Doctors Aweigh/Chapter 3
CHAPTER III
Gold Oak Leaves and Silver Acorns
THERE'S A LOOK in every skipper's eye as he sizes up his new medical officer that is usually compounded of one part pessimism, one part wariness, and one part hope.
The hope is of the incurable nautical variety, endemic among sailors. It is what keeps them going in all weathers and in the face of innumerable misadventures. Undoubtedly it is the quality which made old-time philosophers select a ship's anchor as a symbol of hope. It also — as Navy doctors have reason to know — gets its possessors into innumerable difficulties ashore. But those stories come later.
That look in the skipper's eye reveals that, in spite of all previous experience, he is still looking for the perfect ship's surgeon. When he was a boy he probably read Treasure Island, and he has never forgotten the immortal and invaluable Dr. Livesey.
At Annapolis, his attention was called to the exploits of Sir Francis Drake, through which he made acquaintance with doughty James Wood, of the Garland, chief surgeon of El Draque's fleet, who succumbed to the same epidemic of yellow fever on the day before it killed the mighty mariner whom Spain could not defeat. And to Captain Cook and the useful Mr. Anderson, chief surgeon of the expedition, whose understanding of the psychology of seamen inspired him to limit the ship's supply of sauerkraut to the officers' mess. With the inevitable result, the crew demanded a daily ration from the barrel, ate it defiantly, and so made a voyage, lasting over three years, without a single case of scurvy.
It's a man of that heroic stamp he is looking for.
Through a good many years, and on a good many cruises, under a good many skippers of varying temperaments, I have given a lot of thought to a consideration of what an officer of the Line expects of an officer of the Medical Corps. I have come to the conclusion that what most of them dream of — and stubbornly go on hoping to discover someday — is a M. O. who exhibits a combination of all the virtues of the most famous ships' surgeons in history and romantic fiction plus the qualities which Dumas' Three Musketeers sought in their valets — always on hand and ready to fight for and beside them; one whose ear is always alert to catch the rumbling of any approaching disaster; whom nothing that can happen to men's bodies, to their minds, or even to their souls, can dismay.
Line and Staff — these are the Navy. The Line is the backbone of the service. It is composed of the graduates of Annapolis and a selected few who have been commissioned from the warrant officers, who command the ships and the enlisted men who man them. Officers of the Line are marked by a star on their coat sleeves above the rows of gold braid which denote their rank. To sustain the Line, there are a number of Staff Corps, which are grouped under special departments: The Department of Yards and Docks, the members of which are the architects, construction engineers and builders; the Department of Supply, charged with the job of outfitting ships and naval stations; the Department of Ordnance; the Chaplain Corps, and the Medical Department.
The Medical Department's central administrative organization is the Bureau of Medicine and Surgery, whose chief is the surgeon general, with the rank of rear admiral. The surgeon general is appointed directly by the President for a term of four years.
Our present surgeon general, Rear Admiral Ross T. Mclntire, is a physician of outstanding ability. Under his leadership, the Bureau of Medicine and Surgery has anticipated the demand and provided adequate personnel, supplies, and hospital facilities to meet the unprecedented expansion and the problems which this global war has thrust upon it.
Over the surgeon general, as over the chiefs of all of the seven bureaus of the United States Navy, is the Secretary of the Navy.
That, in brief, is the setup.
The Bureau of Medicine and Surgery is charged with and responsible for the maintenance of the health of the Navy, for the care of the sick and injured, for the custody and preservation of the records, accounts, and property under its cognizance and pertaining to its duty, and for the professional education and training of officers, nurses, and enlisted men of the Medical Department of the Navy.
It is charged with the upkeep and operation of all naval hospitals, medical supply depots, the naval medical and dental schools, and of all technical schools established for the education or training of members of the Medical Corps, Dental Corps, Nurse Corps, and Hospital Corps.
These four corps make up the principal divisions of the Navy's Medical Department.
Each corps has its own insignia. Officers of the Medical Corps — the Medical, Dental, and Nurse Corps are comprised of officers only — wear a spread oak leaf embroidered in gold, surcharged with a silver acorn. The oak is traditionally sacred to the Druid priest-physicians. The Dental Corps wear the same leaf, but with two small silver acorns, one on each side of the stem. The Nurse Corps wear the insigne of the Medical Corps superimposed on a gold anchor. The Hospital Corps comprises the enlisted personnel of the Navy's Medical Department, who wear the red Geneva cross, plus a small number of commissioned and warrant officers, who wear the gold caduceus. The caduceus is the wing-tipped staff twined with two serpents, and was the ancient symbol of Mercury, the Greek god of healing. These insignia are reproduced on the dedication page.
