Annual Report the Surgeon General United States Army Fiscal Year 1960
ANNUAL REPORT OF THE
SURGEON GENERAL
SUMMARY OF MAJOR ACCOMPLISHMENTS
The Army Medical Service continued to make progress during fiscal year 1960 in the numerous fields of activity in which The Sureon General participates in carrying out his functions. There were many
notable improvements and accomplishments. These ranged from the provision of better care to the soldier and his dependents-achieved by keeping pace with the constant advances in medicine, surgery, and allied fields-to the adjustments made in policies, procedures, training, research, and all the other facets of responsibility required to resolve the medical problems of the nuclear age with its increasing variety, range, and lethality of weapons. Presented here is a summary of some of the more important achievements and major developments that are discussed in greater detail in the body of this report.
The health experience of Army personnel during the year was extremely favorable. The major indices of morbidity either reached new lows or declined to near record low levels (p. 37). For the second consecutive year, the average daily noneffective rate among soldiers dropped to a new record low (p. 38). There were nearly 30,000 fewer initial admissions of Army personnel to hospitals than in the previous year (p. 40), and the number of beds occupied in fixed Army hospitals worldwide declined by about 5 percent (p. 41).
The Surgeon General continued his vigorous program to improve outpatient service and procedures in the clinics of Army medical treatment facilities in consonance with the increasing shift of emphasis from inpatient care to treatment of patients on a clinic or ambulatory basis (p. 10). An average of more than a million outpatient visits a month-about half of these by dependents of military personnel-were made to Army medical treatment facilities during the fiscal year (p. 41).
The seven Army hospitals in the continental United States that are under the command of The Surgeon General were redesignated as "general" hospitals. This action was taken to differentiate between named hospitals (class I) which provide local and area medical support and those named hospitals (class II) which are especially staffed and
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equipped for observation, treatment, and disposition of patients requiring long periods of hospitalization and highly specialized care (p. 9).
In accordance with President Eisenhower's suggestion that professional military officers be used 'to enhance and help develop the feeling of friendliness and helpfulness of peoples,' increasing emphasis is being given to the role of the U.S. Army medical officer in furthering this foreign-policy objective in oversea areas (p. 12).
Tuberculosis is losing its importance as a military medical disease. With the introduction of specific drug therapy and the development of new surgical techniques, it has become possible to treat successfully more than 90 percent of the soldiers afflicted with tuberculosis and to return them to active duty immediately after treatment or after temporary retirement (p. 14).
The Army Medical Service made considerable progress in expanding its capabilities in cardiac catheterization and open-heart surgery (p. 15).
Further progress was made in the field of preventive psychiatry and in the care of psychiatrically ill active-duty personnel and their dependents (p. 16). The hospital and quarters admission rate of personnel for psychiatric conditions decreased, for the third consecutive year, to a new record low of 7 per 1,000 average strength (p. 16). More and more individuals are receiving psychiatric evaluation and treatment without the necessity of hospitalization and loss of duty time (p. 16).
The Surgeon General attained an important objective during the year when the Joint Commission on Accreditation of Hospitals surveyed and accredited all the 15 eligible U.S. Army hospitals in oversea areas. This is especially significant because The Surgeon General has placed strong emphasis upon maintaining the highest degree of professional medical care throughout the entire system of Army medical treatment facilities. All eligible Army hospitals in the continental United States except one, approval of which is expected momentarily, had previously been accredited (p. 25).
A change in the Dependents' Medical Care Program, effective on 1 January 1960, restored most of the types of care that had been deleted from the program for economy reasons on 1 October 1958 (p. 26). This change, the second major revision in the program since it was initiated in December 1956, is expected to insure optimum utilization of the medical treatment facilities of the uniformed services, keep the costs of the program at a reasonable level, and provide the care envisioned in the Dependents' Medical Care Act (p. 29).
The first of two new Army Regulations which will consolidate more than 200 Army directives on medical fitness standards and medical examinations was approved by the Department of the Army and sent
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to the Department of Defense for review (p. 47). The Surgeon General initiated action to improve the policies and procedures of the medical and physical evaluation boards, particularly in regard to the disposition of patients and the separation of Army personnel for physical disabilities. The workload of these boards will increase sharply during the next 5 years because of the large number of individuals who will become eligible for retirement (p. 48).
