B/125652 RAND NATIONAL DEFENSE RESEARCH INSTITUTE PROVIDING FOR THE CASUALTIES OF WAR THE AMERICAN EXPERIENCE THROUGH WORLD WAR II BERNARD ROSTKER Prepared for the Office of the Secretary of Defense Approved for public release; distribution unlimited
Contents Foreword Preface Figures Tables Acknowledgments Abbreviations iii v xiii xv xvii xix CHAPTER ONE Introduction: Looking to the Past for Lessons... to Apply in the Future 1 CHAPTER TWO Evolution of the European System of Providing for Casualties: Greece, Rome, the Middle Ages, and the Renaissance 5 The Ancient World 5 Greece 6 Rome 11 Byzantium 17 The Middle Ages 18 Care for the Wounded During the Crusades 20 The Late Middle Ages 22 And Then There Was Spain 22 The Renaissance 23 The Legacy 25 CHAPTER THREE Evolution of the European System of Providing for Casualties in the Age of Enlightenment: France and Britain as the Antecedents of the American System of Care 27 France: From the Monarchy to the Republic and on 27 L'Hotel des Invalides 29 The French Revolution 30 vii
viii Providing for the Casualties of War: The American Experience Through World War II Napoleon Bonaparte 31 The Restoration to the Second Empire 32 The Evolution of the English System 35 Medical Care in the Army Under the Tudors 35 Disabled Veterans in Elizabethan England 36 The English Civil Wars 38 The Restoration 40 Great Britain's Army from the Glorious Revolution to the Napoleonic Wars 41 Care for Veterans 47 The Napoleonic Wars: Medical Care Under Wellington 47 From Waterloo to the Crimean War: The Age of Reform Misses the British Army 48 The Crimean War: Medical Services and the Intervention of Nongovernmental Organizations in the Care of Soldiers and Veterans 50 From the Crimean War to World War I 51 Expanding Care to Include Vocational Rehabilitation: A Prototype for America 53 The Legacy 56 CHAPTER FOUR The American System of Providing for the Wounded Evolves 57 The American Colonies 57 The Continental Army of the American Revolution 58 Caring for the Wounded of the Revolution 60 Caring for the Disabled of the Revolution 62 The Corps of Invalids 63 Invalid (Disability) and Service Pensions 64 Developing a National System 66 Institutional Care 68 Wars of the Early 19th Century: The Indian Wars, the War of 1812, and the Mexican War 69 The War of 1812 70 The Indian Wars in the Southeastern United States 71 The Mexican Wars 71 The Veterans of Both the War of 1812 and the Mexican War 73 The Legacy 73 CHAPTER FIVE The Civil War 75 A New Kind of War 75 The U.S. Army Medical Department Goes to War 77 The Sanitary Commission Helped Shape the Union Medical Department 79 The Field Organization of the Union Army and the U.S. Sanitary Commission 80
Contents ix The Need for More Medical Personnel 82 Innovations in Care for the Union Wounded 84 Military Hospitals 84 Convalescent Camps and Provision of Ancillary Services 85 Shift in Focus 86 Medical Evacuation Ambulances, Trains, and Ships 87 Other Reforms by Surgeon General Hammond 88 Return to Normal 89 The Confederate Army's Medical Department 89 The Types of Casualties 91 Nature of the Wounded 92 Amputations 92 Neuropsychiatric Casualties 96 Providing for the Disabled Veteran 99 Problems at Separation 99 View of the U.S. Sanitary Commission on Establishing Soldiers' Homes 100 Soldiers' Homes 101 Pensions for Veterans 102 Care for the Maimed Veteran 105 Care for Psychological Casualties 105 The Neglected Veterans of the Confederacy 106 State Pensions for Disabled Confederate Veterans 107 The Legacy 109 CHAPTER SIX From the Civil War to the World War 113 The Indian Wars on the Frontier 113 The Spanish-American War 115 The American Empire 117 The Transformation of the Army Medical Department 118 War in Europe 119 Lessons About Military Hospitals 120 Lessons Concerning the Neuropsychiatric Wounded 121 Lessons About Amputations 121 Lessons About the Rehabilitation of Wounded and Neuropsychiatric Patients 122 The Legacy 122 CHAPTER SEVEN The World War 123 A New Paradigm for Caring for Soldiers and Veterans 124 World War I Mobilization, Deployments, and Battle Casualties 126
