The South Atlantic Quarterly Returning the Soldier to Civilian Life CHASE GOING WOODHOUSE The old idea that a pension is the right of every man who has served his country as a soldier or sailor, whether or not he has suffered any loss or disability from such service, has, with many another notion, passed away as a result of this war. That conception of the nature of pensions for many years dominated the pension legislation of Great Britain, France, and the United States. The taxpayers were unjustly burdened with excessive pension lists. Then pension frauds caused a reaction and gave great strength to the belief, held by many even in the heyday of pension granting, that pensions were gratuities and violated the property rights of those who paid them. Under the influence of the World War and of more enlightened theories of social justice, recent legislation has been fairer both to the taxpayer and to his defender in the army and navy. The nations realize that, with the vast number of men under arms and the heavy casualty lists, it would be impossible at the end of the war to allow all those who have received any injury to settle down and live on a pension or in a home for soldiers or sailors provided by the state. Such a practice is demoralizing both to the pensioner and to the other elements of society. It has been estimated in the United States that, out of each one thousand soldiers, fifty will be totally and seventyfive partially disabled. Great Britain and France already count their pensioners by the hundred thousand and Canada. hers by the thousand. The loss of life and capital in this war has been so great that when peace comes each nation will require for reconstruction every unit of labor power that can be mustered. There must be no non-producers after the war. As much as possible of the labor power that has been called out during the war must be retained and every effort made to return the soldiers to productive work with all speed. The man who has suffered some injury in the war must be retrained and made fit to take his place in the ranks of the producers. Not only is this re-training a duty which the state owes herself; she also owes it to the disabled men. War is a social risk. Under the present circumstances it involves every citizen equally. Soldiers are merely citizens delegated to perform a certain public service and the state has an obligation to compensate them for all personal detriment incurred by that service so that they suffer no more through risk of war than every other citizen of the belligerent nation must. Most countries hold the position that soldiers and sailors with similar disabilities must receive similar compensationvarying, however, in most cases with rank-irrespective of previous training, social status, or income. This position is based on the theory that the state is benefited only by a healthy body and that a man is defending not only the state but also the privileged status which any special training, social standing, or income may give him. A pension, therefore, should compensate only for losses of personal bodily ability resulting from war service. The belligerents are all acting in harmony with this principle when they grant pensions under various schedules of disability rates for specified injuries. But there is a tendency in modern military pension regulation increasingly to make the state bear all of a soldier's personal losses resulting from risks of any sort occurring during the period of his service. Great Britain through the system of alternative pensions has practically arrived at that point, and the United States by offering cheap insurance up to the amount of $10,000 provides, in addition to compensation granted in direct A Statutory Committee of the Royal Patriotic Fund Corporation was apjointed under the Naval and Military War Pension Act, 1915. This committee granted supplementary pensions to officers and men in like general financial circumstances, when there was a serious disproportion between the amount of pension granted for disability plus any other income and the pre-war income, because, without such suplementary pension, special hardship would no doubt exist. Facil ities have been secured so that children of disabled men may obtain an education equal to that which they would have received but for the war. This work is now carried on by the Ministry of Pensions. See Cd. 8750. Under the Pension Act an officer who shows that his retired pay under the act, his wound gratuity, and earnings aggregate less than his pre-war earnings, may be granted a total not to exceed his pre-war earnings up to a maximum of £300 a year, plus half any pre-war earnings, between £300 and £600. proportion to bodily disability, a partial means of protection for those whose personal training represents a capital investment and for those who, if disabled, could not maintain their pre-war standard of living on the disability compensation granted. It should be added, however, that the benefits of the United States war risk insurance plan are open to all soldiers alike regardless of pre-war status. Probably the most effective provision for enabling the disabled soldier to retain his pre-war standard of living is to re-educate him in such a way that he will be able to obtain employment in a stable industry upon his discharge from military service. The fact must also be considered that disabilities may prevent a man from getting accident insurance at normal rates and that such insurance is more necessary for a disabled man than for a normal man. For example, if a disabled soldier who had lost his right arm should lose his left in an industrial accident he would be helpless, while a normal man who suffered from the same accident would still have his right arm. Further, in countries with