N. M. S. 127404 (51) MAY I, 1923 The avy as a Special Field for Medical Work By The Surgeon General Illustrated WASHINGTON GOVERNMENT PRINTING OFFICE 1923 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 invited to the Navy for consideration of it as a special field for medical work. The career offered by the Medical Department of the United States Navy is one that should appeal to a reasonable number of qualified medical men. In the Navy the young medical officer has many occasions for travel in congenial company and with an assured position. The remuneration is adequate and the opportunities offered for scientific work are numerous. The practice of medicine per se in the Navy does not differ materially from practice in civil life. The naval medical officer must possess a good working knowledge of general medicine and surgery, but he has ample opportunity to take up the study and practice of one of the specialties such as ophthalmology, ear, nose and throat, tropical medicine, internal medicine, surgery, bacteriology, clinical chemistry, genito-urinary surgery, physiotherapy, roentgenology, psychiatry, etc. The vocation of a naval medical officer, however, constitutes a special field of medical work, as in naval practice the physician is confronted by many problems peculiar to the Navy, the solution of which requires special knowledge and training not essential to general practice or the pursuit of a specialty in civil life. The Navy consists of its ships, its navy yards for the building, repair, and upkeep of thes ships, its naval training stations for the training of recruits, its naval hospitals for the treatment of the sick, etc. The modern battleship with its complement of over a thousand men is a compact community in which the medical officer is concerned with questions of food and water supply, sewage and garbage disposal, the lighting of passageways, living quarters and workshops, heating and ventilation, the protection of the crew from communicable diseases, the maintenance of the general health of the men, and the care of the sick. To be successful the medical officer must keep himself thoroughly informed of the advances made in medical science and in sanitation; he must be familiar with the latest information relative to the cause and prevention of disease, the modern means of lighting and ventilation, special treatment of special diseases; he must have a knowledge of modern gas warfare, aviation medicine, and the special hygienic factors which pertain to the submarine and deep-sea diving. The competent naval medical officer must be ready at any time to undertake to the best of his ability the solution of any problem which he may encounter in his official capacity. The wide range in the character of the work in this special field of medical activity and the responsibilities entailed call for high professional standards and ready adaptability. Medical officers in the Navy are appointed after successfully passing a physical and a professional examination. Physically the applicant must meet the physical requirements of the Navy 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, served a term in a civil hospital, and have successfully undergone examinations for State board registration. Shortly after accepting his commission as a lieutenant, junior grade, in the Medical Corps of the Navy and executing the oath of office, the young naval medical officer is ordered to the naval hospital nearest his home, where he remains on duty until he is ordered to the Naval 3 4 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Medical School in Washington, D. C., to pursue a course of instruction designed to fit him for the special duties required by the naval service. The course at this school consists in lectures and practical laboratory work in tropical medicine, surgery, ophthalmology, otology, clinical chemistry, medical diagnosis, cardiovas- cular diseases, medical department duties, preventive medicine, naval hygiene, epidemiology, sanitation, pathology, medical zoology, physiotherapy, bacteriology, serology, haematology, basal metabolism, gas warfare, aviation medicine, genito-urinary diseases, roentgenology, clinical neurology, and psychiatry. . Upon completion of the course the members of the class are ordered to sea duty. Those who have entered the service without previous hospital experience, however, are usually ordered to a large naval hospital where they serve a year before going to sea. These naval hospitals are located in or near large cities, such as Boston, New York, Philadelphia, Norfolk, San Diego, San .Francisco, and Seattle. Here the young medical officer has an opportunity to perfect himself in the *practical side of his profession and to visit the hospitals and clinics of these cities. Sea duty is quite diversified. TheInewly appointed:medical officer may be ordered to duty as the only medical officer of a small naval vessel which may take him to interesting parts of the world—to the Mediterranean, the West Indies, Central America, China, or Japan. He may be detailed as junior medical officer of a battleship and serve in the fleet. One might wonder what