REPORT OF 
The Department of 
Public Welfare 
Rehabilitation of Physically Handicapped Persons 
[Printed by authority of the Statfe of • STATE OF ILLINOIS 
THE DEPARTMENT OF PUBLIC WELFARE 
Charles H. Thorne, Director 
REHABILITATION OF PHYSICALLLY HANDICAPPED 
PERSONS 
William T. Cross, Survey Officer Springfield, Illinois 
Illinois State Journal Co. 
State Printers 
19 2 1 
46307—1M TABLE OF CONTENTS 
PAGE. 
I. Rehabilitation Work as a State Activity 8 
II. The Condition of the Physically Handicapped. 
A. Examples of Physical Handicap 9 
B. Characterization of the Problem 14 
The Viewpoint of the Disabled Person 14 
Types of Disability 14 
The Main Factors in Physical Handicap 15 
Soldier versus Civilian Problems 16 
III. Number of Physically Handicapped Persons. 
Origin of Handicapping Disabilities 16 
Community Censuses 17 
Number of New Cases Annually 19 
The Community Burden of Handicap 21 
IV. Case Work the Main Requirement. 
Possible Emphases in Organization 21 
Advisory Service and Continuous Control 23 
Rehabilitation Aids ' 23 
V. Physical Rehabilitation. 
Provisions for Functional Restoration 24 
Work to be Organized about Central Hospital Group 26 
Using Facilities of Communities 26 
Facilities for Convalescent Care 27 
Co-operation of Industrial Concerns and Insurance 
Companies in the Physical Restoration of Disabled Persons 27 
Relations with Administration of the Workmen’s Compensation Act.. 28 
Artificial Appliances 29 
VI. Industrial Rehabilitation. 
Industrial Conditions 31 
Avoiding Discrimination 33 
Vocational Training 34 
Organization for Placement ' 37 
Residual Cases 39 
VII. Prevention, Research and Publicity. 
The Prevention of Disabilities.... * 40 
Crippled and Otherwise Defective Children 40 
A. Examples 40 
B. The Community Problem 43 
The Safety Movement 47 
Research and Educational Publicity ...48 
VIII. Summary and Budget. 
Voluntary Community Agencies 49 
Relationship of Various State Departments to Rehabilitation Work. ..52 
Legislation Needed 53 
Organization of the State Rehabilitation Service 53 
Budget Estimate 54 
Sources of Revenue c. ...55 SPECIAL STUDIES AND ARTICLES 
v 
\ (References to this Appendix are made in Appropriate Sections of Report) 
A. Organization and Procedure. 
1. Law Relating to the Rehabilitation of Physically Handicapped Persons. 
2. Organization and Procedure of the Present Survey. 
3. Nomenclature in the Diagnosis of Physical Disabilities. 
4. Plan of Central Registration of Cases of Physical Handicap for a 
Large City. 
5. Legislation and Practices in other States (Summary not published). 
B. Community Censuses and Case Studies. 
1. Community Censuses of Chicago, Springfield, Decatur and other Cities. 
2. Twenty-five Injured Coal Miners. 
3. Case Histories, a Series of Illustrative Summaries. (Study in 
preparation). 
4. “The Economic Condition of Physically Handicapped Persons”, by 
William T. Cross, a Paper read before the American Association for 
the Advancement of Science, Section K, 1920 meeting. (See 
Transactions of the Association.) 
C. Physically Handicapped Persons Known to Welfare Agencies. 
1. Family Welfare Agencies in Illinois and the Physically Handicapped. 
(Study in preparation). 
2. Physically Handicapped Persons known to Social Agencies of Chicago. 
3. Physically Handicapped Persons Known to the Visiting Nurse Asso- 
ciation of Chicago. 
4. Physically Handicapped Persons in Chicago who are House-bound. 
5. Physical Handicap in Relation to Dependency, a Study of Cases known 
to the Jewish Aid Society of Chicago. (Study in preparation). 
D. Medical Facilities. 
1. One Hundred and Seventy-eight Patients in the Medical. Surgical and 
Orthopedic Wards of Two Chicago Hospitals. 
2. Number of Physically Handicapped Persons Leaving Local Hospitals 
and Special Facilities for Their Treatment. 
3. Hospitals, Dispensaries and Clinics of Illinois. 
4. The Central Hospital Group at Chicago. A brief Description. 
5. Health Center—Sometimes called Community Center. An Outline 
Prepared for the Present Report by Dr. Frank Billings. 
6. “Physical Restoration of Disabled Persons”, by William T. Cross, an 
Article to Appear in an Early Number of “Modern Medicine”. 
E. Educational Facilities. 
1. Placement Training given by Industrial Concerns of Chicago. 
2. ' Private Schools of Chicago Affording Vocational Training Opportunities. 
F. Industrial Relations and the Compensation Act. 
1. A Study of Jobs and Conditions of Work in 23 Chicago Plants, with 
respect to "the Employment of Disabled Persons. 
2. Eighty-two Disabled Persons Employed in Eleven Industrial Plants of 
Chicago. 
3. Sixty-two Physically Handicapped Persons Applying at Free Employ- 
ment Bureaus. 
4. Re-employment of the mere Seriously Injured persons included under 
the Compensation Act. 
5. Industrial Accidents in Illinois in Relation to Physical Handicap. 
A Summary of Statistics of the State Industrial Commission and 
the State Public Utilities Commission. 
6. Neglect of Industrial Injuries due to making Compensation Settlement 
prior to Restoring Function of Injured Parts. 
7. Job Specifications for Large Industrial Plants in Relation to the 
Employment of Physically Handicapped Persons. 
8. “The Re-establishment of Disabled Railway Employes”, by William 
T. Cross. Paper read before the American Association of Railway 
Surgeons, October, 1920. (See Transactions of the Association). 9. “The Problem of Employment for the Physically Handicapped in 
Illinois,” by William T. Cross. Paper read before the American 
Association of Public Employment Officers, September, 1920. (See 
Transactions of the Association). 
10. Special Studies of Opportunities for Physically Handicapped Persons 
in Industry. 
11. Minnesota Act Prohibiting Insurance Companies from Raising Rates 
of Concerns that employ Physically Handicapped Persons. 
12. “Making Room for the Disabled Man in Industry”, an address by Dr. 
Harry E. Mock, and discussion by William T. Cross, before the 
Chicago Council, Industrial Relations Association of America, 
August, 1920. (Duplicate copies available). REHABILITATION OF PHYSICALLY HANDICAPPED 
PERSONS 
(A plan of administration.) 
SUMMARY 
In this report the practical operation of the law for the rehabilita- 
tion of physically handicapped persons is traced, through a description of 
conditions that have been discovered by field surveys during the past 
eight months. 
The problems of physical handicap and the processes of rehabilita- 
tion are illustrated with cases that have been studied. It is estimated 
that between 1 and 2 per cent of the population have serious physical 
disabilities, and that as many as 5,000 persons annually will require first 
interviews at the time of becoming disabled. Tim work of other states 
under similar rehabilitation acts is reviewed. 
The most important principle in the State’s dealing with handi- 
capped persons is found to be that of advisory service and continuous 
supervision of cases. For this purpose it is suggested that “rehabilita- 
tion aids” with special training be the representatives of the State in 
dealing with physically handicapped persons. 
The two main steps in the process of rehabilitation of disabled 
persons are stated as being physical restoration and industrial reestab- 
lishment. In providing for physical restoration, as required by the law, 
it is suggested that maximum use be made of existing medical and wel- 
fare facilities of communities and that at the Central Hospital Group, 
now being established in connection with the University of Illinois 
Medical School, special arrangements be provided for functional restora- 
tion of patients during convalescence. 
In industrial reestablishment likewise it is suggested that the work 
of rehabilitation be done as largely as possible through existing facilities 
in the community. The possibility of accomplishing this to a certain 
extent through the cooperation of industrial concerns is shown from the 
results of field studies. Reestablishment at remunerative occupations is 
found to require chiefly a service of employment placement and of train- 
ing in industrial establishments. It is suggested that for a small pro- 
portion of cases “opportunity shops” be established for vocational testing 
and preliminary training. 
It is shown that the problems of physical handicap are in an im- 
portant degree preventable, especially in the care and training of TIIE DEPARTMENT OF PUBLIC AVELFARE 
children and in the avoidance of accidents, and ways are suggested 
whereby the State may enter upon a program of prevention. 
Certain legislative measures are suggested, to add to the effectivenesj 
of the Rehabilitation Act. Ways in which other State departments] 
especially the Departments of Labor, of Education, and of Health, maj ' 
aid in making the law effective are shown. Some of the services whicl 
voluntary agencies in the community may be expected to perform arc 
listed. 
The budget statement on an annual basis, includes the following 
items: 
Staff salaries and traveling expenses $117,501 
Maintenance of handicapped persons' during' training' 50,00 
Research, publication and general administrative expenses 55,000 
Establishment of main rehabilitation center and branches, temporary 
quarters 75,000 
Revolving fund for purchase of artificial appliances 10,000 
$307,50! 
This is the estimated cost for the first year of operation under full 
organization. The amount may be reduced between 25 and 50 per cent 
during the first year of actual administration. The work would have to 
be developed gradually. About one-half of the actual total might be 
secured through revenue from the Federal Government under the Fess- 
Kenyon Act for disabled persons, and from an arrangement whereby 
pajraents due for compensation for fatal industrial accidents, in case 
there are no heirs, would be made into a special rehabilitation fund. 
In addition to the foregoing maintenance costs, it is estimated that 
about $250,000 should be appropriated for a special rehabilitation hos- 
pital, to include an “opportunity shop,” and quarters for the staff o' 
the rehabilitation service, as a part of the Central Hospital Group at 
Chicago. 
I. REHABILITATION WORK AS A STATE ACTIVITY ' 
In years past the State has selected for special attention one class 
after another, out of what had previously been treated as a general mass 
of poverty. The old time almshouse Avas notable as a catch-all for these 
problems. First the able-bodied were taken out and put at labor in work 
houses. Later the insane were removed, as for example in Illinois und 
the State Care Act. The commitnient of children to almshouses av 
then investigated and other methods of care Avere adopted. Mental d 
fectiveness has lately appeared as a definite public problem, and separat 
provision is being made. 
The physically handicapped have until noAv been an undeimei 
element in the problems of poverty and distress with Avhicli every com 
munity has had to deal. Examination of such cases as are cited in this 
report shoAvs that in many instances, through physical and industria' 
.rehabilitation, they may be kept from economic failure. REHABILITATION OF PHYSICALLY HANDICAPPED 
The activities of the State in behalf of those in need have usually 
been directed along- institutional lines. The artificiality of institution 
life and the cost of making material provision for increasing numbers 
have led to the development of out-patient service and the supervision of 
cases in the open community. Advisory service to individuals and the 
use of existing agencies have been emphasized by the legislature in 
making the present arrangement for the rehabilitation of the physically 
handicapped. 
The effects that are sought in the Rehabilitation Act are primarily 
economic. The procedure affects administrative organization in the fields 
of medicine and surgery, of applied psychology, of education, of industry, 
of labor placement and of social work. The primary provision is that of 
continuous dealing with specific cases through a period of readjustment. 
In effective case supervision, leadership on the part of some single 
authority is necessary. The leadership in this instance has been assigned 
to the Department of Public Welfare. The survey has shown that the 
help of other public departments also, and of community agencies, is 
necessary for the reestablishment of disabled persons, and these recom- 
mendations are intended to provide for the distribution of functions 
accordingly. 
ir. THE COALITION OF THE PHYSICALLY HANDICAPPED 
A. EXAMPLES OF PHYSICAL HANDICAP (ADULT) f 
A Recent Industrial Injury. 
When a falling chimney knocked the scaffolding from under the car- 
penters at work on a tall building, Ladd Mann* hung by one hand in 
spite of the tumbling bricks which had crushed his foot and shattered 
one arm. A derrick brought him to the ground, half an hour later. 
A dispute between the construction company and the chimney con- 
cern as to who was responsible, resulted in Mr. Mann’s receiving no 
medical attention for a week. He recovered finally, minus one foot, and 
with a stiffened, partially paralyzed arm. 
He came out of his convalescence convinced b}r liis wife, sympathetic 
friends and coworkers that he had had a hard deal and would henceforth 
be dependent. There were five children in school. Two young girls in 
: the family went to work. Fifteen dollars a Aveek Avas allowed by the 
Industrial Commission. 
A visit from a representative of the survey and reconstruction litera- 
ture opened up an unanticipated future to him. Arrangements are being 
hurried for the artificial leg, and for special occupational therapy to 
increase the usefulness of his arm. Plans are being formulated to put 
Mr. Mann’s expert knoAvledge of blue prints to adArantage in a Avel 1 paid 
job suited to his disability. 
* Names used in this and later case descriptions are fictitious, 
t See Appendix B-2, B-3, P-6. 10 
THE DEPARTMENT OF PUBLIC WELFARE 
Child Labor, Illiteracy and Handicap. 
Oliver Sleszynski was 19 years old at the time of his operation in 
January, 1920. He was an illiterate Polish boy. He had started to work 
in the mines almost as soon as he could lift a pick. In May, 1917, a mine 
explosion crushed his left leg. It was amputated in the middle thigh, 
and he was in the hospital for six months. He was discharged with the 
stump healed, except for a small discharging sinus which the surgeon 
told him would heal shortly. He was not fitted with an artificial leg. 
He received $1,900 compensation. This money was turned over to 
his father and step-mother and, with only a few dollars in his pocket, he 
came to Chicago, where a sister was living. Failing to locate his sister, 
he secured lodgings in a cheap hotel and for three weeks vainly sought 
employment. Other cripples stayed at this hotel and they obtained their 
living by begging. It is the practice for such persons to procure licenses 
to sell shoestrings or other merchandise, which they display only when a 
policeman is in sight. Oliver, despondent and moneyless, was about to 
procure his license Avhen 'someone told him of a society engaged in 
rehabilitation work. 
This society sent him to a hospital for examination. It was found 
that the sinus on the end of his stump had never healed. A reamputation 
was performed, removing four inches more of the thigh. After eight 
weeks of hospital residence he was measured for an artificial limb and in 
two more weeks he was able to walk about without crutches or cane. 
During his stay at the hospital, Oliver was taught English and tried 
his hand at several kinds of occupations. He was anxious to learn 
photography and to become a motion picture operator. Books on the 
subject were procured and many of his English lessons were taken from 
these hooks. When he was ready to leave the hospital a job was found 
with a motion picture concern, developing films at night. For this he 
received $5 a night. In the afternoons he continued his study of English 
and took up other subjects. His pay was raised and recently when the 
concern closed down Oliver secured an excellent job at the same business 
at Kansas City. 
Compensation Money Poorly Invested. 
John Stewart, a colored man, 22 years old, fell from a high build- 
ing while washing windows and injured his spine. In 1917 the com- 
pensation bureau of the state in which the injury took place awarded him 
$2,000 as a lump sum and $6.38 to be paid bi-weekly for the remainder 
of his life. With the $2,000 John bought two houses in the South and 
part ownership in an automobile which he used as a taxicab. The winter 
of 1919 found him and his wife in Chicago, destitute. The houses no 
longer belonged to him. The touring car, which had been mortgaged, 
stood dust covered in a garage. John’s wife, who had been supporting 
him, was ill. John was idle. REHABILITATION OF PHYSICALLY HANDICAPPED 
11 
Rehabilitation in this case would begin with securing an exact diag- 
nosis of Mr. Stewart’s condition. It would be especially helpful to learn 
whether his spinal injury requires that he remain seated at work. 
To train and place this 22 year old man in a trade at which he might 
remain seated probably would he neither a lengthy nor difficult pro- 
ceeding. 
The Fear of Disability. 
John Allen, American, age 24 years, fell ten feet upon a cement floor, 
injuring his coccyx. After three weeks the surgeon removed the coccyx. 
The case was referred to another surgeon, as John had not worked for a 
year. He complained of numbness in his legs, weakness, inability to 
walk in an erect position, sleeplessness, and his general appearance and 
statements indicated a mental attitude of resignation to a state of perma- 
nent disability. 
John was placed in a hospital, and after three clays of careful ob- 
servation his condition was diagnosed as traumatic neurosis. Treatment 
consisted of massage and light exercise, first for two hours a day, later 
for four hours a day; and work in the occupational therapy shops, first 
for two hours a day and later for four hours. John became interested in 
the jig-saw, which he manipulated by foot power, and it was his delight 
to make many scroll designs. At the end of a week he said the numb- 
ness and pain in his legs was better. 
At the end of the second week he went to the park with one of the 
other patients, who was posted to try and induce him to row a boat. He 
rowed the boat for half an hour the first day, and for the next three days 
was eager to go to the park, and the last day rowed a boat for two hours. 
At the end of two weeks in the hospital the surgeon held a conference 
with John, pointing out to him that there was absolutely nothing wrong, 
and that his numbness and pain and sleeplessness had been the result of 
a mental state. He returned to his old occupation the next day, and has 
worked ever since. 
Two Immigrant Miners in cl Small City. 
(As described by the secretary of the local charity society.) 
1. Ten months ago Mr. Kusack, an Austrian miner, injured his leg 
while at work. Five months were spent in the hospital, and now he is at 
home with his wife, a little daughter 3 years of age and twins 2 years. 
He receives $15 a week compensation and has called at the charities 
office for assistance in furnishing clothing for his wife and children. 
A visit to the house reveals need from every point of view. There 
is a dearth of knowledge of the simplest health laws, and the art of home- 
making is unknown. 
When the visitor entered, Mr. Kusack hastened to the wall clock, 
opened it and took out what seemed a precious package—“Bones! Bones! 
from my knee that got hurt in the shaft!” he exclaimed. “How see! 12 
Tim DEPARTMENT OF PUBLIC WELFARE 
work no more !” and throughout the visit this was the strain: that, having 
crippled his left knee, he, aged 44 and the father of three small children, 
could never again perform a day’s labor. An interpreter gave him his 
first hope by explaining for the visitor, the Illinois law relating to the 
rehabilitation of physically handicapped persons. 
Work was begun by starting a simple English course and the land- 
lord became so encouraged with this effort and the possibilities for the 
man that he is repairing the dwelling. 
The next call will be made in company with the mine superin- 
tendent. 
2. Mr. Giolotti, a miner, suffered a stroke of paralysis in the 
spring of 1920 and now finds himself unable to resume his former em- 
ployment because his left arm and leg are useless and his right hand is 
needed to steady a cane. 
Mr. and Mrs. Giolotti and two children are now entirely dependent 
upon the oldest hoy’s earnings. This boy is 21. He left parochial school 
in 5th grade and as a result of an accident in the mill when 16 lost his 
left leg. No one saw just the right opportunity for him then and he 
drifted from otic “light job” to another until the railroad company, 
needing a watchman, gave him the job. A watchman at 21, with a bright 
smiling face, a forgetfulness of his handicap and a love of books! 
He has been told of the Illinois Rehabilitation Law, and only awaits 
an introduction to the rehabilitation program. 
Therapeutic Occupation. 
David Amidson, 25 years old, a Norwegian, has a congenital curva- 
ture of the spine. At the age of seven years he had infantile paralysis. 
This left him helpless in the lower extremities, w'hich have never de- 
veloped. His only way of locomotion was to creep. Three years ago his 
mother brought him to this country, and two years ago he came to 
Chicago, where he has a sister living. He had never worked. 
A certain rehabilitation agency fitted him with braces which en- 
abled him to stand, with the aid of crutches. He was taught basket 
making in his home. About eight months ago he was brought to the 
work shop of the society in a taxicab. A week later he appeared at the 
work shop in a tricycle which he had designed himself, and which neigh- 
bors helped make for him; this he propels bv hand. He lives eight miles 
from the work shop and it takes him two hours to make the trip, but 
since that time he has never missed a cla}r. 
David is now doing piece work six hours a day, and his pay averages 
$14.50 per week. Thus far no means have been found of bettering his 
physical condition, but he has been changed from an absolutely depend- 
ent man to an independent worker. A motor is now being designed for 
his tricycle, which will enable him to get about more rapidly. He is 
planning to enter some business o* his own. rehabilitation of physically handicapped 
13 
How the Employer May Help. 
Mr. Schmidt, 35 years old, American born, had been suffering from 
arthritis, and was unable to continue his work as box maker for a garter 
company. His wife also worked in the garter factory. The' 14 year old 
son was at work and assistance was given by relatives. 
Competent medical care improved Mr. Schmidt’s condition. The 
factory’s interest was aroused, and he was supplied with home work. 
During the time Mrs. Schmidt broke down under the nervous strain. 
It was later discovered that a part of her trouble was due to her posture 
at work. Her job was changed, and work limited to half a day—the 
factory supplementing her wages. 
When Mr. Schmidt was able to earn $17 a week on home work, 
effort was made to replace him in industry. 
Delayed Treatment. 
Frank Henrick, 21 }rears old, while working in a bank, became 
paralyzed. He was quite helpless, not being able to use crutches. For 
six years two young sisters supported the family, as their widowed mother 
had to remain at home to care for Frank. 
He obtained a typewriter and did some work for an advertising 
agency. He also made coarse tatting which he sold. In trying to find a 
cure, Mr. Henrick was under the treatment of doctors of medicine, 
osteopaths, chiropractors, spiritualism, baths, a “bone-setter,” and “sure 
cures.” After he had spent $500, an appeal for financial aid to buy a 
Violet Kay outfit brought him to the attention of a visiting nurse. An 
orthopedic surgeon was called in and muscle training was given. With 
the help of braces and crutches he is expected to be able to walk, and 
thus improve both his outlook on life and his opportunities for gainful 
employment. 
T hre e Industrial .Proh Jems. 
The surgeon advised a man against heavy work. The foreman put 
him to work at pulling a truck. This resulted in tearing down the results 
of treatment and the continuation of compensation payments. The case 
shows lack of cooperation of a large industrial concern with their medical 
advisor. 
A glazier injured his wrist and was temporarily tcx. unsteady for 
work. He could easily do other forms of light work, but for lack of 
opportunity with his employer he had to lay off and be paid compensa- 
tion. The case shows need of a flexible scheme of industrial adjustment. 
Three coal miners with back injuries have been receiving compensa- 
tion for total disability for over a year. It is plain to the surgeon that 
their only hope lies in changing jobs and perhaps in retraining. Vo one 
is especially interested in bringing about such a shift, however, and the 
little village offers little variety of employment, so nothing is being done 
to “reconstruct” these men. 14 
THE DEPARTMENT OF PUBLIC WELFARE 
Safeguarding Machinery and the Home. 
At 18 a Polish boy who had been born with his left hand paralyzed 
was earning $30 a week and supporting his mother and two small sisters, 
when his right hand was caught in a machine and crushed. He received 
$624 compensation. For months this boy, with one hand paralyzed and 
one with fingers stiff and bent, hunted work. He is now carrying meat 
in the stock yards at a lower wage than he received before the accident. 
This is not sufficient to support the home. 
B. CHARACTERIZATION' OF THE PROBLEM 
The Vietcpoint of the Disabled Person. 
What it means to be handicapped is partly told by these histories. 
Even the man who has triumphed over his handicap economically, is not 
apt altogether to throw off the spell of dissimilarity from his fellows. 
A proportion of the seriously handicapped—those chiefly who have not 
come under constructive influences—are affected by the general misun- 
derstanding of the public. Pity is a positive obstacle to self-respecting 
advancement. Furthermore, the disabled man meets frequently with 
practical difficulties. The location of a suitable job at a distance or above 
the ground floor may be prohibitive. He may be unable to get insurance. 
His opportunities for amusement and for companionship may be re- 
stricted. It may be hard for him to advance his interests through asso- 
ciation with his fellows, or through following his natural inclinations 
regarding occupation. For the adult, the suffering of physical disability 
may mean the curbing of ambition or even the abandonment of a lifelong 
desire. The health and development of a man’s family may be affected. 
Appreciation of personal circumstances such as these argues more 
strongly than any other evidence that can be presented, for the adapta- 
tion of the State plan of rehabilitation to thoroughgoing case work. 
Types of Disability.* 
In studying industrial opportunities for the disabled, the more 
frequent types of handicap have been grouped to indicate the outstanding 
conditions affecting employment, as shown by the following list: 
Amputation or lack of use of feet or legs, arms, hands or fingers. 
Deformity or weakness of back or neck. 
Defective heart. 
Blindness or defective vision. 
Deafness or defective hearing. 
Disease of the lungs. 
Hernia. 
For study of individual cases the list below is used, indicating more 
specifically the disease condition: 
* See Appendix A-3 REHABILITATION OF PHYSICALLY HANDICAPPED 
15 
Amputations. 
Tuberculosis of bone and 
joints. 
Paralysis— 
Paraplegia. 
Infantile paralysis. 
Rachitis with deformity— 
dwarfs. 
Arthritis. 
Progressive muscular 
atrophy. 
Pott’s disease. 
Scoliosis. 
Sarcoma. 
Syphilis. 
Neuroses. 
Hernia. 
Defective heart. 
Goiter. 
Deafness or partial deafness. 
Blindness or partial blindness. 
Hydrocephalus. 
Cretinism. 
Chronic osteomyelitis. 
The Main Factors in Physical Handicap. 
Physical handicaps are first of all matters of bodily disability. 
These disabilities range as widely as do the effects of disease, the forms 
of congenital defect, and the results of accidents and of surgical opera- 
tions. Except in case of loss or absence of bodily parts, the physical 
condition is usually associated with organic disease and is apt to he 
improving or growing worse, or else subject to change under certain con- 
ditions. The best occupational adjustment that can he devised for a 
physically handicapped person may not relieve him entirely of physical 
discomfort. Varying and changing conditions of bodily disability there- 
fore appear as the primary explanation of lack of uniformity among 
cases of physical handicap. 
Even the most serious of difficulties frequently are overcome by 
personality. In the development of superior personality the age at which 
the disability occurs and the training given thereafter are important. 
Whatever the disability, it is of no value to make an appraisal of the 
man’s condition without reckoning with the qualities of his personality. 
But physical handicap is more essentially a relation of disabilities 
and personality to specific employment. A great section of cases of dis- 
ability are to be disregarded in planning a program of rehabilitation- 
because the disability does not happen to interfere with the man’s con- 
tinuing effectively at his present occupation. The majority of cases of 
loss of one eye are an example. 
The unskilled or poorly skilled person, however, needs attention 
even though his disability does not affect present employment, for with 
the next shift or job it may seriously embarrass him. For him and for 
the skilled worker whose employment has been affected by disability, it 
is important to weigh in every case certain conditioning factors. These 
include sex, age, intelligence, education and industrial experience, both 
before and after suffering the disability, and the relation of available 
powers to the convenient industries and enterprises. 
A fourth consideration that must be counted in rating physical 
handicap consists of the man’s economic resources, direct and indirect: 
accumulated wealth, family make-up and the assistance of relatives and 
friends. With the disabled young person these possibilities of help and 16 
THE DEPARTMENT OF PUBLIC WELFARE 
protection should weigh the less against the adoption of a plan of re- 
habilitation, for reverses may come and he may need to support himself. 
Indeed, simply as a means to happiness, for both the young and the 
middle aged, the existence of such resources as these should not prevent 
the adoption of a constructive plan to offset the effects of disability. 
Soldier versus Civilian Problems. 
A small proportion of the civilian handicapped will be found to 
correspond, in type and circumstances, to the disabled soldier, but those 
whom the State is now setting in to reestablish are characteristically of 
other sorts. The disabled soldier was in the formative period of life, he 
had been to school fairly recently and had not acquired industrial 
“slant.” He was skilled or could attain skill easily. He was capable of 
development and mobility in matters of industrial adjustment. His 
possibilities of reconstruction had been studied during his convalescence 
in the military hospital. 
The civilian handicapped are of all ages. Those injured at work are 
frequently mature, with fixed habits, with family connections that must 
be conserved, and without standard hospital experience from which to 
start in the work of readjustment. The circumstances of receiving the 
disability and the subsequent treatment usually make for the handi- 
capped civilian a different outlook. His experience has been undramatic. 
It has been estimated* for the country that the industrially injured 
alone would equal the number of disabilities resulting from constant 
active combat of an army of a million and a half. For Illinois it may 
be said that seriously handicapping disabilities occur as frequently as 
one per hour. Especially in the vastly greater number of civilians dis- 
abled and in the variety of cases, and the circumstances preceding the 
application of a plan of rehabilitation, are the men and women who will 
be served under the Illinois scheme of rehabilitation different from 
the returned disabled soldiers. 
III. NUMBER OF PHYSICALLY HANDICAPPED PERSONS 
ORIGIN OF HANDICAPPING DISABILITIES 
The Rehabilitation Act applies to “every phyhically handicapped 
person 16 years of age or over residing in the State of Illinois.” The 
test of handicap as stated in the act is to be actual or potential incapacity 
for remunerative occupation. Such incapacity may originate in any of 
the following ways: 
Congenitally. 
Through accident. 
Through injury. 
From disease. 
* “The Redemption of the Disabled.” Garrard Harris, p. 288. REHABILITATION OF PHYSICALLY HANDICAPPED 
A count of disabilities occurring in the foregoing ways would give 
the gross number of cases with whom the State might be expected to 
deal. However, it is not possible to make a close estimate of the number 
of permanent disabilities that have occurred in these ways. Even if such 
figures were available, they would give no idea of the severity of the dis- 
abilities, or of their handicapping effects. 
The Rehabilitation Act therefore provides that when the work of 
reestablishment is undertaken, contacts with needy cases shall be made 
through certain channels. These are: 
Public and private hospitals. 
The State Industrial Commission (which administers the act 
for the compensation of injured employees). 
Direct applications from physically handicapped persons. 
Surveys to be conducted by the Department of Public Welfare. 
The probable'number of cases that may be anticipated as arising in 
each of these ways is estimated later in this report. 
COMMUNITY CENSUSES* 
Whatever censuses of the general population were made had to be 
undertaken in connection with local activities. House-to-house canvasses 
for cases of disability have been conducted as part of the school census 
in the following cities: Springfield, Decatur, Tavlorville, Danville. A 
house-to-house visitation of certain districts in Chicago also has been 
made, through cooperation of the University of Chicago. In order that 
the results may be reliable it is necessary that the original location of 
cases be followed with a second visitation on the part of a specially 
trained worker, to secure more complete descriptions of disabilities and 
of economic circumstances, and to form some judgment as to the handi- 
capping effects of the disability. The second visitation has been finished 
in Chicago and Decatur, and is being planned for Springfield. A com- 
munity survey, including second visitation of cases and study of indus- 
trial opportunities, is being organized also for the tri-cities, LaSalle, Peru 
and Oglesby. 
Results from these censuses in various stages of completion indicate 
the probable proportion of disabilities in the general population. From 
the small city studies made (Springfield, Decatur) it is estimated that 
slightly less than 1 per cent of the population of small cities are physically 
handicapped. This calculation is borne out by the results from the 
smaller towns (Tavlorville, Danville) where the school canvass was 
limited to persons of school age. From the Chicago study, which is 
limited to certain working class sections, it is estimated that approxi- 
mately 1.5 per cent of the population of large cities are physically 
handicapped. 
This phase of our study has been conducted chiefly with a view to 
stimulating local interest and to acquiring information that would serve 
* See Appendix B-l, B-2. 
—2 R P H 18 
THE DEPARTMENT OF PUBLIC WELFARE 
as a basis of comparison with the results of more elaborate studies outside 
Illinois. The most extensive of these investigations was made in Cleve- 
land in 1916. The entire city was canvassed and a ratio of 6.2 per 1,000 
was established as the proportion of cripples. In a canvass of certain 
areas in New York City having a population of about 110,000, the past 
summer, a corresponding ratio of 6.9 per 1,000 was discovered. This 
ratio of cripples, of about .65 per cent, in the population of large cities 
may therefore be considered to be fairly well determined. 
Persons noted in the schedules in these two cities were handicapped 
through lack of normal use of skeleton or skeletal muscles. Disease con- 
ditions, such as heart defect, tuberculosis or partial deafness were not 
counted. 
In the Cleveland and New York surveys and in a similar one made 
in Birmingham, England, in 1909, notation was made as to whether or 
not the crippled person was self-supporting. The results are as follows: 
SELF-SUPPORT OF CRIPPLES.* 
Self- 
supporting. 
Partly self- 
supporting. 
Dependent. 
Cleveland, 1916, 4,186 cases 
53 per cent 
59 per cent 
3 per cent 
13 per cent 
44 per cent 
28 per cent 
82 per cent 
44 per cent 
56 per cent 
* Publications descriptive of the four censuses here referred to are as follows: Cleveland, “Educa- 
tionand OccupationsofCripples, Juvenileand Adult, ” published by Institute of Crippled and Disabled 
Men, 311 Fourth Av., New York; New York, “Suryey of Cripples in New York City,” published by 
N. Y. Committee on After-care of Infantile Paralysis Cases, address 69 Schermerhorn St., Brooklyn; 
Birmingham, study by a voluntary committee, reportsecured from city public health department; 
Massachusetts, summary here quoted is furnished by the Director of Vocational Training, Industrial 
Accident Board, 272 State House. The Massachusetts figures given here are adapted from a table of 
occupations, in which it is impossible to distinguish between partial and complete self-support, and in 
which the following groups are counted as dependent: Scholars and students, retired, unemployed 12 
months, dependent, and at home under 10 years. 
In the Cleveland study, the 2,553 persons between the ages of 15 
and GO years were classified according to degree of disability, with the 
following results: 
ABILITY TO WORK, 2,553 CRIPPLES, 15-60 YEARS OF AGE, CLEVELAND. 
Not seriously handicapped for normal occupation •_ 29 per cent 
Able to work at selected trades and processes. _ 45 per cent 
Disabled for work alongside normal persons.. 26 per cent 
As noted above, the value of results from these cities in application 
to the Illinois problem is limited, in so far as they do not include handi- 
capping conditions not affecting the normal use of skeleton or skeletal 
muscles. It is an undetermined question, for example, as to whether 
such orthopedic defects as were noted under the more limited Cleveland 
definition interfere with capacity for self-support more or less than heart 
disease or tuberculosis. In this connection the results of the state census 
of “maimed, lame, and deformed” in Massachusetts in 1905 may be 19 
REHABILITATION OF PHYSICALLY HANDICAPPED 
noted. The “causes of handicap” in the 17,134 cases discovered were 
found to occur in the proportions shown in the following table. With 
these results are shown the corresponding proportions discovered in the 
Cleveland study of 1916. 
Massachusetts census of 1905, 
17,134 cases. 
Occupation 13,4 per cent 
Accidents 28.5 per cent 
Disease 45.2 per cent 
Mditary service 3.6 per cent 
Birth — 5.4 per cent 
Not specified.. 3.9 percent 
CAUSES OF DISABILITY, MASSACHUSETTS AND CLEVELAND. 
Cleveland survey of 1916 
4,186 cases. 
Accident at occupation 11 per cent 
Other accidents 32 per cent 
Infantile paralysis 13 per cent 
Other diseases 34 per cent 
Congenital 7 per cent 
Not stated 3 per cent 
NUMBER OF NEW CASES ANNUALLY 
Such results from community censuses are valuable chiefly in pro- 
viding a birdseve view of the effects of haphazard attention in the past 
to the needs of the physically handicapped. Some of the details of these 
surveys, involving acquaintance with individual cases, are more directly 
valuable than the totals, in planning the administration of the Illinois 
act. The law properly emphasizes the establishment of relations with 
new cases at the time of occurrence of the disability. Only in starting 
early with the man who has become handicapped can the State expect to 
demonstrate the value of a constructive program. 
Measurement of the probable intake of new cases every year, and 
not the accumulation of needy cases in the community, is the important 
consideration. 
What the actual demand for the services of a State Rehabilitation 
Bureau may be, can be estimated only broadly, for it is a new type of 
service the State will offer and the demand will depend upon its attrac- 
tiveness to those who become disabled. The best guage of active demand 
for service to new cases of disability may be obtained through the four 
channels mentioned in the law. These are listed here, with numerical 
estimates as explained in the paragraphs that immediately follow: 
Through hospitals 1,500 
Through the State Industrial Commission 2,000 
Through direct application—through local surveys 1,500 
5,000 
In drawing cases for rehabilitation from these various channels the 
law provides for personal presentation of the opportunities of reestab- 
lishment to the disabled person. This “direct salesmanship” is an out- 
standing feature of the act. The lack of visitation of the handicapped 
person immediately upon the occurrence of disability, in nearly all places 
where rehabilitation programs are in operation, makes it difficult to 
apply their results to the Illinois situation. 
Disabilities handled under the Compensation Act* afford the best 
basis for computation, in making an estimate of the prospective demands 
for the State plan of rehabilitation. Of the 36,533 cases handled by the 
* See Appendix F-5, F-4. 20 
THE DEPARTMENT OF PUBLIC WELFARE 
State Industrial Commission during the calendar year 1919, 5,021, or 
14 per cent, were classified in the three groups: total disability, perma- 
nent specific loss, permanent partial disability. The totals for 1919 
ivere somewhat lower than those for the preceding year. We have made 
inquiry into the conditions subsequent to injury of 2,089 of these cases, 
consisting of the more seriously disabled. The results of this study and 
the experience of rehabilitation bureaus in other states dealing with 
compensation cases lead to the conclusion that the services of a State 
rehabilitation service would have been offered to about one-third of the 
5,021 cases included in these three classes, or approximately 1,700. 
With the variation in number of injuries from year to year and with 
the inclusion of a small number of cases of industrial injury from pre- 
ceding years, one should count upon first interviews with about 2,000 
cases a year from this source. 
From a canvass of the general hospitals of the State,* it is esti- 
mated that in the beginning the services of the State rehabilitation 
service should be offered through personal interview every year to about 
1,500 cases of disabilities not covered by the Compensation Act and 
hence not included in the foregoing estimate for the State Industrial 
Commission. Hospital records usually do not cover the economic con- 
dition and prospects of the patient nor do they include a prognosis re- 
garding the capacity of the patient for remunerative occupation following 
his recovery. In order that information may be reported uniformly, a 
standard schedule for use by hospitals in recording physical disabilities 
is now being prepared. 
Other important channels of intake for cases of handicap coming 
to the attention of a State bureau would be the practice of private 
physicians and the work of social agencies, f For purposes of arriving at 
a general result, it may be supposed that as many as 500 cases would 
originate thus every year through direct application. Some of these 
cases would be of long standing, and to that extent undesirable for the 
most effective application of tbe rehabilitation plan. 
Perhaps the most important single source of cases demanding the 
attention of a State rehabilitation service ivould be that of handicapped 
children arriving at the age of 16, the point at which the Rehabilitation 
Act applies. The proportion of disabilities occurring in childhood, as 
revealed by leading surveys is as follows: 
PROrORTION OF ALL CASES INTERVIEWED IN WHICH DISABILITY 
OCCURRED IN CHILDHOOD 
Cleveland 49 per cent under 15 years 
New York City. 63 per cent under 16 years 
Children are of first interest in the program of rehabilitation from 
the standpoint of preventive measures and of educational efforts that 
may reduce their handicaps as adults. The annual intake of cases from 
* See Appendix D-2. 
t See Appendix C-l, C-2. REHABILITATION OF PHYSICALLY HANDICAPPED 
21 
this source can be estimated only broadly, and for present purposes it 
will be supposed that the number would be approximately 1,000. 
The total number of cases for preliminary interviews annually is 
thus estimated to be about 5,000. The proportion of these with whom 
a State rehabilitation service would be concerned after a first interview 
would vary greatly according to the particular source from which any 
case would originate. From the experience of existing rehabilitation 
bureaus, and from the variety of services contemplated in the Illinois 
act, it is estimated that subsequent steps in the profess of rehabilitation 
would be taken in about 3,000 of these cases. 
THE COMMUNITY BURDEN OF HANDICAP 
The foregoing is an estimate of demand specifically for case work 
on the part of a State rehabilitation service such as the present act pro- 
vides. It shows to some extent the volume of work to be done by such 
a bureau, and by cooperating agencies in the community. The burden 
of physical handicap now being borne by local communities is reflected 
somewhat in the ratios already given, of disabilities to population. It is 
indicated further in the experience of welfare agencies dealing with 
families.* The United Charities of Chicago, for example, during the 
year 1919 handled 687 cases of chronic physical disability, among the 
6,842 families to whom they rendered service. During an almost identi- 
cal period of a year, the county agent’s office at Chicago gave relief in 
2,926 cases involving physical handicap of the head of the family, the 
majority being cases of tuberculosis. 
