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

CONCLUSION 
Correcting such ignorance and neglect can be done, but it will 
be a three-phased challenge. First, what knowledge, already 
available and valid concerning performance, endurance, and 
resilience factors must be assessed. 
Second, the determination of what new research will 
broaden our knowledge. We know overloading the soldier is 
detrimental to performance and endurance. How do we stop 
commanders from doing it? We know battle fatigue is a natu-
ral reaction to an unnatural and often bizarre situation that can 
lead to chronic PTSD. But how much exposure is needed? Is 
there a dose–response curve? Can the stress control mecha-
nism be reset? We know repetitive deployments are bad, but 
how bad are they? What have we learned from the deployment 
experience of the 10th Mountain Division in the 1990s or as 
peacekeepers in the Balkans? What have we learned from 
other armies addressing the same problem? 
Third, the philosophy of line to medical education and com-
munication that existed just a century ago must be resurrected. 
Medical science must be continually translated into strategic, 
operational, and tactical terms that a commander can under-
stand. The role of the line staff surgeon must be energized, 
and, most importantly, the theory and practice of military 
hygiene as an educational imperative for line and medical offi -
cers must be re-established for the 21st century and beyond. 
REFERENCES 
1. Davis RW : Service in the Roman Army , pp 3 – 6 , 15, 209, 222–5. 
Edinburgh , Edinburgh University Press , 1989 .
2. Marshall SLA : The Soldier’s Load and the Mobility of a Nation , p 27 . 
Quantico, VA , Marine Corps Assn ., 1950 .
3. Lind J : A Treatise on the Scurvy , Ed 3 . London , Crowder S. , 1772. 
Reprint: Birmingham, AL, Classics of Medicine Library , 1980 .
4. Pringle J : Observations on the Diseases of the Army in Camp and 
Garrison , pp vi – vii . London , A. Millar , 1753 .
5. Brocklesby R : Oeconomical and Medical Observations . London , 
T. Becket , 1764 .
6. Monro D : An Account of the Diseases which were most Frequent in the 
British Hospitals in Germany , pp 309 – 354 . London , A. Millar , 1764 .
7. Lothian NV : The load carried by the soldier . JRAMC 1921 ; 37: 451 – 3 .
8. Steuben FW Baron von : Revolutionary War Drill Manual , pp 81 , 87, 88, 
118–20. Boston, Thomas and Andrews , 1794. Reprint: New York, Dover 
Pubs , 1984 .
9. Rush B : Directions for Preserving the Health of Soldiers: Recommended 
to the Consideration of the Offi cers of the United States Army . Lancaster , 
John Dunlap , 1778 .
10. Lovell J to Calhoun J and Hemphill WE : November 27, 1818 , Hemphill , 
Calhoun Papers , v3 , p 306 .
11. Offi ce of the Surgeon General: Reports of the Surgeon General , 1818–
1819. Bethesda, MD , National Library of Medicine , 1819 .
12. Parkes EA : A Manual of Practical Hygiene , Ed 2 , p vii . London , Churchill 
and Sons , 1867 .
13. Hammond WA : A Treatise on Hygiene . Philadelphia, PA, Lippincott , 
1863. San Francisco, Norman , Reprint, 1991 .
14. Reed W , Shakespeare E , Vaughn VC : Abstract of Report on the Origin 
and Spread of Typhoid Fever in U.S. Military Camps During the Spanish 
War in 1898 
,
176 
, 178.
Washington, DC 
,
U.S. Government Printing 
Offi ce , 1900 .
15. Munson EL : Military Hygiene . Quote in preface . New York , William 
Wood , 1901 .
16. Keefer FR : A Text-book of Military Hygiene and Sanitation . Philadelphia, 
PA , WB Saunders , 1914 .
17. Morrison JF , Munson EL : A Study in the Troop Leading and Management 
of the Sanitary Service in War . Leavenworth, KS , Ketcheson Printing , 
1910 .
18. Jones E , Wessely S : Shell Shock to PTSD , p 25 . New York , Psychology 
Press , 2005 .
19. Myers CS : A contribution to the study of shell shock . Lancet 1915 ; 1:
316 – 20 .
20. Salmon TW , Fenton N (editors): The Medical Department of the United 
States in the World War , v10 , Neuropsychiatry , pp 497 – 547 . Washington, 
DC , U.S. Government Printing Offi ce , 1929 .
21. Dunham GC : Military Preventive Medicine . Harrisburg, PA , Military 
Service Publishing Co ., 1930 .
22. Frank RB : Guadalcanal , pp 51 , 259–260. New York , Penguin Books , 
1992 .
23. Joy RJT : Malaria in American troops in the South and Southwest Pacifi c 
in World War II . Med Hist 1999 ; 43: 192 – 207 .
24. Lothian NV : The load carried by the soldier . JRAMC 1922 ; 38: 21 .
25. Mullins WS (editor): Neuropsychiatry in World War II , vII , Overseas 
Theaters , pp 1 – 10 . Wash., D. C ., OTSG , 1973 .
26. Silsby HD , Jones FD : The Etiologies of Vietnam Post-traumatic Stress 
Syndrome . Milit Med 1985 ; 156: 6 .
27. Dubik JM , Fullerton TD : Soldier Overloading in Grenada . Mil Rev
1894 ; 67: 38 – 47 .
28. Tyson AS : “Weight of Combat Gear is Taking Toll,” Washington Post , 
1 Feb 2009 , p A3 .
29. Brown D : “Failed Sageguards Are Blamed for Marines’ Malaria 
Outbreak,” Washington Post , 10 Sep 2003 , A16 .
30. Brown D : “Malaria Outbreak Blamed on Troops,” Washington Post , 18 
Oct 2003 , A20 .
Downloaded from https://academic.oup.com/milmed/article/175/suppl_8/118/4344680 by guest on 06 September 2023