ITElvWDEXEK            //      /
  ARC 210
August 15, 1918
THE AMERICAN
RED CROSS  g>
Department of Civilian Relief  /
   Washington, D. C.
Home Service and the
   Disabled Soldier
      or Sailor
' y
i^A?>
OFFICE .
\
August, 1918
■ 
 
Foreword
  The debt which this nation owes its disabled soldiers
and sailors is  discharged only when they are given the
best of medical and eurgical treatment, a just financial
compensation  according to the degree of  injury  and,
when necessary, systematic training for an occupation in
which they can successfully compete with able-bodied
men.   Thus equipped,  they may confidently  look  for-
ward to a future of normal human work and play.  The
brave men disabled in this war will expect no more;  the
public should  tolerate no less.
   In  the  Vocational Rehabilitation Law,  approved by
the President on June  27, 1918, this national  responsi-
bility is recognized to the full.  No local authority  and
no private organization can take the place of leadership
rightly assumed by the Federal Government in this work.
But other agencies, under Government control,  will have
suitable opportunity to help.  The Red Cross in partic-
ular,  has  assumed  the obligation to assist every soldier
or sailor and his family, whenever any  aid or counsel is
needed and acceptable.   This relation of service will not
be abruptly broken off  upon the man's discharge,  but
will  continue until he  is adequately re-established in
civilian life.  There will be work here for Home Service
Sections though it must be constantly held in mind that
very  many men, supplementing their own personal re-
sources by the advantages provided by the Government,
will desire no other assistance.
   This pamphlet, written by Curtis E.  Lakeman, of the
headquarters  staff  of this Department,  is published to
give to Home Service workers a comprehensive view of 
4                HOME  SERVICE
the Government's program for the treatment,  training,
and placement of the men injured, or disabled by disease,
in the service of the country, and  to define  the ways in
which Home Service may supplement the work  of  the
Government authorities.  In its preparation the counsel
and the publications of the Federal Board for Vocational
Education, the Surgeon General of the Army, the Bureau
of War Risk Insurance, and of numerous others, as listed
in the appendix, have been freely drawn upon. Grateful
acknowledgment is made to them and to the many friends
in public or private station who  have kindly read the
manuscript or proof.
   It is hoped that this survey of the  subject will prove
useful and suggestive and will stimulate earnest work in
this new field  of Home Service.  For upon the ability
with which the  Red Cross accepts this opportunity may
depend whether the family of many a disabled soldier or
sailor goes forth into  the  future  of  peace  thoroughly
reunited, unconquerably stable, wholly dedicated  to  an
ambitious and happy life.
                              W. Frank  Persons
                                  Director General
                             Department of Civilian Relief 
Home Service and the Disabled

            Soldier or  Sailor


        I.  Principles and Program

  Sympathy and intelligence must be forearmed to deal
effectively with America's duty to its disabled soldiers
and sailors.  A great and difficult problem is presented.
On the basis of Canada's experience it is estimated that
ten per cent of our men sent overseas each year will be
returned physically  unfit for  further military service.
This means that  for every million men from the United
States  100,000 will come  back each year permanently
incapacitated for military duty.
  Wounded American soldiers are now coming home from
France.  The constantly growing tide which for over a
year has set steadily to the East has begun to send back
its ebb of war-broken men, bringing at last to our shores
visible  evidence of the terrible reality of the war.   For
the most part the men now coming home will never fight
again.  They are the more seriously wounded, the per-
manently crippled, handicapped by the loss of limbs, par-
tially or totally  disabled by disease.  Skilled surgeons
with every resource of modern  learning and equipment
are pressing close to the fighting lines in France and re-
storing to the  ranks all wounded men who can be  re-
claimed for further service.  The rest will come home,
are already coming home, bringing new  problems  and
new responsibilities to the Government and the institu-
tions they have fought to save.  Their welcome will be 
6
HOME  SERVICE
the utmost  outpouring of the country's gratitude  and
love.  Will it also hold out to them the promise of far-
sighted national care and of true friendship on the part of
every citizen?  What, in fact, will  the country do for
these men?  What will their own states do?  What will
their  cities,  towns, and  neighborhoods do?  What  will
their  former employers, their churches, clubs, and labor
unions do?  What will the Red  Cross do?  What  will
you do?
  All over the country these questions are being asked.
Everyone is eager  to help,  to learn  how to  help  the
wounded soldier.   There will be  no lack of interest, of
zeal, of friends, of public and private funds. The  only
doubt is whether we  shall do the right thing, whether we
shall  truly help or actually hinder.  This doubt shows
ominously in the report of a Red  Cross worker  in one of
our seacoast cities.  Soldiers suffering from shell shock
are already back  in  that old colonial town.  "But," the
Home Service Secretary reports, "it is sometimes difficult
to tell which kind of bombardment some of these  men
are now really suffering from—German shells or Ameri-
can drinks.  All their 'friends' want to treat them!"
  This illustrates  perhaps the worst  perversion of the
patriotic desire to help the returned soldier.  Pernicious
only in less  degree are other manifestations of a short-
sighted  and thoughtless attitude which public opinion
must  guard against.  The generous feeling that "nothing
is too good for him" must find the wisest possible outlet.
The mind as well as  the heart must be enlisted, and the
impulse  to  lavish sympathy and  friendship  must be
guided into  constructive expression  looking toward the
permanent welfare of the disabled soldier or sailor.  And
above all the  man of independent mind and  ambition
should be allowed to work out his own welfare whenever
he can muster the strength and purpose to do  so. 
         PRINCIPLES  AND  PROGRAM        7

The Country s Debt to the Disabled
  The responsibility of  the state  to care for its disabled
fighting men is now recognized throughout the world to
an extent unknown before the present war.  In the mod-
ern view the country must not only restore these men to
bodily health but must endeavor to make good the ma-
terial loss on  the economic  side,  giving back so far as
possible the ability to secure self-support according to a
standard of living at least not lower than that which pre-
vailed before entrance into military service.  While the
state cannot replace a lost limb, it can, with  modern
scientific methods of physical reconstruction and special
reeducation offer far  more adequate compensation for
disablement than was  ever possible for  the victims of
previous wars.
   The Great War is a matter of whole nations in arms,
not a contest of relatively small bodies  of professional
troops.  Every  American must participate in some way,
and all will share the resulting profit of safety for our
ideals of self-government.  Likewise the cost and the loss
must be distributed as equally as possible among all citi-
zens.
   The present  conception of enlarged responsibility of
the Government is justified by every consideration of
national, social, and individual welfare. Our soldiers and
sailors must be treated in the light of partnership in a
vast enterprise of national safety and progress.

 Conservation of Industrial Resources
   The reconstruction of the disabled soldier is in the first
place a matter of public duty which is called for by every
consideration of  national gratitude  and  justice.   This
alone is a sufficient reason for the fullest expenditure of
needed effort and funds.  But sound  national economic 
8
HOME  SERVICE
policy also requires that the state in order to conserve
industrial and labor resources should make skilled work-
men of its disabled soldiers and find them employment.
After this war every soldier who returns to a condition of
idle  dependence on  Government support will help  to
diminish the  productive power of the nation.  With the
terrible wastage of men and materials every ounce  of
constructive energy will be needed to repair the damage
and to face the renewed intensity of competition in trade
and industry.

A National  rather than a  Local Problem
  Both theoretical and practical  considerations require
that our states and cities should participate in the care
of disabled soldiers only as required and directed by the
national authorities.  In the  first place, the burden is too
great to be borne by any agency other than the National
Government.   Moreover, this war is not being  fought by
or for the North or  the South, the  East or the West,
Maine or California.  The men from Texas assume equal
risks and fight just as bravely as those from New York.
It would be intolerable were there any difference in the
subsequent care, treatment, and opportunities of disabled
soldiers from  Massachusetts and  those from Montana.
Although  the men of the National Army are drafted  in
proportional  quotas from all of the  states, there is,  of
course, no guarantee that they will  be disabled in the
same ratio. Their sacrifice of bodily well-being has been
made to the  country and not to  their state,  and  their
country must make good the loss, if any power can do it.

A Public rather than a Private Duty
  Nor can there be any question as to the desirability  of
public as opposed to private control of the reconstruction
process.  Any system of caring for the disabled soldiers 
PRINCIPLES  AND PROGRAM        9
which would depend upon private benevolence would be
instantly condemned by public opinion throughout the
country.  This would delegate a public  function  to  a
private agency and thereby evade the nation's responsi-
bility.   It must, indeed, be accepted as a first principle
in dealing with disabled men that nothing suggestive of
alms or charity should be allowed to enter into their care.
Men who have risked their lives for their country justly
expect equal treatment under the law in the application
of such benefits as the nation has decided to give them.
It is right that the public should assume the total burden
and administer it impartially to every American.  There-
fore,  no private  organization, however  powerful,  will
question the leadership of the  Government in this work
or  attempt to do what the Government only  can do
wisely and well. Yet under control of the Federal authori-
ties, the state and local governments and such  private
agencies as special foundations, fraternal organizations,
trade  unions, associations of employers,  hospitals,  and
schools can render effective service in contributing their
resources when requested and especially in helping to
form sound public opinion.

An Army from American Homes
   Those who suffer  disablement in this final battle for
democracy  must be  restored to their own homes.   The
soldiers of earlier European wars were largely professionals
who worked at the trade of fighting and knew no home
but tent and barracks.  The crippled veterans  were re-
duced to begging for a living,  or were cared for in insti-
tutions like Napoleon's Hotel des Invalides.
   •At  the present  time  the United States maintains a
number of  national  homes for disabled veterans of the
 Civil and other wars.   In addition,  many  of the states
 maintain homes for disabled  soldiers.  No such syste- 
10
HOME  SERVICE
matic effort as is now contemplated  was made by  the
Government to restore the wounded soldiers of the Civil
War to earning capacity.  The legless or armless veteran
became a common and pitiful spectacle of our daily life.
Only  those of  unusual strength  of character and will
power fought  out their own problems and made their
way in spite of such handicaps.
  A higher standard now exists, and public opinion will
enforce it.  That a  single American lad now fighting in
France should return only to become a life-long inmate
of a soldiers' home is to be thought of only as a last
resort. The disabled American soldier of the present war
must go back to his own home and family and everything
possible must be done to enable him to live a normal and
independent life—to work and play with the rest of us.

Extent of the Problem
  The extent  of the  problem of reconstruction in this
country will, of course, depend  upon the duration of the
war, the number of men maintained at the front, and the
proportion  of casualties.  The latter cannot be foretold
exactly and it may increase or decrease as compared with
the present figures,  and may, for a time, at least, be dif-
ferent in the American as compared with the French and
British armies.  Yet, on the whole, the experience of the
belligerent  countries shows that the number of disabled
men is a fairly constant percentage of the total number
engaged.  Surgeon General  Gorgas is authority for  the
statement that the French  and English get eighty  per
cent of their wounded back into service in two or three
weeks' time, while fifteen per cent remain permanently
disabled.  A recent statistical  study published by  the
Red Cross Institute for Crippled and Disabled Men says
that "it is probable that the proportion of the wounded 
         PRINCIPLES  AND PROGRAM       II

who have to be discharged for permanent disability does
not exceed twenty per cent at most; that on the Western
front and for Germany it does not exceed ten per cent."
Statistics concerning German  wounded published in the
Military  Surgeon  for  April,  1917, indicate that  from
August, 1914, to April, 1915, the percentage of all wounded
who returned  to duty was never less than 84.8 and ran
as high as 91.2.  We  must do as well as this in order to
keep  the total  of  the permanently  disabled down to
100,000 of each million fighting.

The Problem in Perspective

   Though the absolute figures  seem disheartening, it
appears not only that the number of men disabled is not
large in proportion  to the total number fighting, but also
that among the disabled men themselves a still  smaller
proportion are crippled.  The English statistics  quoted
on page 88  indicate less than  100 cases of amputation in
every  1,000 disabilities.
   In   Canada, England, and other countries  the re-
absorption of disabled soldiers has not been beyond the
power  of the  community.   With  America's   natural
resources and industrial development, it should certainly
be easily possible to  care  for all our returning disabled
soldiers.  Yet there is much  to be done, and while the
responsibility of the Government for the measures  to be
taken  is supreme, there is need and opportunity for the
cooperation of other  agencies in the  after-care of  these
men and their readjustment into the community.   The
successful mobilization of community forces for this work
will also  contribute substantially to the welfare of the
nation by amassing experience against  the time when,
with the victory of a durable peace, our armies will be
disbanded. 
12
HOME  SERVICE
The Duty of the Government
  Concretely, the first duty of the Government toward
the wounded soldier is to reduce disability to the lowest
terms.  This means the best of medical and surgical
treatment to cure the  primary wound or disability and
to restore physical function.  In cases of amputation the
Government must provide  tHe best possible artificial
limbs and appliances and keep them in repair.  Next,
vocational training and, if necessary, supplemental gen-
eral education must be given to make possible future self-
support and independence.  Then the Government  must
take the lead in finding suitable employment  for the men
who have received this care and training.  Arrangements
should also be made  for a definite transfer of contact to
state and local educational  organizations so that  they
may keep in touch with these men and give them oppor-
tunities to  qualify for  advancement.  Lastly, the  Gov-
ernment must  provide a just financial compensation
against a physical condition which  will persist during
life.

The Vocational Rehabilitation Law

  In  the enactment of  the Vocational  Rehabilitation
Law, approved by President Wilson on June 27, 1918,
Congress has formulated a national plan for  the civil re-
establishment of disabled American soldiers  and sailors,
after their discharge, which is based upon the principles
suggested in the foregoing discussion.
  This law recognizes the complete responsibility of the
Medical  Departments  of  the  Army and Navy for all
measures aimed at the physical and functional restoration
of sick and wounded  soldiers and sailors.  There is to be
no interference with the jurisdiction of the military medi-
cal authorities in this domain. 
         PRINCIPLES  AND PROGRAM       13

  When  medical  treatment is finished and the men are
discharged from  service, systematic vocational  training
will be offered to them as civilians, under the control of
a civilian department of the Government, the Federal
Board for Vocational Education.  At this stage  no com-
pulsion,  military or economic, will be exercised, except
that  the  law authorizes the  temporary withholding of
some of  his compensation from a man who neglects to
follow a course of training which he has once selected
and begun.  With this  exception, complete  reliance  is
placed upon the returned  soldier's common  sense and
ambition and upon the  superior educational  value of a
plan  of  vocational training to  which he has dedicated
his own  will.
   The Federal Board for Vocational Education is charged
not only with the mobilization of resources for  these
courses of training, but with finding positions for the men
when they are ready to return to work.  In this connec-
tion  the law places at  the disposal of the  Vocational
Board the employment  facilities organized by the Fed-
eral Department of Labor.
   It  is obvious that the success of the national  program
thus briefly outlined depends upon the cooperation of the
Departments responsible  for their  respective shares  in
what should be a continuous process with a single end in
view.  This result is made easier  of attainment by a
clause permitting reciprocal advisory service as between
 the Board for Vocational Education and the Army and
 Navy medical authorities  in the respective  fields over
which they do not have direct control.  Wherever neces-
sary, the vocational training under the Federal  Board
 may thus be developed as a harmonious continuation of
 the curative mental and physical work utilized by the
 medical officers in the military  hospitals.  In developing
 its courses, the Federal  Board for Vocational Education 
14
HOME  SERVICE
has power to utilize to the full the cooperation of all ap-
propriate educational and industrial agencies in charge
of present resources and facilities.
  With the enactment of this law, therefore, the Ameri-
can Government has accepted its plain duty, has outlined
its plans, and is ready, in effect,  to say to every perma-
nently disabled soldier: "You have done your share and
the country is going to care for you in the fullest sense.
If you never had a fair chance or neglected  your chance
to obtain an education, you shall have it now. While you
are recovering from your injury, we will begin to give you
special training .for work which you will choose.   We will
continue this schooling for as long as may be necessary
after you are well, helping your family during that period.
When you are trained, we will help you to find the right
kind of a job and send you back to civil life equipped to
earn as good or even a better living than you were making
before you went into  the Army.  And no  matter how
much you earn, your compensation from the Government
will not  be reduced on  that account.   We will give you
every chance and you, in turn, must do your part.  The
country  expects you  to make  good again  in civil  life
just as you did at  the front."

Participation of the Red Cross
  Among the private organizations whose efforts will
naturally supplement  the national  program, the  Red
Cross occupies a unique position.  Its  purpose and field
of activity are in an unusual degree colored with public
interest and controlled by Government authority.  With
its great financial resources, its 22,000,000 members, its
3,900 Chapters and their 15,000 branches, the Red Cross
is  better equipped than any other private organization
to give aid and comfort to our soldiers and sailors and to
assist their  families at home.   It  offers the  channel 
PRINCIPLES AND PROGRAM       15
through which the American people express their patri-
otic desire to help soldiers and sailors in ways which the
Government cannot so effectively and appropriately un-
dertake.   It approaches the position of a "Committee of
the Whole" of the American people, taking prompt action
to relieve the  suffering caused by the war where the for-
mal governmental organization necessarily requires more
time for consideration.  It is thus more representative in
scope and method than any other private agency.  Such
an organization  will gladly accept the  opportunity  to
extend a  helping hand to any man needing friendly aid
during the critical period after he ceases to be a  soldier
and before he is able to carry the full burden of his duty
as a private citizen and the head of a family.
   Within the organization of the Red Cross, the Depart-
ment of  Military Relief  deals with the soldier or sailor
as a fighting  unit, while the Department of Civilian Re-
lief aids in maintaining his morale by assisting his family.
As soon  as he is discharged and  becomes a civilian, the
responsibility for temporarily continued care  falls upon
 the Department  of Civilian Relief.   Such service will
 begin in  accordance with established policy, only when
 the need and wish  for it is  indicated,  and will properly
 end  when  the former  soldier is restored  to full self-
 support or when  the burden of his care as a civilian has
 been taken up by appropriate public or private agencies.

 Home Service and the Disabled Man
   The purpose of this pamphlet is to give to Home Service
 workers  the necessary background for the intelligent dis-
 charge of this duty.  A brief account will be given of
 each of  the  stages  through which the disabled soldier
 passes from the time he is wounded until he is  restored to
 his normal life at home.  For the phases of medical treat-
 ment, vocational training, and even of placement the Red 
i6
HOME  SERVICE
Cross will assume  no direct responsibility.  Yet it  is
important  that  Home Service  workers should  have a
clear understanding of the entire process  in order that
their assistance  may be effectively applied  with a full
knowledge of what  the national  authorities are attempt-
ing at each stage of the plan.
  In general the duties of Home  Service in relation to the
rehabilitation  of disabled soldiers  and  sailors  may  be
summarized as follows:
  (i)  To bring  solidly behind  the disabled  man at  all
stages of the reconstruction process che moral support of
his  family, remembering that he is at this time just as
much in  the service of his country as when at the front.
  (2)  To assist  the men, through  the competent legal
service at the command of the Home Service Section, to
secure the benefits of the  War Risk Insurance Law and
especially the provisions for compensation and insurance.
  (3)  To urge upon disabled men, as opportunity pre-
sents, the wisdom and necessity  of taking full advantage
of the Government's plans for their care and training.
  (4)  To encourage them in the early and  critical stages
of their vocational training and of their return to employ-
ment, when the struggle  to  overcome the mental and
physical handicap is most  acute.
  (5)  To help bring about a reasonable and sympathetic
attitude on the part of employers, which shall give every
handicapped man  a real  chance,  while  avoiding the
danger of tempting him to forego the necessary  training
for  the specious  attraction of an immediate, temporary
or perhaps unsuitable job.
  (6)  To mold public opinion so that it will discounte-
nance trivial and demoralizing entertainment and hero-
worship,  and  maintain a constructi\e attitude which,
while demanding a  square deal  for  the returned soldier, 
         PRINCIPLES  AND  PROGRAM       17

shall expect from him every reasonable effort to ensure
his self-support.
  (7) To  supply  information,  encouragement,  legal,
medical,  and business advice,  and other service, when
acceptable and necessary, in like manner as is now being
done for  the families of men at the front. 
II.  Treatment
  Adequate medical and  surgical  treatment of  the sick
and wounded  is of course an indispensable phase of the
successful organization  of our  military forces,  and  the
Army  and Navy Medical Departments have not been
obliged to await the action of Congress on the Vocational
Rehabilitation Bill before making comprehensive plans for
the transportation, reception, distribution, and treatment
of the fighting men who come home permanently disabled.
  From the moment he is wounded, the American soldier
enters  upon a straight line of homeward progress under
the tender and  competent care of the  medical  officers.
At any point this line of progress may be broken by his
recovery and return to the front, but in the case of the
severely  wounded it  leads from  the first aid station
through the forward dressing station, the field hospital,
the evacuation hospital, the base hospital, the general
hospital in France, to  the  transport and so home for
further hospital care  and a  longer or shorter period of
convalescence.
  All our soldiers whose injuries are capable of complete
and early cure arc now being cared for in military hos-
pitals attached to the overseas forces and returned to the
front.  In general the purpose, in the light of the experi-
ence of the present war, is to bring surgery as near to the
fighting as possible, both in  time and place.  This  has
led to the introduction of mobile operating units and the
development near the front of special hospitals of many
kinds  in addition to the general base hospitals.   It  has
come to be realized that the employment of highly skilled
specialists as quickly as possible after the occurrence of
the wound will mean not only the saving of life,  but the 
TREATMENT                  19
prevention of crippling disabilities.  In fact, prompt ap-
plication of the requisite special treatment often renders
unnecessary amputation and other severe operations.

