PART ONE
PHYSICAL RECONSTRUCTION AND VOCATIONAL EDUCATION
INTRODUCTION
When the United States entered the Great War all the countries actively participating in the conflict, on either side, had evolved more or less elaborate and apparently satisfactory systems by which to restore the wounded to such physical fitness as would warrant their return to the ranks of the fighting forces or to limited military service, or to such condition of partial physical fitness as would make necessary and possible their reeducation or vocational rehabilitation for living-making in full or in part. Along with the latter phase, in each country was evolved a system of pensions to supplement or to take the place of restoration to economic capacity.
During the Inter-Allied Conference for the Study of Professional Reeducation, held at Paris, in May, 1917,1 representatives of France, Belgium, Russia, Portugal, Italy, and Serbia took active part in the discussion. According to the report of this conference, the greatest amount of interest was taken in the subject by the French, the Belgians, and, so far as the author of the report could judge, by all the Allies. In France, Belgium, and Italy training in hospitals was compulsory (on the advice and under the supervision of the doctor), whereas in England it was not compulsory, even in orthopedic and limbless hospitals which had workshops attached. Compulsory training ceased in France and Italy as soon as the man was discharged from the army. With the Belgians, on the other hand, the State had to maintain them, there being "no Belgium for them to go back to." For this reason training was compulsory so long as it was considered that the man required it.
On the other side of the conflict equal care has been taken to safeguard the war wounded. Sjörgen, then president of the Swedish Medical Association, reported the results of a thorough study made by him of the German plan for reeducation and return to civil life of her disabled soldiers and sailors:2
The broad and solid foundation assured by the law of May 31, 1906, had given a groundwork for the empire's responsibility and care for the thousands of wounded who have been streaming back from the various fronts in unprecedented numbers since the first weeks of the war. The well-planned and powerful organization which has been created for the purpose is called the "Kriegsbeschädigtenfürsonge," but there is no centralization of it for the whole empire. All the private forces and organizations are subordinate to the military organization, and the head of this is the medical department of each army corps, the chief corps medical officer being in charge of the whole for this section.
At Görden, in the Brandenburg district, one of the institutions visited by Sjörgen, the greatest emphasis in the after treatment was not placed on passive orthopedic movements, but on active gymnastic exercises carried out under military words of command.
The medical treatment and the provision of artificial limbs and functional reeducation were controlled by the imperial military authorities and were conducted along uniform lines.3
In Austria and in Hungary reeducation was obligatory and entirely controlled by the governments. The military authorities provided the wounded with the first medical assistance, bore the cost of manufacturing and repairing artificial limbs as long as the patient remained in military service, met the cost of treatment in nonmilitary institutions, kept the wounded under control until recovery of earning capacity or until discharged as an invalid. The aftertreatment and vocational reeducation were controlled jointly by the military and civil authorities. Placement, on the other hand, was entirely under civilian auspices.
Thus, when we entered the war, nearly three years after its commencement, no pioneer road was left for us to follow with respect to the physical reconstruction and vocational reeducation of our wounded or otherwise disabled soldiers and sailors. It was left for us merely to select a plan and to modify it to meet our own needs.
REFERENCES
(1) Report on the Inter-Allied Conference for the Study of Professional Reeducation, and other questions of interest to soldiers and sailors disabled by the war, held at Paris, May 8 to 12, 1917, by Lieut. Col. Sir A. Griffith Boscawen, M. P., parliamentary secretary to the Ministry of Pensions. London, His Majesty's Stationery Office, 1917.
(2) The German plan for care, reeducation and return to civil life of disabled soldiers and sailors. Abstract of a report made to the Swedish Medical Association by its president, T. Sjörgen, and published in full in the Fördhandlingar of the association, November 30, 1917. Journal of the American Medical Association, 1918, lxx, No. 6, 379.
(3) McMurtrie, D. C.: The Disabled Soldier. New York, The Macmillan Co., 1919, 210.
(4) Op. cit., 217.
