Category Archives: Maritime Medicine

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

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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: Tom Farrell on “Corpsmen on Mount Suribachi”

This week, we welcome CAPT Tom Farrell, MC, US Navy, Ret, as our guest blogger. Tom has been working on identifying the Navy Corpsmen present at the iconic flag raising on Mt Suribachi in the Pacific Theater during World War II. Herewith, Tom Farrell’s “say” in the matter.

CORPSMEN ON SURIBACHI: PARTICIPATION IN THE TWO FLAG RAISINGS

Corpsmen of Suribchi

Corpsmen of Suribchi

Thomas C. Farrell, Jr.
Captain MC USN(r) 
Raymond Jacobs
Sgt USMCR

 

“Clifford Langley was not there.” James Bradley1, thus began my search for the identity of the second corpsman that accompanied John Bradley on 1st Lt. Schrier’s patrol to the summit of Mt Suribachi.

February 23, 1945, LtCol Chandler Johnson Commanding Officer 2nd Battalion, 28th Marine Regiment after receiving a briefing from Captain Arthur Naylor that a patrol lead by SGT Sherman Watson, had successfully reached the summit of Suribachi, ordered 1st Lt. Harold Schrier to lead a 40 man patrol composed of elements of the Easy company Third Platoon and personnel from other 2nd Battalion elements up the mountain. After ascending to the summit, the patrol raised a small flag brought along on a pipe at 1030 hours. This was the first flag raised on that day and the event was photographed by Marine photographer Louis Lowery. The subsequent raising of the second, larger flag 2 hours later yielded the famous scene captured by AP photographer Joe Rosenthal. The fact that there were 2 flags raised and confusion as to whether Rosenthal “posed” his shot generated a debate. The first flag on Suribachi’s summit was an immense morale booster to the embattled Marines below. Its unfurling lead to loud cheering and  signaling from the Navy ships offshore. The Rosenthal photo had a massive positive PR benefit to the Corps and as it was the centerpiece of the upcoming 7th War Bond Drive, Commandant Vandergrif ordered all mention of the first flag raising to cease. This directive lead to an institutional ossification during which individuals in the Lowery photos were routinely misidentified in the official Marine Corps records.

My interest in the identity of the first flag raisers peaked after examination of the Lowery photo showed an extra set of hands and helmet in the photo not identified as to owner.

Thanks to the kindness of COL Walt Ford2 at Leatherneck Magazine, I was able to obtain 14 of Lowery’s photos of the event. Using available sources, I tentatively identified all the individuals in the photos. I then sent them to Raymond Jacobs3 (patrol radioman “f” Co), Charles W. Lindberg 4 (“E” Co flame-thrower) and Keith Wells 5(XO “E” Co) asking them to confirm or change my initial identities. I now had eyewitness confirmation of true identities of the participants (see photo#1). It was now clear that individual identified as Schrier holding the flag pole was actually John Bradley!

Two Navy corpsmen accompanied the patrol (plus stretcher bearers, number unknown.) The first, John Bradley PhM2c was assigned to 3rd Platoon “E” Company. The second assigned corpsman was Clifford Langley PhM2c but he was wounded on February 21, 1945 and was not part of the patrol. The identity of the second corpsman remained obscure until recently. John Bradley in an oral interview for the Naval Historical Center (www.history.navy.mil)6 recalled that he and “another corpsman by the name of Zimik (?) Pharmacist mate 2/c were the corpsmen attached to that patrol.” The publication of James Bradley’s Flags of our Fathers 7contained Rosenthal’s Gung Ho! photo. A debate over the identification of some of the individuals eventually led to the recognition of Gerald Ziehme PhM2c as a member of the patrol. His wife Judith told me that “Jerry said Bradley grabbed him and pulled him into the photo.”8 He had volunteered to go as “he had neither a wife or child” though assigned to headquarters from a replacement battalion.

