HISTORY OF THE EFFECTS OF WAR ON MEDICINE*

By MILTON I. ROEMER, M.D.

PATERSON, NEW JERSEY

AN INVESTIGATION of the ef- suppress theological dogmas. Fifty years /yk fects of war on medicine in later, these latter forces had become yyk times such as these is bound more or less effective—although spokes- -A. ™ 1 to reflect an interesting soci- men of medievalism—like William Jen- ological rule applicable to all historical nings Bryan—are to be found in our study. It has been summarized by V. F. own times.3 Thus, the maturation of Calverton as the “theory of cultural Darwin’s theory of the origin of all nat- compulsives.”1 It means simply that the ural processes awaited the development topics of an investigation and the ideo- of a society which would be favorable logical slant given to that investigation to such a point of view, a society, fur- tend to reflect the social demands of the thermore, in which the conception of period in which it is made. We are in a the progress of mankind to higher levels warring world; hence, we are concerned could have a basis in everyday economic about medicine and war, and our writ- experience. What Calverton has shown ing tends necessarily to reflect particu- concerning the development of thought lar points of view toward that war. This in the social sciences, Bernal has shown observation may seem like a truism, but in the biological sciences4 and Hogben it is amazing how often it is not recog- in mathematics.5 nized. Writing will be truthful, there- In general, medical history in our fore, only in so far as its perspective own times is dominated by a particular is broad and humane. cultural compulsive. In all periods, Professor Shryock of the University medical men have tended to glorify the of Pennsylvania recently called atten- past of their profession according to the tion to the fact that the theory of nat- loftiest conceptions of the time. The ural evolution which we attribute to Greeks in tracing the origins of medi- Darwin, had been propounded in a cine attributed them naturally to the paper before the Royal Society in Lon- gods, and Aesculapius was made the don by a young physician named Wells fruit of Apollo’s passion.6 The medieval about 1810 (fifty years before “The church often regarded disease as sin and Origin of Species”), but that nothing Jesus the forgiver was the first healer further came of it at that time.2 The (even as Christian Science says today). reason for this is apparent. Society was But the special feature of modern med- not ready to accept this new theory; ical history is perhaps the attempt to religious thought still dominated the attribute all of medicine’s achievements public mind, and the influence of in- to the work of independent individual dustrialization, urbanization, and tech- men, particularly to persons regarded nology had not widened sufficiently to as the homologues of today’s private *A lecture delivered before the William H. Welch Society at the New York Univer- sity College of Medicine. practitioner. Despite the fact that inves- 2. Organization and administra- tigation hardly bears this out,7 the as- tion sumption is implicit that progress in the B. Post-war and ultimate effects past has depended mainly on individual, 1. Social consequences of war private physicians; hence, if progress (a) Health of people is to be expected in the future, it must (b) Economic situation depend on the preservation of the cur- 2. Political-economic outcome of rent forms of private professional prac- the war. tice.8 Whether this purpose has been Most analyses of the effects of war on conscious or subconscious, its general medicine have been limited to category effect has been to support the status quo A(i) and more usually to A(i a); some in medical practice. to A(i) and A(2). Very little informa- As for the effects of war on medicine, tion is available on B(i) and particu- investigation discloses a vast literature larly B(2), which are far more signifi- narrowly confined by a corresponding cant relationships. point of view. In vain, do we seek the It is clear that to apply such an out- literature for a work on the effect of the line to an analysis of all wars through- world’s wars on the general institution out history would be an encyclopedic of medical practice. Instead there are a task and would, of course, require the great number of volumes emphasizing discipline of a general historian rather the particular technical contributions than that of an amateur medical his- of the physicians of each military cam- torian. What is offered here, therefore, paign in world history to the science of is simply a crude outline of the type of military medicine. The latter, in fact, analysis