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 N. M. S. 127404 
 
 The Navy 
 
 as a 
 
 Special Field for Medical Work 
 
 By 
 
 The Surgeon General 
 
 Illustrated 
 
 f 
 
 
 WASHINGTON 
 
 GOVERNMENT PRINTING OFFICE 
 
 1916 
 
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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. 
 
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 <o 
 
50507—16- 
 
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MAIN BUILDING, UNITED STATES NAVAL HOSPITAL, WASHINGTON, D. C. 
 
 OPERATING ROOM, UNITED STATES NAVAL HOSPITAL, WASHINGTON, D. C. 
 
UNITED STATES NAVAL HOSPITAL FOR TREATMENT OF TUBERCULOSIS, 
 LAS ANIMAS, COLO 
 
 A Tf?OPICAL ST A I i )N. 
 
3iftjij!d '^^^^M^-nf3^^%/<^^^^^ 'Wi^&^j ^^4^KH^. 
 
 WARD IN NAVAL HOSPITAL IN THE TROPICS. 
 
OPERATING ROOM, U. S. S. "SOLACE." 
 
 WARD, U. S. S. "SOLACE. 
 

 HOISTING PATIENT ABOARD U. S. S. "SOLACE." 
 
OPERATING ROOM ON MODERN BATTLESHIP. 
 
 
 HOSPITAL CORPS DETACHMENT WITH MARINE ENCAMPMENT. 
 
FIELD LATRINE. 
 
 FIELD HOSPITAL. 
 
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 ' ' . ,   7X   
 
 
 
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 t^^^M f "S 
 
 
 
 
 HOSPITAL CORPS STRETCHER DRILL. 
 
HOSPITAL CORPS STRETCHER DRILL. 
 
THE NAVY STRETCHER (STOKES SPLINT STRETCHER). 
 
PHYSICAL TRAINING. 
 
THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 5 
 
 and attention, all wounded from engagements on board ship, expeditionary services, etc. This ship 
 is ordered from place to place to meet a demand for her services in connection with the employ- 
 ment of Naval forces. 
 
 There are a number (i8) of large hospitals under the supervision of the Bureau of Medicine 
 and Surgery, most of which are established at large cities like Boston, New York, Philadelphia, 
 etc., and in foreign possessions. These hospitals have a staff of medical officers, are thoroughly 
 equipped with all medical and surgical appliances. X-ray machines, hydrotherapeutic apparatus, 
 etc., and to them are sent the sick of the fleet, the ships, the navy yards, the naval stations, etc., 
 in the immediate vicinity. These hospitals are conducted after the manner of the civilian institu- 
 tions, the nursing staff consisting of a certain number of nurses of the Nurse Corps (female) of the 
 Navy, and the Hospital Corps. To these hospitals as members of the staff every effort is made to 
 assign medical officers who are qualified in particular lines of work, such as a surgeon, an internist, 
 an X-ray specialist, an eye specialist, etc. 
 
 At these hospitals and on board the hospital ship are maintained laboratories for pathological, 
 bacteriological, chemical, and other laboratory procedures. The number of these examinations in 
 all classes is very large. 
 
 Frequently those medical officers who are detailed for duty with marine expeditionary forces 
 are called upon to supply medical attention to the native inhabitants of the locality immediately 
 surrounding the expedition. In this way frequently valuable experience is obtained. Medical 
 officers are at times assigned to general hygienic and sanitary work in connection with the develop- 
 ment of certain island possessions, cleaning up of unhealthy localities in adjacent countries, etc. 
 
 To assist the medical officer in carrying on this very extensive work, books, surgical instru- 
 ments, special instruments, abundant dressings, drugs, and general equipment are liberally supplied 
 at Government expense by the Bureau of Medicine and Surgery. These means may be obtained 
 by submitting requisitions from time to time to the proper authorities. 
 
 Medical officers are encouraged in every way to maintain themselves at the highest state of 
 efficiency in their profession. They are encouraged to perfect themselves in special branches for 
 which they may have a desire to enter, a special bent or previous training. While they are attached 
 to naval hospitals, shore stations, and at times on board certain ships opportunities are available 
 for them to undertake courses in medical schools and hospitals at many of the large cities and 
 medical centers. Medical officers who have so trained themselves are encouraged, in so far as the 
 requirements of the service permit, to pursue their specialty, in that they may be detailed to duty 
 where an opportunity exists, but only when such assignments are available. No special assignments, 
 however, can be made for officers to undertake studies or for personal reasons. By means of the 
 travel afforded a medical officer of the Navy he has an available means for cultivating his general 
 knowledge of foreign lands and peoples in the way of general information as well as professionally. 
 
 The value of the medical officer and his department is coming to be more and more recognized. 
 The highest efficiency in the medical officer is expected; individual merit is thoroughly appreciated 
 and recognized. 
 
