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Dr. Robert J.T. Joy, Legendary USU Professor, Passes Away

By Dr. Dale Smith

Retired Army Colonel (Dr.) Robert J.T. Joy, professor emeritus of the Uniformed Services University’s Section of Military Medical History and the founding Commandant of USU, passed away April 30, 2019.  His family requested that his passing be kept silent until now.

Bob Joy and USU

“Come with me now” … to a Silver Spring, Md., neighborhood establishment called Danny’s off of Georgia Avenue just inside the capital beltway. It is a winter night in 1976 and Dr. Jay Sanford, newly appointed dean of the Uniformed Services University medical school, was meeting the director of the Walter Reed Army Institute of Research (WRAIR), Army Col. (Dr.) Robert J. T. Joy, a long-term professional colleague and friend. 

The pair met in the 1950s when Sanford was an active duty “Berry Plan” physician and then-Capt. Joy was a Fellow at WRAIR.  Although they had discussed aspects of military medicine many times in between, that night Sanford wanted to talk with Joy about the new medical school and how best to meet the mission of educating career military medical officers. After dinner and a pint, there on a Danny’s paper napkin, singed on the corner by a pipe ash burn, was a sketch of how to integrate specialized medical knowledge and professional military education into an accredited medical school curriculum. 

The sketch was refined, expanded upon, and the result presented to the University Board of Regents by Sanford with the recommendation that the University ask the Army to assign Joy as the Professor of Military Science at USU, mandated by language in the federal statute creating the University.  However, Lt. Gen. (Dr.) Richard Taylor, the Army Surgeon General, told Sanford not to get his hopes up, as Bob Joy “was in his dream job” and had even turned down a hospital command and potential star [brigadier general rank] to train and lead military medical scientists, his ‘Regiment’ of more than 20 years.  But, as Joy would later note, one could leave a dream job only for one you could not dream of; and so, with his acceptance of the position, began the military identity of America’s Medical School.  Over the next 20 years the name Bob Joy, would become synonymous with “military medicine” and be second only to Sanford in the shaping of the institution and, arguably, second to none in the memories of its alumni.

His Career and the Discipline of Military Medicine

Robert John Thomas Joy was born in Rhode Island; “lace curtain Irish” was his own description of his world. He attended schools in Narraganset in the spring and fall and St. Petersburg, Florida, in winter as his family of hotel entrepreneurs followed the seasonal tourist trade. He graduated from the University of Rhode Island (pre-med and pre-law) and Yale University Medical School (on a Reserve Medical Officers training scholarship).

First Lieutenant Joy reported to Walter Reed Army Hospital in 1954 as an intern.  In 1955-1956, he completed the Army Medical Department (AMEDD) Advanced Course in San Antonio, Texas, served as a Battalion Surgeon for the 714th Tank Battalion, and then as a Medical Platoon commander. He returned to Walter Reed for a medicine residency from 1956-1958.  After completion of his residency, Capt. Joy pursued the WRAIR Research Fellowship and won the Hoff Medal as honor graduate.

Army Col. (Dr.) Robert Joy leads the Hippocratic Oath during the first USU Commencement ceremony in 1980.  (Uniformed Services University photo)
Army Col. (Dr.) Robert Joy leads the Hippocratic
Oath during the first USU Commencement
ceremony in 1980. 
(Uniformed Services University photo)
In 1959, he was assigned to Ft. Knox, Kentucky, to practice medicine with an interest in cardiology (the AMEDD was not yet supporting much sub-specialization) and additionally to serve in the Environmental Research division of the Army medical laboratory there. After two years, Joy was
asked if he “wanted a challenge”:  the Quartermaster (QM) Corps was transferring the research laboratory at Natick, Mass., to the AMEDD, but no senior AMEDD officer would take the job because the rating chain included a QM general who might begrudge the transfer.

