week; a successful salesman in the employ of an artificial limb company earning $100 a month, who said he could run and dance like a normal man, although to the keenly observant person, a slight limp and slight stiffness of one limb could be detected. There was also the skillful cartoonist with a congenital paralysis of one arm, and a defect of one leg, whose entire life has been as much like that of a normal person's as his judicious parents could make it. So unaccustomed was he to thinking of his handicap that he was almost startled when he was informed by his mother that she had reported him as a cripple to the surveyor. He dances, swims, play tennis with one hand, and enjoys the usual activities of the normal man.

These are merely types of innumerable cripples visited in this survey. Each is different, showing clearly character defects and the variable mental attitude that plays such an important part in directing the failures or successes of the cripple in the economic world,—as important a part as his physical disability and in some cases more.

Of the total number at work 54 per cent were earning a living for themselves. Over one-half of this number were supporting themselves in addition to others. Only a small number of those unemployed were receiving industrial pensions, which immediately raises the question as to whether industry is bearing its just burden in relation to the number of accidents.

The number unemployed, of course, was greater among those having the heaviest kind of handicap although large numbers of those with serious disabilities were at work. The man with double club hands and club feet illustrates the latter type. His parents were Polish immigrants who were illiterate and who never learned to speak English. This man was the oldest of 21 children born in a remote town in Kansas. Although his parents realized his deformity, no doctor was consulted until he was about five years old—his mother had a midwife at birth. As his father was a laborer earning $1.10 a day, the doctor's price was beyond their means, and no further medical advice was sought. Until 12 years of age he was dragged about in a cart by his younger brothers and sisters. About that time the family moved to Cleveland. A shoe-maker in the neighborhood offered to make shoes for him which would enable him to walk. He also taught him to make his own shoes, which he does to this day. From that time he was no longer dependent, and, best of all, he could go to school, an unexpected but longed-for joy. Be

cause the family income was so small, he felt after five years of schooling that he must go to work. During this time no suggestion of public hospital was made to him or to his parents by teacher or neighbors. Therefore, with practically no use of his hands, selling newspapers seemed the only opening.

He

He is now 35 years old, and with the exception of a year when he tried the experiment of keeping a cigar store which was not a profitable business venture he has sold papers on a street corner. has also some regular customers in office buildings. Both parents are dead and he is the support of a sister and two children, and two young sisters whom he hopes to send to high school. Very frankly he said:

My parents were simple, ignorant people who did the best they knew how. I have no complaint to make. I am strong and vigorous. I like to work and am thankful for the opportunity because I must support my family. It is not too much of a care and it gives me something to be responsible for, and a reason to make a home. Think of the types of people with whom I come in contact: think of the side of life that has been revealed to me and from which I can guide my family. No, I have no complaint to make but I trust all cripples may have proper medical treatment; that they may have educational advantages; and that you may interpret us to the community, especially to employers. Both are strongly prejudiced and unwilling to take us for what we are.

This kind of occupation with no future to it would not be advisable for every cripple to follow, but no one watching this man at his work could doubt his businesslike attitude in close competition with the very alive young newsboys who frequent his corner.

The results of this survey may seem so optimistic that one might easily assume that no further plans are necessary for cripples. But when it is known that one-half the total number were crippled in childhood, and that one-fourth of the total crippled population were under the age of 15 years at the time of the survey, very important plans suggest themselves and are already under way in Cleveland.

The importance of making such a survey cannot be overestimated either for Cleveland or other cities. It has not only given the interested groups and social workers in Cleveland a general knowledge of their crippled population in all its phases, but has also given them and others undisputable facts by which to judge this problem fairly. From now on mistaken ideas about cripples

can be dropped. Here is an opportunity to put them right, so to speak, in the minds of their neighbors who are apt to have very wrong ideas about the ambition, ability, and economic status of those who do not present the same outward appearance. From Cleveland, a city largely without industrial training either before or after disablement, where cripples unaided have contributed to their own successful economic independence, much can be learned. The lives of unknown cripples are much more normal than had been supposed, although, because of unequal chances, they have undoubtedly often followed the line of least resistance.

