A MANUAL 
of 
Naval Hygiene 
PREPARED BY 
THE MEDICAL DEPARTMENT 
U. S. NAVY 
UNITED STATES 
GOVERNMENT PRINTING OFFICE 
WASHINGTON : 1943 
For sale by the Superintendent of Documents, Washington, D. C FOEEWOED 
Sanitary and hygienic problems of air and of land, 
of surface and of subsurface craft present themselves 
daily to the medical officer of the Navy. Air consti- 
tuents and pressures, arctic and tropical temperatures 
and humidities, food and water, clothing, lighting, these 
and many other facets are as much the care and con- 
sideration of the naval surgeon as are the diseases and 
wounds of the personnel in sickness and in battle. 
And yet the field of naval hygiene is a sparsely covered 
one as far as textbooks are concerned. It is in response 
to this need that a number of officers of the Medical 
Department have collaborated with me in the prepara- 
tion of this volume. To them I extend my sincere 
appreciation and thanks. 
Eoss T McIntire, 
Surgeon General, 
United States Navy. TABLE OF CONTENTS 
Chapter Page 
I. The ship as a living space and the influence of 
naval architecture on naval hygiene 1 
II. Ventilation and air conditioning on shipboard 4 
HI. Water and its uses on shipboard 38 
IV. Food and food inspection 46 
V. Lighting on shipboard 55 
VI. Naval clothing 65 
VII. General duties of the medical officer of a naval 
vessel. Essential medical department reports. - 92 
VIII. Sanitary inspection of the ship 98 
IX. The sickbay and hospital space afloat 108 
X. The medical department aboard ship in emergen- 
cies other than battle 116 
XI. The medical department aboard ship in battle. _ 125 
XII. Transportation of sick and injured on shipboard 141 
XIII. Accident prevention on shipboard 152 
XIV. Disease prevention on shipboard 156 
XV. The hospital ship 178 
XVI. The dental office on shipboard - 190 
XVII. Submarine medicine _ 198 
XVIII. Deep-sea diving 213 
XIX. Hygiene in aviation __ 227 
XX. Field hygiene and sanitation 265 
XXI. Armored units - 277 
XXII. Recruit selection _ _ 293 
XXIII. Mental hygiene _ 306 
XXIV. Quarantine rules and regulations 317 
XXV. Identification records 326 
XXVI. Procurement of medical and dental supplies 330 
Index. 337 Chapter I 
THE SHIP AS A LIVING SPACE AND THE 
INFLUENCE OF NAVAL ARCHITECTURE ON 
NAVAL HYGIENE 
Man’s power of adaptation to all sorts of living condi- 
tions is nowhere more fully shown than in his ability to 
live on shipboard, both in surface ships and in sub- 
marines, as well as in his adaptation to life in aircraft. 
In the ship there must be air, fresh water, light, heat, 
food, provision for the removal of wastes, for rest and 
recreation, and the care of the sick and injured. All of 
these requirements must be met if the ship is to fulfill 
its primary mission. These matters and many others 
related to them form the subject of nautical or naval 
hygiene. It is apparent that these questions have varied 
with changes in the type, size, and construction of ships. 
The first change in naval architecture which produced 
a profound effect on naval hygiene was the change from 
oars to sail. This permitted the building of larger 
vessels with several decks and consequently greater sea- 
worthiness and ability to make longer ocean voyages. 
As a consequence, questions of ventilation, the preserva- 
tion of food, and the supply of fresh water became im- 
portant matters. Long voyages were responsible for 
diseases resulting from overcrowding; others due to food 
deficiencies, such as scurvy, and contact with the Tropics 
and tropical diseases. 
1 2 
MANUAL OF NAVAL HYGIENE 
The change from sail to steam resulted in the short- 
ening of the voyage, provisions for the manufacture of 
water by distillation, power-driven ventilation, the re- 
frigeration of foods, and improved heating and lighting. 
Perhaps one of the most important changes was that 
from wooden construction to iron and steel. This 
change did away with the leaking through the seams of 
the old wooden vessels and with the resulting dampness 
prevalent in wooden ships, the virtual elimination of 
vermin, and greater ease in keeping the vessel clean. 
Rats, mice, and cockroaches tended to disappear on the 
metal ships, as the absence of food and water in the 
compartments led to their death. The water-tight steel 
compartments of the modern ship contain no water, and 
even if a rat were to enter a compartment containing 
food the absence of water would result in his death. 
The only great disadvantage of the metal ship as a living 
space in contrast to the wooden vessel is the high con- 
ductivity of metal to heat or cold. This makes the steel 
ship cold in winter and hot in summer, hence the de- 
velopment of measures to control the temperature in 
living spaces and the indirect improvements in naval 
hygiene in this respect. The need for temperature 
control was also made necessary by the presence of the 
so-called “wild heat” on steam-driven vessels. This is 
the term used to describe the heat radiated by boilers, 
engines, dynamos, as well as bakeries, laundries, and 
similar places. The necessity for controlling this “wild 
heat” has also led to many improvements in naval 
hygiene. 
Special problems in preventive medicine and naval 
hygiene appeared with the development of the sub- 
marine, the closed-cabin airplane, and various types of 3 
SHIP AS A LIVING SPACE 
naval vessels such as the destroyer, the aircraft carrier, 
and the small, fast torpedo boat. Changes in size and 
design of these vessels and the possible development of 
new types of ships will continue to bring new problems 
and to exercise the ingenuity of the naval hygienist. Chapter II 
VENTILATION AND AIR CONDITIONING 
ON SHIPBOARD 
The medical officer is responsible for the maintenance 
of the health of personnel. Since air conditions consti- 
tute one of the most important factors affecting health 
aboard ship, the medical officer is called upon to define 
the proper air environment. Essentially on the basis 
of physiologic knowledge, he must be able to state the 
criteria that govern not only good air conditions but 
he must also be able to gage the limits of tolerance for 
unavoidable deleterious atmospheres. 
In practice, the medical officer will seek to maintain 
an ideal atmospheric state, while the engineer is com- 
pelled by military considerations to provide only the 
minimal ventilation consistent with the welfare of per- 
sonnel. A balance therefore, must frequently be struck 
between divergent objectives. 
The task, however, of the medical officer is clearly 
defined. It is to supply the engineer with quantitative 
data; to report on the environment in terms of tempera- 
ture, moisture content, air movement, and radiant heat: 
to record physiologic data in terms of pulse rate, body 
temperature (mouth, envelope of skin, and the foot- 
shoe temperatures) and subjective reactions based on a 
fixed sensation scale. 
4 5 
VENTILATION ASNID AIR CONDITIONING 
The Purpose or Ventilation, Heating, and Cooling. 
The Air Conditioning Section of the Bureau of Ships 
lias cognizance over matters of material pertaining to 
ventilation. The Bureau of Ships Manual states: 
The weight added, the space occupied, and the power con- 
sumed by the ventilation, heating, and cooling arrangements on 
a naval vessel must be at the expense of other military neces- 
sities. The minimum of equipment is provided which will 
accomplish the following purposes: 
(a) To maintain, in the living spaces and normally occupied 
parts of the vessel, conditions which will keep personnel fit to 
fight under the strain of frequent watches during prolonged 
wartime cruising. 
(ft) To maintain at battle stations and in working spaces 
conditions which will keep personnel physically fit to fight and 
mentally keen under the circumstances when such spaces must 
be occupied during war. 
(c) To maintain in certain spaces containing equipment or 
material, the conditions necessitated by the presence of that 
equipment or material. 
Basically the environment must be such that the body can 
maintain a proper heat balance and the chemical composition 
of the air must be such that it contains no harmful components 
and provides a sufficient quantity of oxygen. 
The factors to be considered in the air environment 
are temperature, humidity, air motion, odors, bacteria, 
the oxygen and carbon-dioxide contents and harmful 
agents such as smoke and carbon monoxide. 
It is the rapid shift, however, from one type of cli- 
matic environment to another that subjects personnel, 
unaided either by adequate clothing or by artificial 
heating or cooling, to severe hardships. 
The structure of the warship further complicates the 
problem. To supply outside air to a craft catacombed 
with watertight compartments without weakening the 6 
MANUAL OF HYGIENE 
flotation power of the ship provides the naval engineer 
with one of his most difficult problems. In addition the 
steel structure, for the most part deprived of insulation, 
is subject to high surface temperature not only from 
the sun’s rays, but from heat emitted from machinery 
spaces. 
Natural ventilation in the sense of utilizing open 
ports is therefore not feasible, since the modern ship 
presents a sealed hull 15 to 30 feet or more above the 
water line. The tremendous heat loads, moreover, em- 
anating from machinery spaces must be removed pri- 
marily by a continuous supply of fresh air. 
Blowers, both supply and exhaust, are required to 
pump air into and out of compartments, ducts to carry 
the air to the various compartments, and terminals of 
various types to distribute it to best advantage. In 
cold weather heaters are needed, in warm weather 
bracket fans facilitate heat loss from the body. 
At sea, outside air temperatures in naval operating 
areas are determined by the temperature of the sea 
water, 29° to 85° F., seldom exceeding a range of from 
10° to 88° F. 
Within the ship we are concerned with essentially two 
types of spaces. There is the hot dry space, in which 
the primary objective is removal of heat created by 
the operation of machinery. Temperatures of 110° to 
120° F., dry bulb, and 80° to 84° F., wet bulb, may pre- 
vail in this type of space which is usually provided 
with facilities for spot-cooling. On the other hand, 
there is the hot wet space. a sealed or partially sealed 
space in which the removal of moisture from personnel 
is the essential problem. In such spaces the dry-bulb 
temperature may not exceed 90° to 95° F., but the wet- VENTILATION AiNID AIR CONDITIONING 
7 
bulb temperature may be above 85° F., creating an 
atmosphere that is especially debilitating. In the hot 
dry space the factor of radiant heat means that both 
machinery and personnel require insulation. 
The concept of effective temperature enables us to 
resolve the variable factors of temperature, humidity, 
and air motion into a single index to indicate the degree 
of warmth perceived by the body. 
As a result of experiments made on a large number 
of human subjects it was found that the same subjec- 
tive degree of warmth induced, for example, by an 
atmosphere saturated with moisture at 80° F. could be 
maintained at various combinations of wet-and-dry- 
bulb temperatures. Lines joining points on the psy- 
chrometric chart indicative of wet-and-dry-bulb tem- 
peratures imparting the similar sensations of warmth 
are called effective temperature lines. 
The following air conditions, for example, each at 
90° effective temperature, are considered to be equiva- 
lent in their warmth-giving properties: 90° dry bulb 
and 100 percent relative humidity, 105° dry bulb and 50 
percent relative humidity, 120° dry bulb and 20 per- 
cent relative humidity, and 135° dry bulb in perfectly 
dry air or zero percent relative humidity. 
For still air, that is an air velocity less than 30 cubic 
feet per minute, figure No. 1 shows the relationship be- 
tween dry-bulb, wet-bulb, and effective temperatures. 
Moving air lowers the effective temperature for a 
given temperature and humidity as indicated in figure 
No. 2. 
For a saturated atmosphere and an effective tempera- 
ture equal to skin temperature (95° F.), air movement 
gives no cooling. For this condition there is no heat 8 
MANUAL OF NAVAL HYGIENE 
Average Winter Comfort Zone — 
Average Winter Comfort Line 
Average Summer Comfort Zone 
Average Summer Comfort Line 
i i 
Figure 1.—A. S. H. V. E.1 comfort chart for air velocities of 15 to 25 
F. P. M. (still air). Both summer and winter comfort zones apply to 
inhabitants of the United States only. Application of winter comfort 
line is further limited to rooms heated by central station systems of 
the convection type. The line does not apply to rooms heated by 
radiant methods. Application of summer comfort line is limited to 
homes, offices, and the like, where the occupants become fully 
adapted to the artificial air conditions. The line does not apply to 
theaters, department stores, and the like where the exposure is less 
than 3 hours. 
1 American Society of Heating and Ventilating Engineers. 9 
VENTILATION AMD AIR CONDITION 1NO 
loss by either convection or evaporation, either with 
or without air movement. For hotter conditions and 
the same moisture content, air velocity makes the in- 
dividual feel hotter. 
At lower temperatures the cooling effect of air 
motion increases progressively so that at 60° F. satu- 
rated air at a velocity of 100 feet per minute gives a 
sense of cooling equivalent to the lowering of the dry- 
bulb temperature by 3° F. 
Comfort zones are given in the shaded areas in the 
effective temperature chart (fig. No. 1) and are zones 
in which 50 percent or more of the people who were 
subjects in the tests expressed themselves as feeling 
comfortable. It will be noted that the zones extend 
from 70 to 30 percent relative humidity. It is recog- 
nized that extremely low humidities are not comfort- 
able and that they may be conducive to respiratory 
infection in winter. Practical considerations, such as 
the prevalence of condensation on walls and windows, 
limit the humidity which may be used in cold weather 
to low percentages. Single glazed windows in a room 
at 70° F. air temperature with 30 percent relative 
humidity will condense water vapor when the outside 
temperature reaches a value of approximately 38° F. 
Limitations of the effective temperature chart relate 
to conditions where radiation is not a factor. The ex- 
periments were made in rooms having no source of 
radiant heat, since the walls of the rooms were sub- 
stantially at the dry-bulb air temperature. The 
winter condition in most rooms only roughly approxi- 
mates this situation as there is often some radiation 
from heating units and usually some cold wall or 
surfaces to which the bodies of the occupants 10 
MANUAL OF NAVAL HYGIENE 
(Legend for Figure 2 on opposite page.) VENTILATION AND AIR CONDITIONING 
11 
radiate heat. The chart therefore must be interpreted 
as omitting the factor of radiant heat which fre- 
quently is of great importance in the hot spaces aboard 
ship. 
The upper limits of desirable air conditions are 
based upon shipboard test. Temperatures in the range 
of 77° to 83° dry-bulb with respective relative humidity 
values of 80 to 50 percent, will be associated with heat 
loss from the body without visible sweating. That is 
to say, about 60 percent of the heat loss will be brought 
about by radiation and convection, and 20 to 40 per- 
cent by the evaporation of insensible perspiration. 
These values represent the upper limit of air con- 
ditions for comfort. Consideration, however, has been 
given to the fact that clothing can be removed, that 
bracket fans will increase air motion, that the men are 
acclimated to tropical weather, and that a fairly high 
dry-bulb temperature will prevent “cold shock.” 
In the Navy, air conditions conducive to comfort 
frequently do not prevail. Our problem often is to 
determine what air environment can be tolerated. 
The upper limits of endurable air conditions may be 
fixed by various considerations. 
(1) An effective temperature of about 86° F. is the 
upper limit at which heat balance can be maintained at 
rest without a rise in body temperature. 
(2) An effective temperature of 91° F. is an upper 
limit in compartments deprived of spot-cooling, for 
Figure 2.—Effective temperature chart showing normal scale of effec- 
tive temperature. Applicable to Inhabitants of the United States 
under following conditions : A. Clothing: Customary indoor clothing. 
B. Activity : Sedentary or light muscular work. C. Heating meth 
ods: Convection type, i. e., warm air, direct steam or hot water 
radiators, plenum systems. 
516368—43— 2 12 
MANUAL OF NAVAL HYGIENE 
men exposed during a 4-hour watch. A rise in body 
temperature and an increase in pulse rate will occur, 
even during the resting state. An average rise in body 
temperature of 0.5° F., and an individual rise of 1.5° F. 
may be arbitrarily assigned as values limiting fur- 
ther exposure. The corresponding limiting pulse-rate 
value is 140, a purely arbitrary figure but one that has 
proved to be useful in the prevention of collapse due 
to heat. 
(3) As a result of long experience in mining opera- 
tions in South Africa, it is considered that 93° F. in air 
saturated with moisture, hence 93 effective temperature, 
is a critical level above which many cases of heat pros- 
tration occur. 
Some tests indicate that the body temperature will 
reach 100.5° F. in 2 hours at 93 effective temperature, 
in 1 hour at 95 effective temperature, and in Vs hour 
at 99 effective temperature. 
Influence of Adverse Air Conditions. 
Effect of heat.—The heat-regulating mechanism 
fails if the external temperature is so abnormally high 
that body heat cannot be eliminated as fast as it is 
produced. Part of it is retained in the body, causing 
a rise in skin and deep tissue temperature, an increase 
in the heart rate, and accelerated respiration. The 
metabolic rate increases also owing to the excessive 
rise in body temperature, and in extreme conditions a 
vicious cycle may result which eventually leads to seri- 
ous physiologic damage. Example: Heat stroke. 
Acute overheating leads to four syndromes; Tleat 
stroke, heat exhaustion, superdehydration, and heat 
cramps, figure 3. VENTILATION ANiD AIR CONDITHONI'NiG 
13 
HEAT 
EXHAUSTION 
- SUPER DEHYDRATION 
HEAT CRAMPS 
HEAT 
STROKE 
Increased Metcbolism 
Lock of Sweating 
Derongement of Meat Regulatory Center 
_Circu lotory 
Insufficiency 
SCHEMA OF SYNDROMES INDUCED BY EXCESS HEAT 
Vasodilation 
Increased Circulation to Skin 
Increased Pulse Rote 
Temporary Loss of Blood Volums 
EXCESS WATER LOSS 
EXCESS SALT LOSS 
Figure 3. 
HEAT—►■BODY—►INCREASED BODY TEMPERATURE 
SWEAT! NG- 
Increased Ability to Sweat 
Salt Economy 
Decreased Metabolic Rate 
Maintenance of Normal Body 
Temperature 
ACCLIMATIZATION 14 
MANUAL OF NAVAL HYGIENE 
Heat stroke is usually preceded by cessation of 
sweating. There is fever and delirium, with full 
bounding pulse and elevated blood pressure, while the 
skin is flushed and dry. Immediately important in 
therapy is rapid heat removal by the best means at 
hand. 
Heat exhaustion or circulatory insufficiency, on the 
other hand, is characterized by subnormal body tem- 
perature, cold, pale, clammy skin, low blood pres- 
sure and a state of circulatory shock. Here immediate 
treatment should be directed toward raising the body 
temperature to normal, improving the tone of the vas- 
cular system and allaying hyperactivity in the digestive 
musculature. 
Of great importance is the physiologic consideration 
of the shift in blood from the internal organs to the 
periphery. The dilatation of the blood vessels of the 
skin and the abnormal distribution of blood to the skin 
area, merely for the purpose of cooling the body, place 
a heavy load on the cardiovascular system. This shift 
in blood, moreover, may explain the prevalence of 
gastro-intestinal disorders in hot weather. 
A practical precept is that individuals in hot envi- 
ronments must be allowed to sit down periodically to 
relieve the excessive cardiovascular strain. Otherwise 
the common complaint and the factor that limits en- 
durance is tired, swollen feet. 
We are faced by a lack of knowledge as to why one 
individual develops the dynamic hyperpyrexia response 
and another the hypothermic shock reaction. Unfor- 
tunately, one experience with either type of excessive 
heat reaction predisposes the patient to subsequent at- 15 
VENTILATION AND AIR CONDITIONING 
tacks and to troublesome prodromal symptoms with 
exposure to external heat of relatively low order. 
Super dehydration is an excessive loss of water as 
sweat without adequate replacement. The essential 
phenomena are thirst, reduced salivation, oliguria, 
acidemia, dyspnea, exhaustion, subnormal temperature, 
concentration of blood, shriveled skin, and sunken eyes. 
Heat cramps in the skeletal muscles bear little rela- 
tion either to heat stroke or heat exhaustion. The 
cramps are due primarily to excessive salt loss during 
profuse and prolonged perspiration without adequate 
salt intake. Relief is readily obtained by adding ordi- 
nary table salt to the drinking water, or taking it in 
any other convenient form. Sometimes a patient suf- 
fering from heat exhaustion will also be suffering from 
skeletal muscle cramps, but usually the conditions are 
not associated. Laborers in desert heat and in boiler 
or furnace rooms are particularly prone to heat cramps 
because of their excessive perspiration and rapid salt 
loss. 
Salt, salt solutions, fluids, and vitamin C require- 
ments.—Salt loss through the skin as a result of sweat- 
ing is of the order of 0.1 to 0.5 percent depending upon 
the degree of acclimatization. During the period of 
24 hours, 4 to 8 quarts of fluid and 4 to 8 grams of 
salt, equivalent to 1 to 2 teaspoons of salt may be lost 
in this manner. 
Replenishment of this quantity of salt is best ob- 
tained, not through the ingestion of salt tablets, but 
by greater ingestion of salt at mealtime or by adding 
salt to the drinking water to make a solution, of not 
more than 0.15 percent salt. The salinity of this solu- 16 
MANUAL OB' NAVAL HYGIENE 
tion is less than that of milk and in cold water it can- 
not be detected. 
If small quantities of salt are not added to the drink- 
ing water, the serving of soup or tomato juice will take 
care of the problem, which is essentially the replacement 
of salt lost through the skin. 
A bouillon cube containing 2 grams of salt, dissolved 
in a pint of water, twice daily, will usually meet the 
additional salt requirements. 
Present studies have indicated that vitamin C is also 
excreted in sweat and the addition of vitamin C to the 
diet is accordingly desirable. Mills has stated further 
that additional vitamin B*, thiamine hydrochloride, is 
beneficial in hot atmospheres. 
Air Cooling—Naval Considerations. 
Air cooling in living spaces sufficient to prevent men 
from sweating while at rest is a prime requirement. No 
single factor, with the exception of food, can be of more 
value in the maintenance of efficiency. Cooled air en- 
sures the necessary rest for recuperation from strenuous 
daily activity, and makes for the diurnal change in 
atmosphere that is so conducive to efficiency and well 
being in temperate climates. 
The experiences, in terms of continued efficiency and 
well being, at Boulder Dam, in the Tropics, and even in 
Washington, D. C., in the summer, are proof of the 
value of an atmosphere cooled sufficiently to prevent 
sweating of personnel in the resting state. 
Overcooling of the air, on the other hand, should he 
avoided. The principle that must govern naval air- 
conditioning is provision for the least amount of cooling 
required to prevent sweating. Usually not more than VENTILATION AMD AIR CONDlTftONI'NiG 
17 
10° F. difference in dry-bulb temperature should exist 
between the cooled and the untreated air. 
If this is accomplished, men who may be sweating- 
while at work will not be chilled when they are resting 
in the conditioned environment. Moreover, men leaving 
the conditioned compartment will be less likely to 
develop an idiosyncrasy to heat when they are again 
subjected to the usual tropical air conditions. 
Spot cooling is used in certain very hot spaces, such 
as engine rooms where it is impossible to provide suffi- 
cient outside air to maintain satisfactory temperatures 
throughout the spaces. Furthermore, too much air 
change in compartments containing steam propulsion 
equipment merely serves to cool down the equipment and 
thus waste heat and fuel, without appreciable improve- 
ment of the habitability. For such spaces “spot cooling” 
is provided. Near each watchstander’s station a high 
velocity blast of outside air is introduced. Due to the 
high velocity, the incoming air does not at once diffuse 
and mix with the ambient air, so a “spot” of cooler air 
occurs in front of the blast terminal, into which the 
watchstander can occasionally step. This system is 
effective even at high outside temperatures so long as the 
spot temperature is considerably lower than the ambient 
temperature. 
Effects of cold.—In the naval service we are concerned 
not only with the effects of cold air at both normal and 
abnormal pressures, but also with reactions following 
exposure in cold water. 
In cold regions ashore men may be exposed to tem- 
peratures as low as —60° F. In aviation a 2° F. drop in 
temperature for every thousand feet up to altitudes of 18 
MANUAL OF NAVAL HYGIENE 
30,000 feet gives rise to ambient temperatures between 
50° and -60° F. 
The effect of environmental temperature is intimately 
related to the character of the ambient medium. In div- 
ing operations, for example, conducted in cold water at 
a temperature of 40° F., body heat may be rapidly lost 
in the compressed atmosphere; on the other hand in 
rarefied still air at high altitude, temperature —20° F., 
aviators may not be too uncomfortable if they are pro- 
tected from the effect of radiant cooling. 
The general physiologic responses to cold are related 
to a fall in body temperature which may drop from the 
normal range of 97.3° to 99.1° F., to values of 92° F. in 
carbon monoxide poisoning and submersion, to 82° F. 
during cold treatments, and to values as low as 75° F. 
in severe alcoholism. 
The initial responses to cold are indicative of stimula- 
tion of the sympathetic nervous system to produce 
shivering and a secretion of adrenin, which gives rise 
to constriction of blood vessels, increased heart rate and 
blood pressure, hyperglycemia, and increase in metabol- 
ism. There is also evidence that the thyroid gland 
enlarges in response to stimulation by cold. These reac- 
tions tend to be beneficial to the healthy individual but 
harmful to the unfit. 
The harmful effects of chilling are manifest in indi- 
viduals hypersensitive to cold, and in persons susceptible 
to respiratory infections. Some individuals, for exam- 
ple, exposed to cold water or air may exhibit urticaria 
and syncope, symptoms indicative of the liberation of 
abnormal amounts of histamine in the skin. VENTILATION AND AIK CONDITIONING 
19 
There is good evidence showing that exposure to cold 
and to changes in temperature lowers the resistance of 
animals to infection, apparently by depressing their 
defensive mechanism. The prevalence of respiratory 
diseases in cold weather is attributed partly to the 
lowered resistance of the mucous membranes of the nose 
and throat which results from the vasomotor shifts of 
blood in the internal organs. 
The local effects of cold are first exhibited by a painful 
vasoconstriction and cyanosis followed by a reactive 
hyperemia, normal color, and cessation of pain. 
The feet representing a dependent part of the body 
and possessing the poorest circulation, usually show the 
complications resulting from exposure to extreme cold 
and designated by such terms as “trench foot” and “im- 
mersion foot.” 
In commenting on numerous cases of trench foot that 
occurred during the last war, Lake observed that death 
occurred in embryo hearts immersed in Ringer’s solution 
at a temperature 21° F. or lower. Further experiments 
on the rabbit’s ear and the human skin indicated that 
21° F. was a critical temperature with reference to 
solidification and permanent damage to tissue. 
In true frostbite, therefore, Lake believes that the 
tissues have reached a temperature of about 21° F. If 
this happens to the skin of the feet, as was the case with 
men standing in trenches with wet feet, then actual 
destruction of skin takes place which may lead to 
gangrene. 
In the case of chilling without actual frostbite, for 
example, killing of tissues, the parts involved often be- 
come edematous on being warmed up. There can be 20 
MANUAL OF NAVAL HYGIENE 
no doubt that the easiest way to produce the edema of 
chilling consists in alternating cold and heat quite rap- 
idly. Therefore, heat should not he applied to an area 
of the hody affected hy cold. 
Pintection against cold.—Since the normal range of 
body temperature is less than 2° F., and since acclima- 
tization to cold does not permit an average lowering of 
effective temperature of more than 6°, it follows that the 
body must be protected by adequate clothing in cold en- 
vironment, or the environment itself must be modified. 
The tendency has been to overemphasize the second 
procedure to the neglect of the first. 
Thus, heating of the air has often heen excessive, pro- 
ducing a dry, hot atmosphere conducive to debilitation 
and to injury of the membranous nasopharynx, espe- 
cially when subsequent exposure takes place in cold air. 
Emphasis must be placed, therefore, upon the pro- 
tective value of clothing which serves to insulate the 
individual from cold. Electrically heated garments 
provide additional heat, if it is required. It is of in- 
terest that pioneer tests of electrically-heated clothing 
were undertaken at the Experimental Diving Unit, 
Navy Yard, Washington, D. C., in preparation for cold- 
water diving. 
Not only is it possible to insulate the individual from 
cold in order to minimize body heat loss, but compart- 
ment bulkheads can be insulated to reduce the effect of 
radiant cooling and rapid heat-transfer through metal 
conductors. An example of the value of bulkhead in- 
sulation is found in submarine compartments. 
In aviation, especially, the insulation of the cabin VENTILATION AND AIR 'CONDITIONING 
21 
interior is of great value when flights occur in air at a 
temperature of —56° F. The sealing of cabins, more- 
over, serves to eliminate loss of heat by convection. 
Thus the rarefied, still air acts as an insulator against 
rapid heat loss from the body. 
IN CONCLUSION, IT IS EMPHASIZED THAT OVERHEATING OF 
AIR IS TO BE AVOIDED IN WINTER, OVERCOOLING OF AIR MUST 
NOT BE PERMITTED IN SUMMER. 
Vitiation of Air. 
(a) Oxygen deficiency in closed spaces.—In unventi- 
lated spaces such as sealed compartments, and at high 
altitudes, oxygen deficiency and carbon dioxide excess 
are of major significance. 
