Got Grog? The 2012 Winter Edition is now available

It is with great pleasure that we present to you the latest edition of THE GROG, A Journal of Navy Medical Culture and Heritage. In this issue, we offer you a look back at a very key year for the U.S. Navy Medical Department, 1942. Host to the Battles of Guadalcanal, Coral Sea, and Midway, this challenging and transformative year also marked the beginning of the U.S. Navy Mobile/Fleet Hospital Program and the integration of women into the Navy. We follow this article with "The Shadow Nurse," the stunningly true tale of two Navy nurses who succesfully switched lives and careers. Finally, Chief Nurse J. Beatrice Bowman returns to the present day to show the reader around the only Navy hospital ship that was specifically built from the keel up as a hospital ship. As always we hope you enjoy your humble tour of Navy medicine's past. And feel free to pass this link to anyone who enjoys history.

THE GROG is accessible through the link below. PDF copies are availaible too for all interested parties.

http://issuu.com/thegrogration/docs/the_grog_winter_2012/

Echoes of Navy Medicine’s Past: World War II, European Theater

Echoes of Navy Medicine’s Past
Part VI: World War II, European Theater
By Jan Herman and Mr. Grog

“To keep as many men at as many guns for as many days as possible.” This was the Navy Medical Department’s fighting motto during World War II. If the ultimate purpose of military medicine during this conflict was the same as in previous wars—to conserve the strength and efficiency of the fighting forces—Navy medical personnel worked diligently to accomplish that goal.

The ability and means to support the war effort was certainly not in evidence the day Japanese aircraft attacked Pearl Harbor on 7 December 1941 and plunged the United States into World War II. In that year, the Navy had only 18 continental hospitals, 3 overseas hospitals, 2 mobile hospitals, and 2 hospital ships in commission. Approximately 13,500 physicians, dentists, nurses, hospital corps officers, and corpsmen—pharmacist’s mates as they were then called—manned these facilities.

In contrast, by 1945, the ranks had swollen to about 169,000 personnel, a staggering growth of 1,252 percent! They were assigned to 56 hospitals in the continental United States, 12 fleet hospitals, 16 base hospitals, 14 convalescent hospitals, 15 hospital ships, 5 special augmented hospitals, and many dispensaries.

The staggering commitment to winning the war would require all these resources. What transpired between 1941 and 1945 was a cataclysmic event made worse by the nature of the weapons used by the combatants. Although World War I had seen the widespread use of machine guns, submarines, airplanes, and tanks, World War II saw these weapons reach unimagined perfection as killing machines. In every theater of war, small arms, land- and sea-based artillery, torpedoes, and armor-piercing and anti-personnel bombs took a terrible toll in human life. In America’s first major encounter at Pearl Harbor, the victims of the Japanese attack could testify to what modern warfare really meant. Strafing aircraft, exploding ordnance, and burning ships caused penetrating injuries, simple and compound fractures, traumatic amputations, blast injuries, and horrible burns to name just a few.

Even though the story of Navy medicine in World War II is primarily a story of the Pacific war, the Navy not only played a key role in the liberation of North Africa, Italy, and France but also in fighting the U-boat menace in the North Atlantic and escorting convoys to Britain and Russia. Japan may have forced the United States into World War II, but American strategy for winning it focused on defeating Hitler first. Only when Nazism was on the run could the war planners in Washington take full aim at the Japanese.

The Americans who stormed Hitler’s “Fortress Europe” on 6 June 1944 were predominantly troops of the U.S. Army. But D-Day was not solely an Army show. It was Navy ships and personnel that brought the soldiers and their equipment from England, and Navy battleships, cruisers, destroyers, and rocket-firing amphibious assault vessels that pounded German fortifications and cleared the way into the beaches.

Navy personnel were also represented on the Normandy shore. They were not there in large numbers, but their unique skills were essential for the invasion to succeed. These were the men of the 2nd, 6th, and 7th Naval Beach Battalions, units whose mission it was to bridge the gap between sea and land and perform many other functions on the invasion beaches.

These highly trained sailors of the beach battalions had many functions to perform, not the least of which was to treat and evacuate casualties. The care givers—the physicians and hospital corpsmen—had to contend with every wound modern warfare could produce with anti-ship and personnel mines, high velocity small arms, and artillery fire inflicting penetrating wounds of the head, face, neck, and extremities, and fractures, burns and blast injuries.

As the first American troops went ashore at Omaha and Utah Beaches, Navy medicine was represented by these sailors who were dressed as soldiers and indistinguishable from their Army counterparts. Nevertheless, they performed bravely and efficiently, rendering first aid to American personnel, whether they were soldiers or sailors. Physicians provided rudimentary care where possible. Armed with litters, hospital corpsmen administered first aid—a battle dressing, a tourniquet, a morphine injection, a casualty tag—and then moved the wounded down to the water’s edge so they could be evacuated aboard the now empty landing craft heading back out to the transports. When that was not feasible, they sought shelter and set up aid stations above the high tide line.

The Navy was also responsible for returning the casualties from Normandy. Once evacuated from the American sectors of Utah and Omaha Beaches aboard smaller returning landing craft, the wounded were transferred to specially equipped LCTs (landing craft, tank) and LSTs (landing ship, tank) staffed by physicians and hospital corpsmen. Each LST had special brackets to accommodate 147 litters arranged in tiers 3 high on their tank decks. Here they would receive emergency treatment once the tanks and troops went ashore. Two Navy physicians, one Army surgeon, two Army operating room technicians, and 40 Navy hospital corpsmen staffed these versatile ships. They were equipped for providing first aid, stabilization, and an occasional surgery.

Once safely back in England, Navy medical personnel, including nurses, triaged patients, conducted emergency surgery, and stabilized the injured until they could be evacuated to other hospitals in Britain or back to the United States for more definitive treatment.

One of the hospitals designated to care for the casualties of the D-Day invasion was Navy Base Hospital Number 12. The facility occupied the thousand-bed Royal Victoria Hospital at Netley, adjacent to the major Channel port of Southampton and had a staff of Navy medical personnel. U.S. Navy physicians, nurses, and hospital corpsmen operated on patients night and day for the better part of a week. Their dedication and skill guaranteed that 97 percent of the wounded would live—a remarkable statistic.

Seventeen days after the initial landings at Normandy, the casualty evacuation system was working so smoothly that the naval beach battalions returned to England. Although their mission was completed, the cost had been heavy for these brave physicians and hospital corpsmen. Two physicians and 20 corpsmen of the 6th were killed in action. The 7th lost a physician and 10 corpsmen. At Utah Beach, where the invaders met lighter resistance, the 2nd Beach Battalion lost one physician and seven hospital corpsmen. Every bit as much as the soldiers and sailors who wielded the weapons of war, these Navy medical personnel helped insure the success of what Dwight Eisenhower called the “Great Crusade.” The long awaited turning point in the liberation of Europe had finally come.

Although Navy medical personnel were also present during the capture of Cherbourg and landings on the French Mediterranean coast, for the most part Navy medicine’s contributions to the liberation of Europe were over. The real focus of the Navy’s attention was the war against Japan.

Despite deteriorating relations with the Soviet Union and the beginning of the Cold War, dwindling military budgets translated into drastic reductions in resources and manpower for all the services. The Navy Medical Department shrank accordingly. Hospitals were decommissioned, hospital ships went into mothballs, and reserve physicians, dentists, nurses, and hospital corpsmen returned to civilian life. Who could have anticipated what would occur a mere five years later when the Cold War suddenly turned hot in Korea, a country few people could even find on a map.