General Hospitals for Physical Reconstruction

  Only those  men who are permanently incapacitated
for  further  service are  at present  brought back  to
America.  On  their arrival in this country  they  pass
through large  reception hospitals  located at the ports of
disembarkation, from which, after classification, they are
distributed to  the various  general  hospitals where pro-
vision has been made for the particular treatment necessary.
   At the general  hospitals every modern  facility for
medical,  surgical,  and  occupational  treatment is  pro-
vided.   At  present the  following  hospitals  have  been
designated in  whole or in part for  the work of physical
reconstruction of American soldiers and  sailors:
   General Hospital No. 2, Fort McHenry, Md.
   General Hospital Xo. 3, Colonia, X. J.
   General Hospital No. 4, Fort Porter, N. Y.
   General Hospital Xo. 6, Fort McPherson, Ga.
   General Hospital Xo. 7, Roland Park, Baltimore, Md.
   General Hospital No. 8, Otisville, N. Y.
   General Hospital Xo. 9, Lakewood, X. J.
   General Hospital Xo. 11, Cape May, N. J.
   General Hospital Xo. 16, New Haven, Conn.
   General Hospital Xo. 17, Markleton, Pa.
   General Hospital Xo. 19, Azalea, N. C.
   U. S. Hospital, Waynesville, X. C.
   Army and Xavy General Hospital, Hot Springs,  Ark.
   Walter Reed General Hospital, Takoma Park, D. C.
   Letterman General Hospital, San Francisco, Cal.
   Fort Bayard, X.  M.
   Fort Des Moines, Des Moines,  Iowa.
   Plattsburg Barracks, Plattsburg, X. Y.
   St. Elizabeth's Hospital, Washington, D. C. 
20
HOME  SERVICE
  The Indian School at Carlisle, Pa., has also been made
available to the Division of Physical Reconstruction, and
other hospitals  for reconstruction work will  be added
from time to time as necessary.  These hospitals are de-
partmental, providing treatment in general medicine and
surgery and in all specialties, including  cardio-vascular
diseases; tuberculosis;  head surgery; orthopedics; am-
putations;  insane cases; war neuroses (and other neuro-
logical cases); blind, deaf, and speech-defect.

A New Policy toward the Disabled Soldier
  The Official Bulletin of April 2,  1918, carried the sig-
nificant announcement "that hereafter no member of the
military service disabled in line of duty, even though not
expected to return to duty, will be discharged from ser-
vice until he has attained complete recovery or as com-
plete recovery  as is to be expected  that he will attain
when the nature of his disability  is considered."  This
recommendation  of  the Surgeon General of the Army
as approved later by the Secretary of War, establishes a
new policy and is interpreted to provide for  the applica-
tion of all the means of physical reconstruction, including
medicine, surgery, physio-therapy, and curative work.
  To appreciate  the full  meaning  of this new policy it
must be borne in mind that the former practice of  the
Army was to discharge forthwith men who developed
chronic disease  or physical  disability  in the  service,
leaving the  burden of their care to civilian agencies.
All this has now  been changed.  Aside from the rehabili-
tation for civil life of the seriously disabled, it is expected
that this policy of retaining disabled men in the service
and caring for them at the reconstruction hospitals and
other Army institutions, will result in the return to some
form of military duty  of a large number of efficient offi-
cers and soldiers who,  without this continued treatment, 
TREATMENT
21
would never become able to perform even limited service.
The conservation of these men will release an equivalent
force of able-bodied men for active service at the front.

Restoring  the Use of Limbs

   Interesting  and valuable  work  is done by the  ortho-
pedic  surgeons in  bringing  back  the use  of  paralyzed
muscles and stiffened  joints and  in  correcting  defects
and deformities of  bones and tissues caused by wounds.
In France much of this work is done in special  hospitals.
The process is commenced at the earliest possible time,
but usually  not until  after active  hospital  treatment
has been terminated.   Its success means the prevention
of permanent crippling disability.
   In this connection there  is universal  testimony as  to
the value of some kind  of occupation in assisting conva-
lescence.   Sir Robert  Jones, a  prominent British  ortho-
pedic surgeon, has  given a now familiar illustration:
   For example, a man with stiff fingers barely able to grasp even
fairly large objects, is soon utterly wearied if set to grasp spring
dumb-bells or  any other  such  apparatus, but will cheerfully
spend the morning grasping a big duster and cleaning windows.
His mind is set on the dirt he has to remove, not on the fact that
his maimed hand is  repeatedly taking hold of and letting  go
the duster. Later, if he is a carpenter or other skilled  tradesman,
he is promoted to  the use of tools he understands,  and so the
disabled hand is reeducated partly by set gymnastic exercises
and largely by work.
   Driving a plane in the carpenter's work can be employed  for
exercising muscles and joints in both arms and legs.  Men with
stiff ankles soon tire  of working a pedal machine or stationary
bicycle in  the massage department, therefore  as soon  as the limb
is fit for it, he  is offered some  sort of work, such as fret-work,
where his  foot drives the fret-saw but his hands are busy  guiding
the work;  his brain  is interested in what his hands are doing
and not wearied by the curative action which the treadle move- 
22
HOME  SERVICE
ment brings about.  Similarly, bootmakers' shops, splint shoos.
tailors' shops, all provide their share, not only in restoring the
men to health, but in helping the surgical work of the hospital
by making ingenious splints  and devices for the treatment of
their wounded comrades.

Mental and Moral Effects of Occupation

  The effect  of occupational  treatment is  also  an im-
portant  factor  in  offsetting  the danger of the  moral
retrogression which is so likely to follow prolonged insti-
tutional  treatment.  Men who  pass weeks in  idleness
with everything done for them are apt to fall into a frame
of mind  which will not help  them forward  to an active
life of self-support.  Habits  of  idleness are not  easily
shaken off  and if  the patients  are  allowed to  become
despondent and apathetic, they will easily degenerate
into a  state  of chronic  incapability and  dependency.
French figures quoted by the Board for Vocational Edu-
cation show that only five per cent  of the men  take up
vocational training when delayed until after discharge from
the hospital, whereas eighty per cent  continue training if
begun in the hospital.
<  The development in the patients of a proper  outlook
and ambition for the future  is indeed considered to be
one of the most important parts of  restorative hospital
work,  which  must reach  the mind as well as  body.
Wounded men, distressed  by their suffering and  knowl-
edge  of  their incapacity, are often disheartened  and
ready to give up.   They too easily believe that they can
never  again become self-supporting.  There are unfor-
tunately some who accept willingly the prospect of future
dependence upon their pensions and upon charity.  These
are a minority, and every effort must be made to keep the
number  as low as possible.  Therefore a systematic
attempt  is made  in  every  up-to-date reconstruction 
TREATMENT
23
hospital to convince the men that even though they are
disabled  they can and must, through  appropriate re-
education, become able to support themselves. Nothing
helps the men  to  regain confidence more than  the at-
tempt  to perform  some kind of useful  work with their
hands.

Curative Workshops
  The emphasis thus  laid upon  the curative value of
occupation has led to the establishment of  workshops
for carpentry and  other occupations in connection with
the well-equipped reconstruction hospital. These work-
shops supplement  the diversional or 'ward occupation',
as it is called in Canada, through which an  immediate
effort is  made  to  occupy the attention and  interest of
the patient as soon as recovery begins.  Ward occupa-
tional  work  and  that later done in the  hospital work
shops  must be carefully distinguished from  vocational
training  proper.  Yet while the work in the hospitals is
intended primarily to be curative for mind and body, it
may well be made the beginning of an interest in the
actual occupation  which is to be taught later or at least
the means of increasing incidental knowledge of processes
allied  thereto.  For instance, men  who acquire in the
convalescent workshops some degree of mechanical skill,
ability to  interpret  blue prints, a  knowledge  of  shop
arithmetic and mechanical drawing have undoubtedly
increased their commercial value for many lines of future
activity.

The Beginning of Vocational Education
  The ward occupation, shop work for curative purposes,
and vocational training proper  should  be regarded as
successive phases of a single process,  which begins as soon
as the wounded man is able to sit up in bed.  Treatment 
24               HOMESERVICE

should run into training without a break.  The period of
convalesence may last several months.   The  manufac-
ture and adjustment of artificial limbs especially adapted
to  each case require a  considerable  period of  time.
France has wisely recognized the importance of commenc-
ing serious vocational training during this period.  Psy-
chologically, this is the  critical time,  and  everything
possible must be done to encourage the disabled man to
believe  that he  can  fit himself for useful work and  the
enjoyment of home life.   As Miss Grace Harper, of  the
Red Cross Bureau des Mutiles in France says, "If he is
guided into a workshop and the right men tempt him to
do something for the sake of the interest and occupation
which it gives, the possibilities of engaging his interest
seem almost unlimited.   If he is forced into  the shop
under military discipline,  the advantages may  be les-
sened.  There is absolutely no doubt that at this point,
while still in the hospital, the crippled soldier must be
'reached' reeducationally.   The  surgeon, the artificial
limb expert, and the  trade-training teachers are all work-
ing on him at once.  They are all needed and there should
be no dividing line between their labors."
  At each hospital where  reconstruction  work is carried
on  the  Surgeon  General  has accordingly placed special
educational  officers  whose duty it  is to arrange and
supervise under  the direction of the commanding officer
the facilities for the  use of therapeutic work,  to recom-
mend the development of the necessary means of keeping
patients employed, and to act as technical advisers to
the commanding officer in  this general field.  In selecting
these educational officers  on  the basis of training, ex-
perience, and peculiar fitness for the work, men who are
themselves handicapped by some  physical disability and
who have made a success in life will be especially sought.
Above all, it is hoped that many enlisted men who have 
TREATMENT                 25
been through their treatment  and retraining, but who
are unfitted for further field service, will be found capable
of being specially trained and commissioned as officers in
charge of such work.
   In addition 'reconstruction aides' including both men
and women trained in the special features of reconstruc-
tion work  are being provided in two groups:  (i) those
who are  trained in massage work, and  (2) those who will
be expected  to teach suitable occupations calculated to
promote the  contentment and hasten the recovery of
the patients.

Artificial Appliances for the Crippled
   It is estimated that artificial appliances  of some sort
will be required by about one per cent of all the wounded.
The modern view of state responsibility requires that the
Government  should  supply  and maintain in repair the
artificial  appliances   necessary  to  restore a  disabled
 man so far as possible  to  physical  comfort and  self-
 support.   Steps have been taken  to standardize and
 systematize  the provision of artificial limbs, and many
 improvements have been made in the design and manu-
 facture of these appliances.
   The ordinary peg leg is found to be the most useful for
 occupations requiring  the exertion of any force and es-
 pecially in amputations at the hip.  The artificial limb
 which is made to imitate a real leg or arm is more useful
 from  an aesthetic point of view to those, such as clerks,
 whose occupation requires that their  appearance should
 be normal.  For working purposes various types of mod-
 ern apparatus have been found especially useful.  With
 some of these ingenious mechanical  contrivances, it  is
 possible to insert  interchangeably  a knife or fork or
 cutting or holding instruments or tools of many different 
26               HOME  SERVICE
varieties which may be especially adapted to the occupa-
tion of the wearer.  Very often both practical and 'orna-
mental' limbs are provided, the one for working  hours,
the other for 'dressing up'.
  When a man once becomes trained to the use of an
artificial appliance,  he practically  loses his means of
livelihood  if it be broken.   It  is  therefore necessary,
ideally, to supply two artificial limbs so that one may
be kept in  reserve against any such accident.

Application to Industrial Accidents

  It is one of the compensating by-prodilcts of tilt war
that the great stimulus  to the development of special
methods of treatment and restoration of disabled soldiers
promises to carry us forward to a time when the victims
of industrial accidents in  this country will  be cared for
with a sympathetic and  scientific  thoroughness  never
before  possible.  Both in the prevention of work acci-
dents,  in the prevention by prompt surgical and medical
treatment  of permanent crippling  injury  as the  result
of such  accidents, and  in  the highly specialized and
skillful methods for treatment of the remainder who are
severely incapacitated, we seem to be approaching an
altogether new and more hopeful era in the conservation
of the physical abilities of American workmen. Accord-
ing to  the American  Association for Labor Legislation
there are at the present time at least 100,000 victims of
industry who imperatively need vocational rehabilita-
tion.  It is surely to be hoped that  the present patriotic
interest in the treatment and reeducation of war cripples
will lead to the wider appreciation of this problem and to
the use of the same methods and later, perhaps, the same
institutions, for the reconstruction  and conservation of
the victims of industrial accidents. 
                   TREATMENT                 27

Home Service at this Stage
  In  the technical  processes of  physical and mental
restoration of disabled soldiers the Red Cross will have
little or no direct part to play.   Home Service workers
should,  however,  have a  general knowledge  of  these
processes and their significance,  and should endeavor to
bring the encouragement  and support of the family to
bear during the man's convalescence, as well as during
the subsequent period of vocational training.
  This constructive use of the family and neighborhood
influence  becomes  doubly important in supplementing
the Government's new and generous policy of  retaining
men in the service for treatment, and especially in those
cases where a long period in the Army hospital or sana-
torium is necessary. Hitherto the burden on community
social service has come from the premature discharge of
the sick soldier.  Now the problem may well be how to
keep him in the Army and under treatment and training
as long as the responsible authorities want him to stay.
For as soon as some of the men  begin to feel  better and
imagine they are all right or would recover more quickly
at home  (too often a false hope) they will  agitate for
discharge and  perhaps endeavor  to exert influence to
that end.
  For the best interests of  the man, his family and the
community,  this tendency must be  counteracted.  The
Government is investing much money, thought, and care
in a system  for physical  and vocational reconstruction
which offers far more to the modern soldier disabled by
wounds or disease than has ever been possible hitherto.
It is  doing  this not only because justice and humanity
require it, but  because  the country's  future  economic
stability and prosperity may depend upon it.  No soldier,
who at any time refuses the Government's offer of rea- 
28
HOME  SERVICE
sonable treatment which will enable  him to resume his
place as a self-respecting, self-supporting unit in civil and
industrial life, is doing his  full duty by his country.  It
may fall upon the family to  convince the disabled man
that this is so.  It may well fall  upon the Home Service
worker to convince the family. 
                 III.  Training

  In charging the Federal Board for Vocational Educa-
tion with the duty of providing courses of reeducation
for our disabled soldiers, Congress has endorsed  the view
that the  process of making a civilian out of a soldier can
best be carried on by a civilian  agency.  The experience
of Canada and other countries,  strongly impressed upon
Congress at the hearings on the Vocational Rehabilita-
tion Bill, seems to justify this conclusion.  Making the
citizen into the soldier is clearly the function of  the mili-
tary authorities of the Government and the same logic,
based upon the end  in view, apparently calls for civilian
authority to  supervise the reverse process of helping the
ex-soldier again to become a citizen, better trained and
more  competent for the battles of peace.  To meet the
complex  requirements of civil life, to set up the necessary
arrangements in many fields of employment, to  organize
educational  work  in cooperation  with civilian schools,
colleges,  and universities, to provide for further training
in the factory, and to follow the retrained soldier through
his early efforts to make good as a civilian are thought to
be tasks  which civilians should administer.
  Among the existing bureaus  of  the  Federal  Govern-
ment  the Board for Vocational Education was selected
as the most  appropriate  agency for  this work, since  it
consists of the Secretary of Agriculture, the Secretary of
Commerce, the Secretary of Labor, the Commissioner of
Education, and three civilians chosen as experts in the
fields  of  manufacturing and commerce, agriculture, and
labor.  Not only is the Board'thus representative of the
chief interests involved in the reeducation of the disabled 
30
HOME  SERVICE
soldier, but by its original field of work—stimulating vo-
cational training in the various states- it already has the
experience and contacts to qualify it for this new respon-
sibility.
  On the basis of Canada's experience it is estimated that
approximately ten  per cent of the total fighting force will
return disabled to this country each year, and that in
turn ten per cent of  these men will require complete
vocational training while an additional number will re-
quire partial training.  This means that we  must plan
for the special reeducation of at least 10,000 men per year
out of each million we send to France.

What Trades Can be  Taught?
  Probably it is not  generally realized that cripples who
have lost an arm or a leg and who at first sight may seem
hopelessly disabled, can be taught many of the numerous
processes of industry, such as  running a lathe, operating
a motor tractor, or controlling a drill, and other skilled
operations for which mechanical aids can be adjusted to
serve the workmen in place of the lost limb.  It  is not
difficult for  a man who has a leg  amputation  to learn
many of the various trades which  require only the use
of his hands.  The range of choice for those crippled in
this way is great.
  In  France  the  occupations  which offer the  greatest
appeal are said to  be industrial drafting and design; the
making of surgical instruments, tools of precision,  and
small electrical parts; watchmaking; telegraphy; photog-
raphy;  printing;  and  others.   The "Ecole Joffre" at
Lyons, the pioneer French school of reeducation, teaches
accounting and commercial subjects,  toymaking,  book-
binding,  shoemaking,  woodwork,  mechanical drafting,
tailoring, woodcarving, gardening and machine-tool work.
At many suitable schools throughout France agricultural 
TRAINING
31
courses are  given  and a strong effort is  being  made  to
induce disabled soldiers to take  up modern farming,  in
which  there are many specialized mechanical operations
that cripples can readily be taught to perform.
  The National Institute for the training of war cripples
at Paris teaches the standard trades of tailor, shoemaker,
harnessmaker,  and tinsmith, and  also gives  instruction
to properly qualified  pupils in accounting, industrial de-
sign, cabinetmaking,  and automobile  engineering, par-
ticularly  the   operation   and  repair  of  agricultural
machinery.
   In England,  training is given in carpentry and cabinet-
making, printing, polishing, carving and gilding, picture-
framing, toymaking,  basketmaking, metal work,  build-
ing and construction, decorating, and electrical  fitting.
The great hospitals at Roehampton and Brighton, which
are the chief centers for the reconstruction of amputation
cases,  teach especially electrical wiring,  motor driving
and repairs, and woodworking.  In the Canadian schools
the  leading trades are motor mechanics,  machine tool
work, carpentry and woodturning, inside electrical wiring,
 telegraphy,  cobbling, operation  of agricultural tractors,
general farming, and poultry raising.  Instruction is also
 provided in bookkeeping,  general office  work, and civil
 service subjects.
   A particularly appropriate occupation which has been
 taught to disabled men with much success, is the manu-
 facture of artificial limbs and artificial appliances. The
 extent of this increasing need furnishes  opportunity  for
 the creation of an important new industry.  Crippled men
 are said  to be especially successful in this line of work
 through personal sympathetic knowledge of  the require-
 ments.  Improvements in artificial apparatus have been
 frequently designed  and  executed by the men who  are
 forced to use them. 
32
HOME  SERVICE
Choice of Occupations
  In considering which of the available vocational courses
a man should  be  trained in, it is axiomatic to start from
the basis of his previous education and working experi-
ence.   Recent  testimony before the joint committee  of
Congress considering the adoption of the American  pro-
gram strikingly  emphasized Canadian  success  in  this
direction.   For example, a wounded bricklayer was re-
trained and employed again by the same firm as an esti-
mator and cost accountant, earning more than he could
before.  Likewise bridge workmen have been trained  in
mechanical  drafting  and fitted for useful  positions  in
engineering offices.   One  Canadian  mechanic  earning
$3 a day  became, after  training, a foreman with more
than twice that wage.  So a train hand who has acquired
general familiarity with railroad work may wisely be re-
educated as a  telegraph operator with the necessary sup-
plemental training in commercial subjects.  Thus qual-
ified,  he may readily find employment as station agent.
There is the further advantage that the former employer
will in such a case be not only patriotically anxious to
help a man formerly in his own service with whose char-
acter and personal qualifications he is  familiar, but will
be only too glad to get  a newly trained and, perhaps,
doubly competent employee.
  The best practice  calls for fitting the disabled  soldier
for  a particular standard trade, choosing especially  oc-
cupations and  special processes where  the  demand for
skilled workmen is most likely to be the greatest.  Fitting
the job to the man is in some cases possible, but likely to
be dangerous.  Training him to operate a special machine
adjusted to his disability, such  as a typewriter with
special paper feed and shift mechanism, may be successful
as an academic demonstration of the possibility of doing 
TRAINING
33
certain kinds of work, but it is likely to offer a precarious
practical future.  A single position may be arranged for
with an  interested and sympathetic employer,  but in
the face of any one of a great number of possible contin-
gencies  necessitating  separation  from  this  particular
position,  the  workman  may  be  quite unable to find
another job, and the value of his training will thus be
thrown  away.   Crippled men  should,  therefore,  be
trained  if possible to meet the demands  of  standard
trades in which there will be not a few possible jobs, but
thousands of them.
  In  many  instances  the  acquisition of  a  thorough
knowledge of  chosen  occupations, new or old, will, it is
to be hoped, give handicapped men of sufficient general
education the capacity for directing the work  of others
and of becoming small employers  of labor.  Indeed, be-
cause of the disability which  forces a man to think, to
improve  his general education, and to  take a new and
perhaps more responsible attitude toward life, the handi-
cap of a  disabling  wound often comes as a blessing in
disguise.  As a result, many a disabled man becomes an
unusually intelligent workman.  But care  must be taken
that no man handicapped by loss of limbs is permitted to
choose an occupation which can never  yield a good re-
turn.  It will be especially difficult for a disabled man to
compete with those who are  sound when old age still
further reduces his capacity to work.  In these circum-
stances, unless the  disabled man has chosen his occupa-
tion wisely and  learned  it  thoroughly, he will  almost
necessarily become dependent in some degree.

