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Medicine, Military

MEDICINE, MILITARY

MEDICINE, MILITARY, as a specialty, has focused on the surgical management of mass casualties; on the prevention and treatment of infectious diseases, especially tropical diseases; and, in the twentieth century, on the effects of operating military machines such as submarines and airplanes. As part of a military hierarchy, the organization of structured medical command and administrative systems has been important for interaction with the line and for function in combat.

Army Medicine

Medical support for an American army began on 27 July 1775 when the Continental Congress established a medical service for the army of Gen. George Washington during the siege of Boston. The organization followed the model of the British army. Military physicians wrote several texts on surgery, on preventive medicine, and on pharmacy during the Revolutionary War, the first American publications of their kind.

On 14 April 1818, Congress reorganized the staff departments of the army and established the present medical department. Medical officers gained military rank in 1847. A hospital corps, providing formal instruction for enlisted men as physicians' assistants, was formed in 1887; the present civilian programs for paramedical physician extenders have their philosophical base in this system. The army established the Nurse Corps in 1901, the Dental Corps in 1911, the Veterinary Corps in 1916, and the Sanitary Corps in 1917; the latter became the Medical Service Corps in 1947 when the Women's (since 1966, Army) Medical Specialist Corps enrolled dietitians and physical and occupational therapists. Corps functions had existed previously in the medical department, but organization into a corps not only formalized the position of the specialty in the military bureaucracy but also regularized the status of the individuals and provided for commissions, tenure, and pensions. Thus, because she was chief of her corps, it was possible for Col. Anna Mae Violet McCabe Hays of the Army Nurse Corps to become the first female general officer in American history in 1970. One consequence of formal organization, with command overview of health-care delivery, including the supporting infrastructure, was the development of a centrally managed health-care program outside the civilian fee-for-service system, which the Veterans Administration Hospital program later adapted to its needs.

The major military contributions of the surgical disciplines have been in mass casualty management, the evacuation of wounded, and in the treatment of battle wounds. Although the removal of the sick and wounded from the battlefield has always been a part of military operations, the development of an organized system did not come until 1862. Jonathan Letterman, the medical director of the Army of the Potomac, established the system that is now the practice of all armies: staged and echeloned medical care and forward treatment followed by evacuation of patients by medical elements in the rear. The next major advance was the use of airplanes for evacuating hospitalized patients in World War II, and of helicopters as forward tactical air ambulances in the Korean War. Later, having proved its worth in Vietnam, the helicopter was adopted by the civilian community for evacuating those injured in highway accidents. Army studies of wound ballistics, beginning in 1892, established the scientific rationale for wide debridement of wounds, and led to reduction in gas gangrene and wound infection, as well as to the development of individual body armor. Charles Drew, Douglas B. Kendrick, and others, developed systems for mass blood collection, distribution, and transfusion during World War II and introduced the civilian medical community to the concepts of massive blood transfusions for shock and trauma. An army burn research and treatment center, founded in 1947, was the first in the United States, and the use of Sulfamylon to prevent skin infection contributed greatly to the burn research program.

Communicable and infectious diseases have always been the major causes of morbidity among troops, and military medicine has made its greatest contributions in this area. In World War I, the application of infectious disease research to military sanitation produced a milestone in the history of war: lower mortality from disease than from battle wounds.

From 1818 to 1860, the army's medical department mostly concerned itself with patient care at the small army posts scattered over the southern and western frontiers. The department reported morbidity and mortality data in a uniform format, and published the collected reports, which included some civilian data, beginning in 1840; these national public-health statistics, the first of their kind, prompted the beginning of a national approach to public-health epidemiology. Because prevailing opinion believed disease etiology and occurrence were related to climate, post surgeons also included meteorological data with their reports. (The weather observations, separately published, were the only nationwide data of their kind, and the National Weather Service remained a medical department function until 1870.)

When bacteriology became a science in the 1860s, military physicians were among the first to explore this new field. Joseph J. Woodward and Edward Curtis in 1864 introduced aniline dyes in the United States for staining in microscopy, and pioneered photomicroscopy of tissues and bacteria. George M. Sternberg of the U.S. Army published the first American bacteriology textbook in 1892; later, as surgeon general, he established and directed the two "Walter Reed boards" for the study of typhoid and yellow fever, in 1898 and 1900, respectively.

