Comments re my Medical History
The history of medicine is fascinating and we often lose sight of how little we knew before the last 50 or 100 years. I've written a few short articles and I'm web-publishing a few more that I've collected. I hope these are of interest. Obviously they're not to be taken as current medical practice, though it's also interesting how little the basics have changed.
Sincerely, Mark R. Anderson, M.D.
Hammersly's NAVAL ENCYCLOPAEDIA, 1881, pub by Lewis Hammersly, Phila.
Medical Corps of U.S. Navy.
The active list of the medical corps of the navy consists of 15 medical\ directors, ranking with captains; 15 medical inspectors, ranking with commanders; 50 surgeons, ranking with lieutenant-commanders or lieutenants; and 100 passed assistant and assistant surgeons, ranking with lieutenants, masters, or ensigns, according to length of service.
Assistant surgeons enter the service after examination by a board of medical officers, and at the completion of two years' sea-service are subject to another thorough examination, which is competitive, and which determines their permanent place upon the register.
The surgeon general is selected by the Secretary of the Navy, and appointed by the President from among the senior medical officers, and is commissioned for four years, by and with the advice and consent of the Senate. The surgeon general is chief of the Bureau of Medicine and Surgery in the Navy Department, and has charge of all matters pertaining to the medical outfit of vessels, to naval hospitals, and to the naval laboratory; the detailing of medical officers for service; and all papers and records pertaining to the medical department, as well as the expenditure of all moneys for the purchase of supplies and for the maintenance of hospitals.
See MEDICAL OFFICERS, DUTIES oF.
Medical Officers of U.S. Navy, Duties of.
Surgeons of the fleet, who are usually medical inspectors or senior surgeons, are to exercise supervision over all medical officers serving under them and from time to time to inspect their journals, abstracts, instruments, dispensaries, and store-rooms. The fleet surgeon is also to assure himself of the correctness of all medical reports and returns, and endorse as approved all certificates of death or disability, and reports of survey, before forwarding them to the Bureau of Medicine and Surgery.
He also examines and approves all requisitions for medical and hospital stores for the fleet or squadron, and inspects their quality. On foreign stations he purchases these supplies, or selects them from the naval store-house, making requisitions therefor, as far as possible, at regular periods.
He makes and transmits to the Bureau of Medicine and Surgery records of the character and treatment of diseases occurring in the fleet or squadron. He is also to suggest measures for the preservation of health in the fleet.
On the probability of an engagement he is to assure himself that the medical department of very ship is prepared for the treatment of wounded; and after battle will make to the commander-in-chief, and to the bureau, a summary report of casualties. He is also to forward to the bureau an aggregate report for each quarter, comprising all diseases in the squadron, with a summary of bills incurred, and an epitome of the remarks of medical officers in cases likely to give rise to claims for pension.
General Duties of Naval Medical Officers.
-The senior medical officer of every naval station and of every vessel in commission shall keep, or cause to be kept by a medical officer subordinate to him, the following official records, viz.:
A list of patients, with complete description of person, details of and final disposition of each case. This is to be embodied in a quarterly report.
A medical journal, with complete description of person, and history of cases, properly indexed.
A yearly abstract of patients, a concise, alphabetical record of every case of injury or disease occurring in the navy, with full personal description, and whether occurring in the line of duty or not.
A daily report of sick, made every morning to the commanding officer, in a sealed envelope.
A daily binnacle list, of all persons excused from duty.
Whenever a patient is transferred from the charge of one medical officer tothat of another, he must be accompanied by his effects, with a list thereof upon a hospital ticket, which ticket gives a description of the person, and all facts in the case, as well as the origin of the disability, whether in line of duty, or not.
A report of sick is made quarterly to the surgeon of the fleet, or to the Bureau of Medicine and Surgery, and with it are forwarded triplicate receipts for articles obtained from public stores during the quarter, and a triplicate of all bills paid; a daily record of atmospheric observations, and, on April 1 and October 1, requisitions for supplies for the next six months. Medical officers of cruising vessels are required to note on this quarterly report of sick the ports visited, and the number of days at sea and in port during the quarter.
Certificates of disability, and certificates of death, and all other papers interesting to parties claiming pensions, are to be forwarded without delay, through the proper channel, to the surgeon of the fleet or to the bureau direct.
The senior medical officer is to prepare his own receipts and returns ; and if relieved, is to leave to his successor all necessary official papers, taking a receipt for them in duplicate.
At shore-stations, hospitals, and receiving ships the senior medical officer is required to make, on July 1 of each year, an inventory of all property in his charge, which inventory is to be transmitted to the Bureau of Medicine and Surgery.
The senior medical officer of every vessel and station is required, on each 1st of January, to make a sanitary report to the bureau, embracing hygiene, climatology, and medical topography of all places visited, with all attainable information respecting statistics of disease and its causes, medical schools, hospitals, charitable institutions, etc.
By law, all spirits on board ship are to be under the charge of the senior medical officer, and issued only on his prescription.
Assistant surgeons, candidates for promotion, must present to the Board of Examiners testimonials of proper habits from the medical officers with whom they have been associated on duty, and a medical journal in the candidate's own handwriting. Also observations upon the hygiene of vessels and stations to which they may have been attached, and upon medical topography, hospitals, and other matters of professional interest.
Passed assistant and assistant surgeons, when in separate charge, will be governed by the same instructions as surgeons.
