History of Medical Corps Ranks – a Guest Post

by André Sobocinski*

Medical titles for the U.S. Navy were established by the Act of 24 May 1828 for the “Better Organization of the Medical Department of the Navy.”   After 1828, a Navy medical officer could serve as a Surgeon, Passed Assistant Surgeon, and Assistant Surgeon. You also see the term “Acting Assistant Surgeon” which usually denoted temporary service (a la contract) or a physician who was serving aboard a ship but has not yet received a commission or been approved by a Board of Naval Surgeons. It should be understood that Naval medical officers were called “surgeons”, but were qualified nominally to practice both medicine and surgery.

The 1828 Act provided that all candidates for appointment needed to be examined by  a Board of Naval Surgeons (AKA Board of Examiners). Upon
successful completion of the exam, the newly appointed physician would be given the title of “Assistant Surgeon.”   In order to be promoted to
Surgeon, the Assistant Surgeon needed to serve at sea for at least two years and be examined again by the Board of Naval Surgeons.  Successfully passing the board did not mean that he was automatically promoted to Surgeon.  Until vacancies occurred the Assistant Surgeon would be known as a “Passed Assistant Surgeon.”   Medical Officers could serve for years as a Passed Assistant Surgeon. We even have cases of physicians retiring from service as a Passed Assistant Surgeon.

These medical titles did not have an associated rank until 31 August 1846, when new regulations provided for “relative” ranks. Surgeons with more than 12 years of experience held “relative rank” equivalent to Navy line Commanders.  Surgeons with less than 12 years of experience held “relative rank” of Lieutenant Commanders, Passed Assistant Surgeons, as Lieutenants, and Assistant Surgeons were considered roughtly equivalent to Lieutenants (junior grade).

On 3 March 1871, the title structure was again altered.   The Navy Medical Department now had the additional titles of Surgeon General, Medical Director, Medical Inspector, Surgeon, Passed Assistant Surgeon, and Assistant Surgeon.  Each of these conferred additional relative rank (Surgeon General=Commodore (one star), Medical Director=Captain, Medical Inspector=Commander, Surgeon=Lieutenant Commander, Passed Assistant Surgeon=Lieutenant, Assistant Surgeon=Lieutenant (junior grade) or Ensign). In 1899, the Surgeon General/Chief of the Bureau of Medicine and Surgery (“BUMED”) was given relative rank of Rear Admiral (two star).

On 15 August 1918, the concept of relative rank was abolished by General Order 418. Medical Officers were finally accepted in the Naval hierarchy and
looked upon as Naval Officers (the exception to this in 1918 was the Nurse Corps). With this said, the titles Medical Director, Passed Assistant
Surgeon etc continued to be used through 1947, but after WWI were less commonly used.  A Medical Director would typically be called Captain, Passed Assistant Surgeon a Lieutenant Commander, etc.

As for Navy’s medicine’s most senior officers, from 1842-1871, the Chief of BUMED was a Surgeon,  equivalent to Commander; 1871-1899 the Surgeon General/Chief of BUMED was equivalent  to a Commodore (one star); 1899-1918 the Surgeon General/Chief of BUMED had the relative rank of Rear Admiral (two stars); from 1918 to 1965 the Surgeon General/Chief of BUMED had the rank of Rear Admiral. The only exception to this was Ross McIntire who, while serving simultaneously as FDR’s White House physician and Navy Surgeon General, held the three star rank of Vice Admiral. From 1965 to present the Surgeon General/Chief of BUMED holds the rank of Vice Admiral.

The Navy very wisely established Boards of Examiners in a day when medical education in the U.S. was unregulated and quite irregular. To assure a certain level of competence, each candidate for appointment as Assistant Surgeon had to pass a rigorous examination of his knowledge of medicine, surgery, anatomy, obstetrics and gynecology, pharmacy, legal medicine and more. For the convenience of the candidates, the Examining Boards sat at the Naval Asylum at Grays Ferry (Philadelphia), Brooklyn (Naval Hospital/School of Instruction), and later Washington, DC (Naval Museum of Hygiene/Naval Medical School).  In the mid to late 19th century examinations were also conducted  at Norfolk, VA, New Orleans, LA, and at Mare Island Navy Yard, CA.

Image: http://s277.photobucket.com/user/Sheriff__001/media/USNavyOffier.png.html, accessed 27 May 2015. The modern rank of Rear Admiral (lower half) was known as Commodore in earlier years. The Coast Guard retains the rank of Commodore for its one star flag officers.

*André Sobocinski is the Historian in the Communication Directorate at the U.S. Navy Bureau of Medicine and Surgery in Washington DC (his physical location is in Falls Church, VA). André wrote this article in response to a question about medical officer relative ranks put to the Executive Director of the Society for the History of Navy Medicine, Professor Annette Finley-Croswhite.

