Annual Report the Surgeon General United States Army Fiscal Year 1959
SUMMARY OF MAJOR ACCOMPLISHMENTS
One of the changing concepts in the practice of medicine in the U.S. Army Medical Service in recent years has been the gradual shift from hospital care to the treatment of more and more patients on an ambulatory or an outpatient basis. In recognition of this important problem, The Surgeon General initiated an aggressive program in fiscal year 1959 to orient and rehabilitate the clinic services of Army medical treatment facilities in accordance with their expanded role in the diagnosis and treatment of patients (p. 7).
Through careful monitoring of personnel assignments and through frequent staff visits to Army medical treatment facilities, professional consultants to The Surgeon General have been able to effect better utilization of personnel, equipment, and facilities (p. 9).
The Army Medical Service has remained abreast of developments in the field of cardiac surgery, and the Fitzsimons, Walter Reed, Letterman, and Brooke Army Hospitals have been assigned the additional mission of open-heart surgery (p. 10).
Mental hygiene consultation services and other Army outpatient psychiatric activities have enlarged their sphere of operations to include behavioral and disciplinary problems in addition to those presented by the more traditional symptomatic disorders. Prisoner stockade screening has become an established procedure at all posts and stations where psychiatric personnel are assigned, and this has contributed to a marked reduction of the Army prisoner population (p. 11).
Because the optimum period for preventive psychiatry is early in the course of maladjustment, a First Court-Martial Screening Program for disciplinary offenders was initiated in the fiscal year (p. 11).
The Army's alltime low rate of 9 hospital admissions for psychiatric disorders per 1,000 troop strength that was achieved in calendar year 1957 was further decreased to a new low rate of 8 per 1,000 strength in calendar year 1958 (p. 11).
A major revision of regulations covering discharges for administrative reasons incorporated many proposals made by The Surgeon
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General, including the elimination of unclean habits (repeated venereal disease) and chronic alcoholism as causes for undesirable discharge from the Army (p. 12).
Considerable progress was made in developing new techniques of inpatient treatment of schizophrenic disorders (p. 12).
In recognition of the increasing importance of pathology in aviation medicine, a consultant in forensic and aviation pathology was added to the pathology consultant staff of The Surgeon General (p. 14).
The distribution in the fall of 1958 of the Army Medical Service Formulary climaxed several years of effort devoted to the compilation of a single reference which would provide, in one convenient location, essential data on the Army's current therapeutic armamentarium (p. 16).
The need for maintaining the highest degree of professional medical care and treatment throughout the entire system of Army medical treatment facilities has focused attention and efforts on obtaining accreditation of Army hospitals not only in the United States but also of those overseas (p. 17).
The major indexes to morbidity among Army troops indicate that fiscal year 1959 was one in which Army health experience was quite favorable. Hospital admission rates decreased markedly following the epidemic of Asian influenza and the generally high level of respiratory disease incidence of the previous year, and the noneffective rate for Army troops declined to the lowest point on record (p. 19).
At the direction of Congress, two important changes were made in the Medicare (Dependents' Medical Care) Program, effective on 1 October 1958. One of these was the establishment of a Medicare Permit System that restricted the freedom of choice between uniformed services and civilian medical facilities for dependents residing with their sponsor. The other restricted the scope of care available to dependents by prohibiting certain medical and surgical care from civilian sources (pp. 29 and 30). The primary effects of these changes upon the Army have been to increase the number of outpatient visits to Army medical treatment facilities (p. 33) and to increase the workload in obstetrics and gynecology in Army teaching hospitals (p. 78).
The most significant development in the field of physical standards was the initiation of the Consolidated Medical Fitness Standards Project designed to combine directives covering standards of medical fitness into a readily accessible two-part regulation, completely indexed, and printed in a looseleaf binder. In addition, present criteria for Army service are being evaluated as to their current and future appropriateness in the light of recent medical advances and the demands of modern warfare (p. 38).
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Upon the recommendation of the Commission on Influenza of the Armed Forces Epidemiological Board, the influenza vaccine to be used in 1959-60 was modified to include newer strains (p. 44).