Director of the laboratory will receive timely notice of the probable force to be kept afloat, and for this and other current wants will keep in hand, by manufacture or otherwise, an adequate stock of the articles enumerated in the supply table. Accurate invoices, inventories, and receipts are required in receiving supplies from the laboratory, or in returning them, after a vessel has been put out of commission; at which time a final return of property is also to be made to the bureau. When medical stores are publicly sold, an invoice and account of sale are to be sent to the bureau, and the money resulting from such sale to be deposited, without delay, with the nearest government depositary, proper receipts being taken.
-An important duty of medical officers is connected with recruiting, and they are held strictly accountable to the bureau for improper enlistments:
Medical officers are required to make certificates of physical examinations of enlisted men, and to keep a record of physical condition of all minors, including cadets and apprentices, examinations of whom are to be made at intervals of twelve months. The record of the cadets is to be retained at the Naval Academy. In case of apprentices and enlisted minors it will constitute their descriptive list, and accompany them throughout their career in the service.
An accurate list of persons examined for enlistment or appointment is to be kept wherever such enlistments are made, in every case to be signed by the medical officer making the examination.
A descriptive list of all men transferred or discharged is to be signed by the executive-officer and the senior medical officer.
When defects are waived by the Navy Department, in cases of enlisted men, the medical officer is fully to describe the same, and report the case to the Bureau of Medicine and Surgery, as a bar to claims for pension.
Medical officers are to vaccinate all recruits, and to make regular reports of the results.
In sea-going ships, as soon as possible after reporting for duty, the senior medical officer is to inspect the dispensary and store-rooms, examine the outfit, prepare medicines and instruments for use, and report his department ready for inspection. Having secured everything for sea, he opens his medical journal upon the day when the officers and crew are received on board. He examines the crew, by divisions, and reports those whom he considers disqualified for service, and calls for a medical survey if necessary. He causes all who may require it to be vaccinated, and instructs such persons as the commanding officer shall designate in the use of the tourniquet. He will always be prepared for battle, and, after an engagement, will report casualties to the commanding officer and to the surgeon of the fleet, with complete details of each case.
On board ship, all wines, spirituous liquors, mineral acids, and inflammable fluids in the medical department must be locked up by themselves, to be disposed of, in case of fire, as the exigency demands.
-The medical officer in charge of a naval hospital is to enforce strictobedience to the laws and regulations of the Navy Department, in accordance with the established usages and discipline of the service. The hospital, its grounds and appurtenances, and all persons and property attached to it, are to be under his control. He is responsible for the proper treatment of the sick and wounded, and for the good order, cleanliness, discipline, and economy of the entire establishment, and is to preserve everything in good condition. No punishment is to be inflicted without his orders. The medical officer second in rank is to reside in the hospital, and to have general charge in medical duty, but is to consult the officer in charge in all important matters. He is to assign duty to the junior medical officers, and to report to the officer in charge any neglect of duty or breach of discipline.
He is to see that the hospital records are carefully and neatly kept, and signed by the proper officers with name and rank. He, or an assistant, by his order, is to make a careful inspection, daily, of the wards, dining-rooms, kitchens, laundry, and collars, and report their condition to the medical officer in charge. He is also to inspect all provisions, medicines, groceries, and bed and table furniture that may be received, andreport any deficiency to the officer in charge.
Junior medical officers serving in hospitals, in addition to their duties in the wards, shall be detailed, in turn, as officer of the day, and are not to leave the building during their tour of duty. The officer of the day is to inspect the food at meal-times, and to attend to the admission and discharge of patients, and to see that proper papers are sent and received.
The medical officer in charge of a hospital ward is responsible for order, neatness, and good conduct therein, as well as for everything regarding the welfare of the sick and wounded.
The medical officer in charge of a hospital is to make no changes in the hospital building or grounds without permission of the Bureau of Medicine and Surgery. He is carefully to scrutinize the monthly pay-roll of persons employed under the bureau before signing it.
The products of the ground attached to a naval hospital are to be expended for the benefit of the hospital, at the discretion of the surgeon in charge.
The official papers pertaining to the conduct of naval hospitals are principally as follows, viz.:
hospital tickets, alphabetical register, quarterly list, abstract of patients, journal of subsistence, case papers, ration notices, certificate book, certificates of ordinary disability and certificates of death, reports of surveys, declarations for pension, vouchers for expenditure, hospital ration return, receipt and expenditure hook, requisitions, weekly report of sick, weekly report of beds, and monthly pay-roll.
Surveys, upon persons and upon medical property.
-Personal surveys, next to the preservation of life and limb, are the most important duties of medical officers. The Commissioner of Pensions founds his decisions upon them. In case of surveys, and all matters connected with the evidence in pension claims, medical officers are forbidden to give information to agents or others. All such persons must be referred to the Commissioner of Pensions.
A chest containing a supply of medicines for the use of the crew of a merchantman. Every vessel of 150 tons or more, navigated by 10 or more persons in all, and bound on a voyage beyond the United States, and every vessel of 75 tons or more, navigated by 6 or more persons in all, is required to have a chest of medicines, put up by an apothecary of known reputation, and accompanied by directions for administering the medicines. The chest must be examined at least once a year, and supplied with fresh medicines. In case of dispute the owner must prove the sufficiency of the medicine-chest ; it does not lie with the seaman to prove its insufficiency. If a seaman requires further medicines and medical advice than the chest and directions can give, it would seem that the ship ought to bear the expense. If the medicine-chest can furnish all the needs, the ship is exempted.