Capt. Joy, Presidential orders to rate seniors in hand, transferred to become the founding director of the U.S. Army Research Institute of Environmental Medicine (USARIEM) and was awarded the Army Commendation Medal for the task. He was rewarded with an assignment to Harvard University for graduate study in physiology, but instead, earned a Master of Arts degree and left early, volunteering to lead the WRAIR team in Vietnam when the war broke out there in 1965.  Doing pioneering field research on malaria prophylaxis and environmental protection of aviators (receiving an Air Medal and being certified as a flight surgeon), he was awarded his first (of four) Legion of Merit medal and, more important to him, the team received a Meritorious Unit Citation. 

He returned to USARIEM as deputy director for Field Research, and led a team to Greenland to study winter survival gear before going to the Armed Forces Staff College (AFSC) in Norfolk, Va.  The AFSC, which opened in 1946 to ensure that there would be a few officers in each Service with the education to serve on joint staffs, had recently been made equivalent to the individual Service staff colleges for officer professional credentials.

Then-Lt. Joy had read military and medical history for years and had attempted (with mixed success) to use it in staff work in Natick and Vietnam.  He had a year to think about those histories in context while attending the nation’s only multi-service staff college. Thus, he began a professional transition that was ahead of its time and which would serve as his loadstar in the years to come -- he conceptualized military medicine as a new medical discipline that was far broader than “Army medicine.”

Joy had seen all four Services function (essentially independently) in Vietnam and at this point, he was studying how each Service was organized to train, plan, and fight in a far more integrated (“Joint” in today’s lexicon) fashion in the future. After staff college, he was transferred to Washington, D.C., where he was assigned in the AMEDD Medical Research Division, then in the Office of the Secretary of Defense as a senior staff officer in the Directorate of Research and Engineering, and subsequently back to WRAIR as deputy director and director between 1971 and 1976. 

In all three postings, now-Col. Joy refined his understanding of how medicine was used in the various military services and sharpened his growing concept of a “joint” understanding of military medicine that he felt should replace the stove-piped, service-specific medical activities of the past.  This concept of a new, joint military medicine caught Sanford’s imagination that evening at Danny’s and, with Sanford, Joy conveyed it to the Board of Regents: there should be a Department of Military Medicine rather than the typical ROTC service-specific structure reflected in the statutory professor’s title in the founding legislation. The Board concurred on the recommendation of the dean and created the position of Professor of Military Medicine who would chair something new in American medical education: a free-standing Department of Military Medicine.  Joy accepted the challenge to make both the position and the department the engines that would drive a fledgling medical school that would graduate military physicians, rather than simply physicians in the military.

Dr. Robert Joy (center) recruited retired Public Health Service Capt. Peter Olch (left) and Dr. Dale Smith (right) as his first Medical History faculty members.  (Uniformed Services University photo)
Dr. Robert Joy (center) recruited retired Public Health Service Capt. Peter Olch (left) and
Dr. Dale Smith (right) as his first Medical History faculty members. 
(Uniformed Services University photo)

Joy, who was simultaneously appointed to chair the curriculum committee and to serve on the admissions committee, found himself working closely with Sanford as the dean recruited the initial faculty.  One summer day, in the University administration’s office over the People’s Drug Store in downtown Bethesda, Joy asked Sanford who would have military oversight of the active duty student body.  Sanford’s initial response was that this would be a responsibility of the dean, but Joy pointed out that this responsibility could only be assumed by a serving officer. Understanding immediately, Sanford said that made it an easy choice: Joy was already in place, and so he would be given additional duty as “military commander” of the students.  Joy urged “commandant” -- the traditional title for those in equivalent positions in military academies and schools.  As professor of Military Medicine and commandant, Joy would be responsible for professional military education and training as well as medical material, like forward field care, that would not be taught by other departments.

As the direct result of Joy’s efforts as the first chairman of the USU curriculum committee, other departments were taking on much of the military-specific material:  Pharmacology would teach about chemical weapons, while Microbiology would handle the medical aspects of biological warfare.  Physiology would teach the applied physiology of altered environments as well as the physiology required of the national board examinations. The School of Medicine would have a robust Preventive Medicine program because force heath protection was the essence of military medicine.  Joy often quoted Army Maj. (Dr.) Jonathan Letterman on the leading idea in military medicine which “is to strengthen the hands of the Commanding General by keeping his Army in the most vigorous health, thus rendering it, in the highest degree, efficient for enduring fatigue and privation, and for fighting.”  The curriculum committee, again under Joy’s firm leadership, apportioned time in the curriculum to ensure these additional materials could be taught.
 
