The Mission of the Association of the Military Surgeons of the National Guard of the United States. N. SENN, M.D., Ph.D., BY OF CHICAGO, President Ass’n Military Surgeons of the National Guard of the United States, Surgeon-General W. N. G., President Ass’n Military Surgeons of W. N. G., Honorary Member Military Order of New Jersey, Member Societe des Chevaliers Sauveteurs des Alpes Marltimes, Prof, of Surgery Rush Medical College. Reprinted from the “ Journal of the American Medical Association,” April 30,1892. —jrTT"""- r CHICAGO: PUBLISHED AT THE OFFICE OF THE ASSOCIATION. 1892. THE MISSION OF THE ASSOCIATION OF THE MILITARY SURGEONS OF THE NATIONAL GUARD OF THE UNITED STATES. N. BENN. M.D., Ph. D., OF CHICAGO, ILL. Surgeons of the National Guard, Ladies and Gentle- men: Every good citizen takes a just pride and a deep interest in the safety and prosperity of his country. His patriotism should bear a direct ratio to the degree of freedom and protection he enjoys and the richness of the natural resources within his reach. If freedom, protection, and prosperity are the ele- ments which are productive of patriotism every citi- zen of the United States is or should be imbued with love and gratitude for his country and ready to defend it in times of danger. It is a great privilege to be a citizen of the greatest country on the face of the earth, and to belong to the most powerful and progressive nation in the world. Our country has taken a place in the front rank among the ruling nations. Its brief history is an unbroken record of unparalleled growth and prosperity. Its inhabitants composed of the best elements of most every civilized nation, have made good use of the wonderful oppor- tunities presented and have built up cities and indus- tries which have become a source of admiration and envy everywhere. Since the war of Independence 4 and foundation of this, the greatest Republic, a little more than a century ago, we have become the leading nation, not through the influence of a large standing army, but by developing the unlimited resources within our legitimate reach, aided by a wise admin- istration of the laws made by the people and for the people. During this short period of our existence as a nation we have taken an enviable position among the powers of the world, and our beautiful flag, the star-spangled banner, is respected and admired wherever it is unfolded. The Stars and Stripes are everywhere recognized as a symbol of liberty and equality. The history of the war of Independence, and more recently, the war of the rebellion, has proved to the outside world that the American citi- zen is a born soldier. Within a few months, during the late great conflict, large armies faced each other in deadly combat, and on each side a heroism was displayed never excelled before. Battles were fought such as the world has never seen before, nor since. The endurance, discipline, and courage of our citizen soldiers have become a matter of hon- orable record and have never and are not likely to be surpassed by any standing army. Our country came out of this great struggle greater than ever. There is now no North and no South. The “gray and the blue” celebrate their war experiences side by side, and relate their victories and defeats without sec- tional feeling. The star-spangled banner again floats over a harmonious and peaceful nation and is revered and loved as dearly in the South as in the North, and should the time come when it is in dan- ger the whole country will rise in its defense. What a happy choice our forefathers made when they selected the eagle as the emblem of our country! Like the King of the Skies that knows no rival in his sphere, our country has outstripped the Old World in everything that pertains to the welfare of its people. The mingling of many nations has pro- 5 duced a race peculiarly well adapted for self-govern- ment. Our little standing army, composed of less than 25,000 men scattered in small detachments over a vast territory, has been seldom called into active service, except occasionally to subdue a hostile band of Indians on the frontier. Should an emergency arise necessitating military interference either in the defense of our borders or to crush anarchism, our standing army would be too small to answer the requirements. Fortunately every true American citizen regards himself as a guardian of public peace ready to defend his rights and ever ready to protect the country of his birth or adoption. The National Guard of the United States, numbering about 100,000 citizen sol- diers, is a military body of far reaching influence and great power. It is composed of the very best elements of society. It represents almost every pro- fession, trade and business interests. It is composed of men who, under all circumstances, are loyal to their general and respective State governments. It constitutes an efficient police force scattered over this vast country from the Atlantic to the Pacific, and from the British Possessions to the Gulf of Mex- ico. The citizen soldiers have often been made the object of ridicule and even contempt, but they have shown their patriotism, courage and military effi- ciency on many critical occasions. When called upon they have never hesitated for a moment to sac- rifice their personal interests and have obeyed their orders without a murmur, and discharged their duties as soldier in a manner that would be a credit to professionals. By their prompt response when called into active service and by their soldierly behavior and action, they have nipped many a serious riot in the bud and have saved millions of property from destruction. As a rule the different States have made ample provision financially and otherwise to secure the service of an efficient National Guard. 