MILITARY MEDICINE. As exploration and colonization proceeded during the eighteenth century, Texas became one of the most important provinces of New Spain. Doctors who accompanied the Spanish army faced many serious medical problems along with the injuries that resulted from military campaigning. Diseases encountered included fever and chest pains (dolores de costado), venereal disease, dysentery, smallpox, "catarrhal fever," influenza, "bilious fever," and malaria. During the final years of Spanish Texas, Indian uprisings, Mexican revolts, American encroachment, and a depleted treasury virtually paralyzed medical functions in the army. The soldiers were underequipped, malnourished, and disease-ridden. Soon after the Mexican War of Independence in 1821, the director general of the Medical and Surgical Department of the army laid plans to form an army corps of physician and surgeons. This effort was largely unsuccessful in Texas during the years of Mexican Texas. In the Texas Revolution many doctors from the United States answered pleas for help and volunteered their services. They worked and fought alongside Texas physicians and often sacrificed their lives for a cause they had only recently discovered. Six physicians were killed at the Alamo, and more died in the Goliad Massacre, although some were spared after treating the Mexican wounded at La Bahía, where the mission had been turned into a hospital.
Before the battle of San Jacinto, the medical department of the revolutionary army was loosely organized and inefficient. Alexander W. Ewing became surgeon general of the army at San Jacinto and continued in that capacity with the Army of the Republic of Texas until June 1837. He transformed the medical department by quickly organizing and properly distributing all surgeons and by regulating the requisition of medical supplies. Political opposition to Ewing forced President Sam Houston, whom Ewing had treated at San Jacinto, to name a new surgeon general. Houston selected Ewing's friend and roommate Ashbel Smith to succeed him. The equipment of the department was minimal, and a makeshift hospital was established in Houston after legislation for a more complete facility was indefinitely postponed in 1837. Medical stations of the army were formed at Galveston and West Bernard. William R. Smith succeeded Ashbel Smith as surgeon general in 1839, but his regime was short-lived and unremarkable. In 1841 the office of surgeon general was abolished. The army was then a volunteer organization rarely engaged except to repel Indian attacks. The Texas Navy was formed in 1836, and its medical department, although poorly organized, had many enlistments until the navy ended in 1843.
Soon after annexation the United States and Texas were at war with Mexico. This action brought many new physicians to Texas with the United States Army. At the end of the Mexican War, the War Department established the Eighth Military District, which encompassed what is now Texas. After 1853 the district was known as the Department of Texas. Of all the western defensive networks, those of Texas were the most comprehensive and strongly manned. There were two distinct frontiers, each defended by a cordon of forts built and garrisoned to protect settlers against Indian attacks. Disease and disability were commonplace among the soldiers manning these defences. Medical statistics show that soldiers in Texas did not enjoy as good health as did the army in general, with each Texas soldier taken sick, on average, 3.26 times a year, as opposed to the army-wide figure of 2.85 times a year. This deficiency was attributed to the grueling demands of frontier service, with its poor food, meager comforts, isolation, and the prospect of death or disability from disease or enemy action. The rigors were heightened by the environment: sweltering heat in summer and blizzard-like northers in winter. Recruits into the service were frequently unfit for duty, and their habits often adversely affected their health. The leading causes of death were digestive disorders and fevers, of which malaria was the most prevalent. Yellow fever, cholera, dysentery, and scurvy were common among the soldiery. The forts' medical officers, called surgeons, also had to cope with wounds and injuries, alcoholism among the troops, and venereal disease. To complicate matters further, medical officers were often assigned extra duties bearing little connection to the provision of health care. One army doctor of the period wrote that he was required "to receive the savings...of companies...sell bread-tickets...purchase wood and hops and salt...superintend bakers...settle a hundred petty accounts," and more. Under these difficult conditions, the army could attract few qualified physicians for full-time duty. Civilian doctors were often hired on a contract basis, but due to the poor quality of medical education on the frontier, many of these were of questionable ability.
Many Texas physicians served in the Confederate Army during the Civil War. Samuel P. Moore, previously post surgeon at Fort Brown, became surgeon general of the Confederacy. Confederate medical departments were ill-equipped and understaffed. A lack of proper surgical instruments and supplies necessitated many improvised treatments. Military conditions made cleanliness difficult, and high rates of gangrene resulted. Toward the end of the war, when amputation became the standard treatment for fractures, chloroform was unavailable. Disease claimed even more lives than injury because of poor sanitation, inadequate shelter and clothing, impure water, and malnutrition. Dysentery, malaria, diarrhea, typhoid fever, typhus, smallpox, and measles were frequent. Morphine addiction, called the "soldier's disease," became common. One of the few positive contributions made during the Civil War was the mobile unit hospital.
