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

There’s the Medical Corps and… (Part the Final of 5 Posts on the U.S. Navy’s Staff Corps

In the previous four posts, I’ve given short histories of the four non-medical (Supply, Civil Engineer, Chaplain, Judge Advocate General ) and four of the five medically related (Medical – physicians & surgeons, Hospital – enlisted personnel, Nurse, Dental) navy staff corps. Just one, the youngest, remains.

Medical Service Corps.

Throughout much of its history, the navy medical department consisted mostly of “surgeons” (medical officers) and loblolly boys / surgeons’ assistants / pharmacist mates / corpsmen (enlisted medical personnel). In the late 19th century, an increasingly scientific medical enterprise began to call for men with specialized knowledge and skills, in particular in the area of pharmacology. This first led to the introduction of pharmacists, the more experienced of whom earned senior enlisted rates (equivalent to modern day chief petty officers); in World War I, some were awarded officer rank as Warrant Officers. By World War II, a combination of increasing sophistication of medical knowledge, more demanding and complicated combat environments (tropics, aviation, submarine, very hot and very cold), and specialized medical procedures such as blood banking, called for educated, specially trained personnel of officer rank. All of these non-surgeon medical specialists found their administrative “home” within the traditionally enlisted Hospital Corps. Even during the war, it became apparent that it would be desirable to separate these officers into a separate administrative unit of the medical department. On 4 August 1947, the Army-Navy Medical Service Corps Act made this separation official.

Medical Service Corps Insignia (worn on the left collar of working uniforms and above the rank stripes on dress uniforms)

Today, the U.S. Navy Medical Service Corps is comprised of 31 specialties arranged under three categories – medical administration, clinical specialties and scientists. Clinical specialists include such disciplines as psychologists, dietitians, optometrists, podiatrists, physical therapists and social workers. Among navy medical scientists are research psychologists, entomologists, radiation health specialists, microbiologists and biochemists. Medical administrators work in such areas as information management, education and training management, operations research, medical intelligence and general health care administration. About 2,700 officers, active and reserve, currently serve our sailors and marines in the U.S. Navy Medical Service Corps.

(c)2021 Thomas L Snyder

There’s the Medical Corps and… Number 4 of 5 Posts on the Navy’s Staff Corps

In earlier posts I’ve given brief histories of the U.S. Navy’s four non-medical staff corps – the Supply Corps (logistics and supply), Civil Engineer Corps (design, construction and maintenance of Navy shore facilities), Chaplain Corps (spiritual and moral guidance and support) and Judge Advocate General Corps (all things legal) – and two of the five medical-related entities – the Medical Corps (physicians and surgeons) and Hospital Corps (not a staff corps in the usual sense, but the administrative home of medically trained enlisted personnel).

In this post, I shall take up the next two older Navy staff corps, the Nurse Corps and the Dental Corps.

Nurse Corps. The loblolly boy – men taken up from the enlisted ranks to assist surgeons and assistant surgeons in the care of sick and wounded sailors and marines – tradition persisted in the Navy into the early 20th century. Though the name changed (to nurse in 1861, then bayman in 1876), the role was the same. The men learned nursing skills “on the job”. A few volunteer Catholic Sisters of the Holy Cross and several Black laywomen, paid as crew served in the Civil War hospital ship Red Rover, and during the Spanish-American War, three female medical students from Johns Hopkins University and an MIT pre-med student volunteered for duty at the Brooklyn Naval Hospital and served with distinction for the duration of the war.

As early as 1811, Navy Surgeon William Barton advocated for the service of females, referred to as “matrons”, in Naval hospitals just then being established. Most surgeons of the era resisted the notion in the belief that females were too delicate to withstand the rigors of Naval service.

This attitude changed dramatically as a result of the Spanish War experience, most particularly that of the more than 1500 volunteer nurses who served in the Army. In his 1902 Report to the Navy Secretary, Surgeon General Presley Rixey wrote, “There has been a growing conviction in the minds of many of the most experienced medical officers of the service, especially since the war with Spain, that the employment of women for the nursing of the sick in our large hospitals would result in greater efficiency than has been obtained heretofore by the use of male nurses alone, and that such employment would not conflict with the conditions arising from the military character of the institution.” He went on, “It is recommended, therefore, that Congress be asked to provide at its coming session for the establishment of a Woman Nurse Corps for the Navy…” Rixey repeated this recommendation annually thereafter. The Navy Secretary dutifully passed the requests to Congress with full endorsement, and finally, in 1908, legislation passed that established the Navy Nurse Corps.