Three Marine Divisions (3rd, 4th, and 5th) took part in the Iwo Jima invasion (Operation Detachment). Integral to the divisions were 100 Navy Surgeons and approximately 1000 Navy corpsmen. Casualties to these medical elements were: Surgeons 23 (2 killed ) Corpsmen 827 (201 killed ) 9. The nature of the conflict to include large amounts of artillery led to an overall killed to wounded rate of 8% overall versus 3% for WWII in general. The corpsmen’s casualty rate exceeded even that of the Marines. Four corpsmen were awarded the Medal of Honor, two posthumously. John Bradley earned the Navy Cross on February 21, 1945 for conspicuous bravery attending to a gravely wounded Marine while under intense enemy fire.

Typical of WWII veterans, the two corpsmen went on with their lives not discussing their experiences. Bradley did participate in the 7th bond tour, the dedication of the Marine Memorial and played himself in The Sands of Iwo Jima but otherwise resisted attempts at interviews and it was only after his death that his son learned through saved memorabilia of his father’s accomplishments. In fact James Bradley was unaware that it was his father misidentified as Schrier in the Lowery photograph until we showed him the other Lowery photographs. Ziehme did not seek public recognition until he was labeled an “imposter” after his attempts to correct the Gung Ho! photograph identities. His reaction was to hire a lawyer and a forensic photographic expert to confirm his presence in the Gung Ho! Photograph 10.  His wife Judith also told me that Jerry and John Bradley would often run into each other awaiting care at the Veterans Administration Hospital and remained friends.

While Iwo Jima and the two flag raisings remain primarily a Marine Corps icon, it is our hope that this article would highlight some of the contributions Navy Medicine, particularly the corpsmen, made to this epic battle. Navy Corpsmen are “The Jewels of Navy Medicine” and the respect we as Navy medical personnel receive from our Marine comrades, we owe in no small part to their devotion to duty and sacrifices. “THE MARINES HAVE FOUND THEIR FEW GOOD MEN-NAVY CORPSMEN!”

I invite your attention to the following materials.

Corpsmen On Iwo Stanley Drabowski Jan-Feb Navy Medicine 1995

Surgeon on Iwo  James S Vedder Presidio Press 1984

REFERENCES:

  1. James Bradley  Personal communication
  2. COL Walt ford USMC(r)  Personal communication
  3. Raymond Jacobs  Personal communication
  4. Charles W Lindberg  Personal communication
  5. Keith Wells  Personal communication
  6. Naval Historical Center  www.history.navy.mil
  7. Flags of our Fathers  James Bradley Bantum Books May 2000
  8. Judith Ziehme  Personal communication
  9. The History of the Medical Department of the United States Navy in World War II  Volume II FMFRP 12-12 U. S. Marine Corps 22 November 1989 (NAVMED P-5021 1953)

Baltimore in Late October – Visiting USS Constellation

Right now, I’m attending the 2012 Congress of the Naval Order of the United States, a venerable (founded in 1890) organization dedicated to the preservation and promotion of U S Naval history. The Congress venue is located in Baltimore’s Inner harbor area, an attractive collection of museums, hotels, eating establishments, shopping and historic ships open for touring.

Sick Bay aboard USS Constellation. Baltimore MD.

This afternoon, we had some time off from our program of talks (largely about the War of 1812), so I walked the USS Constellation.  As you might imagine, I was particularly interested in how the ship’s medical spaces were portrayed and displayed. Located in ship’s bow, a level below the gun deck (two decks below the weather deck), the surgeon’s pit was quite a bit more spacious than I would have imagined. I’m not sure the photo here gives a good perspective, but here it is. In the foreground you see a box-like bunk for a sick sailor (much more comfortable, one presumes, than the usual hammock), and in the distance you see a table where, presumably, the ship’s surgeon plied his trade. The recorded commentary for the sick bay told that the Assistant Surgeon, Clark – attached to the ship during the Civil War – could amputate an arm in less than a minute. This fact was presumably reassuring to the ship’s crew members! A glass front storage cabinet had on display a set of very sharp-looking amputation knives. I didn’t see any bone saws on display but presumably, if one of the surgeon’s went dull, he had only to call out to the next deck below – where the carpenter worked – for a sharp replacement. The commentary also pointed out that the quality of Civil War Naval surgeons was better than the Army’s because the Navy had a system of rigorous exams that candidate surgeons had to pass in order to receive their Naval commissions. I recall that the topics covered in these exams ranged from anatomy and physiology to obstetrics and gynecology to medical jurisprudence. And the pass rates for candidates graduating from the (now) Ivy League schools was not particularly high.

