissioner of education as well as the assistant commissioner, Dr. Wesley A. O'Leary, the rehabilitation commission is kept fully advised as to scholastic opportunities prevalent in New Jersey which may be of interest to those desiring general or vocational reeducation. The State department of institutions and agencies, by direction of Commissioner Burdette I. Lewis, is active in directing the channel for handicaps who are in need of institutional or home supervision and instruction. The New Jersey Commission for the Blind is conducted as a separate division cooperating with the rehabilitation commission for blind cases or for corrective physical care of the blind. The State of New Jersey was fortunate in the selection of Dr. Fred H. Albee as chairman of the rehabilitation commission. By his advice and counsel our system of physical rehabilitation was made possible. With a medical director selected by virtue of his professional capabilities in charge of each clinic, baking, massage, functional reeducation, heliotherapy, electrotherapy, dressings, operations, plaster casts, hydrotherapy, and orthopedic appliances are administered. Physical examinations, X rays, and pathological laboratory tests are also made through the medical division. A typical report of the medical activities for the month of April is presented herewith. IS \ <>< \ rin\ \i, KI.II \I;II.IT.\ i ION. ( \<-\\ .uk \ .1 i Inn. I. link..!.. ................... ' ^ :i. Km 1. 1 1. >n 1 1 reeducation .................................. i ii.-ii..iiii-i.i|.\ ........ r 1 EJleetrotherapj ...................................... i ' 6 iM.-.injjn .......................................... ....... :ii , Operation M:.|.>, ............................... I Mnu.r ..................... I'i i :. : . i i ................................ I in Orthopedic an 'km. <,< ................................ i i. .01 !' vim i lull- MI ........................................... \ rayt ............................................. is l'ut.hoiovriel ....................................... 12 ''10 r.'i.it I.M \.-\v.nk \ .1 , clinic tor month of April 1922 i , c .u Our vocational c\a miners endeaxor In rccdilca I e or train voca lion:dl\ such mdi\ ulu.nls ilinl pliysicnl and iiUMilnl <>\:imm:it ion slu>\v siiscoplihlo of iviMlurahon or I r.-iiuin^. ui- strips frequently determines dmt ihr liniHlicaj) should in uniiUMli.Mli' rcnniiuM-nlix c MM|>!OVUUMI| llinl Icuds io , l>u( if Ihc iudi\ idunl is responsive, i;vMcnd (Mlucation or a vocal ioiinl Iramiuu: eoui'se is ollVrMl al e\(M\m^ sessions. \Vher> a handicap is not susceptible to training, cll'ort is dii-(M-ted lo locate him in employment l>est suited to the applicant's handicap and capaluhl \ The cooperntion of industrial management in i\\(* employment of the disahleil is hased on t \\ o principles confidence, and education of the obligation tliu the handicap. As a general principle (lie rehabilitation commission has presumed that the greatest obligation to the injured worker should he assumed by the management of the j)lnnt wherein he was injured, und as a conseipience tlu lirst nvenue of appi'oach is mnde in this direction. While it has been ur^ed that an injured \\orkcr will not proper! \ respond to rccmplo\ men! under conditions wherein he was hurl, it is generally found that some other opening in the same plant is ob tamable. The placement of the handicapped should he considered from the \ie\\point not onl\ of securing an immediate connection by which he will be self -support ing, but also his future development in the work selected, in order that he may be equipped to continue on the basis of real service in the event that he loses this particular posi- tion. While the absolute necessity of prompt placement is apparent in a lar^e majority of cases hv reason of their famil\ obligations, the selection of a job which is otTered more in the form of a charily than VOCATIONAL KKH A f',1 J.I I 40 M opening for de velopmcnt ,hould be di lOOttTftgdd, The a ' to ;i position for which the wo ; a rompcn ,;it 10;. tire! fyof tion;.u- lo the services rendered may accompli, h immediate relief, hut, v, : 'iv tend tov, urd the development, of of continuity of plovment. In m always to be borne in mind that where ;it. Jill po -iUe t.hr-, workman should \)f. eventually (ii|uippf,rj HO Unit, \\c i . ;on on \.\n: f>}isi-, of serviCCH : \t\c\\\ of charity. In -f-rjjrin^ \.\K-. coof^-.ration of inrJu^t.rial rnaria^crrMtnt t,h. <:if>h- nhouUl hr- cU-arly \*.(-.\t\. iri rninrj and the, appeal rnao 1 *-, to the ,- on thr- \).; <<-M\-\\\' f ! \\\ . Mflf tAn<:<', in ohhiJnin'/ t.hr; ult.irnaOr training ano 1 (rjijiprnr-nt, of thrt wo: / /)' of ' rh-rjr-,<. hf.i.v/ff-.n tfir- H /i af>il i tat ion commission ami manax'-mcnf. anrl n-al eOOperAtion hcd in a flay, hut only by GOfe tinucrl inf-clli^cnt. anH faith; In \:v/ .h-rscy many of the cont.a' -;iaol- f> . j tfjf- inc-riium of i/. / inspectors ano 1 'ani/.ccpart.me.nt. of Labor, whicii |j as, through it years of conduct, obtained an almost complete acquaintance with the mana;."-menf, of industry in the State, Tn sible a personal appeal for COOpetioO Then, tOO tlie majority of the, employment offices an-, maintained in direct, cooperation with the, chamber** of commerce of the cities wherein they are located, both through com- mittees cooperating m management, and through financial aBttifttance in their maifjierj;;: In most of the, offices the chamber maintains a direct representative aMOHting materially in the efficient administration of the se; The, <-l of t.hr- rehabilitation communion maintains intimate relations with the employment managers, atte/jdin/ the m'-r-tmj/H of their local associations and endeavoring in every way to secure the ' t with thr; actual employing interests, working very closely with Jministration, a prompt knowledge of the injury to the handicapped JH secured and ruinm;' either at school or upon production can better b' plished during the period of payment, of compensation award*. ,nc of the, very important function-, of the rehaf>ili- tation commission is to furnish advice artd assistance at this critical period of a work: ife when jit times it seems that thr; burrh SO severe as to make it, difficult to maintain the proper monde. There can be no doubt that inestimable service has been rendered at this : moment which might, pcrh;i;, M7*;r> 22 i 50 VOCATIONAL REHABILITATION. doybtful rehabilitation work, but, from our viewpoint, any service which may make it easier for the injured to face life with the handicap with which he has been visited is clearly within the province of the rehabilitation commission's obligation. It is as difficult to define a " handicapped" as it is to clearly enu- merate the obligations for service. Many workers with a lesser degree of injury are a far greater problem than those of higher standards with more serious handicaps. The greater intelligence and stronger character equip one with a determination to carry on, whereas another with inferior initial equipment for life and with a shattered morale makes necessary the helping hand of the rehabili- tation representative. As an evidence of this fact, it is continually found that the worker for one reason or another is unable to secure any type of remunerative employment through his original employer or elsewhere, whereas with the assistance of the commission's worker he is at once replaced in industry. In closing, I feel that I should say a word as to how favored each and all of us who have had the opportunity of becoming part of this splendid work should be. The opportunity is given to few people in this world to obtain a livelihood from a work which is so pregnant with possibilities of service to humanity. It is certainly not an occu- pation for the time server or the slothful, and the high character of men and women who are being attracted to the work is, I am sure, a guaranty of its continual growth and its splendid influence in the several communities wherein we labor. May I, through my representative, on the occasion of the national conference, express to the Federal officials in charge of the work in Washington, thanks of the rehabilitation commission of New Jersey for the splendid cooperation and assistance which they have accorded us at all times ? We fully appreciated the visits to our State in the past and trust that a repetition of these calls may assure the con- tinuance of the congenial relationship which has been established. Mr. SPITZ. I should like to add some remarks. A woman came into our office and said that her husband had been struck on the head working in a glass-refining plant. The death certificate at the hos- pital read that the patient had died as the result of sleeping sickness. The widow, with five children, told us the following day that there seemed to be some question as to whether she was entitled to com- pensation. In conjunction with the social agencies with which we are affiliated in the State of New Jersey, we undertook to establish this widow's right to compensation. In order to establish her case before the compensation commission we directed one of our investi- gators to the city in which the person died and got a complete medical history. Fortunately the doctors at the hospital construed that sleeping sickness might have been the direct result of the accident. VOCATIONAL, REHABILITATION. 51 Then we sent our agent to get a statement from the workers of the deceased. We are endeavoring to establish that woman's compen- sation at $3,600; 300 weeks at $12 a week. It means a great deal to this woman and the obligation that the rehabilitation commission feels that it must undertake is the fact that the injured worker and his family, the widow and his children, are entitled to the best that the State can give, so that in connection with other agencies we work to assist such cases. We work in connection with a society known as the Mercy Society and we report such cases and it becomes necessary to follow the case until the children have reached majority. I might say in closing that in this month's issue of the Archives of Occupational Therapy the case of vocational rehabilitation is fairly well established in the editorial by Doctor Hall, of Marble- head. It is our judgment that the more one obliterates technicality in this work the greater will be our degree of success. The forms which we use are those compiled by Mr. Kratz, Miss Copp, and Mr. Elton, originally. It is absolutely essential in order to get the best results to have the best possible information that you can obtain from the handicapped and the members of his family. We had the case of a man, with wife and three children, on the point of starvation; first, second, and third degree burns. Had spent approximately $10,000 on medical treatment. He looked as though he was in the last stage of pulmonary trouble. The wife wanted to go to work and they turned her down in the plant to which she made application on the ground that they took no married women. We saw the superintendent of the plant, told him the facts in the case, and they put her on for $15 per week, and the man who seemed hardly employable was to care for the children. We investigated the case several days later and we found that she had not reported for work, due to the fact that she was down to her last 20 cents and said that if the children were to starve she would starve with them. We sent for the family, brought them to the office; we did the best we could to aid and assist the family with money and food. They were practically starving to death. We arranged with the poor master to give them $4 per week. We have determined that we will put that man back into industry. We had another case of a Syrian. We found that he had sold cigars, and we put him, through the commission's efforts, with one of the large cigar manufacturers and gave him employment as a salesman. At the end of the second week the chap came back to us and told us he was getting $20 a week and in the first two weeks brought the firm $70. Chairman SMALL. Our second speaker is Mr. C. N. Woodruff, who represents Supervisor Angove, of Michigan. 52 VOCATIONAL REHABILITATION. Mr. WOODRUFF. I bring two apologies, one from Mr. Angove that he can not be here due to the fact that he has some speaking engage- ments in northern Michigan and he found that he could not possibly call the dates off, and the other apology is from Doctor Meade of the Ford Motor Company, who was to have given a talk here. Since the Ford Company has taken over the Lincoln plant, Doctor Meade has been kept so busy that he can not get away from his office. PERCY ANGOVE, State Supervisor of Vocational Rehabili- tation, Michigan. (Read by Mr. WOODRUFF.) When we speak of rehabilitation we naturally think placement, and when we think placement our minds are befogged with the numerous and diversified essentials involved and the many obstacles to be overcome before the placing of a person on the job can be made to materialize as a satisfactory placement in the mind of the employer. This means that the man is satisfied with his job and the employer likewise is satisfied with results on the basis of production. The problems to be met with when selling rehabilitation to em- ployers are many. Their sympathy in most cases can be assured, but this is not all that is desired. They perhaps can be appealed to on the basis that we owe a duty to our fellowmen or on the basis of true American citizenship in that all people have a right to become self-supporting and to find their places in society. We can preach that men with certain handicaps can successfully handle certain jobs, but are we convinced of this fact ourselves? In this connec- tion, it is quite possible for us to cite cases who have risen above their handicaps and are now making enviable records, but let it be understood that they are individual cases. In view of the above and in the light and knowledge of previous experiences, it would be reasonable and safe to presume that the employer must and should be approached upon the basis of produc- tion, with the assurance that the so-called handicapped person would be an asset and not a liability to the concern, which is not run as a charitable organization but as one producing a commodity for which they have a right to expect reasonable returns. In consequence, the man placed on the job is producing and should be expected to produce. Since placement is our greatest problem in connection with the complete work of vocational rehabilitation, it is evident that we must look for a means to an end in meeting the situation. Doctor Strayer's Aid of Education might offer food for thought and should become realized, "That of adjusting the individual to the group in order that the welfare of society as a whole may be advanced." In other VOCATIONAL REHABILITATION. 53 words, for one to be able to adjust himself he must.be trained, if necessary, to make the adjustment and then adapt himself. It is my opinion that vocational training for a specific job is the only definite solution of the problem before us. When it can be shown that individuals are trained for certain occupations, the doubt once fos- tered by the employer will give way to a realization that trained minds and skilled hands insure production. The types of training naturally should vary to suit the individual needs. For some cases institutional training is feasible in order that the necessary background may be furnished upon which to build the vocational training. In other cases the training is most satisfactory when given in connection with a trade school, whether publicly or privately owned, providing that the desired course can be pursued on a commercial basis. For most cases, however, the very best results are obtained when training is given on the job and under the instruc- tion and influence of a sympathetic and competent journeyman or foreman. When the matter of final placement presents itself, it is justifiable to approach the' employer on the grounds that the person in question has been trained for a definite job, can do the work, and consequently should receive a salary equal in amount to that of a physically normal individual. When I was asked to speak upon the topic under discussion, I im- mediately set out to ascertain from representative people just what they thought of the matter in question. Following are their state- ments in substance: From the general employment secretary of a town of 60,000 popu- lation : It will bring to our industrial concerns a sense of their obligation to help this class of citizens. If these partially disabled individuals have any sense or idea of gratitude toward the work of rehabilitation and the employer who gives them a chance, they should prove permanent workers. Your work is a concrete evidence of practical Christianity. Most of our educational projects are too academic. A company expects a man to produce. A blind man may not produce as much as a man of similar ability with his sight, but if he is industrious, painstaking, and persistent he possibly may soon over- come his handicap and become a valuable employee. From the employment manager of one of the large industrial plants in Michigan : From an employer's point of view, it seems to me that you should endeavor to make every industrial placement on the assumption that your particular handicapped man is going to be as good a producer as the man with all his physical faculties. You must choose his job with his particular handicap in mind, and if the right choice is made the man will be as valuable to the employer as though he were physically perfect. We have found out from experience that handicapped men are very loyal employees and that they can be depended upon. 54 VOCATIONAL REHABILITATION. From the superintendent of labor of one of Michigan's largest corporations who, when approached upon the subject of a position for which one of our handicapped men was fitted in his establish- ment, said: We, who are employing thousands of men, realize that they have as much right to earn a living as the physically perfect men, and we are willing to find suitable jobs for our share of such men. The head of the welfare department in Michigan's largest auto- mobile concern, who has the responsibility of placing their conva- lescent and handicapped people on suitable jobs, made this state- ment: You can judge by looking over our factory and looking through our personnel records of men whether or not we are interested and sincere in the work of rehabili- tation. Any man who shows the right spirit is given a chance to go back to work after he has been more or less disabled by accident or disease. They are given light work and placed on jobs suitable to their individual needs. A man who, until recently, was head of the safety work of another large automobile corporation stated that industrial rehabilitation appealed to him very strongly. Because an injured man never can be fully compensated for the loss of an eye, arm, or leg by the money he receives from accident insurance or from any other source, he felt that vocational rehabilitation was an added step in helping the man to get back on a self-supporting basis. He felt that accident com- pensation furnished temporary relief and that vocational education or training by the State would insure a lasting assistance to the handi- capped man. These statements are the expressions of only a few people when making contracts with industrial establishments on behalf of indus- trial rehabilitation. Other instances could be cited, but I do not wish to imply for one moment or to convey the impression that the matter of placement in Michigan is an easy one. In fact, we have very few placements to our credit, and I believe that this is true of the work in general. Suffice it to say that those people responsible for the employing of men for industrial concerns are human and very much so. Because of the present industrial situation the matter of finding positions, even for physically normal people, is exceedingly difficult. We can not, or should not, expect an employer to find or create jobs for handicapped people out of sympathy for the individual and at a loss to the concern. We must think, speak, and act in terms of production, especially because the problem right now is not by any means an easy one. It is my opinion that when men are needed to fill positions the handicapped people will be given due consideration along with the physically normal individuals, providing the proper authorities are VOCATIONAL REHABILITATION. 55 approached on the basis of previous suggestions with this assurance that the position is being sought for the man who can do the work. We must endeavor to instill within the conscience of the handi- capped people loyalty to their employer and a sense of responsibility in regard to the job intrusted to them, and as far as possible avoid such disastrous occurrences as the following instance depicts: Mr. - - lost his leg and out of kindness to the man and his family a company in Grand Rapids, Mich., trained him to become a spindle carver. After much time and endurance in teaching him the trade he became an expert. The company paid him 55 cents an hour. For 5 cents more an hour he left his benefactors to work for another firm. Of course, a man is entitled to all he can earn and we can not blame him for bettering himself. We must also consider or recognize the disastrous effect it would have upon the former employer, espe- cially in his relation to vocational rehabilitation. However, these are very rare instances. In almost every case the man becomes very loyal to the concern. Because the matter of placement is at present so difficult, we must expect very slow progress, but, because of the rich experience that we are now having, rehabilitation will have a steady growth. What we must now do is to establish correct relations between the indus- trial managements, those interested in rehabilitation, and the handi- capped people of our respective States. Thus far we have discussed the essential fundamental elements necessary to the right kind of cooperation, namely, training for a specific job or part of a job, upon the basis that training and practice insures skilled labor which, when coupled with the right mental attitude, enables the individual to produce upon the merits of his ability. There are to be considered those cases for whom training is not necessary or feasible. Other methods must be used and forces in- volved in order that desirable contact may be made. After the case has been surveyed and the decision made based upon vocational guidance, definite steps must be taken by which the employer can be convinced of the man's ability to do a certain job. It is quite possible for an individual to go back on his old job or to do work closely related to it, but he will be more or less awkward at the work for at least a few days because of his particular type of handicap and because of his being away from the work for some considerable time. The employers and those in direct charge must necessarily be patient and sympathetic toward the individual. But here again production is the governing feature. For this type of handicapped person it would take only two or three weeks for him to adapt him- self to the work and become efficient. This goal could be attained at very little or no expense to the concern, providing that the State 56 VOCATIONAL REHABILITATION. pay for the short period of retraining, and it seems to me that each State might well lay emphasis upon this type of placement training as a sound and justified procedure from which there need never be cause for retraction. Of course, certain simple jobs can always be found for individual cases for which any form of training is unnecessary. Yet even for some of these a day or two on the job at State expense would insure more satisfactory results. It might appear to some as though we were paying to convince the employer, but, aside from accomplish- ing this, the psychological effect it would have upon the worker would be worthy of any consideration, since he will realize that he is on trial and will only be retained upon condition that he has proven himself an asset to the concern. In Michigan we consider ourselves very fortunate because of the plan of cooperation which is in successful operation in connection with the Detroit public schools. Detroit, representing as it does approximately one-third of the total population of the State, affords an opportunity for systematic treatment of all phases of rehabilita- tion work. Under the board of education a vocational bureau has been organized which is now actively engaged in a program of service representing all phases of investigation, advisement, placement, and follow-up work necessary for the effective administration of all parallel lines of rehabilitation activities. The bureau is immediately in a position to afford local leadership in carrying forward a re- habilitation program without overhead expense to the State depart- ment. The State, however, provides from State funds salaries necessary to carry this additional load of work. This item for the current year covers salaries for two placement officers and one clerk. These officers are employees of the division of rehabilitation, department of public instruction, and consequently are under its direct supervision just as though the Detroit office was separate and distinct from the bureau. For purposes of administration, however, connection with the State office is directly through the vocational staff officers and the city superintendent of schools. The work in general is carried on exactly the same as for the entire State, with regular weekly reports coming to the State office. This plan of cooperation offers to the State an ever-increasing fund of knowledge centering around training and placement. At the pres- ent time a survey of trades is being conducted by the bureau in small as well as large establishments. In this connection, contact is being made with managements regarding jobs which are and can be successfully handled by handicapped people. After the survey is completed, the jobs within a job will be listed to show the kinds of work which can be done by individuals suffering from certain handicaps. This material will also show the establishments in VOCATIONAL REHABILITATION. 57 which the various jobs may be found. At present a similar plan of cooperation is being considered in connection with the vocational school at Grand Rapids. Let it be understood that the plan takes in the city at large, including all manufacturing concerns, whether small or large; also private schools or schools operating for gain, as well as public schools. The preceding remarks constitute a discussion of means whereby direct contact can be made with industrial managements, either through institutional training or placement training based upon vocational guidance. But in addition State workers must solicit the aid of existing agencies, such as industrial accident commissions, accident insurance companies, labor unions, employment bureaus, etc. The laws under which these organizations are working should be thoroughly considered and a complete understanding had of how their benefits could affect the handicapped man by means of mutual cooperation with the State department of industrial rehabilitation. In Michigan, in one or two instances, industrial managements, when approached upon the subject in question, stated that by taking handicapped people in their employ the firm was placed under greater liability. After a conference with the State commissioner of insurance and a representative of a mutual liability company,, at which time rehabilitation was discussed in general, I was pleased to learn that such a law as the antidiscrimination act of Minnesota is unnecessary in Michigan, since the only case where the employ- ment of a handicapped man places the concern under greater liability is when the concern does not elect to operate under compensation laws and consequently the injured man sues for damages. All persons in Michigan injured in the employ of concerns which insure their employees under workmen's compensation insurance risks receive full compensation, which is 60 per cent of their wage at the time the injury was received, regardless of whether or not they were previously handicapped or received compensation for the same. In other words, the company is not required to pay any more insurance for a man minus a limb than for a physically normal man. Likewise, in case of a second injury, the first is not taken into consideration. The case is treated without discrimination. The firms operating on common-law risk in Michigan are, com- paratively speaking, few in number. With these the matter of placing handicapped people in their employ is practically an impos- sibility. But it is very evident that if the laws under which the industrial accident commission is operating make no distinction, the problem of placement is materially lessened because of the fact that the employer as well as employee is safeguarded thereby. Other agencies which can help solve the problems centering around placement are the welfare departments and safety bureaus 58 VOCATIONAL REHABILITATION. of large establishments. The people in charge of these special branches must readily see that with the aid of the State their prob- lems as well as the State's can be sympathetically met on mutual grounds. The State workers must realize that these experts have an ever-increasing fund of knowledge at their disposal as well as an understanding of local conditions. They are interested in the same problems, which can better be solved by mutual understanding and cooperation. We are perhaps very well acquainted with the necessity of the securing of such help through the means described, but it should constantly be brought to the notice of the general public. In this connection State workers should freely make use of the press. Devel- opments or anything of special interest should be published. Peri- odicals whose circulation reaches the right class of people should be made use of. In Michigan the editors of such magazines are enthu- siastic in giving the work of industrial rehabilitation every support through the columns of their publications, and it is my opinion that we must not keep the work in the background, because, if for no other reason than a social and economical one, it is of profound interest to the State and Nation. Why is it that individuals are glad to lend a listening ear? Why is it that clubs such as Rotary, Kiwanis, Lions, and many others are so eager to have State repre- sentatives appear on their programs? And why is it that they indorse the work without question? Because they realize that it is one of the greatest pieces of humanitarian and educational legisla- tion ever enacted by any State or nation. I predict for civilian rehabilitation a future worthy of all the efforts we can now put forth, because it is a forward step in modern civilization, meeting a need for which there is great demand. A retrospect of the past shows that recent developments have been, almost without excep- tion, for the physically normal individual. Until this latest enact- ment, we have had no definite provision made for that class of people who are less capable of taking care of themselves. Now their future can be assured upon the basis that they are no longer de. pendent upon charity for a living, a means having been provided whereby the aid of the State is secured to make of themselves self- supporting citizens. I wish to state again, as in the beginning of this discussion, that Michigan claims no great honors in regard to the securing of employ- ment for handicapped people, because we are passing through an unusual period. Then, too, the work is practically in its infancy. But it is my opinion that industrial managements will give due con- sideration to a worthy cause, since in my experience I find that the employers are usually men big of heart and honest in their intentions. For the sake of the future of the handicapped people in our respective VOCATIONAL REHABILITATION. 