Beth Linker. War’s Waste: Rehabilitation in World War I America. Chicago: University of Chicago Press, 2011. 304 pp. $35.00 (cloth), ISBN 978-0-226-48253-8.
Reviewed by Susan Burch (Middlebury College)
Published on H-Disability (September, 2011)
Commissioned by Iain C. Hutchison
In War’s Waste, Beth Linker considers why rehabilitation became the primary response to America’s disabled soldiers. The work centers on the First World War as the pivotal time when responses to disabled soldiers transformed. As Linker deftly shows, a constellation of governmental, medical, technological, and social motivations underpinned the policy shift from financial benefits for veterans to rehabilitation programs focused on recovery and independence. Carefully researched and presented in engaging, fluid prose, this social history of medicine draws important connections between technology, culture, politics, and economics. As such, it will be of interest to a wide range of readers in U.S. history.
The book is arranged thematically. Chapter 1 examines the nineteenth and early twentieth centuries, mapping the rise of a national pension program for veterans. Based initially on specific notions of patriotic duty and gratitude for sacrifices made on behalf of the nation, pensions represented the presumed debt society owed its military members. By the early 1900s this attitude had changed. Rising costs and tensions over the program’s uneven management motivated Progressive Era reformers to call for a fundamental overhaul of the system. Framing their position as an attack on “war’s waste,” rehabilitation advocates recast disabled veterans as the embodiment of America’s problems: a corrupt and inefficient political and economic program that fostered dependence over self-sufficiency, exacerbated by an overattachment to the past. Valorizing work and independence, they sought programs that would provide physical and vocational training to “reconstruct” injured soldiers, enabling them to achieve their former status as contributing members of society. “Curing” disabled veterans, they posited, had economic advantages by “curing” the need for lifelong monetary assistance.
Chapter 2 highlights the rise of orthopedic surgeons in shaping medical rehabilitation. Prior to the twentieth century, orthopedic surgeons focused almost exclusively on “crippled children.” The First World War provided a unique opportunity for these medical specialists to ally with Progressive reformers in building an “aftercare” medical program. Long committed to rehabilitating disabled children and adults, orthopedic experts answered Progressives’ call for programs that fused medical, vocational, and social restoration. This “new kind of ‘scientific charity,’” Linker tells us, provided medical theory that “validated the felt social need to make the disabled useful through the production of capital” (p. 38). Orthopedists drew on prior experience with vocational hospital schools for children to develop new programs for the Division of Orthopedic Surgery that served injured soldiers abroad and at home. In the process, they significantly expanded their professional status and options.
The third chapter highlights gender and the “new female force” in the rehabilitation movement. Here, Linker offers a detailed study of the often-conflicting roles women played in male soldiers’ medical care. Physical therapy, a new field dominated by women, required intimate physical interactions shaped profoundly by gendered expectations. Female therapists were expected to eschew the ideals of domestic womanhood, subduing their femininity and challenging rather than pampering their (emasculated) patients. At the same time, the presence of female physical therapists was presumed to motivate injured men to regain their masculine roles as breadwinner and spouse. As Linker notes, “Women, and only women, could simultaneously adopt and embody both roles of disciplinarian and domestic ideal” (p. 78). Therapeutic massage, one of the vivid battlegrounds detailed by Linker, drew attention to the competition between nurses and physical therapists, as well as to class and cultural tensions over women’s intimate work with men’s bodies. Similar to orthopedic surgeons, female physical therapists sought greater professional recognition and power and battled on various fronts to achieve a “place of their own” in medical rehabilitation.
In the fourth chapter, Linker argues that rehabilitation “played just as much a role in the shaping of the modern American Hospital as other, more commonly cited factors” (p. 80). The material construction of institutions, such as Walter Reed Hospital in Washington DC, reveals the growing commitment to state medical support rather than to financial benefits for newly disabled soldiers. Walter Reed Hospital literally embodied this outlook, offering patients state-of-the-art medical care, occupational therapy, and vocational training. Linker demonstrates that aspirations of this kind of rehabilitation resulted in architectural changes that profoundly reshaped the construction and understanding of hospitals. For example, workshops, exercise rooms, and other specialized treatment rooms became common features in modern hospitals. The built environment had social ramifications, too. Within Walter Reed’s hybrid space, some Jim Crow boundaries were crossed. Soldier-patients received care in desegregated facilities. Linker is quick to note, however, that Walter Reed only allowed white doctors to treat the men. Ultimately, rehabilitation hospitals like Walter Reed offered a different kind of institutionalization for disabled soldiers that emphasized cure and independence rather than National Homes and long-term government assistance.
