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ADDITIONAL copies of this pamphlet may be obtained without charge upon application to the Red Cross Institute for Crippled and Disabled Men, 311 Fourth Avenue, New York City. The Institute is also prepared to furnish specific information on the organization and method of re-educational work in the various belligerent countries, as well as on the technique of training and employment for industrial cripples. Correspondence with interested individuals or associations is invited.

REHABILITATION OF THE WAR CRIPPLE

ONE of the major costs of war consists in the thousands of crippled and disabled men which are left in its train. In the past, such soldiers have been indemnified for their injuries and insufficiently at best by pension bounty or admission to soldiers' homes. In either instance, they have been relegated to a life of idleness and dependence. These circumstances tend to make for general demoralization, and the popular conception of the adult cripple as lazy, ill-mannered, and intemperate has too often had considerable basis of experience. This situation has been regarded as unfortunate but inevitable. The cripple has been considered as a helpless member of society, to be pitied and maintained, but to whom constructive assistance was not feasible.

This attitude is in process of change, for it has been demonstrated that the cripple, though debarred by his handicap from some occupations, could, almost without exception, be fitted by special training for some trades in which he could become self-supporting in spite of his disability. Several influences contributed to progress in this direction. In the first place the great increase in industrial activity during the past two decades brought about a corresponding increment in the number of employees crippled in work accidents. Injuries were particularly frequent in the period before the advent of the safety propaganda. Again, the state especially in Europe became intimately identified with workmen's compensation, and in many instances itself assumed responsibility for the payment of the compensation award.

The waste involved in the complete support of thousands of workmen injured in more or less serious degree became soon apparent, and the authorities cast about for some means to decrease the percentage of disability. The solution was found notably in Belgium and France in trade schools for the re-education of the crippled victims of industrial accidents. In these schools the man who has lost the use of his leg is trained for a trade at which he can work while seated; the man lacking an arm is prepared for an occupation in which two legs and the sound arm suffice for its pursuit. Since the demand for skilled labor generally exceeds the supply, it is entirely practical to place at steady employment men trained thoroughly in a wisely selected trade. Of course there are many difficulties to overcome, but with patience, success is not only possible, but probable.

The provision of training for disabled men received a tremendous impetus at the opening of the present war. With the call of the able-bodied population to arms, the ensuing shortage of labor necessitated the draft into industry of women and old men. No potential productivity could be neglected, and the rehabilitation of the physically disabled became a national necessity. The dictates of national gratitude and national economy in this instance coincided, and in conjunction have stimulated extensive and vigorous activity.

The first country to make actual and adequate provision for the re-education of war cripples was France. In December, 1914, Edouard Herriot, Mayor of Lyons, obtained the consent of his municipal council to establish a training school for mutiles de la guerre. This school later christened the Ecole Joffre actually opened its doors to the first three pupils in the same month in which its foundation was authorized. Since then the institution has grown phenomenally, and a suburban branch has been opened at Tourvielle. These two centers have served as examples for other schools since started in other cities throughout the Republic.

In England the early work was undertaken by private initiative, but the responsibility is now national, the reconstruction work being carried on under the direction and at the expense of the Pensions Ministry. Germany projected an ambitious program in the early weeks of the war, and made actual beginnings toward its realization but little later than the French work was under way. In Canada a federal commission began promptly the establishment of convalescent homes and training classes. In Italy, hard upon her entrance into the war, there were organized, to provide for the rehabilitation of crippled soldiers, a series of local committees which were later co-ordinated under national authority.

Since the economic rehabilitation of men disabled in the war is a matter of such vital moment, not only to the individual but to the state as well, it is essential that any work undertaken be wise in plan, and thorough in execution. It may be desirable, therefore, to inquire into the principles already developed in this new and promising field.

II

The wounded soldier comes through the field aid base hospital, and, finally, if his disability is such as to disqualify him from further military service, he is returned from overseas to a convalescent hospital at home. Certainly at this point, if not perhaps earlier, preparation for his social and economic rehabilitation should begin.

