A Decade of Progress - Contents
The Beginning of an Era
Make no little plans; they have no magic to stir men's blood, and probably themselves will not be realized. Make big plans; aim high in hope and work, remembering that a noble, logical diagram once recorded will never die, but long after we are gone will be a living thing, asserting itself with ever growing insistency.-DANIEL H. BURNHAM.
CHANGE OF COMMAND
On 1 June 1959, Major General Leonard D. Heaton became Surgeon General of the U.S. Army. Physician-soldier in the tradition begun by Dr. Joseph Warren at Bunker Hill, he was congratulated by President Dwight D. Eisenhower, a warm personal friend as well as the Commander in Chief. His selection was also applauded by his military peers, distinguished physicians, and four former Army Surgeons General who had watched his growth from a promising junior officer in the Medical Corps to a gifted surgeon, outstanding soldier, skilled administrator of world renown, and, with his promotion to lieutenant general in September 1959 (fig. 1), the only Surgeon General to hold three-star rank.
Appointment as The Surgeon General was the apogee of a military-medical career that began in 1926 when Leonard D. Heaton, an honor graduate of Denison University, Granville, Ohio, and the University of Louisville School of Medicine, Louisville, Ky., was commissioned a first lieutenant in the Army Medical Corps. Following completion of his internship at Letterman General Hospital, San Francisco, Calif., to which he was later
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FIGURE 1.-Lieutenant General Leonard Dudley Heaton, The Surgeon General, United States Army, 1959-1969.
to return as commander, he attended the Army Medical School, Washington, D.C., and the Medical Field Service School, Carlisle Barracks, Pa. In 1947, he was graduated with distinction from the Command and General Staff College, Fort Leavenworth, Kansas.
As a physician, he early demonstrated his ability in surgery, serving successively on the surgical services of William Beaumont General Hospital, El Paso, Tex., Tripler General Hospital, Honolulu, Hawaii, the Station Hos-
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pital, Fort Sam Houston, Tex., and the Station Hospital, Fort Francis E. Warren, Wyo., during the 1930's.
He saw active duty in both the Pacific and the European theaters during World War II. Chief of Surgical Service of North Sector General Hospital, Schofield Barracks, Hawaii, on 7 December 1941, he was awarded the Legion of Merit for his skillful handling of mass casualties after the Pearl Harbor attack. After a tour as executive officer, Woodrow Wilson General Hospital, Staunton, Va., from 1942 to 1944, he served in the European Theater of Operations from 1944 to 1945 as commanding officer of the 160th General Hospital and the 802d Hospital Center, both in England.
Promoted to brigadier general in May 1948, he commanded the great Letterman General Hospital. In 1953, then a major general, he assumed command of Walter Reed Army Medical Center, Washington, D.C.
A working practitioner despite the heavy burdens of administrative office as commander of Walter Reed Army Medical Center and later as The Surgeon General, he continued to employ his surgeon's skill for "his country's heroes, the famous and the little-known," as the trustees of Brandeis University, Waltham, Mass., noted in awarding him an honorary degree. Among his famous patients were President Eisenhower (fig. 2), Secretary of State John Foster Dulles, Field Marshal Sarat Thanarat of Thailand, General of the Army George C. Marshall, and Prince Mashhur of Saudi Arabia. A dedicated teacher as well as a gifted physician and surgeon, he continued to operate regularly at the Walter Reed General Hospital with talented younger surgeons, instilling in them his high standards of medical practice, imbuing them with his sense of dedication, and winning their gratitude and devotion for his selfless interest in their careers. He also shared his knowledge of surgery and medical administration with a large audience through the publication of dozens of articles.
The Nation honored him with the award of the Legion of Merit with two oak leaf clusters and the Distinguished
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FIGURE 2.-President Dwight D. Eisenhower and Major General Leonard D. Heaton leave Walter Reed General Hospital after a visit to Secretary of State John Foster Dulles, then a patient, 13 April 1959. (Armed Forces Institute of Pathology photograph.)