 The requirements, appointment, and status pf the medical officer are as follows : 
 
 The naval service, by reason of its world-wide intercourse, requires in its personnel the instincts, 
 discernment, and conduct of a gentleman. As officers of the Navy come into contact with the 
 most cultivated and interesting people of every country, it is essential that personal qualifications 
 should enter into the determination of general suitability for the service. The wide range in the 
 character of the work and responsibilities calls for high professional standards and ready adaptability. 
 In this connection also it may be readily seen that the appHcant's general preUminary education 
 should be of the best. 
 
6 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 
 
 Professionally the applicant must be a graduate from a standard, recognized, reputable school 
 of medicine; evidences of his professional ability, periods of training in actual practice or in hospitals, 
 are of advantage to the applicant. Men who have had special training and experience will find 
 that it stands them in good stead in later life. 
 
 Physically the applicant must come up to the physical requirements and standards and be 
 free from disease. The professional examination is one which any well-qualified physician should 
 be able to pass, particularly those men who have recently graduated from a medical school or who 
 have undergone examinations for State board registration. The examination is conducted in two 
 parts, the preliminary examination being that for appointment in the Medical Reserve Corps. 
 Should the applicant pass this preliminary examination, he is given a commission in the Medical 
 Reserve Corps with a view to attending a special course of instruction and commissioning in the 
 regular corps. Upon receiving a commission in the Reserve Corps the student officer is detailed 
 to the Naval Medical School at Washington, D. C, for a special course of instruction in the 
 various duties of the medical officer of the Navy, in special diseases, in operative surgery, 
 in laboratory, in drills, etc. At the end of this course he undergoes the second and final stage of 
 the examination, upon passing which he is commissioned as an assistant surgeon in the regular 
 Medical Corps of the Navy. 
 
 Should a student officer fail to pass the examination at the end of the school course, he continues 
 as a member of the Medical Reserve Corps. His course of instruction has been of unusual character 
 and value and will be found to his advantage in the practice of medicine in civilian life. 
 
 Subsequent to successfully completing the course at the Naval Medical School and receiving 
 his commission as an assistant surgeon in the Medical Corps the officer is detailed to sea duty, the 
 cruise usually continuing for about three years. He is then assigned to some shore duty for a longer 
 or shorter period (usually about two years) until his services are again required at sea. These 
 alternating periods of sea and shore duty continue until the upper grades are reached, when the 
 officer is detailed to command one of the large hospitals, the medical school, or some other desirable 
 assignment. 
 
 The status of the medical officer is that of a regular commissioned officer in the Navy, having 
 received his commission from the President, with the consent of Congress, and enjoys all the rank, 
 pay, allowances, privileges, courtesies, and advantages of all other officers. In civil life he is regarded 
 as holding a high social, professional, and official standing and place. On board ship he is a ward- 
 room officer, and his personal accommodations are the same as those of other officers. He has a 
 stateroom to himself, messes with all high-ranking officers below the rank of captain. On shore 
 he is provided with quarters which are heated and lighted and kept up at Government expense, or 
 in lieu thereof is granted a stated allowance in money with which to provide for himself, and may live 
 with his family. 
 
 The tenure of office in the Medical Corps of the Navy is for life, unless sooner terminated by 
 removal, resignation, disability, or other casualty. 
 
 Officers of the Medical Corps of the Navy are retired from active service at the age of 64 years, 
 and when so retired (or when retired from active service for disability or other casualty contracted 
 in line of duty before that age) receive an annual pay for life amounting to three-fourths of the 
 (highest) pay of their grade at the time of retirement. 
 
 If, upon examination for promotion, an officer is found disqualified by reason of physical disa- 
 bility incurred in line of duty, he is retired on an annual pay amounting to three-fourths that of the 
 grade to which he is due for promotion. 
 
 When any officer in the Medical Corps of the Navy has been 30 years in the service, he may, upon 
 his own application, in the discretion of the President, be retired from active service and placed upon 
 the retired list with an annual pay for life amounting to three-fourths of the highest pay of his grade 
 at the time of retirement. 
 
THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. " *? 
 
 Immediately upon official notification of the death from wounds or disease, not the result of his 
 own misconduct, of any officer of the Navy, the Paymaster General of the Navy shall cause to be paid 
 to the widow, and if no widow, to the children, and if there be no children, to any other dependent 
 relative of such officer previously designated by him, an amount equal to six months' pay at the rate 
 of pay received by such officer at the date of his death. 
 
 When traveling in the United States, under orders, officers of the Navy receive 8 cents a mile to 
 defray the expenses incident thereto, and when traveling by other than Government conveyance at 
 sea or outside the continental limits of the United States such officers are allowed actual expenses, 
 estimated on a liberal basis and in accord with the position of an officer, both as regard admissible 
 items of expense and the cost of such items. 
 
 For every five years' service the pay of officers is increased lo per cent (though not to exceed 40 
 per cent), calculated on the annual base pay of their grade; but the pay of medical director is 
 limited to $5,000, that of medical inspector to $4,500, and that of surgeon to $4,000. 
 
