Origins of Military Medical Care As an Essential Source of Morale

Military medical care is an essential source of soldier morale and has been for centuries of warfare. To paraphrase Jonathan Woodson, Assistant Secretary of Defense for Health Affairs, in his 2014 commencement address to Walter Reed medical training program graduates, no soldier wants to go to war without knowing that he/she will be taken care of if injured (commencement address given on June 20, 2014, Strathmore Music Center, Bethesda, Maryland). This statement is as true today as it was hundreds of years ago. In his model of combat effectiveness, military historian John Lynn discusses the importance of morale to motivation in combat and reaction to effective medical care as a component of good morale. Effective medical care contributes to the soldiers’ sense that their efforts are valued and sacrifices appreciated, fostering morale and therefore improved combat performance. Elements of effective medical care contributing to morale were present as early as the 17th to 18th centuries and include medical presence with the soldier, evacuation of wounded, and extension of medical care to veterans and enemy wounded. Medical presence with the soldier is a fundamental aspect of military medical care necessary for morale. This principle is stated in the 1910 U.S. Army Handbook for Medical Officers in the Field: “. . . the presence of [medical] personnel at the front gives an assurance of speedy professional assistance that has a powerful effect in sustaining morale of troops. . .. The history of our own wars has indicated that the absence of such assurance has often had a depressing influence upon the morale of our troops.” Before this time, the United States entered its conflicts without adequate medical personnel, supplies, or systems, resulting in devastating consequences for the sick and wounded. As early as the Thirty Years’ War in the mid1600s, Gustavus Adolphus ensured the availability of barber surgeons, the “surgeons” of the time, to his troops. With his innovative tactic of organizing his army into smaller battalions, he also integrated the barber surgeons. In addition, he provided one-tenth of the plunder to the sick and wounded. Under the command of Frederick the Great in the mid1700s, first aid in the field was provided by a regimental barber and four company barbers. Frederick himself determined the location of field dressing stations, ensuring protection from enemy fire, and military hospitals in nearby towns. Frederick recognized that understanding the soldiers’ circumstances and providing for their needs was necessary to prevent desertion. Baron von Steuben, Inspector General of George Washington’s U.S. Army, was a former aide of Frederick the Great. Steuben’s section on treatment of the sick in the first U.S. Army Regulations in 1780 may reflect his experience under Frederick: “There is nothing which gains an officer the love of his soldiers more than his care of them under the distress of sickness; it is then he has the power of exerting his humanity and making their situation as agreeable as possible.” His regulation also states that “The surgeons are to remain with their regiment as well on a march as in camp, that in case of sudden accidents they may be at hand to apply the proper remedies.” Lessons learned from the Revolutionary War, however, were not carried through to future conflicts because of the rapid demobilization of the Army. Effective evacuation of wounded from the battlefield is another aspect of military medical care with profound impact on morale. Baron Dominique Jean Larrey, who ultimately served as Napoleon’s surgeon, developed the greatest advance in casualty evacuation, and in doing so significantly improved soldier morale. As division surgeon of the French Army of the Rhine in the late 1700s, Larrey was appalled by the lack of respect given to the common soldier and absence of any means for salvage of the wounded. The wounded were dehumanized and viewed as obstacles to progression of the Army. Most often they were abandoned and subsequently killed by the enemy. Even the few who were collected by their peers were left Department of Pediatrics, Walter Reed National Military Medical Center, 4954 North Palmer Road, Bethesda, MD 20889. The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-14-00492