An incident, dramatic in its suddenness, occurred on 
the battleship New York 10 years ago. An officer and 
three men entered an upper blister compartment which 
had been closed for several months. The officer who 
was leading, started down the ladder to the lower com- 
partment and suddenly fell to the bottom in collapse. 
Three men immediately descended to his assistance and 
were also overcome. Five additional unprotected per- 
sons attempted to reach the victims and were prostrated 
—nine in all. The officer and one man were dead when 
finally removed by a rescue group. 
Another disaster was reported by the Cavite Navy 
Yard in the Philippines in 1931. Three civilian work- 
men entered a freshly painted submarine pontoon. All 
three were fatally overcome and three additional per- 
sons going to their assistance were removed in a state 
of collapse, but recovered. All of these cases were due 
to a lack of oxygen in the compartment. 22 
MANUAL OF NAVAL HYGIENE 
Precautionary measures to be taken are: 
(1) Thorough ventilation of all spaces prior to entering. 
(2) The adjustment of a life line to a person entering. 
(3) Immediate availability of oxygen apparatus. 
The fatal error repeatedly manifests itself of entering un- 
occupied compartments without taking the second and third 
simple, precautionary measures. 
(b) Carbon dioxide accumulation is discussed under 
submarine ventilation. 
(c) Carbon monoxide and other toxic gases and 
vapors.—In various industrial establishments and 
wherever internal-combustion engines, including au- 
tomobile engines, gas heaters, or other heaters, operate 
under conditions of imperfect combustion, carbon 
monoxide is a serious menace; and in industry benzol 
and many other toxic fumes and gases may present 
grave problems. 
A fundamental principle underlying the physiologic 
action of gases is illustrated by the time of exposure 
versus concentration rule for carbon monoxide. 
Time of exposure v. Concentration Rule: 
(1) Time of exposure in hours multiplied by the coiicenl ra- 
tion in parts per 10,000 equals 3 (no perceptible effect). 
(2) Time of exposure in hours multiplied by the concentra- 
tion in parts per 10,000 equals 6 (just perceptible effect). 
(3) Time of exposure in hours multiplied by the concentra- 
tion in parts per 10,000 equals 9 (headache and nausea). 
(4) Time of exposure in hours multiplied by the concentra- 
tion in parts per 10,000 equals 15 (dangerous to life). 
In the Hudson River tunnels, for example, a concentration 
of 4 parts of carbon monoxide per 10,000 is permissible for a 
truck passing through in 45 minutes. This means 4 multiplied 
bv 0.75 or 3, a concentration devoid of annoyance to the driver. VENTILATION AN© AIR CONDITIONING 
23 
Symptoms in Relation to Concentration of Carbon Monoxide: 
0.01 percent or 1 part in 10,000 No symptoms for 2 hours. 
0.04 percent or 4 parts in 10,000 No symptoms for 1 hour. 
0.06 to 0.07 percent or 6 to 7 parts in Headache and unpleasant 
Concentration Effect 
10,000. symptoms in 1 hour. 
0.10 to 0.12 percent or 10 to 12 parts Dangerous after 1 hour. 
in 10,000. 
0.35 percent or 35 parts in 10,000 Fatal in less than 1 hour. 
(d) Bacteria.—The next type of foreign impurity 
which must be considered in connection with the at- 
mosphere is the presence of living micro-organisms, par- 
ticularly those of a pathogenic nature. Wells demon- 
strated the important fact that while droplets of a cer- 
tain size (over 0.1-0.2 mm. in diameter) settle rapidly 
to the floor, those below this critical value lose their 
water by evaporation before falling any considerable 
distance. He showed that bacteria from this source 
may actually persist in the atmosphere in considerable 
numbers for many hours. These results certainly indi- 
cate the possibility of air-borne infection, and recent 
accomplishments in the sterilization of the air in hos- 
pitals or sickrooms by ultraviolet radiation merit 
further study. 
(e) Odors.—So far as the air of an ordinary occu- 
pied space is concerned, there remains one other factor 
to be considered, that of the unidentified substances 
associated with the odors produced by human bodies 
and by various organic substances. There is reason- 
ably clear evidence of an influence of such odors upon 
appetite which is of real hygienic significance. This 
was demonstrated by the study of the New York Com- 
mission on Ventilation with respect to body odors. 24 
MANUAL OF NAVAL HYGIENE 
Recently, Herrington and Winslow have shown that 
relatively slight odors of heated house dust (even when 
not consciously perceived by the subjects) had a very 
definite effect in reducing the appetite for food, an 
influence of distinct hygienic significance. 
Yaglou has pointed out the value of using odor as 
an index of air quality. He found that the odor index 
as employed by trained observers was a better criterion 
of air supply per person in a space than the carbon 
dioxide concentration. 
The practical application of this fact is of the greatest 
importance in the Navy. Thus, the adequacy of ven- 
tilation of any occupied compartment, particularly a 
berthing space, can be determined quickly by trained 
observers entering the space from another space having 
a much lower odor level. 
Method of conducting studies aboard ship.—It is 
possible to employ small groups of naval personnel, 
comprising 8 or 10 men, for the purpose of making 
systematic observations which serve to define the 
climatic environment as accurately as do the psychro- 
metric. instruments. The men essentially become “com- 
fort” meters to record certain simple but basic 
physiologic data. 
Oral temperature is observed by placing the ther- 
mometer under the tongue for a period of 5 minutes and 
reading in place. Smoking, fluids, and food are pro- 
hibited for a period of 1 hour prior to the reading. 
Envelope temperature is the temperature of the air 
layer between the skin and the undershirt at the level 
of the xyphoid process. It is a convenient index of skin 
temperature and usually is in close agreement with skin 
temperature for the corresponding area, as indicated VENTILATION AND AIR CONDITIONING 
25 
by the following data applicable to engine-room workers 
in tropical waters. 
Skin Envelope 
Date temperature temperature 
May 16 96. 3 F. 96. 6 F. 
May 17 96.1 95.3 
May 18 97. 2 97. 2 
May 19 96. 6 96. 7 
In practice, an 8-inch thermometer graduated to 
0.2° F. is suspended from the neck so that the bulb rests 
over the xyphoid process of the manubrium. The bulb 
is shielded from clothing and skin by means of perfo- 
rated x-ray film or plaster of paris. The distance of 
the bulb from the skin is maintained constant (fig. 4). 
The foot-shoe temperature is obtained by placing a 
thermometer in the shoe so that the bulb rests under the 
instep (fig. 5). 
The feet, representing a part of the body with less 
adequate circulation by reason of distance from the 
heart, and because of the retarding influence of gravity, 
should closely reflect ambient temperature changes. 
Table 1.—Data collected on a watchstdnder in a hot space 
Date and hour 
Oral tem- 
perature 
Envelope 
tempera- 
ture 
Foot-shoe 
tempera- 
ture 
Pulse rate 
Effective 
tempera- 
ture 
(station) 
May 29; 
1 
99.3 
98.5 
101.0 
144 
i 95.5 
2 
99.2 
96.8 
101.0 
140 
3 
98.6 
95.5 
101.2 
108 
4 
98.6 
96.0 
101.2 
116 
1 Collapse would have occurred in such environmental temperature without access 
to “spot-cooling.” 
It appears that this temperature is affected not only 
by the temperature of the foot reflecting, as it does, 26 
MANUAL OF NAVAL HYGIENE 
peripheral blood flow, but also by the temperature of 
the shoe itself which in turn is affected by the tem- 
perature of the ambient air and the deck on which the 
men stand. 
Foot-shoe temperatures between 70° and 90° F, are 
consistent with comfort. Below 60° F. the feet are 
cold and above 100° F. the feet are hot. Regardless of 
the air environment the foot-shoe temperature may be 
regarded as an index of comfort. 
The pulse rate is the most easily determined and per- 
haps the most significant of all physiological observa- 
Figure 4.—Envelope temperature. VENTILATION AND AIR CONDITIONING 
27 
tions. As previously emphasized, an increase in pulse 
rate usually shows a linear relationship to body temper- 
ature. As an indication of the effect of air conditions, 
it has proved to be extremely valuable. 
In an environment compatible with efficient perform- 
ance, the pulse rate in individuals seated at rest falls 
Figuke 5.—Foot-shoe temperature. 
over a period of several hours. In an adverse environ- 
ment, the pulse rate either fails to decrease or it rises. 
The pulse rate level, moreover, is of considerable im- 
portance. 
In trained subjects the increased pulse rate recorded 
under controlled conditions reflects increased peripheral 
blood flow essential for body cooling and for the main- 
tenance of the ability to sweat. 
o 16368—43 3 28 
MANUAL OF NAVAL HYGIENE' 
The constancy of the average pulse rate recorded on 
submarine personnel is shown by the values in table 
No. 2. The range of average values recorded three times 
a day for a period of 10 days lay between 79 and 85. 
A rise in average pulse rate to 90 occurred during a 
break-down of the cooling system. 
Table 2.—Variation in body temperatures and pulse rate 
[Daily observations on 3 groups each consisting of 17 men on a submarine] 
Date 
Hour 
Oral 
tempera- 
ture 
Envelope 
tempera- 
ture 
Foot 
tempera- 
ture 
Pulse rate 
New England data: 
1900 
°F. 
° F. 
°F. 
Aug. 21 _ 
98.6 
89.9 
82 
85 
Aug. 22 . - - 
1000 
98.3 
90.8 
87.7 
78 
1300 
98.4 
89.9 
90 
84 
1700 
97.8 
87.4 
87.2 
77 
Average. - 
98.2 
89.4 
88.3 
80 
Aug. 23 
1030 
98.4 
86.8 
84.6 
78 
Key West data: 
Sept. 11 
1000 
98.6 
91.9 
95.3 
82 
1300 
98.6 
91.3 
94.2 
84 
1700 
98.6 
92.9 
94.5 
80 
Average. 
98.6 
92 
94.7 
82 
Sept. 12 
1000 
98.6 
90.2 
94.2 
84 
1300 
98.8 
92.2 
94.7 
83 
1700 
98.8 
93.8 
95.5 
86 
Average. 
.... 
98.7 
92.1 
94.8 
84 
Sept. 13.. 
1000 
98.6 
91.6 
96.1 
81 
1300 
98.7 
92.7 
96.3 
83 
1700 
98.6 
93.1 
95.9 
83 
Average. 
98.6 
92.5 
96.1 
82 
Sept. 14 . - 
1000 
98.6 
92.8 
96.1 
82 
1300 
98.6 
92.8 
96.1 
82 
1700 
98.8 
93.1 
95.5 
83 
Average 
— 
98.7 
92.9 
95.9 
82 
Sept. 15 
1000 
98.5 
92.3 
95.8 
81 
1300 
98.7 
92 
96.2 
83 
1700 
98.8 
93.1 
95.9 
82 
Average 
98.7 
92.5 
96.0 
82 
Sept. 16-.. 
1000 
98.6 
92.2 
96.3 
85 
1300 
98.8 
91.9 
95.8 
85 
1700 
•98.7 
92.9 
95.7 
83' 
Average... . 
98.7 
92.3 
95.9 
84 VENTILATION AND AIR CONDITIONING 
29 
'Table 2.—Variation in body temperatures and pulse rate—Con. 
Date 
Hour 
Oral 
tempera- 
ture 
Envelope 
tempera- 
ture 
Foot 
tempera- 
ture 
Pulse rate 
Key West data—Con. 
°F. 
°F. 
°F. 
Sept. 17 
1000 
98.5 
93.3 
96 
82 
1300 
98.7 
92.5 
96.1 
83 
1700 
98.6 
93.5 
95.1 
78 
Average 
98.7 
93.1 
95.7 
81 
Sept. 18 
1000 
98.5 
92.6 
95.8 
79 
1300 
98.5 
92.6 
96.1 
83 
1700 
98.9 
92.8 
95.7 
83 
Average- 
98.6 
92.7 
95.9 
82 
Sept. 19_ 
1000 
98.5 
93 
96.1 
82 
1300 
98.7 
92.4 
96.7 
85 
1700 
98.6 
92.8 
95.8 
81 
Average. 
98.6 
92.7 
96.2 
83 
Sept. 20 
1000 
98.5 
93.1 
96.8 
80 
1300 
98.8 
93.6 
97.1 
90 
Average. 
98.7 
93.4 
97.0 
85 
As an upper limit for pulse rate of men engaged in 
light activity in hot environments, an arbitrary value 
of 140 has been used. This limit permits a safety factor, 
since an increase in pulse rate to 170 or 180 frequently 
precedes collapse. 
Weight and urine output should be determined by 
weighing the subject and collecting the urine in a meas- 
uring flask. 
Condition of the skin should be recorded as dry, 
clammy, damp, wet, and running or dripping. 
The mental state should be described as asleep, drowsy, 
awake, and alert. 
Subjective response as to temperature is recorded on 
a fixed sensation scale, using the following terms: Cold, 
comfortabty cool, comfortable, comfortably warm, and 
hot. 30 
MANUAL OF NAVAL HYGIENE 
Table 3.—Average valves JO men observed daily in a enmyarl 
merit of a warship 
ndex 
bfi 
•S 
Temperature 
Air temperature 
J )atc 
and 
hour 
i 3 Schneider i 
<D 
C3 
(-> 
0/ 
Ph 
(2) 
w Oral 
3 Envelope 
rO 
>* 
(5) 
3 Wet bulb 
q Effective 
temperature 
Remarks 
Juno 3: 
°F. 
°F. 
°F. 
°F. 
°F. 
1.... 
10.7 
70 
98.9 
88.6 
78.5 
69 
74.5 
Comfortably cool; Lima, 
2 
3 
10.6 
11. 4 
70 
67 
98.8 
98.8 
89.9 
89.7 
Peru. 
June 4: 
1 _ 
8.8 
75 
99. 1 
91.9 
83 
73 
78 
Comfortable or comfortably 
2 
8. (i 
74 
99. 1 
92. 5 
warm; awake. Sea tem- 
perature 68. 
3 . 
4 ... 
June 5: 
9. 5 
9.9 
71 
68 
98, 9 
98.9 
92. 2 
92.1 
— 
1 __ 
7.6 
77 
99. 4 
91.7 
83 
73 
78 
5 men comfortable and 
2 __ 
8.6 
72 
99. 1 
91.6 
awake; 3 men comfort- 
3 _ 
9.5 
69 
98.9 
92. 1 
able and alert; 2 men 
4.... 
9.9 
66 
98.8 
91.3 
comfortably warm. Sea 
temperature 70. 
June 6: 
1___ 
2... 
3 ... 
4 
8. 1 
8.2 
9.2 
9.5 
74 
72 
69 
68 
99.2 
99.0 
98.9 
98.8 
92.6 
87 
80 
83 
:::::: 
Out of Humboldt current; 
6 men comfortably warm, 
foreheads damp; 4 men 
too warm, sweating. Sea 
temperature 83. 
June 7: 
1 ... 
5. 7 
76 
99. I 
91 
81 
85 
3 men hot, sweating; 4 men 
2 . 
6. 1 
74 
99.1 
too warm; 2 comfort- 
3 
4 
6.9 
8.1 
71 
68 
99.0 
99. 1 
93.6 
ably warm. 
June 8: 
1 
7.2 
76 
99.2 
89 
80.5 
84 
8 men comfortably warm; 
2 
7. 6 
73 
99.1 
2 men hot. 
3... 
4 
Juno 9: 
8.8 
8.5 
69 
69 
99.0 
99.0 
93.6 
...... 
1... 
5. 7 
77 
99. 3 
93.7 
91 
81 
85 
4 men hot, sweating; 3 men 
2.. . 
6.4 
75 
99. 1 
too warm; 2 men com- 
3 
6.4 
73 
99.0 
fortably warm. Sea tem- 
4 
7.2 
70 
99.0 
perature 83. 
June 10; 
1 
8. 7 
■ 73 
98. 9 
93. 1 
87 
76 
81 
Air conditioned. Sea tem- 
2 . 
9.3 
71 
98.9 
91.8 
84.5 
70 
77 
perature 68-70. Men 
3 
9.6 
67 
98.8 
92. 0 
84, 5 
68 
76. 5 
comfortable or comfort- 
4 
June 11; 
11.0 
65 
98.8 
91. 6 
83. 0 
65. 5 
75 
ably cool. 
1 —- 
10.4 
69 
98.9 
90. 2 
80 
68 
74.5 
Sea temperature 62-63. 
2 
11. 2 
67 
98.6 
90. 6 
Men comfortably cool. 
3 
12.4 
63 
98. 5 
90.4 
— 
Long Beach, Calif. 
4 
11.9 
60 
98.4 
89. 1 
— VENTILATION OF SUBMARINES 
“The ventilation system on a submarine by nature of 
its construction merits a special consideration. It has 
three primary functions. It must maintain acceptable 
conditions of habitability so that the crew can function 
properly at all times, it must provide sufficient air for the 
engines when they are operating and it must meet the 
requirements for battery ventilation under the various 
conditions of battery operation. 
“1. Some of the items of this character are listed: 
“(a) The necessity for watertight compartmentation. 
“(b) Carbon dioxide accumulation and oxygen depletion while 
submerged. 
“(c) The possibility of accumulation of hydrogen to a dan- 
gerous concentration both on the surface and submerged. 
“(d) The possibility of the presence of toxic gases from the 
engines or batteries, or from other sources either during normal 
operations or as the result of a casualty to the vessel. 
“(e) The possibility of a necessity to abandon ship while 
submerged. 
“The ventilation systems of submarines are designed 
to provide efficient and adequate ventilation on the sur- 
face regardless of whether the engines are running or 
stopped, whether any hatches are open or closed, whether 
the vessel is cruising or lying to, whether the battery 
ventilation is exhausting inboard or outboard, or 
whether bulkhead doors are open or closed, and sub- 
merged with ventilation inboard and bulkhead doors 
either open or closed. 
31 32 
MANUAL OF NAVAL HYGIENE 
“A submarine ventilation system thus becomes a com- 
promise between the various factors involved and can- 
not be expected to operate to the best advantage at all 
times. The entire personnel of the service whose duties 
require their consideration of the questions of design, 
maintenance and operation of the ventilation of sub- 
marines should give all these factors most careful study 
so that the principle and practice of submarine ventila- 
tion will be constantly improved. 
“On the typical submarine, engine air is supplied 
through the main engine air-induction valve located in 
the conning tower fairwater and through outboard pip- 
ing to the engine room via hull valves. The engines 
take their air from the engine room. The ship’s ventila- 
tion supply air enters through the hull ventilation induc- 
tion valve, also located in the conning tower fairwater, 
through outboard piping and a hull valve to the hull 
supply fan. 
“Ventilation distribution within the vessel is achieved 
by means of a supply main duct and an exhaust main 
duct within the vessel, each running the entire length 
of the ship and each provided with branches in each com- 
partment. The hull ventilation fans are located in one 
of the compartments near the longitudinal center of the 
vessel. The exhaust is so arranged that it can be dis- 
charged to the engine room or engine air induction pipe 
when the engines are running, and can be discharged 
overboard via the engine air induction piping when the 
engines are stopped. All vessels are provided with 
some kind of a cross connection between the exhaust fan 
discharge and the supply fan intake, so that the fans 
may be used for recirculation of the ship’s air while 
submerged.” (Bureau of Ships Manual.) VENTILATION! AN© AIR CONDITIONING 
33 
The ventilation of submarines becomes a problem 
especially during submerged cruising when air is recir- 
culated. As aboard surface ships, the important fac- 
tors for consideration are the physical elements of 
temperature, humidity, and air movement, and, during 
prolonged submergence, the carbon dioxide and oxygen 
content of the air (see also ch. XVII on Submarine 
Medicine). 
The changes in the chemical components of recircu- 
lated air are the accumulation of carbon dioxide given 
off by the body, and the decrease in oxygen content as 
a result of body utilization. 
A man under average conditions in a submarine 
while submerged consumes about 0.9 cubic foot of 
oxygen and gives off about 0.75 cubic foot of carbon 
dioxide per hour. 
The instructions for purification of the air are based 
upon the following factors: 
1. (a) A concentration of carbon dioxide of one percent or 
less can be breathed for an indefinite time without any ill effects. 
(b) A concentration of carbon dioxide of 2 percent will not 
ordinarily be noticed, but will cause some discomfort if work 
requiring strenuous exertion is attempted. 
(c) A concentration of carbon dioxide of 3 percent causes 
discomfort in breathing even at rest if breathed more than a 
short time. The concentration should never be allowed to 
exceed 3 percent and should be reduced as rapidly as possible 
if it reaches that concentration. The length of time necessary 
for the concentration of carbon dioxide to reach three percent 
may be calculated by the following formula: 
v._ C(3—G) 
X 75 N 
where X is the time in hours after diving in which carbon- 
dioxide concentration will reach 3 percent, 34 
MANUAL OF NAVAL HYGIENE 
G is the percent concentration of carbon dioxide in atmos- 
phere at time of dive, 
C is the net air space of the vessel in cubic feet, 
N is the number of men on board. 
With reference to oxygen it is desirable to maintain 
the percentage as closely as possible to the normal level 
of 20.94. These requirements can be fulfilled in sub- 
merged cruising by the early recirculation of air 
through carbon dioxide absorbent and by oxygen re- 
placement from storage cylinders. 
Usually air can be recirculated in submarines for 
about 15 hours before limiting concentrations of oxygen 
and carbon dioxide are present. The percentage of 
carbon dioxide can be easily determined by the colori- 
metric method. In the absence of oxygen and carbon 
dioxide analyses, the increased depth and rate of 
breathing indicates the presence of limiting carbon 
dioxide concentration, while the failure of a candle 
to remain lighted denotes a deficiency of oxygen. 
The statements of Lieutenant Naquin, USN, com- 
manding officer of the disabled U. S. S. Squalus, illus- 
trate some of the problems encountered in an enclosed 
submarine space. 
Every effort was made to conserve the energy of the men, who 
spent a great deal of time sleeping. The men were instructed 
to remain calm, as excitement would increase oxygen consump- 
tion and carbon dioxide output. One tank of oxygen was used 
in the control room, which contained about half of the survivors, 
and another tank in the torpedo room. The intermediate battery 
compartment was not inhabited, since it was feared that chlorine 
gas might be generated as a result of entrance of sea water into 
storage batteries. After a number of hours the odor of chlorine 
was detected in this compartment, and the men wore “lung” 
appliances converted into chlorine protectors en route from the VENTILATION ANID AIR CON 1)1 TIION IN iG 
35 
control room to the torpedo room, where escape into the diving 
bell was effected. Carbon dioxide absorption was facilitated by 
spreading absorbent throughout the compartments. A noticeable 
improvement in respirability followed each fresh addition. Ex- 
cept for the men engaged in communication with surface vessels 
by tapping signals, there was no activity on the part of any of 
the survivors, who remained in the same positions throughout 
the period of 28 to 40 hours prior to rescue. 
The atmosphere in the submarine was dark, cold, and moist. 
The men suffered acutely from cold, which was only partially 
relieved by eating. 
Of greater importance than changes in the chemical 
components of air are the physical factors of tempera- 
ture, humidity, and air movement. It is the accumula- 
tion of moisture in the air which early affects comfort 
and efficiency. The accumulated moisture in the air dur- 
ing submerged cruising comes from storage batteries and 
from the body in the form of sweat and as moisture from 
the lungs. When the temperature of the sea water is 
high, as it is in operations around Panama, men may 
lose an average of 5 pounds of water during a 10-hour 
submerged cruise. Without air conditioning the only 
relief from the increased humidity is to increase air flow 
through the compartments and within the compart- 
ments, provided that the temperature is below 95° F. 
The recent installation of air-conditioning equipment 
is undoubtedly the greatest development affecting the 
health and comfort of submarine personnel. The recir- 
culation of cool, filtered air lessens fatigue and limits 
the spread of infection in the upper part of the respira- 
tory tract. Dry air, clothing, and bedding ensure proper 
relaxation and rest. When this type of equipment is 
generally installed, many of the physical hazards inci- 
dent to submarine service will have been eliminated. 36 
MANUAL OF NAVAL HYGIENE 
Noxious gases in years past have been the cause of 
great concern. Of these, chlorine is most likely to be 
encountered when, as a result of structural damage, sea 
water comes in contact with the storage batteries. Hy- 
drogen generated during the charging of batteries is 
detected by highly sensitive apparatus and eliminated 
by means of an independent and efficient ventilating 
system. Small quantities of hydrogen arising during 
battery discharge may occasionally form inflammable or 
explosive mixtures during submerged cruising. At the 
present time the enforcement of safety precautions and 
the use of gas masks should render negligible any casual- 
ties from gas incident to the operation of the submarine. 
Tobacco smoke constitutes one of our most difficult 
problems, particularly in sealed spaces in ships and in 
the submerged submarine where the air is recirculated. 
For its effects, cf. chapter XVII on Submarine Medicine. VENTILATION OF AIRCRAFT 1 
The essential problem in aircraft is the protection of 
the individual against cold. The atmospheric tempera- 
ture falls about 2° C. for each 1,000 feet of ascent until 
35,000 feet has been reached, after which the tempera- 
ture remains practically constant at —55° C. 
In the still, rare-fled air, however, a temperature of 
— 55° C. is not associated with the heat loss from the 
body that would otherwise occur at ground level. The 
body is insulated from the cold environment in the 
partial vacuum which tends to prevent heat loss, and 
a temperature of —55° C. at 35,000 feet, corresponds to 
a much higher temperature at sea level. 
Under these conditions radiant cooling from the 
cabin walls is a factor of great importance. Hence, 
insulation of the metal walls becomes a most effective 
measure. 
In the open cockpit or one in which there is air move- 
ment, convection cooling renders equivalent a tempera- 
ture of —55° C. at 35,000 feet and at the ground level. 
Under these conditions the individual must be pro- 
tected by heated clothing. 
The heating of aircraft is primarily an engineering 
problem. It should be stressed that the ability of the 
individual to adapt himself to cold is limited. Pro- 
tection must therefore be afforded by the insulated, 
sealed cabin, heated clothing, and heated cabins. 
1 See also ch. XIX, Hygiene in Aviation. 
37 Chapter III 
WATER AND ITS USES ON SHIPBOARD 
For our purposes water aboard ship is obtained from 
two sources, viz., distilled on board, or shore water 
stored on board. In either case the medical officer’s 
responsibility is to make certain that the supply is at 
all times potable. 
To insure this, frequent analysis must be made from 
individual tanks, and any containers used for reserve 
water storage must be inspected and the water changed 
frequently (once each month). Specimens for chemi- 
cal and bacteriological examination should be submitted 
to shore hospitals or laboratories at 3-month intervals, 
if possible, and, in addition, at an early date following 
any casualty in the water system such as salting up, 
or breaks in water lines where contamination has been 
made possible. It is necessary to be on the alert at all 
times for these accidents, and to be water-purity con- 
scious, otherwise too much damage is done before the 
cause is determined. 
In a recent case, following a yard overhaul and dry- 
docking, at which time all fresh-water tanks were 
drained, scrubbed, and painted, routine water samples 
were submitted to a naval hospital. Reports were not 
received prior to sailing for maneuvers, and on the 
second day at sea the medical officer noted the reporting 
of men for sick call with enteritis, most cases mild in 
38 WATEiR ON SHIPBOARD 
39 
degree. There were not many cases, but it was noted 
they came from all departments of the ship, and con- 
tinued for the second day. In the evening of the second 
day a message was received from the hospital labora- 
tory showing contamination of one of the three tanks 
with colon bacilli. The first lieutenant was at once 
consulted and he promptly discontinued the use of water 
from the contaminated tank. No new cases of enteritis 
were admitted following this procedure, and it was felt 
that a near calamity for a crew of 3,000 men had been 
averted. 
Careful inspection revealed that there was a defective 
rubber gasket under the manhole plate to the tank, 
which allowed bilge water to enter the tank from the 
top, thus contaminating the entire tank. The gasket 
was removed, the tank drained, scrubbed, and chlori- 
nated. After careful rinsing, the tank was again filled 
but no water used until samples had again been sub- 
nutted and found to be free of contamination. In cases 
of small ships where storage facilities are limited, one 
would resume the use of such tanks, but if possible this 
water should be used for boiler feed rather than for 
drinking purposes. It should always be kept in mind 
that the ship must carry on, and the medical officer, as 
in all other departments, must at times devise ingenious 
methods of solving difficult problems in order not to 
allow a ship to be crippled or to interrupt its mission. 
The appearance of an excessive amount of salt in the 
drinking water constitutes a danger signal to all hands, 
and is usually promptly reported to the medical officer. 
It has been found that in most cases this is not the result 
of faulty evaporators; the engineers’ force is most likely 
to detect such an accident before it is manifested in the 40 
MANUAL OF NAVAL HYGIENE 
drinking water. This is due to the engineroom’s need 
for properly distilled feed water, more free from salt 
than that needed for drinking purposes. 