The important fact to be faced is that cripples must be divided into two large classes, the helpable by normal educational means and the helpable by specially devised means. By the former is meant those who are able physically and mentally to share normal opportunities of life; by the latter is meant those who are unable physically and mentally to share normal opportunities of life and whom it is not human to force beyond their ability. They should be aided to live out their lives happily with the limited equipment they have. With this division it will be much simpler to establish the normal place of the cripple in the community. To accomplish this means something more than case work with individuals; it means more surveys like Cleveland's, and educational campaigns, legislation, etc., as a basis for needed plans.

What do the cripples themselves want? Turning again to the life stories of the successful ones, they want:

1-Not to be confused with the begging type of cripple.

2-Not to be forced into a special class.

3-An opportunity to be judged by what is left and not by what is gone. 4-To be given an opportunity to make the contribution of which each is capable.

5-To share equally in all chances offered to normal individuals.

This is the appeal from normal, thoughtful cripples to interested individuals, organizations and social workers for an active share in life. The task then, is to extend permanently to all the advantages of community life.

THE SICK

BY EDNA G. HENRY,

Director, The Social Service Department of Indiana University.

Social work, unlike medicine, still suffers lamentably from a want of precise and sufficient knowledge. More complete statistics upon poverty, pauperism and mere misery, their nature, extent and causes must be collected and made available before any social worker can speak with authority. Of two facts, however, he is already convinced. Prevention, and teaching for prevention, are as essential in social work as in medicine. Neither can there be any good social work without access to expert medical practice. This is true equally in the prevention of suffering or in its relief, and true whether the concern is with mass betterment or with individual improvement. Whatever special line of activity occupies the worker, be it public or private, institutional or case work, the situation is the same.

LESSONS FROM THE MEDICAL PROFESSION

In seeking to remedy bad social conditions, they (the workers) have come to recognize more fully the great handicap of bad physical conditions and have learned to welcome, in the effort to remedy these, the aid of a newer and more constructive medical science. Their awakening is due, in part, to their own deepened experience of human need but even more is it due to the socialized members of the medical profession who have led the way in many departments of social endeavor.'

Social workers today are a bit too proud of having socialized the physician. They feel that they have opened his eyes, so that he is aware not only of the fact that a man's heart may not be treated without complete consciousness of the rest of his body but also of the additional truth that he cannot be considered or cured apart from the larger social unit of which he is a fraction. The condition of his lungs and legs may well be less important than his income or his wife's tastes and temperament. Any visiting nurse or social worker can name a dozen points the physician sees now which formerly were invisible to him. Physicians, upon the other hand, do not see, or are too busy to note, how social work has improved since it

1 Mary E. Richmond, "Social Diagnosis," p. 204,

realized and admitted to itself its dependence upon medicine. If the social worker has learned nothing else from the medical profession, there is at least the new value of records and more scientific method.

Many will be inclined to deny that the value of any record has been enhanced by contact with doctors. They point with scorn, and alas, with truth, to the deficiencies of dispensary records. But medical work has made records more valued. For long the best social case workers have known that their records, and the use they made of them, in the end determined the quality of their work. They did not have to point to the obscure and forgotten careers of missionaries to prove that work, no matter how good, is lost and as if never done unless recorded. They regarded as sacred and confidential records which might embarrass individuals or ruin reputations but when medical facts appeared on them, they learned that people's very lives and entire futures might depend upon a date and a diagnosis, or be lost through carelessness. It was then that records became as precious as babies.

Unconsciously, too, workers now follow methods long consciously practiced and taught by physicians. It is not without significance that a book for social workers is called "Social Diagnosis," but only recently have students and new workers been called upon to test their labors with a medical outline. It is beyond dispute that for social woes, the doctor's outline for physical ills should be followed. The order should never vary. Relief of symptoms should always precede, but should be followed by diagnosis, prognosis, treatment, scientific research and public education for prevention.

Even the most unthinking layman will agree to the necessity for any immediate relief of symptoms. No doctor will refuse to allay pain before he knows its cause. The trained social case worker must always have a plan which involves temporary relief first, with investigation afterwards. But this worker also, like the doctor, now demands diagnosis before further treatment. Some seek a prognosis also, although few are courageous enough to act upon it. Treatment, as with the physician, depends upon the individual worker, upon his knowledge and upon his acquaintance with remedies. Like most physicians, the majority of case workers stop at treatment and do not proceed to the further research and consequent possible public education for prevention.