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How Germany Made Preparation for Her Wounded

At the outbreak of the war, Germany of all other countries had laid the most solid foundation for the care of her wounded. Immediately all the resources accumulated in peace time for the rehabilitation of cripples were mobilized -- almost simultaneously with the military mobilization.

One week after the beginning of hostilities, the Kaiserin, at the suggestion of Dr. Biesalski, Germany's leading orthopedist and secretary of the German Federation for the Care of Cripples, sent a telegram to the members of the Federation, asking that the fifty-four German cripple homes throw open their doors to war disabled soldiers. To this, all the homes immediately consented. Dr. Biesalski made a tour of Germany under the auspices of the Red Cross, in which he visited the principal cities, urging the formation of voluntary committees. The immediate result was the initiation of work in all parts of the empire under various auspices and with various plans.

There are four stages in the treatment of the disabled soldier: (i) medical treatment; (2) provision of artificial limbs and functional restoration; (3) vocational advice and re-education, and (4) placement. These activities are cut sharply in half, the first two being, as a rule, controlled by the imperial military authorities, and the last two by private and state agencies.

The medical side of the problem tends thus to be conducted on more uniform lines. The vocational and economic rehabilitation is in the hands of local committees. There is no central authority giving general direction to the work; the re-education schools are of varying types and most unevenly distributed. The matter of re-education is largely in private hands and mostly done by volunteers. It is not even supervised by the imperial government. In spite of the friction that sometimes developed, especially in the beginnings, between the civilian workers and the military officials, the work ranks high, both with regard to volume and to the efficiency of the individual institution. This is due primarily to the existence of a strong body of enlightened public opinion as to what constitutes the duty of the nation toward the wounded.

WHAT PUBLIC OPINION HAS DONE

As in every country, there was in Germany the usual outburst of charity, misguided by the traditional attitude towards the war cripple, which was a combination of hero worship with pity for an assumedly helpless member of society. The newspapers were loud in their demands for Heldenheime (old soldiers' homes), where all cripples could be maintained in idleness for the rest of their lives. Public sympathy towards the veterans was in danger of being absorbed in the undesirable forms of charity, to the total disregard of constructive forms of assistance.

Immediately, however, an educational campaign was started to divert public opinion to an interest in the work of rehabilitation and re-education. This public education on the subject of proper treatment for war disabled has been very efficient and effective. At the present time, German public opinion has fully assimilated the idea that the real public duty towards the handicapped soldier is to restore him to work and to an active participation in the economic life of the country, and that this is a patriotic duty. The faith in the possibility of the rehabilitation has become a part of the patriotic faith. The principle that no one need be a cripple unless he himself wishes it, and that "the wounded man must sink back into the mass of the people as though nothing has happened," is accepted as a creed.

DIFFERENT METHODS, BUT UNITY OF PURPOSE

While the methods used in the different localities and institutions may vary greatly, there is a complete unity of purpose. Germany has a very definite scheme as to what constitutes the reconstruction of her wounded. It is accepted by all the institutions working to this end, it is put in practice, and it is said that in ninety per cent, of the cases the desired results are obtained. Dr. Biesalski puts it this way:

1. No charity; but work for the war disabled.

2. Disabled soldiers must be returned to their homes and to their old conditions; as far as possible, to their old work.

3. The disabled soldiers must be distributed among the mass of the people as though nothing had happened.

4. There is no such thing as being crippled, while there exists the iron will to overcome the handicap.

5. There must be the fullest publicity on this subject, first of all among the disabled men themselves.

Dr. Biesalski says further that from ninety per cent, to ninety-five per cent, of all the war wounded treated are returned to industrial life.

TWO HUNDRED ORTHOPEDIC HOMES

There is a fairly complete network of orthopedic homes distributed all over the empire, about two hundred in number, and all under military discipline. The time of treatment for a man in the orthopedic hospital is from two to six months. Men are kept here until they are ready to go back to the army or are pronounced definitely unfit for service. Even if they are so unfit, the war department does not discharge them until they are pronounced by the physician physically fit to go back to civil life.

More and more emphasis is being placed on physical exercise as a means of bringing the physical condition back to the standard. The plan is that a man shall begin very simple but systematic physical exercises even before he is out of bed. These are gradually increased, until finally he has two or three hours a day under a regular gymnasium instructor. Games and outdoor sports are found to have an immense therapeutic value, both psychological and physical, as compared with medico-mechanical treatment. Though the hospitals do not attempt to train a man to a trade many of them have workshops attached for purposes of functional re-education. There is great stress placed on the fact that even this occupational therapy should be really useful and should lead the patient direct to some practical occupation.

