| Index |
SECTION I. SURVEYS ON INVALIDS. 1227. Surveying Officers.- Surveys upon subjects for invaliding are to be held under the authority of the Commander-in-Chief, or of the senior-officer present, by a Captain or Commander, who is in every case to preside, and three medical officers, including the Surgeon-General or Deputy Surgeon-General in medical charge of the fleet, if any ; when the survey takes place at a naval hospital the surveying officers will be assisted by the Principal Medical Officer. 2. Injuries not affecting bodily health.- When a survey at a naval hospital is held on an officer or man who is brought forward from the hospital for invaliding owing to an injury which does not affect his bodily health, and is not likely to lead to further surgical complications, on which question the medical board is first to decide, the Executive Officer who presides at the survey is to give the final opinion as to whether such injury alone would debar the subject from the proper performance of his duties. If a case of recovery from a simple uncomplicated minor injury occur on board a ship, the subject is not to be submitted for survey at a hospital, but the Captain of the ship is to decide as to his further fitness. 3. Injuries impairing bodily health.- If a man is brought forward for survey on account of an injury which renders him unfit to perform his ordinary duties, or by which his bodily health is impaired, the Executive Officer is to state on the report of survey his definite opinion from an executive point of view as to the duties which the man could properly perform, and the Principal Medical Officer is to state his opinion as to the duties which the man's health would enable him to undertake, and whether he is recommended for service in the Reserve. 4. Claims to Naval Pensions.- Seamen and marines invalided will be examined as to their claims for naval pensions, under Article 1933, on the same days as those on which the invaliding surveys are held. 1228. Application for Survey.- The form S. 333 for survey, carefully filled up in respect to all the subjects, is to be taken to the survey by the Medical Officer if it has not been forwarded to the Senior Officer for a special survey to be ordered, and also the certificates and medical history sheets of the men brought forward. 1229. Information to Surveying Officers.- Subjects for survey from ships are to be accompanied by the Medical Officer who brings them forward, or some other officer conversant with the cases, to afford the surveying officers all the information in his power. 2. Marines from Headquarters.- Officers of Royal Marines from headquarters are to be surveyed at the naval hospital; the Medical Officer of Marines who accompanies them to the hospital mill sign the reports. 431 Marines sent from headquarters to be surveyed are to be accompanied by the Adjutant and a Medical Officer of Marines, both of whom are to sign the reports. 1230. Invaliding Abroad.- In the case of an officer abroad, the surveying officers, if they are satisfied that his continued employment on the service in which he is engaged would be attended with
are to report to that effect on form S. 332 giving full particulars of the causes of disability. 2. At Home.- In the case of an officer at home he is to be sent to the nearest naval hospital with a view to being invalided thence. 1231. Reports of Survey on Officers.- The reports of survey (form S. 332) upon each officer found incapable of continuing on the station where he is employed or in active service, are to be made out in duplicate and signed by the surveying officers; they are to be delivered by the Captain to the Commander-in-Chief, or Senior Officer, who is to send one copy bearing his signature of approval to the officer surveyed, and the other copy to the Secretary of the Admiralty. 2. The fact of an officer being invalided is at once to be telegraphed to the Admiralty, stating the cause, together with the port and probable date of arrival. If these cannot be stated, the name of the steamer or route by which the officer will return to England should be substituted. 3. A commissioned officer invalided abroad shall send the report which he receives to the Admiralty as soon as he arrives in any part of the United Kingdom ; and a commissioned warrant or other warrant or subordinate officer is to present it at the hospital he may repair to, or to the Captain of the ship to which he may be discharged. See 1235 (Survey at Admiralty on arrival Home). 1232. Medical Case.- The Medical Officer of the ship is to send, by the first opportunity, to the Medical Director-General, a detailed statement, on form M. 188, of the commencement and progress of the complaints for which an officer has been invalided. 1233. Reports of Survey on Men.- Separate reports of survey are to be made out on form S. 332a for
Disposal of Reports.- The reports, after having been duly signed, are to be delivered or forwarded to the officer ordering the survey, by whom they are to be sent to the Admiralty. 2. Surveys on Marines.- In the case of marines at the home ports, the report of survey (form S. 332a) is to be sent to the Commander-in-Chief for his information, and is then to be returned to the hospital, where it is to be retained as a record. 1234. Re-survey of Continuous Service Men.- Continuous service men and boys who have been invalided, are, on arrival in England from abroad, or when brought forward at places on the home stations where there is not a naval hospital, invariably to be re-surveyed (form S. 333) at the nearest establishment of that kind. Those found on re-survey to be serviceable, if their 432 ships should be at home, are to be returned to them, or, if they should be abroad, are to be sent to the general depot at the port for disposal. The reports are not, however, to be sent to the Admiralty. 1235. Survey of Officers at Admiralty.- Commissioned officers of the Navy and Marines invalided from foreign stations will be examined at the Department of the Medical Director-General daily (Sunday, Christmas Day, and Good Friday excepted), between 11 a.m. and 2 p.m., and they are to appear there for that purpose as soon as possible after their arrival in England ; if from illness they are unable to do so, they may be examined at the nearest naval hospital. 2. Surveys at Haulbowline.- Officers found unfit for further service after survey at Haulbowline Hospital are to be directed to appear at the Department of the Medical Director-General for examination in the same manner as if they had been invalided abroad. 3. Officers to be surveyed at Hospitals.- Subordinate officers, commissioned warrant officers, and warrant officers invalided from abroad are to be re-examined at one of the naval hospitals at home. If any of them should land at any port in England where there is no hospital, and be unable to travel to one, they must transmit to the Secretary of the Admiralty a certificate of such inability, signed by the Captain and the Medical Officer of the ship in which they came home, or by the Admiralty Surgeon and Agent at the place, or, if there is none, by any registered medical practitioner ; and when able to travel, they are to proceed to the nearest naval hospital. 4. Travelling expenses will be allowed to all officers as provided for in Chapter XL. 5. Officers unnecessarily invalided.- If it shall in any case appear that an officer has been unnecessarily invalided, lie will be ordered back forthwith to rejoin his ship, and the Admiralty will take such other measures with regard to him and to the surveying officers as the case may require. See 3231 (Report of Survey to be sent to Admiralty by 0 Officer on arrival). SECTION II. HOSPITAL AND SICK QUARTERS. 1236. Patients to Hospital.- When practicable, a medical officer is always to accompany a patient to hospital. 1237. Unfit Cases.- If the Medical Officer in charge of a hospital should consider any particular patient (officer or man) sent to hospital not to be a fit case for treatment there, the patient is still to be received, but the Medical Officer will report his opinion, with the grounds for forming it, to the Senior Officer. 1238. Officers' Servants.- No officer while sick in a naval hospital is to take his servant to attend upon him where there is a star of nurses or other attendants provided; in exceptional cases, when it may be necessary to permit a servant to accompany his master to hospital, the victualling of the servant is to be arranged from afloat. 1239. Infectious Cases.- All persons serving in ships who are afflicted with any infectious disease are, if practicable, to be sent to the nearest naval hospital as soon as possible. 2. Itch.- Patients affected with itch are to be received into naval hospitals at home and abroad, provided they are not sent in such numbers as to encroach on the room and accommodation required for the treatment of more serious cases. 433 1240. After Venereal Disease or Itch.- No man after being under treatment for venereal disease or itch is to be allowed to go on leave until eight days have elapsed after his discharge from the sick list. 1241. Patients' Clothing.