THE WORK OF OUR HANDS 
 
The Work of Our 
 Hands 
 
 A Study of Occupations for Invalids 
 
 BY 
 
 HERBERT J. HALL, M.D. 
 
 AND 
 
 MERTICE M. C. BUCK 
 
 
 NEW YORK 
 
 MOFFAT, YARD & COMPANY 
 1915 
 
COPYRIGHT, 1915 
 
 BY MOFFAT, YARD & COMPANY 
 
INTRODUCTION 
 
 THE following words appeared in a recent 
 Boston Herald editorial: "One of the many 
 stultifying effects of war has already found a 
 pathetic example in the Industrial Home for 
 Crippled Soldiers which has been established in 
 Lyons, France. Recognizing the terrible bur- 
 den of incapacitated men a burden not only 
 on the finances but on the general esprit of the 
 country France has taken the institution at 
 Charleroi, Belgium, as a model for its new 
 school, which will open as soon as possible. 
 Here, as at Charleroi, there will be seven de- 
 partments: Shoe-making, bookbinding, har- 
 ness making, tailoring, basketry, matting 
 weaving, and bookkeeping. And here thou- 
 sands of men, most of them young, many of 
 them destined for careers of wide helpfulness, 
 will come, grateful to pick up sufficient knowl- 
 edge to make them partially or entirely self- 
 supporting for the rest of their shattered lives." 
 It is evident that dire necessity must rapidly 
 
 vii 
 
 359152 
 
viii INTRODUCTION 
 
 develop in Europe an industrial idea which 
 social thinkers and workers all over the world 
 have been dreaming about and applying in a 
 small way for many years. The need of ade- 
 quate work for the handicapped in this country 
 is not less real than in Europe, if it is less 
 strikingly evident. 
 
 A war that goes on year after year between 
 the machine and the man, between disease and 
 the man, keeps our ambulances busy and taxes 
 our charities in no uncertain way. The hospi- 
 tals do their best, our charitable organizations 
 are very efficient, but there are thousands of 
 men and women in every great city doomed to 
 idleness and dependence because of injury or 
 some illness that makes ordinary work out of 
 the question. 
 
 The man out of work because of hard times 
 is badly enough off. What of the man who 
 because of some crippling or disfigurement can 
 never hope to work again? Put yourself in 
 that man's place imagine the despair and the 
 final degeneration that must sap at last all that 
 is brave and good in life. 
 
 Then there is the economic side. We know 
 that wealth depends upon productive industry. 
 
INTRODUCTION ix 
 
 The really well to do community or the really 
 prosperous man must be constantly at work, 
 adding to the world's store of valuable things. 
 The moment industries stop there is waste and 
 desolation. 
 
 Although the plight of the handicapped 
 workers in this country is very desperate, much 
 has already been done toward improvement of 
 their condition. Strangely enough the most 
 hopeful progress has been made among the in- 
 sane in the various state hospitals. It has been 
 recognized for many years that mentally dis- 
 turbed and depressed people are better off and 
 get well more quickly if their faculties can be 
 used in some simple and effective way. The 
 first steps that were taken gave the patients 
 simple work to do in the wards and in the 
 service of the institutions. This housekeeping 
 work served a very good purpose, although it 
 was no doubt occasionally abused by the over- 
 driving of certain patients who were willing 
 and able. On the other hand, it left out a 
 great many patients who could not adapt them- 
 selves to such occupations. 
 
 Within the last decade the superintendents 
 of these hospitals have generally realized that 
 
x INTRODUCTION 
 
 by developing the manufacture of goods 
 needed by the institution a great range of pa- 
 tients could be interested and their work uti- 
 lized. The visitor to one of the more pro- 
 gressive state asylums to-day will be deeply 
 impressed with the many activities which are 
 going on. The patients participate in all the 
 household work, especially in the laundry and 
 in the kitchen. They are also employed in the 
 manufacture of clothing, shoes and furniture. 
 They are making and remaking mattresses, 
 and, best of all, they are employed very largely 
 upon the farms in the raising of crops for the 
 use of the institutions. Officials everywhere 
 acknowledge that there is no one remedy so 
 potent as work in these unfortunate cases. 
 Interest is aroused, old faculties are restored, 
 and recovery is hastened. Incidentally a very 
 great saving is made to the state; many thou- 
 sands of dollars yearly in each institution. 
 
 Very lately it has been realized that a certain 
 number of patients who cannot be interested in 
 these more common pursuits will find interest 
 and development in some of the handicrafts, 
 such as weaving, knitting, and basket making. 
 The casual visitor will again be surprised to see 
 
INTRODUCTION xi 
 
 how far these crafts have been followed and 
 what excellent work is turned out. 
 
 The idea of occupation for the handicapped 
 has progressed far enough in this country so 
 that it is now rare to find any institution for 
 chronic patients where there is general idleness. 
 The worst offenders in failure to supply work 
 for the patients are the private institutions 
 where people of means are treated. Here it 
 will not infrequently be observed that patients 
 who would be far better off to be occupied are 
 allowed to sit in idleness day after day, week 
 after week. The day will come when such 
 treatment of any patient able to do even a very 
 small and unimportant work will be consid- 
 ered a disgrace. 
 
 The idea of work for the handicapped both 
 as a remedy and as a means of partial self-sup- 
 port has been developed lately in the interest 
 of the many sufferers from chronic heart dis- 
 ease. Diseases of the heart unfortunately at- 
 tack most frequently those people who are 
 engaged in the most arduous pursuits, who are 
 exposed to bad weather, and who must do 
 heavy lifting and work for long hours. It has 
 been found that after hospital treatment these 
 
xii INTRODUCTION 
 
 patients go back to their old occupations. 
 There is nothing else to do, and they almost 
 invariably relapse and have to be treated all 
 over again. Until very lately there has been 
 no outlook for such cases except a gradual 
 going to pieces under the existing conditions. 
 A little over a year ago there was established 
 at Sharon, Connecticut, a home for convales- 
 cent heart cases* where the patients were 
 taught a new trade, the making of concrete 
 flower pots. Artistic molds were provided, 
 and the technic was worked out in such a way 
 that good results were assured from the tech- 
 nical point of view. It was found that this 
 trade could be carried on without overstrain- 
 ing the injured hearts of these patients, and 
 that most of the men grew stronger under the 
 work, because, as is well known, a moderate ex- 
 ercise strengthens the heart that is diseased 
 just as surely as overwork injures it. These 
 men have been kept in the home in Sharon for 
 several weeks or even months, then sent back 
 to their homes in the city, not to take up their 
 old and too strenuous occupations, but to carry 
 
 *The workshop has recently been transferred to the Burke 
 Foundation Convalescent Home at White Plains, N. Y. 
 
INTRODUCTION xiii 
 
 on in a specially supervised city work shop the 
 quiet trade which they had acquired at Sharon. 
 The astonishing part of this semi-charitable 
 enterprise is that it has been able to pay a con- 
 siderable number of handicapped workers fair 
 wages from the sales of the flower pots. 
 
 As is well known, there are many workshops 
 for the crippled and the blind in many parts 
 of the country, all successful in relieving the 
 harm and illness that are attendant upon idle- 
 ness, if they are not justified from the commer- 
 cial and artistic point of view. 
 
 These small beginnings are pointing the way 
 to very large possibilities of effective industries 
 for the handicapped. It seems likely that a 
 careful and expert study of many industries 
 will reveal the possibilities of modification that 
 will make the labor of the handicapped a thing 
 of great power and value in the industrial and 
 social life of the country. 
 
 The handicap that keeps a man from the 
 regular industries may be very slight indeed, 
 yet the regular industries cannot change their 
 rules and system for the sake of giving him 
 employment. Neither can we go on forever 
 wasting the potentialities of the slightly handi- 
 
xiv INTRODUCTION 
 
 capped. The way out seems to lie in the es- 
 tablishing of special industries where the 
 handicapped may be favored and yet given a 
 chance to use what strength and intelligence 
 they have. 
 
 The whole idea is so simple it is a wonder 
 that it was not fully developed long ago. Side 
 by side with machine work of many kinds are 
 the possibilities of more careful hand work re- 
 quiring time and intelligence and warranting 
 both. Take, for instance, two trades, weaving 
 and cement working. It is evident that hand 
 weavers cannot expect to compete with the 
 power looms. Yet with care and skill avail- 
 able in a hand weaving shop it is possible with 
 special oversight of the workers to turn out 
 products which the power looms could never 
 accomplish and which are eagerly sought be- 
 cause of the charm and interest which belongs 
 to a specially woven fabric. In the making of 
 cement flower pots there could never be the 
 hope of turning out a cheap commercial prod- 
 uct by hand, but the handicapped workers at 
 Sharon are making such a variety of new and 
 interesting shapes, so well decorated and col- 
 
INTRODUCTION xv 
 
 ored, that the demand for the wares is constant 
 and dependable. 
 
 There are two principal elements which 
 enter into the situation and make it hopeful. 
 First of all the fact that many of the men and 
 women who must avail themselves of these 
 special industries are of unusual education and 
 capacity. Secondly, it will be more and more 
 feasible to call to the consideration of the prob- 
 lem the highest type of able-bodied industrial 
 and artistic direction. There is no reason why 
 these handicapped industries should not com- 
 mand the best engineering talent and the best 
 possible cooperation of designers and crafts- 
 men. Undirected and unsystematized, special 
 industries of this sort would undoubtedly fail 
 pathetically. But a small part of the skill and 
 intelligence which is given to the regular in- 
 dustries will find abundant opportunities for 
 the handicapped workers. In the end the sys- 
 tem may turn out to be not charitable at all but 
 a definite business proposition. 
 
 The problem is relatively simple in the va- 
 rious charitable and semi-charitable institu- 
 tions. Here it is being found that a large part 
 
xvi INTRODUCTION 
 
 of the necessary hospital supplies can be manu- 
 factured on the premises. As for instance, in 
 one Massachusetts asylum for the insane, where 
 cement bricks and tiles are made in great quan- 
 tities, then used in actual building operations 
 for the state. And in many other institutions 
 where a large part of the food supply is raised 
 on the farm by the labor of the patients who 
 are able to do such work. 
 
 The great difficulty is encountered when the 
 chronic patient is obliged to leave the institu- 
 tion and go back to his home. There organiza- 
 tion ceases and he finds his handicap painfully 
 evident. The case of the cured or partly cured 
 tubercular patient and of the cured insane is 
 pertinent enough. These people, like ex-con- 
 victs, are looked upon with suspicion. They 
 are either not wanted because their strength is 
 inadequate or because the employer is afraid 
 that some accident will happen. 
 
 In increasing numbers the discharged pa- 
 tients of the great institutions have learned 
 occupations or trades during the time of treat- 
 ment. There has already been some talk, par- 
 ticularly in Massachusetts, of the establishment 
 of outside workshops where under special ob- 
 
INTRODUCTION xvii 
 
 servation chronic patients discharged from the 
 hospitals may find opportunity for remunera- 
 tive work. At first thought it seems impos- 
 sible that any industry conducted for the bene- 
 fit of the handicapped could have successful 
 operation without large charitable support, but 
 a little ingenuity and persistence will in time 
 overcome this prejudice. 
 
 Take for instance the trade of laundry work- 
 ing. As has been stated, a very large number 
 of the patients, particularly in the hospitals for 
 the insane, are employed in the laundry. 
 There, although their mental capacity may be 
 comparatively small, they are patiently trained 
 to perform certain necessary parts of the labor. 
 Most of these patients could not go into a reg- 
 ular steam laundry and succeed. It should be 
 quite possible to establish special laundries 
 where such operatives could be successfully em- 
 ployed. The workers would need to be di- 
 rected by officers who had had experience in the 
 asylum laundries, but with such direction there 
 would be little doubt of success. It is possible 
 that such laundries might have to be subsidized 
 and that their field should be limited so that 
 they would not overlap or compete with the ex- 
 
xviil INTRODUCTION 
 
 isting industries. Those who know the situa- 
 tion realize that there is a wide need of careful 
 hand laundry work. The machines tear and 
 destroy fine fabrics too fast. These handi- 
 capped workers might well be trained to do this 
 special slow work which householders now find 
 great difficulty in getting accomplished. A 
 special price could reasonably be asked for such 
 work and this would offset in some degree the 
 slowness and intermittent efforts of the work- 
 ers. 
 
 If the discharged and handicapped patients 
 from hospitals all over the country could be 
 given legitimate work which would secure them 
 even half of the usual wage, a very great load 
 would be lifted from charity, and a still greater 
 load from the minds and hearts of the workers. 
 There are many hard working families in which 
 the burden of one idle member is a very serious 
 matter. If that patient could be given work 
 which would earn even a very small amount of 
 money the difficult atmosphere of the home 
 would be quite changed. 
 
 There is immediate and pressing need of a 
 new system which will modify old industries 
 and create new ones that will give the handi- 
 
INTRODUCTION xix 
 
 capped a fair chance. The thing must be done 
 systematically and intelligently. If it is done 
 in this way there is no limit to the industrial 
 possibilities. We have been studying the prob- 
 lems of efficiency for the able bodied and with 
 astonishing results. Careful study of the 
 handicapped and their industrial possibilities 
 will be well repaid. The thousands who are 
 now idle, not from choice but because they no 
 longer fit the regular industries, represent a 
 source of power and of wealth that has been 
 curiously overlooked. These men and women 
 are the waste human product of the industrial 
 world, a product so valuable that its use would 
 mean a revolution in industrial and in charitable 
 affairs. 
 
 The skeptical will say there is no doubt about 
 the need of special occupations for handicapped 
 people, but basket making and chair caning 
 and such crafts will not go very far toward 
 the actual support of thousands of needy peo- 
 ple. Such doubters have only to visit the un- 
 promising field of the state asylums to be quite 
 convinced of the enormous economic and moral 
 possibilities of specialized work for the handi- 
 capped. In the workshops of these hospitals 
 
xx INTRODUCTION 
 
 may be seen any day in the year hundreds of 
 people contributing in no small way to their 
 self support by means of carefully directed 
 labor. The principle is proven under these cir- 
 cumstances many times over and its applica- 
 tion to the needs of a much larger and more 
 promising class outside the hospital is only a 
 matter of detail. 
 
 It must not be forgotten that unemployment 
 is as harmful for the well to do as it is for the 
 poor. The writer of these chapters undertook 
 ten years ago to meet in a small way the needs 
 of a class of people who were not in actual want 
 but who from illness or the overstrain of mod- 
 ern life had been obliged to give up their usual 
 occupations. It removes some of the doubt as 
 to the practicability of special industries for the 
 handicapped to know that a young physician 
 in a small town could, without capital, develop 
 in ten years three self-supporting industries, 
 for the benefit of men and women who need to 
 bring back courage and efficiency through the 
 slow accomplishment of manual work. The 
 industries which have been used are pottery, 
 hand weaving, and cement working. That 
 none of them have gone bankrupt although 
 
INTRODUCTION xxi 
 
 managed a good deal of the time without espe- 
 cial business ability speaks volumes for the vi- 
 tality of the idea. 
 
 These experimental workshops began very 
 simply with hand weaving under a compe- 
 tent teacher. This laid the foundation for a 
 considerable industry. The pottery served its 
 purpose as a school for a time, then became 
 professional and is now in that class. The 
 cement working, which is the latest addition, 
 promises well as an industry and is exceedingly 
 useful from the medical point of view. The 
 workshops are at present run in connection 
 with a sanatorium where people of means are 
 given the usual medical treatment for con- 
 valescence and for nervous exhaustion. The 
 shops themselves are conducted by profes- 
 sional teachers and by assistants who come 
 as apprentices to learn the trades that they 
 may in turn become teachers. These appren- 
 tices have often enough been themselves pa- 
 tients who were obliged to make a living and 
 who found opportunity in this way. School 
 teachers who have broken down in their work 
 have found quieter and more practical occu- 
 pation in this new field. During the past five 
 
xxii INTRODUCTION 
 
 years these medical workshops have equipped 
 nine people who are now earning a living in 
 other institutions. Six of these were them- 
 selves patients, the subjects of nervous exhaus- 
 tion in one form or another. One, a teacher 
 of music who for several years had been quite 
 helpless and hopeless, is now earning a salary 
 of $1200 as the head of a social settlement 
 system. One is independent as a teacher of 
 weaving to the blind, two are in charge of hos- 
 pital workshops, and two are earning their 
 living as potters. 
 
 The sales of products from all these work- 
 shops amounted in the past year to about 
 $5000. True, there was no profit, but the 
 shops have given an opportunity for experi- 
 mental work and they have served their pur- 
 pose as a school where people of means who are 
 broken down nervously or physically may grad- 
 ually regain strength and efficiency under 
 medical observation. Part of the product of 
 this institution is the result of skilled labor em- 
 ployed for the purpose, and part of the work is 
 done by people who had broken down and who 
 have gradually regained strength. * It is only 
 fair to say that some of the workers who were 
 
INTRODUCTION xxiii 
 
 not so originally have become highly skilled 
 and should rank as professional. But that 
 does not detract from the significance of the 
 enterprise. It seems reasonable to suppose 
 that similar and other industries might be 
 established elsewhere with increasing benefit to 
 the people. 
 
 Aside from important economic considera- 
 tions medical men will find that carefully con- 
 ducted industries will add a very strong new 
 remedial measure to their practice. If a 
 young woman comes into the doctor's office 
 complaining of sleeplessness, fear of insanity, 
 indigestion and nervous weakness, the long 
 train of trying symptoms familiar to every 
 practitioner, that patient should be sent to 
 some medical workshop as soon as she has had 
 sufficient rest to make it possible. There un- 
 der the influence of quiet work she will forget 
 and leave behind her such symptoms as are of 
 purely nervous origin and the physician will 
 then be able to tell with certainty how much 
 of the trouble is physical and in need of the 
 usual medical treatment, and how much is to 
 be disposed of by the acquirement of courage 
 and self control. There is no better way of 
 
xxiv INTRODUCTION 
 
 separating the real from the imagined, and no 
 better way of leaving fear and unhappiness 
 behind. Carefully regulated work is a remedy 
 of the first order. It must be used with dis- 
 cretion and care, or like any other remedy it 
 may do more harm than good. 
 
 Such briefly is the idea of the work cure. 
 The following chapters will consider in a more 
 detailed way how the principle has been or may 
 be applied in charitable or private practice. 
 
 The first section of the book, written by Dr. 
 Hall, is based upon his experience of ten years 
 in building up a series of medical industries 
 in a private sanatorium at Marblehead, Mass., 
 an institution dealing largely with people of 
 means who have been given manual work as a 
 part of the treatment of nervous disability. 
 The second section, written by Miss Buck, is 
 founded upon her experience of many years in 
 the actual teaching of handicapped patients, 
 mostly mental and organic nervous cases in 
 charitable or semi-charitable institutions in 
 New York City. 
 
 The writers are indebted to the Board of 
 Directors and the Superintendent of the Lin- 
 coln Hospital and Home in New York; and 
 
INTRODUCTION xxv 
 
 to the supervision and hearty interest of the 
 Medical and Nursing Staff and the Social 
 Service Director of the Neurological Institute 
 of New York City; also to the Trustees and 
 Superintendent of the Massachusetts General 
 Hospital in Boston; the Industrial School for 
 Cardiac Convalescents at Sharon, Connecti- 
 cut; and to a large number of physicians, 
 craftsmen, teachers and patients without whose 
 assistance and encouragement the following 
 chapters could not have been written. 
 
 Free use has been made of the material in 
 numerous articles published by Dr. Hall from 
 time to time in the Boston Medical and Sur- 
 gical Journal, and the Journal of the Ameri- 
 can Medical 'Association. 
 
 Dr. Hall takes this opportunity to acknowl- 
 edge with especial gratitude the assistance of 
 the craftsmen and designers who have from 
 time to time devoted themselves to the problems 
 of his experimental work. These workers 
 have had experience not only in the developing 
 and the application of crafts and trades for 
 handicapped labor but they have given very 
 generously of their time and strength to 
 the actual teaching of patients. The Misses 
 
xxvi INTRODUCTION 
 
 Jennie and Ruth Turner, both hand weavers 
 of the highest order, have made possible a very 
 considerable progress along this important 
 line. Miss Margaret Weddle has developed 
 a practical department of dyeing. Miss Wed- 
 dle's dyed yarns are now used effectively in 
 the hand- weaving of several institutions. Miss 
 Edith Griffin has now devoted several years 
 to the difficult subject of cement working for 
 invalid workshops Mr. Percy Griffin has done 
 original work in the iron foundries work lead- 
 ing toward the manufacture of molds suitable 
 for cement castings. Miss Jessie Luther, now 
 an active teacher of crafts in the service of Dr. 
 Grenfell in Labrador, deserves much credit for 
 pioneer work in weaving. She was the first 
 craftsman employed in the medical workshops 
 in Marblehead. Mrs. Edwd. Tutt, Messrs. 
 Arthur Baggs, Arthur Hennessy and John 
 Swallow have made possible the self-support- 
 ing pottery. Miss Frances Wood and Miss 
 Florence Riley have been able assistants in 
 cement working and weaving. Miss Annie 
 Aldrich and Miss Maude Milner have given 
 valuable service as designers. 
 
 These craftsmen and their assistants, many 
 
INTRODUCTION xxvii 
 
 of whom have been themselves invalids, have 
 shown that self supporting workshops may be 
 run in connection with a private sanatorium 
 they have helped to make clear the possibilities 
 of a comprehensive system of industries for the 
 charitable institutions. 
 
 The writers are also indebted to Dr. Walter 
 Fernald and to Dr. Elwood Worcester. Both 
 these gentlemen have reviewed the manuscript 
 and have given valued suggestions and en- 
 couragement. 
 
CONTENTS 
 
 CHAPTER PAGE 
 
 INTRODUCTION vii 
 
 PART I 
 
 I WORKSHOPS IN GENERAL HOSPITALS 1 
 
 II MANUAL WORK FOR PATIENTS IN STATE AND COUNTY 
 
 HOSPITALS 12 
 
 III SANATORIUM TREATMENT FOR PEOPLE OF SMALL 
 
 MEANS 33 
 
 IV TEACHER AND PUPIL 46 
 
 V THE TRAINED NURSE AND THE WORK CURE ... 51 
 
 VI THE WELL-TO-DO PATIENT AT WORK 57 
 
 VII THE INDUSTRIAL PROBLEM OF THE TUBERCULAR . . 61 
 VIII HANDICAPPED LABOR AND THE LAW 66 
 
 PART II 
 
 I TEACHING OF THE HANDICAPPED 71 
 
 II METHODS OF TEACHING 85 
 
 III READJUSTMENT 89 
 
 IV ORGANIC NERVOUS DISEASES 95 
 
 V HYSTERIA 120 
 
 VI EPILEPSY 128 
 
 CHOREA 133 
 
 VII MENTAL DISEASES 142 
 
 VIII BORDER-LINE CASES 156 
 
 IX WORK WITH THE AGED 160 
 
 X NEURASTHENIA 166 
 
 PSYCHASTHENIA 175 
 
 XI WORK WITH CRIPPLES 180 
 
 APPENDIX 187 
 
LIST OF ILLUSTRATIONS 
 
 Weaving Room, Devereux Mansion ..... Frontispiece 
 
 PAGE 
 
 Workshop of the Burke Foundation Convalescent Home . 4 
 
 Knitting Machines, Massachusetts School for Feeble- 
 minded ............... 18 
 
 Cement Flower-pots ............ 42 
 
 Basketry and Weaving ........... 96 
 
 Making Iron-framed Canvas Laundry Bags ..... 146 
 
 In the Wards of Lincoln Hospital ........ 162 
 
 Occupation Room at Hospital for Ruptured and Crippled 182 
 
THE WORK OF OUR HANDS 
 
THE WORK OF OUR HANDS 
 
 PART I 
 I 
 
 WORKSHOPS IN GENERAL HOSPITALS 
 
 THE Massachusetts General Hospital has with- 
 in the past year established a medical workshop 
 in a basement of the new out-patient building. 
 This shop is a hospital department, authorized 
 by the trustees and supervised by the executive 
 staff. The cost of running is very little as 
 there is but one salaried worker. The heat, 
 light and rent cost the hospital nothing as the 
 rooms are kept open anyway. The shop is 
 still very small, accommodating never more 
 than six patients. It has, however, practically 
 paid for itself in the first year through the sale 
 of its products. 
 
 No one doubts the need of part-time work 
 for handicapped people. The difficulty has 
 been to find such employment. This hospital 
 
C;'Y.7 : THE WORK OF OUR HANDS 
 
 shop is equipped with molds for the manufac- 
 tures of cement flower pots, seats, sundials, and 
 such garden accessories. The idea was care- 
 fully tested and worked out for two years by 
 craftsmen in the writer's experimental shops at 
 Marblehead, and later in a more elaborate way 
 in the studio of Mr. Clarence Denny of Hyde 
 Park, Massachusetts, who has generously sup- 
 plied the hospital with special appliances. The 
 molds and appliances have been so constructed 
 as to insure success from the mechanical and 
 artistic points of view. Nothing is left to the 
 choice and initiative of the workers, who are 
 elected from among the chronic out-patients of 
 the hospital people who would otherwise be 
 idle at home or working at some hard, unsuit- 
 able employment. This is, so far as is known, 
 the first attempt of a general hospital to pro- 
 vide work that can be regulated to the capacity 
 of its crippled out-patients, with the idea of 
 protecting these people from the evil effects of 
 idleness or overwork, and for the purpose of 
 keeping them in good physical and economic 
 condition so that they will be less likely to need 
 further ward treatment. The Shop at the 
 Massachusetts General Hospital has employed 
 
WORKSHOP IN GENERAL HOSPITALS 3 
 
 the subjects of various disabilities, including 
 paralytics, accident cases with loss or disabling 
 of members, cases of rheumatic arthritis and 
 post operative disability of many kinds. 
 
 The fact is that this important element of 
 adequate work for partly disabled patients has 
 never been fully met by any outside charitable 
 agency. If the hospital is to undertake to im- 
 prove conditions in the life of the patient after 
 his discharge, it may well begin by providing 
 work. Work with a money return must be the 
 substantial basis of all such improvement. 
 Without that basis, our charity may often 
 enough be wasted. 
 
 The social service workers have in the past 
 few years accomplished a great deal in the 
 right direction. The Social Service Com- 
 mittee of King's Chapel in Boston had in Miss 
 Grace Harper a woman who knows the trades 
 and who was remarkably successful in finding 
 work for handicapped people. But the doors 
 of the regular industries are, often enough, 
 closed to the handicapped. Business is geared 
 too high to give more than an infrequent, sub- 
 ordinate place to men who are not able-bodied. 
 
 It is easy to believe that the whole idea of 
 
4 THE WORK OF OUR HANDS 
 
 specialized work is impractical. If the es- 
 tablished factories and workshops of the world 
 must employ only the most efficient, how can 
 charitable institutions without experience and 
 with crippled workers hope to accomplish ade- 
 quate results? This first hospital workshop in 
 Boston has begun to show the possibilities of an 
 industrial system of tremendous economic and 
 social importance. Not many years ago the 
 great manufacturing plants were throwing 
 away by-products that are now worth their 
 annual millions. The industrial world is 
 throwing away untold values in damaged hu- 
 man material, the reasonable salvage of which 
 might save a great deal of money and an 
 amount of human suffering too great to be 
 reckoned. 
 
 About the same time as the founding of the 
 Massachusetts general workshop, a move- 
 ment began in New York City to provide some 
 kind of light work for the cases of heart 
 disease that are discharged relieved from the 
 various hospitals. These cases of organic 
 heart disease are, of course, much benefited by 
 their short sojourns in the hospitals during 
 acute stages of the disease, but they almost in- 
 
WORKSHOP IN GENERAL HOSPITALS 5 
 
 variably drift back into the wards and they 
 are naturally worse each time. Having no 
 other trades they attempt their old too arduous 
 and exposed occupations. The result is al- 
 ways the same; they break down again and 
 again. Such a cycle is poor economy and 
 poor humanity. Realizing this, the Burke 
 Foundation financed the beginning of an in- 
 dustrial school for convalescents at Sharon, 
 Connecticut. The idea of this school is to 
 keep cardiac cases under favorable conditions 
 for about three months and at the same time 
 to teach them a trade, in this case the making 
 of cement flowerpots and other articles of 
 commerce such as those made at Marblehead 
 and in Boston. The first year's work has 
 been so encouraging that two workshops have 
 been established in New York City so that the 
 men who have learned the trade in Sharon 
 may come back to their homes in the city and 
 go daily to the city shops for employment. 
 The medical reports on these heart cases are 
 most encouraging. The work can be gauged 
 exactly with experience so that the patient 
 gives all the strength he is able without reach- 
 ing the point of fatigue. The simple arm 
 
6 THE WORK OF OUR HANDS 
 
 motions of the technique are as good as espe- 
 cially designed exercises for improving the 
 strength of the circulation, and yet as a result 
 of these movements there is a product of im- 
 mediate market value. The actual financial 
 possibilities of these hospital shops cannot be 
 predicted. They will have to be run intelli- 
 gently and on business principles. At the 
 present time the shops show a growing market 
 with encouraging return. They employ nine 
 men and pay nine dollars a week. A letter 
 from the director says, "Their hours are from 
 nine to twelve. Most of the men are exam- 
 ined once a week by a heart specialist. Some 
 of them have improved so much that an exam- 
 ination once in two or three weeks seems to 
 be enough. All of the men have improved 
 one hundred per cent, since their return from 
 Sharon." At the Massachusetts General the 
 men and women have been paid between four 
 and six dollars a week. At the end of the first 
 year it was found that the shop had paid for 
 all its equipment and supplies, the salaries and 
 other expense, and had a deficit of but $800.* 
 The cement garden and flower pots of these 
 
 * This deficit has since been wiped out by the profits of special 
 sales. 
 
WORKSHOP IN GENERAL HOSPITALS 7 
 
 institutions are only a crude beginning. If 
 the work succeeds so well now, the future is 
 very bright, for not only can this kind of ware 
 be improved and extended, but new manufac- 
 tures of various kinds can be added. With 
 good planning and time the shops should 
 justify themselves from every point of view. 
 
 The first requirement of development is 
 this: That the new handicapped industries 
 must not attempt to compete with machinery 
 along the established lines. The second re- 
 quirement is an assured market for all prod- 
 ucts. This implies that the choice of products 
 shall be wise and far-seeing and that the work- 
 manship shall be good. The third require- 
 ment is that the work shall be of a kind 
 adaptable to physical and nervous limitations. 
 
 If we were to attempt to make flower pots 
 out of clay as they have been made for gen- 
 erations; if our shop force of handicapped 
 people were to compete with the jigger- wheels 
 and the enormous kilns of the great potteries, 
 we should not only fail, but we would amply 
 deserve our failure. But we propose to make 
 flower pots in a new way out of cement this 
 time, and cast in molds that can be handled 
 
8 THE WORK OF OUR HANDS 
 
 by a crippled girl quite as well as by a strong 
 man. If our molds are proportioned and de- 
 signed by an artist of full ability, then the 
 situation changes. The strong men may bend 
 to their wheels, turning out cheap and rather 
 ugly flower pots that sell, to be sure, by the 
 hundred thousand. The greater industry goes 
 its way, and it will not interfere in the slight- 
 est degree with the smaller, slower, but equally 
 justified, process. 
 
 This particular new product gives to the 
 public at a moderate price more expensive 
 than terra-cotta, less expensive than glazed 
 pottery a beautiful and useful article of 
 common use. The material for these cement 
 flower pots costs from three to ten cents each, 
 the selling price is usually from fifty cents to 
 one dollar. Thus is the second requirement 
 fulfilled, or as nearly fulfilled as can be the 
 case with any new idea. We are counting on 
 the well-known market for flower pots, and on 
 the especial characteristics and middle-priced 
 value of our ware. 
 
 The third requirement is more easily met 
 than most of the uninitiated would suppose 
 possible. Here is the key-note of the success 
 
WORKSHOP IN GENERAL HOSPITALS 9 
 
 of all handicapped labor. There must always 
 be a fully trained instructor and a sufficient 
 number of able assistants. Handicapped 
 workers alone are hopeless and helpless; under 
 careful direction there is no end to their pos- 
 sibilities. 
 
 Cement working is but one of many possible 
 modifications of existing industries. The 
 shops at Marblehead, and in many other 
 places, have developed hand-weaving to a high 
 degree of perfection. By our three require- 
 ments, hand-weaving is available for convales- 
 cent or permanently limited people. We 
 would be absolutely lost if we were to attempt 
 to make on hand-looms, cloth such as could be 
 more readily made by power machinery. But 
 by developing especial patterns and individual 
 effects designed by clever craftsmen, we pro- 
 vide a business capable of supporting a great 
 many handicapped workers. At Marblehead 
 is made a small woolen blanket for babies. 
 The material costs about sixty cents. If the 
 workers were to weave a similar length and 
 width of plain wool, they could not sell it for 
 a dollar, but because there is an attractive de- 
 sign and because the ends are finished well, 
 
10 THE WORK OF OUR HANDS 
 
 these specialized blankets sell for five or six 
 dollars. It takes about a day and a half to 
 make one such blanket. The factories could 
 not produce the same thing hand weaving is 
 distinctive and better but the hospital work- 
 shops can take the time, and such a course may 
 mean a partial self-support where help is 
 greatly needed. 
 
