Damage Control Surgery for Combat Injuries

Some years ago, with the help of Sandra DiNoto, Executive Director of the Albany Medical College Alumni Association, I founded what I think is the second (after Yale’s) medical school military affinity group, the Albany Base Hospital No. 33 Society*. We meet annually on Alumni Reunion Weekend. Usually about 30 Albany Med alums who’ve served in the armed forces show up to swap old sea / soldier stories, drink coffee and eat cookies, and listen to a presentation. This year, in a first-time nod to the Zoom era, we will broadcast our meeting via – Zoom. Herewith is the meeting flyer and Zoom link. I sincerely invite you to join us!

About our speaker:

Retired U.S. Army Colonel Kurt D. Edwards, MD completed seven combat tours in Afghanistan, Cambodia, and Iraq in his 26-year military career, where he treated traumatic injuries as chief surgeon and war surgeon. He is a recipient of numerous honors for his service, including two bronze stars, three meritorious service medals, Legion of Merit, Bronze Star with oak leaf cluster, Joint Meritorious Unit Award, Army Valorous Unit Award, Combat Action Badge, Combat Medical Badge, Basic Parachutist Badge, and Air Assault wings. He worked with Infantry, Calvary, and Special Forces Units and has 27 military airborne jumps.

Zoom link for Base Hospital No. 33 Society at Reunion

https://us06web.zoom.us/j/5854241910?pwd=SEZpVnJOeExPc3p1RkF0bXBxMnFOQT09&omn=85050168494

*Originally known as the “Albany Medical College – Military Affinity Group”, the Society was renamed by vote of attending members at its 28 April 2018 meeting. This decision was taken based upon a recommendation of the Army Surgeon General: In a March 1919 communication upon the disestablishment of the World War I Army Hospital organized and staffed by AMC faculty, physicians and nurses, Major General M. W. Ireland wrote: “It is earnestly recommended that effective measures be taken by you to keep the organization intact and that every effort be made to imbue its future personnel with the fine esprit to be expected in the possessors of the glorious heritage of splendid achievement handed down from the Great War by the original personnel of Base Hospital No. 33.” This hospital, located in Portsmouth, England, cared for more than 3500 U.S. soldiers during its deployment between July and December 1918.

The original group’s founding was approved by the Alumni Association Board of Directors on 22 September 2011.

The Mission of the Society is:

• to honor AMC alumni who served or are serving in the Armed Forces of the United States or other nations,
• to promote the support and mentoring of AMC students with a present or potential military affiliation,  and
• to inculcate a culture of philanthropy for College, Medical Center and the student body.

To accomplish this Mission, the Society may sponsor:

• reunion events, including Student Socials,
• panels on Life in the Military, and
• awards for outstanding scholarship graduates.

The Group will serve as a networking opportunity among alumni, faculty and students. It will encourage family member participation in Society events, since they experience the hardships and joys of military life just as do the Alumni.

A Divertissement II – Folk and Popular Music with a Maritime Theme

In Divertissement (I), I promised that I’d present less symphonic examples of nautical music. One of my readers sent me a sea shanty playlist (which I’ll show you below). But first, I was astounded at the number of playlists on offer when I googled “maritime playlists”.

Herewith, just a few.

–If you subscribe to Spotify, you shouldn’t miss “Maritime Kitchen Party – Atlantic Canadian Music”. There’s a whole lot of drinkin’ music on that list. Right now I’m listening to Spotify’s “Harbor Jazz Reflections: Nautical Jazz Music”. It’s OK.

–The Smithsonian offers a 2004 recording on-line. It has 32 very nautical titles. You have to pay for it, though. https://folkways.si.edu/classic-maritime-music-from-folkways/american-folk-celtic-historical-song-world/music/album/smithsonian

–On YouTube, you can enjoy this 54 minute selection of shanties and folk songs –https://www.youtube.com/watch?v=7kT33murB3c

–Reader Mac Perry sent me this link to sea shanties, writing, “The link below contains a collection of sea shanties sung by Leonard Warren—one of the two or three greatest operatic baritones of the mid-20th century. You can appreciate his operatic roots when he really lets it rip a few times in this collection. Hope you and/or your readers enjoy it.” https://www.youtube.com/watch?v=syTcgISukJ0&list=PLnnIF9a8SsS3nz3zgh9LqX-xDo6wAaaII&index=2

And the list goes on. Just google…

Also, send me your favorite playlists and I’ll add them to this post (or put up another, fresh one).

Happy spring!

©2024 Thomas L Snyder

The Navy’s “Ensign 1915” Program – A Recruiting Tool and, later, an early Scholarship Program

Despite the dominant isolationist mood of the nation, with war raging in Europe and in China Congress wisely passed the first-ever U.S. peacetime draft, the Selective Training and Service Act of 16 September 1940. Section 2 of the Act stated, “It shall be the duty of every male citizen [between the ages of 21 and 36] to submit for registration…and … be liable for training and service in the land or naval forces of the United States.” Section 5 of the Act relieved members of the Reserve forces of the obligation to register for such training and service.