Echoes of Navy Medicine's Past: World War II, Pacific Theater

Echoes of Navy Medicine’s Past
Part V: World War II, Pacific Theater
By Jan Herman and Mr. Grog


December 7, 1941 still represents the U.S. Navy’s greatest disaster. In just over two hours much of the Pacific Fleet had been destroyed or seriously damaged. Even before the last Japanese aircraft had disappeared over the horizon, what the raiders had accomplished by their surprise attack was catastrophic. The pride of the fleet—seven battleships that once projected U.S. might and prestige—either lay on the bottom or were too crippled to be of any immediate use. Bombs, torpedoes, and machine guns had taken a terrible toll, with the Navy alone losing 2,008 men.

The wounded and severely burned survivors of the attack required immediate treatment, and Navy medical personnel were on the scene to provide that care. Navy medicine was represented at Pearl Harbor by a naval hospital, a partially assembled base hospital, and USS Solace (AH-5), the Navy’s newest hospital ship. Heroic efforts to save lives by the men and women who manned these facilities began minutes after the first Japanese bomb fell and never waned until the last casualty was tended to.

Physicians, nurses, and hospital corpsmen on duty at Naval Hospital Pearl Harbor performed emergency surgery, treated burns, and comforted the dying. The same scene played out aboard USS Solace, which lay at anchor just beyond “Battleship Row.” Oil-soaked sailors plucked from the harbor were taken to the hospital ship for treatment.

If the ferocity of the Japanese onslaught that followed Pearl Harbor left American forces reeling, isolated, and with scant hope of reinforcement, as an institution Navy medicine was equally stretched. Possessing only limited resources and with a presence only in Hawaii, the Philippines, Guam, a few small installations, and aboard the few vessels of the Asiatic Fleet, Navy medical personnel were hard pressed to treat patients as the Japanese rolled through the Pacific conquering everything before them. On 8 December 1941, World War II came to the Philippines when Japanese bombers hit Clark and Nichols Fields.

Two days later enemy bombers returned, this time destroying the Cavite Navy Yard and killing and maiming scores of Americans and Filipinos. Personnel at the nearby Cañacao Naval Hospital worked frantically to treat the wounded.

Japanese soldiers who landed on Philippine beaches in late December 1941 overwhelmed the ill-equipped and outnumbered Americans and Filipinos. By the time Japanese forces entered Manila on 1 January after GEN Douglas MacArthur declared it an open city, its battered defenders had already withdrew to the Bataan Peninsula to make their last stand.

As food and medicine ran out, disease took its toll among Bataan’s defenders. The lack of quinine for the treatment of malaria was critical, and without it many men came down with the disease. Nearly everyone suffered debilitating weakness from dysentery. Overwhelmed, Bataan’s 75,000 defenders finally surrendered in April 1942.

But out in Manila Bay, the island fortress of Corregidor still remained defiant despite a lack of food and ammunition. After a month of heavy bombardment and finally landings by Japanese forces, Corregidor surrendered on May 6th. American power in the Far East had been extinguished. Yet despite the new reality, the hundreds of medical professionals captured in the Pacific were still “Doc” or “Nurse” to their fellow POWs. Without hospitals or supplies, they continued to practice their healing art, often under unimaginable circumstances.

Some 10,000 surrendered at Corregidor after thousands of captured Americans and Filipinos had already died on the infamous Bataan Death March. Those who survived Japanese brutality and neglect now faced Japanese prison camps. For the approximately 17,000 Americans and 12,000 Filipino scouts who surrendered in the Philippines, the real ordeal had barely begun. Torture, forced labor, starvation and death became the norm in Japanese POW camps throughout the Far East.

Even though physicians and corpsmen did the best they could to provide health care in these camps, they had virtually no drugs or instruments. Malaria and dengue fever were endemic. Sanitation was non-existent and almost everybody had dysentery. Many came down with deficiency diseases like scurvy, optic neuritis, and beriberi. By the summer of 1942 the Japanese held over 50,000 prisoners, 20,000 of whom were Americans.

Eleven of these were Navy nurses from the Cañacao Naval Hospital. They spent the war in internment camps at Santo Tomás in Manila and then at Los Baños in the Philippine countryside, where they were finally liberated in February 1945. Many of their male colleagues never made it home, either succumbing to disease, starvation, brutal treatment by their captives, or dying by “friendly fire” when the so-called hell ships in which they were being transported to Japan were sunk by American submarines or aircraft.

Despite the fate of these unfortunate POWs, the war against Japan was in full swing by the summer of 1942. Reconquering territory held by the enemy was the priority and it meant fighting island by island, each one a stepping stone to Tokyo. Organizing the Navy Medical Department to care for the thousands of Navy and Marine Corps casualties generated by opposed amphibious landings, make them well, and then return them to duty was the major priority. It was in the Pacific war that Navy medicine faced its greatest challenge dealing with the aftermath of intense, bloody warfare fought far from fixed hospitals. This put enormous pressure on medical personnel closest to the front and forced new approaches to primary care and evacuation.

The most dramatic and demanding duty a Navy hospital corpsman could have was with Marine Corps units in the field. Because the Marine Corps has always relied upon the Navy for medical support, corpsmen accompanied the leathernecks and suffered the brunt of combat themselves. Many of them went unarmed, reserving their carrying strength for medical supplies.

Navy corpsmen were the first critical link in the evacuation chain. From the time a Marine was hit on an invasion beach at Guadalcanal, Tarawa, Saipan, Iwo Jima, and a host of other Pacific islands, the corpsman braved enemy fire to render aid. He applied a battle dressing, administered morphine, and tagged the casualty. If he were lucky, the corpsman might commandeer a litter team to move the casualty out of harm’s way and on to a battalion aid station or a collecting and clearing company for further treatment. This care would mean stabilizing the patient with plasma, serum albumin, and, later in the war, whole blood. In some cases, the casualty was then moved to the beach for evacuation. In others, the casualty was taken to a divisional hospital, where doctors performed further stabilization, including emergency surgery if needed.

Navy hospital ships, employed mainly as ambulances, provided first aid and some surgical care for the casualties’ needs while ferrying them to base hospitals in the Pacific or back to the United States for definitive care. As the war continued, air evacuation helped carry the load. Trained Navy nurses and corpsmen staffed the evacuation aircraft.

Enabling the Navy and Marine Corps to defeat the enemy also meant recognizing that disease more often than enemy action threatened this goal. During the battle for Guadalcanal in the Solomons, malaria caused more casualties than Japanese bullets. Shortly after the landings, the number of patients hospitalized with malaria exceeded all other diseases. Some units suffered over a 100 percent casualty rate with personnel being hospitalized more than once. Only when malaria and other tropical diseases were brought to heel could the Pacific war be won.

Navy medical personnel moved quickly to reduce the impact of malaria and other tropical diseases. Personnel trained in preventive medicine oiled malaria breeding areas and sprayed DDT. Physicians and corpsmen dispensed quinine and atabrine as malaria suppressants.

The Pacific war was massive in scale, fought over vast stretches of ocean. Fleets engaged one another often many miles distant from one another. Carrier-based aircraft were the surrogates that sought out the enemy and delivered the ordnance. U.S. Navy task forces consisting of carriers, battleships, cruisers, destroyers, and destroyer escorts required their own medical support and each of these vessels had among their crews corpsmen, physicians, and, aboard the larger vessels, dentists as well. By October 1945 the fleet numbered over 7,000 vessels from landing craft and auxiliaries to the Essex class carriers and Iowa class battleships. The hundreds of vessels smaller than destroyers had their corpsmen to be sure, but the larger vessels rated physicians, corpsmen, dentists, fully equipped sick bays, battle dressing stations, and usually an operating room. The standard medical complement for a 7,250-ton escort carrier was one medical officer, a flight surgeon for the embarked air group, a dentist, and about 13 corpsmen. A much larger 27,100-ton Essex class carrier like USS Franklin (CV-13) boasted four physicians augmented by a flight surgeon, 3 dentists, and 31 corpsmen. During routine operations, physicians and corpsmen serving aboard vessels in the South Pacific encountered and treated heat and humidity related maladies exacerbated by confinement without air conditioning—heat exhaustion and stroke, fungus infections, heat rash, and breathing disorders.