6 Should it become necessary to call out the whole force, an army of 100,000 men well equipped and well drilled could be concentrated in any part of the country ready for duty within three to five days. The many strikes and riots which have menaced the peace and personal and public property for a number of years have shown the necessity of an efficient National Guard. Every loyal and peace-loving citi- zen will consider it a privilege to contribute his share towards securing and maintaining such a force. Money paid out of the State Treasury for such a pur- pose is well invested. The general Government should do all in its power to favor the organization, maintenance and equipment of a strong National Guard in each State. The force should be doubled in five years. The services of at least one ex-officer of the regular army should be secured by each State. This officer should devote his whole time and ener- gies in perfecting the organization within his juris- diction, and in active service should have command of the State troops. Everything which can be made serviceable in elevating the standing and in increas- ing the efficiency of the National Guard will con- tribute largely toward bettering its medical service. There are now about five hundred medical officers connected with the National Guard service. This is an important part of our citizen soldiery. I have every reason to believe that most, if not all of these officers, are good physicians, but we must all admit that few of them possess the requisite qualifications and training to satisfactorily perform the manifold duties required of a military surgeon. With com- mendable zeal our regimental and company officers study their books on military tactics during their leisure hours and apply the knowledge thus gained week after week in drilling the men under their com- mand until they become masters of the situation. The non-commissioned officers and privates receive regular instruction weekly, and once a year officers 7 and soldiers spend a week or two in camp, review the work done during the year, make new plans for the future, and return home well versed in the art of war. What did the medical officers do all this time? Few, if any, made a serious study of standard works on Military Surgery and Hygiene. They attended the encampment, wrote prescriptions, or dispensed med- icines to those who applied for treatment, occason- ally dressed a wound or fractured limb, and only very few imparted their knowledge of the litter drill to a small detail of privates and non-commissioned officers. Most of them, even if they had a desire, had no opportunity to make themselves more profi- cient for camp or field service. I have often heard the complaint made that the line officers do not show proper respect for the military surgeon and do not treat him with becoming courtesy. How could it be otherwise? The only way to command respect in military circles, as in other positions in life, is by meritorious work, and this is appreciated everywhere. As soon as the military officer has the necessary advantages and inducements to perfect himself in his special work and makes good use of them, he will be recognized and his position in the service will be respected by officers and privates alike. It is apparent that something must be done to raise the standing and usefulness of the medical service. I know of no way of accomplishing this object except by concerted action. The military surgeons must educate themselves. We live in an age of organiza- tion, of united effort and concentration of work. The unparalleled advances in science, art and litera- ture that have characterized the last decade are largely due to systematic united work. It is true that a great discovery or an important observation comes occasionally like a flash of lightning from a clear sky, the product of some fertile brain, but the greatest advances requiring thorough scientific inves- tigation have been accomplished by the concerted 8 action of many laboring with the same object in view. The stimulus imparted by the work and suc- cess of others is the motor which impels individual effort, and comparison of the results realized becomes either a source of gratification, or acts like a lash that arouses the latent force to renew action. In our country nearly every profession, trade and business has now its local and national associations. Less than a year ago about fifty surgeons of the National Guard, representing fifteen States, met in the city of Chicago and organized the Association of Military Surgeons of the National Guard of the United States. All present were fully impressed with the necessity of such an Association and manifested a keen inter- est in its organization. The deliberations were char- acterized by harmony and a feeling of fraternity pre- vailed throughout, and every one returned to his respective field of labor with a consciousness that