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Douglas C. (Douglas Crawford) McMurtrie.

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external lesions and 5,810 incapacitated through internal maladies. The latter number
Includes only those who have been found absolutely unfit for the front. In addition,
there were 7,900 cases under consideration.



204 EVOLUTION OF SYSTEMS OF VOCATIONAL REEDUCATION.

For the benefit of those invalids who can not be advantageously
placed in private enterprises, special cooperative shops have been
created.

The regular vocational schools, public and private, have not been
utilized for the reeducation of invalids; nor has any opportunity
been taken of the existing industrial organizations and trade asso-
ciations.

Agricultural education has been rather neglected. Several hun-
dred soldiers have been sent to existing agricultural schools. But
nothing has been done in the way of special education for invalids.

The archbishop of Kalocsa has established, with the assistance of
the Office for Invalids, a settlement for those invalids who can not be
returned to private industry; there, among other things, they are
trained in horticulture, fruit growing, and poultry raising. Another
agricultural colony has been created, thanks to a private donation
of 100,000 crowns. But the State has not undertaken anything for
the development of agricultural settlements for invalids.

The employment service of the Office for Invalids seems to be or-
ganized in a rather bureaucratic way. No cooperation has been
asked either of local or of trade organizations. No vocational ad-
visers are employed. A special council for invalids was planned
since the end of 1915, for the purpose of promoting social activities
in favor of war invalids; it was to consist of the premier, as chair-
man, and of 36 members appointed by him. But it does not appear
that this council has ever been created.

Until the middle of 1916, about 500 invalids obtained employment
through the Office for Invalids. Nearly all the applicants are those
who have been reeducated at the schools for invalids, while the rest
of the invalids seem to ignore the existence of the employment service
and of the office.



VIII.

CANADA.



When the men of the Canadian forces, disabled in action, began
to return from the front it was decided that the Nation owed them
a duty which could not be discharged by mere pension award.

Accordingly an order in council dated June 30, 1915, created the
"Hospital Commission" to deal with the provision of hospital and
convalescent home accommodation for men returning invalided from
the front. In view of the fact that many enlisted men became dis-
abled through injury or disease before proceeding overseas it was
necessary to extend the scope of authorization. A further order in
council dated October 14, 1915, met this difficulty and also changed
the name of the body to " Military Hospitals and Convalescent Homes
Commission." This order also authorized the commission to assist,
in finding employment for invalided soldiers after discharge.

The original idea was that the commission's work was to be carried
on wholly under civilian auspices and that the civilian medical at-
tendance was to be retained. After considerable discussion it was
finally decided that an arrangement to provide medical service be
made with the Canadian Army Medical Corps. In order to exercise
military authority over the men not yet discharged from military
service, there was created by an order in council dated June 24, 1916,
the " Military Hospitals Commission Command," a military division
under the general direction of the commission. Officers of the com-
mand were assigned as disciplinary heads of the various homes and
hospitals. For duty with this command there were to be selected
men incapacitated for assignments at the front, but capable of per-
forming " light duty," preference being given to those distinguished
for conduct or bravery.

The work of the military hospitals commission grew by leaps and
bounds and a vast organization was built up. As soon as the hos-
pitals and convalescent homes were in operation, occupational therapy
and vocational training were provided. The one weakness of the
system, however, lay in the fact that in any given locality no one
person was in complete authority. In one western city the present

200



206 EVOLUTION OF SYSTEMS OF VOCATIONAL REEDUCATION.

writer found five people in charge of different branches of the work,
and no one of them appeared to be responsible to the other. To be
sure each was accountable to some superior in Ottawa, and there was
presumed to be coordination between these superiors, but this was
over a thousand miles away, and had little local effect .

There was an officer of the military command who was concerned
with discipline, a business representative of the commission charged
with construction work, purchases, and finance, a vocational officer
responsible for the immensely important work of reeducation, a physi-
cian responsible to the Canadian Army Medical Corps, and, finally,
a member of the commission itself who was resident in the city.