which it is believed should be has become a special branch of historical made in order to obtain a correct under- research. Perhaps the best American standing of the effects of war on medi- work on the subject is Fielding Garri- cine. son’s “History of Military Medicine,” First, it must be understood that war published in 1922.9 (Again, take note, is not a special, extraneous entity which shortly after World War I had naturally periodically “interrupts” the orderly aroused interest in the subject.) This progress of society. It is rather an ex- erudite volume records in outline form pression of the very course of social de- the technical experiences and lessons of velopment, and an insight into the each military epoch of the past and fur- world’s wars gives us a glimpse of the nishes a tremendous source of material deepest conflicts pervading society and for detailed research. accounting for its movement from stage From such a compilation as this, to stage. Thus, the effects of war on however, we can learn only the least im- medicine are always essentially the ef- portant aspect of the effects on medicine fects of general social and economic of the world’s wars. A complete analysis change, reflected in an acute, political of the effects of war on medicine must, form by military activity. Social science rather, include the following: cannot share the view of Colonel Gar- A. Immediate and direct effects rison and others that war is a “biological 1. Science and technology phenomenon” that has always been with (a) Surgery, etc. us and always will be.10 Just as the dis- (b) Preventive medicine covery of cerebrally conditioned reflexes (represented by specific neural path- culture. With this, the high status of ways) explained the origin of certain be- medicine and the physician gave way, havior traits, previously attributed to at least in the early Roman period, to McDougall’s hypothetical “instincts,” medicine practiced by slaves in great so the exposition of adequate socio-eco- families and to the contributions pe- nomic causes for wars leaves no room culiar to Roman genius, particularly for the mystical, supernatural concepts large-scale sanitary engineering.16 of “biological war drives” in the com- A reservation should be made, how- mon man. ever, concerning the value of certain When we read, for example, of the aspects of “military medicine” as such. wars of conquest of Philip of Macedon In so far as war represents the extreme and of his son, Alexander the Great, we effort of a people and raises special learn from medical military history that problems not encountered in ordinary the wounded in battle were carried on life certain special developments of the backs of their fellow-soldiers and military medicine will prove to be of that one bearer was publicly scourged, permanent importance to mankind. by order of Xenophon (444-357 B-c-)> Thus, the eventual recognition of the for trying to bury a wounded man to get value of skilled troops led to the erec- rid of his burden.11 Or that Glaucus, tion, in the later Roman Empire, of one of the physicians in the Army of military hospitals attached to the camps Alexander the Great, was crucified for —just as valetudinaria or slave-hospitals failing to heal the battle-injured Hae- were used for the preservation of slave phaestion.12 But these episodes are property in civilian life.17 The Christian much less important than the fact that medieval institutions from which we the Greek conquests of Asia Minor, trace the origin of modern hospitals Syria, Persia, and Egypt led to the per- bear, probably, no organic relationship meation of Greek culture and hence, of to the Roman institutions, yet the latter Greek medicine, to these nations.13 And established man’s recognition of the that, in turn, later Greek medicine be- practicality of central buildings for car- came part of Islamic culture, and that ing for the sick. On the other hand, the during the Middle Ages Arabian and small value accorded to the life of the Jewish scholars kept alive the objective common soldier, in general, is evi- rationalism of Hippocratic thought denced by the fact that about 100 a .d ., which was to be rediscovered in the when medical aspects of the Roman Renaissance.14 Such were the ultimate army were already relatively well devel- effects of Alexander’s conquests. oped, there was but one physician to Again, we find that in the stern early each legion of about 7000 men.18 In- Roman armies the wounded were often deed, up to the eighteenth century, not only neglected because care for army physicians had their chief role as them would impair the efficiency of the private attendants of the king or the fighters, but that they were