Evolution of disability in late 19th century America: Civil War pensions for Union Army veterans with musculoskeletal conditions.

This article examines the evolution of musculoskeletal (MSK) disability and its impact on mortality and work patterns in the late 19th century in America, in the context of the Civil War disability policy scheme. The study was conducted on 17,702 Union Army (UA) Civil War veterans. Of these, 10,789 were examined and diagnosed with major MSK conditions, rheumatism, sciatica, and spinal curvature, between 1862 and 1907. Analyses examine MSK (i) prevalence rates by birth cohort and age group; (ii) fatality rates as compared with other disabilities; (iii) risk rates by occupation type; and (iv) lifespan for MSK patients. MSK conditions are commonly claimed disabilities within the Civil War data set, with prevalence rates increasing with age. Regression studies show that working in clerical and professional (relative to manual labor) occupations decreases the likelihood of being examined for and diagnosed with MSK conditions. MSK patients examined at older ages tended to have longer lifespan than those examined at younger ages. The findings suggest that changes in age, environmental, and occupational conditions during the late 19th century affected MSK condition prevalence and the average lifespan of MSK patients. Implications for contemporary disability policy are discussed.