Casualties, Disability & Rehabilitation

[Kyt]

"Inspired" by the two Bader threads, I've been thinking about war and disability, and the medical and post-medical techniques used in the treatment and rehabilitation of casualties.

Basically, with the improvement in surgical procedures and the use of antibiotics meant that a very large percentage of casualties (civilian and military) survived, with disabilities.

However, I have to admit that I am rather ignorant of the types of rehabilitation and "occupational therapy" used during and immediately after the war, and of types of prosthetics used.

I thought I'd start of with this:

"In World War II, great strides in surgical techniques and antibiotics allowed many disabled soldiers to survive disabling trauma and return to their communities. Veterans' organizations have always been among the most powerful groups advocating for public policy changes affecting people with disabilities, though until recently they did not work in coalition with other groups of people with disabilities. Throughout WWII, people with disabilities were encouraged to work--as women were--and employers were encouraged to get over their fears of hiring them. After the war, encouraging employers to "Hire The Handicapped" was the mission of the President's Committee on the Employment of the Handicapped founded by President Truman.

Franklin Roosevelt, who knew what rehabilitation could mean to someone with a disability, wrote the following to the Secretary of War in 1944:

"No overseas casualty [should] be discharged from the armed forces until he has received the maximum benefit of hospitalization and convalescent facilities, which must include physical and psychological rehabilitation, vocational guidance, prevocational training, and resocialization."

The President, with the encouragement of Bernard Baruch, thus gave official standing to a branch of medicine that had long struggled for recognition among other medical specialties. Rehabilitation medicine had started to come into its own, albeit on a small scale, after the First World War, through the efforts of Drs. Albee and Kessler, and Frank Krusen, a specialist in physical medicine. By the 1940s, it had achieved some success with new surgical treatments and other therapies. In cases of disability, the focus of rehabilitative medicine was to treat the whole person, not simply the injured limb or organ. The goal of treatment was to return the patient to society functioning at the highest possible level. World War II, like previous wars, created a huge number of casualties who needed rehabilitation and made the field visible again.

During the war, Dr. Howard Rusk applied that rehabilitation model in his first Army Air Force command with such success that it spread throughout the armed forces. Patients were urged to get out of bed as soon as possible and begin a "reconditioning" program to develop residual capabilities. Even severely disabled patients were kept busy in bed instead of being treated as sick and isolated individuals as they had been in the past. Motivation, psychology, and what we would now call "feedback" were as important as surgical reconstruction.

As the war ended, Rusk and other rehabilitation specialists predicted a huge postwar need for their methods. Major rehabilitation centers were planned where psychiatrists, physical and occupational therapists, and medical social workers would work with medical doctors and surgeons in a unified approach to rehabilitation. Many wanted to harness the technical and scientific expertise of the war effort and put it to peacetime use. The thinking went that, if we could build an atomic bomb, surely we could solve any medical problem-- and disability was perceived primarily as a medical problem, even by rehabilitation specialists.

Postwar rehabilitative medicine had its star doctors and success stories. Howard Rusk was a tireless promoter of his rehabilitation model and appeared in newsreels and picture magazines. But despite vastly increased federal funding for medicine and the new heroic status of doctors-- as seen in TV dramas and picture magazines-- advocates of rehabilitative medicine were never able to get their plans fully funded or the planned centers built.

Rehabilitative medicine had come about because specialized acute care could not meet the needs of many people with disabilities. But most people, including many in the medical professions, continued to believe that the cutting edge of medical work was basic research-- the search for the cause of disease-- or surgery. Rehabilitation wasn't seen as glamorous or urgent. Rather it involved coming to terms with conditions that doctors believed were incurable-- and thus offered less dramatic opportunities.

Still, the doctors who followed Rusk's lead made a great difference in the lives of individuals. People who in other times or under other medical regimes would have been allowed to languish in hospital wards or at home in bed, written off as "hopeless," were given new hope, and new faith in their own abilities. Despite these achievements, many of the people for whom the pioneers of rehabilitation medicine campaigned eventually began to resent and fight against the medical model of disability that most of those doctors held.

Rehab doctors worked in a world that gave immense authority to doctors. As doctors, they determined not only what a person with a disability could achieve, but in many cases how he or she should achieve it. If doctors decided that it was possible for an individual patient to walk, the patient's use of a wheelchair could be interpreted as failure--on both the patient's and doctor's part. Doctors projected their prognosis onto their patients who internalized-- and were consequently constrained by-- the doctor's medical understanding of their abilities. The sociologist Talcott Parsons has pointed out that the tacit contract existing between patient and caretaker implies that if the caretaker agrees to give his all, the patient agrees to get better.

