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Chapter 1

Table of Contents

CHAPTER I

THE ARMY MEDICAL DEPARTMENT BEFORE WORLD WAR I

The development of the medical statistics program in the Army can be ascribed in part to the surgeons general appointed to administer the Army Medical Department. In the course of the development of the Department, surgeons general were cognizant of the place that medical records and statistics hold in an efficiently operating organization. It is appropriate, therefore, before discussing the medical statistics program, to review briefly the development of the Medical Department, stressing particularly the administrations of those surgeons general where major advances in this program took effect. Since it is felt that the Reorganization Act of 1908 resulted in a medical department on the threshold of maturity, as it were, this review is limited to the development of the Department before 1910.

The earliest medical department to be formed after the Colonies became the United States resulted from the act of 5 March 1792, when the existing military forces were organized and a medical service authorized. The Army was formed into a "Legion" under the command of a major general, with a "Surgeon to the Legion." The Legion was divided into four sub­legions, each with a strength of 1,280 men to be commanded by a brigadier general. Each sublegion was allotted a surgeon and three surgeon's mates, one to each battalion. Inasmuch as the authorized medical officers were scattered with the Army over the country in isolated posts, without good means of communication,


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and especially without an executive head in Washington, they were essentially without coordination and were not a medical department in the accepted sense of the term.

In 1798, when war with France threatened, the President was authorized to raise a provisional army of 10,000 men, with the necessary generals and staff officers, among them a physician general with the pay and emoluments of a lieutenant colonel, but without the rank. At the request of General Washington, the physician general named under the act was Dr. James Craik, a physician with an honorable record both in the Indian wars and the Revolutionary War. Regimental and medical officers were appointed; but there were no provisions for a medical department organization with hospitals, medical supplies, and so forth. In December 1798, Secretary of War James McHenry, who was himself a physician, called the attention of Congress to this defect. As a result, Congress passed an act on 2 March 1799 to regulate the medical establishment. Before the troops that were called out were organized, however, it became evident that there would be no war. Consequently, on 14 May 1800, Congress directed that a large proportion of the troops be discharged and, with them, the physician general and all medical officers, with the exception of 6 surgeons and 12 surgeon's mates. By December 1801, the number of mates was further reduced to seven by the failure to fill vacancies.

Early in 1812, it became evident that war with Great Britain was imminent. Since the Army had virtually ceased to exist during the years of peace, the management of military hospitals, the police and hygiene of the camp, the management of diseases peculiar to troops, the medical service in the combat area, and so forth, were topics of which younger men in the profession without war experience were entirely ignorant. No plans or provisions for defense were made by the Army, and the few medical officers serving at isolated stations were not able to provide an adequate medical service. In addition, the surgeons of the Revolutionary Army left no record of their experience, as unsatisfactory as that may have been.

In the act of 11 January 1812, authorizing an increase of the Army, Congress provided for the appointment of one surgeon and two mates for each regiment raised under the act and, in addition, as many hospital surgeons and mates as the service might require, with one steward to each hospital. The two


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groups of surgeons, hospital and regimental, who were constantly vying with each other for authority were maintained as previously. The organization of the Medical Department, unfortunately, had advanced very little since the Revolutionary period.

Every effort was made to appoint the most capable physicians as administrators of large camp areas in order to maintain the health of the Army. For example, Dr. James Mann, an able physician who had served in the Revolutionary War, joined the Army on 19 April 1812, as a hospital surgeon. By virtue of his previous military experience, he was appointed medical director of the Northern Army. In addition to performing those duties, he remained until March 1813 in charge of a general hospital established at Greenbush, across the Hudson River from Albany.

Owing to the inexperience of the officers of the Army and to the general lack of discipline, the sanitary conditions in the camps of the Northern Army were extremely bad. Respiratory diseases, including highly fatal pneumonias, were prevalent in the camps, as were diarrhea and dysentery. Dr. Mann made frequent reports of these conditions and included suitable recommendations. Considerable improvement resulted in some camps, but in others the commanding officers persisted in their disregard of sanitation to the end of the war. In one case, Dr. Mann related, a frontier regiment with a complement of 900 men was reduced in the course of 2 months by filth diseases to less than 200 men fit for duty. On the other hand, the hospitals serving these troops had sufficient medical officers and necessities for the comfort of the sick. This had not been the case during the Revolutionary War.

