Born in Harm’s Way: The Advent of Navy Medicine
by André Sobocinski, U.S. Navy Bureau of Medicine and Surgery
October 24, 2022
"I wish to have no connection with any ship that does not sail fast, for I intend to go in harm's way." Captain John Paul Jones
Today’s U.S. Navy recognizes October 13th as its official birthdate.
It was on this day in 1775 that the Continental Congress authorized the construction of the first Navy ships as well as a special committee to oversee the administration of this service. The provision for medical care followed soon after. The Rules and Regulations of the Navy of the United Colonies of North-America, issued by Congress on November 28, 1775, mandated the role of shipboard medical providers as well as a place on each Navy vessel to care for the sick and injured (Article 16).
Bonhomme Richard vs. HMS Serapis during the Battle of Flamborough Head on September 23, 1775 with reference to 'Born In Harm's Way: The Advent of Navy Medicine'. (Illustration by André Sobocinski, U.S. Navy Bureau of Medicine and Surgery)
Throughout the American Revolutionary War, Navy surgeons and surgeon’s mates ... those first representatives of what we call Navy Medicine today ... could be found on almost every ship of the Continental Navy, as well as colonial privateers and state vessels. During the heat of battle, the need for their services rang as loud as any bell announcing a declaration of freedom and independence from Great Britain. And some 247 years since this mission first commenced, remains as relevant as ever.
Navy Medicine’s Charter Members:
From 1775 until 1783, a total of 136 surgeons and surgeon’s mates served in the Continental Navy. Whereas the surgeon was a commissioned officer who rated a wardroom aboard the ship, the surgeon’s mate was a warrant officer who held the same status as masters-at-arms and sail-makers and typically shared the steerage with midshipmen. Regardless of rate, surgeons and surgeon’s mates were akin to contractors signed to a particular ship for a specific deployment. If their ship was destroyed or decommissioned, they would be permitted to leave service and “sign” elsewhere. And many did. Throughout the war, Continental Navy surgeons and surgeon’s mates could be regularly found moving from ship to ship, from the Continental Navy to privateering vessels, and even to ranks of the Continental Army.
The first Navy physicians on record were Dr. Joseph Harrison of Kent County, Delaware and an 18-year old Surgeon’s Mate Henry Hendren Tillinghast of Providence, Rhode Island. Both reported aboard Commodore Ezek Hopkins’s flagship Alfred in November 1775. Other Navy physicians soon followed reporting as plankowners aboard the Navy’s first ships. They included Surgeon Thomas Kerr and Surgeon’s Mate Michael Jennings of the 14-gun brig Andrea Doria (December 1775); Surgeon John Ernest Kessler and Surgeon’s Mate Thomas Burns of the 24-gun Columbus (January 1776); Surgeon Henry Malcolm of the 12-gun sloop-of-war Providence (January 1776); Surgeon John (Johan) Wiesenthal (Wisenthall) of the 8-gun sloop-of-war Wasp (January 1776); Surgeon William Adams of the 10-gun sloop of war Hornet (January 1776); and Surgeon Robert Wilcox of the 14-gun brig Cabot (February 1776).
Until September 30, 1776, there was no requirement for these physicians to prove their qualifications or medical acumen. On this date, Congress stipulated that the colonies appoint physicians to examine prospective Navy surgeons and surgeon’s mates prior to receiving their commissions and warrants. By 1777, all prospective surgeons and surgeon’s mates seeking appointments were required to provide a certificate of this examination.
Holding a medical degree was not a requirement for Navy physicians in the Revolutionary War, but it was expected that most applicants would have been apprenticed to a practicing physician for a period of two-years and be familiar with existing medical literature. Medical degrees were still uncommon at the start of the war. Of the roughly 3,500 practicing physicians in the 13 colonies only about eleven percent or 400 had MDs. Most of these degreed physicians were graduates from the European medical schools like the University of Edinburgh. At the time only two medical schools existed in the colonies ... the College of Philadelphia (later University of Pennsylvania) and King’s College (later Columbia University of Medicine). In 1775, about 13 percent (or 50) of MDs in the colonies were graduates from these American schools.
