Military medicine, 175, 8: 118, 2010 118 military medicine

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MILITARY MEDICINE, 175, 8:118, 2010
118 MILITARY 
MEDICINE, Vol. 175, August Supplement 2010
INTRODUCTION 
For effi ciency and success, a military organization must be 
composed of individuals fi t enough to withstand the rigors of 
a sustained campaign and combat action. It is a simple con-
cept to understand; in fact it is intuitive. Achieving that goal 
through the application of medical science in a military envi-
ronment has been, and continues to be, a challenge for both 
line and medical offi cers. Not because the knowledge, experi-
ence, and materials do not exist to obtain and maintain such an 
organization, but because the lessons of history go unlearned. 
This article presents a short review of Western military estab-
lishment efforts to obtain and maintain a fi t force. It focuses on 
the importance of science to those efforts and the imperative of 
sound line and medical offi cer education and communication. 
FITNESS BEFORE SCIENCE 
The Romans recruited their soldiers from the young men of 
the northern provinces who engaged in the more manly trades: 
blacksmiths, carpenters, wagon makers, and hunters. These 
fellows were considered healthier, stronger, quicker to learn, 
and easier to train. Basic training consisted of weapons exer-
cises, military drill, ditch digging, felling trees, and march-
ing with equipment.
1
The armies of Imperial Rome were some 
of the most mobile known to history. The legionary carried 
50 (U.S.) pounds as he marched along smooth Roman roads. 
That weight was decreased to 44 pounds as the enemy was 
approached, and the Roman soldier engaged in combat carry-
ing only 33 pounds of equipment.
2
On campaign the legionary 
carried 3 days worth of iron rations: bacon fat, cheese, hardtack, 
and sour wine. But the garrison military diet, consisting of pro-
tein, carbohydrates, and fat, was quite nutritious, depending on 
time of year and location of garrison. The Roman army also 
had an organized, well-trained medical service, which cared 
for the physical, if not the psychologi cal trauma of battle, and 
military hospitals existed in some garrisons later in the empire. 
The Romans obtained and maintained their army in a system-
atic manner entirely on the basis of empirical evidence.
1
From the fall of Rome to the Renaissance, European 
armies came and went, but none were organized, trained, or 
maintained on the scale or in the detail of those of Imperial 
Rome. As the modern nation-state began to emerge in the late 
15th century and with it the continuing development of gun-
powder weapons, standing armies were created on the conti-
nent. Through the 16th and 17th centuries the organizational 
structure—recruiting, training, paying, and supplying—of 
these armies became more complex. The development of 
the tercio—a military formation of about 1,750 pikemen and 
arquebusiers organized by companies—by the Spanish army 
improved tactical effi ciency and strength. Later Dutch mili-
tary reforms increased tactical strength and fl exibility once 
again through routine drill, an established chain of command, 
and the development of company grade offi cers. The Swedish 
army under Gustavus Adolphus II pioneered the idea of a com-
bined arms approach on the battlefi eld. Standing European 
armies were living, breathing organisms of the state. They 
cost money to train and maintain, and therefore the loss of sol-
diers through injury or illness was a fi nancial loss to the state. 
Keeping losses to a minimum catalyzed the establishment of 
formal military medical services, created new responsibilities 
for a commander, and a new relationship between command-
ers and the physicians and surgeons serving a force whether 
on land or sea began to develop.