actually highest generals19 and the care of the avoided and driven away by the chiefs wounded and ill among the rank and of the legions so that the still battling file was left chiefly to the soldiers them- men would not be discouraged by the selves and sometimes to camp-followers sight of their bleeding comrades.15 Yet who served this supplementary nurs- more important is the general fact that ing purpose by day.20 Roman victories meant the end of Greek While many military medical devel- opments may be of permanent social ing factor.23 The specific medical con- value, it is important to disclaim the tributions of the American Revolution, thesis expressed by Dr. Charles Mayo21 were practically nil except in so far as and by Professor Irving Fisher22 in the they provided a makeshift medical de- patriotic fervor of the post-World War partment for the care of the Revolu- I period. That is, the thesis that since tionary army. As a matter of fact, the catastrophic wars present new problems chief impression we gain today is that acutely, they act always as a stimulus to medicine in the Revolutionary period medical progress, and that the good de- was highly disorganized, characterized rived from these technical advances by repeated squabbles among the may eventually outweigh the miseries leaders, Morgan, Shippen, and Rush, produced by the war. This view fails and reflecting the general administra- to take into account the ultimate so- tive difficulties of a young, inexperi- cial effects of war, which differ in each enced party of rebellion.24 instance, apart from the toll of deaths Let us look, on the other hand, at an- and mutilations caused by battle- other type of war, the Crimean War in slaughter and disease. While it is true 1853-56, a conflict at a later epoch and that certain wars may ultimately jus- of smaller proportions but, more im- tify themselves in terms of human prog- portant, for a totally different purpose. ress—this justification does not spring This was not a war of liberation, but from the technical innovations of mili- a war due to imperial conflict between tary or even contemporary civilian the rival European powers of Russia on medicine, but rather from the newly the one hand and France and Britain born social freedoms which may be the on the other, over the question of eco- outcome of certain wars, particularly nomic influence in Turkey and the wars for the liberation of peoples. Balkan countries.25 Yet this conflict When we seek, therefore, to under- which served no ultimate social good stand the effects of a particular war on was the birth-place of the great institu- medicine, we must first learn its ulti- tion of modern nursing. It was during mate consequences to society. There is this war that Florence Nightingale, an no general rule for all wars; each must English lady living in comfortable cir- be judged in the setting of its period cumstances, broke away from tradition and circumstances. When we estimate and established the principle of system- the effect of the American Revolution atically training nurses for a profession on medicine, we must also take into that was to become one of dignity rather account the fact that the liberation of a than degradation.26 Thus, military med- handful of British Colonies from the icine in this war played a highly pro- domination of a powerful crown estab- gressive role, whereas the only long-run lished the groundwork for the develop- outcome of the war was human suffer- ment of a fruitful, productive demo- ing and the strengthening of British and cratic society. America could not have French as against Russian imperialism. developed as a highly advanced capital- Warfare that has contributed to the ist economy under the rule of the Brit- unseating of old, sterile, reactionary ish Government; and in so far as Amer- aristocracies and replacing them with ican medicine made great advances in young, fruitful, energetic peoples has, an expanding American economy, the in general, been responsible for medi- War of Independence was an underly- cal advance—whatever the actual tech- nical or health consequences of the war. larly, the revolutions of 1848 in Europe, In the eleventh century the Crusades particularly in Germany, led eventually undoubtedly produced thousands of to the birth of the Social-Democratic deaths and untold misery, and medical movement which was indirectly respon- provisions were of the most primitive sible for the introduction in 1883 of sort. Yet a direct medical consequence the most important innovation in med- was the establishment of hospitals ical economics in modern times: na- throughout Europe, partly through the tional health insurance.31 efforts of the various