Margarida Portela - Military Historian
Portugal and the treatment of disabled World War I soldiers – An international matter.
Margarida Portela (HTC - NOVA/FCSH, CH - FLUL & CINAV - EN)
As a byproduct of human greed, modern warfare not only kills as well as destroys the bodies of soldiers, sometimes in unnamable ways. World War I was no exception. As “the war to end all wars”, it opened the door to many modern military innovations. Walking along side with the destruction, medical-scientific developments enabled doctors and surgeons to save the lives of many combatants. Some of these would return to civilian life, apparently healed - though traumatized. Others would bear within themselves the marks of conflict, patent on their faces and bodies, mutilated and maimed.
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Portugal, a small Allied country, which only officially entered the conflict in March 1916, will also have its war mutilated. In lesser numbers, but even so embodying the memory of such a horrific conflict that Portuguese society was eager to forget. Doctors, surgeons, physiotherapists and educators will fight to restore their dignity in a learning process that, like war, will become international. Several interallied conferences dedicated to mutilated soldiers were held. Portugal was also present at these meetings, seeking the scientific knowledge necessary for an adequate reception of such soldiers in several national institutions. And even if their plans were not successful, and the cause of mutilated not consensual in Portugal, learning persisted, therefore influencing post-World War I medical experiences.
The birth of a cause
In 1916, once prepared the shipment of Portuguese troops to the Western Front, António Aurélio da Costa Ferreira (1879 - 1922), director of the newly created Medical and Pedagogical Institute [Instituto Médico – Pegagógico], reminds the Ministry of War that soon, Portugal would receive an increased number of injured and mutilated men, and that it would be necessary to provide for their physical and mental recovery. Offering his personal services to the Portuguese Government, in 1917 Costa Ferreira participates in several interallied meetings, in the company of other fellow doctors and physiotherapists, such as Alfredo Tovar de Lemos (1885 - [1961?]), José Pontes (1879-1961) and Francisco Formigal Luz. Elected Vice-Chairman of the "Comité permanent interallié pour l'étude des questions concernant les invalides de guerre", this Portuguese doctor and educator will become the first mentor of the cause of war invalids in Portugal – a cause that, due to a permanent lack of consensus, was object of political problems and divisions that became particularly visible by late 1917.
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Seeking to minimize the suffering of those returning from the operating theaters, Costa Ferreira created in Lisbon, in mid-1917, a Section of Mutilated War Sordiers [Secção de Mutilados de Guerra] within the Pedagogical Medical Institute – better known as the Santa Isabel´s Institute [Instituto de Santa Isabel]. Most of the internees originated from France and were received by the physician, who provided for their physical and emotional recovery. The first Portuguese mutilates arrived in November 1917. The process of their admission into Santa Isabel was very difficult, with some of them having to be ripped from the barracks and the streets, where they survived by begging. Civil society was not prepared for the reception of these war invalids. But Costa Ferreira believed in the emotional and physical treatment of these men, as well as in their full recovery. Admission into the institute would be just the first step in changing their lives and turning invalids into worthy men who could provide for their means of support.
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From Santa Isabel to Arroios
Most of these Portuguese combatants had minor mutilations, having suffered amputations of the fingers or toes. There were about 500 Portuguese soldiers interned in this physical and professional re-education system, created by the War Ministry and operating consistently between 1917 and 1921. Only 80 or 90 would be “grand blessé”[1]. But all of them suffered the trauma of war, fearing their return to civilian life. To welcome them, and following the ideas conveyed in the interallied meetings, Portuguese doctors built a three-way system that, starting at Santa Isabel´s Institute, would go through the Polyclinic of the Portuguese Women's Crusade [Policlínico da Cruzada das Mulheres Portuguesas], ending at the Arroios Institute for the Reeducation of Disabled War Soldiers [Instituto de Arroios para a Reeducação dos Mutilados de Guerra].
A mutilated man relearns how to use a hoe. 1918
(Private Colection)
Santa Isabel was not a military institution. Authorized by the Minister of War, it was a mandatory place of passage for these soldiers, with the objective of obtaining an overall picture and understanding of these men’s real situation. Santa Isabel was therefore the first step towards the recovery of these patients, providing them with the necessary tools that would, in most cases, allow them to quickly return home, work and make a living. In the institute, those who suffered from minor amputations were reeducated in new ways of working in the field – with agricultural work being the predominant professional activity for these former combatants. They also sought to emotionally balance the most traumatized soldiers, since many of the mutilated were equally victims of war neuroses[2]. The psychological treatment was carried out by Costa Ferreira himself who, by talking extensively with his patients, applied a sort of "moral dressing" [penso moral][3] to them.
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For many of these patients the stay was short, spent in the physiotherapy rooms or gardens, where they trained with adapted tools designed to assist them in agricultural work. Others needed reconstructive surgery – essential for many limb amputees. In these situations, they were sent to a hospital, with the surgeries initially scheduled for the Polyclinic of the Portuguese Women's Crusade. Santa Isabel was therefore a transitional institution, that recovered patients with minor injuries, paving the way for the severely maimed, in need of greater care and physical therapy treatment.