The encounters between Japanese and American fleets were most often brutal affairs with many casualties generated in both brief and sustained actions. Torpedoes, bombs, and armor-piercing shells produced horrendous wounds. When the Japanese launched their kamikaze terror campaign, medical personnel were often overwhelmed. A single suicide plane plunging through the flight deck of an aircraft carrier and igniting fueled and armed aircraft produced hundreds of burn victims within seconds. As the fighting drew ever closer to the Japanese home islands in early 1945, thousands of sailors were killed and wounded by these human-guided missiles.

Navy medical personnel also served aboard submarines that prowled the Pacific destroying thousands of tons of Japanese shipping. Among its crew, each submarine carried one highly trained corpsman or pharmacist’s mate, as they were then called. (Physicians were not assigned to submarines.) Indeed, one of the most dramatic stories to come out of World War II recounted an emergency appendectomy performed by a 23-year-old corpsman as his submarine, USS Seadragon, cruised submerged in enemy waters. The corpsman, Wheeler B. Lipes, successfully removed the badly infected appendix and saved his patient. This heroic story not only highlighted the skill and resourcefulness of Navy corpsmen, but also buoyed the nation’s spirits early in the war when news from the Pacific was anything but encouraging.

When World War II finally ended with the Japanese surrender aboard USS Missouri (BB-63) on 2 September 1945, the U.S. Navy had become the largest maritime force the world had ever known. And the Medical Department which supported that Navy would itself never again have as many personnel, or staff as many hospitals, dispensaries, and hospital ships as it did on that day.

What followed victory was rapid demobilization as soldiers, sailors, airmen, and Marines in the Pacific theater headed home. Helping get them there were aircraft carriers, battleships, LSTs, and Navy hospital ships—all of which became troop transports in what was called “Operation Magic Carpet.”

Echoes of Navy Medicine’s Past: Navy Medicine in the “Great War” and Inter-War Years, 1917-1941

Echoes of Navy Medicine’s Past
Part IV: Navy Medicine in the “Great War” and Inter-War Years, 1917-1941
By Jan Herman and Mr. Grog

In April 1917, President Woodrow Wilson called for a declaration of war against Germany, and American isolationism headed for temporary retirement. The United States was now committed to its first European conflict. In order to maintain the health of a rapidly growing wartime Navy and care for its sick and injured, the Navy Medical Department had to recruit and train hundreds of physicians, dentists, and nurses, as well as thousands of hospital corpsmen.

Even though the U.S. Navy never engaged a German fleet during its year and a half participation in World War I, Navy medical personnel served with Marine Corps units on the Western Front; aboard every man-of-war, troop transport, and supply ship; with submarine divisions, aviation groups; and with the United States Railway Battery in France. In 1917, the Navy deployed 38 physicians, 5 dentists, and 348 hospital corpsmen to France; nurses went as well. What they encountered were trench warfare’s frightful realities—trench foot, disease, rats, vermin, the complete absence of the most rudimentary hygiene, and the terrifying results of gas warfare—mustard, phosgene, and chlorine.

Those medical personnel with the Marine Brigade in France also had to deal with other war trauma—shrapnel, blast injury, high velocity projectile wounds, and psychiatric disorders, then collectively known as shell-shock. From that terrible conflict in Europe, medical personnel became skilled in trauma resuscitation, the treatment of wounds and infectious disease, and war’s psychological wounds. disease, and the psychological wounds of war.

Because of the prevalence of communicable diseases, preventive medicine was a major component of a Navy physician’s daily routine. Indeed, illness could be acquired in places other than the battlefield. According to one Navy physician, venereal disease in wartime France increased because control of licensed prostitution had become less rigid. By his account, 50 percent of French prostitutes were infected with syphilis in its primary or secondary stages.

Aviation and submarine medicine were born during World War I. Both fields should not have surprised anyone for the airplane and submarines were, for the first time, used extensively by the combatants. During the 1920s and 1930s, these new technologies would keep many Navy personnel busy learning how to protect the human body in both hypobaric (aviation) and hyperbaric (undersea) environments. To support the American Expeditionary Force in Europe, the Navy established five hospitals. They included Navy Base Hospitals Numbers 1 and 5 at Brest France, Navy Base Hospital No. 2 at Strathpeffer, Scotland, Navy Base Hospital No. 3 at Leith, Scotland, and Navy Base Hospital No. 4 at Queenstown, Ireland.

Notable among these medical facilities were the base hospitals in Brest. That city served as a major port where American troops disembarked and thousands of wounded were sent home. Navy Base Hospital No. 5 had a minimum capacity of 500 beds and throughout the war it averaged 400 patients. During the influenza epidemic that number reached 800. The hospital had all the facilities necessary for providing advanced medical and surgical care and received patients from other naval stations in France, from the Merchant Marine, and from U.S. naval facilities of all classes. The hospital remained in operation until March 1919.

The Navy added to its “fleet” of hospital ships in 1918 with the acquisition of two former steamships, Havana and Saratoga, which became USS Comfort (AH-3) and USS Mercy (AH-4), respectively. Although provisions of the Geneva Convention protected hospital ships, Navy officials feared that the German government would not abide by these agreements. As a result, both vessels remained in American waters until the final month of the war when they were used as troop transports.

Navy medical personnel exhibited great valor during World War I. A total of 60 Medical Corps officers, 12 Dental Corps officers, and 500 hospital corpsmen were assigned to field service with the Marine Corps. By the time the war ended in 1918, two physicians, two dentists, and two hospital corpsmen had earned the Medal of Honor; 684 citations and awards were awarded to the 331 Navy medical personnel who served in France.

Navy Cross recipient Lena H. Sutcliffe Higbee (1874-1941), Superintendent of the Nurse Corps, was one such honoree. She helped pioneer a new training program to augment the number of nurses being deployed to France when trained nurses were in short supply. The “Vassar Training Camp” served as a finishing school for many of these nurses. During Higbee’s tenure, the Navy Nurse Corps grew from 160 in April 1917 to 1,386 by the Armistice in November 1918.
It has been said that the “war to end all wars” closed not with a bang but a “cough.” Even after the Armistice was signed, Navy medical personnel, including Higbee’s nurses, continued to combat the so-called “Spanish Flu” in the pandemic that ultimately killed between 22 and 40 million people worldwide.

A year after the Armistice, Navy medical personnel found themselves involved in another conflict that grew out of the Russian Revolution. When Allied forces intervened in a civil war between “Whites” and “Reds in post-Czarist Russia, the Navy went with them. Navy Medical personnel participated in other post-war foreign interventions, most notably in Haiti. During the U.S. occupation, which lasted from 1915-1934, Navy medical officers and hospital corpsmen served in the public health arm of the newly created Haitian gendarmerie supervising the drainage of low-lying areas, the cleaning of streets in cities and villages, and the control of disease-carrying mosquitoes.

Even though the period between the world wars saw a shrinking military, the United States was the only nation to maintain hospital ships. The aging and obsolete Solace was decommissioned in 1921 and replaced by Relief (AH-1), the first U.S. vessel to be built as a hospital ship from the keel up. She was commissioned on 28 December 1920 with a bed capacity for 500 patients, and served as the largest, most modern, and best equipped hospital ship up to that time. Relief also became the first Navy hospital ship to allow Navy (female) nurses aboard as regular staff.

The inter-war period also saw swift developments in military and civil aviation, which solved many problems concerning human endurance and the adverse effects of accelerative forces, anoxia, fatigue, and psychological stress. To deal with these aviation related issues, the U.S. Naval Medical School instituted a course in aviation medicine.