Joy’s goal was a medical school experience that provided its graduates, regardless of the Service in which they were commissioned, with a common and integrated concept of support of military forces in peace and war. While this was the clearly articulated goal of the new medical school, how to accomplish this was not clear. There was, at that time, no joint doctrine for medical support; there was only material narrowly addressing such Service-specific issues as decompression injury, effects of G-forces, and care of high velocity small arms injuries.  Most students would be direct commissions and not familiar with the Department of Defense and the roles and missions of the four Services, so some professional military education was essential.  Drawing on his experiences at the Armed Forces Staff College, Joy challenged each prior Service student to teach their Service to the other members of the class. He called in favors from friends all over Washington; for example, the Washington Post Pentagon reporter, Charlie Wilson, taught students how to deal with the press.  There were discussions of military professionalism and ethics; the Uniform Code and Geneva Conventions were taught by military lawyers who were experts in the issues.  He drew on colleagues in operational billets from all Services to discuss field medical support, with emphasis on the fact that the physiology was common even if the evacuation and treatment systems varied.

Army Col. (Dr.) Robert Joy was USU’s
founding Professor of Military Medicine and
Commandant of the School of Medicine. 
(Uniformed Services University photo)
With the support of the Board of Regents and Sanford, he requested a Medical Service Corps officer from each Service be assigned to his department on the argument that this was the community of staff officers that ensured the planning and operations of military medicine were carried out as the needs of the patient dictated.  As a historian, Joy knew most of the wartime naval medical officer’s duties centered on patients wearing forest green and the Air Force problems centered on perimeter defense casualties – forward support of land war was the critical skill, but the challenges of medicine at sea and aviation medicine were also taught.  He knew from his own experience that the Army still flew (and that in World War II it had had more hospital ships than the Navy). But since physicians did not serve in isolation and troops came from different cultures, military nurses and curanderos were also part of the preparation of military medical officers. These classes all took place on Friday afternoons so that Joy could take his guest lecturer to the Officers’ Club and the students could continue the discussion in an informal atmosphere.  Many classes scheduled for 2:00-4:00 p.m. continued until 6:00 p.m. with the added benefit of introducing the young officers to other elements of military culture as they met officers from many branches and corps who stopped by the club.  It was not completed in the school’s first year, and refinements of instructors and content continued year after year as the first class, dubbed the “Charter Martyrs”, served as guinea pigs for the new effort. However, a formal curriculum in military medicine emerged, and the classes in the third-year clerkships went to the wards as officers, taking pride both in their unique service AND their joint profession as future military physicians.

That pride arose, in part, from their newly-achieved competencies, but it was augmented by formal presentations presented by Joy in the first academic hour every Friday afternoon. 

Joy was well aware of the empowering nature of pride in professional heritage. He personally took pride from the heritage of Yale, Walter Reed Hospital and the Army; however, he saw both that USU did not have a long tradition of distinguished alumni to serve as a wellspring for such pride, and there was no service-transparent tradition of “military medicine.”

He decided that a study of the history of military medicine would supply a common heritage; informally referred to as “story time” before the first class graduated, the professional heritage Joy brought alive in his lectures on Amboise Pare’s care of the soldier, John Pringle’s commitment to mission, James Lind’s creation of the randomized trial, Dominique Larrey’s commitment to forward surgery, Jonathan Letterman’s organization of health service support, and Walter Reed’s pioneering efforts in human research protection inspired students.  But the story time series began and ended with Gen. William Slim, the line officer who “got it”:  force health protection depends on the command of health – a lecture in which the military medical officers were anonymous advisors and the commander was front and center.

