Monthly Archives: May 2010

We Remember Our Fallen Medical Comrades–And a Call for Vigorous Protection of Medical Workers under the Geneva Conventions

In the early 1980s, when I served as medical officer for a minesweeping squadron, we were called upon to sweep* the shipping channel in the Sacramento River–someone had called in a mine threat because a Russian grain ship was to pass through. I wanted to ride the ‘sweeper to observe the sweeping operations, but my Commodore said “I want you on the beach with me, doctor; if people get hurt out there on the water, I want you here safe to be able to take care of them.” The prudent commander protects his medical assets.

Medical personnel have long accompanied their comrades in times of war, and they were traditionally protected from intentional attack by gentlemen’s agreement between the armies’ generals. This all changed in the mid nineteenth century when the killing power of modern armies was markedly increased, and the fluidity of battleground movement made it increasingly difficult to protect–or even to identify–the medical personnel of the opposing side. The appreciation of this was a major impetus for the development of modern humanitarian law which sets out protections for medical personnel in fields of armed conflict. As part of their Geneva Convention protection, medical personnel were to wear the Swiss red cross to make them easily identifiable both to friend needing aid and to foe so he could shift his fire. As a result, for a time, most wartime deaths and injuries of medical personnel were caused by disease or accident.

Nevertheless, Navy medical personnel go in harm’s way to accompany their Marine and sailor comrades, and they often pay the ultimate price. 18 American enlisted and officer medical men died in service of the U S Marines in World War I, and 165 were wounded or gassed. Medical personnel were among those who died in the Pearl harbor attack, and in total 1170 Navy Corpsmen died during World War II, most in service with the Marines in the Pacific, including 132 who succumbed to the privations and maltreatment they received in Japanese prisoner of war camps. Navy nurses also served and suffered–21 languished in Japanese POW camps and several died from injuiries suffered from a kamikazi attack on hospital ship USS Comfort. In Korea, 108 hospital corpsmen serving with Marines were killed in action, and in Vietnam, 638 died, a rate 120% greater than that of their non-medical comrades. I could not find data for medical casualties in Gulf War I and succeeding conflicts, but we can expect to see those sad statistics, especially in view of the fact that medical personnel now serve very far forward in the field of battle.

One deplorable trend has become apparent since the Vietnam conflict: the deliberate targeting of forward deployed medical personnel. Because they wore the Geneva Convention-specified Red Cross, Navy and Army corpsmen were often specifically targeted by the enemy in Vietnam. As a result they no longer wear the distinctive mark of their medical calling. Even so, corpsmen tending to wounded Marines and soldiers often come under specifically aimed fire from enemy fighters. We need to teach the lesson of history here: in the nineteenth century, army generals, and later the international community, saw significant value in protecting the medical people who take care of the wounded–of both “sides”–in combat. The result was the Geneva Conventions. Those Conventions call for the arrest, extradition and prosecution of people responsible for intentionally attacking medical workers in the field of battle. It’s time for the international community to take seriously this treaty obligation and to vigorously pursue, arrest and prosecute those responsible for the atrocity of intentional attacks on battlefield care givers.

* We found no mines during that sweeping operation–just a bunch of junk like old refrigerators and even the carcass of a car–and the Russian grain carrier transited safely to the San Francisco Bay.

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Society Members Write Books-3

Members of the Society for the History of Navy Medicine are active in their scholarship and publishing. Member Annette Finley-Croswhite and her associate Gayle K Brunelle have recently published Murder in the Metro: Laetitia Toureaux and the Cagoule in 1930s France . It’s a real spy and mystery story set in pre-World War II Paris.

The book reads like a mystery novel, but it’s based on the real life (and death) of young factory worker Toureaux, who was found murdered–the first ever on the Paris Metro–in 1937. The case was never solved.

Historians Finley-Croswhite and Brunelle have well and truly done their historical homework in piecing together information from French government documents to tell a tale of conspiracy and intrigue. Their historical detective work actually offer leads to the identity of the murderer.

