Book Review: Haycock and Archer, eds., “Health and Medicine at Sea, 1700-1900

Your correspondent is serving jury duty (a murder case – could run a month), and accordingly, has not been able to do his usual research to write. Fortunately, this week, Professor Timothy Walker sent me notice if the book review below with the note “this might be of interest to members of your Society [of the history of Navy Medicine]”. I suspect it will be of interest to readers of this blog, too. Thanks to the kind Professor! As you can see, the review comes to us by way of the h-net list serv from MSU.

From: H-Net Staff <revhelp@mail.h-net.msu.edu>
Date: Tue, Jan 8, 2013 at 3:19 AM
Subject: H-Net Review Publication: Fabbri on Haycock and Archer, ‘Health and Medicine at Sea, 1700-1900’
To: H-REVIEW@h-net.msu.edu

David Boyd Haycock, Sally Archer, eds.  Health and Medicine at Sea,
1700-1900.  Woodbridge  Boydell Press, 2009.  xiv + 229 pp.  $95.00
(cloth), ISBN 978-1-84383-522-6.

Reviewed by Christiane N. Fabbri (Yale University)
Published on H-Disability (January, 2013)
Commissioned by Iain C. Hutchison

Surgeons, Sailors, and Slaves in the British Royal Navy: Observations
of Maritime Medicine from 1700 to 1900

Naval medicine in the context of military, colonial, and social
history has become a growing area of historical enquiry, as evidenced
by the number of publications in the field within the past decade.
The nine essays presented in this volume are based on the 2007 series
of historical seminars sponsored by the National Maritime Museum in
Greenwich. Collectively, they highlight the important contribution of
maritime medicine to the development of the British Empire during the
eighteenth and nineteenth centuries. They explore the crucial role
naval surgeons played during this period in the advances in
sanitation and hygiene, surgical techniques, nutritional
deficiencies, and tropical diseases. They also underscore the growing
professionalization and prominence of naval medicine, starting with
the founding in 1694 of a hospital for old and disabled seamen in
Greenwich followed by the establishment of the Sick and Hurt Board
for taking care of sick and wounded seamen and prisoners of war,
through to its contributions in the fields of Laboratory Medicine and
Tropical Diseases at the end of the Victorian era.

The book is based on extensive original research, and includes a
valuable bibliography. Its contributors come from a broad range of
fields: social and cultural history, military and colonial history,
the history of science and medicine, psychiatry, and surgery. The
nine chapters of the collection are grouped around two central
themes: the first five are devoted to the practice and administration
of naval medicine in the Royal Navy, and to the crucial importance of
sailors’ health in war and maritime battles; the second four examine
health at sea in times of enforced migration, during the voyages of
slaves, convicts, and indentured or poor migrants.

The editor’s introductory chapter sets the stage from the opening of
the eighteenth century when the renowned London physician Richard
Mead reflected that “medicine still deal[t] so much in conjecture
that it hardly deserves the name of a science” (p. 1), to the end of
the nineteenth century, when after Louis Pasteur’s discoveries the
causative organisms of most common contemporary infectious diseases
had been identified.

The first chapter, an award-winning essay by medical historian Erica
Charters, discusses the inception of what may be some of the first
large-scale clinical trials conducted for the purpose of maintaining
and improving the health of seamen by the Sick and Hurt Board during
the Seven Years War of 1756 to 1763. Historians have attributed the
success of Britain during this war to the navy’s regular sending out
of fresh provisions; clearly, medical and naval officials recognized
that this was key to maintaining health and preventing disease among
sailors during long periods at sea. Contemporaries such as naval
physician James Lind understood diseases like scurvy to be the result
of a lack of fresh provisions, but still explained the disease itself
with traditional medical theories of putrefaction and lack of
adequate humors rather than lack of a specific substance, namely the
essential nutrient now known as Vitamin C, or ascorbic acid. It was
the initiative and systematic investigation by the Sick and Hurt
Board that led to the institution of early standardized experiments,
first in land hospitals, then at sea, where naval surgeons were
charged with evaluating the efficacy of the experiment. Their
findings led to effective new means of provisioning men at sea, such
as the issue to sailors of the widely popular “portable soup.” Most
likely this empirical approach was motivated as much by strategic
military concerns as by therapeutic ones. Nevertheless, as Charters
shows, in its quest to improve the health of seamen the Sick and Hurt
Board contributed significantly to the development of standardized
clinical research methodology.

