Robert J. T. Joy and the Uniformed Services University of the Health Sciences
Establishing the university When Joy first began to hear the details of the new DoD medical school, the
Uniformed Services University of the Health Sciences, from his perch at WRAIR, he greeted the idea with skepticism. He questioned the need for the school and the ability of the Department of Defense to successfully execute the concept. He felt that most of the expertise lay in the Army and the Navy, not at the Department level. But then Joy's longtime friend and associate
Jay P. Sanford, newly appointed dean of the school of medicine, came calling on Joy, soliciting his ideas on how to bring the school to a successful fruition. By some accounts, their initial meeting was over beer in a bar in Silver Spring, where they talked long into the night, sketching out the concept for the school on a bar napkin. By other accounts, they began their meeting at the university's temporary headquarters over a CVS Pharmacy in Bethesda, Maryland, then adjourned to Joy's house, working late into the evening. In either event, they quickly developed a straw-man concept which they then fleshed out sufficiently to obtain the blessing of the board of regents and began to move forward with plans for the university. It was during this process that Joy, who had been contemplating retirement and had been making quiet inquiries regarding post-service employment, approached Sanford about the position of the Professor of "Military, Naval, or Air Science" called for in the university's enabling legislation. Joy had realized that, rather than retiring, he desired to continue service on the faculty of the university. Sanford agreed, Joy prepared a nomination packet and submitted it through the Army Surgeon General, and was quickly approved by the Board of Regents. He and Sanford then began working on fleshing out the rest of the curriculum, focusing particularly on the military portion of the curriculum. Rather than having a Professor of Military Science, they decided instead to create a Department of Military Medicine, with Joy as the chairman. The new department would focus on those uniquely military portions of the curriculum. But only those truly unique aspects of the military environment. So while the Department of Military Medicine might cover the operational aspects of operating on a chemically or radiologically contaminated battlefield, for example, the effects of chemical agents at the cellular level would be taught in biochemistry, right alongside the Krebs cycle, or the effects of an arid or tropical environment on the body would be taught in human physiology. In this way, the school would integrate the military-unique aspects of the curriculum throughout the university, rather than adding it on as a separate topic, much as ROTC would have been in a civilian institution's undergraduate program. Joy also realized, as he developed his portion of the curriculum, that the University required a military commander for the students, responsible for their day-to-day discipline, as well as ensuring that the administrative minutiae that required a commander's signature could be completed promptly. Joy approached Sanford with the recommendation that Joy should logically hold the position as the senior uniformed officer assigned to the institution. He further argued that the position should be titled "
Commandant," a term traditionally associated with military schools. Sanford quickly agreed, presented the concept to the Board of Regents, and obtained their approval. Joy could then begin recruiting a staff for the new department.
First classes As the first students reported for classes at the
Armed Forces Institute of Pathology on the campus of the
Walter Reed Army Medical Center, which the University was using for classroom and laboratory space, Joy was still recruiting his faculty and staff. This included LTC John F. Erskine, MSC, USA as deputy commandant and associate professor in 1978 and Capt Ann Marie Pease, USAF, MSC and LCDR Anthony R. Arnold, MSC, USN as assistant commandants and assistant professors in 1978 and 1979, respectively. By having an officer from each of the services assigned, they would be better able to deal with students' service-specific issues as they might crop up. Joy set expectations with each arriving class as he oriented them to the Campus, reviewed policies covering attendance, personal and professional behavior, and other requirements associated with military life. As the first class was predominantly military—and small—it served as a learning tool, and adaptations were made with subsequent classes as they increased in size. Beginning with the second class, non-prior service students attended branch orientation courses before arriving at the university. The Commandant's Office also became responsible for those activities which were important to life as an officer—physical training, sporting events,
Dining-ins and Dining-outs, publication of a student newspaper and yearbook, training and selection for students wishing to attend
Airborne or
Air Assault training and, beginning in 1978,
Expert Field Medical Badge testing for all interested students, regardless of service. Additionally, in 1978, Joy, in his role of Commandant, began quarterly inspections of the MS-1 and MS-II students for proper wear and care of their uniforms, as well as personal grooming. Realizing that much of the art of military medicine was understanding the military as much, or more, than understanding medicine, Joy used his connections on the Joint Staff and in the Offices of the Secretary of Defense and elsewhere in the greater DC area to bring in guest speakers to lecture the students on military topics. Joy would hold these lectures at 1400-1600 on Fridays, but would notoriously run long in those early days and would often end up moving to the
Officers Club afterwards, where the students could further interact with the guest speakers. Although a bit rough at first, with the inaugural class nicknaming themselves the "Charter Martyrs," by the time Joy stepped down as chair of the department of military medicine and history in 1981, the training was well synchronized and coordinated. As the inaugural class began attending courses, Joy, assisted by the University's first Assistant Dean of Students, Army Medical Corps Lieutenant Colonel (and future
Army Surgeon General)
Ronald R. Blanck worked to ensure that the instructors met the quality that they expected. Joy and Blanck, along with other senior leaders in the University realized that with the end of