The naval medical officer not only is responsible for the health of the personnel of the Navy, but he is also the medical officer for the Marine Corps. The Marine Corps is an integral part of the Navy and functions under the Secretary of the Navy, although it has its own commandant, with the rank of lieutenant general.
This brings the medical officer into all landing parties, temporary occupation of ports until the Army takes over, and into large military campaigns. During World War I many of our medical officers won great honors and distinction while serving with the Marines in France, particularly in Belleau Wood and at Château-Thierry. I served with the Marine Guard at Peking, China, for a period of about three years, and also in the Philippines, and have never experienced a more pleasant, varied, and interesting duty.
The recent addition of the Waves to the Navy has provided a group of women who are rendering excellent service. There are a number of commissioned officers, as well as those holding enlisted ratings. The commissioned doctors are on duty where there are other Waves stationed, and also in large hospitals, particularly in the technical departments. They serve to release for sea duty members of the regular Navy.
Though a Bureau of Medicine and Surgery was established by Act of Congress only on August 31, 1842, there have been ships' surgeons in the United States Navy since the first ship was commissioned. This was the Alfred, whose first lieutenant, John Paul Jones, hoisted the Star and Rattlesnake flag to her masthead in the harbor of Philadelphia in 1775. Aboard the U.S.S. Alfred, to fight the British in the Atlantic, sailed the first American Navy doctor — Joseph Harrison, M.D.
An act of the Continental Congress of that same year, which ordered the formation of a naval force, allotted "a surgeon and a surgeon's mate to each vessel." The surgeon's pay was approximately twenty-five dollars a month.
Some of those early ships' surgeons were doughty fellows. They had to be, to stand the seafaring life of those days. Wasn't it old Samuel Johnson who remarked to a friend about to take a voyage, "Why go to sea when there are prisons ashore?" Those wooden ships, with their bilges filled with black, stinking water, the crowded quarters, poor facilities for carrying and keeping foods, and the necessarily long voyages, were pestholes to rival the Black Hole of Calcutta.
In those days, the expression "Scurvy as a sailor" was not undeserved. During the great years of the East India Company's trade, the ships that sailed from England to Calcutta regularly lost one third of their crews from this disease on every voyage. Aside from seasickness, scurvy is the one disease which may be said to be almost purely nautical. It occurs on land, of course, among the malnourished; but at the time of the great naval expansion during the sixteenth century, scurvy was comparatively rare, except among seafarers.
Scurvy, as we know now, is one of the deficiency diseases. It results from a diet too low, or entirely lacking, in vitamin C. As the human body is unable to store up any great reserve of this vitamin, a marked reduction in its amount in the diet is soon followed by symptoms of scurvy. Take away from the diet all fresh meats, milk, fruits, and leafy vegetables, and, within as short a time as two weeks, early symptoms of scurvy may appear. Exposure to cold and wet, fatigue, and loss of sleep hasten the onset of the disease.
Given these conditions — and these were the conditions that obtained in all navies in the days of wooden ships and canvas — scurvy was as common aboard ship as rats and cockroaches. Sir John Hawkins, Queen Elizabeth's great captain, says that in his twenty years at sea scurvy cost the British Navy 20,000 men. The disease played less havoc with Spanish, Portuguese, and Venetian sailors than with the British, perhaps because the ships that were outfitted at Mediterranean ports usually carried more of the anti-scorbutic citrus fruits, cabbage, and onions.
My friend, Captain Louis H. Roddis (MC), United States Navy, in his Short History of Nautical Medicine, to which I am indebted for many of these historical facts, tells the story of a Portuguese sailor serving on one of the ships in the East Indies trade who "came to 'request mast' and asked that an onion be added to the bread, oil, cheese, and wine that formed their main ration." The captain roared out at him to demand if he expected luxuries at sea. Yet just that additional onion a day would have saved lives from scurvy.
The disease seems to have been less prevalent on the Dutch merchantmen and naval vessels than on those of other Northern navies. This may be due to the fact that Dutch ships usually carried a hogshead of sauerkraut which was served to the mess.
As Captain Roddis points out, "Many wars and campaigns have been decided more by disease than by arms." Medical writers of the early nineteenth century agree that England's blockade of France, which ultimately annihilated Napoleon's sea power, would have been impossible if scurvy had not been previously eliminated from the British Navy.
Yellow fever and malaria destroyed the power of Drake's fleet off South America and left the Dons in power.
