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Mr. ROBERTS. What is the effect of this injection of serum on a patient who has already developed typhoid fever?
Dr. STOKES. Sometimes it adds to the poison. We take the precaution to take the temperature of every man before he is injected. If you added the prophylactic to the poison he already has, if suffering from typhoid, you might harm him very materially. It is not å serum. It is a vegetable organism—the typhoid organism grown on Japanese seaweed-killed by heat and standardized afterwards.
Mr. Roberts. It is not like diphtheria ?
Dr. STOKES. No, sir; the diphtheria antitoxin sometimes has the same effect. I have stopped giving the injection to whole ship’s companies, as was formerly practiced when cases of diphtheria appeared, because diphtheria antitoxin sometimes affects the heart and breathing, produces a sort of asthma, and in some instances death. We now simply protect those who have been directly exposed or who have the diphtheria germs in their throats.
Mr. BUTLER. Has the Army adopted this method ?
Dr. STOKES. Very good success. It was used in South Africa and in India some years ago with very convincing results. I was talking with a fleet surgeon the other day, and he said that they had simply lost sight of typhoid in the fleet, that they do not think about it any more.
Mr. ROBERTS. The officers and men do not like it very well ?
Mr. ROBERTS. You speak of the needs of the corps as to additional numbers, and say that you should have 400 ?
Dr. STOKES. To properly officer the ships and stations we should have that number.
Mr. ROBERTS. If the number were increased under existing conditions it would not help you, because you can not fill the present vacancies?
Dr. STOKES. No, sir. To me it is a very grave situation. It is not merely a question of treating the sick; there are other important considerations. I think the department realizes the seriousness of the situation, and there is a conscientious inclination to help us out. It is simply a question of determining how best to do it. I do not want to ask for anything unreasonable. I think that something on the square-deal basis for all would appeal to all hands.
Mr. ROBERTS. What is your idea as to grade? Your directors have the rank and pay of captains ?
Dr. STOKES. Yes, sir.
Dr. STOKES. My idea would be to give us the same percentage in grade as the line.
The CHAIRMAN. Your proposition is to incorporate the Medical Corps into the amalgamation?
Dr. STOKES. Practically that.
Mr. ROBERTS. You would have a certain percentage of your directors rear admirals?
Dr. STOKES. Yes, sir; the same percentage as the line.
Dr. STOKES. We have that now. The question is whether or not they should have the title.
Mr. BUTLER. I should have said title
Dr. STOKES. I have always clung tenaciously to the title "doctor," but if a situation arises where in a military establishment this title would tend to discredit me, then I feel that I should have a military title, such as "rear admiral, Medical Corps." It is not with any idea of getting something that does not belong to me or sailing under false colors. That is the way most of us feel. We feel proud of our professional title, but if that tends to discredit us in a military establishment, then, I think, we should have military titles and all that goes with those titles.
Mr. ROBERTS. According to your view, there would be a certain time in the life of a surgeon in the Navy when he would reach the rank of captain and be a captain in the Medical Corps ?
Dr. STOKES. The same as in the Army. Mr. ROBERTS. What is the title they have? Dr. STOKES. Colonel, Medical Corps, United States Army. Mr. ROBERTS. Why is not that the case now? Dr. STOKES. In the Navy ? Mr. ROBERTS. Yes, sir. You have the title and rank? Dr. STOKES. My title, for instance, is surgeon general, not rear admiral. I have the rank but not the title.
The CHAIRMAN. The medical directors have the rank of captain ? Dr. STOKES. Yes, sir. They have not the title.
The CHAIRMAN. Are they not designated as captains, Medical Corps ?
Dr. STOKES. No, sir.
The CHAIRMAN. What improvement on the personnel and encouragement you were speaking of would this running-mate bill which we have acted upon in the committee and which, I believe, is on the calendar, providing promotions for the Staff Corps with the running mates in the line, bring about?
Dr. STOKES. I have been rather quiescent in regard to that bill for the reason that I feel that the bill will help a great many deserving officers, but I do not think that any bill should be called a runningmate bill where two officers run up to a certain point and one stops · short and the other keeps on running. That is the way I feel about it. The bill would hold up the promotions of certain junior officers from 12 to 14 years and I think they should have the same promotion as the line in the upper grades to make up for this.
