Moreover, conditions of life in the disabled man's native place must be considered as a matter of importance. A man from the Mediterranean country has no idea beyond the cultivation of meadows, and one from Picardy none beyond the making of cane baskets for packing flowers.
Judgment is difficult, and in order that the choice may be exercised as reasonably as possible, the careful collaboration of the patient, the doctor and the managers of the workshops is essential. We repeat that this is one of the principal objects for which the centres of re-education are useful. There are some efficient men, we know, who without asking anything of anybody find quickly and unerringly the exact work that suits them. There is no need of anxiety in such cases.
A certain metal worker from the invaded area suffering from pseudarthrosis of the shoulder, whose wound we were treating, sent for his wife, and they began to rear geese. We know two cases of amputation of the right arm, an operative at an aeroplane works and a worker in stucco, who during their stay at hospital and before they had been supplied with artificial limbs, had taught themselves, the one technical design the other ornamental design. Both of them, as soon as they were discharged, have been taken on by their former masters, who no doubt were fully conscious that they were thus combining a good deed with good business. To come to a decision of any value, however, cases of this sort must not be taken as a criterion, for they are in fact exceptional. The majority of the men are in need of guidance.
The procedure employed at the Belgian centre of re-education at Port-Villerz consists in allowing the patient to frequent the workshops at will for a few days, during which time he sees what is going on and is not slow to make his choice, which it appears rarely needs to be amended.
We have dealt chiefly with the conditions which are suitable for the re-education of a man who has lost an upper limb, or, speaking more generally, is disabled in one arm, for whom resumption of work in a workshop will often be out of the question. The question is easier of solution for the lower limb. Cases of amputation of the leg can work standing, if supplied with an artificial limb, at practically any trade. Cases of amputation of the thigh have numerous manual occupations open to them in which they sit for at least part of the time. It must be understood, however, that these professions which require skill can, as a rule, only be learnt in well-equipped workshops at the price of a fairly long apprenticeship. Two or three years are necessary to make a good mechanic, a good watchmaker, glass cutter, etc. This should not deter us in the case of fairly young men. The difficulty is to organise special workshops, often with a complicated equipment, where the maimed man can at least pick up the rudiments of the work, for it is not to be thought of that he can remain there during the whole time occupied in a complete training.
In conclusion, we should like to draw attention to the law of 1831, which regulates the distribution of pensions by means of groups classified according as the loss is of two limbs or of one. No distinction is made with regard to the seat of the amputation. But a man who has lost both legs and has been suitably equipped with artificial limbs can earn a fair wage, whereas a man who has lost both arms is completely disabled so that he cannot even wash or dress himself. Among the amputation cases the difference is also considerable in the lower limb, between amputation through the leg and through the thigh, and even more in the upper limb, between an amputation retaining the movements of the elbow and one in which they are lost. There is, moreover, a great difference in the quality of stumps and the consequent utility of the artificial limb. It is of course impossible to allow with mathematical precision for all degrees of disablement, but the several general distinctions which we have enumerated could be taken into consideration without difficulty.