Walter Reed’s Limb Lab provides a central focus for chapter 5. The mass production of modern prosthetic limbs served multiple purposes in the larger project of rehabilitation. First, advocates believed it would reduce the overall cost of rehabilitation, in part by standardizing and managing production. Orthopedic surgeons ultimately gained control over the Limb Lab and thus the design and application of prosthetic technologies. Advocates also appreciated that the devices “delegitimize[d] the disabled veterans’ claims to federal assistance once rehabilitation was complete” (p. 101). Increased anxiety about damaged and disabled bodies shaped the development of the lab as well. Modern limbs, in theory at least, made possible an opportunity to “pass” as nondisabled. Rhetoric of freedom and autonomy marked the lab and its devices, adding credence to Linker’s broader argument about the changing view of disabled soldiers’ bodies and the impulse toward a “rehabilitation ethic.” This chapter also importantly points out some of the racial and class-based inequalities embedded in the creation and use of modern limbs.
The critical gaze shifts to propaganda in chapter 6. Disparities between propagandized representations of disabled soldiers and the realities on the ground receive significant attention in this section, revealing broader contests over the status and meaning of disabled troops. Despite varying perspectives, Linker adroitly explains, both medical experts and mainstream society typically believed the underlying assumption coloring these representations: that disability inherently emasculated men. An important counternarrative distinguishes this chapter. The author includes stories of disabled male soldiers and their allies who actively challenged these popular, stigmatized representations. For example, materials from The Come-Back, a magazine produced by disabled soldiers at Walter Reed, depict more everyday and human experiences, including (white, heteronormative) flirtations between injured men and doting (white, nondisabled) women. Some attention to racist aspects of both government propaganda and military life remind us that categories, including “soldier,” “disabled,” and “American,” belie an array of interdependent identity factors.
The seventh chapter of War’s Waste charts the transformation from wartime rehabilitation programs to postwar policies that separated medical treatment from vocational training. Concerns over socialism, among myriad factors, ultimately undermined early efforts to expand wartime rehabilitation programs to include disabled industrial workers. Linker returns to prewar American society in this chapter, detailing the rise of vocational education in the decade before the Great War. While she correctly notes that this educational trend especially benefited white male laborers, greater attention to the nineteenth-century roots of vocational education in schools for disabled children may have enhanced her analysis. Not surprisingly, the story of competing factions and evolving cultural-social values extends past the war as vocational educators, military representatives, and medical experts vied for central roles in rehabilitation. This work ultimately demonstrates that contrary to its original expressed aims, rehabilitation never decreased financial demands. As the author astutely notes, its greatest impact was changing the path of funding: from direct payments to veterans to the medical industrial complex.
A number of assets distinguish this book. Weaving together policy, technology, and social history, Linker expands the meaning of hospitals and rehabilitation in the American past. The work draws on a vast array of primary sources, including manuscript collections, memoirs, advertisements, medical journals, government department and professional organizations’ reports, federal policies and congressional records, and photographs. Attention to methodology is evident throughout. This is especially true in the careful examination of the inherent limitation of sources, their multiple meanings, and the context from which they came. Linker also points out individuals’ and groups’ agency, reminding us of the deeply human dimensions of this story. Including experiences of white women, African American men, and working-class white men enhances her overall critique. Greater critical attention to whiteness as a racial category and providing a more consistent study of race and ethnicity throughout might have yielded additional insights. Questioning the construction of disability as a category similarly could have complicated the meaning of rehabilitation in provocative ways. Still, this is an important contribution to our historical understanding of war, medicine, rehabilitation, policy, technology, gender, and American society.
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Susan Burch. Review of Linker, Beth, War’s Waste: Rehabilitation in World War I America.
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