ships, and it becomes necessary, therefore, to obtain special stocks of such oil for this purpose. When the new tank stations now under construction at Bradford, R. I., Norfolk, Va., Charleston, S. C., Key West, Fla., Guantanamo, Cuba, and San Juan, P. R., are completed, it will be possible to maintain adequate supplies of suitable oil without recourse to commercial distributing points. APPROPRIATIONS. The recognized practice for many years by which money appropriated for the naval service has, by the Congress, been divided so as to segregate the totals under the different bureaus and subheads thereof has resulted in the development of a complicated system of accounting which might be greatly simplified should all money be appropriated in a lump sum for each bureau. Attention in this connection is invited to the heterogeneous, not to say unnecessary, arrangement of naval appropriations. At the present time the moneys for the naval establishment are divided into 180 current appropriations, and taking into consideration that each annual appropriation remains open for at least two fiscal years, there are carried on the bureau's books approximately 450 appropriation accounts. It is evident, even to the most casual observer, that the expenditure of some $150,000,000 through the media of from 200 to 500 appropriations must present so many difficulties that an entirely satisfactory method of accounting for such expenditures can not be devised. Under the act of Congress approved June 25, 1910, authority was granted the Secretary of the Navy to make all purchases of stores for stock under one account-i. e., general account of advances-and to make the necessary charges against the appropriations concerned whenever such stores should be issued for the use of the bureau having cognizance thereof. While this arrangement somewhat simplified the store problem and made possible, as stated elsewhere in this report, a cost-of-work accounting system, yet it only altered slightly for the better the very great complexity of the general accounting, because the great number of appropriations against which charges must be lodged eventually has not been reduced. SEA MESSING OF MIDSHIPMEN ON THE ANNUAL PRACTICE CRUISE. For the first time in the history of the Naval Academy the midshipmen during their annual practice cruise were subsisted entirely upon the navy ration as issued to the enlisted men of the practice squadron. Aside from the advantages, such, for instance, as a saving of money to the midshipmen, the lessening of storage spaces required, better refrigerating arrangements, etc., the fact that the enlisted men's rations completely satisfied the midshipmen who are accustomed to the excellent cuisine of the Naval Academy is gratifying evidence as to the character and quality of the navy ration regularly issued to the enlisted men throughout the service. STOREKEEPING AFLOAT. In response to a general demand throughout the service, pay officers were placed in charge of the general stores and the keeping of accounts pertaining thereto on board several ships of the navy, relieving from these onerous duties a number of line officers. This experimental plan, having proved successful, has been universally adopted, and since the close of the last fiscal year orders have been issued extending it to all vessels of the navy in commission. Respectfully, The SECRETARY OF THE NAVY. T. J. COWIE, Paymaster-General, U. S. Navy. REPORT OF THE SURGEON GENERAL, UNITED STATES NAVY. DEPARTMENT OF THE NAVY, BUREAU OF MEDICINE AND SURGERY, Washington, D. C., August 23, 1910. SIR: Conformably to the instructions contained in the department's letter of July 28, 1910, the following annual report is submitted to cover the operations of the Bureau of Medicine and Surgery for the fiscal year ending June 30, 1910, and the health and sanitation of the Navy and Marine Corps for the calendar year 1909. Estimates for the regular annual appropriations for the fiscal year 1912 and a report of the condition of the hospital fund on June 30, 1910, are included. For purposes of familiar reference and ready comparison with reports of former years, the sequence of subjects considered has been varied as little as possible. Without reverting to the custom of publishing annual reports in full with more or less editing, it has seemed proper to quote the words of observers who have had firsthand consideration of many special problems, in order that nothing may be lost by translating their ideas into expression by the bureau. The comprehensive arguments favoring such legislation as has still failed of enactment have not been reiterated for the reason that they have all received the earnest support of the department and the bureau is sanguine that they will ultimately receive the consideration which their relative importance justifies. In connection with the statistical tables, which have been slightly amplified this year, the bureau desires to emphasize the fact that its greatest present need is for a second statistical