As to the wise correction of this defect in the system, there was
wide difference of opinion. The military men were all sure the whole
organization should be militarized, the civilians equally confident it
should be freed of military direction, except as provided for disci-
plinary purposes. The final solution was as follows :

All active treatment hospitals and general convalescent homes were
on April 1, 1918, turned over to th» Department of Militia and De-
fense (Canadian war department) for conduct as military institu-
tions.

The Military Hospitals Commission Command was transferred to
the Department of Militia and Defense as a regular army unit.

The name of the Military Hospitals Commission was changed to
be " Invalided Soldiers' Commission," which was in turn attached to
a new government department known as the "Department of Sol-
diers' Civil Reestablishment," with a minister in the cabinet. In addi-
tion to caring for the rehabilitation of disabled soldiers this new de-
partment is charged with general responsibility for the problems at-
tending demobilization and the reconstruction period.

The Invalided Soldiers' Commission retains the care and custody
of chronic invalids, the more serious cases of permanent disablement,
the blind, the tubercular, and so forth. It also continues to provide
for reopened cases in which necessity for medical care develops or re-
develops after a man's military discharge.

The commission likewise continues under its authority all reeduca-
tional work and vocational training, whether provided for men
undergoing treatment in military hospitals or after discharge. The
conduct of vocational rehabilitation, which is the specific subject of
the present report, has been unaltered by the reorganization.

The branch of the commission which cared for the design, altera-
tion, and construction of buildings was transferred to the public
works department. Purchasing, for which the commission had built
up an effective organization, was transferred to the war-purchasing
commission, which is also charged with the duty of purchasing for
all departments of the Government.



EVOLUTION OF SYSTEMS OE VOCATIONAL BEEDTJCATION. 207

To give some idea of the extent of work performed by the com-
mission, it may be stated that in March, 1918, approximately 35,000
men had been returned from the front, 20,458 having been cared for
by the commission. Approximately 8,000 had completed this trea* -
ment and returned to civilian life.

RECEPTION FROM OVERSEAS.

The disabled Canadian soldiers returning from overseas are landed
at reception or clearing depots at either one of three ports of
arrival, Halifax, St. John, or Quebec, Halifax being the chief port
during the winter. At Halifax there is a reception hospital with a
capacity of 750 beds. Sick cases on stretchers, resident at any point
in the Dominion, are landed from the ocean ambulance transports
at Halifax and are examined by medical boards at the clearing depot,
and, without any stop-over, are sent to suitable institutions as near
their home towns as possible. Well-equipped hospitals on wheels
are assigned for their transportation. Cots are built in and wide
double doors permit stretchers to be passed through the sides of the
cars without discomfort to the injured ones. Doctors and nurses
are in charge and a special dispensary and diet kitchen are provided
on board.

The largest clearing depot, however, is located at Quebec. This
occupies a building which was formerly used by the immigration
officials. With alterations, which have been made, it accommodates
at least 2,000 men. Ambulant cases are cleared through this depot
at the rate of over 100 a day. Men from the western Provinces are
given preference in handling so that they may reach their homes as
soon as possible. There are separate wards for the tubercular, for
shell-shock cases, and for infectious diseases.

When this work was under the jurisdiction of the Military Hos-
pitals Commission each soldier upon arrival was " boarded " by a
medical board, which made recommendations for his future treat-
ment. Those ready for discharge and assessment of pension were
at once sent out with free transportation to their homes. Others,
whose physical condition permitted but who still required further
medical care, were sent to their own military district and given a
furlough of about two weeks in order to permit them to make a visit
to their families. After two weeks at home a soldier is expected to
report back to the military convalescent hospital named in his pass.
At this point his physical rehabilitation begins.

The clearing of men at the discharge depots has now been taken
over by the Army medical authorities. The only change in procedure
is that men are sent to their military districts immediately upon ar-
rival, without being "boarded" and having their future course de-



208 EVOLUTION OF SYSTEMS OF VOCATIONAL BEEDUCATION.

termined. The advantage of this is that a couple of days are saved
in getting a man to his family; the disadvantage is that men may
be practically " lost " to the rehabilitation officials who are under
great difficulties in following them up, as it is possible for a man
to leave for his home immediately on his arrival at his destination in
his military district, and escape examination.