The experienced medical officer on reporting to a ship 
watches on inspection trips for any connecting water 
lines where salt water might inadvertently be turned 
into fresh water lines. It is still a common custom to 
have salt water piped into the spud-peeling room for the 
peeling machine, and into the garbage grinding machine 
or garbage chute. Probably as a result of recent orders 
forbiding the use of salt water on board for any pur- 
poses other than flushing while ships are lying in con- 
taminated harbors, many ships will provide a connecting 
line from the fresh water supply to the above-mentioned 
machines and facilities. Here you often find a neat 
connecting line—one salt water and the other fresh 
water—to a joint outlet. All goes well until some one 
unskilled in the opening and closing of valves turns salt 
water into the line, forgetting to close the valve from 
the fresh water line, thus allowing the salt water to 
back up into the ship’s drinking water supply. Due to 
the pressure it may take several days for this condition 
to manifest itself by taste, during which time contami- 
nation of the drinking water is slowly taking place, 
which may lead to serious results. The remedy is to 
prevail upon the first lieutenant to allow no such hook- 
ups and no connections between fresh and salt water 
lines. Padlocks on valves are not sufficient. Discon- 
nection is the only sure safeguard, and should be in- 
sisted upon. 
The complaint of any man on the ship that the water 
tastes bad should not be disregarded. The cause of the 
complaint should immediately be sought and trouble for WATER ON SHIPBOARD 
41 
an entire ship’s crew may be averted. It should be kept 
in mind that the engineering department provides the 
fresh or distilled water, the first lieutenant has charge 
of storage and distribution, so one’s problems can be 
shared with them. 
Shore Water. 
The chief points for consideration in using shore 
water are source, quality, and methods of transporting. 
When obtained from Government stations or barges, 
current reports as to quality and purity are usually 
available and trustworthy. The medical officer will do 
well to be on hand when connections are made to the 
ship and observe that lines are intact and have not been 
allowed to drag through the polluted water of the harbor 
or other anchorage. It is advisable to look about the 
area and judge from appearances whether the personnel 
involved are experienced in such work and realize the 
importance of clean handling of water. Inexperience 
and ignorance as to the laws of general cleanliness may 
prove disastrous at such times. A hose carrying fresh 
water to a ship should at all times be kept clear of 
polluted harbor water. 
The ship is responsible for the cleanliness of its tanks, 
the shore establishment is responsible for supplying 
pure, potable water. To determine what has been ob- 
tained, samples should be sent to a laboratory at regular 
intervals, and at any other time when in doubt. 
In wartime one must be prepared to remedy con- 
taminations of water supply without expending the 
supply on hand. This may be accomplished by chlo- 
rination in accordance with instructions incorporated 42 
MANUAL OF NAVAL HYGIENE 
in the Manual of the Medical Department, paragraph 
2610. Reserve storage tanks for battle purposes where 
practicable should be cut into the water line in such a 
manner that there will be a continuous flow of water 
through the tank, thus preventing stagnation. This 
is feasible on shipboard, and by installing proper valves 
the flow through the tanks can be cut off at general 
quarters and an emergency outlet opened, thus pro- 
viding a fresh emergency supply of water in case of 
damage to the ship’s water lines. Tanks of 80- to 100- 
gallon capacity may be suspended from the overhead 
or secured to bulkheads as space warrants, and should 
be distributed throughout those areas of the ship in 
which personnel are concentrated at times of action. 
It has been learned that not only do injured men crave 
water during action, but all personnel seem to develop 
an unnatural thirst due to nervous strain and tension. 
Where tanks cannot be made available, water containers 
such as water breakers, jugs, thermos containers and 
milk cans from the galley should be stored. All these 
require inspection for cleanliness and occasional chang- 
ing of the water in them, although stale water uncon- 
taminated is acceptable in the absence of a better 
supply. 
Emergency tanks in sickbay and dressing stations 
should have not less than the equivalent in gallons of 
the number of personnel on board divided by five. 
Water lines are so extensive on a ship that damage 
from bombs or torpedoes, although minor so far as 
ship security is concerned, may interrupt the drinking 
water system, thus making all hands dependent on a 
reserve storage supply. WATER ON SHIPBOARD 
43 
Fundamentally the uses of water aboard ship corre- 
spond to its uses ashore—the difference being that it 
must be in all cases used more sparingly on board ship. 
The amount used is determined by the supply and in 
many cases the medical officer is forced to help to deter- 
mine just where the reductions can be made without 
jeopardizing the health of the men and the sanitation 
of the ship. 
1. Drinking water should be the first consideration. 
In warm climates this requirement may be estimated 
at 3 quarts per day per man, remembering that men 
take salt tablets in these climates. 
2. Bathing requires whatever amount is available 
from one gallon up, and though the amount may be 
small it is best that men have a daily bath in war- 
time, as action may be expected at any time. Salt 
water for bathing is not desirable but may be resorted 
to in real emergencies. 
3. Galley and scullery requirements are almost con- 
stant, due to the use of dishwashing machines and 
sterilizing tanks on most ships. It is believed that this 
may be estimated at from 2 to 5 gallons per day per 
man depending on the size of the organization, facili- 
ties available, and method used for serving food. Dur- 
ing action, sandwiches and cold foods are served which 
reduces the amount of water used for galley purposes. 
4. Laundry requirements vary with the methods 
used. Central laundry facilities are economical in the 
use of water compared to the results obtained by indi- 
vidual work. However, in wartime it is not always 
feasible to spare manpower from guns and war-watches 
Uses of Water on Board Ship, 
516368— 43——4 44 
MANUAL OF NAVAL HYGIENE. 
to operate a central plant, so other means must be 
devised. 
Sickbay laundry is always an item for consideration 
and must be well provided for up to a real scarcity of 
water. At such times bed linen and towels must be 
conserved where possible. The turnover is so heavy 
on large ships that sheets and pillow cases become items 
of concern. Paper towels help to conserve hand towels. 
Pillows may be eliminated in time of stress. Clean 
sheets are essential. 
5. The sickbay is often considered a place where 
extravagant use of fresh water prevails. This can 
easily be true, hence “don’ts” for the medical depart- 
ment are listed. 
Don’t allow the use of water suction for drying test tubes 
and pipettes in the laboratory. 
Don’t permit the use of a constant flow of fresh water 
through x-ray developing tanks. Use ice if necessary. 
Don’t permit the use of a large stream of water over scrub-up 
basins. Have small needle shower heads installed on the outlets 
and make sure the knee-action valves function smoothly. In 
cases of necessity, one can scrub in a basin and have small 
amounts of clean rinse wrater poured over the hands by an 
assistant. 
Don’t allow dripping faucets. Report these leaks to the 
first lieutenant and see that they are repaired promptly. 
Save water in these places so that the galley and 
scullery may continue to use the needed amount to 
maintain proper sanitary measures .in the feeding of 
the crew. 
The use of salt water for scrubbing decks, in the 
spud-peeling machine, and for washing clothes is safe 
on ships cruising a hundred miles off shore. This 
distance may be reduced in areas where large centers 45 
WATER ON SHIPBOARD 
of population do not have to be considered. However, 
the medical officer must be on the alert at all times 
when such substitutions are made to avoid such pitfalls 
as previously mentioned regarding the use of salt 
water. 
Water hours are necessary on many ships, particu- 
larly transports, where ships are loaded beyond their 
capacity for living comfort and conveniences, and it 
will be found that men may keep clean and live under 
sanitary conditions even with limited water supply, 
where proper supervision by division officers is 
maintained. Chapter IV 
FOOD AND FOOD INSPECTION 
In the maintenance and promotion of health, the 
quantity and quality of food are of the utmost impor- 
tance. Food is also important in maintaining the 
morale and the physical and mental efficiency of fight- 
ing men on board ship, in the field, and in the barracks. 
Food may serve as the medium for transmission of 
pathogenic organisms, and diets deficient in certain 
substances will lead to the development of deficiency 
diseases. 
The purchasing of food is centralized in the Bureau 
of Supplies and Accounts, and several field purchasing 
offices are available for food supplies. All food is 
purchased under Federal specifications which are pre- 
pared by a board composed of representatives of all 
the Government agencies concerned with food. All 
food is inspected upon delivery by inspectors of the 
Department of Agriculture or by the Navy’s own 
trained inspectors and chemists. All provisions fur- 
nished the Navy are guaranteed by the contractor to 
conform to the provisions of the Federal Food and 
Drug Act of June 25, 1938. 
Contracts for meat and meat-food products are exe- 
cuted sufficiently in advance to allow the deliveries to 
be inspected properly at the time of preparation, and 
upon final delivery no meats or meat-food products are 
46 FOOD AND FOOD INSPECTION 
47 
accepted that do not bear the special Navy stamp and 
are not in compliance with Federal specifications. 
It is the policy of the Navy to utilize the services of 
inspectors of the Agricultural Marketing Service, 
United States Department of Agriculture, whenever 
possible, in the inspection of fresh fruits and vegetables. 
When this is not possible, effort is made to obtain the 
services of other qualified inspectors of the Department 
of Agriculture. This also applies to inspection of 
poultry, butter, cheese, eggs, milk, ice cream, bread, 
rolls, pastry, and miscellaneous groceries. 
The problem of rationing the Navy dates back to the 
beginning of the Navy itself. There is to be found 
on the statute books, an act dated March 27, 1794, 
which was apparently the first ration law. This act 
not only prescribed the allowances of different articles 
of food, but the particular items which would be issued 
on each day of the week. It was directed that on 
Sunday the total issue for the entire day would consist 
of 1 pound of bread; IV2 pounds of beef; and one-half 
pound of rice. Throughout the week there was little 
variation. Salt pork was issued alternately with beef, 
and peas and beans on days when rice was not issued. 
Potatoes or turnips were allowed on Tuesdays when 
they could be procured. Wednesday was a meatless 
day, and the ration consisted of 1 pound of bread and 
2 ounces of butter, or 6 ounces of molasses; 4 ounces 
of cheese and one-half pound of rice. On Friday, salt 
fish was authorized. This apparently very meager 
ration was augmented by; 
And there shall also be allowed one-half pint of distilled spirits 
per day, or in lieu thereof, one quart of beer per day to each 
ration. 48 
MANUAL OF NAVAL HYGIENE 
The ration cost about 25 cents, including the spirits. 
In September 1862, the rum was discontinued and the 
men’s pay was increased 5 cents a day in lieu of the spirit 
ration. 
The Navy ration has gradually improved until at the 
present time its nutritional value is maintained at a 
high standard. A supply of less than enough of any of 
several specific nutrients constitutes nutritional failure, 
and such failure leads to malnutrition. The several 
nutrients required by the human organism are as fol- 
lows: Oxygen, absorbed by way of the lungs from in- 
spired air; water, obtained as such by drinking aqueous 
liquids, also obtained from many foods, also to a small 
extent by oxidation of the hydrogen in fat and other 
nonaqueous material; calcium, phosphorus, iron and 
other inorganic elements which commonly are spoken of 
as minerals; certain complex organic compounds, among 
which are such amino acids and vitamins as cannot be 
manufactured in the body. 
Amino acids are the building stones of protein. Food 
proteins vary in the amino acids they contain. In gen 
eral, proteins from meats, fish, eggs, or milk meet the 
amino-acid requirements of man better than do the 
proteins of vegetable origin. 
Vitamins are found in all natural or unprocessed 
foods, but more abundantly in some than in others. 
Vitamin C (ascorbic acid), for instance, lack of which 
leads to poor healing of wounds and ultimately to 
scurvy, is provided liberally by orange, grapefruit, 
lemon, lime, and tomato; less well by many other fruits 
and vegetables. It is absent in the grains and low or 
absent in meats. Vitamin lb (thiamine), lack of which 
results in disorders of the nervous svstem and ultimately FOOD AND FOOD INSPECTION 
49 
leads to a polyneuritis, is well provided by grains, 
meats, peas, and beans, less well by other vegetables, and 
relatively little if at all by most fruits. Vitamin A, lack 
of which early affects the eyes and skin, is found in 
butter and cream; the provitamin carotene, which is con- 
verted to vitamin A in the organism, is richly present 
only in vegetables and fruits of a green or yellow color, 
such as carrots and apricots. The fish-liver oils alone 
provide much vitamin D. For this vitamin, lack of 
which interferes with absorption and utilization of 
calcium, dependence by adults is usually placed on ex- 
posure to the sun. 
Two studies have recently been made of the nutritive 
value of the Navy ration. The first study was made on 
the basis of the food received by the personnel of a bat- 
tleship during the calendar year 1940. Average nutri- 
tive values for various food groups such as meats, vege- 
tables, cereals, etc., reported in the scientific literature, 
were used to calculate the nutrients received daily by 
each man. The second study was made on the basis of 
the provision requirements for 1,000 men on a 13-week 
cruise of the United States Pacific Fleet Base Force in 
1941. Results of the two studies are shown in the fol- 
lowing table in comparison with the recommended daily 
allowances for a moderately active man as proposed by 
the Committee on Food and Nutrition of the National 
Research Council. 50 
MANUAL OF NAVAL HYGIENE 
Table 4 
National Re- 
search Council 
recommenda- 
tion 
Average nutri- 
tional factors 
received daily 
by enlisted 
men (battle- 
ship study) 
Average nutri- 
tional factors 
received daily 
by enlisted' 
men (base 
force study) 
Calories- -. _ _ - , 
3,000- . 
4,118-. 
4,620. 
Protein . _ 
70 gm__ 
145 gm 
130 gm. 
Carbohydrate ----- 
504 gm. 
611 gm. 
Fat - - 
167 gm 
180 gm. 
Calcium 
0.8 gm 
0.92 gm __ 
0.84 gm. 
Iron.-- - . 
12 mg.- ... 
27mg-_-. 
32 mg. 
Vitamin A . 
5,0001. a 
16,460 1. U 
15,125 1. 1 . 
Vitamin Bi (thiamine) 
2 mg 
3.2 mg -_ . 
2.6 mg. 
Vitamin C (ascorbic acid).-_ 
75 mg _ 
150 mg 
190 mg. 
Vitamin B2 (riboflavin) --. 
3 rag ----- 
3.5 mg -. 
2.8 mg. 
Nicotinic acid (niacin) 
Vitamin D. . . - -- -- 
20 mg„ 
Percent calorics as— 
Percent 
Percent 
Protein (10 to 15 percent for 
well-balanced diet) 
14 
12 
Carbohydrate (55 to 70 per- 
cent for we'l-balanced diet) 
49 
53 
Fat (20 to 30 percent for well- 
balanced diet) ... 
36 
35 
The values shown above for the Navy ration are on 
the fresh basis and do not take into consideration pos- 
sible losses during storage, cooking, and canning, but 
it is considered that the quantities of nutrients sup- 
plied should be sufficient to cover losses of that character 
which might occur. It will be noted that according to 
present standards, the ration is adequate in all respects. 
Recognizing that rations fail at times to provide an 
adequate supply of vitamins when troops are operating 
far from the home base, a capsule containing the vita- 
mins of established significance has been made avail- 
able on the Navy supply table. This capsule is prepared 
after a formula submitted by the Subcommittee on 
Medical Nutrition of the Committee on Medicine of the 
National Research Council. Its formula is such that FOOD AXD FOOD INSPECTION 
51 
each capsule contains a definite fraction approximately 
one-half of the recommended daily allowances of vita- 
mins for an adult man at moderate activity. Each cap- 
sule provides thiamine 1 mg.; riboflavin 1.5 mg.; niacin 
10 mg.; ascorbic acid 37.5 mg.; vitamin A 2,500 I. U. 
and vitamin D 200 or 250 U. S. P. units. 
Inspection of Food. 
Fresh food not previously passed upon by a United 
States Government inspection should be inspected by 
a medical officer, and acceptance or rejection determined 
at once. Any food found not in accordance with pur- 
chase specifications or which may reasonably be con- 
sidered to menace the health of the personnel should 
be rejected or recommended for destruction, as the case 
may be. The ship’s medical officer as well as medical 
officers with troops in the field should regularly inspect 
the issue rooms, galleys, butcher shops, and bake shops, 
and make suitable recommendations if any unsatisfac- 
tory condition is observed regarding the storage, hand- 
ling, preparation, and serving of food. 
All food handlers—cooks, butchers, bakers, helpers, 
and messmen should be required to keep their hands as 
well as utensils and implements used in the preparation 
and serving of foods, scrupulously clean. Strict super- 
vision should be maintained over the health of food 
handlers to insure prompt detection of infectious 
disease. 
Medical officers should receive copies of the weekly 
menus for the general mess and note whether or not a 
balanced ration is being prepared. The most frequent 
defect, both on board ship and in the field, is a too high 
percentage of carbohydrates. 52 
MANUAL OF NAVAL HYGIENE 
When animals are purchased alive to be slaughtered 
by or for personnel of the Navy or Marine Corps, as 
may be required for a naval vessel under certain cir- 
cumstances or for an expeditionary force in the field, 
a medical officer should inspect the animals before 
slaughter and examine the carcasses after slaughter. 
Ante-mortem inspection.—This inspection will elim- 
inate animals that are immature, emaciated, feeble, crip- 
pled, appearing ill, or exhibiting skin lesions. Females 
in advanced state of pregnancy should be rejected. 
Calves should be at least 3 weeks of age before slaughter. 
Post-mortem inspection.—It is essential that this in- 
spection be made immediately after slaughter when all 
parts are intact; carefully inspecting serous membranes, 
lymph glands, tongue, viscera, glandular organs, and 
lungs for evidence of disease. When in doubt, it is best 
to reject those animals exhibiting undetermined path- 
ological changes. 
Principal diseases and conditions for which animals 
should be rejected. 
1. Tuberculosis. 
2. Pyemia. 
3. Foot and mouth disease. 
4. Actinomycosis. 
5. Pneumonia. 
6. Inflammatory conditions of serous mem- 
branes. 
T. Advanced pregnancy. 
8. Recent parturition. 
9. Metritis. 
10. Pyometria. 
11. Emaciation. 
12. Abscesses. FOOD AND FOOD INSPECTION 
53 
13. Scabies. 
14. Parasitic infections. 
15. Icterus. 
16. Melanosis. 
Good, high-grade meat is dry, firm to the touch, of 
normal color, and free from abnormal odors. A wet, 
slimy, or moldy surface is indicative of beginning sur- 
face spoilage. Slime is to be found most frequently 
on the peritoneal and pleural surfaces or where two 
surfaces are in apposition. Softened areas usually in- 
dicate decomposition. 
The color of choice fresh meat should be as follows: 
Beef Bright red 
Veal Pinkish brown 
Mutton Dark pink or red 
Lamb Light pink 
Pork Light pink 
Abnormally dark colors are caused by advanced age, 
overheating or disease at time of slaughter, improper 
bleeding, or prolonged storage in chill rooms. Sour, 
putrid, or other abnormal odors are indicative of 
spoilage. 
When decomposition of meat is suspected, the tainted 
portions shall be trimmed off and a probe sunk into the 
underlying deep tissues. If decomposition is present, 
the characteristic odor of putrefaction will surround the 
probe. A whole quarter of beef should not be con- 
demned because a portion of it has begun to decompose, 
as it is often possible to trim off the tainted portion and 
use the remainder. 
If meat is to be frozen, it should be placed in a room 
for 24 hours with a temperature of about 84° F. to com- 54 
MANUAL OF NAVAL HYGIENE- 
pletely eliminate body heat. Meat frozen immediately 
after slaughter will spoil in the deep portions. 
Fresh fruit and vegetables.—When these products 
have not been previously inspected and do not show the 
proper stamp, it is important to bear in mind that they 
are very perishable and the surface appearance is no 
guarantee of the interior condition. Common defects 
encountered in fresh fruits are : Cuts, skin cracks, worm 
holes, softness, skin blemishes, overripeness, and poor 
form. Vegetables should be free from decay, mold, 
frost injury, disease, blemishes, and insect or mechanical 
injury. Chapter V 
LIGHTING OF SHIPS 
Proper lighting on board ship contributes definitely 
to good morale. By it the health and comfort of the 
entire personnel is improved. There is no question but 
that good vision is extremely essential and that good 
lighting is equally as essential to protect good vision. 
It has been said that 85 percent of all knowledge is 
gained through the visual sense and at least that much 
of one’s bodily motion is controlled by the eyes. Light- 
ing on board ship is more important today than ever 
before. Due to present war conditions, it has been 
found advisable to do away with all portholes, with the 
result that a great part of the ship’s spaces and com- 
partments must be artificially illuminated at all times. 
The first question to be settled is: What is good illu- 
mination? On a bright, sunny day the level of illu- 
mination out-of-doors may be as high as 10,000 foot- 
candles. We seem to go about in this lighting without 
trouble; in fact, there is something very pleasant about 
it. Even on a very dreary day the number of foot- 
candles runs up to several hundred. Indoors presents 
a different picture. Spaces in a private home are fre- 
quently poorly lighted with foot-candles at best from 2 
to 10. On some desks, or around special reading lights, 
20 to 50 foot-candles are not unusual, but this amount 
of lighting is frequently spoken of as being too bright, 
55 56 
MANUAL OF NAVAL HYGIENE 
however unfounded the criticism. It must be borne in 
mind that on board ship a great many of the hours of 
the day are spent below decks and the personnel are 
required to work under artificial lighting. 
One of the most distressing conditions that comes 
from poor lighting is eye fatigue. There is nothing 
more disturbing to human efficiency than eye exhaustion. 
For example, certain researchers show that ocular 
muscle fatigue, produced by reading, is approximately 
three times as great after reading for an hour under 1 
foot-candle, as it is after an hour’s reading of the same 
printed matter under 100 foot-candles. Very often the 
personnel coming down into the closed spaces have 
been on watch for a number of hours and are already 
fatigued bodily. More discomfort should not be added 
to their weariness by producing eye fatigue .through 
poor lighting. 
Glare.—On the practical side of good lighting is the 
preventing of accidents on board ship. Lighting must 
be of proper quality for good seeing. Glare, diffusion, 
direction, and distribution are all significant factors. 
Glare can be defined as any brightness within the field 
of vision of such character as to cause discomfort, an- 
noyance, or interference with vision. It tends to injure 
the eye and disturbs the nervous system. It causes dis- 
comfort and fatigue and thereby reduces the efficiency 
of the personnel. It interferes with clear vision and 
again reduces efficiency, and in many cases it increases 
the risk of accident or injury to the personnel. 
There are two common forms of glare: Direct and 
reflected. - 
Direct glare is caused by excessive brightness, or high- 
brightness—contrast within the visual field, such as LIGHTING OF SHIPS 
57 
results from unshielded lamps or high-brightness sur- 
faces of fixtures. Direct glare is very common aboard 
naval vessels. Much of it is caused by bare lamps scat- 
tered about passageways and living spaces. These bare 
lamps are too bright and are a source of constant shock 
to the eyes. Glare often results when there has been an 
effort to provide more light by increasing the wattage. 
Crude means of eliminating glare are very common, e. g., 
parchment shades over lamps in staterooms, tin and 
paper cone reflectors over lamps in offices. Metal 
troughs and shades constructed on the ship are useful 
but are not uniform and do not always bring about the 
desired results. The use of improved types of reading 
lamps, such as those that conform to I. E. S.1 specifica- 
tions are to be recommended. 
Reflected glare, as the name implies, is caused by re- 
flection from bright surfaces, such as the overhead, desk 
tops, and any other bright surfaces that may come within 
the visual field. Highly polished machine parts, smooth 
finished surfaces, varnished table tops, and other highly 
reflective surfaces are all too frequent. Reflected glare 
is usually more annoying than direct glare because it is 
generally close to the line of vision and the eye cannot 
avoid it. The answer here should be easy; do away with 
all highly polished surfaces wherever possible. 
Diffusion and distribution of light.—Some directional 
and shadow effects are desirable in general illumination 
for accentuating the depth and form of solid objects. 
Generally only shadows of softer and less pronounced 
types should be allowed. Alternate light and dark areas 
in strong contrasts are undesirable, because the eye has 
difficulty adjusting itself to the two illuminations; under 
1 Illuminating Engineering Society. 58 
MANUAL OF NAVAL HYGIENE 
such conditions seeing becomes trying. For this reason 
purely local lighting, restricted to a small work area, 
is unsatisfactory unless there is sufficient general illu- 
mination in the room. This condition is altogether too 
common on naval vessels. 
Structural conditions in compartments sometimes 
make it impracticable to provide general lighting 
throughout the entire space. The result is that it is 
necessary to have supplementary lighting at the par- 
ticular points of work, either with units attached to the 
machines, or with units mounted from the overhead but 
properly located with respect to the machines. Care 
must be taken to see that the lighting units are not en- 
tirely those producing a closely confined beam directed 
solely at the work. In other words, there should be an 
even diffusion from the lighting source, giving as nearly 
as possible a unified distribution of foot-candles over the 
entire area and surroundings. If this is not done the 
man at work will have his attention focused on the 
brightly lighted area and each time he looks up to rest 
his vision, as he will do normally, his eye must adjust 
itself to the much darker surroundings. The result is 
rapid fatigue of the eye muscles. A good rule to follow 
would be supplementary lighting that will give 50 foot- 
candles and a general lighting of spaces of 10 foot- 
candles. At no time should the general illumination be 
less than 5 foot-candles. 
Color of light.—The “white” light is the one in gen- 
eral use in the Navy and should be considered the 
desirable one. However, the so-called daylight lamps 
which have blue glass bidbs can be used and may be 
more agreeable to some people than so-called white 
light. One must remember, however, that it takes moi-e LIGHTING OF SHIPS 
59 
wattage to give the same amount of light when the 
blue bulb is used. 
Color of surroundings.—In general light-colored or 
tinted surfaces are desirable for walls and overhead. 
They increase the utilization of light because they 
reflect more light toward the working areas. The 
overhead, generally speaking, should be painted a flat 
white. A flat finish is desirable to prevent specular 
reflection from bright light sources which would other- 
wise be shielded from view. A white color provides 
the highest reflection factor. Certain shades of green 
are desirable for side walls, but it should he remem- 
bered that when the darker green is used the foot- 
candles on the working spaces will be reduced accord- 
ingly. Green should never be used for the overhead. 
Lighting fixtures.—Lighting fixtures for naval ves- 
sels cannot be designed entirely for efficiency, good 
lighting, and appearance, as is possible ashore. On 
board ship the factors of weight, size, and strength are 
all-important, and very often a compromise must be 
made. In the turrets and handling rooms, because of 
the tremendous amount of piping, ducts, control cables, 
etc., there is no way to lay down a fixed rule for any 
set lighting fixtures. Safety is paramount here, and all 
fixtures must be designed from a safety standpoint. 
Even so, there is no excuse for glaring, bare lamps. In 
such spaces as a sickbay, dispensary, operating room, 
and dental office a higher level of lighting is considered 
necessary. There should he good general lighting with 
available high-intensity spot lights. 
Working areas—machinery spaces, shops, laundries, 
chart houses, offices.—Most machinery spaces can be 
lighted in a manner very similar to industrial interiors 
516368 43 —5 60 
MANUAL OF NAVAL HYGIENE 
ashore, that is, with dome reflectors, with or without 
steamtight fittings, as the atmospheric conditions of the 
space may dictate. 
In machine shops the lighting fixtures should be 
arranged with respect to the machines and located so 
that the men do not stand in their own shadows. Aux- 
iliary lighting equipment should be provided for all 
such spaces. High illumination should be provided. 
In the laundry there is little need for uniform spac- 
ing of lighting fixtures. Instead, lights should be 
placed with careful regard to such machines as ironers, 
collar machines, sorting tables, etc. 
The chart house is a good example of a space where 
good lighting must be provided, free from glare. It 
is here where men work on fine details over long 
periods. General lighting is desirable with good spot 
lighting, always remembering that the eyes must be 
protected from direct illumination and surfaces must 
be of nonspecular reflecting quality. Indirect lighting 
would be ideal in the charthouse because of the soft 
effect and freedom from shadows, but the confined 
space makes this difficult. A fluorescent fixture gives 
excellent service if it can be installed, but it is usually 
too bulky or cumbersome for charthouse use. 
Lighting of office spaces on board ship is a difficult 
problem. Here, too, fluorescent fixtures are very desir- 
able but unless they are used in desk models it seems 
almost impossible to find room enough to get proper 
installation. An effort should be made to obtain at 
least 30 foot-candles for desk spaces. 
(ralley, pantry, butcher shop, bakery, scullery.—In 
these spaces there is real need for a liberal amount 
of illumination, because cleanliness, accurate work, and LIGHTING OF SHIPS 
61 
good appearance of the products are absolutely essen- 
tial. A high level of lighting is very desirable in all 
of these spaces and it should be provided with fixtures 
that do not give direct or reflected glare. 