What cost France the loss of her empire in the Caribbean was not the strength of the Haitian rebels, but the "yellow jack," which routed Rochambeau's army.
One of the greatest names in the history of naval medicine is that of James Lind, who served as surgeon on board H.M.S. Salisbury in 1747. Lind experimented with twelve cases of scurvy aboard that ship, until he proved conclusively that the disease could be cured, and very rapidly, simply by adding lemon juice to the daily ration. In six days two sailors who had been given a lemon and two oranges daily during the experiment were so far recovered of the disease that one man went back to duty and the other was retained to nurse the remaining ten who had been kept without the ration of vitamin C. Dr. Lind's cure for scurvy was adopted by ships' surgeons in the British and other navies. But it was not until nearly fifty years later that Sir Gilbert Blane, fleet surgeon on Admiral Rodney's flagship, H.M.S. Formidable, who had followed Lind's treatment for scurvy with the result that not one of the nine hundred men aboard the Formidable was lost from scurvy in six months, succeeded in having the Admiralty make lemon juice a requirement for all vessels of the Royal Navy.
With the introduction of a daily ration of lemon juice, to begin after a ship had been at sea for a fortnight, scurvy disappeared from the British Navy as if by magic. At that time there was little distinction made between lemons and limes. In fact, lime juice was often substituted for lemon juice in the ration. This is the origin of the term "limey," used for a British sailor to this day.
In view of what we now know about vitamin C, it is interesting that the quantity of orange or lemon juice recommended by Dr. Blane — one ounce daily — contains almost the exact amount of ascorbic acid which modern scientific studies have shown is required to maintain the vitamin C balance of the body.
If James Lind and Sir Gilbert Blane lead off the roster of famous naval surgeons, the next names in the list are those of Charles Darwin, Thomas Huxley, Karl von Linné, better known as Linnaeus, the great Swedish botanist, and the English botanist, Sir John Richardson.
Among the famous doctors of the American Navy must be mentioned Dr. Edward Cutbush, of Philadelphia. While still a medical student at Pennsylvania Hospital, he served in the fight against the yellow-fever epidemic of 1793 and received the official thanks of the city of Philadelphia. Upon graduation, he joined a force of militia to suppress the Whisky Rebellion. Later he was appointed "surgeon in the Navy of the United States." He served on the Constellation in the blockade of the Barbary ports. This squadron was based at Syracuse, Sicily, where Dr. Cutbush established what was probably the first United States naval hospital, certainly the first one overseas.
Cutbush was probably the first surgeon in our Navy to vaccinate against smallpox. In 1799, only one year after the publication of Jenner's historic treatise, Cutbush vaccinated all those aboard the frigate United States who had not had smallpox. In 1808, at the time of an outbreak of smallpox at the Marine barracks, Philadelphia, the doctor wrote to the Secretary of the Navy, "The natural smallpox has now appeared among the recruits; to arrest its progress, I have, vaccinated thirteen." The official order from the Navy Department, making smallpox vaccination compulsory, did not come until December 1, 1848.
Cutbush's extraordinary energy carried him on to write the first book on naval medicine by an American: a work whose sound common sense and practical suggestions on the subject of food, clothing, water, personal hygiene, disease prevention, recruiting, and the organization and administration of military hospitals have not been surpassed by any writers on the subject since his time. Dr. Usher Parsons, who was Commodore Perry's surgeon at the Battle of Lake Erie, was the only surgeon in the squadron able to attend the sick and take charge of the wounded. The other medical officers with the naval force were ill with what was called "lay fever" — probably malaria. Parsons tells us, "Having sole charge of the wounded of the whole Fleet, and the wounded being passed down to me for aid faster than I could attend to them in a proper manner, I aimed only to save life during the action by tying arteries or applying tourniquets to prevent fatal hemorrhage, and sometimes applying splints as a temporary support to shattered limbs, et cetera. In this state the patients remained until the following morning, under the free use of cordials and anodynes. At sunrise [the eleventh] I began amputations, and in the course of the whole day I visited the other vessels and brought all the wounded on board the Lawrence and treated them in like manner."
After 1820 Parsons resigned from the service and became a civilian physician in Providence, Rhode Island. He was a leader in the medical profession in that state and Professor of Anatomy and Surgery at Brown University. One of Dr. Parsons' greatest services while in the Navy was his effort to bring about the abolishment of flogging as a mode of discipline.
Captain David Porter's account of his voyage in the U.S. frigate Essex around Cape Horn and into the Pacific makes frequent mention of the three medical officers with him. The names of Surgeon Robert Miller and Surgeons Mates Alexander M. Montgomery and Richard K. Hoffman were signed to the Declaration of November 19, 1813, in which Porter took formal possession of Madison Island for the United States. This was our first island possession in the Pacific.
