Civilians have played a vital role in Army medicine from the very beginning. In fact, virtually all medical functions were provided by civilians in the first few decades of the Army’s existence. The history of civilian support to the Army Medical Department (AMEDD) is an integral and inseparable component of our overall medical history.
On 27 July 1775 the Continental Congress established a medical department to provide care for the nascent Continental Army. Although it outlined a rudimentary system of care for the military, the legislation creating the medical department did not designate military rank for medical personnel, nor did it specify the correlation of the department to the larger army. This ambiguity left a corps of pseudo-civilian medical providers to carve out their own place in the Army structure, and spawned counterproductive infighting and confusion that persisted throughout the American Revolution and the subsequent War of 1812.
Despite the challenges of working in this ill-defined system, the civilian cadre of the early AMEDD made significant strides in planning and organizing battlefield medicine, preventive care, and basic logistical support for the Army. Under the purview of a Director General (antecedent of the Surgeon General), the surgeons, assistant surgeons, apothecaries, and purveyors worked tirelessly to overcome obstacles and provide the best care possible. These personnel served in a peculiar, indeterminate state—not exactly soldiers, because they had neither rank nor uniforms, but not exactly civilians, because they were subject to the rules, regulations, and restrictions of the Army. Their pay was meager and the conditions of service were arduous. According to one surgeon who served on the Canadian frontier during the War of 1812, most medical men were only willing to serve for a single year in these circumstances, and then only because of curiosity and a thirst for adventure.
In 1818 Congress finally established a permanent Medical Department with a Surgeon General at its head, although neither he nor the surgeons and assistant surgeons under him held military rank. By 1840 the military surgeons had a standardized uniform and their pay was approaching that of the line officers. Although they were commissioned, they still held no military rank and were not entitled to salutes. This indistinct status was clarified in February 1847, when Congress granted official rank to medical personnel. From this point forward there would be a distinction between the military surgeons and their civilian colleagues, but their roles would often merge and their military functions were frequently indistinguishable.
The contract surgeon was the most prevalent manifestation of civilians serving the AMEDD in the 19th century. These civilian doctors were hired to fill shortages throughout the medical system, often with service at isolated frontier posts or other austere locations. Field commanders were authorized to hire contract surgeons as needed to provide adequate medical care for their units. Their numbers rose steadily over the ensuing years, and during the Civil War more than 5,500 civilian doctors served with the Medical Department. Many of these contract surgeons performed heroically in action with the units they supported. Perhaps the most striking example is the story of Mary Walker, a contract surgeon who served at Bull Run, Chickamauga, Richmond, and Atlanta, and spent time as a prisoner of war. In 1865 Dr. Walker became the first woman to receive the Medal of Honor, and she did it as a civilian in the Army Medical Department. To this day she remains the only female recipient of the award.
At the end of the 19th century the Army continued to augment its regular medical force with civilian doctors, nurses, dentists, veterinarians, and purveyors serving under contract. Contract medical personnel served in Cuba, Puerto Rico, and the Philippines during the Spanish-American War, and when Surgeon General George Sternberg appointed Major Walter Reed to chair a commission investigating yellow fever, he staffed the commission with three contract surgeons. These civilian researchers—Aristides Agramonte, James Carroll, and Jesse W. Lazear—traveled to Cuba with Reed and studied the deadly disease to determine how it was transmitted. Everyone involved in the research was exposed to disease risks, and Lazear died after allowing himself to be bitten by an infected mosquito. Their work proved that yellow fever was transmitted by mosquitoes, and led to sanitation and preventive medicine policies that saved countless lives around the world.
The 20th century ushered in significant changes in the structure of the Army Medical Department. At the turn of the century the AMEDD was comprised of only two corps, the Medical Corps and the Hospital Corps (precursor to the AMEDD Enlisted Corps). Hundreds of civilian contract nurses had been in service during the Spanish-American War, and in 1901 they traded their contracts for commissions with the creation of the Army Nurse Corps. The contract dentists followed suit with the creation of the Dental Corps in 1911, then the Veterinary Corps in 1916 and the Sanitary Corps (later Medical Service Corps) in 1917. By this time, with five officer corps, plus a Medical Reserve Corps (civilian physicians who had agreed to serve in time of need) and a corps of enlisted Soldiers, most contract medical positions had been converted to active military status. However, this did not eliminate the need for civilian augmentation to the AMEDD. When the United States entered World War I, the AMEDD was woefully small and inadequate for the colossal task of supporting over four million troops in a distant war. The majority of the vast surge in medical manpower was filled through the Medical Reserve Corps, but the scope of the required growth necessitated hiring more than 80 contract surgeons. Army hospitals were typically staffed with civilians in a wide variety of positions, including unique specialties and new practice fields that had not yet been fielded in the active force. Civilian reconstruction aides (later termed physical therapists and occupational therapists), dieticians, x-ray technicians, and other medical specialists helped bring state-of-the-art medicine to the Soldiers. A number of Civil Service personnel, including psychologists, also aided in screening new recruits and draftees.