cultural and historical influences on the uniforms and ... · to as the barbary pirates. in 1801,...

Cultural and Historical Influences on the Uniforms and Devices of the

United States Public Health Service

By

CAPT Steven Hirschfeld, MD PhD

LCDR Danny Benbassat, PhD

June 2019

Cultural and Historical Influences

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Table of Contents

Of Symbols and Snakes ................................................................................................................... 3

The Fouled Anchor .......................................................................................................................... 5

A General Cultural Paradigm .......................................................................................................... 5

U.S. Government Maritime History: A Brief Overview ................................................................... 6

Forged by Fire ................................................................................................................................. 6

Reorganization and Expansion ........................................................................................................ 8

New Leadership and Symbols ......................................................................................................... 9

New Frontiers................................................................................................................................ 10

Of Uniforms in General ................................................................................................................. 13

Eighteenth & Nineteenth Century Maritime Uniform History ..................................................... 14

First U.S. Navy Uniform Regulations ............................................................................................. 15

Twentieth Century ........................................................................................................................ 19

World War II Era ............................................................................................................................ 21

Twenty-First Century .................................................................................................................... 23

Closing Comment .......................................................................................................................... 23

References .................................................................................................................................... 26

Table of Figures

Figure 1. Examples of the Caduceus of Mercury and Rod of Asclepius .......................................... 4

Figure 2. United States Public Health Service 1914 Insignia and Ratings ..................................... 14

Figure 3. Drivers of U.S. Maritime Uniform Styles and Functions ................................................ 15

Figure 4. Service suite-undress uniforms c. 1900 ......................................................................... 18


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Of Symbols and Snakes

It is possible that our story begins more than 5,000 thousand years ago in the mountains and

forests of the Eastern Mediterranean and the lands that lay to the East. People had experiences

they could not predict, control or understand, so they attributed their experiences to powerful,

but emotional, pagan gods that lived in the forests, mountains, waters, and the sky. Every

observable phenomenon and every sensation had a god behind it. There were even gods, and

messengers to gods, specifically dedicated to travel and commerce.

The stories of these gods, their personalities, and roles, were distributed by sea faring

merchants. Symbolism, in an era with a limited number of literate people, was critical to impart

meaning. For example, the concept of snake, with its flexible body, was used in several ways.

The snake represented evil power and chaos in some contexts but also renewal (through the

shedding of its skin), healing, and fertility in other contexts.

A Sumerian god named Ningishzida, who was worshipped around 5,000 years ago and was

associated with vegetation and the underworld, had the symbol of a staff with two snakes

intertwined around it. Hermes, the Greek messenger between the gods and humans, carried a

winged staff with two snakes that represented harmony and travel. Interwoven snakes, with or

without a winged staff, indicated merchants and commerce in many cultures. Commerce is, in

principle, a peaceful endeavor, so messengers bearing the snakes were interpreted as coming

in peace. The double intertwined snakes on a staff with wings became known as the Caduceus.

The Roman name for Hermes is Mercury and the caduceus is commonly referred to as the

Caduceus of Mercury.

A single snake combined with a single rod was used to indicate the interchangeability between

stiff and flexible states for illness and healing. Here is an example from the book of Numbers,

Chapter 21:

6 And the LORD sent fiery serpents among the people, and they bit the people; and many

people of Israel died. 7 And the people came to Moses, and said: “We have sinned,

because we have spoken against the LORD, and against you; pray unto the LORD, that

the LORD takes away the serpents from us.” And Moses prayed for the people. 8 And the

LORD said unto Moses: “Make a fiery serpent, and set it upon a pole; and it shall come to

pass, that every one that is bitten, when he views it, shall live.” 9 And Moses made a

serpent of brass, and set it upon the pole; and it came to pass, that if a serpent had

bitten any man, when he looked unto the serpent of brass, he lived.


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The single rod and snake are also associated with the Greek god Asclepius, a healer, son of

Apollo, and grandson of Zeus. A legend is that Asclepius was kind to a snake that consequently

taught him healing skills including resurrection from the dead. The wingless rod, narrow on one

end and wide on the other with a single snake wrapped around it, became known as the Rod of

Asclepius and, subsequently, a symbol for healing in Western culture.

As printing became established, through the combination of movable type and alphabet scripts,

in Europe over the past five hundred years, publishers began to use symbols to catalog

different types of texts. Both the Caduceus of Mercury and the Rod of Asclepius were used in

many contexts and manuscripts, sometimes interchangeably, which led to conflation of the two

symbols. Figure 1 provides some examples of the double snake Caduceus of Mercury along with

the single snake Rod of Asclepius, integrated with other design elements.

Caduceus of Mercury Coat of Arms of the city Flag of Chinese customs Roman mint, 74 A.D. of Jyvaskyla, Finland office (note the crossed design)

U.S. Army Medical Public Health Service Rod of Asclepius Corps patch device

Figure 1. Examples of the Caduceus of Mercury and Rod of Asclepius


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The Fouled Anchor

Foul is a nautical term that refers to entangle or entwine; however, a

broader definition is that something is wrong or difficult. The term foul,

applied to the state of an anchor, means the anchor has become

hooked on some impediment or the anchor cable is wound round the

stock or flukes. The fouled anchor, as a naval insignia, represents the

challenges mariners must face and overcome. The fouled anchor is a

common nautical symbol in the western world. It is also rather common

in cemeteries. The image on the right depicts a memento mori for a

seafaring merchant in Nunhead Cemetery, England (note the use of the

double snake design).

