UB 360 H314r 1919 14030930R NLM OSOTflMII 7 N*TI0N»L LIBRARY OF MEDICINE (LIBRARY OEi EDIC1NF. PROPERTY OF THE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE wi NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF * PROBLEMS OF WAR AND OF RECONSTRUCTION EDITED BY FRANCIS G. WICKWARE THE REDEMPTION OF THE DISABLED Courtesy Carry On. OCCUPATIONAL THERAPY THROUGH BEDSIDE OCCUPATIONS, TJ. S. ARMY GENERAL IIOSPITAI. NO. 9, LAKE WOOD, NEW JERSEY PROBLEMS OF WAR AND OF RECONSTRUCTION THE REDEMPTION OF THE DISABLED A STUDY OF PROGRAMMES OF REHABILITATION FOR THE DISABLED OF WAR AND OF INDUSTRY BY GARRARD HARRIS RESEARCH DIVISION, FEDERAL BOARD^ FOR VOCATIONAL EDUCATION i WITH AN INTRODUCTORY CHAPTER BY FRANK BILLINGS COLONEL, MEDICAL CORPS, UNITED STATES ARMY; CHIEF OF THE DIVISION OF PHYSICAL RECONSTRUCTION, OFFICE OF THE SURGEON-GENERAL AND A FOREWORD BY CHARLES A. PROSSER DD3ECTOR OF THE FEDERAL BOARD FOR VOCATIONAL EDUCATION ILLUSTRATED D. APPLETON AND COMPANY NEW YORK LONDON 1919 UB zeo H3l4r 1919 COPTEIGHT, 1919, BY D. APPLETON AND COMPANY PEINTED IN THE UNITED STATES OF AMERICA This Nation has no more solemn obligation than healing the hurts of our wounded and restoring our disabled men to civil life and opportunity. The Government recognizes this, and the fulfillment of the obligation is going forward fully and generously. The medical divisions of the War and Navy Departments are rendering all aid that skill and science make possible; the Federal Board for Vocational Education is commanded by law to develop and adapt the remaining capabilities of each man so that he may again take his place in the ranks of our great civilian army. The cooperation and interest of our citizens is essential to this programme of duty, justice and humanity. It is not a charity. It is merely the payment of a draft of honor which the United States of America accepted when it selected these men, and took them in their health and strength to fight the battles of the Nation. They have fought the good fight; they have kept the faith, and they have won. Now we keep faith with them, and every citizen is endorser on the general obligation. Woodrow Wilson. PREFACE Out of the Great War have grown some permanent benefits to humanity, and among these perhaps the greatest is the prospect of emancipation for the physically disabled individual from thralldom of unhappy circumstance. Prodigal as was the expenditure of men, even through the very squandering of man power itself, the fighting nations came to realize the value of the individual and the strength each individual, though disqualified for direct military service, could con- tribute to the common cause and aim. Gradually there dawned a different and more enlightened con- ception, based not solely upon the use that could be made of remaining assets of strength or skill left to the injured man, but upon justice to the man himself and to his dependents. This new and revolutionizing conception the United States has been first among the nations to apply in all its broadest significance. The United States has initiated a comprehensive pro- gramme for the benefit of and in justice to all its dis- abled citizens, whether injured upon the firing line in battle or in civil employment contributing to the general community welfare. Europe had been in the maelstrom of war many months before the United States was drawn into the vortex. The problem of the disabled man was in fair way of being solved by France and Belgium and Great Britain. At least they had entered upon the right road — a new and unexplored road, and were following it to their own material and social advan- tage. Canada took up the problem of rehabilitation . vii PllEFACE of her disabled men, and made a distinct advance upon the European systems, adapting the principles to suit her own social conditions, which in no essential differ from our own. Canada was obtaining satis- factory results when the United States came to deal with the task of providing for our own disabled soldiers and sailors. Canada most generously and cordially, without reserve, placed all her knowledge and experience at our disposal. She did more — she loaned this Government Mr. T. B. Kidner, who had so prominent a part in bringing about those intensely practical results attained in Canada, and in the forma- tive days before we were actually started upon the task his advice and experience were invaluable. The United States in undertaking to provide for its disabled men unhesitatingly scrapped all old tra- ditions, theories, and ideas. The sole animating and dominating purpose was justice to the man who was prepared to give his all for the Nation. The country felt that it could do no less than give its best to requite him. That justice was conceived to be restora- tion to opportunity in so far as it was humanly pos- sible to accomplish, with such compensation as could be made for the impairment of earning power. To the honor and credit of the Congress of the United States, the necessary legislation was passed without a dissenting vote, without a voice being raised in either criticism or protest — surely a remarkable record, and an augury of the further results to be expected from the quick grasp our public servants took upon the essential principles of justice which are the founda- tion of the rehabilitation programme. In fairness to the Congress it should be recorded that it wished to extend the benefits of vocational rehabilitation to the disabled of industry at the same time that the soldiers' and sailors' bill was passed, and refrained only upon viii PREFACE the advice of friends and advocates of both redemp- tion projects. Undoubtedly this new national policy will exert very beneficent influences upon our future industrial and social life. The rectification of injustices now suffered by those disabled in employments, a yearly toll of maimed and injured which in the aggregate far exceeds all the casualties the Nation has suffered in the war just ended with those of the Civil War added, offers a wide field for practical and construc- tive effort. At the same time, there will be as a result of this retraining of the disabled concrete evi- dences in almost every community of the value of specialized vocational education. These living testi- monials will inevitably emphasize the advantages of vocational training for those who have not suffered physical impairment, and thus give impetus to the more general acceptance of this inherently practical system of training for life work. When that time comes, there will be eliminated many of those lost years of young manhood and young womanhood wherein workers who have no particular ability earn only the small rewards mediocrity and lack of skill have ever been able to obtain. Much has been written on various aspects and de- velopments of vocational rehabilitation for disabled soldiers. In the main it has either dealt with techni- cal features of no particular interest to the average reader, or else the superficial features of occupational therapy have engaged the attention of magazine ex- positors. At best it has been fragmentary and widely scattered as regards the whole subject, nor has there been anywhere a comprehensive chronicle of the rise and development of this movement in the United States to its present status. There is a plain demand for a record dealing with the whole subject in general ]X PREFACE terms and particularizing with respect to the accept- ance of the fundamental principles by the United States Government and their development in this country. With that aim in view the present work Was undertaken. Much of the material was obtained from original sources opened to the Federal Board for Vocational Education in its studies on the subject of vocational rehabilitation of the disabled in Europe. Other data, public documents of other nations and similar material, have been available, were drawn upon when occasion required and fitted to their places in the narrative. My effort has been to present a general, non-technical, but at the same time accurate survey of the whole field with emphasis upon that part of especial interest to the people of the United States. Acknowledgment of very valuable assistance and contribution of material by Dr. John Cummings of the Research Department of the Federal Board is appreciatively made, as well as the advice and in- terest of the editor of this series throughout all stages of the book's preparation. If the book serves to assist in directing attention to this new system of practical, individual justice, this new exorcism of dependency, this truly wonderful message of hope, and thus in some degree causes the public mind to persist in these inquiries and develop- ments which mean so much to the individuals affected, and through these individuals redeemed to humanity at large, I shall feel amply rewarded. Garrard Harris. r FOREWORD The United States was the last of the great nations to join the Allies who were battling against the Hun for the decency and the liberty of the world. Con- sequently it was the last of the belligerents to make provision for the proper rehabilitation of the soldiers and sailors disabled in the fight for our national honor and our national safety. While the scheme for the vocational reeducation and placement in employ- ment of our disabled warriors came last in point of time, it stands first in the liberality with which this Government has made provision for the proper restoration to civil life of those injured or disabled in the Great War. How successful the plan of vocational rehabilitation for this country which Mr. Harris has described in this book will be in restoring our disabled warriors to successful and happy employment depends upon the efficiency with which the Federal Board for Vocational Education is able to discharge the re- sponsibility for that work as committed to it by the Congress. A large part of this book is devoted to a most ex- cellent exposition of the law and the plans and policies of the Board in the administration of the Vocational Rehabilitation Act which became law on June 27, 1918. As Mr. Harris is connected in an editorial capacity with the Board, he speaks with an intimate knowledge of its work and plans. Combining with this a deep and enthusiastic interest in the whole problem of the handicapped man and a rare ability to write in an attractive way, he has been able to make xi FOREWORD what I regard as a most distinct contribution to the literature of the whole subject. Those interested in a popular comparative study of the schemes of all the belligerents for the vocational rehabilitation of their disabled men will find that the author has not only looked forward toward the work before the Federal Board, but has also summarized clearly the plans and policies of our allies and pointed out the essential oneness of aim and the necessary differences in procedure between each of them and our own country. Best of all, Mr. Harris has set forth the philosophy of the whole movement for the rehabilitation of handi- capped persons whether injured in war or in the dis- charge of the duties of their civilian employments. The fundamental justification and aim of the work is not that of gratitude to those who have been injured in the Nation's defense, though this is a holy reason and the moving cause of the liberal provisions which the warring nations have made for their wounded men. Far deeper than this, even though society may not yet be fully conscious of the trend of this legis- lation, is the need for the conservation of our human resources and the demand for social justice that no democracy redeemed by this awful war can deny. Without reeducation and placement in employment, disabled soldiers and sailors would go to the waste pile as social dependents as so many have done in other wars. As Mr. Harris points out, however, the victims of our modern industrial life greatly out- number those injured in the war. Any programme for the conservation of the handicapped has but little significance until it includes within its benefits this larger group, unsupported as it is by either a soldier's insurance or a soldier's compensation. Whether the handicapped man serve society in war or in peace, his xii FOREWORD restoration to successful employment is a wise busi- ness investment certain to yield large deferred divi- dends in industrial peace, happy homes, self- dependent workers, and national prosperity. Most important and fundamental of all, the restora- tion of the handicapped man as a useful, self-support- ing member of society needs to be asserted as a national policy, and never more so than in these parlous days when some of our friends among the social reformers seem to forget that the inherent spirit and purpose of a democracy is, on the one hand, to establish social justice, and, on the other, to pro- vide the education and the opportunity by which men, according to their abilities and their energies, may be able "to find themselves and to help themselves." Charles A. Prossek. xiii CONTENTS PREFACE FOREWORD INTRODUCTION PHYSICAL RECONSTRUCTION Complete physical and functional restoration the ob- jective of hospital treatment of disabled soldiers and sailors — Division of Physical Eeconstruction organized in the Office of the Surgeon-General of the Army — Its facilities extended to the disabled of the Navy and the Marine Corps — Physical recon- struction an innovation in American military prac- tice — The system developed on the basis of foreign experience — Its organization and personnel — Pub- licity measures — The reeducation programme de- veloped with the Federal Board for Vocational Education — Eeconstruction hospitals — Occupa- tional therapy and "reconstruction aides" — Cura- tive workshops and courses of instruction — Physio- therapy — Special hospitals for special and perma- ment disabilities — Classification of the disabled from a military standpoint — Proportion of wounded refitted for military service — Changed conditions after the armistice — Extension of the system of re- construction hospitals — Incidence of specific dis- abilities— Blindness — Deafness and speech defect — Amputation cases — Tuberculosis ... 3 CHAPTER I REDEMPTION OF THE DISABLED A SOCIAL OBLIGATION The soldier of democracy essentially a civilian — Com- plete restoration to pre-war civil status the Nation's obligation toward its defenders — Rehabilitation, not charity, the new conception of national duty toward the wounded and disabled of war — Con- XV CONTENTS servation of human capacities an enlightened social policy — Complexities of the problem of redemption — Diversity of disabilities — Disabilities rarely total but mainly special and relative — Continuity of redemption process from early convalescence essential — Occupational therapy — Compulsory vocational rehabilitation impossible — Status of vocational education ...... 14 CHAPTER II HUMAN WASTAGE UNDER THE PENSION SYSTEM The tide of our pension expenditures still rising — Ap- propriation for 1918-19 a new high record — Tot:il pension expenditures of nearly five and one-half billions — The pension roll of soldiers and widows — The monthly allowances — Inmates of Soldiers' Homes — Pensions inadequate to discharge the Nation's debt to its defenders -r- Their welfare in- sured only by economic rehabilitation — Needless wastage of human capacities is the lingering blight of previous wars — The programme of rehabilitation. 30 CHAPTER III THE NATION'S DUTY TOWARD THE INDIVIDUAL Individual self-respect a national asset — Charity the old conception of national duty toward the disabled of war — Evil effects of the pension system — Restoration and restitution the new conception of the Nation's duty — The Nation the soldier's debtor — Disability compensation — Vocational reeduca- tion of the disabled......?»9 CHAPTER IV WHAT THE BELLIGERENT NATIONS HAVE UNDERTAKEN The State's regard for the individual enhanced by the war — Restoration of the disabled a national policy of all the belligerents — Economic value of the dis- abled— Restoration policy of the United States — Inclusion of the disabled of industry — Evolution of a new social policy — Its further possibilities . 46 xvi CONTENTS CHAPTER V THE PROBLEM OF RE-EDUCATION Probable number of disabled men requiring reeducation — American casualties in the war — Experience of Great Britain and Canada — Eyesight cases — Am- putation cases — Surgical cases a comparatively simple problem — Medical cases most complicated and troublesome — Placement and supervision of re- educated men — Placement of discharged men in their former occupations — Programme of the Fed- eral Board for Vocational Education CHAPTER VI BELGIUM, THE PIONEER IN RESTORATION WORK Pitiable state of the disabled Belgian exiles — M. Schol- laert 's charitable experiment — Curative effects of work — Depot des Invalides at Havre — Foundation and development of the Ecole nationale beige des mutiles de la guerre at Port Villez — Organization and courses — Compulsory training — Provision for professional students at Paris .... CHAPTER VII SYSTEMATIC DEVELOPMENT IN FRANCE Edouard Herriot and the Lyons schools — The Institut nationale professionel des invalides de la guerre — Schools established by private philanthropy — Gov- ernment vocational schools — Reluctance of dis- charged men to return for training — Schools at- tached to hospitals — National control of restoration work — Centers of readaptation — Registration of the disabled — Departmental committees — Com- pensation of workmen — School discipline — Courses offered — French losses in the war CHAPTER VIII EVOLUTION OF THE BRITISH SYSTEM British policy the most generous to the disabled — Revo- lutionary abandonment of pre-war conceptions — The new programme — Utilization of existing xvii CONTENTS agencies — Coordination under State control — Statutory Committee of the Royal Patriotic Fund Corporation and its local committees — Ministry of Pensions and the Special Grants Committee — Func- tions of local committees — Advisory trade com- mittees for training and placement — Extreme flexi- bility of the system ...... CHAPTER IX RESTORATION WORK IN THE CENTRAL EMPIRES Germany well equipped for rehabilitation of the dis- abled — German Federation for the Care of Cripples — Responsibility evaded by the Imperial Govern- ment — State and private organization — The restoration programme — Treatment in orthopaedic hospitals — Niirnburg hospital — Diisseldorf school — Schools for the one-armed — Placement — Per- centage of cripples restored — Estimate of German losses — Policy of Austria-Hungary — Vienna orthopaedic hospital and schools — Policy of Austria — Policy of Hungary — The Invalidment CHAPTER X THE PRACTICAL CANADIAN SYSTEM First provision for Canadian wounded — The Military Hospitals Commission — Inception of vocational re- education — The Invalided Soldiers Commission — The civilian Department of Civil Reestablishment — Principles of the restoration scheme — Rehabilita- tion work completely demilitarized — Pension allot- ments unaffected by retraining — Vocational re- education limited to the disabled who cannot return to their former occupations — Handling the return- ing invalids — Occupational therapy in the hospitals — The mechanism and process of restoration — Re- turning the disabled farmer to the land — Free education without maintenance open to all soldiers not requiring retraining — Canadian casualties in the war ........ rviii CONTENTS CHAPTER XI AUSTRALIA, NEW ZEALAND, SOUTH AFRICA, AND INDIA Australian Repatriation Commission — State and local boards — Registration and retraining — Returning soldiers to the land — New Zealand Discharged Soldiers' Information Department — Preferential employment and placement of returned soldiers — Vocational retraining not popular — Facilities for agricultural, clerical and technical training — Re- education in South Africa left to private initiative — The Johannesburg Relief Association — Training at the South African Military Hospital, near Lon- don— Imperial Indian Relief Fund — Queen Mary's School at Bombay . . . . .136 CHAPTER XII ITALY AND HER SPECIAL PROBLEMS Italy unprovided with facilities at the beginning of the war — The Milan Institute dei Rachitice — Provin- cial and local committees — Voluntary national federation of committees — National Board for the Protection and Assistance of War Invalids — Its creation and functions — The national rehabilita- tion system — Placement after restoration — The disabled and accident insurance — The problem of illiteracy — Courses in the handicrafts — National War Cripples Association — Italian casualties . 147 CHAPTER XIII THE PROBLEM COMES TO AMERICA The United States as a neutral — Slight interest in rehabilitation work abroad — Its importance to the belligerents — The spirit underlying their restora- tion schemes — Entry of the United States into the war — An agency for the redemption of the disabled at hand — The vocational-education movement in the United States — The Federal Vocational Educa- tion Act — The Federal Board for Vocational Edu- cation — Its composition and functions — Its early war service — Its immediate availability . . 158 six CONTENTS CHAPTER XIV THE DEVELOPMENT OF A NATIONAL PROGRAMME The beginnings of the movement—National scope of the problem — Investigations of the Federal Board for Vocational Education — President Wilson interested — Joint conference of Government bureaus and private organizations — Its proposed legislation — The programme formulated by the Council of Na- tional Defense — The Federal Board for Vocational Education entrusted with its execution — Congress and the Vocational Rehabilitation Act — Principles of the restoration programme . . . . 1C7 CHAPTER XV FINANCIAL PROVISION FOR THE DISABLED SOLDIER The War Risk Insurance Act — Evils of the pension system avoided — The Government's liability as em- ployer in the dangerous trade of war — Allotments mid allowances to dependents of enlisted men — Compensation for death or disability — The demo- cratic principle of the flat-rate scale of disability compensation — The danger of special legislation — Bearing of fiat-rate compensation upon the voca- tional-rehabilitation programme — Rates of com- pensation for death and total disability — Problem of rating partial disabilities — Voluntary life and total-disability insurance ..... 177 CHAPTER XVI THE VOCATIONAL REHABILITATION ACT Its provisions — Classes eligible for reeducation — Powers and duties of the Federal Board for Voca- tional Education — Continuance of military pay, allotments and allowances during training — Dis- ciplinary powers of the Federal Board — Extension of training to classes not totally incapacitated — Cooperation of the Federal Board with other agencies^—Physical restoration under the medical authorities of the Army and Navy — Cooperation in occupational therapy — Special gift fund for voca- tional rehabilitation authorized — Quarterly and an- nual reports required — Rehabilitation work organ- XX CONTENTS ized by the Federal Board — Probable period of training — Instruction not limited to manual trades and industrial processes ..... 193 CHAPTER XVII THE PROCESS OF RESTORATION : CURE BY WORK An improved therapy of restoration a beneficent by- product of the war — Hope the greatest restorative and work its ablest assistant — Hospital training — Physical processes of restoration contributory to vocational rehabilitation — Cooperation of medical authorities and the Federal Board for Vocational Education — Three stages in restoration — The first stage, acute illness, passed abroad — The stage of convalescence — Occupational therapy —'' Invalid'' or '' bedside'' occupations — The '' curative work- shop"— The final stage of vocational reeducation. 202 CHAPTER XVIII THE CHOICE OF AN OCCUPATION All careers open to the disabled man — The welfare of the individual the criterion of choice — Vocational advisers — Their qualifications and functions — Medical limitations on the choice of an occupation — Previous experience of the patient utilized — Examples of retraining in specialized branches of pre-war occupations . . . . . .213 CHAPTER XIX THE TRAINING ADAPTED TO INDIVIDUAL NEEDS The process of reeducation a civilian function — The sense of individual responsibility and initiative atrophied in military service — Its stimulation a primary purpose — Vocation rehabilitation an in- dividual problem — Institutional facilities open to the Federal Board for Vocational Education — Practical workshop classes a concentrated appren- ticeship — Wide range of occupations and courses available — Assistance to complete interrupted col- lege courses — Illiteracy in the draft — Disabled illiterates to receive a fundamental education — Vocational instruction given in small groups . 221 xxi CONTENTS CHAPTER XX THE PROBLEM OF PLACEMENT Placement an essential part of the restoration pro- gramme — Employers protected against increased casualty-insurance rates —Prejudice against em- ployment of " cripples" — The retrained man de- pendent upon no special favors —A Government placement agency organized —Cooperation of state, local and private agencies —A survey of industrial opportunities made — Attitude and education of the employers — The period of probation and adjust- ment—Work the acid test of training — Retrain- in^ and replacement of misfits — Follow-up work after placement — A square deal for the man and for the employer — The attitude of organized labor. 232 CHAPTER XXI OPPORTUNITIES FOR THE RETRAINED IN THE PUBLIC SERVICE The Federal Government as an employer of labor —Its functions enormously extended under war conditions — Probable permanent extension of the civil service — Positions and appointments in the Federal service in normal years — Opportunities open to the dis- abled in the competitive positions — Preferential appointment from lists of eligibles proposed — Op- portunities in state and municipal civil service — Public service in France reserved for the disabled. 246 CHAPTER XXII RECORDS OF INDIVIDUAL SUCCESS Success of the reeducated demonstrated abroad — Ex- amples from Canadian experience — Men retrained with enhanced earning capacity — A rehabilitated blind man — Rehabilitated farmers — A score of miscellaneous cases — Oxy-acteylene welding . . 255 xxii CONTENTS CHAPTER XXIII THE DUTY OF THE HOME COMMUNITY The Government's power of rehabilitation definitely limited — Rehabilitation dependent ultimately upon the attitude and efforts of the home community — Duties of the home community towards the disabled man — Provision of employment — The disabled man entitled to a fair trial as worker and citizen — Social rehabilitation a paramount duty — The dis- abled man needs encouragement, not commiseration — Full admission to community fellowship the obligation of the home community CHAPTER XXIV A SUSTAINED PUBLIC SENTIMENT NECESSARY The Vocational Rehabilitation Act a reflection of public sentiment — Success of the programme dependent upon sustained public interest — Public opinion should condemn pensioned idleness — Dangers of the sinecure job for the untrained man — The women's part — Public opinion crystallized in a consistent course of conduct — Disregard of dis- abilities and concentration on capabilities of the disabled man essential — The disabled man in trade entitled to some preference in patronage — Sound and permanent public sentiment dependent upon in- dividual interest — The disabled man the brother in arms of those who have fought the fight at home. CHAPTER XXV THE LARGER PROBLEM : SALVAGING THE DISABLED OF INDUSTRY Industry takes annually as great a toll of man power as war on a colossal scale — Fourteen thousand an- nually permanently crippled in industry — Addi- tional ravages of tuberculosis and occupational dis- eases — Estimates of specific disabilities — Total loss of man power through non-fatal industrial accidents — The organization for vocational re- habilitation of the war disabled to be devoted to its salvage — The movement in Congress — The pending legislation . .... xxiii CONTENTS CHAPTER XXVI THE PLACE OF THE STATES IN THE PROGIiAMME Early state projects for disabled soldiers — Industrial surveys — State activity su.spended on enactment of the Vocational Rehabilitation Act — Opportunities for state cooperation — Suspension of civil contracts against disabled men — Assistance in placement — Reclamation of waste lands for farm communities — Assistance in the purchase of farms — Tenancy the cause of the drift from the land — Placement of the reeducated disabled of industry a state func- tion — Its relation to the land problem — Con- clusion ........ 300 index.........309 XXIV ILLUSTRATIONS l PAGE Occupational therapy through bedside occupations, U. S. Army General Hospital No. 9, Lakewood, New Jersey ..... Frontispiece Teaching the blind to read and write Braille at Ever- green, U. S. Army General Hospital No. 7, Roland Park, Maryland .... Facing 12 Retraining the blind as masseurs, St. Dunstan's Hostel for the Blind, London . . . Facing 12 French brush maker, blinded and with right arm gone, who pursues his trade with a mechanical work arm and other special apparatus . . Facing 24 A French carpenter with left arm gone in training to resume his trade at the Paris Ecole des Mutiles Facing 48 The machine shop at the pioneer National Belgian School for War Disabled at Port Villez, France Facing 70 Toy makers at the Eeole Joffre, Lyons, France, each man lacking an arm through either amputation or paralysis......Facing 80 The shoe-repairing workshop at St. Dunstan 's Hostel for the Blind, London .... Facing 100 Disabled men being retrained as power-machinery operators on Canadian farms . . Facing 132 Hindus with leg amputations learning to operate knit- ting machines, Queen Mary's Technical School, Bombay, India.....Facing 144 Italian soldiers with leg amputations being trained as tailors by the Naples Committee for War Cripples Facing 154 Fitting artificial legs in a Canadian institution Facing 174 xxv ILLUSTRATIONS TAGP. Patient in a Montreal hospital operating a hand loom, a favorite bedside occupation . . Facing -06 Wood carving, a treatment prescribed for functional restoration of wrist and fingers . . Facing 20 , Curative workshop at U. S. Army General Hospital No. 9, Lakewood, New Jersey . . Facing 234 A man with legs completely paralyzed in training as a linotype operator at Dunwoody Industrial Institute, Minneapolis.....Facing 264 Training in oxy-acetylene welding at Dunwoody Indus- trial Institute, Minneapolis . . . Facing 264 Class in mechanical drafting under a one-armed in- structor, Red Cross Institute for Crippled and Dis- abled Men, New York . . . Facing 282 Woodworking class at the sanitarium for tuberculous Canadian soldiers, Ste. Agathe-des-Monts, Quebec Facing 282 Four French mutiles with arm amputations mowing hay with mechanical work arms . . Facing 304 xxvi THE REDEMPTION OF THE DISABLED INTBODUCTION PHYSICAL RECONSTRUCTION Frank Billings i Complete physical and functional restoration the objective of hospital treatment of disabled soldiers and sailors — Divi- sion of Physical Reconstruction organized in the office of the Surgeon-General of the Army — Its facilities extended to the disabled of the Navy and the Marine Corps — Physical reconstruction an innovation in American military practice — The system developed on the basis of foreign experience — Its organization and personnel — Publicity measures — The reeducation programme developed with the Federal Board for Vocational Education — Recon- struction hospitals — Occupational therapy and " recon- struction aides '' — Curative workshops and courses of instruction — Physiotherapy — Special hospitals for special and permanent disabilities — Classification of the disabled from a military standpoint — Proportion of wounded re- fitted for military service — Changed conditions after the armistice — Extension of the system of reconstruction hospitals — Incidence of specific disabilities — Blindness — Deafness and speech defect — Amputation cases — Tuber- culosis. In August, 1917, the Surgeon-General of the United States Army organized the Division of Physical Re- construction of disabled soldiers in his Office. Physical reconstruction was defined as indicating continued treatment of patients to the degree of as complete physical and functional restoration as is consistent with the nature of their several disabilities. On May 10,1918, arrangements were made with the Bureau of Medicine and Surgery of the Department of the Navy whereby the Surgeon-General of the Army was given 1 Colonel, Medical Corps, U. S. Army; Chief of the Division of Physical Reconstruction, Office of the Surgeon-General. 3 REDEMPTION OP THE DISABLED charge of such sailors and marines as require physical reconstruction. Although physical reconstruction of the disabled has been practiced to some degree in American civilian hospitals, this provision was an innovation in our military practice. Physical reconstruction, however, was an established practice in the military hospitals of practically all other modern Governments. Its best expression in the Great War is found in Great Britain, France and Italy of our allies. Russia even during the early period of the revolution was able efficiently to reconstruct her sick and disabled men. The well developed military organization of Germany included a splendid system of physical reconstruction of sick and wounded soldiers. The plans for the physical reconstruction of disabled American soldiers and sailors under the direction of the Surgeon-General were formulated upon the expe- rience of the medical departments of the armies of our allies in the war. This information was obtained by a personal survey in the field and by a review of the literature pertaining to the subject obtained by a special committee appointed for that purpose. The field survey was made in part through the inter-Allied committee of France, England and Italy and by field officers from the Surgeon-General's Office sent to Canada for that purpose. For the purpose of administration there was organ- ized in the Office of the Surgeon-General, under the Division of Physical Reconstruction, a personnel con- sisting of a chief and assistant chief and Departments of Education and of Physiotherapy. For the head of the Education Department was secured the services 4 PHYSICAL RECONSTRUCTION of an educator of wide reputation, with assistants qualified as technical educators in agriculture, in the industries, and in psychology. That certain perma- nent disabilities of soldiers might receive special at- tention, departments for teaching the blind and the deaf were created. The personnel of the various departments included qualified medical officers as advisers to the several departments in the Division and for field service. It was early recognized that publicity would be necessary to educate the disabled soldiers as to the need of continued treatment to restore them as fully as the nature of their disabilities permitted, and also for the purpose of arousing the families of the disabled soldiers and the general public to the need of physical reconstruction, so that the soldiers might be able to return to civil life completely restored to health, or at least with the handicaps of permanent disability overcome by efficient training and reeducation better to fit them for their old jobs or to qualify them for new and lucrative occupations. To this end, in June, 1918, the Surgeon-General began the publication of the magazine Carry On as a means of disseminating knowledge of the plans for the physical reconstruction of disabled men, for the information of the disabled themselves, their families, and the general public. The problem of the Surgeon-General was rendered less difficult and was placed upon an entirely rational basis by the enactment by Congress of a law, approved by the President on June 27, 1918, which placed upon the Federal Board for Vocational Education the re- sponsibility for the training and reeducation of dis- abled soldiers and sailors discharged from the Army 5 REDEMPTION OF THE DISABLED or the Navy, who because of their disabilities were unable successfully to follow their old occupations or who needed training for new occupations. Between the Medical Department of the Army and the Federal Board for Vocational Education a satisfactory cooper- ative programme was adopted for the training and reeducation of the disabled soldiers by a responsible Educational personnel in the military hospitals and a continuation of this training and reeducation after discharge of the soldiers by the Federal Board. Under the law the Federal Board was also made responsible for the placement of the discharged disabled soldiers and sailors after training and reeducation in civilian occupations. Early in 1918 the Surgeon-General directed that certain general military hospitals should be designated to carry on the work of physical reconstruction of disabled soldiers. In each hospital, in addition to the medical officers, there was appointed a personnel con- sisting of a chief educational officer qualified in gen- eral education, with assistants qualified as teachers in the industries and in agriculture and with the neces- sary instructors. The War Department authorized the Medical Department to employ civilians for curative-workshop instruction. The term'' reconstruc- tion aides" was adopted as the name for instructors in the handcrafts for applying occupational therapy to patients confined to beds and chairs in wards. These instructors were selected on the basis of quali- fications to teach the handcrafts in work with textile materials, such as weaving, knitting, rug making, and knotting; in reed, cane, and fibre work, such as basketry and brushmakmg; in woodworking, such as 6 PHYSICAL RECONSTRUCTION carving and whittling; in cardboard construction and binding, such as bookbinding and novelty box work; in work in applied design, such as stenciling and block printing; in metal work, such as jewelry; in work in plastic materials, such as pottery and modeling; and also for academic work, teaching the illiterate reading, English, spelling, arithmetic, and other academic studies. Workshops were created in the reconstruction hos- pitals where the soldier who had reached the ambula- tory stage could receive curative work in technical courses, including automobile driving and mechanics, blacksmithing, carpentry, bench woodworking, con- crete working, electricity, gunsmithing, general me- chanics, instrument repairing, machinist, mine drill runner, plumbing and pipe fitting, radio operator, radio electrician, telegraphy, sheetmetal working, vul- canizing, welding, wheelwright, drafting, painting, printing, drawing, sign painting, cartoonist, shoe re- pairing, weaving (rug), woodworking, furniture re- pairing, chair caning, cabinet work, ring making, book- binding, willow work. Commercial instruction was given in business correspondence, bookkeeping, com- mercial law, shorthand and typewriting. Agricultural pursuits, such as poultry raising, animal husbandry, crop study and gardening, were taught in the field, ward and greenhouse, with the application of light curative work in grass cutting, path making and road grading. Modern standardized physiotherapy was provided for in buildings and equipment for the application of hydro- electro- and mechanotherapeutics, to which was added recreational courses in military drill, walks, 7 REDEMPTION OF THE DISABLED physical training, and all sorts of play. Each recon- struction hospital has qualified personnel in physio- therapy, consisting of a director with reconstruction aides in physiotherapy. The Publicity Department of the Division of Physi- cal Reconstruction provided encouragement in the hospitals in the form of circulars prepared to furnish information to the disabled soldiers concerning their future. In cooperation with the Federal Board for Vocational Education and the Bureau of War Risk Insurance, more extended literature indicating the provisions made by the Government for the soldier was prepared and distributed. Technical and general literature was provided for each hospital through the Library War Service of the American Library Association. Actual work was begun in U. S. Army General Hospital No. 2, Fort McHenry, Baltimore, Maryland, and at Walter Reed General Hospital, Washington, D. C, in March, 1918; at General Hospital No. 9, Lakewood, New Jersey, and at General Hospital No. 6, Fort McPherson, Georgia, in April; and at General Hospital No. 17, Markleton, Pennsylvania, in May. Gradually a number of hospitals were added with the designation of special hospitals for the treatment and training of the permanently disabled, the blind at General Hospital No. 7, Roland Park, Maryland; of the deaf at General Hospital No. 11, Cape May, New Jersey; of the amputation cases at Walter Reed Gen- eral Hospital; of the shell-shock cases at General Hos- pital, Plattsburg Barracks, New York, and at General Hospital No. 13, Dansville, New York; of the tuber- culous soldiers at Fort Bayard General Hospital, New 8 PHYSICAL RECONSTRUCTION Mexico, at General Hospital No. 8, Otisville, New York, at General Hospital No. 16, New Haven, Con- necticut, at General Hospital No. 17, Markleton, Pennsylvania, at General Hospital No. 18, Waynes- ville, North Carolina, and at the two new General Hospitals at Azalea, North Carolina, and Denver, Colorado. Up to the signing of the armistice, continued treat- ment in the form of physical reconstruction from a military standpoint resulted in the classification of disabled soldiers as (1) those who could be restored to full duty; (2) those who could be fitted for limited service; and (3) those who were so disabled as to unfit them for further military service, to be referred to the Federal Board for Vocational Education after dis- charge from the Army. Before the armistice was signed the greater number of disabled soldiers returned from overseas were those whose disabilities were considered to disqualify them for further military service. A majority of the combat-disabled soldiers received continued treatment in the overseas military hospitals. Approximately 85 per cent, of these disabled men were able to return to combat service within a maximum period of 10 weeks. Many returned to combat service in a much shorter period of time. Of the remaining 15 per cent. of combat-disabled soldiers, a relatively large per- centage, though unfit for further combat service, were returned to special military duty in the non-combat zone. It was found that many of the soldiers returned from overseas were able to return to general military service after a period of treatment in the domestic military hospitals. 9 REDEMPTION OF THE DISABLED With the signing of the armistice there was no longer the need of treatment of the disabled soldiers in overseas hospitals for the purpose of restoring them to combat service, and in consequence as soon as the disabled soldier is able to travel he is returned to the United States for continued treatment in the military hospitals. With the changed conditions due to the armistice it became necessary to amplify the facilities for the physical reconstruction of the larger number of patients to be treated in the military hos- pitals in the United States. This increased bed capacity was secured through the designation as recon- struction hospitals of 17 base hospitals of the canton- ments of various parts of the country. The facilities for carrying on work at these base hospitals was secured through the alteration of existing buildings and the installation of workshop equipment obtained through the Quartermaster Department. The neces- sary increased personnel of educational officers was obtained through the authority to employ civilians as general and technical educators. On January 20, 1919, physical reconstruction was carried on in the following general and base hospitals: U. S. Army General Hospital, Port Bayard, New Mexico. Letterman, San Francisco, California. Walter Reed, Takoma Park, D. C. No. 2, Fort McHenry, Maryland. No. 3, Colonia, New Jer- sey. No. 6, Fort McPherson, Georgia. 10 PHYSICAL RECONSTRUCTION U. S. Army General Hospital, No. 7, Roland Park, Mary- land. No. 8, Otisville, New York. No. 9, Lakewood, New Jersey. No. 10, Boston, Massachu- setts. No. 11, Cape May, New Jersey. No. 16, New Haven, Con- necticut. No. 17, Markleton, Penn- sylvania. No. 18, Waynesville, North Carolina. No. 19, Oteen, North Caro- lina. No. 20, Whipple Barracks, Arizona. No. 21, Denver, Colorado. No. 24, Parkview, Penn- sylvania. No. 26, Fort Des Moines, Iowa. No. 28, Fort Sheridan, Illinois. No. 29, Fort Snelling, Minnesota. No. 30, Plattsburg Bar- racks, New York. No. 31, Carlisle, Pennsyl- vania. No. 36, Detroit, Michigan. No. 38, East View, New York. No. 39, Long Beach, New York. REDEMPTION OF THE DISABLED Departmental Base Hospital, Fort Sain Houston, Texas. Convalescent Hospital, Lawrenceville, New Jersey. Base Hospital, Camp Custer, Michigan. Camp Devens, Massachusetts. Camp Dix, New Jersey. Camp Dodge, Iowa. Camp Funston, Kansas. Camp Gordon, Georgia. Camp Grant, Illinois. Camp Jackson, South Carolina. Camp Kearney, California. Camp Lee, Virginia. Camp Lewis, Washington. Camp Meade, Maryland. Camp Pike, Arkansas. Camp Sherman, Ohio. Camp Taylor, Kentucky. Camp Travis, Texas. Camp Upton, Long Island, New York. The training of the blind in Braille and in various occupations is most efficiently carried out at Ever- green, U. S. Army General Hospital No. 7, Roland Park, Maryland. On January 20 there were 110 blind or nearly blind patients receiving treatment. Of these three were civilians who were blinded while employed in war industries in this country. Present informa- tion indicates that there are still to be returned from overseas approximately 90 more blind or nearly blind soldiers and sailors. The number of totally blind in the Army and Navy due to the Great War is approxi- mately 100. The deaf and those with speech defects are treated and trained in lip reading at U. S. General Hos- pital No. 11, Cape May, New Jersey. The training in lip reading and the correction of speech defects 12 Courtesy Carry On. TEACHING THE BLIND TO READ AND WRITE BRAILLE AT EVERGREEN, 0. S. ARMY GENERAL HOSPITAL NO. 7, ROLAND PARK, MARYLAND. THE BLIND SOLDIER IS BEING RETRAINED AS A PIANO TUNER Courtesy Red Cross Institute for Crippled and Disabled Men. RETRAINING THE BLIND AS MASSEURS, ST. DUNSTAN'S HOSTEL FOR THE BLIND, LONDON. THIS IS A PROFESSION IN WHICH BLINDED ENGLISH SOLDIERS HAVE BEEN VERY SUCCESSFUL PHYSICAL RECONSTRUCTION has been most satisfactory. The number of patients who have received treatment for defects of hearing and speech is 72, and the number discharged after satisfactory training up to January 4, 1919, was 48. On that date 24 remained under treatment. Approximately 3,000 of our soldiers and sailors have suffered from amputation of leg or arm or both. Soldiers with amputated arms or legs or both receive treatment until the stump is in satisfactory condition for the application of a provisional artificial leg or arm and are so trained as to be able to take care of themselves. Many of these men have received training and education, and special attention has been given to training the man with the lost arm to make the remaining member perform the duties of both. Ap- proximately 1,100 disabled soldiers with a lost arm or leg, or both, have been returned from overseas. On January 1, 1919, the number of tuberculous soldiers whose disability was designated as acquired in the line of duty, under treatment in the military tuberculosis sanatoria was 5,195. Application of curative work in the treatment of sick and wounded soldiers has been abundantly justi- fied. The curative work hastens complete restoration or as nearly complete as the nature of the disability permits. It improves the morale of the patient. It improves discipline. It encourages the disabled man to qualify himself for a future occupation, and is a decisive factor in inducing him to volunteer for the training the Government has provided through the Federal Board for Vocational Education, which is the subject of the following chapters. 13 CHAPTER I REDEMPTION OF THE DISABLED A SOCIAL OBLIGATION The soldier of democracy essentially a civilian — Complete restoration to pre-war civil status the nation's obligation toward its defenders — Eehabilitation, not charity, the new conception of national duty toward the wounded and disabled of war — Conservation of human capacities an enlightened social policy — Complexities of the problem of redemption — Diversity of disabilities — Disabilities rarely total but mainly special and relative — Continuity of redemption process from early convalescence essential — Occupational therapy — Compulsory vocational reha- bilitation impossible — Status of vocational education. Essentially the soldier of democracy is a civilian; only incidentally is he a soldier. In the emergency of war, of a war waged explicitly against the ideals for which democracy stands, the ideals of freedom and of civilization as opposed to the mediaeval conception of Kultur, civilian citizens of our democracy and of our democratic allies have been drafted out of their civilian pursuits, or have voluntarily abandoned these pursuits to take up for the duration of the war the trade of soldier or sailor. However efficient they may have become in their new trade, they have no intention or desire to stay in that trade after the war as professional fighters, even if there were opportunity for them to do so — and there will not be any such opportunity. When peace has been concluded, they will return eagerly to their civilian occupations, completely divesting themselves of their temporarily assumed character of warrior. What national duty confronts the democracies 14 REDEMPTION A SOCIAL OBLIGATION which called these men to national service for war out of every field of useful employment? It is written as plain as a pikestaff that the democracies shall restore their civilian defenders, so far as pos- sible, to their pre-war civil status, as regards capacity for "carrying on" in their old pursuits or in new pursuits for which they may be fitted. Many of these civilian soldiers after the peace will return to normal activities better fitted to pursue their former occupations than they were before enter- ing military service. The discipline, training and hardships of war will have developed character and capacities which under normal conditions might not have been developed at all, or at least not in the same degree. Amid all its ruthless devastation of human welfare, this single incidental benefit of war may be freely conceded — not in justification of war as a discipline for civil life, but in recognition of the social value of the capacity to struggle and win against the cult of barbarism so long as it persisted, against every enemy and obstacle to civilization. Others of the millions whom we sent overseas — happily, no great proportion of them — will not return. They are among the immortal "missing" or "killed in action." They have made the supreme sacrifice, yielding up their lives in the defense of our liberties. What fair claim in equity can we, who benefit by their sacrifice and have even required it of them, set forth in justification of our procedure? Why we should have been passed by and others elected to make this sacrifice will never be entirely clear. We who are the beneficiaries will be able to make no 15 REDEMPTION OF THE DISABLED sort of amend to those who are numbered among the missing and the killed in action. Their sacrifice is a finality. We and the generations after us, however ample our gratitude, will remain insolvent debtors to the end of time. Between these extremes, on the one hand, of the men who return fit and disciplined by war, and, on the other hand, of those who have made the supreme sacrifice, are the thousands of men who will return more or less broken, diseased and disabled. Our indebtedness to these men at least we may partially discharge. It is certain that in these first days, when our grati- tude is surging and seeking expression, they will be received back with open arms. Their disabilities, their mutilations and dismemberments will be badges of honor, inspiring respect and affection in their fellows — for a brief period. For a year, to quote a French mutile, the war cripple will be a hero; after that, for life he will be only a cripple. Does this sound unduly cynical ? Bear in mind that very soon, so far as the public is concerned, the war cripple will lose character as a veteran. He cannot wear his war record on hifl sleeve. In appearance he will become a one-legged, one-armed, one-eyed, blind, disfigured, or invalided man. With his handicap, if he is abandoned, he will inevitably drift into those unskilled, even mendicant, employments which have been traditionally reserved for cripples. Is it conceivable that this should be permitted, that 16 REDEMPTION A SOCIAL OBLIGATION we should allow the war hero to become a mere pen- sioner, or an inmate of a home for old soldiers, or a mendicant vender of pencils and shoelaces ? It is of course inconceivable that any such thing should be permitted purposely, with plain intent; but it is more than conceivable that it might happen without inten- tion, and it is certain to happen unless a conscious, determined, persistent effort is made to avoid such a discreditable, but entirely natural and easy, course of negligence on the part of the community, that is to say, the public, the state and the National Govern- ment, to the consequent degeneration of the disabled man. The men returning from France, many of them, will bring back into the walks of peaceful life dis- ablements of mind and body, but these shattered men, as well as those who return unscathed, will bring back with them also the same human interests, affections and desires that they carried overseas. They will enter upon the old paths with trembling limbs; they will reach out to pick up the broken threads of life with nerveless arms; they will resume all the responsibilities of life with decimated powers, disabled and handicapped in their efforts to provide for themselves and their dependent loved ones. What sort of obligation will rest upon the com- munity which has sent them forth to encounter every sort of peril and hardship in its defense and has broken and shattered their mental and physical capacities ? It is, of course, abhorrent to think that our civilian soldiers, having borne the brunt of our war, should be abandoned to their own enfeebled resources and 17 REDEMPTION OF THE DISABLED returned to their families as dependents and burdens. But it should be equally abhorrent to contemplate the idea that the community should rest content with any policy of pauperization or pensioning, however generous, that would provide simply for the keep of the disabled man during his advancing years. Stated abstractly, these courses are inconceivable, but the inconceivable has happened over and over again in the history of wars, and these very things are the natural consequences of the traditional policies of social provision for war veterans. They will certainly follow unless a new conception of the Nation's duty prevails against any traditional policy of drift, or sentimentalism, or mere material pauper- ization. In the following chapters is told the story of what has been undertaken and of what has been achieved for men disabled in the war by ourselves and the other belligerent nations acting under the inspira- tion of a new conception of national duty — a con- ception which in all these countries has triumphed over all remnants of conservatism and scepticism. The end and purpose of the new conception of the Nation's duty is complete restoration of the disabled and their reestablishment in civil life as self-respect- ing, useful, independent citizens. Any thought other than complete restoration, or as nearly as possible complete, is repellant. It remains cnly to determine fit ways and means of achieving this restoration. Our plain duty, it happens, is also our plain in- terest. The policy of restoration is the policy of conservation, applied in this instance to the most 18 REDEMPTION A SOCIAL OBLIGATION precious asset possessed by any community — the asset of human capacity. The craft skill, the pro- fessional training and the natural talents of the dis- abled man can be either conserved or scrapped, according as the man is helped or abandoned at the crucial time when he is seeking, under some strange handicap, to reestablish himself in civil life. No detraction of social motives is implied in the assertion that society is insuring its own best interests in conserving all the potential capacities in the human wastage of the war. For the disabled man, conservation of his powers means enjoyment of nor- mal life. It must be borne in mind that our drafted men are all "boys" — all young men in the prime of life, who may fairly anticipate many years of active, useful employment. For the community, conserva- tion of all the capacities of the disabled men is con- servation of the community's life, in so far as these thousands of young men enter into and cooperate in the various activities and interests of the community or the public at large, embracing the Government as well, municipal, state, and National. To train and educate for some useful employment is a social interest, a matter, if you like, of enlightened social selfishness, as much in the case of men disabled in the war as it is in the ease of the youth of the com- munity enrolled in our public schools. It is no dis- credit to one or the other line of education that it is socially as well as individually beneficial — that it is expedient and economic as well as equitable and con- sistent with all our feelings of human sympathy. It is most important that the emotional, vital powers, originating in the clear obligation resting 19 REDEMPTION OF THE DISABLED upon the community to insure in every respect the future welfare of the disabled soldier or sailor, shall be wisely directed; that it shall not be dissipated in futile coddling of the "hero," who will, if he be a hero in fact, find such coddling fulsome and offensive, but shall be utilized so as to aid the disabled man in escaping from every sort of dependence on charity. The greatest offense that can be committed against the disabled man is by unwise, misdirected charity to confine him in the ranks of charity wards. No self-respecting hero can contemplate with any interest or satisfaction a life of dependency, of fulsome sym- pathy, or of aimless vacuity. He will certainly elect rather a life of opportunity, of useful employment, and of service within such capacities as have been saved from the devastation of the battlefield. But can any workable, systematic policy of con- servation be devised which will in fact effectively con- serve and develop in individual cases such human capacities as have survived the impairments of war? Will it not be found that each case of a young man disabled will be in every respect quite individual and quite dissimilar from every other case? Are there any common factors in these thousands of indi- vidual problems in conservation and restoration that promote social action ? The individual diversities in the problem, the factors making any simple plan of training inapplica- ble to individual cases, are obvious enough. The number and the nature of the disabilities are in- numerable, and in any individual case the aggregate disability may represent any combination of injuries, 20 REDEMPTION A SOCIAL OBLIGATION mutilations, impairments of vital functions, and dis- eases. Under this multiplicity of disabilities lies an equally diverse multiplicity of natural capacities, of occupational and professional experience, or interests, of material resources, and of social status. Can any plan of restoration comprehend satis- factorily this diversity of disabilities, of experience and of outlook? Will it not be necessary rather to proceed without plans to do for each man what can be done for him, without any attempt at systematization or socialization of the work? In a sense the answer is "yes"; but in a much truer sense it is clearly "no." The unmistakable answer to any such query is to be found in the experience during the war of our allies — and, it may be added, of our enemies as well. Rehabilitation as a social, organized, systematized enterprise has been and is being undertaken by every belligerent nation, and it has been wonderfully suc- cessful in salvaging the htfman wastage of the war. The achievements of the belligerents are set forth in some detail in the chapters following, but some conclusions of this experience in the redemption of the disabled may be briefly summarized here. At the outset it should be realized that the disabled man is not necessarily a cripple, a one-armed or one- legged, a blinded, or even a disfigured or mutilated man. He is much more commonly a man who has recovered more or less completely from some wound, infection or disease, so far as further active medical or surgical treatment is concerned. But he has emerged from this treatment with impaired physique — with, it may be, a weakened heart, an infected 21 REDEMPTION OF THE DISABLED lung, a disorganized nervous or mental system, a stiffened joint, or a weakened muscle. For such a man the problem is not one of devising an artificial arm or leg which will do the work of a natural arm or leg. It is rather a matter of educat- ing the man in an occupation in which his acquired weakness and susceptibilities to disease will not prove to be real handicaps. Of such occupations there is in most cases a wide range from which to choose, and training for one of these pursuits presents in the case of the disabled man no greater difficulties than are encountered in the vocational training of normal individuals. Cases of this sort constitute a very large proportion of our rehabilitation cases. Each man so disabled will be directed into and assisted to master that vocation which, in the opinion of the physician and the vocational expert, he is best capable of learning and practicing. The gist of the matter is that disabilities, whether they be incurred in war or in industry, are not, ex- cept in comparatively few instances, absolute and total. In the great majority of cases they are rather special and relative to some given employment or group of employments. The one-legged man, of course, is incapacitated for two-legged pursuits, but when one surveys the whole field of industrial occupations, one finds that the number of two-legged pursuits is surprisingly small. The chances are preponderant that the man who loses a leg in the war will be able to resume his former occupation on the basis of 100 per cent, efficiency. In the few instances in which he cannot do this, he 22 REDEMPTION A SOCIAL OBLIGATION can be given a wide range of choice in electing for training a new occupation. The man returning with a weakened heart obvi- ously cannot resume an occupation that will sub- ject him to violent physical strains, but a wide range of other occupations in which no dangerous physical exertion will be imposed are available for election and training. Innumerable open-air pursuits are avail- able likewise for those whose disabilities indicate as dangerous close and continuous confinement in factory or workshop. It is not intended to suggest that all cases of dis- ability will present simple problems. The man who has lost a hand or arm, especially a right hand or arm, clearly presents a much more difficult problem in restoration than many other types of disability. In some cases an artificial member can be provided which will largely overcome, in the given case, the man's special handicap in his former occupation, a work hand or arm to be worn in the shop or in the field. But in every such instance the problem of training and placement will still require most care- ful and persistent attention. Fortunately, it is precisely the case of the man who has lost a hand or an arm or both hands or arms that has especially enlisted the interest of experts. In his behalf ingenious devices in the way of artificial members adapted to use in various occupations have been perfected, and to the solution of this most diffi- cult problem in restoration countless experts are un- tiringly devoted. In the work of vocational rehabili- tation for the armless and handless, the vocational expert can render service of inestimable value to the REDEMPTION OF THE DISABLED man so disabled. In his case also, as in other cases, the disability is special, not total, and it can be mitigated by scientific treatment and expert service in training for work. Total disability is the rarest accident in the war. The man who escapes death in the devastation of the trenches, in nearly every instance and however seriously disabled, will be a human being full of potential capacities for work. Certain pursuits, among which may or may not be numbered his former occupation, will be closed to him. His range of choice among pursuits may be wide or narrow, but in some employment, if it is chosen wisely and if he is trained intelligently, he can become 100 per cent. efficient. The obligation rests clearly upon society to make him so. Again, it has been amply demonstrated that the process of restoration, if it is to achieve the fullest measure of success, must be initiated early in the period of convalescence, and must be continuous and uninterrupted, sustaining the man with the inspira- tion of hope at every moment in his progress back from the front-line first-aid station, through the base and convalescent hospitals, on board the transport that brings him home overseas, and during hospital convalescence after his return, until his restoration, physical, functional and vocational, is completed and he is fully established in a suitable employment. Even then it will remain to insure his permanent success in the occupation upon which he has entered, and to safeguard him from victimization in case he falls into the hands of unscrupulous employers or in 24 Courtesy Red Cross Institute for Crippled and Disabled Men FRENCH BRUSH MAKER, BLINDED AND WITH RIGHT ARM GONE, WHO PURSUES HIS TRADE WITH A MECHANICAL WORK ARM AND OTHER SPECIAL APPARATUS REDEMPTION A SOCIAL OBLIGATION case he develops unsuspected disabilities for the employment chosen. The first days of recovery from the shock of cruel injuries, after the excitement of action has subsided, are days of despondency, or may be so if the man is left to brood over his condition, suffering the while the pains immediately incident to surgical and medi- cal treatment. In this critical period every effort should be made to inform and inspire him. He should be told of the provision made for his complete restoration, and its realization should be initiated at the earliest moment possible. Needless to say, during the whole period of con- valescence the man's recovery will dominate every other interest, but it has been found that recovery itself can be facilitated, even in the early stages of convalescence, by the therapy of work. This therapy is a logical development of the universally employed therapies of massage, of passive and of active muscu- lar exercises of parts, and of bedside and curative- workshop occupations. Occupational or vocational therapy introduces the wonderfully curative anti- toxin to hospitalization. The patient feels the in- spiration of the appeal to begin his training for future usefulness, and he responds to that appeal eagerly. Under this inspiration the torn muscles and nerves unconsciously resume their normal functions, and, in many cases at least, much more rapidly than they would under any purely therapeutic treatment, provided always that the physician is at hand to in- sure complete cure and to check dangerous experi- ments with work. Treatment will merge into training during con- 25 REDEMPTION OF THE DISABLED valescence, and after convalescence training will merge into work. The patient will not be subjected to the demoralizing influences of idleness during pro- tracted periods of convalescence. As his recovery progresses, he will be given an employment he may safely undertake and such employment only as will facilitate his cure. When his active treatment has reached finality, his vocational training will be con- tinued also to finality, and he will then be established as a productive worker in the community. Strictly vocational training may be given in some existing technical school or in some special school established by the Government, in a workshop or office or on a farm under some agreement with em- ployers regarding training, wages, hours, and em- ployment after training, or in any other way that may seem best on consideration of the individual case. But the whole process of restoration must be continuous and uninterrupted. No period of aban- donment or idleness during or after treatment must intervene, for reclamation of the man who has lost ambition to work is much more difficult than the restoration of the physically disabled. And if the disabled man rejects the proffer of restoration to vocational competency, shall he be com- pelled for his own welfare to take it, or shall he be let go, freely, "on his own"? The answer is that training under compulsion, more especially, training under military discipline, cannot be enforced, even if it were desirable, as it is not, that it should be under- taken. Men who cannot be brought to realize its value will be released, but the door will be held open 26 REDEMPTION A SOCIAL OBLIGATION for their return after they have encountered the opinion of the public and of their families. They may return at any future date for the purpose of taking such training as may be approved for them and by them. Training under compulsion, if it is ever wise, is inconceivable for these men of mature years. They must enter into training freely, of their own election, and it is just this condition of success- ful rehabilitation work that makes it vitally essential that the disabled be fairly informed during con- valescence of every opportunity open to them, and of the achievements of their fellows who have triumphed over every sort of disability. It may be conceded that some men will elect un- wisely, that some will neglect their opportunities to their own detriment, and that some may sink into nerveless dependency. But, on the other hand, it may be anticipated confidently that a great ma- jority will elect wisely, and it is a fact which cannot be avoided that compulsion, where any attempt has been made to enforce it, except under very excep- tional conditions which will be noted later, has failed. The process of "civilization" must be divested of every aspect of militarization. The training for civil employment must be presented as an opportunity, not enforced as a military service. The process of mak- ing a civilian out of a soldier must be under civilian control, even as the process of making a soldier out of a civilian must be under military control. At this stage in educational progress it is quite unnecessary to undertake any general defense of vocational education. Vocational training has estab- 27 REDEMPTION OF THE DISABLED lished itself in our educational system. It has won over to its support a large proportion even of con- servative educators and school men, who, in its initial stages, regarded it with misgivings and suspicion. It has won out with the rank and file of labor and with labor organizations, which also have regarded it in the past with some suspicion. It has won out with employers, and, finally, it has won out with the public as a whole, as is evidenced by the fact that Congress has appropriated large sums of money to be expended from year to year for the promotion of vocational education in the public schools. That which has been provided out of public funds for the normal worker, to whom the Government is under no especial obligation, certainly cannot be de- nied to the disabled soldier or sailor, whose disability constitutes a very special claim which cannot be avoided. The duty resting upon the whole com- munity, a duty which will be eagerly performed pro- vided it is once clearly comprehended as a duty, is to "see the disabled man all the way back to his pre-war civil status." This policy of complete restoration is dictated by every consideration of simple equity. It is a policy of conservation directed against the human wastage and devastation of war, a natural, enlight- ened, human reaction against that wastage. And incidentally, as compared with the policy of maintain- ing the disabled man in a condition of idle de- pendency, or of abandoning him to drift into mendi- cant pursuits or into a charitable institution as a ward of the state or of private charity, the policy of complete restoration is the policy which costs the community least. Above all, it is the policy which 28 REDEMPTION A SOCIAL OBLIGATION will establish the disabled man as a self-respecting, self-sufficient, independent citizen among fellow citizens. Compensation will be given to all according to their disabilities, but the new conception of the commun- ity's duty embraces much more than the payment of pensions. It embraces complete restoration, or restoration as nearly complete as can possibly be achieved by the expenditure of public money, by the utilization of every existing public agency, and by the development of such new agencies as may be required. 