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RECENT HISTORY & HISTORY of SMCAF

The Society of Medical Consultants to the Armed Forces Archives and History Committee: Oral History Program.

Armed Forces Consultants Remembered at 50.

 

Accomplishments 1998-2008

During the past 10 years, SMCAF has engaged in numerous issues important to the continued health and development of the Military Health System.  The major accomplishments are as follows:

1.    Representation of Military Medicine on the Health Care Committee of The Military Coalition (TMC).  TMC is comprised of 35 organizations representing more than 5.5 million members of the uniformed services-active, reserve, retired, survivors, veterans—and their families.  Thru advocacy at all levels of government they have been instrumental in influencing legislation to benefit all members of their coalition.  While benefits in general are their focus, SMCAF has articulated the importance of maintaining the integrity of the Direct Care System, and the importance of Graduate Medical Education (GME) in that effort.  TMC has been directly involved in the President’s Tasks Force on Health Care, with input supplied by the Health Care Committee.

2.    SMCAF has represented Military Medicine at the AMA and National Medical Veterans Society (NMVS) during the period of time when advocacy for physician bonuses was critical to the success of those efforts.  Also during this period, various government officials proposed the closure of USUHS.  Direct involvement of the AMA and NMVS with elected officials assisted in forestalling that possibility.

3.    Dr. Ken Swan, a noted SMCAF member, with others has published a series of 4 articles in Military Medicine, from 1997-2008 entitled “Don’t Know-Don’t Care”.  In these studies involving east coast and midwest medical school medical students, he documented the lack of knowledge and interest in military medicine, and the available programs and financial resources available to assist students in need.  The authors also recommended programs to improve these attitudes for the future.

4.    At the suggestion of the Surgeons General, SMCAF has established a nationwide network of SMCAF members to assist the Service Recruiters.  This network consists of 6 Regions, with designated Nodes, and designated member coverage for each state.  The function of SMCAF members is to assist in answering professional questions and espousing the advantages of a career in Military Medicine.   Educational materials regarding existing programs have been supplied to all designated members.

5.    A distinguished panel in the mid-1980s recommended the development of a “military unique GME curriculum.  SMCAF assisted in recommending elements and evaluating that effort, resulting in a structured curriculum designed to prepare graduating residents with the knowledge and tools needed to “hit the ground running” when they start their initial clinical duty assignment.

6.   In the past several years, SMCAF members, notably Dr. Harold Koenig, were instrumental in effecting significant improvements in the benefits package now offered to incoming medical school students utilizing the military’s Health Professionals Scholarship Program (HPSP) and for civilian residents using its Financial Aid Program (FAP).  In addition SMCAF influenced a recent “fix” of HPSP and USUHS student pay inequities, allowing for “Save Pay” for those with prior military service.  These improvements will help attract more and higher caliber applicants to our military medical school programs.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Society of Medical Consultants To The Armed Forces
Robert M. Hall, MD, MPH, MHA
Contents
Background
Purpose
The Consultant System

Establishment of the Society
Medical Care of Veterans
12345Consultants to Veterans Administration Hospitals
12345Affiliation of VA Hospitals with Medical Schools
12345Establishment of Residency Training Programs in VA Hospitals
First Annual Meeting
12345"An organization the likes of which had never existed before"
The Hawley Club

Military Graduate Medical Education, the "Lifeblood" of the Military Medical Services
Visiting Consultants Program
Recruitment and Retention of Medical Officers
The Assistant Secretary of Defense for Health Affairs
Medical Education for National Defense (MEND) Program
Armed Forces Physicians Appointment and Residency Consideration Program (Berry Plan)
Uniformed Services University of the Health Sciences
John R. Seal Award
The Zarafonetis Collection
The Society's First Half Century
12345Accomplishments
12345Medical Care of Veterans
12345White Papers
1234567890Armed Forces Institute of Pathology
1234567890Military Graduate Medical Education
1234567890Uniformed Services University of The Health Sciences
12345
Relationships with the Assistant Secretary of Defense for Health Affairs and the Surgeon General
12345
The Institutional Memory of Military Medicine
Remembering the Lessons of History

12345Tri-Service Office of Military Medical History
12345The National Museum of Health and Medicine
Anthrax Vaccine Immunization Program