Nurse Corps collar device, worn on the left collar of work uniforms; the embroidered analog of the device is worn above the rank stripes on dress uniform sleeves and shoulder boards.

From an initial 20 nurses in 1910, the Corps grew to more that 1550 by the end of World War I. Despite interwar contraction, Navy nurses added new skillsets to their armamentarium, including physical therapy, anesthesia and dietetics. World War II saw the Nurse Corps grow to more than 11,000 in number, the vast majority of whom were Reservists brought on active duty. Navy nurses served on virtually every continent, several Pacific islands, afloat in hospital ships, and even while being held as prisoners of war. In 1945, the first class of Flight Nurses was graduated at Alameda, California; today, Navy nurses not only perform the usual hospital and clinic duties, but also serve with Marines as Combat Nurses, in amphibious assault ships and aircraft carriers, and in surgical response teams in support of special operations personnel.

Dental Corps. While evidence of dental procedures can be seen in ancient bodies, and individual writers dealt with diseases of the teeth and mouth, dentistry as a separate discipline didn’t appear until the early 1800s. The first dental school in America, in Baltimore, Maryland, opened in 1839 and offered the Doctor of Dental Surgery (DDS) degree. Even as trained dentists entered the profession, dental care in the Navy remained largely an ad hoc undertaking – mostly tooth-pulling, practiced by ships’ surgeons.*

While the Navy did engage a trained dental surgeon to serve as an Acting Assistant (Dental) Surgeon at the U.S. Naval Academy from 1873 to 1879 (and continued practice there as a civilian for several more years), it was slow in pushing professional care out to the fleet. In the early 1900s, several enlisted men, with varying amounts of formal training, provided dental care to the fleet, a situation then-Navy Surgeon General P. M. Rixey considered to be, “…not satisfactory to the Bureau and is neither just to the men [practicing dentistry i the navy –Ed.] nor pleasing to the dental profession.”

Dental Corp embroidered device

Finally, Congress authorized establishment of the Navy Dental Corps in August 1912. Two months later, first Dental Officers were sworn in. The two Hospital Stewards went on also to pass the Naval dental exam and receive their commissions. So rapid and successful was the organization of the Dental Corps that two years after its authorization, the Navy Surgeon General could report that the Navy no longer would need to reject potential recruits solely because of bad teeth.

World War I saw expansion of the Dental Corps from 35 to at least 124 dental officers and more than 375 enlisted personnel. The dental corps reached about 13,000 at its peak in WWII. Today active duty and reserve dental officers number around 1,300, and they cover a wide spectrum of dental activities from forensic odontologists (they help identify human remains by use of dental records), to dental public health specialists (they promote dental health and disease prevention) to general dentists (the dentists you likely know from every day experience). Navy dentists serve aboard larger ships, with the Marines, and in military clinics and hospitals around the world.

*Even in 1970, I was given a short course in dental first aid before I undertook my duties as a destroyer squadron medical officer.

(c) 2020 Thomas L Snyder

There’s the Medical Corps and the Dental Corps and the… Part 3 of a 5 Part Series on the Navy’s Nine “Corps” (of Which Five are “Medical”)

Of the 9 Corps in the U.S. Navy – I don’t include the Marine Corps (in some Navies referred to as Naval Infantry) here, for this is a topic for another day – you have read about the four that are “independent” staff Corps in previous posts:

–the Civil Engineer Corps, housed administratively in the Naval Facilities Engineering Command;

–the Chaplain Corps, the Chief of which reports to the Secretary of the Navy through the Chief of Naval Operations;

–the Supply Corps, housed administratively in the Naval Supply Systems Command;

–the Judge Advocate General Corps, the Chief of which reports to the Secretary of the Navy through the Chief of Naval Operations.

Now, I will take up the remaining staff corps, all of which are housed administratively within the Bureau of Medicine and Surgery, under the command of the Navy Surgeon General, serving in the role of Chief of the Bureau. “BUMED”, as it’s abbreviated in Navalese [Ed: my term, in no way “official”], is the only remaining of ten Bureaus that were in place when that system was gradually abolished in the 1960s, to be replaced by Systems Commands and Shore Commands. The Navy briefly established the Navy Medical Command around that time, but soon reverted back to the traditional (and comfortable) BUMED.

