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Comprehensive Plans Are Being Worked Out to Help Soldiers Get Remunerative Employment in Spite of Even the Most Serious Wounds or Other Injuries

BY FRANK PARKER STOCKBRIDGE

THE problem of putting the crippled or disabled soldier or sailor back into self-supporting civil life is one with which all the European belligerent nations have been struggling for nearly four years, with only partial success in its solution. Based upon the combined experience of the Allies and the Central Powers, studied at first hand by a corps of specialists, and supplemented by co-operative research under the direction of the Red Cross Institute for Crippled and Disabled Men, and the National Association of Manufacturers, a program has been worked out by the Surgeon General's office of the army which is calculated to insure to every soldier of the United States who comes back from "Over There" minus an arm or a leg, blind, deaf, or otherwise handicapped, a better chance of reinstatement as a useful member of society than was afforded to any of the soldiers of the Allies in the first two or three years of the war.

Germany alone, the only nation that was prepared for this war, had included detailed plans for the reconstruction of maimed and mutilated soldiers in its war program from the beginning, and, under its autocratic system of government, has been able to enforce these plans, with the result that every crippled German soldier is put to work at some useful occupation with the slightest possible delay after his injury. The Allies have had to evolve their general plans as well as particular methods out of the bitter experience of war, in this as in other phases of the great conflict.

It was not until after the United States entered the war -- in May, 1917, to be exact -- that there was anything like a complete exchange of experiences and principles evolved from them in respect to the war cripple. Out of the first Interallied Conference on Reconstruction and Re-education of the Disabled Combatant, held in Paris May 8 to 12, 1917, at which delegates from the United States Surgeon General's office sat for the first time as representatives of their nation at war, came an international interchange of knowledge and ideas concerning the war cripple. At a second conference, held in London last November, a permanent interallied committee was established which will have its headquarters in a new Permanent Institute for the Disabled, endowed by the French Government with 150,000 francs ($30,000) for building and equipment, and maintained by annual appropriations of 30,000 francs ($6,000) each by the different allied nations represented. Already this clearing house of scientific and economic information for the benefit of the war cripple has done invaluable work in enabling the warring nations to profit by each other's experiences and mistakes. Not the least valuable contributions have come from American sources, our army surgeons having had opportunities for comparative, observation of methods in vogue in different countries denied to those whose nations had been actually at war for three years. The United States, therefore, will begin its work of restoration with the accumulated experience of nearly four years to build upon.

So far as the phases of rehabilitation and reconstruction which will naturally come under the control of the Medical Departments of the army and navy are concerned, the general plan is substantially complete; minor details only remain to be worked out; the fundamental principles have been quite well established and the medical and surgical technique developed to a very high degree. The full scope of the Government's program for the ultimate vocational re-education of those requiring specialized technical training before they are again able to become economically self-supporting remains to be developed. A comprehensive plan has been worked out under the direction of Surgeon General Gorgas, in operation with various other Governmental agencies. A bill has been introduced in Congress for the purpose of securing the necessary enabling legislation to deal with the disabled soldier who has been discharged or is about to be discharged form the army for disability.

The first steps toward reinstatement to a self-supporting status, and by far the most important steps, must be begun almost immediately after the soldier receives the incapacitating injury and carried on continuously and cumulatively throughout the period of his hospital care.

This is especially true in the case of the soldier who has lost a limb, or who has been blinded. One of the most important lessons gained from the experience of the Allies, if not the most important, is that the problem of the restoration to usefulness of the crippled soldier is a psychological one, even more than it is surgical or economic. There experience of the French authorities, who had to deal with a terrific proportion of the mutiles in the first two years of the war, was disheartening. Fewer than 17 per cent. of disabled soldiers expressed a desire or even willingness to learn how to do useful work. A large proportion had "lost their nerve" at the same time that they lost their limbs or their eye-sight. Most of them felt that they had done enough for their country -- that the nation owed them their living without effort. Because facilities for the early employment of patients, even at trivial occupations, were lacking in the military hospitals, they had acquired the habit of idleness which, when once fixed, is almost ineradicable.

