The tendency to-day is in this direction, as, for example, at the Grand Palais, thanks to the efforts of J. Camus, and also in the agricultural centre of the XIIIth district under the direction of Belot and Privat. At a given moment all treatment may be suspended and the patient may devote himself exclusively to work with results the excellence of which Nepper and Vallée have demonstrated.
The workmen are then eligible for work in a town in private workshops, but so far this freedom has more inconveniences than advantages. A man whose working capacity is much reduced, and more especially a man who requires re-education, has no place in an ordinary workshop where neither the proprietor nor the foreman nor his fellow-workmen are in truth much inclined to concern themselves about him. Where actual education is necessary this is best supplied in special workshops where the patient will be among comrades handicapped like himself, whose progress he will be able to watch and whose efforts he will imitate, rather than among able-bodied workmen, by comparing himself with whom he is bound to be discouraged.
The problem has been solved by the Belgians in a remarkable establishment opened at Port-Villerz, and by the Austrians at Vienna under the direction of Spitzy, as Nové-Josserand and Bouget inform us, by delaying a maimed soldier's discharge from the army until his re-education is as complete as possible. This method has proved to be to the interest both of the individual and of the State, but we do not seem to have considered this solution, and it is still to be feared that it would accord ill with the independence of our national character. The actual fact, though it has not been brought into prominence, is that our usual system of "watertight compartments" has been applied by adding to the centres of physiotherapy centres of agricultural or industrial re-education, the results obtained in which are dependent upon the efficiency of the director of physiotherapy.
This matter seems to have received very little special attention in connection with amputation cases. It is, however, of great utility to develop the strength and agility of the remaining limbs by suitable gymnastic exercises, to teach a man with only one leg, for example, to jump without an artificial limb and to climb a slippery rope or a ladder; or to train the left hand of a man who has lost his right; to develop the greatest possible strength in the stump by training it in movement combined with the exertion of force. In addition to this, early and provisional equipment with artificial limbs must become general. These temporary limbs are undoubtedly rudimentary contrivances, but they are functionally good and are useful on account of their mere weight.
In this connection the temporary arms used by Nové-Josserand and Bouget in their agricultural re-education centre are very interesting models. The great advantage of using a temporary limb is that the time required for the construction of the permanent apparatus, often a considerable period, is not lost in idleness, the mother of all the vices.
II
It was said at the beginning of the last chapter that whenever possible a disabled man should be given a real trade and not one of those frivolous and trifling occupations which were at one time the fashion.
In the choice of a trade the ruling principle is that of aiming to restore as nearly as possible the man's former occupation. This principle should not, however, be carried to an extreme.
As Camus has justly said, by his previous work a man has stored up a mass of ideas, a fact which is too little realised, especially by himself. These include the manner of choosing, holding, and attacking the materials upon which he works, and of appreciating their qualities and faults; knowledge of their market value, of the value of the labour, etc. This should be utilised in his future work even though it be realised, as M. Bourillon has remarked, that the resumption of his trade in its entirety may be impossible.
With the tools that have been described a man who has lost his forearm may be able, for example, to undertake a locksmith's work and to execute correctly all the movements required in plying the trade. Granted; but how long will he take to make one piece, let us say, as well as his neighbour? If he produces little he will not find an employer to give him daily work, while if he does piecework, apart from the fact that it is not in good repute among those who are the actual leaders of the working classes, it will not be remunerative, and to earn 3 frs. a day when a comrade earns 10 or 12 frs. is practically an impossible solution.