United States Soldiers, Veterans, and Health Policy, 1917-1924 Jessica L. Adler Submitted in partial

472 Pages·2013·31.43 MB·English

by  Jessica Adler

Paying the Price of War:
United States Soldiers, Veterans, and Health Policy, 1917-1924

Jessica L. Adler

Submitted in partial fulfillment of the
requirements for the degree
of Doctor of Philosophy
in the Graduate School of Arts and Sciences

COLUMBIA UNIVERSITY
2013
© 2013
Jessica L. Adler
All rights reserved
ABSTRACT
Paying the Price of War: United States Soldiers, Veterans, and Health Policy, 1917-1924
Jessica L. Adler

During eight turbulent years in the World War I era, policy makers, soldiers, and veterans
laid the groundwork for the extension of government sponsored medical care to millions of
former service members. In the process, they built a pillar of the American welfare state.
Legislation and rehabilitation plans formulated shortly after the U.S. entered the Great War
aimed to minimize the government’s long-term obligations to veterans, but within less than a
decade, those who had served gained conditional access to their own direct assistance agency
and a national system of hospitals. This dissertation explains why that drastic transition occurred,
and how one group of citizens won the right to obtain publicly funded health services. The story
of wartime health policies has a variety of larger implications. It shows how veterans’ welfare
shifted from centering on pension and domicile care programs rooted in the nineteenth century to
the provision of access to direct medical services; how rehabilitation and citizenship rights were
conceived of and perceived at the dusk of the Progressive Era; how race, class, and gender
shaped the health-related experiences of soldiers, veterans, and caregivers; how shifting ideals
about hospitals and medical care influenced policy; and how interest groups capitalized on the
tense political and social climate to bring about change. On a general level, an examination of the
roots of a nationwide veterans’ hospital system demonstrates how privileges were won in the
twentieth century United States. It reveals a moment of state expansion, but it also illustrates the
wider tendency of the U.S. government to award entitlements selectively. Given those factors,
the policies that paved the way for the advent of a veterans’ medical system deserve to be
considered – alongside later federal assistance programs such as Social Security, Medicare, and
Medicaid – as foundational in the development and shape of the American welfare state.
TABLE OF CONTENTS

Acronyms……………………………………………………….............................................. ii

Acknowledgements………………………………………………………............................... iii

Introduction
Medical welfare and the Great War………………………………………………………….. 1

Chapter One
Preparing the homefront for the health outcomes of war: Policy
provisions for domestic medical care of service members (1917)…...…….………………… 28

Chapter Two
“Take your place and carry on”: Occupational therapy and rehabilitation
at the new Walter Reed Army General Hospital (1918-1919)……………………………….. 83

Chapter Three
Soldier-patients become civilian-citizens: Shifting presentations and
perceptions of a military hospital (1918-1920)………………………………………………. 142

Chapter Four
“War was hell but the after-war effects were ‘heller’”: An army
responsibility becomes a societal obligation (1918-1920)…………………………………… 198

Chapter Five
Civilian-citizens become veteran super-citizens: Interest group advocacy (1919-1921)..…… 269

Chapter Six
“One of the epochs of veteran relief”: Creating the Veterans’ Bureau and
planting the roots of an autonomous veterans’ hospital system (1920-1921)………………... 334

Chapter Seven
“That centralization of activities that some people call socialism”: Empowering
the Veterans’ Bureau and growing a veterans’ hospital system (1921-1924)……………….. 374

Postscript
“No end of trouble”: Conditional, fluctuating privileges, and the legacy
of Great War health policy…..…………………………………............................................. 428

Bibliography………………………………………………………......................................... 435

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ACRONYMS

AEF: American Expeditionary Forces

AHA: American Hospital Association

AL: American Legion

BWRI: Bureau of War Risk Insurance

CND: Council of National Defense

DAV: Disabled American Veterans

DPR: Department of Physical Reconstruction (U.S. Army)