Medical Corps. The Rules for the Regulation of the Navy
of the United Colonies of North-America of 28 November 1775 implied the presence of surgeons aboard colonial men-of-war by specifying that ship Captains should set aside a space to which they could “remove sick or hurt men … with their hammocks and bedding when the surgeon* shall advise the same to be necessary.” Further, a Resolution of the Continental Congress, 25 November 1775 authorizing the “capture and confiscation of British armed vessels, transports and supply vessels” specified that the ship’s surgeon should receive 5 shares of the proceeds from any such capture or confiscation (the ship’s Captain was allotted 6). Until the Naval Act of 27 March 1794 specified that surgeons would be “commissioned” by the President of the United States, ship commanders hired the doctor of their choice, typically for the duration of a given cruise. Physicians continued to serve as “civil officers”, and it wasn’t until 1841 that “assimilated” or “relative” military ranks were ascribed to navy physicians, that of “surgeon”, “passed assistant surgeon”, and “assistant surgeon”. A year later, Congress instituted the Navy “bureau system” and henceforth, navy doctors were administratively organized within the Bureau of Medicine and Surgery. In 1846, surgeons with more that 12 years’ seniority were granted the relative rank of Commander; less than 12 years, Lieutenant Commander; Passed Assistant Surgeons were equivalent to Lieutenant and Assistant Surgeons, that of Lieutenant junior grade.

Medical Corps “device”, worn on left collar of working uniforms and above rank stripes on dress uniform sleeves and shoulder boards.

The Medical Corps dates its establishment as 3 March 1871, when legislation back-handedly mentioned the name, presumably for the first time, thus: “SEC. 5. That the officers of the medical corps on the active list of the navy shall be as follows: –Fifteen medical directors, who shall have the relative rank of captain…” [from Acts of the 41st Congress, Session III, Chapter 117, 1871, Approved March 3, 1871].

Navy General Order No. 418 of 15 August 1918 finally gave surgeons the same rank titles as navy line officers – Ensign, Lieutenant (junior grade), Lieutenant, and so on – “Applicable alike to regulars and reservists, the uniform of any given rank or rating in the Navy shall hereafter be identical in every respect throughout, except for the necessary distinguishing corps devices, and every officer in the Navy shall be designated and addressed by the title of his rank without any discrimination whatever” – though usage of the old titles of Medical Director, Medical Inspector, Surgeon and so on persisted well into World War II.

The Medical Corps underwent its largest growth during World War II, when, under the direction of Surgeon General Ross T McIntire, it went from 841 medical officers on 30 June 1939 to 14,191 by the end of the war. Traditionally, navy doctors have trained in and practiced all the usual medical and surgical specialties in navy hospitals, clinics, larger ships and in field hospital. Some Navy physicians train and practice unique service-related specialties like aviation medicine (supporting aviators and aircrew) and undersea / hyperbaric medicine (supporting submariners and divers). Today, however, such specialties as obstetrics and pediatrics may be undergoing a de-emphasis as military medicine adjusts to a more “operational” emphasis required by legislation that stood up the Defense Health Agency in 2013. The goal of these reforms is to assure a “medically ready force and a ready medical force” for combat operations. I plan to write more on the topic of military medical reform in the near future.

*“Surgeon” in the navy is a generic term, interchangeable with “doctor”, “physician” or “surgeon”. The term “medical officer” is a more modern usage. Navy etiquette calls for medical officers to be addressed in conversation as “doctor” (not “doc”, which is reserved for Corpsmen, see below) until they attain the rank of Captain, after which that honorific is generally used.

Hospital Corps. The Hospital Corps is not a staff corps in the standard sense, though it played that role for a time through the mid 20th century. It is the administrative home for enlisted sailors – corpsmen – who receive training in medical skills.

Historians generally assume that loblolly boys^ served in ships from the time of the Continental Navy, but the first one actually named in Navy records was in June 1798. The nomenclature for enlisted health workers has changed several times – to Surgeon’s Steward (~1828); Nurse (in “special service to the sick aboard ships, June 1861); Surgeon’s Steward, Hospital Steward and Nurse (November 1861); Apothecary (a Surgeon’s Steward who received pharmacy training, 1866; the caduceus replaced the Swiss red cross as the emblem); Nurse became Bayman (referring to duty in sick bay, 1873).

Emblem of the Hospital Corps. It sits in the center of the rating patch on the Corpsman’s sleeve.