knightly orders On the other hand, in the highly or- which came out of the pilgrimages to ganized armies of Napoleon Bonaparte and from the East.27 But of pre-eminent wTe find a large, elaborate medical de- importance is the fact that the Cru- partment with many of the medical per- sades, by opening trade routes to the sonnel high in the general hierarchy of East and taking large numbers of vas- the French army.32 Yet from these wars sals and serfs from the feudal manors, of conquest and destruction for solely contributed to the eventual collapse of nationalistic purposes—like the Fascist Feudalism and the flowering of Renais- wars of destruction today in China, in sance culture.28 To the spirit of inde- Ethiopia, in Republican Spain, and pendent inquiry to which the Renais- now in all the world—no ultimate so- sance gave birth, we may trace the cial advance can be said to have come. origins of modern science. Economic collapse and mass suffering In fact, many military conflicts of were the chief consequences and only which the ultimate effects on the med- from the social control reactions to ical institution were of the greatest con- ameliorate these did medicine and sequence were accompanied by no de- human welfare derive any benefit. veloped military medical organization In American history, we associate spe- at all. The French Revolution of 1789- cial medical achievements with each of g4, for instance, was the final death the major wars. In the Civil War of blow to the rule of the landed aristoc- 1861-1865 we find the first develop- racy in Europe, and from its ruins there ment of an efficient system of taking grew the flower of parliamentary de- the wounded systematically from the mocracy, the industrial revolution, the field of battle and transporting them to most far-reaching advancement of sci- base hospitals for care.33 This consti- ence and human welfare.29 Yet so far tutes, in fact, the origin of the modern as its strictly technical aspects were con- ambulance, adapted to civilian use— cerned the medical organization of the although the sirens piercing through French army was completely disassem- city streets sound often more like air- bled by an edict of the young Republic. raid warnings appropriate to their his- The edict did away with the aristocrats toric origins. But more far-reaching in army commissions, replacing them medical and health consequences of the with graduates of “schools of military Civil War are apparent today. That the medicine” of inferior competence.30 American nation would not have devel- But how trivial is this consequence of oped to its position of present world so-called “mob rule” as against the leadership—and corresponding medical glorious achievements in social welfare leadership—with the secession of the of the French Revolution of which South is surely conceded.34 At the same modern medicine is a living part! Simi- time, the freeing of the slaves engen- dered a host of social and health prob- fects, the technical advances made in lems which we are only just coming to traumatic surgery are well known: de- grips with throughout America. Not bridement, the Carrel-Dakin technique, that the same health problems did not the Orr management of osteomyelitis, exist in the days before plantation cul- chest surgery for empyema, and many ture was gone with the wind; indeed, others. Advances in preventive medi- records show that, contrary to the idyl- cine and sanitation were numerous: the lic picture of Negro life painted by cause of trench mouth was discovered apologists of southern Bourbonism, the and its ravages controlled, the efficacy health conditions of slaves were the of typhoid vaccine and tetanus anti- most miserable imaginable.35 But the toxin were demonstrated on a large difference today lies in the fact that in scale. Methods of sanitation, water democratic America the problem of supply, and sewage disposal were im- Negro health looms as a challenge to proved.41 In psychiatry, great knowl- all sections of the country in which edge was gained through the observa- Negroes have settled. So severe is the tion of thousands of men under severe problem that statisticians nearly always emotional stress—with the emergence classify the figures for mortality and of the syndrome of “shell shock”—and morbidity on the basis of the Negro through intelligence test records of mil- and the white population lest too un- lions of men.42 favorable rates of illness and death be As for organization and administra- attributed to the country as a whole.36 tion, thousands of privately practicing The Spanish-American War calls to physicians learned methods of efficient mind the devastations of yellow and organization under