29 CHAPTER II HUMAN WASTAGE UNDER THE PENSION SYSTEM The tide of our pension expenditures still rising — Appropria- tion for 1918-19 a new high record — Total pension expenditures of nearly five and one-half billions — The pension roll of soldiers and widows — The monthly allow- ances— Inmates of Soldiers' Homes — Pensions inade- quate to discharge of the Nation's debt to its defenders — Their welfare insured only by economic rehabilitation — Needless wastage of human capacities the lingering blight of previous wars — The programme of rehabilitation. In the rising tide of pension expenditures in the United States, the '' crest wave'' of one year has been speedily overtopped by succeeding crest waves, which have continued to roll in, year after year, mounting ever higher in the face of insistent prediction of subsidence to lower levels. The tide which set in after the Civil War has been steadily making, and even after half a century it is doubtful if the turn has really begun. The following excerpt from the Congressional Record of June 19, 1918, tells its own story of the last record-breaking roller: There being no objection, the Senate, as in Committee of the Whole, proceeded to consider the bill [the general Pension Appropriation bill for 1918-19] which had been reported from the Committee on Pensions with an amend- ment. The amendment was, on page 2, line 1, to strike out " $185,000,000 " and insert " $220,000,000," so as to make the bill read..... The amendment was agreed to. The bill was reported to the Senate as amended. 30 WASTAGE UNDER THE PENSION SYSTEM It was brought out in the few minutes' considera- tion given to the amendment that the new amount was higher by $12,000,000 than the pension appro- priation had ever been before, that it included a deficit for the preceding year of $23,000,000, but that even without this deficit it was still the highest in the history of the Government. Doubt was ex- pressed as to whether there would ever be another general pension bill for Civil War veterans, and it was stated that "next year" pensions would de- crease "at least 15 per cent., and perhaps 20 per cent." In regard to these statements one Senator commented as follows: I do not think it will be the last general pension bill for . Civil War veterans. I remember, a number of years ago, reading the statement of President Garfield. He stated that when the pension roll reached the maximum of $27,000,000 — the Senator from Ohio corrects me and says it was $35,000,000, but the statement which I saw attributed to him the sum of $27,000,000 — it would recede, and that would be the highest crest of the wave. With a pension bill of $220,000,000, it merely illustrates what a poor prophet the great President Garfield was. It illustrates, furthermore, that the further we recede from the period of that great strife the larger the pensions and the heavier the drafts made upon the Treasury of the United States. The amendment was agreed to, and the bill as amended was read a third time and passed. A little over one column of the 50 columns in which the pro- ceedings of the Senate on June 19 are reported in the Record comprehends the report of the bill, the text of the bill as amended, the reported discussion on the amendment, its passage, and the passage of the bill. Pension appropriations have become more or less 31 REDEMPTION OF THE DISABLED routine and the passage of such legislation through Congress can be expedited. Disbursements for pensions in the period of 52 years (1866-1917) since the close of the Civil War have totaled over five billions, approximately, $3,- 119,000,000, to which must be added $133,000,000 to cover the cost of maintenance of the pension system, making a grand total of $5,252,000,000. With the appropriation for 1918-19 the amount is approxi- mately five and one-half billions. The total amount paid in pensions from 1790 to 1917 is $5,216,000,000. Of this amount $70,000,000 represents the Revolu- tionary War; $46,000,000, the War of 1812; $14,- 000,000, Indian wars; $51,000,000, the war with Mexico; $58,000,000, the war with Spain and in the Philippines; $59,000,000, the regular establishment and unclassified; and $4,917,000,000, the Civil War. With a few years of inconsiderable temporary re- cessions, the number of pensioners on the rolls increased from 126,732 in 1866 to 999,446, or prac- tically one million, in 1902. In succeeding years the number fell off to 673,111 in 1917. In this latter year expenditure for field and special examinations amounted to $79,503, and for fees and expenses of examining surgeons to $35,627. Among the "interesting facts" reported by the Commissioner of Pensions for the year ending June 30, 1917, are the following: Civil War soldiers on the roll, June 30.......... 329,226 Civil War widows on the roll, June 30......... 284,216 The largest number of Civil War soldiers on the roll was in 1898.......................... 745,822 32 WASTAGE UNDER THE PENSION SYSTEM The largest number of Civil War widows on the roll was in 1912.......................... 304,373 Employees of the Bureau of Pensions at begin- ning of fiscal year 1917-1918.............. 1,115 Amount of fees paid to attorneys, 1917......... $100,554 An Act of 1916, among other provisions, provided a pension for any widow who had married a soldier or sailor with the requisite service record prior to June 27, 1905, extending the former date limit 15 years, from June 27, 1890. Under this Act, to June 30, 1917, 6,147 original pensions had been granted to widows who had married soldiers in the years 1890 to 1905. In the year ended June 30, 1917, the Mail and Supplies Division of the Pension Bureau received 117,552 applications of all kinds, of which 98,759 were accepted and classified as formal applications. Most of these, of course, were applications for in- creases under the various laws of Congress, but dur- ing the fiscal year ended June 30, 1917, original first payments were made to 299 Civil War veterans under Acts of 1907 and 1912, and to 16,915 Civil War widows under Acts of 1908 and 1916. Under these Acts cases of first payment of increases and reissue in the course of the year numbered 48,641 to veterans and 113,114 to widows. Exclusive of those of the war with Spain, original claims to pensions have been allowed since March 4, 1861, to the number of 1,180,164. During the fiscal year 1917-18, 25 omnibus pension bills were passed by Congress, granting pensions or increases of pensions in 4,178 individual cases. This special pension legislation, of course, deals with cases 33 REDEMPTION OF THE DISABLED for which grants or increase of grants are not pro- vided by the general laws. The average annual value of Civil War pensions in 1916-17 was $247.71, or $20.64 per month. The number running at $20 was 171,574, and the num- ber running at lower amounts, ranging from $6 to $19.75, was 206,832, including 133,642 running at $12. Larger pensions included 228,424 running at amounts ranging from $20.36 to $30, and approxi- mately 5,000 at higher amounts. An Act of June 10, 1918, amending the pension laws of the United States, raised pensions to Civil War veterans, paid under the Act of May 11, 1912, and running at amounts of less than $30 per month, to $30 for soldiers and sailors of any age who had served 90 days or more during the Civil War; to $32 per month for those aged 72 and over who had served six months; to $35 for those who had served one year; to $38 for those who had served one and one-half years; and to $40 for those who had served two years or more. These automatic increases are granted without application to veterans receiving pensions under the Act of May 11, 1912. Others eligible under this Act must qualify by application. Approxi- mately 268,000 veterans will receive pensions or in- creases under the new Act. Finally, it is reported by the Commissioner of Pensions that the number of inmates of the United States Soldiers' Home, St. Elizabeth's Hospital, and the various branches of the National Home for Dis- abled Volunteer Soldiers was 17,973 in the last quar- ter of the fiscal year ended June 30, 1917. In so far as the vast sums disbursed in pensions 34 WASTAGE UNDER THE PENSION SYSTEM have insured the welfare of our war veterans in the past, the expenditure may be justified. Men dis- abled in the war just ended also will be fairly entitled to compensation for disabilities incurred in the National service. In every war this lingering cost must in all fairness be paid in full, and the com- munity most certainly will not seek to avoid it. In providing for disabled veterans of the Great War the ruling consideration will be, not economy, but insurance of welfare. No expenditure, however great, provided it confers benefits upon the deserv- ing, will measure the community's obligation to its defenders. But pensions are not the chief means of insuring the veterans' welfare. Disabilities cannot be commuted into money payments. No compensa- tion or pension under any schedule, however liberal, can be regarded as payment in full. It is at best a pitiful recompense for the loss of a leg or an arm or an eye, or the impairment of some vital function by disease. Something more is clearly required, namely, such training and placement in industry as will largely eliminate the handicap of the disability which cannot be paid for or completely remedied. Confronted with our pension record, one cannot conclude that our veterans of previous wars have been overpaid for their services or that too ample incomes have been provided for deserving dependents. An income of $20 a month obviously has been quite in- adequate to maintain a decent standard of living, and even $30, the maximum amount for the great mass of our pensioners even under the recent Act of June 10, 1918, will not maintain a standard approaching that of the humblest of our unskilled laborers. And 35 REDEMPTION OF THE DISABLED what shall be said of the 133,000 pensions that have been running at $12 a month ? It will hardly be maintained that the pensions ranging from $6 to $30, as they have been designated in individual cases, have measured exactly, or even approximately, the individual disabilities incurred directly in war service or indirectly in consequence of such service, or even that they have been so ad- justed to present wage-earning power under any Acts of Congress as to insure decent standards of living. They measure rather simply the liberality of Con- gress, dispensed under general and special legislation. Such consideration as has been given to individual cases has regarded the individual's need rather than his capabilities. Congress has undertaken to pro- vide for these needs, has appropriated vast sums for the purpose, but the needs have persisted and have developed cumulatively from year to year. It is at least open to question whether the needs have not developed more or less directly as a reaction upon the pension system itself, and leaving out of account the undeserving cases, it is quite conceivable that many a worthy veteran would have fared better if he had been thrown entirely upon his own resources. Certainly he would have fared better if the Govern- ment, instead of resorting to the easy palliative of a pension grant, had undertaken to develop his capaci- ties for self-support, and had retrained him and placed him in the way of earning a livelihood imme- diately upon his discharge from the service and before any habits of hopeless dependency had become fixed. Such a programme also undoubtedly would have avoided a large portion of the financial burden which 36 WASTAGE UNDER THE PENSION SYSTEM has cumulated in the deferred granting of pensions, and the whole cost of providing for our Civil War veterans would have been much less than it has been in fact. It is precisely this wastage of human capacities for self-support and for living a normal, happy life that has constituted the real wastage of our wars. Pen- sions do not and cannot in any degree measure this wastage, nor can they neutralize it, since it is absolute and final. The pension, if it is fairly determined, simply assesses a portion of the loss upon the com- munity as a whole, by making some scant provision for the disabled man, commuting some portion of his disability into a money compensation, instead of removing and eliminating the disability itself. So long as the disability persists, the wastage is cumu- lative from year to year for the veteran and for the community, and as mortality gradually reduces the roll of pensioners, the community must write off as absolute and irreclaimable losses the cumulated wastage of lives which, although they have been capa- ble of rendering every useful service, have been never- theless dragged on in avoidable indigence. This wastage cannot be measured, even for the indi- vidual whose full record as a pensioner in the com- munity is opened up for analysis and estimate. For the individual, the loss of capacity, the gradual sub- sidence into dependency and the dissolution of am- bition which inevitably result from the experience of charity in place of stimulation of effort to become self-sufficient — this wastage of all the potentialities of a happy, normal life transcends measurement. For the community in a much greater degree the loss 37 REDEMPTION OF THE DISABLED of potential usefulness of hundreds of thousands of its citizenry over a long period is a loss the aggregate value of which transcends every scale of measurement. These potentialities are altogether too complex to be simply summed up. The wastage is a mortal blight, a protracted mortality, to which its victims succumb, not on the battlefield or in the base hospital, but only after years of increasing indigence. It is the purpose of the programme of rehabilita- tion, as that programme has been formulated in the belligerent countries of Europe and America, to avoid this lingering blight of war, the incalculable wastage of capacities for welfare, independence and happi- ness which in other wars has been added to the un- avoidable sacrifice of lives on the battlefield; to re- gard, not merely the needs of the disabled, but rather chiefly his unimpaired capacities for usefulness; and to train and develop those capacities so as to insure reentrance into civil life under conditions that will inspire in the disabled man well grounded confidence that he can "carry on" to the end for himself, for those dependent upon him, and for the country which summoned him to its defense against the onslaught of barbarism. 38 CHAPTER III THE NATION's DUTY TOWARD THE INDIVIDUAL Individual self-respect a national asset — Charity the old con- ception of national duty toward the disabled of war — Evil effects of the pension system — Eestoration and restitution the new conception of the Nation's duty — The Nation the soldier's debtor — Disability compensa- tion— Vocational reeducation of the disabled. Perhaps the most universal trait of human nature is the sense of individuality, independence, and con- sequent pride in the possession of either faculties, abilities, or property. "A poor virgin, an ill-favored thing, sir, but mine own," Shakespeare makes Touchstone say of the wench Audrey, as illustrative of this spirit. It is egoism which is responsible for the advance- ment of individuals. Where individuals are offered the greatest advantages and the least obstacles, they naturally develop into a self-respecting, self-support- ing, home-owning community. Such communities collectively constitute the states, as the aggregation of states constitutes the national entity. This egoism has many healthy manifestations, but none more so than the individual's sturdy belief in his potential capacity for equality with other men, or for superiority where it can be attained by skill in a trade, ability in a profession, success in business, or the like. The desire for possession and position is but another manifestation of it, and the spirits of emulation, competition, and leadership are similarly 39 REDEMPTION OF THE DISABLED grounded. The logical sequence is community pride and civic spirit as the collective reflection of indi- vidual aspirations and achievement. Such a spirit wise Governments foster, for its growth is into national consciousness, love of country, and readiness for service for the public good in peace as well as in war. It is the spirit that, convinced of the righteousness of national aims and aspirations, leaps forward to maintain them even by charging the cannon's mouth. Every man who is independent, therefore, is a self- respecting man, self-confident and secure in his right of road toward the attainment of his own individual development. In this respect he is a pillar of strength in his own community, not only in his own individual capacity, but no less so as an example and stimulus to others. So long as he has the right to hope, the incentive to strive, and belief in his ability to attain at least a measure of his aspiration, he is a valuable citizen. On the other hand, if a man is bereft of pride, made to feel inferior to his fellows, kept conscious at all times that he is of markedly less value and standing than others, either economically or socially, he is in precisely the same relative position in his community as a broken thread in the warp of a fabric. The broken thread lessens the value of the whole piece intrinsically, as it lessens its strength and wearing quality, and it is a defective community that main- tains as an integral part individuals who occupy the position of the broken thread in the cloth. If the feeling of inferiority is fixed upon the man by public action that recognizes and brands him as 40 THE NATION'S DUTY inferior, the state of affairs is abnormal and un- healthy not only for the man, but for the community that acquiesces in a situation which ought not to be permitted. The direct evil is by no means limited to the man himself. His family is touched by it, and made to feel that they are participants in the low and inferior status of father or brother, tolerated on sufferance rather than considered in full fellowship of responsibility and of opportunity. Among the several causes of the condemnation of individuals to positions of inferiority, misdirected charity is chief. Individuals have been guilty of it, and communities, states, and finally, the greatest offender of all, the Nation itself. The traditional national policy of war pensions, which has worked incalculable harm, is revealed, in the light of recent developments, as a ghastly mistake. It may freely be conceded that the Nation and the several states have been doing what they thought was right. Indeed, there appeared, perhaps, nothing else to do. In all the tide of time the course of nations has been to dismiss the fighting man when he became disabled and of no more use as an offensive or defen- sive unit. No one seemed to think of anything else for him except a pittance of a pension, invariably calculated only to prevent actual starvation. America alone went farther, and established Soldiers' Homes for the helplessly disabled, or at least for those who had no relatives upon whom the main burden of car- ing for these wards of the public could be saddled. Then we rather preened ourselves upon our generosity. The public attitude had its reflection first in the pension laws — idle indigence in public homes for 41 REDEMPTION OF THE DISABLED disabled soldiers, or insufficient pensions and, in many instances, equal idleness outside. There were many disabled soldiers who had nothing besides their pen- sions to live upon — unless they had relations. The soldier himself, in many instances, had a mistaken notion that he should not be expected to do anything toward his own support. The public acquiesced, and he became a sort of ward of the community. He was given sinecure jobs at small pay. As time went on, many of these men became small office holders and chronic office seekers. They were poverty-stricken, and they and their families endured many hardships on account of loss of earning capacity and insufficient pensions from the Government. Not only did the maintenance of these men as indigent incompetents have an evil effect in itself; it caused bitterness in the hearts of the men and of their dependents. There was resentfulness — the feeling that the Nation had poorly requited a volun- tary sacrifice for its good. And there was the in- evitable forgetfulness on the part of the public that their disabilities were acquired on behalf of that same public which now regarded the men merely as poor or indigent individuals and no longer credited their account with a duty well performed. This in itself has had a bad effect, for it has lessened the national eagerness for national service. "Republics are un- grateful," is a common remark, and the illustration has been to point to the treatment of the veterans of our wars and their unhappy condition. There has come about, however, a new conception of the proper attitude of the community, the state, and, finally, the Nation toward men who have become 42 THE NATION'S DUTY disabled in the common defense. It is a radical change from the old idea of charity for men who had lost their economic independence by reason of willing- ness to face the enemy for the common good. The new and enlightened conception is that charity does not enter into the matter at all. It is a complete reversal of the previous conception. From the old viewpoint the injured man was held to be a poor mendicant, entitled to some small recognition from the Government, which, although it was a thing apart from, and over and above and beyond him, neverthe- less consented to bestow a gratuity upon him. The position now is that it is the Government who is the debtor and the injured man the creditor — not as one apart, but as a component unit for whom too much cannot be done. With this new idea and ideal has come a new sense of national duty toward the disabled man. The obli- gation is now held to be restoration and, as far as possible, restitution. The man was called from his peaceful vocation to serve for the common good. His ability to support himself has suffered permanent im- pairment by reason of that service for the public, and his loss is a debt which the public, or the Nation, must discharge. This can be done most fully by restoring him, as far as possible, to the condition he was in prior to his entrance into military service, or if it can be done to a better condition. He is given a "compensation " instead of a "pen- sion," the latter term implying a semi-mendicancy which has been abolished. The compensation is arrived at from abundant actuarial data showing the loss in earning capacity the average man suffers from 43 REDEMPTION OF THE DISABLED certain disabilities or combinations of disabilities. All men with similar disabilities fare alike as regards disability compensation. In theory, this compensa- tion is to equalize the injured man between his dis- abled capacity and what he would otherwise have been able to earn. In fact, it does not do so, but there was no other way to arive at a means of dealing equally and equitably with all injured men except on the basis of averages. To do otherwise would be to reopen the Pandora's box of evils and scandals of private and partisan pension legislation, from which the country has suffered so greatly in the past, and still suffers, with a host of undeserving beneficiaries absorbing millions of dollars from the public treasury. The Government, realizing that equal treatment under the compensation law was bound to produce some measure of inequality in individual cases, next proceeded to furnish the man himself with the means of counteracting his individual loss by so educating him that there would be absolute equality of oppor- tunity among all who had suffered impairment for the Nation's sake — in other words, that each man would be put in a position to utilize to the utmost the capabilities remaining to him. The effect of the combination of disability com- pensation and vocational reeducation is, in the ma- jority of cases, to restore the man to civil life in a better condition as regards income and prospects of progress and development than he was before he donned a uniform in response to the call for national service. The further effect is that there will be no more semi-mendicant veterans, exhibiting their wounds and craving compassion and help; the dis- 44 THE NATION'S DUTY abled of this war will help themselves. There will be no more pensioned men in semi-charitable jobs; the redeemed disabled will be given regular pay for regular and efficient work. There will be no more burdens on the communities; for these men will pay their taxes and bear their share of whatever other burdens the community may have to shoulder. True, these men may be minus an arm or a leg or deficient in health in one way or another, but these things will be merely incidents of their individual make-up and no more the cause of economic insufficiency than the color of hair or eyes or any other purely personal characteristic. It is a healthier state of mind for the communities and the Nation to be in. This modern conception of the Nation's duty to the individual who serves it is bound to have its reaction in a finer sense of obliga- tion and responsibility of the individual generally toward his Government, and this in turn will serve as a basis for a heightening of the ideals of govern- ment. 45 CHAPTER IV WHAT THE BELLIGERENT NATIONS HAVE UNDERTAKEN The State's regard for the individual enhanced by the war — Eestoration of the disabled a national policy of all the belligerents — Economic value of the disabled — Restora- tion policy of the United States — Inclusion of the dis- abled of industry — Evolution of a new social policy — Its further possibilities. Never in all the roll of years has the individual citizen been so much the object of regard and solici- tude on the part of his Government as since the Great War began; nor has there ever before been exhibited such paternal interest in the welfare of workers generally in all lines, and particularly in those related to the vast and complex industry of making war. Nations have awakened suddenly to the actual truth of the saying that the very founda- tion stones of a country are its men. Consequently there has been a hurried shifting of position in every belligerent nation to conform national conduct with the new conception, not only in the attitude of in- terest toward its men before throwing them into the maelstrom of conflict, but also in the development of salvage and conservation for those who emerge, even though they may be useless for the battle line. No other war has approached this in magnitude of requirements of men for actual fighting in the field or of material necessary properly to munition and supply them. The truth early began to dawn upon the Allied peoples that it was to be a struggle to the 46 WHAT THE NATIONS HAVE UNDERTAKEN death for national existence and development against a crafty, powerful foe who had emerged from the nebulae of nations as a warring, plundering, aggres- sive, unscrupulous tribe, and who had held through its history the same ideals ever since Caesar thrashed Ariovistus and drove his rapacious hordes back across the Rhine from the very fields from which the Allies have lately ejected descendants of those same Teutons. The Allied nations at last came to the proper conception that it would be a war of exhaus- tion; the uttermost effort of each was required, and the cause upheld by the most resources and reserves of industrial strength was ultimately to triumph. A movement which started originally as a private, patriotic effort on the part of a few individuals to extend charity to scattered and destitute disabled soldiers has became in the short space of three years the policy of nations, but not with the same object in view. The belligerent nations speedily developed the broader and the correct view, which is, primarily, justice to the disabled man. It was suddenly found also that this conception coincided with the best in- terests of Governments. The demonstration was complete and overwhelming that an enormously potential reserve of strength had previously been overlooked by the Governments, and that their disabled soldiers were full of essential values hitherto unsuspected. It became clear that these men were of quite as much use, disabled and retrained, as they were before they suffered in- capacitating injuries, and in many instances became of more real value to the State. A disabled man was able, after undergoing training, to take the place 47 REDEMPTION OF THE DISABLED of an uninjured man engaged in some essential phase of war industry behind the lines, thus adding enor- mously to the strength of the nation by providing entirely unexpected and unlooked-for reserves of vital resistance. Instead of being put out of action and discarded as a unit of strength to his country, the disabled man was replaced in the front lines by a fresh, uninjured man, and at the same time the place of the uninjured man behind the lines was taken by the disabled soldier. The process of restora- tion multiplied the fighting ability of the nation. It was also recognized by the belligerents that by the addition of a considerable body of men trained in trades, industries and processes, even though not im- mediately related to the business of making war, the industrial life of the nation would be maintained to a larger extent than would otherwise be possible, and that, this being true, at the conclusion of hostilities the transition from a war to a peace basis would be a less violent reaction. These disabled men, made over into skilled artisans, mechanics or experts in the hun- dreds of other occupations requiring a trade or tech- nical education, would also replace in large measure the loss to the nation of men in those lines who had been killed outright or died of wounds or disease. Thus, by having its trade, manufacturing and busi- ness strength reinforced for the critical period of industrial and commercial readjustment at the end of the war, the nation would be in better position as regards reconstruction and the resumption and re- covery of business would be accelerated. So it be- came apparent that by the retraining of the disabled, every man thus taught successfully was transformed 48 Courtesy Red Cross Institute for Crippled and Disabled Men. A FRENCH CARPENTER WITH LEFT ARM GONE IN TRAINING TO RESUME HIS TRADE AT THE PARIS ECOLE DES MUTILES WHAT THE NATIONS HAVE UNDERTAKEN from a liability into an economic asset. Instead of being an idle consumer, each man returned to earning ability would be a contributing unit to the national wealth in proportion to his productive capacity — in no wise a dead weight, as the disabled of other wars have always been to some extent, on relatives, com- munities or the national purse. None of the Allied Governments has allowed the vocational reeducation and subsequent restoration to earning ability of the disabled man to affect in the least the amount of pension or disability compensa- tion allotted to the individual. In the United States the compensation has been calculated strictly as a casualty-insurance problem, on the basis of the ex- perience of most of the accident-insurance companies operating in the country. The method of awarding disability compensation was arrived at months before provision was made for vocational retraining, and the amount of compensation or "pension" a man receives is absolutely unaffected by any earning power the disabled man may be able to develop through retraining. The latter is entirely gratuitous, and additional to any monetary compensation for dis- ability paid by the Government. Aside from these very material benefits provided by the Federal Government, a great forward stride was made in the new conception of what is due the man disabled through service for his country. The con- clusion that restoration as nearly as possible to the status quo ante helium is a matter of justice, not charity, marked a distinct advance in national ideals and in the proper conception of individual rights. The provision of machinery to carry this conception 49 REDEMPTION OF THE DISABLED into effect involved a species of paternalism which must have caused a rapid "turning movement" in the graves of the earlier statesmen of this Republic to whom all forms of paternalistic government were anathema. But just as benevolent despotisms have been known, so has the United States Government become democratically centralized in order to carry out its programme of benevolent justice to a class of its citizens. The project was given unanimous ap- proval by men of all shades of political thought and theory; the measure providing for it passed the Con- gress without a dissenting vote, and it has been rati- fied by the universal approval of the citizenry. This first step, whereby the physically disabled by war are restored to civil usefulness, has led to the inevitable conclusion that if the war disabled are so abundantly worth salvaging, those similarly disabled by the industries of the country are equally so. The Congress now has before it legislation providing for the extension of vocational rehabilitation to the more than 50,000 disabled men of working age who com- prise the average toll of our industries every year. The project is backed by the Administration, by all organized labor, and by practically the same unan- imous approval of the lawmakers that passed the original rehabilitation bill. Thus, in the short period of less than four years, conservative democracies have turned into conserv- ing democracies a change which probably fifty years of slow progress under peace conditions would not have accomplished. The State has already be- come humanized to an unthought-of degree. The demonstration has served and is serving as a quicken- 50 WHAT THE NATIONS HAVE UNDERTAKEN ing impulse all over the world. The people are learning the great lesson that the welfare of the in- dividual is no longer a matter of indifference to the multitude or to government, but that that government is most effective which is most interested in the units composing the body of which it is merely the repre- sentative. A closer supervision will be required in future that its members may have larger equality of opportunity, and restoration of opportunity when it has been lost. Nearly all of the belligerent nations have become thoroughly awake to the importance of the economic redemption of their disabled; the more representa- tive the government of the people, the more effective these measures have become — the broader scope they have taken of usefulness. The evolution from chance charity to private system, then to State-fostered activity merely to utilize again the disabled, then to national policy founded upon justice, and finally to the recognition by peoples and Governments that all disabled are soldiers of the common good, whether in war or industry, and are equally entitled to be sal- vaged and restored to opportunity to earn and work, is an amazing development. It is no less amazing in its further possibilities, which a very few years ago would have been scouted and rejected as impractica- ble and Utopian, but which today are considered gravely as the next steps in the newly blazed trail through the wilderness of selfishness. What may be the further extension of the idea, and what may evolve out of it, no one can say, but it is an attractive field for speculation. As vocational re- habilitation of the disabled is largely a matter of 51 REDEMPTION OF THE DISABLED diagnosis and physical adaptation of the injured man to that occupation for which he is best fitted, and then of providing the means for training his remain- ing capabilities to function to their full value, the possibilities of extending this system of diagnosis and industrial or civic adjustment are vast. If the diagnostic and adaptive process is so successful with men whose disabilities are mainly physical, is it too great a stretch of the imagination to vision the day when economic misfits shall be passed upon by much the same sort of system ? Is not a misplaced man an economic cripple? What readjustments may not be possible when each man can be more nearly fitted into the particular niche in life in which he can work with most effect, accomplish most with greatest happiness, and be of greatest value not only to him- self but to society in general! With accumulated experience might not the system be carried further to prevent the misfits as well as to readjust them — to direct education and development of the young along the lines of their manifest destiny, tastes, talents, inclinations and desires, instead of following the present utterly haphazard method whereby the development of the citizen is almost entirely a matter of chance, environment and circumstance? No one can say where the system will lead, but the evidences we now have are that its results will be good for humanity. 52 CHAPTER V THE PROBLEM OF RE-EDUCATION Probable number of disabled men requiring reeducation — American casualties in the war — Experience of Great Britain and Canada — Eyesight cases — Amputation cases — Surgical cases a comparatively simple problem — Medi- cal cases most complicated and troublesome — Placement and supervision of reeducated men — Placement of dis- charged men in their former occupations — Programme of the Federal Board for Vocational Education. Statistics from all available sources, particularly those from British and Canadian experience, give some dependable idea as to the magnitude of the problem that would have confronted the United States in the reeducation and placement of its disabled soldiers and sailors had hostilities not come to an unexpectedly early end. These figures are the result of about four years of warfare. They include the casualties of open or field activities, trench fighting, and the swing back to open operations again. They comprehend about the whole range of military activi- ties as at present developed, and they may be regarded as very fairly indicative of the ratio of retraining cases with which the United States will be compelled to deal. From the average obtained from the various bel- ligerents, the figures show that for every million men mobilized, 10,000 annually will be subjects for voca- tional reeducation; that is to say, 10,000 men will be so severely injured that they will not be able to return 53 REDEMPTION OF THE DISABLED to their former callings or trades, and needs must be reeducated by the Government to fit them to make use of the capabilities remaining to them after passing through the hospitals and being cured as far as it is possible for medical and surgical science to cure them. This problem of reeducation should not be confounded with that of the men who are merely wounded. There will be thousands of others who will be severely hurt, but not so disabled as to compel them to take up a different means of gaining a liveli- hood from that which they followed prior to going into the Army. Not all of these casualties are the direct result of actual warfare. War has been classed as "the most hazardous of trades." Still, among three million people in the United States, even in the regular and beaten paths of ordinary life, there is normally a total of serious accidents running into the thousands every month. Transplant three million men into an entirely different mode of living, into a life of violent and constant action amid surroundings entirely un- familiar to most of them, and even in the midst of profound peace there would still be a large number of accidents. Add to that situation the constant handling of deadly weapons and explosives, the use of motor trucks and the perhaps more deadly "Gov- ernment mule " as a large part of motive power, and it will be seen that absolute accidents of themselves will contribute largely to the casualty list. The sudden termination of hostilities, of course, has reduced the magnitude of the retraining problem very greatly. General Pershing cabled on February 2, 1919, that the total American casualties to that date 54 THE PROBLEM OF RE-EDUCATION were 311,349, including missing and prisoners. The figures were: Killed in action (including 381 at sea). 30,978 Died of wounds..................... 12,904 Died of disease...................... 18,774 Died of other causes................. 2,701 Wounded......................... 229,326 Total......................... 294,683 Wounded, severely.................. 94,122 Wounded, degree undetermined....... 43,168 Wounded, slightly................... 92,036 Total......................... 229,326 Missing.......................... 14,290 Prisoners......................... 2,275 This total of wounded does not at all comprise the total of men who will be possible subjects for voca- tional rehabilitation. The months of occupation of enemy territory and police duty will bring its in- evitable toll. It must also be recalled that a con- siderable expeditionary force was operating in Siberia and on the Murman Coast in February, 1919. Dr. Charles A. Prosser, Director of the Federal Board for Vocational Education, testifying before the Senate Committee on Education and Labor on Decem- ber 11, 1918, said: "I am figuring on having to deal with, altogether, not less than 75,000 men who have been disabled." But it must be remembered that only about one per cent, of the disabled are so disabled as to make it imperative that they be reeducated vocationally. It must be kept in mind also that the problem in reeducation is by no means solely that of the man who has lost a leg or an arm or his sight. Of the blind the number is so small proportionately as to 55 REDEMPTION OF THE DISABLED amaze, in view of the extreme deadlincss of warfare as it is now practiced and the multiplicity of weapons employed, including the use of liquid flame. Out of 41,000 Canadians invalided home, less than forty had lost their sight, and this is about a fair indication of the way the average will run, week in and week out. Of 341,025 cases of pensions granted in England, only 2.8 per cent, were eyesight cases, and this figure of course includes all manner of eye impairments — the loss of one eye, general injury to vision, and the like. The percentage of Americans blinded is also astonish- ingly small. In December, 1918, Dr. J. E. Hendrick- son, after conference with the Surgeon-General of the Army, announced that to that date the total of men blinded as a result of wounds, accident, and otherwise was only 30. According to a statement made on January 6, 1919, by Major William T. Shoemaker, an eye specialist who was in charge of the eye depart- ments in all the American hospitals in England, the total American blinded during the war did not exceed 100 men. Said Major Shoemaker: When we consider the many casualties of our troops, it is astounding that wounds causing permanent injury to the sight were so few. Of course, there were many eases of men losing one eye. Gas used during the war did not cause much blindness. It makes the eyes very sore, but the essential parts were never impaired from the use of gas. The amputation cases also are much less than five per cent. The English pension records above men- tioned show that wounds and injuries to legs necessi- tating amputation were only 2.6 per cent., while wounds necessitating arm amputations ranged still lower, only 1.4 per cent., these being the lowest of all 56 THE PROBLEM OF RE-EDUCATION the traumatic injuries, that is, injuries caused by violence applied externally. In general terms, of the 10,000 injured men in each million who will need reeducation, it may be assumed that this number will be divided almost equally be- tween the medical and the surgical cases; that is to say, 5,000 will be wards of the physicians alone, and 5,000 will be purely surgical cases in which operations of some sort are involved, not necessarily amputation or dismemberment, but operations in which the wounds are those for the care of the surgeon rather than the physician. Of the 5,000 surgical cases, ap- proximately 500 will be cases of "dismemberment," in which a limb or a hand or a foot will have to be removed. The average further shows that of the 500 amputation cases, there will be about 300 who will lose legs as against 200 who will lose arms. Some- times the proportion varies, but these figures will be found fairly to represent the average. Some data from the Military Orthopaedic Hospital at Toronto, Canada, are interesting and illustrative. These figures, it must be borne in mind, are from an institution which is strictly an orthopaedic and am- putation hospital where cases of this sort are con- centrated. Up to and including May 24, 1918, there had been 1,169 amputation cases at the institution. Of these, 868 were leg amputations, and 301 were arm amputations. Of the former, 523 were amputa- tions above the knee, and 345 were removals below the knee. Of the arm losses, 194 were removed above the elbow and 105 below. As a rule, it will be found that injuries requiring amputation are most frequent in the left arm and the left leg, for the normal posi- 57 REDEMPTION OF THE DISABLED tion in firing a rifle is with the left arm exposed and supporting the barrel, while the breech and stock give a measure of protection to the right arm; and in the firing position also the left leg is usually advanced, and consequently more of a target than the right leg. The British pensions statistics also are of interest in this connection. Of the 341,025 pensions awarded up to April 30, 1918, the percentage of injuries ran: eyesight cases, 2.3; wounds and injuries to legs neces- sitating amputation, 1.4; to legs, not necessitating amputation, 11.9; to arms, not necessitating amputa- tion, 8.45; to hands, not necessitating amputation, 4.45; wounds and injuries to head, 4.0; hernia, 8.0; miscellaneous wounds and injuries, 5.55; chest com- plaints and tuberculosis, 11.60 (highest percentage of any of the injuries and complaints listed); rheu- matism, 6.5; insanity, 0.75; deafness, 2.0; frostbite, including cases of amputation of feet or legs, 0.9; miscellaneous diseases and causes, 18.36. It is evident, therefore, that the problem is by no means that of the cripple alone. It is more the problem of the man with a complication of troubles, and it will be seen that the cripples comprise a small percentage of the surgical cases. For instance, a man may have a piece of the muscle of his arm or leg shot away which will cause him to lose the active use of that member, and he is effectively debarred in many instances from pursuing his former calling on that account. The wide range of these possible injuries is amazing. These strictly surgical cases are the simplest of all, both for the hospital authorities, and in regard to placement and reeducation, for while the possibilities and the impossibilities of a dismembered 58 THE PROBLEM OF RE-EDUCATION man, or a man who has become defective in arms or legs, are comparatively easy of disposition into a well defined list of employments which are suitable or not suitable, the medical cases do not admit of any such easy classification. These may run the whole gamut of organic trou- bles, both singly and in an amazing number of com- plications. A man may have been gassed and his lungs and heart impaired; he may be suffering from a shattered nervous system as a result of shell shock, and at the same time be extremely subject to rheu- matism. In his case, it will be seen, the determina- tion of an occupation which will not require heavy lifting and thus put strain on heart or lungs, which will not subject him to noise or irritating disturbances, and which will not place him where damp or cold will affect his rheumatism, is something of a compli- cated and puzzling problem. The determination of what manual work can be arranged for a one-armed man is an easy task. Many of them will not require reeducation. It is perfectly patent that a lawyer will not have to study another profession because he has lost an arm, but a dentist, a paperhanger, a riveter or boilermaker, or a painter is obliged to. A farm laborer who has lost a leg in most cases must be reeducated, and so must many men in mechanical lines. But these questions are resolved without any great difficulty. It is the medical cases that give the most concern, and em- phasize the fact that in the last analysis the problem of reeducation is an individual problem. Medical men are called in to say what the man should not be allowed to do. They indicate that no strain should 59 REDEMPTION OF THE DISABLED be put on a man with a weak heart, or that a man who is subject to epilepsy should not be allowed near rapidly moving and dangerous machinery, or that a rheumatic should be given a sheltered occupation, Then comes the task of finding something within the lines laid down by the medical and surgical author ities that will appeal to and interest the man him- self, for it is vital that the subject should concur heartily and be really interested in the work sug- gested for him, otherwise it is useless to attempt to train him or to expect him to make progress in a new occupation. Efforts have been made to catalogue the trades with indication of the handicaps that do and those that do not prohibit success in their operations. It is very difficult to make any generalization in regard to the adaptability of certain injuries to particular trades. Men who have suffered the loss of the right arm, which is conceded to be the most difficult of all injuries for retraining, have made good in many occupations from which they would seem to be debarred, except for their determination to succeed. T. R. Bigler, a crip- ple with but one leg and one arm, demonstrated in a New York piano factory in 1918 that he could do satisfactorily many of the processes. He proved to the surprise of experts that a one-legged and one- armed man could do practically every job in the factory. John Cuthbert Faries of New York says in this connection: The stories of men who have succeeded in spite of handi- caps and of those who have not are merely suggestive of what may be attempted for others. Each case for readjust- ment will be a problem in itself, in which a man's education, 60 THE PROBLEM OF RE-EDUCATION his previous industrial experience, his tastes and aptitudes, the nature of his injury and other handicaps, the conditions in industry in general, or in a particular trade, and a multi- tude of other factors will affect the solution. The convention of industrial surgeons, meeting in Chicago on June 10, 1918, virtually agreed that the question is an individual one and every case must be "investigated separately in the light of the medical, technical, economic and personal factors of his case." At the same meeting Mr. T. B. Kidner, under whose guidance the Canadian system came to its full efficiency, and who was loaned by the Canadian Gov- ernment to the United States Government as an ad- viser to the Federal Board for Vocational Education in getting the work under way in the United States, made practically the same statement: "There are no readymade lists of vocations to which men with certain disabilities can be assigned as a matter of routine. Each case must be handled on its own merits." Dr. Bourillon, the French educationalist, declares: "It would be rash to draw up a limited list of the trades which can be taught to the mutilated, for often an ingenuity and unsuspected skill allows of their doing work which at first sight seemed to be impossible." The Federal Board in a memorandum on the subject declares: "It is the same in this in- dividual struggle as in the great world struggle now going on: 'We will win if we have the will to win.' " In addition to reeducating the disabled men who are so injured as not to be able to return to their old employments of trades or callings, the Government has undertaken to place them in the occupations for 61 REDEMPTION OF THE DISABLED which they have been reeducated. Not only will they be placed in suitable wage-earning positions, but the authorities will maintain contact with them aud supervise their welfare. This in itself is a task of considerable magnitude. It does not mean that the men are to be coddled or led to expect special privi- leges. Nothing of the sort. When the men are turned out of the retraining courses, they will be expert men in particular lines, in which they will be amply able, physically and by education and training, to hold their own. But the Government will look after them to see that they are given "a square deal" and are not discriminated against, and also to see that they are giving a square deal to their employers in the work they are being paid to do. Besides the retraining of these men and placing of them in their new callings, the Government has under- taken to place back in industry the wounded men who, discharged from the Army by reason of wounds incapacitating them for further military service, are not so injured that they cannot go back to their former occupations. The Federal Board for Voca- tional Education will undertake to have employment ready for these men coincident with their recovery and discharge from hospital in condition again to take up the work of making a living. It is realized that the man who has spent some time in the Army or Navy, and has lost touch with industrial condi- tions, may have considerable difficulty in obtaining employment. War times are extraordinary; the em- ployment the man quits to take up soldiering may not be available for him on his return, and conditions may have changed in that particular industry. The Gov- 62 THE PROBLEM OF RE-EDUCATION ernment will endeavor to place these men without delay and to keep in touch with them so that there will be no obstacle to their merging back into the industrial and creative work of the Nation. CHAPTER VI BELGIUM, THE PI0NEEK IN RESTORATION WORK Pitiable state of the disabled Belgian exiles — M. Rchollaert \s charitable experiment — Curative effects of work — The Depot des Invalides at Havre — Foundation and develop- ment of the Hcole nationale beige des mutih's de la guerre at Port Villez — Organization and courses — Compulsory training — Provision for professional students at Paris. In the tragic, earlier days of the war, after Bel- gium's army was overwhelmed and all save a single corner of the heroic little country was overrun by German hordes, the plight of the disabled Belgian soldier was a most unhappy one. Handicapped though he was by sickness and wounds, he could not return to his own country, for it was in the hands of the invaders. If he had been in a hospital in Bel- gium, there was little he could do to help himself after discharge unless he was able to make his way to England or France. The Belgian Government was not able to help him, not because of indifference, but because it did not know what to do. It was, besides, in a death grapple for its very existence. Some of the disabled men, after discharge from the hospitals, made their way to France and across the Channel. Many of them were skilled artisans who were not so badly shattered that they could not work at their trades, and the munitions and other factories of the Allies readily gave them employment. But there was a larger proportion of the disabled Belgians who were totally demoralized and bereft of 64 BELGIUM, THE PIONEER either initiative or hope. They wandered about over France, lamenting their fate and that of their coun- try. They were in rags of uniforms; they had wounds, or disease, or shell shock; they were be- wildered, aimless and hopeless; they were beggars and subsisted on charity. Certainly they were not im- proving their own condition, and they were not only an economic burden upon the generous householders of France, but they were spreading demoralization and fear of the enemy behind the lines. M. Schollaert, President of the Belgian House of Representatives, had a country home at St. Addresse, near Havre, France, to which he had retired when it was no longer possible to remain in his own country. Some of these poor, broken and destitute wounded Belgian soldiers applied there for food, clothing, and dressing for their wounds, unhealed by lack of atten- tion. The men were taken in, of course; they were fed, washed, clothed, and given the medical and surgi- cal help needed. Other men came, and all found a refuge in which they could recuperate and win back their strength and nerve. Some of them wanted to work and endeavor to requite the good Schollaert for his kindness. He, of course, refused to permit this, but told the men that if they could make any- thing during the period of convalescence and could dispose of the goods, they were more than welcome to keep the proceeds. Several who were brushmakers set up a temporary shop in the stable. The entire house by now was filled with wounded, and a shoe- maker had started a shop in the parlor. Some turners in wood were working in the kitchen, and others who had crafts were endeavoring to work 65 REDEMPTION OF THE DISABLED wherever a place for their operations could be found. The good effect of work, of something to occupy the minds of the wounded and disabled men, was at once apparent. They became more cheerful and im- proved physically. Those who had no trades, or were incapacitated for following their own trades, began tentatively trying to help those who were working and to adapt themselves in respect of their several handicaps. All of these men began to show marked improvement. M. Schollaert at this point presented the matter to 'the Belgian Minister of War and asked permission to maintain regularly a house and school for a larger number of wounded soldiers in need of care and reeducation. It was granted, of course, together with some financial assistance. Portable "knock-down" houses were set up on the estate to serve as workshops and barracks, and thus came into existence the Depot des Invalides. An organization was formed to provide nursing, medical care and vocational instruction. The citi- zens of Havre were interested and gave assistance. Artisans of that city volunteered to help in the work of reclamation and reconstruction of their un- fortunate allies. The curriculum of the school was speedily enlarged to include carpentry, brushmaking, toymaking, plumbing, saoot making, cooperage, mechanics, metal turning, electrical work, upholster- ing, wood turning, patternmaking, shoemaking, tailor- ing, paper binding, printing, envelope making, and the manufacture of artificial limbs. The school was organized with a competent medical department, a technical department, and an academic 66 BELGIUM, THE PIONEER department. The pupils were made to take academic work in addition to the practical shop work. The institution admitted all disabled or invalid soldiers assigned to it by the Belgian War Department. The Government paid it two francs 50 centimes per day for each man. Out of this 25 centimes was paid to each pupil. The Quartermaster furnished clothing, and the Medical Corps beds and bedding. Men of the older classes, unfit for active service, were de- tailed from the Army as instructors, and nurses and stretcher bearers were assigned as nurses and dis- ciplinarians. While the men were in the "apprentice class," they received wages of from 50 centimes to one franc a day. When they acquired journey- man's skill, they made, on an average, two francs 50 centimes per day, or 60 francs per month. Ten francs of this was given each man for pocket money; the rest was deposited in a savings account for the man, to be paid to him on his discharge. Each man also acquired a complete set of tools, when such were needed for his trade, and paid for them gradually. The Belgian War Minister was quick to see the ad- vantage of the institution as it was being developed by M. Schollaert. The economic possibilities of the work at once became manifest. To a small country which had suffered grievous losses in man power, the salvaging of the scrapheap offered many opportunities to reduce the loss. The disabled men could be taught to do the things necessary to maintain the remnant of the Belgian armies — repair shoes, harness and guns, make munitions, and do the thousand and one things needful to keep an army in going condition as regards equipment. Besides, every man not able to return 67 REDEMPTION OF TIIE DISABLED to the ranks could be used to replace an ablebodied man, and to release the hitter to take his part in the actual work of driving the invaders from Belgian soil. A patriotic Belgian presented to the Government a considerable tract of land on the River Seine, at Port Villez, near the town of Yernon, almost midway between Paris and Rouen. The French Government was entirely agreeable as host to the exiled Belgians, and a reconstruction hospital and curative workshop on a large scale was projected at Port Villez. A sec- tion of army engineers and other workers commenced to clear the land on July 12, 1915, as the preliminary to building operations. On August 21, before any but a small portion of the work was done or the estab- lishment was read3r, disabled men began to arrive; they had been discharged from the hospitals, but were decided to be proper subjects for reeducation and restorative work. In one year from the time ground was broken, the Ecole nationale beige des mutiUs de la guerre (National Belgian School for War Disabled) was in full operation, and 1,200 men were in training and being reclaimed, reeducated, and refitted for use- fulness to their country and to themselves. As soon as the school was determined upon, in November, 1914, the Belgian Government issued a decree making reeducation compulsory for men still in the army hospitals. This decree was at once ex- tended to include all discharged men who were wounded or disabled. The discharge papers were re- voked, and all of the discharged soldiers were rounded up and given a physical reexamination. Those who had been drifting around the country were sent to the military hospitals for such further treatment as 68 BELGIUM, THE PIONEER seemed necessary. Some were sent direct to Port Villez or to M. Schollaert's Depot des Invalides. Those of the discharged men who had found steady jobs in France or England were not disturbed, but were put back on the rolls as on leave without pay. There are shops in connection with the Belgian hospitals at Rouen, France, which also are being used now for reeducational purposes. The institution at Port Villez has grown to a vast establishment of more than 90 long wooden barracks, each of the same type as the portable field-hospital hut, with double walls and cement foundations. Some buildings on the place when it was taken over have also been utilized. At one end of the rows of bar- racks there is a large meeting hall, and beyond it the infirmary and officers' quarters. At the other end of the row is a steam sawmill, a joinery, and a shed for hand carpentry. The sawmill and carpenter and joiner's shops were used in reducing trees on the place to lumber and fixtures to be utilized in the con- struction of the cantonment. Beyond the sawmill is the garage and repair shops and motor-mechanics school, and, farther on, the stables and the poultry yards where poultry farming is taught; from the latter institution substantial help for the commissary for the invalids in the way of chickens and eggs is obtained. There is a large and intensively cultivated garden and truck farm in front of the institution, which serves the doubly or trebly useful purpose of serving to teach market gardening to some of the pupils, to give needed curative exer- cise to others, and to furnish a considerable amount of good food for the support of the men. The erection 69 REDEMPTION OF THE DISABLED of necessary buildings has kept pace with the needs of the institution. A colonel is superintendent, and there is strict military discipline. The school is divided into three departments — medical service, academic, and technical training. The main duty of the medical service is to provide functional reeducation for those who need it, to study and catalogue the men according to their capacities. It also manufactures orthopaedic appliances which make it easier for crippled men to work at certain trades. The physiotherapy and regular gymnastics given the men to restore atrophied muscles and stiffened joints and to develop muscles in stumps is supplemented by exercise in the workshops. The academic department provides schooling for men learning trades, and gives theoretical instruction in the trades and special courses for men who desire to fit themselves for clerical occupations. The gen- eral plan of theoretical instruction is the same for all the trades. It includes the study of tools and ma- chinery, raw materials and sources, processes in the trades, and methods of determining sale price and of placing the output on sale. The director of the department, together with the technical director, holds a meeting of all the shop foremen and in- structors to discuss methods and technical questions, and everything possible is done to make the theoretical instruction a real aid in the practical work. Wood and metal workers, for instance, attend classes in drafting, so that they may learn to read and to make working drawings. The commercial courses are for men of suitable previous experience and education who wish to take 70 Courtesy Red Cross Institute for Crippled and Disabled Men THE MACHINE SHOP AT THE PIONEER NATIONAL BELGIAN SCHOOL I OH WAlt DISABLED AT PORT VILLEZ, FRANCE BELGIUM, THE PIONEER up office or clerical work. There are four main branches — primary, preparatory for civil-service positions, a regular commercial division, and a nor- mal division for the training of teachers. Pupils in the primary section are taught French, Flemish, arithmetic, geometry, elementary principles of busi- ness, history, geography and the elements of social economics. The Belgian Government, owning the railways of the country, employed before the war a great many men as engineers, brakemen and porters. Those who on account of their injuries cannot resume their former occupations are now being trained as clerks, cashiers, telegraphers, ticket sellers, station agents and office employees. The course generally has been divided into two terms each of six months' duration. The course of the department for civil-service posi- tions includes the two national languages, a third language, writing, history, geography, business and constitutional law, arithmetic, elements of algebra, plane and solid geometry, elements of physics, social economics, stenography and typewriting. This work is divided into three terms of four months each. The commercial course is divided Into two terms of six months each. During the first term all students study the elements of bookkeeping, commercial arith- metic, four languages, commercial geography, stenog- raphy and typewriting. In the second term they specialize as expert bookkeepers, commercial corre- spondents, or wireless operators. The normal course covers two terms of six months each. In most instances the teachers were, before the war, school and college teachers, expert ac- 71 REDEMPTION OF THE DISABLED countants in large banks, or men holding important administrative posts. When men arrive at Port Villez, they are first given a thorough medical examination to determine what sort of physiotherapeutic treatment they require. They are next examined as to their previous general schooling and their mental qualifications. This is done for the double purpose of grouping them in classes for further instruction and to help in directing the subjects to a suitable occupation to be studied in the school. There are, of course, certain callings that are unsuitable for men who are without a good general education or a quick mentality. A third examination is conducted by the technical director, who is a man of unusual understanding and sympathy, with a wonderful capacity for getting in touch with the subject's or pupil's real self and inner consciousness and of communicating enthusiasm and optimism. He accompanies the new arrivals on in- formal tours of the workshops, lets them talk to the men engaged in studying and working at the various trades, and endeavors thoroughly to understand the latent aptitudes and tastes of the new man who has not yet decided what he wants to take up. After this preliminary survey each individual is brought separately before a committee composed of the examining physician, the academic director and the technical director. The members of the com- mittee compare their individual notes as to the man's capacities. They confer and consult with him as to his inclinations and preferences, and then decide that he shall be given a trial apprenticeship at a certain trade. If after a week's trial it appears that the man 72 BELGIUM, THE PIONEER has been misplaced, the case is reconsidered and he is assigned to some other trade more congenial or better suited to his capabilities. Over 40 trades are taught in the department of technical training, among them being machine car- pentry, hand carpentry and cabinetmaking, pattern- making, making of toys and small articles for arma- ment and for household use, woodcarving, wooden- shoe making, wood polishing, pyrography, brass and leather repousse work, general mechanics, oxy-acety- lene welding, a course for chauffeurs and automobile mechanics, plumbing and zinc working, clockmaking, electricians, shoemaking, saddlery, tailoring, furriers, upholstery, basketry, typesetting, both by hand and linotype, printing pressmen, engraving and lithog- raphy, photogravure, motion-picture machine opera- tors, hairdressing, brushmaking, industrial designing and drafting, sculpture and modeling, painting in its several branches, baking, poultry raising, truck farm- ing and general agriculture. There is no fixed length of time for learning a trade; necessarily there cannot be. It depends upon the aptitude of the student, his interest and his facility in overcoming his handicap. The author- ities, however, have found that good teaching methods can reduce very greatly the time supposed to be neces- sary for an apprenticeship in a given trade in ordi- nary civil life and under normal conditions. The shops are operated for production as well as for teaching, but efficiency in teaching is never sacrificed for the purpose of increasing production. Most of the shop products are used to fill orders from the Belgian Government, but when these orders do not 73 REDEMPTION OF THE DISABLED provide the necessary variety for thorough apprentice- ship, orders from private firms are taken. The steady inflow of new men does not disarrange the classes or the work of good apprenticeship. New- comers are grouped together and started to work under the supervision of a monitor; after preliminary tryouts new groupings are made in accordance with the ability and progress of individuals. The work is very carefully supervised by monitors, foremen and doctors, and the men are never allowed to become dis- couraged. In some of the trades there is a monitor for every four men. Techically speaking, the training at Port Villez was compulsory; practically the compulsion was found to be valuable only to the extent of requiring disabled men to report there, holding them there, and enforcing discipline in the institution. In the earlier days of its existence there was friction in plenty, and the Peuple Beige of Paris of July 22, 1917, after rather heatedly discussing the subject, in part said: In short, much of the failure there is said to be due to the maintenance in uniform and under military discipline of men, who, in view of their reeducation and its aims, should be returned to civilian life, and to employment in a civilian capacity of men whose proper place should be in the army. These matters of friction gradually readjusted themselves as the expediency of compulsory methods became more uncertain and the military features grew less prominent. Persuasion was found much more effective in inducing the men to take up and pursue the courses of training and it grew to be the rule, while the military end of the institution was reserved 74 BELGIUM, THE PIONEER for its administration. Concerning this feature at Port Villez, " Recalled to Life, No. 2," says: Here there is no doubt at all as to the propriety any more than the legality of compulsory training, but it is found to be ineffective as training. M. Alleman, the director of studies there says: "Compulsion should never be employed. In certain schools, 80 per cent, of failures occurred through misapprehension of this principle." All of the cost of the Port Villez school is borne by the Belgian Government. It is managed in a most economical way, and the construction costs have been held down to lowest possible amounts consistent with sound workmanship and material. It is the intention to use the portable barracks and cottages now used as dormitories in rehabilitating the devastated regions. The permanent structures were built out of materials furnished by the owner of the property. The heating has cost only the labor of cutting and hauling the wood on the estate. Food cost is held to low levels by the large supply of vegetables, poultry, pigs, etc., raised by the pupils who are taking the agricultural, gardening and poultry-raising courses. Butchers, bakers and others among the personnel render service according to their several capacities and trades. The men in the school are maintained by the Bel- gian Government, and the regular rate of army pay, 43 centimes per day, is allowed. In addition, wages of from 50 centimes to one franc a day are paid out of the proceeds of the sale of articles made in the shops. These proceeds are used to help defray the general expenses of the school. For men who do not care to take up manual trades and who are by previous education fitted to study a 75 REDEMPTION OF THE DISABLED profession other than the limited courses offered at Port Villez, there is the "Home University" at Paris. There instruction in the higher branches of learning may be had in the great schools and colleges of the French capital — law, medicine, natural sciences, philosophy, teaching, and commercial collegiate courses. Books and instruments are furnished by the Ministry of Arts and Sciences of the Belgian Government, and students are allowed to attend the various institutions giving instruction in the particu- lar lines desired. They are granted a certain amount for maintenance, and are not required to reside in barracks. Such medical or surgical attention as may be required from time to time has been arranged for with the French authorities. 