Public Health and the US Military

A History of the Army Medical Department, 1818-1917

Bobby A. Wintermute

• Publisher: Routledge
• Year: 2010
• Print ISBN: 9780415881708
• eBook ISBN: 9781136892677
• Edition: 1
• Topic: History
• Subtopic: Military & Maritime History
• Index: History

Public Health and the US Military is a cultural history of the US Army Medical Department focusing on its accomplishments and organization coincident with the creation of modern public health in the Progressive Era. A period of tremendous social change, this time bore witness to the creation of an ideology of public health that influences public policy even today. The US Army Medical Department exerted tremendous influence on the methods adopted by the nation's leading civilian public health figures and agencies at the turn of the twentieth century.

Public Health and the US Military also examines the challenges faced by military physicians struggling to win recognition and legitimacy as expert peers by other Army officers and within the civilian sphere. Following the experience of typhoid fever outbreaks in the volunteer camps during the Spanish-American War, and the success of uniformed researchers and sanitarians in confronting yellow fever and hookworm disease in Cuba and Puerto Rico, the Medical Department's influence and reputation grew in the decades before the First World War. Under the direction of sanitary-minded medical officers, the Army Medical Department instituted critical public health reforms at home and abroad, and developed a model of sanitary tactics for wartime mobilization that would face its most critical test in 1917.

The first large conceptual overview of the role of the US Army Medical Department in American society during the nineteenth and early twentieth centuries, this book details the culture and quest for legitimacy of an institution dedicated to promoting public health and scientific medicine.

1 Practice, Status, Public Health, and the Army Medical Officer, 1818–1890

DOI: 10.4324/9780203840597-2

“A few medical officers had long seen the need for an improved military status for themselves and their fellow, and by their insistence upon military forms, titles, salutes, drills, and other outward symbols they incurred no little ridicule,” wrote Colonel Percy Moreau Ashburn, U.S. Army Medical Corps, about his onetime mentor and friend, Major John Van Rensselaer Hoff. ¹ Described as an eccentric “tin-soldier” by critics and friends alike, Hoff embodied the medical officer in his struggle for legitimacy and status. He and others like him cared little for the comments of others as they sought recognition within the Army community. Yet, as Ashburn noted: “To those who did know them, whether in the field or in garrison, their abilities, courtesy, learning, high character, efficiency, and dignity were such as to stifle ridicule. Without shadow of turning they held their way.” ²

Commissioned as an assistant surgeon in 1874, Hoff witnessed the Army’s waning days on the frontier firsthand. He spent part of his early career on the shrinking American frontier, at such famous places as Fort Leavenworth, Fort Reno, and Fort Riley. Hoff was present at the Sioux’s last gasp at Wounded Knee, where he was mentioned in orders and recommended for the Medal of Honor “for conspicuous bravery and coolness under fire in caring for the wounded in action.” ³ Such displays of bravery were fortuitous, coming after he made his name within the Army as a harsh disciplinarian and Prussian-style martinet. In 1887 at Fort Reno, Hoff created the first formal manual of drill for Hospital Corps and Company bearers. The sight of his putting the enlisted orderlies through their paces brought laughter and ridicule. But their conduct at Wounded Knee, where his orderlies and bearers performed admirably, proved the merit in Hoff’s method. As future Surgeon General Merritte W. Ireland later noted:

His name was at this time universally associated with the militarization of the medical service—an advance which was much needed as the lessons of the Civil War had by this time been almost completely forgotten, and the only recognized function of the Army doctor was to treat the sick. The use of military titles and forms by Medical officers was at this time was not customary, even in official correspondence, and … Hoff [was] much ridiculed on their use. Gradually it became obvious that in an Army military methods were necessary for good results. ⁴

Hoff’s obsessions ran beyond rank and command, to include the question of the medical officer’s legitimacy and status. Members of the Medical Department, Hoff argued, “were in the army but not of it. They were without rank and had few rights that any one was bound to respect.” ⁵ Overtasked and underpaid, denied the most basic military courtesies by a culture insistent upon proper form and respect, the Army medical officer was an essential adjunct to the line, but was nevertheless treated like an outsider.