Before deciding what can best be done for him, the recent experience of the crippled soldier must be taken into account. In the first place, he has been away from home influence and environment for some time perhaps one year, perhaps three. During that period he has led a life in the open, free from the many routine responsibilities of the civilian. He has been provided automatically with every necessity of life his only reciprocal obligation being to obey the mandates of military discipline. After his injury he has been given every care which the medical corps and its auxiliaries have been able to provide. Every effort has been made to minimize worry or exertion on his part. These influences have the effect of deadening his initiative and his sense of social responsibility, and readjustment to civil life becomes in consequence more difficult.

The new handicap usually throws the man into a state of extreme discouragement. The loss of a hand, an arm, or a leg seems to the man formerly able-bodied an insuperable obstacle to his future economic activity. The prospective pension is the only mitigating feature of this depressing outlook, and he begins to calculate how he can exist on the meager stipend which will become his due. He has basis for this expectation, for has he not known in the past several men each of whom lost a limb through accident? It was necessary for them to eke out a living by selling pencils on the 'street, or in some similar enterprise of make-shift character. Again, life will hold no pleasure in the future; he will always feel sensitive about his missing limb. Besides, nobody has any use for a cripple.

Such a state of mind will be encountered in the convalescent soldier. It must be met and overcome. With returning health, initiative must be reawakened, responsibilities quickened, a heartened ambition must replace discouragement. We can go to him and truthfully say: "If you will yourself help to the best of your ability, we will so train you that your handicap will not prove a serious disadvantage; we will prepare you for a job at which you can earn as much as in your previous position. Meantime your family will be supported and maintained. You will be provided with a modern artificial limb so that a stranger would hardly know you are crippled. Finally, we will place you in a desirable job."

The first reaction to this program is fear that an increase of earning power will entail a reduction of pension. When re-education of war cripples was first begun in both France and Germany, it was found that many of the men were unwilling to undertake training, in apprehension of prejudicing their pension award.

The solution of the difficulty was official announcement that such would not be the case, but that pensions would be based on degree of physical disability alone, without reference to earning power. In Canada, a placard to this effect is posted in all military hospitals and convalescent homes.

The choice of trades in which war cripples may wisely be trained is of primary importance. In addition to considering whether men with certain types of physical disability can engage in a given trade, its present and prospective employment possibilities must be taken into account. If it is a seasonal trade, if the number of workers in any locality is so small as to make difficult the absorption of many newly-trained men, or if the industry is on the wane rather than enjoying a healthy growth, the indications are negative. The ideal trade is one in which the wage standards are high, the employment steady, and the demand for labor constantly increasing. In picking trades the present boom conditions should be discounted. Machinists are now earning fabulous wages, but it should be considered whether there will not be an extreme reaction after the war.

The trades actually being taught to war cripples are many and varied. In France at the notable Ecole Joffre at Lyons there is instruction in accounting and commercial subjects, toymaking, bookbinding, shoe-making, woodwork, mechanical drafting, tailoring, wood-carving, gardening, and machine tool work. At the suburban branch at Tourvielle, agricultural courses are given. In Paris at the Institut National Professionel des Invalides de la Guerre are taught the standard trades of tailor, shoemaker, harnessmaker, and tinsmith. Also, dependent on the ability of the individual pupil, instruction is provided in accounting, industrial design, cabinet-making, and automobile engineering particularly the operation and repair of agricultural tractors.

In Rome, the Italian war cripples are being taught commercial subjects, carpentry and wood-carving, bookbinding, box-making, saddlery, and leather work, shoemaking, tailoring, and blacksmithing. At Naples there is instruction in shoemaking, tailoring, telegraphy, and commercial subjects.

The school in connection with the Maximilian Hospital at Petrograd offers a considerable range of courses, among them the following: manufacture of orthopedic apparatus, locksmithing, shoemaking, cabinet-making, and tailoring.