Selective Service—and with it the Doctor Draft—in 1973, the Armed Forces would become increasingly reliant on women to fill the ranks of the Medical Corps, and they expected their instructors to reflect a welcoming environment. No more locker room humor, coarse talk, or inappropriate slides will be allowed. With the first class over 10% female, the second class about 20% female, and later classes approaching 1/3 female, this was an important early framework for the university, and one both men took to heart, each being the father of daughters themselves. Joy was also challenged with developing summer experiences for his MS-I and MS-II students. Unlike civilian medical students, who had their summers off, the university's students were active duty military officers, entitled to only 30 days a year of leave. This meant that Joy had to develop summer experiences for his students between their first and second years to fill about six weeks constructively. It was during these summer periods that the students would join their services in the field. Some students would attend Airborne or Air Assault training (like the EFMB, not limited by service); Air Force and Naval students interested in flight medicine could conduct altitude certification training at Andrews Air Force Base. Other students might, depending on their service, go to sea with a naval ship on a short shakedown cruise, go to an army division and serve as an assistant battalion surgeon, or work in an air force hospital for three weeks, followed by three weeks shadowing an Air Force flight surgeon. At the end of their summer experience, they would be allowed to take two weeks of leave before beginning their second year of studies. And then, of course, came the history courses—some 33 hours of lecture in the MS-I curriculum. Joy used the history course to provide a common linkage for the students. To show them how what they were doing tied into what had come before them, and the role that physicians played in society and history. He built on the common military medical heritage that they shared, and how what they did was influenced by those that went before them—from
Dominique Jean Larrey and
Jonathan Letterman to
James Lind,
Malcolm Grow,
Louis Pasteur,
Luther Terry,
Walter Reed, and
Carlos Finlay. In addition to attending lectures, each student had to prepare a history paper on a subject mutually agreed upon by the student and Joy, which led to their letter grade in the course—and built a small cottage industry of avocational military medical historians as well among those students who gained an interest in the subject. At first he relied on others, including guest speakers and other faculty members with a penchant for storytelling, but by the time the inaugural class graduated, Joy owned the history program—and with that ownership came speaking engagements, both locally, in the United States, and abroad. Military Medical History now had a face, and that face was Robert J. T. Joy's. And through it all, of course, he continued to tell the story of a nameless young malaria researcher in Vietnam who, despite his ability to quote Sir
William Slim of Burma, was unable to influence senior commanders in the
Military Assistance Command, Vietnam to implement proper malaria control regimes.
Section of Medical History After the graduation of the inaugural class of medical students in 1980, Joy informed Sanford of his intent to retire from military service. At Sanford's request, Joy agreed to remain for an additional year to allow for an orderly search for a replacement. Additionally, Sanford wanted to make some organizational changes in the University. With the approval of the University's
Board of Regents, he reorganized the Department of Military Medicine and History and the Section of Operational and Emergency Medicine into a Department of Military and Emergency Medicine and a separate Section of Medical History, and separated the duties of the Commandant from those of the Chair of Military Medicine. When Joy again announced his intent to retire, this time in March 1981, Sanford offered Joy the position of chair of the Section of Medical History—subject to a national search and approval of the board of regents—and Joy agreed, subject to his ability to hire a tenure track
assistant professor. Sanford agreed, a search committee was formed, and when Joy retired on November 1, 1981, he was appointed
professor and chair of the Section of Medical History. Joy then organized a national search for an assistant professor of medical history, gathering resumes and holding final interviews at the 1982 annual meeting of the American Association for the History of Medicine, hosted that year by the Uniformed Services University of the Health Sciences. After completing panel interviews at the meeting, Joy selected Dr. Dale C. Smith, PhD, a recent graduate from the History of Medicine program at the University of Minnesota as the new assistant professor in the Section of Medical History. Smith joined the section in July 1982, joining Joy and Dr. Peter Olch, MD, a retired
United States Public Health Service Captain who had recently retired as the Deputy Director of the History of Medicine Division of the
National Library of Medicine who had joined the section as an
adjunct associate professor. With the expanded faculty, the section could begin to take on additional workload, and it did. From 1982 to 1987, Joy served as the editor of the
Journal of the History of Medicine and Allied Sciences, while Smith served as associate editor. It was also in 1982 that the USUHS started its first Master of Public Health Class, and Smith prepared and taught a 36-hour course in that program. From 1994 to 1998, Joy and Smith also taught a 24-hour series of lectures on the history of medical research to the
Walter Reed Army Institute of Research Fellowship in Medical Research—the same fellowship program where Joy and
Sanford originally met in the 1950s. Commitments to lecture in other teaching programs in the National Capitol Region soon followed. Invitations for speaking engagements continued to come to the section, and increased, as did travel. Invited lectures for all three members of the faculty increased, both in the United States and abroad, as the section's reputation as a center of expertise in the unique specialty of military medical history became more widely known. Over time, Joy decreased the lectures he gave in the MS-I course, while Smith and Olch developed their own as replacements. Additionally, the faculty participated in committees of associational and institutional government, serving on
National Institutes of Health study sections, the editorial boards of several journals, council and executive board memberships, society officers, and USUHS committees. In 1986, the Section of Medical History hosted the annual meetings of both the
American Military Institute and the US Air Force History Association. Both had asked to have military medical-themed speaker topics and themes for their conferences, which the section provided. By 1995, after 14 years as chair and twenty years with the university, Joy announced his intent to step down and enter
emeritus status, officially ending his working career.
