- Email: [email protected]
DISABLEMENT AND EMPLOYMENT
411
Special
Articles
DISABLEMENT AND R. WATSON-JONES,
EMPLOYMENT
M CH ORTH.
LPOOL, F R C S
DIRECTOR, ORTHOPÆDIC AND ACCIDENT SERVICE, LONDON HOSPITAL; CONSULTANT IN ORTHOPÆDIC SURGERY, ROYAL AIR FORCE
A DISABLED man, despite his disability, should be an asset and not a burden. When treatment is completed it is our duty to consider his ability rather than his disability. His handicap can be minimised. He can be in almost every type of industrial trained and and professional activity. The success with which this is achieved is one of the standards by which the civilisation of a country may be judged. On the one hand, a cripple may be a social outcast dependent upon alms ; on the other, he may be restored to useful employment and full citizenship. Much has been done in this country ; but much remains to be done, and in many respects we have failed. In former years when disability resulted from war service, and the community felt an obligation to repay its debt, employers appointed unwanted commissionaires and superfluous lift-attendants. But there can be no greater degradation .than to engage a man on duty which he knows to be unimportant, unnecessary, and specially prepared as a concession. The compassionate approach’ is misplaced ; the charitable creation of artificial jobs is misguided. Moreover when disability was due to the hazards of industry, and the debt of the community was less clearly recognised, we often added to the insult of degradation the injury of financial hardship. We were content to award compensation by the payment of a few shillings each week, or to dismiss the matter once and for all by the payment of a sum in final settlement.
employed
WHAT HAS TO BE DONE
In recent years it has been recognised more and more fully that the treatment of physical disability is not a simple problem of surgical intervention. Good surgery and good medicine may be of primary importance ; but equally important are those measures of active exercise, massage, gymnastics, occupational therapy, and recreational treatment which have become.known as medical rehabilitation ; and of no less importance are the social services of vocational retraining and resettlement in the life of the community, which alone complete the treatment of disability. These three phases-medical treatment, rehabilitation, and resettlement-are of equal significance ; and if the problems of the disabled are to be solved they must be closely coordinated. The necessary coordination has been achieved in the orthopaedic service of the Royal Air Force. The airman with multiple injuries who is treated in hospital is transferred direct to a rehabilitation centre ; if necessary he is readmitted to hospital for further surgery ; he is transferred once more to the rehabilitation centre where treatment is completed in the gymnasiums and playing-fields ; he attends refresher courses in his former trade ; if the disability is permanent he is reassessed while still in the rehabilitation centre, and arrangements are made for retraining in a new trade ; if medical problems arise during retraining he goes back once more to the rehabilitation centre or to the hospital. There is absolute continu-
ity of supervision ; there is no break in the sequence ; there is close coordination of surgical treatment, rehabilitation, and industrial resettlement. That which has been achieved in one military service, and is now being attempted by the Miners’ Welfare Commission in the civilian service of coalmining, and by the Birmingham Accident Hospital in the industries of that city, must be achieved in the country as a whole.
