The Top 5 Reasons Americans Were Unfit for Military Service During World War I

A World War I-era draft lottery. (National Archives)

The Pentagon has been sounding the alarm for years: More and more American males are unfit for military service. The calls for action haven't gone unheard, but the branches of the military are still struggling to meet recruiting goals.

Read: Even More Young Americans Are Unfit to Serve, a New Study Finds. Here's Why.

In 2022, the top reason was obesity: 11% of American youth are just overweight. Drug and alcohol abuse and mental and physical health were the next largest factors, and 44% of young Americans have some combination of these. More than 100 years ago, the reasons were entirely different.

When the U.S. entered World War I in 1917, 70% of the U.S. armed forces were conscripts, and American males between the age of 18 and 45 were subject to local draft boards to weed out the exemptions, one of which was based on medical issues. Every recruit was subject to a medical exam.

The surgeon general of the United States compiled the results of the physical exams Army doctors made of these draftees. The compilation was published in 1919 as "Defects Found In Drafted Men," and is a snapshot of the physical ailments common in Americans at the time.

While not all of the "defects" kept men from serving (4.8 million total Americans served in the military throughout the war), many of them were nonstarters. For every 1,000 of those drafted for military service in the U.S., 557 of them were found to have restrictive conditions that exempted them from military service.

Here are a few of the most common things that would have kept an American out of the trenches.

1. Mechanical Problems Involving Bones and Joints

The largest issue that kept American conscripts from entering military service were "mechanical problems, involving bones and joints and appendages of the hands and feet." Of all the men who registered for the draft, were called to service and were disqualified by medical review boards, 39% were rejected because of this. Of particular note were "weak feet."

There were a lot of causes of these conditions. Previous injuries can cause mechanical issues, as can everyday wear and tear, so this result isn't a surprise. In 1916, 30% of Americans worked in agriculture, many on their own farms, the highest farm population in American history. Diseases such as osteoarthritis can also cause mechanical problems in bones and joints.

2. Defects of the Sense Organs

The second-largest medical issue that kept draftees from fighting was "defects of the sense organs," of which 12% of those rejected suffered. These issues aren't limited to being blind or deaf. The eye is susceptible to a surprising number of diseases, and glaucoma is just the beginning.

Ruptured eardrums, differences in pressure between ear spaces and chronic sinusitis were all reasons to exempt someone from service. Impaired sensation of the voice organs, neuromuscular diseases, and loss of equilibrium and balance were also problems.

3. Tuberculosis

In an age before antibiotics (which were introduced in 1943), a bacterial infection of the lungs could mean a slow and painful death. By the time someone starts to show symptoms of TB, the infection has already overcome the immune system. Spread by coughing, spitting and sneezing, a TB outbreak in the trenches would have been devastating, and 11% of WWI draftees had it.

In case you ever wondered why spitting on sidewalks was illegal.

Tuberculosis doesn't only affect lungs. The microbe that causes TB, ​​mycobacterium tuberculosis, can attack any part of the body; the lungs are just the most common. A vaccine for the disease wasn't used on humans until 1921.

4. Venereal Disease

Venereal disease, or VD, is an antiquated term for sexually transmitted infections, most commonly syphilis and gonorrhea. These two diseases were particularly trouble for troops on the battlefield, and Gen. John J. Pershing, commander of the American Expeditionary Force, knew it.

VD had an overwhelming effect on his campaigns in the Philippines and Mexico before World War I. It was particularly hard to manage because troops contracted it while on leave, and away from the oversight of officers. Even before they got to the trenches, 11% of draftees were rejected for these diseases.

Boy, was it ever.

5. Cardiovascular Conditions

Ten percent of draftees were rejected due to heart conditions, issues with blood vessels or problems with their blood. Any number of conditions could have amounted to a cardiovascular problem.

Other reasons for rejection by draftee medical boards included "defects of developmental processes," "nervous and mental troubles," "diseases of the skin and teeth" and "defects of the respiratory organs [other than tuberculosis]."

-- Blake Stilwell can be reached at He can also be found on Twitter @blakestilwell or on LinkedIn.

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