The United States’ approach to assisting soldiers returning from war shifted during the late nineteenth and early twentieth centuries. Following the Civil War, Union soldiers were promised lifelong pension payments; during World War I, the emphasis shifted from cash benefits to vocational rehabilitation. The issue of how to provide the most effective support for returning veterans was still hotly debated during World War II.

The United States’ approach to assisting soldiers returning from war shifted during the late nineteenth and early twentieth centuries. Following the Civil War, Union soldiers were promised lifelong pension payments; during World War I, the emphasis shifted from cash benefits to vocational rehabilitation. The issue of how to provide the most effective support for returning veterans was still hotly debated during World War II.

More than sixteen million Americans fought in World War II, and many returned from the battlefields with physical or mental disabilities. In this speech, Major General Norman T. Kirk—then surgeon general of the United States Army—discussed the medical care injured soldiers receive from the military before returning home. He acknowledged the desire of the American public to assist returning soldiers, but he emphasized the need for a sense of resilience and self-sufficiency. He argued that pity and charity damage soldiers’ recovery and believed rehabilitation was the best approach to help disabled soldiers return to civilian life.

Following the Civil War, the US government promised a lifelong pension to soldiers of the Union army. But by the early twentieth century, the government was feeling the financial strain of these payments. As the beginnings of World War I stirred in Europe, Americans became concerned about potential US involvement, which, in turn, led to concern that the pension model was not sustainable if the number of war veterans were to grow significantly. Additionally, reformers suspected that some returning veterans falsely claimed disabilities in order to collect benefits and avoid working, and that the system favored those who could afford expensive attorneys to help them secure these benefits.

As a result, the federal government tried a different approach for soldiers returning from World War I: rather than pay disability benefits to injured veterans, the government emphasized occupational therapy and vocational rehabilitation. The plan was to help soldiers either return to their prior jobs or qualify for new ones, in hopes that doing so would strengthen the economy and create a more efficient workforce.

Even though the United States was officially involved for only a short time, close to five million Americans served in World War I, and approximately two hundred thousand suffered permanent injuries. To address the growing needs of veterans, in 1917, Congress established disability compensation, vocational rehabilitation, and insurance programs, along with three agencies to administer these programs. However, many veterans struggled to rejoin civilian life and find employment, particularly as the Great Depression took hold.

The United States officially joined World War II in December 1941, following Japan’s attack on the Pearl Harbor military base in Hawaii. More than sixteen million Americans served in the military during World War II, and many returned from the battlefields with physical or mental disabilities that made readjustment to civilian life difficult.

The large number of returning veterans, combined with the lessons learned following World War I, raised another call for reform. Concerns about widespread unemployment and social unrest among returning veterans led to the Servicemen’s Readjustment Act of 1944, often known as the GI Bill. This bill established support systems for returning soldiers, including assistance with expenses to attend college or vocational school, low-interest mortgages for purchasing homes, low-interest farm and small business loans, and a living allowance for unemployed veterans. The bill also established veterans’ hospitals and vocational rehabilitation programs.

Despite general agreement that the federal government should provide support systems for returning veterans, public opinion was sharply divided on the most appropriate way to achieve this. Speaking at the New York Times Conference in New York City on October 12, 1944, Major General Norman T. Kirk, then the surgeon general (or chief medical officer) of the United States Army, delivered a speech sharing his thoughts on how the United States should care for returning soldiers.

Norman T. Kirk was born on January 3, 1888, in Rising Sun, Maryland. He graduated from medical school at the University of Maryland in 1910, and served as resident physician at the University Hospital in Baltimore for two years. In 1912, he was commissioned a first lieutenant in the Army’s Medical Reserve Corps, thus beginning his career as a military doctor.

During World War I, Kirk specialized in bone and joint surgery; while at the Walter Reed General Hospital in Washington, DC, he treated nearly one-third of the amputees returning from World War I battlefronts. After the war, he served as chief of surgical service at several hospitals in the United States and the Philippines, and, as World War II loomed, he worked with the supply division of the Surgeon General’s Office to ensure proper supplies for treating soldiers wounded in battle.

In 1943, President Franklin D. Roosevelt appointed Kirk surgeon general of the United States Army. Kirk was credited with establishing preventative health-care programs and emergency treatment protocols for the battlefield that dramatically increased the survival rate of frontline soldiers during the war. He served in this position until his retirement on June 1, 1947. Kirk died in Washington, DC, on August 13, 1960.