government direc- malarial fevers, and the shameful rec- tion, an experience that Professor Bos- ord of deaths due to sickness, which sard of the University of Pennsylvania surpassed greatly deaths on the field of maintains is of primary importance in battle.37 The ultimate consequences of shaking the pillars of the private prac- the war were essentially the aggrandize- tice institution.43 It is no accident, for ment of American commercial influ- example, that group medical practice in ences in Latin-America,38 and since America started shortly after World such interests are usually associated War I.44 The venereal disease program with a growth of financial monopolies which today occupies so large a part of in the domestic economy, we may at- public health work had its inception in tribute to it the hastening of all the this period—an answer to soaring rates economic processes incident to the ad- of venereal diseases found among the vance of monopoly business, particu- men in the army (and later the civilian larly the violent undulations of population) as in all past history at war- business cycles.39 These, of course, by times.45 The Red Cross, with its ideal affecting mass purchasing power, have of medical and general aid to all suffer- continuing influences on the rendering ing peoples of whatever side of the bat- of medical service.40 tle, took root and has grown to a The effects of World War I on Amer- tremendously important world-wide ican and world medicine are, of course, medical institution.46 evident on all sides. Here we can more The immediate social effects of the thoroughly apply the scheme of analysis War, however, were of the most wide- previously suggested. In immediate ef- spread importance. With 60,000,000 men under arms there were at least generally increased government role in 20,000,000 deaths in the youngest, most health provisions.50 In addition should productive age groups.47 This was said be cited developments such as group to be the first great war in which deaths hospitalization, the Committee of “430” in battle exceeded deaths from disease Physicians, the antitrust conviction of in the armies. When the ravages of the the American Medical Association, the post-war influenza epidemic are in- Committee on the Costs of Medical cluded, however, we find again the Care, the National Health Survey, and usual picture of disease-deaths ranking finally the emergence of widespread higher. Malnutrition with “war support for a “national health pro- edema,” due to insufficient protein in- gram. 01 take, and increased susceptibility to all In Germany, the effects of Fascism infectious diseases was responsible for on medicine have become known to all the tremendous mass suffering in the of us. Suppression of free research, cur- countries of the Central Powers that tailment of medical education, encour- ■we see pictured poignantly in the agement of mystical cultist practices, sketches of Kathe Kollwitz.48 With the general deterioration of the people’s sudden cessation of war production, all health, elimination of Jewish doctors nations were visited by the economic and extreme regimentation of all the devil of inflation; prices sky-rocketed rest—are all part of the picture.52 and money lost its value. In defeated On the other hand, the success of the Germany, money was used to paper the Socialist Revolution in Russia has led walls. The purchasing power for pri- to changes—at least in the realm of vate medical services and for support medicine—which, according to reliable of medical research and education was reporters like Drs. Newsholme, Kings- cut nearly to zero. Dr. Sigerist has bury, and Sigerist, have advanced med- pointed out that the relative mainte- ical science and service at a rate unprec- nance of health in defeated Germany edented in history.53 Judged by criteria was due largely to the efficiency of its of the morbidity and mortality rates, well organized health insurance pro- the available medical personnel, the gram.49 output of medical research, the avail- But the ultimate political-economic able medical facilities and institutions outcome of the War [B (2) in the sum- —by every accepted health and medical mary] has had the most profound effect criterion—Soviet medicine has shown of all on world medicine. For from the a remarkable record, whatever else we economic disasters of the War have may think of the Socialist society. Here sprung a series of decisive political is perhaps the most impressive instance events. In 1929 America experienced in world history of the ultimate effect a cataclysmic depression, and after this of war on medicine. a highly popular governmental New On the basis of this type of