Titus M. Coan, M.D.

U.S. Navy Assistant Surgeon Application

 

By Norman L. Herman, M.D., PhD.

The following is a dictated translation of the hand-written application to the U. S. Navy Examination Board during the Civil War by a civilian physician/surgeon for a position as a medical officer in the Federal Navy or for promotion to Assistant Surgeon by an Acting Assistant Surgeon.  The actual applications are in the possession of the author and presented to enlighten the general public and other researchers as to the education process before and during the Civil War, the personal history of the applicants, as well as to show their personal level of medical knowledge in answering the questions asked by the Navy Board of Examiners.  (Some applicants failed to pass and did not serve or served in the Union Army.)

This written presentation was first of a part of a two-part exam consisting of a written exam and an oral exam.   Many of these applications are rich with highly detailed medical content offering an interesting perspective on the medical knowledge and practices of the period.  A broad sampling of these exams is presented to give you a 'picture' of the type of applicant being examined and admitted to or rejected by the Federal Navy in 1863.   Much more detail on the individuals and their personal and naval history will be presented in a forth-coming book by Dr. Herman.

(The actual written exam photos are available, but not presented on these pages due to the size of the files.  An example of a hand-written exam is on the 'List of all Applicants' page)

If you have additional information or images for any of these doctors, please contact us.

A list with links to all applicants in this survey of U.S. Navy Applicants for 1863

Example of a handwritten exam given by the Navy Examination Board

 


Applicant: Titus M. Coan, M.D.

  

To the Board of Naval Surgeons,

U.S. Naval Asylum, Philada:

                                                         

I have the honor to state, in conformity with the requirement of the Board, that I was born on the 27th day of September, 1836, in the town of Hilo, on Hawaii, one of the Hawaiian Islands.  At the American schools of those Islands I pursued a course of study identical with the ordinary academic course of similar schools in United States. 

 

In the year 1856 I came to the United States, and during the following autumn entered the Junior Class of Williams College.  I completed the regular course classical, mathematical, and other studies, in 1859; the commenced the study of medicine with Dr. Elijah Harris, of New York.  I was graduated at the College of Physicians and Surgeons in the same city.  Immediately after graduation I was examined as a candidate for medical service in the Hospitals under the control of the New York Commissioners of Public Charities and Correction, viz.: the Bellevue, Blackwell’s Island, Small Pox, and Randall’s Island Hospitals.  In these I spent seventeen months as interne [sic, underlined a different ink], – the greater part of the time at the Bellevue Hospital; and was house-surgeon or house-physician during twelve months of this period.  Surgical and medical cliniques were held almost daily in the wards by professors of the various medical schools of the city.

                      

I took the opportunity, from time to time, of compounding medicines, and of acquiring some acquaintance with druggists’ duties.

                      

I have studied the French and German languages; and while at college I claimed some knowledge of Botany, Geology, and Conchology.

                                          

I am, very respectfully, your obedient servant,

T. M. Coan.

September 29th, 1863.                                             

 


Questions by the Board:

 

Questions to be answered in writing, by Dr. Titus M. Coan.

1.  What are the different means of arresting hemorrhage?

2.  What is hydrocele, and what is the diagnosis?

3.  Give a description of Dislocation of the thigh on the Dorsum Ilii, + mode of reducing by manipulation?  [sic]

4.  What is cinchona – describe it – giving its source, nature, preparations uses etc – write a prescription without abbreviation.

5.  What is the composition of alcohol + describe chemically the process by which it is obtained from corn.

6.  What is the sense of hearing?  Describe the parts involve + the properties and action of the air in audition.

7.  Describe the deep perineal fascia.

8.  What are the causes, symptoms, lesions, + treatment of Asiatic Cholera?

9.  What are causes, symptoms, lesions + treatment of Puerperal Peritonitis?

 


Answers by Coan:

  

1.  The different means of arresting hemorrhage may be divided into I. Temporary; II. Permanent.

   I  The Temporary means are (a) manual pressure – (b) pressure applied by bandages and compresses (which may also be a permanent means when the hemorrhage is moderate in amount) – (c) the tourniquet.

   II  The Permanent means are (a) the ligature, applied to the proximal or to both the distal and proximal side of the arterial wound - (b) torsion, in the case of the smaller arteries – (c) the actual cautery - (d) styptics, applied externally or internally – (f) cold – (g) exposure to the air.

     

2.  Hydrocele is a serous effusion into the tunica vaginalis testis.  It is diagnosticated from hernia by its gradual enlargement from below upwards; by its less rapid development; by its irreducibility; by the lack of a communication of impulse to the tumor when the patient coughs; by its pyriform shape, with larger extremity downward; and, most certainly, by its translucency when held between the surgeon’s eye and a candle, in a darkened room, in such a manner as to render the scrotal integument tense.

       

From cirsocele its diagnosis is similar.  From haematocele it presents the same points of difference, excepting in its shape.  From syphilitic disease of the testis, whether constitution or local, and from malignant invasion, it can be discriminated by the softer feel the tumor, but the absence of any high degree of sensitiveness in it, and by attention to the history of the case, as well as to the 3d, 4th, and 6th points enumerated in the diagnosis from hernia.

     

3.  In dislocation of the thigh on the Dorsum Ilii the symptoms are (a) shortening of the length of a limb, from 1 to 2 inches in extent; (b) eversion [“x” mark and underlined] of the foot; (c) adduction the limb ports the opposite one the; (d) nil a complete loss of power to move the limb.

     

To reduce this dislocation by the method of manipulation, the patient should first be anaesthetized to an extent sufficient to produce complete muscular relaxation.  The surgeon should then flex the thigh upon the body, carrying the knee inward and upward, or, in general, following the direction which presents the least obstacle to flexion.  Upon making a moderate oscillating movement of the thigh the head of the bone will now return to the acetabulum with a distinct snap, the sensation of which is not easily confounded with any other.  Perfect rest in bed for a couple of weeks or more should now be directed.  A splint is not usually necessary to the cure.