©2015 André Sobocinski

Paeon to Corpsmen

Recently, I came across this praise of medics. It’s from the 3rd Armored Division newsletter. It was written by a journalist who served in the 3rd AD during World War II. The story he tells could be repeated today in Afganistan and elsewhere. It’s a powerful and poignant tribute to selfless and brave folks:

© Leslie Woolner Bardsley  Woolner Index      NEXT

Frank Woolner
Journalist, Headquarters, 3rd Armored Division

Published in 3AD Association Newsletter – December, 1974

Every time I read about some gutless dim-bulb who advocates surrender rather than serving his country in a time of need I am reminded of our pill rollers. There is little doubt that many of the gentlemen who served as medics in WWII were conscientious objectors, but they didn’t run and they were major contributors to our ultimate victory.

Admittedly, back in the states (where every rookie is a self-appointed hero) those of us who were silly enough to think war a glorious adventure made bad jokes about the moral fiber of aid-men. We should have had our mouths washed out with yellow, GI soap!

Much later, in combat, our definition of bravery underwent some startling changes. It turned out that 90 per cent of us were scared blue; we performed our duties, but it was no piece of cake. I’m sure the medics were scared too, but I never saw better soldiers.

Indeed, if comparisons are necessary, then I held these crusaders of the red cross on an absolute par with the crazy, wonderful gladiators of The Big Red One, the Ninth, the Screaming Eagles – and the best of our own superb Spearhead warriors. Today I’ll buy drinks for any aging character who admits that he was a medic in the big leagues.

Whether they were company aid-men or battalion, we got to know our pill rollers in combat. They were gentle men. Few of them wanted to kill, yet they lacked no intestinal fortitude. They were as beat-up and dirty as any of us, but they were angels of mercy toting plasma and sulphanil-amide and bandages – and hope.

Ever stop to think that the medics are directly responsible for the fact that many Spearhead veterans are getting old? One of Woolner’s sage maxims is an observation that aging is an alternative; otherwise one dies young.

A certain company aid-man I knew rather intimately, due to mutual suffering in basic training and later operations in assorted beer joints, may have been typical. Maybe I should name him, but I won’t – other than to say his first name was John and he originated away back East. This guy was well-read and cultured, really officer material, yet he shook his head at the thought of killing other human beings. John went AWOL out of Camp Hood, Texas, eluded all of the MP’s, thumbed his way back East and married “that girl” in his life. Then he returned to face the music.

They gave him a month of hard labor, and he took it in stride, never complaining.

Hard labor wasn’t much fun. On several occasions I had to be watch-dog and, once, having fouled-up a given task, I had a day of it myself. You dug latrines, broke rocks and raked sand. It was dawn to dusk under armed guard. The hard labor boys were temporary second-class citizens, and you’d better believe it.

John felt that his “crime” was worth the punishment. Laughing it off, he served his sentence and went back to company duty, a buck private with no immediate dream of advancement. That man served with distinction when the guns began to pound; he was a hell of a great soldier.

Spearhead brats must realize that a red cross on arm and helmet was no armor, yet these characters scurried out under the heaviest of fire to rescue the wounded. Lots of them were killed in action, daring too much. Some were slaughtered by the spiteful SS, but more caught it because machinegun fire and artillery is indiscriminate. The rank and file of the German Army respected aid-men. Often, in surrounded pockets. Kraut and GI medics worked together to save the lives of soldiers of both sides.

There may have been medics who dogged it, but I never saw one. To those of us up front they were all heroes, and I might add that our standards were pretty high. How else do you rate a man who darts out of cover during a tremendous bombardment to succor the wounded? While brave infantrymen were crouching in foxholes and tank commanders tried to get hull-down and inconspicuous, these wonderful bastards answered every call for help.

In the Third Armored Division, as in every true lighting formation, we swiftly reached a point where “pill-roller” was uttered only if, like Owen Wister’s Virginian, “you smile when you say that!”

Commanders reap most of the glory and combat troops harvest a lion’s share of medals, but talk to “old soldiers, broke in the wars,” and you’ll find their greatest praise reserved for the unarmed medics who didn’t want to kill anybody, but who had the guts to conquer fear, to dive into a furnace and save the lives of comrades. No braver men ever served America.


Erosion of the Historical Landscape

“Fires Continue to Plague Historic Forts” is the headline in the most recent number (318) of Headquarters Heliogram, the Council on America’s Military Past newsletter. The article then details damage to structures at Fort Wayne (Indiana), Fort Niagara (upstate New York), and Fort Mifflin (near Philadelphia) over the past year. In my own backyard, the 6.0 American Canyon earthquake in August damaged several historic buildings – including the Museum and the main hospital structure – in the Mare Island Navy Yard historical area of northern California.  The Heliogram article closes: “Fires and vandalism [I’d add “nature and neglect”] seem to be a constant threat to historic sites. While some have around-the-clock security or alarm systems, many do not due to technical or financial challenges. Making repairs also costs money and many sites don’t have adequate insurance or reserves to cover the cost of [repairs of] damage.” City and other governmental agencies are often as dangerous to our history as “fires and vandalism”. My own city of Vallejo saw the wholesale destruction of historical structures – including a lovely and iconic Carnegie library – in its haste for urban renewal in the late 1960s.

