Heather R. Perry. Recycling the Disabled: Army, Medicine and Modernity in WWI Germany. Disability History Series. Manchester: Manchester University Press, 2014. Illustrations. 240 pp. $105.00 (cloth), ISBN 978-0-7190-8924-4.
Reviewed by Emmeline Burdett (University College London)
Published on H-Disability (November, 2017)
Commissioned by Iain C. Hutchison
Heather R. Perry’s book, based on research she carried out while a doctoral student at the University of Indiana, shows how an increasingly acute labor shortage in Germany and the realization that the result of World War I would be likely to be determined more by troop endurance and a dependable supply of war materials than by brilliant military strategy had an effect on war-disabled soldiers. These men, who had previously been considered no longer part of the workforce, found that they were increasingly being required to engage in, and complete, rehabilitation as quickly as possible in order for their dormant skills to be used for the war effort. Unsurprisingly, this also meant that orthopedics—previously a rather undervalued branch of medicine—came to assume far greater importance.
Chapter 1, “Healing the War-Disabled: The Re-orientation of German Orthopedics,” discusses this latter issue in detail. Although nineteenth-century industrialization had seen their expertise broaden considerably, by 1914 orthopedists were still widely regarded as a subgroup of medical practitioners whose expertise was only appropriate to so-called cripple-care (Krüppelfürsorge) and for private treatment beyond the financial reach of many Germans. Additionally, the introduction of new national accident, invalidity, and sickness insurance laws in the 1880s meant that orthopedists, who specialized in treating congenital and growth problems, were sidelined in favor of so-called traumatologists, who assessed and treated the growing number of industrial accidents that had given rise to the need for the new insurance laws in the first place. Orthopedists fought back against their continuing marginalization, and in 1906, the Berlin pediatrician Dr. Konrad Biesalski (1868-1930) embarked on the “cripple census” (Krüppelzählung), which he used to show the high levels of impairment within German society and the resulting importance of orthopedics and its practitioners. Biesalski’s primary aim in taking his “cripple census” was to draw attention to the need for far greater investment in the care and treatment of disabled children; he was one of a number of orthopedists who founded homes to house and treat disabled children throughout the German Empire in the first decade of the twentieth century. This did nothing to address the situation of disabled adults, but, as a result of the census, the years leading up to the outbreak of the First World War saw a number of initiatives, many of which came about as a result of the German Association for Cripple Care (Deutsche Vereinigung für Krüppelfürsorge or DVK), formed in 1909, which was itself a result of Biesalski’s census. An example of one of the DVK’S initiatives was the founding of its own journal, which offered both lay and professional readers up-to-date news on every aspect of orthopedics, and which also helped to keep the discipline in the public eye. In addition, many concerted efforts were made to show that orthopedics was a medical discipline in its own right, not merely a branch of surgery. To this end, the Munich orthopedist Fritz Lange (1864-1952) published his comprehensive Lehrbuch der Orthopädie (Textbook of orthopedics) in 1914. It was the first textbook for the specialty. When Germany declared war on August 4, 1914, orthopedists were quick to offer their services, recognizing a golden opportunity to demonstrate once and for all the importance of their discipline. In 1915, Lange, who, the previous year, had seen for himself how vital the skills of orthopedists were, published his book Kriegs-Orthopädie (War orthopedics), a field manual for army doctors. Lange argued that the present dire situation was caused in part by the lack of attention paid to orthopedics, which now meant that many army doctors were simply incapable of treating the injuries with which they were confronted. The skills of orthopedists, and their abilities to devise new treatments for the severity and scale of the injuries they would encounter, were certainly put to the test over the next four years.
Chapter 2, “Re-arming the Disabled: WWI and the Revolution in Artificial Limbs,” opens with a quotation from Erich Maria Remarque’s classic First World War novel All Quiet on the Western Front (1929). The quotation used makes reference to the much greater number of functionally superior artificial limbs that became available during the years 1914-18. As the chapter makes clear, this development was driven by an increasing need to ensure that injured soldiers could still work, and a realization that prevailing artificial limbs, in particular prosthetic arms and hands, were not sufficient to achieve this end, either having been made for cosmetic purposes or being claws, capable of performing only simple functions. The expense of these prostheses put them out of the financial reach of most Germans, and their fragility meant that they could not be used for any kind of work. It was orthopedists who were in charge of making artificial limbs, and they enlisted the help of industrial scientists, mechanical engineers, and other experts. There follows a short section exploring pre-World War I prosthetics, from antiquity, through medieval developments like the prosthetic arm supposedly worn by the knight Götz von Berlichingen (1480-1562) whose hand had been shot off by a musket during the siege of Landshut in 1504, to developments in the nineteenth and very early twentieth centuries. Part of the reason why prewar prostheses were not sufficient was that people who had lost their arms had not generally been expected to return to their previous professions, or even to any form of full-time employment. As the wartime labor shortage became more acute, this was no longer sustainable. When orthopedists found that they could not produce limbs which combined cosmetic appearance with functionality, they concentrated on functionality. This requirement governed the development of prosthetic arms throughout the First World War period, and the need to return the owners of prosthetic arms to the labor market meant that in their designs for prostheses, orthopedists implemented the principles of Arbeitswissenschaft, or the science of work. In practice, this meant designing prostheses that maximized a worker’s productivity and, by means of a basic arm with different attachments depending on the worker’s profession, literally turned the worker himself into a tool. Individual orthopedists also designed prosthetic arms for different kinds of workers, including piano tuners, letter carriers, farmers, and the so-called Kopfarbeiters (head-workers) such as teachers. This latter category could also make use of preexisting “cosmetic” arms as they did not need to operate machinery or make quick movements. The chapter also shows how available prosthetic arms tended to reinforce class distinctions by having different types of arms for different types of jobs (as opposed to having universally useful arms that would facilitate social mobility).