59 States, we must think, speak, and act in terms of production, which is, generally speaking, insured by skilled labor by labor made skill- ful through training and practice. The above is a treatise on the topic assigned, and I believe is based upon sound theory and practice. Experience in the work of rehabili- tation continuously demonstrates to us that the methods expounded would insure tangible results. Other phases might be worthy of space and consideration, and of course are absolutely essential, but I have discussed what I consider the logical and outstanding features. At least they might be considered as food for thought in bringing about a solution of the problem before us. GENERAL DISCUSSION. Mr. GRANT. I would like to raise a question which I do not believe has been touched upon by the previous speakers. In talking with large employers, I frequently find an attitude on their part of unwil- lingness to reemploy the men who have been injured in their plant. Two considerations seem to arise in their mind. In the first place, they are afraid of establishing a precedent which they may be required to follow, that they will reemploy all their injured workmen, the men being thus led to believe that they are sure of employment by that firm whether or not they make good on the job. The second consideration which appears to arise in their minds is that in any given case the accident will probably have been due to carelessness, and a man who has had one accident as a result of carelessness and is inclined to be careless is likely to have other accidents. Mr. WOODRUFF. I have been a safety engineer for a period of two years in a mechanical plant, and I want to say that records disprove that a man is an added risk who has suffered a serious accident. He has had his lesson and is going to be a more careful man in the future for having had that accident. I have heard certain safety men and foremen say that a man should be dismissed who has been careless and suffered an accident, but this should not be. Statistics prove on the other hand that he is going to be a safe man in the future. If the company keeps records it will prove every time that a man will be more careful in the future. Mr. SPITZ. What the gentleman from Michigan said is that the injured workman does not very often repeat his carelessness in the second place. It has been said in New Jersey that if a worker had lost an eye and was compensated for that eye and then through another accident lost the other eye, the employer at the time of the second accident could not be held responsible for total disability because the total disability did not occur out of and in the course of employment, so that it is rare indeed that such an accident does duplicate, as the gentleman from Michigan has explained, but we 60 VOCATIONAL REHABILITATION. have that answer and interpretation from our commission and one of the big jobs, as we see it, is to educate the employer up to our standard of vision that the handicapped can be made an asset rather than a liability. Mr. FAULKES. We had the case of a man who lost one eye and was taken care of by the Wisconsin statutes. This man was operating a grinding machine at the time of his injury. I found him back at the grinding machine. Now I believe that fellow should have been placed in some other job, if he had lost his eye there. There is more of a hazard, so we have to use a little judgment in placing the man back at the job, although he could do the work. There are some employments that offer additional hazards to certain kinds of handi- caps. Mr. WRIGHT. I am wondering, is it possible to determine why the employer takes the attitude he does, whether or not it is a mental attitude toward the man who is careless. If you have had any conferences in foreman training, using the illustration of accident due to carelessness, while discussing the matter of carelessness on the job, you will recall that the foreman when asked, "What would you do?" says, "I would fire him, separate him from his job." He does not go back of the important fact that this man was careless. But the question arises, why was this man careless, wiiat are the causes, and you begin to discuss the matter. You list the reasons why men are careless and you find it is because they have not been fairly instructed, etc. The answer to each of them is that the man should not be fired for most of those cases of carelessness. Of course, there are cases of willful or persistent carelessness for which the man should be separated from his job. After going through this the foreman is inclined to retain the man. I am wondering if the employer is in a similar state of mind. This fellow was careless and he got hurt. The employer does not stop to consider why the man was hurt; was it through carelessness, through igno- rance, or any one of a dozen causes that we might mention for the purpose of causing them to appreciate their responsibility. Mr. MEYER. I called on a business man who employs about 1,000 men and he said to me, "I do not want to place that disabled man because of the psychological effect it will have on the other em- ployees. They would not want to work because they feel that it is a hazardous occupation." He had this attitude because the friends of this person would look upon the work as hazardous. Mr. RIDDLE. A young lady lost her hand in a press; we wanted to train her and get her back on the job. The first statement of the employer was: " We will help her all we can but we do not want her back. If we employ this woman without a hand, and it is known she lost her hand in our employ, it would have a tendency to create a VOCATIONAL REHABILITATION. 61 feeling of dissatisfaction among the other employees, believing it to be an unusually hazardous employment." I agreed with him to a certain degree. I told him: "If it is to your advantage to get your employees from the community surrounding the plant this girl is known around here. It is known that she is going to be trained for a different line of work. It is known to all your employees you are going to add to the stigma. You are going to create disabled per- sons, and then to add to that the fact that you will just cast them out." He rather admitted the strength of that argument and after a time he agreed with me that the better plan would be to reemploy disabled persons whenever they could be employed in suitable employment. Another case was a man 55 years old, a highly skilled pressman, who lost a hand in employment. The publishing company admitted that he could possibly do something more in the plant, but could not be quite as competent as he had been before. Still the employer held back; did not want to reemploy the man. Their final argument was, you are a rehabilitation agency, you can and will take a man who is disabled and make him fit for another employment. My answer was that, with having been employed in this line of work all his life, what reasonable argument do you have to think we can take him at 55, beyond the age at which it is expected a man is receptive to a different kind of work, and make him self-supporting on a different line? He was replaced with the firm, back at the wage he had re- ceived before. Mr. SPITZ. In answer to Director Wright, as to bringing the employer to the viewpoint of the rehabilitation agency, I might say it was my privilege to attend a conference that was called in Chicago by the Federal Board, and at that meeting we were addressed by the vice president of the Pullman Co., an organization that employs approximately 50,000 men and women, and his job was that of reha- bilitation with the Pullman Co. and he dwelt on it in detail, and so we have taken opportunity to use that example to the managers and foremen in New Jersey showing that if the Pullman Co. could take rehabilitation as their own responsibility, why not others. GENERAL MEETING. MAY 16, 2 P. M. CHAIRMAN: J. C. WRIGHT, Director, Federal Board for Vo- cational Education, Washington, D. C. Chairman WRIGHT. Mr. Mclntosh, who is scheduled for the first part of the program, has not arrived, and perhaps will not be in at- tendance at all. We shall need to make some adjustments in the order of the program because of absentees. There are several people here to take their places, so that the numbers will be filled. I am going to call upon a man who is on the program and who perhaps has had as much to do in forming the national vocational education policy of this country as any other person, with the possible exception of Doctor Prosser. His interest has been from the standpoint of public service. In 1914 the President appointed a committee to study the needs of our country for a national act for the promotion of vocational education. That commission was called to meet in Washington early in the spring of 1914. Under the terms of the act the appropria- tion was limited. I do not know how many of you have ever read that report to the President. It is well worth your time to do so from the standpoint of the philosophy of that commission. There was a man from the State of Indiana who had had a number of years' experience in State legislation and who, therefore, came to the Pres- ident's commission with considerable experience. Doctor John A. Lapp is the man referred to. I do not know what Doctor Lapp will tell you here to-day, but I do know that whatever he tells will be of interest to us. SOCIAL AND ECONOMIC SIGNIFICANCE OF VOCATIONAL REHA- BILITATION. Dr. JOHN A. LAPP, Editor, The Nation's Health, Chicago, 111. It is a great satisfaction to see so many representatives from so large a number of States assembled to-day to discuss one phase of the vocational education problem. This meeting is in marked con- trast with the early days of the promotion of vocational education, say 10 or 15 years ago. I remember one of the early great conven- tions in Indianapolis about 15 years ago to discuss the subject of vocational training. The meeting had been nationally advertised. 62 VOCATIONAL REHABILITATION. 63 It was headed by strong men who knew how to plan meetings. On the opening night of that conference one of the distinguished lecturers of the country, who as a popular lecturer would have filled any hall in the city, was the principal speaker. The chairman of the meeting informed me that when he stepped forward to introduce this distin- guished speaker he looked into the faces of some 20 or 25 people. That was the interest in the subject at that time. To-day we have representatives from 30 to 35 States assembled to discuss one phase only of the vocational movement, and that the latest, although by no means the least, phase in the great movement for social welfare. The subject which I am scheduled to discuss to-day is the " Social and Economic Significance of Vocational Rehabilitation." Let me, if possible, at the outset, place before you the part which vocational rehabilitation plays in the promotion of social welfare. I would like to place it in its proper setting in the field of social work. In the present scheme of things there are three social groups, viewed from an economic and social standpoint: There are those who are above the line of economic independence and who are likely to remain there, barring any serious calamity; second, there is the great class of peo- ple who live precariously, who, when times are good and calamities do not happen, are able to support themselves, but who otherwise are in danger of falling into distress; third, there is the class of peo- ple who have been unable to sustain themselves and have fallen into poverty. The trend of social life in these groups is from higher to lower standards due to the calamities of life. There are many reasons why people slip downward, including sickness, accident, old age, vice, unemployment, etc., but the chief calamities which drive people down and hold them down are sick- ness and accident, the very subjects with which vocational rehabili- tation deals. In the past the principal object of social work was to care for those who had fallen into poverty. The next great step was to attempt to prevent people falling into poverty by preven- tive measures and by stabilizing economic society above the pov- erty line. The third step is one which you are now taking, namely: The rehabilitation of those who have slipped down into a precarious living or into poverty, so that they may take their place again as wage-earners and lift themselves out of the unhappy state into which sickness and accident have driven them. It can be readily seen, therefore, that the rehabilitation of handicapped people plays a most constructive part in the program of social work. It is, of course, better to prevent sickness and accident, but after all is done that can be done, sickness and accidents will take their toll. Rehabilitation comes in to lessen the burden of care and to put new hope into the individuals who have been victims of these calamities. 64 VOCATIONAL REHABILITATION. At this point let me point out the widespreading extent of the movement in which you are making beginnings. At present the plan extends to those who are handicapped from injury. It will presently extend to those who have been handicapped by sickness, and it will not merely reach those who have fallen into distress but will be a powerful factor in stabilizing economic conditions among those who are living a precarious life. Vocational education itself is one of the most important factors in social work, through the ability which it gives to individuals to support themselves ade- quately. If every person in the United States had a vocational education there would be far fewer individuals slipping down from economic independence into poverty. When the full extent of re- habilitation is realized in practice, the field will be many times larger than that which we now contemplate. There are fully seven times as many people handicapped by sickness as by accident, and the prob- lem of their rehabilitation is perhaps even more difficult than that of rehabilitating the persons who have been crippled by accidents. It is apparent to all in this movement that its scope is much broader than mere vocational training; it is interwoven on the one side with medicine and surgery and on the other with social work. Those who undertake rehabilitation through vocational education soon find the necessity for physical rehabilitation as a preliminary. The physician and surgeon must be called upon to help in restoring the physical functions before vocational education can be made effective. All of the means of physical restoration, including the provision of artificial appliances, must be mobilized. On the other hand, the placement of the worker for training, and his placement afterwards in industry calls for the highest type of social work. There is no case work more difficult to handle than the placing of a handicapped man, and his mental and moral rehabilitation into a steady, hopeful, worker. Mental and physical conditions must be taken into consideration; the morale of the individual must be established, and all the direful results of handicaps must be overcome. Those who engage in voca- tional rehabilitation must, therefore, call into cooperation all of the restorative agents on the one side, to aid them in fitting a man for em- ployment, and on the other side all of the skill of the social worker in making that employment permanently effective. Everyone must recognize that it is not merely a matter of education, but is rather one of the most practical forms of social work now in operation. The work which you are called upon to do is exactly what the ad- vanced social worker has done in handling difficult dependent cases. She has had to call in the physician, surgeon, educator, mental hygienist, and occupational adviser, in an attempt at rehabilitation. Vocational rehabilitation is merely in its beginning. Five years ago the subject was scarcely discussed. To-day we have 34 States coo] ,es coop- VOCATIONAL REHABILITATION. 65 crating with the Federal Government in a nation-wide program. Two years ago very few had thought of the wide limits of the program. To-day we have come to realize that there is a vast range of activi- ties and a great amount of salvage to be obtained from the wrecks caused by sickness and accident. When the vocational rehabilitation bill was first proposed in Con- gress, it was thought that it should be limited to the persons injured in industry. How absurd such limitation seems to us to-day As a matter of fact, we are coming now to the recognition that its main purpose should be outside of industry, because we are recognizing that the scope of workmen's compensation laws should be broadened to take care of the rehabilitation of those who are injured in employ- ment. Why should it not be a burden of all industry to handle all of the results of accidents, distributing that burden by insurance, rather than merely to give the small cash benefits and the limited medical service now given ? Workmen's compensation laws are being broadened, and some day in the not far distant future we shall find that the whole financial burden of rehabilitating workers injured in industry will be borne under the workmen's compensation laws. We shall see in the not far distant future, too, the recognition that the insurance of the worker against the loss of health is even more impor- tant than insurance of his loss by accident. We shall in the not far distant future have health insurance as a means of stabilizing condi- tions of workers, and that insurance, too, will then be recognized as covering the rehabilitation of the worker when he has been forced by sickness out of the ranks of the employed. The advantage of these schemes of insurance will be primarily that they will provide funds to carry on the work which you are now beginning. The statement is frequently made that these desirable ends are good, but may not be obtained because of the cost entailed. That statement is equivalent to saying that the social order is bankrupt; that it can not pay its debts. The statement overlooks the fact that these burdens are being borne now but are not so distributed as to be borne easily. We are to-day carrying our social burdens chained around our feet. If we place these burdens upon our backs and properly distribute them, they can be borne with comparative ease. The total cost of providing adequate compensation against accident and disease, through the means of insurance, is so slight when distributed over the whole body as to be scarcely a burden at all. It is merely a matter of tackling the whole problem com- prehensively and distributing the cost scientifically as a social burden. It has been fairly well demonstrated that there are three factors in the decay of individuals: First, the industry in which he works; second, society which fails adequately to protect him: 1476522 5 66 VOCATIONAL REHABILITATION. and third, the individual's own weaknesses and vice. These factors are about equal as causes of physical deterioration and handicaps. If such be the case we might reasonably distribute the burden of all this work in about that proportion : one-third to industry, one-third to individuals, and one-third to society as a whole. What has been accomplished thus far should make us all optimistic for the future. Fifteen years ago we had very little vocational training of any kind; we had very few effective child labor laws; we had no workmen's compensation acts for industrial accidents; there were few effective factory inspection departments; very little of the great comprehensive legislation of the last ten years had been enacted. In this brief space of ten years we have accomplished much. Vocational education has become a national system; work- men's compensation laws have been enacted in forty-three States; child labor laws in forty-five; factory inspection laws in a large number. All of these and many others have resulted in great social good, and now we have this achievement in which you are taking the leading part, the program for vocational rehabilitation of handicapped people, which is in my judgment, although the latest, still the greatest boon to social welfare. Chairman WRIGHT. The next speaker this afternoon is Dr. George B. Mangold. Dr. GEORGE B. MANGOLD, Missouri School of Social Work, Missouri State University, St. Louis, Mo. Vocational rehabilitation is a distinct and important form of social work. There is no object in denying that it is social work, for in its genuine essence it is a form of work absolutely parallel with other forms of social service. In one sense it lies in the field of prevention, for if successfully carried out, it will prevent poverty, homelessness, and family dependency. In another sense it is remedial work, for it deals with the victim of misfortune and does not prevent that /nis- fortune in the first place. In the long run it is more desirable to prevent physical disability and accident, but at any particular time the problem of the victim makes a greater claim on us. As a conse- quence the importance of vocational rehabilitation must be empha- sized. When we provided a method of compensating the victim of industrial accident, we felt that a great gain had been made. We were making provision for him and for his family so that the door of want need not be open and the wolf need not appear. However, we had not thoroughly analyzed the situation. No individual is satisfied when he is denied the opportunity to make something of himself and that possibility still remains. The man who has been disabled can not be satisfied to live on a set pension for the remainder of nis life when he still has in him capacity for useful service. It is this new VOCATIONAL REHABILITATION. 67 idea that permeates the principle of vocational rehabilitation and that must animate all agencies attempting to develop new capacities and abilities in those temporarily victimized by diseases or other misfortune. Every man ought to be self-supporting and also able to support a family, and no man has a social right to refuse to contribute in some way to the wealth and to the progress of society; that is, no man has a right to belong to a distinctively leisure class that does nothing ex- cept enjoy itself and spend an income made possible by the service of a previous generation. Nor has any man who is crippled a right to be idle and enjoy the gratuitous support of relatives or of a philan- thropic agency or of the public. He ought to serve the community in such ways as he can, and if it is not possible for him to do so with- out some training or education it is the business of the community to provide such training and education. Men who are idle deteriorate not only physically, but morally and socially as well. It is work it is doing things that tones up the man or woman and safeguards his citizenship and his social life. Those made helpless through misfor- tune impose on society a double burden. In the first place, they are withdrawn from the army of producers and no longer contribute to the material or social wealth. In the second place, they are an eco- nomic liability in that the production of others is necessary to main- tain them. We are thus draining our resources from both ends and adding greatly to the liabilities of a community. THE CAUSES OF THE DISABILITY WHICH NECESSITATES REHABILITATION . The number of industrial accidents is enormous. We have been told again and again that every year our industrial warfare costs us in lives and injured more than the killed and wounded in the American Army in a year of the Great War. In other words, every year we are fighting an industrial war similar to that of the military war through which we so recently passed. The number of injured in industrial accidents, however, represents only part of the total number in need of rehabilitation. Accidents to workers and to young persons on the eve of industrial service, but occurring not in connection with their employment, are amazingly common. There are many more accidental deaths outside of industry than occur from the effects of industrial operations, and, of course, there are thousands of nonfatal accidents as well. A third source of disability comes from diseases. Many diseases leave men and women crippled and helpless or variously disabled and incapacitated for their former occupations. These, too, are in need of the service that will restore them to capacity for useful employment. It is very probable that in the average community more cases of industrial handicap are due to nonoccupational causes 68 VOCATIONAL REHABILITATION. than to occupational causes. Accordingly, we have before us a prob- lem the magnitude of which is not all revealed by the statistics of industrial accidents. Physical disability is responsible for a series of acute social condi- tions. To begin with, a large- proportion of homelessness and tramp life is due to this condition. In her excellent book on " Homeless Men" Mrs. Solenberger says that 254 out of a thousand, or slightly more than 25 per cent of the homeless studied, had suffered from some kind of accident and this was partly the cause of their industrial mal- adjustment. Physically disabled, incapable for the moment of enter- ing gainful employments, they lose their habit of work and good behavior and drift aimlessly into poverty and crime. It is well known that a large proportion of the head wage earners in families asking for relief from social agencies are physically in- capacitated. Sickness is indeed a large factor, but physical handicap is a much greater one. In our own city 60 per cent of the families coming to a leading social agency present the problem of physical disability. This may not have been the only problem, but it is a serious fact to observe that in 60 per cent of the cases such disability was a factor. Inability to do a day's work means lack of earning power, and this in turn incites to crime and other evils. How* large a proportion of our criminals are physically handicapped has not been ascertained, but the influence of the handicap in causing crime is not to be doubted. The economic effects of physical handicap are not the only conse- quences *to which we must give consideration. How often have we seen the blind with sordid and pessimistic attitude toward life. An attitude brought about to a large extent by their inability to readjust themselves. In many cases the pleasure of living is largely destroyed by the accident or the development of such handicap, and with it life loses its naturally hopeful and rosy color and is darkened by unending hopelessness. One consequence of this result is the desire of friends, relatives, and others in touch with those who are handicap- ped to get rid of them, to place them in institutions, or to turn them over to philanthropic agencies. It is not encouraging to observe the extent to which the helpless and old are being forsaken by their children and abandoned to the social agency, nor should we aggravate the situation by permitting those who are helpless but capable of restoration to be abandoned in similar ways. It is remarkable how the attitude of mind changes toward those who are made capable to some extent at least of self-support. It is safe to say that no matter how well the community may compensate the victims of industrial accident, life to the victim is much more hopeful, much more natural, if through vocational reeducation the individual has some of his earn- ing power restored to him. VOCATIONAL REHABILITATION. 