workmen's compensation laws which oblige employers to contribute to the insurance premiums, high rates for disabled men would be a deterrent to their employment. Great Britain, France and the United States. have all more or less directly and adequately met this situation by schemes under which the pensioner is relieved from any abnormal cost due to war disabilities for personal insurance up to limited amounts. There has been a surprising degree of uniformity among the various belligerents in their methods of dealing with the disabled soldier. Differences in the measures adopted depend not upon any fundamental differences in the principles underlying them, but upon the differences in the social organization of the nations for which they are designed. Each nation is trying to restore its soldiers to their ante-bellum status. There is a great similarity between the principles followed and those underlying much of the recent legislation providing for workmen's compensation. Several definite steps in the treatment of injured men can be traced. First the disability is removed, as completely as medical science makes its possible, by treatment and the provision of artificial limbs. Then there follows a period of training so that the injured member may be made to perform its normal function as perfectly as possible and that men who require artificial limbs may be taught to use them. In many cases it is not wise or even possible for the disabled man to return to his former occupation. In this case he must receive training fitting him for a new and suitable occupation and, at the completion of the training, employment must be found for him. Meanwhile the question of his pension must be settled. As we have noted, pensions are being generally granted in proportion to the degree of disability suffered and are sufficient to secure a decent standard of living when added to the amount which the man is still able to earn. His earning capacity is estimated according to remaining ability and in no case is the pension decreased if the man should increase his earning capacity through training. This point is of great importance. In the early months of the war in Great Britain it was not made clear, and many disabled men refused to take vocational training fearing that it would result in a decrease of the amount of their pension. On the administrative side it has been found advisable to have a single administrative authority controlling all the executive agencies dealing with disabled men. Also the work should be carried on by the government on a standard basis and not left to private benevolence; and, since the work of rehabilitation of disabled soldiers is temporary, existing plants and institutions should be made use of whenever possible in order to save the large sums necessary to erect new ones. Functional re-education is the term under which are grouped all of the means, other than active surgical treatment and the provision of artificial limbs, adopted to secure the restoration of the maximum of its normal function to an injured part. Active and passive mechanotherapy, various electrical treatments, baths of various sorts, massage, gymnastics and exercises are employed. Experience has completely demonstrated the greater value of active movement, initiated by the patient himself, than of passive treatment. The exercises first given are simple and require little effort. For example the exercises for the leg comprise walking along lines, straight or irregular, stepping over obstacles of various heights and shapes, mounting or descending stairways with irregular treads, etc. Opinion is universal that work properly graded and selected has the highest therapeutic and psychic value and constitutes the best possible means of reaccustoming muscles and mind to action. Whenever possible the work given constitutes an introduction to the vocational training.2 This is the term applied to the instruction given to disabled men in order to make them employable. Primarily vocational training would seem to be a medical problem, but it is equally an educational and economic one. The first consideration is the remaining physical ability of the man. This must be decided by the medical officer. The function of the vocational officer is to connect the medical officer's knowledge with his own knowledge of modern industry. He must have an expert and detailed understanding of industries and of the methods of training workers for them, must know the demand for labor in the different industries and in new or projected industries, the liability to seasonal employment, occupational diseases, etc. An expert survey of existing industrial conditions is essential. Every care must be taken to avoid the suggestion that disabled men are a special class and deserve special treatment in the industrial world. They must be taught not pastimes, but standard trades, for they must compete, on the merit of their work, with men who are whole. To get the full value of the functional and vocational training the disabled man must begin work as soon as the medical officer decides that he is physically fit for it. There must be continuity of treatment and the disabled man should pass from purely medical treatment to the vocational courses without a break. A definite plan has to be outlined with a view to combating the idea that, since the soldier has been injured in the defense of his country and through no fault of his own, he should be supported indefinitely by the public. This idea is not good for him. Men must be taught to use such energies as they have left for their own reconstruction. The French government has definitely ordered the physicians and J. L. Todd & T. B. Kidner: "The Retraining of Disabled Men," pp. 8-11. Reprinted from American Medicine, New Series, Vol. XII, No. 5. |