Surgeon’s Cabin: his cover on his desk, bunk behind.

“Officers’ Country”, where the ship’s commissioned officers lived and slept is located in the stern of the ship on the same level as the sick bay. Arrayed on either side of a spacious central gathering and eating space were the officers’ cabins – those of the line officers (the ship’s Executive Officer and lieutenants) to starboard, the staff officers (purser, surgeon, chaplain) to port. The ship’s dispensary, a small space located to starboard between Officers’ Country and sick bay was where the surgeon’s steward mixed and dispensed drugs. Much drug treatment was termed “heroic medicine” – purgatives to clear bad fluids and discharges from the body. A few truly effective medicines were available though: quinine for “fever” (especially, of course, fever of malarial origin) and mercurials, which, if used judiciously, might be useful in treating syphilis, if over-prescribed, could kill a man with mercury poisoning.

The derivation of the term the ship’s “head” (bathroom) in a sailing ship became quite clear on tour in Constellation: all crew members except the Captain (who enjoyed the pleasure of a private head – and a bathtub) had almost to climb the bowsprit at the very front of the ship to do their business. And this never occurred to me before: since the wind was coming from behind the ship, it would in fact blow the waste away, ahead of the ship. And, as the commentary noted, copious sea spray helped keep things pretty clean up forward.

One other observation: the smell below decks in Constellation reminded me of the smell in the aging caves in California wineries. I think it’s the smell of the oak used to make ships and wine barrels. And another thing: the decking timbers is least an inch and a half thick. They were pretty generous in their use of that oak, back in the day.

©2012 Thomas L Snyder

The Navy’s World War II Blood Program

Up until the beginning of World War II, the use of whole blood transfusion for combat casualties was very much a primitive, often ad hoc undertaking. Blood was usually collected on a direct “as needed” basis, a cumbersome procedure which quickly broke down under combat conditions. Two practical problems and one conceptual problem had to be solved before large scale use of blood for combat casualties would be instituted. The practical problems were those of  transfusion reactions – solved by the application of knowledge of blood grouping and the Rh “factor”; and storage or “banking” of blood solved by the used of anticoagulant-preservative solutions and refrigeration. The conceptual problem was the recognition that hemorrhage was actually the cause of shock in trauma, and that blood replacement rather than volume replacement was necessary for successful resuscitation of shock patients in preparation for surgery.

Early in the War, the U S blood program, organized mostly by the Army, in coordination with the American Red Cross, focused on the collection blood for its non-cellular fractions – plasma. It was a very successful program. For the month of June 1944, for example, the American Red Cross reported that its 33 major processing centers throughout the nation had collected more than half a million units of blood. Most of this blood was processed to produce dried plasma, which could be reconstituted in the field. This procedure reduced weight and volume (important when logistical space was limited and need for combat materiel was great), and avoided the problem of degradation of the fluids by heat and time. It wasn’t until late 1944 that Army medical officials accepted the notion that plasma alone was an inadequate medium for resuscitating shock patients, and that oxygen carrying capacity – red blood cells – was critical to survival in emergency surgery and for post-operative recovery. The Army began shipments of whole blood from the US to Europe in only in August 1944.

In the Pacific area, initial supplies of blood came from the Red Cross blood bank in New South Wales, Australia, where studies on blood storage had resulted in the use of  the preservation medium – dihydric sodium citrate-glucose solution (“ACD”*) – recommended by the British Medical Research Council – and the use of  heavily insulated wooden boxes fitted out to hold 10 1-liter bottles and 56 lbs of ice, suitable for transporting whole blood, at  4.5 – 8 degrees C, by air. This system was worked out and functioning for Australian troops as early as December 1942. By August 1943, U S forces in the southwest Pacific area were receiving blood from Australian sources, transported by air and sea.

