The Knife is Not Enough

THE book was the parting gift from the vice-president of KIR (Kessler Institute of Rehabilitation Inc.). It remained in the bookshelf for a long time. Each time I turned some pages and put it back. It was like reading an English novel, if one could withstand the beginning rest comes easy.

The cover proclaims: “An American surgeon’s story of his fifty years in rehabilitation medicine”. Better could have been “an American surgeon’s story of development of rehabilitation medicine”. Because Dr. Kessler not only tells us the development of the concept of rehabilitation in USA but in many of the countries he visited.

Dr. Kessler graduated in medicine during World –War-I and incidentally met great orthopaedic surgeon Dr. Fred H. Albee who was instrumental in the establishment of first of the three reconstructive hospitals, U. S. General Hospital No. 3 in 1919. It’s really heartening to note that at the time when even the name ‘rehabilitation’ was not known to many and rehabilitation medicine was in primitive stage Dr. Albee conceived of a rehabilitation programme which he called ‘three legs of the tripod: physical restoration services, vocational guidance and placement’. A philosophy which still is the backbone of any meaningful rehabilitation programme.

An incident involving the treatment of the mentally retarded severely disabled cerebral palsied children shows the then prevalent attitude of even the medical fraternity and administrators towards these children. Mothers of these children sought Dr. Kessler’s help in finding a baby sitter while they could go for shopping or visit the beauty parlour or even see a movie, one afternoon a week, things they had been unable to do for thirteen years.

Dr. Kessler advised them instead to raise little more money which could help buy the part time services of a physical therapist, an occupational therapist and a rehabilitation worker for proper management of those children.

Mothers did raise the required money but when Dr. Kessler sought the permission of the board of trustees of the hospital he was bluntly told “Why do you want to play around with children? You know they are hopeless and helpless.”

This incident, his discovery that his twenty years of work in rehabilitation had but destroyed during his absence in Navy and realization that if rehabilitation work was to be carried out properly, then the community had to play a major role. Away from the Government control and political bossism/interference, and the providence needed at these times led to the establishment of KIR in New Jersey, in 1948.

Another incident which had an impact on Dr. Kessler ought to be written for the benefit for those who are ‘camp/quantity’ oriented.

On his first visit to Germany Dr. Kessler got to see the working of ‘Cranes’ arm (an artificial limb). So impressed was he that on his return to New Jersey Rehabilitation clinic he began to prescribe the Cranes arm as a slandered device till he got dressing down by the Governor Edge. The Governor told Dr. Kessler that out of hundred and twenty three Cranes arm provided by him only six patients were using the arm after two years. The others had discarded them.

Dr. Kessler’s book is like a historical novel or travelogue. History of rehabilitation of the disabled people, not only of the USA but of many countries visited by him.

Exactly half way the book turns into an international traveler’s note book ‘cause Dr. Kessler not only describes the then prevailing conditions of the disabled people and rehabilitation programme of the numerous countries he visited but also the then political and social  conditions. He has poignantly describes the winter of Yugoslavia, a war torn nation in about fifty pages, where he found as in most countries no concept of rehabilitation.

But U.K. and more so Germany found the flavor of Dr. Kessler. Rather he learned new techniques in Germany like the ‘Cranes’ arm and t he concept of ‘reengineering’ (page 152)

Though his comments on India were: ‘this was India, where isolated instances of grandeur and public service existed side by side with mass misery and poverty’ he was most impressed by Ms. Fathema Ismail who he felt was determined, persistent and unbeatable for her zeal towards rehabilitation of the disabled people.

As common with these types of books (autobiographies) which deal with the life of many other people this book too has a fair share of human interest stories. Stories of the people who lost not one but two or more limbs, children who had double disadvantage, poverty and disability. Victory of human spirit over odds of the toughest kind. Instances which not only touched the inner core of Dr. Kessler but taught him a lesson or two

But then history of rehabilitation is full of tales of courage, hard work and hope that have led to even the most hopeless cases emerge as victorious over adverse circumstances.

In the end a word of caution, for the non-medical readers, or my apprehension; the book implies that Dr. Kessler made all the paraplegic patients, who came to him for treatment and rehabilitation, walk with the help braces and crutches. Same observations are made about the cases of Polio, which is not so.

Some gems/excerpts:

  • THIS experience made me realize again the tremendous potential in the human being, potential that cannot be revealed by ordinary clinical methods. The doctrine of using the remaining ability of an individual, even in the presence of severe physical defects, became one of the pillars upon which the programme of rehabilitation later developed. (page 47) 
  • A female paraplegic patient lady wrote to Dr. Kessler: “…..Rehabilitation is a process of readjustment. In order to readjust my life I had to concentrate on putting to the fullest use possible all the abilities I did have left. And then she said, “But isn’t life more a concentration of what you have rather than on what you have not?” (page 148)
  • Re-engineering- It was difficult to develop courses of training for the war disabled since teachers and money were scare. Instead of training a man for a new job, the Germans simply modified or “re-engineered” job. He (Dr. Kessler) was told the story of a man who worked as a ticket-taker at the gate of a railroad station. This man lost his right arm, yet was able to return to his former job, in spite of the fact it was a two handed job. Normal practice was for t he ticket-taker to grasp the ticket with one hand and use the punch with the other. Now, however, the job was re-engineered so that he grasped the ticket with his left hand and punched it with a machine that he operated with his foot. (page 152)
  • I remember watching one child, blind and without arms, learning to read Braille with the tip of his tongue and the tip of his nose. (page 155)
  • From an economic view point, no country can afford the luxury of wasted manpower or the financial burden of caring for the cripple. The cost is always a double cost. There is not only the price of hospitalization and medical care and pensions, but also the loss of the productivity of the handicapped. One of the beautiful purposes of rehabilitation is to help the handicapped back to their rightful and fruitful place in society. (page 165-166)
  • The fundamental principle was the fit of the limb not the material or weight. the artificial limb could be made of solid gold, but if it did not fit, it was no good. (page212)
  • The whole philosophy of rehabilitation: it is ability that counts, and disability. (Page 260)
  • Thus I began to understand that an institution, whether large or small, is built not merely of bricks and mortar. Its strength lies in people, qualified, dedicated people with vision and imagination as well as understanding and compassion. (page 282)
  • Train them and develop them so that they can be independent. Provide them with physical and vocational equipment that will enable them to face the competition. (page 286)
  • Rehabilitation is finally, the precious gift of hope translated into action. (page 286)
  • Story