John Cardwell’s essay, “Royal Navy Surgeons, 1793-1815: A Collective
Biography,” is part of an ongoing research project seeking to provide
insight into the geographic and social origins, medical training, and
professional expertise of the naval surgeons of the French Wars.
Contemporary caricatures of “middle-aged sawbones, driven to the Navy
by alcoholism or incompetence” (p. 38) are not borne out by the
extensive data culled from multiple primary sources, including
service registers and other Admiralty archives. Indeed, the
prototypical naval surgeon of the era, in spite of his usually
relatively modest background, received considerable education and
training, comparable to that of his civilian counterparts, including
apprenticeship as well as university and teaching hospital study.
Tracing the career paths of his cohort, the author demonstrates that
a considerable number of naval surgeons developed successful
practices after their naval service, with some, such as Scottish
surgeon and naturalist Sir John Richardson, garnering lasting fame
for their advancement of nineteenth-century science and letters.

Michael Crumplin, himself a retired surgeon, focuses on the practical
challenges faced by the ship’s medical officer after what, in the
author’s view, was often inadequate experience or haphazard training.
He describes the training and credentialing of naval surgeons, and
provides much interesting detail of their practice setting, including
allocation by rate of ship, daily practice and record-keeping
requirements, surgical instruments needed and supplied, together with
medicinal inventories and sick-bay and dispensary plans. While most
of the surgeon’s duties entailed the care of common ailments such as
gastrointestinal complaints, colds, and rheumatism, combat injuries
would rapidly overwhelm a lone practitioner with few or no
assistants, no matter how sophisticated his casualty triage system.
Until 1795, naval surgeons were able to fine their patients fifteen
shillings for presenting with venereal infections. These were
considered shameful but reportedly accounted for over 60 percent of
urinary tract complaints, and the protocol surely discouraged
consultation (p. 77). Ships medical officers were also called upon to
deal with gruesome battle wounds and perform major operations such as
limb amputations under extremely difficult conditions.

Pat Crimmin’s essay sheds light on how political contexts and cost
considerations influenced the activities and therapeutic choices of
the Sick and Hurt Board. Her painstaking study of the board’s
archival records helps explain some of the difficulties encountered
in improving naval medicine and sailors’ health, as well as the
board’s own ultimate demise when it was abruptly abolished in 1805.
The accusations were a deplorable state of its business, financial
slackness, and poor record keeping. After all, “medical men, by their
training, could not be expected to transact the business of accounts”
(p. 106).

At the end of the Napoleonic Wars, and over the half century
following the abolition of the slave trade, the career of a Royal
Navy surgeon had become so unattractive that it deterred most
volunteer candidates. The health of the navy and the working
conditions of seamen received equally little attention. Mark
Harrison’s essay details how the problems of naval antislavery
operations in tropical stations, and the high death rates of the
crews of the West Africa Squadron, ultimately focused public
awareness on the plight of sailors and brought about a turning point.
Thus the fateful Niger Expedition (1841-42) not only resulted in the
development of medical topography and quinine prophylaxis against
fevers, but also led to broader reforms of naval medicine and health,
including improved conditions for its surgeons. At the end of the
nineteenth century these efforts culminated in the founding of the
London School of Tropical Medicine. The formal study of tropical
diseases had grown out of what was originally a branch of the
Seamen’s Hospital Society.

