Given a maimed man the first care should be to educate to the maximum all the uninjured and remaining parts. It is too often forgotten that among the parts remaining the brain plays a leading rôle, even the chief rôle, not only because it is the organ of "good will" without which all attempts at re-education are fruitless, but also because good will being given the intelligent man will succeed better and will be able to adapt himself to more delicate work. "Physiotherapy cannot be prescribed," says J. Camus, "as quinine is prescribed. The malarial patient who takes the latter medicine benefits whether he wishes to or not. The wounded man who submits each morning to his mechanotherapeutic treatment does not recover unless he wishes."
It is very difficult to make the layman understand this. He invariably takes for granted the good will of the patient, with all of whose complaints he sympathises, without for a moment realising that they sometimes degenerate into jeremiads, often with an ulterior motive. An examination by a doctor—and an experienced doctor—is therefore necessary in order to determine under what physical and mental conditions an amputation case can be re-educated; so that he may understand that it is entirely to his interest to work as quickly and as well as possible, that begging is degrading, and above all that private charity is temporary and exhaustible; and that in consequence he must as quickly as possible put himself into a condition to supplement by a salary justly earned the pension or gratuity which is certain to be insufficient for his maintenance.
It can never be sufficiently insisted upon in dealing with the maimed that by resuming work, and on account of the functional improvement resulting from doing so, they need have no anxiety that their pension will be reduced, because the amount of this is based on the extent of the injury itself and on the man's rank, and not on his profession before he became a soldier. In the same rank the pension is the same for a surgeon or a lawyer, if both have lost a hand.
It is a deep-seated notion, instilled into the minds of injured workmen by the often suspicious folk who advise them, that if they begin work before their case has been settled their pension will be less.
It must be acknowledged on the other hand that the civil expert is often faced with a difficulty. As our law stands—and it is unfair—work cannot be resumed partially with provisional half-pay followed later by whole-time work with permanent salary. This difference is important to our wounded soldiers, who have everything to gain by a rapid and complete re-education and whose duty it is to do whole or part-time work while their legal position is being arranged and before the wound, in legal phraseology, has become "consolidated," that is to say, before the completion of treatment.
It is only fair to add that the patients are not alone to blame and that the administration has for long been guilty of an error against which reaction is growing, viz. delaying re-education until the time when the local condition has become permanent and the patient has been discharged and has received his prosthetic apparatus.
This delay is deplorable, on both medical and social grounds. On medical grounds because in very many cases before treatment is quite complete the addition of carefully graduated and supervised work is an important part of the treatment. On social grounds because it is necessary to fight in every possible way against the common tendency of the patient to fall into habits of laziness and intemperance.
This is now understood, and almost everywhere to-day the wounded soldier can resume work in workshops attached to the centres of physiotherapy, and thus begin his re-education while continuing his treatment.
At a certain stage resumption of work becomes the best therapeutic agent of all.
It is obvious that this resumption of work cannot supply the place of certain special treatments such as electrical treatment during the regeneration of a nerve, balneotherapy, or graduated gymnastic exercises; but is it not true that work with its continual active movement is infinitely superior to passive mobilisation by means of apparatus however ingeniously the latter may be contrived? Morover it is surely a more efficacious course of mechanotherapy when the patient works for half or all the day than is provided by the special course occupying only an hour or two.