- Officers are to be allowed to take with them to hospital such clothes or effects as they may desire ; but men are to take the whole of their clothes and effects. See 1168 (Arms and Accoutrements of Marines). 1242. Supplies of Clothing.- If a patient should require to take up a supply of clothes or material at the hospital, the value is to be charged as directed by Article 1588 when provided with a ticket ; otherwise as directed by Article 1601. 1243. Discharge of Patients.- Captains are to receive from the hospital authorities the particulars relative to patients from their ships who may die, or be discharged invalided, or are otherwise disposed of, so that proper notations may be made on the ship's books. See 1601, clause 3 (Pay Ticket). 1244. Disposal of cured Patients.- When patients are cured, they are to be returned to the ship to which they belong if she is in port ; but if not, they are to be discharged from the hospital, received as supernumeraries, and retained either for passage or disposal, in such ship as, in the absence of general local orders on the subject, the senior officer present may specially direct. 2. Patients from hospital as well as from the sick list may be treated as convalescents for so long as the Medical Officer of the ship may think it necessary. 3. Discharged Patients unfit to rejoin.- If any patients on being discharged from hospital should be deemed unserviceable, or if there are urgent reasons why they should not be received on board, and if reference to a senior office is impracticable, they may be sent back, but the Principal Medical Officer of the hospital should receive from the Captain and the Medical Officer of the ship with the returned patients a statement of the grounds for refusing to receive them, and full particulars are also to be at once furnished to the superior authority under whom the Captain may be acting. 4. Misconduct in Hospital.- The misconduct of a man while in hospital is to be reported by the Principal Medical Officer to the Captain of the ship or the Commandant of the division to which the man may belong. 1245. Men invalided.- When a man is invalided out of the Service at a hospital, the officer presiding at the survey is to certify to the fact by his signature on the service certificate. In the case of a marine he is to notify the fact of the invaliding to the Colonel Commandant of his division. See 829, clause 7 (Assessment of Character) ; 1168, clause 2 (Disposal of Marines). 1246. Landed for Treatment.- If the necessity should arise for landing sick officers or men at a place where there is no hospital or sick quarters, the Senior Officer is to make the best arrangements in his power. If the services of a private practitioner are necessary, he is to enter into a contract with him for the attendance and medicines for each patient, and the victualling also if deemed expedient, on such terms as may be best for the public service, with due regard to the comfort and care of the patients. 2. Duties of Private Practitioners.- The practitioner so appointed is to be required to render any returns or reports that may at the time be deemed necessary. He should be informed that he will receive the usual documents with the patients, and when they are returned to their own or to any other 434 ship he is to send back the documents, and obtain from the Captain a certificate that the patients have been received. If any patient die or desert, he is to note the date on his ticket, and send it, with a statement showing how his effects have been disposed of, to the Admiralty for the Accountant-General, and a duplicate thereof to the Captain, or, if the ship has left English waters, to the Commodore of the man's port division. In cases terminating fatally, he is to note the particulars of death on the medical case which accompanied the patient, also the course of the illness and the treatment, and transmit it to the Medical Director-General. 3. Payment.- Before approving of the payment of these accounts, the Senior Officer will assure himself that they have been carefully examined by competent officers. 4. Illness, &c., on Leave.- Where there is no naval hospital nor regularly established sick quarters, the expense of medical attendance by private practitioners, consequent upon accidents or illness occurring to officers while on leave, will only be allowed when the Admiralty are satisfied as to the circumstances and causes thereof, and where the exigencies of the case would not admit of the officer being removed to a naval hospital. A special report is to be made on each case, which will be considered on its merits. The expenses of dental treatment will not be allowed. 5. In a case of emergency, where it is necessary for a surgical operation to be performed on an officer on leave by a private practitioner because the officer's condition renders him unable to travel to a naval hospital, the sum allowed in payment of such operation will be specially considered, but will not exceed 251. unless in very exceptional circumstances. 1247. Sick Quarters.- When patients are sent to sick quarters on shore other than those of established Surgeons and Agents, or to civil hospitals, &c., a statement, showing why the case could not be safely treated on board, is in each instance to be approved by the Captain and forwarded at once to the Admiralty for the Medical Director-General. When there is no Medical Officer in a ship, the Captain will obtain this information for transmission from the practitioner to whom the patient is sent. 1248. Subsistence.- No charge will be made for the subsistence of patients of the Naval or Military Service in the hospitals of either Service, but the stoppages to which army officers are liable under Army Allowance Regulations, are to be received, and the Accountant Officer of the hospital is to debit himself with the amount as a credit to the proper Vote. 1249. Distressed British Subjects.- Distressed British subjects arriving home in ships may be sent to naval hospitals until they can be received in the union workhouses as casual poor, or conveyed to their proper unions or parishes. 1250. Deaths and Funerals.- If a person belonging to the Fleet should die on board a ship at a place where there is a naval hospital, the body is to be sent to the hospital for interment ; but if the friends of the deceased desire to undertake the burial, the body is to be delivered up to them, and a sum in aid of the funeral expenses, not exceeding the cost that would have been incurred had the funeral been carried out by the hospital authorities, is to be allowed them if they apply for it. This is to apply also to officers and men of ships who may die at their homes or elsewhere on shore, at any place where there is a naval hospital, and whose friends may prefer that they shall be buried from their homes rather than be sent to the hospital for interment wholly at the public charge. 435 2. When a body is sent to hospital for interment, the Medical Officer of the ship is to forward a statement, approved by the Captain, of the deceased's age, date of death, and the disease of which he died. 1251. Deaths while on Leave.- Officers and men of ships, including any on leave, who die at a place where there is no naval hospital or burial ground, may, unless their friends wish to undertake the burial, be interred at the public expense ; but if their friends wish to undertake the burial, the body. is to be delivered up to them, and a sum in aid of the funeral expenses, not exceeding the limits prescribed hereunder, may, if applied for, be allowed. In no case can a grant in aid be sanctioned by the Admiralty exceeding 141. for the funeral of an officer, or Pit. for that of any other person. Proper vouchers, for such payments as the Captain may direct to be made under this head, but which are not to include the cost of hatbands, scarves, or gloves, are to be transmitted by the Accountant Officer with hip cash account. The amount specified for the funeral of an officer or man is for actual funeral expenses only, and is not to include any expenditure for the erection of a tombstone or monument. 2. Coast Guard officers are also instructed to make the necessary arrangements when such persons die near to their stations. See 653 (Funeral Service). 1252. Private Practice.- Medical officers on full pay are forbidden to engage in private practice except in cases of sudden emergency or accident, nor are they to receive fees from persons outside the Naval Service, whore it may be their duty to relieve when application for assistance is made, or when. they are directed to give it. SECTION 111. DUTIES OF MEDICAL OFFICER. Surgeon-General or Deputy Surgeon-General. 1253. General Duties.- On appointment for service afloat, he is to perform such medical duties as may be required of him by the Commander-in-Chief or Senior Officer of the fleet, squadron, or station, or by the Captain of the ship in which he may be serving, or other his superior officer, and he will comply with all orders he may receive from the Admiralty, or from the Medical Director-General. 