 A great deal of combined medical and in- 
 dustrial observation will be needed before the 
 idea of hospital industries can be carried out 
 in a really adequate and comprehensive way. 
 It seems reasonable, however, that the idea 
 should be taken up by the proper authorities 
 in the larger and smaller general hospitals. 
 The way has been shown for a beginning at 
 least. Occupation for the handicapped is a 
 fine adventure there is no telling what it may 
 lead to along clinical or economic lines. 
 
 If there were no other justification for the 
 work, the production of hope and courage 
 under adverse conditions would be enough. 
 The idea is one of enlarged and improved so- 
 cial service; it means a chance for the handi- 
 capped to make at least a partial living when 
 other opportunity is denied. This is the very 
 
WORKSHOP IN GENERAL HOSPITALS 11 
 
 root of Social Service. No amount of kindly 
 advice and social or hygienic uplift can ever 
 take its place. There is a fair chance of 
 reaching the moral and social needs of a man 
 after he is given work to do while he is idle 
 his various needs can be reached only with 
 great difficulty. 
 
 Hospital authorities who may object to 
 such enterprises need only be shown that work 
 for handicapped people is of definite medical 
 value. The new workshops may well be 
 recognized as legitimate clinical departments 
 of any charitable hospital. One has only to 
 see the discouraged and depressed paralytic 
 take heart or the incurable grow happy and 
 contented under this system to be convinced 
 of its medical value. 
 
II 
 
 MANUAL WORK FOR PATIENTS IN STATE 
 AND COUNTY HOSPITALS 
 
 THE practice of medicine has changed in no 
 way more remarkably than in the new respon- 
 sibility it assumes for the social and moral 
 welfare of its patients. We need no longer 
 call attention to the need of social service in 
 connection with hospital and dispensary work 
 it is an established thing. That the charita- 
 ble institution, and especially the state hospital, 
 should concern itself seriously with the matter 
 of carefully specialized work for its patients 
 both in and out of the hospital is a newer con- 
 ception that merits careful attention. 
 
 When work is proposed for a sick man in 
 hospital or out, the first thought is a revulsion. 
 It would seem that the sick might be left in 
 peace to recover at leisure. But we are not 
 thinking of the acute and more painful ill- 
 nesses in which work is impossible. There are 
 thousands of people in the state and county 
 
 12 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 13 
 
 hospitals who cannot ordinarily be depended 
 upon for intelligent work, but who have ca- 
 pacities that are being developed with no in- 
 considerable profit to everybody concerned. 
 To say nothing of the economic possibilities, 
 work is almost a moral necessity. It is essen- 
 tially an expression of good-will and common 
 service that helps to keep life wholesome. 
 Even if it does not mean much money return 
 it can always bring some degree of self-re- 
 spect. There need be no quarrel with diver- 
 sion and amusement, but there comes a time 
 when these things pall and there is need of 
 real employment. It is no new thing for the 
 chronic patients in the state and county hospi- 
 tals to be given work to do. Such action has, 
 however, until recently, been desultory, and 
 due to the chance initiative of individual su- 
 perintendents. There is growing up now a 
 new science of work which will not be satisfied 
 with the demand of household service from 
 those who are most able. The -new science 
 will study the possibilities and the effect of 
 productive work upon each patient, and it will 
 require measured work for therapeutic as well 
 as economic reasons. 
 
14 THE WORK OF OUR HANDS 
 
 There are many state hospitals where to- 
 day a great deal of useful house or ward work 
 is done by the inmates. Here and there may 
 be found well-equipped workshops. The cut- 
 ting and making of clothing for the patient's 
 own use is one of the best outlets for unused 
 energy. Through the installation of knitting 
 machines it has become possible for patients to 
 make such things as stockings, sweaters, mit- 
 tens and caps in great quantities. These 
 products represent real money value. Among 
 the occupations already found useful for the 
 insane and feeble-minded are brush- and 
 broom-making, cane-seating, rug-making, and 
 the hand-weaving of many fabrics, printing 
 for institutional use, lace-making, cabinet- 
 making and shoe repairing. These things are 
 all done well by the people who would ordi- 
 narily be considered useless members of so- 
 ciety. The only difference is that a great deal 
 of time is consumed and especial conditions of 
 oversight and system must be maintained. 
 The work is professional in the best sense. It 
 is rare to find poor craftsmanship. More- 
 over, here is a valuable means of treatment, 
 most potent toward creating efficiency and the 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 15 
 
 restoration of disordered functions, a valuable 
 means of treatment that should cost nothing. 
 Here is a medical agent of the first quality 
 which may actually save the State large sums 
 of money. It is true that many institutional 
 superintendents do not know how much 
 money is saved by the occupation of patients. 
 One of the best managers in the country con- 
 fessed to the writer that the repairs on boots 
 and shoes done in his workshops would cost 
 the institution in excess of $5,000 annually if 
 done by outside help. He did not, however, 
 publish that amount or other much larger sav- 
 ings in the various departments because he 
 was afraid that the politicians and perhaps the 
 friends and relatives of the patients would 
 look upon the matter as an exploitation of 
 helpless inmates and so put a stop to all work. 
 In this shoe-repairing shop where the foot- 
 wear of twelve hundred people is kept in re- 
 pair, a long row of happy boys with their 
 mouths full of brads, hammers out a cobbler's 
 chorus that answers all the objection of ig- 
 norance. 
 
 The employment of the insane in the ward 
 and house work of the institutions is a long 
 
16 THE WORK OF OUR HANDS 
 
 established custom. A great deal of money is 
 saved this way that would otherwise be spent 
 for service. This is undoubtedly the oldest 
 form of occupation for the insane. Under 
 careful restriction it is wise and legitimate. 
 But no kind of occupation is so liable to abuse 
 or so difficult to apply scientifically. Dr. Eva 
 C. Reid of San Francisco in a recent article 
 on "Ergotherapy in the Treatment of Mental 
 Disorders" * says of the female patient: "If 
 she shows an inclination to work she is given 
 a trial in the laundry, sewing- or dining-room 
 of the institution. If she proves careless or 
 inefficient in her work, she is sent back to the 
 ward. Because she allowed an 'iron to burn 
 out,' spoiled a garment in the making, or 
 broke a few dishes, many a poor soul has been 
 condemned to perpetual idleness, for the re- 
 mainder of her life. . . . On the other hand if 
 a patient proves to be a willing and efficient 
 worker, she is condemned to a life of hard 
 labor. In every state institution we find old 
 demented patients whose life has become an 
 existence of hopeless drudgery with no time 
 allowed for recreation or diversion." 
 
 * Boston Medical and Surgical Journal, August 20, 1914. 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 17 
 
 Such a conception of work for the insane is 
 not much longer to be tolerated. There must 
 be no routine employment without the most 
 careful consideration of the medical and social 
 needs of the patient. If these needs can be 
 met by carefully planned house and ward 
 service well and good otherwise that work 
 must be done by hired help, and the difference 
 made up in some other department of labor. 
 
 Farming and gardening present themselves 
 as primitively possible. As a matter of fact 
 these pursuits have been carried on for a good 
 many years with great success in many insti- 
 tutions. Naturally, better farming is done 
 when the work is in the hands of able-bodied 
 and experienced men, but there is an enor- 
 mous amount of routine that can be done per- 
 fectly well by the handicapped when there is 
 steady and careful supervision. Among the 
 feeble-minded and the insane such work has 
 its largest development. Ordinarily the boys 
 and men farm in small gangs under the direc- 
 tion of competent foremen. These foremen 
 are sometimes professional farmers, but often 
 enough they are old patients who have be- 
 come competent. The asylums report excel- 
 
18 THE WORK OF OUR HANDS 
 
 lent work and splendid financial returns and 
 they also report mental and bodily improve- 
 ment, less restlessness and violence among pa- 
 tients otherwise inclined to be difficult. Here 
 is fine healthful work. Every stroke of the 
 shovel and hoe that does not overtax the 
 strength is clear gain to the patient, and to 
 the commonwealth. The idle farm and the 
 idle patient seem existing for each other. The 
 time has come when economy and therapeutics 
 both demand the raising of crops, road-mak- 
 ing, the grading and draining of land. 
 
 It is a question whether it is wise for state 
 hospitals to engage in the manufacture of ar- 
 ticles to be sold outside in the open market. 
 This is done sometimes and with apparent ad- 
 vantage. In one large New England city, 
 where there is a state hospital, the local trade 
 is supplied with brooms and brushes made in 
 the hospital. Certainly it is wise to manufac- 
 ture articles which can be used in the hospital 
 where they are made or in other state institu- 
 tions. 
 
 The matter of reward in return for industry 
 is still open for discussion. It seems only fair 
 that direct money returns should be made to 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 19 
 
 the patients or their families. In some cases 
 extra freedom, especial diet, etc., will be 
 enough. Beyond a fair return to the worker 
 or his family money saving should be largely 
 returned to the State that it may diminish in 
 some degree the increasing burden of support. 
 
 There are great possibilities of the reciproc- 
 ity between institutions. One hospital might 
 well specialize in some line, such as the making 
 of socks and stockings. In this way high skill 
 could be acquired and a large and desirable 
 output be maintained for the supply of an in- 
 creasing chain of institutions. 
 
 If we bear in mind two essentials, that the 
 patient must be benefited physically and 
 mentally by the work and that the product 
 must be first class in every respect, we shall 
 not go far astray, and we shall begin to reach 
 the financial gain as well as the clinical ad- 
 vantages of the new system. 
 
 Already such beneficent occupation is the 
 rule rather than the exception; The great 
 need now is of system and classification. We 
 must know surely what classes of cases react 
 best to given kinds of work and we must make 
 common knowledge of the difficulties and sue- 
 
20 THE WORK OF OUR HANDS 
 
 cesses of institutional occupations all over the 
 world. This much is certain, that there are 
 vast sources of productive power lying unnec- 
 essarily idle in the state institutions for the in- 
 sane. State hospital superintendents agree 
 that much useful work is possible, that it may 
 represent large savings to the State and that 
 productive occupation is welcomed by patients 
 of all classes. 
 
 In the prisons of most States productive oc- 
 cupations occupy a foremost place adequate 
 systems of exchange of commodities have been 
 established between institutions and an im- 
 mense saving is made for the State. No one 
 doubts the advantage to the prisoners. Our 
 insane and feeble-minded are prisoners in the 
 larger and better sense, they are restrained for 
 the safety of the community and for their own 
 advancement. It would seem that there is no 
 good reason why these mental "prisoners" 
 should be denied the advantages offered to 
 criminals. 
 
 A series of questions sent recently to super- 
 intendents of state hospitals throughout the 
 country brought most interesting answers. 
 The questions were as follows: 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 21 
 
 1. What work is being done by insane or 
 feeble-minded patients in your hospital? 
 
 2. What is the effect, generally speaking, 
 upon: 
 
 A. The excited cases, 
 
 B. The depressed cases, 
 
 C. The feeble-minded cases? 
 
 3. Does the work of your patients represent 
 a definite saving in money to the institution? 
 Is this saving great or small? 
 
 Almost without exception the answers were 
 enthusiastic in regard to the value of occupa- 
 tion for patients of all classes, and with very 
 few exceptions the saving to the institution 
 was considerable. 
 
 Extracts from some of the letters follow: 
 
 EASTERN STATE HOSPITAL, 
 
 WlLLIAMSBURG, VA. 
 
 G. W. BROWN, M.D., SUPERINTENDENT 
 In answer to Question 1 will state that a large 
 number of our men work on our farm and garden; 
 about the yards and grounds. Some of them work 
 at carpenter's trade, some in the shoe shop, baker's 
 shop, tailor shop, some in the chair and mattress fac- 
 tory, some in the kitchen and of course a great many 
 of them do janitor work. We are now erecting a new 
 Infirmary and a great many of our male patients 
 
22 THE WORK OF OUR HANDS 
 
 who are able bodied (70 per cent.) do some kind of 
 work. All the clothing for the patients is made at 
 the Institution both for men and women. A great 
 many of them do fancy work and we have a special 
 instructress who makes an effort to retrain our 
 dementia praecox cases and some of the dements. 
 This is in needle work, fancy work, and rug weav- 
 ing. 
 
 In answer to Question % will state that a great 
 many of all classes are improved ; however, we do not 
 work our acutely excited cases. We generally keep 
 these on the ward and give them hydrotherapeutic 
 treatment until they become tractible; after which 
 time we make an effort to get them out on the farm 
 and yards and give them outside employment until 
 they become more quiet. 
 
 In answer to Question 3 will say that we have no 
 definite figures which we can give you. I am certain 
 that this labor is quite a saving to the Institution. 
 I figure that it reduces our wage scale about one-half. 
 
 VERMONT STATE HOSPITAL 
 
 WATERBURY, VERMONT 
 DON. D. GROUT, M.D., SUPERINTENDENT 
 The effect upon all classes of having what work 
 they are capable of doing is beneficial in every way. 
 The work of the patients is profitable in every way ; 
 it lessens our per capita cost of maintenance very 
 materially, probably fifty per cent. 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 23 
 
 TOPEKA STATE HOSPITAL 
 
 TOPEKA, KANSAS 
 T. C. BIDDLE, M.D., SUPERINTENDENT 
 
 Aside from the farm and garden work, I have, in 
 recent years, been doing much of our construction 
 with patient labor. The insane under supervision 
 of one or two competent constructionists can be em- 
 ployed successfully in any kind of building enterprise, 
 especially concrete construction. 
 
 Throughout the two years we have been able to 
 supply our male patients with a large amount of con- 
 genial employment. The usual request of our pa- 
 tients is to be allowed to go out with the working 
 parties and an opportunity to engage in some use- 
 ful exercise. We find no remedial agent that affords 
 more positive results in restoring the mental balance 
 of our cases. Unfortunately, we find greater diffi- 
 culty in providing suitable occupation for our female 
 inmates. This can best be provided by establishing 
 a crafts and art department, under the direction of a 
 competent instructor. It is a well established fact 
 that much can be done in stimulating recovery in cur- 
 able cases through useful occupation. 
 
 STATE OF NEW YORK, CENTRAL ISLIP HOSPITAL 
 G. A. SMITH, M.D., SUPERINTENDENT 
 
 We have found the effect of diversional and other 
 occupations more beneficial than any other one 
 therapeutic agent. This applies to substantially all 
 cases except the delirious. Eor the latter class we, 
 
24 THE WORK OF OUR HANDS 
 
 of course, pin our faith largely on the several 
 hydrotherapeutic agents. 
 
 While the labor of our patients represents a 
 definite saving in dollars and cents, we regard that as 
 nothing when the beneficial effects on the mental and 
 physical condition of the individual patient is taken 
 into consideration. 
 
 BOSTON STATE HOSPITAI>, 
 
 DORCHESTER CENTRE, MASS. 
 
 H. N. FROST, M.D., SUPERINTENDENT 
 
 1. The enclosed list of patients' occupations, out- 
 side of hospital routine work, shows in more detail 
 what our patients are doing. 
 
 2. The effect of this industrial activity, generally 
 speaking, is decidedly favorable, diminishing excite- 
 ment, stimulating those who are depressed and in- 
 active, and putting some degree of efficiency into the 
 feeble-minded. 
 
 3. The work of our patients represents a con- 
 siderable saving in money, which, however, I am not 
 able to give in figures at this time. 
 
 Patients 9 Industries 
 
 Women: Sewing, mending, embroidery, crochet- 
 ing, lace making, tatting, weaving, spinning, rug mak- 
 ing, basketry, straw braiding, hat making, knitting, 
 raveling, stenciling, kindergarten work, paper work, 
 bead work. 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 25 
 
 Men: Mattress making, upholstery, furniture re- 
 pairing, chair caning, basketry, straw hat manufac- 
 ture, mat making, rug making, weaving, stocking 
 knitting (machine), broom making, cement and clay 
 modeling, metal work, leather work, wood carving, 
 cabinet making, picture framing, book binding, etc. 
 
 Dr. George Kline of the Danvers (Massa- 
 chusetts) State Hospital reports a saving of 
 about $1400 a year on one item, the making of 
 soap from the waste fats of the institution. 
 The men who do this work enjoy it and take 
 great pride in their product. 
 
 A general idea of the extent of State Hos- 
 pital occupation in Massachusetts may be ob- 
 tained from the following table published in 
 Bulletin No. 7 of the Massachusetts State 
 Board of Insanity: 
 
 Occupations and Industries 
 
 Herewith is presented a report of a survey of occu- 
 pations for a single day at each of the State institu- 
 tions under the supervision of this Board, being an 
 average day's work, showing the whole number of 
 patients at each hospital on that day, the number 
 employed, those unable to be employed, and the num- 
 ber idle, with per cents. 
 
THE WORK OF OUR HANDS 
 
 Iff 
 
 A H 
 
 a . 
 
 =-2 W 
 *$ 
 
 o 
 S H . 
 
 S> H M 
 
 UM 
 YED 
 
 O 00 (30 
 rfi rH CO 
 b- r Ci 
 
 "H -* CO rH 5 
 0* CD CO rH 0> 
 r G* CO t- t*- 
 
 CO 
 00 
 
 CO t- 5 05 *O *005t--J<G*G>050 
 
 **: <* cc i- * ^^co^^"*'-!'-! 
 
 ^ G* ' 
 
 ^O "5 CO 
 
 * CO* t^ O CO CO 5 rH O O 5 05* b-' rH O5 
 rH rH G< rH rH G< CO G< CO rH CO D 
 
 ^ O CO ^O CO 
 
 CO 
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 CO O 1-; 05 CO. rn <Q Cl r-i CS* 
 W5O*O5COrHCD COrHOrHO^OJCDO O 
 OiClCDCOCDt- tttOO'iO 1 *TtiT}< CO 
 
 W5O5'SrH^J< < fiCDCDrH "5 
 t-Oi*OO*O5CO^"!j< G* 
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 4* * CO 
 
 
 j 
 
 s;! 
 si 
 
 ! 
 
 w w 
 fe 
 
 In additi 
 Exclusive 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 27 
 
 The following shows, in addition, a detailed state' 
 
 ment of tlie work at each hospital, g'wing 
 
 hours of employment, etc.: 
 
 Gardner State Colony 
 
 Per cent. 
 
 Total number of patients in hospital, .... 740 
 
 Total number of patients unable to work, ... 24, or 3.24 
 
 Total number of patients employed, .... 681, or 92.03 
 Total number of patients employed for less than 
 
 1 hour, 3, or .40 
 
 Total number of patients employed for 1 hour, 9, or 1.23 
 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 40, or 5.41 
 
 38, or 5.14 
 
 49, or 6.62 
 
 51, or 6.89 
 
 30, or 4.05 
 
 55, or 7.43 
 406, or 54.86 
 
 681, or 92.03 
 
 Worcester State Hospital 
 
 Per cent. 
 
 Total number of patients in hospital, .... 1,418 
 
 Total number of patients unable to work, . . . 110, or 7.76 
 
 Total number of patients employed, 1,273, or 89.77 
 
 Total number of patients employed for less than 
 
 1 hour, 167, or 11.78 
 
 Total number of patients employed for 1 hour, 185, or 13.05 
 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours,. 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 223, or 15.73 
 
 162, or 11.42 
 69, or 4.87 
 87, or 6.13 
 
 137, or 9.66 
 71, or 5.01 
 
 172, or 12.12 
 
 1,273, or 89.77 
 
28 
 
 THE WORK OF OUR HANDS 
 
 Monson State Hospital 
 
 Total number of patients in hospital, . . . . 
 Total number of patients unable to work, . . . 
 
 Total number of patients employed, 
 
 Total number of patients in school, 
 
 Total number of patients employed for less than 
 
 1 hour, 
 
 Total number of patients employed for 1 hour, 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Per cent. 
 938 
 
 103, or 10.98 
 787, or 83.90 
 
 40, or 4.27 
 
 7, or .75 
 
 15, or 1.60 
 
 7, or .75 
 52, or 5.54 
 11, or 1.17 
 
 687, or 73.24 
 
 8, or .85 
 787, or 83.90 
 
 Medfield State Hospital 
 
 Total number of patients in hospital, .... 
 Total number of patients unable to work, 
 
 Total number of patients employed, 
 
 Total number of patients employed for less than 
 
 1 hour, 
 
 Total number of patients employed for 1 hour, 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Per cent. 
 1,630 
 
 226, or 13.86 
 1,326, or 81.35 
 
 164, or 10.06 
 
 149, or 9.14 
 
 171, or 10.49 
 
 199, or 12.21 
 
 210, or 12.88 
 
 169, or 10.37 
 
 157, or 9.63 
 
 52, or 3.19 
 
 55, or 3.38 
 
 1,326, or 81.35 
 
 Worcester State Asylum 
 
 Per cent. 
 
 Total number of patients in hospital, .... 1,391 
 Total number of patients unable to work, . . . 96, or 6.90 
 Total number of patients employed, .... 1,094, or 78.65 
 Total number of patients employed for less than 
 
 1 hour, 39, or 2.80 
 
 Total number of patients employed for 1 hour, . 165, or 11.86 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 
 
 Worcester State Asylum continued 
 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Per cent. 
 
 77, or 5.54 
 11 9, or 8.56 
 231, or 16.61 
 
 79, or 5.68 
 156, or 11.21 
 129, or 9.27 
 
 99, or 7.12 
 
 1,094, or 78.65 
 
 Taunton State Hospital 
 
 Total number of patients in hospital, . . . . 
 Total number of patients unable to work, . . . 
 
 Total number of patients employed, 
 
 Total number of patients employed for less than 
 
 1 hour, 
 
 Total number of patients employed for 1 hour, 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Per cent. 
 1,263 
 
 203, or 16.07 
 899, or 71.18 
 
 39, or 3.09 
 
 54, or 4.28 
 112, or 8.87 
 286, or 22.64 
 114, or 9.03 
 
 17, or 1.34 
 
 255, or 20.19 
 
 1, or .08 
 
 21, or 1.66 
 
 899, or 71.18 
 
 Westborour/h State Hospital 
 
 Per cent. 
 
 Total number of patients in hospital, .... 1,211 
 
 Total number of patients unable to work, . . . 143, or 11.81 
 
 Total number of patients employed, 855, or 70.60 
 
 Total number of patients employed for less than 
 
 1 hour, '. . 252, or 20.81 
 
 Total number of patients employed for 1 hour, . 108, or 8.92 
 
 Total number of patients employed for 2 hours, . 74, or 6.11 
 
 Total number of patients employed for 3 hours, . 61, or 5.04 
 
 Total number of patients employed for 4 hours, . 18, or 1.48 
 
 Total number of patients employed for 5 hours, . 1, or .08 
 
 Total number of patients employed for 6 hours, . 341, or 28.16 
 
 855, or 70.60 
 
30 
 
 THE WORK OF OUR HANDS 
 
 Danvers State Hospital 
 
 Total number of patients in hospital, . . . . 
 Total number of patients unable to work, 
 
 Total number of patients employed, 
 
 Total number of patients employed for less than 
 
 1 hour, 
 
 Total number of patients employed for 1 hour, 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Per cent. 
 1,455 
 
 294, or 20.21 
 901, or 61.92 
 
 16, or 1.10 
 
 59, or 4.05 
 
 167, or 11.48 
 
 156, or 10.72 
 
 112, or 7.70 
 
 105, or 7.22 
 
 203, or 13.95 
 
 25, or 1.72 
 
 58, or 3.98 
 
 901, or 61.92 
 
 Boston State Hospital 
 
 Total number of patients in hospital, .... 
 Total number of patients unable to work, . . . 
 
 Total number of patients employed, 
 
 Total number of patients employed for less than 
 
 1 hour, 
 
 Total number of patients employed for 1 hour, 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Per cent. 
 1,421 
 
 430, or 30.26 
 854, or 60.10 
 
 20, or 1.48 
 116, or 8.16 
 
 92, or 6.47 
 166, or 11.61 
 
 63, or 4.43 
 129, or 9.08 
 105, or 7.39 
 149, or 10.49 
 
 14, or .99 
 
 854, or 60.10 
 
 Psychopathic Department, Boston State Hospital 
 
 Per cent. 
 
 Total number of patients in hospital, .... 83 
 Total number of patients unable to work, ... 58, or 69.88 
 Total number of patients employed, 25, or 30.12 
 
MANUAL WORK FOR PATIENTS IN HOSPITALS 31 
 
 Foxborough State Hospital 
 
 Total number of patients in hospital, . . . . 
 Total number of patients unable to work, . . . 
 
 Total number of patients employed, 
 
 Total number of patients employed for less than 
 
 1 hour, 
 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 8 hours, 
 
 Northampton State Hospital 
 
 Total number of patients in hospital, . . . . 
 Total number of patients unable to work, 
 
 Total number of patients employed, 
 
 Total number of patients employed for less than 
 
 1 hour, 
 
 Total number of patients employed for 1 hour, 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Mental Wards, State Infirmary 
 
 Total number of patients in hospital, . . . 
 Total number of patients unable to work, . . 
 Total number of patients employed, .... 
 Total number of patients employed for 1 hour, 
 Total number of patients employed for 2 hours, 
 Total number of patients employed for 3 hours, 
 Total number of patients employed for 4 hours, 
 Total number of patients employed for 5 hours, 
 Total number of patients employed for 6 hours, 
 Total number of patients employed for 7 hours, 
 Total number of patients employed for 8 hours, 
 
 Per cent. 
 284 
 
 72, or 25.36 
 154, or 54.22 
 
 35, or 12.32 
 
 56, or 19.72 
 4, or 1.41 
 2, or .70 
 
 57, or 20.07 
 
 154, or 54.22 
 
 Per cent. 
 883 
 
 353, or 39.98 
 438, or 49.60 
 
 46, or 5.22 
 32, or 3.62 
 54, or 6.11 
 20, or 2.26 
 156, or 17.67 
 
 25, or 2.83 
 105, or 11.89 
 
 438, or 49.60 
 
 Per cent. 
 
 711 
 
 127, or 17.86 
 
 348, or 48.95 
 18, or 2.53 
 22, or 3.10 
 26, or 3.66 
 47, or 6.61 
 17, or 2.39 
 29, or 4.08 
 84, or 11.81 
 
 105, or 14.77 
 
 348, or 48.95 
 
32 THE WORK OF OUR HANDS 
 
 Wrentham State School 
 
 Per cent. 
 
 Total number of patients in school, 640 
 
 Total number of patients unable to work, . . . 30, or 4.69 
 Total number of patients employed, 610, or 95.31 
 
 Massachusetts School for the Feeble-Minded 
 
 Per cent. 
 
 Total number of patients in school, 1,595 
 
 Total number of patients unable to work, . . . 420, or 26.33 
 Total number of patients employed, 1,175, or 73.67 
 
Ill 
 
 SANATORIUM TREATMENT FOR PEOPLE OF 
 SMALL MEANS 
 
 MEN and women of small means or none are 
 beset with conditions especially liable to break 
 down the morale and to precipitate what in 
 more prosperous circumstances is called nerv- 
 ous exhaustion. It is probably true that the 
 necessity for work prevents many cases of 
 chronic functional illness, but privation and 
 anxiety often produce serious functional dis- 
 turbances. Mental suffering of this kind is 
 often untreated until it reaches on into the 
 more serious psychoses. The private sana- 
 toriums take care of the situation for those who 
 can pay, but must stop there. Besides the dis- 
 abled but untreated cases of nervous exhaus- 
 tion there are among the poor all of the recog- 
 nized types of chronic organic diseases of the 
 nervous system. At present there are very 
 few institutions where proper medical care can 
 
 33 
 
34 THE WORK OF OUR HANDS 
 
 be given in chronic illness of any kind. There 
 is, as a matter of fact, a great deal besides 
 medical care that needs to be managed for 
 these people. Most of the functional nervous 
 cases and many of the organic disabilities need 
 the occupation which is denied them in the in- 
 dustrial world. Many of these chronic inva- 
 lids could partly pay for their treatment, and 
 most of them by working under favorable con- 
 ditions could pay something toward mainte- 
 nance. 
 
 The present chapter will consider especially 
 the situation with reference to the functional 
 nervous cases that are not cared for anywhere, 
 because the more evident disabilities are always 
 first to receive attention. Even if these were 
 definitely charitable cases the overcrowded 
 hospitals and dispensaries and asylums could 
 not give the right kind of treatment. Obvi- 
 ously the State or private charity cannot hope 
 to supply the luxuries of the high priced sana- 
 toriums. Yet the time will come when char- 
 ity will consider especially the needs of the pa- 
 tient of small means and who can help out a lit- 
 tle in the cost of treatment. Charity after all 
 has two sides; it gives for humanity's sake and 
 
TREATMENT FOR PEOPLE OF SMALL MEANS 35 
 
 it gives because it actually pays to put the 
 fallen on their feet. Accumulated weight of 
 disability in time rolls back upon society with 
 destructive force. Idle men and women mean 
 increased taxation and widespread suffering. 
 Idleness, moreover, too often leads along the 
 paths of violence and crime. Inefficiency in 
 the worker is a great industrial menace we 
 cannot forever supply the demand for skilled 
 labor unless we do something to restore those 
 who have broken down under the strain of com- 
 petition and the stress of speed. A new type 
 of sanatorium will have to be invented it will 
 be neither hospital nor asylum and it must ac- 
 complish its results, without much expense to 
 the community. Such a sanatorium seems at 
 last possible through the advent of the work 
 cure. Work, if it is within the capacity of 
 the so-called nervous patient, is often helpful 
 in the highest degree. It is one of the reme- 
 dial agents that intelligently used may restore 
 and comfort just as it harms when it is 
 over-used or mis-used. Work as a remedy 
 may become an actual pleasure while it brings 
 back confidence and strength and renews 
 wasted nerve and muscle tissue. The work 
 
36 THE WORK OF OUR HANDS 
 
 cure takes the weakened individual and ex- 
 amines him critically to see what he may safely 
 do without detriment to mind or body. Then 
 it proceeds to supply that work as part of the 
 cure. Experience already shows that there is 
 no good reason why work which is used as a 
 remedy should not be made to yield a money 
 return. It looks very much as though work 
 well directed and under favorable conditions 
 might become a remedy for wornout bodies 
 and minds, and as though it might at the same 
 time do something toward meeting the neces- 
 sary cost of treatment. 
 
 Before discussing some of the possibilities 
 of handicapped labor it will be well to inquire 
 a little into the nature of nervous exhaustion. 
 Nervous exhaustion, sometimes called neuras- 
 thenia or psychasthenia, is often considered to 
 be a disease when it is really a symptom-com- 
 plex of widely varying underlying causes. 
 Comprehensive definition would be difficult, 
 yet every one knows the condition. Nervous 
 exhaustion is not only "the great American 
 disease" ; it has been for long the great Ameri- 
 can puzzle. The medical world has finally 
 come to agree that practically every case of 
 
TREATMENT FOR PEOPLE OF SMALL MEANS 37 
 
 nervous exhaustion has some physical weak- 
 ness or disability behind it or in it. There are 
 great differences in individual stamina irre- 
 spective of physical conditions, but with a reg- 
 ularity that is more and more apparent it is 
 found that nervously broken down people are 
 also physically weak the subjects of more or 
 less evident defects or disease. Often enough 
 there are local troubles to be corrected or 
 ameliorated, joint affections, broken foot 
 arches, defective vision, poisoning from bad 
 teeth and unhealthy gums, and a long list be- 
 sides. When the body is in constant distress 
 physical fatigue begets mental and nervous 
 fatigue and irritability. We see the familiar 
 picture of the "nervous wreck," who cannot 
 sleep or eat or even think successfully. No 
 wonder old and new fears and doubts come in 
 to dominate the picture. 
 
 Sometimes it happens that nervous patients 
 are examined most carefully by competent 
 medical men who find nothing organically 
 amiss. That otherwise hopeful finding may 
 have most unfortunate results, for it stamps 
 the patient as neurasthenic and makes him in 
 the eyes of the world at least to blame for his 
 
38 THE WORK OF OUR HANDS 
 
 inability to bear the burden and heat of the 
 day. A very large proportion of the nerv- 
 ous breakdowns without apparent cause are 
 now known to be associated with the condition 
 called enteroptosis, in which the whole body 
 droops from muscular fatigue and from a cer- 
 tain congenital or acquired laxity and physical 
 unbalance. All the internal organs, but es- 
 pecially the stomach and intestines, share in 
 the failure of tone. As a result of the bodily 
 drooping we have some of the most distressing 
 forms of indigestion, some of the most in- 
 tractable cases of circulatory and nervous dis- 
 turbance. Some day it will be more generally 
 understood that cramped and relaxed bodies 
 are a menace, that they shut up the vital or- 
 gans in very narrow and unwholesome quar- 
 ters. It may be shown that even organic as 
 well as functional disease can come about 
 through such interference with circulation and 
 nerve supply. Corrections of posture, the 
 clearing up of old infections, the improvement 
 of muscular and ligamentous tone all these 
 are slow processes requiring not only time but 
 the constant cooperation of trained workers. 
 We must look to sanatoriums of some sort for 
 
TREATMENT FOR PEOPLE OF SMALL MEANS 39 
 
 the necessary patience and equipment. Real 
 cure, moreover, is usually not confined to phys- 
 ical improvements. There must be hope and 
 courage, there must be a conception of life fine 
 enough and big enough to bridge all gaps with 
 sufficient faith and understanding. There 
 must be a wholesale clearing away of old and 
 hampering misconceptions, a lightening of 
 fears and other mental burdens. These es- 
 sentials also require much time for their com- 
 ing and their coming is more likely under such 
 conditions as the sanatoriums can afford. The 
 usual treatment at home does not get at the 
 bottom of things. Too frequently it leaves 
 untouched some of the great fundamental re- 
 quirements. Without new training in life and 
 work, treatment can not bring self-respect and 
 self-confidence. In a surprising number of 
 cases of nervous exhaustion, work, under fa- 
 vorable conditions, will do this essential thing. 
 For rich or poor the market value of effort 
 is deep and significant. Without it there is a 
 sense of futility which is deadly. So it hap- 
 pens that productive work may become, not 
 only gymnastic and so physically restorative, 
 but morally strengthening as well. Within 
 
40 THE WORK OF OUR HANDS 
 
 the writer's observation a man has loosened up 
 the stiffened joints of an old and obstinate 
 rheumatic affection by the use of interesting 
 physical work after massage and electricity, 
 hydrotherapy and mechanotherapy had ut-, 
 terly failed. At the same time he cast off a 
 despondency that philosophy and religion it- 
 self had failed to lighten. From being help- 
 less and hopeless he became independent and 
 happy. This is an example of the work cure 
 at its best. If such a thing can be done for 
 one man, it can be done in varying degrees for 
 many. 
 