69 Vocational rehabilitation, therefore, has a tremendous social and economic significance. It will add materially to the wealth of the community, but it adds also in good will, in better living, and happy home relations, and in the pleasantness of mutual contacts. The program of vocational rehabilitation should be carefully dove- tailed into an existing scheme of philanthrophy. It is most unwise for any public bureau or department to slight the social agencies that are dealing with similar problems, often with the same family, and to act as though these agencies were entirely nonexisting. In the first place, these agencies probably have a better appreciation of the problem which the case presents than the public bureau. It under- stands the disaffected man or woman better and can often give wise and important advice. Again, the aid of the social agencies is often necessary to work out the family problem during the period of time when the education for the new adjustment is being given. Public bureaus can not afford to scorn private agencies, but must bend all efforts in the direction of that complete cooperation which makes not only rehabilitation a success, but safeguards the social aspects as well as the economic. Social agencies are sources of information. They are instruments of service, they are avenues for contacts. No plan of vocational rehabilitation can develop these forms of service with- out greatly expanding its force of workers and increasing its budget. Nor should it cover a field that can be and is covered by philanthropy, whether public or private. It is the business of the bureau to use such agencies, to cooperate with them and, together with them, help to promote those standards of living for which every agency is work- ing. The public bureau, likewise, needs the continued support of the social agencies in order that its tenure of office may be more certain, and that its program may not be interrupted by partisan feuds and jealousies. We have only to witness the outcome of such attempts in recent years to see how necessary it is for a definite public opinion to be developed in behalf of constructive social work. There is no stronger or better support than that obtained from and through those social agencies with which such a bureau may cooperate. A program of vocational rehabilitation requires patience, and that is precisely the quality which the partisan in politics does not possess. He wants results, and then wishes to declare these results to the pub- lic and convince the public of the nature of his achievement. Because these results are not always accomplished, many are the enterprises that die before they have had a chance to demonstrate their useful- ness. It is most important that a great principle such as this be ingrained into the thought of our people, and that they be made to realize that nothing short of complete vocational rehabilitation, as far as that is possible, must be a goal of modern philanthropy. All those who work for the benefit of the industrially handicapped, 70 VOCATIONAL REHABILITATION. whether connected with bureaus of rehabilitation or not, must also endeavor to teach the public that it has no right to demand less than this, and that it must insist from now on that results be obtained. We come back to our starting point. Jobs or positions for all, and everyone made capable of holding some job or position; then only shall we have gained those ecomomic and social results which are implied in the phrase " normal living," and which are necessary to insure social progress to that plane of better living to which we all should aspire. Chairman WRIGHT. It gives me pleasure to announce that we have with us today a gentlemen from the field of industrial relations who will speak of the " Responsibility of industrial management in vocational rehabilitation." Mr. Worth of the International Har- vester Co. will now speak to us. RESPONSIBILITY OF INDUSTRIAL MANAGEMENT IN VOCA- TIONAL REHABILITATION. W. E. WORTH, Assistant Manager, Industrial Relations Department, International Harvester Co., Chicago, 111. The thing that stands out most in my mind on this subject, respon- sibility of industrial management in vocational rehabilitation, is where does responsibility start and end. I have been able to answer that it starts within industry and that we are really responsible for the rehabilitation, mental and physical, of the people who are injured in industry. Where it ends, as the previous speakers have said, there are more people injured outside of industry than in industry I have not found the answer. I believe you feel that industry must be called upon to take a great many people into industry, and give them employment and vocational rehabilitation. In addition to the fact that more people are injured outside of industry than in industry, by a ratio of proba- bly two to one, particularly on the farm, we must realize from this that after all industry is generally recognized by the public only by the names of great corporations, such as the one I represent, and that the public does not realize that the great majority of the people employed in industry are not employed in large companies like the large steel corporations, but in thousands and thousands of smaller industries. The question of responsibility is a great one, and I wondered, as I listened here to what was said, whether we have overlooked the fact that there is some responsibility resting on the smaller industries for the taking care of these people who are injured. That brings to me this thought : what about the man who is a trusted worker in the employ of the small contractor who can not give steady employment, with whom men do not build up records of service but VOCATIONAL REHABILITATION. 71 come and go the building trades generally, for instance. The con- tractor furnishes one job and goes on to another. Is that part of industry which gives continuity of employment expected to take men injured by smaller industries, or on the farm, and train them? Where does this responsibility start and where does it cease ? As far as larger employers are concerned, my observation is that they do maka an effort to take care of the people who are injured in their industry. With pride I say that that is the case in the Inter- national Harvester Co. We make it our business to prevent acci- dents, so that we shall have fewer and fewer to rehabilitate. It is not the belief of the company that because they have compensated a man for an injury that their work is finished. The question before us is to put the man into such physical condition that he can resume, if not his original occupation, some other, and that his earning status is not unduly if at all impaired. This can be said of a great many of the other large corporations. There is no question in my mind that the larger industries, those to whom you are looking for help, will take care of those who are injured in their employ. The matter of great concern for youas, what about the people who are injured in the employ of the smaller plants which do not or can not take care of them as the larger employers can. Are we going to be called upon to take the people who are injured on the streets who are in the large majority and the men from the smaller institutions, and the men from agriculture and care for them all. I do not think we can do it, because after all we must select our employees for physical fitness, so that as they enter into the employment we shall not increase our exposure, thereby bringing about accidents and adding to those in need of vocational rehabilitation. Therefore, we must have physical examinations, not for the purpose of picking out only the physically perfect, but for the purpose of knowing their defects and assigning them to work which is not hazardous to their physical condition. We do not hesitate to take into our employ people who are not physically perfect. We all know the result of examinations in the war. W"e would have a fine time manning our plant. Place them in occupations that will not cause undue strain or expose them to hazards of accidents. I have jotted down five principles here, general, as being the basis of fairly good management and which have a bearing upon this work: (1) Prevention of disease and accident. If the employer does not attempt to prevent disease and prevent accidents, then this group in this room won't be large enough to see that the necessary work and functions of one State is carried out in proper manner. We must do something to prevent this disease and these accidents or we are going to have need of much larger appropriations than Doctor Mangold thinks the average. 72 VOCATIONAL REHABILITATION. (2) Constant health supervision. We must not only rehabilitate those who are injured as the result of accidents, but we must see that the health of those who did not meet with accidents is conserved. (3) Adequate medical and surgical care for all disabled. If those who are disabled are given promptly good, efficient medical care, a good many of these cases maybe avoided. My experience leads me to believe that if the average surgeon was hired for his ability instead of for the smallest possible salary, there would not be so many cases necessitating rehabilitation. (4) Proper selection of work according to the physical qualifi- cations of each individual, including properly chosen work for the handicapped after recovery first, determining that a proper recovery has been effected, and, secondly, selecting proper work for the indi- vidual. (5) Practical vocational training in the plant for new occupations. Sometimes we can overdo this question of vocational training because we get impractical in our desire to set up a scientific method of training and work. In our company when a man is injured we do all possible to speed his recovery; we see that he is given proper medical atten- tion, and then get him back to work as quickly as consistent, no man being returned unless we have the authority of the surgeon. The reason for returning him as soon as consistent is that you help him retain his morale. The person who sits around conferring about the results of his injury gets to a very low ebb in morale. This question of practical vocational training should be a simple matter. The person to be trained should be given production work, not a watchman's job, not a mere sitting at the gate which, in most instances, injures the pride of the average worker. He must not be allowed to feel that he is getting such a job or training simply because some one feels sorry. It is an unfortunate condition when one gets to that point and we should feel a moral responsibility when it is so easy to put them at something where they can earn their daily bread and uphold their personal pride. One or two experiences of men returning to work. In one case a man received a pretty severe back injury, and was not able to return to his regular employment. The question was what should we do for him? Should we make a watchman out of him or an elevator operator ? But the man himself had other ideas. The man said he always wanted to be a pattern maker and after the doctor, superin- tendent, and one or two others had considered the matter, it was decided to give him a trial. It was necessary to build that man a chair, or bench, because of the condition of his back. After a year he not only developed into a good pattern maker, but he is now con- sidered one of the best pattern makers in the plant. VOCATIONAL REHABILITATION. 73 We have had other instances of that kind showing the possibilities of practical vocational training. I simply mention this case to show that if we approach the management from a practical view point, and not with too much of the scientific theory of vocational training, results will be forthcoming. I have never in 15 years (the past 2 years with the International Harvester Co.) had a man injured for whom I could not find a job, if that man wanted to remain in the employ, and every man understood that he could remain. On the property with which I was connected before coming to the Harvester Co. we had a man, an elevator operator, who had his foot badly smashed as the result of his own carelessness. For a year we had masseurs work on him and could not get proper ankle motion. We gave him an opportunity to become a checker in the freight house. You must be patient with these men. It took two years to properly train him, during which time he received regular wages and did the regular w^ork, although the average fellow ought to be able to learn it in six months. After that time he was able to go into his new occu- pation and with the increase in wages, as a result of the war increases, he was soon earning two and one half times as much as he earned at the time of his injury. We had a motorman whose leg was run over and had to be ampu- tated. We made a dispatcher out of him. It takes patience on the part of those supervising, but after all it is worth while. I feel personally, and I am glad to say that the officials of the International Harvester Co. feel, that a man who is injured in industry should be given every opportunity to return to his old occupation and become self-supporting, that he may hold up his head and not feel that he is an object of charity. This question of where the responsibility starts and ceases is one which you might well consider, because you will have to go to industry for your placement in the majority of cases. The board in Chicago has come to us. When business picks up and we need new men we will gladly take those whom we can use and train them in certain classes of work. We already have several disabled veterans, and we have had no regrets over taking them. Remembering that the ratio is 10 injured outside of industry to 1 injured in industry, we must try to distribute the burden and not expect the larger corporations to absorb all that are injured outside of industry. It is necessary, as I said before, for us to select people physically qualified for the job. You must cooperate in every way with the management, help- ing them properly to place those in need of training. If we can not make proper selection and do it in cooperation with you, then, of course, we are going to be discouraged in our efforts to assist you in this very worth-while work. 74 VOCATIONAL REHABILITATION. I have not a solution for this question. I hope some day I may hear it. It may be 10 years from now before we have solved this question of vocational rehabilitation and so coordinated rehabilita- tion with efficient management that we shall have the answer to that important question. If you will give serious consideration to that side of the question, I am sure that industrial management will accept its share of the responsibility in this great movement, as we have met the situation in the compensation laws, which as they have worked out have been of mutual advantage to employer and em- ployee. But if you expect us to accept the responsibility that you ' lay upon us, I just want to leave the thought with you that you be as practical as you can and seek the viewpoint of the practical manager. Then I am sure you will get his support on this important question of vocational education. GENERAL DISCUSSION. Chairman WRIGHT. What difference does the speaker make be- tween practical and vocational training ? Mr. WORTH. I was not trying to differentiate. Vocational train- ing means to train people for vocations for which they are best fitted. When I dwell upon the practical side I simply mean that there are two ways of approaching the problem. When you are training a man for a certain job pattern maker he goes through a process of vocational education. We give it to him in a practical rather than a scientific way. The average shopman is generally a practical fellow. He started out, possibly, as an office boy, and he has come up through the lines and he has a practical viewpoint. His ideas on how to best train this man are practical. Still, when I say approaching them from a practical viewpoint I mean that we may have formulated some rules on how best to train people for certain kinds of work, but if the practical shopman can accom- plish the same result in his practical way, the point I tried to make is, would it not be the better to concede to him ? Mr. WHITE. Is it not theoretical versus practical rather than vocational versus practical ? Mr. WORTH. It is simply the difference between theoretical and practical methods. Mr. DALLAS. In the training of this man in pattern making, would you be willing to lay out the program, stating what progress he should make in 6 or 12 weeks, so that the supervisor might be able to follow up his work, if he supplements it by evening school training ? Mr. WORTH. Are you speaking from the viewpoint of the voca- tional training that the men will get outside or the kind in the shop ? Mr. DALLAS. The opportunity of practical training in industry. I want to know whether, if I went to your establishment and made VOCATIONAL REHABILITATION. 75 arrangements, you could lay out a program so that I might follow a man through the progress of his course. Mr. WORTH. Very easily. In one of our plants we had 15 dis- abled soldiers taking engineering, all of whom got employment else- where. We selected the employment, the manager kept track of the men to watch their progress. Mr. DALLAS. Would you cooperate to the extent of providing a program of evening school instruction in connection with his shop training? In the case of this man taking pattern making, would you be willing to plan a program in the evening vocational school located in the city ? Mr. WORTH. We would go the limit, regardless of what it might be. Mr. WRIGHT. The chair was in doubt as to what you meant by practical. I am now satisfied and what you have said is what my idea is of a vocational education program, so we agree with you quite naturally and quite fully. I am very happy at the point that you brought out. It happens to have been a pet hobby of mine. I believe that there are about three stages in this thing, (1) find your man; (2) get him placed; (3) give him some training. If you stop at the second you have only half completed your job. The question of the third is no different from that of taking any normal man and giving him vocational training. If you have a normal man perhaps the thing is not so expedient, the emergency is not so great, and you can take a little more time, but certainly when you are dealing with adults, with men and women who are dependent upon the job for their daily bread, you must be practical. Mr. GUILD. You mentioned that when you took men into your plant you gave them certain medical examinations to determine whether or not the persons were physically able. I want to know if you do the same from the point of view of mentality. Mr. WORTH. Do you mean psychological or trade tests? No, only in so far as by the questions that a man gets when he asks for employment. When we employ a man we expect him to stay in our employ. We start out on that theory. By the time we have explained our various incidents of employment and the time that he has answered the questions and has talked to the foreman and talked to the doctor, we can pretty well determine whether or not he is the kind of person we want. We have a good idea of his mentality. Question. The point is you would not take a man who does not understand arithmetic and make a pattern maker out of him. Mr. WORTH. No, but you can always determine. We do not employ the ordinary psychological test. Because a man could not say the tables of six we would not reject him as a drill press operator. 76 VOCATIONAL REHABILITATION. Mr. LAND. What percentage of the people taken into your industry have to be retrained for the job ? Mr. WORTH. It is pretty hard to answer that question, because we use so many types. We prefer to employ the experienced men, but the boy or the foreigner who is coming up to the ranks of the skilled worker takes his retraining rather automatically. If we hire a man as a laborer, we may make a drill press operator out of him, so that his process of training is not continuous. There is no par- ticularly definite training period. Chairman WRIGHT. The message from organized labor will be given by Mr. David Kreyling. THE WORKER'S INTEREST IN REHABILITATION. Mr. DAVID KREYLING, Secretary-Treasurer, Central Trades and Labor Union, St. Louis, Mo. I must say that I am here this afternoon not knowing fully what was expected from the representative of the American Federation of Labor until just a few minutes ago. Mr. Wilson was the speaker who was selected by Mr. Gompers originally and it was found that Mr. Wilson was unable to reach here and I was delegated at the last hour, not having any opportunity to look up particular data on the question before us. I want to be excused by simply submitting to you the action of the American Federation of Labor at their convention held in Denver last year. This will give you an idea as to the interest that organized labor has taken in vocational training work. The local labor union men have interested themselves in this movement ever since its inception, and at the first meeting there was a committee of the Central Trades and Labor Union present acting in conjunction with that Board and they have been in closest touch with them ever since, doing everything that they can to aid the Board in its efforts. The following resolution, which I shall read, was passed at the forty- first annual convention of the American Federation of Labor, Denver, Colo., June 13-25, 1921: Whereas the Congress of the United States has enacted a law to provide for the promotion of vocational rehabilitation of persons disabled in industry and otherwise and their return to civil employment, which provides that the State board for vocational education in States which accept the provisions of the Federal act shall cooperate with the Federal Board for Vocational Education in carrying out the pro- visions of said act, and further provides an appropriation for these States on the con- dition that every dollar of Federal money used must be matched by at least another dollar by the State; and Whereas the industrial rehabilitation act was approved by the President of the United States June 2, 1920; and Whereas the American Federation of Labor has for many years advocated the pro- motion of vocational rehabilitation as well as all progressive legislation to meet the VOCATIONAL REHABILITATION. 77 needs of the large group of men and women who have been disabled in industry and otherwise, and for their preparation to enter wage-earning pursuits; and Whereas we realize the necessity for this legislation when we are informed statisti- cally that during our nineteen months' participation in the World War 48,000 lost their lives, and during the same nineteen months there were 126,000 killed in industry and public accidents in the United States, and that our average death rate from acci- dents is 75,000 a year, and last year statistics tell us that 3,000,000 men and women were injured in industry; 35,000 were killed or died as a result of their injuries, and 200,000 permanently disabled, many of whom would be feasible cases for rehabili- tation; and Whereas the vocational rehabilitation act provides large sums of public money to promote this much needed type of education and service; and Whereas the program for industrial rehabilitation provides the following services: (1) Service of cooperation, advisement, and guidance. This service must exist in every case, and upon its success or failure all other forms of service depend. Bound up in this service is not only the creating of suitable opportunities for employment or training, but even more important is the necessity for creating a receptive attitude on the part of the disabled person. The question of moral and financial assistance to the person by the creation of an optimistic attitude toward the future, by removing discouragement through assisting in obtaining employment for dependents, or main- tenance during the period of unemployment or reduced earning power, and the ex- ample of others who, similarly or more greatly disabled, have been successful, is undoubtedly not only necessary but fundamental to the successful rendering of a disabled person fit to engage in a remunerative occupation. Such assistance, which may be called advisement, guidance, or personal service, continues throughout the complete program of rehabilitation for any individual. (2.) Service leading to physical reconstruction, or functional restoration, enabling the person to return to his former occupation, or through training (or without it) to enter a new occupation in dependent or in-independent employment. (3) Service leading to the supplying of a prosthetic or special mechanical appliance, and the instruction in its use, enabling the person to return to his former occupation, or through training (or without it) to enter a new occupation in dependent or in independent employment. (4) Service providing persons having certain disease tendencies or bodily disfigure- ments with favorable working conditions or work, enabling the person to return to his former occupation, or through training (or without it) to enter a new occupation in dependent or in independent employment. Whereas it is generally recognized that the above services will bring about the purposes provided in the industrial rehabilitation act for the return to employment of those persons who have been injured in industry and otherwise; and Whereas the American Federation of Labor, recognizing the importance of this work, recommends that advisory committees composed of representatives of employ- ers, employees, and the public are indispensable in any State or community in the promotion and conduct of vocational rehabilitation: Therefore be it ' Resolved, That the American Federation of Labor urge both State and Federal Boards for Vocational Education and upon local boards of education the necessity of maintaining effective standards that will be of practical value in giving intensive vocational training courses standards and courses which will insure an equal oppor- tunity for the large number of men and women who have been incapacitated in industrial occupations or otherwise; and further be it Resolved, That we recommend cooperative understandings between State boards for vocational education, the committees on education of the State federations, the city central labor bodies, and the several trades that may be now, or in the future, will become, interested, to see that these men and women are trained efficiently, 78 VOCATIONAL REHABILITATION. so they may take their dollar because they have earned it and not because they were disabled in industry or otherwise; and further be it Resolved, That the American Federation of Labor urge upon the State federations of labor the necessity for calling to the attention of their legislatures the advantages of the industrial rehabilitation act and that the State federations of labor request their legislatures to accept the Federal act for industrial rehabilitation, and we com- mend the work of industrial rehabilitation now carried on by those States that have accepted the industrial rehabilitation act. The American Federation of Labor represents 4,000,000 wage earners, and I believe that this resolution clearly outlines the interest that they have taken in the past, and the interest that they will continue to take, and the activities that they intend to continue in connection with the training of persons who are suffering from industrial accident. We hope and trust that conferences throughout the country will result in solving your problems to the satisfaction of all. The Central Trades and Labor Union of St. Louis has from time to time taken this proposition up and manifested quite an interest, and the State federation will no doubt take it up again, and other steps will be taken for cooperating with this vocational board. I listened attentively, especially when they spoke of the accidents in industry here, only one in industry to five that happen on the outside of industry. There are reasons. The labor men not only in the State but throughout this country have been very active for many years in bringing about legislation for safety devices in all factories. There have been many labor-saving devices adopted through legislation, and some of them on the part of the employer, which have prevented many accidents in the last 10 or 15 years. The accidents in industry have decreased and we are glad that they have. What we want is to avoid accidents. We have succeeded in having many States adopt safety devices in our factories. Outside of that I can not add any more, only wish you Godspeed. You can expect from us the strongest cooperation. Chairman WEIGHT. We have found that various other Government agencies are willing to cooperate in many of our educational move- ments. Miss Mary Anderson, chief of the Women's Bureau, Depart- ment of Labor, is here this afternoon, and will continue the discussion of the last topic, as given by the previous speakers. Miss ANDERSON. I do not know that I can add anything to the discussion this afternoon. It has been very thorough both days that I have attended your sessions. I want to say that the women from the Department of Labor, Washington, are interested in this project, because we perhaps are trying as much as any governmental agency can to prevent you having any work at all. We are trying to see that the standards and policies we recommend be so carried out that the work will not be very heavy so far as the industrial situation is concerned. So far as we are able to do that you will be the judges. VOCATIONAL REHABILITATION. 