It didn’t take medical students long to figure out that if they were accepted in the naval reserve, they would be protected from being drafted into the Army. In response, Navy quickly established the “Ensign, Probationary (Medical) Program”, which provided deferment from service until medical school graduation. Students were thus “protected”, and the Navy was assured of a source of committed medical officers. Originally established to enroll medical school juniors and seniors, within months Navy officials expanded eligibility to all four years. Students thus enrolled would serve in an inactive Reserve status until they graduated. Then, upon completing an internship (Navy or civilian, presumably), they would enter Navy active duty. It’s uncertain when the designation “1915” came in. “191” indicates an officer under instruction in a medical school, while “5” indicates status in the Navy Reserve. I couldn’t find any information on how many of the Navy’s roughly 19,000 wartime doctors graduated from the Ensign 1915 program.

In 1948 and 1953, the Universal Military Training and Service Act (as the previous “Selective…” Act was renamed in 1948) authorized the President to invoke a more specific registration of medical and allied medical specialists. Those who were accepted for volunteer enrollment in the Reserves (including the Ensign 1915 Program) would exempt themselves from draft into the Army, and be assured that their service would be in the Navy (and Marine Corps). This provision took on special significance during the Korean and Vietnamese conflicts.

At some uncertain time, the Navy introduced the Senior Medical Student Program. Medical students accepted into this program received a commission as Ensign (1915) and served in an active “Duty Under Instruction” status, thus receiving Ensign’s pay, benefits and accrual of retirement credits during their senior medical school year. As such, the program represented a sort of medical school scholarship arrangement. The “payback” here was a basic 2 years of active duty service after internship (Navy or civilian) plus an additional year.

The Ensign 1915 Program went out of business with the elimination of the Draft in 1973.

(Editor’s Note: I am a product of the Senior Medical Student Program. I received DUINS orders as Ensign (1915) for my last year (1968-69) at Albany Medical College. After a straight surgical internship in Chicago, I began my active duty service, first for two weeks’ “knife and fork school” at the Navy Amphibious Base in San Diego. Then the Navy then flew me out to Subic Bay in the Philippines for my first assignment as Squadron Medical Officer, Destroyer Squadron 15. My reward for suffering the rigors of a year of sea duty (only about 4 months of which was actually spent at sea – much of this in Vietnamese territorial waters) was a two year assignment as a General Medical Officer – GP – at the Naval Postgraduate School in Monterey. (This was at a time when Monterey actually had an “off” season, were prices at really excellent restaurants dropped to about half!) Not a bad payback…

A year later, while I was a resident at Rush Medical College in Chicago, I joined the Navy Reserve and enjoyed a terrific career in that role.

(c)2024 Thomas L Snyder

A Divertissement – Music With a Maritime Theme

This past weekend I had the good fortune to attend the inaugural concert of a new Bay Area choral ensemble, Vox Humana. Their interesting and diverse program included a work by Finnish composer Jaakko Mäntyjärvi , Canticum Calamitatis Maritimae. It’s a meditation based on a Latin* description of the tragic 1994 shipwreck of the passenger ship MS Estonia in which several hundreds lost their lives.

* The composer apparently found the Latin description on Finnish radio YLE 1, which broadcast news summaries – Nuntii Latini – in Latin from 1989 until 2019. The Vatican, a reasonably assumed source stopped their Latin brodcasts in 2022. Bremen Zwei, a German source, still posts monthly news reviews in Latin.

This got me to thinking – how much music with a maritime theme is “out there”? Well, as you might imagine, there’s a lot! The first work to come to mind was American broadway composer Richard Rogers’s Victory at Sea, which he wrote for the 1952-53 NBC television series, a pretty American-triumphalist portrayal of World War II. (It was, after all, written just 6 years after the end of the war.) The music, though surely triumphalist in sections, is also charming in its portrayal of some of the exotic places sailors saw and visited.

What other symphonic music evokes the sea?

The Los Angeles Philharmonic’s writeup on La Mer (1905) tells us that its composer Claude Debussy had considered becoming a sailor, and thought of the sea as an old friend.

Ralph Vaugh Williams’s A Sea Symphony (1909), written for baritone, soprano, chorus, semi-chorus and orchestra, begins with the line, “Behold, the sea itself, And on its limitless, heaving breast, the ships.”

Nicolai Rimsky-Korsakov, according to Wikipedia, was an officer in the Russian Navy, and later served as inspector of Navy Bands. He reportedly fell in love with the sea at an early age, influenced by his older brother’s tales of Navy life. The first and fourth movements of his famed Scheherazade (1888), entitled “The Sea and Sinbad’s Ship” and “The Festival at Bagdad – The Sea – The Shipwreck“, definitely have a nautical tone.