1254. When in a Hospital Ship.- When in a hospital ship, he or the medical officer in charge is to have medical charge of all the patients, and he is to visit them regularly morning and evening, or oftener if necessary. All arrangements relating to the part of the hospital ship appropriated for the sick and wounded are to be entirely under his control, and when necessary he will propose to the Captain any measure likely, in his opinion, to conduce to the comfort of the sick or to the acceleration of their cure. 1255. Visits to Ships.- Under the direction and with the sanction of the senior officer on the spot, he is to visit from time to time the ships present, to inquire into their sanitary state and the treatment of their sick. He may call on the Medical Officers of ships for written statements as to the prevalence of any disease, or as to the treatment or progress of any particular case or cases. He will also make himself thoroughly acquainted with the conduct and abilities of the several Surgeons. 1256. Inspections.- He is occasionally to examine the instruments, medicines, and necessaries in the ships, and when from any cause he finds remedial measures necessary, he will suggest them to the Senior Officer. 436 1257. Reports.- He is to report, on form M. 170, to the Commander-in-Chief or to the Senior Officer, weekly, or oftener, if required
1258. Suggestions.- He will suggest to the Commander-in-Chief or Senior Officer any measures which he may consider will improve the health of the men or check the progress of disease in particular ships, or promote the health of the fleet generally. 1259. Reports to Medical Director-General.- He will report annually, on form M. 171, to the Medical Director-General upon the health of the fleet ; he will enter fully into the sanitary state of the respective crews as regards their effectiveness, and also into the medical topography of the station. He will report fully upon any epidemic that may have broken out, or any disease that may have been unusually prevalent. In order that he may be fully informed on these subjects, the Medical Officers will be required to furnish him quarterly with duplicates of their nosological returns. 1260. Visits to Hospitals.- When on a foreign station, if required to do so by the Senior Officer, he is to visit the naval hospitals or sick quarters, when not in charge of a medical officer senior to himself, and report on the medical treatment, diet, and comfort of the patients, and on the general economy of the establishment, as well as upon the expenditure and condition of the stores, and the general efficiency of the officers and others employed therein. 1261. Surveys.- When directed to attend a survey on officers or men, he will assist the surveying officers with his opinion. 1262. Reports, Correspondence, &c.- He will forward his correspondence in the following manner:
1263. Advice to Commander-in-Chief.- The Surgeon-General or Deputy Surgeon-General in charge of a hospital at a home or foreign port is to assist and advise the Commander-in-Chief as required, on questions of sanitation and other matters pertaining to the medical profession and duties within the command, but should the Commander-in-Chief wish him to leave the port on any special duty the Admiralty is to be informed. 2. Inspection Duties.- He is to inspect the marine infirmaries, dockyard surgeries, and the sick quarters of the various establishments at the port once 437 a quarter, reporting to the Commander-in-Chief on their sanitary condition, the state of the surgical instruments, the cooking of food for the sick, and any other special matters which may come under his notice, and, when required by the Commander-in-Chief, he will visit the ships in harbour and make a similar report on the above matters. The Principal Medical Officer of a Fleet. 1264. General Instructions.- The Medical Officer of the senior flag-ship of a fleet, or of a detached and independent squadron, is to be recognised as the Principal Medical Officer of that fleet or squadron. He will be appointed on the staff of the Commander-in-Chief or of the Flag Officer commanding the independent squadron and will wear an aiguilette. He will act as the Admiral's principal adviser on all medical and sanitary matters connected with the fleet, and it will be his province to report to the Admiral periodically upon the arrangements for the treatment of the sick, the sanitary conditions, and the state of the medical appliances in the various ships; also to supervise and report upon the arrangements for the treatment and transport of wounded, the instruction given in first aid, and other matters as he may be directed. He will have direct access to the Admiral and be in a position to propose for his consideration any measures likely to conduce to the efficiency of the medical organisation of the fleet, and he will be directly responsible to the Admiral for keeping him informed on these matters generally. Fleet or Staff Surgeon or Surgeon-in-Charge. 1265. General Duties.- He is to obey not only all orders he may receive from his Captain, or other his superior officer, but also any directions relating to
1266. Communications to Medical Director-General.- Any medical officer serving on board any of His Majesty's ships, previous to sending any letter or any communication whatever relative to his public duty to the Medical Director-General is to submit it to the Captain, who is to note thereon his approval, or such observations as he may think necessary. 438 1267. Instruments. The Medical Officer is to provide himself with, and keep in proper repair, at his own expense, a complete set of surgical instruments, as specified in form M. 200 ; on commissioning he will obtain a certificate from the naval hospital as to their number and condition, and send it to the Medical Director-General. 2. Surgeons' Instruments.- He is to frequently examine the surgical instruments with which the Surgeons are hereby required to provide themselves, to see that they are in good repair and according to form M. 200, giving, or. the same form, annually, certificates of their number and condition. 1268. Supplies.- On commissioning he will apply to the nearest hospital or depot for the established supplies of medicines and medicine chests, utensils, necessaries, bedding, appliances, and surgical instruments, specified in established -scales (forms S. 570, 571, and 571a). 1269. Medicine Chests.- The contents of one of the medicine chests, when more than one are supplied, and of the grocery and necessary chests, are to be stowed away in the dispensary, and the empty chests immediately returned into store, addressed to the officer in charge of the depot from which they were issued. The other complete medicine chests will be placed in a safe place, so that the Medical Officer may have ready access to them, and from these chests the medicines required from time to time in the dispensary are to be drawn, the empty bottles and jars being returned into the spaces from which the full ones are taken. 2. Where only one medicine chest with one or more " Necessary " chests are supplied, they are to remain on board, and in vessels where there is no dispensary the medicines and necessaries are to be kept in their respective chests. Diagrams showing the position of the medicines are supplied with the articles on commissioning. 3. Care of.- The medicine chests are not to be struck down into the hold or spirit room upon any pretence whatever, nor placed in any situation where they may sustain injury. Accommodation being provided for the clue care of all medicines and medical stores, the Medical Officer will be held responsible for their preservation. 4. Demands to complete.- He is annually, or oftener if necessary, to make out demands in forms M. 174 and 175 showing the quantities remaining, and the quantities required to complete the established proportions according to the scales. These demands, when approved by the Captain, are to be taken, with the medicine chests, to the hospital or depot, in order that the requisite supplies may be obtained ; and to prevent inconvenience or delay, demands are to be presented there, if possible, before three o'clock in the afternoon, and no stores are to be returned after that hour. Demands are not to be repeated for medicines, utensils, or necessaries within a year, nor for groceries within six months, unless the ship is ordered on detached service, or extraordinary circumstances shall have caused, or are likely to cause, an unusual expenditure, the reason for which is to be explained on the demand, and to be reported to the Medical Director-General by letter at the same time. Trusses, however, are to be completed as often as necessary. As to purchases, see 1271 (Purchase of Articles for Sick Berth), and 1274 (Moneys for Sick Mess). 5. Home Stationary Ships.- The Medical Officers of stationary ships at home ports where there are no hospitals or medical depots are not, when making their demands, to send the empty chests and bottles ; their supplies will be sent in contractor's bottles, which are to be emptied and retained until an opportunity offers of sending them to the issuing depot free of expense. 439 1270 When no Medical Officer.- The Commanding Officer of any vessel not bearing a Medical Officer is to keep in his possession a daily sick book (M. 195) in which medical officers visiting the vessel are to make the usual entries, rendering a report to the Commanding Officer on each occasion. At the end of each quarter the Commanding Officer is to forward the book through the usual official channels:
