Book Review

Canada and the United States

This insightful study traces the history of medical practice in the U.S. Navy from 1794 to 1842. These dates mark the construction of the first American naval vessels, including the U.S.S. Constitution, and the establishment of the Bureau of Medicine and Surgery. Harold D. Langley is a former curator of naval history at the National Museum of American History, Smithsonian Institution, and the author of important contributions to naval history. Research for the study was drawn from a wide variety of sources, since the U.S. Navy medical records for this period are not gathered in a single collection. In fact, medical records before 1842 were rarely collected at all. This fact makes it difficult to understand not only the practice of medicine but also its practitioners. What Langley has accomplished in light of this handicap is a tribute to his determination and patience and the assistance of others recognized in more than five pages of acknowledgments.	1
The book consists of seventeen chapters that interweave the history of naval medicine with that of the development of the newly created U.S. Navy and the emergence of the American state. The quasi-war with France (1798–1801), the Barbary Wars, and the War of 1812 receive special attention because of the medical needs of a wartime navy. Langley's account of the period after 1812 strikes a different tone, emphasizing more the creation of a professional service and the institutionalization of health care through reform efforts. The establishment of the Bureau of Medicine and Surgery forty-eight years after the creation of naval surgeons and mates in 1794 was a defining moment in the history of naval medicine. Readers will find instructive Langley's explanation for the reorganization of the navy at that time. Much of the impetus was due to several scathing articles published between April 1840 and June 1841 in the Southern Literary Messenger by Lt. Matthew Fontaine Maury, writing under the pen name of Harry Bluff. His criticisms of the navy included the practice of medicine. Ship captains could limit medicines taken aboard their vessels, driving some surgeons to list their supplies in Latin to avoid scrutiny. Maury proposed that a navy medical bureau be established. The election of 1840 swept out the Democrats and brought in the Whig William Henry Harrison as president. Virginian Abel Parker Upshur was made secretary of the navy and recommended a restructuring of the navy to Congress. By August 1842 the House and Senate approved the plan with amendments, and it was signed by President John Tyler.	2
Langley's examination of the early practice of naval medicine contains some enlightening and shocking revelations. Foremost is the ponderous movement of bureaucracies, most notably the Navy Department, which could not produce a decision on the means to provide care and treatment for wounded and infirm sailors. No permanent naval hospital was built until 1830. Six years earlier, examinations to qualify medical officers were established by navy doctors. Professionalism was further enhanced by the establishment of the medical school in Philadelphia linked to the Medical Institute and the University of Pennsylvania.	. . .