The CHAIRMAN. They run up together to a certain point? Dr. STOKES. Yes, sir. Then the line goes two grades higher. The CHAIRMAN. To the grade of rear admiral? Dr. STOKES. Yes, sir. The CHAIRMAN. The Surgeon General thinks that the ranks of admiral and rear admiral of the upper and lower nine should be open to the Medical Corps ?
Dr. STOKES. Yes, sir. In other words, we should all have the same. It would lead to contentment in the service, and I do not think there ought to be any serious objection to it anywhere.
The CHAIRMAN. In the appropriation for 1913 of $430,000, will you have a surplus or a deficiency?
Dr. STOKES. Judging from our expenditures last year, it would appear that we would have a deficit of at least $30,000 and possibly
more. We are struggling to keep our expenditures down in order to make the deficiency as little as possible, and in some cases I have felt that we are really crippling the sick. We have taken requisition after requisition and slashed them and cut them, trying to keep as close to this amount as possible. I think we shall possibly have a deficit of $50,000.
The CHAIRMAN. You will have 4,000 men additional under the bill of last year who will be enlisted and which you did not have during the whole of the year 1913 ?
Dr. STOKES. That will add some. We estimate that it costs the Medical Department about $7 a year to care for a man, and that would be $7,000 for a thousand men.
The CHAIRMAN. Does the Medical Department take care of the sick in the Marine Corps ?
Dr. STOKES. Yes, sir.
The CHAIRMAN. Can you put in the hearings an itemized statement showing the necessity for the increased appropriation of $80,000, which is asked for here-the items which will compose it?
Dr. STOKES. Yes, sir. Fifty thousand dollars of that apparent increase can be accounted for by the two items mentioned in the note at the foot of page 75 of the bill; i. e., $30,000 for increased medical supplies and $20,000 for original outfits for 2 battleships, 8 destroyers, 9 submarines, 2 colliers, 2 gunboats, and 2 submarine tenders.
Twenty thousand dollars will be required for pay of additional civil employees when the three New England hospitals are placed in commission.
Ten thousand dollars or more will be needed for typhoid and other prophylactic and preventive treatment, already explained in this hearing:
Of course you understand the hazard of making an estimate of expenditures a whole year in advance, where the activities are so varied as in the naval service and where the unexpected so frequently happens, but the foregoing is as nearly true as I can calculate at this time.
The CHAIRMAN. The next item is “Contingent, Bureau of Medicine and Surgery," and the language is the same, except that the appropriation is increased from $97,000 to $142,000. The note, taken from the estimates, states that:
To provide for the general expense incident to the 4,400 enlisted men authorized by the naval act for 1913, $7,000; for dental outfits (about 15) not provided by the naval act for 1913, $8,000; for dental supplies, other than original outfits, $30,000.
What are the 15 dental outfits?
Dr. STOKES. The law provides for a dental corps of 30 acting assistant dental surgeons. The act of 1913 provided for 15 dental outfits. We estimate that these 15 outfits will actually average about $500 apiece, and in order to provide outfits for the balance of the 30 acting assistant dental surgeons we are asking for $8,000. That is at the rate of practically $500 an outfit. We have calculated that it will be necessary to allot to each dental surgeon $1,000 a year for dental material. That would be roughly $2.50 a day for material expended for those requiring dental attention, and I think that is rather a modest and probably an underestimate. That totals $30,000.
Mr. ROBERTS. What do you use in the Navy for fillings? Dr. STOKES. The sort of filling we would probably use is the simplest kind of amalgam.
Mr. ROBERTS. No gold ?
Dr. STOKES. No, sir.
Dr. STOKES. No, sir; only the work absolutely necessary to preserve the teeth and maintain health.
Mr. ROBERTS. You do not attempt to supply missing teeth?
Dr. STOKES. Not unless it is absolutely necessary to maintain health.
Mr. ROBERTS. Is much of that done?