As Commandant of Students, Joy asked for and received responsibility for student time on Wednesday afternoons; usually he gave these hours “back to the students;” he realized they had errands to run, parent-teacher conferences to attend, haircuts to acquire.  Occasionally he held a formation to see that the haircuts were being maintained, once in a great while he assembled a class for an “I am not pleased” talk.

The greatest challenge he faced was in making the relatively few women in the class comfortable in a military that remained paternalistic.  There was some misconduct by classmates, often thought as joking but hurtful for the female targets; minds had to be changed. He invited in female role models and recruited a female Air Force officer as one of his first department faculty appointments.  In an era when the first slide in medical school lectures was frequently a “pin-up,” he and Sanford forbade such displays, attended talks by every lecturer and “educated” many on the changing nature of the Medical Corps. Faculty who were “not educable” never returned.  Both he and Sanford had daughters making their way in the professional world and recognized that women could not change the world of men, men had to agree and support the changes.  He often quoted Gen. Abrams from an earlier civil rights struggle in the military, “I cannot change the way you think, but I can change the way you behave.”
 
However, Joy knew behavior change required multiple and visible role models, and so he recruited from the clinically-affiliated officer faculty a group of assistant Commandants, one for each ten students, whom he coached and prepared with the assistance of the first assistant dean of students, Army Lt. Col. (Dr.) Ronald Blanck. These faculty members served as mentors, role models and sounding boards for the class, and provided the Commandant with insight into the professional growth of each student.  As class sizes grew, his successors found the program difficult to maintain and other arrangements would be made, but for the first half dozen classes it provided a remarkably effective professionalism program.

USU’s first Commandant of Students, Army Col. (Dr.) Robert Joy (right), leads the faculty procession for the University’s first Commencement in 1980.  (Uniformed Services University photo)
USU’s first Commandant of Students, Army Col. (Dr.) Robert Joy (right), leads the faculty procession for the
University’s first Commencement in 1980.  (Uniformed Services University photo)

By 1978, Joy and Sanford were ready to tackle the unknown once again.  The napkin from Danny’s had a single twelve-week block in the fourth-year curriculum; it was simply labelled “Military Medicine clerkship” – such a thing did not exist anywhere in the world. They defined the block’s goal as “To prepare the graduate to serve successfully, following internship, as a general medical officer in the emergency room of a fixed military medical facility or as a general medical officer at the forward-most point on the modern battlefield at which physicians are positioned.”  The block was to end with a several-day medical field problem based upon medical support in a forward aid station.

Turning to history, Joy told Sanford of early efforts by Lyman Munson to teach sanitary tactics to field officers at Ft. Leavenworth and how after World War I, the Army Medical School had expanded with the creation of the Medical Field Service School at Carlisle Barracks with a set of field problems based on tactical realities of modern medical care in the field.  They created a Section of Operational and Emergency Medicine at USU that was intentionally independent of all the traditional medical school clinical departments and reported directly to the dean. The fourth-year program used clinical rotations in high-volume military and civilian emergency departments and a complex field exercise named “Operation Bushmaster”; that Section would eventually be integrated into the Department of Military Medicine to create today’s Department of Military and Emergency Medicine.

Impressed by the first USU field exercise, each Surgeon General privately requested that USU conduct a similar course for “their” new Medical Corps officers. Seeing in these Service-specific requests an opportunity to instead highlight their evolving concept of “military medical jointness,” Sanford and Joy offered University-sponsorship on the condition that participants from all Services participate in a common curriculum.  Under their supervision, the first-ever joint military medical field exercise was conducted in 1980. The resulting Joint (DHS) Combat Casualty Care Course expanded to include other military medical providers as students, and continues to offer multiple yearly iterations forty years later. 

Joy, in his role as chair of the Curriculum Committee, was integral to the first Liaison Committee for Medical Education (LCME) accreditation of the medical school; as Commandant, he learned that the university needed Middle States Commission on Higher Education accreditation to allow students to continue to defer their undergraduate loans and worked with Sanford and the Board of Regents to acquire the regional accreditation authority’s provisional stamp of approval.