analysis, Deal; and in Germany there occurred a what prophecies may we hazard about prolonged depression and the rise of the ultimate effects of the current the National Socialist (Nazi) Party to World War on medicine? And by what power in 1933. The depression in policies may we govern our actions as America has, of course, had innumer- a result of these prophecies? First of all, able effects on medical practice and it is clear that this war has, like all wars, health, most important of which is the already brought certain serious sacri- fices of social welfare services in its panded defense production—it should wake. All social security measures in be possible to find funds sufficient to the United States have suffered cuts and provide for the medical needs of re- the movement for tremendous expan- habilitation of rejected selectees and all sion of our health facilities originally the other health needs of the war sponsored by President Roosevelt in period. Since the hue and cry of the the form of a Wagner National Health day, and correctly so, is, We must stop Bill has been given the Administra- inflation, we must absorb in some way tion’s kiss of death.54 Public health ex- the greatly increased purchasing power penditures in many places have been of the people—the question arises: why cut, and movements are under way to cannot some way be devised to spend curtail medical education (particularly some of this increased purchasing the advanced years of interne training) power on services such as medical serv- in order to furnish medical men ices, since consumers’ commodities are promptly to the military services.55 All not available? social activities in our nation have been Whatever the management of these geared to the demands of the defense problems of the defense program, the program. stake of medicine in the outcome of the At the same time, with the increased present war is quite clear. Despite any burden on our people of an all-out de- of the immediate disadvantages that ac- fense effort, it has been widely recog- crue to the health of the people and nized that the need for a high standard the provision of medical services, due of national health is greater than ever.56 to war, we know that by far the greater Especially sharply has this been empha- disaster would be the victory of those sized by the tremendous amount of world forces which have declared and physical inadequacy revealed by the ex- demonstrated themselves to be anti- amination of the 2,000,000 men from thetical to all that is embodied in mod- 21 to 35 years of age summoned by the ern science and humane social service. draft—the rejections reaching, by the We know that the democracy in which latest official estimate, 50 per cent of alone science and medicine can flour- the total number examined. Already, ish to its greatest heights,58 is at stake— of course, offices have been established and it is this supreme fact which must by the federal government to super- condition our judgment of the mean- vise the host of medical and health ing of the present war. No matter what problems created by the new situation: the outcome, it has become clear to a Health and Medical Committee of many observers that the social organiza- the National Defense Council (headed by Dr. Abel, former president of the tion of the world will undergo deep American Medical Association) and an changes; the laissez-faire economic Emergency Medical Service Division of forms in which medical practice has the Civilian Defense Administration been couched for the last 150 years are (headed by Dr. George Baehr of New certain to give way to other forms. York). These bodies are still in an or- And with these changes, provided that ganizational phase and the major tasks democracy is victorious, medicine is lie ahead.57 But with proper govern- likely to reach greater heights in sci- ment management of the tremendously ence and social service than it has yet increased income incident to our ex- seen. Refe rences 1. Calve rton , V. F. Modern anthropology 18. Garri son . Op. cit., p. 63. and the theory of cultural compulsives. 19. Ibid. P. 5. In The Making of Man, edited by Cal- 20. Ibid. P. 108. verton. New York, 1931, pp. 1-37. 21. May o , C. War’s Influence on Medicine. 2. Meeting of the New York Society for New York M. J., June 9, 1917. Medical History on “Approaches to 22. Fish er , I. Health and War. Am. Labor Medical History,” at the New York Legislation Rev., Vol. 8, No. 1, 1918. Academy of Medicine, New York, No- 23. Shaf er , H. B. The American Medical vember 12, 1941. Profession, 1783-1850. New York, 3. Allen , F. L. Only Yesterday. New York, 1936. Also: Sigeris t , American Medi- 1931, pp. 201-206. cine. New York, 1934. 