Japanese aggression in China, the rise of Nazism in Germany, and the threat of a new world conflict initiated a rebuilding program for the U.S. Navy in the 1930s. In a message to Congress, President Franklin Roosevelt recommended a 20 percent increase in our naval strength, and Congress took heed. From June 1939 to June 1941, the number of active duty Navy physicians went from 841 to 1,957; the Dental Corps increased from 255 to 511; the Nurse Corps increased its rolls from 439 to 524; and the Hospital Corps increased in size from 4,467 to 10,547. By the summer of 1941, the Navy had 23 hospitals in commission and two hospital ships. It was not enough. On 6 December 1941, who could have anticipated what lay ahead for a nation and a Navy unprepared for war.

Echoes of Navy Medicine’s Past: Enter the All Steel Navy (1866-1917)

Echoes of Navy Medicine’s Past
Part III: Enter the All Steel Navy (1866-1917)
By Jan Herman and Mr. Grog

If he were still alive in the years immediately following the American Civil War, French magistrate Alexis de Tocqueville may have observed a nation devoted to uniting its “house divided” through free enterprise and Western expansion. The U.S. Navy did not fit into this equation for national healing. After the Civil War, it lapsed into a period of dramatic decline as naval appropriations were cut and the number of ships and men on active duty shrank dramatically. The Navy and Navy Medical Department were, in a true sense, landlocked.

Medical Department resources were deemed “entirely inadequate to the proper support of the naval medical service, however prudently administered.” Because of inadequate remuneration in pay, low entry rank, and scant opportunity for promotion, few young physicians joined the Navy.

In his 1867 annual report to the Secretary of the Navy, Chief of the Bureau of Medicine and Surgery, Dr. Phineas Horwitz (1822-1904), complained bitterly about the Medical Department’s immediate prospects. He pointed out that 48 vacancies existed in the Medical Corps which were impossible to fill “properly.” The number of unfilled vacancies since the end of the recent war had grown to such a degree that according to some, the Navy Medical Department would simply disappear. Horwitz urged Congress to pass legislation immediately to increase the opportunities for promotion in respect to both rank and pay.

On 3 March 1871, Congress acted, granting medical and other staff officers of the Navy “relative rank” with grades “equal to but not identical with the grades of the line.”

This Act went further than any previous Congressional action in strengthening and transforming the Navy Medical Department. The Chief of the Bureau of Medicine and Surgery now held the additional title “Surgeon General,” with the relative rank of Commodore.” Surgeon General William Maxwell Wood (1809-1880) stood at the helm of this “revitalized” organization. At the time, Wood was a man entering his 42nd year of a naval career as unusual and varied as could be. He had served aboard USS Poinsett, one of the first steam vessels of the Navy, and designated flagship during the “expedition for the suppression of Indian hostilities on the coast of Florida” (a.k.a. the Seminole War). Wood served shore duty at Sackett’s Harbor, NY, Baltimore, was Fleet Surgeon of the Pacific Fleet, and served under Commodore Sloat in California during the Mexican War. Despite his credentials as the first Navy Surgeon General, he served less than two years.

The health of the Navy’s personnel steadily improved following the war partly due to the new emphasis on preventive medicine and hygiene. This was attributable, at least in part, to the transition from wooden hulls and sail to the all-steel, steam-powered Navy. The storage of coal in below-deck bunkers and the exhaust gases generated by its combustion required adequate ventilation. Moreover, the foul condition of many ships’ bilges had become a regular theme of reports from the Navy Surgeon General to the Secretary of the Navy. Conditions aboard many naval vessels were blamed for yellow fever outbreaks and led to the establishment of the short-lived and seldom used Navy quarantine hospital on Widow’s Island in Maine’s Penobscot Bay (1887).

On 20 March 1878, the Navy Department created a board of naval officers to solve the ship ventilation problem. The board advocated a ventilation plan consisting of a tube network running through every part of the ship and terminating in a large main through which air was drawn by a steam blower. In 1879, Surgeon General Phillip Wales urged the rapid installation of this new ventilation system throughout the fleet

During the 1870s the naval hygiene movement was promoted by Medical Directors Joseph Wilson, Jr., author of Naval Hygiene (1870), and Albert L. Gihon’s Practical Suggestions in Naval Hygiene (1871). As early as 1879, the Bureau of Medicine and Surgery (BUMED) established a laboratory for investigating hygiene-related issues and began collecting items which would comprise the collection of the Navy Museum of Hygiene, established in Washington, DC, in 1882. Until it merged with the Naval Medical School in 1905, the Museum exhibited ship’s ventilation systems and housed displays illustrating disinfection techniques. It also was a leader in promoting environmental and occupational medicine. The institution went beyond its museum role by becoming an education center for the promotion and development of laboratory research, particularly with chemical, bacteriological, and microscopic investigations.

As American interests in the Pacific and the Far East became more prominent in the 1870s, so did the scope of the Navy Medical Department. Between 1867 and 1869, USS Idaho, which had been converted into a hospital ship and kept at anchor in Nagasaki, served as a floating hospital for the American Squadron in the Far East.

To provide more adequate medical facilities for the U.S. Navy’s Pacific activities, the Navy constructed new hospitals at Mare Island, CA (1870) and Yokohama, Japan (1872), which became the first U.S. Navy hospital in Asia.

Throughout the 1880s and 1890s U.S. Navy presence became increasingly evident throughout the world as Navy vessels were being assigned to the North Atlantic, South Atlantic, European, Pacific, and Asiatic stations. In addition to routine cruises, the Navy was frequently called upon to protect American citizens and American interests; to give assistance to victims of shipwrecks, earthquakes, fires, floods, and civil war; and to carry out special explorations in the Arctic, Alaska, Central America, and elsewhere.

As Navy medical officers went ashore at hundreds of ports throughout the world, many of them wrote detailed observations of climate and medical conditions, the people, quality of medical facilities available, endemic diseases, and the methods being employed to combat them. Many of these narratives were published in volumes of the Annual Reports of the Navy Surgeon General (1871-1859).

On 17 June of that year, a century after the “first” loblolly boy reported for duty aboard USS Constellation, an Act of Congress established the Navy Hospital Corps. Navy Surgeons General had long promoted a well-trained professional corps to provide medical care in the field. However, it was only after the outbreak of the war with Spain that Congress finally acted. The first group of hospital corpsmen numbered only 25 pharmacists (apothecaries) with rank, pay, and privileges of warrant officers.

The Hospital Corps came just in time. Following the Spanish-American War, the world’s newest colonial power had “spoils” to administer—Guam, the Philippines, Puerto Rico, Cuba, and Samoa. The United States was now a Pacific naval power with new ships, new stations, and enlarged hospitals. Navy medical officers had to confront tropical diseases few Western physicians had ever seen before—dengue, yaws, leishmaniasis, leprosy, yellow fever, intermittent fever, filariasis, dysentery, elephantoid fever, not to mention venereal afflictions sailors acquired in exotic liberty ports.

The Navy Medical Department dealt with these issues through training. In 1902, the Navy Medical School, then located at the U.S. Naval Laboratory in Brooklyn, NY, relocated to the Naval Museum of Hygiene in Washington, DC. Its mission was straightforward: The new school was “for the instruction and training of newly appointed medical officers in professional branches peculiar to naval requirements.” Here was an institution where newly commissioned physicians could learn the kind of medicine they would not have been exposed to in civilian medical schools—tropical medicine, the treatment of ballistic wounds, burns—in short, the grist of naval medicine. A five-month course had a curriculum covering microscopy, naval hygiene, military law, and a program of physical exercise and military drill akin to what any student might experience in a military school or service academy.