Communicable disease among Army troops during the year was unusual in one respect-a marked shortening of the duration of the respiratory disease season (p. 50). The use of standardized adenovirus vaccine, beginning in February and March 1960, marked the fruition of more than 6 years of studies and trials within the Army (p. 50).
In addition to the occupational health hazards associated with industrial operations and the complexity of the newer weapons systems, the Army Medical Service is now faced with problems arising from the development of 'closed ecological systems' (isolated and controlled environment), within which men may be expected to live and carry out their military tasks. Liaison was established during the year with other technical services concerned to facilitate the exchange of technical and medical information relative to the solution of these new problems (p. 51).
With the rapidly increasing use of radioactive materials within the Army and the resultant increase in the number of persons handling them, the exposure to the hazard of ionizing radiation is constantly growing. A very large portion of the work of the Preventive Medicine Division in the Office of The Surgeon General is now devoted to dealing with problems of radiation (p. 53)
The increased resistance of numerous species of insects to insecticides in many areas of the world has developed into one of the more important problems in arthropodborne disease prevention. During the year, the U.S. Army Environmental Health Laboratory prepared and distributed a worldwide list of medically important insect-resistant species of arthropods (p. 54)
Information on health practices and disease conditions in the various countries of the world is being collected and published in a series of reports by the Department of Health Data of the Walter Reed Army Institute of Research for the use primarily of Army Medical Service officers. Eight studies published during the year were devoted to tropical and subtropical countries (p. 58)
With more than 6,000 Army aviators now on active duty and the number expected to increase during the next few years, there has been a correspondingly increased requirement for Army aviation medical officers to provide the necessary preventive and therapeutic medical
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care. During the year, 7 more medical officers qualified as flight surgeons, increasing the number in the Army Medical Service to 18 (p. 62). There were 138 Medical Service Corps aviators on active duty at the end of the fiscal year as compared to 125 on 30 June 1959 and the established requirement for 158 (p. 64). Three of the four Army Medical Service helicopter detachments in the continental United States were equipped during the year with the new turboprop Bell HU-1A (Iroquois) helicopters which have demonstrated their ability to perform well in all kinds of weather and at varying altitudes while fully loaded (p. 64).
The Army Medical Service took another stride forward in its program to modernize medical units in accordance with the present concepts of future warfare when the Department of the Army approved the establishment of the first medical air ambulance company (p. 67).
All aspects of the medical support provided during the Lebanon Operation (July-October 1958) were evaluated and measures were recommended for improving and strengthening such support in any similar operation in the future (p. 70).
Fiscal year 1960 marked the first year of operation of the expanded U.S. Army Medical Service Combat Development Program. This program was established for the purpose of developing and testing new concepts of doctrine, operations, organizations, and materiel for field medical units in consonance with the constantly changing concepts of the Army and of future warfare (p. 73). During the year, progress was made in developing a system for estimating nuclear warfare casualties (p. 72).
The budget of nearly $16 million made available to the Army Medical Service for its Research and Development Program in fiscal year 1960 supported 28 major projects, primarily in the fields of communicable disease, medical problems of ionizing radiation, and internal medicine, including metabolism and nutrition. Research in the field of accidental trauma, recognized as a national problem, is being transferred from the Army to the U.S. Public Health Service (p. 74). The progress made during the year in the various fields of research is discussed in the body of the report.
Although there were still shortages in certain medical specialties, the situation in regard to the procurement and retention of Medical Corps officers was generally brighter. There were increases in applications for many of the procurement programs, and the number of physicians who volunteered for active duty exceeded the requirements (p. 86). The increasing impact that the professional training program is having upon the procurement and retention of Regular Army medical officers is evidenced by the net gain of nearly 400 in the past 4 years. The Regular Army strength of the Med year was 1,725-only 8 short of the
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Regular Army strength of the Medical Corps at the end of the fiscal year was l,725-only 8 short of the post-World War II peak attained during the Korean War period (p. 86). Of the total Army Medical Corps strength (3,644), there were 1,496 specialists (board-certified and board-eligible officers) representing 28 different medical specialties on duty at the end of the fiscal year, as compared to estimated requirements for 1,838 (p. 105).