The American public should be told the truth about what war does to its fighting men. It should know that some of our men are struck down by disease, that they lose arms or legs and that they come home nervous invalids.

The public should also know that in no war have soldiers been given more scientific, painstaking medical care and more human understanding. They will continue to get that care and understanding wherever they are.

On my recent tour of the European battlefronts I was particularly interested in finding out how long it took for medical aid to reach a wounded man. Soldier after soldier told me that he had received medical aid within minutes after he had been hit. The medical soldiers are right alongside of those boys who are fighting in the front lines. They are prepared to give them first aid and get them back for medical and surgical treatment in the shortest possible time.

The evacuation of the wounded may be compared to a long conveyor belt. It starts when the wounded man is picked up by the medical soldiers, given first aid and carried to the battalion aid station for emergency surgery and medical care often under artillery fire. From there he is taken to collecting stations which prepare the men for transportation and to the clearing stations which have complete surgical equipment. He then goes to the evacuation hospital and from there to the general hospital far removed from the combat zone. If he cannot be returned to duty within a limited time, he is sent to a general hospital in the United States.

The man who reaches the general hospital in the United States and is discharged from the Army, is the one which I want to talk to you about today.

He may have lost an arm or a leg. He may have lost both arms or both legs. His face or head may be disfigured. He may be a nervous wreck from battle fatigue and labeled psychoneurotic or psychotic. But no matter what his condition is I want to assure you that he will get the best care that medical science can provide.

Spirit Has Been Developed

All along the line of this medical conveyor belt he has received treatment. His spirit has been developed. He has put his dependence upon the doctors and the nurses. He has seen others with possibly more serious wounds get well. He learns to take the loss of an arm, leg, eye or disfigurement in his stride. He believes he will soon be well to do a job and has complete confidence in what the doctors and nurses tell him. That this confidence is not misplaced is shown by the fact that 97 per cent of those wounded who reach Army hospitals get well.

The amputee is happy with others like himself. He is furnished a prosthesis and taught how to use it. The blinded man is taught to be self-reliant. Plastic surgery takes care of the facial disfigurement. His morale is high. He is ready to face the world. And then what happens?

When he sees his mother, she breaks down and cries. When he walks down the public street he is a subject of morbid curiosity. When he boards the street car someone tries to help him. These are the things that destroy his self-confidence and the work of months is sometimes undone in minutes.

The wounded soldier does not want sympathy. Neither does he want charity. Legislation and the grant of funds, embellished by ballyhoo, is not the answer to making him a useful citizen. He wants to be self-supporting and self-reliant. It is only humanitarian to subsidize him in accordance with his handicap but he does not want pity, gratuities or sob-sister aid. Many of these men when properly trained have a higher earning power than when they entered the Army. They are normal beings and they want to be treated as normal human beings.

Clarifies Term Psychoneurotic

Now let us take a look at the psychoneurotic case. First of all the term is widely misunderstood. The public confuses the term with psychosis and immediately labels him crazy.

There is nothing mysterious about psychoneurosis. It does not mean insanity. It is a medical term used for nervous disorders. It manifests itself by tenseness, worry, irritability, sleeplessness, loss of self-confidence or by fears or over-concern about one’s health.

A great many of those symptoms are manifested by people in civilian life, to greater or lesser degree. You are all familiar with the chronic complainer. Nearly everyone has some idiosyncracy about health. In spite of all this the psychoneurotic in civilian life is not labeled nor does he have difficulty in carrying on his business. Some of our most successful business and political leaders were psychoneurotics.

But put that successful, psychoneurotic businessman into the Army and the doctors immediately have a problem on their hands. Our Army is for the most part a civilian army. The majority of our soldiers have had no previous military training. Our citizens have not been regimented. They are used to a Beautyrest mattress, a private bath and all of the other conveniences that have made our American way of life so desirable. Some of these men are pampered by over-indulgent mothers and co-workers from early morning till late at night.

When this type of person is put into the Army he has a lot of adjustments to make. He becomes part of a vast machine that is regulated like clockwork. His job becomes an important part of an over-all job. He is not always in a position to know the ultimate objective of his work. So he starts to worry about it.

Adjustments Are Difficult

He has other adjustments to make. There is mass feeding. Oftentimes he is on K rations. Sometimes he has no rations and he has to shift for himself. There is mass sleeping. The man next to him snores. Unfamiliar sounds disturb his sleep. On maneuvers he has to sleep on the ground and on the battlefront he may not get any sleep for hours at a stretch. These are all disturbing elements to him.