a physician could do on one of these large vessels each of which carry from 1,200 to 1,600 men. The medical officer, of course, takes care of the sick and for this purpose he has available a spacious sick bay or ward containing from 20 to 25 bunks, and having all the conveniences for the treatment of injuries or disease to be found in the wards of a hospital on shore; an isolatioli ward for the treatment of communicable diseases; a fully equipped operating room with operating table, sterilizing apparatus, and cabinets of surgical instruments; a dispensary or small pharmacy where prescriptions are filled, raedicincis compounded, and the clerical work of the medical department is performed; a dressing and examining room completely equipped for dressing surgical cases, performing minor surgical procedures, and the examination of men. The medical department of each ship is equipped with a small clinical laboratory with sufficient apparatus and materials to make any of the clinical examinations required in the practice of modern scientific medicine. There is a medical storeroom containing supplies sufficient to meet the needs of a long cruise. The medical officer is responsible for the sanitation of the vessel, hence he must make frequent inspections of the decks, the sleeping quarters of the men, the ship's ventilation system, the galleys or kitchens, and the food served. He is intimately concerned in those measures which make up what is known to-day as preventive medicine. Ris endeavors to keep the crew well are equally as important as his measures to treat those who are sick. Hence he must be constantly on the watch to prevent the spread of communicable disease, to keep down the incidence of venereal disease, and to prevent men whose duties confine them more or less below decks from becoming below par physically. He must be interested in the ship's athletic activities and the physical drills which materially aid the physical well being of each member of the crew. As the battleship is designed primarily for battle the medical officer is concerned in the preparations for battle. For this purpose the ship is equipped with certain battle dressing stations behind armor and supplied with the necessary appliances to care for the wounded during an engagement. Definite plans are made for the conduct of the medical department of the ship during battle. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 5 The medical officer has to assist him on board ship a detachment of the Hospital Corps of the Navy. He is responsible for their instruction and consequently is interested in their advancement to higher ratings. Although the medical officer's day is usually crowded with official activities there is always time for recreation or the pursuit of a hobby. Often there is opportunity for boating, hunting, and fishing such as only the very wealthy may enjoy. Golf, tennis, and baseball may be played in nearly every port. Every one in the Navy must know how to swim, and there is plenty of chance for this pastime in the warm waters of the Tropics. Prominent among the amusements on board ship are moving pictures on deck at night and the ship's amateur theatricals and minstrels. While on the various types of fighting ships the medical officer's patients are men, on the Navy transports one encounters practice among women and children. Duty with the various submarine flotillas and with the airplane carriers requires a special knowledge of submarine hygiene and ventilation problems on the one hand and aviation medicine on the other. If the young medical officer has special qualifications he may be ordered to duty on one of the hospital ships of which at the present time the Navy has four, the Relief, the Mercy, the Comfort, the Solace. These vessels are complete floating hospitals with all the conveniences and equipment found in any modern hospital on shore. These ships carry a full staff of medical officers, most of whom are specialists in various branches of medicine. To the hospital ship are sent the sick of the fleet—those who are critically ill, those whose ailments will require a long time to cure, such surgical cases as demand special operative treatment, all wounded from engagements on board ship, or the wounded from shore expeditions. The hospital ships are ordered from place to place to meet the demands for their services in connection with the employment of naval forces. Although the medical officer's first cruise is generally upon a war vessel, he may be ordered to one of the Navy's foreign shore stations, such as the naval hospitals in Yokohama, Japan, Canacao in the Philippines, Guam, or at St. Thomas in the West Indies; he may find himself with the United States marines in San Domingo, Haiti, or Cuba, or with the naval forces on the Panama Canal Zone or connected with the American Legations at Managua, Nicaragua, or at Peking, China. 