Cases of disability handled by voluntary agencies, by employment 
bureaus and by other local public departments are not to be considered 
in all instances as subject to reference to the State rehabilitation service. 
Many of these people will continue to be handled partially or altogether 
by such agencies as are now dealing with them. More specialized 
services may be offered by the State or by new private agencies, and a 
system of industrial reconstruction developed for the individual in need, 
such as has been wanting heretofore. The* service of rehabilitation when 
initiated at the right time, namely, at the occurrence of disability, may 
be performed nearly altogether above the line of poverty and economic 
distress. The purpose is essentially to present the development of 
discouraging end results such as now make up a large proportion of the 
more difficult cases handled by public and private welfare agencies. 
IV. CASE WORK THE MAIN REQUIREMENT 
POSSIBLE EMPHASES IN ORGANIZATION 
Under the conditions described, it is plainly possible to apply the 
Illinois Rehabilitation Act through more than one type of organization 
* See Appendix C-l. THE DEPARTMENT OP PUBLIC WELFARE 
Under a law containing the same general provisions hot limited to the 
industrially injured.f Pennsylvania has begun its work by handling 
chiefly matters of replacement in industry, with secondary emphasis on 
retraining. New Jersey, likewise with a similar law but limited to 
industrial injuries, has established a system of state clinics for the 
physical reconstruction of the disabled, with secondary emphasis on re- 
employment. Under a much simpler statute Minnesota is developing 
a procedure in which the emphasis is placed on vocational reeducation 
and coordination of voluntary social service. In Massachusetts, where 
activities to date have been mainly in the nature of preliminary study, 
attention is given chiefly to putting the disabled person in good physical 
condition, and to such practical training as will enable him to go back 
to work as soon as possible. 
The situation in New York City is notable for the pioneer activities 
of the Institute for Crippled and Disabled Men, under whose auspices 
the possibilities of institutional leadership and of a specialized employ- 
ment in the program for the physically handicapped, are being 
worked out. The situation in Cleveland is notable for the original city- 
wide canvass made in 191G and the subsequent formation of an Asso- 
ciation for the Crippled and Disabled through whose several departments 
the work for the physically handicapped in the city has been coordinated. 
These examples illustrate the many-sidedness of the problem of 
rehabilitation and suggest that to succeed with the undertaking it may 
be necessary to organize a system through which all these services would 
be provided. Conditions in Illinois favor the development of a more 
complete system than any that has been observed elsewhere. 
In New York City and Cleveland the work of rehabilitation has 
developed almost entirely under the leadership of voluntary agencies. 
One case reported by the Institute for Crippled and Disabled Men in 
New York* affords a picture of the possibilities of action by private 
organizations: 
One department of the Red Cross paid for artificial legs, another 
looked after the man’s transportation. One organization sent friendly 
visitors to the hospital and his home; two clinics looked after his eyes 
and teeth; a hospital provided for the re-operation on a troublesome 
stump; the institute attempted to give him training and made his legs; 
one organization furnished him with a teacher at home, another gave 
the services of a visiting nurse, and the employment department finally 
placed him. The field work department engineered the whole job. 
The limitations of voluntary work, through possible delay and over- 
head expense in negotiating arrangements, are suggested in this illus- 
tration. 
The Illinois law provides a plan which is flexible enough for modifi- 
cation with changing conditions. As an example of the need of flexi- 
bility, following the establishment of the state clinic at Newark, New 
t See Appendix A-5. 
* “Three Years of Work for Handicapped Men,” p. 61, a report of the activities 
of the Institute for Crippled and Disabled Men, by John Culbert Faries. REHABILITATION OF PHYSICALLY HANDICAPPED 
23 
Jersey, insurance companies are said to have set up facilities for group 
diagnosis of persons injured in industry, so that the patronage of the 
state clinic has been reduced. If the State rehabilitation service should 
be developed chiefly as an advisory agency, it will tend to bring out the 
maximum possibilities of private institutions and societies and of indus- 
trial concerns, to place the work of reestablishment of the disabled as 
largely as possible upon the several communities, and thereby to reduce 
the cost to the State. 
ADVISORY SERVICE AND CONTINUOUS CONTROL 
Emphasis on the part of the State upon the advisory type of service 
to disabled persons is inherent in the procedure of rehabilitation. The 
State may, on the one hand, provide certain benefits to all the physically 
handicapped, such as facilities for securing artificial limbs and appliances. 
On the other hand, to succeed in making a man independent economically 
and vocationally, calls for his personal cooperation and for favorable 
conditions in the locality in which he lives and works. The State can 
only seek to develop favorable personal and environmental conditions; 
uniform success cannot be guaranteed. 
Another principle of importance is the necessit}r of unifying the 
work done with each case. Effective rehabilitation is a continuous pro- 
cess, from the date when the disability is received to the time when the 
person is profitably reemployed. It is the concensus of opinion of those 
who have dealt with the handicapped, that difficulty and failures have 
arisen chiefly as a result of shifting control of the case from one agency 
to another. The handicapped man drops from sight, out of the current 
of cases handled from day to day by clinics, employment bureaus and 
charitable agencies. What is most needed is a controlling authority 
which will focus the work of various agencies on the individual, and help 
him develop his capacities, from the point of receiving the original 
diagnosis showing disability to the point of ultimate reestablishment in 
industry. 
REHABILITATION AIDS 
The fundamental importance of these two principles, namely ad- 
visory service and continuous control of the process of rehabilitation, 
calls for administrative organization that will favor effective personal 
relations with each handicapped individual. It is the almost universal 
testimony of those engaged in work for the handicapped in states and 
cities referred to above, that personal supervision is the key to rehabili- 
tation. This type of work is emphasized in the Rehabilitation Act, 
which directs the Department of Public Welfare "to arrange for social 
service to and for the visiting of physically handicapped persons regis- 
tered with the Department of Public Welfare and their families in their 
homes during the period of treatment and training and after its com- 
pletion, and to give advice regarding any matter that may effect rehabili- THE DEI’ARTM E N T OF FULL IC W E L F A RE 
tation.” The personal service required calls for special knowledge, on 
the part of the worker, of the effects of various physical disabilities, and 
of industrial conditions and opportunities. The law implies that the 
worker shall trace all the important relations of the handicap to the 
man’s personality and to his industrial opportunities. 
These requirements should enter into the training and appointment 
of a staff of “rehabilitation aids,” who will be the representatives of the 
State in reaching and assisting the handicapped man. They will con- 
duct the original interviews with disabled persons, whether reported 
by hospitals or otherwise. “The best time to discuss the problem of re- 
education with a wounded soldier is the day before he is injured,” and 
the best practicable time to present the prospect of rehabilitation to the 
disabled civilian is as soon as possible after his disability. The rehabili- 
tation aids will “meet the injured man upon the threshold of his altered 
life with a positive message of hope.” At a time when the man’s mind 
is upset by his disability and his attitude often pessimistic, the rehabili- 
tation aid will present the plan of reestablishment attractively. She will 
be acquainted with the facilities of the State and with the resources of 
the communities in which the man lives. 
The case histories of disabled persons that have been reviewed as 
part of the present survey have been studied with a view to determining 
the advantage that would have come from a definite offer, at the most 
appropriate moment, of the kind of service described in the Rehabilita- 
tion Act.* In nearly every instance it has appeared that a specific 
appraisal of a man’s physical capacities and industrial possibilities and 
an attractive presentation of a plan of reestablishment would have 
shortened the course of a social treatment that was actually followed, or 
might have resulted in the rehabilitation of persons who now are in 
discouraging circumstances. Good salesmanship of the ideas of health 
and of self-support seems to have been the key to the situation in nearly 
every case. 
Whatever adjustment the man’s condition and inclinations require, 
the rehabilitation aid will assist him through to the point of satisfactory 
employment. Assurance of advice and of suitable aid at the time of 
occurence of disability has been shown in practice to constitute an im- 
portant feature of reestablishment. To carry out these provisions of 
the act in respect to initial visitation will be a unique and advanced 
step in rehabilitation work as undertaken in the several states. 
V. PHYSICAL REHABILITATION 
PROVISIONS FOR EDUCATIONAL RESTORATION 
The law requires that arrangements be made for physical restor- 
ation as apart of rehabilitation of handicapped persons. Describing the 
* See Appendix C-l. REHABILITATION OF PHYSICALLY HANDICAPPED 
25 
importance of reestablishing functional activity following surgical oper- 
ations, Dr. Frank Billings says*: 
The average surgeon is happy if his patient with a fracture of a 
long bone gets through without deformity or shortening of the lower 
limb. As a rule, he does not see to it that the function of the joints 
and muscles of the involved extremity are exercised and trained to re- 
store function definitely. 
For the disabled Canadian soldier it is reportedf that “at least 
50 per cent of all hospital populations required and received some kind 
of physio-therapeutic treatment; in special hospitals, such as the Domin- 
ion Orthopaedic Centre, in Toronto, the percentage has been very much 
higher/’ 
The State Rehabilitation Bureau of New Jersey, working under an 
act similar to the Illinois law, has been given almost entirely to physical 
rehabilitation. In New York City a private institution, the Clinic for 
Functional Reeducation, was organized in 1918 and is handling cases 
of physical rehabilitation for social agencies, for industries and insurance 
companies, and for the War Risk Insurance Bureau of the Federal Gov- 
ernment. They handle currently about 40 resident patients and at the 
same time give treatments to about 400 out-patients. In the last two 
years approximately 3,000 cases have been handled, 2,000 of whom re- 
ceived treatment for functional restoration. Fifty per cent of these are 
reported to have been cured and 25 per cent in addition to have been 
discharged as improved. 
A State activity in Illinois showing the possibilities and benefits of 
State leadership in this field has been the organization and conduct of 
community clinics for infantile paralysis under the State Department 
of Health. The Department of Public Welfare has recently conducted 
a series of clinics for eye defects, especially trachoma, as an extension 
of the work of the State Eye and Ear Infirmary. Nearly 1,200 persons 
have been examined and referred to local physicians, or have been treated 
when they-could not properly be referred. large proportion of these 
individuals would not otherwise have sought treatment. The service 
rendered has cost only a small fraction of the usual amount. These 
activities have affected for the most part children under 16 years of age 
who therefore do not come immediately under the provisions of the 
Rehabilitation Act. They demonstrate, however, the low cost at which 
the service of the State may be extended to communities in cooperation 
with local practitioners, and the increase in use of medical facilities that 
comes from conducting community clinics under State auspices. 
Some inquiry has been made regarding the provisions for functional 
retraining in Illinois. The general hospitals of the State have been 
canvassed.J With a few exceptions it is found that apparatus and or- 
* “Physical Reconstruction applied in the Treatment of Pulmonary Tuber- 
CUl°T‘‘RePportP ont’the Physio-therapeutic Work in the Various Military Hospitals 
throughout Canada,” Dominion Department of Militia and Defense, p. 8. 
t See Appendix D-2, D-3. 26 
TIIE DEPARTMENT OF PUBLIC WELFARE 
ganization for this purpose are almost entirely lacking. One industrial 
concern with an employed force of about 6,000 has established a well 
equipped and staffed department of physio-therapy in connection with its 
medical service. 
WORK TO BE ORGANIZED ABOUT CENTRAL HOSPITAL GROUP 
The provisions of the law with respect to physical restoration of the 
disabled man require a positive program on the part of the State.f 
That the State either may organize for the physical rehabilitation of 
disabled persons directly, or may depend upon community agencies, is 
shown by the fact that under similar legislation both alternatives are re- 
presented in the procedure of New Jersey and Pennsylvania.! The au- 
thority already given the Department of Public Welfare in the organiza- 
tion and management of the Central Hospital Group at Chicago, in con- 
nection with the University of Illinois, affords unique opportunity as 
compared with other states for Illinois to develop a comprehensive pro- 
gram for reestablishment of the physically handicapped, beginning with 
initial physical restoration. 
This arrangement will be helpful in affording a demonstration 
center and in giving guidance to existing hospitals and other medical 
agencies in working out the program of complete restoration of their 
patients following care for acute ailments. It will at the same time be 
a means of caring for that small percentage of cases registered with the 
rehabilitation service that otherwise would go without adequate hospital 
attention for lack of local facilities. Such a plan would assure the 
State rehabilitation service of opportunity to work out the provisions of 
the law in a limited number of cases completely under its own control. 
USING FACILITIES OF COMMUNITIES 
The main principle in connection with physical restoration of handi- 
capped persons, however, should be that of use and development of exist- 
ing facilities in the various communities. The Behabilitation Service 
should constantly disseminate information regarding existing clinical 
and hospital facilities. A limited number of post-operative cases might 
be received at the Central Hospital Group from other hospitals, for 
functional restoration, but the circumstances of medical supervision of 
cases are such that in most instances this cannot be done, and physical 
restoration will depend upon the facilities and staffs of local hospitals, 
clinics and dispensaries. At the present time two of the leading hospitals 
in Chicago are planning extensions of plant affecting the functional 
restoration of patients. 
The work of hospitals and other agencies in noting and treating 
cases of prospective handicap and in reporting them to the State Be- 
habilitation Service, will be furthered by the adoption of uniform 
nomenclature, in recording diagnoses.% 
t See Appendix D-4. 
t See Appendix A-3. REHABILITATION OF PHYSICALLY HANDICAPPED 
27 
A system of State licensing and inspection, by showing the necessity 
of high standards, would add weight to the pleas of hospital executives 
for increased facilities. Eegarding hospitals handling industrial acci- 
dents, it would seem to be an essential procedure for the State in some 
way to pass upon the type of restorative service rendered in cases coming 
before the State Industrial Commission.* The recently adopted plan 
of certification of hospitals under the Medical Practice Act, for intern- 
ships prior to granting the medical degree, may provide a helpful means 
of improving the arrangements of the leading hospitals for functional 
treatment. 
FACILITIES FOR CONVALESCENT CARE 
While the problem of rehabilitation is not identical with that of con- 
valescent care, a large proportion of convalescent patients need rehabili- 
tation, and in many cases an important part of the process of reconstruc- 
tion takes place during the period of convalescence. It would be well 
for the Central Hospital Group to include facilities for adequate conva- 
lescent treatment for all their Rehabilitation Service patients. The 
arrangement would correspond in principle to that of the Army Hos- 
pitals, in which it was required that all possible be done for the physical 
restoration of the patient before discharge. The convalescent facilities 
in Chicago, for example, are known to be inadequate. There are appar- 
ently J less than 125 beds in institutions available the year round. It 
is said that the average convalescent case needs care for a period of ten 
weeks. If an operative or medical bed is occupied on the average by a 
patient for two weeks, this would indicate that there should be in the 
community five convalescent beds for every operative bed. The number 
of convalescent beds thus required in special institutions would be reduced 
in proportion to possibility of satisfactory convalescent treatment in 
homes. 
Whatever the shortage in convalescent facilities in Illinois com- 
munities, the situation has a direct bearing upon the success of a State 
Rehabilitation Service, and experience in the work of reconstruction 
would lend valuable support to the movement to increase facilities for 
convalescent care. 
COOPERATION OF INDUSTRIAL CONCERNS AND INSURANCE COMPANIES 
IN TIIE PHYSICAL RESTORATION OF DISABLED PERSONS 
The work of industrial concerns and of casualty insurance com- 
panies will be affected by the operation of the Rehabilitation Act, and 
their intelligent cooperation is essential to the success of the plan.f In 
dealing with industrial establishments the Rehabilitation Service will 
emphasize the importance of medical departments and of job analyses. 
These are the chief means of guarantying that employees will be placed 
* See Appendix F-6. „ „ . ,TT „„ 
% The Social Service Directory, published by the Department of Public Welfare, 
City of Chicago, 1918 edition, 
t See Appendix F-7. THE DEPARTMENT OF PUBLIC WELFARE 
iii jobs for which they are physically qualified. Analyses of jobs should 
include specific indication of the possibility of performance by persons 
with any of the more common types of disability. In sending a man 
whose physical capacities are understood, to a task whose physical re- 
quirements are known, and in safeguarding the processes of promotion 
and transfer, room is made for the employment of an indefinitely large 
number of the physically handicapped and a barrier is erected against 
the occurrence of accidents and disease. The improvement of medical 
service, especially of a preventive nature, tends to establish a better re- 
lationship between man and job. 
Establishments that pay more attention to these matters will be 
sought both by the handicapped worker and by the able-bodied. When 
industrial firms and insurance companies have gone as far as possible in 
this direction, and especially when they have used every device and in- 
centive in the reestablishment of disabled employees, mutual understand- 
ing and successful rehabilitation will tend to take the place of mistrust 
and tragic deterioration such as now frequently follow injuries to work- 
men. 
Representatives of insurance companies have taken an interest in 
the progress of the present study of the physically handicapped in Illi- 
nois and have been generous in furnishing information. An insurance 
company is now establishing at Chicago a clinic for functional restora- 
tion and there is good reason to believe that all the leading companies 
will readily undertake whatever work the State Rehabilitation Service 
may show to be practical in the physical reconstruction of employees 
of concerns insuring with them. 
RELATIONS WITH ADMINISTRATION OF THE WORKMEN’S 
COMPENSATION ACT 
The establishment of the State Rehabilitation Service will be a long 
step in the direction of broadening the benefits of the Workmen’s Com- 
pensation Act.* Rehabilitation Aids on visiting injured workmen will 
acquaint them with their opportunities under the Compensation Act and 
especially with the constructive purpose of the law. They will guard 
them against the effects of misinformation and afford an influence toward 
fair judgment in situations which usually are colored with distress and 
the spirit of accusation. 
By affording a channel of information about individual cases com- 
ing under the Compensation Act, their work will facilitate high grade 
medical and surgical service and settlements based on clearer represen- 
tation of facts. The State Rehabilitation Bureau in New Jersey is re- 
ported to have reduced the amount of settlement for permanent total 
disabilities in 90 per cent of the cases they have handled. This has been 
welcomed by industrial firms and insurance carriers, and at the same 
* See Appendix B-2, P-5, F-6. REHABILITATION OF PHYSICALLY HANDICAPPED 
29 
time the physical improvement has been of great benefit to the injured 
men. 
Prosthetic appliances are only rarely furnished as a part of required 
medical treatment under the Compensation Act. In some states they are 
specifically required in all cases in which they are needed. It is sug- 
gested that this requirement be incorporated in the Illinois law. 
Many persons who are severely injured make settlements with their 
employers before the exact nature of their injuries is known. Following 
settlement, they fail to secure such surgical, medical or physio-therapeu- 
tic-e treatment as may be needed to restore function in the injured part 
of the body. Case descriptions illustrating this practice are presented in 
the appendix to this report. The Compensation Act, which now allows 
early settlement, in many instances to the detriment of the injured per- 
son’s physical rehabilitation, could be made to favor the man’s 
tion by providing that no final settlement shall be entered into until the 
employing organization has shown, by competent medical testimony, 
that no further improvement can be expected from medical or surgical 
treatment. 
The purpose of the Rehabilitation Service as indicated in the law, 
and especially the need of maintaining confidential relations with the 
handicapped individual, favor the separation of the Rehabilitation Serv- 
ice completely from the medical section of the State Industrial Com- 
mission. 
ARTIFICAL APPLIANCES 
The law provides that the Department of Public Welfare shall “pro- 
cure and furnish at cost to physically handicapped persons, registered 
with the Department of Public Welfare, artificial limbs and other ortho- 
pedic and prosthetic appliances to be paid for in easy instalments.” 
From such evidence as we have obtained, it seems probable that the 
entry of the State into this field of furnishing prosthetic appliances will 
be of advantage to the handicapped person of small means and will be 
welcomed by medical agencies and leading practitioners.* Lack of pros- 
thetic appliances has been found to be frequent among the physically 
handicapped in Illinois who are unemployed, and those successfully em- 
ployed have been found to be supplied with such appliances. The manu- 
facture of prosthetic appliances has been revolutionized as a result of the 
war; models have been improved and the utility of various devices more 
carefully determined. The great demand for appliances on the part of 
the Federal government, the establishment of the Canadian Government 
Limb Shop and the production of artificial limbs on a non-commercial 
basis by the Institute for Crippled and Disabled Men in New York, are 
major developments the effect of which on the commercial trade are 
scarcely yet apparent. 
Two courses are open to the State in the application of this section 
of the act. The first involves patronage of commercial manufacturers. 
* See Appendix F-2, F-3. 30 
THE DEPARTMENT OF PUBLIC WELFARE 
The Department of Public Welfare may purchase limbs and other appli- 
ances as needed, perhaps at a slight reduction in cost for quantity, and 
resell to persons registered under the Rehabilitation Service on easy 
terms. The saving over list price of appliances in this way would prob- 
ably be small, merely offsetting the cost to the private concern of solici- 
tation of individual sales. Or the Rehabilitation Service may'be simply 
a go-between for the manufacturer in establishing connections with the 
disabled man, facilitating the sale and assuring the firm of complete re- 
imbursement in case the man fails to pay. This latter practice is being 
followed by the state bureau in Pennsylvania. The main advantage, as 
far as improving the quality of the service to the disabled goes, seems 
to be that of supervising the transaction and the fitting of the limb. 
The State department is relieved of the expense of travel and of making 
various .adjustments in supplying the needs of disabled person in widely 
separated localities. 
The other possible procedure would be for the State Department of 
Public Welfare to enter upon the manufacture of prosthetic appliances 
according to the plan of the Canadian Government Limb Shop at 
Toronto. They report that they are now issuing artificial legs, for ex- 
ample, at a cost of $71.57 such as could not be purchased from private 
concerns for less than $180. In addition to the saving on manufacture, 
they save also the cost of solicitation. They guarantee the quality of 
the limb. About the same saving is reported by the artificial limb shop 
of the Institute for Crippled and Disabled Men in New York. The 
Government Limb Shop is undoubtedly the dominating factor in the 
trade in Canada, and it is working in the direction of improving the 
quality of materials and workmanship and the standardization of acces- 
sory parts and appliances issued to the disabled man. 
If the State were to enter upon the manufacture of prosthetic appli- 
ances, some opposition on the part of private concerns would have to be 
reckoned wdth—coming in the beginning perhaps largely through mis- 
understanding of the intention of the State to serve a limited clientele 
that ordinarily are not profitable for private sales. 
The most important consideration would probably be the capacity 
of the State through the Department of Public Welfare to conduct a 
manufacturing enterprise such as this with a high degree of efficiency. 
Skilled makers and fitters would have to be employed and the business 
maintained steadily through an initial period when standards vrere being 
established and the relations of supply and demand determined. The 
Canadian project has been favored through statutory prohibition of de- 
rogatory statements on the part of private concerns and through the 
right of the National Government to take advantage of all patents 
granted for improvements of prosthetic appliances. 
The need of manufacture by the State and the possibilities of suc- 
ceeding with the enterprise are more evident as regards orthopedic REHABILITATION OF PHYSICALLY HANDICAPPED 
31 
braces.* Braces are used more frequently for children than for adults, 
and a State undertaking of this kind of manufacture would naturally 
be based on a recognition of responsibility for problems of physical handi- 
cap affecting persons under 1G years of age. This interest on the part 
of the State is evidenced by its provision of orthopedic Avards for chil- 
dren in the Central Hospital Group now being established. Early use 
of braces may prevent physical handicap in later years. The cost of 
providing braces for growing children is burdensome and often pro- 
hibitive, according to the experience of charitable agencies. The wave 
of infantile paralysis that has affected Illinois has added materially to 
the need of the State’s entry into the field of manufacture. In New 
York City five hospitals are operating brace shops on a non-commercial 
basis. Tn Chicago the business is entirely commercial. 
It is suggested that special inquiry be made by the Department of 
Public Welfare into the possibilities of manufacturing prosthetic appli- 
ances and braces in connection with the administration of the Rehabili- 
tation Act and of the Central Hospital Group. 
VI. INDUSTRIAL REHABILITATION 
After physical restoration, the law provides for reestablishment at 
remunerative occupations. The following methods are indicated: 
Vocational training, directly or through arrangement with 
local schools or industries. 
Placement, through cooperation with the State Free Employ- 
ment Bureaus. 
The final step in the work of rehabilitation, as indicated in the law, 
is reestablishment at remunerative occupation. Hence the conditions of 
industry that may favor or retard reestablishment need to-be examined. 
INDUSTRIAL CONDITIONS 
A study has been made by the survey staff of opportunities for em- 
ployment of physically handicapped persons in 23 industrial plants in 
and near Chicago, representing the range of industrial occupations.f 
The characteristic processes and jobs were examined as to possibility 
of performance by men with various types of disability. In these plants, 
having a total employed force of 13,400, it was found that 6,411 positions 
could be filled by handicapped workers, as far as the effects of their 
physical disabilities were concerned. This is 9 per cent of the total 
number of employees. The least handicapping of the disabilities that 
were selected for study were: 
1. Amputation or lack of use of one leg. 
2. Hernia. . 
3. Defective hearing. 
4. Deafness. 
5. Amputation or lack of use of fingers. 
• See Appendix C-3. 
t See Appendix P-1. THE DEPARTMENT OF PUBLIC AVELFARE 
For several types of disability few possible jobs were found. No 
place for a person without arms was discovered among the 92 jobs selec- 
ted for study. This study shows that there is a large number of jobs 
possible of performance by the physically disabled, in comparison with 
the number who may be seeking work, and that special attention will be 
required to find work for persons with certain types of disability. The 
physical possibility of performing a job was found to be of less import- 
ance in many instances in placing the disabled at work, than such con- 
siderations as the attitude of the employer, attractiveness of the work, 
trade unionism and the man’s intelligence and training. 
In most of these plants disabled employees are put at work along- 
side the able-bodied, but in the assembly departments of two establish- 
ments studied, the disabled are grouped. 
Information has been secured regarding 82 handicapped persons 
employed in ten of these plants.f These employees have, in most in- 
stances, only minor disabilities. Two-thirds of them are receiving wages 
of $25 or more a week. A fourth of the number are 50 years of age and 
over, most of these older workmen having been with their firms for more 
than 10 years. Only a fourth of the entire number were disabled in the 
service of their present employers. Sixty-seven, of the 82, were either 
working at the same occupation as before injury or had other jobs on the 
same industrial level. TAvelve were shown to have changed for the 
worse and 3 to have improved in their employment, since becoming handi- 
capped. In addition to two soldiers in training, 5 others had been re- 
trained on account of disabilities for periods ranging from two weeks 
to six months. These disabled employees represent more than 1 per 
cent of the total employed force of the plants in which they are working. 
No examination has been made in individual instances to see how suc- 
cessful has been the arrangement for reemployment. 
This study shows that industries may be expected to do the work 
of reestablishment in many cases. Certain types of concerns will em- 
ploy the less seriously disabled and the more promising of the severely 
handicapped, without reference to the State Rehabilitation Service. The 
smaller concerns do not have so great a variety of jobs nor are they so 
Avell equipped for retraining. 
It is the impression of officers of the State Industrial Commission 
that at present fully nine-tenths of those aat1io receive compensation for 
temporary injuries are reemployed in the plants in Avhich they were 
injured. Regarding instances of more serious injury, a special study* 
has been made of the circumstances of reemployment of 2,089 persons 
whose disabilities occurred during the year 1919. It is found that 66.5 
per cent of these Avere reemployed, at least for a short time by the same 
concern. Three-fourths of those reemploved were put back at their 
former jobs. Young men seriously injured are found to have a better 
t See Appendix F-2. 
* See Appendix F-4. REHABILITATION OF PHYSICALLY HANDICAPPED 
33 
chance of being retrained by their employers than older ones. The 
various industries are found to be evenly represented as to the question 
of returning severely injured men to former employers, with a few 
exceptions such as “construction and building,” in which only 1 of 37 
men went back to the same plant. Scarcely any systematic retraining 
had been given the men who were reemployed. The problems suggested 
by this study are to be dealt with partly through the adoption by in- 
dustrial concerns of better plans of physical restoration of injured em- 
ployees, and partly also through adoption of systematic measures for 
retraining and reestablishing them. 
Employers have indicated that they see the need of rehabilitation 
work, and that they are ready to assume their appropriate share.f The 
manager of a medium sized establishment, for example, says that he has 
at his disposal a fund of $5,000 to meet the special expenses of training 
disabled persons for work in his establishment, and that he will be satis- 
fied if he succeeds with half of the handicapped persons who apply. The 
manager of another plant has requested assistance in securing a teacher 
of deaf apprentices. The Industrial Eelations Association of Chicago, 
consisting of employment managers from the larger concerns, recently 
has named a committee to cooperate with the State in the placement of 
the physically handicapped. 
The reestablishment of injured employees in the larger industries, 
such as the railroads, cannot be carried on to advantage bv outside 
agencies.* Eehabilitation departments within the industries themselves 
are required, in order to take advantage of special knowledge of in- 
dustrial conditions and opportunities of pension regulations and channels 
of advancement, of the operation of relief funds, etc. A few larger con- 
cerns in other states are known to have established rehabilitation depart- 
ments, but none have been found in Illinois. 
AVOIDING DISCRIMINATION 
One of the chief handicaps to crippled workers is discrimination 
against their employment. Two of the main causes of this difficulty 
appear to be removable. One of them lies in the Compensation Act. 
Under the law, the employer is required to pay compensation for 
total permanent disability in case of a second major injury, instead of 
being responsible only for the disability caused by the second injury 
when considered independently. For example, if an employee who is 
blind in one eye loses the second eye, the employer must pay the award 
for total disability due to blindness, as he would if both eyes had been 
blinded while in his service. The employment managers of five plants 
that were surveyed objected strongly to the employment of handicapped 
persons on account of increasing the hazard of the work. These con- 
t See Appendix F-12. 
* See Appendix F-8. 
-3RPH 34 
THE DEPARTMENT OF PUBLIC WELFARE 
cents employed a total of nearly 10,000 people. In two of these plants 
no disabled persons were being employed. 
The remedy lies in the adoption of the special fund plan already 
in operation in eight states.* According to this plan the employee is 
compensated for the disability resulting from the combined injuries. The 
additional compensation for the extra liability is paid out of a special 
fund provided by the State. Under such a provision in New York only 
eight cases have occurred since the passage of the law four years ago. 
From this it appears that the actual liability of loss to the em- 
ployer under the present Illinois arrangement is almost negligible. 
Nevertheless there is a fear of risk even though it is not substantiated by 
the real hazard, and it would be of assistance to the physically handi- 
capped to make the legislative provision described. 
Discrimination against employment of the physically handicapped 
also arises out of the idea which has been found to exist among em- 
ployers who carry casualty insurance, that rates will he increased if they 
employ disabled workmen.f No study is known to have been made of 
the added risk that is due to employment of the disabled. Whether there 
would be any increase in risk would depend upon the care with which 
jobs were selected for the handicapped, and the regulation of transfers 
within plants. With the development of rehabilitation work under the 
auspices of the State and of industrial concerns, this liability may be 
expected to he reduced. A prohibition of increase of rates by insurance 
companies on account of employment of the disabled would spread the 
added risk, in whatever degree it may occur, among insuring concerns. 
In Minnesota a law has been enacted prohibiting insurance com- 
panies from raising rates on account of the employment of physically 
handicapped persons.| The director of rehabilitation work in that state 
reports that the question of discriminatory rates comes up frequently and 
that such discrimination has evidently occurred in the past. Decently, 
however, there appears to have been very little raising of rates. The 
law prohibiting discriminatory rates seems to the rehabilitation bureau 
to he a good measure because employers are now assured that they can 
employ handicapped workers without having to pay higher premiums. 
Conditions in Illinois seem to be similar to those in Minnesota, and 
legislation of this nature would probably reenforce the present Rehabili- 
tation Act. 
VOCATIONAL TRAINING 
The Rehabilitation Act provides that the State Department of 
Public Welfare shall have authority and it shall be its duty: 
To establish and conduct a school of rehabilitation and branches 
as they may be needed. 
* “Monthly Labor Review,” December, 1919, p. 329. 
t See Appendix P-7. 
:i: See Appendix F-ll. REHABILITATION OF FIIYSICALLY HANDICAPPED 
35 
To arrange for training courses in the public schools, or other 
educational institutions, or in commercial or industrial establish- 
ments. 
A need of elementary education is evident with many physically 
handicapped persons who have been included in this survey. An out- 
standing example is the group of 25 injured coal miners described in 
the Appendix, only 11 of whom can read and write English.f Among 
the severely disabled included in the study of working class districts in 
Chicago, those who surmounted their difficulties were found to be better 
educated and Americanized than the others. A large proportion of 
injuries occur at low-skilled, repetitive jobs, into which workers with 
poor education and little industrial training tend to drift. Persons of 
this type are not well fortified against the consequences of physical 
disability, and their rehabilitation requires especial emphasis upon voca- 
tional education. 
The only example of a special school of the kind described in the 
act is that conducted by the Institute for Crippled and Disabled Men in 
Xew A'ork City. The enrollment and results of training in the ten 
courses offered by the institute during a period of two years are reported 
as follows:* 
STATISTICS OF TRAINING DEPARTMENT. 
Total. 
Drafting. 
Artificial limb. 
Printing. 
Motion picture. 
Welding. 
Jewelry. 
Typewriter repairs. 
Plating. 
Enameling. 
Telephone operator. 
Number enrolled 
336 
20 
7 
31 
73 
85 
53 
38 
6 
7 
16 
61 
22 
16 
6 
8 
1 
1 
2 
15 
3 
1 
2 
2 
3 
3 
1 
11 
1 
1 
3 
5 
1 
20 
2 
1 
1 
8 
2 
4 
1 
1 
25 
4 
2 
5 
3 
4 
4 
1 
1 
1 
13 
1 
2 
2 
4 
4 
25 
1 
2 
1 
8 
7 
3 
2 
i 
Placed in work trained for 
115 
9 
2 
16 
28 
29 
12 
6 
1 
l 
11 
In training May 1, 1920 
51 
8 
14 
14 
9 
1 
4 
1 
The chief advantages of conducting this school seem to have been in 
the immediate facilities for training which could be used directly for 
any disabled person, by the same organization that was supervising his 
rehabilitation in other ways. The training departments in addition 
have afforded a laboratory for discovering the aptitudes of applicants. 
The sight of handicapped men in training is encouraging to disabled 
persons who visit the institute for the first time. 
t See Appendix B-l, B-2, E-2. 
* “Three Years of Work for Handicapped Men,” p 42, a report of the activities 
of the Institute for Crippled and Disabled Men, by John Culbert Faries. 36 
THE DEPARTMENT OF PUBLIC WELFARE 
These advantages can be attained largely through the establishment 
of “opportunity shops” at the main rehabilitation center and its branches, 
under the supervision of capable vocational instructors and well equipped 
for initial training in mechanical and related subjects. The idea of the 
opportunity school has been developed in vocational training for children, 
as exemplified in the Denver Opportunity School and at the Manhattan 
Trade School in New York. These schools are equipped for instruction 
in a great variety of trades, and those who enroll are not required to 
select at once specific courses, but are encouraged to “try their hands” 
for brief periods, at various pursuits. This principle of the opportunity 
school: has been adopted to a certain extent by the Federal Board for 
Vocational Education in the retraining of disabled soldiers. An example 
is the use that is made of the Washburn School in Chicago, where nearly 
GOO men are in training. 
The chief value of an opportunity shop, or vocation-finding labora- 
tory, would be in providing a staff and mechanical equipment that would 
help a disabled man quickly to establish an understanding of a new 
occupation and a determination to take it up. By this means occupa- 
tional therapy would be related as closely as possible to vocational train- 
ing, and the period required for reestablishment in industry would be 
shortened. Whether complete trade courses should be given in the 
opportunity shop may be decided after the demand has been tested out. 
In the vocational guidance and training of disabled persons an 
obstacle appears in the fact that a course of action cannot be arrived at 
by any formula. In each individual instance, specific abilities must be 
balanced against mental capacity and attitude and many other considera- 
tions. To have an opportunity shop associated with the State Hospital 
Group would be of practical advantage in that personal aptitudes dis- 
covered during the course of convalescence might be developed further 
in the training laboratory. This connection would be of advantage also 
in that it would offer facilities for trying out and making adjustments 
to prosthetic appliances, such as might be necessary in any case for the 
pursuit of a given occupation. 
Such opportunity shops would be most useful in work with cases in 
which vocational possibilities are not evident. Experience with them 
would help to establish principles for dealing with the larger proportion 
of the handicapped registered with the rehabilitation service, whose 
inclinations and capacities Avere more easily determined. 
It is desirable that the abilities of difficult or doubtful cases be tried 
out first-hand. This Avould prove an aid not only in successful place- 
ment, but also in the development of a reputation for reliability in 
employment of the disabled. Such trade testing Avas found to be essential 
in the assortment and placement of soldiers in mechanical positions 
during the war. At the time of the Armistice 70 per cent of all soldiers 
Avho claimed trade ability could be tested.* The results of tests of those 
* “The Army Trade Tests,” William T. Bawden (pamphlet), pp. 5-6. REHABILITATION OF PHYSICALLY HANDICAPPED 
37 
who claimed to be mechanics showed that 6 per cent were experts, that 
24 per cent were journeymen, that 40 per cent were of apprentice grade 
and that 30 per cent were inexperienced. For the British army, a plant 
was established in Woolwich Arsenal, in which soldiers were classified 
for mechanical work through performance tests. The opportunity shops 
suggested will afford facilities for performance tests of ability of the 
physically handicapped prior to placement. 
Eighty-two per cent of the industrially injured who were given 
assistance by the Pennsylvania Bureau of Behabilitation during the first 
seven months of its operation were either placed immediately at work 
or given placement training in industrial plants.f Placement training 
has come to be emphasized in the vocational program for soldiers, 
especially in recent months when initial courses of an academic nature 
are being concluded. The importance of depending upon the industries 
themselves for training is evidenced also in the work of the Department 
of Soldiers Civil Reestablishment of Canada. This method offers the 
special advantage of apprenticeship at a job in which the man may 
expect to continue, usually on Avages from the beginning. 
The maturity and occupational connections of the civilian handi- 
capped and the fact that many live in localities where classes cannot be 
organized will probably require that placement training in'industrial 
establishments be the chief method of vocational education under the 
Rehabilitation Act.| 
A study has been made of placement training in industrial plants 
in and near Chicago. Of 435 leading firms canvassed by letter, 231 
replied.§ Thirty-nine, or 17 per cent, of these reported they were giving 
training. About half of these, averaging 3,000 employees each, reported 
organization and courses sufficiently extensive to warrant study of their 
methods and comparison of results. A number of firms have indicated 
their intention of starting training courses at an early date. 
ORGANIZATION FOR PLACEMENT 
Training and advancement will be provided more frequently through 
skillful placement than through formal education. The disabled man’s 
chief wish is usually to secure a good job. This is shown, for example, 
by the experience of the Institute for Crippled and Disabled Men in 
New York in making contacts with the handicapped through newspaper 
advertisements. Little response was received to the advertisement of 
training courses open to disabled persons, but many men came in on 
reading the advertisement that an employment bureau was being con- 
ducted for the disabled. Forty-one per cent of the more serious injuries 
coming before the State Industrial Commission during 1919 were sus- 
t See Appendix A-5. 
$ See Appendix B-2. 
§ See Appendix E-l. 38 
THE DEPARTMENT OE PUBLIC WELFARE 
tained by persons over 35 years of age. The age., the mental maturity 
and the economic circumstances of many handicapped persons, require 
the adaptation of the service of industrial rehabilitation to immediate 
placement. 
In placement work under the Rehabilitation Act, the purpose of the 
State, through whatever channels it may be attained is the reduction 
of unemployment and of poor employment due to physical handicap. 
The State undertakes to assist all of the disabled in securing employment 
and, for those who are placed, to recommend as good jobs as possible. 
Emergency placement to prevent imminent poverty and unemployment, 
is necessary for many persons now applying at employment bureaus, but 
under the provisions of the Rehabilitation Act it will usually be avoided 
by establishing relations with a man at the time of occurrence of dis- 
ability, before the need of employment has become acute. 
The majority of physically handicapped persons in need of employ- 
ment who are not registered in connection with physical restoration or 
industrial training may be expected to negotiate employment directly 
with industrial concerns without the aid of the State. This is evident 
from studies of industrial plants that have been made as described 
above.* Attention to the physical needs and to the employment of the 
disabled, on the part of industries, will tend to reduce the number of 
persons applying to the State rehabilitation service and public employ- 
ment bureaus. Their service to the disabled will be increased and im- 
proved through surveys of industrial plants made under the auspices of 
the State rehabilitation service, to discover openings for the physically 
handicapped, and through advisory relations with employment managers 
and industrial surgeons. 
