REPORT OF THE SURGEON GENERAL UNITED STATES NAVY. DEPARTMENT OF THE NAVY, BUREAU OF MEDICINE AND SURGERY, Washington, D. C., October 1, 1911. SIR: The health of the Navy during the calendar year 1910 has been good. Neither epidemic disease nor military operations have served to produce an unusual morbidity rate. The year may be regarded as a normal one, considering the mortality and morbidity in the service. The death rate from disease is slightly higher than last year, but there is a marked reduction in comparison with the "average year." The death rate from injuries shows an increase over last year, and is also in excess of the rate of the "average year." This marked increase in the death rate is due to the large number of drownings. A reduction in the total damage from disease and injury in the service indicates an improvement in the general health of the entire Navy and Marine Corps. The damage from injuries is slightly increased when compared with last year, but lower than the average year. The marked decrease in the damage done the service by diseases (compared with both last year and the average year) makes the combined damage by injury and disease less than last year, and certainly much less than the average year. This is shown in statistical Table No. 1, on page 42. ESTIMATES. In obedience to the direction of the department, no estimate for appropriation by Congress for the construction of new naval hospitals has been submitted. Until other provision is made, all expenses in connection with naval hospitals, for enlargement and necessary repairs, will be provided therefor, of necessity, from the naval hospital fund. No appropriation under the title "Repairs, medicine and surgery," was made for the fiscal years ending June 30, 1911, and June 30, 1912, and no request has been made on Congress for an appropriation under that title for the fiscal year ending June 30, 1913. It has been recommended that the appropriation "Medical Department" should be increased to $400,000, to provide (a) for all medical and surgical supplies, ashore and afloat, for the proper care of the sick and injured of the Navy and Marine Corps, and of civil employees of navy yards to whom first-aid treatment is given; and (b) for the pay of all civil employees of the Medical Department at navy yards and naval hospitals. This is the most important of the appropriations made for the support of the Medical Department of the Navy. Under the appropriation "Contingent, medicine and surgery," an increase of $3,000 is recommended, making the appropriation $82,000. The cost of caring for the dead increases from year to year with the growth of the Navy, and $1,000 of the additional sum is for this purpose. With the growth of dental work on board receiving ships and at stations, performed by members of the Hospital Corps for the enlisted force, the expense of dental material is no longer a negligible quantity, and $2,000 is estimated as the cost for such dental material required for the next year. Under the appropriation "Bringing home remains of officers, etc., Navy Department," an increase of $2,000 has been recommended in order to restore the appropriation to its original amount. This appropriation was reduced on the recommendation of the Bureau from $15,000 in the fiscal year 1906. The reduced amount has been found insufficient, and its restoration to the original amount is recommended. This appropriation enables the department to bring home the remains of naval dead to bereaved parents and widows too poor themselves to undertake the expense. The naval hospital fund had its beginning in the act of July 16, 1798, when Congress made provision for the relief of sick and disabled seamen of the Navy and merchant marine. This fund was then known as the marine hospital fund. Its separate existence, however, dates from the act of February 26, 1811. Congress does not contribute for the support of this fund by appropriation as for all other naval purposes. Its sources of revenue are as follows: The hospital tax of 20 cents per month (sec. 4808, Rev. Stat.). The value of one ration per day for each person during continuance in hospital (d) Pensions of persons entitled thereto during continuance in the hospital (sec. 4813, Rev. Stat.). (e) Forfeitures on account of desertion (act of June 7, 1900). Under the authority of section 4810 of the Revised Statutes the Secretary of the Navy has, during the past several years, undertaken the building of the three hospitals at Portsmouth, N. H., Chelsea, Mass., and Newport, R. I., at an approximate cost of $900,000; of additional buildings at the naval hospital, Great Lakes, not provided by specific appropriation, at an approximate cost of $145,000; the renovation of the hospital at Philadelphia, and the enlargement and improvement of the power plant, at an approximate cost of $173,000; the extension of the hospital at Washington, and the construction of quarters and additional buildings, at an approximate cost of $275,000; the erection of three officers' quarters, power house, stable and garage, and nurses' quarters at the naval hospital, Annapolis, at an approximate cost of $115,000. In addition to the foregoing mentioned work, the naval hospitals at Canacao, Las Animas, and elsewhere have been developed and enlarged at a cost of about $500,000, making a total for construction purposes and repairs and improvement of over $2,000,000 outlay without expense to the United States. These large expenditures have been made possible only because of the accumulation of money during preceding years when building opera tions were not undertaken, and when the Bureau received material assistance from Congress through two appropriations aggregating nearly $100,000 annually. Both of the appropriations have been eliminated during the past several years. The Bureau renews the recommendation made in its last annual report for the repeal of the provision made in the naval act for the fiscal year 1910, approved March 3, 1909, diverting from the naval hospital fund money for the transportation to their homes, or places of enlistment, of naval prisoners, and for the purchase of suitable civilian clothing for the same, and that these expenses be made a charge against the United States under the appropriation "Pay, miscellaneous," or "Transportation, Bureau of Navigation." NAVAL HOSPITAL FUND. The condition of this fund is as follows, viz: Balance on hand July 1, 1910... Transferred to credit since July 1, 1910..... Total. Expended since July 1, 1910... $13, 890. 76 1, 239, 762. 68 1, 253, 653. 44 1,253,653. 