Vocational Guidance
  Where, as in many cases, there is no former experience
on  which to build  a  structure of  reeducation, general
principles of vocational guidance  must determine  the 
34
HOME  SERVICE
choice of the trade.  Here the services of expert voca-
tional counsellors familiar with trade education, with the
requirements of various industries, with labor union con-
ditions, and with the labor market generally,  will  be
needed.  According to Miss Harper's report on the work
in France, diagnosis of each individual's vocational pos-
sibilities must take into account:  (i) the man's physical
disability and the limitations created by it; (2) his former
occupational experience and his natural aptitude  or taste
for a given kind of work;  (3)  the favorable or ominous
conditions in the industry for which he may seem to  be
especially fitted; (4) his social environment and economic
needs.  In this question of guidance, the experts in the
various fields may be represented on the steering com-
mittee.   Unless the mutile can express his own needs
fluently, there must be another  member of  the com-
mittee  to  represent the  knowledge  of  his  family, his
home conditions, his tastes,  and ambitions.   "Yet even
this is not enough," Miss  Harper  says.   "With the most
careful provision for giving him expert guidance, the deci-
sion should finally rest with the disabled man himself."
  In the American plan, which will, doubtless, be organ-
ized by the Surgeon General and  the Federal Board for
Vocational  Education with  reference  to the successful
Canadian methods in this particular,  the soldier will
choose his new occupation  under the expert and friendly
guidance of vocational officers working in close  confer-
ence with the Army medical authorities and always with
reference to the man's personal and family relationships.
Here is another opportunity for Home Service workers  to
aid the constituted authorities and the ex-soldier in reach-
ing a sound vocational  diagnosis and prescribing the
best solution of  each such  problem.   Experienced voca-
tional officers testify to  the great  importance  of the
family relationship, often affected profoundly by the sep- 
TRAINING
35
aration of military service, in its bearing upon the frame
of mind in which the ex-soldier begins his course of train-
ing, and upon the success with which he pursues it.  Aside
from the difficult and complex personal and family fac-
tors, such problems as the intangible feeling of caste in
employment may have to be dealt with.  Those who have
worked as clerks may hesitate to enter mechanical trades,
even though in view of their modified physical condition
such occupations may offer  the best future  from  several
points of view.  In helping the man and his family to face
all such  questions there will be need of the wisest and
most sympathetic counselors, both official and unofficial.

 Voluntary Choice of  Vocational Training
  That  the decision  on  the  part of  the soldier to under-
take training must be voluntary would seem almost self-
evident, for although a man  under military discipline can
be ordered to a classroom, he cannot be compelled into
a state of receptivity or enthusiasm over his studies.  The
unwilling pupil will learn little, indeed, but much can  be
done to stimulate and inspire the voluntary choice.  On
the other hand, it is true that wounded soldiers being in
an abnormal condition, both psychologically and physi-
cally, do not always realize  the necessity for undergoing
the immediate sacrifice involved in vocational training.
For their own best interests and for the interests of the
country  some  form  of  inducement  may be  necessary.
Obviously, the influence of  the family, wisely guided by
Home Service workers, is of the utmost  importance  at
this point.

Red Cross Institutional Work
  Through the gift of $50,030 and an appropriate build-
ing by Jeremiah Milbank, of New York City, which was
accepted by the War Council in the spring  of 1917, the 
36
HOME  SERVICE
Red Cross was enabled to establish in New York an ex-
perimental institute for the reeducation of crippled sol-
diers.  With unusual resources of literature on  the  gen-
eral subject of care for cripples, this Red Cross Institute
for Crippled and  Disabled Men  has  published several
series of both popular and technical papers,  describing
the best results of  European study and experience in this
field.  Vocational training in specially selected trades has
been commenced for purposes of trial and demonstration.
A careful survey of cripples now resident  in  New York
City has been made with reference to the nature of their
injuries,  their present physical and economic condition,
and their capacity for useful work..
   The Red Cross Institute in  New York and the special
Red Cross Institute for the Blind, later referred to, are
organized under the Department of  Military Relief of
the Red Cross.  This is in accordance with a policy where-
by work of an institutional nature which the  Red Cross
does for soldiers and sailors will be administered by that
Department,  leaving  to  the Department of  Civilian
Relief responsibility for  the  community  and family
phases of such assistance as the Red Cross may render
in this field.

Duties of Home  Service Sections at this Stage
   (i)  The most important duty of Home Service in con-
nection with the vocational training stage has already
been suggested.  It is to ensure the support and encour-
agement of the  family in the  man's effort to make the
most of his new opportunities.  The adoption by Congress
of the principle of  voluntary civilian control, as opposed
to military control of the  men needing vocational train-
ing, means a challenge to the family and to its Red Cross
friends to help the  man make the wise and right decision
and stick to it. 
TRAINING
37
  (2) Knowledge on  the part of the vocational counsel-
lors of the man's personal, family, and community back-
ground  is an essential aid in helping them to give him
sound advice. This must be supplemented by consideration
of the available occupations in the home locality.  Often
Home Service workers will be able to give this information.
  (3) When an attracti\e light job under present abnor-
mal  labor conditions offers the man may be tempted to
give up the training which will  in the long run be more
to his advantage.  Home Service influence must try to
prevent such mistakes.
  (4) During  vocational  training either in the trade
school or in the factory, perhaps in a strange city, many
men may have to face a further period of  separation
from their families.  They may need help and counsel
then, as at no other time.  This is work for men attached
to the Home Service Section in the city where the factory
or school is located.
  (5) A  special responsibility   may  fall  upon Home
Service at this  stage unless Congress provides a remedy,
as it doubtless  will do.  Under the so-called Civil Rights
Act  the exemption  from civil action for debt, which the
soldier or sailor now enjoys, expires sixty days after his
discharge from the service.  At the time this law was
passed  it was  not clearly determined that for several
months after their discharge many of these men would be
undergoing  training at the hands of a civilian branch of
the  Government.  Obviously, this would be the worst
possible time for the ex-soldier, just entering with hope
and enthusiasm  on his studies,  to have to worry about
debts or other  troubles at home.  Unless and until Con-
gress amends the law to extend this moratorium,  Home
Service must charge itself with every possible effort to
forestall such a contingency.  Here is work for the legal
members of the Home Service Sections. 
              IV.  Employment

  When the disabled soldier has been cured of his wounds
and refitted for a life of self-support through appropriate
special education,  it remains  for  the  Government  to
help him find suitable work.  Moreover, suitable  voca-
tional guidance and  help in placement should be avail-
able for those returned men  who need  such  service,
whether disabled or not.  In these tasks the Government
agency should have  the intelligent cooperation of em-
ployers, of  working men, of Home Service workers, and
of other friends and neighbors.

Present and Future Employment Conditions
  At present it is  relatively easy to find work and the
temptation is strong for returning soldiers to take the
first job that offers, at the unusually high wages now pre-
vailing.   Moreover, there  is a universal desire to assist
disabled soldiers, and the highest standards of  work and
output are  not exacted.  Yet it does  not require much
imagination to realize that after the war conditions will
be very different.   With  millions  of  soldiers  returning
to civilian life throughout the world,  it  will become in-
creasingly difficult to  find desirable work  unless  some
special ability more than counteracts  the incapacity
from injury.  For a time the patriotic interest of employ-
ers will sustain many men who are  not up to the  normal
standard of efficiency;  but in the  course of five or ten
years the natural, but too  often sentimental and ephem-
eral  desire  to help disabled soldiers  will have  passed
away, the cause of disability will be less vividly remem-
bered, and thousands  of men with government compensa- 
E M P L O Y M E N T
39
tion, but (unless they have been wise in time) individually
less competent, will attempt to compete on even terms
with able-bodied workmen.   In the  event *of a labor
depression following the war, the first to lose their jobs
will inevitably be the untrained disabled men who are
now enjoying good wages.   It will be too late then to
train them.  And remembering  better times their own
attitude may cause them  all too easily  to drift into a
state of chronic unemployment with its attendarJ social
dangers.

Need of Expert Placement
  Under normal  conditions  there is  far too much hap-
hazard  employment,  without  reference  to  individual
training and capacity.  With the return of a flood of men
from  the war, as  with the  crippled  soldiers  returning
already, there will be a greatly increased danger of putting
them into positions for which they  are  not suited.   A
dozen men may all be seriously misfitted to a dozen jobs,
and yet with skillful and scientific adjustment of capacity
to the requirements they might  all be ideally  placed in
the very same positions.  This points the need of expert
employment service  such  as is  promised through  sys-
tematic central control under the Vocational Rehabilita-
tion Law, which requires  the Federal Board for Voca-
tional Education to administer this assistance to disabled
soldiers, utilizing the  facilities already organized by the
U. S. Department of  Labor.

Handicapped Men  Not a Special Class
   Employment bureaus operated  for the assistance of
disabled men alone would result in the wounded being
treated as a special and, in a sense, inferior class, so that
they would be in constant danger of being offered lower
wages.   This is  contrary  to *the  first principle of the 
40
H O M E  S E R V I C E
modern effort to rehabilitate disabled  soldiers, which is
to prepare them carefully for a selected occupation, in
which they will be able to compete on equal terms with
able-bodied men, the advantage of a freshly trained mind
offsetting  the physical handicap.  Therefore, no place-
ment service should consent to having these men looked
upon as a special class of cheapened labor.  Government
control of the employment system will obviate this danger
which might arise in the operation of private employment
agencies.

Industrial  Surveys
  Now  that jurisdiction  over training and employment
has  been  lodged in  the Federal Board for Vocational
Education, it may be expected  that the cooperation of
large industries will  be  systematically sought and de-
veloped on the lines successfully followed in other coun-
tries.  It  is  impossible to teach in the average  trade
school   the  great  number of  diversified  processes  of
modern industry in which disabled men may expect  their
best opportunities.   Classroom training  is therefore
limited  in many instances to the laying of a general basis
of theory,—to be supplemented by practical work in the
actual  industry.  For this purpose, surveys are made of
many industries to determine the number and nature of
the activities in which disabled men can engage, the sani-
tary conditions of the shop and the general suitability
to the  end in view.   The men in training are then sent
in to complete their courses  under actual working con-
ditions.  Until their  period  of  training is ended  they
remain  under Government pay and allowances, and are
subject to regular inspection  and supervision. - The firm
is not obliged to pay them, nor is  it bound to employ them
afterward.  And under the arrangements made it cannot
exploit their labor, or  limit them to routine work without 
EMPLOYMENT
41
value for training. Any attempt to do so would result in
the men being promptly removed.  Practically  there is
almost  never  an inclination to do this,  while, on  the
other hand, there is usually good  reason for the firm to
employ the men  upon the completion of  their training.
Not only are the industries ready to make these mutually
beneficial arrangements out of a sound patriotic instinct,
but they profit by getting well-trained men to fill their
depleted ranks.  This  plan therefore  solves both  the
training and the  employment problem in  an apparently
ideal manner.

Compensation Laws an Obstacle
   In practically every country dealing with the disabled
soldier  problem,  the necessity of  adjustment  in respect
to workmen's compensation laws has arisen.  There are
two phases of  the difficulty.  In the first place the danger
of accidents in general is alleged to be so increased if
crippled men  are employed that the rates of the insur-
ance  companies are raised against that industry. ■ This
creates a disposition among  employers against taking
on disabled workmen.  In the second place, there is the
more specific difficulty that a  man with only one arm or
one leg or one eye becomes a subject of compensation for
total disability if through a work accident he loses  the
other member.  This ruling makes it practically impos-
sible for partly disabled workmen  to obtain employment
in the hazardous industries.  Among other possible solu-
tions it has been held that these laws should be so amended
that men disabled in service should have the same status
as far as industrial  accidents are concerned,  as though
they had never been injured.
   The adjustment of these problems will call  for special
effort and thoughtful consideration in this country, where
workmen's compensation  laws vary in the several states. 
42               H OME  SERVICE
What Employers Should Not Do
  The danger in appealing to employers to find work for
disabled men is that the emphasis may be thrown upon
adjusting work to  the men's limited conditions  rather
than on fitting the men for open market competition with
their fellows.  Care must be taken not to foster the well-
intentioned  but short-sighted desire to give some kind
of a job to a disabled  soldier immediately on his  return
and regardless of his future prospects.  The self-interest
of some employers  and the overwhelming desire on the
part of the soldier to resume the earning of wages may
coincide here to bad effect.  The wiser and more patriotic
employers will  not  offer positions in such a manner as
to entice disabled men  away from opportunities for voca-
tional  reeducation.   The tendency  to do this, though
with the best of  motives, exists and must be  offset  by
prompt and thorough  discussion of the subject  among
thoughtful and patriotic employers.  The first impulse is
to plan for and promise to "take care of" a given number
of returned  soldiers.   This means  raking up  odd jobs
and putting the ex-soldiers at work  without considering
whether they earn  the wages or not.   One can readily
picture a local  committee of employers getting together
at luncheon and  agreeing  to divide among  themselves
responsibility for a quota of twenty or fifty or a hundred
returned soldiers.  Jones can take care of five, Smith a
dozen, Jackson  fifty in  his big factory.   It is all  arranged
in a few minutes, and  the business  men return to  their
desks  with the sincere consciousness of a  patriotic job
well performed.
  But a little thought  would convince them that on the
contrary they have shirked their real responsibility, and
that their  activity may  prove more  pernicious  than
patriotic. Workmen placed  in this  hit-or-miss manner 
EMPLOYMENT
43
will in all  probability be down  and out before many
years, finding themselves unable  to face competition in
normal times.  Moreover, the men will soon realize that
they have  been given jobs  on a charity basis,  and, at
first ashamed of it, they may later come to expect and
insist on  such semi-philanthropic  support.   Certainly
the tendency in such a plan is to  demoralize rather than
to stimulate independence  and ambition.  Most serious
of all, the method takes no account of the workman's
future.   It, means one of two things.  Either the man
has been placed in a 'dead end' job such as watchman or
elevator attendant, with no promise for the  future, or
he has been given a job beyond his capacity in which he
stands  no chance of making  good.   This means that
he  will be dropped eventually, when gratitude to war-
heroes has cooled off a bit, and will have advanced him-
self no whit during the  tjme  he  accepted  industrial
charity.

 What Employers Should Do
   Employers who have the interests of these men,  of the
community, and of the nation truly at heart will spend a
little more time around the committee table and will do
a little more hard thinking.  Then they will go back and
study each man assigned to them and help him into a job
especially  suited to his condition.  First of all, they will
encourage in every way his ambition and desire to  seek
 special training for a promising line of work.  Then out
 of  the enormous number  of manifold industrial  pro-
 cesses and requirements at  their  collective  command,
 they will help each man to that  which he is, with train-
 ing, just as capable of doing  as his  able-bodied fellow-
 workman. 
44               II o M E  SERVICE

How Home Service May Help in Placement
  (i) Help create the right attitude among employers.
Too many business  men  are ready to  give alms—the
easy way;  too few will spend time  and thought to help
the cripple into a really suitable and  constructive job.
  (2) Help employers to be considerate and patient at
first.  Given a job, a handicapped  man, because  of his
initial awkwardness and lack of skill, often has difficulty
in keeping it through lack of patience on the part of the
employer, shop superintendent, or foreman.  This aggra-
vates the man's discouragement, and often it is a case of
getting  and losing several  jobs, all of which tends  to
lessen his morale and ambition.
  (3) While dealing  one by  one  with  the individual
men and their employers, Home Service Sections may
wisely endeavor to assure the steady interest of employ-
ers  and employers'  associations  in  providing every rea-
sonable opportunity  for crippled soldiers, and, for that
matter, for the soldier who returns sound in body and
mind.   Local  organizations of workers and employers,
labor unions, chambers of commerce, employment man-
agers' associations, and public-spirited individuals may be
expected to cooperate with the Red  Cross in community
plans to assure the successful re-absorption into the local
industrial life of all returning  soldiers and sailors.  The
American  Federation of Labor and  the  Chamber  of
Commerce  of  the United  States are both  on record  in
favor of the national plan  for vocational training  of
returned soldiers and both  urged  the passage of the
Vocational  Rehabilitation Law.
  (4) Home Service workers may find it desirable to co-
operate as individuals in securing any just and necessary
modification of compensation laws. 
              V.  Compensation

  The United  States  has  throughout its history  been
noted for the generosity of its policy toward those dis-
abled in  its wars.  As  early as 1636 the  Pilgrim Fathers
decreed that any man who was  sent forth to fight the
Indians and returned  maimed should be maintained by
the colony for the remainder of his life.  The other Ameri-
can colonies enacted similar laws  because of their battles
against  the  Indians  and   the French.   Virginia  and
Pennsylvania were the first states of the Revolutionary
period to establish disability  pensions, and finally  Con-
gress,  at Washington's insistent  demand, granted pen-
sions to  disabled soldiers and  their widows and orphans.
In 1864 the United States adopted the principle of giving
special pensions for particular forms of disability, and in
1870 a law was passed requiring the provision of arti-
ficial limbs by  the  Government and the renewal of such
apparatus at public cost every five years.  The founding
by the Federal and State Governments of institutions for
the care of needy and  homeless veterans  and the provi-
sion of extra payment for aid  and attention to those re-
quiring  special  treatment,  established  long ago in  the
United States principles which are now for the first time
recognized in some of  the European countries as part of
the duty of the state toward disabled soldiers.
   Since  the  Civil  War there has been  much prodigal
legislation at variance with the principles of the  present
compensation system.  Instead of all ex-soldiers faring
equally  under  the impartial  operation  of just  general
laws, individuals have frequently been able to advance
their particular claims by private pension bills. 
46
HOME  SERVICE
  Yet in the face of these aspects of our pension legisla-
tion it is pleasant to record the opinion of a highly com-
petent British authority that "the Americans have set an
example to the world by undertaking in a more thorough
manner  than any other nation before this war, the care,
as distinct from the pensioning, of the disabled soldier."1

The  War Risk Insurance Law

  Since  the enactment on October 6,  1917, of the Mili-
tary and Naval  Insurance Law,  the United States still
better deserves the good opinion of this friendly critic.
Returning to the solid rock  of a just and impartial  gen-
eral law, this measure makes liberal provisions for  men
while in  service and for their  dependent  families both
during the war and in  the future  to which these depen-
dents must look fonvard after the disablement or death of
the principal wage earner.   The  underlying theory was
well stated by Judge Julian  W. Mack,  Chairman of the
committee which drafted the bill, as follows:
  The proposed provisions  for the men and  their  dependents
should not be offered as gratuities or  pensions, and they should
not  be deferred until the end of the war.  The wives and children,
the  dependent mothers and fathers of the men, should not be left,
as in previous wars, to the uncertain charily of the communities
in which they live.  The minds of our soldiers and sailors should
be put at rest, so far as their loved ones are concerned, by the
knowledge that they will be amply provided for by their Govern-
ment as a part of the compensation for the service they are ren-
dering to  their  country.   In like manner they should  know in
advance that if they are  killed  in battle, definite and just pro-
vision has been made for their dependents,  and that if  they are
disabled,  totally or partially—if they come back armless, legless,
sightless,  or otherwise permanently injured—definite  provision is
made for  them, and that they are not going to be left to the un-
certain chances of future legislation or to the scandals of our old
  1 Pensions: by Captain Basil Williams in "Recalled to Life," No. I, pagt; 90. 
COMPENSATION
47
pension system.  Every man should know that the moment he is
enlisted in the military service of the Government these definite
guarantees and assurances are given to him not as charity, but
as a part of his deserved compensation for the extra-hazardous
occupation into which his Government lias forced him.

