I Love Archivists (Again…)! The Navy’s WW II V-12 Medical Program

I’ve said it before and I’ll say it again, and again – and again: I love archivists! They are the keepers – the restorers, sorters, preservers – of our documentary and artifactual past. Without archivists and their work, we risk having no “history” upon which to build an informed future.

The Alumni Association of my medical alma mater – Albany Medical College – underwrites a half-time archivist to oversee the College and Medical Center collections. Her name is Jessica Watson, and she is a gem. Every week or so, Mrs Watson sends out a new number of “Facts From the Past”. These are short written pieces – usually accompanied by an image – about some historic personage, say from the Class of 1846. A few weeks ago, however, there was a pleasant surprise waiting in my in-box:

"First 'GI Doctor' Class to Receive Commissions"

“First ‘GI Doctor’ Class to Receive Commissions”

In 1943, the Navy introduced the “V-12″† Program.  Its purpose was to provide an ongoing stream of college-educated officers for the service. Both services also instituted medical, dental and theological programs. An important part of these programs’ design was the “accelerated” schedule of instruction that utilized summer and other vacation periods for instructional time. The result: a normal 4 year degree could be earned in 3 years. Accordingly, new classes began every nine months.V-12 ran until the end of 1945, with the last V-12 classes graduating early in 1946.*

Each of the ~56 medical schools enrolled in the program had a V-12 unit, typically with a junior naval line officer in command, to which the navy medical students were assigned for administrative purposes. Students wore navy (Midshipman?) uniforms, and received a junior enlisted man’s salary. According of one source, men in the Navy program were not required – or the requirement was not enforced – to perform military drill, in contrast to their Army colleagues. This apparently caused no end of amusement among the Navy doctors-in-training, as they watched their Army colleagues sweating on the drill field while they lounged in the comfort of their dormitories!

The Navy received an allotment of 25% of the slots in each medical school class; this could be expanded by about 3% if the 20% of civilian slots were not filled. Medical schools continued to use their method of selecting students.  Other than with the accelerated program of instruction, Navy policy was not to interfere with medical school administration and curriculum, with a couple of exceptions born of military necessity: a course in military medicine / surgery was added; and the usual class in tropical diseases beefed up. Once they graduated and received their commissions, the new medical officers were subject to a strict Navy requirement for “rotating” (vs “specialized”) internships.^ Here again, military contingency ruled the day: after their abbreviated 9 month internships, these men would be assigned to shipboard duty or duty in remote locations, where a general and well-rounded medical knowledge was required. No superspecialized young doctors in the jungles of Guadalcanal!

Altogether, about 4600 physicians and dentists graduated from the V-12 program. One writer asserted that at the end of the war, nearly a quarter of Navy medical officers were products of the V-12 Medical program.

† Also designated “H-V(P)”, a code I have yet to penetrate…
 
* The Army Special Training Program was an equivalent, and much larger, operation.
 
^ Rotating internships have the new doctors serving rotations for experience and training in the major areas of the medical arts: internal medicine, general surgery, obstetrics/gynecology, pediatrics; with additional short rotations – typically 2 – 3 weeks – in such areas as ear-nose-throat, dermatology, urology, orthopedics. “Specialty” internships place an emphasis in time, education and experience in one area, such as internal medicine or surgery, to the general exclusion of all other areas.
 

©2012 Thomas L Snyder, MD

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The Society for the History of Navy Medicine Future in Doubt

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Society for the History of Navy Medicine Medallion

The Society for the History of Navy Medicine, “sponsor” of this blog, came into being in 2006 after discussions between your humble blogger (and Society founding executive director) and André Sobocinski, historian at the Navy Bureau of Medicine and Surgery. André noted that while several people cycled through the Historical Office on research missions, there was no real scholarly “home” for people who are interested in that narrow little corner of history that is maritime medicine. Thus challenged, yours truly, with André’s enthusiastic support, set about to establish the Society.

