War's Waste: Rehabilitation in World War I America

BETH LINKER is an assistant professor in the Department of History and Sociology of Science at the University of Pennsylvania.

The University of Chicago Press, Chicago 60637

The University of Chicago Press, Ltd., London

© 2011 by The University of Chicago

All rights reserved. Published 2011

Printed in the United States of America

20 19 18 17 16 15 14 13 12 11    1 2 3 4 5

ISBN-13: 978-0-226-48253-8 (cloth)

ISBN-10: 0-226-48253-7 (cloth)

ISBN-13: 978-0-226-48255-2 (e-book)

Publication of this book has been aided by a grant from the Bevington Fund.

Library of Congress Cataloging-in-Publication Data

Linker, Beth.

War’s waste : rehabilitation in World War I America / Beth Linker.

p. cm.

Includes bibliographical references and index.

ISBN-13: 978-0-226-48253-8 (cloth : alk. paper)

ISBN-10: 0-226-48253-7 (cloth: alk. paper) 1. Disabled veterans—Rehabilitation—United States—History—20th century. 2. World War, 1914–1918—Veterans—Medical care—United States—History—20th century. 3. Medical rehabilitation—United States—History—20th century. I. Title.

UB363.L56 2011

362.1086'970973—dc22          2010045280

This paper meets the requirements of ANSI/NISO Z39.48-1992 (Permanence of Paper).

War’s Waste

Rehabilitation in World War I America

BETH LINKER

The University of Chicago Press

Chicago and London

Contents

Introduction: The Roots of Rehabilitation

1 The Problem of the Pensioner

2 Reconstructing Disabled Soldiers

3 A New Female Force

4 Maximalist Medicine at Walter Reed

5 The Limb Lab and the Engineering of Manly Bodies

6 Propaganda and Patient Protest

7 Rehabilitating the Industrial Army

Epilogue: Walter Reed, Then and Now

Acknowledgments

Notes

Bibliography

Index

For Damon

INTRODUCTION

The Roots of Rehabilitation

Watching Garth Stewart skip down the steps to catch a New York City subway, you would never suspect that he’s wearing a prosthetic leg or that he’s a veteran of the Iraq war. At the age of twenty, Stewart lost his lower left leg outside of Baghdad on April 5, 2003. After a brief return to service, he became an undergraduate at Columbia University with the help of the Servicemen’s Readjustment Act, known informally as the GI bill, and received a bachelor’s degree in history in 2009. His story has piqued the interest of many media outlets. He regularly receives invitations to gala events, hobnobbing with the cultural, military, and political elite. Former Deputy Secretary of Defense and friend Paul Wolfowitz calls Stewart a rock star. Like any rock star, Stewart has big plans. He dreams of becoming a senator, perhaps even president one day. If he continues to follow the motto that he had taped to his dormitory door—Rest When You’re Dead—he just might succeed.¹

Stewart readily admits that he has become a poster child of the war.² But he could not have achieved such heights if he had not first become a poster child of rehabilitation, triumphantly overcoming his disability to the point where he no longer appears disabled in the public eye. If a wounded soldier refuses rehabilitation and does not take the necessary steps to become as physically and financially independent as possible, he is considered a failure, not a hero. War wounds in themselves are not enough to earn respect. The maimed veteran who earns accolades is the one who makes good, applying his (and now her) military skills to fight for a full recovery. This is the ethic of rehabilitation.

That ethic has a history. From America’s earliest wars to those of the second half of the nineteenth century, soldiers permanently injured in the line of duty received a lifetime of monetary reimbursement in the form of federal pensions, without any explicit demand of returning to gainful employment or a life of self-sufficiency.³ Congress passed the first disability pension law in 1792, stating that all wounded soldiers of the Revolutionary War shall be taken care of and provided for at the public expense.⁴ At the end of the Civil War, President Andrew Johnson wrapped disability pensions in the blanket of patriotic duty, declaring that a grateful people will not hesitate to sanction any measures having for their object the relief of soldiers mutilated . . . in the effort to preserve our national existence.⁵ The pension system persisted for the remainder of the nineteenth century, operating on the assumption that in a just society, the government and its people owed disabled soldiers a simple debt of gratitude.⁶ The disabled soldier had proven his patriotic worth. He had done his civic duty. Nothing more should be asked of him.