FBH: Federal Board of Hospitalization

FBVE: Federal Board for Vocational Education

OT: Occupational therapy

PHS: Public Health Service

VA: Veterans’ Administration

VB: Veterans’ Bureau

WRIA: War Risk Insurance Act

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ACKNOWLEDGEMENTS

Archivists, librarians, and gracious scholars helped me gain access to crucial primary
source materials. When I first began studying military and veterans’ health issues, John R. Pierce
was kind enough to meet with me and share documents he had gathered during his many years
researching Walter Reed Army Medical Center. Although my project has changed much since
our initial conversations, Dr. Pierce’s passion for his life’s work helped me develop a respect for
and curiosity about the history of soldiers’ and veterans’ medical care, and set me on my way.
Columbia University Reference Librarian, Mary Cargill, tirelessly fielded my requests for
assistance locating obscure congressional documents and always came through. I am grateful to
James Chaney and Alice Bersch, who granted me the privilege of looking through unsorted files
at the Disabled American Veterans headquarters, and provided copies of the organization’s early
meeting minutes. David Keough offered a wealth of information and served as a patient guide at
the United States Army Heritage and Education Center. Also at USAHEC, Dick Sommers took
the time to discuss my project in its early stages and provided helpful feedback. At the National
Archives and Records Administration in College Park, Maryland, Mitch Yockelson offered
expert assistance with World War I era government records. Howard Trace and the staff at the
American Legion headquarters’ Library were accommodating and very helpful hosts. Sanders
Marble took the time not only to gather and photocopy a fat pile of documents from the U.S.
Army Medical Department’s Office of Medical History, but also lent me an open ear and some
handy advice as I began pursuing research.
This project was supported by the Doris G. Quinn Foundation, the Institute for Political
History, the U.S. Army Military History Institute, and Columbia University. Christina Ching,
Thomas Darke, Michael Lisman, and Michael and Gwyneth Neuss welcomed me in their homes
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during research and conference trips; I am grateful for their warm hospitality and their
friendship.
Colleagues and faculty at Columbia and beyond provided support as well. I consider
myself lucky to have worked among a cohort of capable, sharp, and quick-witted graduate
students and friends. Thai Jones and Tamara Mann offered open ears, critical feedback, humor,
and perspective; I have been enriched by their scholarly prowess and loyal companionship.
Elizabeth Blackmar, Eric Foner, Kenneth Jackson, and Nancy Stepan provided training and
guidance in seminars and personal meetings. Stephen Ortiz, of Binghamton University, offered
valuable feedback on portions of this work, and demonstrated on numerous occasions that he is
committed to providing a helping hand to graduate students. At the University of Rochester,
Daniel H. Borus and Robert B. Westbrook awakened me to the rigors and rewards of studying
history. They are inspirational teachers, writers, researchers, and men, and I would doubtless be
on a different life course had I not been lucky enough to encounter them.
Members of my dissertation committee have been especially generous with their time and
expertise. After introducing me early on in my graduate career to some of the most important
sources in the literature of the American welfare state and public health, Samuel Kelton Roberts
offered trenchant advice on this project as it developed. Rosemary A. Stevens serves not only as
a model scholar, but also was kind enough to provide valuable guidance and positive feedback to
a graduate student she had never met. David K. Rosner, whose has a deep passion for and
commitment to his craft, ignited my interest in the history of public health, and in so doing,
helped to shape my graduate work. I have learned much about the study of United States political
history during seminars and meetings with Alan Brinkley, who has taken the time and care to
discuss this dissertation with me in each of its stages. Finally, Alice Kessler-Harris has proven to
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be a ceaselessly devoted advisor and mentor. Because she makes an effort to know her students
as both people and scholars, she senses when they need (and deserve) positive reinforcement or a
kick in the pants. She has pushed me to do better and do more, and also encouraged me to post a
note on my computer containing two words: “Have Fun.”
Finally, my family has given me love and then some. My father, Edward Adler, has
always encouraged me to live on my own terms and pursue happiness – even if that meant
leaving a seemingly stable job to enter graduate school. Watching him partake in conversations,
exchanges, and debates with strangers, friends, and family helped me realize the potential beauty
and art in asking questions. I am fortunate to be the sister of Seth Adler, who is my oldest friend
and confidante, a steadfast advocate, and a constant force of positivity. Coming through as a
stellar uncle and babysitter so I could have more time to research and write is only his most
recent act of loyalty, generosity, and love. My daughter, Lael, reminds me to prioritize, laugh,
dance, and every once in a while, partake in a parade in the living room or a sing-along on a
crowded city bus. Thank goodness she has her father’s easy and kind disposition. Aaron
Mattfeld, my husband and comrade, motivates and calms, pushes and sustains me. From Miyagi-
ken to the halls of academia, and everywhere in between, he has made adventures great,
tragedies bearable, joys intense, and challenges surmountable. My mother, Laura Adler, was a
devoted educator, a zealous reader, a dedicated family woman, and an all-around wise person.
Her work, humor, and love are my inspiration.

