Thanksgiving 2012

The cornucopia – horn of plenty – symbolizing the abundance of a good harvest, comes down to us from the ancient Romans. Americans have traditionally associated the symbol with Thanksgiving.

We have the great good fortune to live in a nation that is wealthy enough to be able to support a robust historical establishment. University programs and fellowships produce their own cornucopiae of newly minted historians each year. Many if not most cities and communities sponsor or at least encourage local historians to accession and preserve their communities’ stories. Some corporations have historians on staff (I retired from Kaiser-Permanente, a company that does this). Even our popular culture embraces – and purchases – the works of excellent historians who have plumbed the far reaches, and the nooks and crannies of our national history. The instant popularity of Jon Meacham’s biography of Thomas Jefferson is but the most recent example of this.

Personally, I’m thankful that a generous and well-planned retirement Plan permits me the leisure and the resources to pursue my own historical interests. I suspect there are a good many others like me in this country.

The Society for the History of Navy Medicine enjoys the great good fortune of having a membership whose voluntary dues-donations provide generous financial support for graduate students whose papers are accepted for presentation at Society panels, and for a graduate student research grant – all to encourage research, study and publication in our narrow little corner of history.

Yes, we are experiencing hard financial times, and funding for some historical work is hard to come by. Yet the work does go on. Ours may not be a perfect historical world, we do indeed have much to be thankful for.

Navy Medicine Guadalcanal Campaign

By this time in 1942 – 70 years ago – the vicious battle for the control for Guadalcanal in the Solomon Islands had been decided in the Allies’ favor, even though several battles were yet to be fought. This struggle was decisive: from now on, the Japanese would be fighting a defensive , and ultimately, losing effort.

With the American victory at the Battle of Midway in June and with the realization that construction of a Japanese airbase on Guadalcanal represented part of a strategic threat to Australia, CNO Admiral Ernest King convinced President Roosevelt to modify his “Europe First” policy(1) to permit a “limited offensive” to prevent this eventuality. This led to the US Solomon Island Campaign and the conquest of Guadalcanal.

The campaign to take Guadalcanal, the first major and extended effort in the Pacific, saw Marines and Army units fighting in extremely challenging jungle terrain, facing swarms of insects and mosquitoes, suffering from tropical rains and mud, experiencing frequently irregular food and ammunition supplies, all the while being continually threatened by a dedicated enemy who launched wave after wave of bombing, artillery, naval gunfire and infantry attacks.(2)

The landing force Marines were accompanied by Navy Battalion aid station units consisting of 2 medical officers and 20 hospital corpsmen. Medical companies, consisting of 6 medical officers and 80 corpsmen followed. Maintaining a position about 200 yards behind front lines, company aid men administered resuscitation fluids (typically plasma) and applied splints and dressings as required. Stretcher parties initially evacuated injured troops, but jeeps specially fitted as

Evacuation by Jeep, Guadalcanal. Source (3), p 69. Note plasma being administered (by soldier on the left) en route.

stretcher carriers were the preferred means of moving men to the rear, whenever this was feasible. Men had to be evacuated several hundred miles from the action before they could receive definitive surgical care because field hospitals on the island were subjected to virtually daily air or artillery attacks.

Initially, poor communication facilities and lack of centralized controls created chaotic evacuation patterns as wounded

Air Evacuation of Casualties, Guadalcanal. Source (3), p 72. This was a tremendous morale booster, even for the uninjured.

men were moved to ships offshore. As the battle progressed, air evacuation of casualties became feasible and then desirable. By mid September, just six weeks after the assault on Guadalcanal had begun, 147 men had been evacuated by air. During October and November, more men were evacuated by air (2,879) than by sea. Specially trained corpsmen and nurses tended the men during their flights to hospitals far away from the fight. Medical officers briefed on triage for air evacuation screened out wounded men with chest or abdominal wounds, as these generally did not tolerate air evacuation at high altitude.

