Book Review: Burdens of war: Creating the United States veterans health system

• Author: James Griffith
• Published date: 01 January 2020
• Date: 01 January 2020
• DOI: http://doi.org/10.1177/0095327X18790967
• Subject Matter: Book Review

Book Review

Book Review

Adler, Jessica L. (2017). Burdens of war: Creating the United States veterans health system.

Baltimore, MD: Johns Hopkins University Press. 368 pp. $49.95 hardback, ISBN

978-1-42142-287-9.

Reviewed by: James Griffith, National Center for Veterans Studies, University of Utah, Salt Lake

City, UT, USA

DOI: 10.1177/0095327X18790967

The title of this book, Burdens of War, is appropriately named. What are the human

costs of war? When young men answer the call to war, whose responsibility is it to

care for them upon return? The story begins with discussions among the federal

legislature, veterans groups, military health-care leaders, and policy makers con-

cerning how to care for veterans, in particular, those from the Spanish–American and

Civil Wars, right before eve of the Great War. At this time, a Congressional act

created the Bureau of War Risk (BWR)—responsible for the protection of men and

women who served in the armed forces, including monetary compensation for death

and disability. There were 4 millio n veterans of the Great War. Approxim ately

234,000 soldiers suffered combat wounds—bullet wounds, gas exposure, and still

more from “shell shock.” Many of these conditions were treated by the Army

Medical Department, though capacity was limited and further treatment of chronic

conditions and extended rehabilitation greatly limited its functioning.

In 1918, the Public Health Service (PHS) was the only government hospital

services accessible to veterans. At the time, the PHS had about 19 hospitals and

120 relief stations to available service members. As the need for veterans’ medical

care multiplied, key policy questions arose:

For what conditions was the government obliged to treat, specifically, con-

ditions among draftees that led to their rejection? Adler cites one example of

52,600 young men who were accepted into military service but later rejected

due to physical and mental health problems. In late 1919, Congress passed a

law stipulating that such individuals were eligible for compensation and

medical care.

Among those who served, there was debate whether to treat preexisting

conditions and yet not-so-recognized neurological conditions such as mental

defect, mental disease and pathological mental states, organic nervous

Armed Forces & Society

2020, Vol. 46(1) 185-187

ªThe Author(s) 2018

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