This would all change with the First World War.⁷ Opposed to the perceived economic inefficiencies and political corruption of the pension system, Progressive Era reformers encouraged the Wilson administration to institute programs in rehabilitation, providing injured soldiers with long-term medical care and vocational training in order to drastically reduce—and potentially erase—cash payments made out to veterans. Emboldened by their faith in the new social and medical sciences, Progressive reformers believed that the government could (and should) rebuild war cripples, curing them of their disabilities so that veterans of the First World War would make a speedy return to work and rely on their own wage-earning capacity rather than on government pensions. Men returning home with amputated arms and legs were to be refitted, not only with prosthetic limbs, but also to an appropriate workplace, so that, as one rehabilitation advocate put it, a soldier’s disability would not be a handicap.⁸ With proper physical and vocational reconstruction, blind men, deaf men, and dismembered men could all produce wealth and contribute to society.

Rehabilitation proponents aimed to rid the nation of war’s waste, a turn of phrase that referred to the human remains of war as well as to the economic cost that the nation had to endure after the battle was over.⁹ Pension spending for the nation’s aging Civil War veterans had reached an all-time high on the eve of America’s declaration of war against Germany in April 1917.¹⁰ One economist estimated that by the year 1916, the United States had spent over $5 billion on Civil War pensions, an amount that exceeded the price of the actual war.¹¹ Looking across the Atlantic at the human toll wrought by the First World War, Americans feared that engagement would lead to a heavier economic burden than all of the nation’s previous wars combined. The promise of rehabilitation—that once the disabled soldier had been rebuilt, he would require no further monetary assistance—made the prospect of entering the Great War much easier to stomach.

But more than economic concerns drove the rehabilitation campaign. In World War I America, rehabilitation symbolized a dream, a hope that physical handicaps, pauperism, and defects of manhood could all be conquered on the home front.¹² It was a vision of physical and social perfectionism, but within limits. Unlike eugenicists who wished to sterilize defectives and enforce ugly laws to keep aesthetic undesirables out of public view, rehabilitation officials did not shun men with permanent disfigurements and missing limbs.¹³ They sought instead to educate the nation to accept disabled soldiers while also providing the injured with the tools to reintegrate into normal life as seamlessly as possible.

Supporters of the World War I rehabilitation effort came from all walks of life. Some, such as Edward T. Devine and Julia Lathrop, had backgrounds in social work and others in law, for example, Judge Julian Mack. Certain big-business philanthropists like Julius Rosenwald supported the cause, but so, too, did labor leader Samuel Gompers. Presidents Theodore Roosevelt, William Howard Taft, and Woodrow Wilson all shored up the movement to get maimed soldiers back to work, as did key figures in the medical profession, such as William James Mayo, cofounder of the Mayo clinic, and Frank Billings, one-time president of the American Medical Association and dean of faculty at the Rush Medical College in Chicago.

Although a diverse lot, these reformers shared some common assumptions, most notably about the importance, virtue, and redemptive value of work.¹⁴ Coming from native-born, middle-class white Protestant families, many rehabilitation proponents believed that work formed the core of a moral life. Following the old adage that idle hands are the devil’s tools, they thought that work could cure many evils, from alcoholism and adultery to nervousness and disability. Adherents of this philosophy included both the able-bodied and the disabled. Helen Keller, for example, insisted that work was necessary to living a happy life. Blind and deaf herself, Keller argued that a lack of wage work resulted in a bondage of idleness and despair, a state of idleness more terrible even than loss of sight.¹⁵ The Protestant work-ethic informed the tradition of work therapy that began in the late nineteenth century as a treatment for both the insane and sufferers of tuberculosis—and it culminated in the early twentieth-century rehabilitation effort, pushing the work ethic to a new extreme, making work both the means and the end of recovery.¹⁶

While rehabilitation proponents considered the industrial workplace to be dangerous and potentially exploitative, they nonetheless believed that it was the best place for male laborers.¹⁷ The workplace, as they envisioned it, promised a well-ordered life, in both the private and public spheres. If married men embraced their role as breadwinner, they would be busy at work, thereby securing a domestic life for their wives and children at home. Operating within the established structures of industrial capitalism—trying to improve what was already there rather than restructuring it—this breadwinner ideal motivated much of the labor legislation of the Progressive Era.¹⁸

