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Introduction

Table of Contents

Books and Documents > The Evolution of Preventive Medicine in the United States Army, 1607-1939

PART I

PRINCIPLES, OBJECTIVES, PROGRAMS

Preventive medicine programs for armies, from antiquity to the present, have been designed and operated to prevent physical and mental diseases and disabilities, and to preserve and promote health among all personnel essential to the military effort. With varying degrees of potential efficacy, conditioned by the state of knowledge and by the enterprise of leaders and their followers, these programs have provided for the application of measures of control not only in strictly military situations but also in civilian populations in the environment of war areas when conditions in such groups were threats to the health of troops or possible hindrances to the progress of campaigns. These programs have been, and must be, intelligent combinations of measures which rest upon the responsibility of the individual person and of public health activities which are the responsibility of the community. Military preventive medicine is in fact the public health of the community of the Army.

Like civilian preventive medicine, military preventive medicine is the total of all those activities projected to keep well people well, or, as is so often said in the Army situation, to keep the soldier fit to fight. To this end, in the modern view, health is regarded as a positive thing, not to be expected as a gift of nature or of God, but something that must be fought for and cherished regardless of cost in order to maintain the fighting efficiency of the Army. Furthermore, as prevention is so much less expensive than curative medicine demanded by outbreaks of


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disease, a good control program, well operated, saves large sums of money and averts enormous economic losses.

ARMY STRUCTURE AND GOVERNMENT

For insight into the characteristics and operations of military preventive medicine, attention must be paid to the influences exerted by the Army's structure and composition, and by its mission, government, and procedures, as clearly pointed out by Lt. Col. (later Maj. Gen.) George C. Dunham, MC, USA (1). Military authority greatly facilitates the practice of preventive medicine. In the disciplined force, compulsory regulations compel obedience and drive action, although regulations do not entirely take the place of explanation, persuasion, and agreement. A knowledge of the military environment in which the principles of preventive medicine are to be applied is essential to successful practice. Conditions in military situations which modify civilian preventive medicine are mainly those resulting from the following: (1) the characteristics peculiar to a military population of enlisted men (males in the 20- to 30-year age groups); (2) concentrations of men and crowding; (3) the primitive environmental conditions of the field; and (4) the restrictions imposed by the military mission, as when strategic and tactical considerations override sanitary doctrine and requirements.

Important as are these and other Army affairs, it has never been sufficient for a military preventive medicine organization to be merely Army centered. It is necessary for the vitality and progress of the preventive medicine organization that the closest possible association and cooperation be maintained with every significant institution or body-laboratories, medical schools, universities, and public health departments, at home and some abroad-concerned with biology and medicine, chemistry, physics, and, in general, with both the natural sciences and the social sciences. Such institutions can contribute to the Army highly important informed advice, expert personnel, and a long range of facilities.


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MEDICAL DEPARTMENT JURISDICTIONS

As the Medical Department of the United States Army has never had executive powers outside of its own units, its preventive medicine officers and representatives have served as advisers to line officers-the military commanders upon whom has rested the final responsibility for the health of their commands. This has been so from General Washington to General Marshall, from Dr. Shippen to Dr. Kirk, and from Dr. Benjamin Rush to Dr. James S. Simmons. In certain instances, however, limited and special command functions among troops in the line have been delegated to preventive medicine to be performed by a variety of specialists. It is to be noted, additionally, that, through the performance of its inspectorial, advisory, and recommendatory duties, military preventive medicine is concerned with the administration of the whole Army. Consequently, its scope exceeds that of all other parts of the Office of The Surgeon General. When its recommendations are approved by the War Department (more lately the Department of the Army), they have the force of highest Army authority. For example, all sanitary regulations and regulations for the preservation of the health of troops Armywide, are, according to a practice as old as the Army itself, issued by order of the Secretary of War (nowadays by order of the Secretary of the Army) over the signature of the Chief of Staff, or The Adjutant General, or other appropriate officer. Thereby, these regulations are directly binding upon Army personnel. An appreciation of these functions, relationships, and procedures is necessary for a true understanding of the place and powers of preventive medicine in the United States Army.

STATE OF THE ART

Equally essential to the soundness of a program is the state of biological, medical, and scientific knowledge, the so-called "state of the art." From the vantage ground of

 


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today's sophistication, it is seen that most of the wars in man's history, prior to about 1900, were fought without benefit of scientific preventive medicine. Although this is true, it connotes a belittlement of the intellectual content of the past. Accounts of sound ideas and salutary empirical practices are to be found in the history of military and civilian preventive medicine from antiquity onward. Before the "bacteriological era," however, beginning in the last quarter of the 19th century, the key to the puzzle was missing. There was no experimentally verified knowledge about micro-organisms as causes of communicable diseases, or about vectors, intermediate hosts, and carriers of infectious agents. Without this knowledge, definitive protective measures could not be devised.

Nevertheless, there prevailed among people, their physicians, and military commanders, many sensible and practical ideas, which, if they had been applied rigorously, would have prevented much sickness and many deaths, even in the colonial era and in the years before Pasteur and Koch. By various routes, elements of this folklore became incorporated in the doctrines and practices of preventive medicine in the United States Army. The number and importance of these elements, constituting most of the basic principles, are impressive. They might be reviewed at length; but since Garrison (2) and others have written much about them, there is no need to recapitulate the precolonial details, except for a special note to be made later (p. 33) on the Mosaic sanitary code, which influenced British and American military surgeons and line officers including George Washington.

PERIOD COVERED

As pointed out in the preface, medical and military events of the 17th and 18th centuries in England, in the American Colonies, in the American Revolutionary War, and in the first years of the Republic, furnished many of the ingredients of the program of military preventive medicine with which this volume is concerned. This period of

 


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192 years began with the founding of the English colony at Jamestown, Virginia, on 14 May 1607 and ended in 1799 (3).

The narrative of the whole span of 332 years, from Jamestown in May 1607 to the outbreak of World War II in Poland on 1 September 1939, may be divided into sections, parts, or chapters in various ways, depending on the intentions of the writer. There is no fixed paradigm for chronological division. In any case, the divisions are bound to be arbitrary. A division into parts based chiefly on the occurrence of wars within the period seemed a natural arrangement to the author who, like many others, is impressed by the evidence that, as one reviewer expressed it, "wars have regularly sparked an upsurge in preventive medicine knowledge and practice." Such a division conforms also with related civil events, such as the sanitary movements and reforms of the mid-19th century which were quickened by the Crimean War and the American Civil War. Therefore, this volume has been divided into parts composed of combined accounts of significant events in military preventive medicine and civil public health, with an attempt to correlate research and the advancement of knowledge with Army medical and sanitary affairs, and to furnish examples of the utilization of medical and scientific knowledge.