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Once inside this three-way system, the ideal life course for a mutilated soldier would be to enter Santa Isabel and be subjected to medical screening. Then – and only if strictly required – the soldier would be transported to a hospital where he would be evaluated and subjected to one or more surgeries. If this process was not found necessary – or in case of previous recovery and discharge from the hospital – the patient would then be admitted to Arroios Institute for the Reeducation of Disabled War Soldiers, where he was subjected to educational and labor re-education and to more specific physiotherapy treatments. The Arroios Institute had been designed by the Portuguese Women's Crusade to be a modern institution, well supplied with medical material and served by the best therapists and teachers. However, in late December, when everything was about to start working, Sidónio Pais took Lisbon by storm, in a Coup that overthrew the old Portuguese Republic. This change of political regime had serious consequences on the system designed to treat the Portuguese mutilated. The Polyclinic of the Portuguese Women’s Crusade was transformed into a military hospital and the Arroios Institute, took months to open its doors.
​diers”.
Some soldiers and nurses at Arroios.
Ilustração Portugueza, série II, nº. 646, Lisboa, 8 de Julho de 1918, p. 28.
What happened is still unclear, but the Arroios Institute, entirely funded by the Portuguese Women's Crusade, was taken from it by the Government of Sidónio Pais and set as an example of the overspending habits of the former political regime. During 1917, the institute had received large sums from the Ministry of War and was object of a very significant investment in medical and nursing personnel – as well as in physical therapy equipment. Directed by Alfredo Tovar de Lemos, the Arroios Institute will thus be removed from its founders' tutelage, opening several months later, in May 1918, after extensive financial audit.
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The outcome of this change was catastrophic. Santa Isabel became the only place of internment for those mutilated men and remained so until mid-1918. With the Polyclinic of the Portuguese Women's Crusade out of the circuit, soldiers waited months for their surgeries, performed in overcrowded military hospitals. In the meantime, the – already late –opening of the Arroios Institute was expected. It was necessary to continue with the teaching and rehabilitation of the mutilated, guaranteeing them access to possible new professions and better physical therapy treatments. The slow opening of Arroios congested a system that, had it not been altered, would no doubt have worked much better.
Aftermath
Without the Polyclinic of the Portuguese Women's Crusade, and especially with the forced absence of the Arroios Institute, Costa Ferreira was unable to grant treatment to the most serious cases in his small Section of Mutilated War Soldiers. When the Arroios Institute opens, Tovar de Lemos will finally work with war invalids, giving them the opportunity to improve their fitness and to learn new skills, a better chance at social reintegration. However, outside the Institute doors, this permanent struggle to improve the living conditions of the mutilated was never capable of providing adequate disability pensions, and even political debate about what to do with these fighters will be of little relevance – something which distances Portugal from countries like France or England.
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Still, the work of doctors and physiotherapists allowed many of these former soldiers to obtain prosthetics and work-tools, and access to basic education, taught at Arroios. Some of them managed to get jobs within the civil service. However, the vast majority were unhappy with the treatment they received, considering that the Government and civil society had not paid the deserved attention to the mutilated and their cause.
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For men like Aurelio da Costa Ferreira, Jose Pontes or Alfredo Tovar de Lemos – victimized by intense exchanges of insults and accusations, which filled the front pages of newspapers – the years 1918 and 1919 were very difficult. In January 1919, the first Portuguese prisoners of war arrived in Portugal, badly in need of extra care, having suffered from lack of adequate treatment in the German camps for prisoners of war. Like so many others, they went through Santa Isabel, and Costa Ferreira’s «moral dressing», until the institution closing on July 31, 1919.
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On April 9, 1920, the Arroios Institute for the Reeducation of Disabled War Soldiers would return to the Portuguese Women's Crusade, but the harm was already done. The New Republic of Sidónio Pais, accused by doctors and institutions of not safeguarding its war invalids, produced little legislation and the protection it provided them was scarce. This tendency towards forgetfulness remained strong, even after the murder of Sidónio Pais. And so did the mutilated distrust about doctors and latest treatments.
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In Portugal, and despite the desire of these combatants – which included not only amputees, but also gassed, blind, and victims of war neurosis – no mutilated associations were created, with almost no attempts at social mobilization. The Arroios Institute's motto, “Pela Pátria. Pelos Mutilados”[4], was not enough to mobilize Portuguese society. In November 1920, tired of accusations and rumors, Alfredo Tovar de Lemos leaves the Arroios Institute. By this time, the patients who were residing there, were few – and the space had long been divided with war orphans. The institution was dying as much as these men´s cause, now transformed and absorbed by other causes, namely that of the work-related injured. But medical-scientific learning remained with, for instance, Francisco Formigal Luz, with significant impact in the future of Portuguese Physiotherapy.
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As for the mutilated, their future was as uncertain in 1921 as it was in 1917. And so it remained for these forgotten World War I Portuguese combatants.
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[1] French name covering combatants suffering from a higher degree of impairment, the vast majority of them being upper and/or lower limb amputees. Portugal also had an uncertain – but small - number of militaries with mutilated faces, which in France were known as "gueule cassée".
[2] Known today as PTSD (Post Traumatic Stress Disorder).
[3] Penso Moral or «Moral Dressing», would be in line with the ideas of “speech healing” present in Sigmund Freud's Psychoanalysis.
[4] “For the Motherland. For our maimed sol