Rehabilitation was thus a way to restore social order after the chaos of war by (re)making men into producers of capital. Since wage earning often defined manhood, rehabilitation was, in essence, a process of making a man manly. Or, as the World War I Creed of the Disabled Man put it, the point of rehabilitation was for each disabled veteran to become a MAN among MEN in spite of his physical handicap.¹⁹ Relying on the breadwinner ideal of manhood, those in favor of pension reform began to define disability not by a man’s missing limbs or by any other physical incapacity (as the Civil War pension system had done), but rather by his will (or lack thereof) to work. Seen this way, economic dependency—often linked overtly and metaphorically to womanliness—came to be understood as the real handicap that thwarted the full physical recovery of the veteran and the fiscal strength of the nation.

Much of what Progressive reformers knew about rehabilitation they learned from Europe. This was a time, as historian Daniel T. Rodgers tells us, when American politics was peculiarly open to foreign models and imported ideas.²⁰ Germany, France, and Great Britain first introduced rehabilitation as a way to cope, economically, morally, and militarily, with the fact that millions of men had been lost to the war.²¹ Both the Allied and Central Powers instituted rehabilitation programs so that injured soldiers could be reused on the frontlines and in munitions in order to meet the military and industrial demands of a totalizing war. Eventually other belligerent nations—Australia, Canada, India, and the United States—adopted programs in rehabilitation, too, in order to help their own war injured recover. Although these countries engaged in a transnational exchange of knowledge, each nation brought its own particular prewar history and culture to bear on the meaning and construction of rehabilitation.²² Going into the Great War, the United States was known to have the most generous veterans pension system worldwide. This fact alone makes the story of the rise of rehabilitation in the United States unique.

To make rehabilitation a reality, Woodrow Wilson appointed two internationally known and informed Progressive reformers, Judge Julian Mack and Julia Lathrop, to draw up the necessary legislation. Both Chicagoans, Mack and Lathrop moved in the same social and professional circles, networks dictated by the effort to bring about reform at the state and federal level.²³ In July 1917, Wilson tapped Mack to help work out a new program for compensation and aid . . . to soldiers, one that would be an improvement upon the traditional [Civil War] pension system.²⁴ With the help of Lathrop and Samuel Gompers, Mack drafted a complex piece of legislation that replaced the veteran pension system with government life insurance and a provision for the rehabilitation and re-education of all disabled soldiers. The War Risk Insurance Act, as it became known, passed Congress on October 6, 1917, without a dissenting vote.²⁵

Although rehabilitation had become law, the practicalities of how, where, and by whom it should be administered remained in question. Who should take control of the endeavor? Civilian or military leaders? Moreover, what kind of professionals should be in charge? Educators, social workers, or medical professionals? Neither Mack nor Lathrop considered the hospital to be the obvious choice. The Veterans Administration did not exist in 1917. Nor did its system of hospitals. Even in the civilian sector at the time, very few hospitals engaged in rehabilitative medicine as we have come to know it today.²⁶ Put simply, the infrastructure and personnel to rehabilitate an army of injured soldiers did not exist at the time that America entered the First World War. Before the Great War, caring for maimed soldiers was largely a private matter, a community matter, a family matter, handled mostly by sisters, mothers, wives, and private charity groups.²⁷

The Army Medical Department stepped in quickly to fill the legislative requirements for rehabilitation. Within months of Wilson’s declaration of war, Army Surgeon General William C. Gorgas created the Division of Special Hospitals and Physical Reconstruction, putting a group of Boston-area orthopedic surgeons in charge.²⁸ Gorgas turned to orthopedic surgeons for two reasons. First, a few of them had already begun experimenting with work and rehabilitation therapy in a handful of the nation’s children’s hospitals. Second, and more important, several orthopedists had already been involved in the rehabilitation effort abroad, assisting their colleagues in Great Britain long before the United States officially became involved in the war.