Every disabled person must be treated, reha,bilitated, and resettled with no interruption and no break in continuity. The surgeon who accepts responsibility for one part of the treatment must accept responsibility for the whole of it. It is no defence to urge that he is untrained as a social service worker and has no contact with industry ; he might as reasonably take no part in rehabilitation because he is untrained as a masseuse, or be unwilling to perform an operation because he is untrained as an instrument-maker. He must organise surgical treatment with a team of nurses and assistants, rehabilitation with a team of -physiotherapists and gymnasts, and resettlement with a team of almoners and disablement rehabilitation officers. WHAT IS BEING DONE
The Government has given an inspiring lead in this task. It has placed upon the statute-book the Disabled Persons Employment Act. It is true that the exigencies of war made it necessary to enlist the full man-power of the nation, and that utilisation of the services of the disabled was thus encouraged. But there is a determination in the Government to create the opportunity for employment of the disabled, not because the country is in peril but because the disabled are capable and worthy of employment ; there is a determination to ensure that Britain shall undertake pioneer work in rehabilitating those who suffer" a handicap in obtaining or keeping employment." An advisory council has been appointed to assist in implementing the Act, a council which includes not only employers but ’workers, not only doctors but disabled, a council which is already at work and is capable of great achievement. The Ministry has appointed disablement rehabilitation officers throughout the country whose duty it is to interview patients while still under treatment. They are willing and anxious to assist as soon as it is known that the disability will be permanent and that retraining may be necessary. But they cannot succeed without the sympathetic aid of medical men, and of this they are still urgently in need. The Ministries concerned are faced with great problems. Every voluntary association which can aid in the vast programme must dedicate itself to the task. The British Council of Rehabilitation was recently formed with this purpose. It is endeavouring to secure closer cooperation between physiotherapists, occupational therapists, and educational gymnasts, and even if possible to achieve some measure of common training; it is promoting the development of hospital almoner services ; it is coördinating the many schools of- training for the crippled, the blind and the deaf. In the words of Lord Rushcliffe, chairman of the council : " the primary aims are to bring together workers in every field of rehabilitation ... to become a source of information and guidance ... to organise short-term courses of study... and to promote research into problems arising, more particularly those which concern the economic outlook of the permanently disabled." ’’ Confidence and hope do more good than physic thus wrote Galen two centuries ago. The words apply In relieving the handicap of the no less forcibly today. disabled person our task is to complete his treatment, explain his problems, anticipate his fears and reassure his mind, to offer hope and give confidence-confidence in himself and confidence in the future. We must reestablish for him normal family life, normal employment, and normal recreation, and reinstate him in the privileges and duties of citizenship. -
WOMEN MEDICAL OFFICERS IN UNITED STATES ARMY.—The office of the Surgeon-General at Washington states that 74 women medical officers are serving in the Army, of whom 4 are majors, 36 captains, and 34 first lieutenants, and 17 are
serving overseas.
Special
Articles
DISABLEMENT AND R. WATSON-JONES,
EMPLOYMENT
M CH ORTH.
LPOOL, F R C S
DIRECTOR, ORTHOPÆDIC AND ACCIDENT SERVICE, LONDON HOSPITAL; CONSULTANT IN ORTHOPÆDIC SURGERY, ROYAL AIR FORCE
A DISABLED man, despite his disability, should be an asset and not a burden. When treatment is completed it is our duty to consider his ability rather than his disability. His handicap can be minimised. He can be in almost every type of industrial trained and and professional activity. The success with which this is achieved is one of the standards by which the civilisation of a country may be judged. On the one hand, a cripple may be a social outcast dependent upon alms ; on the other, he may be restored to useful employment and full citizenship. Much has been done in this country ; but much remains to be done, and in many respects we have failed. In former years when disability resulted from war service, and the community felt an obligation to repay its debt, employers appointed unwanted commissionaires and superfluous lift-attendants. But there can be no greater degradation .than to engage a man on duty which he knows to be unimportant, unnecessary, and specially prepared as a concession. The compassionate approach’ is misplaced ; the charitable creation of artificial jobs is misguided. Moreover when disability was due to the hazards of industry, and the debt of the community was less clearly recognised, we often added to the insult of degradation the injury of financial hardship. We were content to award compensation by the payment of a few shillings each week, or to dismiss the matter once and for all by the payment of a sum in final settlement.
