Volunteer Medical Service Corps
NEWS AND COMMENT.
For the purpose of completing the mobilization of the entire medical and surgical resources of the country, the Council of National Defense has authorized and directed the organization of a Volunteer Medical Service Corps, which is aimed to enlist in the general war-winning program all reputable physicians and surgeons who are not eligible to membership in the Medical Officers’ Reserve Corps.
It has been recognized always that the medical profession is made up of men whose patriotism is unquestioned and who are eager to serve their country in every way. Slight physical infirmities, or the fact that one is beyond the age limit, fifty-five years, or the fact that one is needed for essential public or institutional service, while precluding active work in camp or field or hospital in the war zone, should not prevent these patriotic physicians from close relation with governmental needs at tbis time.
It was in Philadelphia that the idea of such an organization was first put forward, Dr William Duffield Robinson having initiated the movement resulting in the formation last summer of the Senior Military Medical Association, with Dr W. W. Keen as president?a society which now has 271 members.
Through the Committee on States Activities of the General Medical Board, the matter of forming such a nation-wide organization was taken up last October in Chicago at a meeting attended by delegates from forty-six states and the District of Columbia. This Committee, of which Dr Edward Martin and Dr. John D. McLean?both Philadelphians?are respectively chairman and secretary, unanimously endorsed the project. A smaller committee, with Dr Edward P. Davis, of Philadelphia, as chairman, was appointed to draft conditions of membership, the General Medical Board unanimously endorsed the Committee’s report, the Executive Committee?including Surgeons General Gorgas of the Army, Braisted of the Navy, and Blue of the Public Health Service? heartily approved and passed it to the Council of National Defense for final action, and the machinery of the new body has been started by the sending of a letter to the State and County Committees urging interest and the enrolment of eligible physicians.
It is intended that this new Corps shall be an instrument able directly to meet such civil and military needs as are not already provided for. The General Medical Board holds it as axiomatic that the health of the people at home must be maintained as efficiently as in times of peace. The medical service in hospitals, medical colleges and laboratories must be up to standard; the demands incident to examination of drafted soldiers, including the reclamation of men rejected because of comparatively slight physical defects; the need of conserving the health of the families and dependents of enlisted men and the preservation of sanitary conditions?all these needs must be fully met in time of war as in time of peace. They must be met in spite of the great and unusual depletion of medical talent due to the demands of field and hospital service. In fact, and in view of the prospective losses in men with which every community is confronted, the General Medical Board believes that the needs at home should be even better met now than ever. The carrying of this double burden will fall heavily upon the physicians, but the medical fraternity is confident that it will acquit itself fully in this regard, its members accepting the tremendous responsibility in the highest spirit of patriotism. It will mean, doubtless, that much service must be gratuitous, but the medical men can be relied upon to do their share of giving freely, and it is certain that inability to pay a fee will never debar needy persons from the attention required. Conditions of membership are not onerous and are such as any qualified practitioner can readily meet. It is proposed that physicians intending to join shall apply by letter to Dr William F. Snow, Secretary of the Central Governing Board, who will send the applicant a printed form, the filling out of which will permit ready classification according to training and experience. The name and data of applicants will be submitted to an Executive Committee of the State Governing Board, and the final acceptance to membership will be by the national governing body. An appropriate button or badge is to be adopted as official insignia. The General Medical Board of the Council of National Defense is confident that there will be ready response from the physicians of the country.
Vocational Reeducation of Soldiers and Sailors.
That 100,000 out of every 1,000,000 soldiers sent overseas will return to the United States during the first year of fighting, and that 20,000 of these will need some kind of vocational reeducation or rehabilitation, is the estimate made by the Federal Board for Vocational Education in a report just published as Senate Document 166.
“Long before the close of activities in the summer of 1918, the return of men will begin, and vocational reeducation must start with the first men sent back, and must be developed as the number of men in hand for training increases,” declares the report. “The development of facilities for undertaking vocational reeducation must, in fact, anticipate the return of the men, since adequate provision cannot be improvised after the men are actually in hand for training.” A comprehensive Federal system for the reeducation and placement in wage-earning occupations of every disabled soldier and sailor is presented by the Federal board. This plan involves a central administrative agency at WashNEWS AND COMMENT. 31 ington, the coordination with that agency or every Federal and State agency concerned and with similar public, semi-public and private agencies, the establishment of “curative workshops” for the treatment of war cripples, together with a complete system providing for subsistence and pay during the period of reeducation.
Basing its opinion on foreign experience, the report declares that “vocational rehabilitation can not be regarded as costing the community, except temporarily, anything whatever. The disability of the soldier or sailor is an economic handicap reducing productive power. Unless the men are vocationally reestablished, and to the extent that they are not completely reestablished, the economic loss to the community will be cumulative during a long period of years. Even a slight increase in vocational capacity, as a result of vocational training initiated during the period of convalescence, will result in an economic gain which also will be cumulative over a long period. This aggregate cumulative gain will certainly exceed any expenditures for vocational rehabilitation.”