In 20th century war, combat casualties typically outnumber casualties due to accident or illness. This was not the case at Guadalcanal, where tropical diseases like malaria and dengue fever laid Marines and soldiers low in numbers much greater that by enemy action. Although Atabrine malarial suppressive treatment was begun very early in the campaign, malaria nevertheless became rampant. For instance, nearly 69% of the Second Marine Division fell victim to the disease. It was soon learned that the troops were throwing away their medication and it fell to medical personnel to stand in the mess lines to dispense the medication – and then to inspect soldiers mouths to see that they had actually swallowed  the pills! Despite this, “…it is safe to assume that every man who served on the island during the period of 7 August 1942 and 9 February 1943 fell victim to the disease.”(3)

About 7100 allied forces died to capture Guadalcanal. The island became a major transport and resupply for the duration of the war in the Pacific.

(1) “Europe First” was the US strategy to fight a purely defensive war in the Pacific in order to concentrate Allied efforts on the defeat of Germany and its ally Italy in Europe. With victory in Europe assured, then Allied efforts would shift to focus on the defeat of Japan.
(2) Potter, E B, Editor. “Sea Power – A Naval History”. Annapolis. Naval Institute Press. 1981. An overview of the strategic and logistical problems facing US and Allied forces in the Solomon Islands campaign, pp 302-305.
(3) The History of the Medical Department of the United States Navy in World War II (Navmed P-5031), Volume I. Washington, GPO, 1953, p 73.

A Warm Welcome to Guest Blogger Sanders Marble – “On the Quality of Army Surgeons During the Civil War”

A couple of weeks ago I wrote about my visit to USS Constellation. In that post, I mentioned that the Navy had, fairly early on, instituted a program of quite rigorous examinations for prospective Assistant Surgeons. As a result of this system, I wrote, in the 19th century, Navy surgeons generally were of higher quality than their Army brethren. Shortly after I posted that blog, my friend Army medical historian Sanders Marble wrote to say “… but wait!” Herewith, Sanders’s very heartily welcomed rejoinder.

Last week Tom’s blog included the comment that the quality of Civil War naval surgeons was better than that of army surgeons. That caught my attention, and he’s graciously allowed me some space to discuss that and ask if you have any ideas about one of the underlying causes. First, from the establishment of the Army Medical Department (AMEDD) in 1818 the regulations had allowed for an entrance examination to make sure doctors were qualified. Actual procedures only developed over time, and the first examining board was not until 1832. The AMEDD also had a retention/promotion exam: after 5 years service a doctor had to pass a second exam to be allowed to stay in and be eligible for promotion. That peacetime system continued in the Mexican War. The AMEDD waived age limits on volunteer doctors but continued examinations as the Regular Army was expanded about 50%. The new regiments had to wait up to a year for their surgeons to volunteer, be examined, approved, and arrive. But the war also brought a backdoor: the volunteer regiments, enlisted by the states for the duration of the war, selected their own doctors. The AMEDD was not impressed with them: they didn’t understand sanitation, they didn’t understand Army procedures, and they were profligate with supplies. This pattern was repeated during the Civil War, but on a vastly larger scale. Most of the troops that fought were state volunteers; there were only 44 regiments of regular infantry against hundreds of state regiments. Doctors volunteering for the Regular Army still had to pass the exam, but they were a small percentage of the total serving. This created quality problems, and the AMEDD struggled to close the back door.

Civil War Field Hospital at the Battle of Savage Station http://www.sonofthesouth.net/leefoundation/civil-war-medicine.htm

Some solutions were at a local level: both Charles Tripler and Jonathan Letterman (as medical directors of the Army of the Potomac) organized boards within the AoP to weed out incompetents. Surgeon General William Hammond won an organizational battle and gained authority to examine surgeons of volunteer regiments. Many were rejected (I lack numbers, but the peacetime Army rejected at least half of applying doctors) and this played into a multifaceted struggle between Hammond and Secretary of War Edwin Stanton. Hammond eventually yielded, lowered the standards, and more doctors passed the examinations. Given the problems in diagnosis and treatment in the period, it’s not clear that stricter or looser examinations made a great deal of difference in patient outcomes. So the AMEDD had quality problems (I won’t deny that) but because it could not exercise adequate quality control over all doctors in the Army. But they found ways to purge the worst offenders and regained control of the personnel system. After that, the perceived quality of Army doctors rose, although whether that had much effect on patient care is unknowable. Now to relate this back to naval medicine. How did BuMed retain control over its personnel system? Structure may be part of the answer: there were not militia and volunteer ships that joined the US Navy as the states sent regiments. Numbers were probably lower, allowing the system to work. The Navy had a more gradual mobilization.  But the bottom line is the USN apparently managed to increase the volume of doctors that passed its entrance examination while not (greatly) compromising quality. How? For more, see The Army Medical Department 1818-1865 by Mary C Gillett, online at http://history.amedd.army.mil/booksdocs/civil/gillett2/gillett.html

