THE PLACE 
or 
MILITARY 
Medicine and Surgery 
IN THE 
MEDICAL COLLEGE 
CURRICULUM 
A PAPER PRESENTED TO THE 
ASSOCIATION OF MILITARY SURGEONS 
OF THE UNITED STATES, 
AND REPRINTED FROM THE 
PROCEEDINGS OF THE 
SEVENTH ANNUAL 
MEETING. 
By GEORGE M. KOBER, M. D., 
PROFESSOR OF HYGIENE AND MILITARY SURGERY, MEDICAL 
DEPARTMENT GEORGETOWN UNIVERSITY. 
COLUMBUS, OHIO : > 
BERLIN PRINTING COMPANY. 
1897 . THE PLACE 
or 
MILITARY 
Medicine and Surgery 
IN TMC 
.AEDICAL COLLEGE 
CURRICULUM 
A I* A I’1C It PRESENTED TO THE 
ASSOCIATION OF MILITARY SURGEONS 
OF THE UNITED STATES, 
AND REPRINTED FROM THE 
PROCEEDINGS OF THE 
SEVENTH ANNUAL 
MEETING. 
By GEORGE M. KOBER, M. D., 
PKOPHSSOK OF HYOIHNE AND MILITARY SURGERY, MEDICAL, 
DEPARTMENT GEORGETOWN UNIVERSITY. 
COLUMBUS, OHIO : 
BK K LIN PRINTING COMPANY. 
1897 . THE PLACE OF MILITARY MEDICINE AND 
SURGERY IN THE MEDICAL COLLEGE 
CURRICULUM. 
By GEORGE M. KQBER, M. D., 
PROFESSOR OF HYGIENE ANI) MILITARY SURGERY, MEDICAL DE- 
PARTMENT GEORGETOWN UNIVERSITY. 
T ~y ERHAPS few men will question that Military Medicine 
I and Surgery should have a place in the medical college 
curriculum; those who are iq doubt will simply have to 
recall our history in the past and consider the possibilities in the 
future. There is no country of its size which has a smaller stand- 
ing army, and perhaps no country in {lie world which may find 
itself so readily in the throes of a civil \yar than our own, and “as 
our strength and safety are in a general dissemination of military 
knowledge among the people,” so the character and efficiency 
of the Medical Officers of our future armies must depend upon 
the training received in our medical schools in Military Medicine 
and Surgery. 
In the fall of 1874, while stationed as an Acting Assistant Sur- 
geon on the Pacific Coast, I read in onq of the German periodi- 
cals, an extract from an oration delivered by Rudolf Virchow 
on “The Progress of Military Medicine.” Since the Germans 
are accustomed to speak highly only of the practical talent of 
Americans, but shrug their shoulders in a very significant man- 
ner about our scientific attainments, T translated the opinion of 
this masterly and certainly not over-indulgent critic for the Pacific 
Medical and Surgical Journal. November, 1874. In speaking of 
infectious diseases and the lessons of war. he says: 
“Truly it is fearful to think of the scjiool of suffering which 
the armies had to pass through before the truth was finally ac- 
knowledged. T11 the Crimean war the French army lost one man 
out of three of the whole army, and it is estimated that of the 
95,615 lives lost only 10,240 fell before the foe. About as many 
died of wounds in the hospitals, and the rest, more than 75,000 4 
Professor George M. Kober. 
men, died of infectious diseases. It is calculated that in the Ameri- 
can war of secession 97,000 men fell in battle, and 194,000 perished 
of infectious and other diseases. What an excess of pain and 
sorrow, what an ocean of blood and tears are contained in these 
figures! And what a mass of false regulations, and prejudices and 
misunderstandings, too! It is not necessary to recount here the 
long lists of sins and mistakes. These are known too well and 
serve as a terrible warning to others. But it must here be ac- 
knowledged, that it was not the necessity alone that revealed the 
evil and brought the help. That the French in the Crimea 
learned from their experiences little or nothing, and the Ameri- 
cans in their civil war so much as to create a new era in military 
medicine—these results were brought about not by the magni- 
tude of the need which the Americans had to suffer—for this was 
not greater than that experienced by the French in the Crimea,— 
but rather by the critical and truly scientific spirit, the open mind, 
the sound and practical common sense which in America gradu- 
ally permeated all departments of army organization, and which, 
under the wonderful co-operation of an entire nation, reached the 
highest point in humane efforts ever attained in a great war. 