The fouled anchor was the personal seal of Sir Charles Howard, Baron of Effingham. He was

appointed the Lord High Admiral of England by Queen Elizabeth I in 1585 and oversaw the

defeat of the Spanish Armada in 1588. During this historical period, it was customary that the

personal seal of a great officer of state was adopted as the seal of his office. The fouled anchor

still remains the official seal of the Lord High Admiral of Great Britain, an honorary position held

by Prince Philip at the time of this publication.

Sir Charles Howard is also credited, along with Sir Francis Drake and Sir John Hawkins who

served as Treasurer of the Navy, of promoting a fund to support disabled seamen who fought in

the war against Spain. The fund, financed by deductions from active seamen’s pay in the Royal

Navy, began in 1588 with the money deposited in a chest at Chatham Dockyard in Kent. The

fund thus became known as the Chatham Chest fund. When a sailor established that he

suffered from a disability, the fund would pay relief and maintenance. The Chatham Chest fund

continued until 1803, when it was merged with the Greenwich Hospital fund due to

irregularities in the maintenance and security of the funds in the chest1,2. The Greenwich

Hospital was founded in 1692 as a home, with a medical wing, for retired sailors.

A General Cultural Paradigm Maritime customs in the United States were influenced by British Naval customs. Within the

United States, the U.S. Navy is the usual driver for the customs and policies of the other

maritime services, although occasionally one or more of the other maritime services diverge

from or anticipate changes in the Navy. Any consideration of the uniforms and customs of the

U.S. Public Health Service should recognize this paradigm.


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U.S. Government Maritime History: A Brief Overview The U.S. Navy, following the American Revolution, was a protective force primarily for U.S.

shipping interests and the U.S. economy. The U.S. Navy was part of a larger U.S. maritime

infrastructure that evolved over the Ninetieth-Century. This larger infrastructure was regulated

by the Department of the Treasury and included the predecessor agencies of the modern-day

Coast Guard (Lighthouse Service, 1789; Revenue Marine, 1790; Life Saving Service, 1848;

Steamboat Inspection Service, 1852; Bureau of Navigation, 1884). The Treasury Department

also regulated the Marine Hospital Fund (1798) which, along with the Revenue Marine,

protected commerce along our nation’s coastal and inland waterways.

In 13 October 1775, during the period of the American Revolution, the second Continental

Congress established a Continental Navy consisting of pre-existing vessels and primarily British

sailors who switched commands to join the fledgling United States. At the end of the

Revolutionary War, the Continental Navy was disbanded making the operations that eventually

became the U.S. Coast Guard the longest continuing sea service in the United States. In 1790,

The U.S. Congress, with the recommendation of the Secretary of the Treasury, Alexander

Hamilton, established an armed Revenue Marine as a customs enforcement agency.

The modern U.S. Navy was began on 30 April 1798 when President John Adams added the first

Secretary to the U.S. government, thus formally establishing the Department of the Navy. That

is why President Adams is referred to as the father of the U.S. Navy. At the time, the U.S. Navy

owned six frigates to protect U.S. shipping interests and support the growing economy. In the

same year, the fifth congress of the United States passed an Act for the Relief of Sick and

Disabled Seamen. This Act, again signed by President Adams, was supported by a 20-cent tax on

seamen’s wages3, modeled after the Chatham Chest fund in England4. This is both the first

documented prepaid health insurance plan in the United States and is conventionally

considered the origin of what was to become the U.S. Public Health Service (USPHS). President

John Adams is, therefore, also referred to as the father of the USPHS. On 2 March 1799, the Act

was expanded to include all “officers, seamen and marines of the navy of the United

States”5(p729).

Forged by Fire The first major U.S. Navy combat encounters came with French ships in the French West Indies

because the U.S., noting a change in government in France, declared null debts owed to the

prior French government. The new French government countered by attempting to collect U.S.

assets at sea. Although neither side declared war, the U.S. Navy quickly gained combat


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experience so that when hostilities ended in 1800, the Navy was ready to enter formal wars

against pirates during the Barbary Wars.

The European shipping trade was threatened for many years by disputes between European

powers and pirates sanctioned by semi-independent Muslim countries located in North Africa

that correspond to the current countries of Morocco, Algeria, Tunisia, and Libya. The latter

three were affiliated with the Ottoman Empire while Morocco was considered an independent

sultanate. The dominant people in North Africa were the Berbers, and the pirates were referred

to as the Barbary pirates.

In 1801, following seizure of American vessels and crews by Barbary corsairs for ransom, the

U.S. joined Sweden in the First Barbary War fighting the pirates to keep shipping lanes open

and safe. Concurrently, the first hospitals of the newly formed Marine Hospital Fund in Boston

Harbor and Norfolk Virginia served the beneficiaries of the Sick and Disabled Seamen Act,

similar in concept to the Greenwich Hospital in London, England.

In 1804, Congress passed a Navy Hospital Fund that paved the way to establishing permanent

Navy hospitals. Similar to the Marine Hospital Fund, Navy officers and sailor contributed 20

cents each month to bolster the fund. In 1811, Congress approved an Act to establish

permanent Navy hospitals4. However, it wasn’t until 1821 that the Commissioners selected the

first Navy hospital site in Washington DC and not until 1830 that the first Naval hospitals

opened in Portsmouth, Virginia.

Francis Scott Key was born in Frederick County, Maryland in 1779. He trained as an attorney

and practiced in Washington, DC. In 1805, the U.S. Marine Corps successfully attacked an

enemy stronghold in Libya and Mr. Key, on hearing of this success, wrote a poem called "When

the Warrior Returns." He merged the lyrics with the music of a British song by John Stafford

Smith called “To Anacreon in Heaveni.”

