Dr. Dale Smith, Professor of Military Medicine and History at the Uniformed Services University of the Health Sciences (USUHS), published an article recounting AMSUS’s formation in the April 1999 edition of Military Medicine. By the 1890s, Smith wrote, “the majority of militia surgeons had not been mobilized since the end of the Civil War, a quarter-century earlier. How were the new ideas and trauma surgery experiences to be communicated to those who might need them? To Senn, and to most other physicians of the later 19th century, the answer was a medical society.” Senn envisioned an organization that would advance trauma surgery and the health and welfare of the National Guard’s civilian soldiers.

On Sept. 17, 1891, Senn convened a dinner meeting at Chicago’s Leland Hotel that included the Surgeons General of six states, and surgeons from at least 15 National Guard organizations. The first annual meeting of the new organization, the Association of Military Surgeons of the National Guard of the United States, was held the following day at Rush Medical College, and featured clinical presentations on gunshot wounds and bone infection. The content of these presentations was published as The Transactions of the Association of Military Surgeons of the National Guard of the United States for the Year 1891. Annual publications of these meetings continued until 1897, when Maj. James Evelyn Pilcher, USA, founded The Journal of the Association of Military Surgeons of the United States – the journal known today simply as Military Medicine.

The organization became the all-inclusive AMSUS in 1893, at its third annual meeting in Chicago, when its constitution was revised to allow membership to medical officers of the regular Army and Navy, as well as to officers of the Public Health and Marine Hospital Service (today’s Public Health Service, or PHS). When AMSUS was officially chartered by Congress on Jan. 30, 1903, its incorporating document recognized it as an organization founded

… for the purpose of advancing the knowledge of military surgery, medicine, and sanitation in the medical departments of the Army, the Navy, and the Marine-Hospital Service of the United States and of the militia of the different States, and to increase the efficiency of the different services by mutual association and the consideration of matters pertaining to the medico-military service of the United States in peace and in war.

At the time, there was neither a Reserve component nor a Veterans Administration, but AMSUS membership would be made immediately available to medical professionals from those organizations when they were established in 1908 and 1930, respectively. Military dental officers began their association with AMSUS in 1913, while a new group of military medical officers – flight surgeons, attached to the Aviation Section of the U.S. Army’s Signal Corps, and to the Navy – joined with AMSUS in 1925.

Senn served as the organization’s president for its first three years, and outlined several areas in which the new association needed to work toward improvement of military medicine: Because relatively few members would be able to attend the annual meetings, state associations would be essential. To stay abreast of advances in weaponry and the different aspects of future wounds, association members would need to remain engaged in original research and propose new ideas and methods for treating trauma; field dressing; transport/evacuation of the wounded; and field medical facilities. The association must also remain engaged in setting the standards for medical service in the National Guard to retain the confidence of the line commands.

In 1894, at the annual meeting in Washington, D.C., AMSUS elected its second president, Brig. Gen. George Miller Sternberg, who had recently been named U.S. Army Surgeon General. Discussions over the next several meetings helped to evolve the concept of the modern combat medic, and enlisted corpsmen and medical officers began to train together at the Army Medical School founded by Sternberg in 1893.

Senn served as the 6th Army Corps Surgeon, with the rank of lieutenant colonel, during the Spanish-American War of 1898. The war was the first time the United States military had projected American power overseas, and the U.S. Navy, to meet this requirement, purchased a hospital ship, the USS Solace, which served practically non-stop during the war, returning sick and wounded servicemen from Cuba to Navy hospitals in Norfolk, New York, and Boston. Solace was staffed by five medical officers and three corpsmen, and was outfitted to care for 200 patients. Among the ship’s many historic milestones during the Spanish-American War was the first antiseptic surgery performed at sea.

While the war ended in swift and decisive American victory, it was a logistical nightmare for both service members and those who provided medical support. While 932 U.S. service members died from war wounds, 5,438 died of diseases, such as malaria and yellow fever, in the tropical jungles of Cuba and the Philippines.

The inability of dedicated, trained, and qualified medical personnel to properly administer transport and care to the sick and wounded prompted a round of study and reform in medical logistics and casualty evacuation. When William C. Gorgas became Army Surgeon General in 1914, he began to study the ways in which the French and British military medical establishments had relieved military physicians from administrative and other non-medical burdens. Gorgas began to assemble a “Sanitary Corps” of administrative and scientific specialists to aid and support the U.S. military medical team, and by the time the United States had entered World War I, the War Department had issued orders for this corps to consist of up to 1,000 officers and 3,905 enlisted personnel, representing specialties from accounting to nutrition.

In Europe, medical evacuation was performed through an echelon system, with the wounded evacuated to battalion aid stations, then mobile field or evacuation hospitals, and then to fixed general hospitals. The Army also introduced air transport of the injured. In the Pacific, this echelon system was, of necessity, altered somewhat.

The Navy’s Bureau of Medicine and Surgery (BUMED), meanwhile, undertook its own reforms. One of the most significant issues was whether the medical officers or line officers should command hospital ships. President Theodore Roosevelt settled the issue on the side of BUMED when he named Navy Surgeon Charles Stokes to command the hospital ship Relief in 1908.

When American medical officers and their supporting Sanitary Corps entered the trench warfare of World War I, the automobile had helped to revolutionize the evacuation and transport of wounded combatants. U.S. medical teams adopted a system similar to that already employed by the British, who staged Casualty Clearing Stations (CCSs) several miles behind the front lines: Non-physicians treated casualties in the trenches and prepared them for transport to front-line first-aid stations, which fed field hospitals staffed by surgeons, anesthetists, and nurses. Some casualties were eventually taken to special or general hospitals in the United Kingdom or United States.