clerk, to be trained in the interpretation and correlating of returns, in order to correct. and account for the many discrepancies which have long since been recognized but unavoidably allowed to remain unadjusted during the past ten years of the service's expansion through the lack of sufficient clerical force. The one clerk who has for many years compared and combined the statistical reports of the sick was hardly sufficient when the personnel, ships, and stations aggregated onefifth their present number, and this division of the bureau has been additionally handicapped through the illness of another clerk, part of whose duties have devolved upon this statistical clerk. Attention is invited to the closing page of last year's report, which argues the authorization of an additional clerk. The bureau feels justified by the few results of the new classification of distribution of disease in the personnel already attained in predicting the solution of many sanitary problems and consequent reduction of preventable affections if this need is promptly filled. It is recommended that the bureau be freely consulted in planning for prospective cruises and expeditions, in order that it may give the department timely advice as to the sanitary features of these military movements and make proper provision for the care of the sick and wounded, as would undoubtedly be done in actual warfare. So far as cruises, expeditions, and the activities of service could be expected to influence sanitation and the movement of disease and injury, the year 1909 in the navy might be considered to have approximated to an unusual degree the "average" or "normal" year. The combined statistical tables for disease, injuries, invalidings from the service, and deaths for 1909 indicate a generally diminished damage ratio as compared with that of the previous year and the average of the previous ten years. The death rate of 5 per thousand is lower than has ever been previously recorded for the navy. That this improvement is not merely apparent on account of the separation of the sick days at Las Animas is shown by the fact that, if they are included for purposes of just comparison, the total admission ratio dropped from 725.36 for 1908 to 698.25, the ratio of daily average of patients from 29.10 to 28.52, the average number of sick days for each individual from 10.66 to 10.41, the ratio of total discharges from disability from 35.49 to 30.59, and the death rate from 5.76 to 5.002. The total damage for disease alone in percentage of sick was 3.952, which, when compared with Medical Inspector Gatewood's ten-year tables, is found to be lower than for any year since the SpanishAmerican war. The grand total damage in percentage of sick for 1909 was 4.619 as compared with 5.218, the average computed in the above-mentioned ten-year tables. That these ratios should continue to fall and gradually approach the minimum compatible with the service's inherent cosmopolitan environment is to be expected largely from the awakened sense of sanitary responsibility in the communities with which the personnel must come in contact. The results may also be especially attributed to the increasingly recognized functions of the medical department to prevent the occurrence of disability rather than to await its inception to attempt to effect the cure. The position of the sanitarians of the fleet is unmistakably advancing. In general, from year to year the total damage from disease and injury appears proportionate to the increasing personnel and this feeling that conditions approximate the normal may blind us in certain instances to habitual and seemingly unnecessary losses. This seems particularly applicable to the larger number of drownings recorded each year, and while special diseases and accidents are discussed in the usual section, the means of prevention are in this case without the province of the medical department, yet of sufficient importance to merit early and special mention. It would appear that one of the first requirements to be insisted upon after enlistment of the recruit or appointment of the midshipman, commissioned or warrant officer should be the demonstrated ability to swim a substantial distance, say, 300 yards, and to sustain the head above water for fifteen minutes in the presence of a light breeze. An endurance and confidence such as will hardly be attained in a small tank would undoubtedly contribute to the saving of a considerable number of lives. ESTIMATES. Following the policy adopted by the bureau and approved by the department several years ago no estimates for appropriations by Congress for the construction or repair of naval hospitals have been submitted, and until other provision is made all expenses in connection with naval hospitals for new construction, enlargements, and necessary repairs will be provided from the Naval Hospital Fund. No appropriation under the title "Repairs, Medicine and Surgery" was made for the current fiscal year ending June 30, 1911, and no request has been made