76 CHAPTER VII SYSTEMATIC DEVELOPMENT IN FRANCE Edouard Herriot and the Lyons schools — The Institut national professionel des invalides de la guerre — Schools established by private philanthropy — Government voca- tional schools — Eeluctance of discharged men to return for training — Schools attached to hospitals — National control of restoration work — Centers of readaptation — Eegistration of the disabled — Departmental committees — Compensation of workmen — School discipline — Courses offered — French losses in the war. As in Belgium, the system of reeducation and re- habilitation of disabled soldiers in France has been an evolution from a start initiated by one man. In the late summer and fall of 1914, the hard fight- ing along the Belgian border and the great Battles of the Marne and the Aisne had filled the French hospitals. Presently the hospitals began to discharge the disabled for whom there was nothing more to be done in a medical or surgical way. A large pro- portion of them had recovered and rejoined their com- mands at the front. There was another percentage which would never again fight on a battlefield. Their wounds and their amputations were healed and they were equipped with the necessary artificial legs or arms, but these men, in so far as further usefulness to the French Army was concerned, were permanently out of consideration. It is true that the minute, not to say infinitesimal, French pension was awarded them, but this was utterly insufficient to maintain them. 77 REDEMPTION OF THE DISABLED It was a time when human fuel was being fed into the war machine with a prodigal lavishness. The Government could not stop to consider such charred and unconsumed bits of material as were raked out of the roaring furnaces. The ashheaps might be picked over later for salvagable matter and useful residue, but with an abundance of prime energy giving food for the flames the need was not then apparent, nor did it seem to occur to anyone that the necessity would ever arise. Thus, the men who had given their blood, their limbs, their ability to support themselves and their dependents, were relegated to the dead eddies of life, far in the rear and away from the lashing fury of the storm at the front. These soldiers were done for. They were an economic burden, producing nothing, yet consuming. They were miserable over their out- look down the years and were dampers upon the enthusiasm of others, for in their helpless condition a future of mendicancy or charity support seemed inevitable. It does not do in war time to dwell upon these things too deeply. Such meditation is depress- ing, and it is reflected upon the morale of those who are in the actual shock of battle. Back to the city of Lyons drifted a quota of these broken men. That they deserved better than to have their eager gift of superb young manhood requited only by an insufficient pension seemed a general view, but no one thought of anything more substantial. They were lionized for a few days or weeks, but the Nation was so busy with the vital fight that the heroes of last week were pushed to the rear by the heroes of a later battle. So matters went until the Mayor of 78 SYSTEMATIC DEVELOPMENT IN FRANCE Lyons, M. Edouard Herriot, began wrestling with the problem. M. Herriot concluded that these muffles were men of potential or of residual value. He saw that possi- bly they could be made useful for necessary work behind the lines, which was requiring the services of men able to carry arms who were badly needed at the front to oppose the invading hordes. He also evolved the idea that not only could the war machine be given this hitherto neglected power, but on the return to peace these men would play a most important part in the general readjustment, when skilled men in the various trades would be scarce. Thus, instead of being a dead weight upon the country, mere pensioners upon the public treasury and beneficiaries of the bounty of their relatives or of the various communities, he perceived that the disabled could be fitted actually to carry some of the burden in the war as well as in the after days of peace. Mayor Herriot initiated his experiment by sug- gesting that the municipality of Lyons should organize a school in which men rendered unfit for their former occupations should be taught other crafts for which, despite their wounds or handicaps of physical condition, they could qualify. The idea was approved, and on December 16, 1914, the munici- pal school of Lyons opened with three pupils. By the following May its accommodations were taxed to the utmost, and another school was opened in the suburbs of the city. The first institution was called the Ecole Joffre, in honor of the hero of the Marne, and the second, the Ecole de Tourveille. As in the case of Belgium, whose Government was 79 REDEMPTION OF THE DISABLED quick to recognize the value of the work initiated by M. Schollaert at his Deput des Invalides, the French Government saw great possibilities in M. Herriot's Ecole Joffre and as promptly took action. At St. Maurice, near Paris, there was an industrial home for cripples. It was taken over, and in May, 191;"), the Institut national professionel des invalides de la guerre, with accommodations for 300 students, was opened, and soon filled. As knowledge of the marvels of reeducation extended and the public became aware that the disabled men could have their handicaps neutralized by reeducation to take advantage of their remaining capabilities, steps were taken in other parts of the Republic to inaugurate the work. Mu- nicipal authorities, departmental governments, trade unions and private philanthropy showed intense in- terest and went earnestly into the scheme of restora- tion. The idea of rehabilitating the disabled men caught the popular fancy. The people had recognized that a mere pension and, perhaps, a decoration for valor were inadequate for the long, hard years when peace should come again. They were willing and anxious to do more, and eagerly followed when M. Herriot showed the way. Schools were organized at many points and speed- ily filled with pupils. The injured men who sought them went at the work with the same fire and deter- mination with which they had fought. They realized that if they could take the places of men back of the lines, the latter could take the places the wounded men had left vacant at the front. It was a sort of vicarious fighting which appealed to them immensely. And the practical side of it was not overlooked — the 80 Courtesj' Red Cross Institute for Crippled and Disabled Men TOV MAKERS AT THE ECOLE JOFFRE, LYONS, FRANCE, EACH MAN LACKING AN AEM THROUGH EITHER AMPUTATION OR PARALYSIS SYSTEMATIC DEVELOPMENT IN FRANCE advantage of supplementing the little, pension with ample wages after the war. The Minister of Commerce adapted the vocational schools under his jurisdiction so they might be used to reeducate the disabled men. In some of the schools the soldier students entered the regular classes where the work was suitable for them; in other instances special classes and instructors were provided. Some of the existing schools organized separate branches for the muffles under the supervision of the Minister of Commerce. The Ministry of Agriculture under- took to organize such branches of agricultural educa- tion as would be suitable for the disabled. Trade organizations and arts and crafts schools joined in the effort to develop the new education. By the fall of 1915, France had embarked definitely upon a policy of restoration for every injured man, fitting him for some phase of usefulness compatible with the abilities remaining to him. The Government had bent every effort to have the National Institute at St. Maurice as nearly perfect as possible in appointments, teaching staff, curriculum and methods, so that it might be used as a model for other institutions to be established throughout the Republic by agencies other than the national Govern- ment. Public attention became much engrossed with the duty of the country to the mutilated fighting man, and very rapid strides were made in rehabilitation and placement work. A survey conducted by the Ministry of Commerce in 1916 disclosed that at that time there were more than 100 schools available for restoration work. Some of these were capable of receiving only a few pupils, while others were large 81 REDEMPTION OF THE DISABLED enough to accommodate from 200 to 300. Most of these schools were the creation of public and private patriotism, and they were designed only for dis- charged soldiers. None of them was operated in con- nection with a military hospital except the National Institute, another school in Paris, and a third at Neuilly. Some of the schools soon began to complain of lack of pupils. Not that there was a scarcity of men proper to be reeducated, but the men, especially those who had been discharged from the hospitals a con- siderable length of time, would not take the training. Some of them had been spoiled and demoralized by the adulation of friends and the public; they con- sidered it beneath the dignity of a local hero to go back to unheroic work. Others thought the training a war service and flatly declared that they had done enough. More feared that if they equipped them- selves to earn more, their pensions would be cut down. Still others, after the excitement of army life and the long siege in the hospital, could not get down to matter-of-fact existence again. There had not yet crystallized a sound, general, public sentiment on the subject to force the men into the schools. Having been discharged from the Army, there was no au- thority to compel these men to take the training, and thus the situation was rather chaotic. It was found that the men who were approached in the hospital, before they had had an opportunity to have their heads turned or taste of the sweets of liberty, idleness and adulation, almost invariably re- sponded to the suggestion, went directly from the hospital into the training school, and pursued the 82 SYSTEMATIC DEVELOPMENT IN FRANCE courses with diligence and enthusiasm. The author- ities soon became convinced that vocational training should really be started before discharge from the hospital. A decree of June 2, 1916, proceeded to initiate the work in connection with the large physio- therapeutic hospitals and amputation depots, and such schools as were in existence in their neighbor- hoods were annexed to the hospitals. The Govern- ment also began at once the policy of establishing hospitals of physiotherapy in connection with each reeducational school of sufficient importance to war- rant such an installation. After schools were organ- ized in connection with the hospitals, it became easier to get pupils, and now practically all of the men who are offered the opportunity of taking a course of re- education are delighted to do so. Thus is demon- strated the value of starting the work of restoration before the patient has a chance to gain the idea that he should be immune from work, or should be pre- sented with a sinecure government position in which he can loaf comfortably for the remainder of his life. The great diversity of control, financial arrange- ments, and the like was found very confusing, and in March, 1916, a National Office for dealing with the war wounded and disabled was created. The head- quarters were located in Paris, and suboffices were established in the 80 and more administrative dis- tricts of the Republic. The National Office was the result of an interdepartmental decree in which the Ministries of "War, Labor, and the Interior partici- pated. The Paris office coordinates generally the work of reeducation; the departmental offices see that the work proceeds in accordance with the general plan. 83 REDEMPTION OF THE DISABLED The general scheme of the work in France has now definitely settled into a programme arranged by the National Office. In every important region of the Republic a " center of readaptation " has been estab- lished. This center is not localized, but is distributed over several towns and cities. It comprises a hospital of physiotherapy, where treatment is given and fundamental functional reeducation applied; an in- stitution where artificial limbs are made, distributed and adjusted; and a school or schools where reeduca- tion is provided in trade, commercial and agricultural subjects. There are now over 30 of these centers. A wounded man needing functional treatment is sent from the general hospital to a physiotherapeutic hospital, preferably the one nearest his home. In each of the 11 military regions there are hospitals of physiotherapy with vocational training schools an- nexed. While undergoing the prescribed treatment, the patient at the same time commences his trade education. One of the difficulties encountered was that at the conclusion of his treatment he expected his discharge, and this obtained, it was often very diffi- cult, if not impossible, to hold the man to finish his education. This has been met by holding up the discharge until the man has completed his course of training. A registry is kept of every disabled soldier. A blank is filled in by the hospital authorities where he is first received after his injury, and again before the patient leaves. This shows the man's residence, his dependents, his civil or military status, his education, the nature of his disability, his former occupation, reeducation if any, and the nature of the employment 84 SYSTEMATIC DEVELOPMENT IN FRANCE desired. The filled blank and a card with " medical observations," describing the man's needs for arti- ficial limbs or further treatment, if any, and his capacity for vocational reeducation, are filed with the National Office. When a man finds employment, a placement card relative to his situation makes the record complete. The departmental committees, composed of local representatives of the Ministries of Labor, War, Edu- cation, and Agriculture, together with other members appointed by the prefect of the department, who is ex officio the president, exist for the purpose of look- ing after the men arriving in the particular depart- ments or provinces. These committees see that the wounded soldier receives the training best suited for him. As taking up the work is purely voluntary on the part of the wounded man, members of the com- mittee of his department call upon him and impress upon him the advantage to be derived from the op- portunity, and in some instances his relatives are sent for to consult with him and urge him to agree to retraining. Effort is always made to get a man of the same trade as the injured to call upon him and con- vince him of the probability of his making a good living, notwithstanding his handicap, if he will take the reeducation. The schools that exist solely for the discharged soldiers have found much difficulty in getting the men to take up training. Advertisements in papers, handbills, post cards, notices in hospitatls, and a booklet issued by the Ministry of the Interior and presented to each discharged man are used, and the mayors of towns and the prefects of departments are 85 REDEMPTION OF THE DISABLED urged to impress upon these men the value of train- ing. It has been found, nevertheless, to be a most difficult matter to get them into the recducational work once they have got away. The men are maintained free in the schools an- nexed to the hospitals, and the regular Army separa- tion allowance to the families is continued during training and before the pension begins, on final dis- charge. In some of the schools wages are paid, be- ginning with 50 centimes or one franc a day, and later reaching four to six francs a day. In others, the product of the workshop is sold and the proceeds, less the cost of the raw materials, are divided among the workmen. At St. Maurice half the amount earned is paid out every fortnight; the other half is retained and paid to the man when he finishes. At Tourveillc the value of the labor on the articles made is paid for whether the articles are sold or not, the money being divided among the workmen at the end of the month according to their productive capacity. The men are encouraged to save half of this in order to have a small capital on leaving. Other schools have varia- tions of these two plans. The matter of discipline in the French schools is the acme of simplicity. The director of the National School at Montpelier defines it as follows: Every pupil whose conduct, work or attitude of mind does not give satisfaction is sent away. If a pupil could commit any fault and give a bad example to others at the price of a mere reprimand, the school would not be what we want it to be. There are no punishments and there should be none. Every new pupil is given this explanation of the school, and is made to understand its full signifi- cance. 86 SYSTEMATIC DEVELOPMENT IN FRANCE This school is neither a barracks nor a college, nor a workshop of the kind you have known in the past. It is an institution established by philanthropists to teach dis- abled men how to make an honorable living. You will be boarded, lodged, clothed and instructed, all at the cost of the institution. If you are industrious and become a good workman, we will try to find a position for you or help you to set up your own shop. In return we demand only two things: that you work industriously, and that you have the right spirit. If a man forgets he is here for work, he must go. Here are no pun- ishments. You are not obliged to come: we are not obliged to take you. If we are not satisfied with you, we will send you away and give your place to a more earnest pupil. But if you do your best, we will aid you with all the means in our power. Sometimes, in order to be fair and to make certain of justice, a warning is given, and in a few instances, a repetition with deprivations of leave, but in the main the attitude defined above prevails and no trifling is tolerated, for preparing for the battles of peace with shattered forces is quite as earnest a busi- ness as that of preparing for war. The departmental committee also has the duty of investigating the labor situation. Bureaus of in- formation have been opened for maimed men on all matters affecting their interest or advantage. Ex- tensive inquiries among placement agencies, labor inspectors, manufacturers and other employers have enabled the National Office to compile a list of oc- cupations possible for men of various disabilities and a list of disabilities compatible with different occupa- tions. This survey disclosed many instances of men injured in the industrial field making good livings notwithstanding their handicaps, and the examples 87 REDEMPTION OF THE DISABLED are used to arouse the emulation of wounded soldiers. Large industrial plants are asked to put in special workshops for war cripples, where they can serve apprenticeship at their old trades or new ones. In the larger schools the training offered is divided into instruction in manual trades, office work, and general schooling. Figures show that the manual trades most in demand are shoemaking, tailoring, basketry, harnessmaking, saddlery, tinsmithing and carpentry. The reason for the popularity of these trades is that they will afford a living almost any- where, in the city or in a tiny village. They do not require expensive equipment, and they are the trades selected by the men themselves. Most of the soldiers are from villages and small towns, and these desire to acquire a trade that, when eked out with their pen- sions, will give a good living and yet not be too exact- ing. These men will open shops in their homes, and have time also to work in the garden, cultivate their tiny farm patches, and attend their vines. Among other trades taught are those of mechanic, typography, lithography, typefounding, bookbinding, the manufacture of artificial limbs, expert workers in wood, iron and leather, locksmith, brushmaking, toy and paper-box making, oxy-acetylene and electrical welding, metal and wood turning, electricians, mould making and stucco work, carriage and vehicle paint- ing, upholstery, fur work, photography, jewelry mak- ing, diamond cutting, sabot and galoche making, stone carving, hairdressing, dental mechanics, wireless telegraphy, and many others. Several of these trades are being emphasized on account of the number of Germans engaged in them 88 SYSTEMATIC DEVELOPMENT IN FRANCE prior to the war. As the Germans have been either killed in battle or sent back to Germany and will not find France a congenial place of sojourn for many years to come, the vacancy in these industries is going to be taken advantage of. In various districts where particular industries prevail, men are being instructed in them, such as diamond cutting at St. Claud, and the celluloid industry at Oyonnaux. The officials are having a great deal of difficulty in persuading the wounded men from taking up the commercial lines, and in showing them that there is infinitely better chance of profitable employment in the trades. It seems to be the consuming ambition of the majority of disabled workmen to become clerks. There are courses to fit these men, and if they insist, they are given them. There is now a healthy public sentiment in France against the injured man's remaining merely a pen- sioned idler or a seeker of sinecures under the Gov- ernment, and the number of men who do not take reeducation, either immediately or after going out and finding that the aimless existence does not meet the approval of friends or the public, is growing con-. stantly smaller. As time goes on, the work becomes more efficient and better organized, and France is now one of the leaders among the nations who are taking care of the war wounded and refitting them for lives of usefulness. Some idea of the French loss in man power and the number out of which those requiring retraining came is given in a statement by Deputy Lucien Voilin in the French Chamber of Deputies on December 20, 1918. During the course of a debate and interpella- 89 REDEMPTION OF THE DISABLED tion of the Government on problems of demobilization, he said: I betray no secret when I say that the problem of demobilization presents itself thus: We have mobilized 6,900,000 men. We have had about 1,400,000 killed —in which are included deaths from disease and wounds — total casualties resulting in death. We have 800,000 who have recovered from wounds. The French High Commission to the United States on January 14, 1919, authorized the publication of the following statement of French losses up to November 1, 1918: Dead (killed in action and dead of wounds)....... 1,028,800 Missing (given up for lost)...................... 299,000 Total (Colonial troops not included).......... 1,327,800 Colonial troops: Dead..................................... 42,500 Missing................................... 15,000 Grand total of dead and missing......... 1,.385,300 Wounded (about).............................. 3,000,000 [Of which 700,000 crippled and pen- sioned. To this figure must be added a great number of the 435,000 Frenchmen war prisoners henceforth unfit to work.] Grand total of French casualties............. 4,385,300 90 CHAPTER VIII EVOLUTION OF THE BRITISH SYSTEM British policy generous to the disabled of the war — Eevolution- ary abandonment of pre-war conceptions — The new pro- gramme— Utilization of existing agencies — Coordina- tion under State control — Statutory Committee of the Eoyal Patriotic Fund Corporation and its local committees — Ministry of Pensions and the Special Grants Committee — Functions of local committees — Advisory trade com- mittees for training and placement — Extreme flexibility of the system. Present British policy in regard to the after-care of disabled soldiers and sailors may fairly be defined as a policy of seeing the disabled man and his family "all the way back " to his pre-war economic status or to a condition approximating it as nearly as pos- sible, the process of restoration being guaranteed, directed, and, to the extent necessary, financed by the State. It may be pointed out that the fundamental prin- ciple in accordance with which this policy has been developed has not been generally understood or ac- cepted on the Continent. There it is argued that compensation for the loss of an arm or a leg or an eye or for any other injury should be proportioned in each instance to the disability without regard to pre- war earnings. In the case of any given injury, since the hurt is absolute, the compensation should be un- varying; "for the same hurt there should always be the same compensation." Remarking upon this dif- ference in conception between Britisher and Con- 91 REDEMPTION OF THE DISABLED tinental, Sir Arthur Grifiith-Boscawen doubts that the Continentals "will ever appreciate our stand- point any more than we shall subscribe to their doctrine of abstract egalite." The French conception of justice, or rather the conception more consistent with the French than with the British policy, seems to underlie our own pro- cedure in the United States, where, under the law, compensation for disability is assessed without regard to military rank or pre-war earnings. In this re- spect it may be felt that the British policy of complete restoration is rather less democratic than our own, since it recognizes social status; but it may fairly be contended in defense of the British policy that, grant- ing it to be more conservative, it is at the same time more liberal in its provisions than any of the Con- tinental policies. The private does not get less, al- though the officer may get more. It may be noted also that in our own compensation law, the flat-rate scale of payments was determined by eliminating from the original bill a provision for higher com- pensation for officers without increasing the com- pensation proposed for privates, the final scale adopted being, in fact, somewhat below that provided for privates in the bill as originally drawn. In any case, judged by conventional, pre-war British social philosophy regarding the State's obli- gation in provision for the disabled, the present policy of seeing the men "all the way back" is nothing less than revolutionary. Traditionally in Great Britain the after-care of disabled soldiers and sailors has been principally an affair of private initiative and of pri- vate financial support. Pensions and allowances have 92 EVOLUTION OF THE BRITISH SYSTEM been granted by the State, but they have been ad- mittedly inadequate and, indeed, have been kept so as a matter of public policy, which has proceeded upon the assumption that the inadequate grants by the State would be and might better be supplemented out of private funds. "While this more or less orthodox social philosophy fell away almost imme- diately upon the outbreak of the war, the institutions and funds built up under the old regime continued to function as very real factors in the new social order. The persistence of old institutions represent- ing a social philosophy which had been discarded ex- plains many original inconsistencies in the British system, which, in its initial stages, was characterized as "the mere product of chronology," and, in con- sequence, "complicated and chaotic." State provision for the invalided before the Great War had embraced as its principal benefits, a small pension, and in the case of a crippled man, an arti- ficial limb. Beyond this the State frankly disclaimed responsibility. "The old plan had been," in the words of Sir Arthur Griffith-Boscawen, '' to award or refuse a pension to the man, as the case might be, and to turn him adrift." Established private agencies undertook any further provision made in compliance with the community's humane regard for the welfare of the disabled. "Marrying on the strength," that is to say, while in service, seems to have been rather bad form in the pre-war period. Britain's regular army was not only numerically insignificant, judged by present stand- ards, but was largely an army of celibates enlisted as professional soldiers. The invalided Tommy Atkins 93 REDEMPTION OF THE DISABLED might himself become a public charge or a charge upon private philanthropy, but his dependents did not generally include a wife and children. It is very different now, as may be inferred from the state- ment that the number of wives on the War Office payrolls increased during the first two years of the war from a few hundred to over a million. The Tommy Atkins of Britain's expeditionary forces today is not a man permanently set apart from civilian interests and responsibilities. He has as- sumed the uniform and taken up the trade of war in a world crisis. Uniform and tradition will be dis- carded when peace is concluded, and the soldier or sailor, the fit and the unfit, will seek to return to civil employment. The State has recognized the inade- quacy of private philanthropy; one may even say that it has recognized also the discredit which would attach to a policy of relying upon private philan- thropy to achieve the reinstatement of these men in civil employments. Especially has it recognized its full responsibility for the complete restoration of the disabled. As early as February, 1915, an official report on the provision of employment for disabled men expressed the opinion that the care of such men "is an obliga- tion which should fall primarily upon the State," and that this provision should embrace not only restora- tion to health, but assistance to enable the disabled man "to earn his living in the occupation best suited to his circumstances and physical condition.'' In this work, it was felt, best results could be achieved by full cooperation of all agencies, public and private, under State administration and support. The report 94 EVOLUTION OF THE BRITISH SYSTEM recommended the establishment of a central com- mittee and of local subcommittees which should co- ordinate the activities of public and private agencies and make such new provision for treatment and voca- tional training as might be required. The recom- mendations of the report were as follows: I. The care of the soldiers and sailors should be assumed by the State. II. This duty should include: (a) The restoration of the man's health where practicable; (6) The provision of training facilities if he de- sires to learn a new trade; (c) The finding of employment for him when he stands in need of such assistance. III. For the discharge of these duties, a central com- mitte should be appointed and empowered to act, either through the agency of the appropriate public department, or independently as the case might require. IV. The central committee should have the assistance of subcommittees for Ireland and Scotland, and local commit- tees in any part of the United Kingdom where the circum- stances justify the establishment of such an organization. The central committee, known as the Statutory Committee, appointed in accordance with these recom- mendations, declared its acceptance of the principle that men whose health and earning powers had been impaired were '' entitled to such training or continued treatment as will restore them, as far as possible, to normal health and earning powers." The principle of reestablishing the pre-war status has been carried even to the extent of providing in certain cases an allowance to cover anticipated earnings of a man who at the date of his enlistment was undergoing a period of training or apprenticeship. 95 REDEMPTION OF THE DISABLED The principal pre-war agency of after-care work was the Royal Patriotic Fund Corporation, which held in trust the Royal Patriotic Fund, an amalgamation of private charitable funds, dating back in its origin to the Crimean War, and administered in the interest of disabled soldiers' and sailors' widows and orphans. The grants by this corporation were supplementary to State awards of pensions and allowances. The In- corporated Soldiers' and Sailors' Help Society, estab- lished at the close of the South African War, and the Soldiers' and Sailors' Families Association also were actively engaged in the field of after-care work for disabled men and their dependents. The services, resources and experience of these and other agencies have been fully utilized and coordinated during the war in Europe. One enterprise of the Soldiers' and Sailors' Help Society is deserving of special mention. This Society has established workshops for disabled men unable to compete in the open labor market. Handicapped soldiers and sailors and their dependents are taught trades and are employed in these shops, which, in recognition of Lord Roberts's interest in the enter- prise, have come to be known as the Lord Roberts Memorial Workshops. The shops are organized primarily to provide employment rather than train- ing, and to provide rather for those who cannot com- pete than for those who can be made by training 100 per cent, efficient in some trade. Under an Act of 1909 there had been built up in Great Britain a national system of labor exchanges extending to every section of the country. These, originally under the Board of Trade and subsequently 96 EVOLUTION OF THE BRITISH SYSTEM in the Ministry of Labor, have cooperated with the newly created Ministry of Pensions in the work of placing disabled men in factories and workshops un- der fair conditions of remuneration. The Military and Naval War Pensions Act of 1915 provided the fundamental law upon which the present State system for after-care has been developed. This statute defined large discretionary powers to be exer- cised by the administrative agencies created by the Act, and under it Royal warrants and executive regu- lations have been issued which give definition and form to the State's policy. In its executive capacity the State appears, not only as administrator of State funds made available in such amounts as are required, but also as supreme coordinator of every social effort in behalf of disabled men. The Act created the Statutory Committee for ad- ministration of the Royal Patriotic Fund — a com- mittee of 27 members representing various offices and associations under appointments by the Crown, the War Office, the Admiralty, and other Government offices, by the Royal Patriotic Fund Corporation, and by the Soldiers' and Sailors' Families Association. The Act provided that the Statutory Committee should establish local committees, one in each county or equivalent area or subdivision of a county, and one in each urban district of 5,000 population whose council so desired, and upon request in smaller urban districts at its discretion. Some 300 local committees have been set up. In 1916 the Act creating the Ministry of Pensions brought the Statutory Committee with its entire sys- tem of local committees under control of the new 97 REDEMPTION OF THE DISABLED Ministry. By the Military and Naval War Pensions Act of August 21, 1917, the Statutory Committee was dissolved, and the Minister of Pensions was instructed to organize a new committee of 12 members to be known as the Special Grants Committee. Some of the functions of the old Statutory Committee were transferred to the new Special Grants Committee, and some were assumed direct by the Ministry of Pensions. The latter, and the Local War Pensions Committees, are "charged with the medical treatment or training for industrial life that a discharged soldier may need.'' In the country as a whole the Ministry of Pensions and the Special Grants Committee, and in local areas the local committees, are the agencies of coordination of all after-care work for disabled men. These com- mittees are organized by local county councils in accordance with schemes approved by the Minister of Pensions, and their membership is made representa- tive of different local agencies, even the disabled men themselves being represented. In order to provide more adequately for the diverse needs of the men, joint committees have been formed, composed of rep- resentatives of the local committees in a county or group of counties. Under the administration of these joint committees, the resources of larger areas are made available to the local committees operating within those areas. Three weeks before the disabled man is discharged from the local hospital as unfit for further service, he is visited by a representative of the local com- mittee of the district in which the hospital is located, and facts regarding his condition, capacities, handi- 98 EVOLUTION OF THE BRITISH SYSTEM cap, former employment, and need for training are recorded and forwarded to the local committee in the man's home district, together with a medical state- ment regarding his need for further treatment. When the man is discharged, the home committee undertakes to arrange for such treatment and train- ing as may be necessary. The man is not compelled to take training or treatment, but if he refuses to take the treatment recommended, half his pension may be withheld. He may have received some vocational training given as a therapeutic measure during con- valescence in the hospital before discharge from the service. After training is completed, the problem of place- ment is taken up. In each case the training has been recommended with a view to arranging for final place- ment in a wage-earning pursuit. The man is not en- couraged to train for any employment he may fancy unless it offers good promise of permanent employ- ment in the home community. When the training has been given in a workshop, it has been with the expectation that the man will be employed perma- nently in the shop. Some technical institutions have been acting on their own initiative in placing men when they have been trained, and the labor exchanges may be utilized for this purpose. Generally little difficulty has been encountered in placing men. Em- ployers have cooperated freely, and under present conditions demand is active for labor to supply the places of those who have been withdrawn from civilian pursuits to render war service. Liability-insurance companies have undertaken to insure employers who take on handicapped men 99 REDEMPTION OF THE DISABLED against accidents to their employees without increas- ing premium charges on account of the employment of such men. The companies thus assume any added cost of insurance arising from the increased hazard to the disabled man himself or to his fellows which the the disability involves, and by taking this action they have greatly facilitated the placement of retrained men. Cooperation between the Ministry of Pensions and other central offices is systematically promoted. The Ministry of Labor has cooperated in "arrangements for establishment of trade advisory boards and com- mittees, and for inquiries into different forms of em- ployments" that would be suitable for the training of disabled men and that would give fair prospects of remunerative and steady employment. The labor exchanges of this Ministry aid in placing trained men. The Board of Education cooperates in the organiza- tion of training in technical schools, and the Board of Agriculture in the "admission of disabled men to the agricultural training in colleges," and in advis ing upon "schools of training on farms" and upon settlement in farm colonies. Arrangements have been made with the Post Office for weekly payment of pen- sions and allowances by postal drafts. The Local Government Board has given assistance in various ways. Under direction of the Ministry of Pensions, the local committees control expenditure of the public moneys available and of such private funds as are locally subscribed, and it is principally through the local committees that the appeals are made for volun- tary subscriptions. It is still true that the flat-rate 100 Courtesy Carry On. THE SHOE-REPAlltING WORKSHOP AT ST. DUNSTAN'S HOSTEL FOR THE III.IND, LONDON EVOLUTION OF THE BRITISH SYSTEM schedule of pensions and allowances in accordance with which grants are made by the Admiralty and the War Office does not provide for or take into account individual needs, except as these needs are assumed to be fairly represented in the schedule. Individual cases of hardship are dealt with by the Special Grants Committee and the local war-pensions committees, which may provide such supplementary grants as are required for treatment or training. Great care is taken to inform the men that their State disability pensions will not be reduced by their taking training and so increasing their wage-earning power. The pension, once determined, is permanent and cannot be diminished. It may result, and in indi- vidual cases often does, that the pension, added to the wage of the disabled man who has been retrained, provides an income greater than that which he was earning before the war, and it is believed that the proportion of such cases may be large. Advisory bodies for assisting the Ministry of Pen- sions and the local committees in training and place- ment work have been organized locally and nationally. Trade advisory committees have been set up jointly by the Ministry of Pensions and the Ministry of Labor in the principal trades for which training is under- taken. These committees include in equal numbers representatives of employers and labor and one repre- sentative each of the two Ministries. They advise "as to conditions under which the training of dis- abled men in the trade can be best given; the best methods of training, the suitable centers for it, and generally how to secure uniformity in training." In trade centers local committees become known as 101 REDEMPTION OF THE DISABLED technical advisory committees, having been set up by the Central Trade Advisory Committee to advise the local war-pensions committee regarding suitable local schemes for training individual men and the prospects of their employment after training. These com- mittees also are made up of employers and representa- tives of labor. Local advisory wages boards also have been set up in the principal industrial centers under direction of the two Ministries. Each board is under a chairman appointed by the Ministry of Labor, and is composed of representatives in equal numbers of employers and of labor, together with not more than three members of the local war-pensions committee, who have no vote. The advice of these boards may be sought by em- ployers, by workmen and by secretaries of local com- mittees in regard to the adjustment of wages in individual cases. Great Britain is thus enmeshed with committees, and one result of the committee system has been to arouse interest and to enlist support generally throughout the community. Organized labor and em- ployers of labor have given full support to all schemes for training and placement of disabled men, labor insisting only that such schemes shall not be operated to impair union wage and living standards. While general instructions have been issued by the Ministry of Pensions covering the provision of train- ing for disabled men, these instructions, it is felt, are not sufficiently specific for all trades. Accordingly certain trades have been designated "special trades," and for them detailed instructions have been issued. The purpose of these special instructions is to regu- 102 EVOLUTION OF THE BRITISH SYSTEM late training so as not to conflict with the interests of employers or of labor. The number of men trained for each trade is carefully adjusted to the capacity of the trade to absorb the new men without disturbance of established standards. The character of the train- ing and the length of the course are specified in detail, as are the fees to be paid by the Government and, in cases where the training is given by employers in workshops, the wages to be paid to the man in train- ing as he acquires wage-earning efficiency. Maintenance allowances to the men and their families are continued during training, the amount being generally regulated so as to insure that the men shall not be financially worse off for taking instruction. In many cases, of course, they are much better off even during the period of training than they would have been if they had not taken it, since they may receive allowances during that time such as would be paid in cases of total disability, although they may be quite incapable without vocational reeducation of earning wages of equal amount. One is tempted to write down as a chief character- istic of the British system that very lack of system which has been designated the mere product of chro- nology and experience rather than of conscious plan- ning. Expressed more fairly, however, the chief characteristic of the British system is its flexibility and competency to deal with particular, individual needs. This element of flexibility is found chiefly in the exercise of free discretion by the Ministry of Pensions in approving expenditures covered by a fund placed at the disposal of the Ministry, and in the relatively 103 REDEMPTION OF THE DISABLED free exercise, under general supervision, of judgment on the part of each local committee in arranging and financing out of public or voluntarily subscribed funds all forms of after-care work. In a word, the British system insures the highest degree of flexibility in adjustment of treatment and training to special, individual needs, by making ample financial provision in the form of a central State fund applicable to the support of any scheme of training approved by the Ministry acting through the local committees; by utilizing all voluntarily supported private funds under State supervision; and by full cooperation of all public civil offices, central and local, and of all private agencies under supervision of central and local civil authorities. Individual needs and particular conditions obtain- ing locally are the factors chiefly regarded, and finan- cial support and control is thus found for very diverse undertakings. The training provided may be in workshops, under supervision and in conformity with special regulations, or it may be in regular or special classes organized in technical schools or in special institutions established by the Government. No rigid general plan is imposed which interferes with any special provision that in the individual case may be deemed beneficial. 104 CHAPTER IX RESTORATION WORK IN THE CENTRAL EMPIRES Germany well equipped for rehabilitation of the disabled — German Federation for the Care of Cripples — Besponsi- bility evaded by the Imperial Government — State and private organization — The restoration programme — Treatment in orthopaedic hospitals — Nurnberg hospital — Dusseldorf school — Schools for the one-armed — Placement — Percentage of cripples restored — Estimate of German losses — Policy of Austria-Hungary — Vienna orthopaedic hospital and schools — Policy of Austria — Policy of Hungary — The Invalidment. In a Government so highly centralized as was that of Germany, it is somewhat surprising to find the posi- tion taken that reeducation and care of the crippled soldier are not a governmental function. Responsi- bility for the wounded soldier, in so far as he requires physical and medical care, was admitted and dis- charged, but all responsibility for reeducation and return to civil life was held to belong to private charity, or to the different states of the Empire, if they cared to assume it. Germany at the beginning of the war was in much better condition to deal with the problem of rehabili- tation than any of the other belligerents. For many years she had been a leader in orthopasdic surgery and the rehabilitation of cripples, and possessed many specialists of international eminence in these lines. She possessed also a society of long standing, the German Federation for the Care of Cripples, whose membership comprised 58 cripples' homes, some of 105 REDEMPTION OF THE DISABLED which had a century of service behind them. There had been developed during the last half century 51 cripples' homes, ranging in size from six to 300 beds. These had among them 221 workshops, teaching 51 trades. The German system of social insurance also had devoted much study to the treatment and re- education of cripples. The sick-benefit societies and employers' accident-insurance associations had hos- pitals, which were also available. The Red Cross established orthopaedic hospitals at centers where needed, and in 1918 it was estimated that there were 200 institutions of the sort in the country, amply adequate to care for all war cripples. A few days after war was declared, at the request of the Empress, the cripples' homes threw open their doors to war cripples. The director of the Federa- tion began a tour of the country under the auspices of the Red Cross, urging the formation of voluntary committees for the care of war cripples, and spread- ing the doctrine which has become a fundamental of orthopaedic treatment, namely, that almost any crip- ple can be made fit to work again, a nd that education for work should be the regular treatment. Many volunteer committees were formed in cities, some of the states and provinces formed committees, and the work was started under various auspices and plans. The general local organization had so far pro- gressed that the Federation called a conference in February, 1915, to coordinate the work. Officials of the various states and provinces and representatives of the medical profession, teachers, employers, work- men, the military authorities, large social-welfare organizations, the Red Cross, sick-benefit societies, the 106 THE CENTRAL EMPIRES state accident-insurance associations, and so on, were present. The policy of the Imperial Government was made clear. This was, in brief, that the Government, through the Ministry of War, should be responsible for the wounded soldier in so far as he required physical care, but that all responsibility for reeduca- tion and return to industrial life should belong to private charity or to the different states of the Em- pire. There was a great deal of criticism in the con- vention of the Government's attitude, but as late as 1918 there had been no change. The states, prov- inces, local communities and private charity had permanently foisted upon them the burden and the duty of the Imperial Government in regard to the mutilated men who had been injured in upholding its cause. As the work proceeded, Army aumorities expressed great appreciation, and promised to consult with the private agencies as to the assignment of men to dif- ferent hospitals and not to remove or discharge men suddenly, without regard to the interests of their training. They also promised that private agencies should have facilities for visiting the hospitals for teaching and vocational advice, and that Army offi- cers should be instructed to cooperate in every way. There was a good deal of friction with local military authorities and many difficulties between individual commanders and the volunteer agencies in their dis- tricts, but apparently their relations were finally adjusted. The work has gone forward in various ways, the Imperial Government always evading the duty and unloading it on civilian, local and state charity and 107 REDEMPTION OF THE DISABLED sense of obligation. Germany has 26 states, and each state has its provinces. Bavaria alone of the states has financed and entirely directed the work within its borders, with the aid of advisory committees of local people who actually help. All of the Prussian prov- inces but one, which means about half of Germany, have initiated and directed the work, but with private cooperation and support, using to the full all existing schools, almshouses and hospitals; the provinces furnished the funds with the understanding that the Kingdom of Prussia, and ultimately the Imperial Government, must take over the burden. The city of Berlin assumed responsibility for its own cripples on the same basis, but there was no commitment from the Imperial Government, which merely donated the entirely inadequate sum of 5,000,000 marks. The Imperial Government asserted exclusive respon- sibility for medical treatment, through the Ministry of War, and all hospitals where wounded receive treatment were under military authority and dis- cipline. The principle upon which rehabilitation work pro- ceeds1 is that practically every cripple can be made fit to work again. This is accepted in Germany as a finality on the subject. The director of the Federa- tion for the Care of Cripples asserts that from 90 per cent, to 95 per cent, of all war cripples treated are returned to industrial life. Dr. Leo Mayer states that of 400 cases treated at the hospital of Am Urban, only two were unable to go back to work, but i The discussion following relates to conditions before the signing of the armistice: the status of the restoration work in the Central Empires since that time is unknown. 108 THE CENTRAL EMPIRES whether these were selected and hand-picked cases to demonstrate upon is not known. The whole German scheme of rehabilitation, then, is thus summarized: No charity, but work, for the war cripple. Cripples must be returned to their homes and their old conditions; as far as possible, to their old work. Cripples must be distributed among the mass of the people just as though nothing had happened. There is no such a thing as being " crippled " while there exists the iron will to overcome the handicap. There must be the fullest publicity on the subject; first of all, among the cripples themselves. There seems small difficulty in handling the men. This is due to the fact that they are partly under military discipline, and also that the schooling is started early, before the "pension psychosis" has taken hold of their minds. The appeal to them is a patriotic one, in effect, that no man is a worthy citi- zen of the Fatherland who does not use his will to overcome his handicap. A great deal of literature has been published to fix this idea among the cripples and the public as well; and the motto, ''The German will conquers!" is iterated constantly. Men are treated in the orthopaedic hospitals from two to six months, until they are ready to go back to the Army or are pronounced unfit for further work in the active military establishment. Even if re- ported unfit, the Army does not discharge them until they are pronounced fit to go back to civil life. But if a man has a relapse after his discharge, or if a further and expensive treatment might improve his condition, the military authorities take no further 109 REDEMPTION OF THE DISABLED notice of him. He is at the mercy of private charily, being rated now as a civilian. Reeducation and medical treatment are simultane- ous, for the reason that experience has shown that best results are had only by getting hold of the patient at the earliest stage of convalescence. The fact that the Imperial Government will not contribute any- thing toward reeducation is another consideration im- pelling the local committee to use the time the man is in the hospital as far as possible, for the purpose of saving on his maintenance. Trade training in the military hospital thus begins usually as soon as the man is out of bed. The local "care committee" of voluntary or privately supported workers sometimes has its workshops in the hospital, and sometimes at some place outside to which the men are transported daily. As every city has its technical school as part of the educational system, these furnish equipment ready to hand, and usually also a staff of teachers, specialists in vocational training. The hospital at Niirnberg is perhaps the most com- plete example of the manner in which Germany is handling the problem of reeducating and refitting her permanently disabled men. Most of the work is car- ried on in direct connection with the institution, al- though some work is done in connection with the city schools. The discipline being military, men are as- signed by the director to the shops to spend a certain number of hours each day. The civilian instructors do not attempt to force the assigned men to work, but the knowledge that curtailment of privileges or rations may be ordered by the military authorities is a compelling incentive; the example of other pupils 110 THE CENTRAL EMPIRES who are interested and making progress, however, is generally sufficient for even the most apathetic. In a few of the hospitals, notably the Kortan agricul- tural school, it has been possible to assign disabled soldiers — officers — as instructors, and in such cases the discipline is entirely military. There are 900 beds at the Niirnberg hospital, which occupies three buildings. These were not constructed for the purpose, but were turned over to the author- ities by the city of Niirnberg, furnished with all modern orthopaedic equipment. The facilities in- clude a large piece of land and 12 workshops. The shops are fitted with machinery and tools, the gift of patriotic manufacturers. The teaching is done by professional instructors, who donate their services, and by foremen from manufacturing shops whose ser- vices are donated by their employers. The instruc- tion is in two classes — general and theoretical in- struction in the schools of Niirnberg, and practical work in the hospital workshops. The branches taught under the auspices of the Niirnberg institution are typical. They embrace left-hand writing, improved writing with right hand, typewriting, stenography, commercial courses, general course for industrial workers, farm bookkeeping, theoretic course for building trades (carpenters, joiners, locksmiths, and the like), theoretic course for builders (masons, plasterers, plumbers), decoration and design, theoretic course for machinists, left-hand drawing, office management, practical work in shops, tailoring, painting, bookbinding, printing, locksmith- ing, shoemaking, saddlery, weaving (both hand and machine), orthopaedic mechanics, machine-tool work, 111 REDEMPTION OF THE DISABLED carpentry, farming, paperhanging, toy making, black- smithing, brushmaking. Each course has regular hours, and the teachers, volunteers from the various trades, demand that work be turned out that is strictly up to commercial standards. At Diisseldorf there are 50 hospitals. Here the local committee has taken possession of a school build- ing equipped with shops and tools, and offers 20 courses to men from all hospitals. Where the men go out from the hospitals for training, it is called "outdoor instruction" and is not under military discipline. Attendance is not compulsory, and men cannot be punished for misbehavior, but the school reserves the right to refuse pupils who are idle or are subversive of order. In addition to the courses given at Niirnberg, the Diisseldorf institution pro- vides instruction in general education, telegraphy, course for store clerks, agriculture, handicrafts, elec- trical work, metal work, carpentry and cabinet work, graphic trades (printing, lithography, etc.), card- board and leather work, plastering, upholstery, and dental laboratory work. It is considered in Germany that the one-armed man has the greatest handicap, and there are special schools for his training at Strassburg, Baden-Baden, Heidelberg, Munich, Wurzburg, Kaiserlautern, Lud wigshaven, Niirnberg, Erlangen, Frankfurt, Hanover, Chemnitz and Diisseldorf. A school for one-armed men means special courses for them, given in regular city schools where the men later will be taught trades. The course includes instruction in the ordinary acts of life made difficult by the loss of a hand. Six weeks usually puts a one-armed man in condition to go on 112 THE CENTRAL EMPIRES with regular training. One-armed teachers are em- ployed, and much of the work is in convincing the students that the handicap can be overcome by a little practice. Left-hand writing is given all who have lost the right arm, and excellent script is usually attained in from 12 to 20 lessons. Left-hand drawing, designing and modelling are usually added to impart deftness. Men are taught to use the typewriter, sometimes with a special apparatus added on the stump of the lost arm, and sometimes with a shift key worked with the knee. All the schools emphasize physical training, and at Heidelberg, under a regular gymnasium in- structor, the men do almost all the athletic feats pos- sible for two-armed men. The Heidelberg school has a list of a hundred occupations suitable for one-armed men, and believes that as a rule these men are able to continue in their old trades. Of those being re- educated at Heidelberg, only five per cent, have been obliged to take up another trade. It is held that the best opportunity is in a narrower specialization in the old trade; for instance, a carpenter can take up polishing and wood inlay, a tailor can become a cutter, and so on. The most important point is held to be for employers so to arrange their work as to reserve for one-armed men the places they are able to fill. There are ten agricultural schools for war cripples. The one at Berlin accommodates 200 and trains crip- ples as farm teachers. The instruction in the main is of that simple sort useful for small farms. The chief need is to fit the small peasant farmer to go back to his own holding where, with the help of his wife and children, he may manage truck gardening, poultry 113 REDEMPTION OF THE DISABLED raising, and the like. The possibilities of farm ma- chinery seem not to have been gone into. Among additional agencies, nearly all of the larger employers of labor, such as Krupp, are maintaining hospitals to take care of their former employees who return disabled from the front, and in many of these there is room to care for other disabled men. Work is provided after discharge according to the capabili- ties of the disabled men. Most of the large concerns have shown much enthusiasm. The matter of placement is simplified by the Ger- man creed that " a man must go back to his former trade, and if possible to his former position.'' There are several agencies to which the cripple can turn, but there is no uniform manner of fitting the men back into industry, the regular municipal system of employment bureaus working in conjunction with private enterprise and associations. The Government has an enormous number of places at its disposal, as the railways are Goverment-owned. The Government has promised that all disabled former employees will be taken on, if not in their old positions, then in kindred ones; and according to a late decision of the Government, these men are to be paid without consideration of their pensions. The Post Office will give all future agencies and sub- agencies in agricultural districts to war cripples, pro- vided they are fit for the position and wish to settle on the land. There are no reliable statistics of the general pro- portion of cripples who return to work. The German habit of bragging taints all their statements with sus- picion. However, the provincial care committee of 114 THE CENTRAL EMPIRES the Rhine Province for June, 1917, gives the follow- ing figures: number of unemployed cripples dealt with by the 43 local care committees under the pro- vincial committee, 927 ; of these there were, willing to work, 209; work shy, 92; temporarily unfit for work, 395; permanently unfit, 231. As to the proportion of cripples going back to their old trades, of 454 appli- cants for work at Coblenz in two months, the per- centage of men going back to their old trades was 89, although only 42 per cent, had so intended. At Baden, out of 204 applicants, 188 went back, although only 95 had so intended. In the first three years of the war, it is claimed, 20,000 cripples were taught the art of oxy-acetylene welding by Theo. Kautney, and these essential repair men were dubbed "Kautney's Army." In the Reichstag on April 23, 1918, General Schultze, Sur- geon-General of the Imperial Army, stated that only 1.5 per cent, of the German wounded die, and that 2,700,000 injured men had been restored sufficiently for military duty; there had been, however, 629,000 discharges from the Army for unfitness on account of wounds or disease, and to date Germany had to reckon with some 98,000 cripples. "Taking into consideration the German habit of brag, and the fact that "military duty" covers anything men can be employed at for the Army, from mending shoes to picking up scrap iron and brass on the battlefield or sorting it after it is brought back to the junk yards, the admitted damage to effectives was certainly 1,250,000 men, ex- clusive of the killed, before the beginning of the Picardy and Flanders offensives of 1918 and the sub- sequent fighting along the whole line. 115 REDEMPTION OF THE DISABLED The German casualties all told were more than six million, with total deaths of somewhere near two million — very likely more than two million, for much sanguinary fighting occurred after the latest obtain- able figures were published. The Cologne Gazette, al- ways a semi-official paper, stated on November 25,191S, that the total casualties reported up to October 25 were 6,066,769, of whom more than 4,750,000 were Prus- sians. This total includes the naval casualties, which were 70,000, composed of more than 25,000 dead, more than 15,000 missing, and nearly 29,000 wounded. The Gazette casualty list No. 1284, published on October 24, 1918, placed the number of dead at 1,612,104 and the missing at 772,522. The paper says that of the number reported missing, 180,000 may be considered dead, thus bringing the total dead up to 1,792,104. The paper calls the casualties among the officers "appalling." Up to October 24, 1918, it reported 44,700 officers killed, 82,460 officers wounded, and 13,- 600 missing, a total of 140,760; the Gazette points out the loss in officers alone exceeds the total casualties of Germany in the Franco-Prussian war of 1870, when the total German losses were 129,698. As German army officers were drawn in the main from the nobility, the seminobility, and families of social and financial prominence, it will be seen that these classes have been hard hit by the casualties. The official apportionment of casualties among the various contingents on October 24, 1918, which did not include casualty lists from the fighting on the western front after that date nor the considerable German losses in Palestine, was given by the Cologne Gazette as follows: 116 THE CENTRAL EMPIRES Prussia.