National Maritime Day

Saturday 22 May is National Maritime Day; it is being celebrated in parallel with World Maritime Day, and is an opportunity to reflect upon our maritime heritage and the necessity of the maritime realm to our prosperity.

The Society for the History of Navy Medicine has for its motto Aesculapius commisit pelago ratem meaning, roughly “Aesculapius has gone down to sea in ships”–medicine may be presumed to have been part of the human maritime venture since the earliest times. Seafaring men (and thus it was until relatively recent times) must have recognized the need for skilled medical attention in an environment that is hazardous and often inhospitable. While documentary evidence is hard to find, one can imagine that the wound doctors of ancient Mesopotamia and Egypt counted among their patients victims of injuries suffered aboard vessels of commerce plying the waterways of the fertile crescent and Mediterranean.

Athens was from the earliest times a maritime city, depending upon her Navy to protect her colonies and commerce and to fight wars against rivals. Homer describes two sons of Asclepius–Podaleirios and Machaon–as healers as well as fleet masters in the expedition against Troy.

To the Romans we owe the first western documentary (gravemarker) evidence of seagoing physicians who served in the Roman Navy, and Roman ships given names of medical significance are thought by some to represent actual “hospital ships”. That the Roman navy operated against commerce raiders is well documented. Naval physicians were regularly paid double that of their Army brethren, presumably to compensate for the fact that Navy service was less prestigious–and more rigorous–than service in the Army.

Fast forwarding to the late 16th century, it was the Netherlands East Indies fleet, a commercial fleet, that issued lemon juice to its sailors–the first documented use of antiscorbutics in western medicine–this nearly one hundred years before British Royal Navy surgeon James Lind wrote a scholarly article on the matter and was recognized as the discoverer of the antiscorbutic benefits of citrus.

As Navies developed, physicians and surgeons were called upon to serve in ships and ashore. And as Navies developed to protect and advance the commerce of nations, the medicine and surgery of the day followed, even unto today, when navies are actively engaged in protecting commerce against the predations of pirates in many parts of the world.

Society for the History of Navy Medicine Announces Papers for Fourth Annual Meeting and Papers Session

This blog’s sponsor, The Society for the History of Navy Medicine, is pleased to announce the papers accepted for delivery at its 3 November 2010 meeting in Phoenix.

Steven Oreck, MD: “The Development of Navy-Marine Corps Medical Doctrine for Amphibious Warfare”. Steve is a retired Navy Captain and retired Professor of Orthopedics at the University of Wisconsin, and is a graduate student in history there. This paper comes from his graduate thesis work.

Daniel Grabo, MD: “Samuel D Gross: from Operating Room to Battlefield Surgeon”. Gross served in the US Civil War. Dr Grabo is ship’s surgeon in USS Enterprise (CVN 65); this June, he will begin a fellowship in Trauma / Critical Care at the University of Pennsylvania. He holds a special certification in General Surgery.

Ludwig M Deppisch, MD: “The Medical Care of First Ladies Ida McKinley, Ellen Wilson and Grace Coolidge”. Dr Deppisch is author of the acclaimed book “The White House Physician: a History from Washington to George W Bush”, which has been highlighted on this blog. A pathologist, Lud lives in Tucson.

The Society’s Invited Master and Commentator for this meeting is Jan Herman. Jan is the Historian of the Navy Medical Department and is widely published on Naval medical historical topics.

You can find updated meeting details–including registration and housing information–on the Society website.

Recent Books by Members of the Society for the History of Medicine-2

The Mission of the Society for the History of Navy Medicine is to encourage research, study and publication of all aspects of the history of maritime medicine.