In June 1944, Captain Lloyd R Newhouser, MC, USN, the director of the Navy’s blood program, was ordered to the Pacific to evaluate the need for, and means of supplying whole blood and blood products to the Pacific area. Early on, Captain Newhouser and his Army colleague Colonel Douglas B Kendrick, MC put their emphasis on procurement of blood locally, first in Australia, and then in Hawai’i. However, these sources were simply inadequate to the need. And with the high rate of malaria then prevalent among troops in the Southwest Pacific Area of Operations, surgeons became reluctant to use locally obtained blood. In October, Army Brig. Gen Fred Rankin (Chief Surgical Consultant to the Army Surgeon General) and Captain Newhouser agreed that the Navy should establish a processing laboratory in California. The Army would provide all necessary equipment. Red Cross collection centers in Los Angeles, San Francisco and Oakland initially provided blood for the Pacific airlift; as the need for blood increased, the Red Cross added centers in Portland, OR and San Diego to the supply chain. Chicago went on line for the Pacific in January 1945, and after the end of hostilities in Europe, whole blood for the Pacific began to flow from New York, Boston, Philadelphia, Washington and Brooklyn.

The Navy’s processing center actually ended up in Oakland.

The first air shipment of blood left San Francisco on 16 November 1944. Between December 1944 and September 1945, 88,728 units of blood were shipped by air from the US to the Pacific. Shipments varied from none in a day to up to 12,000 pints shipped in one week, in May 1945. Blood flown from Oakland would be inspected and re-iced at Pearl Harbor after a 12 hour flight. It then went by air to Guam, from where it could be distributed to points of need throughout the western Pacific. While the actual flight time for blood was about 48 hours, when transport and flight stopovers are taken into consideration, most blood arriving at, say, Leyte, was up to five days old.

There is little doubt that the Navy’s blood air transport program saved thousands of lives. One Army field surgeon in the Pacific estimated that the mortality rate from abdominal wounds dropped 20% when whole blood, penicillin and oxygen therapy became available. Surgeons in the 119th Station Hospital noted that plasma was of little value for casualties received for care; their conclusion: “Blood is what is needed.” By the end of the war in the Pacific, the ratio of blood use was 1.5 units for every soldier or Marine in action. This from early in the war, when high U S medical officials denied the need for any red cells at all.

Next time: LST 464

 

* The Army blood program used a preservative called Alsevers Solution. While adequate for the purpose – refrigerated whole blood preserved with it could be safely used for up to 16 days after collection – it had the disadvantage of requiring 500 ml of solution for every 500 ml of whole blood. “Volume’ was an issue when considering valuable shipping space aboard aircraft carrying military supplies to Europe. The Navy’s choice of ACD, which preserved refrigerated whole blood for at least 21 days, had the additional advantage of much reduced volume of preservative (initially, 4:1 blood to preservative volume, later reduced to 6:1). From the beginning, the Navy used ACD for blood shipped to the Pacific.  The Army switched over to ACD for shipments of blood to Europe in April 1945.

Source for this Post: Kendrick, Brigadier General Douglas B, “Blood Program in World War II”, Office of the Surgeon General, Department of the Army. Washington, 1964

©2012 Thomas L Snyder

Benevolence Sunk!

This is the headline – emblazoned on a facsimile of a yellowed newspaper front page – that greeted me when I opened my home town newspaper, the Vallejo Times-Herald, yesterday morning.

USS Benevolence was  laid down on 26 July 1943 as a transport ship, SS Marine Lion, at Sun Shipbuilding and Drydock Company in Chester, PA. A year later, facing a surge in casualties in the Pacific Theater of Operations,the U S Navy designated her a hospital ship, AH-13. Todd Erie Basin Shipyard in Brooklyn completed her conversion to hospital functions, and she was commissioned on 12 May 1945. Benevolence transited the Panama Canal on 22 June, and after a brief stay in Hawai’i, made her way to the Eniwetok lagoon, where she provided care for war-wounded and sick Marines, sailors and soldiers until the end of hostilities. After a period of time at Yokosuka, where she gave care and comfort to liberated US POWs and civilian internees, she brought her first 1000 patients back to San Francisco in November. By 15 February 1946, she had completed her third “Magic Carpet” mission of bringing service personnel from Pearl Harbor back to  San Francisco.