Not even a brief sketch of the history of the United States Naval Medical Corps would be complete without the story of Dr. Lewis Heermann, who was surgeon of the Enterprise — Decatur's ship. At the time the Bey of Tripoli was making trouble for American merchantmen, a squadron of observation sailed from Hampton Roads with orders to visit the North African ports. While the blockade of these ports was maintained, American ships used to put in at Malta, Gibraltar, Malaga, and Port Mahon on the Island of Minorca, to take on supplies, make repairs, or land sick and injured. We had temporary naval hospitals on Minorca, the record of which has vanished except in the old American sea chantey:
Off Cape de Gatte
I lost my hat,
And where do you think I found it?
In Port Mahon
Under a stone,
With all the girls around it.
During the war, the frigate Philadelphia was captured by the enemy and its officers and men held prisoners for nineteen months. One of the Philadelphia's medical officers, Dr. Jonathan Cowdery, became a favorite of the bashaw and was called in by him as obstetrician at the delivery of one of his favorite concubines.
As soon as the news of the capture of the Philadelphia became known, plans were made by Commodore Preble to destroy her before the Tripolitans could complete her salvage. The Americans had captured a small lateen-sailed ketch, sailing to Constantinople with the bey's present to the sultan of a cargo of female slaves. This vessel was renamed the Intrepid, under command of Stephen Decatur, and manned by a crew of volunteers. She looked like any one of the ordinary Mediterranean craft commonly seen along the coast of Algiers and Tripoli. Decatur's orders were to sail her into the harbor of Tripoli and up alongside the Philadelphia. The crew was to board the Philadelphia, drive the Tripolitan prize crew overboard or below, set the frigate afire, and then cast off from the burning vessel and row out of the harbor away from the fire of the bey's forts and men-of-war. It was a bold plan, and executed as boldly. Lord Nelson, no bad judge of naval exploit, called it the most daring act of the age.
Now we come to Dr. Heermann, the surgeon aboard the Enterprise. Lieutenant Decatur told the doctor: "The brig Siren will accompany us to give succor if required, and to cover our retreat if necessary. I shall want you, Doctor, to go with me. But before I go into the harbor, I shall put you on board the brig."
Dr. Heermann begged for permission to remain on the ketch — an idea which Lieutenant Decatur discouraged, saying: "The expedition is too dangerous to expose surgeons. Suppose, sir, you should be killed or wounded it would reflect on me." But the doctor persevered: "My life, sir, is not more valuable than that of any of the other brave officers and men who are to accompany you. Should I be killed or wounded, the officers and crew would be as well provided for after their achievement by Dr. Marshall alone as by him and myself united." He went on to urge the lieutenant with the argument: "The presence of a professional man to assist the wounded might save you many valuable lives that may be sacrificed from loss of blood for want of a surgeon conversant with the most effectual means of stanching it. And will not sailors more regardlessly expose themselves when they know that professional aid is near at hand? Should you have many wounded, would not some confusion arise to impair your effective force?"
In all the literature of the sea I do not believe there is a more eloquent argument for the presence of the Navy surgeon than these words.
Decatur yielded to them. When the time came to board the Philadelphia, he put the command of the ketch under the doctor, with seven seamen. His warning was: "The enemy, when pressed hard, will be apt to retreat from the spar deck and board the ketch from the ports of the frigate. As boats may be sent from shore to their assistance, your safety will consist in giving no quarter. I shall expect you to defend the ketch to the last man, as the successful issue of the expedition may depend on its preservation."
Heermann played his part well, and the success of the exploit in which he figured has passed into American naval history.
The United States Marines have a song for it:
From the Halls of Montezuma
To the shores of Tripoli . . .
On those same shores of Tripoli and Tunis, United States naval doctors have carried on the tradition established by Dr. Heermann: landing by parachute with paratroopers; serving aboard submarines and the destroyers and cruisers convoying armed land forces to our campaign in North Africa, and establishing laboratories for the investigation and ultimate elimination of diseases like typhus, dysentery, and cholera, which, so far, have always followed in the wake of war.
In the past seventy-five years medicine has progressed from an art to a science. The doctor today has diagnostic aids which would have seemed fabulous to the physician of a hundred years ago. Exact laboratory tests and the X ray enable the physician to base his treatment on definite knowledge. These are as available to the surgeon and doctor aboard ship as to the man working in the most modern and extensive medical center.
