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N THE message from your Secretary-General requesting that a paper be read at this convocation, it was suggested that the subject. be: "Contributions of the Medical Corps, United States Navy, to American Medicine." This seemed a very broad subject and one which, if discussed at length, would require a much longer time to be handled properly than the twenty minutes allotted. Before proceeding to this discussion it seems proper to give you a slight understanding of the ordinary duties. of the naval medical officer, the work he does in his daily round, and of the benefits that are derived from this work, both by the nation and by American medicine, since whatever benefits the people of the nation in a physical way must be a contribution to medicine.

Before the year 1842, the Bureau of Medicine and Surgery did not exist as such and the duties of naval medical officers were not well defined. Their status was indefinite. They were really civilians within a military organization but not part of it. Their duties consisted in caring for the sick and injured on board ship and in being ready, at all times, to care for

1 Read before the American College of Physicians, Washington, D. C., March 12, 1925.

the wounded during and after an engagement. Naturally their contact with their associates on board ship was intimate and this, together with the fact that they themselves were forced to live under the very adverse conditions that prevailed on the wooden sailing ships of the old type, caused their efforts to be directed to ameliorating these conditions to as great an extent as lay within their power. It was essential that the men be kept "fit to fight." To accomplish this it was necessary that life on board ship should be made as nearly normal as possible. Thus much time and thought were given to the problems pertaining to ventilation, heating, lighting, and bathing as well as to the matter of a proper dietary on board ship. Much of our modern comfort of living, on shore as well as on the sea, to say nothing of the improved conditions under which our factory employees labor, is due to the suggestions made and devices utilized by these early pioneers in hygiene and preventive medicine whose aim was, as is also the aim of the present day naval medical officer, to keep the men at the guns.

The Bureau of Medicine and Surgery was one of the five bureaus of the Navy Department established by the Act of August 31, 1842. Regulations

ANNALS OF CLINICAL MEDICINE, VOL. III, NO. 12

then issued defined for the first time the duties of the Bureau, which was charged with responsibility in all matters pertaining to the health of the naval personnel. Summing up these duties, the Regulations state:

It shall safeguard the personnel by the employment of the best methods of hygiene and sanitation, both afloat and ashore, with a view to maintaining the highest possible percentage of the personnel ready for service at all times. It shall adopt for use all such devices or procedures as may be developed in the sciences of medicine and surgery, which will in any way, tend to an increase in military efficiency.

Saying that the Bureau of Medicine and Surgery is charged with these duties is equivalent to saying that these are the duties which must be performed by the individual medical officer. When their scope and extent is considered it is very evident that the time required for their proper performance leaves little opportunity for the average, conscientious medical officer of the Navy to engage in research work or to attempt to develop new methods of diagnosis or treatment of disease. It is his duty to know of the advances made by others and to apply these in such a way that the greatest benefit may derive to those under his care in the Naval service and to those native population wards of our government for whose physical welfare he is responsible.

By carrying out these duties the naval medical officer has assisted in making the Navy of today one of the healthiest bodies of young men in the world as well as an almost ideal training ground for the youth of the nation.

Not all of the men who enter the

naval service remain therein and those who go out after receiving the benefits. of its training, spread far and wide the gospel of cleanliness and healthy living.

In the final analysis, the disease incidence in the Navy is dependent upon that in the civil population. The Navy in safeguarding the health of its personnel cannot but influence the health of the nation, inasmuch as the men trained in personal and general hygiene sooner or later all return to civil life and disseminate through the United States the knowledge gained in the Navy as to how to keep well.

Herein lies the greatest benefit conferred upon the nation by the officers of the Medical Corps of the United States Navy and this is their great contribution to American Medicine.

Another very important service is in connection with providing opportunities for the evaluation of problems in preventive medicine. In the Army and Navy we have a definite complement serving under varying but ascertainable environments, so that the results of public health methods can be weighed with an exactness not possible in civilian communities. The studies made on the physical defects and disease incidence of the men serving in the Army and Navy during the World War are recognized as the most valuable contributions to the future health and welfare of the nation that have ever been published. The Army and Navy, as well as the nation, were fortunate during that period in having the services of the greatest men in the medical profession, whose patriotism and talents made these statistics a contribution of inestimable

value to future generations. Although returned to their practices or professorial chairs, they appreciate the opportunities in the hands of the medical officers of the regular establishments and give us their approval and encouragement.