Because tropical disease had accounted for many of the casualties suffered by troops in Cuba during the recent war with Spain, it was a chief focus of attention at the school. Indeed, future Surgeon General of the Navy Edward Rhodes Stitt (1867-1948), today considered the pioneer in tropical medicine, taught at the school and was one of its first commanding officers.

Following the establishment of the Army Nurse Corps in 1902 by Congressional Act, BUMED campaigned for its own nurse corps. This effort paid off on 13 May 1908, when the U.S. Navy Nurse Corps was established. The first nurses in the Navy—a.k.a. the “Sacred Twenty”—reported for orientation and duty later that year at the new U.S. Naval Hospital, Washington, DC. The site also housed the Museum of Hygiene and Navy Medical School. On 8 August 1908, former U.S. Army nurse, Esther Voorhees Hasson (1867- 1942) became the first superintendent of the Navy Nurse Corps.

The Medical Department continued to expand. On 22 August 1912, President William Howard Taft signed a bill authorizing “not more than 30 acting assistant dental surgeons to be part of the Medical Department of the United States Navy.” By the beginning of World War I, the Navy Medical Department had grown in size to four separate corps. The Surgeon General, now with the rank of rear admiral, was at its helm. The Medical Department had 2 hospital ships and 17 naval hospitals to administer.

On 9 April 1914, Mexican soldiers arrested U.S. Navy personnel seeking supplies in Tampico, Mexico. The Mexicans released the soldiers but without the apology President Woodrow Wilson demanded. Wilson ordered RADM Frank F. Fletcher to occupy the Mexican port of Vera Cruz with the naval forces under his command. The U.S. intervention and occupation fomented fierce Mexican resistance and generated casualties on both sides. For their heroic actions treating the wounded under fire, Navy surgeons Middleton Elliott (1872-1952), Cary Langhorne (1873-1948), and Hospital Apprentice 1st Class William Zuiderveld (1888-1978) were awarded the Medal of Honor. Shortly thereafter, there would be ample opportunities for heroism. Just four years after the Mexico intervention, Navy Medical personnel would find themselves braving U-boats in the North Atlantic German soldiers on the Western Front.

Echoes of Navy Medicine's Past: The Civil War (1861-1865)

Echoes of Navy Medicine’s Past
Part II: The Civil War (1861-1865)
By Jan Herman and Mr. Grog

“David goes out to meet Goliath and every man who can walk to the beach sits down there, spectators of the first ironclad battle in the world... The day is calm, the smoke hangs thick on the water. The low vessels are hidden by the smoke. They are so sure of their invulnerability they fight at arm’s length. They fight so near the shore, the flash of their guns is seen and the noise is heard of the heavy shot pounding the armor.”

This is how U.S. Navy physician Charles Martin described the legendary fight between the ironclads USS Monitor and CSS Virginia. What made the Civil War at sea different from what came before is indeed that image—the first seemingly unequal duel of the ironclads—the Yankee cheese box on a raft versus the slope-sided, ungainly ex-Merrimack. After all, the once U.S. Navy sloop of war had just hours before set Congress afire, rammed and sank the Cumberland, and run Minnesota aground. The following day she was headed out to finish off the grounded vessel when Monitor, her low-freeboard decks nearly awash, popped into view and saved the day, fighting Virginia to a draw.

What was the medical aftermath of that now legendary combat: On the Union side, three men were injured on Monitor. One was the acting master whose knee came into contact with the turret at the same instant one of Virginia’s heavy shot struck it. Knocked senseless by the impact, he regained consciousness 10 minutes later. Another seaman in the turret was knocked unconscious in a similar manner. Acting Assistant Surgeon Daniel Logue described this sailor’s injury as a concussion of the brain. His circulation remained depressed and it became necessary to administer stimulants. When the patient regained consciousness, Dr. Logue watched for a reaction and then applied cold affusion to the head.

Toward the close of the action, the Confederate ironclad inflicted its last and most significant casualty—Monitor’s skipper John Worden. LT S. Dana Green, Monitor’s executive officer described the event:

“Soon, after noon, a shell from the enemy’s gun, the muzzle not ten yards distant, struck the forward side of the pilot house directly in the sight hole or slit and exploded, cracking the second iron log and partly lifting the top, leaving an opening. Worden was standing immediately behind this spot and received in his face the force of the blow which partly stunned him and filling his eyes with powder, utterly blinded him...

“[Sent for], I found him standing at the foot of the ladder leading to the pilot house. He was a ghastly sight with his eyes closed and the blood apparently rushing from every pore in the upper part of his face. He directed me to take command. I assisted in leading him to a sofa in his cabin. Dr. Logue examined his eyes, succeeded in removing tiny scales of iron and a small quantity of paint, and then made cold applications to his eyes.”

Following the battle, only Worden left the ship for hospitalization in Washington. The other two patients returned to duty the following day. Worden, it turned out, proved to be the only serious casualty of the battle, permanently losing the sight in one eye and incurring a disfiguring scar on his face.

On the Confederate side, Virginia’s crew did not get away unscathed. In her unequal fight with Congress, Cumberland, and Minnesota the previous day, Virginia suffered several killed or wounded. In contrast, her wooden-hulled victims suffered enormous losses. Cumberland alone lost over 100 men. Before the ship went to the bottom, all the wounded who could walk were ordered out of the cockpit; but those of the wounded who had been carried into the sick bay and on the berthdeck were so mangled that it was impossible to save them. So recalled her acting commander. During her engagement with Virginia the following morning, Monitor’s two 11-inch Dahlgren smoothbores did moderate damage, wounding a few aboard the Virginia but killing no one. As it turns out, the Confederates got a lucky break. Although each 11-inch Dahlgren aboard Monitor threw a shot weighing 168 pounds, Worden was under orders from the Navy Department to fire half-weight powder charges of 15 pounds for fear the guns would explode.

If this first great combat between the ironclads ended in a draw, war at sea had changed forever and with it the practice of naval medicine. What made the naval environment different from the Civil War battlefield was the advent of the ironclad ship. John Ericsson’s Monitor employed the new technology, incorporating many technical advances for the time including forced ventilation of living spaces, a protected anchor which could be raised and lowered without it or the crew being exposed to enemy fire, and a protected pilothouse.

Nevertheless, the new technology of iron and steam introduced brand-new hazards—exploding boilers, scalding with live steam, burn injuries, and primary and secondary wounds resulting from large caliber, rifled naval guns. Ironclad vessels also introduced environmental and occupational concerns for sailors aggravated by badly ventilated and hell-hot engine rooms. It is estimated that a typical low ranking coal heaver aboard a poorly ventilated ironclad routinely endured temperatures approaching 130 degrees F. In fact, aboard Monitor in summer, temperatures of 125 degrees were recorded on the berth deck and 150 degrees in the galley. One cannot underestimate the utility of awnings in deflecting the sun from ironclads decks.

Almost everyone has experienced opening the door of an automobile after the vehicle has been baking in the summer sun all afternoon. Those freshly scrubbed teak decks on World War I and World War II era battleships were not designed for aesthetics. They insulated steel decks and made living conditions somewhat bearable in the days before air conditioning. One can only imagine then, the plight of the typical Civil War ironclad sailor stationed on an inland river of the deep south or in the vicinity of the besieged Charleston, SC. Add the oppressive humidity of July or August and now one can begin to understand the life of an ironclad sailor.

There were other hazards to be endured. With only inches of freeboard, many ironclads of both navies were literally only inches from disaster. One has only to contemplate Monitor’s ill-starred voyage to Hampton Roads even before her fight with ex-Merrimack. Only one day out of New York, she encountered a storm which soon had heavy seas cascading over her deck, washing out turret caulking, flooding her berth deck, disabling her blowers, and nearly extinguishing her boiler fires. Her paymaster recalled what the ironclad’s fight for survival meant for her crew.

