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

MILITARY MEDICINE, Vol. 175, August Supplement 2010 121
about the performance, endurance, and resilience of soldiers 
on the modern battlefi eld. 
Trench warfare and the climate of the Western Front 
resulted in a new appreciation of cold injuries. Additional 
clothing increased the soldier’s load and the diagnosis of 
trenchfoot was added to the lexicon. The threat of chlorine gas 
brought more protective equipment, increasing the soldier’s 
load and risk of overuse injuries once again. Weaponry and 
tactics could generate thousands of casualties in a single day 
creating a never ending collage of horrors from which there 
was no escape. What we call post-traumatic stress disorder 
was fi rst noticed by British, French, and German armies early 
in the war. The French established immediate forward treat-
ment of psychiatric casualties with the expectation that they 
would return to the trenches and were therapeutically quite 
successful, boasting a 91% return to duty rate.
18
The British 
labeled these cases as “shell shock” and began treating them 
in forward areas with rest and hypnosis, but ignored expec-
tancy.
19
By the time Surgeon General William C. Gorgas sent 
Thomas Salmon, MD to study British and French methods 
of dealing with war neurosis in 1917, the treatment imper-
atives of proximity, immediacy, and expectancy had been 
established. Salmon incorporated the best parts of French and 
British therapy into three levels of psychiatry at the front—
through division psychiatrists, at neurologic hospitals, and at 
base hospitals.
20
MILITARY HYGIENE VERSUS PREVENTIVE 
MEDICINE 
In the immediate postwar years, military hygiene as an inte-
grated line to medical education process at Leavenworth con-
tinued, but was signifi cantly reduced as the course was cut 
from 2 years to 1. Moreover, during the interwar years the 
term military hygiene faded away to be replaced by military 
preventive medicine, a term with a more modern and scientifi c 
ring. Science was developing preventive and treatment modal-
ities that tremendously affected soldier fi tness. The causes of 
dietary defi ciency diseases—beri-beri, pellagra, ricketts—
were being worked out and a new player known as a vitamin 
was being described, work that would improve the nutritional 
value of future military rations. German scientists developed 
an effective synthetic antimalarial (Atabrine) and the fi rst 
safe, effi cient,and practical antimicrobial agent (Prontosil) 
that would be followed rapidly by more effi cient second and 
third generation sulfa drugs. In 1937, a safe and effective yel-
low fever vaccine was produced and a year later a fairly effec-
tive epidemic louse-borne typhus vaccine, and the National 
Institutes of Health established the requirements and standards 
for tetanus toxoid and cholera and plague vaccines, both pro-
duced in the 1920s. By 1939, the United States had the means 
in its medical arsenal to preclude most of the mobilization and 
operational infectious disease threats it would encounter in 
World War II. In fact, the medical science of the interwar years 
gave physicians something they had never had before: an abil-
ity to intervene in the infectious diseases they encountered. 
Specialization blossomed during this era; the American 
Medical Association (AMA) gained power and prestige. 
Medical corps offi cers began to identify with these organiza-
tions, exchange knowledge, and work with civilian colleagues 
more routinely than in the past. By the time the Axis Powers 
declared war on the U.S., the Division of Medical Sciences of 
the National Research Council in conjunction with its mili-
tary liaisons created seven primary committees to answer the 
military’s burgeoning number of questions across the whole 
fi eld of medicine. COL James S. Simmons, Chief, Preventive 
Medicine Division for the Surgeon General, established 
the Board for the Investigation and Control of Infl uenza and 
Other Epidemic Diseases in the Army. Consisting of distin-
guished civilian scientists and medical department offi cers, the 
board —known today as the Armed Forces Epidemiological 
Board—worked in coordination with their respective research 
facilities to solve major disease problems affecting the army. 
However, military preventive medicine was not military 
hygiene. COL George Dunham, MC, USA wrote
Military 
Preventive Medicine , but it was never intended as a guide for 
line offi cers as Munson’s had been. No discussion of rations, 
clothing, equipment weight, marching, or hot and cold cli-
mates was included.
21
Modern medicine, which had improved 
the general fi tness of the armed forces through rational recruit-
ing standards, immunizations, and the sulfa drugs, only broad-
ened the educational and social gap between line and medical 
offi cers. This, to some extent, disengaged the medical offi cer 
from critical staff planning and the mundane health problems 
of an army on campaign. From this situation, lessons from the 
First World War notwithstanding, occurred some of the more 
memorable blunders affecting performance, endurance, and 
resilience during World War II.