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Researching Neuropsychiatry and Veterans Hospitals During the 1930s at the New York Academy of Medicine 

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By Dr. Michael Robinson, National Army Museum Research Fellow, University of Birmingham (UK), and the Library’s 2024 Paul Klemperer Fellow in the History of Medicine 

I spent one month working in the New York Academy of Medicine’s magnificent library and reading room in the autumn of 2024. This residency enabled me to look at a host of materials dedicated to the treatment of mentally ill American Army veterans of the First World War during the Great Depression (1929–1939). I undertook this research hoping to utilise the USA as an important comparative case study on my current research project dedicated to mental illness and British Great War veterans during the 1930s. By examining mental breakdown and psychiatric medical care during this decade, this research seeks to reveal the delayed traumatic after-effects of war service on ex-service personnel and the potential for additional psychosocial determinants to influence mental ill-health.  

I first became interested in the American experience of post-First World War disability and mental healthcare owing to its regular appearance in the archival records of Britain’s Ministry of Pensions, the government agency responsible for distributing veterans’ pensions and medical care. During the inter-war period, British policymakers regularly cited the US experience of veteran after-care as a deterrent and a case study to avoid replicating. They actively held up the US system as being unfairly exclusive, costly, and liberal owing to its incremental but costly expansion of veteran rights and facilities. Britain significantly reduced its liability on behalf of veterans during the 1920s and 1930s, including the closure of most veterans’ hospitals. Veterans’ medical care in Britain was primarily outsourced to broader public health facilities, the civilian welfare state, and the charity sector.  

By contrast, the US witnessed increased state liability, including a vast financial outlay in funding exclusive Veterans Administration (VA) hospitals and medical facilities. In 1936, owing to the two nations’ inversed approaches to veteran care, one Ministry of Pensions official described the UK and US responses as being of ‘opposite extremes.’1 The primary purpose of my time at the NYAM was to better understand why the British and US systems were the complete inverse of one another. I also sought to appreciate how these contrasting policy trajectories and medical infrastructures affected the lives of mentally ill veterans.  

Portrait of Thomas Salmon, from History of the Interurban Clinical Club 1905-1937, edited by David Riesman (1937).

This comparative approach first led me to NYAM records relating to Dr. Thomas Salmon (1876–1927). For those unfamiliar, Salmon was the American Expeditionary Forces’ chief consultant in psychiatry during the First World War. Before this important role, following the country’s entry into the global conflict in 1917, Salmon visited England to study how it dealt with mental wounds during the war to help inform his country’s approach.2 As a leading figure in the US National Hygiene Movement before and after his war service, the records of Salmon’s war experience reflect a relatively progressive military medical official. He regularly stressed the environmental causes of soldiers’ breakdown. In short, Salmon was more inclined to blame combat neurosis and stress on the dehumanising and brutalising effects of war service than citing faulty hereditary genetics, as was more apparent amongst British military officials. This more empathetic outlook continued into Salmon’s advocacy on behalf of veterans following his return to America. Unlike the more reclusive and disillusioned Dr. Charles Myers, the British Army’s leading psychiatric official, Salmon advocated for healthcare and welfare on behalf of the mentally disabled First World War veterans during the initial post-war years. Described by his biographer as a successful ‘spokesman for veterans,’ the force of Salmon’s personality and his effective collaboration with the American Legion help explain why the American mentally ill veteran stopped being admitted into larger public mental hospitals.3 Instead, the US Federal Government established exclusive medical facilities for veterans from the early 1920s onwards.  

Salmon died unexpectedly whilst sailing near Long Island in 1927. Reflecting his prestige amongst his contemporaries, the National Committee for Mental Hygiene, an advocacy organization founded in 1909 by Clifford W. Beers, set up the Salmon Committee on Psychiatry and Mental Hygiene at the New York Academy of Medicine in 1931.4 Regardless, the exclusive medical infrastructure he had helped establish continued to cater to mentally ill First World War veterans into the 1930s. In stark contrast to Britain’s minuscule and dwindling psychiatric infrastructure, the VA provided seventeen neuropsychiatric facilities across its national network of forty-nine hospitals. It offered 10,633 beds for mental ailments, marking a 467% increase over 1921’s availability. The number of beds would be set to increase for the rest of the decade.5 With this exclusive federal medical care program for veterans, the VA published its Medical Bulletin journal throughout the 1930s. Pouring through these issues reveals a lively forum of VA medical officials discussing the continued difficulties of treating veterans during this period.  