The nautical poetry of Goethe inspired Beethoven in 1815 to compose the cantata Calm Sea and Prosperous Voyage. Beethoven’s work inspired Mendelsohn to write a concert overture with the same name, in 1828, this time without the poetry, which apparently at the time was so well known that he didn’t need the words.

Of course, there are many more. Google really helps…

What about opera? Here the list may be a little shorter, let’s see:

Probably the most well known of this genre is Richard Wagner’s Flying Dutchman (1841), which is based on a mythological ghost ship. Lyric Opera of Chicago describes the opera thus: “The prevailing story was that a Dutchman was unable to dock his vessel during a bad storm and got lost at sea — and ever since then, the Flying Dutchman appears on the waters during turbulent weather.”

The British composer Benjamin Britten wrote two “oceanic” operas. Peter Grimes (1945) (the link is to an excerpt; no complete performance is available on line) is a complicated tale about an introverted fisherman unfairly accused of murder. He sails off to sea and his death as angry townspeople come to lynch him. Billy Budd (1952) tells the story of a foretopman who’s falsely accused of inciting mutiny by his ship’s Master-at-Arms. The innocent is so astounded by the accusation that he strikes his accuser dead with one stroke. The law demands hanging, and thus the innocent man goes to his death.

Italian composer Antonio Smareglia composed Oceàna in 1903. It’s a kind of nautical romance involving a beautiful young women, an elderly suiter, and various gods of the sea. “Successfully premiered at La Scala under Toscanini in 1903, the opera has a haunting sirens’ chorus and pervasive sea music which sets the pace of the action in an unbroken spell of dreamlike visions.”

Probably the most popular works of the genre are those of British dramatist W. S. Gilbert and composer Arthur Sullivan. Their comic operettas HMS Pinafore (1878) and The Pirates of Penzance (1879) were both parodies of the English social structure, featuring romances between the women of the upper and men of the lower classes.

Next time: nautical folk music (sea shanties) and the ocean in popular music.

Please send me your take on this topic. Have I missed any significant musical works? Tell me your favorite musical representations of our oceanic world: thomaslsnyder@gmail.com

(c) 2024 Thomas L Snyder

“Purple Suit” Medicine On the Way?

Originally Posted on My WordPress Blogsite “Seagoing Sawbones” on 2013/08/01; I’ve Edited It for Relevance. A Lot Has Happened in the Past 10+ Years.

Lost to history is the genius who coined the term “purple suit” to characterize the presumed color of a military uniform made up of combined Army green, Navy white and Air Force blue – a representation of the “jointness” so prevalent in U S military staff and operational training.

While the services have a long tradition of operating their own medical establishments (the Army medical department dates from 1818, the Navy Medical Corps from 1871, the Air Force medical service from 1949), soon after World War II General Dwight Eisenhower raised the notion of combining them into one, thus:“….. after giving careful consideration to the problem of providing medical service for
the Armed Forces, I have reached a conclusion that there is but one real solution, the
establishment of one single, integrated medical service ….. to my mind it is absolutely
silly to have individual service medical systems”(1)

When I was on active duty during the Vietnam conflict, I received at least one survey from the Navy chain of command soliciting my opinion on purple suit medicine. In fact, the 2006 Military Business Board report noted that “the Department [of Defense] has studied the consolidation of military medical health services (MHS) at least 16 times since 1948” (emphasis mine). The Board went on to once again recommend that the Secretary of Defense move immediately to establish the transitional teams required to effect establishment of a unified medical command.(2) It further recommended that “all shared services” including Tricare management be brought into the unified command.

Finally, in October 2013, the new entity – the Defense Health Agency – was stood up. Its first director was an Air Force Lieutenant General. As originally conceived, the shared services to be consolidated under the DHA included medical logistics, pharmacy, facilities operation, education and training, R & D, Information Technology (including the electronic medical records system), and Tricare management. Interestingly, each service was retain its Surgeon General structure and organic medical services.

How much of this still holds, and where have things gone since those early days of 2013? I hope to have answers for you ober the next several posts. If you know people who are “living the changes”, please send them my way.

(1) Quoted by Colonel Bruce W McVeigh, Army Medical Corps, in a paper he wrote while he was a student at the Naval War College in 2006, http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA463546&Location=U2&doc=GetTRDoc.pdf, accessed 31 July 2013.

(2)http://dbb.defense.gov/Portals/35/Documents/Reports/2006/FY06-5_Military_Health_System_2006-9.pdf, accessed 1 August 2013. This Board recommended a “mixed consolidation” of actual medical care, however: all Level III (definitive care with a combat zone) and Level IV (definitive care outside a combat zone) medical facilities would be  operated jointly. Level I (immediate first aid and basic wound care) and II care (basic x-ray, lab,surgical services for stabilization and initial management) – that is, battlefield and other forward care – would be remain organic to the individual services.