the first steps had been taken towards self-education in the duties of the military surgeon and in elevating the position of the medical staff in the estimation of the line officers. Today we have opened our first annual meeting in this beautiful city and have received such a warm welcome on part of the State, the city, the medical profession and citizens seldom extended to a scien- tific body. As an association we have not yet reached our first birthday, and yet we have attained a mem- bership of over 200. A deep interest in the welfare and prosperity of our Association has been mani- fested outside of our ranks throughout the United States. The newspapers and medical journals have treated us with every mark of courtesy, and have brought our good work to the attention of military officers, the public, and the medical profession. The general government has encouraged us from the very beginning by detailing for our benefit a number of the oldest and most experienced surgeons to attend our meetings. We have eagerly availed ourselves of 9 their wise counsel in planning the sphere of our work and will look to them in the future for instruc- tion in the practical details of our duties as military surgeons. lam convinced that we have as a body the good will and moral support of the entire National Guard, and particularly of its officers. The future success of this Association is therefore assured, provided its members will do their duty towards themselves and the Association. It is my intention on this occasion to call your attention to some topics which should be earnestly discussed at this our first annual gathering, at the same time I desire to outline some of the work which should be accomplished in the near future by our united efforts, subjects which properly come under the title of this address : “The Mission of the Association of Military Surgeons of the National Guard of the United States.” State Association of Military Surgeons.—Our Na- tional Association should be the center of our actions and at its meetings a uniform plan for study, inves- tigation and practice should be made and recom- mended for adoption to the different State Associa- tions. If we do our work well it is only a matter of a few' years before nearly every National Guard sur- geon will be a member of this Association. The extent of our territory is so great that wre can hardly expect an attendance of more than 150 or 200 at any of the annual meetings. The absent members will read our transactions, but will not become infused with the necessary stimulus for work which can only be imparted by being present at the meetings, taking part in the proceedings and coming in personal con- tact with the members. The actual wmrk must be done nearer home, at shorter intervals, and in smaller meetings. lam strongly impressed with the necessity of the formation of an association of Mili- tary Surgeons in each State. These associations should be organized upon a uniform plan and should be legally chartered corporations and in affiliation 10 with the National Association. Meetings should be held at least three times a year, one of them shortly before encampment, at which the work during camp life should be thoroughly planned. Litter drill, first aid to the wounded, camp sanitation and other mat- ters pertaining to the welfare, usefulness and happi- ness of the civilian soldier should be freely and thoroughly discussed. Each one of these associa- tions should be represented at the annual meeting of the National Association and report through one of its delegates the work done during the year, with recommendations and observations of interest to the national body. The State should not only furnish free transportation, but should also defray the actual expenses of each member attending these meetings. Appointments by Competitive Examination.—Our Constitution very wisely provides that all National Guard surgeons holding a commission and in actual service are eligible to membership. For reasons which it is unnecessary to mention here, school legis- lation has been entirely ignored. It is our intention now to unite all military surgeons of the National Guard of this country into one great body for united effective work. We cannot legislate for the past, but we must use our combined influence to secure the best obtainable material for the medical staff in the future. In most of the States the appointment of military surgeons is virtually in the hands of the regimental commander. Personal friendship, polit- ical influence and social qualifications have often been more weighty in securing a commission than a thorough knowledge of the art and science of medi- cine and surgery and other qualifications necessary to make a good military surgeon. This is certainly not as it should be. A colonel is expected to know all about military tactics and discipline, but the law or usage which gives him the unlimited power to appoint his medical officers is a great evil and should be abolished if we expect to fill vacancies as they 11 occur in the future with the best available material. The appointments should be made as in the regular army by competitive examination conducted by a board of medical officers. This can readily be accom- plished as soon as each State has its own Association of Military Surgeons. Let each State Association