Some medical officers could—and often did—break under such a stifling climate of indifference, leaving as their five year enlistment expired. Others lost themselves in the new field of microbiology, where they made a different name for the Army Medical Department. Hoff chose another course. Immersing himself in the branch’s history, he made a strong case for promoting the communal identity of the medical officer as a point of esprit de corps distinguishing the military surgeon as a unique professional. Despite his eccentricities and prickly personality, Hoff gathered around himself a collection of like-minded younger medical officers who were no less vocal or eloquent in making their case alongside their patron. ⁶ Over nearly twenty years, from 1898 through 1917, Hoff pushed for greater respect, legitimacy, and status for Army medical officers.

Hoff needed all of his contacts, friends, and mentors, as he eventually— perhaps expectedly—overstepped his bounds. Over the summer of 1918, complaints mounted over the unequal rank between the Army and Navy medical heads, and the spillover problem of low respect accorded medical officers in the National Army. In July 1918, Hoff wrote an editorial criticizing a recent War Department decision to post reservists to duty with the General Staff. Caught up with his own sensitivity over the status of regular medical officers, Hoff unleashed a torrent of criticism_ “Some might infer from this that the General Staff is ignorant of the fact that there are stupendous medico-military problems connected with war, requiring the advice and experience of experts who had devoted their lives to the study of such; but this is not our inference.” ⁷ Hoff was formally reprimanded by Secretary of War Newton D. Baker. ⁸ Chastened, Hoff left the journal, disgraced and never to enter public life again. He died two years later.

Hoff’s story serves as an introduction to the larger account of the Army Medical Department’s Progressive public health policies and practices. Between 1890 and 1917, the quest for improved status, recognition, and acceptance by their uniformed peers was as important to medical officers as their medical, scientific, and sanitary accomplishments. Before we can understand the importance of science and sanitation to the Army physician, we must appreciate the role of status and how public health was seen as a means to obtaining the legitimacy so desired by men like Hoff.

The Organization of the Army Medical Department, 1818–1890

The Medical Department was established as an autonomous staff branch on May 14, 1818. Congress authorized a Medical Department under the direction of a Surgeon General, supported by two assistant surgeons general and an apothecary general, with a cadre of two assistant apothecaries, forty post surgeons, and one surgeon and two surgeon’s mates for each regiment. This new department fit into Secretary of War John C. Calhoun’s plan to bring the Army’s senior division commanders under War Department control through an independent staff corps. This General Staff, including the Quartermaster Department, the Subsistence Department, the Office of the Adjutant General, the Ordnance Department, and the Medical Department, was charged with providing essential logistical and staff support, while remaining under War Department control. ⁹ Intended to provide elasticity for future Army expansion, Calhoun’s structure survived three years. Claiming fiscal austerity, in 1821 Congress imposed stark reductions. Distinctions between post and field medical officers were eliminated, as were the apothecaries and the assistant surgeons general. The title of “surgeon’s mate” was also eliminated, replaced with the title “assistant surgeon.” In addition to the Surgeon General, the new establishment was set at eight surgeons and forty-five assistant surgeons. Since each of the army’s garrisons, forts, and encampments required at least one medical officer, surgeons and assistant surgeons often served alone. ¹⁰

Calhoun’s scheme was resisted by line officers accustomed to managing their own affairs with minimal interference. The absence of centralized authority, save for occasional directives from Washington, and the way units were scattered across the country allowed the Army’s commanders great latitude in their conduct. Indeed this independence was the impetus for Calhoun’s decision to extend greater control over the military. Major General Andrew Jackson’s recent occupation of Spanish Pensacola under the pretense of quelling the Seminole was a prime example of a line officer exceeding his mandate. Though reluctant to reprimand Jackson publicly, Calhoun used the staff to bring the headstrong General into line. Whenever Jackson ignored regulations by dealing directly with staff officers in his division as though they were loyal only to him, Calhoun countermanded his orders and reprimanded the General for neglecting the express orders of the War Department. For his part, Jackson had little use for the new staff arrangement, hardly surprising for a man who viewed staff officers as “intermeddling pimps and spies of the War Department.” ¹¹