Joy retired from active duty in 1981 and was awarded the Distinguished Service Medal for his Army career.  The medical history program was separated from the Department of Military Medicine to establish a stand-alone Section of Medical History with Joy as the first chair. He retained the 1:00-2:00 p.m. Friday story time block with the grade integrated into the Military Medicine grade, but the separation made possible the broader recruitment of the next professor of Military Medicine and commandant.

Dr. Robert J.T. Joy
As a civilian professor, he continued to advise Sanford and subsequent Military Medicine department chairs and commandants.  His faculty colleagues trusted him so much that he had the dubious honor of chairing the first two ad hoc faculty grievance committees and overseeing the school’s first research ethics investigation; by the mid-1980s he turned requests for his services into faculty
development opportunities, frequently declining, but nominating a younger faculty member in his stead.  These efforts assisted the professional development of more than a dozen young academics, civilian and military.  Joy assisted the Department of Preventive Medicine and Biometrics in shaping and achieving support for a military-specific Master of Public Health degree program.  At the request of the AMEDD, he established a Military Medical History Fellowship program and trained a dozen officers to teach and collect data in deployments to aid in the shaping the next generation of military medical heritage stories.

Joy was a Fellow of the American College of Physicians, of the American Association for the Advancement of Science and of the College of Physicians of Philadelphia, and was a member of numerous clinical, scientific and historical societies, serving in leadership positions in several of them.  He has held more than 84 named lectureships and visiting professorships in the U.S. and in England, Canada, Israel, Germany, and Australia. He served on several editorial boards and as editor of the Journal of the History of Medicine.  Internationally recognized as an expert in military medical history, Joy published more than 147 articles, chapters and reviews and was a consultant and on-camera narrator on several television programs. He was appointed Professor Emeritus in 1996 but continued to teach. His contributions to military medicine were repeatedly acknowledged over the years through receipt of the John Shaw Billings Award and the Kern Award of the AMSUS, the Hunter Award in Tropical Medicine, the Order of Military Medical Merit.

Joy’s contributions to the development the discipline of military medical history were literally revolutionary, virtually creating a scholarly discipline, as USU acknowledged by the exceptional awarding of an honorary degree to one of its own faculty after he retired. He was honored for his contributions by the Nicholas Davies Award in Medical Humanities of the American College of Physicians and the Lifetime Achievement Award of the American Association for the History of Medicine. 

But these accolades from colleagues paled in his sight when compared with the appreciation of his students: the first-year medical school classes named him outstanding lecturer every year for almost 20 years; the entire student body honored him as outstanding military educator in 1980 and again in 1996 as the outstanding civilian educator; in 1994, the class dedicated the yearbook to him.  When word of his last lecture circulated in 2005, alumni came from posts, camps, and stations around the world to once again fill the lecture hall.  Current students found themselves sitting on the stairs and standing as colonels and admirals took again their student seats for story time.

But Joy’s greatest legacy is the conduct of his students in deployment and garrison over the decades since he pioneered a new Service-agnostic concept of military medicine in those early years of shaping USU teaching.  By the 1980s, young officers were working on improving evacuation technologies and testing field equipment in graduate education settings. The public acknowledgement was in Desert Shield/Desert Storm where about 100 USU graduates demonstrated the value of joint thinking in military medicine. From surgical teams moving forward independent of their MASH base, to joint logistics and resource sharing, to systems of communication and evacuation that were innovative and multi-Service, USU graduates began a change in military medical practice; a change noticed and supported by their line officer raters.  As he retired a few years later, they were working on turning the experiments into the doctrine to reduce the large medical footprint and improve care in deployment. Today, they remain the leaders the American military medicine profession that has brought killed-in- action and died-of-wounds rates to historic lows.

The magnitude of Joy ’s achievement was captured by retired Army Brig. Gen. Robert Doughty, professor and chair of History at the United States Military Academy at West Point: “No one else contributed as much as he to our understanding of military medicine and its history… his contribution has influenced, and will continue to influence, students, historians, and soldiers for decades to come.”