Society member James O Finnegan, MD, was a combat surgeon in Vietnam during the siege of Khe Sanh. His book In the Company of Marines: A Surgeon Remembers Vietnam relates his experiences and brings forth the tremendous respect Finnegan developed for the Marines with whom he served. The Marines must have held Dr Finnegan in pretty high regard, too, for they saw to it that he was awarded a Bronze Star with Combat “V” to accompany his Purple Heart–and the Marines are known for taking such awards very seriously.

With often poignant and moving vignettes, his is a very personal take on a unique corner of the history of Navy medicine.

Jim Finnegan practices general and thoracic surgery in Pennsylvania.

U S Navy Nurse Corps Established This Date 1908

In the fourth volume of Medicine and the Navy, their history of the Royal Navy, Christopher Lloyd and Jack Coulter say that the development of the (British) Naval Nursing Service was a “long and tortuous process”.

The same can be said for that of the U S Navy. In the mid-nineteenth century–for instance, at the Naval Hospital at Mare Island in California–“nurses” (and called such) were always males; they were paid about the same as assistant cooks, and worked 12 hours a day, seven days a week. Their training was entirely “on-the-job”. It appears that the first females to work in U S Navy facilities did so during the Civil War, when four Catholic sisters served in this role aboard the Navy (originally Army) Hospital Ship Red Rover. They were thanked for their service and dismissed as the Civil War wound down.

A great wave of patriotic fervor during the Spanish-American War prompted many nurses and nursing associations to write the Navy Surgeon General with offers to volunteer their services to the navy. The SG invariably courteously declined these offers, indicating he thought it inappropriate for women to serve “in view of trying conditions attendant upon naval warfareā€¯. However, four women–three medical students from Johns Hopkins and a pre-med student from MIT–reported for duty at the Brooklyn Naval Hospital on 18 May 1898, and served with distinction “for the duration”.

It wasn’t long, then, before Navy Surgeon General Rixey wrote in his annual report (1902) to the Secretary of the Navy “[t]here 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 “[i]t is recommended, therefore, that Congress be asked to provide at its coming session for the establishment of a Woman Nurse Corps for the Navy, to consist at first of one superindendent [sic] nurse, eight head nurses, sixteen nurses of the first class and twenty-four nurses of the second class, these numbers to be increased at the discretion of the Secretary as the needs of the service indicate.”

Initially reluctant–perhaps for truly budgetary reasons–Congress finally assented with legislation providing for the establishment of the Nurse Corps of the United States Navy.

Immediately their service was appreciated: the Commanding Officer at the Mare Island Navy Hospital requested the assignment of more nurses to his facility within months after the first complement of 8 arrived in 1910. Navy nurses have gone on to serve in increasingly difficult circumstances with honor and valor.

Recent Books by Members of the Society for the History of Navy Medicine

The Society for the History of Navy Medicine promotes “Community, Collaboration and Camaraderie” among people who are interested in research, study and publication on all aspects of the history of medicine of navies and the maritime environment. Today, I highlight one of our member-authors.

Ludwig Deppisch has made a study of the doctors who care for American Presidents. There’s a Navy connection here, as many (if not most) Presidential physicians have been senior Naval officers. Beside telling the story of every Presidential physician since Washington’s, Deppisch’s book, “The White House Physician: A History from Washington to George W Bush” tells the stories of all Presidential physician through the ages. Lud also highlights the progress of medical art and science through the Presidential terms. (You can purchase this book by following the link on its title; by doing so, you support the work of the Society for the History of Navy Medicine.)

Lud Deppisch is a New York-born MD pathologist who now lives in Tucson.

I'll report on more books by Society members in the next several posts.

Medical Aspects of the Battle of Manila Bay

1 May marked the 102nd year of the Battle of Manila Bay (or Cavite), the opening shots of the Spanish-American War. Commodore George Dewey brought his fleet up from Hong Kong, under orders to aggressively pursue the Spanish fleet at Manila. This he did, and in a short battle on 1 May 1898, Dewey’s fleet overwhelmed the undergunned and poorly prepared Spanish.