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 area occupied. In this way frequently valuable experience is obtained. Medical officers are at times assigned to general hygienic and sanitary work in connection with the development of certain island possessions, cleaning up of unhealthy localities in adjacent countries, etc. A medical officer's first cruise usually lasts from two and a half to three years. On coming ashore he generally finds himself due for promotion with consequent increase in pay and allowances and receives an assignment to duty at one of the various shore establishments. Among these may be mentioned the naval hospitals, navy yards, training stations, torpedo stations, the. Hospital Corps schools, the Naval Medical School, recruiting stations, naval dispensaries, aviation fields, the various marine bases and barracks, and the Naval Academy. The naval hospitals in the United States are located at Portsmouth, N. H.; Boston, Mass.; Newport, R. I.; New York, N. Y.; Philadelphia, Pa.; Washington, D. C.; Annapolis, Md.; Norfolk, Va.; Charleston, S. C.; San Diego, Calif.; Mare Island, Calif. (near San Francisco); Bremerton, Wash. (near Seattle); and Honolulu, Hawaii. These hospitals are large, completely equipped establishments and compare favorably with the best civilian hospitals. 6 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. An idea of the magnitude of these hospitals may be gathered from the following description of the naval hospital recently erected at San Diego, Calif.: The hospital site, consisting of 10.7 acres, is located on ground about 224 feet above sea level and surrounded by the park system of San Diego, known as Balboa Park. The plan selected for this hospital is that of a rectangular block. The orientation is westerly, this being necessitated by the nature of the terrain; the hospital, facing the Pacific Ocean and the harbor of San Diego, is favorably situated in regard to the prevailing breeze. In order to conform to the local style of architecture, the mission type has been adopted. The construction is fireproof, consisting of hollow tile with light buff stucco exterior. The interior is finished with plaster laid on metal lath, with hollow-tile partitions. The roofs are pan-and-cover red tile, or, where required, glass tile; and on flat roofs a pitch composition is used. In the wards and corridors of the hospital building red magnesite has been adopted, this being laid on a concrete base with a cove of the same. The diet kitchens, toilets, bathrooms, utility rooms, and dressing rooms have a white vitreous 21-inch square tile floor and wainscot. The lobby of the administration building has the floor and wainscot of gray Tennessee marble. The dining rooms in the subsistence building have a magnesite floor. The main operating rooms have a floor of white marble tiles 6 by 6 and also a 7-foot wainscot of the same material. The walls generally, where no wainscot is provided, are of plaster and painted a light buff color. No artificial ventilation system is provided, but all ward spaces are furnished with double-hung windows provided with separate shades for each section. The various buildings of the hospital are provided with automatic telephone connections. A silent call system is installed in all spaces occupied by patients. Electric elevators (not automatic) are provided in all separate buildings. Automatic electric dumb-waiters are furnished for serving the food to the diet kitchens on the various floors. The power house, located in the southeast corner of the reservation, supplies steam for all purposes. A recently devised burner of high efficiency, through the use of compressed air, makes this arrangement very economical. Electric current is obtained from the city mains. Heat is supplied by direct radiation, steam being carried through high-pressure lines to each building and there reduced. Hot water is furnished from generators in the basement of each building. In the completed hospital the erection of the following buildings is contemplated: An administration building is located at the center of the west side of the rectangle with a two and one-half story ward building on either side. On the east side of the rectangle at the center is a three-story subsistence building and on either side of that a three-story ward building. The inclosed court, having dimensions of 380 by 85 feet, is divided into three equal portions by walks, and will contain an operating building and a specialty building, the former located between the proximal ends of the northerly wards and the latter in corresponding position between the southerly wards. In the rear of the subsistence buildings there is to be erected a building for the installation of the various artificers' workshops and on the second floor barracks for the hospital corpsmen. To the northward of this building is a recreation building erected by the Red Cross. North of the main hospital will be erected a ward for officer patients and quarters for the medical staff and for the nurses. To the south of the hospital there is to be a contagious building, and in the southeast corner a building for the civil personnel. All the buildings assigned for the care and treatment of the patients are to be connected on their court side by a covered and partially inclosed passageway, that portion connecting the operating building with the wards being entirely