A second section of four essays centers on the morbidity and
mortality that befell crew and passengers onboard slave ships and
during the enforced voyages of convicts and indentured laborers. The
death rates among such migrant populations were a consequence of
the often appalling and inhuman circumstances: overcrowding and
inadequate provisioning (to maximize profits) together with filthy
conditions. All this made fertile environments for the spread of
diseases such as dysentery, smallpox, and scurvy; it is estimated
that gastrointestinal diseases caused over 40 percent of such deaths.
Slave mortality during the so-called Middle Passage is reported to
have fluctuated widely, from about 10 percent to over 50 percent. In
1693, of 700 slaves bound for Barbados on the Royal Africa Company’s
ship Hannibal only 480 arrived alive. Decreases in death rates in the
transatlantic slave trade by the middle of the nineteenth century
reflect the direct impact of improved health conditions and the
critical role of the ships’ surgeons. Interestingly, mortality rates
of the crew, likely due to malaria or yellow fever contracted in West
Africa, remained unchanged over the same period of study.

The lessons learned by the Royal Navy of the eighteenth century were
gradually implemented during the transport of convicts and other
emigrants from Britain to Australia in the nineteenth century.
Legislation supporting strict sanitary guidelines for surgeons and
captains of government-commissioned ships resulted in much lower
passenger mortality rates during these voyages compared to those of
the much shorter, but unregulated, transatlantic crossings.

This book will be of interest to many historians, particularly those
working in the field of maritime and colonial history, and the social
history of medicine and public health. Clearly, maritime medicine in
the eighteenth and nineteenth centuries is “a rich subject, … ripe
for further investigation” (p. 17). Navy surgeons not only played an
important role in the health of their ship’s passengers, but also
made incontrovertible contributions to the development of
investigational medicine and public health. Future avenues of
research might profit from greater scrutiny of the veterans of
maritime service: the numerous retired and/or disabled sailors and
their physical and emotional sufferings, post-traumatic casualties of
the era.

Citation: Christiane N. Fabbri. Review of Haycock, David Boyd;
Archer, Sally, eds., _Health and Medicine at Sea, 1700-1900_.
H-Disability, H-Net Reviews. January, 2013.
URL: https://www.h-net.org/reviews/showrev.php?id=37836

This work is licensed under a Creative Commons
Attribution-Noncommercial-No Derivative Works 3.0 United States
License.

Advertisements

Guest Blogger: Commander David A Thompson, CHC, USNR, Ret, On the Great Flu Epidemic of 1918

Today, I welcome a guest blogger, retired navy Chaplain David A Thompson. He is researching the 1918 Influenza epidemic. 

Since starting this research, I have had a lot of living relatives of WW I vets come out of  the woodwork to tell their stories of their loved one’s death or survival of the flu in the military in 1918: One 85 year old woman shared with me her dad served with my dad at Camp  Dodge…and was, as a admin NCO [administrative non-commissioned officer, ed.], directed to order over 700 coffins for the dead and had to  help contact families of  dead and dying soldiers. Another clergy friend shared his mother’s dad died of the flu in the Army, meanwhile at home his mother lost her mother, three brothers and a sister to the flu …and was orphaned…all in two weeks in the Fall of 1918! Another Army chaplain friend shared how his dad was with fledgling Army Air Corps in France and was tasked by the CO [commanding officer, ed.] in ministering to dying soldiers due to the flu and ghost writing letters of condolences to families for the CO in lieu of lack of a chaplain. All these children/grandchildren of WW I vets, are now in their later 60”s-80’s like me (I’m a young 66).

A typical letter was shared by a writer friend in St. Paul about an Uncle  who was in the Navy who died of the flu pandemic in World War I :

