VG i9Je ^ \ N. M. S. 127404 The Navy as a Special Field for Medical Work By The Surgeon General Illustrated f WASHINGTON GOVERNMENT PRINTING OFFICE 1916 A5^ T-'S H u THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. The attention of medical practitioners, more particularly those who have recently graduated in medicine, is cordially and earnestly invited to the Navy for consideration as a special field for medical work. This is the age for specialization in medicine, and one when all persons of the medical profession are endeavoring to perfect themselves in some special branch of medicine upon which they have decided as their chosen life work. Any military service is a special field of medical and sanitary practice, the conditions existing therein determining the essential differences between it and civil practice. It must be remembered, therefore, that the medical officer of the Navy is a specialist; that Navy medical work is a special branch of medical and sanitary practice and must be viewed as one among the many other special fields of medicine, as eye, ear, neurology, hygiene, etc.; and that the practitioner who takes up this line of work must likewise be specially trained as is the specialist in another branch. It, however, differs so essentially from civil practice that this training must be of a character peculiar to the problems of the naval service. The applicant must approach his decision to undertake this special work as he would the question of entering any other specialty. In conjunction with his duties the medical officer may also perfect himself in some branch of medicine for which he has a particular bent or liking. He may specialize as a hygienist, a specialist in tropical medicine, eye, ear, etc. Let us now look upon what constitutes this field of medicine. The Navy consists of its ships or floating force, its navy yards for the building, repair, and upkeep of these ships, its naval training stations for the training of men to man these ships and yards, its naval hospitals for the treatment of the sick, etc. Each one of these units is a community in itself, with one department interdependent upon another. A ship with its complement of several hundred men is similar to a small town, having consideration for its water and food supply, its sewage disposal, lighting of its passageways and living apartments, heating and ventilation of its living quarters, protection against epidemic diseases, maintenance of the general health of the community, general hygienic and sanitary matters; in fact, almost every question that arises in a small civilian community. On board this ship there are officials who represent in a similar way the various officials of a town. It can be readily seen, therefore, that the medical officer represents not only the board of health but also the sanitary inspector and the medical adviser and family physician. In other words, he looks out for the general hygienic and sanitary matters and treats all the sick. His is a combined duty. He represents all the medical talent available to any community. However, as this community in which he is located moves about over the globe from one region to another, he first must deal with conditions of a northern climate and again with the conditions of a tropical climate. He must at all times maintain the health of the personnel in the highest state of effective- ness. In order to do this the medical officer must keep himself thoroughly informed of advances upon all medical matters and general sanitation; he must be familiar with the latest information relative to the cause and prevention of disease, modern means of lighting and ventilation, special treatments of special diseases, and be ready at any time to undertake to the best of his ability any question which may be brought to his attention. It is therefore necessary that he do much reading of medical publications, and that he must not lag behind in the rapid advances of medical knowledge, 50507—16 (3) 345935 ^ c» ^,« e «^c' . :.,; „-'', '-vj-jjj, i^AVY AS A SPECIAL FIELD FOR MEDICAL WOEK. The general work of the medical department consists of the following: From the practitioner's standpoint the medical officer begins with the physical examination of all applicants for enUstment or candidates for commission in the Navy and Marine Corps. In this work many men are specially trained, and the work requires much attention to detail, a thorough knowledge of the physical requirements and the means of making physical examinations, in order that the men accepted may be physically fitted for the occupation in which they are to engage. Having accepted these men, the medical officer must maintain them in the best possible health. These men must be vaccinated for smallpox and typhoid; they must be suitably clothed, fed, and supplied with heat and fresh air in their living and sleeping apartments. They are subject to all manner of diseases, many of the contagious diseases of childhood being found among them upon entrance. On board ship sick call is held daily, and all those who are suffering with any disease oi-^ injury present themselves for treatment. These treatments may consist of temporary medications, -, applying emergency dressings, and work similar to an out-patient department. Men may be suf- , fering from conditions which require them to be treated in bed; these ,inen are admitted to the sick . list and are placed under treatment in the sick bay (the ward), where;|hey are kept until convales- . cent, being nursed by members of the Hospital Corps. Special treatment, such as to the eye, ear, nose, and throat, etc., may be required. Should surgical cases arise, it may be necessary to perform minor and major operations in the well-equipped operating room of the ship. Should at any time cases of a medical or surgical nature of such a serious character arise for the treatment of which the facilities aboard the ship are not adequate, or the case is of such a nature as to be long drawn out, the patient may be transferred from the ship to the hospital ship or to a naval hospital for further observation, treatment, and convalescence. The decision in this matter rests entirely with the medical officer concerned. Should an epidemic disease break out the medical officer must carry out means of isolating all cases, fumigating the compartments, and making such disposition of the circumstances as possible. At this point his work joins that of the Public Health officials. We will, therefore, look to the general sanitary feature of the work. General hygienic and sanitary problems confront the medical officer at all times. In part there are questions as to ventilation of the ship's compartments — a matter of the greatest importance on board ship — where moisture, heat, foul air, and the close association of human beings enter into its consideration; the question of sufficient heat in order that one part of the ship will not be too hot and another too cold; the isolation of cases and general disinfection and fumigation with refer- ence to contagious epidemic infectious diseases; the supervision of the ration, its character and quan- tity; attention to the sewerage system of the ship, suitable bathing faciHties, laundry, etc. From time to time medical officers are assigned to duty with marine expeditionary forces, this duty being similar to that of an Army surgeon. In this particular, therefore, camp sanitation and hygiene must be familiar to the medical officer, and general supervision of the camp, policing of the grounds, and disposal of waste come under his purview. The medical department on board ship is established in a generous space, specifically provided for in the plans of the ship. This space on the larger ships is divided usually into an examining room, a dispensary, an operating room, bath room, and a large compartment, termed the sick bay (similar to a hospital ward), containing several beds for the sick, and also a small isolation room for conta- gious disease. In a near-by section of the ship a storeroom is designated for medical, surgical, and other supplies only. The operating room is equipped with modern appliances, furniture, sterilizers, and surgical instruments, etc. The whole department is furnished with all appurtenances necessary for the ordinary care of such cases as may be presented. In attendance upon the fleet there is a hospital ship which in every way is as well equipped as any civilian hospital. This ship carries a full staff of medical officers, most of whom are specialists in various branches of medicine. To this ship are sent the sick of the fleet, those who are critically ill, those whose cases will require a long time to cure, such surgical cases as demand special care 'ir^^S; ^-nr^ CHEMICAL AND PATHOLOGICAL LABORATORIES, UNITED STATES NAVAL MEDICAL SCHOOL. TYPE OF MEDICAL OFFICER'S QUARTERS. TYPE OF NAVY YARD DISPENSARY AND SURGEON'S OFFICE. Ui^#