“Turning to go down from the turret I met one of our engineers coming up the steps, pale, black, wet and staggering along gasping for breath. He asked me for brandy and I turned to go down and get him some and met the sailors dragging up the fireman and other engineers apparently lifeless. I got down as soon as possible and found the whole between decks filled with steam and gas and smoke; the sailors were rushing up stifled with gas. I found when I reached the berth deck that it came from the engine room, the door of which was open. As I went to shut it one of our sailors said he believed that one of the engineers was still in there—no time was to be lost, though by this time almost suffocated myself, I rushed in over heaps of coal and ashes and fortunately found the man lying insensible. One of the sailors who had followed me helped pull him out and close the door.”

This nightmare would be played out again—fatally—at the end of the year when Monitor’s pumps failed to stem the incoming seas and John Ericsson’s ironclad pioneer plunged to the bottom off Cape Hatteras with the loss of several crewmen.

Even the fuel that fired an ironclad’s boilers was a threat. Coal, while not a new fuel used by the Navy, had the potential of becoming a silent killer. Fossil fuels require proper ventilation and this concept was not yet adequately understood by Civil War engineers. Untold casualties, some fatal, occurred when crewmen either loaded wet bituminous coal in below-deck bunkers or bilge water contaminated the fuel. Both the Mississippi Squadron and the South Atlantic Blockading Squadron reported a number of cases of sailors being discovered either dead or unconscious below deck. The more fortunate were revived when exposed to the fresh air. Besides unconsciousness, surgeons described their patients as being cyanotic—blueness of the skin caused by oxygen starvation with foreheads and eyelids markedly swollen. Similar cases reported aboard a coal-fired ship in 1913 recognized the problem as carbon monoxide poisoning. Wet, unventilated coal produces high levels of that dangerous gas.

Indeed, there were significant differences in warfare once ironclads came into their own. Naval guns up to the middle of the nineteenth century had an effective range of only about a mile and a half. These were the smoothbores throwing balls weighing 24 and 32 pounds. The strategy therefore called for close-in fighting terminated by boarding parties and hand-to-hand combat.

There were many differences between wounds sustained in battle on the old wooden ships and those encountered aboard ironclads. Shots striking wooden vessels tended to throw about splinters which, as secondary projectiles, caused many of the wounds. Burns were uncommon. In yardarm engagements and during the hand-to-hand fighting resulting from boarding an enemy’s vessel, many wounds were caused by small arms, cutlasses, bayonets, and pikes.

In ironclad fighting, splinters might be fewer, but burns and fragment wounds became commonplace. The so-called protected environment an ironclad warship provided was illusory. If anything, it offered fatal hazards the crew of a wooden ship rarely experienced. Take the example of the monitor Nahant. Engaged in Samuel Du Pont’s attack on the Charleston forts in April 1863, shellfire from the forts slammed against her pilot house and turret with such velocity that broken bolts ricocheted about her pilot house like bullets, killing one man and injuring two others, including her captain.

Iron shot weighing over 150 pounds were now common, making the 24- and 32-pound size thrown by earlier guns seem quite puny in comparison. What’s more, a newer generation of rifled guns that could pulverize masonry forts could do worse to those enclosed within an iron-sheathed hull. What resulted was the “garbage can” effect. Imagine yourself encased in a typical galvanized steel garbage pail or a 55-gallon steel oil drum, ears unprotected, and then having your antagonists hurling 50-pound cement blocks against your cocoon, one per second. With blood dripping from nose and ears, crewmen were sometimes driven mad under the barrage of both rifled and unrifled artillery impacting against iron armor. And if not driven mad, many sailors had their eardrums ruptured or, at very least, suffered temporary or permanent deafness. Civil War sailors frequently described ringing in the ears or tinnitus. With noise levels aboard Civil War ironclads routinely exceeding 130 decibels, one can only conjecture what kind of hearing damage resulted among these warriors. For comparison, a modern F-18 jet engine produces about 125 decibels of noise. The noise on the flight deck of a modern aircraft carrier during flight operations routinely exceeds that level. And these crews have available hearing protection. One can only imagine the degree of hearing loss suffered by Civil War sailors.

As similar as the practice of medicine may have been for both Army and Navy physicians--certainly in the treatment of battle injuries--the marine environment offered some very unique circumstances. Sailors on blockade duty experienced little battle and much boredom. Off Cape Fear, NC, a sailor in the blockading squadron wrote home to his mother that she should get some notion of blockade duty if she would go to the roof on a hot summer day, talk to a half dozen degenerates, descend to the basement, drink tepid water full of iron rust, climb to the roof again, and repeat the process at intervals until she was fagged out. Then go to bed with everything shut tight.

Needless to say, under these conditions, the psychological health of sailors was often in question. “Give me a discharge and let me go home,” a distraught coal-heaver begged his skipper after months of duty outside of Charleston. “I am a poor, weak, miserable, nervous, half crazy boy. Everything jarred upon my delicate nerves.”

And this routine was accompanied by an unbroken diet of moldy beans, stale biscuits, and sour pork. To ease the monotony or perhaps to anesthetize themselves from reality, mess crews specialized in the manufacture of outlaw whiskey distilled from almost any substance that fermented in the southern heat. Commanding officers and medical officers assigned to the James River Flotilla complained a great deal of the lack of fresh provisions and vegetables. Following a July 1862 inspection, Fleet Surgeon of the North Atlantic Squadron, Dr. James Wood, recommended that vessels be furnished with fresh provisions twice a week. His report on his inspection also contained a recommendation for improving the water supply used in the vessels. He said that the “turbid and objectionable” river water used tended to produce diarrhea. He saw no reason for continuing to use impure river water, since steam vessels could condense more pure water than their crews needed.

Even though sanitary conditions aboard ship were often superior to those ashore, and both navies probably fared better than the armies when it came to the frequency of disease, rheumatism and scurvy kept the doctors busy along with typhoid, dysentery, break bone fever, hemorrhoids, and damage done by knuckles. In the southern climes, insect-borne malaria and yellow fever laid low many a crew. And, regardless of what they had to work with, surgeons aboard the ironclads, and indeed every vessel, had no medicine for the ills of the spirit brought on by the strain of monotony, poor food, and unhealthy living conditions which produced much longer casualty lists than did Confederate shells or mines.

The ironclad navy of the Civil War was neither all wood nor all iron. Nevertheless, it represented the first, halting steps into the modern age. Even though many of the hulls were still wood with but a veneer of iron, such vessels as Monitor and the vessels it spawned would soon become commonplace. The age of sail was over and had been since Monitor and Virginia fought their legendary duel in 1862. It was a new navy in 1865, even though hard-bitten conservatives in Washington had been loathe to trade traditional wooden hulls and canvas for an all-iron fleet. By the late 1870s and certainly by the turn of the twentieth century that fact was a reality. Medical planners and health care providers would now have to face squarely the realities Civil War surgeons had already encountered during their war. The new steel ships now carried rifled, breach-loading artillery. What their muzzle-loading predecessors had inflicted upon human flesh and bone had already been demonstrated. Traumatic amputations, penetrating fragment wounds, and horrific burns had become commonplace during that war. In the post- Civil War environment, these wounds would increase exponentially as would new kinds of injuries merely hinted at during the Civil War—primary and secondary blast injuries, scalded skin and flesh caused by ruptured steam pipes and boilers, toxic smoke inhalation—the products of fire below decks. The problems first encountered during the war of the ironclads would now have to be dealt with aboard ships of the all-steel, all-steam navy.