However, although able men were appointed to take charge of large sectors of the Army and hospitals, Congress had not appointed an executive head nor created a central medical bureau. This was the chief obstacle to proper administration. Another administrative difficulty was that the hospital officers had no rank, even of relative character, to enable them to perform their duties. The first obstacle was temporarily remedied by the act of 3 March 1813, which provided for a physician and surgeon general with an annual salary of $2,500. Dr. James Tilton was chosen. He had distinguished himself during the Revolutionary War, when he had been a leading exponent of


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the small hospital to prevent cross-infections. Although he hesitated to accept the position because of his age, he finally consented.

This act, approved on 1 May 1813, gave to the physician and surgeon general the power to appoint stewards and nurses; it defined, for the first time, the uniform and dress of the Army, including the Medical Corps; and, most important, resulted in rules and regulations for the Army to be issued by the President. Among the duties and functions ascribed to the physician and surgeon general was the directive that he prescribe rules for the government of Army hospitals and see that they were enforced.

General Tilton proceeded immediately to fulfill his responsibilities. During the previous winter, the troops under Gen. Henry Dearborn at Sackett's Harbor, N. Y., had experienced an epidemic of respiratory diseases accompanied by a very high fatality rate. Upon personal inspection, General Tilton found the hospital in a filthy and neglected condition. He immediately convened a medical board to prepare additional regulations for the management of hospitals and to examine all incompetent officers. The importance of both personal cleanliness and cleanliness in the wards and buildings was stressed. As a result, the regimental and general hospitals seemed to function much more efficiently thereafter. The effects of crowding on the spread of disease, however, were soon manifested by an increased number of deaths and by the slow convalescence of the patients, especially in the hospital at Burlington.

In fact, throughout the war there was a large amount of sickness and many deaths from causes that would now be considered easily preventable. In August 1813, for example, more than one-third of the soldiers were on sick report. Notwithstanding the deficiency of medical knowledge then as compared with today, the fact of greatest importance was inadequate discipline for the enforcement of established sanitary and health protective measures. The Nation was unprepared for war generally; medically, there was no organization at the beginning and little later.

The Army was again reduced by the act of 3 March 1815 to 10,000 men, and, with this reduction, a large proportion of the medical officers were discharged. By a General Order issued 15 March 1815, defining the peacetime military establishment,


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the President directed that, pending further legislation by Congress, 1 apothecary general, 2 assistant apothecaries general, 5 hospital surgeons, 15 hospital surgeon's mates, 2 garrison surgeons, and 10 garrison surgeon's mates be retained in the Medical Department.

On 27 December 1815, Secretary of War William Harris Crawford, realizing that the medical care of the Army was inadequate, made certain recommendations to Congress. These included the permanent retention of the apothecary general and of four assistant apothecaries and an increase in the number of hospital surgeons and mates, together with the appointment of a sufficient number of post surgeons to meet the requirements of the Army. These recommendations were embodied in a bill approved 24 April 1816. Patchwork legislation, however, enacted from year to year, did not provide an efficient Medical Department, and it was clear that complete reorganization was required.

This reorganization was begun with the act of 14 April 1818 which included a provision that "There shall be one Surgeon General, with a salary of $2,500 per annum, one Assistant Surgeon General with the emoluments of a hospital surgeon * * *" Thus there was established, for the first time, a permanent organization for the Medical Department. The title of surgeon general was bestowed upon the service chief who was also given the rank of colonel. In addition, the act provided for an apothecary general, 2 assistant apothecaries, 40 post surgeons, and 1 regimental surgeon, with 2 mates to each regiment. Hospital surgeons were transferred at this time to the list of post surgeons removing at long last the problems of authority that existed between these two groups.

The man chosen to direct the Medical Department was Surgeon Joseph Lovell, who was appointed on 18 April 1818. Although not yet 30 years of age, he had shown ability during his 6 years of service in the Regular Army, in the administration of the general hospital at Burlington, Vt., and while serving with Gen. Winfield Scott and Gen. Jacob Brown on the northern frontier. His able reports on various subjects connected with the medical service of the Army had designated him as the most suitable officer to assume the responsibility for reorganizing the Medical Department. His appointment gave great satisfaction both to the Army at large and to the medical staff. From


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this date henceforth, the continuity of the Medical Department and of the position of surgeon general has been unbroken, regardless of the size of the Army.

