INTRODUCTION PHYSICAL RECONSTRUCTION FRANK BILLINGS 1 Complete physical and functional restoration the objective of hospital treatment of disabled soldiers and sailors-Division of Physical Reconstruction organized in the office of the Surgeon-General of the Army-Its facilities extended to the disabled of the Navy and the Marine Corps Physical reconstruction an innovation in American military practice The system developed on the basis of foreign experience Its organization and personnel - Publicity measures-The reeducation programme developed with the Federal Board for Vocational Education Reconstruction hospitals - Occupational therapy and " reconstruction aides " - Curative workshops and courses of instruction Physiotherapy - Special hospitals for special and permanent disabilities- - Classification of the disabled from a military standpoint - Proportion of wounded refitted for military service Changed conditions after the armistice Extension of the system of reconstruction hospitals — Incidence of specific disabilities BlindnessDeafness and speech defect - Amputation cases - Tuberculosis. In August, 1917, the Surgeon-General of the United States Army organized the Division of Physical Reconstruction of disabled soldiers in his Office. Physical reconstruction was defined as indicating continued treatment of patients to the degree of as complete physical and functional restoration as is consistent with the nature of their several disabilities. On May 10, 1918, arrangements were made with the Bureau of Medicine and Surgery of the Department of the Navy whereby the Surgeon-General of the Army was given 1 Colonel, Medical Corps, U. S. Army; Chief of the Division of Physical Reconstruction, Office of the Surgeon-General. charge of such sailors and marines as require physical reconstruction. Although physical reconstruction of the disabled has been practiced to some degree in American civilian hospitals, this provision was an innovation in our military practice. Physical reconstruction, however, was an established practice in the military hospitals of practically all other modern Governments. Its best expression in the Great War is found in Great Britain, France and Italy of our allies. Russia even during the early period of the revolution was able efficiently to reconstruct her sick and disabled men. The well developed military organization of Germany included a splendid system of physical reconstruction of sick and wounded soldiers. The plans for the physical reconstruction of disabled American soldiers and sailors under the direction of the Surgeon-General were formulated upon the experience of the medical departments of the armies of our allies in the war. This information was obtained by a personal survey in the field and by a review of the literature pertaining to the subject obtained by a special committee appointed for that purpose. The field survey was made in part through the inter-Allied. committee of France, England and Italy and by field officers from the Surgeon-General's Office sent to Canada for that purpose. For the purpose of administration there was organized in the Office of the Surgeon-General, under the Division of Physical Reconstruction, a personnel consisting of a chief and assistant chief and Departments of Education and of Physiotherapy. For the head of the Education Department was secured the services of an educator of wide reputation, with assistants qualified as technical educators in agriculture, in the industries, and in psychology. That certain permanent disabilities of soldiers might receive special attention, departments for teaching the blind and the deaf were created. The personnel of the various departments included qualified medical officers as advisers to the several departments in the Division and for field service. It was early recognized that publicity would be necessary to educate the disabled soldiers as to the need of continued treatment to restore them as fully as the nature of their disabilities permitted, and also for the purpose of arousing the families of the disabled. soldiers and the general public to the need of physical reconstruction, so that the soldiers might be able to return to civil life completely restored to health, or at least with the handicaps of permanent disability overcome by efficient training and reëducation better to fit them for their old jobs or to qualify them for new and lucrative occupations. To this end, in June, 1918, the Surgeon-General began the publication of the magazine Carry On as a means of disseminating knowledge of the plans for the physical reconstruction of disabled men, for the information of the disabled themselves, their families, and the general public. The problem of the Surgeon-General was rendered. less difficult and was placed upon an entirely rational basis by the enactment by Congress of a law, approved by the President on June 27, 1918, which placed upon the Federal Board for Vocational Education the responsibility for the training and reeducation of disabled soldiers and sailors discharged from the Army or the Navy, who because of their disabilities were unable successfully to follow their old occupations or who needed training for new occupations. Between the Medical Department of the Army and the Federal Board for Vocational Education a satisfactory coöperative programme was adopted for the training and reëducation of the disabled soldiers by a responsible Educational personnel in the military hospitals and a continuation of this training and reeducation after discharge of the soldiers by the Federal Board. Under the law the Federal Board was also made responsible for the placement of the discharged disabled soldiers and sailors after training and reeducation in civilian occupations. Early in 1918 the Surgeon-General directed that certain general military hospitals should be designated to carry on the work of physical reconstruction of disabled soldiers. In each hospital, in addition to the medical officers, there was appointed a personnel consisting of a chief educational officer qualified in general education, with assistants qualified as teachers in the industries and in agriculture and with the necessary instructors. The War Department authorized the Medical Department to employ civilians for curative-workshop instruction. The term "reconstruction aides" was adopted as the name for instructors in the handcrafts for applying occupational therapy to patients confined to beds and chairs in wards. These instructors were selected on the basis of qualifications to teach the handcrafts in work with textile materials, such as weaving, knitting, rug making, and knotting; in reed, cane, and fibre work, such as basketry and brushmaking; in woodworking, such as carving and whittling; in cardboard construction and binding, such as bookbinding and novelty box work; in work in applied design, such as stenciling and block printing; in metal work, such as jewelry; in work in plastic materials, such as pottery and modeling; and also for academic work, teaching the illiterate reading, English, spelling, arithmetic, and other academic studies. Workshops were created in the reconstruction hospitals where the soldier who had reached the ambulatory stage could receive curative work in technical courses, including automobile driving and mechanics, blacksmithing, carpentry, bench woodworking, concrete working, electricity, gunsmithing, general mechanics, instrument repairing, machinist, mine drill runner, plumbing and pipe fitting, radio operator, radio electrician, telegraphy, sheetmetal working, vulcanizing, welding, wheelwright, drafting, painting, printing, drawing, sign painting, cartoonist, shoe repairing, weaving (rug), woodworking, furniture repairing, chair caning, cabinet work, ring making, bookbinding, willow work. Commercial instruction was given in business correspondence, bookkeeping, commercial law, shorthand and typewriting. Agricultural pursuits, such as poultry raising, animal husbandry, crop study and gardening, were taught in the field, ward and greenhouse, with the application of light curative work in grass cutting, path making and road grading. Modern standardized physiotherapy was provided for in buildings and equipment for the application of hydro- electro- and mechanotherapeutics, to which was added recreational courses in military drill, walks, |