Occasionally with the less seriously handicapped, however, and fre- 
quently with those suffering from major disabilities, difficulties are met 
with other than that of physical unfitness of the man for the job. + 
These include his attitude and that of his employer, the location of the 
work, the conditions of transfer and opportunities for advancement, 
monotony, etc. These conditions in the industrial situation and in the 
handicapped man’s personality in every instance require investigation 
prior to placement. 
Those whose circumstances thus need special investigation, and 
those who have come to the attention of the State in connection with 
physical restoration or industrial training, will make up the group who 
require the supervision of the State rehabilitation service in connection 
with placement. In assisting such persons in securing employment, 
rehabilitation aids will consult with officers of the Free Employment 
Bureau, if such a bureau exists in the locality. By this arrangement the 
services of the State employment offices will he used and at the same 
* See Appendix F-10. 
t See Appendix F-l. REHAB IT. IT AT IO X OF PHYSICALLY HANDICAPPED 
39 
time advantage will be taken of the knowledge and understanding that 
exists between the rehabilitation aid and the disabled man. 
The Illinois Free Employment Bureaus have received applications 
from more than GO disabled men.* Publicity that would be given the 
establishment of the State rehabilitation service may be expected to 
increase the number of applications of disabled persons at the free em- 
ployment bureaus. The number of applicants that may be expected by the 
employment bureaus and by the rehabilitation service is suggested by the 
fact that at the bureau conducted by the Institute for Crippled and 
Disabled Men, in New York City, an average of 1,100 persons have 
applied each year for two years, and that at the corresponding bureau in 
Cleveland about 700 have applied in eleven months. 
The inclusion in the law of a provision for cooperation in placement 
work between the Department of Public Welfare and the Department 
of Labor suggests the desirability of an arrangement whereby the regis- 
tration of any physically handicapped person with a free employment 
bureau would bring him all the advantages of the rehabilitation service. 
The State free employment bureaus are equipped chiefly for handling 
great numbers of ablebodied applicants and aiding them in securing 
jobs immediately. The plan of rehabilitation of the physically handi- 
capped calls for thorough matching of a man’s qualifications with indus- 
trial opportunities and the improvement of conditions, or elimination of 
those obstacles in his home situation or in his mind which are in the 
way of advancement. Arrangement for liaison officers between the 
rehabilitation service and the free employment bureaus would provide 
for applicants requiring more extensive consultation and investigation. 
Through this channel it would be possible to make constant use of in- 
dustrial studies such as are contemplated in the law and to give assistance 
with respect to physical restoration, artificial appliances, or industrial 
training. 
RESIDUAL CASES 
A certain number will be found who cannot be trained to the degree 
of efficiency that is necessary in working alongside others at standard 
industrial pursuits, or whose inclinations and habits are strongly set 
against regular employment. A picture of these classes as sifted out in 
the rehabilitation process is afforded in the experience of the Institute 
for Crippled and Disabled Men in New York City. Among the un- 
placeable they find the man who is paralytic, the epileptic, and those 
with communicable diseases, the man with a double arm amputation, the 
man of clerical type with paralysis of one side and speech defects, and 
the man who has formed mendicant habits. To this group should be 
added the bedfast or otherwise housebound, and wheelchair cases. In 
addition to the shut-ins, the very seriously disabled and those who 
present extreme temperamental problems, the residual group will be 
* See Appendix F-9, F-3 40 
the department of public welfare 
found to include also a number whose difficulty is magnified by family 
situations and by industrial conditions in their localities. 
The first concern of the State is in the adoption of methods that 
will succeed with the larger proportion of the physically handicapped. 
With some of the residual types described rehabilitation work may be 
undertaken through private philanthropy. In Boston for many years 
workrooms have been maintained for handicapped women. The payment 
of wages through charitable subsidy of workshops may lead to the hand- 
ling of persons in this manner for whom an enterprising placement 
officer would be able to find work in private industrial establishments. 
For severely handicapped soldiers, Canada is experimenting with so- 
called vet-craft shops. They have no immediate expectation of getting 
these shops on a self-supporting basis, however. The present State law 
providing pensions for the adult blind suggests a possible solution for 
problems of extreme handicap sifted out through the operation of the 
Rehabilitation Act. 
VII. PREVENTION, RESEARCH AND PUBLICITY 
THE PREVENTION OF DISABILITIES 
While the rehabilitation of physically handicapped persons will 
require the cooperation of many individuals and many agencies, public 
and private, the prevention of disabilities can be accomplished only by 
the attention of everyone in the community. Certain conditions have 
been observed during the survey that relate to a preventive program. 
These are discussed here under the following headings: 
1. Crippled or otherwise defective children. 
2. The safetjr movement. 
3. Research and educational publicity. 
The key organization for a preventive program in any community is 
the health center. Such a base of operations in every community would 
help focus many State-wide undertakings. Dr. Frank Billings has 
generously contributed to this report a brief outline of organization of a 
health center, which is included in the Appendix.* 
crippled or otherwise defective children 
A. EXAMPLES 
Artificial Legs and Self-respect. 
Bobbie Kern, II years old, American, while “tipping” freight cars 
fell under the wheels and had both legs cut off above the knees. After 
three months in the hospital he was discharged, but no effort had been 
made to teach him to use artificial legs. At his own request he left the 
hospital after dark and was carried into his home the back way, so that 
the neighbors could not see him. For ten months he seldom went out- 
* See Appendix D-5. 41 
REHABILITATION OF PHYSICALLY HANDICAPPED 
doors, except for an occasional automobile ride, when lie was carried out 
the back way. He was very sensitive about his condition, and his parents 
were heartbroken. The mother frequently remarked that she would 
much rather her son had been killed. 
A rehabilitation agency became interested in Bobbie and referred 
him to a hospital. The physiotherapy department gave daily massage, 
and he was taught to make pressure on the ends of the stumps. At the 
end of ten days he was fitted with short temporary peg legs, and a month 
later these were lengthened so that they were approximately two feet 
long. By means of these temporary legs Bobbie was able to walk, first 
with crutches, then with a cane, and at the end of four weeks he could 
walk alone. 
On his discharge from the hospital this time Bobbie entered his 
home by the front door. During his stay in the hospital he was eh- 
couraged to take up his school work once more. At the end of four 
months he was fitted with permanent artificial limbs. He returned to 
school this fall. 
A Crippled Boy Wants a Trade. 
Albert suffered from infantile paralysis of both lower limbs. He 
was slow and dull. The father was a drunkard, the mother was dead and 
Albert lived with an aunt, who was burdened with a large family of her 
own. The Spaulding School (for crippled children) clothed and fed the 
boy and tried to keep up his interest in his studies. Their cobbling 
equipment was installed when he was in the seventh grade and he took 
to it as a “duck to water.” Every spare minute he went to the cobbling 
shop and his graduation from eighth grade was due to his efficiency in 
this line. 
A special worker for the handicapped, employed at the Vocational 
Guidance Bureau, placed him in the shoe repair department at one of 
the big department stores. They took him as an act of charity, but at 
the end of the first year they regarded him as a necessity. Last year he 
received next to the largest bonus in the department. A very happy 
relation has sprung up between the department head and Albert. They 
call each other “father” and “son.” 
Albert has recently been able to discard his crutches indoors and is 
also riding a bicycle. He is well dressed and self-respecting. 
A Child with Weak Heart in Regular School. 
Guiseppi had stayed in school seven months past his 14th birthday 
in order to graduate from the 8th grade. The father was making $25 a 
week; there were eight children and the mother, an exceptional Italian 
woman, had been at her wits’ end to keep her family going and allow 
Guiseppi to graduate. They had borrowed money on the expectation 
of Guiseppi’s going to work. But when they came to the certificate 
issuance office thev were told that a certificate could not be issued to 1'IIE DEPARTMENT OF PUBLIC VVELFARI 
Guiseppi, because of a very bad heart condition. His mother was finally 
won over to allowing him to have a scholarship (from a fund provided 
by the Vocational Supervision League) and to continue in school. 
A relative of the family in New York is a designer of men’s clothing. 
He has offered to teach Guiseppi the trade when he grows older. If 
Guiseppi can be guarded so as to preserve his health until that time, he 
will be well taken care of. 
Bordering on the Career of a Useless Cripple. 
John, an Italian boy, came with his mother to procure a work cer- 
tificate shortly after his 14th birthday. He was extremely thin, and had 
a decided outward curvature of the spine, presumably from an early 
tubercular condition. The mother was prematurely aged and nearly 
blind from trachoma. The father and an older brother worked, but the 
family felt that John had now reached an age when he should con- 
tribute. 
John was not allowed to work. He was fitted out with clothing and 
books and induced to return to school. The mother was sent where she 
could receive treatment for her eyes. Later in the year when Arden 
Shore Camp was organized, John was sent there. He did not improve 
much at first and a bursitis of the knee developed. Ilis tonsils were 
removed, and he improved more rapidly. During the time while he was 
in the hospital, he wrote one of the vocational guidance staff a letter 
which indicated literary ability. 
After John’s physical condition had been built up he came home 
and was sent back to school. He thought he would like to become a 
printer, but learned that his handicap would probably bar him from 
this occupation. He was encouraged to go ahead in school, with the 
idea of becoming a proof reader. A scholarship (from a fund provided 
by the Vocational Supervision League) was secured and John was 
returned to school. 
However, the family persists in the idea that this 14-vear old cripple 
should contribute to the family purse. 
Reconstructive Surgery. 
John Vest, 12 years old, is one of six children whose parents are 
very poor. John was born without arms. For four years he attended 
the Spaulding School for Crippled Children and there he learned to do 
a great many things for himself, such as opening a door by grasping the 
knob between his cheek and right shoulder. He could write well by 
holding the pencil in the same manner, and lie could operate a typewriter 
by using a long stick. 
Two leading surgeons and two of the most skilled artificial limb 
men were consulted and they agreed that artificial arms could be attached 
to the rudimentary stumps at John’s shoulders. Operations were per- 
formed successfully. John is now wearing the two artificial arms. With REHABILITATION OF PHYSICALLY HANDICAPPED 
43 
them he is able to write and eat without difficulty. He shows excellent 
talent as a cartoonist and is planning to take up this work after he has 
completed his education. This will be better for him than exhibiting in 
a museum, a career which John’s father had had in mind for him. 
B. THE COMMUNITY PROBLEM 
More than half of those who are crippled, as shown by the censuses 
of cripples in Cleveland and New York City, become disabled before 
the age of 15 years—the point beyond which the Illinois Rehabilitation 
Act applies. The dwarfing and handicapping effects of physical defects 
in many instances are not appreciated until the child approaches adult 
life and is expected to earn a living and take a place in the community. 
The relation of physical conditions in adult life to causes occurring 
frequently prior to school age, are reflected in the following statement 
by Dr. Julius Levy of Newark, New Jersey:* 
Spinal curvature and poor posture, which have given considerable 
impetus to the movement for physical training, have a basis in anaemia 
and malnutrition which are the results of improper care and feeding in 
the first years of life. * * * Particularly deformaties of the hones, 
such as pigeon breast, bow-legs, knock-knee, weak feet, or flat feet, so 
frequently found in school children of the poorer neighborhoods, are the 
result of poor nutrition and bad hygiene that occurs usually between six 
months and two years. In various schools it has been estimated that 
from 3 to 30 per cent of the children are suffering from the results of 
rickets. 
Of 2,046 crippled children under 15 years of age discovered in the 
Cleveland survey, 68 per cent were found to have been disabled before 
reaching the age of 5 years. 
Childhood is preeminently the period for the correction of abnormal 
physical conditions that later may interfere with remunerative occupa- 
tion. Physical restoration and education, up to the point of employ- 
ment, if the child is not to continue in school, can be carried on with 
the best results before the age of 16 has been reached. It is to the in- 
terest of the State that, of all .children, those should be given most 
attention in physical development and vocational preparation whose 
adjustment in later life is most apt to constitute a public problem. 
The chief means whereby boards of education may know of the 
existence of crippled children in the community is the school census.f 
The census schedules used in some Illinois cities makes specific provision 
for listing crippled or otherwise handicapped children. Information 
received in this way in Chicago is supplemented by reports from visiting 
nurses and truant officers. Parents of defective children are inclined 
to conceal them from census enumerators. Experience with the survey 
to date leads to the belief that better understanding on the part of the 
parents would result in the listing of many crippled children who are not 
now carried on school records. 
* The Survey, May 15, 1920, p. 245 
t See Appendix B-l. 44 
THE DEPARTMENT OF PUBLIC WELFARE 
The most extensive educational provisions in any community of 
the State, for the various classes of crippled or otherwise defective 
children, is that made by the Chicago Board of Education. At the 
Spaulding School for Crippled Children, 300 day pupils are assembled 
for regular instruction with special facilities for medical care, muscle 
development, nutrition and occupational therapy. The entire work of 
the Board of Education for physical defectives is summarized in the 
following table: 
PHYSICALLY HANDICAPPED CHILDREN OF SCHOOL AGE IN CHICAGO 
Enrollment in special schools and classes under Board of Education, November 
30, 1920, and estimate of number for whom no special provision is made.* No special 
provision is made in the schools for children with defective hearts, and no estimate 
of their number is included in the following’ table. Dr. Julius Levy, of Newark, 
estimates that two per cent of school children in New Jersey have heart disease. 
Two per cent of the population of compulsory school age of Chicago would be 
approximately 10,000. 
Physical 
condition. 
Number. 
School grouping. 
Under 
care. 
Uncared 
for. 
Remarks. 
t 
Jahn School ___ 85 
Fallon School ... ... _ 154 
Not in special schools (estimate). 
In no schools 300 
527 
1,500 
Out of bounds of busses 
or parents object. 
54 classes in 23 schools, annual enroll- 
1,750 
(Only 1 in 15 of anaemic are being 
given special care according to esti- 
mate of Dr. Bruner). 
22 
culosis in family. 
2. Glandular cases or 
those with healed pul- 
monary scars. 
3. Malnourishedandanal- 
mic (blood count less 
than 75). 
Blind 
46 
15 
Attending regular schools, 
parents object to their 
taking cars to attend 
special schools. 
324 
325 
Defective speech 
2,200 
. 
Special teachers ______ _ 12 
Children are treated individually 
twice each week. 
In districts where no special instruc- 
tion is provided (estimate) 
8,800 
About 600 stammer, re- 
maining having defects 
of articulation. 
If Chicago has as many crippled children under 15 years of age in 
proportion to population as were discovered in Cleveland in the city-wide 
canvass of that community, there would be 4,168, of whom 3,423 would 
be of the ages 5-14 years. This number is to be compared, according to 
definition adopted in the Cleveland study, only to the two items in the 
foregoing table under “Crippled” (under special care, 527; estimated 
not under special care 1,500). 
* Special report (by letter) from Dr. Frank G-. Bruner, Director of Special 
Schools. REHABILITATION OF PHYSICALLY HANDICAPPED 
45 
The survey staff has communicated with school hoards throughout 
the State, suggesting that special attention be paid to securing informa- 
tion regarding physically handicapped children. 
An exact interpretation of the statistics of medical inspection of 
schools in terms of physical handicap is not possible. The elimination 
of any physical defects in childhood, however, will tend to reduce the 
public problems of physical handicap in adult life. School physicians 
and nurses are reported* for cities located in 77 of the 102 counties of 
Illinois, the number of physicians being 44 and the number of nurses 
249. The extent to which they are engaged in supervision of the physical 
development of children, as distinguished from inspection merely to de- 
tect contagious diseases, is shown by answers to a questionnaire from the 
survey office which are summarized as follows: 
Inspection for contagious diseases only—number of counties reporting 38 
Inspection for physical defects—number of counties reporting 8 
Number of cities and districts in these eight counties for which physical in- 
spection is reported 9 
Rural inspection for physical defects 2 
Certain cities, including Cincinnati, Milwaukee and Grand Rapids, 
have adopted record forms which include information about physical 
condition and development, by the use of which continuous account is 
kept of every child from the day he is first known to the board of educa- 
tion until he finishes school or leaves the city. This plan is in operation 
in the tri-cities, LaSalle, Peru and Oglesby. The extent of its use 
elsewhere in Illinois has not been ascertained. Such an arrangement 
is necessary to assure constant attention to the physical development of 
school children. It is especially desirable in case of the physically 
handicapped or those with defects such as may develop into permanent 
handicaps. 
Under the Board of Education of Chicago provision is made for 
physical examination of all children between 14 and 16 years of age who 
apply for work certificates. Those found to be seriously defective are 
prohibited from work, and through social service organization an effort 
is made to secure for them medical attention, proper home care, and 
recreation. The statistics of this bureau reveal the extent of physical 
handicap among working children, hiearly one-third of those examined 
are found to have physical defects of such seriousness as to require with- 
holding work certificates. The following table shows the kinds of defects 
noted and their comparative importance: 
PERCENTAGE OF DEFECTS AMONG WORKING CHILDREN, EXAMINATIONS BY VOCA- 
TIONAL GUIDANCE BUREAU, CHICAGO BOARD OF EDUCATION YEAR ENDING 
JUNE 30, 1920. 
Number of examinations 52,151 
Number of casesin which defects were discovered- 16,081 
Percentage 31 per cent 
* Illinois School Directory, 1919-20, pp. 112-14. THE DEPARTMENT OF PUBLIC WELFARE 
COMPARATIVE IMPORTANCE OF DEFECTS AMONG 6,307 CHILDREN REFUSED CERTIFICATES 
FOR THE FIRST TIME. 
Defective vision 
Nose and throat findings, nasal obstructions. 
Malnutrition, size and weight 
Defective teeth 
Skin—pediculosis 
Cardiac findings 
Pulmonary findings.. 
Thyroid enlargement with toxic symptoms 
Defective conditions amounting to 1 per cent: 
tions, deformities, defective hearing—discharging 
kidney, jaundice. 
30 per cent 
20 per cent 
- _29 per cent 
11 per cent 
— - 4 per cent 
--- - 2 per cent 
1 per cent 
1 per cent 
Subnormal nervous condition, hernia, malforma- 
ears, genito-urinary, glands, defective speech, 
To assure proper attention to defects that have been discovered, the 
medical resources of every community need to be planned in relation 
to local needs. Institutional facilities include the number of beds in the 
orthopedic services of hospitals, the facilities of convalescent homes, 
sanatoria, children’s clinics and heart clinics, open-window schools, and 
summer outings for children. 
Local facilities may be supplemented in handling many children’s 
cases by the use of State agencies. Through clinics in six cities during 
the two years 1917-18, the State Department of Health* ministered “to 
an average of 117 crippled children each week, 80 per cent of whom are 
the victims of infantile paralysis and the remaining 20 per cent crippled 
by other diseases such as tuberculosis, rickets, cerebral palsy and acci- 
dent.’’ During the past year in its community clinics for trachoma, the 
State Department of Public Welfare has examined 355 children of ages 
between 5 and 10 years. The Surgical Institue for Children to be estab- 
lished as part of the Central Group of Hospitals under the auspices of 
the Department of Public Welfare and the University of Illinois will 
afford facilities for many acute cases. 
In order to reduce the number of physically disabled persons arriv- 
ing at the age of 10 years with such handicaps as to require the attention 
of the State Pehabilitation Service, it is desirable that a preventive plan 
be adopted in every community. This will require that all children of 
school age be examined periodically for physical defects and that those 
with handicapping disabilities be given the maximum education for 
which they are mentally fitted, the possible need of remunerative em- 
ployment being considered in every case, and arrangements made for 
vocational guidance. 
Under the British Education Act, hoards of education are authorized 
under exceptional circumstances to make any provision, including board 
and lodging, “which they think best suited for the purpose of enabling 
* * * children to receive the benefit of efficient elementary educa- 
tion.” Local education authorities are required to pay for physically 
defective children in suitable hospital schools, where they exist; and in 
case none have been established, to provide them before March, 1927. 
Local boards are, in addition, given supervision over the working con- 
ditions of children, if the work is reported to have harmful effects. 
* Report of directors under the Civil Administrative Code, 1918, p. 494; subse- 
quent report available in January, 1921. REHABILITATION OF PHYSICALLY HANDICAPPED 
SAFETY MOVEMENT 
The importance of accidents as causes of physical disability is indi- 
cated in the results of the Massachusetts and Cleveland censuses, as 
shown by the following table: 
PROPORTION OF DISABILITIES DUE TO ACCIDENT. 
At 
occupation. 
Otherwise. 
Per cent 
of total 
number of 
of cripples. 
Massachusetts census, 1905—17,134 cases- 
13.4 per cent 
11. per cent 
28.5 per cent 
32. per cent 
41.9 per cent 
43. per cent 
Cleveland survey, 19l6—4,186 cases. 
These results, with striking coincidence, show over 40 per cent of 
all disabilities to be due to accidents, about one-fourth of which are 
industrial injuries. 
Approximately 40,000 injuries at work come to the attention of the 
State Industrial Commission every year.* The Illinois Compensation 
Act, it is estimated, covers approximately 55 per cent of all employees 
in various industries in the State. About nine-tenths of these are classi- 
fied as temporary injuries. 
The safety movement has demonstrated the possibility of preventing 
accidental injuries. Industrial concerns that have been associated with 
this movement have in some instances reduced the number of injuries 
by as much as 80 per cent. Communities that have been organized for 
accident prevention during the “no accident week” when the National 
Safety Council is holding its annual meeting, have reduced the number 
of accidental deaths by amounts ranging from 80 to 100 per cent. 
A study of “The Safety Movement in the Iron and Steel Industry” 
made by the United States Department of Labor for the period from 
1001 to 1917 shows that in this kind of work “fatal accidents and serious 
accidents arc primarily due to fundamental engineering or structural 
defects in which the workman has no part.”f The remedy lies partly 
in the provision of safeguards on dangerous machinery. Standardiza- 
tion of mechanical safe-guards and formulation of safety codes is being 
worked out by the American Engineering Standards Committee. Legal 
requirements of such safeguards in Illinois is made in the Factory ActJ 
under the title, “Health, Safety and Inspection.” 
The remedy for the more serious accidents lies also in the provision 
of safe tools and in requiring safe construction. 
The avoidance of industrial accidents depends upon the cooperation 
both of the worker and of the management. The workman must not 
only exercise intelligent care, but must have special training in safe 
practices. Frequently haste leads to accidents. 
* See Appendix F-5. 
t Bui. U. S. Department of Labor, Bureau of Labor Statistics, June, 1920. 
} Paragraphs 230-5. 48 
THE DEPARTMENT OF PUBLIC WELFARE 
Correlation between compensation administration and accident pre- 
vention is shown, through studies made by the United States Bureau of 
Labor Statistics,f to be an important means of prevention of injuries 
at work.J Such a connection has been provided in the laws of nine 
states, not including Illinois. In Wisconsin, for example, when an in- 
jury is found to be due to the failure of an employer to comply with any 
safety order of the State Industrial Commission the compensation of the 
injured person is increased by 15 per cent; if the injury is found to be 
due to wilful refusal of the employee to use such safe-guards, the com- 
pensation is decreased by 15 per cent. In some states having such legis- 
lation it is customary for safety regulations to be established only after 
they have been adopted by employers representing the industries con- 
cerned, and for frequent conferences of employers to be held under the 
auspices of the State Industrial Commission. 
Plant safety committees have been organized by more than 300 in- 
dustrial concerns in Illinois and have in most instances affiliated with 
the National Safety Council, whose offices are in Chicago. A community 
safety council has been organized in Chicago with the purpose of pre- 
venting accidents of all kinds, including industrial injuries. Flint, 
Michigan, offers an example of community organization with a paid 
director on a part time basis who is also on the staff of the local chamber 
of commerce. St. Louis furnishes an example of a community plan 
which is being developed through instruction in public and parochial 
schools.** The plan includes not only instruction regarding safety prac- 
tices given in the established curriculum, but also the organization of 
school children with the idea that they shall be responsible for the pre- 
vention of accidents. The State Industrial Commission of Ohio stimu- 
lates the teaching of safety in the public schools. 
The State Pehabilitation Service will afford information about the 
consequences of industrial accidents and diseases which will be valuable 
for the purposes of safety education. If safety work should be under- 
taken as a specialized activity of the State Government, it would be or- 
ganized most effectively as a division of the Department of Labor. In 
this way a plan might be formulated for close association with the func- 
tions of factory inspection, of compensation administration and of 
statistics and publicity. 
RESEARCH AND EDUCATIONAL PUBLICITY 
The Pehabilitation Act provides that it shall be a duty of the De- 
partment of Public Welfare: 
To conduct investigations and surveys of the several industries 
located in the State to ascertain the occupations within each industry 
in which physically handicapped persons can enter upon remunerative 
employment under favorable conditions and work with normal effective- 
f Monthly Labor Review, December, 1919, p. 325. 
J Monthly Labor Review, December, 1919, p. 5. 
** See “Education in Accident Prevention,’’ by E. George Payne. REHABILITATION OF PHYSICALLY HANDICAPPED 
49 
ness and to determine what practicable changes and adjustments in in- 
dustrial operations and practice may facilitate such employment. 
To make such studies and reports as may be helpful for the opera- 
tion of this act. 
The adaptation of industrial processes and devices and methods of 
employment to the needs of the physically handicapped requires exten- 
sive study. The rapid survey that has been made of industrial plants 
has shown this to be a profitable subject of study and an indispensable 
means of establishing connection with employing concerns. Research 
is needed because rehabilitation of the physically handicapped has only 
recently been established as a public function and consequently informa- 
tion regarding its practical phases is lacking. 
An inquiry sent to the universities and colleges of Illinois at the 
the beginning of the present survey resulted in a number of expressions 
of interest in the study, and statements that special topics included 
in the survey might be chosen as thesis subjects by graduate students. 
Four graduate students of the University of Chicago have assisted 
with special phases of the survey to date, and about fifty graduate 
and under-graduate students have assisted with field work. From 
this experience it would appear to be desirable to include in the plan for 
future research, in connection with the administration of this law, an 
arrangement for the cooperation of graduate students at various colleges 
and universities. 
Under the law it becomes the duty of the Department of Public 
Welfare “to keep the people of the State informed regarding the oper- 
ation of this act.” 
From conditions discovered in the survey it is apparent that the 
success of the rehabilitation program will depend upon the concerted 
cooperation of all public and private agencies that are concerned with 
physically handicapped persons. The effectiveness of the State plan 
in solving the problem of the physically handicapped will be increased 
through the establishment of a better understanding of the processes 
of rehabilitation, so that the work will be done, not so much by the 
State, as by industries, by medical agencies and by the individuals con- 
cerned. 
For this purpose it will be desirable to publish the results of treat- 
ment of typical cases, the findings of surveys and accounts of progress 
in work for the physically handicapped in other states. 
YIII. SUMMARY AND BUDGET. 
VOLUNTARY COMMUNITY AGENCIES 
The work of institutions and societies that are concerned with the 
treatment of physically handicapped persons in Chicago is being studied 
with a view to determining the extent of their service and its relation- 
ship to a public program of rehabilitation.* Likewise inquiry is being 
* See Appendix C-l, C-5 
—4 R P H 50 
THE DEPARTMENT OF PUBLIC AVELFARE 
made into the work of family welfare agencies in other communities. 
The histories of a number of seriously handicapped persons handled by 
two family service agencies in Chicago have been examined. They, show 
the importance of an understanding on the part of voluntary agencies 
of the methods of industrial reestablishment of disabled persons and the 
advantage that would come from such service as the Rehabilitation Act 
provides. The more difficult cases on the records of family welfare 
agencies are in many instances those of families that contain physically 
handicapped persons. 
The value of voluntary agencies in supplementing the work of pub- 
lic departments for physically handicapped persons, is exemplified by 
the Yocational Supervision League of Chicago. During six months of 
the year 1920 it rendered special service to 102 handicapped children 
who sought employment certificates from the Board of Education. Forty- 
nine were helped to secure specially adapted jobs, G3 were taken to dis- 
pensaries, school adjustments were made for 22, and scholarships secured 
for 8, so that they would not need to work. Service of various other 
types was rendered, including cooperation with 24 medical and social 
agencies. 
Voluntary agencies organized for assistance to specific groups of 
physically handicapped persons are able to render service to their groups 
which cannot easily he provided through State organization. Work for 
the partially deaf, for example, as stated by the Chicago League for 
Hard of Hearing:* 
has to do with those who in adult life are confronted with a partial 
or complete loss of hearing, for which there is no hope of improvement 
from treatment. * * * The problem is to devise means by which 
the chasm resulting from the loss «of hearing can in a measure be bridged 
over. This is a very definite problem, the solution of which has several 
well defined aspects. One of these is the acquiring of skill in lip-read- 
ing. This is perhaps of first importance, for it brings to these cases as 
nothing else can do, a hope of something definite for which to work. 
Another aspect of the problem is the social aspect. These people need 
help which can only be provided by bringing them together as the League 
is attempting to do. Then, too, there is the economic problem. A per- 
son who is losing his hearing finds increasing difficulty in earning a 
livelihood, and if left to himself has no very bright outlook on life. 
There are many things that the person with defective hearing can do. 
Voluntary agencies of this specialized type may follow about the same 
plan after the establishment of the State Rehabilitation Service as they 
have already adopted. Any agency that deals with persons handicapped 
by various types of physical disability may find it desirable to develop 
its plans in such a way as to supplement the work to be established under 
the State Rehabilitation Act. 
Voluntary organization will be required for the rehabilitation of 
persons not included under the provisions of the Rehabilitation Act or 
not faking advantage of it. The following groups are of these types: 
* Year book 1919-20, p. 11 REHABILITATION OF PHYSICALLY HANDICAPPED 
51 
1. Physically handicapped persons over 1G years of age who 
do not choose to take advantage of the State plan. 
2. Those who may require attention following completion of 
the State service to them. 
3. All physically handicapped persons under 1G years of age. 
(Service for the physically handicapped child is in a large measure 
the responsibility of local boards of education.) 
The effectiveness of the State plan of rehabilitation will depend upon 
the cooperative service of voluntary agencies in the community in sup- 
plementing and carrying through certain processes begun under State 
auspices. These lines of activity will include: 
1. Assistance during training that may be required in excess 
of the $10 a week authorized in the law. 
2. All financial assistance to physically handicapped persons 
not in training. 
3. Services to shut-ins in addition to whatever industrial 
training the State may give. 
4. Recreation for physically handicapped persons, especially 
summer outings. 
~>. Work with groups suffering with single types of disability, 
as for example the tuberculous or the blind, and associations of per- 
sons within such groups for mutual stimulation. 
G. Facilities for occupational therapy, functional retraining 
and other services in connection with medical or surgical work, in 
addition to what may be provided by the State at the Central Hos- 
pital Group. 
7. Family case work in instances in which the State rehabili- 
tation service is not the natural leader, as, for example, where the 
correction of criminal tendencies in a child is more important for 
rehabilitation of the family than any service that may be rendered 
to a physically handicapped parent. 
8. Organization for expeditious reference of cases of physical 
handicap between community agencies, including central registra- 
tion in the larger cities. 
9. Community surveys under supervision of State rehabilita- 
tion service. 
10. Development of public opinion, including part of the pro- 
gram of prevention of disabling conditions. 
Local chapters of the American Red Cross have assisted with com- 
munity studies made as a part of the present State survey. Other local 
agencies have furnished valuable data and have shown an interest in 
adapting their work to the needs revealed by the survey. Experience 
with the administration of the Rehabilitation Act will indicate the extent 
to which such agencies are equipped to provide supplementary services 
such as are listed above, and whether new organizations may be needed. 52 
THE DEPARTMENT OF PUBLIC WELFARE 
Central councils of community welfare agencies, such as have been 
formed in some cities, afford an appropriate means through which it 
may be determined whether or not the community is well equipped for 
rendering the services indicated. 
RELATION OF VARIOUS STATE DEPARTMENTS TO REHABILITATION WORK 
The more important services to be rendered in connection with the 
program of rehabilitation through State departments other than the 
Department of Public Welfare are the following: 
1. State Department of Labor: 
(a) Furnishing information regarding persons injured 
in industry; 
t(b) Finding employment for physically handicapped per- 
sons who apply at free employment bureau; 
(c) Organization for safety and the prevention of indus- 
trial disease. 
2. State Department of Health: 
(a) Conduct of clinics for infantile paralysis and other 
orthopedic defects; 
(b) Extension of medical inspection of schools, including 
periodic physical examinations; 
(c) Education in health and hygiene. 
3. State Department of Public Instruction: 
(a) Delations with State Board for Vocational Educa- 
tion affecting Federal appropriation for vocational education 
of civilian handicapped, under the Fess-Kenyon Act. 
4. State Department of Trade and Commerce: 
(a) Deporting through the State Public Utilities Com- 
mission of persons injured by railroads and the public utilities. 
Within the Department of Public Welfare, the operation of a State 
rehabilitation service may afford helpful information bearing on the 
industrial training and vocational guidance of the blind and the deaf, 
and assistance with securing emplo}'ment for persons with these types 
of disability. Work done under the Dehabilitation Act should tend to 
reduce the number of commitments to county homes. Through replies 
received from superintendents of county almshouse in 36 counties of 
Illinois, not including Cook, it is found that 9 per cent of the popula- 
tion of these institutions are physically handicapped persons under 60 
years of age, and that of this physically handicapped group 18 per cent 
are considered by superintendents to be in need of prosthetic appliances 
or industrial training or placement. Ten inmates of the Cleveland 
City Infirmary were recently placed at work in industrial establishments. 
This circumstance led to the appointment on the staff of the infirmary of 
a social wrorker to handle such matters. REHABILITATION OF PHYSICALLY HANDICAPPED 
53 
LEGISLATION NEEDED 
For the effective operation of the Rehabilitation Act, new legisla- 
tion or administrative orders will be needed for the following purposes 
as explained in previous sections of this report: 
1. Providing a State fund for payment of difference in com- 
pensation between total disability and second injury resulting in 
total disability. 
2. Providing a State rehabilitation fund into which shall be 
paid the minimum compensation allowance in case the injured per- 
son dies leaving no heirs. 
3. Providing that prosthetic appliances of the best design 
shall be given when needed as a part of medical treatment under 
the Compensation Act. 
4. Providing that maximum restoration of function of injured 
parts of the body shall be required in every settlement between 
employer and employee under' the Compensation Act. 
5. Prohibiting the raising of insurance rates on account o'f 
the employment of physically handicapped persons. 
6. Providing research scholarships through arrangements with 
colleges and universities in connection with further study of the 
rehabilitation of physically handicapped persons and not requiring 
appointment under civil service. 
7. Provision for reporting to the State rehalibitation service 
by the State Public Utilities Commission of all cases of injury 
known to them, similar to present provision in Rehabilitation Act 
for relations with State Industrial Commission. 
ORGANIZATION OP THE STATE REHABILITATION SERVICE 
The recommendations contained in this report contemplate the 
provision of the following institutional facilities: 
1. A rehabilitation hospital, to be a unit in the Central Hos- 
pital Group now under construction at Chicago. 
2. “Opportunity Shops” for initial industrial training and 
trade testing in connection with the rehabilitation hospital and 
also at whatever centers are provided under the law for districts 
throughout the State. 
3. Quarters for the general staff of the rehabilitation service 
in connection with the rehabilitation hospital and opportunity shop, 
and headquarters for field workers at centers in other districts. 
4. Temporary quarters for initial rehabilitation work pre- 
ceding the completion of permanent quarters. 
Rehabilitation of physically handicapped persons has been found in 
the survey to occur more easily in communities which afford the greater 
variety of industrial opportunities. If the districts under the rehabilita- 
tion service are laid out so as to include both agricultural and manufac- 54 
THE DEPARTMENT OF PUBLIC WELFARE 
hiring industries, for example, it will facilitate the administration of 
the act. 
The administrative personnel that will he required under this law 
as suggested in these recommendations includes: 
1. Rehabilitation aids for visitation of disabled persons in the 
hospital or elsewhere, for social service in the home and for place- 
ment in industry. 
2. Industrial officers for vocational guidance and instruction 
in opportunity shops, for surveys of industrial plants and for liaison 
with the State Industrial Commission and the free employment 
bureaus. 
3. General staff officers for administrative direction and super- 
vision, for the work of publication and research and for clerical 
service. 
The lack of well qualified workers has been found to be an obstacle 
to effective service by rehabilitation bureaus that have been established 
elsewhere. It will probably be necessary for the success of the State 
program of rehabilitation in Illinois that arrangements he made for 
special training for rehabilitation aids. 
In those states where a beginning has been made with laws similar 
to the Illinois act, only a small portion of the total number of handi- 
capped persons eligible have so far been given attention. By proceeding 
gradually, principles of administration may be tested before they are 
adopted on a large scale and a staff of trained and experienced workers 
may be provided. It may be possible to attain a complete organization 
for the service contemplated in the Rehabilitation Act by the end of the 
second year of operation. For attaining the best results with cases 
handled during the period of gradual establishment of the rehabilitation 
service, the following order of priority of groups handled is suggested: 
1. New cases reported to State Industrial Commission. 
2. Physically handicapped persons discharged from hospitals. 
3. Cases referred from various agencies, public and private. 
4. Direct applications from physically handicapped persons. 
5. Old cases known to the State Industrial Commission. 
6. Cases discovered through community surveys. 
BUDGET ESTIMATE 
The annual cost of maintaining the rehabilitation service when fully 
organized, and the cost of renting and equipping temporary quarters and 
of purchasing artificial appliances for resale to disabled persons, are 
estimated as follows: 
Staff salaries and traveling expenses $117,500 
Maintenance of handicapped persons during training 50,000 
Research, publication and general administrative expenses 55,000 
Establishment of main rehabilitation center and branches, temporary 
quarters 75,000 
Revolving fund for purchase of artificial appliances 10,000 
$307,500 REHABILITATION OF PHYSICALLY HANDICAPPED 
This estimated annual cost may be reduced by as much as 40 per 
cent in appropriating for the first year, on account of gradual establish- 
ment, and by as much as 20 per cent for the second year, the full amount 
being required for complete organization beginning with the third year. 
For the rehabilitation hospital unit in the Central Hospital Group 
at Chicago, in case provision is made apart from units now under con- 
struction, for an opportunity shop for headquarters for the general 
rehabilitation staff in connection therewith, it is estimated that $250,000 
should be appropriated for buildings and equipment. The cost of 
permanent quarters for rehabilitation centers in districts that may be 
established is not included in this estimate. 
SOURCES OF REVENUE 
The number of persons dying from industrial injuries covered by 
the State Compensation Act, and leaving no heirs, during the year 1919, 
was 47. Comparing this figure with the statistics of previous years it is 
estimated* that an average of 63 cases of this type will occur each year 
for the years 1921 and 1922. The minimum payment for death under 
the Compensation Act is $1,650. It is estimated thus that if such pay- 
ment were to be made into a State rehabilitation fund an income of 
$103,950 might be expected each year for the next two years. Provision 
of this nature is made in the New York Compensation Act,f the death 
claim payment being $1,000, $100 of which is set aside for payment of 
difference between total disability rate and rate for second injury fol- 
lowing first injury when the second accident results in total disability. 
Under the Industrial Kehabilitation Act of California,\ a similar fund 
is created, the payment being $350 for each death claim in case no heirs 
are left. 
Under the act of Congress providing for rehabilitation of persons 
disabled in industry or otherwise, commonly known as the Fess-Kenyon 
Act, the amount of $46,146.75 is available for vocational rehabilitation 
in Illinois. For each of the three years 1921-24, approximately $61,000 
will be available.§ Under the terms of this Federal law it will be neces- 
sary for the revenue from the United States Government to be matched 
with an equal appropriation for corresponding purposes by the State and 
for the service to which the money is devoted to he of the nature of 
vocational rehabilitation, under the auspices of the State Board for 
Vocational Education. In accommodating the present Illinois law to the 
requirements of the more recently enacted Federal legislation it will be 
necessary to “provide for the supervision and support of the courses of 
vocational rehabilitation to be supported by the State Board for Voca- 
tional The Federal act contemplates a certain amount of 
adjustment to conditions in the several states, although no specific 
* By the secretary of the State Industrial Commission, 
f N. Y. Consolidated Laws, chap. 67, sec. 15, par. 7, amended, 
t Calif. Laws 1919, chap. 183, sec. 1. 
§ Bulletin 57, issued by the Federal Board for Vocational Education, p. 47. 