GENERAL INTEREST IN ARTIFICIAL LIMBS

All artificial limbs are furnished and kept in repair by the government. The government has prescribed maximum prices for the different types. Otherwise there is no official supervision: no standard pattern is prescribed, and the matter is left lo the doctors and engineers of the country.

The result is an immense stimulation of activity. The magazines are full of descriptions of new appliances recommended by doctors and manual training teachers from all parts of the country. At an exhibition of artificial limbs, held at Charlottenburg, there were shown thirty kinds of artificial arms and fifty legs in actual use. The German Orthopedic Society has devoted much discussion to the matter and there has been wide education and publicity.

The principle now thoroughly accepted is that the appliance should reproduce not the lost limb but the lost function. It should not be an imitation arm or leg, but a tool. The standard of merit is the number of activities it makes possible. The so-called Sonntagsarm (Sunday arm) is never supplied except on request to clerical workers.

RE-EDUCATION WITH MEDICAL TREATMENT

Re-education in Germany goes on at the same time as the medical treatment. This has two causes: First, there is the strong conviction that results can be obtained only by getting hold of a patient at the earliest possible moment of convalescence, and second, the fact that, since the Imperial Government does not pay anything towards re-education, it is more economical for the care committees to attend to it while the men are in the hospitals and thus save themselves the expense of maintenance.

The first civilian function in the care of the war handicapped is vocational advice. The local care committee usually appoints vocational advisers, whose appointments must be sanctioned by the local military authorities, controlling the visits made to the men at the hospitals. As soon as a man is well enough to be visited, the committee sends to him its representative to get full facts on his experience and his physical condition and then advise him as to re-education or immediate work. It is insisted that a man must, if humanly possible, go back to his old trade, or, failing that, to one like it.

In most instances, there are no workshops maintained at the hospitals. The local care committee may utilize the local trade schools. There are excellent facilities for this, since every town has at least one trade school. Some representative of the educational authorities generally serves on the local care committee and the schools are eager, in any case, to offer free instruction.

German magazines are full of advertisements of free courses for soldiers, offered by schools of the most varied kind, public and private, from agricultural and commercial schools to professional schools and universities. On the other hand, in a large town, with a large number of hospitals, the committee may create a school of its own. Thus, in Dusseldorf, for instance, where there are fifty hospitals, the committee has taken possession of a school building equipped with shops and tools and given twenty courses open to men from all the hospitals.

GREAT VARIETY OF TRADES

The instruction offered and the trades taught present a great variety. It is planned that none of the courses shall take more than six months, the maximum time for hospital care. These short courses are intended for men of experience who need further practice in their old trade or in an allied one. If a man needs further training after this short course, he becomes the charge of the local care committee, which supports him while he attends a technical school or pays the premium for apprenticing him to a master workman.

A special effort is being made to return to the land all who have any connection with it, such as farmers, farm laborers and even hand-workers of country birth. All the hospitals which have any land give courses in farming and gardening for their inmates. It is estimated that there are several hundred such hospital farms, small or large, run by the wounded. In addition to this, there are definite summer farm courses at agricultural schools and universities, which are free to cripples. There are in the empire ten regular agricultural schools for war wounded.

There is no uniform machinery for the placement of war disabled. The principle is universally recognized that a "man must go back to his former trade and, if possible, to his former position." The care committees, while interviewing the man in the hospital, get also in touch with his former employer. Sometimes a position is thus secured even before the man has started his training, and the latter is then adapted to the requirements of that particular position. It is, however, not always possible to place a man with his old employer. Some of the larger care committees run employment bureaus of their own. Others turn over the man who cannot be taken back to his old position to another agency.

Employers' and workmen's associations are of considerable assistance in the placement of war cripples, especially the Federation of German Employers' Associations, which has been recently formed for this particular purpose, and the many master guilds of hand-workers. There are also a number of agencies due to charitable or private initiative.

Finally, there are open to war disabled a very large number of positions in government service. The Imperial Government has promised that all former employees of the railways, post office, and civil service will be re-employed, if not in their old capacity, in a kindred position. These men are to be paid without consideration of their pensions. The post office department has decided to give all future agencies and sub-agencies in the rural districts to ex-soldiers, provided they are fit for the positions and want to settle on the land. Many city governments make efforts to take in the handicapped. A number of employments under the war department are reserved. The war department, through its recently created welfare department, attempts. also to develop a placement activity wherever there is no very active local care committee, and publishes twice a week a journal which lists the positions open for handicapped veterans.