In the galley adequate light is particularly needed 
over the ranges, kettles, sinks, and work tables. The 
health of the crew may be affected seriously if cooks 
cannot see properly in preparing the food. Lighting 
fixtures should be cleaned frequently to remove the 
coating deposit caused by steam and vapors. 
The same comment can be made on the pantry, 
butcher shop, bakery, and scullery insofar as good light- 
ing means cleanliness. 
Living spaces—staterooms, wardrooms, C. P. O.'s 
mess.—The lighting should be such as to promote com- 
fort and at the same time be of adequate quantity for 
reading and for other visual tasks. Indirect or semi- 
indirect lighting is greatly to be preferred, but the low 
overhead makes indirect lighting difficult. Supple- 
mentary lights may be provided by the use of well- 
constructed reading lamps. 
Crew spaces.—Here we have a difficult problem in 
lighting because of the considerable wattage required 
if adequate seeing conditions are to be made available 
for all of the men living in these large compartments. 
It is likewise impracticable to provide individual bunk 
lighting. Nevertheless the men will read in their 
bunks, regardless of whether or not the light is suffi- 
cient for reading purposes. The most practical solu- 
tion seems to be to select certain sides, or corners, of 
the crew’s spaces where the men naturally congregate 
for reading, writing, or card playing, and here lighting 
should be provided of from 30 to 50 foot-candles. Gen- 62 
MANUAL OF NAVAL HYGIENE 
eral lighting should be provided in these spaces of not 
less than 5 foot-candles. 
Light sources.—The incandescent lamp has been the 
standard light source on naval vessels for many years. 
The lamps designed especially for rough service have 
a much greater ability to stand shock than the standard 
lamps used ashore. They are available in from, 50- to 
200-watt sizes. It should be pointed out, however, that 
in obtaining greater ruggedness there is some loss in 
the efficiency of light production. 
Table 5 
Xavy spec- 
ifications 
(general 
fighting) 
American recom- 
mended practice (mini- 
mum on work) 
Machinery spaces, engines, generators, etc 
Switchboards (gages, etc.) 
Shops—general, repair, etc . _ 
Shops—fire control, aviation, radio.. 
Shop—print,. .. . 
Paint mixing 
Stowage... 
Bakery .. . 
Laundry. . 
Offices. 
Charthouse 
Passageways. ... 
Foot-candles 
10 
21) 
10 
10 
2 
3 
10 
5 
1 
Foot-candles 
20. 
30. 
(20- rough work. 
130—medium work. 
(50 -fine work. 
\100—extra fine work. 
30 to 100. 
10. 
(5—bulky. 
110—fine. 
20. 
20. 
(25—general work. 
150—long, close work. 
30. 
5. 
From the above table it is apparent that the values of general lighting may be raised 
by supplemental lighting (detail illumination) to yield the values given in column 2. 
The greatest upward step in efficiency of light sources 
has been the development of the fluorescent lamp. These 
lamps are quite rugged. The main problem, however, 
is that of supporting a relatively long glass tube so that 
there will be minimum breakage. Unfortunately, in the 
present state these lamps have to be tubular in form and LIGHTING OF SHIPS 
63 
supplied with alternating cutrent for good efficiency. 
Fluorescent lamps have another specific advantage in 
that they efficiently produce light which is roughly com- 
parable to daylight. We all like daylight color, for our 
eyes have been educated under it. The fluorescent lamp 
also provides cooler light. Less than half the watts are 
needed to give the same level of illumination as in the 
standard light. Furthermore, fluorescent lamps are 
relatively soft to the eyes, a helpful feature when bare 
lamps are used. The fluorescent lamp seems to be the 
answer in a search for better lighting conditions on 
board ship: 
(1) In the lowering of glare; (2) from the 
standpoint of getting additional foot-candles 
without great increase of electrical consumption; 
(3) in providing better seeing conditions. 
The use of fluorescent lamps, however, presents some 
complications because of the pecularities of construction 
on board ship. They require a great many more elec- 
trical connections than do incandescent lamps. A trans- 
former is generally necessary, and this means additional 
weight; and often a starting mechanism of some kind 
to preheat the cathodes in the lamps further places 
demands upon the ship’s space and tonnage. 
Common sense must be used at all times when con- 
sidering lighting in any form. Research is going on 
constantly, and during the past 2 years much has been 
done to utilize the red end of the spectrum of light 
sources. For many years battle lights have been blue. 
Lighting of gunsights and other instrument panels have 
been by means of blue lights. It is a well-known fact 
that a blue light will be seen at a much greater distance 64 
MANUAL OF NAVAL HYGIENE. 
at night than will a light that has its chief rays in the 
red end of the spectrum. Hence, the red light is recom- 
mended for all purposes where it is essential to maintain 
dark adaptation. 
Again we turn to research for better light and better 
lighting, and in the development of both new and old 
light sources, more simple and reliable means of lighting 
will be found. Chapter VI 
NAVAL CLOTHING 
Clothing promotes the efficient and comfortable func- 
tioning of the human body under varying conditions by 
(1) protecting it from heat, cold, water, fire, trauma, 
etc.; (2) by mitigation of climatic factors; and (3) by 
aiding in the maintenance of dynamic body-heat bal- 
ance. In effect, clothing acts to establish an immediate 
environment about the body which is more conducive to 
its functioning than external conditions. 
For practical utilization of clothing, it is essential 
to appreciate the fundamental problems and relation- 
ships between the physiologic, climatic, and engineer- 
ing elements involved. 
Physiology of Body Heat Balance. 
Heat is a vital byproduct of the living human body. 
The body balances heat gain and heat loss by varying 
heat production and by altering heat loss. The elements 
involved are graphically outlined in figure 6. 
Balance, under warm environmental conditions or 
when heat must be dissipated from the body, is main- 
tained by an increased blood flow to the surface of the 
body. This additional body heat may be brought on 
by work, by exercise at ordinary temperature, or- by ele- 
vated temperature due to weather conditions and sim- 
ilar factors. The flow of blood to the body surface is 
65 66 
MANUAL OF NAVAL HYGIENE. 
increased, and the sweat glands are stimulated to activ 
ity. The activity of the sweat glands raises the mois 
Based on Du Bois (1937) 
and Pinson and Benson (1942) 
RADIATION 
CONVECTION 
CONDUCTION 
VAPORIZATION 
THE BALANCE OF HEAT GAIN AND HEAT LOSS IN THE HUMAN BODY 
HEAT LOSS 
Cooler environment 
Decreased clothing or 
lets insulotive value 
Air movement over body 
Temperature of air 
(varies with density) 
Contact with substance 
Temperature of substance 
Specific heat of substance 
From lungs: 
Vapor content of inspired air 
Insensible perspiration 
Sensible perspiration (sweating) 
-- both types influenced by 
increased skin circulation 
and temperature, change in 
temperature gradient, increased 
radiating surface. 
Major Factors Increasing**™* 
Figure 6. 
•Y MEANS OF 
Musculor "tenting" 
Conscious exercise 
involunfory 
Specific dynomic 
action of food 
HEAT PRODUCTION 
BASAL METABOLISM 
PROTEINS 
FATS 
CARBOHYDRATES 
INCREASED BY 
ture content and the heat is lost normally by radiation 
convection, vaporization, and conduction. 67 
NAVAL CLOTHING 
Perspiration and vaporization must account for most 
of the body-heat loss under hot conditions, especially 
where surrounding surfaces possess a higher radiation 
value or are warmer than the body, and where air 
movement is at a minimum or the air is warmer than 
the body. Perspiration can lower the body temperature 
only when it evaporates from the body. If it evaporates 
from clothing, it may lower the temperature of the 
immediately surrounding air. Water of perspiration 
that runs otf the body or is wiped off represents a loss 
in terms of vaporization. If the environmental air is 
both hot and saturated with water, all modes of heat 
loss are restricted, body temperature will rise, and heat 
stroke result.1 
Balance under cold environmental conditions is a 
problem of conservation of heat produced by the body. 
Sweat secretion ceases. Heat loss by vaporization is 
restricted to (1) insensible perspiration through the 
skin, and (2) evaporation due to saturation of inspired 
air in the lungs. 
Heat stored in the tissues of the body protects against 
sudden changes incurred by external cooling. Storage 
supplies a specific amount of heat on demand by the 
atmosphere before the body itself can increase its metab- 
olism to meet increased requirements. However, when 5 
or 10 percent of this storage has been removed from the 
body, pain sensations begin. This is, in effect, the cold 
warning the body of its heat deficiency. The body, 
taking cognizance, increases its metabolic rate by shiv- 
ering. 
1 For further discussion of the physiological effects of heat, salt, and 
water loss, and heat stroke see ch. II, “Ventilation and Air Conditioning 
on Shipboard,” especially fig. 3, “Scheme of Syndromes Induced by 
Excess Heat.” 68 
MANUAL OF NAVAL HYGIENE 
Iii acclimatization to cold conditions the principal 
physical adjustment involves blood redistribution. 
Blood flow to the skin is decreased, thus conserving vital 
body heat. As a result, the tissues become poorer con- 
ductors of heat in a ratio of approximately 1 to 4. This 
effect is most notable in the extremities. The hands and 
feet—especially the fingers and toes—are, therefore, 
the best thermostatic indicators of body temperature 
conditions. In these areas decreased blood flow serves 
the essential and quite useful purpose of reducing heat 
loss and enabling the body as a whole to maintain a heat 
balance. But in a sense the appendages are sacrificed, 
for the decreased circulation raises the minimum toler- 
able environmental temperature which these extremi- 
ties can withstand without freezing. 
As compared with persons acclimatized to cold, the 
extremities of the unacclimatized body are supplied with 
greater quantities of heat. Acclimatized persons can 
stand the pain of cold more readily, can dress with less 
body clothing, and can therefore move with greater 
efficiency. Paradoxically, however, they apparently 
will suffer cold hands and feet more quickly than the 
unacclimatized person when metabolic heat production 
drops. On the other hand the unacclimatized person, 
when exposed to conditions potentially lethal, will per- 
ish sooner because the same flow of heat from his body 
which temporarily is warming his extremities is also 
sapping vital heat. 
Numerous other variables enter into body heat pro- 
duction. Unconscious tensing of muscles and shivering 
may increase body-heat production substantially, but 
the process is decidedly unpleasant. Emotional reac- 
tions, especially fear, expressly affect the thermal out- 69 
NAVAL CLOTHING 
put of the body, and are apparently capable of increas- 
ing body-heat output by as much as 200 to 300 calories. 
Fatigue is an important negative factor. Illness may 
disrupt the entire body-heat balance mechanism by pre- 
venting the relief from fever provided by perspiration. 
Trauma may specifically affect localized areas of the 
body, and alter local thermal output. The quantity, 
quality, digestibility, and caloric content of food are 
important factors.2 
The Influence of Climate 
The major external variant affecting the heat pro- 
duction of the body is what is normally termed climate. 
Although it has been customary to express environ- 
mental conditions affecting body heat primarily in 
terms of temperature, properly humidity, wind velocity, 
altitude, and varying man-made conditions also should 
be considered. These conditions may be enumerated as 
operations on board ship, below the sea, in the air, in 
fire rooms, in armored vehicles, and the like. 
Under hot environmental conditions, excessive hu- 
midity inhibits the heat-loss mechanisms of the body. 
Between 90° and 95° Effective Temperature3 the 
limit of human endurance is normally reached, at least 
for periods of 3 hours or more. Wind velocity and 
the resulting cooling effect is a factor of considerable 
importance under both hot and cold conditions: Under 
the former to be taken advantage of as a means of 
removing heat from the body; under cold conditions, 
to insulate the body against its cooling. Variations in 
2 See ch. IV, “Food and Food Inspection,” for further elaboration. 
3 See ch, II, “Ventilating and Air Conditioning on Shipboard,” for a 
discussion of the effective temperature concept. 70 
MANUAL OF NAVAL HYGIENE 
altitude affect air pressure, availability of oxygen and 
temperature. For altitude temperature changes see 
pages 37 and 235. 
Thermaldtnamic Aspects of Textiles. 
Textile fibers in most common use are cotton, wool, 
and rayon. These differ in suitability for a given pur- 
pose depending upon their physical properties such as 
fineness, strength, elasticity, resilience, moisture con- 
tent; upon their sensitivity to chemicals such as 
cleaning compounds; ami upon their susceptibility to 
organisms such as fungi, bacteria, and insects. 
The thermal insulation afforded by a fabric is more 
dependent upon the thickness of the fabric than upon 
the kind of fiber. Cotton, wool, and rayon, if made 
into fabrics of the same thickness and of similar con- 
structions, afford relatively the same thermal insula- 
tion. Wool, however, is particularly suitable for 
making thick fabrics of low density. Such fabrics 
contain large amounts of enmeshed air and accordingly 
have high resistance to the passage of heat. Thin, 
open-weave fabrics are cool because they allow the 
free circulation of air. 
Fabrics differ substantially in their ability to absorb 
or transmit moisture and it is essential, especially under 
cold conditions, that perspiration, sensible and insen- 
sible, be allowed to evaporate. A dry garment, before 
it comes into hygroscopic equilibrium with the body 
and atmosphere, will absorb insensible perspiration 
from the body to the extent of canceling the normal 
10 percent heat loss from this source. 
In fact garments having a lower relative humidity 
than the atmosphere will attempt to absorb moisture, 
thereby increasing their temperature due to heat re- NAVAL CLOTHING 
71 
leased by condensation. This absorption usually occurs 
within the first or second hour. Thus garments, espe- 
cially of wool, not only serve as insulators, but as minor 
heat producers. 
Major Types and Problems of Clothing 
Protection from heat.—Free ventilation of the skin 
is essential to promote cooling by evaporation of per- 
spiration. As a general rule hot-weather garments 
should be loose, thin, and lightweight. The neck 
should be open, the sleeves and trouser legs short. 
Constriction at the trunk may be avoided by shorts 
buttoned to the shirt, or by suspenders when a coat 
is worn. Longitudinal slits under the arms of the 
shirt and coat promote ventilation and are visible only 
when the arms are raised. Heavy starched clothing 
is impervious to air and should be avoided. Under- 
clothing, even for persons with poor perspiration, is 
much to be desired. 
Shorts and shirt, such as officially designated by the 
Xavy for general tropical wear, afford little protection 
from insects, scratches and abrasions, or flash burns. 
Standard undress whites, frequently worn without the 
jumper, also result frequently in serious sunburn. Men 
on watch, at guns, and on lookout should be thoroughly 
protected, including sun or other helmet. 
Jungle fighting in the Pacific area has clearly dem- 
onstrated the necessity of long trousers and sleeves for 
all types of operations. Apparently as compared to 
shorts, long trousers of similar material only insignifi- 
cantly increase body heat. 
The color of hot-weather clothing affects substan- 
tiallv the amount of solar radiation that will be ab- 72 
MANUAL OF NAVAL HYGIENE 
sorbed. White will generally absorb the smallest 
amount of radiated energy, black twice as much. 
The best interests of hygiene in the Tropics are served 
by clothing that cannot only be readily and repeatedly 
washed, but that can also be sterilized or disinfected by 
boiling. Parasitic skin diseases are very prevalent in 
the Tropics and it is regarded as next to impossible to 
cure those caused by molds or mites without thorough 
and repeated disinfection of all clothing in contact with 
the infected skin. 
Care must be taken to protect against sudden or con- 
siderable changes in temperature. After prolonged 
exposure to constant heat, the body becomes extremely 
sensitive to such changes. A drop of more than 10° F. 
produces a disagreeable sensation of cold, and unless 
warmer clothing is put on promptly a further drop may 
cause chilling and diarrhea. 
Acclimatization in advance of arrival of troops 
shifted from their native climates to tropical areas is 
of special importance. The United States Naval Med 
ical School suggests the following practical steps: 
1. If time is available and the season is suitable, troops 
destined for service in the Tropics should undertake a month 
of vigorous work in summer beat, just before sailing. 
2. If time is short and the season is unfavorable, equally 
good results can be secured by having the men do hard work 
to 2 hours daily for 3 or 4 weeks in a building with 
controllable temperature and humidity as follows: 
Simulating average tropical climate—Temperature 90° F., 
humidity 70 percent. 
Simulating average desert climate—Temperature 104° F., 
humidity 25 percent. 
Merely having the men work for ll/> to 2 hours daily 
for 7 days in an artificially heated building will produce 
good results; or having them march for 7 days at 4 miles NAVAL CLOTHING 
73 
per hour on the level, or 3% miles per hour on a 5-percent 
grade, long enough to raise body temperature and pulse 
rate, and promote free sweating. If such daily exercises 
are found to be too exhausting, a rest day may be interpolated 
after the second and fourth days. 
8. Since most well-acclimatized men tend to retain their 
condition for at least 3 weeks after stopping work, it is recom- 
mended that men during transit to a tropical combat area be 
given enough vigorous exercises each day to induce free sweating. 
4. Since sweating depends on skin area, and since skin area 
per unit of hulk is greater in medium and thin individuals, 
there is theoretical objection to the stocky and large build for 
tropical work involving great physical stress. 
Protection from cold.—Three layers of clothing are 
normally involved in cold weather protection; (1) The 
underwear layer, (2) the insulation layer; and (3) the 
wind and water resistant layer. These are well illus- 
trated by the Navy’s winter clothing issues (figs. 7 
and 8). 
(1) Underwear is one of the most important ele- 
ments of cold weather clothing. It serves as a heat 
filter to slow down radiation and convection and to con- 
duct moisture away from the body. Underwear should 
be form-fitting, moderately dense, absorbent, light- 
weight, soft but with sufficient body to withstand com- 
pression. One-piece woolen underwear is preferable 
since it absorbs a large amount of perspiration, main- 
tains the body in relative dryness, eliminates double 
insulation at the trunk and makes for more comfortable 
wearing. 
Intense drying of all woolen clothing, especially un- 
derwear, socks, etc., increases its efficiency considerably. 
Frequent changing of garments, and the practice of 
drying at night the underwear used during the day 
are especially helpful. 74 
MANUAL OF NAVAL HYGIEXIEi 
Figure 7.—The 
Navy’s special win- 
ter clothing is de- 
signed to provide 
protection for per- 
sonnel assigned to 
duty in which they 
are required to un- 
dergo continuous 
exposure to se- 
verely cold 
weather. The il- 
lustrated outfit 
consists of a two- 
piece woolen un- 
derwear suit with 
full-length sleeves 
and legs. This is 
worn under regu- 
lar clothing and 
knee-length woolen 
socks. Outer gar- 
ments are made of 
tight-woven, wool- 
lined Jungle-cloth 
in dark blue. 
Trousers are of 
overall type, tieing 
at the ankles over 
the arctics. The 
Jacket, fastened by 
a zipper, has woven 
wrist, neck, and 
waist bands. 
Gloves a' e one- 
finger, leather with 
wool lining. The 
helmet is jungle- 
cloth, fleece-lined, 
with a neck-shield. 
For extreme 
weather dark- 
tinted plastic gog- 
gles are supplied 
as well as a jungle- 
cloth face mask 
with an apron 
which fits beneath the Jacket neck. (Outfit from Bureau of Ships ; photo- 
graph by Bureau of Aeronautics.) NAVAL CLOTHING 
75 
(2) Insulation involves usually normal clothing plus 
special outer wear. Figure 7 illustrates the Navy’s 
present prescribed cold-dry-weather outfit. 
Care must be exercised not to overdress because, with 
activity, body heat production increases. Perspiration 
should always be avoided. The body is unable to 
check the flow of perspiration water to the skin surface 
when skin temperature rises to about 95° F. The re- 
sultant flood of moisture dampens the clothing and 
tends to cool the body by added conduction. This will 
continue even after the need for sweating has ceased. 
Personnel exposed to cold conditions should learn to 
estimate their clothing needs in terms of environmental 
conditions and expected degree of activity, should at- 
tempt to underdress rather than dress for inactivity, 
and be prepared to take immediate steps to. facilitate 
cooling by increased ventilation when body heat rises 
above the comfort level. This latter may usually be 
accomplished by baring the hands, which act much 
as an automobile radiator in cooling. 
(3) Wind and water resistance normally is a function 
of a third clothing layer. Approximately 75 percent of 
potential heat loss from the body may be due to an 
increase in air movement. The most effective means of 
reducing this loss is by creating a shell which is more 
or less impervious to wind. A long-staple cotton fabric 
of dense weave is the most efficient fabric for such 
purposes (fig. 8). 
A windproof garment reaches optimum efficiency with 
a combination of thin pliability, minimum weight, and 
a density just short of moisture imperviousness. A 
windproof garment may be made water-repellent but 
should never be made waterproof, because in the latter 
ol 6*308—43 6 76 
MANUAL OF NAVAL HYGIENE 
Figure 8.—For wet and 
windy weather, the il- 
lustrated garments are 
worn over the special 
winter clothing shown 
in figure 7. The trou- 
s e r s and parka-type 
jacket are made of very 
tightly woven material, 
which while not entirely 
waterproof in the same 
degree as oilskins, is far 
more satisfactory be- 
cause the material 
“breathes” — allows 
body moisture to be 
transferred out—but at 
the same time breaks 
the force of the wind 
and prevents water 
from saturating the in- 
sulative layers of gar- 
ments. (Outfit from 
Bureau of Ships ; photo- 
graph by Bureau of 
Aeronautics.) NAVAL CLOTHING 
77 
case water of perspiration will accumulate in large 
quantities inside the clothing. 
Aviation Clothing. 
The problems of aviation clothing involve most of 
those associated with general heat and cold protection, 
as well as a multitude of conditions peculiar to aircraft 
operations. These include: Weight, bulk, resistance to 
flame, floatation, ease of putting on or taking off, inte- 
gration with equipment, ability to protect against tem- 
perature extremes, limitation of normal activity, protec- 
tion afforded when forced down, and the like. 
While heating of the aircraft interior remains a pos- 
sibility, for practical purposes the burden of air-crew 
protection from cold is a matter of clothing technic, in- 
volving unheated and heated types. 
Unheated insulative clothing derives its main advan- 
tages from the independence afforded each crew member 
from all outside heat sources under all conditions, in- 
cluding forced landings on cold terrain. It is frequently 
difficult to adjust clothing worn to the amount required 
by widely varying conditions. This is most acute in 
the case of the pursuit pilot who must don clothing on 
the ground—under conditions perhaps quite warm— 
which will protect him at high-altitude temperatures. 
Perspiration accumulates at ground level temperatures, 
making the garment uncomfortable and inefficient when 
cold is encountered. 
Shearling—sheepskin with the wool inside—while 
long the main reliance for aviation suits, in actual service 
is at a disadvantage because of its excessive weight and 
bulkiness, its stiffness, relative impermeability to water 
vapor, and the difficulty of drying because of the neces- 78 
MANUAL OF NAVAL HYGIENE 
sity for coating the outside for durability. Manufac- 
tured clothes, such as cotton and wool pile, seem to be as 
effective in insulation and facilitate mobility of the 
wearer and “breathing” of the garments. 
The normal reaction for a fighter pilot is to desire 
freedom of movement even if he gets cold. The best 
present padded suits, with all of their bulk, can protect 
at most to around +20° F. for approximately 6 hours. 
Below this temperature, and for longer periods, body- 
heat production must be increased. This process is com- 
plicated by the fact that it necessitates an increase in 
oxygen consumption and because of confined quarters 
it is not possible for all air crew members to exercise to 
the extent necessary to maintain heat balance. 
Figures 9 and 10 illustrate lightweight Navy flying 
clothing. Figures 11 and 12 are photographs of the 
shearling, heavy insulative Navy flying outfit. 
Heated aviation clothing permits reduction in bulk 
and protects against extremely low temperatures. Heat 
may be supplied from two sources—by circulation 
through the suit of air warmed by the engine; and by 
means of an electrical inner lining, with energy taken 
from the plane’s power plant. 
Electrically heated clothing appears to hold much 
promise, being used with varying amounts of insulative 
clothing. However, inadequate protection is afforded 
in case of failure of the power supply, or in case of 
forced landing and abandonment of the ship on a cold 
terrain. A substantial amount of electrical energy is 
needed for each suit at extremely low temperatures, even 
when moderate insulative clothing is used. In the 
case of air heating, danger of carbon monoxide poi- 
soning is a factor, and in both types aviators balk NAVAL CLOTHING 
79 
FIGURE 9.—Xavy pilot’s light-weight summer cover-all. (Photograph 
from U. S. Xaval Air Station, Anacostia, D. C.) 80 
MANUAL OF NAVAL HYGIENE 
Figure 10.—Medium-weight Navy leather flying jacket and helmet. 
Worn with regular blue denim work outfit. (Photograph from U. S. 
Naval Air Station, Anacostia, D. C.) NAVAL CLOTHING 
81 
Figure 11.-—Aviator donning suspender-type trousers of standard 
heavy insulative flying outfit. These are of shearling, fastened by 
zippers, and worn over regular clothing. Note the fleece seals at 
ankles and waist. These merge into the similar linings of boots and 
jacket to provide a cold-proof seal. (Photograph from U. S. Naval 
Air Station, Anacostia, D. C.) 82 
MANUAL OF NAVAL HYGIENE 
Figure 12.—The complete Navy stand- 
ard two-piece aviator outfit for 
normal high-altitude flying. Boots 
are equipped with a special zipper 
release for quick removal if forced 
down in water. The outer skin of 
the shearling is coated and quite 
impervious (o air. With the wool 
lining and with woolen underwear 
this disadvantage, however, may be 
largely overcome and a considerable 
amount of perspiration absorbed. 
(Photograph from U. S. Naval Air 
Station, Anacostia, D. C.) 83 
NAVAL CLOTHING 
Figure 13.—The electrically heated flying outfit of the Navy for use in 
extreme cold conditions and for long-range, high-altitude flights. The 
suit is one piece of coated leather, with an inner lining containing 
the heating grid. Gloves of the five-lingered typo connect into the 
heating circuit by means of two snaps. (Photograph from U. S. 
Naval Air Station, Anacostia, D. C.) 84 
MANUAL OF NAVAL HYGIENE 
Figure 14.—Air crewman fully attired in electrically heated Naval 
aviator’s suit, showing electrical connection and master switch. 
(Photograph from U. S. Naval Air Station, Anacostia, D. C.) NAVAL CLOTHING 
85 
somewhat at the necessity of external connections be- 
tween their clothing and the plane. Figures 13 and 14 
illustrate the Navy’s adaptation of the electrically 
heated air crew outfit. 
Special Clothing Problems. 
Protection of the extremities is more difficult than 
protection of other parts of the body, yet adequate pro- 
visions must be made if total body protection is not to 
be undermined. Principles for keeping the feet warm 
may be summarized: 
(1) Keep feet dry; foot coverings for use in temperatures 
above 0° F. and under wet conditions are usually snug-fitting 
and waterproofed. Perspiration is only of secondary considera- 
tion, since there is little danger of socks freezing. One or 
more pairs of woolen socks, preferably ribbed for greater 
elasticity, are indicated. They will take care of insensible 
perspiration. Socks should be thoroughly dry before they are 
put on. The standard Navy arctic is illustrated in figures 7 
and 8. 
(2) Under extremely cold and dry conditions (below 0° F. 
with a slight breeze) footgear precautions shift radically from 
an attempt to keep moisture from entering, to an attempt to 
conduct moisture outside or to facilitate absorption within. 
Thus oil-tanned or waterproofed shoes and boots, impervious 
to water, are contraindicated. Experience in the polar regions, 
and the customs of the Russians, Canadians, Eskimos, and 
other northern peoples tend to the use of dry tanned leather, 
felt, burlap, and other similar materials. Most successful is 
the Eskimo mukluk. In this the sole and toe consist of a 
dry tan leather which remains flexible in the coldest weather. 
The upper, about 12 inches long, is of burlap. This is worn 
over two or more pair of woolen socks, between each of which 
is a felt inner sole. The outer covering is kept in place by 
tie strings loosely wound spirally and fastened above the calf. 
Under wet; conditions, a waterproof boot may be substituted for 
the outer. 86 
MANUAL OF NAVAL HYGIENE 
(3) Large, roomy, cold-climate footgear is essential. Any 
constriction will cause a decrease in the blood circulation, 
which circulation is of course the prime factor in maintaining 
body heat in the feet. 
(4) Feet are especially subject to freezing. As long as easy 
movement is had and the sensation of cold is acute, freezing 
is not imminent. If cramping prevents movement of the toes, 
and if pain of great intensity lets up without undue reason, 
the feet should be promptly examined. Circulation arrested 
by freezing or frostbite can be restored by placing them next 
to warm flesh.5 Never treat by rapid heating over a stove, 
by rubbing with snow, or by any strong abrasive handling. 