At Nurnberg, Germany, the crippled soldier learns to become a blacksmith, locksmith, maker of orthopedic apparatus, machinist, cobbler, tailor, cabinet-maker, saddler, upholsterer, weaver, paint-brush maker (a strong local industry), printer, or book-binder. There is also instruction in industrial design as applied in varied fields. At the Dusseldorf school instruction is given in machine tool work, mechanical drafting, building trades, telegraphy, and commercial and civil service subjects.

In England, the workshops of the Incorporated Soldiers and Sailors Help Society provide training in the following trades: carpentry and cabinet-making, printing, polishing, carving and gilding, picture framing, toy-making, basket-making, metal work, building and construction, decorating, and electrical fitting. The principal subjects at Roehampton and Brighton (Queen Mary's Convalescent Auxiliary Hospitals) are inside electrical wiring, motor driving and repairs, and woodworking, which includes bench and lathe practice. At Cliveden and at other points in Britain agricultural training is available.

In the Canadian schools, under the auspices of the Military Hospitals Commission, 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.

The section of the country in which a man lives also has a bearing on the choice of a trade in which he is to receive instruction. Thus, a Canadian living in Montreal may be trained as a machinist; the same man, if a resident of a far western province, would better be given instruction in the operation of motor tractors for agricultural work.

It is axiomatic that a man should be given his course of training in a locality near home. Here he will not feel so strange, friends will not be far away, and the educational authorities will be in closer touch with the local industrial requirements and employment conditions.

III

It is the general consensus of experience that the decision by the man to undertake a course of training must be a voluntary one. Of course, he may be retained in the military organization and detailed to trade classes in the same way as he is detailed to guard duty, but this would not make for successful results. The unwilling and rebellious pupil learns but little; the earnest and ambitious one makes rapid progress. The man must be persuaded, therefore, to take up instruction; the future advantages of being a trained workman in some skilled trade should be pointed out, and the practical arrangements to be made for him during the course of instruction carefully explained. There is no royal road to success in this effort, but after gaining the soldier's friendship and confidence, a patient persistence will win the battle. If a competent visitor has been in touch with the man's family during his absence at the front, the members of the home circle can be easily convinced of the wisdom of his re-education; this will make all the simpler persuasion of the man himself.

A great aid in helping a soldier to decide about his future is acquaintance with the records of other men with similar physical handicaps who have made good men who have been trained and who are now holding jobs at attractive wages. In addition, such practical results lend plausibility to the expectations in prospect which are being held out to him. A difficulty, however, is found in the abnormal premium on industrial labor in war time. Even a disabled man may be able to go out and earn seven dollars a day in a munitions factory. This constitutes a very potent present counter-attraction to representations of moderate but permanent employment after a course of training. If he makes the opportunist choice he will, upon the return of employment conditions to normal, be reduced to the status of a casual laborer, perilously near the verge of mendicancy. No pains should be spared to avert this eventuality.

Care should be taken, however, that representations to the man, while encouraging, should in the main be accurate. Workers with crippled soldiers should not be misled by reports of extraordinary success in isolated cases. The men will, sooner or later, learn the truth, which will thus tend to discredit the veracity of the vocational officials.

In deciding which of the available courses an individual disabled soldier should pursue, the first effort should be to fit him for an occupation related as closely as possible to his former job. His past experience far from being discarded should be built upon. A competent journeyman bricklayer who has lost an arm may be prepared by a suitable course in architectural drafting and the interpretation of plans, to take a position as construction foreman of a bricklaying gang. It were idle to give such a man a course in telegraphy. But a train hand who has been all his life familiar with railroad work may most wisely be trained as a telegraphic operator, with a little commercial instruction on the side. This man will then be fitted to obtain employment as station agent at some minor point on the road. There is an additional advantage in instances such as the two mentioned in that the former employer will be willing to engage again a man with whose record and character he is familiar once there is assured the competence of the ex-soldier in his new capacity.