inclosed, THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 7 The administration building is three stories in height in the wings and five in the center, the latter being surmounted by two ornamental mission. tOwers. The first floor of this building has a waiting room, offices for the commanding and the executive officers and the officer of the day, offices for administrative purposes generally, and a dispensary. On the second floor are located consultation rooms, a medical library, chief nurses' offices, and offices for the junior medical officers. On this floor, and also on the third and fourth floors, with the necessary toilets, utility rooms, and diet kitchens, are 30 rooms for sick officers. The roof over the central portion is partially inclosed for use as a solarium. The ward buildings are so similar that one description will, with minor exceptions, serve for all. Each is calculated for 30 beds on 8-foot centers, giving approximately 1,200 cubic feet of air space per patient. The proximal portion of each ward space contains four quiet rooms, a linen room, dressing rooms, utility, bath, toilet, diet kitchen, and nurse's room. At the distal end is located a large solarium separated from the ward by a utility room and toilets. Each ward wing on the west side has two complete stories and for about half its length a fourth floor which is designed for treatment in the open air, having a large open area 20 by 20 feet, the rest of the space being occupied by a recreation room, diet kitchen, and the usual utility rooms. The ward buildings on the west side of the rectangle differ from the preceding only in that they have an additional ward in each. The north and south buildings, completing the inclosure, will be two stories at the western end and three stories at the eastern end, being adapted to the height of the adjoining wards on the west and east sides, respectively. The subsistence building has a basement in which is located a carbonic acid refrigerating machine, which also manufactures ice for the hospital. Separate chill rooms are provided for fresh meats, smoked meats, poultry, butter and eggs, milk, vegetables, and ice cream, the temperature of each of these spaces having automatic thermostatic control. The remaining space of this basement affords storage for dry provisions and the meat and vegetable preparation rooms and a mess room for the civil employees. The supplies are transported to the main kitchen by means of dumb-waiters. On the first or ground floor, centrally located, is the main kitchen, with a complete equipment of ranges, stock kettles, steam roasters, and steamers. The fuel used in the ranges is crude oil, which is economical and convenient. Adjacent to the main kitchen is the main diet kitchen. The wings of this building are occupied by two mess rooms, each accommodating 96 patients, and scullery equipment. Two sterilizing and dishwashing machines assure thorough cleansing of tableware. On the second floor is located the mess rooms for the hospital corps (72 men) and 119 patients, also a dining room for the staff mess. The operating building' consists of two stories. On the ground floor is the dental operating rooms, dressing room, operating room for nose and throat department, a small laboratory, and X-ray room. This floor is magnesite. The main operating rooms, two in number, are situated on the second floor, with a northern exposure, and have between them the sterilizing and instrument rooms. Separated from the above by an east-and-west corridor are the anesthetizing rooms, recovery room, the nurses' dressing room, and a workroom. Artificial lighting of the operating rooms is provided by five 100-watt ceiling lights. Access to this floor is by means of elevator and also by a stairway. The main operating rooms have white marble floors and wainscoting of the same. The specialty building contains the general laboratory activities, chemical bacteriological and seriological, also the X-ray department, the eye, ear, nose, and throat, and physiotherapy services. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. At the navy yards which are located near large cities the medical officer is associated with an industrial establishment employing thousands of men and is concerned with industrial hygiene, accident prevention, and all those special endeavors which make up the rapidly progressing specialty known as industrial medicine. The Navy Department maintains four large training stations for the prepnration of young men between 18 and 21 years of age for the naval service. These stations are located at Newport, R. I.; Norfolk, Va.; Chicago, Ill.; and San Francisco, Calif. A new training station is in course of construction at San Diego, Calif. Duty at these training stations ranks among the most important of the varied duties which fall to the lot of a naval medical officer. At each station are gathered between 1,500 and 3,000 young men at an Age when environment and association make lasting impressions. These men come from the country or from the city, bringing to the stations all of the communicable diseases common to childhood and early adult life. The responsibility for the