Compensation for Total Disability
   Article III of this law aims at this ideal by setting up
a new system based upon the accepted principles of mod-
ern compensation legislation. It is unnecessary to repeat
all the provisions in detail as they are familiar to every
Home Service worker and are conveniently summarized
in the  Red Cross  Handbook of Information for  Home
Sennce  Sections (A R C 207).  The  schedule of monthly
compensation for the  total disability of an enlisted man
or officer, or a member of the Army or Navy Nurse Corps,
as embodied in Section 302 of the law (as amended June
25, 1918, to take effect retroactively October 6,  1917),
is as  follows:
A. If the  disabled person  has neither wife nor  child
    living, S30.
B. If he has a wife but no child living, $45.
C. If he has a wife and one child living, $55.
D. If he has a wife and two children living, $65.
E. If he has a wife and three or more children living, $75.
F. If he has no wife  but one child living, $40, with $10
    for each additional child up to two.
G. If he has a mother or father, either or both dependent
    on him for support,  then,  in addition to the  above
    amount, $10  for each.

   To an injured  person  who is totally  disabled and  in
addition so helpless as to be in constant need of a nurse
or attendant, an  additional sum not  exceeding  $20 a
month  may be paid in the  discretion of the Bureau  of 
48
HOM E  S !•'. R V I C K
War Risk  Insurance.  For the loss of both feet,  both
hands, or both eyes, or for becoming totally blind or help-
less and permanently bedridden lrom causes occurring in
the line of duty in the service of the United States, a com-
pensation of £100 a month  is to be paid, without addi-
tional allowance in that case for a nurse or attendant.
  The amendments of June 25, 1918, also provide for the
apportionment of compensation where the disabled per-
son and his wife are not living together or where the
children are not in  the  custody of the disabled person.
Another amendment makes  the term  'wife' as used in
Section 302 include 'husband' if the husband is depen-
dent on the wife for support, and  if she is the disabled
person.

Compensation for Partial Disability
  If, however, the disability is partial, the law  provides
a monthly  compensation at  a graduated  percentage of
that which would  be payable for  total disability.   No
compensation  is payable for a reduction in  earning ca-
pacity rated at less than ten per cent, but beyond  that
the award is adjusted to the degree of the reduction in
earning capacity resulting from disability.  The  schedule
of ratings applied by the Bureau must be based upon the
average impairment of earning capacity resulting from
similar injuries in civil  occupations  and  not upon  the
impairment in earning capacity in each individual case.
This means that there is no reduction of compensation in
an individual instance if the man succeeds in  overcoming
the handicap of a permanent injury.
  This point deserves emphasis, since  it brings our law
into accord with the  recent  experience and practice of
other belligerent nations.  In England the pension was at
first reduced  as  the  man's earning  power increased.
Many of the ex-soldiers thereupon took the attitude  that 
                 COMPENSATION              49

they would not undergo training which would result in
diminishing their pensions, and thus the whole program
of reeducation faced a serious set-back.  In the light of
this experience the English system was changed to the
sound  basis of adjusting the pension to  the disability
rather  than to earning capacity.   But it is only by stren-
uous campaigns of education still carried on that British
and  Canadian  soldiers are  convinced  that vocational
training will not operate to reduce their pensions.
  The American law, however, contemplates in this con-
nection a further distinction between temporary and
permanent disablement, either partial  or  total.  Com-
pensation is payable for disability incurred by reason of
disease, for example, and continues during the existence
of such disability.  In this case the compensation is rated
according to the reduction  in the individual's earning
capacity.   It diminishes with  physical and economic
recuperation  and  ceases  when the  man  is restored  to
health and full earning power.  -
   But for permanent impairment as in  loss of members
or other irreparable injuries, the compensation is fixed,
as above stated, according to an average  scale, and can
not be changed if the man overcomes the  handicap.

Insurance for Total and Permanent Disability
   But over and beyond the provisions for compensation
for death or disability in the service, the War Risk Insur-
ance Law in Article IV also makes available  to  every
commissioned officer and enlisted man and to every mem-
ber of the Army Nurse Corps (female) and  Navy Nurse
Corps (female)  when employed in active  service,  the
benefits of life and  disability insurance carried by the
Government  at  a very low  premium.  In the event of
death  or total and permanent disability the amount of the
policy (which may be any sum in multiples of $500, be- 
50
HO M E  SERVICE
 tween Si.ooo and $10,000) is payable in 240 monthly in-
 stallments.   If, however, the insured  person  becomes
 totally and permanently  disabled and  lives longer than
 240 months, payments will be continued as long as he
 lives and is so  disabled.   If death occurs before the end
 of 240 months, the balance of the insurance will be paid
 in like monthly installments to the beneficiary.
 Vocational Reeducation as a National  Policy
  Section 304 of the War Risk Insurance Law contained
 the  first promise in the law of the United  States to go
 beyond a mere pension and provide vocational training
 which will place the disabled soldier in a position for self-
 support.  This section was repealed by the Vocational
 Rehabilitation  Law but its provisions  were in  effect re-
 enacted  therein, although with important  modification
 of the emphasis on military and  economic  control.  Its
 original enactment was intended to establish a principle,
 to be worked out in detail by later legislation as has now
 been done.
  The War Risk Insurance Law and the Vocational Re-
 habilitation Law are among the most constructive mea-
 sures of social legislation which the United States has ever
 adopted.   It may be  confidently expected   that the
 essentially new  principle introduced in  the field of com-
 pensation laws, namely, adding vocational training and
 rehabilitation to the financial provisions of  such legisla-
 tion, will hereafter prevail in the industrial field and that
 after the war not only the principles of these  laws but
 the very institutions which the Government will neces-
sarily develop will be made available for the victims of
work accidents.
 Compensation Adjusted to the Family
  In adjusting the compensation to the family  need the
War Risk Insurance Law strikes a new note as compared 
COMPENSATION                51
with  ordinary  workmen's  compensation laws.   Judge
Mack has expressed it thus:
  In all the workmen's compensation acts, if a man is disabled,
the  amount of compensation that is paid to him depends upon
his salary in the business, and his family does not enter into the
consideration.  We felt  in drafting this act, however, that the
situation was different,  particularly in  view of  conscription.
Under ttie conscription  law the family is conscripted when the
breadwinner is taken away.  The family in giving up its head is
serving  the country,  and the family, therefore,  ought to be
looked at in determining the amount that the Government pays
for disability or death; and so the amount that is paid, if a man
becomes disabled in the  service or, as the law puts  it, in  the line
of duty, varies according to  the size of  his family; and, as  a
matter of justice it was felt, and Congress indorsed the idea, that
it should vary according to the size of his family from month to
month.
  Too  often the treatment of veteran soldiers and sailors
has become a  question of partisan politics.  There is
felt to be danger both in Canada and in the United States
that  the organized  influence of returning  soldiers and
sailors  may  be used for political purposes by creating or
expressing dissatisfaction with the arrangements made by
the Government  for their  return to  civilian life.   It
would  be  unfortunate if  false  ideas of what is  due to
soldiers should become general, and if action should be
taken for  the  purpose  of urging unreasonable claims by
political propaganda.   Considering the proportion of the
soldier vote, especially in the  present  war,  the dangers
presented by such a situation in every country possessing
a representative form of Government are very real.   But
the enactment of such wise and equitable legislation as
the War Risk Insurance Law will go far to remove such
dangers,  especially  if  there be a  sound public  under-
standing of the whole  problem and  adequate support of
 the law and of the machinery for its administration. 
52               II O M E  SERVICE
Compensation During Vocational Reeducation
  Home Service workers should note the ways in which
the new law supplements or modifies the provisions of the
War Risk Insurance Law with which  they are  already
familiar. Section 2 of the Vocational Rehabilitation Act
provides that a person following a course of training as
provided for therein 'shall 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 the War Risk In-
rarance Law, 'whichever amount is the greater'.  Since
vocational rehabilitation is offered to all who are entitled
to compensation and who are unable to resume a gainful
occupation, this clause  applies to officers as well as men.
  If, however, 'such person was an enlisted man at  the
time of his discharge .    .  his  family shall receive com-
pulsory allotment and family allowance' according to  the
provisions of Article II of the War Risk Insurance  Law.
This allotment and  allowance will be  continued to his
family  during  the period of training just as if he  were
still an  enlisted man in service, and for  the purpose of
computing  the amount of allotment and allowance,  the
man's compensation is to be treated as his monthly pay.
In this  connection it should be remembered  that sub-
sequent sections give the Federal Board for Vocational
Education  power  and  means to pay  'the expense of
travel, lodging, subsistence,  and  other necessary expenses
of such  persons while following the prescribed courses'.
  The  provisions for vocational training are also made
available to those receiving compensation who are able
to follow a gainful occupation.  This training  will be
offered under conditions to be established by the  Federal
Board for Vocational Education. 
                 COMPENSATION               53

Home Service Duties at this Stage
  (i) Make it a patriotic duty to support and to secure
support for the principles of the War Risk Insurance Law
as supplemented by the Vocational Rehabilitation Law
and  to further the  practical and successful operation of
their provisions*.
  (2) Inform returned soldiers of their rights under these
laws and assist  them to file their applications to obtain
the benefits thus conferred upon them and their families.
Home Service Sections with well-organized  information
service  will  have been  doing  just  this work from  the
beginning.
  (3) See that no disabled soldier or  sailor wrongly
believes that his compensation will  be  reduced .if he fits
himself for higher wages.
  (4) See that the  disabled  man,  or someone in  his
behalf,  writes a letter giving the man's full name, service
number, military unit, and the facts regarding  his dis-
ablement,  which addressed  to  the Bureau of War Risk
Insurance, Washington',  D. C, will set in motion  the
necessary procedure to establish the claim and will make
certain  that  full instructions  with the  required forms
will be  sent directly to the claimant.
   (5)  Remember  that  compensation  is  awarded only
when the injury or disease was incurred 'in line of duty'.
While the decision  on this point rests in the first instance
on  the  report of the Army surgeons, the  Bureau of War
Risk Insurance will consider evidence  submitted by the
claimant  tending to prove that a pre-existing diseased
condition or injury was aggravated by  military duty.  -
   (6) When requested by a representative of the Bureau
of War Risk Insurance to do so, supply promptly and
accurately the facts in  possession of the Home Service
Section which will assist in the just  determination of 
54
HOME  SE R V I ( E
the actual conditions  of  the  disabled man and of his
family and in the just award of compensation  to  him.
In all such cases the Home Service Section should  omit
all opinion and all recommendation.  Only the facts are
desired. And the Home Service Section should not make
special inquiry to determine these facts when not aire idy
known. The Bureau of War Risk Insurance has its own
agents for that purpose.   Moreover, the family  may
resent—and properly so—any such inquiry as intrusive
and outside  the  proper sphere of the  Home  Service-
Section.  Such  information  as is  already at hand, how-
ever, may be given as a service to the family.
  (7)  In awaiting action, be patient.  Use  perspective
and consider  the number of men  in service, the number
of claims presented, and the number  of inquiries which
the Bureau of War Risk Insurance must face as its daily
task.  Those who burden Government offices with need-
less inquiries and then complain of delay are  not doing
their best  to  help win  the war. 
            VI.  Public Opinion

  Whether or not the returned soldier profits from all
the opportunities the Government offers him will depend
in the last analysis very largeh' upon the attitude of the
general  public.  The  public  means well toward  the  re-
turning soldier but too often acts unwisely.  It is essen-
tial that the principles upon  which the reconstruction of
the disabled soldier is based, under the best modern prac-
tice, should be widely understood, so that the interest of
the public  generally  may be  turned to the  best account
in supporting in every  detail the action of the author-
ities.   Home Service workers know, but the public must
also understand, that disabled  men who  neglect their
opportunities  for treatment and training do so at grave
cost to themselves as well as  to the community.  A man
who unreasonably refuses these opportunities, penalizes
himself and by his own unwise choice remains less capable
of supporting himself and his family than  he might  be.
This means loss for all concerned.

How Not  to  Treat the Disabled Soldier
   The danger of pampering and idolizing  the disabled
soldier into a  state of exaggerated self-esteem and moral
disintegration has been illustrated in a story  related by
a  well-known representative of a prominent war relief
association in one of the allied countries.  The wife of a
returned soldier complained to the representative of this
relief agency  that after his  return her husband  would
never spend  any time  with  her  or  with  the children.
When  she  had  hoped  that  he  would accompany  his
family for a little outing in the park, he had disdainfully 
56
HOME  SERVICK
refused, saying that he was going out for an automobile
ride and later to a tea and entertainment at one of the
fashionable  hotels.  This  musical  afternoon  was  being
provided by society women of the city, whose sincere but
misguided zeal thus enticed the men from their families
in order to make 'heroes' of them.
  One of the most dangerous forms of wrongheadedness
is the indiscriminate treating of disabled ex-soldiers at the
corner saloon.   Even where the harm done by a  drink
would  ordinarily be debatable, in the case of a mentally
or physically disabled  soldier, alcohol may be the  worst
thing for him that could  be imagined.  It is,  indeed, a
false kindness for the public to condone drunkenness, dis-
orderly conduct, idleness, and dependency on the part of
the returned soldier on the ground that he has risked his
life for the country and so deserves a special relaxation
in his  favor of all ordinary restraints on  social conduct.
It is said that in some cities the patriotic hysteria of the
public has been such that neither the police nor the mili-
tary authorities have been permitted to restrain or pun-
ish returned soldiers even  when they have become seri-
ously  disorderly and objectionable.  Aside from the fact
that  this is a most unwise way of treating the men, it
gives  obvious ground  for  unfavorable reflection on  the
service as a whole.
  Obtrusive pity of disabled  men is particularly out of
place.  As  the editor of the English journal Recalled to
Life  very  appropriately   observes,  "A  disabled  man,
though he  may frequently be an object for small  helps
and courtesies, does not want to  be fussed about, does
not want obtrusive pity, and  extremely often is actually
sensitive to the annoyance of being noticed."
  The wisest  and  kindest  public opinion will  demand
that  the returned soldier shall not  be spoiled by  over-
indulgence  and relieved of all responsibility for his own 
                  PUBLIC  OPINION               57
 future, but that on the contrary he should be truly helped
 by being given every facility and opportunity to make
 the best of his remaining powers, so that he may become
 an asset rather than a liability in the accounts of society.
 The courage displayed in overcoming his handicap should
 be as warmly appreciated by the public as was his courage
 in going "over the top."

 Public Opinion in France

   As the result of a carefully directed campaign of public
 education  in  France  very few intelligent people in that
 country are now  without a clear understanding of the
 conditions  under  which  a disabled man  is  discharged
 from military service. Reeducation is voluntary and its
 success has, therefore, been conditioned largely  upon the
 education  of  the  soldiers and the public.   At first there
 was a universal tendency to assume that a disabled sol-
 dier had nothing to hope for but a long, idle life under
 pension.  With the successful development of a definite
 policy of public instruction, all this was changed.   How
 this was carried on has been described by a writer in the
 American Journal of  Care for Cripples:
   Leading writers such as Barres, Brieux, and many others have
 contributed notably .to this cause.  Every method of  conveying
 information has been used with the full approval and prestige of
 the Government.  Newspapers, magazines, posters, the clergy,
 trades unions, manufacturers' associations, boards of trade, pub-
 lic service corporations, and all available  channels have been
 utilized in bringing about a clear realization of the obligation of
 the State, on the one hand,  to insure an independent position to
those who have been disabled in its service, and of the  obligation
upon the citizen, on the other hand, both to be self-supporting in
the measure of the ability remaining to him and to  receive from
his fellow citizens no more  than is his due.  The result of this
campaign has been to teach that in France it is  not enough to 
58
II O M E   S E R V I ( i:
say 'Poor fellow' in seeing a wounded man.  Instead it has been
constantly insisted that what in effect must be said is "There is
a man to whom the possibility of a self-earned livelihood musl
be assured." The public is learning that there is little true benevo-
lence in contributing to  the  dependence of a wounded soldier,
but that it is lasting kindness so to direct  public and private
resources for  his training that the man will no longer need help.

Public Opinion  in Canada
   Likewise  an admirable  campaign of  public  education
has also been carried on by the Canadian Military Hos-
pitals Commission (recently reorganized as the Invalided
Soldiers  Commission),  the governmental agency which
is charged with the welfare of handicapped men returning
from military service.   The use of lantern slides, moving
picture films, posters,  newspaper and magazine articles
has been  effectively developed.   The object  is both  to
convince  the man himself that his future prospects are
good and to bring the public at large  to understand that
a disabled man is not  necessarily a helpless dependent,
but is capable of a high degree of useful activity, provided
the necessary facilities are furnished  and the  ex-soldier
does his  own part.

Official Educational  Activities in  America
   It is of the greatest importance that American public
opinion should  be similarly  directed  along sound and
constructive lines.   This is building  for  the  future.
Nothing will so surely bring about a decrease in the num-
ber of men  tending to rely on their pensions alone and
who would eventually become public charges.
   The Surgeon General of the Army has anticipated the
need of this kind  of educational work and has commis-
sioned experts  who have been  developing  plans for
months past.  A number of motion picture films depicting
the success of cripples in overcoming their handicap have 
PUBLIC  OPINION
59
been  prepared.   A  new magazine  called  Carry On  is
already being published by the Surgeon General with the
cooperation  of  the Red Cross, which  is also aiding in
meeting the expenses of other phases of this educational
work.   Every Home Service Section has been placed on
the mailing  list for Carry On.
  The Federal Board for Vocational Education has also
begun appropriate educational work with the publication
of a new series of bulletins and with other activities com-
menced as soon  as  its  present authority was received
from Congress.