The Medical Officers of the flag-ships and parent ships to which the daily Sick books are sent will be responsible for the medical returns which, in the case of flag-ships, are to be rendered on lists separate from the ship's return. Daily sick books are to be returned to the vessels to which they belong without delay. 2. In a small vessel not bearing a medical officer, except in the case of torpedo boats and torpedo boat destroyers, to which Article 1803 is to apply, the officer in command is to have the charge of the medicines and medical stores, which; with the Medical and Surgical Handbook, containing the quantities allowed, instructions for using the medicines, and directions for applying tourniquets, will be supplied from the nearest naval hospital on demand when commissioning. He will take care to replenish the medicines or the stores as occasion may require. See 1329 (Dispensing Medicines). 3. He is to render an account of the stores on form M. 177, unless the vessel is a tender, in which case they will be accounted for by the Medical Officer of tile parent ship. See 1805, clause 2 (Rendering of Accounts for Tenders). 1271. Purchases of medicines or medical stores included in forms S. 570, S.571, and 571a are not to be made at ports where there are medical depots or ships which can supply them, but should those sources not be available, the articles may be purchased by the Medical Officer on his complying with the regulations on this subject laid down in Articles 1783, 1784, and 17$5. 1272. Sick Mess.- The Medical Officer will superintend the sick mess, which is to be formed in each ship for the comfort of the sick and wounded. He will record in his sick book daily the number victualling in the sick mess. He will cause the Accountant Officer to be informed when any man in the sick list is to join the sick mess, so that the man may be checked of his provisions. 2. Spirit Stoppage Book.- He will see that the Sick Berth Steward records each day in the prescribed book (S. 76b) the names of all persons on the sick list, and that the book is taken daily to the ship's office, in time to enable the Accountant Officer to check the men of their spirit. The Medical Officer may, however, if he deem it necessary, allow the issue of the spirit ration, inserting the permission, attested by his initials, in the spirit stoppage book, for the information of the Accountant Officer. See 1089, clause 2 (When Sick Mess cannot be formed). 1273. Medical Comforts.- The Medical Officer is to demand from the Accountant Officer, with the approval of the Captain, such articles of diet, medical comforts, c& c., including wine and spirit, as he may consider necessary for the use of the sick and invalids ; but, while fully providing for the due comfort and subsistence of those for whom the ordinary ration is unsuitable, lie is to guard against profuse expenditure or unnecessary indulgence, and he 440 will adhere as closely as may be to the following daily scale of diet for the sick:
2. Receipts for Supplies.- For these supplies he is to grant receipts quarterly and to obtain from the Accountant Officer counterparts or issue notes with his signature thereto. It is, however, to be understood that the Medical Officer is not to give receipts to the Accountant Officer for any articles forming a part of the authorised scale of rations for men unless the quantities supplied may have exceeded the proportions allowed for the number victualled in the sick mess ; care being taken that in regard to tea, sugar, and other articles specified in scale B, form S. 571, the excess, if any, is limited to the proportions allowed by that scale, except on extraordinary occasions, which are to be stated by the Medical Officer in his reports. The Medical Officer is to certify each month, across the right-hand page of the mess book, that the totals of the provisions shown therein as issued for use in the sick mess have been properly expended for that purpose. 1274. Moneys for Sick Mess.-The Medical Officer, in accordance with Article 1654, will demand of the Accountant Officer on first commissioning or joining, such sum of money as he may think necessary to provide for extra fresh diet, washing, and other small occasional expenses on behalf of the sick. At the end of each quarter, or sooner if the advance is nearly exhausted, he will render to the Captain a detailed statement (form S. 16) of the payments made, to be accompanied, when practicable, by receipts or sub-vouchers ; he will then, on the Captain's approval, receive from the Accountant Officer a sum equal to the amount actually accounted for, so as to have in his hands the amount originally advanced. On being superseded, or on the ship being paid off, or in case of his death, the balance of this public money is to be returned to the Accountant Officer, with the accounts and vouchers for the intervening period since the accounts were last rendered. 1275. Accounts.- An account of the medicine and medical stores is to be rendered for a period of 12 months from the date of the officer taking charge (form M. 177), and for each ensuing 12 months from the date of completing the last account ; or for any shorter period on giving up charge or on the ship being paid off. 1276. Supplies.- Medicines and medical stores supplied from a regular establishment will be accompanied by invoices in forms M. 62 and 63, by which 441 he is to examine the several quantities, and, if correct, they are to be entered in the proper columns of his account. All articles obtained from any other source, or purchased for the sick berth, except diet, for the sick, are also to be entered in the account ; all invoices, issue or supply notes, are to be preserved by the Medical Officer for future reference. 2. Expenditure of Stores.- The articles received are to be administered as occasion requires for the relief of the sick and wounded, and no part of them is to be wasted or applied to any other purpose than that for which they are intended ; and if any unusual expenditure of medicine or stores should occur, an explanation of the circumstances causing such expenditure is to be forwarded with the account. Should any articles of medicine, utensils, bedding, necessaries, appliances, or surgical instruments, become unfit for use, they are not to be taken credit for, nor returned into store, until a survey has been held upon them. Credit will not be allowed for any bedding or utensil expended, unless in unavoidable circumstances, which must be satisfactorily explained; and an explanation on form M. 189 of the cause of all losses and breakages must be transmitted with the account. 3. Losses due to Theft.- The instructions contained in Article 1810 as to special reports to be made in the case of losses of stores due to theft, or of prosecutions under the Public Stores Act, 1875, are applicable to medical stores. 1277. Trusses.- Receipts for all supplies to other medical officers and for trusses issued (form M. 184), as well as for all articles returned into store, are to be obtained and are to accompany the account. 1278. Surveys.- The account is always to be closed by a survey, as directed by Article 1837, except when the ship is paid off, when the whole of the remaining stores are to be returned into the nearest medical establishment, and the receipts for the quantities returned into store transmitted as vouchers to the final account. 2. Schedule.- The account is to be transmitted by the Captain, and is to be accompanied by a schedule prepared by the Medical Officer on form S. 558 to be obtained from the Accountant Officer, specifying the documents forwarded with it. 1279. Transfer to Successor. When the Medical Officer is superseded or invalided, he is to deliver the whole of the stores in his charge to his successor, or in his absence to some authorised person, by survey, as directed by Article 1837. 1280. Naval Sick Quarters.- In matters of account,, naval sick quarters on shore which are not in charge of a resident medical officer are to be treated as sick berths on-shore of the ships from which men have been sent for treatment, or on the books of which they may be borne if left behind in the quarters, in charge of the Medical Officer of another ship. 2. Purchases.- All articles, other than of diet, purchased for men sent to such sick quarters, and treated there by the Medical Officers of their ships, are likewise to be accounted for by the Medical Officers on their annual account of medicines and stores, and a receipt is to be obtained by them from the officer who has charge of the sick quarter buildings, for any stores which they may leave at the sick quarters on the final departure of their vessels from the port. 3. Bedding and Stores.