An Act of Congress, 17 June 1898 formally established the Hospital Corps and created or confirmed the titles of Warrant Pharmacist (a Warrant Officer), Hospital Steward, Hospital Apprentice first class and Hospital Apprentice. In 1912, Congress created a new rank of Chief Pharmacist; and in 1916, Chief Pharmacist and Pharmacist were created as Warrant Officer ranks in the Hospital Corps, while enlisted rates of Chief Pharmacist Mate, Pharmacist Mates 1st, 2nd, and 3rd Class, and Hospital Apprentices 1st and 2nd Class.

On August 4, 1947, Congress created the Medical Service Corps (about which next post). Now, Pharmacist Mates could advance beyond Warrant Officer and transfer to the new Corps. Gradually, all Hospital Corps officers moved to the Medical Service Corps, so that the Hospital Corps now consists only of enlisted personnel. The final change in nomenclature happened in April 1948, when the rating of Pharmacist Mate was converted to the current Hospital Corpsman, with rating structure that runs from the highest, Master Chief Hospital Corpsman to Hospital Apprentice.

Hospital Corpsmen (women carry the same designation) serve in a large variety of roles, from laboratory and X-ray technicians to tropical disease research assistants to duty as the sole “Medical Department Representative” aboard smaller ships like destroyers and submarines, to front line service with Marines in combat. As a group, Hospital Corpsmen are the most decorated group of men and women in the Navy. It is said that a Corpsman’s stethoscope is not only for listening to a sailor’s lungs and heart, but to his or her soul.

^Loblolly boy, a title imported from the British Royal Navy, refers to enlisted men typically drawn from a ship’s crew to assist the surgeon and surgeon’s mate in the care of sick and injured sailors. The name actually refers to the serving of warm gruel to their patients. In 1818, Naval Regulations specified loblolly boy duties, to wit, “The surgeon shall be allowed a faithful attendant to issue, under his direction, all supplies and provisions and hospital stores, and to attend the preparation of nourishment for the sick. . . . The surgeon’s mates shall be particularly careful in directing the loblolly boy to keep the cockpit clean, and every article therein belonging to the Medical Department. . . . The surgeon shall prescribe for casual cases on the gun deck every morning at 9 o’clock, due notice having been previously given by his loblolly boy by ringing of a bell.”

(c)2020 Thomas L Snyder

There’s the Medical Corps and the Dental Corps and the… Part 2 of a 5 Part Series on the Navy’s Nine “Corps” (of Which Five are “Medical”)

Civil Engineer Corps. Civil engineers have served the Navy or served in the Navy from its earliest years. From 1804 until 1836, individual engineers worked essentially as contractors to the Navy Department for design and construction of Navy Yards, dry docks and other facilities. In 1836, the Navy appointed William P. S. Sanger, “civil engineer for the Navy” to serve on the staff of the Board of Navy Commissioners, the early professional managers of Naval operations. An 1842 Congressional Act to reorganize the Navy Department abolished the Board and replaced it with five Bureaus, each with separate administrative responsibilities. It was to the Bureau of Navy Yards and Docks that civil engineering fell and thus Sanger became the first full time engineer staffer in that Bureau.

As the Navy expanded, Commandants of Navy Yards around the country hired their own civil engineers, often upon the advice of Sanger. The Navy created the Civil Engineer Corps on 2 March 1867 (the official CEC birthday); Sanger and his colleagues formed the nucleus of this new establishment. While these men received their appointments from the President – i.e., were “commissioned” – their status as Naval Officers was vague until 1871, when they were assigned uniforms and relative Navy ranks, and the symbol of their Corps (the modern version of which is displayed below). was introduced.

Civil Engineer Corps “Collar Device” – Worn on the Left Collar of Working Uniforms

It wasn’t until 1898 that a Civil Engineer actually became Chief of the Bureau of Yards and Docks. Through the first half of the 20th century, CEC officers carried out their usual activities of planning and overseeing construction and maintenance of Navy Yards and shore establishments. Individual officers also participated in Panama Canal construction, design and construction of the Navy’s worldwide network of pioneering radio towers, and development of a Texas plant designed to extract helium from natural gas for the burgeoning lighter-than-air programs in the U.S. Navy and elsewhere. During World War I, CEC officers oversaw construction of a huge office building in downtown Washington – the Army’s and Navy’s predecessor of the Pentagon.

While World War II saw the development of the famous “Seabees” – CBs / Construction Battalions – their precurser, the Twelfth Regiment (Public Works), was the brainchild of CAPT William A.Moffett when he commanded the Naval Station Great Lakes. In 1917, eager to rapidly expand the base to train sailors for a growing Navy, he enlisted the help of a series of CEC officers to organize and lead the 12th of the station’s training regiments, but this one manned entirely by recruits experienced in the construction trades. These men went on to speedily build out the capacity of Moffett’s command from 15,000 trainees to 50,000.

