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Thursday, March 2, 2017

Naval Medicine: The Birth of Veteran's Healthcare Rights

From: learningabe.info


           In his 2nd Inaugural Address, President Lincoln turned from the divisive bitterness at the war’s roots to the unifying task of reconciliation and reconstruction. In the speech’s final paragraph, the president delivered his prescription for the nation’s recovery:

          “With malice toward none, with charity for all, with firmness in the right as God gives us to see the right, let us strive on to finish the work we are in, to bind up the nation’s wounds, to care for him who shall have borne the battle and for his widow, and his orphan, to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations.”

         "The Federal Navy's Bureau of Medicine and Surgery experienced a substantial loss of officers during 1861. It responded to the loss and the increased demand for its services by augmenting its regular medical officers with volunteer physicians. The medical corps more than doubled in size between 1861 and 1865 as a result of the recruiting efforts. Navy physicians were involved in blockade duty, anticommerce raider cruises, amphibious assaults, riverine duty, and staffing naval facilities ashore. Their services are virtually unknown despite their involvement in most naval activity during the war. This article illuminates their efforts. It does so by analyzing individual service records and reports compiled in the Official Records of the Union and Confederate Navies during the War of the Rebellion. The Bureau of Medicine and Surgery successfully met the demands made upon it during the American Civil War.

          The Federal Navy's Bureau of Medicine and Surgery receives little attention in American Civil War-related publications and discussions. Its medical officers are even more ignored. Answers to basic questions like how the bureau was affected by the war; what was the physician rank structure, how experienced were navy physicians, what was the physician attrition during the war, what assignments were available, what maladies did they treat, and how were they recognized for meritorious service are not readily available. This article attempts to answer these questions by analyzing service records and official war-time naval reports.

The Bureau of Medicine and Surgery Expands
Dr. William Whelan was Chief of the Bureau of Medicine and Surgery (BMS) during the war years.1 He was a senior surgeon, having joined the Navy as an assistant surgeon on January 3, 1828. (He was promoted to surgeon on February 9, 1837.) His physician corps on January 1, 1861 included 61 surgeons, 25 passed assistant surgeons, and 45 assistant surgeons.2 BMS lost 41% of its January 1861 physician complement by the end of the year. A massive recruiting effort soon began, and BMS rapidly grew as a result. Many civilian physicians volunteered and entered the service as acting assistant surgeons. The volunteer physicians comprised 56% of BMS' medical officer strength by 1865.2 The majority of the volunteers either resigned or received honorable discharges soon after the war ended. The strength of the BMS peaked in 1864 with an average of 463 physicians present that year.

The 1864 Navy Register, which surveyed  the Navy for 1863, showed the following statistics for all Navy  medical staff:
Regular Navy
Surgeons:  80
Passed Assistant Surgeons:  7
Assistant Surgeons:  108
Resigned Assistant Surgeons for '63:  11
Death for '63:  4
Dismissed in '63:  1
__________
Total: 211

Volunteer Navy
Acting Assistant Surgeons:  197
Resigned in '63:  20
Revoked in '63:  9
Dismissed in '63:  3
Death for '63:  9
__________
Total: 238

Medical Officer Ranks and Years of Experience
          There were three ranks for Civil War era naval medical officers. These were (in reverse order of seniority): assistant surgeon, passed assistant surgeon, and surgeon. BMS physicians in January 1861 were experienced officers. On average, assistant surgeons had 6 years in grade (range, 1-23 years); passed assistant surgeons had 14 years of service (range, 6-32 years) with 6 years as assistant surgeons and 7 years as passed assistant surgeons; and surgeons had 27 years of service (range, 2-49 years) with 8 years as assistant surgeons, 7 years as passed assistant surgeons, and 17 years as surgeons.

          Promotion was rapid at the war's outset. All of the passed assistant surgeons were promoted to surgeon by August 1, 1861. Six of the assistant surgeons were promoted to passed assistant surgeon (four of these newly promoted passed assistant surgeons were soon thereafter promoted to surgeons) by December 1861. Nine assistant surgeons were promoted directly to surgeons by the end of 1861.

          The application by civilian doctors was required to provide responses to a variety of medical related questions in order for the Naval Board to determine qualifications for the position. The responses are rich with highly detailed medical content offering an interesting perspective on the medical knowledge and practices of the period.