The history of Walter Reed's work on the transmission of yellow fever in 1900 is well known: he and his colleagues, using volunteer test subjects, took only a few months to disprove fomite infection, document mosquito transmission, and define the organism as nonbacterial. Less well known is the story of the "Typhoid Board" of 1898, which studied recruit camp epidemics, documented that contact mattered more than water in transmission, and suggested that a carrier state existed.

When Sternberg founded the Army Medical School in 1893—the first school of public health and preventive medicine in the United States—he began the trend of formal postgraduate education in the basic sciences for army medical officers. Renamed the Walter Reed Army Institute of Research, the organization became the largest tropical medicine research organization in the United States.

Tropical parasitic diseases occupied the attention of military physicians. Bailey K. Ashford, working in Puerto Rico after the Spanish-American War, isolated the American hookworm, Necator americanus, as the cause of anemia in Puerto Rican farm laborers. His program for detection, therapy, and prevention later became the model by which the Rockefeller Foundation attacked hookworm in the American South. Charles F. Craig wrote an early text on medical parasitology in 1911, developed serological tests for amebiasis, and described new intestinal parasites. Work at the Army Medical Research Board in the Philippines from 1900 to 1934 proved that dengue was a virus and that mosquitoes were the vector. The research also documented the usefulness of emetine in treating amebiasis; showed that Aedes mosquitoes were major vectors for equine encephalitis; and made critical contributions in new rabies and rinderpest vaccines, in the treatment of beriberi, and in zoonotic diseases.

Frederick F. Russell developed an American typhoid vaccine in 1909 at the Army Medical School. In 1911 the army immunized all its soldiers—the first time for an entire army—causing typhoid to disappear as a major cause of morbidity and mortality. Carl Rogers Darnall's introduction of anhydrous chlorine to purify drinking water in 1910 became the basis for present systems of municipal water purification. William C. Gorgas used the new findings on mosquito transmission to control yellow fever and malaria, permitting the building of the Panama Canal. In 1933, the Army Medical Research Board in Panama conducted the first American studies on the efficacy of atabrine as a prophylactic drug against malaria; it became the standard drug of World War II until the chloroquine-primaquine combination tablet replaced it following definitive studies in Korea in 1960. In 1963, the army's medical department began to support the only large international research program for the development of new antimalarial drugs.


During World War II, the United States of America Typhus Commission, a joint military-civilian organization, did broad-scale work on the typhus fevers and was responsible for applying DDT to delouse populations and for field trials of vaccines. Similarly, military-civilian investigators of the Army Epidemiological Board investigated viral hepatitis, separated infectious and serum hepatitis as entities, and demonstrated the usefulness of gamma globulin for passive protection. After World War II, the concept of joint military-civilian teams persisted and led to such contributions as the use of chloramphenicol to treat typhoid fever and scrub typhus and the use of broad-spectrum antibiotics in the treatment of plague.

During and after the Korean War, members of the medical department studied communicable and infectious diseases, leading to the description of the ecology of the transmission cycle of Japanese B. encephalitis in 1955; the isolation of the Asian influenza virus in 1957; the isolation of the German measles virus in 1962, for later development of a vaccine by the National Institutes of Health; and the development of effective vaccines against adenovirus infection in recruit camps in 1967. Researchers also developed vaccines against meningococcal meningitis, while Central American countries used a vaccine against Venezuelan equine encephalitis during epizootics in 1969 and 1970.

Other discoveries and contributions made by medical department members have been important to general medicine. In 1833, William Beaumont published his classic work on the physiology of digestion from his ten-year study of the gastric fistula of Alexis Saint Martin. In that decade, the surgeon general established a collection of medical books, which grew over time—and especially after the Civil War—to become the Army Medical Library; in 1956 it became the National Library of Medicine under the aegis of the Department of Health, Education, and Welfare.