Army Fellowship in Military Medical History In 1984 Colonel Thomas Munley, Chief of the
Academy of Health Science's Military Science Division, which was responsible for the
Army Medical Department's Officer Basic and Advanced Courses, approached Joy and asked if it would be possible to establish a training program to produce a qualified military medical history instructor for the academy, to increase the amount and quality of history presented in the Officer Basic and Advanced Courses. Established as a postgraduate
fellowship rather than a formal degree granting program, the Fellowship in Military Medical History allowed Army
Medical Service Corps officers in the rank of
captain or
major to apply as part of the Army Medical Department's formal schooling program. They would then be screened for suitability as an instructor by the Military Science Division, and satisfactory candidates would be sent to the Section of Medical History for final selection by Joy and Smith. Funding for the program, almost exclusively for the cost of temporary duty travel to conferences, was funded by the Academy of Health Sciences. Once assigned to the Fellowship Program, which involved a permanent change of station move, the student entered a directed reading program described by Joy as "a book a day." The goal of the program was to develop an officer with a strong background in the history of medicine, in general military history, and military medical history, and in particular those things which have had a strong influence on how medicine in the United States—and in particular the
United States Army reached its current state. This was no history and heritage training course, but a graduate level program in the history of military medicine, taught in the
Socratic Method, with the student preparing lectures to present to Joy, Smith, or other faculty members. In addition to the formal education, the Fellows attended the annual meeting of the American Association for the History of Medicine and the Society for Military History (still named the American Military Institute in the early years of the fellowship). They also attended seminars at the
Johns Hopkins University Institute for the History of Medicine and other local DC groups, such as the monthly "Military Classics Seminar." They visited the
United States Army Center of Military History and the
Military History Institute at Carlisle Barracks, Pennsylvania. And from the fourth fellow onward, they attended the TRADOC Military History Instructor Course en route to the fellowship. All of these additional experiences served to provide a well-rounded historian, prepared to be an operational historian, and not just an instructor for the Academy of Health Sciences. In 1994, the Fellowship was converted to a formal Master's producing program, and its length was expanded to 15 months. To ensure that the Fellows—now Masters students, but still referred to by that term by their fellow alumni—received proper training in historiography and other areas, the students took several classes at
American University to round out their training. Between 1984, when the first Fellow was admitted, and 2010, when the last Master's student graduated (although the program remains on the books), the program produced seven fellows and five Master's recipients. Of those, three published peer reviewed papers during their fellowships, one won first place in the Annual U.S. Army Center of Military History writing contest, and one won the
Association of Military Surgeons of the United States History Paper competition. The production of trained historians provided one benefit that was unanticipated at the time the program was created, and that was the ability to deploy medical historians to an active theater of operations. During the Vietnam War, the
44th Medical Brigade, the Army's senior medical command and control headquarters in country, had the 27th
Military History Detachment, commanded by a
Medical Service Corps officer, embedded in its headquarters for most of its deployment, where it collected documents, prepared historical reports, and supervised the historical activities of the command. The Army Medical Department had lost that capability in the ensuing years, and the fellows returned it to the Department.
Operation Desert Storm saw two fellows deployed—one with the
Center for Army Lessons Learned collection team, and a second as the theater medical historian, who collected oral history interviews, sent them to the Center for Military History, collected artifacts for the Army Medical Department Museum, and prepared the Command Historical Report for the
3rd Medical Command (Provisional). Since Desert Storm, USUHS History Fellows continued to deploy in the role of operational historians until the last of them left active duty, with the majority of them having served overseas as medical historians. ==Later years==