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

120 MILITARY 
MEDICINE, Vol. 175, August Supplement 2010
as medical director and inspector of hospitals demonstrate a 
concerted effort to improve soldier fi tness on a broad scope.
11
Scientifi c predictability, however, remained elusive for mil-
itary physicians of the early and mid-19th century. During this 
era, John Dalton introduced atomic theory; Friedrich Woehler 
established organic chemistry, Justus von Liebig began study-
ing the chemical components of food, and Claude Bernard 
established physiology as a science. Furthermore, Britain and 
America were embracing a more humanitarian approach to 
social problems. The wretched working conditions of indus-
trial factories were exposed, poverty became associated with 
disease, as did fi lth and immorality, and a growing public con-
sciousness and responsibility for these issues arose. 
SCIENCE-BASED FITNESS 
Before the new science or social consciousness could impact 
the military, the Crimean War intervened and proved to be 
a powerful catalyst for change in the British Army Medical 
Service. The 18th century line–medical relationship had van-
ished, concern for the common soldier was nonexistent, the 
supply system failed miserably, and evacuation was inade-
quate. Cholera, malaria, dysentery, and scurvy soon inundated 
the ranks compounding the supply and transport problems, 
overcrowding the hospitals, and increasing the mortality 
rates. 
The British minister of war dispatched Florence Nightingale 
and the English Sanitary Commission to re-establish order 
and effi ciency. In 1857, a royal commission was appointed to 
inquire about the sanitary condition of the British army and 
prepared a new edition of the Queen’s hospital regulations.
12
The new regulations made the medical offi cer an advisor to 
the commanding offi cer “in all matters affecting the health 
of troops whether as regards garrisons, stations, camps and 
barracks, or diet, clothing, drills, duties, or exercises.” The 
commission also recommended the establishment of an Army 
medical school in which “the specialties of military medi-
cine, surgery, hygiene, and sanitary science” could be taught 
to new medical offi cers.
12
To assist with this educational task, 
Edmund A. Parkes wrote Practical Hygiene , a text book that 
addressed the medical offi cer’s duties and responsibilities in 
recruiting, feeding, clothing, training, and quartering the sol-
dier, based on science and experience. 
The time between the work of the royal commission and 
Parkes’ text and the beginning of the American Civil War 
was too short to impact the U.S. Army Medical Department. 
Medical care at First Bull Run was as disastrous as the battle. 
This led to the creation of the U.S. Sanitary Commission, a 
civilian directed organization with semioffi cial government 
status and plenty of political clout, which they used to have 
William Hammond inserted as surgeon general. Hammond’s 
tenure would be short—he and Secretary of War Stanton never 
got along, but his ideas for the administration, education, and 
operational employment of the department make him one of 
the U.S. Army’s fi nest surgeons general. In the spring of 1862, 
he ordered the establishment of an army medical museum, 
directed a medical history of the war be prepared, and planned 
for a postgraduate army medical school. The following year 
he published A Treatise on Hygiene and had it issued to med-
ical offi cers. In it he defi ned the parameters of the military 
physical examination, temperament, heredity, and the impact 
of age, etc., on recruits and reasons for their rejection.
13
In the 40 years following the Civil War, a wide range of 
technical sciences developed that changed the organization 
and operations of our military and naval forces. Likewise, 
physiology, bacteriology, and immunology began to redefi ne 
the practice of surgery, medicine, and public health. In both the 
military and in medicine, these new sciences created a special-
ized body of knowledge that required specifi c and continued 
education. While this fostered a new sense of professional-
ism, it also broadened the intellectual gap between line and 
medical offi cers. The expanse of that gap became apparent in 
our war with Spain in 1898. Yellow fever terrorized our army 
on Cuba, but malaria brought it to its knees. Simultaneously 
typhoid fever ravaged state volunteers in mobilization camps 
where sanitation and hygiene discipline had been ignored by 
troops, commanders, and regimental surgeons alike.
14
In the aftermath, the Dodge Commission investigated why 
the army and its medical department had not covered them-
selves with glory. Many recommendations were forthcom-
ing regarding medical personnel, supplies, reporting, etc., 
and Surgeon General George M. Sternberg added an addi-
tional responsibility: education of the line offi cer concern-
ing soldier health. This revival of 18th century thought was 
supported in full by Edward Munson’s comprehensive text, 
Military Hygiene , in 1901 as he noted it was meant as “a 
practical guide to offi cers of the line.”
15
In it he discussed 
rations, clothing, equipment and weight, marching, camps, 
etc. Four years later courses in sanitation and hygiene, taught 
by medical corps offi cers, were begun at West Point, and 
in 1914 a textbook was published for the cadets.
16
In 1908, 
Captain Munson was detailed to the School of the Line at Fort 
Leavenworth where he worked with Major John Morrison to 
integrate soldier health into the military art curriculum and 
educate the commander about his sanitary assets, responsi-
bilities, and the value of his medical staff.
17
The benefi cial 
results of their efforts—as well as medical advances, such as 
water chlorination, typhoid immunization, and the Lyster bag, 
which prevented diseases common to soldiers—were seen 
during the expedition to Mexico in 1916 and continued as we 
deployed soldiers to the war torn fi elds of France the following 
year. 
World War I was a watershed in military and military 
medical history, the fi rst industrial war. The use of automatic 
weapons, heavy artillery, submarines, aircraft, and chemi-
cal weapons became routine and lethal, and medical science 
achieved a tremendous amount of predictability. Medical 
examinations were now more effi cient at fi ltering out recruits 
mentally and physically unfi t for service, typhoid immuniza-
tion, and camp sanitation and hygiene became standard prac-
tices. The First World War was also a laboratory for learning 
Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/118/4344680 by guest on 06 September 2023

---

Military Hygiene Enters the 21st Century