It is interesting to note that the total appropriation for the administration of the Office of the Surgeon General was $1,540 per year, excluding salaries of military personnel but including the salary of the clerk, the purchase of 15 cords of wood, stationery, printing, and so forth. After the Army had been reduced to less than 5,000 men in 1822, the annual appropriation for the entire medical service was $23,000, including funds for payment of supplies already received. The amount estimated for medical service for each soldier was $2.50 per year.

When the Civil War threatened, the Army and the Medical Department were unprepared. At the beginning of the war, the Regular Army numbered 15,000 officers and men, scattered in small commands throughout the country, poorly trained, and poorly supplied. The Medical Corps consisted of the Surgeon General, with the rank of colonel, 30 surgeons, and 83 assistant surgeons. Of that number, 3 surgeons and 21 assistant surgeons resigned to accept commissions in the Confederate Army, and 3 assistant surgeons were dismissed for disloyalty. There was a small but indefinite number of hospital stewards in the small Army hospitals. No female nurses were available, nor were there any male nurses to act as wardmasters or cooks, except such as were detailed from the line.

Ashburn,1 in speaking of the War Department at that time, says: "At the heads of its departments were old men, most of them veterans of the War of 1812, honored relics of a distant past, in which their minds lingered * * *. The Army had practically no supplies when war began and it took time to make them, but the war did not wait." There were no provisions by law for retirement, either for age or physical disability. General Scott, who was in command of the Army, passed his 75th birthday on 13 June 1861.

The war progressed, however, and volunteer regiments soon began to arrive in Washington. They came in coaches and cattle cars, which were often overcrowded and without provisions

1Ashburn, P. M.: History of the Medical Department of the United States Army. New York: Houghton Mifflin Co., 1929.


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for sanitation or for the comfort of the men. No preparation had been made for care of the volunteers.2

Thinking people feared for the health of the Army. The unfortunate experiences of the Allied and Russian Armies in the Crimean War had been given wide publicity in the United States, and many felt that these conditions could be repeated in our Army. So great was the interest that on the very day the President called for troops, 15 April 1861, the women in Bridgeport, Conn., organized a society with the somewhat vague idea of affording relief and comfort for the volunteers. Numerous meetings of similar character were held throughout the country. One such meeting at the Cooper Union Institute in New York on 29 April 1861 resulted eventually in the organization of the Sanitary Commission. From that group and similar ones in New York City, a committee was selected to proceed to Washington to offer the services of the several groups to the Federal Government.

The committee, appreciating the inexperience of volunteer soldiers, with untried and untrained officers, felt that, if disaster was to be avoided, careful supervision would be required during the early period of organization and training. Arriving in Washington on 16 May, the day after train service from the north was reestablished through Baltimore, they found conditions in the city and in the War Department which justified their apprehension and fear.

Fortunately, the leaders of the movement were wise men with vision who realized that its work could best be accomplished by cooperating in the improvements of existing governmental agencies and by supplementing such activities when the national situation required it. They made their first call upon General Scott. This meeting was followed by an interview with Acting Surgeon General Robert C. Wood, in the absence of Surgeon General Thomas Lawson, who was ill. Surgeon Wood, though at first disposed to question the value of any such assistance, yielded to the request after a conference with the leaders and supported their view. On 22 May, he gave the committee a letter to Secretary of War Simon Cameron, suggesting that the organization might render valuable assistance.

2Margaret Leach, in her Reveille in Washington, paints a very vivid picture of conditions in the city at that time.


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After some delay, on 9 June the plan received the approval of the Secretary of War and of President Lincoln.

The activities of the Sanitary Commission that resulted from these conferences correspond in many respects with those of the American Red Cross, combined with certain of those of the Council of National Defense during World War I. The Commission often furnished valuable assistance-notably so at the battle of Antietam and later at Gettysburg-by supplementing the supplies of the Medical Department. It continued to furnish splendid service to the Medical Department and to the Army as a whole throughout the remainder of the war.