The career of John Shaw Billings typifies military involvement in the mainstream of American medicine. In 1870 Billings's investigation and recommendations changed the Marine Hospital System to its present U.S. Public Health Service structure. He designed Johns Hopkins Hospital and was responsible for the selection of William H. Welch and William Osler as faculty for its medical school. As librarian of the Army Medical Library, he developed the Index-Catalogue and, with Dr. Robert Fletcher, developed and published the Index-Medicus. He recommended the use of electrically sorted punch cards for medical record-keeping, and oversaw Herman Hollerith's testing of such a system at the surgeon general's office. In retirement, Billings organized and built the New York Public Library and became its first director.

The Civil War period saw the founding of the Army Medical Museum, renamed the Armed Forces Institute of Pathology in 1949, from which, in the next thirty years, came the Medical and Surgical History of the War of the Rebellion, the first detailed account of the medical and surgical findings of the impact of war on an army. This era also saw the beginning of formal research in pathology in the United States.

Navy Medicine

Congressional appropriations on 2 November 1775 provided for surgeons on naval ships, but the navy did not establish its Bureau of Medicine and Surgery until 1842 and did not authorize flag rank for the surgeon general until 1898. The navy established its Nurse Corps in 1903 and its Dental Corps in 1912.

Edward R. Squibb, who later founded the pharmaceutical firm of the same name, founded a naval laboratory for the production of pure drugs in 1853. The Naval Medical School was established in 1902. The navy introduced annual physical examinations for officers in 1903, laying the foundation for programs of multiphasic health screening.

Edward R. Stitt, later surgeon general, wrote the first modern American text on tropical medicine in 1914. In 1958, navy physicians developed methods for fluid replacement in the treatment of cholera, which became standard procedures, especially during epidemics. Toxicological research on trace-element effects in the closed environment of submarines produced some of the earliest data now useful for civilian pollution studies.

Aviation Medicine

Aviation medicine began in Europe as a medical problem of the army, and in 1917, with the entry of the United States into World War I, the army established a research laboratory and the School for Flight Surgeons. Louis H. Bauer, the first commandant of the school, wrote the first American textbook of aviation medicine in 1926 and became the first director of civil aviation medicine for the Department of Commerce. In 1936, Harry E. Armstrong, later surgeon general of the U.S. Air Force, built the first centrifuge to study the effects of acceleration on humans.

The Air Force established a separate medical department in 1949. In 1950, the School of Aerospace Medicine began biological research on the effects of space flight, and air force officers conducted the great majority of the medical work in the National Aeronautics and Space Administration. John Paul Stapp's studies in 1954 on abrupt deceleration founded the present field in crash injury. Air force studies of anthropometry, human factors, designs of instruments, displays, and basic work in vibration effects and noise-level tolerance have had widespread application to design.

BIBLIOGRAPHY

Ashburn, Percy M. A History of the Medical Department of the United States Army. Boston: Houghton Mifflin, 1929.

Bayne-Jones, Stanhope. The Evolution of Preventive Medicine in the United States Army, 1607–1939. Washington, D.C.: Office of the Surgeon General, 1968.

Hume, Edgar Erskine. Victories of Army Medicine: Scientific Accomplishments of the Medical Department of the United States Army. Philadelphia: Lippincott, 1943.

Peyton, Green. Fifty Years of Aerospace Medicine: Its Evolution since the Founding of the United States Air Force School of Aerospace Medicine in January 1918. Brooks Air Force Base: U.S. Air Force School of Aerospace Medicine, 1968.

Roddis, Louis. A Short History of Nautical Medicine. New York and London: P. B. Hoeber, 1941.

Tobey, James A. The Medical Department of the Army: Its History, Activities and Organization. Baltimore: Johns Hopkins Press, 1927; New York: AMS Press, 1974.

Robert J. T.Joy/c. w.

See alsoEpidemics and Public Health ; Hospitals ; Medical Profession ; Medical Research ; Medicine and Surgery ; Pharmacy ; Sanitation, Environmental ; Weather Service, National .

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Military Medicine

MILITARY MEDICINE

MILITARY MEDICINE. SeeMedicine, Military .

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