“Dave, thank you very much for your email. I hope you do tell that important story. It reminds me of one from my own family. My father was a World War II navy veteran. His oldest brother, a gifted athlete, had enlisted in the navy in World War I at 18. He was sent to a naval station in South Carolina where he was assigned to train marksmen while preparing to ship overseas. You probably know what’s coming. Flu swept through his barracks and he came down with it. A telegram was sent to the family in Illinois, but by the time my grandfather, who worked for the railroad as the salvage yard manager, had boarded the train to go East, he was traveling not to see an ill son but to claim his body. He accompanied the coffin and, at one point on the trip back, realized the car it was in was being decoupled. He immediately got off the train and waited with the car for a day until he could see it was safely joined to another train headed to Illinois and that he was with it. My aunts always said that the family never really recovered from Ted’s death. When I was going through my father’s things after his own death, I found his mother’s gold star and a pipe in a leather case with Ted’s initials scratched into it. I felt it was a legacy that needed a special home and one day realized it should go to my cousin’s daughter, who was serving as an officer in the navy and had grown up a mile from that South Carolina barracks and whose grandmother was Ted’s closest sibling. I also put copies of the clippings about Ted together for my children and niece and nephew so that he could stay part of the family life and heritage.”

David McCullough illustrates problems with the flu on the home front, that worried WW I servicemen, in his book Truman. He wrote that Captain Harry Truman (later President Truman) serving as an Army Field Artillery Officer in the 35th Division in France with the AEF [American Expeditionary Force, ed.], hearing of the influenza epidemic in his home town in Missouri, “became so alarmed he hardly could contain himself.” His sweet-heart Bess, her brother Frank, and two friends all had the flu. Truman wrote home, “everyday someone of my outfit will hear that his mother, sister, or sweet-heart is dead. It is heartbreaking almost to think we are so safe and so well over here and the one’s we’d like to protect more than all the world have been more exposed to death than we.”

It was a terrible time for deployed soldiers and sailors, as well as those in training camps in the US, who were  filled with anxiety and concern for family and friends back home who were ill with the flu (25.8 % of the civilian populations) and thousands (675,000) dying back home.

Since there were no ‘footprints” in VA hospitals of wounded warriors from this terrible flu epidemic in WW I (you either got well in 6 weeks or you were very quickly dead), only mute testimony of these flu deaths related to the military (as well as civilian population) is found in US civilian cemeteries or ABMC military cemeteries in France and England (see: http://www.abmc.gov/cemeteries/cemeteries/su.php ) and Brookwood American Cemetery, 35 miles southwest of  London, England (see:http://www.abmc.gov/cemeteries/cemeteries/bk.php ). The Meuse Argonne American Cemetery (see: http://www.abmc.gov/cemeteries/cemeteries/ma.php ) located 150 miles northeast of Paris, France with 14,000 graves, also has many flu casualties buried there. It was during the Meuse Argonne Campaign when the pandemic hit the AEF in full force in October-November 1918 during this battle (over 20,000 + AEF troops died of the flu in this 6 week period of this campaign), while  30,000 died in CONUS [Continental United States, ed.].

Military flu casualties in the US were buried in VA or thousands of community cemeteries in the US, like the one in Texas noted here (see website:  “WW I Casualties from Fayette County”  from a county in Texas that documented so many flu victims among WW I veterans in its county cemeteries http://www.fayettecountyhistory.org/deceased_WWI_veterans.htm ). Most CONUS Navy flu casuloaties were buried in this matter…bodies shipped home by train for quick 15 minute graveside services with only immediate family and clergy without military honors, due to quarantine.

In discussing the WW I Centennial Commemoration of WW I with the American Legion National HQ, there may be an interest in mobilizing American Legion Posts in every county across our nation to dig into county WW I records (like they did in Fayette County, TX) to find veterans who died in the Great  War due to combat or to the flu and tell their story during the WW I Centennial Commemoration in 2018. Such an excavation of WW I veteran records with photos and cause of death will bring to life for the public the sacrifices of WW I veterans and the impact upon our forces of the Great Flu Pandemic of 1918.