79 So far we have not been able to do very much. For many, many years to come you will have work as far as industrial rehabilitation is concerned. I am particularly interested from the standpoint of women, because we are the Women's Bureau in the Department of Labor. In our industrial situation every fourth worker is a woman, and the prospects are that is going to increase as time goes on. Only in mines are women not employed in some way or another, so that in the proportion that women are working in the industries shall we have industrial accidents among the women. I am very glad indeed that when this movement was started they took into consideration the workers rather than the men, as we have been heretofore trying to do. In establishing the vocational bureau we had two women on the commission, so that from the very inception of the vocational education service to the rehabilitation service the question of the women has been taken into consideration. I am very glad to be with you. I am not going to discuss any of your problems. I have not met them, and from that standpoint I can not discuss them, but I know that your division will have a work for many years, and I know that the question of rehabilitation and the question of industrial accident are very great, and far too great for the safety of our country. For that reason it is good that the Government, in conjunction with the States, has undertaken to do something in this field. You are pioneers. You are the vanguard. We hope you will go as far as it is necessary to go. GROUP MEETING. MAY 17 9 A. M. CHAIRMAN. MARGUERITE LISON, Director Industrial Reha- bilitation, South Dakota. Chairman LISON. It has been my experience, and I believe it has been the experience of all other rehabilitation officials, that State de- partments can give us a good deal of assistance in our work. In order to do this and maintain this cooperation there has to be more or less of a formulated machinery set up. An example of this in my own work has been the work with the blind school. Heretofore indi- viduals placed in training were trained more or less as a group with- out any attention paid to the industrial needs of the time or the interest or capability of the person placed. As much as possible for the children and adults who are placed there, a survey is made and a plan worked out for their future. More attention is now paid to the industrial needs of the community. Do not train men for things for which there will be no demand. This is just one of the many things that can be done. Some of the larger States have formed a rather formal program and we shall hear from some of them this morning. The subject for discussion is " Cooperation by other State departments in the rehabilitation work." The first speaker is Mr. H. L. Stanton, supervisor industrial rehabilitation, North Carolina. COOPERATION BY OTHER STATE DEPARTMENTS IN REHABILI- TATION WORK. H. L. STANTON, Supervisor Industrial Rehabilitation, North Carolina. We have already heard considerable about cooperation, and I see by the program that we are to hear much more on this subject before the conference is ended. It is one of the big, vital needs in rehabili- tation work at the present time. Another is publicity. The two go hand in hand. Without publicity the needed cooperation can not be obtained. From our experience and the experience of other States we have learned that vocational rehabilitation is not a simple problem, involv- ing a single service, such as vocational training, but it is often a complex problem requiring the rendering of a number of varied VOCATIONAL REHABILITATION. 81 services. A very recent case handled by the department in North Carolina illustrates this fact. A young man who lost a leg a few inches above the ankle in a railroad accident several years ago was reported to the department by a cooperating agency. After an investigation of the case it was found necessary to send the boy to the State capital, which is some distance from his home town. The associated charities in his own city provided him with transportation, arrangements were made for giving him placement training for a suitable occupation, and he was inducted into training. A few days later a telegram was received* from a policeman in his home town, requesting the department to hold and search him for a watch belonging to a certain lady. Upon investigation it was found that the young man had the watch in his possession and that it had been intrusted to him by his sweetheart to have it repaired. He had carried the watch with him for this purpose. We also learned that the lady involved was the sister of the policeman and upon hearing it mentioned that the boy had her watch he immediately wired the department. A few days after adjusting this matter a representative of an artificial limb company, with an agent of the department, called on the young man for the purpose of taking his measurement for a limb. It was then found that the boy's stump was sloughing and was not in condition to have a limb fitted. Arrangements were completed for an examination which revealed the fact that gangrene had sent in and an operation was urgent. As the department has no funds available for surgical or medical treatment it was necessary to make an appeal to a philanthropic organization which not only arranged for the operation to be performed by one of the best sur- geons in the State without charge, but also agreed to pay the cost of the hospital bill. The young man entered the hospital last week for this operation. Upon his recovery he will be furnished with an artificial limb and will return to his training, in which he has already made a good start. We are trusting that most of our problems in this case have been solved. However, much time will be required to supervise his training until its completion. I am sure that those who are experienced in the rehabilitation work will agree with me that this is no unusual case with reference to the number of services required. When we multiply the time and effort necessitated in handling this case by even a few hundred we get some idea of the amount of service required in the work of industrial rehabilitation. For one man, or half a dozen men, to attempt to render all the services demanded in the rehabilitation of the many cripples to be found among a population of over two and a half million, scattered over territory of more than 50,000 square miles, as is the case in 1476522 6 82 VOCATIONAL REHABILITATION. North Carolina, is to attempt the impossible. Without the coopera- tion of all the agencies which are in a position to assist in this work, it is impossible for us to render the service contemplated and made possible by the Federal and State acts. We could do nothing more than scratch the surface. In order to obtain the cooperation of all the existing agencies in the State, a personal appeal was made to the heads of the organiza- tions with a request that they send out with us joint letters to all of their representatives in the State, explaining the work of indus- trial rehabilitation and requesting their cooperation. The State departments to whom this appeal was made are The State board of public welfare. The State board of health. Agricultural State extension service. Department of labor and printing. State department of public instruction. We did not attempt to secure a different service from each of these departments, but asked them all to give us the same assist- ance. North Carolina is one of the few States that has a well organ- ized department of public welfare, and since the county welfare officers are dealing with the same general class of people as the de- partment of industrial rehabilitation, we have been able to obtain more assistance from this organization than from any other State department. Of the 100 counties in the State 47 have whole- time public welfare officers, and all of the others have officers who devote some time to welfare work. Among the duties of these officers are the care and supervision of the poor, the administration of the poor fund, the finding of employment for the unemployed, and the investigation of causes of distress. These duties naturally bring them into close touch with many of the problems of industrial rehabilitation, which probably accounts for the fact that we are able to obtain more assistance from them than from any other group working under the direction of a State department. The State board of health has 28 full-time county health officers, and a part- tune officer in each of the other 100 counties. These officers do much to relieve the physical suffering of indigent persons in each county, and naturally come in touch with many of the crippled and handicapped. We are receiving excellent cooperation from a number of these officers. Under the division of public health nursing, the board of health has 25 county nurses and 7 community nurses located in towns. As the work of these nurses brings them into contact with a large number of incapacitated persons they are glad to avail themselves of the assistance offered by the department of VOCATIONAL REHABILITATION. 83 industrial rehabilitation. Some of our most valuable assistance is secured from these nurses. The agricultural State extension service has 70 white and 15 negro farm agents, and 50 home demonstration agents. This department offers a large number of persons whose cooperation might be obtained, but to date only a very limited amount of assistance has been received. The department of labor and printing maintains six employment offices in the State. Some valuable aid has been obtained from those in charge of these offices. Through the State department of public instruction we have endeavored to interest the 100 county superintendents of education. Some of these are doing much to promote the work in their counties. The assistance which we sought through these agencies was the giving of publicity to the work, the reporting of cases to the State department, the making of investigation of cases upon the request of the department, arranging for applicants to meet State agents when visiting the county, advising with the agent on plans of reha- bilitation, assisting in the securing of financial assistance in providing surgical treatment and prosthetic appliances, and assisting State agents in securing suitable placement training opportunities and employment. Our joint letters brought only a mediocre response from the repre- sentatives of these departments, but they did valuable service in paving the way for personal solicitation, which in turn enabled us to interest many of the best workers in industrial rehabilitation. In appealing to both State and private agencies for their cooperation we stressed the fact that we were offering them an opportunity to render valuable and much appreciated service to needy individuals and through them to the communities in which they lived. We have found that the concrete results obtained in this work with the favor- able impressions which they make on the community produce a very strong appeal to all social workers. A short time ago a county wel- fare officer, who is one of the best in the State, informed me that he had found it difficult to make many people see the need and value of his services, but since his participation in vocational rehabilitation the public has shown a much greater interest in and appreciation of his work. As we traveled throughout the State dealing with the cases re- ported to us, we endeavored to form personal contact with each of the representatives of the State departments mentioned, as well as with all other social workers, in order that we might interest them further in vocational rehabilitation and select the most capable rep- resentatives in each county or community whose whole-hearted cooperation could be secured. In some counties it was a public wel- fare officer; in some it was a public health officer; in others, a county 84 VOCATIONAL REHABILITATION. nurse; an employment officer; a county superintendent of schools; a Y. M. C. A. secretary; a Red Cross secretary; and in others the sec- retary of the associated charities. In practically every one of the 100 counties we have found at least one active social worker who welcomed the opportunity of aiding the handicapped residents of the county in conjunction with the State department of rehabilitation. The cooperation of these individuals has been a big factor in our success. They are familiar with the employment conditions in the community and are well acquainted with the employers. With this knowledge they are able to advise us as to the best places to seek employment or placement training opportunities for the disabled. Our experience has been that the employer's attitude is much more favorable when approached by a State agent in company with a local social worker. We have found that these workers have been willing to give very liberally of their time for rehabilitation work. They have reported many new cases, always investigated cases promptly upon request, and greatly aided the State representatives in getting in touch with the disabled parties by arranging interviews or, when necessary, by driving the representative to the home of the disabled, some times many miles. They have been of much assistance in advising on cases, and in helping to make arrangements for placement training. We have much of the latter to do owing to the fact that we have very few institutions in the State that are offering real vocational courses. By this plan of cooperation with local social workers we were able to develop, through experience, at least one rehabilitation agent in each county. Owing to the rapid increase in the number of cases, and the large amount of service required in many of them it soon became apparent that a different plan of cooperation was necessary. We were willing to try any plan that appeared to offer a solution of our problem. Our attitude was much the same as one of our county welfare officers when he expressed himself as willing to ride the devil if he were going his way with a bridle and saddle on. Just at this time a copy of the report of Mr. Shaw's discussion of " Cooperation of social agencies in Ohio" before the National Society for Vocational Education at Kansas City came to our attention. The plan of organizing an advisory committee in each county appealed to us as a probable solution of our problem. We adopted the plan as outlined by Mr. Shaw and have been giving considerable time for the past few months to the organizing of local rehabilitation bureaus. I am glad to say that these bureaus have more than filled our expectations. The social worker in each county, already experienced in rehabil- itation work, has served as an excellent nucleus for the formation of such a bureau. We have experienced no difficulty in getting the VOCATIONAL REHABILITATION. 85 very best people in each community interested in the work and will- ing to serve on a committee. About two weeks before coming to St. Louis I visited a community in which the county nurse has been our active local representative. In company with her I interviewed a number of leading citizens with reference to serving on an advisory committee. Everyone called upon agreed to serve. On Tuesday of last week I returned to the county to be met by the nurse and driven 12 miles to the county seat where I found arrangements had been completed for a meeting of the committee, with not only every mem- ber present, but more than a dozen cripples assembled outside of the courthouse awaiting the consideration of their cases by the com- mittee. In this county we have one of the most successful merchants as chairman. Associated with him is an excellent physician; a prom- inent and influential woman, who is very much interested in social work; the county nurse; and other welfare workers. After explaining to the committee in detail the various ways in which we can assist the disabled, we called in the cripples one at a time and worked out a plan of rehabilitation for each. Three hours were required for explaining the work to the committee and for deal- ing with the applicants, and although several members of the com- mittee are very busy professional and business men, everyone re- mained until the work was completed. We have experienced no difficulty in interesting this class of people in doing rehabilitation work. I want to give you some of the results we have been able to obtain through these local bureaus, or advisory committees. A very interesting case is that of a negro who lost his left arm at the shoulder in a railroad accident. Upon recovery he secured em- ployment as an operator of a freight elevator. One day a fire broke out, a heavy trapdoor went shut, and he was obliged to make his exit by climbing up a burning stairway. The man's ears were burned entirely off, and the fingers on his only hand were so badly burned that its was necessary to amputate all fingers and thumb at the palm. A Red Cross secretary, who is one of the members of the committee in this county, was interested in the case and had raised $30 to pay toward the purchase of an artificial appliance to attach to the palm of his hand. The case was reported to the department and an appeal made to assist this man in getting an artificial appliance. The committee was advised that if any work could be secured for the man the state department would assist in purchasing such an appliance for him. Just last week I received a letter stating the committee had secured employment for the man at a dollar a day and requested the department to assist in securing an artificial appliance. An artificial-limb company advised that it would be necessary for the man to visit the factory in order to 86 VOCATIONAL REHABILITATION. satisfactorily fit him with an appliance. An agreement has been reached whereby the Red Cross funds will be used to pay the ex- pense of his trip to the factory and the department of rehabilita- tion will bear the cost of the appliance. Through these local bureaus we have obtained some excellent publicity by means of local newspaper stories as well as advertise- ments furnished by the bureaus. Many civic and social organiza- tions have had the rehabilitation work presented to them by the members of these committees. Valuable assistance has been ren- dered the department by some of the bureaus in obtaining suitable placement training opportunities. A superintendent of public welfare, who is' a member of one of these committees, spent an entire day with an agent of the State department in visiting all of the printing offices in the largest city of our State, with a view of obtain- ing an opportunity for training a crippled young man in linotype operation. Near the close of the day an opportunity was found, and as a result the young man is today operating a linotype machine for one of the largest printing establishments in the State. A number of these committees have been organized and are func- tioning very successfully. Within the next few months we plan to have at least one committee in each of the 100 counties of the State. When this has been accomplished we know that the efforts of the members of the rehabilitation staff will be multiplied many times and that the permanency and success of industrial rehabil- itation in North Carolina will be assured. Chairman LISON. We will now hear from Mr. Ernest L. Schneider on the same topic. ERNEST L. SCHNEIDER, State Supervisor of Industrial Rehabilitation, Missouri. Just one year ago the task of organizing the rehabilitation division of the State department of education of Missouri was assigned to me. To-day, as I look back over the first year's work, with a broader vision and better understanding of the philosophy of vocational rehabilitation for the physically handicapped, I note where I did not in every instance measure up to the full responsibility and authority which was in me vested as State supervisor, but by and with the helpful advice and friendly counsel of those who were engaged in promoting the work and administering the program, I feel that our organization is becoming solidly founded. At the outset it was not considered advisable to begin the work with an elaborate State machine, and the following references to cooperation by other State depart- ments in rehabilitation work do not exhaust possible interdepart- mental relationships in this State. VOCATIONAL REHABILITATION. 87 STATE INDUSTRIAL INSPECTION DEPARTMENT. Under the plan of cooperation between the State board for voca- tional education and the State industrial inspection department, the latter is (1) to bring to the attention of the employers of the State through its agents, the scope of the rehabilitation program: (2) to assist through its employment offices in the placement and follow-up work of men in industry and commercial occupations; (3) to furnish the name, address, and nature of injury of all seriously impaired persons who come to their notice and attention. The State board for vocational education agrees to furnish the State industrial inspection department (1) information in regard to the disposal of each case reported by them; (2) facts in regard to the placement and follow-up work of all persons who have been retrained; (3) statistical records in regard to rehabilitation service as may be desired by them. MISSOURI COMMISSION FOR THE BLIND. We are gradually and profitably interlinking our activities in the rehabilitation of the blind with the Missouri Commission for the Blind. I feel that it is well to digress here to quote the law under which the commission functions, because of the intelligent manner in which it is drawn. Section 12361, Revised Statutes of Missouri, 1919, reads: The duties of said commission shall be to prepare and maintain a complete register of the blind persons within this State and to collate information concerning their physical condition, cause of blindness and such additional information as may be useful to the commission in the performance of its other duties as herein enumerated, and to investigate and report to the general assembly from time to time the condition of the blind within this State, with its recommendations concerning the best method of relief for the blind; to adopt such measures as the commission may deem expedient for the prevention and cure of blindness; to establish and maintain at such places within this State as the commission may deem expedient shops and workrooms for the employment of blind persons capable of useful labor, and to provide superintendence and other assistance therefor and instruction therein; to compensate the persons so employed in the manner and to the extent that the commission shall deem proper; to provide such means for the sale of the products of the blind as the commission shall deem expedient; to act as a bureau of information for the purpose of securing employ- ment for the blind of this State elsewhere than in the shops and workrooms of the com- mission, and to this end the commission is authorized to procure and furnish materials and tools, and to furnish aid and assistance to blind persons engaged in home industries, and to buy and sell the products of the blind wherever and however produced within this State; to provide for the temporary cost of the food, raiment, and shelter of de- serving blind persons engaged in useful labor; to ameliorate the condition of the blind by such means consistent with the provisions of this article as the commission may deem expedient: Provided, however, that no part of the funds appropriated by the State shall be used for solely charitable purposes; the object and purpose of this article being to encourage capable blind persons in the pursuit of useful labor and to provide for the prevention and cure of blindness. 88 VOCATIONAL REHABILITATION. You will see, therefore, the wonderful opportunity afforded by this law for reciprocity between this commission and our division. The commission fosters and partially supports several local associations for the blind throughout the State by distributing a portion of its $75,000 biennium appropriation, as follows: To the St. Louis Asso- ciation for the Blind, $7,500; Kansas City Association for the Blind, $5,000; Jefferson City Association for the Blind, $3,600; and St. Charles Association for the Blind, $1,200. These associations have home teachers and field workers for the adult blind, except in the city of St. Louis, where there is conducted, under the above law, one of the greatest and biggest workshops for the blind in the world. The rehabilitation division is utilizing the facilities afforded by the commission and association, which help it to function more effi- ciently in bringing to them new forms of training and new work opportunities through research study and experiment. COOPERATION OF OFFICE OF STATE AUDITOR. The office of the State auditor permits representatives from the rehabilitation division to review the applications of persons who are enrolled for the pension for the deserving blind, under an act of the Fifty-first General Assembly of Missouri, approved March 29, 1921, which was made possible in November, 1920, when the voters, by a great majority, adopted an amendment to the State constitution wherein the State legislature was authorized and empowered to make such enactment as might be necessary to pension the deserving blind. On May 12, 1922, there was enrolled a total of 5,280; 4,708 in the State outside of the city of St. Louis, which had 572. The application partakes in part the nature of a questionnaire, and a glance reveals whether there is a possibility of vocational rehabilita- tion for the enrolled person. It may be interesting to know that the pension is $300 per annum, payable in equal quarterly install- ments, and that it is not paid if gross income amounts to or is greater than $780 per annum. COOPERATION OF COUNTY COURTS. During the latter part of December, 1921, a campaign was put on to bring the rehabilitation work to the attention of every county court of our 114 counties, and it was particularly planned to show them that to cooperate with us meant profit to ceunty courts as well as to the individuals. The initial letter, or letter of introduction for the subject, was made clear and concise, and in part said: Our recent legislature passed a law accepting the Federal grant and appropriated matched funds to be used in training handicapped or disabled civilians so that they may become self-supporting, tax-paying citizens. No doubt your county court has VOCATIONAL REHABILITATION. 89 one worthy handicapped individual who is of employable age but who is given some county funds for maintenance, and if properly trained to do a job would become self-supporting. We then endeavored to make clear to them what we could do and how we could spend the money for the above purpose, and finally asked them to report the cases of such persons. While the results of this campaign were varied and not wholly successful, some good cooperation has developed, and I have reason to believe it would have been about 100 per cent if it could have been followed up with personal presentation of the matter; then, too, the various county courts in the State convene in irregular order, depending, as you know, upon the amount of business to be transacted. However, every few days letters still come from county clerks in reporting this man or that man as a possible candidate for the benefits of the vocational rehabili- tation act. Up to date we have about thirty definite promises of cooperation through this medium, with several cases reported. COOPERATION OF TRADES AND INDUSTRIAL DIVISION OF STATE BOARD. It is the policy of the department of industrial rehabilitation to cooperate with all forms of public-school training within the State. Missouri has one of the largest public trade schools in the country, located at Kansas City. We are earnestly endeavoring to place some of our people for rehabilitation in the schools of trade training and are confident of success. STATE BOARD OF CHARITIES AND CORRECTIONS. Quite satisfactory contacts have been established between the State board of charities and corrections and the rehabilitation division in a number of instances. Their records are particularly helpful in learning the attitude of the county courts in the matter of public outdoor relief. Since they have to deal, also, with crippled children, we shall have to carefully work out a program whereby we shall have contact with them when they reach the age of employ- ability. STATE BOARD OF HEALTH. The State board of health agrees to furnish the State board of vocational education with the following facts in regard to injured persons who come under the care or observation of said board or its agents: (1) The name, address, and nature of injury of all seriously impaired persons who come under their care and observation; (2) information in regard to the physician's rating of the individual's ability; (3) assistance in making investigations to determine the kind of occupations disabled persons can enter. We in turn are to furnish them (1) information in regard to the disposal of each case 90 VOCATIONAL REHABILITATION. reported by them; (2) information on such subjects as quality of medical care provided and suitability of prostheses; (3) statistical records in regard to rehabilitation service as may be desired by them. STATE BUREAU OF MINES. I want to* say here that the lines are laid to full and hearty co- operation with the officials of the State bureau of mines, who have reported to them all cases of fatal and nonfatal accidents, but that we can not possibly take care of our present business with the size of the present staff. We decline to pile up cases and hold them in the works. I want to say again, by way of digression, we desire to work the cases through to a logical and satisfactory disposition, thereby avoiding holding them as pending cases over a long period of time, which is discouraging to all concerned. The bureau of mines will turn over all accident report records to us for review. BUREAU OF LABOR STATISTICS. The bureau of labor statistics also holds its records open to us. and they contain valuable information. For example, every owner, operator, or lessee of any factory, foundry, or machine shop, or other manufacturing establishment doing business within this State must report annually on or before the 1st day of March to the commis- sioner of the bureau of labor statistics name or title of establishment, name of corporation, firm or individual owner, location of factory and general office, nature of industry, specifying kind of goods manu- factured, etc. Provision is made for the reporting of accidents incurred by persons while working at their occupation, as to whether they are fatal, or non-fatal; also, nature of accident, number recovered, number partially recovered, cause of accident, etc. We have not been able to work out a satisfactory arrangement yet whereby we can avail ourselves to good advantage of the several free employment bureaus operated by this department of our State. I can not close these remarks without saying that we do not have a workmen's compensation commission functioning in this State for' the reason that the law has been referred to the people; to become operative if favorably acted upon by the voters on November 7, 1922. Regarding the results of a questionnaire, which was sent to the officials in charge of industrial rehabilitation in the remaining 33 States, it was learned from the 24 replies received in answer to the question " What other State departments are cooperating with you ?" that there has been effected satisfactory arrangements with VOCATIONAL REHABILITATION. 