Service Medal with two oak leaf clusters (fig. 3). The Government of Thailand conferred on him its two highest decorations, an honor rarely accorded a foreigner. The Royal Army Medical College awarded him the Guthrie Medal in March 1968 in recognition of his outstanding services to military surgery and his unfailing cooperation with the medical services of the British Army. He was elected an Honorary Fellow of the Royal College of Surgeons in April 1969. The medical profession recognized his talents with the diploma of the American Board of Surgery and fellowship in numerous medical organizations. He was awarded honorary degrees by Denison University, University of Louisville, West Virginia University, Brandeis University (fig. 4), Seoul National University, Seoul, South Korea, and Gettysburg College, Gettysburg, Pennsylvania.
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FIGURE 3.-General Heaton received the Distinguished Service Medal from General Earle G. Wheeler, Chief of Staff, U.S. Army, 15 May 1964. (U.S. Army photograph by Sgt. K. C. Uchima.)
President John F. Kennedy accorded him a signal honor in 1963 when he extended his tenure as The Surgeon General to June 1965, the first time in more than 30 years that such an assignment had been extended beyond the usual 4-year period. In a precedent-shattering action, President Lyndon B. Johnson extended his assignment until May 1969. In approving Secretary of Defense Clark D. Clifford's recommendation that General Heaton be retained as The Surgeon General, President Johnson stated:
As you have earned his confidence and the admiration of all in the Armed Services, so you have won my own respect and appreciation. Your leadership has been marked with a consistency of wisdom and compassion that is rare to any executive level. I know that you will continue to demonstrate that singular devotion to duty and to the most humane interests of man. You will always have my personal gratitude for that.
Thus, General Heaton, who had ably served under three
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FIGURE 4.-Dr. George P. Berry, Dean of Faculty and Dean, Harvard University Medical School, Boston, Mass., with actress Helen Hayes and Lieutenant General Leonard D. Heaton at the Thirteenth Commencement of Brandeis University, Waltham, Mass., 7 June 1964. General Heaton received the degree of Doctor of Humane Letters, honoris causa. (U.S. Army photograph.)
presidents, continued his service as The Surgeon General under a fourth, when Richard Nixon was inaugurated as 37th President of the United States in January 1969. On 23 May, President Nixon formally extended General Heaton's term of office until 1 October 1969. Commenting on General Heaton's impact on the Army Medical Department1 in the period that he was The Surgeon General, Major General Laurence A. Potter, Commanding General, Brooke Army Medical Center, Fort Sam Houston, Tex., said:
1Known as the U.S. Army Medical Service at the beginning of the decade, the name U.S. Army Medical Department was restored by Public Law 90-329, 4 June 1968. It is best known by this designation, which was used from 1818 to 1950. Accordingly, "Army Medical Department" will be used in the narrative of events in the decade from June 1959 to June 1969.
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The tremendous advances in the quality of medical services rendered to the soldier and his dependents in the U.S. Army over the past 10 years bear the indelible stamp of Lieutenant General Leonard D. Heaton, who has insisted that the soldier must go "first class" where medical care is concerned.
MAGNITUDE OF THE TASK
The mission of the Army Medical Department is to maintain the health of the Army so as to conserve its fighting strength and to prepare in time of peace for service in time of war. This mission is clear and single in purpose, but the instruments and mechanics for accomplishing it are multiple and complex. The Army Medical Department is concerned with the selection of the physically and mentally able soldier, prevention and control of diseases and injuries, evacuation and care of the sick and wounded, research and development, training, logistics, management, and organization. It involves men and women of diversified skills and experience; many types of facilities, equipment, materiel, and services; and, of course, considerable sums of money. Funds to support Medical Department activities in fiscal year 1969 totaled more than $550 million. Noteworthy is the fact that this sum did not include funds appropriated for military pay, construction of medical facilities, or direct costs for medical support of combat operations in Southeast Asia.