early detection and prevention of the spread of these diseases among the men under training, or, more important still, the prevention of the transmission of these diseases to the fleet, rests with the medical officer. Therefore each recruit on arrival is placed in a detention barrack for a period of three weeks. While in quarantine he is vaccinated against smallpox, typhoid, and paratyphoid fever, and is given instruction concerning personal cleanliness and the venereal diseases. He is given a thorough physical examination in order that any defect may be detected which inadvertently may have escaped the notice of the examining surgeon at the recruiting station. At the end of the period of detention the recruit enters upon the course of instruction provided for him by the Navy Department. All through his training he is under the watchful eye of medical officers who are ever ready to nip in the bud an impending epidemic or to eliminate those who are found during the course of training to be physically or mentally unfit for sea duty. Recruiting stations are maintained in many large cities throughout the country, in order that the vacancies which occur daily in the Navy by reason of the expiration of enlistment periods may be filled. The duty of medical officers at these stations is also highly important and in reality constitutes a specialty. The medical officer on recruiting duty must be capable not only of making a thorough physical examination of each applicant, but he must be able to judge from the general make-up of the man whether or not he will be able to maintain bodily efficiency under essential service conditions. No medical officer ever develops the skill required for the examination of recruits for the naval service unless he has been at sea on a cruising ship and has noted the physical qualificationiirwhich:are:necessary in the various ratings on board ship in order to maintain that ship in the state of greatest efficiency. Two schools for the training of Hospital Corps men are maintained by the medical department of the Navy, in which the younger medical officers act as instructors. From the foregoing we see that the medical officer's field of activity is quite diversified. The alternating periods of sea and shore duty continue until the upper grades are reached, when the officer is detailed as the senior medical officer of a navy yard or a training station, or is detailed to command one of the naval hospitals, the Navy Medical School, or is given some other desirable assignment. Medical officers are encouraged in every way to maintain themselves at the highest state ot efficiency in their profession. They are encouraged to perfect themselves in special branches which they may have a desire to enter because of a special inclination 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 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 9 43131-2 3----2 , Naval Hospital, San Diego, Calif. 10 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 1.1111,11........ r......" 0 0 7-777,,ó; '1' 6 .- eV 02,, - CiP ‘, PLOT , PLAM SCALE • i ' • 4ol-o! ...."7:77 100 . 1\IP,VAL,1-105PITAL, .___1"---1 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 11 United States Naval Medical School, Washington, D. C. Chemical and pathologica llaboratories, United States Naval Medical School. 12 Type of AfedicalOfficer's Quarters. Type of Navy Yard Dispensary and Surgeon's Office. 14 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 15 nite. States Naval Hospital, Norfolk, Va., Type of older institution thoroughly remodeled 16 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Medical officer's quarters at a naval hospital in the tropics. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 17 A naval hospital in the tropics. • 43131-23-3 18 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. U. S. Naval!Hospita1,1Yokohama,!Japani Entrance to the U. S. Naval Hospital, Yokohama, Japan. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. I • I w • r 1111111 f L. O .,••••.11 Ids . Li 1-7 L-- ° r-- - L--- 0 if; 8 0 I. nl Floor plan, new hospital construction. 111111 A • UI rl 2 CDNICG2111a caobAN 4 Jx UI 0.2 CI ri 0 0 . 18 Sci 01I k] 04 11 a 201 Dor tuD x iEf 19 20 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Naval hospital, Newport, R. I. The personnel of a naval hospital. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 21 Operating room, Naval Hospital, Norfolk, Va. 22 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Operating room, Naval Hospital, New York Medical ward. Naval Hospital, Norfolk, Va. Clinical laboratory at a naval hospital. 23 24 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. A corner of a clinical laboratory in a naval hospital. Pneumonia ward in a naval hospital. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 25 Medical officer's office in a naval hospital. 43131-23-4 Kitchen of a naval hospital. United States Naval Hospital, Mare Island, California. Medical officers, United States Naval Hospital, Mare Island ,California 26 Commanding officer and nurses, Muted States Naval Hospital, Mare Island, California. Hospital Corps detachment, United States Naval Hospital, Mare Island, California. 