Such treatment tends to aggravate the condition and to abrade 
the skin and set up conditions for infection. Frozen toes 
should be cupped in warm hands, and gentle pressure and 
release of pressure should be applied until normal circula- 
tion has been restored. 
Basic principles for protecting the hands under cold 
conditions are similar to those for the feet: 
(1) Avoid lengthy exposure, do not touch metal, snow, etc. 
Keep the wrists, back of hands, and palms covered as much as 
possible. 
(2) Use loose fitting woolen mittens, with separate wind- 
impervious coverings. Avoid use of gloves that separate the 
fingers, since radiation between the fingers is an important heat 
source. 
(3) Chilled hands frequently are the result of overheating 
of the rest of the body and of constriction, which prevents proper 
circulation of the blood. Avoid the use of garments fitting tightly 
on the inside of the upper arm or under the armpits, where large 
blood vessels come near the surface. 
(4) Keep the hands and hand gear as dry as possible, since 
moisture increases conductivity. Changing mittens when hands 
and mittens are wet and cold will immediately produce a feeling 
of warmth. 
5 See also chapter XIX, “Hygiene in Aviation,’’ for further informa- 
tion regarding frostbite. NAVAL CLOTHING 
87 
(5) Freezing of hands is treated as described for feet, i. e., 
stimulation of circulation by gentle massage by warm hands, or of 
placing the hands next to warm flesh under the armpits, between 
the thighs, or next to the abdomen. 
The head, particularly the face, is adapted to with- 
stand a greater change of external climatic conditions 
than the body as a whole. The vital areas to be pro- 
tected in their probable order of necessity are : 
(1) The ears, because of their thinness, poor circulation, and 
exposed location, are susceptible to quick and painful freezing. 
Even in moderately cold weather, earmuffs are indicated, even 
though the rest of the head may be uncovered. 
(2) The back of the neck must be protected because of the 
vital sensory nerve cords and tendons which lie close to the 
surface. The temples, forehead and throat, because of super- 
ficial blood vessels, must also be protected. 
(3) The top of the head—when normal hair is present—will 
be safe without covering down to about 0° F. if no wind is 
blowing, although a light covering is preferable. Air crew per- 
sonnel can usually keep their heads sufficiently warm, even under 
severe conditions, by an outer leather helmet over the cloth 
inner unit (figs. 9 through 14). The chief problem is that of 
providing comfortable support for ear phones, microphone, 
oxygen mask, and goggles. 
(4) The chin will withstand a considerable range of tempera- 
tures, but when the wind is strong it requires protection. Simi- 
larly for the nose and cheeks, but as in the case of the mouth 
and eyes they are difficult to shelter. Face masks are used in 
severe weather (figs. 7 and 8). 
(5) The eyes offer special problems. Snow-blindness is par- 
ticularly serious. No matter how strong a man may consider 
his eyes to be, he will succumb to snow blindness and perhaps 
permanent injury to his eyesight if he does not take suitable 
precautions. Snow blindness is caused not only by direct sunlight 
on the snow, but also by diffused light on a cloudy day. Polaroid 
glass does not help, especially since light is reflected from many 
planes. Goggles issued with Navy winter clothing (figs 7 and 8) 
are suitable for cold weather use. Glare from the sun and water 88 
MANUAL OF NAVAL HYGIENE. 
in tropical regions may be somewhat mitigated by dark glasses. 
The antiflash eye shield in amber color (fig. 16) is being used by 
some Navy personnel. 
(6) Freezing of the flesh about the face or head may proceed 
so quickly as to go unnoticed. At the moment of freezing a 
sharp twinge of pain shoots through the affected part, and it 
suddenly blanches white. The unwritten law, in cold countries, 
requires that each man call attention to his companion’s face 
whenever he sees the appearance of an ashen area of freezing. 
Protection against gas, flame, flash.—Gas-protective 
clothing usually consists of an over-all impregnated 
covering, with impregnated woolen socks and gloves, 
rubber overshoes and a gas mask. In emergency, al- 
most any type of clothing which covers the entire body 
and is of relatively close weave may be impregnated and 
used more or less successfully. 
Efficient flame-resisting suits which will enable dam- 
age-control measures to be taken promptly and effect- 
ively are necessities. The Navy’s present fire-protection 
equipment is illustnted in figure 15. It should be noted 
that the rescue-breathing apparatus is worn on the 
outside of the suit. The rubber face piece of the appa- 
ratus should be worn under the hood of the suit, the 
corrugated breathing tubes protruding through the hole 
in the hood, with the bag outside. When the breathing 
apparatus is not used, an asbestos flap covers the hole 
in the hood. 
A major and relatively new type of casualty which 
has made its appearance in World War II is “flash burn” 
from exploding bombs, explosions, and fire. Such burns 
were of primary concern after the Pearl Harbor attack 
and have been prominent in practically every action. 
The extent of burns is directly related to the covering 
afforded the body by clothing, since the injury is caused NAVAL CLOTHING 
89 
Figure 15. — T li e 
£1 am e-resisting 
suit of the Navy 
is equipped with 
an efficient res- 
cue breathing ap- 
paratus, and is 
considered indis- 
pensable in fire 
fighting for gain- 
ing access to 
compart m e n t s 
under severe fire 
conditions and 
for taking dam- 
age control meas- 
ures. This outfit 
is light, not hav- 
ing wire inserts, 
and for practical 
purposes entirely 
fireproof. (Pho- 
tograph from Bu- 
reau of Ships.) 90 
MANUAL OF NAVAL HYGIENE 
Figure 16.—Antiflash protec- 
tion is currently afforded 
personnel by use of this out- 
fit, consisting of long, gaunt- 
let-type gloves and hood 
made of cotton, a gauzelike 
mask, and a plastic eye- 
shield. It is fundamentally 
important that all portions 
of the body be completely 
covered. The neck-apron 
may be worn under the 
blouse. (Outfit from Bu- 
reau of Ships, photograph by 
Bureau of Aeronautics.) NAVAL CLOTHING 
91 
by a sudden instantaneous but intense wave of radiant 
heat, not by prolonged intense heat or actual flame. 
Thus short-sleeved shirts, open collars, and shorts are 
in distinct disfavor. 
Flash burns at first sight rarely seem serious, appear- 
ing merely to be a slight searing of the skin. However, 
several hours after the blast the victim is usually found 
to be suffering from severe physical shock. He may 
lose control of the injured parts, and death may quickly 
supervene. 
The Navy antiflash outfit is illustrated in figure 16. 
It consists of long, elbow-length gauntlet-type gloves 
and hood made of lightweight cotton, a stiffened gauze 
“bib” to protect the mouth, and a plastic eye-shield. 
Any type of other clothing may be worn, providing all 
areas of the body are covered. In action all personnel 
should be protected. 
The British—whose outfit is essentially similar and 
in fact is the forerunner of this outfit—report that in 
spite of the discomfort naturally associated with the 
outfit, little difficulty is encountered in enforcing its use, 
especially with personnel who have seen action. Amer- 
ican experience has apparently not followed this pat- 
tern. Care should be taken to see that clean outfits in 
good order are at all times available for instant use by 
all members of the crew in exposed quarters. 
516368—43 7 Chapter VII 
GENERAL DUTIES OF THE MEDICAL OFFICER 
OF A NAVAL VESSEL—ESSENTIAL MEDI- 
CAL DEPARTMENT REPORTS 
All medical officers ordered to ships and those already 
aboard ships should refresh themselves on chapter 7, 
sections 2 and 3 of the Manual of the Medical Depart- 
ment, U. S. Navy. Here the duties are outlined and 
laid down in detail. They are practical and will be 
found to fit themselves into an effective routine, ad- 
herence to which will provide an efficient ship’s Medical 
Department. The following comments constitute an 
attempt to apply these instructions. 
The working day begins with morning sick call which 
should be expedited within the limits of safety, in order 
that as many as possible may be returned to their divi- 
sions prior to muster for quarters. Minor ailments and 
repeat dressings may be seen, and their treatment out- 
lined to be carried out by a corpsman. Thus a great 
percentage of what appears to be a large sick call may 
be handled in a relatively short time. Cases seen for 
the first time, or those not progressing properly, will 
require more careful inspection and study, hence will 
take up more time. Ear, nose and throat cases require 
close scrutiny, as it is here one can hope to limit the 
spread of the common cold, and perhaps to observe early 
signs of acute contagious diseases. For this reason all 
92 GEOSTiEIRAL DUTIES 
93 
drafts of new men reporting aboard are to be routed 
to the sickbay by the officer of the deck and examined 
for venereal or contagious diseases. 
Following completion of sick call a careful inspection 
of the ward and other sickbay spaces is made. Any 
special work for the corpsmen is outlined, and the medi- 
cal officer may proceed to the sanitary inspection of the 
ship (ch. VIII). It is well to do this in a deliberate 
manner observing not only sanitation, but any hazards 
which might lead to injury of personnel. The general 
welfare of the men may be bettered by the efforts of an 
interested medical officer who is observant. He can 
give helpful suggestions to the executive officer on im- 
proved living conditions. Minor insanitary conditions 
existing can usually be remedied in the department in- 
volved by cooperation with those responsible. Where 
resistance is encountered, and in the more flagrant 
breaking of rules, report is at once made to the execu- 
tive officer and with his cooperation the situation is 
remedied. It should be kept in mind that the executive 
officer is responsible to the captain for all the detailed 
upkeep of the ship and any minor details that can be 
remedied by department heads relieves him to that 
extent. 
Morning reports for the medical department on board 
ship can only be completed after sick call. They con- 
stitute a written report and summary of the health of 
the ship to the captain and all department heads. 
Promptness in submitting the morning report of sick, 
binnacle list and muster report is expected. Careful 
checking by the medical officer of these reports obviates 
embarrassment later due to incorrect impressions con- 
veyed by errors. 94 
MANUAL OF NAVAL HYGIENE' 
Physical examinations are frequent, consisting of 
those for promotion, reenlistment, confinement, and 
study of cases. So far as possible these should be worked 
in with regular routine, but when they present in 
large groups they must be planned or scheduled. In 
wartime all these extras require careful planning both 
from the standpoint of medical officer and examinee, to 
avoid conflict with important war watches. 
Instruction of hospital corpsmen must be a continuous 
activity and in general is best given in the afternoon. 
Instruction schedules made out on a weekly or monthly 
basis are practical, and allow men to prepare in advance 
of the instruction period. These periods can be made 
interesting by delegating part of the instruction to senior 
corpsmen who through special training or long practice 
are able to present a subject properly. Effort should 
be made to relieve all men from duty who can be spared 
for this period, providing only a skeleton crew for the 
hour or two required. 
First-aid instruction for the crew is best organized by 
divisions and in many cases can be arranged as part of 
the general instruction period held by division officers. 
In wartime it is sometimes necessary to give instructions 
to groups while they are on watch at the guns or on 
other stations. This should be done with the help of 
well-trained corpsmen in order that all members of the 
crew receive the fundamentals of first aid soon after 
joining the ship, and will thus be prepared for action. 
In combat zones it is found that all personnel soon be- 
come first-aid conscious and will cooperate in every way 
with the Medical Department in its attempt to dis- 
seminate knowledge along those lines. Thought and 
application to this instruction are necessary in order that 95 
GENERAL DUTIES 
it may apply to one’s particular ship and to one’s par- 
ticular problems as they arise. Experience shows that 
oftentimes lives are saved by the first persons reaching 
the wounded, hence the imperativeness of first-aid in- 
struction to all hands. 
Daily physical exercise, such as setting-up exercises 
for the crew, requires much consideration. It is dif- 
ficult under war conditions to have any large percentage 
of the crew present at a stated time daily for such drills. 
However, it has been found practical and beneficial to di- 
vide the ship’s company, by divisions or departments, 
into three or four sections and rotate these sections. 
In this manner all men are given some exercise in the 
fresh air twice weekly, and are further urged to spend 
some time on deck each day. 
Battle organization, dressing station equipment, first- 
aid boxes, etc., are described in chapter XI. 
Maintenance of property and property returns are 
duties to be delegated to the chief pharmacist’s mate 
or the senior corpsman. It is necessary for the medical 
officer to devote considerable time to this detail in order 
to indoctrinate an assistant in the proper estimation 
of the needs of the department, storeroom upkeep, and 
issue of supplies. 
Careful checking of health records is necessary and 
should be done against the ship’s muster roll to insure 
that all records are on board. To check them carefully 
on arrival for inoculations and vaccinations is a prac- 
tical method of keeping them up to date. Missing 
records should be requested from the last station at 
once, and all health records should be forwarded 
promptly upon detachment of personnel. Identifica- 96 
MANUAL OF NAVAL HYGIENE 
tion tags are to be made for all who do not already 
have them, and notation made in the health record. 
Care of the dead is a responsibility of the medical 
officer. Embalming, preparation of report of death 
(Form N) and proper handling thereafter is carefully 
outlined in the Manual of the Medical Department. 
In wartime some variations from the standard prac- 
tices, such as burial at sea, are authorized and are out- 
lined in Bureau letters and instructions. Divisional 
officer duties are to be the responsibility of the junior 
medical officer or dental officer; depending on the num- 
ber of officers in the department this detail should be 
rotated and at all time supervised by the senior medical 
officer. 
Essential Medical Department reports are enumerated 
in part and briefly discussed as follows: 
Health record—all entries are to be made promptly and to 
be complete with signature of medical officer where required. 
Hospital ticket (Form O)—upon transfer of patients. 
Morning report of sick—submitted daily. 
Binnacle list—may be combined with morning report of sick. 
Daily muster report—required on most ships by the executive 
officer, shows presence or absence of all Medical Department 
personnel. 
Medical Department Journal—daily entries of all important 
activities in the department and signed by the medical officer 
on duty. 
Treatment hook—-provides for entries of all patients treated, 
with their disposition. 
Prescription files—to be kept up to date in the pharmacy, with 
separate file for narcotic prescriptions. 
Narcotic hook—to be maintained at all time ready for in- 
spection and checking with preparations on hand. 
Alcohol hook—entries to be made at time of expenditure. 
Ward hook—list of patients with orders listed for each; to 
be signed daily by the ward medical officer. ESSENTIAL MEDICAL REPORTS 
97 
Laboratory book—showing all laboratory procedures under 
proper dates with a record of the findings. 
Dental appointment book—maintained by the dental corps- 
men under the direction of the dental officer. 
Venereal treatment book—listing all treatments and orders 
as given by the medical officer in charge. 
Hull report—a weekly report to the first lieutenant’s office 
regarding structural condition of medical department spaces. 
Form F cards—to be made up on admission of a patient 
and completed at time of discharge. 
Monthly Form F—smooth form made up from the F cards, 
for purpose of compiling statistics. 
Monthly report of venereal diseases and treatments given— 
includes record of any untoward reactions, which may serve 
to detect a faulty shipment of material. 
Communicable disease report—submitted monthly. 
Special reports—may be made to the Bureau and to the fleet 
surgeon at any time regarding unusual occurrences, and must 
be submitted in the presence of an epidemic. 
Allotment reports {Form B)—are submitted quarterly for 
financial purposes. 
Surveys of Medical Department property—may be forwarded 
at any time. 
Annual, other monthly and quarterly reports are tabulated In 
section 3552, Manual of the Medical Department. A check-off 
list of these should be maintained in the record office to insure 
prompt and complete returns from the department. 
Bills of health, pratique, etc., are discussed in chapter XXIV. 
Procedures outlined in this chapter may be applied 
to all types of Navy ships. On small ships the prob- 
lems are proportionally less in number and smaller in 
size. The organization must always be built on the 
complement allowed, and should be enlarged as de- 
mands require. A less complex organization is more 
easily expanded and can be better supervised, and 
therefore is to be desired at all times. Chapter VIII 
SANITARY INSPECTION OF THE SHIP 
To maintain a ship in good sanitary condition re- 
quires routine inspections by a medical officer, supple- 
mented by a sense of good housekeeping instilled into 
the minds of all hands. To accomplish this it is neces- 
sary for the executive officer, first lieutenant, and medi- 
cal officer to cooperate in all matters pertaining to life 
aboard the ship. 
Routinely it is the duty of the medical officer to in- 
spect the galley, scullery, ship’s service store, pantries, 
living and messing spaces, brig spaces, heads and wash 
rooms, and, of course, sickbay, daily. 
In the galley the necessity for a close supervision is 
dependent upon the morale of the commissary depart- 
ment. All supply officers are well versed in the quality, 
storage, preparation, and handling of food; and will 
insist upon scrupulous cleanliness on the part of the 
galley personnel. 
A copy of the week’s menu for the general mess 
passes over the desk of the medical officer usually on 
Friday or Saturday for the following week. Here the 
medical officer has his opportunity to observe quantity, 
balance, and sufficiency of the ration. He should ob- 
serve in this menu whether there are foods to be served 
which require special precautions, such as cold meat, 
salads, hash, and cold beans. All of these require pre- 
98 SANITARY INSPECTION 
99 
cautions. Meats served on the second day after cook- 
ing are just as good as are the methods of refrigerating 
and handling, but no better. In a well-organized gal- 
ley, meats for salads are cooked early the day of use; 
the same will apply to hash and the use of cold beans. 
Exceptions may be made in the interests of economy, 
but close supervision is required to prevent spoilage, 
and climatic conditions must be considered as a guide 
to procedure. 
All meats used on board ship—except in emergen- 
cies—are Government inspected and are so marked. 
Due to the time interval involved, one must guard 
against relying entirely on this procedure, and all 
doubtful appearing meat noted in the galley should be 
referred to the medical officer for his inspection. 
Tinned meats are used more and more. Generally 
speaking they keep well, but tinned hams will at times 
show signs of softening and even liquefaction in some 
areas, which unfit them for use. Economy is necessary 
but dangers of contaminating an entire meal are not to 
be compared with the discarding of a few items of food 
in that meal. 
All fresh foods, which are often obtained from local 
sources, must be inspected by some member of the Medi- 
cal Department. This may oftentimes be the duty of 
an experienced corpsman who is instructed to notify 
the medical officer at any time there is a doubt regard- 
ing the quality of the supplies. Milk, ice cream, and 
seafoods require close watching, and a knowledge of 
the source of the supply is often helpful in determining 
their qualities. Local health regulations and reports 
are usually reliable as to the dairy products in a com- 100 
MANUAL OF NAVAL HYGIENE' 
munity, and should be used by the ship’s medical officer 
for guidance. 
Galley spaces are inspected for general cleanliness of 
material; all utensils and machines used in the prepa- 
ration of food should be closely watched. Meat-slic- 
ing machines, if not properly cleaned, may be a source 
of food tainting or spoilage. 
The butcher shop is usually a matter of pride to the 
commissary officer; it can be maintained in a neat, 
clean, and orderly fashion at almost all times. Meat 
blocks require careful scraping and cleaning, and are 
usually covered with a layer of clean salt to remove ex- 
cessive moisture and to prevent development of odors. 
The spud-peeling and vegetable room is difficult to 
maintain in a neat condition, but reasonable cleanliness 
must be maintained. Cold-storage spaces must be in- 
spected at weekly intervals, and at any other times as 
indicated by break-downs or doubtful food preserva- 
tion. Here it is difficult to avoid moisture, but cleanli- 
ness in appearance and a minimum of odors can be 
maintained. Washing down with soda water will often 
remove undesirable food odors as well as cleanse. 
Personnel inspection of all food handlers on the 
ship excepting the breakout men should be carried out 
weekly. This involves at times careful organization 
and cooperation with the commissary officer and master- 
at-arms, but can be arranged so that all men are present 
for inspection. Remember the man who is too busy 
to appear for inspection may be the one who is harbor- 
ing a venereal infection. Throat, skin, and venereal 
infections are to be looked for on these inspections. 
The scullery is of particular interest to the medical 
officer as it may be the point at which the spread of SANITARY INSPECTION 
101 
disease is interrupted, or through inefficiency it may be 
the source of an epidemic of disease. It is directly under 
the first lieutenant, who more or less delegates its oper- 
ation to the chief master-at-arms. Men assigned here 
for duty are taken from all departments of the ship and 
most often are men least experienced in life aboard ship. 
Their stay is often limited to 1 to 4 months; hence 
there is a constantly changing force. 
Ships provided with a modern dish-washing machine 
and sterilization tank can maintain a sanitary scullery. 
With the cafeteria system of feeding which prevails, 
there are fewer dishes to handle, thus reducing chances 
for individual contamination. Aluminum trays may be 
readily sterilized, carefully dried in air, and stored for 
the next meal with no handling by individuals. Thor- 
ough cleansing with hot water and soap powder in the 
washing machine prepares them for the sterilizing tank. 
Here they withstand a temperature of 212° F. or above 
for the 3- to 5-minute period without harm. A record- 
ing thermometer connected to the sterilization tank is 
an excellent safeguard and shows the temperature of 
the water in the tank during the hours of operation. 
It is strongly recommended for all sculleries. 
Ship’s service stores which manufacture and sell ice 
cream require close supervision. These stores are al- 
ways under the supervision of a commissioned officer 
whose duty it is to maintain them in good working 
order. Sanitary conditions must be maintained and 
personnel working in the store must report for inspec- 
tion with other food handlers. For ice-cream manu- 
facture, dry mix is used at sea. In port wet mix is 
often obtained from a local dairy and is frozen aboard. 
Dry mix is put up in sealed tins and keeps for long 102 
MANUAL OF NAVAL HYGIENE 
periods of time without deterioration. Wet mix must be 
carefully handled and of course kept in cold storage 
until used. In either case samples of the finished prod- 
uct should be submitted for laboratory examination at 
times to guard against all breaks in methods of 
preparation. 
Pantries for the various officers’ messes are inspected 
daily. Dependent upon the efficiency of the mess treas- 
urers and the help provided them, they are kept in good 
or poor sanitary condition. Again with rapid expan- 
sion, men of less experience and training will be used 
and it is incumbent on the Medical Department to be 
more than ever on the alert during inspections for 
cleanliness. Presence of food particles in cracks and 
crevices leads to the attraction of roaches which so often 
invade pantries. Constant attention to thorough clean- 
ing after each meal, supplemented by occasional spray- 
ing with Navy insecticide does much to eliminate this 
evil. 
Ice boxes should be inspected for cleanliness and for 
proper temperatures. Certain foods should be stored in 
separate compartments to avoid complaints regard- 
ing mixed flavors which are often interpreted as harmful 
contaminations. Butter will absorb flavors from other 
foods, rendering it unpalatable. 
Small dish-washing machines are desirable for pan- 
tries, but are not available on all ships. Hence constant 
indoctrination must be carried on to impress the stew- 
ards and mess boys with the importance of proper dish- 
washing. Facilities for washing hands should be avail- 
able either in or near all pantries. Mess boys should 
frequently wash their hands while working about pan- SANITARY INSPECTION 
103 
tries and serving food. This is doubly important in 
warm climates where they are handling ice for cold 
drinks in the wardroom. The question of proper han- 
dling of left-overs here is an important one as stewards 
attempt all sorts of economies to maintain a reasonable 
mess assessment. The medical officer must be vigilant 
and at the same time as helpful as possible in solving 
these problems. 
Responsibility for cleanliness in living spaces and 
messing compartments is primarily that of the division 
officer. He may at times need helpful suggestions from 
the medical officer and this should be freely given. 
Hammocks should be swung on a minimum of 3-feet- 
centers, and alternate men should sleep with heads in 
opposite directions. Bedding should be aired at not 
too long intervals, depending on weather conditions. 
While being aired—on upper decks usually—it should 
be inspected by the medical officer for cleanliness, state 
of repair, and infestation. A mattress showing bugs, 
or evidence of bugs having been present, should be 
traced to its bunk frame and a proper search made for 
bedbugs. This procedure at times may lead to the 
location of an entire compartment infested with bugs. 
Remedies to be used emphasize the sterilization of all 
infested mattresses if a large autoclave is available. If 
none is available the mattresses should be sprayed fre- 
quently during a period of i week. Spraying in the 
compartment, supplemented with the use of a blow torch 
on metal frame and springs will usually control the situ- 
ation. Remember this is a time when treatments often 
require repetition and perseverance on the part of your 
sanitary squad or corpsman. Carboxide gas is a deter- 
rent, but cannot be looked upon as a sure remedy for bed- 104 
MANUAL OF NAVAL HYGIENE 
bugs. Painting for the sealing of cracks is helpful. 
Any method used must be followed up closely and an 
attempt made to limit the spread of the infestation. 
There is a marked tendency to overcrowd berthing 
and messing spaces over the designed capacity during 
wartime conditions. Ventilation has, of course, fallen 
below standard with the elimination of ports, and this 
must be compensated by artificial ventilation, which, is 
often a problem. During wartime with ships darkened 
at night necessitating the closing of ports (if present) 
and outside doors, forced ventilation by blowers must 
be used. Blower motors will only stand a stated speed 
for continuous operation, and do not attempt to have 
them operated over that speed. Sometimes by in- 
stalling a portable blower or fans, a situation may be 
remedied or helped. Ships are constructed with a 
definite ventilating system which is difficult to alter on 
short notice. The minimum ventilation standard is 
30 cubic feet per man per minute, plus an added 
volume to reduce heat. Where wild heat is present, 
as from adjoining machinery spaces, 40 cubic feet per 
man per minute is required. 
Heating presents some problems, but is usually con- 
trollable by proper inspections and the taking of tem- 
peratures in various locations in the ship. The slogan 
here should be to under rather than over heat. Co- 
operation with a representative of the engineers’ force 
should solve most of the heating problems. (See ch. 
II, Ventilation.) 
Lighting requires some supervision, but again, it is 
built into the ship and if not the victim of too many 
changes and too much economy is usually adequate for 
all purposes. Seats in the living compartments should 105 
SANITARY INSPECTION 
be near proper light in case men wish to read. (See 
ch. VI, Lighting.) 
Drinking fountains on modern ships are conveniently 
located and adequate. Their operation is dependent 
upon the engineers’ force and are usually well main- 
tained. 
Brig spaces are to be livable but not luxurious. Ade- 
quate ventilation and light along with cleanliness is 
all that can be required in these spaces. 
Heads or toilets should be inspected for cleanliness, 
proper flushing facilities, and the best ventilation ob- 
tainable. The flushing is accomplished in the crew’s 
head by a constant flow of salt water in sufficient quan- 
tity to prevent stagnation. Any interference with 
this system should be at once reported and remedied. 
It is well to set aside one stall for venereal patients 
and have it so marked. This provides mental relief for 
the individual who fears contracting a venereal disease 
from a toilet. 
Toilet and lavatory facilities should approximate the 
following: 
Toilets; One per 20 men. 
Urinals: One urinal or 1 foot of trough for each 25 men. 
Showers: One per 25 men. 
Lavatories: One lavatory for every 5 men. 
Proper scrubbing of seats, which are removable, 
should prevent the spreading of crabs (Pediculus 
pubis). 
Urinals are prone to be odorous. Increased flushing 
is about the only remedy along with the deodorant 
cakes which merely serve to change the odor. 
Washrooms present little difficulty to the medical 
officer except to see that they are kept clean, and open 106 
MANUAL OF NAVAL HYGIENE 
sufficient hours per day for all men to keep clean. 
Whether showers are provided or not, it is found that 
most men use the washrooms and bathe daily. 
Laundries are to be inspected for proper methods of 
operation, mainly to determine that sufficient hot water 
and soap are used to insure cleanliness. Laundry from 
contagious cases is to be treated in the sickbay prior 
to sending it to the general laundry. Either live steam, 
autoclave, or solution of cresol should be used for this 
purpose. Laundries are usually located in closed 
spaces, which fact associated with the steam and hot 
water used, produces very high temperatures. Per- 
sonnel working here should be observed at intervals 
for general health, and where possible, additional ex- 
haust ventilation provided to lower the temperature 
and humidity in the space. 
Barber shops on the ship should be inspected for 
proper sanitary precautions. Post a list of precautions 
to be taken as to working on men with skin lesions, or 
men who are manifestly ill. Proper sterilizing facili- 
ties should be available and inspections repeated to see 
they are being properly used. All barbers are to be 
inspected at weekly intervals for cleanliness and per- 
sonal health. Blood Kahns are to be taken before 
allowing new men to begin work, and checked as indi- 
cated after that time. 
Inspection of sickbay spaces requires little comment. 
Here the character of the medical officer is reflected 
more than in any other part of the ship. It should be 
clean and orderly at all times, and maintained with a 
spirit of cheerfulness made possible only by proper 
selection of ward master and thorough indoctrination 
by the medical officer. Constant alertness for conta- SANITARY INSPECTION 
107 
gious diseases must be practiced and, when noted, 
proper methods of isolation instituted. Cubicle isola- 
tion has been found to be effective on ships affording no 
isolation ward, but must be strictly supervised. 