Military-Unique Aspects of Graduate Medical Education Programs
Background
1234World War II had just ended when The Society of Medical Consultants to the Armed Forces (SMCAF) was founded by fourteen of the nation's leading medical specialists and educators. They had served in the Army as consultants in the medical, psychiatric, and surgical specialties, and founded the Society as a means whereby they could help the Army Medical Department cope with the problems it confronted at the war's end. The most pressing of these, they knew, was the need to continue providing optimal professional care to patients in Army hospitals.
1234The Society has grown and now consists of more than one thousand physicians, representing every medical specialty and most of the nation's medical institutions. Among its members are active duty and Reserve members of the military medical services, prominent academicians, former Assistant Secretaries of Defense for Health Affairs, and former Surgeons General, Command Surgeons, and Chiefs of the major specialties in each of the services
Purpose
1234The Society was proposed in the summer of 1945 by Brigadier General Fred W. Rankin, Chief Consultant in Surgery in the Army Surgeon General's Office. Rankin had left his position as Clinical Professor of Surgery at the University of Louisville to assume the position of Chief Consultant at the request of The Surgeon General, Major General James C. Magee. He had served in France during World War I, following which he was one of the leading surgeons at the Mayo Clinic, a professor of surgery in the University of Minnesota School of Medicine, president of many of the nation's leading surgical organizations, and president of the American Medical Association.
1234Rankin discussed his proposal with the other two chief consultants in the Office of The Surgeon General, Brigadier General Hugh J. Morgan, the Chief Consultant in Medicine and Brigadier General William C. Menninger, Chief of the Neuropsychiatry Division. Before entering on active service at the request of The Surgeon General, General Morgan, a veteran of World War I, had been Professor and Head of the Department of Medicine Brigadier General Fred W. Rankin, MC, Chief Consultant in Surgery,
Office of The Surgeon General
at Vanderbilt University School of Medicine and Physician in Chief at Vanderbilt University Hospital. General Menninger had been President of The Menninger Foundation, in Topeka, Kansas.
Brigadier General Hugh J. Morgan, MC, Chief Consultant in Medicine,
Office of The Surgeon General
12345During the war, the Regular Army's medical officers carried out the necessary medical command and staff functions of the greatly expanded Army, while the civilian physicians brought into the Army provided most of the patient care and treatment. The war's end brought with it a widespread clamor for the immediate discharge of these physicians so they could return to their communities. Major General Norman T. Kirk, who
Brigadier General William C. Menninger, MC, Director, Neuropsychiatry Consultants Division, Office of The Surgeon General had succeeded General Magee as The Surgeon General in 1943, protested in vain that these physicians were needed to care for the great number of patients remaining in Army hospitals.
12345
General Rankin and the others were aware of this and other problems confronting the Army Medical Department. They realized that the Army's career medical officers would need refresher training before
returning to professional work. They knew also that the physicians who had received their medical education during the war and now were entering the Army for their period of obligated service would need additional training and supervision. The four years of pre-war medical education had been reduced to two and one-half years during the war, and the internship that followed had been shortened to nine months
12345Rankin and the others realized that the Army would have to offer opportunities for postgraduate training, specialization, and professional work if it were to attract capable physicians to replace those it was losing. They knew also that the Office of The Surgeon General would have to be removed from its subordinate position under the Army Service Forces if the measures necessary for solution of the Medical Department's problems were to be carried out. The Surgeon General's Office had been an agency of the War Department Special Staff until the U.S. entered the war. At that time the Office of The Surgeon General was placed under the Services of Supply, later renamed the Army Service Forces. 1
The Consultant Group at Cheltenham, England 1944
These officers became the nucleus of
The Society of Medical Consultants to the Armed Forces
The Consultant System
12345Establishing consultants in the Office of The Surgeon General and in Commands in the U. S. and in overseas Theaters of Operations during the war had not been an easy process. Prewar plans had made no provision for consultants, despite their proven benefit during World War I. There were no position vacancies nor job descriptions for them. The consultants' objectives were the prevention of disease and injury, ensurance of accurate diagnosis and optimum therapy, reduction of hospitalization, and the return of soldiers to duty as quickly as possible. Despite this, there were long delays in establishing the necessary consultant positions, and sufficient rank was not authorized. The reception accorded the consultants at the headquarters to which they were assigned varied from indifference to hostility, but their imagination, resourcefulness, tact, and obvious competence led to welcomed acceptance in most cases. Their activities soon extended beyond clinical matters into related fields, such as personnel assignments, medical supply, and hospitalization and evacuation policies.
12345There were no effective official channels of communication between the consultants in the Office of The Surgeon General and those in the various Commands in this country and the overseas Theaters of Operations. This was because, in every instance except the North African Theater of Operations, the surgeons had been made subordinate to other staff sections, and in many cases, their offices had been fragmented and medical functions assigned to other staff sections. The consultants, therefore, established their own, unofficial channels of communication.
12345By the end of the war, the Army's consultants had worked together for several years, and had developed a pronounced esprit de corps and sense of loyalty to the Army. Generals Menninger, Morgan, and Rankin believed the consultants could continue to be of service to the Army after returning to civilian life if they remained together. Surgeon General Kirk encouraged these discussions and the formation of a society.