91 1. Workmen's compensation or Indus- 11. State tuberculosis sanatorium, trial accident commission. ! 12. State industrial school. 2. State board of health. 3. Board of public welfare. 4. Department of labor. 5. State- wide school system. 6. State school for the blind. 7. State railroad and warehouse com- 13. County auditors. 14. County commissioners. 5. State-city employment offices. County public health physicians. 17. State board of control. 18. State board of children's guardians. 15. 16. mission. | 19- County welfare officers. 8. Veterans welfare commission. j 20. Here are omitted those of Missouri 9. County farm agents. not covered in this list. 10. State purchasing department. GENERAL DISCUSSION. Mr. DALLAS. Can you give me some information regarding the cooperation received from the Veterans' Bureau? Mr. SCHNEIDER. The district vocational office in St. Louis has given us permission to use whatever of their records we desire to copy. Mr. Kidd has given to our Miss Davis in St. Louis some very valuable information from the records there which could be used here in St. Louis. They have given us every cooperation, and we in turn have cooperated by advising them regarding several of their blind cases, three of which we have in training in Jefferson City. Mr. DALLAS. My experience has not been such. On one occasion the district officer flashed an official order that he had received from Washington, in which he was told not to discuss the case of any trainee unless the trainee was present and gave his permission. Two men came to us at different times. These disabled felt in both cases that an injustice had been done them. We have, I might say, no cooperation in Massachussetts. Mr. SCHNEIDER. Mr. Head, when he was heading up the work last summer, wrote a letter to each of his field agents who are located in five different cities of the State, and asked them to report disabled persons who had come to their attention and who had no just claim for compensation and training, and they were asked to report those to the State civilian rehabilitation service. As to the present status, I do not know whether that ruling has been promulgated. I could not say what the present attitude is. Mr. SHAW. I would like to ask Mr. Stanton how do you meet the problem in rural counties; where you have no town of any size you have such counties how do you get the proposition back to those people where you haven't much in the way of an agency ? Mr. STANTON. In every county we have some one person cooperat- ing with us. It may be a nurse, a health officer, or public health officer. In one county of the kind you mention, very thinly popu- lated, there is an ex-Red Cross secretary. I meet the disabled 92 VOCATIONAL REHABILITATION. people at her home. She is very much interested in the work. We have not yet established these committees in every county. We are just doing that at the present and we have established them in the larger counties. I do not know just how that is going to work. Do you mean you can not find people to help you in such communities ? I had not anticipated that problem. I believe we can get enough people interested who will be willing to give us at least some assist- ance. In that connection we have worked through this agency. We worked through them in organizing the committee. They have given us a great deal of assistance in finding proper persons who would give us the best cooperation and who are the people who are best able to serve on the committee. GROUP MEETING. MAY 1710.30 A. M. CHAIRMAN: W. F. FAULKES, Supervisor, Industrial Rehabilitation, Wisconsin. Chairman FAULKES. The purpose of this group meeting is to develop suggestions as to methods of cooperation with private agencies. Mr. Shaw, of Ohio, is the first speaker. COOPERATION BY PRIVATE AGENCIES IN REHABILITATION WORK. W. F. SHAW, Supervisor of Civilian Rehabilitation, Ohio. Private agencies are likely to be in existence as long as human nature remains human. They afford a method of self-expression to groups of people associated freely for the purposes of general welfare. Never yet have they become obsolete. In this democracy of ours they have always pioneered the way. During the late World War they were quick to take advantage of the opportunity to meet emer- gencies for which Federal and State legislation was wholly lacking. They have always had certain advantages over any Federal or State method of meeting religious, moral, and social needs. Very little progress could be expected if the Government were given the entire lead in any great social movement. It is axiomatic to say that before any cause can go forward it must win through merit the consent of a majority. REHABILITATION IS A COMMUNITY RESPONSIBILITY. Any one of these conclusions is written large in the history of any State. In the special field of rehabilitation there is need to recog- nize the value of these private agencies which often in the minority, sometimes alone, and usually against some transient drift of popular clamor have maintained in living power the high standards of com- munity life which must obtain if civic virtues are to be perpetuated. We are perfectly frank to say that we can see little hope of justifying our existence as rehabilitation agencies or of winning the public support, without which our work will be seriously retarded, if we fail to emphasize the fact that the rehabilitation of disabled, handi- 93 94 VOCATIONAL REHABILITATION. capped men and women is a community responsibility for which the community must accept the largest share of social obligation. Though all of us recognize our allegiance to the Nation and hold legal residence in a State, we eat and sleep in towns and townships. Our everyday living involves a triangular cooperative relationship by which our lives in a great measure are influenced. VALUE OF STATE ORGANIZATIONS. In an earlier group meeting emphasis was directed to the benefi- cial results attained by working with other State departments. The writer would be remiss in his duty if he failed to pay just tribute to other State departments for services gladly and unselfishly given. Within the last ten months in the State of Ohio we have profited greatly from having as helpers the trained workers of the industrial commission with 14 claims examiners and 40 field agents from whom we have received approximately 1,700 new cases for investigation; the department of industrial relations with 8 State-city employment offices strategically, located in our largest employment centers; the State department of health with 88 county health commissioners (one in every county), 82 city health commissioners, and 2,000 public health nurses. On invitation of the State department of health, coop- erating with Rotary clubs, we have been permitted to attend 48 clinics for crippled children, resulting in the listing of 1,564 names of of boys and girls under 16 years of age a part of our army of 15,000 crippled boys and girls in Ohio all of whom sooner or later may need our help. For the logical and consistent aid of State agencies we are grateful, but our attention must be specifically directed to the still larger group of private agencies who take pride in reflecting in terms of action the highest levels of community aspirations and ideals. CERTAIN PRIVATE AGENCIES LISTED. If all of us were to list these agencies of a private character it is believed that our lists would not differ greatly. They seem to vary only with the different methods of community organization. In Ohio we have received practical help from such private agencies as the Ohio State Medical Association with 87 affiliated county medical societies, the councils for social agencies, which are closely organized in our eight largest cities, the District Nurses, the Red Cross working through 75 home service secretaries, the Rotary, Kiwanis, and Lions clubs, the newspaper associations, the Ohio Society for Crippled Children, parent- teacher organizations, Y. W. C. A. and Y. M. C. A. groups, chambers of commerce, the county farm agents, city and county officials, various church brotherhoods, fraternal orders, and the Federation of Women's Clubs. VOCATIONAL REHABILITATION. 95 CLEARING AGENCIES ESTABLISHED. Ninety cities have designated " clearing agencies" to which we may refer cases for preliminary study and recommendations. The efforts of these " clearing agencies" are supplemented by advisory committees (usually of five or six members) selected by leaders of the different private agencies. Almost without exception an advisory committee represents the local interests which have most knowledge of our problems and greatest ability to meet our needs. In the largest cities we are meeting regularily each month with this advisory com- mittee. Such an arrangement now obtains in 11 cities, Cleveland, Cincinnati, Dayton, Middletown, Lima, Springfield, Lorain, Canton, Akron, Youngstown, and Toledo. WORKING WITH AN ADVISORY COMMITTEE. To-day (May 17) in the city of Dayton this group is in session with a representative from our office. Six people carefully selected by the bureau of community service because of what they know and can do are sitting about the table discussing their own disabled men and women. This group is representative enough to touch every needed avenue of approach in their civic life. Here is the head of the district nurses, the coordinator of vocational education, the executive secre- tary of the Red Cross, the representative of the employers' associa- tion, a representative of the hospitals, the director of the State-city employment office, and the director of the bureau of community welfare. Back of them and ready to serve upon call are the biggest and busiest people in this manufacturing city whose products are known throughout the Nation. By faith they built a new Dayton which towers above the horrors of a flood. With faith in their own people they now turn to the reconstruction of human lives. One by one cases are considered, accepted, rejected, referred for % placement, or tabled for more personal investigation. To-morrow a similar scene will be enacted in Cincinnati with another committee of big, busy people who know intimately their own city and its vocational possibilities, and who plan with us to help their own people. From the community chest through the handicap placement bureau, in addition to office rent and steno- graphic service, we have been given a full-time social worker, and a placement officer, both of whom serve under the leadership of the director of the handicapped placement bureau, who acts as the " clearing agency." CONFERENCES WITH REPRESENTATIVES OF PRIVATE AGENCIES. Twice a year conferences of the " clearing agency" representatives are called for the purpose of keeping communities in touch with the 96 VOCATIONAL REHABILITATION. work and developing new policies of local and State interest. Late this month we expect to hold two such meetings, one for workers in the northern part of the State and one for those in the southern part. We shall try to bring to these workers the high spots of this con- vention and to discuss our plans for the coming year. Naturally, the discussions will center on our failures rather than on any measure of success which may have been attained. SERVICES OF A GENERAL CHARACTER MAY BE GIVEN. There are certain types of service which lie outside the field of work on individual cases which private agencies can do more ef- fectively than a State agency. TAKING A STATE CENSUS. 1. For instance, a strong private agency may take a State census of the disabled. In Ohio the week of May 8 was designated as " rehabilitation week." The State medical association, with 5,000 members, took this census and reported to our office at the end of the week all the names secured. Two hundred and seventy news- papers, through the Western Newspaper Union, carried a series of three articles, asking the people of the State to report to their local doctors the names, addresses, and nature of impairments of any legal residents of the State of Ohio over 16 years of age whom it was desired to call to the attention of the civilian rehabilitation service. We used the idea that the doctor was a figure familiar to all, and that he has a telephone on his desk. The State Medical Journal carried two articles, The Ohio Manufacturers Bulletin indorsed the move- ment, the Better Schools Bulletin supported it, the Lake Division Red Cross News urged cooperation, a radiogram was broadcasted by the director of health, moving pictur3 houses carried slides, and many ministers gave space in the church bulletins to this effort. Such a plan has obvious weak points. Naturally we secured the names of many persons for whom no rehabilitation program can be planned. A certain few resented the idea of being reported as dis- abled. Of course duplicate reports were received. Some few doctors ignored the appeal. These, and other defects in the plan were for- gotten in the job of reading the responses which " rehabilitation week " brought. We now have a better view of State- wide needs. We know something more of our types of disabilities. We know where our disabled people live, and this in turn tells us where we need to center our efforts to develop strong community cooperation. We took our proposals right into the homes of our people. Now they know who we are, why we are, and where we are. VOCATIONAL REHABILITATION. 97 CENTERING ALL THE REHABILITATION ACTIVITIES. 2. Another valuable contribution which may be made by a group of private agencies welded into one association in a city is vividly illustrated by the recent opening (March 3) of the new Orthopedic Center in Cleveland. Here is the focal point of all the work being done in the city for the disabled, both children and adults. For this significant achievement the civilian rehabilitation service does not claim any credit, but it is desired to point to this as an example of what may be accomplished by a city whose people are interested in meeting the needs of their handicapped men and women. The activities which are centered here include (1) an information depart- ment, (2) a social service department which in addition to doing medical social service furnishes transportation and administers a loan fund for the purchase of artificial limbs, (3) a home industries department which provides work and thus diversion and income to the home-bound, (4) a home physiotherapy department which provides treatments for those for whom no arrangement can be made through the regular clinics, (5) the Sunbeam training school and workroom, which offers training and work opportunities in the making of chil- dren's clothes to girls and women who can not be placed in regular industry, (6) an employment department closely affiliated with the one branch office of the civilian rehabilitation service, which is housed in this center, and the Sunbeam shop which is the salesroom for the products of the training school and workroom, (7) a brace shop, and (8) the occupational shop conducted by the association in the wards for the crippled at the city infirmary. Such concen- tration of interests and activities radiates an ever-deepening under- standing of the problems confronting those who work here with the handicapped. Visits to this orthopedic center are certain to stimulate healthy activities in meeting local rehabilitation problems elsewhere. Private agencies again pioneer the way. STUDYING THE COUNTY AS A REHABILITATION UNIT. 3. It is possible for a small agency working alone to accomplish great good. For instance, the 40 members of the Lions Club of Lima, the county seat of Allen County, recently surveyed the county for the civilian rehabilitation service. Two members of the club were assigned to each township and through the citizens in these town- ships a survey was completed. Slides were provided for use in every moving picture theater in the county, full newspaper publicity was given to the work, every church cooperated either with announce- ments from pulpits or in church bulletins, members of the club were required to appear before various organizations during the preceding 1476522 7 98 VOCATIONAL REHABILITATION. week. Upon completion of the survey the ineligible cases were eliminated and there were submitted to the rehabilitation agent and the advisory committee those cases for whom it was believed training was necessary and feasible. Plans were initiated to bring an eminent orthopedist of national reputation for a clinic to determine if the crippled adults who were recommended for training may first be helped through surgery. Those who can be helped are to be given assistance by the Lions Club in arranging for hospital and surgical care. Following this orthopedic work the cases are to be surveyed with a view to determining vocational training needs. Undoubtedly in some cases it will be found that physical rehabilitation is all that is necessary to restore normal earning power. SPECIAL STUDIES MAY BE UNDERTAKEN. 4. Without attempting to exhaust the possibilities we hold the opinion that it is feasible for private agencies when properly organized to undertake other worth-while studies such as the following: 1. An industrial study of the handicapped: a. To make an investigation of employment opportunities to ascertain how many and what kinds of jobs could be held by certain classes of handicapped workers and what training would be necessary for such jobs. b. To determine how many and what kind of places are being filled satisfactorily by certain classes of handicaps. c. To establish friendly relations with employers in order to insure their cooperation. 2. A medical study of the handicapped: a. To determine what kind of work the handicapped can do and its effect upon the physical condition. 6. To ask medical agencies to assist by reporting the diag- nosis so that intelligent plans may be made. c. To urge trainees to report periodically to physicians in order to ascertain the effect of work upon their health. Such knowledge would furnish valuable information for placing similar applicants. d. To request hospitals to furnish active lists of handi- capped men and women in order to insure prompt follow-ups. 3. A social study of the handicaps: a. To study the abilities of persons physically handicapped. 5. To determine the number of the handicapped, where they are employed, and the nature of their work. c. To learn how we may best test their willingness and fit- ness for the job. VOCATIONAL REHABILITATION. 99 WORKING WITH INDIVIDUAL CASES. Along with such activities of a general character must go the work with individual cases. In an excellent address at the Kansas City meeting early in January, Mr. Oscar M. Sullivan discussed forms of rehabilitation. In his clear manner, step by step, he presented different methods used to accomplish the desired results. To me it has been interesting to check the work of private agencies in accom- plishing individual rehabilitations through the methods suggested by Mr. Sullivan. 1. Physical restoration. We are thinking of a young woman 19 years of age residing in a southern Ohio city, who was crippled by a fall received 16 years ago. This young lady was reported to us by the Red Cross Home Service secretary, and was found to be in a children's home where she was working for her room and board. She wanted to qualify for a position as nursery governess. An opportunity was found for her in Cleveland through the efforts of the Association for the Crippled and Disabled, where she accepted a training and employment opportunity in Rainbow Hospital. She worked five days; then an orthopedist told her that an operation would make it possible for her to walk again almost as well as any- body. A very successful operation and the necessary hospital atten- tion were given free of charge. The young lady expects to resume her place in Rainbow Hospital about the 1st of June. Without the help of the Red Cross, the Association for the Crippled and Disabled, and the hospital authorities, we could not have accomplished this rehabilitation. 2. Securing suitable prosthesis for a man 54 years of age with a double leg amputation will make it possible for him to carry on successfully in the small store which he has purchased. To quote his own sentence, "Reading your letter of March 24th brought tears of joy to my eyes. The darkest hour of my life has loomed to day- light. When you come here be sure to walk in my store. I want you to see me walking on the legs and feet you got for me to walk by." 3. Sometimes upbuilding the morale will practically accomplish a rehabilitation. We are thinking of a newsboy with a juvenile court record who was found on the city streets. He had a stiff knee with a resultant shortening of the right leg. It was possible for him to walk only by stooping down in a most awkward position. His parents reluctantly gave their permission to have an operation performed. This young man now stands erect and walks with a slight limp. He has entered upon a training program which will open to him entirely new avenues of usefulness. Only a private agency able to interest the boy, to take him off the streets, and to 100 VOCATIONAL REHABILITATION. secure the necessary surgical care and hospital attention could have made this result possible. 4. Placement training with an engraving company 21 miles from his home, plus the interest of a Kiwanis club, is making possible the rehabilitation of a man 32 years of age who must spend the rest of his days in a wheel chair. The jewelers in his home town and in two near-by towns have agreed to give him all of their engraving work which previously was sent to Buffalo. Four private agencies in two cities are working harmoniously on behalf of this young man whose rehabilitation now seems to be an assured fact. 5. Institutional training was secured through the efforts of a community service association for an 18-year-old lad with a left-hand amputation. Maintenance was provided locally. The training was given in a city 70 miles distant, where the Council for Social Agencies, through the Y. M. C. A., was interested in giving every possible opportunity to benefit by the training. When his placement seemed impossible in the city where the training was given, and in his home city as well, the rehabilitation agent used a Social Service Federation in still another city to make the placement. 6. Tutorial instruction in poultry husbandry, supervised by the county farm agent in a rural county, is making possible the rehabili- tation of a man who has both hands amputated at the wrist. Before entering upon this training arrangement, however, because the man himself felt that he wanted to be a draftsman or a bookkeeper, through the Rotary Club he was given an opportunity to spend 10 days in the office of a leading architect in Toledo. During this time he was also placed in touch with the head of a good commercial school in that city. This man convinced himself that he did not want to become a bookkeeper or a draftsman. He is now satisfied that his training program is one suited to his particular personality and we believe he will succeed. It required both city and county agencies working together to establish this training program. 7. Correspondence training, supplemented by employment in a power plant, has solved the problem for a young married man who has a right-arm amputation just above the elbow. This man may well look forward to the time when he will be a competent electrical engineer. Only through the efforts of an interested employers' association and a real foreman was this rehabilitation undertaken. 8. Establishment in a business of his own supplemented by the sympathetic help of a wife and mother, is going far toward turning a blind man to economic independence. In this case the industrial commission granted a lump-sum award following an investigation made by the rehabilitation agent and representatives of at least three private agencies. VOCATIONAL REHABILITATION. 101 WHAT PRIVATE AGENCIES HAVE TO CONTRIBUTE. The more we study rehabilitation problems the more we feel we have in common with private agencies. Cooperation with them may decrease neither volume of travel nor financial outlay. It most cer- tainly will increase that feeling of mutual trust and helpfulness which must exist when good people are stirred by the spirit of service for others. In developing our State program we work with private agencies primarily for these reasons : 1. They serve to keep alive an intelligent interest in the com- munity problem of assuming responsibility for its own handicapped men and women. 2. They center the efforts of individual groups representing widely diversified interests so that an advisory committee may be secured which will be representative of the highest levels of community life' which will speak with authority for all, and with complete knowledge of vocational possibilities within the community. 3. Upon request they are equipped to conduct initial investiga- tions in the homes of disabled men and women through trained work- ers, to make reports following such visits, to steady the morale of the trainee in his home, to bring the rehabilitation agents quickly into touch with training opportunities and placement possibilities, and to make training inductions in the absence of the rehabilitation agent when the training program has been approved. 4. They can readily eliminate ineligible cases through preliminary studies and thus save the time of the rehabilitation agent, who then need consider those cases deemed most worthy by the advisory com- mittee. For instance, at our request, a committee of 10 seniors in the sociology class at the University of Cincinnati studying "Our community/' recently made calls at the homes of 114 men and women disabled in industry in their city and receiving compensation for these injuries from the State industrial commission. These prelimi- nary visits give us definite knowledge of the real problems concerned in what had been merely a list of 114 names. Effort then centered on getting help to the interested people in the best possible manner with the least possible loss of time. 5. They keep on the alert for new cases, new training possibilities, new employment opportunities, through constant contact with ebbs and flows of local industrial tides. Any community will take com- mendable pride in being able to carry forward to completion training programs for their own disabled men and women. 6. They secure from the agency best prepared to meet a known need such helpful services as the following : (1) Maintenance during the training period if this is not provided by law. 102 VOCATIONAL REHABILITATION. (2) Proper surgical care, necessary prosthetic appliances, and hos- pital attention. (3) Office space, equipment, stenographic help, placement officers, social workers, and the like. (4) Such gifts, financial and other, as the community may desire to make toward meeting situations for which the law does not provide, but which the community recognizes as essential in the development of the work. 7. They keep the home people advised of what is being done, emphasizing the fact that achievements in individual rehabilitations will not rise higher than community effort. To accomplish much these private agencies must undertake much and then be contented to let results speak. Later on if votes are needed for additional legislation found to be necessary, the proofs of the value of the work are matters of common knowledge back home where the legislators live, and where the votes are counted. THE PHILOSOPHY BEHIND THE APPEAL TO A LOCAL COMMUNITY. The other day a much-loved doctor, who is somewhat of a philos- opher, and who for years has worked in his home city to be ready to greet the first rehabilitation agent, expressed in his gentle manner the essence of what we are trying to do for each community. His sincere words will bear repeating: " Start the work slowly; let it grow gradually; tell us all about it; make us want to help you so much that we come to look upon this work as a necessity. " And so the work will grow from day to day, meeting the challenge of new oppor- tunities, secure in its position as an established factor in community life, strong in its grip upon those who must give it legislative encourage- ment and support, and deeply implanted in the lives of those whom we serve. Chairman FAULKES. Let us now hear from Director Fulmer on the subject of " Cooperation." C. A. FULMER, Director of Vocational Education, Nebraska. The necessity for effective cooperation in the vocational rehabilita- tion program between the State board for vocational education and private agencies is, in the light of experience, now fully apparent. Some of the means by which such agencies can be of assistance, as indicated in one of the Federal Board's bulletins (Misc. 240, Part III), under " Cooperation with Social Service Agencies/' will serve as a general outline for this paper. A free exchange of experiences is perhaps the most helpful form of conference called for the consideration of any program in process of development. For that reason some of Nebraska's successes and fail- ures in dealing with private agencies will be reviewed. VOCATIONAL REHABILITATION. 