Perhaps they were unsung heroes of the Civil War. http://ameddregiment.amedd.army.mil/nco/historynco.html AMEDD/NCO Enlisted Soldier History At the outbreak of the Revolutionary War, medical support was hampered not only by the limited availability of trained medical personnel, but the lack of adequate medicine and equipment. Insufficient care not only of the wounded, but the lack of treatment and prevention of the diseases that ravaged the army caused Washington to address the issue of medical care with Congress. Finally, on 27 July 1775, Congress authorized the establishment of a "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), four surgeons, one apothecary, 20 surgeon's mates, one clerk and two 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 NCO's) 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. When the British loyalists evacuated Boston, Dr. Morgan who was the Director General had his Hospital Stewards collect all the blankets, pillows and bed sacks left behind for use of the army. Thomas Carnes, a steward at the general hospital in New York, 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 NCO's also contacted the diseases that ravaged the military hospitals and died doing their duty. 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. While the Hospital Steward had no official rank in the army and were soldiers detailed from the line, they played a key role in providing healthcare for the soldiers. They had to be able to read and write, some background in mathematics, chemistry or pharmacy. Few soldiers of this era had these abilities. In 1808, Dr. Edward Cutbush, Medical Director of the Pennsylvania Militia during the Whiskey Rebellion, published the first manual on hospital administration. He stated that a steward was an individual who was honest and above reproach. His duties included discipline of staff and patients, personnel management, food service, medical supply and overall administration of the hospital. In 1813, the reorganization of the Army began and had a major impact on the Army. The pay and allowances for a steward was twenty dollars and the wardmaster received sixteen dollars and both received two daily rations. Congress did not extend the authorization for 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 but without authorization from Congress. Hospital Stewards were taken from the line and the preference was a NCO. Stewards were required to attend three drills a week with the rest of the soldiers. This severely impacted on the care of patients and the regulations were changed to make the steward attend only the weekly inspection and payroll muster. Hospital Stewards were learning 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. Hospital Stewards were dedicated and often placed in situations that challenged their knowledge in keeping records, dispensing of medicine and caring for the sick. John Bemrose, who served as a steward wrote in his memoirs describing his duties during the Second Seminole Indian War in 1835. He included the cases of wounded that he treated and his written case histories were as detailed as any surgeon of that period. 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 Army supported his efforts and in 1851 issued an addendum to the Regulations for the Uniform and Dress of the U.S. Army that authorized a "Half Chevron" consisting of a green background with yellow trim and a Caduceus to denote the rank of the Hospital Steward. Finally in 1856, Congress authorized the Secretary of War to appoint as many Hospital Stewards as needed in the army and mustered onto the hospital rolls as "NCO's". This action permanently attached the stewards to the Medical Department. 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 was 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. Some Hospital Stewards were physicians in civilian life but had no desire to serve as surgeon. and were often treated with equal status from the surgeons they were serving under during the war. 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. Dental care for the army consisted primarily of extraction of teeth and was done by the surgeon or his Hospital Steward. The first dentist in the army 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. Only individuals who served as hospital stewards for over 25 years were exempted from the tests. All other stewards were required to take written tests in order to retain their rank. It was not easy test as it required them to do math and chemistry problems and also 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 totally 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 formed of personnel trained in all aspects of medical support for field and garrison operations. 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 NCO's 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". GENERAL ORDER 29 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. To ensure that the privates of the newly formed corps had the necessary skills to perform their duties, "Companies of instruction" were established in 1891. Under this concept, infantry drill regulations were integrated with medical training in the areas of anatomy and physiology, nursing, pharmacy and first aid. The were also rotated through the post hospital. The "Hospital Corps Knife" was issued as standard uniform equipment and used for making litters or small triage areas in the field. The newly organized Hospital Corps would not escape scrutiny by the Army. It was the responsibility of the Inspector General to visit and evaluate the corps to see if it was an effective organization. The Spanish American War and Philippine Insurrection gave the Hospital Corps its first true test outside the Indian wars. Upon arrival at the port, there were no docks empty to unload the supplies and equipment. The material had to be offloaded into small boats, and transported to shore. As in all past wars, battle injuries were few in comparison to diseases such as Yellow Fever and Malaria. Criticism of the Army Medical Department during the war was not solely based on its personnel being inadequately trained, but that it was far too small to meet the needs of the war. 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 NCO's 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 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 (91C) 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 challenge 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. 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. 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 actions. Humanitarian Missions The AMEDD has always supported humanitarian missions on a world- wide basis In July 1958, the Medical Department sent several units to support the US operations in Lebanon. The 58th Evacuation Hospital, Medical Platoon of the 187th Airborne Battle Group, Medical Detachments of the 3d Tank Battalion and 299th Engineer Battalion, 100th Veterinary Food Inspection Detachment and the 485th Preventive Medicine Company. Health problems among the US Forces during the first 30 days were heat exhaustion due to exercising without being acclimated. Mosquito nets were not used, salt intake was not enforced and refuse and human waste disposal was inadequate. Personal hygiene was unsatisfactory due to the lack of changing clothes, and no bathing and laundry facilities. No combat was incurred, but had there been, a medical disaster would have occurred. In May 1960, the 7th and 15th Field Hospitals were sent to Chile to provide aid after a large earthquake. In July 1963, the 8th Evacuation Hospital was sent to Yugoslavia to provide aid after a large earthquake. In March 1964, AMEDD sent personnel to Alaska after a massive earthquake and flood disaster. In 1965, the 15th Field Hospital, 584th Ambulance Company, 53d Surgical Team, 714th Preventive Medicine Team, 54th Helicopter Ambulance Detachment, 139th Orthopedic Team and the 307th Medical Battalion were deployed to support US Forces during the Dominican Republic crisis. . In the last ten years, the AMEDD has participated Operations Other Than War (OOTW). Some examples are the humanitarian missions to Croatia, Haiti, Somalia, Bosnia, Albania and Yugoslavia.