Dramatic changes took place in the Army Medical Department to accommodate the demand for rehabilitation. Because virtually every type of war wound had become defined as a disability, the Medical Department expanded to include a wide array of medical specialties. Psychiatrists, neurologists, and psychologists oversaw the rehabilitation of soldiers with neurasthenia and the newly designated diagnosis of shell shock.²⁹ Ophthalmologists took charge of controlling the spread of trachoma and of providing rehabilitative care to soldiers blinded by mortar shells and poison gas.³⁰ Tuberculosis specialists supervised the reconstruction of men who had acquired the tubercle bacillus during the war.³¹ And orthopedists managed fractures, amputations, and all other musculoskeletal injuries.

Rehabilitation legislation also led to the formation of entirely new, female-dominated medical subspecialties, such as occupational and physical therapy. The driving assumption behind rehabilitation was that disabled men needed to be toughened up, lest they become dependent of the state, their communities, and their families. The newly minted physical therapists engaged in this hardening process with zeal, convincing their male commanding officers that women caregivers could be forceful enough to manage, rehabilitate, and make an army of ostensibly emasculated men manly again. To that end, wartime physical therapists directed their amputee patients in stump pounding drills, having men with newly amputated legs walk on, thump, and pound their residual limbs. When not acting as drill sergeants, the physical therapists engaged in the arduous task of stretching and massaging limbs and backs, but only if such manual treatment elicited a degree of pain. These women adhered strictly to the no pain, no gain philosophy of physical training. To administer a light touch, feel good massage would have endangered their professional reputation (they might have been mistaken for prostitutes) while also undermining the process of remasculinization. Male rehabilitation proponents constantly reminded female physical therapists that they needed to deny their innate mothering and nurturing tendencies, for disabled soldiers required a heavy hand, not coddling.³²

The expansion of new medical personnel devoted to the long-term care of disabled soldiers created an unprecedented demand for hospital space. Soon after the rehabilitation legislation passed in Congress, the US Army Corps of Engineers erected hundreds of patient wards as well as entirely novel treatment areas such as massage rooms, hydrotherapy units, and electrotherapy quarters. Orthopedic appliance shops and limb laboratories, where physicians and staff mechanics engineered and repaired prosthetic limbs, also became a regular part of the new rehabilitation hospitals. Less than a year into the war, Walter Reed Hospital, in Washington, DC, emerged as the leading US medical facility for rehabilitation and prosthetic limb innovation, a reputation the facility still enjoys today.

The most awe-inspiring spaces of the new military rehabilitation hospitals were the curative workshops, wards that looked more like industrial workplaces than medical clinics. In these hospital workshops, disabled soldiers repaired automobiles, painted signs, operated telegraphs, and engaged in woodworking, all under the oversight of medical professionals who insisted that rehabilitation was at once industrial training and therapeutic agent. Although built in a time of war, a majority of these hospital facilities and personnel became a permanent part of veteran care in both army general hospitals and in the eventual Veterans Administration hospitals for the remainder of the twentieth century. Taking its cue from the military, the post–World War I civilian hospital began to construct and incorporate rehabilitation units into its system of care as well. Rehabilitation was born as a Progressive Era ideal, took shape as a military medical specialty, and eventually became a societal norm in the civilian sector.³³

Despite the wide variety of war wounds and the highly individualized experiences of sustaining a permanent disability from battle, rehabilitation officials used amputee care as a model for creating a uniform treatment plan that could be implemented in all cases of disablement. Soldier-amputees, in turn, became (and still largely are) the model patients of the military rehabilitation effort. By war’s end, amputee soldiers made up 5 percent of the wounded, whereas pulmonary tuberculosis accounted for 15 percent, and other orthopedic conditions 25 percent.³⁴ Although amputees represented only a fraction of the wounded, War’s Waste focuses on this patient population in order to explain how and why they became the gold standard of rehabilitation. Antipension proponents who wanted to bolster the virtues of rehabilitation frequently utilized—in image and text—success stories of amputee veterans who, with the flip of a prosthetic strap, could appear cured. Artificial limbs allowed caregivers and society as a whole to engage in the illusion that the human ravages of war could be erased with a technological fix. The more complex and gruesome conditions—crushed skulls, empty eye sockets, permanent psychological trauma—brought the ideal of rehabilitation into question, for the aim of a cure appeared more uncertain and seemingly unattainable. Then, as now, rehabilitation holds out the promise that the wounds of war can be healed, and thus forgotten, on the national as well as the individual level.