- As these sick quarters are, however, provided with all necessary bedding, furniture, hospital stores and utensils, by demand of the officer in charge of the buildings upon the Medical Director-General, to 442 whom he is responsible for duly maintaining the stock of such stores, Medical Officers of His Majesty's ships are not to make purchases of any articles of the foregoing description for the use of officers and men under treatment in these quarters. 1281. Convalescents.- He is to represent to the Captain whenever he may consider any men from recent illness or impaired health unfit for any shore boat, or detached service which is about to be undertaken. See 1244, clause 3 (Convalescents front Hospital). 1282. Sulphate of Quinine.- Whenever the Medical Officer considers it advisable, he will administer to every person about to form part of a working party on shore in unhealthy localities, whether tropical or not, 4 grains of sulphate of quinine in water before landing, and again on his return ; if any men remain on shore all night, the officer in immediate charge should be furnished with a sufficient quantity of the solution for each man night and morning. When the Medical Officer considers wine or spirit more advisable than water, he will inform the Captain, who will direct the Accountant Officer to make the requisite issues. 2. The formula for making the sulphate of quinine for issue in the manner above directed is given in Appendix E. to the Medical and Surgical Handbook, copies of which will be supplied to ships for boat service. 3. Extra Issues of Wine, &c.- He will not charge himself with these extra issues of wine or spirit, but he will observe and report very fully on their effects, and note the total quantity so issued at the end of his journal. 1283. Disinfection of New Entries.- Should he consider any newly raised men, who have been found fit for the Service, to be likely, from any cause, to propagate any infectious disease, although no such disease may have been developed, he will inform the Captain, who will order the men and their clothing to be thoroughly disinfected and kept apart from the ship's company for a reasonable time. Should the disease have developed itself at the place from which the suspected men came, the Captain will, in addition to these precautions, report immediately the particulars to his Commander-in-Chief. 1284. Infectious Disease on board.- When an infectious disease breaks out, he will at once apprise the Captain, for the information of the Commander-in-Chief or senior officer present. If the ship should be absent from a flag or senior officer, the Captain is immediately to communicate the particulars direct to the Admiralty, as provided for in Article 1883. The Medical Officer will also inform the Principal Medical Officer of the fleet or squadron, if any, but otherwise the Medical Director-General, and state his opinion as to the nature of the disease and the health of the ship's company generally ; and he will give full information on these points in his nosological returns. 2. After an epidemic of infectious disease on board, the Medical Officer, in conjunction with the Captain, is to decide as to the necessity for disinfecting, and whether it shall include the whole or only part of the ship. If the epidemic has been that of a serious infectious disease it will be necessary to disinfect the whole ship. Disinfection is to be carried out under the personal supervision of the Medical Officer in accordance with the approved Admiralty procedure. See Enclosure No. 56 to " Guard Book containing Special Memoranda." 1285. Disease prevalent and Infectious Cases.- If he should learn on arrival at a place that any disease is prevalent which is likely to prove detrimental to the health of the ship's company in his medical charge, he will inform the 443 Captain, so that proper measures may be adopted to prevent its occurring or breaking out in the ship or among any of the ship's company. Should it break out or occur, or should he have reason to suspect its presence in a latent form, he will adopt, with the Captain's sanction, every possible measure to prevent its spread or development. Patients with infectious diseases should be at once removed from the ship, or if that be not practicable, separated as much as possible from the ship's company ; the bedding and clothing of all these patients when changed or on recovery should be thoroughly disinfected, or, in those cases where thorough disinfection is impossible, destroyed. See 1239 (Infectious cases to Hospital). 1286. Ventilation and Clothing.- Whenever necessary, and especially when infectious diseases have broken out or are threatening, the Medical Officer will suggest to the Captain to cause stoves to be placed in parts of the ship where they are required for ventilation or for dryness. He will also make such suggestions as may occur to him as necessary with reference to clothing when going from a warm to a colder climate, or vice versa. 1287. Antiseptic Precautions.- If wounds or sores under treatment should assume unhealthy action, or septic disease break out, the most careful antiseptic precautions are to be taken, and the patients affected should, so far as practicable, be kept perfectly isolated in a well-ventilated part of the ship, if they cannot be removed from her. 1288. Injuries.- He will report to the Medical Director-General the particulars of any accident occurring on board, whereby severe injuries are sustained by any of the ship's company. See 1318 (Certificate for Injuries). 1289. Malingering.- Whenever in the course of his duties the Medical Officer shall discover that any person has wilfully produced, concealed, aggravated, or feigned any disease to the prejudice of the Service, he will report the particulars of the case to the Captain, so that, if deemed advisable, the offender may be punished as the case shall deserve. 1290. Concealed Diseases.- When directed by the Captain, he and the Surgeons will inspect the men, to ascertain if they have any concealed diseases requiring treatment. When cases of venereal disease or itch are discharged cured, he will in each case make a particular report in order that the provisions of Article 1240 may be complied with. 1291. Visiting Sick.- He and the Surgeons are to visit the sick at least twice a day, and oftener when necessary ; he will take care that the nurses or attendants fully understand that day or night he is at once to be called in case any doubtful or unfavourable change takes place in a patient. 1292. Authority in Sick Berth.- The sick berth itself, and the sick-berth staff, are to be entirely under his direction. The berth is to be kept dry, clean, and sufficiently warm. All bedding and other articles supplied for the use of the sick are to be kept clean, and ready for immediate use. He will judge what patients should remain in the berth, and, when necessary, will apply to the Captain for any further requisites that may be needed for the sick or any additional men as day or night nurses. 1293. Testing Water.- Whenever supplies of water are obtained from the shore, or from rivers, for drinking or cooking purposes, he will institute as careful an analysis (form M. 191) of it as is possible with the chemical tests supplied, and he will at once inform the Captain if any doubt exist as to its purity, in order that it may be rejected altogether. 444 2. All such analyses are to be duly recorded in the medical journal. 1294. Precautions generally.- His attention is not to be confined exclusively to men on the sick list, but he will watch attentively every circumstance likely to affect the health of the ship generally. Should he suspect the presence of disease or indisposition in any man, he is at once to examine and deal with him as may be requisite. 2. Food.- He will exercise a watchful supervision over all articles of food which may be brought on board, paying particular attention to all supplies of milk, mineral waters, tinned provisions, fruit, and vegetables. If he should have reason to suspect anything of a deleterious nature, he should immediately inform the Captain, in order that an investigation may be made, and, if necessary, steps taken to prevent its issue. 1295. Wounded Men.- He is to take care that every preparation is made for the accommodation and treatment of the wounded. When clearing for action, he, with the Surgeons and others appointed to attend him, will repair to their station, where a platform with every convenience is to be provided. 2. Instruction in First Aid.- He is to arrange for the instruction of the undermentioned officers and men, in the principles of first aid to the injured, and is responsible that the necessary appliances for use by those instructed are readily available in those parts of the ship where they will be needed in action :-- All officers of the Non-military Branch. 3. Officers and men detailed to assist the medical staff in action and afterwards, are, in addition to first aid, to be given instruction in some of the simple nursing rules. 