On 3 August 1861, the Congress passed an act for the better organization of the military establishment. For the first time, provision was made for the retirement of officers either for disability or on application after 40 years of consecutive service. However, not more than 7 percent of the officers of the Regular Army could be placed on the retired list. The act also provided for 10 additional surgeons and 20 additional assistant surgeons and for a corps of 50 medical cadets for duty as dressers in general hospitals and ambulance attendants in the field. The Surgeon General was authorized to employ female nurses in general or permanent hospitals as substitutes for soldiers. The nurses so employed were to receive 40 cents per day and one ration in lieu of all emoluments, except transportation in kind.

During this time, Acting Surgeon General Wood was in complete accord with the activities of the Sanitary Commission. However, following the death of Surgeon General Thomas A. Lawson, Clement A. Finley was appointed as Surgeon General. With this appointment, difficulties arose in connection with the proposed Sanitary Commission. Surgeon General Finley disapproved entirely of the Commission and informed the Secretary of War to this effect. When the members of the Commission became aware that cooperation would not come from the new Surgeon General, they prepared a plan for the reorganization of the Medical Department and pushed it through Congress. The Surgeon General, who had difficulties also with the Secretary of War, was removed from his office by the Secretary of War after less than 1 year's service and was directed to repair to Boston to await orders. After several vain appeals against the treatment he had received, he applied for retirement


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under the act of 3 August 1861 and was placed on the retired list on 15 April 1862.

On the following day, 16 April 1862, an act providing for the reorganization of the Medical Department became a law. It provided that the surgeon general to be appointed under the act should have the rank, pay, and emoluments of a brigadier general, that 1 assistant surgeon general and 1 medical inspector should have the rank, pay, and emoluments of a colonel of cavalry, and that there should be 8 medical inspectors, each with the rank, pay, and emoluments of a lieutenant colonel of cavalry. Also there were added to the Medical Corps 10 surgeons and 10 assistant surgeons, 20 medical cadets, and as many hospital stewards as the Surgeon General might consider necessary.

Many candidates came forward for the appointment as surgeon general. After a thorough canvas of the available men, the Sanitary Commission recommended the appointment of Assistant Surgeon William A. Hammond, then 34 years of age. The Commission had appealed to General McClellan, who, in a conference with the president of the Commission, after going over the Army lists, expressed his opinion that Dr. Hammond was well qualified for the position and that he would faithfully perform the duties. Dr. Hammond was a man of considerable repute as a writer and one of unfailing energy and force. He had first entered the Army in 1849 and had served several years in the far west. He had resigned from the service in 1860 to accept the chair of anatomy and physiology at the University of Maryland. Upon the outbreak of war, he again took the examination, was appointed assistant surgeon, and held that grade when appointed Surgeon General.

Subsequent events proved that General Hammond's selection was a wise one. He was a man of vision and understanding. In his first annual report to the Secretary of War in 1862, he submitted several important and far-reaching recommendations. They included the formation of a permanent hospital corps, the establishment of an Army medical school, the establishment of a permanent general hospital in Washington, the necessity of establishing autonomy of the Medical Department in the construction of hospitals and transportation of supplies, and the establishment of a medical laboratory. He revised the


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system of medical reporting that furnished invaluable information for the preparation of the medical history of the war. He stressed the importance of furnishing details and outlines of surgical and medical cases. On 21 May 1862, he directed the organization of an Army medical museum and the collection of specimens and material for it. A definite plan was prepared for, and improvements were made in, the construction and equipment of military hospitals.

The forceful personality of Surgeon General Hammond aroused the animosity of Secretary of War Edwin McMasters Stanton. Their relations became strained, and Hammond was dismissed as a result of a court-martial on 18 August 1864. All of Hammond's constructive recommendations came to be realized in time and, at the end of his term, it appeared that the Army Medical Department was developing on a broad foundation. Much of its further progress paralleled the progress in scientific medicine and depended to a large degree on the type of individual holding the office of Surgeon General. For example, Joseph K. Barnes, who succeeded Hammond as Surgeon General, had served as attending surgeon for the city of Washington in 1862. While on this duty, he became acquainted with Secretary of War Stanton, who was favorably impressed with him. Their friendship lasted throughout their careers and had profound effects not only on the future activities of Barnes but on the fortunes of the Medical Service.