Chapter 3, “Rehabilitation Nation: Re-membering the Disabled in Wartime Germany,” shows how war-disabled soldiers were rehabilitated, not just by the healing of their wounds but also by their reinsertion into society. The chapter argues that the rehabilitation of war-disabled soldiers was a national project (known as Wiedereingleiderung or re-membering) aimed at restoring the fabric of society despite the difficulties of the wartime situation. To this end, so-called Arbeitstherapie (work therapy) was practiced in specialist orthopedic workshops, and the number of therapies of this nature increased dramatically. Successful outcomes from these therapies were needed to return wounded men to the workforce as quickly as possible, but, as Perry makes clear, there was a general feeling among orthopedists that existing therapies were insufficient to achieve this. This problem was compounded by the so-called pensions psychosis: the refusal of wounded soldiers to participate in their own rehabilitation for fear that doing so would lose them their pensions. This response was an important factor in the development of new types of rehabilitation, usually led by orthopedists and often designed to get wounded soldiers back into the workforce as quickly as possible. The introduction of Berufsberäter (job counselors) facilitated this by intervening quickly to ensure that war-disabled soldiers were retrained or reassigned for appropriate work—not merely concierge or receptionist posts that they apparently expected to be offered. The chapter also shows that unwillingness to retrain was interpreted as simple laziness, or, as discussed above, fear that rehabilitation would result in the loss of war pensions. One shortcoming of the chapter is that although these attitudes to war-disabled soldiers are shown, they are not really investigated, so the reader is not able to judge, for example, how widespread they were. This would, I feel, also help to illuminate attitudes to all disabled people in Germany at the time—something that is surely important.
Chapter 4, “Inventing Disability: Re-casting ‘the Cripple’ in Wartime Germany,” takes as its subject the problem of how war-disabled soldiers were perceived both by society as a whole and, in some respects, by themselves. This involved a huge public relations campaign, spearheaded by German orthopedists, designed to show that war-disabled soldiers were just as capable as other workers. Perry terms this “the cultural invention of disability” (p. 119). In his book Kriegskrüppelfürsorge (War cripple welfare), the orthopedist Dr. Konrad Biesalski described those who thought that it was cruel to expect war-disabled soldiers to return to work as “sentimental sops” (p. 120). As Perry shows, the idea that physical impairment automatically entailed loss of earning capacity had been encouraged by the social insurance and military pension practice in imperial Germany where those who had been permanently injured in work-related accidents had simply been given a pension. Perry writes that this had given rise to a culture of entitlement, in which disabled ex-workers felt entitled to financial support, particularly if, as with the case of servicemen, their injuries had been incurred while in the service of their country. Orthopedists also criticized the German public for reinforcing this attitude by treating war-disabled soldiers as though they were no longer capable of being productive members of society. Pensions also reinforced the social order, with officers being much better compensated than ordinary soldiers with the same injury. Indeed, pension systems were revised in 1917 to take into account a soldier’s prewar salary and social status.
This reconceptualization of the disabled soldier as someone who was still capable of being a productive member of society also brought about a revolution in treatments for life-changing injuries. Even so, the increasingly hysterical insistence that a wounded serviceman had a patriotic duty to work and that the most serious injury could be “overcome” with the right attitude is alarmingly reminiscent of the current UK government’s “austerity” policies, which might look superficially progressive but in fact merely demonize anyone in need of support (p. 132). Rehabilitation became something of a national project; public exhibitions showcased the capabilities of disabled soldiers, the developments in medical aids, and the virility of wounded ex-servicemen whose prosthetics had given them a new lease on life.