The impracticability of hiring civilian construction crews to build navy shore facilities and airfields in the South Pacific led to the development of what came to be known as Seabees. In January 1942, Construction Battalion BOBCAT (the code name for the island BoraBora, where it was to construct a navy fueling station) – actually only Company sized, with 8 officers and 250 men to start – was stood up. Subsequent units bore the official title of Construction Battalions, and the BOBCATs, as the original outfit’s members called themselves, took on the name SeaBees. So valued was the work of the Seabees in WW II that in 1947, they were made a permanent part of the Navy, and, for the first time, Civil Engineer Officers were made their commanding officers (previously, they were titled “officer in charge”, an important distinction). Seabees played important roles in the Inchon and Wonsan landings in Korea. In Vietnam, CB units built hospitals, landing strips, warehouses and roads, both for military and civilian use. During my time in the Reserves, CBs provided expertise in setting up our field hospitals, and operating and maintaining such necessary utilities as generators, and refuse systems.

In 1966, the Bureau of Yards and Docks was abolished and replaced by the Naval Facilities Engineering Command, under which rubric the Navy’s civil engineers and their enlisted tradesmen oversee construction and maintenance of Navy facilities and train Seabees for service in war and peace.

Judge Advocate General Corps. The fact the the “JAG Corps” is the Navy’s youngest, established by law only in 1967, belies the fact that lawyers have served the Navy, or in the Navy, since the Civil War. Before that time, simple, straightforward Naval Regulations adopted from the British Royal Navy, and relatively simple administration obviated the requirement for lawyers. By the Civil War, however, legal and administrative matters became complex enough that Navy Secretary Gideon Welles felt compelled to appoint a “Solicitor of the Navy Department”, initially to present the government’s case in complicated court martial proceedings. In March 1865, Congress made official the commissioning of a lawyer as “Solicitor and Naval Judge Advocate General” as a staff civilian in the Navy Department. In 1871, the office was moved to the newly established Department of Justice, as “Naval Solicitor”. 1878 saw the first uniformed chief lawyer, a Marine Corps Colonel, and in 1880, the naval billet of Judge Advocate General was created.

Judge Advocate General Collar Device – Worn on the Left Collar of Working Uniform. The “mill rinde” at the center is a traditional symbol of the law, denoting provision of a even grinding by the (mill) wheels of justice.

It wasn’t until after World War II that line officers serving in JAG roles were permitted to restrict their activities to the law only, and in 1950 Congress required that Judge Advocate General officers be actual lawyers and members of the bar. In 1967, President Lyndon Johnson signed legislation that finally established the Judge Advocate General Corps within the Department of the Navy. JAG officers handle any legal matters one might imagine in this complicated world. These include traditional admiralty law, but also environmental law, military justice, administrative law and international law. JAG officers also provide legal assistance to sailors and officers in such things as creating wills prior to deployments and similar services.

(c) 2020 Thomas L Snyder

There’s the Medical Corps and the Dental Corps and the… (Part 1 of a 5 Part Series of Brief Histories of the Nine Navy “Corps” – of Which Five are “Medical”)

A short while ago, I was reminded that 22 August was the 108th birthday of the U.S. Navy Dental Corps. And that got me to thinking: what’s the story about all these “Corps” in the Navy? [Editor’s note: the military term “corps” is pronounced “core” (singular) and “cores” (plural), but is spelled the same for both usages – hence “medical corps” – “core” and the several “staff corps” – “cores”.]

From the beginning of our Navy, officers responsible for navigating and operating our ships – we call them “line officers” nowadays – depended upon “civil officers” to manage the ships’ supplies and pay the crew – pursers; to render medical and surgical care – “surgeons”; and to tend to crewmembers’ spiritual and moral guidance – chaplains. The Naval Act of 27 March 1794 directed that the surgeon and the chaplain be “appointed and commissioned in like manner as other officers of the United States are”, but that the purser be “employed” as a warrant officer, “appointed [but not commissioned] by the President…”. It also specified their pay and subsistence. For instance, the ship’s Captain earned $75 a month plus 6 rations a day. His lieutenant received $40 and 3 rations. The surgeon fared pretty well at $50 and 2 rations, the chaplain rated $40 and 2 rations as did the purser. Note that a ration included a pound of bread and a pound and half of beef or pork each day, along with a variety of fillers like beans or rice, and a pint (that’s 16 oz!) of distilled spirits or a quart of beer, daily.