— Dead, 1,262,060; wounded, 2,882,671; missing, 616,139; total, 4,760,870. Bavaria.— Dead, 150,658; wounded, 363,823; missing 72,115; total, 586,596. Saxony.— Dead, 108,017; wounded, 252,027; missing, 51,787; total, 411,831. Wtirttemberg — Dead, 64,507; wounded, 155,654; miss- ing, 16,802; total, 236,963. Navy.— Dead, 25,862; wounded, 28,968; missing, 15,679; total, 70,509. The famed German efficiency seems to have col- lapsed at the end of the war, as illustrated by the following news dispatch of December 26, 1918, from The Hague: A Berlin special correspondent telegraphs that Berliners taking their favorite promenade in Unter den Linden Sun- day afternoon witnessed a frightful and heartbreaking spectacle. The League of Wounded Soldiers organized a demonstration to protest against the low rate of pay. They receive a mere pittance and have to wait months for it. The grateful fatherland is very stingy toward its brave heroes. The old system of giving wounded soldiers hand organs still obtain in new Germany. These tens of thousands of men, broken by Germany's war, protest against the Berlin system, and Berlin witnessed a demonstration of wretchedness and misery such as the world had never seen. Tens of thousands of men, cripples for life, marched in fours at a pace regulated by cripples, unable to walk without crutches. Many were without one leg, many had lost both. These were followed by cripples without arms, then came the blind and men with faces injured so terribly that one woman fainted in the arms of the man accompanying her. I saw tears in the eyes of many onlookers. The dismal procession took hours to pass the ministry of war in 117 REDEMPTION OF THE DISABLED Leipzigerstrasse, where a deputation waited on State Secre- tary Bauer to ask for improved conditions. From the balcony Bauer announced to the wounded that legal channels were necessary; that provisional measures had been taken in the meantime to comply with the demands of the wounded. In November, 1914, the Ministry of the Interior of Austria-Hungary made the first move toward an organization to assist the disabled soldiers of the Dual Monarchy. For many reasons, but mainly that of diversity of linguistic and economic conditions, the care of the war disabled and invalids was entrusted to the various " crownlands," or states. A commis- sion for each crownland was created, its duties being to provide medical care and vocational reeducation for the war invalids of the crownland and the neces- sary facilities therefor. The institutes for the ad- vancement of industry which exist in every crown- land were ordered to cooperate, and the same order was given to all the public trade schools. A decree of the Minister of War dated June 8, 1915, made vocational reeducation of war invalids obligatory and defined the functions of the various agencies. The military authorities provide the wounded with all medical assistance, bear the cost of manufacture and repair of artificial limbs as long as the patient stays in the military service, and bears the cost of maintenance of the soldiers in non-military institu- tions. They keep the wounded under control until recuperated to capacity to work or until discharged as invalids. The military authorities, in cooperation with the civil authorities, provide the final treatment 118 THE CENTRAL EMPIRES and vocational reeducation. The civil authorities organize the employment service. A wounded man is not discharged from military service until he is able to return to a civilian occupation. The Government early proceeded to open ortho- paedic hospitals, at Vienna and other points. The Vienna hospital is the largest. It had 2,000 beds in January, 1915, and preparations were under way to add 1,000 more. It has been filled with patients since it opened. Reeducation is the principal purpose of this institution. The aim is to refit the man to enable him to go back to his former occupation or a related occupation in the same trade. This hospital claims to have attained this result in 95 per cent, of the cases treated. After having undergone preliminary treatment, each patient in the Vienna hospital is assigned to a workshop. There are 42 barracks capable of accom- modating 100 men each, and the shops are scattered among the barracks. In one of the halls is a col- lection of agricultural implements and machinery, with such modifications as are necessary to fit the devices for the use of men with artificial limbs, and the men who go into agriculture are encouraged to handle them. There is an estate in connection with the hospital where training in agriculture is carried on under the direction of a physician and a one- armed teacher. A special school has been created for one-armed men, directed by a one-armed architect. The Vienna schools for invalids do not attempt to turn out thoroughly skilled workers. The education is complete only in the case of the invalids who can be entirely restored to their former callings or adapted 119 REDEMPTION OF THE DISABLED to some easier branches of their former trades. The primary purpose is to find the most suitable occupa- tion for the invalid, and then to give him the pre- paratory instruction, the elements of a theoretic and practical trade education. The specialization in skilled trades is left to other institutions or regular vocational schools, with which arrangements have been made regarding the training of these men. Instruc- tion is given in photography, lithography, printing, compositor's work, metal working, electricity, motion- picture operating, and the like. The Vienna school is under military control, but the administration is mixed. The medical director is a military official; the technical director is not. These two direct all the reeducation work and advise the patients in the choice of an occupation. Patients are not discharged until able to return to the Army or to their former occupations in civil life. In the latter case, the patient does not leave the hospital before employment is found for him. In this placement of men, the hospital works with the public Board for Vocational Advice of Vienna and with representatives of the Ministry of Public Works. When the patient is an independent landowner or artisan, the hospital before discharge makes an inquiry to ascertain whether the revenue to be expected from his enter- prise would be sufficient for the support of the in- valid. All cases discharged are kept on the records of the hospital and observed as to conditions of work and earnings. The policy of the Austrian Government has been to handle the physical disablements in institutions of large size located in the large cities, usually in the 120 THE CENTRAL EMPIRES capitals of the various crownlands. At the beginning of 1915, such institutions were in operation in Prague, Reichenberg, Troppan, Teschen, Graz, Cracow, Linz, Mehor-Ostrian, and several of the larger industrial centers. The railways have an organization of their own to take care of injured employees and maintain a convalescent home as well. The placement of the rehabilitated was made a governmental policy on June 28, 1915, when a decree was issued causing the creation of an employment service in every kingdom and crownland of the Em- pire with offices at the various capitals. The effort is always made to get the invalid back with his former employer, or, failing this, to get the man back in his former occupation or one closely allied with it, and, if possible, always at the man's home or near by. Those injured men unable to return to their previous occupations are passed upon by the vocational council and if necessary transferred to the schools for in- valids. A record of each invalid is kept for at least six months after his placement, and his welfare is closely watched. If he is discharged from his em- ployment, the matter is looked into and reinstate- ment accomplished when possible. All injured men who are able to work and willing to work are main- tained until they are placed in positions. They are given board, lodging and clothes at the Vienna bar- racks and a small subsidy in cash. Men entirely dis- abled and incapable of work are assigned to special homes prepared for them. Employers are asked to give the invalids, even those with diminished capacity, suitable employment at fair wages. Invalids whose capacity has not been di- 121 REDEMPTION OF THE DISABLED minished are to receive the same wage as other work- men in the same group, and are to be covered by the same collective wage agreements whenever such are in force. Remuneration of invalids with diminished capacity is to be fixed by agreement between em- ployers and employees, or, when the employee deals with the labor organization, the terms are arranged between the latter and the employer. When work is paid for by the piece, no distinction is to be made between invalids and others, and the pension received by the individual from the military authorities in no case shall be taken into account. Appeals are issued to the working classes to help the returning invalid to develop his full capacity for work. In Hungary the problems of the war invalids were first attempted by the Red Cross and private organ- izations. This system was abandoned where a Gov- ernment institution called the Invalidment was created. The same law decreed that orthopaedic ap- pliances should be supplied gratuitously, and made the reeducation of disabled soldiers obligatory, the treatment and reeducation to last not more than a year. Final treatment and reeducation could be given in State institutions, or institutions under military control, or by the Hungarian Red Cross. Special reexamination commissions were established at Budapest, Pressburg, Kolozovar and Zagreh, ap- pointed by the Hungarian Premier from medical and industrial circles. Injured men refusing prostheses or treatment, or to follow the plans for reeducation, have to appear before these commissions. Those who persist in their refusal against the findings of the commissions forfeit all or a part of their claims to 122 THE CENTRAL EMPIRES pensions, except in the case of those who have been in active military service for ten years or more. All of the medical institutions were created anew under the Invalidment. The start was made at Budapest with four hospitals accommodating 4,500, and by the middle of 1916 there were over 10,000 places at the hospitals at Budapest alone. Similar institutions exist at Pressburg, Kolozavar, Kassar, and other cities. The school at Budapest is the largest, accommodat- ing 700 in 1916. The object of the education appears to be mainly to turn out independent small craftsmen. As high as 90 per cent, of the pupils are peasants, and the classes with the largest attendance are those for shoemakers, tailors, harnessmakers, cartwrights, lock- smiths, and cabinet makers. Illiterates are trained in reading and writing, and stenography and type- writing are taught in some of the schools. Similar institutes exist at Pressburg, Kassar and Kolozovar. At the Institute for the Blind at Budapest the in mates are taught carpet weaving, brushmaking, mas- saging, and the like. As there are a number of in- valids who cannot advantageously be placed in industry, special cooperative schools have been created to deal with them. An employment service is maintained by the In- validment which does not ask for private or local or trade cooperation. Casualties of the Austro-Hungarian armies from the beginning of the war to the end of May, 1918, accord- ing to official statistics, were slightly over 4,000,000; of these it is claimed that from all causes the total of lives lost was over 1,500,000. 123 CHAPTER X THE PRACTICAL CANADIAN SYSTEM First provision for Canadian wounded — The Military Hospi- tals Commission — Inception of vocational reeducation — The Invalided Soldiers' Commission—The civilian Depart- ment of Civil Reestablishment — Principles of the restora- tion scheme — Rehabilitation work completely demilitar- ized— Pension allotments unaffected by retraining — Vocational reeducation limited to the disabled who cannot return to their former occupations — Handling the return- ing invalids — Occupational therapy in the hospitals — The mechanism and process of restoration — Returning the disabled farmer to the land — Tree education without maintenance open to all soldiers not requiring retraining — Canadian casualties in the war. About the middle of 1915 the backflow of injured Canadians from overseas battlefields began to assume such proportions as to demand Government action. The Military Hospitals Commission was the first agency employed to handle the men invalided home. Civil cooperation was hearty. A chain of hospitals was created across the continent. There was no lack of accommodations or of proper treatment for the wounded and disabled. But when the hospital treat- ment was over and the man discharged, there seemed to be something lacking. A hearty, husky farmer lad, for instance, would be turned out of hospital "with a peg-leg and a pension." His abilities as a farmer were nullified almost entirely by his injury. He did not know anything else but farming and the utiliza- tion of his former brute strength. Seemingly, his future was that of a pensioned idler for the rest of 124 THE PRACTICAL CANADIAN SYSTEM his days, or if he worked at all, certainly in some occupation paying minimum wages. It seemed a great pity. Some of the Canadian authorities learned of what was being attempted in France in the reeducation of the disabled men so as to fit them for useful occupations in spite of their handicaps. The experiment in France, however, had not progressed far enough to be of much value as a guide to Canada. All that was known was that the work had been started and was apparently a success. Nevertheless, the Dominion decided to try it out. To quote T. B. Kidner, vocational secretary of the Canadian work: We knew absolutely nothing of this problem. We ob- tained a little information from France which was then in a very chaotic condition as far as vocational reeducation was concerned. We tried to obtain information from other sources. We had the experience of bodies which had dealt with it in a very limited way with industrial cripples, but there was practically nothing to go on. We tackled the problem by interviewing every man who came back to Canada and finding out what his needs were. It speedily developed that the problem was an individual one in every case, and that we could not establish any set of regulations, for instance, as to the kind of trade for which a man suffering from a certain disability was to be trained; but that we would have to try every individual case and study it in the light of the man's whole nature and of the opportunities he had had, and of the remaining pos- sibilities in him. And that is the beginning and end of our theories on the work. The rest of it has been evolved, usually out of a process of what a Avorkman would call " cutting and trying." Thus the Canadian system had its inception and thus it grew, practical always, and adapted to the 125 REDEMPTION OF THE DISABLED needs of the men of that country. In the evolution the Military Hospitals Commission became the In- valided Soldiers Commission, and a Department of Civil Reestablishment was created. This latter is a civilian organization which works with and in the hospitals, as well as out of them. It was ascertained early that the militarizing of the rehabilitation work would not do. The men had been too well trained as soldiers to unbend and confide in a commissioned officer or even in a sergeant. The men could not bring themselves to it — the effect of discipline was too strong and too lasting. There was a gulf which neither men nor officers seemed able to cross. But it was found that the returning men were eager to unbosom themselves to civilians and to turn to them for advice and help and counsel. Not that they did not respect and trust their officers or con- sider them as capable to advise, but military discipline discourages any except a formal relation which in a few months becomes habitual and ingrained. So it was determined early in the formative period of the reconstruction work that as a matter of fundamental policy, it would be strictly in all respects a civilian affair. To make a soldier, soldiers were needed; to unmake a soldier and turn him into a civilian again, civilians were required. Another necessary preliminary settlement had to do with the attitude of many of the men, who imagined that if they took training and thereby increased their earning power, the fact would be taken advantage of by the Government in adjusting the pension allowance for their injuries and might result in a decreased pension. The same idea, as we have seen, was preva- 126 THE PRACTICAL CANADIAN SYSTEM lent in France and in England. The Government promptly made it plain that no matter how much a man might be able to earn as a result of reeducation, his status as a pensioner would not be affected. The pension allotment is on the basis of the man's dis- ability in the open labor market and not on his earn- ing capacity in any particular occupation for which he may have been trained. The effect of this announce- ment was to remove any reluctance of the men to take training. The next step was to make it plain that a man would not be taught a new trade or given training leading to some new occupation merely as a reward of valor or because he had been overseas. Voca- tional reeducation at public expense is provided only for those who demonstrably cannot return to their former occupations with efficiency and good prospects of earning power. We have seen in another connection (Chapter V) that the Canadian survey of the problem developed the fact that more men were disabled in a medical than in a surgical sense, but of the subjects for re- education the division was about equal between the two classes. The problem was seen to be not so much that of the crippled or "dismembered" man; those were the simplest cases to deal with. It is the problem of the man with a complication of troubles. The surgical injuries run the gamut of wounds, but the medical cases present almost every possible organic trouble and complication. Canada was thus driven to the conclusion that the task of reeducation was one which must deal with each case individually; that there could be no hard and fast rules outside of the 127 REDEMPTION OF THE DISABLED main purpose to give the disabled men the opportun- ity of returning to civil life as efficient, wage-earning, self-supporting and self-respecting citizens who ask nothing except the chance to earn their living on their merits as workmen. The Invalided Soldiers Commission has wide au- thority "to see the men all the way back." To the civilian Department of Civil Reestablishment are en- trusted the vocational reeducation of the men who require it and the care of the tubercular, the insane, the chronic invalids and the blind according to their several necessities. The Commission also looks after the training that is given the injured man in the hospital, and endeavors wherever possible to coordi- nate the occupational therapeutics of the hospital with the reeducation the man is to receive later, so as to insure a continuous restoration process and the enlistment of the interest of the disabled man at the earliest possible moment. Officials of the Commis- sion are in the hospitals overseas and on the hospital transports coming home. Their business is to en- courage the wounded and disabled men, to acquaint them with the opportunities for remunerative work in spite of their handicaps, and to induce them to take up the training offered, for it is an entirely volun- tary affair. The men are assured that they will be fed, clothed, lodged, and given pay as well as re- education by the Government. The family allot ments and allowances are continued to the dependents of the man in training just as if he were still over- seas on the battle front. When a wounded man is invalided back to Canada, he is sent, to the military depot nearest his home. He 128 THE PRACTICAL CANADIAN SYSTEM is naturally anxious to see his people, and if he is able to travel, he is given a ten-day furlough to visit his home, exclusive of time occupied in going and com- ing. If further hospital treatment is needed, on return from the furlough the man reports to the designated hospital, usually selected by the author- ities on account of its proximity to the place of resi- dence of the patient's family or friends. The man, having talked the matter over with his family, decides to go in for reeducation, or perhaps he has not made up his mind definitely. In any case, as soon as possible after he gets to the hospital, he is seen by the "vocational adviser," who is an officer of the Invalided Soldiers' Commission. This adviser is under the direction of a higher official who is in charge of a certain area and is known as the "district vocational officer." Under him are the various hos- pital advisers and a medical man who considers each man's case with his adviser. If it appears that the injury will clear up in time and that the man will be able to go back to some phase of his former occupa- tion, the vocational adviser and the doctor endeavor to induce him to enter classes that will improve him and make him a more valuable man, even if he is not going in for a regular course of vocational reeduca- tion. In other words, the occupational therapy of the hospital is made to serve a practical purpose, and it has been the means of returning many a man to his calling much more expert than he formerly was. Workshops are connected with the hospitals for their curative value, and usually also there are classes for general education and for some occupations that may be taught without elaborate equipment, such as 129 REDEMPTION OF THE DISABLED drafting, bookkeeping, stenography and typewriting, and the like. If at the end of his hospital treatment the man is able to return to his former civil occupation, the voca- tional work with him is ended. But if his condition as a result of military service, whether because of wounds or of disease, is such that he cannot resume his former civil occupation, he then becomes a sub- ject for further reeducation at public expense. He is carefully examined and a record is made of the various occupations he has followed, his principal trade or occupation, and his education, mentality and capabilities. In considering his vocational future, special effort is made to ascertain the wishes and inclinations of the man himself, the idea being that unless the man is willing and really desires to go into the occupation for which he is being trained, it is more than likely that all effort will be wasted upon him. Often the man's own choice is not an appro- priate one. It is then the duty of the vocational adviser to direct him into something for which he can be trained with a good prospect of employment after the war, because, after all, the test of the success of training for a new job can be measured only by the ability of the man to hold it. The duty of the medical officer has been more to indicate the things the man is not fit for, from a medical standpoint, than to suggest trades to train for. For example, the medical officer may find that a man had suffered from epilepsy, and will indicate that the man should not be trained for any occupa- tion which would cause him to be near dangerous or rapidly moving machinery; or that he has perhaps 130 THE PRACTICAL CANADIAN SYSTEM become subject through exposure to recurrent rheu- matism, and should not be given a trade which would involve any amount of exposure. When it is established that the man must be re- trained, a committee composed of the vocational offi- cer, a special medical officer who has studied the case and considered the man's capabilities, and a third man, chosen because of his knowledge of local economic conditions and industries, the possibilities of employment and the likelihood of new jobs, sit on the case. The third man is not always the same. If a special trade is being considered, the third man may be invited because of his special knowledge of that trade or industry, the demand for labor and the prospects of steady work therein. The guiding thought of the board is: " Can we put him back in his own industry?" By returning the man to some branch of his former calling, his valuable training and education, obtained in the exer- cise of it, are not thrown away. If he cannot go back to his former occupation, he can often be fitted for some other branch of the same trade. For example, a structural-iron man, used to working on skyscrapers and iron bridges, may have a stiff knee, incapacitating him for his former job. In such case he would probably be trained as an office man in steelworks making the product with which he had formerly worked and was thoroughly familiar. The training would be some six months in a technical school, where, among other things, he would study shop arithmetic, shop mathematics, drafting, and related subjects. His knowledge as an iron worker is supplemented and enlarged. 131 REDEMPTION OF THE DISABLED If, however, the possibilities of the man's former line of work are exhausted, the board turns to some allied industry. As an instance may be cited the training of a former rough barn carpenter and wooden-bridge builder. He was rendered incapable of enduring exposure or heavy work, but with little difficulty he was made into an excellent factory cabinetmaker. The same general principle applies all along the line, in ascertaining what is best in view of the particular case, the history of the man, his trade knowledge and capabilities, and his personal preference. Farmers are given special inducements to go back on the land. They are trained as tractor and farm mechanics, as creamery men, in poultry raising and truck growing, both under glass and out of doors, and in various other branches of agriculture that can be followed despite the injuries. The Government is extremely anxious to get as many men on the land as possible, and under certain conditions will give homesteads and lend money to develop them. There are many hospitals in all parts of the Dominion that have shops and facilities of various sorts. Altogether the Canadian Government has been training disabled men in some two hundred occupa- tions. A great many of the returned soldiers want to take the training for reeducation, but the Government has thus far stuck closely to its original plan, the re- educating only of those who are so disabled that they cannot return to their former occupations. However, any man in a hospital may start on any appropriate course being given in the hospital, and thus better 132 THE PRACTICAL CANADIAN SYSTEM himself and increase his trade knowledge. The men are encouraged to do so, but this training ends when the man's hospital sojourn ends. He may continue it afterwards without cost to himself, but he cannot be allowed pay and family maintenance allowances. Men are given on discharge a bonus of three months' pay, and numbers of them, feeling the need of more specialized education in their trades, are taking the free education thus offered. The men are encouraged in every way to take it. Sometimes it happens that the trade selected is ascertained after the man has started training to be not suitable for him. The choice is then rectified and he is started on something else that promises to give the desired results in efficiency. Mr. Kidner has recently stated the problem as he views it: There are two opposite poles of thought in this question of dealing with the returned man. There is the man who says we cannot do too much for the returned man in the way of his reeducation, and that we should carry it as far as possible. Those are the men who would give the re- turned man a high-school education and a college course after it. On the other hand, there is the so-called practical man who says: " All you need to do is to train these chaps for a job in the quickest possible time!" And there are plenty of jobs today. The truth lies somewhere in between. There are certain men for whom the best thing you can do is to train them for a job and get them into the job and put Ihem to work. But, remembering that jobs are easily ob- tained at the present time, one must think ahead a little and say: " What are these men going to do when the inevitable economic pressure comes after the war, when, instead of there being three jobs for every man, there are three men 133 REDEMPTION OF THE DISABLED for every job."' So I think a medium plan should be adopted. We should always have before us the possibility of discovering men of exceptional talent and ability who have not found a way out before, and we should not limit the training which we give to exceptional men, but neitiier should we succumb to the temptation of merely training a man in the quickest possible way for a job in a factory, or some specialized industry; but we should give every man a little technical training along with his industrial training. Our average course in Canada — the average course in length, is about six and a half months, but where it is neces- sary to make a man efficient, we will put in longer time upon him. The course is also largely an individual matter, dependent upon the capacities of the student, and what he has to assimilate and master. There is ample machinery for placement; after the men have been reeducated, the proper authorities take them in hand and usually have them placed in wage-earning occupations within a few days after they are ready to take a job. The result has been that with the better wages the men receive by reason of having been made skilled workmen, they very often make much more than they did before the war when they were entirely whole, and with their pensions and earnings together are comfortably off in the way of income. By the cessation of hostilities Canaoa had raised, equipped, and sent overseas a total of 418,052 troops. A total of 220,182 casualties, with 60,383 dead, was suffered by Canadian forces up to December 31,1918, according to the official announcement made by the Canadian Government on January 2, 1919. Of this total, 9,989 were officers and 204,397 of other ranks. The list as issued is: 134 THE PRACTICAL CANADIAN SYSTEM Officers Others Total Killed in action............ 1,842 33,824 35,666 Died of wounds............. 614 11,806 12,420 Died of disease............. 220 5,185 5,405 Wounded................. 7,130 148,669 155,799 Prisoners of war........... ............ 3,575 Presumed dead............. 142 4,529 4,671 Missing................... 41 384 425 Deaths in Canada........... ............ 2,221 Totals.............. 9,989 204,397 220,182 Total deaths, 60,383. 135 CHAPTER XI AUSTRALIA, NEW ZEALAND, SOUTH AFRICA, AND INDIA Australian Repatriation Commission — State and local boards — Eegistration and retraining — Returning soldiers to the land — New Zealand Discharged Soldiers' Information Department — Preferential employment and placement of returned soldiers — Vocational retraining not popular — Facilities for agricultural, clerical and technical training — Reeducation in South Africa left to private initiative — The Johannesburg Relief Association — Training at the South African Military Hospital, near London —Imperial Indian Relief Fund — Queen Mary's School at Bombay. In the first years of the war, the work of '' repatria- tion," as it is called, in Australia was entirely in the hands of private philanthropy and patriotism. An Australian Soldiers' Repatriation Fund of con- siderable proportions was raised, but it finally be- came evident that private efforts were not meeting the problem. They were diverse and divergent, without central cohesion or authority. The conviction grew that, as the country had called the men for overseas service, the Nation should direct their return to and establishment in civil life. As a result, the Australian Soldiers Repatriation Act was passed by the Commonwealth Parliament in September, 1917, placing the whole work in the hands of a Repatriation Commission of seven members. The Minister of State for Repatriation is chairman, and two of the members are returned soldiers. The Commission's duty is to plan the general course of repatriation and supervise the work of putting it into 136 OTHER BRITISH DOMINIONS effect. The active work of carrying out the plan is done through state repatriation boards, which, under the Act, are established in the capital of each state. Each state board has seven members, all appointed by the Governor-General, and each board has as members two returned soldiers or sailors. Under the direction of the state boards are district or local boards. The Repatriation Commission was authorized by the Act to take over all the properties and securities of the Australian Soldiers Repatriation Fund, but all sums needed for carrying on the work are appro- priated by the Government. No voluntary contri- butions are sought for the central Fund, this being supported by the national treasury, but local com- mittees are given rather a free hand in raising and disbursing funds, except that their activities are con- trolled and their books are audited by the state boards. The first duty of the Repatriation Commission is to register the condition and requirements of all re- turned soldiers before their arrival in the country. The voyage out on the returning transports is utilized for this purpose. All registrations of soldiers that show a need for help are dealt with by the state boards assisted by local committees. The latter are expected to investigate employment opportunities and they use the system of placement agencies for the returned men. Curative workshops are attached to the larger hospitals, and advanced technical training is given to those who are so disabled as to require it. For the totally disabled, homes are established for those who choose to become inmates, and a special allowance of 137 REDEMPTION OF THE DISABLED 10s. a week is granted those who prefer to be cared for by relatives or friends. Artificial limbs are pro- vided by the Government military authorities. The matter of establishing men upon the land has received a great deal of attention. Probably in none of the countries engaged in the war has there been a higher percentage of men who desire to get on the land. A questionnaire submitted to the Australian soldiers brought replies from 40,000 who wished to become land holders and cultivators. At a confer- ence held in February, 1917, between representatives of the Commonwealth and the state Governments on the subject of land settlement as a repatriation measure, a plan was worked out whereby it could be accomplished. As the states possess the crown lands, have land departments and control land legislation, they undertook to provide the land and place the soldier settlers on it. The Commonwealth Govern- ment was to have as its part the lending to each settler of a sum of money sufficient to enable him to make improvements and buy seeds, plants, stock, and the like. The usual limit of advance is 500Z. sterling but in some cases 750?. sterling is allowed. The land is usually given free for the first five years; after that period small payments are required. The money for equipment is loaned at seven per cent., of which five per cent, covers the interest charge and two per cent. goes toward amortization of the capital amount. It has been agreed also between the Commonwealth Government and the states that training farms should be established in order to equip the soldier settlers in some measure for their new tasks, the cost of such 138 OTHER BRITISH DOMINIONS training farms to be divided equally between the Com- monwealth and the state. The Government of New Zealand has established machinery called the Discharged Soldiers' Informa- tion Department, which is charged with obtaining em- ployment for returned soldiers and assisting them by every possible means in the readaptation to civil life, with especial reference to the men who have suffered impairment of earning power and are perma- nently disabled. The Department is actively as- sisted in its work by local committees in all principal towns. These committees are composed of influential citizens and representatives of local patriotic societies. They afford an enormously valuable assistance in dealing with particular cases. New Zealand is able, by reason of her geographical location, to obtain complete data of every man in- valided home. The long voyage of the transports gives time for every man to be recorded and classified and a full report of his case card indexed before arrival at a home port. The Government has instructed all of its depart- ments that ex-members of the expeditionary forces are to be given preference for all vacancies they are qualified to fill, and the Information Department has conducted a propaganda to obtain preference in em- ployment opportunities for the returned men. All agencies have been utilized — farmers' unions, patriotic organizations, local authorities, and private employers have all been interested. The Department keeps a card index of men waiting for employment, one set being classified according to occupation and 139 REDEMPTION OF THE DISABLED another according to residence; offers of employment also are suitably indexed. A statement of the number of candidates for em- ployment in each district is sent weekly to the local committee. Up to January, 1918, the total number of men registered was 14,240, this including the gen- eral type of invalid as well as physical disablements. Of this total, 10,195 cases had been disposed of, that is, had found employment, returned to old employ- ment, rejoined the forces, failed to reply to repeated communications, or left New Zealand. There were 1,420 cases in course of being personally interviewed — men not ready for work, and the like. There were 219 on the register of those wanting employment, this class being composed mainly of men who had just been discharged. There were 2,406 recorded as "not ready for action" — men not discharged from the Army, and 2,000 of this number represented a con- tingent that arrived in the two weeks preceding the date of the report. The efforts to get the men to take special training are reported as "not encouraging; and the response has been indifferent." The Department endeavors to dissuade men capable of more skilled occupa- tions from taking on such casual employment as those of messenger and elevator boys, but many of the returning soldiers decline to avail themselves of the facilities offered for training in new trades. One of the reasons, entirely erroneous and unfounded, is given as fear that the man's pension will be cut down if he increases his earning capacity. Arrangement has been made with the Department of Agriculture to take on a limited number of men 140 OTHER BRITISH DOMINIONS for instruction at state farms. Here will be taught dairying, fruit farming, cropping, poultry raising, bee culture and market gardening. In scientific training, Lincoln College, at Wellington, takes a limited number of students in agricultural and pastoral subjects. Clerical training for disabled soldiers is provided free of expense to the Govern- ment or the men by the New Zealand Society of Accountants. Reports are that '' a considerable num- ber have entered the classes, but with few exceptions the attendance has been desultory and progress poor, and it has lately been intimated to the Department that the council of the Society is now considering whether it is justified in continuing the expenditure of some hundreds of pounds sterling, for such un- satisfactory results.'' Disabled men incapacitated for returning to their former occupations are offered free tuition at the various technical schools through the country. At Wellington Technical College, courses are provided in building construction, painting, decoration and sign writing, carpentry and joinery, plumbing, ma- chine work, jewelry making, metalwork, plastering and modelling. Training for the disabled soldiers has been inaugurated also at the technical schools at Christchurch, Dunedin and Invercargill. The most popular subjects are reported as being wool-classing and machine-tool work. Up to December, 1917, there had been enrolled in reeducation classes only 63 men. Men partially or totally blind are given training at the Jubilee Institute. The Government grants to men taking training a "training allowance" of one pound per week, irre- 141 REDEMPTION OF THE DISABLED spective of pension payments, and the Government has allowed disabled men to accept positions at rates of pay less than those fixed by current awards or agreements and minimum-wage legislation. The Cov- ernment also allows the training of disabled men in private factories; this legislation was necessary be- cause of the peculiar labor situation in New Zealand. The establishment of special schools for the re- education of war cripples has been urged by various individuals and organizations. The minister in charge of the Discharged Soldiers' Information De- partment, however, declined to approve or support the scheme, giving as his reason the very limited use that had been made of existing facilities and the un- likelihood that special buildings, apparatus and insti- tutions would be used to any greater extent. Be- cause of the doubt that the results would justify the expense, nothing has been done toward creating special schools. Men of the British forces disabled in operations in Africa are given medical care in hospitals in prin- cipal centers of the Union of South Africa. Those requiring artificial limbs are sent ultimately to the hospital at Richmond, near London. No provision appears to have been made by the Union Government for the reeducation and place- ment of disabled men. The matter is left to local and private initiative. In Capetown and other places there are local boards for vocational education which attempt to provide both reeducation and employ- ment. In other places associations have been formed for the purpose of finding work for and extending 142 OTHER BRITISH DOMINIONS general relief to discharged and returned men. The association at Johannesburg is reported to have ob- tained a promise from the Union Government that no man would be discharged from the base hospitals until he was fit to receive civil employment or his relatives were willing to undertake his care. In 1917 the Johannesburg Relief Association organ- ized for the care and relief of returned soldiers and declared reeducation of these men to be one of its chief purposes. Plans were made to ascertain the capabilities of each man, decide the proper class of work for him, and so on. The training was to be given in technical institutions and in public and private workshops. A survey of these facilities was made, preliminary organization work done, and em- ployers interested and asked to give places to the men. The South African soldiers disabled in military operations in Europe, on the other hand, are well taken care of as regards reeducation. At Richmond Park, near London, the South African Military Hos- pital has been in operation for some time. To enter the course of training is optional, but having entered, the man must submit to military discipline and incur military penalties for failure to obey the rules. The idea of obtaining the benefits of reeducation has ap- pealed strongly to the South African disabled and the percentage of those going in for reeducation is as high as 90 per cent. The work begins at an early stage of convalescence. When a man arrives at the hospital he is classified in one of three classes: (1) certainly unfit for further military duty; (2) doubt- ful; (3) expected to become fit. If he falls into the 143 REDEMPTION OF THE DISABLED first class, his reeducation commences at the earliest possible moment. The curriculum is varied and broad. It includes bookkeeping, shorthand, typewriting, secretarial work, accounting, metal working, carpentry and cabinet making, electricity, stationary-engine operating, and the like. Only instructors of high skill are em- ployed. The result is that work fully up to expert standards is turned out. The men realize that they are being given an extraordinary opportunity, and they are very anxious to avail themselves of it. The training does not cease when the men are dis- charged from the hospital. Quarters have been pro- provided on the grounds where those not needing further hospital treatment can live comfortably until they finish their courses. They remain in uniform and under military discipline as long as they are in the school. A number of the graduates have passed examinations of the London Chamber of Commerce and the National Union of Teachers. The Imperial Indian Relief Fund, among other functions, has that of extending relief to permanently disabled soldiers and their families. Bureaus have been established at various centers for the employ- ment of disabled men, for placement purposes, and the like. Chambers of commerce and such associa- tions are cooperating in finding civil employment for disabled, discharged and pensioned soldiers. There are military hospitals at Bombay, Cawnpore and Umballa, and Red Cross hospitals at Mussorie and Delhra Dun. The marine hospital at Bombay takes care of all cases requiring artificial limbs. 144 sf: ■ i B ■* ■ ! i < j 1 * - ': Courtesy Red Cross Institute fur Crippled and Disabled Men, HINDUS WITH LEO AMPUTATIONS LEARNING TO OPERATE KNITTINO SCHOOL, BOMBAY, INDIA MACHINES, QUEEN MARYS TECHNICAL OTHER BRITISH DOMINIONS Orthopaedic and organic treatments are given at the other hospitals. In May, 1917, a technical school for disabled soldiers was established at Bombay, called Queen Mary's School. Funds were raised mainly through efforts of Lady Willingdon, wife of the Governor of Bombay. The institution accommodates 200 men. Disabled soldiers in various parts of the country who want to attend are provided with railway fare, a return ticket and traveling expenses. The school is under joint military and civil administration and finance. The military authorities defray the charges of fitting artificial limbs and teaching their use. The educational side of the work is under civilian auspices, the cost being met in part by the Bombay Women's Branch of the Indian War Relief Fund and in part by private subscriptions. Training courses average six months in length. The selection of a trade to train for is optional; each man takes that which most appeals to him and in which he thinks his chances are best. The men are fed, supplied with clothes and given quarters, and those graduating in a trade re- quiring tools are usually supplied with a set on leaving. Among the subjects taught are tailoring, hosiery knitting, dyeing, making of artificial flowers, car- pent r}7-, elementary engineering, motor-car mechanics, stationary engineering, agriculture, poultry farming, truck gardening, and the like. A placement com- mittee is attached to the institution, constantly en- deavoring to find employment for the men. They are used as tailors in regiments and at Army clothing departments and as chauffeurs in the Army mechani- 145 REDEMPTION OF THE DISABLED cal-transport departments. Others are used as turners, fitters, machinists, engine drivers, ammuni- tion-box makers, and the like, in Government dock yards, ordnance factories and arsenals. Private factories and workshops also absorb numbers of them. It is estimated that the skilled men are able to add from 20 to 100 rupees per month to their pensions as a result of their training and subsequent placement in some line of work. 146 CHAPTEE XII ITALY AND HER SPECIAL PROBLEMS Italy unprovided with facilities at the beginiiig of the war — The Milan Institute dei Bachitice — Provincial and local committees — Voluntary national federation of commit- tees— National Board for the Protection and Assistance of War Invalids — Its creation and functions — The national rehabilitation system — Placements after restora- tion — The disabled and accident insurance — The prob- lem of illiteracy — Courses in the handicrafts — National War Cripples Association — Italian casualties. Italy at the beginning of the war had practically no facilities for the work of caring for and rehabili- tating disabled men. There were few social organ- izations competent to undertake it; there were only a few homes for cripples, really no system of educa- tion for them, and no factories for the manufacture of artificial limbs. Diverse and scattered private agencies began the work, and these initial efforts were later adjusted and coordinated for the work in hand. The Milan Institute dei Rachitice, which served as a model for succeeding institutions, was the only institution really started to meet the emergency dur- ing the first year of Italy's participation in the war. A provincial committee was organized in Lombardy in connection with the Milan Institute for the purpose of giving orthopaedic treatment to injured men. This committee was planned to work in close cooperation with the military authorities, and the institution was made a military reserve hospital, the officers being given military rank. Men were sent there direct 147 REDEMPTION OF THE DISABLED from the field hospitals and given orthopaedic treat ment under military discipline. The Government and the Lombardy committee shared the expense of buildings and upkeep, the Government paying an agreed sum per day for each man's board, and the committee making a small allowance to the man. After the men have been given orthopaedic treatment, if they desire it and the committee decides they are suitable subjects for vocational education, they are transferred to a subsidiary convalescent home for trade training, this also being carried out under military control. The choice of trade or occupation is voluntary with the patient. In November, 1917, there were in all 24 provincial committees operating on the Lombardy plan, capable of accommodating about 20 per cent, of all the war cripples. There was no coherency among the pro- vincial committees, and the lack of coordination led to the formation of a voluntary national federation of committees for the assistance of blind, lame and crip- pled soldiers. Its function was, in the main, ad- visory, and the local committees were independent of it. These local committees have no common standard of organization. In Lombardy and in Sicily, for in- stance, there is only one committee for the whole province and the work is concentrated in the largest city; in other provinces there are groups of small committees working in coordination and running sev- eral small separate schools. The main function of the federation was to coordinate and supervise the work of local committees, to inform them of new de- velopments in the work, and to devote its main ener- gies to legal measures for the care of war cripples. 148 ITALY AND HER SPECIAL PROBLEMS A monthly magazine was published by the federation, handling topics of special interest. The Italian Government on March 25, 1917, passed a law creating the National Board for the Protection and Assistance of War Invalids. This law is the real basis for Italian reeducational work. The scope of authority of the Board is to provide medical treat- ment if treatment supplementary to that given by the Army medical authorities is needed, and to afford material relief for reeducation, placement, claiming and adjustment of pensions. The National Board, which replaced the voluntary federation of committees, did not take over these duties. It is supervisory and cooperative, and fills in gaps where they appear. The schools of reeduca- tion remain under the management of local commit- tees, the Board acting in a supervisory and inspect- ing capacity. It issues charters to new committees and calls in those previously granted when suitable standards are not reached. The Board is composed of 19 members. Four are elected by Parliament, two Senators and two Depu- ties. The Crown appoints the other 15 on the sug- gestion of the Prime Minister, as follows: five minis- terial nominees representing the ministries of the Interior, War, Navy, Treasury, and Industry and Labor; two nominees of the Surgeon-General possess- ing special technical qualifications; three nominees of the volunteer associations for the care of war crip- ples; and four elected by the National War Cripples Association. Annual appropriation is made for the support of the Board from the budget of the Ministry of the 149 REDEMPTION OF THE DISABLED Interior, and it is under the direction of the Minister of that governmental division. A report must be made to him annually which he is required to present to Parliament. The headquarters of the Board is in Rome, the office quarters and force being supplied by the Government. It is supposed to have an author- ized representative in every locality and thus work in close connection with all the societies and institu- tions over the country having to do with war cripples and their rehabilitation. The law creating the National Board prescribes generally the system for treating cripples in all parts of Italy. After the first surgical treatment, cripples are to be sent to one of the nine military reserve hos- pitals for orthopaedic treatment, located at Turin, Milan, Genoa, Verona, Bologna, Florence, Rome, Naples and Palermo. The soldier in each case is to be assigned to the hospital nearest his home, or when this is not possible, to the next nearest. At these hospitals the men are given functional reeducation, massage and mechano-therapy, and furnished with temporary artificial limbs at the expense of the Gov- ernment. When the cure has progressed to a point at which reeducation can be commenced, the patient is given usually a month's leave and allowed to visit his home. On the expiry of the furlough, those designated by the hospital as capable of reeducation must present themselves, under military orders, at the nearest re- educational school. The men not so ordered are only those hopelessly crippled or those who have given proof that they do not need reeducation or can attend to their own rehabilitation. 150 ITALY AND HER SPECIAL PROBLEMS Under the law the compulsory stay at the school is limited to 15 days. In that time the man is fitted with his permanent artificial limb or other apparatus, which is selected for him by the Government experts. During the time of adjustment, the authorities bend every effort to convince him of the value of reeduca- tion. If he agrees to take the training, he remains under military discipline; if he refuses, he is dis- charged by the local military authority and must shift for himself as best he can with his pension. When a man is accepted for reeducation, he re- mains a member of the Army, and may stay at the school pursuing his course for a maximum of six months. The Ministry of War pays the school for his maintenance, and maintains his family at the same rate as though the student were in active ser- vice. If the training is not complete at the end of six months, the Board may keep the student longer at its own expense. If ready to go sooner, or if he is unruly or proves to be unfit for training, the local military commander may discharge him at any time. When a man enters the school, a committee consist- ing of the head physician, director of the school, and an inspector from the Ministry of Industry and Labor or a person designated by the National Board passes upon his case. Proper consideration is given to the wishes of the cripple or his relatives or repre- sentative and of the representative of the War Crip- ples Association attached to the staff. The trade the man is to be trained for is then decided upon. The same committee decides when a man's training has been completed, and authorizes his dismissal from the 151 REDEMPTION OF THE DISABLED school. A cripple leaving the institution, after hav- ing done conscientious work and become really able to support himself, may be given a money prize by the National Board. After discharge from the schools and the Army, the National Board is expected to assist the cripples. Those needing continued medical care, on account of developing illness or relapse, are provided for in con- valescent homes. For men who have no families to return to, yet require some looking after, it pays board in private families, who are required to render regular accounts and reports to the Board. For all men capable of earning their own living, the Board is supposed to find positions. Public employment bureaus are subsidized by the State, and provincial and communal employment bureaus also are expected to attend to the placement of war cripples without charge. All employees in civil service or in charitable in- stitutions who have become war disabled have a right to reinstatement if physically able to do the work. A list of civil-service positions to be reserved for war cripples has been published. Men applying for them must have a physician's certificate that they are able to do the work, and of such men the most eligible will be chosen. In competitive examinations for civil- service positions, other things being equal, war crip- ples will be given the preference. Private firms are obliged to reinstate their employees crippled in the war if the employee can pass an examination, medi- cally, proving fitness for the particular work. The examination and the certificate are furnished by the National Board, which also arbitrates between the 152 ITALY AND HER SPECIAL PROBLEMS cripple and his employer in case the latter refuses reinstatement without reason. The National Board looks after the interests of cripples in settling pensions or in any legal difficulties in which they may become involved, and also acts as guardian for those of unsound mind. It is the means of procuring loans for injured soldiers on the security of their pensions to be used for the purpose of buying land. Pensions are not to be affected in any way by either reeducation or employment of those receiving them. Accident-insurance companies are obliged to insure war cripples on the same terms as any other work- man, and the companies are not allowed to charge a higher premium to stores or factories where war crip- ples are employed unless the number of these passes a certain proportion. If there is a particularly large number of war cripples in any establishment, a slightly higher premium may be agreed upon with the Ministry of Industry and Labor. The problem of reeducation in Italy is complicated by the fact that 80 per cent, of the population are peasants with no background of experience in any trade and very illiterate. The result is that the re- education schools must include a much longer ele- mentary-school course than is required in other countries, and that the trades taught cannot be so advanced and specialized. The character of the Italian school is formal and institutional, in order to impress the primitive minds with which it has to deal. The general plan of the schools has more in common with that of a regular public school for children than with those in Germany, for instance, where the dis- 153 REDEMPTION OF THE DISABLED cipline is not military and the trades taught are suited to mature and experienced men. Most of the Italian students reside in the schools under military discipline, although day pupils are taken. The men are required to take an elementary course when necessary, and an intermediate course before beginning a trade. On finishing each course they are graduated with ceremonies, and given a diploma before being promoted to the next. On completing the school work, they receive a certificate stating their fitness to follow a trade and support themselves, and usually are given prizes from the committee and chief citizens of the town. It has been found that these ceremonies are a decided help in keeping up the men's interest and pride in their work. This opportunity for education, even though com- pressed into the short space of six months, has proved a great opportunity for the illiterate peasants of Italy. It means a mental discipline and a founda- tion of learning that is foreign to the small, remote hamlets from which many of them come and to which the feeling of national unity has not really penetrated. Many of the promoters of these schools feel that the seeds of national development and real patriotism are being planted thereby. Much is expected of private initiative. Each school is under the direction of a volunteer local committee which works in close touch with the National Board. Its work includes founding the school, arousing public interest in it, attending to the practical direction with help in discipline, raising funds to aid in its support, and placing the men when they leave. The National Board supports the committees and stimulates their 154 Courtesy Red Cross Institute for Crippled mid Disabled Me ITALIAN SOLDIERS WITH LEG AMPUTATIONS BEING TRAINED AS TAILORS BY THE NAPLES COMMITTEE FOE WAR CRIPPLES ITALY AND HER SPECIAL PROBLEMS organization in the areas where none exists. The National Board operates an employment office to help the local committees in the placement of graduates of the reeducation schools, and publishes employment in- formation in its bulletin. The trade school of the Institute at Milan accom- modates 500, and the courses are basketry, leather work and inlay, tailoring, shoemaking, wood carving, making of wooden shoes, saddlery, broom and brush making, telegraphy, and general mechanics. The courses are adapted to the Italian civilization, which includes a larger proportion of handicraft trades than that of any of the other countries, with notable special- ization work, such as at Florence, which is celebrated for its toys, Venice, long famed for its art in wrought iron and stamped leather, and other points that are famed for particular handicraft work of one kind or another. Italy recognizes her backwardness in agriculture, and in five of the schools — Perugia, Palermo, Spezia, Turin and Padua, agricultural courses have been in- stituted, with indications that, owing to its im- portance, this education will be given in all of the institutions. It has been difficult to convince the Italian cripples of the value of reeducation. At Bologna 28 per cent. of the men eligible refused to take it. "The con- servative peasant mind," declares an Italian report, "is hard to appeal to." Military discipline in the schools appears to be the only workable plan, and even under this system 12 men were expelled from the Bologna institution for various causes in one year. The idea of the value of reeducation does not 155 REDEMPTION OF THE DISABLED seem to sink into the mentality of many of them, but it must be considered that the percentage of ignor- ance and illiteracy is perhaps higher in Italy than in any of the other leading Allied countries. Italy, although late in entering the war, has never- theless developed in a remarkably short space of time, efficient facilities not only for caring medically for her disabled, but also for conserving them economically and vocationally. The work is progressing, and the war cripples of Italy have formed a National As- sociation with headquarters at Milan. The spirit of brotherhood is being fostered, and the Association also acts as intermediary between cripples and em- ployers, maintaining the rights of its members when neglected either by the Government or by the public. An officer of the Association declared at the time of its organization: Our country will be grateful for the defense we have given of her glory and her spirit, but we shall be even more worthy of her if, united in a firm organization, we regain the strength and will to be real men, useful to ourselves and to our families. The eyes of all are turned toward us, as of the elect, and this high consideration should guide us to right conduct and straight living. The Association will be the kindly guardian of every member, but it will not hesitate to take stern but necessary measures against all of those who fail in their civil duty. Salvatore Barzilai, former member of the Italian Cabinet, who accompanied King Victor Emmanuel to Paris for the preliminary peace discussions, stated in Paris on December 21, 1918: Italy lost 500,000 dead. To those actually killed in battle must be added 300,000 who died of disease, particularly 156 ITALY AND HER SPECIAL PROBLEMS malaria contracted in Albania, Macedonia and along the Piave. The severely wounded numbered 300,000 while 500,000 of the 5,000,000 called to the colors were taken prisoner. Minister of War Zupelli declared in the Italian Senate on December 14, 1918, that 15,600 Italian officers had been killed, and more than 30,000 wounded severely. He also asserted that Italy had more men under arms, proportionate to population, than any other nation. The problem of redemption was made more serious in Italy by the fact that a large preportion of the population was illiterate, which made it necessary to begin the work from the bottom up. For Italy the war, in spite of its loss of life and hardship, has proved in a certain measure a blessing. Many a crippled Italian soldier is today better off than he was before he received his injury. The benevolence of the Government has done much to stimulate education among the masses, who now see it demonstrated to them that even a one-armed man with training can earn better wages and is a happier citizen than a whole man or boy who grows up in ignorance. The effect cannot fail to be beneficial to the population as a whole. 