This rule applies, however, only to men who were, previous to their enlistment, operatives in the skilled trades. Their problems are the simplest of solution. But in the present war, when not only professional soldiers, but whole nations are in arms, there will return disabled many young men who had not yet attained a permanent industrial status. Some will have entered the army direct from high school or college; others will have been migratory workers who had not yet found a permanent niche and whose experience has been too varied to be of much value, still others will have been drawn from unskilled and ill-paid occupations which hold little future opportunity for the able-bodied worker, and almost none for the physically handicapped. Among the latter will be found those who have been forced to leave school and go to work at too early an age, and to whom society has not given a fair chance. When they now return from the front crippled for life and having made a great patriotic sacrifice, it is surely the duty of the state to repair so far as practicable the former inequality of opportunity, and provide for them the best possible training. It would be a cause for national pride if, in the future, such men could date their economic success from the amputation of their limb lost in their country's service. And this is entirely within the realm of probability.

With these latter classes there is, therefore, no former experience of value to serve as a guide in the choice of a trade in which the war cripple is to be trained. We must then fall back on the general principles of vocational guidance. The more important factors will be natural talent, personal preference or taste, habits of work, temperament, and the general character of the individual. Advice in each case should be given by an expert vocational counsellor, a man familiar at once with trade education, with the requirements of the various industries themselves, and with the current status of the labor market. His opinion should take into account the report and prognosis of the medical officer, and also the past record of the individual. As has been pointed out, the friendship and confidence of the soldier are absolutely essential. Very often these are difficult of attainment and the prospective pupil's reserve is penetrated only in the fourth or fifth visit. As the decision to undertake training at all must be voluntary, so must the choice of particular trade meet with the full approval of the soldier himself. And if, after beginning the course, the subject proves definitely distasteful, the opportunity to change to another trade should within reasonable limitation be permitted. It cannot be too strongly emphasized that the unwilling pupil is a poor learner indeed.

It would seem inadvisable to train a man for an occupation which he can pursue only by use of specialized apparatus adapted to the individual motor limitations imposed by his deformity. While a badly crippled man may be taught to operate a lathe with special treadles or to run a typewriter with special paper feed and shifting mechanism, his employment opportunities will be precarious. It may be possible to secure for him one specific job which may be arranged for at the time he starts training. But if he cannot get along personally with his employer, if his family must move to another city, if his wages are not advanced as his product increases for these and a myriad other reasons, he may become practically unable to obtain other employment, and the value of his training will be thus nullified. Ingenuity should be directed rather to fitting crippled men to meet the demands of standard trades, in which there will be, not one or a dozen possible jobs, but thousands. Only thus can the man be made actually independent.

It is absolutely essential that training, if provided at all, be thorough. The pupils are men, not boys, and they cannot go out in the apprenticeship category, as do the graduates of regular trade schools and even in these the present-day standards of proficiency are high. If ill-trained men are graduated from the classes the results will not be fortuitous. Employers will be convinced that the theory of re-educating returned soldiers is unsound; the men will come to distrust the representations of prospective success which have been made to them. There will be, further, an unjustified disturbance of the labor market and its wage standards if a school turns out into a trade as professedly skilled operatives a crowd of undertrained and inexperienced men. Schools of re-education must not contribute to difficulties of this character.

One of the most notable features of the work in France is the length of some courses in which the war cripples are trained. To even comparatively simple subjects instruction periods of twelve and eighteen months are allotted. This permits the men to obtain not only a theoretic education, but a fair degree of practical experience as well an experience which is of especial necessity in restoring to the soldiers a confidence in their own competency.

IV

The attitude of the public toward the returned soldier will do much to make or mar the success of work with the war cripples. The man returning disabled from the front deserves the whole-hearted gratitude and respect of the nation, but to spoil and pamper him is an ill-advised way of meeting the obligation. Parents who wish to do the best possible by their children do not manifest affection by spoiling their digestion with an eagerly received surfeit of candy. They rather seek to provide a good home environment, exert a firm but kindly discipline, and obtain for their children the best educational opportunities. In other words, the emphasis is on values of permanence. The same general principles apply in the relations of the public to the ex-service man.