 Sometimes a patient who is nervously 
 broken down has as the chief symptom a fa- 
 tigue that almost precludes work of any kind. 
 Very likely the patient does not know he can 
 work, or is so alarmed by the appearance of 
 fatigue that he easily gives up. Whether such 
 fatigue is physical or psychic, in hundreds of 
 cases it is possible to bring about efficiency by 
 gradually increasing the effort. This cannot 
 be done carelessly or quickly; it is a problem 
 for experience and skill, a task for the new 
 sanatorium. 
 
 There are ample justifications for the work 
 
TREATMENT FOR PEOPLE OF SMALL MEANS 41 
 
 cure even if it is only a background for ade- 
 quate medical and surgical treatment, even 
 when it does not rise to the dignity of a posi- 
 tive cure in itself. 
 
 The idea of the work cure is not new except 
 in its systematic application under institu- 
 tional management. It has always been real- 
 ized that work may be curative, that it may 
 reorganize and regenerate lives that have long 
 been idle. There is danger, perhaps, that the 
 matter may be overdone by indiscriminate ap- 
 plication, and that cruel injustice may be vis- 
 ited upon people who actually cannot work. 
 The field, however, is a very large one and it 
 does not stop with the treatment of nervous 
 exhaustion. There are thousands of people in 
 the cities partly disabled by accident or dis- 
 ease, able to work part of the time or under 
 favorable conditions, but who can find no place 
 in the regular industrial systems because they 
 are not fully efficient. The time will come 
 when practical industries will be conducted in 
 connection with sanatoriums or hospitals, in- 
 dustries which will give these people their 
 chance. 
 
 It is amazing what skill and expedition can 
 
42 THE WORK OF OUR HANDS 
 
 be acquired by many severely handicapped 
 workers. The reason is not far to seek. They 
 are often trained people, used to harder work, 
 to the fine manual dexterity acquired in their 
 regular occupations. 
 
 The sanatorium shop and the general hos- 
 pital shop have one and the same ends except 
 that the sanatoriums should be able to care es- 
 pecially for nerve and chronic cases, and for 
 a longer time. Both institutions can be made 
 to serve a large class of people too sick to work 
 in regular industries, but able to go to these 
 special shops daily. The hospital shop is very 
 desirable because it may keep families together 
 and save the heavy cost of the maintenance of 
 beds in an institution. But there must some- 
 time be regular housing facilities for handi- 
 capped people, especially the nervously dis- 
 abled, because they will so often need treat- 
 ment that cannot be carried out at home. 
 These sanatoriums for such they must be 
 will have as their aim the restoration of the 
 sick to regular wage earning possibilities, but 
 in many instances they must themselves main- 
 tain specialized industries. 
 
 It would be very desirable to have some- 
 
CEMENT FLOWER POTS MADE FROM DEVEREUX 
 MANSION DESIGNS. 
 
TREATMENT FOR PEOPLE OF SMALL MEANS 43 
 
 where a well-equipped and endowed experi- 
 mental plant where various industries could be 
 tried out, modified, and adapted to new uses. 
 There could be no better opportunity for pri- 
 vate charity than the establishment of such 
 an experimental plant. The "station" could 
 study the field in a large way not only devel- 
 oping new industries, but transferring patients 
 from one institution to another so that condi- 
 tions might be found to suit the especial indus- 
 trial capacity of the individual. It is said that 
 few men are doing the work for which they 
 are best fitted. Under a system of handi- 
 capped labor it might at last be possible to fit 
 the work to the man. It is not inconceivable 
 that in this way a partial disablement might 
 actually increase a man's earning capacity as 
 well as his health and happiness. 
 
 A school teacher broke down in her work a 
 few years ago; she was in fact never fitted for 
 teaching. As a part of the treatment of her 
 disability she learned the art of hand-weaving. 
 She is now earning more money as a teacher 
 of weaving than she did as a teacher in the 
 schools. Incidentally she is cured of nervous 
 exhaustion. 
 
44 THE WORK OF OUR HANDS 
 
 In sanatoriums situated in the country, 
 farming would prove a most desirable occu- 
 pation, but it would not by any means do for 
 all. There are in the cities great numbers of 
 people who need protected occupation but who 
 would never make good farmers. They are 
 shop workers, city dwellers from first to last; 
 they cannot live happily and successfully in the 
 country. For the benefit of such people the 
 general hospital workshops would be the best, 
 or perhaps sanatorium workshops in the city 
 where manufacturing could be carried on un- 
 der favorable conditions. 
 
 There are very great commercial possibili- 
 ties for handicapped labor. If the handiwork 
 of great numbers of half-time people can be 
 directed and coordinated toward an adequate 
 end, the results will be surprising. The prob- 
 able deficit in such industries need not be a 
 severe tax to charity, for a considerable pro- 
 portion of the patients should be able to pay 
 something for treatment. In this way it 
 might become possible for people of small 
 means to get the necessary sanatorium treat- 
 ment without paying more than they can af- 
 ford and without becoming wholly dependent 
 
TREATMENT FOR PEOPLE OF SMALL MEANS 45 
 
 upon charity. Any one who is acquainted 
 with sanatorium work knows that many nerv- 
 ous patients possess talents and abilities of a 
 very high order. Such an industrial plan 
 might over and over again give back to the 
 world rare genius and ability that would other- 
 wise be lost. These regenerations can come 
 only through the most careful medical and re- 
 educational treatment such as only well- 
 equipped hospitals or sanatoriums can afford. 
 
IV 
 
 TEACHER AND PUPIL 
 
 IF invalid occupations are to be carried out in 
 a large way there will be need of a good many 
 trained people to conduct and to supervise the 
 work. This should be a new and desirable 
 field for women. The business will have to 
 be relatively light because even the men who 
 work will be too much disabled for very stren- 
 uous exertions. What sort of person is best 
 fitted to perform such an office and what train- 
 ing will be necessary? Obviously it depends 
 upon the direction taken by the new indus- 
 tries. If, as seems likely now, the ancient 
 handicrafts are used in a simplified way, do 
 we need trained craftsmen for teachers or can 
 the teaching and producing be done by the 
 average girl who graduates from school or col- 
 lege? Experience has made it very clear to 
 the writer that the trained craftsman is often 
 a poor teacher. Probably the best assistants 
 
 46 
 
TEACHER AND PUPIE 
 
 will be women who have natural teaching abil- 
 ity, who would do well in the schools. The 
 work has to be simplified anyway to make it 
 available for the handicapped so that a woman 
 of teaching qualification but no artistic train- 
 ing might reasonably do very well after the 
 work had been planned and developed by ex- 
 perts. Somewhere along the line experts 
 must come in, but as a rule they should be en- 
 gaged in experimental work and in the teach- 
 ing of teachers who will pass on the necessary 
 technique to the invalid pupils. 
 
 The shop at Marblehead has had some suc- 
 cess in training partly invalided women to be 
 teachers. Although dealing for the most part 
 with well-to-do patients this shop has been able 
 to take at reduced rates a number of young 
 women who had broken down nervously but 
 who were recovering. The idea has been to 
 make teachers or assistants by training these 
 women in various kinds of modified labor. 
 The plan has been a success, generally speak- 
 ing, although the experience of putting respon- 
 sibility onto the shoulders of invalids has often 
 been a trying one, both to the invalids and to 
 the director. 
 
48 THE WORK OF OUR HANDS 
 
 Suppose light blacksmithing were to be used 
 as an invalid occupation. (Absurd as it 
 sounds, it is quite possible to use this trade. 
 The making of fire-irons such as pokers and 
 tongs, shovels and forks, is delightful work.) 
 It should be possible to call upon a trained de- 
 signer for the proportions and the working 
 drawings. Then there must be an experienced 
 blacksmith who will at once go about the ac- 
 tual making of the desired articles. This man, 
 though presumably a good workman, will 
 rarely be a good teacher. In working out 
 the plan he should have an apprentice who 
 has the teaching qualifications. This appren- 
 tice will learn how to work the iron, then he or 
 she will take on a pupil of the invalid class 
 who is able to do certain detail work under 
 close supervision. This is the working plan 
 a designer who may be useful in other depart- 
 ments, a craftsman who need not be a teacher 
 but who can train an apprentice who will teach. 
 In this way the pupils get their instruction; 
 they learn to do what they are told while the 
 trained craftsman is at liberty to go on with 
 his work, producing articles which serve as an 
 example and which help to support the system 
 
TEACHER AND PUPIL 49 
 
 by their sale. The apprentice teacher should 
 be able to handle a considerable number of 
 handicapped pupils. It is really a modified 
 factory system in which the invalid is the op- 
 erative while the craftsman and his apprentice 
 are the planners and directors. The work may 
 be so systematized and subdivided that the fee- 
 blest person may do something that counts. 
 
 Here then is a new field for designers, for 
 craftsmen and for men and women who are 
 willing to teach detail. These teachers must 
 have patience and tact to be successful, the de- 
 signer and the craftsman must be skillful and 
 above all there must be competent medical su- 
 pervision so that the invalid workers may not 
 be overtaxed, and that they may realize that 
 the work is doubly valuable as a money earn- 
 ing expedient and a training back to efficiency 
 and health. 
 
 If it is planned, as must often be the case in 
 the charitable institution, to make only such ar- 
 ticles as can be used in the households and up- 
 keep of the hospitals, the teachers may possi- 
 bly be practical workers taken from the regu- 
 lar outside industries. The chances are, how- 
 ever, that there will have to be assistants of a 
 
SO THE WORK OF OUR HANDS 
 
 more versatile sort the kind of people who 
 can deal with the human element as well as the 
 mechanical requirements. Especially trained 
 nurses may some day meet some of the indus- 
 trial requirements. 
 
 Any one acquainted with the living condi- 
 tions of the asylums will realize that the work 
 of teaching is no sinecure. There is much that 
 is disagreeable and even revolting the girl 
 ready to teach sewing in a city day school is 
 not necessarily prepared to meet these condi- 
 tions. It will be seen at once that there should 
 be a training school for teachers a school 
 where the proposed teacher may be brought 
 gradually in contact with the difficulties of the 
 work. Such a school might easily be estab- 
 lished in connection with any state hospital. 
 Beyond this, the teaching is essentially a mis- 
 sionary work and requires the missionary 
 spirit. Such schools as that at Northfield, 
 Mass., where the atmosphere is of service and 
 where the training is hard and practical, might 
 well furnish the best of teaching stock. 
 
THE TRAINED NURSE AND THE WORK CURE 
 
 THE average nurse graduating from our best 
 general hospitals is notoriously helpless in deal- 
 ing with the shifty and uncertain prob- 
 lems of the neurasthenic or mental patient. 
 This cannot well be otherwise, for the hospital 
 has little to do with such cases. As a matter 
 of fact the so-called nervous case is apt to be 
 badly bungled even by experienced physicians 
 unless some definite system of management is 
 applied. If we forget the thousand and one 
 symptoms and look at the case from the stand- 
 point of efficiency we shall begin to bring order 
 out of chaos. The physical cause of nervous 
 breakdown should of course be -corrected if 
 possible. Then there remains the inefficiency, 
 the fear, the restlessness and depression. 
 These so-called nervous symptoms, then, con- 
 stitute an illness in themselves which may be 
 
52 THE WORK OF OUR HANDS 
 
 dealt with independently and often with excel- 
 lent results. Even if there is incurable physi- 
 cal handicap life may often be made useful 
 and happy when fear and relative inefficiency 
 are taken away. We are too apt as doctors 
 and nurses to think that because a man has 
 locomotor ataxia his usefulness and happiness 
 are over. "Make him comfortable" is the 
 usual idea. Make him as useful as possible is 
 a far better idea, because in making him useful 
 you are quite likely to take away hopelessness 
 and despair ; and because you may even relieve 
 some of the most distressing physical symp- 
 toms. 
 
 The long and patient personal dealing with 
 chronic invalids falls to the trained nurse or 
 attendant. If the nurse has had a training 
 that helps her to make her patient efficient she 
 is likely to be of the greatest possible service. 
 Of course, there are amusements that help in 
 chronic cases, but in the long run some useful 
 occupations will be of far greater service. For 
 this reason the hospital workshops may in time 
 play a very important part in the training of 
 nurses. In these shops the nurse may deal at 
 first hand with the problem of efficiency for the 
 
THE TRAINED NURSE AND THE WORK CURE 53 
 
 handicapped. She may see the paralytic 
 learning to use a knitting machine as well as 
 an able-bodied operator. She will see the 
 difficulties to be overcome and will help to 
 overcome them. The hospital workshop will 
 then be comparable with the normal school for 
 the training of teachers the school where the 
 teacher learns teaching by teaching. 
 
 The Teachers' College of Columbia Uni- 
 versity is starting a course of instruction in in- 
 valid occupations for graduate nurses. There 
 are infinite possibilities for such a school. It 
 may be that the hurry of the general hospital 
 will not allow time for the undergraduate to 
 work in the shops. In this case such a course 
 as that at Columbia might well cooperate with 
 the hospitals in giving graduate pupils ade- 
 quate time as apprentices in the new indus- 
 tries. 
 
 There are, of course, many nurses who will 
 specialize in surgery for instance, and these 
 might not find it profitable to deal with invalid 
 occupations. So the work training may have 
 to be optional. But that it can be extremely 
 useful to some, there is no doubt. 
 
 It is true that nurses taking private cases 
 
54 THE WORK OF OUR HANDS 
 
 might rarely wish to find real work for their 
 patients. It will some day be understood, 
 however, that real work is the best training for 
 the efficiency that every patient needs and de- 
 sires. There will be opportunity for the nurs- 
 ing instinct and judgment to be used in hold- 
 ing back those who are too eager and in urging 
 those who are loath to exert themselves. There 
 is a whole profession in this function alone, for 
 the nervous invalid is prone to grasp at a new 
 idea, to try it feverishly and to fail. Failure 
 is the rule for a considerable time. Patients 
 must be taught that the first step is to adapt 
 the occupation and the whole life to the exist- 
 ing limitations to do this not grudgingly but 
 hopefully and thankfully. This means get- 
 ting a footing. This first foothold will some- 
 times be all that can be gained, but often, after 
 a time, indefinite progress usually becomes pos- 
 sible. The nurse trained in the efficiency idea 
 will realize that too rapid progress for the in- 
 valid is fatal to success. She will understand 
 that much happiness and general improvement 
 may come from some very small accomplish- 
 ment. She will have the satisfaction of know- 
 ing that in many cases she will have the chance 
 
THE TRAINED NURSE AND THE WORK CURE 55 
 
 of restoring full efficiency and happiness where 
 these might never have come. 
 
 It is an open question whether the appren- 
 tice teacher or craftsman in the hospital or 
 sanatorium workshop should be told the na- 
 ture of the disease with which she deals or the 
 intimate history of the patient. Sometimes 
 such knowledge would be of decided advantage 
 to both parties. On the other hand it is true 
 that without a great deal of hospital training 
 medical information is often misunderstood 
 and misapplied. There are undoubtedly some 
 industrial teachers, not nurses, who can make 
 excellent use of professional knowledge. As a 
 rule, however, the physician will need nurses 
 to help him out in dealing with the whole prob- 
 lem. These especially trained nurses will 
 form an important link in the new industrial 
 system. They will have the confidence of the 
 patients and the physician, teachers and crafts- 
 men. In many instances they will themselves 
 be the best teachers to serve under the crafts- 
 men. 
 
 It will be well to warn here against a ten- 
 dency to teach nurses a smattering of a few 
 amusing occupations these may be well 
 
56 THE WORK OF OUR HANDS 
 
 enough for convalescent children, but the nurse 
 to be well equipped industrially must go into 
 the workshops and work herself side by side 
 with the patients. The occupations taught to 
 nurses must be real and legitimate, not foolish 
 "fancy work." 
 
VI 
 
 THE WELL-TO-DO PATIENT AT WORK 
 
 IT is no longer a strange thing for doctors 
 to advise work as a remedy for people who 
 have never known the significance of manual 
 occupations. Many people are nervously ill 
 because their lives lack purpose and dignity. 
 The rush of social engagements, the stimula- 
 tion of travel, the search for amusement 
 these things may satisfy for a while, but they 
 are not enough to last. It is true that we 
 would not always wish to make weavers or 
 potters out of the daughters of society. But 
 these young women, when they go to pieces 
 nervously, do so sometimes because there is no 
 depth and substance in their lives. There is 
 an "aching void" that is not filled, especially 
 when they fail to marry. The handicrafts can 
 hardly fill this void, but when the nervous in- 
 valid gets down to honest work with her hands 
 she makes discoveries. She finds her way 
 
 57 
 
58 THE WORK OF OUR HANDS 
 
 along new pathways. She learns something 
 of the dignity and satisfaction of work and 
 gets an altogether simpler and more whole- 
 some notion of living. This in itself is good, 
 but better still, the open mind is apt to see new 
 visions, new hope and faith. There is some- 
 thing about simple, effective work with the 
 hands that makes men creators in a very real 
 sense makes them kin with the great creative 
 forces of the world. From such a basis of 
 dignity and simplicity anything is possible. 
 Many a poor starved nature becomes rich and 
 full. All this is aside from the actual physi- 
 cal gains that may come from new muscular 
 activities. 
 
 The tired business man who seeks relaxation 
 and refreshment by running through Euro- 
 pean capitals is apt to be disappointed. He 
 will sometimes be disappointed when he does 
 better than that and takes the course at Carls- 
 bad or Vichy. He is still dealing with too 
 complex and highly evolved things. For real 
 rest his mind must get down to primitive life. 
 This need not always be in a medical work- 
 shop, though theoretically that should be the 
 place. Sometimes a walking trip or a shoot- 
 
THE WELL-TO-DO PATIENT AT WORK 59 
 
 ing expedition will do. The trouble with these 
 expedients is that he gets away from medical 
 advice, a very good thing to do if he is well 
 enough, and a bad enough practice otherwise. 
 A patient who tried the work cure at Marble- 
 head and who used blacksmithing as a means 
 to the desired end, said after working for a 
 week, "It is the most refreshing thing I ever 
 did. When I get to thinking about myself 
 or my business, I burn my fingers. I keep my 
 mind on the iron because I have to." 
 
 Medical workshops in private practice or in 
 connection with sanatoriums will come more 
 and more into vogue because the need of simple 
 work for nervous men and women is becoming 
 every day more widely recognized. It is not 
 enough to say to the sensitive and overwrought 
 woman, "You need to simplify your life by 
 work with your hands." We must be more 
 explicit. The direction of such work is a fine 
 art. A man nervously ill may try to work in 
 the garden on the advice of his physician. The 
 result may be a miserable failure with an added 
 disgust for gardening because such general di- 
 rection will not do at all. The patient must 
 know how much work, just what kind of work, 
 
00 THE WORK OF OUR HANDS 
 
 and when to do it. To direct work carefully, 
 to know when to advise it, and when not, is an 
 especial branch of medicine requiring experi- 
 ence and equipment. 
 
 For the well-to-do there are very attractive 
 possibilities along the line of medical occupa- 
 tions. It should be possible with the aid of a 
 silversmith, for instance, for the overwrought 
 lawyer to acquire an avocation that would keep 
 his mind in the best possible condition. Golf 
 might do it, but the season often interferes 
 and there is something about work with tangi- 
 ble results that discounts sport in the end. 
 
 For the well-to-do, work with the hands 
 may be a potent remedy against the harmful 
 effect of idleness. Last of all it may open the 
 heart and mind to a greater respect for labor. 
 If men who are themselves benefited make it 
 possible for handicapped people of the poorer 
 classes to find specialized and adapted work 
 when they need it, then the work cure will have 
 fulfilled a wide and useful purpose. 
 
VII 
 
 THE INDUSTRIAL PROBLEM OF THE 
 TUBERCULAR 
 
 EXPERIENCE has shown that the tuberculous 
 patient, except in the actively febrile stages of 
 the disease, is not only capable of a good deal 
 of physical exertion but that he may be actu- 
 ally benefited by it. Nevertheless the known 
 possibilities of contagion, and the general 
 prejudice against work for invalids, have 
 greatly narrowed the field of possible occupa- 
 tion. Vast numbers of tubercular convales- 
 cents await a possible release from the eco- 
 nomic and moral slavery of idleness. The 
 "arrested" tubercular cases, when they work 
 at all, drift back naturally to their old occupa- 
 tions and to the old conditions under which 
 the disease developed. The unsuitable occu- 
 pations are the recognized cause of a great pro- 
 portion of the relapses. With the tubercular 
 it is the cardiac situation over again the same 
 
 61 
 
62 THE WORK OF OUR HANDS 
 
 necessity for work, the same certainty of break- 
 ing down and the same poor economy for char- 
 ity to build up the patient only to have him 
 break down again and again coming back for 
 more expensive hospital or sanatorium treat- 
 ment. It is poor economy and it is to a con- 
 siderable extent an unnecessary waste, for as 
 has been demonstrated in a small way with the 
 heart cases a lighter, more favorable labor 
 may not only bring its money return, but may 
 prove a positive therapeutic value. 
 
 The situation for the tubercular does not 
 present all the difficulties of the cardiacs be- 
 cause the regular work of the tubercular is 
 usually not so severe in physical exactions. A 
 very great proportion of the tubercular in cities 
 comes from the garment industries. Here we 
 shall find excellent conditions for transmission 
 of the disease. Here are close, hot rooms full 
 of dust and many workers in small space. 
 In these shops there are usually inadequate 
 lavatory accommodations and a thousand op- 
 portunities for direct infection. The hours 
 and the work itself are trying enough, but the 
 actual physical effort is often not so very great. 
 If these people could work at the same trade 
 
INDUSTRIAL PROBLEM OF THE TUBERCULAR 63 
 
 under very much better conditions it is reason- 
 able to suppose that there would be less tuber- 
 culosis. Suppose an out-of-doors shop in sum- 
 mer, and an especially ventilated one in winter 
 suppose plenty of space between machines 
 and every hygienic facility such a shop 
 would be a good place for the tubercular con- 
 valescent to work. He would have the tre- 
 mendous advantage of using his own well- 
 learned trade and if he were guarded against 
 overwork it is reasonable to suppose that he 
 would be far less likely to break down than 
 would be the case if he went unrestricted back 
 to the old shop. If practical clothing manu- 
 factories could be established in connection with 
 the tubercular sanatoriums or the tubercular 
 camps in the cities we might see a great ad- 
 vantage gained in the fight against this dis- 
 ease. There are many points in favor of such 
 a plan. Its hygienic and economic benefits 
 might be enormous. The State could well af- 
 ford to pay the market price for the products. 
 If the labor unions were to object to this kind 
 of labor the answer is very simple let the 
 product be paid for and used by the State. 
 Another and more insistent objection will be 
 
64 THE WORK OF OUR HANDS 
 
 raised: Is it not dangerous to put into use 
 garments made by tubercular workers? The 
 answer is straight and strong: There is 
 scarcely a regular clothing shop of any size 
 that does not employ, knowingly or unknow- 
 ingly, tubercular workers. There is no at- 
 tempt made to sterilize the products they are 
 sent out and accepted by the trade. Undoubt- 
 edly, the garments made in the regular shops 
 carry possible infection. The garments made 
 in special tubercular shops would all be 
 sterilized as a matter of course they would 
 therefore on the chances be safer to use than 
 those from the regular shops. 
 
 It has been suggested that tubercular con- 
 valescents be settled on farms, that they at- 
 tempt market gardening and the like. Here 
 the objection to tubercular labor is plain 
 enough. Most city dwellers would find farm 
 life wholly impractical because they prefer the 
 city and do not like farming, which is quite 
 out of their line. More than this, while mar- 
 ket gardening and farming might be ideal 
 work for the tubercular, there would undoubt- 
 edly be possibilities of infection. 
 
 The tuberculosis camps and sanatoriums are 
 
INDUSTRIAL PROBLEM OF THE TUBERCULAR 65 
 
 performing scarcely more than half their duty 
 when they cure or arrest the disease. They 
 are not fulfilling their duty even when they 
 maintain a corps of social service workers or 
 nurses to go to the homes of former patients 
 in the interests of hygiene and social better- 
 ment. Sooner or later the State must take 
 seriously the problem of employment for the,/ 
 tubercular convalescents. If the tubercular 
 are state charges, it is only fair and reasonable 
 that they should partly support themselves, if 
 this is possible without detriment./ 
 
 Unquestionably it is good judgment to make 
 use of already learned trades if these can be 
 adapted to the new requirements. The cloth- 
 ing trade seems to offer many advantages 
 chief among which is the fact that the product 
 could be used and regulated by the State, and 
 that the State might well afford to pay the 
 workers enough to make the exertions worth 
 their while. Foremen and skilled instructors 
 could undoubtedly be found the business end 
 could be taken care of. There should be no 
 delay in trying out a plan that promises so 
 much. 
 
VIII 
 
 HANDICAPPED LABOR AND THE LAW 
 
 WORKINGMEN'S Compensation is still new in 
 this country. It is as yet impossible to pre- 
 dict what the final adjustments will be. This 
 much is certain: that the manufacturers must 
 pay something, probably two-thirds of the in- 
 jured employee's usual wages during times of 
 disability even if the disability is long con- 
 tinued. This payment will usually be made 
 of course by the liability companies. In 
 Massachusetts, at least, the liability company 
 diminishes its payments proportionately if any 
 money is earned by the workman during the 
 period of disability. Furthermore the com- 
 pany has the right to find or recommend light 
 occupation for the injured workman. If this 
 occupation is approved by a board of arbitra- 
 tion the workman must perform it or lose his 
 compensation altogether. It is evident that 
 this provision would do away with unneces- 
 
 66 
 
HANDICAPPED LABOR AND THE LAW 67 
 
 sarily long convalescence on the part of indi- 
 viduals inclined to take advantage of the liber- 
 ality of the law. Apparently the liability 
 companies might with profit to themselves and 
 advantage to their clients actually assist in the 
 founding and maintenance of specialized in- 
 dustries for the partial employment of the 
 handicapped. Let us suppose that a man 
 earning $10 a week is disabled by a crushing 
 injury to one hand. Some of these injuries 
 are a long time healing four months might 
 not be an unreasonable period of disability. 
 This would mean a total payment of $106.72. 
 If after the first month the man could earn $6 
 a week in a hospital workshop the company 
 would make a saving of $4 a week for three 
 months a total of $48. It would not seem 
 an unreasonable arrangement to return half 
 of this saving to the workshop and some por- 
 tion of the other half to the employer in the 
 way of reduced premiums. 
 
 If these specialized workshops are under 
 hospital control there will be no danger of in- 
 justice to the handicapped worker, for the 
 physical condition will be carefully studied and 
 the work carefully adapted to the case. This 
 
68 THE WORK OF OUR HANDS 
 
 is a new aspect of the situation but one worth 
 the consideration of employers, insurance 
 companies and hospitals. 
 
 Industrial accident problems are likely to 
 grow more and more perplexing for some time 
 to come. The number of the unemployed will 
 be increased by the unwillingness of the insur- 
 ance companies to allow the handicapped in any 
 regular industry. The companies cannot be 
 blamed for this because the danger of accident 
 is increased by such employment. So we shall 
 see the growing necessity for an adequate sys- 
 tem of handicapped labor protected and en- 
 couraged by manufacturers, by insurance 
 companies and by the charities. From the 
 point of view of the injured employee there is 
 advantage both moral and financial to be found 
 in low pressure industries. So far as early 
 and very limited observation go the men are as 
 a rule glad to be at work, especially when it 
 means the learning of a new trade which may 
 save them from final dependence. There are 
 many cases in which the injured employee 
 through no fault of his own gets out of the 
 way of work loses his knack and becomes 
 dependent. Sometimes a carefully conducted 
 
HANDICAPPED LABOR AND THE LAW 69 
 
 campaign of modified occupation would save 
 such an unfortunate occurrence. There are 
 many trades which could support a hand work- 
 ing department on low wages with benefit to 
 all concerned. The product would be small 
 but it need not be inferior and it is conceivable 
 that cleverness of design and special workman- 
 ship might produce surprising results. It is 
 probable that the employer could afford in 
 many instances to conduct such a side line since 
 he would pay less for his product and since he 
 might in this way reduce in time the size of his 
 insurance premiums. 
 
PART II 
 I 
 
 TEACHING OF THE HANDICAPPED 
 Introduction 
 
 IN directing the handicapped, the manual 
 training teacher must solve many complex and 
 peculiar problems. 
 
 The work here described covers about ten 
 years of personal experience, and includes 
 groups of handicapped students, such as those 
 deformed from childhood, those crippled by 
 accident or old age so that they have ceased to 
 be wage earners ; and a large number suffering 
 from functional and organic nervous diseases, 
 and from mental diseases. 
 
 In some cases work has gone on with the 
 same pupil for several years, and he has be- 
 come sufficiently expert to need only super- 
 vision, not instruction, and to earn a modest 
 income. It may be definitely stated that the 
 
 71 
 
72 THE WORK OF OUR HANDS 
 
 work has been sufficiently hopeful to be con- 
 vincing of the great possibilities of handicrafts 
 in the future, not only as a means of reclaim- 
 ing to productive industry many at present in- 
 capacitated through illness or lack of proper 
 training, but as a therapeutic agent of great 
 value. In every community, even the smallest 
 village, there are people who never get the sat- 
 isfaction which work gives. The household in- 
 dustries of a hundred years ago were usually 
 carried on in such a way that even the crippled 
 and mentally deficient had their share, and 
 there were few drones in the hive. Weaving, 
 shoe making, coopering, cane and rush seating, 
 netting, and other handicrafts were planned 
 so that some humble share could be assigned 
 even to the least efficient. It appears that it 
 is through such simple means that the incompe- 
 tent may still be rehabilitated. Some of these 
 industries can, of course, be carried on better 
 by machinery, but there are many which, like 
 chair caning and cobbling, can still be best done 
 by hand, and others in which cooperative work 
 can be done, as in cement work, so as to employ 
 several individuals. 
 
 In the large cities the hospital clinics are 
 
TEACHING OF THE HANDICAPPED 73 
 
 visited by "chronics" who never get quite well 
 enough to work at anything our complex city 
 life affords, and often end prematurely in the 
 almshouse. Among such are rheumatics, par- 
 alytics, cardiac cases, the partially blind, all 
 able to do a little if only the way could be 
 pointed out, and that along lines where they 
 would not compete with other people strug- 
 gling to earn a livelihood. 
 
 The ideal plan in the work cure is to have a 
 craftsman who plans the work, the details of 
 which are carried out by a teacher or a teach- 
 ing nurse. But in many places, especially 
 where the work is first introduced, the design- 
 ing and teaching fall to the lot of one person. 
 
 In order to succeed in teaching any craft the 
 instructor must be familiar with every detail 
 and enthusiastic over that particular industry, 
 but if her mind is so concentrated on fine crafts- 
 manship that she is indifferent to human in- 
 terests, she will surely fail in this new field. 
 She is not merely teaching him how to work, 
 but how to think, how to use disused members, 
 how to work effectively when he is unused to 
 working at all. She must be able to rouse in- 
 terest in him when he does not want to be in- 
 
74 THE WORK OF OUR HANDS 
 
 terested, and to detect the difference between 
 laziness, which she has to help him to outgrow, 
 and fatigue, which she must give him a chance 
 to overcome by proper rest. She must be pre- 
 pared for sudden flagging in interest, and "off 
 days" when nothing goes right with him. She 
 may be so fortunate as to have a physician to 
 do some of the thinking for her, and a nurse 
 to watch the signs of fatigue, but still the fact 
 remains that the brunt of the daily routine 
 must fall on her, and if this constant adapting 
 of the work to individual needs seems boring 
 to her, she is not fitted for this kind of teach- 
 ing; if she is adapted for it the difficulties 
 enumerated will only add zest to the game. 
 
 The quality which is indispensable in a 
 teacher of the handicapped is an ability to 
 rouse interest, and this can be largely culti- 
 vated. All manual work is in itself so full of 
 charm that the teacher ought to be able to se- 
 lect the salient features so as to call the pa- 
 tient's attention to them, even in humble indus- 
 tries like basketry; but she must be perfectly 
 familiar with her subject; for instance, a bas- 
 ketry teacher ought to know how to make 
 at least twenty kinds of baskets for every con- 
 
TEACHING OF THE HANDICAPPED 75 
 
 ceivable purpose, and have some good samples, 
 and then she has a sure frame work on which 
 to build up her fabric of interest. 
 
 A very necessary quality is patience will- 
 ingness to look ahead for results, to work with 
 almost imperceptible advance from day to 
 day, sometimes to allow for backslidings in 
 health or interest on the part of the pupil and 
 to overlook little peculiarities due to invalid- 
 ism or depression, such as irritability and fits 
 of pique against the teacher or the work. 
 
