Table of Contents

Foreword iii

Preface v

Figures xiii

Tables xv

Acknowledgments xvii

Abbreviations xix

Chapter 1 Introduction: Looking to the Past for Lessons … to Apply in the Future 1

Chapter 2 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 3 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'Hôtel des Invalides 29

The French Revolution 30

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 4 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 5 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

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 6 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 7 The World War 123

A New Paradigm for Caring for Soldiers and Veterans 124

World War I Mobilization, Deployments, and Battle Casualties 126

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 8 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

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 9 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

Appendix: Military Personnel and Casualties from Principal U.S. Wars 267

Bibliography 271