appoint a board of examiners, composed of three members, which can conduct the examination of can- didates at any of the regular meetings whenever it becomes necessary to fill a vacancy. As soon as it is generally known that appointments are made on merit and not by favoritism, the reputation of the medical department of the National Guard will be greatly enhanced in the estimation of the line offi- cers, the medical profession and the public. The standing of the medical officer in military circles and the community will be proportionate to the height of the standard fixed by the examination. When com- missions are obtainable only after a thorough and satisfactory examination they will be of some value to their holders, and it will then be some honor to be known and seen as a military surgeon. The require- ments of admission into the medical service of the National Guard should be gradually made so strin- gent that any one who gains entrance will be recog- nized as a scientific man and physician and surgeon of more than average ability. A commission obtained in this way will then be regarded as of far greater value than a diploma from any of our medical col- leges. Let me express the hope that the time is not far distant when the regimental commander shall have no voice in the appointment of his surgeons, but when the door to the entrance into the medical ser- vice shall be carefully guarded by a competent med- ical board and only such candidates are permitted to pass who shall be a credit to the National Guard and an honor to the medical profession. Medical Corps.—ln most of our States the medical officer remains with the regiment, squadron or bat- 12 tery with which he first became identified. If he is connected with a regimental organization he may expect eventually to reach the rank of a major, but if he is attached to a smaller troop, promotion is out of question. It sometimes happens that the pleasant relations which first existed between the commanding officers and a surgeon for some reason or other are disturbed to the mutual detriment of both sides, ren- dering at the same time military life unpleasant. It is also often the case that military surgeons are placed on duty with their organization in localities much nearer the home of another colleague than his own, making it necessary to travel unnecessary dis- tances to supply the command with medical aid. For these and other reasons it would be advisable to establish a medical corps in each State, to be under the supervision of the Surgeon General or a Medical Director who could detail the medical officers for duty as location and other circumstances might dic- tate. By making the medical officers independent of any particular regiment or smaller detachment many unpleasant experiences might be obviated and the medical service would be rendered more efficient, and often no inconsiderable expense to the State could be saved; at the same time the surgeons would make many additional pleasant acquaintances. I am very anxious that this subject should receive due attention not only here, but in the different State Associations. Uniform of the National Guard Surgeons.—In con- sequence of the too close identification of the mili- tary officer with the organization with which he is connected, National Guard surgeons, when assembled in a body, present a unique and picturesque appear- ance. Infantry, cavalry and artillery uniforms are worn, thus rendering it often impossible to distin- guish between a line officer and a surgeon. It is desirable that this Association take some steps to adopt a uniform that shall be worn by all National 13 Guard surgeons. As it is becoming more and more the policy of military officers to pattern as closely as possible after the regular army, it seems to me that the uniform of the surgeons of the regular army would be most appropriate, and that we recommend its adoption to the different State Associations. As military surgeons are not only doctors, but also mil- itary men, it is only proper that during the meetings of the State and National Associations the members should appear in uniform and greet and address each other during the session not as doctors, but as mili- tary men. Original Research.—Military surgery is at present in a transitional stage. Human ingenuity has ex- erted itself to the utmost during the last few years in perfecting cannon, guns and other implements of destruction. The smokeless powder and the small calibre conical bullet surrounded by a steel mantel have revolutionized modern warfare. Rapid firing and certainty of aim at a great distance will make the battles of the future of short duration, but the loss of life and the number of disabled by wounds will be fearful. The bullet wounds that will come under the treatment of the military surgeon of future wars will present an entirely different aspect, and will call for different treatment than those inflicted by the old weapons. The modern bullet, by virtue of its great penetrating power, will either produce a speedily fatal wound or the injury it produces will be more amenable to successful treatment because it produces less contusion of the soft tissues and splin- tering of bone than the heavy bullet used in the past. Bruns, Bardeleben and others have made careful ex- perimental researches concerning the effect of the new