US Naval Hospital Corps School - Yearbook (San Diego, CA)

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HISTORY OF THE MEDICAL DEPARTMENT The story of the Medical Department of the United States Navy is one to arouse pride and stimulate enthusiasm in every American citizen. Such continuous, and at times stu- pendous strides forward, have been taken in the quality of the medical care provided for personnel of the Navy and Marine Corps as to be almost unbelievable. It is good to note and give thought to just how far we actually have advanced beyond the conditions of ignorance and neglect that were prevalent in the eighteenth century. Then, disease and pestilence were rampant, and a severely wounded sailor had little hope of survival, now, the mor- bidity rate in the Navy has been reduced to the lowest point in history, and in the Korean Conflict the mortality rate for Navy and Marine Corps personnel who had been wounded in combat was only 2.0 per cent, truly an all-time low. The practice of naval medicine in America had its be- ginnings late in 1775, when the first American fleet was placed in commission by acts of the Continental Congress. Physicians originally were selected by commanders of naval vessels to serve on individual voyages, and often were assisted only by the oldest or most incompetent of the seamen on board. Much of the financial reward the Surgeon could ex- pect consisted of a share in such booty as the ship might capture. In 1798, when the Navy Department was established, sur- geons and surgeons' mates were given the status of commis- sioned officers, but then and for the next 44 years there was no medical department, only individual officers who were not organized in any sense. During this period, there was only gradual evolution toward adequate medical support of the Navy. A Marine Hospital Fund, made up of monthly pay- ments from all seamen and later augmented by money from fines and forfeitures, was established to finance hospitals. Most hospitals were in unsatisfactory buildings selected with- out plan, and a major accomplishment of the Fund was mak- ing arrangement for building the first permanent hospital, at Norfolk, Virginia. This hospital began to receive patients in 1830. Other hospitals, financed by regular appropriations, soon followed-in Philadelphia in 1833, in Boston in 1836, and Brooklyn in 1838. Throughout this first portion of the nineteenth century, a number of able and energetic physicians fought for a well- organized and adequately-equipped medical department. Their efforts resulted in considerable improvement in the quality of professional personnel, in medical equipment and supplies, and in quarters for the sick on board ships and at hospitals ashore. Notable among these men were Edward Cutbush, Usher Parson, Lewis Heerman, and William P. C. Barton. Doctor Barton, in particular, made numerous contributions that had a great and lasting- effect in improving medical care. He was an early advocate of increasing the space as- signed as a sick bay on board ship, and of standardizing equipment and supplies for the medical departments of ships. He also was responsible for establishing a medical library in each naval medical unit and for instituting a medical journal on each patient, however, his proposal for utilizing female nurses in hospitals went unheeded for two generations. Perhaps his greatest contribution was in writing his Treatise Containing A Plan for the Internal Organization and Government of Marine CNavyJ Hospitals. Certainly this classified treatise and his continuous efforts had much to do with the establishment in 1842 of the Bureau of Medicine and Surgery, which was created to supervise naval medical affairs along the lines he had proposed. Most appropriately, he was named the first Chief of Bureau. fThe title of Surgeon General was not created until 1871 and was first held by William M. Wood, the fifth Chief of Bureauj From its inception, the new Bureau made notable progress in organizing, developing, and perfecting naval medicine. Fascinating accounts of many aspects of this progress can be found in the reports to the Secretary of the Navy made each year since Civil War times by the Chief of Bureau or, after 1871, by the Surgeon General. This unbroken series of annual reports has been of great value to students of preventive medicine, vital statisticians, and public health

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authorities, in determining trends of morbidity and mortality rates. One development that had an early beginning-the estab- lishing of hospitals in ships-conferred mobility on definitive medical and surgical care, making it possible to furnish such care wherever on the seven seas it might be needed. The best-known hospital ship employed during the Civil War, the Red Rover, was a Mississippi sidewheeler cap- tured from Confederate forces and converted for use as a hospital under the command of Surgeon Ninian Pinkney. The staff included the first female nurses of whom there is any record in the Navy. They were Nursing Sisters who volunteered only for service during the war. Other hospital ships followedg of these the USS Solace, converted to hospital use in 1898 during the Spanish- American War, was the first of our naval vessels to fly the Geneva Red Cross flag. A long controversy over whether -a medical or a line officer should command such a ship finally ended in placing a line officer in command of the ship proper, with a medical officer in command of the hospital within the ship and of all professional medical matters. During World War 1 and World War ll, more and more advanced hospital ships were developed, particularly those few that were built from the keel up for this purpose. Near the close of the latter war, some 12 hospital ships were in operation by the Navy, those of the Haven class being of advanced design. Still greater effectiveness was achieved during the Korean Conflict by the addition of landing platforms for helicopters so that casualties wounded in battle could be flown in a matter of minutes from close behind the front line to the safety and expert care available on the ship. Such atraumatic and expeditious handling saved many lives. Other early developments of great value were instituted by the Bureau of Medicine and Surgery. A book of Instruction for Medical Officers, now known as the Manual of the Medical Department, was first published in 1886. A Naval Medical School was established by Surgeon General Presley M. Rixey in 1902 for post graduate instruction of newly appointed medical officers in special aspects of naval medi- cine. Annual physical examinations of naval personnel were begun in 1909. To provide information on current progress in professional matters to Medical Department personnel, wherever they might be, publication of the U. S. Naval Medical Bulletin was inaugurated in 1907. The Bulletin with its successor, the U. S. Armed Forces Medical Journal, have been published continuously to the present day. A supple- mentary Hospital Corps Quarterly, now the Medical Tech- nicians Bulletin, was provided for non-professional Medical Department personnel. It is especially enlightening to consider the changes that have taken place over the years in the status of various com- ponent groups having a part in naval medicine. The term, Medical Corps, was first employed in an appropriation act of 1871. Thereafter medical officers were listed as mem bers of the staff corps of the Navy. Their grades were Medi- cal Director, Medical Inspector, Surgeon, Passed Assistant Surgeon, and Assistant Surgeon, with ranks of Captain, Commander, Lieutenant Commander, Lieutenant, and Master flater changed to Lieutenant, junior gradej. Since 1918, medical officers have held the regular military titles of their rank. Prior to 1898, enlisted assistants to medical officers were known successively as loblolly boys, surgeons' stewards, apothecaries, nurses, and baymen. In that year the Hospital Corps was established by legislation, which specified quali- fications and duties. The 60 years that have elapsed since then have seen the Hospital Corps demonstrate increasingly high morale and technical competence based both on the fine quality of personnel assigned to the Corps and the careful training afforded each member. The Navy Nurse Corps was established without commis- sioned rank in 1908, and women nurses thereafter served ably in many shore-based hospitals and on hospital ships. In World War I1 over 11,000 nurses were in service. An act of 1947 made members of the Nurse Corps permanently commissioned staff officers with rank, pay, and allowances equal to those of other staff officers up to and including Captain. Officers of the Nurse Corps have performed in- valuable service in field medical units in Japan and Korea,