The rise of rehabilitation was not simply a top-down process, controlled and orchestrated by the political and medical elite.³⁵ Disabled soldiers of the First World War engaged in power struggles with their treating physicians, playing a significant part as makers and shapers of the rehabilitation movement. These men fought against the rehabilitation ideal, which held that after six months of medical care, disabilities would disappear and wounded soldiers would be able once again to enjoy the rights and luxuries regularly taken for granted by able-bodied men. But while they fought against the propagandized ideal of rehabilitation, disabled soldier-patients agitated for more medical care, not less. In the absence of a generous pension system, many disabled soldier-patients wanted more time in the hospital to recover from their wounds, to adapt to prosthetic devices, and to overcome the physical and mental trauma of war. One of the outcomes of this resolve was that from World War I onward, US veterans of war would benefit from a federally funded system of health care, a form of socialized medicine that the nation’s civilians would be denied time and again throughout the twentieth century. One of the greatest legacies of the Great War was the creation of the Veterans Administration and its system of federally funded hospitals, places devoted solely to the health care and rehabilitation of America’s soldiers.³⁶

By May 1919, six months after the signing of the Armistice that ended the Great War, approximately 120,000 disabled soldiers (almost the same number as war dead) passed through the army’s rehabilitation program. Of those who underwent rehabilitation approximately one-quarter returned to duty, employed in some capacity by the US Army. Five percent received a surgeon’s certificate of discharge for disability. Of that 5 percent, 90 percent of the disabled soldiers reportedly resumed their old occupations, without further medical care or vocational training.³⁷ Although less than 50 percent of disabled soldiers had completed their course of rehabilitation a year after the war’s end, the program appeared to be a resounding success.

But the Progressive Era experiment in eliminating veteran pensions and bonuses came under repeated attacks in the decade following the end of World War I. Veterans of the Great War felt aggrieved by the federal government’s attempt to scale back their benefits. By World War II, members of the American Legion and the Veterans of Foreign Wars reclaimed a more robust system of entitlements. The post–World War I agitation culminated in the GI Bill, granting all veterans paid college tuition to learn a new vocation, low-interest home mortgages, and a small readjustment allowance to cover unemployed veterans until they found work.³⁸

Progressive Era reformers may have failed in their efforts to reduce the cost of veteran pensions and benefits, but the institution of rehabilitation fundamentally transformed how our nation would understand and treat its veterans. During the Great War, the United States was one of the few belligerent nations to make rehabilitation mandatory for all of its disabled soldiers.³⁹ If a disabled soldier refused rehabilitation, he faced the possibility of being dishonorably discharged and thus forced to relinquish all other benefits that come with military service. Through rehabilitation, Progressive Era reformers instituted a form of medical welfarism that obliges disabled soldiers to make every effort to recover from their war injuries so as to avoid becoming permanent wards of the state.

Garth Stewart is a product of this history. The leg amputation he sustained within the first months of the Iraq war has not slowed him down. He dons and doffs various models of prosthetic legs like clothing. He has one leg for boxing, another for running, and yet another for when he traipses around campus, like any other college student.⁴⁰ By his own account, he is always at work, whether in school, at fundraising events, or at the gym. He rarely sits still. The Progressive reformers who legislated and instituted rehabilitation could not have imagined a more ideal disabled soldier-patient. He is their dream made real.

ONE

The Problem of the Pensioner

On September 29, 1915, one hundred thousand visitors descended upon Washington, DC, for what was billed as the most exhilarating military parade in decades. Red, white, and blue adorned the parade route; American flags—now embroidered with forty-eight stars after the recent acquisition of Arizona and New Mexico—fluttered from windows and housetops. As throngs of people lined up from the Capitol Building to the White House, submarine torpedo boats navigated north up the Potomac River, docking in the Navy Yard near Georgetown Heights. The weather was ideal, according to one Los Angeles Times reporter: a crisp autumn morning.

