Reforming the veteran: propaganda and agency in the First World War Reconstruction hospitals

The United States’ entry into the First World War prompted progressives to reform veterans’ entitlements in the hopes of creating a system insulated from corruption and capable of rehabilitating disabled veterans into productive members of society. The replacement of pensions with medical care for wounded and disabled soldiers through the Reconstruction Hospital System was originally intended as a temporary measure but resulted in establishing the foundations of the modern veterans’ health care system. Yet, these reforms would not have been possible without the support from the community of war veterans to which these reforms applied. By examining the communal values expressed in publications produced by and for soldiers, this paper explores the ways in which the Great War’s veteran community expressed agency in the process of reforming the US veteran entitlements.

Henry Wade (1876-1955), pioneer of urological surgery, museum conservator and war veteran

Henry Wade graduated in the Edinburgh Medical School in 1898 before spending two years with the British army during the Anglo-Boer war. Returning to this country, he joined Francis Caird, surgeon to the Edinburgh Royal Infirmary. Appointed Conservator of the museum of the Royal College of Surgeons of Edinburgh, Wade met young William Ford Robertson. In a study of experimental cancer they concluded that some neoplasms were caused by bacteria. Wade became increasingly recognised as an authority in urology. His growing practice was interrupted by the First World War. Already a member of the Royal Army Medical Corps, he served for five years in the Middle East, in Gallipoli and then with the army in an approach to Jerusalem. Resuming civilian life, Wade combined an extensive urological practice with membership of the Council of the RCSEd. He became President in 1935. Married in 1924, his wife died four years later after an operation by a colleague, David Wilkie. Director of Surgery to the Scottish Emergency Medical Service when the Second World War broke out, Wade was made a Knight Bachelor in 1946. He died in 1955.

[Concomitance of depressive disorders and enduring personality change after catastrophic experience in repression victims in the years 1940-1956]

AIM

The aim of the research project was to assess the incidence of depressive disorders and enduring personality change in the victims of the WWII combatants and repression victims in the years 1940-1956.

MATERIALS AND METHODS

The study group consists of 57 members of combatant organizations in the Lodz Voivodeship. Two groups are discerned. Group one comprises individuals with depressive disorders and group two is made up of individuals without depressive disorders. The Beck Depression Inventory and Medical Socio-demographic Questionnaire were applied.

RESULTS

The group one (with depressive disorders) is characterized by a high incidence of mental disorders whereas the group two (without the disorders) demonstrates a high prevalence of psychosomatic disorders. Mental disorders related to enduring personality change following exposure to catastrophic stress are more common in the group with depressive disorders.

CONCLUSIONS

The researchers wish to point to the need of thorough examination of various combatants and repression victims since the symptoms of enduring personality change following a catastrophic experience as well as after depression may coincide.

"The Service I Rendered Was Just as True": African American Soldiers and Veterans as Activist Patients

In this article, I examine how African American soldiers and veterans experienced and shaped federally sponsored health care during and after World War I. Building on studies of the struggles of Black leaders and health care providers to win professional and public health advancement in the 1920s and 1930s, and of advocates to mobilize for health care rights in the mid-20th century, I focus primarily on the experiences and activism of patients in the interwar years. Private and government correspondence, congressional testimony, and reports from Black newspapers reveal that African American soldiers and veterans communicated directly with policymakers and bureaucrats regarding unequal treatment, assuming roles as "policy actors" who viewed health and medical care as "politics by other means." In the process, they drew attention to the paradoxes inherent in expanding government entitlements in the era of Jim Crow, and helped shape a veterans' health system that emerged in the 1920s and remained in place for the following century. They also laid the groundwork for the system's precedent-setting desegregation, referred to by advocates of the time as "a shining example to the rest of the country."