H Sixty-sixth Congress, H. R. 4438, section 3, sub-section 4. 56 
THE DEPARTMENT OF PUBLIC WELFARE 
reference is made therein to conditions similar to those in Illinois. The 
application of the plan of administration suggested in this report will 
depend largely upon its organization under the State Department of 
Public Welfare. That feature of rehabilitation work which essentially 
must be organized under the State Board for Vocational Education, if 
Illinois is to take advantage of the Federal law and appropriation, 
appears to be the arrangement for courses of vocational rehabilitation.! 
If it should be found desirable by the General Assembly to accept the 
provisions of the Federal act referred to, it is suggested that the plan 
already adopted for administration under the Department of Public- 
Welfare may be preserved if provision be made for the supervision of 
vocational training courses by the State Board for Vocational Education. 
|| See especially enumeration of matters to be reported upon, in the second 
paragraph of the first section of the act of Congress. REHABILITATION OF PHYSICALLY HANDICAPPED 
57 
APPENDIX A-l 
LAW RELATING TO THE REHABILITATION OF PHYSICALLY HANDICAPPED 
PERSONS . 
(Laws of Illinois, Fifty-first- General Assembly, 1919, pp. 534-537.) 
REHABILITATION OF PHYSICALLY HANDICAPPED PERSONS 
§ 1. Definition. 
§ 2. Duties and powers of Department 
of Public Welfare. 
§ 3. Shall employ such persons as may 
be necessary. 
§ 4. To promulgate rules and regula- 
tions. 
Ax Act in relation to the rehabilitation of physically handicapped persons. 
Section 1. Be it enacted by the People of the State of Illinois, repre- 
sented in the General Assembly: It shall he the duty of the Department of 
Public Welfare to direct, as hereinafter provided, the rehabilitation of every 
physically handicapped person, sixteen (16) years of age or over, residing 
in the State of Illinois. 
“A physical handicapped person” shall mean any person who, by reason 
of a physical defect or infirmity, whether congential or acquired by accident, 
injury or disease, is, or may be expected to be, incapacitated for remunerative 
occupation. 
“Rehabilitation” shall mean the rendering of a person physically handi- 
capped, fit to engage in a remunerative occupation. 
“Person residing in the State of Illinois” shall mean any person who is 
and has been domiciled within the State for one year or more. 
This act, however, shall not be construed to apply to aged or helpless 
persons requiring permanent custodial care, or to blind persons under the 
care of the State, or to deaf persons under the care of the State, or to any 
epileptic or feeble-minded person or to any person who may, in the judgment 
of the Department of Public Welfare, not be susceptible of such rehabili- 
tation. 
§ 2. The Department of Public Welfare shall have power, and it shall 
be its duty: 
(a) To establish relations with all public and private hospitals to re- 
ceive prompt and complete reports of any persons under treatment in such 
hospitals for any injury or disease that may permanently impair their earn- 
ing capacity. The persons thus reported shall be visited by representatives 
of the Department of Public Welfare who shall make records of their condi- 
tion and report to the Department of Public Welfare. The Department of 
Public Welfare shall then determine whether the person is susceptible of 
rehabilitation. Such persons as may be found so susceptible shall be ac- 
quainted by the Department of Public Welfare with the rehabilitation facili- 
ties offered by the State and the benefits of entering upon remunerative 
work at an early date. Any person who chooses to take advantage of these 
rehabilitation facilities shall be registered with the Department of Public 
Welfare, and a record shall be kept of every such person and the measures 
taken for his or her rehabilitation. The Department of Public Welfare shall 
offer to any such person counsel regarding the selection of a suitable occupa- 
tion and of an appropriate course of training, and shall initiate definite plans 
for beginning rehabilitation as soon as the physical condition of the person 
permits. 
(b) To arrange with the Department of Labor to receive reports of all 
cases of injuries received by employees in the course of employment which 58 
THE DEPARTMENT OF PUBLIC WELFARE 
may result in permanent disability. The persons thus known to he injured 
shall be visited, examined, registered and advised in the same manner and 
for the same purposes as specified in Clause (a) of this section. 
(c) To receive applications of any physically handicapped persons re- 
siding within the State for advice and assistance regarding their rehabili- 
tation. The persons thus known to be physically handicapped shall be 
visited, examined and advised in the same manner and for the same purposes 
as specified in Clause (a) of this section. 
(d) To make a survey to ascertain the number and condition of physic- 
ally handicapped persons within the State. The persons thus known to be 
physically handicapped shall be visited, examined, registered, and advised 
in the same manner and for the same purposes as specified in Clause (a) 
of this section. 
(e) To arrange for such therapeutic treatment as may he necessary for 
the rehabilitation of any physically handicapped person registered with the 
Department of Public Welfare. 
(f) To procure and furnish at cost to physically handicapped persons 
registered with the Department of Public Welfare, artificial limbs and other 
orthopedic and prosthetic appliances, to be paid for in easy installments. 
(g) To establish, equip, maintain and operate in one of the large cities 
in the State, a School of Rehabilitation, and to establish, equip, maintain 
and operate branches of the school at such other places as may in the judg- 
ment of the Department of Public Welfare be necessary. There shall be pro- 
vided at the school and its branches courses of training in selected occupa- 
tion for physically handicapped persons registered with the Department of 
Public Welfare whose physical condition may, in the judgment of the Depart- 
ment of Public Welfare, require special courses of training to render tliem 
fit to engage in remunerative employment and who are assigned by the De- 
partment of Public Welfare to the school or to any of its branches for the 
purpose of such special training. 
The Department of Public Welfare shall make the necessary rules for 
the proper conduct and management of the school and its branches; shall 
have control and care of the building and grounds used by the State for 
the school and its branches, and shall prescribe the course and methods of 
training to be given at the school and its branches. 
(h) To arrange with the State and local school authorities for training 
courses in the public schools of the State in selected occupations for 
physically handicapped persons registered with the Department of Public 
Welfare. 
(i) To arrange with any educational institution for training courses 
in selected occupations for physically handicapped persons registered with 
the Department of Public Welfare. 
(j) To arrange with any public or private organization or commercial, 
industrial or agricultural establishment for training courses in selected 
occupations for physically handicapped persons registered with the Depart- 
ment of Public Welfare. 
(k) To provide for the maintenance, during the prescribed period of 
training, of physically handicapped persons registered with the Department 
of Public Welfare: Provided, that the cost of such maintenance shall not 
exceed ten dollars ($10.00) per week for twenty weeks, unless an extension 
of time is granted by the Department of Public Welfare. 
(l) To arrange for social service to and for the visiting of physically 
handicapped persons registered with the Department of Public Welfare and 
their families in their homes during the period of treatment and training 
and after its completion, and to give advice regarding any matter that may 
effect rehabilitation. 
(m) To cooperate with the Department of Labor in the placement in 
remunerative employment of physically handicapped persons registered with 
the Department of Public Welfare. 
(n) To conduct investigations and surveys of the several industries 
located in the State to ascertain the occupations within each industry in 
which physically handicapped persons can enter upon remunerative employ- 
ment under favorable conditions and work with normal effectiveness and REHABILITATION OF PHYSICALLY HANDICAPPED 
59 
to determine what practicable changes and adjustments in industrial opera- 
tions and practices may facilitate such employment. 
(o) To make such studies and reports as may be helpful for the opera- 
tion of this act. 
(p) To keep the people of the State informed regarding the operation 
of this act. 
(q) To cooperate with any department of the Federal or State govern- 
ment or with any private agency in the operation of this act. 
(r) Provided, however, that no person shall be subject to this act or 
to any of its provisions, and shall not be examined, registered, or advised 
unless such person first elects to take advantage of the privileges afforded 
by this act and to come under its terms and conditions. 
§ 3. The Department of Public Welfare, subject to the provisions of 
civil service law which is now or which hereafter may be in force in this 
State, shall employ such persons as may be necessary for the enforcement 
of the provisions of this act, and shall prescribe their duties, compensation 
and terms of employment. 
§ 4. The Department of Public Welfare shall promulgate reasonable 
rules and regulations relating to the enforcement of the provisions of this 
act. 
Approved June 28, 1919. 
APPENDIX A-2 
ORGANIZATION AND PROCEDURE! OF THE PRESENT SURVEY 
Beginning with the appointment of William T. Cross, of Chicago, 
as survey officer on February 15, 1920, the survey has been organized 
with the following staff: 
Name. 
TABLE I—STAFF OF THE SURVEY 
Type of Service Rendered. 
Period 
. of Service. 
William T. Cross 
Organization and direction of 
the survey 
Feb. 
15 
to 
Jan 
10 
Margaret W. Wagner 
Assistant with case studies and 
agency surveys 
Aug. 
18 
to 
Jan. 
10 
Dr. John D. Ellis 
Part time advisory service re- 
lating to medical problems 
Aug. 
15 
to 
Oct. 
30 
Charles M. Larcomb 
Assistant with industrial studies 
and with summary of survey 
June 
22 
to 
Oct. 
15 
results 
Nov. 
15 
to 
Dec. 
15 
Helen Perry 
Field worker, Chicago block 
study 
Nov. 
22 
to 
Dec. 
15 
E. LeRoy Walters 
Assistant with industrial studies 
June 
22 
to 
Sept. 1 
H. D. Byrne 
Student investigator, study of 
placement training 
June 
1 
to 
Dec. 
15 
Mrs. Lulu C. Starkey 
Secretarial and clerical service 
March 1 
to 
Jan. 
10 
Della Sideman 
Stenographer 
Aug. 
26 
to 
Dec. 
15 
In addition to the above, special service in connection with com- 
munity studies has been rendered by Prof. E. W. Burgess of the Uni- 
versity of Chicago, and a number of students under his supervision; by 
the Macon County Chapter American Red Cross, Mrs. Inez J. Bender, 
executive secretary; by the Board of Education of Springfield and the 
Sangamon County Chapter American Bed Cross; and by the LaSalle 
County Chapter, American Bed Cross, Miss Effie E. Doan, executive 
secretary, in connection with a study of the Tri-Cities (LaSalle, Peru, 
and Oglesby). The Central Division of the American Red Cross, 
through the services of Mr. Walter E. Davidson, associate manager, has THE DEPARTMENT OF PUBLIC WELFARE 
encouraged its local chapters in Illinois to undertake studies of the 
physically handicapped in connection with the State survey. 
Generous assistance has been given by a number of leading phy- 
sicians and surgeons, teachers, social workers and executives of com- 
munity agencies. Dr. Frank Billings, formerly chief of the Division of 
Physical Reconstruction of the United States Army and Dr. Harry E. 
Mock, of the staff of the same division, have given extensive considera- 
tion to the survey during its progress and have contributed to the present 
statement of results. 
The State Department of Labor has generously donated office space 
and facilities at the Chicago Free Employment Bureau, upon recom- 
mendation of the superintendent of the bureau, Mr. Charles J. Boyd. 
The State Industrial Commission has furnished information concerning 
persons injured at work and the operation of the Compensation- Act. 
Other State departments, through related divisions, have facilitated the 
study by furnishing information. 
In dealing with medical and social agencies and various public 
departments, both State and local, special effort has been made to develop 
relationships that will be advantageous when administration of the 
Rehabilitation Act is undertaken. 
Numerous national and state authorities outside Illinois have assisted 
with information. Some of the more significant developments outside 
Illinois have been observed at first hand bv the survey officer. 
APPENDIX A-3 
NOMENCLATURE IN THE DIAGNOSIS OF PHYSICAL DISABILITIES 
In order to secure reports of physical disabilities from medical in- 
stitutions, physicians and welfare agencies, which will be uniform and 
mutually understood, a schedule of the more important types of dis- 
ability has been prepared. This is based on the schedule, adopted 
recently by a committee representing the United States Bureau of 
Census.* 
It has been submitted for criticism, to a number of leading 
physicians of Chicago. 
The grouping and numbering as shown here correspond to the 
original list. A more extensive schedule than the one reproduced here 
has been prepared also. It is suggested that in reports of hospitals and 
other agencies, under the Rehabilitation Act this nomenclature be used: 
II. Tuberculosis, pulmonary. (Arrested.) 
Tuberculosis, all other. (What parts?) 
III. Veneral Disease: 
Syphilis, all of what part or system? 
* Standard Nomenclature of Diseases and Pathological Conditions, Injuries 
and Poisonings, Bureau of Census, 1919. REHABILITATION OF PHYSICALLY HANDICAPPED 
61 
IV. General Diseases: 
Tumors, of what part? 
Cretinism. 
Goiter, simple. 
Exophthalmic goiter. 
Diabetes. 
Poisoning, chronic—clue to what? 
V. and VI. Nervous and Mental Diseases: 
Speech, defective. 
Neurasthenia. 
Multiple sclerosis. 
Epilepsy. 
Jacksonian epilepsy. 
Hysteria. 
Tubes dorsalis. 
Other diseases of nervous system. 
VII. Diseases of the Eye: 
Blindness. 
Defective vision, one or both eyes? 
VIII. Diseases of the Ear: 
Defective hearing, one or both ears? 
Deafness. 
IX. Diseases of the Nose. 
X. Diseases of the Throat. 
XI. Circulatory System: 
“Heart disease.” 
“Weak heart.” 
Aneurysm, where? 
Hemorrhoids. 
Varicose veins. 
Varicocele. 
XII. Respiratory System: 
Asthma. 
Bronchitis, chronic. (Cause.) 
XIII. Digestive System: 
Hernia. (Location.) “Threatened and incipient 
hernia.” 
Inguinal rings, enlargement of. 
Fistual in ano. 
Other diseases of digestive system. 
XIV. Genito-urinary System: 
Nephritis, chronic. 
“Brights disease.” 
“Kidney disease.” 
Nephroptosis—“floating kidney.” 
Hydrocele. 
XV. Diseases of the Skin: 
Large disfiguring scar of face. 
Disfiguring or offensive skin disease. 
XVI. Bones and Organs of Locomotion: 
Osteitis deformans — “deforming rheumatism.” 
(What part affected?) 
Ankylosis, of joint—“stiff joint.” 
Bursitis. 
Tenosynovitis. 
Relaxed ligaments of joint. 
Joint, resection of. 
Chronic dislocation. 
Bunion. 
Hammertoe. 
Ingrowing nail. 
Loss of part of foot. 
Deformities of foot. THE DEPARTMENT OF PUBLIC WELFARE 
Depressed fracture of skull. 
Deformities of hand. 
Loss of one or more fingers. (Which ones? Which 
hand? Man right handed?) 
Loss of part or whole of lower extremity. 
Paralysis, part or whole lower extremity. 
Scar of head or neck. 
Deformity of spine. 
Hernia of muscle. 
Other diseases of bones and organs of locomotion. 
Healed fractures with deformity interfering with 
function of part. 
XVII. Malformation and Ill-Defined Diseases: 
Defective physical development. 
Overweight. 
Underweight. 
Malnutrition. 
Crytorchidism. 
Fistula, post operative. 
Fistula, other. (Where?) 
Ill-defined diseases. 
APPENDIX A-4 
PLAN OF A CENTRAL REGISTRATION OF CASES OF PHYSICAL HANDICAP FOR 
A LARGE CITY 
Every agency and institution dealing with physically handicapped 
persons would be asked to register its cases with this bureau. Any 
agency making inquiry about a specific person Avould be given the in- 
formation recorded, including the names of whatever agencies had prev- 
iously handled the case. The request for establishing the registry for 
the handicapped may well come from a meeting of representatives of the 
more important agencies concerned with registration, or from the Council 
of Social Agencies, if such a central association exists in the city. 
The immediate advantage of this bureau would be the practical 
service it would render as a clearing house for community agencies 
dealing with the physically handicapped. At the same time through 
the efforts of various agencies joining in the plan, a common under- 
standing would be reached regarding the classes of disabled persons 
being handled, the particular needs served by each agency, and parts of 
the field for which no provision may have been made. 
The present State survey of the physically handicapped, and local 
studies made in connection therewith, would be used as a stimulus to all 
agencies to register their cases. 
A central registry for any large city may be the barometer of the 
physically handicapped. By this means may be learned the character 
and volume of work being done for the handicapped and more essential 
facts about all cases now under treatment. 
Such registry may be organized effectively under the staff of the 
Social Service Begistration Bureau, if any such central clearing house 
exists in the city. The cards may be kept separate, and the management 
supervised by a specially appointed committee. The cards at the Begis- REHABILITATION OF PHYSICALLY HANDICAPPED 
63 
tration Bureau would indicate automatically the number of handicapped 
persons known to the various agencies, their types of disability, and 
certain other items such as are included on the following form for a 
card measuring 3 by 5 inches: 
Surname 
Man 
Born 
Woman 
Born 
Children 
Born 
Born 
Born 
Eng.-' 
Diagnosis 
By 
Residence 
In 
School3 
At 
Work 
Date 
Registering 
Agencies 
1 Handicapped person to be listed on fourth line. 
2 “Eng. ’’ signifies whether'handicapped person reads and writes English. 
3 Each registering agency indicates whether, at the time, the handicapped person is in school or at 
work. 
Anticipating that the number of cases on record at the end of the 
first year would be 10,000, the cost of establishing a registry of the 
physically handicapped in connection with an existing Social Service 
Registration Bureau, and operating it the first year is estimated to be 
between $600 and $1,000. For the second and third years, it is estimated 
that the saving (over the first year) in equipment, materials and service, 
would be offset by increase in volume of business. 
APPENDIX B-l 
COMMUNITY CENSUSES OF CHICAGO, DECATUR AND OTHER CITIES 
In school censuses made during the early summer of 1920, physically 
handicapped persons were listed as shown on the first four lines of the 
following table. In each instance the local school board received a 
schedule of disabilities to be included, and suggestions to census enumera- 
tors concerning methods of finding physically handicapped persons. The 
types of disability considered are given on page 443 of the present report. 
At Springfield and Decatur, the enumerators were teachers, and before 
making the canvass met with the State survey officer and an orthopedic 
surgeon. In these two cities, adults were included in the returns. 
For Chicago, a series of districts which are considered to have a 
“working class population” were selected and each house visited by a 
student in the sociology department of the University of Chicago. 
At both Chicago and Decatur persons listed as physically disabled in 
the house-to-house canvass were later visited by trained workers and 
more complete information secured. TABLE I—PROPORTION OF PHYSICAL DISABILITIES IN POPULATION AS SHOWN BY 
FIRST HOUSE-TO-HOUSE CANVAfe. 
THE DEPARTMENT OF PUBLIC WELFARE 
City. 
Population* 
of city or 
districts. 
Age group 
included 
in census. 
Number of 
disabled 
persons. 
Per cent. 
59,183 
43,818 
*35,000 
5,606 
11,172 
all ages 
all ages 
902 
1.6 
893 
2.0 
96 
.3 
33 
.6 
Chicago-.. - 
all ages 
568 
5.1 
* Springfield, Decatur, Danville, 1920 United States census; Taylorville, estimate by Superinten- 
dent of schools; Chicago special census from house-to-house visitation. 
The relation of findings from the initial canvass to the results of the 
second visitation is shown for Chicago and Decatur by the following 
table: 
TABLE II—REHABILITATION PROBLEMS REPRESENTED AMONG CASES ORIGINALLY 
NOTED AS DISABLED. 
Chicago. 
Decatur. 
Number. 
Per cent 
of total 
population. 
Number. 
Per cent 
of total 
population. 
11,172 
43,818 
568 
893 
Group A. No schedules made— 
Groups not revisited, including cases discarded as in- 
dicating minor disabilities— * 
*16 
*8 
17 
108 
318 
*9 
*49 
*85 
235 
375 
Group B. Schedule cases, not counted as physically 
handicapped— 
2 
20 
11 
4 
15 
51 
3 
82 
87 
113 
162 
Group C. Physically handicapped persons— 
Adults, disability serious, but does not interfere with 
present work __ 
f59 
.46 
119 
.24 
Need rehabilitation— 
Adults.- 
101 
.90 
80 
.18 
Children.- - 
60 
.53 
157 
.36 
220 
356 
Handicap cases estimated for starred items 
52 
.47 
41 
.37 
Proportion of physically handicapped persons and others 
2.36 
1.15 
t Includes 3 children. 
The schedules used on second visitation, and filled out more com- 
pletely for persons in Group C as shown in the foregoing table, were as 
follows, for adults and for children, respectively: REHABILITATION OF PHYSICALLY HANDICAPPED 
Please write plainly 
with pen 
1 Name 
City 
Street and number 
By whom filled out 
Official connection 
Sex 
Age 
(Years) 
Color or 
race 
Born what 
country 
How long 
in U. S. 
(Years) 
How long 
in Illinois 
(Years) 
Speak 
English 
Last removal from (Town and State) 
Date form filled out 
HANDICAP AND ECONOMIC CONDITION 
(use key LIST OF HANDICAPS, FORM 2) 
Part of body 
affected 
Ampu- 
tation? 
Nature of injury 
Injured 
at work? 
Congenital defect 
Disease or condition 
Condition 
(check) 
static 
improving 
growing 
worse 
Now receiving 
medical 
treatment? 
Date became 
handicapped 
At age of 
(years) 
Use of artificial limbs, 
appliances, etc. 
Education (check) 
Common school 
Grade 
High school 
College 
Married 
or 
single 
(check) 
Number in 
household 
Circumstances of becoming handicapped 
Economic condition (check) 
Dependent 
Partially self-supporting 
Self-supporting 
Supporting others 
Compensation for industr 
Total received Compensation 
to date ceased when 
S 
ia 
1 injury 
Total in To cover 
prospect period of 
Family income per week from 
Insurance Charity 
S $ 
List every person who is handicapped “by reason of a physical defect or infirmity, whether congenital or acquired by accident, injury or disease, ” 
STATE OF ILLINOIS DEPARTMENT OF PUBLIC WELFARE 
ENUMERATION CARD 
SURVEY OF THE PHYSICALLY HANDICAPPED 
Form 1 
For persons over 
15 years of age 
—5 R P H THE DEPARTMENT OF PUBLIC WELFARE 
PRESENT CIRCUMSTANCES 
PREVIOUS TO HANDICAP 
Description of occupation (Be specific) 
1. General class of industry 
2. Exact job, or operations performed 
Description of occupation (Be specific) 
1. General class of industry 
2. Exact job or operations performed 
Posture at 
work 
* 
Number of 
years at this 
occupation 
Steady or 
casual 
(check) 
Average earn- 
ings per week 
$ 
Number of years 
at this occupation 
Steady or 
casual 
(check) 
Average earnings 
per week 
Name and address of present employer 
Name and address of employer at time of handicap 
Check if same 
establishment 
where handicap 
occurred 
Check if never 
has worked 
Managing own 
business 
One other employer and address 
* 
COMMENT 
Return this enumeration form, properly filled out, to William T. Cross, Survey Officer, 116 N. Dearborn St., Chicago. 
EMPLOYMENT AND INDUSTRIAL ADJUSTMENT REHABILITATION OF PHYSICALLY HANDICAPPED 
67 
Child Surname Given name 
Name of parent 
City 
Street and number 
By whom filled out 
Official connection 
Sex 
Age 
(Years) 
Color or race 
Mother 
Born what 
country 
How long 
in U. S. 
(Years) 
How long 
in Illinois 
(Years) 
Speak 
English 
Last removal from 
(Town and State) 
Date form filled 
out 
Father 
SCHOOL AND HOME 
In Elementary School 
-- - - grade 
High school 
- year 
School attending 
Distance 
Walk to school 
Means of transportation 
Household 
Father... 
Mother _ ... 
Children (No.) 
Others (No.) 
Employed 
Number of 
children in 
school 
Economic condition 
of family 
Good 
Fair 
Poor 
Parental attitude 
toward treatment 
for child 
Assistance being received 
Assistance needed by family (To secure apparatus, transportation, vocational education, etc.;) 
Lack of ability or 
compensatory ability 
developed in 
Eating Dressing Cleanliness 
Locomotion Vocation 
Please write plainly 
with pen 
List every child who “by reason of a physical defect or infirmity, whether congenital or acquired by accident, injury or disease, is or may be expected to be incapacitated for 
remunerative occupation.” 
STATE OF ILLINOIS, DEPARTMENT OF PUBLIC WELFARE 
CHILD STUDY CARD 
SURVEY OF THE PHYSICALLY HANDICAPPED 
Form 5 
For children under 
16 years 
(35470—5m-6-20) THE DEPARTMENT OF PUBLIC WELFARE 
Part of body 
affected 
Ampu- 
tation? 
Nature of injury 
Injured at 
work? 
Congenital defect 
Disease or condition 
Condition 
(check) 
static 
improving 
grp wing 
worse 
Date became 
handicapped 
At age of 
(Years) 
Use of artificial limbs, 
appliances, etc. 
Now receiving 
medical 
treatment 
Name and address of family physician 
Circumstances of becoming handicapped 
0 
History of tuberculosis 
in family 
Former diagnosis 
When 
Physician or hospital 
Former or present treatment 
(Underscore which) 
Other hospitals in which child has been 
When 
For what cause 
Attending physician or surgeon. 
Other physical defects 
Treatment prescribed for physical handicap 
By Dr. 
Return this form, properly filled out, to William T. Cross, Survey Officer, 116 N. Dearborn St., Chicago. 
HANDICAP AND ECONOMIC CONDITION 
(use key list of handicaps, form 2) REHABILITATION OF PHYSICALLY HANDICAPPED 
DESCRIPTION OF DECATUR AND CHICAGO AREAS 
The population of Decatur increased 40.7 per cent during the decade 
1910-20. While the city is in an agricultural section, it has 82 factories* 
employing approximately 11,000 people, 1,000 of whom are women. In 
Decatur are located the Wabash Eailroad shops, employing about 2,700 
men. Two coal mines are being operated there. The place is noted also 
for corn milling and for the manufacture of brass plumbing and soda 
fountains. 
The Chicago area consists of blocks, located in all parts of the city, 
which had been studied two years previously by the State Health Insur- 
ance Commission. Concerning their selection it is said in the report of 
the commission (p. 180) : 
Instead of the geographical block the social block was made the unit 
of investigation. By social block is meant the two sides of a residential 
street. Social and civic workers recognize that the social block repre- 
sents a natural social group and that the alley is a line of separation 
rather than of communication between the families. 
The blocks studied were carefully chosen in order to be representa- 
tive of Chicago’s wage-earning population. The investigations made by 
the School of Civics and Philanthropy into housing conditions in Chicago 
were utilized in the selection of blocks with known differences in physical 
structure, racial composition and economic condition. So far as possible 
a normal distribution of the different immigrant and racial groups in 
Chicago are provided for. An attempt was also made to secure adequate 
representation of all degrees of economic condition from casual laborer 
to the skilled workman. The location of blocks with reference to dis- 
pensaries, hospitals and other welfare agencies was given special atten- 
tion, and their geographical position in relation to the chief industries 
of the city was taken into account. 
A wage-earning family is defined in this study (see p. 184) as 
being one in which the normal or the chief breadwinner is working for 
an employer for a stipulated wage paid most frequently by the week, 
but occasionally by the day or the month. 
While the Decatur results may be considered to be representative of 
the middle-size cities of Illinois, the Chicago areas cannot be taken as 
typical of the entire city or of metropolitan centers. The result is prob- 
ably high in proportion of physically handicapped persons to population, 
especially on account of the number of persons who are employed and 
are exposed to industrial accidents. This very circumstance, however, 
adds to the importance of the study. 
ANALYSIS OF RESULTS 
The types of disability represented by these cases are an important 
feature of the study, although an analysis cannot be given in this 
summary. 
Classification was made into the two groups, “Heed Rehabilitation,” 
and “Handicap Does Hot Interfere with Present Employment,” on the 
following basis: 
The “Heed Rehabilitation” group consists of men who in almost 
every case need medical attention. They are idle, holding temporary 
* Data on industries taken from recent community study made by the local 
chapter of the American Red Cross. THE DEPARTMENT OF PUBLIC WELFARE 
or makeshift jobs, have work unsuited to their disabilities, or are young 
men with fair education who, evidently for lack of better opportunities, 
have drifted into lower grade occupations. In the majority of cases, 
however, medical assistance will be necessary before any progress can be 
made toward an economic readjustment. For children, the same classi- 
fication was made, with the interpretation that “Need Rehabilitation” 
indicates need of attention from the medical, educational or social service 
standpoint. 
The second group, “Disability Does Not Interfere with Present Em- 
ployment,” are men who have had adequate medical attention, and are 
highly skilled, semi-skilled or holding jobs suited to their education, 
experience and handicap. A man 65 years old, with partial paralysis, is 
allowed to remain in the second group, but a boy of 22 with the same 
disability, doing the same work, calls for rehabilitation. 
The classification then is based on: 
1. Need of medical treatment. 
2. Need of occupation. 
3. Need of change of occupation, because of 
(a) Age. 
(b) Disability. 
(c) Capability. 
THE MORE SERIOUSLY DISABLED 
Those considered to be seriously disabled and of special interest in 
connection with the Rehabilitation Act are here grouped for study. 
The figures used correspond to the three items in Group C of table 2, 
preceding. Age and sex, for the group, are as follows: 
TABLE III—SEX AND PRESENT AGES OF THE MORE SERIOUSLY DISABLED PERSONS, 
DECATUR AND SELECTED AREAS IN CHICAGO. 
* 
Decatur. 
Chicago. 
Number. 
Per cent 
of those 
stated. 
Number. 
Per cent 
of t ose 
stated. 
Children*— 
0- 2 years ... 
2 
1.3 
6 
10.0 
3- 5 years, 
15 
9.6 
11 
18.3 
6- 9 years 
55 
35.3 
23 
38.4 
10-15 years-- 
84 
53.8 
20 
33.3 
1 
Total 
157 
100.0 
60 
100.0 
Men— 
16-19 years 
14 
15.2 
9 
10.6 
20-29 years 
17 
18.5 
12 
14.1 
30-39 years 
14 
15.2 
32 
25.9 
40-49 years_ 
20 
21.7 
17 
20.0 
50-59 years 
15 
16.3 
17 
20.0 
60 and over 
12 
13.1 
8 
9.4 
Total 
92 
100.0 
85 
100.0 
* For Decatur the proportion of male children is 55 per cent, and for Chicago 54 per cent. REHABILITATION OF PHYSICALLY HANDICAPPED 
71 
TABLE III—Concluded. 
Decatur. 
Chicago. 
Number. 
Per cent 
of those 
stated. 
Number. 
Per cent 
of those 
stated. 
Women— 
16-19 years 
14 
13.1 
9 
13.0 
20-29 years... 
16 
15.0 
9 
13.0 
30-39 years 
27 
25.2 
18 
26.1 
40-49 years 
24 
22.4 
10 
14.5 
50-59 years 
14 
13.1 
15 
21.8 
60 and over. 
12 
11.2 
8 
11.6 
1 
Total 
107 
100.0 
70 
100.0 
Grand total 
356 
215 
The relations of groups in the foregoing table are shown more 
clearly as follows: 
DecatUT. Chicago. 
Children 157 ..44 per cent 60 28 per cent 
Men 92 26 per cent 85 40 per cent 
Women 107 .30 per cent 70.. .32 per cent 
The comparatively large proportion of children in the Decatur 
group may be due partly to better medical facilities and organization in 
Chicago. The greater proportion of men in Chicago may be due largely 
to the greater number of industrial accidents, as shown in a later table.. 
In the preceding table and the one that follows, it is especially 
necessary to keep in mind the fact that the cases under study are selected 
as having an important relation to the problem of rehabilitation. Recon- 
struction measures will be directed chiefly toward the treatment of 
disabilities at the time of their occurrence. Table 4 shows the age of 
occurrence of disabilities: 
TABLE IV—AGE OF OCCURRENCE OF DISABILITY, OF SERIOUSLY DISABLED 
PERSONS. 
Age of occurrence. 
Decatur. 
Chicago. 
Number. 
Per cent 
of those 
stated. 
Number. 
Per cent 
of those 
stated. 
Children— 
At birth 
16 
17.6 
21 
39.6 
0- 2 years 
21 
23. 1 
14 
26.4 
3- 5 years.. 
26 
28.5 
3 
5.7 
6- 9 years 
19 
20.9 
8 
15.1 
10-15 years 
9 
9.9 
7 
13 2 
66 
7 
Total. 
157 
100.0 
60 
100.0 TIIE DEPARTMENT OF PUBLIC WELFARE 
TABLE IV—Concluded. 
Decatur. 
Chicago. 
Age of occurrence. 
Number. 
Per cent 
of those 
stated. 
Number. 
Per cent 
of those 
stated. 
Men— 
11 
12.5 
24 
27.3 
5 
6.1 
11 
12.5 
7 
8.5 
3 
3.4 
8 
9.7 
9 
10.2 
14 
17.1 
10 
11.4 
15 
18.3 
7 
8.0 
18 
22.0 
13 
14.7 
15 
18.3 
4 
3 
92 
100.0 
85 
100.0 
Women— 
At birth 
11 
11.6 
2 
3 0 
19 
20.0 
6 
9.0 
9 
9.5 
2 
3.0 
6 
6.3 
5 
7.4 
15 
15.8 
12 
17.9 
17 
17.9 
18 
26.9 
10 
10.5 
13 
19.4 
8 
8.4 
9 
13.4 
12 
3 
107 
100.0 
70 
100.0 
356 
215 
From this analysis it appears that 70 per cent of the handicapped 
children became disabled before reaching school age. Forty per cent 
of the women became disabled in the period of 20-39 years. 
STUDY OF DISABLED MEN 
For the men, the proportions are as follows 
Decatur. 
Chicago. 
Number of cases.- 
.. 88 
82 
Under 16 years .. ... 
.... ..... . 52.3 percent 
14.6 per cent 
16-29 years. _ _ _ ._ 
_ _ .13. 6 per cent 
26.8 per cent 
30 and over _. 
. . 34.1 per cent 
58.6 per cent 
A striking number in Decatur were disabled before reaching 16. 
This may indicate the result of neglect of adjustment in early life. The 
small proportion occurring in the period 16-29 years is due in part to the 
comparative infrequency of industrial accidents. The Chicago figures 
show, in comparison, a high percentage of disabilities occurring above 30 
years of age—a period of exposure to industrial accidents and of greater 
difficulty in readjustment following illness or injury. The relations, as 
to injuries and Americanization, are as follows: 
Decatur. 
Chicago. 
Industrial accidents 
... 16 per cent 
38 per cent 
American born ._ 
97 per cent 
48 per cent 
The average length of residence in the United States, for the Chi- 
cago gronp, is 21 years. 
By comparing the men in these two cities who “Need Rehabilita- 
tion” and those who seem to have made satisfactory adjustments, light is REHABILITATION OF PHYSICALLY HANDICAPPED 
73 
thrown on the conditions that affect rehabilitation. The more important 
of these circumstances appear to be as follows: 
TABLE V—COMPARISON OF SERIOUSLY DISABLED MEN WHO “NEED REHABILITA- 
TION” AND THOSE WHO DO NOT. 
“Need rehabilitation.” 
Disability does not 
interfere with present 
employment. 
Number 
32 
50 
Occupation and change at time of becoming disabled. 
Seriousness of disability 
Chicago ..48 
Decatur— 
Chiefly unskilled 
before becoming 
disabled. Tend- 
ency to change to 
casual work, or 
not re-employed. 
50 per cent not 
now employed. 
Chicago— 
50 per cent not now- 
employed. 
Does not appear to affe 
Chicago 37 
Decatur— 
Same work or better 
position. 56 per 
cent now at 
skilled work. 
ct situation in either 
Decatur 
or Chicago. 
Chicago.. 
... 5 per cent 
Chicago 
Average number in family 
Chicago-. 
...14 per cent 
Chicago 
.59 per cent 
Proportion injured at work. 
Chicago.. 
... 5 per cent 
Chicago 
. 5 per cent 
Proportion disabled under 16 years of age 
Chicago.. 
..47 per cent 
Chicago 
.24 per cent 
Proportion disabled 16-19 years of age 
Chicago. _ 
...6 per cent 
Chicago 
.27 per cent 
Chicago.. 
-..13 per cent 
Chicago... 
6 per cent 
While the specific occupations in which the more successful men are 
engaged in some instances suggest lines for others to follow, they vary 
greatly and apparently are not the cause of success. 
WOMEN" AND CHILDREN 
The chief occupation of the disabled women is that of the house- 
wife. The gainfully employed women who do not “Need Rehabilitation” 
are more frequently doing skilled work than are the others. 
The school attendance of children in need of some rehabilitation 
service is shown as follows: 
TABLE VI—SCHOOL ATTENDANCE, 217 CHILDREN UNDER 16 YEARS OF AGF 
“NEEDING REHABILITATION." 
Decatur 
Chicago. 
Number. 
Per cent 
of those 
stated. 
Number. 
Per cent 
of 1 hose 
stated. 
Below school age-- - _ .... - - 
14 
8.9 
16 
27.6 
Of school age— 
In regular school. 
119 
75.8 
24 
41.4 
Special schools or class, or private tutor 
1 
.6 
5 
8.6 
Notin school .. 
23 
14.7 
13 
22.4 
2 
Total - 
157 
100.0 
60 
100.0 74 
THE DEPARTMENT OF PUBLIC WELFARE 
For the same group of children, the investigator’s indication of 
economic condition of the family is here summarized: 
TABLE VII—ECONOMIC CONDITION OF FAMILIES OF 217 PHYSICALLY 
HANDICAPPED CHILDREN “NEED.NG REHABILITATION.” 
Decatur. 
Chicago. 
Total. 
Per cent 
of those 
stated. 
53 
24 
•77 
39.5 per cent 
66 
20 
86 
44.1 per cent 
21 
11 
3 • 
16.4 per cent 
17 
5 
22 
157 
60 
217 
100.0 per cent 
FURTHER ANALYSIS 
The value of the information contained in the case records of the 
surveys of Decatur and of Chicago blocks is much greater than is shown 
in the summaries here given. It would be especially profitable to study 
the relations of types of disability to remunerative occupation and to 
make a more intensive examination of the rehabilitation problems rep- 
resented. 
APPENDIX B-2 
TWENTY-FIVE INJURED COAL MINERS 
Injured coal miners present perhaps greater problems of rehabilita- 
tion than the victims of any other type of industrial accident in Illinois. 
During the year 1919, 28 per cent of the more serious injuries covered by 
the Compensation Act occurred in the coal mining business. (See 
Appendix F-5 to this report.) This was nearly twice as many as 
occurred in the industry nearest in number of serious accidents, namely, 
the metal trades. Forty-one per cent of all total disabilities during 
1919 occurred in coal mining. 
The problem is as important in the degree of occupational disability 
that results, and the difficulty of reestablishment, as it is in the number 
of persons injured. The coal miner usually has spent most of his work- 
ing life under ground, and he has had few, if any, other occupational 
associations. Many coal miners do not read and write English. 
Mining communities ordinarily afford little variety of occupations, 
or chance for learning new trades. They do not have welfare agencies 
that are developed and differentiated in types of service rendered. Even 
in the larger cities in mining districts, the injured coal miner presents 
a problem that is recognized as baffling by agencies engaged in family 
rehabilitation. 
How serious and extensive is this problem is indicated somewhat 
by the following summary of twenty-five cases of seriously injured coal REHABILITATION OE PHYSICALLY HANDICAPPED 
miners in an Illinois mining village of 1,872 population (1910 census). 
These records were secured by Dr. John S. Coulter,* an industrial 
surgeon of Chicago. They do not represent all the seriously injured 
miners in this community, nor do they show the extent of physical handi- 
cap when the effects of other accidents and of disease are considered; 
yet these twenty-five eases constitute 1.3 per cent of the population of 
the village. 
The problems of rehabilitation represented in each of these cases is 
illustrated by the following description. Other illustrations of the 
problem of the injured coal miner are given near the beginning of the 
report: 
John Samon was hurt while working in the mines in 1919. He was 
told he had a sprained back and tried to return to work, but was unable 
to. A later examination showed that he had four fractures in his spine. 
He was awarded compensation on the basis of permanent total disability. 
The case appealed and in consequence Samon has received mo compen- 
sation for 6 months. He is about 40 years old, intelligent, and had 
wrorked for this company for four years. He can do any light work that 
does not entail heavy lifting. He receives a small income, $100 a month 
from his position as “town policeman,” which in this instance is not 
a dependable job, nor does it afford him a good outlet for future em- 
ployment. 
The condition of the 25 men about whom information has been 
secured is summarized as follows: 
Ages.—From 25 to 61 years, average 40. Seventeen are 40 or less. 
Disability.—Twenty-two are spinal fractures or sprains. 
Time since Injury.—-Within the last year in 21 cases. 
Present Occupation.—No occupation in 19 cases. The remaining 
six are as follows: 
Selling soft drinks. 