Carnegie Exterior

Carnegie Library Vallejo CA. Opened 1904. Demolished 1969. Photo Courtesy Vallejo Naval and Historical Museum via http://www.carnegie-libraries.org/california/vallejo.html

Carnegie interior

Carnegie Library Vallejo CA. Interior. Image Courtesy Vallejo Naval and Historical Museum via http://www.carnegie-libraries.org/california/vallejo.html. Opened in 1904, it was demolished in an ill-advised flurry of downtown urban renewal in 1969.


And so we see that the inevitable result of the insults of time, nature, people and events – plus the lack of resources or interest to restore, preserve and protect them –  is the gradual degradation and disappearance of the most compelling records of our history – the physical evidence as represented by structures and landscapes.

So, what should historians – professional, academic and amateur – do?

First, of course, is to do what historians have always done: research and collect the information, write about it, analyze it, and make sure the historical structure, event, person, is made part of the historical record. While material published by traditional means – be it on stone, clay or paper – is pretty durable, especially if published in periodicals and books published by the hundreds or thousands, electronic publishing is problematic. Will the electronic format change? Will electronic storage “tanks” fall into disuse and neglect as time and technology move on? (The whole issue of archival storage is a topic for another day.)

Second, historians need to “sell” history to a public very interested in their past. Lectures given at libraries and museums are a natural. Lectures given to local service clubs like Rotary or Soroptimists deliver a message to community business and professional leaders, people with influence and money, people for whom “getting things done” is a way of life. Want to raise money or workers to restore a local icon? Get the Rotarians involved! Another way to deliver history to the public is by being a docent at a museum, park or historic site. Docents make history come alive by their enthusiastic and knowledgable story telling and explanations. My personal favorite is giving walking tours of historic sites; there’s something compelling about walking in the steps of the people who were part of the history you’re telling.

Third, historians need to become involved in the “politics” of restoration/reservation/protection. This may take the form of serving on the Commission that’s responsible for overseeing a community’s heritage or landmarks. Historians who give testimony or who advocate for preservation bring powerful and respected voices to any discussion about preserving our past. I know a local historian who quite literally single-handedly faced down developers and sympathetic local legislators to preserve a significant historic resource that was just weeks from being demolished for a construction project. (She gives credit to the historical society, but the reality is, she was one person – tenacious to be sure – who saved an important historical resource.) Public advocacy works!

Finally, historians can learn how to establish tax-exempt foundations to support preservation efforts of important resources. It’s easy to do – Nolo Press publish a handy go-by that really works. I know because I’ve set up three 501(c)(3) non-profits using their publication. Of course the non-profit corporation is just the first step. After that, you have to go out and beat the bushes for money. See steps two and three above. And recruit friends, colleagues and relatives to help out!

There you have it. Historians working to preserve our past by researching and publishing it, by selling it to a public hungry to know more, by advocating for restoration/preservation/protection at a local governmental level, and by raising funds for those efforts. No small order, but committed action does get results.

Tell us what you have done in your community. Give us your best ideas and best practices for restoring/preserving/protecting our past. Post your comments and I’ll make sure our readers see them.

©2014 Thomas L Snyder, MD


Whither the History of Medicine (Again…)

Last month, in an article entitled Offline: The moribund body of medical history, Lancet Editor-in-Chief Richard Horton opined that, since the 1980s, medical historians have lost the bubble on “important issues of the past as they might relate to the present.”  He declaims that the academics dominating the field have somehow forgotten that  the esteemed Owsei Temkin (a father of the study of medical history in the west) related the history of medicine to the social, cultural, political and economic milieu in which the art and science are practiced. Temkin, he says, felt that historians, more than mere toters-up of medical events, should interpret the ebbs and flows of this most human of human endeavors. Citing what he sees as a dearth of current relevant historical inquiry, Horton’s damning peroration is: “So where are the historians of today to illuminate the past as we struggle with the aggressive commercialisation of medicine, failures of professional leadership, notions of free will and death, misuse of medicines, paralysis in public health policy, or catastrophic failures of care? They appear to have evaporated, leaving a residue of dead and inert dust.”

University of Manchester medical historian Carsten Timmerman, replying in the Guardian blog The H Word, begged to differ. He lists several recent works that offer the kind of inquiry Horton despairs of seeing ever again, and points to his own bookshelf as proof. But here, Timmerman admits, may lie the problem. The books on his shelf are probably on the shelves of other medical historians, and that’s about all. He allows that there are so many historians of medicine now that they mostly content themselves by discussing the high topics of the day – with each other. So what Horton sees as a coffin may simply be an historical echo chamber!