4. Officers qualified in first aid are to be given a certificate, and in the case of men the fact is to be noted on their service certificates. A candidate for a certificate of competency as master or mate in the mercantile marine will be exempted from the first aid portion of the Board of Trade examination, provided that he can produce a naval first aid certificate which has been obtained within three years of the date of the Board of Trade examination. 1296. Deaths.- When he is so informed, he is to report at once to the Medical Director-General every death that occurs among persons borne on the ship's books, whether on board, on leave, or at hospitals, except naval hospitals. 2. The reports to the Medical Director-General are to contain full details of the cases, and where the death arose from wounds or injury he is to state how the accident occurred and whether the person was on duty and sober at 445 the time. When a death from disease is considered to be due to extraordinary exposure on duty, or exertion on service, thereby making it attributable to the service, the evidence in support of such opinion is to be included. 1297. Sudden Deaths.- In cases of sudden death, without previous indisposition, he is, with the sanction of the Captain, to examine the body to ascertain the cause ; should there be any appearance of a suspicious character, he will at once inform the Captain, so that, if advisable and practicable, an inquest may be held. See 576 (Inquiry into Accidental Deaths) ; 577 (Inquests). 1298. Subjects for Survey.- He is to represent to the Captain, on form S. 333, whenever he considers any officers or men, from impaired health or other causes, are fit subjects for survey ; he will be very careful not to suffer himself to be deceived by men feigning disabilities for the purpose of being discharged or sent home. 1299. Medical Cases of Invalids.- When sick persons are sent to a ship for passage home, a concise statement of each case, in form M. 188, is to accompany them, detailing the medical treatment to the period of their being discharged ; it is to be handed over to the Medical Officer of the hospital or ship into which they may be discharged on their arrival home. When officers are sent home sick from foreign stations, the Medical Officer is to deliver to each a detailed statement, sealed up, of the commencement and progress of his complaint, or he may send it by the first opportunity through the proper channel to the " Director-General, Medical Department." 1300. List of Invalids.- A nominal list (form M. 185) of all the invalids embarked is to be transmitted to the Medical Director-General, and, should any of the invalids have died during the passage, the Medical Officer is to transmit the original cases (form M. 188) received with them, accompanied by a detail of the symptoms and mode of treatment while under his care. 1301. Military Invalids.- Should military invalids be embarked in a transport or freight ship on board which there is a naval medical officer in medical charge of naval ratings, he is to assume medical charge of the military invalids in the absence of an officer of the Royal Army Medical Corps. 1302. When to send to Hospital.- When men can be conveniently cured on board, they are not to be sent to a hospital, hospital ship, or sick quarters ; but if labouring under an infectious or contagious disease, or if their injuries or complaints render their retention on board dangerous to others or injurious to themselves, or if the number of sick and wounded be so great as to prevent their receiving proper attendance, they are to be sent to hospital as soon as possible. Whenever, therefore, it becomes necessary to send patients to a hospital, the Medical Officer is to inform the Captain, who will give the requisite orders for preparing their pay and sick vouchers, noting upon the latter whether or not the patient has been victualled on board for that day and inserting on it an inventory of each man's effects. The patients' effects are to be carefully stowed in bags or other receptacles, which are to be labelled and sealed in a similar manner to a mail bag, the mail seal issued to His Majesty's ships being used for that purpose. The label is to be signed by the person who enters the effects on the sick voucher and by the responsible officer. 2. The Medical Officer will also give as early information as possible to the Principal Medical Officer of the number of patients to be sent to the hospital, and the probable time at which they will be disembarked, in order that due preparation may be made for their reception. When practicable, a medical officer is to accompany the patients to see that they are properly received 446 at the hospital or sick quarters, and that they are conveyed thither with as little inconvenience as possible ; and should two boats be required, he is to be sent in the one with the worst cases in order to afford ready relief on the passage. A detailed statement of each case, sealed up, is to be delivered with the patients at the hospital, showing the manner in which they were first seized, the nature and progress of their disorders, the means used for their cure, and whether there is, reason for suspecting any of their complaints to be feigned. 1303. Rupture.- Patients with rupture, strangulated or in a dangerous state, are to be sent to hospital ; but no man should be sent for simple uncomplicated rupture unless he first expresses his desire to be operated on for its radical cure, and the Medical Officer of the hospital considers it a fit case, and the man a suitable subject for such operation. 1304. Visits to Patients in Hospital.- The Medical Officer from whose ship men have been sent to a hospital is to visit them as frequently as the Captain may require ; obtaining in every case the previous consent of the Principal Medical Officer of the hospital, who will give such information as may enable the Medical Officer of the ship to inform the Captain when any of them are likely to return to their ship. 1305. Daily Sick Book.- The Medical Officer is to keep a daily sick book (form Al. 195) which is to contain the names of all the sick on board, and which he is to submit to the Captain every morning, at the same time suggesting any measure he may consider necessary for the comfort and benefit of his patients. 2. Whenever the name of any person is inserted in the sick book for a wound or injury, the part of the body injured is to be stated, and, if possible, how the wound or injury was occasioned. 1306. Weekly Return of Sick.- He is also to deliver to the Captain weekly, or at such other periods as he may direct, a return of the sick on board on form M. 186. 1307. Nosological Return.- He is to forward quarterly to the Medical Director-General a nosological return (form M. 178) of the state of the sick, properly filled up and signed by himself, subjoining to it, under the head of Remarks, a clear and succinct account of the several diseases, the state of the weather, of any peculiarities of climate, and the average heat registered by the thermometer, and he is also to detail every other circumstance that may have had an influence in promoting health or generating sickness in the ship's company. This return is to be completed and ready for transmission within one week after the termination of the period for which it is made up, excepting returns from general depots and stationary ships at home with large and varying complements, in which it may be impossible to ascertain the average numerical strength of the ship's company, until the Accountant Officer can certify to the correctness of the average complement during the period to which the return relates, when it may be forwarded within a reasonable time. Before being transmitted to the Medical Director-General it is to be submitted to the Captain for his information, and any delay in forwarding it is to be fully explained by letter to the Medical Director-General. In each return a list is to be given of men to whom hurt certificates have been granted or trusses issued during the period ; or if none have been granted, it is to be so stated. In the event of a continuance of any prevailing sickness when abroad, whether of an endemic or epidemic character, or whether originating from infection, contagion, or other causes of a climatorial nature, a special report in connection therewith is to be sent monthly, or as often as opportunities may offer. 447 A copy of every nosological return is to be transmitted to the Principal Medical Officer of the fleet or squadron to which the ship belongs. 2. Non-invalided Sick from other Ships.- In the case of non-invalided men borne in any of His Majesty's ships, other than that to which they belong, for passage to hospital for treatment, separate lists, giving ships, names, ages, ratings, diseases, dates of admission and discharge, and days' sickness of the men conveyed, should be transmitted with the nosological return and journal of the Medical Officer of the ship in which they are borne for passage. 1308. Journals.