The work done by the city of Lyons has been followed in many localities,—Bourges, Bordeaux, Marseille, Rouen, and others, in most cases endowed by the municipalities. At Bourges additional classes are held in silver-engraving, hair-dressing, and locksmith work.
In the similar school in Marseille, tinsmiths, foundry workers, jewelers, and metal workers are trained. At Cluses, in 1915, seventy partially disabled men were serving an apprenticeship in clock-making. This is sitting work, but it demands the possession of one hand and at least two fingers on the other, and an exceptionally good eye, so it is not so generally taught as other trades. At Cluny a course of training has been established for the former workmen who wish to become master workmen and designers; that is, the school specializes in training those whose ability is above the average.
It must be remembered that in French provinces there are many more hand processes in use than in the United States. Joinery and carpentry, for example, employ tools to make parts which in this country are turned out in factories. The industrial difference is evident in some of the photographs of the rehabilitated French workmen who are shown ingeniously at work with artificial "hands and arms" on processes for which there is no field here. Many French soldiers, too, find employment in toy making, a real industry for France and Germany, but one which is unlikely to be developed here to any extent. In America we must fit our disabled men to tend machines, and not make the blunder of preparing men for operations which are out of date in our standardized machine industries. In a very moving little book, "Les jeunes filles françaises et la guerre" (Jules Combarieu, Paris, 1916), we read of a man who was employed in a joinery establishment after suffering the amputation of both hands. His left arm was furnished with a leather glove to which was adapted an ingenious instrument for holding nails. His right arm was fitted with another glove arrangement to which a hammer was attached. With the left he took the nails; and with the right he pounded them into a piece of wood. Marvelous as the achievement may be, in America this workman would belong to the class for whom special relief workshops must be maintained. Work in reëducation must naturally be adapted to the demands of the vicinity; the French towns of Nancy, Clermont, and Montpellier have not the industrial conditions of Pittsburgh, Worcester, or Birmingham.
In Paris the model government institution of St. Maurice contains both a convalescent hospital and a training school for discharged patients. It has the advantage over L'École Joffre of uniting hospital and school, giving an opportunity of combining physical with industrial reëducation. It is therefore possible to have at St. Maurice, under the direction of Dr. Bourillon, physiotherapy by massage, electricity, medical gymnastics, and mechanotherapy, which prepare the man for his reëducation. Dr. Bourillon affirms that this preliminary medical care reduces the effort which the patient must make to learn and exercise a trade.
The French government also maintains at Paris the Laboratoire des Recherches sur le Travail Professionel,—an establishment for the scientific examination of wounded men, particularly to ascertain the percentage of their disability in the labor market. The question of how many disabled men are capable of reëducation is one not rigidly determined. There are, of course, some hopeless cases which will have to be entirely dependent on the government for their support, whether by pension or other means under discussion. But the figures of Dr. Jules Amar, director of this laboratory of industrial research, a man who has devised mechanical apparatus for developing the capacities of injured limbs, show that of the maimed cases which have come under his observation at least 80 per cent are capable of vocational reëducation. Of this proportion 45 per cent succeed in earning normal salaries after a training including some specializing; 20 per cent are partially restored to normal wage earning; while the remaining 15 per cent can only obtain work in shops maintained especially for the disabled, such as a toymaking studio. Of the reëducation of this 80 per cent Dr. Amar says: "It is a question of science and method; it demands the organization of training schools.... It unites medical and technical knowledge to the end that artificial limbs shall be adapted to satisfy physical and vocational capabilities. The proportion of men dependent upon relief is then reduced; and one must endeavor, without ceasing, to diminish it."[6]
The method in the Paris schools is scientific. "In the training schools," he continues, "the object of the instruction is to supplement the diminished physical capacity of the disabled man with a greater knowledge of his trade, superior technical instruction, or better vocational adjustment."
The first responsibility falls on the medical examiner. To reëquip the maimed physically, an indispensable prosthesis (an addition of an artificial part to supply the missing member of the body) is made, the dynamical prosthesis—not the kind which replaces the member, but that which reëstablishes or repairs the functions. What the wounded man needs is not an admirable imitation of the missing arm or leg, ingenious and often fragile appliances, but a practical working tool,—a socket into which a variety of tools can be fitted.
Next, in the laboratory of the school an analysis of the workman's movements is made in relation to their regularity, direction, speed, and according to the force they expend. The measure of the man's physical incapacity is deduced from impressions gathered in this analysis, and from it the method of training must be devised. Furnished with his card of qualifications, the man passes from the hospital laboratory to the workshop, where experts instruct him in theory and practice. The first thing to determine is whether a man cannot perform the operations of his former trade. In many cases a man imagines that the disability caused by amputation of fingers, hand, or arm makes him unfit for the work he did previous to the war. But where the school is attached to a hospital and the man's disability can be accurately known, the union of medical skill and technical instruction makes it possible to restore him to usefulness with the minimum of effort and waste.
Dr. Amar recommends for special relief work for the 15 per cent who are not capable of any great degree of reëducation, shops which will execute orders for easily manufactured articles, involving such processes as light cooperage, stamping, plaiting, toymaking,—work such as is offered at the shop in Rue de la Durance, Paris.
Another institution whose methods are similar to those employed at St. Maurice and by Dr. Amar is the Anglo-Belgian Military Institute, at Port Villez, Vernon, under the technical director Major Haccourt. It accommodates over 800 men, and is self-supporting, the land where it is situated having been originally covered with forests, the sale of which financed the undertaking at first. Forty-three trades are taught here, and a large farm is maintained on which horses wounded in war are cared for and made useful. The workshops provide for commercial courses, telegraphy, wall-paper designing, the manufacture of motor vehicles and electrical machinery of all kinds, plumbing and tinsmithing, rabbit and poultry farming, fur curing and dyeing, etc. The shops make fuse boxes for munitions, and various army supplies. At Vernon the men pupils are regarded as still in the Belgian army, receiving military pay; they have no option as to entrance, since they are under military discipline, but enter as soon as they are discharged from the Anglo-Belgian hospital at Rouen. In this school the services of the best professors in different trades are obtained without trouble, for the director can requisition any man in the Belgian army for any required purpose. Before the war Belgium had a large proportion of highly trained workmen; and with compulsory reëducation and military discipline the operation of this institution is much simplified.