USS Benevolence Anchored in Bikini Atoll for Atomic Tests, 1946 (Photo: NavSource Online: Service Ship Photo Archive, http://www.navsource.org/archives/09/12/1213.htm, accessed 26 August 2012)

From May to September 1946, Benevolence provided medical support for the Bikini atomic tests. After a 19 day rest in San Francisco, she deployed again, this time to serve as a station hospital off Tsingtao, China. After nearly six months, she returned to the US, this time to be decommissioned at Hunters Point Naval Shipyard in San Francisco. She was laid up in the Pacific Reserve Fleet until the outbreak of the Korean Conflict. She underwent refurbishment at the Mare Island Naval Ship Yard.

On her return from sea trials, with a small medical contingent and a large number of civilian technicians aboard, in heavy fog and zero visibility, Benevolence collided with the commercial ship SS Mary Luckenbach. The stricken hospital ship sunk within 25 minutes. Fortunately, all but 31 of her crew and passengers of more than 500 were able to get off the ship and into the frigid waters off San Francisco Bay. 18 people died or were lost. If she had had patients embarked, the tragedy could have been much worse.

USS Benevolence on her side off San Francisco Bay, 1950 (Photo: NavSource Online: Service Ship Photo Archive, http://www.navsource.org/archives/09/12/1213.htm, accessed 26 August 2012)

The ship lay in the shipping lane for 16 months while attempts were made to salvage her. When these were unsuccessful, salvage workers used three explosive charges to demolish her. She was stricken from Navy rolls on 20 December 1950.

I extracted the ship’s history  from Navy records, accessed 26 August 2012, http://www.history.navy.mil/danfs/b5/benevolence-i.htm
 
©2012 Thomas L Snyder

Navy Medicine in the War of 1812 – Action in the Year 1812, Part I

War of 1812 Propaganda Poster (Image: Ohio History Central. http://www.ohiohistorycentral.org/entry.php?rec=565)

The history community in the US and Canada (I don’t know about the UK) are ramping up for observations of the 200th anniversary of the War of 1812. Inasmuch as this war was in large part fought on water, it occurs to me that we should be looking, so far as we can, at the role navy medicine played in the conflict. For Part I of this discussion, I will depend largely on Professor Harry Langley’s 1995 book A History of Medicine in the Early U.S. Navy.

You’ll recall that British had raised the ire of Americans by their interference in our commerce with Napoleonic Europe, and, more importantly, by their impressment of American mariners into the Royal Navy. Initially, the US Congress retaliated with legislation – the Embargo and Non-Intercourse Acts of 1807 and 1809 – but these further decreased our overseas trade.  With New England merchants crying economic ruin, first the House (79-49 on June 4, 1812), then the Senate (19-13 on June 17) voted for war, and President Madison signed the Declaration on 18 June.

Commodore John Rodgers’s quickly assembled a squadron of four ships. Soon after they departed New York, on 25 June, they encountered HMS Belvidera, 36, northeast of New York. A brief but violent action followed, with USS President, 44,  pursuing. In the end, Belvidera ran north to Halifax, having sustained the loss of 2 killed and 22 wounded. President, the only American ship to engage, experienced 3 killed and 19 wounded. Langley says “…its surgeon and mates cared for the wounded.”(1)

Commodore Rodgers and his squadron proceeded to patrol within a day’s sail of the English Channel. Despite success in capturing British merchant ships – he had 80 – 100 prisoners aboard – the squadron had to return home to Boston earlier than planned because of a widespread outbreak of scurvy among his crews.(2) Langley says that his crews were hospitalized at the Boston Navy Yard, but this care must have been given in the Marine Hospital, because a Navy hospital in Boston was not constructed until 1836.(3)

USS Constitution meets HMS Guerriere (Image: U S Naval History and Heritage Command)

On August 19, USS Constitution won a celebrated victory over HMS Guerriere. Constitution suffered 7 killed and 7 wounded while her adversary lost 15 dead and 62 wounded. Surgeon Amos A Evans(4) and Surgeon’s Mate John D Armstrong attended the American injured; when the fighting was over, the two men transferred to Guerriere to assist her surgeon, who himself had been wounded, in the care of British sailors. Professor Langley gives us an interesting detail of Evans’s care of an amputee, one Richard Dunn. Two days after his surgery, when the patient complained of stump pain, Evans “wetted it with laudanum and gave the patient laudanum mixed with wine”.(5)

In October, November and December, ships in the American navy fought three more sea battles (I’ll write about lake battles later in this series) resulting in injuries cared for by naval surgeons. Stand by for future posts.

