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tonsillitis, many cases of which disease are found among men occupying the same compartment during the day and night, this being especially manifest in the lower wing passages where the firemen's washrooms are located, and where the clothing of many men is kept. These spaces are constantly in use, are artifically lighted, and with difficulty kept sufficiently well ventilated, and too large to be properly and thoroughly disinfected during the cruising period of a ship, except in extreme emergency. These cases are not serious, but add greatly to the number of noneffectives during the year. Were ships placed out of commission or even in reserve every two years and given a thorough cleaning and disinfection, it is believed that the health of the crew would be materially improved.

The medical officer of the Reserve Torpedo Flotilla invites attention to an insanitary feature of the construction of torpedo boats in the following words:

A few of the torpedo boats, such as the U.S. S. Bailey, are so constructed as to have the "heads” below decks and adjacent to living compartments or galleys. This I believe to be extremely deleterious to health. The “head” is almost inside the forward living compartment, and foul, noxious odors are in this compartment constantly. This, in the course of time, certainly would lower the bodily resistance of those who occupy this space and predispose them to almost any prevailing diseases. As the allotted air space per man aboard these torpedo boats is very small (from 100 cubic feet in some to 150 cubic feet in others) I should suggest that the galleys and heads be placed above decks.

FLEET SURGEONS.

If solidarity of organization and coordination of effort are desirable for the maintenance of a maximum of efficiency of the growing trained fighting force, no less are they desirable desiderata in the effort to keep the physical condition of this expensive trained fighting force at the highest possible standard of efficiency.

The necessity for coordination of the activities of the medical departments of the ships of the fleet is obvious. The Bureau is of the opinion that the senior medical officer of the flagship of each division be designated and appointed as division surgeon, and should be directly responsible to the fleet surgeon, who, in turn, should be on the personal, as well as the fleet, staff of the commander in chief. The fleet surgeon should be relieved of all duties as medical officer of the flagship of the commander in chief, to the end that he may devote his entire time and effort to supervision of the medical affairs of the fleet, frequent sanitary inspections of ships and frequent inspections of the drills of the medical departments, in order that the commander in chief may have at all times information and recommendations looking toward the common aim of all, viz, constant preparedness in all departments for any eventuality.

It is believed that until the position of the fleet surgeon is fixed by statute, as recommended in the Annual Report of the Surgeon General, United States Navy, for 1909, the best interests of the service will suffer.

It is further believed that if increased rank is required, because of responsibility, in connection with command of a larger force, it would seem that corresponding increase of rank commensurate with increase of duty should not be denied the fleet surgeon.

In this connection it may be remarked that upon the occasion of the recent visit of the U. S. S. South Carolina to Cherbourg, the commanding officer of the naval hospital at that place was "a naval medical officer of the rank of rear admiral."

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Further, the Bureau considers it desirable that younger men should reach the grade of fleet surgeon sufficiently early to insure activity and best effort from officers serving as fleet surgeons.

HOSPITAL SHIPS.

The efficient service performed by the U. S. S. Solace during the year is a continued and practical demonstration of the need by the fleet of a hospital ship at all times.

A community of 14,000 persons would have numerous physicians' offices for consultations and treatment of minor ailments, and would, of necessity, have a well-equipped hospital for the care of serious or chronic cases.

The personnel of the Atlantic Fleet and its auxiliaries probably exceeds in number that of the city of 14,000 population. In the fleet there is always the greater need for hospital facilities, not alone for treatment of disease, but also in order that the fighting efficiency of the organization may neither be impaired by the presence of sick or wounded, nor hampered by quarantine because of the presence on board the ship or ships of contagious disease.

The presence of a hospital ship in the fleet guarantees the availability of a number of medical officers trained in the special branches of medicine, who are ready at all times to do for the sick or injured of the fleet all that any well-equipped hospital can do.

In addition to general medical and surgical work, pathological examinations, chemical analyses, X-ray work, bacteriological examinations, eye, ear, nose and throat treatments, electrotherapy, hydrotherapy, and dental work are thus available, and, in addition, isolation wards for treatment of infectious diseases are always ready to disembarrass any fighting unit in the fleet of quarantinable diseases occurring among its crew. Embalming apparatus and facilities for preservation of bodies are provided, thereby enabling transmission of the dead to the next of kin.

Numerous structural changes have been made in the Solace during the year, with a resulting increase in efficiency of service and comfort of the sick.

An excellent medical reference library has been placed on board for the use of the staff attached to the Solace and for members of the Medical Corps attached to the ships of the fleet. When practicable, the medical officers of the fleet meet for clinical and medical conferences on board the hospital ship.