Timmerman offers an answer to this problem of communication, and it’s one that will be familiar to readers of this blog: make your historical work relevant by talking to doctors and other health care givers. To this I would add, talk to the general populace by participating in the debate about social and medical policy through op-ed articles, letters to the editor, media interviews, and talks at your local Rotary club.

©2014 Thomas L Snyder, MD

A View of the People’s Liberation Army Navy (PLAN) Hospital Ship ”Peace Ark”

I’ve written about hospital ships before. Since then, I have privately wondered if there was a combat-casualty role for them in the modern world of sophisticated forward combat care hospitals and air transport to evacuate the most severe combat casualties to the highest levels of care. Moreover, big gray ships are increasingly being fitted out with sophisticated medical capabilities. In my posting on hospital ships, I mentioned the German Berlin-class Fleet Support Ship as an example. US amphibious ships, intended to provide support for Marine Corps operations, are all fitted out for surgery; the new USS America (LHA 6) will have expanded medical spaces in view with her capability to take on casualties by helicopter evacuation.(1) With this apparent move away from big white ships with big red crosses, whither hospital ships?

Peoples' Liberation Army Navy Hospital Ship "Peace Ark". Xinhoa Photo

People’s Liberation Army Navy Hospital Ship “Peace Ark”. (Xinhua Photo; Source: USNI News)

Enter the PLAN’s Peace Ark. This bwswbrc, the only Type 920 Hospital Ship in the Chinese inventory, possibly the only active PLAN hospital ship of any class, made a dramatic appearance at the recently concluded RIMPAC 2014 exercises. The Naval Institute news blog carried a nice article on the ship on 23 July.(2) Featured was Senior Captain Sun Tao, identified as the officer in charge of the ship’s medical detachment. Captain Sun told his interviewers that, when not under way, the ship carries a crew of 113 and a 20 person medical detachment. When at sea, the crew would increase to 300+ and the medical detachment to around 100.

While capable of receiving war casualties by helicopter, boat or high line, it appears that the ship has been used mainly for humanitarian / public affairs visits since it was first deployed beyond Chinese waters in 2010. Her most recent overseas activity was a humanitarian mission to the Philippines after super typhoon Haiyan.

The ship is fitted out with 8 operating rooms, 20 intensive care beds and 300 general care beds. Apparently, much of her medical gear is manufactured by the Dutch firm Phillips. She is equipped with an ultrasound suite, and CT and x-ray

Senior Captain Sun Demonstrates an Operating Room in PLAN Hospital Ship "Peace Ark" (Source: USNI News)

Senior Captain Sun Demonstrates an Operating Room in PLAN Hospital Ship “Peace Ark” (Source: USNI News)

capabilities. Interestingly, even her life boats are equipped to handle up to 18 stretchers or 24 ambulatory patients. Captain Sun showed off a gynecological examining room; this was a space, he said, that was particularly useful during humanitarian missions.

Given that navies of the world are apparently building ever more med-surg capability into big gray ships that are capable of protecting themselves against terrorist attacks, one is left wondering if hospital ships have any military utility at all. On the other hand, the dramatic good-will advertising power of a big white ship with big red crosses showing up in times of humanitarian need, makes the civilian utility of such vessels pretty obvious.

©2014 Thomas L Snyder, MD

(1) Defense Media Network Article “USS America (LHA 6) – a different kind of gator”, accessed 2014August06

(2) USNI News Article “Peace Ark: Onboard China’s Hospital Ship”, accessed 2014July24

On Reaching Age 70

In a 1905 speech marking his departure from the Johns Hopkins medical faculty, the revered William Osler offered that he had “two fixed ideas” about age. The first of these “is the comparative uselessness of men above forty years of age”, evidence for which, as he saw it, was the paucity “of human achievement in action, in science, in art, in literature -” arising from men above that age. He went on, “[t]he effective, moving, vitalizing work of the world is done between ages twenty-five and forty – these fifteen golden years of plenty, the anabolic or constructive period, in which there is always a balance in the mental bank and the credit is still good.”

Osler’s second fixed idea “is the uselessness of men above sixty years of age, and the incalculable benefit it would be in commercial, political, and in professional life if, as a matter of course, men stopped work at this age.” Osler quotes Donne stating that in ancient Rome, men at age sixty and beyond were denied the vote and were referred to as Depontani “because the way to the senate was per pontem [by way of the bridge], and they were not permitted to come thither.” He then cited – tongue firmly in cheek, I believe – Anthony Trollope’s novel “The Fixed Period” where that author advocates for “the admirable scheme of a college into which at sixty men retired for a year of contemplation before a peaceful departure by chloroform[!]“.

I retired – at Osler’s prescribed age 60 – from a very busy practice of urology. Part of my motivation was that the specialty was undergoing a sea change in surgical technique – to a much more laparoscope-based approach. I expected this would take me a good 3 or 4 years to master, just about in time to retire anyway. Better to make room for younger people brought up in the new surgical environment.

