Recycling the Disabled: Army, Medicine, and Modernity in WWI Germany by Heather R. Perry (review)

Heather R. Perry’s fascinating history of World War I–era Germany simultaneously traces the medicalization of combat-acquired disability, the development of prosthetic technology, and the professionalization of orthopedics. During World War I, the German military experienced significantly more casualties than in previous conflicts. Perry successfully argues that German orthopedists responded to the crisis by using medicine and surgery to “recycle” the war wounded into essential industrial and agricultural workers, freeing able-bodied men to reinforce the fighting forces on the frontlines and ensuring an adequate workforce after the war’s end (pp. 3–4). Along the way, orthopedists substantially improved their professional status for the long term.

In chapter 1, Perry describes the pre-war development of orthopedics as a “surgical subfield” focused on pediatric patients (pp. 22–23). Orthopedists had expanded their scope of work to include treating adults with chronic orthopedic conditions resulting from childhood poverty and disease and harsh working conditions. Nevertheless, at the start of the war, they had still not acquired official recognition as a specialty, and orthopedics was not a standard part of the medical school curriculum or of licensure examinations. The onset of war offered the opportunity “to emerge from under the professional shadow of surgery and child medicine” (p. 30).

Initially, orthopedists expanded the scope of their professional authority by relinquishing their former resistance to trauma surgery in the face of overwhelming need. They wanted to go beyond merely salvaging lives, however, and restore the war wounded to usefulness, simultaneously making themselves essential to the state and enhancing their own professional status. Chapters 2–5 detail three ways that the orthopedists set about accomplishing these goals.

Chapter 2 analyzes the orthopedists’ role in “revolutionizing” prosthetic limb technology. Perry focuses on the development of functional prosthetic arms for industrial and agricultural work. “By war’s end,” she notes, “orthopaedists in Germany had established their authority in the design, distribution, and fitting of prosthetic devices” (p. 75). Their professional skill and authority extended beyond merely salvaging soldiers’ lives by repairing their bodies; “they were sending them back to work and re-building a social order crumbling in the midst of war” (p. 77).

Getting soldiers back to work was not simply a matter of repairing their bodies and then fitting them with prosthetic limbs, however. Orthopedists also devised and implemented rehabilitation programs involving physical therapy and “work-therapy” in “orthopaedic workshops” in order to retrain injured bodies for “productive” occupation in the post-war era (p. 94). In chapter 3, Perry details orthopedists’ involvement in structuring rehabilitation programs to meet postwar labor demands while maintaining social boundaries by adapting the war disabled to resume their pre-war occupations or something comparable. Chapter 5 explores the ways that the rehabilitation project evolved as the war dragged on. By 1916, rehabilitation was no longer just about meeting the post-war industrial needs of the nation, but about supporting the war effort itself by “recycling” war-wounded men back into the military or harnessing their labor for wartime industrial or agricultural work (pp. 159–60).

While expanding their roles in prosthetic design and rehabilitation, German orthopedists discovered another essential component in their effort to “recycle the disabled”: a campaign to re-educate the public about the nation’s vital need for economic participation by the war wounded, the topic of chapter 4. By the onset of war, Germany had a well-established pension system for wounded soldiers that had resulted in a “culture of ‘entitlement,’” a belief that the government would take care of “war cripples” for life (p. 121). In the face of a severe wartime labor shortage, orthopedists developed outreach and public relations programs to retrain Germans to see rehabilitated soldiers not as “cripples” but as productive and valued members of society. Perry terms this process the “cultural invention of disability” (p. 119).

Perry argues that orthopedists, by extending their...