Railroad tracks run up to the discharge depot at Quebec and the
convalescent men are sent direct to a central point in each geograph-
ical division, from which they are provided transportation to their
own homes. The trains are made up of regular sleeping cars and a
diner, and are in charge of a physician and nurses who provide for
dressings or other treatment which may be required en route.

FUNCTIONAL REEDUCATION.

No description of the Canadian provision for disabled soldiers
would be complete without reference to the splendid and original
work in functional reeducation carried on by Prof. Edward A. Bott
at Hart House, University of Toronto. Here have been devised the
most effective, yet simple, types of apparatus for active exercise,
with which have been accomplished excellent results in restoring
function, impaired through injury or disease. Effort has also been
directed to the " reeducation " of amputation stumps, to make them
useful and to prevent "sets" of undesirable direction or character.

The principles and aims of this work are thus 1 described by Prof.
Bott:

First, the standpoint is curative rather than occupational. The aim is to
restore a broken man to his normal condition as completely and as quickly as
possible. The special measures used toward this end are distinct from, but
are undertaken in conjunction with such other post-operative treatment as may
be required, for example, massage, electro, hydro, thermo therapy, and curative
workshops, the last providing a patient with such manual employment as is
expected will call his particular disability into action.

Secondly, the procedure is psychological. In the restoration of voluntary
functions " cure " is equivalent to " control." An attitude of intelligent coopera-
tion and of determination to improve must first be inspired in a patient. He
is urged to be his own doctor even while he is being guided and assisted through
each step of his treatment. Individual direction by skilled and tactful oper-
ators is essential. Simple mechanical appliances for bringing specific disa-
bilities into operation are indispensable and the appliances are fitted with
metrical devices which record and stimulate daily performance by appealing
to the eye or the ear. In this way a patient is brought face to face with his
incapacity and is encouraged to use his whole power to overcome it. The
psychological basis of this treatment differs from that of the curative workshop
in requiring the patient to concentrate upon rather than to forget his injury.
The advantage is that he attacks his disability directly, watches his improve-
ment from day to day, and aims at a consistent recovery.

1 Canada : Invalided Soldiers' Commission. Reconstruction. Bulletin, March, 1918,
pp. 13-15.



EVOLUTION OF SYSTEMS OF VOCATIONAL REEDUCATION. 209

Thirdly, the treatment is self-educative. When a patient has learned to
wrestle with the severer points of his case for 40 minutes each day, the habit
of self-treatment at frequent intervals during the day soon grows. Point by
point his disability is taken in hand and mastered, and the danger of neglecting
the restoration of finer coordinations is overcome.

Finally, reeducation is a mental tonic. The attitude of indifference or de-
pression which patients frequently exhibit in commencing treatment is usually
characteristic of their general outlook. Under such circumstances it is easier
to gain a man's confidence by doing something for his present condition, than
by discussing his future welfare. The spirit of accomplishment and of sus-
tained initiative which reeducational methods foster during the period of con-
valescence is an important contribution toward the larger task of rehabilitation.

The other curative methods, medical and surgical, require no de-
scription here.

ARTIFICIAL LIMBS.

The fitting of artificial limbs for disabled men in Canadian forces
has been concentrated at Toronto. The limbless soldiers are given
their surgical aftercare at the Military Orthopedic Hospital in North
Toronto. In connection with this has been established a Government
limb factory.

A local branch for the fitting of artificial limbs has recently been
established at Winnipeg, but this is the only other point at present
at which such work is done. Fitting only is done at Winnipeg, the
set-ups or rough limbs being made in the main factory at Toronto.