"The Astronomer" by Vermeer  (Credit: http://vermeer0708.wordpress.com/about/)
“The Astronomer” by Vermeer
(Credit: http://vermeer0708.wordpress.com/about/)

But no chloroform exit for me! In fact, enjoying a “comfortable” retirement has given me a sense of what it must have been like in 17th and 18th century Europe when men of means, who did not have to work for the next meal, could spend their mental energy immersed in artistic, literary or scientific endeavors. And thus it’s been for me in the intervening 10 years: I’ve researched and written some history and some commentary, In 2003, I founded the Society for the History of Navy Medicine to serve as a scholarly home for people interested in research, study and publication in the history of maritime medicine. For the last 2 years, I wrote a nearly weekly blog on various medical history topics (I just “retired” from these last two endeavors, on my 70th birthday). And then, there is “Community Involvement”: a Rotary club presidency, reorganizing the Fleet Admiral Nimitz Chapter of the Association of the United States Navy after decades of unconscionable silence; leadership in historical organizations both local and national; and recently, chairing a committee to establish a Poet Laureate program for my city.

One of the saddest things I observed in my practice were men whose lives essentially ended with retirement. With no “purpose” in life, these men descended into sometimes dreadful depressions. But for no reason! I believe that, in any community, all one has to do is let it be known that one is retired, and the phone will ring off the hook with offers of opportunity for community service. This is often joyful work, done alongside other people of good will who are doing it simply because they want to!

So, at age 70, at the beginning of the “third half” of my life, my calendar is “booked” right up through my 75th year. If I were to die tomorrow, I’d do so satisfied with a life well lived – but really pissed because there’s so much more I want to do!

This article was originally posted to my blog “Of Surgeons and the Sea” on 30 April 2013

©2013, 2014 Thomas L Snyder, MD


Of Ships and Surgeons Going “Private”

I started this blog when I was the Executive Director (Founding) of the Society for the History of Navy Medicine. I intended the blog to be the public voice of the Society, and so it was during my directorship of six years. When the Society’s next Director, Jim Dolbow took the helm, he created a blog specifically (and appropriately) for Society news and events. I suspect that the Society’s third Executive Director, Professor Annette Finley-Croswhite will expand the use of that site to get the Society’s word out. Given the firm establishment of the Society’s blog, I believe now’s a good time to take this blog, which is really my personal “historical” statement, “private”. Henceforth, the blog will be my personal means of communicating maritime medical history and commentary to the world.

After posting an article (typically of 400 – 600 words, and usually a researched historical piece) a week here for nearly two and a half years, my brain was pretty much sucked dry – I REALLY respect professional writers who must work to a weekly deadline for a whole career! – and the muse left me. But now, after a year’s sabbatical, I think it’s time to tiptoe back into the arena. Accordingly, I will post such occasional piece here, either history or commentary, as I am moved to produce. I hope you gain some benefit from these scriblings

The Blogger-in-Chief

(c) 2014 Thomas L Snyder, MD

The Grog, Issue 37, 2013 (A Journal of Navy Medical History and Culture)

The latest “ration” of The Grog, A Journal of Navy Medical History and Culture, is now online and can be found on our website here.

According to Andre Sobocinski, editor and historian, “In this edition, we look back at the U.S. Navy’s long history with sharks–from curious cases of shark attacks documented by Navy physicians to the development of “full-proof” repellents.  We follow this with an assortment of original stories and sidebars ranging from a look back on the life of a long-living World War II Prisoner of War and the service of Navy flight nurses in the Pacific and in Brazil to the recollection of Surgeon General Edward Stitt’s “Budget Battles” and a glimpse at the Navy Medical Department in 1963.

As always, we hope you enjoy this journey on the high seas of Navy Medicine’s past!”

Guest Blogger: Chaplain Dave Thompson on Non-Combat Casualties

Our blog-friend Chaplain Dave Thompson joins us for another post. This time, he writes about the matter of non-combat casualties of war since the Civil War.

As you are well aware, I have been trying to tell the story of disease in our wars…especially WW I ( The Great Flu Pandemic of 1918 in WW I), which cost more lives than combat in that conflict, For every American war before WW II, this largely was the case… death to disease trumped all combat deaths in these conflicts!.

In the Civil War a similar phenomenon of more deaths to disease than combat occurred (see: http://www.civilwarhome.com/casualties.htm ). Of the 618,000 soldiers who died in the Civil War, 2/3rd’s of them died of disease (414,152) and only 1/3 died in combat (204,070).

Then there were an additional 24,866 soldiers who died in prison due to disease and mistreatment as POW’s by both Union and Confederate forces!Outside of McKinley Kantor’s Pulitzer Prize Winning novel of a Confederate POW camp in SW Georgia,  Andersonville (see: http://www.amazon.com/Andersonville-Plume-MacKinlay-Kantor/dp/0452269563/ref=sr_1_1?s=books&ie=UTF8&qid=1362578878&sr=1-1&keywords=andersonville ), much of  the darker story of neglectful treatment of POW’s in the Civil War, on both the Union and Confederate sides, is rarely told today in general American History texts covering the 19th Century. See the Camp Sumter/Andersonville POW Prison story ( http://www.nps.gov/ande/historyculture/camp_sumter.htm ), where 45,000 union POW’s were imprisoned (see:http://www.nps.gov/ande/historyculture/camp_sumter.htm ), and where 13,000 died of a variety of diseases (see: http://www.nps.gov/ande/historyculture/causesofdeath.htm ).