Despite their equivalent pay and subsistence, the line officers still looked upon these men as something less than “real officers”, and hence the notion of corps of “staff”, vice “line” officers had its origin.

Supply Corps. The Navy Supply Corps (“core”) dates its origin with the establishment, in 1795, of the office of Purveyor of Public Supplies in the Department of Treasury. This act was done to organize and supervise the purchase and distribution of all supplies purchased by the federal government. Ships’ pursers, who managed the supplies and money provided by the “public”, naturally fell under the purview of this office. Pursers functioned like today’s civil service personnel, with no formal rank, until 1841, when General Regulations of the Navy and Marine Corps of the United States adopted a system of “assimilated” (or “relative”) ranks: pursers of more than 12 years’ service would rank with commanders and of less than 12 years, with lieutenants. These ranks were “relative”, though, because a line officer, even of lower rank, would still have precedence in the command structures of naval establishments ashore and at sea. While not specified in the Regulations, one assumes pay followed rank.

Supply Corps “Device” or symbol. It is worn on the left collar of service and work uniforms, and above the sleeve rank stripes on dress uniforms.

The Naval Appropriations Act of 22 June 1860 declared, “That pursers in the navy of the United States shall hereafter be styled paymasters, and that all laws and regulations applying to them as pursers, and all responsibilities and obligations attaching to them as such, shall remain in full force, and continue to apply to them, under the title of paymasters…”. Paymasters apparently fell under a newly established Pay Corps, but I was unable to find any specifics despite a diligent internet search. A single line in the Naval Appropriation Act of 11 July 1919 provided that henceforth the Pay Corps would be called the Supply Corps. A Navy careers website details Supply Corps duties thus:

…[Y]ou will perform executive-level duties in inventory control, financial management, physical distribution systems, petroleum management, personnel transportation, and other related areas. You might:

• Analyze the demand for supplies and forecast future needs
• Manage the inspection, shipping, handling, and packaging of supplies and equipment
• Direct personnel who receive inventory and issue supplies and equipment
• Evaluate bids and proposals submitted by potential suppliers
• Study ways to use space and distribute supplies efficiently
• Determine the fastest, most economical way to transport cargo or personnel
• Oversee the handling of special items, such as medicine and explosives.

Chaplain Corps. [Continental] Navy Regulations of 28 November 1775 stated, “The Commanders of the ships of the thirteen United Colonies, are to take care that divine service be performed twice a day on board, and a sermon preached on Sundays, unless bad weather or other extraordinary accidents prevent.” Only two chaplains are known to have served in the earliest iteration of the American Navy. With the adoption of the new Constitution, and with our shipping suffering the depredations of Algerian corsairs and the French navy, Congress stood up a naval defensive force in 1794. Naval Regulations issued that same year for the first time specifically provided for the assignment of chaplains to ships of the navy. The first chaplains received their commissions in 1799. While commissioned into the Navy, Chaplains served essentially as civil servants, and only the stimulus of the Civil War brought about such reforms as rank equivalency and the right to wear a symbol of their ministry, the Roman cross (“corps device” in Naval parlance), promoted among those who served an increasing sense of common purpose led to an increasing reference to their being part of a “Corps”. An Act of Congress on 3 March 1899, stipulated that the words “relative rank” were amended to “the rank of”, thus giving full and official naval ranks to all staff officers, Chaplains included. It was only with the expansion of the Navy and Marine Corps incident to the runup to World War I that the office of head of the Chaplain Corps was established, in November 1917. Congress made this office official only in 1944.

Chaplain Devices / Symbols (l to r): Christian, Jewish, Buddhist, Muslim, Hindu (proposed). The Navy has not commissioned a Hindu Chaplain. One of these devices is worn on the left collar of service and working uniforms and above the rank stripes on dress uniforms, depending upon the faith of the Chaplain.

The early Chaplains were all Protestants. But an increasing number of Roman Catholic men joining Navy ranks after the Civil War made it sensible to admit priests to the Chaplaincy, and so it is that 30 April 1888 marks the first commissioning of a Roman Catholic priest. A total of four were admitted as the 19th century closed out. World War I saw the appointment of the first Jewish Chaplain, in November 1917. He had to wear the Roman Cross device until June 1918, when the Secretary of the Navy approved the use of a shepherd’s crook to designate Jewish Chaplains. The Navy adopted the current Tablet and Star of David device in 1941.

