the office is quite different from that with which he entered. Ten per cent of the applicants come for advice regarding their future occupation. They usually accept this advice and adapt themselves to an entirely new work which will not tax their reserve strength and yet will enable them to earn a fairly normal wage. After their convalescence is completed the cardiacs are referred to this bureau by the cardiac worker of the hospital social service. department. They are given a diagnosis from the doctor as to their condition and the length of time they can work. If referred by a private physician this information is obtained by telephone. In case the patient has not been sent by either of these sources he is referred to the cardiac clinic in his neighborhood, from whom the desired. information is obtained. Much is to be desired about this diagnosis. For the placement worker it matters not if the man has an aortic regurgitation or a mitral stenosis. But it is essential to know what degree of compensation is present or what his work tolerance is. For the assistance of the placement worker some classification should be adopted that would denote the amount of work the cardiac is capable of. For instance, a first degree cardiac might denote only a slightly lowered work tolerance, and a second degree a lowered exercise tolerance, and a third degree case may be capable of only the lightest kind of work. Some grading of cardiacs covering these distinctions would be most practical for the placement service. Social workers should acquaint themselves with such a classification and have the physician give the patient such a rating before referring him for employment. Of the total applicants at the Handicapped Bureau, 10 per cent are cardiac patients. All nationalities and races are represented and at least 25 per cent are unnaturalized foreigners. The applicants vary from children under 16 years of age to men and women over 70 years or even 80 years old. From June 9th, 1919, to February 29th, 1920, there have been 305 cardiacs referred to the Bureau. Of the 161 who have been placed 117 were still in their original position. Thirty have been lost track of, and 16 were too feeble to work when they applied at the Bureau. The latter were referred by outside agencies and did not come from hospitals. Many came for advice only. In finding employment for cardiacs the placement worker must remember that a cardiac is a cripple just as much as a man with but one leg or minus a hand. He is "crippled" because he cannot lift in connection with his work, cannot climb stairs, and cannot operate any but a small hand machine. He can do light sedentary work. Among the suitable industries are the fountain pen factories, grinding pens, polishing barrels, etc. This work is well paid and has been found excellent, but apprentices have to be below 25 years of age. The jewelry business offers opportunities for both men and women in filing, chasing, assorting, while pearl stringing is available to women. The piano factories have suitable work in assembling small parts, making the felt hammers and glueing the parts. For some, work in the tobacco industry, such as stripping and packing is suitable, but some patients cannot stand the odor. The older men and women have been placed in hotels washing glasses and doing other light work. There is less cost from breakage when the washing is done by this class of people, and they receive good pay and main tenance. Very few industries will take men over 25 as an apprentice, consequently the older men are placed in suitable work in institutions, hotels and at newsstands. Some industries will not co-operate on account of the workmen's compensation law. Because they have no knowledge of the subject, they think that the heart case is going to drop dead at work. We are hoping to convince these employers by assuring them that the cardiacs referred by the Bureau have had convalescent care, and have been for some time under proper medical supervision and follow-up. As there have been no sudden deaths and no accidents among the cardiacs placed from the Bureau, no workmen's compensation has been paid to any of our people. This shows the small amount of risk the employers take in placing the cardiac. The industrial hazards in the selected types of work are slight by nature of the occupation. Children under 16 years of age when supplied with working papers are placed. Work suitable for boys is plentiful. They are Greater always consulted about the kind of work they would like. Another boy not 16 was placed in a wholesale jewelry house as stock room assistant marking stock and is now junior clerk. From September to February (when he became 16) he was allowed by the firm to attend the English class in his school every Tuesday morning in compliance with working paper laws. He occasionally has days when he must rest, and the superintendent, himself a cardiac, takes a fatherly interest in the boy and tells him to stay at home and insists on the boy attending the clinic regularly. His salary is paid when he is out, and in addition to a bonus January 1st, has had an increase in salary. The majority of the men have held