projectile, but this subject is not exhausted and there is plenty of room for original work by our members in this department of military surgery. The operative treatment of penetrating wounds of the chest and abdomen on the battle field offers an- 14 other inviting field for original investigation. The various materials devised to dress wounds on the battle field have all their faults and merits, but none of them are perfect and I hope it will be left for some one of you to immortalize himself and this Associa- tion by devising a dressing that will answer every requirements on the battle field. The methods of transportation of the sick and wounded, the construc- tion of tents and movable barracks are not closed chapters, and are only susceptible of improvement by original thought and investigation. More ingenuity has been displayed of late years in perfecting fire- arms and in the invention of machines for wholesale destruction of life than in devising ways and means in saving the lives of those seriously injured. It is our duty as military surgeons to counteract as far as we can the horrors of war by devising life-saving operations and by protecting the injured against the dangers incident to traumatic infection. Antiseptic and aseptic surgery must be made more simple than they are now, in order that we may reap from them equal blessings in military as in civil practice. Enough has been said to show you that a military association of this kind can become an inestimable boon to mankind if some of its members will explore unknown regions and bring to light the priceless jewels of original thought and research. I hope that at each annual meeting at least one or two papers bristling with original ideas will be presented, and I am confident that some of them will be accepted as foundation stones upon which will be erected the coming structure of modern military surgery. Military Medical School.—For nearly one hundred years our government has made ample provision for the education and practical training of the officers of the Army and Navy. The Naval Academy at Annap- olis, and the Military Academy at West Point, are model institutions of their kind. Hundreds of young men have left these institutions with a thorough 15 knowledge of the science and art of warfare, and many of them have become immortal as leaders of victorious armies in the history of this country. The students of these academies have been selected from the cream of our population. From the time they enter these institutions they aie in the service of our Government. The education is not only without ex- pense to themselves, but they receive from the be- ginning a small salary which enables them to enjoy many of the pleasures of life. Affer their gradua- tion they enter military service, with the rank and pay of second lieutenant. They are well prepared for their life work—they have passed through a thor- ough theoretical and practical training. They are respected and honored wherever duty compels them to go. How different with the medical officer of the United States Army! He has spent a number of years in a high school, academy or college, and three years or more in a medical college at his own expense. He is now required to pass a very rigid examination, and if successful is assigned to some small post, with the rank and pay of a first lieutenant. He is, as a matter of course, a good doctor, but knows nothing of military life and discipline. He is entirely ignor- ant of the many details of clerical work required of him, and has a most serious time before he can make out a report that will prove acceptable at headquar- ters in Washington. No wonder that he is made the laughing-stock in his little community until, by hard work and close observation, he has become in- itiated into military life and customs. He has paid for his education as a doctor, he must educate him- self as a military surgeon. Is there any justice or excuse in discriminating to such an extent between a line officer and a surgeon of the regular army? Is it not about time that they should be treated alike and placed on the same level from the beginning to the end? All of the larger countries in the Old World have excellent military medical schools, where the 16 army surgeons are trained not only as doctors, but also as military men. It is a burning shame that no such institution exists in this the greatest and rich- est country. Let us, as an Association and as indi- viduals, do all in our power to secure proper recogni- tion for our colleagues of the regular army. Let us use our influence with the officials at Washington and the members of Congress, and ask for the establish- ment of a model military medical school, in which the military surgeon of the future shall receive his education at the expense of the country for which he is to devote his life. Such a school should be located either at Chicago or St. Louis; both of these cities have excellent railroad facilities, and would furnish an abundance of clinical material. The East has the academies at West Point and Annapolis, let the West have the third National military educational institu- tion. The cadets entering such a school should have a thorough preliminary education, and should be re- quired to study medicine and surgery and the collat- eral branches for at least five years. The classes