Neurology in the Vietnam War

Between December 1965 and December 1971, the United States maintained armed forces in Vietnam never less than 180,000 men and women in support of the war. At one time, this commitment exceeded half a million soldiers, sailors, and airmen from both the United States and its allies. Such forces required an extensive medical presence, including 19 neurologists. All but two of the neurologists had been drafted for a 2-year tour of duty after deferment for residency training. They were assigned to Vietnam for one of those 2 years in two Army Medical Units and one Air Force facility providing neurological care for American and allied forces, as well as many civilians. Their practice included exposure to unfamiliar disorders including cerebral malaria, Japanese B encephalitis, sleep deprivation seizures, and toxic encephalitis caused by injection or inhalation of C-4 explosive. They and neurologists at facilities in the United States published studies on all of these entities both during and after the war. These publications spawned the Defense and Veterans Head Injury Study, which was conceived during the Korean War and continues today as the Defense and Veterans Head Injury Center. It initially focused on post-traumatic epilepsy and later on all effects of brain injury. The Agent Orange controversy arose after the war; during the war, it was not perceived as a threat by medical personnel. Although soldiers in previous wars had developed serious psychological impairments, post-traumatic stress disorder was formally recognized in the servicemen returning from Vietnam.

Policy commercializing nonprofits in health: the history of a paradox from the 19th century to the ACA

POLICY POINTS: Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector. This policy paradox persists during the implementation of the Affordable Care Act of 2010.

CONTEXT

For more than a century, policy in the United States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. The implementation of the Affordable Care Act of 2010 (ACA) began yet another chapter in the history of this policy paradox.

METHODS

This article explores the origin and persistence of the paradox using what many scholars call "interpretive social science." This methodology prioritizes history and contingency over formal theory and methods in order to present coherent and plausible narratives of events and explanations for them. These narratives are grounded in documents generated by participants in particular events, as well as conversations with them, observing them in action, and analysis of pertinent secondary sources. The methodology achieves validity and reliability by gathering information from multiple sources and making disciplined judgments about its coherence and correspondence with reality.

FINDINGS

A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health sector. Participants in this consensus include leaders of governance who have disagreed about many other issues. The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment, and management of illness.

CONCLUSIONS

The policy paradox that has incentivized the growth and commercialization of nonprofits in the health sector since the late 19th century remains influential in health policy, especially for the allocation of resources. However, aspects of the implementation of the ACA may constrain some of the effects of the paradox.

From Shell Shock to Shellac: The Great War, Blindness, and Britain's Talking Book Library

Britain's Talking Book Service began as a way of providing reading material to soldiers blinded during the First World War. This account traces the talking book's development from the initial experiments after the War to its debut and reception among blind soldiers and civilians in the 1930s. It has been put together using archives held by the Royal National Institute of Blind People (before its Royal Charter, the NIB) and Blind Veterans UK (formerly St. Dunstan's), the two organizations responsible for Britain's Talking Book Service. The essay's first section reconstructs the search for an alternative way of reading that would benefit people with vision impairments. The next part demonstrates the talking book's impact on the lives of people with disabilities, recovering the voices of blind readers left out of most histories of books, literacy, and reading practices in the twentieth century. The final section reconstructs a debate over the value of recorded books, showing that disputes over their legitimacy are as old as recorded books themselves. In sum, this essay confronts the central issue raised by the convergence of books, media, and disability in the War's aftermath: can a book talk?

Prosthetic Manhood in the Soviet Union at the End of World War II

Millions of Soviet soldiers were disabled as a direct consequence of their service in the Second World War. Yet despite its expressions of gratitude for their sacrifices, the state evinced a great deal of discomfort regarding their damaged bodies. The countless armless and legless veterans were a constant reminder of the destruction suffered by the country as a whole, an association increasingly incompatible with the postwar agenda of wholesale reconstruction. This article focuses on a key strategy for erasing the scars of war, one with ostensibly unambiguous benefit for the disabled themselves: the development of prostheses. In addition to fostering independence from others and ultimately from the state, artificial limbs would facilitate the veterans' return to the kinds of socially useful labor by which the country defined itself. In so doing, this strategy engendered the establishment of a new model of masculinity: a prosthetic manhood.

Half a Man: The Symbolism and Science of Paraplegic Impotence in World War II America

At the conclusion of the Second World War, more than 600,000 men returned to the United States with long-term disabilities, profoundly destabilizing the definitions, representations, and experiences of male sexuality in America. By examining an oft-neglected 1950 film, The Men, along with medical, personal, and popular accounts of impotence in paralyzed World War II veterans, this essay excavates the contours of that change and its attendant anxieties. While previous scholarship on film and sexuality in the postwar period has focused on women's experiences, we broaden the analytical lens to provide a fuller picture of the various meanings of male sexuality, especially disabled heterosexuality. In postwar America, the paralyzed veteran created a temporary fissure in conventional discussions of the gendered body, a moment when the "normality" and performative features of the male body could not be assumed but rather had to be actively defined. To many veterans, and to the medical men who treated them, sexual reproduction--not function-became the ultimate signifier of remasculinization.