1234 Rankin knew that if such a society were to be effective, it would have to be organized quickly. This would require the efforts of someone with extraordinary energy, drive, managerial ability, and prestige, and Rankin had just such an individual in mind, Brigadier General Elliott C. Cutler. Brigadier General Elliott C. Cutler, MC, Chief, Professional Services Division, Office of The Chief Surgeon, European Theater of Operations, U.S. Army
Establishment Of The Society
1234Cutler had returned to Boston from the European Theater of Operations, where he had been Chief Surgical Consultant. Following that, he was the Chief of the Professional Services Division in the Chief Surgeon's Office. As he was preparing to resume his position as Mosely Professor of Surgery at Harvard and Surgeon-in-Chief at the Peter Bent Brigham Hospital, he received a letter from Rankin stating, "I am going to give you a job that I believe you will revel in, namely, organization of 'The Society of Consultants in World War II.'" A rough draft of a constitution and by-laws for the Society, prepared by Colonel Michael E. DeBakey, one of Rankin's assistants, was enclosed with his letter.
1234Rankin had chosen wisely. Cutler had served with distinction during both World Wars and was held in the highest regard by the medical professions on both sides of the Atlantic. His many contributions to the nation and to the Allied cause during both wars were recognized in 1970, when his name was given to the Army's new hospital at Fort Devens, near Boston.
1234After numerous discussions between Cutler and others, fourteen consultants representing medicine, neuropsychiatry and surgery met at the Army-Navy Club in Washington, D.C., on February 19, 1946. During this organizational meeting of what they termed "The Society of Medical Consultants in World War II," they agreed on initial statements of its purpose and objectives, elected officers to serve until the Society's first annual meeting, adopted a preliminary constitution and by-laws, and decided that membership in the new Society would be by invitation and voluntary. They also discussed possible ways whereby the new Society could assist the Office of The Surgeon General and the Army Medical Department. 2
1234Cutler demonstrated the wisdom of Rankin's choice. Securing the names of all who had served as consultants in the Army and the Army Air Corps in the overseas theaters and in the continental U.S., Cutler examined the qualifications of each. He wrote those who were considered qualified for membership. They were told of the Society and its purpose, invited to join, and informed that a constitution and by-laws would be adopted and new officers elected at the Society's first meeting, October 18 and 19, 1946.
1234Two individuals were especially helpful to Cutler at this time. They were Colonel Michael E. DeBakey and Lt. Colonel Bernard J. Pisani, who had been Cutler's Executive Officer during the war. Dr. Pisani had returned to his practice in New York City. They knew that Cutler was driving himself to complete what he spoke of as an opportunity to perform "one last service for my country" despite having increasingly severe pain from spreading Colonel Michael E. DeBakey, MC, Consultant in General Surgery, and Later, Chief Consultant in Surgery, Office of The Surgeon General
prostatic carcinoma that had been discovered after his return from the European Theater of Operations. These two physicians worked tirelessly in support of Cutler's efforts, and contributed immeasurably to the timely and effective organization of the new Society.
1234The consultants who had served with the Army Air Corps were members of the new Society from the beginning. Shortly before the first meeting Cutler
Lieutenant Colonel Bernard J. Pasani, MC, Director, Medical Field Service School, and Later, Executive Officer, Professional Serviices Division, Office of The Chief Surgeon, European Theater of Operation, U.S. Army
explained his vision "of the Consultants Club" as "a real power in molding a better medical service. not only for the Army but all the federal services." He said, I would like to see the Navy consultants taken in, and possibly have an active liaison with our Canadian colleagues in a similar capacity." Dr. Richard A. Kern, who would be a President of the Society, was the first Navy consultant to become a member. Dr. Benjamin H. Balser, an Air Force consultant, was the first reservist to become a member, and served later as the Society's President. Dr. Cutler had already requested that two women, Drs. Margaret Craighill and Marion Loizeaux, be considered for membership. It was not long before Australian and British, as well as Canadian consultants, became Honorary Members. The Society's present name, The Society of Medical Consultants to the Armed Forces, was adopted at its meeting in November, 1952.
Medical Care of Veterans
1234 Physicians who would become founding members of the Society were instrumental in alleviating what was aptly termed a 'crisis' at the time. Patients who had been returned from the overseas theaters of operations remained in Army hospitals. There was an enormous backlog of patients who required specialized surgery. The surgeons who were required to perform this surgery were being discharged from the Army. Surgeon General Kirk wrote to each of them. He described the problem and explained why the limited number of individuals in the critical specialties had become 'indispensable.' He asked each specialist to remain on active duty beyond the expiration of his term of service until the patients no longer required his services. This they did, with only rare exceptions. Plastic surgery was one of the most critical of the specialties. Col. Barrett Brown, one of the founding members of the Society, had been the chief consultant in plastic surgery for the European Theater of Operations. He was greatly respected, and influential, as plastic surgeons agreed to remain on active duty, in some cases for as long as an additional two years, until every veteran who required plastic surgery had received it.
1234 Long before the Society's first meeting, Drs. Cutler, Middleton, Pisani, and many others of the original members were assisting the Veterans Administration. Some, in fact, could not attend the first meeting because of prior commitments to the VA.
Major General Paul R. Hawley, MC, Chief Surgeon, European Theater of Operation, U.S. Army The problems facing the Veterans Administration were many and well known. General Omar Bradley was asked by President Truman to assume the task of administering the VA. General Bradley agreed, contingent on his securing the services of Major General Paul L. Hawley as Medical Director. Hawley, who had been the Chief Surgeon of the European Theater of Operations, called upon those who had been consultants with him in Europe to act in a
