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Dr. STOKES. About $1,500; two horses and harness.
Mr. BUCHANAN. You mean $400 each?
Dr. STOKES. Yes, sir.

Mr. ROBERTS. Would it not be a good idea to look into the upkeep and, if more economical, to do away with the horse ambulances?

Dr. STOKES. I think it would. We should then require two motors.
Mr. BUTLER. Is the driver of the ambulance a hospital steward ?
Dr. STOKES. No, sir; a civil employee.
Mr. ROBERTS. How about the chauffeur ?

Dr. STOKES. We usually develop him from an ambulance driver. At Boston, for instance, we had a very reliable man, a competent man, who took 'lessons in automobile engineering in anticipation of the arrival of this motor ambulance; as he develops he will become a very valuable man and his pay will probably be increased.

Mr. BUTLER. What are you authorized to pay him under existing statute ?

Dr. STOKES. There is no fixed pay.

Mr. ROBERTS. How does the pay of a chauffeur compare with the pay of a driver of a horse ambulance ?

Dr. STOKES. It is higher.
Mr. BUTLER. He gets about $75 or $100 a month?
Dr. STOKES. $60, $65, or $70.

Mr. BUTLER. Can you always depend on your motor machine and dispense with the horses?

Dr. STOKES. Not always; no, sir.
Mr. BUTLER. Would it be safe to do so?

Dr. STOKES. I do not think it would be safe to have a single ambulance of the motor type.

Mr. ROBERTS. At all the stations you have two now?

Dr. STOKES. One motor and one horse ambulance at the stations mentioned.

Mr. ROBERTS. You have a horse ambulance at all the stations?
Dr. STOKES. At all large stations.
Mr. ROBERTS. At some stations you have more than one?

Dr. STOKES. At some stations we have a motor and a horse ambulance.

The CHAIRMAN. The next item is "Bringing home the remains of officers, Navy Department.” The language is the same, and you are asking for an increase of $2,000 ?

Dr. STOKES. Yes, sir.
The CHAIRMAN. Why is that?
Dr. STOKES. It is all a question of increase of the personnel.

The CHAIRMAN. Has the increase of the personnel increased the number?

Dr. STOKES. It has in a measure, but the number dying abroad has been increased through the cruises abroad. Any big fleet, such as the cruise to the North Sea and the cruise the year before, taking a large number of men abroad, there are always a certain number of deaths, and it is the remains of those people that are brought home by this appropriation.

The CHAIRMAN. Did you have any surplus or deficiency out of the $15,000 that has been appropriated, or will you have?

Dr. STOKES. If we do not secure an increase this year, I think we will not be able to meet our obligations.

Mr. ROBERTS. Do you call Guantanamo or down in the Caribbean abroad?

Dr. STOKES. Yes, sir. Panama and the Philippines would also come under that construction.

The CHAIRMAN. I notice you change the caption. It has been reading “Transportation of remains," and you have it "Bringing home the remains of officers, Navy Department.” The language in the paragraph reads:

To enable the Secretary of the Navy, in his discretion, to cause to be transferred to their homes the remains of officers and enlisted men of the Navy and Marine Corps.

Why change the caption ?

Dr. STOKES. The change was made to the title given the appropriation by the Treasury Department in the Digest. It is a matter not under my cognizance.

The CHAIRMAN. The caption is limited to officers, but the body of the legislation provides for officers and enlisted men. Is there any good reason for a change?

Dr. STOKES. I can not see any; I do not know of any. This is not in any sense restricted to officers. In fact, it not only includes officers and enlisted men of the Navy and Marine Corps, but may be used for the transportation of the remains of civilian employees as well. The title in the Estimates is “Bringing home remains of officers, etc., Navy Department." The addition of the "etc.” will make the title less ambiguous.

The CHAIRMAN. Doctor, I want to invite your attention to pages 63 and 64 of the bill, where appears the item "For the purchase of the necessary land for the location of the Naval Academy dairy, at some point in the vicinity of Annapolis, Md., convenient for communication and for the transportation of dairy products," etc., which is the new dairy project going on there. Have you any statement to make or any information which you can give the committee as to the past operation of the dairy and the result and effect, and also as to the proposed scheme for the future?

Dr. STOKES. I have practically no information on the subject, except what I have gleaned in an unofficial way after the original plan was under contemplation and consideration. I know the present site, across the county road from our hospital building. The general report is that the dairy is run in a sanitary way; that it has the help of the representatives of the Bureau of Animal Industry, and the herd is in good condition.

The CHAIRMAN. Have you taken any official action with reference to investigating the milk or the health of the midshipmen?

Dr. STOKES. Not since the outbreak of typhoid, about two years ago. We then went very thoroughly into the milk supply, I sent my representatives up into Pennsylvania to examine a supplemental supply, and we had the regular milk supply for the academy looked into as well.

The CHAIRMAN. Where was the milk obtained at that time which was supplied to the academy? Was it purchased from the farmers adjoining the academy or was it purchased from some other source away from the vicinity of the academy?

Dr. STOKES. My recollection is that there was a contract entered into with a man not far from Annapolis to supply the bulk of the

milk, and at one time there was a shortage and he was unable to meet the demands of the academy and he had to supplement the supply by going elsewhere; and it was about this time that they had some sick through typhoid and we made an investigation of the sanitary condition of the different dairies, and I imagine that is what initiated the dairy project or had much to do with it.

The CHAIRMAN. What did you ascertain officially when you made that investigation as to typhoid and the milk supply?

Dr. STOKES. We found that the milk which was being supplied was not properly safeguarded, as we understand the sanitary method of handling milk to-day. There was no positive demonstration of typhoid contamination. There was some demonstration, as I recall, of a contamination that should not have been there; in other words, dirt.

