UNITED STATES ARMY SERGEANTS MAJOR

ACADEMY

HISTORY OF THE MEDICAL NCO

(1700 - 1999)

BY

MSG TROY L. FOSTER

STUDENT #616

LIS

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HISTORY OF THE MEDICAL NCO

At the outbreak of the Revolutionary War, the limited availability of trained medical

personnel and the lack of adequate medicine and equipment hampered medical support.

Insufficient care not only of the wounded, but the lack of treatment and prevention of the

diseases that ravaged the army caused President George Washington to address the issue of

medical care with Congress. On 27 JULY 1775, Congress authorized the establishment of an

"AN hospital" or Medical Service. This date is known as the ANNIVERSARY OF THE ARMY

MEDICAL DEPARTMENT. This important step made provisions for a Director General and

Chief Physician (Surgeon General), 4 surgeons, 1 apothecary, 20 surgeon's mates, 1 clerk, and 2

storekeepers. It also provided one nurse to every 10 sick, and laborers as needed.

Dr. Benjamin Church was selected as the first Surgeon General. Based on the

recommendations of the Director General, on July 17, 1776, congress authorized the

employment of "HOSPITAL STEWARDS (MEDICAL NCOs) which were the forerunners of

the AMEDD NCO Corps. Although not authorized prior to this legislation, Hospital Stewards

were assigned to hospital as early as December 1775. The Director General had his Hospital

Stewards collect all the blankets, pillows and bed sacks left behind for use of the army. Some

stewards advertised for dry herbs such as balm, hyssop, wormwood, and mallow for care of

patients. Linen sheets and rags were also procured to make bandages and tourniquets. In 1777,

George Washington ordered the army inoculated against small pox, which had been a major

factor in the failure of the Quebec campaign. Some hospitals were overcrowded and infection

took its toll. Like the soldiers they treated, the surgeons and medical NCOs also contacted the

diseases that ravaged the military hospitals and died doing their duty.

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In April 1777, a "HOSPITAL STEWARD" (Medical NCO) was allowed for every

hundred sick or wounded. Their responsibilities were to receive, dispense, and maintain

accountability of articles of diet from the hospital commissary. Pay for the hospital steward was

fixed at one dollar a day and two rations. In March 1799, a hospital steward was authorized for

each military hospital. By September 1780, Hospital Stewards were given the added

responsibility to purchase whatever was necessary for use in the care of the sick and wounded.

Their role in the hospital was rapidly expanding and they were expected to handle major

administrative and logistical functions in the hospital. At the end of the war, Congress reduced

the size of the Army. From 1784 to 1789, there was no organized Medical Department. Medical

soldiers held No OFFICIAL RANK in the army and were soldiers detailed from the line, played

a key role in providing healthcare. They had to be able to read and write, have some background

in mathematics, chemistry, or pharmacy. Few soldiers of this era had these abilities.

In 1808, first manual on hospital administration published, stated a steward was an honest

individual and above reproach. Duties were discipline of staff and patients, personnel

management, food service, medical supply and overall hospital admin. In 1813, the

reorganization of the Army began. Congress did not authorize stewards. In order to meet the

needs of providing qualified individuals to fill the duties of a hospital steward, the Secretary of

War authorized the enlistment of individuals for a limited period without authorization of

Congress. Hospital Stewards were taken from the line and the preference was a NCO. Hospital

Stewards learned patient care by "ON THE JOB TRAINING" and were often left behind to care

for the sick when the surgeon accompanied the troops to the field.

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During the War with Mexico, the Hospital Steward accompanied the surgeon into battle,

dressing wounds and dispensing medicine. The army staff recognized the importance of the

hospital steward but still no action was taken by Congress to authorize the enlistment of men for

the sole purpose of serving in this capacity. In 1847, the Surgeon General had asked Congress

several times to authorize positions for Hospital Stewards and he would set up a formal school to

train them, however, his requests were turned down. The Anny supported his efforts and in

1851 issued an addendum to the Regulations for the Uniform and Dress of the U.S. Anny that

authorized a "HALF CHEVRON" consisting of a green background with yellow trim and a

CADUCEUS to denote the rank of the Hospital Steward.

The civil war tested Hospital Stewards in every aspect of their abilities. Wounded soldiers

arrived at the field and general hospitals by the thousands. Hospital Stewards were often

directed to report from one hospital or post to another and unlike most soldiers that moved as a

unit, they traveled independently. If a surgeon were not available, at the hospital, the steward

would report his arrival in writing to the next higher level and begin working until a surgeon was

assigned. The Hospital Steward was responsible for assisting the surgeon in minor surgical

procedures, dispensing medicine, and supervising the attendants and other civilians who worked

in the hospitals. They were charged with procuring vegetables, meat, and bread from the local

area when the normal supply system was interrupted. Some stewards worked in the government

laboratory supervising the production of medicine.