- He is to keep a rough and fair journal of his practice (forms M. 179 to 181), transmitting the fair journal to the Medical Director-General made up to 31st December of each year; but should he take charge within three months of the expiration of the year, he is to transmit his journal completed to 31st December of the following year, taking care that all the tables in the journal are drawn up according to the instructions given therein. 1309. Particulars in Journal.- In his journal he is to give the daily symptoms of particular cases, including all those sent to hospital, invalided, or dead, being careful in every case to record the " place where," as well as the " date when " the patient was placed on the sick list ; and under the head of General Remarks, a history of the complaints prevalent in the ship during the period of the journal, as well as any information of a professional character, or in connection with the collateral sciences, that he may think of value. If any malignant or infectious diseases make their appearance, he is to endeavour to trace them to their source, to account for their introduction, and to explain the means used for destroying the infection and preventing their reappearance. 2. He is to include in the general remarks a concise statement of meteorological observations. 3. He is to keep his fair journal in such a state of forwardness that at any time it may be transmitted to the Medical Director-General ; and it is at the latest, to be transmitted within three weeks after the period for which it is due. 4. The importance of these injunctions cannot be overrated, as pensions and gratuities are often dependent upon the care with which the cases of both officers and men have been recorded in the medical journals of the ships in which they have served. 1310. Medical History Sheet.- A medical history sheet (form M. 190) is to be provided for each man or boy on first entry by the Medical Officer, by whom these documents are to be kept and carefully filled up. 2. The medical history sheet is always to accompany the service certificate so that it may follow the man wherever he goes. When he is finally discharged the Service, it is to be sent to the Medical Director-General, and if he re-enters it is to be forwarded to the Medical Officer of the ship on the Captain's application. When he dies, it is to be sent to the Medical Director-General with the report of death. 3. If a history sheet is missing, the fact is to be at once made known to the ship, depot, or hospital from which it should have been received, and the said ship, depot, or hospital will be held responsible for its replacement. 4. Should the man or boy be borne as part complement, the Medical Officer will record " Nil," in case he should never have been on the sick list. 5. In ships without a Medical Officer, the Captain is to tale care that the Medical Officers who may be called on to give occasional attendance shall make the necessary entries in the medical history sheets. 6. When men or boys are being medically examined, the Medical Officers will note on the medical history sheet all marks or scars on the person or other 448 peculiarities, congenital or otherwise, which would be useful for future identification, or, if already noted, he is to verify and, if necessary, amend the previous notations. 7. The sickness of men and boys on leave is to be shown on the medical history sheet. 8. Medical history sheets are never to be allowed to be in the possession of any petty or non-commissioned officer, man, or boy. 9. At all inspections the inspecting officer is to insert on the report a note as to whether the rules respecting medical history sheets are properly observed. 1311. Medical Examination of Men and Boys.- When directed by the Captain to examine men or boys, lie is not only to examine their persons very carefully, to ascertain whether they are fit for the Service, but he is also to inquire very particularly into their previous history, so as to be able to judge whether there is any risk of their bringing infection into the ship. 1312. Examination for Admission to Navy.- When a medical officer is examining any person for admission into the Naval Service or into the Royal Marines, he is first to observe whether he is deformed, or lame, or has an impediment in his speech, or is of weak intellect ; whether he has any marks of wounds or injuries of the bones of the head ; whether the sight of either eye is defective, or the perception of colours imperfect, each eye being separately examined by means of Snellen's tests ; or whether the hearing of either ear is impaired. Should any of these or other mental or physical defects exist to such an extent as might, in the opinion of the examining officer, disqualify him for the efficient discharge of his duty, he is to report him unfit. 2. He is to ascertain that there is no disease of the eye or eyelids, of the ear, or of the nose, that the teeth are good, strong, and sufficient in number, the palate, throat, and tonsils healthy. 3. Should the person so far present no cause of unfitness he is to be directed to strip, and the Medical Officer is then to satisfy himself, by a careful inspection of the entire cutaneous surface, that it is free from disease, and shows no evidence of the existence of constitutional defect, that there are no extensive or adherent cicatrices on the body or limbs, and no varix. 4. Limbs, &c.- He is to observe also that there is a proper and just proportion between the different members of the body, that there is no spinal weakness or deformity, that the limbs are of equal length, strong and well developed, and that there is no evidence of old fracture. 5. The Chest should be carefully examined in reference to its form and capacity, and the condition of the heart and lungs ascertained. 6. The Abdomen should be examined with a view to detect any disease of the contained viscera, hernia or any tendency thereto, disease or malformation of the genital organs. 7. Upper Limbs.- The examining officer will next direct the person to extend and slowly raise his arms until the hands meet above his head; he is then to perform the various movements of the shoulder, elbow, and wrist joints ; to flex and extend, supinate and pronate the forearm, to flex and extend the fingers and thumbs, and by holding on by a rope, show that he can bear the weight of the body clear of the ground without any difficulty with each hand for at least five seconds. 8. Lower Limbs.- In the examination of the lower extremities the person is to be made to walk, to hop first on one foot and then on the other, to flex and extend the limbs and feet, and show that the movements of the various joints can be freely and rapidly performed. 449 1313. Physical Requirements for Officers.- The regulations as to the physical requirements of candidates for commissions in the Royal Navy are contained in the Quarterly Navy List. 2. Men and Boys.- The Regulations for the medical examination of men and boys for entry in the Royal Navy and Royal Marines are contained in the " Recruiting Instructions." 1314. Final Medical Examination.- The medical examination of candidates for the Navy, whether men or boys, is to be considered final in all respects, when carried out by naval medical officers on board any of His Majesty's ships or at the recruiting stations on shore. 1315. Examination for Re-entry.- In the case of men, or of pensioners reentering for further periods of service, the examining officer may exercise his discretion and accept persons with minor defects, who may be desirable candidates from a Service point of view. The applicant's medical history sheet should, however, be consulted whenever practicable, so that persons who are subject to chronic complaints may not be accepted. 1316. Re-vaccination.- All persons entering the Service are to be revaccinated ; should no results follow on the first operation, a second vaccination is invariably to be performed. In the case of candidates for artificer and artisan ratings, the operation is to be deferred till they have been finally accepted for the Service. 2. All persons who have not been re-vaccinated between their first entry into the Service and the age of 18 shall be re-vaccinated as soon as possible, however good their primary vaccination cicatrices may appear, or even should they present unmistakable evidence of having suffered from small-pox previous to that age. The re-vaccination is to be made with calf lymph from a recognised establishment which is carried on under proper supervision. 3. On both the home and foreign stations the Medical Officer will obtain supplies of calf lymph by written application to the Principal Medical Officers of the naval hospitals ; on foreign stations, if supplies cannot be obtained at the naval medical depots, such calf lymph should be locally purchased but if such cannot be procured, application is to be at once made to the Medical Director-General. 4. No person shall be considered re-vaccinated who has had the operation performed with lymph taken from the arm of a re-vaccinated person, but all persons so re-vaccinated shall again be vaccinated with lymph taken from the sources specified above. 