Andersonville’s decrepit conditions were chronicled in the diary on P.O.W Newell Burch. Burch of the 154th New York Infantry, was captured the first day of the Battle of Gettysburg and imprisoned at Belle Isle and then Andersonville. He is credited with being the longest held Union Soldier during the Civil War, a total of 661 days in Confederate hands (usgwarchives.net). His diary is currently possessed by the Minnesota Historical Society.

The breakdown of casualties to disease and battles was quite interesting. Again, the stunning statistics of disease in war (over 66% of Civil War soldiers died in bed not in battle) that is often airbrushed out of our American histories, only telling the “glory” side of war.  More Civil War soldiers died of dysentery and diarrhea alone (way over 200,000) than were killed in all the battles and battlefields of the Civil War. Yet, you don’t see that kind of detail dealing with sickness in Civil War museum exhibits or re-enactments of battles…no field hospitals are built in rear areas in these re-enactments, nor any effort made to tell the general public the story of disease that accounted for the deaths of 2/3 of all the Civil War deaths in the Union and Confederate Armies. Many Americans are ignorant of this fact as we near the 150th Anniversary of the Civil War.

The “other war” against disease in conflicts is the kind of military history that is not talked about a lot in our “battle-centric” telling of war stories. Fundamentally, I sense, especially among military historians a problem in methods of historiography which focuses on battles as the easiest and most interesting things to report in a conflict, as well as an easy way to add up winners and losers by territory conquered or numbers killed (KIA) or  wounded (WIA). Meanwhile, lurking in the background are less jazzy statistics, like death dealing diseases in rear area cantonments, that cumulatively would trump the numbers of any combat casualties of a particular battle, campaign, or war.

Thus, we often ignore this larger background story of disease in war that dismally claims massive numbers of victims by a 2-1 margin in rear area field and general hospitals and POW camps, because it may have little to do with a 2 or 3 day battle like the Battle of Gettysburg. Unless a disease struck in the middle of a battle (like the 1918 Flu Pandemic did at the height of the Meuse Argonne Campaign in WW I, where General Pershing’s AEF was being decimated by this malady that made so many troops ineffective in  that battle), little is ever said in the course of a war about the role of disease in a war (except that written by medical historians and buried in medical record archives of the Army and Navy). Only in long Civil War sieges like that of Vicksburg or St. Petersburg, or the discovery of terrible health conditions in POW camps, would reports of sickness creep into a battle history, and then only in a sentence or paragraph of historical commentary, before getting back to what really was interesting…the movement of the chess pieces of armies and stories of bravery of solders, marines or sailors in combat.

Yet at the end of the war, when you add all the casualties related to cause of  death, we are shocked to discover the overwhelming numbers of those who lost their lives to disease…and a fair minded person asks, “where did that come from?” This big under-reported story of disease during the progress of a war is often ignored in our battle-centric focus of war reporting and military history inquiry, causing this “end of war statistic” to jump out at us after the war is over… but the military histories have already been written excluding this stark fact.

This dismal and boring aspect of disease in war largely goes under-reported in war…just like the story of logistics in war…the thousands of logistics ships and convoy escort ships that kept our forces going for four years to Europe and across the Pacific in WW II (a really big story of one of the main reasons we won WW II, which was lost in the historical glitter and clutter of reporting only 2 day to a week battles at sea…at Midway, Coral Sea, the “Slot” off of Guadalcanal, and Philippine Sea…or the terrible Pacific Island campaigns fought by sailors and marines that each took several weeks to a month per island). My eyes were opened to this little told “boring” logistical history, when I served on the USS Sacrament (AOE-1) that kept a whole aircraft carrier battle group going in beans, bullets/bombs and ship and jet fuel and supplies and mail  for a deployment in the Western Pacific and Indian Oceans (see: http://en.wikipedia.org/wiki/USS_Sacramento_%28AOE-1%29 ). Wars and combat operations would grind to a halt in weeks without this logistical tail working well. Rarely is that story told in our histories.

You are then struck with the challenge of historiography…how we select what we report on and what we ignore in our telling of military history. My sense is disease has not been given equal billing…or at least paid its due, in many of our American war chronicles of military history. It would make a great topic at a convention of military historians…and hopefully the presenter would not be thrown out of the presentation room for pressing for better reporting of this often lost story of the “other war” with disease that goes on in every one of our conflicts. The diseases change from war to war, but the challenge remains: Today we still face the danger of a variant of the 1918 flu pandemic bug getting away for us with CDC estimates of 100 million casualties…or “super drug resistant bugs” that can overwhelm a military hospital full of wounded military personnel and kill through infection many servicemen in record time.