Thanks mostly to poor Spanish gunnery, American casualties were few. The two deaths were both of non-combat causes. One was a heart attack brought on by the excitement of incipient battle. The other, sadly, was the Commanding Officer of Dewey’s flagship, USS Olympia, Captain Charles F Gridley. Gridley, ill even before the battle, suffered a quick decline afterward; he died en route to the United States, presumably of liver cancer, a month later. Only seven U S sailors were injured; almost all were able to return to duty immediately after receiving first aid type treatment, and none were left with permanent disability.

The Spanish, on the other hand, suffered grievously. At the end, 167 died, while 214 survived their injuries.

Assistant Surgeon Kindleberger, aboard Olympia, wrote in a contemporary narrative report (excerpted):

“As junior medical officer on the Olympia my station in battle was in the sick-bay situated forward on the berth-deck beneath the eight-inch turret, and close to the forward ammunition-hoist. Before we left Mirs Bay [Hong Kong] the men had been instructed in the application of tourniquets and first aid to the injured. At the same time bandages and tourniquets were distributed to each division. All were instructed to have their hair clipped short, and most of the officers and men complied. This was for better endurance of the fierce heat and to facilitate the dressing of scalp wounds.

“Instructions were also given in the art of carrying the wounded both by bearers and on stretchers, and orders were passed that all sick and wounded were to be brought at once to the sick-bay or the medical station aft. In charge of the forward bay was the senior medical officer, Dr. Price, assisted by myself, two baymen, and the apothecary. Aft was the senior assistant medical officer and Chaplain Frazier. About 6 P. M. we began to prepare the sick-bay for the coming battle. The battle ports were closed and a canvas screen placed around all the sides and on the inboard partitions to protect the surgeons and the wounded from splinters. Our instruments were laid out readv for operations; antiseptic solutions, ligatures, tourniquets, stimulants, anesthetics, etc., were placed on a table close by; and the operating-table was in position to receive patients.”

and later,

“At noon the day after the battle the Spanish evacuated Cavite. I was sent ashore to bury eight Spaniards, and landed at the hospital on the point near Cavite. I went through all its wards. The sight was terrible. It is a good hospital, with detached wards in little pavilions grouped about the central buildings. Everything was in good order and cleanly. I conversed with several of the doctors in French, as I do not speak Spanish and they had no English at command. They were extremely courteous, but to my question, “How many Spanish were killed and wounded? ” they replied sadly that they did not know. In the wards I saw over eighty wounded. The horrors of war were seen at their worst. Some of the men were fearfully burned, some with limbs freshly amputated, others with their eyes shot out, their features torn away by steel or splinters-every kind of injury that surgery records. The shrieks and groans of the wounded were appalling. I could not stay to hear them, though my profession is calculated to harden one against such scenes. Had I been working, I should have endured it, but as an onlooker it was unbearable. We had received urgent messages from these doctors saying for God’s sake to send Americans to guard the hospital against the insurgents, who, they feared, would murder them and their patients. We had posted guards as soon as possible, but not before the insurgents had robbed them of all the clothing not on their backs and all their food except enough for twelve hours…

“I shall not forget the burial of the eight men for whose interment I had been despatched with a line officer and party. We came upon them lying on a little porch behind a small hospital in the Cavite navy-yard. The bodies were mangled and ghastly. A leg was missing from one, the back of the head of another, the wall of the abdomen from a third. Those who were not instantly killed must have died soon after receipt of their injuries. Evidently they had been laid where we found them and then deserted. Shells had wrought the fearful havoc. Although dead but a few hours, the corpses were in an advanced stage of decomposition, owing to the climatic conditions. We dug a trench, covered the bodies with quicklime, and consigned them to the earth. The hospital inmates at Cavite were afterward sent to Manila under the Geneva cross in a captured steamer.”

Thanks to www.spanamwar.com; the quotes are from a Century Illustrated Monthly Magazine article cited in that website.