x Providing for the Casualties of War: The American Experience Through World War II Mobilization 126 American Casualties 127 Caring for the American Soldier 129 Advances in Medicine 129 Hospitals of the American Expeditionary Forces 132 Organization of Medical Support and Evacuation of the Wounded 133 Advances in the Care of the Wounded: Amputations 133 Advances in the Care of the Wounded: The Neuropsychiatrically Impaired 137 Caring for Soldiers in the Zone of the Interior 147 Army Hospitals During the Mobilization 148 Initial Care for the Returning War Wounded at Debarkation and General Hospitals 148 Hospital Trains and the Distribution of Patients 149 The Development of Special Programs for Physical Reconstruction and Vocational Training 150 The Surgeon General's Plan 150 The Need to Coordinate Plans with Other Departments 152 Demobilization of the Army's Physical Reconstruction and Vocational Education Program 154 Three Governmental Organizations Share the Responsibility for Caring for Disabled Veterans 156 The Bureau of War Risk Insurance 159 A New Role for the U.S. Public Health Service 161 A New Paradigm for the Care of the War Wounded: Vocational Rehabilitation 162 Problems 165 The New Program Needed to Be Changed 167 The Rise of the American Legion 169 A New Beginning: The Veterans' Bureau 169 Veterans' Programs Between the World Wars 170 Extending Care to Veterans with Non-Service-Connected Disabilities 170 Establishment of the Veterans Administration 171 The Legacy 173 CHAPTER EIGHT World War II 175 The American Soldier of World War II 176 Organizing the Army Medical Department for a New War 179 Mobilization 180 The Reorganization of March 1942 180 Problems of "Status and Jurisdiction" 182 Contributions of the Medical Department 184 Tension Between General Somervell and Surgeon General Magee 185
Contents xi The Resurrection of the Office of the Surgeon General: Planning for Peace and the Return of the War Wounded 187 Care for the American Soldier 188 Advances in Military Medicine 189 Advances in the Care of the Wounded: Amputations 198 Advances in the Care of the Wounded: The Psychologically Impaired 200 General Medical Care in the Zone of the Interior 217 General and Specialized General Hospitals 217 Convalescent Hospitals 218 Personnel to Provide Rehabilitative Services 219 Medical Discharges During the War 222 Demobilization and Contraction of the Zone of Interior Hospital System 224 The Case of 2LT Robert Dole 226 Providing Care for the World War II Veteran 228 The Veterans Administration Goes to War 228 The Veterans Administration During World War II 229 Increasing Veterans' Benefits During World War II 231 The Postwar Veterans Administration 232 The Bradley Revolution 232 All Good Things Must Come to an End: The VA After Bradley 237 The Legacy of World War II 239 CHAPTER NINE Summary: What Happened? What Have We Learned? How Did We Get Here? 241 Nature of Combat, the Wounds Received, and the Ability of Physicians and Surgeons to Deal with Disease and the Consequences of Wounds 242 The Ancient World 242 After Rome 243 In America 244 Organization of Medical Services on and off the Battlefield 247 The Ancient World 248 After Rome 249 In America 251 Role of the State in Caring for Veterans 255 The Ancient World 255 After Rome 256 In America 258 Recent Awareness of Psychological and Cognitive Injuries: The Invisible Wounds That Transcend the Immediate Battle 263 Themes 264
xii Providing for the Casualties of War: The American Experience Through World War II APPENDIX Military Personnel and Casualties from Principal U.S. Wars 267 Bibliography 271