The goal of rehabilitation in the postwar years was to make possible the integration of people with disabilities into society. But despite the commitment of rehab therapists to seeing the disabled person whole, the commitment ended at the hospital door. Once the doctors and therapists had done all they could, patients-- and their caretakers and families-- were on their own. The person with a disability still had to navigate and come to terms with society individually.

Crippled Child Magazine was published from the 1920s until the 1950s by the Society for Crippled Children. The early issues were devoted to the work of establishing hospitals and services for children with various disabling conditions, and professionalizing their staffs. In the twenties and thirties, the focus continued to be children, but attention turned to building networks of professionals to advance social welfare policy. During the war years, suddenly, adults with disabilities appeared everywhere in the magazine, working to help the war effort, and programs for newly disabled veterans became popular subjects. In the fifties, the magazine turned its attention again to the needs of children.

"Not Charity But an Opportunity" President’s Committee on the Employment of the Handicapped

President Harry S. Truman founded the President’s Committee on the Employment of the Handicapped in 1947 to assist physically disabled veterans in finding employment. In the 1960s, PCEH expanded its mission to include persons with mental retardation and mental illness. Although PCEH played an important role in drawing attention to employment of people with disabilities, its most important contribution in relation to the disability rights movement were unofficial results. Each spring PCEH sponsored a spring conference to provide a national forum for discussing disability issues. Many people with disabilities from around the country came for the spring conferences and began forming relationships with other people from different regions and with different disabilities. Thus, by the early 1970s, PCEH functioned as the primary gathering place for disabled activists on a national scale. Disability advocates, disability professionals, and public officials could share ideas and set agendas for the future. One of the most important outgrowths of PCEH was the creation of the American Coalition of Citizens with Disabilities. At the 1973 PCEH spring conference, a group of disability activists began discussing the need for a consumer-led, cross-disability organization. They met at the following year ’s conference with more than a hundred people with disabilities to found ACCD and began writing a constitution and bylaws. Then they met in conjunction with the 1975 spring PCEH conference to elect a board of directors and executive officers."

WWII veterans perform rehab exercises, circa 1940's


Beyond Affliction: Policy 1930-1970

Interesting. I know a lad who has a perforated eardrum from being too close to a ships gun that shouldn't have been fired. But there we have it. It was 3days before he could get to hopital in New York, where his ship called in to drop him off. He was later told that if he had been dumped in a British hospital at the time his hearing would have been totally destroyed. But as he was in the American Naval hospital partial hearing was saved through their advanced treatments.
Since the war all wounded Veterans have preferential treatment on the NHS. How many know this and actually make use of it to jump the ridiculous waiting lists?

[Kyt]

An interesting article written in 1945:

Rehabilitation of War Personnel Subjected to Aural Trauma

Rehabilitation of War Personnel Subjected to Aural Trauma

[von Poop]

The Guinea pig club fits the topic quite well, recent documentary described how revolutionary some of the treatments they received were. The film of hands attached to faces to grow the skin from one to the other certainly seemed pretty advanced for the '40's.
The RAF Guinea Pig Club

[Kyt]

It isn't easy being a war casualty:

McClatchy Washington Bureau | 09/27/2005 | WWII veteran wins fight over disability payment

But sometimes, it was funny being disabled:

BBC - WW2 People's War - A Thoroughly Disabled War Or I was Britain’s Secret Weapon

[Kyt]

It was worse for WW1 veterans:

Scott Gelber | A 'Hard-Boiled Order': The Reeducation of Disabled WWI Veterans in New York City | Journal of Social History, 39.1 | The History Cooperative

[von Poop]

Originally Posted by Kyt

Scott Gelber | A 'Hard-Boiled Order': The Reeducation of Disabled WWI Veterans in New York City | Journal of Social History, 39.1 | The History Cooperative

Strewth!

The organs used in approving cases are the eyes and the brain. The ears and the heart do not function. Be hard-boiled ... Put cotton in your ears and lock the door. If you are naturally sympathetic, work nights when nobody is there.7

An Interesting read.

[sapper]

A subject that unfortunately I know a great deal about. Having had to live with the injuries that I sustained both in Normandy, and again in Holland.
The hospitalisation, then clawing my way back into employment, and having to live with the injuries for the last 62 years.

It is am experience that the modern service man will have little idea of.
Thank heavens !
Sappwe

[Kyt]

From: MEDICAL DEPARTMENT UNITED STATES ARMY IN WORLD WAR II

[Kyt]

From: Railway of Death

Various types of improvised prosthetics and artificial limbs used by soldiers who had lost either all or part of their leg and/or foot. They were locally manufactured by soldiers at the prisoner of war (POW) Base Hospital.