       

4.  Cinchona is the bark of various species of the C. Calisaya, a South American tree, of which a large number of species and of varieties have been described by Humboldt and later explores.  The usual commercial varieties of cinchona are the red and the white [“x” mark and underlined], of which the chemical composition differ slightly; but both contain those vegetable alkaloids which are among the first in value known to the Materia Medica, - Quinia and Chinchonia.  Of these the former is the most potent, and its disulphate is by far the most extensively used preparation of the drug.  Its effects upon the system are those of a simple bitter tonic; but it also possesses, in a marked degree, the power of controlling those diseases in which periodicity is a characteristic element, and which generally depends upon miasmatic poisons for their development in the human subject.  Quinine possesses also an almost certain power of prophylaxis against these diseases, when properly administered (Trans. N.Y. Med. Soc. 1861).  Taken in overdose, it induces the condition termed cinchonism, – characterized by an excited state of the arterial circulation, by ringing of the head, and by impaired sight and hearing.

        

A convenient form of administering quinine, in combination, as a tonic, is the following

    Recipe

                 Quiniae disulphatis

                 Ferri Sulphatis,   ana,                                    grana viginti;

                 Extracti Vernicae Trucis [?, unclear]           grana quinque;

                 Misce. Fiat massa in pilulas viginti dividenda.

                 Signa – Capiat unum, ter in die.

          

5.  The chemical composition of Alcohol is C4H6O3; it is obtained from corn by subjection to the successive processes of saccharine, acetoris [unclear], and vinous fermentation, and from the product of the last it is separated by distillation and rectification.

            

6.  The sense of hearing is a reception of impressions of sound by the organs and the faculties which they are designed to affect.

                    

The parts involve are the External Ear, or Concha; the Middle Ear; and the Internal Ear, or Labyrinth.

                    T

The External Ear consists of a cartilaginous expansion for the convergence of sound toward the meatus auditorius; and comprises Pinna, Tragus, Antitragus, and Lobe

                     

The Middle Ear consists of the Meatus, Tympanum, and Ossicula Auditis, which include the Incus, the Malleus, + the Stapes.

                       

The Internal Ear consists of the Labyrinth, a complicated system of osseous channels of which the function is imperfectly understood; and is in near relation with the Eustachian tube, a conical canal, having its larger extremity directed anteriorly to the posterior nares.

                        

In audition the tympanum and ossicula auditis are thrown into vibration which correspond in intensity and in duration with those of the air which produce them.  The pitch of the resulting sound, as recognized by the sense, is exactly determined by the number of these vibrations in a second, and is constant for each number.  The quantity of these vibrations determines the character of the sonorous body.

          

7.  The deep perineal fascia extends transversely across the floor of the perineal space, underlying the muscular structures of the region – the acceleratori urinae, the compressor urethrae, the transversus perinea; and is encountered after these in the operation of perineal section.

  

8.  Asiatic cholera is considered by some writers to have its cause in the presence of minute floating sporules of vegetable origin which fill the atmosphere of the infected region; and by others to be excited by deleterious gases diffused throughout it; but no satisfactory theory, to my knowledge, has been announced.  The attack is sudden; there is great weakness and prostration, often accompanied by alarm; watery stools are frequent.  This formative stage, if not checked in its progress soon passes into the colliquative stage; the surface is cold and moist; the face has a pale, haggard, and anxious look; the discharges assume a peculiar character which has procured for them the name of “rice-water dejections”; the other symptoms deepen; and death, often preceded by delirium, closes the scene.

             

The treatment is infinitely varied; but the most approved plans advise the exhibition of mild astringents and of simple nutrients during the first or formative stage; and of stimulants and tonics during the later stages.  There is no very satisfactory treatment.

         

9.  The causes of Puerperal Peritonitis are (a) The poison of decaying animal substances introduced into the circulation of the mother, either from without or from retain portions of the uterine contents – (b) An infection poison which lurks in fomites or in the air, and is thought to be of a nature similar to the former.  The symptoms are acute tenderness of the abdomen, the febrile condition, chills, suppression of the lacteal and of the lochial discharge, mental agitation, and insomnia.  The lesions are those of acute inflammation of the peritoneum, is of one or more of the pelvic organs; the inflammation varies widely in its locality, the amount of fibrine in the blood is diminished.  The treatment is (a) Warm fomentations or turpentine stupes to the abdomen; (b) Opium, in quantity almost unlimited, except by the effect it produces upon the disease. – I have seen the Tr. Virat. Virid. exhibited in Dr. B. F. Barker’s service at Bellevue with results hardly inferior to those of opium.

                                                        

T. Munson Coan

11 Lafayette Avenue, Brooklyn, N. Y.

 


Certificate of Physical Capacity

                    

I declare on honor that my health at this time is good and robust; and that, to the best of my knowledge and belief, I am free from any accidental or constitutional defects, and without any predisposition to Epilepsy, Phthisis, Gout, Apoplexy, or chronic disease of any kind.  I am not at present affected with Varicocele, disease of the urinary organs, Hernia, or Hemorrhoids; nor am I aware that there is anything hereditary in my constitution which would hereafter be likely to incapacitate me, for the arduous duties of a Medical Officer of the Navy.

                

All my organs of sense are without imperfection.

 

T. M. Coan

Candidate for the office of Assistant Surgeon in the Navy of the United States

U.S. Naval Asylum, Philadelphia.                

September 29th, 1863.


A list with links to all applicants in this survey of U.S. Navy Applicants for 1863

Example of a handwritten exam given by the Navy Examination Board