4. Bern al , J. D. The Social Function of 24. Ste ve ns on , Iso bel . The Medical Depart- Science. New York, 1939, pp. 13-34. ments of the Army and Navy During 5. Hogb en , L. Mathematics for the Million. the War of Independence. Ciba Sym- New York, 1938. posia, 2:498-507, 1940. 6. Siger ist , H. E. Medicine and Human 25. Beck er . Op. cit., p. 369 ff. Welfare. New Haven, 1941, p. 105 ff. 26. Andr ews , M. R. S. A Lost Commander— 7. For an account of the complex social Florence Nightingale. New York, 1933, forces back of medicine’s great dis- pp. 101-121. coveries see Bern har d Stern , “Social 27. Garri son . Op. cit., p. 86. Factors in Medical Progress.” New 28. Ste vens on , Carl . Medieval History. New York, 1927. The great achievements in York, 1937. reducing mortality rates, usually cited 29. Beck er . Op. cit., pp. 226-232. by the organized profession in defense 30. Garr iso n . Op. cit., p. 139. of the status quo, are the conquests of 31. Siger ist , H. E. Historic Developments: smallpox, typhoid fever, diphtheria, European Experience in Medical Or- tuberculosis, diabetes, pernicious ane- ganization. In The Medical Profession mia, infant mortality, syphilis by ars- and the Public. Philadelphia, 1934, phenamine, and more recently the coc- PP- 34’35- cic infections by the sulfonamides. It 32. Garr ison . Op. cit., p. 161 ff. is to be noted that all of these achieve- 33. Steve nso n , Iso bel . American Medicine ments were accomplished through the During the Sixties. Ciba Symposia, 3: organized efforts of large social groups, 894-9°7» 1941- mostly with government backing, and 34. Bear d , C. and M. The Rise of American none of them principally by the pri- Civilization. New York, 1937, Vol. II, vate medical profession. pp. 105-121. 8. Sel wy n -Brow n , A. The Physician 35. Swados , F. Negro Health on the Ante Throughout the Ages. New York, Bellum Plantations. Bull. Hist. Med., 1928. 10:460-472, 1941. 9. Garri son , F. H. Notes on the History of 36. Dubl in , L. and Lotka , A. Twenty-Five Military Medicine. Washington, 1922. Years of Health Progress. New York, 10. Ibid. P. 2. *937- 11. Ibid. P. 42. 37. Garrison . Op. cit., p. 185. 12. Ibid. P. 44. 38. Bear d , C. and M. Op. cit., Vol. II, p. 13. Beck er , C. Modern History. New York, 368 ff. 1931, p. 16. 39. Competition and Monopoly in American 14. Sig eris t , H. E. Medieval Medicine. In Industry. Monograph No. 21 of Tem- Studies in the History of Science. porary National Economic Commit- Philadelphia, 1941, p. 44 ff. tee’s “Investigation of Concentration 15. Garrison . Op. cit., p. 54. of Economic Power.” Washington, 16. Cas tigl ion i, A. A History of Medicine. 1940, pp. 16-18. New York, 1941, pp. 232-241. 40. Ree d , L. The Ability to Pay for Medical 17. Ibid. Pp. 238-39. Care. Publication No. 25 of the Com- mittee on the Costs of Medical Care. 51. Davi s , M. America Organizes Medicine. Chicago, 1933. New York, 1941. 41. Darn all , J. R. Contributions of the 52. Gump ert , M. Heil Hunger, Health World War to the Advancement of under Hitler. New York, 1940. Medicine. J. A .M.A., 115:1443-1451, 53. News holme , A. and Kin gs bury , J. Red 1940. Medicine: Socialized Health in Soviet 42. Free man , F. N. Mental Tests, Their His- Russia. New York, 1933. Also: Siger - tory, Principle, and Application. Bos- ist , H. E. Socialized Medicine in the ton, 1926, p. 3. Soviet Union. New York, 1937. 43. Boss ard , J. Problems of Social Well- 54. Sige ris t , H. E. What Happened to the Being. New York, 1927. National Health Program? New Masses 44. Moore , H. H. American Medicine and (New York), June 18, 1940. the People’s Health. New York, 1927, 55. Bacon , C. S. America Needs Their Skill. pp. 235-244. Friday (New York), pp. 25-27 (April 45. Parran , T. Shadow on the Land. New 18), 1941. York, 1937. 56. Mc Nutt , P. V. Health and National De- 46. The League of Red Cross Societies. The fense. Labor Information Bulletin Secretariat of the League, Paris, 1925. (New York), pp. 1-4 (July), 1941- Also: 47. Darnal l , J. R. Op. cit., p. 1443. Par ra n , T. Health and Medical Pre- 48. Heil bor n , A. Kathe Kollwitz. Berlin, paredness. J.A.M.A., 115:49-51, 1940. about 1940 (not dated). 57. Baehr , G. The Work of the Medical 49. Siger ist , H. E. Historic Developments: Division of the Office of Civilian De- European Experience in Medical Or- fense. 70th Annual Meeting of Amer- ganization. Op. cit., p. 37. ican Public Health Association, At- 50. Moore , H. H. Health and Medical Prac- lantic City, October 17, 1941. tise. In Recent Social Trends in the 58. Sig eris t , H. E. Science and Democracy. United States. Edited by William Og- Science and Society (New York), 2:291- burn. Washington, 1932. 299,