The participants in the parade were autumnal as well. This was not a dispatch of young American troops to the European theatre of war, the crimson battle that had been killing men by the hundreds of thousands since June 1914 (the United States would not commit to fighting the Great War until April 1917). Rather, this was a commemoration of Union war veterans. The gray-bearded boys of ’65 planned to retrace the path they took fifty years earlier, recreating the Grand Review—a parade that President Andrew Johnson arranged to celebrate victory over the Confederacy. Even by 1915 standards, the Grand Review was considered to be one of the most spectacular military incidents of the history of the world. Approximately thirty thousand veterans marched in military formation along Pennsylvania Avenue.¹

President Woodrow Wilson assumed the same position that Andrew Johnson did a half-century earlier on a grandstand in front of the White House. Born in Virginia and raised in Georgia and South Carolina, Wilson was the first southern-born president to preside over an anniversary parade of the Grand Review. At the sound of a 10:00 a.m. cannon shot, Wilson’s Secretary of War Lindley M. Garrison, Secretary of the Navy Josephus Daniels, and the Commander-in-Chief of the Grand Army of the Republic Colonel David Palmer, joined Wilson on stage. Dressed in a conventional frock coat and silk hat, Wilson stood silently for four hours watching the procession of 30,000 elderly men (only a fifth of the original number of participants), who were, on average, 72 years of age. The men veered left and right toward cheering audiences, shaking hands, and gesturing for more applause. Eager to catch up with old friends, they talked incessantly along the parade route, at times drowning out the tried and true tunes of When Johnny Comes Marching Home and The Battle Hymn of the Republic. When the disorderly platoons finally reached the grandstand, however, they prettied up to salute President Wilson and the other dignitaries. Wilson reportedly had tears in his eyes on and off throughout the procession.²

There were many reasons for Wilson to shed a tear on this day, for this dedication to the past seemed to portend the future. Only months earlier, the president, known for his commitment to peace, ordered Secretaries Garrison and Daniels to expand the army and navy, transforming the small 100,000-man US military into a world-class fighting power. Wilson’s shift from neutrality to military preparedness evolved over the summer months of 1915, following the German submarine attack on May 7 on the Lusitania, a commercial British liner that sank, leading to the death of 128 Americans. Tensions on the diplomatic front, as well as within the Wilson administration, ran high. Secretary of State William Jennings Bryan, a well-known pacifist, resigned from office a month after the Lusitania sinking, convinced that war with Germany was in the offing.³ The fact that Wilson wanted to expand the army and not just the navy gave Bryan all the proof he needed. Building a navy could be construed as a purely defensive move undertaken to protect American ships in enemy waters; expanding the army, however, indicated that the United States planned to send its own ground troops into trench warfare.⁴

Not all Americans who watched the semicentennial parade of the Grand Review felt the stirrings of patriotism produced by the military display of wars past or imminent. Despite the fact that in early twentieth-century America, the Civil War frequently offered a mother lode of nostalgia, evoking sentimental memories of battle and glory in which romance often triumphed over reality, certain Americans found these veterans guilty of dragging the nation down a path toward moral and economic decline.⁵ Contrary to the hero-worship displayed by the cheering crowds on the parade route, a growing number of early twentieth-century journalists, elected officials, social scientists, and politicians argued that the Civil War veteran who had once been honored for his sacrifice in battle was now no better than [a] deserter, a straggler . . . a coward.⁶

The Civil War veteran’s fall from grace arose not from antiwar sentiments, but rather from perceived injustices occurring in the Treasury Department, the branch of government responsible for paying out pensions to veterans after the war. By 1915, the aggregate cost of the 50-year-old pension system exceeded $3 billion dollars, with the US government paying out over $200,000,000 annually. Most Americans assumed that the cost of Civil War pensions would take a drastic plunge by the early twentieth century, since, fifty years after the war, very few veterans would still be living and able to make benefit claims. But the opposite happened. With the passing of each year of the twentieth century, more and more money went into the pension system. By 1915, the cost of the pension system had exceeded the actual cost of the Civil War itself.⁷

The men who benefited most from the pension system were precisely the men marching in the anniversary Grand Review parade—the men of the Union, the former soldiers of the Grand Army of the Republic (GAR). The pension system was originally established in 1862, a year after the War of the Rebellion commenced, as a way to recruit soldiers. Thereafter, the pension remained a prize granted exclusively to the victors of war.⁸ Throughout the first half of the twentieth century, Confederate veterans were repeatedly denied Civil War pensions. Black veterans, whether Union or Confederate, faced a similar yet more dismal fate. The Pension Bureau engaged in explicit racism when it came to African-American claimants. Not only did fewer African Americans actually apply for pensions, but many who did were denied.⁹ The majority of the pension money therefore went to white, GAR veterans who came from the mid-Atlantic and Midwestern region of the country. The home states of these beneficiaries—Ohio, Pennsylvania, Upstate New York, Illinois, Indiana, Michigan, and Missouri—collectively became known as the pension belt.

