Office of Medical History HOME FAQ CONTACTS LINKS MEDCOM SITEMAP ARMY.MIL AKO SEARCH ACCESS TO CARE Section 1 The Histories of the Commissions - Contents HISTORY OF THE OFFICE OF MEDICAL Commission on Acute Respiratory Diseases HISTORY ANC HISTORY Incorporating Three Other Commissions: Commission on Air-Borne Infections Commission on Meningococcal Meningitis Commission on Pneumonia AMEDD BIOGRAPHIES This history is dedicated with grateful appreciation to Drs. John H. Dingle and Colin M. AMEDD CORPS HISTORY MacLeod. Dingle's pioneering work was highly instrumental in ensuring success of the Commission on Acute Respiratory Diseases. MacLeod, his friend and associate, directed the BOOKS AND first Commission on Pneumonia and made lasting contributions not only to a number of DOCUMENTS commissions, but to the Armed Forces Epidemiological Board. It is not possible to measure the HISTORICAL ART impact of each of these two remarkable medical scientists in the whole field of preventive WORK & IMAGES medicine. MEDICAL MEMOIRS Foreword AMEDD MEDAL OF HONOR RECIPIENTS The annals of military preventive medicine provides a remarkable record of achievement ORGANIZATIONAL extending from Beaumont to Billings to Sternberg, Reed, Strong, Siler, Simmons, and so many HISTORIES more. Their work was a culmination of intelligent thought and scientific innovation all aimed at THE SURGEONS solving problems that arose from those social forces and political upheavals that involve GENERAL society as a whole. So often, there has been productive interaction between military and civilian scientists. Their combined opinions and collective funds of knowledge have helped ANNUAL REPORTS OF THE SURGEON determine just what should be done and how it might be accomplished, all with the aim to GENERAL better maintain the highest standards of health in military personnel. AMEDD UNIT PATCHES William S. Jordan, Jr., has carefully evaluated and addressed these principles in preparation of AND LINEAGE his history of four commissions of the Armed Forces Epidemiological Board (AFEB). Each THE AMEDD commission, in its own unique way, was involved in vital issues that required identity of cause, HISTORIAN clarification of pathogenesis, and how best to prevent specific illness in the individual and NEWSLETTER throughout the military population. Throughout the AFEB's illustrious history, no one has been more devoted and contributed more to the cause of prevention and control of infectious diseases in the U.S. military services than Dr. Jordan. He was in an admirable position to prepare this account of the activities of the Commission on Acute Respiratory Diseases (CARD) and three related, short-lived Commissions, having knowledge of them almost from their beginnings. John Dingle, first director of the CARD, was one of Jordan's attendings in 1940 and 1941, when he was a medical student serving as a substitute intern on the Harvard Medical Service at Boston City Hospital (BCH). After graduation in 1942, he interned at BCH with such mentors as Drs. Chester Keefer and Maxwell Finland before active duty as a Naval Medical Officer. When home on leave in his hometown of Fayetteville, North Carolina, in the summer of 1944, he visited Dr. Dingle and the CARD laboratory at Fort Bragg. After World War II and more training at BCH, he joined Dr. Dingle's new Department of Preventive Medicine at Western Reserve University, working there during the years that Dr. Dingle continued as director of the CARD and later as president of the AFEB. Dr. Jordan then moved to the University of Virginia School of Medicine in Charlottesville to create his own Department of Preventive Medicine and to serve for 6 years as the CARD director. Subsequently, as dean of the College of Medicine at the University of Kentucky in Lexington, and as director of the Microbiology and Infectious Diseases Program at the National Institute of Allergy and Infectious Diseases, he continued to participate in the activities of the AFEB. Never have I known Bill to shirk a difficult assignment because of being "too busy." Furthermore, the ultimate product always came as close to the best solution as possible. Although technically retired, he continues as an involved public servant performing with his characteristic alert, vigorous, and wise approach to problem solving. http://history.amedd.army.mil/booksdocs/historiesofcomsn/section1.html[11/25/2014 12:55:12 AM] Office of Medical History -Theodore E. Woodward, M.D. History of the Commission on Acute Respiratory Diseases, Commission on Air-Borne Infections, Commission on Meningococcal Meningitis, and Commission on Pneumonia William S. Jordan, Jr., M.D. INTRODUCTION Five of the first seven commissions formed at the first meeting (6 February 1941) of the Board for