157 CHAPTER XIII THE PROBLEM COMES TO AMERICA The United States as a neutral — Slight interest in rehabilita- tion work abroad — Its importance to the belligerents — The spirit underlying their restoration schemes — Entry of the United States into the war — An agency for the redemption of the disabled at hand — The vocational- education movement in the United States — The Federal Vocational Education Act — The Federal Board for Vocational Eductaion — Its composition and functions — Its early war service — Its immediate availability. Before the entry of the United States into the war, no particularly keen interest was manifested in this country in reports of what the belligerent nations were doing for their wounded and disabled men. There were occasional newspaper articles that ex- ploded shell fragments, shell cases and other metals were salvaged off the battlefields to be remelted and used again. Occasionally also there were reports of the retraining of disabled men in France and Belgium. One item made about as much impression as the other. Possibly, to our practical mind, the salvaging of the scrap metal made the deeper impression, for men at that time seemed fairly inexhaustible, and metals were becoming scarce. It was quite otherwise in the belligerent nations. As the war went on and the awful drain on man power grew more acute, the work those injured men were doing rose rapidly in importance. As soon as it became apparent that disabled men could be trained to do some kinds of essential war work and thereby 158 THE PROBLEM COMES TO AMERICA release able-bodied men for active service at the front, the various Governments became keenly alive to the residual usefulness of their disabled soldiers. Although not able to operate the guns on the battle line, they could certainly make ammunition with which to feed the guns. They could help make the guns, the shoes, the uniforms, bayonets, gas masks, small arms — indeed there was scarcely a process of the whole vast lot of things to be done to supply the armies for which the injured could not in some way be used. It only required a sort of evolution of placement, a sorting out of available man power for the tasks each man was fitted to perform most use- fully to his country. On account of their tremendous value as economic reserves disabled men first won their way into the real solicitude of the warring nations, and despite their injuries they were transformed in the main from a liability into an asset. The viewpoint in regard to the wounded soldier changed very rapidly. Having proved themselves abundantly capable of doing valua- ble work after being retrained, the conclusion was inevitable that if these men were of value economically in the stress of war, doing specialized work and doing it as well as sound men physically, their value would be just as great after the war when the whole system of manufactures and commerce would be desperately in need of every man who could contribute in some particular way, creatively, by knowledge of manual process or labor, to the resumption of the occupations of peace. With this sound basis of value established, the bellig- erent nations began to develop a new interest in the 159 REDEMPTION OF THE DISABLED wounded and to devote more attention to the con- servation of their human resources. The subject be- came one of lively moment, and facilities for re- educating disabled men and making them effective were enlarged. It was no longer a matter of mere humanity or charity or abstract right of the man. There was immediate value and worth in the frag- ments of men gleaned from the battlefields, just as the brass and copper and steel and lead had value. The melting pot made the metals serviceable again; the crucible of specialized education did the same thing for the human salvage. It is by no means intended to imply that this great system was wholly utilitarian and devoid of soul either in its inception or in its development. It had its origin in the purest humanity toward those dazed and disabled Belgians who in their misery turned to their countryman, the good M. Schollaert, for relief. But through its practical merits it won recognition in effective war making, and it was thus given an im- petus and an immediate importance that it certainly could never have attained either as a matter of human- ity or justice to the disabled, or of national duty towards those of whom the nations had demanded the initial sacrifice of leaving their homes and exposing themselves to injury and death. Along with the development of the reeducational system for the war disabled there grew a new public sentiment, first given voice in the Canadian announce- ment that the Dominion proposed to "see its men all the way back.'' This was at first, perhaps, more the result of a burst of generosity and an idea of a "square deal" for the individuals who had suffered 160 THE PROBLEM COMES TO AMERICA impairment in behalf of their country than of any compelling sense of moral duty on the part of the public at large, but it marked an advance from the European conception of the work. Thus was rehabilitation brought to these shores, first in Canada. It was given some attention in the United States by philanthropists and students of vocational education, and some kindhearted people raised considerable funds to be expended in helping to reeducate disabled French soldiers, but in the main the work did not bulk large in interest alongside the epic struggle in Europe. Mere individuals or col- lections of individuals, mere classes or their welfare, were insignificant in comparison with the fate of nations, of whole peoples, of freedom, or with the menace to the right of peoples to national existence according to their own ways. The United States entered the war on April 6, 1917. In the hurry and bustle incident to turning '' a nation of shopkeepers" into a nation of soldiers and war workers, it was perhaps inevitable that some problems would be overlooked. The main thing was to get the Nation on a war basis, with all haste directed toward the immensely important and immediate essentials. When that great object should be in fair way of accomplishment, time could be taken to give attention to other things less immediately essential. The country was most fortunate in having ready at hand an agency fully qualified to take up the work of retraining our injured men. The experimenta- tion, the groping, the working out of training courses at the expense of beginners, was not necessary in the United States as it was in the European countries. 161 REDEMPTION OF THE DISABLED Already specializing in this work of vocational train- ing, already in touch with the available agencies in the country, with the experience of the Europeans al- ready studied and assimilated, the Federal Board for Vocational Education was ready at hand to take up the work of teaching the war disabled new occupa- tions. For some years before the war there had been mani- fested in the United States a very lively interest in vocational education. A national society was devoted to the promotion of the cause. Several of the states had inaugurated the work in some of its phases, and some municipalities had established vocational schools. Numerous private institutions were devoted to voca- tional training, and progressive educators generally had become interested in the subject. Finally the movement crystallized in the Smith-Hughes Federal Vocational Education Act, approved on February 23, 1917. This measure stands as a monument to the long years of patient work and propaganda and the unselfish devotion of those advocates of vocational education who appreciated its great value and im- portance to the country. The Federal Vocational Education Act created a large fund, starting with an initial appropriation of $1,700,000 and increasing by annual increments to a maximum of $7,161,000 in 1925 and annually there- after, to be distributed among the states accepting the terms of the Act and matching the Federal funds dollar for dollar, the money to be expended under Federal supervision in teaching vocational or, as it has been aptly termed, " commonsense " education. Its very name conveys adequate conception of its 162 THE PROBLEM COMES TO AMERICA function — the teaching of vocations or callings by which people may make their living, or amplify their earning power, or prepare themselves for greater use- fulness in their chosen lines of endeavor. To administer this fund and to supervise the progress of the states in this new and specialized form of education, the Act created the Federal Board for Vocational Education, composed ex officio of Secretary of Commerce (William L. Redfield), the Secretary of Agriculture (David F. Houston), the Secretary of Labor (William B. Wilson), the Commissioner of Education (Philander P. Claxton), and three ap- pointive members representing, respectively, com- merce and manufactures, agriculture, and labor. The organization of the Board was completed in July, 1917, by the appointment of James P. Munroe, repre- senting commerce and manufactures, Charles A. Greathouse representing agriculture, and Arthur E. Holder representing labor, and the election as director of Dr. Charles A. Prosser, one of the leading exponents of vocational education of the country, then director of the great Dunwoody Institute of Minneapolis, Minnesota, an institution with an endowment of $5,000,00 for vocational and technical training, the most modern and perhaps the most comprehensive of similar institutions in the United States. All of the appointive members of the Board had been for years prominent advocates and workers in the cause of vocational education, and had done much towards inducing the Federal Government to commit itself to the promotion of education of this sort. The work of organizing the different states, all of 163 REDEMPTION OF THE DISABLED which accepted the provisions of the Vocational Edu- cation Act, was proceeding in the early fall of 1917 when the Army and the Navy called upon the Federal Board for help in providing trained men especially needed in various technical lines. The first war ser- vice of the Board in response to this appeal was the compilation by its staff of experts of courses of in- struction for emergency use in war training. These included courses for radio and buzzer operators; ship- building courses for shipyard workers; mechanical and technical training for enlisted men (Air Divi- sion, U. S. Signal Corps) ; training for motor-truck drivers and chauffeurs; and courses for machine-shop occupations, blacksmithing, sheet-metal working and pipe fitting, electricians, telephone and telegraph re- pairmen, linemen and cable splicers, gas-engine, motor-car and motorcycle repairmen, oxy-acetylene welders, airplane-engine mechanics, airplane wood- workers, riggers and sheet-metal workers. The War Training Division of the Federal Board reported that on June 15, 1918, 12,000 men had al- ready been trained through these courses and gradu- ated into various branches of the service, 6,000 of them in mechanical lines, 5,000 in radio and buzzer work for the Army and Navy and merchant marine, and 1,000 in clerical occupations for the Quarter- master Corps. This represents the work of the various states under the direction of the Federal Board and using its courses. The War Department Committee on Education and Special Training reported 7,066 men in training on these courses in April, 1918,10,685 in May, and 26,666 in June. Contracts in force provided for the train- 164 THE PROBLEM COMES TO AMERICA ing of 100,000 men during 1918 in special lines from the courses of the Federal Board. This was training under military control, found necessary to provide for the needs of the Army; in addition, training was given in voluntary classes under the direct super- vision of the Federal Board. Of the latter, the re- turns for May, 1918, showed 5,370 in radio classes, 2,508 in .mechanical classes, and some hundreds in other branches. The whole lot of student soldiers, however, were using the courses of the Federal Board. By November 11, 1918, at the close of hostilities, the Federal Board had promoted the training of 19,- 694 radio operators, not less than 5,000 of whom were inducted into the Signal Corps of the Army. Absolute figures cannot be given, but all the evidence points to an equal number for the Navy and the mercantile marine. Moreover, several thousand other men received training which was utilized in corps service in some phase of radio operation or repair. Through state departments for vocational education the Federal Board prepared for service in mechanical occupations in the Army 14,599 men trained in even- ing classes, and established with the War Department a system of identification, certification, and assignment to service where their skill could be utilized. The total enrollment in training classes was 34,293, by occupa- tions as follows: radio, 19,694; auto mechanics, includ- ing gas-engine repair men, 4,367; auto and truck drivers, 1,353; machinists, 1,290; woodworkers, 436; electricians, 816; airplane workers, 462; oxy-acetylene welders, 613; sheet-metal workers, 209; blacksmiths, 310; mechanical draftsmen, 573; and other courses, 4,170, which included photography, topographical 165 REDEMPTION OF THE DISABLED draftsmen, concrete workers, shoemaking, veterinary science, horseshoeing, paper work, and army cooks. These details are given to demonstrate the imme- diate availability of the Federal Board for Vocational Education for the vocational rehabilitation of the dis- abled soldiers. It was clear that if the Federal Board was competent to train men especially for the stress and strain of warfare, it was abundantly able and qualified to prepare them for the walks and works of peace. This was the conclusion of those who were charged with the provision for the welfare of the war disabled. They decided that this efficient agency, in smooth running order, must be utilized in the retrain- ing of the men who would be compelled to enter new lines of endeavor to gain a livelihood. Other coun- tries had been compelled to evolve this machinery by experimentation and experience. The United States, fortunately, had an adequate medium at hand, ready, and deeply interested in the subject of the injured man and his future. 166 CHAPTER XIV THE DEVELOPMENT OF A NATIONAL PROGRAMME The beginnings of the movement — National scope of the problem — Investigations of the Federal Board for Voca- tional Education — President Wilson interested — Joint conference of Government bureaus and private organiza- tions — Its proposed legislation — The programme formu- lated by the Council of National Defense — The Federal Board for Vocational Education entrusted with its execu- tion — Congress and the Vocational Eehabilitation Act — Principles of the restoration programme. As students and exponents of vocational education, the members of the Federal Board for Vocational Education were keenly alive to the importance and significance of the movement in Europe for retraining disabled soldiers. This was nothing more or less than vocational education reduced to its simplest, most practical, and concentrated essentials. When it be- came evident that steps must be taken to provide for the future disabled soldiers of the sea and land forces of the United States, the members of the Federal Board were among the earnest and active advocates of some system embodying the best features of the European and the Canadian rehabilitation schemes, with such improvements as study might suggest. Many organizations and individuals the country over were bestirring themselves to make some sort of preparation for the disabled men of the armies. Some of the state legislatures had before them measures providing for the rehabilitation of the disabled, and an astonishing amount of interest in the subject was 167 REDEMPTION OF THE DISABLED displayed in nearly every section. Nothing definite was done by these agencies, however, for a general conviction rapidly developed that the subject was one of National importance, to be dealt with by the National Government, the only repository of power adequate to do it justice. It soon became apparent from the magnitude of our prospective armies that the problem was likely to be one of tremendous proportions. There appeared also a very considerable sentiment indicating a wide- spread belief that the work of reeducation and return of men to civil life and occupations was not a military function. Some European countries had tried it as a work directed by the military authorities and had not been particularly successful, while other countries that had placed the work under civilian control had achieved better results. Although the function of the Medical Corps of the Army was recognized, and it was accredited as being paramount in the work of restoring men to health, giving medical and surgical attention to the injured, and in functional restora- tion, the consensus of public opinion determined that there the functions of the medical department ended. The public mind could not see that the medical de- partment was preeminently qualified to teach men to be gas-engine mechanics, oxy-acetylene welders, farm- tractor operators, motor repairmen, radio operators, stenographers, poultry raisers, truck farmers, office men, architects, draftsmen, or other of a list of some four hundred occupations. Public interest in the problem grew. The Federal Board for Vocational Education adopted a resolution on August 15, 1917, providing for a study of the 168 A NATIONAL PROGRAMME work of rehabilitation of disabled soldiers abroad, and investigations were immediately started by the Re- search Division of the Board. Informal conferences were initiated by the Board looking toward definite action and the crystallizing of sentiment, notably with the Chamber of Commerce of the United States and the National Association of Manufacturers. Both these organizations responded with immediate appre- ciation and helpful interest and activity. As the studies of the Federal Board approached completion, the imperative need for a clear and settled policy in regard to our disabled men returning from overseas and from training camps was made manifest. It was agreed among the members of the Board and those associated with them that the best way to bring the matter to a focus was to lay the situation before President Wilson and invoke his interest, and at the December, 1917, meeting of the Board the Chairman (Secretary of Agriculture Houston) was requested to present the matter officially to the President and re- quest him to act. President Wilson promptly appreciated the value of the Board's suggestion and of the preliminary work that had been done, and through the Secretary of War he called a conference of all organizations in- terested in the problem. There were represented at the first meeting in January, 1918, in the office of the Surgeon-General in the War Department, besides the Surgeon-General, the Bureau of War Risk Insurance, the Federal Board for Vocational Education, the United States Public Health Service, the Council of National Defense, the American Federation of Labor, the National Association of Manufacturers, and the 169 REDEMPTION OF THE DISABLED American Red Cross. Subsequently, other confer- ences were held. It was decided at these meetings to draw up a tentative measure for presentation to Con- gress embodying the views of the conference. The subcommittee to whom the matter was referred finally reported a measure, which was adopted unanimously by the conference, providing that the work of vocational rehabilitation be placed under an advisory board of five members, representing, respec- tively, the Army, the Navy, the Treasury Department, the Department of Labor, and the Federal Board for Vocational Education. This tentative draft went the length of extending Federal aid and supervision of vocational rehabilitation to the cripples of industry as well as to the men incapacitated in the armed ser- vice of the Government. Meanwhile, the Federal Board had issued (Bul- letin No. 5) in February " Vocational Rehabilita- tion of Disabled Soldiers and Sailors: a Preliminary Study," a book of 112 pages based on the investiga- tions of the Research Division. Closely following it came (Bulletin No. 6) " Training of Teachers for Occupational Therapy for the Rehabilitation of Dis- abled Soldiers and Sailors," the work of the same Division of the Board. The wealth of material ac- quired by the Federal Board comprised the whole experience and progress of the Allies and of the enemy as well. It confirmed the need for positive action at the earliest possible moment if the United States was to be prepared adequately to care for the Nation's disabled fighters. Congress meanwhile had begun to show interest in the rehabilitation pro- gramme, but the interested members, knowing that 170 A NATIONAL PROGRAMME the situation was being studied with a view to evolving a proposal for legislation, refrained from attempting to enact a law on the subject until they ascertained what had become of the recommendations of the conference. So the matter rested, with no adequate preparation for the problem of vocationally reeducating and re- placing the disabled men in civil life, until early in April, 1918, almost a full year after the United States entered the war. Then decisive action was taken by the Council of National Defense, composed of the six Secretaries of War, the Navy, the Treasury, Agricul- ture, Commerce, and Labor, who had become con- cerned and uneasy over the apparent suspension of activity. The tentative measure recommended by the conference was taken up, considered and approved by the Council, with no material change except the re- jection of the proposed joint board for the super- vision of reeducation work and the substitution of the Federal Board for Vocational Education as the supervising agency. The measure was then brought before the Cabinet, which approved without a dis- senting voice the recommendations of the Council of National Defense relating to the rehabilitation of the war disabled. The provision of the original measure concerning the rehabilitation of industrial cripples was eliminated, on the ground that although the Cabinet heartily approved the Federal care of the victims of industry, the President and the Cabinet had promised to bring no legislation before Congress at that time except such as related to war measures, and this feature of the proposed bill could not be classed as a war necessity. 171 REDEMPTION OF THE DISABLED Meanwhile, Senator Hoke Smith of Georgia, through his general interest in vocational education (he was chief sponsor for the Smith-Hughes Vocational Education Act), had become deeply impressed with the necessity for vocational rehabilitation of dis- abled soldiers and sailors, and was preparing on his own initiative and account to report a bill from the Committee on Education and Labor of the Senate, of which Committee he was chairman. Learning of the action of the President and Cabinet and the endorse- ment of the Council of National Defense, he withheld his own measure, but with the understanding and agreement that when the Administration measure was ready, it should be introduced through his Committee. This arrangement was carried out and the bill was introduced by Senator Smith (Sen. 4284), and simultaneously in the House by Representative Sears of Florida (H. R. 11367), on April 6, the anniversary of the declaration of a state of war with Germany. Hearings were conducted before the Joint Committee on Education and Labor of Senate and House on April 30 and May 1 and 2. The Smith-Sears Voca- tional Rehabilitation bill, carrying a preliminary ap- propriation of $2,000,000 with which to start the work, passed the Senate unanimously on May 25, the House unanimously on June 11, and was signed by the President and became law on June 27, 1918. Thus the most comprehensive programme of educa- tion and rehabilitation of any of the belligerent nations was made a vital part of the war programme of the United States. The work of vocationally rehabilitating the dis- abled in Europe had its origin in compassion and 172 A NATIONAL PROGRAMME charity. Its rapid development came through the necessity of using all available man power and the recognition of the possibility of substituting retrained but physically disabled men for those yet physically able, but detained behind the lines as workers in essential war industries. Its present status is due primarily to the insistent demands of war work, but partly in addition to the realization by European Governments that there will be a great shortage of trained men in all lines of industry after the war. That country possessing the greatest reserve of skilled workmen, even though in some respects physically disabled, will have a distinct advantage in recuperation over those less favorably situated. With the United States none of the foregoing con- siderations was the moving cause of the resolution to reeducate for civil life its disabled men, prevented by reason of their injuries from returning to their former means of gaining a livelihood. Indeed, these considerations played small part in the decision, and then only as incidentals of benefit and cause associated with a course already shaping itself upon broader and even higher grounds. That the programme had phases that might redound to the general good was pleasant to contemplate, but the seeking of a direct national benefit, either as a present or as a post- bellum excuse or reason was never considered as a governing factor. In brief, the position of the United States, as evi- denced by its legislation on the subject of vocational rehabilitation for disabled soldiers and sailors, is that the Nation owes them neither charity nor alms; that their sacrifice and service deserve more than a 173 REDEMPTION OF THE DISABLED gratuity; that the Nation is in fact indebted deeply to them, and under the highest moral obligation to discharge its debt fully and generously; and that complete restoration to pre-war civil status is a matter of simple justice to the men who have been disabled and handicapped by reason of their service in defend- ing the commonwealth against its armed foes. The inadequacies of the obsolete pension system were so obvious that it had not a single adherent or apologist. Its pernicious effects upon the pensioners and the public, and upon legislation and politics, were so evident that it was not even a subject of discussion except as to the best way of avoiding it. The pen- sion system was the best the Nation could devise at the time it was inaugurated, and even until recently, but it was recognized that the march of events had carried the world forward to new conceptions and ideals, and among them that restoration and restitu- tion, including such compensation as might be neces- sary to accomplish these objects, and the establish- ment of equality of opportunity was the course to be followed in dealing with the disabled of war. Certainly, it was not possible actually to restore an amputated arm or leg, but there were equivalents, or at least as near equivalents as human ingenuity could devise. The crippled man should be given an arti- ficial member capable of performing many of the functions of the lost limb. He should be paid a sum of money based upon years of experience of accident- insurance companies and other data on the impair- ment of earning capacity by his particular injury. And finally, if he were injured sufficiently to prevent him from returning to his former vocation in the 174 FITTING ARTIFICIAL LEGS IN A CANADIAN IXSTITUTION. THE MEN ARE GIVEN VARIOUS EXERCISES UNTIE THE NEW LIM11S ARE PEHFECTI.V FITTED AN!) THE PATIENTS AT EASE WITH THEM A NATIONAL PROGRAMME civil life from which the Nation called him to take up arms, he should be reeducated for some other call- ing offering equal, if not better, chances of remunera- tive employment or return, and a place found for him in that new employment. It was accepted as fundamental also that if the man were so injured as to require vocational re- education, the loss of time in pursuing the studies necessary to fit him for his new calling should also be a charge upon the Government. Not only should the man be paid at the rate he was drawing when wounded, or better, but all allotments and allowances for the support of his family or dependents should be continued during the training period just as if he were still on duty at the front; for it was recognized that no man can do good mental work if harassed and worried by lack of sufficient money to maintain his family in at least the necessaries of life. Finally, the consensus of opinion was that the whole process should be a voluntary one on the part of the man to be reeducated, and that it should be, in all its essentials, a civil operation. Military authority should play no part in it. The transition from mili- tary back to civil life was to be made with the as- sistance of civilians, in a civilian atmosphere. The programme contemplated justice, not alms, for the disabled, in so far as justice could be done and restitution made for suffering and loss of earning ability. This was the sole principle guiding the de- liberations and avowed purpose of those who were working for the proper recognition and treatment of the men who had dared so much and suffered so greatly. This clear conception prevailed from the 175 REDEMPTION OF THE DISABLED first, and it was accepted at face value by Congress. The resources of the country in man power were too vast to necessitate the reeducation of these disabled men as a military necessity, and certainly no one was thinking of the post-bellum effect upon trade and industry. Nevertheless, every facility possible to de- vise was prepared for offering to the disabled man, in order that, despite his injuries, he might become independent as a wage earner and supplement by his own efforts the amount received as disability com- pensation, thus being enabled to live in the enjoy- ment of comforts and with equal opportunity to pursue his course toward happiness along with other men. 176 CHAPTER XV FINANCIAL PROVISION FOR THE DISABLED SOLDIER The War Bisk Insurance Act — Evils of the pension system avoided — The Government's liability as employer in the dangerous trade of war — Allotments and allowances to dependents of enlisted men — Compensation for death or disability — The democratic principle of the flat-rate scale of disability compensation — The danger of special legisla- tion— Bearing of flat-rate compensation upon the voca- tional rehabilitation programme — Eates of compensation for death and total disability — Problem of rating par- tial disabilities — Voluntary life and total-disability insurance. Insurance against death and total disability con- stitutes a special feature of great social importance in the American programme of restoration, distinguish- ing it from the programmes adopted by our allies. The provisions of the War Risk Insurance Act of October 6, 1917, however, are not restricted to insur- ance. On the contrary, the Act embraces other ex- ceedingly important provisions — for allotments and allowances for the soldier's family while its head is in military service, compensation in case of death or disability, and a somewhat vaguely defined promise of vocational reeducation for the man incapable of tak- ing up his former occupation or who requires special retraining for it under the conditions of his handicap. All of these provisions, except those relating to voca- tional training, will be considered as constituting in the aggregate, together with the provision for re- education made specifically in the Vocational Rehabili- 177 REDEMPTION OF THE DISABLED tation Act1, the Government's scheme of providing for the present needs of dependents of men in ser- vice, for the particular future needs of men disabled and of their dependents, and for the needs of the dependents of men who lose their lives in the Nation's service. The Act of October 6, 1917, amends the Act of September 2, 1914, establishing the Bureau of War Risk Insurance in the Treasury Department, and creates in that Bureau two divisions, a Division of Marine and Seamen's Insurance to carry on the work for which the Bureau was originally created, and a Division of Military and Naval Insurance to assume the new functions imposed by the amendatory Act of October 6, 1917. It is with the functions of this second division that the following summary account deals.2 For half a century the lengthening chain of Civil War disability and service pensions, dragging on in- terminably, has fastened upon the country a burden of dependency merging more and more with each generation into pauperism and ever lending itself to widespread corruption and abuse of the Nation's gratitude towards its veteran warriors of the sixties. This burden, dragged on from year to year, increas- ing in the face of natural mortality by the addition in a new generation of thousands of young widows who have married into the army of pensioners, has been ungrudgingly assumed and carried by the community l For the detailed provisions of this Act, see Chapter XVI. 2 For a detailed discussion of the Government's scheme of allotments and allowances and death and disability compensa- tion and insurance, see, in this series, Samuel McCune Lindsay, Government Insurance in War Time and After. 178 FINANCIAL PROVISION — ungrudgingly, because the Nation has determined to guard the welfare of the veteran and of his de- pendents without any too nice discrimination of merit or desert among those dependents. But the abuses of the system have become each year more patent and more numerous, and even more brazen and uncompromising. Each year a host of veterans has fallen out of the ranks of the army of pensioners, but the army has nevertheless marched on, recruiting its swelling numbers more and more from the undeserving, until its character as a veteran army has fallen away, and it has become in larger proportion an army of valiant pensioners. The war service is mainly a flimsy, unsubstantial fiction, and the service of many of the present pensioners is that of bearing with some childish old man until he passed over the river and the pension can be enjoyed with no service in return. Not the least damning characteristic of the pension has been its capacity for impairing the sterling man- hood qualities, even among the veterans themselves. The worthy pensioner, moreover, has been subjected to the odium of association with the unworthy, profiteering sort, with the unnatural, degenerate veteran who has finally yielded to the seductions of pensioned indigence, and with the unscrupulous woman who, with clearly ulterior motives, married shamelessly into the ranks a generation after the war. Could any such discreditable record be avoided after the Great War, in which it seemed entirely prob- able that the millions enlisted for service would far exceed the Civil War enrollment and, in consequence, the number of pensioners, worthy and unworthy, 179 REDEMPTION OF THE DISABLED would be tremendously multiplied? Or must the community enter upon another protracted period of service- and disability-pension legislation, gathering into the toils of dependency from year to year a larger and larger proportion of the country's manhood and womanhood 1 It is believed that a way of avoiding any such social calamity has in fact been provided in the War Risk Insurance Act of October, 1917. The provisions of this Act may be briefly summarized as they bear directly upon the end and purpose of restoration of the discharged man to his pre-war status of economic and social independence — a status absolutely incom- patible with the persistence of pensioning or pauper- ization. It is not the intention here to undertake any detailed exposition of the Act as regards its precise terms, but merely to set forth its general character and the principles in accordance with which its pro- visions have been drawn. In a word, as it has been aptly put, the Act con- cedes war to be a "dangerous trade" and the Gov- ernment to be the "employer" of those engaged in it, and it proceeds to determine the employer's liabil- ities and obligations under this conception. These liabilities and obligations embrace (1) allowances to families of men in the service, (2) compensation to men in case of disability and to their families in case of death, and (3) insurance, which may be voluntarily assumed against disability or death. As regards allowances to the dependents of en- listed men during service, it is provided that the enlisted man shall allot a portion of his monthly pay, a minimum of $15, before any allowance by the Gov- 180 FINANCIAL PROVISION ernment is granted. Up to not exceeding one-half of his pay, the soldier by allotment must "match" the Government allowance dollar for dollar, but he is not required to match allowances in excess of this amount. The maximum Government allowance on account of the dependents of any enlisted man is $50 per month. When this maximum does not provide for all dependents the allowance to which they would otherwise be entitled under the graduated scale estab- lished by the Act — that is, to a wife with no children, $15; with one child, $25; with two children, $32; and for each additional child, $5; or, if there is no wife, to one child, $5; to two children, $12.50; to three children, $20; to four children, $30; and to each ad- ditional child, $5; to each parent, $10; and to each dependent grandchild, brother, sister or additional parent, $5 — grants are made by precedence, to Class A dependents (present wives or children or divorced wives) or Class B dependents (parents, grandchildren, brothers and sisters). "Wives" includes divorced wives in receipt of alimony and common-law wives, and "children" includes illegitimate, adopted and stepchildren to the age of 18 years, with certain safe- guarding provisos. Men with wives or children dependent upon them are compelled to make allotments, but no compulsion obtains with reference to Class B dependents. Some allotment, a minimum of $5, must be made to Class B dependents, however, before any allowance is granted to them by the Government. Allowances are not paid except on application of either the soldier or of the beneficiary. As will be noted elsewhere (Chapter XVI), allotments and allowances will be virtually 181 REDEMPTION OF THE DISABLED continued, under the Vocational Rehabilitation Act, after release from military service in the case of men who elect to take vocational training during the period of such training. When allotments and allowances proved insufficient to provide for the dependents of enlisted men, it was expected that additional provision would be made either by the several states or by such agencies as the Civilian Relief Section of the Red Cross. Even be- fore the passage of the Federal Act, seven states (Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Michigan and Wisconsin) had provided allowances for dependents of men in military service. Such provision it was fairly anticipated would be made generally, and individual cases of hardship would be taken care of by private agencies. It was possible also Congress itself might at any time in- crease the scale of allowances as established in the present Act. It was assumed that officers, out of their more ample pay, would be disposed to provide adequately for their families. The compulsory provisions of the Act relating to allotments and allowances, therefore, were not extended to officers. Compensation in case of disability or death is pro- vided for officers as well as enlisted men under a flat-rate scale, which determines compensation inde- pendently of military rank or pay. In the bill as originally proposed, compensation varied with pay, officers receiving in the case of any given disability and number of dependents a larger compensation than enlisted men. The compensation was stated in terms of percentages of pay, with specified minima, for 182 FINANCIAL PROVISION example, to a surviving widow without children, 25 per cent, of pay, but not less than $30 per month. This principle was opposed as being undemocratic, and it was clearly a violation of the principle accepted in the draft, which required civilians to abandon their civilian pursuits and enter military service as privates under a uniform wage scale which ignores all differ- ences of individual capacity and earning power. The $30 a month private may have been drafted out of a civilian employment in which he was earning much more, or possibly, in the case of apprentices or learners of trades, somewhat less than $30 a month. His military pay will not measure relatively to other men in service his sacrifice in responding to the draft, nor in case of death or disability will it measure his loss of original earning power. In the judgment of Congress, and it must be conceded that this judg- ment seems fairly in accord with the fundamental principles of democracy, the claim of the officer for higher compensation than is given to enlisted men for the same disability and dependency is not clear. It cannot be easily demonstrated that the need for money compensation, which, in the nature of the case, must be generally inadequate to cover the sacrifice, will be less when the man's natural resources or capacities are small and when his military or social rank is low, and it would seem certainly foolish to assume that the needs of the disabled man and of his family will vary directly in proportion with his military pay under conditions of the draft, which has, in fact, instituted equality of status for the millions of privates, in complete disregard of their various civil capacities prior to enrollment. Any argument 183 REDEMPTION OF THE DISABLED that can be formulated for adjusting compensation to pre-war earning capacity will apply equally to mili- tary pay itself. If the compensation of men dis- abled should be proportional to their pre-war earning capacity, so also, under the same conception of justice, should pay for the military service of men drafted into the Army or Navy. No such proposal has been entertained, but the logical conclusion of flat-rate compensation for service is certainly flat-rate com- pensation for disability. Similiarly, it may be fairly contended, as it has been contended in France, that the sacrifice involved in any disability, for example, the loss of a hand or a leg or an eye, is in fact absolute, and not in any real sense relative to earning capacity prior to enlistment. The man, officer or private, skilled or unskilled, of large or small earning capacity, who has been killed in the service or has had a right hand shot away has rendered a definite sacrifice which is not greater in the case of a man capable of earning $5,000 a year than it is in the case of the humblest common laborer. This principle has not been accepted in Great Britain, but seems to have obtained generally on the Con- tinent, and Congress has admitted it tentatively in drawing the AVar Risk Insurance Act. Perhaps a more effective statement of the case for a flat-rate scale may be made in negative terms. Within the maximum limits of compensation granted by the Government under the most liberal provisions contemplated, the compensation will not in fact ex- ceed the sacrifice involved in the case either of death or of disability. The officer or the man of large ca- pacity, accustomed to a higher standard of living, may 184 FINANCIAL PROVISION deserve more; but certainly the private, whatever hia former earning capacity, does not deserve less. Some fear has been expressed that in the flat-rate scale provision, the door is left open for entrance upon a new policy of special pension legislation to cover individual cases of special handicap. It is at least doubtful if this danger could be entirely avoided by adopting a scale prescribing compensation in terms of percentage of military pay or even in terms of percentage of pre-war earnings, unless all maximum limits were narrow or only high maxima were intro- duced. Under the present law it may fairly be anticipated that only exceptional cases of very special merit and of obvious hardship will receive considera- tion in Congress at any time in the future, since one fundamental motive of our present programme is the establishment of a system of compensation that will make special disability- and service-pension legislation unnecessary and unjustifiable. Rare instances of in- dividual merit may receive special consideration by Congress, but this consideration may be given without again entering upon a policy of wholesale pensioning, such as has discredited our procedure in the past. Under the Act, therefore, compensation is deter- mined irrespective of military pay or rank or pre-war social status, and with reference solely to a flat-rate scale of disabilities. Death, whether of private or officer, whether of a poor or a rich man, carries its own unvarying compensation, and similarly but one rate is provided for the loss of a hand or foot or any other disability. This principle of compensation has a direct bearing on the general policy of com- plete vocational restoration of the disabled so far as 185 REDEMPTION OF THE DISABLED it can be achieved. Under the Act, disability is physical and absolute, determined when active medi- cal and surgical treatment of the man has reached finality. Obviously, a very slight physical disability, for example, the loss of a finger or a stiffening of the wrist joint in the case of a violinist or a pianist, may constitute total vocational disability for the man's former occupation, and vice versa a very serious physical disability involving a major operation may not impair at all seriously a man's vocational capacity in his former occupation. Obviously too, any given degree of physical disability, over the whole range from total disability to very slight impairments, may involve, and in individual cases certainly will in- volve, a varying degree of impairment of vocational earning capacity in the former occupation or in any new occupation for which training may be given. These varying impairments of actual or potential earning capacity do not figure in the determination of the man's compensation. For the loss of a finger he will receive compensation fixed by a scale of dis- ability in which the loss of a finger, whether it be the finger of a violinist or a farm laborer or a banker, is assessed as a fixed proportion of total disability. Once the disability is determined as a permanent physical condition, the compensation does not diminish or vary according to future development or variation of earn- ing power, and it is determined in the first instance without reference to that power in individual cases. Every inducement is thus presented to the man under disability to become effective either in his own or in some other occupation. He may enter upon a course of vocational training in the full assurance that 186 FINANCIAL PROVISION his compensation will not be fixed with reference to his earning capacity or be reduced as he achieves new earning capacity. Any policy of reducing compen- sation in more or less direct proportion to the man's reacquirement of efficiency would be disheartening, and would fatally compromise the whole programme of vocational rehabilitation. Unquestionably, in many instances compensation plus earnings will exceed pre- war earnings, and it is to be hoped that such instances will constitute a very large proportion of the reeduca- tion cases. The experience of the Canadian reeducated appears to afford strong ground for this hope. The Act provides a scale of compensation in cases of death and of total disability graduated according to the number and character of dependents. In the case of death, the monthly compensation is: for a widow alone, $25; widow with one child, $35; with two children, $47.50; and for each additional child, $5; where no widow survives, for one child, $20; two children, $30; three children, $40; and for each additional child not exceeding two, $5; and for a widowed mother, $20. In the case of total disability the scale runs as follows: for a man alone, $30; for a man with wife and no child, $45; with one child, $55; with two children, $65; with three or more children, $75; for a man with no wife but one child, $40; for each additional child not exceeding two, $10; and for a widowed mother, $10. The Act provides that partial disability shall be compensated as a percentage of total disability, the ratings being based, not upon individual impairments of earning capacity, but upon "the average impair- ments of earning capacity resulting from such injuries 187 REDEMPTION OF THE DISABLED in civil occupations ... so that there shall be no reduction in the rate of compensation for individ- ual success in overcoming the handicap of a permanent injury.'' The difficulties in determining such averages are obvious. Impairment of earning capacity in conse- quence of any given injury will have a wide range of variation from, occupation to occupation. The loss of a right-hand thumb, for example, may totally inca- pacitate a man for the trade of barber, but not at all seriously impairs the efficiency of a man in many other occupations, skilled or unskilled, or in the pro- fessions. These actual impairments, in fact, cannot be averaged with any high degree of certainty that the resulting average will fit individual cases, but the intention of the Act is clearly that for each class of injuries, some estimate shall be made of the resulting impairment of a man's general earning capacity, hav- ing regard not to a man's particular occupation but to the whole range of civil employments. The problem referred by Congress to the Bureau of War Risk Insurance, therefore, is to devise a classi- fication of injuries and to assess each type of injury for compensation as representing in the impairment of earning capacity a given percentage of total dis- ability. Each possible injury or combination of inju- ries will present its own specific problem, and the solution of the problem is required to be equally specific, for example, that loss of the right arm in- volves in every instance a given percentage of total disability, loss of an arm and a leg another percent- age, loss of two legs another, and so on through the whole range of injuries and combinations of injuries. 188 FINANCIAL PROVISION Probably in no case would an injured man be able himself, or would anyone be able for him, to assess accurately the monetary equivalent of his disablement. Certainly, few men could answer offhand such a ques- tion as: "What amount of money, if any amount, would induce you to part with your right hand, or arm, or finger, or foot, or leg?" Having lost one or several of these members, the disabled man would generally be equally incapable of assessing, either alone or with the help of other persons, his impair- ment of earning capacity with reference to the future. In many cases the future would be clouded with uncertainty. The old employment might or might not be available, and the election of an employment, whether the old one was or was not available, might be determined accidentally. Congress has wisely delegated the perplexing task of assessing injuries as percentages of total disability to the discretion of those administering the Act. While the terms of the Act specify average impair- ment of earning capacity, it is fairly clear that other considerations must be more or less in mind in devis- ing any scale of disability compensation. The loss of a leg will not, and indeed cannot, be assessed solely as an average impairment of earning capacity. For- mally it will be so assessed, but really it will be assessed, as it should be, with reference to the whole range of activities, economic and social, at home and in the workshop, personal and public, in which the normal man may or must participate. The injury will be assessed as a handicap for normal life, rather than as simply a handicap for earning wages. Finally, insurance is provided under the Act for 189 REDEMPTION OF THE DISABLED those in military service who may voluntarily assume it, and in some respects this provision is the one which may be expected to have most far-reaching conse- quences. Any man in the service may take out, with- out medical examination, insurance of from $1,000 to $10,000 against death or total disability, naming only near relatives (parents, grandparents, children, grand- children, wife, brothers or sisters) as beneficiaries. Since the United States Government bears all admin- istrative expenses and assumes all of the extra hazard Avhich active military service imposes, the cost of this insurance to the soldier or sailor is less than the cost of similar insurance under normal peace conditions. For the duration of the war the insurance is "term" insurance, on the basis of annual periods, and the policies acquire no surrender value. Within five years after the end of the war, however, they may be con- verted, without examination, into whole-life, payment - life, endowment, or other forms of insurance. Each policy for $1,000 will provide in case of death or total disability 240 monthly payments of $5.75 to the beneficiaries. A $5,000 policy will thus provide monthly instalments of $28.75, and a $10,000 policy, monthly instalments of $57.50. The cost of the insur- ance is deducted from the soldiers' monthly pay. It ranges from 63 cents per month per $1,000 for men from 15 to 17 years of age to $1.08 for men 49 years of age. For men of the first draft ages, 21 to 30 years, the cost ranges from 65 to 69 cents per $1,000. Although acceptance of this insurance is voluntary, a very large proportion of the men in camps have assumed it. To quote Paul H. Douglas at the end of the first year of war: 190 FINANCIAL PROVISION The insurance on the books of the Bureau on April 6 was nearly four times as great as that of the largest commercial life-insurance company in the world, and more than one- half of the total amount of life insurance carried by private companies in the United States . . . This includes neither the marine insurance carried by the Bureau, nor the insurance of men in the trans-Atlantic merchant marine. The story of the inauguration of the work of insur- ing our soldiers and its development is an amazing record. To Lieutenant Coke Flanagan of the Army belongs the distinction of filing the first application, which was for $10,000, the full amount. The first insurance certificates were delivered personally by Secretary McAdoo, the recipient being Sergeant Larry E. Meadow of the Army and First Class Yeoman M. J. Crum of the Navy, both being for the maximum $10,000. By cable General John J. Pershing applied for the maximum amount for himself. No man was disqualified by physical condition. The fact that he was in the Army or Navy was all that was necessary. The War Risk Insurance Act became law on October 6, 1918. Within the first month after its passage, applications representing $311,498,500 had been re- ceived. By December 15, 1917, the applications num- bered 246,104, and the amount of insurance was $2,133,383,500. By January 18, 1918, more than 470,- 000 men were insured for more than $4,000,000,000. By January 28 more than 550,000 men were insured, and on that day 32,004 applications were received, aggregating more than $260,000,000, and bringing the total close to $5,000,000,000 of insurance in force. In the next three days applications poured in at the rate of about $200,000,000 a day. 191 REDEMPTION OF THE DISABLED At midnight of February 14, 1918, all world records for insurance were smashed by the receipt of 54,000 applications aggregating more than $500,000,000. On Febraury 12 eight Army camps, with an average strength of about 30,000 men each, were 99 per cent, insured or better, while the lowest camp had 93 per cent, of its personnel insured. The Official Bulletin recorded that on February 19, 1918, the percentage of insured in 26 Army camps ranged from 92 to 99.9 per cent. In the six weeks from January 1, 1918, more than $6,000,000,000 of insurance was written. On May 14 more than 2,000,000 soldiers and sailors had been insured for more than $16,500,000,000. On June 30, 1918, Secre- tary McAdoo announced that more than $21,500,- 000,000 of insurance was on the books, with an aver- age policy of $8,387. By October 6, the anniversary of the passage of the Act, this average was raised to approximately $9,300 per man. The Government has entered the field of life insur- ance on an enormous scale, and is under contract to remain in the field for a long period after the war. It is extremely improbable that it will ever withdraw, or that it will refuse eventually to extend the priv- ilege of insurance to classes of public servants other than those now provided for — perhaps generally to all classes. 192 CHAPTEE XVI THE VOCATIONAL REHABILITATION ACT Its provisions — Classes eligible for reeducation — Powers and duties of the Federal Board for Vocational Education — Continuance of family allotments and allowances dur- ing training — Disciplinary powers of the Federal Board — Extension of training to classes not totally inca- pacitated— Cooperation of the Federal Board with other agencies — Physical restoration under the medical author- ities of the Army and Navy — Cooperation in occupa- tional therapy — Special gift fund for vocational rehabili- tation authorized — Quarterly and annual reports required — Eehabilitation work organized by the Federal Board — Probable period of training — Instruction not limited to manual trades and industrial processes. The development of the national programme for the reeducation of our disabled soldiers and sailors has been traced in Chapter XIV, and the story told of the origin, course and enactment of the Vocational Rehabilitation Act of June 27, 1918. It remains to examine the provisions of the Act and the manner in which they will be carried out. In brief, the Act provides (Section 2) " that every person who is disabled under circumstances entitling him, after discharge from the military or naval forces of the United States, to compensation" under Article III of the War Risk Insurance Act of October 6, 1917, and who, after his discharge, in the opinion of the Federal Board for Vocational Education, is unable to carry on a gainful occupation, to resume his former occupation, or to enter upon some other occupation, or having resumed or entered upon such occupation is 193 REDEMPTION OF THE DISABLED unable to continue the same successfully, shall be furnished by the said Board, where vocational rehabilitation i.-s feas- ible, such course of vocational rehabilitation as the Board shall prescribe and provide. The Board shall have the power, and it shall be its duty, to furnish the persons included in this section, suitable courses of vocational rehabilitation to be provided and prescribed by the Board, and every person electing to fol- low such a course of vocational rehabilitation shall, while following the same, receive monthly compensation equal to the amount of his monthly pay for the last month of his active service, or equal to the amount to which he would be entitled under Article III of said [War Risk Insurance] Act, whichever amount is the greater. If such person was an enlisted man at the time of his discharge, for the period during which he is so afforded a course of rehabilitation, his family shall receive compulsory allotment and family allowance according to the terms of Article II of said [War Risk Insurance] Act in the same manner as if he were an enlisted man, and for the purpose of computing and paying compulsory allotment and family allowance his compensa- tion shall be treated as his monthly pay: Provided, That if such person willfully fails or refuses to follow the pre- scribed course of vocational rehabilitation which he has elected to follow, in a manner satisfactory to the Board, the said Board in its discretion may certify to that effect to the Bureau [of War Risk Insurance] and the said Bureau shall, during such period of failure or refusal, withhold any part or all of the monthly compensation due such person and not subject to compulsory allotment which the said Board may have determined should be withheld: Provided, however, That no vocational teaching shall be carried on in any hospital until the medical authorities certify that the condition of the patient is such as to justify such teaching. It will be noted that the disciplinary provision is so drawn that the family or dependents of the man taking a course of reeducation will not be made to suffer by his misconduct. Should he neglect his 194 VOCATIONAL REHABILITATION ACT course or start on a career of drinking or carousing, the money cut off will be only that portion of his monthly pay above his family allotment. In other words, his pocket money and the money reserved for himself personally will be withheld, and his family will not be made innocent sufferers through his lazi- ness or willful misconduct. The Act provides further that: The military and naval family allowance appropriation provided for in Section 18 of said [War Risk Insurance] Act shall be available for the payment of the family allow- ances provided in this section [supra] ; and the military and naval compensation appropriation provided for in Section 19 of said Act shall be available for the payment of the monthly compensation herein provided. No compensa- tion under Article III of said Act shall be paid for the period during which any such person is furnished by said [Federal] Board course of vocational rehabilitation except as is hereinbefore provided. This provision leaves a large opening for the dis- cretion of the Federal Board. It means that the Board may give training in vocational reeducation courses to persons who have not been so badly injured as to come within the category of those unable to resume or otherwise pursue a gainful occupation, when the Federal Board deems these persons worthy of such training. The Act proceeds (Section 3) : That the courses of vocational rehabilitation provided for under this Act shall, as far as practicable and under such conditions as the Board may prescribe, be made available without cost for instruction for the benefit of any person who is disabled under circumstances entitling him, after discharge from the military or naval forces of the United 195 REDEMPTION OF THE DISABLED States, to compensation under Article III of said [War Risk Insurance] Act, and who is not included in Section 2 hereof [the Vocational Rehabilitation Act]. In other words, soldiers who are disabled enough to receive compensation for their injuries may, in the discretion of the Federal Board, be given such educa- tion as will better their condition, and this education is to be at no cost to them; but pay and compensation for the family of the student is allowed only to the enumerated classes of cases. This greatly enlarges the scope of the work, and places within roach of many a poor fellow who has occupied a place of undue insignificance in the business and working world educational facilities through which he may have a fair chance to rise and develop. The Act continues: Sec. 4. That the Board shall have the power and it shall be its duty to provide such facilities, instructors, and courses as may be necessary to insure proper training for such per- sons as are required to follow such courses as are herein provided; to prescribe the courses to be followed by such persons; to pay, when in the discretion of the Board such payment is necessary, the expense of travel, lodging, sub- sistence, and other necessary expenses of such persons while following the prescribed courses; to do all things necessary to insure vocational rehabilitation; to do all things necessary placement of rehabilitated persons in suitable or gainful occupations. The Board shall have the power to make such rules or regulations as may be necessary for the proper performance of its duties as prescribed by this Act, and is hereby authorized and directed to utilize, with the approval of the Secretary of Labor, the facilities of the Department of Labor, in so far as may be practicable, in the placement of rehabilitated persons in suitable or gain- ful occupations. Sec. 5. That it shall also be the duty of the Board to 196 VOCATIONAL REHABILITATION ACT make or cause to have made studies, investigations, and reports concerning the vocational rehabilitation of disabled persons and their placement in suitable or gainful occupa- tions. When the Board deems it advisable, such studies, investigations, and reports may be made in cooperation with or through other departments and bureaus of the Government, and the Board in its discretion may cooperate with such public or private agencies as it may deem advis- able in performing the duties imposed upon it by this Act. Sec. 6. That all medical and surgical work or other treat- ment necessary to give functional and mental restoration to disabled persons prior to their discharge from the military or naval forces of the United States shall be under the con- trol of the War Department and the Navy Department, respectively. Whenever training is employed as a thera- peutic measure by the War Department or the Navy De- partment, a plan may be established between these agencies and the Board acting in advisory capacity to insure, in so far as medical requirements permit, a proper process of training and the proper preparation of instructors for such training. A plan may also be established between the War and Navy Departments and the Board whereby these de- partments shall act in an advisory capacity with the Board in the care of the health of the soldier and sailor after his discharge. The Federal Board is enjoined to cooperate with the War and Navy Departments in establishing its rules and regulations for vocational training "in so far as may be necessary to effect a continuous process of vocational training.'' This means that a plan should be worked out whereby, when it is necessary to give a man exercise in the hospital as a therapeutic meas- ure, this work must be so arranged as to dovetail in, whenever possible, as a part of the vocational training, and thus to economize time and energy as far as expedient. 