similar capacity to the VA in its Washington headquarters and regional offices. Other members of the Society became consultants to the VA soon afterwards. Eventually, some ninety percent of the Society's members became associated with the Veterans Administration. Many, including several of the Society's presidents, have served the VA as its Chief Medical Director and in other responsible positions.
1234 Mr. Bernard Baruch, the elder statesman and adviser to presidents, suggested to General Bradley that the hospitals of the Veterans Administration be affiliated with medical schools, and that residency training programs be established in them whenever possible. Dr. Loyal Davis, who had been one of the European Theater consultants, recruited Dr. Paul Magnuson to help General Hawley develop the necessary affiliation Colonel William S. Middleton, MC, Chief Consultant in Medicine, Office of The Chief Surgeon, European Theater of Operations,
U.S. Army
programs. This program has grown steadily in importance, and approximately fifty percent of all residents are now trained in the hospitals of the Veteran Administration. The respected Dr. Owen Wangensteen once stated that this affiliation of the Veterans Administration with medical schools ranked with the Flexner Report and the establishment of the National Institutes of Health as one of the three most important contributions to the quality of the nation's medical education that had occurred during his lifetime.
First Annual Meeting
1234One hundred and seventy eight individuals who had served as consultants with the Army and the Army Air Corps in the United States and the overseas theaters of operations had accepted membership by the time of the society's first meeting at the Walter Reed General Hospital, October 18 and 19, 1946. Those attending the meeting made their own hotel reservations, and arrangements were made for the banquet to be held at the Mayflower Hotel. Four days before the meeting was to begin, however, the Washington hotel workers went on strike, making all room reservations and the banquet arrangement at the hotel valueless. The Office of the Surgeon General rose to the occasion. Cutler and a few others stayed with the Surgeon General at his quarters, the remaining members were billeted at Fort Myer, and the banquet was held at the Walter Reed Army Medical Center's Officers' Club.
1234In his opening statements to the members, Cutler said the fact that eighty of them were attending this first meeting of the Society, despite the strike, was "a happy augury" for its future. Later, during his presidential oration, he spoke of his hope that the Society would not confine its efforts to the benefit of the federal medical services and the increased needs of the governmental services, including the Veterans Administration, but would extend its efforts to benefit the nation as a whole.
1234Cutler referred to the well-known fact that the pre-war Medical Department had not profited from the experience of World War I, and cited examples of the price that had been paid in lost lives and limbs and reduced operational effectiveness as a result. Then, citing another example of the price paid for failure to consult the pages of history, he mentioned the delays and inadequacies that had attended research activities throughout most of the war because of the policy that clinical investigations would be done by civilians. This was due, he said, to the fallacious concept that a military program can be detached from its military background and solved as an abstract problem in a civilian laboratory by civilian investigators who are unfamiliar with its military origin or background.
1234Another speaker, Major General W. S. Paul, the Army's Director of Personnel Administration (G-1), described the recent reorganization of the Army, resulting from the recommendations of a War Department Committee on which Cutler and Menninger had served. The Office of the Surgeon General was moved from under the Services of Supply, that had so hindered its effectiveness during the war, to its pre-war position as an agency of the War Department Special Staff.
1234General Paul was followed on the podium by Surgeon General Norman T. Kirk, who described the extensive consultant system that was being established in the continental United States, and told the members that consultants visits to overseas theaters would be welcomed.
1234The banquet was attended by the Secretary of War, Robert P. Patterson, and other dignitaries. The principal speaker, Major General Hawley, said that the formation of the Society indicated that "a distinguished group of medical soldiers" had left the active service with a friendly feeling toward the Army. They intended to keep alive their interest in its welfare by perpetuating an association begun during the war years in an organization the likes of which had never existed before. He gave a concise description of the need for and the workings of an effective Professional Services Division, and ended his talk with a moving tribute to the individual who had been Chief of the Professional Services Division in his office. Turning to him, he said, "I give you Elliott Cutler--a distinguished surgeon, a courageous soldier, a great man, my friend, for whom I hold the highest admiration and the deepest affection." 3
The Hawley Club
The European consultants had established close relationships during the years they had served together, and wanted to continue their personal association. They organized an intramural club within the Society, named it "The Hawley Club," and met for luncheon during the Society's annual meetings. Not wanting to become a "last man" club, its members disbanded after General Hawley's death, in 1965.
Military Graduate Medical Education
Colonel Edward D. Churchill, MC, Chief Consultant in Surgery, Medical Section, Allied Force Headquarters, North African Theater of Operations, and later , Mediterranean Theater of Operations 4Shortly after the Society's formation, its Advisory Board, consisting of its officers and other council members, assisted the Surgeon General's Office in planning and organizing the Army's graduate medical education (GME) program. Established in 1947, the GME program enabled the Medical Department to offer physicians postgraduate training, specialization, and professional work, and ensured the delivery of optimum health care.
1234Even before the formal GME program began, other members of the Society had taken the initiative locally, and had established training programs and conducted teaching rounds at nearby Army hospitals throughout the country. It was not long before military residency
programs were considered equal to the finest civilian programs, and the quality of care furnished patients in military hospitals was recognized as meeting the highest standards. Military hospitals were accredited, and independent observers noted that health care was provided more efficiently in military than in civilian institutions.
