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Chapter XV


Chapter XV


Rehabilitation Hospitals

Rehabilitation and reconditioning were matters of considerable importance even before D-day, because an overwhelming proportion of hospital admissions in the United Kingdom Base consisted of bone and joint injuries. Col. Rex L. Diveley, MC, who was the first senior consultant in orthopedic surgery, developed a special interest in this field. Shortly before D-day he was relieved of his consultant duties to become chief of the Rehabilitation Division in the Office of the Theater Chief Surgeon. Meantime, a number of enlisted personnel from the United States Army were trained in rehabilitation work in the Royal Army Medical Corps institutions for rehabilitation at Kingston-on-Thames, Aldershot, Taunton, and Edinburgh.

The first American rehabilitation center was set up at Bromsgrove, England, and was originally planned as a superorthopedic center, where the more difficult orthopedic procedures would be handled in addition to rehabilitation. The idea was sound as long as the expeditionary force remained small. It ceased to be practical by the time that 3,065,505 troops were in the theater and were being served by about 200 general and station hospitals.1

After D-day, as the flood of casualties increased, the load became too heavy even for the special rehabilitation hospitals which had been set up, and the program many times had to be assumed by rehabilitation sections in individual station and general hospitals, sometimes with distinctly inferior results. Even in the best hospitals, the program was somewhat slow in getting under way after D-day. Then it began to improve, particularly as cooperation between orthopedic and rehabilitation sections became closer. Nonetheless, rehabilitation of orthopedic casualties was best handled in hospitals set up for this special purpose. Without them, there would have been a great deal of delay in getting many men back to duty because the large hospital centers were too crowded and too busy to undertake the work properly, and on the wards rehabilitation often had to give way to more urgent problems. A maximum number of orthopedic casualties were returned to duty, in optimum condition, from the rehabilitation hospitals. Furthermore, as time passed, evacuation policies were improved, and one error which had taken up much time and bed space unnecessarily, was corrected; namely, men with relatively minor injuries were no longer sent to these units.

1Strength reports of the Army, prepared by the Office of the Chief of Staff.


Physical Therapy Programs

The load of rehabilitation in bone and joint injuries was chiefly carried by the department of physical therapy. There was, however, a constant shortage of properly trained physical therapists and technicians to handle the volume of injuries which became their responsibility. As a result, the therapists were not on the ward as often as was desirable, and much of the instruction and the persuasion necessary to implement the program were necessarily left to the ward attendants, who were constantly with the bed patients and who could insist that the prescribed exercises be carried out.

Most orthopedic surgeons were fully conscious of the need for rehabilitation and reconditioning and regarded definite programs of exercise for both bed and ambulatory patients with bone and joint injuries as part of their therapeutic responsibility. One or two hospitals displayed a good deal of imagination in setting up these programs.

An elaborate program of rehabilitation was set up at the 802d Hospital Center, where it was started as soon as the patient was admitted. It was carefully explained to him, as soon as his condition permitted, that his recovery depended more upon his general condition than upon any other single factor and that his general condition depended, in turn, upon his eating, keeping all his muscles in optimum tone, and keeping himself interested, cooperative, and eager to live and recover. He was told that the hospital would make his surroundings as attractive as possible, that the first few days would be difficult but that, nonetheless, he must make himself participate in all the activities which were prescribed and that he would soon find participation easier. It was explained to him that a healed bone was useless without a functioning muscle, and that a prosthesis would be of small value without muscular function. He was also plainly informed that, once muscles were allowed to become wasted, it was very hard to rebuild them. The physical therapist and a technician were present when the patient was given this information by the medical officer, and they, in turn, explained and demonstrated to the patient the remedial exercises required of him to achieve the results expected.

Early each morning all roentgenograms taken the previous day were reviewed by the chief of the orthopedic section and his entire staff, including the physical therapist. Progress was discussed, and a general review of the whole program was undertaken. Informal rounds were made during the week, to keep those in charge of the program fully abreast of it. On Sunday, formal rounds were made by the chief of the orthopedic section and were attended by everyone who had any connection with the program. At this time, the exercises for each patient were outlined for the following week.

On the ward, regularly performed remedial exercises were the basis of rehabilitation. The wardmaster was responsible for the supervision of the patients. Each hour was announced by him and, for the next 5 minutes, all other activities that could be stopped were discontinued while the prescribed exercises were carried out. Whenever possible, new or difficult exercises


were checked by the physical therapist or by the physiotherapy technician to be certain that they were being carried out correctly. Three times daily, at 10, 2, and 4 o'clock, exercises for the entire hospital were directed over the loudspeaker system. Ward personnel were encouraged to take the exercises with the patients.

As might have been expected the results of reconditioning and rehabilitation at this hospital center were unusually good. Time and effort were spent on the program, which was directed with energy and imagination, and the patients responded to the program with equal enthusiasm and interest.

Another excellent program was directed and carried out at the 129th General Hospital. One of its features was the presentation to each patient of a booklet entitled "Fracture Facts" which had been written by Lt. Col. Philip S. Foisie, MC, and illustrated by Sgt. William Pitney (see extracts from booklet, pages 180 to 183). The necessity of using the arms and legs to prevent muscular atrophy from disuse was clearly set forth, and the booklet proved of great value in the rehabilitation of patients with bone and joint injuries.

Replacement Centers

From the standpoint of orthopedic surgery, replacement centers did not function as well as could have been wished. Soldiers sent to them with precise recommendations for limited duty were frequently returned to their original units or were sent to other units in which the duties were equally arduous. As a result, they were soon on their way back to the dispensary or the hospital.

This was extremely unfortunate. There were in the theater many positions which were occupied by men who were good combat material and which could quite well have been filled by men qualified only for limited duty. Too frequently, until the last weeks of the war, little or no attempt was made to substitute these men for men fitted for frontline duty. Even then, the exchange was often not entirely satisfactory. On the other hand, some of the men designated for limited duty were in need of rehabilitation themselves, and sometimes in need of actual hospital care. This waste of manpower in World War II should be borne in mind in any future war. It could have been partially avoided by having mature and experienced medical officers, preferably with combat experience, serve on disposition boards and in replacement centers.



FRACTURE FACTS (continued)

FRACTURE FACTS (continued)

FRACTURE FACTS (continued)