In fact, when Barnes became Surgeon General, Secretary of War Stanton became as solicitous for the Medical Service as he had been inimical during Hammond's term of office. For the remainder of the Secretary's term of office, he manifested a great interest in the health and hygienic conditions of the Army, in the comfort and welfare of the sick and wounded, and in efforts to extend the facilities and opportunities of the medical officers.

The work of collecting material for the Medical Museum and for the Medical and Surgical History of the War of the Rebellion was pushed vigorously during 1863 and 1864. Hammond had first suggested the writing of the history and invited cooperation in the collection of material by means of a circular sent to medical officers. In 1865, the Surgeon General issued a report upon the extent and nature of the material available for its preparation. Four of the six monumental volumes were


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completed under General Barnes' administration, and the other two were far advanced at the time of his retirement.

Surgeon General Barnes also displayed a great interest in the development of the Army Medical Library. During his term of office, the library, under the supervision of Maj. John S. Billings, was expanded from a small collection of textbooks to first rank among medical libraries in the country. One of the most outstanding contributions to the medical world from the library was the appearance in 1880 of the first volume of the Index Catalogue, edited by Billings. The continuous publication of these volumes to 1955 has brought worldwide fame and acclaim to the library and to the Army Medical Service.

In the reorganization of the Army following the Civil War, General Barnes was successful in retaining for the Medical Department the same proportion of the several grades of officers as existed during the conflict. This was a most important achievement, because heretofore, when the Army was disbanded at the conclusion of a war, the Medical Department was also reduced to such a number as to cripple the functions of the Department.

Maj. Charles Henry Crane, who was assistant surgeon general to General Barnes, relieved his chief of the routine of the office, thus giving Barnes the opportunity to exercise the tact and diplomacy of which he was master and for which there was so much need in the various dealings with Secretary Stanton, Congress, and the Sanitary Commission. In connection with the arduous and exacting work incident to the war, Crane combined remarkable executive ability with sound judgment and a delicate sense of justice and right. He was, without doubt, a considerable factor in the degree of discipline and efficiency displayed by the Medical Department in the later years of the war.

With the retirement, for age, of General Barnes in 1882, Crane was given the appointment of Surgeon General. He continued the same patient, earnest, and careful attention to the business of the office which for years he had shown as assistant. During his term of office, the surgical portion of the Medical and Surgical History of the War of the Rebellion was completed and the medical portion was well under way. His sudden death within the first year of office as Surgeon General left that office open. Many candidates sought the appointment,


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but President Chester Arthur solved the problem by appointing the senior officer, Assistant Surgeon General Robert Murray, to the vacancy.

During Barnes' administration, the question of the military control of general hospitals was finally settled by a directive3 which confirmed the right of the medical officer to command in his own sphere of action. This question had been a vexing one from the beginning of the war, since the order placing general hospitals under the supervision of the Surgeon General was not sufficiently explicit in its provisions regarding the right of command of the medical officers in charge of these hospitals. The good will of Secretary of War Stanton in this regard was again displayed when an order4 was issued giving to the Medical Department entire control of hospital transports and hospital boats.

General Murray was of a naturally conservative disposition, tending more toward the preservation and improvement of existing conditions than to the initiation of new movements. His term of office was at a time of scientific awakening in the corps, coincident to a similar phenomenon in the profession at large. Bacteriology and hygiene of modern type were exciting attention. General Murray's report of 1884 mentions for the first time in such reports the subject of antisepsis and antiseptic surgery. In 1883, operations were being performed under antiseptic technique in United States Army hospitals while Lister was still a subject of ridicule in London. In his report of 1885, Murray, in discussing the sanitation of posts, suggested the probability of water supplies as carriers of disease germs and recommended the disposal of garbage by incineration. In this year, he was instrumental in sending Maj. George M. Sternberg to Rome as a delegate to the International Sanitary Conference.

General Murray was succeeded in office by Surgeon General John Moore, appointed by President Cleveland although Col. Jedediah H. Baxter was the senior officer of the corps. General Moore retained Colonel Baxter as his assistant, however, and brought into the office Maj. Charles R. Greenleaf and Maj. Charles Smart. These three strong and capable men helped

3War Department General Orders No. 306, 7 Apr. 1862.

4War Department General Orders No. 18, 8 Feb. 1865.