At the present time I consider the control of venereal diseases our greatest problem as approximately twentyfive per cent of the damage done the Navy by diseases is from this cause.

We now have a board of line officers associated with us in the application of measures for the control of venereal diseases which we believe to be ethically correct and scientifically sound.

The environmental influences in many of the cities and towns from which our sailors come, are so bad, from a social hygiene standpoint, that we can hope for little result from our instruction. For the success of an educational program, explaining the dangers of venereal diseases and inculcating the necessity for continence, the start should be made in the home and in the schools. In the Navy we try to make the man think of the future, pointing out the effect. of disease on his advancement and the dire consequences which may follow in case of marriage.

If our advice is ignored, and infection follows, we encourage the men to seek early treatment, avoiding as much as possible all measures tending to weaken trust and confidence in their medical officers. In the control of any communicable disease it is essential that we have complete reporting, for which reason we discourage pressure on the men or medical officers which might encourage concealment of disease. Only concealment of disease

and failure to seek early treatment should be punishable.

We have spared neither effort nor money in the application of chemical prophylaxis, constantly seeking new formulas which may be more effective, but so far such measures have not given us the results we hoped for.

Living apart from the companionship of women makes more strong the longing for such association, and we recognize the help that can be given us by churches and other organizations in arranging entertainments where the enlisted men can meet young women of the right type and thus form desirable acquaintanceships.

Recognizing the importance of public opinion we try to support the influence of the man of character and to put an end to the pernicious activities of the man of loose morals. In our statistical reports and supporting analyses we are trying to assist in the solution of this most difficult problem.

Another study that we are conducting, which has aroused great interest among the psychologists, deals with the utilization of recruit material found intellectually deficient by psychometric tests. Such individuals, provided the psychiatrist does not recommend their immediate discharge, are kept under close observation by company commanders and their vocational response from week to week noted and recorded. This problem, like the venereal disease one, requires hearty cooperation between the line. officer and the medical officer. I often wonder whether there is as close coordination between medical and lay efforts in community welfare as such activities demand.

The ready response of the men of the Army and Navy to hazard their health or lives, when by so doing they may benefit others, is something we appreciate. The heroism of the men of the Hospital Corps of the Army who made possible the epochal discoveries of Walter Reed and his colleagues are well known to all of you.

In the Navy, we are very proud of the men of our enlisted force who subjected themselves to the efforts of Commander Rosenau, Surgeon McCoy and their colleagues of the Navy and Public Health Service to solve the epidemiology of influenza. The first experiments were made at the time of the devastating epidemic of 19181919, when death stalked in the shadow of the disease.

In the experiments at Boston and San Francisco there were 118 enlisted men who submitted themselves to experimentation, after being warned specifically that they were risking their lives. Various attempts to transmit the disease by inoculating pure cultures, and filtered and unfiltered secretions from typical cases of influenza, were carried out with entirely negative results. The well-known abilities of those who conducted these researches attest the thoroughness with which the experiments were planned and executed, and these tests established facts which could have been determined in no other way.

At the time I entered the Navy, thirty-six years ago, many of our senior officers had served in the period when the American clipper ships held sway. It is to be regretted that so few of these men published their experiences encountered in out of the way ports of every part of the world.

Their willingness to give to native peoples the advantages of medical skill must have made friends for American medicine and American institutions. Only recently I was reading of some of the remarkable operations done by Surgeon Ninian Pinkney in his cruises in South American waters. So well known was his surgical skill that when his ship would visit a port he was called upon to perform perform operations beyond the capabilities of the local surgeons. It may interest you to know that later on he was in charge of the first Naval Hospital Ship of the Civil War, the Red Rover, and the records of his operations on that ship explain the fame he had acquired in former years. His work must have added to the prestige of American medicine in South America.

When revolutions or civil wars take place in another country it is usual to send a man-of-war to give assistance to such Americans as may be living in that country. In this way many opportunities to help the wounded soldiers offer themselves to our medical officers. Frequently, the burden placed on the local surgeons is so vast that were it not for the help of the surgeons from visiting warships many of the wounded would die from lack of attention. In giving such service we often have the opportunity to make observations of value to medical science.

In 1891, while ashore in Valparaiso treating the wounded of the battles of Placilla and Concon, I was able to make notes on the differences between wounds made by small calibre bullets and those caused by lead bullets fired from older type rifles. This was the