(1) Langley, Harold D., “A History of Medicine in the Early U.S. Navy”, Baltimore, Johns Hopkins Press, 1995, p 176.
(2) It is curious that scurvy should have been seen in large numbers at this late date, as the disease had been virtually eliminated from the Royal Navy by 1800, due to the common acceptance – by medical officers and commanders alike – of citrus juice as an effective antiscorbutic. The discussion of the conquest of scurvy in the Royal Navy by Lloyd and Coulter (Lloyd, Christopher, and Jack L S Coulter, “Medicine and the Navy, 1200-1900. Volume III–1714-1815”, Edinburgh and London, Livingstone, 1961, Chapter 18) is comprehensive.
(3) Langley tells that Congress appropriated $15,000 for a hospital in Boston to care for all sailors, both merchant mariners and navy sailors in 1802. The Boston Marine Hospital was constructed in 1803, and received its first patients in January 1804. The Marine Hospitals were operated by the Secretary of the Treasury; Navy officials came to believe this was an unsatisfactory arrangement because navy sailors had a propensity to desert from these places as they recovered from their illnesses or injuries. A Naval Hospital Fund, intended to pay for construction of hospitals specifically for the Navy, was passed in February 1811 and immediately funded with $50,000 transferred from the Marine Hospital Fund. The War of 1812 interrupted plans to build a Naval Hospital in Boston. It finally saw fruition in 1836. http://www.nps.gov/nr/travel/maritime/nav.htm accessed 4 August 2012.
(4) According to a brief University of Michigan biography, Evans studied medicine with a hometown practitioner “and attended lectures by Benjamin Rush in Philadephia”. He was admitted to the Navy in 1808, served in the naval hospital in New Orleans, in USS Constitution. While on shore duty, he earned his MD from Harvard in 1814. In 1815, he was promoted to be the navy’ s first Fleet Surgeon. He resigned from the navy in 1824. http://quod.lib.umich.edu/c/clementsmss/umich-wcl-M-262eva?view=text, accessed 3 August 2012.
(5) Langley, pp 177-178. Laudanum – tincture of opium – is a powerful narcotic pain medication. In his “Materia Medica and Therapeutics” (Philadelphia, F A Davis, 1891), John V Shoemaker, AB, MD, describes its beneficial application to wounds as “an antiseptic and to relieve pain”. http://books.google.com/books?id=SqBmb4sJKoIC&pg=PA783&lpg=PA783&dq=topical+laudanum&source=bl&ots=kL0jaQRZP4&sig=FknCNMtEPs3HcW-HAorPYvDeYTI&hl=en&sa=X&ei=2oUcUImjLMiuiALs3YGABA&sqi=2&ved=0CFAQ6AEwCA#v=onepage&q=topical%20laudanum&f=false accessed 3 August 2012.

©2012 Thomas L Snyder

Rum In the Navy

Two weeks ago, I related the urban legend of how Lieutenant – later Rear Admiral – Lucius Johnson, Medical Corps, U. S. Navy, introduced the rum-based daiquiri to Washington DC society in the late 19th century. I want now to briefly review the history of rum in the Navy.