Publicity Work of the Red Cross Institute
   It has been from the  first one of the principal objects
of the Red Cross  Institute for Crippled and Disabled Men
to assist in  the general  campaign  of public education  in
this country, regarding  the results which can  be accom-
plished jn retraining disabled soldiers.   The Institute be-
gan this phase of its activities by publishing the following
advertisement in the  leading daily  newspapers of  New
York, Washington, Chicago,  and other cities:
         A Square Deal for the Crippled  Soldier
   When the crippled soldier returns from the front, the Govern-
ment will provide  for  him, in addition to  medical care, special
training for self-support.
   But whether this will really put him back on his feet depends
on what the public does to help or hinder.
   In the past, the attitude of the public has.been a greater handi-
cap  to the cripple than his physical disability.   People have
assumed him to be helpless.  Too often, they have persuaded him
to become so.
   For the  disabled soldier there has  been 'hero-worship';  for
the civilian cripple there has been a  futile kind of sympathy.
Both do the cripple more harm than good.
   All the cripple needs is the kind of job he is fitted for, and per-
haps a little training in preparation for it.  There are hundreds of 
6o
HOME  SERVICE
 seriously crippled  men now holding down jobs of importance.
 Other cripples can do likewise, if given the chance.
   Idleness is the calamity too hard to be borne.  Your service to
 the crippled man,  therefore, is to find for him a good busy job,
 and encourage him to tackle it.
   Demand  of the  cripple that  he get back in the work of the
 world, and you will find him only  too ready to do so.
   For the cripple who is occupied is, in  truth, no longer handi-
 capped.
   Can  the  crippled soldier—or the industrial, cripple  as well,
 count on you as a true and sensible friend?

   The Institute  has also organized a lecture bureau and
 has  made available  an  extensive  collection of lantern
 slides and  motion pictures showing the  details  of  the
 work for crippled soldiers abroad and in Canada.

 Home Service and Public Opinion
   The Red Cross  Chapter of each  community through
 the Home Service Section should take the lead in creating
 locally  this force of  healthful public opinion.  At Red
 Cross conferences and at other suitable  public  meetings
 in the community, Home Service Sections should seek
 opportunities to have the subject properly presented and
 thus to  assist in the spread of sound views as to what
 should be done for  the disabled soldier.  In so far as Red
 Cross influence can be brought to bear on the sources of
 publicity, everything possible  should be done to  arouse
 interest  in what  this country  is doing for  its returning
 soldiers and sailors and thus make for the wisest applica-
 tion of the good will to help.
   In sum,  the following steps in connection  with the
 guidance of public sentiment are  suggested to  Home
 Service  Sections:
   (i) Distribute effectively the present handbook (A R C
2io)  and other approved literature,  such as that  of the 
PUBLIC  OPINION
6l
Red Cross Institute, all of which may be obtained from
the Division Director of Civilian Relief.
  (2) Have the principles stated in this chapter empha-
sized at every possible Red Cross meeting.
  (3) Procure the publication in local  newspapers  of
special articles discussing  the subject along these lines.
  (4) Arrange special meetings  in each community  to
discuss  the problem of the disabled soldier and have
addresses given by the best speakers obtainable who will
emphasize the modern constructive and scientific prin-
ciples which are now being developed on the basis  of
experience in other countries.
  (5) Cooperate with all other local sources and agencies
of public opinion, such as churches, universities,  libraries,
women's clubs, chambers of commerce, labor unions, and
similar community groups in organizing the effective dis-
cussion  of the subject.
  (6) Endeavor  to  convince the public that the most
harmful thing which can be done for the returned  soldier
generally is to give or in  any way encourage the  giving
of money on the street to any soldier or any one who begs
in the guise of a soldier.
  (7) In a word, prepare for a sane and helpful reception
of the returned soldier.  Make it an event  long to  be
remembered by him, and remembered in a way  that will
make him hopeful and grateful ever after. 
VII.  After-Care
  The time will come after the disabled soldier or sailor
has received the benefit  of  the  Government's  medical
and surgical care and  vocational training when  he  will
go to work at  his old occupation or in a new  position
which the Government has found for him. Our country
will have done everything possible to restore  to each
man what  has been taken  and used  in the national
service.  From  this time the  Red Cross and  other com-
munity agencies will gradually take over the chief respon-
sibility for such further assistance as the man may need.
The rest depends upon the individual and his personal
will-power and  capacity for recuperation.
  For  many returned  men  who will supplement their
innate resourcefulness with these advantages, no further
assistance will be needed.  Others, less forceful and self-
reliant, or more seriously handicapped and disheartened,
will require some degree of friendly sympathetic oversight
and encouragement  to carry  them  through the  first
critical months  until  they  have found themselves in their
new work.   This is no work for a distant and  impersonal
official agency.   Rather it is  a task for personal friends
close at hand and intimately  aware of the man's every-
day problems and difficulties.  This is appropriate work
for the Red Cross.  It is especially appropriate work for
the Home Service Section which in many instances  has
already had the privilege  of helping to maintain intact
the standards of health, education, and  home life of  the
soldier's family  during his  absence.

The Goal of Home Service in After-Care
  The Red Cross  is strategically well-equipped to  un-
dertake the follow-up care of returned soldiers.   Each 
                   AFTER-CARE                 63
soldier discharged on account of disease or wounds will
return to a community where the Red Cross will already
have  served  his family,  if there has been any kind  of
need.   It is  appropriate that this same  Home Service
should continue  such assistance as may  be necessary
to the reunited  family.  The  problem must now  be
approached from  a different angle.   A  new  factor is
involved  and emphasis must be placed on the encourage-
ment, support, and social rehabilitation of the chief wage-
earner himself, as the means of insuring the permanent
stability  of the  family.  In this task the  fact that  the
Home Service Section has already had opportunity  to
understand the needs and problems of the family will  be
of the greatest advantage.   Obviously, there will be a
renewed  interest on  the part of every Home Service
Section called upon to deal with the needs of such men.
There is  not only the opportunity for  real service, but
also the chance to make secure all the earlier hopes and
plans  for the family's permanent welfare.

The Problems of the Returning Soldier
  More concretely, What are the problems of the returned
soldier or  sailor  at this stage  of  his  readjustment  to
civil life, and what can the Home Service Section do for
him over and beyond what  the Government has done
so well?
  In the first place, the change  from the military to the
civilian status involves a radical psychological readjust-
ment.  For many months, perhaps years, the  man has
given  no  thought to the source of his daily bread. Supe-
rior authority has regulated his every act, telling him what
to do  and  when to do it.  A long period of hospital care
under constant attendance may  have accustomed him to
the notion of getting through the day  with  little or  no
concentrated effort and attention to anything more stren-
s 
64
HOME  S E R V I C E
uous than playing games or enjoying concerts and the
'movies'.  To be sure, an effort has been made to offset
this danger by giving him systematic doses of divcrsional
and curative occupation even in hospital  days,  and  a
period  of thorough-going  vocational  reeducation has
supervened.   But at best there is a vital difference be-
tween going to school and going to work, and the  soldier
must go through the adjustment to a new and different
mode of life, which this change involves.
  So, when the reconstructed soldier strikes out again in
the world for himself, there will inevitably be periods of
discouragement. He may find uncongenial working con-
ditions, unsympathetic employers,   inconsiderate fore-
men, sharply competing associates.   All these things  or
any of  them may dash his  reviving  hope and interest in
his  own  future, and he may quickly yield to despair.
Then is the  time to call for the reserves. Home Service
workers must not be slow to rally  to his support.  He
must meet and overcome these discouragements.   If he
loses one job he must  find another, and if necessary,  a
third, fourth, fifth, and so on, until  the right and  lasting
connection is made and the worker is settled in his work,
in his  mind, and in his outlook on life.  In  all these
days he may be greatly helped by the sturdy advice and
encouragement  of  some older man—a member  of the
Home Service Section.

The Mental State of the Disabled Man
  Perhaps  no  one  except  the  soldier who  has been
through the terrible experiences of  modern warfare can
imagine its unsettling effect on mind and character.  Any-
one who has ever left  a civil occupation for months of
foreign travel knows how hard it is to get back into har-
ness.  Add to that the effect of the military regime and
the conditions of life at the front, and it is  little wonder 
AFTER-CARE
65
that the returned soldier finds it hard to resume the daily
round of ordinary civilian  life.  Restlessness in the  new
job can be overcome only gradually, with the tonic effect
of work and with constant support and encouragement of
family and  friends.
   An unusual insight into the frame of mind of the crip-
pled soldier appears in the following extracts from a letter
written by a highly educated American teacher—himself
a  cripple—at the request  of the office  of  the Surgeon
General of the Army:
   At your suggestion I am outlining what, in my opinion, should
be done on the other  side for men crippled in action.  What I
have to say is based on direct personal experience, having  been
'through the mill' myself and having studied the question for the
last twenty years quite fully.
   You must  not only fit  a man to become a wage-earner but,
fully as important, you must fit him to enjoy the  wages  thus
earned with his fellows. You will find, at least in the  mind of the
cripple, that this second factor is the all-important one.  In all
candor and seriousness, you cannot hope to make a cripple a self-
respecting member of society if this factor  is not  taken  into
account.  This is not a theory but a cold fact.  Think  of the thing
a moment even in terras of the normal man;  very few of us are
very choice about how we earn our money so long as society lets
us live on a par with others who earn their living, no matter  how.
  The cripple does not care how many trick devices you fasten
on him in order to enable him to become a productive wage-
earner, but to carry them  into his home and in his social amuse-
ments of whatever kind they are, high or low, is as repugnant as
can be imagined. One basic fact stands out:  you must show your
cripple that he can  enjoy life.  You realize the force and bearing
that this has on the whole problem.  I am not overestimating its
importance when I say that unless you prove to a cripple  that
there  is enjoyment ahead, you can do very little to help  him.
Frankly, what is the incentive, why  should he work, why  even
live, what do  we live for, anyway? The pursuit of happiness, in
the main. 
66
II O M E  S E R V I C E
   Now let me outline just  what happens and suggest the cure.
When a man is wounded and  crippled the realization  of that
crippling comes at a time when the nervous system is least able
to bear the additional shock which the realization brings.  But
the shock does come to the mind and with it a feeling that worse
than  deatli has come;  not only complete dependency,  but the
robbing of the cripple of all, or nearly all, that makes life livable.
Pictures arise of beggars and shoe-string peddlers and all kinds
of helpless and maimed individuals.
   The mental suffering is very  acute, although the doctors and
nurses may never hear of it.  The mind of the patient is in no
condition  to undergo the ordeal at this time. For throughout the
weeks of  forced  inactivity,  a mental  state, perhaps a different
psychology, is built up and often strengthened by sympathetic
nurses who do little more them confirm the worst suspicions of the
invalid as to his own position in the world.   From a humanitarian
standpoint this suffering must be alleviated and from  the stand-
point of the future development of the cripple this is the crucial
time.   Couple with a shattered  nervous system, weeks of forced
inactivity with the idea of  helplessness,  with the idea of life
abnormal, outside the pleasures of the world, it is wonderful that
all cripples are not helpless.
   You must kill  the idea of helplessness almost as soon  as it is
born,  for in a  few weeks it becomes very strong.  You must show
moving pictures of men who are crippled enjoying themselves in
normal ways, dancing, skating, paddling  a canoe, swimming,
playing billiards, rolling cigarettes,  and hundreds of things they
cannot or do  not know about.   I could multiply these things a
thousandfold, things which  you would refuse to believe.  But
they must be  'put across' to the men early, and it must be done
by men who have had the experience first-hand.

'The  Way  Out1

   This cross section  of the psychology of the  cripple is
of deep interest, and it should be added that the methods
therein suggested  are being developed by the  Surgeon
General of the Army.  Among other means  of  reaching 
AFTER-CARE
67
the men  a pamphlet entitled The  Way Out,  published
with the cooperation of the Red Cross, will be placed in
the hands of every disabled soldier as  soon as he  has
recovered sufficiently to read it. This  booklet .will carry
a true message of cheer and hope stated by many people
in various ways.  The Government, the Red Cross,  the
medical,  engineering, and other professions, employers,
labor unions, farmers, vocational experts, and the public
will each be represented by a brief letter of encourage-
ment.  But substantially the book  will consist of actual
biographies of  successful cripples  who  have  overcome
their handicap  and have learned anew to  live and work
and play.  To this  book the Director General of Civilian
Relief of  the Red  Cross has contributed the following
promise of its aid:

To the Men Who Come Back:
   Let  me say this one thing  to every fighting man—the  Red
Cross is for you and with you.
   It is the aim of Red Cross Home Service \x> keep safe the homes
of those who fight to  make the world safe for our homes.
   To an equal extent—and that extent means  to our utmost-
it shall be our aim to make for you who are returning, bearing
 the marks of camp life, trench life, or  battle, a world at home
 wherein you may live as full and useful and happy a life as ever
 before.
   Those marks of battle are sacred symbols of your service to a
 high cause.  More than chevrons, bars, or any insignia they have
 given you a rank among your fellows.
   That rank makes you, forever, one of those to whom the nation
 will always look for future sacrifices as noble as those you have
 already made and for future achievements worthy of your  past.
   No  matter  what  has befallen you, you  are still  a  soldier.
 Although you have  returned  from the front, you still have to
 fight foes more worthy of your steel than  the Germans. Those
 foes are discouragement, the letting down of ambition, readiness
 to accept the easiest way, reluctance to play one's part in the 
68
HOME  SERVICE
peace-world.  We know you will conquer all these enemies.  Your
country needs you yet to fight the battles of peace.
  And you are still one of the world's workers.  In spite of your
handicap, you can produce with hand or with brain just as much
as the next man.  Your country needs soldiers in the great army
of workers. -
  You will not have to  go it alone.  The Government and the
Red Cross will see you  through.   The Government: will make
you well, it will restore to you the use of injured  members, it will
teach you a trade, it will find for you an opportunity to earn a
living just as you  did before—perhaps  better than you did be-
fore.  It will make you a skilled producer.
  And all along the line,  the Red Cross will be with you and your
family—your ally and the Government's in this greater warfare
in which you as a soldier of peace are fighting to make the world
better because of your being in it.  The Red Cross will come to
you whenever you ask—when courage is at low ebb—in any hour
of distress; it  will  go to  your family if there  is any information,
counsel, service, or aid they need; it will stand by you in the new
job and believe in you and sustain you if it be found that the job
doesn't  fit.  It will see you through if you want to go through.
  After a while, there will come to you this thought: "What I
have lost—arms, legs, sight, physical strength—is insignificant
by comparison with what I have saved and what I have gained.
I still have my friends, old and new, my family, my  brain, my
courage, my will to succeed, my soul, which must be the  only
thing really worth saving because it is that alone which God has
deemed worthy to make eternal. And if I take  what is offered,
I shall have skill to produce and earn, and  I shall have oppor-
tunity  to do a man's work in the world and to  receive a man's
meed.  I can still laugh and love and serve.
  All you want is the equipment to do the task before you and
an opportunity to take  your place in the ranks of the world's
indispensable producers.   You will not get more than you earn,
but you will earn what every other man who can look the world
in the face earns—a competent, independent  livelihood.
  You can do  it.  It has been done by many. Their  stories are
in this book.  It will be done in the future by all who will.  Never 
AFTER-CARE
69
before has the  Government, and the public given a guarantee
such as this—physical and mental rehabilitation, vocational re-
education, replacement in industry, and constant encouragement
to those who have suffered and sacrificed.
  You can do it.  We have pledged our faith in you.  We are for
you and with you—always.
  This is the message of the Red Cross.
   And this promise it is the responsibility of Home Ser-
vice to fulfill.  When these men come under the direct
care of  Home Service Sections  everything that  is done
for them must be based on a sympathetic understanding
of  their spiritual as well as their physical  sufferings.
Home  Service  must  complete  the  work of  the Army
doctor and the vocational officer in this domain. Reports
from the Red Cross delegates indicate that at the third
meeting of the Interallied  Conference on the After-Care
of  the Disabled Soldier held in  April, 1918, at London,
the need for  greater appreciation of the mental state of
these  men  w^as strongly brought out.  It was  reiterated
over and over again  that the soldier  who returns from
France comes back with a changed outlook, and that this
must be understood by those who are  trying to help him
before they will succeed in doing so.

Medical Service
   In certain instances some form of continued medical or
surgical treatment and oversight may be desirable.  Here
the Home Service  Section will  be  on familiar ground.
 Its efforts  to maintain  health standards for the  families
of soldiers and  sailors  will already have acquainted it
with local  resources of  hospitals, dispensaries  and sana-
toria and with  the  local personnel of the medical profes-
sion.   Standards of professional service with  particular
reference to war needs have been established and willing
counsel is available through  the Volunteer Medical Ser- 
70               h o m i   sERVir !•:
vice Corps, an official national organization of physicians
which is pledged, among other objects, to assist the Sur-
geon Generals of the Army and Navy, and to aid in the
care of soldiers' families.
  Section 303 of the War  Risk  Insurance  Law  provides
that persons applying for or in  receipt of  compensation
shall submit to medical examination and shall accept such
reasonable surgical  or medical  treatment as the United
States may provide or cause to be provided. Acting with
this authority, the Bureau of  War  Risk Insurance  is
utilizing the resources of the United States  Public Health
Service  in  personnel and hospitals in order to provide
examinations and offer treatment to discharged men who
are entitled to compensation under the law.  This service
was organized before the  enactment of the Vocational
Rehabilitation Law,  and in practical  effect will presum-
ably have a diminished importance in the future,  when
the full  effect of the new Army policy of curing disabled
men before they are discharged from the service is felt.
Nevertheless Home Service workers will have occasion to
inform  and assist  many  disabled men  to  secure the
benefits of this plan.

Recreation
  The important factor of wholesome recreation for the
returned man and his family must not be  overlooked.
The Home Service Section must consider how it may best
be provided under the circumstances of each case.  Al-
ways  necessary,  proper recreation  is  more  than ever
indispensable for the  returned disabled soldier or sailor.
But it must not be arranged for or offered in any way that
neglects the family's right  to  share   the  ex-soldier's
pleasures. 
                   AFTER-CARE                 JI
Community Resources
  Turning now from the man to his environment, it falls
upon  the  initiative of the Home Service Section to help
organize all available community- resources which can be
effectively brought to  bear upon  the welfare of the  re-
turned soldiers and sailors.  But such local agencies must
be employed only  in accordance  with  the  general plan
and under the guidance of the  national authorities.  It
may happen that a soldier's ambition is so stimulated by
his course of vocational  training under the  Govern-
ment that he will desire to continue his studies after  his
return to  his home city.  Or he may be  anxious to im-
prove his  general education by attending night school, or
by taking advantage of other educational opportunities.
In many  instances the  Home Service Section may  be
able  to stimulate ambition  and  the desire for further
training and to assist in providing the requisite facilities.
   It should be remembered that  a discharged man who
has missed the  wisest choice of the best opportunities
for trade training open to him has  not necessarily thrown
away his  last  chance.  Even a short experience and the
example of his comrades  who are doing so much  better
may quickly change his views.  New circumstances,  in-
creased knowledge,  reviving energy and  ambition may
bring him to realize how much better off for the future is
the skilled in  comparison  with  the unskilled worker.
The door is always open to such a convert. The Govern-
ment courses are still available, and  local opportunities
for further schooling can  be found. The Home Service
worker  must be  *-eady to help each  such man realize
his ambition. 
    VIII.   Special Medical Problems

  The war cripple makes such a special appeal to public-
interest and sympathy that  it is  easy  to  lose the true
perspective of'the whole problem  of caring for disabled
soldiers.  It is the experience of this war that the wounded,
and  especially  those who have lost limbs,  constitute a
relatively small proportion of the total number incapaci-
tated for service.  On the whole,  the  medical  cases out-
number the surgical.  Tuberculosis, especially, is a large
factor.  Out  of 1,000,000  men serving,  it  is  estimated
that 10,000 each year will be subjects for vocational
reeducation and  of these approximately   half will  be
medical and half surgical  cases.   Of each 5,000 surgical
cases only 500  would involve dismemberment, 300 with
loss of legs, and 200 with loss of arms.  As a recorded fact,
out of 41,000 Canadian soldiers who have been returned
for all causes there were less than 1,500 cases of amputa-
tion, and less than 50 cases of blindness.
  The principle of Home Service responsibility for  the
after-care of  disabled soldiers applies regardless  of  the
particular nature of the disability.  No  distinction can
be made between the wounded man  who may soon re-
cover his normal earning capacity and  the man who must
pass through a long period of treatment and convales-
cence from disease.  Although  the foregoing chapters
have discussed in some detail plans for  the care of  the
war cripple, the  general principle stated must be held
applicable, so far as the Red Cross is concerned, to  the
after-care of men discharged on account of  any form of
physical disability, medical or surgical.   Broadly speak-
ing, the disabled soldier presents a single  problem calling 
              MEDICAL  PROBLEMS           73

for  systematic  and  sane application  of  Home  Ser-
vice assistance whenever necessary to supplement  the
work of the Government agencies.   Special preparation
has been made by the authorities for dealing with each
group of disabilities, however, and these should be known
in a general way to Home Service workers in order that
they may act with some  knowledge of the Government's
plans and methods.