In one of the allied countries the wife of a returned soldier complained to the representative of a patriotic relief agency, which had been attending to the family needs while the chief breadwinner was at the front, that her husband would never spend any time with her or with the children. She had wanted that afternoon to have him accompany them to the park, but he disdainfully refused, saying that he was going out for an automobile ride and later to a 'sing-song' at one of the fashionable hotels. The musical entertainment referred to was being provided by the society ladies of the city, so mother and the children went to the park alone, while the 'hero' was receiving appropriate recognition of his services.

Of course the most pernicious expression of this attitude is the indiscriminate 'treating' of the disabled soldier at the corner saloon except of course in those localities which have made this more or less impossible by the enactment of total prohibition.

In some cities the 'patriotic' hysteria of the public has been such that neither the police nor the military authorities are in a position to restrain or punish returned soldiers, even when they have become seriously disorderly and objectionable. This is no kindness to the men and casts a most unfavorable reflection on the service as a whole.

On the other hand, the nation cannot go too far in showing gratitude to the war cripple, provided the manner of its expression is sound. To give him the best of medical care, a first-rate artificial limb, a thorough and capable training to fit him for a remunerative trade, and a chance of employment a little better than the average these constitute the real public duty, a duty not so simple of fulfillment as the mere provision of social entertainment.

The one form of expression should be frowned upon as actually unpatriotic; the other should be promoted and encouraged. Some propaganda for public education in this respect may become necessary, if the plans for the war cripple are to be worked out to a thoroughly successful conclusion.

V

The greatest obstacle in the past to the success of schools for the trade training of adult cripples lay in the support of the pupil during the period of the course. A school could offer the best of facilities, and be in a position to practically promise a man at the conclusion of its course a position at double his former wages, yet the prospective pupil could not even consider the proposition because meanwhile he could not manage to exist, and must needs continue at even the worst type of makeshift occupation.

But with the soldier cripple, this difficulty disappears. The man is already on the payroll of the state, he has been injured in his country's service, and it is logical and proper that he should be adequately supported until he is fitted for repatriation. His military pay and the separation allowance to his family should both be continued, or, if discharged from the army, corresponding training stipends awarded; with such provision he can enter upon his training in peace of mind without which the instruction could not be effective. If the institution he attends is a boarding school, maintenance would also be provided; if it were wise for the man to live at home there could be made a further allowance in commutation.

To complete physical rehabilitation in amputation cases, artificial limbs must be supplied. At the outbreak of the war, the supply of limbs presented to the European countries a most difficult problem. The demand was many times greater than it had ever been in the past, and the major portion of the continental supply had always been drawn from Germany. In the emergency thousands of appliances were imported from the United States, which has always been credited with making the best artificial limbs. Later the various belligerent countries began to manufacture limbs themselves. The factories, operating under official auspices, are enabled to utilize any patented features without paying royalties.

Each limb must be made to individual specifications and fitted to the stump of the patient who is to wear it. This makes desirable centralization of this activity. In Canada, for instance, all amputation cases go to a hospital in Toronto with an accommodation of four hundred; here the limbs are manufactured, fitted, and applied.

That a stump shrinks for some time after amputation introduces one element of difficulty, in that a limb which fits six months after amputation may come far from doing so after twelve months. For this reason it may be wise to provide the soldier at first with a simple temporary limb, and later with a more elaborate and permanent one. He must be quite explicitly assured of this plan, however, as he will otherwise become suspicious of being put off with an inferior article.

Very remarkable results, in cases of arm amputation are now being accomplished by prosthesis, i. e., the fitting to the stump of special appliances. Thus, instead of being provided with a well-appearing artificial arm, there will be attached to his stump a chuck in which he can insert interchangeably a knife, a fork, a tool, a hook, or some special implement by which to guide or steady work on which he is engaged. These 'working prostheses' are often individually to meet the requirements of the particular trade which their wearer is to follow.

