Annual Report of the Surgeon General United States Army Fiscal Year 1961
The broad objectives of the Army Medical Service are five in number; namely, the practice of medicine, including the art of medicine; field medicine or combat readiness; medical education and training; medical research and development; and medical administration and management. During the past fiscal year, The Surgeon General and his staff continued to guide the Army Medical Service toward a fulfillment of these objectives in order that the ultimate goal, which embraces each of these five essential areas, the practice of total medicine, might be achieved. Significant progress was made throughout the year in a variety of areas. The following is a summary of some of the more pertinent accomplishments and developments that are discussed in detail in the report:
For the third successive fiscal year, both the rate of admission to hospital and quarters for disease and injury and the noneffective rate due to disease and injury were at extremely favorable low levels. The admission rate was 321 per 1,000 average strength per year, about 7 percent lower than that of the previous fiscal year (p. 29). The noneffective rate, which is the daily average number of Army personnel per 1,000 strength who are in an excused-from-duty status because of illness or injury, was 11.8 during the year, about the same as the record low of 11.7 rate recorded in fiscal year 1960 (p. 30).
The increasing shift of emphasis from inpatient care to the treatment of patients on an outpatient basis was again evident for, while the number of inpatients treated during the year remained quite consistent with that of recent previous years, the number of outpatient visits continued to increase (p. 9). Improvement was also made during the year in the staffing of the departments of medicine of Army medical treatment facilities. As of the end of fiscal year 1961, for example, all hospitals in the continental United States, except two, having a bed capacity of 26 or more, will have a field grade Regular Army officer or a career reservist, who is either board certified or board qualified, as chief
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of medicine (p. 10). In the practice of surgery at Army medical treatment facilities, there is also an improved status since trained and experienced surgeons in all surgical specialties, except otolaryngology, have been assigned to all such facilities (p. 12).
The Army psychiatry program continued its efforts in preventive psychiatry by increasing the quantity and quality of the mental hygiene consultation services (p. 12). For inpatients, the use of milieu therapy at Walter Reed General Hospital has proved most successful and its use will be expanded to include the neuropsychiatric treatment center at Fitzsimons General Hospital (p. 14).
In November 1960, the Army inaugurated a vigorous preventive dentistry program. This effort represents the first organized and positive action of this magnitude to implement prevention by a major segment of the dental profession (p. 22).
The restoration of certain types of medical care to the Dependents' Medical Care Program has resulted in an increase in morale among members of the uniformed services and their dependents, and also has been possible of accomplishment without depriving service treatment facilities of the number of patients they require for efficient and economical operation. There has been a rise in the admission rate of dependents to nonservice hospitals; however, this rise is due more directly to the increase in the number of dependents of uniformed service personnel than to the restoration of certain types of medical care to the program (p. 27).
Three chapters of AR 40-501, a new Army regulation pertaining to medical fitness standards, were published. Originally, this regulation was to have been published in two separate volumes, to be known as AR 40-501A and AR 40-501B. It was determined, however, that since both A and B regulations applied to all levels of medical examining facilities, two separate suffixes were not necessary (p. 33).
Total Army rates for common respiratory disease and influenza declined markedly in fiscal year 1961 when compared with those of the past 10 years. The common respiratory disease and influenza rate for continental United States for the period July 1960 through April 1961, for example, was 94.7, while the rate for a similar period in fiscal year 1960 was 119.6. It is felt that the reduced rates represent, partially at least, a beneficial effect from the use of adenovirus vaccine containing types 4 and 7 killed organisms (p. 41).
A number of changes occurred in the Army immunization programs. Some of the most significant were the standardization of the jet injector apparatus, the distribution of freeze-dried lyophilized smallpox vaccine, and the establishment of a standard dosage of immune serum globulin
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at 0.05 milliliter per pound body weight for the prevention of infectious hepatitis (p. 42).
Major effort continued to be expended on the control of hazards to health from ionizing radiation. Surveillance of Army activities in this field, which exposes some 15,000 persons each month to this subtle and potentially dangerous hazard, is being carried out in order that the Army will be fully prepared should it need to cope with this problem on a large-scale basis in the future (p. 45).
The AMEDS Mobilization Plan, formerly published as the AMEDS Mobilization Program, was issued on 15 May 1961. A major feature of this plan is the establishment of a no-year basis for mobilization planning, thereby eliminating the timelag of fiscal year programing (p. 66).
The importance of the helicopter as a vehicle of mercy was highlighted when the American Helicopter Society chose the 56th and 57th Medical Detachments (Helicopter Ambulance) as the recipients of the William J. Krossler Award for 1960. This award was given for the units' superior performance, under adverse conditions, during the Chilean disaster (p. 69).
