For all wars to date, medical planning has followed the uniform pattern of providing for an exclusive medical service for the armed forces, including medical men assigned or attached to troop units, military hospitals and ancillary personnel for administration, supply and evacuation.
With few exceptions, civilized warfare to date has shared one common characteristic—so long as civilized populations have refrained from overt acts of war they have been spared from enemy action. Not since 1813 has the United States been invaded; nor, with the exception of a few shells lobbed on the West Coast by a Japanese submarine in World War II, has a hostile shot landed on Continental United States.
In wars of this character, the medical needs of civil populations were limited to routine care, and no special consideration was made necessary by the state of war. A rather large proportion of the medical potential of the country could be allocated for the exclusive use of the armed forces without serious consequences among the civil population.
This kind of warfare has now been relegated to a place among other extinct customs of mankind. From now henceforth, so long as war is an instrument of political relations, civil populations will find themselves in the thick of the fight….
Added to the danger from explosive missiles is that from bacteriological warfare, the effects of which promise to extend far beyond industrial areas and involve peaceful people in rural communities.
… In drafting one coordinated medical plan, we can start from the premise that, in theaters of war and in all foreign territory, the armed forces must have their own exclusive medical services….
Regardless of where and how the next war will be fought, a very large part of the medical needs of the armed forces will be within Continental United States. All casualties requiring protracted treatment will be brought home, and all troops will be mobilized and trained here….
… There can be no economic or professional justification for the operation of exclusive military hospital beds for the definitive treatment of casualties of no further military usefulness—such as the blinded, the major amputees, the tuberculous, the psychotic, and others too seriously and too permanently disabled ever to bear arms again. Such cases should immediately be transferred to civil institutions, government or voluntary, where they can be cared for by medical people on part-time service, so that some of this medical potential can be reserved for the civil population….
While civil medical institutions are a military asset, the reverse is not true. Military hospitals are for the exclusive use of the armed forces, and they can not be included in plans for the care of the civil populations.
… More and more military hospitals are being opened, and a large part of their load is the permanently disabled…. We are operating exclusive hospitals and withdrawing medical people from the rest of the civil populations for their care. This is not only uneconomical, it is extremely unfair.
The military requirements for medical care have created another very serious problem. This is the disruption of programs of training of medical specialists. The effects of this will be serious for years to come, and may well cause this country to lose the medical leadership of the world to which it has risen in the past 30 years. A coordinated medical plan for all the people would not save the resident training program, it would promote it….
As I stated before, I do not think that this extravagance and this muddled planning will create a really critical problem if our mobilization is limited to 31/2 million men. However, the danger is that we may find ourselves at any minute—over night and without warning—in an all-out war which will be much worse even than World War II. When that happens, the time for planning has ended, and we are struck with the plan of the moment.
… We must start now with a medical plan which can be expanded smoothly to meet any situation up to total war in which every man, woman and child in this country is involved.