Regarding neuropsychiatry—I was struck by how hospital superintendents, nurses, vocational trainers, and social workers regularly articulated a holistic approach to mental healthcare. They cited the psychosocial determinants of health outside of hospital walls. This includes, for example, the detrimental impact of unemployment and poverty on an individual’s mental and bodily health, the emasculating stigma attached to male mental illness, and the potential for harmful self-medication practices such as alcoholism.  

United States Veterans’ Bureau Medical Bulletin (1931), a collection of articles by VA staff and associates dedicated to all aspects of veteran after-care. These various scans come from volume 7.

The materials I reviewed at the NYAM provide a complex and nuanced picture of the post-war treatment of mentally ill World War One veterans. On the one hand, they give an image of an expansive, caring and financially generous veterans’ system. On the other hand, however, they provide comparatively little insight into the personal perspectives of veteran patients to verify the progressive narrative offered by medical officials. In addition, contemporary medical journals reveal increasing resentment from American citizens regarding the spiralling costs of veteran medical care with little in return in terms of cure and recovery.6 This counter-narrative also appears worthy of further research.  

Before arriving in New York, I was unsure how exactly the USA would fit into my larger project of Great War veterans during the Great Depression. However, my time at the NYAM proved incredibly rewarding by revealing how fascinating and unique an American case study is. I look forward to continuing this research into 2025. 

Notes: 

1 Nineteenth Annual Report of the Ministry of Pensions, 1935-1936, 33. 

2 For a write-up of Salmon’s observations and recommendations, see Thomas Salmon, The care and treatment of mental diseases and war neuroses (“shell shock”) in the British Army (War Work Committee of the National Committee for Mental Hygiene, 1917). 

3 E. D. Bond, Thomas W. Salmon: Psychiatrist (W. W. Norton & Co, 1950), 160. 

4 For more information on the Salmon Committee on Psychiatry and Mental Hygiene and its records that are held in the NYAM, see https://www.nyam.org/library/collections-and-resources/archives/finding-aids/ARN-0006.html/ [last accessed 18 November 2024]. 

5 E. O. Crossman and Glenn E. Myers, ‘The neuropsychiatric problem in the US Veterans’ Bureau,’ Journal of the American Medical Association, vol. 94, no. 7 (1930), 473–478. 

6 For example, see the Crossman and Myers article cited above. 

War and Veterans Health: Some History for the 70th Anniversary of D-Day

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By Paul Theerman, Associate Director, Center for the History of Medicine and Public Health

June is Men’s Health Month. As a concept, men’s health—a focus on the health and wellness issues particular to men—is still new, first arising in the men’s movements of the 1960s and 1970s. The emergence of AIDS sharpened the idea of men’s health, as gay men took the brutal first hits of the pandemic. By the 1990s, though, the idea of men’s health had become more mainstream. Congress first designated an official men’s health week in 1994, sponsored by Senator Robert Dole. By the early 2000s, the CDC began to include men’s health as a separate category in its consumer health site. In 2014, NYU’s Langone Medical Center opened the Preston Robert Tisch Center for Men’s Health, the counterpart to its Joan H. Tisch Center for Women’s Health of 2011.

The original men’s health movement, though, focused on war veterans. Each war brings up the issue—for Vietnam, for example, it emerged in such popular books as Peter Bourne’s Men, Stress, and Vietnam (1970; by the physician who became President Jimmy Carter’s drug czar). An escalating cycle of concern, growth, failure, and reform—so apparent in today’s veterans health scandal—has deep roots in American military history.

The federal government first extended general health and medical benefits to veterans in 1917 due to the large number of Great War veterans.1 In 1921, this led to a separate agency, the Veterans Bureau—which, joined with two other agencies, became the Veterans Administration in 1930. The VA ran a separate hospital system, with 74 facilities by the end of 1932.1

Photograph in: Armfield BB. Organization and Administration in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1963.

Photograph in: Armfield BB. Organization and Administration in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1963.

