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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
Page 2 of 31
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
Cultural and Historical Influences
Page 3 of 31
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.
Cultural and Historical Influences
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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
Cultural and Historical Influences
Page 5 of 31
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.
Cultural and Historical Influences
Page 6 of 31
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
Cultural and Historical Influences
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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
Cultural and Historical Influences
Page 8 of 31
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.
Cultural and Historical Influences
Page 9 of 31
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
Cultural and Historical Influences
Page 10 of 31
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
Cultural and Historical Influences
Page 11 of 31
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.
Cultural and Historical Influences
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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
Cultural and Historical Influences
Page 13 of 31
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.
Cultural and Historical Influences
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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.
Cultural and Historical Influences
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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
Cultural and Historical Influences
Page 16 of 31
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).
Cultural and Historical Influences
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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.
Cultural and Historical Influences
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Public Health Service (c. 1900) Revenue Cutter Service (1898)
Navy (c. 1908)
Figure 4. Service suite-undress uniforms c. 1900
Cultural and Historical Influences
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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
Cultural and Historical Influences
Page 20 of 31
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).
Cultural and Historical Influences
Page 21 of 31
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
Cultural and Historical Influences
Page 22 of 31
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
Cultural and Historical Influences
Page 23 of 31
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
Cultural and Historical Influences
Page 24 of 31
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.
Cultural and Historical Influences
Page 25 of 31
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.
Cultural and Historical Influences
Page 26 of 31
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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].
Cultural and Historical Influences
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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]