Dr. STOKES. I do not think there is any of it done. I do not know of any. That point is one which we have to deal with very carefully. There is plenty of opportunity for all sorts of things to
in. My idea is to make the rule hard and fast that nothing but the simplest kind of work to conserve health and to avoid disability through destruction of the teeth or infection shall be done.
Mr. BUTLER. You want to avoid the toothache?
Mr. ROBERTS. Can the officers or men, by paying for it, have that work done?
Dr. STOKES. We have not considered that. On the Relief, when we were going around with the fleet, the dentist, a hospital steward, charged for special work. In Honolulu I went ashore and consulted a number of prominent dentists as to what was a fair price for certain classes of work. I realized that these men, the makeshift dentists, were getting a lot of privileges which they did not get on shore, and so I shaved the prices down so that those who wanted special work done might get the work done fairly well at a reasonable price.
Mr. ROBERTS. I have noticed many of the men with gold work and gold teeth, and I wondered if they got it through the regular service or whether they got it outside or how it came about.
Dr. STOKES. That goes with the old spirit of the bluejacket to go ashore and get a heavy watchchain or a ring or get himself tattooed. Possibly some feel that if they can put gold in a conspicuous place in their mouths they have acquired an asset. I do not mean to say this to the discredit of the bluejacket. I have too much respect for him.
Mr. Roberts. They do not get that in the service?
Dr. STOKES. No, sir; as far as I know, no. We do not provide the materials.
Mr. ROBERTS. Do the dental surgeons carry gold privately so that they can do the work?
Dr. STOKES. In the case of the men on the Relief, yes, sir. We have not got the new corps under way yet. Our first examination takes place Monday, when we have some 21 men coming before the board.
Mr. BUTLER. How many do you expect to have?
Dr. STOKES. There was no restriction as to the number. Of course a good many of these will fail physically and, perhaps, some mentally.
Mr. ROBERTS. How many automobile ambulances have you in the service now?
Dr. Stokes. We have one here, one in Philadelphia, one in Boston, one at Las Animas, and one at Norfolk.
Vr. ROBERTS. Are they all the same make ?
Dr. STOKES. The White steamers cost between $5,000 and $6,000. The last type cost $2,200.
Jr. Roberts. What is the one here in Washington?
Dr. Srokes. It is about six months old. It has an advantage over the White steamer in that the White steamer in an emergency takes five or six minutes to get underway. It has to be warmed up. The Cadillac operates with a self-starter and you can drive off without delay; it is very much lighter, thus saving the expense. The White engines have given excellent service.
Vr. Roberts. The Cadillac is lighter?
Dr. STOKES. Yes, sir; I consulted with a carriage maker here in planing the body and we cut the weight well down.
Mr. ROBERTS. Is it a four-cylinder machine?
Dr. STOKES. Yes, sir. I said we had a motor ambulance at Las Animas. It has been condemned and is no longer in use. We have there a run of 7 miles.
Mr. ROBERTS. What make of motor have you there?
Dr. STOKES. I feel that we ought to have one at New York, for instance, one at the Great Lakes, one at Puget Sound, and one at Mare Island. There is a great saving in horses.
Mr. ROBERTS. How many horse ambulances have you? Dr. STOKES. We have a horse ambulance at almost every station. We find that we must have them to supplement the motors in case of mishap.
Mr. ROBERTS. You keep the horse ambulance at the same station where you put in an automobile ambulance?
Dr. STOKES. Yes, sir.
Mr. ROBERTS. They used to have a horse ambulance at Boston, and I wondered if you still kept that.
Dr. STOKES. We keep the horse ambulance. We are building & garage to house the White steamer there.
Mr. ROBERTS. You still use both?
Mr. ROBERTS. What is the relative cost of upkeep between the horse ambulance and, say, the Cadillac ambulance?
Dr. STOKES. That can be determined. I can not say.
Mr. ROBERTS. What is the original cost of a horse ambulance outfit?
Dr. STOKES. As I recollect, between $600 and $700 for the ambulance, and horses to-day cost about $400.
Mr. ROBERTS. That is about $1,000?