CHAPTER XII
Summary
The present Army Medical Service has evolved from a very small beginning in 1818. When Joseph Lovell was appointed Surgeon General in that year, he had a small office in Washington with a very limited staff. It was his responsibility to coordinate the efforts of a few physicians in widely scattered and isolated stations, serving in primitive hospitals with meager equipment. The evolution that has occurred in the 140 years from that date did not come about by chance but as a result of the continued and untiring efforts of many dedicated medical men and allied scientists. The list of notable names might include Lovell, whose foresight and wisdom built such a firm foundation for an ever-expanding and improving medical service; Beaumont, in physiology; R. H. Coolidge, in medical history; Hammond, who in 1 year`s service as Surgeon General outlined so accurately the advances in the medical service for over one-half century; Letterman, whose name connotes medical field service; Barnes, whose wise policy and diplomacy so effectively carried out his own and Hammond`s plans; Billings, the great librarian and bibliographer; Sternberg, the pioneer bacteriologist and scientist; Hoff, the medical organizer and sanitarian; Reed, the scientist, whose work with his Board gave man control over yellow fever; Gorgas, the great sanitarian, whose work demonstrated to all the world the great possibilities of effective sanitation; Kean, who, through his great wisdom and foresight, provided the sanitary code of Cuba that has for more than 50 years furnished a guide for the prevention of yellow fever there and also assisted in laying the firm foundation of the present medical service, including the Reserve Corps, the first in the Department of Defense; Russell, with his pioneer work with antityphoid inoculation; Ashford and his antihookworm work in Puerto Rico; Damall, who first demonstrated the
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effectiveness of liquid chlorine in water sterilization and who pioneered so effectively in field medical supplies; Craig, the great parasitologist; and finally, but by no means least, Surgeon General Ireland, who made many outstanding contributions, one of the greatest of which was certainly founding of the world`s first Medical Field Service School. Other names might well be added to this list, including Wood, Ainsworth, and Myer who left the Medical Service for duty in other branches of the Army. Mention might also be made of the pioneer work of the Medical Department in meteorology, ornithology and other scientific subjects.
With specific reference to medical statistics, the first Surgeon General, Lovell, recognized the necessity of accurate disease accounting and, in one of his first directives after his appointment, required medical reporting from all stations. This directive was issued 40 years before Florence Nightingale, who, after her return from the Crimea, forced adequate study and use of viral statistics in the English Army. Hence, the beginning in 1818 of medical reporting, compiling of medical statistics, and the publication of the Surgeon General`s reports. These reports, unbroken (except for the period of the Mexican War) for almost a century and a quarter from 1818 until the outbreak of World War II, contained a continuous administrative, legislative, and medical statistical history of the Army Medical Service.
The story of the evolution of the Army Medical Statistics Program from 1818 through 1908 is told briefly in this treatise and that of medical reporting from 1818 to the present. Statistical work from 1917 is described in greater detail. War was declared on 6 April 1917, and the Selective Service Act was approved on 17 May 1917. Between the latter date and 11 November 1918, military training camps sprang into being; approximately 4,000,000 men were organized, equipped, and trained by the Army; 2,000,000 of these were transported overseas; and approximately 1,000,000 were in the combat zone on 11 November 1918. The physical examination of these 4,000,000 young adult males, drawn from every section of the country without regard to any previous environmental or economic condition, offered an unusual and, in fact, the first opportunity for a physical census of great value. Such statistics
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could be compiled and studied not only by States and by urban and rural areas but also by racial groups. The medical records of so many young adults serving in many places and under many diverse conditions offered a great challenge to the statistical office. Such questions arose as, "What was the initial health condition of these men?" and "How did they react when living under conditions so foreign to so many of them?" Measurements were sought of the amount of sickness that prevailed, the number of injuries, the disabilities, the deaths, and the loss of time. In addition, a careful study was required of all battle casualties.
Before World War I, the Medical Statistics Office had evolved an efficient method of compiling statistics by hand counting. Obviously, such a system was inadequate for the work to be done in solving the problems mentioned. Fortunately, the Hollerith electrical sorting and tabulating equipment was available. Dr. Herman Hollerith had invented the equipment primarily for United States census enumerations. In fact, the machines were used extensively for the enumeration of the 1890 census. However, even before its use for the census, the equipment was used in the Office of the Surgeon General in 1888 or 1889 but was considered unsatisfactory for the purpose at that time. In the 30 years following, not only had the equipment been greatly modified and improved but the statistical problem was vastly different from that which existed in 1889. Since 1917, further improvements have been made in the equipment and now, as the IBM machines, they are indispensible in the administration of large business.
It is fortunate that the authors were able to include in this treatise an account, largely in Dr. Hollerith`s own words, of the original Hollerith equipment. In addition, the authors were able to describe the successful use of the machines in the 1890 U.S. census as reported by T. C. Martin, a science writer of that day.
Through the use of the Hollerith equipment, it was possible to make extensive studies of the war experience and of the Selective Service registrant`s health and anthropometric data. A careful study was also made of selected anthropometric measurements of 100,000 men at demobilization, the measurements having been made under expert supervision. Following the
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conclusion of this work, additional studies were made of war casualties in relation to medical and hospital requirements, and a series of biometric studies of Army officers were made. For this last-named study, a sample was available of 5,000 officers who had been under observation for an average of 20 years each or for a total of 100,000 man-years of life.
Since the conclusion of these studies, the tabulating equipment was continued in use with expanding usefulness and application. Such expansion has been required especially since the onset of World War II. As the Army expanded in numbers, as well as in worldwide scope and responsibilities, so did the activities of the Medical Statistics Division. Every effort was made by those responsible for the medical statistics program to keep forms, equipment, procedures, and reports parallel in their development to that of the Army and the country itself. Since World War II, the ever widening scope of activities of the country through its Armed Forces has resulted in an even broader medical statistics program. Based essentially on the experience of the individual, this program has for its purpose the development of uniform methods for solving common problems not only with the other branches of the Armed Forces in this country but on an international scale, to the mutual benefit of all participants.
It is the sincere hope of the authors that those administering the Army will be as wise as the Founding Fathers of the Medical Department and that there will be continued encouragement and support for the satisfactory compiling, analysis, and publication of both current and permanent statistics. Scientific statistical analysis can furnish the Army Medical Service and the country as a whole with the only reliable measurement of current success and continued advancement in its mission.