Tuberculosis
  Under a long-standing policy, continued in force dur-
ing the first year of the present war, all  men who, upon
thorough  medical  examination and observation  at  the
camps, were found to be  suffering from tuberculosis were
forthwith discharged from the Army. If the disease was
diagnosed as acute tuberculosis or if chronic tuberculosis
developed after the man had  been three months in  the
service, it was accepted  in effect that the Government
was responsible, and such  soldiers were discharged "in line
of duty."  This meant that they were regarded as having
incurred the disability by reason of their military service,
just as if they had been  wounded, and were prima facie
entitled to compensation under Article III of the War
Risk  Insurance Law.  If, on the other hand,  the disease
was discovered within three months after  enlistment it
was assumed that it had existed previous to entrance
into'the service and had escaped detection.  In such
cases,  unless it was  shown that  some other disease or
excessive fatigue or  exposure since enlistment had  re-
activated tuberculosis, the discharge was "not in  line of
duty," and the War Department recognized no responsi-
bility  for the  man's subsequent  care and  treatment.
Under the operation  of this policy almost exactly 10,000
men were discharged from the Army from the beginning
of the war up to June 1,  1918. 
74
II OME  S E RVICE
  At the present time (July, 1918) a complete change of
policy, involving a more liberal view of the Government's
responsibility, has gone into effect.  In the first place, the
Bureau of War Risk Insurance has ruled that it will take
under  consideration, even  when a  man has been dis-
charged as "not in line of duty," any evidence that  he
may submit to  show that a previous condition was ag-
gravated by his military service, and that it will hold it-
self free to award compensation  in  such cases.  In  the
second place, and more important, the recommendation
of the Surgeon  General, approved by the Secretary of
War early in May, 1918, has resulted in postponing dis-
charges on  account of  tuberculosis (as well  as  other
causes of disability) until the men are cured or as nearly
cured as the nature of the disability will permit.  At the
same time, General Order No. 47 of the War Department
issued  May 11, 1918,  ended for  practical purposes  the
distinction as regards "in line of duty" by providing that
when a man is once accepted for  service upon his physi-
cal examination at a military station, any  subsequent
determined disability shall  be regarded  as having been
contracted in the line of duty "unless such disability can
be shown to be the result of his own carelessness,  mis-
conduct,  or  vicious habits,  or unless the history of  the
case shows unmistakably that the disability existed prior
to entrance into the service."
  This means that men who develop tuberculosis in the
service will ordinarily be sent to Army hospitals and kept,
if possible, until the disease is arrested, certainly as long
as they will  stay.  Contrary to an impression which has
obtained some currency, the Army sanatorium treatment
is  not limited  to three months  or any other definite
period. In fact, the chief difficulty which is now antici-
pated  is to get  the men to stay long enough.  It is the
wish of the Surgeon General that  tuberculous soldiers 
MEDICAL PROBLEMS
75
shall be kept in the service as long as they are willing to
remain,  provided  there  is  sufficient  accommodation
for all of them in hospitals, and provided further that the
individuals in question have need of further  treatment.
But the first desire of the soldier wdien told he has tuber-
culosis is usually to go home.  Too often this desire will
be aided and abetted by an anxious mother who is sure
her boy will die unless at once sent to her to be cared for
in what she considers the only proper way.  Here is the
obvious but difficult task of Home Service—to make it
clear that this particular soldier boy owes a further duty
to his country, to his dependents, and to himself,  namely,
the supreme  duty of  getting well, and that this can  be
accomplished far more quickly and surely under the care-
ful supervision and treatment which  he will  receive at
the military hospital.  Moreover, he will be taught how
to live so that he will  not relapse, or become a menace to
his family and his fellow-workers.  So the wisely guided
mother will not insist that he  come home, even on fur-
lough,  until the medical officers are ready  to discharge
him.
  The Surgeon General has not failed to provide tuber-
culosis  hospital facilities commensurate with  the in-
creased need.  Besides the regular Army hospital at Fort
Bayard,  N. M., new institutions at New Haven, Conn.,
Markleton, Pa., and Waynesville, N. C, are in operation,
with a total  present capacity of 1,305  beds.   Other
sanatoria at Azalea, near Asheville, N. C, Denver, Col.,
Whipple Barracks, Ariz., and Otisville, N. Y., will bring
the total up to 5,875  beds before the end of the present
year.

Following Up the Tuberculous Soldier
  In an  endeavor  to  meet the pressing  situation at the
time that great numbers of men were being discharged 
76
HOME  SERVICE
from the camps under the old policy, arrangements were
made whereby  the  Surgeon  General furnished to  the
National Tuberculosis Association  lists  of names of all
men discharged from the Army on account of tuberculo-
sis.  With  the  approval of  the  Surgeon General,  the
National Tuberculosis Association has, in turn, forwarded
these lists to the appropriate  local agencies in the three
following groups:  (i) State boards  or  departments of
health;  (2) State anti-tuberculosis associations; (3) Divi-
sion Directors  of Civilian  Relief of  the American Red
Cross.   The Division Directors have  been clearing these
names to the appropriate Home Service Sections in order
that they might cooperate with the  public and private
health  agencies and supplement their more specialized
medical activities with such measures of relief and ser-
vice to the family and to the patient himself as might be
necessary in each  case.  In carrying through this pro-
cedure, the strongest emphasis has been placed upon the
need of  intelligent cooperation to prevent duplication of
work among the three agencies, which would result in
excessive and unnecessary visiting of the patient and  his
family.   Under  the  operation of the new Army policy
above referred to, the problem should be distinctly mod-
ified and the burden upon Home Service and other local
agencies should be materially reduced.   Doubtless  the
cooperative  procedure already established in the several
Divisions will need to be continued in force with respect
to the after-care of men already discharged or who may
eventually be discharged after  sanatorium treatment, but
who will need subsequent care and advice in their homes.
  In taking account of the facilities for men discharged on
account of tuberculosis, it should be remembered that the
National Home for Disabled Volunteer Soldiers with ten
branches throughout the country will admit for institu-
tional care  and  treatment men discharged  from any 
              MEDICAL PROBLEMS            77

branch of the  service.  Of the  ten  branches, however,
only four have facilities for the care of men suffering from
tuberculosis.  These branches are at Dayton, O., the so-
called Mountain Branch  at  Johnson City,  Tenn.,  the
Pacific Branch  at  Los Angeles, Cab, and  the  Battle
Mountain Sanitarium, Hot Springs, S. D. Furthermore,
every soldier in the regular Army who is disabled on ac-
count of disease or injury contracted in line of duty is
entitled to become a beneficiary of the Soldiers' Home at
Washington, D. C.  This home has no branches, but if
the soldier in question has tuberculosis  he is sent from
the Home at Washington to Fort  Bayard, N.  M., for
treatment in the Army hospital there.  Soldiers already
under treatment at Fort Bayard, and eligible for admis-
sion to the Soldiers' Home on discharge are permitted .to
make application to that  effect and be admitted as bene-
ficiaries of the Soldiers' Home, whereupon  their  treat-
ment at Fort Bayard may continue without interruption
after their discharge.
  Under Section 303 of the  War Risk  Insurance Law,
provision  may be made by the Bureau of War Risk In-
surance for the sanatorium treatment of men entitled to
compensation after their discharge from the Army.  The
Bureau pays all expenses of travel and treatment in such
cases.  Accordingly, the  first thing for the  Home Ser-
vice Section  to do in assisting a man discharged on ac-
count of tuberculosis, as, indeed, for any other disease or
disability, is to make sure that  application for compen-
sation under the War Risk Insurance Law has been filed
and all the information desired by the Bureau in deciding
the  case  promptly  furnished.   In  frequent instances
Home Service workers have complained earnestly of the
delay and failure of the War Risk Bureau to act, when the
fault has been with the applicant and his advisers in not
carefully reading the instructions and providing the in-
\ 
/8               HOME  SERVICE
formation desired.  The Bureau  asks for no data which
is not absolutely essential under the law before it can act
on the application.  Home Service workers fail  in their
duty if they do not take the pains to learn from the  law
and from their Division offices just what is required and
see that  it  is forthcoming.  Especially to be emphasized
is the requirement that a statement of a local physician
or other  competent person be filed as evidence that  the
man is actually incapacitated from performing his regu-
lar work.

The Blind

  The blinded soldier makes a strong appeal to the emo-
tions, and perhaps for  this  very reason  the extent
and importance  of this form of  disability has been  ex-
aggerated in  the public mind.   The French experience
indicates that only a half of one per cent of the  soldiers
engaged in  battle are blinded.  In Canada the number of
soldiers blinded in three years of war was less than  the
number of civilians who  lost their sight in the  Halifax
disaster.   Nevertheless, be  the number large  or small,
humanity requires  the utmost effort for the alleviation
of their condition.
  It  must  be remembered that many blinded  soldiers
will be   suffering  from other  forms of disability.    In
blindness caused in the industries, ninety-eight per cent
of the eye  injuries  are without  such complications,
whereas in  war forty per cent are multiple, that is, these
blind men also have amputations of arms or legs or both,
facial burns,  destruction  of jaws, and so on.  To these
particularly unfortunate individuals, the nation owes a
lasting duty.  Patriotic zeal will provide adequate care
for these men at present, but only invested capital and
far-reaching plans will make their future certain.
/ 
              MEDICAL  PROBLEMS            79

  As  soon as the American soldiers, blinded in battle,
recover from their immediate wounds at the base hospi-
tal, the special work for them will be commenced.  At
first the chief effort will  be to cheer  them  and inspire
them with some degree of hope.  Later, as the  men im-
prove, they will be concentrated at the port of embar-
kation in France under care of a special staff which will
expand the measures of elementary instruction,  teaching
the men to get about and attend to their immediate needs,
in other words, teaching them "how to be blind."  On the
way home they will be grouped according to the degree of
injury, and upon  arrival in the United States they will be
sent to the United States Military General Hospital No. 7
at Baltimore for  further medical and surgical treatment
and special teaching.   The technical training given by
the Government will be the very best obtainable, and only
paid professional  instructors will be permitted to give it.
The ideal of the Government will be to place  every
blinded man in a condition to take care of himself and
those dependent  upon  him.   Where it is  possible for a
soldier to return to his old occupation or one allied to it,
the aim will be to have him do so.  Otherwise a special
suitable occupation will be taught, and in  many cases it
is hoped that the men will be able  to command a larger
salary after  taking  the training than  before  they lost
their sight. Among the trades and professions which will
be taught are broom-making, mattress-making, rug and
carpet  weaving,  telephone operation,  farm work, mat
making, tuning in piano factories, winding of  coils for
armatures, piano tuning as an individual trade, salesman-
ship, massage, and typewriting and  dictaphone  oper-
ating.  There will also be ample facilities for recreation
in  the  school, including table games, dancing, singing,
cross-country walking,  roller skating, attendance at the-
aters, musicales, and other entertainments, medicine ball, 
8o
HOME  SERVICE
push  ball, punching  bag, relax* races,  gymnastics,  field
sports, running, climbing, swimming, diving, and skating.

Red Cross Institute for the Blind
  To carry out this program a fortunate combination of
public and private resources has been effected.  Through
the generosity of  Mrs. T. Harrison Garrett, a suitable
estate of  ninety-nine acres at  Baltimore  was offered  to
the Surgeon General and accepted as the central hospital
and school for blinded officers and men.  The Red Cross
War Council has supplemented the Army's plan  by cre-
ating the  Red Cross Institute for the Blind, in order  that
certain phases  of the social and economic supervision  of
these men may be  provided for.   The medical officer  of
the Surgeon General's staff  who  is responsible  for the
official Army program for the blind has also been made
director of the Red  Cross Institute for the Blind, and will
work in close touch with the Federal Board for Vocational
Education, thus insuring thorough-going unity of policy
and control.
  One function of the Institute will  be  to  provide
certain necessary financial aid to equip the blind man
after his  reeducation  is completed.  For example, every
blind man who enters commercial life will need a type-
writer, and one of the special stenographic machines used
in conjunction with typewriters.
  A central  purchasing bureau  and  a central  selling
agency will be established to promote the successful ope-
ration of special workshops for those blind men who can-
not re-enter commercial or industrial establishments.
  A survey must be  made to unearth new occupations
for  the blind.  The average wage of the blind man is now
about S4.62 per week.  A  special board will undertake
this study of possible occupations not merely to deter-
mine the  type of education necessary but to suggest the 
MEDICAL  PROBLEMS
8l
adoption of appliances which will minimize danger and
increase efficiency.
  An important feature of the Red  Cross Institute for
the Blind will be a savings association to encourage thrift
and investment of  part of the liberal compensation and
insurance payments of $100 a month or more, which the
totally blinded men may  become entitled  to while still
under the care of the military authorities.
  Other  functions will be  to provide additional facilities
for the production of literature for the blind, to plan the
after-care and  supervision of  the blind men  placed in
industry, and to establish homes and arrange home work
for those who cannot go into factories or offices.
  The Red Cross Institute, as one of its most important
activities, will transport to Baltimore and maintain the
relative who will be responsible for the care of the blinded
man when returned to his home.  It is the intention to
instruct  one such  relative in the government training
school side by side with the blinded soldier, as  is now
done by the British and French.  The purpose is that the
blind man's family may be informed  as to his difficulties,
ambitions, training,  and  needs,  so  as to  prevent the
mental deterioration which often results from false  sym-
pathy.   Friendly  relations  between  the  family  and
teachers will  be a potent means of stimulating the interest
of the blind man.
  J The blind man has three serious  difficulties to over-
come before  he can make his  own living:  his own tim-
idity, the misplaced sympathy of his family and friends,
and the reluctance of industry to employ him.  To over-
come his own handicap the Government will educate him.
To offset the reluctance  of industry, it will be demon-
strated that the trained blind man can take his place and
do his part.  To help the family realize both the limita-
tions and the possibilities of the blind man, reliance is 
82
II O M !•  SERVICE
placed upon  the plan of educating one member of each
man's family and upon the intelligent and informed after-
care work which will be organized by the Red Cross In-
stitute for the Blind in cooperation  with  the  Home Ser-
vice Sections.
  In order that the Division  Bureaus of Civilian Relict
may  be  in a position to provide expert advice in  the
after-care of  the blind the same training facilities will be
made available to selected staff representatives  from  the
Division offices.

Deafness and Speech Defects

  The Medical Departments of the Arm)- and  Navy have
to deal not only with the defects of  hearing arising from
the ordinary  diseases of the ear as in civil life, but with
several groups caused directly  by the conditions of war.
These include four main types of injuries.  First is  the
shock due to a single violent explosion.   Many of these
patients  recover  their  hearing completely.    Another
type is the concussion deafness caused by the continuous
action of high explosive shells, shrapnel, hand grenades,
and the  more or less continuous play of machine guns.
These cases exhibit organic changes in the internal  ear
involving permanent impairment of hearing.  A third
class is the slowly progressive type of deafness which has
for  a long time been commonly observed among gunners
and artillerymen.   The fourth group  includes all cases
where the deafness results from wounds in the head.
  A special  section of the Division  of Physical Recon-
struction of the Surgeon General's office will have charge
of all-curative and educational measures for the deaf and
those suffering from speech  defects.  This work for  the
deaf and speech defect cases will for the present, at least,
be  organized at General  Hospital No.  n, Cape May, 
               MEDIC A L  PROBLEMS            83

N. J., and the parent school and teaching center will be
located there.
  All the leading institutions and  private organizations
for the care of the deaf and the foremost teachers and
experts in this field are ready to give every possible aid
in the plans of the Surgeon General.
  Reeducation  of the deaf will  take the  form  of lip
reading, stimulation  of  the auditory centers  in appro-
priate cases, and, where lip reading is impossible, manual
teaching.   Careful  study  of  individual  conditions of
speech defects will determine whether by operative pro-
cedure and other methods  something like normal  voice
production  can be restored.  In some instances certain
single muscles or groups of  muscles  are injured so that
they do not function, meaning that certain words cannot
be pronounced.  Here it is a problem of suggesting the
proper synonym to be added to the patient's vocabulary.
  From  the vocational point of view there are many oc-
cupations which a deaf man  can  take up with every
chance of success in competition with those who have
normal hearing.  Agriculture, printing, and tailoring have
been  found by the French to be especially appropriate.
  Two psychological  factors in connection with the deaf
are of particular importance in any consideration of the
social  after-care of  these  men, namely, suspicion and
social ostracism.  The deaf man, as is often  observed,
comes to believe that the conversation which he cannot
hear is directed toward him and his infirmity.  There is a
too common aversion to talking with a person who is
deaf or hard of hearing.  Added to the direct suffering
from the disability itself,  this avoidance goes far to create
an unhappy state of mind in the afflicted person.  By con-
trast, the blind are in  a sense more fortunate, in that the
world quickly comes  forward to them with its sympathy.
Doubly unfortunate  are those in whom facial wounds 
*4
HOME  SERVICE
have not only produced  repulsive appearance, but, as
often happens, have caused  defects of speech.  Uncon-
scious cruelty thus marks the attitude of society toward
both the deaf and those who are subject to the humilia-
tion caused by their inability to speak  in  the normal
manner.  There is a field for the application of much
intelligent  sympathy  in these  cases and  Home Service
workers may  well  take the  lead  in modifying the too
common attitude of the public.