          Because of the rapid loss of officers to the Confederacy and expansion of the Federal Navy during 1861, the Federal Navy quickly recruited civilian physicians into service. During the course of the war, three ranks existed for naval medical officers; assistant surgeon, passed assistant surgeon, and surgeon. The prospective surgeons made application in writing to the Navy and then were vetted by a board or individual as to their ability to serve and their experience.)

Medical Officer Assignments
          Medical officers were assigned to either shore or sea duty. Many of them served aboard vessels on blockade duty. An important operational assignment was searching for enemy commerce raiders.

          The Navy undertook many littoral raids, often to flush out Confederate units that periodically attacked Union naval forces. During the night of April 8-9, 1864, the USS Minnesota at Norfolk, Virginia was damaged during a daring attack by a Confederate Navy torpedo boat (which escaped). On April 9, the navy arranged a combined operation with the army against the area from which the torpedo boat was suspected to be operating. The expedition left on April 14 and returned the next day. The riposte was unsuccessful in finding the torpedo boat and caused two federal naval casualties-one man was killed and one was severely wounded.

          BMS physicians ashore were found in hospitals, a laboratory, a naval asylum, naval rendezvous (recruiting centers), and navy yards. Naval hospitals were located in Washington, DC, Boston (Massachusetts), New Orleans (Louisiana), New York (New York), Norfolk (Virginia), and Pensacola (Florida). Physicians assigned to these hospitals in January 1865 were: Surgeon Joseph Beale, Assistant Surgeons Robert T. Edes and William K. Van Reypen (Boston); Surgeon Samuel J. Jones, Assistant Surgeons Thomas H. Land and Heber Smith (New Orleans); Surgeons Thomas L. Smith and Benjamin Vreeland, Assistant Surgeons Josiah H. Gunning, Joseph Huge, and William F. Plant (New York) ; Surgeons A.A. Henderson and William Johnson Jr., Passed Assistant Surgeon Walter K. Scofield, and Assistant Surgeons N. H. Adams and J. Wesley Boyden (Norfolk); Surgeon Thomas J. Turner (Pensacola); and Surgeon F. M. Gunnell (Washington, DC).

          Navy yards with medical officers were Baltimore, Boston, Mound City (Illinois), New York, Norfolk, Pensacola, Philadelphia, Portsmouth (New Hampshire), San Francisco (California), and Washington, DC. Physicians assigned to these facilities in January 1865 were: Surgeons Daniel Egbert and Robert T. Maccoun (Baltimore); Surgeon Samuel Jackson, Assistant Surgeon Charles T. Hubbard (Boston); Surgeon William T. Hord, Acting Assistant Surgeon Vincent H. Gaskill (Mound City); Surgeons Benjamin F. Bache (naval laboratory) and J. M. Browne, Passed Assistant Surgeon Newton L. Bates (naval laboratory), and Assistant Surgeon J. J. Allingham (New York); Acting Assistant Surgeon James Kinnear (Norfolk); Assistant Surgeons John H. Austin and James R. Tyson (Pensacola); Surgeons Thomas Dillard, J. S. Dungan (naval asylum), and David Harlan (naval asylum), and Assistant Surgeons George H. Cook and A. A. Hoeling (naval asylum) (Philadelphia); Surgeon M.G. Delaney, Assistant Surgeon John H. Clark (Portsmouth); Surgeon J. A. Lockwood (San Francisco); and Surgeon M. Duvall, Assistant Surgeon D. R. Brannon (Washington, DC).

          Naval rendezvous with medical officers included Boston, Chicago, Illinois, New Orleans, New York, Philadelphia, and Portsmouth.5 Physicians at these recruiting facilities in January 1865 were: Surgeons J. Brinckerhoff and J. Winthrop Taylor (Boston); Assistant Surgeon Frank L. DuBois (Chicago); Acting Assistant Surgeon D. McLean (New Orleans); Surgeons Charles Chase, Edwin R. Denby, S.W. Kellogg, John Thornley, Robert Woodsworth, and Assistant Surgeon D. F. Ricketts (New York); Surgeons G.R.B. Horner and Philipe Lansdale and Assistant Surgeon Henry C. Eckstein (Philadelphia); and Assistant Surgeon E.C. Ver Meulen (Portsmouth).