Selling claims. 
Policeman. 
Loader in mine. 
Mine committeeman. 
Light work in mine. 
Number of Years Worked for Present Alining Company.—In 23 in- 
stances, for one year or longer; average, 3 years. 
Job in the Aline.—Per week: For 20 men, average $12.81 ; the 
remaining five being as follows: 
One, receiving no income. 
One has just received a cash compensation settlement of $2,000. 
Two, working in mine, at standard scale. 
One, temporarily $9 a day as mine committeeman. 
Source of Present Income.—Compensation payments in 21 cases; 3 
paid wages by mining company, and the policeman paid by the town. 
* See also “Industrial Clinics” by Drs. Paul B. Magnuson and John S. Coulter, 
J. B. Lippincott & Company, 1920. THE DEPARTMENT OF PUBLIC WELFARE 
Number in Family.—Six single men, 6 with only 2 in family, the 
remaining thirteen men averaging 4.4 members in the family. 
Other Occupations Known.—“None” in 23 cases; one of the remain- 
ing two understands farming and the other clerical work. 
Bead and Write English.—Yes, 11; no, 14. 
APPENDIX C-2 
PHYSICALLY HANDICAPPED PERSONS KNOWN TO SOCIAL AGENCIES OF 
CHICAGO 
(Preliminary report.) 
Inquiries have been sent recently to social agencies of Chicago* 
that were most likely to be acquainted with physically handicapped per- 
sons. No hospitals, dispensaries, clinics, public departments or institu- 
tions were included. The types of cases to be considered were explained 
as in other inquiries covered by this report. The returns received are 
summarized as follows: 
Number of agencies to whom inquiry was sent 220 
Number of replies received 157 
Agencies from which replies were received indicating they were in 
touch with physically handicapped persons were asked to furnish indi- 
vidual case record forms. One of the three forms that were used for 
this purpose is reproduced here: 
CASE RECORD FOR SURVEY OF PHYSICALLY HANDICAPPED. STATE DEPARTMENT 
OF PUBLIC WELFARE, 116 N. DEARBORN STREET, CHICAGO. 
Confidential information Form 10. 
Agency 
By whom filled out 
Handicapped person 
Sex 
Race or color 
Single 
Address 
Age 
Born where 
Married 
Diagnosis of Disability 
How does disability interfere with work 
Cause of Disability 
Dale became Any artificial 
disabled applicances used 
Present Occupation 
Wages | Occupation before handicap Wages 
School grade reached Speak English Read English Write English 
Service rendered by Agency to Handicapped Person 
* As listed in the Social Service Directory, published by Department of Public 
Welfare of Chicago, 1918 edition. REHABILITATION OF PHYSICALLY HANDICAPPED 
77 
Form lOx 
Living with whom: 
Dependent 
Condition (check) 
Static 
Improving 
Growing worse 
Does what kind of work: 
Habitual posture 
Bedridden 
Wheel-chair case 
Hours per day 
able to work 
Average weekly 
earning 
If work is irregular state reason why: 
Able to go out 
Means of Locomotion 
Assisted 
Unassisted 
Has what form of recreation: 
Attitude toward home work: 
History of case: 
Tli9 number of physically handicapped persons reported by various 
agencies is shown by the following table: (Table I.) 
There is no duplication between the two columns of figures in the 
table; hence the results of the inquiry may be stated as follows: 
1. Number of agencies reporting 157 
Have no physically handicapped clients 99, 
Have physically handicapped clients 58 
Number of clients 5,429 
2. Number of agencies furnishing individual record cards 26 
Number of individuals thus reported 1,876 
While the individual cards have not been cleared to determine the 
number of cases listed by more than one agency, it is probable that 
duplications w'ould constitute not more than one per cent of the total 
number of card records received, 1,876. 
The types of disability included among these 1,876 persons, and 
their ages, are shown in Table II on pages 508-509. 
TABLE I—NUMBER OF PHYSICALLY HANDICAPPED PERSONS KNOWN TO COMMUNITY 
AGENCIES OF CHICAGO. 
(Preliminary Report) 
Type of agency. 
Name of agency. 
Number 
handi- 
capped 
reported. 
In- 
dividual 
records 
received. 
Specialized agencies for 
physically handicapped 
Vocational Committee for Shut-Ins (39 not shut-ins) 
201 
6 
24 
300 
75 
200 
Service League for the Handicapped (Approximately) 
500 
Visiting Nurse Association (Infantile and spastic 
562 
190 
39 
Chicago schools. .. ... 
Special schools and classes _ ... 
407 
567 78 
THE DEPARTMENT OF PUBLIC WELFARE 
TABLE I—Concluded. 
Type of agency. 
Name of agency. 
Number 
handi- 
capped 
reported. 
In- 
dividual 
records 
received. 
6 
2 
I 
2 
2 
3 
2 
92 
3 
39 
10 Child Welfare report no physically handicapped- 
Rest and Outing Associa- 
6 Rest and Outing Associations report no physically 
Family welfare agencies.. 
231 
687 
4 Family Welfare Agencies report no physically 
86 
71 
17 
1 
1 
1 
1 
German Evangelical Orphanage and Old People’s 
4 
Working Boy’s Home of the Mission of Our Lady 
3 
18 
Not stated 
8 
40 
1 
Chicago Home for Convalescent Women and Chil- 
2 
10 
Settlements and Day 
13 
6 
10 
15 
33 
7 
2 
2 
14 
1 
15 Settlements and Day Nurseries not heard from.. 
21 Settlements and Day Nurseries report no physic- 
Clubs and miscellaneous.. 
3 
48 
Not stated 
1 
7 
2 
5 
6 
8 
The Chicago Christian Industrial League and Free 
26 
800 
8 Civic Organization report no physically handi- 
3,553 
1,876 THE DEPARTMENT OF PUBLIC WELFARE 
TABLE II—PHYSICALLY HANDICAPPED PERSONS 
Disability. 
Special agencies 
for physically 
handicapped. 
Visiting Nurse 
association. 
agencies. 
1 
Spaulding 
school. 
Training 
school. 
Homes. 
Settlements. 
Clubs and 
miscellaneous. 
M. 
F. 
M. 
F. 
M. 
F. 
M. 
F. 
M. 
F. 
M. 
F. 
M. 
F. 
M. 
F. 
225 
272 
105 
99 
1 
1 
11 
13 
2 
3 
11 
23 
41 
23 
4 
2 
1 
41 
26 
23 
14 
16 
25 
7 
25 
1 
2 
2 
2 
1 
3 
1 
1 
4 
14 
2 
36 
5 
1 
2 
3 
13 
10 
14 
9 
4 
4 
5 
13 
10 
12 
3 
1 
8 
11 
25 
5 
2 
2 
6 
15 
3 
3 
1 
3 
1 
1 
1 
2 
8 
4 
2 
3 
10 
9 
5 
2 
6 
6 
9 
6 
1 
9 
3 
7 
1 
1 
1 
15 
2 
3 
13 
6 
3 
3 
2 
3 
3 
1 
4 
I 
1 
1 
2 
8 
2 
1 
4 
6 
2 
1 
2 
4 
1 
2 
1 
6 
2 
3 
1 
3 
1 
6 
2 
7 
Blind . . 
1 
5 
1 
2 
3 
1 
2 
1 
1 
4 
1 
3 
1 
4 
1 
1 
3 
1 
I 
1 
1 
1 
1 
2 
I 
i 
1 
i 
1 
i 
4 
6 
1 
3 
5 
1 
17 
8 
2 
3 
18 
21 
- 
2 
1 
1 
4 
7 
i 
Total 
66 
108 
280 
447 
27 
15 
257 
204 
9 
2 
98 
95 
21 
15 
5 
.... REHABILITATION OF PHYSICALLY HANDICAPPED 
81 
REPORTED BY SOCIAL AGENCIES OF CHICAGO. 
Prisoners’ aid 
I 
Total. 
Age distribution. 
o 
M. 
F. 
M. 
F. 
<D 
Ph 
0-2 
3-5 
6-9 
10-15 
16-19 
20-29 
30-49 
50-59 
60-69 
Un- 
known . 
344 
388 
44.9 
36 
208 
247 
200 
26 
1 
15 
57 
48 
6.3 
3 
10 
32 
48 
6 
1 
64 
40 
6.3 
9 
29 
41 
6 
3 
3 
1 
33 
54 
5.1 
5 
5 
3 
5 
ii 
9 
20 
15 
6 
8 
1 
7 
3.8 
3 
3 
3 
23 
22 
1 
29 
22 
3.1 
1 
11 
11 
23 
5 
19 
32 
3.1 
7 
8 
15 
16 
3 
12 
33 
2.7 
3 
7 
2 
2 
32 
12 
2.6 
6 
16 
1 
3 
5 
21 
18 
2.3 
14 
14 
4 
2 
2 
20 
14 
2. 
3 
10 
9 
12 
5 
18 
1.4 
2 
1 
$ 
2 
15 
1. 
7 
3 
13 
1. 
7 
5 
4 
9 
5 
.8 
4 
4 
4 
1 
3 
11 
.8 
1 
3 
7 
2 
1 
4 
9 
.8 
2 
1 
2, 
3 
2 
i 
6 
7 
.8 
1 
1 
7 
i 
1 
1 
1 
6 
4 
.6 
1 
1 
1 
l 
7 
2 
.5 
8 
i 
5 
3 
3 
2 
1 
2 
6 
2 
2 
4 
1 
1 
7 
.4 
2 
2 
2 
i 
1 
6 
.4 
2 
i 
i 
3 
2 
3 
.3 
1 
1 
2 
1 
3 
2 
.3 
1 
1 
2 
1 
l 
1 
4 
.3 
5 
1 
4 
.3 
1 
1 
i 
4 
1 
.3 
1 
2 
2 
3 
.1 
2 
1 
2 
1 
.1 
2 
1 
1 
2 
.1 
2 
1 
1 
1 
1 
1 
1 
1 
1 
29 
21 
3. 
4 
2 
6 
21 
4 
3 
3 
7 
2 
30 
27 
3.4 
1 
2 
4 
4 
8 
6 
32 
9 
772 
886 
99.9 
82 
281 
388 
417 
88 
48 
105 
83 
47 
119 
—6 R P H 82 
THE DEPARTMENT OF PUBLIC WELFARE 
NEED OF CENTRAL REGISTRATION 
The results of this inquiry show the need of closer cooperation of 
all agencies in the community in dealing with disabled persons. An 
important arrangement to facilitate cooperation is the central registra- 
tion of all cases known to the various agencies. A plan of registration 
is described in Appendix A-4 to this report. Among the services to be 
expected from central registration would be the following: 
1. Increasing cooperation between agencies and less duplica- 
tion of effort. 
2. Diagnoses and statements of social problems made suc- 
cessively by specialized agencies handling a case become available to 
all agencies concerned. For example, unsuccessful industrial place- 
ment of a man may be due to the fact that all the placement officer 
knows is that the man has a “lame left leg,” the lameness may be 
due to a tubercular hip requiring either medical attention or change 
of occupation. 
3-. Accumulation of information for guidance of local agencies 
and State departments. 
RETARDATION OF PHYSICALLY HANDICAPPED CHILDREN IN SPECIAL 
SCHOOL 
Of 31G children enrolled at the Spaulding School for whom age and 
grade have been reported to the survey office, the status of advancement 
in school is as follows: 
TABLE I—ACCELERATION AND RETARDATION OP 316 PUPILS AT 
SPAULDING SCHOOL. 
Accelerated by 2 grades 1 
Accelerated by 1 grade 6 
Normal grade for age 4 4 
Retarded by 1 grade 79 
Retarded by 2 grades 78 
Retarded by 3 grades 49 
Retarded by 4 grades 32 
Retarded by 5 grades 19 
Retarded by 6 grades 3 
Retarded by 7 grades 4 
Retarded by 8 grades 1 
Total 316 
The average retardation of those retarded is 2.5 grades. 
Ages and grades reached are shown in the following table, the 
underscore line indicating the normal grade for the age. In this schedule 
no unit smaller than a year or a grade is used. REHABILITATION OF PHYSICALLY HANDICAPPED 
83 
TABLE II—AGE AND GRADE OF 316 CHILDREN IN SPAULDING SCHOOL 
(Underscore indicates normal grade) 
Age. 
Number 
of 
children. 
Grade reached. 
1 
2 
3 
4 
0 
6 
7 
8 
6 
17 
15 
2 
7 
20 
18 
2 
g 
30 
9 
1 
9 
26 
3 
10 
8 
5 
10 
34 
3 
3 
13 
11 
4 
11 
46 
2 
6 
10 
12 
9 
5 
2 
12 
42 
3 
3 
12 
9 
9 
4 
2 
13 
30 
2 
4 
5 
8 
4 
14 
37 
1 
1 
7 
7 
5 
9 
7 
18 
1 
4 
4 
4 
5 
16 
11 
2 
1 
3 
5 
17 
3 
1 
2 
18 
1 
1 
19 
1 
1 
316 
57 
35 
42 
55 
41 
29 
32 
25 
APPENDIX C-3 
PERSONS AFFLICTED WITH INFANTILE PARALYSIS WHO ARE KNOWN TO 
COMMUNITY AGENCIES OF CHICAGO 
The age and sex of persons afflicted with infantile paralysis, as re- 
ported by community agencies of Chicago (see Table II, Appendix C-2) 
are as follows: 
TABLE I—INFANTILE PARALYSIS CASES REPORTED BY COMMUNITY AGENCIES OF 
CHICAGO. 
Sex. 
Age (Years)* 
Total. 
M. 
F. 
0-2 
3-5 
6-9 
10-15 
16 
497 
225 
272 
36 
204 
138 
102 
204 
105 
99 
95 
83 
10 
Home for Destitute Crippled 
12 
7 
3 
1 
7 
2 
Country Home for Convalescent 
7 
3 
4 
1 
3 
2 
2 
2 
2 
1 
1 
1 
1 
727 
342 
385 
36 
208 
243 
195 
26 
100 
47 
53 
5.1 
29.4 
34.3 
27.5 
3.7 
For 599 of these cases, the part of body affected- by paralysis is 
shown in the following table, No. 2. It is noteworthy that, as indicated 
* Age not given in 19 cases. 84 
THE DEPARTMENT OF PUBLIC WELFARE 
by the first four lines in the table, 88.6 per cent of these cases represent 
paralysis of the lower extremities. This fact is important as an indica- 
tion that, aside from therapeutic treatment, a chief problem of infantile 
paralysis during school years is locomotion, and that these children 
should be fitted for sedentary occupations. 
TABLE II—PART OF BODY DISABLED, 599 CASES OF INFANTILE PARALYSIS. 
Part of body affected. 
Number. 
Per cent. 
284. 
47.4 
114 
19.0 
99 
16.5 
34 
5.7 
43 
7.2 
11 
1.9 
8 
1.3 
5 
.9 
1 
.1 
599 
100.0 
VISITING NURSE ASSOCIATION 
Of the 497 cases of infantile paralysis reported by the Visiting 
Nurse Association, all were receiving treatment at the time of report. 
The majority were being given muscle training. All were reported to 
be showing improvement, with the exception of a few cases in which 
obstacles had been met in the ignorance or indifference of parents. 
From the records of 372 of these cases the incidence of the epidemic 
may be traced as shown by the following table: 
TABLE III—YEAR OF OCCURRENCE OF INFANTILE PARALYSIS AMONG CASES KNOWN 
TO VISITING NURSE ASSOCIATION. 
Year of occurrence. 
Number. 
Per cent. 
1916 
90 
147 
36 
52 
47 
24.2 
39.5 
9.7 
14.0 
12.6 
1917 
1918 _ 
1919 
1920 
372 
100.0 
The age of occurrence, as shown in the following analysis of 147 
cases for 1917, is notable for its indication that in 92 per cent of these 
cases the child had not passed the first year of school age. 
TABLE IV—AGE OF OCCURRENCE, OF THE 147 CASES OCCURRING IN 1917. 
Number. 
Per cent. 
3 
2 
92 
63 
40 
27 
12 
8 
147 
100 REHABILITATION OF PHYSICALLY HANDICAPPED 
85 
APPENDIX C-4 
PHYSICALLY HANDICAPPED PERSONS IN CHICAGO WHO ARE HOUSE-BOUND 
AND OTHER ADULT CASES UNDER SUPERVISION OF VISITING NURSES. 
Among the 174 persons listed in the first column of Table II, of 
Appendix C-2 under “Special Agencies for Physically Handicapped,” 
are 159 “shut-ins” reported by the Vocational Society for Shut-ins. 
The disabilities of these 159 shut-ins are represented in the table referred 
to, the chief ones being paralysis, arthritis and rheumatism, and varicose 
veins. 
Working conditions as reported for 116 of these cases are as follows: 
43 idle, chiefly because they are unable to work or because 
suitable work has not been found. 
73 are doing work in their homes. 
The number of hours a day these shut-ins are able to work varies, 
many of them working as long as eight hours. The types of work at 
which they are engaged are reported as follows: 
TABLE I—TYPES OF WORK DONE IN THE HOMES 
By women. 
Needle work. 
Machine sewing. 
Card coloring. 
Tag tying. 
Basketry. 
Knitting. 
Crocheting. 
Weaving. 
Rug making. 
Dressmaking. 
Damp shade making. 
Quilting. 
Card board work. 
Addressing envelopes. 
Mai! order business. 
By men. 
Basket making. 
Hair goods. 
Toy work. 
Brush work. 
Coloring cards. 
Globe work. 
Envelope making. 
Occupational therapy. 
Trying mantels. 
Making victrola dusters. 
Trimming rubber goods. 
Sorting leather bands. 
Compiling real estate valuations. 
Printing. 
Using clay. 
The habitual posture or means of locomotion for the 159 cases are 
as follows: 
117 normal. 
38 use wheel chair. 
4 bed-ridden. 
The economic status is reported to be as follows: 
106 dependent (6 United Charities cases). 
26 independent. 
27 not stated. 
The only type of recreation reported for these shut-ins is reading, 
and that is mentioned in only a few instances. 
PHYSICALLY HANDICAPPED PERSONS KNOWN TO VISITING NURSE 
ASSOCIATION 
An occupational problem of a group closely related to the shut-ins 
covered by the foregoing analysis, is that of physically handicapped per- 
sons known to the Visiting Nurse Association of Chicago. Of the adult 
cases summarized in Table II of Appendix C-2, reported by the Visiting 
Nurse Association, the occupational status is given in 182 instances. 
This is summarized in relation to disabilities in the following table: 86 
THE DEPARTMENT OF PUBLIC WELFARE 
TABLE II—NUMBER NOT WORKING, AMONG 182 PERSONS 16 YEARS OF AGE OR OVER, 
KNOWN TO VISITING NURSE ASSOCIATION. 
Disability. 
Total. 
Male. 
Number 
idle. 
Female. 
Number 
idle. 
36 
11 
8 
25 
12 
22 
1 
1 
21 
11 
20 
3 
2 
17 
15 
17 
2 
1 
15 
3 
16 
3 
3 
13 
4 
16 
1 
1 
15 
10 
10 
3 
1 
7 
2 
10 
4 
6 
2 
8 
3 
5 
3 
7 
7 
3 
Blind 
6 
1 
5 
3 
6 
2 
2 
4 
1 
4 
1 
3 
1 
4 
4 
182 
35 
19 
147 
70 
100.0 
19.2 
54.3 
80.8 
47.9 
It is noticeable from this table that in case of both men and women 
approximately one-half are not engaged in any remunerative occupation. 
APPENDIX D-l 
ONE HUNDRED AND SEVENTY-EIGHT PATIENTS IN THE MEDICAL, SURGICAL 
AND ORTHOPEDIC WARDS OF TWO CHICAGO HOSPITALS 
This study was undertaken for the purpose of determining more 
exactly the relations between hospital administration and the plan con- 
templated in the Rehabilitation Act. It consisted of an enumeration of 
the patients in certain wards of two Chicago hospitals, as follows: 
Cook County Hospital 2 Surgical wards. 
2 Medical wards. 
2 Orthopedic wards. 
St. Luke’s Hospital ....1 Surgical ward. 
1 Medical ward. 
Two members of the survey staff, a surgeon and a social worker, 
interviewed each patient and consulted the interne and the hospital 
records, filling out the following record: 
COOK COUNTY HOSPITAL WARD STUDY. 
Date .Ward Interne .Att. Dr 
Name . .Address. ..Age 
Specific diagnosis of condition under treatment 
Handicapping conditions, treatment 
Primary 
Secondary .* 
Prognosis, medical. 
Occupational 
Probable date of discharge Date admitted 
Former occupation 
Referred by.. Compensation 
Name of head of family or wife 
The dates on which the enumeration was made were as follows: 
Cook County Hospital Sept. 28, 29-Oct. 7, 1920 
St. Luke’s Hospital ....Oct. 11, 17, 18, 1920 REHABILITATION OF PHYSICALLY HANDICAPPED 
87 
These results are valuable chiefly in affording a view of the types of 
cases given treatment in wards of the classes selected, in the larger hos- 
pitals, and the kind of information that is available from the hospital 
for the purpose of the State rehabilitation service. The value of these 
results as a representation of the hospital situation in Chicago is limited 
especially through the lack of inclusion of smaller hospital. Their repre- 
sentation of conditions throughout the State is problematical especially 
in comparison with the types of cases usually handled by the small com- 
munity hospital. 
THE NEED FOR PHYSICAL REHABILITATION AS SHOWN IN THE MEDICAL 
AND SURGICAL WARDS OF TWO HOSPITALS 
In the medical ward were found many more permanently handi- 
capped than in the surgical ward, as shown in Table 1. (See Table I on 
page 517.) 
This is largely explained by the high percentage of chronic heart 
cases, the predominant group, seconded by arthritis. In almost every 
case interviewed, the patient suffering from chronic heart trouble had 
returned to the hospital many times in a few years. The failure in 
obtaining good results in heart cases was due to the fact that the patient 
could not be kept under observation for a long enough period; or the 
type of work and number of hours spent at work after leaving the hos- 
pital could not be supervised. 
One man was particularly noticeable, who had returned to the hos- 
pital eight times in three years, spending several weeks there in each 
instance. He was ambitious, energetic and inclined to belittle his ail- 
ment; consequently, he took whatever work was offered to him rather 
than to remain idle. 
Another case, which brings out the need for supervision, after 
leaving the hospital, was that of a colored porter, who had suffered from 
severe heart trouble for nine years, and during the past five years had 
been in the hospital several times. After leaving, improved, he returned 
to the Pullman Company and was sent on long trips as porter. Two or 
three of these experiences soon put him back in the hospital. It is 
doubtful now if he will ever be able to do work of any kind again. He 
is only thirty-three years old. 88 
TILE DEPARTMENT OP PUBLIC WELFARE 
MEDICAL AND SURGICAL WARDS, BOTH HOSPITALS 
Sixty-five Men, Medical Wards, 
St. Luke’s and Cook County 
Hospitals 
Seventy-five Men, Surgical 
Wards, St. Luke’s and Cook 
County Hospitals 
ORTHOPEDIC WARDS, COOK COUNTY HOSPITAL 
Eighteen Men 
Fourteen Women 
Need Rehabilitation 
Need Supervision 
Need Institutional Care 
Temporary Disability REHABILITATION OF PHYSICALLY HANDICAPPED 
89 
TABLE I—SOCIAL TREATMENT NEEDED BY 178 PERSONS INTERVIEWED AT ST. LUKE’S 
AND COOK COUNTY HOSPITALS. 
Medical wards. 
Surgical wards. 
Orthopedic wards. 
St. Luke’s 
Hospital. 
Cook 
County 
Hospital. 
St. Luke’s 
Hospital. 
Cook 
County 
Hospital. 
Cook Couni 
Men. 
y Hospital. 
Women. 
Pet. 
Pet. 
Pet. 
Pet. 
Pet. 
Pet. 
1. Need rehabilitation. _ 
7 
53.8 
21 
40.4 
8 
47 
14 
24.3 
13 
72.4 
2 
14.3 
2. JNeed medical super- 
vision 
3 
23.1 
4 
7.6 
2 
11.8 
6 
10.3 
3 
16.6 
10 
71.4 
3. Need social supervi- 
1 
1.9 
2 
3.4 
4. Need institutional 
1 
7.7 
7 
13.5 
3 
5.1 
2 
11 
2 
14.3 
o. Temporary disability 
2 
15.4 
19 
36.6 
7 
41.2 
33 
56.9 
Total number in 
13 
52 
17 
58 
18 
14 
TABLE II—DISABILITIES OF 178 PERSONS INTERVIEWED AT ST. LUKE’S AND COOK 
COUNTY HOSPITALS. 
A. Medical Wards. 
Disability. 
Cook County Hospital. 
St. Luke’s Hospital. 
17 
Per cent. 
32.7 
4 
Per cent. 
30.7 
4 
7.7 
4 
7.7 
4 
30.7 
4 
7.7 
1 
7.9 
6 
11.5 
17 
32.7 
4 
30.7 
Total 
52 
13 
B. Surgical Wards. 
Disability. 
Cook County Hospital. 
St. Luke’s Hospital. 
*24 
10 
7 
17 
Per cent. 
41.4 
17.2 
12.2 
39.1 
tl5 
Per cent. 
88.2 
Appendicitis, abscesses, cancer, etc.. . 
Total . 
2 
11.7 
58 
17 
* 10 of these fractures. Many street accidents, lacerations, gun-shot wounds, few railroad cases, 
t 9 of these fractures. Four railroad cases and 2 taxicab accidents out of the 15. 
The surgical ward had a high percentage of accident cases, and the 
great majority of these were fractures. The many cases of hernia, frac- 
tures and appendicitis, etc., keeps the surgical groups more nearly 
normal. Although the age average is lower, the need for rehabilitation 
is even greater, as shown in the chart following Table I. This is ex- 
plained in part by the greater number of severe accidents among the 
younger men. The Industrial Commission report shows that the per- 
centage of seriously injured takes a sudden leap at twenty-one, and holds 90 
THE DEPARTMENT OF PUBLIC WELFARE 
the same average until forty is reached, when there is a decided slump. 
From the information obtained in the survey of twenty-three industries 
(See Appendix F-l, Study of 23 Industrial Plants), it was found that 
45.3 per cent were hurt between the ages of thirty and fifty. This is the 
period when a man has the heaviest responsibilities. On the other hand 
the medical ward shows a sudden increase in its number of cases over 
thirty years of age. 
(See Table III on page following.) 
SOCIAL TREATMENT 
In making the five classifications in Table I, the interne in charge 
was consulted as to the patient’s diagnosis and probable medical prog- 
nosis, an examination of the medical chart was made and, in a majority 
of cases, the patient himself was consulted. 
“Needs rehabilitation” was a term used in its industrial sense rather 
than in the physical sense. It expresses whether or not a man would be 
able to return to his former occupation on leaving the hospital. For 
example: 
A young colored man about thirty years of age was very ill 
from lead poisoning, having worked in a white lead factory for a 
long time. This man is classed in the “rehabilitation group” as he 
will be unable to return to his former occupation. Whereas, an 
elderly man, badly crippled by osteo-arthritis, was a skilled work- 
man on musical instruments. His disability will in no way inter- 
fere with his work, and he is classed among the “need of medical 
follow-up.” 
The word rehabilitation includes necessary medical treatment; 
therefore, the group “in need of medical treatment” implies that the man 
will be able to return to his old job, but will need some supervision. 
Example: 
A young colored man who had a dilated muscle of the heart, 
due to an infection, with intelligent care, after leaving the hospital, 
should completely recover. On the other hand, the trouble, aggra- 
vated by abuse, might eventually become chronic heart trouble. 
They also include the chronic invalid group who will return home, 
and who ordinarily would have the attention of the Visiting Nurse Asso- 
ciation. REHABILITATION OF PHYSICALLY HANDICAPPED 
91 
TABLE III—AGES OF 178 PATIENTS INTERVIEWED AT ST. LUKE’S AND COOK COUNTY 
HOSPITALS. 
Medical wards. 
Surgical wards. 
Orthopedic wards. 
St. Luke’s 
Cook 
St. Luke’s 
Cook 
County 
Hospital. 
Cook County Hospital. 
Hospital. 
County 
Hospital. 
Hospital. 
Men. 
Women. 
1 
Pet. 
7.7 
2 
Pet. 
4 
1 
Pet. 
5.5 
6 
Pet. 
10.3 
3 
Pet. 
16.7 
Pet. 
35.7 
1 
7.7 
3 
6 
4 
23.5 
11 
19 
6 
33.3 
3 
21.4 
7 
53.8 
13 
26 
6 
35.5 
18 
31 
7 
38.9 
4 
28.6 
4 
30.8 
16 
32 
6 
35.5 
tl8 
5 
31 
2 
11.1 
2 
14.3 
*18 
33 
77 
52 
17 
58 
18 
14 
* Cases whose ages were unknown were almost entirely in the temporary disability group, 
t Three of these cases were above 70 years of age. 
Need institutional care, are the very sick with poor prognoses, who 
will probably die in the hospital, or the very helpless and severe chronic 
illnesses, such as cancer. 
Temporary disability is the large group who may he expected to 
return to normal, after a short period of convalescence. 
THE INDUSTRIAL PROBLEM 
In almost every case the patient was interviewed as to his former 
occupation and his probable future. Usually, the men appeared not to 
have considered their future possibilities and had no suggestion them- 
selves to offer as to the kind of work for which they might be fitted. 
The fact that men of better education and belonging to the more 
skilled group are more easily reassimilated into industry, after becoming 
disabled, is clearly brought out in the comparison of the patients at Cook 
County and St. Luke’s Hospitals. The majority in Cook County Hos- 
pital were laborers, machinist helpers and mendicants; whereas, St. Luke’s 
patients were on a higher level, composed of carpenters, machinists, 
engineers, railway men, salesmen, etc. In one ward in St. Luke’s Hos- 
pital, out of thirteen patients, six had jobs waiting for them with their 
old concerns, although out of the six, four would he unable to return to 
their former jobs. The men all showed records of having worked for the 
same company for many years, and in every case the readjustment should 
require little time and effort. 
TABLE IV—ORTHOPEDIC WARDS OF COOK COUNTY HOSPITAL. 
Men and Women in Orthopedic Wards. 
Disease. 
Men. 
Women. 
6 
4 
7 
4 
3 
4 
2 
2 
18 
14 
* Osteomyelitis, poliomyelitis, flat foot, scoliosis. 92 
THE DEPARTMENT OF PUBLIC WELFARE 
The orthopedic ward, eighteen men and fourteen women, was com- 
posed almost entirely of old tubercular spine and joint cases. In the 
men’s ward, thirteen out of the eighteen were tubercular, and in the 
women’s ward, eight out of the fourteen. In both, the remainder, 
excepting two, were arthritis cases. The group is not so interesting to 
this study as the wards appeared to be a dumping ground for old stub- 
born cases, except in showing the difference of treatment apparently 
needed for men and women with the same disability. 
As shown in Table I, a large percentage of the men needed rehabili- 
tation and a comparatively small group among the women. This is 
partially explained by the larger number of girls of school age, in the 
group, also because of their type of work. For example: 
A young woman with tubercular hip had been a milliner (trim- 
mer). After leaving the hospital she will be able to return to her 
work. 
Another instance is a young colored woman with arthritis, who 
had previously worked in a shade factory and will be able to continue on 
leaving the hospital. 
The married women were to return home to care for their children, 
and would be helped with the washing, scrubbing, etc., by the children 
and husbands. 
The most striking case in need of rehabilitation was that of a well 
educated elderly woman, suffering with tubercular spine and lupus 
(tubercular skin disease) on the face and neck. On recovering she will 
be frightfully disfigured. She has been a governess all her life. 
The men suffering similar disabilities had been laborers, machine 
helpers, teamsters, machine movers, etc., all the heavy lower types of 
labor depending on physical strength alone. Others had make-shift 
jobs, such as vaudeville performer, helpers in food factories and seasonal 
jobs, probably because of their inability to work steadily. A note was 
made in this ward of the cases which had been previously treated in 
hospitals. Out of eighteen, fifteen had been in a hospital at least once 
before, and of the fifteen, ten had been treated in Cook County Hospital 
before. 
APPENDIX D-2 
NUMBER OE PHYSICALLY HANDICAPPED PERSONS LEAVING LOCAL HOS- 
PITALS, AND SPECIAL FACILITIES FOR THEIR TREATMENT 
On August 12 a letter was sent to 237 hospitals and allied institu- 
tions in Illinois, calling attention to the Kehabilitation Act and 
especially to the section referring to hospitals. A questionnaire was 
enclosed for information on the following points: 
1. Whatever statistics or estimates you may be able to give, of 
number of cases discharged from the hospital during your last fiscal 
year that left with permanent or chronic physical disabilities. REHABILITATION OF PHYSICALLY HANDICAPPED 
93 
2. List of physio-therapeutic apparatus with which the hos- 
pital is equipped. 
3. Organization and staff for occupational therapy, with ac- 
count of training given and number of patients. 
4. Social service organization and staff, work accomplished 
and number of patients followed up after discharge during your 
last fiscal year. 
Replies were received from 101 of the 237 institutions canvassed. 
Estimates made of the number of physically handicapped persons 
discharged from the hospital during the last report year may be sum- 
marized as follows: 
TABLE I—PHYSICALLY HANDICAPPED PERSONS LEAVING HOSPITALS DURING ONE 
YEAR. 
Number 
of 
persons. 
Beds 
in the 
hospital. 
1,042 
500 
200 
133 
100 
430 
2,700 
400 
350 
452 
145 
1,549 
Total _ _ _ 
2,405 
5,596 
Answers to this question, while they are for the most part estimates, 
and while they do not include a number of large hospitals, afford evi- 
dence of the extent to which the State rehabilitation service will be 
called upon to visit disabled persons before their discharge from hos- 
pitals. According to the foregoing table, by the estimates of managing 
officers of hospitals, the number of physically handicapped persons dis- 
charged last year is 43 per cent of the number of beds in these hospitals. 
The twenty-nine institutions included in this table are general hospitals. 
The capacity of one hundred and seventy-six general hospitals in Illi- 
nois, as given in Appendix D-3, is 17,404 beds. Applying the propor- 
tion of 43 per cent, the number of physically handicapped discharged 
annually would be 7,483. 
It is noteworthy that among the 29 hospitals reporting on this 
point, nearly four-fifths of the number of physically handicapped persons 
were handled by five hospitals. From this is indicated the possibility of 
organizing the work of first visitation, as required in the Rehabilitation 
Act, in connection with the larger hospitals, and the further possibility 
of reduction in the amount of interviewing that may be required through 
close cooperation with the social service staffs of these larger hospitals. 
Provisions in eighty-two hospitals making reply concerning physio- 
therapeutic apparatus are summarized as follows: 
Have no physio-therapeutic apparatus 63 
Have some physio-therapeutic apparatus 19 9 4 
THE DEPARTMENT OF PUBLIC WELFARE 
The types of apparatus usually listed are hydro-therapeutic and 
electro-therapeutic equipment. 
With regard to organization and staff for occupational therapy, the 
replies indicate: 
No organization or staff 71 
Have organization and staff 4 
75 
In one hospital the occupational-therapy department includes three 
workers; in another this work is regularly supervised by members of the 
medical staff. 
Regarding social service organization and staff the replies indicate 
the following situation: 
Social service organization reported 6 
Social service organization in prospect 4 
Special interest in following up cases after discharge and in using local service 
agencies 7 
No organization 84 
101 
In this connection it should be noted that social service organization 
is known to exist in connection with 21 local hospitals and other medical 
agencies as listed in section D-3 of this appendix, immediately following. 
The following special reports from the largest general hospital in 
the State, Cook County Hospital, with a capacity of 2,700, is of special 
interest in connection with questions summarized above. 
Physically handicapped patients who left the Cook County Hospital 
during the year 1920, were approximately as follows: 
Osteomyelitis 104 
Organic heart disease 378 
Myocarditis 130 
Tuberculous bones and joints 129 
Osteo-arthritis and arthritis deformans 166 
Chronic nephritis 135 
1,042 
The social service director has assigned tivo women to care for 
physically handicapped persons, one to orthopedic and one to cardiac 
cases. 
Number. 
Visits. 
Em- 
ployment 
secured. 
Orthopedic— 
95 
65 
311 
Cardiac— 
90 
37 
183 
Total-.- 
287 
494 
50 
Of an approximate total of 1,042 cases, 287 were cared for by the 
social service department. REHABILITATION OF PHYSICALLY HANDICAPPED 
95 
APPENDIX D-3 
HOSPITALS, DISPENSARIES AND CLINICS IN ILLINOIS 
The location, types and number of hospitals in Illinois are reported 
to be as follows: 
General hospitals— 
100 or more beds 60 
25 to 99 beds 114 
Less than 25 beds 43 
Not stated 15 
Children’s hospitals I 3 
Sanitorias, or homes for convalescents 6 
Industrial hospitals. 7 
Orthopedic hospitals- 1 
Surgical hospitals 1 
Tuberculosis hospitals. 18 
Sanatoria devoted to hydro-therapeutic treatment, electro-therapeutic, or physio-therapeutic 
treatment 2 
Other types of hospitals and allied institutions - 169 
* From correspondence with the Modern Hospital Publishing Company, Chicago. 
TABLE I—HOSPITALS OF ILLINOI 
For 176 general hospitals in Illinois of 25 or more beds, the capacity 
and volume of work per year are reported by the American College of 
Surgeons to be as follows: 
TABLE II—GENERAL HOSPITALS OF ILLINOIS CAPACITY AND VOLUME OF WORK.1 
Total. 
25-99 
beds. 
100 or 
more beds. 
176 
125 
51 
17,404 
6,379 
990 
11,025 
2363 
573 
317,805 
18 
110,535 
17 
207,270 
19 
35.03 
1.75 
3.28 
6,350,978 
20 
2,327,867 
21 
4,023,111 
19 
Eatio patients to population _ 
4 20 
57 
31 
1 Bulletin of the American College of Surgeons for January, 1920, pp. 21-23. 
2 For all states, the average is 483. Illinois is eighth in the list of states, the lower figures being 
for California, Connecticut, District of Columbia, Maryland, Minnesota, Montana and New York. 
3 For all states, the average is 350. Illinois is fifth in the list of states, those showing greater per- 
centage of population treated in hospitals being California, District of Columbia, Montana and New 
York. 
4 For all states the average is 1 to 29. Illinois is fifth in the list of states, the states showing more 
favorable ratios being the same ones as given in Note 3. 
The number, location and types of dispensaries and clinics in the 
State were reported by the State Health Insurance Commission in 1919 
to be as follows: 
DISPENSARIES AND CLINICS 96 
TIIE DEPA11TMENT OF PUBLIC WELFARE 
TABLE III—DISPENSARIES AND CLINICS IN ILLINOIS.* 
CHICAGO. 
General dispensaries 19 
Special dispensaries— 
Eye, ear, nose and throat 2 
Women and children _ 4 
Children. 4 
Obstetrics 2 
Veneial disease 2 
Osteopathy, chiropractic, etc 5 
Dental . 14 
Tuberculosis 8 
41 
60 
ILLINOIS OUTSIDE OF CHICAGO. 
General dispensaries ; ... 8 
Special dispensaries— 
Tuberculosis 18 
Infantile paralysis , 11 
Other special dispensaries 8 
37 
45 
* Report of the State Health Insurance Commission, 1919, p. 348. 
* Report of the State Health Insurance Commission, 1919, p. 348. 
While it is not possible to make an exact comparison between the 
types of service rendered or even between the number of patients handled 
respectively by hospitals and by dispensaries or clinics, an approximate 
idea of the situation in Chicago may be gained from the following figures 
taken from the report of the Chicago Department of Health, to which 
these agencies are required by law to report. 
TABLE IV—NUMBER OF PATIENTS TREATED, YEAR 1918, BY HOSPITALS AND DIS- 
PENSARIES OF CHICAGO REPORTING TO THE CITY DEPARTMENT OF HEALTH.* 
98 HOSPITALS. 
(87 General, 11 Maternity.) 
27 DISPENSARIES. 
Admissions— 
Medical cases 49,912 
Surgical cases 82,797 
Total 132,709 
Old cases 103,159 
New cases 68,505 
Total 171,564 
Under 14 years 68,789 
Overl4years 102,775 
Total 171,564 
* Report for 1911-18, pp. 1066-7. 
Medical social service departments are reported by the American 
Association of Hospital Social Workers for Illinois as follows: 
State Institutions: 
Elgin State Hospital. 
Jacksonville State Hospital. 