"Shell  Shock" and Nervous Disorders
  These cases in the group of "war neuroses," as the doc-
tors prefer to  describe them, are of peculiar  importance
from the point of  view of family understanding and in-
fluence.  Moreover, they constitute a  surprisingly large
factor in the total of disabilities.  Twenty per cent of all
discharged Canadian  soldiers suffer from some form of
mental  or  nervous disorder.   And of  all the American
soldiers so  far returned from France, nearly twenty-five
per cent have  been discharged for this form of disability.
  The Division of  Neurology,  Psychiatry and Psychol-
ogy of the Army Medical Department has done much to
select the men at the cantonments who suffer from mental
defect or give evidence of such nervous instability that
they would be likely to suffer serious breakdown under
the stress  of  service.   Up to  the present time 35,000
such men have been discharged from the  Army.
  A special center for the treatment of war neuroses has
been  established  at Plattsburg, N.  Y.   A hospital  of
2,000 beds, capacity is planned, with  a staff of medical
officers,  nurses, and attendants all of whom  have had
experience  in  the  care of nervous diseases  in civilian
life.   All the appliances for electric treatment,  baths,
etc., which have demonstrated value in this work will be
provided.  Occupations will  be relied  upon  to a  great 
MEDICAL  PROBLEMS
85
degree for their wholesome effect in arousing and con-
trolling the patient's mental attitude.   Likewise, recre-
ation will be emphasized and provided for, but preferably
in such form as will enlist the patient's interest and his
active  mental.participation.  Mere diversions where  the
patients are entertained by the efforts of others have less
value.
   A careful study  will be made of each case from  the
point of view  of the personal, family,  and community
background.   In this respect,  Home Service Sections,
when specially  requested by the Division office, may later
be expected to give confidential information which will
be of definite help to the medical authorities in  effecting
exact  diagnosis,  prescribing treatment, and reaching a
decision as to  whether  and when the  patient may be
safely  discharged to complete his convalescence at home.
A social worker  trained in this special  field will be at-
tached to  the Plattsburg hospital and  will establish
contact  with the proper person in  each Division office
for the adjustment of questions of this kind.
   Essentially, the public should come to appreciate that
in many of these cases the physical condition depends on
the mental.  There is even a danger that such patients
will  be treated on  the  basis of physical symptoms in a
manner which will retard their recovery by relaxing their
will  through pampering care in hospitals and convales-
cent homes, making it harder than ever for them to exert
their mental powers and bring about their own improve-
ment.   Some who are familiar with the war neuroses even
regret  that such men are sometimes given a  generous
pension on the basis of their apparent physical disability,
which  exaggerates the difficulty of removing the real and
mental seat of the  trouble.
   It is not possible here to do more than suggest the ex-
ceedingly complex  and difficult nature  of the problems 
86
HOME  SERVICE
involved in treating the war neuroses, and to emphasize
the great importance in this field, above all, of controlling
and directing the family influence to aid the work of the
doctors.  War neuroses differ in  no respect from  those
with which the medical profession has long been familiar
in civilian life, except that the thoughts and scenes con-
nected with war and  battle constitute  the disturbing
cause of the mental condition.  And the same methods of
treatment which  have been found effective in civil life
are found equally successful in restoring the men suffer-
ing from the manifold forms of mental and nervous dis-
ability caused by the conditions of war.
  The term "shell shock" is inadequate, because  men
break down with the same disabilities who have never
been within sound of a gun.  Army  medical officers de-
clare that bad  news from home is one of the most potent
factors in causing nervous breakdown in the soldier.   The
lesson for Home Service is too obvious to need emphasis.
The family must be  safeguarded not only in order  that
the man may be able to fight the Germans, but that he
may conquer this intangible and elusive,  but  none  the
less real and formidable, danger to his health.
  A peculiarly discouraging phase of the problem familiar
to all who have dealt with nervous disorders, but thrown
now into prominence under  war  conditions,  is   that
friends, and even members of the family  too  often re-
fuse to believe that  there is anything wrong  with  the
patient, who often exhibits no physical symptoms which
even intelligent people somehow seem to demand as evi-
dence of disease.   Only the person who has been through
it himself knows how impenetrable is the cloud of incom-
prehension that intervenes between him and the one who
repeats that platitude so bitter to the patient—"there is
nothing the matter with him." 
MEDICAL  PROBLEMS
87
  Another very different and equally cruel misapprehen-
sion  said  to  have at first been observed  in the case of
British  soldiers suffering  with these conditions, is  that
the public, and even physicians, confuse these war neuroses
with insanity.
  No group of disabled soldiers will need more in the way
of intelligent treatment, and of sympathy, patience, and
moral support  on the part of the family.  This support
must be directed both toward prevention  and cure.  As
already indicated, the family must, if at all  possible,  be
prevented from sending discouraging letters which  may
have this  most untoward  effect on the men at the front.
And whenever a  soldier  breaks  down from this cause,
everything possible must be done to have  his family
and  friends understand the nature of his very real illness
and  help  him  make the  effort upon which  his  cure  so
largely depends.

The Insane
  Unhappily, the insanity rate among soldiers is  three
times as great  in war as in peace.  To meet the need for
enlarged provision for the treatment of the insane, the
Army  hospital at  Fort Porter, N. Y., has  been desig-
nated for  this purpose.  Some of  those who are incurable
will  be discharged to  the care of relatives, or of state
hospitals  in  the  states  from  which  they came.   The
remainder will  be transferred to St. Elizabeth's Hospital
Washington, D. C.

Other Forms of Disability
  An approximate idea of the distribution of the causes
of disablement in the service may be obtained from the
following  table1  analyzing the causes of  all discharges
for disability from the British Army and Navy from the
  1 Cf. Hutt, C. W., "The Future of the Disabled Soldier," p. 2. 
88
HOME  SERVIC E
beginning of the war to May 31,  1916.   It is  said  that
very slight change,  if any, had taken  place in these pro-
portions to March,  1917.
                                             Number   Per
                                            discharged  cent
Chest complaints                              3.<>4°      <)<)
Rheumatism                                   '.365      4()
Heart diseases                                 -.503      7.4
Epilepsy                                       353      10
Nervous diseases                               999      3-°
Miscellaneous disabilities—Bright's disease, de-
  bility, gastric ulcer, varicose veins, etc.        2,870      8.5
Insanity                                       168      0.5
Eyesight cases                                 1,381     4-1
Deafness                                       985      2.9
Wounds and injuries to legs (necessitating am-  •
  putation)                                   1,366     4.1
Wounds and  injuries to arms or hands (neces-
  sitating amputation)                          858     2.5
Wounds and  injuries to legs (not necessitating
  amputation)                                 5,345     x5-8
Wounds and injuries to hands (not necessitating
  amputation of complete hand)                2,496     7.4
Wounds and injuries to arms (not necessitating
  amputation)                                 4,688     14.0
Wounds and injuries to head                    2,446      7.3
Frost bite (including amputation of feet or legs)    394      1.2
Miscellaneous wounds  and injuries  (not  in-
  cluded in above)                             2,122      6.3
Hernia                                        334      i-O
      Total discharged for disability         33,719      100

  It is possible that this table may not indicate  a dis-
tribution which will hold true  for  the American Army,
but it is fair to deduce from it  what is,  indeed, the fact,
namely, that a great  majority of discharged men will
return  to civil life  with  perhaps  little more  need  of 
              MEDICAL  PROBLEMS            89

medical  attention  than  would  be expected  among a
group  of somewhat  older  men in  civilian  life.   The
plans for the  American soldier provide  for thorough
observation  and  treatment  of those  suffering  from
familiar forms of medical disability, such as lesions of the
heart, kidney, stomach, and other internal organs, as well
as for the wounded and for the special groups of diseases
already discussed.  The present Army policy of thorough-
going physical reconstruction  contemplates that every
sick or wounded man, regardless of the nature of his dis-
ability, shall be returned to civil life only after everything
possible has been done to cure the particular disorder and
to send him back  home, if at all possible,  in  as good or
even a better state of health than  when he entered  the
service.
  Those suffering  from diseases such as tuberculosis,
insanity, and  other mental  and nervous disorders may
require   treatment  for  a  considerable  period  under
special  conditions.   For the most part,  however,  the
time of retention in Army hospitals after  return to  the
United States will be relatively short.  Some will be so
nearly well as to permit of their discharge almost imme-
diately upon landing.  A considerably larger number will
require  treatment for a few weeks or a month or  two
in the general hospitals.  But, altogether, perhaps ninety
per cent  of the returned disabled men will be discharged
after a comparatively brief period of  treatment and will
require  no special measures  of  physical  and  vocational
reconstruction.
  Yet it  must not be thought that Home Service is with-
out responsibility in relation to this very group.  These
men will  go directly to their homes, and probably to their
old occupations, without passing through the systematic
course of treatment and training which the Government
will provide for their more seriously disabled comrades. 
90               11 O M E  S E R V I C E
They will, therefore, miss some of the compensating ad-
vantages which the more seriously  injured will  obtain.
It may well be that the less seriously disabled will for a
time  need  the help of Home Service  even more than
their  comrades returning after more extended hospital
care  and  special  training.   Perhaps a  too  ambitious
attempt to resume a former occupation under unfavor-
able conditions will result in unexpected breakdown and
again precipitate a family problem to be carefully studied
and solved.  Always, in such cases, the man may  turn to
the advantages of training provided by the Vocational
Rehabilitation Law.

Reporting of Names to Home  Service Sections
  Arrangements have been  made  through  Red  Cross
channels to furnish to each Division  Director of Civilian
Relief, who will in turn clear the information to the appro-
priate Home Service Section, the names of all soldiers
and sailors discharged at the ports of disembarkation, as
well as from the various Army hospitals.  This will en-
able the  Home Service Section  in  each community  to
know immediately of. the return or expected return of a
disabled soldier to  that town or city, and with discretion
and in accordance with the established principles outlined
in the Manual of Home Service (A R C 201) to take the
necessary  steps  to insure that all  needed  and desired
assistance is forthcoming  to each such man and to his
family. 
              IX.    Organization

  The after-care of disabled soldiers and sailors, so far
as this is a Red Cross problem, is to  be  accomplished
through the Home Service Section  in each locality.  No
new Chapter  committee is required  since the work by
its very nature is an integral part of Home Service to the
family.   There is no essential difference in the methods
and principles  underlying  assistance rendered  to the
family of a soldier undergoing  treatment  and training,
and that rendered to the family of a soldier at the front.

Organization within the Section
  In adapting the work of the Home Service Section to
this new task, little or  no change in the form of organiza-
tion is necessary.  Nevertheless, it must be held in  mind
that  the  Home Service  Section  is  now  dealing  with
problems changed by a new factor, the return of an ex-
soldier who may himself be struggling with a complex
group of difficulties  further affected by the bearing of
family  relationships   and  family  problems  upon his
condition.   It is chiefly a question of emphasis, calling
for the designation from within  the Section, or the  addi-
tion from  without,  of competent persons—men  espe-
cially—with interest in this work.   The same visitors,
often, should  be used  in assisting the family of  the re-
turned soldier as in  assisting the families of those in
active service.  But it is exceedingly important that  a
man—a member of the section with sound judgment and
personal influence—should have those personal dealings
with the returned soldier which concern his own  affairs.
  It is good organization to find for the Section,  one or 
92
HOME  SERVICE
more  specially  qualified  persons, who will make it their
duty  to study  the  whole question of after-care of dis-
abled men,  and to develop  the educational  aspects  of
this work.

This is Home Service  Work for Men
  Direct dealing with the man himself, while undergoing
treatment or training, or starting out in a new job, is
first  of all a man-to-man problem.   A returned soldier
or sailor  will naturally prefer to take his personal prob-
lems  and difficulties  to  an older man friend for  sym-
pathetic  advice.  This new duty of  Home Service Sec-
tions  will appeal to many men in business,  labor,  and
professional circles.   It  is a new opportunity  for per-
sonal service in the war  which  will attract men of sym-
pathy and judgment.

Strengthening the Consultation Committee
  Aside from the men who will have personal relations
with  returned  soldiers  and  sailors,  there is need  and
room for others on the Consultation Committee who are
qualified to give expert  or professional advice.   Repre-
sentatives from both the employers and  the  workmen's
groups should  be enrolled.  This  applies especially  to
the  larger   centers  where  Consultation  Committees
(See  ARC  201,  page  49)  already  exist.   In  smaller
towns elaboration of organization  should be avoided—
the whole Home Service Section meeting in consultation
on difficult problems.

Cooperation
  Effective organization requires that the best working
relations  be established with other  interested  commu-
nity  agencies.   While  the Home  Service Section  will
take  its  just responsibility  for assisting  the family  of 
                  ORGANIZATION                93,

the disabled soldier and the man himself, there may be
other organizations properly interested and equipped to
help.   In many cities there are organizations to help
the blind, the deaf, the mentally defective,  the tubercu-
lous,  and others with severe  disabilities.   Cooperation
should be developed with these organizations, nationally
and locally.   Likewise, employers,  chambers of  com-
merce, and other business men's organizations,  on the
one hand, and organizations of workmen, on the other,
will be specially concerned to help with the placement of
disabled men.  With all  of these  agencies the  Home
Service Section will cooperate in order  to avoid waste
and duplication, and  to utilize the specialist effectively
at every turn. 
                    Appendix  I

     Vocational Rehabilitation  Law

  An 'Act To provide for vocational rehabilitation and return to civil
employment of disabled persons discharged  from the military or  naval
forces of the United States, and for other purposes.

  Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, That this Act
shall be known as the Vocational Rehabilitation Act.  That the
word "board," as hereinafter  used  in this Act, shall mean the
"Federal  Board  for  Vocational  Education."  That the word
"bureau," as hereinafter used in this Act, shall mean the "Bureau
of War Risk Insurance."
  Section 2.  That every person who is disabled under circum-
stances entitling him, after discharge from the military or naval
forces of  the  United States, to compensation under Article III
of the Act entitled "An  Act to amend an Act  entitled 'An Act to
authorize the establishment of a Bureau of War Risk Insurance
in the Treasury Department'," approved October sixth, nineteen
hundred and seventeen, hereinafter referred to as "said Act," and
who, after his discharge, in the opinion of the board, 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 unable  to  continue the same
successfully, shall be furnished by  the  said board, where voca-
tional rehabilitation is feasible,  such course of vocational re-
habilitation as the board shall prescribe and provide.
  The board shall have power, and  it shall be its duty, to furnish
the persons included in  this section  suitable courses of vocational
rehabilitation to be prescribed and provided by the board, and
every person electing to follow such a course of vocational re-
habilitation 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 
VOCATIONAL  REHABILITATION LA W   95
he would be entitled under Article III  of said 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 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 compensation shall be treated
as his monthly pay: Provided, That if such person willfully fails
or refuses to follow the prescribed course of vocational rehabili-
tation 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 and the said bureau shall, during such period
of failure or refusal, withhold any part or all of the monthly com-
pensation due such person and not subject to compulsory allot-
ment which the said board may have determined should be with-
held: 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.
   The military and naval family allowance appropriation pro-
vided for in section eighteen of said Act shall be available  for the
payment of the family allowances provided by this section; and
the military  and naval compensation appropriation provided for
in section nineteen of said Act shall be available for the payment
of the monthly compensation herein provided.  No compensation
under Article III of said Act shall be paid for the period  during
which any such person  is furnished by said board a course of
vocational rehabilitation except as is hereinbefore provided.
   Section 3.  That the courses of vocational rehabilitation pro-
vided 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 States, to compensation
under Article III of said Act and who is not included in section
two hereof. 
96
H O M K  SERVICE
  Section 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 persons as are
required to follow such courses as 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, subsistence, and other necessary expenses of such
persons while  following the prescribed courses;  to do all things
necessary to insure vocational rehabilitation; to provide for the
placement of rehabilitated persons in suitable or gainful occupa-
tions. The board shall have the power to make such rules and
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 gainful occupations.
  Section 5.  That it shall also be the duty of the board to make
or cause to have made studies, investigations, and reports regard-
ing the vocational rehabilitation of  disabled persons and  their
placement in suitable or  gainful occupations.  When  the board
deems it advisable, such studies, investigations, and  reports may
he 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
advisable in performing the duties imposed upon it  by this Act.
  Section 6.  That all medical and surgical work or other treat-
ment necessary to give functional and mental restoration to dis-
abled persons prior to their discharge from the military or naval
forces of the United States shall be under the control of the War
Department and the Navy Department, respectively.  Whenever
training is employed as a therapeutic measure by the War Depart-
ment or the Navy Department a plan may be established between
these agencies and the board acting  in an 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 departments 
     VOCATIONAL  REHABILITATION  LAW  97

shall act in an advisory capacity with the board in  the care of
the health of the soldier and sailor after his discharge.
  The board shall, in establishing its plans and rules and regu-
lations for vocational  training, cooperate with the War Depart-
ment and the Navy Department in so far as may be necessary
to effect a continuous process of  vocational training.
  Section  7.  That  the board  is hereby authorized and  em-
powered 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," 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 disbursements therefrom, shall be submitted
annually to Congress by said board.
   Section  8.   That  there is hereby appropriated,  out of any
money in the Treasury of the United States not otherwise appro-
priated, available immediately and until  expended, the  sum of
$2,000,000 or so much thereof as may be necessary to be used by
the Federal Board for Vocational Education for the purposes of
this  Act,  to wit, for renting  and  remodeling buildings  and
quarters, repairing, maintaining, and equipping same, and for
equipment and other facilities necessary  for proper instruction
of disabled persons, S250,ooo; for the preparation of instructors
and salaries of instructors, supervisors, and other experts, includ-
ing necessary traveling expenses, $545,000; for traveling expenses
of disabled persons in connection with training and for lodging,
subsistence, and other necessary expenses in special cases of per-
sons  following prescribed courses, $250,000;  for tuition for dis-
abled persons pursuing courses in  existing institutions,  public
or private, $545,000;  for  the placement and  supervision after
placement  of. vocationally  rehabilitated  persons, $45,000;  for
studies, investigations, reports, and preparation of special courses
of instruction, $55,000; for miscellaneous contingencies, including
special mechanical appliances necessary in special cases for dis- 
9«
HOME  S E R V I C I!
abled men, $110,000; and for the administrative expenses of said
board  incident to performing the duties  imposed by  this Act,
including 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  necessary ex-
penses incurred by the members of the board and  by its em-
ployees under its orders,  including attendance at meetings of
educational associations and other organizations, rent and equip-
ment of offices in the District of Columbia  and elsewhere, pur-
chase of books of reference, law books, and periodicals, stationery,
typewriters and exchange thereof, miscellaneous supplies, postage
on foreign mail, printing and binding to be done at the Govern-
ment Printing Office, and all other necessary expenses, $200,000.
  Section 9.  That said board shall  file with the Clerk of the
House and the Secretary of the Senate on July first and  every
three months thereafter, for the information of the Congress,
an itemized account of all expenditures made under this Act,
including names  and salaries of  employees.  Said board  shall
also  make an annual report to the Congress of its doings  under
this Act on or before December first of each year.
  Section 10.  That section three hundred and four of the Act
entitled "An Act  to authorize the establishment of a Bureau of
War Risk Insurance in the  Treasury Department," approved
September second, nineteen hundred and fourteen, as amended,
is hereby repealed.
  Section ii.  No person of draft age physically fit for military
service shall be exempted from such service on account of  being
employed under the terms of this Act.
Approved June 27, iqi8. 
                   Appendix II

               List of References

  The following  articles among  others have been freely
used in the preparation of this pamphlet  and are recom-
mended to those who desire  to obtain a  wider acquain-
tance with the subject:
I.  Todd, John L.  The French System for Return to Civilian Life
   of Crippled and Discharged Soldiers.  Publications of the Red
   Cross Institute  for Crippled and  Disabled Men.  Series I,
   No. 5.
2.  McMurtrie, Douglas C.   The War  Cripple,  Columbia
   University War Papers.  Series 1, No. 17.
3.  Harper, Grace.  Vocational Reeducation for War Cripples in
   France.  Publications of the Red Cross Institute for Crippled
   and Disabled Men.  Series II, No. 1.
4.  Brock,  L. G.  The Reeducation of the Disabled.  Nineteenth
   Century and After, London, 1916, lxxx, 822-835.
5.  Jarrott, Thomas L.   The Problem  of the Disabled Soldier.
   American Journal of Care for Cripples, 1917, iv, 226-243.
6.  Hutt, C. W.  The Future of the Disabled Soldier.   London,
   1917.
7.  Federal Board for Vocational Education:
   Bulletin No. 5 (Reeducation Series No. 1), Vocational Rehabili-
     tation of Disabled Soldiers and Sailors.
   Bulletin No.  6 (Reeducation Series No. 2), Training of Teach-
     ers for Occupational Therapy for the Rehabilitation of Dis-
     abled Soldiers and Sailors.
   Bulletin No.  15  (Reeducation  Series No. 3), The Evolution of
     National Systems  of  Vocational Reeducation for  Disabled
     Soldiers and Sailors.
8.  The  Red Cross  Institute  for Crippled  and Disabled Men,
   311  Fourth Avenue,  New York City,  has issued several series 
IOO
HOME  SERVICE
   of publications in  this field, some intended for the general
   reader and others for those interested in special or technical
   aspects of the problem.   Every person who is interested in
   this subject should write to the Institute and ask to be placed
   on the mailing list.
9.  American  Journal of Care for  Cripples, 2929 Broadway,  New
   York City.   From  the  beginning of the  war  this quarterly
   has  reprinted a large number  of the most significant articles
   appearing in other domestic and foreign periodicals.
10. Recalled to Life.  A journal devoted to the care, reeducation,
   and return to civil life of disabled sailors and soldiers.  Edited
   by Lord Charnwood and  published  by John  Bale,  Sons »x
   Danielsson, Ltd., Oxford  House,  83 Great Titchfield Street,
   Oxford Street, London W. 
Index
After-care  of the  disabled  soldier  or
  sailor, 62-71.
Agencies other  than  Federal  Govern-
  ment, may care for disabled  men, 3,
  44;  The Red Cross, 3, 14, 44; state
  and  local,  9;   private,   9;  their
  assistance  will contribute to national
  welfare,  11;   must operate under
  guidance of national authorities, 71;
  special, for blind, deaf, etc., 92.
Agricultural  courses in France,  30.
Allotment and allowance continued dur-
  ing period  of training, 52.
American Association for Labor Legis-
  lation, 26.
American Federation of Labor, 44.
American Journal of Care for Cripples,
  quotation  from, 57.
Amputation: centers for reconstruction
  of cases of, 31;  percentage  of cases
  of, 72; percentage in Canada, 72.
Army and  Navy  medical  authorities,
  reciprocal  advisory  service with  Fed-
  eral Board for Vocational  Education,
  13-
Army and Navy medical departments:
  responsible for measures for  restora-
  tion of the disabled, 12; provisions of,
  for wounded men, 18;  forthedeaf, 82.
Army medical  department:  division of
  physical reconstruction, 20, 82;  divi-
  sion  of  neurology,  psychiatry,  and
  psychology, 84.
Army nurse corps: compensation  for,
  47;  insurance for, 49.
Artificial appliances for the crippled:
  government should  supply, 25; mak-
  ing of, an  appropriate  occupation for
  the  disabled,  31; law  requiring  gov-
  ernment to provide, 45.