103 SOME OF THE MEANS BY WHICH SUCH AGENCIES CAN BE OF ASSISTANCE. " (a) By reporting cases not otherwise heard of." Out of 150 disabled persons now listed, only a few reported them- selves. Many deserving and eligible men and women, on account of modesty, suspicion, misunderstanding, discouragement, and un- willingness to accept what some might call charity, or resignation to their disabilities, hesitate to apply for or even consider the benefits of retraining. Evidently a large percentage of cases will be reported by interested individuals or agencies. Last October a brief announcement entitled "A New Chance for Disabled Men and Women, " together with a request that it be given publicity, was sent to State papers. All complied with the request. This was the announcement : A NEW CHANCE FOR DISABLED MEN AND WOMEN. FEDERAL AND STATE FUNDS NOW AVAILABLE. WHO MAY BE BENEFICIARIES. Men or women who are so disabled physically by accident or disease that they can not earn a livelihood and who are capable of being rendered fit to engage in some other occupation. In each case the feasibility of retraining both from the physical and vocational standpoints must be determined. WHERE THE RETRAINING IS DONE. In public and private institutions, industrial plants, shops, offices, at home, or anywhere the student may be trained efficiently in the most advantageous way and in the shortest possible time. No classes are formed because each case must be treated individually. USE OF FUNDS. Funds may be used for instruction, incidental fees regularly charged by schools, necessary books and supplies, but no funds are available for the maintenance of stu- dents during training. WORKMEN'S COMPENSATION ACT. Acceptance of training by persons injured in industry does not deprive them of any rights under the workmen's compensation act. FOR CIVILIANS. This service is distinct from that of the rehabilitation of disabled soldiers, sailors, and marines of the World War now being carried on by the Federal Government. YOUR HELP. You can help by sending in the names and post-office addresses of any disabled persons whom you may know or of whom you may learn. Address: C. A. FULMER, 204 University Temple, Lincoln, Nebr. The State director's name was signed in order to assist readers in distinguishing vocational rehabilitation from soldiers ; rehabilitation. 104 VOCATIONAL REHABILITATION. The papers publishing the announcement were the Nebraska Manufacturers Association Bulletin, State Medical Journal, the Nebraska Teacher, the Middle-West School Review, State Nurses Association Bulletin, Nebraska Tuberculosis Association Bulletin? and the five leading State daily papers. The bureau of health in the department of public welfare sent a copy of the announcement to each nurse in the State. The Western Newspaper Union which supplies about 2,450 newspapers with plate matter, in response to the request, wrote as follows : " I am answering your letter of a few days ago by inclosing proof of your .copy as we will use it in our State News. It is not often we can use such a long article, but realizing the importance of this one we made special effort to give it space. " The announcement reached every part of the State and it was read by thousands of people. Quite naturally, a flood of responses was expected but only a few came straggling in. However, they keep coming and in as large numbers as they can be handled thoroughly. Cases have been reported by teachers, preachers, doctors, nurses, Red Cross, American Legion, Department of Labor, County Super- intendents of Schools, and by others who have read or heard about the work. " (&) By bringing influence to bear upon persons who should accept rehabilitation service but are refusing or postponing it." As stated before, many persons, for various reasons, hesitate to accept rehabilitation service. Often some one who understands the person and the service can change the attitude of mind from that of indifference to interest. C. M. offers an illustration of just such a case. C. M., a man who fought overseas, the cause of whose disability (ankylosis of the cer- vical vertebrae) could not be traced to actual Army service, had become embittered by what he considered unfair treatment at the hands of Government officials. A banker friend, unable to interest C. M. in the announcement that appeared in the local paper, wrote a letter of inquiry and signed it with C. M.'s name in typewriting. Three letters written by the State office to C. M. were unanswered. The fourth one brought a reply. Then as the result of an agent's visit and the friendly interest of the banker friend, C. M. is being trained for a certified accountant, and he is in a happy frame of mind. Success in almost every case, no doubt, is the result of several influences brought to bear upon the prospective trainee and all coop- erating with the State office. " (c) By supplying or arranging for maintenance for the disabled person and his family during the period of training, or by sup- plementing inadequate grants of maintenance." VOCATIONAL, REHABILITATION. 105 In Nebraska all of the immediate functions of rehabilitation are assumed directly by the State board, and the State department of labor cooperates by rendering assistance at points at which the compensation work and the rehabilitation work touch. Inasmuch as the relation between workmen's compensation and industrial reha- bilitation is a subject of another discussion on the program, it will not be considered in this paper. AMERICAN LEGION AND RED CROSS. An act of the 1921 legislature provided for an invested fund of $2,000,000, the income from which is to be used for the care and relief of discharged soldiers, sailors, marines, and nurses. The disburse- ment of the interest accumulations of the fund is intrusted to the executive committee of the State American Legion. Moneys re- ceived may be expended in furnishing food, wearing apparel, medical or surgical aid, care, or relief. The important bearing of this act upon industrial rehabilitation is obvious. A man, disabled since his dis- charge from service, may receive maintenance from this fund during industrial rehabilitation. The Legion executive committee has ex- pressed a desire to cooperate with the State boaro!,, and already funds have been appropriated in two cases. Local Legion posts are willing to provide or arrange for the mainte- nance of service men during training. Red Cross funds are also available in some cases. The case of V. M. is an example of all-around cooperation. V. M., a service man disabled since the war, will live at the Lincoln Y. M. C. A. during training. His local Legion post out in the State and the local Red Cross chapter provided maintenance on the 50-50 basis. The case of R. M. is another illustration. R. M., a disabled man living in a small town, is being taught the cobbler's trade in a shop equipped by funds loaned by the county Red Cross. The instructor of R. M. was sent out from Lincoln by the State board. HOSPITALS. S. M. is a patient in the Nebraska Hospital for Tuberculosis. Last fall the attending physician reported that S. M.'s disease was practically arrested and that he would probably be discharged this coming summer. Since that time S. M., while living in the hospital at the State's expense, has been pursuing a course in retraining in the Kearney State Normal College which will be completed by the time he is discharged. Another case is that of J. W., a patient in the State Orthopedic Hospital in Lincoln. J. W. is deaf, and he also has a hip deformity. 106 VOCATIONAL REHABILITATION. He will be in the hospital until some time next fall. Meanwhile he attends school in an " opportunity" room, where he is receiving instruction in lip reading, and the State board is giving him a course in cartooning. C. W., a disabled man, widower with three children, is janitor in a sanitary dairy company. The company offers to furnish mainte- nance for C. W. and children during the period of retraining " (d) By securing medical service for the disabled person or his family during the period training." The State fund for the aid of discharged soldiers, sailors, marines, and nurses is available for this purpose. UNIVERSITY OF NEBRASKA, COLLEGE OF MEDICINE. The following letter is self-explanatory: Replying to your favor of the 21st (May, 1921), I am glad to advise that we shall lie glad to assist the rehabilitation work in any way possible. As you know, the uni- versity hospital affords free treatment to those citizens of Nebraska who are without property or earning power and consequently unable to pay a physician. Individuals coming under this category will be cared for. Cordially yours, IRVING S. CUTTER, Dean. W. A. applied for rehabilitation service. He had lost full use of his legs. The city physician thought that he might be helped and possibly cured by medical treatment. He was a patient in the uni- versity hospital for three weeks. His ailment was diagnosed as locomotor ataxia, incurable and progressive. The case was closed. This hospital is willing to cooperate in cases requiring physical as a prerequisite to vocational rehabilitation. OTHER HOSPITALS. The State board has been encouraged to believe that certain private and church hospitals will offer the same liberal cooperation. SOCIETY FOR THE RELIEF OF THE DISABLED. The Society for the Relief of the Disabled, an Omaha institution, collects approximately a thousand to fifteen hundred dollars each year and expends this sum almost wholly for the purchase of braces and orthopedic appliances for worthy poor. This society, also, is willing to cooperate with the State board. PHYSICIANS. In a number of cases physicians have furnished medical and sur- gical service gratuitously to prospective trainees. Physical exam- inations have been made without charge. In three instances local physicians have taken measurements and made casts for artificial arms. VOCATIONAL REHABILITATION. 107 AMERICAN LEGION AND RED CROSS. Local Legion posts and Ked Cross chapters are always ready for such service. 11 (e) By supplementing the efforts of the State board's agents to keep the person in the ' carry on' frame of mind throughout the period of training, and of adjustment in employment following train- ing." Success in the work depends in a large measure upon the ability of the State board's agents to secure the cooperation of one or more persons who are in intimate touch with the trainee. Discouragement and depression of spirit incident to a physical disability make an almost constant stimulation of interest and hope necessary. For these reasons the State board should seek to cultivate helpful rela- tions with all private agencies within reach. The following cases will serve as illustrations: 1. V. M. Maintenance provided by American Legion and Red Cross, 50-50, while trainee lives in Y. M. C. A. building, where picked men will "big brother" him. 2. C. H. His pastor, in whom he has confidence, surveyed the case, managed his physical examination, advised with the agent who visited C. H., and is now keeping in close touch with the man. 3. V. B. Is a Mexican who can not speak English. He has a wife and six children. After an agent had explained re- habilitation work to a group of University of Nebraska graduate students in social science, the professor in charge asked permission for the group to assume responsibility for one case. The V. B. case was selected for the study. One of the group, who has had successful experience in social work, made the necessary contact with the man through an interpreter, surveyed the case, won his confi- dence, made arrangements for a course in English for for- eigners and returned to the State board a report of her work. After the man learns to speak English the board's agent will take charge of his training, which has already been agreed upon. This student made frequent reports to her group with the result that scores in the department are now interested in rehabilitation. The Americanization of V. B. is proceeding rapidly since he learned that Americans are interested in him. 4. E. B. A teacher with considerable talent aspires to be a short- story writer. Mrs. Bess Streeter Aldrich, a Nebraska woman whose stories in the American Magazine and other periodicals are read with so much pleasure and profit, at the suggestion of the board's agent, has been corresponding 108 VOCATIONAL REHABILITATION. with E. B., offering advice and inspiration. Mrs. Aldrich will later travel across the State to spend a little time with E. B. 5. F. O. A man partially paralyzed from his hips down began training for a shoe cobbler. The president of the local Rotary Club, Mr. D., upon request of the board's agent, formed an acquaintance with F. O., " big-brothered " and encouraged him until it became apparent that on account of defective vision training for the cobbler's trade was not feasible. Since then through Mr. D.'s influence and advice F. O. has become established in a peanut and popcorn business. The relationship between the agent and F. O. has become so personal that friendly letters are exchanged at least once in two weeks. 6. J. K. Is an epileptic with the rank of junior in a college of engineering. His occasional seizures although very light made classroom work and employment in an architect's or an engineer's office undesirable. ' Worry and disappointment aggravated his affliction. Through the good offices of the State secretary of public works J. K. was given a position on a salary in the drafting department under the instruc- tion of a few men who understood his case. J. K. has made a creditable record, and he has had no seizure since he was placed in this position. He will prepare for out-of-doors engineering work. 7. J. P. Suffered an injury to his spine that required more than a year's hospital treatment. He draws $15 per week compensation. Upon leaving the hospital he reported to the commissioner of labor, who directed him to the State board for information concerning rehabilitation. The attending physician, J\ P., and the agent agreed upon the barber's trade as suitable for the young man. He was discouraged, almost despondent. His case was presented to S., one of the leading barbers in the city, who formed his acquaintance and assured him success in the work. S. introduced J. P. to the manager of a barber's college in which training is now being given. J. P. and S. visit frequently and as soon as the course of training is completed the "big brother" will assist the young man in setting up in business. 8. M. A ne'er-do-well in a small town, reported by the super- intendent of schools and encouraged by the agent, the local Red Cross, and the cobbler-teacher who has spent six weeks at the bench with the trainee, has been trans- formed into a self-respecting man who has now establish a growing business. VOCATIONAL REHABILITATION. 109 These cases might be duplicated in every State. Another means might be added to those listed above, viz, (/) by educating the people, through all these private agencies, up to an appreciation of the value of vocational rehabilitation looking to- ward adequate supporting legislation and appropriations. After all, continuance of vocational rehabilitation, begun so success- fully, depends in a peculiar way upon the support of many persons and agencies whose interest has been stimulated by participation in the great work. Cooperation is the slogan. GENERAL DISCUSSION. CHAIRMAN FAULKES. In Wisconsin we have worked out a plan wherein splendid cooperation is given by the vocational education department. We have secured, also, the cooperation of welfare and social organizations. Members of Rotary clubs, Kiwanis clubs, Lions clubs, chambers of commerce, Red Cross, and other agencies are active in their communities in assisting in our work. I believe in this, that eventually rehabilitation is going to be a local responsi- bility, but it is a responsibility that should be shouldered by the tax- payers of the community and not by the private agencies. They can give us assistance that is worth while and that we should have. .In our State we are developing a plan of using local committees on ocational rehabilitation. These committees will be mostly of an advisory nature, but their personnel will include a working secretary who will make a study of local conditions and be prepared to co- operate with the State department in promoting our service in the community. The committees will in most instances be made up of representatives of the various social, health, business, and labor organizations in the local community. Each local committee will choose its own chairman and vice chairman and such other officers as it deems essential to the proper execution of the work. For obvious reasons it seems advisable that the executive secretary be named by the State department. Since much of the training pro- gram will be taken up by the local vocational schools, when such exist, they will assist in these fields of endeavor, and such institutional training as may be required in the rehabilitation of any handicapped person will be undertaken in full cooperation with the local vocational school. In connection with these committees, our plan is to have two State conferences a year, for the purpose of developing plans and policies and to convince local boards that they should shoulder a part of the responsibility for the work. Mr. Shaw and Mr. Fulmer brought up things that warrant dis- cussion. 110 VOCATIONAL REHABILITATION. Mr. STANTON. Mr. Shaw asked me a question regarding the organiz- ing of cooperating committees in the smaller counties and in the larger cities. We have not done much in organizing these commit- tees in the larger cities in the State. Mr. Shaw, how do you select the best people? The social workers are usually so busy that it is not so easy to get them to cooperate in the larger cities as in the smaller ones. Mr. SHAW. It has been easy in our larger cities simply because of a State condition. We have the eight largest cities already organized, through which every social agency must function, so that we claim no credit. In a city where there is no such organization it is necessary to convince the agencies of the county that can offer most help. Sometimes we go to the chamber of commerce to find out who the big, busy people are. In every city there are groups and groups within groups. If we can get a leader out of such a group we can make our initial contact. The big problem is to get back to the agricultural groups and the men disabled in the mines. There we have had to use the Smith-Hughes teachers and the home "service secretaries of the Red Cross. The nurses have been a tremendous help in getting into these inaccessible places. There is a way in every city. Our problem is to set up an organization there through which we may work. Mr. SPITZ. It might be interesting for the conference to learn the result of the survey that Ohio made the number of cripples and handicaps in the State. We have been asked how many there are in New Jersey, but we have hesitated to make such a survey for fear we might be swamped with cases that might all want to be rehabilitated at the same time. There are so many new cases that it takes all our time. There are 16,000 industrial workers injured in our State each year. It might be comforting to know the result of the survey made in Ohio. What is the population of Ohio ? Mr. SHAW. Five million.- Mr. SPITZ. New Jersey's is 3,000,000. Mr. SHAW. We debated a long time before we took this step. We did not know whether we would be swamped with requests. The biggest thing was in the publicity, and the fact that everybody had an opportunity to know who we were. We have had more than 800 replies from doctors, some of them have sent in as many as six or eight names. We shall probably get 1,500 replies from doctors. But the best thing is the fact that every doctor now knows how to present one of his cases to us. An avenue of approach for the succeeding years to the rehabilitation agencies of the State has been opened, and from now on these doctors may come to us, and even doctors who now know of no persons needing our services. We were not swamped. VOCATIONAL REHABILITATION. Ill We apportioned the names received to other avenues in the State for investigation. I think that is about the result any State will get. Mr. FAULKES. A survey was made in Wisconsin, a survey of the blind, developing 2,500 to 2,600 cases. They had not built up the organization to take care of them. As a result they are getting a kick back. I believe, however, that if you go at the survey very cautiously, you can get a lot of information across. Miss BLANCHE RENARD. It is true that if social agencies were sold on this proposition that the rehabilitation office would be so busy that they would never get through their work, because every agency conies in contact with rehabilitation work. Mr. Shaw's present social work is perhaps better organized. They have not only well- organized federated work, but, also, they have a marvelous survey of the crippled people. In other words, they had their problem before you ever had to get on the job. Cooperation should be coor- dination, by supplementing the thing you are offering. The big problem of the social workers is that they are not financially equipped to provide living expenses for individuals or families through a long period of training. As supervisor of the Home Service Section of the Red Cross, we had no difficulty persuading the men disabled in the service to take vocational training, because their living expenses were paid at the time. WTiat can we do where the person is willing to get the thing you are offering him, and where no provision is made to provide living expenses during training? We can give them medical care, social service, and many of the other services, but our agencies are not equipped to provide living expenses while in training by the Federal Board. Has that difficulty been encountered in other States ? Mr. FAULKES. Wisconsin has a maintenance fund which is limited, by which we provide maintenance. We have had the cooperation of the Red Cross. We found one fund of $70,000 left over from the subscription from the war. We have made it a revolving fund for maintenance. We do not give maintenance to anybody. Giving money to anybody is a bad habit. We loan that money out to the person. We will loan a person a certain amount and he pays it back. Our State fund amounts to about $10,000. Mr. SHAW. I rather welcome the challenge. I am glad we do not have a maintenance fund. We have been buffaloed in eight cases where we had to go into the committee and ask for funds, but it can be worked out in the community, and not by using the agencies most commonly called upon. We have a boy who is a Presbyterian. He has been helped by a fund from the Presbyterian church. It is our job to find them. Work it out locally. 112 VOCATIONAL REHABILITATION. Mr. FAULKES. The Elks have a big fund for promoting work among the cripples. I am taking it up with the supervisory officers to get that fund for State-wide work. Mr. RIDDLE. We can pay a living maintenance in Pennsylvania. The rehabilitation agency is allowed to pay $15 a week as a maxi- mum for the support of the rehabilitation program. We make a survey, decide the cost and general expenses, and estimate the weekly amount we should pay the disabled person. If necessary we can pay all the $15 for living maintenance. In a great number of cases that we are training living maintenance is not quite so vital as might be presumed, living maintenance coming from the State rehabilita- tion agency. Our adjusters plan as if we had no maintenance fund. Everything that we do pay out for maintenance is, of course, not matchable from Federal funds, and as we want every cent of the Federal fund, we try to limit payments to actual school expenses, which can be matched from Federal funds. The result is we told our adjusters we do not want a cent of maintenance that can be avoided. As a result of that, although we usually have an average of 50 cases receiving regular payments for rehabilitation purposes, I do not think at the present time more than 5 or 6 of them are receiving maintenance out of the bureau's appropriation. At the start we started out with the usual idea. We did pay maintenance that could have been avoided. We did not have a highly organized state of social agencies, as in Ohio. Our cooperation with' the social agencies in Pennsylvania is individual. Each community made a complete survey of every agency that would be expected to give relief. The cases come to us in an amount greater than we can handle. One person can handle more cases in a city than in a county. We decided what we wanted to do for getting a person back in employment. As a result we worked with every agency and our local men are in close touch with every agency, such as workmen's compensation, Red Cross, associated aids' in every community. We use every type of agency that can be of benefit, fraternal organi- zations and the like. In some cases where compensation has expired, or where it is not favorable, we have been going to the employer saying that we are limited in our funds. " Don't you feel you would like to contribute a bit toward the reeducation of this man for suitable employment?" We do not go to the employer until we have something definite in mind. If intensive work is done in combing every community you will not find maintenance so vital. We do not have to spend a great deal of money for maintenance. Workmen's compensation is not a com- plete relief. Almost half of our cases that were industrial accidents were reported after our law was enacted. They were injured before 1919. The compensation for a permanent disability runs usually VOCATIONAL REHABILITATION. 113 over a period of three to four years, and many of our cases have been paid all the compensation to which the law entitled them. I really believe that if an intensive effort is made to uncover any available funds and to see the actual living conditions, living maintenance is not so vital. I always ask, How is the man living now what is his main subsistence ? If the man is living now, why is it necessary to subsidize him further for maintenance ? I admit that there are many cases that must have maintenance, but I always start out asking, Is this man starving to death? We have a definite questionnaire for the purpose. When an adjuster recommends school training, he decides what is the present financial status of the family. Miss DAVIS. I do think it takes a lot of time to enlist agencies in the initial stage of the work. We must have some sort of maintenance. We spend three or four days chasing around looking for means for maintaining a disabled person while in training. I think we should suffer if we had a high maintenance, because I think we should not want to give it to everybody. We spend a lot of tune combing the territory, and we can not rely on agencies, because the social agencies are so busy. I think if we had a small sum of money, even $12 as a maximum, lots of handicapped people who are not taking training because of their lack of means of support would avail themselves of our services, and our chances would be improved to do a better job and perhaps take care of the family. We have to go slow, we must have some sort of maintenance, and the workmen's compensation is going to take care of the persons injured in industry. Mr. KRATZ. This afternoon in the discussion of future legislation the matter of maintenance will be taken up. Of course, we know that in the State of Missouri they do not have an operating compen- sation law, hence all the persons who come to the State department might be considered in the otherwise group. I was wondering whether Mr. Hubbard wanted to say something. They do not have any maintenance fund in Mississippi, and I am sure they met this situation. Mr. HUBBARD. Our experience so far has been that we have had a very limited number of cases where maintenance was absolutely necessary. In practically all of those cases we have been able to meet the situation. We have received funds from private individuals and Rotary clubs, and different kinds of organizations have made loans. In no case have we asked them to give the money outright. They give a note, and it is understood, of course, that the organization that is lending the money has no collateral to back up such a note. That is the way we have handled it, and we do not consider it a very serious problem. 