©2013, 2024 Thomas L Snyder, MD

My Book’s Done! Looking to the Future.

“NAVHOSPMAREISLAND – The Navy’s First Hospital on the West Coast”, a 20 year (!) project is done. I sent it off to the Naval Institute Press (a long shot, for sure) on Monday. Any advice (maybe sympathy) you can offer pending the inevitable (I imagine) rejection, will be appreciated. It’s a short work – ~72,000 words – but I think it gives a compact yet comprehensive history of this pioneering (in many ways: first hospital on the West Coast, first woman employed on the Mare Island Navy Yard, medical sponsor of first ambulance boats for San Francisco Bay and Norfolk, VA, pioneering prosthetics using plastics and metal joints in World War II) medical institution. It tells a story of intrepid doctors, nurses and corps personnel in what was once a small and remote station far, far away from the Centers of Power that grew to be the premier naval medical institution in the west.

Late last year, I also passed off leadership in the Society for the History of Navy Medicine, which I co-founded with Andre’ Sobocinski, BuMed’s historian in 2008, and, my duties and Ship’s Store manager for the Naval Order of the United States.

What to do with all this freed-up time??

Well, there’s the VFW (I’m a Vietnam veteran) – I’m now the surgeon for Carl H Kreh Post 1123 in Vallejo, CA, and California District 16. BUT THAT’s ALL!

How about writing? Well, this sorely neglected blog requires attention – some “Notes on Maritime Medicine Past and Present” are long overdue.

What of Maritime (and military medicine in general) in the present? Monumental changes in the American sphere are in progress as a result of legislation contained in the National Defence Authorization Act of 2013. As I understand it, the intent of the Act was to push the military medical establishment toward being a “purple suit” enterprise – that is, to combine medical operations of the three services into one consilidated operation. (“Purple” is the imagined color of a uniform if you combined Navy blue, Air Force blue and Army green). The notion, of course is to save costs by eliminating duplication of effort, among other things.

One very visible result of this consolidation was the renaming / rededication of the National Naval Medical Center in Bethesda MD as Walter Reed National Military Medical Center. I know there was a lot of heartburn in some Navy circles over this change, especially given that the history of the place – having been designed by FDR (whose personal physician was Navy Surgeon General Ross McIntire) and utilized as the flagship of Navy medicine from its dedication in 1940 – was all-Navy. Today, the facility is staffed by medical personnel from all three services. Its current “director” is a Navy medical corps captain.

I hope, over several future posts, to track the changes seen more widely in the navy / military medical establishment. How are these changes affecting medical personnel? How are they affecting recipients of care, both active and retired military personnel and their families.

If you have personal experience with the changes afoot, please let me know!

I may also try to reach back through the veil of the the past for some historical perspectives.

Happy 2024!

©2024 Thomas L Snyder

Guest Article: Symbols of Navy Medicine

Our friend and co-conspirator in the founding of the Society for the History of Navy Medicine, Andre’ Sobocinski, is the historian at the Navy’s Bureau of Medicine. As such, he’s tasked with researching and writing on the topic. Below is a recent Andre’ product, posted here with his permission. Enjoy!

Symbols of Navy Medicine
19 August 2021

From ANDR£ SOBOCINSKI

From uniforms and branding to wall decorations and command seals, Navy Medicine is steeped in symbolism. Oak leaves, acorns and caducei adorn the collars and sleeves of Navy medical personnel. Red Crosses emblazon our white-hulled hospital ships. Images of triumphant eagles and fouled anchors and the colors “blue and gold” abound throughout the Enterprise connecting us to big Navy. Throughout its history, Navy Medicine has continually leveraged these powerful communication tools to create a service and mission identity. But where did these symbols come from? And why were they adopted?

The Geneva Red Cross and Hospital Ships:

Across the globe the Red Cross (or Geneva Red Cross) is the universal symbol of impartiality and medical assistance. Under the Geneva Conventions, medical providers who wear the Red Cross are protected in armed conflicts. The symbol was originally designed by Swiss humanitarian and founder of the International Committee of the Red Cross Henry Dunant. It is the inverse of the Swiss national flag and a nod to his country’s long history of neutrality. Owing to the misperceived connotations as a religious and mediaeval heraldic symbol carried into battle by Crusaders, the Red Crescent and Red Crystal were later adopted as alternative symbols that carry the same meaning.

In 1898, the Navy’s USS Solace (AH-2) became the first U.S. hospital ship to fly the Red Cross flag denoting its role as a non-combatant in the Spanish-American War. However looking at photographs of the ship in 1898 you will not find a Red Cross painted on its hull. Red Crosses did not appear on hospital ships until after 1899. Thereafter, in accordance to the Geneva Conventions, all hospitals ship-regardless of service or country of origin-were to be painted white with Red Crosses on the “sides, superstructures, stacks and decks for identification purposes.” Today hospital ships USNS Mercy and USNS Comfort are each marked by nine Red Crosses.