Sanders Marble studied at William & Mary and King’s College, University of London. He has worked in the U.S. Army’s Office of Medical History from 2003-12 around a period as command historian at Walter Reed Army Medical Center in 2010. He has written and edited a variety of articles, chapters, and books on WWI, military medicine, and the history of technology.

©2012 The Society for the History of Navy Medicine

Sir William Osler on Military Medicine – Part The Final (3)

In two previous posts (here, and here), I discussed medicine’s beloved William Osler’s thought on military medicine in his early and middle years. In these times – up to about 1905, when he moved to Oxford to become the Regius Professor of Medicine – his concern was largely about individual workers and their work to discover and characterize diseases found throughout the world. Only lately (after 1900) had he come to write about the role of armies in their “public health” function of carrying out successful mass immunization programs against smallpox and, later, typhoid.

In 1914 speech to soldiers and officers (1), Osler – ever the internist’s internist – still keyed his thoughts to disease and its prevention. He said:

What I wish to urge is a true knowledge of your foes, not simply of the bullets, but of the much more important enemy, the bacilli.
In the wars of the world they have been as Saul and David—the one slaying thousands, the other tens of thousands. I can never see a group of recruits marching to the depot without mentally asking what percentage of these fine fellows will die legitimate and honourable deaths from wounds, what percentage will perish miserably from neglect of ordinary sanitary precautions ?

But, four months into the war, he noticed something which was to him remarkable. In a letter to the U S medical community published in the Journal of the American Medical Association (2) he wrote, “The outstanding medical feature of the campaign in France and Belgium is that wounded, not sick, are sent from the front. So far, disease has played a very small part and the troops have had wonderful health, in spite of exposure in the trenches.” In the same letter, he actually took notice of combat injuries, commenting that wounds from artillery weapons (shrapnel) were more dangerous than bullet wounds because the shrapnel was usually contaminated with mud and dirt. And the dirt and mud of this fertile region were heavily populated with bacterial pathogens. As Osler put it, “The surgeons are back in the pre-Listerian days and have wards filled with septic wounds.”

1915 appears to be the last time Osler spoke about war medicine, in a speech “Science and War”, given early in October. Here he acknowledged that science had, in the early 20th century, made the waging of war “more terrible, more devastating, more brutal in its butchery”. But Sir William Osler, non-surgeon, Professor of Medicine and honorary Colonel in the Oxfordshire Regiment, saw – perhaps only dimly – the future of combat medicine, also a product of science: “[an] enormous number spared the misery of sickness, the unspeakable tortures saved by anesthesia, the more prompt care of the wounded, the better surgical technique…”. Add effective shock management, antibiotics and modern imaging, and we have the picture of modern combat casualty care as practiced nearly 100 years later.

William Osler survived the war, but died at age 70 of pneumonia, in 1919. It is said that he never recovered from the loss of his only son, Edward Revere, an artilleryman  who succumbed to shrapnel wounds sustained at Ypres in August 1917.

(1) Osler, William, “Bacilli and Bullets” , Oxford Pamphlets, Oxford Press, 1914. Accessed online at http://ia600307.us.archive.org/5/items/bacillibulletsby00osle/bacillibulletsby00osle.pdf, 02 November 2012.
 
(2) Osler, William, “Medical Notes on England at War”, correspondence, in JAMA, vol LXIII [63], No 26, December 26, 1914, p 2303 ff
 
(3) Quoted in Cushing, Harvey, “The Life of Sir William Osler”, Vol 2, pp 492 – 495, Oxford, Clarendon Press, 1925.
 
©2012 Thomas L Snyder
 

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

William Osler on Military Medicine (2)

In the first of this series, I noted that the beloved William Osler, teacher, writer, philosopher of medicine, had little to say about military medicine in his years at the University of Pennsylvania and Johns Hopkins.

