Douglas C. (Douglas Crawford) McMurtrie.

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mover in the organization was Dr. Konrad Biesalski, director of
the Oscar-Helene Heim fur Heilung und Erziehung Gebrechlicher
Kinder (Oscar Helene Home for Treatment and Education of Crip-
pled Children) in Berlin-Zehlendorf. Immediately after the outbreak
of the war, the Kaiserin, at Dr. Beisalski's suggestion, sent a tele-
gram to the Vereinigung fur Kriippelf iirsorge, asking that the Ger-
man cripple homes throw open their doors to war cripples. To this
all the homes immediately consented. Further than this, Dr. Biesal-
ski undertook a tour of Germany under the auspices of the Red


Cross, in which he visited all the principal cities, urging the forma-
tion of voluntary committees for the care of war cripples. The
gospel he preached was one which had been the creed of leading
German orthopedists for many years, namely, that almost any crip-
ple could be made fit to work again, and that education for work
should be the regular treatment. The immediate result was the
formation of volunteer committees in many cities and of larger ones
in some States and Provinces, and starting of work in all parts
of the Empire under various auspices and with various plans. By
February, 1915, this local organization had proceeded so far that
the Vereinigung fur Kruppelfiirsorge, under the auspices of the
Kaiserin, called a special meeting in Berlin to compare notes and
lay down the guiding principles.

At the meeting there were present officials of the various States
and Provinces, representatives of the medical profession, the teachers,
the employers, the workmen, the military authorities, and of the
large social welfare organizations, the Red Cross, the sick benefit
socities, the State accident insurance associations, etc. The general
principle was laid down as above, that the Imperial Government,
through the War Department, should be responsible for the wounded
soldier in so far as he required physical care, but that all responsi-
bility for reeducation and return to industrial life should belong
to private charity or to the different States of the Empire, if they
cared to take it up. Dr. Schwiening, staff surgeon of the Garde-
korps, in laying down the position of the military authorities, said :

The aim of the military authorities is to restore to the wounded man, as
fully as possible, the use of his injured or weakened limbs. * * * Our
purpose is not only that men should have the requisite practice in the use
of their prostheses and should then be discharged. The military authorities
are prepared to keep them even longer under care and give them opportunities
in special hospitals for further practice and in preparation for a trade. * * *
Naturally, for various reasons, it is not possible to keep all wounded and crip-
pled men in hospitals until they have fully learned a new trade or are able
to resume their old one. But to give them the preliminary practice for this,
and thus to smoothe the transition into civil life, to this the military authori-
ties consider themselves dubitably bound.'

This left the division of labor clear. Dr. Schwiening's allusions
to " opportunities for further practice " turned out to mean nothing
more than cordial intentions and a little manual training in the wav
of functional reeducation. The private agencies represented at the
meeting, therefore, prepared to leave to the war department all
questions of physical care and to concentrate on vocational advice,
reeducation, and placement. The question of financial responsibility
was touched on, but not settled. There was no authority from the
Imperial Government for assuming that any expenses would be de-

* Zeitswhrift filr Kriippelfiirsorge, Leipzig, 1915, vlll. 146.


frayed, except those for physical care. The private societies and
the individual states were left to finance their part of the work with
any support they could get: There was obvious, even at this early
meeting, the split of opinion as to this division of responsibility.
Several speakers stated definitely that the Imperial Government
ought to control and plan the work or, at least, to finance it. No
government representative, however, had been authorized to make
any promises on this subject and the aloof attitude then assumed
has continued, under growing criticism. The general understand-
ing, however, was a thoroughly cordial one. The military authori-
ties expressed themselves as deeply grateful for the volunteer work
and in full cooperation with it. They promised to consult with
the private agencies as to the assignment of men to different hos-
pitals and not to remove or discharge men suddenly without regard
to the interests of their training. They also promised that private
agencies should have facilities for visiting the hospitals for teaching
and vocational advice and that army doctors should be instructed
to cooperate with them in every way.