The experience of France differed only in degree from that of the other allied nations. To avoid a similar experience and not only give every crippled soldier the best possible chance to become self-supporting, but to insure that he avails himself of the opportunity thus afforded, the psychological and economic rehabilitation of every American incapacitated by his injuries for further military service will begin with and go on parallel with his physical rehabilitation, which, in turn, will be a process not merely of "patching up," but of the actual development to their utmost usefulness of all of the injured man's remaining physical powers.

The first reaction of the man who has lost a limb is utter despair. He is "done for," in his own estimation. "Nobody has any use for a cripple," is the way in which nine out of ten express it. Unless he is a man whose former occupation has been mental, not dependent upon his physical energies, he sees no ray of hope for his own future. Unless immediately rectified, this state of mind quickly becomes fixed and all but irremediable. So the first step toward rehabilitation, which will begin almost as soon as the injured man comes out from under the anesthetic, is what they are terming in the Surgeon General's office "cheer-up work." By every means that can be devised the cripple is to be convinced that his case is not hopeless, that he still has chances of becoming again a useful industrial unit -- perhaps a better chance than he has ever had before.

One of the most important means of instilling this vitally important lesson will be through the utilization of "cheer-up men," themselves cripples, who have lost arms, legs or sight, and who have, nevertheless, made good. Plans are complete for the employment of a large corps of these "cheer-up workers"; they are being enlisted through the aid of the Red Cross Institute, the National Association of Manufacturers, insurance companies dealing with industrial accidents, and from the ranks of Canadian and British soldiers who have suffered mutilation in this are and are again self-supporting civilians. Eventually, unless the war comes to a much earlier termination than Washington is figuring on, our own army will provide a supply of "cheer-up men" from the graduates of the reconstruction hospitals. These workers are to be attached to the base hospitals, the hospital ships that will bring the incapacitated soldiers back to America for treatment, and to the general special hospitals on this side.

Supplementing the work of the "cheer-up men," whose function is to demonstrate both orally and visually that a cripple is far from useless, will be books, pictures, motion pictures, and other exhibits calculated to inspire the will and stimulate the ambition of the injured man. In he Surgeon General's office a wonderful book is being compiled, under the direction of one of the most famous of American surgeons, in which the life stories of hundreds of maimed and crippled men who have overcome their handicaps are told in simple but convincing fashion. Profusely illustrated, copies of this book will be available for the perusal of every crippled soldier in the hospitals. Motion-picture films showing crippled men who have undergone almost every conceivable form of mutilation, performing useful work for good pay, with and without the use of artificial members, are being prepared by the Red Cross Institute and elsewhere for exhibition to the maimed soldier as early as he is able to see them.

To insure against the habit of idleness, provision is being made up for the employment of every crippled soldier at some form of work as soon as he is able to use any of his faculties. Special nurses, male and female, are being trained as "bedside teachers," to give the wounded man a start at employing his faculties before he is able to leave his cot. The things he does at first will necessarily be trivial in the results, but they will be required duties, gauged to the man's capacity and strength, and leading to his future career as a crippled civilian. Hus, the man who has lost his right hand will be taught to use his left for the things he was accustomed to do with his right: the stenographer who has lost a hand will learn to operate a typewriter with one hand -- not so difficult a feat as it may seem. As the cripple becomes a convalescent, able to leave his bed, more work will be required of him. By this time he will be on the hospital ship, on his way back to the United States, for every wounded soldier who cannot be quickly restored to active service will be sent back to this country as soon as he can be transported, for further treatment or discharge. On the hospital ship and in the reception hospital on Ellis Island there will be special officials whose duty it will be to ascertain all the available facts about each man's personal ability, previous occupation, earning capacity, social status, and similar data on which to base a judgment as to the particular form of re-education best adapted to his needs.