Both prosthetic apparatus and artificial limbs advantage by simplicity. When too complicated the men lose faith in and discard them. For some types of manual workers it may be wise, for instance, to provide the primitive 'peg and bucket' leg for use in working hours, and in addition a more esthetic type for wear on Sundays and holidays.

VI

As the choice of trades should be influenced by the labor conditions of the community, so must employment of the graduates be closely integrated with the course of instruction. Not only must a position be secured for the re-educated soldier, but he must be placed as intelligently as possible. To the man the work must be satisfactory and the environment agreeable; to the employer the personality of the soldier must be acceptable and his product sufficient to the requirements. Of course, this ideal can only be approximated, but a trained and capable employment officer can do much in this direction. Only by skilled and thorough work can permanent results be obtained and nothing is more costly to all parties concerned than short-time employment and frequent change of job.

Ten men placed in ten jobs by the opportunist method of sending the first available applicant to the first available position may be unhappy themselves and unsatisfactory to their employers. Yet the same ten under different and wiser placement direction may be almost ideally located in the same jobs. It is to this end that tends the natural system of employment and discharge, but it is a costly method and one that, for the crippled soldier, should be made unnecessary.

The first job for the man returned from the front is easy to secure so easy that we should not be misled by the superficial indications. The employer is patriotic and anxious to help the crippled soldiers. But when the war shall have been over a few years, these motives will be no longer effective. The man taken on in a time of national stress will be just one of the employees, and his retention in service will depend upon performance alone. If the original placement was intelligent the man will have made progress, gained confidence and experience, and made his position sure. If, on the other hand, he was ill-fitted for the job, he will have grown progressively less efficient and in consequence discouraged, and his status will be precarious indeed. A permanent injury might thus result from an employment bungle in the first instance. All this simply means that effective placement is not an amateur job.

Employment work for returned soldiers would be immensely facilitated by the enactment of national prohibition. In one province of Canada placement of soldiers is extremely difficult, and for some men ten and fifteen positions must successively be obtained, each job being lost for one reason only intoxication. In a neighboring province, with prohibition, these difficulties do not appear. Soon, by virtue of recent legislation, traffic in liquor will be forbidden in all parts of the Dominion; we should not fail ourselves to profit by this example. The chance of successful rehabilitation will be tremendously enhanced by protecting the men from the influence of the saloon.

The actual methods of placement need not be here discussed, but to one feature attention may be called. Disabled soldiers must be regarded as a special class. The transition from military to civilian life involved in entering on the first job is a more radical step than is taken by the average employee going from one position to another. The placement must, therefore, be followed up after the first few days of work, the apprehensions of the 'green' employee must be dispelled, his difficulties adjusted, and his confidence fortified. If this follow-up can be done by a person whom the ex-soldier knows and trusts, it will be all the more effective.

VII

Should the support and direction of after-care for the war cripple be public or private? The answer to this question is unequivocal the responsibility is most emphatically a national one. This can be demonstrated not only as a matter of principle but also by actual experiential results.

From the viewpoint of principle, it may be concluded that the returned soldier should not be dependent for one of his most vital necessities on the dole of private charity, for which is expected a grateful appreciation. Were the work's auspices of such character it would materially prejudice the attitude of the men. The soldiers might very logically object to passing around the hat in order to provide for them facilities, the need of which is not open to argument. There should be not the least hint of patronage or pauperization in this partial restitution made by the state to those who have been disabled in its service.

Empirically, the indications for public assumption of responsibility are all positive. The most obvious point lies in the uncertainty that the facilities privately provided shall be commensurate with the demands. In the wealthy urban centers schools for re-education would be numerous and well-equipped; in the rural sections and in the smaller cities there might be almost no provision at all. It would be intolerable did a crippled soldier from Arizona have any less chance for future success than his fellow veteran from Boston or New York.