Take a look, for example, at the sick bay aboard the U.S.S. Brooklyn. Here is a typical doctor's office with its desk, medical library, and lockers for medicines and instruments. The bulkheads are scraped bare of paint to meet battle conditions. It has been found that in battle, when the ship's ventilating system is shut off and all hatches are closed, the paint tends to heat and may become a fire hazard.
Next to the medical officer's office is a completely equipped operating room with its table under shadow-proof lights and every surgical instrument you would find in the best hospitals ashore. Off this is the sterilizing room with its stainless-steel equipment. There is also a small but adequate pharmacy and laboratory, where members of the Hospital Corps put up prescriptions, make blood and urine analyses, and do all the technical work required by modern surgery and medicine.
Along the passageway is the office of the ship's dental officer, whose X-ray machine serves medical officers also.
Across the passageway is the cruiser's hospital, or sick bay, with beds for twenty-five patients. The complement of a cruiser is about 1,200 men, so the hospital facilities more than equal those of the most progressive civilian communities. The medical staff of a cruiser usually consists of a chief medical officer, together with an assistant and a dental officer. Under these officers are several pharmacist's mates, trained as anesthetists, laboratory technicians, bacteriologists, and chemists, who give advanced first aid and care for the injured and sick.
Many doctors come into the Navy from civil practice, as Medical Reserve officers for the duration of the war, and wonder at first how they are going to carry on without women nurses, and in the small confines of a fighting ship. The first discovery they all make — and admit with a simplicity that is quite touching to a doctor of the regular Navy — is that the hospital corpsmen, some of whom are lads less than twenty years old, who were students, plumbers, shoe clerks, morticians' helpers, and welders before they enlisted, make most efficient, dependable, and loyal nurses.
The second discovery they make is that they can treat the infinite variety of ailments and injuries which come to a sick bay with the limited but expertly selected pharmacopoeia a ship carries. This may call for a more inventive and exact knowledge of drugs and chemistry than many of these physicians required in civilian life, when they had offered for their use innumerable preparations put out by all the drug manufacturers in the country.
The Navy's Medical Corps is made up of physicians who are graduates of recognized medical schools. For appointment, they must be citizens of the United States and less than thirty-two years of age. The number of medical officers in the Navy, as prescribed by law, is six and one half per thousand of the total authorized strength of the Navy and Marine Corps.
Applicants for the Navy Medical Corps are selected after careful physical and professional examinations. Those selected are then sent to the Navy Medical School, which is now located at the National Naval Medical Center, a few miles outside of Washington, at Bethesda, Maryland. There the "boot" doctor is inoculated with Navy training, regulations, and tradition. He also brushes up on phases of medical work and surgery which may be more prevalent in the Navy than in civil life. For example, today very few doctors in general practice, or young internists, have had a chance to study at firsthand cholera, bubonic plague, yellow fever, dengue, dysentery, or typhus. Few of them have seen advanced cases of malaria. The Navy doctor, who may be sent to service in the Solomons, in Panama, or with the fleets in either ocean, will have need of knowledge of these tropical diseases. This we try to give him at the Navy Medical School before he reports for active duty.
The school also serves as a consultant center for the entire naval service. Medical officers from all parts of the world send pathological specimens there for diagnostic study and confirmation.
In addition to the regular officers of the Medical Corps we have the Reserve officers — physicians in civilian practice who may be called into the Navy's service during an emergency. These Reserve officers serve in naval hospitals ashore and aboard the fighting ships under exactly the same conditions and regulations as regular Medical Corps officers. They include many of the outstanding men in the various fields of surgery, medicine, epidemiology, psychiatry, and research. Because of their age a number of these doctors did not have to join the armed forces, but they have unhesitatingly and voluntarily given up lucrative practices and the comforts of home to render what service they can for the alleviation of the sick and wounded soldiers, sailors, and Marines.
While this book was in process of writing, the lady who has assisted me with the material and its arrangement saw a young sailor sitting patiently on a bench in Grand Central Station. When she spotted the red Geneva cross on his left sleeve, which marked him as a member of the Navy's Hospital Corps, she went over and sat beside him in quest of copy.
It was hard digging. The boy had been well drilled in the necessity for withholding all information that might be of use to the enemy. Finally, in desperation, the interviewer gave as her excuse for asking questions the preparation of this book.
The boy took a long, sharp look at her. Then he blurted out:
"Even if it gets to Hitler, I'll tell you this — the Navy's got the best damn doctors in the world."
Then, swinging his duffel bag over his shoulder, he took refuge in flight.