Epilogue
THE YEARS OF CHANGE
The period from 1865 to 1917 was one of great change for the Army Medical Department. The department initially resumed after the Civil War the form and function it had before that conflict; very little changed from the prewar model. With the Army again broken down into small units scattered about among many posts, the individual surgeon was once more responsible for all aspects of the health of a relatively few men. Medical officers had no significantly greater ability to prevent, diagnose, or treat disease than their predecessors, and their surgery was distinguished from that of 1818, when the Medical Department was first organized, principally by their use of anesthesia. But by 1917 two great revolutions-one in medicine, the other in the organization of the U.S. Army-had transformed a small department into a much larger and more complex organization whose officers were among the leaders in a new age of scientific medicine.
The gradual acceptance of the fact that small living organisms caused disease and infection opened a vast, unfamiliar, and exciting world to the physicians of the late-nineteenth century. The nation's outraged reaction to the epidemics of the Spanish-American War suggested that by 1898 the American public felt entitled to expect that the Medical Department would prevent the diseases that had traditionally devastated armies in wartime. In assigning several medical officers to study ways in which this expectation might be met, Surgeon General Sternberg, a Civil War veteran, was following in the footsteps of his illustrious predecessor of that period, Surgeon General Hammond, who had assigned some of the department's most distinguished scientists to study the illnesses that had afflicted the Union Army. By 1898, however, a confident faith in the ultimate triumph of scientific medicine had replaced Hammond's desperate hope that department scientists would discover how such diseases as typhoid were spread.
To battle these old foes, medical officers had to be able to identify the disease and pinpoint the means of its spread. Examinations of specimens of blood, urine, sputum, and feces, as well as of samples of water and food, were now part of preventive medicine and required the creation of many laboratories, both small and large. By 1917 every post hospital was expected to have the means of performing simple tests. Each major geographical area was assigned a large central laboratory, where more elaborate studies could be conducted. New and more equipment was necessary, as well as new facilities to house it, and the men who would use the equip-
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ment required training in its use, whether they were physicians or enlisted men.
The acceptance of the germ theory also transformed the practice of surgery. The adoption of antiseptic techniques minimized the chances of infection, and medical officers began to undertake operations they would never have dared during the Civil War. Appendectomies and hernia repairs became common as surgeons ventured ever further into once forbidden territory. The drive to reduce infection after surgery led to a requirement that a room be set aside exclusively for surgical operations, a step that could lead to the expense of new construction.
To the changes brought about by the new developments in the world of medicine were added those resulting from the nation's new image of itself. After 1898 the Army never returned to its pre-Spanish-American-War size, for as the nation gradually accepted its inevitable role as a world power, the responsibilities borne by its armed forces increased. The realization that the United States might have to defend its new empire from encroachment by other great nations and that it was by no means ready to do so led to the transformation of a small, simply organized military force into a larger, more complex Army and, as a result, to a larger, more complex Medical Department. Although Congress slowly acceded to the need for greater expenditures to meet the department's requirements, the new openings it created were never sufficient to meet the growing demand for medical personnel. The department was expected to furnish officers to design and manage public health campaigns in conquered territories, to conduct research into the various diseases that threatened U.S. troops wherever they were, to train civilian doctors who might be called in to assist them in an emergency, and to provide the best available medical care to sick and wounded soldiers. The department was also expected to find solutions to the administrative problems highlighted by the Dodge Commission and to produce an effective plan for hospitalization and evacuation that would be adaptable to large-scale warfare on foreign territory.
Under such circumstances, the creation of several specialized corps within the Medical Department was inevitable, in the interests both of efficiency and of guaranteeing the Army's patients the best possible care. The Dental Corps was created when it became obvious that a handful of hospital corpsmen functioning as dentists could not successfully treat the rapidly decaying teeth of the large numbers of troops being sent to the tropics. The constant need for nurses and the obvious superiority of nursing school graduates over men hastily trained led to the creation of a permanent Army Nurse Corps. The desire to guarantee the Army's animals the benefits of modern medicine resulted in the creation of the Veterinary Corps. In the movement to organize the department according to the specialties of its staff, however, the Hospital Corps, with its enlisted men who, as jacks of many trades, were often masters of none, lost its separate identity.
The trend toward specialization that led to the creation of new corps for the Medical Department affected individual Army physicians as well. The many administrative duties arising from the growing size and complexity of the department could seriously interfere with the scientific work that was also a part of the department's responsibilities to the nation's soldiers. To deal with this problem, some medical officers were allowed to concentrate for ap-
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preciable periods of time upon research with the official support of the department, which made available to them its resources in men and equipment. Those serving on the disease boards and those working in the major laboratories could not have given their research the continued effort it necessitated if they had been required at the same time to attend sick call; to function as regimental, brigade, or division surgeons; or to train National Guard doctors.
To deal with the growing size and complexity of the Medical Department and the many and varied demands that were made upon it, the Surgeon General's Office also grew in both size and complexity. The number of civilians serving the department in Washington increased significantly, in large measure to manage the vast collection of records resulting from the Civil War, but for many years the number of medical officers changed remarkably little. Even when overwhelmed by the demands of the Spanish-American War, the surgeon general delegated few of his major responsibilities to others.
Ironically, as World War I came ever nearer, the solutions to some of the Medical Department's problems complicated the solution of others. Sending medical officers to observe the work of their European counterparts enabled the department to prepare more effectively for the time when the United States would become directly involved in the conflict, but it also reduced the number of experienced military physicians available to perform more routine tasks or to train the doctors of the Medical Reserve Corps and the National Guard. The development of hospitalization and evacuation plans designed primarily for use in a major war added to the volume of information that Regular Army doctors would have to impart to their civilian counterparts. Thus the problems created by the constant shortage of regular officers were exacerbated by the effort to establish a large group of trained physicians to assist them in time of emergency.
By the spring of 1917, however, the Army Medical Department was in a position to give military patients the benefit of the most recent developments in medicine. It was also making significant progress toward instituting an organizational structure capable of handling battlefield casualties swiftly and efficiently regardless of the scale of the conflict and toward establishing both a large reserve of supplies and an effective system for delivering them wherever they might be needed. The department had even made some headway against an almost unsolvable problem, that of creating a large pool of civilian physicians who were familiar with the demands of modern military medicine. But despite the magnitude of the changes made since the late 1860s and the years of effort that followed the Spanish-American War, the Medical Department had not actually achieved any of these goals by April 1917, when the United States entered a conflict being conducted on a scale never before encountered by the armed forces of the United States.