Whether victims of disease or hostile action, sailors required treatment and much Navy medicine took place in the three existing hospitals at Chelsea, Brooklyn, and Philadelphia. By the fall of 1862, all three were filled to their utmost capacity. As a result, medical facilities at navy yards and naval stations were expanded and both civilian and Army hospitals were also treating naval patients. To remedy the situation, a major hospital expansion campaign began. Unfortunately, many of these improvements weren’t realized until the very end of the war.

Following their recapture by Union forces, the two naval hospitals in the South--Portsmouth and Pensacola were put back into operation. In addition to the naval hospitals that had been established before the war, at least four others came on line between 1862 and 1865. These hospitals at Mound City, IL (1862); Memphis, TN (1863); New Orleans, LA (1863); and Port Royal, SC (1864), were located within the theater of operations of the blockading river squadrons and acted as receiving hospitals, taking patients on a short-term basis.

Ironically, one of the medical stations that could perform long-term care was not stationary at all. In 1862, Union forces captured a Confederate side-wheeler, Red Rover. Under the order of the Naval Fleet Surgeon, the ship was converted into what can be considered the Navy’s first hospital ship (however, there is evidence that Navy ships used during the Tripolitan Wars were used as floating hospitals). According to a Navy General Order of June 1862, “only those patients are to be sent to the hospital boat who it is to be expected to be sick for some time, and whose cases may require more quiet and better attention and accommodation than on board the vessels to which they belong.”

Regardless, Red Rover was something of a naval anomaly. The vessel had a laundry; an elevator that could transport the sick from lower to upper decks; an amputation room; nine water closets; an icebox to store fresh food; and gauze blinds to keep flies, mosquitoes, cinders, and smoke from “annoying” the patients. It was also the first ship to have a staff of female nurses trained in the medical arts.

On Christmas Eve, 1862, Sisters of the Order of the Holy Cross of St. Mary’s of Notre Dame in South Bend, IN, reported aboard the medical vessel to care for sick and wounded seamen. One hundred years later, the Navy helped to honor these women at a ceremony on the campus of Notre Dame as true pioneers of the Navy Nurse Corps.

From 1862 until 1865, the medical staff on-board Red Rover cared for 2,450 casualties, including 300 wounded Confederates. In roughly the same time period, Navy shore facilities handled more than 31,000 patients, with 990 treated in 1864 alone, a record for a four-year conflict. However, the conflict was not without other distinctions. The war took a heavy toll on the Navy Medical Corps, killing 33 surgeons including Assistant Surgeon William Longshaw, Jr., who was acknowledged by Secretary of the Navy Gideon Welles and RADM John Dahlgren for gallant behavior for his action on 15 November 1863 when he, under heavy fire, volunteered to retrieve the monitor Lehigh which had run aground. In January 1865, Dr. Longshaw was killed in an assault on Fort Fisher, NC, while binding the wounds of a dying man. His heroism under fire encapsulates Navy medicine’s real Civil War legacy.

Echoes of Navy Medicine's Past: Loblollies and Mess Decks

Part I: Loblollies and Messdecks (1775-1860)
By Jan K. Herman and Mr. Grog


Where there’s conflict there is always the need for medical care. The first shots of the American Revolution fired at Lexington and Concord on 19 April 1775 marked both the birth of a nation and the Continental Army. However, it was the British blockade of the American coast and the need to break that blockade that spawned the Continental Navy and Navy Medical Department.

In October 1775, the Continental Congress voted to fund the Continental Navy to augment the existing force of privateers and state vessels. The ships in this tiny fleet—Alfred, Andrew Doria, Cabot, Providence, Columbus, and Hornet—housed sick bays where Continental Navy physicians practiced their healing art. Surgeons and surgeons mates hired by the Continental Congress represented the early Navy Medical Department.

Drs. Joseph Harrison, Thomas Kerr, and Henry Tillinghast were some of these medical pioneers. Assisting them in the daily care of the sick and wounded were personnel called “loblolly boys,” enlisted boys and men named for the thick porridge or “loblolly” they rationed out to the sick. Loblollies also provided containers for amputated limbs, hot tar for cauterizing stumps, and sand for spreading on decks to absorb blood shed during combat and surgical procedures.

The Continental Navy did not long survive the Treaty of Paris in 1783. The United States was without a naval fleet until 1794 when Congress authorized the construction of six new vessels to defend its ever growing commercial interests. These warships, which became the nucleus of the new United States Navy, each had a surgeon, and, for the larger vessels of 36 guns, two additional surgeon’s mates.

The Department of the Navy came about on 30 April 1798 during the “Quasi-War” with France. A significant development during this period was the shore hospitalization of sick and disabled seamen. By an act of 1798, Navy sailors could now be admitted to civilian hospitals designated by directors appointed in ports of entry. These directors paid the incurred expenses from a Marine (later Navy) Hospital Fund maintained by monthly deductions of 20 cents from every merchant and Navy seaman, naval officer, and Marine. Subsequently, Navy hospitals were established in Syracuse, Sicily (1804) and New Orleans, Louisiana (1810) but neither hospital survived very long.

On 26 February 1811, Congress approved “An Act establishing Navy Hospitals.” The Act directed that money collected from naval personnel and the unexpended balance from the Marine Hospital Fund should be paid to the Secretaries of the Navy, Treasury, and Army. These were to act as the so-called “commissioners” of Navy hospitals. The commissioners were authorized to choose suitable sites for permanent hospitals and were then to construct buildings at these locations.

A decade went by before the first site was selected at Washington, DC, in 1821. This was followed by the acquisition of other sites—Chelsea, MA (1823); Brooklyn, NY (1824); Philadelphia, PA (1826); and Norfolk, VA (1827). In 1830, the Naval Hospital at Norfolk became the first of these facilities to admit patients, followed soon thereafter by the Philadelphia Naval Hospital located in the famed Naval Asylum. This multi-tasked institution, designed by noted architect William Strickland, also served as the home of a Navy school that would soon after morph in the U.S. Naval Academy in 1845.

What was health care in the early days of the U.S. Navy? Fortunately, the writings of some early Navy health practitioners provide some answers. While serving aboard USS United States, Surgeon Edward Cutbush, later dubbed the “Nestor of the Navy Medical Department,” reported that venereal diseases and diarrhea were quite common among the crew. He also reported their state of mental health. There were days, he said, in which sailors seemed “very low” and labored “under Nostalgia or a constant desire to return [home].” Surgeon’s Mate Benjamin Harris of USS Philadelphia reported that venereal diseases and influenza were common, and he treated the latter through “copious bleedings and other evacuations.” Harris stated that injuries from accidents during the warship’s Caribbean cruise were frequent in the early part of the voyage because of the crew’s inexperience. Scurvy also posed a problem for Harris and other Navy surgeons until 1812 when citrus fruits were issued to ships regularly at the urging of William P.C. Barton, Navy surgeon and future Chief of the Bureau of Medicine and Surgery.

Following the Revolutionary War, the United States Navy fought against France, the Barbary Pirates, and Britain in the War of 1812. Throughout these conflicts, the duties of the Navy surgeon were quite defined. The surgeon visited sailors under his care at least twice a day, supervised surgeon’s mates, consulted with other surgeons in the squadron about difficult cases, daily informed the captain of his patients’ condition, and was expected to be prepared with his mates and assistants for battle. He kept a day-book, containing the names of his patients, their prescriptions and methods of treatment, when and how they became ill or injured, when they recovered or died, and when they were discharged to duty. From this document, he made two journals: a record of his “physical” practice and a journal of his “chirurgical” practice. At the end of each voyage he sent the two journals to the Navy Department. When ordering patients to hospitals, he was to send with them a record of their cases. The Navy surgeon was only authorized to send sailors to hospitals and sick quarters when they could not be adequately cared for aboard ship. He had charge of the requisition, inspection, storage, accounting, and dispensation of all medical supplies used aboard his ship. Upon receipt of defective or faulty supplies, the surgeon was to notify the captain. He also forwarded accounts of medical supplies received and consumed to the accountant of the Navy at the end of each cruise.

