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.

RECRUITING.

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.

HYGIENIC PROBLEMS.

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 sleeping 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 lvmphadenitis) 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

with the wear upon the shellacked deck. On one ship, where wax was tried as a substitute for shellac in dressing the deck, the number of cases of tonsillitis was excessive.

The bubbling-spring drinking device effectually prevents the transmission of communicable disease which is incident to the use of common drinking cups. While many of these devices have been installed aboard ship, the bureau recommends their further installation on ships and ashore at all places under control of the Navy where drinking water is supplied.

Eyestrain.-The effects upon the eyes of prolonged use of the periscope in submarines, the eyestrain incident upon the use of telescopic sights by gun pointers, the effect upon the eye of constantly working below decks under electrical illumination, and the deleterious effect upon the eye of working the powerful searchlights now used aboard ship are all problems which are receiving careful study by the Medical Corps with view to ameliorate, so far as possible, the conditions under which this exacting work must be done, in order that these trained units may be preserved in the service for the purposes for which they are being drilled, viz, to fight.

Effect of gunfire upon the ear.-Again the damaging effect of gunfire upon the hearing of officers and enlisted men is receiving careful consideration. Various devices for the protection of the eardrums are being used with varying results.

The problem of deafness in the service is a serious one, and the elimination, if possible, of damage to the eardrum by gunfire is the Bureau's desire and aim. At present an inexpensive ear device of rubber is being tested to avert damage to the ears, not only from gun blasts, but to prevent the disability resulting from swimming and high diving and also to prevent deafness in boiler makers.

Alcoholism is steadily decreasing in the naval service. One is much impressed with the lessened use of alcoholics among the officers and men of the fleet. In making a comparison between the present time and 20 years ago the difference is very striking. In 1900 the admission rate per thousand was 10.8, in 1905 it was 7.3, and in 1910 the admission rate per thousand is 5.9.

Prolonged tours of duty in the Tropics prove ultimately deleterious to the personnel. Monotony and nostalgia incident to such service produce nervous effects, which can not be regarded as negligible. Service under such conditions is apt to be perfunctory and halfhearted and too frequently results in nervous disorder or infraction of regulations, due rather to mental state than to criminal intent.

Clothing of the personnel serving in the Tropics requires consideration. The white uniform in active service ashore is too conspicuous, affords too ready a target, and is too easily soiled. A khaki, olivedrab, or slate-colored washable uniform and headdress would be more serviceable.

The present headdress for officers and men serving in hot climates is far from ideal. It affords no protection to the head and neck from the rays of the sun. A campaign hat, a helmet, or a straw hat would afford necessary protection and save officers and men from the dangerous effects of prolonged exposure to the rays of the tropical sun. Protection against insects is important. Galleys, mess halls, pantries, and all places where food is present should be thoroughly

screened. Flies, mosquitoes, roaches, ants, and other insects, as well as vermin, should be the objects of an unrelenting war of extermination. Sick bays and rooms containing infectious cases should be screened if flies or mosquitoes are prevalent.

SPECIAL DISEASES.

Special diseases will be considered under the following heads:
1. Affections which depend upon probable predisposition.
2. Affections depending upon the environment of recruits.
3. Affections depending upon ship life.

4. Affections depending upon exotic exposure.

5. Affections depending upon special conditions of service.

1. Affections which depend upon probable predisposition.-Flat foot is a condition which has shown a marked increase in the service during recent years.

The admission rate for flat foot during 1910 was 3.88, as against 2.66 during 1909. The high invaliding rate (2.59) for this affection is an increase of 0.72 over that of last year. It is believed that the exercises which have been recommended will do much toward preventing flat foot in the service, as they will greatly strengthen the weak parts.

The increasing number of invalidings for this condition presents a perplexing problem. It is believed that (1) faulty enlistment, (2) increased service activity, (3) and malingering are chiefly responsible for the larger rate of admission for flat foot than was seen in the service formerly.

Properly gauged practice marches with the special exercises now practiced at training stations will do much toward early elimination of flat foot which occasions disability.

Hernia caused 372 admissions and 17,828 sick days. This is an increase of 0.34 per thousand over last year. A possible factor in the increased rate of admission is the greater care in examining men for transfer and discharge.

Hemorrhoids and varicocele both show a reduction from last year's admission rates. The number of sick days for varicocele was reduced by 1,229, and for hemorrhoids by 462.

Myopia shows a reduction of 0.9 per thousand in the admission rate, while the admission rates of hyperopia and astigmatism are slightly reduced. The admission rate for errors of refraction is decreased; the invaliding rate is increased.

Epilepsy shows an increased admission rate, 1.87 per thousand, as against 1.42 per thousand for 1909.

Color blindness.-The number of admissions for this condition during the year 1910 is more than double that of 1909, although there is a relatively small increase in force. This increase is due to the increased vigilance used in the reexamination of recruits at receiving ships or barracks by naval medical officers, after they have been passed by civilian or other examiners who fail to appreciate the importance and value of this test.

2. Affections depending upon the environment of recruits are chiefly the general infective diseases, venereal and nonvenereal.