1234Having helped establish the military graduate medical education (GME) programs and assisted their development into the keystone that supports the military medical structure for quality health care delivery, the Society has found it necessary, from time to time, to defend the GME Program from the efforts of those who believe GME programs should be in civilian institutions. The Society, as an organization, and its members, as individuals, have defended these programs in testimony before congressional committees and in correspondence with members of Congress, officials of the Department of Defense, and other professional associations and veterans groups. The Society's efforts have included the preparation of two White Papers on the subject. "Military Graduate Medical Education Under Stress," was prepared and distributed in October, 1987, and "Graduate Medical Education: The Lifeblood Of Military Medicine" was prepared and distributed ten years later, in October, 1997. Both emphasize that "Graduate medical education is the chief guarantor of quality medical care and an unmatched incentive for the recruitment and retention of active duty medical officers. It is the essential prop supporting the entire voluntary military medical structure." It is the "lifeblood" of the military medical services.
Visiting Consultants Program
1234During its second annual meeting in 1947, the Society was asked to furnish consultants who would tour military hospitals overseas as well as in the continental U.S., in order "to tutor the younger and less experienced medical officers assigned to them." Consultant visits began soon afterwards and continued for many years. Consultants went from hospital to hospital, usually spending a day and a night at each. Colonel Maurice C. Pincoffs, MC, Chief Professional Services, and Chief Consultant in Medicine, Office of The Chief Surgeon, U.S. Army 4
They gave lectures, conducted rounds, and inquired about problems which they brought to the attention of The Surgeon General in their trip reports. Their visits not only ensured that patients received optimum care; they served also as morale boosters to the medical officers who were serving obligated tours of active duty.
1234Less than a year later, the Army's Deputy Surgeon General wrote to the Society's President and stated that he had reviewed the reports of the Society's consultants after their field trips, and "felt obligated to let you know that we regard them as some of the most important documents ever received by the Army Medical Department."
1234Within three years of the Society's formation, Major General Raymond W. Bliss, The Surgeon General, wrote to the Society, stating that, "Because of the assistance the Consultant Group has given us . . . we have been able to develop officers to the point that a greater portion of the teaching and professional responsibilities can be assumed by them." He continued, stating that the Consultant Program "has been a significant factor in providing and maintaining high standards of medical care for our military personnel."
Recruitment And Retention Of Medical Officers
Colonel Perrin H. Long, MC, Chief Consultant in Medicine, Medical Section, Allied Force Headquarters, North African Theater of Operations From its beginning, the Society and its members were involved in efforts to support the recruitment and retention of medical officers in the military services. Before the Society had its first meeting, Secretary of War Patterson appointed an Advisory Committee to advise him on problems concerning the Medical Department. The Committee consisted of several of the Society's founding members: Dr. Churchill, its Chairman, and Drs. Cutler, DeBakey, Menninger,
Morgan, and Pincoffs. The Department's most acute problem was the need for physicians in the Regular Army. The Advisory Committee's recommendations to the Secretary of War, and later recommendations to Congress by the Society and its individual members, other professional organizations, and veterans associations, were influential with respect to the enactment of legislation concerning additional pay for physicians and other measures designed to support the recruitment and retention of medical officers.
1234Manpower problems occupied much of the Society's attention. A major problem was the need to replace nearly two thousand Army Specialized Training Program (ASTP) medical officers who left the Army in 1948 after completion of their period of obligated service. Other graduates of the Army's ASTP and the Navy's comparable V-12 Program, who had been deferred from active duty, educated, and paid to go to medical school during the war, but who had not yet served, were discharged from all requirements to serve on active duty by congressional action. The result was that the Army had only one or two general duty medical officers available per station hospital in the continental U. S., and very few more in the overseas hospitals. The situation gradually improved as ambitious younger physicians were attracted to the military by the residency training programs and opportunities for board certification in all specialties.
The Assistant Secretary Of Defense For Health Affairs
1234The efforts of Society members led to the establishment of the Armed Forces Medical Advisory Committee in 1948, and the Office of the Assistant Secretary of Defense for Health Affairs (OASD-HA) in 1954. The position of Assistant Secretary of Defense for Health Affairs was held by members of the Society for many years. Several years after the position's establishment, it was reduced one echelon. The Society, along with other organizations, was influential in having it returned to the Assistant Secretary of Defense level.
Medical Education For National Defense
1234With the outbreak of the Korean War in June 1950, the military medical services discovered, as they had discovered after the U.S. became involved in World War II, that many of the physicians being called for military service lacked knowledge of the functions they were required to perform within the military units to which they were assigned. The American Medical Association and the Association of American Medical Colleges studied this Colonel Francis R. Dieuaide, MC, Chief, Tropical Disease Treatment Branch, Office of The Surgeon General
problem, and concluded that many of these physicians would function equally ineffectively in their own communities in the event of a civilian disaster, whether natural or the result of enemy attack.
1234With the passage of the "Doctor Draft Law" in September 1950, it appeared a reasonable possibility that for many years to come almost all physically qualified male medical school graduates would serve in one of the military services. In addition, it had become apparent that the two year period of service did not provide sufficient time for the necessary in-service indoctrination programs in military medicine.
1234As a result, the Medical Education for National Defense (MEND) Program was established in 1952. This furnished instruction at the medical undergraduate level in subjects of importance in wartime, and in civilian disasters ranging from an auto accident to wartime nuclear attack. The strength of the program at each school depended on the competence and qualities of the faculty member designated as the MEND Coordinator.