Over its 6 years of life, the Society has grown to more than 165 members from around the world: academics, health practitioners, military and civilian, active and retired. We have mounted scholarly panels on the history of maritime medicine at annual meetings of the American Association for the History of  Medicine (of which we are an affiliate member), the Association of Military Surgeons of the United States; and the biennial McMullen History Seminar at the U S Naval Academy. We established the Foundation for the History of Navy Medicine, a tax-exempt 501(c)(3) public charity to receive donations to support the work of the Society. From our members’ $20 voluntary dues-donations and $250 Life Memberships, we have funded Graduate Student Travel Grants – given to students whose papers are accepted for presentation on our panels; and we have funded a $1500 research grant in the history of maritime

Foundation for the History of Navy Medicine Medallion

Foundation for the History of Navy Medicine Medallion

medicine.

But all of this good work may come to an end in 2013. At the April 2012 Foundation Board meeting, I announced my intention to step down as Society executive director – on my 70th birthday – in April 2013. The Society, I feel, needs new energy and new ideas. And, from a strictly personal standpoint, I have some historical work of my own – the history of the Naval Hospital at Mare Island, CA (the Navy’s first on the west coast), and other projects – that I’ve been neglecting and want to complete in the remaining time allotted to me in this world.

Since that announcement, I have searched for my replacement in this volunteer and altogether felicitous job. But to no avail. Now, with no one at the helm, a Society, like a ship, must necessarily founder and sink. To avoid that fate, unless a new executive director appears on the scene between now and April, this vessel of scholarly support will go out of commission, and the blog you are reading will become – history.

©2012 Thomas L Snyder

Pearl Harbor Day – Navy Medicine on the Day of the Attack

“Men of the Navy Medical Department at Pearl Harbor were just as surprised as other Americans when the Japanese attacked on the morning of 7 December 1941…” Thus begins the narrative of “Pearl Harbor Navy Medical Activities”, a report from the Naval History and Heritage Command.(1)

The attack began at about 0745, and the Naval Hospital at Pearl Harbor had all treatment facilities and operating room set up and ready by 0815. In the first three hours, about 250 patients – the most seriously wounded or burned – were admitted. By the end of the day, 546 patients were admitted, and 200 ambulatory patients had been treated and returned to their duty stations.(2)

The hospital ship Solace, undamaged in the attack, began to receive casualties by 0825, and boats from the ship were soon picking injured sailors out of the oily and sometimes burning waters of Pearl Harbor soon thereafter, often at great risk to their crews. 132 patients were admitted aboard this ship and 80 men given first aid and returned to duty.

Shock Care in Hospital Ship Solace

Shock Care in Hospital Ship Solace

U. S. Mobile Base Hospital No 2 had arrived at the Navy base crates just 12 days before the attack. But its personnel were able to break out needed equipment and supplies to care for 110 patients that day.

The USS Argonne also set up to care for casualties, and later, with the help of medical personnel from other ships in the harbor, set up a sort of receiving and clearing station at the dock where she was moored. This open and uncovered area soon had about 150 cots set up for the injured and wounded. Under the direction of the Base Force Surgeon, these patients were moved to the Navy Yard Officers’ Club, a more protected place. By 1030, a functioning “field hospital” was operating there, stocked with necessary materials for the care of the wounded, injured and burned. The dock-side clearing station continued its work, however, sending the most seriously injured patients to the hospital; less severe casualties went to the Officers’ Club “Field Hospital” and to the Mobile Base Hospital.

In addition to these naval hospital and hospital-type facilities, a few patients were sent to the Aeia Plantation Hospital and the Kaneohe Territorial Hospital for the Insane. These men were later returned to duty, or transferred to the Naval Hospital.

About 60% of casualties that day were burn cases, some from burning fuel oil; many more, however, were “flash burns” caused by exploding bombs or gas fires. Traumatic amputations and compound fractures were frequently seen as well. Altogether, nearly 1000 men were admitted or cared for at Naval hospitals and organized facilities in one 24 hour period.

Many heroes that day were made…

(1) http://www.history.navy.mil/faqs/faq66-5.htm, accessed 7 December 2012.
(2) “The History of the Medical Department of the United States navy in World War II – A Narrative and Pictorial Volume” (Navmed P-5031), United States Government Printing Office, 1953, Volume 1, pp 63-66.
 
