ISSUE 3 : Mar/Apr - 1977 - Australian Defence Force Journal

in the armvBrigadier W. B. James, MBE, MC, MB,BS, DPH, DIM & H, D1H, MFCMDirector of Medical Services — ArmyIntroduction: The Problems of PublicHealth in the Army"In 1943, for every man wounded, 1 waslosing 120 from sickness. My daily evacuationrate was 13 per 1,000. A simple calculationshowed me that the whole of my(Fourteenth) Army would melt away in threeor four months."THIS extract from a speech by Field MarshalSir William Slim to the Royal AustralasianCollege of Physicians in 1957 very clearlyshows the folly of thinking that the only medicalrequirement in war is to provide surgical servicesfor the men wounded in combat. Butthis notion, that the medical services in warare required only to provide treatment for thewounded, dies hard and too often lessons ofthe past are forgotten. So that with each newcampaign tragedies of great suffering, illnessand death still occur because the principles ofpublic health are not appreciated. Slim goeson to acknowledge this in his speech — "Thisgloomy picture . . . was changed by early 1945into that of the healthiest Army Britain hasever had overseas. Our sickness rate of evacua-Hrigadier James graduated from RMC Duntroon in1951. He served in I RAR in Korea as a platooncommander. As a result of this service, he M-asawarded a Military Cross. After service witharmoured units in Australia, he left the Army andstudied medicine. He was reappointed to theRAAMC. He served as Senior Medical Officer1 Task Force in South Vietnam, and, after trainingin the United Kingdom, was appointed Director ofMedical Services. I Military District. He is currentlyDMS (Army).tion was 1 per 1,000 per day. The transformationwas only possible, the existence letalone the victory of my Army was only possible,because of the skill, courage, ingenuity,energy and devotion of my doctors. I yieldto none in my admiration for our surgeons. . .theirs was the more spectacular role, but themen who saved and restored my Army werethe physicians. It was their research whichdiscovered new means of grappling with causesof disease ... it was their advice which enabledmy officers to order preventative measures thatreduced startingly the incidence of sickness."These extracts also clearly illustrate the twomain aspects of the problems of Public Healthin the Army, the first being the appreciationof the necessity of public health facilities andmeasures in any community, and the secondaspect being the means, and knowledge, to solvespecific problems encountered in a particularcampaign relating to time, place and nature ofthe conflict. In the succeeding chapters it isintended to show that the former problem hasusually been the most difficult to solve whilstsolution to specific public health problems arefar less difficult. It is strange that this shouldbe so, for at the conclusion of both the CrimeanWar and the Boer War Royal Commissionsreported and stressed the need for sound publichealth measures and employment of "a MedicalOfficer charged especially with the sanitarysupervision of the Army" (Herbert 1860) yetin the early phases of World War I and WorldWar II the importance of military hygiene wasignored. Lewis in the British Army Reviewof 1961 writes of this as "an attitude of laissezfairetowards hygiene insidiously developing