It can be argued that the Red Cross has done its job in identifying and protecting hospital ships. To date, only one Red Cross-marked hospital ship has been attacked by an enemy combatant-USS Comfort (AH-6) off of Okinawa in May 1945.

The Red Cross has also been a symbol used by the Navy Hospital Corps and before 1948, Corpsmen wore Red Crosses on their uniforms. Early in World War II, at battles like Guadalcanal, Red Crosses marked the helmets and brassards worn by Corpsmen making them prime targets for enemy snipers eager to shift the tide of battle. But even without these markings Corpsmen have been identifiable because of their actions on the battlefield. Pharmacist’s Mate First Class Stanley Dabrowski once noted that Corpsmen at Iwo Jima were often singled out because they looked and behaved differently from Marines. “We carried [medical kits] which I didn’t like at all because they marked us as Corpsmen. . .because of this, we were told to carry side-arms not as offensive weapons, but for self-protection.”

The Herald’s Wand and Aesculapian Staff:

Outside of the Red Cross the caduceus is arguably the most recognizable “medical” symbol in the world. One study found that 76 percent of American healthcare organizations used the caduceus as part of their branding. This includes the Army Medical Department which has utilized the caduceus since the nineteenth century; and its Medical Corps has worn the caduceus since 1902. For Navy Medicine, the caduceus was once worn by warrant officer-pharmacists in the early years of the Hospital Corps; it has also adorned the uniforms of the largest enlisted rating in the Navy since 1948.

The symbol’s hallmarks are two snakes or serpents intertwining a staff capped by a pair of wings. In Greek mythology the caduceus was an attribute of Hermes, the herald or messenger of the gods. In fact, the name “caduceus” is a Latin term that derives from the Greek for “herald’s wand.” Whether through the herald’s connections to alchemy or simply by error, the caduceus was purportedly first used as medical symbol as early as the sixteenth century. Some scholars contend that the caduceus was used erroneously in place of the staff of Aesculapius which, by contrast, features a single coiled snake.

Aesculapius—the Greek god of medicine and healing—has often been referred to as the “snake-bearer.” His association with the snake—a symbol of healing and immortality—may be tied to the creature’s ability to shed its skin and perceivably “begin life anew.” Some scholars have also theorized that the image of the snake on the staff was inspired by the ancient practice of removing parasitic worms from subcutaneous tissue by making an incision in skin in the worm’s path and then wrapping it around a stick until it was fully extracted. In either case, this tried and true symbol of medicine has appeared on the uniforms of Navy surgeons as early as 1830 and is featured on the seals of the Navy Medical Department, Air Force Medical Service and the Defense Health Agency today.

Acorns, Oak Leaves and Tall Tales:

First adopted by the Bureau of Medicine and Surgery in 1948, the Navy Medical Department flag featured a heraldic shield with the caduceus (symbol of the Hospital Corps) and four variations of a spread oak leaf (for each staff corps). The oak leaf—symbolic of the oak tree and in turn strength and longevity—has long been used as a motif by the Navy and Navy Medicine. Sprays of live oak have adorned uniforms of both Navy line and staff officers as early as the 1820s. The oak leaf has been a chief symbol of the Navy Supply Corps. And gold and silver oak leaves are used today to denote rank of Navy lieutenant commanders and commanders, respectively.

In 1826, the oak leaf insignia first appeared on the collars of Navy surgeons. Sixty years later, the oak leaf and acorn were officially adopted by the Navy Medical Department and have been utilized as Medical Corps insignias ever since. In his Short History of Nautical Medicine (1941), historian and Navy physician Capt. Louis Roddis acknowledged the popularity of the oak leaf in the Navy, but theorized it also held a deep medical connection through its association with ancient Druids:

“The physician-priests of the Druids are linked closely with the oak leaf and acorn, which are with equal propriety considered as symbols of the medical profession. These are the insignia worn by the Medical Corps of our own Navy. . . the connection of the oak with medicine is very definite.”

Whether or not the members of the uniform board conjured thoughts of Druids when they settled on the oak leaf we just don’t know and the existing records do not reveal the decision making process. What we do know is in the ensuing years the Nurse Corps, Dental Corps and Medical Service Corps have each

adopted the oak leaf symbol to represent their own communities.

• Nurse Corps. From 1918 to 1947, Navy nurses actually used an insignia identical to Medical Corps (gold oak leaf with silver acorn) and distinguished only by the letters “NNC” (for Navy Nurse Corps). After 1947, the Nurse Corps adopted the acorn-less oak leaf representing their foundational role in Navy Medicine.
• Dental Corps. The Dental Corps’ oak leaf insignia features two acorns which symbolize Dental Surgeons Emory Bryant and William Cogan, the Navy’s first two commissioned dentists.
• Medical Service Corps. Since 1948, the Medical Service Corps has been represented by an insignia known as the “twig” (an acorn-less spread oak leaf with a stem). The stem represents the support the Medical Service Corps provides to the Navy Medical Department.