As a matter of fact, the actual working out of this cooperation
depends on the Bezirkscommando (the local military authority)
in any given place. For military purposes Germany is divided
into 32 districts, all the hospitals in any district being under the
authority of the commander of the local army corps. It is in thia
man's power to facilitate private work or to make it difficult, and.
since most of the younger and more progressive men are at the
front, the army commander is sometimes a man with little appre-
ciation of the cripples' wider needs.

There has, at times, been friction between individual military
commanders and the volunteer agencies in their districts. The war
department is fully awake to the harmful effects of this state of
affairs and, on December 27, 1916, issued the following decree"
looking to more complete cooperation :

The problems of vocational advice, reeducation, and placement can be solved
by the military authorities only by constant and systematic cooperation with
the civilian agencies for the care of war cripples. It should, therefore, not "be
left to the discretion of the local military hospital authorities, whether voca-
tional advisers should be permitted in the hospitals or not ; there should be
a regular understanding on this point with the central care committee. * * *
The military authority must accord every possible support to the upbuilding
and the intensive growth of the' civilian cripple work because, after demobiliza-
tion, the further social care of our war cripples will fall entirely on these
clyilian agencies. In preparation for that time, these agencies must be placed
in a position to discharge their heavy task with the greatest possible success.

■Leitsiitze iiber Berufsberatung und Berufsausbildung, Berlin, 1917, p. 20. (Kvlchsaus-
Bchuss der KriegsbeschSdigten Fursorge. Sond-rsohriften. Heft 2.)


The organization of the volunteer work, as reported at the Berlin
meeting, varied greatly with the different parts of the empire.
Germany is divided into 26 states, the largest of which, Prussia,
has 12 provinces, each larger than many of the other states. Roughly,
it may ,be said that the eastern part of the empire is the more sparsely
settled agricultural section and the western the populous industrial
section. The degree of development of schools, hospitals, and in-
stitutions for social welfare differs according to the character of the
individual states and according to their location.

Though the Imperial Government had taken no part whatever in
the organization of reeducation work, the governments of the various
German states and of the Prussian provinces had sometimes assumed
responsibility. The work thus organized falls under three classifica-
tions :

1. Work financed and directed entirely by the state government. —
Bavaria stands alone under this head. The whole work is financed
and managed by the state under the ministry of the interior, assisted
by an advisory committee of representative citizens. The various
government officers throughout the state are the officers of the cripple
welfare work and each one has an advisory committee of local people
to help with the actual case work.

2. Work initiated and directed by the government but with private
cooperation and support. — Under this head fall all but one of the
Prussian provinces, including more than half of Germany. The
head of a Prussion province is called the Landeshauptman. In al-
most every case, the Landeshauptman formed a special care com-
mittee with himself at the head, and the local committees all over the
province were subordinated to this central authority. The plan was
to use to the full all existing provincial institutions, such as schools,
almshouses, and hospitals. The funds were furnished by the prov-
ince, but with the understanding that the State of Prussia and, ulti-
mately, the Imperial Government, must take over the burden. 6
The city of Berlin assumed the responsibility for its own cripples
on the same understanding. 7 In August, 1917, there was formed a
central organization for all Prussia.

3. Work initiated and financed by private agencies but with Gov-
ernment cooperation. — This is the plan in Saxony, Baden, Wiirttem-
berg, the Thiiringian States, Hesse, Waldeck, and the Prussian prov-
ince of Hesse Nassau, which has joined forces with the last two. 8 In
Wiirttemberg, the minister of state issued the call for organization
but left the actual work to private societies ; in Hesse, Hesse Nassau,

• Korrespondenz filr Kriegswohlfahrtspflege, Berlin. 1915, i, 69.
'Zeitschrift fur Kruppelfflrsorge, Leipzig, 1915, viii, 290.

8 Zeitschrift fur Kruppelfiirsorge, Leipzig, 1915, viii. 67 ; 1916. ix, 24. Korrespondenz
filr Kriegswohlfarhtspflege, Berlin, 1915, i. 69.


and Waldeck, the whole organization was volunteer, the state govern-
ments taking only the most passive cognizance of it.