Investigation and Control of Influenza and Other Epidemic Diseases in the Army dealt with respiratory pathogens: Commissions on Influenza, Measles, Meningitis, Pneumonia, and Streptococcal Infections. At its third meeting 5 months later, the Board formed the Commission on Cross Infections in Hospitals, which was renamed the Commission on Air- Borne Infections shortly thereafter because the sterilization of air was a common problem for all groups seeking to prevent disease by limiting the dissemination of airborne organisms. Within 1 year, the Commissions on Acute Respiratory Diseases (CARD) and Neurotropic Viruses began. Thus, 7 of the first 10 commissions were concerned with airborne bacteria and viruses that cause respiratory infections. As the Board gained experience with the commissions and as new problems were identified, new commissions were formed and existing ones merged or terminated. The Commission on Measles soon added Mumps to its title and eventually joined the Commission on Neurotropic Viruses to become the Commission on Viral and Rickettsial Diseases. The Commission on Hemolytic Streptococcal Infections was folded into the CARD in 1946 but was revived in 1949. The other three respiratory pathogen-related commissions were incorporated into the CARD after World War II,: Pneumonia in December, 1945, and Air-Borne Infections and Meningococcal Meningitis in April, 1946. These and subsequent administrative actions are listed in chronological order in Appendix 1. The research projects undertaken and observations made by the last four above-named commissions are listed in approximate order in Appendix 2. As far as possible, study results are dated when they were reported to the Board or to the Commissions, rather than when they were published, to illustrate better the evolution of the problems explored, information gained, and control measures tested. Except for the items in Appendices I and II, the material related to streptococcal infections has been incorporated in the account of the Commission on Streptococcal and Staphylococcal Diseases (CSSD). The following sections discuss the origins and organization of these four commissions, with emphasis on the longer-lived CARD. The scientific contributions made during their periods of service are then summarized, along with information as to the current knowledge of the etiology, epidemiology, prevention, and control of the diseases of concern to them. Lists of the publications of the Commissions are appended and will not be referenced here. Those interested in learning of the details of a particular study can do so by matching Appendix 2 with the list of publications and by consulting the supplemental references that cite the relevant and subsequent reports of others. 6 ADMINISTRATION Acute Respiratory Diseases The specter of a repeat of the influenza pandemic of 1918 and 1919 and its attendant high mortality from pneumonia accounted for the inclusion of influenza as the only specific disease mentioned in the title of the Board for the Investigation and Control of Influenza and Other Epidemic Diseases in the Army. The structure of the Board and its commissions was similarly shaped by the experience in these years. In World War I, the Pneumonia Commission of 1917 had supplemented undermanned military staffs with civilian physicians, and the Pneumonia Board of 1918 had organized specialist groups on short notice to investigate pneumonia whenever the need arose. Among the commissions formed by the Board at its first meeting 10 months before the attack http://history.amedd.army.mil/booksdocs/historiesofcomsn/section1.html[11/25/2014 12:55:12 AM] Office of Medical History on Pearl Harbor were those for Influenza and Pneumonia. The minutes of this meeting note that the Influenza Commission is to include "related acute respiratory diseases," although a mission statement prepared after the third meeting of the Board just a few months later makes no mention of this fact. One year later, at the fifth meeting of the Board in May, 1942, John H. Dingle, M.D. presented the report of a group appointed to investigate primary atypical pneumonia at Camp Claiborne, Louisiana. In addition to discussion of that disease, the minutes emphasize the difficulty in characterizing respiratory disease, noting that "advance requires a major effort in etiology and serology." There was prolonged and detailed discussion of the proposal, first outlined by Dr. Dingle in response to an informal suggestion by Colonel James Stevens (Steve) Simmons, that a permanent commission or group be established to study respiratory diseases. The Board recommended to The Surgeon General that provision be made for a permanent year-round study of respiratory disease by a specially selected group of investigators,