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Dental care for the anny consisted primarily of extraction of teeth and was done by the

surgeon or his Hospital Steward. The first dentist in the anny was a medical NCO assigned to

care for the dental needs of the students at West Point.

With the Civil War over, the Medical Department continued to face great odds during the

Indian Wars and epidemics that occurred on a frequent basis. A physician and one steward were

assigned to each post and provided care for soldiers under the most austere working and living

conditions. All stewards were required to take written tests in order to retain their rank. Only

individuals who served as hospital stewards for over 25 years were exempted from the tests. It

was not easy test as it required them to do math and chemistry problems and show their ability to

write. Even though their tests were reviewed by the surgeon over them and accepted, it was

again reviewed by the senior surgeon. This method ensured that only the best would be retained

in the AMEDD.

Many of the posts had little or no drainage and often built in areas where the source of

water supply was contaminated. While many of the facilities used as hospitals were very

inadequate, the surgeon and steward labored to provide the best care to the sick as was possible.

The steward lived in the hospital (one room) and could be relied on to respond to the patients at

any time. Some stewards served at small detachments where no physician was available and

provided the bulk of medical care supported by a contract surgeon as needed. In 1885, the

Surgeon General's annual report contained a recommendation that a "HOSPITAL CORPS" be

fonned of personnel trained in all aspects of medical support for field and garrison operations.

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On 1 MARCH 1887, the HOSPITAL CORPS was finally established. "NEW

CHEVRONS" denoting the ranks of the hospital stewards were introduced similar to the

chevrons worn by all NCOs in the Army. Hospital stewards wore full sized chevrons that had

three stripes below and one on top with a Red Cross in the center. Acting hospital stewards wore

the same chevrons except for the stripe on top. Privates of the Hospital Corps wore the "WHITE

ARM BAND WITH A RED CROSS" and this date is considered the "ANNIVERSARY of the

HOSPITAL CORPS." After one year of service with Hospital Corps, privates were eligible for

appointment as acting hospital stewards. After one year of probation and passing of another

examination, they could be appointed "PERMANENT" hospital stewards. In its first year, some

600 privates transferred to the new corps, with only 24 passing their examinations and promoted

to acting hospital stewards.

"COMPANIES OF INSTRUCTION" were established in 1891 to ensure that the privates

of the newly formed corps had the necessary skills to perform their duties. Under this concept,

infantry drill regulations were integrated with medical training in the areas of anatomy and

physiology, nursing, pharmacy, and first aid. They were also rotated through the post hospital.

The "HOSPITAL CORPS KNIFE" was issued as standard uniform equipment and used for

making space for litters or small triage areas in the field.

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Bernard J. D. Irwin (1830-1917)

The first recipient of the Congressional Medal of Honor, for whom the Irwin Army Community Hospital at Fort Riley has been named.

Irwin's heroic rescue occurred almost a year before the Medal of Honor was introduced to the US Congress. Indeed, Irwin himself did not receive the Medal of Honor until January 24, 1894 ... . more than 50 years later. But his actions the

cold mornings of February 13-14, 1861 are recorded in history as the FIRST MEDAL OF HONOR ACTION.

Rank and organization: Assistant Surgeon, U.S. Army.

Place and date: Apache Pass, Ariz., 13-14 February 1861.

Entered service at: New York.

Born: 24 June 1830, Ireland.

Date of issue: 24 January 1894.

Citation: Voluntarily took command of troops and attacked and defeated hostile Indians he

met on the way. Surgeon Irwin volunteered to go to the rescue of 2d Lt. George N. Bascom,

7th Infantry, who with 60 men was trapped by Chiricahua Apaches under Cochise. Irwin

and 14 men, not having horses began the 100-mile march riding mules. After fighting and

capturing Indians, recovering stolen horses and cattle, he reached Bascom's column and

help break his siege.

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In 1900, the Hospital Corps played a major role in the study of the causes and transmission

of Yellow Fever. These men volunteered to be bitten by infected mosquitoes to prove that it was

the culprit in the transmission of Yellow Fever. They also slept on bedding that was soiled with

"URINE, FECES AND VOMIT" of yellow fever patients to disprove the theory that the disease

was transmitted by fomites. Walter Reed in his report to Congress said he had never

"WITNESSED GREATER ACTS OF BRAVERY" than those of the "MEDICAL SOLDIERS"

who participated in the yellow fever study.

On 2 March 1903, the Hospital Corps was disestablished. The terms Hospital Steward and

Privates of Hospital Corps were replaced by the terms Sergeant and Private with an exception for

the Master Hospital Sergeant, which was used until 1920. During World War I, enlisted

personnel of the Army Medical Department began training at Fort Oglethorpe, Georgia.