In all these divisions of the empire, no matter what the chief au-
thority was, there were local organizations in almost every town. In
these local committees, whether they were the real directors of the
work as in Hesse, or only advisory bodies as in Bavaria, the agencies
represented were usually the same. They comprised representatives
of the municipality, the local Bezirkscommando (military district
command), the accident insurance associations, the Bed Cross, the
women's clubs, the employers, and, with varying frequency, the cham-
ber of commerce, the chamber of trades, the chamber of handwork,
and the unions. The arrangement was a Hauptfiirsorge organization
(general committee) composed in this way and representing the
whole state or province, and under it Fiirsorgestellen (local offices)
in the various towns. In the very small places, individual men would
represent the cripple work. By August, 1916, it could be reported
that Germany was thoroughly covered with a network of such or-
ganizations. 9 They were, of course, not all of equal efficiency, since
the social conditions and the facilities differed greatly in the differ-
ent states. In Westphalia and the Rhine, which are thickly settled
industrial provinces, the arrangements are excellent ; in Mecklenburg,
which is agricultural and conservative, reports showed very scant
progress. The efficiency of the whole organization depends on the
enthusiasm and ability of the different individuals concerned in the
work. There have been complaints in the papers that the Fiirsorge-
stelle in some localities exists only in name or that the local repre-
sentative is an uneducated person unable to discharge his responsi-

Present Organization.

The unsystematized character of the whole work soon began to pre-
sent difficulties. The Prussian provinces, having organized their
work with a good deal of formality, felt the need of common stand-
ards for the whole country and, as early as September, 1915, called a
meeting of representatives of the cripple work to discuss a common
organization. At this meeting, the Reichsausschuss (national com-
mittee) was formed. The committee consists of one representative
each from all the states of the empire. The 12 Prussian provinces
have only one representative, but they meet beforehand to select him
and to agree on their policy. Cooperation of the Reichsausschuss
with the Imperial Government is secured by the presence of a com-
missioner appointed by the ministry of the interior. * * * The
ministers of the interior of each of the separate states may also send

• Verhandlungsbericht iiber die Tagung fur Kriegsbesehadlgtenfursorge in KSln, Berlin,
1917, p. 20. (Reichsausschuss der Kriegsbeschiidlgtenfiirsorge. Sonderschriften. Heft 1.)


representatives if they are not otherwise in touch with the work.
This makes the Reichsausschuss an extremely large body. Its actual
work, however, is done by an executive committee consisting of 13
representatives chosen equally from the north, the middle, and the
southern states, and from the city of Berlin. Its'president is Dr. von
Winterfeldt, Landeshauptman of Brandenburg.

The duty of the Reichsausschuss is to coordinate the work of the
various organizations and to make investigations and plans for fu-
ture work. It has published sets of guiding principles for vocational
advice, reeducation and land settlement and for the general work of
the local committees. All doubtful matters and questions of policy
are referred to it. It has subcommittees to investigate and report
plans in the following fields : Legal action, cooperation of local com-
mittees, finance, publicity, statistics, medical treatment, vocational
advice and reeducation, placement, land settlement and housing,
families of war cripples. 10 It also is the medium through which any
funds contributed by the Imperial Government are distributed. So
far, these have consisted only in one grant >af 5,000,000 marks which
is almost negligible compared with what the private organizations
are spending. 11


The responsibility for medical treatment, as stated above, is ex-
clusively the province of the Imperial Government, as represented
by the war department. All hospitals where wounded soldiers are
treated, whether for first surgical care or later convalescent care,
are under military authority and discipline. These hospitals fall
into two divisions, not according to function, but according to man-

The first type is that called Reservelazarett, Festungslazarett or
Garnisonlazarett (reserve hospital). In these the staff are all regu-
lar army men or civilians recently elevated to army rank, and the
hospital is financed by the war office and devoted entirely to the care
of wounded soldiers. 12 The second is called Vereinslazarett (affiliated
hospital). These are private hospitals which have put at the dis-
posal of the war department sometimes their whole plant and some-
times merely a certain number of beds. In such cases, the hospital
continues to manage its own finances and is under the direction of
its regular staff, but the war department puts in a representative
who is responsible for the discipline of the soldiers received. The

10 Verhandlungsbericht tiber die Tagung fur Kriegsbeschadigtenfiirsorge in Koln, Berlin,
1917, p. 21-26. (Beichsausschuss der Kriegsbeschadigtenfursorge. Sonderschriften
Heft 1.)

