Public Health and the U.S. Military: A History of the Army Medical Department (review)

Bobby Wintermute is interested in what the U.S. military doctor was doing when he was not at war; in this account, he deliberately “eschew[s] combat medicine” (5) in order to focus on the army physician’s professional aspirations and role in promoting public health and hygienic reform. Early in the volume, Wintermute emphasizes the peculiar occupational status of the army doctor, who desired respect both as a man of medicine and as an officer in the army. Although full surgeons carried the rank of major in the nineteenth century, that was a commission for convenience only, which determined their pay scale and housing, but did not carry the same authority or privileges of rank accorded to line officers. They had no place, in Wintermute’s phrase, in the “command structure and culture of rank” (25) basic to the army life. If the regular military man epitomized all that was masculine, the physician was somewhat feminized by his association with the female role of caring for the sick. This meant that even as late as the Spanish-American war, medical officers lacked the authority they needed to enforce sanitary regulations and camp hygiene, to the detriment of troop health.

Army medical leaders were more successful in elevating the quality of medical practitioners who became army doctors. In 1832, the medical hierarchy established a system of examination boards which privileged the graduates of regular medical training, especially those with exposure to anatomical teaching and clinical experience. At a time when the regular profession was increasingly challenged by sectarians and an antielitist ethos, the army could and did turn away four out of five applicants as unfit. The founders of the American Medical Association saw the army system as a model for elevating the medical profession in 1849; with the coming of Civil War, the army’s standards became the norm for the many men who applied to serve in the Union medical corps. By war’s end, there were more than twelve thousand Union army surgeons of various ranks, but with the rapid demobilization that followed that number quickly dropped to around two hundred.

Wintermute believes that this small medical corps made a big impression on U.S. public health over the following twenty-five years. “In the absence of a strong civilian agency responsible for public health and medicine, the Army Medical Department and its Surgeon General were the de facto watchdogs of American public health and medicine,” he claims at one point (56), and again, that by 1895, “the image of the medical officer as scientific researcher par excellence dominated the public’s imagination” (45–46). These assumptions about American public health and medicine over the course of the last quarter of the nineteenth century go against the grain of the traditional historiography, to say the least, and could have been better supported. There is no mention here, for example, of the National Board of Health (1879–1884) and the yellow fever crisis that gave it birth, or of the rise of the Marine Hospital Service (later U.S. Public Health Service) which built its public support on both yellow fever control and combating the “immigrant menace.” The author would do well to consult Bert Hansen’s work, Picturing Medical Progress from Pasteur to Polio: A History of Mass Media Images and Popular Attitudes in America, New Brunswick, New Jersey, Rutgers University Press, 2008, on the public perception of medical science and bacteriology in this period before making such claims.

He is on much firmer ground when it comes to the events of the Spanish-American war and the army’s medical participation in the formation of American empire. Walter Reed, William Crawford Gorgas, and other army physician researchers did bring glory to American medicine and make the tropics safe for U.S. troops. Here the account would have been clearer if a consistent...