 Another quality to be cultivated is farsight- 
 edness. The question often arises as to how a 
 certain person should be trained. Physical 
 and mental ability must be considered, but the 
 work selected should be based on the physi- 
 cian's judgment. Is the work given to be a 
 temporary diversion, a means of cure, or is it 
 something to be part of the patient's life, either 
 as an absorbing interest or a source of income? 
 In the first instance the teacher might be justi- 
 fied in giving pieces of work pleasing as speci- 
 mens, which do not show any special progres 
 sion. A convalescent from typhoid might be 
 amused by work which would be a waste of 
 time for a cripple who needed to spend his time 
 
76 THE WORK OF OUR HANDS 
 
 on something which might be helpful to him 
 physically, or lead to some financial benefit. 
 
 Physician and Teacher 
 
 There must be a complete understanding 
 between the doctor and the teacher as to how 
 much may reasonably be expected of the pa- 
 tient. No person so ill as to be in a sanatorium 
 or under the care of a physician at home can 
 work like a normal individual. The amount 
 to be done, the nature of the work, whether it 
 should require much or little physical strength, 
 whether it should stimulate the creative pow- 
 ers or be of a restful monotony, all these points 
 should be made clear to the teacher. Such 
 conditions can be condensed into a few words 
 on a card, as per example 
 
 May 1, 1914 
 
 Occupation work 
 
 Mrs. X Room 50 
 
 Light occupation in bed. 
 
 Basketry or Knitting. 
 
 Not more than 1 hour daily. 
 
 , M.D. 
 
TEACHING OF THE HANDICAPPED 77 
 
 May 1, 19U 
 
 Mr. D , Ward . 
 
 Occupation in workshop. 
 Heavy Work. 3 hours daily. 
 Running Printing Press. 
 
 , M.D. 
 
 The teacher's province is particularly to 
 start the patient working, and make him feel 
 that work is worth doing. The carrying out 
 of the directions may then be left to a nurse 
 or an attendant. Often the physician can 
 pave the way for the teacher by trying to in- 
 terest the patient and make him feel that work 
 is a privilege, not a penance. 
 
 The question as to whether it is necessary 
 for the teacher to know the diagnosis and fam- 
 ily history of a patient is one often raised by 
 new teachers. Generally speaking, it is not 
 necessary. Work is one of the few normal 
 habits left to the patient, and the nearer he 
 can approach to health in his relations with 
 the teacher the better. A knowledge of the 
 nature of his illness and the causes leading to 
 it are liable to lead the teacher and patient into 
 unprofitable conversations. 
 
78 THE WORK OF OUR HANDS 
 
 On the other hand there are certain diseases 
 in which the therapeutic value, and there are 
 others in which the social value of work is 
 greatly enhanced hy the knowledge of the pa- 
 tient's especial discouragements and disabili- 
 ties. Where the physician feels that the 
 teacher can cooperate with him more closely 
 by knowing the nature of the patient's malady, 
 he will generally be glad to inform her. Work 
 for a definite aim is naturally more interesting 
 to the teacher, and the writer's own experience 
 has been that when she worked intelligently 
 with the physician to obtain a certain result the 
 occupation was much more satisfactory. 
 
 The teacher should remember in making re- 
 ports to the physician in regard to occupation 
 work that they should be concise. Where 
 there is any marked peculiarity, such as long 
 continued apathy in regard to work, or stub- 
 born opposition, it should be reported, as it 
 may indicate an abnormal mental condition. 
 
 The physician who has a trained nurse look- 
 ing after a patient can call on her to aid the 
 teacher, who may see her pupil only three or 
 four times a week. Generally the nurse be- 
 
TEACHING OF THE HANDICAPPED 79 
 
 comes interested, and works with her patient, 
 which is stimulus to both. 
 
 In some hospitals, occupation work for 
 nurses covering only work which can be done 
 without equipment in the patient's home has 
 proved useful. The course includes the mak- 
 ing of a few reed and raffia baskets, caning a 
 chair, binding a kodak album, etc., and takes 
 one evening a week for six months. It enables 
 the nurse to supplement the work of the crafts- 
 man teacher, and in some instances, to work 
 with the patient without this supervision. 
 Nearly every nurse who has taken this work 
 has reported it as being of practical value, par- 
 ticularly in dealing with nervous invalids. 
 
 Study of the Patient 
 
 Work with invalids may be roughly grouped 
 into two classes: 
 
 A. Palliative. 
 
 B. Remedial. 
 
 What is called diversional occupation might 
 be put into the first group, and would be suit- 
 able for patients in receiving hospitals who 
 remain only a week or so for diagnosis, and for 
 
80 THE WORK OF OUR HANDS 
 
 patients in the advanced stages of cancer or 
 tuberculosis, to whom nothing could do more 
 than brighten the weary hours. (Yet some 
 very good work is done in homes for incurables 
 and it may be noted that even with such hope- 
 less cases real work like basketry, knotted raffia 
 bag making or coarse knitting, seems to give 
 more pleasure than the making of egg-shell 
 dishes, and paper furniture, sometimes called 
 diversional occupation, but which would seem 
 most suitable for children.) 
 
 Remedial work may be subdivided into that 
 which is done 
 
 1. For its therapeutic value, as a means of 
 treatment, and that which is done 
 
 2. For its economic value, to enable the pu- 
 pil to become master of some handicraft which 
 will bring him money. 
 
 The remarkable success which has followed 
 the attempts to teach industrial work to the 
 blind and crippled show the possibilities along 
 these lines. Other groups, like epileptics, 
 cardiac cases, dementia praecox cases, etc., are 
 now being worked with in the same way to put 
 them in a position to earn a livelihood. 
 
 In the effort to consider the practical value 
 
TEACHING OF THE HANDICAPPED 81 
 
 of occupation work, the effect on character 
 must not be overlooked. Work is so much a 
 part of the normal human life that the absence 
 of it for any length of time throws the indi- 
 vidual out of balance. In old people's homes 
 the inmates are often full of petty feuds and 
 foolish animosities; in nearly every such insti- 
 tution where occupation work has been intro- 
 duced life has become happier. In hospitals 
 where patients are allowed work to while away 
 the time, they have had one tie to hold them to 
 the work of health and activity, and have had, 
 too, less time in which to meditate on their own 
 sufferings and on the shortcomings of their 
 nurses. They have often got new interests in 
 life. Industrial teachers have often received 
 letters of thanks from patients taught only a 
 few weeks. 
 
 In choosing work of economic value it is im- 
 portant to know whether the prognosis for the 
 patient is for an early and complete disability 
 or for a long semi-invalidism. The patient 
 should always be studied for some time before 
 any handicraft is chosen as a possible means 
 of livelihood. 
 
 The attitude of the patient toward work is 
 
82 THE WORK OF OUR HANDS 
 
 often puzzling to the inexperienced instructor. 
 The habit of invalidism is the strongest habit 
 in the prospective pupil, and to bring him back 
 to the normal attitude toward work as an es- 
 sential part of the daily routine takes tact and 
 perseverance. There are some pupils who 
 plunge into work with a feverish eagerness, 
 which, if unrestrained, soon tires them out, and 
 there are others who are so preoccupied with 
 their symptoms that they have little thought 
 to spare for work. Besides these there is an 
 apathetic class, easily bored, complaining of a 
 fatigue for which there is no cause apparent to 
 the teacher, in the physical labor attempted. 
 This is perhaps the true neurasthenic type, 
 easily tired and easily worried. The patient 
 of this type frequently becomes interested and 
 finally enthusiastic; he often develops resources 
 hitherto unsuspected, even by himself, and his 
 return to health may result in his living on a 
 higher plane than before his illness. 
 
 Another type of patient shows an appar- 
 ent indifference, a dullness which is almost 
 lethargic, due to an organization so poorly en- 
 dowed that he must be counted a "constitu- 
 tional inferior" or a "mental inferior" ; he lacks 
 
TEACHING OF THE HANDICAPPED 83 
 
 vigor of mind and body; his perceptive facul- 
 ties are dull, and his muscles flabby so that 
 little beauty reaches him through the senses, 
 and he cannot get much pleasure from using 
 his strength or skill. A most unpromising 
 outlook, yet such individuals, children and 
 adults, have frequently a surprising degree of 
 "stick-to-it-iveness," and well chosen work sim- 
 ple enough to be done well, but not lacking in 
 variety, may provide a road along which they 
 may walk happily. Our complex civilization 
 offers a poor foothold for such as these, but the 
 teacher who can understand this apparent in- 
 difference, and rouse the latent activity, may 
 find there is truth in what William Penn once 
 boldly asserted, that "Industry supplies the 
 want of parts." 
 
 Helping such individuals as this is peculiarly 
 the province of the teacher, rather than that 
 of the physician or nurse. There must be a 
 continued appeal to the pupil's interest and a 
 constant variety in the method in which work 
 is presented, with adults as well as with chil- 
 dren of this type. If there is any one talent, 
 however trifling it may seem, it must be made 
 much of to give self-confidence. Much work 
 
84 THE WORK OF OUR HANDS 
 
 of this kind is already being done with children, 
 but it is the writer's conviction that in a few 
 years the field will be enlarged to include 
 adults who have never "made good," but who, 
 under proper training, will develop unexpected 
 capabilities. "Efficiency tests" such as are 
 now used in many industrial concerns may in 
 time be applied to bring out abilities in such 
 persons. Meanwhile, it will be seen that the 
 initial attitude of the pupil, in any of these 
 groups, counts for little, and the teacher's at- 
 titude is the important one. If she is fully 
 convinced herself that honest work is the back- 
 bone of life, her work-room will be cheery, 
 and her pupils, no matter how depressed on 
 beginning, will become imbued with this op- 
 timistic spirit of the true craftsman who sings 
 at his work. If there are expert workers who 
 are not invalids, or those cured of their ills, 
 working at the same craft, it often adds to the 
 feeling of stability on the patient's part. 
 Work no longer seems a therapeutic agent, 
 ordered by the doctor along with Nauheim 
 baths, and eight eggs a day, but a natural, 
 wholesome part of life. 
 
II 
 
 METHODS OF TEACHING 
 
 THE methods of teaching invalid pupils must 
 vary with the facilities at hand and with the 
 nature of the diagnosis. Sufferers from 
 purely physical maladies uncomplicated with 
 "nerves" may work together comfortably in 
 large classes for several hours at a stretch. 
 They often show unexpected powers of endur- 
 ance ; cripples, especially, seem often to be able 
 to work a long time without change of posi- 
 tion. Perhaps nature in adapting them to 
 live handicapped by deformity has given them 
 an armor which makes them fatigue-proof. 
 Often, too, suffering has given them "the 
 philosophic mind," and they can make the best 
 of circumstances and work skillfully and hap- 
 pily under trying conditions, unwilling to ad- 
 mit that they are tired. As a matter of fact, 
 physicians assert that few cripples are inca- 
 pacitated for steady work, and the considera- 
 
 85 
 
86 THE WORK OF OUR HANDS 
 
 tion of methods may concern itself with physi- 
 cal conditions, such as proper tables and chairs 
 for individuals, and the selection of work, 
 adapted to peculiar physical limitations. 
 
 The methods of work with those suffering 
 from nervous and mental diseases is a much 
 more complex problem. The question of the 
 necessity for individual teaching is an impor- 
 tant one. Wherever possible, the worker 
 should be made to feel himself an essential unit 
 of a whole ; but in many cases, if he is unused 
 to work, he must have an opportunity for un- 
 disturbed effort until he becomes accustomed 
 to the work-room. A secluded corner may 
 save much weariness of mind and body, as well 
 as the avoidance of errors in his work. The 
 noise of machinery, conversation, or any out- 
 side sound, disturbs the attention of one long 
 unaccustomed to work. Often such a patient 
 does better at first in his own bedroom; his in- 
 terest can be roused so he is in a receptive at- 
 titude toward work in the shop before he be- 
 gins to work there. On the other hand, some 
 depressed patients become interested at once 
 in the work of others; their spirits rise with 
 the sight of cheerful, industrious people, and 
 
METHODS OF TEACHING 87 
 
 the sooner they get in the midst of a group the 
 better. Such points in regard to the manage- 
 ment of the work-room may generally be best 
 settled by the physician who knows the pa- 
 tients' temperaments. These details are much 
 more important than they may appear. We 
 all remember that the nearest neighbors in our 
 school days were influential in helping or hin- 
 dering our work; no one is so completely ab- 
 sorbed in work as to be oblivious to his neigh- 
 bors, even in a factory. This is eminently true 
 in regard to the grouping of workers where the 
 craftsmen are invalids, and great tact must be 
 used in order to keep the atmosphere whole- 
 some. Praise for effort should be given un- 
 grudgingly ; but praise of results should not be 
 too lavish. Sometimes a piece of work which 
 looks very simple is the first actual accomplish- 
 ment for years in the way of handicrafts, and 
 to carry it to completion is a milestone in the 
 way to recovery. It is often difficult to decide 
 whether a patient should stick to one thing un- 
 til it is completed, or should be allowed variety. 
 There are some nervous invalids who are al- 
 ways craving change, their interest needs con- 
 tinual fillips produced by new work. Such 
 
88 THE WORK OF OUR HANDS 
 
 patients may have been under the charge of 
 many physicians, and may have wandered from 
 Maine to California. Trying to hold them to 
 one thing sometimes arouses stubbornness. It 
 is a good plan to have a variety of the same 
 kind of work, so that the interest may be kept 
 up, while the patient is still working at the 
 same craft. Sometimes, too, it is wise to allow 
 the patient a liberty of choice in order to find 
 any genuine talent for some kind of work. 
 
Ill 
 
 READJUSTMENT 
 
 ONE who falls a victim to any organic disease 
 may remain the same in character, his quali- 
 ties and inclinations may be unchanged, the- 
 oretically he may be the same individual, but 
 not infrequently he has changed from a plus 
 quantity to a minus. If he becomes a plus 
 again it is because his efficiency has survived, 
 and he has devised some means by which he 
 can carry on his work, or because he has mani- 
 fested an adaptability which has enabled him 
 to turn his energies into new channels. But, 
 unfortunately, before he is in a condition to 
 readjust his life to changed circumstances he 
 must go through a period of mental struggle, 
 if he is at all sensitive, almost as hard to bear 
 as his physical pain. To become a burden to 
 his friends, or worse still to rely on public 
 charity, to become unable to walk, to have 
 years of suffering as his only future outlook, 
 
90 THE WORK OF OUR HANDS 
 
 these forebodings of evil only too often rivet 
 his attention. Character is prone to dete- 
 riorate under such a strain; the patient is liable 
 to become despondent, leaning on others and 
 demanding an unnerving pity which makes 
 him feel more and more that his sufferings are 
 undeserved, or he may shut himself away from 
 the natural wholesome sympathy which would 
 give him new courage. This point is illus- 
 trated by a physician's letter to a patient suf- 
 fering from an agonizing form of heart dis- 
 ease, in which the following sentence occurs : 
 "Physical pain is an insidious enemy, and we 
 cannot come to the end of the trap that it can 
 lay for us in our imaginations. Above all, 
 avoid falling in love with your own inevitable 
 isolation; and do not use the conquered tor- 
 ments of your body as stones to build a walled 
 castle for your mind." Perhaps no real physi- 
 cian would write to a patient in such language 
 (this one lives in the pages of a novel) , but he 
 has hit on a danger which needs pointing out, 
 and one in which a thoughtful teacher can be 
 of great service to his patient. 
 
 The teacher who is associated in the pa- 
 tient's mind with the activities of life, with 
 
READJUSTMENT 91 
 
 work and wages and other mundane interests, 
 can help hold him to these, so that he will not 
 necessarily feel himself out of it at all. How- 
 ever handicapped he may be physically, he can 
 be made to feel himself still an individual unit 
 in a world of working men and women, that 
 his efficiency is merely in abeyance, not lost. 
 
 This period when the patient is trying to be- 
 come accustomed to his unfamiliar physical 
 disability is perhaps harder for him to bear 
 than an actual burden of invalidism in the later 
 years but frequently it is the teacher's great 
 opportunity. The results of occupation work 
 are too often measured in terms of so many 
 baskets or so many pages of typewriting. 
 Keeping alive the desire for efficiency, and 
 stimulating the imagination toward develop- 
 ing new resources are always legitimate efforts. 
 With the return of a more normal state, when 
 mind and body have become habituated to new 
 conditions, the interest in occupation may well 
 become a dominant one. Possibly stored up 
 reservoirs of energy are tapped; at any rate, 
 there is often a surprising degree of adaptation 
 to changed conditions, when there is no great 
 improvement in actual health. 
 
92 THE WORK OF OUR HANDS 
 
 One of the most important features in re- 
 education is the opening out of broader inter- 
 ests to those who are liable to remain incapable 
 of getting out. The "shut-in" may be a 
 pitiable object, or he may be a person with a 
 wide knowledge and a philosophical mind. It 
 is well within the province of the occupation 
 teacher to open new channels of thought, and 
 to clear out the debris from long disused ones. 
 Any one familiar with hospital life knows that 
 the usual basis of thought is illness, compari- 
 son of symptoms and personal experiences in 
 regard to physicians and nurses. In any large 
 city hospital there are many nationalities rep- 
 resented, and there are possibilities for real 
 social intercourse. The subject of national 
 music, for instance, is one of real interest, and 
 among those from country districts, the meth- 
 ods of agriculture, and primitive industries. 
 Men and women whose recent work has been 
 in the monotony of factories, or of crowded 
 tenements, recall with pleasure the scenes of 
 their childhood in Europe. Old crafts are dis- 
 cussed, and interest in handicrafts is stimulated 
 by such social intercourse. Basketry, for in- 
 stance, has been the subject in the writer's 
 
READJUSTMENT 93 
 
 classes, where the pupils were Italian, Russian, 
 Hungarian, and sometimes German or Aus- 
 trian. The revival of old memories seemed to 
 distinctly stimulate their mental life. 
 
 Men and women alike seem to be benefited 
 by their interest in a common handicraft. 
 What may be called the cultivation of the 
 power to exchange ideas is often sadly lacking 
 in the lower classes of the great cities. If, as 
 has been said, "The happiness of life depends 
 very largely on being able to get into ready 
 touch with the mind of others," it is worth 
 while for the teacher to encourage these dis- 
 cussions of work. All handicrafts go back far 
 into the history of the race, and are connected 
 with every phase of life. An interest in any 
 one of them must be wholesome, even if they 
 do not offer fields of employment to the handi- 
 capped. 
 
 The work of the occupation teacher fre- 
 quently overlaps that of the teacher of re- 
 educational physical exercises, so in this phase 
 of readjustment the physician should be the 
 one responsible for every step taken. In cer- 
 tain forms of paralysis, for instance, manual 
 work often aids in the regaining of the use of 
 
94 THE WORK OF OUR HANDS 
 
 the affected members, but as the work given 
 should be planned in relation to the cause of 
 the paralysis it should be prescribed by the 
 physician. In some cases the patient needs to 
 be encouraged to use his will, to get control 
 of the part affected; in others, the less con- 
 sciously the effort is made the more beneficial 
 the effect. Some of these cases will be taken 
 up in detail later on. In general, it may be 
 said that therapeutic manual work is particu- 
 larly helpful in the treatment of all physically 
 handicapped patients, who find more interest 
 in it than in calisthenic drills. 
 
IV 
 
 ORGANIC NERVOUS DISEASES 
 
 Tabes (Locomotor Ataccia) 
 
 IN order to thoroughly test the value of oc- 
 cupation work for those suffering from organic 
 nervous diseases it is essential that the teacher 
 have the opportunity to come in contact with 
 each patient for a long period of time. This 
 is not often possible, as the patient frequently 
 changes his hospital or his physician, usually 
 in the vain hope of speedy recovery. Often, 
 too, such cases come from the shifting part of 
 the population, unskilled laborers accustomed 
 to working wherever they can get a job, in 
 the habit of moving often, so that it is difficult 
 to keep track of the home address. The na- 
 ture of certain maladies is such as to make the 
 victims restless, and to sap their ambition. 
 Persons crippled by accident are more desir- 
 ous to become self-supporting than those 
 handicapped by disease. There are certain ail- 
 
 95 
 
96 THE WORK OF OUR HANDS 
 
 ments which tradition has credited among the 
 ignorant with causing a slow and painful death 
 in life. Tabes is one of these. As a matter 
 of fact, however, there are many tabetic men 
 and women who are able to earn a good liveli- 
 hood, some in their regular avocations, and 
 others in new ones, adapted to meet their 
 changed conditions. The discouragement and 
 restlessness of many of these individuals there- 
 fore seems to be partly due to an unnecessary 
 lack of self-confidence. 
 
 The following records of tabetic patients who 
 have been under observation as pupils for the 
 last six years show what good work can be done 
 by an average group of comparatively helpless 
 men and women, all past middle life, and in a 
 home for chronic invalids. They have good 
 living conditions, simple food, regular hours, 
 and cleanliness. No lessons have been given to 
 reeducate them in walking, and the only exer- 
 cise most of them have had is that incidental to 
 making baskets, caning chairs, etc., yet only 
 one of this group has failed markedly in the 
 six years; on the other hand, they are all able 
 to use their hands better, some are able to walk 
 better, and all have a better mental outlook 
 
BASKETRY AND WEAVING DOXE AT BLOOMINGDALE 
 HOSPITAL, WHITE PLAINS, N. Y. 
 
ORGANIC NERVOUS DISEASES 97 
 
 owing to the fact that they are able to work, 
 that their lives are regulated by a systematic 
 routine, and that they have broader interests 
 growing out of their common tasks. The 
 teacher of this group found constant encour- 
 agement necessary at first. It was very diffi- 
 cult to inspire a belief in future efficiency. 
 This constant optimistic attitude had at last 
 a distinct therapeutic effect. Encouragement 
 became less and less necessary and self-confi- 
 dence returned. 
 
 CASE I. Swede. Male. Age 50. Elec- 
 trical engineer. 
 
 When his lessons began he had been ill five 
 or six years; had gradually become unable to 
 walk (on entering the hospital he used a wheel 
 chair), thought he could not use his hands for 
 any fine work; had become unnaturally taci- 
 turn; was at first unwilling to try to make 
 baskets, as he called this "peasant's work." He 
 soon began to use his hands freely and became 
 very proficient. His work is so good as to sell 
 at the sales of the National Society of Crafts- 
 men, and he has learned to make seventy-five 
 distinct styles of baskets. Many of these are 
 variations of the Swedish birds' nest basket, 
 
98 THE WORK OF OUR HANDS 
 
 flower baskets, etc., which he saw in his youth. 
 He still finds walking difficult, and while he 
 walks two miles a day for exercise in the corri- 
 dors in the hospital he keeps one hand on his 
 wheel chair, pushing it in front of him. He 
 cannot use a hammer or saw, or do any work 
 requiring much strength, but his lower arms 
 and hands are entirely under control, and he 
 has resumed the study of the violin, which he 
 had been unable to play for many years, and 
 plays with great delicacy. He is able to do 
 mechanical drawing again, and is in hopes after 
 twelve years of invalidism to take a residential 
 position in a school to teach draughting and 
 manual training. 
 
 CASE II. Colored. Male. Age 36. Car- 
 penter. 
 
 Was in bed nine months before industrial 
 treatment began. At that time he was up and 
 beginning to walk, but with much fear of fall- 
 ing; said he was unable to walk at all without 
 a cane; could not use hands well; had difficulty 
 in dressing himself; he welcomed with eager- 
 ness the chance to try some basketry, but could 
 not make reed baskets. After some experi- 
 menting the teacher found he could use very 
 
ORGANIC NERVOUS DISEASES 99 
 
 fine materials and do raffia work sewed with a 
 needle (like Indian basketry), but he could 
 not thread a needle, nor pick it up in case he 
 dropped it. He had, however, a great degree 
 of persistency, and natural courage. He soon 
 got control of his materials, although he says 
 he still has no feeling in his fingers, but that 
 he has learned to "manage without it." His 
 work is artistic in color, and the designs are 
 worked out very accurately. His baskets are 
 sold by the National Society of Craftsmen for 
 from $5 up. He is able to do fine work as 
 his eyesight has remained good. He is be- 
 ginning to use his arms, and is trying chair 
 caning to get control of the upper arm. He 
 tried weaving, but could not prevent the 
 threads tangling because of the numbness of 
 his fingers. He walks better, but sometimes 
 falls. He had formerly a good singing voice. 
 For two or three years he could not control it, 
 and it was harsh, discordant, but the quality 
 has returned, and he is able to control it well 
 enough to sing in a choir. 
 
 CASE III. Colored. Male. Age 50. 
 Nearly white, part Irish. 
 
 "Handy Man" who never had a trade; had 
 
100 THE WORK OF OUR HANDS 
 
 been ill five or six years; walked with great 
 difficulty and preferred to use wheel chair. 
 Had frequent attacks of indigestion and spent 
 nearly half his time in bed in great pain. 
 Very irritable and quarrelsome, no interest in 
 life, no mental resources, convinced in his own 
 mind that "he could never be any good." Re- 
 fused to try any occupation work, until he saw 
 other patients sell work. As soon as he began 
 to work he became interested. His work at 
 first was crude, his hands were not under his 
 control. He soon began to develop originality, 
 and on his bad days lay in bed, and planned 
 what he would do when he got up. His prog- 
 ress toward good work was very slow but he 
 can now do both basketry and chair caning. 
 He makes very large, coarse raffia baskets, very 
 substantial and decorated with animals in 
 quaint designs, owls, parrots, bluebirds, and 
 even bulls and deer. He can sell all he can 
 make at $4 each. His eyes are very defective; 
 he walks badly, but he is happy in his work, in 
 fact, his nature has changed considerably for 
 the better. Previous to this time he had no 
 opportunity to learn any work that was either 
 interesting, or well paid, and he has also an 
 
ORGANIC NERVOUS DISEASES 101 
 
 artistic instinct which never "had the 'opjpor-' 
 tunity of expression. He is able to buy his 
 own clothing, and to pay his own carfare for 
 short visits to his friends, and gets great sat- 
 isfaction in not being entirely an object of 
 charity. 
 
 CASE IV. Englishman. Age 49. Cab- 
 inet-maker. 
 
 Had been in hospital one year; walked very 
 badly, and had trouble with his eyesight ; could 
 not lift a heavy hammer, nor control his arm 
 to drive a nail. He was, however, able to learn 
 to weave on a hand-loom very quickly, and had 
 no difficulty except in threading it. His work 
 was salable from the first. He also learned 
 reed basketry, and filled an order for five 
 dozen baskets from a florist. He was very 
 easily discouraged and his lack of control of 
 his fingers exasperated him. His threads be- 
 came tangled in weaving, and he fumbled with 
 his basket materials. He constantly compared 
 his former skill with his present inefficiency. 
 He recovered the use of his hands somewhat, 
 and was able to do part time work on the 
 switch-board as telephone operator, and he also 
 walked better so that he could act as a mes- 
 
102 THE \TOBK OF OUR HANDS 
 
 senger for the hospital, as well as do indus- 
 trial work. Later he had a general break- 
 down, and is just recovering after several 
 months in the hospital ward. He walks well. 
 
 CASE V. Light, or "bright-skinned" col- 
 ored woman, with some Indian blood. Age 60. 
 
 When lessons began she had been ill five or 
 six years; walked with difficulty with a cane. 
 Hands jerked when she attempted to move 
 them. Very irritable temper; complained of 
 her eyes troubling her and of headache ; willing 
 to learn basketry because she was under ob- 
 ligations to several people to whom she would 
 like to make a present. She became interested 
 at once, and showed great persistency, and 
 some color sense; had difficulty in controlling 
 her hands, but work on a small hand-loom 
 seemed to help her regain control of them. 
 She has never shown much originality, but her 
 work is exceptionally firm in quality, and she 
 has better control of her hands, but cannot do 
 fine sewing. She walks about the same as 
 ever, using a cane. Her work has been of 
 great benefit socially, as it keeps her happily 
 occupied, and affords her a means of working 
 
ORGANIC NERVOUS DISEASES 103 
 
 off her irritability on an inanimate object in- 
 stead of on her neighbors. 
 
 CASE VI. German-American. Age 43. 
 Pianist in music halls. 
 
 Eyesight very poor, willing to try basket- 
 weaving as a curative measure, but not in- 
 terested in craft work for its own sake. 
 Thought he could not learn basketry or chair 
 caning, after trying for some weeks, as he said 
 he became confused when he looked at the 
 work. (This was soon after the onset of his 
 illness and he was depressed, and self- 
 centered.) The teacher concluded he might 
 be helped through interest in other invalids, 
 and got him to play ball with child patients. 
 He soon learned to use his hands and arms 
 sufficiently to play ball with a soft, large rub- 
 ber ball. After this he was taught to cut out 
 pictures to make a scrap-book for child pa- 
 tients. He had difficulty in holding scissors 
 at first, but finally succeeded, and learned also 
 to cut accurately and to eventually manage 
 pasting. As he regained the use of his hands, 
 he wished to try to practice on the piano, and 
 permission was obtained for him. He was 
 
104 THE WORK OF OUR HANDS 
 
 very slow in getting control of his fingers, but 
 this may have been partly due to lack of con- 
 fidence, as his depression was so extreme as 
 to seem almost like melancholia. His atten- 
 tion was fixed on his own condition, and he 
 was sure he would never be any better. Dur- 
 ing a gastric crisis he attempted suicide by try- 
 ing to jump from a fourth floor window. 
 However, these symptoms disappeared as he 
 became able to play again, and to get about 
 the streets. He never recovered his courage 
 sufficiently to attempt to walk in the street, 
 and goes about on a tricycle. He is able to 
 fill some professional engagements, and if 
 necessity forced him to depend entirely upon 
 himself he could probably do so. It might 
 be better for him if he had to support himself. 
 These six cases are selected from eighteen 
 or twenty taught for the same length of time 
 as showing average results. The choice of 
 work was necessarily limited, for attempts at 
 heavier work proved that it would be useless 
 to try anything requiring much physical 
 strength. Not one of these patients can as 
 yet handle a hammer. 
 
ORGANIC NERVOUS DISEASES 105 
 
 CASE VII. American. Age 52. Country 
 merchant (small notion store). 
 
 This man kept at work until his illness was 
 so severe that he was often confined to his bed. 
 Some of his wealthy customers formed a com- 
 mittee to help him dispose of his property, 
 which he did, investing the proceeds, a few 
 hundred dollars, so the interest would help pay 
 the bills of his two children in a semi-private 
 "home." He was admitted to the county 
 home on condition that he be allowed a pass to 
 go out to peddle small wares through the 
 country in the summer. After he had tried 
 this two summers he was sent to the clinic with 
 the suggestion that he learn chair caning to do 
 in the winter, when he could not go out. His 
 eyesight was not good, and he worked awk- 
 wardly, but anyway his inattention and lack of 
 interest would have prevented his becoming 
 proficient. He openly said that he had plenty 
 of friends to help him, and that he did not care 
 to bother to learn anything new. He could 
 walk quite well, and tried to avoid going out 
 wet days, so that the exercise seemed likely 
 to be good for him, but the next summer he 
 
106 THE WORK OF OUR HANDS 
 
 lost many customers, perhaps because of the 
 fact that he had begun to trade on his in- 
 firmities and try to arouse sympathy. He 
 asked for food from farmers' wives, and ate 
 irregularly. He also began to frequent 
 country taverns and to drink, on the ground 
 that walking tired him so much. His charac- 
 ter, in fact, seemed to deteriorate, much to the 
 surprise of the committee which had devised 
 this plan of keeping him self-supporting. He 
 finally became so intemperate that his "pass" 
 to go out was revoked. During the ensuing 
 winter he died of so-called heart failure. 
 
 There have been, however, a considerable 
 number of patients with locomotor ataxia, who 
 have been under treatment, and who have 
 been able to earn a modest livelihood. One 
 was a stenographer, who had to give up her 
 position, and take an easier one with shorter 
 hours. In spite of her complaint that her 
 finger tips were numb, she has been able to do 
 successful work for about three years. An- 
 other stenographer gave up her stenographic 
 work to become an interpreter. 
 
 A re-toucher in a photographic studio gave 
 up his special line to do more general work 
 
ORGANIC NERVOUS DISEASES 107 
 
 in outdoor photography. The change of 
 scene proved beneficial in keeping him from 
 worrying, and the outdoor air and exercise also 
 helped him. 
 
 Many more instances could be cited of per- 
 sons who have been able to remain self-sup- 
 porting, and of others who have become so 
 after a period of illness, but it must be ad- 
 mitted that strength of character is required 
 for a tabetic man or woman to keep the poise 
 and self-confidence necessary to bear the pain 
 and discouragement incidental to the illness, 
 and at the same time work for a living. 
 
 Work is sometimes interrupted for days 
 and even weeks by attacks of severe pain, and 
 fits of depression. Gloomy weather often de- 
 presses tabetic patients, and the difficulties of 
 locomotion seem to be greater at such times. 
 
 Usually the depression becomes less after a 
 time, and the intervals of awkwardness less 
 frequent as the patient gets better control of 
 his hands, so that any teacher starting work 
 with tabetic patients can honestly encourage 
 them in the hope of years of usefulness, within 
 moderate limits. The process of reeducation 
 is a tiresomely long one, and the sticking to 
 
108 THE WORK OF OUR HANDS 
 
 routine is a severe trial to those in whom the 
 work-habit has been lost, so that much re- 
 sponsibility at first devolves on the teacher. 
 
