FIG. 173. The carpenter shop. Work of this type is invaluable not only as a form of physiotherapy for patients suffering from injuries to the shoulder, elbow and hand, but also as psychotherapy. The patient at the extreme left for instance, was suffering from marked neurasthenic symptoms due to the exertion and psychical strain of the war. His condition improved remarkably within a short time after he was allowed to begin carpenter work.

The detailed work in the shops requires the constant supervision of the physician, so as to bring about the most advantageous results. The impossible must, of course, not be expected. Thus for instance, if a man has a severe injury to the hand which prevents his gripping with the normal strength, then the instruments should be SO modified as to enable him to grasp them despite the defect

FIG. 174. The beginners' course in bookbinding for patients with injuries to the hands and fingers. Work in this shop constituted a routine part of the after-treatment of the tendon operations described on page 172 et seq.

FIG. 175.-A class in weaving for soldiers who have suffered injuries to the -hands or fingers. The patient at the extreme left did excellent work despite a paralysis of the median and ulnar nerves, and the circulation in the hand improved distinctly through this type of exercise.

under which he is laboring. Fig. 177 shows a variety of modifications of the handles of planes and chisels for patients unable to flex their fingers completely. The increased circumference of the handle of the implement makes it possible to get a firm grip despite the injury to the flexor tendons.

FIG. 176. The Bracemakers shop. This serves a triple purpose: (1) It enables the Hospital to manufacture its own splints. (2) It affords opportunity for the crippled to learn a productive trade. The patient in the right foreground is working despite amputation of the right hand. (See also Figs. 169 and 170.) Back of him stands a lad whose right arm is crippled by a marked deformity of the ulna. The patient in the left foreground is manufacturing his own artificial limb for a disarticulation at the hip. (3) It acts as a form of physiotherapy and enables all the amputated to learn how to repair their own artificial limbs.

In Figs. 178 et seq. are illustrated similar means of helping another type of injury. The badly mutilated hand is that of a butcher, who because of the missing fingers found it impossible to continue at his trade. The difficulty was easily solved by taking a clay impression of the patient's fist, and modeling the handles of his knives correspondingly.

Note the

FIG. 177.-Carpenter's tools for soldiers with crippled hands. enlarged handles enabling the patient to grasp the tool, even though the flexor tendons are not able to function normally.

FIG. 178.-Badly mutilated hands of a patient, who in civil life had been a butcher. To enable him to grasp his knives, a clay impression of the grip of his right hand was taken and the handles of the knives correspondingly carved. See Figs. 179 and 180.

In the shoemaker's shop the device shown in Fig. 181 was a great assistance to the amputated and to those who were unable to bend the knee or the hip. For the patients with an ankylosed hip, a special chair, Fig. 182, so made as to support the sound leg without interfering with the injured, proved helpful.

If the patient has suffered amputation of both legs or a high amputation of one, then an occupation should be selected which enables him to work when seated; thus for instance a man with a mechanical turn is taught the fine mechanics, necessary for instrument making, construction of microscopes, watches, etc. A smith is taught how to do fine hammered iron or brass work. In other words the man's previous training and his natural bent are in every instance taken into consideration.