Whoever takes up and reads the extensive publications of the 
American medical staff will be constantly astonished at the wealth 
of experience therein found. The greatest exactness in detail, 
careful statistics, even about the smallest matters, and a scholarly 
statement embracing all sides of medical experience are here 
united in order to preserve and to transmit to contemporaries and 
posterity in the greatest possible completeness the knowledge 
purchased at so vast an expense.” 
This happy appreciation of Professor Virchow of our achieve- 
ments in Military Medicine applies to an epoch where the United 
States with a small standing army and a small corps of trained 
Medical Officers were suddenly involved in a gigantic war, abso- 
lutely unprepared for the struggle, except that we had men gifted 
with good common sense, powers of observation and application 
and a generous nation to provide over fifty million dollars for the 
care and treatment of our sick and wounded. I naturally asked 
myself the question, if the American Medical Staff accomplished 
so much without special training, how much more might have 
been achieved had the Medical Officers enjoyed preliminary in- Military Scroery in the Medical College. 
5 
struction in Military Medicine and Surgery, such as is given at the 
Army Medical School at Xetley, or in the Friedrich Wilhelm Uni- 
versitat at Merlin. But someone will say, “Necessity is the mother 
of invention,” “Experience is the best teacher,” “We did it before, 
and we can do it again.” 
Yes, but how did we do it? Shall the future medical histo- 
rian be compelled to chronicle the fact, that ten days after the first 
engagement “600 wounded still remain on the battle field in can- 
sequence of the insufficiency of ambulances and the want of a 
proper system for regulating their removal; many have died of 
starvation, many more will die in consequence of exhaustion, and 
all have endured torments that might have been avoided.” 
Virchow’s comments were based upon <>7,000 men, who died 
of their wounds, and 19.4,000 who perished from infectious and 
other diseases. As a matter of fact, the total deaths in the Union 
Army numbered 350,496, over 15 per cent, of the entire number 
of enlistments. Of this number 224,586, or nearly two-thirds died 
from disease, while 134,910 were killed in battle or died from the 
effects of wounds. Indeed it is calculated that in our Civil War 
the Union Army treated over six million cases, including 151,384 
cast's of continued fever, mostly typhoid; 1,739,135 cases of 
diarrhoea and dysentery, with 44,558 deaths; there were also 76,318 
cases of measles, with 5,177 deaths; 18,952 cases of small pox, with 
7,058 deaths, and 24,812 cases of erysipelas, with 2,107 deaths. 
Think of this array of preventable diseases? Consider, if you 
please, the fact that in addition to the terrible sacrifice of human 
life, a generous nation expends one hundred and forty millions a 
year for the support of invalids of this war. 
Who can deny that, had the Medical Officers of the late war 
known more of army diseases, their causes and prevention, had 
they appreciated the importance of accurate and complete hos- 
pital records, our pension roll would be smaller and a just dis- 
crimination would have been possible between deserving invalids 
and malingerers, and individuals who studiously arrived at a de- 
terioration of their physical condition in order to enlist svmpa- 
thy and a higher rate of pensions. 
Shall the sins of omission and commission, the prejudices and 
false regulations be repeated? No; for they are too well known 
and serve as a terrible warning to others. But how shall this 6 
Professor George M. Kober. 
warning be heeded? Simply by transmitting in the medical 
schools of this country to contemporaries and posterity the knowl- 
edge purchased at so vast an expense. Our medical colleges have 
very generally introduced instructions in personal and public 
hygiene, in fact the medical profession is striving every day to 
lessen sickness by the enactment of health-laws, and to thereby cut 
off its own revenue, and there should be no difficulty in convincing 
medical schools that it is a patriotic duty to establish courses of 
instruction in military surgery and sanitation. 
After the receipt of Major Hoff’s lecture on “The Military 
Medical Officer in Peace and War,” delivered at the Medical 
School of Harvard University in November or December, 1894, 
I was requested by the Medical Faculty of Georgetown Univer- 
sity to supplement my instructions in hygiene with a course on 
Military Surgery and Medicine, and I am convinced that interest 
in the general course on hygiene has been stimulated thereby. It 
is no more difficult to interest the average student in this than in 
any of the subjects taught, provided the course is made obligatory 
and he is required to pass a satisfactory examination. This is 
sufficient to insure prompt attendance and attention, but apart 
from this we can appeal to the patriotism and ambition of the 
student. In my introductory remarks I point out the advantages 
of a medical career in the Army, Navy and Marine Hospital Ser- 
vice, and that merit alone is the key to success; reference is made 
to the status of Medical Officers in the National Guards, and their 
usefulness in time of peace, as educators of the masses in the prin- 
ciples of personal and public hygiene, first-aid and transport of 
suffering humanity, and lastly, attention is directed to the fact that, 
in the event of a war, when the services of one Medical Officer for 
every 150 fighting men are required, it will be clearly their duty 
to contribute their share for the nation’s defense and the manner of 
doing it will largely depend upon their preliminary training. 