 Disseminated Sclerosis 
 
 There are several organic diseases of the 
 central nervous system, in which the use of the 
 hands is lost or impaired. As these are de- 
 generative diseases, their progress may be but 
 slightly stayed by any therapeutic occupation 
 and it would be in many cases, an unkindness 
 to encourage patients to look forward to doing 
 remunerative craft work. Practice gives but 
 little increase in skill, although occupation 
 work: frequently adds much to happiness. 
 Special attention is given here to this class of 
 patients, as these diseases are becoming more 
 common (or more promptly recognized) and 
 patients suffering from them are liable to ap- 
 pear before almost any occupation teacher. 
 These comparatively unfamiliar diseases offer 
 a new field for study and in many instances 
 the possibility of new forms of gainful occupa- 
 tion. Few of them affect the mind, and men- 
 tal resources may sometimes be cultivated in 
 
ORGANIC NERVOUS DISEASES 109 
 
 many who could never become expert in ap- 
 plied art. 
 
 Among twenty patients taught, not one has 
 done really good work, although most of them 
 have been young men and women of intelli- 
 gence, interested in their work. The effort to 
 use the hands almost always caused so much 
 tremor that good work could not be done. 
 This "intention tremor" increased as an at- 
 tempt was made to raise the hands high enough 
 to do basketry or other hand work, and it did 
 not yield to the control of the will, even when 
 the habit of work was well established. Some 
 patients were distressed and disheartened by 
 it, others simply took it as a matter of course, 
 and tried to work in spite of it. Defective 
 eyesight also made work difficult, the princi- 
 pal complaint being of dimness of vision. 
 Some patients said they could see nothing but 
 objects directly in front of them. Some of 
 these patients walked well, others with great 
 difficulty, and some not at all at times. It is 
 interesting to note that most of these were 
 ordered occupation work by their physicians 
 and that they took a normal interest in the 
 
110 THE WORK OF OUR HANDS 
 
 work, in spite of their comparatively poor suc- 
 cess. One or two were depressed, others were 
 inclined to fits of giggling which seemed to 
 surprise and embarrass them. Speech was sel- 
 dom under control, rhythmic inflections like 
 scanning of poetry preventing natural expres- 
 sion. 
 
 Several persons have come under the writer's 
 observation who were particularly interesting, 
 and worth individual description. 
 
 CASE I. American. Age 30. School 
 teacher. 
 
 This young lady had become suddenly ill 
 six years before and spent most of her time in 
 a wheel-chair. She hoped to be able to fit her- 
 self as a manual training teacher, and take a 
 residential position as her peculiar speech pre- 
 vented ordinary teaching. She made every ef- 
 fort to succeed in manual work, trying first 
 basketry, then book-binding and then knitting. 
 In basketry her greatest trouble seemed to be 
 her sight, the reeds confusing her. Raffia 
 basketry was even harder, as she could not 
 pull the thread tight. Folding paper for book- 
 binding troubled her, and she could not see to 
 sew the sections together. Typewriting was 
 
ORGANIC NERVOUS DISEASES 111 
 
 also unsuccessful. After several weeks her 
 physician sent her home from the hospital. 
 
 CASE II. Italian girl. Age 20. 
 
 This girl had become ill gradually; she 
 could walk (slowly), but could not stand 
 long, and her speech was poor. These con- 
 ditions prevented her doing shop or factory 
 work, and as the family needed money, it was 
 necessary for her to find something adapted 
 to her peculiar limitations. After various 
 trials it was found that she had good taste 
 in color and could learn coarse embroidery. 
 She does Bulgarian embroidery for a fancy 
 goods store, and is greatly pleased with her 
 work. At last reports her general health was 
 about the same, after three years. 
 
 CASE III. American. Male. Age 28. 
 Designer. 
 
 This young man was a designer of pottery 
 and of advertising posters. He was ill for 
 three years, during one year of which he was 
 unable to walk or use his hands. He grad- 
 ually recovered the power of locomotion, but 
 his hands and eyesight are not quite the same. 
 He earns his living at present as critic of the 
 advertising work submitted to a large bus- 
 
112 THE WORK OF OUR HANDS 
 
 iness concern, and is thus able to make use of 
 his art knowledge without depending on the 
 use of his hands. 
 
 One woman who is the mother of a family 
 is able to superintend her house, and another 
 young woman unable to walk, does much of 
 the family cooking. Men seem to be at more 
 of a loss than women to adapt themselves to 
 the peculiar conditions imposed by this dis- 
 ease. Those who can walk seem to get satis- 
 faction from bodily exercises. One young 
 man said running the printing press "lim- 
 bered him up," another found carpentry 
 helped him in muscular coordination. 
 
 Chair caning seemed a promising form of 
 occupation work, as the frame afforded a 
 guide for the hands. Both women and men 
 patients succeeded in it. Basketry was not 
 generally well done, although it seemed to 
 arouse interest. Sewing was generally un- 
 satisfactory, coarse knitting fairly good, but 
 none of these occupations gave real control of 
 the hands such as tabetics gain from hand 
 work. Cement work might afford such pa- 
 tients a means of livelihood, where weaving, 
 basketry, etc., would be too difficult. 
 
ORGANIC NERVOUS DISEASES 113 
 
 Syringomyelia 
 
 Several patients with this disease were 
 taught, all about alike in their inability to use 
 the hands freely, the fingers being numb, 
 stiff, and drawn up, and the thumb and fore- 
 finger sometimes unable to grasp anything. 
 
 CASE I. Austrian. Art student. Age 20. 
 
 This young man had been earning his liv- 
 ing day times and studying art in night school 
 for three years previous to his illness. He 
 had become tired out and came to the hospital 
 to find out what ailed him, as at times he 
 could hardly walk. He grew worse, but still 
 thought he must earn his living, and as his 
 study of art had given him knowledge of de- 
 signing, he found a firm for whom he could 
 design monograms at home. His work at 
 first was excellent, as he had good color sense, 
 and originality, but he worked very slowly, 
 and with great effort. After a few weeks he 
 became unable to "feel the paint brush" as 
 he expressed it, and his fingers began to curl 
 in. His right hand only was affected, and he 
 might have in time learned to work with his 
 left hand, but his general health began to 
 
114 THE WORK OF OUR HANDS 
 
 grow worse, and he went to a home for in- 
 curables. 
 
 Chronic Myelitis 
 
 Among several patients taught, one shows 
 what can be accomplished with work exactly 
 graded to the ability of the individual with 
 this disease. 
 
 An Italian about 25, gifted with a keen 
 sense of color and good taste, felt it necessary 
 to keep on working. He had very little phys- 
 ical strength and could not do any heavy 
 work, but finally learned to make delicate lit- 
 tle baskets to hold bonbons, or nuts, which a 
 fruiterer was glad to buy. His problem 
 seems to have been solved satisfactorily as he 
 is happy, able to put his talents to use through 
 his artistic ability, and earn a modest liveli- 
 hood, without any danger of bodily or mental 
 exhaustion. 
 
 Poliomyelitis 
 
 This disease has become so common among 
 children that it is not necessary to report in- 
 dividual cases, the methods used in treatment 
 being well known. Generally speaking, man- 
 
ORGANIC NERVOUS DISEASES 115 
 
 ual work given should be such as to bring the 
 whole body into a normal activity, with some 
 special work in case the physician orders it, 
 for the parts most affected. Carpentry work, 
 chair caning, basketry, and weaving are in- 
 teresting to children, and require the use of 
 both hands. If carpentry and weaving are 
 well taught, so that the child holds himself in 
 a good position while at work, they are ex- 
 cellent exercises for the whole body. Chil- 
 dren in bed frequently work in awkward and 
 strained positions, and care should be exer- 
 cised by the teacher to give very light work at 
 first, and get the child into the habit of work- 
 ing in a natural position. Cutting out pic- 
 tures may precede any real manual work. 
 Spool knitting is interesting to very small 
 children. Making braided or chain stitch 
 horse reins of coarse cord is good work also. 
 Adults taught were most interesting; one was 
 able to get considerable physical benefit from 
 doing heavy basketry, although she sat in a 
 wheel-chair. Making scrap baskets gave 
 good exercise to the whole upper part of the 
 body. She also did coarse knitting, her phy- 
 sician having ordered that she do as heavy 
 
116 THE WORK OF OUR HANDS 
 
 work as was convenient in her cramped posi- 
 tion. Another patient who was able to walk, 
 ran the printing press two hours a day, print- 
 ing several hundred treatment cards. 
 
 Paralysis Caused by Accidents 
 
 Among the most interesting patients taught 
 were some who had become crippled by ac- 
 cident so as to lose the use of the lower part 
 of the body. 
 
 CASE I. American. Colored woman. Age 
 40. Cook. 
 
 This woman fell on the ice and injured her 
 spine. After being unable to walk for eight- 
 een months, she could not stand any length 
 of time. This of course prevented her re- 
 suming her ordinary work. She could not 
 learn to become a good sewer, and the teacher 
 finally decided to try her on very light laun- 
 dry work, which can be done sitting (doing 
 up lace, lingerie, waists, fine underwear, etc.). 
 A domestic science teacher gave her six les- 
 sons, after which she returned to her home 
 in the South and is earning a good living at 
 this work. 
 
ORGANIC NERVOUS DISEASES 117 
 
 CASE II. Bohemian. Age 30. Hod- 
 carrier. 
 
 This man was very ignorant, and after his 
 accident (a fall from a building) he lay for 
 a long time in a kind of stupor, as no one in 
 the hospital could speak his language, and he 
 was too discouraged to try to rouse himself; 
 he was finally put in a wheel chair and found 
 he could sit up. He was given the opportu- 
 nity to learn chair-caning. He at once became 
 enthusiastic, and evinced a dexterity quite re- 
 markable in one who had never done any 
 skilled work before. He has now taken up 
 the making of reed tea trays, and is rapidly 
 becoming expert. He could probably earn 
 more now, after one year's training, than he 
 ever earned when he had his full bodily 
 strength. 
 
 CASE III. Irishman. Age 25. Hostler. 
 
 This man injured his spine by a fall from 
 a horse. He sat in a wheel chair. He was 
 liable to be deported, and work had to be 
 chosen which he could do in Ireland, if he 
 went back to a small village. A cobbling 
 teacher was engaged for him and it was found 
 
118 THE WORK OF OUR HANDS 
 
 that he could learn to put on patches, and 
 mend soles, but not to make new shoes, as he 
 could not bear so much pressure on his knees. 
 
 Caisson Disease 
 
 CASE IV. 
 
 Two most interesting cases of this form of 
 paralysis were taught. 
 
 The first one was a worker in the Hudson 
 Tunnels, who had been crippled for two years. 
 The occupation work given at first was of the 
 lightest order, and he used his hands awk- 
 wardly. His strength gradually became 
 greater, until he ended his work cure by paint- 
 ing the walls of a room, part of the time 
 standing on a ladder. 
 
 The second was also a tunnel worker, who 
 was brought as an emergency case to the hos- 
 pital. As soon as he was able to use his 
 hands, he asked for work, and began basketry 
 before he could walk at all well. He seemed 
 to derive much benefit from weaving rag rugs 
 on a very heavy loom. Both these men ex- 
 pressed particular satisfaction in doing heavy 
 work requiring the use of all parts of the body. 
 
ORGANIC NERVOUS DISEASES 119 
 
 The second is now on night duty in a hospital 
 ward where he has to do much lifting of pa- 
 tients, and continues to improve. 
 
V 
 
 HYSTERIA 
 
 AMONG the diseases which seem to derange 
 the whole system, altering character, at least 
 temporarily, and interfering with the activi- 
 ties of the body, hysteria has a place all its 
 own. How much occupation can do to help 
 an individual so afflicted is still an open ques- 
 tion. In most of the cases here recorded, oc- 
 cupational treatment has been kept up for 
 several months. Results have been compara- 
 tively poor and difficult to obtain. It is prob- 
 able, however, that the patient can by system- 
 atic work and keeping the attention centered 
 on immediate ends to be accomplished day- 
 by-day, partially control the manifestations of 
 the disease. Whether such "assuming a vir- 
 tue if you have it not" can bring about a final 
 cure is doubtful. Work certainly holds the 
 patient to a purpose, and it would appear that 
 it might ward off violent attacks, as in the 
 
 120 
 
HYSTERIA 191 
 
 present series a hysterical patient has never 
 had an attack further than a fit of trembling 
 which usually stopped as soon as the attention 
 was again centered on the work. Paralysis 
 of the hands sometimes hindered work, and 
 sometimes the patient unconsciously used a 
 hand while working, which seemed to be help- 
 less at other times. Curiously enough, the 
 workmanship of every hysterical patient was 
 of a high order, in spite of apparent paralysis, 
 rigidity, etc. Neatness and exactness seemed 
 to be a matter of pride, even where the patient 
 would admit no interest in the work. There 
 was almost always also considerable artistic 
 ability, the general standard being high. It 
 might be supposed that such clever workers 
 would be easy to teach; on the contrary, they 
 were very difficult, as most of them accom- 
 plished nothing in group work. This seemed 
 due to the proximity of others, rather than the 
 need of individual teaching, as the same pa- 
 tients could work well alone in a room. As 
 a rule they were but little interested in the 
 work of other patients unless the interest was 
 rather forced upon them. 
 
 Individual teaching, however, was satisfac- 
 
122 THE WORK OF OUR HANDS 
 
 tory, after the patients had become used to the 
 condition; at first they seemed often puzzled 
 by their own lack of interest, and difficulty of 
 concentration. It may be observed that the 
 method used was a simple appeal to the sense 
 of sight and touch in making work that looked 
 attractive and useful, and was pleasant to 
 work on. The amount of work was increased 
 gradually, also the degree of intricacy and 
 originality, but it was never necessary to be- 
 gin with childish work. After a short time 
 the patients found no difficulty in doing fine 
 embroidery, tatting and other intricate work, 
 and seldom complained of fatigue. They 
 were often difficult to manage, capricious, and 
 sometimes irritable. Wherever possible the 
 hysterical patients were given large work, re- 
 quiring use of all parts of the body, but this 
 was usually beyond their ability at first. 
 When it became possible, large heavy work, 
 like weaving or carpentry, seemed especially 
 beneficial in holding the attention, giving 
 good muscular coordinations and affording 
 an outlet for the constructive imagination. 
 Group work was beneficial when the patient 
 
HYSTERIA 123 
 
 had got to the point of a normal interest in 
 other people. 
 
 A few cases are reported to show individual 
 peculiarities. 
 
 CASE I. American woman. Age 30. 
 
 Had been an invalid for eight or nine years 
 and during all that time had thought she could 
 not walk. Was under treatment by a physi- 
 cian who succeeded after eighteen months in 
 relieving her. Her occupation work was at 
 first entirely individual in her room, was much 
 interrupted by fits of trembling, talk about 
 her inability to work, etc. It took a whole 
 winter to make one sewed basket and one em- 
 broidered waist, both exquisitely done, after 
 which she seemed to have a sudden releasing 
 of energy and worked willingly and efficiently, 
 and enjoyed group work. After her return 
 home she not only applied all she had learned 
 in her own work, but also made use of much 
 knowledge she had picked up by watching 
 other patients, and is constantly occupied in 
 doing really beautiful craft work. 
 
 CASE II. American woman. Age 40. 
 Pianist. 
 
124 THE WORK OF OUR HANDS 
 
 This lady had a sudden attack which 
 seemed like a stroke of paralysis, after which 
 she could scarcely walk, and could not use 
 the left hand. She soon began to gain except 
 in the dragging of one foot but was still un- 
 able to use her paralyzed hand, which caused 
 her much anxiety as she had to earn her liv- 
 ing as a pianist. She tried to use the type- 
 writer with her left hand but was unable to 
 strike the keys with sufficient force to make 
 any impression unless she was alone in the 
 room, and even then could not control the in- 
 dividual fingers. At times her fingers worked 
 fairly well for a few minutes. This patient 
 was not interested in manual work, and the 
 teacher thought it would be better for her 
 to devote her time to piano practice. She 
 seemed suggestible and her physician and the 
 teacher kept before her attention the thought 
 that the use of her hand depended on her own 
 efforts. As soon as she fixed her attention 
 on this one thing, she began to practice on 
 the piano steadily, three or four hours a day, 
 a half hour at a time; concentrating her at- 
 tention on one thing seemed to help her, as 
 she not only slowly regained the use of her 
 
HYSTERIA 125 
 
 hand, but her inability to walk seemed to leave 
 of itself. She seemed to forget all about it. 
 At last reports she was able to resume her 
 work. 
 
 CASE III. American woman. Age 25. 
 
 This young lady had mastoiditis when she 
 was twenty, and afterwards became a semi- 
 invalid; at one time thought she had flat-foot 
 and could hardly walk. About two years ago 
 she decided she could not do her hair up as 
 her scalp was sensitive. This prevented her 
 going into society, and she became a kind of 
 recluse, living mostly in her bedroom. She 
 took up basketry at home, and worked with 
 great success as far as technique was con- 
 cerned, but her capriciousness made her a dif- 
 ficult pupil. Some days she complained of 
 dimness of vision, and acted as if she could 
 hardly see, until she became interested, when 
 she worked splendidly. She ruled her own 
 affairs entirely, as her family had given up 
 trying to control her. She would have no 
 physician, and, in fact, looked well to the cas- 
 ual observer, so that her people did not urge 
 her to put herself under medical care. She 
 was very unhappy, and it seemed pitiful that 
 
126 THE WORK OF OUR HANDS 
 
 the best years of her life should be wasted, so 
 she was urged to go to a neurologist, who put 
 her in the hospital. Singularly enough, she 
 evinced the same trait shown by other hysteria 
 patients of being unable to do group work, 
 although she had been so successful in bas- 
 ketry at home. However, she took up knit- 
 ting in her room, and took some interest in 
 it. Her physician estimated that her recov- 
 ery would take at least eighteen months 
 longer, the first few of which are being spent 
 in a sanatorium, in the country where she 
 leads an active outdoor life. 
 
 CASE IV. Italian- American. Male. Age 
 12. School-boy. 
 
 This boy was in the hospital first for 
 chorea, and was isolated for a few weeks. He 
 was ordered occupation work as soon as the 
 twitchings allowed, and became at once en- 
 thusiastic, doing excellent basketry and chair- 
 caning, and evincing intelligent interest in the 
 work of others. He went home cured. A 
 year later he returned to the hospital, and the 
 teacher naturally expected him to resume his 
 former interest, but far from it. His nature 
 was altered, he worked only when urged to 
 
HYSTERIA 127 
 
 and then ungraciously, paying no attention 
 to what others were doing. This time he 
 made only a brief visit to the hospital, as his 
 parents were instructed how to care for him, 
 but he illustrates the altering of character 
 which may occur in hysteria even in a child. 
 
 CASE V. Irish- American. Female. Age 
 11. School-girl. 
 
 This child-patient was depressed and seemed 
 to feel it a reproach that she could not use 
 her right hand. She had an unhappy life in 
 an orphan asylum. Cheerful surroundings, 
 and constant encouragement to use her hand 
 in exercise, and manual work, and her success 
 in basketry, helped her much. She went 
 home cured. 
 
VI 
 
 EPILEPSY 
 
 OCCUPATION work for epileptics must be 
 planned so as to avoid fatigue from over- 
 exertion which might bring on an attack, and 
 so as to avert any danger of injury from fall- 
 ing on sharp tools or getting caught in ma- 
 chinery during a seizure. This might seem to 
 limit the work, but much remains which can be 
 attempted without risk and there is no class 
 of patients more benefited by occupation 
 than epileptics. There is nothing in their ill- 
 ness to prevent enjoyment in work, and the 
 satisfaction in accomplishment which comes 
 from technical skill. Without great original- 
 ity, as a rule, they nearly always show per- 
 sistency and the desire to excel, so that their 
 work is generally substantial. 
 
 The actual teaching of epileptics is marked 
 by great differences among the various pa- 
 tients. Out of fifty or more taught, a few ap- 
 
 128 
 
EPILEPSY 129 
 
 peared dull mentally; others were lethargic 
 and lacking in interest because they were so 
 disheartened at finding themselves the victims 
 of a disease which they believed would cut 
 them off from all social activity and success 
 in life; others spent their time in looking for- 
 ward with dread to attacks; others were per- 
 fectly cheerful, with a normal attitude to- 
 ward life. It was difficult, on account of the 
 self-evident nature of their malady to avoid 
 some talk about it. It was, therefore, pos- 
 sible for the teacher to reassure the disheart- 
 ened often with reports of successful work 
 done by individuals and in epileptic colonies 
 and to try to convince them that the quality of 
 their work and their attitude toward life were 
 under their own control and need not be af- 
 fected by their illness. Turning the atten- 
 tion toward readjustment often seemed to 
 produce a change in the patient and a salutary 
 effect in causing him to plan for the future in- 
 stead of brooding over his misfortunes. Chil- 
 dren were naturally less affected in spirit 
 than adults by the disease, as they seldom 
 knew what it was that caused their uncon- 
 sciousness, but they were often subject to 
 
130 THE WORK OF OUR HANDS 
 
 spells of dullness or irritability before an at- 
 tack, which prevented work. It seemed bet- 
 ter when such a condition manifested itself, 
 to let the child rest, as work had no effect in 
 changing the course of events. 
 
 One characteristic stood out markedly in 
 most of the patients taught, a peculiar degree 
 of absorption in what they were doing, so that 
 once started they did not easily turn their at- 
 tention to anything else. This persistency 
 was marked even in young children, amount- 
 ing almost to stubbornness. 
 
 Many of these children showed poor mem- 
 ory for mental work, but excellent memory for 
 handwork. What was demonstrated by the 
 teacher's own hands generally remained fresh 
 in the child's mind and he usually found great 
 satisfaction in applying this knowledge. In 
 some cases the special senses seemed to give 
 feeble sensations and ignorance, appearing al- 
 most like feeble-mindedness, was not uncom- 
 mon, even where the will-power seemed to be 
 good. Other children were really feeble- 
 minded. 
 
 Manual work is an important part of the 
 training of the epileptic child, not only on ac- 
 
EPILEPSY 131 
 
 count of the opening up of the avenues of the 
 special senses, thus allowing freer expression 
 of activity, but for social reasons as well. 
 The possibility of his life being somewhat iso- 
 lated, if he lives at home, and the trend to- 
 ward the choice of some simple manual work 
 as a means of livelihood in later years, must 
 be considered. It would doubtless be impos- 
 sible for the State to provide a home and 
 training for every epileptic, no matter how 
 desirable segregation might be. Aside from 
 this, there are city dwellers who would like, 
 if possible, to keep their epileptic children with 
 them, and would gladly try to follow direc- 
 tions as to diet, regular hours, etc. Educa- 
 tion, however, is a question which must gen- 
 erally be settled outside the home, for some 
 children well cared for physically grow up in 
 deplorable ignorance, their parents being un- 
 fit to teach them. They are often unable to 
 fit into the ungraded classes of the public 
 schools, as there is no one to take them to and 
 from school. Idleness certainly breeds de- 
 generacy in such cases. Many parents of 
 epileptic children taught by the writer have 
 complained of their children's impudence, 
 
132 THE WORK OF OUR HANDS 
 
 sulkiness, bad temper, etc., yet these very 
 boys and girls worked happily for several 
 hours a day in the hospital workshop, never 
 showing these defects, except just before or 
 after an attack. One little girl of nine had 
 such a report from her mother; she was ex- 
 tremely ignorant and it was evident that no 
 effort had been made to teach her. She was 
 anxious to learn and although backward, with 
 no more knowledge than she should have had 
 at five years, she at once began to catch up 
 mentally. Her mother was given careful di- 
 rections as to how to teach her, and her visit 
 to the hospital, while it ended in the confirma- 
 tion of the mother's fears in regard to the 
 nature of the child's illness, brought much help 
 to both. 
 
 Among those simple industries suitable to 
 be taught to epileptic children, reed basketry, 
 chair caning and coarse knitting on wooden 
 needles are safe; sewing and raffia basketry 
 are proscribed for those liable to frequent at- 
 tacks. Running the printing press or any 
 other machine is not safe, but weaving is en- 
 tirely satisfactory. It may be recalled that 
 Silas Marner earned his living as a weaver, 
 
EPILEPSY 133 
 
 in spite of his strange attacks of unconscious- 
 ness. This refers, of course, to the old fash- 
 ioned weaving by hand and foot power. Ma- 
 chine weaving on a power loom would be 
 proscribed. 
 
 All these industries are mentioned as educa- 
 tional occupation work. Gainful work might 
 in some cases grow out of them, and there 
 are many other forms of work equally suit- 
 able. Farming is perhaps the most satisfac- 
 tory, as it is healthful, interesting and re- 
 munerative and can be carried on even if a 
 mental degeneration sets in as it sometimes 
 does. Colonies like the Craig Colony have 
 demonstrated the suitability of agricultural 
 work both in keeping the patients in good 
 general health and in keeping them happy 
 and efficient. 
 
 Chorea 
 
 Children with beginning chorea are usually 
 so ill as to be unable to do any work for a few 
 weeks, and are frequently ordered rest in bed 
 and isolation. Later, when the choreic 
 twitchings begin to be less marked, these pa- 
 tients can begin work, but it must be very 
 
134 THE WORK OF OUR HANDS 
 
 light, at first, and planned so as to give the 
 maximum amount of simple pleasure with the 
 minimum amount of fatigue. Work seems to 
 help the patient by putting him temporarily in 
 a condition of normal interest in something 
 outside of his own illness, although, as a rule, 
 these children seem indifferent to work and to 
 what is going on around them. They seldom 
 attempt to express their feelings in words, and 
 are credited with being dull and sulky. A 
 close observer realizes how really ill they are. 
 Most children, after a while, meet the teacher 
 half way when occupation is suggested. They 
 require tact and patience in handling, how- 
 ever, and the teacher must try to regard the 
 dullness as a phase of the disease, not as a trait 
 of character. As such children often remain 
 lacking in spontaneity for some time, it is bet- 
 ter to set them to work as soon as the spas- 
 modic movements have subsided sufficiently, 
 unless, as is sometimes the case, an attempt at 
 voluntary movement causes the twitching to 
 increase greatly. 
 
 Each choreic child or youth is a separate 
 problem; out of more than fifty taught, each 
 one showed individual traits, but there were a 
 
CHOREA 135 
 
 few marked groups. Some patients were able 
 to get a fair voluntary control of the hands 
 while still quite ill, and to force themselves to 
 write, and also to do good manual work. 
 Others whose general condition was good still 
 had uncontrollable muscular movements which 
 prevented accurate work. Others seemed 
 nervously exhausted and could hardly work at 
 all, mental and physical energies alike being 
 at a very low ebb. Generally speaking, they 
 were not good workers, and only in excep- 
 tional cases were they able to do well techni- 
 cally, but just as neurasthenics have to be 
 trained to work by slow degrees, these chil- 
 dren had to be taught step-by-step. The pur- 
 poseless movements discouraged them and it 
 took a distinct effort to rouse the attention suf- 
 ficiently to get any attempt at working; this 
 effort had to be repeated every day, as the 
 interest did not seem to carry from one day 
 to another; it seemed as if the child sunk again 
 into self-absorption between lessons and for- 
 got his work. However, these children may 
 have learned much more than was apparent, 
 and may have stored up knowledge which 
 would help them later. On visits to the phy- 
 
136 THE WORK OF OUR HANDS 
 
 sicians in the dispensary after they were bet- 
 ter, some of these patients asked to see the 
 teacher, and told her of braided raffia work, 
 etc., which they had done at home, by remem- 
 bering work done at the hospital. One little 
 girl of eleven, who was too ill to be ordered 
 regular work, happened to have a chance one 
 day to sort over some large bright-colored 
 beads, suitable work for a child of five or six. 
 Her hands twitched, and she looked ill and 
 unhappy, and the teacher was surprised on the 
 child's return about six months later to have 
 the little girl tell her how much she had en- 
 joyed sorting those beads. At the time of this 
 visit, which was in order to allow the physician 
 to judge of the child's progress, she was able 
 to do simple basketry, but still seemed behind 
 other children of her age, not only in manual 
 work, but in mentality. 
 
 The question of what is suitable occupation 
 work for a child with chorea requires consid- 
 eration. It must be simpler than would ordi- 
 narily be given a normal child of the same age, 
 as is true in all occupations for children whose 
 physical disability enters into the possibilities 
 of success. Mental dullness and lack of mem- 
 
CHOREA 137 
 
 ory are also factors to be reckoned with. In 
 most patients work suitable to the child's age 
 did not rouse any keener interest than that 
 much simpler. But the work chosen should 
 be worth doing, no matter if it is simple 
 enough to be suited to a kindergarten child. 
 Work with color seemed to arouse the atten- 
 tion, and painting (as the use of a brush is 
 easier than holding a pencil or scissors) 
 seemed very good for the first step. Free- 
 hand drawing of outlines was generally impos- 
 sible, and the use of well-designed cards, 
 printed in outline to be filled in, proved a sat- 
 isfactory way to get around this difficulty, and 
 to give specially good training in muscular 
 control. These cards come printed on rough 
 paper, in designs of flowers, fruits, and of 
 Easter and Christmas subjects. Some origi- 
 nality is allowed in the choice of color in fill- 
 ing in. 
 
 CASE I. 
 
 A girl of 11, who could not even braid raf- 
 fia, constantly compared her present unsuc- 
 cessful work with what she had been able to 
 do and was discouraged by her lack of success, 
 found that she could do effective work with 
 
138 THE WORK OF OUR HANDS 
 
 these cards, and at once began to gain self- 
 confidence. Later she cut out pictures and 
 made a scrap-book, and eventually was able 
 to do raffia work. The scrap-books she made 
 gave pleasure to many other children who 
 were unable to work at all, but were well 
 enough to be interested. 
 
 CASE II. 
 
 A boy of 11 recovered the use of his hands 
 slowly and was forbidden to work, but he knew 
 all that was going on in the workshop, and 
 watching others seemed to rouse him out of 
 his own bad feelings. Every day he asked his 
 physician to be allowed to work, but when at 
 last he got consent, he found to his discourage- 
 ment that he still made involuntary move- 
 ments. At first he could work only at some- 
 thing that could be fastened in position, and 
 did fret-sawing, in which the work was held 
 securely, and the tool alone required manipu- 
 lation. He sawed out many little animals for 
 smaller children who were also patients. This 
 boy was at first dull and easily discouraged; 
 after each failure he would go off by himself 
 and sulk, but the teacher took pains to show 
 him exactly how to use his hands, and he 
 
CHOREA 139 
 
 gradually became quite expert in fret-sawing. 
 Later he took up chair-caning, which he did 
 fairly well. Training in the use of the hands 
 bore unexpectedly good fruit in this case, and 
 the careful teaching exactly how to handle 
 materials and tools, and insisting on the child 
 imitating the teacher's movements, proved ex- 
 cellent discipline. It aroused the boy's intel- 
 ligence and he cooperated well. His sense of 
 touch and sight were both dull. This, with 
 the corresponding lack of motor control, 
 formed such a double burden that no wonder 
 the boy seemed dull under such physical limi- 
 tations. His mental ability, however, seemed 
 to be good, and at last reports he had nearly 
 caught up with others of his age. The teacher 
 learned much from her observation of this 
 case, and afterwards tried to simplify the work 
 given to choreic children, and confine it to 
 work which makes a vigorous appeal to the 
 color sense and to touch, and the muscular 
 sense, keeping also to work so easy as to be 
 done successfully, minimizing the limitations 
 of illness, instead of emphasizing them. 
 
 One other type of choreic patient worthy of 
 special attention is the over-ambitious child 
 
140 THE WORK OF OUR HANDS 
 
 said to be broken down by overwork. Such 
 children are not dulled by the disease to any 
 great extent, and their interests remain nor- 
 mal. After the spasmodic twitchings mod- 
 erate they can work for short lessons at ordi- 
 nary manual work. If kept at too childish 
 work they become depressed and lose their 
 self-confidence and it is well to plan work in- 
 teresting enough to keep up their spontaneous 
 attention. 
 
 A little girl of nine, who was very small for 
 her age, had been attending music classes and 
 sewing school, besides public school and was 
 quite expert in embroidery. On coming to the 
 hospital her physician ordered her to rest in 
 the open air, but her interest in the work adult 
 patients were doing induced her to beg her 
 doctor to allow her to work at the same thing, 
 chiefly heavy reed basketry. A compromise 
 w r as made by which she was to work a certain 
 length of time on condition she rested the re- 
 maining time. She kept her end of the bar- 
 gain conscientiously, and while she used much 
 lighter materials than her adult fellow-work- 
 ers, she made the same kind of baskets. She 
 was slow in working and probably below her 
 
CHOREA 141 
 
 normal level at quickness of thought and in 
 the control of her hands. This child had 
 never wanted to play; her great aims in life 
 were learning and doing. The necessity of a 
 time for rest and play was explained to her, 
 as it seemed she was more to be depended on 
 than her mother for her future program, 
 and she promised to carry out any suggestions 
 that would help her to catch up in size with 
 others of her age and make her grow into a 
 strong woman. Many others of these chil- 
 dren seemed sensible and willing to learn, in 
 spite of their seeming dullness and retarda- 
 tion. Most of them had always been rather 
 delicate and seemed liable to remain fragile. 
 It seems, therefore, that the habit of system- 
 atic industry, and the satisfaction in doing 
 skillful hand work are particularly worth cul- 
 tivating in them, as aids in giving stability to 
 an organization liable to remain nervously un- 
 stable. 
 
