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  • A History of Medicine in the Early U.S. Navy
  • John Duffy
Harold D. Langley. A History of Medicine in the Early U.S. Navy. Baltimore: Johns Hopkins University Press, 1995. xix + 435 pp. Ill. $49.95.

When Congress authorized the first American navy in 1794, the bill specified one surgeon and two surgeon’s mates for each frigate. However, no provision was made for hospitals until 1798 when, after years of delay, the Marine Hospital [End Page 532] Service law was enacted. This measure, the first federal action relating to health, provided a limited health insurance program for both merchant and naval seamen. Although naval seamen contributed to the program, captains were reluctant to send men to the marine hospitals, fearing they might desert. In any case, the medical care for seamen ashore, which was provided largely by private physicians in a variety of hospitals ranging from private homes to almshouses, can only be described as makeshift and inadequate. The quality of the care, which varied widely, depended largely on the commanding officers and the ability or conscience of the attending physicians. The picture during the early years is grim.

The first secretary of the navy was appointed in 1798, and he was responsible for the appointment of all medical personnel. The inevitable communication delays meant that captains took it upon themselves to appoint surgeons and surgeon’s mates or to employ private physicians. The pay of naval surgeons was far below that of their counterparts in the army, and even when dealing with medical concerns they had little authority. The makeshift nature of hospitals led Congress in 1811 to pass an act requiring the establishment of naval hospitals. The outbreak of war delayed action, and congressional failure to implement the act meant that it was not until 1830 that the first naval hospital was built. Beginning in the 1820s slow progress was made toward improving the medical training, pay, and status of naval surgeons, and toward reforming the administration of the medical system. The most significant step came in 1842 with the reorganization of the navy into five bureaus, one of which was the Bureau of Medicine and Surgery under the direction of a surgeon.

Langley has done a fine job of research and has produced a thoroughly detailed history covering the period from 1790 to the 1840s. Knowing how difficult it is to deal with a large mass of miscellaneous sources, I hesitate to criticize the organization. Yet in trying to summarize this history, I found myself constantly needing to check earlier pages. Presented with so much detail, the reader loses the thread of history. Nonetheless, Langley has provided a basic work on early American naval history.

John Duffy
Tulane University Medical School
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