Chapter 5 deals with the subject of the “total war” declaration in 1916, and shows how the attitude toward the rehabilitation of war-disabled soldiers affected this declaration. The pamphlet by Prussian engineer Friedrich Syrup (1881-1945) on the best way to use labor in German factories, published in the year total war was declared, is testament to this, arguing as it does that hiring disabled workers was crucial to the national economy. The numbers of such soldiers returning from the front did not go unnoticed by the various ultranationalist expansionist organizations that sought to repopulate the countryside and gain more territory for the German Empire. In many instances, these organizations combined professed concern for the welfare of war-disabled soldiers with their political agenda. Examples of this include the Settlement Help Society for German Soldiers (Verein Ansiedlungshilfe für Deutsche Krieger) which, as detailed in the June 4, 1916, edition of its newsletter, Die Ostern, aimed to resettle German soldiers near the Baltic Sea, to “create a national bulwark in the East in order to improve the security of our borders against the land-hungry Muscovites” (quoted by Perry, p. 163).
A practical example of how war-disabled soldiers fared in the workplace is that of Siemens. By 1917, the company was employing twenty war-blinded soldiers, seventeen residents (both male and female) of the Berlin Municipal Blind Home, and one blind female homeworker. In that same year, the company’s chief engineer, Paul H. Perls, published an article looking at Siemens’s employment of both blind workers and others with significant impairments, such as paralysis or the loss of a limb. According to Perls, this was an experiment as much as anything else, and he wrote that the unparalleled numbers of men with permanent injuries incurred in the service of the Fatherland made it a moral imperative to investigate how these men could best be used in the workplace. Perls offered thirteen case studies of disabled workers employed by Siemens, as well as a more general overview of the reasons for the factory’s success in this regard. He argued that the nature of the work—low paid, low-skilled mass production of everyday items—was ideal for seriously injured people but less attractive to the non-disabled, who were thus free to assist in the war effort in other ways. One problem Perls encountered was the previously mentioned fear among war-disabled soldiers that earning money would threaten their pensions. Indeed, many disabled soldiers clamored for the traditional “injured worker” posts from which they were being discouraged, rather than persevering on the factory floor.
Reports like Perls’s came to the attention of the German military, who also responded to the labor shortage by “recycling the disabled.” As early as 1916, Paul von Hindenburg (1847-1934) and others proposed lowering the age limit for enlisting from seventeen to fifteen, including women in the draft, and employing those previously held to be “unfit,” and by the end of the war the labor of disabled soldiers was essential to the war effort, whether performing agricultural work, working in munitions factories, or actually fighting. Pensions psychosis had become less of a problem thanks to the increasingly draconian measures brought in to deal with those unwilling to assist in the war effort. As Perry points out, the difference between these initiatives and earlier ones was chiefly that in this instance, the disabled soldier was being rehabilitated not for his own good but to provide the state with a worker—or with cannon fodder.
This is an important book, one that increases our collective knowledge. I found it particularly interesting because I have just translated a book about the experiences of disabled Belgian soldiers during and after World War I. The few objections I have of the book result from my own background in disability studies. There are several points at which I felt that a disability studies perspective would have been helpful and would have resulted in a stronger book. For example, the question of pensions psychosis was, as Perry correctly identifies, pathologized, but someone with a disability studies, rather than a social history of medicine, perspective might have gone a bit further and considered the possibility that the men who exhibited this kind of behavior were being “othered”; in other words, those who called their behavior a “psychosis” were placing expectations and assumptions on disabled soldiers that they would never have held about themselves. Indeed, orthopedists such as Adolf Silberstein and Konrad Biesalski showed that this was not unique to war-disabled soldiers but more likely a consequence of both pension reforms and simple greed, which in fact permeated the whole of society. Though Perry identifies both of these issues, a disability studies perspective would have enabled her to connect them. Similarly, the phrase “nothing about us without us”—well known in disability studies and disability activism—was not far from my mind, as the book is primarily about orthopedists, with the war-disabled soldiers themselves in a sense absent from their own story. I would also argue that war-disabled soldiers are in many respects often regarded as an elite, so a focus on efforts to assist them of necessity obscures the situation of other disabled people in the society under investigation. Perry quotes Silberstein, head doctor of the military’s reserve hospital in Nuremberg, as stating in 1915 that it would not be possible to treat war-disabled soldiers alongside disabled German civilians because, in cripple-homes, the former, who were previously “the strongest and most powerful elements of our economy,” would find it “extraordinarily depressing” to be placed alongside “the weakest elements in our society” (p. 92). Perry’s chapter on what she calls the “cultural invention of disability” shows just how much work had to go into changing the prevailing attitude that an impairment made one unfit for any employment, and Perry finds two examples of recommendations that blinded ex-soldiers should be paid for their work, which suggests that this did not habitually happen (p. 171). I do feel that in paying more attention to this, Perry might well have written a very different book. Nevertheless, the book she has written is very informative and makes an excellent contribution to our collective knowledge.
. Perry provides English translations of German terms, book titles, etc., to assist the reader.
. The full citation for this work is Konrad Biesalski, Kriegskrüppelfürsorge: Ein Aufklärungswort zum Troste und zur Mahnung (Leipzig: Leopold Voss Verlag, 1915).
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Emmeline Burdett. Review of Perry, Heather R., Recycling the Disabled: Army, Medicine and Modernity in WWI Germany.
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