The transforming of American medicine in World War II

This month marks the 60th anniversary of the end of World War II. The end came on Aug. 15, 1945, with the surrender of Japan; the destruction of Germany's Nazi regime had been completed two months earlier, on May 8. The war was one of the most momentous events in civilization's history and shaped many of the elements of the world we live in today.

For medicine, and for thousands of American physicians, the war was also a watershed experience. The 1940s, including the postwar period, produced changes in medicine that have never been equaled in such a short period of time.

Most importantly, battlefield care of the wounded improved dramatically. Wounded men received plasma for shock and morphine for pain almost immediately. Wounds were packed with sulfanilamide and other antibacterials, and as the war progressed, the administration of penicillin became routine.

The United States' soldiers, sailors, airmen and marines -- despite the traditional grumbling -- were the best-fed military personnel in history, and emphasis on immunization and improved sanitation greatly reduced the toll from such traditional scourges as diphtheria, cholera, typhoid, dysentery and smallpox.

Yet despite the tireless work of military doctors and nurses, medics and corpsmen, more than 400,000 Americans lost their lives in the conflict.

It's been estimated that about 67,000 physicians served in the U.S. Armed Forces during the war. On the home front, the demands on those physicians not in the military were severe. For those who remained at home -- mostly older physicians, women, and those with health problems -- the demands were intense. To meet the civilian population's need for health care, they worked long hours and went days and months without time off.

The American Medical Association was involved throughout. Its elected officials and staff served on dozens of committees and advisory committees wrestling with problems caused by the war. The AMA served as a resource for the selective service system to assure an adequate supply of physicians for the military. An AMA president, Fred W. Rankin, MD, served as a brigadier general in the Office of the Army Surgeon General. The AMA also published a number of periodicals to provide clinical information for military physicians, and sent thousands of copies of JAMA to military physicians. When the eventual allied victory became apparent, the AMA also was heavily involved in postwar planning activities.

The fighting ended in 1945, but the evolution in medicine continued at a rapid pace. The growing realization that there was a global medical community led to formation of the World Medical Assn. Veterans Administration hospitals and rehabilitation centers proliferated. And physicians and prospective physicians began to take advantage of the Serviceman's Readjustment Act of 1944, popularly known as the GI bill.

The GI bill provided medical school financial assistance for veterans. Perhaps more importantly, it enabled many physicians who had served in the military to enroll in specialty residencies, accelerating the trend toward specialization that had just been heating up when the war broke out. (Physicians entering the military during the war with specialty training -- at least two years in a residency -- were commissioned as Army captains or Navy lieutenants. Those without a residency were commissioned one grade lower and the differential in rank usually remained throughout their term in the military.) The life of a small-town generalist didn't look quite as attractive to many military veterans, and the doctors who had stayed at home were weary of 80-hour workweeks and saw other attractions in specialty and group practice arrangements. That trend, coupled with the explosive growth in scientific knowledge, served as the launching pad for the specialty-oriented practice of medicine that exists today.

Few physicians and potential physicians who took part in World War II could have envisioned what the future held in store. For the most part, they were concerned with getting the job done and getting back to a normal life. At the same time, the war made a lasting impression on virtually every participant, including those on the home front.

Today, the ranks of World War II veterans are diminishing daily, but their contributions and sacrifices will live long after them. The nation's debt to all who served -- at home and abroad -- can never be repaid.