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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.