“Rum had always been the naval drink, since beer and water did not keep at sea…” wrote Lloyd and Christopher in their definitive history of British naval medicine, “and gin was largely confined to the land, or to the wardroom.” When Admiral Sir Edward Vernon arrived in the West Indies in 1740, he was taken with the “swinish vice of drunkenness” he saw there. After consultation with his surgeons, Vernon hit upon the notion of diluting the rum ration with water as a way of reducing its intoxicating effect. The formula Vernon (referred to as “Old Grog” for the Grogram water-proof cloak he habitually wore) specified in the order he issued to his ships’ commanders was a quart of water added to the sailors’ half-pint daily rum ration. Thus was the famed navy grog invented.(1)

While Admiral Vernon’s innovation was widely adopted, Naval surgeons fretted and Admirals thundered about the “crime of drunkenness” throughout the 18th century. While floggings and other punishments were instituted in attempts to quell the widespread problem, another reforming Admiral, Lord Keith wrote in 1812, “…it will be impossible to prevent [it] so long as the present excessive quantity of spirits is issued in the Royal Navy; for men seem to have no other idea of the use of spirits than as they afford them the means of running into excess and indulging in intoxication”(2) According to Lloyd and Christopher, it was only with the changing mores incident to the Victorian era that abuse of spirits decreased. Cocoa became the more popular “pick-me-up” in the Royal Navy.

Despite the Revolution, our Navy adopted many customs of the Royal Navy, including the rum ration. As one naval history source(3) puts it, “[i]n the early days of the U.S. Navy rum was a part of daily life and the grog ration was a half-pint a day. During the days of Constellation there was a saying that showed the importance the men placed on their daily ration of grog. This saying was: “Blow up the magazines; throw the bread over the side and sink the salt horse – but handle them spirits gentle like.”

Late 19th Century Navy Copper Measures. Smallest is 1/2 Gill. U S Navy daily ration was 2 gills (Photo: http://www.thepirateslair.com/4-us-navy-copper-measures-1.html)

By the 1820s, the nation began to develop a predominating opinion toward temperance. The House of Representatives reflected this emerging sentiment by adopting a petition to encourage the Secretary of the navy to assess the effects of alcohol upon the service.  John Branch (served as Secretary of the Navy 1829-1831 tasked Surgeons Heerman, Barton and Harris the task of evaluating whether the grog ration was a “naval necessity”. Presumably reflecting informed medical opinion of the day, all three believed the grog rations “was unnecessary and harmful to morals and health”, and “subversive to discipline”. These experts recommended to the House of Representatives that sailors be encouraged to commute their spirit ration by being paid a generous sum of money as a means voluntarily reducing alcohol consumption.(4) Branch’s successor Levi Woodbury instituted this reform in 1831, setting the commutation rate at 6 cents per day.

In succeeding decades, despite multiple pressures for reform, the grog ration was not officially ended until 1862, by an Act of Congress passed 14 July. Personal stores of alcohol, the officers’ wine mess and alcohol retained for medicinal purposes and under control of the Surgeon were still permitted. It was not until 1 July 1914 that Secretary of the Navy Josephus Daniels’s General Order 99 prohibited “the use or introduction for drinking purposes of alcoholic liquors on board any naval vessel, or within any navy yard or station”. Medicinal alcohol is still retained. Your author, in destroyer service during the Vietnam conflict, had occasion to break out the medicinal brandy to reward a crew for rescuing a man overboard in hazardous conditions.

1. Lloyd, Christopher, and Jack L S Coulter, “Medicine and the Navy: 1200 – 1900 Vol III”, London, E & S Livingstone, 1961, p 88ff.
2. Quoted in Lloyd and Coulter, above, p.90
3. http://www.history.navy.mil/faqs/faq78-1.htm#anchor94512, paragraph “Grog”, accessed 23 July 2012.
4. Langley, Harold D., “A History of Medicine in the Early U. S. Navy”, Baltimore, The Johns Hopkins Press, 1995. pp 294-295.
 
©2012 Thomas L Snyder

Medical Care at the Battle of Midway, Part II: Combat Casualty Care Aboard a Sinking Ship; Rescue Ships and Medical Care

Last week, I commented that some lessons of previous wars have to be learned anew; the case I cited was that of flash burn prevention, relearned only after the Battle of Coral Sea. This week, we read how the chaos of ships under attack complicates the delivery of casualty care. We also learn a lesson or two about medical preparedness.

I mentioned last week that I depended on on-line sources for these postings; in particular, the Battle Reports of the Commanding Officer of USS Yorktown(1), sunk at Midway, and Commander Destroyer Squadron SIX (TF 17.4)(2). These reports, written just days after the events they portray, are as raw as they are economical in words.