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INTRODUCTION
Medical Welfare and the Great War

The transition was remarkable. In September 1917, as millions of Americans mustered
into service and the nation’s army and industry mobilized for war, hopes were high. “Science to
Rebuild Our War Cripples,” boasted a New York Times headline. Military hospitals would heal
and re-educate each wounded soldier, the newspaper reported, then “return him to civil life ready
to be as useful to himself and his country as possible.”1 Approximately two years later, it was
clear that things were not going according to plan. Some soldiers were not being returned to
“civil life ready to be… useful,” but instead remaining in government hospitals and “receiving
treatment that cannot be justified by anyone who has any regard for the well being of the men
who fought to maintain the country.”2 By 1923, early wartime hopes had come full circle. There
had been “huge waste” in the expenditure of hundreds of millions of dollars on hospital care for
those who served during World War I, the Washington Post reported. The money had been
“loosely spent” and “lavished with only the vaguest sort of plan.”3 In the shadow of that
realization, the government moved forward in the early 1920s with the creation of a vast
veterans’ hospital system, which would ensure that former service members – even in “civil life”
– would have access to publicly funded hospitals.
From 1917 through 1924, policy makers, soldiers, and veterans laid the groundwork for
the extension of government sponsored medical care to millions of people. In the process, they

1 "Science to Rebuild Our War Cripples," The New York Times September 17, 1917.
2 "Bad Treatment of Sick Soldiers," The Atlanta Journal-Constitution January 28, 1920.
3 "Charge Huge Waste in Hospitalization," The Washington Post March 21, 1923.
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built a pillar of the American welfare state. World War I-era policies shaped military and
veterans' health care for the greater part of the twentieth century, and underpinned the 1921
creation of the Veterans’ Bureau (VB), one of the nation’s first and most enduring direct
assistance government agencies. In 1924, all ex-soldiers – not just those harmed in the line of
duty – gained legal access to the veterans’ hospitals overseen by the VB. The guarantee of
medical care for veterans provided allowances for some of those who made extreme personal
sacrifices. It also instantiated and furthered the precedent that, in the U.S., state-sponsored
privileges could be earned not by national birthright, but by virtue of membership in a definable
group.
Medical treatment for U.S. military personnel and veterans was not expanded strictly by
virtue of an unbridled societal commitment to “care for him who shall have borne the battle,” as
Abraham Lincoln said in his second inaugural address. Indeed, for many months after President
Woodrow Wilson similarly proclaimed, in the winter of 1918, “this nation has no more solemn
obligation than healing the hurts of our wounded,” the government struggled to come to terms
with its self-declared responsibility.4 A calamitous situation resulting, in part, from pre-war
planning oversights, as well as vigorous political lobbying rooted in widespread anti-radicalism
and expanding expectations of professional medicine, led to the creation and growth of a
federally sponsored hospital system for veterans.

The story and its significance
In the months surrounding the United States’ declaration of war in April 1917,
government officials and medical professionals readily acknowledged that wounded and ill

4 "President Wilson’s Message on Healing the Hurts of Our Wounded," The Come-Back December 24, 1918.
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