Mortality of first world war military personnel: comparison of two military cohorts

OBJECTIVE

To identify the impact of the first world war on the lifespan of participating military personnel (including in veterans who survived the war).

DESIGN

Comparison of two cohorts of military personnel, followed to death.

SETTING

Military personnel leaving New Zealand to participate in the first world war.

PARTICIPANTS

From a dataset of the New Zealand Expeditionary Forces, we randomly selected participants who embarked on troopships in 1914 and a comparison non-combat cohort who departed on troopships in late 1918 (350 in each group).

MAIN OUTCOME MEASURES

Lifespan based on dates of birth and death from a range of sources (such as individual military files and an official database of birth and death records).

RESULTS

A quarter of the 1914 cohort died during the war, with deaths from injury predominating (94%) over deaths from disease (6%). This cohort had a significantly shorter lifespan than the late 1918 "non-combat" cohort, with median ages of death being 65.9 versus 74.2, respectively (a difference of 8.3 years shown also in Kaplan-Meier survival curves, log rank P<0.001). The difference for the lifespan of veterans in the postwar period was more modest, with median ages of death being 72.6 versus 74.3, respectively (a difference of 1.7 years, log rank P=0.043). There was no evidence for differences between the cohorts in terms of occupational class, based on occupation at enlistment.

CONCLUSIONS

Military personnel going to the first world war in 1914 from New Zealand lost around eight years of life (relative to a comparable military cohort). In the postwar period they continued to have an increased risk of premature death.

[Research and treatment of war neuroses at the Clinic for Nervous and Mental Diseases at the Jagiellonian University in Krakow before World War II in the context of psychiatry in Europe]

The aim of this article is to offer an overview of the research into diagnosis and treatment of war neuroses at the Clinic for Nervous and Mental Diseases at the Jagiellonian University in Krakow before the outbreak of World War II. It also includes a profile of the work of Prof. Jan Piltz, the then director of the Clinic, and his major scientific achievements. The publications cited in the article date in the main from the period of World War I, and comprise clinical analyses of the consequences of stress suffered at the front as well as a description of the ways in which they were treated. These are presented alongside other major findings related to war neuroses being made in Europe at the time. The article draws attention to the very modern thinking on treatment of war neuroses, far ahead of the average standards of the day, evinced by Prof. Piltz and his team. The most important innovative elements of their treatment of these conditions were the fact that they perceived the cause of the neurosis to lie in previous personality disorders in the patients, their recommendation of psychotherapy as the main method of treatment, and their emphasis on the need for further rehabilitation following the completion of the course of hospital treatment. They also paid significant attention to the importance of drawing up individual therapy plans for each patient.

Great aspirations: the postwar American college counseling center

In the decade after World War II, psychologists, eager to bring the benefits of counseling to larger numbers, convinced hundreds of American colleges and universities to establish counseling centers. Inspired by the educational-vocational counseling center founded by psychologists at the University of Minnesota in 1932, Carl R. Rogers's "client-centered" methods of personal adjustment counseling, and the 400-plus college counseling centers created by the Veterans Administration to provide the educational-vocational counseling benefit promised to returning World War II servicemen under the 1944 GI Bill, these counseling psychologists created a new place to practice where important currents in psychology, higher education, and federal policy converged and where they attempted to integrate educational-vocational counseling with personal adjustment counseling based on techniques from psychotherapy. By the mid-1960s, half of America's colleges and universities had established counseling centers, and more than 90% offered students educational, vocational, and psychological counseling services, a great achievement of the first generation of counseling psychologists.

