On the Mend

The toll of war is often measured in fatalities. But immediately following that count is almost always the number of soldiers who have been injured—those in dire need of care after suffering a trauma on the field of battle. Because of the urgency involved in getting wounded soldiers the attention they need, the first modernized rehabilitation program was created during World War I—at a time when both national image and economic health weighed heavily on America’s shoulders.

Much of the philosophy behind institutionalized rehabilitation was political. Fiscal constraints, due to the ballooning cost of the war, eventually led to the reevaluation of veteran pensions. Officials were well aware that during the Civil War, pension payout outpaced the total cost of the ground war. In order to counter this in World War I, the government sought to establish a program that would guarantee a soldier’s continuing contribution to the war, whether it be back on the front lines—or in a munitions factory.

“Back then quality of life referred less to personal happiness than it did to productivity,” says Beth Linker, Assistant Professor of History & Sociology of Science and author of War’s Waste: Rehabilitation in World War I America. “Think of it like a daily checklist: can you get from point A to point B; can you open your front door and feed and clothe yourself? This also had its roots in themes of masculinity and the viability of wounded soldiers as mates. For financial and public image reasons, the government sought to reform the way in which it dealt with injured veterans and their recuperation.”

“Before World War I, the only type of insurance that existed was life insurance. It wasn’t until an addendum was tacked onto a bill responsible for insuring naval ships that the corporal welfare of soldiers was officially recognized.” – Beth Linker

The military was also sensitive to the stigmatized images of the panhandling veteran and was fighting these tropes every step of the way. Amputees were considered a sort of poster child for the functional wounded. They were often used as props in photographs with government officials because their injuries—and remedies—were visible. But this kind of positioning often led to misplaced priorities. For example, the initiative to mass produce artificial limbs largely failed due to the government’s haste and lack of foresight regarding the individualization of treatment. Because of these botched attempts to get injured soldiers back on their feet as fast as possible, often maimed soldiers often went outside the system and revert to more primitive technology—such as hook hands.

“This was all fairly new territory. The legislation that supported rehabilitation had only just recently been enacted,” says Linker. “Before World War I, the only type of insurance that existed was life insurance. It wasn’t until an addendum was tacked onto a bill responsible for insuring naval ships that the corporal welfare of soldiers was officially recognized. Later the GI Bill was introduced, which offered a much more robust standard.”

Due to the fact that institutionalized rehabilitation was largely nonexistent, the military had to construct a model. Hospital schools had existed prior to the war with the similar goal of returning injured and disabled children to a physical condition under which they might eventually enable to work in handicraft. Up until World War I, however, hospitals were generally considered places of disease, not centers for recuperation. The reimagining of the hospital as a place for convalescing spurred a societal transition that saw the eventual privatization of physical therapy and other rehabilitation services, which in-turn led to the establishment of civilian practices.

“The intricacies of post-war rehabilitation have slowly revealed themselves throughout the years,” says Linker. “The military has been forced to adapt to a number of changes—woman’s entry into the service, for instance. In addition, there are important contemporary policy debates surrounding issues like the rise in suicide rates among soldiers and post-traumatic stress syndrome’s lasting effects which need to be continually reevaluated.”