The Army Occupational Health Program continued to expand to meet the health problems created by industrial developments and by the increasing complexity of the newer weapons system (p. 44). The protection of Army military and civilian personnel against hazards to health from ionizing radiation is a dominant part of The Surgeon General's occupational health program. Although some 30,000 persons were exposed to such radiation during the year, no acute damaging exposures occurred (p. 46).
An audiometric test program initiated at Fort Dix, N.J., demonstrated the feasibility of testing large groups within the framework of Army administrative procedures. It is estimated that the identification of persons having defective hearing among the first 10,000 men tested resulted in a saving of $125,000 in potential compensation claims against the Government (p. 45).
The Surgeon General appointed a Special Assistant for Combat Development and authorized him to assemble a small staff for the purpose of coordinating and monitoring the Army Medical Service Combat
Development Program and to organize a combat development group as a class II activity (p. 53).
The dispatch of U.S. Armed Forces to Lebanon early in the fiscal year provided the first real test since the Korean War of how well the Army Medical Service is accomplishing one of its basic missions- combat readiness (p. 55).
The status of Regular Army medical officer procurement and retention continued to improve as a result of the strong emphasis placed on professional training programs designed to make a career in Army medicine more attractive to recent graduates of medical colleges and other young civilian physicians (p. 60). At the end of the fiscal year, the Regular Army strength of the Medical Corps was 1,607, as compared to the authorization of 2,217 (p. 60).
The Army ordered to active duty 210 medical specialists who had been deferred under the Berry Plan to complete their residency training (p. 60).
The Professional Education and Training Committee selected 161 individuals from among the 361 who applied to enter the residency training program in September 1959 (p. 63).
The Regular Army strength of the Dental Corps continued its upward trend, reaching a new alltime high of 536, while the rate of resignation declined to a new low (p. 63). Total Dental Corps strength
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was reduced to 1,801, only slightly above the authorization, as contrasted to the large overstrength throughout the previous year (p. 64).
Despite a net gain of 175, the Regular Army strength of the Medical Service Corps remained far below its authorization (p. 64). With the exception of clinical psychology, substantial progress was made in filling vacancies in the Medical Service Corps (p. 65).
Following the decision to retain the Veterinary Corps in the Army, most of the vacancies in the Regular Army of that corps were filled with Reserve veterinary officers who had previously qualified, some as early as November 1955 (p. 66). The corps was at full strength for the first time since fiscal year 1957 (p. 66).
The total strength of the Army Nurse Corps registered a small gain in spite of the increasing impact of the Reserve Officer Personnel Act of 1954 and the newly implemented mandatory retirement aspects of the Army Nurse and Medical Specialist Act of 1957 (p. 67).
Although the shortage of dietitians in the Army Medical Specialist Corps persisted, the prospect for overcoming this shortage appeared brighter (p. 67). The first male dietitians were appointed and called to active duty in the Reserve (p. 68).
The Department of the Army established a new policy requiring the mandatory release of non-Regular warrant officers who are qualified for retirement (p. 69).
The reenlistment rate of 28 percent among Army Medical Service enlisted personnel was higher than in previous years when the rates ranged as low as 15 percent (p. 72). The enlisted military occupational specialty classification system is being adjusted to meet the changing composition of the modern Army (p. 74). Considerable progress was made in implementing the two new higher enlisted grades (p. 75). Testing of enlisted personnel under the new proficiency testing and evaluating system was started during the year (p. 76). The first proficiency pay awards were made in November 1958 (p. 76).
The number of medical officers in residency training in Army teaching hospitals increased by more than 13 percent, reaching an average monthly strength of 433 during the year (p. 77).
The former requirement that Medical Corps officers attend the 22-week Company Officer Course at the Army Medical Service School before entering residency training was eliminated. Instead, they now are enrolled in the 5?-week orientation courses, thus enabling them to begin residency training in September, rather than in January or July (p. 77).
Of the 1,607 Regular Army Medical Corps officers on duty at the end of the fiscal year, 502 were certified as diplomats of American
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specialty boards, and 372 were board eligible (p. 78). The number of board-certified members of the Dental Corps increased during the year from 53 to 58 (p. 78).
