Eugene J. Taylor

A new approach to the objective evaluation of physical disability

MUCH has been said in the last decade of the outstanding advances of medicine and surgery, and, as a direct result, of the prolongation of life. Persons with formerly fatal congenital deformities, disease, or injury, were saved. So also were those suffering from acute infections kept alive. Further, the fact that people lived longer meant more people were reaching the age group where the chronic degenerative and disabling conditions were prevalent. Concomitant with these developments was the enormous expansion of industry, spurred by the war and the development of new technological processes. The result of expanded and more complex industrial processes together with the advances in medicine has been a great rise in the number of chronically ill and disabled persons as well as a large addition to this number yearly. Thus, every physician and especially those in contact with industrial medicine, sooner or later must concern himself with disability evaluation. That proper evaluation represents a problem of major proportions is attested to by the fact that the Journal of the American Medical Association has recently begun to publish a series of guides to the determination of medical impairment [l]. Disability is differentiated from impairment by the fact that “disability” includes socio-economic factors in addition to the purely medical. Many types of schedule have been devised to permit evaluation of disability but these have all been based on anatomic loss alone, probably due to the difficulty of measuring socio-economic factors. Although the physician is not responsible for determinations in the socio-economic areas, he is often a member of a team where these considerations are raised. The rising tide of disability has to a great degree been responsible for legislation in the fields of vocational rehabilitation, social security, workmen’s compensation, etc. However, these attempts to handle the problem have only been partially successful because similar cases might be judged totally disabled in one state, partially in another, or not at all, from a vocational point of view, in a third.

Army Air Forces Convalescent Training Program

W E ARE having an opportunity in the armed forces to carry out one of the greatest clinical studies ever attempted in rehabilitation and convalescent care. Our total numbers of cases have run into the thousands, our controls have been reasonably constant, our opportunities for clinical observation have been unlimited, and our results have been most interesting. They have shown us that any program designed to give the patient maximum treatment and opportunity to return to civilian life as a self-respecting, selfsustaining citizen with a community contribution to make, must, to be successful: (1) treat the whole man, regardless of what his needs may be; (2) treat the patient as an individual; and (3) be early, continuous, and progressive from the earliest possible moment following acute illness or injury until maximum possible benefits have been received. It is upon these premises that the Army Air Forces has built its plan for the treatment and management of its sick and wounded.