Sources.

Friedlander, WJ. The Golden Wand of Medicine: A History of the Caduceus Symbol in Medicine.

Greenwood Press, 1992.

Gray, David. Many Specialties, One Corps. The Pictorial History of the U.S. Navy Medical Service Corps. Second Edition, 2017.

Kanmodi, K., et al. On Snake or Two? Exploring Medical Symbols Among Medical Students. Acta Medica Martiniana, Vol. 19, No. 2, 2019.

Massman, E. Hospital Ships of World War II: An Illustrated Reference to 39 United States Military Vessels. Jefferson, NC: McFarland & Co., Inc., Publishers, 1999.

Miller, DG. History and Symbolism of the Naval Medical Corps Insignia. Armed Forces Medical Journal, Vol III, No. 7, 1952.

Nayernouri, T. Asclepius, Caduceus, and Simurgh as Medical Symbols, Part I. AIM, Vol. 13, No. 1, January 2010.

Roddis, Louis. A Short History of Nautical Medicine. New York: P. Hoeber, Inc, 1941.

History Played in Slow Motion

I’m working on a history of the Navy’s first west coast hospital, on Mare Island Naval Shipyard (which closed in 1997), across the Napa River from my northern California home of Vallejo. The spine of this historical narrative lies in correspondence between hospital commanders and the Navy’s Bureau of Medicine and Surgery in Washington DC. That correspondence has served my historical purpose very well, from before the hospital’s founding in 1870 until about 1930. Then, almost suddenly, the volume and content of written correspondence dropped alarmingly, (due to the telephone, I suspect) and I despaired finding enough material to sustain my story through until the 1940s, when the hospital and its people experienced their most brilliant days.

In desperation, I turned to a hometown newspaper, the Vallejo Times-Herald, physically bound and stored in the cellar of the Vallejo Naval and Historical Museum. (No digital copies have been made, so far as I can find). As I leafed through this particular “first rough draft of history”*, I soon noticed that certain themes – fascist vs communist conflict in Germany, monarchist vs republican conflict in Spain, growing Japanese assertiveness in the western Pacific, Gandhi stirring the nationalist pot in India – showed up on a regular basis. With knowledge of ultimate outcomes, this has become something like watching history unfolding before my eyes. It’s intriguing, almost compelling – and has substantially slowed my search for “naval hospital” sub-headlines.

But there’s more. Advertisements for the latest radios (“7, 9 or 11 tubes!” “Beautiful sound due to screen grid technology!” “Superheterodyne design!”) – pieces of living room furniture really – and for electric refrigerators (contrasted with almost desperate ads from the local ice distributor, “the most popular way to keep your food cold!”) – highlighted an almost frantic commercial push for modernity. A local car dealer’s ad daily announced, “A home is not complete unless you have two cars.” This was 1931. And aviation: there are almost weekly reports of new altitude or distance records being set (by male and female pilots!), and – almost weekly, too – headlines about crashes and deaths of those intrepid pioneering aviators.

What’s also interesting is the relative paucity of “depression” coverage in this local press. There is the occasional editorial comment about economic tough times, and infrequent articles about hungry workers in large eastern cities. But not the huge headlines we might expect, given today’s understanding of the Great Depression. Museum Director Jim Kern tells me the reason for this local indifference to economic news was that Vallejo’s dominant industry, Mare Island Naval Ship Yard, with its workforce steadily employed repairing and building ships, insulated the city from the worst of the depression’s impacts.

The page-by-page stroll through the news is giving me a vital sense of historical context for my own narrative. It’s something today’s scholars, picking through word-search-culled digital files will miss. Modern historical research methods certainly offer the benefit of efficiency. But at the price of a loss of context. The modern historian’s work is a little impoverished for not seeing history played in slow motion.

*The phrase “[Journalism] is the first rough draft of history” is the subject of a 2020 Slate.com article by Jack Shafer, here.

©2021 Thomas L Snyder

Today in Naval History from CAPT James Bloom, Medical Corps, U.S.N., Retired – Guest Author

TODAY IN NAVAL HISTORY

150^th ANNIVERSARY

3 MARCH 1871

 MEDICAL CORPS BIRTHDAY

“Let us endeavor to preserve the health of those who bravely enter the field of battle, or expose themselves on the boisterous ocean in defense of their country.”  The words are those of Dr. Edward Cutbush, acknowledged by many to be the Father of American Naval Medicine.  In his 1808 treatise, Observations on the Means of Preserving the Health of Soldiers and Sailors, the first American text on naval medicine, he detailed measures to improve hygiene, prevent disease, and reduce contagion.  However, surgeons had been common on ships of the Royal Navy as much as 300 years earlier.  In the 18^th century British Navy, the pay of the surgeon (and the chaplain) was generated by the crew.  Each sailor was required to contribute two-pence per month.