In addition to performing an active hospital service for the fleet, a systematic examination of the eyes of the gun pointers serving on the various ships has been in progress.

It is purposed to repeat this examination of the gun pointers' eyes at frequent intervals, in order that no gun's efficiency may be impaired because of defective vision, the result of existing or induced refractive error, or of an insidiously developing disease.

The Bureau is of opinion that properly designed hospital ships should replace the vessel now in use, which is an adaptation of a merchant vessel for hospital purposes, and at best is an unsatisfactory substitute for a properly designed vessel. A hospital ship for each fleet is recommended.

20956°

-NAVY 1911

30

CONCLUSIONS.

Recommendations are summarized as follows:

1. The detail of a properly qualified medical officer as inspector general of the Medical Department, to serve under the aid for inspections.

2. Ty phoid prophylaxis to all persons under 45 years of age in the service.

3. The installation of the bubbling-spring drinking device at all places where drinking water is supplied to the service.

4. Require all officers and men in the service to be able to swim.

5. Erection of sanitary barracks at navy yards for the accommodation of the crews of ships undergoing extensive repairs.

6. Substitution of a sanitary unit system of barracks for receiving ships.

7. Require all persons aboard ship to participate in the physical drill once daily.

8. Establishment of a centrally located dispensary in Washington. 9. Construction of a hospital ship for each fleet. 10. Definition by regulation of the duties, etc., of fleet surgeons. 11. Consideration of changes in uniform. 12. Limitation of athletic sports. 13. Improvement of ventilation of ships underway. 14. Improvement of illumination of living spaces aboard ship: 15. Quarterly physical examination of all persons in the service. 16. Forfeiture of pay by all persons in the service during disability from disease of venereal origin.

17. Prescribe by regulation a percentage of the crews of ships as permanently detailed stretcher men.

18. Urge modification of the liability act of May 30, 1908.

19. Permit the engine-room force to come up on deck in clean dungarees, and require them to spend time each day in the sunlight or fresh air, when possible.

20. No transfer from seaman branch to coal passer's grade, unless recommended after physical examination of medical officer.

21. That those exposed to the damaging effects of gun blasts, and those whose ears are unfavorably affected by swimming and diving, be required to wear ear protectors.

22. Provision for the better protection of food from insects, especially flies.

23. Require denial by recruits of history of “fits,” enuresis, drug habit, and insanity.

C. F. STOKES,

Surgeon General, U. S. Navy. The SECRETARY OF THE NAVY.

STATISTICS. .

year 1910.

The vital statistics of the Navy for the calendar year 1910 are shown in the following tables:

1. General view of the effects of disease and injury in the Navy during the year 1910. 2. Atlantic Station. -Names of ships, average complements corrected for time, admissions and readmissions for disease and injury, sick days, daily average of patients, transfers to hospitals, discharges from tne service, and deaths on each ship for the year 1910.

3. Pacific Station. Name of ships, average complements corrected for time, admissions and readmissions for disease and injury, sick days, daily average of patients, transfers to hospitals, discharges from the service, and deaths on each ship for the year 1910.

4. Asiatic Station.-Names of ships, average complements corrected for time, admissions and readmissions for disease and injury, sick days, daily average of patients, transfers to hospitals, discharges from the service, and deaths on each ship for the

5. Receiving ships and station ships.-Names of ships, average complements, admissions and readmissions for disease and injury, sick days, average of patients, transfers to hospitals, discharges from the service, and deaths on each ship for the year 1910.

6. Navy yards, marine barracks, and other shore stations.-Names, average complements, admissions and readmissions for disease and injury, sick days, daily average of patients, transfers to hospitals, discharges from the service, and deaths during the year 1910.

7. Detailed statement of disease and injury among the force afloat, 1910.

8. Detailed statement of disease and injury among the force at navy yards, marine barracks, receiving ships, station ships, and other shore stations, 1910.

9. Detailed statement of diseases and injuries treated at naval hospitals and on hospital ships during the year 1910.

10. Report of vaccinations.
11. Prevalence of special diseases and injuries (relation by scale).
12. Mortuary record.
13. Deaths relation by scale).
14. Detailed statement of disease and injury in the entire service.

15. International nomenclature.-For a comparison of international naval medical returns, the total amount of disease and injury in the Navy during the year 1910 is given in terms of the official English translation of the International Nomenclature.

16. Table showing distribution of disease among occupational groups of the personnel for 1910 by admission, admission rates, sick days, and computed damage.

17. Table showing ships which had infectious and contagious disease on board during 1910 and the character and number of such.

18. Table showing infectious and contagious diseases at navy yards, receiving ships, marine barracks and camps, and other shore stations.