would be necessarily small, consequently each mem- ber could receive thorough hospital training for at least two years. The graduates would not only be well educated, successful doctors, but also military men, well prepared by practical training to com- mence their life work. It is well known that many of the surgeons of the regular army, for want of a proper stimulus derived from daily application of their knowledge, gradually lose their interest in their profession, and choose some other occupation in spending a great part of their leisure time. I know of nothing that would do more towards securing their interest in the progress of medicine and surgery than a three or four months’ post-graduate course every five years in such an institution. The utility of such a school would also be greatly increased if its doors were thrown open for the National Guard surgeons, who should receive instruction free of expense. I 17 have consulted several members of Congress in refer- ence to the advisability of making an effort to se- cure the establishment of a military medical school, and I have been assured by all of them that should such a movement come through the proper channel, the request would receive favorable consideration. This important matter should be brought to the at- tention of the Government and the representatives in Congress, and I express the hope that in less than five pears we shall have a military school in this country in which the coming military officers of the Army and Navy will receive a medical and military education which will prepare them fully to enter the service, and in which the surgeons of the Army and Navy and of the National Guard can receive from time to time the necessary post-graduate instruction. International Congress of Military Surgeons.—The next year the eyes of the whole world will be turned towards this country. All nations will send visitors to the Columbian Exposition. Among them will be a fair percentage of medical men, and many military surgeons. It has occurred to me that it would be a good idea to utilize this opportunity, to take now the necessary initiatory steps toward the organization of an International Congress of Military Surgeons. That such an association is desirable no one will de- ny, that it can be effected through our young and vig- orous Association few will doubt. It is difficult to realize what great things could be accomplished for the benefit of humanity, and the advancement of military surgery, by an association of military sur- geons representing all nations. Should you think favorably of this suggestion, I would recommend the appointment of a committee representing as many nationalities as are at our disposal, with power to in- vite the different nations to send delegates to our next meeting. The delegates can be made members by in- vitation, and towards the close of the session the Congress could be organized. The Congress should 18 meet as often as the World’s Fair, and if possible in the same city. This would always insure a good at- tendance. Military surgery is a branch of the heal- ing art which not only interests the medical profes- sion, but it is also a subject which deeply concerns Governments, military men and the people at large. The military surgeon is in the employ of the Gov- ernment, to which he is responsible for his be- havior and actions. An International Congress of Military Surgeons would represent the most import- ant branch of non-combatants, and would afford an opportunity to its members to form many personal acquaintances which would become a source of pleas- ure in times of peace, and of the greatest value and importance in case of war. I trust that this matter will receive your earnest attention during this ses- sion, and that in case the plan outlined is deemed feasible and desirable, every member of this Associa- tion will do all in his power towards its realization. Surgeons of the National Guard.—Permit me, in conclusion, to thank you sincerely for the honor you have conferred upon me at the first meeting in elect- ing me as your first presiding officer. It is an honor that I fully appreciate, and that I shall always re- member with gratitude. I congratulate the Associa- tion upon its rapid growth and the bright outlook for its future success. lam sure that you will all join with me in thanking Col. Chancellor, the Chairman of the Committee of Arrangements,' for the work he has done since our first meeting. To his untiring in- dustry, and his earnest devotion to the task imposed upon him, is due the success of this our first annual meeting, the hearty welcome we have received and the many pleasures that await us. St. Louis has immor- talized itself in the annals of our Association. The lavish hospitality we are enjoying here can never be duplicated until in the course of time, we again se- lect this city as our place of meeting and Col. Chan- cellor as Chairman of the Committee of Arrange- 19 merits. The success of an Association, like that of an individual, depends on hard, honest and persever- ing toil. Make the cause of this Association your own, and in less than five years the Association of Military Surgeons of the National Guard of the United States will be one of the largest, most influ- ential and useful Associations in this country, hon- ored and respected at home and abroad.