Following the end of the First Barbary War in 1805, the U.S. Navy subsequently became

involved in combat during the War of 1812 when the British attacked the United States. All the

wounded of the USS Constitution (“Old Ironside”) and Guerriere were treated in the Marine

Hospital in Charlestown, Boston, the first to be constructed using the 1798 Act funds6. In his

role as a Washington based attorney, Mr. Key was sent to Baltimore as part of a team to

negotiate prisoner release following the burning of Washington, DC and a raid on Alexandria,

VA. The British intended to attack Baltimore next. Key and his colleagues were kept on a British

ship during the night of 13 September 1814 and saw the bombing of Fort McHenry.

The Americans defending the fort never yielded and when the dawn came, the U.S. flag was still

flying. The inability to raid Baltimore, combined with the death of a British general from sniper

fire, resulted in a British withdrawal. Key immediately wanted to capture his emotional


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reaction. He began a poem on a letter in his pocket and finished the text a few days later. Key

called the poem “Defence of Fort M’Henry” and subsequently, with the assistance of musician

and publisher Thomas Carr, merged the words with the same tune he previously used for the

Barbary War poem. Together, the combination of the Fort McHenry text with the “To Anacreon

in Heaven” music became known as the “Star Spangled Banner” and more than a century later,

in 1931, the national anthem of the United States of America.

In 1815 the U.S. Navy entered a second Barbary War that ended a year later. The U.S. Navy was

then at peace for the next three decades. The Marine Hospital Fund expanded during the early

to mid-Nineteenth-Century to include facilities to provide service to seamen along the rivers

and inland waterways as well as those facilities located at ocean facing seaports. The Mexican-

American War of 1846 brought the U.S. Navy into combat again when activities included

fighting pirates in the Caribbean and the Mediterranean and fighting ships guarding the slave

trade in West Africa.

The Revenue Marine became engaged in combat operations in 1861 when the Revenue Marine

cutter Harriet Lane fired the first volley of the Civil War maritime conflict. Together, the U.S.

Navy and the Revenue Marine continued combat operations during the Civil War.

Reorganization and Expansion The end of the civil war and the purchase of Alaska from the Russians in 1867 increased

demand for maritime trade and safety. This prompted George S. Boutwell, Secretary of the

Treasury under President Ulysses S. Grant, to reorganize and reformat the Treasury

Department. He established an interim Revenue Marine Bureau under the leadership of N.

Broughton Devereux. The new bureau consisted of the Revenue Marine, the Steamboat

Inspection Service, the Marine Hospital Fund, and the Life Saving Service. The bureau became a

permanent agency in 1871.

As part of the overhaul effort, President Grant commissioned a report from the Treasury

Department specifically on the Marine Hospital Fund and requested John Shaw Billings, a Civil

War Veteran, Army Surgeon, bibliophile, and statistician to consult. Billings was the person

responsible for building the Library of the Surgeon General’s Office of the U.S. Army just after

the Civil War, which eventually became the National Library of Medicineii.

The Marine Hospital Fund disbursed monies to local port authorities to construct and

administer hospitals, a business model that Billings deemed “unsatisfactory.” The Billings

Report recommended the establishment of a centralized management model for the Marine

Hospital Fund with a military structure and a Supervising Surgeon. Two other reports

recommended overhauls of the sister sea service, the Revenue Marine.


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Consequently, in 1870, both the Marine Hospital Fund and the Revenue Marine were

reorganized and, concurrently, the tax on seamen’s wages was raised to 40 cents to increase

funds for the Marine Hospitals.

New Leadership and Symbols The new centralized Marine Hospital Fund became a separate Bureau within the Department of

the Treasury and renamed the Marine Hospital Service. Dr. John Maynard Woodworth was

appointed, by President Grant, to the post of Supervising Surgeon in 1871. Previously, Dr.

Woodworth served as a U.S. Army Surgeon and, later, Medical Director of the Army of the

Tennessee. He also served under General Sherman and evacuated the sick and wounded to

Savannah. As a Supervising Surgeon of the Marine Hospital Service, Woodworth established the

use of service standards, prescribed uniforms, and designed an official device with a fouled

anchor and a Caduceus of Mercury in 1872.

Since documentation is lacking, we may never know what motivated Woodworth to use the

Caduceus of Mercury, or to cross the caduceus with a fouled anchor. It is

likely that Woodworth saw the caduceus on the uniforms of U.S. Army

hospital stewards during the Civil War. Thus, it is possible that

Woodworth associated the caduceus with the sick and disabled. It is

also possible that Woodworth knew that the caduceus is a symbol for

non-combatants tending to the sick and disabled. The third option is that

Woodworth recognized the caduceus as a symbol for merchants and commerce and used it as a

symbol for the mission of the Marine Hospital Service and the Revenue Marine – Protection of

commerce. The use of the caduceus as a symbol of commerce has been widespread in western

cultures and can be found on the U.S. Department of Commerce building in Washington, DC.

As noted, we may never know what Woodworth was thinking. However, we do know that

Woodworth saw the caduceus and fouled anchor inside the Treasury Department building prior

to 1871. To this day, the building is adorned with symbols that represent its historical bureaus

and offices. For example, a visit to the Cash Room will reveal multiple caduceus in the

balustrade that date back to 1869. The balustrade was designed by Goldsborough Bruff, a

government draftsman and designer for 61 years7. Bruff also designed eleveniii utilitarian

chandeliers to light the corridors of the Treasury Building. In one, Bruff superimposed (crossed)

the Treasury Department’s key on a Caduceus of Mercury to denoted the contribution of the

Treasury bureaus to the economy. The practice of crossing the caduceus with maritime

symbols, such as the trident, to represent maritime commerce was also common. In the 1850s

and ‘60s, Bruff produced lithograph plans for federal buildings. In one, he crossed the Caduceus

of Mercury with the trident to refer to Marine Hospitals. Such examples were plentiful in the


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Treasury Department. The device of the modern USPHS could have been a crossed caduceus

and trident had Woodworth preferred the trident as a maritime symbol.