Venereal inspections of the personnel are indicated 
at times, governed by the areas in which the ship is 
operating. Conditions in general are reflected in the 
local health departments, and these records should be 
consulted. Surprise inspections are time-consuming 
and if not properly organized may be very upsetting 
to the routine of the ship. Much can be accomplished 
by proper observation of all men reporting to sick 
call, as this group constitutes a good cross section of 
the personnel. If the medical officer has the confidence 
of his personnel, obtained through tact and a proper 
professional interest in their condition, concealment 
of venereal or any other diseases will be maintained 
at a minimum. 
Instruction as to venereal disease prophylaxis must 
be repeated frequently. Printed instructions which 
may be read to divisions by division officers or hospital 
corpsmen when ships are entering port, are practical 
and cause little interference with ship’s routine. This 
is best accomplished at a regular quarters-for-muster 
formation. 
510308—43 8 Chapter IX 
THE SICKBAY AND HOSPITAL SPACE 
AFLOAT 
The sickbay and hospital spaces found in our naval 
vessels of today evolved from their predecessor, the 
cockpit of the early British and American ship of the 
line. 
A corresponding evolution has taken place in the 
Medical Department equipment, supplies, and person- 
nel provided in our present-day ships. In con- 
trast with the traditional equipment and crude surgical 
methods, including the ministrations of the “loblolly 
boy,” the Medical Department facilities of a combat 
ship today are equipped to provide care for the sick 
and injured of the type found in hospitals ashore. 
The planning and arrangement of hospital spaces 
in naval vessels will never remain static, being de- 
pendent on changes in ship design and variables in 
the methods of medical and surgical practice. A de- 
scription of today’s Medical Department aboard ship, 
therefore, probably will not be applicable for any 
great length of time. 
The scope of the Medical Department facilities pro- 
vided in a vessel is also dependent upon the complement 
of attached personnel and the mission of the ship. 
Thus, in a submarine, or a small surface ship, medical 
care is rendered by a pharmacist’s mate, with a min- 
108 THE; SICKBAY 
109 
imum of equipment and supplies; while the larger 
combat ship or transport, with her medical officers, 
dental officers, hospital corps officers and men, and the 
superlative type of equipment and supplies now avail- 
able, is in a position to render complete and definitive 
hospital care and treatment. 
Hospital ships have been developed to the point 
where the Medical Department spaces provide facilities 
which are the full equivalent of a hospital ashore. 
Complete surgical, medical, ear, eye, nose and throat, 
x-ray, laboratory, and dietetic facilities are included. 
The sole mission of these ships is the care of the sick 
and wounded, which permits them to operate under the 
terms of the Geneva Convention. 
Certain vessels are designed or designated for the 
transport and care of large numbers of casualties as 
an incidental mission of these ships. They are not 
hospital ships but are classed as hospital transports; 
they are ships used for the evacuation of the sick and 
wounded to areas where full hospitalization is 
available. 
In discussing the layout of hospital spaces aboard 
ship it will be obvious that each ship or class of ships 
presents an individual planning problem. It must be 
decided, on the basis of attached personnel, mission, 
and design of the ship, what should be provided and 
what may be accomplished in the arrangement of the 
hospital spaces. The Bureau of Medicine and Surgery 
has always maintained an active liaison with the design 
section of the Bureau of Ships. This has contributed 
greatly to bringing about many improvements in the 
arrangement and fixed equipment of the hospital spaces 
afloat. It is not always possible to have the most de- 110 
MANUAL OF NAVAL HYGIENE' 
sirable location for sickbay and hospital spaces but by 
compromise and adjustments in design it is usually 
possible to provide at least suitable ones. 
The number of bunks provided in the hospital spaces, 
as required under General Specifications for Building 
Vessels of the U. S. Navy (1936 edition), is fixed at 2 
percent of the crew and 1 percent of troop berths. No 
specification exists for the lay-out or arrangement of 
hospital spaces, and plans must be developed to give the 
best possible functional result in meeting the require- 
ments of each individual ship or class of ships. 
The principal spaces and fixed equipment provided 
in a sickbay based on 30 sick berths are as follows: 
Sick Bei thing Spaces. 
Sick ward.—Hinged berths are ordinarily arranged 
in tiers, two high, with a private locker for each berth. 
A suitable number of surgical beds is provided. Linen 
lockers, drinking fountains, and medicine cabinets are 
provided. Where possible a diet pantry and utility 
room are placed in spaces adjoining the ward. The 
ward head (toilet) should be adjacent and contains, in 
addition to toilets, showers, and lavatories, a sitz bath 
and soiled linen hamper. A bedpan and urinal rack or 
locker is also included in the head space if a utility 
room is not provided. 
Quiet room.—At least one quiet room with private 
bath, toilet, and lavatory for seriously ill or for officer 
patients is desirable. 
Isolation tvard.—A separate space fitted with a 
suitable number of berths, with adjoining private head 
facilities, is provided for the treatment of communi- 
cable diseases. THE SICKBAY 
111 
Insane ward.—In certain vessels, depending on the 
ship’s mission, an insane ward is provided. The fittings 
in this space are so designed that escape and possibility 
of injury are prevented. When possible, separate head 
facilities and a space for a continuous watch are in- 
cluded. 
Sanitary standards of sickbay berthing spaces.—In 
the sickbay berthing spaces the following are considered 
as minimum standards: 
Toilets : One per 10 berths. 
Urinals: One per 10 berths. 
Showers: One per 20 berths. 
Lavatories : One per 10 berths. 
Dispensary.—This space, corresponding to the phar- 
macy ashore, is regularly provided on all but the smallest 
ships and may be combined with the laboratory or cleri- 
cal office. It is equipped with a drug cabinet with stand- 
ard racks for bottles above, sink, and distilling appara- 
tus. A Dutch door is provided for dispensing. 
Bacteriological laboratory.—If possible, it is desirable 
to provide a separate laboratory for esthetic as well as 
medical reasons. The equipment for this space should 
be a single built-in unit to meet all needs in carrying 
out laboratory procedures aboard ship. 
Surgical dressing room.—If space is available, the 
surgical dressing room should be a separate compart- 
ment large enough to accommodate the facilities for 
carrying out the bulk of routine sick call, examinations, 
treatment, and minor surgical procedures. This will 
permit the proper reservation of the operating room for 
clean surgical cases. The space is equipped with a fold- 
ing type operating table, and recently developed surgical 
lights with four mounting brackets so that desired light- 112 
MANUAL OF NAVAL HYGIENE. 
ing arrangements can be made. A built-in surgical 
cabinet is also provided for the improved stowage of 
supplies and equipment. Other equipment, such as 
therapy lamps, diathermy apparatus, office sterilizers, 
or treatment chair may be provided for this space as 
desired. 
Operating room.—When sufficient space is available 
for both a surgical dressing room and operating room, 
the latter is used for the exclusive treatment of non- 
infected and major surgical cases. Attention is given 
to the details of construction in this space in order to 
provide materials, equipment, and functional arrange- 
ments which will insure proper surgical cleanliness 
and methods of operating. The deck should be of suit- 
able nonabsorbent material which can be easily cleaned. 
Electrical conductivity of the deck is usually not neces- 
sary to consider because explosive anesthetics are rarely 
used aboard ship. The operating room is not air- 
conditioned except under special circumstances where 
structural conditions make it necessary. The operating 
light consists of four surgical lights of 200 volts with 
8 mounting brackets which permit various lighting 
arrangements. A built-in surgical supply cabinet is 
provided preferably flush with the bulkhead in order 
to eliminate dust-catching surfaces. A major type oper- 
ating table, dressing and instrument stands, and hinged 
washbowls are installed. Means are provided for 
securing all loose equipment in a seaway. 
Sterilizing room.—When possible a separate space for 
sterilization is provided in order to avoid the dissemina- 
tion of steam and wild heat from sterilizers into the 
operating room. The sterilizer equipment usually con- 
sists of a combination pressure dressing sterilizer (auto- THE SICKBAY 
113 
clave) either 16 by 24 inches or 20 by 36 inches, a boiling 
type sterilizer 16 by 6 by 4 inches or 20 by 10 by 9 inches, 
and a hot- and cold-water sterilizer (usually combined 
in one tank) of 8 or 15 gallons capacity. The combina- 
tion sterilizer may be either steam or electrically heated 
and it is frequently necessary to provide odd combina- 
tions of these units to fit the space available. A hood 
is installed over the combination sterilizer to carry off 
excess vapor. If space permits, a dressing cabinet with 
work counter is included in the sterilizing room. 
Scrub room.—When possible a separate scrub room 
or scrub alcove is provided to adjoin the operating 
room. It is equipped with a standard scrub sink, soap 
container, and, if space permits, a small clothes locker. 
X-ray darkroom.—This room is used for film proc- 
essing and for storage of the “suitcase” type x-ray 
machine. A complete processing outfit, with cooling 
apparatus, work bench, and storage cabinets is provided. 
Dental office.—Dental facilities are provided on the 
basis of space for one dental operating unit for ap- 
proximately each 500 to 1,000 men of the ship’s com- 
plement. Each dental operating space is equipped 
with a standard dental chair and unit, lavatory, small 
sterilizer, and instrument cabinet. A dental x-ray is 
provided. In addition, a built-in cabinet provides 
space for the air compressor, supplies, records, narcotic 
safe, etc. A complete and compact prosthetic unit has 
been designed for ships requiring dental prosthetic 
equipment. 
Venereal treatment room.—This space is provided 
for venereal prophylaxis and treatment. Straddle 
stands, prophylactic locker and lavatory are provided. 
Examining room {aviation).—A space is provided in 114 
MANUAL OF NAVAL HYGIENE. 
aircraft carriers where the special examinations re- 
quired for aviation personnel can be conducted. This 
space, if possible, should be 24 feet in length and fitted 
with such special equipment as the Barany chair and 
a phorometer. 
Doctor’s office.—A doctor’s office is provided for pur- 
poses of administration and private consultation. It 
may be equipped with desk, files, bookcases for medical 
reference books, and facilities for conducting limited 
physical examinations. 
Clerical office.—This space is fitted with the neces- 
sary furniture and equipment for carrying on the cler- 
ical work for the Medical Department. If possible, the 
clerical office should be provided as a separate space, 
although it is frequently necessary to combine it with 
the doctor’s office. 
Utility room.—This space is included in large ships 
to provide proper servicing of sickbay utensils. A 
bedpan washer and sterilizer, utensil sterilizer, bedpan 
and urinal racks, soiled linen hamper, and cleaning- 
gear locker comprise the equipment furnished. 
Medical storerooms.—It is important that adequate 
storeroom spaces be provided for medical supplies. 
There should be two or more such spaces located in 
as widely separated parts of the ship as possible in 
order to provide dispersion of materials. Available 
storeroom space is usually in the lower parts of the 
ship, so that it is desirable to have an issue storeroom 
located in the sickbay country. A ship carrying 
around 1,500 personnel should have a minimum of 
2,500 cubic feet in the main medical storerooms, plus 
500 cubic feet in the sickbay issue storeroom. All THE SICKBAY 
115 
storeroom spaces are fitted with metal shelving and 
bins. 
Medical storeroom, destroyers.-—The medical store- 
room of a destroyer, more properly called the sickbay, 
is the victim of the crying need for space in these ships. 
The usual destroyer sickbay contains no berths, and the 
space allotted is hardly adequate to serve as a dispensary 
and for storage of supplies and equipment. In the 
present war operations the destroyer is frequently called 
upon to receive casualties, and a medical officer is aboard 
each of these ships. Besides the standard equipment of 
drug cabinet, boiling type sterilizer, and prone examin- 
ing table, there has now been added a portable surgical 
light and a pressure dressing sterilizer. A prophylaxis 
locker is provided in the crew’s head. 
Battle dressing stations.—Battle dressing station 
spaces are provided for the emergency treatment of cas- 
ualties during and following an action. These spaces 
are set aside and equipped with emergency surgical fa- 
cilities in dispersed positions within the ship. The 
principal fixed equipment comprises a water-storage 
tank, hot-water heater, lavatory, hinged shelves for 
dressings, sterilizer, and storage space for supplies. A 
portable surgical light operating from ship’s current or 
battery is valuable. 
With changes in ship design incident to damage con- 
trol it has developed that auxiliary dressing stations are 
necessary to care properly for casualties. These are 
provided in suitable locations, accessible to the ship’s 
battle stations, and are equipped with material similar to 
that furnished at the battle dressing stations. (See 
ch. XI.) Chapter X 
MEDICAL DEPARTMENT ON BOARD SHIP IN 
EMERGENCIES OTHER THAN BATTLE 
Naval personnel at sea are confined within the steel 
wall of ships where many emergencies may occur other 
than those caused by battle. To combat successfully 
these emergencies, coordinated and concerted effort on 
the part of all is required. 
Emergencies which occur on board naval vessels fre- 
quently result in casualties both to personnel and mate- 
riel. The materiel casualties are primarily the re- 
sponsibility of the damage control officer, whereas the 
transportation and care of personnel casualties is pri- 
marily the responsibility of the Medical Department. 
To accomplish efficiently the mission of the Medical 
Department in these emergencies, careful planning fol- 
lowed by thorough indoctrination and drilling of all 
personnel is imperative. 
For maximum efficiency, this planning and training 
should be coordinated with that of all other depart- 
ments. To assure this, all watch, quarter, and station 
bills are prepared by the heads of departments con- 
cerned and submitted to the commanding officer for his 
study and approval. With this approval they become 
the standard practices. 
The design and equipment of naval vessels render 
them more hazardous than their commercial sisters in 
carrying out their missions in peace and in war. 
116 EMERGENCIES OTHER THAN BATTLE 
117 
Listed among the more important additional hazards 
are: 
1. Greater concentration of personnel. 
2. Power plants of much greater magnitude and 
output. 
3. General naval and military agents. 
4. Special nautical hazards incidental to high 
speed and maneuvers in formation. 
To provide for such possibilities, ship’s watch, quar- 
ter, and station bills include sections on: (a) Fires; 
(b) collision; (c) fire and rescue party; (d) abandon 
ship; (e) man overboard; and (/) landing force. 
The medical officer of the ship prepares the watch, 
quarter, and station bill for the surgeon’s division. 
A type bill is presented to meet these major emer- 
gencies. It covers the general principles of planning, 
organizing, and training for the specified emergencies. 
All preparations aboard ship are now predicated on 
war, therefore emergencies of any nature are usually 
met from a general-quarters setup, which this bill 
provides. 
Included are provisions for landing exercises either 
in preparation for war or to assist fire and rescue 
parties in such emergencies as may result from major 
catastrophies ashore, including earthquakes, fires, hur- 
ricanes, floods, etc. 
Each ship is an entity in itself because of the type 
of ship, individual structural characteristics, person- 
nel, and its mission. 
The following is based on a complement of 3 medical 
officers, 1 dental officer, and 12 hospital corpsmen. 118 
MANUAL OF NAVAL HYGIENE 
Name 
Rank 
Fire 1 
Collision 1 
Fire and 
rescue 
Aban- 
don 
ship 
Man over- 
board 
General quarters 
Land- 
ing 
force 
Watches 
< 
Condition 1 
Condition 2 
Condition 3 
Port 
Starboard 
Senior medical 
officer. 
First junior medi- 
cal officer. 
Second junior 
medical officer. 
Dental officer 
MBDS(SB) 
ABDS 
MBDS(SB) 
ABDS 
MBDS(SB) 
MBDS(SB) 
With party 
MBDS(SB) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
MBDS(SB) 
Meet boat 
on its re- 
turn. 
MBDS(SB) 
MBDS(SB) 
MBDS(SB) 
ABDS 
(3) 
(3) 
(3) 
(3) 
w 
(0 
(0 
X 
X 
X 
X 
FBDS 
FBDS 
FBDS.. 
Beach 
party. 
FBDS.. 
FBDS .. 
FBDS 
1 A medical officer and one hospital corpsman nearest the scene of fire or collision will report at the scene of emergency. 
2 All Medical Department personnel will assist in evacuating patients; thence to abandon ship station in accordance with ship’s 
abandon ship bill. 
3 Medical Department personnel will be at battle dressing stations, maintaining communication watches and reducing personnel 
to watch and watch. 
* Medical Department will maintain communication watches and carry on routine care of sick. 
MBDS(SB)—-Main battle dressing station (sickbay). 
ABDS—After battle dressing station. 
FBDS—Forward battle dressing station. 
Abandon ship “A”.—Eapid sinking; no time to lower boats. Life rafts launched where possible. 
Abandon ship “B”.—Slow sinking; all boats and life rafts made available. 
Table 5.— Watch, quarter, and station bill—Officers EMERGENCIES OTHER THAN BATTLE 
119 
Name 
Rating 
Fire 1 
Collision 1 
Fire and rescue 
No. 
No. 
Allowance 
Actual 
1st section 
PhMlc 
PhMlc 
FBDS.. 
FBDS 
FBDS. 
PhM3c 
PhM3c 
1-TSP. 
1-TSP 
With party. 
HAlc 
PhM3c 
MBDS(SB) 
MBDS(SB) 
MBDS(SB). 
td section 
PhMlc ... 
PhMlc 
ABDS 
ABDS.. 
ABDS. 
PhM2c... 
PhM2c 
2-TSP 
2-TSP.. 
With party. 
PhM3c 
PhM3c 
1-DCP 
1-DCP.. . 
1-DCP. 
3d section 
PhMlc 
PhM2c 
FBDS 
FBDS 
FBDS. 
PhM2c._ 
PhM2c 
3-TSP 
3-TSP 
3-TSP. 
PhM3c 
PhM3c 
2-DCP 
2-DCP 
2-DCP. 
ith section 
CPhM 
CPhM 
MBDS(SB) 
MBDS(SB) 
MBDS(SB). 
PhM2c 
PhM2c 
3-D CP 
3-D CP 
3-DCP. 
PhM3c. 
PhM3c 
ABDS 
ABDS 
ABDS. 
1 A medical officer and 1 hospital corpsman nearest the scene of fire or collision will report at the scene of emergency. 
Table 6.—Watch, quarter, and station bill—Hospital Corps {Surgeon’s Division) 120 
MANUAL OF NAVAL HYGIENE 
Bunk 
No. 
Locker 
No. 
Name 
Abandon 
ship 
General quarters 
Land- 
ing 
force 
Watches 
Cleaning 
station 
“A” 
“B” 
Man over- 
board 
Condition 1 
Con- 
dition 
2 
Con- 
dition 
3 
Port 
Star- 
board 
1st section 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
(2) 
• (2) 
MBDS(SB)... 
With boat 
MBDS(SB)-.. 
MBDS(SB),.. 
FBDS 
(?) 
C3) 
(3) 
(3) 
(3) 
(3) 
(3) 
(3) 
(3) 
(3) 
(3) 
(3) 
(4) 
(4) 
(4) 
(4) 
(4) 
(4) 
(4) 
(4) 
(4) 
(4) 
(4) 
(4) 
1st St 
ction 
X 
X 
X 
ction 
— 
1-TSP 
MBDS(SB).... 
ABDS 
--- 
2d section 
X 
2d st 
X 
X 
X 
3d st 
2-TSP 
MBDS(SB)... 
MBDS(SB)... 
MBDS(SB) . 
MBDS(SB).-. 
MBDS(SB) 
MBDS(SB)... 
1-DCP 
X 
3d section 
FBDS_. 
3-TSP 
ction 
X 
X 
X 
action 
2-DCP_ 
Jfth section 
MBDS(SB) 
3-D CP 
ith s 
X 
X 
X 
ABDS 
X 
2 All Medical Department personnel will assist in evacuating patients; thence to abandon ship station in accordance with ship’s 
abandon ship bill. 
• Medical Department personnel will be at battle dressing stations, maintaining communication watches and reducing personnel 
to watch and watch. 
4 Medical Department will maintain communication watches and carry on routine care of sick. 
MBDS(SB)—Main battle dressing station (sickbay). 
ABDS—After battle dressing station. 
FBDS—Forward battle dressing station. 
1-TSP—No. 1, Topside patrol, etc. 
1-DCP—No. 1, Damage control party, etc. 
Abandon Ship “A”.—Rapid sinking; no time to lower boats. Life rafts launched where possible. 
Abandon Ship “B”.—Slow sinking; all boats and life rafts made available. 
Table 6.—Watch, quarter, and station bill—Hospital Corps (Surgeon’s Division)—-Continued EMERGENCIES OTHER THAN BATTLE 
121 
Emergency Drills 
The paramount duty of the Medical Department is 
the prompt response to and comprehensive action in 
the various emergencies. Therefore the surgeon’s di- 
vision must be indoctrinated and drilled until their 
state of training is thoroughly adequate and so main- 
tained. 
Fire Bill, 
Alarms.— 
1. Word passed over loudspeakers, giving loca- 
tion. 
2. General alarm. 
3. Rapid ringing of ship’s bell followed by one, 
two, or three strokes to indicate whether fire 
is forward, amidships, or aft, respectively. 
4. ‘‘Fire Quarters” sounded on bugle, followed by 
one, two, or three blasts to indicate location. 
5. Word again passed over loud-speakers. 
6. “Commence Firing” on bugle is the signal to 
turn on water at scene of fire. 
7. “Cease Firing” is the signal to turn off water. 
Duties of Surgeon’s Division.—The surgeon’s di- 
vision will prepare to remove sick and to treat injured. 
A medical officer and one hospital corpsman will report 
at the scene of the fire equipped to treat and transport 
personnel casualties. The remaining Medical Depart- 
ment personnel will report to their battle stations. 
Collision. 
Alarms.— 
1. One long blast on the siren. 
2. Word passed over loudspeakers, giving frame 
number and side of ship. 122 
MANUAL OF NAVAL HYGIENE 
3. General alarm. 
4. Collision quarters on the bugle. 
In a collision of some magnitude, the personnel of 
the battle dressing station most convenient will report, 
if required, at the scene of the collision to render first 
aid and to transport the injured, thus augmenting the 
damage-control party. The personnel of all battle 
dressing stations will prepare for the reception and 
care of the injured. 
Fire and Rescue Party. 
The fire and rescue party may be called upon to 
assist a vessel on fire or otherwise in distress and to 
rescue personnel therefrom, or to render assistance on 
shore. 
Alarms.— 
1. General alarm. 
2. By boatswain pipes and loudspeakers: 
{a). “Away fire, salvage, and rescue party.” 
(h) “Away fire party.” 
(c) “Away rescue party.” 
(d) “Away salvage party.” 
3. Boat calls on bugle followed by “Double time.” 
4. “Assembly” on bugle followed by “Double time.” 
A junior medical officer and one hospital corpsman 
with one large hospital corps pouch and one Stokes 
stretcher will attend. 
Abandon Ship. 
Abandon ship may become necessary following seri- 
ous underwater damage caused by collision, stranding, 
explosion, or damage sustained in battle. The above EMERGENCIES OTHER THAN BATTLE 
123 
conditions will generally find the crew at collision 
quarters or battle stations. 
This bill provides for abandoning ship under two 
conditions: 
A. Rapid sinking—No time to lower boats. Life 
rafts launched where possible. 
B. Slow sinking—All boats and life rafts made 
available. 
General instructions.— 
1. The general alarm will be sounded, followed by 
a number of blasts on the alarm to indicate 
conditions A or B. 
2. The “condition” will, if possible, be announced 
over all loud speakers. 
3. Life preservers will be worn by all hands for 
either condition. 
4. All officers will wear loaded pistols for condi- 
tion B. 
5. The report “Ready to abandon ship” will be made 
as indicated hereinafter. 
6. No one will either embark in boats or life rafts 
or jump overboard until so ordered by the 
commanding officer. 
7. If any boat or life raft to which personnel are 
assigned is unavailable, the personnel so as- 
signed will stand-by to abandon ship as or- 
dered by the commanding officer. 
8. The sick and injured, provided with life jackets, 
will be taken to the port quarterdeck to as- 
signed boats or life rafts. All Medical De- 
partment personnel, except those otherwise 
assigned, will assist in debarking patients. 
516368—43 9 124 
MANUAL OF NAVAL HYGIENE 
Sick and injured are given priority in aban- 
doning ship. 
9. Men so detailed by the medical officer will salvage 
valuable records. 
Signals and variations in each condition.— 
Condition A.—Word passed: “All hands abandon 
ship, condition A”, and when directed by the command- 
ing officer, “All hands overboard.” 
All hands will jump overboard and swim clear of 
the ship as quickly as possible to avoid suction and may 
later return to life rafts or floating equipment. Sick 
and injured will be assisted over the side and away from 
the ship by all available personnel. 
Condition B.—Word passed: “All hands abandon 
ship, condition B”; “Away all boats and life rafts.” 
Sick and injured will be evacuated by the surgeon’s 
division to the abandon-ship station designated for that 
purpose and debarked therefrom when directed. Per- 
sonnel of the division not required to accompany sick 
and injured will report to their abandon-ship stations. 
Man Overboard. 
Alarms.— 
1. General alarm. 
2. Word passed over loud speakers. 
Duties of surgeon's division.—A medical officer will 
stand-by on the bridge to render such assistance as may 
be required. A hospital corpsman with first-aid pouch 
will proceed “on the double” to the lifeboat to be 
lowered. Chapter XI 
THE MEDICAL DEPARTMENT ON BOARD 
SHIP IN BATTLE 
Our experiences in modern warfare have necessitated 
marked changes in the medical preparations for battle 
aboard all types of ships. This has been incidental to 
new weapons and improved methods of attack; both 
being factors of increased exposure of personnel man- 
ning details which are without full benefit of armor 
protection. 
Our previous concepts that both medical personnel 
and material should be behind armor during battle must 
be abandoned to a large extent. Stringent rules against 
the opening of watertight doors in enemy areas make 
battle dressing stations below protective decks inaccessi- 
ble, therefore their number must be reduced to a mini- 
mum, and be classified as “reserve” stations rather than 
“active” ones. Bombs and torpedoes have reduced the 
element of protection to a relative degree only. Means 
of assistance must be organized roughly on the system 
of land warfare, in that our trenches start on the weather 
decks and proceed downward to the lowest deck occu- 
pied by the personnel. 
It is necessary to bring first aid to casualties by all 
available means possible; expeditiously, efficiently, and 
adequately. Expeditious emergency treatment to cas- 
ualties where found obviates their descent en masse, 
125 126 
MANUAL OF NAVAL HYGIENE 
TnfTTt 
B-403-A 
Collecting 
Stations 
Rendered by 
First Aid 
MAJOR SURGERY 
MINOR SURGERY 
B. D. S. 
C.P.O. Mess 
S. S. Store 
FIRST AID ONLY 
Gas Decontamination 
and treatment at 
"6 R. Pwd. 
A-416-L 
ORGANIZATION OF THE MEDICAL DEPARTMENT FOR BATTLE 
—srft? 
Midship 
B.D. S. 
Eng. 3rd Deck 
Rendered by 
Crew from 
First Aid 
Main Deck 
A-604-L 
Repair I 
Officer’s Kits 
(Morphine, etc.) 
D-601-L 
DRESSING STATIONS 
B.D.S. 
COLLECTING STATIONS 
C-601-L 
IMMEDIATE FIRST AID 
GAS D.C. STATIONS 
A-610-L 
Repair I I 
Patrol 4 
Fireman’s 
A-611-L 
Figure 17. 
General 
FIRST AID 
BOXES 
distributed 
Crew’s Shower 
A-603-L 
After 
A-420-L 
Repair II 
M.'!nT)ecl 
-rt 
Tai 
IMMEDIATE FIRST AID SUPPLIES 
Officer's 
' 'Afte'r ' 
D-408-A 
PORTABLE LOCKERS 
Ell 
STORE ROOMS 
IIMAip. 
Storeroom 
B-426V4-A 
nrrn 
C-601 
First Aid 
Storeroom 
-wrri 
Midship 
prn 
D-40I-L 
Gu D.C. Station 
Lookers 
VTin—| 
Storeroom 
prn 
A 420-LI MEDICAL DEPARTMENT IN BATTLE 
127 
with assisting shipmates, upon the dressing stations, 
tending to cause confusion, disruption of orderly assist- 
ance, near panic and hysteria. These considerations, 
secondarily to humanitarianism, justify our system of 
taking first aid to the wounded rapidly. The ship’s 
“watertight integrity” must not be violated, nor the 
“volume of fire” decreased in this process. 