Despite the fact that about 120,000 women served in the maritime services during World War II, the Chaplain Corps and the Navy Secretary did not see fit to admit women into the Chaplaincy, even though Navy officials received a large number of applications from ordained women. It wasn’t until 1973 that a woman was admitted to the Navy Chaplaincy, and the first Black female in 1974.

The increasing religious diversity is now being reflected in the Chaplain Corps. Several Christian faiths are represented. The Navy’s first Muslim chaplain received his commission in 1996. The first Buddhist chaplain was commissioned in 2004. In 2018, Navy authorities gave preliminary approval for accepting a humanist / “non-theist” into the Chaplaincy, but rigorous condemnation of the idea from several Senators and Congressmen brought the idea to a halt. Currently, over 800 Navy Chaplains representing more than 100 faith groups are in service. A Navy Chaplain Corps brochure describes the duties of a Chaplain thus:

• Conduct worship services in a variety of settings
• Perform religious rites and ceremonies such as weddings, funeral services and baptisms
• Counsel individuals who seek guidance
• Oversee religious education programs, such as Sunday school and youth groups
• Visit and provide spiritual guidance and care to hospitalized personnel and/or their family members
• Train lay leaders who conduct religious education programs
• Promote attendance at religious services, retreats and conferences
• Advise leaders at all levels regarding morale, ethics and spiritual well-being.

Next Time: the Civil Engineer Corps and the Judge Advocate General Corps

(c)2020 Thomas L Snyder

War Risk Insurance and Sailors (and Soldiers)

From the earliest years of the Republic (and even before*), our Congressional representatives saw the need to provide for medical care for seafarers and sailors. The 1794 legislation that provided for the construction of the Navy’s first post-revolutionary ships also prescribed the number, pay, and rank of physicians to be called to serve aboard them. Follow up legislation in 1797 confirmed the assignment of medical men to care for sick or injured officers and men. This latter Act also outlined a scheme of compensation (though not medical care per se) for officers and men disabled in the line of duty. But Revolutionary soldiers and sailors pretty much had to fend for themselves, purchasing medical care from their own funds until Congress passed the War Pension Act in 1818. Even then, the overwhelming number of claims resulted in prompt reductions in benefits. And still, medical care wasn’t part of the benefits package. It took until 1833 before a Naval Asylum opened in Philadelphia. It was the nation’s first veterans’ retirement home and hospital.

The Civil War produced a huge number of disabled veterans, including over 60,000 amputees. By and large, these men received care in military hospitals and homes operated by the U.S. Sanitary Commission. But the end of the war brought these provisions to a halt. Congress and the public debated whether pensions or homes and hospitals would be the best means of veteran support. Congress decided on both: legislation funded the creation of 11 federal veterans’ homes for long term care, starting, in 1865 with the National Home for Disabled Volunteer Soldiers, and several states and veterans’ organizations built similar homes; Congress also provided for veterans’ and widows’ pensions – the largest welfare system in the world at the time. Confederate veterans did not receive recognition for their wartime service until 1958.

World War I brought about a sea change in the whole matter of governmental responsibility for the compensation of veterans and their families for their service and their losses of life and limb. It all started with the War Risk Insurance Act of September 2, 1914. The sole purpose of this Act was to establish the Bureau of War Risk Insurance within the Treasury Department to indemnify U.S. commercial shipping and cargoes against losses due to acts war, which losses commercial insurance policies specifically exclude. The law was passed when the U.S. was still neutral, and we were exporting all sorts of products to both sides of the war in Europe. A 12 June 1917 extension of the Act provided for life and disability coverage for masters and crewmembers of ships of commerce.

Then in October 1917, the largest and most fundamental change in veterans care came into being, when Congress added provisions to provide for life insurance for servicepeople (recall that commercial life policies typically exclude coverage for losses due to “acts of war or insurrection”), for allotments of service members’ pay to their families, and, most significant to this post, for provision of health care, including such things as prosthetic limbs, for veterans of the war. This led to a patchwork of poorly coordinated programs, dissatisfaction with which led, on 9 August 1921, to a new organization, the Veterans’ Bureau. Another consolidation, by way of an Executive Order signed by President Herbert Hoover in 1930, created the Veterans Administration.

Thus did a simple desire to indemnify shippers from war losses morph into on of our nation’s largest social welfare programs.

*For instance, in perhaps the earliest attempt on this continent, civilians in Virginia established a hospital for the care of seamen near Norfolk in 1758-59.