Applications for residency training were made by 130 of the 178 medical interns who completed their internships, as compared to the 109 who applied the previous year (p. 80). The Dental Corps received 104 applications for 24 dental intern spaces (p. 80).
In order to conserve training man-years and achieve maximum use of available manpower, a new training pattern for Army Medical Service officers was adopted along with other adjustments in the courses and quotas at the Army Medical Service School (p. 81).
The Deputy Chief of Staff for Military Operations approved a request by The Surgeon General to adopt a plan which will enable Army Medical Service personnel to enroll in courses in European civilian institutions (p. 91).
In cognizance of the requirement for training personnel to meet and cope with many problems expected in the event of a nuclear attack or any other major disaster, the Army Medical Service has geared its logistic support to the training of officers and enlisted personnel in the immediate care of mass casualties (p. 98).
Observer and school training for foreign nationals was greatly increased, with 500 participating as compared to 171 the previous year (p. 98).
Two-thirds of all the medical schools in the United States are now taking part in the MEND (Medical Education for National Defense) Program (p. 98).
The Army Medical Service initiated career-management programs for civilian employees (p. 99). The greatest deterrent to recruitment was the curtailment imposed by the Deputy Chief of Staff for Logistics on the hiring of civilians for a 7-month period (p. 102). The number of civilian employees declined from 9,748 to 9,055 (p. 102). Continuing use was made of monetary and honorary awards as a means of giving recognition to deserving employees for their achievements and of encouraging improvement in operations (p. 102).
Significant changes were made in the Army Medical Service organization for research and development and in the emphasis placed on certain types of research studies (p. 103). Productive results were obtained with the expectation of important improvements in the prevention of radiation injury and in the treatment of nerve injury, major fractures, and acute renal failure (p. 104). For the first time, the Army Medical Service entered the field of bioastronautics and achieved successful flight into space by living primates (monkeys) (p. 104).
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The distribution of medical supplies for the emergency care of nuclear casualties was initiated. Packing and packaging procedures were also developed for the Phase I set which is positioned with each 100 personnel and which contains quantities of 26 different medical items for self-aid and buddy-type care during the immediate postattack period (p. 111). The rehabilitation and repacking of nine field hospital assemblages in the possession of Strategic Army Corps units was completed (p. 111). The Army Medical Service was assigned the mission of fabricating spectacles for the Navy in the western area of the United States (p. 113). During the year, 284 new supply items were classified as standard (p. 114).
Eleven Army aviation medical officers were designated as flight surgeons-the first to qualify (p. 116). The table of organization and equipment for the new medical air ambulance company was approved by the U.S. Continental Army Command and was being reviewed at the Department of the Army level (p. 117).
Continued progress was made in the Army's hospital replacement program. Two new hospitals were dedicated, work was nearing completion on two more, and construction was started on two others (p. 120). Considerable progress was also made in the program to provide modern quarters for female officers, primarily Army nurses. Construction of the pilot model was completed in June 1959, work was underway on two more, two others were in the design stage, and three more were authorized (p. 123).
By the end of the fiscal year, the Army Command Management System, of which the Hospital Command Management System is an integral part, was functioning at all of the installations and activities under the command of The Surgeon General (p. 125).
The most significant modifications of the new Reserve Forces Troop Program, announced in December 1958, was the addition to the program of a number of aviation medical companies and about 100 professional teams from the TOE 8-500 series. Because size, vulnerability, and lack of maneuverability would preclude their use in future warfare, the 1,500- and 2,000-bed general hospitals, the 750-bed evacuation hospital, and the larger station hospitals were eliminated from the program (p. 128).
As a means of promoting public awareness of the need for civilian as well as military medical preparedness to meet any national emergency, Army Medical Service personnel presented a mass casualty care program at the annual Medical Civil Defense Conference sponsored by the Council on National Defense of the American Medical Association, on 6 June 1959, in Atlantic City, N.J. A helicopter ambulance was also placed on display (p. 131).
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The publication of two more historical volumes brought to 14 the number published on the history of the Army Medical Department in World War II (p. 132).