Similarly, we may never know if Woodworth used the fouled anchor to represent seamen in

distress or maritime service. We do know that the Revenue Marine used the fouled anchor as

its device. In fact, to this day the flag of ranks for the Treasury Department includes the U.S.

Coast Guard shield and fouled anchor. The flag of rank for the Treasury Department’s Office of

the Secretary was adopted from the Coast Guard flag.

In addition to leading the Marine Hospital Service, Dr. Woodworth also founded the American

Public Health Association. In 1873, the designation of Supervising Surgeon was changed to

Supervising Surgeon General but did not come with a military rank until 1879 when the second

Supervising Surgeon General, John B. Hamilton, another former U.S. Army surgeon, was

appointed Rear Admiral by President Rutherford Hayes.

The 1878 Quarantine Act gave the Marine Hospital Service the authority to protect U.S. ports

from the spread of diseases. The service maintained a fleet of speedy boarding tugs used to

board any ship flying the yellow quarantine flag and those suspected of carrying infectious

diseases. To assist in quarantine measure, the Revenue Marine worked closely with the Marine

Hospital Service. For example, the Revenue Marine detailed enlisted and armed men to assist at

immigrant detention camps and routinely furnished vessels to the Marine Hospital Service6.

New Frontiers While the services of the Revenue Marine Bureau were receiving attention and resources, the

U.S. Navy did not and through the 1870s the Navy declined in size and power. By 1879 the

entire fleet had less than 150 vessels, the ships were made either entirely of wood or ironclad

wood, none had a long-range gun, and only one third were seaworthy and available for service.

During the 1880s, the U.S. Congress took interest in building a strong Navy with global reach

and authorized the building of steel hulled ships and enlisting sailors and officers. The 1880’s

was also a time of continued growth for the other maritime services. The Revenue Marine was

given additional resources and renamed the Revenue Cutter Service in 1894. Simultaneously

the tax on seamen’s wages to fund the Marine Hospital Service was abolished and replaced by a

tax on shipping companies based on tonnage. Also in 1894, an act extended the benefits of the

marine hospitals to the keepers and crews of life-saving stations8.

In 1887, the Marine Hospital Service established a one room Hygienic Laboratory for research in

the Staten Island quarantine station. This one room laboratory later evolved into the National

Institute of Health (currently, National Institutes of Health). The first Director of the Laboratory


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was Dr. Joseph Kinyoun, who, as part of his training, studied bacteriology with Professor Robert

Koch in Germany.

The year 1889 was significant in the evolution of the Marine Hospital Service because Congress

passed an act to regulate appointments in the Marine Hospital Service. Since 4 January 1889,

physicians were appointed medical officers of the Marine Hospital Service, just as any other

military officer9.

By 1890, the American Frontier, or open land to the west of the informal boundary of the

settled part of the United States, was formally declared closed by the U.S. Census Bureau.

Consequently, U.S. interests and trade had an ever-increasing international focus which

became evident during the Spanish-American War of 1898. Following the engagement of U.S.

forces, including the now refurbished Navy, in a global operation, the United States gained

control of the Philippines, Guam, Cuba, and Puerto Rico.

In 1902, the U.S. Congress renamed the Marine Hospital Service to the Public Health and

Marine Hospital Service and the Supervising Surgeon General title became Surgeon General.

Also in 1902, the Biologics Control Act provided the service the authority to regulate vaccines,

anti-sera, and other products.

The Biologics Control Act implicated the Public Health and Marine Hospital Service in two ways.

The first was that the Surgeon General was a member of an oversight board under the

Secretary of the Treasury with the authority to issue, suspend, or revoke biological product

licenses. The second was the Hygienic Laboratory had the responsibility for testing products,

performing inspections, and renewing licenses. This mission eventually evolved into part of the

Food and Drug Administration.

In 1906, Congress abolished the tonnage tax and provided a direct appropriation to support the

mission of the Public Health and Marine Hospital Service. In 1912, Congress shortened the

name of the service to the U.S. Public Health Service while increasing the scope of activities

including investigations into human diseases, sanitation (including water supplies and sewage

disposal), and support of a nationwide hospital system. As shown in Table 1, the service

consisted of commissioned and non-commissioned uniformed personnel.

In 1915, the Revenue Cutter Service and the Life Saving Service combined to form the modern-

day U.S. Coast Guard. Following the great flu pandemic in 1918, the Public Health Service

established a Reserve Corps. At the same time, the U.S. Navy grew to have more personnel

than the British Royal Navy and by the start of the 1920s had as many ships.


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Table 1. Public Health Service personnel organization in 191410

Commissioned

Officers

Warrant

Officers

Junior Enlisted Petty Officer

First Class

Petty Officer

Second Class

Surgeon General

Assistant Surgeon

General

Senior Surgeon

Surgeon

Professor of

Hygienic

Laboratory

Passed Assistant

Surgeon

Quarantine

Inspector

Acting Assistant

Surgeon

Chaplain

Interne

Pharmacist

Clerk

Station Engineer

Pilot

Marine Engineer

First Cook

Cook

Coachman

Carpenter

Yardman

Messenger

Laundryman

Female Nurse

Night Watchman

Ship Keeper

Boatswain

Coxswain

Ordinary Seaman

Fireman

Coal Passer

Boy

Station Engineer

Pilot

Marine Engineer

First Cook

Surgical Nurse


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The growth of the U.S. Public Health Service during the mid-Twentieth-Century is well

documented but some key events that influenced the present-day mission include:

• 1930 - Parker Act commissions pharmacists, dentists, scientists, and engineers, thereby

expanding the officer ranks to non-physicians.