Illinois School for the Blind, Jacksonville. 
Illinois School for the Deaf, Jacksonville. 
Chicago Hospitals and Dispensaries: 
Central Free Dispensary. 
Chicago Lying-in Hospital. 
Children’s Memorial Hospital. 
Children’s South Side Free Dispensary. 
Cook County Hospital, Illinois Training School. 
German Hospital of Chicago. 
Hahnemann Hospital. 
The Home for Destitute Crippled Children. 
Jewish Dispensary. 
Northwestern University Dispensary. 
St. Luke’s Hospital. 
Mary Nazareth Hospital. 
Michael Reese Dispensary. REHABILITATION OF PHYSICALLY HANDICAPPED 
97 
Juvenile Psychopathic Institute. 
Mercy Hospital. 
Passavant Memorial Hospital. 
Presbyterian Hospital of Chicago. 
Resthaven Convalescent Home. 
Chicago State Hospital. 
Wesley Memorial Hospital. 
West Side Dispensary. 
APPENDIX D-4 
THE CENTRAL HOSPITAL GROUP AT CHICAGO 
The plan and history of the Central Hospital Group, now under 
construction at Chicago, are given in the three articles in the Institution 
Quarterly here referred to, and summarized in the initial quotation: 
A working agreement'has been entered into between the State De- 
partment of Public Welfare and the University of Illinois Medical School 
for the creation of a great central group of hospitals for research. Two 
squares, formerly the Chicago National Ball Park, south of the Cook 
County Hospital in Chicago have been purchased and soon work will 
begin on the construction of buildings to house the Illinois Charitable 
Eye and Ear Infirmary, now located at 900 West Adams Street, Chicago; 
the State Psychopathic Hospital and Institute, the nucleus of which is 
now at the Chicago State Hospital and the Surgical Institute for Crippled 
Children, created a few years ago hut never vitalized by an appropria- 
tion. These three institutions are contributed by the Department of 
Public Welfare. The medical school will build a clinical hospital. One 
million and a half dollars are available to begin this work. Architects 
have finished the block plan and are now working on detailed plans so 
that construction may begin in the spring. 
Future plans call for a number of other hospitals and institutions 
and the removal of the college laboratories to new buildings on the site. 
The department will administer the group and the university will furnish 
the professional service. 
Included in the functions of this group will be the State’s training 
schools for psychiatric nurses, social workers and occupational therapists 
and hydrotherapists, the department having established the policy of 
training its own specialists for its institutions.—Institution Quarterly, 
March 31, 1920, p. 115. 
“The Need of a Central Hospital for the State” by Dr. Edward H. 
Ochsner, president, Illinois State Charities Commission, a paper read 
before the Chicago Woman’s City Club, February 19, 1917, appearing 
in the Institution Quarterly for March 31, 1917. 
“Illinois Central Hospital Group” a description of the project in 
its preliminary state, Institution Quarterly for September 30, 1919, pp. 
10-14, 
“The Medical Organization of the State Department of Public Wel- 
fare” by A. L. Bowen, a paper written for “Modern Medicine.” Institu- 
tion Quarterly for March 31, 1920, pp. 114-117. From this the above 
extract is taken, indicating the results achieved at that date. 
-7 R P H THE DEPARTMENT OF PUBLIC WELFARE 
98 
APPENDIX D-5 
HEALTH CENTER—SOMETIMES CALLED COMMUNITY CENTER 
(An outline prepared for the present report by Dr. Frank Billings.) 
1. A health center embraces a modern hospital with laboratories— 
chemical, bacteriological, serological, X-ray and pathological—adequately 
equipped, and an out-patient department to serve as a diagnostic center 
for a community. The hospital to contain one bed for each unit of five 
hundred people in the community it serves. The hospital to care for the 
sick and injured requiring hospital care, a lying-in department, a 
pavilion for tuberculosis, a pavilion for contagious diseases including 
patients-suffering from diphtheria, scarlet fever, measles and the like. 
2. The organization of the center involves a personnel of full-time 
individuals including a qualified medical director, qualified laboratory 
technicians, medical social workers, public health nurses and other indi- 
viduals whose services may be required as the work of the center develops. 
3. A commission to conduct the business administration of the 
center to be composed of three or five commissioners, one or more of 
whom should be a medical man or woman, to be elected by the people 
of the district or appointed by the county judge or other officer. 
4. A medical board of management to'be responsible for the med- 
ical and surgical care of the patients of the out-patient department and 
of the hospital. This board to lie appointed or nominated by the County 
Medical Society subject to the approval of the directing commission of 
the center. 
5. The Department of Health of the State to standardize the hos- 
pital and other buildings to insure uniformity and also the laboratories, 
the equipment, and the public health work carried on in the center. 
The laboratories of the center to serve as branch laboratories of the 
main central laboratory of the Department of Health of the State. 
(5. The work of administration of the health center to be carried 
on by the people of the district served through its business commission, 
the medical board of management, and the full-time personnel under 
the qualified director mentioned. (Decentralization of administration 
is, T believe, necessary for effective work in health matters.) 
7. A health center may serve a community of say one hundred 
thousand or more people as residents of a political geographical terri- 
tory in a ward or wards of a city; a township, a county or a district of 
two or more counties. 
8. That a community of a territory described in paragraph 7, may 
establish such a center, a bill including the principles and policies 
enumerated in all of the paragraphs above written should be prepared to 
secure an enabling act permitting the people by referendum to tax them- 
selves directly or by issue of bonds upon the territory involved, to 
establish such a center, and to maintain it from year to year. REHABILITATION OF PHYSICALLY HANDICAPPED 
99 
9. The State may encourage the people of the district to establish 
such a center by voting a subsidy of say 25 per cent of the cost of con- 
struction of necessary buildings, purchase of equipment, etc., and also 
in the maintenance of the center from year to year. This would give 
the State a rational basis for the right to standardize the character of 
buildings, equipment, and to supervise and standardize the character of 
public health work carried on in the center. 
10. A center so organized affords the medical profession of the 
center facilities of diagnosis and the treatment of the people of the dis- 
trict. The members of the medical profession of the district who are 
lawfully licensed to practise medicine, should have access to the diagnos- 
tic facilities of the center and to the hospital for the treatment of such 
patients as may need hospital care. Xo interference with individual 
practice should be contemplated, but under the qualified director, the 
character of the work done in the hospital by the members of the medical 
profession would be under surveillance and encouragement given to each 
doctor to improve his own practice by the adoption of better methods or 
by the assistance which will be readily available to him. Indeed, the 
center will serve as a postgraduate school to the medical members of 
the center and enable each doctor to improve his professional work, if 
that is needed. While individual practice will not be interfered with, 
there will be a natural tendency toward group practice. 
11. It will be seen, therefore, that an established, well organized 
health center will furnish the community of the center with modern 
up-to-date medical and surgical service, medical social care, public 
health activities in the prevention of disease, in maternity, in parental 
and infant and child welfare, in school children inspection and treat- 
ment and the supervision of the physical education of the children of the 
district. It will furnish the medical profession of the district with up- 
to-date modern facilities of diagnosis and treatment of the people of the 
district. 
APPENDIX E-l 
PLACEMENT TRAINING GIVEN BY INDUSTRIAL CONCERNS OF CHICAGO 
The following summary consists of extracts from a study of the 
subject made by Mr. H. D. Byrne, of the State Xormal College, Kent, 
Ohio, under appointment as an assistant in the present survey of the 
physically handicapped. The complete report of the study has been 
submitted as a thesis for the degree of Master of Arts at the University 
of Chicago. 100 
THE DEPARTMENT OF PUBLIC WELFARE 
This study was undertaken to ascertain the exact extent and char- 
acter and growth tendencies of the training given the employees of 
Chicago firms. It is confined wholly to training, organized and con- 
ducted by the various industrial establishments, and thus excludes the 
continuation schools, as well as the schools conducted entirely out of the 
funds of the various public, semi-public, and private agencies. 
On June 14, 1920, a carefully prepared questionnaire was sent out 
to 435 firms in Chicago employing an aggregate of about 400,000 
people. This was later followed by a letter to the firms, which had 
failed to respond. In many cases the second and. third letter was 
written, supplemented by numerous telephone calls, in an attempt to 
make the data as complete as possible. In addition to this, personal 
visitation was made to several of the representative industries. In these 
various ways reports were had from a total of 231 firms. Of this num- 
ber, 192 or 83 per cent replied in the negative; that is, they Avere giving 
no training. The other 39 firms, or 17 per cent of those reporting, 
replied that they Avere giving some form of training. This varied in 
extent and character in the different firms from a simple beginning on 
the one hand to thorough and systematic courses on the other. 
FIFTEEN CHICAGO FIRMS GIVING MOST SYSTEMATIC TRAINING, AS AIIOWN 
BY' THEIR REPORTS 
The Northern Trust Company. 
The A. T. & S. F. Railway Company. 
Commonwealth Edison Company & Central Station Institute. 
Montgomery Ward & Company. 
The Federal Reserve Bank of Chicago. 
The Union Special Machine Company. 
Butler Brothers. 
Automatic Electric Company. 
R. R. Donnelley & Sons Company. 
Marshall Field & Company (Retail). 
Curt Teich & Company. 
Postal Telegraph Company. 
Western Electric Company. 
Armour & Company. 
The International Harvester Company (Reported by Four Plants). REHABILITATION OF PHYSICALLY HANDICAPPED 
101 
TABLE I—SHOWING RANK, NUMBER AND PER CENT OF FIRMS OFFERING SOME 
FORM OF TRAINING, BY INDUSTRIES. 
Industry. 
Number 
of firms 
reporting. 
Number of 
firms 
offering 
training. 
Per cent of 
firms 
offering 
training. 
Rank. 
Automobile—including bodies, parts, accessories 
5 
Banks and trust companies 
11 
3 
27 
6.5 
Car construction- _. 
2 
1 
50 
3 
Chemical manufacturers—including paints, oils, var- 
nishes, soaps, perfumes, rubber, etc 
12 
Clothing and furnishings _ 
17 
2 
12 
12 
Electrical machinery, apparatus and supplies 
7 
3 
43 
4 
Foundry and machine shop products.- 
22 
6 
27 
6.5 
Food products—cereals, yeast, starch, confections. .. 
12 
Iron and steel, steel works and rolling mills 
19 
3 
16 
10 
Leather, and leather goods. . . . 
10 
Merc handise—wholesale .. .. 
13 
1 
8 
13 
Merchandise—retail. . . 
11 
4 
36 
5 
Merchandise—mailorder .. .. 
4 
4 
100 
1 
Paper boxes, bags, etc . 
7 
Pianos and furniture . 
7 
1 
14 
11 
Printing and publishing-. 
18 
3 
17 
9 
Service companies—telephone, telegraph, news, 
dairy, light, power, railway 
19 
5 
26 
8 
Slaughtering, meat packing. 
3 
2 
67 
2 
Miscellaneous _. . 
32 
1 
3 
14 
Total . . 
231 
39 
In general the data shows that industries which employ a large 
percentage of common labor do the least in the way of training. On the 
other hand those employing more highly skilled labor and especially 
clerical people, are found to offer considerable in the way of training 
facilities. 
TRAINING COURSES OFFERED 
For purposes of clearness and convenience the training courses 
offered were classified under four general heads: 
1. Company business, practice and policies (14 firms). 
2. Complete trade training (22 firms). 
3. Short unit courses for operators, inspectors, etc. (13 firms). 
4. General or up-grading training (7 firms). 
COMPANY BUSINESS, OR PLANT PRACTICE AND POLICIES 
Company business, or plant practice and policies include training 
courses that are peculiar to a particular business or industry (plant) 
in a. rather strict sense. Such training would be marketable only in a 
very limited field. 
Fourteen firms report courses under this head, as follows: 
Clerical, special. 
Company methods, etc. 
Department operations (2) 
Elements of banking. 
Electrical, special. 
Federal reserve system. 
General course. 
History of banking. 
Modern productive methods (pack- 
ing). 
Office training. 
Paint manufacture and uses. 
Salesmanship (2). 
Store rules, systems, etc. (3). 
Supervisors. 
Superintendents. 102 
THE DEPARTMENT OE PUBLIC WELFARE 
SHORT UNIT COURSES FOR OPERATORS, INSPECTORS, ETC. 
Short unit courses are those requiring skill in a limited number oi 
operations or processes. For the most part they can be mastered in a] 
brief period of time and are marketable in a rather wide field. 
The following short unit courses were reported by twenty-two 
linns: 
Adding machine operators (4). 
Automatic telephone operators. 
Bookkeeping. 
Bookkeeping machine operators 
(3). 
Billing clerks (2). 
Cashier’s inspectors. 
Cash register operators. 
Comptometer (2). 
Cutters. 
Dictaphone operators. 
Elevator operators. 
Endorsing machine operators. 
Floor managers. 
Graphotype operators. 
Hand sewers. 
Indexing clerks. 
Morse operators. 
Parcel carriers. 
Sales clerks. 
Service desk clerks. 
Sewing machine operators (2). 
Supervisors. 
Stenographers. 
Telephone operators (2). 
Telegraphy. 
Typewriting (5). 
COMPLETE TRADE TRAINING 
Complete trade training comprises the usual training of the crafts- 
man. Thirteen firms report training of this type including the following 
trades: 
Auto body layout and construc- 
tion. 
Boilermaker. 
Carman. 
Drafting. 
Electrician. 
Electrical engineering. 
Machinist. 
Mechanics (2). 
Molding. 
Operative engineers. 
Printing (2). 
Sheet metal worker. 
Telephone mechanic. 
Tool, disc and die making (3). 
GENERAL, OR UP-GRADING TRAINING 
General, or up-grading training, includes courses of purely cultural 
value, as well as those that combine a commercial value along with the 
cultural. The courses listed here are distinct from those reported later 
under Americanization. Seven firms have checked general training in 
the following subjects: 
Arithmetic. 
Business English. 
Civics. 
Commercial geography. 
Economics. 
English grammar. 
French. 
Literature. 
Public speaking. 
Spanish. 
Writing. 
Lectures (general). 
Besides the courses listed here, wnich are conducted by the various 
firms individually, a considerable amount of training is done by Chicago 
firms in a cooperative way. Two important organizations of a distinctly 
cooperative type, which conduct training, are the Chicago Typothetae 
School of Printing, and the Chicago Chapter of the American Institute of 
Banking. The former is maintained by about twenty printing firms. It 
takes on boys who have completed the eighth grade and trains composing 
room apprentices for all the twenty firms. REHABILITATION OF PHYSICALLY HANDICAPPED 
103 
TABLE II—SHOWING CHARACTER OF INSTRUCTION—METHODS AND DEVICES 
USED BY THIRTY-EIGHT FIRMS. 
Methods. 
Regular. 
Occasional. 
| Incidental. 
6 
13 
9 
4 
2 
2 
Laboratory: Scope— 
4 
2 
5 
i 
Shop work: Supervised by— 
3 
2 
5 
12 
7 
1 
Inspection or observation trips— 
3 
1 
2 
_ . .. 
The instructors in the cases reported represent various degrees of 
professional training. Some are simply individuals with a good know- 
ledge of their subject who have shown special aptitude for teaching and 
have been assigned to that work. Others are individuals with a high 
degree of professional training and often with considerable public school 
experience. In cases where three or more instructors are employed bv 
a firm the one in charge of the educational work is generally well trained 
and is given the title of educational director. The duties of the latter 
include the planning of courses, the selection of subject matter and 
general supervision of the educational work as well as teaching. 
A number of other persons assist in instruction in the larger plants. 
These are foremen and experienced employees. Their service is in con- 
nection with the production end of the business and is not a part of the 
class room or theoretical phases of the work. 
The salaries paid the instructors indicate, in a measure, the im- 
portance attached to educational work by industry. These range from 
$1,500 to $3,600 per year. The approximate average is $1,800. Since 
a number of the instructors are women, the salaries compare favorably 
with those of teachers in the public schools of Chicago. 
METHOD OF SELECTING EMPLOYEES 
The methods a firm uses in selection and promotion of its employees 
has a significance in connection with placement training. For this 
reason a section in the questionnaire was devoted to this topic. The 
firms were asked to check the methods used and to rank numerically the 
three they considered the most important. The general results, as re- 
ported by twenty firms employing over 50,000 people, are shown in the 
table below: 
THE TEACHING STAFF 104 
THE DEPARTMENT OF PUBLIC WELFARE 
TABLE III—SHOWING METHODS OF SELECTING EMPLOYEES AND THEIR RELATIVE 
RANK ON BASIS OF FREQUENCY REPORTED BY TWENTY FIRMS. 
Methods. 
Rank. 
Graphic and percentage 
representation of 
importance on basis of 
frequency. 
1 
19 cases—95 per cent. 
13 cases—65 per cent. 
13 cases—65 per cent. 
12 cases—60 per cent. 
6 cases—30 per cent. 
4 cases—20 per cent. 
2 cases—10 per cent. 
12 cases—60 per cent. 
2 
3 
4 
5 
6 
7 
All psychological tests 
8 
APPENDIX E-2 
PRIVATE SCHOOLS OP CHICAGO AFFORDING VOCATIONAL TRAINING 
OPPORTUNITIES 
The following information is taken from a dissertation entitled— 
“Vocational Training Opportunities for Young Men in 137 Private 
Schools of Chicago/’ presented by Joseph V. Hanna in June, 1930, as 
a Master’s thesis at the University of Chicago. 
One hundred and nineteen of the 137 schools were classified as 
follows: 
Art schools 3 
Law schools 7 
Schools of medicine and surgery 7 
Engineering schools 3 
Schools of theology 7 
Schools of music and expression 35 
Schools for teachers and social workers 5 
Business colleges and shorthand schools (including priv- 
ate high school commercial courses) 22 
Miscellaneous schools 8 
Technical, industrial and trade schools 17 
Commercial schools of college grade 5 
The last two groups are listed as follows: 
Technical, Industrial and Trade Schools. 
GROUP I. 
1. Chicago Technical College. 
2. The Joseph G. Branch School of Engineering. 
3. Pullman Free School of Manual Training. 
4. Coyne Trade and Engineering School. 
GROUP II. 
1. Chicago Painting School. 
2. The Koester School. 
3. Greer College of Automatic Engineering. 
4. Moler Aviation School. 
5. National Petroleum Schools. 
6. Ambu Engineering Institute. 
7. Chicago School of Watchmaking. 
8. Winter School of Engraving. 
9. Moler School for Training of Barbers. REHABILITATION OF PHYSICALLY HANDICAPPED 
105 
10. Siebel Institute of Technology. 
11. National School of Mechanical Dentistry. 
12. American Ladies’ and Gentlemen’s Cutting and Designing 
School. 
13. Chicago Telegraph Institute. 
Commercial Schools of College Grade. 
1. College of Commerce, De Paul University. 
2. School of Commerce, Northwestern University. 
3. Y. M. C. A. School of Commerce. 
4. College of Commerce and Administration, University of Chicago. 
5. Mayo College of Commerce. 
In addition, three school systems are described as follows: 
Knights of Columbus, 3 Evening Schools. 
Jewish Educational Centers. 
Young Men’s Christian Association Schools. 
The schools studied are for the most part listed in the College anti 
Private School Directory of the United States, published by the Educa- 
tional Aid Society. Questionnaires were mailed originally to 235 
addresses of private schools. Concerning the representative character 
of the study, the author said: 
A large majority of schools listed, particularly professional schools 
and other schools of college grade, have responded with information 
desired. We can without hesitancy, therefore, conclude that the 127 pri- 
vate schools treated are representative, and in the main inclusive, of the 
best there is in Chicago private schools. 
The absence of uniformity of admission requirements, of tuition 
fees, and of courses of study is noted particularly by the author. Re- 
garding entrance requirements he says: 
It is easy to understand that private schools which are operated 
primarily for profit are willing to receive students irrespective of prev- 
ious training. Schools which are exceptions to this rule, in appealing 
to higher grade students, doubtless find it more profitable to impose 
entrance requirements, thus maintaining somewhat higher standards. 
The business colleges furnish the most striking example of schools 
making practically no demands for preliminary training of the.ir 
students. 
APPENDIX F-l 
V STUDY Ok JOBS AND CONDITIONS OF WORK IN 23 CHICAGO PLANTS, WITH 
RESPECT TO THE EMPLOYMENT OF DISABLED PERSONS 
In order to determine the conditions under which physically handi- 
capped persons may be reestablished in industry, a field study of con- 
cerns in and near Chicago was undertaken. The character of industries 
in Illinois and the volume of their products as reported in the United 
States Manufacturers’ Census for 1914 were studied. For each industry 
a chart was made to show the number of plants of various sizes. Twenty- 
three plants belonging to the largest employing industries were selected 
for visitation. The relation of each concern to the employment of 
physically handicapped persons, including such circumstances as general 
industrial conditions and attitudes of foremen and employment man- 106 
TIIE DEPARTMENT OF PUBLIC WELFARE 
agers were noted. In each plant all types of work being done were 
observed, and several jobs were selected for examination to determine 
the possibility of employing persons with various kinds of disability. 
The visitations were made by two investigators together and only those 
conclusions were set down upon which they were in agreement. 
From this study it appears: 
That 9 per cent of the positions in plants visited could be filled 
by disabled workers. 
That certain disabilities are less handicapping than others. 
That certain circumstances of employment are more important 
than physical fitness of the man for the job. 
TABLE I—TWENTY-THREE INDUSTRIAL PLANTS SELECTED FOR STUDY. 
Key 
General industrial 
Specified type of work done. 
Number of 
employees. 
Number 
of jobs 
No. 
classification. 
Male. 
Female. 
Analyzed. 
1 
200 
200 
4 
2 
600 
20 
4 
3 
4 
Steam car construction- 
Steam railway maintenance 
Manufactures men’s ready to 
595 
5 
4 
40 
10 
2 
5 
Manufactures men’s furnishings 
Manufactures high grade candy 
Manufactures laboratory and 
225 
225 
4 
(i 
325 
325 
6 
7 
Electrical machinery and 
ap- 
90 
4 
7 
8 
Electrical machinery and 
ap- 
Manufactures parts of and 
420 
180 
8 
9 
Electrical machinery and 
ap- 
1,082 
544 
2 
10 
Foundry and machine 
shop 
Manufactures building hard- 
200 
30 
6 
11 
Foundry and machine 
shop 
375 
45 
3 
12 
Foundry and machine 
shop 
500 
12 
3 
13 
390 
60 
2 
14 
15 
92 
3 
540 
60 
5 
16 
Lumber and timber products-. 
Manufactures doors, sash and 
100 
4 
17 
Musical instruments, pianos and 
Manufactures phonographs 
725 
75 
3 
18 
Musical instruments, pianos and 
180 
2 
19 
200 
26 
2 
20 
600 
400 
1 
21 
Copper, tin and sheet iron prod- 
1,450 
400 
8 
22 
Copper, tin and sheet iron prod- 
Manufactures tin can covers 
250 
400 
7 
23 
1,060 
150 
2 
10,229 
3,171 
92 REHABILITATION OF PHYSICALLY HANDICAPPED 
107 
STATE OF ILLINOIS, DEPARTMENT OF PUBLIC WELFARE SURVEY OF THI 
PHYSICALLY HANDICAPPED. 
Plant 
1. Machine. 
2. Posture: 
Sitting ..Standing Walking 
3. Work: 
Heavy. Medium Light 
4. Strain: 
Bending Reaching Lifting «... 
5. Accuracy: 
6. Judgment: 
7. Sight: 
8. Hearing: 
Job description: 
JOB ANALYSIS CABD. 
Job name 
Number in plant. 
9. Unionism: Yes No.. 
10. Apprentice: Number weeks 
11. Training: School 
(a) On job 
(b) Elsewhere in plant 
(c) Outside plant 
12. Hours ..Lunch 
13. Pay plan: Piece Day 
14. Wage: Maximum Minimum 
1. Amputation or lack of use of: 
(1) leg: One .Two.. 
(2) arm One Two 
(3) hand: One ...Two 
(4) fingers: 
2. Back or neck ailment: 
3. Weak heart: 
DISABILITIES LIST 
4. Sight: 
(1) Blind 
(2) Defective 
5. Hearing: 
(1) Deaf 
(2) Defective - 
6. Lungs: 
7. Rupture:. 
The chief values of this study appear to have been as follows: 
1. A comprehensive idea was obtained of the possibilities for 
physically handicapped persons in industries. The analyses of indi- 
vidual jobs, while in no sense final and conclusive, will afford some 
guidance in placement work and helpful clues for further study. The 
general picture of the situation, statistically, affords a concrete basis for 
determining to what extent physically handicapped persons may be 
ipected to be taken into industrial plants. 
2. The detailed examination of jobs has revealed to a surprising 
extent the importance of circumstances other than those involved in the 
specific matching of a man’s physical capacities with the particular 
operations that are to be performed on any given job. Examples of this 
physical matching of disabled men with jobs exclusive of other considera- 
tions, are the study of “Opportunities in Ship-building for the Physically 
Handicapped” made by the United States Shipping Board Emergency 
Fleet Corporation, and the study of opportunities for blinded soldiers 
made during the war, for the American Red Cross by Mr. A. L. Seegur 
and others. 
3. Contacts were made with employers and employment managers 
■which were useful, not only in securing information, but also in opening 
the way for cooperation in the administration of the Rehabilitation Act. 
At the same time, the survey office gained a familiarity with a varied 
series of jobs and with working conditions in general that will be helpful 
in the administration of the law. 
4. A technique of industrial survey relating to the employment of 
physically handicapped persons was developed, which will be useful for 
future industrial studies, as contemplated in the Rehabilitation Law. 
This relates especially to: 108 
THE DEPARTMENT OF PUBLIC WELFARE 
1. Form of inquiry at the industrial plant: 
(a) Officials to see and plan of interview. 
(b) Scheme of job study. 
2. Cooperating groups in the industrial community. 
3. Correlation with industrial data already available. 
4. Use of results of field work for practical placement of dis- 
abled persons. 
The first and second groups of findings in this study, characterized 
above, are here amplified through the presentation of detailed material 
from the survey. 
THE PHYSICAL MATCHING OF MEN WITH JOBS 
The plant study was organized with the purpose of determining 
through rapid survey the extent to which men having any of a given 
series of disabilities could he employed. The types of physical defects 
are indicated in the form given above under head “Disabilities List/’ 
For example, beginning with the first item in the list, the investigator 
determined whether a man with one leg useless or amputated could per- 
form the particular job which he was viewing in the plant. It was 
assumed that the man had no outstanding mental defect and no com- 
bination of physical disabilities, that he had no problem of transporta- 
tion in reaching the plant on account of his disability, and that the 
requirements regarding apprenticeship, unionism, etc., had been satis- 
factorily met. 
In other words, the survey was intended to show by rapid observa- 
tion the extent to which any given physical disability would interfere 
with remunerative employment, all other conditions being assumed to 
be favorable. 
The results from this stud}7- are not of the same nature as those 
reached through actual placement of handicapped workers. In practical 
placement of disabled persons at work, other factors than the physical 
matching of men with jobs must be considered. Practical placement 
would have proceeded too slowly for the purposes of the present survey 
and it would not have been possible to test conditions in a wide variety 
of plants. 
The following summary affords an example of the way in which the 
circumstances and requirements of each job were described: 
1. Description of Plant. This plant was the repair shop of a rail- 
road system. There were 450 employees, 400 male and 50 female. Cer- 
tain notes were made about welfare work in the plant, and the prospect 
for the employment of physically handicapped persons. Note was made 
of what appeared to be the characteristic or fundamental processes in 
the plant, and what were the allied or more superficial processes. 
2. Jot) Description. For this illustration, the job of operating a 
locomotive turn table is chosen, this being a part of the work of receiv- 
ing and storing, which is one of the “characteristic processes” of the 
plant. The following description is noted by the investigator: “The 
operator sits in a small house and operates a controller similar to those 
on street cars. Movement of the controller crank and shifting of a lever REHABILITATION OF PHYSICALLY HANDICAPPED 
109 
regulates movement of the turn table. Job easily learned and not 
strenuous.” This is not a complete description for the purpose of de- 
termining whether the job can be performed by persons with various 
types of handicap, as the investigators decided that from direct obser- 
vation. The description is given as a memorandum chiefly to suggest 
the type of operations performed and the bodily positions of the worker. 
3. Job Analysis. The requirements of the job with respect to 
motion, condition of work, training, etc., are amplified by checking on 
the form reproduced above, so as to furnish, in this case, the following 
information: 
The operator sits most of the time but stands when shifting the 
lever. The work is light and the only strain is that of reaching, which 
is slight. A high degree of accuracy is not required and the necessary 
judgment is easily acquired. Good or fair sight and hearing are re- 
quired. No apprenticeship is required, either inside or outside the plant. 
The task can be learned in one week. Eight hours of work are required 
and a half hour for lunch. During the lunch hour the man may be 
called on to work when locomotives are called out or brought in; but 
since the turning of an engine takes only a few minutes this does not 
interfere greatly with his lunch period. The pay is on the day rate, at 
43 cents per hour. 
4. Physical Disabilities. In the judgment of the investigators, this 
job could be performed by a man having any one of the following disa- 
bilities: 
(1) One leg amputated or useless. 
(2) One hand amputated or useless. . 
(3) Fingers of one hand amputated or useless. 
(4) Back or neck ailment. 
(5) Weak heart. 
(6) Slight hernia. 
On the basis of analyses of this kind, information was obtained from 
the study of industrial plants which may be summarized as follows : 110 
TIIE DEPARTMENT OF PUBLIC WELFARE 
TABLE II—JOBS THAT MAY BE PERFORMED BY PHYSICALLY HANDICAPPED 
Key Dumber of 
plant. 
Number 
employees in 
plant. 
Number of jobs 
analyzed. 
Names of jobs analyzed. 
Male. 
i 
Female. 
Total. 
1 
200 
200 
400 
4 
Pasting labels, inspecting cookies, coating cookies, trimming at wafer 
2 
600 
20 
620 
4 
Driving planttractor, nut tapper, bolt threader, core maker. _ 
3 
595 
5 
600 
4 
Call clerk, turntable operator, time keeper, stationary engineer-. - _ 
4 
40 
10 
50 
2 
Pulling bastings, pressing 
5 
225 
225 
450 
4 
Banding neck-ties, operating suspender machine, deductor, cutting, 
assembler, checker .. 
6 
325 
325 
650 
6 
Packing candy, dipping chocolates, placing bars on enrober, packing 
candy in glass jars, attending enrobers, wrapping candy bars 
7 
90 
4 
94 
7 
Assembler, metal japanner, scale weight tester, winder, testing ap- 
paratus, lathe operator, hand screw machine operator.- .. 
8 
420 
180 
600 
8 
Greasing irons, filing contacts, wrapping cords, curling iron assembler, 
inspecting flat-irons, assembling irons, attatching switch, setting up 
contacts .. _ 
9 
1,082 
544 
1,626 
2 
Annealing, assembling ......... , 
10 
200 
30 
230 
6 
Assembling, grinder, drill press operator, polisher, buffer, sorter __ 
11 
375 
45 
420 
3 
Crib keeper, core maker, pattern maker 
12 
500 
12 
512 
3 
Drill press operator, inspector, bench cleaner 
13 
390 
00 
450 
2 
Finishing, cutting covers - 
14 
92 
92 
3 
Winder, weaver, framer 
15 
540 
60 
600 
5 
Polisher, hanging hides up to dry, staking, oiling and glazing, wringing 
16 
100 
100 
4 
Finisher, planer operator, cabinet maker, molding sticker. 
17 
725 
75 
800 
3 
Spring tester, hand polisher, grinder, motor part assembler, drill press 
operator.. 
18 
180 
180 
2 
Piano tuner, finisher, ■_ 
19 
200 
26 
226 
2 
Cigar maker, cigar bander. . ...» __ __ 
20 
600 
400 
1,000 
1 
Packing ------ _ 
21 
1,450 
400 
1,850 
8 
Line inspecting, die setter, lumber man, body maker, feeder, scroll 
shear feeder, can tester, solder 
22 
250 
400 
650 
7 
Jar ring maker, lacquerer, header machine, jar ring inspector, shearer, 
operator, sorting and assembler, punch press operator 
23 
1,050 
150 
1,200 
2 
Paint tester, paint mixer. 
10,229 
3,171 
13,400 
92 REHABILITATION OF PHYSICALLY HANDICAPPED 
111 
PERSONS IN TWENTY-THREE INDUSTRIAL PLANTS OF CHICAGO. 
Number of workers 
on these jobs. 
Number of employees in 
plant for each specific handicap. 
Amputation or lack of use. 
Sight. 
Hearing. 
Back or neck 
ailment. 
Weak heart. 
Lungs. 
Hernia. 
One '.eg. 
Two 
legs. 
One 
arm. 
Two 
arms. 
One 
hand. 
Two 
hands. 
Fingers. 
Blind. 
Defec 
tive. 
Deaf. 
Defec- 
tive. 
19 
12 
7 
6 
6 
10 
10 
10 
19 
19 
19 
23 
18 
5 
12 
12 
11 
6 
17 
17 
17 
17 
12 
17 
8 
6 
2 
8 
8 
8 
2 
8 
8 
5 
8 
9 
9 
9 
9 
35 
31 
10 
4 
4 
18 
18 
18 
25 
6 
29 
119 
119 
76 
91 
91 
119 
119 
119 
23 
19 
4 
6 
14 
7 
3 
21 
21 
19 
28 
28 
27 
18 
18 
24 
24 
26 
28 
28 
28 
202 
202 
2 
2 
20(7 
200 
6 
200 
49 
49 
6 
4 
4 
6 
49 
29 
25 
8 
3 
5 
3 
8 
2 
8 
47 
47 
7 
37 
47 
47 
10 
47 
10 
47 
26 
26 
14 
14 
14 
14 
26 
14 
26 
28 
23 
5 
28 
23 
28 
52 
53 
4 
4 
23 
23 
8 
52 
1 
50 
52 
6 
6 
56 
6 
12 
50 
11 
31 
36 
41 
41 
30 
36 
36 
42 
20 
20 
16 
4 
16 
16 
20 
20 
20 
20 
152 
152 
144 
152 
144 
8 
152 
6 
6 
6 
6 
6 
6 
6 
6 
115 
115 
60 
60 
115 
111 
114 
111 
68 
99 
106 
104 
10 
8 
8 
59 
20 
95 
10 
111 
6 
3 
6 
6 
6 
3 
3 
1,158 
1,150 
38 
114 
127 
14 
634 
67 
97 
915 
964 
421 
612 
267 
1,038 112 
THE DEPARTMENT OF PUBLIC WELFARE 
The jobs chosen for analysis were picked, with the expectation that 
they would offer some possibility of employment of physically disabled 
persons. Plant superintendents or foremen were consulted in arriving 
at conclusions. Such jobs as those of elevator operator, watchman and 
clerical work, to which disabled persons are usually assigned, were not 
included among those analyzed. While only 92 jobs were analyzed in 
relation to performance by persons with physical disabilities, it appeared 
to the investigators that many more of the hundreds of jobs observed 
could be done by the handicapped either under present arrangements, or 
with slight adaptation of machinery or organization. In the 92 jobs 
here listed, 1,158 employees were engaged, this being 9 per cent of the 
total number, 13,400 in all the plants. 
The possibility in many instances of one job being performed by 
persons, among whom occur a variety of disabilities greatly increases the 
opportunity for employment of the physically handicapped. For ex- 
ample, at Plant I of the foregoing table, “pasting labels” might be done 
by persons having amputations of either one or both legs, or back or neck 
ailment, or weak heart or hernia. Seven persons were engaged at pasting 
labels in this plant. Multiplying 7 by the 5 types of handicaps, the 
total number of possibilities for disabled applicants is 35. 
Table I has been constructed in such a way as to show this possi- 
bility while only 1,158 positions were represented in the jobs found 
possible of performance by the disabled (column 7), as many as G,411 
persons with the disabilities specified would be physically qualified to 
fill these positions (grand total of columns 8-22). 
The proportionate relation between the various types of physical 
disability that were considered, based on the number of persons employed 
at each job capable of performance by a man with the given disability is 
shoAvn by the following list derived from the foregoing table: 
TABLE III—RELATION BETWEEN CERTAIN PHYSICAL DISABILITIES IN THE 
PERFORMANCE OF 92 SELECTED JOBS IN 23 INDUSTRIAL PLANTS. 
Physical disability 
‘Number of 
employees 
possible. 
Percentage 
*of total job 
opportunities. 
1,151 
38 
17.9 
. 6 
114 
1.6 
Amputation or lack of use of one hand __ . . _ 
80 
14 
1.7 
9 
634 
10. 
i. 
Blind- .. - -- 
67 
97 
1 5 
916 
14.3 
964 
421 
612 
9.4 
267 
4.1 
1,038 
16.2 
Total _ _ .. 
6,411 
100 
* As shown by preceding Table No. 1, for each job found possible of performance by a man with the 
given disability is listed the total number of employees engaged on that job in the plant. REHABILITATION OF PHYSICALLY HANDICAPPED 
113 
The value of the results shown in Table II is limited by the fact 
that neither one of the investigators was a physician and by the addi- 
tional circumstance that only limited attention could be given to the 
less apparent conditions of the work, as for example the likelihood of 
exhaustion or excitement at a job noted as possible of performance by 
persons with weak hearts. This limitation is important especially in 
connection with disabilities related to organic diseases. 
CONDITIONS OF EMPLOYMENT OTHER THAN PHYSICAL FITNESS FOR JOB 
An imaginary exclusion of all other considerations than that of a 
single disability as affecting the performance of a given job was neces- 
sary in arriving at any comparison of industrial opportunities in a series 
of plants. W hen this imaginary situation is compared with the con- 
ditions of practical placement, however, the outlook is very different. 
The prospect for the physically handicapped in each of the 23 plants 
studied was noted by the investigators, as shown in the illustration 
above. In some instances, where few disabled persons were being em- 
ployed, the plant superintendent nevertheless showed a receptive attitude. 
Further “salesmanship” of the idea of industrial rehabilitation, when the 
present law is put in operation, may be expected to change the situation 
radically. This prospect of increasing the number of industrial oppor- 
tunities for the disabled through educational effort, alone, has seemed 
to justify the foregoing analysis of jobs on the assumption that other 
obstacles than the fitness of the man for the job will be removed. The 
considerations other than physical fitness of man for job may be sum- 
marized as follows: 
1. Attitudes of Employers.—The outlook for employment of 
physically handicapped persons was discussed with officials of each of 
the 23 firms visited. The plan of the Kehabilitation Law, for non- 
chai'itable employment of the disabled alongside the ablebodied, was 
explained. Their attitudes toward cooperation in the plan may be sum- 
marized as follows: 
Very favorable, 12. 
Moderately favorable, 9. 
Unfavorable, 2. 
2. Attractiveness of Employment.—Jobs which offered opportuni- 
ties for persons with various types of disability sometimes were found to 
be performed in surroundings which distinctly limited the group of 
applicants to be recommended to them. For example, in a leather goods 
plant employing 600 men and women, 15 of whom were physically dis- 
abled, and having many jobs that could be performed by disabled per- 
sons, the investigators made the following note: 
“Several of the jobs, especially in the hide house and the tanning 
room, are disagreeable in the surroundings and are for the most part 
filled by the older and lower classes of workers, those that cannot stand 
—8 R P H 114 
THE DEPARTMENT OF PUBLIC WELFARE 
the pace in other factories. There are no openings for high grade skilled 
workers with physical disabilities.” 
3. Increasing ihe Hazard of Employment.—The extent to which 
the employment of a physically disabled person at a given job might 
increase the likelihood of injury to himself or to fellow workmen was 
not noted in the job analysis, but only those jobs were listed as possible 
of performance by disabled persons in which there was no evident likeli- 
hood of increasing the risk of injury. The representatives of five of the 
23 firms, with an employed force of 9,120, said they considered the em- 
ployment of handicapped workers would increase the number of injuries. 
Two of these firms decline to employ any disabled persons and, in case of 
the other three, handicapped workers are taken only in certain depart- 
ments. They said that they saw a positive obstacle to the employment 
of disabled persons in the compensation rule, whereby the employer must 
pay for total disability, in case a man with a disability receives a second 
injury which, taken with the first, constitutes total disability. 
