War, Politics, and Philanthropy: The History of Rehabilitation Medicine (review)

Lawyer and disabled advocate Richard Verville has written a first take on rehabilitation medicine in America from WWI to the recent past. It is largely an institutional history rather than a clinical one, first tracking the growth of the specialty to board recognition and AMA approval, then largely shifting to the politics in Congress and with the White House.

The first third looks at events before WWII. Verville focuses on five persons, Henry Kessler, Frank Krusen, Howard Rusk, Bernard Baruch, and Mary Switzer. Because they were not particularly active before WWII, Verville mostly treats that period as a prologue instead of a time with its own events. He has limited sources for anything before 1945 and fairly limited sources throughout: there are no archival footnotes. Some interviews are cited, but it is unclear where they are archived. And while the bibliography is fairly lengthy, the chapter notes cite far fewer works. At times, it is obvious that he is a prisoner of limited sources. For instance, he comments on the public outcry in 1944-45 when military hospitals provided only temporary prostheses, but he does not explain that government policy was for the military to provide initial care and the Veterans Administration to provide definitive rehabilitation.

The middle third covers 1941 through the 1960s, plus an out-of-chronology chapter on FDR, polio, and rehabilitation. While "war" is the first word in the title, it takes little time to cover WWII and then move to the rehabilitation programs that gradually expanded during the 1950s. This section truly brings in Kessler, Krusen, Rusk, and Baruch. Switzer is lauded for her role in expanding care from within the federal bureaucracy. It is really only here that a thesis is developed: that the physicians developed procedures that helped patients, that Baruch put up money that helped pioneers show their value to the public, and that Switzer provided a sympathetic ear in the federal government to provide funding.

The last third of the book takes place after Verville's "big five" were retired and is largely about the political developments of disability rights and rehabilitation care. As might be expected of someone who has worked in the field, Verville is strongly in favor of the expansion and the medical groups, politicians, and lobbying that have steadily expanded rehabilitation, going beyond its roots in physical medicine. As Verville was active in this period, he is strong on what factors were involved in various developments. Yet enough was happening that even giving it 40 percent of the book seems a bit rushed.

The book could use better editing; the present tense crops up repeatedly, and there are times when the text says "now" that will be problematic in a few years' time. The lack of recognition of anything outside the United States should also raise some eyebrows. Apparently rehabilitation medicine has a history only in the United States. The British fighter ace Douglas Bader had two artificial legs, not just the one that Dale Lyons had (photo caption following p. 150).

There are significant weaknesses in this book, mainly in sources. It would also have been useful to explain what rehabilitation has meant at various times; one reason it is far more expensive now is that more is being done, but the reader is largely left to imagine this. Yet Verville set himself a task wider than many of us would care to tackle. As it is, his argument seems reasonable, and with better research it would look more plausible.