19. Discharges for disability (relation by scale).
20. Surgical operations.
21. Patients, sick days, averages, etc., at naval hospitals.
22. Statement of cost of maintenance of United States naval hospitals.
23. Recruiting statistics.

24. Insane from the Navy at the Government Hospital for the Insane, Washington, D. C.

25. Tuberculous patients from the Navy at the Naval Sanatorium for Tuberculosis, Las Animas, Colo.

26. Statement of the work done by the Record and Pension Division of the bureau.

27. Table showing diseases which have been most markedly increased or decreased during the year 1910.

a

1. General view of the effects of disease and injury on the Navy and Marine Corps during

the year 1910.

1

Average strength of the Navy and Marine Corps
Average strength shown by reports of medical department?
Average strength of the force afloat 3.
Admissions for disease, afloat and ashore 4
Admissions and readmissions for disease, afloat and ashore.

Ratio per 1,000 of strength, 1910.
Ratio per 1,000 of strength, 1909.

Ratio per 1,000 of strength for 10 years (1898–1907).
Admissions for injuries, afloat and ashore.
Admissions and readmissions for injuries, afloat and ashore.

Ratio per 1,000 of strength, 1910..
Ratio per 1,000 of strength, 1909.

Ratio per 1,000 of strength for 10 years (1898–1907).
Total admissions to sick list during the year 1910...

Ratio per 1,000 of strength, 1910...

Ratio per 1,000 of strength, 1909.
Total admissions and readmissions to sick list during the year 1910.

Ratio per 1,000 of strength, 1910..
Ratio per 1,000 of strength, 1909..

Ratio per 1,000 of strength for 10 years (1898–1907).
Daily average of patients, 1910..

Ratio per 1,000 of strength, 1910.
Ratio per 1,000 of strength, 1909.

Ratio per 1,000 of strength for 10 years (1898–1907).
Total number of sick days due to disease..
Total number of sick days due to injuries..
Total number of sick days (including officers' sick leave, 3,874 days)5.

Average for each man of the Navy and Marine Corps, 1910...
Average for each man of the Navy and Marine Corps, 1909.
Average for 10 years (1898–1907)..
Average days for each case treated, 1910.,
Average days for each case treated, 1909.

Average for 10 years (1898–1907).
Discharges from the service for disease 5

Ratio per 1,000 of strength, 1910..
Ratio per 1,000 of strength, 1909..

Ratio per 1,000 of strength for 10 years (1898–1907).
Discharges from the service for injuries 5.

Ratio per 1,000 of strength, 1910..
Ratio per 1,000 of strength, 1909..

Ratio per 1,000 of strength for 10 years (1898–1907).
Total discharges for disability

Ratio per 1,000 of strength, 1910.
Ratio per 1,000 of strength, 1909..

Ratio per 1,000 of strength for 10 years (1898–1907).
Deaths from disease .....

Ratio per 1,000 of strength, 1910.
Ratio per 1,000 of strength, 1909.

Ratio per 1,000 of strength for 10 years (1898–1907).
Deaths from injuries (including poisons)".

sio per 1,000 of strength, 1910. natio per 1,000 of strength, 1909. Ratio per 1,000 of strength for 10 years (1898–1907).

58, 340
56, 721
35,567
32, 419
41,952
739.62
797.28
648.38
5,585
6,843
120.64
119.56
126. 59
38,004
670.01
697.29
48, 795
860.26
916. 85

775.95
1,534.13

27.05 26.13

32.83 470,091

89, 867
559, 958

9. 87
9. 53
11. 82
11. 47
10.44
15.00
1, 190
20.40
23. 45
29. 63

228
3.91
4. 11
5. 10
1,689
28.95
27. 56
32. 72

159
2.73
2.36
4.05

171 2.93 1.90 2.57

6

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1 Used in computing ratios of deaths and discharges for disability.
2 Used in computing all ratios except those of deaths and discharges for disability.
3 Exclusive of hospital ships, receiving ships, and station ships.

• Exclusive of Naval Hospital for Tuberculosis, Las Animas, Colo. When a patient is admitted to this Institution it is considered as a discharge for disability. Therefore, sick days and deaths at Las Animas

, and also at the Government Hospital for the Insane, are not used in computing the above ratios, but the admissions to these institutions are included in reckoning the invaliding Pate, or discharges for disability

. | 5 Exclusive of Naval Hospital for Tuberculosis, Las Animas, Colo., and Government Hospital for Insane. 0 Includes 206 patients invalided to Naval Hospital for Tuberculosis, Las Animas, Colo., and 65 to the Government Hospital for Insane.

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