The Dental Corps Regular Army strength increased to a new alltime high of 555 despite the decline in the total strength of the corps (p. 88). The Army Medical Service encountered no difficulty in procuring general-duty dental officers, but was again unable to meet the procurement requirements for such specialists as oral surgeons, periodontists, orthodontists, and prosthodontists (p. 87). Three dental officers were certified by American specialty boards during the year, and the Dental Corps had a total of 56 diplomates on duty at the end of the fiscal year (p. 107).
In order to maintain a balanced Regular Army Veterinary Corps, the Department of the Army authorized The Surgeon General to procure 29 additional Regular Army veterinary officers in the rank of first lieutenant (p. 88). The Surgeon General has placed greater emphasis on the training and utilization of veterinary officers in research in order to develop improved techniques in food inspection and to provide timely and efficient support of field armies in keeping with the latest concepts of modern warfare (p. 140). Veterinary officers are engaged in continuous research on animal diseases transmissible to man (p. 141).
The procurement of Regular Army officers for the Medical Service Corps continued at an unusually high rate, and the yearend Regular Army strength of the corps was only 187 below the authorization of 1,612 (p. 88). With the number of vacancies in the Medical Service Corps steadily decreasing, The Surgeon General has raised the minimum educational requirements acceptable for appointment in either the Regular Army or the Reserve components of the corps. Under this new policy, no applicant will be considered for a commission unless he has a bachelor's degree (p. 89). The Deputy Chief of Staff for Personnel directed that, beginning in fiscal year 1961, most of the newly commissioned Reserve officers ordered to active duty in the Pharmacy, Supply, and Administration Section of the corps will be selected from Reserve Officers' Training Corps graduates (p. 89).
The steadily decreasing number of Regular Army officers in the Army Nurse Corps is a matter of great concern, since within the next 5 years of the officers will be mandatorily retired (because of age) or will elect to retire voluntarily on the basis of their years of service. A vigorous recruitment program has been directed toward influencing
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young Reserve officers to apply for Regular Army commissions (p. 90). Most Army stations, particularly those in the continental United States, experienced a consistent shortage of Army nurses during the year (p. 95).
The overall status of Army Medical Specialist Corps officer procurement and retention continued to improve, and all three sections of the corps were either at or above their authorized strength at the end of the fiscal year. Because of the higher retention rate, procurement of officers for this corps was halted in the middle of the fiscal year in order to meet the programmed yearend strength (p. 91). Losses sustained during the year, however, resulted in a decline of the Regular Army strength of the corps to 175-only 50 percent of its authorized strength (p. 93).
Under a new warrant officer career program established by The Adjutant General, Reserve warrant officers in the Army Medical Service will be restricted in the foreseeable future to one specialty-medical equipment repair technician. All Reserve medical administrative and medical supply warrant officers with less than 15 years of total active service will be required to retrain in the medical equipment repair field, to apply for some nonmedical specialty, or to be released from active duty (p. 96).
Although there was a net overstrength of 2,648 enlisted personnel in the Army Medical Service at the end of the fiscal year, this represents approximately the number of losses anticipated during the early months of fiscal year 1961. The only significant shortage of enlisted personnel was that of pharmacy specialists, which has resulted from the fact that smaller numbers of pharmacists are entering the Army through the Selective Service System (p. 97).
The Surgeon General's plan of affiliating certain class I hospitals with class II hospitals which are conducting approved residency training programs in general surgery is being implemented. This is to be a pilot program and, if successful, may be extended to include other surgical specialties (p. 104).
The Surgeon General continued to place special emphasis on the training of the individual soldier for survival in the event of a nuclear attack (p. 128). The latest Army Medical Service doctrine for response to nuclear disaster was demonstrated in Operation SURVIVAL conducted in March 1960 at Fort Sam Houston by the Army Medical Service School before some of the Nation's leading civilian medical educators, top-ranking military personnel of the three military services, and Army Medical Service instructors (p. 128).
More than 530 foreign nationals from 70 countries participated in observer and school training conducted during the year by the Army Medical Service (p. 129). This training has contributed to a better
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understanding and improved relations between the United States and its allies.
By the end of the fiscal year, all but 5 of the 87 accredited medical schools in the country were participating in the Medical Education for National Defense Program, established in 1952, to indoctrinate medical students in applying the principles of medicine and surgery to a military situation involving mass casualties resulting from a nuclear attack or civil disaster (p. 129).