• 1930 - Federal Bureau of Prisons is established, with U.S. Public Health Service providing

medical care for prisoners.

• 1930 - Ransdell Act establishes the National Institute (singular) of Health as a research

enterprise.

• 1939 - President Franklin Roosevelt transfers USPHS out of the Treasury Department,

ending a 140-year association, into the newly formed Federal Security Agency (FSA).

• 1942 - Office of Malaria Control in War Areas created to suppress malaria near U.S.

military training bases during World War II. The Communicable Disease Center (CDC)

replaced the Malaria Control in War Areas in 1946.

• 1943 - Nurse Corps established, under USPHS patronage, to address nurse shortages

during World War II.

• 1944 - Public Health Service Act adds nurses, sanitarians, dietitians, scientists, and

therapists as professional categories.

• 1947- Veterinarian profession is added to USPHS.

• 1953 - President Dwight Eisenhower transfers USPHS, and the other FSA programs, into

the newly formed Department of Health, Education, and Welfare (HEW).

• 1955 - Indian Health Service is established under USPHS patronage.

• 1979 - USPHS, and health and welfare programs, are reorganized as the new

Department of Health and Human Services (HHS).

• 1981 - The USPHS Hospital System is closed, thereby ending 183 years of continuous

marine hospital operation and the original mission of the service.

Of Uniforms in General The first use of uniforms is not known but, generally, uniforms were used to identify a group

and indicate the hierarchy within that group. The same group or organization may have several

uniforms, each for a particular rank, use, or occasion. The cloth, or fabric, by itself does not

make the uniform. In fact, the pattern and textile cut of some foreign militaries is nearly

identical to the U.S. military. As shown in Figure 2, it is the insignia, devices, and badges that

make the uniform. Insignia and devices are symbols that signify a membership in an

organization, rank within the organization, or distinguished achievements. Badges signify

special skills or qualifications earned by service personnel. In the maritime services, rating

badges refer to the role or profession of an individual.


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Figure 2. United States Public Health Service 1914 Insignia and Ratings

A common example of a naval military uniform is a “dress” uniform used for all occasions of

ceremony, weekly inspections, muster on board vessels, and on inspection duty. Less formal

uniforms may be designated “undress” due to lack of decorative elements or markings and use

in daily functions.

Eighteenth & Nineteenth Century Maritime Uniform History The British Navy did not have uniforms until the mid-Eighteenth-Century. The first uniform

regulations appeared in the 1790s with rank indicated by coat cuff embroidery, buttons, and

epaulets. In the fledgling United States of America, the Army was the first organization to have

a uniform, followed by the U.S. Navy.

As shown in Figure 3, the general trend was that U.S. Navy uniforms were influenced by the

British Royal Navy uniforms, general clothing fashion, and secular trends. In turn, the

forerunners of the U.S. Coast Guard and Public Health Service were influenced by U.S. Navy

uniforms.


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Figure 3. Drivers of U.S. Maritime Uniform Styles and Functions

First U.S. Navy Uniform Regulations The first record of naval uniforms was approved by

the Massachusetts Council in April 1776. Officer

uniforms were green and white and the Colors on

Massachusetts state navy vessels was a white flag

with a green pine tree and the inscription “An appeal

to Heaven.” On 5 September 1776, the Marine

Committee, Philadelphia, released the first uniform

regulation for naval officers. Officers wore blue cloth

with red lapels, blue breeches (trousers), and red

waistcoat11,12. In 1777, a group of naval officers,

including John Paul Jones, adopted an unofficial

uniform. The blue and white uniform bore a strong

resemblance to that of the British Royal Navy and it

was difficult at times to distinguish friend from foe12.

On 24 August 1797, the Secretary of War issued

uniform instruction for naval officers. The basic 1797 Navy uniform was blue and buff

(yellowish-beige) and similar to that worn by the Army. Rank was indicated by buttons and coat

cut. For example, a captain sported long coat lapels and four buttons on the cuffs. On the other

hand, a lieutenant had short lapels and three cuff buttons. The Navy used the button count to

indicate rank for many years12.

A surgeon’s coat was cut like that of a captain but made of green cloth with black velvet collar,

lapels, and cuffs. Surgeons also wore a double-breasted red vest and green breeches. Like

captains, Surgeons wore nine buttons on the coat, to indicate commissioned status. Like

British

Navy

Secular

Trends

U.S. Navy U.S.

Maritime

Services


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lieutenants, Surgeons sported three cuff buttons. In 1797, the only commissioned staff officers

were surgeons, surgeon’s mates, and chaplains13. On 2 March 1799, the President was

authorized to order all Revenue Marine cutters to operate with the U.S. Navy. In addition,

Revenue Marine officers started to wear uniforms (designed by the Navy) and use naval titles14.

On 27 August 1802, the uniform regulations changed to prescribe all officer uniforms to be in

blue and gold with rank indicated by buttons and gold lace trim. A lieutenant had a single

epaulet that was worn on the left when second in command and on the right when in

command. The buttons had a fouled anchor with an eagle and 15 stars. The surgeon’s coat had

trim of gold lace frogsiv on the buttons.

While no federal uniform regulations were issued for enlisted men, ship commanders had the

option to issue uniform orders and the Commodore of the Mediterranean, Captain Edward

Preble of the U.S. frigate Constitution, ordered the crew to have available white jackets with

white vests when in warmer climates. The first centralized uniform instructions for enlisted

personnel were not to appear until 1841v. The Navy added the first uniforms for Navy hospital

personnel in 181315. In 1814, uniform regulations were updated to substitute pantaloons for

breeches, as that was the major shift in clothing fashion in the civilian world as the Nineteenth-

Century progressed. Common practice was to personalize and customize the uniform

regulations. Though not mandated, it became common to wear white trousers as well as white

jackets in the tropics.