The increase of the earning power of the handicapped man, thus rendering him economically independent, is the ultimate object of this program. The plea is made that “all the experience and all the special equipment required for emergency war work will be needed to provide for similar work in the vocational rehabilitation of men disabled in factories and workshops, of the victims of accident in all dangerous employments, and of the thousands of otherwise injured and crippled persons thrown upon the community each year. The number of such persons in normal times greatly exceeds the capacity thus far developed for their vocational rehabilitation.”
In addition, the report discusses methods of financing, organizing, and administering a national system of vocational rehabilitation; foreign experience and legislation are reviewed; and the proceedings of an inter-departmental conference held on the subject in Washington are summarized,together with suggested legislation.
The vocational and educational problems involved in the rehabilitation of disabled soldiers and sailors are analyzed and discussed by the Federal Board for Vocational Education in Senate Document 167, just published under the title “Rehabilitation of Disabled Soldiers and Sailors?Training of Teachers for Occupational Therapy.”
Emphasis is placed on the immediate and pressing demand for the training of teachers of occupational therapy to take care of the handicapped men on their return from France. It is estimated that for every 1,000,000 men overseas, a minimum of 1200 teachers will be needed. What must be the qualifications of these teachers in view of the experience of the belligerent countries; how they may be trained; what problems are to be met; and how they are to be met in the course of vocational rehabilitation; the social and economic aspects of rehabilitation; and the need for a national system for the rehabilitation of the maimed and crippled in industry as well as in war, are the main topics of the bulletin. The document is written by Elizabeth G. Upham, under the direction of Charles H. Winslow, assistant director for research of the Federal board. The emergency program outlined in the report is summarized as follows: The returned disabled men are divided into four classes: 1, those who are permanently invalided; 2, those who are able to work, but cannot engage in competitive occupations; 3, those who must learn new occupations in the light of their handicaps; 4, those who are able to return to their former occupations. About 80 per cent of all the disabled fall into the fourth group, and about 20 pre cent into the third group. The first two groups are relatively small. For group 1 the treatment prescribed is “invalid occupations,” which are occupations that help pass the time and save the patient from brooding. For group 2, those who will in all probability be unable to complete in any line of work, simple occupations are prescribed to be carried on under the guidance of occupational therapeutists. Such occupations as wicker furniture-making, chair-caning, toy-making and semi-trades, will be taught these men.
For the 20 per cent who must learn new occupations a more elaborate course of rehabilitation is suggested. This will include simple occupations such as are taught to the men of the second group, followed by courses in general education wherever necessary, and followed in turn by prevocational education, that is to say, elementary vocational education; and, lastly, by vocational education in whatever line is best adapted to the qualifications and handicap of the man. A similar curriculum is proposed for the 80 per cent who will probably be able to return to their old occupations. Under the lead of the occupational therapeutist the patient will be gradually taught simple occupations, his general education will be “brushed up” and the deficiencies supplied, and he will be reeducated so as to resume his former trade in spite of his handicap. The Federal board presents in this bulletin an outline of an emergency course covering eight weeks for the training of teachers to handle all four groups of disabled men. It is expected that a fraction of the disabled men themselves will serve as instructors. Nurses and teachers of arts and crafts will be available for the invalid occupation work; trained and selected women of education, with previous experience in the arts, crafts and the “semi-trades” will be drawn on to teach simple occupations to group 2. In addition to these, there will be need in groups 3 and 4 of vocational teachers, preferably men, and men and women teachers in general education subjects, instructors in manual training, commerical subjects, mechanical drawing, drafting, etc. Teachers of each group should have had practical experience in hospitals or institutions, and it is recommended that teachers in groups 3 and 4 should have experience in the same line of work in the military hospitals of Canada.
That every dollar invested by the Government in the vocational rehabilitation of disabled soldiers and sailors will bring handsome returns in national efficiency is maintained in the report. “If the war should finally end in economic exhaustion,” says the report, “that Nation will ultimately triumph which is best able to use over again her men. It is claimed that Germany uses 85 to 90 per cent of her disabled men back of the lines, and that the majority of the remaining 10 to 15 per cent are entirely self-supporting. Belgium, whose depletion has been the greatest, was the first nation successfully to use over again her men. Not only has the large Belgium reeducation center of Port Villez been self-supporting, but in addition it has paid back to the Belgian Government the entire capital cost of installation… . “Economic necessity has made possible the results achieved in Belgium. For the other nations not so hard pressed the rehabilitation of the disabled and the strengthening of the vitality of the civil population may be an important and, perhaps, a determining point in their economic future. … It is certain that our own economic future depends to a large extent upon the rehabilitation of those disabled both in war and industry.”
The bulletin discusses at length the possibilities of development of occupational therapy and the equipment needed for all the groups described. Suggested blanks for keeping the records in the curative workshops and for hospital registration are included.
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