Veterans' stories: what they may have to tell us--a personal reflection

It has been said that we learn much from war. Not only how to conduct it and to be successful, but we learn how the body works and how to assist in regaining function. Without our veterans, much of today's medical knowledge would not be nearly as complete. We have learned how to care for and celebrate our veterans when they return from the war. Vietnam veterans can share what it is like to come home to a country that is not only entirely different, but even antagonistic, to the veteran as a person. This article will consider the types of homecoming experiences veterans have encountered while also introducing examples of the medical knowledge that has been gained from the struggles of those who have fought, and often died, for our country.

Realizing Major William Borden's dream: military medicine, Walter Reed Army Medical Center, and its wounded warriors, 1909-2009: an essay review

This essay review examines three books dealing with the founding and subsequent activities of Walter Reed Army Medical Center (WRAMC) and the evolution of military medicine from 1909 to 2009 recently published by the US Army's Borden Institute. Established by fellow army doctor William Borden to honor Walter Reed himself, WRAMC, located in Washington, DC, soon became the public and professional face of medical care for American soldiers. The discussion highlights the ongoing issue of the care and treatment of combat amputees; aspects of gender within military medicine; and WRAMC's function as an educational and research facility. Also discussed are the archival and documentary bases for these books and their utility for historians. Complimentary analysis of two of the books which are, in particular, explicitly about the history of WRAMC is contextualized within the celebration of the centennial of this army post contemporaneously with its closure, amalgamation, and relocation primarily to Maryland.

Casualties

Privation and disease have mainly killed soldiers until very recently. Now that enemy action predominates, faster and better control of bleeding and infection before and during evacuation spares ever more lives today. This essay focuses on psychological war wounds, placing them in the context of military casualties. The surgeon's concepts of 'primary' wounds in war, and of would 'complications' and 'contamination', serve as models for psychological and moral injury in war. 'Psychological injury' is explained and preferred to 'Post-Traumatic Stress Disorder', being less stigmatizing and more faithful to the phenomenon. Primary psychological injury equates to the direct damage done by a bullet; the complications - for example, alcohol abuse - equate to hemorrhage and infection. Two current senses of 'moral injury' equate to wound contamination. As with physical wounds, it is the complications and contamination of mental wounds that most often kill service members or veterans, or blight their lives.

War, suffering and modern German history

This introduction proceeds in five steps. First, it briefly considers the etymology of the term "suffering," as well as the way in which scholars from different disciplines have approached it conceptually and empirically. Second, drawing on the contributions to this issue, it raises general themes emerging from the study of the Thirty Years, Franco-Prussian and First World Wars, with particular attention to gender, the disabled, and Jewish-German veterans. Finally, it considers the most politically contested field of German suffering - the Second World War - and reflects on how that suffering can be narrated and understood without running into the intellectual dead ends of either self-pity or collective guilt.

From war service to domestic service: ex-servicewomen and the Free Passage Scheme 1919-22

At the end of the First World War, the British government put into operation a Free Passage Scheme for ex-servicemen, ex-servicewomen and their dependants to emigrate to the colonies and dominions of the Empire. This scheme was driven by a complex network of interlinked beliefs and policies concerning both the relationship between the metropole and the Empire, and the perceived necessity for social stability in Britain and in the dominions and colonies. This article examines the Free Passage Scheme, paying particular attention to the ways in which it was envisaged as a means of restoring a gendered balance of the population in Britain, where young women outnumbered young men at the end of the war, and in the dominions, where men outnumbered women, and was also seen as a way of emigrating women whose wartime work experiences were understood to be in conflict with gendered identities in the post-war period. The article argues that the Free Passage Scheme needs to be understood as gendered, as it envisaged the transformation of female members of the auxiliary wartime services into domestic servants for the Dominions. The scheme's failure, it is argued, prefigures the failure of the far larger Empire Settlement Act of 1922 to emigrate large numbers of British women as domestic servants.

Veterans' welfare, the GI Bill and American demobilization

The passage of the Servicemen’s Readjustment Act of 1944 — or GI Bill — opened up a dialogue about men’s physical and mental health, for it addressed very directly what ordinary men would need to recover from extraordinary violence. Political leaders identified veterans’ “welfare,” by which they meant general well-being, as a top priority of World War II’s recovery, and the GI Bill was the centerpiece of their agenda. The bill’s passage was an impressive legislative triumph, the collective product of massive medical, legal, and social science research, bipartisan politicking, and veterans’ activism. It provided education, housing, and small business assistance, along with mental and physical rehabilitation in government-funded hospitals. All of these programs, whether they served mind, body, or wallet, amounted to welfare — a set of government-sponsored policies and services designed to aid a soldier’s transition from enlisted man to healthy, productive citizen. Thus we have to think about the broad reach of the GI Bill’s welfare provision as one of the health legacies of World War II.