William Osler, Regius Professor of Medicine, Oxford, 1906. http://digital.library.mcgill.ca/osler/fullrecord.php

This changed when Osler, a Canadian citizen, moved to Oxford as the Regius Professor of Medicine in 1905. Always a bibliophile, he began to avidly collect medical antiquities, and he may have dusted off his Latina and perhaps his Greek reading skills. As a result of his collecting and reading, he seems to have become more aware of the role of military doctors in the history of medicine. Among the antiquities, for instance, he cited Dioscorides, an army surgeon in Nero’s time as one of the first “scientific” students of pharmacology. (1)

In 1909, Osler reflected his study of more recent medical history when he mentioned the work of British Royal Navy scurvy pioneer James Lind, and malaria researcher Vandyke Carter of the British Indian Medical Service to highlight their individual contributions to the advancement of medical knowledge.(2)

Up to this point, Osler’s outlook emphasized the work of individuals in their quest to advance medical science. Gradually, however, he began to express appreciation for  the importance of military medical organizations, in what we would today call public health initiatives. Already, in a 1901 essay Medicine in the Nineteenth Century, he had cited the success of the German army in eliminating smallpox from its ranks by vaccination (3). In 1909, he noted the key role of a military organization in eliminating endemic tropical diseases thus:

It was a fortunate thing that the head of the American occupation of Cuba was General Leonard Wood, himself a well-trained physician, and deeply interested in problems of sanitation.  Backed by the military arm it took Dr Gorgas and his colleagues nine months to clear Havana, which had been for centuries a strong hold of [yellow fever].(4)

In 1914, with the outbreak of the Great War, Osler put on the uniform of an Honorary Colonel in the Oxfordshire Regiment, and by August, he was advocating for compulsory vaccination of British troops

Colonel Sir William Osler at Clivedon, site of a Canadian Military Hosptial, of Which He was Chief Physician. http://digital.library.mcgill.ca/osler/fullrecord.php

against typhoid fever. In a letter he prepared for The Times of London late in the month, he cited “the work of French army doctors and of British army surgeons, particularly in India” for “the remarkable reduction in the incidence of typhoid when vaccination is carried out”. In the same letter he wrote “[the] experience of the American Army is of special value, as the disease is so much more prevalent in the United States…” (5) In October, he again cited the success of armies (German, French, American) in virtually eliminating the disease by vaccination. (6)

I’ll conclude this consideration of Sir William Osler’s thoughts on military medicine in my next post.

(1) Cushing, Harvey, The Life of Sir William Olser, Oxford, Clarendon Press, 1925, vol ii, p 122, quotes an Osler letter in which he detailed his exploration of the Vienna Hofbibliothek, where he had a chance to see a fifth Century Dioscordian manuscript; he described this as “one of the great treasures of the library”.

(2) Osler, William, The Nation and the Tropicsan address at the London School of Tropical Medicine, quoted by Cushing, vol ii, pp 192-194, and published in the Lancet, 1909, vol 2, pp 1401-6.

(3) See Osler’s volume Aequinimitas, with Other Addresses to Medical Students, Nurses and Medical Practitioners, available in several printings and editions. The 1905 edition (Blakiston, Philadelphia) cites the elimination of smallpox in the German army by a program of  “efficient revaccination”, pp 251-252.

(4) The Nation and the Tropics, cited above.

(5) Letter to The Times is quoted by Cushing, vol ii, p. 427

(6) Osler, William, Bacilli and Bullets, an address to the Officers and Men in the Camps at Chum. I originally found this in the Osler Library in McGill University, in a volume “The Collected Essays of Sir William Osler” by John P McGovern and Charles G Roland, Editors, The Classics of Medicine Library, Birmingham (Alabama), 1985. This is now available on line: http://archive.org/stream/bacilliandbullet031212mbp#page/n9/mode/2up, accessed 19 October 2012.