1234The Society was involved with the MEND program from its inception. The program's importance was emphasized and the program was publicized during the Society's 1954 meeting. The Society's members were on the faculties of fifty-six of the nation's medical schools, and many served as the MEND Coordinators for their schools. The 1954 meeting emphasized that all physicians need to know the basic principles of disaster medicine, and the place to learn them is in medical school. The ideal way to apply the MEND Program was to integrate it into the teaching of the various divisions of the curriculum, since this had been found more effective than its presentation as a separate program. By 1963, all of the nation's medical schools were participating in the program. Despite the recommendation of the National Research Council that it be continued because of its demonstrated worth, the MEND Program was discontinued during Fiscal Year 1969.
The Armed Forces Physicians' Appointment And Residency Consideration Program (Berry Plan)
1234The Armed Forces Physicians' Appointment and Residency Consideration Program (Berry Plan) was established in 1954. It was named for the Society's third president, Frank B. Berry, M.D., who instituted the Plan while serving as Assistant Secretary of Defense (Health and Medical). The Berry Plan allowed physicians to be deferred from military service while they acquired training in civilian institutions in specialties in which they would fulfill their two year military obligation.
Colonel Lloyd J. Thompson, MC, Senior Consultant in Neuropsychiatry, Office of The Chief Surgeon, European Theater of Operations, U.S. Army 1234At the Society's meeting in 1966, Dr. Shirley Fisk, the Assistant Secretary of Defense for Health Affairs, spoke of the Berry Plan and its products. He commented that its graduates were eminently qualified, but only so far as civilian practice in the U.S. was concerned. He echoed the statements of the Society's original members after WW II, of its members who visited the hospitals in Korea during the early days
of the Korean War, and of those now visiting the hospitals in Vietnam. His comments were that, once again, lessons learned during past wars had been forgotten. In Vietnam it had been necessary to relearn the lessons concerning the treatment of wounds and infectious diseases that had been relearned previously during World War II and the Korean War. Regrettably, the same comments were made during the Society's 1991 meeting by physicians who had participated in the Gulf War.
Uniformed Services University Of The Health Sciences
1234 Members of the Society emphasized the need for an institution such as the Uniformed Services University of the Health Sciences (USUHS) during the Society's second meeting in 1947. The Society's efforts and the actions of many of its members were instrumental in securing approval for establishment of the USUHS in 1972. Two of the Society's Presidents were especially influential in this regard: Dr. Louis M. Rousselot, while serving as Assistant Lieutenant Colonel Norman Q. Brill, MC, Deputy Director, Neuropsychiatry Consultants Division, Office of The Surgeon General
Secretary of Defense for Health Affairs, and Dr. Chris J. D. Zarafonetis, in written testimony to U. S. Congressman F. Edward Hébert.
1234 The Society's efforts, as well as those of other associations and individuals, have been successful in countering repeated attempts to close the University. The Society's White Paper, "The Uniformed Services University of the Health Sciences: An Essential Component of Appropriate Medical Care for Men and Women in Uniform," prepared in 1994, was the basis for the latest successful effort.
John R. Seal Award
1234 During its 1986 meeting, the Society presented the first John R. Seal Award to Dr. Chris J.D. Zarafonetis, its twenty-fifth President, in recognition of his numerous contributions to the nation and its military medical services. This Award was given its name in recognition of the fact that Dr. Seal had exemplified, during his distinguished and productive career in the Navy and later, the qualities the Society wished to recognize when the Award bearing his name was bestowed on a member.
The Zarafonetis Collection
Lieutenant Chris J. D. Zarafonetis, MC, United States of America Typhus Commission 5 1234Dr. Zarafonetis presented his large collection of old and rare medical, military, and military-medical books and other documents to the Society in 1996. He did this so the collection would be available to students of military-medical history, medical planners, and others. The Society, in turn, presented The Zarafonetis Collection and volumes donated by other Society members to the Uniformed Services University
of the Health Sciences, where a special area of the library has been set aside for them.
The Society's First Half Century
1234 The Society observed its fiftieth anniversary as its members met in 1995. They recalled the Society's founding and purpose, and reviewed its half-century of service to the nation. They considered those goals and objectives of the Society that had been realized, and those that had not been achieved. They also considered the additional roles that had been conferred on the Society with the passage of fifty years, and considered new ones that the Society might adopt in response to current needs.
The wisdom of the Society's founders in adopting as an objective the establishment of military residency training programs had been evident for many years. The military's graduate medical education programs have improved the quality and extent of patient care, attracted capable physicians who would not otherwise have been available, and become the lifeblood of the military medical services. Colonel Lauren H. Smith, MC, Neuropsychiatric Consultant, Ninth Service Command
Patients in military hospitals receive medical care that is comparable to that received in the finest civilian institutions.
1234 Patients in the Army's hospitals at the end of World War II were well cared for. The veterans who were transferred to the hospitals of the Veterans Administration were cared for in the excellent system that had been interwoven with the nation's medical schools.
1234 The Society's White Papers, such as those concerning the Armed Forces Institute of Pathology, Military Graduate Medical Education, and the Uniformed Services University of the Health Sciences, have assisted the military medical services at critical periods.
1234 The Society's founders could well take pride in the evolution of the Society's relationships with the Assistant Secretary of Defense for Health Affairs and the Surgeons General. These relationships have assumed progressively greater significance as they have involved broader issues and increasingly more complex factors that mirror the changes in society and the health care delivery system. The Society has provided the military medical services a forum where they can discuss their problems and requirements.