World War II led to a new crisis in veterans health. In 1945, the number of living veterans from all previous wars numbered some 4 million men; World War II immediately added 15 million more.2 This surge threatened to overwhelm the system, and led to major reform of veterans health care, undertaken by Major General Paul R. Hawley.

In World War II, Hawley (1891–1966) served as the theater surgeon for the European Theater of Operations. As such he was responsible for all medical care for American armed forces fighting in Europe, with 250,000 medical men under his command. Among other accomplishments, he planned the medical support for D-Day, June 6, 1944, arranging for the construction of field hospitals (with some 11,000 beds) in Normandy right after the invasion. These hospitals began as concrete slabs to hold tents, as there were almost no existing hospitals in the landing area. He called this work “one of the finest pieces of planning in the entire campaign.”3,4

Photograph in: Wiltse C. Medical supply in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1968.

Photograph in: Wiltse C. Medical supply in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1968.

Indeed, planning was Hawley’s strength. In 1945, the new head of the Veterans Administration was General Omar Bradley, who had commanded American invasion forces in Europe from D-day through to German surrender. Bradley brought in Hawley to reorganize the health services. To this task, Hawley brought a keen sense of what was possible and a reliance on improving health by raising the quality of the system’s doctors. The Veterans Administration began by engaging in hospital building—by the late 1940s, the number of VA hospitals has risen to almost 100—but as a first measure, Hawley advocated using private clinics to help veterans, and he looked to county medical societies to provide the services. His vision was to have “every physician in each community designated a veteran’s physician.”5 For, ultimately, he saw the nation’s physicians and surgeons as the backbone of the system. He had great confidence in physicians’ abilities; indeed, more than any other factor, he gave well-trained doctors the chief credit for the greatly reduced casualty rates in World War II.3

Armfield BB. Organization and Administration in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1963.

Photograph in: Armfield BB. Organization and Administration in World War II. Washington, D.C.: Office of the Surgeon General. Department of the Army; 1963.

And so, after revitalizing local clinics, Hawley’s chief reform was getting good doctors into veterans hospitals. He loosened the employment structure, removing it from civil service system, and increased the top salaries to about $125,000 in today’s dollars. For board-certified specialties, there was a 25% premium above that—all free of office and support expenses, as he pointed out. He allied VA hospitals with medical schools as much as possible, allowing VA physicians to teach, and he provided for expansive professional development programs. He went out of his way to secure the best physicians—his February 1946 JAMA article on the Veterans Administration2 is really an extended recruitment notice. By the time he left the position in 1947—he went on to head Blue Cross/Blue Shield and then the American College of Surgeons—Hawley had substantially raised the level of care in veterans’ health.

The Veterans Health Administration has gone through successive periods of reform since the late 1940s. The last major period was in the 1990s under Kenneth Kizer, and included implementing one of first effective electronic medical records systems, VistA. By the 2010s, though, the Administration was again overwhelmed, overseeing care for war veterans going back to World War II as well as from recent U.S. wars and incursions—and now serving both men and women. Many of the same issues are there as Hawley faced: the challenge of providing increasing numbers of veterans with the care they need. New, and newly recognized, medical conditions have stressed the system as well. One is PTSD, a consequence in previous wars but not well understood; another are the injuries from IEDs. Neither was a major factor when Hawley reformed the Veterans Health Administration, and now both are huge. We await the next cycle of reform.

References

1. Weber GA, Schmeckebier LF. The Veterans’ Administration: Its History, Activities and Organization. Washington, D.C.: The Brookings Institution; 1934.

2.Hawley PR. New opportunities for physicians in the Veterans Administration. J Am Med Assoc. 1946;130:403.

3.Hawley PR. Advances in war medicine and surgery as demonstrated in the European theater of operations. Med Ann Dist Columbia. 1946;15:99–109.

4. Hall DE. “We were ready”: Health services support in the Normandy campaign. US Army Med Dep Off Med Hist. 1993. Available at: http://history.amedd.army.mil/booksdocs/wwii/Overlord/Normandy/HallNormandy.html. Accessed June 5, 2014.

5. Hawley PR. Medical care for veterans. Ill Med J. 1945;88:294–96.