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CHAPTER 1
Introduction
The term disaster usually evokes images of massive material damage and great human distress caused by some swift catastrophe. In offering a more rigorous definition, a leading sociologist has defined a disaster as a sudden event that disrupts the social structure, and prevents execution of some or all of its essential functions. Commonly, disasters caused by natural forces or events are distinguished from those that man brings upon himself. With one exception, the disasters examined in this study are natural, though they may have been provoked or exacerbated by human customs or follies. Specifically, the study examines how Army medical personnel have responded to such events and shows how they aided disrupted civil societies or communities by furnishing health care.1
Studies of disaster relief usually focus on fires, floods, storms, and earthquakes. Two other types of calamities- famines and epidemics- are included here. Such happenings are in truth disasters since they disrupt the social structure and interrupt some of its essential functions. They often occur as direct results of natural upheavals or of war, and a story of medical assistance that excluded them would obviously be incomplete.
Significant changes in the response to disaster have developed over the past two centuries. Disasters of all types awed early Americans, who did not understand their causes; settle interpreted disaster as a supernatural message, while others sought an elusive natural explanation, Since the eighteenth century, the search for causes has revealed disasters to be understandable natural occurrences that scientists have tried with increasing sophistication to explain, predict, and- especially for epidemics- prevent. Without an organization to deliver aid, however, more knowledge would have accomplished little. During the same period, American society developed a much more organized and comprehensive response to disaster;
1Charles E. Fritz, "Disaster," in Contemporary Social Problems, ed. Robert K. Merton and Robert A. Nisbet (New York: Harcourt, Brace & World, 1961), p. 655; "Disasters," in International Encyclopedia of the Social Sciences (New York: Macmillan Co. & Free, Press, 1968), pp, 202- 7. One disaster that was caused by man, the Texas City explosion of 1947, is included in this study because it did disrupt the community and because the Army responded in the same fashion as in natural disasters.
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in this evolution, the federal government came to play an increasing role.
In the early nineteenth century, the national government accepted no responsibility for helping its citizens cope with disaster. Nor did many local agencies or voluntary groups exist to provide relief, though most Americans considered disaster assistance a task for local government or voluntary associations when self-help failed. But in the latter half of the nineteenth century, the, suffering of victims- the "overruling demands of humanity" in the language of the War Department`s first regulation on civilian assistance- began to transform traditional attitudes and practices. During the century and a half that followed, the nation organized, perhaps over organized, for disaster relief as it did for other purposes. By the 1970`s a plethora of acts administered by a host of agencies guided federal relief efforts, and many local agencies and voluntary groups furnished assistance as well.2
Within this changing context, the relief role of the Army Medical Department developed. Medical Department aid was almost always part of the Army`s overall disaster assistance mission. From the first, Army regulations delegated authority over assistance missions to area commanders who, when they considered it necessary, integrated medical units or personnel into relief operations. These line officers, rather than The Surgeon General or the department he commanded assumed responsibility in planning before disasters and in committing medical resources once calamity struck. The history of Army medical relief, consequently, is more a story of the contributions of individual medical units and personnel than an institutional study of the Medical Department. Because the department rarely acted alone, its work must be examined as part of the development of the Army`s overall relief mission.
Army disaster relief began shortly after the Civil War and increased throughout file late nineteenth century. During that period, Army aid rarely included medical care, in part because of the relatively primitive state of the healing arts. Only with the emergence of modern medicine did doctors acquire skills that equipped them to offer significant help to distressed communities. At the time that happened, however, neither local authorities nor voluntary associations had the capability to provide extensive medical assistance. In this organizational near-vacuum during the first years of the twentieth century, Army medical personnel became the nation`s primary source of medical and public health aid in domestic disasters.
After World War I, tensions arose between the Army and the Red
2Quote from Special Regulation 67, "Regulations Governing Flood Relief Work of the War Department," 1917, copy in Record Group 407, National Archives, (NA).
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Cross over authority in relief operations and between the Army and Congress over funding of relief activities. As a result, the Army became uncertain about its assistance role in the interwar years, and Army medical participation declined. After the Second World War, the federal government accepted greater responsibility in disaster situations and created civilian institutions to reduce tensions between agencies and ensure funding, but it never completely abandoned older traditions of localism and voluntarism. In fact, the federal government gradually concentrated its efforts, on long-term rehabilitation, leaving the responsibility for immediate relief to local and private groups. Within the newly organized federal disaster aid structure, Army medical participation continued at the low, pre-World War II level, though certain emergencies so taxed civilian resources that some military assistance continued to be needed.
Unlike domestic relief, foreign disaster assistance was rendered only sporadically before World War II. The United States undertook a few missions in the nineteenth century and many more-often with the help of the Army-during the early twentieth century in Caribbean countries and the Philippines. For a short time after the Spanish-American War and also after the First World War, unusual circumstances involved the Army Medical Department insubstantial relief operations abroad. Both periods proved exceptions, however, to the general inactivity. In the years after 1945, intercontinental air transportation, the stationing of American troops abroad, and the cold war increased both the means and motives for the United States to provide assistance abroad. The government created civilian coordinating institutions to direct and provide such relief, but Army medical personnel still frequently rendered foreign disaster assistance.
By 1976, the United States government had a history of providing disaster assistance both to its own and to foreign communities. Relief that had been rendered only in isolated instances in the nineteenth century had become routine, and complex civilian bureaucracies had developed to direct both foreign and domestic operations. Once the only agency to which the government could turn to provide disaster relief, the Army was now but one of many from which civilian relief officials could request help. At times, however, civilian resources still proved inadequate, and Army medical personnel went once again to the assistance of civilian communities.