44 The statement of the cost of maintenance of United States naval hospitals for the fiscal year 1911 is shown in the statistical table on page 92. MEDICAL CORPS. Twelve medical officers were lost during the year by death, resignation, or retirement, and 16 assistant surgeons were commissioned. There are at present 41 vacancies in the corps. The greatly increased activity in the service has operated to enlarge the field of usefulness of the medical officer. I have endeavored to widen the scope of their activities by stimulating interest in the purely naval and military duties, and opening up new fields of work along these lines, such as the sustaining of life in disabled submarines, study and prevention of the harmful effects of the periscope; turret conditions, including personnel and material; the prevention of the effect of big-gun blasts on ears; smoke and powder gas problems; fireroom problems; actual conditions of battle, and first-aid and other drills, in order to keep as many men at their stations as possible during action. The purpose of the Medical Department in battle is to devote its energies toward winning the fight-its duties are primarily naval and military, and, secondarily, humanitarian. The examination of officers for the physical exercise, professional attention to workmen at navy yards, as required by the liability act of May 30, 1908, the increased size and service of naval hospitals, and work incident to the preparation of necessary returns greatly increase the work of medical officers. The maintenance of the health of the personnel, the study of so-called occupational diseases of the Navy, preventive medicine, hygienic needs of the personnel afloat and ashore, the study of disease, the treatment of sick, battle drills, recruiting, acquisition of a working knowledge of the specialties, etc., are enough to engage their constant attention, and they are more actively employed than heretofore. 20986°-NAVY 1911-28 HOSPITAL CORPS. Pharmacists: The number of pharmacists allowed by existing law, namely, 25, is entirely insufficient for present needs. The commissary departments at the larger hospitals are presided over by pharmacists, with marked improvement as regards economy and service, and the Bureau is particularly anxious that this plan be followed uniformly. Enlisted men: The total number of enlisted men in the Hospital Corps on July 1 was 1,138, classified as follows: Hospital stewards, 288; hospital apprentices, first class, 513; hospital apprentices, 337. This number has been inadequate, despite the efforts to stimulate enlistments in this branch of the service. THE NURSE CORPS. The efficiency of the female Nurse Corps has been fully demonstrated by the results attained in the hospitals where they have been stationed. The difficulties of proper ward management and general hospital administration have been materially lessened by this capable body of women. Their activities in the field of instruction of the Hospital Corps have been of material benefit. DENTISTS. The imperative necessity for the establishment of a corps of properly qualified dentists in the Navy has been dwelt upon in previous reports, and experience emphasizes and confirms what has previously been written. THE BUREAU. The distribution of the Bureau's work into several divisions is resulting in a coordination and systematization of the constantly increasing volume of work and an increase in economy and efficiency. During the year the Surgeon General personally made inspections of most of the naval hospitals within the continental limits of the United States; also made an inspection of the facilities afforded by the ships of the Atlantic Fleet for the care, treatment, and transpor tation of the sick and wounded. The establishment of a naval medical reserve corps is again recommended. An effort is being made to render uniform, so far as the types of the vessels will permit, the system of treatment and care of wounded in action. For humanitarian, as well as military reasons, it is highly desirable to evacuate the killed and wounded so soon as possible and to transfer them to medical transports where the wounded may be treated without hampering the fighting efficiency of ships which might be immediately needed for further service. For the rapid evacuation of the wounded, a plan has been developed by which it is estimated that the wounded from each ship of the fleet may be transferred and new sanitary units of personnel and material may be supplied to each vessel if necessary within four or five hours. This plan contemplates one medical transport to care for the killed and wounded of the ships of each division of the fleet, assuming that each division will consist of five fighting ships. The administrative organization of this transport will consist of one naval medical officer in command, having a pharmacist as assistant, with three hospital stewards and six hospital apprentices, first class. Preservation of neutrality requires that these transports be under the Red Cross. This administrative section is to have charge of the records received from the five medical divisions, all official correspondence, and the commissary department. The medical and surgical work will be done by the medical division, which will comprise 5 distinct units, each to consist of 1 medical officer of the regular service in charge, 10 medical officers of the medical reserve corps (if such be established by Congress), or volunteer medical officers, 1 hospital steward, and 50 hospital apprentices. Five units of the above organization will be under the administrative medical officer, and will be designated "A," "B," "C," "D," and "E." The space on the transports will be so apportioned that the wounded from individual ships will be kept together while on board. To each division will be assigned an equal number of the transport's lifeboats, in which to convey the killed and wounded from the fighting ships to which the division has been assigned. Each division will have its dressings (marked "A," "B," "C," "D," "E"), and when the wounded are brought on board the transport they will be assigned to the berthing spaces previously designated for each division. As each of the five units from each transport will have its own distinct organization, dressings, etc., each will be capable of independent action, and should need arise the entire medical department of each ship could be immediately replaced by a fresh medical unit not fatigued by the stress of recent conflict. Two sanitary bases, one on the Atlantic coast and one on the Pacific coast, have been selected, organized, and plans have been worked out in minute detail as to methods of operation, in case of national need. The United States Public Health and Marine-Hospital Service, with its corps of trained sanitarians, stands ready to cooperate with, and under direction of, the Medical Department of the Navy in caring for the sanitation of these bases, thereby leaving the Medical Department of the Navy to care for the large number of men who would probably be wounded in a modern naval engage ment. It is planned that the medical transports shall bring the wounded to these sanitary bases. When the sick and wounded have convalesced sufficiently, they will be transferred to the various naval hospitals as necessity may demand. The recently instituted practice of having first-aid instruction given at least twice weekly by line officers who have been thoroughly instructed by the medical officers will undoubtedly lead to increased efficiency, imparting to the enlisted personnel knowledge which, if promptly applied in time of need, will not only save life, but keep many men at their stations during battle. This continuous instruction insures that all will be thoroughly grounded in principles of first aid—a desideratum unattainable by the methods of first-aid instruction formerly employed. The Surgeon General's article on naval surgery, which is sent out with the confidential instructions promulgated by the director of |