Mr. BUCHANAN. Are the men in the Navy troubled much with rheumatism?

Dr. STOKES. I think not. There are a certain class of men who work under high temperatures and who perspire freely who, if they are not properly safeguarded, are apt to suffer from what is commonly called rheumatism; that is, muscular inflammation.

Mr. BUCHANAN. What is the remedy for that?

Dr. STOKES. We are very careful to make them shift into dry clothing and rub down before they clothe themselves. True rheumatism, as we understand it to-day, is usually an infection through the throat, the tonsils, and the lodging of the germs in the joints that causes articular rheumatism. Muscular inflammation, a stiff back, and aching bones often come from exposure, as I say. The fireroom force, the people in high temperatures, are the most exposed.

The CHAIRMAN. That form of what is called rheumatism, inflammation and soreness of the muscles, is not rheumatism poison ?


Mr. BUCHANAN. If it is neglected, or a man does not take the proper care against rheumatism, does that result at once, or is it liable to come in years afterwards?

Dr. STOKES. If it were due to exposure, it would be likely to come at that particular time. The cases that come later on are due oftentimes not only to neglect, but indiscretion, the gout type and the uric-acid type.

Mr. ROBERTS. Are the midshipmen given the typhoid prophylactic?

Dr. STOKES. Every soul in the Navy under 45 years of age who had not had typhoid, 62,000 people, including the whole personnel of the Navy, Marine Corps, and some civilian employees, had three of these injections, and of that number only one mild case developed. Mr. BUCHANAN. What is the effect at the time of the injection?

Dr. STOKES. Within the first 24 hours there is a little reaction, a little fever, and within the next 24 hours there is a little local soreness, and then it fades away.

Mr. ROBERTS. How long does the fever run?
Dr. STOKES. Not over 24 hours, usually. Sometimes overnight.
Mr. ROBERTS. What is the interval between the injections ?
Dr. STOKES. Ten days.

The CHAIRMAN. Have you any other matter that you wish to call to the attention of the committee? If so, we will be glad to hear you.

Dr. STOKES. I thank you, sir. I have spoken at length of the shortage in the Medical Corps. I want to speak of the Medical Reserve Corps. We can not go into battle without this body of officers which Congress has authorized, and my aim has been to bring into the Reserve Corps the highest type of men possible, and there are many who stand ready to come in. It seems to me that to apply their title, “assistant surgeon, as required by the law, to a professor of surgery, say, at the Jefferson Medical School or 'the University of Virginia or the New York College of Physicians and Surgeons or Harvard—to apply the title "assistant surgeon, United States Navy, Medical Reserve Corps," is inappropriate, as it implies that there is another grade in the Reserve Corps. It seems to me if a bill could be introduced which would clearly define their rank as junior lieutenant and their title surgeon, Medical Reserve Corps, United States Navy, it would dignify the position, and I think it would be an attraction. The department appears to be absolutely in favor of it; it seems to me desirable.

The CHAIRMAN. Is not the same language used in the Army? Dr. STOKES. Their title is a little different, "first lieutenant, Medical Corps."

The CHAIRMAN. Are they not called “assistant surgeons'

Dr. STOKES. "First lieutenant and assistant surgeon, Medical Reserve Corps,” but “assistant surgeon, United States Navy,” does not look to my mind--and that seems to be the opinion in the department-attractive. The other would make a more dignified title.

The CHAIRMAN. You want to strike out the word 'assistant”? Dr. STOKES. And keep the rank as it is; yes, sir.

Mr. BUTLER. You have already spoken to us about the Reserve Corps ?

Dr. STOKES. Yes, sir.

Mr. BUTLER. As I recall it, it will be composed of surgeons and of men in the profession entirely outside of the Navy?

Dr. STOKES. Absolutely.

Mr. BUTLER. And without charge or cost of any kind to the Government?

Dr. STOKES. It will bring a great deal of interest and many prominent people to the Navy.

There is one other matter which I would like to speak of, if I may, along the line of preventive medicine. I would like to ask later on for a dietician, such a person to be a part of the Nurse Corps, female, who is trained in the preparation of foods, etc. While we try to exercise all due economy in running the hospitals, I think there is a lot of waste. I know of a person who was appointed in a big civil hospital who brought the commissary expense down to 33 per cent of what it had been before and the service was better.

The CHAIRMAN. A saving of 664 per cent ?

Dr. STOKES. Yes, sir. I think such a person to visit the hospitals and train the nurses and cooks, teach them how to buy, and the economies of serving and looking out for waste, would save her salary many times over during a year. The CHAIRMAN. You do not want but one for the whole Navy?

Dr. STOKES. Yes, sir. My idea was to have this person stationed here for three months, go to the Annapolis hospital for three months, the Philadelphia hospital for three months, the New York hospital

for three months, and then the Boston hospital for three months, and so on.

Mr. BUTLER. She would be an instructor?
Dr. STOKES. Yes, sir.

The CHAIRMAN. State to the committee the result of sanitation in the field.

Dr. STOKES. I mentioned that matter last year, but I did not mention it by name; I spoke of the sanitation in Panama, but not by noting the place.

It is believed that Camp Elliott is now not only the most healthful spot on the Isthmus, but as healthful as most towns in the United States. The following figures show the steady improvement since 1906:

Percentage of sick. 1906.

7. 37 1907.

4. 11 1908.

3. 47 1909.

2. 02 1910.

1. 35 1911.

1. 39 These remarkable results could only have been attained with the cordial and conscientious cooperation of the commanding officer in supporting the sanitary recommendations of the medical officer and seeing that they were put into effect.

The committee thereupon adjourned until Monday, December 9, 1912, at 10.30 o'clock a. m.

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