The medical paragraph in the Yorktown report is especially informative:  the initial bombing attack on Yorktown resulted in the near-destruction of battle dressing station 5 in the wardroom annex. Personnel there “were badly shaken but were not otherwise injured… These personnel proceeded to the flight deck and hangar deck to assist wounded there.” In the following torpedo attack, battle dressing station number 4 was flooded and destroyed. I could find no comment about medical personnel injuries or deaths.

Shrapnel caused the vast majority of injuries among the 55 men who went on to require hospitalization. Many patients experienced severe penetrating shrapnel wounds; these cases required blood transfusions and plasma administrations, most if not all administered in the battle dressing stations. 60 men received minor wounds or rope burns from sliding down ropes into the water.

Yorktown survived the initial attacks. Severely wounded men were prepared for surgery, and the operating room activated. Within minutes, however, torpedoes hit the ship. All lights and communications went down, and the ship immediately developed a heavy list. When the Captain issued “abandon ship” orders, medical personnel immediately commenced evacuating the casualties. This process was made almost impossible because ladders leading from sick bay were damaged so that stretchers could not be used to lift patients out of the hold. Slippery decks and the ship’s list made it impossible to carry stretchers, so men were reduced to sliding them across the deck, or bodily man-handling casualties. Rescues below the main decks had to be carried out in pitch-black darkness, perhaps with the aid of flashlights only.

Lifeboats on the high side of the ship could not be launched, so wounded men were lowered over the side in straps from other ships, or onto life rafts, or into the water, and picked up later.

Destroyers Balch, Benham, Russell, Anderson, Morris, Hughes, Hammann (she sank quickly when two torpedos struck her as she lay along side Yorktown providing engineering support to salvage efforts) and Bidell provided rescue operations, and it fell to the medical departments aboard these small ships to care for about 2270 survivors. Claude M Lee, Jr, LT (jg), MC, USNR and his assistants aboard USS Balch cared for 544 survivors. “His all night occupation with the operative and surgical care of injured men, his forethought in providing adequate and special medical supplies and in training of personnel to handle this particular emergency” came in for special commendation from ComTaskFor17.4.

Few medical “lessons learned” find their way into these after action reports. The Destroyer Task Force commander did point out that “[t]horough instruction and stationing of officers and men for rescue work is essential”. It makes sense: once the fighting is done, or when a ship can no longer be fought, the combat work of officers and men is done. The emphasis now shifts to rescuing survivors, and this should be almost an “all hands” operation, with all hands trained to properly carry it out.

Another lesson is not stated in these reports, but I think this has significance in today’s naval activities. Big naval units (translate this “aircraft carriers” in the U S Navy) are the big targets, too. They are also well supplied with sophisticated medical and surgical personnel and equipment. But if one of these big targets is successfully attacked, use of these medical assets may be compromised or lost, and casualty care then falls to smaller rescue ships – destroyers- whose medical “kit” often consists of a senior hospital corpsman and one or two junior assistants. These ships need to have their medical staffs – and their medical equipment and supplies – beefed up significantly when combat is anticipated. I believe that the US propensity to depend upon helicopter evacuation of casualties can’t be depended upon in the chaos of naval battle because the airspace may be dangerous from enemy action, or too full and too confined around an aircraft carrier for orderly and rapid evacuation of something like 2500 or 3000 casualties.

We should learn and apply these lessons now, lest they have to be re-learned in future naval battles.

(1) Buckmaster, E. (Commanding Officer, USS Yorktown): Report of Action for June 4, 1942 and June 6, 1942, 18 June 1942, http://www.history.navy.mil/docs/wwii/mid7.htm, accessed 7, 8, 15 June 2012.
(2) Sauer, E. P. (ComTaskFor17.4), Japanese Torpedo Plane Attack on U.S.S. Yorktown During Battle of Midway, June 4, 1942 — Report of, June 12, 1942, http://www.history.navy.mil/docs/wwii/mid8.htm, accessed 7, 8, 15 June 2012.
 

©2012 Thomas L Snyder