strenuous positions as longshoremen, as shipyard workers, engineers or in other lines of work which require heavy lifting and plenty of overtime. Men of reasonable intelligence are placed as detectives and watchmen on government piers and in hotels and private homes. A young man 26, with a charming personality who speaks several languages has been placed with one of the leading firms in the United States as an interpreter at their plant in France. He was examined by the company's physician who did not feel that his mild cardiac condition outweighed his extreme usefulness in adjusting difficulties arising from the in ability of the laborers to understand conditions, when no one spoke their language. A longshoreman, apparently healthy, had to give up this strenuous work with excellent salary. He realized that he must readjust himself to lighter work, and took a position in a factory on a small production machine where he is now making a splendid salary with no great effort. A machinist who had to give up heavy work, was placed in a fountain pen factory and taught grinding pens, where he is doing splendidly. Women are referred to positions in carding jewelry and sewing and mending laces. The home work is horribly underpaid and therefore does not meet the situation and in most cases it is against the tenement house laws. Some firms give out hand and machine sewing to women. Rattan and reed work offer agreeable occupation and are fairly well paid. One woman cardiac 76 years old who will not allow relatives to support her, was placed in a hotel washing cups and saucers. In addition to her salary, she has all maintenance and is very happy. That great care has been exercised in placing the cardiacs in suitable positions, is shown from the reports of the hospital social service departments stating definitely that the cardiacs placed by the Bureau in the past nine months are in better shape physically than when referred for a position. The mental stimulus of occupation and a brighter future are wonderful tonics. A close follow-up of the cardiac is kept through this office by letter asking our people if they attend the clinic, how the work agrees with them and if they are not working to call again. As it is not advisable to take up the employers time by personal visits except in rare cases, brief follow-up inquiries are made by telephone. During the war many surveys of industries were made which provided some permanent data, and made it inexpedient to repeat surveys again. The Bureau does not follow-up the cardiac at his home as the social service worker from the hospital does this. Cardiacs are quite permanent, they do not usually give up a position unless overtaken by illness. Fifty per cent of those placed in the last 6 months are still in their positions, the others have left of their own accord and were not dismissed by the employer. There are as in all classes, a certain percentage of workers who change occupations frequently. The slope from the level where the so called "normal" individual is found in industry to the level of the handicapped is not sharply defined because many of our "normal" workers, according to the findings of industrial medical examinations are moderately affected by disease. The percentage who are rated in class A by the examinations. is low. Therefore the difference in quality of work performed by the different classes is not necessarily striking. The handicapped class passes from the field of industry through the testing and tempering process of the hospital and clinic, much as a machine is tested and adjusted when it goes to the repair shop. When the handicapped worker returns to his place in the shop he is in the company of those who have yet to seek the similar clinical service he has obtained. Social service in this application acts as a human engineer who recreates a community asset from a liability. The educational value to workers, and the acquired knowledge of community conditions are significant in social medicine. As Emerson1 has well expressed the situation, the hospital enters into a tacit contract with each patient it accepts that it will try to reach the cause of his disease. But is the hospital in reality living up to the spirit of its contract if it does not help a cardiac find a lighter job after his first admission? Is the hospital not squandering trust funds to spend money to treat a patient if they know that the good done will be quickly lost if he returns to his old occupation? If the proper treatment of a cardiac is not drugs but a change of occupation, should this not be supplied just as an operation would be given free to a hernia patient or quinine to a case of malaria? But objection is made to the cost of supplying the machinery necessary for this placement work. The cost of finding a cardiac lighter work is far less than the cost to the same hospital of this cardiac who will repeatedly return for longer and longer periods if he is allowed. to undertake his former occupation. If the hospital superintendents would only realize how many days. of hospital care could be saved their institutions by the proper em 1 Emerson, C. P. Hosp. Soc. Ser, Quar. 1919, I, 263. |