Sources:

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

Lindsay, S. M. (1918 Sept). Purpose and Scope of War Risk Insurance The Annals of the American Academy of Political and Social Science, 79, pp 52-68. https://www.jstor.org/stable/1013965?seq=1#metadata_info_tab_contents, accessed 19 Sep 2020.

U.S. Treasury Department. (1920). Annual Report of the Director of the Bureau of War Risk Insurance for the Fiscal Year Ended June 30, 1920. Washington, Government Printing Office. https://www.va.gov/vetdata/docs/FY1920.pdf, accessed 19 Sep 2020

U.S. Department of Veterans Affairs. History – Department of Veterans Affairs (VA). https://www.va.gov/vetdata/docs/FY1920.pdfhttps://www.va.gov/about_va/vahistory.asp#:~:text=The%20second%20consolidation%20of%20federal,activities%20affecting%20war%20veterans.%22%20At, accessed 19 September 2020.

Blakemore, Erin. (2018). Pensions for Veterans Were Once Viewed as Government Handouts. History.com, History Stories. https://www.history.com/news/veterans-affairs-history-va-pension-facts

(C)2020 Thomas L Snyder

Cadet Nurse Corps (1943-1948)

A short while ago, this image popped up on my screen:

Photo: Charity Hospital [New Orleans] School of Nursing Alumni Association – http://www.charityalumni.org/Nurse-Cadets.html

It’s well known that the demands of World War II produced a shortage of civilian physicians and surgeons as doctors were drafted in droves. What’s less well known is that a similar shortage of nurses occurred in the civilian sector, as nearly 30% of graduate nurses went into the Army and Navy Nurse Corps in the first year of the war. This created a shortfall of 17,000 nurses for work in civilian hospitals and agencies.

In response to this crisis, Congresswoman Frances P Bolton (R-Ohio), a long time advocate of nurse education, introduced a Bill to establish a national program of nurse education. Passed on 1 July 1943, the new law, with a Senate-added provision that prohibited discrimination based on race, led to the creation of the Cadet Nurse Corps, administered by the U.S. Public Health Service.

To be eligible for the program, prospective Corps members from age 17 to 35 had to graduate from an accredited high school with good grades, be in good health and agree to serve for the duration of the war. In return, the program provided full tuition support, room and board, a small monthly stipend,  summer (gray and white seersucker) and winter (gray wool) uniforms, and a gray velour overcoat and gray raincoat. The uniform was topped with a “Montgomery” beret.

For their part, nursing schools had to be accredited and agree to modify their programs to permit student graduation in 30 months instead of the usual 36.

An aggressive recruitment program followed. This included a series of advertisements like the one featured here, sponsored by the Eastman Kodak Company of Rochester, NY. They appeared in woman-read periodicals such as Cosmopolitan, Vogue and Ladies Home Journal

Source: http://www.charityalumni.org/Nurse-Cadets.html

The program exceeded its recruitment goals of 65,000 annually from the beginning, and by the time it was disestablished in 1948, more than 124,000 women had joined. The non-discrimination clause had an effect too: as many as 3,000 Black women enrolled; 350 Japanese Americans gained acceptance, despite rampant discrimination even before, but especially after the attack on Pearl Harbor; and in 1945, 40 Native American women from 25 tribes entered the program at the Sage Memorial Hospital School of Nursing, located in the Navajo nation in Arizona. Of  the then 1,300 U.S. nursing schools, 1,125 participated in the program. The federal financial support they received permitted them to expand and modernize their facilities; the antidiscrimination clause integrated the Cadet Nurse Corps, the first federal professional group to be so integrated.

At the end of 2019, Congress granted CNC graduates “veteran status”. Contained in the 2019 National Defense Authorization Act, the bill requires SecDef to issue honorable discharges to the CNC alumnae. They will now be eligible for burial benefits and medals, but not for health care or any veteran pension. A belated but well-earned recognition of service in response to a critical need.

©2020 Thomas L Snyder

Sources (all accessed 1 Sep 2020):

http://www.charityalumni.org/Nurse-Cadets.html

https://uscadetnurse.org/node/4

https://en.wikipedia.org/wiki/Cadet_Nurse_Corps

https://www.wsna.org/news/2019/the-push-to-recognize-the-u-s-cadet-nurse-corps-as-veterans

https://www.womenshistory.org/articles/making-difference-us-cadet-nurse-corps

https://connectingvets.radio.com/articles/wwii-cadet-nurses-get-veteran-status-under-ndaa