In the United States a congressional act on January 6, 1776, authorized the first Surgeons as officers and Surgeon’s Mates as warrants.  Pay for surgeons on ships of under twenty guns was later established at $21.33 per month, their mates made $15.  Nine years after the dissolution of the Continental Navy, the Navy Act of 1794 revived our service by authorizing the construction of six frigates.  This act authorized the billeting of one surgeon and two mates on frigates of 36 guns and one surgeon with three mates on frigates of 44 guns.  Competition for these posts was keen owing to the fact new frigates would be constructed with state-of-the-art medical spaces called “cockpits.”  One of the best known of those early surgeons was Dr. Amos A. Evans.  After studying medicine in Philadelphia under Benjamin Rush, Evans entered the Navy in 1808 as a Surgeon’s Mate.  Four years later he was assigned as Surgeon on USS CONSTITUTION, 44, and sailed with her through her colorful engagements with HMS GUERRIERE and the HMS JAVA.

In truth, because the cockpit was below the waterline where enemy shot would not likely penetrate, it was cramped, dark, damp, and often foul smelling.  Early surgeons labored here triaging and treating heavy loads of casualties while shot and canister crashed above.  Bullets and splinters were extracted, mangled limbs amputated, and surgical stumps cauterized with hot pitch.  Often, they “…did not the best we would, but the best we could,” as a Civil War physician was to eloquently phrase later.  Mortality from a battle wound in those days was about 30%.

On August 31, 1842, a reorganization of the Board of Navy Commissioners established five new Navy Bureaus including the Bureau of Medicine and Surgery.  And on this date 30 years later an act of Congress formally organized Surgeons into the Navy Medical Corps.  Indeed, we have progressed.  In modern times mortality among Navy/Marine Corps battle casualties is less than 2-4%.

Watch for more “Today in Naval History”   8 MAR 21

CAPT James Bloom, Ret.

Clark, William Bell, (ed.), Department of the Navy, Naval History Division.  Naval Documents of the American Revolution Vol 3  1775-1776.  Washington, DC: GPO, 1968, pp, 655-57.

Langley, Harold D.  A History of Medicine in the Early U.S. Navy. Baltimore, MD: Johns Hopkins Univ. Press, 1995.

Roddis, Louis H.  A Short History of Nautical Medicine.  New York, NY: Paul B. Hoeber, Inc., 1941.

Sweetman, Jack.  American Naval History:  An Illustrated Chronology of the U.S. Navy and Marine Corps, 1775-Present, 3rd ed.  Annapolis, MD: USNI Press, 2002, pp. 44, 84.

USS Constitution Museum, Education Department.  Naval Medicine in the Early Nineteenth Century.  Boston, MA, 1981.

[Editor Note: thanks to CAPT Bloom for letting me publish his work here. He puts out a roughly weekly piece on some aspect of naval history. You can subscribe by emailing him at jrbloom4u@gmail.com.]

Sir William Osler and Other Heroes in (Military) Medicine

I am an Oslerian – a member of the American Osler Society and a devotee of the man and his medical ideals. Sir William Osler (“Oh-zler”) was a Canadian born and trained physician who moved to the U.S. to teach at Penn. From there he was asked to join the revered founding faculty of the Johns Hopkins medical school. In his later years he became Regius Professor of Medicine at Oxford, where he served with distinction until his death in 1919. Osler is revered in western medicine as a pioneer, an exemplar of humane and humanistic, patient-centered practice, and is seen as the first to utilize a “modern”, science-based approach to the art. He was also a devoted historian of medicine and a serious bibliophile. Osler’s friend and colleague Harvey Cushing, himself a hero of medicine for his many discoveries, wrote an admiring two volume biography of the man (for which he received a Pulitzer prize) in 1925. A later Osler biographer, Michael Bliss, who’d described a previous biographical subject, insulin discoverer Sir Frederick Banting, as a “horse’s ass”, admits that he fully expected to find figurative skeletons in Osler’s closet as well. In fact he may have been hoping this would be the case because, as he wrote, “[This is] an age when biographers make their reputation by claiming to have discovered hidden internal derangements in their subjects.” But Bliss was not thus rewarded. In fact, he wrote in the preface to his 1999 biography, “Try as I might, I could not find a cause to justify the death of Osler’s reputation. He lived a magnificent, epic, important and more than slightly saintly life. For the most part, Osler ‘revisionism’ does not work.”