4. Belation to Compensation Act.—The foregoing observation 
shows a direct relation of 'the Compensation Act to conditions observed 
in these 23 plants. Another observation of this type made by the in- 
vestigators is that the representatives of these firms in some instances 
considered that payment of compensation award to an injured employee 
discharged their responsibility completely in relation to him. Their 
viewpoint was that of self-justification. This viewpoint cannot, how- 
ever be said to be representative of the employers interviewed. The 
study shows that some concerns do not employ disabled persons in pro- 
portion to the number of ablebodied whom they injure, but further 
investigation would be required to determine the extent to which this 
characterizes other concerns. 
5. Trade Unionism.—Approximately 16 per cent of the number of 
employees in the jobs analyzed in this study were unionized at these 
plants. The extent to which work of similar nature in the community 
and State may be unionized is not known. Some inquiry was made 
regarding union relationships and the attitudes of trade union leaders 
toward the employment of physically handicapped persons, but no 
general conclusions have been reached. The attitude of unions towards 
their disabled members is reflected in the study of “Trade Union Benefit 
Systems,” reported by the Illinois Health Insurance Commission in 
1919 (pp. 550-551). The provisions they have made, however, refer to 
sick benefits, funeral expenses and life insurance. They are not con- 
cerned with rehabilitation. Reestablishment of persons in industry 
appears to be a recent subject in the discussion of unions, upon which 
only genera], sympathetic expressions have been given. The introduction 
of disabled workers into unionized trades will affect regulations and 
practices in which heretofore only the ablebodied workmen have been 
considered. As an example the following quotation is taken from a 
paper prepared by Mr. C. Van Riper, supplementing the present survey: REHABILITATION O.F PHYSICALLY HANDICAPPED 
115 
The next thing to be explained was the “exclusiveness” of certain 
local unions, and the Workers Union was mentioned as an ex- 
ample. Here a very strong local has been built up. Wages are high, it 
is a choice location, and the work is pleasant. Naturally every one would 
like bo gain entrance to this local, and the present members simply and 
frankly wish to keep their good fortune for themselves. Their answer 
to a man’s plea for admission, no matter who the person was, would 
most likely be to go and help build up some weaker branch where his 
presence was needed and wanted. 
Then, again, in the building trades one finds a seasonal occupation. 
It is up to the men to make just as much as possible in the time at 
their disposal, and a limitation-of-numbers policy makes the wages high 
for those admitted. Hence in some of these locals a whole man might 
find as much difficulty securing entrance as one who was handicapped. 
From this study there appears to be great need for educational 
effort among some labor groups, such as will follow the adoption of the 
State program of rehabilitation provided in the present law. The 
obstacles to employment of the physically handicapped, as far as trades 
unions are concerned, are to be located and overcome in much the same 
way as opposition in dealing with some employers, namely, through 
constant effort on behalf of individual cases for whom employment is 
sought. Generalizations about the situation are of little use. 
G. Foreign and Illiterate Groups.—A number of specific observa- 
tions regarding racial lines in the employment of these 23 concerns have 
been made, and these situations compared with the grouping of foreigners 
in other industries, large and small. Hot, dirty, heavy and disagreeable 
work is frequently done by foreigners of more or less distinct racial 
groups. This condition is explained not so much by racial characteristics 
or American prejudices towards them, as by the tendency toward illiter- 
acy and poor skill in certain racial groups. Frequently these racial 
groups have little opportunity to improve their living and working con- 
ditions or to acquire skill. The educated foreigners frequently follow a 
skilled trade. These observations from the industrial standpoint em- 
phasize the need of fundamental education for many immigrants and for 
the illiterate, including the learning of English, in the educational 
phase of the rehabilitation program. The unskilled and poorly educated 
worker, when disabled through accident or disease, is more apt to present 
a problem of rehabilitation which the community must undertake than 
the better educated and skilled. 
7. Light Work and Some of Its Problems.—The usual types of 
low skilled occupation in which physically handicapped persons are to be 
found in numbers, are various types of assembly, of punch press opera- 
tion, of polishing, and salvage of used materials. Jobs of the type 
indicated are usually designated “light work,” are easily taught, are 
sedentary, and involve little risk in respect to loss of materials, or 
injury to the workman or his fellows. These jobs exist in nearly all 
large manufacturing establishments. In them severely handicapped 
persons, as for example the blind, frequently acquire greater skill and 
speed than the ablebodied. The work is often monotonous and sometimes THE DEPARTMENT OF PUBLIC WELFARE 
unattractive for the ablebodied. These observations suggest problems 
for further study when the placement of physically handicapped persons 
is undertaken under the present law. One problem that has appeared 
in the present study is the temporary character of work of this nature in 
job industries, as reflected in the following comment by the investi- 
gators : 
The company, while turning out great quantities of product, change 
the jobs from time to time as they do big job work according to specifi- 
cations. The guide taking us through this plant pointed out the diffi- 
culty resulting from their constantly changing jobs. In such a large 
plant it might be possible to find some other job the handicapped person 
could do, but the slight extra administrative effort is not likely to be 
expended. 
Another problem is represented in the frequent reduction of oppor- 
tunities for employment through the installation of mechanical inven- 
tions. Examples are the introduction of automatic buffing machines 
and the invention of a process of casting together certain small clock 
parts which formerly required assembly by hand. Another problem 
which is to be foreseen in the placement of low-skilled, disabled workers 
in these types of employment is represented in the employment of women. 
When a job which is known to he “light work” becomes sufficient stand- 
ardized and requires a number of workers, the concern is likely to con- 
sider the hiring of women. An example is switchboard operating, at 
which women are now used almost universally, the problem is suggested 
by the following illustration: 
A carpenter in a small town met with an accident which resulted 
in amputation of one leg at the hip. About this time, the telephone was 
being introduced into rural districts. He saw the opportunity and in- 
vested some money in the new company, having the switchboard put 
into his house. With the aid of his family, he was able to take care of 
the job night and day. He maintains a good standard of living and 
has saved money. 
Girls were found operating punch presses in four of the 23 plants 
visited. In one plant they were used as operators of hand screw 
machines which require dexterity of hand and arm and steady attention 
to the machine, but little skill or judgment. The employment manager 
explained that the work required hut a few days to learn and that female 
help turned out more work and a product of better quality. In one plant 
90 per cent of the workers on jobs that were selected for analysis in rela- 
tion to physical handicap, were women, although only 65 per cent of the 
employed force were females. For the study of the whole, 43 per cent 
of the workers on jobs classed as suitable for handicapped persons were 
females. 
8. Large versus Small Plants.—In studying the range of indus- 
trial opportunities for the physically handicapped, as represented in the 
selection of the 23 plants visited, an outstanding observation is that of 
the great variety in number of persons employed by concerns within a 
single industry. In the printing business in Chicago for example,* 
* United States Census of Manufacturers for Illinois, 1914, p. 27. REHABILITATION OF PHYSICALLY HANDICAPPED 
the greatest number of workers, 22 per cent, are engaged in plants which 
employ between 100 and 250 persons. One establishment employs more 
than 1,000 persons. But there are more than 1,200 places that employ 
five persons or less, and 61 per cent of the plants in the city employ fewer 
than 21 persons. 
The circumstances in large and in small plants must therefore be 
compared, in the adoption of any policy of training and placement of 
physically handicapped persons. Observations in studying large and 
small plants have been compared, and an attempt made to characterize 
the differences as they affect the employment of physically handicapped 
persons. It is understood that the placement of anyone in a position is 
an individual matter and that in handling a given case, personal qualities 
such as mentality and training would be more important to consider than 
such relationships as are here summarized. It was probably the man 
of more than average capacity and ambition whom one of the field 
workers had in mind in expressing the following judgment: 
Where the disability necessitates transfer from the man’s estab- 
lished occupation, the best protection against down-grading through 
routinized assembly work or machine operation and probable loss of job 
due to changing industrial processes, and through reduction of wages 
with increasing age, is his entrance into small shop work. 
The examination of advantages and disadvantages of large and 
small plants for the employment of physically handicapped persons has 
not been carried to sufficient extent to warrant any conclusive recom- 
mendations. The following list is presented chiefly for the purpose of 
calling attention to the problem : 
TABLE IV—LARGE VERSUS SMALL PLANTS—ADVANTAGES AND DISAD- 
VANTAGES FROM THE STANDPOINT OF PHYSICALLY HANDICAPPED 
EMPLOYEES 
LARGE PLANT 
A. Advantages: 
Subdivision of labor tends to group the light work. 
Greater opportunity for change within plant. 
Systematic training, in case school or apprenticeship system has been 
established. 
More expert management, to discover handicap jobs. 
Easier to have a man’s material brought to him. 
Closer medical supervision, so that heart, hernia, and lung handicaps for 
example, are less exposed to increased hazard on account of transfer. 
Large plant more likely to have personnel department, for expert super- 
vision of relations with employers. 
Possible for man of average or low intelligence to become a specialist 
at repetitive processes. 
More safety precautions. 
B. Disadvantages: 
Routinized. poor chance to learn more than one job. 
Man’s physical condition may be endangered by transfer to job for which 
he is not fitted. 
Man r.ot so likely to receive personal attention of management. 
The worker usually does not acquire much trade training for subsequent 
employment. 
Tendency to confusion of the worker, and loss of independent feeling of 
job. Large plant not so likely to be near to man’s home. 
Greater competition with female labor. 
Greater competition with machines on repetitive processes. 118 
THE DEPARTMENT OF PUBLIC WELFARE 
SMALL PLANT 
A. Advantages: 
Greater possibility of adaptation of job to physical handicap, as a result 
of more personal consideration from the management. 
Work more likely to involve managerial functions. 
Man may start directly as manager or contractor. 
Less likelihood of displacement through the rough employment of women. 
Greater opportunity to learn as much of the trade as physical disability 
will permit. This general trade knowledge, combined with a certain amount 
of skill, is an important asset in securing subsequent positions. 
Small plant likely to be located near residence of handicapped person. 
More immediate attention on part of the management. 
B. Disadvantages : 
Small firm more likely to go out of business. 
Necessity of change from job to job within the plant may prevent em- 
ployment of disabled persons. 
Danger of taking a chance on helping with unanticipated task, at which 
he may be injured. 
Disabled person’s peculiarities are brought directly to the attention of 
the management, and this may make it more difficult for him to hold his 
position. Small firm less able to take increased risk of employing disabled 
persons. 
APPENDIX F-2 
EIGHTY-TWO DISABLED PERSONS EMPLOYED IN ELEVEN INDUSTRIAL 
PLANTS OF CHICAGO 
Information has been secured concerning 8*3 employees of plants, 
which have been studied in the present survey. The number of disabled 
employees reported by each firm is shown in the following table: 
TABLE I—INDUSTRIAL CONCERNS AND NUMBER OF DISABLED EMPLOYEES FOR 
WHOM INDIVIDUAL RECORDS WERE MADE. 
Key 
No. 
Kind of industry. 
Total 
number of 
employees. 
Number 
of disabled 
employees. 
1 
600 
9 
2 
620 
21 
3 
94 
10 
4 
420 
4 
5 
92 
4 
6 
650 
8 
7 
800 
2 
8 
512 
7 
9 
500 
7 
10 
1.0C0 
9 
11 
1,200 
1 
6,488 
82 
Interest attaches to this study partly from the fact that these cases 
represent 1.3 per cent of the total employed force of these plants, this 
being near the average proportion of serious disabilities in the popula- 
tion. Some of the disabilities in this group, however, as shown in Table 
II, do not constitute serious handicaps. REHABILITATION OF PHYSICALLY HANDICAPPED 
119 
The form on which each case was reported is as follows: 
Plant 
Name of employee 
Sex Age 
Name of disability 
Artificial appliances used 
Years in employ this firm 
Disabled while in employ this firm? 
Job now 
Job before handicap 
Wages now per week $ 
Reported by 
Education 
Date 
1920 
Years ago disabled 
No. weeks spent retraining 
Disabilities and use of artificial appliances among this group are 
shown by the following table: 
Location or nature of disability. 
Total 
number of 
persons. 
Per cent 
of 
persons. 
Amputa- 
tions. 
Number 
of 
prostheses. 
Lower limbs _ 
26 
31.7 
7 
7 
One foot. 
7 
8.6 
3 
3 
One arm 
4 
4.9 
3 
3 
Hand 
17 
20.7 
6 
3 
3.7 
4 
4.8 
10 
12.1 
4 
4.9 
7 
8.6 
Total. 
82 
100.0 
29 
13 
TABLE II—DISABILITIES AND PROSTHETIC APPLIANCES. 
Comparing this group with the 62 cases reported by public employ- 
ment bureaus, it appears that in case of amputations of feet or lower 
limbs, all are provided with artificial appliances, whereas among those 
coming to public employment bureaus the corresponding proportion was 
43 per cent. 
The wage effects of persons remaining in the service of an employer 
in whose plant the disability occurred is reflected in the following table: 
TABLE III—PERSONS DISABLED IN SERVICE OF PRESENT EMPLOYERS OR OTHER- 
WISE. 
Number. 
Per cent 
of those 
reporting. 
Average 
wage 
per week. 
20 
26 
*30.53 
56 
74 
*29.32 
From this it appears that one who is working for a concern in whose 
employ his disability occurred has little advantage over one whose dis- 
ability occurred otherwise. It is probable, however, that the cases here 
reported represent permanent positions, and the inclusion of handicapped 
persons engaged in temporary work might have resulted in a much lower 
average wage comparatively for those not in the employ of concerns in 
wdiose service their disabilities were received. THE DEPARTMENT OF FUBLIC WELFARE 
That the wage level is fairly high in this group, is shown by the 
fact that 54, or 66 per cent, of these employees were receiving wages of 
$25 or above.* 
Few of these men and women graded low in respect to education, 
most of them having reached the sixth or eighth grade, and nine of them 
having education above grammar school. 
. CHANGE OF OCCUPATION 
Twenty-three of these cases, or 28 per cent, are reported as having 
changed their occupations at the time of becoming disabled. The extent 
to which this change was for the better or for the worse is indicated by 
the nature of the job or the wages paid as follows: 
Seven Women: Ages: Six over 34 years. 
Wages: Ranging from $14 to $21; average, $17.50. 
Disabilities: Four hip trouble; 2 blind; 1 stiff elbow. 
Period of employment with present firms: Two for 10 
years; 1 for 22 years. 
Nature of work: Clerical and factory work. 
Only 1 disabled in employ of present firm. 
Twenty of the Ages: Fifty years or over. 
Older Men: Period of employment: Eight for 25 or more years; 15 
for 13 or more years; average, 
20 years. 
Twelve had received disabilities 
in employ of present firms. 
RETRAINING 
Seven men had received or were receiving training for new work on 
account of disability. Of these, 2 were soldiers, who were receiving 
training for 4 months as pattern apprentices. One had been a car car- 
penter and the other a core maker. The circumstances of retraining of 
the remaining 5 are indicated by the following table: 
TABLE IV—RETRAINING ON ACCOUNT OF DISABILITY. 
Age. 
Physical handicap. 
Old job. 
New job. 
Period 
of re- 
training. 
New 
wage per 
week. 
60 
23 
Stationary engineer 
Cook grinder on 
Three first fingers right hand 
single spindle 
2 weeks... 
S42.00 
32 weeks.- 
28.80 
44 
Assistant in ship- 
28.60 
36 
27 
Right eye much weakened 
Instrument making 
36.00 
6 months. 
26. CO 
* Seven of the 82 workers, or 9 per cent, had never worked for any other 
employer. REHABILITATION OF PHYSICALLY HANDICAPPED 
121 
APPENDIX F-3 
SIXTY-TWO PHYSICALLY HANDICAPPED PERSONS APPLYING AT FREE 
EMPLOYMENT BUREAUS 
(Ail applicants between March 1 and December 1, 1920.) 
The cases included in this study are valuable for representation of 
the service now being rendered by free employment bureaus in connec- 
tion with the rehabilitation of physically handicapped persons. 
The information has been recorded on the enumeration card (for 
form see page 493). The number of case records received and the 
employment offices represented are as follows: 
Chicago 47 
Peoria 8 
Decatur 5 
Danville 2 
Total 62 
The lack of cases from the remaining 7 free employment offices in 
the State may be taken as an indication that few physicially handicapped 
persons applied for placement during this period, as the superintendents 
of all bureaus were supplied with report cards, and they expressed a 
desire to cooperate by furnishing information regarding any physically 
handicapped persons who might apply. The following note from the 
superintendent of the Peoria bureau indicates that records could not be 
expected from downstate offices for all physically handicapped appli- 
cants. It shows also the wandering habits of some of these men. 
Several applicants who called on us for assistance during the past 
month were physically disabled, but as they did not contemplate stopping 
long in Peoria they refused to fill out an application blank. We also 
find some people who are reluctant about discussing their injuries. 
The small number of disabled persons applying during this period 
of nine months may be considered as an indication, to a certain extent, 
that during this period of excess demand for labor handicapped persons 
had little difficulty in securing jobs. It may result also partly from the 
circumstance that the free employment bureaus, with the exception of 
Chicago, which has a special placement officer for disabled and aged 
persons, were not in a position to advertise special service in securing 
jobs, and for that reason only the ablebodied were inclined to make 
application. 
These results are of value chiefly as showing the relation of the free 
employment bureau to reestablishment of the physically handicapped 122 
THE DEPARTMENT OF PUBLIC WELFARE 
before the liehabilitation Act has been put in operation. These 62 men 
are only an extremely small and select group of the physically handi- 
capped who may need rehabilitation. 
The disabilities and use of prosthetic appliances represented in this 
study are shown in the following table: 
TABLE I—DISABILITIES AND USE OF ARTIFICIAL LIMBS OR OTHER PROSTHETIC 
APPLIANCES. 
Location or nature of disability. 
Total 
number of 
persons. 
Per cent 
of persons. 
Ampu- 
tations. 
Number 
of 
prostheses. 
12 
19.3 
7 
6 
7 
11.2 
4 
2 
3 
7.8 
2 
1 
1.6 
1 
26 
41.9 
23 
6 
1 
1.6 
5 
8.0 
5 
2 
3.2 
Blind 
2 
3.2 
3 
4.8 
62 
99.8 
42 
14 
* One soldier. 
Considering the first four items in this table it appears that 43 
per cent of those having amputations of one or both feet or legs were 
without artificial feet or limbs. Comparing this group with similar 
amputation cases among the 82 employed persons whose records are pre- 
sented in Appendix F-2, it appears that the employed workers are better 
supplied with artificial limbs. The ten persons with similar amputations 
have them. 
AGE AND SOCIAL CONDITION 
All of these 62 applicants were males. Their age distribution is 
shown as follows: 
TABLE II—AGES OF 02 PHYSICALLY HANDICAPPED PERSONS WHO APPLIED FOR 
EMPLOYMENT. 
Age group. 
Number. 
Per cent. 
10 
16 
23 
37 
9 
15 
10 
16 
7 
11 
3 
5 
62 
100 
While only 12 per cent of those under 30 years were married, about 
one-half of those in the higher age group were reported as being married. 
Fourteen were reported as having been born in foreign countries, all 
except two of them having been in the United States 10 years or longer. 
All spoke English. REHABILITATION OF PHYSICALLY HANDICAPPED 
123 
INDUSTRIAL AND WAR INJURIES 
Number: Twenty-six, or 43 per cent of the 62 cases. 
Ages: Three-fourths over 30 years old. (The younger men are 
freer to move about, have fewer dependents, get better 
jobs, and their injuries usually have occurred since the 
passage of the Compensation Act.) 
Compensation: Fourteen received compensation, varying from $1,200 to 
$3,000. 
Soldiers: Four received from $12.50 to $100 a month from Federal 
Government. 
EDUCATION AND SKILL 
On an average, these men had received education as high as the 
seventh grade. The value of the information on this point is doubtful, 
however, and other circumstances shown by the records would indicate 
that most of the men had not reached the seventh grade. 
Eighteen of the men, or 29 per cent, were common laborers both 
before and following disability. Habits of work were reported in 29 
cases and of these 72 per cent appear to have been steady workers both 
before and after disability, the remaining group having changed from 
steady to casual labor at the time of becoming handicapped. 
WAGES AND ECONOMIC CONDITION 
Approximately one-third had no occupation, and tv ere not referred 
to a job; approximately one-third were doing low-skilled work (watch- 
men, switch tenders, odd jobs, etc.) and the remaining one-third were 
classed as semi-skilled and clerical—(drill press operators, elevator 
operators, janitors, one inspector). 
Information was given regarding wages in 25 cases. For these men 
the average wage before disability was $19.24 a week and after disability 
$18.62. The decrease in earning power is much greater than these 
figures indicate, for the reason that in most instances the war-time rise 
in wages had occurred since the men had become disabled. The degree 
of self-support is shown for 42 cases in the following table: 
TABLE III—SELF SUPPORT, 42 CASES 
Dependent 4 per cent 
Partially self-supporting J2 Per cent 
Self-supporting 59 per cent 
Supporting others “2 Per cent 
More than half of the men who reported themselves as self- 
supporting were under 30 years of age. 
SUBSEQUENT HISTORY OF EMPLOYMENT 
On December 15 the employment status of the 47 Chicago cases 
represented in this study was as follows: 
At work 
Unemployed o 
Never assigned to jobs ° 
In business for self THE DEPARTMENT OF PUBLIC WELFARE 
The cause of unemployment in the 17 cases noted is to be seen partly 
in the industrial situation. The recent reduction in demand, and in- 
crease in supply, of labor is shown by the following table: 
TABLE IV—MONTHLY RATIO OF DEMAND FOR WORKMEN MADE AT ILLINOIS FREE 
EMPLOYMENT BUREAUS TO SUPPLY OF APPLICANTS FOR JOBS. 
(Number of applicants registered to 100 positions open.) 
A. Total by months, year 1920: 
February 73 
March.. 78 
April 80 
May 81 
June 84 
B. Ratio by industries, year 1920: 
July. 99 
August 92 
September 96 
October , 103 
November ' 128 
Industry. 
August. 
September. 
October. 
November. 
Agricultural __ 
77.5 
133.2 
103.2 
99.2 
Boys work _. 
120.6 
95.8 
132.0 
205.0 
Building and construction 
108.0 
63.7 
104.3 
168.4 
Clerical 
91.4 
114.1 
151.4 
203.0 
Domestic and personal service hotel and restaurant-- 
79.3 
75.1 
80.7 
100.9 
Factory work 
111.0 
83.9 
115.2 
144.6 
Metals and machinery. . _ 
75.9 
142.6 
110.4 
236.0 
Transportation and public utilities 
195.0 
203.9 
180.1 
209.9 
120.1 
153.4 
259.9 
56.0 
89.5 
Miscellaneous - 
93.9 
132.2 
143.8 
210.8 
Common labor - 
88.9 
80.0 
92.3 
109.3 
Casual labor 
99.9 
97.7 
98.7 
102.3 
Total 
92.0 
96.3 
102.8 
127.9 
This unusual amount of unemployment among the physically handi- 
capped is due also to the circumstance that most of the men considered 
in this study were placed at temporary jobs, and with the restriction of 
output they were among the first to be laid off. Whether the situation in 
this respect among the physically handicapped is identical with that 
among the ablebodied cannot be determined from the records of the 
employment office but it is believed by placement officers that the able- 
bodied who were placed in temporary jobs have been laid off in about the 
same proportion as the disabled. 
The remedy for unemployment among the physically handicapped 
on account of temporary or casual work, apparently lies in the direction 
of more thorough examination of their condition and needs at the time 
of application, vocational training in some instances as provided in the 
Rehabilitation Act, and greater attention to placement and follow-up 
service. 
APPENDIX F 4 
REEMPLOYMENT OF TILE MORE SERIOUSLY INJURED PERSONS INCLUDED 
UNDER THE COMPENSATION ACT 
To obtain more exact information regarding the circumstances of 
reemployment of persons who are seriously injured at work, a study has REHABILITATION OF PHYSICALLY HANDICAPPED 
125 
been made of 2,089 cases taken from the records of the State Industrial 
Commission for the year 1919. 
It is the impression of officers of the Industrial Commission that 
nearly all of those who are temporarily injured return to their previous 
jobs. the more seriously injured, they can make no estimate. 
In this classification of “the more seriously injured” are included for the 
year 1919 those grouped under the following terms: total disability, 
permanent specific loss, and permanent partial disability. These number 
5,021, or 14 per cent of the entire number of cases coming before the 
Industrial Commission during the year 1919. 
For the present inquiry, 2,670 cases were selected from among 
those whose compensation amounted to $300* or more; and from those 
with this compensation were chosen the cases in which physical disabili- 
ties were apparently the more serious. 
For each of these 2,670 cases, an inquiry was mailed to the em- 
ploying concern asking for information regarding employment subse- 
quent to injury, to be returned on the following form: 
1. Reemployed at - 
Fill in “same job” or description of new job. 
2. Continued on our pay-roll until 
“Now” or date when left. 
3. Wages! increased) 
(decreased)(underscore) by per cent since injury. 
(improved) 
4. Conditions of work and chance for advancement(same j(underscore) 
(declined ) 
5. weeks spent(at this plant)in retraining for new job. 
(outside ) 
Additional comment: 
To these 2,670 inquiries, 2,089 replies were received, which is 78 
per cent of the number of questionnaires sent. 
In all cases there was an interval of at least seven months since the 
injury was incurred, as the first inquiries were mailed on July 15, 1920. 
This period was sufficient for nearly all persons concerned to have re- 
turned to work where they had been employed, providing relations with 
their employers were harmonious and suitable work was offered. For 
persons injured in January, 1919, nineteen months had elapsed before 
the inquiry was made. But as far as reemployment is concerned, the 
interval between injury and date of inquiry seemed to make no difference, 
according to the returns received. 
In some cases employers went to great length to find out and report 
the circumstances of reemployment after injury, even when the men had 
* A few inquiries were sent regarding persons whose compensation amounted to 
less tha#i $300 but more than $250. 126 
THE DEPARTMENT OF PUBLIC WELFARE 
gone to other plants. A number of letters were received describing the 
difficulties of making proper adjustment following injury. Several 
employers expressed interest in the adoption of a State program for 
persons injured in industry. 
In examining the results of this inquiry it is to he borne in mind 
that they represent exclusively the statements of employers. 
The age distribution of these 2,089 seriously injured persons and 
whether or not they were reemployed, are shown by the following table: 
TABLE I—AGES OF INJURED PERSONS AND WHETHER OR NOT REEMPLOYED 
Age. 
Number 
of 
persons. 
Per cent 
of 
persons. 
Number 
re- 
employed. 
Number 
not re- 
employed. 
15-19 
177 
8 
177 
60 
20-29 . 
467 
22 
328 
139 
30-39 
524 
25 
366 
158 
40-49 2 
417 
20 
279 
138 
50-59. 
228 
11 
151 
77 
60-69 
97 
5 
51 
46 
70-79 
15 
1 
8 
7 
164 
8 
89 
75 
2,089 
100 
1,389 
700 
The age grouping of these cases corresponds fairly evenly with that 
of the entire group of 5,021 cases from which they were selected. In 
this table is shown a tendency, above the average, to reemploy injured 
persons between the ages of 20 and 40, and below the average not to 
reemploy those between the ages of 60 and 80. 
Two-thirds of those included in this inquiry appear to have been 
reemployed subsequent to injury. 
The following table shows the number of reemploved or not re- 
employed according to the amount of compensation allowance: 
TABLE II—AMOUNT OF COMPENSATION AND REEMPLOYMENT. 
Amount of compensation. 
Re- 
employed. 
Per cent. 
Not re- 
employed. 
Per cent. 
$250.00 to $500.00 
690 
71 
286 
29 
$501.00 to $750.00- 
297 
65 
162 
35 
$751.00 to $1,000.00 
133 
58 
97 
42 
$1,001.00 to $1,250.00 
103 
72 
39 
28 
$1,251.00 to $1,500.00 
78 
70 
34 
30 
$1,501.00 to $1,750.00 
36 
68 
17 
32 
$1,751.00 to $2,000.00 
18 
53 
16 
47 
24 
37 
40 
63 
10 
53 
9 
47 
Total 
1,389 
Av. 66 
700 
Av. 33 
From this it appears that there is a marked tendency for persons 
receiving more than $1,750 compensation not to be reemployed by the 
firms in whose service they were injured. This is shown by the variation 127 
REHABILITATION OF PHYSICALLY HANDICAPPED 
in the column of percentages from the average of the column. This may 
be due to the disinclination of a man receiving a large compensation 
award to return to work, or to the seriousness of his injury or to the 
antipathy of the employer occasioned in the process of agreement upon 
the allowance. 
The outlook for remunerative employment, as indicated by answers 
to the fourth question in the schedule, is shown by the following table: 
TABLE III—CONDITIONS OF WORK AND CHANCES FOR ADVANCEMENT. 
Condition. 
Those 
re- 
employed. 
Per cent 
of those 
reported. 
Those 
not re- 
employed. 
Per cent 
of those 
reported. 
Same.. _ 
896 
77 
34 
47 
Increased... ... __ _ _ . _ 
192 
17 
14 
19 
Decreased _ _ . 
71 
6 
25 
34 
230 
627 
Total . 
1,389 
100 
700 
100 
With respect to those reemployed the statement would be more 
accurate if it were based on the combined judgment of employment 
managers and physicians. These replies were made at a period of maxi- 
mum demand for labor and to that extent they may be discounted for 
over-statement of a man’s future chances. Even under these circum- 
stances, however, the replies on this point are noteworthy for their 
indication of: 
1. The relatively small proportion of those who were reem- 
ployed whose industrial opportunities were diminished. 
2. The relatively large proportion among the few cases re- 
ported of those not reemployed whose opportunities were diminished. 
A similar tendency regarding prospects subsequent to injury is 
shown in the amount of wages reported in the following table: 
TABLE IV—WAGES AFTER THE INJURY OF THOSE REEMPLOYED AND THOSE NOT 
REEMPLOYED. 
Wages. 
Those 
re- 
employed. 
Per cent 
of those 
given. 
Those 
not re- 
employed. 
Per cent 
of those 
given. 
Same . __ 
420 
36 
11 
25 
Increased . 
690 
58 
28 
64 
Decreased ... 
72 
6 
5 
11 
207 
656 
Total 
1,389 
100 
700 
100 
The greater proportion of those showing increase of wages in Table 
IV, as compared with those showing increase in prospects for advance- 
ment in Table III, may be assumed to be due to the constantly in- 
creasing wage scale at the time those replies were made. 
The reasons for failure to reemploy the injured persons as given in 
these replies from employing concerns are as follows: THE DEPARTMENT OF PUBLIC WELFARE 
TABLE V—REASONS EMPLOYERS GAVE FOR NOT REEMPLOYING 
SERIOUSLY INJURED PERSONS 
Never applied after accident 279 
Not recovered from accident : 65 
Went to other employer 35 
Job upon which injured was temporary 26 
Refused job on which injured 22 
Went into business for himself 23 
Refused new job 10 
Dead 9 
Physical handicap such could not reemploy 6 
Undesirable mental attitude 3 
Shirker 2 
Reason not given 220 
Total 700 
Whether those reemployed were taken back into the same jobs or 
were put at different work is shown by the following table: 
TABLE VI—WHETHER REEMPLOYED AT SAME OR AT DIFFERENT JOB. 
Number. 
Per cent 
of those 
answering. 
1,031 
302 
77 
23 
56 
Total 
1,389 
100 
It is likely that of the 302 reported as being put at different jobs 
after injury, some were so assigned temporarily during period of re- 
cuperation. 
The industries in which 2,089 seriously injured persons under 
inquiry were engaged are as follows: 
TABLE VII—INDUSTRIES IN WHICH THE MORE SERIOUSLY INJURED WERE ENGAGED. 
Re- 
employed. 
Not re- 
employed, 
1. Agricultural implements . - 
75 
16 
2. Automobiles, inc. bodies and parts, also accessories - - - - -- 
16 
4 
1 
4. Bread and other bakery products 
10 
3 
5. Brick, tile, pottery and other clay products - - 
11 
2 
2 
7. Carriage and wagons and materials .. - - - -- 
3 
3 
8. Cars and general shop construction and repairs by steam railway companies 
2 
1 
9. Cars, steam railroad, not including operations of railroad. ... 
21 
9 
4 
2 
11. Clocks and watches, including cases and materials - 
4 
2 
12. Clothing, men’s, including shirts ... 
1 
1 
1 
1 
11 
5 
15. Construction and building. _. . 
37 
34 
16. Copper, tin and sheet iron products 
24 
11 
17. Electrical machinery, apparatus and supplies, telephone, telegraph, etc... 
45 
13 
18. Flour-mill and grist-mill products, elevators, grains - 
24 
23 
19. Foundry and machine shop products. — 
188 
83 
20. Furniture and refrigerators. - 
18 
8 
1 
8 
3 
1 
24. Iron and steel, steel works and rolling mills 
65 
36 REHABILITATION OF PHYSICALLY HANDICAPPED 
129 
TABLE VII—Concluded. 
Re- 
employed. 
Not re- 
employed^ 
7 
* 
26. Leather, tanned, curried and finished, 
7 
1 
27. Liquors, malt, and breweries 
7 
3 
28. Lumber and timber products , 
28 
12 
339 
166 
30. Musical instruments, pianos and organs and materials 
14 
8 
31. Oil, refining and pipe line _ 
26 
10' 
5 
3 
33. Paper, felt and pulp works 
6 
3 
34. Printing and publishing, 
21 
6 
35. Sand, cement, quarrying, etc 
13 
4 
36. Slaughtering and meat packing , 
45 
26 
37. Smelting and refining, zinc, aluminum, iron and lead 
14 
8 
4 
1 
39. Stoves and furnaces, including gas and oil stoves, , , 
9 
5 
19 
12 
41. Transportation, railroad, etc 
62 
20 
42. Wholesale and commission merchants, mail order _ . 
13 
6 
180 
140 
1,389 
700 
Whether or not in any industry there is a strong likelihood of an 
injured person’s returning to work with his former employer, is shown 
by comparison for any industry with the average ratio for the entire 
group, namely, two persons reemploved for everyone not reemployed. 
The attitude of the specific firm, however, is in some instances more 
important than the industrial classification given in the foregoing table. 
Some large concerns reengage nearly all employees injured in their 
service, and some take back comparatively few. 
Taking specific occupations, as far as they can be determined from 
the records of the Industrial Commission, 'an approximate statement of 
relationship between skilled and unskilled work is here made. It was 
necessary to guess the meaning of some occupational designations as, for 
example, “machinist,” which may indicate any grade of work from that 
of a routine machine operator to that of a master machinist. The classi- 
fication here made has been submitted for correction to an expert in job 
analysis, to an employer in the milling business, and two members of the 
State Industrial Commission with varied industrial experience. For 
1,935 persons who could he classified according to this method, the fol- 
lowing results were given: 
TABLE VIII—DEGREE OF SKILL 
Degree of skill. 
Those reemployed. 
Those not reemployed. 
Number. 
Per cent. 
Number. 
Per cent. 
Skilled -- --- 
630 
49 
352 
55 
Semiskilled .. 
187 
14 
69 
11 
Unskilled — -- -- -- 
476 
37 
219 
34 
Total 
1,295 
100 
640 
100 
—9 R P H THE DEPARTMENT OF PUBLIC WELFARE 
The table indicates that the degree of skill can scarcely have had 
much effect upon the reemployment of those seriously injured persons. 
The question as to retraining disabled men for service in the plant 
was answered in the affirmative by 36 firms. To these employers was 
sent an inquiry as to the character of training given. Twenty-four 
replies were received, and from these it appears that only ten of the 
firms had carried on the retraining according to any plan. These ten 
replies are here summarized. These replies altogether related to 63 
employees: 
Yes. No. 
1. Was man retrained by special person or departments 4 6 
2. Was he retrained in the department where it was expected he would 
be reemployed 6 4 
3. Did retraining consist in a course of instruction fitting for a new type 
of work 8 2 
4. Did it include operating a machine or contrivance different than the 
one previously operated 8 2 
5. Did he start the job at full production 1 9 
From replies received, it appears that the retraining given was in 
most instances casual, the two notable exceptions being a large enameling 
concern having an exceptionally well arranged medical department, and 
an electrical concern having a well developed apprenticeship school. 
INDUSTRIAL ACCIDENTS IN ILLINOIS IN RELATION TO PHYSICAL HANDICAP 
APPENDIX F-5 
A. Compensation Cases 
Fifty-five per cent of the number of employees in gainful occupa- 
tions in Illinois are covered by the Compensation Act, either in its 
compulsory or in its elective provisions.* 
In the following series of tables and charts, parts of the statistical 
report of the State Industrial Commission for the calendar year 1919 are 
presented. 
Except where otherwise stated, only those classes are considered in 
the summaries which include the more serious disabilities. These groups, 
and the number in each for the year 1919, are as follows: 
* “Comparison of the Compensation Acts of the United States and Canada up 
to January 1, 1920,” Carl Hookstadt, Bureau of Labor Statistics, U. S. Department 
of Labor, Bull. 275, p. 31. REHABILITATION OF PHYSICALLY HANDICAPPED 
131 
TABLE I—CLASSIFICATION OF THE MORE SERIOUS INJURIES UNDER THE COMPEN- 
SATION ACT, FOR 1919. 
Male. 
Female. 
Total. 
25 
2 
27 
4,609 
120 
264 
4,873 
1 
121 
Total _ 
4,754 
267 
5,021 
The total of. these groups, 5,021, constitutes 14 per cent of the 
total number of compensation cases when deaths, disfigurements and 
temporary disabilities are included, namely, 36,533. 
TABLE 2—AVERAGE OF COMPENSATION AND MEDICAL COST OF THE VARIOUS TYPES 
OF DISABILITY. 
Cost. 
Number of 
accidents. 
$9,334 
3,012 
861 
544 
279 
196 
62 
27 
535 
121 
4,873 
78 
813 
32,042 
Average __ 
$177 
Total 38,042 
Derived from Table II, of the report of the Industrial Commission. 
TABLE 3—SEX AND AGE OF THE MORE SERIOUSLY INJURED. 
Age. 
Male. 
Female. 
Total. 
Per cent. 
Under 16 years 
11 
1 
12 
.3 
16 to 20 
598 
93 
691 
14.3 
21 to 25 
619 
58 
677 
14.1 
26 to 30 
617 
20 
637 
13.2 
31 to 35 
641 
20 
661 
13.7 
36 to 40 
674 
18 
692 
14.4 
41 to 45 
389 
8 
397 
8.2 
46 to 50. 
383 
9 
392 
8.1 
51 to 55 
333 
2 
335 
6.9 
56 to 60. : 
171 
2 
173 
3.6 
Over 60 _ 
154 
3 
157 
3.2 
Total - - 
4,590 
234 
4,824 
100.0 
Derived from Table 9 of the report of the Industrial Commission. 
TABLE 4—PARTS OF THE BODY INJURED. 
Part of body. 
Number 
of cases. 
Per cent. 
Chief 
subdivision. 
Per cent 
of cases 
in subdi- 
vision. 
Upper extremity 
17,970 
37.4 
Hand or fingers.- 
76 
15,485 
11,193 
2,657 
984 
32.2 
14 
22.9 
54 
5.5 
58 
2.0 
93 
Total -- 
48,289 
100.0 
(38,289 injuries including the lighter forms of disability) THE DEPARTMENT OF PUBLIC WELFARE 
TABLE 5-SEX AND WAGES OF THE MORE SERIOUSLY INJURED. 
Weekly wages. 
Male. 
Female. 
Total. 
Per cent. 
$5 and under $10 
25 
15 
40 
.8 
$10 and under $15 . 
153 
133 
286 
5.5 
$15 and under $20 _ 
698 
85 
783 
15.6 
$20 and under $25 
1,642 
22 
1,664 
33.3 
$25 and under $30 _ 
836 
5 
841 
16.9 
$30 and under $35.. 
627 
1 
628 
12.6 
317 
317 
6.3 
153 
153 
3.0 
45 
45 
.9 
25 
25 
.5 
$55 and under $60 . . . 
3 
3 
15 
15 
.2 
Salary not reported _ 
215 
6 
221 
4.4 
Total 
4,754 
267 
5,021 
100.0 
Derived from Table 6, of the report of the Industrial Commission. 
TABLE 6 OCCUPATIONS IN WHICH THE MORE SERIOUS INDUSTRIAL INJURIES 
OCCURRED IN 1919. 
Industry. 
Permanent 
total 
disability. 
Permanent 
partial 
disability. 
Specific 
loss. 