VII 
 
 MENTAL DISEASES 
 
 WORK may be made the connecting link for 
 the mentally afflicted, between the normal 
 world of working men and women and that 
 other world in which the inmates are isolated 
 by abnormality in ideas and acts. The in- 
 stinct of workmanship frequently remains 
 after reason is permanently overthrown. 
 Many times those whose idle hours are most 
 wretched on account of distressing delusions 
 become self -forgetful when at work, and reach 
 a physical and mental altitude far higher than 
 would be expected. Nearly all classes of in- 
 sane people can work, except those in the ad- 
 vanced stage of general paresis, and those in 
 certain temporary states of extreme depres- 
 sion or exaltation. 
 
 Manic Depressive Insanity 
 
 There has been considerable difference of 
 opinion as to whether patients in an excited 
 
 142 
 
MENTAL DISEASES 143 
 
 state should be urged to work. No absolute 
 rule can be laid down, but the general opinion 
 among modern alienists is in favor of work as 
 a remedy even in considerably excited cases. 
 Hydrotherapy is of unquestioned value, but 
 work should follow the calming measures as 
 soon as possible. The patient who puts his 
 excess nervous energy into work is far less 
 likely to need restraint or sedatives. 
 
 In teaching manic patients in a state of ex- 
 altation a careful distinction should be drawn 
 between occupation which is intended to hold 
 the attention and real creative work. An ex- 
 cited patient restlessly moving about, and 
 unable to "think straight," could hardly be ex- 
 pected to concentrate the attention and sit still 
 an hour or so planning out and executing 
 basket designs. But the aimless psycho- 
 motor activity which prompts the tearing up 
 of paper into bits might be directed to tearing 
 strips of cloth for weaving, or bits of paper to 
 fill a pillow cover. Winding yarn, or winding 
 carpet rags on a reel, or, in fact, any simple 
 work which allows free play of some part of 
 the body frequently holds the attention, espe- 
 cially if the work is with bright-colored ma- 
 
144 THE WORK OF OUR HANDS 
 
 terials. Work that can be done standing 
 seems often satisfactory to the patient, and if 
 he wishes to walk about occasionally, it is often 
 a relief to do so. The teacher must keep in 
 mind that the restlessness which is a charac- 
 teristic of the state must find some vent. 
 Frequently the patient in such a state is ob- 
 serving keenly everything that is going on, 
 and is afterward able to make use of knowl- 
 edge gained from watching others. An inci- 
 dent to illustrate this is the case of a young 
 girl who was too excited to leave her room 
 and was, in fact, under the constant care of a 
 nurse, who happened to be making a basket. 
 The patient, talking much of the time to imag- 
 inary companions, was apparently oblivious to 
 the nurse. But afterward, when she became 
 able to work, she displayed a surprising 
 knowledge of basketry. This same patient 
 was sent to a country home where she had an 
 opportunity to weave. She seemed to like the 
 freedom of motion, and the bright colors em- 
 ployed, but her attention was diverted by the 
 conversation of imaginary companions, to 
 whom she must address remarks, friendly or 
 unfriendly, in an excited manner. It was 
 
MENTAL DISEASES 145 
 
 useless to try to convince her that there was 
 no one present but herself and the teacher, and 
 the latter tried the expedient of getting her 
 attention back on her work by holding up the 
 shuttle, or a bit of bright material for weaving. 
 She soon became able to talk to the teacher 
 intelligently about her work and planned and 
 made two rugs. It seemed that the novelty 
 of doing something unfamiliar was a whole- 
 some stimulus in this particular case. She 
 was large and naturally muscular, and took 
 pleasure in the use of her strength. Weaving 
 seemed to be just the thing for her. 
 
 Another type of manic excitement is repre- 
 sented by a Jewish woman of about fifty. She 
 would sit humped up for a few minutes and 
 then get up and walk around excitedly. She 
 did this at least a dozen times during a short 
 interview. When the teacher asked her if she 
 would like to complete a basket begun by an- 
 other patient who was just leaving, she ex- 
 pressed pleasure, went to work at once, and 
 did not get up again for over an hour, al- 
 though she had to be occasionally encouraged. 
 Her expression, at first quite wild, became 
 softened to one of intentness in her work, and 
 
146 THE WORK OF OUR HANDS 
 
 she smiled at the teacher and thanked her for 
 giving her something to do, as she said she 
 liked to work, and had five children at home, 
 where her hands were never idle. She showed 
 no particular originality, but her work was 
 strong, and in the course of two or three days 
 she had a very satisfactory basket, at least it 
 was very satisfactory to her. In this woman 
 the liking for work remained in the midst of 
 confusion in regard to other things. There 
 are other cases with whom work seems to be 
 almost an impossibility, unless the instructor 
 has the time to give much individual help, but 
 if the patient is under the charge of a nurse 
 who is interested in occupation work, and co- 
 operates with the teacher, the effort to arouse 
 interest in work is usually successful. The 
 adaptability of the nurse has much to do with 
 the success of the effort, because if the nurse 
 tries to make the patient sit still and work 
 steadily she generally fails, while if she allows 
 her to get up and walk around, and then again 
 presents the work, perhaps pointing out some 
 new feature, the patient starts in again. For 
 the patient in a highly excited state the only 
 chance of success lies in individual teaching. 
 
MENTAL DISEASES 147 
 
 After the preliminary stage is past these pa- 
 tients often enjoy group work; in fact, they 
 seem to take particular pleasure in working 
 with others. They then may take up finer 
 work. 
 
 In general, patients in this state are easily 
 distractible, and even when they are suffi- 
 ciently improved to plan original work, they 
 need variety. Their physical uneasiness usu- 
 ally persists after their general state is im- 
 proved, and they frequently appear worse off 
 mentally than they really are. This bad habit 
 of physical restlessness may frequently be cor- 
 rected by occupation work, since it substitutes 
 useful movements for idle walking, restless 
 moving of the hands, etc. 
 
 The choice of work should be careful, and 
 what is given the patients in an extreme con- 
 dition of excitement should be such as to pave 
 the way for more advanced work. Whether 
 it is familiar or not must rest on the patient's 
 temperament. Sometimes familiar work ex- 
 aggerates the excitement, and something en- 
 tirely new arouses wholesome interest. In 
 other cases familiar work is most satisfying 
 unless it is something connected with the be- 
 
148 THE WORK OF OUR HANDS 
 
 ginning of the patient's malady. The work 
 must restore the self-confidence of the patient. 
 If it fails to do this something else must be 
 tried. It, therefore, behooves the teacher to 
 invoke the physician's aid in finding out the 
 past likings and abilities of the patient. 
 
 There is generally a chance for the patient 
 to progress, and do fine original work. The 
 foundations laid during the excited state must 
 therefore be secure. The great danger is in 
 overstimulating the patients, as they are liable 
 to become too eager, and to overestimate their 
 physical strength. In restoring their self- 
 confidence care must be taken not to overdo 
 it, and recreation must constantly be used in 
 connection with the work. 
 
 Patients suffering from manic depression 
 are often at a very low ebb, physically and 
 mentally, and whatever work is given should 
 be restful, planned to prevent the deteriora- 
 tion of absolute idleness, rather than the 
 stimulation of trying new work. It must, 
 however, be something useful, or the patient 
 will be likely to grow stubborn, and refuse to 
 do anything. Such patients are frequently 
 distrustful and working at anything which 
 
MENTAL DISEASES 149 
 
 seems to them useless makes them feel that 
 they are being made fools of. They often 
 feel that their friends were wrong in making 
 them stop work, and to offer them diversional 
 occupation is adding insult to injury. In 
 dealing with such patients the teacher must 
 remember that she is dealing with a temporary 
 condition, in individuals who will in all proba- 
 bility recover, and however simple the work 
 she offers them it need not be such as could 
 legitimately be given to those who are bound 
 to become less and less efficient. Outdoor 
 work is often very helpful to such patients, if 
 it is not too tiring physically. It is almost 
 impossible to keep the attention on intricate 
 work, and whatever tends to peace of mind is 
 beneficial. Sometimes group work is helpful, 
 and sometimes it seems to make the patient 
 more depressed in realizing his own ineffi- 
 ciency, so that it is hard to make a general 
 rule, further than that there should be an op- 
 portunity given the patient to get through a 
 trying period without undue stimulation, and 
 yet keep him occupied sufficiently to prevent 
 an undue amount of leisure tinie for gloomy 
 thoughts. "Keep constantly occupied" is a 
 
150 THE WORK OF OUR HANDS 
 
 direction frequently sent by the physician to 
 the teacher in regard to such cases, but it is 
 generally accompanied by a warning to avoid 
 complex or fatiguing work. 
 
 Mixed State 
 
 Many patients show both excitement and 
 depression at frequent intervals. Most of 
 these work better than those suffering from 
 depression. One such case was that of a 
 young Irishwoman, whose chief symptom was 
 confusion. She was unable to distinguish in- 
 dividuals whom she saw every day, and some- 
 times was unable to recognize members of her 
 own family. She had days of extreme de- 
 pression when she refused to speak, or try to 
 rouse herself, but on her better days she got 
 satisfaction from running a small printing 
 press. She was entirely unable to do even the 
 simplest basketry without constant supervi- 
 sion, as she forgot which thread to weave with, 
 but she printed hundreds of cards without dif- 
 ficulty, and took pride in her work. Later 
 her days of depression became less frequent, 
 and she was able to sew. Some months later 
 she had another attack, and returned to the 
 
MENTAL DISEASES 151 
 
 hospital. She had forgotten the teacher and 
 attendants, but curiously enough remembered 
 the printing press, and wanted to print. 
 
 Dementia Prcecox 
 
 Dementia prsecox so often stops the devel- 
 opment of the mental faculties that work must 
 be chosen which will not demand any great 
 degree of originality, or future creative abil- 
 ity. Most sufferers from this disease, how- 
 ever, are able to do accurate work, and take 
 pleasure in it, and as they are often young at 
 the onset they may be able to gain mechanical 
 skill which will make good workmanship a 
 habit. Good work in itself prevents deteri- 
 oration, as it covers up the marked failing in 
 efficiency which is characteristic. Simple in- 
 dustries like chair caning, plain weaving, bas- 
 ketry, are suitable crafts. 
 
 There are, however, difficulties in the way 
 of the teacher who would get good work from 
 this class of patients. One is the frequent 
 occurrence of a catatonic, or apathetic state, 
 from which the patient can hardly be roused 
 to eat, to say nothing of working. This state 
 sometimes lasts for weeks, and the patient 
 
152 THE WORK OF OUR HANDS 
 
 may seem almost in a stupor, hardly conscious 
 of his surroundings. It is sometimes a ques- 
 tion whether it is not as well to let the patient 
 rest altogether. But a surprising amount of 
 construction work can be accomplished even in 
 this state. It is useless to try difficult work 
 in many cases, and the teacher's effort to make 
 the patient think may awaken stubbornness. 
 Coarse knitting is so familiar that the move- 
 ments used require little thought; raffia work, 
 or anything else well known, may do much to 
 rouse the patient's interest. 
 
 In the excited states these patients like to 
 spend hours talking over their grievances, ex- 
 plaining away their failures, and sometimes 
 talking about their strange beliefs. It is hard 
 at first to get them to express themselves in 
 acts, as often they seem to feel that their 
 moralizing and going over and over the same 
 ground in words is valuable, and work would 
 be a waste of time. The teacher has to use a 
 good deal of tact to get them working, and 
 needs to have much time for each individual. 
 There is undoubtedly much good material 
 going to waste among this class of patients. 
 Self-directed, they generally think they can 
 
MENTAL DISEASES 153 
 
 accomplish wonders, and really accomplish 
 next to nothing. The teacher who can direct 
 their activities into possible lines of achieve- 
 ment is doing a really great work. This ap- 
 plies especially to those who are not obliged 
 to be placed permanently in institutions. In 
 the modern state hospitals where careful at- 
 tention is given to every type of mental dis- 
 ease, many of this class are doing excellent 
 work, but there are many outside, who seem 
 more "queer" than actually insane, who fail 
 from year to year in efficiency, who could be 
 helped by good advice and good industrial 
 teaching. 
 
 In the actual teaching of more than a hun- 
 dred cases of this disease the writer found a 
 marked indifference to the work of others to 
 be characteristic; they never compared their 
 work with that of others, or even with the sam- 
 ples in the workroom, unless asked to do so. 
 Their work improved steadily, and usually 
 showed good color and design, and a sense of 
 proportion, but was without originality. It 
 afforded satisfaction to the workers, who spent 
 many hours a day pleasantly occupied. Most 
 of these patients seemed to the teacher capable 
 
154, THE WORK OF OUR HANDS 
 
 of real success in simple handicraft work, not 
 only on account of their willingness, after they 
 were fairly started, but because they were able 
 to do solid, strong work. 
 
 Many interesting patients were among this 
 group. One man, who had been a typesetter 
 in his youth, had dropped down to be a day 
 laborer. His hands were hardened with 
 coarse work, and it took him some time to 
 learn again to handle type. He did not be- 
 come very expert, but he reassured himself 
 that he had not lost all his manual skill, and 
 this appeared to give him much satisfaction. 
 It seemed that he had ability to be more than 
 a laborer, but not the ability to get into a bet- 
 ter paid and higher grade of work, unless 
 helped by some one, and this help he had evi- 
 dently lacked. 
 
 One girl who had been a milliner came to 
 the Neurological Institute very ill physically 
 and mentally. For nearly two months she 
 worked in the occupation room without volun- 
 teering a single remark, and seldom answering 
 if addressed. Yet during that time she did 
 much neat work, making towels, winding 
 bandages, sewing raffia napkin-rings and 
 
MENTAL DISEASES 155 
 
 baskets. In all this work she seemed to show 
 no interest, but at last she noticed a doll's hat 
 that some one else was making. She made 
 and trimmed one herself and began to appear 
 slightly less inert. Materials were given her 
 to make herself a spring hat, which she did 
 very neatly, copying the trimming from a 
 fashion book. Soon after this she went home. 
 After she had been away three or four 
 months she returned. She disclaimed all rec- 
 ollection of making herself a hat, but at once 
 took up millinery where she had left off, trim- 
 ming a doll's hat as soon as the materials were 
 set before her. 
 
 Most of these patients who were able to work 
 successfully expressed no mental disturbance 
 in words or actions while engaged in their 
 work, but at times nearly all of them appeared 
 to be in a reverie and it was hard to get them 
 started working. 
 
VIII 
 
 BORDER-LINE CASES 
 
 MENTAL idiosyncrasies such as incessant 
 worry, depression, fear, etc., often become so 
 marked as to render their victims unfit for 
 business or family life. As far as the teach- 
 er's attitude is concerned, it makes little dif- 
 ference whether these are delusions or only 
 foolish worries. They alike arrive at the re- 
 sult of causing their unfortunate possessors to 
 appear "queer" and to expose them frequently 
 to endless and useless argument from their 
 friends and relatives, who think they can talk 
 them out of their "strange notions." Fre- 
 quently they are put under the care of the 
 neurologist, to give him the opportunity to 
 observe and to ascertain whether the symp- 
 toms are based on "nervousness" or indicate 
 incipient insanity. Formerly such afflicted 
 individuals frequently were committed to in- 
 sane asylums, and we have great reason to be 
 
 156 
 
BORDER-LINE CASES 157 
 
 thankful that with more extended knowledge 
 and more humane methods, recoveries can 
 often be made without this final step. These 
 so-called border-line cases are particularly in- 
 teresting to occupation teachers, as they are 
 often benefited surprisingly by work. While 
 they might be unable to pursue their regular 
 callings they are usually able to do ordinary 
 craft work, with an immediate result in restor- 
 ing their self-confidence and drawing their 
 attention from their distressing thoughts. 
 
 In many cases, the attitude toward work re- 
 mains normal and the natural liking for activ- 
 ity thus finding vent, gives a marked renewal 
 of energy. Sometimes interest in work pre- 
 cedes ability, and the process of getting 
 started at really valuable work is a slow one, 
 but there are very few who cannot eventually 
 do good work. 
 
 Women accustomed to needlework fre- 
 quently find the same relief in doing some- 
 thing familiar, but generally are unable to 
 plan new work without help. On the other 
 hand, some dressmakers find anything con- 
 nected with their avocation disturbing, and 
 need something entirely novel. 
 V 
 
158 THE WORK OF OUR HANDS 
 
 Many of these patients seem to benefit 
 much more by work requiring considerable 
 physical energy than by sedentary occupation ; 
 others find pleasure in doing intricate work 
 demanding close attention, such as the making 
 of raffia hats, bags and lamp shades, made in 
 Solomon's knots. It is not always necessary 
 to begin with simple work; quite often some- 
 thing intricate seems to be beneficial in rousing 
 the patient to show his ability. 
 
 Where a patient shows a liking for any par- 
 ticular thing, this work will generally prove to 
 be of benefit, and in general it may be said 
 that if the work gives pleasure, and is in accord 
 with the ideas and capabilities, so that it stimu- 
 lates effort, it is well chosen. 
 
 The ability to work in groups is frequently 
 lost in these patients, and it is well for the 
 teacher to try to get them gradually accus- 
 tomed to working with others, so as to 
 avoid the danger of absorption in depressing 
 thoughts. Also, most working people, even 
 housewives, have to work with others about 
 them, and it is well for the patients on recov- 
 ery to have the habit of being with other peo- 
 ple at work. It is not necessary to consider 
 
BORDER-LINE CASES 159 
 
 reeducation in new means of livelihood, as 
 many such cases are able to resume their ordi- 
 nary work; occupation work while they are ill 
 is a curative measure. These remarks, how- 
 ever, apply only to those who are regaining 
 their normal condition; those whose malady is 
 progressive must be taught according to the 
 nature of their disability. 
 
IX 
 
 WOBK WITH THE AGED 
 
 THE "Good old age released from care" of 
 which the poet sings may be so care-free as to 
 be exceedingly dull and monotonous. No one 
 likes to be considered past his usefulness, and, 
 as a matter of fact, most old people are "laid 
 on the shelf" in America long before their 
 working days should be over. For him who 
 loves to read, a period for adding to knowl- 
 edge which can be interpreted through the ex- 
 perience of a long life, may be a most happy 
 time, but for the more common type, getting 
 pleasure from activity rather than from con- 
 templation, old age offers few resources. The 
 initiative for seeking new fields is a thing of 
 the past, and help must come from without. 
 
 What can be a more pathetic spectacle than 
 that of rows and rows of aimless old men and 
 women, sitting in the wards of an almshouse, 
 dull and apathetic, with no thought beyond the 
 
 160 
 
WORK WITH THE AGED 161 
 
 next meal? Truly enough Cicero said that 
 "To one oppressed with poverty, however 
 otherwise qualified, old age can never prove 
 easy." It makes very little difference how far 
 poverty in old age may be due to self-indul- 
 gence, to lack of forethought, or to inability to 
 control circumstances, the fact remains that 
 all these faults may have come from a lack of 
 physical and mental equipment at the outset, 
 or from lack of proper training. Judgment 
 should not be passed too hastily. We are 
 prone to assume that a poverty-stricken old 
 age, as a ward of the State, must be a just 
 desert. A careful study of the groups in any 
 almshouse affords a surprising number not 
 much past middle life, weak, inefficient faces, 
 of those who have never been able to make 
 good in our complex social system. 
 
 This is not the place to go into the study of 
 heredity, to trace out the decadence of a fam- 
 ily from generation to generation till pauper- 
 ism is the last step reached, nor is it fitting here 
 to take up the question of the ravages of alco- 
 hol. The immediate problem to be considered 
 is what can be done with the thousands now 
 "prisoners," actually if not nominally, in the 
 
162 THE WORK OF OUR HANDS 
 
 "city homes" and in poor-houses all over this 
 country. The beginning already made has 
 been surprisingly successful. In nearly every 
 institution where work has been introduced 
 vitality has seemed to rise higher, not only in 
 those able to work, but also in those able only 
 to watch. Life has more interest, and there 
 is something to which to look forward. Craft 
 work is a pleasant change from the routine of 
 housework, and "doing chores." The work 
 itself may be planned so as to be of no mean 
 economic value. For instance, braided rag 
 rugs, made from their discarded clothing, pro- 
 vides nearly seventy men with work in the 
 Brooklyn "City Home." These rugs are 
 good in color, and well made, and of immedi- 
 ate use all over the building. Baskets for 
 various uses in the home are also made. 
 Where money is not given to the workers, it 
 may be hard to keep up the enthusiasm, but if 
 the work is so eminently practical as in this 
 case, the desire to see the work used adds to 
 the interest. 
 
 Both women and men like basketry. Knit- 
 ting, crocheting, and sewing are of course 
 
IN THE WARDS OF THE LINCOLN HOSPITAL AND 
 HOME, NEW YORK CITY. 
 
 Quite often it is possible to carry on light work in the hospital 
 wards and without heavy equipment. 
 
WORK WITH THE AGED 163 
 
 especially the province of the former. Net- 
 ting hammocks is another ancient industry 
 which men enjoy, and there is almost always 
 some old sailor who knows how to put in the 
 rings and side cords in a truly "ship-shape" 
 way, which will interest every one. Some- 
 times the products of one place can be traded 
 for those of another; for example, hammocks 
 might be exchanged for rope door mats, or for 
 braided rugs. The industries mentioned may 
 be considered typical. Weaving is also suit- 
 able, but provides occupation for only one or 
 two at a time. Chair caning is always useful. 
 
 Undoubtedly the earning of money is a 
 stimulus to the interest, but as in some cases 
 the will-power is so destroyed by the indul- 
 gence in alcohol or drugs, that it is dangerous 
 to allow the worker money; a rule is often 
 made that the payment must be made in some 
 other way, extra tobacco, food or clothing, or 
 a treat of some kind. This may be used as a 
 step toward payment in money. 
 
 A most wholesome stimulus is well-earned 
 praise. Variety is necessary to keep up the 
 interest. Little opportunity should be al- 
 
164 THE WORK OF OUR HANDS 
 
 lowed for depressing introspection or retro- 
 spection, and if the work is changed in form 
 if not in kind the attention is held. 
 
 Work should be given tactfully so as to 
 keep the worker from feeling his helplessness. 
 No one likes to be reminded that he is growing 
 decrepit, and it is just as easy for the teacher 
 to leave the pupil at the end of a lesson with 
 a sense of well being, as it is to leave him 
 brooding over his infirmities. Pride should be 
 aroused. Often pride in work leads to pride 
 in personal appearance. 
 
 Teachers are at first often confused by the 
 difference in the workings of the mind in old 
 people and in children. The tendency with 
 children is to tear things to pieces to see how 
 they work, and they are commonly indifferent 
 about putting them together again. Experi- 
 ence of life and habit make the old want to 
 build up, to construct rather than take apart. 
 They are always anxious to see their work 
 completed. Work which requires much plan- 
 ning, and of which it is hard to construct a 
 mental picture, confuses the old. Occupation 
 should be pleasurable, and it is not pleasurable 
 if it bewilders the worker. Work should not 
 
WORK WITH THE AGED 165 
 
 be too restful. Rest and quiet are not gen- 
 erally needed so much as a wholesome interest. 
 The teacher may find it hard to waken in- 
 terest in work that is soft in color. It is hard 
 to rouse sense perception, and vivid colors may 
 not appear vivid to the old student. Some- 
 times it is well to explain that the people who 
 buy the work like dull colors. Tact and com- 
 mon sense are necessary in dealing with old 
 people, and an appeal to the reason is gen- 
 erally met with a prompt response. 
 
X 
 
 NEURASTHENIA 
 
 THE most puzzling problem confronting the 
 inexperienced teacher in dealing with asthenic 
 patients is the difficulty of rousing interest. 
 Perhaps it is as well to let this question go 
 until the patient is started on the road to re- 
 covery, and simply carry out the doctor's 
 prescription as to a certain amount to be ac- 
 complished. The inability to become inter- 
 ested is part of the lack of initiative and power 
 to execute which are characteristics of the dis- 
 ease. Mental and physical forces are often at 
 a low ebb, and interest is often unattainable, 
 no matter how much the patient may want to 
 become interested, or how conscientiously she 
 may try to fix her attention on her work. The 
 teacher should consider lack of interest as a 
 passing phase of the disease. It sometimes 
 occurs that physical strength returns, so that 
 the patient can take long walks, play golf, or 
 
 166 
 
NEURASTHENIA 167 
 
 even, in the writer's experience with neuras- 
 thenics, saw wood for an hour at a time, and 
 yet be completely floored, almost panic- 
 stricken, at being asked to plan a simple piece 
 of manual work. Men especially are often a 
 puzzle to the teacher in this respect. Some- 
 times an entering wedge of efficiency can be 
 inserted through some familiar work, in which 
 the patient has been heretofore so proficient 
 that his habitual skill helps him out, without 
 any great mental effort. Typewriting is a 
 good example. Most business men know how 
 to use the typewriter, and it seems to them a 
 natural thing that they should be asked to type 
 their own letters, or help with hospital work. 
 Very little of that train of doubting thought 
 is aroused, which is so worrisome to the patient 
 and precedes almost every volitional act. The 
 usefulness of the work frequently appeals to 
 a latent sense of practicality, which can gen- 
 erally be reached in a neurasthenic man if the 
 teacher digs deep enough. 
 
 Women patients frequently benefit from 
 weaving on a loom. It requires some degree 
 of attention, not too much, and is distinctly in- 
 teresting. It can be planned easily so that the 
 
168 THE WORK OF OUR HANDS 
 
 difficulty decreases from day to day. Pro- 
 gression in work is quite necessary with this 
 type of patients. 
 
 The teacher cannot disregard all the pa- 
 tient's symptoms. She must use tact as well 
 as skill. For instance, many neurasthenics 
 complain of a blurred vision and inability to 
 see colors vividly, others are peculiarly sensi- 
 tive to harsh colors and much distressed by 
 piercing sounds. Allowance can easily be 
 made by the teacher to give the patients a 
 quiet place to work at first, and a good choice 
 of colors and the conditions can gradually be 
 changed to reach the normal, as the patients 
 gain and grow accustomed to work. It 
 should never be forgotten by the teacher that 
 she is dealing with a disease that is very diffi- 
 cult to cure, and if the work is part of the cure 
 is must be given with as much scientific knowl- 
 edge as are medications or baths. This does 
 not mean that if a patient works three hours 
 to-day, she must work the same time to-mor- 
 row; it may mean that to-morrow being a bad 
 day, she should work only two hours, or, if she 
 seems much better and more interested, she 
 may work four hours. Common sense must 
 
NEURASTHENIA 169 
 
 underlie the application of all rules. The 
 teacher's steadiness of purpose, and confidence 
 in the patient's ultimate recovery, generally 
 has an influence in suggesting hopeful trains 
 of thought, even where there is no word of dis- 
 cussion of illness ever allowed. The question 
 often arises as to whether, in view of the ina- 
 bility to take responsibility being a part of 
 neurasthenia, it is not a good plan to try to 
 overcome this by making a neurasthenic help 
 in teaching or in the care of others. The 
 writer's experience has been, that while suf- 
 ferers from mental diseases frequently benefit 
 greatly from having responsibility put on 
 them, neurasthenics, unless almost well, are 
 more likely to hurt themselves than they are to 
 benefit others. A teacher's report on such a 
 case is given below: 
 
 Matron, aged 36, spent about six months 
 in the hospital. The first day I heard her tell 
 the physician that she knew all about what 
 was the matter with her; what she wanted was 
 for him to help her cure herself. She took the 
 whip hand in the same way in regard to occu- 
 pation work, and the physician ordered the 
 teacher to let her do what she chose. She se- 
 
1TO THE WORK OF OUR HANDS 
 
 lected a very intricate bag of knotted raffia 
 work, hard on the eyes, and so elaborate as to 
 be very trying to work at steadily. She took 
 this to her room at the physician's suggestion, 
 and tired herself out so that she was unable to 
 do any more occupation work for some days. 
 She was then willing to be guided by the teach- 
 er's advice, and started a sewed basket, but she 
 was able to raise all sorts of difficulties over 
 this; she could not get smooth enough raffia; 
 her reed broke easily. The basket, when at 
 last completed, was a beautiful piece of work, 
 but she at once gave it away, as she said it had 
 caused her so much anxiety she never wanted 
 to see it again. She had the same attitude to- 
 ward other people's work that she had toward 
 her own perfection of technique was her only 
 standard, and she constantly discouraged other 
 patients who were working happily, if some- 
 what clumsily, and made them feel themselves 
 awkward and inexpert. The idea that the ef- 
 fort might be valuable where the result was 
 only fair technically, was one she could not 
 grasp. (She had been for years a retoucher 
 of lantern slides for stereopticon lectures, and 
 perfection was her hobby.) Her physician 
 
NEURASTHENIA 171 
 
 talked to the teacher about her, sometimes he 
 stopped her work for a time, and finally he 
 suggested that she be encouraged to feel her- 
 self valuable in helping other patients. The 
 teacher and nurse tried to be tactful in making 
 her feel herself very useful, although they did 
 all the real work, and in about two days she 
 reported to her physician that the occupation 
 teacher and the nurse were shirking, and let- 
 ting her do their work. She also wrote a 
 sharp note to the occupation teacher and said 
 that she was doing the work the teacher was 
 paid for, and even reported this to the super- 
 intendent, much to the embarrassment of the 
 physician, who decided that the patient had 
 outlived the good of hospital residence, and 
 shortly after, following a week in bed from 
 over-fatigue, sent her home. She was able to 
 return to her vocation in a few weeks. This 
 was an extreme case, but represents a type of 
 half-sick patients who are a peculiarly difficult 
 problem for the occupation teacher. While 
 such an incident should not be taken too seri- 
 ously, it is really worth careful thought. This 
 woman was kind-hearted, and meant well to 
 the other patients; her meticulous devotion to 
 
172 THE WORK OF OUR HANDS 
 
 perfection of work was an outcome of years in 
 a vocation demanding it. 
 
 The result of trying to have her help was to 
 show how ill she really was, as she could not 
 rise to so simple a situation without great dis- 
 turbance. 
 
 Another patient, who seemed reasonably 
 able to work, rebelled against doing anything, 
 and said she "only worked because she was 
 made to." She seemed very intelligent, be- 
 came in a few hours quite interested in a com- 
 parison of various styles of basketry, decided 
 she could do work as good as any samples in 
 the workroom, and, after that, worked six or 
 seven hours a day, evidently without fatigue, 
 as the physician said she slept better for hav- 
 ing worked hard. Her attention was success- 
 fully diverted from her illness. The effect, 
 however, reached no further than this ; she took 
 no interest in what other patients were doing, 
 was particularly annoyed because children 
 were allowed to work in the same room with 
 her, although she had been a teacher and might 
 naturally be supposed to like children. 
 
 In many cases it has seemed to the occupa- 
 tion teacher that patients really needed to 
 
NEURASTHENIA 173 
 
 work alone at first, but her judgment in this 
 case was quite the opposite. This woman 
 needed to be taught to be respectful of others' 
 rights. The presence of others did not seem 
 to really disturb her, as she did not appear con- 
 fused or easily tired, and the excellence of her 
 work showed that she was in fair condition 
 physically. She was the true old-fashioned 
 type of "malade imaginaire." It may be 
 stated parenthetically that her physician 
 pumped enough common sense into her so that 
 she went home at the end of a week "cured." 
 One case that seems to illustrate the possi- 
 bilities of occupation work for neurasthenics 
 was that of a young man, a stenographer, 
 broken down in the financial crisis of 1907; he 
 was pale and thin, and became easily tired, so 
 that, at first the work he did had to be such as 
 required the lowest degree of physical strength 
 and of planning. He first made a pierced 
 brass ink well, bought stamped ready to deco- 
 rate. As he had never done any kind of craft 
 work, the novelty of it attracted him. He 
 next made a basket in Indian work, that is 
 made with raffia, with a needle, over a foun- 
 dation of reed. By the time this was done 
 
174 THE WORK OF OUR HANDS 
 
 he had more control of his hands, and was also 
 able to plan out what he wanted to do. He 
 planned a scrap basket with a wooden bottom, 
 made by himself, decorated around the top 
 with a band of color. By this time he really 
 enjoyed his work. After this, he drew a wood 
 carving design for a box and carved the top 
 panel. When he was able to go home, he ex- 
 pressed himself as having got a new attitude 
 toward work, and that he would like to make 
 more use of his physical powers, and would 
 like to build a bungalow. A more active and 
 manly kind of life had evidently opened itself 
 up before him, where he could still make use 
 of the dexterity and quickness which had for- 
 merly been used only in typewriting. For a 
 time he worked with a surveyor's corps, lead- 
 ing an active outdoor life. This young man 
 cooperated intelligently with his physician and 
 with the teacher, in regard to the occupation 
 work; trained to systematic habits, he kept 
 them even in this serious illness. 
 
 Among other men patients taught, one had 
 never come in contact with real work, although 
 he was a man over forty. His physician asked 
 that he be roused to take an interest in several 
 
PSYCHASTHENIA 175 
 
 kinds of work. At first he was rather un- 
 willing to try, became easily fatigued, and 
 paid little attention to anything outside his 
 own condition. But he must have had a natu- 
 ral aptitude for hand work, as he gained rap- 
 idly in proficiency, and (as he happened to 
 be associated with some patients who earned 
 their living as artisans) he got a new attitude 
 toward manual labor, which he himself said 
 he had never had before. He appeared to be 
 naturally delicate and had, perhaps, always led 
 a sheltered life, so that this was the first time 
 he had felt the satisfaction of using his 
 strength in honest work. 
 