1234 Dr. Zarafonetis spoke of the Society's involvement in broader issues when he was interviewed for the Society's Oral History Program. He furnished examples of how the Society's archives have served as "the institutional memory" of military medicine. "It seems that people are creating difficulties with old questions which we thought had long been resolved . . . . Unfortunately, much of the documentation and backup information which has dealt with such issues in the past has been lost." Explaining that the necessary information had been furnished from the Society's archives, he said that this was "all the more reason that we should have a continuing organization in order to help for just such occasions."
1234 Dr. Zarafonetis also identified a role he believed the Society might assume in response to a demonstrated need when he said, "I think one of the mistakes we've made is that too many medical personnel really don't know much about combat medicine." He recommended preparation of a White Paper that would define and illustrate the unique and specialized nature of Military Medicine, stating that he believed one of the benefits of such a paper would be an unassailable justification of the need for the Uniformed Services University of the Health Sciences.
Remembering The Lessons Of History
1234 A purpose of the SMCAF is the preservation and dissemination of "the experience and knowledge of military medicine gained in both armed conflict and peacetime practice and research." Dr. Michael E. DeBakey, while addressing the members during the Society's fiftieth meeting, repeated what had been said by Dr. Elliott C. Cutler in his opening statements during the Society's first meeting. Both emphasized the need to remember the lessons learned at such great cost in lives, limbs, and combat effectiveness during a war, so that the mistakes by means of which they were learned would not be repeated during the next one. This goal has not been achieved. Mistakes made during the early phase of World War II were made again during the early phases of the Korean, Vietnam and Gulf Wars.
1234 Despite these and other admonitions to remember the military-medical lessons learned during combat operations, there was no provision for this to be done. Dr. Benjamin Baker, the Society's President, brought this to the attention of the Assistant Secretary of Defense for Health Affairs in April, 1996. His letter said that Society members were "concerned at what they see as a lack of knowledge, or worse, of disregard for the history of military medicine." He then quoted Santayana's dictum, as had Drs. Cutler and DeBakey, that "Those who cannot remember the past are condemned to repeat it."
1234 Dr. Baker explained that the organization of the Army Medical Service during the Korean War, as well as the concepts and doctrine that governed its operations, were based on the recommendations of leaders of American medicine with extensive military-medical experience during World War II. They incorporated lessons learned during that war, including the one lesson stated by Surgeon General Leonard Heaton to have stood out among those learned by the Medical Department during World War II. This was that the surgeon, at every level of command, must be an "active and distinct member of the commander's staff. His position should not be subordinated nor included with any other staff member's office."
1234 "History was overlooked," Dr. Baker wrote, and the organizational structure that General Heaton had warned against was reinstituted. He then referred to statements made by Gulf War veterans during a panel discussion of their Gulf War experiences held during the SMCAF's annual meeting in 1991, and said that these statements, "if true, indicated a regression with respect to certain medical capabilities and standards of field medical service that were less than in World War II, and in some cases less than in World War I!"
1234 He continued, stating, "The Korean War system could well serve as a model today--except there is no history of medical services during that period." He referred to a volume that had been written about the Army Medical Service during the Korean War, saying that it is replete with "numerous errors of fact. Reviewers, in SMCAF and elsewhere, noted that the system of treatment and evacuation of the wounded is not described and that no mention of the principles of wound surgery is made. It appears to have been written by nonmedical people for nonmedical readers. Absent an accurate source, it stands alone as an authoritative reference." He continued, emphasizing that no history has recorded the new and integrated roles assumed by the Navy and Air Force Medical Departments during the Korean war.
1234 Dr. Baker ended his letter by stating, "We believe a tri-service medical historical office is badly needed. Its first assignment should be to correct inadequacies and errors of fact in The Medics' War. It is critical to preserve institutional memory of wartime experiences. We stand ready to assist in every way we can."
1234 The Society again emphasized the importance of preserving the institutional memory of wartime experiences in a letter to the Assistant Secretary of Defense for Health Affairs in August, 1999. In it the Society's President, Dr. Nicholas Rock, emphasized the importance of the National Museum of Health and Medicine as a repository of lessons learned, and expressed the Society's whole-hearted support for its retention.
Anthrax Vaccine Immunization Program
1234 The following month, in September 1999, the Society expressed its support of the Anthrax Vaccine Immunization Program of the Department of Defense. In letters to the Secretary of Defense and the Surgeons General, President Rock furnished documentary evidence of the need for and the safety of the Immunization Program, and declared that "The Society of Medical Consultants to the Armed Forces endorses the decision of the Surgeons General to proceed with priority attention, to provide protection against anthrax for our military forces".
Military-Unique Aspects of Graduate Medical Education Programs
1234 As 1999 drew to a close, The Society of Medical Consultants to the Armed Forces began consideration of how it can best assist the military medical services with the military-unique aspects of their graduate medical educational programs. The Society also considered the need for such a program in civilian graduate medical educational programs as well, because of the threat to the nation's civilian communities from biological and other forms of terrorism.
1234 With this, as well as other matters in mind, The Society of Medical Consultants to the Armed Forces reaffirms the declarations of Dr. Zarafonetis, its twenty-fifth President, that its members stand ready, "to assist our colleagues in the military services in every way possible," and the expressed hope of Dr. Cutler, its first President, that the Society would extend its efforts to benefit the nation as a whole.

