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The Armed Forces Epidemiological Board

The quality and productivity of any endeavor depends most of all upon the dedication and wisdom of those given the responsibility to carry out that mission. Those who conceived of a medical advisory board to assist the Department of the Army were leaders with vision; they understood the current military-medical problems, and they perceived the health matters that would plague the military in the future. Not only were men like Simmons, Bayne-Jones, Blake, and MacLeod able medical scientists in their own right, but they also had uncanny insight and common sense.

The Armed Forces Epidemiological Board (AFEB) was founded on rock. A system of commissions, comprising some of the most capable medical scientists available, was assembled with the scientists being assured that they would perform relevant research that would aid the military. (This research was not intended to compete with other military medical research programs.) The founders conceived that all research activities would culminate in the maintenance of a healthy military force. World War II proved to be mankind's greatest conflict and resulted in staggering numbers of deaths and human suffering beyond belief. The new Board and its scientist-members were able to make recommendations that profoundly affected the health of the troops. The impact of some of the discoveries that the Board recommended and that the military implemented is beyond measure.

The AFEB system that was conceived in 1940 worked. I have assembled the relevant data and documented the events-by reproducing the records, accounts of events, minutes of meetings, agendae, and correspondence-that helped to shape military health standards and preventive medicine practices during World War II and thereafter. The material is organized both chronologically and by topic. There is considerable overlap in the chronology simply because the Board has considered the major medical problems of our time repeatedly.

It is refreshing to recount that those many leaders in American medicine, busy as they were, found time to contribute their capable services to this remarkable system. Their unstinting urge to participate is attributable to their proud sense of obligation and the privilege of serving our country. Personal gain was not an objective. The opportunities to meet with, work with, and argue with the leaders in infectious diseases and other fields during the Board's meetings, work sessions, and small discussions were really mini- postgraduate learning sessions. Almost everyone took away a new idea that answered a dead end question or that illuminated a detour around a difficult obstacle. Information was willingly shared among civilian and military scientists.

The spring meetings of the AFEB and its working Commissions usually lasted three days. Those who attended these meetings up to 1973 were privileged to hear the most current data pertaining to the pathogenesis, therapy, and control of the important infectious diseases that were prevalent both abroad and in the United States. Truly, these three-day sessions were dress rehearsals for the later spring meetings of the American Society for Clinical Investigation and the Association of American Physicians, usually held in Atlantic City in early May. The participating contributors were usually the same.

Some of the available former Board members and Commission Directors or members who have contributed to the AFEB's fifty-year enterprise are preparing historical accounts of the individual Commissions. The Commission's research, its field activities, and its recommendations will be described in detail. The photographs of many of the former Commission members, together with brief biographical sketches and descriptions of their contributions, will also appear in these Commission histories. The AFEB-Commission relationship was unique in its kind and productivity; it was at the Commission level, up to 1972, that the effective activities of the AFEB occurred, as the founders had intended.

After 1973, when the Commission system was abolished, the Board assumed a new role and functioned under a new Charter. (The Charters of the AFEB may be found in Appendix 4.) Indeed, during a short period in the mid-1970s, the Board experienced a sinking spell that might well have led to its demise. Happily, the Board survived. Respect and pride were maintained and a good working relationship was re-established among the three military services, the Department of Defense, and the AFEB. Necessity also played a part. In addition to the new problems that arose, (such as the need to reevaluate the physical and safety standards of the military and the emergence of new environmental concerns) the old-time infectious diseases (such as malaria, dengue, enteric diseases, Rift Valley fever, venereal diseases, and tuberculosis) never disappeared. Drug and alcohol abuse, obesity, high blood pressure, excessive smoking, and heart attacks were always present. Acquired immune deficiency syndrome provided a whole new constellation of problems. The Board was asked to direct its attention to these issues and many more, to the interest and gratification of both its members and those military personnel with whom the Board was privileged to collaborate.

I am grateful to all those who played a role in the Board and its Commissions' activities during these fifty years. I sincerely thank those special persons who willingly and unselfishly took on the immense job of preparing a Commission history. Gus Dammin was President of the Board from 1960 to 1973; in spite of his pressing daily activities at Harvard, he is preparing a separate history for the years of his tenure. Gus is the only person who can provide an accurate portrayal of the activities of the Board and its Commissions during that important and productive period. (This account that I have prepared only briefly describes some of these events.) I am grateful to Gus for his helpful suggestions to me as I prepared this volume, but am particularly beholden to him, and a host of others, for their remarkable devotion to the public good.

The Executive Secretaries of the AFEB have my profound admiration. Traditionally, they have been medical officers in the Army, Navy, or Air Force, appointed by the Secretary of the Army for a four-year rotation, subject to the approval of the Secretary of Defense, and based on nominations received from the three services. The Executive Secretary was responsible to the Secretary of the Army as the management agent on administrative matters, and to the Board on professional matters. The Board occupied a small office in the Pentagon, usually near that of the Surgeon General of the Army. This proximity allowed daily discussions between the two offices. The responsibility for the organization of the Board's office fell to the Executive Secretary; he was placed in full charge of the Board's activities, and responded to requests for help from the respective service officers. Not only did the Executive Secretary serve the President of the Board; in the days of the original

Board, he was also expected to fulfill many of the obligations that fell to the Directors of the Commissions or their contractees. With such a diverse research program, it was obviously necessary that the Executive Secretary have a background in medical science, and the character traits of diplomacy, efficiency, administrative ability, and dedication to military service problems were also desired attributes.

Just on their heels are secretaries Betty Gilbert, Jane Eldridge, Jenny McGinnis, and Jean Ward, without whom much less would have been accomplished. Colonel Robert Nikolewski, BSC, Colonel Robert A. Wells, Ph.D., MSC, and Jean Ward retrieved much valuable information from the files, which Jean willingly transcribed. I will not forget the long hours, the telephone calls beyond counting, and the many drafts of the reports of the Commission on Epidemiological Survey (which I chaired up to 1973). The endless typing and retyping of this history was done by Carol Young, my secretary for more than three decades. The AFEB and its Commissions, Subcommittees, and ad hoc Committees would have been short-lived without these secretaries.

Mr. S. Paul Klein and Mr. George Sangaleer, of the Division of Medical Audiovisual Services of the Walter Reed Army Institute of Research, provided valuable help. Without their assistance, it would have been impossible to reproduce many of the photographs that are included in this volume.

Grateful appreciation is expressed to Lieutenant General Frank F. Ledford, Jr., The Surgeon General of the U.S. Army, for his support in making this book possible. Special thanks are extended to Colonel Russ Zajtchuk, MC, and the editors of TMM Publications in the Center of Excellence in Military Medical Research and Education, Walter Reed Army Medical Center.

The purpose of this memoir is to provide our military and civilian readers with a factual account of the relevant military research that culminated in a series of objective and carefully formulated recommendations. These actions and events will help document the rich heritage of our medical services and help elucidate how civilian consultants, through their contributions to the AFEB and its Commissions, interacted with the military. I hope that these accounts will stimulate others to carry on and extend the remarkable achievements of the military health programs. Many important events may have been overlooked. Others may question the validity of some of the entries. Errors of omission or commission are attributable to a semiretired teacher and practitioner of medicine with a limited memory span.

Theodore E. Woodward, M.D.

January 1990
Baltimore, Maryland