197 REDEMPTION OF THE DISABLED The Federal Board is (Section 7) authorized and empowered to receive such gifts and dona- tions from either public or private sources as may be offered unconditionally. All moneys received as gifts or donations shall be paid into the Treasury of the United States, and shall constitute a permanent fund, to be called the " Special fund for vocational rehabilitation," to be used under the direction of the said Board, in connection with the appropriations hereby made or hereafter to be made, to defray the expenses of providing and maintaining courses of vocational rehabilitation; and a full report of all gifts and donations offered and accepted, and all disburse- ments therefrom, shall be submitted annually to Congress by said Board. The object of the gift fund is to provide a means for interested persons to help in the work, from which perhaps they are debarred by lack of training to assist otherwise. It is also to provide the Federal Board with a fund that can be used as circumstances and particular cases justify. It is quite conceivable that there will arise cases of men being trained in a trado and having no capital to provide the necessary tools. The gift fund will cover such cases as this and other meritorious projects of relief or help. The Act carried an initial appropriation of $2,000,- 000 to start the work. Congress prescribed reports of the progress of the work every three months, to be filed with the Secretary of the Senate and Clerk of the House of Representatives for the information of Congress, and also an annual report. The Act pro- vided that no person of draft age should be exempted from draft by reason of employment by the Board. The Act gives the Federal Board the widest powers and latitude. Under its provisions the Board may 198 VOCATIONAL REHABILITATION ACT exercise a very wide discretion; in fact, amazingly few restrictions are placed upon it. The work of organizing for its new duties was taken up vigorously, yet cautiously, by the Board, and by September 1,1918, it was ready and had begun the rehabilitation of dis- abled soldiers and sailors, offering them a fair chance to become self-supporting, self-respecting members of society. Illustrative of the many national elements mak- ing up the population of the United States and its Army was the first man placed for reeducation — Louis Theodore, born on the island of Patras, Greece. He was a baker, disabled by sudden transitions from hot bakerooms to the severe weather of the winter of 1917-1918, and was discharged for chronic sciatic rheumatism. He desired a business course and was placed in a business college in Washington, where he made excellent progress and obtained high marks in all his studies and in the English language. He also completed his American naturalization; he is inordi- nately proud of being an American citizen, and over- whelmingly grateful for the opporunity which, through his disability, was given to him. The Board has announced that thorough training is to be its main object — such preparation that the graduated student will be able to go directly from his final class into a workshop or trade or profession and do the things he has been taught in such a manner as to compare favorably with men who have long been engaged in doing those very things as a means of livelihood. The length of time required to graduate a man depends upon his mental quickness, the nature of his 199 REDEMPTION OF THE DISABLED injury, and the application he puts into his study. In the simpler trades and processes, judging by the experience of other countries, notably Canada, it may be said that six months of training is about the general average. This presupposes, of course, the student to be faithful and diligent, and to have some knowledge of the subject in some other branch before he takes up specialized training. The impression must not be gained that all of the instruction is necessarily in manual trades and indus- trial processes. There are many men who have no inclination, talent or taste for such a means of liveli- hood, and whose previous education is such that they are not at all inclined toward any but a semi-profes- sion or a profession. It is quite within the bounds of reason, for instance, to suppose the case of a lawyer who returns shot through the lungs and with perhaps incipient tuberculosis, arrested it is true, but which makes it imperative that if he is to live and have health, he must be out in the open and mainly in a high, dry atmosphere. Such a case could be educated as a forestry expert for use in the Government forest reserves in the West, or as an irrigation specialist for the semi-arid regions. Or again, some skilled manual worker with good fundamental education may lose a hand. He may be strongly inclined toward the law. There is no reason why, if he is especially suited for development in that line, he should not be accorded it; but in such a case there must be some overwhelm- ingly good reason for the large expenditure necessary thus to reeducate a man, and not merely his whim or his notion that he would like to be a lawyer. The underlying principle of the whole reeducational 200 VOCATIONAL REHABILITATION ACT programme is justice to the man. The Government desires to restore the disabled to civil life in as good condition, if not better, as regards making a living, as they enjoyed at the time they were called to the colors. The Government bears the expense of retrain- ing and placement in the trade or calling for which they are reeducated, and also assumes a continuing monetary consideration for injury, paid regardless of the earning capacity of the retrained man. 201 CHAPTEE XVII THE PE0CESS OF EESTORATION: CURE BY WORK An improved therapy of restoration a beneficent by-product of the war — Hope the greatest restorative and work ita ablest assistant — Hospital training — Physical processes of restoration contributory to vocational rehabilitation — Cooperation of medical authorities and the Federal Board for Vocational Education — Three stages in restoration — The first stage, acute illness, passed abroad — The stage of convalescence — Occupational therapy — "Invalid" or '' bedside occupations''— The '' curative workshop''— The final stage of vocational reeducation. One of the few beneficent by-products of the Great War is the knowledge gained regarding influence of the mind, exerted through occupation, upon physical recuperation. A great stride forward in therapy has been registered, and in the coming years the new paths in restorative methods which now lead in short cuts directly to amazing results will have become main highways in medical science. It is not longer open to question that a new and greatly improved method of handling convalescents has been evolved. The experi- ence of every belligerent country in dealing with its wounded has been the same. The general verdict is that a wonderfully effective system of restoration has been developed; the thousands of cases in which it has been used with entire success attest its worth beyond the peradventure of a doubt. Briefly stated, it consists primarily in impressing upon the patient that, notwithstanding his injuries, he is not incapacitated for civil usefulness, that his 202 CURE BY WORK handicap of disability will be largely, if not entirely, neutralized and overcome by education designed pre- cisely for that purpose; and that the sooner he gets at the work of training, the more efficient he is likely to be in his rehabilitated status. The active, healthy, self-supporting young man who loses a leg or an arm or has his system shattered almost invariably descends into an abyss of gloom and despair. He pictures himself as a mutilated mendi- cant, or as a burden to his family, or as facing a life of uselessness bounded on the one side by charity and on the other by lack of opportunity to better his con- dition. He thinks he has been rendered useless and placeless in the scheme of things; that he is debarred from the right of every true man, the love and com- panionship of some good woman and a home of his own, by reason of not being able to support a family. The future looks dark indeed to him. From these depths he is raised to hope and desire for life again. He is convinced that notwithstanding his injuries, he is still the architect of his own for- tunes. He is shown irrefutable records of other men as badly injured as he, who, by force of will and deter- mination, have overcome their disadvantages and are in as good position, if not better, regarding earning capacity as they were before they joined the colors. He is impressed with the idea that he must again prove himself a soldier and a man. As such, he must rally his forces and determine to cooperate with the Govern- ment in training to be an effective soldier in the army of peace, engaged in obliterating the scars of war and constructing anew a greater temple of civilization. It is rare indeed that the disabled man does not 203 REDEMPTION OF THE DISABLED answer such a call to go forward and put up a fight again. The message inspires him as the bugle's ring- ing summons carried him into the charge on the bat- tlefield. He should then be made to see that every minute of the time counts, and if he has a long con- valescence ahead of him, that he can employ the hours to the greatest advantage by doing some of the pre- liminary study. The admonition of Marcus Aurelius is peculiarly applicable to the philosophy of the wounded soldier's situation: "Hasten then to the end which thou hast before thee, and throwing away idle hopes, come to thine own aid, if thou carest at all for thyself, while it is in thy power." So the injured man should be convinced that such study will add to his efficiency when he takes up the work of reeduca- tion in earnest on his discharge from the hospital. Not only that, but it should actually aid in his recov- ery and hasten the end of his term in the hospital. Advantage is thus taken of the medical fact that when the mind of the patient is occupied with some- thing in which he is interested and which has a bear- ing of advantage in the way of improving his status in life, he will progress much faster to recovery than the man who is not so occupied and who broods over his condition or his future. Just what this reaction is, just what are the subtle processes in the repair laboratory with which each human system is equipped by nature, has not yet been analyzed. Suffice it to say that it is a fact. Hope is the greatest restorative of all, and work is its ablest assistant. As a part of the programme of inspiring the coope- ration of the patient himself, the policy should be adopted of explaining to him the purpose of the vari- 204 CURE BY WORK ous things that are being done for him, so that he can understand and bring an approving and assisting mentality to bear upon and aid in the processes of restoration. If it is a question of exercise to rehabili- tate a set of impaired muscles and the movements must be persisted in, whenever possible those movements should be given which are used in the trade or occu- pation or process for which the man has chosen to be reeducated. The patient should be made to under- stand that while he is bringing back into function his muscles, he is not doing aimless exercise, but is actu- ally being educated in a part of that calling which will afford him after his return to civil life good wages and a steady occupation. Under the law the injured man is under the juris- diction of the War or the Navy Department, accord- ing to whether he belongs to the Army or the Navy, until he has received his final discharge from the hospital and from the service on account of disability; that is to say, his health and care in the hospital is given the supreme consideration. The law, however, confides his vocational reeducation to the Federal Board for Vocational Education, and the medical authorities and the Federal Board are enjoined to work in cooperation in his vocational rehabilitation for civil life. Three stages are traversed by the patient in his return to civil life: first, acute illness or need for medical or surgical care; second, convalescence, which is often lengthy; and third, the real vocational reedu- cation. These stages may merge into one another or they may be separate and distinct. With the majority of the disabled men of the United States forces, it is 205 REDEMPTION OF THE DISABLED likely that the first stage will be passed in France or England, at least until there is no danger in undertak- ing a journey to a port at which the disabled man can be embarked upon one of our admirable floating hos- pitals and brought to his own country for recupera- tion, convalescence, and such extended or specialized training as his case may require. The hospital facil- ities of France and England are heavily taxed, and our men are invalided home as fast as it is possible or expedient to move them. As the patient begins to emerge from his first and acute condition of pain or disease, he may be given what is known as "invalid" or "bedside occupation," also designated as "occupational therapy"; and later, when he is so far recovered as to leave bed or ward, "curative workshop occupation" may be given. The broad term, "occupational therapy," covers all of these activities, and this is the treatment that the war has so greatly developed. Occupational therapy is the science of healing by occupation. In the cura. tive workshop the more advanced patients in conval- escence are given occupational treatment, which should be made, whenever possible, a part of the course of reeducation to come later. In the first or acute stage of disability and when the patient is just beginning to mend, "invalid occu- pation" is largely used as a part of the treatment, especially in cases in which his condition condemns the injured man to remaining in bed for an extended period. These occupations are designed mainly to help pass the time, but very often they may prove of considerable physical benefit. One of the main objects also is to help the wounded man to feel that he is not 206 PATIENT IN A MONTREAL HOSPITAL OPERATING A HAND LOOM, A FAVORITE BEDSIDE OCCUPATION WOOD CARVING, A TREATMENT PRESCRIBED FOR FUNCTIONAL RESTORATION OF WRIST AND FINGERS CURE BY WORK entirely wasting the hours, to save him from too much introspection and to ward off brooding. Depression, lack of exercise and worry are found to have a bad effect on physical condition, and it is with a view to forestalling these by keeping the man's mind and hands busy that these employments are chiefly de- signed. If they can have some relation to the course of vocational education the man has made up his mind to take, even though remote, so much the better, and they have a very much greater value. The range of bedside occupations is necessarily limited, and they cannot always have a direct practical value and bear- ing upon the future of the patient. But in some instances they can be made the initiatory processes in the course of training the man will afterwards take, and if he is made aware of this fact he will usually enter upon them with a zest and an interest not to be found in doing things merely because it is a part of treatment or a matter of exercise. After the patient is able to leave his bed and is progressing, the "curative workshop" should be the next stage for him. "Occupational therapy" should be continued during convalescence, designed to cover the tedium of that time during which medical or surgical treatment has become of less importance, but while it is still necessary for the man to have strict medical supervision. Long convalescence is involved in many of the disabilities of the injured soldier, such as nerve disorders, heart trouble, general debility, tuberculosis, rheumatism, injuries requiring ortho- paedic treatment, and the like. What is done in the convalescent stage forms the vital link between medical treatment and vocational 207 REDEMPTION OF THE DISABLED reeducation or economic readjustment. It may be asserted that the success of vocational reeducation, which is the final stage in restoration, can be helped much by the right kind of occupational therapy in the curative workshop. The convalescent stage is the most critical and important of the three stages of rehabilitation. During this period ambition and the desire for self-support and economic usefulness may be fostered with best results, replacing the apathy, despair and dependent condition into which so many of the men are apt to fall. This is the period also in which the patient regains the functional use of the body. The extent to which he becomes interested in the activities of the curative workshops determines in many cases whether he can be roused to take voca- tional education later. The curative workshop, like the other parts of the hospital, must be under military discipline. Author- ity is necessary during convalescence so that the men shall not retard their recovery by excessive exercise or rest, wrong food or bad habits. The "work pre- scription" must be enforced just as rigorously as any other prescription. Beyond this point, and except in rare instances, there should be no recourse to military discipline. A Canadian report, speaking of the cura- tive workshop and its effects, says: The greatest benefit derived by the men is the hardening of mind and muscle in preparation for civilian life. For many months they have not been compelled to think for themselves, nor have they been compelled to think of their own food or raiment or even the welfare of their families. For the greater part of the time the daily effort required in military life has not been as great as they formerly made in earning a living. After the pain and suffering of their 208 CURE BY WORK wounds are allayed, they spend many weeks in hospitals and convalescent homes in a state of pampered and glori- fied idleness. The classes fill in the gaps between the other items of routine, such as massage, physical training and the like, and produce a well ordered and well rounded day, much like the civilian life which they are rapidly approach- ing again. It is in the curative workshops that the Federal Board for Vocational Education should begin with the men, feeling them out, testing their capacities, finding out what their residual or latent capabilities are. It must be borne in mind that a large percentage of the American forces were drawn from the ranks of young men who were just starting out; many of them had no very fixed occupation and had been trained for no particular trade. To turn a man loose with no means of doing any particular thing, and with a handicap of physical disability as well, would be criminal. Hence, the task is made difficult by the necessity of finding out what these young fellows are best suited for, and then starting from the very bottom to teach them something useful by which they can make a living. The Board's "vocational ad- visers," skilled men of wide trade information, of personality and with broad understanding, were de- signed to be in the hospitals to plan with the men their future, to ascertain what each man's previous occupa- tional history was, if any, and what he wants to do in future. Having arranged these fundamental pre- liminaries, the man should be given such training in the occupational therapy and while still under medical supervision in the curative workshop as will lead up to or be a part of the course he has chosen. 209 REDEMPTION OF THE DISABLED The convalescent patient begins with short periods of work. As his recovery progresses, the time re- quired for medical treatment decreases, and the time for work increases. In the earlier stages of con- valescence, the medical treatment is the chief concern; this diminishes in importance as the patent recovers, while the value of training increases in like ratio. When the medical authorities have pronounced him well, or at least, that everything possible has been done for him in the way of medical and surgical treat- ment, and his continuous presence in or about a hos- pital is no longer necessary, he is given his discharge from the hospital and from the Army or the Navy. Thereupon, if he has elected to take the training offered by the Government, he is granted a "training allowance " of $65 per month to support him while he is undergoing the course he has elected. If he is married and his wife lives with him while he is training, he is allowed $75 per month. If he is mar- ried and does not live with his wife in the training period, she is allowed $30 per month for herself and $10 per month for each child up to three. If there are more than three children, the Federal Board will make such additional payment as may be necessary to maintain them. The $65 paid the man for support is supposed to cover board, lodging, clothing and in- cidentals. He is furnished transportation to the point at which he is to enter upon his studies. If it is in a college or trade school, all fees are paid, books are furnished free, and expenses for laboratory material and the like are also met by the Federal Board. Officers receive training compensation at the rate of 210 CURE BY WORK pay they received during the last month of service and no family-support allowance is made. Officers are expected to support their dependents out of the fairly liberal pay of their respective ranks, but in other respects the procedure is the same. If the dis- abled man has been supporting a mother or other dependents, provision will be made for them on the same terms as were in force while the man was on active service. The Federal Board for Vocational Education has established branch offices in 14 districts, covering the whole of the continental United States. Each branch office is in charge of a District Vocational Officer. Attached to each office is a local board of three mem- bers, one representing the employers, one represent- ing labor, and the third a physician. This board sits with the District Vocational Officer and his vocational advisers in passing upon applications made to the district office. The recommendations of the local boards are subject to final review at the main office of the Federal Board in Washington, but they are usually followed. All disabled soldiers, whether in or out of the hos- pital, should address their communications to the Federal Board for Vocational Education, Washington, D. O, or to the district office of the Federal Board of the district in which he is located. The district offices of the Board are located at the following points: District No. 1: Maine, Vermont, New Hampshire, Massa- chusetts, and Rhode Island. Office: Room 433, Tremont Building, Boston, Mass. District No. 2: Connecticut, New York, and New Jersey. Office: Room 711, 280 Broadway, New York. 211 REDEMPTION OF THE DISABLED District No. 3: Pennsylvania and Delaware. Office: 1000 Penn Square Building, Philadophia, Pa. District No. 4: District of Columbia, Maryland, Virginia, and West Virginia. Office: 606 F Street NW., Washing- ton, D. C. District No. 5: North Carolina, South Carolina, Georgia, Florida and Tennessee. Office: Candler Building, Atlanta, Ga. District No. 6: Alabama, Mississippi, and Louisana. Office: 822 Maison Blanche Annex, New Orleans, La. District No 7: Ohio, Indiana, and Kentucky. Office: 906 Mercantile Library Building, Cincinnati, Ohio. District No. 8: Michigan, Illinois, and Wisconsin. Office: 1600 The Westminster, 110 South Dearborn Street, Chicago, 111. District No. 9: Iowa, Nebraska, Kansas, and Missouri. Office: 517 Chemical Building, St. Louis, Mo. District No. 10: Minnesota, North Dakota, and South Dakota. Office: Room 742 Metropolitan Bank Building, Minneapolis, Minn. District No 11: Wyoming, Colorado, New Mexico, and Utah. Office: Denver, Colo. District No 12: California, Nevada, and Arizona. Office San Francisco, Cal. District No. 13: Montana, Idaho, Oregon, and Washing- ton. Office: Seattle, Wash. District No. 14: Arkansas, Oklahoma, and Texas. Office: Dallas, Tex. This does not mean that a disabled man is obliged to make a trip to consult the officials of the Board of his district. On the contrary, a vocational adviser will be sent to call upon him in his home and spare him the expense. In cases when it is advisable to have the subject appear personally before the district board, his expenses are paid. Thus far the system of dividing the country into districts and initiating the work from the district offices has operated admirably. 212 CHAPTER XVIII THE CHOICE OF AN OCCUPATION All careers open to the disabled man — The welfare of the indi- vidual the - criterion of choice — Vocational advisera — Their qualifications and functions — Medical limitations on the choice of an occupation — Previous experience of the patient utilized — Examples of retraining in special- ized branches of pre-war occupations. It is well to state here and now, that all careers are open to the disabled man. He is not confined to a choice of manual trades. Whatever is best for that man, whatever offers the greatest opportunity for civilian usefulness, per- sonal happiness and content, and well paid return accord- ing to his capabilities, that training shall he have. This statement was made by the Federal Board for Vocational Education soon after Congress placed upon it the duty of reeducating the disabled men. It gives the underlying principle of the work in a nut- shell. With these principles ever in view the work of rehabilitation is undertaken. The welfare, future usefulness and happiness of the man are the real criteria. This is a fact that those who are to be re- educated should firmly grasp. The whole scheme is based upon nothing else than the desire to do as much as can be done for the disabled man. His future, his happiness, his opportunity to be a useful, well paid citizen, his development and progress, are the funda- mentals a grateful and appreciative Nation is en- deavoring to insure. The whole matter of vocational rehabilitation is voluntary on the part of the disabled man. There is 213 REDEMPTION OF THE DISABLED no compulsion about it. He can take it or leave it, just as he pleases. If he desires to leave the hospital with incapacitating injuries and with only a pension to fall back upon, qualified only for some semi-chari- table work, able to earn actually but a mere pittance in the long years to come, that is his privilege. Ho can go out of the door the day he is well, with no one to say him nay. But how insanely foolish would be any man who adopted such a short-sighted and utterly indefensible course! If he has no regard for himself, a man tempted to this course should have some for his relatives and dependents, upon whom in the course of time he will inevitably sag down for support. In recognition of the fact that he has played a man's part, his country is going to do its best to stand by the disabled man. But the country still expects him to do his duty, and that duty is to make himself a useful, self-supporting, public-spirited citizen. To this end it offers him every possible aid. With this purpose in view, the disabled man is recommended to meet and confer with the " vocational adviser," the accredited agent and representative of the Federal Board for Vocational Education. An adviser is attached to each hospital in which men are convalescing, in the larger hospital centers, and each branch office of the Federal Board has several advisers on its staff. The vocational advisers are charged with the duty of advising with the men who may be subjects for vocational reeducation, as well as with the military officials and the surgeons, in regard to the future welfare and the preliminary vocational training of the injured men. The vocational advisers are, in the main, civilians. 214 THE CHOICE OF AN OCCUPATION Their function is to assist each man to get back into civil life to the best advantage to himself and his future as a citizen. When men of the right qualifica- tions who have served in the ranks and are them- selves disabled are found, they are employed as voca- tional advisers, but at the start civilians exclusively had to be employed. It is felt by the Board that a man who has himself served with the colors and been wounded will probably be able to get closer to the disabled men than one who knows nothing of army life; hence, ex-soldiers of the right type who can qualify are given preference for these places. The work requires rather an exceptional type of man, full of human sympathy and understanding, of infinite patience and tact, big-hearted and frank, always ready to see the other fellow's point of view, and genuinely anxious to be of service to the disabled man seeking his advice. He must be a keen judge of human nature, with some successful experience in handling men. He must have a wide range of know- ledge regarding trades and occupations, their require- ments, opportunities, disadvantages as well as advan- tages. He must be of a type the wounded will in- stinctively desire to confide in, talk to in man-to-man fashion, and one whose ability and knowledge will inspire respect for their genuineness. It is a pretty hard job to qualify for, and not one man in a thou- sand can qualify. But there are men of this type, and the Federal Board is seeking them out for its service. If one is found among former army men, so much the better. When it has been determined by the medical and surgical authorities that a man has received such in- 215 REDEMPTION OF THE DISABLED juries that he must be discharged from the service and that it is unlikely that he can return to his pre-war occupation, the vocational adviser has a talk with him. In this preliminary conference the adviser endeavors to get the man to see the advantage of taking the re- education the Government provides for him. If the patient is interested, data of his education, previous trade or calling, experience, likes and dislikes in the matter of work, and preference in regard to a new trade or occupation for reeducation are recorded, and the vocational adviser seeks a medical estimate of the case. The medical men, having gone over the patient thoroughly, are in a position to report upon his limita- tions, the things, from a medical and health point of view, he should not do. For instance, if the man has been gassed and his heart affected, the doctors may report that he should not enter an occupation involv- ing heavy strains; or, if he has contracted severe rheumatism from exposure in the trenches, that he should choose a sheltered occupation in which he would not be exposed to dampness and cold. If his lungs have been weakened, he should be out of doors, or if he has traces of epilepsy, he should by no means be allowed around swiftly moving and dangerous ma- chinery, or on tall buildings from which he might fall in an attack of dizziness. The vocational adviser, with such a report as a guide, knows definitely what occupations his subject cannot enter, and, conversely, he can also tell fairly well what occupations the man can be trained for and follow without injury to his health. Next the vocational adviser and the man go over 216 THE CHOICE OF AN OCCUPATION the subject again in a cordial, mutually helpful fashion. It may be that the first choice of the dis- abled man of an occupation to train for has been vetoed by his physical condition and another choice must be made. The vocational adviser is there to aid the man with his expert knowledge. The primary endeavor is to fit the individual man for the job for which his inclination and capacity seem to indicate the strongest probability of success, scientifically ad- justed to the likelihood of there being a demand for his services in the line of work selected. The whole range of occupations, trades and professions suited to the abilities of the disabled man are canvassed in the effort to decide upon something appropriate for him to train for, something that he can do well, that affords good prospects of steady employment, and that he wants to do. This last is one of the main points — getting the man into something in which he is really interested. Whenever possible, he is induced to go into some specialized branch of the trade or occupation he al- ready knows, so as not to lose the knowledge he has gained by experience, which is the most valuable sort of trade knowledge. That equipment is built upon and capitalized, and perhaps made of more value to the man than it ever was before. If the disabled man has any experience in an occupation, he is vastly more fortunate than those who have not. If he has had no experience, then the task is to fit him into some occu- pation he is adapted for, has a liking for, and is earnestly impressed with as being desirable to follow for a livelihood. If, for instance, the disabled man has been a 217 REDEMPTION OF THE DISABLED farmer, likes farm life, and prefers to return to it if he can, the question is to decide where he will fit in. Usually farm work requires considerable strength and agility — and suppose the man has lost a leg. It may be that to train him as a farm-tractor and farm- machinery operator is the very thing for him. With a tractor he can plow and harrow his own land and that of the neighborhood. In these times of shortage of help, farmers are turning more and more to mechanical assistance, and there is a growing tendency to have the plowing, harrowing, reaping and thresh- ing done by contract with labor-saving machinery. As a tractor operator the disabled man could also take on a contract for the upkeep of a stretch of country roads by using a scraper and roller on them with his tractor as motive power. He could buy a threshing outfit, and haul it from place to place and operate it with power from his tractor. He could use his tractor to cut silage for farmers, operate well- boring machinery or a small portable sawmill, and so on. Some tractor men in Canada have found it a most remunerative occupation. Thus the man's knowledge of farming conditions and rural life is utilized in a practical way in his reeducation. It would be foolish in the extreme to try to make out of such a man a salesman or a dentist, a lawyer or an accountant. As another illustration, we may refer again to the case of a structural iron worker who has, let us say, a stiff knee, and no longer possesses the agility re- quired to clamber around the skeletons of skyscrapers or the framework of bridges. The obviously sensi- ble thing is to make use of his trade knowledge in re- 218 THE CHOICE OF AN OCCUPATION educating him. It would be folly to discard his ex- perience and practical knowledge and train him as a veterinary or a mail clerk or a cabinetmaker. He should be prime material to be fashioned into an in- spector of structural-steel construction, a foreman for steel works, an architect or draftsman specializing in work involving structural steel, a contractor's as- sistant, or an office man or yard superintendent in works manufacturing steel shapes. He would make an admirable construction man with a bridge works, an estimator on contracts, a salesman, and possibly in some other positions his practical knowledge would count heavily in his favor and give him a distinct advantage in going forward to success. The same principle applies all along the line in several hundred occupations, trades, professions and callings. In no case is previous valuable experience thrown on the rubbish heap unless there are over- whelmingly good reasons for discarding it. There are some cases in which it is expedient to abandon a former general line of work, but in the main the former vocation will be developed and specialized. It is rather a trait of human nature to believe that some other occupation is better and offers more oppor- tunities than the one engaged in. It is the duty of the vocational adviser to disabuse the minds of his subjects of such notions unless they are well founded, and to endeavor to make them see that in their trade knowledge they have a valuable capital which they can turn to good account. It is the function of the vocational adviser to ex- plain all these matters to the wounded man, to ascer- tain what he is best qualified for, and then to get the 219 REDEMPTION OF THE DISABLED man to see it for himself and heartily acquiesce in the choice. However, if the disabled man positively will not make use of his valuable capital of knowledge or experience and has his mind and heart set on trying some other line of endeavor, he will be allowed to do so, unless it is clearly preposterous and a waste of time and money to endeavor to fit him for it. In the case of the man who has never acquired any particular skill or knowledge or trade, or of the youth who had just begun at a soda fountain or as clerk or in farm work, the problem is more difficult of solu- tion, but in its general aspects it is the same. Per- haps the wife or mother or sister of the soldier is consulted. The object is to start him at something he has a taste for, along the line of his likings and manifest abilities. When that has been done and a wise selection made, the most difficult problem of retraining has been met and overcome. When the man finally decides upon what he wants to do, and his choice is approved by the vocational adviser, he should be given another medical survey with a view to the risks and incidence of that par- ticular trade or occupation. If it is approved by the medical men, the student has the comforting assur- ance as a fundamental that it is perfectly safe for him to engage in it and that his health will not be in the least jeopardized or affected thereby. 220 CHAPTER XIX THE TRAINING ADAPTED TO INDIVIDUAL NEEDS The process of reeducation a civilian function — The sense of individual responsibility and initiative atrophied in mili- tary service — Its stimulation a primary purpose — Voca- cational rehabilitation an individual problem — Institu- tional facilities open to the Federal Board for Vocational Education — Practical workshop classes a concentrated apprenticeship — Wide range of occupations and courses available — Assistance to complete interrupted college courses — Illiteracy in the draft — Disabled illiterates to receive a fundamental education — Vocational instruction given in small groups. When the disabled man finally passes out of the hospital and the curative workshop, when all has been done for him physically and mentally that medical or surgical science can afford, he is discharged from the Army or the Navy. He is thenceforth a civilian, being reeducated for civilian life and responsibilities through the medium of a civilian agency. There was a definite purpose in thus cutting the bonds that attach the man to military life. In the service he has been subject to authority every moment of his time. Initiative and individual responsibility have necessarily been submerged in the mass. His every act has been regulated according to a schedule in which his part is only to follow and obey. He has given no thought, nor has he had any choice, as to where and when and what to eat, or what to wear, or how to employ his time. In a short while he has become, in large measure, dependent upon having his existence arranged and ordered for him. It is sur- 221 REDEMPTION OF THE DISABLED prising how soon a man becomes dependent upon con- ditions of this sort, and how slow his readjustment is when he is again "on his own." It is best that his dormant sense of responsibility and initiative be stim- ulated from the start as an invaluable asset for his reentrance into civil life, in which these two qualities or their absence count for so much as a help or as a deferent to the individual. Hence, Congress wisely decided that for the good of the man himself, the work of vocational reeducation should be a purely civilian function. The only discipline to which the student is subjected is the loss of his pay should he wilfully neglect his studies or fail to exercise reasonable dili- gence in pursuing his course, with the ultimate with- drawal of the privilege of reeducation when he is obviously not interested and is making no effort to progress. In no other line of instruction as in the retraining of the disabled is the necessity so great for individual attention to the student. The men cannot be grouped into broad divisions or classifications, either by inju- ries or by trades. It cannot be said that this, that, or the other is a proper occupation for a one-armed man or a one-legged man or a tuberculous man. It may be a trade suitable for a one-armed man, but is the man suited to the occupation ? Is the loss of an arm the whole of his disability? Has he any previous experience in that or an allied calling? Is there a demand for such workmen, or opportunities in such a trade near where he lives and has his savings, his home, his acquaintances, friends and relatives? And finally, most important of all, does the man himself want to take up that occupation, and is he interested 222 TRAINING ADAPTED TO INDIVIDUALS in that method of making a living? For, unless he is interested in it, believes in it and its worth, and ear- nestly wants to utilize it as a means of livelihood, it is worse than useless to expend the time, money and effort in endeavoring to fit him for it. Hence, the problem obviously resolves itself into one of individual treatment from the very beginning, with many differ- ent angles and phases to be considered. Hence, also, the instruction must be along individual lines if proper results are to be had. After the man has consulted with the vocational adviser in the hospitals and has determined for what he wants to be reeducated, and the medical authorities have approved his choice from the standpoint of his physical abilities and future physical welfare, and after he has left the curative workshop, the Federal Board for Vocational Education automatically takes charge of his education and the real course of training begins. This education is not being administered in large cantonments, camps or specially created institu- tions or workshop hospitals, with an exception per- haps in the case of tuberculous patients, who must have certain special conditions for continuous treat- ment while engaged in qualifying, so that they build health at the same time as they receive instruction. There is a wealth of institutional material available in the country which has the equipment and facilities to give almost any instruction called for in practical lines. Nearly all of the states have "land-grant col- leges," better known as "colleges of agriculture and the mechanic arts," where the whole range of agri- culture, dairying and its branches, stock raising, poul- try raising, bee-keeping, small-fruit growing, truck 223 REDEMPTION OF THE DISABLED farming, market gardening, the florist's and garden- er's occupations, and the like may be learned thor- oughly and practically. Many of these institutions also have mechanical equipment enabling them to instruct in various lines, such as farm-machinery operation, care and repair, the machinist's trade, woodworking in its various branches, textiles and its branches; and a few of them have more elaborate facilities for instruction in trades and in industrial occupations. There are also at various points trade schools and technological institutions of high grade, in which the whole of education under these heads is covered. There are also other excellent schools and colleges teaching more specialized callings. A programme was formulated by the Federal Board to give even more practical instruction than that outlined above. Classes in certain industries are arranged and put in works under the tuition of highly skilled operatives and teachers. The result is a sort of concentrated and scientific apprenticeship by which the students accomplish in a term of months that which in ordinary circumstances requires an appren- ticeship of several years. Having qualified as a com- petent man in the subject of his training, the student makes the transition from the status of learner to that of worker in familiar surroundings and in a trade in which he has received instruction from experts who make their living by that trade. The merely theoret- ical teacher is barred. He must not only be able to tell how a thing or a process is done, but he must be able to do it. The impression must not be gained that the educa- tion furnished by the Federal Board is necessarily in 224 TRAINING ADAPTED TO INDIVIDUALS trades alone or in manual work or the like, for such is by no means the case. A large proportion of the sub- jects for vocational reeducation are men who can only follow an occupation under very especial conditions. Such, for instance, are men with arrested cases of tuberculosis. Men thus afflicted must have an out-of- doors life, with a maximum of fresh air and sunshine and a minimum of exertion. They will perhaps be given courses in poultry raising — real scientific train- ing by men who have made commercial successes on their own account. The instruction is given possibly upon a poultry farm, arrangements having been made to that end by the Federal Board. Or the student may desire to take up market gardening or truck farming, or the growing of flowers, plants and bulbs in the open for sale to dealers and the trade generally; or he may fancy growing violets and other such plants under glass; or he may want to take a course in civil engineering or forestry, or as an orchardist, or in cattle raising. All of these occupations, and many others, are at his disposal to make a choice from. The number of courses available approaches the 400 mark. An examination of the first 159 cases approved for training by the Federal Board is most interesting. There are 63 different trades represented in this num- ber of cases. The most numerous class is that of agriculture and allied occupations or specializations — 25; the next is commercial education, with general business education following a close third. The elec- tions of the 159 cases are divided as follows: Academic............... Accountancy............ Agriculture............. 225 1 6 18 REDEMPTION OF THE DISABLED Animal husbandry........................ 2 Architecture............................ 1 Automobile driving and mechanics.......... 3 Banking................................ Bookkeeping............................. 3 Bookkeeping and farm production.......... 1 Bookkeeping and office management........ 1 Building construction...................... 1 Business course, general................... 12 Chemist................................. 1 Civil engineering.......................... 2 Commercial.............................. 19 Dairying, scientific........................ 2 Drafting................................ 1 Electrical course, general................... 4 Electrical drafting........................ 1 Electrical engineering..................... 3 Electrical plant operation.................. 1 Embalming.............................. 1 Engine designing and drafting............. 1 Exporting............................... 1 Farm management........................ 1 General education......................... 1 Jeweler................................. 1 Jewelry and watch repairing.............. 1 Law.................................... 4 Lip reading.............................. 3 Lip reading and bacteriology.............. 1 Machine operator......................... 1 Machinist............................... 1 Marine gas-engine operation............... 1 Meat inspection........................... 2 Mechanical drafting...................... 1 Mechanical engineer....................... 4 Mechanics and shop practice.............. 4 Medicine................................ 2 Milk inspection........................... 1 Monotype operator........................ 1 Motor mechanics.......................... 11 Normal teacher........................... 1 Normal training.......................... 1 Oxy-acetylene welding..................... 1 Penmanship............................. 1 Poultry and swine raising................. 1 Poultry raising........................... 1 Salesmanship............................ 2 Secretarial course......................... 3 Sheet-metal designing..................... 1 Show-card writing and painting............ 2 226 TRAINING ADAPTED TO INDIVIDUALS Silversmithing and designing.............. 1 Special gas-engine course.................. 1 Stationary steam engineer................. 1 Steam engineering........................ 1 Store management........................ 1 Tailoring................................ 1 Telegraphy.............................. 3 Telegraphy and business course............ 2 Tool and instrument making............... 2 Traffic management....................... 1 Window dressing and designing............ 1 As evidence that the disabled men are being placed in the best institutions available, these first 159 men were distributed among the following, some, however, being placed directly in trades or industry for instruc- tion: Alabama Polytechnic Institute American Institute of Banking Amherst College Baltimore Business College Boston University Law School Bryant and Stratton Business Colleges Burdette Business College Clemson College Colorado University Columbia University David Ranken Trade School Dunwoody Institute Filene's Department Store Franklin Union College George Washington University Hampton Institute Harvard Law School Harvard University Hawley School of Engineering Howard University Indiana State Normal College Lehigh University Maryland State Agricultural College 227 REDEMPTION OF THE DISABLED Maryland University Massachusetts Institute of Technology Michigan State Agricultural College Mississippi Agricultural and Mechanical College New York School of Commerce North Carolina Agricultural and Mechanical College Ohio State University Pratt Institute Purdue University Soule Business College Strayers' Business College Tennessee State Agricultural College Tulane University Tuskegee Institute University of California University of Illinois University of Michigan University of Nebraska University of Nevada University of Tennessee University of Texas Virginia Polytechnic In the case of the young man who has not yet fin- ished his education, he may without disappointment expect the Federal Board to assist him. If in the course he was pursuing when he forsook his studies for military duty, he was qualifying for a profession which might reasonably be expected to yield him a livelihood, and he was well started 1 herein, he can look to the Federal Board to help him to finish it. That is, he may expect help within reason. Again it is an individual matter. If the man was educating him- self at the time of his enlistment or draft call, was approaching completion of his studies, and thus suf- fered his financial arrangements to be disrupted and perhaps his savings used up in the support of depend- 228 TRAINING ADAPTED TO INDIVIDUALS ents, there is hardly a question that the Federal Board will enable him to complete his course if there is reasonable ground to believe that he will make a success in his chosen profession. Illustrative of this is a case among the first 25 awarded training by the Federal Board. This young man was in his sophomore year at a well known technical school in the South when the draft called him to the colors, and he was manifesting exceptional ability in his studies to be a civil engineer. He has been awarded support and maintenance in the college until he graduates, and is now back at his studies. The draft law, aside from its military value and necessity, has been the means of revealing an aston- ishing percentage of illiteracy among the men taken for service. By this means the attention of educa- tional authorities has been directed to the localities in which this condition exists and steps are being taken to remedy it. But the unfortunate products of such an environment, who from lack of schools or through necessity are deficient in the fundamentals of an edu- cation, will be given their chance also. They will be taught the essentials of a good common-school educa- tion, and then, when this foundation has been pre- pared, they will be given further and specialized training suited to their needs in some trade or calling in which they are best fitted to make a success. In assigning men to various approved institutions, the first thought is to send each man to an institution as close to his home as possible. The wisdom of this plan as a matter of economy, as well as of educating each man where the greatest amount of interest will be taken in him, is strikingly shown by the testimony 229 REDEMPTION OF THE DISABLED of Dr. Prosser, Director of the Federal Board, before the Joint Committee on Education and Labor of House and Senate on December 11, 1918, the Bankhead- Smith bill providing for the vocational rehabilitation of the disabled of industry being then the subject be- fore the session. Dr. Prosser, detailing the progress made by the Federal Board in handling the reeduca- tion of disabled soldiers, said in part: When this war sloughed off, the Federal Board did not have a spade in the ground, or a pile of brick or a sack of cement or a typewriter being used for instructional pur- poses. We made up our minds that we were going to use the facilities of this country in schools and offices and shops and farms — and I want to say that the way the people of this country of all classes have thrown open their resources is remarkable. So, we did not need that item of $350,000 for equipment. The tuition cost we are paying is practically negligible. We are trying to educate these fellows back near the folks at home in their own schools, and when that occurs and we go to the threshold of the state and submit the matter to the state educational officers they say: " We do not want any Government money whatever for these fellows. They are our own sons. Instead of asking money with which to educate them, we owe them more than they do anybody and we want to do more for them than we have done for anybody." So we cannot spend that $445,000 for tuition as provided in the Smith-Sear's law. Care will be taken not to crowd the facilities so as to interfere with thorough training. At all times there will be a sufficient number of competent instructors to give the maximum of attention to each man who is taking a course. The greatest care is given individuals in developing them to their fullest capacities. The aim 230 TRAINING ADAPTED TO INDIVIDUALS is to utilize the remaining capabilities of the disabled man to the maximum. Each man, therefore, presents a different problem. No two injuries are in all respects similar; no two men have the same background of education, experi- ence, trade knowledge, inclination or capacities for absorbing training. This necessitates a system of instruction in which small groups of students are handled. By reason of this extra care and attention, the recipients of instruction are enabled to make progress not possible when classes are larger. In the latter instance, as in the case of a convoy of troop ships, the distance covered is limited by the speed of the slowest vessel in the fleet; but with what amounts to individual instruction, there is absolutely no check upon individual development and the capacity of the individual to go ahead. 231 CHAPTER XX THE PROBLEM OF PLACEMENT Placement an essential part of the restoration programme — Employers protected against increased casualty insurance rates — Prejudice against employment of "cripples"— The retrained man dependent upon no special favors — A Government placement agency organized — Cooperation of state, local and private agencies — A survey of industrial opportunities made — Attitude and education of the employers — The period of probation and adjustment — Work the acid test of training — Eetraining and replace- ment of misfits — Follow-up work after placement — A square deal for the man and for the employer — The atti- tude of organized labor. After the disabled man has finished the course of study, training or education that he has chosen, and is pronounced competent to engage in that occupation as a worker, utilizing it as a means of livelihood, the next step is to find a position for him. This is no less a part of the Government's programme for voca- tional rehabilitation than the training, for it is recog- nized that there still persists more or less prejudice in the minds of the generality of employers against the hiring of disabled men, and this must first be over- come. Much work has been done along these lines and satisfactory progress has been made. The employer has been first assured that the casu- alty-insurance companies will not increase the rate on the blanket policy carried on his works because of the employment of a few retrained men therein. No other country has experienced a rise in casualty rates for industrial plants on this account, and assurances have 232 THE PROBLEM OF PLACEMENT been given the Federal Board for Vocational Educa- tion by representatives of the casualty companies that a similar policy will be followed in this country. The next step was to convince the employers that a retrained man is not necessarily a man deficient in his work. In the case of a process requiring only manual dexterity, it is obvious that the presence or absence of a natural leg does not at all affect the operator's working capacity. The whole theory of retraining is to make use of those capacities or members unimpaired by the experience of the subject in army life. Not- withstanding all this, there has persisted the practice of calling men "cripples" when they are not in fact crippled, and the idea that the employment of such men was a condescension has been exceedingly diffi- cult to combat and replace with the correct concep- tion. The retrained man, in the majority of in- stances, can do as good work in the line for which he has been trained as any other man, and he is not asking special favors or special consideration in any sense. In placing the men it was decided that the efforts of a Government agency were likely to be more effec- tive and systematic than private or even state effort. These, however, can be utilized most advantageously as aids to the Government placement agencies. They can assist greatly in helping to propagate the correct conception of the disabled or retrained man; they can bring the influence of public sentiment to bear upon the employers of labor in its various forms and per- suade them to agree to extend to these men the oppor- tunity to work and honestly earn their living. More- over, local authorities can ascertain local conditions 233 REDEMPTION OF THE DISABLED in industries and assist in the placement of each man near his home, where he will not be among strangers but returned among his former friends, associates and community interests. In every case an effort is made to find employment for the man in his former com- munity, and, if possible, in some branch of the in- dustry in which he was engaged before the war. A systematic search of the various industries of the country, for the purpose of listing all of the employ- ment opportunities offered in which retrained men can be utilized, has been in progress for many months. In this survey the United States Department of Labor has directed, and it has cooperated with the Federal Board for Vocational Education in classifying and cataloguing the results. State compensation commis- sions and labor bureaus have rendered hearty assist- ance within their especial territories, and in the main there has been cordial cooperation by the press and by private individuals. The result has been the assembly of a vast amount of data on the various industries and occupations and their capacity to absorb the men who have been reeducated for them. This information is classified and immediately avail- able for use to the fullest extent in the placement programme. Once the employers clearly understood that there was nothing of a charitable nature about trying the reeducated men or giving them employment, the way was easy. Many employers did not understand. They were willing to contribute money for the dis- abled men, willing even to carry them on their pay- rolls in some capacities, if need be, as open and acknowledged incompetents; but they dreaded the 234 Courtesy Carry On. CURATIVE WOllKSIJOP AT IT. S. AHSIY GENEHAl. HOSPITAL NO. 9, LAKE WOOD, NEW JERSEY THE PROBLEM OF PLACEMENT disorganization the induction of supposed incompe- tents or superficially trained men would create In their plants. After the employer grasped the idea that the retrained man wanted it forgotten that an arm or a leg was missing or other injuries existed, and desired that his rating be solely upon the basis of the work he was able to do in that particular factory and not upon what he could not do in some other industry, the way was made much easier for cooperation. In the main, little difficulty was experienced in obtaining a hearty consent from the employing pow- ers. To give the retrained man a chance appealed to them as a fair, sporting proposition. As a generality the employers became enthusiasts on the subject of aiding the disabled men back into their places as workers and useful members of the civil community, and there are few employers in the country today who will not welcome the retrained man to their works and give him as square a deal as any man should want or expect. "With rare exceptions the employer will greet him with the respect the ex- soldier is entitled to — that of a brave man who has done his full duty by his country in time of war, and who now desires to continue to do his duty by becom- ing a useful, busy, employed citizen in time of peace. Employers in the main have been willing to do more, but they have been told that kindly interest, square treatment, and the opportunity for the retrained man to work and be paid a fair wage for fair work are all that is asked. The matter of placement is not as simple as it sounds, for it involves a period of probation, study and adjustment before the man is finally assigned to 235 REDEMPTION OF THE DISABLED a job or a line of work in which he may consider him- self as permanently employed. When men have been given training in shops or works in which they expect to continue as employees, the process is easier in many respects, and less time is required to get each man into his new occupation as a qualified and competent worker. But the man trained otherwise, both for his own sake, for the sake of the reputation of the reeducated men generally, and for the satisfaction of the employer, must be kept under supervision for some time. Despite all efforts to make his training an absolute duplicate of the work to be done later commercially, it is not wholly successful in all essen- tials, and there must necessarily be a period of ad- justment in the actual industry and at the commer- cial work. It is the policy of the Federal Board to keep in close touch with the probationers during this critical and transitory stage through which nearly all of the re- trained men must inevitably pass. Experts in the lines for which the men have been reeducated will be in constant touch with them, encouraging them, cor- recting methods when necessary, and generally as- sisting to fit them into actual working conditions in such a way as to insure their successful pursuit of their chosen trades or occupations. When the new man acquires a sufficiency of self-confidence and be- gins to forge ahead, the supervision is gradually relaxed until it is evident that he is a full-fledged, competent workman and can make his own way without help. Work is the acid test of training, which in itself may have been excellently well conceived and exe- 236 THE PROBLEM OF PLACEMENT cuted, and yet may prove in individual cases, when subjected to the test in factory, shop or office, to have been inadequate or even misdirected. Under the first strain of sustained regular labor the well trained man may develop unsuspected weaknesses. Latent and deferred disabilities, mental and physical, may be uncovered, and provision must be made for these de- velopments, as well as for breakdowns, relapses and recurrences of old troubles after apparently complete convalescence. Moreover, it is naturally improbable, even with the most systematic, scientific, painstaking and searching survey of each man's vocational ca- pacities upon initiation of his training, that precisely the right sort of training will be determined upon and given to every man for precisely the right sort of occupation, taking account of each man's educa- tion, experience, disabilities and preferences, on the one hand, and, on the other, of openings for perma- nent employment in the chosen occupation in the home community to which the trained man will eventually return. Training for a given occupation is a comparatively simple matter. It is not the training itself that is difficult, but rather the election of that single line of training which is best adapted to the man's capacities and preferences, and which will most completely avoid his special handicaps. For any one of hundreds of occupations, schemes of training have already been perfected, and teachers entirely competent to conduct the training effectively are available. None of the problems of training is in itself difficult or unsolved, although, of course, the methods of instruction must be somewhat modified and adapted to the require- 237 REDEMPTION OF THE DISABLED ments and characteristic mental attitudes of the war disabled, who were men before they went overseas and who will return matured beyond their years by the hardships and fierce discipline of the war. They will not be children, and except in the first stages of con- valescence and as means of diversion and amusement, they will not take kindly to raffia and bead work, em- broidering and playing with picture puzzles, or to kindergarten methods of instruction. They will be in many cases difficult of approach, impatient of re- straint, mentally isolated from civilians by their ex- perience in the trenches, and possibly indisposed to respond frankly to the first appeals that may be made to them. They will naturally be separate and re- served, if not hardened and resistent. Absorbed in the contemplation of their own recent experiences, and incapable of communicating these experiences to others, they may be mute and silent in all other mat- ters as well, which for the time being may naturally appear to them to be in comparison trivial. They will be serious-minded, quick in the detection of schemes, and uncompromising in the condemnation of amateurish trivialities. They will apply to others the standards and exacting tests by which they them- selves have been valued in the service '' over there.'' For the newly returned, seriously disabled, mentally alienated, detached and possibly despondent man, the awakening of normal interests in civilian life may be gradual and long deferred. He may be temporarily indifferent in the matter of selecting an occupation. Such training as is proposed he may formally approve and enter upon without careful consideration of future requirements and opportunities or frank dis- 238 THE PROBLEM OF PLACEMENT closure of natural aptitudes. It is quite conceivable also that a man may honestly believe that he wants to train for a certain trade, and find after he gets into it that he has made a mistake and cannot make a living at it. Under these conditions in some propor- tion of the thousands entering upon training the wrong occupation is certain to be elected, and in every case the final test of the election must be made in the workshop, factory or office, or on the farm, in the man's home community, and after graduation from the prescribed course of training. Whenever the work test develops deficiencies in training, the disabled man may return to the Federal Board for such additional training as he may require. In the case of the obvious misfits the way is kept open for remedying the original error and for entering upon a new and suitable course of instruction. But it is manifest that there must be overwhelmingly good reason for such a course; otherwise the small propor- tion of those who lack stability, or who desire to change jobs merely for the sake of change, or who acquire a dislike for their work, would take advantage of this possibility, and not do as good work as they are capable of in training in the first instance, or apply themselves with proper resolution to their trades after they have been placed. It is only the exceptional man and the exceptional set of circumstances that will obtain a retraining and replacement. Follow-up work after placement is necessary also to insure fair treatment of the retrained man and suitable conditions of employment, particularly in regard to physical welfare, wages and hours of labor. This supervision will see that he is getting a square 239 REDEMPTION OF THE DISABLED deal from the employer, for, although most employers would scorn to take advantage of or exploit any man, much less a disabled one, there are undoubtedly a few who would not hesitate to do so. These will be at- tended to with an iron hand. Conversely, the super- vision will include the part the man himself is playing toward his employer. The insistence upon a square deal on the part of the disabled man will be no less strong than on the part of the man whose wages he is taking. There should be no presuming upon his military service or upon his disability. Undoubtedly there will be some men of the presuming sort among the thousands trained and placed, but such a slacker will be found to be the great exception. When a case of the kind is found, the matter is readily adjusted. The man is shamed into abandonment of his unworthy part, and made to see that for a soldier who asked no favors of the Hun and who did his duty on the battle- field, he is not "carrying on." The programme of placement and follow-up work has definite ends and aims, and does not embrace among these the coddling of the disabled. It pro- poses only to enforce a square deal in each individual case and to neutralize unfavorable and varying trade and industrial conditions. A square deal implies full efficiency on the part of the worker, and equally on the part of his employer full recognition of that efficiency. The disabled man made 100 per cent. efficient is not to be employed on the basis of 50 or 75 or even 90 per cent, efficiency, and paid 50, 75, or 90 per cent, of the wage which he earns in full. Wage adjustments, when these are necessary to cover irreducible deficiencies, will be made under special 240 THE PROBLEM OF PLACEMENT agreements with employers and with trade unions in organized trades. The formulation and enforcement of these agreements constitutes an important phase of placement work and of supervision after placement. It may be difficult in the early stages of retraining to develop in the disabled man a spirit of determina- tion to win out against any sort of handicap; difficult to arouse again those ambitions which in the natural reaction upon his shattered condition he has aban- doned in the first days of his disability or during pro- tracted convalescence; difficult to reestablish those normal interests which must inspire his efforts if he is to achieve efficiency and through efficiency inde- pendence. But when these difficulties have been over- come, as they must be overcome in each individual case, and the disabled man has in fact won out against his own enervation, the battle will be only half WOn — will, in fact, be lost unless the community as well as the disabled man performs its full duty. The disabled man will not seek work as a charity to be extended to a cripple. The square deal implies full recognition of efficiency, fair valuation of service ren- dered, and opportunity to render that service. Where special appliances, safeguards or equipment are required as means of overcoming special handi- caps, these must be provided under fair agreements with employers, and some supervision after placement will be necessary to insure the proper carrying out of such agreements. Some systematic record of each man's experience and success or failure after placement, which will in- dicate in each case the specific causes of success or failure, will provide data for perfecting the scheme 241 REDEMPTION OF THE DISABLED of rehabilitation as a whole, and for correcting past errors of training and policy. The whole problem of rehabilitation is largely an individual problem, but in solving the individual problem presented by each man, some general principles may be applied, and these must be defined in terms of practical experi- ence. Especially causes of failure as developed under wage-earning conditions must be noted, in order that they ma}' be eliminated in future cases. The Federal Board for Vocational Education has accordingly organized its placement and follow-up staff, with representatives in every section of the country where disabled men will be established in new occupations. Branch offices of the Board are established for this purpose in Boston, New York, Philadelphia, Washington, Atlanta, New Orleans, Cincinnati, St. Louis, Dallas, Denver, Chicago, Minne- apolis, San Francisco and Seattle. Detailed records are made of each case, and these records will be continuous and open for additional entries from time to time as occasion arises. In the aggregate each man's record will tell the complete story of the whole process of his rehabilitation, from his entrance into the hospital, through all the stages of his convalescence and training, to his final placement in some wage- earning employment and his experience after placement. In the problem of placement the attitude of organ- ized labor is an important factor, and it is well to outline here the general attitude of labor towards the rehabilitation programme as defined by its most im- portant organization. 