The U.S. Navy uniform order of 1 May 1830 began the modern practice of a standard system of

rank insignia and use of devices to indicate the status and specialty of staff officers. The amount

and location of gold embroidery in full dress continued to determine rank, but corps devices

were added to help identify staff officers. (e.g., Medical Corps, Chaplain Corps)16.

In 1830, the Revenue Marine also issued its first uniform regulations using the new Navy

uniform but replaced the buttons with U.S. Treasury insignia buttons. Nevertheless, uniforms

management did not exist in the Revenue Marine until 184314. In 1830, Navy Surgeons were

ordered to display a "live oak leaf, on the upper and front edges of the collar, and around the

cuffs. The club of Esculapius [sic] is also to be embroidered on the collar"17(p616). In 1832, Navy

Surgeons were informed that "the serpent and staff be removed from the collar of the full dress

uniform of the Surgeons and Assistant Surgeons, and a branch of live oak is to be substituted” 17(p616).


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In 1847, medical officers were ordered to wear the letters “MD”

in old English charactersvi on the shoulder strap and cap. The

cap had oak branches with acorns around the letters. In 1852,

the silver “MD” was replaced with one sprig of olive. With the

olive sprig, oak branches, and acorns, the Navy Medical officers

was dubbed “a veritable walking arboretum” 17(p617). In 1864, a

silver oak leaf replaced the olive sprig. The same 1864 order

limited the device to the cap or cover, so uncovered officers

could only be identified by rank. In 1869, the Navy followed the British Royal Navy’s practice

and identified staff officers by placing band of colored cloth between the gold rank stripes on

the sleeves of the dress coat. Each staff corps had a different color. While the British used red

or scarlet to identify Surgeons, the U.S. Navy chose cobalt blue17.

On 3 March 1871, the U.S. Navy established a Medical Corps with the

mission of providing medical care to U.S. Navy and U.S. Marine Corps

personnel. A year later, the Marine Hospital Service started to use the

fouled anchor with the double snake caduceus insignia. The Marine

Revenue continued using the fouled anchor on top of the Treasury

Department seal with the Old English letters U.S.R.M.

Twelve years later, in 1883, new uniform regulations established the

modern-day device of the U.S. Navy medical corps; a spread oak leaf

embroidered in dead or dull gold with an acorn embroidered in silver upon it. Alternative

designs of a Maltese Cross with a Geneva Cross superimposed upon it and a fouled anchor with

the Caduceus of Mercury as the shank were rejected for the more generic historic symbol of

oakvii. Over the centuries, the oak referenced ships that were made from wood. The oak was

also used by the Druids of ancient Europe. These pre-Hippocratic healers displayed the gold oak

leaf and acorn device on their white robes. Historically, the caduceus and oak symbolized

humane service17.

For the Marine Hospital Service, parts of circulars, such as No. 74 (1884) and No. 142 (1887),

prescribed uniform standards, but it wasn’t until 1890 that formal regulations were

established18. These early uniforms mirrored those of the Revenue Marine. In turn, the

Revenue Marine uniforms were almost identical to the U.S. Navy uniforms of the day. Officer

uniforms included dress suit, social dress, service suit-undress, and overcoat. As shown in

Figure 4, the most salient difference in the service suit-undress was the use of dark sleeve

insignia by Public Health Service and Revenue Cutter Service officers. Enlisted uniforms

included working suits (later, fatigue uniforms), white duck jackets, jumpers, or overalls19.


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Public Health Service (c. 1900) Revenue Cutter Service (1898)

Navy (c. 1908)

Figure 4. Service suite-undress uniforms c. 1900


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In the picture on the left, Joseph Kinyoun (front row, left), is

shown pressing the camera flash tripwire to capture a photo of

himself in social dress uniform shortly after joining the Marine

Hospital Service in 1886. Kinyoun founded the Hygienic

Laboratory in 1887 (note the anchor and caduceus on the cover

and the letters M.D. on the lapels).

In 1886, the U.S. Navy established 15 rating badges. Until

February 1948, rating badges were worn on the right or left

sleeve, depending on whether the sailor or officer was assigned to

port or starboard watch. Since February 1948, all distinguishing marks have been worn

exclusively on the left sleeve between the shoulder and elbow.

The Marine Hospital Service employed enlisted men as petty

officers, hospital stewards, quarantine employees, seamen (petty

officers, ordinary seamen, firemen, coal-passers, stewards, cooks,

and boys), and attendants. Enlisted personnel wore ratings on each

sleeve. Attendant engineers wore a chevron of red felt cloth with a

cross. Quarantine pilots wore a chevron of red felt cloth with a

steering wheel and quarantine engineers wore a propeller wheel or

helix of red felt cloth with added chevrons of red cloth in 1893.

Seamen, nurses, and attendants (in kitchens, dining room, and

laundry) wore white duck jackets, jumpers, or overalls. Sky-silk

service stripes on each sleeve denoted length of service and the cap was adorned with the

letters M.H.S.

Twentieth Century

British soldiers stationed in India in the 1840s took their white

uniforms, soaked them in a mixture of mud, coffee, and curry

powder, and developed a khaki colored uniform that would blend

in with the landscape. In 1902, the U.S. Public Health and Marine

Hospital Service was authorized to wear a khaki uniform in

addition to the service dress uniform, the white uniform, and

fatigues20-22.

The khaki was to be worn as a substitute for the service suit-undress uniform at stations where

recommended by the commanding officer. The khaki uniform was similar to the fatigue uniform


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in design with a coat and cravat. U.S. Navy pilots unofficially adopted the Marine Corps flyers

khaki uniform and brown shoes in 1912-1913, one year after the Navy first acquired airplanes.