©2012 Thomas L Snyder

William Osler on Military Medicine

William Osler, MD

William Osler – later, Sir William Osler – is seen by many in the profession as the father of modern medicine. Born (1849) and educated in Canada (University of Toronto and McGill), he matured at McGill (1874 – 1885) and the University of Pennsylvania (1885 – 1889), and reached the apogee of his career as one – along with William Henry Welch (pathology), William Halstead (surgery) and Howard Kelly (Gynecology) –  of the “Founding Four” professors of the Johns Hopkins Medical School (1889 –  1905). In his maturity, Osler, still a Canadian citizen, was invited to become the Regius Professor of Medicine at Oxford (1905 – ), a post he held until his death in 1919. Osler introduced bedside teaching at Johns Hopkins, an innovation at that time. He was accused of being a therapeutic nihilist, when in reality he simply did not use treatments that had no backing in science or in experience. His textbook of medicine, first published in 1892, was very influential; with updates, it continued in publication until 2001. Osler’s humanitarian and scientific ideals are held in very high regard within western medicine to this day. There are Osler Societies throughout the English-speaking world, and in Japan.

I first “met” William Osler while I was researching the history of my (Albany) medical school’s World War I  (Army) Base Hospital No 33. Albany Med stood this unit up after the onset of hostilities in Europe, as did many US medical schools and hospitals, under provisions of the National Defense Act of June 3, 1916. When the outfit set up shop in Portsmouth England in 1918, William Osler, then an honorary Colonel in the Oxfordshire Militia and consultant to many Canadian Army hospitals in England, was on hand at the hospital’s commissioning and personally raised the American flag over the facility.

By this time, with England embroiled in that devastating war, and Osler’s  thought was inevitably dominated by military medicine. But this was not always the case. In fact, according to Osler’s biographer the great physician Harvey Cushing, Osler “hated war”. (1) Certainly the lack of writings on military medicine in his early professional years bespeaks at least of disinterest in the matter.

However, during his years at Penn, he developed friendships with several Army medical leaders, among them the eminent bacteriologist and epidemiologist George M Sternberg. When he became Army Surgeon General, Sternberg established the Army Medical School, and it was he who induced Osler to speak to the first graduating class of the school on “The Army Surgeon”. (2)

In his talk to the five members of the Class of 1894, Osler offered the thought that the isolation experienced by Army Surgeons stationed in remote forts could lead, in a man of independent nature, to a healthy self-reliance, and he named such medical luminaries as Jenner and Koch as men who did their pioneering medical research in isolated settings.  Addressing a strength of military organization, he noted the remarkable success that several armies had enjoyed in public health efforts to prevent diseases like smallpox (through systematic revaccination) and typhoid fever through careful attention to field sanitation.  He closed by emphasizing that these new graduates would have great opportunities to advance medical knowledge; all they had to do was to seize them. This was all pretty academic stuff, and Osler made no mention whatever of the matter of combat casualty care.

Two years later, in a talk  “On the Study of the Fevers of the South”, given at the AMA in Atlanta, Osler pondered war and pestilence. He gave the nod to pestilence:

Humanity has but three great enemies: fever, famine and war; of theses by far the greatest, by far the most terrible, is fever. Gad, the seer of David, estimated aright the relative intensity of these afflictions when he made three days’ pestilence the equivalent of three month’s flight before the enemy, and of three (or seven) years of famine. As far back as history will carry us, in ancient Greece, in ancient Rome, throughout the Middle Ages, down to our own day, the noisome pestilence, in whatsoever form it assumed, has been dreaded justly as the greatest of evils.

 Osler did appreciate recent advances in medicine to reduce the impact of “fever” – cinchona for treatment of (malarial) fever,  vaccination for prevention of diseases, and asepsis in surgery – he celebrated only the work of civilian medical workers in these successes.(3)

Despite the good news in medicine that Osler highlighted at the AMA, he did not report, and may have been unaware that a shift in the cause of soldier deaths was already under way. Nevertheless, the American Civil War bore out his conviction about the impact of pestilence – nearly twice as many men had died of non-combat causes, “pestilence” mostly, than had died of their wounds in that most horrific of armed conflicts. Just five years later, however, in the Franco-Prussian War, the numbers were reversed: about 28,000 Germans died of their wounds while around 12,000 succumbed to infectious diseases. (4) The data for French soldier deaths are more evenly distributed, but the trend was established: as scientific principles of disease prevention became applied, the impact of pestilence upon mortality in armies fairly rapidly declined. We do not know if Osler was aware of this change at the time.

It was only when he moved to England to take up the Regius Professorship of Medicine at Oxford, that military medicine began to enter the great physician’s thinking anew.