Under all of these conditions it is difficult for him to adjust. It’s hard enough for a rugged, hardy individual to adjust, let alone a man with psychoneurotic tendencies. Therefore the nervously inclined individual, who was a success in civilian life, fails in the Army and receives a discharge.

We also have the moron, the mental defective and the constitutional psychopath to deal with. We get the alcoholic, the pathological liar and the pre-criminal in the Army. We have the boy who has been a failure all his life. He is a problem child at home and his school and occupational records have always been poor. Very few of these men ever make good soldiers.

Then we have the nearly normal individual who cracks under combat. Everyone has his limit of mental and physical endurance. A man can stand just so much. Put him in combat and under prolonged shelling and bombing, combined with poor rations, sometimes none at all, he becomes a casualty.

It’s not the first time strong men have broken down after giving what it takes!

We may have as many of this type of casualty as we do physically wounded, and the cycle of medical care for him starts immediately.

If he does not return to active duty within a reasonable time after treatment he is brought back to the United States and after reconditioning may be discharged.

Reconditioning Has 3 Phases

Reconditioning is a new term in this war. Previously the Medical Corps officer has been interested in the hospital treatment and recovery of his patients. But a soldier patient is of no use to his organization until he is returned to active duty. The sooner he is returned, the greater the manpower of the Army. In addition, the sooner his hospital bed is released, the sooner another casualty can be cared for. For discharged veterans there is a definite responsibility to return them to civilian life in the best state of physical and mental health possible.

Reconditioning consists of three phases—physical, educational and occupational. All patients in the Army Service Forces hospitals are included in the program except those acutely or seriously ill. The bed patient is given orientation and education in addition to physical bed exercises or occupational bed handicraft. As he increases to a ward ambulant stage these activities are intensified. The program is progressive through all stages of convalescence and balanced so that no one phase is overemphasized. Thus, if he is to be discharged, he is ready to undertake the occupational training offered by the Veterans Administration or go into his former job.

The most important thing which friends and relatives of the disabled veterans can do is to treat them naturally—treat them as normal men. Attention should not be forced upon them. People should not shudder at their afflictions and they should not be gushed over. These men are hypersensitive. If they have lost an eye or an arm or a leg they may feel, if friends or relatives unwittingly encourage that feeling, that the bottom has dropped out of the world they knew. But that isn’t true. We all know men and women who have successfully overcome grave disabilities and have lived useful lives.

Sympathy Is Needed

Give him some sympathy, sure. The injured man needs to know that his family and friends care for him. That is very important. But they must also know that this soldier is no longer a “boy,” except to his mother who will always think he is, and he should not be so treated.

Through training and leadership he was, when wounded, a soldier—a soldier who could give and take—lick the best the enemy could offer. In other words he was a courageous, mentally and physically fit man. Don’t ever let him lose this fighting spirit.

The wounded soldier must be allowed to do things for himself. If he finds he can tie his own tie or lace his own shoes, it is much better that he do it than it be done for him. He must discover that despite his handicap, he can do these and other things to give himself confidence and self-respect.

Parents, relatives and friends should not attempt to minimize the result of his injury. They must be realistic and honest. They should not tell him he looks fine, when he doesn’t. But they can tell him he will soon be as good as new. These wounded and disabled service men have no desire to be martyrs. They don’t want to be treated as heroes. They want to lead normal lives and be treated as normal human beings. They have rendered a great service to our country. They have made a great sacrifice. So a great responsibility rests on the public. Public behavior has got to be adjusted so that by ill-considered actions additional handicaps are not placed upon the disabled soldier.

On the other hand, by intelligent understanding of their problems and needs, the public can help them along the road to success and happiness.

ambulant: moving from place to place; able to walk

ballyhoo: clamor or outcry

invalid: an infirm or sickly person; someone too weak to care for themselves

Kirk begins his speech by describing the medical care delivered to frontline soldiers in times of war. As the surgeon general of the United States Army, he reassures his audience that soldiers receive the best possible care for their injuries, both on the battlefield and after they return to the United States. He acknowledges that many men return from war with physical and mental disabilities. However, he implores the public to recognize that these injured men need support rather than sympathy or charity.