Laboratory, radiology, dental, veterinary and psychiatric classes were established with some

courses taught at civilian universities. Training was also implemented for NCOs to ensure that

they could perform their duties on and off the battlefield. World War One clearly established the

need for enlisted soldiers to be trained in each new specialty that resulted from the evolution of

military medicine. In 1924, the first formal course of instruction for Noncommissioned Officers

of the active, National Guard and Reserves was conducted at Medical Field Service School,

Carlisle Barracks; Carlisle, Pennsylvania. The enlisted medical force not only worked in field

and post hospitals, they supported the training of new medical officers and were an integral part

of the test and evaluation program for new medical equipment. In 1941, Medical Replacement

Training Centers were established at Camp Lee, Virginia and Camp Grant, Illinois. These camps

conducted basic and specialized training for medical and surgical technicians. Even with the

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accelerated training at these camps, the shortage of medical personnel on the front lines remained

critical. Soldiers were transferred from the line, given a limited amount of medical training, and

sent to the front lines where on the job training enhanced their skills. The term "DOC" became a

common form of respect used by all soldiers for medical personnel. Although medical personnel

were protected under the Geneva Convention, and some volunteered to stay with the wounded,

they also became Prisoners of War (POW). Like their fellow comrades, they often experienced

the same treatment by the enemy. In some cases, the medics were executed along with the

wounded.

In 1944, enlisted female soldiers of the "Women's Army Corps" (WAC)" were trained as

pharmacy, laboratory and x-ray technicians. The availability of trained female soldiers in the

United States reduced the critical shortages overseas. In 1946, the Medical Field Service School

(MFSS) was relocated to Fort Sam Houston, Texas and all specialized training for enlisted

personnel was consolidated with the exception of the line medic. In 1950, the Surgeon General

directed that a 48-week course in practical nursing (91 C) for enlisted soldiers be established at

Walter Reed Army Medical Center. In 1950, the Medical Readiness Training Centers increased

their training capacity to meet the needs of the Korean Conflict. During the "BLOODY

BATTLES" in Korea, frontline Medics had to be prepared for the mental chal!enge of removing

the dead Killed in Action (KIA). There was no time for proper handling and moving the dead.

Bodies were thrown into the back of vehicles or over the edge of the road. This was necessary to

preclude new reinforcements coming up the hill from seeing dead. The major concern was that

soldiers who have never been in battle would become mental casualties and refuse to go any

further or even run back down hill.

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In Vietnam, personnel who volunteered to become Flight Medics received their training on

the job gaining experience with each mission. New quicker and larger helicopters were used and

flight medics played a major role in saving lives of wounded being evacuated from the field.

Medical personnel assigned to combat elements were scheduled to spend six months as a platoon

or company aidman. Due to the shortage of medical personnel, they often spent their entire tour

at the front. In a few cases, line soldiers were trained to fill the shortages. Regardless of the

circumstances the NCOIC of the Battalion Aid Station was responsible for ensuring that new

medical personnel were capable of performing their duties prior to accompanying units by

themselves. Medical personnel participated in the Medical Civil Action Program (MEDCAP).

This program consisted of teams made up of one to nine individuals, who would visit villages

and provide medical and dental care for the local populace.

The Medical Training Center (MTC), Fort Sam Houston, Texas, increased their training

capacity due to the shortage of enlisted medical personnel. In 1969, the MTC trained 25,982

medics, 24,135 enlisted men in other specialties and 1,846 female soldiers. Over 225,000

medics were trained since 1954. "CONSCIENTIOUS OBJECTORS" were also trained the

MTC. They were housed separately but received the same medical training but no weapons

training. Many were highly decorated and two received the Medal of Honor. "DRUG USE" by

soldiers in Vietnam was a major problem. In 1971, medical personnel were sent TDY to

Vietnam to identify and attempt to rehabilitate "DRUG USERS" prior to their return to the

United States.

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In 1991, AMEDD enlisted personnel published for the first time a "Lessons Learned: After

Actions Report" dealing with ENLISTED ISSUES DURING DESERT SHIELD/DESERT

STORM. Medical personnel were not prepared for the large numbers of Enemy Prisoners of

War (EPW). They were required to provide medical care and guard duty, due to no units being

attached to perform guard duty. During Desert Shield/Desert Storm, units of the National Guard

and reserves were called to active duty and were recognized for outstanding service. Seven

medical soldiers died of hostile and nonhostile actions.

In closing, medical personnel and medical NCOs have been an invaluable asset of our

military culture since the Revolutionary War. Despite all obstacles, medics and medical NCOs

have provided superior medical support to our Soldiers throughout history. This support

continues today on the battlegrounds of Afghanistan and Iraq; "To Conserve the Fighting

Strength. "

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Works Cited

The United States Army Medical Department Regiment, October 2005

http://ameddregiment.amedd.anny.millenlisted history.asp

George E. Orner, Jr., An Army Hospital: From Dragoons to Rough Riders,

Fort Riley, 1853-1903

http://www.kshs.org/publicat/khq/1957/5740mer.htm