Although the early Navy medical community was small, many giants paved the way to today’s modern organization. Surgeon Edward Cutbush (1772-1843), a former doctor in the Pennsylvania militia, authored Observations on the Means of Preserving the Health of Soldiers and Sailors (1808). In this pioneering text, Dr. Cutbush proposed techniques for cleaning, disinfecting, ventilating, and drying ships. He advocated strict physical examinations of all recruits coming aboard to eliminate disease. Cutbush also urged sailors to wear their hair short, to shave regularly, and to wash themselves and their clothing.

Surgeon William Paul Crillon Barton (1786-1856), the son of the United States Seal’s designer and nephew of a well-known American botanist, proposed that Navy ships be better equipped for the care of the sick and wounded. He also suggested a system for organizing Marine hospitals and adopting better physical standards in recruiting. Barton emphasized that sick days compiled by the Navy were traced to the practice of accepting mentally and physically unfit sailors for duty. Dr. Barton experimented with lime juice and lemonade aboard ships years before the Navy recognized the importance of antiscorbutic treatment for the dreaded vitamin C deficiency. He was also one of the first to propose that female nurses “be included among Navy personnel.”

Surgeon Lewis Heermann (1779-1833), who served under LT Stephen Decatur in the war with the Tripolitan pirates, later established a naval hospital in New Orleans with his own funds. Andrew Jackson’s troops used this hospital after repelling the British invasion of New Orleans in 1815. The well traveled and educated physician’s organization of this short-lived hospital served as a model for future naval hospitals.

Surgeon Thomas Harris (1784-1861) founded in 1822 what is considered to be the first U.S. Navy medical school. Located in Philadelphia, school instructors taught newly commissioned Navy medical officers hygiene, military surgery, and naval customs.

It can be argued that the Navy Medical Department, or more accurately, the doctors who comprised the Navy medical community, were treated unequally compared to their compatriots in the rest of the U.S. Navy. For one, Navy physicians’ salaries were a great source of dissatisfaction. Drs. Barton, Cutbush, and Heermann protested against the paltry remunerations, stating that their pay should be at least equal to their counterparts in the U.S. Army, let alone the physicians in the British Navy.

Rank was another concern. Navy medical men were classified simply as surgeons or surgeon’s mates and did not have relative rank with naval officers. The Act of 24 May 1828 for the “Better Organization of the Medical Department of the Navy” marked the first time the status of personnel in the Navy Medical Department received serious attention. In this act, the title “assistant surgeon” replaced the designation surgeon’s mate. The act stated that all candidates for appointments as surgeon or assistant surgeon must first appear before and be approved by the Board of Naval Surgeons, that no person could be appointed as surgeon until he had served at least two years on board a public vessel of the U.S at sea, followed by an examination and approval for promotion by a Board of Naval Surgeons. After satisfying the requirements of the Examining Board, the assistant surgeon still would not receive an appointment as surgeon until surgeon vacancies occurred. During the waiting period, the successful candidate was known as “passed assistant surgeon,” a status that was not officially classified until 1898.

The same act created the title of “Surgeon of the Fleet” which authorized the president to designate and appoint to every fleet or squadron an “experienced and intelligent surgeon, then in the naval service.” The Fleet Surgeon was to serve in the flagship and be generally responsible for all medical matters within the fleet or squadron in which serving.

In the Act of 3 March 1835, Congress first considered surgeons and assistant surgeons as officers when these positions were finally subject to the same pay scale as Navy line officers. The General Order of August 1846 finally conferred relative rank to physicians serving in the Navy. “Commanding and executive officers, of whatever grade, when on duty, will take precedence over all medical officers. This order confers no authority to exercise military command, and no additional right to quarters.” By this General Order, surgeons of the fleet and surgeons with more than 12 years service were to have equivalent rank of commanders.

In addition to issues of rank and pay, Navy medicine also had organizational problems. On 31 August 1842, Congress passed a Navy appropriations bill that was a blueprint for efficiency. The legislation provided for five bureaus to replace the outdated Board of Navy Commissioners—Yards and Docks; Construction, Equipment, and Repair; Provisions and Clothing; Ordnance and Hydrography; and Medicine and Surgery. The president appointed a chief to head each bureau.

The Bureau of Medicine and Surgery (BUMED) became the central administrative headquarters for the Navy Medical Department, and those names became interchangeable. The General Order of 26 November 1842, which defined the duties of the new bureaus, charged BUMED with:

-All medicines and medical stores of every description, used in the treatment of the sick, the diseased and the wounded;
-All boxes, vials, and other vessels containing the same;
-All clothing, beds, and bedding for the sick;
-All surgical instruments of every kind;
-The management of hospitals, so far as the patients therein are concerned;
-All appliances of every sort, used in surgical and medical practice;
-All contracts, accounts, and returns, relating to these and such other subjects as shall hereafter be assigned to this bureau.

BUMED’s establishment contributed a great deal to the Medical Department’s development and efficiency. The availability and quality of medical supplies and equipment improved. The year 1853 saw the construction of the naval hospital at Annapolis, MD, and the establishment of the Naval laboratory in Brooklyn, NY. The lab, headed by Surgeon Benjamin F. Bache and Passed Assistant Surgeon Edward R. Squibb, experimented with the production of chloroform and ether anesthesia. Squibb’s major contribution was providing the Navy Medical Department with a reliable source of pure pharmaceuticals. In 1857, Dr. Squibb resigned from the Navy and founded the pharmaceutical house that bears his name.

What kind of medicine did Navy surgeons practice in the mid-nineteenth century and how was it different from the practice of their Army colleagues? The instruments of civilian manufacture were similar. A Navy physician’s surgical kit was almost identical to that of an Army physician, and, most likely, carried the same brand name. A surgical scalpel was a surgical scalpel, a tourniquet a tourniquet, the treatment of choice for a shattered limb was amputation. Indeed, many Army and Navy surgeons attended the same medical schools.

The difference was the environment in which the naval surgeon practiced. The maritime venue was decidedly different from the battlefield. Certainly the marine theater had its own unique hazards—handling of anchor gear, hoisting apparatus, dangers incident to storms or heavy weather at sea, falls from mast tops, spills down hatchways and ladders, being struck by a lead line, being caught between boats and gangways on ships and docks, entanglement in parting lines or cables when mooring or unmooring. The term loose cannon had an original and more deadly meaning. Sailors fell overboard and either drowned or died of hypothermia. Fire caused by spilled oil or kerosene lamps below decks was a constant and sometimes fatal hazard. Contagious respiratory diseases ran through close packed living spaces, leaving entire crews incapacitated.

By the eve of the Civil War, Navy medicine already had one foot firmly placed in the new age of steam. The new technology of ironclad ships and rifled guns would soon add a very new dimension to treating the sick and wounded.

U.S. Navy Memorial Presents John Barry: An American Hero in the Age of Sail.

On 13 October 2011, the Navy memorial will be hosting acclaimed author Tim McGrath who will present his book John Barry: An American Hero in the Age of Sail. Guests are invited to learn about one of the U.S. Navy’s founding fathers through this biography, which explores the life of “Father of Time” John Barry, whose legendary career extended from the Continental Navy through the early years of the U.S. Navy. The reading is part of the U.S. Navy Memorial’s “Authors of Deck” book lecture series and is free and open to the public. Following the presentation, McGrath will be available for a Q&A session and book signing.


WHEN:
Thursday, 13 October 2011 @12:00pm

WHERE:
United States Navy Memorial
Naval Heritage Center
701 Pennsylvania Avenue, NW
Washington, D.C. 20004
www.navymemorial.org

COST: Free and open to the public