The prime requisite for an efficient organization is 
dispersion of both personnel and material throughout 
the ship at all times. This permits availability to as 
many persons as possible and despite contingencies inci- 
dental to the ship’s damage. Decentralization cannot be 
overemphasized. Its accomplishment can only be at- 
tained by thorough study of each ship’s compartmenta- 
tion, availability of utilities, easy accessibility for the 
greatest number in each area, and facilities for storage 
of supplies at the site. The structural variations exist- 
ing in the different types of ships preclude a standard 
plan, but all organizations should essentially possess the 
following characteristics which are adaptable to a bat- 
tleship. Modifications to suit type and size of ship must 
be selected. 
Battle Dressing Stations. 
Equipment.—This must be adequate to perform sur- 
gery and major dressings. It should include instru- 
ments, dressings, drugs, intravenous solutions, plasma, 
and anesthetics of local, intravenous, and spinal vari- 
eties. The location must furnish lighting systems of 
both emergency and normal types, power sockets for 
sterilizers and water heaters, water from ship’s system 
and from emergency tanks or portable containers. 
Emergency toilet facilities, portable storage battery 128 
MANUAL OP NAVAL HYGIENE 
lights, canned foods, folding dressing tables, lockers, 
and operating table of the folding variety, or its equiva- 
lent, are needed. Additional equipment such as buckets 
with sand, fire extinguishers, and swabs are necessary. 
The stations should be located where they can afford 
aid to the greatest number, be accessible and with what- 
ever protection is compatible with their function. One, 
fMtltfEMCV EATTLt 
DRtSSlMG LOCKtl 
CON STRUCT 10*4 
Ho be constructed oP 
S/-52" galvanized iron. 
Hop to overlap box when 
closed i Hi”. Legs to be 
I "angle iron rivet hinged. 
Designed by 
Comdr. UtA'POMtRpV (MO USH. 
Iron band reinforced iip 
Figdke 18.—Emergency battle dressing locker (Pomeroy). 
by all means, must be accessible with a minimum of 
effort to weather deck and casemate personnel. 
Battle Lockers. 
These consist of portable metal lockers as suggested 
in figure 18. MEDICAL DEPARTMENT IN BATTLE 
129 
Contents, battle dressing locker (Pomeroy) 
Acid, tannic, % pound bottle 4 
Alcohol, ethyl, % gallon tin 1 
Applicators, bundle 1 
Assorted sutures and needles assorted 
Bag, hot water, rubber 1 
Bandage, gauze, 1-inch, dozen 1 
Bandage, gauze, 2-inch, dozen 3 
Bandage gauze, 3-inch, dozen 2 
Bandage, muslin, 4-inch 4 
Battle dressings, large 20 
Battle dressings, small 40 
Blankets 1 
Blood plasma, 250-cc. units : 0 
Boric acid, in gallon jug, to make a saturated solution 1 
Case, forceps, hemostatic ] 
Case, pins, scissors and dressing forceps 3 
Case, pocket 1 
Castor oil, 2-ounce bottle and medicine dropper 1 
Cotton, 1-pound roll 1 
Dextrose, 5 percent normal saline (vacoliters) 6 
Dressings, sterile, (4 by 4) 25 in package 4 
Dressings, sterile, (2 by 2) 25 in package 4 
Flashlight 1 
Flask, Erlenmeyer, 125-cc. (sterile) 2 
Flit gun 1 
Gauze, plain, 25-yard roll 3 
Gentian violet, powdered, 10-gm. bottle 1 
Gloves, rubber, sterile, pair 2 
Jelly of tannic acid, 8-ounce tubes 12 
Medicine glasses, (sterile) 2 
Morphine Syrettes 1 40 
Pencil, lead 1 
Pencil, wax, red (skin pencil) 1 
Petrolatum, liquid, 1-quart tin 1 
Plaster, adhesive, roll (2 inches by 5 yards) 5 
Procaine hydrochloride, 0.0740-gm. 100 bottles 1 
Shipping tags 36 130 
MANUAL OF NAVAL HYGIENE 
Figure 19.—Portable instrument kit (Allen) 
Contents, battle dressing locker (Pomeroy)—Continued 
Soap solution, 16-ounce bottle 1 
Splints, basswood 6 
Sulfanilamide, powdered, -pound bottle 4 
Syringe, glass, 10-cc. sterile needle 2 
Syringe, glass, 5-cc. sterile needle 1 
Syringe, glass, 2-cc. sterile needle 2 
Tablespoons (for retractors) 2 
Test tube, with 3-inch needles 1 
Tincture merthiolate, 16-ounce bottle 2 
Tincture green soap, 16-ounce bottle 1 
Tongue depressors, bundle 1 
Tourniquet, instant, rubber 12 
Towels, sterile ! , 6 
Water, distilled, 10-ce. vial : 6 
The recommended minimum of portable lockers is 10 
for battleships and aircraft carriers, 5 for cruisers, 2 MEDICAL DEPARTMENT IN BATTLE 
131 
for destroyers, and proportionate numbers for ships of 
other types. Their contents must be sufficiently com- 
plete to outfit an emergency aid or casualty collecting 
station, or to take care of any fairly large group of 
wounded cases in an isolated area. 
Their distribution must be in strategic compartments 
throughout the ship, and independent of the battle 
dressing stations. 
A portable instrument kit, (Allen) such as illus- 
trated in figure 19, has many excellent features. It is 
made of scrap plane metal, and allows of sterilization 
by complete immersion or autoclaving. 
Boxes—F irst- Aid. 
These should be the “l-cubic-foot” or “breadbox” 
variety for installation as subdressing stations wher- 
ever 20 or 30 men are on duty. They should contain 
practical first-aid materials, be portable, clearly marked 
with a red cross, and wire sealed for easy access. These 
boxes should contain morphine Syrettes at all times. 
A minimum of 100 in each battleship is indicated. 
Gun Bags. 
These should be made of canvas and attached in the 
immediate vicinity of all guns for use by gun crews. 
Contents consist of: 
(a) Cotton, for ears. 
(h) Tourniquet, rubber, instant. 
(c) Small dressings. 
(d) Bandages. 
(e) Tannic acid jelly (tube). 
Gas-Decontamination Lockers. 
These are metal lockers with hinged table top as sug- 
gested in figure 20. 132 
MANUAL OF NAVAL HYGIENE 
Df CONTAMINATION 
LOCKR 
Figuee 20.-—Gas-decontamination locker (Maher). 
Contents, gas-decontamination locker (Maher) 
Adhesive plaster, 2-inch by 5-yard rolls 2 
Alcohol, ethyl, 95 percent, pint bottle 2 
Applicators, bundle 1 
Bandage, gauze, 2-inch, dozen I 1 
Bandage, gauze, 3-inch, dozen 1 
Bleach paste, gallon , 1 
Boots, rubber, pair 1 
Boric acid, 208-gin. in gallon bottle 1 
Brushes, nail 6 
Buckets 2 
Carbon tetrachloride, gallon 1 
Cotton, absorbent, 1-pound roll 1 
Clothing, impregnated, suit 1 
Cupric sulfate, 2-ounce bottle 1 
Dressings, battle, small 24 
Dressings, battle, large 3 
Dressings, gauze, 6 by 8’s 24 MEDICAL DEPARTMENT IN BATTLE 
133 
Contents, gas-decontamination locker {Maher)—Continued 
Dressings, gauze, 2 by 2’s 48 
Ferric hydrate paste, tin pail for 1 
Ferric sulfate solution, pint 1 
Gauze, plain, 25-yard roll 2 
Gloves, rubber, size 8, pair 6 
Irrigating can, ready for use 1 
Milk of magnesia, pint 3 
Mineral oil, with dropper, 100 cc 1 
Petrolatum, white, can 4 
Rags, cleaning, bundle 2 
Salt water soap, bar 3 
Sodium bicarbonate, 75 gm. in gallon bottle 1 
Sodium hydroxide, 24 gm. in bottle 1 
Spoon, large 1 
Tannic acid jelly, tube 10 
Tincture green soap, gallon 1 
Tincture iodine, 3% percent, 200-cc. bottle 1 
Tongue depressors 24 
Site of installation should be chosen for availability 
of running water, and its adaptation for rapid segrega- 
tion of contaminated and decontaminated cases. 
Casualty Collecting Stations. 
They should be selected in accordance with size, 
accessibility, and their regularly installed facilities and 
utilities. These spaces will be for the collection and 
classification of the wounded before receiving further 
treatment at the battle dressing station. 
Burn Lockers. 
These can be made portable and stowed in previously 
designated compartments, with the idea of utilizing 
them as far as practicable for the reception, segregation, 
and emergency treatment of burn cases. 134 
MANUAL OF NAVAL HYGIENE 
Main Storeroom. 
This is situated in the compartment designated on 
the ship’s plans. It will contain the excess medical 
stores for replenishment of the previously mentioned 
sources throughout the ship. A small “issue” space 
may be used as a subsidiary to the main storeroom. 
Boat Box. 
The following is a list of the contents of the Navy 
boat box, a fixture in all boats used in abandoning ship: 
Jelly of tannic acid, tube 12 
Morphine Syrettes 10 
Petrolatum, liquid, quart 2 
Spirit of ammonia, aromatic, tube and paper cup . 4 
Acid, acetylsalicylic, 0.324 gm., 100 1 
Extract of cascara sagrada, 100 1 
Soda mint tablets, 0.324 gm., 100 1 
Tincture of iodine, mild, 10-cc. applicator vial 3 
Bandage compress, 2-inch 8 
Bandage compress, 4-inch 1 
Bandage, gauze, compressed, 1-inch 6 
Bandage, gauze, compressed, 2-inch. 6 
Bandage, gauze, compressed, 3-inch 6 
Bandage, triangular, compressed 2 
Cotton, absorbent, compressed 4 
Gauze, plain, compressed 6 
Pins, safety, large 12 
Splint, wire mesh for, 5 x 36 inches __ 1 
Tourniquet, web 1 
Sulfadiazine, 24 1-grarn tablets in package 2 
Sulfanilamide, powdered (for topical application), 5-gram 
packet 25 
Haft Kit. 
The understandable limitations of space aboard a life 
raft necessitate the following compactness: MEDICAL DEPARTMENT IN BATTLE 
135 
Jelly of tannic acid, %-ounce tube 2 
Bandage compress, 4-inch 2 
Morphine Syrettes, 5 tubes; and tincture of iodine, mild, 
10-cc. applicator vial, 1 vial in package 1 
Sulfadiazine, 24 1-gram tablets in package 1 
Sulfanilamide, powdered (for topical application), 5-gm. 
packet , 5 
Medical Personnel 
Distribution.—Medical and dental officers are assigned 
to each of the battle dressing stations. Hospital corps- 
men are distributed as follows: 
(1) Battle dressing stations. 
(2) Repair parties. 
(3) As patrols on weather decks. 
(4) Decontamination stations, 
(5) Stretcher bearers (from crew). 
It is preferable that they be billeted near their stations 
for increased decentralization and for availability at all 
times. Each corpsman must wear a basic equipment 
which is supplemented for those having topside patrols 
or with repair parties. 
Basic equipment.—Applicable to the medical comple- 
ment as a whole. 
(1) Hospital Corps pouch (large), with substitution of con- 
tents to suit wartime conditions. 
(2) Flashlight, hand, with suitable lanyard to avoid loss at 
all times. 
(3) Scissors, bandage—with lanyard. 
(4) Gas mask. 
(5) Life jacket. 
Special equipment.—For corpsmen detailed to repair 
parties or as roving patrols on weather decks. Emer- 136 
MANUAL OF NAVAL HYGIENE 
gency kits or instrument carriers of a type similar to the 
following illustrations in figures 21, 22, and 23, Their 
Figure 21.—Handy instrument carrier (Broaddus) 
purpose is to increase supplies for immediate use, but 
they must not be sufficiently bulky to interfere with MEDICAL DEPARTMENT IN BATTLE 
137 
locomotion, or with passage in narrow openings, or in 
damaged spaces. 
Contents of instrument carrier (Broaddus) 
Pocket No. Item 
1, 2, 3. Morphine Syrettes. 
4. Adhesive tape, on reel. 
5. Tannic acid jelly. 
6. Flag bunting (green) or suitable means to indicate that 
morphine has been given. 
7. Bandage shears. 
8. Ophthalmic ointment. 
9. Jackknife. 
10. Hemostats. 
11. Tourniquets. 
12. Flashlight. 
Stretcher hearers—are an important adjunct to the 
rendering of aid to the injured. These men should 
be detailed systematically, especially instructed for 
rendering medical assistance, and have a complete 
knowledge of available medical facilities and their loca- 
tion, The number of stretchers aboard is roughly 8 
to 4 percent of complement, and consists of the Stokes, 
the Army litter, and “zipper” or “hammock” varieties. 
The number will vary with the type of ship. 
The organization should be made flexible in every 
sense, both as to personnel and material. The mem- 
bers should be regularly instructed in their battle 
duties, rotated periodically in the various details to 
allow familiarization with all spaces aboard ship, and 
thoroughly taught routine treatments for the more 
common casualties. In this respect attention is called 
to bums which usually predominate in naval combats. 
It is desirable to select one recognized simple method 138 
MANUAL OF NAVAL HYGIENE 
of treatment for each ship: this avoids confusion and 
delay. 
Figure 22.—Carry-all for first-aid supplies (Marron). 
The entire ship’s complement must be instructed in 
first aid, a highly essential feature, repeatedly demon- MEDICAL DEPARTMENT IN BATTLE 
139 
Figure 23— Carry-all for flrst-aid supplies (Morrison). 
516368—43 10 140 
MANUAL OF NAVAL HYGIENE 
strated as a lifesaver in all battles of this war. 
Stretcher bearers will require special instructions for 
their duties. 
The organization must be sufficiently flexible to per- 
mit rapid appropriation of improvised spaces for maxi- 
mum assistance where casualties are found. By that 
token, the need exists for readily obtainable supplies 
in adequate quantities. Some special items are essen- 
tial, such as morphine Syrettes in all dispersal sources, 
intravenous and spinal anesthetics, intravenous solu- 
tions—glucose and saline, dry blood plasma at all battle 
dressing stations, splints, plaster of paris, burn rem- 
edies, and large quantities of eye lotions. 
Portable drinking fountains of suitable types are 
needed to quench the extreme thirsts noted in battle. 
Ship’s water supply lines are often broken in action. 
The possible rupture of electric cables will require 
hand battery flashlights for each individual at all times. 
Thongs or lanyards are indispensable to prevent their 
loss as a result of sudden blows, concussions, and falls. 
Magazine or battery lamps for the operating tables 
should be furnished at the battle dressing stations. 
Failure of the lighting systems aboard a warship 
furnishes a terrible handicap, especially if accompanied 
by smoke or explosion gases, and damage caused by 
shells, bombs, or torpedoes. 
Sterilization of instruments by means other than 
steam should be available. 
Glassware, reduced to a minimum, should be pro- 
tected by use of scotch tape, or its equivalent, to pre- 
vent shattering by gunfire or explosions. Chapter XII 
TRANSPORTATION OF THE SICK AND 
INJURED ON BOARD SHIP 
Transportation of the sick and injured aboard ship 
presents problems influenced by type of injury, condi- 
tion of patient and his location aboard said ship. 
There are many compartments and spaces only acces- 
sible by means of scuttles, small hatches, manholes, and 
tortuous and narrow passageways. Some spaces are 
further restricted by stanchions, machinery, boilers, 
and lockers to a degree which presents a complicated 
problem of transportation to the stretcher bearer. 
Necessity and ingenuity have combined to solve these 
by primitive manhandling, and by mechanical devices 
designed so far as possible for the painless, harmless 
extraction and transportation of casualties. 
“Manhandling” or hand carry should be performed 
carefully to avoid further injury, and can be fairly 
safely performed by two or more volunteers. 
The unconscious patient, with complicating fractures 
of extremities or back, will require careful assistance 
by means of mechanical appliances such as the 
following: 
(1) Stokes stretcher, or some of its modifications 
(2) Pole stretcher. 
(3) Army litter. 
(4) Weber “zipper” stretcher. 
141 142 
MANUAL OF NAVAL HYGIENE 
Figuke 24.—A.—Stokes splint stretcher. B and C.—Pole litter, folding. 
D.—Same, nonfolding. 143 
TRANSPORTATION OF INJURED 
(5) Hammock stretcher (Farrar). 
(6) Canvas “zipper” litter (Davis). 
(7) Neil Kobertson (British). 
(8) Totsuka (Japanese). 
(9) Hammock type (German). 
and several other ingenious modifications adequately 
fulfilling the purpose. 
The most commonly used is the Stokes splint 
stretcher (fig. 2T-A). This stretcher is a galvanized 
iron or aluminum stretcher basket so constructed that 
immobilization of body and lower extremities is pos- 
sible, thereby allowing a thoroughly secured patient to 
be hoisted in an upright position through hatches and 
manholes if necessary, or permit of transfers from ship 
to ship at sea by means of any suitable hoisting appa- 
ratus available. The disadvantages are its rigidity and 
width when used in complicated spaces, such as escape 
hatches, narrow tortuous passageways, turrets, han- 
dling rooms, and machinery spaces. It is an excellent, 
safe, comfortable means of transportation. Some 
modifications have improved the original design by 
slightly changing its shape, decreasing weight, and by 
articulation in its middle for better storage. It is 
provided with hand grips for hand carry or for at- 
taching a bridle for hoisting. A septum separates the 
legs, which can be secured for immobilization. Ad- 
justable foot rests permit the body weight to be car- 
ried by one or both legs in the upright position. 
Canvas straps are used to retain the patient firmly in 
position. These straps should always be attached, 
rolled neatly and simply to allow rapid securing of 
patient. 144 
MANUAL OF NAVAL HYGIENE' 
The Army-type litter (fig. 24) and its counterpart as 
improved, articulated, and made much lighter for field 
and shipboard use, is also available. It can be used 
Figure 25.—Modified “gas-pipe” stretcher (King). 
only when no difficulties of transportation are present 
and when the patient will not be exposed to the pos- 
sibility of falling. These can be employed as tempo- 
rary beds when a major casualty has exhausted the TRANSPORTATION* OF INJURED 
145 
The front of the suit consists of three pieces of canvas, two side, 
and one center. The side pieces are identical, 60 by 6 or 7 inches 
The lower edge is straight. The upper edges form a downward 
curve with the centerpiece as illustrated to allow room for the neck. 
The center piece of the front is 13 by 55 inches, a little longer at the 
outer edges to meet the line from the side pieces. The lower part is 
cut out to conform to the dimensions of the back piece canvas ol 
the legs. To give extra room in the crotch, a piece of canvas, 5 
inches at the widest portion—i. e., the crotch—and gradually taper- 
ing off to 2 inches, is sewed between the front and back piece of the 
legs. See drawing. To the inside of the crotch is sewed a pad of 
hair-felt horizontally, dimensions 10 by 6 by 2 inches. 
Figdhe 26.—Weber zipper stretcher 146 
MANUAL OF NAVAL HYGIENE 
usual facilities. Hence 20 or 25 of these should be in 
each battleship with a proportionate number in smaller 
crafts. 
The removal of injured or sick from areas difficult 
of access is accomplished by the use of flexible appa- 
Figure 27.—Hammock stretcher (Farrar). 
ratus, with or without some immobilizing features, and 
usually made of canvas. One of these is the Weber 
“zipper” stretcher or “zipper stretcher suit” (fig. 26) d 
The procurement of zippers may be difficult, due to pri- 
orities, in which case grommets and white-line lacing 
1 Original description appeared in U. S. Naval Medical Bulletin, July 
1936. TRANSPORTATION OF INJURED 
147 
may be substituted. The effects of salt air, weather, 
and encroaching clothing may cause failure of zippers 
to function. 
A simple, easily made canvas “hammock stretcher” is 
illustrated. Hammocks are always available aboard 
ships, and the stretcher may be easily folded for storage 
at strategic spots. Its method of use is shown in 
figure 27. 
Another simple canvas appliance having many uses 
is shown in figure 28. 
The Germans use an ordinary hammock (fig. 29-C) 
with beckets placed at the outer quarters to allow some 
overlapping for security; three beckets on each side, 
two near the head, and canvas straps securing patient 
by crossing at perineum. 
The Xeil Robertson stretcher (fig. 29-B) used by the 
British is light, serviceable, made of canvas, and rein- 
forced by bamboo. It allows splinting for carrying, 
may be suspended vertically and hung as a hammock. 
The Japanese Totsuka stretcher (fig. 29-A) is fairly 
similar in construction. All canvas appliances are 
strictly for shipboard use unless they are further 
equipped with loops for the introduction of poles which 
convert them into rigid stretchers. A tendency is to 
employ heavier canvas than needed, and to overlook the 
necessity of a rope attached at all times for assistance 
in lifting from lower decks or lowering from fighting 
tops. 
Transportation of sick and injured involves transfers 
at sea from one ship to another, or rescues of survivors 
from the ocean. Smaller ships such as destroyers are 
preferable for use because of their speed and low free- 
board, Cargo nets may be thrown over the side, thereby 
making it possible for survivors, not severely injured, 148 
MANUAL OF NAVAL HYGIENE 
to climb aboard. Much assistance can be rendered by 
the ship’s company in this manner. 
Figure 28.—Simple canvas stretcher (Davis) 
A member of the Medical Department will assist 
greatly by classifying and distributing the casualties as 
they come over the side. This will prevent confusion TRANSPORTATION OF INJURED 
149 
Figure 29.—A—Totsuka stretcher. B—Neil Robertson stretcher. 
C—German hammock type. 150 
MANUAL OF NAVAL HYGIENE. 
Figdre 30.—Litter lifting rods (Broaddus). TRANSPORTATION OF INJURED 
151 
and unnecessary crowding in the sickbay or in spaces 
previously prepared for the reception of specific types 
of injuries. 
Should there be many severely injured cases, these 
can be expeditiously handled from ship to ship by means 
of appliances quickly improvised by the rescuing ship. 
One of these is the construction of a platform with 
raised edges, and suspended from slings. It is prefer- 
ably made to carry three stretchers at a time, and 
equipped with securing lines for lashing which will 
afford additional protection against sliding. The edges 
of the platform must be sufficiently high to equal the 
depth of a Stokes stretcher. 
A breeches buoy may be used for transfer of slightly 
wounded from ship to ship if, for military reasons, it 
is necessary to do this underway. 
Two- or three-litter-capacity lifting rods consisting 
of two IV;-inch galvanized pipes, the ends of which 
have been flattened and drilled with a l/2-inch hole, may 
be used as in figure 30. The poles (pipes) are 51 inches 
for the two-litter lift, and 73 inches for the three-, and 
are passed through the legs of Army type stretchers. 
Patients on Army litters must be thoroughly secured to 
prevent their falling. This is accomplished by the 
use of canvas straps, bunk straps, or single-ply canvas, 
12 inches by 72 inches, cut to form three-tailed ends 16 
inches long, and tapering to 2 or 3 inches wide at 
the ends. These are passed under the stretcher and 
the three opposing ends are tied across the patient’s 
abdomen. Chapter XIII 
FUNDAMENTALS OF ACCIDENT 
PREVENTION ABOARD SHIP 
Both a physical hazard and faulty human behavior 
are necessary for an accident to happen. Full atten- 
tion must be given to both. We must use every 
means of eliminating or reducing the physical hazard, 
and in addition do everything possible to control the 
human behavior. 
Wherever accident frequency and severity are kept 
under control, the fundamental principles of scientific 
accident prevention must exist. These are; The crea- 
tion and maintenance of active interest in safety; 
periodical inspections of machines, tools, equipment, 
processes, and work procedures; accident investigation 
for the determination of causal facts; and corrective 
action based on these facts. 
The creation and maintenance of active interest in 
safety as a first principle of accident prevention must 
apply to officers as well as to the men. 
From the standpoint of the first lieutenant, the medi- 
cal officer, and division officers, a job of salesmanship 
is necessary. To arouse and maintain the interest of a 
person it is necessary to appeal to one or more of his 
stronger senses or desires such as: Self preservation— 
appeal to the individual’s fear of personal injury; de- 
sire for personal gain or reward; loyalty to one’s com- 
manding officer, division officer, and to shipmates; 
sense of responsibility to one’s job, division, shipmates, 
and to ship. 
152 ACCIDENT PREVENTION; 
153 
Pride in one’s work, in one’s division, and in one’s 
ship is one of the strongest incentives a man can have 
for producing the best work within his ability. Ap- 
proval of good work is a successful medium of ap- 
proach because it is human nature to appreciate 
recognition. The pride of living up to a standard, 
rivalry, the comparison with good practice, a desire 
for leadership or promotion are all forceful and com- 
pelling factors. Logic and a sense of humanity can be 
inculcated; arouse humanitarian instincts by giving- 
first-aid courses. 
A health and safety program should be organized on 
every ship, and safety committees appointed in each 
division to assist the first lieutenant and medical 
officer with the program. Frequent talks should be 
given to the men on the subject accident prevention 
and its importance. Posters, pamphlets, slides, mo- 
tion pictures, and articles in ships’ papers should be 
utilized. 
Periodical inspections to locate and identify physical 
hazards are exceedingly important. The following 
list of basic items that should be looked into is used by 
a safety engineer of long experience : 
Housekeeping, which includes inspection for loose material 
and objects underfoot or overhead, method of piling, projecting 
nails, disposal of scrap and waste, grease, water or oil spillage, 
and tool maintenance. 
Material and store handling methods. 
Guarding of transmission machinery. 
Point of operation guards. 
Decks, ladders, railings. 
Cranes, hoists and derricks. 
Lighting. 
Electrical equipment, particularly extension cords. 154 
MANUAL OF NAVAL HYGIENE 
Eye protection from harmful light, rays, heat or glare, flying 
objects, splashes of corrosive substances, etc. 
Other personal protective equipment: In certain types of 
work men need respirators, life lines, life jackets, safety shoes, 
special gloves and other protective clothing. 
Dusts, fumes, gases, vapors. 
Ventilation of storerooms and confined spaces. 
Pressure vessels. 
Any other fire and explosion hazards, as volatiles, gases, 
chemicals. 
Other dangerous substances. 
Inspection of chains, cables, slings, etc. 
Access to overhead valves, equipment, etc. 
The above list is limited almost wholly to physical 
hazards because the discovery and correction of unsafe 
working practices requires continuous watchfulness and 
painstaking training and education. 
Every disabling accident aboard ship should be inves- 
tigated immediately for “cause analysis” and not for the 
sole purpose of fixing blame. All minor accidental 
injuries and as many near-injury occurrences as possible 
should also be investigated. Continuous analysis of 
operations and jobs to discover and permit the correction 
of hazardous conditions should be maintained. The pur- 
pose of accident investigation is to find hazardous condi- 
tions and practices that can be corrected so as to prevent 
the recurrence of similar accidents. 
Principles of accident investigation that should be 
followed to secure maximum results include the use of 
common sense and clear thinking in collecting facts, 
weighing the value of each, and reaching conclusions 
justified by the evidence. Sufficient familiarity with 
the equipment, operation, or process to permit an under- 
standing of possible hazards that may exist, is essential. 
Each clue and factor, even when apparently of little ACCIDENT PREVENTION 
155 
importance, should be fully investigated. Since a physi- 
cal hazard and faulty human behavior are both present 
in the majority of accidents, both must be considered 
fully. After an accident investigation if a definite 
recommendation for corrective action is not made then 
the investigation was not satisfactory. Immediate in- 
vestigation of all accidents is necessary because condi- 
tions may change quickly and details be forgotten. 
Corrective action should be based on available and 
pertinent facts and may include a consideration of any 
of the following: 
1. Personal: 
a. Instruction, enforcement of instruction or education. 
&. Protective equipment and devices, such as respirators, 
goggles, life lines, and protective clothing. 
c. Prevention or at least reduction of amount of exposure 
to hazards. 
2. Medical: 
а. Periodical physical examination. 
б. Salt intake for prevention of heat reactions. 
3. Mechanical: 
a. Ventilation, general or local exhaust. 
h. Change, enclose, or isolate harmful processes. 
c. Substitute less toxic for toxic material. 
d. Adequate guarding of all moving parts of machinery 
likely to injure someone. 
e. Adequate natural or artificial lighting according to 
the type of work or operation being performed. 
f. Revise any operation that can be done in another, 
safer, and better manner. 
The Navy proceeds with the belief that dangerous 
material can be handled safely and that any mechanical 
job can be performed safely if proper study is given 
in advance and the necessary precautions observed. 
516368—43 11 156 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Actinomycosis- 
1. Recognition by clinical mani- 
1. Quarantine: None. 
1. Concurrent disinfection of 
testations confirmed if possible 
2. Immunization: None. 
lesions and articles soiled 
by microscopic examination of 
3. Instruction regarding oral by- 
therewith. 
discharges from lesions. 
