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—the act or process of introducing new ideas, devices, or methods
The Stokes Stretcher—also known as the wire basket stretcher—is arguably one of the oldest medical devices in continuous use by the military. First exhibited at the St. Louis World’s Fair in 1904, it was conceived by the Navy physician Stokes (1863-1931) who in the Spanish-American War witnessed first-hand the difficulties of transporting wounded through a Navy ship’s gauntlet of gangways, ladders and hatches.
Unlike "ambulance cots" and "transferring boards" that had commonly used by the Navy at the end of the nineteenth century, the Stokes was both stretcher and splint in one. It could immobilize the injured parts, allow for the carrying of the patient with minimum direct handling of extremities and, according to its inventor, offer some "comfort and a sense of security."
In January 1906, by order of President Theodore Roosevelt, a joint board of Army and Navy medical officers convened to look at "improving the [military] medical de¬partments." Along with the proposal for standardized diagnostic tags, and the use of a Hospital Corps pouch (forerunner of the unit bag), the medical officers called for adoption of the Stokes Stretcher by the Army and Navy for use aboard hos¬pital ships, transports and at seacoast ar¬tillery stations.
Dr. Stokes would go to serve as the first medical officer to command a Navy hospital ship (USS Relief ) sailing it around the globe with Roosevelt’s "Great White Fleet" in 1908. In 1910, Stokes was appointed the Navy’s fourteenth Surgeon General, holding the office until 1914. He retired from the Navy as a Rear Admiral in 1917.
Today, his namesake stretcher, still in use throughout the world, is a testament to the staying power of one Navy physician’s great idea.
Throughout the 1930s and 40s, Navy Medicine investigated “acceleration effects and protective measures for overcoming ‘G’ in flight.” Early studies were carried out at the Fatigue Laboratory at Harvard University and the Naval Aircraft Factory in Philadelphia, PA, using dogs as test subjects and leading the way for the development of an “anti-G” compression belt and later the pressurized suit. By 1943, the suits were flight-tested and proved successful measures for preventing combat pilots from blacking out. The “Anti-G Suit” technology would be further developed in the 1950s and serve as the foundation for the “pressurized suit.”
In the 1920s, Louis Bazy and George Ramon of the Pasteur Institute developed a tetanus toxoid that would stimulate the body’s ability to make antitoxins for immunizing (i.e., “active immunization”). Many of the early toxoid studies were continued in the United States in the 1930s; and beginning in June 1934, the U.S. Navy pioneered the largest experimental tetanus toxoid study ever conducted on a control population. Lead by researcher Lcdr. (later Captain) W.W. Hall, Medical Corps, USN, and taking place aboard the hospital ship USS Relief (AH-1), the Navy study looked at the proper intervals between injections as well as the required number of injections for successful immunization with an alum-precipitated toxoid.
The study offered promising results and showed that the body’s resistance to the disease was greater than the “natural or artificial introduction of an antigen.” Soon after, Hall was dispatched to the Naval Academy at Annapolis, Md. to test the toxoid injections on a larger population of volunteers. In 1938, Hall, in conjunction with Capt. Reynolds Hayden, Commanding Officer of Naval Hospital Annapolis, inoculated the entire student body at the Academy (2,300 midshipmen) with an alum-precipitated tetanus toxoid. The researchers found that although the toxoid provided immunity it also yielded too many reactions. Researchers determined that it was necessary that future batches of tetanus toxoid be tested to ensure safety and effectiveness.
In part due to the success of the USS Relief and at Annapolis trials, in 1941, BUMED instituted a program of immunizing all Navy and Marine personnel against tetanus with the alum-precipitated toxoid. Due to the research and practice of immunization not one American serviceman or woman would die of the disease in World War II.
After combating both enemy forces and disease on Efate and Guadalcanal in 1942, the Navy developed field laboratory teams or Navy Epidemiology Units (NEU) (later Epidemiology and Malaria Control Units) to control insect-borne diseases, like malaria. Throughout World War II malaria was a debilitating and very serious issue affecting combat troops. Between 7 August 1942 and February 1943, some 60,000 American troops contracted the disease leading to over a million “man-days” lost. This compares to 104,781 man-days over the same period due to war wounds. The Epidemiology and Malaria Control Units (each staffed with malariologists/parasitologists, entomologists and laboratory technicians) would enter the combat zone and help eradicate the mosquito breeding grounds and greatly reduce the transmission of deadly diseases.