The Medical Department was soon the specific target of Jackson’s disdain. As newly empowered members of the General Staff, medical officers were ex officio representatives of the War Department, required to make quarterly reports on the relative health and wellness of their associated commands. ¹² This did not sit well with the imperious Jackson. Accustomed to ruling his command as a personal fiefdom, he ignored regulations and ordered all surgeons’ reports be routed through his office before going to Washington. Surgeon General Joseph Lovell took notice and reported to Calhoun that while he expected some time was needed for most surgeons to learn the “proper form and regular manner” required in their reports, those in General Jackson’s district had failed to observe even the most basic reporting requirements outlined in the department’s regulations. “Some few surgeons chiefly at the South have as yet neglected all orders,” he wrote, “and unless good reasons be assigned therefor, it will be necessary to adopt some means of enforcing obedience, or to supply their places with those who are disposed to be more attentive to duty.” ¹³

Calhoun quickly responded. “Both the publick interest and humanity towards the Army require an efficient medical staff, but it is not possible to render it efficient, unless by a rigid adherence to the laws and regulations,” Calhoun wrote. “I am persuaded that no one is more deeply convinced of the truth of this proposition than yourself, and that it is only necessary to call your attention to the irregularities which I have stated to relieve me from the necessity of determining whether I shall permit the orders of the Government to be habitually neglected, or resort to the proper means of enforcing them. Should the alternative be presented I will not hesitate to do my duty.” Jackson relented, acknowledging the General Staff’s independence and unintentionally setting a precedent for staff autonomy. ¹⁴

The 1821 reductions were only the first in a cycle of Congressional tampering. In 1832, four surgeons and ten assistant surgeons were added to the lists. In 1836, three surgeons and five assistant surgeons were added, as were another seven surgeons in 1837, bringing the department’s established strength to eighty-three medical officers. While Surgeon General Lovell requested more surgeons and assistant surgeons to match the increase in the Army’s posts (which had grown from thirty-five in 1826 to sixty-four in 1831), Congress ignored his requests. Instead, the increases of the 1830s were motivated by an immediate need in the field. The 1832 expansion was a response to the Black Hawk War, while the 1836 and 1837 increases came amidst the protracted guerrilla fighting in Florida against the Seminole Indians. Soon enough, Congress returned to its original form, slashing the numbers of surgeons and assistant surgeons to twenty and fifty, respectively, in 1842 as soon as the war in Florida ended. ¹⁵ As the call for volunteers for service in Mexico went out in 1847, Congress authorized an additional two surgeons and twelve assistant surgeons, plus another 135 civilian physicians as volunteer medical officers. Ten more assistant surgeons were authorized in 1849, followed by an additional four surgeons and eight assistant surgeons in 1856, bringing the Medical Department’s total establishment on the eve of the Civil War to 107. ¹⁶

The department achieved its manpower peak during the Civil War. The July 22, 1861 call for volunteers provided each regiment with an organic medical establishment: one surgeon, one assistant surgeon, and one hospital steward. ¹⁷ Serious expansion and reorganization followed an April 16, 1862 bill introduced by Massachusetts senator Henry Wilson. In addition to providing ten surgeons and ten assistant surgeons, twenty medical cadets, “and as many hospital stewards as the Surgeon General may consider necessary,” the Wilson Bill also gave the Medical Department power over its own affairs. ¹⁸ According to Bonnie Blustein, the bill instituted “a new structure for the centralized direction and inspection of medical work in the army,” going beyond the normal prospect of simply adding new personnel to the Medical Department. A formal structure for sanitary inspection, “whether in transports, quarters, or camps” as well as in hospitals was implemented, through a new Medical Inspector establishment. Inspectors had authority to report any volunteer or regular medical officer and contract surgeon who was “disqualified, by age or otherwise, or unfitted for the performance of his professional duties” for a medical review board. ¹⁹

The Wilson Bill also revived the old position of assistant surgeon general. Since the assistant surgeon general’s rank was set at that of a colonel of cavalry, the surgeon general was increased to a brigadier general, a level commensurate with other staff heads. Finally, on July 2, 1862, Congress extended the Regular Army’s authority over the thousands of volunteer medical officers, ordering all brigade surgeons to be appointed medical staff surgeons of volunteers, “under the direction of the surgeon general.” Congress authorized forty surgeons and 120 volunteer surgeons, as well as an additional assistant surgeon for every volunteer regiment in service. ²⁰