11 Zeitschrlft fur Kriippelfiirsorge, Leipzig, 1916, ix, 139.
" Zeitschrift fiir Krtippelfiirsorge, Leipzig, 1915, viii, 53.


department may also assign army men to act as teachers at their
regular army pay, and a good many crippled officers and noncom-
missioned officers are employed in this way.

There is an informal understanding between the military authori-
ties and the Vereinslazaretten, which are often specialized orthopedic
hospitals and cripple homes, that the department will try to send
men to hospitals which are in their home district or which specialize
in the treatment of their particular injuries. If the disposition can
not be made at first, the department arranges to transfer men ulti-
mately, so that they will get the benefit of specialized care. The
department pays the Vereinslazaretten 3.50 marks a day for each
wounded soldier received.

There are no reports of the total number of orthopedic hospitals
in Germany. Dr. Schwiening, chief medical officer of the Garde-
korps, Berlin, in February, 1915, made the following statement:

On the 10th day of mobilization, there were about 100,000 beds in the Reserve
and Vereinslazarette at the disposal of the military authorities and this num-
ber doubled in a short time. * * * In countless hospitals, we had at our
disposal, medico-mechanic and other apparatus for physical and hydrothera-
peutic cure. We had also military convalescent hospitals and sanitaria for
mechano and hydrotherapy. * * * The greatest specialists, if they were
not already at the front, were appointed consulting experts at the military

He gave the following figures as to the number of medico-mechani-
cal institutions at the disposal of the war department, according to
military districts. Each district is designated not geographically, but
by the number of the army corps under whose authority it falls :

Gardekorps, Berlin 24

Army Corps No. II 7

Army Corps No. X I 15

Army Corps No. VI ^1

Army Corps No. XI 8

Army Corps No. VII, Rhein 80


Army Corps No. XIV 3

Total 134

There are places in 107 sanitaria reserved for soldiers. 14 These
figures would seem to apply both to Eeserve and Vereinslazaretten
but are obviously not complete, since there are 32 army corps dis-
tricts in the empire.

These Vereinslazaretten, temporarily united under Government
service, are of the most various kinds. Germany had paid a great
deal of attention to the care of cripples, even before the war. There

13 Plus 7 hydrotherapeutic.

» Zeitschrift fur Kruppelfursorge, Leipzig, 1915, viil, 142.


had been developed, during 50 years' experience, 54 cripple homes,
ranging in size from six beds to 300. Some of them were already
taking adults as well as children ; they had among them 221 work-
shops, teaching 51 trades. Dr. Biesalski, secretary of the Vereini-
gung f iir Kriippelfiirsorge gives a list of 138 establishments belong-
ing to the Vereinigung and caring for war cripples. Some of these,
however, are only out-patient clinics.

Another agency which had promoted the study of the care and
training of cripples was the German system of social insurance.
Under the insurance laws there are two agencies responsible for the
care of industrial cripples. The Krankenkassen (sick-benefit socie-
ties), to which employers contribute one-third and employees two-
thirds, take charge of a workman for the first 26 weeks of illness.
After that, the Berufsgenossenschaften (employers' accident insur-
ance associations) support him for the rest of the time, or in case of
permanent invalidity. This support means both medical care and
sick payments. The medical care may be given either in the patient's
home or in a hospital, and the injured man is obliged to accept the
kind of treatment offered or forego his privileges.