242 THE PROBLEM OF PLACEMENT When the movement had progressed to the point of official recognition and the President had suggested a conference of all interested organizations, at the first meeting in the Surgeon-General's office both the National Association of Manufacturers and the American Federation of Labor were represented. Both were equally interested in the measure. While these preliminary conferences and activities on the part of labor leaders were largely upon their indi- vidual initiative, their attitude was heartily endorsed by the annual convention of the American Federation of Labor in June, 1918. The Vocational Rehabilitation bill, agreed upon in these preliminary conferences and approved by the Administration, had already passed the Senate when on June 10 the following section of the report of the Executive Council was adopted by the convention of the American Federation of Labor: This measure is a corollary of the war-risk insurance measure and rounds out a beneficent and humanitarian policy to be adopted by this country. In former years there has been left in their train a vast multitude of men who because of their injuries have been incapacitated to follow their former vocations, or have become dependents upon society. Under the spur of modern thought and action, the welfare of humanity has become the chief activity of our interest and the measures referred to are calculated to rehabilitate, reeducate, refit and return to industry in whatever capacity science and physical ability may suggest for the disabled victim of the war. In fact, with the rehabilitation measure enacted into law, coupled with the war-risk insurance law, our country will have taken an advanced step in the welfare of its citizens. With the passage of this measure there will rest a Herculean task on the Federal Board for Vocational Education to perform, 243 REDEMPTION OF THE DISABLED for these bills provide that the administration of the reedu- cation, refitting and returning to industry shall be in charge of the Board mentioned. It is interesting to recall that the American Federation of Labor for a number of years stood sponsor for and urged the adoption by Congress of a Federal vocational educational law, and its efforts were finally crowned with success. This Board during its infancy (for it has only been in existence approximately a year) has extended the work of aiding the states in estab- lishing systems of vocational training. As it is now equipped with data and an experienced personnel, it is capable to administer the provisions of the rehabilitation and reeducation bills if they are enacted into law. The American Federation of Labor is particularly inter- ested in the reeducation and reentry of disabled soldiers and sailors into industry. The members of our organiza- tions will have an opportunity to perform an invaluable service to society in cooperating with the Federal Board for Vocational Education in carrying on its work. In all the countries actively engaged in the present war, work of a similar character is being performed, and in those countries the organizations of labor are giving their hearty support and cooperation. It is perhaps unnecessary to bespeak the cooperation of the American labor movement in this great humantarian work, for it can be confidently expected that in every locality of our country where our organizations are located, there the members of those unions will give material assistance to the carrying out of this great national humantarian work. Representatives of the American Federation of Labor assisted in the framing of the bill, and the membership will without doubt assist in the execution of the law when it is placed upon the statute books. That there may be a close cooperation, it has been suggested (and that suggestion is offered for approval) that the three resident members of the executive council located in Washington be authorized by the convention to cooperate with the Federal Board for Vocational Educa- tion in assisting and administering the law when it shall have been passed. The duty of the hour requires that all 244 THE PROBLEM OF PLACEMENT classes of citizens, whether they be employers or employees, give a full measure of support and active cooperation in administering a law which has for its purpose the making of disabled soldiers and sailors productive members of society. Thus the great council of organized labor recorded itself squarely in favor of the project. Subsidiary organizations have vied with one another in the en- deavor to be helpful in realizing the full aims of the Government as regards the retraining of disabled soldiers and their absorption into the skilled trades or occupations for which they have been trained. The magazines and publications of the various branches of union labor have been hearty and cordial in their endorsement of the plan. Individual workers in shops and elsewhere have taken great interest in help- ing to give the disabled men instruction and in as- sisting them to master the intricacies of various trades. On the whole, the attitude of organized labor has been brotherly, helpful and patriotic, nor has it been grudging or half-hearted in any phase of the programme in which it has been concerned. 245 CHAPTER XXI OPPORTUNITIES FOR THE RETRAINED IN THE PUBLIC SERVICE The Federal Government as an employer of labor — Its func- tions enormously extended under war conditions — Prob- able permanent extension of the civil service — Positions and appointments in the Federal service in normal years — Opportunities open to the disabled in the competitive positions — Preferential appointment from lists of elig- ibles proposed — Opportunities in state and municipal civil service — Public service in France reserved for the disabled. One immediate and impressive effect of the war has been the tremendous enlargement of the function of the Federal Government as an employer of labor. Waging war is a supreme function of every state, that function of sovereignty that, more than any other, has determined the continuous development of the state's eminent powers as they are defined in existing governments. As war has become largely an in- dustrial enterprise, involving the manufacture and transport of the machinery and munitions of war and the maintenance of all the various services necessary for the support of armies, the war powers inherent in every government have accordingly become largely industrial powers. These powers are latent and potential in every state, but they are not exercised in full in any state except in the actual emergency of war. Especially in a democracy they may be, as they were in our own case, so remote from the practical programme of politics as to be disregarded and even 246 OPPORTUNITIES IN PUBLIC SERVICE very generally denied during long periods of peace. But upon the outbreak of war every restriction upon the power of the state weakens and yields to the pres- sure of the emergency. In the case of our own democracy, the abandonment of traditional restrictions upon the power of the Federal Government has been complete; it was ac- cepted as a matter of course in the first months of the war. Legalistic definitions of the respective powers of the Federal Government, of the several state gov- ernments, and of private individuals have had no meaning since the outbreak of the war; the absolute supremacy of the Federal Government has been un- reservedly conceded in the emergency. Inevitably the exercise of these latent powers is a social experience in which conventions and traditions are dissolved. With the restoration of peace certain powers which have been exercised in war time may be resigned by the Federal Government, but it is quite inconceivable that this nation, or any other nation that has waged war on any such scale as measures our recent engagement, will emerge from the experi- ence with its political philosophies unaffected. Even if the Government does not retain permanently under its direct control the railroads and the wires, and does not proceed from the policy of Government control and operation to the policy of Government ownership, it is inconceivable that the old regime of private ownership and control as it had developed before the war will be completely reestablished; and it is incon- ceivable, further, that the Government will completely resign its newly assumed powers of regulation in other industries and in domestic and foreign commerce, 247 REDEMPTION OF THE DISABLED The nation at war commandeers industry, and the government becomes for the time being the ultimate employer of all labor, directly or indirectly. Private employers are permitted to continue to operate in the industrial field on suffrance, subject to such govern- ment direction and control and as may seem expedient for war purposes. This enlargement of the character of the government as an employer of labor involves social adjustments that are in their nature more or less permanent, and the assumption of social respon- sibilities of which the government cannot immediately divest itself under any policy that may be adopted upon the termination of the war. It may safely be assumed that the functions of the Federal Government as an employer of labor will be permanently and considerably enlarged in conse- quence of its war activities, and this enlargement may have important consequences in effecting the de- mobilization of the overseas forces and the return of men discharged from military service to civil employ- ment. Through its enlarged powers the Government will be able to control the whole process of de- mobilization. For a considerable period after the war the Federal Government will certainly continue to operate in the industrial field as an employer of labor more exten- sively than it has done in the past, and it is during precisely this period that the problem of providing employment for men disabled in the war and voca- tionally retrained will be most acute. In its char- acter as an employer of labor the Government cannot and will not avoid those obligations to the disabled that it seeks to impose upon other employers. Clearly 248 OPPORTUNITIES IN PUBLIC SERVICE the Government cannot refuse to take back into its enlarged civil service any who have been drafted out of any branch of that service into the Army or Navy, if it proposes to private employers that, so far as possible, they shall similarly provide for their former employees. In general, any proposal that the Gov- ernment makes to private employers, it must itself accept as regards reservation of suitable employments for disabled men. Under the amplified industrial activities of the Government, this reservation of Government employ- ments may very well provide a much larger field for the placement of disabled, retrained men than any list of civil-service employments prepared in the past would indicate, but without considering these ampli- fications of Government functions, even before the war the Federal Government was a very large employer of labor. For the fiscal year ending June 30, 1917, the number of classified competitive positions in the Fed- eral civil service, as reported by the United States Civil Service Commission, was 326,899. In that year 212,114 persons were examined by the Civil Service Commission, 156,927 were passed, and 86,312 were appointed. The appointments included approxi- mately 20,000 post-office clerks, carriers and post- masters, 60,000 in the various field services of the Government, and 7,000 in the departmental services in Washington. Of the total number of departmental classified competitive positions, the number in Wash- ington was 35,477, and outside of Washington, 291,422. Excepted, non-competitive, unclassified, and Presi- dential positions bring the total number of civil service positions up to 497,867, of which 41,417 were 249 REDEMPTION OF THE DISABLED in Washington and 456,450 outside of Washington. Additions to the service by appointment and in other ways during the fiscal year ending June 30, 1917, totaled 121,768, distributed as follows: In Outside Class of position Total Washing- Washing- ton ton Classified competitive positions . 97,231 11,678 85,553 Excepted and non-competitive positions ................... 7,959 597 7,362 Unclassified positions.......... 16,578 740 15,838 Total ..................... 121,768 13,015 108,753 Guarantee of employment to disabled men is an important provision in our adopted rehabilitation policy, and the civil service of the Federal Govern- ment clearly provides one large field for placement of retrained men. In this service, although clerical em- ployments are numerically predominant, the range of occupations is sufficiently extensive to provide a great variety of openings for men of special attainments, skill and capacities. Men who have lost one or both legs and an arm will not thereby be incapacitated for rendering efficient service in many Government offices. The Government employs thousands of accountants, statistical clerks, schedule editors, typists, stenograph- ers, file clerks, secretaries, and other office assistants. It employs thousands of field agents for the collec- tion of data relating to agriculture, industry and commerce; thousands of inspectors, of customs asses- sors, of postmasters, of printers, of engravers, of car- penters and mechanics. It employs by the hundred lawyers, chemists, physicists, biologists, astronomers, mathematicians, economists, geologists, financial and 250 OPPORTUNITIES IN PUBLIC SERVICE banking experts, architects, writers, and editors. In each of these fields and in many other fields the public service embraces men of every degree of skill, experience and capacity, from that involved in routine office work to that involved in purely scientific re- search which is the farthest removed from routine. Janitors, doorkeepers and nightwatchmen are in the Federal civil service, but they do not constitute a very considerable portion of that service. Under our newly adopted policy, such employments will not be reserved in the future, as they have been in the past, especially for disabled veterans. It is not proposed that these employments or any other employments in the civil service shall be reserved for disabled men, except in so far as the disabled men may qualify to fill the positions in open competition with all candi- dates. It is proposed to train the disabled man for full efficiency in the civil service, if he elects to enter it, as in private employment if he elects that. Adequate training will qualify many of the disabled men for civil-service appointments under competitive examinations. Approximately two-fifths of the can- didates qualifying for appointment under competitive examinations receive appointments. It may fairly be proposed that in making appointments from lists of eligibles after the war, preference shall be given to those who have rendered service in the Army and Navy, and especially to those who have returned from the war unfit on account of injuries or impaired health to resume their former occupations. A bill introduced by Representative Harrison (now Senator- elect) of Mississippi establishing such preference is now on the calendar of the House of Representatives. 251 REDEMPTION OF THE DISABLED No exemption from examination or lowering of standards in favor of disabled men would be in the best interests either of the public service or of the disabled men themselves, nor is any thing of the sort proposed by the Harrison bill. A fundamental princ- iple of our policy of rehabilitation is that each man shall be made 100 per cent, efficient for some employ- ment, and shall qualify for that employment in open competition. No remission of requirements or special favor or concession in the matter of efficiency is requested or desired. For some employment each disabled man, with very few exceptions, can be made fully efficient, provided the employment is intelligently selected so as to avoid the special handicap or handi- caps in each individual case. Giving preference to the disabled men over others who qualify for civil-service appointments is very dif- ferent from remitting requirements or lowering stand- ards. It is simply recognition of an obligation resting upon the community as a whole and assumed by the Federal Government to return disabled men to civil employment. Such men as can qualify should be given first preference for appointments to be made by the Government itself, as well as by other employers of labor. It may be expected that states, counties and munici- palities, as well as the Federal Government, will recog- nize their obligation to provide employment for dis- abled men when such employment can be provided without impairing the efficiency of the public service. The number of public-service positions available under local governments cannot be accurately determined, but the 1910 Federal census, in its table of occupa- 252 OPPORTUNITIES IN PUBLIC SERVICE tions, gives in one section, under "public service not elsewhere classified,'' the number of various classes of "state officials and employees," which total for males approximately 12,000. The total of "county officials and employees" is approximately 30,000, and of "city and town officials and employees,'' 175,000. Some of the occupations specified for men in these local public services are inspectors of food and other products, bookkeepers, accountants, clerks, stenographers, type- writers, stationary engineers, teamsters, keepers of charitable and penal institutions, surveyors, weighers, foremen, firemen, machinists, and meter readers. Here also, in the local public services, is an exten- sive field for the placement of disabled men who have been retrained, and it may confidently be anticipated that the states and municipalities will cooperate heart- ily with the Federal Government in opening their public services to such men. Many of these employ- ments are obviously of such a character as to be entirely suitable for handicapped men. They include, for example, many lines of outside work, such as may be especially indicated for tubercular convalescents, and many lines of clerical work that may be under- taken by those unfitted for strenuous physical labor. The loss of a hand or an arm certainly would not dis- qualify a man for employment as a meter reader, or as an inspector of foods, or as a weigher. The loss of a foot or a leg would not generally disqualify for ren- dering efficient service as a bookkeeper, accountant, typist, stenographer, clerk, or in many other public- service positions. In France the policy of reserving public-service positions for disabled men has been definitely adopted, 253 REDEMPTION OF THE DISABLED and a survey of such positions available has been made to determine specifically the requirements of each position. In making appointments to such posi- tions it is provided that for a limited period of years preference shall be given to disabled men who can qualify under the requirements specified. This is not the old story of the scarred veteran being carried on the public payrolls as a sort of pen- sioner. It cannot be too often reiterated that the scarred veterans of the Great War will be made effi- cient for service, and having been made efficient, they will enter upon employment and will work in the public service, as in other service, in free competition with all comers. This condition of employment will not be a hardship for the disabled. It will be, on the contrary, a stimulus, a means of inspiring self-respect, and a guarantee of that contentment and happiness which attaches to the performance of useful labor. 254 CHAPTER XXII RECORDS OF INDIVIDUAL SUCCESS Success of the reeducated demonstrated abroad — Examples from Canadian experience — Men retrained with enhanced earning capacity — A rehabilitated blind man — Eehabili- tated farmers — A score of miscellaneous cases — Oxy- acetylene welding. All innovations are received with more or less skep- ticism. The popular mind, in the mass, is conserva- tive in the extreme and rather difficult to convince. It is frankly dubious of the merit of new things and adheres with tenacity to those familiar. It has been somewhat slow to accept the fact that in some cases the disabled man can be made more effec- tive and given a greater earning capacity than he had before he received his injury and subsequent disability to continue in his pre-war occupation. It is a seem- ing paradox to those persons who do not take the trouble to reflect and to analyze the large list of trades and occupations that afford excellent pay and steady employment. Very few of these occupations are dependent upon mere brute strength or upon all the strength or all the capacities of a man. On analysis, most of them will be found to be specialized opera- tions requiring the use of only a few muscles. Hence, it is not difficult to assort the trades and the disabled men, and to fit the men into occupations in which they are as well equipped to work as if they had suffered no injuries whatever. This is largely the secret of reeducational success. Dr. Prosser, testifying before 255 REDEMPTION OF THE DISABLED the House and Senate Joint Committee on Education and Labor put the matter in a nutshell: There is not any difference at bottom between taking the normal man, and a disabled man and educating him, after you once determine what you are going to educate him for. That the reeducated men have attained success is no longer a subject of controversy or doubt. There are thousands of them in England, in France, Italy, and Canada. The United States has just got the work well under way, training the injured properly for occupations for which they are especially fitted, and placing them in positions when they are qualified. The Federal Board made a remarkable record for effi- ciency in " getting on the job." The Smith-Sears Act was signed by President Wilson and became law on June 27, 1918. The first week in the following September, two months and a week from that date, the work of placing disabled soldiers for reeducation was under way. As practically none of the courses is of less than six months' duration, however, it is as yet (February, 1919) too early to point to men who have been graduated and placed back in industry or in civil life; but of the successful accomplishment of this result there is not the slightest shadow of a doubt. Canada, upon whose system ours is modeled, furnishes us proof in great abundance of what vocational re- education can, and does, accomplish. Some testimony given before the Joint Committee on Education of the Senate and House in the hearings on the Smith-Sears Vocational Rehabilitation bill is of considerable interest. The witness was Mr. A. E. Holder, member for labor of the Federal Board for 256 RECORDS OF INDIVIDUAL SUCCESS Vocational Education and one of the expert machin- ists of the country. Mr. Holder had made two trips to Canada to observe the working of the reeducation of soldiers, and was giving some of his observations. Said Mr. Holder: I found in one case a bricklayer, who had never, before the war, done anything but follow the general routine of his trade in laying bricks. When he returned, disabled, he was not able to lay bricks on the outside, on account of his injuries. Of course, it is not possible to expect that a man can get easy work at bricklaying; but through the benefits of the opportunities afforded him in the new vocational school he has developed into being an estimator and cost accountant, and his old employer has given him an oppor- tunity to work at 85 cents an hour, whereas the highest rate he made as a bricklayer before the war was 75 cents an hour. I found the case of a machinist, who previous to the war was occupying a subordinate position in a machine shop, running a drill press. He came back into the Montreal Technical School and after six months' intensive training, he had qualified himself to take a position in the tool room of the Dominion Iron Works as not only tool caretaker, but toolmaker at $125 per month. A most remarkable exhibition was also revealed in that particular school, of a young man whose right arm was still in a sling and who had only his left hand and arm free to work with. He had been in the machine gun corps on the front. He had found that in operating a machine gun at night, the flashes betrayed the position of the men operat- ing it and invited the enemy fire. So he had invented a device which did not deflect the shot or interfere with the precision, but which hid the flash; and when I asked him did he expect to get a patent on it he said: "No indeed. This is for the Canadian people to protect their own rights!" That man had never seen a machine shop before the war. The device he constructed was an intricate piece 257 REDEMPTION OF THE DISABLED of work requiring the greatest precision, and the instructor of the school, who was an old time mechanic and a man who was thoroughly competent to judge, showed me — as an expert in the machine shop myself — some of the particular niceties of this especial contrivance. Representative Fess: Mr. Holder, in the cases where the rehabilitated soldier was getting higher pay than before, was there any element of sympathy in that, or was it hia training that merited it? Mr. Holder : I think it was because of pure merit. I found a boiler maker — and undoubtedly you are familiar with the usual rough work of a boiler maker in a boiler shop. This man had never been familiar with mathematics; he had never been familiar with pencil and paper to draw plans; and yet in the course of six months' instruction, after discharge from the hospital, his drawings, shown to me by the instructor, of flanges and sheets and designs were almost impossible to believe true. This man had obtained a position which was paying him more than the maximum rate that he had been paid as a boiler maker before the war. Merit alone won him the place. One of the most extraordinary things was the case of a young Greek, who in January of this year was unable to write in the English language. A copy book was exhibited to me by Major Stanley, the director of the school — one of the ordinary copy books of about 50 pages — and on tho first page there were the letters of the English alphabet written clumsily, inaccurately, and almost illegibly, and in the course of a few pages we found the letters improving and being connected with others, making syllables of two letters and three letters and the like; and on the 15th of April his last copy was one of the classics from one of the school readers, and it had the appearance of fine copper- plate work. With these exhibitions before us of the extraordinary development and progress of these students, it of course haa the effect of enabling us to say that all of the old ideals of a tedious course, either in elementary education or tech- nical education, have been shattered. 258 RECORDS OF INDIVIDUAL SUCCESS Other Canadian cases placed in evidence before the Committee were equally interesting, and of course beyond question true. At the Guelph School, for instance, one young man with a severe scalp wound was a farmer-teamster and general laborer, earning wages averaging around $60 a month before the war; he is now employed at $70 a month in a more agreeable occupation. Another was a lumberman, accustomed to earning $3.50 a day; but on returning to the woods he took charge of a stationary engine, for which work he had been reeducated, and drew $4 a day. Another who formerly made $35 a month now gets $65. All three of these men had been very badly wounded. Private Henry Gerrish lost his entire left arm; he studied in the convalescent hospital, passed his civil- service examination, obtained an appointment as post- master at $125 per month, and persuaded one of his nurses to marry him. One man who applied to the Canadian authorities for help had lost both legs and an eye. He was a married man with two children. The pension office had rated him as a 100 per cent, disability and pen- sioned him on that basis. The vocational reeducation authorities took him to a wholesale jewelry firm and arranged for him a course in silver polishing. After five and a half months' training he not only learned polishing but soldering and gilding as well. The firm employed him at $75 a month to start, which is, of course, in addition to his total-disability pension. Most remarkable is the case of Captain Edward Baker of the Canadian forces. He was 21 years of age when he enlisted on the declaration of war, and had just graduated as an electrical engineer. He won 259 REDEMPTION OF THE DISABLED the Croix de Guerre and the British Military Cross in thirty days after he arrived in France. On a recon- noitering expedition he was shot through the front of the head and was totally and permanently blinded. With the fine spirit of a soldier he determined to make the best of it, and went to St. Dunstan's Hostel, London, where the blind are trained. He took up typewriting and reading Braille, and in seven months returned to Canada. He was awarded the total-dis- ability pension plus $35 a month, as he has to have someone to lead him around. The Hydro-Electric Company at Toronto employed him as typewriter. In 1918 he was taking dictation direct from dictaphone, taking trouble reports over the long-distance telephone all the way along the line between Niagara and Toronto, and making out the trouble reports on a sheet of paper with twelve rulings on it. By a very ingenious spacing arrangement at the top of his typewriter which he invented himself, he could put in the date, the time of day, the trouble, the peak load, the low load, and the number of min- utes, and sign his name as fast as a man with full sight, and do it all accurately and neatly. He earns a very fair salary. There are hundreds of other cases, authenticated beyond any possible doubt. A few of them are given below as typical, the names only being withheld by request of the reeducational authorities to protect the men from undesired publicity. The men themselves exhibit a marked disinclination to figure in the public prints or be considered as marvels or in any way out of the ordinary. They do not ask any special consid- eration on account of the injuries suffered, and insist 260 RECORDS OF INDIVIDUAL SUCCESS upon going strictly upon their own merits as workers in the particular lines for which they have been trained. Aside from the omission of names, there follows a transcript of official records. The first list deals with a number of young farmers and farm hands, a calling which certainly cannot be classed under usual condi- tions as a particularly highly paid or desirable occupation. A. had swollen legs due to blocked veins; took telegraphy and obtained a position as operator at $90.95 per month to start with. B. had lesion of the left external popliteal nerve; took course in oxy-acetylene gas welding and upon finishing found immediate employment with a large ironworks at 40 cents per hour. C, with severe gunshot wound in head, took the tractor and gas-engine and farm-machinery course and found ready work operating a farm tractor for $100 per month and his board. D. lost his left foot; took farm-tractor and gas-engine course and was employed during the season of 1918 at $100 per month and board operating a tractor. E. had his back injured in a mine explosion in France; graduated from farm-tractor course and was employed in 1918 at $5 a day and board operating a farm tractor and machinery on a large wheat farm. F. lost some muscle from his right thigh; took motor- mechanics course and was offered and accepted a half- interest in a flourishing garage business on account of his technical knowledge of motors. G. took the farm-machinery course and is now a travel- ing salesman for a farm-machinery house, drawing a mini- 261 REDEMPTION OF THE DISABLED mum salary of $80 per month and expenses with commis- sions on sales in addition. H. was just a farm hand around a dairy before the war. Left leg was injured and he was deafened. He took the dairying course and is now manager of a branch cream- ery at $100 per month and good prospects. I. lost the use of his left leg from gunshot wound; took course in telegraphy and on graduation got a job as station agent with house, light and fuel furnished and $82.50 per month salary. J. lost his left arm; took telegraphy and graduated into a job with a railroad at $85 per month. K. had developed tuberculosis; it was arrested, but he had to have an out-of-doors occupation. Took a course in bee-keeping and now has his own apiary and is doing well. L. developed chronic nephritis; always wanted to go into mechanics; took the machine-shop course and is employed in a large motor company at 43 cents an hour. Many other illustrations could be given of cases in which farm hands have developed into able workmen in various lines, but the above are sufficiently indica- tive. Many a chap through the blood and mud of the Flanders trenches has found the way to his real voca- tion, which, by reason of poverty or lack of oppor- tunity, he otherwise would have never been able to attain. Some other instances, for which the writer vouches absolutely, the details only of names and places being withheld at the request of the authorities, are: A., former stage-hand, had stiffness of left shoulder joint; took the motor-mechanics course; obtained employ- ment as chauffeur at $24 a week. 262 RECORDS OF INDIVIDUAL SUCCESS B., a prospector and extra conductor; left shoulder muscle dead and left wrist joint removed; took commercial course and is employed by a mining company at $25 a week. C, overage; bronchitis, myalgia, etc.; glazier and painter; took course in stationary engineering; has steady employment at 40 cents per hour. D., limited movement left elbow and weak left arm; was student, no profession; took civil engineering; found place at $125 per month on his completing course. E., ordinary teamster; shell wound of abdomen; took motor-mechanics course; has place as chauffeur at $80 per month. F., former blaeksmith; loss of lung tissue from gunshot wound; took the machine-shop course; is now employed as section tool fitter at 40 cents per hour. Gr., farm laborer; lost left leg; talent for draAving; took course in drafting; obtained employment to start on with large firm at $20 per week. H., former butcher; left wrist damaged by gunshot wound; took commercial course and is now traveling sales- man for a butcher's supply company at $80 per month minimum and expenses guaranteed, with commissions. I. was a glove cutter; lost use of right wrist; took com- ercial course and his first job was as bookkeeper at $80 per month. J. was a bakery wagon driver and clerk; developed valvular heart disease from strain, also neuresthenia. Took course in stenography and typewriting and on graduation went to work at $100 per month. K. was a plumber; compound fracture of left leg and leg shortened; took commercial course and is inspector with public works department of a city at $100 per month. 263 REDEMPTION OF THE DISABLED L. had been carriage and wagon carpenter; lost some fingers of his left hand; studied heating-plant operation and landed with a big coal company as demonstrator, sales- man and trouble man at $3.25 per day. M. was a woods laborer; got drop wrist from wound; studied steam engineering; graduated into a steady job with a large manufacturing concern at 60 cents per hour as pipe fitter. N. was a railway fireman; got stiff knee from gunshot wound; took the course in stationary engineering and readily obtained position as engineer at a sawmill at $3.75 per day. 0. suffers from shell shock; former textile-roller maker; took course in machine-shop practice and started as machin- ist with a manufacturing company at 30 cents per hour. P. was a railway fireman; lost his left leg from wounds; took a course in poultry raising; on completion got a job with a large poultry ranch at $60 per month for practical experience before embarking for himself. Q. was a seaman; developed chronic rheumatism of leg; had a mechanical bent and took a course in toolsmithing. Went right into a job as toolmaker at $90 per month. R. was a locomotive engineer; paralysis in leg from wound; took electrical engineering and his first job started him at $75 per month. S. was an ordinary telephone lineman; bullet wound in left leg gave him a stiff knee which ended his career climb- ing telephone poles. He took the electrical-engineering course and graduated into a job in charge of a power house at $110 per month. T. was a riveter; gunshot wound of left lung; took farm- tractor course and was employed steadily on a big wheat farm at $110 per month. 264 TRAINING IN OXY-ACIVVYLENE WELDING AT DUNWOODY INDUSTRIAL INSTITUTE. .MINNEAPOLIS. THE MAN HOLDING THE TORCH IS A DIS- CHARGED SAILOR, FORMERLY A BOILERMAKER, WITH IMPAIR- MENT OF ONE EYE A MAN WITH LEGS COMPLETELY PARALYZED IN TRAINING AS A LINOTYPE OPERATOR AT DUNWOODY, INDUSTRIAL INSTITUTE, MINNEAPOLIS RECORDS OF INDIVIDUAL SUCCESS U. was a butcher; shrapnel wound in both knees; took commercial course and civil-service examination and was at once appointed to a $1,000 job in a custom house. Another coming trade is that of oxy-acetylene weld- ing. The following are a few instances of men who have taken it up: A. was a young fellow without any trade — a drifter; had chronic endocarditis; took the welding course and at once obtained steady employment at 54 cents per hour. B., a former car repairer, incapacitated by measles, pneu- monia and complications; graduated as an oxy-acetylene welder and obtained ready employment at 54 cents per hour. C. was a machinist's helper, incapacitated by sciatica of left leg, and on completing the oxy-acetylene welding course, went to work at 54 cents per hour. D. was a miner with stiffened knee from gunshot wound; graduated in oxy-acetylene welding and obtained a steady job at 45 cents per hour. All of the above are actual cases, and only a very few of the many to be found on record. They are cited to show that the retrained men are still "carry- ing on" with profit to themselves and to their country, which gains in proportion as the usefulness of its citizens and their earning power increase. 265 CHAPTER XXIII THE DUTY OF THE HOME COMMUNITY The Government's power of rehabilitation definitely limited — Eehabilitation dependent ultimately upon the attitude and efforts of home community — Duties of the home com- munity towards the disabled man — Provision of employ- ment — The disabled man entitled to a fair trial as worker and citizen — Social rehabilitation a paramount duty — The disabled man needs encouragement, not commisera- tion — Full admission to community fellowship the obliga- tion of the home community. Although the Federal Government proposes to do all that it can do to insure the future welfare of the disabled soldier or sailor returning to civil employ- ment, and has provided ample funds out of the public purse for carrying out its programme of training and placement, it is obvious that there are very definite limits to the scope of its powers. The need for training and placement may be de- scribed as an acute need requiring active treatment, a need pertaining to the process of rehabilitation. Just as the physical disabilities of the disabled man require active surgical and medical treatment to insure complete convalescence and functional restora- tion, so his vocational disabilities require active educa- tional treatment to insure his complete vocational convalescence and restoration. This active vocational treatment the Federal Government can and will pro- vide. But the period of active treatment will be gen- erally of short duration, seldom extending over more than a year, and being completed in many cases within 266 THE DUTY OF THE HOME COMMUNITY a few months. The Government, as has been noted already, will stand ready to resume the active treatment in the case of any retrained and placed man who develops deficiencies of training or new weak- nesses or disabilities after entering upon employment. Need for the resumption of active treatment, however, in the form of more training in the occupation which has been selected or of new training in a different occu- pation, will probably develop in comparatively few cases. Generally the retrained man will be definitely placed in a suitable occupation at the end of his first course of training and will not return for further active treatment. After this brief period of training, the disabled man will enter upon a life-long period of work and service in his home community. To help him perform man- fully the daily routine of economic and social activ- ities will be the function of the home community. The retrained man will not be constitutionally ailing, subnormal and dependent, but the fact must be faced frankly that no camouflage of artificial limbs will enable the one-legged or legless man to walk with an entirely natural stride, or the one-armed or armless man to perform all the little courtesies or even the more serious services of life with entirely natural ease and grace. To the end of his life the disabled man will be carrying on manfully, but carrying on, we must not forget, as a one-legged or legless man, a one- armed or armless man, a one-eyed or blinded man, a man with a disfigured countenance, a weakened heart, or overstrained nerves. These handicaps will be real, but they can be largely overcome provided the home community performs its full duty, not merely during 267 REDEMPTION OF THE DISABLED the first months after the soldier's return, in the first glory of his homecoming, but as well during the long years to follow, after that first glory has faded and the man is again on his own as a plain civilian going about his daily routine labor, ungracefully, it may be, but with a will to win. For the home community the problem of the re- turned disabled man will be essentially a personal problem — the problem of providing for John and William and Henry, rather than for Smith, or Jones, or Robinson. In the draft files of the Bureau of War Risk Insurance there are thousands of Smiths, Joneses and Robinsons, including a thousand more or less of John Smiths. But in the home town there will be only one John, one William, one Henry, and their file numbers will be entirely superfluous as means of identification. In the home town it will not be: "Smith, John. No. 3,768,471. Amputation right elbow; former occupation carpenter, retrained as building inspector"; but: "John has come back. He's been a bit shot up over there. He can't do car- pentering, but wants a chance to make good in another line of work, and it's up to us to fit him in, and see that he has that chance. He won our war for us, and we must help him win out against that empty sleeve.'' In some such way as this the problem of the returned disabled soldier will present itself in every home community. Bear in mind that John will have been thoroughly retrained for work in some occupation that has been selected in conference with him as the occupation in which he can most certainly make good in spite of his disability. If upon trial he does not make good, the 268 THE DUTY OF THE HOME COMMUNITY Federal Government will stand ready to retrain him for some other occupation, and to continue this process until John finds an occupation in which he can com- pete on terms of equality with the best men in that trade. John will want employment. He will want a chance to demonstrate that he can earn a man's wages. He will want this the day after he arrives, and as soon as he has shaken hands all round. The Federal Govern- ment proposes to find a job for him in his own home town, but the Federal Government cannot provide the job, and it cannot find one unless the home community provides it. John's old employer may be holding open for him his old place in the shop or office. If John cannot take up his former work, perhaps he has been trained for some other closely allied line of work. If he had been a carpenter but cannot now resume his trade, he may perhaps have been trained for drafting or for office work, and his old employer may find that he is a more competent workman in this new line than he was in his old occupation before enlistment. John may have been taught things that will enable him to qualify as a foreman. To his practical experience as a carpenter may have been added a technical know- ledge of his trade that he might never have acquired while working for his old employer. But perhaps John's disability is of such a character that he would better not return to his old employer at all. Some entirely new line of work may have been determined upon as John's best chance. In that case a new employer must be found, or rather a new em- ployer must come forward and offer to give John a 269 REDEMPTION OF THE DISABLED trial on the Government's guarantee of his capabilities as developed by training. In this task of fitting John in, various agencies can render helpful service. Local boards of trade and chambers of commerce, for example, will be natural agencies for discovering precisely where in the economic life of the community he can best be placed and given the opportunity to which he is entitled. Labor organizations can aid by entering into agree- ments that will insure fair conditions of employment and fair wages. In individual cases the employer may cooperate with the Federal Government in pro- viding machinery with special appliances and adjust- ments that will enable John to do his work and will safeguard him against accident. No employer will be expected to employ John at a loss. On the contrary, he will be expected not to employ him at a loss, but rather, if he fails after fair trial in free competition with fellow workmen, to report to the agent of the Federal Board for Voca- tional Education that John is not making good. After fair trial — that sums up the whole case. The employer, the labor union, the church, the social club, in fact, the home community in all its complex eco- nomic and social relationships, must insure John a fair trial, nothing more and nothing less — a fair trial as a worker certainly, but above all a fair trial as a citizen and neighbor, as John who has come home again. John will certainly be fitted in, because the Federal Government has undertaken his placement and has already sufficient assurances from employers that they will heartily assist in the work. But the home com- 270 THE DUTY OF THE HOME COMMUNITY munity must see to it that John does not get shuffled out of place after he has been finally released from any sort of Government supervision, for in his own best interests he must eventually pass out from under that supervision. Expressed negatively, it will be the duty of the home community not to forget, not to neglect, not to segregate, not to provide old soldiers' homes, not to be content with rendering merely "lip gratitude." If it avoids these offenses in the long years of John's carrying on, it will experience no difficulty in understanding and discharging its full obligation in each individual case. The square deal is not entirely a matter of employ- ment under fair conditions. Work is not the whole of life for the disabled any more than it is for others. It is a foundation of happiness and contentment, but there are other conditions essential to normal life, and there are other obligations towards the disabled man than that of making him efficient in some voca- tion, and providing employment for him at fair wages and under fair conditions. These other obligations neither the Federal Government nor the local com- munity in its official or organized character can fulfill. Rather they rest directly upon each individual sev- erally in the home community. They are the obliga- tions of common fellowship that arise in the small contacts of everyday life. Disability incurred in the Great War service will be a badge of honor, not a badge of dependency or of mendicancy. Commiseration, favoritism, or charity, in the usual sense of that term, will be a mistaken expression of individual interest in the welfare of the returned soldier or sailor. It will, in fact, be worse 271 REDEMPTION OF THE DISABLED than that — it will be a vulgar offense against common courtesy. Above all other things the disabled man will long for unaffected comradeship, and this he is fairly en- titled to enjoy. He will be sensitive to any expres- sion of sympathy, however well intentioned, that sets him apart from his fellows as a poor but deserving unfortunate who must be provided for. All expres- sions of sympathy that imply a certain superiority on the part of the person expressing it, in his own estimate of himself in comparison with the disabled man, will be in exceedingly bad taste, to put it mildly, in the case of men disabled in the war. The physically and mentally fit man commiserating the disabled man will seem to be saying: '' You poor fellow! You see how fit I am. All my members and senses and capacities are as prime as can be. I am superlatively fit. I am sorry for you. You are not quite all there. Let me exhibit my superlative fitness a little by telling you how exceedingly sorry I am for you. Poor fellow!'' Perhaps the disabled man will not be all there, but he might very well reply in thought, if not in words, somewhat to this effect: '' I am not all here, but I do not feel that the sacrifice which I have made of limb or capacity warrants any assumption of superiority or any patronizing by you who have come out of the war superlatively fit in mind and body. Your prime physical and mental fitness is your good fortune, perhaps, rather than greatly to your credit. My disability is for me at least as fair an occasion of self-respect as your fitness is for you. My unfitness I do not regret in the least. I do not ask your favor or sympathy, but only, if you will 272 THE DUTY OF THE HOME COMMUNITY give it, I ask that comradeship which bars out every assumption of superiority on account of your fitness. In such a comradeship, if my right sleeve is empty, I am proud to extend to you my left hand. I do not regret the empty sleeve, and I do not understand your commiseration on account of it. It seems to me rather an evidence of duty performed. With my left hand I propose to continue the performance of my duties as well as I am able to do. If you can help me to do my work, I shall accept your help, not as a personal favor to me, but as a service for which, if I have not already compensated you by my public service, I shall in the future repay you in full by working faithfully with such capacities as have been saved to me from the ravages of the war.'' However unfit he may be, the disabled man will certainly have the best of the argument. Even if the disabled man, being only human, is disposed to accept the "tea and lip gratitude" that, as John Galsworthy has aptly put it, will "unsteel his soul," the first duty of the community and of each individual in it is to avoid in all of its insidious and varied forms precisely this unsteeling of the soul. Commiseration in every form will be essentially and inevitably and in every instance relaxing in its effects upon the inner spirit of the disabled man. It will not be less so when the disabled man is disposed to accept rather than to resent it. It will in all cases be un- steeling because it will represent a false attitude — that of the commiserated to the commiserator. The true attitude is that of common comradeship between the man who has rendered a service and his fellow who would make such return as he is able to make, not as 273 REDEMPTION OF THE DISABLED a favor, but as a plain duty, not as an expression of pity or sympathy, but as an expression of neighborly fellowship and of common interest in a great achieve- ment involving common sacrifices as the price of common benefits. Public opinion sums up individual thinking and by reaction formulates individual codes of conduct. It is essential for the development of a helpful public sentiment in regard to disabled soldiers that each individual shall think straight and act accordingly. As a basis of straight thinking it is essential that each individual keep in mind the Federal programme of rehabilitation in its broadest aspects. It is a simple programme, but it is nevertheless complete and ade- quate. No man injured in the service will be aban- doned in need. He will, on the contrary, be made as physically fit as medical science and surgery can make him, and he will be given such a course of train- ing as is best adapted to make him most fit to work. He will be replaced in civil employment and protected against exploitation or danger to physical wellbeing so long as he is in need of protection. During his lifetime he will be paid monthly a sum of money as compensation for any permanent injury received. His wages and his compensation will generally under normal conditions provide fairly for him and his family. The Federal Government does not propose to abandon the disabled man to private philanthropy. Certainly, in simple justice to the disabled man, the Federal Government can do no less than it is pro- posing to do; but also, in simple justice to the Federal Government, private individuals should not presume that the disabled man is unprovided for and that he 274 THE DUTY OF THE HOME COMMUNITY is being returned to civil life as a ward of public or private charity. For these men the Government does not ask charity. It asks more than that. It asks good fellowship. It asks that they shall not be set apart from other men in their home communities, made heroes of for a day and dependents for life, by thoughtless doles of pity and by even more pernicious doles of money, whether in the form of sums given outright or of wages paid when not fairly earned. Every citizen, including the injured man himself, must understand that the Nation purposes to perform its full duty in behalf of every man disabled in the war, even as the disabled man himself has performed his full duty in behalf of the Nation. Every citizen, including the injured man, must understand that the returned soldier or sailor disabled in military service who refuses to take such retraining as he may require to enable him to resume the responsibilities of civil life in full economic independence, and who freely elects to enter upon the career of a pensioned idler, is as much a slacker in peace as he would have been in war had he avoided a military duty. Whether or not pensioned slackers will vitiate our civil life for a generation to come will be determined largely by the individual contacts in the first years of home community life after the disabled man's return. If he is admitted into the community fellowship, as a man among men, respected for and endeared by his services and sacrifices but not pitied or unsteeled by charity doles, all will be well with him and his and with the community in which he lives. This is the duty of the citizen who was not elected to render 275 REDEMPTION OF THE DISABLED military service to the citizen soldier or sailor who was so elected and has returned to civil life. To him must be extended, not charity, but the right hand of fellowship. 276 CHAPTER XXIV A SUSTAINED PUBLIC SENTIMENT NECESSARY The Vocational Eehabilitation Act a reflection of public senti- ment — Success of the programme dependent upon sus- tained public interest — Public opinion should condemn pensioned idleness — Dangers of the sinecure job for the untrained man — The women's part — Public opinion crystallized in a consistent course of conduct — Disregard of disabilities and concentration on capabilities of the dis- abled man essential — The disabled man in trade entitled to some preference in patronage — Sound and permanent pubbc sentiment dependent upon individual interest — The disabled man the brother in arms of those who have fought the fight at home. In the enactment of the law authorizing the voca- tional reeducation and rehabilitation of disabled soldiers and sailors, Congress believed it was voicing a general sentiment of the people of this Republic that not charity, but a chance, should be extended to the men who had lost their earning capacity and sacrificed their future for their country's good. Certainly, all indications have been that this concep- tion of the public attitude was correct. Utterances of newspapers, magazines, publicists and prominent men from every section and region have confirmed the position taken by the national lawmakers. There has been a remarkable unanimity of opinion, not in regard to the precise method to be adopted, for that has been largely an evolution, but in the fundamental decisions that the very best and most advantageous thing possible should be done for the disabled men. Acting upon this general agreement of the public 277 REDEMPTION OF THE DISABLED mind, Congress enacted a law based upon the broad wish of the American people, but entrusted its execu- ! tion to a competent agency with sufficient freedom of : action and latitude in which to use a wise discretion, adapt methods to suit conditions, and take advan- ; tage of improvements and the results of experience : both at home and abroad. The only fixed and definite ; command was that the disabled men were to have the i best advantages obtainable in retraining, and were to be given a fair chance to make good in the lines for : which they have been qualified through specialized : reeducation. ] At all times the success of the programme is largely i dependent upon the active and sustained interest of the public, and especially is this true in the final realization of results. The public mind is, after all, : but the composite reflection of many individual minds, i and in proportion as the individual intelligence shines is the public interest bright or dim. One influence of sustained public sentiment upon the work of redemption may be illustrated by the case of a badly injured soldier who receives a pension for almost total disability, let us say between $75 and $100 per month. His one great desire is to get out of the hospital and back to his family. He does not respond to suggestions from the vocational adviser that he take up a course of training which will enable him to supplement his pension by earning as much or more. He feels that he has "done his bit" and should not be expected to work at anything. His idea is to settle down and subsist upon the pension awarded him. If he learns through the public prints, from visitors, from people he meets, from relatives and 278 A SUSTAINED PUBLIC SENTIMENT others interested in him, that his conception is wholly wrong, that he is running counter to public opinion, and that, notwithstanding his grievous condition, as long as he has life and a measure of potential ability he owes duties of citizenship, he will undoubtedly be amenable to reason. If he learns that the unanimous verdict is that he is a "quitter" because he has dropped the fine spirit of the brave soldier to become a querulous, utterly idle pensioner, refusing to make the most of his remaining capabilities, indifferent alike to his dependents, his community and himself, shame may overcome his selfish and narrow conception and cause him to follow that course best for himself and for his community. To many a disabled man also the temptation is great to go into some immediate, sinecure job, offered in the flood tide of patriotism and while the war spirit is high. These things pass to some extent. In the long, lean after-years of peace, when the fight is transferred from the fields of France and Flanders to the warfare for daily existence, what of the in- capacitated man who cannot render value received in some particular line? He who has an empty sleeve, or a scarred body, or a disease-racked system — can he survive economically? Manifestly not, in the race with an expert in a particular line created out of a man similarly disabled by vocational retraining! The man with no expert knowledge of anything is at a tremendous disadvantage. Inevitably in course of time he will be compelled to fall back upon his rela- tives or the public for support. If the man can be made to see this and realize it as the public realizes it, and the time to make him see it is before he leaves the 279 REDEMPTION OF THE DISABLED hospital and becomes a "drifter" in civil life, the result will be that instead of a pensioned idler, he will become a highly trained workman, earning good wages. His family will not suffer by reason of in- adequate income supplied only by the pension. His children will not be compelled at an early age to find employment with which to eke out the family revenue, thereby jeopardizing their education and prospects of the right mental training to insure a fair chance in life's struggle. The man himself will be a respected member of his community, one who has brought to the problems and battles of daily existence his experience in other battles, his ability to command himself and overcome his inclination to a life of pensioned idleness. It is well to point out here that the success of this first fundamental task of the Government in repairing ravages of war depends vitally upon the interest and sustained cooperation of our women. The women are expected largely to render aid in persuading their loved ones in uniform, upon whom fate has cast in- capacitating injuries, to accept the offer made by the Nation as part of a just due. Further, it is for the women largely to mould the public opinion that will convince the disabled man that he still has soldierly qualities that are expected to be exercised in ex- emplifying good citizenship. The women must in the first instance adopt the proper attitude toward the disabled man. In their keeping is the ability to make or mar his future, to render effective the assistance proffered by the Gov- ernment or to neutralize it. One of the great handi- caps other nations have found is the tendency of the disabled man's womenfolk to condole with him and 280 A SUSTAINED PUBLIC SENTIMENT inculcate or encourage the germ of that most un- manning virus of self-pity, or cause him to regard himself as a hero of whom no further effort should be expected and beneath whose dignity is all work. In nearly every instance the women can strike the key- note to which the man's future life and viewpoint can be pitched. They can cause him to accept the view that he should "carry on" and become a citizen be- fitting his fine record as a soldier, or they can make a weakling of him, clinging to others for support and bewailing that which the fortunes of war have appor- tioned him. The natural maternal instinct is to pet and make much of the injured boy or husband or brother. It is wholly admirable in reason if with it is admixed the commonsense and resolution that will make the disabled man see what is best for himself, best for those dependent upon him, and best for his community. So much for the effect of the public mind upon the disabled individual, acting as a spur to his manhood, his conscience and his sense of duty. This is the first and primary influence. It can be achieved, however, only when public sentiment goes further than the mere urging and advising of the soldier. It must be more than lip service, and it must never be tainted with the condescending attitude of a superior. The public view must be crystallized into a consistent course of conduct, which, for those individuals affected in the general mass, should be as sharply defined and certain as it is in regard to the soldier himself. The public mind, that is to say, the local community mind, must focus upon what the disabled man can do, and not, as it is usuaUy inclined, upon what he cannot 281 REDEMPTION OF THE DISABLED do. It is best to cease regarding him in terms of dis- ability and to visualize and appreciate his remaining capacities, which are often, by reason of specialized education and development, vastly more valuable to him than those he lost. We do not judge a man's worth or ability in a given line by the color of his eyes or hair or his degree of baldness. Why then should we persist in regarding as an incapable and an object of semi-charity a man who has lost his legs but has been trained, let us say, as a tailor ? A tailor does not sew with his feet. The presence or absence of feet has nothing to do with what the man is actually able to accomplish with his arms and hands. This prin- ciple holds through a long list of disabilities. Nor, on the other hand, should a man be put down as a malingerer or imposter simply because he bears no visible evidence of violent injury. Up to October, 1918, 36 per cent, of the claims for pensions presented to the Bureau of War Risk Insurance were on account of tuberculosis contracted or developed in service. Dr. Prosser, testifying before the Joint Senate and House Committee considering the Bankhead-Smith bill for vocational education of the disabled of industry, re- marked : '' The worst problem is that of the tubercu- lous man. He is in worse shape than the man who loses an arm or a leg. Thirty-four per cent, of the casualties resulting from this war will be men suffering from consumption.'' Is a man with arrested or persistent tuberculosis, contracted in a foul hole burrowed in a trench wall or in crowded barracks, any less to be respected than the man who has merely lost an arm? Lacerated flesh and bone soon heal, but the menace of the insidious 282 CLASS IX MECHANICAL DRAFTING UNDER A ONE-ARMED IXSTRUCTOR, RED CROSS INSTITUTE FOR CRIPPLED AX'D DISABLED MEN, NEW YORK WOODWORKING CLASS AT THE SANITARIUM FOR TUBERCULOUS CANADIAN SOLDIERS, STE. AGATHE-DES-MONTS, QUEBEC A SUSTAINED PUBLIC SENTIMENT disease is never entirely removed; a lessening of vital- ity, and it has pounced upon its victim like the lurk- ing cougar from the limb over the path. A man with tuberculosis may be prevented from returning to his well paid place as bookkeeper, his office, or his indoor trade, and forced, in order to live, to take up the growing and vending of vegetables, or the raising of chickens, or small farming. It all goes to show that appearances, the great superficial American standard of the past, are utterly worthless. It is quite conceivable that the expert tailor may not be a good hand at pushing his business, and his lack of legs may be a handicap to him in promoting his trade. It is in realizing this and neutralizing it that the public can render patriotic service, by giving him preference. Or the poor fellow who is trying to dispose of his vegetables may not be able to grade them as exactly or prepare them for the market as attrac- tively as those in the greengrocers' establishments from long established farms. Is it asking too much of the housewives to give his vegetables the prefer- ence? These men do not want charity — all they want is a chance. Are we not going to give it to them, and keep it up as long as is necessary ? We as a people are much given to fine fervors of enthusiasm. We commit ourselves to a course and order this or that done in furtherance of it. We con- tinue our lively interest for a while, but as the novelty palls, we pass on to other things, vaguely assuming that what we have decreed or commanded will be self- executing, and that our institution will function according to our desires and aims. Frequently we are shocked to ascertain afterwards that something 283 REDEMPTION OF THE DISABLED has happened to prevent the realization. The result usually is that we look for a scapegoat, quite forget- ting or overlooking the fact that the responsibility is upon us, the people, individually and collectively. We minimize the fact that through over-optimism, overconfidence, lack of attention and failure to culti- vate a systematic interest our original ambitions have been frustrated. The average citizen would indignantly deny the assertion that he will abate his interest in the welfare of the disabled soldier, or fail to be at all times the advocate and champion of these men. Yet it is hardly doubtful that he will unconsciously allow his interest to become dormant in course of time, and depend more or less upon others for leadership and action in proving faith by the more substantial and visible works. It is just this sort of easygoing optimism we must guard against, for in the lessening of vigilant individual interest, community effectiveness suffers. In the weakening of the local community standard, the whole rehabilitation programme begins to disinte- grate. The foundation upon which the National Gov- ernment has sought to build a permanent citadel of refuge for its disabled fighting men is rendered inse- cure. Presently the new walls of the edifice are crumbling, leaving the whole a melancholy monument to justice unsustained — good intentions which failed by reason of indifference and lack of individual appreciation of responsibility. This individual interest must be directed toward all those who may possibly be brought in contact with the injured, retrained men. Employers of labor must be made to feel the weight of public conviction which 284 A SUSTAINED PUBLIC SENTIMENT holds them under moral obligation to open their shops or factories to disabled men who may be qualified for their particular lines of work. Those employers, if any there be, who would seek to exploit the disabled, by means of discrimination in wages for equally good work with uninjured men or otherwise, should be smitten with the lash of public scorn and condemna- tion. If possible, the goods of such a man should be boycotted, the offender made to feel himself a pariah indeed, his name anathema and a warning to others who would profit by the disadvantages of helplessness of these disabled men who are putting up a brave fight to sustain themselves as civilians. Conversely, the employers who give a fair chance and a square deal to the retrained men should be sustained by public opinion and the more substantial evidence of approval accorded. The people who have remained at home backing up the armies with money and munitions, should feel a keen comradeship with the soldiers from the front, for they are, in fact and in truth, all soldiers in a glorious common cause, each serving according to his or her ability and fitness. Toward the disabled soldier they should feel only that by fortunate circumstance he has been able to give more, to give of his very self, of his blood instead merely of his possessions or a lesser service. When he was lying wounded and helpless in No Man's Land, slowly perishing for want of assist- ance, his comrades risked a thousand forms of death and brought him back to safety. They did it unself- ishly, gladly, and as a privilege. They needed no orders, no suggestions, no exhortation. It was the spontaneous feeling of comradeship, the esprit de 285 REDEMPTION OF THE DISABLED corps, the instant recognition of brotherhood in a com- mon cause and duty beyond mere regulations. The menace of death itself could not hold them back; the thought of self was as base as the bloody mud about their feet. It was a sublime privilege to make the sacrifice, if need be — an exaltation of spirit and a transcending of the command, '' Love thy neighbor as thyself,'' for no man would voluntarily have gone out into that Golgotha on a mission of his own. So it is the duty of the ununiformed soldiers who have fought the good fight here at home, whether by sweating under the blazing sun to see that the armies were fed, or by denying themselves to furnish funds or by more direct forms of service, to cultivate that same conception of oneness with the fighting man, that readiness to stand by him and for him, to rescue him and aid him in disaster, to march side by side with him in fair weather as in foul. The disabled man who is putting up a glorious fight against adverse cir- cumstances must not be allowed to perish out in the No Man's Land of selfish indifference here at home. We must be as ready for rescue as the powder- grimed, bloody fighters in the advanced trenches. We have no bullets to face, no shells, no mines, but the barbed entanglements of selfishness, the insidious poison gas of indifference, we must fight across and over and under and against every day — a Hinden- berg Line it is the achievement of some few of us finally to vanquish. Such should be the attitude toward the disabled man. He is our brother, our more privileged com- rade, and by proxy the man to whom was given the power and the glory of doing on the actual battlefield 286 A SUSTAINED PUBLIC SENTIMENT what all of us in our hearts fervently wished we could do. We should not overwhelm him with ill-considered adulation for a while and then forget him, or turn his head with flattery for having done his duty; but there should be accorded him that brotherly recognition that is deeper and more lasting than the mere enthusiastic acclaim given returning, successful warriors to the home and headquarters of the real Grand Army of the Republic, of which every loyal citizen is upon the muster rolls. 