The Civil War also threatened the professional reputation of the Medical Department. Many volunteer surgeons and assistant surgeons were appointed on the basis of political allegiances and personal favors. As a result, well-trained physicians were joined by hundreds of quacks and pretenders. Accordingly, many soldiers looked askance at regimental medical officers, particularly if they had a penchant for drink. Even officers had their doubts. In his study of the Union Army, Bell Irvin Wiley recounts the comments of a captain in the Second Massachusetts Regiment: “‘I pray the regiment may improve … but with our present surgeon I see no prospect of good medical attendance in case of sickness. He is a jackass—a fool—and an ignorant man—three quarters of the sickness could have been prevented by a good physician.’” ²¹

Still Congress created a massive uniformed health infrastructure. By 1865, the Medical Department included forty-six surgeons and 110 assistant surgeons, seventeen medical inspectors, six storekeepers, seventy medical cadets, 547 volunteer staff surgeons and assistant surgeons, 5,991 volunteer regimental surgeons and assistant surgeons, eighty-five acting staff surgeons, and 5,532 acting assistant surgeons. This institutional empire was short lived. After the war, Congress began demobilizing the Union Army. On July 28, 1866, Congress set the Medical Department’s established strength at 217 physicians: seven administrators (one Surgeon General with the assimilated rank of brigadier general, one assistant surgeon general with the rank of colonel, five medical purveyors with the rank of lieutenant colonel); sixty surgeons with the rank of major; and one hundred and fifty assistant surgeons, at the rank of captain and lieutenant. ²²

Somehow the department made do. In 1869, for example, the Army consisted of 32,896 officers and men, stationed at 239 posts across the country and its territories, against the Medical Department’s paper strength of 210 physicians. Despite Surgeon General Barnes’ criticism that any change to the 1866 establishment “would prove prejudicial to the welfare of the troops and the efficient discharge of its duties,” Congress barred all appointments and promotions throughout the entire service. ²³ The effects of the freeze were dramatic. By 1873, there were sixty-three unfilled vacancies in the Medical Department, including five surgeons and fifty-five assistant surgeons. On June 23, 1874, Congress finally lifted the promotion freeze, but only after cutting three medical purveyors and ten surgeons. Likewise, the number of civilian contract surgeons was limited to no more than seventy-five. Congress removed this limitation after the Surgeon General’s Office was forced to hire private physicians on a fee-for-visit basis. ²⁴

Constantly seeking more fat to trim from the Federal budget, Congress continued to target the Medical Department. In 1876, the number of assistant surgeons was reduced to 125 and the office of medical storekeeper was abolished. Exacerbating these actions was a Congressional oversight leaving the entire Army unfunded until November 1877, with all soldiers and officers going without pay for several months. Finally, in 1894, Congress reduced the number of assistant surgeons to 110. ²⁵

Matters were not helped by the peacetime necessity of contracting services from civilian practitioners. In 1828, Surgeon General Lovell noted while the number of forts, posts, and rendezvous had grown in the last seven years, the number of authorized medical officers had not kept pace, “so that it is now impracticable to furnish one Surgeon to a station, even if they should all be on duty.” ²⁶ His pleas, and those of his successors and supporters from the line and the War Department, were unheeded. As late as 1858, at least six posts functioned without a medical officer. Hiring civilian physicians was the only solution. Pay was low—between $20 and $30 a month—and conditions harsh, yet doctors still applied. Some, like one Dr. Goodrich retained to accompany a company of recruits from Vicksburg to Forts Smith and Gibson in the Cherokee Territory in 1835, were clearly unqua...

Table of contents

• Cover Page
• Half Title Page
• Other Title
• Title Page
• Copyright Page
• Table of Contents
• Illustrations
• Introduction: Waging Health—The U.S. Army Medical Officer's Quest for Identity and Legitimacy
• 1 Practice, Status, Public Health and the Army Medical Officer, 1818–1890
• 2 The Medical Officer in “The New School of Scientific Medicine”, 1861–1898
• 3 The Other War of 1898: The Army Medical Department's Struggle with Disease in the Volunteer Camps
• 4 Making the Tropics Fit for White Men: Army Public Health in the American Imperial Periphery, 1898–1914
• 5 The Ascendance of Sanitation in the Army Medical Department and the Quest for Preparedness, 1901–1917
• 6 Vice and the Soldier: The Army Medical Department and Public Health as Morality, 1890–1917
• Notes
• Bibliography
• Index