Specifically, Kirk explains that, throughout the recovery process, injured soldiers receive encouragement and support from all the medical personnel they encounter. Their spirits are high because they survived a life-threatening injury, and they have learned how to operate a prosthetic limb or handle disfigurement. With the help of the Army’s well-trained medical staff, soldiers regain the self-sufficiency necessary to rejoin the civilian world.

However, Kirk notes that once they leave the military, disabled soldiers are often looked upon with pity when they try to rejoin civilian life. He understands that the public only wants to help soldiers who appear to be in need, but he explains that misplaced charity can actually hurt more than help. He insists that, while it is “humanitarian to subsidize him in accordance with his handicap,” it is important to recognize that the former soldier is intelligent and highly trained. Veterans value their independence and pride themselves on their self-sufficiency. He argues that passing legislation and granting funds to disabled soldiers is not the most important ingredient in helping them return to living their lives, but rather the acceptance and support of their friends, relatives, and the public at large.

Kirk also explains that many soldiers returning from battle experience “psychoneurosis” as a result of the stresses and strains of living in combat zones. They work and fight long hours, sleep in uncomfortable quarters, and often have only army rations to eat. These conditions can make even the strongest man crack under the pressures of a combat situation; and as Kirk points out, some men enlist already struggling with mental difficulties, so the stress of combat only makes these situations worse.

Finally, Kirk outlines the “reconditioning” program, newly established by the US military for soldiers returning from World War II battlefronts. The program includes physical, educational, and occupational therapy, and is designed to help returning soldiers reintegrate into civilian life in the best physical and mental state possible. This might mean teaching soldiers how to adapt to their old jobs given their limitations, or helping them learn a new skill and transition into a new occupation.

As Kirk explains in his speech, the medical care provided to soldiers on the frontlines during World War II was quick and often effective: within minutes after a soldier was wounded in battle, medical soldiers provided first aid, and he was evacuated to a safer location for further care. This system helped many soldiers return home alive, but the increased survival rate—particularly among soldiers with more serious injuries—led to concerns about the country’s ability to care for the growing number of disabled war veterans.

By 1944, the United States had been involved in several major wars in its history. Each was accompanied by pressure to provide support to the returning soldiers who had sacrificed their health and safety to defend the country. Following the financial strain of providing pensions to Union army soldiers after the Civil War, and motivated by public pressure to remove the incentive for returning war veterans to remain unemployed, the federal government switched from a benefits model to a vocational rehabilitation model. As a result, many World War I veterans received only a small amount of cash and a train ticket home upon their return. But as the Great Depression took hold in the early 1930s, many former soldiers—particularly those who were disabled due to battle injuries—struggled to find work. Social unrest persisted throughout the decade; by 1932, it culminated in a confrontation in Washington, DC, between veterans who had been promised additional compensation for their service and President Herbert Hoover’s administration, which was withholding those benefits.

The federal government enacted the GI Bill in 1944, hoping to avoid making the same mistakes with returning World War II veterans. This bill provided significant health-care benefits to returning veterans, as well as the opportunity to attend college or obtain vocational training. But some of its provisions caused controversy: for example, Congress deadlocked over the unemployment benefits provision, and the bill almost failed as a result. This revived the debate over whether cash benefits provided necessary relief or simply discouraged soldiers from looking for work. As evidenced by his speech, Kirk favored the rehabilitation model; he sharply criticized the benefits model as a danger to the independence and morale of returning soldiers.

However, despite concerns over these provisions, far more veterans took advantage of the education benefits and home-loan programs than the unemployment benefits. By 1956, nearly eight million of the sixteen million World War II veterans had participated in an education or training program, and more than two million had participated in the home-loan program. By contrast, veterans claimed less than 20 percent of the funds allocated for unemployment payments.

• Altschuler, Glenn C., and Stuart M. Blumin.The GI Bill: A New Deal for Veterans. New York: Oxford UP, 2009. Print.
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• Johnson, Greg. “Rehabilitating Soldiers after War.” Penn Current. U of Penn., 15 Dec. 2011. Web. 7 Nov. 2014.
• Morin, Rich. “The Difficult Transition from Military to Civilian Life.” Pew Research: Social and Demographic Trends. Pew Research Center, 8 Dec. 2011. Web. 7 Nov. 2014.
• “Norman T. Kirk.” Office of Medical History. US Army Medical Dept., 20 Feb. 2009. Web. 7 Nov. 2014.
• “Primary Sources: GI Bill.” The National WWII Museum. National WWII Museum, 2013. Web. 7 Nov. 2014.
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