In a former volume, "The Work of Our Hands," the authors have studied the advance which has been made along industrial lines in the hospitals and asylums of this country. The present volume is intended as a text book of a few crafts which have proved to be of special value to handicapped workers outside the institutions. The directions given are elaborate and detailed as far as possible so that the individual worker may be able to study out and practice a vocation for himself. The book will also be found of value to crafts workers who are dealing with handicapped labor in the various institutions; and in the private practice of physicians who realize that a patient at work is a patient half cured.

The subject of occupation for the handicapped has fortunately received an increasing amount of consideration in the past few years. The time is coming before long when the mere fact that a man is partly disabled will not debar him from the advantages of labor. He may not be able to pursue his usual work, but a competent system for the benefit of the handicapped will promptly secure him a chance to work at something, even though it brings him half a loaf instead of a whole one. Not only are hospitals and asylums providing suitable work for their partly disabled charges, but there is on the way a larger movement which will some day meet in really adequate fashion the needs for the handicapped everywhere.

There are two principal reasons why an injured man should be given something to do as soon as possible after his injury. The first and perhaps the most pressing reason is that he should not degenerate and become a chronic invalid as he is very likely to do when his faculties are not used. The second reason is directly in the interest of private and public economy. According to our present system of compensation the injured employee often receives through the insurance companies a certain proportion of his wages while he is disabled. It has been found that the time of disablement is often unnecessarily prolonged by the disinclination or the apparent inability of the patient to work again. This is not always the patient's fault because in many cases the initiative fails and the injury may easily be such as to make possible progress difficult. It has been suggested that experimental workshops be provided covering a variety of trades; workshops under medical supervision where the sick or injured may be given instruction and help along the lines of returning efficiency. In these shops it would soon become evident if the old trade could ever be used again, and it would also be possible in many instances to adapt the individual to some new occupation. The experimental workshop at the Massachusetts General Hospital has already demonstrated in a number of cases the soundness of this idea. During the past year one of the liability companies paid indemnity for many months to a young woman who had received a cut across the palm of the hand. This girl happened to be of an hysterical tendency, so that beside the actual difficulty of working with stiffened tendons after the cut had healed, she would become hysterical at the slightest manual effort and progress would cease. She was introduced to the workshop which is a part of the hospital organization. She realized that she was under medical supervision and was not so much afraid as she would have been in other circumstances. She was given, more or less under protest, a little simple work to do in connection with the flower pot industry which is being carried on at the hospital. At first she could not use the injured hand at all, but worked with the other. By degrees it became convenient for her to steady the work with the injured hand, and finally to perform slight progressive motions with it. In the course of a few weeks she was using the hand satisfactorily and has since gone back to her old employment. The unnecessary delay was in no sense the fault of the patient who might never have been able to use the hand except through some such gradually progressive and carefully guarded method as this. A man, the subject of mild multiple arthritis, had been obliged to give up his work as a cooper. It was evident that he could not for a long time at least go back to that rather strenuous occupation. He had been given all kinds of the regular treatment including massage, electrical, and the

Zandar machines, without much improvement. In the shop he began working at fairly simple tasks requiring slight motions of the hands. The interest in the work became considerable and by degrees he was able to increase the motions of his joints until finally he was equal to a full day's work at a special cement working occupation. He has since found permanent and lucrative employment in an outside shop doing the same kind of work. The reason for his improvement is at first not evident because the stiffened joints of rheumatism are supposed to be very difficult to relieve. The fact was that the man without realizing it was protecting his joints against the pain of motion. He was afraid to use them as much as he could. The interest of the work overcame that fear and the joints were at once more effective. Gradual use overcame most of the remaining difficulty. These are, of course, especially favorable cases but they are typical of a great many that could be benefited and even restored to full usefulness by the use of modified occupation which is at first easily within the compass of crippled joints and minds. It is, of course, evident that the restoration of disabled workmen to even partially remunerative labor means the relief of economic strain. The time has come, if it is not already here, when the demands upon the family, the state, and upon industries for charitable or semi-charitable support of injured and disabled workmen will be a serious burden. In the workshop of the Massachusetts General Hospital it has been possible through the sale of manufactured products to pay the men and women employed in making the cement flower pots a dollar a day during the time of partial disability. A considerable proportion of them have been graduated into better jobs. The workshop has become in a small way a laboratory where part time workers can be studied with the idea of finding new occupations and of reducing the time of disability.

The principle which applies so clearly to the large industrial problems applies also with equal force to the individual who has failed in life and who needs to be put on his feet. This individual problem involves not only the pressing financial difficulty but the moral situation as well. Few of us are able to be idle successfully. Prolonged idleness almost always means unhappiness and degeneration. Thousands of men and women throughout the country who have failed in their first attempt at livelihood need to be studied and directed into possible channels of success. A sort of revocational system is needed. Every one recognizes the advantages to be gained from vocational study and training in youth. Is there not even a greater need of similar study and direction when in spite of early hopes and ambitions failure has come whether through illness or accident or through unfortunate choice of occupation?

The work cure idea has advanced very rapidly in the past few years, especially in the sanatoria for the treatment of nervous exhaustion in its various forms. It has become evident that the disability of nervous exhaustion, real and undeniable as it is, may be rapidly overcome in a great proportion of the cases by systematic work planned in such a way as to avoid overstrain and discouragement. It has been found that many of the symptoms of nervous exhaustion, the lack of initiative, the sense of fatigue, irritability and fear, will be modified in a most astonishing manner when the patient has become efficient along some simple line of work. Of course, the work must be different from that which has been customary. Among brain workers the work must be largely physical; and among those who have worked with their hands, it must usually be simpler and more primitive than that which has produced the fatigue. In connection with ordinary medical treatment and with baths and special sanatorium management, systematic work will give a sure foundation for mental and nervous control. A man who has given out in business comes to the sanatorium. Instead of being allowed to worry and fret about his business, he is given some simple work to do. Perhaps he becomes an amateur blacksmith or a hand weaver. The mental strain is relieved, the physique improves, and the cure is often permanent. Beside that, the patient has acquired a new interest, an avocation which will always be useful to him as an offset against mental and nervous fatigue.

The casual reader may wonder how a livelihood is to be made from the crafts described in this book, and it undoubtedly is true that only in occasional instances will these crafts prove wholly self supporting. But if they help to keep the wolf from the door, if they restore confidence and courage, if they do in some measure reduce the burden of public and industrial obligation to the handicapped, they will serve a most valuable purpose. Because the book is intended for the use of pupils as well as teachers, its phraseology has been kept simple and untechnical as far as possible. Some of the crafts described can be successfully carried on without trained teaching, but it is becoming increasingly possible to obtain teachers for the handicapped. The sanatorium workshop at Marblehead, Massachusetts, under the control of Dr. Hall, is training teachers as fast as possible to meet the needs of hospital and asylum industries. Other institutions should take up this normal-school idea so that in days to come there will be no lack of skilled direction for handicapped labor. Patients themselves may easily become teachers and in this way succeed in saving not only themselves but many others from the dangers and positive harms of idleness. In all large cities there are craftsmen who will for a consideration give lessons. Usually they have not the patience to teach invalids but it should be possible for prospective teachers to obtain a knowledge of weaving, or bookbinding, for instance, so that they may become teachers of invalids.

The writers take pleasure in acknowledging the valuable assistance of a considerable group of craftsmen and designers, all of whom are mentioned in "The Work of Our Hands." Acknowledgment is also made to the Massachusetts General Hospital for the privilege of referring to cases treated there.

Thanks should also be extended to the Craftsman Publishing Company for the courtesy of reproducing both printed matter and illustrations.