The marked downward trend in the number of civilian employees in the Army Medical Service continued with only 8,386 on the rolls as of 30 June 1960 as compared to 9,055 a year earlier and 9,748 at the end of fiscal year 1958. Most of this decline has been in the class II installations and activities (p. 130). There was an increase in the number of civilian employees participating in the Army's suggestion program, and the suggestions that were adopted resulted in an estimated first-year savings to the Army Medical Service of more than $97,000 (p. 134).
The distribution of supplies for the emergency medical care of nuclear casualties was continued during the year when more than $3,300,000 was made available for the procurement and distribution of Phase I and Phase II Emergency Medical Treatment Units to posts, camps, and stations (p. 135).
While the Military Medical Supply Agency, under the direction of single manager (Navy), purchases wholesale stocks of standard items of medical equipment and supplies for all three military medical services, The Surgeon General is responsible for certain purchasing and contracting functions at the retail level. The extent of The Surgeon General's responsibility is indicated by the fact that purchasing and contracting officers in the Office of The Surgeon General and class II installations and activities contracted for supplies and services in the amount of nearly $80 million in the fiscal year (p. 136)
Emphasis continued on the program initiated in fiscal year 1958 to reconstitute major medical assemblages (p. 137). Special stress was also placed on the effective maintenance of medical equipment, particularly at the using level (p. 138). Continuous effort is being made to replace wornout and obsolete equipment in use at medical facilities with modern and improved equipment in order to keep pace with new trends in medical technology (p. 140).
One new Army hospital was dedicated, construction of two more was nearing completion, and contracts for three others were awarded during the year as progress continued on the program to replace outmoded facilities (p. 142). A project for the construction of a new "health facility" at the Aberdeen Proving Ground, Md., was included
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in the proposed fiscal year 1961 military construction program. This health facility includes a 75-bed hospital, a dental clinic, outpatient facilities, and a heating plant. This new concept of providing health facilities was developed primarily to provide for the ever-increasing outpatient loads at Army medical facilities (p. 145). As the result of a change in programming procedures for hospital construction at class I installations, The Surgeon General will initiate all hospital replacement projects (p. 145). Further progress was made during the year in the program to provide modern quarters for female officers (p. 146).
In an effort to promote better care, The Surgeon General established a system to provide for the exchange among the various medical facilities of information concerning noteworthy improvements developed by hospitals and dispensaries in the management of their facilities (p. 149). The Army Medical Service continued its program for modernization of accounting operations through mechanization (p. 151).
Military careers of more reasonable length can now be anticipated for Army Medical Service Reserve officers as a result of the signing by the President of H.R. 8186, a bill to amend the Reserve Officer Personnel Act of 1954. The revised act authorized the Secretary of the Army to retain Medical, Dental, Army Nurse, and Army Medical Specialist Corps reservists in an active status within the Reserve, with their consent, until they reach 60 years of age. This should reduce the large number of losses of officers which had been expected in these corps during the next 5 years (p. 154). The amendment also raises the top authorized rank for Army Nurse and Army Medical Specialist Corps officers in the Reserve (p. 154).
In response to the request for assistance from the Chilean Government, to the U.S. State Department, after the devastating earthquakes in Chile late in May 1960, the U.S. Army airlifted two field hospitals, along with their personnel and equipment, and two medical helicopter ambulance detachments to assist in the evacuation and care of the injured and to help prevent outbreaks of epidemic diseases (p. 157). After this assistance had been provided, the U.S. Government donated the equipment of the two field hospitals to the Chilean Government. Apart from the humanitarian aspects of the mission to Chile, the airlift demonstrated that the U.S. Army Medical Service field hospitals could be assembled, transported, and set up for operation within a relatively few hours, regardless of the distances involved.
A proposal to reorganize the organizational structure of the Office of The Surgeon General and establish a directorate system was under study during the year (p. 161).
The Surgeon General initiated a series of technical bulletins designed
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to disseminate current professional and administrative information for the guidance of Army Medical Service personnel (p. 162).
A new Department of Defense directive authorized the Surgeons General of the three military medical services to establish procedures whereby access to medical records may be granted to qualified individuals engaged in medical research and study (p. 163).
The 15th volume in the history of the U.S. Army Medical Department in World War II was published, and the 16th and 17th volumes were about ready to go to press as the fiscal year ended. Manuscripts for 5 more volumes were being edited, while 22 other volumes were in various stages of preparation (p. 165) .