During this past fiscal year, construction of two hospitals was completed and both were placed into operation. They are the Munson Army Hospital, Fort Leavenworth, Kans., and the Kimbrough Army Hospital, Fort George G. Meade, Md. Four other hospitals which are under construction at this time will be completed and ready for occupancy during the coming fiscal year-a 100-bed facility at Fort Lee, Va.; a 100-bed facility at Fort McClellan, Ala.; a 116-bed unit at Fort Eustis, Va.; and a 25-bed facility at Carlisle Barracks, Pa. (p. 71).
Additionally, a new 'health activity' which will include a 75-bed hospital, a dental clinic, and a complete outpatient service has been approved, and construction will begin at the Aberdeen Proving Ground, Md., during July 1961. This unit will be the forerunner of the Army health facility concept of the future (p. 71).
A concerted effort is being made to replace wornout and obsolete equipment by the orderly acquisition of replacements or the purchase of newly developed diagnostic and therapeutic devices. Additional moneys have been allotted to The Surgeon General for this purpose, and the program is now progressing satisfactorily (p. 78).
The need for increased emphasis on selected difficult problems in medical research and development has led to a critical appraisal of the entire effort and has resulted in the formulation of a dynamic, well?balanced, and realistic program with far-reaching potential. At the end of the year, plans were complete for an expanded and more vigorous
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program in fiscal year 1962; additionally, a 5-year plan for medical research and development for fiscal years 1962-66 was published (p. 83).
Commensurate with the policy of improving the Army capability to conduct limited war, increased effort was directed toward solution of medical problems anticipated in operations in remote or underdeveloped regions where such actions are most likely to occur. Specifically, attention was focused on problems associated with infectious diseases which do not occur in the United States but which have demonstrated capability to cause explosive outbreaks of disease in troops operating in certain oversea areas. Studies include identification of heretofore unknown diseases, isolation of causative agents, investigation of insect vectors or reservoirs, and development of new or improved vaccines and other preventive measures, or effective therapeutic methods (p. 83). New or improved methods for surgical treatment of battlefield injuries have been reported, including work on new anesthesia procedures. Problems associated with rapid movement of troops to extremely cold or hot environments have received increased emphasis (p. 85).
Field tests recently conducted indicate that administration once per week of a single tablet, with combined chloroquine and primaquine, is safe, simple, and effective. The importance of this work is obvious when malaria still poses the most important infectious disease problem in the world today (p. 89).
Operations in extremely hot or cold climates still pose problems. Laboratory studies and field trials on a small scale have shown that it may be feasible to preacclimatize military personnel for immediate deployment in a hot or cold environment and that, with such acclimatization, performance is materially improved. Further field trials are being planned (p. 85).
Laboratory studies on nutritional requirements have indicated that the long-accepted theory that individuals residing in hot climates require less food, while those in cold climates require additional food, is incorrect. Experiments have shown that more energy-producing nutrients are required for activity in a warm climate, and that fewer calories are required to perform the same activity in temperate or cold climates. No appreciable difference was found regarding the energy requirements between temperate and cold climates. Further studies under field conditions are indicated (p. 84).
Studies in the use of electricity in anesthesia have led to the production of an experimental model, consisting of a high frequency generator through which a current is transmitted to the patient by means of
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simple electrodes applied to the head. Narcosis was achieved and terminated on a few selected patients with almost the same rapidity with which the current was turned on and off. Preliminary tests indicate a minimum of the postoperative symptoms which are often associated with commonly used inhalation anesthetics (p. 86).
An improved litter which can also serve as a simple, sturdy, and lightweight bed has been developed (p. 93). A rugged, easy-to-operate field autoclave has been readied for tests (p. 96).
At the U.S. Army Medical Research and Nutrition Laboratory, green algae have been studied as a possible food supplement for human consumption. It is highly nutritive but has a repulsive taste which present efforts aim to correct (p. 85).
Studies on the survival of renal homotransplants have been undertaken. By the use of an initial dose of total body radiation, supplemented intermittently throughout the early postoperative course by the administration of cortisone and smaller doses of radiation, investigators have succeeded in obtaining at least 18 months' survival of a homotransplanted kidney in nonidentical twins (p. 86).
All the specialties of the Army Medical Corps are well covered within medical treatment facilities, except that of otolaryngology. This has been achieved despite a slight increase in the resignation rate of the Regular Army Medical Corps during fiscal year 1961. The Dental Corps of the Regular Army also experienced an increase in resignations (p. 98), and the Army Nurse Corps decreased by a total of 90 during the year (p. 98).
At the end of the fiscal year, the actual strengths of the several corps of the Army Medical Service were as follows: Medical, 3,623; Dental, 1,781; Veterinary, 400; Medical Service, 3,430; Army Nurse, 3,244; and Army Medical Specialist, 423 (p. 97). Of the 3,623 Medical Corps officers on duty, 1,780 were members of the Regular Army. Approximately 90 percent of this number were either board certified (57 additions during the year making a total of 531) (p. 106), board eligible, or in residency training.
The Berry plan continued to be the prime source of procurement of Medical Corps officers for the Army Reserve. Approximately 90 percent of the fiscal year 1961 procurement authorization, in both medical specialists and general medical officers, was obtained from this source (p. 101).