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much toward the improvement of the medical service and toward the success of the administration. For example, General Orders No. 86, issued on 20 November 1886, introduced instruction in first aid throughout the Army. Following, and as a result of this order, there appeared a succession of small manuals of first aid by medical officers of the service, usually combined with a manual of drill for the newly authorized Hospital Corps. The Hospital Corps was formed as a result of a law passed by Congress on 1 March 1887 (24 Stat. 435). The corps was to be filled by transfers of men from the line of the Army. Army General Orders No. 56 were issued 11 August 1887, promulgating rules and regulations for the government of the Hospital Corps. The formation of this corps was a great event in the history of the Medical Department. It has developed into the splendid corps of enlisted noncommissioned officers and privates of which the Department is justly proud.

General Moore was popular with the medical profession at large. The cordiality of the regard in which he was held was manifested at a dinner given in 1887 for him and the Surgeon General of the Navy by the New York Practitioners' Society. The dinner was a striking tribute, not only to the two honor guests but also to the interest of the civilian profession in the military branch. A similar interest was evident in the meetings of the Military Section of the Ninth International Medical Congress held in Washington later in the same year.

Upon the retirement of General Moore in 1890, the vacancy was filled by Jedediah H. Baxter. Baxter had been, through an appointment by President Johnson, an assistant medical purveyor with the rank of lieutenant colonel during the reorganization of the Army following the Civil War in 1867, during the administration of General Barnes. In 1872, Baxter received the appointment of chief medical purveyor which he held through the terms of General Crane, General Murray, and General Moore. As chief medical purveyor, General Baxter's work was of high advantage to the service. Medical supplies were of better quality and more abundant in quantity. General Baxter increased markedly the professional literature furnished to medical officers and was sympathetic to requests for instruments and appliances from those proposing to make special research. In addition, he prepared the two-volume Medical Statistics of the Provost Marshal General's Bureau


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published in 1875. This work which presented the results of the physical examination of more than a million men, contained also a discussion of anthropometry, recruiting regulations of other nations, and reports from medical officers of the bureau, including not only their special work but also the topography and diseases of their districts. Further discussion of this work is given on p. 81.

Early in Baxter's career, he developed an understandable ambition to head the Medical Department, and with each successive vacancy he not only was a candidate but was always strongly supported for the position. With the retirement of Surgeon General Moore in 1890, circumstances were finally propitious for Baxter. Secretary of War Redfield Procter and Benjamin Harrison, the President, were longtime patients and friends of Baxter. There was no real contest for the vacancy, and Baxter was appointed Surgeon General on 16 August 1890. He had shown excellent administrative ability in the conduct of the supply department and had many plans for far-reaching and comprehensive improvements in the department. These never reached fulfillment, as he died after being in office only 4 months.

Following the death of Surgeon General Baxter in December 1890, there were the usual number of candidates for the vacated office, but President Harrison followed the precedent broken only in recent years and on 23 December 1890 appointed the senior officer, Col. Charles Sutherland, to be Surgeon General. His administration has been described as being "conservative and progressive," which can be interpreted that General Sutherland's term of office was as progressive as the conservative temper of the War Department of his day would allow. General Sutherland had been a medical purveyor and, with a continuing interest in medical supply, gave the Medical Department new field equipment but deprived the medical officer of personal equipment which he had formerly been issued.

With the retirement of General Sutherland, for age, George Miller Sternberg, one of the most eminent professional men in the service, was appointed Surgeon General by President Cleveland. The 9 years that General Sternberg was in office (1893-1902) was a time of medical scientific progress to which he contributed outstandingly. Sternberg was responsible for the establishment of the Army Medical School in 1893, the organization


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of a contract dental service and the Army Nurse Corps, and the creation of the tuberculosis hospital at Fort Bayard, N. Mex., and of a special surgical hospital at Washington Barracks. The equipment of the Army Medical School included laboratories of chemistry and bacteriology, and a liberal policy was adopted in furnishing laboratory supplies to the larger military hospitals. The Spanish-American War occurred during Sternberg's administration. The problem of hospitalization resulting from the epidemic of typhoid fever among the soldiers, though difficult, was met with fair success.