Throughout World War II, the Naval Medical Research Institute (NMRI)’s staff of scientific troubleshooters pioneered aviation first aid kits, insect repellents, and resuscitation devices and devised new protective measures against blast injuries, immersion foot, seasickness and sunburn. But, all of these developments would follow in the wake of its first assigned project: devising a full-proof method for desalting seawater and developing special food rations for the war’s unfortunate sea castaways. Although there are no official statistics on how many World War II Sailors, Marines, merchant mariners and military aviators awaited rescue aboard life rafts in World War II, a conservative estimate would have been tens of thousands. Following the loss of their ships or aircraft, the castaway would often face a gauntlet of inclement weather conditions, the threat of secondary attacks, sharks, and subsist—if “lucky”—on limited food and water rations. Without food, the average person can survive for about 21 days; and without water for about three days. Beginning in 1943, NMRI experimented with chemically processing seawater so that it could be drunk by personnel adrift on life rafts. In February 1943, NMRI scientists developed a multi-process filtering system for desalinating seawater. A similar, but simpler method developed by the Permutit water conditioning company in collaboration with NMRI would later be adopted for widespread use. The “Permutit-Navy Desalting Kit” contained a plastic drinking bag with a cloth filter at its base and five briquettes of desalting chemical. The castaway would collect seawater in the drinking bag, drop in a briquette, seal the bag and shake it. Within 20 minutes they would have access to a pint of fresh water that they could drink through a tube beneath the filter. Within the year, the kit would be adopted by the Army, Navy as well as American Airlines.
The year is 1944. At Naval Hospital Bethesda, Md., medical personnel are no longer able to procure glass eyes for wounded veterans. Hearing about new advances in ocular prosthetics, the hospital’s Chief of the Ear, Nose and Throat Department asks researchers at the Navy Dental School to explore a solution to the glass eye shortage. Within the year, three Navy dentists and a medical illustrator would develop a process for fabricating acrylic eyes and forever revolutionize the field of prosthetics.
Since the 19th century German artisans in the state of Thuringia were considered the unrequited masters of the artificial glass eye fabrication; their craftsmanship was so unparalleled that at the beginning of World War II almost all of the artificial eyes in the United States came from the same place, Thuringia. The war would interrupt this steady supply and set the stage for Navy dentists Capt. Rae Pitton, Lt. Cmdr. Phelps Murphey, Lt. Cmdr. LaMar Harris and medical illustrator Lt. Cmdr. Leon Schlossberg, Hospital Corps.
Owing to their extensive knowledge of impression methods, plastic materials, anatomy of the head and esthetic appearance of the face it was logical that dentists and an illustrator became involved in the research. The acrylic eye was fabricated much like a denture base. The dentists would make an impression of the eye socket using an alginate or hyper colloid molding. Once the impression was removed, a stone working cast was poured over the impression. The working cast was removed from the impression, lubricated and a plaster lock was poured over it. The cast was cut vertically to allow removal of a wax pattern. The pattern/model was then smoothed , dropped in ice water, removed, and lubricated with liquid petroleum before trying out in the eye socket. The dentist fitting the eye would then study the lid reaction and profile view to ensure that it mimicked the contour of the uninjured side. If deemed satisfactory, the model was duplicated with acrylic material. After the prosthetic was fabricated, the medical illustrator was then tasked with painting the eye—complete with sclera, blood vessels and iris—to ensure it was an exact replica of the patient’s existing eye.
Unlike its glass counterpart, the acrylic eye was very durable, and could be adapted to utilize the remaining eye muscles. It also afforded maximum comfort to the patients. And unlike the glass eye, each acrylic prosthetic was specially fitted for the patient.
In November 1944, the Naval Dental School instituted a 6-week course of instruction to teach dental officers this technique. Course graduates would be assigned to naval hospitals at Great Lakes, Ill., Philadelphia, Penn., Seattle, Wash., San Diego, Calif., and St. Albans, N.Y.
The news of the Navy’s acrylic eye caught the public’s imagination so much so that that the Bureau of Medicine and Surgery and the Naval Dental School were besieged with requests from people around the world for a chance to obtain acrylic eye. The Navy Medicine’s policy held that only individuals who were patients at naval hospitals would be authorized for fittings. Even military dependents were not immediately granted access. The only exceptions made were children of two Navy Sailors—a 9-month old born with an eye tumor and a 9-year old boy who lost an eye in an accident. Both were fitted with prosthetic eyes in 1946.
In 1944, the Navy established the Air Evacuation School at Naval Air Station, Alameda, CA under the instruction of Mary E. J. O’ Connor, a former Airline stewardess and registered nurse. Later dubbed the “flyingest woman in the world,” O’Connor would help oversee the eight-week course of lectures and demonstrations on survival training, air evacuation techniques, physiology of flight, first aid with emphasis on shock, splinting/redressing wounds, and treatment of patients in non-pressurized cabins. Students also learned about artificial horizons, and altitude through flight simulation exercises. Hallmark in the course was the intensive 18-hour “watermanship” training organized to simulate conditions of a water landing/crash scenario. The prospective flight nurses were required to swim under water, swim one-mile, and be able to tow victims 440 yards in 10 minutes.
The Navy’s first flight nurses would be deployed to Iwo Jima in February 1945, and later sent to Okinawa where they help save the lives of thousands of war wounded.
In the 1940s, Navy Radiologists stood vanguard in the development of atomic medicine, studying radiological safety, introducing photodosimetry, and establishing procedures in the clinical use of radioisotopes. One of these pioneers would write the first textbook on the subject of Atomic Medicine (1949).
In World War II and Korean War, the Navy made pioneering advances in soft and suction socket prostheses for the war wounded.
Established by the Naval Medical Research Unit (NMRI) in November 1949, the Navy Tissue Bank was designed for procurement of skin and bone for war-related injuries such as burns and severe fragment damage. The Tissue Bank would become a model for others established around the world.