Injuries, Diseases, and Wounds
          The doctors' professional services mainly consisted of attending to the sick or those injured during the course of performing the ship's mundane duties. Common illnesses were malaria, yellow fever, dysentery, scurvy, and sexually transmitted diseases. One surgeon faced 24 men injured when the ship's anchor chain surged during weighing of the ship's anchor. The loss of tension caused the capstan to spin uncontrollably, thus injuring the sailors. Combat injuries were caused by gunshot, cutlasses, shrapnel, cannon shot, and steam.

Recognition of Service
          Medical officers were rewarded in several ways. Officers aboard the blockading vessels gained prize money, often substantial sums, if their ship captured a blockade runner. Officers advanced up the seniority list as a result of meritorious performance. Deeds of valor or exceptional work were commonly mentioned in commanders' reports ("mentioned in dispatches"). Medical officers were mentioned in dispatches and some came to the Secretary of the Navy's attention as a result of their gallantry. William Longshaw was one such physician. Longshaw was aboard a monitor that grounded off Morris Island, Charleston, South Carolina, during the November 16, 1863 bombardment of rebel batteries at Cumming's Point. Rear Admiral Dahlgren noted in his official report of the engagement that Longshaw volunteered twice to take a towing line to another vessel despite being under heavy fire. Dahlgren asked that Longshaw receive appropriate recognition for his bravery. Whelan endorsed the recommendation and suggested that Longshaw be allowed to sit for his passed assistant surgeon examinations and, if he passed, be promoted to passed assistant surgeon to date from the examination day and without regard to others in his class or promotion date. The Secretary of the Navy concurred and had the recommendation read around the fleet.

Medical Officer Attrition
          BMS lost 491 physicians to resignation, sickness, or combat during the war. There were 229 resignations for various reasons, 62 dismissals, 27 retirements, and 52 deaths 2.  One physician who died was Assistant Surgeon William Longshaw. (Doctor Longshaw joined the Navy on June 25, 1862 as an acting assistant surgeon. He became an assistant surgeon on November 9, 1862.) By January 1865, Longshaw was aboard the USS Minnesota on blockade duty off of Wilmington, North Carolina. Longshaw was part of the USS Minnesota's 241-man contingent assigned to the Naval Brigade that participated in the January 15, 1865 assault that captured Fort Fisher (Wilmington, North Carolina). Longshaw was killed by grapeshot during the assault. The USS Minnesota's landing party suffered a nearly 14% casualty rate during the attack. Of the 33 casualties it suffered, 8 were killed and 25 were wounded in action. Other naval physicians who participated in this action were Acting Assistant Surgeon John Blackruer, who was also killed during the assault, and Assistant Surgeon B. H. Kidder, who commanded the naval field hospital established approximately 1 mile from Fort Fisher. This hospital initially treated the 200 sailors and marines who were wounded during the assault.

The commander of the ship's landing party commented in his official report:
          I regret to report the death of Assistant Surgeon William Longshaw, Jr. He was always near the front with instruments and tourniquets, and was bending over a wounded and dying man when he was shot in the head and instantly killed. Their bodies were found together after the battle. His bravery was conspicuous, and he nobly discharged the duties of his office.
Longshaw's remains were transported to the Norfolk hospital for final disposition.

          Twelve Civil War veterans eventually headed the BMS. These men were: Phineas J. Horwitz, William M. Wood, Jonathan M. Foltz, James C. Palmer, Joseph Beale, William Grier, J. Winthrop Taylor, Philip S. Wales, Francis M. Gunnell, John M. Browne, James R. Tryon, and William K. Van Reypen. Only James Tryon began his naval career as an acting assistant surgeon (March 19, 1863), but he was soon accepted into the regular Navy as an assistant surgeon (September 22, 1863).

          BMS responded well to the challenges presented by the American Civil War. Its physicians succored their patients as best they could, often under less than ideal conditions. Some of them sacrificed their health, even lives, while defending the Union. They gained valuable experience that served BMS well over the succeeding years. This experience proved helpful for the planned (but ultimately truncated) expansion of the service at the beginning of the Spanish-American War. This article is a tribute to the men who served in the Civil War-era Bureau of Medicine and Surgery.

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