The Kishon affair: science, law, and the politics of causation

This article describes how science and law were called upon (and failed) to resolve a controversy that created a painful rift between the Israeli State and some of its elite soldiers. The controversy, which came to be known as "the Kishon affair," erupted in 2000, when veterans of an elite and secretive unit in the Israeli navy claimed that pollution in the Kishon River where they had trained and dived during their military service had been the cause of a rash of cancers. The veterans demanded that the Ministry of Defense take responsibility for their illnesses, finance their medical treatment, and support their families if they die. The military denied the causal connection between the polluted river and the veterans' cancers and rejected their demands. The dispute quickly escalated into a bitter public controversy, and a high-rank commission comprised of one of Israel's top jurists and two prominent scientists was called upon to study the disputed causal relation and reveal its true nature. However, after nearly three years of intense inquiry the jurist and the scientists reached opposing conclusions: the jurist found a causal connection while the scientists rejected it.

Federal policy and the rise in disability enrollment: evidence for the Veterans Affairs' Disability Compensation Program

The U.S. Department of Veterans Affairs compensates 13 percent of the nation’s military veterans for service‐related disabilities through the Disability Compensation (DC) program. In 2001, a legislative change made it easier for Vietnam veterans to receive benefits for diabetes associated with military service. In this paper, we investigate this policy’s effect on DC enrollment and expenditures as well as the behavioral response of potential beneficiaries. Our findings demonstrate that the policy increased DC enrollment by 6 percentage points among Vietnam veterans and that an additional 1.7 percent experienced an increase in their DC benefits, which increased annual program expenditures by $2.85 billion in 2007. Using individual-level data from the Veterans Supplement to the Current Population Survey, we find that the induced increase in DC enrollment had little average impact on the labor supply or health status of Vietnam veterans but did reduce labor supply among their spouses.

Memories from the edge of the abyss: evaluating the oral accounts of World War II veterans

Since the "greatest generation" is rapidly passing from the scene, this article maintains that the time is ripe for the oral history community to engage in a serious examination of the strengths and weaknesses of World War II veteran interviews. Using a small case study about the battle of Okinawa (April-June 1945), the essay examines some aspects of the memory quality of World War II veterans interviewed late in life. It presents three arguments. First, American veterans of World War II were frequently reticent about recounting their memories. They often waited until late in life to do so. Second, the American World War II veterans' interviews were generally reliable and accurate even when given late in life. Nonetheless, some problems were encountered in interviewing veterans long after a battle. Third, the veterans could provide greater detail about their initial experiences during a campaign. Recollections about their later experiences during the same campaign were foggier. The author concedes, however, that the small size of his case study means that the conclusions can only have validity if confirmed by the experience of other oral history interviewers. Hence the author's goal is to initiate this important conversation rather than to conclude it.

War’s long shadow: masculinity, medicine, and the gendered politics of trauma, 1914-1939

War is an inherently traumatizing experience, and during the First World War more than 15,000 Canadian soldiers were diagnosed with some form of war-related psychological wounds. Many more went unrecognized. Yet the very act of seeking an escape from the battlefield or applying for a postwar pension for psychological traumas transgressed masculine norms that required men to be aggressive, self-reliant, and un-emotional. Using newly available archival records, contemporary medical periodicals, doctors' notes, and patient interview transcripts, this paper examines two crises that arose from this conflict between idealized masculinity and the emotional reality of war trauma. The first came on the battlefield in 1916 when, in some cases, almost half the soldiers evacuated from the front were said to be suffering from emotional breakdowns. The second came later, during the Great Depression, when a significant number of veterans began to seek compensation for their psychological injuries. In both crises, doctors working in the service of the state constructed trauma as evidence of deviance, in order to parry a larger challenge to masculine ideals. In creating this link between war trauma and deviance, they reinforced a residual conception of welfare that used tests of morals and means to determine who was deserving or undeserving of state assistance. At a time when the Canadian welfare state was being transformed in response to the needs of veterans and their families, doctors' denial that "real men" could legitimately exhibit psychosomatic symptoms in combat meant that thousands of legitimately traumatized veterans were left uncompensated by the state and were constructed as inferior, feminized men.