This unofficial Navy pilot uniform became official in 1917. Navy submariners began to wear

khakis in 1931. In 1941, the khaki uniform was authorized for all U.S. Navy Officers.

In 13 May 1908, the U.S. Congress established a Nurse Corps for the U.S. Navy but specific

uniforms for nurses, other than the generic white costume worn by hospital ward nurses, were

not issued until 1924.

In 1912, Congress passed a law that not only changed the name of the Marine and Public Health

Service to the Public Health Service but also extended the scope of field work. The rural

sanitation campaign that began in 1911, and the increased work in epidemiology, may explain

why the Public Health Service adopted the olive-drab service uniform.

According to the 1914 Public Health Service

Uniform Regulations, the olive-drab service

uniform was worn “while serving on epidemic

duty, except in hot climates, when khaki

service uniform may be substituted

therefor”10(p12). There is evidence that the

olive-drab was used prior to 1912 and it

remained in service until WWII. The picture

on the right depicts Hugh Cummings’ (c. 1920)

olive-drab and special full dress uniforms.

Cummings worked at the Hygienic laboratory and was assigned to the U.S. Navy during WWI.

Later, he became the fifth Surgeon General (note the use of the letters U.S. as used by the

Army)

During the 1920s the cap for U.S. Navy and Public Health Service officers changed. It now

sported a larger top and gold embroidery on the visor for senior officers (Commander –

Admiral) (note that the eagle is facing left, not right as used today).


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Public Health Service enlisted continued to wear ratings on their left sleeve. The number of

ratings increased from 3 to 15, such as Coxswain, Boatswain, Carpenter, Laundryman, and Night

Watchman (see Figure 2). Officers wore ratings on the epaulettes to indicate their

specialization.

In 1937, the dress blue uniform made its

appearance. The dress blue uniform,

blue service rain coat, and blue service

overcoat were almost identical to

modern-day uniforms. The white service

uniform was more similar to the modern-

day dress white uniform. Rating badges,

worn on the sleeve, expanded to 31 for

enlisted personnel. Specialized Corps

devices were also used to indicate

professional category (note Rod of

Asclepius for Warrant Officers).

World War II Era When the U.S. Coast Guard was put under the Navy on 1 November 1941, the Public Health

Service went to war as well. From 1941 to 1945, 663 Public Health Service officers served with

the Coast Guard. The Public Health Service decommissioned the olive-drab uniform and service

uniforms aligned with that of the U.S. Navy. In theater, Public Health Service officers wore the

khaki uniform, including the dress khaki, as did Navy officers.

A U.S. Public Health Service Officer, Haskell D. Rosenblum, MD,

was killed in action when the weather ship he served on, USS

Muskeget, was torpedoed by a German submarine on 9

September 1942, all hands were lost. Dr. Rosenblum served as

the Assistant Surgeon onboard the vessel when it was hit23. In

2017, the Public Health Service marched, for the first time in its

history, in the National Memorial Day Parade in Washington, DC.

Participating officers dedicated the event to Dr. Rosenblum.

A 1943 law established the Cadet Nurse Corps to train nurses and

support the war effort24. The Cadet Nurse Corps paid for the

education of 85 percent of nurses graduating between 1943 and


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1946. The distinctive uniform of the Cadet Nurse corps used the same Public Health Service

Cadet Nurse insignia used in 1937 for nurse interns. Also in 1948, the Public Health Service

abolished the enlisted and warrant officer grades and became a commissioned corps18.

In October 1943, the first African-American, LT John C. Eason Jr., was

commissioned as a Public Health Service officer. He became one of

the first Public Health Service officers to be assigned to the Office of

International Health where he supervised and supported health care

missions to various countries. He retired as a Captain in 197425. When

the Public Health Service deployed to combat Ebola in 2014, the Corps

christened the Monrovia Medical Unit (MMU), Camp Eason.

In 1972, the Secretary of Transportation approved a distinct uniform

to the U.S. Coast Guard. Admiral Chester R. Bender became

Commandant of the U.S. Coast Guard in 1970 and felt that the service needed a distinctly

different uniform from that of the Navy. In the early days of the Republic, Marine Revenue and

Navy uniforms were almost identical. In fact, Naval officers often took positions in Revenue

Cutters without relinquishing their Navy uniformsviii. In the 1920s, the Coast Guard started to

differentiate itself with distinct uniforms. However, in the 1940’s the Coast Guard officially

adopted Navy standards. Both services wore identical clothing with distinct corps devices,

buttons, shoulder marks, and a few other uniform elements. The 1972 uniform marked the first

major change in over a century of Coat Guard Uniforms. Today, the only uniforms that the

Coast Guard shares with the Navy are the summer white service and full dress

combinations26,27.

On 1 January 2015, the Battle Dress Uniform (BDU) was decommissioned and each service

adopted its own fatigue uniform. The Public Health Service considered using the Navy Working

Uniform (NWU), but eventually chose the Coast Guard’s Operational Dress Uniform (ODU).