In the years leading up to World War I, certain Progressive reformers began to see the veteran as a problem to the social order. This chapter tells the story of why Progressive Era reformers wanted to overhaul the pension system and how the call for reform set into motion the eventual institutionalization of rehabilitation. The primary criticism of the Civil War veteran welfare system was that it allowed pensioners to live off the government without the government expecting anything in return. The promise of rehabilitation was that it would get veterans, whether injured or not, back into the workforce, making them productive, tax-paying citizens. The reformers who criticized and effectively brought about the end of the Civil War pension system by 1917 were the same reformers who established institutions of physical and vocational rehabilitation as a substitute for pensions.

The World War I veteran returning home in November 1918 would, in many ways, walk a path different from that of the gray-bearded boys of ’65 marching down Pennsylvania Avenue that September day. The notion of what the country owed its citizen-soldiers injured from war was radically redefined during the Wilson administration. The veterans of America’s First World War were expected to become citizen-workers once their military service was over; they were to make useful lives, not to languish at the expense of the US Treasury. In a real sense, they were expected to be the opposite of the Civil War veteran. Thus, to understand why a program in rehabilitation was created in the first place, one must have an appreciation for how the Civil War pensioner became a problem that Progressive reformers aimed to solve.

Creating a Veteran Welfare State

At the turn of the twentieth century, the United States had one of the world’s largest singularly targeted welfare plans, providing generous sums of money for its veterans of war. A century later, it is hard to believe that the United States ever outpaced Europe in welfare spending, but contemporary critics of the Civil War pension system were well aware of the fact. With the Old World serving as a benchmark for imperialism, socialism, and overtaxation, one early twentieth-century critic of the system noted, with disdain, that the United States spent twice as much on its veterans as did Germany, France, and Great Britain combined.¹⁰ Such evidence led another critic to conclude—well before the Bolshevik Revolution—that America was approaching not socialism, but communism in [its] pension measures.¹¹

Yet the Civil War pension system was not intended to serve as a welfare-state program. Congress passed the General Law of 1862 because the Union needed more soldiers. The North paid a heavy toll during the first several months of war, and the pension plan was seen as a way to persuade men to volunteer for service instead of conscripting soldiers as the Confederacy was doing. Although this measure of political persuasion proved to be ineffective in raising a large enough army (the Union Conscription Act was instituted in March 1863), the General Law served as the baseline for the Civil War pension system well into the twentieth century.¹²

The fact that Congress instituted a pension program covering a war that was still being waged was unprecedented. The United States adopted its first veteran pension after the Revolutionary War.¹³ By the 1810s, stories abounded of old war heroes being forced to totter from door to door with desponding heart and palsied limb, begging for alms.¹⁴ In the absence of a federal system of poor relief, as Great Britain had, President James Monroe in 1818 proposed a two-tier pension benefit based on military rank and financial need: officers received $240 annually while noncommissioned officers and privates collected $96 a year. To get the money, however, claimants had to provide testimony of service and an oath of indigency certified by a court of record.¹⁵

To certain congressmen, the Revolutionary War Pension Act of 1818 undermined the republic, creating a privileged class—here, white veterans—subsidized by taxes on the poor. Others argued that it flew in the face of the republican ideal of the citizen soldier who serves his country out of a sense of duty rather than for material gain.¹⁶ Republican senator Nathaniel Macon from North Carolina warned that, in addition, it would set a dangerous—and costly—precedent. To undertake to provide for those who will not provide for themselves, Macon argued, will, on experiment be found an endless task . . . it will drain the treasury, no matter how full.¹⁷ Supporters of the pension countered with assurances that it would be a short-lived program that would apply to fewer than 2,000 men. When the bill was eventually passed on March 18, 1818, the Senate estimated that it would cost approximately $115,000.

Such forecasts proved naïve. Within the first six months of the bill’s passage,