After the war many of the posts abandoned by federal troops were reactivated as the nation continued to wage campaigns against the southwestern Indians. Army surgeons in the postwar period treated relatively few battle wounds, but their responsibilities were greatly expanded. They made frequent inspections of all physical properties and living areas, of the water supply, and of food preparation. They functioned as post sanitarians and oversaw the cemeteries. They directed the hospitals, provided care for the families of men and officers, administered the financial accounts of the post's medical department, supervised the pharmacy, acted as coroners, and examined recruits. Once again, poor dietary and living conditions were responsible for continuing illness.
In the last years of the nineteenth century and the early years of the twentieth, the United States Army became increasingly involved in preventive medicine. Dr. George M. Sternberg, surgeon general of the army during that period, has been called the "pioneer bacteriologist of America." He established boards for the study of tropical diseases that led to major advances in the struggle against yellow fever, malaria, and typhoid fever. An antityphoid vaccine administered to the army in Texas in 1911 resulted in startling reductions in the incidence of that disease. In the decades that followed, further advances in bacteriology, improved sanitation, larger numbers of more highly trained medical personnel, and greater prophylaxis in military medicine resulted in a higher quality of health care offered to the nation's troops.
During World War I developments in aviation medicine moved rapidly. Primarily because of its central geographical location, Texas became the center of the nation's military aviation activity. In 1931 the School of Aviation Medicine was transferred to Randolph Field, near San Antonio. This important research facility had been the site of much significant medical investigation, including the discovery of the basic physiological principles of blind-flying instruments. Texas physicians, like the rest of the state's population, contributed their skills to the national defense efforts during the two world wars. After World War II exceptional medical institutions were established in Texas. In 1946, Brooke Army Medical Center at Fort Sam Houston in San Antonio was activated, replacing what had been a post hospital established in 1881. Also in 1946 the Medical Department Field School, which dates back to 1920, was transferred from Carlisle Barracks, Pennsylvania, to Fort Sam Houston, where it was first called the Army Medical Service School and subsequently the Academy of Health Sciences. It is the largest school of allied health sciences in existence, with nearly 35,000 persons enrolled in courses of study in 1993. At that time Brooke Army Medical Center itself was the second largest of the eight United States Army Health Services Command medical centers. Fort Sam Houston is also home to Military Assistance to Safety and Traffic, established in 1970. Through this effort, medical personnel are able to provide emergency air transportation to residents of a broad geographical area.
In 1949 the first department of space medicine in the western world was established at the School of Aviation Medicine at Randolph Field. Aerospace medicineqv research advanced swiftly with the development of an antigravity suit, diluter-demand oxygen systems, improved night vision, and a theory of weightlessness. In 1954 the school installed an experimental pressurized "sealed cabin" in its research laboratories to study how the human body responds in a closed ecological system at heights greater than 80,000 feet. As early as 1957 the school had developed a plan for selecting and training crews for orbital spacecraft.
In 1950, with the advent of the Korean War, Congress passed a law known as the "Doctor Draft." Physician conscription was separated from the regular draft, from which all qualified physicians were removed and placed in a special category. When a physician received notice that his draft number was about to come up, he was given the opportunity to accept a commission in the medical corps of the service of his choice. As a result, the Doctor Draft accounted for an increase in the total medical corps from around 5,000 in 1950 to 18,500 in 1953, thus eliminating the shortage of qualified medical personnel at the beginning of the war.
Another medical center of the United States Army Health Services Command is William Beaumont Army Medical Center in El Paso, founded in 1972. This center operates the army's first residential treatment facility for alcoholism as well as a regional trauma center. The United States Army Health Services Command itself, one of the fourteen major worldwide commands of the Department of the Army, is headquartered at Fort Sam Houston. It commands all health-care installations on the continent. Services include hospitalization, outpatient care, environmental hygiene, dental care, optometric care, veterinary services, nursing care, physical and occupational therapy, and dietetic services. At the command, more than 50,000 military and civilian personnel work together as a team to provide total health care to army personnel.
The state of Texas played a monumental role during the nation's military conflicts of the late twentieth century. For example, the United States Air Force School of Aerospace Medicine in San Antonio educates medical officers of all services to become qualified in that specialty. It also develops appropriate doctrine and strategies of combat medical support. Likewise, the United States Army Academy of Health Sciences at Fort Sam Houston supports all services with basic and advanced courses in military medicine. One example is a fine master's-degree course in health-care administration, offered in conjunction with Baylor University. The nationally famous Burn Center is an element of the army's Research and Development Command housed at Fort Sam Houston; it accepts military and civilian burn patients from around the world and has served as a model for similar centers around the country. In addition to extensive research efforts, the Burn Center trains numerous professionals in the care of burn patients. Fort Sam Houston has served as the staging center for army medical units of every variety in preparation for overseas deployment. The United States Army Medical Department Museum at Fort Sam Houston is of the highest order and depicts well the history of army medicine.
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The following, adapted from the Chicago Manual of Style, 15th edition, is the preferred citation for this article.Handbook of Texas Online, Robert Bernstein, "Military Medicine," accessed July 30, 2016, http://www.tshaonline.org/handbook/online/articles/smm03.
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