 Psychasthenia 
 
 This caption covers such a wide range of 
 humanity that we cannot expect to do more 
 than generalize. Often the nervous instabil- 
 ity which makes the individual a prey to 
 fatigue, to distressing thoughts, and to periods 
 of low vitality finds a natural balance in work. 
 Successful physical effort seems to satisfy and 
 benefit these patients by relieving the nervous 
 tension. The work done must be restful 
 rather than stimulating or it fails of its effect. 
 
176 THE WORK OF OUR HANDS 
 
 It is in relation to patients of this type that 
 there would seem to be a peculiar field in the 
 higher applied arts, requiring creative power 
 and dexterity, and some strength. It might 
 be that many could thus reach their maximum 
 of mental and bodily health, and avoid recur- 
 ring setbacks from ill health. 
 
 The attitude of these patients towards work 
 is generally one of keen interest; frequently 
 they are over-enthusiastic. Occasionally this 
 intensity of interest is due to a desire on the 
 patient's part to do something that will keep 
 her from too much thinking of her health, or 
 whatever dominant idea had her in its clutches. 
 In other cases it is due to a genuine interest in 
 the work in hand, and it seems that this nor- 
 mal interest is not disturbed by illness. It is, 
 however, often necessary to hold back patients 
 from working too long and too steadily. The 
 desire to complete work seems to be too keen. 
 The mind seems to leap far ahead of what the 
 body can accomplish, and the impression the 
 teacher gains is that these patients need rest- 
 ful guidance rather than stimulation. In fact, 
 what gain is derived from occupation work 
 seems to be from mechanical work, rather than 
 
PSYCHASTHENIA 1T7 
 
 from that requiring creative power. This ap- 
 plies to patients so ill as to require hospital 
 care. The most engrossing of craft work, re- 
 quiring the keenest use of the creative power, 
 probably never cause a "nervous breakdown" 
 such as are often attributed to teaching and 
 other vocations where the human element 
 enters in. 
 
 A few examples may illustrate the teaching 
 of these cases. One of these was a school- 
 teacher of about thirty who had been in school 
 work twelve years, and had had several break- 
 downs, when she could not sleep or eat. Her 
 attention was entirely taken up with her own 
 condition, physical, mental and moral. She 
 spent many hours a day thinking over her re- 
 ligious beliefs, and talking about them if she 
 could get any one to listen. So absorbed was 
 she in this self -analysis, that rules forbidding 
 conversation about one's ills were entirely for- 
 gotten. When allowed to work, she plunged 
 into basketry and wanted to work before 
 breakfast and late at night. The teacher 
 switched her off onto chair caning, which be- 
 ing somewhat monotonous and mechanical, 
 seemed to quiet her at once. The difficulties 
 
178 THE WORK OF OUR HANDS 
 
 presented were sufficient to hold her attention, 
 but not over stimulating. She caned eight 
 chairs in a fortnight, and soon after was able 
 to return home. 
 
 Another patient, a trained nurse of about 
 50, had much the same restless activity. 
 Her physical condition was the subject of her 
 depressing thoughts, but she also was amen- 
 able to discipline through manual work. She 
 became interested in basketry, and it had the 
 same effect in restoring her balance that chair 
 caning had on the first-mentioned patient. 
 She became a successful teacher of craft work 
 in a Boys' Club. 
 
 A third case of peculiar interest is that of a 
 young woman of about 30, so delicate that 
 she had constant nervous attacks if she at- 
 tempted, as she put it, to "live like other peo- 
 ple." She decided to spend one winter under 
 the care of a nerve specialist to "learn how to 
 live." She wanted work to occupy an hour or 
 two a day and chose basketry, deciding to make 
 one really beautiful sewed basket. At first 
 she could work only a few minutes, and the 
 teacher had to help her plan the design. 
 Later, she elaborated the original design and 
 
PSYCHASTHENIA 179 
 
 introduced more colors. The basket, when 
 completed, was really a work of art and the 
 patient calculated it had filled more than two 
 hundred hours. She meanwhile had gained 
 so in strength and became so much interested 
 in craft work, that she decided to take a course 
 in book-binding, and has made a great success 
 of it. This is a type of person who knows she 
 has inherited a neuropathic temperament and 
 is systematically trying to fortify herself, with 
 good results. 
 
XI 
 
 WORK WITH CRIPPLES 
 
 THE crippled and the blind were among the 
 first to demonstrate the possibilities of handi- 
 craft work as a means of livelihood. Wher- 
 ever work was started it became almost 
 immediately successful. The results of early 
 attempts at training cripples in Europe and 
 this country have been carefully studied so 
 that it can be estimated with a fair degree of 
 accuracy what work should be possible for one 
 limited by any particular handicap, such as 
 the loss of a hand or a foot. / 
 
 Among the European countries which took 
 up, many years ago, scientific work with the 
 crippled and injured, was little Denmark. 
 Reverend Hans Knudsen in 1872 opened a 
 clinic and school. The aim of this clinic was 
 "ameliorating the corporal deformity of the 
 cripple, and afterward by means of an indus- 
 trial school, teaching him how to work, so that 
 
 180 
 
WORK WITH CRIPPLES 181 
 
 be might contribute to his own sustenance." 
 The Government backed him financially 
 shortly after he started in this work, and he 
 aimed from the outset to help every cripple in 
 the confines of Denmark. In one of the re- 
 ports of this school the following statement 
 occurs : 
 
 "The cause of the deformed is taken up all 
 over Denmark with the greatest sympathy, 
 which finds expression in many ways. Most 
 daily papers insert advertisements free of 
 charge. The annual report is printed for 
 nothing, nor is any charge made for telephone, 
 paper, medicine, hospital treatment, etc." 
 
 The output from this school is bought not 
 only by private individuals, but by the Govern- 
 ment. The railways buy linen and cotton 
 goods, furniture, brushes, etc., and the street 
 cleaning departments buy brushes. 
 
 After the success of the Danish school was 
 assured, Pastor Knudsen longed to bring hap- 
 piness and financial help to cripples in other 
 countries. In 1884 an International Con- 
 gress of Physicians held in Copenhagen 
 brought many visitors, and an opportunity 
 was given to show the work done. A new 
 
182 THE WORK OF OUR HANDS 
 
 school was soon started in Gothenburg, 
 Sweden, in which weaving, printing, and book- 
 binding are among the industries taught. 
 The making of orthopaedic boots, braces, and 
 other hospital appliances is also very satisfac- 
 torily done. Pupils who have completed their 
 course in the school and learned a trade are 
 sometimes given a set of tools to work at home. 
 It is said that there is no cripple who could 
 possibly become self-supporting left untrained 
 in Scandinavia. In addition to the benefit 
 from learning trades, these cripples gained 
 much physically. 
 
 In England the schools have been con- 
 ducted on a somewhat different principle, 
 small children being taken as pupils and given 
 therapeutic gymnastics and craft training up 
 till the age of sixteen. Jewelry work, tailor- 
 ing and harness making are among the trades 
 taught. 
 
 Many schools in this country have been con- 
 ducted successfully on a somewhat similar 
 principle, the only difference being in the fact 
 that the graduates frequently continue to work 
 in the school workshop, instead of carrying on 
 their trades at home. As many of them live 
 
OCCUPATION" ROOM AT HOSPITAL FOR RUPTURED 
 AND CRIPPLED, NEW YORK CITY. 
 
 Such a great room as this could be utilized for large classes of 
 crippled workers coming in from outside for daily work 
 and treatment. 
 
WORK WITH CRIPPLES 183 
 
 in tenements, it goes without saying that em- 
 broidery and many other trades can be better 
 done at the school* x 
 
 The Hospital' of Hope in the Bronx, New 
 York City, under the enthusiastic direction of 
 Dr. Jaeger, is an enterprise on a somewhat 
 more scientific basis, in that it aims to train 
 young men between the ages of sixteen and 
 thirty-five in skilled trades, especially chosen 
 with regard to individual handicaps. These 
 workers can then carry on their trades in any 
 shop where they can get positions. Among 
 the work done is reed and willow furniture 
 making, cabinet making, silver smithing, 
 monograms and wood engraving, die work, 
 show card writing, and mechanical drawing. 
 The men who enter the school must be able to 
 walk, but the loss of one hand, or one foot, 
 does not make the applicant ineligible. The 
 work that seems the most remarkable to the 
 general observer is that done in art glass, or 
 mosaic work, by one-handed men. A treadle 
 operated by the foot is used in placing the 
 work. Small pieces of glass are used to form 
 the design. This is one of the most lucrative 
 trades taught. 
 
184 THE WORK OF OUR HANDS 
 
 One great difficulty met with in the train- 
 ing of adult cripples is the restoring of self- 
 confidence. So many seem to have "lost their 
 grip," and feel thejnselves far more incapable 
 than they are./^Bpecial attention has been 
 paid to this phase of the subject in the chap- 
 ters on Reeducation and on Tabes/ The same 
 thing is true in regard to those crippled by 
 accident, and it is well to have as short an 
 interval as possible between discharge from 
 hospital care and the beginning of training. 
 This is one of the best arguments for trade 
 work in hospitals. 
 
 The teaching of crippled children must 
 necessarily be done with great care. In the 
 case of Infantile Paralysis, it may be com- 
 bined with physical exercise in order to get 
 the best therapeutic effect. This has already 
 been touched on in the chapter on Paralysis. 
 In the work with children suffering from bone 
 tuberculosis, Potts' Disease or hip disease, the 
 physician may be able to predict how much de- 
 formity must be allowed for, so that, if the 
 child is liable to be permanently misshapen, 
 work requiring little strength may be given. 
 
WORK WITH CRIPPLES 185 
 
 frequently these children have great delicacy 
 of touch, and a keen color sense, and these 
 characteristics may be made use of in planning 
 work* 
 
APPENDIX 
 
 As an example of the variety and the extent 
 of the work done in one state hospital The 
 State Colony for the Insane, at Gardner, 
 Massachusetts the following list of manufac- 
 tures and products is copied from the Annual 
 Report for 1914. 
 
 The State Colony at Gardner is above the 
 average in industrial efficiency, but the possi- 
 bilities of production have only begun. A 
 very small proportion of the farm is utilized in 
 any way and many possible industries are cur- 
 tailed or omitted for lack of support or funds. 
 
 INDUSTRIAL DEPARTMENT 
 WORK DONE BY WOMEN 
 
 Aprons, dining-room... 110 Bags, candy, Christmas. 117 
 
 Aprons, gingham 42 Bags, coffee 51 
 
 Aprons, kitchen 258 Bags, Irish crocheted... 4 
 
 Aprons, white 70 Bags, jelly 6 
 
 Babies' bib, embroidered 1 Bags, laundry 170 
 
 Baby's pillow tops, em- Bags, tea 49 
 
 broidered 2 Bags, twine, laundry. ... 31 
 
 187 
 
188 
 
 APPENDIX 
 
 Bags, twine, school 12 
 
 Baskets, raffia 114 
 
 Baskets, reed 14 
 
 Bibs 136 
 
 Bibs, apron 6 
 
 Blankets, hemmed 1T6 
 
 Books covered, library . . 80 
 
 Bonnets 2 
 
 Brush and broom cases, 
 
 embroidered 4 
 
 Bureau covers, hem- 
 stitched 133 
 
 Burial robes 24 
 
 Canvas pillow support. . 1 
 Canvas covers and 
 swings for continuous 
 
 bath 2 
 
 Caps, cloth 4 
 
 Caps, corduroy 56 
 
 Case for rubbers, em- 
 broidered 1 
 
 Cases, leather, medicine 
 
 bottle 5 
 
 Chemises 281 
 
 Chemise yokes, Irish 
 
 crocheted 4 
 
 Coats (men patients) . . . 133 
 
 Coats (women patients) 4 
 Collar and cuff sets, Irish 
 
 crocheted 2 
 
 Collar, Irish crocheted.. 1 
 Collar and yoke, Irish 
 
 crocheted 1 
 
 Corset covers 26 
 
 Covers, baseball base ... 3 
 
 Cover, blasting mat, .... 1 
 
 Covers, broom 6 
 
 Covers, canvas buffers . . 79 
 Covers, dentist chair 
 
 hand rest.. 34 
 
 Covers, cotton floor, 
 
 painters' 5 
 
 Cover, printing-press ... 1 
 
 Covers, requisition book. 60 
 
 Covers, screen, hospital. 12 
 Crocheted beading and 
 
 cord (yards) 9 
 
 Crocheted doilies, table. 6 
 
 Crocheted napkin rings. 18 
 Crocheted slippers 
 
 (pairs) 7 
 
 Curtains, scrim (pairs). 131 
 Curtains, dressing-room, 
 
 khaki 2 
 
 Curtain ties (pairs).... 39 
 
 Cushion covers 9 
 
 Doilies, hemstitched 3 
 
 Dolls, dexter cotton 14 
 
 Drawers, cotton, pa- 
 tients' 224 
 
 Dresses, patients' 651 
 
 Embroidered boudoir cap 1 
 Embroidered bureau 
 
 scarfs 4 
 
 Embroidered center 
 
 pieces 7 
 
 Embroidered collar and 
 
 cuff sets 5 
 
 Embroidered collars 2 
 
 Embroidered doilies 58 
 
 Embroidered lunch cloth 1 
 
 Embroidered neckties. ... 6 
 Embroidered pillow 
 
 cases 24 
 
 Embroidered pillow tops 7 
 
 Embroidered pincushions 8 
 
 Embroidered table covers 12 
 Embroidered waists, 
 
 voile 5 
 
 Golf capes 17 
 
APPENDIX 
 
 189 
 
 Handkerchiefs (dozen).. 19 
 Handkerchiefs, crocheted 
 
 edge 3 
 
 Handkerchiefs, hem- 
 stitched 23 
 
 Hats, palm-leaf 139 
 
 Holders, kitchen 282 
 
 Jabots, Irish crocheted . . 2 
 
 Jumpers 310 
 
 Kimono 1 
 
 Lace, knitted (yards) . . . 37 
 Lunch sets, crocheted 
 
 (20 pieces in set) 4 
 
 Mattress cases 79 
 
 Mats, Colonial (3 pieces 
 
 in set) 45 
 
 Mittens (pairs) 704 
 
 Napkins, sanitary 264 
 
 Napkins, table 342 
 
 Neckties 181 
 
 Neckties, crocheted 2 
 
 Nightgowns 417 
 
 Overalls 984 
 
 Padded aprons, dish- 
 washers 3 
 
 Pillow cases 587 
 
 Pillow tops 8 
 
 Pillow shams, drawn 
 
 work 2 
 
 Rags, sewed for rugs 
 
 (pounds) 1,725 
 
 Reefers 28 
 
 Rugs, braided 183 
 
 Rugs, hooked 17 
 
 Rugs, woven 145 
 
 Scrim curtains, hem- 
 stitched 33 
 
 Shawl, knitted 1 
 
 Sheets, officers 145 
 
 Sheets, patients 1,820 
 
 Shirts, hospital 62 
 
 Shirts, outside 504 
 
 Shirtwaists 8 
 
 Shoe tops, stitched 
 
 (pairs) 697 
 
 Sideboard covers, hem- 
 stitched 3 
 
 Sideboard covers, hem- 
 stitched, drawn work. 2 
 
 Skirts, dress 6 
 
 Slippers, crocheted 
 
 (pairs) 2 
 
 Socks toed (pairs) 3,116 
 
 Stand covers 35 
 
 Suspenders (pairs) .... 818 
 
 Tablecloths 39 
 
 Table covers, hemstitched 43 
 
 Table covers, plain 45 
 
 Tag case 7 
 
 Tatting collars 11 
 
 Tatting doilies 5 
 
 Tatting edge and inser- 
 tion (yards) 10 
 
 Towels, embroidered ... 5 
 
 Towels, hemmed 5,840 
 
 Tray cloths 27 
 
 Trousers (pairs) 922 
 
 Underskirts 601 
 
 Upholstered cushion lin- 
 ings 4 
 
 Vests 88 
 
 Wash cloth, embroidered 1 
 
 Window shades stitched. 211 
 
 Worsted Santa Claus . , 24 
 
190 
 
 APPENDIX 
 
 MENDING 
 
 Aprons 172 
 
 Bags, tea and coffee 8 
 
 Barber's chair cover.... 1 
 
 Baseball pants 10 
 
 Bedspreads 6 
 
 Blanket, bed, cotton .... 1 
 
 Bureau cover 1 
 
 Cape 1 
 
 Caps 50 
 
 Chemises 64 
 
 Coats, men's 1,391 
 
 Corset covers 23 
 
 Curtains 12 
 
 Dishwashing pads 6 
 
 Drawers 115 
 
 Dresses 976 
 
 Flags 14 
 
 Gloves (pairs) 3 
 
 Horse blankets 4 
 
 Jumpers 491 
 
 Kimonos 2 
 
 Laundry bags 37 
 
 Mittens (pairs) 221 
 
 Nightgowns 322 
 
 Nightshirts 47 
 
 Oilcloth table covers ... 13 
 
 Overalls 1,761 
 
 Overcoats 2 
 
 Petticoats 542 
 
 Pillow slips 2 
 
 Reefers 70 
 
 Rugs 9 
 
 Sheets 24 
 
 Shirts, men's, colored . . 1,834 
 
 Spreads 8 
 
 Stockings 4,034 
 
 Sweaters 4 
 
 Tablecloths 10 
 
 Tent 1 
 
 Trousers 2,499 
 
 Underdrawers 1,579 
 
 Undershirts 1,180 
 
 Underskirts 12 
 
 Vests . 312 
 
 WORK DONE BY MEN 
 BLACKSMITH AND MACHINIST 
 
 Anchor irons made 
 
 Andirons made (sets) .. 
 
 Angle irons made 
 
 Axe wedges made 
 
 Bands, etc., made 
 
 Bitstock socket 
 
 Bolts made 
 
 Braces made 
 
 Braces straightened .... 
 
 Bracket made 
 
 Bunk-irons made (set) . 
 
 Cant hooks shaped 
 
 Carriages repaired 
 
 136 Catches made 
 
 7 Chafe irons made 
 
 264 Chain and toggle made. 
 
 12 Chains made 
 
 8 Chains repaired 
 
 1 Chisels made 
 
 505 Chisel sharpened 
 
 83 Clamps made 
 
 2 Clevis made 
 
 1 Coal shovel repaired . . . 
 
 1 Crowbars made 
 
 3 Crowbars sharpened . . . 
 6 Cultivators repaired . . . 
 
 4 
 
 4 
 1 
 5 
 
 80 
 2 
 1 
 
 14 
 1 
 1 
 4 
 
 61 
 4 
 
APPENDIX 
 
 191 
 
 Cut and flange (1-inch 
 
 pipe, for steps) 1 
 
 Cutting piece of smoke- 
 stack 1 
 
 Damper iron made 1 
 
 Door guides made 2 
 
 Door latch made 1 
 
 Doorstep repaired 1 
 
 Draw irons made 3 
 
 Eyebolts made 7 
 
 Eyelets made 5 
 
 Evener made 
 
 Evener repaired 
 
 Evener staple made 
 
 Fertilizer spreader re- 
 paired 
 
 Flag-pole ring made .... 
 
 Gambrel made 
 
 Garden basket legs made 4 
 
 Gear pullers made 2 
 
 Grass hooks repaired ... 2 
 
 Grate lifter made 1 
 
 Grub hoes sharpened. ... 11 
 
 Hames repaired 2 
 
 Hammer strap made 1 
 
 Hammer wedges made. . 24 
 
 Hangers made 50 
 
 Harrows repaired 10 
 
 Hasps made 2 
 
 Hay hooks made 3 
 
 Hinges made 16 
 
 Hinges repaired 3 
 
 Hoes repaired 2 
 
 Holes drilled 602 
 
 Hooks made 34 
 
 Horses shod 152 
 
 Horse shoes set 36 
 
 Horse shoes sharpened . . 10 
 
 Ice plow repaired 1 
 
 Ice tongs made (pair) . . 1 
 
 Ice tongs repaired (pair) 1 
 
 Iron gate made 1 
 
 Iron plate made 1 
 
 Iron stakes, fence, made 10 
 
 Irons straightened 2 
 
 Lamp clamp made 1 
 
 Latches and bolts made. 3 
 
 Light protectors made . . 16 
 
 Links, chain, made 8 
 
 Manure spreaders re- 
 paired 3 
 
 Meat saw repaired 1 
 
 Mowing machines re- 
 paired 2 
 
 Neck yokes made 10 
 
 Neck yokes repaired.... 2 
 
 Oxen shod 142 
 
 Ox yokes repaired 7 
 
 Payout reel made 1 
 
 Picks resteeled 47 
 
 Picks sharpened 234 
 
 Pinch bars sharpened... 2 
 
 Pipe rests made 6 
 
 Plows repaired 2 
 
 Plow rod repaired 1 
 
 Pole end iron and pin 
 
 made 1 
 
 Potato parer repaired ... 1 
 
 Presser foot arm made . . 1 
 
 Punch made 1 
 
 Remnant bag supports 
 
 made 2 
 
 Ring bolts made 2 
 
 Rings made 40 
 
 Rods bent 42 
 
 Rods made 208 
 
 Rods straightened 2 
 
 Saw handles repaired ... 2 
 
 Scale repaired 1 
 
 Screw driver repaired... 1 
 
192 
 
 APPENDIX 
 
 Screw made 1 
 
 Shaft box repaired 1 
 
 Shaft iron repaired 1 
 
 Shafts repaired 7 
 
 Shipper irons made 3 
 
 Shovels repaired 3 
 
 Sled dogs made 2 
 
 Sleds repaired 8 
 
 Sled shod 1 
 
 Sleighs repaired 4 
 
 Sleighs shod 5 
 
 Soldering irons repaired 3 
 
 Stanchion irons made... 16 
 
 Stanchion latches made . . 2 
 
 Stanchion repaired 1 
 
 Staples made 38 
 
 Stepladder stays made . . 2 
 
 Stone drills made 23 
 
 Stone drills sharpened. . 1,085 
 Stone drill spoons 
 
 made 3 
 
 Stone drill spoons re- 
 paired 3 
 
 Stone hammers refaced. 7 
 
 Strap irons made 92 
 
 Stripping hammers re- 
 faced 3 
 
 Sulky plows repaired ... 3 
 
 Tailboard irons made .... 2 
 Tires made and put on 
 
 wagon 4 
 
 Tires set, carriage 6 
 
 Tires set, wagon 2 
 
 Trimming knife made. . . 1 
 
 Wagons repaired 8 
 
 Wagon yoke made 1 
 
 Washers made 31 
 
 Welding (pieces) 3 
 
 Whiffletree iron set 1 
 
 Whiffletree repaired 1 
 
 Window openers made.. 12 
 
 Wrench made 1 
 
 BROOM AND BRUSH DEPARTMENT 
 
 Brooms made 219 
 
 Rattan 12 
 
 Toy 1 
 
 Whisk 1 
 
 Brushes made: 
 
 Ceiling 16 
 
 Counter 114 
 
 Floor 130 
 
 Mane and tail 50 
 
 Radiator 125 
 
 Scrub 248 
 
 Scrub, long-handled . . 41 
 
 Vegetable 320 
 
 Window 67 
 
 Mat, cocoa (9 feet 6 
 
 inches by 6 feet 5 
 
 inches) 1 
 
 Mattresses : 
 
 Hair (4-foot) 10 
 
 Hair (2 feet 6 inches) 65 
 
 Pillows, hair 38 
 
 Stockings knitted (pairs) 514 
 
 Toweling woven (yards) 171 
 Upholstery: 
 Carriage backs and 
 
 seats 2 
 
 Chairs, arm 6 
 
 Cushions made, leather 
 
 (2 feet by 5 feet) . . 6 
 
 Sleighs 2 
 
APPENDIX 
 
 193 
 
 Axe handles made 
 
 Bannister repaired 
 
 Barn ceiling repaired... 
 
 Bathroom platform re- 
 paired 
 
 Box, book, made 
 
 Box, blasting mat, made. 
 
 Boxes, bushel, made 
 
 Boxes, half-bushel, made 
 
 Box, cheese, made 
 
 Boxes, guinea pig, made 
 
 Box, special, made 
 
 Box, motor and switch, 
 made 
 
 Bread boards made 
 
 Bread boxes repaired. . . . 
 
 Cabinet benches made. . . 
 
 Cabinet closets made. . . . 
 
 Cart repaired 
 
 Carriages repaired 
 
 Chain guard, door, put 
 on 
 
 Chair swing repaired. . . . 
 
 Chicken houses made .... 
 
 Cleat, flagpole halyard, 
 made 
 
 Clothes boxes repaired . . 
 
 Clothes line posts made. 
 
 Clothes locker made 
 
 Clothes rack repaired... 
 
 Coat hangers repaired . . 
 
 Cold-air shaft repaired . . 
 
 Cold frames, vegetable, 
 made 
 
 Counter, store 
 
 Counter-motor, store, 
 made 
 
 Crates, hot-water heater. 
 
 CARPENTER 
 
 7 Cupboards made 4 
 
 Door casings repaired ... 2 
 
 Door hung, barn 1 
 
 Door jam repaired 1 
 
 Door knobs repaired 3 
 
 Door spring repaired... 1 
 
 Doors, inside, made 3 
 
 48 Doors repaired 225 
 
 12 Doors, screen, made 6 
 
 1 Drawers repaired 14 
 
 6 Ensilage barrow repaired 1 
 
 1 Evener made 1 
 
 Extension ladders made 
 
 1 (24 feet each) 6 
 
 2 Fenders, swing stage 2 
 
 2 Fertilizer screen made.. 1 
 2 Fertilizer spreader re- 
 
 2 paired 1 
 
 1 File handle made 1 
 
 3 Flagpoles made (60 feet 
 
 high) 2 
 
 1 Flagpole caps made 2 
 
 1 Floor, horse stall, made. 1 
 15 Floor polishing blocks 
 
 made 6 
 
 1 Floors repaired 7 
 
 2 Floor swabs made 9 
 
 2 Frames, window, made.. 3 
 
 1 Fuse box, switch, made. . 1 
 
 1 Gate, chicken coop, made 1 
 
 10 Grading stakes made... 620 
 
 1 Grove seats made 18 
 
 Handles, payout-reel, 
 
 2 made (set) 1 
 
 1 Harrows repaired 3 
 
 Hen houses repaired. ... 2 
 
 1 Hen trap nests made 24 
 
 3 Hog troughs made 2 
 
194 
 
 APPENDIX 
 
 Horse stalls repaired... 12 
 
 Horse rack made 1 
 
 Hot-bed - frame sashes 
 
 made 15 
 
 Ice plow sharpened 1 
 
 Ice run made (feet) 61 
 
 Ironing boards and 
 
 stands made 5 
 
 Ironing board made.... 1 
 
 Keys made 35 
 
 Kitchen sink repaired ... 1 
 Kitchen utensil rack 
 
 made 1 
 
 Lawn mowers repaired . . 3 
 
 Locks put on 73 
 
 Locks repaired 295 
 
 Lumber planed (feet) .. 1,100 
 
 Meat board made 1 
 
 Neck yokes made 46 
 
 Overlook cottage, built . . 1 
 
 Ox yokes repaired 2 
 
 Pantry shelves made 
 
 (set) 1 
 
 Partitions made 2 
 
 Patterns, casting, made. 10 
 
 Piano legs repaired 4 
 
 Piazza repaired 1 
 
 Platform cover repaired. 1 
 
 Platforms repaired 2 
 
 Rack, paper bag, made . . 1 
 
 Rack, time card, made . . 1 
 
 Refrigerators repaired . . 2 
 
 Roofs repaired 7 
 
 Rubbers put in door 
 
 steps 6 
 
 Sawhorses made 7 
 
 Saws filed 200 
 
 Screen doors made 5 
 
 Scuif hole repaired 1 
 
 Scuttle repaired 1 
 
 Sections, strawberry- 
 crate, made 24 
 
 Shelves made 5 
 
 Shipping box made 1 
 
 Shoe rack made 1 
 
 Signs made 24 
 
 Slaughter house 1 
 
 Sled, log, made 1 
 
 Sledge hammer handles 
 
 replaced 150 
 
 Sleds repaired 12 
 
 Sleighs repaired 2 
 
 Snow shovels repaired ... 5 
 
 jStair railings repaired.. 1 
 
 Stairs repaired 5 
 
 Stakes, grade, made .... 450 
 
 Stanchions repaired 15 
 
 Step made (4-foot) 1 
 
 Stepladders made (2 
 feet, 4 feet and 6 feet 
 
 each) 3 
 
 Sticks, laundry rack, 
 
 made 24 
 
 Stone boats made 36 
 
 Table shelf made 1 
 
 Tennis court screens 
 
 erected (feet) 100 
 
 Toilet paper box re- 
 paired 1 
 
 Tool box cover made .... 1 
 
 Tool box made 1 
 
 Towel rack repaired.... 1 
 
 Trucks repaired 2 
 
 Vegetable boxes made. . 36 
 
 Ventilator repaired .... 1 
 
 Wagon body made 1 
 
 Wagons repaired 4 
 
 Wall boxes made 4 
 
APPENDIX 
 
 195 
 
 Wardrobe made 
 
 Water closet repaired.. 
 
 Whiffletrees made 
 
 Windmill repaired 
 
 Window casing made 
 
 Window frames repaired 
 Window guard repaired. 
 Window sash repaired . . 
 
 1 Window screens made. . 73 
 
 1 Window screens repaired 250 
 
 6 Windows made 4 
 
 1 Windows repaired 70 
 
 1 Window stops put on .... 250 
 
 64 Wooden screen, bathtub. 1 
 
 1 Wood rack made (10% 
 
 1 by 3y 2 feet) l 
 
 FURNITURE DEPARTMENT (NEW WORK) 
 
 Apparatus, gymnasium, 
 set up 
 
 Bases, wood basket 
 
 Baskets, berry 
 
 Baskets, office 
 
 Baskets, wood 
 
 Beds set up 
 
 Benches made (102*4 
 feet) 
 
 Box, card index 
 
 Boxes, drawer, library 
 card 
 
 Boxes, flower 
 
 Boxes, flower, reed 
 
 Boxes, flower, with 
 stands 
 
 Boxes, knife 
 
 Boxes, special 
 
 Boxes, toilet paper 
 
 Brackets, flower box 
 
 Brass nosing put on stairs 
 
 Bulletin board with card 
 holder 
 
 Cabinet, phonograph . . . 
 
 Cases, thermometer .... 
 
 Castors, chair 
 
 Chairs, dining-room .... 
 
 Chairs, patients', dining- 
 room . 
 