ENDNOTES
1.
In his Foreword to the volume Organization and Administration in World War II, one of the volumes in the series comprising the official history of the Medical department of the U.S. Army in World War II, Surgeon General Leonard D. Haton states (italics in the original), "If one single lesson stands out among those learned by the Medical Department in World War II, it is this: That at every important level of command the surgeon, if he is to carry out his mission effectively and well, must be an active and distinct member of the commander's staff. His position should not be subordinated nor included within any other staff member's office." (Return)
2.
The fourteen founding members and those elected as the first officers of the Society were: Doctors Norman Q. Brill, Edward D. Churchill (Council), Elliott C. Cutler (President), Michael E. DeBakey (Secretary-Treasurer), Francis R. Dieuaide, Perrin H. Long, William C. Menninger (Council), William S. Middleton (Council), Hugh J. Morgan (Council), Maurice C. Pincoffs (Vice-President), Fred W. Rankin, Lauren H. Smith, Douglas A. Thom, and Lloyd J. Thompson. (Return)
3.
Cutler was determined to carry on during the meeting; however, DeBakey had to care for him as a patient before the meeting ended. His death occurred before the next meeting of the Society, shortly after the Secretary of War had traveled to the Cutler home in Brookline, Massachusetts, where he presented to Dr. Cutler his second Distinguished Service Medal. (Return)
4.
Colonel Pincoffs wears the ribbon of the Distinguished Service Cross, awarded during service as an Infantry battalion surgeon during World War I. (Return)
5.
Lieutenant, later Colonel Zarafonetis, investigated typhus in Greece, Germany, and Bosnia/Hercegovina, to which he carried "clean" lice used in the study. Taped to his body in pill boxes, the lice fed on him during the journey. (Return)

 

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