287 CHAPTER XXV THE LARGE PROBLEM : SALVAGING THE DISABLED OF INDUSTRY Industry takes annually as great a toll of man power as war on a colossal scale — Fourteen thousand annually perma- nently crippled in industry — Additional ravages of tuber- culosis and occupational diseases — Estimates of specific disabilities — Total loss of man power through non-fatal industrial accidents — The organization for vocational re- habilitation of the war disabled to be devoted to its sal- vage — The movement in Congress — The pending legis- lation. If the United States maintained an army of 1,500,- 000 men in the field, year after year, and this army was engaged in constant hostilities, its annual output of permanently incapacitating disablements would just about equal the number of those resulting annu- ally from industrial accidents, despite the advance made in safeguarding workers, and despite the con- stant preaching of "safety first" to the workers themselves. The estimate of 14,000 industrial accidents resulting in permanent disablement annually does not take into consideration the ravages of tuberculosis. This dis- ease is recognized as having in many cases a direct, causal relation to conditions of employment or to con- ditions of living for which wage standards and other conditions of employment are responsible. The Army recognizes tuberculosis as a cause of permanent dis- ability and discharges men who have contracted it as unfit for military service. If tuberculosis and other 288 THE DISABLED OF INDUSTRY occupational diseases were counted as permanent dis- abilities, it would be found that the annual output of permanently disabled from industry would equal, if it did not considerably exceed, that from an army of more than 2,000,000 men in active campaigning. We are appalled at the wastage of war, yet we are sub- jected to an annual drain upon our man and woman power in profound peace equals to that created by a colossal army engaged wholly in the business of destruction. The above estimate of the number of industrial crip- ples was arrived at from the industrial-accident reports of seven important states — Massachusetts, New York, Pennsylvania, Ohio, Wisconsin, California and Washington, the figures covering in most cases a period of three years. The injuries taken for the purposes of the estimate are amputations of arms, hands, legs and feet, total loss of sight of one or both eyes, and permanent impairment of the use of these members to the extent of more than 50 per cent. In order to make the estimate applicable to the entire United States, the computation was made upon the basis of the ratio of the permanent disabilities to the number of industrial fatalities. This was adopted as the most suitable basis as there is a reasonably accu- rate estimate of the number of industrial fatalities. On this basis of 22,500 industrial fatalities each year, the estimates of annual permanent disablements are as follows: loss of arm, 810; loss of hand, 1,310; loss of leg or foot, 1,600; loss of eye or of sight, 4,981; and of permanent impairments of more than 50 per cent.: arm, 930; hand, 3,000; leg, 680; foot, 540; eye, 74; making a total of 13,900, or approximately 289 REDEMPTION OF THE DISABLED 14,000 permanent disabilities of all kinds among American wage earners. The statistics of industrial injuries show the average age of injured wage earners as between 30 and 33 years. It may reasonably be as- sumed that these industrial cripples might continue to be wage earners for a period of 20 years, and this re- sult gives the approximate number of the industrial cripples existing at present as 280,000. There are cer- tainly a considerable number disabled by injuries other than those specified above, who would be equally handicapped if they desired to return as industrial wage earners in their former occupations; the total of existing industrial disabled may safely be consid- ered as nearer 325,000. Testifying before the Joint Committee on Education and Labor of House and Senate on December 11,1918, when the Bankhead-Smith bill for the rehabilitation of the industrially disabled was under consideration, Mr. Arthur E. Holder, member of the Federal Board for labor, said in part: During the last five years, ending December 31, 1917, 65,327 men — no women included — in the mines, quarries and on the railroads of the United States have been killed, and 980,764 have been permanently injured; 13,065 were killed annually and 196,153 disabled — this from three of the most hazardous occupations. The other two are long- shoremen and structural steel workers. Representative Towner: I am told that the industrial accidents of the United States alone, within the last 25 years, annually totaled greater than all the wars that had occurred in that period in all the world. Mr. Holder : The only really accurate data we have is in regard to mining and transportation. For the five-year period ending December, 1917, a total of 16,526 workmen were killed and 49,000 injured in our mines and quarriea. 290 THE DISABLED OF INDUSTRY For the same period the railroads of the United States killed 48,801 and injured 931,764. Of the killed and in- jured more than seven out of eight were railroad employees. My authority for these figures for mines and quarries comes from the Bureau of Mines of the United States Department of the Interior; and as to transportation accidents, from the safety division of the Interstate Commerce Commission. The work of retraining the disabled soldiers and sailors will obviously come to an end in a few months or years. Meanwhile, there will have been perfected an organization highly skilled in the process of sal- vaging the residual capacities of men. Shall it be disbanded, scrapped, just as its accumulated experi- ence in handling thousands of cases has brought it to the highest point of efficiency? With its vast poten- tialities for the alleviation of human misery and the banishment of poverty, shall it be thrown aside when there is so much yet to do? By no means! It will be devoted to the rescue and vocational rehabilitation of those victims of industrial processes who otherwise would remain human wrecks and economic burdens. This idea came immediately to the fore when the original Vocational Rehabilitation bill for soldiers and sailors was in process of drafting and enactment in Congress. There were numerous proposals to tack upon the measure amendments providing for the coin- cident vocational training of the industrially disabled. These amendments were withheld upon the earnest representations of the proponents and friends of the original measure, who felt that the bill should not be overloaded or too great a task undertaken at once. They feared that to add the care of industrially disabled to the restoration of the war disabled would 291 REDEMPTION OF THE DISABLED make a work of such stupendous character that diffi- culty would be encountered in getting under way at a time when speed was essential. Accordingly the original bill went through, and under it the Federal Board for Vocational Education began functioning as the agency for the redemption of the war disabled. The measure was signed by the President on June 27, 1918. In the first week of September disabled soldiers were being placed for retraining, and by December 31, 1918, 3,600 cases had been handled by the Federal Board, with a rapidly growing list of applications. When the organization for vocational rehabilitation of disabled soldiers and sailors was well under way, so that the addition of non-military cases could be handled without detriment to the first claim of the war disabled, the friends of the project for the voca- tional rehabilitation of the disabled of industry united upon a measure which was simultaneously introduced in the House by Representative William B. Bankhead of Alabama and in the Senate by Senator Hoke Smith of Georgia on September 4, 1918. Its provisions are quoted in extenso: That in order to provide for the promotion or vocational rehibilitation of persons disabled in occupations or otherwise and their return to civil employment, there is hereby appro- priated for the use of the States, subject to the provisions of this Act, for the purpose of cooperating with them in the maintenance of vocational rehabilitation of such dis- abled persons, and in returning vocationally rehabilitated persons to civil employment, for the fiscal year ending June thirtieth, nineteen hundred and nineteen, the sum of $500,000; for the fiscal year ending June thirtieth, nine- teen hundred and twenty, the sum of $750,000; for the liscal year ending June thirtieth, nineteen hundred and 292 THE DISABLED OF INDUSTRY twenty-one, and annually thereafter, the sum of $1,000,000. Said sums shall be allotted to the States in the proportion which their population bears to the total population in the United States, not including Territories, outlying posses- sions, and the District of Columbia, according to the last preceding United States census: Provided, That the allot- ment of funds to any State shall not be less than a mini- mum of $5,000 for any fiscal year. And there is hereby appropriated the following sum, or so much thereof as may be needed, which shall be used for the purpose of provid- ing the minimum allotment to the States provided for in this section, for the fiscal year ending June thirtieth, nine- teen hundred and nineteen, the sum of $66,000; for the fiscal year ending June thirtieth, nineteen hundred and twenty, the sum of $46,000; for the fiscal year ending June thirtieth, nineteen hundred and twenty-one, and annually thereafter, the sum of $34,000. Sec. 2. That in order to secure the benefits of the appro- priations provided by section one, any State shall, through the legislative authority thereof, (1) accept the provisions of this Act; (2) empower and direct the board designated or created as the State board for vocational education to cooperate in the administration of the provisions of the vocational education Act approved February twenty-third, nineteen hundred and seventeen, to cooperate as herein pro- vided with the Federal Board for Vocational Education in the administration of the provisions of this Act; (3) in those States where a State workmen's compensation board, or other State board, department, or agency exists, charged with the administration of the State workmen's compensa- tion or liability laws, the legislature shall provide that a plan of cooperation be formulated between such State board, department, or agency, and the State board charged with the administration of this Act, such plan to be effective when approved by the governor of the State; (4) provide for the supervision and support of the courses of voca- tional rehabilitation to be provided by the State board in carrying out the provisions of this Act; (5) appoint as custodian for said appropriations its State treasurer, who 293 REDEMPTION OF THE DISABLED shall receive and provide for the proper custody and dis- bursement of all money paid to the State from said appro- priations. All moneys expended under the provisions of this Act from appropriations provided by section one shall be upon the condition (1) that for each dollar of Federal money expended there shall be expended in the State, under the supervision and control of the State board, at least an equal amount for the same purpose: Provided, That no portion of the appropriation made by this Act shall be used by any institution for handicapped persons except for the special training of such individuals entitled to the benefits of this Act as shall be determined by the Federal board; (2) that the State board shall annually submit to the Fede- ral board for approval plans showing (a) the kinds of vocational rehabilitation and schemes of placement for which it is proposed the appropriation shall be used, (b) the plan of administration and supervision, (c) courses of study, (d) methods of instruction, (e) qualifications of teachers, supervisors, directors, and other necessary admin- istrative officers or employees, (f) plans for the training of teachers, supervisors, and directors (3) that the State board shall make an annual report to the Federal board on or before September first of each year on the work done in the State, and on the receipts and expenditures of money under the provisions of this Act; (4) that no portion of any moneys appropriated by this Act for the benefit of the States shall be applied, directly or indirectly, to the pur- chase, preservation, erection, or repair of any building or buildings, or equipment, or for the purchase or rental of any lands; (5) that all courses for vocational rehabilita- tion given under the supervision and control of the State board and that all courses for vocational rehabilitation maintained shall be available, under such rules and regula- tions as the Federal board shall prescribe, to any civil employee of the United States disabled while in the per- formance of his duty. Sec. 3. That the Federal Board for Vocational Educa- tion shall have power to cooperate with the State boards 294 THE DISABLED OF INDUSTRY in carrying out the purposes and provisions of this Act, and is hereby authorized to make and establish such rules and regulations as may be necessary or appropriate to carry into effect the provisions of this Act and to provide for the vocational rehabilitation of disabled persons and their return to civil employment. It shall be the duty of said board (1) to examine plans submitted by the State boards and approve the same if believed to be feasible and found to be in conformity with the provisions and purposes of this Act; (2) to ascertain annually whether the several States are using or are prepared to use the money received by them in accordance with the provisions of this Act; (3) to certify on or before the first day of January of each year to the Secretary of the Treasury each State which has accepted the provisions of this Act and complied therewith, together with the amount which each State is entitled to receive under the provisions of this Act; (4) to deduct from the next succeeding allotment of any State, whenever any portion of the fund annually allotted has not been expended for the purpose provided for in this Act, a sum equal to such unexpended portion; (5) to withhold the allot- ment of moneys to any State whenever it shall be deter- mined that moneys allotted are not being expended for the purposes and conditions of this Act; (6) to require the re- placement, by withholding subsequent allotments, of any portion of the moneys received by the custodian of any State under this Act that by any action or contingency is diminished or lost: Provided, That if any allotment is withheld from any State, the State board of such State may appeal to the Congress of the United States, and if the Congress shall not direct such sum to be paid, it shall be covered into the Treasury. Sec. 4. That the Secretary of the Treasury, upon the certification of the Federal board as provided in this Act, shall pay quarterly to the custodian of each State ap- pointed as herein provided the moneys to which it is entitled under the provisions of this Act. The money so received by the custodian for any State shall be paid out on the requisition of the State board as reimbursement for services 295 REDEMPTION OF THE DISABLED already rendered or expenditures already incurred and approved by said State board. The Federal Board for Vocational Education shall make an annual report to Congress on or before December first on the administration of this Act, and shall include in such report the reports made by the State boards on the administration of this Act by each State and the expenditures of the money allotted to each State. Sec. 5. That there is hereby appropriated to the Federal Board for Vocational Education the sum of $200,000 annu- ally for the purpose of making studies, investigations, and reports regarding the vocational rehabilitation of disabled persons and their placements in suitable or gainful occu- pations and for the administrative expenses of said board incident to performing the duties imposed by this Act, in- cluding salaries of such assistants, experts, clerks, and other employees in the District of Columbia or elsewhere as the board may deem necessary, actual traveling and other neces- sary expenses incurred by the members of the board and by its employees, under its orders, including attendance at meetings of educational associations and other organiza- tions, rent and equipment of offices in the District of Columbia and elsewhere, purchase of books of reference, law books and periodicals, stationery, typewriters and exchange thereof, miscellaneous supplies, postage on for- eign mail, printing and binding, to be done at the Govern- ment Printing Office, and all other necessary expenses. Sec. 6. That the Federal Board for Vocational Educa- tion is hereby authorized and empowered to receive such gifts and donations from either public or private sources as may be offered unconditionally. All moneys received as gifts or donations shall be paid into the Treasury of the United States, and shall constitute a permanent fund, to be called the " Special fund for vocational rehabilitation of persons disabled in industry," to be used under the direc- tion of said board, to defray the expenses of providing and maintaining courses of vocational rehabilitation in special cases, including the payment of necessary expenses of per- sons undergoing training. A full report of all gifts and 296 THE DISABLED OF INDUSTRY donations offered and accepted, together with the names of the donors and the respective amounts contributed by each, and all disbursements therefrom, shall be submitted an- nually to Congress by said board. The measure has the approval of the Administra- tion, it is regarded almost without exception by mem- bers of Congress as highly desirable, and of course it has the hearty approval of organized labor. At the hearings on December 9-11, 1918, the Committee on Education and Labor had before it as witnesses repre- sentatives of state compensation boards, state boards for vocational education, the American Federation of Labor, the Brotherhood of Locomotive Engineers, the National Manufacturers' Association, the National Anti-Tuberculosis Society, the American Museum of Safety, the United States Employees Compensation Commission, and the Bureau of Labor Statistics of the Department of Labor, as well as members of the Fed- eral Board for Vocational Education and employees of that Board. The hearings extended over three days. Opponents of the measure were called for and invited to present objections. None appeared. The hearings developed that not less than three- quarters of a million casualties occur among wage earners in all occupations each year, and there was testimony to show that at present there are not less than 500,000 persons of working age who are suffering from permanent vocational handicaps. With the ex- ceptions of a few experiments by private agencies, no provision, public or private, has ever been made in this country for retraining and placing industrially handi- capped persons. The Committee report to Congress says: 297 REDEMPTION OF THE DISABLED These people, without this help have been doomed to mendicancy or dependency, or casual and uncertain em- ployment, or employment in low-grade positions in which they eke out an unhappy existence. The loss to the man and his dependents is great, but in the aggregate, the loss to the Nation in man power, in undeveloped skill and talent and in the support of dependency is enormous. . . . Practically every one of the great army of handicapped men in our midst could be made a national asset instead of liability. The expenditure annually of a small amount of money among the states by the National Government would be a wise investment, yielding annually large and rich dividends in increased earning power for the individual, with all this means in comfort and happiness for himself and his dependents, and increased economic and social efficiency and wellbeing for the Nation. ... In our highly specialized modern industrial life with its minute division of employment and tasks, it is possible, therefore, for practically every handicapped man under an intelligent programme of vocational rehabilitation to discharge ac- ceptably some task as a full substitute for a normal man. In each individual case the problem is simply one of select- ing the right employment and training for it. . . . To continue to neglect the development and utilization of the great human resources of the army of handicapped people, increasing in size each year with the growth of our popula- tion, is a national folly. . . . Clearly, if it was wise as a business investment and as a policy of national conserva- tion of human resources to provide for the instruction and full support of disabled soldiers and sailors at the expense of the National Government it is equally wise and equitable that the National Government shall provide annually a much smaller sum of money to enable the states to in- augurate and maintain a plan of vocational instruction for that much larger army of persons who become disabled through no fault of their own in the performance of duties necessary to the comfort and prosperity of the country. The report goes on to say that this is the third and necessarily final step in a programme of nation-wide 298 THE DISABLED OF INDUSTRY vocational education initiated by the Vocational Edu- cation Act of February, 1917, for the normal boys and girls and men and women employed in wage-earning occupations. Those same benefits have now been ex- tended to the men who have been handicapped as a result of their service in Army or Navy. It is pointed out that the time is peculiarly opportune for the enact- ment of the measure; that public sentiment has become focused on the need for conservation of our human resources and convinced of the worth of such work. The Committee then reported the bill favorably and recommended its passage, the report being presented to the Congress on December 11, 1918. Thus will have been accomplished the transition of a war-emergency measure into a settled policy of this Government, which is of infinite capacity for good, viewed from every possible angle — a species of paternalism against which no objection can be urged. The after effects upon our industrial life are incalculable. 299 CHAPTER XXVI THE PLACE OP THE STATES IN THE PROGRAMME Early state projects for disabled soldiers — Industrial surveys ■—State activity suspended on enactment of the Vocational Rehabilitation Act — Opportunities for state cooperation — Suspension of civil actions against disabled men — Assistance in placement — Eeclamation of waste lands for farm communities — Assistance in the purchase of farms — Tenancy the cause of the drift from the land — Place- ment of the reeducated disabled of industry a state func- tion — Its relation to the land problem — Conclusion. Soon after the declaration of a state of war with Germany, several of the states, through individual officials, announced Utopian programmes for the re- turned disabled soldiers. In the early months of the war these announcements appeared from time to time, stimulated perhaps by the imminence of elections or political campaigns. Sifting the matter down to essentials, however, it may be said that practically nothing of fundamental value has been done by the states. Some so-called surveys of industries were made to ascertain what avenues of employment were open to returned, disabled men. The number of affirmative answers from employers was astonishingly large, but they are hardly to be taken as more than a manifestation of patriotism. They showed a thor- oughly commendable spirit in the employers of labor, but one based, in the main, upon the wholly wrong conception that these men were to be employed as a matter of charity or favor. The employers seemed largely to regard their promises of employment as 300 THE STATES IN THE PROGRAMME agreements to place upon their payrolls a certain number of incompetents as a reward for what the disabled men had suffered for their country. The passage of the Vocational Rehabilitation Act by Congress put a quietus on state effort and the announcement of state benefits for the returned men. Since then little has been heard of any particular plans of any of the states for their soldier-sons who may re- turn disabled. In truth, there is not very much that the state can do for the disabled man until after his vocational retraining is completed. The National Government educates the disabled man, pays him and makes an allowance to his family while he is taking the course, and places him in a job after he has been fitted for it. Nevertheless, there are several ways in which the various states can aid in the programme of rehabilitation. The Federal allowance to the man and his family while he is undergoing training educationally is thought to be liberal and sufficient, and it is far more liberal than that of any other belligerent nation. Nevertheless, it is quite conceivable that in many in- stances it will not be adequate. Sickness may over- take the family, death occur, or extraordinary and unlooked-for expenses unavoidably arise. From many causes necessary debts may have to be contracted while the father is away on active service. If the head of such a family is retrained for some salaried em- ployment, it is not maligning human nature too much to say that as soon as he obtains a job, and perhaps before he can *' make a pay day,'' he will very likely be subjected to court summonses, judgments, garnish- ments and all the other legal bedevilments. Possibly 301 REDEMPTION OF THE DISABLED as a consequence he may be discharged by his em- ployer, who has something else to do besides answering garnishments and the importunities of collection sharks. The states can take steps to protect the returned soldier against such contingencies and give him a fighting chance to get on his feet in civil life again. The uniform protects him while he is in the Army, but it would be the acme of folly to have his reeduca- tion and placement nullified by the act of grasping creditors and their legal harpies. Some state action should undoubtedly be taken. The Army pay and family allowance is sufficient for only a bare living of the plainest sort, and many families who had been accustomed to comfortable living have undoubtedly found it impossible to keep strictly within it, with the purchasing power of the dollar steadily shrinking. The people who profiteered in the food the soldier's Army pay and allowances were inadequate to furnish, or in his rent or the other necessities of his family, will not hesitate to try to grab the first dollar he makes when he is a citizen again. The man who shed his blood that these creatures might be protected safely at home should certainly be protected against them and allowed a chance to get a start once again. In this field the states may find an opportunity for great usefulness, as it is peculiarly a matter for state regulation. The states through their proper authorities can act with the United States Department of Labor and the Federal Board for Vocational Education in endeavor- ing to find places for the reeducated men in the trades, industries and occupations for which these men have 302 THE STATES IN THE PROGRAMME qualified themselves. The states can cooperate with the Federal authorities in giving the gallant fellows opportunity to work, and perhaps can aid further by remitting to them such privilege or occupation taxes as may be levied upon their trades or callings. The greatest possible field of usefulness for the states is in taking steps to assist their returned, dis- abled soldiers to acquire land for homes and for farm- ing purposes. In many of the states there are im- mense areas of perfectly good lands uncultivated, such as the cut-over pine lands of the South and the logged lands of the East and of the Northwest. In the main these lands are owned by large lumber corporations or absentee landlords, are assessed at small fractions of their value, and bring a correspondingly small re- turn to the states in the way of taxes. The states should provide for the acquisition of large tracts of these lands, not too remote from railroads or existing towns; the law of eminent domain should be invoked and the lands condemned for public use at the valua- tions on which they have been assessed for years. These tracts should be surveyed into 20-, 40- and 60-acre farms. Good roads should be constructed through the territory, and the farm homes grouped in neighborhoods or villages, which could easily be ar- ranged if the farms were surveyed as the spokes of a wheel radiate from a hub, the hub in this case being the village or center. Good, comfortable houses and barns should be constructed, preferably of reinforced concrete, to reduce fire risk and for warmth in winter and coolness in summer, as well as for durability. Adequate water systems should be constructed, either for the community or for the individual places. The 303 REDEMPTION OF THE DISABLED land should be cleared of stumps, fenced, and put in tillable condition. These little farms should be sold to the soldiers who have been reeducated for farming and who want to get back on the land. The sales should be made on the basis of annual payments extending over 20 or 25 years or possibly longer, with no payments required for the first two years. A tax of one mill on each taxable dollar in the less wealthy states, and probably a half-mill in the richer states, would provide a fund for this purpose, which in a few years would begin to flow back into the states' coffers, to be utilized again in the same manner for the benefit of the industrial cripples who will have been reeducated for farming or allied pursuits. The law should provide that the places cannot be resold. If the tenant should desire to leave, he should be compensated by the state for the improvement he has brought to the land, the fix- tures he has put on it, the fruit trees he has planted, and the same idea should prevail in the settlement of estates of decedents. But the title should remain with the state. By this means the object of fixing a part of the population upon the land may be accomplished, and the speculators and profiteers who are always ready to take advantage of either the necessitous, the improvident or the restless will be absolutely barred. The man who goes on the place may remain as long as he lives, and if his children or his widow desire to con- tinue farming it, they may do so on the payment of a rental which should just about cover taxes and de- terioration ; but absolute alienation should be guarded against, and these, communities held by the states as havens for their citizens who have fought the good 304 Courtesy Red Cross Institute for Crippled and Disabled Men. FOUR FRENCH M UTILES WITH ARM AMPUTATIONS MOWING HAY WITH MECHANICAL WORK ARMS THE STATES IN THE PROGRAMME fight, in either the military or the industrial army, and who by the fortunes of war have been incapaci- tated for further fighting. This is a wonderful field for creative statesmanship. There is another way in which the states may be of assistance, not only to the disabled returned soldier but to other soldiers as well, that is by the creation of a fund which may be loaned to those who desire to acquire small farms, and from which they may be assisted in the purchase of implements, seeds and stock — the same idea as that underlying the Federal farm-loan bank, but strictly as a state affair, with a modest maximum loan and with the procedure simpli- fied so that it will not be such a monumental sort of undertaking as it is to obtain a loan from the Federal bank. This could be made a permanent "revolving fund," much on the order of a building and loan association, with the people of the state furnishing the funds to be loaned, to be paid back minus profits or high interest or any except the bare expenses of administration and amortization. The cry from all over the country is for land, and at the same time there is scarcely a state in the Union in which there are not tremendous areas owned by absentee landlords who are holding the land for speculation and at prices all out of proportion to what was paid for it. The states undoubtedly have the right to invoke the sovereign power of eminent domain. If the state can delegate this power to a railroad for the public good therein contained, surely the state itself can employ it to reacquire its soil to be used for the general good. There has been a steady drift away from the farms 305 REDEMPTION OF THE DISABLED for years. It has been because the people who live upon the farms do not in the main own them. They cannot pay the rents and make profits. They have not the incentive to improve the usually squalid, bare, unhomelike houses and premises. So great has been the drift away from the soil that only by the utmost exertions, only by shifting labor to the country and enlisting the cooperation of former agricultural work- ers and schoolboys and girls, was our immense agri- cultural domain able to meet the food crisis of 1917 and 1918. It is time for the states to be considering this question, basing their consideration upon the fundamental axiom that a home-owning citizen is a satisfied, happy and valuable citizen. The announced policy of the Government to reeducate the disabled of industry is going to throw a vast new problem into the hands of the states for adjustment. The United States Government will furnish part of the money for reeducation, but the actual reeducating, the place- ment and after-care of the industrial disabled is going to be strictly a state problem. And these people must have land to live upon. The bill now pending in Congress for the rehabilita- tion of the disabled of industry provides that the United States shall appropriate approximately a million dollars annually, to be distributed on a basis of population engaged in industry among the states agreeing to match the Federal grant dollar for dollar, the funds to be spent under the direction of the Federal Board for Vocational Education in the voca- tional rehabilitation of those who have been perma- nently disabled as the result of industrial accident. Every state in the Union is going to accept these pro- 306 THE STATES IN THE PROGRAMME visions. There is no set of state officials or legis- lators who would dare face an outraged constituency and admit helping to reject the Federal grant. Every worker in every state will vote solidly for the men who are in favor of accepting it, and thus putting the state in the march of progress to do justice to its disabled workers. The placement of the industrial disabled after they are reeducated is going to be strictly a state problem, and it will inevitably bring forward the land ques- tion. Man}' of the disabled of industry are subject to diseases for which the nature of their occupations is largely responsible, such as pulmonary complaints among textile workers, and the like. These people will have to be educated for open-air occupations; after they are educated, where are they going to exer- cise their knowledge and training ? Not on the public roads or commons or on rented land at rents which squeeze all the profit out of their endeavors! They must have land, and they will have land. Thus, although the work for the disabled soldiers is not particularly a state problem, and the brunt of it is being borne by the Federal Government, it behooves the states to begin organizing to work in close co- operation with the Federal Government in order to insure the maximum of benefit. Furthermore, the problem of taking care of the disabled industrial workers promises to be a live issue and a permanent one in every state that has an appreciable class of workers in industry. Thus do we progress. We rose to heights of pure justice in securing to the disabled soldier the right to 307 REDEMPTION OF THE DISABLED be a self-respecting, self-supporting citizen instead of a pensioned burden. From that higher plane in the larger horizon became clear the rights of the indus- trial workers who, as ununiformed soldiers of the common good, suffer from disabilities and injuries as much as the men who received theirs on the battle- field. It was plain that the commonwealth owed them such reparation and new opportunity as it could con- trive. Congress has made the first step and com- mitted the Federal Government, as a settled policy, to the financial assistance and the expert direction and supervision of the vocational rehabilitation of the disabled of industry. The states have been invited to come in and bear only half the cost. Terrible as is the price in blood and treasure we have paid for upholding our ideals in France and Belgium, in Italy and Russia, such results for the good of humanity go far toward balancing the ac- count. Had not the war forced these matters upon our attention, it is doubtful that the dawn of the next generation would have seen them as completely set- tled as they now are, or the public mind become so generally acquiescent in the rights of the individual and the duty of the mass to the disabled member thereof. 308 INDEX Airplane workers trained by Federal Board for Voca- tional Education, 165. Allotments and allowances to soldiers' dependents, 181. American Casualties, 55. American Federation cf La- bor cooperates to obtain passage of rehabilitation law, 244; endorses rehabil- itation, 244. Amputation cases, average percentage of, 57; in United States forces, 13. Analysis of first 159 cases placed for reeducation, 225. Armistice changes medical conditions in army, 10. Artificial aids to the disabled, 23. Australia, establishes soldiers' homes, 137; furnishes land for her soldiers, 136; gov- ernment supplies all funds for land in, 138; Eepatria- tion Commission of, 136; system of land purchase and financing soldiers of) 138; vocational reeducation for the disabled in, 137. Austria-Hungary, 118; casual- ties of, 123; military au- thorities provide medical care in, 118; orthopaedic schools in, 119; placement of disabled men in, 121; places care of disabled on states of the Empire, 118; policy of, one of concentra- tion in large institutions, 120. Automobile drivers and mech- anicians trained by Fed- eral Board for Vocational Education, 165. Bankhead-Smith bill for re- habilitation of the disabled of industry, committee re- port on, 298; hearings on, 297; text of, 292. Bedside occupation, 206. Belgium, "Home University" for disabled men opened by, at Paris, 76; inception of restoration work by, at St. Addresse, France, 65; re- construction camp of, at Port Villez, France, 68; the pioneer in restoration work, 64; plight of wounded and exiled of, 64. Benefits of rehabilitation a beneficent by-product of war, 308. Best interests of man sole aim in rehabilitation work, 213. Blind, American cases, num- ber of, 12, 56; average of, in various armies, 56; treat- ment of, in United States, 12. Blindness not caused by poi- son gas, 56. Branch offices of Federal Board for Vocational Edu- cation, 211. Canada, casualties of, 134; continues family allowances while retraining, 128; De- partment of Civil Reestab- lishment of, 128; facilities for return of disabled to the land in, 132; first in Amer- INDEX ica to reeducate disabled soldiers, 124; first provi- sion for wounded in,124;in- ception of vocational reedu- cation in, 125; Invalid Sol- diers, Commission of, 126, 128; makes special effort to ascertain wishes of disabled men, 130; method of hand- ling returned disabled men in, 128; Military Hospitals, Commission of, 124; occu- pational therapy in the hos- pitals in, 129; offers educa- tion free but without main- tenance to certain classes of soldiers, 132; pensions un- affected by retraining in, 126; placement work in, 134; reeducation in, limited to disabled who cannot re- sume former occupations, 127; rehabilitation system of, 124; rehabilitation work demilitarized in, 126; suc- cess of, in rehabilitation, 257; system of, a practical evolution, 125; utilization of disabled man's family in, 129; wounded of, given furloughs to visit home, 129; wounded of, sent to depot nearest home, 128. Casualties, American, 55; Austro - Hungarian, 123; British, 58; Canadian, 134; French, 90; German, 116; Italian, 156. Central Empires, restoration work in, 105. Charity undesired and un- Avelcome, 20, 271. Choice of an occupation to train for, 213, 218; medi- cal limitations on, 216. Civil-service positions, number of, 249, 250, 253. Classification of disabled from a military standpoint, 9. Coddling the disabled man has no place in the programme, 241. College courses, assistance to complete, 2:29. Commiseration '' unsteels the soul,"^ 273. Community obligations to dis- abled men, 28, 241. Complete restoration of dis- abled the new National pol- icy, 29. Compulsory training a fail- ure, 26. Congress, interest of, in re- habilitation, 170. Conservative democracies turned into conserving de- mocracies, 50. Convalescent patient should start on reeducation, 210. Convalescent stage of ten vital links between medical treat- ment and vocational reedu- cation, 207. Council of National Defense acts to procure legislation, 171. Courses available through Fed- eral Board of Vocational Education, number of, 225. Creditors of disabled men should be restrained, 302. Cripples small portion of problem, 58. Curative, work in hospitals de- cisive factor in inducing volunteers for vocational re- education, 13. Curative workshops and courses of instruction in United States hospitals, 8; must be under military dis- cipline, 208; when work should begin in, 209. Deafness and speech defects, 12. INDEX Debt of the Nation to the dis- abled man, 16. Deficiencies in training cor- rected, 239. Depot des Invalides, Belgian, established, 66; compensa- tion to inmates of, 67; cur- riculum of, 66; instructors in, 67. Determination of course for disabled man crux of the problem, 256. Disabilities not necessarily visible, 283; rarely total, 22; specific, incidence of, 13. Disability incurred in Great War a badge of honor, 271. Disability compensation, 49. Disabled, average of, under modern system of war, 53. Disabled men, assigned for training to institutions near- est their homes^ 229; im- perative to have interest of, in retraining, 220; instances of retraining of, in line of previous experience, 218; country still expects them to do their duty, 214; long for unaffected comradeship, 272; may be '' slackers'' by refusing to take training, 275; not necessarily crip- ples, 21; previous valuable trade knowledge of, never discarded, 219; primary en- deavor to fit them where chance of success is best, 217; a potential reserve to warring nations, 47; real reeducation of, begins after discharge from Army, 223; restoration of initiative of, important, 221; retrained examples of success of, 255; retrained, wantonly a fair trial, 270; under jurisdic- tion of War and Navy De partments until discharge, 205. Disabled of industry the larger problem, 289; see also under Industry. Disabling wounds often high road to real success, 262. Disregard of disabilities and concentration on abilities essential, 282. Division of Physical Eecon- struction, Surgeon - Gen- eral's Office, 4. Duty of the home community, 266; of the citizen toward the disabled man, 275; of the whole citizenry to its disabled members, 308. Early days after injury criti- cal in psychological sense, 25. Economic redemption of dis- abled a national investment, 51. Educational institutions used in placing first reeducation cases, 228. Effect of work on wounded first noted at St. Addresse, France, 66. Electricians trained by Fed- eral Board for Vocational Education, 165. Employers of disabled men need educating, 234; ex- ploiting disabled should feel public wrath, 285; gen- erally willing to give re- trained a chance, 235, 300; had wrong conception of re- trained men, 300; not^ ex- pected to employ retrained at a loss, 270; protected against increased casualty- insurance rates, 232. Encouragement, not commiser- ation, need of disabled, 284. Equality of opportunity now 311 INDEX the aim of the Government, 44. Expenses of retraining paid by the Federal Board for Vocational Education, 210. Families of untrained men the sufferers, 280. Farm, states can check drift from, 305. Farm community for soldiers, suggested plan of, 303. Farms for soldiers, states should provide, 303. Federal Board for Vocational Education, authority of, to prescribe course, 194; au- thorized to make studies of disabled of industry, 296; authorized to receive gifts for use of disabled of indus- try, 296; authorized to supervise rehabilitation of disabled of industry, 294; began retraining operations promptly, 292; composition and functions of, 163; co- operates with other agen- cies, 197 ; district or branch offices of, 211; district vo- cational officers of, 211 ; empowered to accept gifts and donations, 198; en- trusted with reeducation work by Congress, 171; first man placed for reeducation by, 199; first 159 cases placed by, analysis of, 226; given large discretion, 196; has disciplinary powers over students, 194; holds "all careers open to the disabled man," 213; immediately available to retrain dis- ables, soldiers, 166; institu- tional facilities available to, 223; institutions utilized by, 227; local boards of, their composition and functions, 211; organizes rehabilita- tion work, 199; powers and duties of, 194; powers of, in administering Vocational Rehabilitation Act, 198; re- quired to file reports, 198; service of, to war branches of the Government, 164; spent nothing for teaching equipment, 230. Federal Government as an em- ployer of labor, 246. Federal Eehabilitation Act put quietus on state and private effort, 301. Financial provision for the disabled soldier, 177. Follow-up work after place- ment, 239. France, casualties of, 90; compensation and mainte- nance of disabled men in schools of, 86; difficulty in inducing men to take reedu- cation in, 82; disabled am- bitious for clerkships in, 89; disabled qualifying for trades formerly occupied by Germans in, 88; discipline in schools of, 86; finds the discharged disabled most difficult to interest, 85; Government reeducation school of, Institute Na- tionale, opened, 80; manual trades most preferred in, 88; reeducation work in, an evolution, 77; reserves public service positions for disabled soldiers, 253; schools available for reedu- cation in, 81; system of re- education of, 84; system of, inaugurated by Edouard Herriot, 78. Germany, agricultural schools in, for war disabled, 113; casualties of, 116; creed of, INDEX "man must go back to his trade," 114; Federation for the Care of Cripples in, 105; Imperial Government of, evades responsibility, 105; League of Wounded Soldiers makes demonstra- tion in, 117; orthopaedic hos- pitals in, 109; percentage of cripples restored in, 115; placement system of, 114; scheme of restoration of, summary of, 109, 110; schools available for re- training in, 106, 110; schools for the one-armed in, 112; system of, state and private organization in, 108; teaches many oxy- acetlene welding, 115; well equipped for rehabilitation, 105. Gifts and donations, Federal Board empowered to accept, 198, 296. Government as an employer of labor, 248; is debtor to in- jured man, 43. Government's power of reha- bilitation limited, 266. Great Britain, advisory trade committees in, 102; casual- ties of, percentages and classes of, 58; casualty in- surance rates in, 99; co- ordinates all forces under state control, 97; employers in, cooperate in placement, 99; enmeshed in commit- tees, 102; local advisory bodies in, 101; local com- mittees in, and their func- tions, 98; "Lord Eoberts' Workshops" in, 96; Min- istry of Pensions of, cre- ated, 97; plans of, for care of disabled not rigid, 104; policy of, one of generosity, 91; pre-war point of view of, changes, 92; procedure of, with the disabled man, 99; programme of, outlined, 92; programme of, revision of, 95; realizes the problem as one for the state, 93; Eoyal Patriotic Fund Com- mittee of, 96; Soldiers and Sailors Help Society of, 96; system of placement of, co- operative, 99; system of re- education of, 91; system of, one of great flexibility, 103; system of, well adapted to individual needs and local condition, 104; traditional policy of, overturned, 92; utilizes existing agencies, 97. Herriot, M. Edouard, founder of French system of reedu- cation, 79. Holder, Arthur E., testimony of, on Canadian system, 257. Home community, agencies that can help disabled men in, 270; can aid in over- coming handicaps, 267; duty of, to disabled re- trained man, 267, 269; must insure a fair trial to re- trained man, 270; must see disabled are not shuffled out of jobs, 271; problem of, a personal one, 268; re- sponsibility of each individ- ual of, 271. Homes for disabled men, states' opportunity for service in providing, 303. Hope the greatest restorative, 204. Hospital treatment of dis- abled, its objective, 13. Hospitals, reconstruction, of U. S. Army, 7. 313 INDEX Hungary, reeducation school of, at Budapest, 123. number and sources of, 288, 289, 290, 291; organized labor approves measure for rehabilitation of, 297; pri- vate experiments in rehabil- itation for, 297; rehabilita- tion programme for, 291, 292; states expected to co- operate in work for, 293. Institute dei Eachetice at Mi- lan, 147. Invalid or bedside occupa- tions, 206. Italy, 147; accident insurance rates in, 153; casualties of, 156; claims largest per- centage under arms, 157; compels private firms to re- instate employees, 152; fa- cilities for caring for dis- abled of, 156; Government of, has stimulated educa- tion, 157; maintains fam- ilies of men undergoing re- education, 151; National Board for Assistance of War Invalids of, 149; National Federation of Committees in, 148; National War Cripples Association of, 151; peasant population of, 153; placement system of, 152; pensions in, not af- fected by reeducation, 153; provincial and local com- mittees in, 148; redemption problem in, complicated by illiteracy, 153, 157; reedu- cation schools under direc- tion of volunteer local com- mittees in, 154; rehabilita- tion system of, 150; re- serves civil-service positions for war disabled, 152; schools of, 154, 155; some of, will require farms, 306; unprovided with retraining facilities at beginning of war, 147. Idle indigence no proper compensation, 42. Idleness a demoralizing fac- tor, 26, 207. Illiteracy revealed by the draft, 229. Illiterate disabled given fun- damental education, 229. India, British, educational work of, 144; government of, employs many retrained men, 145; supplies retrained with free tools, 146. Individual citizen the object of governmental solicitude, 46. Individual development the main problem, 223. Individual interest must be sustained, 284. Individual needs, training adapted to, 221. Individual responsibility atro- phied by military service, 222. Individual self-respect a na- tional asset, 39. Industrial accidents, 289. Industrial opportunities for disabled men surveyed, 234. Industrial plants, practical in- struction given in, 224. Industry, disabled of, appro- priations proposed for re- habilitation of, 292; an as- set neglected, 298; average age of, 290; Bankhead- Smith bill for rehabilitation of, 292, 297, 298, 299; care for, is third step in Na- tional programme, 299; gift fund for, authorized by Congress, 296; larger in ag- gregate than war disabled, 298; national loss in, 290; INDEX Johannesburg Belief Associa- tion, 143. Justice, not alms, the United States programme, 175. Labor approves vocational re- education, 243. Land-grant colleges utilized by Federal Board, 223. Latent disabilities sometimes uncovered, 237. Legislation needed in states to protect disabled men, 301. Local public service extensive field for placement, 253. Lyons center of French move- ment for retraining, 79. Machinists trained by Federal Board of Vocational Educa- tion, 165. Medical or surgical care of disabled confided to Army and Navy, 197. Medical cases, average of, 57; moat difficult, 59. Mental attitude of patient highly important, 202; of recently returned disabled men, 238. Military life atrophies initia- tive, 208. Nation gains in proportion as usefulness of citizens in- creases, 265. National programme in the United States, development of, 167; scope of, 168. Nation's duty to war disabled, new conception of, 18, 48; reflected by higher concep- tion of individual, 45. Navy and Marine Corps dis- abled functionally treated by Surgeon-General's office, 3. New Zealand, courses offered by, 141; disabled do not take to special training in, 140; Discharged Soldiers Information Department of, 139; furnishes free techni- cal training, 142; instruc- tion in agriculture in, 141; local committees active in welfare work in, 139; means employed for helping re- turned men in, 142; prefer- ence given soldiers in gov- ernmental employment in, 139; '' training allowances'' in, 141. Occupational diseases, 289. Occupational therapy and re- construction aids, 6; its place, 206. Occupations, choice of, 213, 218; list of, trained by Fed- eral Board for Army, 165. Officers, status of, under War Eisk Insurance Act, 183, 211. One-armed man, determination of work for, 60, 222. Opportunities for retrained in public service, 246, 249, 252. Organized labor and the re- trained man, 242, 243, 245. Oxy-acetylene welding, 115, 165, 265. Pension system, abuses of, 179; evil effects of, 36; ex- penses of, still rising, 30; had no advocates in Great War, 174; a mistake as a national policy, 41. Pensioners, number of, 32; number of, receiving in- creases under Act of June 10, 1918; widows contribute bulk of, 33, 178. Pensions, abolished for "com- pensation, " 43; expendi- tures for, 32; high-water INDEX mark of, 30; impaired ster- ling quality of pensioners, 179; number of, Civil War, 34; special legislation on, 34. Permanent disabilities, spe- cial hospitals for, 12. Physical reconstruction, defi- nition of, 3 ; division of, or- ganized by Surgeon-Gen- eral, 3; development of sys- tem of, 6. Physiotherapy, 7, 83. Placement, agency for, or- ganized by Government, 233; an essential part of restoration programme, 62, 196, 232; problems of, 232; requires cooperation of state local and private agencies, 233; state authorities assist in, 234. Placement Division of Federal Board, 242. Port Villez, France, Belgian rehabilitation center at, 68. Preference in civil service to veterans and disabled, 251, 252. Preference in patronage, han- dicapped entitled to, 283. President Wilson calls con- ference on retraining of dis- abled soldiers, 169. Probation and adjustment period for retrained men, 235, 236. Process of restoration, cure by work, 202. Professional education may be continued, 228. Psychology of hope and ambi- tion, 203. Public mind, its effect upon the individual, 281. Public sentiment, largely moulded by women, 280; Eehabilitation Act a reflec- tion of, 277; should frown upon idle pensioners, 279; sustained, necessary, 277. Radio operators trained by Federal Board, 164. Eeconstruction aides, 6. Reconstruction, physical, de- fined, 3; process of, in hos- pital, 13. Reconstruction hospitals of U. S. Army, 7, 8, 10. Reeducated men, definitely placed after first course rf training, 267; dependent upon no special favors, 235; records of success of, 255; Bhould be given chance to get started, 301; succeed in Canada, 256, 261. Reeducation, vocational, of disabled soldiers, confided to Federal Board, 194; Gov- ernment bears all expenses of, 201; inception of idea of, 47; law requires it to be continuous process, 197; length of time required for, 199; measure for, 172; not confined to manual trades, 200; number of cases for, per million under arms, 53; problem of, 53, 62; pro- gramme of Surgeon-Gen- eral's office for, 6; special- ized, examples of, 225; strictly a civilian function, 222. Rehabilitation of disabled sol- diers, conferences on, ini- tiated by Federal Board, 169; critical psychological period in, 204; importance of, to the belligerents, 158; inception of movement for, in United States, 167; no background of trade know- ledge complicates problem of, 220; primary impression to be made on patient in, 316 INDEX 202; problem of, an indi- vidual one, 242; real prob- lem of, is to fit disabled into vocation where his im- pairments will not handi- cap, 22; restoration of in- active a prime necessity in, 208; several stages of, 205; tentative measure for, drawn, 170; underlying principle of, 201; Vocational Rehabilitation Act for, 193. Self-pity, an unmanning atti- tude, 281. Sheet-metal workers trained by Federal Board, 164. Sinecure jobs, temptation strong to take, 279. Smith-Hughes Vocational Edu- cation Act, 162. Smith-Sears Vocational Reha- bilitation Act, 172, 193. Society insures best interests by conserving human wast- age, 19. Soldier of democracy essen- tially a civilian, 14. Soldiers' Homes, inmates of, 34. South Africa, rehabilitation system of, 142. Special hospitals for special disabilities, 10. Special occupations in army, Federal Board furnishes training for, 165. Special training given direct in industries and trades, 224. Square deal for disabled not merely matter of employ- ment, 271. Square deal insisted upon from employee and em- ployer, 240. States, can assist in various ways, 301; can loan funds for acquisition of farms by disabled, 305; efforts of, suspended on passage of Federal Rehabilitation Act, 301; great opportunity of, to help disabled obtain homes, 303; have much un- used land available for dis- abled soldiers, 303; place of, in rehabilitation pro- gramme, 300; should co- operate in placement of dis- abled, 302; should cooper- ate more closely with Feder- al agencies, 307; should protect disabled retrained man, 301; supplement allot- ments and allowances of war-risk insurance, 182; surveys of, for employment opportunities, 300. Success despite disability, Canadian cases of, 259. Surgeon-General's office, Divi- sion of Physical Reconstruc- tion of, 6. Surgical cases simplest to deal with, 58. Temporary employments un- wise for disabled men, 279. Tenancy the cause of drift from the farms, 305. Therapy of work, its develop- ment, 25. Total disability the rarest ac- cident in the war, 24. Trades and industries utilized for training purposes, 224. Training, adapted to indi- vidual needs, 221; allow- ances during, 210; necessar- ily an individual problem, 59; not as difficult as selec- tion of proper line to train for, 237. Tuberculosis, in U. S. Army, 13 ; percentage of claims for compensation for, 282. 317 Tuberculous man the hardest problem, 282. Unearned wages a pernicious form of charity, 275. United States, as a neutral, small interest in rehabilita- tion in, 158; enters the war, 161; had reeducation agency ready at hand, 161; makes reeducation a voluntary civil operation, 175; programme of, most comprehensive, 172. United States forces, blinded in, 12; casualties of, 55; percentage of wounded re- turned to duty in, 9. Untrained disabled cannot survive economically, 279. Vienna, orthopaedic schools in, 119. Village trades popular with French disabled, 88. Visible evidences of injury not reliable guide, 282. Vocational advisers, 209, 214, 215. Vocational education, firmly established, 28; given im- petus by war work, 52. Vocational Education Act, 163. Vocational occupations in army, men trained by Fed- eral Board for, 165. Vocational reeducation; see under Beeducation. Vocational rehabilitation; see under Behabilitation. Vocational Rehabilitation Act, 172, 193. Wage adjustments with dis- abled, 240. War the most hazardous of trades, 54. War risk insurance, Act of Oct. 6,1917,177; allotments and allowances, 181; aver- age amount of policy, 192; classification of injuries for, 188; compensations for deatli or disability in, 182; cost of, and how paid for, 190; designed to obviate special pension legislation, 185; flat-rate scale of compensa- tion in, 184; officers and private on same footing in, 183; partial disability com- pensation in, 187; percent- age of men insured, 192; provided for voluntary takers, 190; total written, 192; scale of compensation in, 187; special impairments in, 186; states supplement allotments and allowances of, 182. War Training Division of the Federal Board, 164. Waste lands of states can be used as farms, 303. Wastage of man power under pension system, 37. Women, success of programme depends largely on, 280. Work the acid, test of train- ing, 236. '' Work prescription'' the same as medical prescrip- tion, 208. Wounded refitted for military service, proportion of, 9. 318 Heollh Service » Bethesdo, Md. " U.S. Deportment of » Heolth, Educolion, °? and Welfare. Public *> Heollh Service <* Bethesda. Md. » US. Department of " Health. Educolio iiionpj 'u,i|oan jo luauiijodarjc, n Pw 'opjaijiag ssiajoc; u,i|°9H 3!|°,nd 'a,°)|3M Puo "uoi|03np3 'i^oa^ jo luatuuodag 5 n pw 'opsau^ag sjiajbj u,i|oa|_| Heolth Service » Bethesdo. Md °i U.S.Deportment of *> Heollh. Education, 5 and Welfare, Public *> Health Service °J Bethesda. Md. » U S Deportment of <* Heollh. Educohoi .< < -< < -c < •< r < iitosnp] '141)0314 jo luauiuodarj 5 f| pyy'optaifiag asiAjac; u,MoaH 3llclnd 'a'°il3M Puo •uoiioanpj 'i(i|oan jo luauiuodag ;n pw'opsa^iag asi*jas u,i|03h *> US Deportment of °i Heollh. Edi 0 US Department of °? Heollh, Edc 'U0i(03np3 'm|oan UB 360 H314r 1919 14030930R NLN QSDTflMTT 7 NATIONAL LIBRARY OF MEOICINE NLM050984997