Next Post: The Evolving Thought on Military Medicine of Osler as Regius Professor of Medicine at Oxford

(1) Cushing, Harvey, The Life of Sir William Osler, Vol 1 (of 2), Oxford, Clarendon Press, 1925, p 631. Cushing wrote this in his commentary about Osler’s life in Baltimore, during his Johns Hopkins years. Cushing’s magisterial biography is available in many editions, including a one-volume book, published in 1940 and 1946. It is also available in a print-on-demand paperback edition, all from http://www.abebooks.com.

(2) Published in a collection entitled Aequanimitas with other Addresses to Medical Students, Nurses and Practitioners of Medicine. H.K.Lewis, London, 1904. The speech is available on-line at http://mcgovern.library.tmc.edu/data/www/html/people/osler/PA1/P25000.htm

(3) Osler, William, The Study of the Fevers of the South, JAMA, Vol XXVI, No. 21, May 23, 1894, pp 999-1004.

(4) The online source Statistics of Wars, Oppressions and Atrocities of the Nineteenth Century (the 1800s), http://necrometrics.com/wars19c.htm, accessed 14 October 2012, cites several authors with general agreement among them.

©2012 Thomas L Snyder

More on the Navy’s History and Heritage Command

My younger son is in town for a visit before he ships out to Maputo, Mozambique for a two year tour at our embassy there, so I won’t be writing this week.

However, you might find a podcast interview with the new Director of the Naval History and Heritage Command, done by the redoubtable “CDR Salamander” to be of interest. The link delivers you to the CDR Salamander blog page; then just follow the prompts to the podcast under “Talking History”.

CDR Sala-mander’s Logo

Next week, I’ll start posting a short series on Sir William Osler’s thoughts on military medicine. Born and trained in Canada, Osler came to the US to teach at Penn late in the 19th century. He found fame as one of the “Founding Four” of the Johns Hopkins University School of Medicine. Beloved by many in the profession as the father of modern western medicine, Osler was a prodigious writer on medicine in  its scientific, philosophical and historical dimensions. I researched this topic for a paper I gave at the American Osler Society a couple of years ago. I’ll put up a distilled version of that paper.

Sir William Osler

Briefing Medical Students on Military Medical Life: Albany Medical College-Military Affinity Group’s Symposium on Life in the Military

Earlier this year we organized “AMC-MAG” with three Missions: – to provide for camaraderie among Albany Med alumni who’ve served in uniform; – to support AMC students currently enrolled or interested in enrolling in the Health Professionals Scholarship Program; – to inculcate a culture of philanthropy to the College. I believe that ours is the only such organization in an American medical school.

(Left to Right:) CAPT Tom Snyder ’69, AMC-MAG founder and Symposium organizer; MGen Kevin Kiley, AMC-MAG Faculty Advisor and Symposium participant; RADM Jim Sears ’63, AMC-MAG Honorary Chair (Image: Martha Hubbard)

On Saturday, 22 September, the Group mounted the first (of what we hope will become annual) Symposium on Life in the Military. Our first panel – “Medicine in the Military” – made up of alumni Colonel Dave Siegal ’57, Col Michael Zapor ’75, Major Andrew Plunkett ’03, Commander Ken Ortiz (who flew up to Albany from Norfolk on Navy TAD orders)

Commander Ken Ortiz, MC, USN, Navy Plastic Surgeon, briefs an Albany Med student on Medicine in the Military (Photo: Martha Hubbard)

 and faculty advisor MGen Kevin Kiley (AMC’s Chair of OB-GYN and former Army Surgeon General) gave our attendees a comprehensive view of various aspects of the practice of medicine in the armed services, from working in a large recruiting station performing physical exams on recruits to combat casualty care near the troops in Iraq and Afghanistan. Two of our participants, Col Zapor and Major Plunckett, joined us via Skype – an interesting and somewhat frustrating experience…

Our second panel – Family Life in the Military – featured Colonel Siegal’s wife, Bonnie, PhD, General Kiley’s wife Babs and Commander Ortiz. Noting her expertise gained from 26 change of station orders, Bonnie gave a detailed talk on military moves. Mrs Kiley gave an overview of military programs for support of families. Commander Ortiz gave

Colonel (retired) Dave and Bonnie (PhD) Siegal with invited Army Recruiter. The Siegals gave their experience as a medical practitioner and spouse manager of military moves – after 26 of them! (Photo: Martha Hubbard)

the view from a mid-career officer’s standpoint.