©2012 Thomas L Snyder, MD

On the “Real” State of Medical History

Last week, I wrote an optimistic Thanksgiving reflection on the status of the history of (navy) medicine. Then, I received the latest newsletter from the American Association for the History of Medicine (AAHM). In the newsletter’s introductory presidential message , Professor Nancy Tomes paints a considerably more grim picture:

Why care about the history of medicine?
Readers of the AAHM newsletter have likely been asked some version of that question, couched in different degrees of disdain, many many times. We hear it from our students, our colleagues, and our Deans. In an era when universities, including academic medical centers, are struggling to reposition themselves in a difficult economic climate, history can easily seem irrelevant. We produce no patentable commodities. Our research attracts comparatively little private or public funding. Perhaps most damningly, we study a field associated with rapid and transformative change, where any minute some new development—it may be genomic medicine, or electronic medical records, or high tech prosthetic devices—will supposedly Change Everything. In a field such as health care where change occurs at a mind boggling rate, why should anyone care what happened a week ago, much less 500 years ago? [emphasis mine]

Professor Tomes’s “dependable if not particularly original set of answers” echoes my own: she invokes Santayana’s oft-quoted saw, “Those who cannot remember the past are condemned to repeat it”. Professor Tomes suggests that Santanyana quite easily passes muster among her colleagues in the “Arts and Sciences” faculty. It’s in the health sciences faculty that the history of medicine runs into trouble as it competes with “bioethics and  literature”. In the hospital and the clinic, Santayana’s formula falls on increasingly deaf ears.

But it’s in the clinic, I think, that Santayana, by invoking the notion of historical “retentiveness”, offers us at least a partial answer to our profession’s apparent historical deafness.  Our history constitutes a “base” upon which we build a more enlightened future. The research / scientific arm of medicine “gets” this – even if “history” is not explicitly credited – because any researcher worth his or her salt readily acknowledges that most scientific progress is based on work that has been done before. “We stand on the shoulders of our predecessors.”

So, how do we convince the everyday physician – the busy medical student, resident or practitioner – of the value of the hallowed history of the profession?

I tend to associate the halcyon days of medical history – when it was held in high regard within the medical profession – with a generation of medical doctors who were respected as doctors, and especially as historians, or promoters of the value of medical history. The famed and revered Owsei Temken and Henry Sigerist were among the former; the beloved William Osler, of the latter. While subsequent generations of professional historians indubitably have served “history” well, I believe that the disconnect between medical professionals and their history comes at least in part from the replacement of MDs by PhDs in the medical history “establishment”.

My “formula” is this: “doctors talking to doctors”. I submit that people of a “culture” (and “medicine” is most definitely a “culture”) will more readily listen to, and value, the words of others from the same “culture”.

It may well and regrettably be true that medical school teaching budgets – both of money and of time – are too tight to accommodate formal courses in medical history. Yet, a respected clinician who spices his or her bedside or didactic teaching with historical vignettes will plant the seed of appreciation in students whose minds are open to such information. I also think it’s incumbent upon physicians and their historical associates to bring history to medical school in small and inexpensive (free is best!) doses. For instance, I have found it relatively easy to convince the provost of a local medical school to grant me time for an occasional lunch hour history presentation. (Most recently, it was a “Research Thursday” lecture: I highlighted my historical research…) These talks are pretty well attended, and we don’t even offer pizza and Cokes. Inevitably, a few students will stay after – their curiosity about medical history piqued.

I also submit that we can encourage an interest in our professional history in a new generation by encouraging work by current students. To this end, the Society for the History of Navy Medicine (this blog’s original “sponsor”) offers travel grants to students whose papers are accepted for presentation at our annual papers panels, and we offer a research grant for work leading to publication in the area of naval or maritime medical history. Finally, we should bring history to the conferences that practitioners – the “history creators” – attend. Last year, the Society mounted two panels on naval medical history at the Naval Academy’s biannual History Symposium. And the year before, we mounted our panels at the annual meeting of the Association of Military Surgeons of the United States. Both of these sessions were very well attended.

There is interest among medical professionals in their history. The key to getting them to listen, I submit, is to bring their history conveniently to them rather than hoping they will take time from their incredibly busy schedules to come to the historical fountainhead.

©2012 Thomas L Snyder, MD

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