As a former Navy Fleet Hospital Chaplain for a 500 bed combat zone fleet hospital,  I am impressed with this side of war that a lot of chaplains in military hospitals, as well as military doctors, nurses and medics/corpsmen, see with great regularity. It is not the glory side of war, but the gory side of war…with field and general hospitals filled with wounded warriors and service personnel stricken with all manner of death dealing diseases, soon forgotten as the battle moves on…and the story quickly moves on to the next battle or campaign.

The big lesson of history in our wars is the critical role our military medical departments play in dealing with wounds of war and infectious and debilitating diseases of the battlefield that can swallow large portions of armies and navies over the course of a war. It is a cautionary tale to military leaders not to neglect paying attention to disease in war that easily can kill more service personnel than any combat they may encounter. The record of history is clear that to ignore the medical aspect of military operations is to traverse into a deadly kill zone at one’s own peril with often devastating consequences. Only as we report this “other war” against disease and it becomes part of our military histories and learning from past conflicts, will we remain vigilant and prepared to fund and support efforts to deal with future medical challenges of disease on the battlefield.

Well, I have waxed long on the topic of disease getting better billing in our military histories. You are welcome to float this topic at a convention of military historians, but I am not sure what kind of reception you will receive. The “glory story of war” bias is alive and well among many military historians who see reporting diseases during wars as a distraction from what really is important in military history…reporting battles, campaigns and politics of war.

All I would hope would happen is an act of inclusion of reporting on disease among military historians…not exclusion …not diminishing the acts of valor or sacrifices of combat…but including better reporting of the role of disease in war in keeping with the scope and dimension of the problem… in the larger sphere of military history reporting.

©2013 David Thompson

Guest Blogger: Chaplain Dave Thompson on World War I Flu and Combat Deaths, as Seen Through a Wisconsin Lens – and, a World War I Memorial

Chaplain Dave Thompson, USN, RET, has become something of a regular correspondent. Regular Readers may remember that the 1918 Influenza pandemic is one of my core interests, so when Dave sent this piece on flu and combat deaths among Wisconsin soldiers, I took notice. Now you can, too. Jim also mentions efforts to create a World War I Memorial on the National Mall in Washington,DC.
archives (1)
Herewith, Chaplain Dave:

I came across an interesting document yesterday demonstrating the impact of disease to combat deaths of a 50:50 ratio in WW I. The Gold Star List is quite a document and testament of the huge role disease played in WW I.  “Wisconsin’s Gold Star List: Soldiers, Sailors, Marines, and Nurse casualties for WW I”, was written in 1920 shortly after WW I and spells out in detail the cause of death of all Wisconsin service personnel in WW I (see: http://www.accessgenealogy.com/worldwarone/wisconsin/ ). The Wisconsin Gold Star list encompasses soldiers, sailors, marines and nurses who were casualties from that state by county listing in WW I (click on any county to look at the list).

The Wisconsin WW I Gold Star List takes cold national statistics of 50,280 combat deaths, 57,000 deaths to disease (with 52,199 being  American  troop deaths due to the pneumonia/influenza epidemic of 1918), and the remainder due to suicide and accidents to make up 116,000 deaths  of American Service personnel in WW I… and it personalizes these large casualty figures into cause of death and assigns real names to people who “just lived down the block” from our relatives, before going off to war and never returning. It helps us better remember all those who lost their lives in World War I due to combat action or the Great Influenza/pneumonia Pandemic of 1918.

What makes Wisconsin WW I Gold Star List so unique is, outside of North Carolina, to my knowledge, no other state did this kind of historical retrieval of information on WW I casualties and put it in one organized place like this for states to commemorate WW I (usually the names of Army personnel are buried in Army division casualty lists and are not organized by state to see the impact of World War I upon a state and counties and cities within their boundaries.

This document really brings the cost of war home to Wisconsin residents, who knew these people or their families. Many grand-children and great-grandchildren will recognize their loved on from such a list and it makes more personal for all American the cost of World War I in human lives.

Also, what makes Wisconsin a rather unique study of casualties is: It gives a much more balanced reporting of casualties at home in WW I U.S. military training camps where some  30,000 service personnel died of the flu, as well as  identifies  flu/pneumonia deaths and other diseases WW I servicemen suffered with the AEF in Europe, along with combat casualties and death from wounds and accidents.

Any objective reader of these lists can see the stark, almost equal proportions of casualties between those who lost their lives to disease (mostly to pneumonia, which  was the last stage of the influenza that raged through our armed forces in 1918 during WW I)… as well as listing those who lost their lives due to combat action with the American Expeditionary Forces in Europe WW I.

