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Providing for the Casualties of War The American Experience Through World War II Bernard Rostker NATIONAL DEFENSE RESEARCH INSTITUTE Providing for the Casualties of War The American Experience Through World War II Bernard Rostker Prepared for the Office of the Secretary of Defense Approved for public release; distribution unlimited The research described in this report was prepared for the Office of the Secretary of Defense (OSD). The research was conducted within the RAND National Defense Research Institute, a federally funded research and development center sponsored by OSD, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community under Contract W74V8H-06-C-0002. Library of Congress Cataloging-in-Publication Data Rostker, Bernard D. Providing for the casualties of war : the American experience through World War II / Bernard D. Rostker. volumes cm Includes bibliographical references. ISBN 978-0-8330-7836-0 (v. 1 : alk. paper) — ISBN 978-0-8330-7835-3 (v. 1 : pbk. : alk. paper) 1. War casualties—Medical care—History. 2. Battle casualties—Medical care—History. 3. Veterans—Medical care—History. 4. Medicine, Military—History. I. Title. UH215.R67 2013 355.3'450973—dc23 2013009885 The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R ® is a registered trademark. Cover design by Carol Earnest. Cover background image from the History of Medicine at the National Library of Medicine. Images in rows: (a) History of Medicine at the National Library of Medicine; (b) George A. Otis and D. L. Huntington, The Medical and Surgical History of the War of the Rebellion, Part III, Vol. II: Surgical History, 1883; (c) Library of Congress, C.M. Bell Collection of Glass Negatives; (d) Reeve Photograph Collection, Otis Historical Archives, National Museum of Health and Medicine; (e) U.S. Army Medical Department Office of Medical History website; (f) VA Salt Lake City Health Care System. For more details, see the photo insert. © Copyright 2013 RAND Corporation Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. For information on reprint and linking permissions, please visit the RAND permissions page (http://www.rand.org/publications/permissions.html). Published 2013 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665 RAND URL: http://www.rand.org To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] Foreword [In war], the latest refinements of science are linked with the cruelties of the Stone Age. —Sir Winston Churchill Speech, London March 26, 1942 The above quote applies especially to military medicine: Weaponry has become increas- ingly lethal, but medical advances are making horrific wounds survivable. It was my job as the Surgeon General of the Army to build a robust medical presence on the bat- tlefield and a sophisticated system of recovery care and rehabilitation for our wounded soldiers. In Providing for the Casualties of War, Dr. Bernard Rostker sets my task against the backdrop of history. Histories of military medicine usually concentrate on battlefield care and trans- portation, occasionally on recovery in hospital systems, and rarely on rehabilitation. Efforts to consider all aspects of care, from the time of wounding through ongoing rehabilitation and all the systems supporting this spectrum, are rare indeed, and I am not aware that it has ever been done with the detail Dr. Rostker has provided. Beginning with a history of casualty care from ancient to modern times, this volume describes the progression from early primitive care, to more “modern” prac- tices (e.g., bleeding, cauterization) that can best be described as well intended, and to the rapid improvements of the 20th century. The recognition that there is need for additional care, including rehabilitation, is recounted in this volume. Rostker clearly shows the progression of care from the battlefield to follow-up care through the ages, especially how France and Great Britain laid the groundwork for the establishment and evolution of the American systems of care we enjoy today. The interplay of mili- tary care with that of care for the disabled and veterans is chronicled, along with the establishment of benefit programs. Of particular note is the growing recognition of mental health problems and the difficulty of recognizing, diagnosing, and treating these conditions. This is a unique, comprehensive, and well-written history of the scope of military medicine, from the time of wounding to follow-up care as a veteran. It covers ancient iii iv Providing for the Casualties of War: The American Experience Through World War II times through World War II and its immediate aftermath. It is for both the serious stu- dent and the interested casual reader and should be a useful reference for policymakers, care providers, and history buffs alike. LTG Dr. Ronald R. Blanck, U.S. Army (Ret) Former Surgeon General of the Army Preface The current and future care of the casualties of war1—those who have been wounded or injured or who are mentally or physically ill—is of primary importance to the mili- tary and civilian leadership of the military services, the Department of Defense, and the Department of Veterans Affairs. The 2010 Quadrennial Defense Review Report highlighted the care of wounded warriors as a major, high-priority initiative: Apart from working to prevail in ongoing conflicts, caring for our wounded war- riors is our highest priority, and we will strive to provide them the top-quality physical and psychological care that befits their service and sacrifice. Providing world-class care and management, benefit delivery, and standardization of services among the Military Departments and federal agencies continues to be the focus of the Department’s most senior leadership. Our wounded, ill, or injured service members deserve every opportunity to return to active duty following their recov- ery, or to make a seamless transition to veteran status if they cannot be returned to active duty. (U.S. Department of Defense, 2010, p. 49) As with every other aspect of the military, the relevant policies have evolved over time, and having a basic grasp of their roots and evolution should improve understand- ing of today’s policies. This volume begins with the ancient and European roots of care for fallen soldiers. It continues through America’s own wars, describing how the U.S. government has arrived at its current set of policies for caring for its injured and ill sol- diers and veterans. For each historical example, the discussion addresses the nature of the conflict, combat casualties, and the way both soldiers and veterans were treated. It addresses such questions as who were able to remain in the service and who had to sep- arate, either through discharge or retirement, and what roles their families, their com- munities, or (more recently) the Department of Veterans Affairs played in their care. 1 As used throughout the volume, the term care includes assistance rendered on the battlefield, in military hospi- tals before separation from the military, and in veterans’ facilities after separation from the military. While some include support for housing, education, and postservice jobs under the banner of care, here it deals primarily with medical care and generally only what the government provides in the form of pensions and medical services. v vi Providing for the Casualties of War: The American Experience Through World War II The focus is on the U.S. Army because, throughout U.S. history, it has suffered the most war casualties of all the services. While all the services share some common history, they are distinct organizations with their own stories to tell. Sorting out the areas of overlap and paying each service the same degree of attention as is given to the Army here was beyond the scope of this effort.