Operational Medicine in its Heroic Age:
In January 1776, Commodore Ezek Hopkins led a fleet consisting of the ships Alfred, Andrea Doria, Cabot, Columbus, Providence, Hornet, Fly and Wasp to attack forts at New Providence, Bahamas and seize much needed gunpowder for the Continental Army. This Raid on Nassau, as it was later known, and the fleet’s return voyage presented many of the first medical challenges to Navy Medicine’s charter members.
For Drs. Harrison, Tillinghast and the other naval physicians taking part in this operation the practice of shipboard medicine required the treatment of an assortment of diseases, shipboard occupational injuries, and ... during combat ... wounds caused by gunshot, cannon, and burns. Medical care was still in its heroic age where venesection (bloodletting), blistering, and purging were the rule. Shipboard medical chests contained the usual assortment of anodynes, antiarthritics, astringents, cathartics, emetics, diaphoretics, diuretics, rubefacients, stimulants and tonics ... some of which were equipped to induce a host of iatrogenic disorders such as mercury poisoning and dehydration. Calomel (mercury chloride) and jalap (a poisonous root) were commonly used to stimulate the intestinal tract and rid intestinal irritation. Peruvian bark (later known as quinine) was ever-present and used in the treatment of malaria and other malignant fevers. Opium and laudanum (tincture of opium in alcohol) were used to relieve pain and induce sleep. Teas and tonics were commonly used to settle digestive complaints.
Infection remained a chief concerned for these shipboard physicians. During the Revolutionary War, infections led to 90 percent of war deaths. In the decades before the discovery of antisepsis and germ theory, there was little shipboard physicians could do.
The fleet departed New Providence with 24 casks of gunpowder, 47 cannons, and five mortars. Many of the Sailors and Marines that took part in the landing party seizing the stores, later fell ill with a fever and delirium that was described by Hopkins as a “new malignant fever.” When the fleet landed in New London, Connecticut, Navy physicians helped offload over 200 sick Sailors and Marines, many with smallpox.
At the time, our Navy physicians typically inoculated crews through the practice of variolation. By the 1770s this method was widespread throughout the American Colonies as a means of immunizing against smallpox. Even Benjamin Franklin and General Washington were among its greatest advocates. Variolation gets its name from variola (Latin for smallpox) and refers to the process of taking pus, vesicles or ground scabs from individuals exhibiting mild cases of small pox and introducing it to others through the nose or skin. Before the advent of the smallpox vaccine in 1796, one to two percent of those variolated died compared with 30 percent of those with smallpox.
Navy Medicine at the Battle of Flamborough Head:
On September 29, 1779, the Continental Navy ship Bonhomme Richard engaged in one of the most iconic sea battles in history when it fought against HMS Serapis in Flamborough Head, off the coast of York, England. Commanding the 42-gun Bonhomme Richard was the fierce, and determined Captain John Paul Jones, a seasoned sailor who had already established a reputation for his daring victories and raids. But it was his actions in the bloody battle of Flamborough Head that cemented his place in the pantheon of naval heroes and earned him the moniker the “Father of the U.S. Navy.”
Jones was far from alone in this fight. The Bonhomme Richard included 347 crewmembers on board including physicians Surgeon Lawrence Brooke and Surgeon’s Mates Elijah (Elisha) Perkins and John Peacock.
The Bonhomme Richard had originally been built a merchant ship named Duc de Duras by the French East India Company 12 years before the battle. When her owners went bankrupt in 1769, the ship was used by the French Crown as a troop transport before being acquired by a merchant and used for shipping goods. Through Benjamin Franklin’s influence as the first American ambassador to France it was gifted to the United States and refitted as a warship. Franklin selected Jones as its first Captain in February 1779. And in tribute to his benefactor, Jones named it in honor of Franklin’s nom-de-plume, “Poor Richard” (known as “Good Man Richard” or “Bon Homme Richard” in France).
Among the ship’s plankowners was Dr. Lawrence (Laurence) Brooke who Jones appointed as ship surgeon in April 1779. A native of Virginia, Brooke was born 4-miles outside of Fredericksburg on the Rappahannock River. There is possibility that either he or his family had known Jones in Fredericksburg prior to hostilities. In 1774, at the age of 15, Brooke and his younger brother Robert ... a future Governor of Virginia ... left the colonies to study at the University of Edinburgh. When colonists became barred from studying at University of Edinburgh, Lawrence fled to Paris where he may have continued his medical education. On April 5, 1779, Brooke offered his services to Jones as surgeon of the newly acquired Bonhomme Richard. Brooke’s name appears in the correspondence of several dignitaries and it is said that he dined with both Franklin and John Adams and earned a reputation for skill and comportment. As one naval officer who encountered Brooke later wrote, “He was . . .a great favorite, an agreeable, cultured gentleman as well as a skillful surgeon.”