The selection of the ODU is symbolic of the historic partnership with the United States Coast

Guard. The Revenue Marine relied upon the Marine Hospital Service for physical examination

and professional treatment when sick or disabled28,ix. Marine hospital physicians were

responsible for medical care and examination, but were not stationed on cutters. Instead,

treatment at sea was restricted to onboard medicine chests29,x. That changed by the Spanish-

American War when the Revenue Cutter Service joined the Navy. The roster of the USRC Hugh

McCulloch, that took part in the Battle of Manilla Bay on 1 May 1898, includes the name of the

Marine Hospital Service Assistant Surgeon, Joseph B. Greene30. Marine hospital officers were

also detailed on revenue cutters engaged in arctic cruising in 189828. In 1906, the Public Health

and Marine Hospital Service started providing medical care to midshipmen at the forerunner of

the United States Coast Guard Academy31. On 24 June 1914, Congress authorized the Secretary


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of Treasury to "detail for duty on revenue cutters such surgeons and other persons of the Public

Health Service as…necessary”32(p387),33. This act officially assigned Public Health Service

physicians to cutters, and later USCG aircraftxi. On 2 November 1986, CDR David Rockmore, a

USPHS flight surgeon on board HH-3F CG1474, and five other crew members lost their lives

when their helicopter crashed while on a medevac mission near Kodiak, Alaska34. Since 1942,

USPHS officers that detail to the U.S. Coast Guard wear the Coast Guard uniform with the Public

Health Service insignia35.

Wearing the uniform of the Public Health Service while on active duty is a requirement. In the

1970’s and 1980’s the uniform was not worn on a daily basis. With the Corps Transformation

initiative of Surgeon General Vice Admiral Richard Carmona in the early 2000s, daily uniform

wear was mandated. The USPHS uniform has the same significance as for the Armed Forces.

Unauthorized wearing of a USPHS uniform carries the same penalties as for any other service

uniform as described in Title 18 Part I Chapter 33 § 702 of the United States Code. In addition,

honorable active service in the Commissioned Corps of the USPHS or the Armed Forces is

defined in Title 5 § 8331 – Definitions of the U.S. Code as military service for determining

retirement status and benefits.

Twenty-First Century

The Patient Protection and Affordable Care Act, section 5209, eliminated the cap on USPHS

active duty officers and section 5210 assimilated all Reserve Corps officers into the Regular

Corps. The section also established a Ready Reserve Corps36.

Closing Comment

In the classic 1924 silent film from F.W. Murnau,

known in English as “The Last Laugh,” a hotel doorman

is defined by his ornate uniform. When seen struggling

with a heavy trunk by an assistant manager, he is

replaced the next day by a stronger man, and must

give up his uniform. As the late film critic Roger Ebert

wrote, “And when he takes the uniform off, he ceases

to exist, even in his own eyes” 37.

The opposite is true when given the privilege to wear

a U.S. uniformed services uniform. Wearing the uniform is a means to change a person in some

ways that become permanent, with or without the uniform. The USPHS always had a uniform

that was aligned with the other U.S. maritime services. However, the insignia, markings, and,

most importantly, mission have been unique. This uniqueness of engaging in different types of


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battles, those fought without ordnance, is what distinguishes the Public Health Service from

other uniformed services and renders its role in this nation’s assets ongoing and justifiable.

Health is fragile and merits protection at a national and international level through dedicated

professionals willing and able to train, serve, and make the ultimate sacrifice, if needed.

Throughout its history, USPHS officers devoted themselves to protecting the health and safety

of our nation.


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The Uniform

The following words were read by Captain Hirschfeld at his retirement ceremony 30 July 2018.

The uniform is-

About service

About diminishing the I for the we

Of earning an identity that is above and beyond self, one of many and the many become one.

Honoring those who went before and to establish honor for those to come as each one dons the

uniform and grows into its tradition and meaning, accomplished through performance that

shapes the collective identity into something greater.

The uniform has a voice. It speaks without words in a visual language.

The uniform outlives all who wear it.

And on retirement, undoubtedly many good things are yet to come, but there will be nothing

better than the ability to wear the uniform and all that it means.

Even if no one can see it anymore I will still be in that uniform.


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i The Anacreontic Society was formed in London in the mid-Eighteenth-Century and named after the Greek poet Anacreon, known for his songs to wine and to love. The Society consisted primarily of amateur musicians and had a weekly meeting beginning with a concert, followed by a meal, followed by general light entertainment. The Anacreon song, considered difficult to sing, was usually relegated to a soloist on behalf of the members, and was traditionally sung after the meal to capture the spirit of the Society. The Society disbanded in 1792 but the song was published and various texts were substituted for the original over the course of time. ii Subsequently, Dr. Billings moved on to other endeavors and used his many talents and organizational skills to develop the principles of the Index Medicus, which he applied to the Library of Medicine, direct the 1880 and 1890 U.S. Census, invent the cardboard punch card for tabulating data by machine, found the New York Public Library, and design the Johns Hopkins Hospital and medical teaching campus with its characteristic architecture. iii Only two seem to have been manufactured iv A frog is a fastener for garments made usually of braid in an ornamental loop design[38p262] v Regulations for enlisted men’s uniform in the Revenue Service appeared in 1834[39].


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vi A similar practice was also used by the U.S. Army. Until 1872, Army medical doctors were identified by the Old English Letters MS (originally for Medical Service) on their epaulettes. Knots with the letters MD (for Medical Department) replaced the epaulettes after 1872 and remained in use until 1890[40] vii The U.S. Army also rejected the Geneva cross since it was the national symbol of Switzerland[40] viii This practice ended on 30 April 1832 when Navy officers in the Revenue Marine had to choose between the two naval services[39,41,42]. ix Marine hospital officers also examined pilots for the Steamboat-Inspection Service, surfmen and keepers for Life Saving Service, and immigrants for the Immigration Bureau[43,44]. x In 1881, the Marine Hospital Service published the Handbook for the Ship’s Medicine Chest[45] xi The furnishing of “medical and hospital care and making medical examination” (p. 17) to personnel of the Coast Guard was a duty imposed by law on the Public Health Service in the 1944 Public Health Service Act[46]

cultural and historical influences on the uniforms and ... · to as the barbary pirates. in 1801,...

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