The primary mission of the Army Medical Department has remained the same since its inception in the Revolutionary War. The only changes since that time have been in the scope of the task involved and in the conditions and circumstances under which this mission must be accomplished. These changes were monumental in the decade that General Heaton was The Surgeon General. The practice of military medicine, in truth, became more complex with each passing year. Not only did the scope of professional medical care steadily broaden with the constant advances that were made in medicine and surgery, but also the medical problems
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of military preparedness increased in magnitude and intensity in the uncertainties of an atomic age. Responsibility for the execution of this mission was vested in The Surgeon General.
THE ROLE OF THE SURGEON GENERAL
The Surgeon General has both staff and command responsibilities. As a staff officer under the Deputy Chief of Staff for Personnel, he is chief of the health services of the Army and adviser to the Chief of Staff on health and medical matters as well. He also commands certain Army medical facilities and exercises technical staff supervision over others, as well as over all Army medical units. As chief of the Army Medical Department, he is responsible for medical professional training, career development of commissioned personnel, and Army medical research and development activities. On health and medical matters, The Surgeon General has direct access to the Secretary of the Army and the Chief of Staff.
In 1962, a momentous reorganization of Department of the Army headquarters was consummated. As planning for this reorganization gained momentum in 1961, General Heaton guided his staff in a successful presentation of the need for a strong medical element in the structure of the Army Headquarters and the retention of major medical facilities and teaching hospitals under the command of The Surgeon General. The case was presented and pursued in a manner that left the position and prerogatives of The Surgeon General stronger after the reorganization, which was designed to abolish the technical services, than it had been before. The loss of direct control over the advanced individual training of enlisted personnel of the Medical Department was counterbalanced by the designation of The Surgeon General as program director of all medical service activities, the recognition of The Surgeon General as the agent for the assignment and career development of
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all Medical Department officers, the shifting of the Office of The Surgeon General from Army general staff supervision by the Deputy Chief of Staff for Logistics to supervision by the Deputy Chief of Staff for Personnel, a change long sought by General Heaton, and the assignment of full responsibility for all medical research programs and activities within the Army to The Surgeon General.
In contrast to the formal and official delineation of his responsibilities embodied in regulations, General Heaton expressed his view of the scope and complexity of his duties in blunt words and homely terms when he became The Surgeon General in 1959:
The responsibilities of The Surgeon General are numerous indeed, ranging from daily operational actions to the broadest of policy decisions; from signing routine correspondence to advising the Chief of Staff and the Secretary of the Army. However, there is one responsibility that looms above all others. One responsibility on which there can be no buck passing. The Surgeon General must direct the course of the Army Medical Service * * * the operating philosophy of the Army Medical Service, if you please. He and he alone is responsible for that.
CONCEPT OF OPERATIONS: THE FIVE PILLARS OF MILITARY MEDICINE
Commenting on the base-rock principles which guided General Heaton during the turbulent decade in which he exercised top leadership of the Army Medical Department, General Potter said: "His philosophy of office has been quite simple-to provide the best possible medical service for the time and the place for all those eligible for care."
General Heaton expressed his philosophy in yet another way soon after he became The Surgeon General in June 1959. At that time, he had been a physician-soldier for more than 33 years. Reflecting on the ideas that he had formulated in this period of service, he commented wryly: "It is inevitable that over this long period I should have formulated some definite concepts
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as to the major objectives of the Army Medical Service and the road that we must take to achieve these objectives." This interrelated body of doctrine, which became the "operating philosophy" of the Army Medical Department, he termed the five pillars of military medicine: The practice of medicine, including the art of medicine as well as curative and preventive medicine; field medicine or combat readiness; medical education and training; medical research and development; and medical administration and management.
In assuming the office of The Surgeon General, General Heaton took command of a Medical Department that was, in his judgment, "a well going concern that is doing an excellent job today and has momentum for doing a better job tomorrow." He considered it his duty, he stated succinctly, "to see that the progress of the Army Medical Service is not only continued but accelerated during my period in office." The manner in which true progress could be achieved would be to move forward on a broad front to attain the highest degree of perfection in all of these objectives. "The goal," he stated, "is the practice of total medicine."
