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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.
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 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 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 engagement.
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 gunnery, will be read by the officers and will lead to a better understanding of our mutual relations and responsibilities.
A self-indexing document filing system for health records and returns has been inaugurated in the Bureau. This system, as well as the new health records, clinical cards, and blank forms, is working satisfactorily. The statement of the work done by the Record and Pension Division of the Bureau during the year is shown in the statistical table on page 95.
The sanitary inspection of offices of the Navy Department is done by the medical officers of this bureau. Overcrowded offices have been remedied somewhat, but there is still some evidence of overcrowding and insufficient ventilation.
The detail of a properly qualified medical officer as inspector general of the Medical Department of the Navy, to serve under the aid for inspections, is recommended.
The Naval Medical Bulletin continues to be of great value to the service. It is useful, in that it contains much of professional value to the Medical Corps, enabling them to keep informed of the latest advances in medicine and surgery, and economical, in that it saves the expense of subscription to many medical journals, as reviews of all important articles in current literature are placed in the hands of naval medical officers by means of the Bulletin.
NAVAL MEDICAL SCHOOL.
The Naval Medical School continues to prove an important factor in the maintenance of the efficiency of the Medical Corps. The benefits accruing to the service through the medical officers who are sent out from the school can scarcely be overestimated. The inability to give the usual spring course to surgeons
and passed assistant surgeons, because their services could not be spared, is a source of regret to the Bureau. This spring course is of much value to those officers who are able to attend and thus come in practical contact with the latest advances in medicine and surgery. .
INTERNATIONAL RELIEF WORK.
The necessity for international relief work by the Medical and Hospital Corps of the Navy has been small. Worthy of mention was the excellent work done by medical officers of the United States Navy at Bluefields, Nicaragua, subsequent to the Battle of Recreo.
Following the engagement at La Ceiba, Honduras, officers of the Medical Corps and ambulance parties established a temporary hospital on shore and performed a work of humanity worthy of note and of the best traditions of the service.
This is one of the most important duties to which a naval medical officer may be assigned. It requires experience, nice discrimination, and keen judgment in its performance. Officers who have had the experience of at least one cruise to teach them practically the type of men likely to maintain physical efficiency have been, so far as possible, assigned to this duty.
The scarcity of medical officers has rendered it impossible to detail a naval medical officer to all of the recruiting stations of the Navy and Marine Corps, and the Bureau has made special efforts to obtain the services of experienced and qualified practitioners of good standing, who will act as medical examiners where it is impossible to detail a naval medical officer.
At some of the principal stations civilian examiners have been appointed as acting assistant surgeons after examination and special instruction, and it is believed that the assurance of certain compensation will attract a better class of examiners than could possibly be engaged under the system of paying a small fee for each candidate examined.
It is hoped that the large number of surveys for disability which existed under the old system will be materially reduced.
Strict adherence to the standard table of height and weight should be observed, for experience repeatedly shows that recruits under weight for height are frequently potentially tuberculous.
The enlistment of drug habitués and mental defectives is to be especially guarded against, and a declaration as to the presence or absence of fits, enuresis, drug habit, and insanity should be required of each applicant. This will tend to eliminate the insane recruits and reduce the number of cases of malingering among malcontents.
Based upon reports of medical officers afloat, this bureau believes no transfer of rating from seaman branch to the rating of coal passer should be made unless recommended by a medical officer after physical examination of the applicant for transfer. The laborious duties of a coal passer require a more powerful physique than might be present in a member of the deck force. Recruiting statistics are shown in the table on page 95.
Venereal diseases continue to be the most potent factor of damage to the naval service. During the past year 138,083 sick days were caused by venereal disease alone.
During the past year a system of prophylaxis against venereal disease has been carried out. The Bureau is of opinion that prophylaxis against venereal disease is of value. The decrease in the number of cases of syphilis is striking. It is believed that some form of prophylactic packet, which can be taken by the men and used immediately after exposure, will prove more effective.
That there is not a more marked decrease is due to the more rigorous search for concealed cases; also a more widespread knowledge of the dangers of venereal infections has brought to the surface an increment of hitherto carefully concealed disease. To-day we are obtaining a more nearly accurate admission rate for venereal disease than the statistics of the Navy have hitherto shown.
It is believed that a forfeiture of pay during disability because of venereal disease would tend materially to increase the use of prophylactic treatment offered.
For the further control of venereal as well as other infectious diseases it is recommended that all persons in the naval service, especially those afloat, be examined physically, each quarter, when practicable, and that such examination be provided for by regulation. The medical officer would thus be able earlier to detect incipient diseases, concealed infections, or venereal disease.
Typhoid fever caused 9,471 sick days and 10 deaths during the past year. Typhoid prophylaxis is no longer in an experimental stage, and compulsory vaccination against this disease is believed to be most desirable for all persons under 45 years of age in the naval service, and it is so recommended.
Tuberculosis was the cause of 19 deaths and 11,913 sick days during the year. This does not include the United States naval hospital at Las Animas, Colo., where 25 more deaths occurred. This disease caused the greatest number of discharges for disability during the year.
The prevalence of tuberculosis in the Pacific Fleet has been the subject of special investigation by a board of medical officers. It was found that from 1909 to May, 1911, 50 cases of pulmonary tuberculosis have developed among complements of 6 ships. In addition to these frank cases of tuberculosis, 54 persons have suffered from chronic bronchitis or pleurisy: “Over 75 per cent of the men contracted the disease aboard ship.'
The following recommendations were made by the board: All persons who have been under treatment for tuberculosis shall have at least one year's duty on shore, under medical observation, and shall be examined by a board of medical officers before being sent to sea.
Ships should be disinfected every two years throughout.
In the wing passages leading to the engineer's wash rooms the deck should be covered with cement, to which boot topping is applied weekly. These passages should be well lighted.
Members of the engineer's force should be allowed to go on deck in clean dungarees and should be encouraged to do so.
Loafing and eleeping in the wing passages should not be allowed; they should be kept clear of lockers and other impedimenta.
Wash rooms and locker rooms for the engineer's force should be separate.
Wash rooms should be better ventilated. The deck should have a greater drainage angle and a sanitary type of washbasin should be installed. Cases of chronic bronchitis should be removed from the ship as early as possible.
The importance of the part of the medical officer at the recruiting station in the prevention of this disease is again emphasized.
Among the predisposing causes of the disease among the force afloat are insufficient ventilation (especially when the ships are under way), promiscuous expectoration, and the sailor's habit of frequently sleeping upon a mat on deck, where he would most likely suffer contact with the inspissated sputum.
If tuberculous expectoration should find its way to the deck, unquestionably those sleeping upon the deck would be most likely to suffer contact with the inspissated sputum. Babies crawling upon the floors suffer tuberculous infection (manifested by cervical lymphadenitis) more frequently than adults, who breath in a slightly higher air stratum, and it is believed that the actual lying upon the deck habitually is a menace to the health of the personnel.
In this connection it is interesting to remark the prevalence of tuberculosis among races who live upon mats in their houses, using neither beds nor chairs (e. g., the Japanese).
Tonsillitis was second only to venereal diseases in prevalence during the year, causing 3,121 admissions and 16,445 sick days. There were 1,045 cases in the Atlantic Fleet alone last year. Coincident with shellacking of the decks on some ships is the decrease in the number of cases of tonsillitis, and there is a corresponding increase pari passu