The Army Medical Service has become increasingly dependent upon the Army Student Nurse Program as a source of nurse personnel; 70.2 percent of officers commissioned in the Army Nurse Corps for fiscal year 1961 completed their education as participants in the program.
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Although gains from the Army Student Nurse Program have increased annually since inception of the program, these gains have not been in sufficient numbers to offset losses and the Army Nurse Corps numerical strength is declining in a steady pattern (p. 99).
The growing national shortage of nurses has prompted aggressive action to increase the number of enlisted personnel trained at the advanced medical specialist MOS 911.3 level in order to alleviate in part the shortage of available Army nurses. The Medical Specialist Advanced Course is offered at six medical installations in the United States. This is a 40-week course which provides both didactic training and supervised practical experience in all areas of patient care (p. 116).
The Medical Service Corps reflected a new increase in the Regular Army strength for the fiscal year. This was due partly to the fact that mandatory and voluntary retirements were not yet an expressive portion of the total losses annually. Resignations, for the most part, were from among officers qualified in specialties other than those of pharmacy, supply, and administration (p. 98).
The Army Medical Specialist Corps continues almost wholly dependent upon its procurement education program to maintain its strength. The procurement figure of 55 officers for fiscal year 1961, 48 students and 7 qualified officers, underscores this situation. Procurement reflects the national shortage of dietitians, physical therapists, and occupational therapists, and is similar to the problems found in Army Nurse Corps procurement (p. 100).
During fiscal year 1961, the input into the Veterinary Corps, Army Reserve, was a total of 101 officers against a quota of 105. Accessions to the Regular Army Veterinary Corps, during the same period, were 12 (p. 102).
The actual strength of the enlisted personnel assigned to the Army Medical Service was 40,597, including 1,590 enlisted women, at the end of fiscal year 1961. Although this represented a net overstrength of 142, there is a significant shortage of 1,046 medical corpsmen and 160 pharmacy specialists. The shortage of medical corpsmen is considerably offset by an overage of 1,460 other highly trained medical specialists. The pharmacy specialists, however, continue in a critical short supply (p. 114).
Training of all personnel of the Army Medical Service, in Army Medical Service training centers and schools, in other service schools, in schools of other Federal agencies, and in civilian institutions continued to be vigorously pursued.
Residency training has proved a prime source of qualified professional personnel. During the year, 162 military residents and 46
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civilian residents completed such training and were assigned for duty (p. 119).
As an example of the broad scope of training in various institutions, it is significant to note that 409 Army Medical Service personnel were enrolled in courses conducted by services other than the Army Medical Service; 105 Army Medical Service officers attended long courses and 204 attended short courses at civilian institutions (p. 121). Within the Army Medical Service itself, 1,242 Army Medical Service officers attended postgraduate short courses held in Army medical installations and activities (p. 134).
The downward trend in the number of civilian employees within the Army Medical Service, which has been evident during the past several years, continued during the past fiscal year, although the reduction in numbers for this reporting period was slight. The strength as of 30 June 1961 was 8,581 (p. 144). The Army Medical Service has been a hearty supporter of the Presidential policy on the employment of the handicapped, and civilian personnel officers have attended several conferences which were aimed at expanding the potential usage of the handicapped in governmental positions (p. 142). Three civilian personnel of the Army Medical Service received high awards from the Secretary of the Army and The Surgeon General in recognition of major contributions made to the Army Medical Service (p. 143). Concurrently, civilian personnel responded heartily to the Chief of Staff's suggestion program, and a substantial number of the civilian members of the Army Medical Service submitted suggestions during the month of May 1961, which had been designated by the Chief of Staff as 'Suggestion Month' (p. 143).
A number of regulations applicable to Reserve matters have been modified and combined. Of special significance is the fact that these new regulations clarify the extent of, and responsibility for, training and, to a considerable degree, permit responsible officers to reduce military training to the extent they feel advisable. The long-established policy which had permitted medical and dental officers to be subjected to involuntary recall to active duty was modified by AR 135-14, so that such draft-eligible individuals, with exceptions, may be deferred from involuntary call providing they are assigned to, and participate with, TOE or TD units of the Ready Reserve (p. 149).
The proposed reorganization of the Office of The Surgeon General was announced in February of 1961 with the issuance of OTSG Administrative Letter 10-4 (p. 79). The new organizational structure reduces the span of control of The Surgeon General by the creation of directorates which have absorbed many of the divisions of the Office of The Surgeon General.
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On 20 September 1960, The Surgeon General established a policy review council. Its mission is to provide a forum for the evaluation of policy and to advise The Surgeon General of trends and anticipated changes which may affect the future of the Army Medical Service (p. 155).
Four volumes of the history of the U.S. Army Medical Department in World War II were sent to the U.S. Government Printing Office. An additional 11 book manuscripts are in the editorial processing stage, 8 of which are scheduled to be forwarded to the Public Printer during fiscal year 1962 (p. 156).
