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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.