The decision to establish a Government factory was based, accord-
ing to the commission, on social considerations. 2 " Many privately
owned factories were making limbs of different standards, but owing
to the condition of the market for this commodity before the war,
none had very great capacity for production. The Government's
access to all the best patented features of any or all of these types
of limbs made it inadvisable to place a contract with one factory, and
ordinary business sense forbade buying different types of limbs from
many different factories scattered all over the country to be dis-
tributed by one agency. The market price of artificial limbs also is
based on sales conditions, which are very slow. The cost to the
country of limbs manufactured in the commission's own plant is
that of labor and material only."

Most of the work of the limb factory is carried on in a warehouse
building on Spadina Avenue, Toronto. The fitting is done at a
branch attached to the Military Orthopedic Hospital at North
Toronto. An endeavor is made to employ in the limb factory as many
disabled returned soldiers as possible.

The leg made in the Government factory is of the standard Ameri-
can type, the stock used being brittle willow or golden osier. The

' Reconstruction. January, 1918, p. 8.
57710—18 14



210 EVOLUTION OF SYSTEMS OF VOCATIONAL BEEDUCATION.

present practice is to work the wood up into rough legs, turned out on
a duplicating lathe, and to put them in stock in various sizes, follow-
ing the usual method of stocking shoes.

When a man is sent by the medical officer to be fitted for a limb, his measure-
ments are taken and the stock limb most nearly approximating his measure-
ments is tried on. The top of the artificial leg is then hollowed with special
tools made for that purpose, and in above-knee amputations the stump leg is
fitted into the spcket until the patient bears his weight on the pelvic bones,
virtually sitting down on the leg and walking. In the case of below-knee ampu-
tations the weight is carried, when possible, partially on the end of the stump
and partially on the bones of the knee.

After the man's stump has been fitted into the rough leg, the patient wears
his new limb around the hospital until it has become quite comfortable, trimming
being done on the inside to remove unevennesses as suggested by the patient.

As soon as comfort is attained the limb is hollowed out as thin as possible and
wet rawhide is drawn tightly over the outside and attached to the wood with
glue. The rawhide, when hardened, protects the limb from splitting, and
strengthens the leg, so that instances have been known where the wood had
been badly shattered and the limb still retained its shape. A coat of enamel
finishes the exterior, and the interior is surfaced with a high-grade, shiny wood
oil varnish, the most resistant varnish material known.

Boots to fit the artificial feet are made in the branch of the factory devoted
to orthopedic shoemaking. It has been found that a man wearing one artificial
leg places such a great strain on the other, especially in the early stages, that
a special shoe is required. The patients are measured and fitted with boots
designed to prevent weakness developing in the one good foot remaining. Every
upper is fitted.

While men are still under the care of the Military Hospitals Com-
mission their requirements in the line of artificial limbs are taken
care of automatically by the hospital authorities. Limbs for men who
have been discharged from the hospitals are also provided free.

Free repairs to the Government-made limbs will also be arranged
for. It is planned to open at various points throughout the country
several repair branches, in addition to the one already operating at
Winnipeg.

A civilian who has used for some time an artificial limb similar to
the one provided by the Government has been employed by the Mili-
tary Hospitals Commission to demonstrate to the returned men the
possibilities of its use. It is claimed that this man can run, box,
dance, or walk practically as well as a man with two sound legs.

Early in its work, the commission began the manufacture of an
artificial arm, with a working hook which is capable of holding a
knife, fork, or pen, and by which a man can dress himself, eat, or
write very satisfactorily. It holds tools and picks up articles. One
man working in the factory served his time as apprentice and became
a journeyman plumber with the aid of a similar tool. The hook can
be exchanged as desired by the wearer for a gloved hand with a



EVOLUTION OF 'SYSTEMS OF VOCATIONAL REEDUCATION. 211

movable thumb. With this dress hand a man can hold an umbrella
or a valise, or comfortably carry his coat on his arm.

A more recent appliance is a special hook and ratchet grip
invented by one of the men working in the limb factory. This
appliance embodies many of the good features of the prostheses
developed in European experience. The power of the grip is
extremely strong and holds so surely that a smooth steel bar will not
slip in its grasp.