27 28 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. The grounds of the U. S. Naval Hospital, Mare Island, California. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 29 In the grounds of the U. S. Naval Hospital, Mare Island, California. FIG. 21.—The_base ball team of a Naval Hospital composed of Hospital Corpsmen. Athletic team at a naval hospital. 30 31 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Living room of nurses quarters at a naval hospital. Porch of medical officer's quarters at a naval hospital. 32 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. United States Naval Hospital, Boston, Mass. A group of convalescing patients at a naval hospital. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 33 A ward in the naval hospital, Newport, R. I. 34 Recreation rooms at a naval hospital THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. A corner of a clinical laboratory at a7navalhospital. A portion of the grounds at a naval hospital. ( 35 36 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. United States Hospital Ship " Relief." THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 37 Wardroom on the Hospital Ship "Relief." MEDICAL QFF -ERs NI 1:g NAVY YARN• JA, 38 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Medical officer's stateroom on a hospital ship. >$. 1 t LI E.F mrpicAt_ OFFICERS snvre.Room. r\„pr 'ffk,11). C1ttLA ri,e 3. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK, 39 Operating room, U. S. Hospital Ship "Relief." 40 THE NAVY AS A SPECIAL FIELD FOR. MEDICAL WORK. Hoisting patient aboard a hospital ship. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 41 Operating room on modern battleship. (A\L\\t\t\f‘i\--0‘,Lra.t%r17Ekv)%‘, 42 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 516K BAY 15O LATIOR °ATE' WARD TrEAT4iitgr KO om .316K crews JPACE \ r---4-- \ OPERATING Roots CIIEMic t L4 80.t11 DENTAL X 4 Aft. PIS PY ofrficE, Room Type of medical department space on modern battleship. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORN.. 43 A section of the sick bay on a modern battleship. 44 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Aviation ambulance boat. Aviation ambulance. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 45 The operating room of a field hospital and its personnel. MIL all111111110111111MUM 1•111.61061.-. a I II /P1,--- 8.1r • • a kats - - tlY! 1 Physical development in the Navy. 46 U. S,Haspital;Ship "Solace" ready for a cruise. [Native houses nearithe[navallhospital, Guam. A portion of the naval hospital, Guam. 47 48 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Near the naval hospital, Guam. The waterfront at San Juan, Porto Rico. 49 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Street leading to the United States Naval Hospital, St. Thomas, Virgin Islands. United States Naval Hospital, St. Thomas, Virgin Islands. 50 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. A view near the Naval Station, Samoa. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 51 A view from the Naval Station, Samoa. In far-away Japan. 52 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Holiday festivities at the Naval Station, Samoa. A Samoan house. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. "East of Suez." "Bag inspection," Hospital Corps school. 53 54 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Using blanket roll in fracture of leg. First-aid drill. O 0 0 0 "E:1 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 55 Hospital Corps stretcher drill. 56 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Hospital Corps stretcher drill. 57 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Laboratory instruction at a Hospital Corps school. 58 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Class work at a Hospital Corps school. 59 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. Instruction in first-aid. Instruction in typewriting at a Hospital Corps school. 60 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. The Navy stretcher (Stokes {splint stretcher). THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 61 order that they may be detailed to duty where an opportunity exists. Special assignments are made for the purpose of enabling officers to undertake studies or research. 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 and the study of languages as well as professionally. 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. He 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 wardroom officer, and his personal accommodations are the same as those of other officers. He has a stateroom to himself, and 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 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 disability 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. 