Occupational career and risk of mortality among US Civil War veterans

Previous studies have extended the traditional framework on occupational disparities in health by examining mortality differentials from a career perspective. Few studies, however, have examined the relation between career and mortality in a historical U.S. population. This study explores the relation between occupational career and risk of mortality in old age among 7096 Union Army veterans who fought the American Civil War in the 1860s. Occupational mobility was commonplace among the veterans in the postbellum period, with 54% of them changing occupations from the time of enlistment to 1900. Among veterans who were farmers at enlistment, 46% of them changed to a non-farming occupation by the time of 1900. Results from the Cox Proportional Hazard analysis suggest that relative to the average mortality risk of the sample, being a farmer at enlistment or circa 1900 are both associated with a lower risk of mortality in old age, although the effect is more salient for veterans who were farmers at enlistment. Occupational immobility for manual labors poses a serious threat to chance of survival in old age. These findings still hold after adjusting for the effects of selected variables characterizing risk exposures during early life, wartime, and old age. The robustness of the survival advantage associated with being a farmer at enlistment highlights the importance of socioeconomic conditions early in life in chance of survival at older ages.

Internal influences in the making of the English military hospital: the early-eighteenth-century Greenwich

This chapter uses records at the Royal Greenwich Hospital for ex-sailors to analyse the nature of care, and to uncover how the chronically disabled patients themselves experienced the hospital. Greenwich became a 'reverse' institution, in that the ex-servicemen were closely regulated and treated like unruly visitors, while only officers and medics had free movement and influence. Although initially the inner workings of the Hospital owed much to almshouse and shipboard models, over time medical considerations became paramount. Physicians and surgeons became involved actively in governance and discipline, promoting environmental and dietary changes.

War neurosis, adjustment problems in veterans, and an ill nation: The disciplinary project of American psychiatry during and after World War II

After World War II, the confidence of American psychiatrists was at an all-time high as a result of their successful participation in the war. When the incidence of mental breakdown in the American armed forces rose to unprecedented heights, new and effective psychotherapeutic methods were developed to treat the traumatic effects of the extraordinary stresses of warfare. At the same time, social scientists concluded that breakdown incidence was inversely related to morale, which led to the development of preventive measures aimed at specific groups. Both initiatives stimulated a number of psychiatrists to plan projects of social engineering after the war. They first focused on aiding the reintegration of returning veterans. Later, they addressed the poor mental health of the American population as a whole, which they considered to be the consequence of faulty child-rearing methods.

Association of kidney function with mortality in patients with chronic kidney disease not yet on dialysis: a historical prospective cohort study

Significant mortality occurs in populations with chronic kidney disease (CKD), but the relative contributions of lower glomerular filtration rate (GFR) itself, accompanying comorbidities, and the numerous abnormalities that develop with advancing CKD are poorly studied. We examined all-cause predialysis mortality in 861 United States veterans with CKD stage 3 to 5 not yet on dialysis. The association of GFR with mortality was analyzed by the Kaplan-Meier method, and the effects of several confounding variables on mortality were assessed in a Cox proportional-hazards model. Overall death rate was 102.1/1,000 person-years (95% CI: 90.2 to 115.6). Lower kidney function was associated with higher mortality (relative risk [95%CI] for GFR less than 20 v 41 to 60 mL/min/1.73 m2: 2.56 [1.61 to 4.07], P<0.001) after adjustment for age, race, diabetes mellitus, cardiovascular disease, smoking status, body mass index, mean arterial pressure, serum albumin, blood cholesterol, haemoglobin, and 24-hour urine protein. For every 10 mL/min/1.73 m2 lower estimated GFR, the adjusted relative risk of mortality (95% CI) was 1.28 (1.12 to 1.45), P<0.001. Lower kidney function is associated with increased mortality in patients with moderate and advanced CKD. This association is present even after adjustment for several confounders.