5. A notation of the date of re-vaccination is to be made by the Medical Officer on each man's medical history sheet, specifying the result, whether successful or otherwise, and such cases only are to be considered successful in which either vesicles, normal or modified, or papules surrounded by areolæ have resulted. When the first operation is followed by no result, which should, however, be rare when it has been carefully performed, vaccination should be repeated in 14 days from the first attempt. 6. The Medical Officer, as soon as convenient after he joins a ship, will satisfy himself, by personal inspection, that each officer and man has been successfully vaccinated, and when necessary re-vaccinated, and so also with regard to every officer and man who may subsequently join, except those borne for disposal or as temporary supernumeraries in home ships, and whose stay in them will be but short. 7. He is to certify, on the second nosological return (form M. 178) which he sends into office after joining the ship, that he has done so, and that the instructions have been fully carried out. 450 8. When vaccination or re-vaccination cannot be satisfactorily performed in a ship, recourse is to be had to local vaccinators, who, under the authority of the Captain, will be paid by the Accountant Officer for each successful case, on the certificate of the Medical Officer or, when none is borne, of the Captain. 9. When circumstances arise rendering recourse to local vaccinators necessary, the facts are to be immediately reported by the Medical Officer to the Medical Director-General. 1317. Record of Examinations for Entry.- All persons examined for entry into the Naval Service or Marines by a Medical Officer are to be entered in form M. 93, in ships and establishments especially furnished therewith ; in other cases on a list in the medical officer's journal for the ship. In all cases of persons rejected the cause of unfitness is to be correctly recorded. 1318. Hurt Certificate.- When any person shall receive a wound or hurt in any act of duty while serving either afloat or on shore, or shall become insane from what is clearly the result of an accident on duty, or in consequence of extraordinary exposure or exertion on service, the Medical Officer is to prepare a hurt certificate, on form M. 183, describing minutely the nature of the injury or disability, together with the manner in which it was received, the particular act of duty on which the injured person was employed, and whether he was sober or not at the time ; the certificate is to be signed by the Captain and by the Medical Officer, and also, if possible, by some officer of the Military Branch, or if there is none, by some other person who witnessed the accident. The certificate is to be granted whether the injury disable the individual from continuing in the Service or not. 2. When not to be given.- These certificates, except in an act of duty whilst on leave, are not to be given for wounds or hurts received on leave or occasioned by drunkenness or other improper conduct, but shall be confined solely to injuries received in acts of duty. 3. Rupture.- They are not to be granted for rupture, unless the individual shall make application immediately after the accident, in which case they should be made out within 48 hours of the rupture. In exceptional cases, when this rule cannot be observed, the reasons are to be given on the certificate. 4. Custody of Hurt Certificates.- Men's hurt certificates are to be kept and dealt with in the same manner as their service certificates until they are pensioned or otherwise disposed of. Officers' hurt certificates are to be delivered to them. 5. Marines at Headquarters.- When marines are at headquarters a hurt certificate, signed by the Commandant and the Medical Officer, and by some officer or other person who witnessed the accident, is to be granted under the same conditions as when serving afloat. 6. Notices are to be posted up on board all ships and at the marine divisions cautioning men to report immediately any appearance of rupture. 1319. Medical Officers' Addresses.- All unemployed medical officers upon the active list of the Navy are to keep the Medical Director-General informed of their permanent addresses, so that they may be speedily communicated with as occasion shall require ; and whenever such officers are in or passing through London, on appointment to a ship, or after discharge from a ship, they are without fail to communicate personally with the Medical Director-General. 1320. Rendering Returns.- The Medical Officer is to transmit regularly all the medical returns, accounts, and other documents required by these Instructions, to enable his accounts to be speedily closed. 451 1321. Certificates to Surgeons.- The Medical Officer is to grant to Surgeons serving under him at the end of each year, and also when he or they leave the ship, a certificate as to the conduct of their professional duties. This certificate is to be approved by the Captain and will be forwarded by the Surgeons to the Medical Director-General with their journals. 2. In the event of the certificate not being satisfactory the Captain will call upon the Medical Officer for a detailed report, which he will forward to the Admiralty through the Commander-in-Chief with leis own remarks. 1322. Friendly Societies.- On being applied to, the Medical Officer may certify to the secretary of any established friendly society the nature of the illness under which any officer or man of the ship, who is a member of the society, may be suffering. 1323. Encouragement to acquire Information.- As medical officers are afforded many opportunities of obtaining a knowledge of the medical topography of the places they visit, of the more prevalent diseases and the approved anode of treatment, and of the healing properties, preparations and uses of medicinal plants or productions, they should report all the information they can collect on these interesting and other cognate subjects that they may believe to be new or but little known ; and the senior medical officers should encourage those serving under them to cultivate a taste for scientific observation, which can hardly fail to be of use to the individual himself as well as to the Service and the cause of science. Surgeon (not in Charge). 1324. Duties generally.- The Surgeons are to make themselves acquainted with the foregoing Instructions for the Medical Officer, and to comply therewith at all times in so far as they may relate to their duties, or when they are acting for the Medical Officer. 1325. Instruments and Journal.- They are to provide themselves with the instruments specified in form M. 200, and when not in medical charge they are to keep a Surgeon's journal (form M. 182) and to forward it to the Medical Director-General on 31st December in each year. 1328. Medical Certificate.- Every Surgeon is to send to the Medical Director-General at the end of every year's service, and on quitting a ship, a certificate of conduct signed by the Medical Officer, together with form M. 200, certifying that he has furnished himself with the instruments required, and that they are in complete order. 1327. When Medical Officer absent.- In the absence of the Medical Officer, or in slips where no Fleet or Staff Surgeon is borne, the senior Surgeon on board is to observe and follow the foregoing Instructions ; and in the event of the invaliding or death of the Medical Officer, he will be held responsible for the medical returns and accounts of the ship until another joins. SECTION IV. GENERAL. 1328. Operations at Naval Hospitals.- Whenever operations are to be performed at any naval hospital timely notice will be given, in order that as many as possible of the Medical Officers in port may attend ; and, on receiving notice that operations are to be performed elsewhere, medical officers in charge 452 will attend and encourage those under them also to attend, that no opportunity may be lost of enlarging their surgical experience. 1329. Dispensing Medicines.- All medicines are to be uniformly received issued, and accounted for by avoirdupois weight of 16 drachms to the ounce, and 16 ounces to the pound, but they will be dispensed by the weights and measures of the British Pharmacopoeia. 1330. Poisons, Precautions as to.- All medicines or medicinal compound, kept in chests or in dispensaries are to be dealt with as follows :
2. When supplied to patients, whether for internal or external uses, they are
3. No other bottles or labels are on any account to be used. 4. All medicines labelled POISON are to be kept under lock and key, and apart from the others in the dispensary. 5. The Medical Officer is to be responsible for the correct issue and use of all drugs, in order to avoid accidents caused by the administration of medicines, poisonous or otherwise, in improper doses. 1331. Distillation.- The purest water available is to be used for distillation. 453 ^ back to top ^ |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||