 Chairs, rattan rock- 
 
 4 ing 36 
 
 6 Chair rounds made 35 
 
 6 Chiffonniers 12 
 
 5 Curtains, shades, rollers 
 
 1 and fixtures 23 
 
 11 Desks, writing 3 
 
 Diet board 1 
 
 15 Dressers 7 
 
 1 Forms, laundry bag 12 
 
 Frames, lacework 23 
 
 Q Frames, picture 15 
 
 6 Gags, mouth 23 
 
 4 Handles, hammer 2 
 
 Jacks, tailor 2 
 
 2 Key 1 
 
 4 Machines, power sewing, 
 
 3 set up 5 
 
 8 Plugs, bed 3 
 
 18 Presses, tailor 3 
 
 18 Racks, apple drying 4 
 
 Racks, book 2 
 
 1 Racks, laundry bag 8 
 
 1 Rack, table and pan .... 1 
 
 7 Rack, table, 24-lock 
 
 36 drawer 1 
 
 36 Racks, towel 2 
 
 Rods, flag 12 
 
 46 Rollers, curtain 5 
 
196 
 
 APPENDIX 
 
 Rubber treads put on 
 
 stairs 18 
 
 Screens, bedside folding. 3 
 
 Shanks, shoe 1,300 
 
 Shuttles, loom 10 
 
 Shuttle, sewing machine. 1 
 
 Stand, inkwell 1 
 
 Stools, foot 2 
 
 Stool, high 1 
 
 Stools, milking 6 
 
 Stretcher, loom 1 
 
 Swift, loom 1 
 
 Tables, day room, round 
 
 top 8 
 
 Tables, card 6 
 
 Tables, folding 6 
 
 Tables, dining, officers'.. 6 
 
 Tables, reed 1 
 
 Table, telephone 1 
 
 Table, work 1 
 
 Ventilator, window, port- 
 able 1 
 
 Wands, gymnasium 18 
 
 Wheelbarrows assembled 24 
 
 FURNITURE DEPARTMENT (REPAIRS) 
 
 Barber's shears sharp- 
 ened 31 
 
 Baskets, laundry 9 
 
 Belts, sewing machine . . 3 
 Belts, sewing machine, 
 
 tightened 7 
 
 Benches 25 
 
 Bench, piano 1 
 
 Billiard cues 100 
 
 Boxes, shipping 3 
 
 Boxing, sewing machine 
 
 head 1 
 
 Bookcase 1 
 
 Chair, barber's 1 
 
 Chairs 260 
 
 Clocks 5 
 
 Clocks set up 3 
 
 Clocks, watchman's, re- 
 paired 3 
 
 Couches 5 
 
 Couch top reseated 1 
 
 Curtains 12 
 
 Curtains and fixtures set 
 
 up 4 
 
 Curtains changed 20 
 
 Curtains hung 41 
 
 Drawers, sewing machine 2 
 
 Foot rest 1 
 
 Frames, mat 10 
 
 Frames, picture 12 
 
 Graphophones 4 
 
 Grommets put in canvas 9 
 
 Guns, wooden, with rack 16 
 
 Handles, floor brush .... 2 
 
 Handles, swab, put in.. 7 
 
 Hooks, rug, refiled 6 
 
 Knives sharpened 51 
 
 Locks put on 41 
 
 Looms 6 
 
 Machines, sewing, 
 
 cleaned 3 
 
 Machines, sewing, re- 
 paired 32 
 
 Mirror set up 1 
 
 Pedal, organ 1 
 
 Pianolas 3 
 
 Piano tops 2 
 
 Pool table, covered 1 
 
 Potter's wheel 1 
 
 Pulls, curtain, put on ... 4 
 
 Rods, curtain 23 
 
 Roller curtain . 1 
 
APPENDIX 
 
 19T 
 
 Rubber mat foot stool, 
 
 dentist 
 
 Saw filed 
 
 Settees 
 
 Scissors 
 
 Scissors sharpened 
 
 Stand 
 
 Stools 2 
 
 1 Tables 16 
 
 1 Table, cutting 1 
 
 26 Tables, sewing 14 
 
 21 Tray, letter 1 
 
 93 Wheelbarrows 64 
 
 1 Wheelbarrows repainted. 7 
 
 MASON 
 
 Brickwork: 
 
 Bricks laid, red 1 10,000 
 
 Chimneys built 3 
 
 Clean-outs built 9 
 
 Closets built 2 
 
 Cold-air boxes built 2 
 
 Fireplaces built 2 
 
 Kettles set 2 
 
 Manholes built 4 
 
 Piers built 6 
 
 Refrigerator built 1 
 
 Cement work: 
 
 Cellars cemented 3 
 
 Cesspool made 1 
 
 Chimney caps made 3 
 
 Coping made (60 feet by 
 
 2 feet by 6 inches) ... 1 
 
 Cow barn floor put in . . 1 
 
 Curb made (feet) 30 
 
 Door sills made 9 
 
 Flagpole footings made. 2 
 
 Footings made 18 
 
 Grain boxes made 3 
 
 Hitching posts made ... 3 
 
 Ice landing made 1 
 
 Mangers made 2" 
 
 Refrigerator cemented . . 1 
 Reenforced chimney 
 foundation made (10 
 feet by 10 feet by 12 
 
 feet) 1 
 
 Roofs made 2 
 
 Room floors put in 9 
 
 Silo fixed 1 
 
 Terrazzo floors put in . . 2 
 
 Trestle piers made 2 
 
 Walks put in (cubic 
 
 yards) 30 
 
 Window sills made 9 
 
 Miscellaneous : 
 
 Blasting (days) . 50 
 
 Chimneys cleaned out ... 6 
 Chimney clean-outs put 
 
 in 4 
 
 Holes drilled in cement 
 
 floors 100 
 
 Holes drilled in stone 
 
 walls 10 
 
 Range repaired 1 
 
 Switch boxes repaired . . 12 
 
 Thimbles set 3 
 
 Tile pipe laid (feet) .... 1,000 
 
 Tile floors relaid 6 
 
 Ventilators put in 3 
 
 Windows repaired 12 
 
 Plastering: 
 
 Chimneys plastered .... 3 
 
 Patches put on 150 
 
 Plastering (square 
 
 yards) 900 
 
 Skimming (square 
 
 yards) 900 
 
198 J 
 Walls plastered 
 
 kPPB 
 6 
 
 5 
 4 
 
 PAH 
 
 1 
 1 
 1 
 1 
 
 22 
 14 
 82 
 2 
 1 
 4 
 2 
 5 
 11 
 2 
 1 
 5 
 1 
 96 
 285 
 1 
 6 
 4 
 3 
 1 
 3 
 7 
 1 
 8 
 7 
 2 
 2 
 
 NDIX 
 Chimney built 
 
 1 
 3 
 1 
 
 20 
 6 
 1 
 
 3 
 1 
 
 66 
 4 
 
 2 
 7 
 4 
 4 
 2 
 1 
 4 
 639 
 2 
 1 
 2 
 6 
 2 
 3 
 8 
 12 
 
 2 
 5 
 2 
 
 14 
 6 
 
 2 
 5 
 
 Pointing: 
 
 Culverts built 
 
 Ice house underpinning. 
 Piers built 
 
 Stone walls 
 
 Stone work: 
 
 Retaining walls built. . . . 
 Storehouse underpinning 
 
 ran 
 
 Eveners painted 
 
 Ambulance painted .... 
 Automobile painted .... 
 Bakery oven painted. . . . 
 Barber chair refinished. . 
 Beds enameled 
 
 Express wagon painted. 
 Fence post painted . 
 
 Fire escapes painted .... 
 Flagpole balls painted.. 
 Floors varnished 
 
 Benches finished 
 
 Blinds painted (pairs). 
 Bookcases finished 
 
 Flower stands painted . . 
 Flower tubs painted .... 
 Folding screens painted. 
 Food truck enameled .... 
 Game boards painted... 
 Glass set (panes) 
 
 Book holder finished 
 Bread boxes lettered. . . . 
 Bread mixers painted . . . 
 Buildings painted inside 
 Buildings painted outside 
 Bulletin boards finished. 
 Butter case finished 
 Carriages painted . . . 
 
 Halls painted 
 
 
 Heavy wagons painted . . 
 Hitching posts painted . . 
 Hot-bed sashes painted. . 
 Inkwell stands refinished 
 Knife boxes finished .... 
 License frames finished. 
 Looking-glass frames 
 finished 
 
 Cart pole painted . . . 
 
 Chairs finished 
 
 
 Checker board finished . . 
 Chiffonniers finished 
 Clothes closets finished.. 
 
 Meat tubs painted 
 
 Dentist chair refinished . . 
 Desks finished 
 
 Medicine trays finished. 
 Miscellaneous boxes fin- 
 ished 
 
 Desks refinished 
 
 Diet board finished 
 
 Miscellaneous cabinets 
 finished 
 
 Doors finished 
 
 Dressers finished . 
 
 Miscellaneous cases fin- 
 ished 
 
 
 Electric cabinets . , . . 
 
 Neck yokes painted .... 
 
APPENDIX 
 
 199 
 
 Ox carts painted 
 
 Piazza floors oiled 
 
 Picture frames finished. 
 
 Refrigerator painted .... 
 
 Rooms refinished 
 
 Screen doors painted .... 
 
 Settees refinished 
 
 Sewing machines refin- 
 ished 
 
 Shafts, new leather 
 (pairs) 
 
 Shafts painted (pairs) . . 
 
 Shoe boxes finished 
 
 Shovels painted 
 
 Signs painted 
 
 Sled painted 
 
 2 Sleighs painted 7 
 
 6 Steam kettles painted... 8 
 
 3 Steel ceilings painted... 13 
 
 1 Steps painted 3 
 
 31 Stools finished 4 
 
 33 Storm porches painted.. 3 
 
 25 Storm windows painted. 50 
 
 Tables finished 56 
 
 7 Toilet boxes finished 8 
 
 Water tower roof 
 
 2 painted 1 
 
 2 Window frames painted. 10 
 
 2 Window screens painted. 419 
 
 15 Window strips painted.. 280 
 
 85 Whiffletrees painted 4 
 
 1 
 
 SHOE DEPAETMENT 
 
 Baseballs resewed 15 
 
 Baseball gloves repaired. 12 
 Bass-drum head repaired 1 
 Case for night watch re- 
 paired 1 
 
 Fan belts for automobile 2 
 Harnesses repaired: 
 
 Single harnesses ..... 30 
 
 Double harnesses 7 
 
 Lacings for basket ball. . 6 
 
 Medicine cases made 3 
 
 Ox muzzle straps put on 8 
 Shoes made: 
 
 Brogans (pairs) 368 
 
 Goodyear welt (pairs) 142 
 
 Slippers (pairs) 416 
 
 Women's (pairs) 282 
 
 Shoes repaired: 
 
 Buckles put on 21 
 
 Counters 66 
 
 Eyelets (pairs) 38 
 
 Heels, leather (pairs) . 1,624 
 
 Heels, rubber (pairs) . 82 
 
 Insoles 62 
 
 Lacing hooks 33 
 
 Linings sewed 2 
 
 Moccasins sewed 
 
 (pairs) 2 
 
 Patches, leather 145 
 
 Rubbers patched 82 
 
 Relasted (pairs) 34 
 
 Resoled, leather 
 
 (pairs) 86 
 
 Resoled, rubber (pair) 1 
 
 Soles sewed (pairs) ... 3 
 
 Tapped (pairs) 1,442 
 
 Tips sewed 2 
 
 Tongues, new 4 
 
 Uppers sewed 119 
 
 Sleigh repaired 1 
 
 Slippers repaired: 
 
 Heels (pairs) 641 
 
 Patched 44 
 
 Relasted (pairs) 15 
 
 Tapped (pairs) 601 
 
200 
 
 APPENDIX 
 
 TAILORING DEPARTMENT 
 
 Patterns drafted and made:- 
 
 Drawers 
 
 Dress skirt 
 
 Jumper 
 
 Mitten 
 
 Nightgown 
 
 Overall 
 
 Sack coat 
 
 Skirt 
 
 Store coat 
 
 Trouser 
 
 Vest 
 
 Waist 
 
 Coats cut out: 
 
 Sack 
 
 Store, long 
 
 White duck . 
 
 Khaki 140 
 
 3 Dresses cut out: 
 
 3 Night 144 
 
 4 Regular 294 
 
 2 Strong 3 
 
 1 Jumpers cut out 451 
 
 4 Mittens cut out 1,038 
 
 12 Shirts, colored, cut out.. 696 
 
 5 Trousers cut out: 
 
 1 Corduroy 51 
 
 10 Khaki 387 
 
 8 Regular 436 
 
 10 White duck 14 
 
 Vests cut out 137 
 
 29T Coats made, sack 326 
 
 6 Trousers made 39 
 
 14 Vests made 5 
 
 DOMESTIC DEPARTMENT 
 
 MANUFACTURED 
 Soap made (pounds) . . . 147 
 
 Soap, soft, made 
 (pounds) 2,575 
 
 PICKLES, PRESERVES, ETC. 
 
 Apple jelly (quarts) ... 2 
 
 Beans, string (quarts) . . 41 
 
 Blackberries (quarts)... 112 
 
 Blueberries (quarts) 718 
 
 Catsup, tomato (quarts) 12 
 Catsup, tomato and apple 
 
 (quarts) 16 
 
 Cherries (quarts) 8 
 
 Chili sauce (quarts) 32 
 
 Chow-chow (quarts) 34 
 
 Corn, sweet (quarts) 344 
 
 Crab-apple j elly 
 
 (quarts) 8 
 
 Cucumbers, pickled 
 
 (quarts) 96 
 
 Cucumbers, salt (bar- 
 rels) 5 
 
 Currant jelly (quarts).. 94 
 
 Grape jelly (quarts)... 42y 3 
 
 Pears (quarts) 387 
 
 Pears, pickled (quarts). 6 
 
 Peas (quarts) 26 
 
 Piccalilli (gallons) Ill 
 
 Pickles (gallons) 57 
 
 Pickles, sweet (gallons). 16 
 
 Plums (quarts) 20 
 
APPENDIX 201 
 
 Pumpkin (quarts) 17 Tomatoes, canned 
 
 Raspberries (quarts) ... 74 (quarts) 548 
 
 Rhubarb (quarts) 89 Tomatoes, sweet pickled 
 
 Strawberries (quarts) ... 116 (gallons) 190 
 
PRODUCTS OF FARM, 
 BY COLONIES 
 
 BELCHER COTTAGE 
 
 Apples, firsts, barrels, 25, at $2 $ 50.00 
 
 Beans, dry, bushels, 32, at $2.65 84.80 
 
 Beans, shell, bushels, 10, at $0.85 8.50 
 
 Beans, string, bushels, 57y 2 , at $0.85 48.87 
 
 Beet greens, bushels, 8, at $0.40 3.20 
 
 Beets, bushels, 26 MJ, at $0.60 15.90 
 
 Blackberries, quarts, 28, at $0.12 3.36 
 
 Blueberries, quarts, 205, at $0.14 28.70 
 
 Cabbage, pounds, 4,533, at $13 a ton 29.46 
 
 Carrots, bushels, 90^, at $0.60 54.30 
 
 Celery, boxes, 8, at $0.75 6.00 
 
 Chard, bushels, 91, at $0.40 36.40 
 
 Chicken, pounds, 282, at $0.24 67.68 
 
 Cordwood, cords, 65, at $5 325.00 
 
 Corn, green, bushels, 47, at $0.60 2B.20 
 
 Cucumbers, boxes, 8, at $1 8.00 
 
 Eggs, dozen, 1,065 y 2 , at $0.25 266.35 
 
 Ensilage, corn, tons, 195, at $5 975.00 
 
 Fodder, corn, tons, 6, at $5 30.00 
 
 Fodder, rye, tons, 1%, at $5 8.75 
 
 Fodder, Hungarian millet, tons, 2%, at $5. . 12.50 
 
 Fodder, oats and peas, tons, 1%, at $5.... 7.50 
 
 Fodder, green hay, tons, 11%, at $5 56.25 
 
 Fowl, pounds, 229 y 2 , at $0.17 39.01 
 
 Hay, English, tons, 26, at $20.75 539.50 
 
 Hay, Hungarian millet, tons, 2, at $12 24.00 
 
 Lettuce, boxes, 43, at $0.25 10.75 
 
 Mangel-wurzels, bushels, 64y 2 , at $0.25 16.12 
 
 202 
 
APPENDIX 
 
 203 
 
 Manure, cords, 220, at $6 $1,320.00 
 
 Manure, hen, barrels, 20, at $0.75 15.00 
 
 Onions, bushels, 15%, at $0.60 9.40 
 
 Parsnips, bushels, 8%, at $0.65 5.68 
 
 Peas, green, bushels, 14, at $2 28.00 
 
 Potatoes, bushels, 65, at $0.55 35.75 
 
 Pumpkins, pounds, 302, at $0.01 y 2 4.53 
 
 Radishes, bushels, 2, at $0.75 1.50 
 
 Rhubarb, pounds, 56, at $0.01 .56 
 
 Spinach, bushels, 11, at $0.35 3.85 
 
 Scullions, bushels, 8y 2 , at $0.25 2.13 
 
 Squash, winter, tons, 1%, at $20 27.50 
 
 Tomatoes, ripe, bushels, 17, at $1 17.00 
 
 Tomatoes, green, bushels, 20, at $1 20.00 
 
 Turnips, bushels, 150%, at $0.75 112.68 
 
 Turnip greens, bushels, 38, at $0.25 9.50 
 
 $4,397.18 
 
 FAIHVIEW COTTAGE 
 
 Apples, barrels, 1%, at $2 $ 3.33 
 
 Blueberries, quarts, 150, at $0.14 21.00 
 
 Eggs, dozen, 73%, at $0.25 18.46 
 
 Pears, bushels, 5y 2 , at $0.75 4.13 
 
 Turnips, bushels, 20, at $0.75 15.00 
 
 $ 61.99 
 
 GARDEN AT RECEIVING GROUP 
 
 Asparagus, box, 1, at $4 $ 4.00 
 
 Beans, shell, bushels, 65y 2 , at $0.85 55.67 
 
 Beans, string, green, bushels, 66%, at $0.85. 56.74 
 
 Beans, string, wax, bushels, 10, at $0.85 8.50 
 
 Beets, bushels, 89 y 2 , at $0.60 53.70 
 
 Beet greens, bushels, 332, at $0.40 132.80 
 
 Blackberries, quarts, 129, at $0.12 15.48 
 
 Blueberries, quarts, 1,147, at $0.14 160.58 
 
 Cabbage, pounds, 15,357, at $13 ton 99.82 
 
 Carrots, bushels, 56, at $0.60 33.60 
 
 Cauliflower, bushels, 205/ 8 , at $0.55 11.34 
 
 Celery, early, boxes, 58^, at $0.75 43.75 
 
 Celery, late, boxes, 66%, at $0.75 50.00 
 
204 APPENDIX 
 
 Chard, bushels, 140, at $0.40 $ 66.00 
 
 Cordwood, cords, 35, at $5 175.00 
 
 Corn, green, bushels, 551, at $0.60 330.60 
 
 Cucumbers, boxes, 79%, at $1 79.75 
 
 Currants, quarts, 373, at $0.05 18.65 
 
 Fodder, cabbage and turnip tops, tons, 3, 
 
 at $5 15.00 
 
 Fodder, corn, tons, 16, at $5 80.00 
 
 Gooseberries, quarts, 9, at $0.10 .90 
 
 Hay, meadow, tons, 4, at $11 44.00 
 
 Lettuce, boxes, 82, at $0.25 20.50 
 
 Parsley, bushels, 10%, at $0.65 7.00 
 
 Parsnips, bushels, 30, at $0.65 19.50 
 
 Peas, green, bushels, 56, at $2 112.00 
 
 Peppers, green, bushels, 3, at $0.50 1.50 
 
 Potatoes, bushels, 64 y 2 , at $0.55 35.47 
 
 Pumpkins, pounds, 800, at $0.01 y a 12.00 
 
 Radishes, bushels, 59, at $0.75 44.25 
 
 Raspberries, quarts, 120, at $0.18 21.75 
 
 Rhubarb, pounds, 387, at $0.01 3.87 
 
 Spinach, bushels, 43, at $0.35 15.05 
 
 Squash, summer, barrels, 5% , at $0.60 3.06 
 
 Squash, winter, pounds, 2,146, at $20 per ton 21.46 
 
 Strawberries, quarts, 1,056, at $0.12 126.72 
 
 Tomatoes, green, bushels, 74, at $1 74.00 
 
 Tomatoes, ripe, bushels, 182%, at $1 182.25 
 
 Turnips, bushels, 248%, at $0.75 186.38 
 
 $2,412.67 
 
 GARDNER COTTAGES 
 
 Apples, cider, barrels, 5%, at $0.30 $ 1.73 
 
 Apples, seconds, barrels, 5, at $1.50 7.50 
 
 Apples, firsts, barrels, 7y 2 , at $2 15.00 
 
 Beans, shell, bushels, 14y 2 , at $0.85 12.33 
 
 Beans, string, bushels, 21 y 2 , at $0.85 18.28 
 
 Beets, bushels, 24y 8 , at $0.60 14.47 
 
 Beet greens, bushels, 8, at $0.40 3.20 
 
 Blueberries, quarts, 683, at $0.14 95.62 
 
 Cabbage, pounds, 1,154, at $13 a ton 7.50 
 
 Carrots, bushels, 19634, at $0.60 118.05 
 
APPENDIX 205 
 
 Chard, bushels, 29, at $0.40 $ 11.60 
 
 Cordwood, cords, 130, at $5 650.00 
 
 Corn, green, bushels, 27, at $0.60 16.20 
 
 Cucumbers, pickling, pecks, 133^, at $0.35 . . 46.66 
 
 Cucumbers, boxes, 35y 2 , at $1 35.50 
 
 Eggs, dozen, 809% 2 at $0.25 202.31 
 
 Ensilage, corn, tons, 60, at $5 300.00 
 
 Fodder, oats and peas, tons, 13, at $5 65.00 
 
 Fodder, turnip tops, tons, 2, at $5 10.00 
 
 Hay, English, tons, 30, at $20.75 622.50 
 
 Hay, oats and peas, ton, 1, at $15 15.00 
 
 Lettuce, boxes, 37, at $0.25 9.25 
 
 Mangel-wurzels, bushels, 118y 2 , at $0.25.... 29.63 
 
 Manure, cords, 45, at $6 270.00 
 
 Manure, hen, barrels, 12, at $0.75 9.00 
 
 Milk, quarts, 20,029, at $0.05% 1,134.98 
 
 Onions, bushels, 82y 2 , at $0.60.... 49.50 
 
 Peas, green, bushels, 14, at $2 28.00 
 
 Potatoes, bushels, 2,598, at $0.55 1,428.90 
 
 Radishes, bushels, 6%, at $0.75 4.69 
 
 Raspberries, quarts, 14, at $0.18 2.52 
 
 Rhubarb, pounds, 136, at $0.01 1.36 
 
 Scullions, bushels, 10y 2 , at $0.25 2.62 
 
 Spinach, bushels, 11, at $0.35.. 3.85 
 
 Squash, summer, barrels, 2% , at $0.60 1.26 
 
 Squash, winter, tons, 1%, at $20 32.00 
 
 Tomatoes, green, bushels, 6, at $1 6.00 
 
 Tomatoes, ripe, bushels, 14%, at $1 14.75 
 
 Turnips, bushels, 304y 2 , at $0.75 228.37 
 
 Turnip greens, bushels, 94, at $0.25 23.50 
 
 $5,548.63 
 
 HILLCREST COTTAGE 
 
 Apples, firsts, 148%, at $2 $ 297.20 
 
 Apples, seconds, barrels, 22, at $1.50 33.00 
 
 Apples, cider, barrels, 20%, at $0.30 6.24 
 
 Beans, string, bushels, 14%, at $0.85 12.11 
 
 Beans, shell, bushels, 14%, at $0.85 12.11 
 
 Beans, dry. bushels, 7%, at $2.65 20.76 
 
 Beets, bushels, 20%, at $0.60 12.15 
 
206 APPENDIX 
 
 Blackberries, quarts, 15, at $0.12 $ 1.80 
 
 Blueberries, quarts, 273, at $0.14 38.23 
 
 Cabbage, pounds, 729, at $13 per ton 4.74 
 
 Capons, pounds, 66%, at $0.29 19.35 
 
 Carrots, bushels, 23J&, at $0.60 13.92 
 
 Celery, boxes, 5, at $0.75 3.75 
 
 Chard, bushels, 5y 2 , at $0.40 2.20 
 
 Cherries, quarts, 8, at $0.12 .96 
 
 Chicken, pounds, 666y 8 , at $0.24 160.05 
 
 Cordwood, cords, 80, at $5 400.00 
 
 Corn, green, bushels, 10^, at $0.60 6.10 
 
 Cucumbers, boxes, 4,y 12 , at $1 4.08 
 
 Eggs, dozen, 1,702% 2 , at $0.25 425.65 
 
 Fodder, corn, tons, 52, at $5 260.00 
 
 Fodder, oats and peas, tons, 10, at $5 50.00 
 
 Fowl, pounds, 254%, at $0.17 43.24 
 
 Grapes, pounds, 109, at $0.04 4.36 
 
 Hay, alfalfa, pounds, 300, at $23 per ton. . 3.45 
 
 Hay, English, tons, 5, at $20.75 103.75 
 
 Lettuce, boxes, 1 i/ 2 , at $0.25 .38 
 
 Mangel-wurzels, bushels, 78, at $0.25 19.50 
 
 Manure, cords, 11, at $6 66.00 
 
 Manure, hen, barrels, 22, at $0.75 16.50 
 
 Milk, quarts, 6,352, at $0.05% 359.95 
 
 Onions, bushels, 120, at $0.60 72.00 
 
 Parsnips, bushels, 6, at $0.65 3.90 
 
 Pears, bushels, 4, at $0.75 3.00 
 
 Peas, green, bushels, 11, at $2 22.00 
 
 Potatoes, bushels, 255, at $0.55 140.25 
 
 Pumpkins, pounds, 109, at $0.01 % 1.64 
 
 Radishes, bushel, y 2 , at $0.75 .38 
 
 Raspberries, quarts, 53, at $0.18 9.54 
 
 Scullions, bushels, 1114, at $0.25 2.81 
 
 Squash, summer, barrels, li/, at $0.60 .80 
 
 Squash, winter, pounds, 342, at $20 per ton. 3.42 
 
 Strawberries, quarts, 46, at $0.12 5.52 
 
 Tomatoes, green, bushels, 4, at $1 4.00 
 
 Tomatoes, ripe, bushels, 17y 2 , at $1 17.50 
 
 Turnips, bushels, 149, at $0.75 111.75 
 
 $2,800.03 
 
APPENDIX 307 
 
 HIGHLAND COTTAGE 
 
 Beans, string, bushels, 3, at $0.85 $ 2.55 
 
 Blackberries, quarts, 3, at $0.12 .36 
 
 Blueberries, quarts, 363, at $0.14 50.82 
 
 Tomatoes, green, bushels, 7, at $1 7.00 
 
 $ 60.73 
 
 VALLEY FARM COTTAGES 
 
 Apples, barrels, 53, at $2 $ 106.00 
 
 Asparagus, box, 1, at $4 4.00 
 
 Beans, string, bushels, 20y 2 , at $0.85 17.43 
 
 Beans, dry, bushels, 7y 2 , at $2.65 19.87 
 
 Beets, bushels, 96 y 2 , at $0.60 57.90 
 
 Beet greens, bushels, 21, at $0.40 8.40 
 
 Blackberries, quarts, 75, at $0.12 9.00 
 
 Blueberries, quarts, 253, at $0.14 35.42 
 
 Cabbage, pounds, 1,738, at $13 per ton 11.30 
 
 Carrots, bushels, 182%, at $0.60 109.50 
 
 Celery, boxes, 37, at $0,75 27.75 
 
 Chard, bushels, 52, at $0.40 20.80 
 
 Cherries, quarts, 12, at $0.12 1.44 
 
 Chicken, pounds, 121, at $0.24 29.04 
 
 Cordwood, cords, 75, at $5 375.00 
 
 Corn, green, bushels, 63, at $0.60 37.80 
 
 Crab apples, barrel, %, at $2.25 1.80 
 
 Cucumbers, boxes, 6y 8 , at $1 6.13 
 
 Currants, quarts, 2, at $0.05 .10 
 
 Eggs, dozen, 1,414%, at $0.25 353.71 
 
 Ensilage, corn, tons, 120, at $5 600.00 
 
 Fodder, millet, tons, 8, at $5 40.00 
 
 Fodder, oats and peas, tons, 10, at $5 50.00 
 
 Fowl, pounds, 218, at $0.17 37.06 
 
 Grapes, pounds, 150, at $0.04 6.00 
 
 Hay, English, tons, 25, at $20.75 518.75 
 
 Hay, meadow, tons, 6, at $11 66.00 
 
 Hay, oats and peas, tons, 14, at $15 210.00 
 
 Lettuce, boxes, 98 y 2 , at $0.25 24.62 
 
 Mangel-wurzels, bushels, 304, at $0.25 76.00 
 
 Manure, cords, 30, at $6 180.00 
 
 Manure, hen, barrels, 25, at $0.75 18.75 
 
208 APPENDIX 
 
 Milk, quarts, 6,788, at $0.05% $ 384.65 
 
 Onions, bushels, 31 y 2 , at $0.60 18.90 
 
 Parsnips, bushels, 25, at $0.65 16.25 
 
 Peaches, bushel, 1, at $2 2.00 
 
 Pears, bushels, 2, at $0.75 1.50 
 
 Peas, green, bushels, 4y 2 , at $2 9.00 
 
 Plums, bushel, 1, at $1 1.00 
 
 Potatoes, bushels, 1,504, at $0.55 827.20 
 
 Radishes, bushels, 2y 2 , at $0.75 1.87 
 
 Raspberries, quarts, 31, at $0.18 5.58 
 
 Rhubarb, pounds, 30, at $0.01 .30 
 
 Rowen, ton, y 2 , at $10 5.00 
 
 Scullions, bushels, 21%, at $0.25 5.45 
 
 Squash, summer, barrels, 9%, at $0.60 5.52 
 
 Squash, winter, pounds, 1,050, at $20 per ton 10.50 
 
 Straw, rye, tons, 3, at $15 45.00 
 
 Tomatoes, bushels, 22 y 2 , at $1 22.50 
 
 Turnips, bushels, 169, at $0.75 126.75 
 
 $4,548.54 
 
 WESTMINSTER COTTAGES 
 
 Apples, barrels, 94, at $2 $ 188.00 
 
 Asparagus, boxes, 8, at $4 32.00 
 
 Beans, dry, bushels, 30, at $2.65 79.50 
 
 Beans, shell, bushels, 4, at $0.85 3.40 
 
 Beans, string, bushels, 24, at $0.85 20.40 
 
 Beets, bushels, 39%, at $0.60 23.80 
 
 Beet greens, bushels, 21, at $0.40 8.40 
 
 Blackberries, quarts, 374> at $0.12 44.88 
 
 Blueberries, quarts, 785, at $0.14 109.90 
 
 Cabbage, pounds, 2,599, at $13 per ton 16.89 
 
 Carrots, bushels, 154%, at $0.60 92.88 
 
 Cider, gallons, 440, at $0.15 66.00 
 
 Chard, bushels, 36, at $0.40 14.40 
 
 Chicken, pounds, 85%, at $0.24 20.58 
 
 Cordwood, cords, 115, at $5 575.00 
 
 Corn, green, bushels, 36, at $0.60 21.60 
 
 Cucumbers, boxes, 32, at $1 32.00 
 
 Cucumbers, pickling, pecks, 15, at $0.35. . . . 5.25 
 
APPENDIX 209 
 
 Dandelions, bushels, 7, at $0.35 $ 2.45 
 
 Ensilage, corn, tons, 60, at $5 300.00 
 
 Eggs, dozen, 1,018%, at $0.25 254.58 
 
 Fodder, barley, ton, 1, at $6 6.00 
 
 Fodder, cabbage, ton, 1, at $5 5.00 
 
 Fodder, corn, tons, 8, at $5 40.00 
 
 Fodder, millet, tons, 2, at $5 10.00 
 
 Fodder, oat, tons, 2, at $5 10.00 
 
 Fodder, rye, tons, 7, at $5 35.00 
 
 Fowl, pounds, 111, at $0.17 18.87 
 
 Grapes, pounds, 165, at $0.04 6.60 
 
 Hay, bluejoint, tons, 11, at $11 121.00 
 
 Hay, English, tons, 24, at $20.75 498.00 
 
 Hay, millet, tons, 2, at $12 24.00 
 
 Hay, rye, tons, 6, at $15 90.00 
 
 Lettuce, boxes, 13, at $0.25 3.25 
 
 Mangel-wurzels, bushels, 63, at $0.25 15.75 
 
 Manure, cords, 65, at $6 390.00 
 
 Manure, hen, barrels, 14, at $0.75 10.50 
 
 Milk, quarts, 20,180, at $0.05% 1,143.53 
 
 Muskmelons, crates, 3, at $1 3.00 
 
 Onions, bushels, 117, at $0.60 70.20 
 
 Parsnips, bushels, 20, at $0.65 13.00 
 
 Pears, bushels, 14, at $0.75 10.50 
 
 Peas, green, bushels, 23 at $2 46.00 
 
 Posts, fence, 175, at $0.20 35.00 
 
 Potatoes, bushels, 971, at $0.55 534.05 
 
 Pumpkins, pounds, 2,500, at $0.01 y 2 37.50 
 
 Radishes, bushels, 3y 2 , at $0.75 2.62 
 
 Rhubarb, pounds, 1,125, at $0.01 11.25 
 
 Spinach, bushels, 12, at $0.35 4.20 
 
 Squash, summer, barrels, 6, at $0.60 3.60 
 
 Squash, summer, barrels, 6, at $0.60 3.60 
 
 Squash, winter, pounds, 2,340 at $20 per ton 23.40 
 
 Stakes, fence, 250, at $0.10 each 25.00 
 
 Strawberries, quarts, 327, at $0.12 39.24 
 
 Tomatoes, green, bushels, 8, at $1 8.00 
 
 Tomatoes, ripe, bushels, 7, at $1 7.00 
 
 Turnips, bushels, 85y lo , at $0.75 63.83 
 
210 APPENDIX 
 
 GENERAL 
 
 Beef, cow, pounds, 6,216, at $0.09 $ $59.44 
 
 Beef, steer, pounds, 3,763, at $0.12 y a 470.38 
 
 Calf skin, 1, at $0.75 .75 
 
 Calves sold, 26, at $4 104.00 
 
 Calf sold, 1, at $7 7.00 
 
 Calf sold, 1, at $6 6.00 
 
 Guinea pigs sold, 392 118.70 
 
 Hides, cow, green, pounds, 754, at $0.12 90.48 
 
 Hides, steer, green, pounds, 375, at $0.12 45.00 
 
 Ice, tons, 842, at $3 2,526.00 
 
 Lamb, pounds, 544, at $0.16 87.04 
 
 Lumber, oak, chestnut, maple, 10,000 feet, at 
 
 $25 M 250.00 
 
 Lumber, hemlock, spruce, pine, 56,000 feet, 
 
 at $20 M 1,120.00 
 
 Milk, quarts, 111,200, at $0.05% 6,301.33 
 
 Pigs sold, 3 20.00 
 
 Pork, fresh, pounds, 16,009, at $0.12 1,921.08 
 
 Sawdust, cords, 16, at $2 32.00 
 
 Slabs, cords, 16, at $2 32.00 
 
 Stone, crushed, tons, 1,295, at $1 1,295.00 
 
 $14,986.20 
 
 Total farm products $40,092.70 
 
 LIVE STOCK 
 
 Bulls, 2 $ 250.00 
 
 Calves, 15, at $26 390.00 
 
 Cockerels, 100, at $0.50 50.00 
 
 Cows, 47, at $80 3,760.00 
 
 Guinea pigs, 187, at $0.30 56.10 
 
 Heifers (one-year), 9, at $46 414.00 
 
 Heifer (two-year) ,1 50.00 
 
 Hens, 405, at $0.75 303.75 
 
 Hogs, 13, at $25 325.00 
 
 Horses, 18 3,280.00 
 
 Oxen, 15 1,725.00 
 
 Pigs, 8, at $5 40.00 
 
APPENDIX 211 
 
 Pullets, 286, at $0.60 $ 171.60 
 
 Roosters, 9, at $1.25 11.25 
 
 Sheep, 5, at $15 75.00 
 
 Shoates, 52, at $10 520.00 
 
 $11,421.70 
 
 THE END 
 
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