employed
WHAT HAS TO BE DONE
In recent years it has been recognised more and more fully that the treatment of physical disability is not a simple problem of surgical intervention. Good surgery and good medicine may be of primary importance ; but equally important are those measures of active exercise, massage, gymnastics, occupational therapy, and recreational treatment which have become.known as medical rehabilitation ; and of no less importance are the social services of vocational retraining and resettlement in the life of the community, which alone complete the treatment of disability. These three phases-medical treatment, rehabilitation, and resettlement-are of equal significance ; and if the problems of the disabled are to be solved they must be closely coordinated. The necessary coordination has been achieved in the orthopaedic service of the Royal Air Force. The airman with multiple injuries who is treated in hospital is transferred direct to a rehabilitation centre ; if necessary he is readmitted to hospital for further surgery ; he is transferred once more to the rehabilitation centre where treatment is completed in the gymnasiums and playing-fields ; he attends refresher courses in his former trade ; if the disability is permanent he is reassessed while still in the rehabilitation centre, and arrangements are made for retraining in a new trade ; if medical problems arise during retraining he goes back once more to the rehabilitation centre or to the hospital. There is absolute continu-
ity of supervision ; there is no break in the sequence ; there is close coordination of surgical treatment, rehabilitation, and industrial resettlement. That which has been achieved in one military service, and is now being attempted by the Miners’ Welfare Commission in the civilian service of coalmining, and by the Birmingham Accident Hospital in the industries of that city, must be achieved in the country as a whole.
Every disabled person must be treated, reha,bilitated, and resettled with no interruption and no break in continuity. The surgeon who accepts responsibility for one part of the treatment must accept responsibility for the whole of it. It is no defence to urge that he is untrained as a social service worker and has no contact with industry ; he might as reasonably take no part in rehabilitation because he is untrained as a masseuse, or be unwilling to perform an operation because he is untrained as an instrument-maker. He must organise surgical treatment with a team of nurses and assistants, rehabilitation with a team of -physiotherapists and gymnasts, and resettlement with a team of almoners and disablement rehabilitation officers. WHAT IS BEING DONE
The Government has given an inspiring lead in this task. It has placed upon the statute-book the Disabled Persons Employment Act. It is true that the exigencies of war made it necessary to enlist the full man-power of the nation, and that utilisation of the services of the disabled was thus encouraged. But there is a determination in the Government to create the opportunity for employment of the disabled, not because the country is in peril but because the disabled are capable and worthy of employment ; there is a determination to ensure that Britain shall undertake pioneer work in rehabilitating those who suffer" a handicap in obtaining or keeping employment." An advisory council has been appointed to assist in implementing the Act, a council which includes not only employers but ’workers, not only doctors but disabled, a council which is already at work and is capable of great achievement. The Ministry has appointed disablement rehabilitation officers throughout the country whose duty it is to interview patients while still under treatment. They are willing and anxious to assist as soon as it is known that the disability will be permanent and that retraining may be necessary. But they cannot succeed without the sympathetic aid of medical men, and of this they are still urgently in need. The Ministries concerned are faced with great problems. Every voluntary association which can aid in the vast programme must dedicate itself to the task. The British Council of Rehabilitation was recently formed with this purpose. It is endeavouring to secure closer cooperation between physiotherapists, occupational therapists, and educational gymnasts, and even if possible to achieve some measure of common training; it is promoting the development of hospital almoner services ; it is coördinating the many schools of- training for the crippled, the blind and the deaf. In the words of Lord Rushcliffe, chairman of the council : " the primary aims are to bring together workers in every field of rehabilitation ... to become a source of information and guidance ... to organise short-term courses of study... and to promote research into problems arising, more particularly those which concern the economic outlook of the permanently disabled." ’’ Confidence and hope do more good than physic thus wrote Galen two centuries ago. The words apply In relieving the handicap of the no less forcibly today. disabled person our task is to complete his treatment, explain his problems, anticipate his fears and reassure his mind, to offer hope and give confidence-confidence in himself and confidence in the future. We must reestablish for him normal family life, normal employment, and normal recreation, and reinstate him in the privileges and duties of citizenship. -
WOMEN MEDICAL OFFICERS IN UNITED STATES ARMY.—The office of the Surgeon-General at Washington states that 74 women medical officers are serving in the Army, of whom 4 are majors, 36 captains, and 34 first lieutenants, and 17 are
serving overseas.