CHAPTER XII

ITALY AND HER SPECIAL PROBLEMS

Italy_unprovided with facilities at the begining of the war The Milan Institute dei Rachitice Provincial and local committees Voluntary national federation of committees National Board for the Protection and Assistance of War Invalids - Its creation and functions - The national rehabilitation system-Placements after restoration The disabled and accident insurance - The problem of illiteracy Courses in the handicrafts- National War Cripples Association Italian casualties.

Italy at the beginning of the war had practically no facilities for the work of caring for and rehabilitating disabled men. There were few social organizations competent to undertake it; there were only a few homes for cripples, really no system of education for them, and no factories for the manufacture of artificial limbs. Diverse and scattered private agencies began the work, and these initial efforts were later adjusted and coördinated for the work in hand.

The Milan Institute dei Rachitice, which served as a model for succeeding institutions, was the only institution really started to meet the emergency during the first year of Italy's participation in the war. A provincial committee was organized in Lombardy in connection with the Milan Institute for the purpose of giving orthopedic treatment to injured men. This committee was planned to work in close coöperation with the military authorities, and the institution was made a military reserve hospital, the officers being given military rank. Men were sent there direct

from the field hospitals and given orthopaedic treatment under military discipline. The Government and the Lombardy committee shared the expense of buildings and upkeep, the Government paying an agreed sum per day for each man's board, and the committee making a small allowance to the man. After the men have been given orthopedic treatment, if they desire it and the committee decides they are suitable subjects for vocational education, they are transferred to a subsidiary convalescent home for trade training, this also being carried out under military control. The choice of trade or occupation is voluntary with the patient.

In November, 1917, there were in all 24 provincial committees operating on the Lombardy plan, capable of accommodating about 20 per cent. of all the war cripples. There was no coherency among the provincial committees, and the lack of coördination led to the formation of a voluntary national federation of committees for the assistance of blind, lame and crippled soldiers. Its function was, in the main, advisory, and the local committees were independent of it. These local committees have no common standard of organization. In Lombardy and in Sicily, for instance, there is only one committee for the whole province and the work is concentrated in the largest city; in other provinces there are groups of small committees working in coördination and running several small separate schools. The main function of the federation was to coördinate and supervise the work of local committees, to inform them of new developments in the work, and to devote its main energies to legal measures for the care of war cripples.

A monthly magazine was published by the federation, handling topics of special interest.

The Italian Government on March 25, 1917, passed a law creating the National Board for the Protection and Assistance of War Invalids. This law is the real basis for Italian reëducational work. The scope

of authority of the Board is to provide medical treatment if treatment supplementary to that given by the Army medical authorities is needed, and to afford material relief for reeducation, placement, claiming and adjustment of pensions.

The National Board, which replaced the voluntary federation of committees, did not take over these duties. It is supervisory and coöperative, and fills in gaps where they appear. The schools of reeducation remain under the management of local committees, the Board acting in a supervisory and inspecting capacity. It issues charters to new committees and calls in those previously granted when suitable standards are not reached.

The Board is composed of 19 members. Four are elected by Parliament, two Senators and two Deputies. The Crown appoints the other 15 on the suggestion of the Prime Minister, as follows: five ministerial nominees representing the ministries of the Interior, War, Navy, Treasury, and Industry and Labor; two nominees of the Surgeon-General, possessing special technical qualifications; three nominees of the volunteer associations for the care of war cripples; and four elected by the National War Cripples Association.

Annual appropriation is made for the support of the Board from the budget of the Ministry of the

Interior, and it is under the direction of the Minister of that governmental division. A report must be made to him annually which he is required to present to Parliament. The headquarters of the Board is in Rome, the office quarters and force being supplied by the Government. It is supposed to have an authorized representative in every locality and thus work in close connection with all the societies and institutions over the country having to do with war cripples and their rehabilitation.

The law creating the National Board prescribes generally the system for treating cripples in all parts of Italy. After the first surgical treatment, cripples are to be sent to one of the nine military reserve hospitals for orthopedic treatment, located at Turin, Milan, Genoa, Verona, Bologna, Florence, Rome, Naples and Palermo. The soldier in each case is to be assigned to the hospital nearest his home, or when this is not possible, to the next nearest. At these hospitals the men are given functional reeducation, massage and mechano-therapy, and furnished with temporary artificial limbs at the expense of the Gov

ernment.

When the cure has progressed to a point at which reëducation can be commenced, the patient is given usually a month's leave and allowed to visit his home. On the, expiry of the furlough, those designated by the hospital as capable of reeducation must present themselves, under military orders, at the nearest reeducational school. The men not so ordered are only those hopelessly crippled or those who have given proof that they do not need reeducation or can attend to their own rehabilitation.

Under the law the compulsory stay at the school is limited to 15 days. In that time the man is fitted with his permanent artificial limb or other apparatus, which is selected for him by the Government experts. During the time of adjustment, the authorities bend every effort to convince him of the value of reeducation. If he agrees to take the training, he remains under military discipline; if he refuses, he is discharged by the local military authority and must shift for himself as best he can with his pension.

When a man is accepted for reeducation, he remains a member of the Army, and may stay at the school pursuing his course for a maximum of six months. The Ministry of War pays the school for his maintenance, and maintains his family at the same rate as though the student were in active service. If the training is not complete at the end of six months, the Board may keep the student longer at its own expense. If ready to go sooner, or if he is unruly or proves to be unfit for training, the local military commander may discharge him at any time.

When a man enters the school, a committee consisting of the head physician, director of the school, and an inspector from the Ministry of Industry and Labor or a person designated by the National Board passes upon his case. Proper consideration is given. to the wishes of the cripple or his relatives or representative and of the representative of the War Cripples Association attached to the staff. The trade the man is to be trained for is then decided upon. The same committee decides when a man's training has been completed, and authorizes his dismissal from the