1476522 8 114 VOCATIONAL REHABILITATION. Mr. STANTON. We have a very small fund in North Carolina, $5,000. We have no workmen's compensation, and even if we had it would not help because a large percentage would not be receiving maintenance, because disabled in public accident, from illness, or by congenital disabilities. We are trying to spare that fund just as far as it is possible. In some cases interested parties are going to pay half the expenses, and in a number of cases that we have had the employer gave them sufficient on the start to pay their expenses; but I agree with Miss Davis with reference to the time and the effort which is required to obtain that fund. We have so many services to perform that I do not believe we should be called upon to solicit funds. We feel that it aids us greatly, the small fund we have. Mr. JEWELL. Does it operate as direct weekly payments or loan ? Mr. RIDDLE. I am not very strong on the loan proposition. Mr. STANTON. Our attitude is the same as Pennsylvania. We do not care to set up any machinery for running a collection agency, and where we pay maintenance we make it a gift, because even when you get a man back on a paying basis it is a long time before he could pay anything back. GENERAL MEETING. MAY 17 2 P. M. CHAIRMAN: OSCAR M. SULLIVAN, State Department of Education, Director of Reeducation, Minnesota. Chairman SULLIVAN. Before we have the first of the papers, I am requested to announce a trip to the David Rankin Trade School for those who can stay over to-morrow. We will meet in the hotel Jobby at 9 o'clock. The first speaker of the afternoon is Mr. White, of Tennessee. PROPOSED INVESTIGATIONS TO BE UNDERTAKEN BY THE FEDERAL AND STATE BOARDS. ROBT. H. WHITE, Director of Civilian Rehabilitation, Tennessee. In the initial stage of a program for civilian rehabilitation our alpha and omega should be, "Get facts, cold facts, cruel facts," and then disseminate these facts to the public without saturating them with sentimentality or coloring them with inaccurate interpretations. From the United States Department of Labor there comes a recent report that within a period of 12 months 3,000,000 American workers were injured in industrial accidents and 24,000 were killed. Of the 3,000,000 injured, 3,000 were unable to resume work, 600,000 were unable to work for more than a month, 500,000 for a period ranging from 2 to 4 weeks, and 2,000,000 from 1 to 14 days, while up- ward of 63,000 sustained permanent disabilities, such as the loss of a leg, an eye, a hand, or an arm. Undoubtedly the economic wastage thus involved would run far into millions of dollars if it could be computed, and social liabilities are evidently tremendous; the cost to individuals and families in human suffering and grief is bey and calculation. Add the tragic toll of 24,000 killed 80 men for each working-day of the year, 10 for every hour of the standard working-day. These authentic facts are sufficient to impress the citizenship of the country with the importance and necessity of formu- lating a salvaging program that will reclaim and restore to gainful occupations as much of this human wreckage as is possible. With this official report as a basis, each State can make an approximate 115 116 VOCATIONAL REHABILITATION. estimate as to the probable number of disabled citizens in its own confines. For the sake of clarity and brevity, proposed investigations to be undertaken by the Federal and State boards are listed under three divisions, as follows: I. Statistical investigations. II. Vocational investigations. III. Related problems for investigations. I. STATISTICAL INVESTIGATIONS. a. County survey of disabled persons: It may be assumed that the citizenry in each State will desire and, perhaps, demand to know whether there is any real need within that particular State for the establishment and promotion of a pro- gram dealing with the rehabilitation of disabled citizens. More convincing than oratorical effusions or frenzied rhetoric will be facts as to the number of disabled persons in the State as obtained from a disability survey of the State. The securing of such a survey in- volves both time and continuous effort. Two methods of securing this survey have occurred to me. First, acquaint representative citizens and all important organizations in each county with the purpose and program of civilian rehabilitation. After this prelimi- nary work has been done, let each county or city select personnel for a permanent rehabilitation committee, whose duty and privilege will be to obtain a county or city survey of all seriously injured civilians. Such an enumeration will, of course, not be absolutely accurate, but it will give a somewhat definite and approximate idea as to the number of disabled persons in the county or city. Furthermore, this method secures splendid publicity for the work. A second method of securing the disability survey is to select three or four type counties, one of which may be agricultural, another industrial, and another mining. Go into these type counties and personally direct the disability survey. From the data thus obtained, an approximate estimate can be made as to the probable number of disabled persons in the State. From one type county in an agricultural section of middle Tennessee, a survey was made, conducted largely by the public-school teachers, the Red Cross, the county physicians, and publicity in the local press. Guided by both oral and written instructions from the director and supplied with prepared blanks for recording a limited amount of necessary data, the cooperative agencies in this county reported the names of 89 persons as being disabled. Thirty-one of these disabled persons appeared to have disabilities of a minor nature and, for that reason, their cases were not at the time investigated further. A letter VOCATIONAL REHABILITATION. 117 explaining essential facts of the civilian rehabilitation work was sent to the remaining persons, a number of whom made reply. It should be said that in the main only physical disabilities of a visible nature were recorded, it not being feasible to have examined by physicians those persons with latent disabilities, such as lung, heart, and other internal involvements. As fast as it is humanly possible, other coun- ties will be surveyed, though local conditions in some of the counties will perhaps make necessary a different method for obtaining the survey. b. Job changing as result of industrial accidents and occupational disease : Whenever an injured person is compelled to change jobs due to an accident or disease, there is of course a resultant economic loss. He who was a skilled workman prior to his impairment becomes, on account of his vocational handicap, an apprentice or a mere novice on the new job. With his occupational skill gone to waste because of his physical injury, and with no adequate supervision during his blind alley period of occupational readjustment, a loss in wages and % shrinkage in economic productivity inevitably follow. To ascer- tain the approximate economic loss due to this imperative changing Df jobs is probably an impossible task. Certainly an accurate survey of this matter could not be obtained without large expenditures of time and money. It is possible and might be advisable to select certain type counties which could be closely surveyed over a past five or ten year period, and for which an approximate estimate could be made as to economic loss involved from job changing. Unques- tionably a few specific type cases could be found and used to advan- tage in convincing the public of this economic loss, and thereby more readily public support and cooperation in the promotion of civilian rehabilitation could be won. c. Frequency of second-injury accidents: If the adage, "a burnt child dreads the fire," has any application as to the recurrence of industrial accidents, undoubtedly an injured person is more careful than one who has never met with physical injury. From the meager data available, it appears that second- injury accidents are very rare, amounting almost to a negligible quantity. If such data could be obtained and then presented to the employers of labor, it might soften the callous attitude sometimes displayed by employment managers toward the employment of dis- abled persons. Accurate statistics on this question would, in my judgment, overthrow the usual alibi, "Our compensation laws are very strict and we can not afford to take any additional risk by employing disabled persons." 118 VOCATIONAL REHABILITATION. i d. Earning power of rehabilitated persons : As soon as the program for civilian rehabilitation has been suffi- ciently developed, accurate statistics as to the earning power of the rehabilitated persons, from a pre and post injury standpoint will be in all probability the strongest argument for the promotion of this work. Obviously, all diasbled persons will be either self-supporting or dependent upon others for support. The acid test to which re- habilitation training will be subjected is whether or not the injured person has been retrained for and placed in successful employment. Actual figures on pre and post injury wages will be available in prac- tically every rehabilitated case. Such figures, however, may be mis- interpreted and thereby prove to be misleading. It would not be fair to select the high mark of wage received prior to injury, and then compare to that wage an imperatively reduced wage after rehabilita- tion training had been completed. It would appear to be a fair propo- sition to take as a basis for wage computation the actual earning status of the disabled person at the time he was inducted into rehabilitation training, rather than to accept as his earning capacity the highest wage ever received by him prior to injury. It happens frequently that disabled persons with relatively high wage capacity have re- ceived little or no wage after the injury. H. VOCATIONAL INVESTIGATIONS. a. Occupational census of the State : The importance of knowing what particular occupations are available in the State is evident. Surely no training course should be approved unless such a course leads to definite employment. If the trainee is reasonably sure as to his future abode, it would not be a difficult matter to determine with him the most feasible and available occupations to be found in or near his home community. All other matters being equal, it is a policy of mine to attempt to train the person for some occupation that can be found in or near his home community. In my judgment, nothing would be so productive of confusion, dissatisfaction, and ultimate loss of both time and money as to lend any encouragement to a training program that would put a premium upon ill-founded and ofttimes aimless migration. The average American person is already a migratory bird, and it is not in the interest of the individual or of society that he should be encouraged to play the role of an industrial gypsy. To prepare a disabled person to accept specific employment in some well-defined geographical location, making possible thereby a stable citizen, ought to be a rather positive policy on the part of the rehabilitation officials. VOCATIONAL REHABILITATION. 119 &. Suitable occupations for widely prevailing types of major-injury cases : A classification of occupations which have been demonstrated as feasible for specific types of major-injury cases will be helpful in determining what occupations are generally followed by disabled persons with certain recognized disabilities. For example, it would be interesting to any State to know what particular jobs are being held down by that portion of its citizens who have sustained the loss of a right hand or right arm. Such data as might be obtained from this investigation would be perhaps of most benefit along the lines of vocational advisement. Of course, the occupations that are most generally followed by one-armed men in one State will differ, in many cases, from the occupation followed by one-armed men in many other States. Such a difference, however, is accounted for largely by industrial and geographical conditions. c. Special problems in the rehabilitation of the blind: In all probability the actual rehabilitation of the blind will prove to be the most difficult of all types of disabled persons coming before rehabilitation officials for solution. Thus far, very little has been done in regard to making any special investigations as to what occupations are most feasible for the blind. The usual type of vocational train- ing offered the blind is of a purely manipulative nature, such as broom making, chair caning, rug weaving, etc. Industry is nowadays of a highly specialized nature, which faot ought to make it easier to ren- der the blind employable in industrial establishments. Here again, the attitude of the employer will need to be changed if any real con- sideration is given to the problem of securing adequate employment for the blind. With reference to the rehabilitation of, the blind, it is my belief that the Federal board and all State boards should pool their information so as to place before all rehabilitation officials eveen. possible bit of information that will help solve this question. In my own State, the training of the blind in the past has received but scant attention. For the past six months, however, the Tennessee Com- mission for the Blind has been working in close cooperation with the Department of Industrial Rehabilitation. Three blind teachers were secured and have been stationed temporarily in three of the largest cities in the State, where they are going into the homes of the blind and encouraging them to take up such types of industrial training as are practical. Within the next six weeks these home teachers are going into some of the rural counties and do extension work among the blind. As of date 72 blind persons are now in rehabilitation training. Several of these blind persons are now earning a small wage for part-time work. In view of the fact that there are 2,400 adult blind persons in Tennessee, serious attention will be given to 120 VOCATIONAL REHABILITATION. this portion of disabled citizens with a view of doing everything possible to alleviate their social, mental, and economic condition through suitable, available (training. d. Vocational training in small town and rural districts : The problem of civilian rehabilitation is rendered particularly acute in view of the fact that the small town and rural district afford little or no training facilities. In a great number of cases, disabled persons residing in the small town or rural district are unable, for financial or other reasons, to go to a city where training facilities and employ- ment opportunities are more abundant. The disabled landowner, with little or no education, and handicapped by some serious physical impairment, presents a difficult type of case; the disabled tenant, with little or no education, seriously injured and with no fixed social or economic status, presents a case that is extremely difficult to handle. The disabled, handicapped residents of agricultural regions constitute a group that will call for serious study, and perhaps pro- longed investigation, before an adequate rehabilitation program can be devised. There are, of course, some possibilities in poultry rais- ing, dairying, stock judging, and beekeeping, but lack of funds and a disinclination to take up any highly specialized form of agriculture tend to complicate the problem involved in the rehabilitation of unskilled, uneducated farmers. III. RELATED TOPICS FOR INVESTIGATION. a. Mental measurements : If there is any virtue and there is in psychological tests to determine the mental ability and fitness of an able-bodied person for specific vocations, certainly there is no reason for not applying mental tests to persons with only apparent physical disabilities with a view of determining their mental fitness for feasible occupations. Mental measurements have been given with success to large groups of disabled soldiers. On the whole, disabled soldiers do not differ materially from disabled civilians. It follows, therefore, that if mental tests are good for disabled soldiers, mental tests can not be bad for disabled civilians. The importance of mental measurements, in my judgment, should have serious attention and wide application in dealing with the problem of rehabilitating disabled persons. b. Physical reconstruction, an aid to rehabilitation: On the whole, first attention should be directed toward utilizing all physical reconstruction possible in eliminating the vocational handi- caps. This is a matter, however, which can not be dealt with either successfully or humanely by laymen. Expert medical and therapeu- tic attention should be given by competent technically trained persons. VOCATIONAL REHABILITATION. 121 c. Social and mental readjustment: During convalescence and also during the training period and place- ment in employment, the injured person is likely to lose morale and drift into an aimless and even rebellious state of mind, which often retards physical recovery and destroys initiative and ambition. It is here that the injured person needs the assurance that the State and societ}^ are ready to render assistance. During the initial period of employment, the retrained person will be subject to discouragement and will need the sympathetic but sane assistance of rehabilitation agents and employers. Mental and social readjustments are also imperative in many cases. To a person who has been accustomed to receive a high salary, his mental and social relations are subject to a severe test when he finds his earning capacity reduced to perhaps one-half of his former income. d. Maintenance pay for disabled persons undergoing training: A civilian rehabilitation program without provision for mainte- nance of disabled persons while undergoing rehabilitation training will delay and in many cases defeat the intention of the law and the purpose of the social program. With compensation laws that cover certain, but limited, cases of industrial workers, it is apparent that the large army of injured civilians fall beyond the pale of the work- men's compensation law. There are varying and vexatious excep- tions to the compensation law, which alleviate certain interests from financial outlay, but which leave greater interests totally un- provided for. To cite my own State as an example, Tennessee exempts from the provisions of the workmen's compensation law all agricultural work- ers, domestic servants, those engaged in interstate traffic, coal miners, all employees of State, county, and municipalities, as well as employ- ees in industrial establishments employing less than 10 persons on a full-time basis. An employee injured on a farm, in a country saw- mill, or a small- town ice factory, receives no compensation from the workmen's compensation act. Furthermore, that larger number of disabled persons those who are crippled by disease or congenital defects are without compensation of any sort. As a rule, the fami- lies in which there are disabled persons are generally the poorest families in the State. Their resources have been strained to the narrowest margin on account of sickness, hospital confinement, sur- geons' bills, nurse hire, and nonproductivity of the injured member. When these conditions are faced squarely, it can be seen readily that the payment of tuition and the purchase of books and tools mean comparatively nothing to such persons. The offer of the State and Government to provide for tuition, books, and tools is about the equivalent of saying, "Here, my one-legged, illiterate farmer boy? the State, your National Government, and society as a whole are 122 VOCATIONAL REHABILITATION. interested in training you for a successful vocation in order that you may take your stand as a useful member of society. For each dollar necessary to train you for this vocation, you put up 90 cents and the responsive National and State Governments will generously donate the remaining dime." Thus far, the cases on file in my office indi- cate that only 1 out of 20 with whom contact has been made are financially able to pay for board and lodging while training is being given. In my judgment, however, the maintenance of disabled per- sons in rehabilitation training is primarily a matter that should be investigated and handled by each State, due to varying condi- tions brought about by the racial, color, industrial, and economic conditions. Finally, civilian rehabilitation is an epoch-making advance in social legislation. It is enacted and exists for the benefit of indus- trial workers disabled in the nondramatic struggle for daily bread; it is not something to be put over on the people, but it is a sane, practical program that must be worked out by intelligent effort and sympathetic cooperation. GENERAL DISCUSSION. Mr. KRATZ. The Federal Board in the first year and a half of ad- ministering the vocational rehabilitation act has had many duties. First we have had to cooperate with the States in passing the neces- sary acceptance legislation. After a State had accepted our act it was necessary that we go there to give whatever assistance was needed to get the work organized. In that period of time the map of the United States, which you can see in the rear of this hall, has been painted largely white, and I make no idle boast when I say that by next spring a number of those blue States will become white. In casting about as to how the industrial rehabilitation division might be of most help to the States, we have realized that after getting the work started, it would be necessary to promote and stimulate the making of research or investigations into the philosophy of rehabili- tation and into methods of case procedure, realizing always that we are in partnership with the States. We did not attempt to begin any study without first consulting the States for their experiences, that we might better find out what they thought might be desirable along lines of investigation. You all recall that about two months ago you received some 14 possible suggestions with regard to possible lines of investigation, with the request that a vote, so to speak, be made, selecting at least five of the studies in the order of preference, so we might receive some indications as to what you wanted us to do. We listed three columns, indicating that the study might be made by the Federal Board, the State board for vocational education, or VOCATIONAL REHABILITATION. 123 by both. I am sure that you are anxious to know the results of that vote, which has been made by the States. I want to explain these sheets, which will be passed out a little later. Each State voted on five studies and indicated an order of preference. If, for instance, you selected as first choice " Scope and methods of work of organized social agencies," we weighted that five, and your fifth choice was weighted one. We should like again to submit these possible lines of investigation to you before you get away for a revised selection, if you so desire. It might be that in view of the discussion and in view of more mature experience you might wish to change your preference. The Federal Board wants to do something. We think we should promote some investigation, but we want to do it with the advice and cooperation of you folks in the States. With the permission of the chairman, I am going to ask Mr. Clayton and Mr. Cummings to pass out these sheets. Mr. FAULKES. In promoting our work and in getting ready for the legislatures, I realize, as Mr. White said, that we must get public opinion back of this matter. In Wisconsin we are about to try to reach every county with an article on rehabilitation. Would it not be a wise thing to get into a county paper and get a good write up ? In that way you will cover the district represented in the legislature. I am in favor of something of that kind. Chairman SULLIVAN. Mr. Kratz will touch on that. Mr. RIDDLE. I do not want to emphasize the choice in regard to the blind. There are certain lines of demarcation regarding the blind. In New York State they have a commission for the blind which gets more than the bureau of rehabilitation. The idea is to get the blind back into productive industry, but at any rate it can do everything to improve the condition of the blind. New Jersey operates under virtually the same condition. In Pennsylvania we have drawn no such lines. Pennsylvania has two schools for blind children. One institution provides traveling instructors. There is a Pennsylvania Association for the Blind which maintains schools with workshops in three or four communities Wilkes-Barre, Pitts- burgh, and Philadelphia. In all, our State appropriated for the im- provement of the blind $350,000 to $400,000. It appropriated for rehabilitation generally $100,000. I have entire sympathy with the work for the blind, but I would like to see definite lines set up. Our agency in Pennsylvania is the only State agency which is definitely working for the benefit of persons suffering from disabling injuries. There are other agencies with even more State funds available working for the blind. In our first year we spent $4,000 definite living maintenance for the blind. We even now are maintaining three or four institutions where they will be trained. In addition to what we spend on blind cases the $400,000, mentioned before, 124 VOCATIONAL REHABILITATION. goes for the blind. Our $100,000 appropriated for rehabilitation purposes goes for the benefit of all handicapped persons. If we attempt to use $50,000 per year for the blind, we will find that we may be charged with discriminating against the other types of disabled persons. Were we to start out on an intensive program for the blind we would have very little to expend for the other types of disabled persons. I would like to see some sort of a demarkation, or some- thing. I would like to hear from some other States in this connection. We have gone the limit, but we do not know how to turn down blind cases. They are always well represented by their organiza- tions, w^ith whom we are in entire sympathy, but it is merely a matter of State administration. What is the trend along this line, particu- larly in view of the fact that that is the first choice ? I have laid the cards on the table for Pennsylvania. They are not criticizing us in Pennsylvania. Here is the money; what can we do? There is a chance of considerable criticism along that line. There are no organized agencies of state-wide scope supporting the interests of other handicapped persons, but there are for the blind persons. Chairman SULLIVAN. You have raised a very interesting question. The principle could be applied that where there is any other State agency equipped to handle it, the State rehabilitation agency would be entirely justified in keeping out. It illustrates how the conditions vary from State to State, how hard it is to draw any lines, because conditions will vary in each State. In Minnesota there is not as much done for them in the State, and we hope to get that problem further along toward a solution by our efforts and get it correlated with our work. Just to broaden your question a little, you have not only that problem where there is no other State agency, but also where the class may be a legitimate class. You could devote all your time to that group. By the second or third year, when your work is developed, there will be a tremendous number of applications or lists, and you have got to begin to exercise choice, and every State will have to set up standards, especially of these possible groups which are almost infinite in number. Mr. GRANT. I think the Iowa situation is just exactly opposite. There is no aid to the blind at all in Iowa, excepting the State law providing that the local poor funds can be drawn on. There is no organization that is state- wide that is providing adult blind welfare. There is no consolidated movement. I am trying to fashion some- thing of that sort. We are facing a time where there will be some leg- islation. The blind is decidedly my first choice because it would be a great aid to me in my work if I knew all the conditions in my State. Mr. SHAW. We have an Ohio Commission for the Blind. We take no case for training. We consider no case for training until that case has been referred to us by the Ohio Commission for the Blind; VOCATIONAL REHABILITATION. 125 thereafter we attempt to do what we can. We could spend every penny of our money in dealing with the blind alone. This is one reason why we have had the commission go as far as they could- We have considered perhaps 15 cases. Chairman SULLIVAN. I should not have said we could spend all of our money on the training of the blind. The choice of vocations for the blind is a pretty difficult thing and it takes quite a time work- ing out a training program. Mr. FAULKES. We have practically the same working arrangement that Ohio has, because they have no training, and of course in the cases they refer to us they take responsibility for maintenance. They have a fund of $25,000 for doing the work for the blind in Wisconsin. Mr. STANTON. We are very much interested in the study of the problem for the blind. We have no organization in North Carolina for assisting the blind over the age of 21. Furthermore, we find that a large number of people who have graduated are not self-supporting. We have had an undue number, out of proportion, reported to us, and we have made some simple effort to help them. Mr. ROCKEY. I am very much interested in this question of the blind. We have that problem in New Mexico. One thing the Federal board could do to help us would be to discover those things that a rehabilitated person turns to that are a success in one State and a failure in another. Mr. Riddle spoke of broom making as in com- petition with the machine-made brooms. In one place they tell you that basketry is a success, in another weaving. I would like to have it gotten down into a businesslike analysis, not just broad general statistics. Chairman SULLIVAN. You could market that stuff as genuine Indian work. Mr. JOB. I believe the situation in Indiana as to relief to the blind is neglected in a way. In those cases in which we have under- taken a definite vocational training program, there has been cooper- ation with the State board for industrial aid for the blind. I should not be at all surprised that the blind people think the board is doing it all. There seems to be some sort of an underground communi- cation, and if one blind person gets something they all know it. Chairman SULLIVAN. You won't get the credit of the expenditure of funds. Mr. JOB. The State school for the blind under age has been suc- cessful, but I think it is somewhat open to criticism. A decided effort has been made to make every blind person a musician. The result is we find them out in pairs and quartets on the street, collect- ing their daily wage. This is somewhat a side issue, but it is a thing which we shall have to do some time. About the registration of the 126 VOCATIONAL REHABILITATION. blind in Tennessee: Our registration is somewhat larger than in Tennessee. More than 50 per cent are men and women way beyond the age of rehabilitation and, therefore, present no problem to the rehabilitation division. A very large percentage of the remainder are below the age of employability and for the present are not prob- lems for our division. I took occasion last year to look over the registration of blind persons and I found a very small percentage I would say not more than 2 per cent of the cases in Indiana that I should consider as fit subjects for rehabilitation. It seems to me that we can easily become alarmed. I am surprised that special problems connected with the blind received first rank. I think there are a lot of problems more important. In Indiana the last legislature appropriated $100,000 for the purpose of constructing a building for the trade training of blind persons. After the building is completed, I think I shall ask a ruling of the State board to elimi- nate all cases. The blind people have received more consideration than has any other group. There are several reasons for it. I am in complete sympathy with the blind, and I agree with Mr. Riddle about this situation for the blind, and I should regret to see a study made if we could make only one study. Mr. DALLAS. Massachusetts was a pioneer in the study of the care of the blind. The director of the commission of the blind in Massa- chusetts told me their appropriation for maintenance was $90,000 and he asked for $100,000, for training and the like; it is quite a consid- erable amount. Shortly after our work was organized the blind people came to receive what additional help they might receive. I went to the commission for the blind and arranged a kind of contract in which I said if any blind person came to me I would refer him to the commission for the blind, and if they were willing to recommend any kind of training I would be very glad to give it. We have had so far only one person. Man wanted to take the bar examination. The division had no money to take care of him. A reader for this man was needed. I furnished him the reader. We are doing it on the recommendation of the commissioner for the blind, but are to supervise the work. I think in those States the work should be on some such basis as that. Mr. JOB. I think there is very great danger of letting the commis- sion for the blind get advantage of us. This thing of taking up a recommendation for the blind person does not appeal to me at all for the reason that I could spend all my time following the recom- mendations of the board. They are just that willing that I supple- ment their work. That may not be true in other States. Chairman SULLIVAN. Special conditions are not especially illu- minating. The reason it was voted for was that that was the domi- nant problem not adequately cared for. These States are exceptional. VOCATIONAL, REHABILITATION. 