As a consequence, both Krankenkassen and Berufsgenossenschaften
have excellent hospitals. Particularly the Berufsgenossenschaften,
which have charge of the men for longer periods and are more con-
cerned with cripples than with mere cases of sickness, have made a
special study of the physical and mental training of industrial crip-
ples. Preparing a man to resume his trade was to their advantage,
since it relieved them of the necessity of paying him a permanent

At the outbreak of the war cripple homes, Krankenkassen and
Berufsgenossenschaften, all offered their hospitals to the war
department, as Vereinslazaretten and the municipalities offered their
hospitals and almshouses. Beside this, the Red Cross established
some orthopedic hospitals in localities where there seemed a lack, and
private individuals and charitable institutions did the same. The
result was a fairly complete network of orthopedic homes distributed
all over the empire, to which men could be sent for final intensive
treatment. Dr. Leo Mayer, recently of the Orthopedic Hospital Am
Urban, Berlin, states that there must be at preeent about 200 such
institutions and that it may confidently be said that Germany's facili-
ties for giving orthopedic treatment to crippled soldiers are quite

Process of Treatment.

The principle upon which the orthopedic treatment proceeds is that
practically every cripple can be made fit to work again. This attitude
is assumed by all the German writers, in contrast to the French, who


make much more conservative estimates. It appears to be a definite
public policy to assume as an article of faith that rehabilitation is an
absolute success and that discussion is superfluous. Dr. Biesalski states
that from 90 per cent to 95 per cent of all war cripples treated are
returned to industrial life. Dr. Leo Mayer says that of 400 treated
at the Hospital Am Urban only two were unable to go back to work.

The time of treatment for a man in the orthopedic hospital is from
two to six months. Men are kept here until they are ready to go back
to the army or are pronounced definitely dienstunfahig, unfit for serv-
ice. Even if they are so unfit the war department does not discharge
them until they are pronounced by the physician physically fit to go
back to civil life. It sometimes happens that a man has a relapse after
discharge or that a further, expensive treatment might improve his
condition. In this case, the military authorities take no responsibility
and private charity must attend to him as a civilian.


There is great enthusiasm in Germany over the advances made in
orthopedic treatment, and it is certain that the best hospitals are
excellently equipped. The arrangements at Niirnberg, for instance,
include an operating room, a room for making plaster casts, an X-ray
machine, hot and cold baths, massage, electric and medico-mechanical
treatments of all sorts. To what extent all the hospitals are supplied
with modern orthopedic devices can not be ascertained. There has
been some complaint in the papers that the remoter hospitals have
very incomplete arrangements and that the great demand for ortho-
pedists leaves some places unsupplied. New short courses for ortho-
pedists have been put in at some of the medical schools and there is an
enthusiastic effort to meet the lack ; also there is wide publicity on the
subject which tends to bring the poorer hospitals up to the standard.

More and more emphasis is being placed on physical exercise as a
means of strengthening the stump and also the remaining limbs and
of bringing the physical condition back to the standard. The plan
is that a man shall begin very simple but systematic physical exercises
even before he is out of bed. These are gradually increased until
finally he has two or three hours a day under a regular gymnasium
instructor. In many places, physical directors from the public schools
and universities have volunteered their services and act as- part of
the regular hospital staff. Turnvereine, or athletic clubs for adults,
are very common in German towns and these often have a gymnasium
or an athletic field which they turn over to the cripples. Most of the
larger towns have public parks and swimming pools which they place
at the disposal of the hospitals. Games and outdoor sports are found
to have an immense therapeutic value, both psychological and physi-
cal, as compared with medico-mechanical treatment.


At Munich, at the Konigliche Universitats-Poliklinik and the
Medico-mechanischen Ambulatprium, 2,000 wounded men receive
regular physical training. The Oscar-Helene Heim, Berlin-Zehlen-
dorf , reports as part of its regular training for one-armed and one-
legged men, ball playing, spear throwing, bowling, shooting, and
qaoits. 15 The sports at Ettlingen include work on parallel bars for
one-armed men, and handball and jumping for one-legged men, be-
sides regular calisthenic exercises pursued in the open. At the one-
armed school at Heidelberg, Dr. Risson reports club swinging for
one-legged men, a contest with the horse between the one-armed and

Online LibraryDouglas C. (Douglas Crawford) McMurtrieThe evolution of national systems of vocational reeducation for disabled soldiers and sailors → online text (page 16 of 38)