Surgeon General Sternberg, interested in medical research, caused the organization of, first, the Typhoid Fever Board, consisting of Maj. Walter Reed, Maj. Victor C. Vaughan, and Maj. Edward O. Shakespeare, which established the facts of contact infection and flies as mechanical carriers of the disease; and, second, the Yellow Fever Commission, headed by Major Reed, which established the mode of transmission of yellow fever, specifying the particular species of mosquito. On his recommendation, the first tropical disease board was established in Manila in January 1900, where it functioned for about 2 years to be reconstituted in 1906.

Surgeon General Sternberg was succeeded by William H. Forwood, an outstanding surgeon and teacher. General Forwood's appointment came only 3 months before his compulsory retirement age. After serving the 3 months, he was succeeded by Robert O'Reilly. Instead of following the usual practice of selecting assistants from among the senior officers of the corps, General O'Reilly surrounded himself with a group of young, alert, active men, who went far toward directing the fortunes of the corps for the next two decades. These men included Jefferson R. Kean, Walter D. McCaw, Charles F. Mason, and James D. Glennan, junior majors, and Merritte W. Ireland, Francis T. Winter, Charles Lynch, and Carl R. Darnall who held the rank of captain at that time. Major Kean was made executive officer, and the others were assigned to the charge of divisions into which the office was organized.

The unsatisfactory conditions in the Army disclosed by the Spanish-American War caused the appointment by President McKinley of the Dodge Commission. The findings of this commission, relating to the Medical Department, took the form of a number of recommendations which it devolved upon


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General O'Reilly to carry out. These recommendations included the following: (1) A larger force of commissioned medical officers; (2) authority to establish in time of peace a proper volunteer hospital corps; (3) a nurse corps of selected trained women nurses ready to serve whenever necessity should arise; (4) a year's supply, for an army of at least four times the normal strength, of all medicines, hospital furniture, and stores as would not be materially damaged by keeping, to be held constantly on hand in the medical supply depots; (5) charge of transportation to such an extent as would secure prompt shipment and ready delivery of all medical supplies; (6) simplification of administrative paperwork, and (7) provision for purchase of subsistence funds of articles of special diets for the sick. In his last annual report, that of 1908, General O'Reilly was able to state that all of these objectives had been realized or were in good prospect of realization.

General O'Reilly and his staff achieved a relation with the Army, Congress, the medical profession, and the public never visualized by any previous administration. During his term, every Medical Department activity was studied, overhauled, and improved. Toward the latter part of his term an appropriation was obtained from Congress for the purchase of the site and for the beginning of the construction of a general hospital in Washington (the Walter Reed General Hospital), a project under advisement since the days of General Hammond.

Perhaps the most outstanding accomplishment of General O'Reilly's term of office was the Reorganization Act of 23 April 1908 (35 Stat. 66). This act increased and reorganized the Medical Corps and the Hospital Corps, eliminated the meaningless titles held by medical officers with the substitution of the titles sergeant and corporal for the obsolete titles of non­commissioned officers, and created the Medical Reserve Corps. General O'Reilly was president of the board which recommended the adoption of typhoid prophylaxis for the Army. In 1906, he ordered the reconstitution of the Board for the Study of Tropical Diseases in Manila, with certain objectives set for it. In that same year, he represented the United States at the International Conference at Geneva, Switzerland, for the revision of the Geneva Convention.

From this short review of the development of the Army Medical Department, it can be seen that not only did the


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growth of the department parallel the needs of the Army but at times the Medical Department was prepared to meet oncoming needs, as a result of the vision of the several officers in the position of surgeon general. In the years following, the Army Medical Department continued to grow to meet its responsibilities to the Army.

References

Annual reports of the Surgeons General of the Army, for each fiscal year from 1819 to 1910.

Brown, Harvey E.: The Medical Department of the United States Army from 1775 to 1873. Washington: Surgeon General's Office, 1873.

The Geneva Red Cross Movement, European and American Influence on Its Development. A compilation, with notes by Albert G. Love. Army M. Bull. No. 62, May 1942.

Phalen, J. M.: Chiefs of the Medical Department, United States Army, 1775-1940. Army M. Bull. No. 52, April 1940.

Pilcher, James E.: The Surgeons General of the United States of America. A Series of Biographical Sketches of the Senior Officers of the Military Medical Service From the American Revolution to the Philippine Pacification. Carlisle, Pa.: Association of Military Surgeons, 1905.

Stille, Charles J.: History of the United States Sanitary Commission. New York: Hurd and Houghton, 1868.

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