on Congress for an appropriation under that title for the fiscal year ending June 30, 1912. Under the appropriation "Medical Department" an increase has been recommended from $315,000 for the fiscal year 1911 to $350,000 for the fiscal year 1912. The increase so recommended is greater than that recommended in the estimates of preceding fiscal years as the appropriations under this title for the fiscal years 1908, 1909, and 1910 have each required deficiency appropriations of $36,000, $17,000, and $40,000, respectively. Under the appropriation "Contingent" an increase has been recommended from $76,500 for the fiscal year 1911 to $79,000 for the fiscal year 1912, and provision has been made in the text of the appropriation covering the necessary repairs at naval medical supply depots, the elimination of the appropriation "Repairs, Medicine and Surgery," leaving no specific provision for this work. Under the appropriation "Transportation of Remains" an increase has been recommended from $10,000 for the fiscal year 1911 to $13,000 for the fiscal year 1912. This appropriation, formerly $15,000, was reduced by recommendation of the bureau in the fiscal year 1906 to $10,000. The latter amount has been found insufficient during the past two years, and the increase of $3,000 has been recommended to meet the increased expenses due to the larger naval personnel. This beneficent appropriation enables the department to bring home the remains of their dead to bereaved parents and widows too poor themselves to undertake the expense. The Naval Hospital Fund was created, without appropriation, by an act establishing naval hospitals approved February 26, 1811. It draws its revenues from the naval service and not from appropriations by Congress. Section 4810 of the Revised Statutes authorizes the Secretary of the Navy to procure at suitable places sites for naval hospitals, and to erect necessary buildings and additions to buildings when the funds permit and circumstances require. During the past several years both of the conditions imposed by this statute have existed and new naval hospitals are being constructed at Portsmouth, N. H., Chelsea, Mass., and Newport, R. I., from the Naval Hospital Fund and without cost to the United States. At Portsmouth and at Chelsea the new buildings have been placed on parts of the naval reservation already in possession of the department, but at Newport a new site on the mainland opposite the naval station was secured by purchase, and condemnation proceedings have just been instituted for an additional plat of about 44 acres. Unless the increment of the Naval Hospital Fund should be further diverted to other purposes than those contemplated in the laws creating it, it will probably be sufficient for the maintenance of an adequate hospital service in the navy without expense to the United States, but the bureau has to strongly recommend that the provision made in the naval act for the fiscal year 1910, approved March 3, 1909, diverting from the Naval Hospital Fund moneys for the transportation to their homes or places of enlistment of naval prisoners and for the purchase of suitable civilian clothing for the same be repealed, and that these expenses be made a charge against the United States under the appropriation "Transportation, Bureau of Navigation." NAVAL HOSPITAL FUND. The condition of this fund is as follows, viz: Balance on hand July 1, 1909..... Transferred to credit since July 1, 1909. Total..... Expended since July 1, 1909.... Balance on hand June 30, 1910.............. The average cost of maintenance of naval as compared with civil hospitals for fiscal year 1909 appears as follows: Average cost per day at naval hospitals without salaries... Average cost per day at naval hospitals with salaries..... Average cost per day at civil hospitals of the poorer class. Average cost per day at civil hospitals of the best class.. Average daily cost for subsistence, naval hospitals... Average daily cost for subsistence, civil hospitals... $1.49 2.32 1. 17 2.50 to 3 .478 .35 A general analysis of the detailed figures for fiscal year 1909 showed that the daily cost for uncooked food is about one-third higher in naval than in civil hospitals, which is probably to be accounted for by the fact that naval hospitals have a much higher percentage of full-diet patients (convalescents). It appears, however, that the cost of maintenance of naval hospitals is considerably less than obtains in civil institutions, they having a considerably smaller number of employees at lower wages, and supplies, being obtained in large contract lots, are relatively cheaper. This lower maintenance figure, therefore, in a measure compensates for the higher subsistence figure and brings the daily cost of the two classes of institutions to within a small general variation. Where comparison is practicable by the similarity of other conditions, economy and efficiency seem more in evidence at those hospitals where pharmacists have been in charge of the commissary department. |