The 32nd Red Arrow Division from the Wisconsin National Guard was involved in heavy fighting in Europe involving its citizen solders in heavy combat, unlike many other states that never got their National Guard units overseas. The 32nd Division suffered the 3rd highest casualties  of AEF Army Divisions in WW I, 13,261 casualties (2,250 KIA & 11,011 WIA) in WW I. They were in the thick of the fighting  in the Meuse Argonne Offensive when the Great Influenza/Pneumonia Epidemic struck our AEF forces in Europe in 1918.

The 32nd Division was also used in post-war occupation duty in Germany and some of its subordinate units were used in an expedition to Russia to support the White Russian Army against the Red Army in 1919 (suffering casualties to disease, including the last wave of the influenza/pneumonia epidemic in 1918-1919). They came home to Wisconsin in the summer of 1919, serving much longer after World War I than many other Army units and WWI soldiers who were not part of occupation duty and were demobilized much earlier.

The Gold Star List records deaths due to combat action (killed in action or “KIA” or Died of Wounds or “DW”), accidents, suicide, murder, and death due to disease or “DD,” spelling out the specific disease that claimed their life…including many influenza and pneumonia deaths caused by the 1918 Flu Pandemic.

I have taken 10 samplings from around the State of Wisconsin to demonstrate how both disease (mostly the influenza/pneumonia epidemic in 1918) and combat contributed to this list in almost equal proportions (see: sample below):

(1)  Ashland Country (Northeastern Wisconsin): 39 casualties, with 23 dying of disease (19 by influenza/pneumonia  and 4 by other diseases)  and 16 dying from combat (14 KIA and 2 died of wounds).

(2)  Brown County (East central Wisconsin around Green Bay, WI):  46 casualties, with 28 dying of disease (23 by influenza/pneumonia and 5 by other diseases) and 18 dying from combat(12 KIA and 6 died of wounds).

(3)  Dane County (South Central Wisconsin near the State Capitol in Madison, WI) : 142 casualties, with 77 dying of disease (60 by influenza/pneumonia and 17 by other diseases)  and 65 dying from combat (52 KIA and 13 died of wounds).

(4)  Douglas County (Northern Wisconsin around Superior, WI on the border with Duluth, MN): 51 casualties, with 27 dying of disease (23 by influenza/pneumonia and 4 from other diseases) and 24 dying from combat (15 KIA and 9 died of wounds).

(5)  Eau Claire County (North Central Wisconsin near Eau Claire, WI): 50 casualties, with 29 dying of disease (27 by influenza/pneumonia and 2 from other diseases) and 21 dying from combat (19 KIA and 2 died of wounds).

(6)  Fond du Lac County (South Central Wisconsin near Fond du lac, Wisconsin): 77 casualties, with 34 dying of disease (28 by influenza/pneumonia and 6 from other diseases) and 43 dying from combat (29 KIA and 14 dying of wounds).

(7)  Kenosha County (southeast corner of Wisconsin near Kenosha, Wisconsin on the Illinois border): 43 casualties, with 23 dying of disease (21 by influenza/pneumonia and 2 from other diseases) and 20 dying from combat (13 KIA and 7 dying of wounds).

(8)  La Crosse County (southwestern Wisconsin near La Crosse, WI on the southeastern border of MN): 55 casualties, with 29 dying of disease (24 by influenza/pneumonia and 5 from other diseases) and 26 dying from combat (14 KIA and 12 dying of wounds).

(9)  Milwaukee County (south eastern Wisconsin near Milwaukee, WI): 387 casualties, with 165 dying of disease (118 by influenza/pneumonia and 47 from other diseases) and 222 dying from combat (183 KIA and 39 dying of wounds).

(10) Waukesha County near Waukesha, WI in southeastern Wisconsin, a western suburb of Milwaukee, WI): 61 casualties, with 43 dying of disease (38 from influenza/pneumonia and 5 from other diseases) and 19 dying from combat (15 KIA and 4 dying of wounds).

A fair and balanced picture of WW I casualties in this sample of 10 representative Wisconsin Counties is that 478 service personnel died of disease (381 died of the influenza/pneumonia epidemic of 1918) and 474 died of combat…almost in equal numbers,

This state sample from Wisconsin squares pretty much with national statistics of the close to 50:50 ratio between casualties to combat and those to disease in WW I.

Hopefully the newly created  WW I Centennial Commission created this year and any WW I Memorial that may be created on the Mall in Washington, DC might reflect this balanced perspective on WW I casualties and tell the story of WW I to reflect the losses both in combat and to disease in The Great War.

This is an interesting and valuable document that tells in a more balanced way the terrible cost of war and the role disease (especially The Great Flu Pandemic of 1918)… as well as combat… and how it played out in this conflict, which claimed the lives of 116,000 servicemen (many whom have yet to be properly recognized in a National WW I Monument or in our many county, state or national museums covering World War I.

I hope you find this interesting and helpful information to include in the WWI story, as we prepare for the Centennial of WW I and consider an effort to have a National WW I Monument built on the Mall in Washington DC by 2018.