As a means to attain increasing perfection in each of these objectives and thus move closer to the goal of the practice to total medicine, he recommended adoption of the methods and techniques he had successfully employed throughout his career as a physician-soldier and administrator. He emphasized the importance of attention to details, the need for balance and proportion in planning as well as the simultaneous pursuit of improvement in all programs, the careful selection of subordinate personnel, and the necessity for the delegation of authority wherever possible. General Potter, commenting on General Heaton's unusual qualifications for the office of The Surgeon General, said:
To keep all the programs of improvement in the Medical Department simultaneously in high gear has required a very special individual known and respected both in and outside of the Army, both in and outside the field of medicine as a surgeon of great
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skill, a successful commander, and increasingly evident as a most effective staff officer and an outstanding leader of men. His high order of intelligence, long military service, and professional experience serve him well, but tying these together and extending their effectiveness are his prodigious memory and his ability to turn a job over completely to a carefully selected subordinate and leave it entirely to his hands, while he, without second thoughts, gave his entire attention and time to other pressing problems and emergencies. These two things above all else have permitted him to survive the pressures of one of the most prolonged periods of intense military activity in our history.
THE OFFICE OF THE SURGEON GENERAL
The Office of The Surgeon General is the medium whereby the policies of The Surgeon General are translated into specific programs and plans. It is the agency through which he directs the day-to-day worldwide operations of the Army Medical Department.
Keenly interested in improving the caliber of administration throughout the Medical Department, General Heaton approved a plan in February 1961 calling for the reorganization of the Office of The Surgeon General under a directorate system similar to that of the Office of the Deputy Chief of Staff for Logistics, Department of the Army. Under this system, which has remained basically unchanged since that date, the various divisions and offices of the Office of The Surgeon General were grouped by function into directorates, each responsible directly to The Surgeon General.
In addition to addressing himself to the reorganization of the Office of The Surgeon General for greater efficiency and effectiveness, General Heaton nurtured and supported the development of medical commands in overseas areas. The establishment of the U.S. Army Medical Command, Europe, and the U.S. Army Medical Command, Japan, which reflected his interest in keeping in step with major organizational trends in the Army also contributed significantly to the flexibility and efficiency of the Army Medical Department in overseas areas.
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HISTORY AND TRADITION
Medical Historical Program
The Army medical historical program had General Heaton's wholehearted support, as it had the support of each of his predecessors during the past two and one-half decades. This program produced several scores of volumes which, in General Heaton's judgment, are major contributions to American medical literature.
The Historical Unit, Army Medical Department, the organization charged with the responsibility of preparing official medical histories for The Surgeon General, has published 35 volumes in the series under the general title of The History of the United States Army Medical Department in World War II; nine additional volumes in this series are in various stages of preparation at The Historical Unit.
Apart from the World War II history volumes, other volumes and monographs on related subjects are published for other activities under the direction of The Surgeon General. One of these, "Emergency War Surgery," the American version of the "NATO Emergency War Surgery Handbook," published for the Department of Defense, is being widely used in Vietnam.
In consonance with General Heaton's policy that all Medical Department programs be reviewed and revised frequently to meet changing requirements, the program of The Historical Unit was evaluated periodically to ensure that it was, in truth, fully responsive to the needs of the Army Medical Department. As a result, in part, of these periodic reviews, as well as the fact that the publication of the World War II history volumes was drawing to a successful close, emphasis shifted to a comprehensive current history program.
A Proud Name Restored
In March 1968, Secretary of the Army Stanley R. Resor asked the Congress to change the 18-year-old
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name of the Army Medical Service back to its former 132-year-old designation as the Army Medical Department. The terminological confusion the Army had hoped to eliminate by changing the title from "Department" to "Service" as part of the Army Organization Act of 1950 had persisted in another form, Secretary Resor noted.
Since his appointment as The Surgeon General, General Heaton had pressed for this change, arguing that it would eliminate confusion with the multitude of service functions in the Army. Indicative of the depth of his interest in the matter is the fact that he reported personally to the Association of Military Surgeons of the United States in February 1969 that the proud name, Army Medical Department, a name, which in his judgment was more in keeping with the basic character and importance of military medicine and the professionalism of Army medical activities, had been restored by the Congress in June 1968.