And yet a new attempt at this revisionism is under way, pointedly summarized by a recent symposium mounted by Osler’s medical alma mater, McGill University in Montreal. “Perspectives on Sir William Osler in the 21st Century” was prompted in part by a medical student body resolution calling to – in today’s terms – “Cancel” the abundant Osler symbology at the school, because, they wrote, Osler “held white supremacist and sexist views”. The basis of this demand was two items, one citing an opinion attributed to Osler in 1914 that Canada should be reserved as a white man’s domain; the other a report that he once told a woman contemplating the study of medicine at Johns Hopkins, “Don’t. Go Home.”

The Symposium, held via Zoom, with 130 attendees, featured a panel of prerecorded speakers representing a spectrum of opinion and advocacy. This ranged from the most vigorous “cancel” position – based in this case on a young Osler’s quite scurrilous satirical (and reportedly inaccurate) treatment of the sexual and birthing practices of indigenous Canadians, to a most vigorous defense that cited among other things, Osler’s quite comprehensive open mindedness, noting for example, his opposition to nationalism in medicine and his praise of Muslim, Asian and other “medical heroes”.

Then followed a gentle debate that started out with a consideration of “presentism” – the application of today’s moral and social values to people of other eras when other sensibilities carried the day – and whether it’s appropriate to use it to balance the value of past heroes and the history they represent. While all agreed that we need ways to capture the stories of human agency in the history and progress of medicine, what emerged was the “safe” idea of naming teams of people as an all purpose historical shorthand. And there the symposium ended.

What are we to make of this conversation?

From the mid-19th century and for about 100 years, it was physicians – many of them retired from practice – who took up the study of our history. In the early years many were classically trained, so they could plumb ancient Greek and Latin writings to bring back to life such ancient medical luminaries as the Greek physicians Hippocrates, Diascorides and Galen (the latter two practiced in Rome) and the renowned Islamic physician Avicenna (Ibn-Sina). Physicians naturally look at our history from the inside – referred to as “internalist history” – because our practice is the lens through which we see things. Progress in our art – and hence our history – has a direct and immediate effect on our patients. Moreover, physicians are acculturated to look to the individual exemplar – think of the professor making ward rounds with his white-coated retinue or the surgeon as captain of the ship in the OR – when seeking their “shorthand” to history. Hence, we especially value the stories of intrepid individuals who advanced our art and science to produce better treatments for our patients. Military medicine is replete with such figures as Jonathon Letterman (combat casualty evacuation and care), Walter Reed (mosquitoes as vector for yellow fever; case management of cholera), William Gorgas (malaria and yellow fever vector control) and Charles Drew (blood banking and the use of blood and blood products in the management of shock) – all heroes of medicine whose work directly impacted the lives of soldiers, sailors and Marines even to this day.

By about the 1960s, PhD historians became ascendant in formulating medical historiography. Not privileged to write history from the intimate inside, they necessarily take an “externalist” outlook, one that frequently if not exclusively concerns itself with the impact of society upon “them” – medical practitioners – and of medicine upon “them” – anonymous members of society. This lens generally replaces famous men or women icons of progress with collective, “societal” entities like the AMA or the CDC, or government policy and legislation.

So how should we shorthand medical history and progress in future? While PhD historians will continue to look at the social milieu within which medicine exists, physician historians will still want to chronicle the impact of progress of our art and science in that physician-patient nexus. Will history highlight the work of teams or of individuals? I think we can already get a hint: think about popular coverage of the COVID pandemic. Is it teams or individuals that the media seek out as shorthand for our experience? My answer is Dr Fauci, Dr Walensky, even the discredited Dr Scott Atlas, not the CDC or the FDA. Not at least in the “first draft of history”. But when the fog of epidemiological battle clears and scholars sit down to write the pandemic’s history, who will historians use for their shorthand, the faces we daily see on TV, or shadowy international and governmental agencies? I have to admit that even as a physician, I don’t see individuals playing a dominant role; it will be the WHO, the CDC, and the NIH that will be chronicled, criticized, or praised. Maybe, just maybe, we’ll learn about an intrepid virologist who decoded the virus’s genome, the brilliant scientist who designed an mRNA vaccine, or the wily entrepreneur who brought the product to market. I suspect our history will be some sort of hybrid, and future generations of physicians brought up in a culture that emphasizes equity and collaboration will be less inclined to lionize heroes in our profession. Standouts will still offer us an essential historical shorthand that may be difficult to ignore. Perhaps we in military medicine will continue to honor heroes just as the Marines lionize their Chesty Pullers and the Navy their Nimitzes. But will we be required to hold heroes in high esteem, only to abandon them if their human faults become an unacceptable burden to history? In this, I think history would best be served by a “preponderance of evidence” standard, much as we do in making our clinical judgements.

Oslerians, who know full well that Sir William’s work was decidedly not a committee activity, will still idolize their hero, but now with full cognizance of his only slightly less than saintly humanity. They will continue to champion internalist medical history, and their meetings will be celebrations of advances championed by intrepid individuals. I suspect our patients will feel the same way.

©2021 Thomas L Snyder