Fourteen of the general hospitals being constructed by the War Department in as many different sections of the United States are to be used as reconstruction hospitals, where the maimed may be restored to their fullest usefulness. To each will be attached workshops, where at least the rudiments of different trades may be practiced; gardens and farm-land for outdoor work, and every possible facility for encouraging the cripple to do his utmost toward self-restoration. Here, too, will be entered the work of the "reconstruction aids," a corps of instructors in physical training, specially trained for the work of drilling crippled men in the fullest use of their remaining muscles, to the end that they may exercise heir faculties to the utmost. He degree to which the stump of an arm or a leg may become mobile and useful has been carefully calculated as a result of French experience; it is surprising to a sound man to discover how useful half a forearm, for instance, may become. The corps of reconstruction aids is being recruited from among men and women instructors in gymnastics under the direction of Miss Marguerite Sanderson of Boston.

The fitting of artificial members to missing hands and legs has become almost a science in itself. Wonderful results have been achieved in Europe with marvelous and complicated hand mechanisms that enable their wearers to perform almost miraculous feats. For most crippled soldiers, however, the simpler forms, variations of the plain hook or the various forms of clamps for holding tools, are much more serviceable as working hands. A specialized body of surgeons is studying the whole subject under the direction of the Surgeon General Gorgas, with a view of fitting every American soldier who may need such artificial aid with the type best adapted to his civilian needs.

The exact point in the course of his rehabilitation and re-education at which the invalided soldier is to be discharged from the army and become a civilian again will be determined in each individual case by circumstances, and as a whole, by the action of Congress. What has been broadly outlined above covers substantially the work of the Medical Department of the army. When the soldier has been stimulated with ambition, and compelled to acquire the habit of work, taught to use what powers he has to their fullest usefulness, rendered as physically sound as medical science can make him, and fitted with and taught to use the form of artificial limb best adapted to his abilities, there is little more the army is through with him, however, it is the belief of those who have been making an intensive study of this subject, that he should have determined, or had determined for him, what particular trade or occupation he is to follow after his discharge, so that he may not only receive some special training in that direction, but be ready to step immediately from the hospital either into a job or into a special school for re-education. In Canada, out of 19.000soldiers discharged as incapacitated in the first three years of the war, only 900 required re-education; the remainder, more than 95 per cent, were able to resume their former occupations, or take up other employment, immediately upon leaving the hospitals.

The general plan of reconstruction work contemplates caring for each disabled soldier or sailor in the reconstruction hospital nearest his former home. The plan of vocational rehabilitation contemplates training him to do something as nearly like his former occupation as possible. For instance, a journeyman carpenter who has lost an arm may be trained into a good superintendent of construction. If this can be done by placing him in a school where he will have an opportunity to learn how to read blueprints and understand specifications, such a school will be found. So far as possible, existing schools are to be utilized; most of the large industrial organizations already maintain technical schools for their employes, and these and other similar institutions will be opened to the discharged crippled soldier. And while the soldier or sailor is undergoing such re-education he will continue to receive the disability compensation to which he is entitled under the War Risk Insurance act. If the advice of those who have studied European experience is taken, any pension to which he may be entitled is to be based upon the nature and extent of his injuries and not upon his earning capacity.

Obtaining jobs for the rehabilitated and reeducated soldier will be part of the function of whatever board or central authority may be created. Already hundreds of manufacturers have promised to give positions to such men, so far as they are qualified to fill them. The whole aim of the rehabilitation program is to make each of its beneficiaries competent to hold up his end in competition with his fellow-workmen who are physically whole.

Both the reconstruction hospitals and the general scheme of rehabilitation in all probability will be open to civilian employes of the Government, injured in the discharge of their duty, and under certain restrictions the vocational rehabilitation may be made available for any person injured in any civil employment under conditions to be established by the Rehabilitation Board. Out of the emergency of war, therefore, there will thus develop a permanent asset for peace, a long step toward solving the problem of putting the industrial cripple as well as the war cripple back on the payroll.