Again, the extent and thoroughness of the work would be subject to fluctuation, varying with the results obtained in solicitation of funds. The income would likewise adversely be affected by a competing financial campaign another issue of Liberty Bonds, a second Red Cross week, might mean dropping a useful subject, shortening a course, refusing admission to some eligible applicants.

Under private control, furthermore, the standard of work would vary greatly. The schools would not have the advantage of central direction by expert and capable executives. There is also no riper field for the expression of mawkish sentimentality than in caring for the crippled or blind, and the injured soldier must be protected from becoming its victim. With schools operated under local auspices there would be a few good ones, and many of the indifferent variety. And there is no problem more delicate than that of coping with ill-directed and silly charitable enterprises. One can picture the invective of local newspapers if the military authorities refused to assign soldiers to a certain institution because its standards of administration and instruction were considered below par. The time to avert such predicaments is prior to their rise.

Let us consider, on the other hand, the advantages accruing from centralized public control. The factor of most moment is the character the work then assumes in its relation to the individual war cripple. It becomes regarded much as is the public school system; the soldier is thus entitled to training by virtue of his rights as a citizen and an honorable public servant. There is of charity no taint whatever.

With an acknowledged national responsibility, the facilities provided can keep pace with or, indeed, ahead of the requirements. The work can be carried out on a plan fixed in advance, and its standards be consistent country-wide.

Another advantage of federal control lies in the simplicity of integration between the medical and educational interests. The former is under military and, therefore, national authority, and simplification of procedure cannot but result from having the latter of like scope. The training classes must in many instances be carried on in medical institutions, as there is a considerable period of convalescence in which the men should be under re-education. Again, one of the principal method of restoring disabled soldiers to health is the prescription of specified exercise, and it has been found that this is best gained in workshops rather than with mechanotherapeutic apparatus. Finding that they can do some practical thing, however simple, is immensely encouraging to men who may have lost all hope of future usefulness. Occupational therapy plays now one of the leading roles in the convalescent treatment of the wounded, and this makes all the more desirable a close relation between the two branches of the work.

A central and national direction of the work for war cripples does not in the least preclude the utilisation of volunteer effort and facilities. In fact, voluntary contribution of time and money is highly desirable, particularly in committing more people to a first-hand interest in the enterprise, and in giving the schools root in their local communities. Buildings can be loaned, trade school classrooms and equipment made available, machinery and apparatus for instruction donated, funds contributed, and personal service volunteered. Existing organizations can offer to provide the necessary social service work in the homes of the men; local employment agencies can be of help by acting links in the national chain.

Such private assistance will be more than desirable; it will be essential. Because provision for war cripples is a temporary problem, and it would not be wise to erect new buildings, equip expensive machine shops, and build up a complete and self-sufficient organization for a few years' work. For trade classes it will be better to obtain the use for part time of shops in existing schools institutions which will be in position to afford such facilities on account of the number of their regular students who will have been called to arms. In England, the technical institutes are being widely used; in France, many war cripples are being instructed in the regular schools of agriculture.

But under these conditions the private contribution helps rather than hampers the effectiveness of the national plan.

It may be remarked in passing that the facilities built up for war cripples will not be entirely temporary, but that part will be continued to provide re-training for industrial cripples a class more numerous even in time of war than disabled soldiers, but one whose needs have in the past been seriously neglected. This may be one beneficent outcome of belligerency.

A concrete program for the reconstruction of disabled American soldiers and sailors has not, at this writing, been determined upon. It is clear, however, that the responsibility for this work will be nationally assumed. The details of system and method can easily be worked out under competent administration, but it is imperative that definite action be taken without delay so that preparation of facilities for our returning men can be set at once under way.

Let us discharge, to the highest possible degree, the nation's obligation to the war cripple. Let us so act in this greatest of all wars as to mitigate the shame of his treatment in the past.