©2013 David A Thompson

New Years 2013 – More on “History”

Image

New Year seems to be the expected time – indeed, a convenient time – to reflect on the state of the world. Or in this particular case, the state of the “historical” world. I’m the eternal optimist. So when I went to the New York Times book best seller lists, I expected to see several non-fiction works of (popular) history. To be sure, I found named in this week’s combined print-and-ebook 10 best sellers no fewer than four works, two of which were written by respected historians. Not bad, I thought! Then, I looked for a list of best sellers combining all genres. The most recent one from USA Today, lists just 7 recognizable historical works among 150 best sellers. One of these is the final volume in the Manchester Churchill biographic trilogy; only two of the remaining 6 were written by recognized historians. All of which prompts me to wonder, as the famed WW II cartoonist Bill Mauldin put it in 1946 –

Image

perhaps history is an “Un-American Activity”. Mauldin’s cartoon* above, published 2 April 1946, anticipates the most egregious workings of the House (of Representatives) Committee on Un-American Activities and that of Senator Joseph McCarthy. But we’re not talking about some conspiracy of historians with Communists or terrorists here. I’m simply suggesting that history is not currently an American “thing”.

By way of confirmation of this thesis, we read in October about Florida Governor Rick Scott wanting to reduce funding for teaching of liberal arts in that state’s public universities. And in April, Daniel Weiss, the outgoing President of my own undergraduate alma mater, Lafayette College, highlighted the challenges facing liberal arts education in private institutions. His six word summary: “The market is happening to us”. While these stories make no specific mention of it, it’s clear that the teaching of history, along with that of other liberal arts disciplines, is at risk of being downgraded (to oblivion…?)  in both public and private higher education.

But this problem starts even earlier –  in public elementary and high schools – where students demonstrate distressingly poor performance in history. In results released in June 2011, the National Assessment of Educational Progress reported that just 20% of 4th graders, 17% of 8th graders and a really scary 12% of high school seniors demonstrated proficiency in history. The questions weren’t complicated: who was North Korea’s ally in the Korean Conflict? Why is Abraham Lincoln an important figure in U S history? What social issue did Brown v Board of Education address? A New York Times article reporting these results blames public policy for this failure of public education:  No Child Left Behind places emphasis on improving math and reading scores to the neglect of other topics like history. I think Daniel Weiss’s formula “The market is happening to us” applies in the political / public realm every much as it does to private education. Popular perception (and probably the experience of a good many history majors…) has it that a history degree doesn’t predictably lead to a paying job. And that’s the whole story. Rick Scott said it: “So I want that [taxpayer] money to go to degrees where people can get jobs in this state.” Read this “STEM” – science, technology, engineering, mathematics.

What should be the historian’s role in this brave new world of the hard-science dominated marketplace, if we are to avoid being condemned to relive the past we forgot (or never studied)? As I wrote on New Years last year, I believe that historians must come out of their ivory towers and bring history to the people. Popular history is often looked down upon by academic historians. Yet if the marketplace is well and truly to dominate even the historical scene, practitioners of the discipline must respond by creating products that will do well in a marketplace that is very full and very competitive. Last year I argued that it is past time for academic historians to get out their Powerpoint presentations and knock on the doors of local history groups, libraries, service clubs and PTAs. I also promised that they would be gratified by the reception they receive: people really are hungry to hear their history – so long as it’s even remotely relevant to their lives and presented in an accessible manner.

There’s another thing – a lesson we can learn from the marketplace – that we need to incorporate in to our thinking. I call it the Google principle: you give away some useful product in order to gain customers. Historians must get used to doing some sort of free work in their communities if they are to earn the trust and respect of their communities of tax payers. Once the tax payers actually see what they are “buying”, historians will have gained a share of the marketplace.

So, I propose a goal for 2013: each historian, from Department Head to first year graduate student will give three presentations to lay groups in their communities. Let’s flood our communities with knowledge of their past. Everyone will be the better for it; the outreach may begin a movement that proves the relevance and importance of the study and teaching of history in our marketplace nation; and historians may thereby assure that the practice of their discipline once more becomes an All-American Activity.

* Cartoon is from DePastino, Todd, ed., “Willie and Joe Back Home”, a collection of Bill Mauldin’s post-war cartoons. Seattle, Fantagraphic Books, 2011.
 
©2012 Thomas L Snyder

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

The Society for the History of Navy Medicine Future in Doubt

society-logo-compressed-resized-for-website.jpg

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