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 will cause to be paid to the widow, and if no widow to the children, and if there he no children to any other dependent relative of such officer previouslr 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 under orders, by other than public conveyance, officers of the Navy receive 8 cents a mile to defray the expenses of such travel performed from point to point within the United States, and when so traveling abroad are allowed actual personal expenses, estimated on a basis varying with the rank of the officer, both, as regards admissible items of expense and the cost of such items. In case of a permanent change of station, transportation for wife, dependent children, and household effects is furnished. Medical officers in the lower grades of the Medical Corps are advanced in rank up to and including the rank of lieutenant commander with the officers of the line with whom or next after whom they take precedence under existing law. Promotions to the higher grades are made by selection by a board composed of five medical officers to fill vacancies as they are created (by legislation, resignation, retirement, or death), and for each promotion a physical and professional examination is required by law. For further information address the Surgeon General, United States Navy, Navy Department, Washington, D. C. 62 THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. PAY AND ALLOWANCES OF COMMISSIONED OFFICERS. Pay. Allowances. With dependents. Without dependents. Rank. Pay. Personal cash allowance. Rental. Ssaub- Ret- Subsistence allow-. ance. $2, 200 allow- • t, allow-awe.* 500 ance.* ence ance. $438 438 438 438 Admirals $8, 000 $1, 262 $960 960 960 960 $219 219 219 219 Vice admirals 8, 000 1,262 Rear admirals (upper half) 8, 000 1,262 Rear admirals (lower half) 6, 000 1,062 Un- Over Over Over Over Over Over Over • Over Over Over Over $960 $219 der 3 years. 6 years. 9 years. 12 years. 15 years. 18 years. 21 years. 24 years. 26 years. 27 years. 30 years. 960 219 3 $4, 900 960 219 years. Captains: $3, 500 $3, 675 4, 200 $3, 850 $4, 025 4, 6001 $4, 200 $4, 375 $4, 550 $4, 725 5, 600 $5, 800 $6, 000 $1, 440 $438 Over 26 years' service 4, 000 4, 400 4, 8001 5, 000 5, 200 5, 400 $5, 600 1, 440 657 Less than 26 years' service.. 1 1, 440 438 Staff, selected to captain Under 3 years. Over Over Over Over Over Over Over Over Over Over $5, 075 $438 3 years. 6 years. 9 years. 12 years. 15 years. 18 years. 20 years. 21 years. 24 years. 27 years. Over 657 30 years. 657 $5, 750 657 Commanders: $3, 000 $3, 150 $3, 300 $3, 450 $3, 600 $3, 750 $3, 900 4, 550 $4, 725 $4, 900 1$1,440 $960 $219 Over 30 years' service 3, 500 3, 675 3, 850 4, 025 4, 200 4, 375 $4, 550 1, 440 960 219 Over 20 but less than 30 years' 1, 200 720 219 service 1, 440 960 219 With less than 20 years' service Staff, selected to commander Un- Over Over Over 12 years. OverOver Over Over Over Over Over Over Over • der 3 6 years. 9 years. I 14 years. 15 years. 18 years. 21 years. 23 years. 24 years. 27 years. 30 years. $219 3 years. years. $3, 750 $3, 900 219 219 219 Lieutenant commanders: 42, 400 $2, 520 $2, 640 $2, 760 $2, 880 3, 600 $4, 050 $4, 725 $4, 900 $5, 075 $5, 250 1$1,440 $657 $960 Over 23 years' service 3, 000 3,150 3,300 3, 450 $3, 600 1, 200 657 720 Over 14 but less than 23 years' 960 438 720 service 1, 200 657 720 With less than 14 years' service First appointed above ensign Un- Over Over Over Over Over Over Over Over Over Over Over Over der 3 years. 6 1 7 9 years. 12 years. 15 years. 17 years. 18 years. 21 years. 24 years: 27 years. 30 years. 3 years. years. 760 $3, 750 $4, 500 years. Lieutenants: $2, 000 $2, 100 $2, 640$2, $2, 880 $3, 000 $3, 900 $4, 050 $4, 200 $4, 350 $1,200 $657 $720 $219 Over 17 years' service 2, 4011 2,520 $2, 200 960 438 720 219 Over 7 but less than 17 years' 2, 400 2, 520 2,640 720 438 480 219 service 2,6401 960 438 720 219 With less than 7 years' service 960 438 720 219 First appointed above ensign Commissioned as lieutenant from or prior to 1 July,1920 Un- Over Over Over Over Over Over Over Over Over Over Over $438 der 3 years. 6 years. 9 years. 10 years. 12 years. 15 years. 18 years. 21 years. 24 years. 27 years. 30 years. 438 3 2,000 $2, 200 $3, 480 $3, 600 219 years. 438 Lieutenants (junior grade): $2,100 42, 300 $2, 880 $3, 000 $3, 120 $3, 240 $3, 360 $960 $720 $219 Over 10 years' service $1, 500 $2,760 720 480 219* Over 3 but less than 10 years' 480 480 219 service 720 480 219 With less than 3 years' service First appointed above ensign *Rental allowances do not accrue to any officer on shore duty furnished public quarters or to officers without dependents when on sea or geld duty. When the total of pay and allowances exceed $7,200 the rental allowance shall be reduced by the amount of the excess above $7,200. THE NAVY AS A SPECIAL FIELD FOR MEDICAL WORK. 63 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. Personal 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. A Navy ambulance. The service is eminently scientific, following out lines of research, of construction, of developing improvements, of education. Its traditions are of the best. It is attended by responsibilities which are heavy and of greatest importance, and frequently far overreach those in civilian practice. There are pleasant and unpleasant 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 distinct and unusual value to one's country. 0