 When an officer goes to sea or leaves the continental limits of the United States under assignment 
 to stations or for the performance of other duties beyond the seas, his pay is increased 10 per cent, 
 and this increase is calculated upon the pay, including increases for length of service, which said 
 officer may be receiving at the time of entering upon such duty or to which he may succeed by virtue 
 of promotion or length of service during the performance of such duty. This increase for sea duty 
 or service beyond the continental limits of the United States does not fall under the statutory restric- 
 tions above mentioned, which control the increase of pay for length of service in the grades above 
 passed assistant surgeon. 
 
 Promotions to the higher grades are made in the order of seniority to fill vacancies as they are 
 created (by resignation, retirement, or death), and for each promotion a physical and professional 
 examination is required by law. 
 
 EXPENSES. 
 
 The expenses of an officer depend entirely upon his personal tastes and inclinations. The mess 
 bill in any mess averages $30 per month. The only mandatory expense is that of uniform, and here 
 again within reasonable limits an officer may be as extravagant or conservative as he desires. Per- 
 sonal and miscellaneous expenses are the same as would exist under the circumstances of civil life. 
 
 The duties of the Navy medical officer will keep him fully occupied. 
 
 The service is eminently scientific, following out lines of research, of construction, of developing 
 improvements, of education. It is attended by responsibilities which are heavy and of greatest 
 importance, and frequently far overreach those in civilian practice. There are pleasant and unpleas- 
 ant duties, hardships and hazards, as in all walks of life. It is however an honorable, progressive, 
 stimulating, self-respecting calling, satisfying to ambition, and of which the medical man may feel 
 justly proud, for can we not point to the many advances and discoveries in the development of medical 
 science which have originated with or have been determined by medical men of the military 
 establishments ? 
 
 There is also the satisfaction of giving a service not only of a special character but also of dis- 
 tinct and unusual value to one's country. 
 
 Note. — For further information address the Surgeon General, U. S. Navy, Navy Department, Washington, D. C. 
 
.•••4 
 
 THE NAVY AS A SPECIAL FIELD FOE MEDICAL WORK. 
 
 Examination Questions for Candidates Desiring to Enter the Medical Reserve Corps op the Navy, 
 WITH A View to Entering the Regular Corps at a Later Date. July 6, 1915. 
 
 1. Describe the abdominal aorta and its branches. 
 
 2. Describe the popliteal space and contents. 
 
 physiology. 
 
 1. (a) Define reflex action, (b) Discuss reflex arc, and 
 
 illustrate by diagram the simple reflex arc for the 
 spinal cord, (c) How is inhibition of the spinal re- 
 flexes brought about? (d) Discuss the knee jerk: 
 Method of production, reenforcement. 
 
 2. Discuss (a) secretion of gastric juice; (b) changes in 
 
 food undergone in stomach; (c) absorption from 
 stomach. 
 
 general surgery. 
 
 1. i)fescribe Pott's fracture and its production. Give treat- 
 
 ment. 
 
 2. Symptoms, diagnosis, and treatment of acute appendi- 
 
 citis. Describe operation in detail. 
 
 general medicine. 
 
 I. Discuss: (a) Etiology and modes of conveyance of 
 typhoid fever, (b) Complications of diabetes melli- 
 tus. (c) Morbid anatomy of Hodgkin's disease. 
 
 2. (a) The symptoms and physical signs of acute fibrous 
 pericarditis, (b) Diagnosis of uremia, (c) The pa- 
 thology and symptoms of herpes zoster. 
 
 materia medica and therapeutics. 
 
 1. Digitalis series : (a) Name three important plants which 
 
 contain bodies belonging to this series. (6) Name 
 three important glucosides in digitalis, and which 
 is the most powerful, (c) Discuss the action of 
 therapeutic doses of digitalis on the mammalian 
 heart. 
 
 2. (a) Give four methods of treatment other than 
 
 by drugs, with examples of each, (b) Discuss 
 treatment by vaccines, giving immunological 
 principles involved, method of use, and specific 
 examples. 
 
 OBSTETRICS. 
 
 I. (o) Describe briefly a normal labor in a primipara, giv- 
 ing the approximate duration of the several steps. 
 (b) Diagnosis of extra-uterine pregnancy. 
 
 Outline of Courses at the Naval Medical School. 
 
 Surgery, general, of warfare, operative (laboratory). 
 
 Ophthalmology. 
 
 Tropical medicine (also laboratory). 
 
 Pathology, bacteriology, helminthology (laboratory 
 
 courses). 
 Psychiatry. 
 Hygiene, general, military and naval. 
 
 and 
 
 Chemistry, volumetric and analytical (laboratory). 
 Medical Department duties. Naval Regulations 
 
 Instructions. 
 Drills for ambulance party. Hospital Corps, etc. 
 Roentgenology (including operation of apparatus). 
 Correspondence course for Reserve Corps and militia 
 
 officers. 
 
 o 
 
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