127 It is perfectly true that you could be swamped with the blind, not because they are blind but because of a number of other things. The rehabilitation agency will always have a definite obligation because of men blinded in industry. It seems to me that the rehabili- tation agency will have a mission and duty to perform and something that ought to be performed quickly before the man gets into the condition of the other blind. Mr. KRATZ. The difficulties of the blind will always be a problem. Work for the blind has been an organized effort under State auspices for many years. We are interested in this connection solely in the vocational rehabilitation of the blind. The work of a commission for the blind is considerably more comprehensive and will always continue to be, because the blind make a special appeal. May I say, however, that we are discussing two things, first, the matter of making investigations that will help us and certain kinds of legislation. Both have been adequately covered. The reason I think that most of the States voted for this topic was that when they were faced with the vocational rehabilitation of blind persons they were at a loss to know in what kinds of vocations blind people can best carry on. Mr. Sullivan is making just such an investigation in his State. As I understand it, blind persons are going into the industries and experimenting in performing tasks and they are thereby developing job opportunities. Chairman SULLIVAN. I think that Mr. Kratz has touched upon the point. I agree with Mr. Job that the agency that wants to be on top is the rehabilitation agency. We felt that the problem had always been approached in a traditional way, so we hired a blind young man who is not exceptional. He tries out different industries in the State. He picks out certain processes for the blind men to try. In the course of that undertaking we have found a certain number of processes, ten or more, giving openings. We will find more. It is hard to make such a study. We investigated in Minneapolis and St. Paul. We took this blind demonstrator first to discover the the jobs and also to convince these particular employers that blind men can do the work. Then we have to find the blind men to place in those plants. Mr. SPITZ. I would like to say that we can not handle the blind of New Jersey because the law specially provides otherwise. We have a State commission. The census is about the last thing we would want to do. We are just a little fearful of raising a hope that we can not meet. This entire program ought to receive the consideration of the individual States in the order that they express the preference. What applies to Oklahoma might not apply to Pennsylvania. My suggestion is rather than making a hard and fast ruling the States be allowed to take those subjects which are most necessary in their State. 128 VOCATIONAL REHABILITATION. MJ-. RIDDLE. I agree with Mr. Spitz, especially with regard to the danger of duplication. I am thinking of surveys made in connection with the Federal board for disabled veterans. They have made numbers of surveys of such things which might be of assistance. Mr. KRATZ. I have some blanks here. If anyone wants to revise his vote he may do so by getting one of these sheets. Chairman SULLIVAN. You are all acquainted with the next speaker on the program, Mr. John A. Kratz, chief, division of industrial re- habilitation, Federal Board for Vocational Education, who will speak now on the subject, " Problems of future legislation." PROBLEMS OF FUTURE LEGISLATION. JOHN A. KRATZ, Chief, Division of Industrial Rehabilita- tion, Federal Board for Vocational Education. The problems for future legislation naturally divide themselves into two groups, first, those in connection with the Federal legisla- tion, and second, those dealing with State legislation. The Federal rehabilitation act has been in operation for a year and a half and the experience of the Federal Board in administering it indicates that it is on the whole a good law. It is general enough to make its ad- ministration easy and to avoid the many difficulties which usually beset those who carry out such laws. The definitions given in the act for " disabled persons" and "rehabilitation" could not, in our judgment, be improved upon. Were I charged with the respon- sibility of revising this act at the present time, I should find that in very few instances would I be inclined to make any changes. Such changes as I feel should be made will be taken up by me a little later. In analyzing the problems of future legislation, I might say, first of all, that it will not be very long before we shall be very vitally concerned with reenactment of the Federal law. It is my opinion that a considerably longer time than four years will be re- quired to establish the work of vocational rehabilitation throughout the Nation, but I would only take your time were I to discuss with such a sympathetic audience as this the reasons for a continuance of the Federal legislation. In this connection, of course, I think we are all agreed that allotments to the States should be consider- ably increased. There are certain provisions of our act which need clarification, such as, for instance, the purpose for which Federal funds may be expended. Another indefinite provision refers to the conditions under which Federal funds may be used for the training of disabled persons in institutions for the handicapped. One point that I should like to stress is that of the place of the administration of the act in the States. At this time we might be inclined to say that the way would be easier for us if we were per- VOCATIONAL REHABILITATION. 129 mitted to cooperate with other State departments, such as labor and compensation, which departments in some States are carrying on the work of rehabilitation. This is a matter of considerable ques- tion, however, and will be worked out in due time. With regard to legislation both Federal and State, we are planning to have come to Washington next October a group of representative men and women who are qualified to sit on a committee to discuss this very matter. We have in mind persons who have had consider- able experience with social legislation. We expect to call in State rehabilitation persons and to make the committee as representative as possible, and to have developed at these sessions such drafts of proposed legislation as would be open to the least possible criticism by State and Federal legislators. It is needless for me to say that the finding of this committee will be reported to you. In connection with your own State legislation, may I say that as there seems to be a growing tendency in the country to standardize laws, it would be well for you to know what other States are doing in the fields of rehabilitation and compensation, in order that you might be in a position to suggest to your own legislators any revisions of your laws, which you might believe wise. We are now making a digest of State laws and will be in a position later to submit the results to you. These will be helpful in acquainting you with what other States are doing. In advancing your own State legislation you should consider carefully matters of maintenance and physical rehabilitation. Problems in this connection vary from State to State, and each State man will know his own local conditions best. I have asked the'chairman, Mr. Sullivan, that at this point he turn over the meeting to me. I know that this is an unusual request, but I am sure you will understand it, because I see at this point a splendid opportunity in having you all here, to discuss with you our administration of the Federal act. We want your suggestions to come freely and whole-heartedly, as I know they will. We are administering this law to the best of our knowledge and ability. We constantly realize, however, that we are partners with you in the work. We want to know your problems and difficulties and to help you to solve them. Chairman SULLIVAN. In accordance with the wish of Mr. Kratz, I shall, therefore, turn the meeting over to him. GENERAL DISCUSSION. Chairman KRATZ. Please feel free now to ask any questions which may come to mind. Mr. HOCKEY. Regarding the question of paying tuition for a man in training, even if he does receive something from the employer, 1476522 9 130 VOCATIONAL REHABILITATION. we have the wrong viewpoint he should necessarily work his way through it. If he is giving to the employer, he ought to get some- thing from the employer. I think he is entitled to his earnings. He gets what he earns and not any more. I place a man in training and I have taken a double contract to protect that man. We have in our State no training arrangements of any kind. I might make arrangements with the Aldry Trade School in Smith-Hughes work. The type of training has never yet been suitable to the type of reha- bilitation cases that have come to us. I have some men that I might possibly train in rug weaving. We have quite a trade for the tourists. I have tried to get some one to teach a man this work. There is no agency in the State which has a loom. I can not buy a loom. I go to the men who are skilled in it and they want to use their looms all the time themselves, and there is no time in which the loom is free to get this man on it. Could that be instructional supplies or equipment ? Mr. SCHNEIDER. The distinction is made in Missouri along this line as far as possible. Instructional supplies are considered supplies which are expendible, that is, supplies which will be used up during the process of training. Mr. FAULKES. Rehabilitation means rendering a disabled person fit to engage in remunerative employment. The first thing to render a man fit is to give him opportunity for medical or surgical aid. I feel that in every rehabilitation program the Federal Government should bear its share of that in every State. I think one of the investiga- tions I voted for was physical rehabilitation facilities. I believe that is an important thing. I do not like to ask doctors to do this free. I have done it with success. I think if the Federal Government would give us an opportunity along that line it would be well. About the matter of equipment and supplies, it is the biggest piece of graft. We had it in our State vocational education law. The locality would want everything. I believe that in some of these other things, if they would match us in physical restoration I think we could take care of the equipment. It is hard to distinguish between equipment and tools, which are perishable. They are really a supply item, as far as the course is concerned, and it is a pretty hard thing to deter- mine the difference between supplies and equipment. I believe, for instance, that a watchmaker's tools, in some cases being highly perish- able, should be considered as supplies. Mr. HOCKEY. We reflect the atmosphere of the different localities, or the problems that are there. In Wisconsin there are facilities that are greatly different from ours. This question was originally inter- preted in New Mexico. We have no facilities for training. We simply have to go out and do the job and put it into the hands of the people. VOCATIONAL REHABILITATION. 131 Mr. RIDDLE. In the question of supplies and equipment, common sense ought to rule. You take a man, put him into bookkeeping or drafting. He has to have books, board, etc. Some courses run very high. I think we are perfectly justified in paying $5 for drafting tools, but not for watchmaking tools. Drafting instruments are just as much instructional supplies as equipment. We will pay for instruction in institutions where it is necessary to pay tuition. We will not pay a cent to a man in an industrial establishment. There are some institutions where men will bill you so much for tuition. Ordinarily his board is provided; nothing doing. No such record on the books. We will pay straight tuition. I think you can not get a local interpretation. The more we clutter this work up with definite standards, the more we are going to put ourselves in a fix. For instance, I do not think a set of plumbers' tools are properly supplies. Mr. ROCKEY. The matter of interpretation is a local problem. Mr. STANTON. My understanding of the spirit and purposes of the law is that they are for the purposes of fitting a man for employment. We have just completed the training of several men in mattress making and renovating. In order for them to carry on it is necessary to have a machine, costing $75. Those men can not support them- selves in that employment without the machine. Chairman KRATZ. Mr. White, have you anything to say on this subject? Mr. WHITE. Not a thing. I think Mr. Riddle struck the nail on the head when he said that it all revolved around the proposition of the use of common sense in the States. Chairman KRATZ. Mr. White, does common sense vary in the States ? Mr. WHITE. Common sense is nothing more than horse sense; it is something a jackass hasn't got. I had a young lady who wanted to take a course in music. She made the very modest request that she wanted a baby grand piano. If you start out on the theory that you must supply a man everything, you get into difficult straits. Just exercise judgment. I agree heartily with Mr. Riddle. I would not think of buying a complete set of tools in watchmaking for a jeweler. In mechanical drafting a man needs those tools as indi- vidual supplies. The watchmaker will find tools available on the job. What you are going to do is to instruct the man; that is the only method I see. Mr. SHAW of West Virginia. I believe that we can buy tools for the man to have for the time of training and not carry over beyond that. Mr. FAULKES. I do not agree with the man on jewelry tools. No jeweler will give them tools. The standard set of tools he finds in a shop are 10 years out of date. You can get that training. If you want training on the job for a man, jewelry or clock repairing, you 132 VOCATIONAL EEHABILITATION. have to buy those tools. Why are they not supplies in the same sense of tools as a draftsman's ? I can not see that at all. Mr. DALLAS. Mr. Faulkes, do you mean you would contribute those to the trainee after his training course is complete, or furnish them for the training period alone ? Mr. FAULKES. I would not want to use that man's set of tools, because another fellow could not use those tools. They are second- hand tools. As far as jewelry or clock repairing tools are concerned, half of them are perishable. Fine tools are broken. It is more of a supply item than it would be in drafting tools. A man uses the same pen for 10 years. I do not see how you can pass a drafting set from one man to another. It is done in schools, but it is a mighty poor practice. You must get away from the academic system of training. You can not get any results that way. Mr. DALLAS. Our policy in Massachusetts is to furnish supplies where necessary during the training period. Each trainee signs a receipt. He can keep the tools until such time as he reimburses the State or returns them to the State. They remain the property of the State. After his training period ceases, he must return the tools or make some arrangements for the proper payment. I have not found one person who has objected to that. Mr. SHAW, Ohio. We have no institution in Ohio where we can train men for watchmaking. I have a man 32 years old, going away from home to take training in watchmaking. The training is costing us nothing, travel nothing, and tools will cost in the neighborhood of $55. When the man has finished training, he goes back to his home in the country. He is going to get the work of three jewelers. I would like to release the tools to that man. In some cases we may pay as much as $150 for an artificial appliance and through that rehabilitate the person. In others we may pay considerably more for tuition, and rehabilitate the person through training. The ques- tion in the last analysis is that rehabilitation is our goal and it would seem to me that it makes mighty little difference for what purpose the expenditure goes so long as it is reasonable. Mr. STANTON. My experience in watch repairing has been the same as Mr. Faulkes and Mr. Shaw. In the majority of cases we find very little use for Federal funds. We can not expend funds for operations or medical treatment. In a majority of cases, we do not pay any tuition. It is employment training, and we do not think it is the best thing to pay for tuition in that training. We use matched funds for artificial legs. As Mr. White said in his speech, we can only offer them 10 cents on the dollar toward helping them. Chairman KRATZ. Do you pay tuition for employment training? Mr. STANTON. No. VOCATIONAL REHABILITATION. 133 Mr. STRUCK. There is some danger along the lines regarding equipment and supplies. We should agree as to what should be called supplies and what should be called equipment. We look upon those things as supplies that are used within a certain time. On the other hand, a set of drafting instruments is not supplies, it is equipment. I think it is a good thing for us to get together and form some conclusions. Chairman KRATZ. We haven't heard from Mr. Woods. Mr. WOODS. We believe that anything that is worth while is worth paying for, and if we pay the training agency they will take a personal interest and take a great interest in the individual receiving training. As to instructional supplies and equipment, I would like the interpretation to remain just as it has been. Recently I placed a man in a barber school and we gave him razors and the few brushes that were necessary. The thing that we are watching is the total cost of rehabilitation. We are trying to keep the total cost down. Mr. STRUCK. I do not object to paying for education. That is the proper thing, but that is quite different from paying for employ- ment training, to recompense for that employment and where the main object is money rather than instruction. If you put a man on the job in industry, the main purpose is production. It is not the main practice of our shops to give instruction. Therefore, I hesitate putting money in employment training. Mr. SULLIVAN. I thought that we were going to talk about future legislation. Chairman KRATZ. If the Federal act is wrong, it ought to be re- vised. If the State acts are not broad enough, they should be revised. The Federal board has to set up policies of administration. It is very evident that rehabilitation is a highly individual process, and we are told that in some cases all you have to give a man is thera- peutic training and that is rehabilitation, but unfortunately the Fed- eral act does not contemplate using money for physical rehabilitation. You can use Federal funds for prosthetic appliances in vocational rehabilitation. I recently heard of a case which could have been rehabilitated through the purchase of a fruit- stand. You have every possible variation. The main thing before us is what revisions of our act are needed. Mr. SULLIVAN. It is much more important to consider whether the subsidy is to be continued. It seems to me that the sentiment in the country as it is would be to broaden the expenditures under the Federal act. As to any revised definition of what supplies are, you can not make them uniform around the country. The less tinkering you do the better. Chairman KRATZ. As said before, the division contemplates calling to Washington persons interested in our legislation and qualified to 134 \ r OCATIONAL REHABILITATION. give us expert advice. We will go before Congress with a very definite program. Mr. Sullivan's point is well taken. We believe this is a good act. An act may be ever so good, but it may be poorly administered. Mr. FULMEE. As far as I am concerned, unless our State legislature should restrict or limit us, I want to let it alone. I do not want to open it up. I would like to ask the chairman whether this matter of purchasing of supplies is written into the Federal act at the present time or is that an interpretation of the Federal board. Also the matter of prostheses. Suppose we go before Congress, we may get what we do not want. Let the Federal board continue its inter- pretations. Mr. JOB. Entirely aside from the question under discussion, I do not want this conference to go by without stating that I would like to see some change in the law, designating the State board for voca- tional education in the various States as the agency for administering the vocational rehabilitation law. I feel very keenly that in some States our work would be very much better off if the State board of education were not burdened with the administration of the law. Our State superintendent has said to me, "Why in the world was this work ever put under our department?" The hardest thing I have to do is to keep the board educated. If the law were under the compensation commissioner, we could do our work much more efficiently. It is very hard in Indiana to make those school super- intendents, whose thought is of the interest of school children, think of this thing in the light of an industrial problem. If the Federal law is to be revised, I personally should like to see the matter of fixing the responsibility in the States left open so that the States could, if they wish, designate some institution or organization other than the State board of education as the agency responsible- for the administration of the law. Mr. SPITZ. Might I say that we in New Jersey fully agree with the sentiment of the gentleman from Indiana. We have had this ques- tion of rehabilitation up to our board and they say it does not belong to them. We can not at any time lay down hard and fast rules. For instance, we have a man under our care who did not know the compensation law, who could not speak English. He had been in the country for 10 years. He had a fall in a shop, and allowed the statute of limitations to run and could not claim compensation. Another man, a derelict, discovered in a hospital, had his hand amputated. That man is just homesick to get back to Europe, and with a stretch of imagination I think our division will be able to fur- nish him with transportation to send him back to his home abroad. In our judgment that is just the right kind of rehabilitation to give that individual. You can not lay down a hard and fast n rule. We VOCATIONAL REHABILITATION. 135 find ways and means either within the law or without the law. Con- sideration should be given by the Federal board to that chapter in our law which says that the provisions be liberally construed. That is the crux of the whole situation. The service is each State is just as strong as the executives make it. Mr. RIDDLE. I agree with Mr. Job, I would like to see in the Federal act provision that the choice of administration would be left to the State. When the Federal act became effective there were already 10 States that had passed law for the work, and in almost every one of them provision had been made to start it in another department of the State than the Board for Vocational Education. I understand that the sentiment before Congress was that it would be possible to get Federal funds appropriated more readily for an extension of education rather than for an expansion of workmen's compensation payments for industrial training. Mr. MEYER. How far will the Federal board assist us in getting a ruling from the Civil Service Commission in employing disabled men ? Chairman KRATZ. The Federal board has had this matter under consideration and has taken it up with the commission. We will press it further. The time has now come when we must close our conference. It has been your conference, but we as Federal board people have enjoyed it immensely. We have heard lots of comments upon it of a complimentary nature. May I take this occasion to express our appreciation of the services of every person who has con- tributed to make this conference what it has been. The Federal board is always at your service for the purpose of promoting your State rehabilitation work. Whether the Federal board will con- tinue to administer a Federal act in the promotion of vocational rehabilitation will depend not so much on what your State law is, what your State legislators will do, but upon the kind of a job that you do. It is not what you say to your politicians, or your legislators, but what you do. Some one has said in an analysis of character, "What you do speaks so loudly I can not hear what you say." If you rehabilitate or serve a great many persons no legislature under heaven can refuse to make adequate appropriations for your work. Our meeting stands adjourned. Mr. DALLAS. I would like to offer a vote of thanks to the Federal board, to the local supervisor, and to the people of Missouri for their courtesy to us during our visit in St. Louis. (Adjournment.) AVAILABLE BULLETINS OF THE FEDERAL BOARD FOR VOCATIONAL EDUCATION. Annual report. Bulletin No. 1. Statement of Policies. Revised edition, April, 1922. Bulletin No. 13. (Agricultural Series, No. 1.) Agri- cultural Education Organization and Admin- istration. Bulletin No. 16. Emergency War Training for Radio Mechanics and Radio Operators. Bulletin No. 17. (Trade and Industrial Series, No. 1.) Trade and Industrial Education Organiza- tion and Administration. Bulletin No. 18. (Trade and Industrial Series, No. 2.) Evening Industrial Schools. Bulletin No. 19. (Trade and Industrial Series, No. 3.) Part-time Trade and Industrial Education. Bulletin No. 20. (Trade and Industrial Series, No. 4.) Buildings and Equipment for Schools and Classes in Trade and Industrial Subjects. Bulletin No. 21. (Agricultural Series, No. 3.) The Home Project as a Phase of Vocational Agricul- tural Education. Bulletin No. 22. (Commercial Education Series, No. 1.) Retail Selling. Bulletin No. 23. (Home Economics Series, No. 1.) Clothing for the Family. On sale by Super- intendent of Documents, Government Printing Office. 15c per copy. Bulletin No. 26. (Agricultural Series, No. 4.) Agri- cultural Education Some Problems in State Supervision. Bulletin No. 27. (Agricultural Series, No. 5.) The Training of Teachers of Vocational Agriculture. Bulletin No. 28. (Home Economics Series, No. 2.) Home Economics Education Organization and Administration. Bulletin No. 30. (Trade and Industrial Series, No. 5.) Evening and Part-time Schools in the Tex- tile Industry of the Southern States. Bulletin No. 31. (Trade and Industrial Series, No. 6.) Training Courses in Safety and Hygiene in the Building Trades. Bulletin No. 34. (Commercial Education Series, No. 3.) Commercial Education Organization and Administration. Bulletin No. 35. (Home Economics Series, No. 3.) Use and Preparation of Food. On sale by Superintendent of Documents, Government Printing Office, 20c per copy. Bulletin No. 36. (Trade and Industrial Series, No. 7.) Foreman Training Courses. Part I. Bulletin No. 36. (Trade and Industrial Series, No. 7.) Foreman Training Courses. Part II. Bulletin No. 37. (Home Economic Series, No. 4.) Survey of the Needs in the Field of Vocational Home Economics Education. 1476522- -10 Bulletin No. 38. (Trade and Industrial Series, No. 8.) General Mining. On sale by Superintend- ent of Documents, Government Printing Office. 15c per copy. Bulletin No. 39. (Trade and Industrial Series, No. 9.) Coal-Mine Gases. On sale by Superintend- ent of Documents, Government Printing Office. 5c per copy. Bulletin No. 40. (Trade and Industrial Series, No. 10.) Coal-Mine Timbering. On sale by Super- intendent of Documents, Government Print- ing Office. 15c per copy. Bulletin No. 41. (Trade and Industrial Series, No. 11.) Coal-Mine Ventilation. On sale by Super- intendent of Documents, Government Printing Office. lOc per copy. Bulletin No. 42. (Trade and Industrial Series, No. 12.) Safety Lamps, including Flame Safety Lamps and Approved Electric Lamps. On sale by Superintendent of Documents, Govern- ment Printing Office. lOc per copy. Bulletin No. 43. (Employment Management Series, No. 8.) The Labor Audit. A Method of In- dustrial Investigation. Bulletin No. 44. (Employment Management Series, No. 5.) The Wage-Setting Process. Bulletin No. 45. (Employment Management Series, No. 3.) Job Specifications. Bulletin No. 46. (Employment Management Series, No. 6.) The Turnover of Labor. Bulletin No. 47. (Employment Management Series, No. 7.) Industrial Accidents and Their Pre- vention. Bulletin No. 48. (Employment Management Series, No. 4.) Employment Management and Indus- trial Training. Bulletin No. 49. (Employment Management Series, No. 2.) The Selection and Placement of Em- ployees. Bulletin No. 50. (Employment Management Series, No. 1.) Employment Management: Its Rise and Scope. Bulletin No. 51. (Employment Management Series, No. 9.) Bibliography of Employment Manage- ment. Bulletin No. 52. (Trade and Industrial Series, No. 13.) Theory and Practice. Machinist's Trade. On sale by Sperintendent of Docu- ments, Government Printing Office. lOc per copy. Bulletin No. 53. (Agricultural Series, No. 6.) Les- sons in Plant Production for Southern Schools . Bulletin No. 54. (Commercial Education Series No. 4.) Survey of Junior Commercial Occupa- tions. 137 UNIVERSITY OF CALIFORNIA LIBRARY BERKELEY Return to desk from which borrowed. This book is DUE on the last date stamped below. RETURN TO DOCS 61954 APR 2 7 72 [ JUH 1 4 DEPT LD 21-100m-7,'52(A2528sl6)476