Barres, 57-
Blindness: percentage of, in the armies
  of  France,  78;   percentage  of,  in
  Canadian  army,  72, 78; complicated
  with other disabilities, 78;  care of
  American blinded commences at base
  hospital, 79;  care  continued in the
  United  States, 79;   trades and pro-
  fessions taught, 79;  recreation for, 79.
Brieux, 57.
Brighton Hospital: trades taught in, 31.
British Army and Navy.   See  Disable-
  ment in service, causes of, fn the British
  Army and Navy.
Bureau des Muliles, 24.
Bureau  of War  Risk  Insurance:  ac-
  knowledgment to,   4;   will  set  in
  motion procedure to establish claims,
  53; will consider evidence on effect
  of military duty on pre-existing dis-
  ease or injury, 53; Home Service may
  supply facts to, S3;  provides medical
  examination, etc., 70;  makes  provi-
  sions  for sanatorium  treatment  of
  men, 77.

Canadian Military  Hospitals Commis-
  sion, 58.
Canadian soldiers: number of amputa-
  tion cases, 72; number of blind, 72,
  78;  percentage suffering  from war
  neuroses, 84.
"Carry On," new publication of  Surgeon
  General's office, 59.
Chamber of Commerce of the United
  States,  44.
Choice of occupations:  previous edu-
  cation  and  former  experience  the
  guide in, 32; the best practice  in, 32;
  care  in,  to  avoid  unremunerative
  work, 33; vocational counselors will
  assist in, 34; determined by  each in-
  dividual's vocational possibilities, 34;
  make-up of committees for assisting
  in, 34;  vocational  officers will work
  with  Army  medical authorities  to
  assist men in, 34.  See also Occupation.
Civilian and military  control of the ex-
  soldier distinguished, 12, 13,  29.
Civilian control of vocational training.
  See Vocational Rehabilitation  Bill and 
102
HOME   SERVICE
  Civilian and military control of the ex-
  soldier distinguished.
Civil rights act, 37.
Committees  on  vocational  guidance
  make-up of, 34.
Community resources, 71.
Compensation, 45-54-
Compensation laws as affecting the dis-
  abled, 41.
Compensation  laws:   Home   Service
  workers may cooperate for modifica-
  tion of, 44.
Compensation:   cemporary  withhold-
  ing of, 13; a portion conditioned upon
  the taking of vocational courses, 13;
  for permanent  injury not reduced by
  economic recuperation,  14, 48, 49;
  monthly rates for total disability, 47,
  48;  a graduated percentage for par-
  tial disability,  48;  continues during
  temporary disability, 49;  adjusted to
  the family,  50;  conditions of, during
  vocational reeducation, 52.
Compulsory vocational training.  See
  Compensation.
Conservation  of industrial resources, 7.
Conservation  of officers and men, 20.
Crippled soldier:  letter from,  to  Sur-
  geon General, 65.
Cripples.   See  Disabled  soldiers  and
  sailors.
Curative workshops,  23.

Deafness and speech  defects:  result
  from four types of injury, 82;  cura-
  tive and  educational measures under
  division  of  physical reconstruction
  of  Surgeon  General's office, 82; Gen-
  eral  Hospital  at Cape  May,  N. J.,
   82;  forms  of  reeducation for  those
  afflicted  with,  83;  occupations for,
   83; difficulties met, 83.
Department  of   Civilian  Relief:  its
   place in dealing with  the disabled
   soldier, 15, 36.
Department  of   Military  Relief:  its
   place in dealing with the soldier and
   sailor, 15;  supervises Red Cross In-
   stitutes  for the  Disabled  and  the
   Blind, 36.
 Director General of  Civilian Relief, 4;
   promise to "the men who come back."
   67.
Disabled soldiers and sailors:  debt to,
  when discharged,  3;  estimated  per-
  centage of American, 5, 30; return of,
  brings new problems, 5. 63; questions
  concerning,  6;  attitude  of public
  toward,  6;   country's debt to, 7;
  state should make skilled workmen of,
  8; a  national problem,  8;   a public
  duty, 8;  must  be restored  to  their
  own homes,  9; national homes for, o;
  state  homes for,  9;  percentage  of,
  in France and England,  10,  n;  per-
  centage of,  in Germany,  11; on the
  Western front,  11;  cooperation of
  other agencies with the Government
  in the reabsorption of, 11; duty of the
  Government toward,  12;  recommen-
  dation of the Surgeon General of the
  Army  concerning,  20;   approval of
  this  recommendation by the Secre-
  tary of War,  20;  percentage  of re-
  turned requiring vocational  training,
  30, 72;  how  not  to treat  the, 55;
  mental  state  of,  64;  mental  state
  portrayed in  letter  from  a  cripple,
  65; percentage of medical cases, 72;
  percentage of surgical cases,  72;  per-
  centage of amputation,  72;  percen-
  tage of amputation in Canada, 72;
  percentage of  blindness,  72,  78.  See
  also Handicapped men.
Disablement in service, causes of, in the
  British Army and Navy, 87.
Division Directors of  Civilian Relief:
  will furnish  form letters, 53;  place in
  the care of  tuberculous  soldiers,  76.
Division of neurology, psychiatry, and
  psychology  of the Army medical de-
  partment.   See  Army  medical  de-
  partment.
Division  of  physical  reconstruction.
  See Army medical department.

Ecole Joffre:  trades taught at, 30.
Educational activities (official) in Amer-
  ica, 58.
Employers of  labor.  See Handicapped
  men.
Employers: what they should not  do,
  42; what they should do, 43.
Employment  conditions:  present and
  future, 38. 
                                   INDEX                            103

Employment  for  the disabled soldier    General hospitals for physical recon-
  and sailor, 38-44.                         struction.   See Reconstruction  hos-
Employment, should be  found by  the      pitals.
  Government for both  the able and    General Order, No. 47, 74-
  disabled ex-soldier, 38; need of  ex-    Gorgas, Surgeon General:  quoted, 10.
  pert placement, 39.                     Government.  See Federal Government,
England: occupations taught in, 31.        responsibility of, to  disabled men.
Family:  the part of the, in reconstruc-
  tion,  16;  Home  Service must  influ-
  ence, 16, 27, 35;  attitude of, has im-
  portant bearing on the ex-soldier, 34,
  35-
Federal  Board for Vocational Educa-
  tion: acknowledgment to, 4; a civil-
  ian department of the Government,
  13;  has control of vocational educa-
  tion of discharged men, 13;  reciprocal
  advisory service with Army and Navy
  medical authorities,  13;  has power
  to utilize existing agencies, 13;  pro-
  vides  employment for  the disabled
  through the United  States  Depart-
  ment of Labor, 13, 39; French figures
  quoted by, on percentage of men who
  continue  training,  22;  personnel of,
  29;  will assist men in choice of occu-
  pations, 34; what may be expected
  of it in the industrial field, 40;  pays
  certain expenses  to disabled men fol-
  lowing prescribed courses, 52; assists
  in education of public opinion,  59.
Federal Government:  responsibility of,
  to disabled men,  3. 8, 9.  12, 13, 14. 25-
Foreword, 3.
Form  letters furnished by Division Di-
  rectors of Relief, 53-
Fort  Bayard, New Mexico, Army hos-
  pital, 77-
Fort Porter, New York, Army hospital
  for the insane, 87.
France:  occupations  which  offer the
  greatest appeal to the disabled in, 30;
  education of public  opinion in, 57;
  reeducation is voluntary in, 57-
The Future of the Disabled Soldier, 87.


Garrett, Mrs.  T. Harrison:  gift of, for
  central hospital and school for blinded
  officers and men, 80.
General Hospital,  No. n, 82.
General Hospital, No.  7, 79.
Handbook of Information for Home Ser-
  vice Sections, 47.
Handicapped  men:  sought as educa-
  tional officers,  24;  may become em-
  ployers of labor,  33;   not  a special
  class, 39.  See also  Disabled soldiers
  and sailors.
Harper,  Miss Grace:  quotation from,
  on time for beginning vocational edu-
  cation,  24;  quotation  on vocational
  guidance, 34-
Home  Service Sections:  work for,  in
  reestablishing  the  disabled in civil
  life,  3;  resume of duties of, in rela-
  tion to rehabilitation, 15; should in-
  fluence family and  neighborhood  in
  the  treatment of the  disabled,  27;
  opportunity for, in assisting ex-sol-
  dier to a sound vocational  diagnosis,
  34; duties of, in training the disabled,
  36;  in placement, 44;  in matters re-
  lating to compensation, 53; may aid
  in forming  public opinion, 60;  may-
  reach their  goal in after-care, 62, 69;
  may  furnish  medical  service,  69;
  when responsibility  is applicable, 72;
  place of, in care of tuberculous sol-
  diers, 76, 77, 78; will work with Red
  Cross  Institute  for the  Blind,  82;
  may use their good  offices for  the
  deaf, 84; place of,  in  the  treatment
  of war neuroses, 85;  responsibility of,
  to  the  less seriously  disabled,  90;
  names of all disabled soldiers reported
  to, 90; organization within, for after-
  care, 91; but little change  in present
  form necessary,  91; work for men,
  92;  strengthening  the  consultation
  committee,  92;  cooperation   with
  other community agencies, 92.
 Hospitals  for physical  reconstruction.
  See Reconstruction hospitals.
 Hotel des Invalides, 9.

 Indian School, Carlisle, Pa., 20. 
104                     home

Industrial accidents: methods and prin-
  ciples of after-care of disabled men as
  applied to,  26;  number of  victims
  of, 26.
Industrial resources.   See Conservation
  of industrial resources.
Industrial surveys, 40.
Insane: Army hospital for, 87;  propor-
  tion of, among soldiers, 87.
Insurance:  provided  for by  the War
  Risk Insurance Law, 49-
Interallied Conference  on After-care, 69-
Invalided Soldiers' Commission, 58.

Jones, Sir Robert: testimony of, con-
  cerning value of occupation in ortho-
  pedic work, 21.

Lakeman, Curtis E., 3.

Mack, Judge:  on War Risk Insurance
  Law, 46, 51.
Manual of Home Service, 90.
Medical departments of  the Army and
  Navy.  See Army and Navy  medical
  departments.
Medical problems, 72-90.
Medical service, 69.
Mental state:  of the disabled  man, 64;
  portrayed in letter from a cripple, 65.
"Men who come back:" promise to, 67.
Milbank,  Jeremiah:   gift  of,  to Red
  Cross Institute, 35.
Military control of disabled men, when
  it  ends,  13.   See also Civilian  and
  military control distinguished.
Military Surgeon, 11.
Moratorium.  See Civil rights act.
Motion picture films, 58.

Names of disabled soldiers reported to
  Home Service Sections, 90.
National  Government.    See   Federal
  Government, responsibility of, to dis-
  abled men.
National Home for Disabled Volunteer
  Soldiers, 76.
National Institute for the Training of
  War Cripples: trades taught in,  31.
National Tuberculosis Association,  76.
Navy  nurse corps:  compensation for,
  47;  insurance for, 49.
Nurse or attendant, 47.
SERVICE

   Occupation: value of, in convalescence,
     21; Sir Robert Jones on, 21;  mental
     and moral effects  of, 22; advantage
     of beginning in hospital.  2y, curative
     workshops,  23;   'ward'  work  dis-
     tinguished from vocational training,
     23; work in  hospital shops distin-
     guished from vocational  training, 23.
     See also Choice of occupations and Vo-
     cational training.
   Official Bulletin,  20.
   Orthopedic work:  restoring the use of
     limbs, 21; value of occupation in, 21;
     testimony of Sir Robert Jones, 21.

   Pay  and  allowances  from the Govern-
     ment continue during training of the
     disabled, 40.

   Pensions:  in the colonies, 45;  since the
     Civil War, 45;  quotation  from British
     authority on, 46;  in  England, 48.
   Persons, W. Frank, 4.
   Placement:  need of expert.   See  Em-
     ployment.
   Plattsburg, N. Y.:   special center for
     treatment of war neuroses, 84.
   Politics:   danger of after-care becoming
     a question of, 51.
   Principles and program of Home Service
     for the  disabled man, 5-17-
   "Professionals:" soldiers of earlier Euro-
     pean wars, 9.
   Public opinion, 55-61.
   Public opinion:   in France,  57; educa-
     tion of  American, 58; in  Canada, 58;
     campaign conducted  by  Canadian
     government, 58.
   Recalled to Life:  quotation  from Capt.
     Basil  Williams  in,  46;  quotation
     from editor of, 56.
   Reconstruction aides, 25.
   Reconstruction:  extent of the problem
     of, 10;  character of, contemplated by
     Army  program, 89.
   Reconstruction  hospitals:  list  of, pro-
     vided by the Government, 19; work-
     shops in connection with, 23; special
     educational officers for, 24.
   Recreation, 70.
   Red  Cross Institute for Crippled and
     Disabled Men: statistical study pub-
     lished  by, 10;  gift of Jeremiah Mil- 
INDEX
105
  bank, 35;  offers vocational training
  in specially selected trades, 36;  pub-
  lishes popular  and technical papers,
  36;  organized  under Department  of
  Military  Relief of  Red Cross, 36;
  publicity  work of,  59;  has a lecture
  bureau, etc., 60.
Red Cross Institute for the Blind:  or-
  ganized under Department of  Mili-
  tary  Relief of  Red Cross,  36;  on
  estate given  by  Mrs.  T.   Harrison
  Garrett,  80;   created  by  the War
  Council,  80;  medical  officer of the
  Surgeon General's staff, a director of,
  80; will work in unison with Federal
  Board for Vocational Education,  80;
  will  provide financial  aid, 80;  pur-
  chasing  bureau  and  selling agency
  will be  established, 80; new occupa-
  tions will be sought, 80; a savings as-
  sociation  will be a feature, 81; will
  maintain a relative of the blinded
  soldier, 81; will give training facilities
  to staff representatives of Division
  offices,  82.
Red Cross:  obligation of, to disabled
  men, 3; participation  of, in the care
  of disabled men, 14; community or-
  ganizations should work with, 44.
Reeducation of the blind.  See Blind-
  ness.
Reeducation of  the deaf.  See Deafness
  and speech defects.
Roehampton Hospital:   trades taught
  in, 31.

St.  Elizabeth's Hospital,  87.
Secretary of War approves  new  policy
  for care of the disabled, 20, 74.
"Shell shock" and nervous disorders.  See
  War  neuroses.
Soldiers' Home, Washington, D. C, 77-
Speech  defects.   See   Deafness and
  speech defects.
A Square deal for the Crippled Soldier,
  59-
Surgeon General of the Army: acknowl-
  edgment  to, 4; policy of, concerning
  disabled men, 20,  74;   policy of, will
  result  in  conserving  officers and
  soldiers, 20; will assist men in  choice
  of occupations through medical  au-
  thorities, 34; assists in educating pub-
  lic opinion,58;  letter to, from a crip-
  ple, 65. See also Gorgas.

Time of retention in  Army hospitals
  relatively short, 89.
Trades which can be taught, 30; occu-
  pations which  offer the greatest  ap-
  peal in France, 30;  taught at "Ecole
  Joffre," 30;  agricultural  courses  in
  France, 30;  taught  at National  In-
  stitute in Paris, 31;  taught in Eng-
  land,  31;   at   Roehampton   and
  Brighton, 31;  in Canadian schools,
  31;  making of  artificial  limbs  and
  appliances, 31.
Training of disabled men, 29-37.
Treatment of disabled men,  18-28.
Tuberculosis   Army   hospital.     See
  Fort Bayard, N. Mex.
Tuberculosis:  former policy of Govern-
  ment with reference to, 73;  present
  policy, 74; number discharged for, 73.
Tuberculosis hospital facilities, 75-
Tuberculous soldier:  follow-up care of,
  75-

United States Department of Labor:
  to assist in placing the ex-soldier, 13,
  39-
United States Military  General Hos-
  pital No. 7  for the  Blind, 79',  gift of
  Mrs. T. Harrison Garrett, 80.
United States Public Health Service, 70.

Vocational  counselors:   will  assist in
  choice of occupations, 34-
Vocational education: the beginning of.
  See Vocational training.
Vocational guidance, 33-
Vocational  reeducation:   provided for
  in the Vocational Rehabilitation Law,
  50;  a national policy, 50.  See also
   Vocational  training  and  Vocational
  Rehabilitation Law.
Vocational  Rehabilitation Law:  recog-
  nizes  national  responsibility to  dis-
  abled men, 3;  analysis of,  12;  calls
  for  civilian  authority in re-making
  the soldier  into a  citizen  13,  29;
  promises expert employment service,
  39;  attitude of American Federation
  of Labor and Chamber of Commerce
  of  the  United  States toward,  44; 
106                     HOME   SERVICE
   makes reeducation a national policy,
   50; social significance of, 50;  supple-
   ments War Risk Insurance Law, 52;
   should  be  supported by Home Ser-
   vice Sections, 53.
Vocational rehabilitation:   number of
   victims of industry in need of, 26.
Vocational training:   offered  by  the
   Federal Board for Vocational Educa-
   tion,  13;  offered in hospitals for re-
   construction  work,  20;   effect  of,
   when begun in the hospital, 22; per-
   centage taking, after discharge,  22;
   percentage  continuing,  if begun  in
   hospital, 22;  must be  distinguished
   from  ward occupational  and hospital
   shop work, 23; begun in France dur-
   ing  convalescence,  24;   should be
   linked  with  hospital training,  24;
   quotation from Grace Harper on, 24;
   educational officers in hospitals sup-
   plied  by the Surgeon  General,  24;
   percentage of disabled men requiring,
   30, 72;  choice of, must be voluntary,
   35; offered  to all who are entitled to
   -ompensation, 52;  expenses paid for
   hose following  prescribed  courses,
   j2; provisions for a special class, 52.
   See  also  Vocational  reeducation and
   Vocational Rehabilitation Law.
Voluntary choice of vocational training,
   35-
Voluntary reeducation in France, 57.
Volunteer Medical Service Corps, 69.

Ward occupation:  distinguished from
   vocational training proper, 23.
 War neuroses:  percentage of Canadian
   soldiers suffering from, 84;  percen-
   tage of American,  84;  number  dis-
   charged  from  the  Army  for,  84;
   helped by the division  of neurology,
   Army medical department, 84;  spe-
   cial center for treatment of, 84;  social
   worker  at  this  center  will keep in
   touch with each  Division  office, 85;
   family  influence very  essential  in
   treatment of, 86, 87;   distinguished
   from "shell shock," 86; not  to be con-
   fused with insanity, 87.
 War Risk Insurance Law:  purpose of,
   stated by Judge  Mack,  46;  provides
   for  monthly  compensation for total
   or for partial disability,  47, 48;  pro-
   vides  insurance,  49;  social  signifi-
   cance  of, 50;  compared with work-
   men's compensation law, 50; quota-
   tion from Judge  Mack on, 51;  pro-
   visions of,  supplemented  by  Voca-
   tional  Rehabilitation Law, 52; should
   be supported by Home  Service Sec-
   tions, 53; provides for medical exam-
   ination,  70;   makes  provision  for
   sanatorium treatment of men, 77.
 The  Way Out, 66.
 "Wife," defined, 48.
 Williams, Capt. Basil, 46.
 Workmen's Compensation laws.   See
   Compensation laws  as  affecting  the
   disabled and War Risk Insurance Law.

Appendix  I.  Vocational  Rehabilita-
   tion Law.
Appendix II.  List of references. 
 
I