27 
121 
4,873 
97.2 
.5 
2.3 
13 
11 
66 
1,275 
2 
14 
1 
1 
26 
2 
22 
1 
27 
2 
16 
1 
3 
160 
1 
6 
733 
4 
447 
2 
199 
1 
311 
44 
22 
1 
85 
1 
81 
98 
1 
33 
2 
45 
2 
7 
336 
41 
9 
1 
31 
4 
201 
1 
2 
49 
4 
90 
1 
31 
2 
104 
1 
13 
2 
3 
37 
1 
12 
2 
4 
86 
1 
64 
1 
1 
46 
5 
1 
8 
2 
1 
28 
11 
Derived from Table 2 of the report of the State Industrial Commission. REHABILITATION OF PHYSICALLY HANDICAPPED 
133 
THE MORE SERIOUSLY INJURED, BY COUNTIES. 
d 
O to6 cases 
7 tolO cases 
11 to50 cases 
51 to 150 cases 
More them 150 case 5^j THE DEPARTMENT OF PUBLIC WELFARE 
The number of injuries, of the three classes under consideration, in 
the highest ten counties, were as follows: 
1. Cook 2,534 
2. Franklin 274 
3. Williamson 271 
4. Saline 203 
5. St. Clair 149 
6. Madison 146 
7. Winnebago 117 
8. Macoupin 106 
9. Montgomery .... 76 
10. Rock Island .... 74 
B. Accidents Reported by Public Utilities 
Only a part of the injuries that occur in the service of public utility 
companies are covered by the Compensation Act. The number of acci- 
dents reported to the Public Utilities Commission and those included in 
the statistics of the State Industrial Commission are shown in the fol- 
lowing table: 
TABLE 7—NUMBER OF INJURIES IN CONNECTION WITH PUBLIC UTILITIES. 
*Compensable 
accidents, 
year ending 
Dec. 31, 1918. 
**Accidents reported to 
Public Utilities Commission 
year ending June 30, 1919. 
Employees. 
Passengers 
and others 
persons. 
1,507 
557 
738 
238 
10,805 
552 
1,279 
1,649 
6,361 
70 
3,040 
12,636 
8,080 
* Annual report, State Industrial Commission, p. 16. 
** Manuscript report from chief engineer, dated September 14, 1920. 
Prom this table it appears that 13 per cent of the number of acci- 
dents reported to the Public Utilities Commission during one year were 
reported for a similar period of twelve months by the State Industrial 
Commission. The comparison is not exact, as the report years end re- 
spectively on June 30 and December 31. 
The report of the Public Utilities Commission shows the following 
occupational classification of employees injured non-fatally during the 
year ending June 30, 1919: 
TABLE VIII—OCCUPATIONS OF EMPLOYEES INJURED NON-FATALLY IN SERVICE OF 
PUBLIC UTILITIES COMPANIES, YEAR ENDED JUNE 30, 1919. 
Steam 
rail- 
roads. 
Interur- 
ban rail- 
roads. 
Street 
rail- 
roads. 
Total. 
Per cent. 
I. STEAM AND ELECTRIC RAILROADS. 
A. Movement of trains— 
4 
4 
. 1 
2 
2 
6 
1 
7 
.2 
12 
12 
.3 
9 
9 
.02 
127 
6 
133 
4. REHABILITATION OF PHYSICALLY PIANDICAPPED 
135 
Steam 
rail- 
roads. 
Tnterur- 
ban rail- 
roads. 
Street 
rail- 
roads. 
Total. 
Per cent. 
A. Movement of trains—Concluded. 
1,259 
1,530 
114 
37 
27 
1,323 
1,653 
126 
40.3 
12 
111 
50.4 
3 
9 
4.3 
3,061 
60 
148 
3,269 
100.0 
B. Other than movement of trains and cars— 
216 
3 
61 
280 
3.5 
859 
2 
861 
10.9 
.3 
28 
1 
2 
31 
1,710 
21 
9 
12 
1,731 
25 
2f. 9 
1 
3 
.3 
29.3 
2,221 
251 
4 
78 
2,303 
307 
7 
49 
3. 9 
32 
1 
33 
.4 
1,062 
1,088 
4 
19 
1,085 
1,154 
77 
13.8 
10 
56 
14.7 
74 
1 
2 
1. 
7,562 
42 
283 
7,887 
100.0 
II. PUBLIC UTILITIES—NOT TRANSPOR ATI ON. 
8 
. 6 
31 
2.5 
2.6 
33 
23 
1. 8 
67 
5.3 
34 
2.7 
2.1 
26 
27 
2.1 
30 
2.4 
21 
1.7 
47 
3.8 
72 
5.8 
138 
11. I 
105 
8.4 
14 
1. 1 
5 
. 6 
55 
4.4 
4 
.3 
109 
8.8 
35 
2.8 
5 
.4 
1 
8 
. 6 
287 
23.1 
65 
5.2 
1,250 
100.0 
TABLE II—Concluded 
APPENDIX F-6 
NEGLECT OF INDUSTRIAL INJURIES DUE TO MAKING COMPENSATION 
SETTLEMENTS PRIOR. TO RESTORING FUNCTION OF INJURED PARTS 
In this section is shown: 
The interest of industrial concerns and of their insurance carriers, 
in arriving at early settlements of liability for injuries to workmen, 
frequently results in permanent disabilities which might otherwise have 
been prevented. 136 
THE DEPARTMENT OF PUBLIC WELFARE 
The injured man is unable to judge the extent of his injury or the 
possibility of future improvement, and is therefore willing to make an 
early settlement, provided the company will admit a considerable degree 
of disability. The firm and the insurance carrier prefer an immediate 
settlement to a long continuance of a case. The advice of specialists is 
not easily available in many instances, and the obscure effects of the 
injury are not recognized, nor the possibility of restoring function to 
the injured part. The circumstances are favorable to driving a bargain 
immediately, and letting the man fare for himself. The man, after a 
settlement has been made, is not likely to get the expert advice and 
treatment needed for restoration. 
The effect of the compensation settlement is to confirm in the man 
the impression that he is totally and permanently disabled, with the 
result that he leaves his trade and may drift into idleness and de- 
pendency. 
Cases that are brought before the State Industrial Commission for 
arbitration and which are found to require special examination or diag- 
nosis, are referred to the medical section of the Commission. Descrip- 
tions of six of such cases are presented herewith, to illustrate the 
foregoing statements. These case histories have been summarized by the 
medical director of the commission, Dr. Paul B. Magnuson.* In pre- 
senting these case records, Dr. Magnuson says: 
These cases, as well as many others that we see, sometimes daily, 
demonstrate that, by expert surgical and medical attention, many so- 
-called permanent disabilities can be relieved, which would seem to indi- 
cate that there are two things necessary: 
First—A place where men can be sent, where they will be sure to 
have expert advice of all kinds, not only surgical and medical, but neu- 
rological, orthopedic, dental and genito-urinary; where there are proper 
laboratory facilities and the many things that are necessary to make 
proper diagnosis. 
Second—It should be compulsory for the company to show, by com- 
petent medical testimony, that no further improvement can be expected 
from medical or surgical treatment before a settlement is allowed. There 
should be a clause in the law which would compel employers to furnish 
this treatment, to the maximum restoration of the patient. 
I—Philip Coxf fell some forty or fifty feet, suffering a fracture of 
the sixth cervical vertebra, without serious displacement or injury to the 
cord. At the same time he received a fracture of the skull with severe 
laceration of the scalp. He came to the Industrial Commission totally 
disabled for work on account of a serious limitation of motion in the 
neck. He could not turn his head either way, nor raise it to look up. 
The case came up for settlement on the basis of permanent disability, 
and upon examination I recommended that further treatment be estab- 
lished with a view to reducing the disability which he had ; my diagnosis 
being that the man had an inflammatory process in the joints of the 
vertebrae of the neck which, if relieved, would improve his condition. 
« see also “Industrial Surgical Clinics,” by Drs. Paul B. Magnuson and John S. 
Coulter, J. B. Lippincott & Co., 1920. 
t used in this series are fictitious. REHABILITATION OF PHYSICALLY HANDICAPPED 
137 
There was considerable argument as to the amount of expense and 
whether it would be cheaper to pay the man for his disability and let 
him go, or whether we could assure the company of enough improvement 
to warrant their going to the expense of trying to cure him. Urged by 
the commissioner, the company consented, and after six weeks of treat- 
ment in the hospital, without operation, the patient was discharged with 
full motion in the neck. He has now returned to light work until such 
time as he is strong enough to take up his regular employment. 
This condition, without treatment, would have become progressively 
worse and would have resulted in permanent total disability, whereas 
proper treatment restored the patient to a practically normal condition. 
II— Arthur Hull was brought before the commission for determin- 
ing the amount of disability present after a twisting injury to the arm, 
which resulted in a paralysis of the muscles of the shoulder and part ot 
the muscles of the arm. 
It was recommended that electrical treatment and relaxation of the 
affected muscles be instituted, instead of giving the man a rating of 
partial permanent disability. This treatment restored the entire group 
of muscles to normal function. It took about ten weeks’ daily treatment 
and the expense was considerable, but the young man was able to control 
his arm and shoulder. 
While I have not been in touch with Hull for some months, when 
he left the hospital, the muscles were all working, although they were not 
as strong as they would be after he had used them. It is my under- 
standing that he went back to work for the same people who employed 
him before the accident. 
III— William Rodhouse fell from a scaffolding, fracturing his left 
heel. He came before the commission and a settlement was agreed upon 
of 60 per cent loss of use of the left foot. He was sent to the medical 
department for examination and it was recommended that an operation 
be performed, which would probably reduce the disability by a consider- 
able amount. There was a great deal of argument between the attorney 
for the company, the man’s attorney and the medical department, as to 
whether it would not be cheaper to pay the man for the partial loss of 
his foot rather than go to the expense of an operation. 
The medical director stated he believed the disability could be 
reduced at least 30 per cent and, on account of urging by the plaintiff’s 
attorney, it was finally agreed that the man should have the operation. 
As a result of the operation Mr. Rodhouse has regained almost complete 
use of his foot. When last seen he made the statement that he was 
going back to his old job, as a bricklayer. 
Had it not been for the generous attitude of the plaintiff’s attorney, 
however, in insisting that Mr. Rodhouse be restored to as nearly normal 
as possible, the man would probably have taken his 60 per cent loss of 
the foot, which would have amounted to 65 weeks at $15 per week, and 
would have remained a cripple, unable to follow his trade. 138 
IV— Arthur Wallace suffered a fracture of both bones of the fore- 
arm with mal-position of the fragments. He had no rotation in the fore- 
arm because of the bad position of the bones. He was up for settlement 
of partial permanent loss of use of the arm. 
It was recommended that an operation be performed to reduce this 
deformity and disability, which was finally accepted. The man was 
operated upon, the bones of the forearm straightened, the excess callous 
removed and the fractures fixed in place by internal splinting. As a 
result, the man has a perfectly normal forearm with no disability and is 
able to do his regular work. 
V— William Mansur received an injury to his back as a result of 
falling coal which bruised the joints of the spine, especially in the lumbar 
region, and strained the ligaments in this region. As a result he was 
judged to be a permanent total disability, so far as mining was con- 
cerned, and was being paid compensation as a result. He was sent to 
Chicago for examination and a diagnosis was made of arthritis as the 
result of a combination of traumatism and infection. 
It was found that all of his teeth were badly infected and after con- 
siderable persuasion on the part of the surgeon the teeth were extracted. 
The back was immobilized by a brace for a number of weeks, with subse- 
quent treatment by massage and heat and in three months the patient 
returned to his old work as a miner, as happy as a young lad. 
VI— Alvin Blanco was struck by a piece of steel which entered his 
forearm about four inches above the wrist and just to the outside of the 
ulna. At the time of the examination, the scar was tender (eleven 
months after the injury) and upon pressure he said there was experienced 
pain that ran up to his shoulder. Also he complained of pain in the little 
finger side of the palm of the hand, especially at night. There was a 
distinct atrophy of all the hyperthenar muscles, distinct atrophy of the 
palm of the hand, and complete atrophy of the adductors of the thumb. 
There was an abrasion over the outside of the little finger, which he had 
received a number of months prior to the date of examination and which 
he said would not get well. There was complete anaethesia of the little 
finger and of the little finger side of the ring finger. 
There was an 80 per cent loss of use of this hand as a result of this 
injury, which will be permanent, because the condition will gradually 
become worse. 
This case should have been treated bv an open operation for the 
suturing of the ulnar nerve, soon after the accident. 
THE DEPARTMENT OF TUBLIC WELFARE 
APPENDIX F-7 
JOB SPECIFICATIONS FOR LARGE INDUSTRIAL PLANTS LN RELATION TO THE 
EMPLOYMENT OF PHYSICALLY HANDICAPPED PERSONS 
A physically handicapped person finds employment in an industrial 
plant at the present time usually under one of the five following con- 
ditions : REHABILITATION OF PHYSICALLY HANDICAPPED 
139 
1. On account of shortage of the labor supply, until recently, 
it has been difficult in some plants to keep ablebodied workmen at 
the more tedious light jobs or the handicapped may excel in ability. 
An example is a Chicago firm manufacturing phonographs, which 
until recently has employed about 30 handicapped persons in its 
assembly department. 
2. An industrial concern may decide to employ persons with 
various types of physical handicaps in considerable numbers regu- 
larly and to adjust its organization and processes with that end in 
view. An example is the Ford Motor Company of Detroit, where 
it is said that no applicant is refused employment and no employee 
is discharged on account of his physical condition. Recently this 
concern was reported to be employing 9,500 persons who were 
physically handicapped among a total employed force of 33,000.* 
3. A firm may determine to employ a number of persons 
having a single type of physical disability and adapt its organiza- 
tion and methods to that purpose. An example is the employment 
of the blind in coil and armature winding, and other jobs in the 
electrical industry, f 
4. Many concerns continue to employ persons who have been 
injured in their service. The disabled employees are often ac- 
quainted with other opportunities in the plant, in case it is neces- 
sary for them to shift on account of their disabilities, and their 
foremen and associates are ready to cooperate in making adjustment 
to the advantage of the injured employee. Certain types of work 
are kept in view for disabled employees, such as watchman or ele- 
vator operator. These jobs, in many instances, offer little prospect 
for advancement. Some firms have provided special organization 
and adopted regular procedure for this purpose, as, for example, 
the E. I. DuPont de Nemours Company, of Wilmington. Delaware. 
5. The philanthropic motive, and at the close of the war the 
patriotic motive, have been the basis of much of the employment of 
the handicapped. Four concerns included in the present survey, 
with a total employed force of 1,722, were found to have a policy of 
employing disabled persons for professed philanthropic motives. 
During the war a number of industries were surveyed with a view 
to the possibility of employing disabled soldiers. The war-time surveys 
ordinarily brought a new viewpoint to the employment departments of 
* “Salvage of Men,” a pamphlet published by the Ford Motor Company, p. 4. 
f “Information about Profitable Industrial Occupations for the Blind” in the 
Finger Industry News, Ampere, New Jersey. THE DEPARTMENT OF PUBLIC WELFARE 
the concerns studied, regarding the possibilities of using disabled persons 
for work which formerly had been considered only possible for ablebodied 
persons. In most instances a practical test of these findings was not 
made by putting groups of physically handicapped persons, properly 
qualified to undertake the work, on the jobs selected. 
Many of these concerns, and others that have given attention to the 
question, are willing to assist in the employment of handicapped work- 
men, if they will make application, and if specific opportunities are 
located in the plant. The installation of disabled workmen as they may 
apply occasionally, is the most practical procedure at the present time. 
THE NEED OF JOB ANALYSIS 
If a handicapped person who has, since becoming disabled, had 
experience in some factory operation, as, for example, a man with a leg 
amputation who can operate a punch press—makes application for that 
kind of a job, he presents somewhat the same employment problem as 
an ablebodied workman. 
But if the man has a weak back, and if he be qualified for only those 
jobs in a given plant in which he may occasionally be required to do 
heavy lifting; or if his disability be in his lungs Or his heart and the 
work should be of an exhausting nature, it would be desirable to know 
these conditions prior to placement. If in taking a job the physically 
handicapped man has in view securing the advantages that come through 
continued employment with the same concern and advancement in the 
service, it is necessary to have in mind at the outset a possible line of 
promotion in which his disability would not be a handicap. 
While in the smaller concerns circumstances such as these may be 
easily kept in mind by the manager of the plant, for the larger concerns 
it is desirable that they be reflected in the job specifications which are 
prepared for the guidance of thS employment department. 
In the study of opportunities for physically handicapped employees 
in 23 industrial establishments in Chicago, job analyses were observed to 
be in use in two of them. The descriptions of the jobs or processes were 
useful in determining the possibility of performance by a person with a 
given disability, but nevertheless it was necessary to study the job first- 
hand before a clear understanding of its physical requirements could be 
obtained. 
STUDY OF A SPECIFIC SCHEME OF JOB ANALYSIS 
The job analysis scheme of one of the largest employment concerns 
in Chicago, not included among the 23 plants studied, has been examined 
as to its usefulness as a guide in finding opportunities for the physically 
handicapped. A copy of the job specification sheet in use is reproduced 
here: REHABILITATION OF PHYSICALLY HANDICAPPED 
141 
Dirty 
Greasy 
...B-7 
Job No.. 
University 
Dust 
Fumes 
Acids 
Technical 
■i(c). 
Hot 
Cold or 
Outside 
Wet or moist 
High 
are from., 
to 
DESIRABLE EMPLOYEES’ QUALIFICATIONS. 
[X] Public 
is from., 
to 
NATURE AND CONDITIONS OF WORK. 
[ ] Rough 
[X] Close 
[ ] Exacting 
Bonus or Premium.. 
JOB SPECIFICATIONS. 
SCHOOLING 
| hour 
] day 
] week 
] hour 
1 day 
] week 
[ ] Quick 
[ ] Slow or 
Monotonous 
[X] Dangerous 
RATE DATA. 
Starting rate 
.Approximate 
piece work 
earnings 
Approximate time required to train an inexperienced employee to do this work... 
(b). 
ENGLISH [X ] Speak [X] Read [X] Write 
BELTMAN’S TOOLS. 
[ ] Heavy or 
Fatigue 
[XI Medium 
[X] Light 
..SEE NOTE.. 
..BELTMAN.. 
[X] Standing 
[ ] Sitting 
[ ] Stooping 
Personal Hand Tools Required. 
[ ]Day work job [ ] Piece work job 
is from (a).. 
to 
is from..... 
to 
Kindred Occupation 
Machine Tools Operated... 
[Xl Male [ ] Female. 
Job Name 
Departments. 
hour 
day 
week 
hour 
day 
week 
[X] Floor 
[X] Bench 
[X] Machine 
Overtime.. 
Remarks.. 
Day [ 
Work [ 
Rate [ 
Base 
Rate 142 
THE DEPARTMENT OF PUBLIC WELFARE 
THE NECESSARY EMPLOYEE QUALIFICATIONS TO FILL THIS 
JOB ARE: 
(1) Must be a thoroughly experienced beltman able to make, repair and install 
belts of any material for all kinds of power transmission and conveying 
purposes. 
(2) Must be handy in the use of beltman’s tools such as knives, belt scraper, 
belt hoe, belt shave, long skiver, punch, awls, and clamping tools. 
(3) Must be able to figure and measure belt lengths, thickness, and widths, for 
all sizes of pulleys, making necessary allowances for splicing and cementing. 
(4) Must be capable of squaring, scraping, splicing and cementing or punching 
and lacing all sizes of belts, and be familiar with the different kinds of belt 
fasteners and belt cements. 
(5) Must be able to repair and splice large belts in place and be experienced in 
dressing and treating belts. 
(6) Must be an active, careful workman, possess good eyesight, observant to 
avoid accidents and capable of working from ladders or elevated structures. 
(7) Must know the dangers involved and be thoroughly familiar with all “safety 
first” rules and also be capable and willing to follow such instructions very 
carefully. 
(8) Must be capable of directing helpers. 
Remarks: Before starting this job the employee must be instructed as to any dangerous or hazardous conditions in connection with his duties and made familiar 
with all “safety first” rules _ 
..-B-7 
Job No 
To install and maintain all kinds of power transmission and conveying belting. 
NOTE: At some works the duties of this job also involve the operation of a 
power scarfing machine. 
THE DUTIES OF THIS JOB ARE: 
BELTMAN... 
Job Name REHABILITATION OF PHYSICALLY HANDICAPPED 
In this printed form the chief advantage in ascertaining opportuni- 
ties for physically handicapped persons appears in the section entitled: 
“Nature and Conditions of Work.” It is important always to know 
whether the work is heavy or fatiguing, or repetitive, or rough, or dirty, 
or cold or wet, or in connection with fumes or acids. For certain types 
of disability, for example, defective heart or blindness or useless lower 
limbs, one would be inclined to scan especially the specifications for 
jobs marked “machine, sitting, light, repetitive, slow and fine.” 
While under “Duties” and “Qualifications” there appears some 
characterization of the work that is to be done, no description is given of 
the detailed operations, as, for example, would appear in a motion study 
description. Such a detailed account is especially desirable in job 
analysis sheets if they are to be of practical usefulness in placement of 
the physically handicapped. 
The section on “Qualifications” in this analysis form was found to 
be only of limited use in relation to placement of disabled persons, be- 
cause the qualifications were written in terms of experience rather than 
of physical condition. It was noted that in the job specification sheets 
reviewed the “Qualifications” required experience on the particular job. 
This may have been due partly to the fact that nearly all of these jobs 
are highly specialized routine machine operations, requiring not so much 
general skill as practice with the given machine. 
VISITATION OF PLANT 
The specifications for 35 of these jobs which seemed to promise 
opportunities for the physically handicapped, were selected and taken 
to the plant. Although the job analysis sheet led the investigator to 
think that handicapped workers might be used, the jobs were actually 
not capable of performance by disabled persons in many instances because 
of circumstances not mentioned in the specifications, chief of which was 
the fact that the specifications were prepared with the ablebodied work- 
man in mind. One job which could be performed by a disabled person 
was made impossible for certain types of disability because of the loca- 
tion nearby of two babbiting machines which created excessive heat. 
The job descriptions for this company would be much more useful 
if the medical department were to make extensive notes regarding the 
effects of the work in each instance on the health of the employee and 
its relation to his physical capacity. A combination of such detailed 
notes with more complete description of job operations, and checking in 
each instance to indicate the possibility of performance by persons with 
any of the main types of disability, would increase the value of these 
job analysis from the standpoint of systematic employment of physically 
handicapped persons. 
The job specification sheets that have been observed in the survey 
of this and other plants are all apparently constructed with the able- 
bodied employee in view. With a better understanding of the problems 144 
THE DEPARTMENT OF PUBLIC WELFARE 
of the physically handicapped and of their value in industry, a greater 
willingness may be expected on the part of employment departments to 
take less than the cream of the labor market for some jobs. 
The note regarding safety, given as a standard instruction under 
"Remarks” in the foregoing form, represents an effective method of 
associating with each job the idea of prevention of accidents. 
Job analyses and charts showing lines of promotion, have a distinct 
value for employment of physically handicapped persons in large num- 
bers. The foregoing examination of a schedule of specifications indicates 
that if a statement of possibility of employing persons with given dis- 
abilities were included, the schedule would be more useful for this pur- 
pose. In some instances where there is prospect of employing large 
numbers with specific disabilities, motion study according to the method 
of F. W. Gilbreth would be advantageous. 
APPENDIX F-10 
SPECIAL STUDlfiS OF OPPORTUNITIES FOR PHYSICALLY HANDICAPPED 
PERSONS IN INDUSTRY 
The following tabular summary is made of studies of industrial 
opportunities for physically handicapped persons in the publications of 
the 
Federal Board for Vocational Education, "Opportunity Mono- 
graph” series; 
Red Cross Institute for the Crippled and Disabled, Xew York 
City; 
United States Shipping Board, Emergency Fleet Corporation. 
In addition to the opportunity monographs of the Federal Board 
for Vocational Education, noted in the schedule, general descriptions of 
occupational opportunities are available in the same series on many other 
subjects, 135 of which were announced in "The Vocational Summary” 
for August, 1919. A series of standard descriptions of occupations is 
being published by the United States Department of Labor. 
STUDIES OF OPPORTUNITIES FOR THE BLIND 
Several plant surveys were made during the war by the American 
Red Cross, under the direction of Mr. A. L. Segur, an industrial engineer 
of Chicago, to determine the number of opportunities for employment of 
blinded soldiers. An elaborate schedule of investigation was used and 
the industries selected afforded various types of employment. In all but 
one of the plants studied the investigators found opportunities for em- REHABILITATION OF PHYSICALLY HANDICAPPED 
145 
ployment of blind workers ranging between 8 and 20 per cent of all 
jobs in the plant. 
In summarizing the results of these surveys, the superintendent of 
the Red Cross Institute for the Blind at Baltimore says :* 
Mr. Segur submitted quite a detailed and elaborate report of his 
work. All of this material is on file at the Red Cross Institute for the 
Blind where it may be studied by any one interested. His report gives 
in detail the physical qualifications required to perform the various jobs 
in the plants surveyed. The most detailed report pertains to the Armour 
Packing Company’s plant. This report covers practically every depart- 
ment of that very large industry. The data covering other plants is 
not so elaborate, nor does it cover every department. There is data, 
however, pertaining to one or more departments of the following plants: 
1. The Diamond Chain & Manufacturing Company, Indianapolis, 
Ind., manufacturers of steel roller chains for trucks, motor cycles, light 
machinery, and for various other purposes. 
2. The Crane Company, Chicago, 111., manufacturers of all kinds 
of valves, pipe fittings and pipe. The report pertains particularly to 
core making. 
3. Johnson Chair Company, Chicago, 111., manufacturers of chairs 
and office furniture. The report covers a number of operations in the 
finishing department. 
4. Automatic Electric Company, Chicago, 111., manufacturers of an 
assorted line of electrical equipment. Report covers various depart- 
ments. 
5. Packard Motor Car Company, Detroit, Mich., manufacturers of 
automobiles and trucks. Report covers the foundry and forge depart- 
ments. 
6. Burroughs Adding Machine Company, Detroit, Mich. The re- 
port covers very little relative bo this plant, as the work was brought 
to a conclusion about the time this plant was entered. However, it is 
thought that there are a number of operations that can be successfully 
performed by blind men in this character of manufacture. 
7. The Goodyear Tire & Rubber Company, Akron, Ohio. Quite an 
amount of material pertaining to this industry was obtained. Some 
seven or eight specific jobs can be performad by blind men. These oper- 
. ations offer potential employment to two or three hundred blind men. 
The company is very friendly towards the idea. 
The detailed report covering these plants, indicates potential em- 
ployment possibilities for all types of handicap, as well as of the blind. 
In this digest only potential jobs for blind and near blind are given, 
because that is our chief concern. It is to be remembered also that the 
statement that these operations can be performed by blind and near 
blind is, in a large measure, the opinion of Mr. Segur and his assistants, 
which has been reenforced by statements from engineers and officials 
of the plants wherein surveys were made. While it is mere opinion 
and not a demonstration, yet we have had sufficiently close contact with 
the work to be disposed to believe that a very large percentage of the 
— operations classed as being open for the blind can be demonstrated to be 
• A practicable. Because of our close contact with the Goodyear Company 
- and the Diamond Chain & Manufacturing Company plants, we are quite 
positive that the operations listed for the blind in those plants can be 
pf done very successfully. This leads us to believe that the same is true 
of all operations classed in this report as possible for the blind. 
If our work continues for some years, a test should be made of the 
feasibility of all jobs classified as possibilities for the blind. If the 
demonstration should succeed for only 50 or 60 per cent of the jobs 
listed, that would open potential employment sufficient adequately to 
take care of practically all of the able-bodied adult blind of this country. 
* Summary attached to letter of August 3, 1920. 
-10 R P H THE DEPARTMENT OF PUBLIC WELFARE 
146 
Occupation. 
Reference. 
Other handicaps than amputation 
noted. 
Is amount of training 
for each process 
described? 
General 
No 
No 
No 
Yes 
Yes 
18 as sample 
No 
Yes 
No 
Yes 
No 
No 
Yes 
Yes 
Heart trouble, hernia, hearing, sight 
Yes 
• 
OCCUPATION STUDIES OF SPECIAL USEFULNESS IN TRAINING AND PLACING THE PHYSICALLY HANDICAPPED. REHABILITATION OF PHYSICALLY HANDICAPPED 
147 
Occupation. 
Are physical 
surroundings 
described? 
Are 
wages 
discussed? 
Is 
promotion 
discussed? 
Are hours 
of work 
discussed? 
Are specific handicaps 
discussed and index reference 
to occupation given? 
Special features. 
Yes, page 4 
Yes 
Very general 
Yes 
Yes. 
Table on p. 56 is noteworthy, showing occupation 
and all features. 
Pp. 8-11, charts and tablesshowing national growth. 
Noteworthy summary of advantages and dis- 
advantages. 
Noteworthy summary of advantages and dis- 
advantages. 
Unique study of one hundred cases. 
A useful standard outline form. 
A useful standard outline form. 
2. Brush manufacturer 
No 
Yes, very good, p. 
Yes 
No 
No 
Yes, very good, pp. 53-56 
26 
Yes, very good 
Yes 
Yes 
No 
No 
Yes 
Yes 
No 
No 
Yes, very good 
Yes 
No 
Yes 
No 
6. Commercial occupations 
No 
Yes 
No 
No 
Yes 
No 
No 
No 
Yes 
Yes, but at end of each section 
Yes, p. 4 
Yes 
No 
Yes 
No, but general, p. 7 
Yes 
No 
No 
No 
No, general, p. 10-11 
Yes 
Yes 
Very general 
Yes 
Yes 
Exceptionally complete, different tabulation. 
No 
No 
No 
Yes 
Yes 
Yes 
Yes 
No 
Yes 
No 
13. Motion picture industry 
Yes 
Yes 
Yes 
Yes 
No 
No 
Yes 
No 
No 
Yes, p. 29-31 
Cites skilled and unskilled jobs possible with 
artificial limbs. 
Lists possibilities for leg and arm handicaps. 
Yes 
Yes 
No 
No 
V es, for amputations 
Yes 
Yes 
No 
No 
Yes, for amputations 
Yes 
Yes 
General 
Yes 
Yes 
Yes 
Yes 
Yes 
No 
Yes 
Excellent descriptive analysis in standardized form. 
Specially complete study. 
No 
No 
No 
No 
No 
Yes 
Yes 
Yes 
No 
Yes, pp. 105-110 
— 
===== 
OCCUPATION STUDIES OF SPECIAL USEFULNESS IN TRAINING £ND PLACING THE PHYSICALLY HANDICAPPED-Concluded. THE DEPARTMENT OF PUBLIC WELFARE 
It is understood, of course, the training of the blind man for the job, 
and the obtaining from the employer of permission to give the man a 
chance. I am confident that the latter can be accomplished if properly 
approached. This is true because the modern industrial plant manu- 
facturer is progressive and is willing to undertake new things, if they 
are properly presented. 
APPENDIX F-l 1 
MINNESOTA ACT PROHIBITING ' INSURANCE COMPANIES FROM RAISING 
RATES OF CONCERNS THAT EMPLOY PHYSICALLY HANDICAPPED 
PERSONS 
I. Text of Law. 
(Minnesota Laws of 1919, Chapter 367. Approved April 23, 1919.) 
An Act making it unlawful to discriminate against handicapped persons 
through workmen’s compensation insurance rates and providing pen- 
alty. 
Be it enacted by the Legislature of the State of Minnesota: Section 1. 
No person, partnership, association or corporation, or their agents or em- 
ployees writing workmen’s compensation insurance in this state shall make 
or charge any rate which discriminates against the employment by the in- 
sured of any person who is physically handicapped by reason of loss or loss 
of use of any member due to accident or other cause. 
Section 2. Any person, partnership, association or corporation, or their 
agents or employees, offering a rate of compensation insurance forbidden 
by section 1 of this act shall be guilty of a misdemeanor. 
Section 3. Whenever any company or its agents or employees shall 
have been convicted of a violation of this act, such fact shall be sufficient 
cause for the cancellation of its license by the commissioner of insurance. 
Section 4. This act shall take effect and be in force from and after its 
passage. 
II. Comment on its Operation 
(Extract from letter from Oscar M. Sullivan, Director of Reeducation of 
Injured Persons, State Department of Education, dated 
November 20, 1920.) 
Our Minnesota act is a separate act and not a part of the compensa- 
tion law. 
While we believe there is very little actual discrimination shown by 
compensation insurance companies in this state, I think it is a good 
thing to have such a law on the statute books because one can then 
reassure employers. The question comes up frequently and there has 
evidently been discrimination in the past or employers would not have 
so strong an idea that their rates were going to be raised. 
If you plan an act for Illinois, I would suggest that you broaden 
the language a little; there is question whether our Minnesota act would 
cover discrimination against one-eyed or partially deaf persons. This 
is because of the use of the word “member.” There are some narrow 
court decisions which hold that a member refers solely to the extremities 
of the body. The question had not been raised in Minnesota at the time 
this act was framed but since that time there has been a Supreme Court 
decision which touched upon the point rather ambiguously with the 
result that at the present time we are mot certain whether, if it came 
to an issue, compensation could be required for partial loss of vision, 
for instance. INDEX. 
A 
Accidents, industrial, in Illinois in rela- 
tion to physical handicap, 130-135 
Artificial appliances, 29 
B 
Bender, Mrs. Inez J., 59 
Billings, Dr. Frank, 25, 60 ; article on 
health center, 98 
Boyd, Charles J., 60 
Budget estimate for maintaining re- 
habilitation service, 54 
Budget, summary and, 49-56 
Burgess, Prof. E. W., 59 
Bruner, Dr. Frank G., 44 
Byrne, H. D., 59, 99 
C 
Case work the main requirement, 21-24 
Censuses, community, 17 
Central Hospital Group, 97 
Central Hospital Group, rehabilitation 
work to be organized about, 26 
Chicago and Decatur, description of 
areas surveyed, 69 
Chicago, community census, 63 
Children, crippled or otherwise defective, 
examples of, 40 
Children, physically handicapped, of 
school age in Chicago, 44 
Children. retardation of physically 
handicapped in special schools. 82 
Children, working, percentage of defects 
among, 45 
Clinics, dispensaries, hospitals and, in 
Illinois, 95-96 
Coal miners, study of twenty-five in- 
jured, 74-76 
Community agencies, voluntary, 49 
Community censuses, blanks used in, 
65-68 
Community censuses, Chicago, Decatur 
and other cities, 63 
Community center, 98-99 
Community problem, 43 
Compensation Act, reemployment of the 
more seriously injured persons in- 
cluded under, 124-130 
Compensation Act, Workmen’s, rela- 
tions with rehabilitation, 28 
Compensation settlements, neglect of in- 
dustrial injuries due to making, prior 
to restoring function of injured parts, 
135-144 
Contents, Table of, 3-5 
Convalescent care, facilities for, 27 
Cook County Hospital, study of physi- 
cally handicapped patients at, 86-92 
Cripples, table showing number self- 
supporting, 18 
Cross, William T., 1, 59 
D 
Davidson, Walter E., 59 
Decatur and Chicago, description of 
areas surveyed, 69 
Decatur, community census, 63 
Disabled persons, cooperation of indus- 
trial concerns and insurance com- 
panies in the physical restoration of, 
27 
Disabled persons, study of 82 employed 
in 11 industrial plants of Chicago, 
118-120 
Disabled persons, study of jobs and 
•conditions of work in 23 Chicago 
plants, with respect to the employ- 
ment of, 105-118 
Disabled persons, viewpoint of, 14 
Disabled workers, avoiding discrimina- 
tion against, 33 
Disabilities, causes of, Massachusetts 
and Cleveland, 19 
Disabilities, handicapping, origin of, 16 
Disabilities, prevention of,, 40 
Disabilities, proportion occurring in 
childhood, 20 
Disability, types of, 14 
Dispensaries, Hospitals and clinics in 
Illinois, 95-96 
Doan, Miss Effie E., 59 
E 
Educational restoration of physically 
handicapped, 24 
Ellis, Dr. John D., 59 
F 
Free employment bureaus, 62 physically 
handicapped persons applying at, 121- 
124 
G 
Gilbreth, F. W., 144 
H * 
Health Center, 98-99 
Hospitals, dispensaries and clinics in 
Illinois, 95-96 
Illinois, industrial accidents in, in rela- 
tion to physical handicap, 130-135 
Industrial concerns of Chicago, place- 
ment training given by, 99-104 
Industrial injuries, neglect of, due to 
making compensation settlements 
prior to restoring function of injured 
parts, 135-144 INDEX 
Industrial plants, job specifications for, 
in relation to the employment of phy- 
sically handicapped persons, 138-148 
Industrial rehabilitation, 31-40 
Infantile paralysis, persons afflicted 
with, who are known to community 
agencies of Chicago, 83-84 
Injured, seriously, by counties, map 
showing,' 133 
Insurance companies, Minnesota Act 
prohibiting, from raising rates of 
concerns that employ physically 
handicapped persons, 148 
L 
Larcomb, Charles M., 59 
Legislation needed for effective opera- 
tion of Rehabilitation Act, 53 
Levy, Dr. Julius, 43 
M 
Magnuson, Dr. Paul B., 136 
Medical and surgical wards, Chicago 
hospitals, graphs showing needs of 
physically handicapped patients in, 88 
Medical, surgical and orthopedic wards 
of two Chicago hospitals, study of, 
86-92 
Miners, study of twenty-five injured, 
74-76 
Minnesota Act prohibiting insurance 
companies from raising rates of con- 
cerns that employ physically handi- 
capped persons, 148 
Mock, Dr. Harry E., 60 
N 
Nomenclature in diagnosis of physical 
disabilities, 60 
Nurse Association, Visiting, 84 
O 
Orthopedic, surgical and medical wards 
of two Chicago hospitals, study of, 
86-92 
P 
Perry, Helen, 59 
Physical disabilities, nomenclature in 
diagnosis of, 60 
Physical handicap, examples of, 9-14 
Physical handicap, plan of central reg- 
istration of cases for a large city, 
62-63 
Physical rehabilitation, 24-31 
Physical rehabilitation, need for, 87 
Physical handicapped, condition of, 9-16 
Physically handicapped persons in Chi- 
cago, house-bound, 85 
Physically handicapped persons, job 
specifications for industrial plants in 
relation to the employment of, 138- 
148 
Physically handicapped persons known 
to social agencies of Chicago, 76-83 
Physically handicapped persons, number 
leaving local hospitals and special fa- 
cilities for their treatment, 92-94 
Physically handicapped persons, number 
of, 16-21 
Physically handicapped persons, special 
studies of opportunities for, in industry, 
144 
Placement training, list of Chicago firms 
giving, 100 
Placement, organization for, 37 
Placement training given by industrial 
concerns of Chicago, 99-104 
Prevention, research and publicity, 40- 
49 
R 
Registration, need for central, 82 
Rehabilitation Act, legislation needec 
for effective operation of, 53 
Rehabilitation Act, text of, 57 
Rehabilitation aids, 23 
Rehabilitation, industrial, 31-40 
Rehabilitation, physical, 24-31 
Rehabilitation service, organization of, 
53 
Rehabilitation work as a State activity, 
8-9 
Rehabilitation work, relation of various 
State Departments to, 52 
Research and educational publicity, 48 
Revenue, sources of, 55 
S 
Safety movement, 47 
St. Luke’s Hospital, study of physically 
handicapped persons made at, 86-92 
Segur, A. L., 144. 145 
Sideman, Della, 59 
Social agencies of Chicago, physically 
handicapped persons known to, 76-S3 
Social treatment needed by persons in- 
terviewed at two Chicago Hospitals, 
89 
Starkey, Mrs. Lulu C., 59 
Summary and budget, 49-56 
Surgical and medical wards, Chicago 
hospitals, graphs showing needs of 
physically handicapped patients in, SS 
Surgical, medical and orthopedic wards 
of two Chicago hospitals, study of, 
86-92 
Survey of physically handicapped, or- 
ganization and procedure of, 59 
T 
Table of contents, 3-5 
Thorne, Charles H., 1 
Training, courses included, 101-102 
Training Department, statistics of, 35 
Training, placement, given by industrial 
concerns of Chicago, 99-104 
Treatment of physically -handicapped, 
special facilities for, 92-94 
V 
Vocational training, 34. 
Vocational training, private schools of 
Chicago, 104 
Visiting Nurse Association, 84 
Visiting nurses, adult cases in Chicago 
under supervision of, 85 
W 
Wagner, Margaret W., 59 
Walters, E. LeRoy, 59 
Workmen’s Compensation Act, relations 
with rehabilitation, 28