At the completion of our panels, we retired to the Hilton Garden Inn across New Scotland Avenue from the medical center for a leisurely lunch and conversation.

Luncheon for Symposium Attendees and Panelists: an Opportunity to Continue the Conversation About Medical Life in the Military (Image: Martha Hubbard)

Our first-time-ever effort was quite well received. Both students and panelists expressed the desire to see a similar event next year.

©2012 Thomas L Snyder

LST 464

According to the official history of the navy medical department in World War II(1), in early stages of the war in the Pacific, LSTs(2) carried one medical officer and equipment for emergency surgery. Experience quickly demonstrated that when these small ships took on casualties for evacuation to larger hospitals or hospital ships, the medical staffs were simply inadequate to provide necessary care for the 100 – 200 casualties typically taken aboard. And, given that the time it took to get casualties to definitive care under these conditions often exceeded 24 or even 48 hours, it became clear that facilities for major surgery closer to the area of combat were a necessity. While the small ships (not LSTs in this case) accompanying the landing forces at Arawe, New Britain in December 1943, for instance, carried surgical teams of 2 surgeons and 10 corpsmen, the care these teams could provide was not sufficient to the need.  Around this time, LSTs converted  specifically to accommodate casualty care and manned with surgical teams came into being, and they participated in the Cape Gloucester (at the northwest end of New Britain) invasion on 26 December 1943.

As operations continued in the Bismark / Solomon Sea areas, the need for a forward-deployed ship capable of providing definitive, specialized surgical casualty care became urgent. LST 464, the first and only LST converted into a hospital ship, served that need.

Work done in Sydney Australia fitted out its tank deck with an operating room, offices, laboratory, a radiology room, and an isolation ward. Its staff included a surgeon, internist, dermatologist, urologist, EENT specialist and supporting hospital corps officers and corpsmen. Additional surgeons were ordered aboard on an as-needed basis, and an anesthesiologist and psychiatrist were added later. Thus staffed, LST 464 supported early operations like Lae, Arawe and Cape Gloucester from advance bases at Cape Sudest, Morobe or Buna, where she received casualties from amphibious craft and transported them to Milne Bay, some 350 miles distant. After Humboldt Bay (now known as Yos Sudarso Bay, on the north central coast of Papua-New Guinea) was taken in April 1944, the ship moved there to serve as a base hospital to support construction battalions and other troops locally.

In preparation for the invasion of Leyte, a blood bank (3) was established in LST 464. Its director was LT Ernest E Muirhead, MC, USNR, a physician experienced in blood bank operation. LT Muirhead had previously demonstrated the feasibility of such an operation when he prepared blood on another LST and carried it ashore to aid casualties in the Noemfoor Island landings of July 1944. The ship proved to be of particular value in the Leyte landings because she remained close-in, unlike the much actual hospital ships, which proved to be tempting targets for kamikaze pilots then being thrown into battle.  LST 464 remained in the Leyte gulf as a station hospital until March 1945, when she transited to Subic Bay in the Philippines, to serve the same role. At the end of the war, she was redesignated LST(H)-464. She served for a short time in Korea after the cessation of hostilities.

(1) NAVMED P-5031, The History of the Medical Department of the United States Navy in world War II – A narrative and Pictorial Volume (Volume 1), Washington, United States Printing Office, 1953. P 184, 187-188.

(2) LSTs (Landing Ship, Tank) fitted out for casualty care carried their usual armament and therefore did not enjoy the “protection” of the Geneva Conventions, which appear to have been largely ignored by the Japanese in any case. LST-464 was laid down in October 1942, launched in November, and commissioned in February 1943. After her conversion to a hospital ship function later that year, she was distinguished only by the six foot high white “464” painted on her hull amidships (http://en.wikipedia.org/wiki/LSTH, accessed 15 Sept 2012).

(3) Kendrick, Brigadier General Douglas R, “Blood Program in World War II”, Washington, Office of the Surgeon General, Department of the Army, 1964. Pp 594-595, 616-618, 620.

©2012 Thomas L Snyder