It cannot be expected that every young physician will choose 
the army or other public services for his professional career, but 
there will be ample opportunities for the application of the knowl- 
edge thus acquired as sanitary officers in connection with health- 
boards, as physicians and surgeons in charge of private or State 
hospitals, reform schools, jails, prisons, asylums, ship and police 
surgeons, pension examiners, surgeons in the employ of railroad Military Surgery in the Medical College. 
and mining companies, surveying expeditions, medical examiners 
of insurance companies, and in the home of almost every patient. 
When a student is told, for example, that the general rules to be 
observed in the examination of recruits will enable him to select 
able-bodied men for the police force and life insurance policies, 
and that the question of food, its preparation and the care of cook- 
ing utensils are of practical importance in the management of his 
patients, his interest in these subjects will be stimulated. Indeed 
he will soon learn that the aphorisms of the army cook’s creed are 
not less applicable to the civilian. Take for instance the follow- 
ing, the truth of which the soldier learned from bitter experience: 
“Cleanliness is next to godliness both in persons and kettles. 
It is less dangerous to work your elbows than your comrade’s bow- 
els. Remember that beans badly boiled kill more than bullets, 
and too much grease is more fatal than powder.” 
The average student of to-day will not forget the import of 
these aphorisms, and takes pride in being able to explain that dirty 
and greasy pots furnish food for certain saprophytic germs and 
consequent toxic products, which in turn produce gastro-enteric 
disorders,—that an excess of grease and improperly cooked beans 
render the digestive tract vulnerable to the germs of water-borne 
diseases like typhoid fever and dysentery and are to a great ex- 
tent directly responsible for the many cases of simple and chronic 
diarrhoea. I le will also appreciate the many circumstances under 
which he may be called upon to investigate an outbreak of so- 
called cholera morbus, due perhaps to improper food. It is very 
important to refer to the practical application of the knowledge 
thus acquired under the varied conditions of both civil and military 
life. 
It goes without saying that the student of military medicine 
should be perfectly familiar with the principles of personal and 
public hygiene. Mv lectures on hygiene are delivered to third 
and fourth year classes, and the course extends over two sessions, 
at the end of which the lectures on military hygiene and surgery 
are given. 
Among the subjects discussed are: 
i. The national necessity of instruction in military sanita- 
tion and surgery in our medical schools. 
7 
/ 8 
Professor George M. Kouer. 
2. The duties of Medical Officers, professional and admin- 
istrative. 
3. The duties of Medical Officers as sanitary officers. 
4. The importance of examination of recruits, and dis- 
charges on surgeon’s certificate. 
5. The training of the Hospital Corps. 
6. The hygiene of troops in permanent posts. 
7. The hygiene of troops upon the march and in camps. 
8. Preparation and supplies for field service and active hos- 
tilities. 
9. Modern firearms, explosives and projectiles. 
10. The effects of modern firearms in battle and probable 
amount of surgical work in a given number of wounded. 
11. General consideration of gunshot, sabre and bayonet 
wounds, primary symptoms and complications of gunshot wounds. 
12. First-aid and transport of the sick and wounded. 
13. Dressing stations, field, base and general hospitals. 
14. Secondary complications of gunshot injuries. 
15. The ultimate results of gunshot wounds, especially after 
excisions of joints. 
16. Army diseases, their causes and prevention. 
Last year I handed the examination papers to Surgeon 
Charles Smart, U. S. Army, and asked him to kindly rate them as 
he would before an Army Medical Board. According to his esti- 
mate only one man dropped below 75 out of a possible hundred. 
In conclusion, it affords me great pleasure to state that the course 
on Military Surgery in the Georgetown Medical School will be 
much more thorough hereafter, as the subject, upon my own re- 
quest, has been assigned to Colonel and Assistant Surgeon Gen- 
eral W. H. Forwood, U. S. Army, Professor of Surgical Pa- 
thology and Military Surgery.