The Bonhomme Richard was part of a squadron of ships that also included the 36-gun Alliance, the 32-gun Pallas, and the 12-gun brig Vengeance. Each ship also included a complement of its own surgeons and surgeon’s mates. On the morning of September 23, 1779, the squadron encountered two British warships ... the 20-gun Countess of Scarborough and the 44-gun British warship Serapis ... escorting a convoy of merchant ships. As the Vengeance targeted the merchant ships, and Pallas set out in pursuit of the Scarborough, Jones set his sights on the Serapis.
Bonhomme Richard approached the Serapis on his larboard bow at 1920 in the evening. Captain Richard Pearson of Serapis called out to the ship to identify itself to which Jones replied, “The Princess Royal.” Pearson then asked, “Who do you belong to?” When he did not get a reply he asked again stating that if they did not answer that the Serapis would “fire into them.” Bonhomme Richard then fired a broadside, which was answered by the Serapis.
On the first broadside, two of Richard’s 18-pound cannons exploded leading to massive carnage on the gundeck. With the help of available crewmembers, Surgeon’s Mates Perkins and Peacock went into immediate action carrying wounded to the orlop deck. There Surgeon Brooke helped stabilize the wounded, working quickly to remove gunshots, splinters, controlling bleeding, setting fractures, and when nothing could be done to salvage the wounded limbs, performing amputations through use of tourniquets, surgical saws and knives. The location and type of wound was key ... and there was nothing any Navy surgeon could do for injuries to the abdomen and thoracic cavity other than administer opium for pain relief. In treating burns, Brooke would likely have adhered to the practice of the time ... using linseed oil, cerate of oil, or spermaceti on the burn before applying an emollient poultice.
The repeated exchange of cannon fire left a gaping hole in Richard’s side forcing the crew to abandon the lower decks. Bonhomme Richard was every bit the sinking wreck and any opposing ship captain would have surely expected Jones to “strike the colors,” meaning to surrender. Pearson of the Serapis asked Jones if he was was ready to “strike” to which he is said to have defiantly answered, “I have not yet begun to fight!”
Brooke reported to Jones about the flooding in the lower decks and that water was coming in so fast that the wounded were “being floated out of the cockpit.” Jones is said to have replied, “What! Would you have me strike to a drop of water, doctor?”
As the two ships maneuvered for strategic advantage they collided. Jones used this as an opportunity to grapple onto the Serapis hooking into the ship’s bulwark rails and rigging and ultimately linking their fates. Richard’s Marines strategically positioned topside began using muskets to pick off enemy combatants while an enterprising seaman climbed to the ship’s mainyard and began dropping grenades onto Serapis’s decks. These actions turned the tide of the battle and forced Pearson to surrendering the Serapis.
The casualty totals on both ships was significant. Eighteen percent (63) of Bonhomme Richard’s company were killed and 25 percent (87) were wounded; the Serapis suffered 19 percent (54) killed and 27 percent (75) wounded.
The 1783 Treaty of Paris formally ended the Revolutionary War, and with it the Continental Navy. With war’s cessation and a depleted treasury, Congress began selling off what was left of its fleet. On August 1, 1785, the frigate Alliance ... the last of the Navy’s ships ... was sold into private hands.
The Navy’s gradual resurgence was spurred by the signing of the Naval Act of 1794, ongoing difficulties with the Barbary States and a “Quasi-War” with our former ally France. This new Navy, formally established on April 30, 1798, came with similar requirements for shipboard medical personnel and the care of Sailors and Marines as its Continental forbearer.
Over the ensuing years, through wars, conflicts and peacetime operations, the Navy built an impressive legacy. Every step of way there have been representatives of Navy Medicine working to provide our warfighters the care they need while ensuring that they remain ready for the fight. And for as long there is a Navy Medicine this will remain our North Star guiding us.
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