Up to January 15, 1918, there had been returned to Canada 1,051
major amputation cases. Of these 266 had been discharged. The
remainder were still under care in orthopedic and convalescent
hospitals. Of the total, 328 are cases of arm amputation; 723 cases
of leg amputation.

Men who have incurred in army service disabilities which require
appliances such as orthopedic shoes, trusses, spectacles, rubber
bandages, and belts will be provided by the board of pension com-
missioners with an annual credit in such amount as the Military
Hospitals Commission estimate will cover the cost of these appli-
ances purchased in the open market. The man is notified that he
may purchase where he chooses appliances to the amount of the credit
named, and render accounts to the board of pension commissioners ;
the board, however, reserving to itself the right to prohibit the use
of appliances which have been found unsatisfactory. At the end of
the year any balance remaining in the hands of the pensions board
will be remitted to the man himself.

THE COURSE OF REHABILITATION.'

The clearest conception of the Canadian plan can be gained from a
study of its working in some specific district, and one of the most
favorable for this purpose is the Province of Alberta. It seems that
many of the first enlistments in the Canadian Expeditionary Force
came from the West, and many of the earlier returns were in conse-
quence first received there.

A soldier who enlisted in southern Alberta is assigned to the Og-
den Military Convalescent Hospital at Ogden, a suburb of Calgary.
The building utilized by this institution was formerly a hotel which,
due to miscalculations regarding the direction of real estate develop-
ment, was not being used at the time the war opened. There is also
an annex, a store building made over into dormitories.

The main building contains the administration offices, small wards
and private rooms, quarters for massage, electrical work, and other
medical treatment, general dining room and kitchen, diet kitchen,

» Douglas C. McMurtrie. Crutches into Plowshares. A lesson for the United States In
the reconstruction of Canadian w»r cripples. Survey, New York, 1917, mix, 105-110.



212 EVOLUTION OF SYSTEMS OF VOCATIONAL REEDUCATION.

bowling alley, library, a lobby of generous dimensions, and three class-
rooms. In the annex there is also a carpenter shop, in addition to
dormitories and rooms. Cases requiring more or less active medical
treatment are housed in the main building ; men in an advanced stage
of convalescence live in the annex across the street.

The institution is military in organization and discipline. As
the men are convalescent from serious injuries, the disciplinary ad-
ministration is not exacting, but in cases of serious misbehavior
there is available all the machinery of courts-martial.

The medical treatment and the military routine take but little of
the men's time. Most of the day is free for good use or ill. Here
appears the new feature in providing for the disabled soldier. The
commission provides occupation in various classes and shops for the
men who are willing to participate. This work has a double
purpose.

First,* it acts as occupational therapy; it benefits the metal condi-
tion of the men by giving them something to think about beside their
own troubles; it is an advantage to their physical condition in that
it brings into play — involuntarily on the man's part — disused and
semiparalyzed functions. To many men who have given up hope
of ever again doing useful work, one simple operation mastered leads
to the attempt at still another. Thus is ambition kindled once more.

Second, the work in the shops and classes has a direct practical
value to most of the men. There is evident advantage to adult men
on the verge of return to civilian life in " brushing up " the subjects
they learned at school. A farmer taking even a short commercial
course will be better able to keep accounts of his business transactions ;
the householder learning at the bench to make simple articles of
furniture will find this facility very useful in doing odd jobs around
his place.

Occupational therapy is thus the first category of vocational work,
which is undertaken rather casually during the period of physical
convalescence. Such activity would terminate with completion of
the medical treatment. T}ie second category — and the one of by far
the greatest economic consequence — is known as vocational reeduca-
tion. This is intended for men whose permanent disability debars
them from returning to their former occupation, yet who would
profit from retraining in some subject within practical limits of in-
.struction. This category embraces the serious and thorough prepa-
ration of the war cripple for self-support.



Online LibraryDouglas C. (Douglas Crawford) McMurtrieThe evolution of national systems of vocational reeducation for disabled soldiers and sailors → online text (page 23 of 38)