2. Isolation: None. 
gione. 
2. Terminal disinfection by thor- 
ough cleaning. 
3. Check possibilities of exposure 
to infected cattle or use of 
infected milk. 
Angina, Vincent’s 
1. Recognition on clinical mani- 
1. Inspection of mouth and throat. 
1. Check on efficacy of dish- 
(stomatitis, Vin- 
festations with or without bac- 
2. Correction of abnormal or dis- 
washing facilities. 
cent’s), (gingivitis, 
teriological confirmation. 
eased conditions of gums and 
2. Check against possible use of 
Vincent’s). 
2. Isolation; None. 
teeth. 
common drinking cup. 
3. Correction of abnormal or dis- 
3. Instruction in regard to diet 
3. Concurrent disinfection: All 
eased conditions of gums and 
(particularly in reference to 
discharges from nose and 
teeth. 
vitamin C), gum massage, use of 
throat. 
4. Instruction in regard to diet 
(particularly in reference to vita- 
min C), gum massage, use of 
dental floss, and the tooth brush. 
dental floss and the tooth brush. 
4. Quarantine; None. 
5. Immunization: None. 
4. Terminal disinfection; None. 
Anthrax. 
1. Recognition by clinical and (if 
1. Check possible contact with in- 
1. Concurrent disinfection of dis- 
possible) bacteriological means. 
fected hides, wool, hair, bristles. 
charges from lesions (spores can 
2. Isolation: Until the lesions have 
2. Quarantine: None. 
be killed only by such measures 
healed. 
3. Immunization: None. 
as burning or steam under 
pressure). 
2. Terminal disinfection: Thor- 
ough cleaning. 
3. Search for the source of infec- 
tion (hides, wool, hair, bristles 
of infected animal). 
Chapter XIV 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP DISEASE, PREVENTION 
157 
4seariasis- . _ __ 
1. Recognition by identification of 
ova lumbricoides, ascaris, in 
stools. 
2. Isolation; None. 
3. Suitable treatment with appro- 
priate agent such as hexylresor- 
cinol, and of chenopodium or san- 
tonin should reduce the com- 
municability of the disease. 
1. Quarantine: None. 
2. Immunization: None. 
tary disposal of feces and wash- 
ing hands in soap and water 
after defecating and before 
eating. 
2. Terminal disinfection: None. 
Catarrhal fever includ- 
ing: 
Bronchitis, acute; 
common cold; 
laryngitis, acute; 
pharyngitis, acute; 
rhinitis, acute; 
tracheitis, acute; 
tracheobronchitis, 
acute. 
1. Recognition on clinical mani 
festations. 
2. Isolation: During febrile period. 
1. Quarantine; None. 
2. Immunization; None. 
1. Concurrent disinfection of the 
discharges from the nose and 
throat or articles soiled there- 
with. 
Cerebrospinal 
(meningitis, 
gococcus). 
fever 
merlin - 
1. Recognition on clinical mani- 
festations, confirmed if possible 
by microscopic and bacterio- 
logical examination of spinal 
fluid as well as bacteriological 
examination of nasal and pharyn- 
geal secretions. 
2. Isolation; Until 14 days after 
onset of the disease or until 
negative swabs are obtained 
from the nasopharynx. 
3. Prompt treatment with an 
appropriate chemotherapeutic 
agent such as sulfadiazine or 
sulfanilamide should be useful 
in limiting communicability. 
1. Quarantine; None. 
2. Advise contacts to avoid as far 
as possible for 10 days excessive 
chilling, bodily fatigue, physical 
strain. 
3. Observation of nonimmune 
contacts daily for 10 days follow- 
ing last date of contact unless 
bacteriological studies of nasal 
and pharyngeal secretions nega- 
tive. 
4. Prophylactic use of an appro- 
priate chemotherapeutic agent 
such as sulfadiazine or sulfanila- 
mide in the close contacts may 
be helpful. 
5. Immunization: None. 
1. Concurrent disinfection of the 
discharges from the nose and 
throat or articles soiled there- 
with. 
2. Terminal disinfection: Clean- 
ing. 
3. Increase separation of individ- 
uals and discourage crowding. 
4. Improve ventilation of living 
and sleeping quarters. 158 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Chancroid including: 
chancroidal lympha- 
denitis. 
1. Recognition by clinical mani- 
festations and exclusion of 
syphilis and lymphogranuloma 
venereum ((a) Withhold local 
medication until 3 negative 
dark-field examinations, carried 
out on successive days, have 
been obtained; (b) do Frei test 
for lymphogranuloma venereum 
if possible; (e) do a blood serologic 
test for syphilis and repeat every 
month for 6 months after heal- 
ing of lesions.) 
2. Isolation; Place on “venereal 
restricted list” and refuse all 
shore leave until lesions heal. 
3. Education: Stressing (a) that 
continence is compatible with 
health and normal development; 
(b) that prophylaxis is available 
and advisable if self-control 
has failed and promiscuous sex- 
ual intercourse has occurred. 
4. Proper treatment with saline 
dressings alone the first 3 days 
followed by appropriate chemo- 
therapeutic agents such as sul- 
fanilamide locally and sulfathi- 
azole or sulfadiazine systemi- 
cally should render a patient 
noninfective in 14 days in most 
instances. 
1. Quarantine: None. 
2. Immunization; None. 
3. Search made for infected person 
from whom patient received in- 
fection. Report made to proper 
authorities to bring about con- 
trol and treatment of this 
spreader. 
1. Concurrent disinfection: Sani- 
tary disposal of all dressings, 
disinfection of all articles soiled 
by discharges. 
2. Terminal disinfection; None. 
3. Cheek against common use of 
towels and toilet articles. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE, PREVENTION 
159 
Chickenpox (varicella) 
1. Recognition by clinical means 
only (be meticulous to eliminate 
the possibility of smallpox). 
2. Isolation: From all nonimmune 
until all blebs are dried but not 
necessarily until all scabs are 
shed. 
1. Quarantine: None 
2. Immunization: Passive immu- 
nization, in exceptional cases 
only, of nonimmune contacts 
with intramuscular injection of 
2 to 10 cc. of serum from a patient 
4 to 6 weeks convalescent from 
chickenpox. 
3. Observation every second day 
of all nonimmune contacts 
through period of 21 days. 
4. No observation of contacts pre- 
sumably immune. 
1. Concurrent disinfection: Arti- 
cles soiled by discharges from 
lesions. 
2. Terminal disinfection: Thor- 
ough cleaning. 
Cholera 
1. Recognition by clinical symp- 
toms confirmed if possible by 
bacteriological examination of 
stools. 
2. Isolation: In sickbay or screened 
room for 7 to 14 days and until 
cholera vibrios are absent from 
bowel discharges. 
1. Quarantine; Contacts for 5 days 
from last exposure, or longer if 
stools are found to contain the 
cholera vibrio. 
2. Immunization: Prophylactic 
reimmunization of ship’s per- 
sonnel with 1 cc. “booster dose.” 
1. Concurrent disinfection: 
Prompt and thorough disinfec- 
tion of stools and vomitus. 
Disinfection of articles used by 
or in contact with patient. 
Food left by the patient should 
be burned. 
2. Terminal disinfection: Thor- 
ough cleaning of entire room 
and the contents. 
3. Search for unreported cases or 
carriers. 
4. Investigate water, milk, food— 
chlorinate all water, cook all 
food. 
Coccidioidomycosis 
1. Recognition on clinical manifes- 
tations confirmed by bacterio- 
logical examination if possible 
of the fresh discharges. 
2. Isolation: None. 
1. Quarantine: None. 
2. Immunization: None. 
3. Instruction regarding impor- 
tance of obtaining prompt treat- 
ment of all skin wounds, even 
trivial ones. 
1. Concurrent disinfection: All 
discharges, from skin lesions or 
necrotic lymph nodes and all 
sputum and articles soiled 
therewith. 
2. Terminal disinfection: Not 
important. 160 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
- 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Dengue 
1. Recognition by clinical mani- 
festations. 
2. Isolation: In sickbay or screened 
quarters for 5 days. 
1. Quarantine: None. 
2. Immunization; None. 
1. Concurrent disinfection: None. 
2. Terminal disinfection: None. 
3. Search for unreported or un- 
diagnosed cases. 
4. Measures to eliminate the 
Aides aegypti mosquito and its 
breeding places. 
Diphtheria .. 
1. Recognition by clinical symp- 
toms with confirmation, if pos- 
sible, by bacteriological examina- 
tion of discharges. 
2. Isolation: Until 2 cultures from 
the throat, and 2 from the nose, 
taken not less than 24 hours 
apart, fail to show the presence 
of diphtheria bacilli. Where 
termination by culture is im- 
practicable, terminate at 16 days 
after onset. 
1. Quarantine: All contacts who 
handle food until shown by 
bacteriological examination not 
to be carriers. 
2. Observation; Daily for 15 days 
following last exposure. 
3. Immunization; All Schick-posi- 
tive contacts should be actively 
immunized with toxoid (in order 
to minimize local and constitu- 
tional reactions it is desirable to 
make a preliminary “toxoid re- 
action test,” nonreactions to re- 
ceive multiple small doses of 
suitably diluted toxoid). 
1. Concurrent disinfection: Of 
all articles soiled by discharges 
from patients, and all articles 
that have been in contact with 
patient. 
2. Terminal disinfection: Thorough 
cleaning or renovation and 
thorough airing and sunning 
of sick room. 
Dysentery, balantidic 
(amebic). 
1. Recognition by clinical symp- 
toms confirmed, if possible, by 
microscopic examination of stools. 
2. Isolation: None (but patients 
should be instructed regarding 
hand washing and forbidden to 
handle food to be eaten by others 
until repeated microscopic 
examination of stools shows 
absence of the Entamoeba 
histolytica). 
1. Quarantine: None. 
2. Immunization; None. 
3. Microscopic examination of 
stools of work associates of 
patient. 
1. Concurrent disinfection: Sani- 
tary disposal of bowel dis- 
charges. Hand washing after 
use of toilet. 
2. Terminal disinfection: Clean- 
ing. 
3. Search for direct contamina- 
tion of water and food by 
human feces. 
4. Check against possibility of 
water pollution by cross-con- 
nection and back-flow connec- 
tion. 
SPECIFIC MEASURES FUR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE PREVENTION 
161 
Dysentery, bacillary 
1. Recognition by clinical symp- 
toms; confirmation if possible by 
laboratory tests. 
2. Isolation: During acute phase 
of disease and until the dysen- 
tery bacilli are absent from the 
bowel discharges. Food han- 
dling forbidden until stools 
negative. 
1. Quarantine; None. 
2. Immunization; None. 
1. Concurrent disinfection of all 
bowel discharges. Hand wash- 
ing after use of toilet. 
2. Terminal disinfection; Clean- 
ing. 
3. Search for contamination of 
water, milk and food by 
human feces. 
Encephalitis, lethargic.. 
1. Recognition by clinical symp- 
toms assisted by microscopical 
and chemical examination of 
spinal fluid if possible. 
2. Isolation: For 1 week after 
onset. 
1. Quarantine: None. 
2. Immunization: None. 
3. Search for unreported cases 
amongst shipmates. 
4. Observation of close contacts 
every 2d day for 21 days. 
1. Concurrent disinfection of dis- 
charges from the nose, throat, 
and bowel, and articles soiled 
therewith. 
2. Terminal disinfection; None. 
3. Take such steps as are prac- 
ticable in controlling or pre- 
venting contact with mos- 
quitoes. 
Erysipelas 
1. Recognition by clinical mani- 
festations confirmed if possible 
by bacteriological means. 
2. Isolation: Until lesions are 
completely healed. 
3. The use of appropriate sul- 
fonamides may reduce the com- 
municability. 
1. Quarantine; None. 
2. Immunization; None. 
1. Concurrent disinfection: Dis- 
charges from lesions and articles 
soiled therewith, 
2. Terminal disinfection: Thor- 
ough cleaning. 
Favus 
1. Recognition on clinical mani- 
festations confirmed if possible 
by microscopic examinations of 
crusts and cultures on Sabou- 
raud’s medium. 
2. Isolation; Yes, until skin and 
scalp lesions are healed and 
microscopic examination is neg- 
ative. Patient should wear a 
tight-fitting cotton skullcap 
which is boiled frequentlv. 
1. Quarantine; None. 
2. Immunization: None. 
3. Instruction of contacts ■ to re- 
port to medical officer the occur- 
rence of any scalp lesions. 
1. Concurrent disinfection: Toi- 
let articles of patient; 
2. Terminal disinfection: None. 
3. Check against use of common 
hair brushes and combs. 162 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
f 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Filariasis. _ 
1. Recognition on clinical mani- 
festations—confirmation by find- 
ing embryos in blood after 
symptoms have occurred. 
2. Isolation: Not practicable be- 
cause of prolonged period of 
communicability. Patient 
should be made inaccessible to 
mosquitoes. 
1. Quarantine: None. 
2. Immunization: None. 
1. Concurrent disinfection. 
2. Anti-mosquito measures par- 
ticularly against Culex fatigans: 
screening of all sleeping quar- 
ters with screens eighteen 
mesh to the inch. 
3. Terminal disinfection; None. 
Fungus infection of the 
1. Recognition on clinical mani- 
1. Quarantine: None. 
1. Concurrent disinfection. 
skin (ringworm). 
festations. 
2. Isolation: No, but severe cases 
should be excluded from com- 
mon bathing facilities until con- 
dition reasonably well cleared. 
2. Immunization; None. 
Cleanliness of body and under- 
clothes. Use of cotton socks 
which can be boiled. Use of 
formaldehyde or powdered 
acetylsalicylic acid for disinfec- 
tion of shoes. 
2. Terminal disinfection: None. 
3. Survey of common bathing 
facilities to assure all precau- 
tions being taken. 
German measles (ru- 
1. Recognition by clinical mani- 
1. Quarantine: None. 
1. Concurrent disinfection: All 
bella). 
festations. 
2. Immunization: None. 
articles soiled with the secre- 
2. Isolation: From onset of ca- 
3. Non-immune contacts of first 
tions of nose and throat. 
tarrhal symptoms or rash until 
eases should be observed every 
2. Terminal disinfection: 
disappearance of rash. 
second day (particularly look- 
ing for post-auricular nodes) for 
21 days from the last day of ex- 
posure. Observation of con- 
tacts when the disease is epi- 
demic is probably futile. 
Thorough cleaning. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE PREVENTION 
1C3 
Glanders 
1. Recognition by clinical mani- 
festations followed if possible by 
the complement fixation test, 
the mallein test, the agglutina- 
tion test or the Straus reaction 
and confirmation by culture and 
identification of Bacillus mallei. 
2. Isolation: Yes, until bacilli dis- 
appear from discharges or until 
lesions have healed. 
1. Quarantine: None. 
2. Observation of close contacts 
daily for 5 days. 
3. Immunization: None. 
1. Concurrent disinfection: Dis- 
charges from patient and arti- 
cles soiled therewith, 
2. Terminal disinfection: 
Thorough cleaning. 
3. Search for any infected horses. 
Gonorrhea including: 
Gonococcus infection, 
all types. 
1. Recognition by clinical mani- 
festation confirmed, if possible, 
by bacteriological examinations. 
In absence of laboratory facili- 
ties treatment of acute purulent 
urethral discharges should begin 
anyway, a smear for subsequent 
examination first being pro- 
cured. 
2. Isolation; Placed on “venereal 
restricted list” and refused all 
shore leave until discharges dis- 
appear. 
3. Patient instructed regarding 
care of hands and discharges 
until declared cured. 
4. Education: Stressing (a) that 
continence is compatible with 
health and normal development, 
(bi that prophylaxis is available 
and advisable if self-control has 
failed and promiscuous sexual in- 
tercourse has occurred. 
5. Proper treatment with appro- 
priate chemotherapeutic agents 
such as sulfathiazole or sulfa- 
diazine should be useful in limit- 
ing communicability. 
1. Quarantine; None. 
2. Immunization: None. 
3. Search made for infected person 
from whom patient received in- 
fection. Report made to proper 
authorities to bring about con- 
trol and treatment of the 
spreader. 
1. Concurrent disinfection: Dis- 
charges from lesions and arti- 
cles soiled therewith. 
2. Terminal disinfection: None. 
3. Check against common use of 
towels and toilet articles. 164 
MANUAL OF NAVAL HYGIENE. 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Hookworm disease 
1. Recognition by clinical mani- 
festations confirmed by finding 
ova in feces. 
2. Isolation: None. 
3. Treatment with tetrachlorethyl- 
ene, hexylresorcinol or carbon- 
tetrachloride should reduce the 
communicability. 
1. Quarantine: None. 
2. Immunization: None. 
3. Education as to dangers of 
spread through soil. 
1. Concurrent disinfection; Sani- 
tary disposal of bowel dis- 
charges to prevent contamina- 
tion of soil and water. 
2. Terminal disinfection: None. 
Impetigo contagiosa 
/ 
1. Recognition on clinical mani- 
festations. 
2. Isolation: Yes, until pustules 
are healed. 
1. Quarantine: None. 
2. Immunization: None. 
3. Instruct contacts to report any 
skin lesions promptly to medi- 
cal officer. 
1. Concurrent disinfection: Sani- 
tary disposal of dressings and 
moist discharges from lesions. 
2. Terminal disinfection: None. 
3. Check against use of common 
towels. 
Influenza. 
1. Recognition by clinical symp- 
toms only (very difficult in in- 
terepidemic periods). 
2. Isolation: During acute stages 
of disease, especially in severe 
cases and those complicated by 
pneumonia. 
1. Quarantine: None. 
2. Immunization: None. 
3. Instruction: Report promptly 
to physician if feeling feverish- 
ness. 
1. Concurrent disinfection: Dis- 
charges from nose and throat. 
2. Terminal disinfection: None. 
3. Increase separation of individ- 
uals and reduce crowding. 
4. Improve ventilation of living 
and sleeping quarters. 
5. Check efficacy of dish washing 
facilities. 
Jaundice" "epidemic 
(Weil’s disease). 
1. Recognition on clinical mani- 
festations (confirmation if pos- 
sible by isolation of Leptospirae 
from blood or urine and positive 
serological tests). 
2. Isolation; None. 
1. Quarantine; None. 
2. Immunization: None. 
1. Concurrent disinfection: Urine 
and other discharges of the 
patient. 
2. Terminal disinfection; None. 
3. Check rat-control measures. 
4. Protect workers in infected 
water, with boots and gloves. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE PREVENTION 
165 
Leprosy 
1. Recognition on clinical Symp- 
I. Quarantine: None. 
1. Concurrent disinfection: Dis- 
toms confirmed by microscopic 
2. Immunization: None. 
charges and articles soiled with 
examination where possible. 
3. Search made for infected per- 
discharges. 
2. Isolation; Yes, transfer to na- 
son from whom patient received 
2. Terminal disinfection; Thor- 
tional leprosarium as soon as 
possible. 
infection. 
ough cleaning of patient’s 
quarters. 
Lymphogran iiloma've- 
1. Recognition on clinical mani- 
1. Quarantine: None. 
1. Concurrent disinfection: Dis- 
nereum. 
festations (diagnosis should be 
2. Immunization: None. 
charges and articles soiled there- 
confirmed by Frei antigen in- 
3. Search for case of origin par- 
with. 
tradermal test). 
ticularly among prostitutes, 
2. Terminal disinfection: None. 
2. Isolation: Placed on “venereal 
among persons of Negro race, 
and among former residents of 
tropical and subtropical areas. 
Report made to proper authori- 
ties to bring about control and 
treatment of this spreader. 
3. Check against common use of 
restricted list” and refused all 
shore leave and the handling of 
all food as long as there are open 
lesions on the skin or mucous 
membranes. 
3. Education: Stressing (a) that 
continence is compatible with 
health and normal development, 
(b) that prophylaxis is available 
and advisable if self-control has 
failed and promiscuous sexual 
intercourse has occurred. 
4. Proper treatment with appro- 
priate chemotherapeutic agents 
such as sulfathiazole, sulfadiazine 
or sulfanilamide may be useful 
in limiting communicability. 
towels and toilet articles. 
Malaria 
1. Recognition by clinical mani- 
1. Quarantine: None. 
1. Concurrent disinfection: None. 
festations always confirmed if 
2. Immunization: None. 
Destruction of Anopheles mos- 
quitoes in patient’s quarters. 
possible by microscopical exam- 
3. Administration of suppressive 
ination of the blood. 
doses of quinine or atabnn for all 
2. Terminal disinfection: None 
2. Isolation: From mosquitoes 
those who have been or still are 
Destruction of Anopheles mos- 
quitoes in patient’s quarters. 
only. 
exposed to Anopheles mosqui- 
3. Proper treatment with appro- 
toes. (0.2 gram (3 grains) ata- 
3. Killing mosquitoes in all living 
priate chemotherapeutic agents 
brin twice a week or 0.3 gram (5 ; 
quarters. 
such as quinine, atabrin and/or 
plasmochin should be useful in 
limiting communicability. 
grams) quinine sulfate daily. 
4. Screening sleeping and living 
quarters (use of screening at 
least 16 wires to the inch). 166 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Measles (rubeola) 
1. Recognition on clinical mani- 
festations with special attention 
to rise of temperature, Koplik 
spots, and catarrhal symptoms 
in exposed individuals. 
2. Isolation: During the period of 
catarrhal symptoms and until 
the cessation of abnormal secre- 
tions. 
1. Quarantine: None. 
2. Observation; Of all nonim- 
mune contacts daily for period 
of 21 days. 
3. Immunization: Not as a rule. 
In exceptional cases injection 
nonimmunes with 3 to 6 cc. of 
immune globulin or 20 to 50 cc. 
of the whole blood of immunes 
or 4 to 10 cc. of convalescent 
measles serum, within 5 days 
after first exposure may be used 
with the hope of averting an 
attack. 
1. Concurrent disinfection: All 
secretions of nose and throat 
and articles soiled therewith. 
2. Terminal disinfection; Thor- 
ough cleaning. 
Mumps (parotitis, epi- 
demic) . 
1. Recognition on clinical mani- 
festations. 
2. Isolation: For period of swell- 
ing of a salivary gland. 
1. Quarantine: None. 
2. Observation: All exposed non- 
immunes daily for period of 21 
days from date of last exposure. 
3. Immunization: None. 
(Passive temporary immuniza- 
tion by convalescent serum or 
blood may be used.) 
1. Concurrent disinfection; None. 
2. Terminal disinfection: None. 
Paratyphoid fever 
1. Recognition on clinical mani- 
festations confirmed, if possible, 
by specific agglutination test or 
by bacteriological examination 
of blood, bowel discharges or 
urine. 
2. Isolation: In fly proof room 
until repeated bacteriological 
examination of discharges shows 
absence of the infecting organ- 
ism. 
1. Quarantine: None. 
2. Immunization: Exposed sus- 
ceptibles to be reinoculated with 
“booster dose” of triple typhoid 
vaccine (0.1 cc. intracutane- 
ously). 
1. Concurrent disinfection of all 
bowel and urinary discharges 
and articles soiled with them. 
2. Terminal disinfection; Clean- 
ing. 
3. Check sanitation of water, 
milk, shellfish, or other food. 
4. Check for unrcportcd cases or 
carriers among food handlers. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE PREVENTION 
167 
Pediculosis 
1. Recognition by direct inspec- 
tion for lice and nits. 
2. Isolation: Yes; until lice are 
destroyed and nits removed 
from hair. 
3. Proper treatment should be 
useful in limiting communica- 
bility. 
1. Quarantine: None. 
2. Inspect heads, bodies and cloth- 
ing contacts. 
1. Concurrent disinfestation: 
Such washing of person and 
treatment of body clothing 
and toilet articles as will 
destroy lice and nits. 
2. Terminal disinfestation: None. 
3. If infestation found general, 
institute disinfestation pro- 
cedure for entire personnel of 
ship. 
Plague (bubonic) (pneu- 
monic) . 
1. Recognition by clinical mani- 
festations confirmed if possible 
by; (a) bacteriological examina- 
tion of blood or pus from glandu- 
lar lesions, orsputum; (b) animal 
inoculation. 
2. Isolation; In a screened room 
free from vermin until complete 
recovery (masks, gowns and 
gloves must be worn by those 
coming in contact with case). 
1. Quarantine: Of all contacts of 
pneumonic cases for 7 days take 
temperatures every 12 hrs. 
2. Immunization: Reinoculation 
of ship’s personnel with “a boos- 
ter dose” of 1 cc. plague vaccine 
is indicated. Those not pre- 
viously immunized should have 
the full course of immunization. 
1. Concurrent disinfection: Spu- 
tum and articles soiled there- 
with in pneumonic type of 
disease. 
2. Terminal disinfection: Thor- 
ough cleaning followed by fumi- 
gation to destroy rats and fleas. 
Bodies of persons dying of 
plague to be handled under 
strict antiseptic precautions. 
3. Check rat proofing of ships 
and presence of fleas. 
Pneumonia (lobar) (pri- 
mary, atypical). 
1. Recognition by clinical mani- 
festations. Bacteriological and 
serological tests should be done 
if possible. 
2. Isolation: Yes, until sputum no 
longer carries the infectious 
agent. 
3. Prompt treatment with an ap- 
propriate chemotherapeutic 
agent such as sulfadiazine may 
be useful in limiting communi- 
cability. 
1. Quarantine: None. 
2. Immunization: None. 
1. Concurrent disinfection: Dis- 
charges from nose and throat of 
patient. 
2. Terminal disinfection: Thor- 
ough cleaning and airing. 
3. Increase separation of individ- 
uals and discourage crowding. 168 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Poliomyelitis 
1. Recognition by clinical mani- 
festations assisted if possible by 
microscopical and chemical ex- 
aminations of the spinal fluid. 
2. Isolation: Yes, for2 weeks from 
onset. 
1. Quarantine: No (but nonim- 
mune exposed food handlers 
must not handle food to be eaten 
uncooked for 14 days from last 
exposure). 
2. Observation; Of all nonimmune 
close contacts daily for 14 days 
from last exposure. 
3. Immunization: None. 
1. Concurrent disinfection: Nose, 
throat, and bowel discharges, 
and articles soiled therewith. 
2. Terminal disinfection: None. 
Psittacosis 
1. Recognition by clinical mani- 
festations. Confirmatory lab- 
oratory tests usually not avail- 
able on board ship. 
2. Isolation: Yes, during febrile 
and acute clinical stage. (Those 
handling patients with a cough 
should wear masks with 8 
layers of gauze 40-48 threads per 
inch or 16 layers of gauze 20-24 
threads per inch). 
1. Observation of close contacts 
of patient daily for period of 15 
days following last exposure. 
2. Immunization: None. 
1. Concurrent disinfection; Of 
all discharges. 
2. Terminal disinfection. 
Thorough cleaning. 
3. Quarantine; Quarters which 
housed infected birds should 
be quarantined until thorough- 
ly cleaned and disinfected. 
4. Incriminated birds should be 
killed, their bodies immersed 
in 2 percent cresol, their spleens 
aseptically removed, part 
placed in equal parts of sterile 
glycerin and standard phos- 
phate buffer solution of pH 7.5, 
and part in a suitable fixative 
and both specimens sent to 
the nearest available labora- 
tory for examination. Car- 
casses should be burned before 
feathers dry. 
Rabies 
1. Recognition of disease by 
clinical symptoms confirmed if 
possible, by examination of brain 
of animal for Negri bodies and 
1. Quarantine; None. 
2. Immunization: None. 
1. Concurrent disinfection of 
saliva of patient and articles 
soiled therewith. 
2. Terminal disinfection: None. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE PREVENTION 
169 
by animal inoculations with 
material from the brain of such 
animal. 
2. Isolation; None if patient is 
under medical supervision and 
attendants are warned of possi- 
bility of inoculation by human 
virus. 
3. Immunization: Semple vaccine 
should be given promptly to 
patient bitten or mouthed over 
by animal seriously suspected of 
being or proved to be rabid. 
Rat*bite[fever 
1. Recognition of disease by his- 
tory of rat bite and symptoms. 
Means of laboratory confirma- 
tion rarely available on ship 
board. Prompt cure by arsphen- 
amines is of diagnostic value. 
2. Isolation: None. 
1. Quarantine: None. 
2. Immunization: None. 
1. Concurrent disinfection; None. 
2. Terminal disinfection: None. 
3. Rat eradication and preven- 
tion of rat bites. 
Relapsing fever,. _ 
1. Recognition by clinical symp- 
toms, confirmed if possible by 
laboratory means; curative ac- 
tion of arsphenamines also con- 
firmatory. 
2. Isolation: None. 
1. Quarantine: None. 
2. Immunization: None. 
1. Concurrent disinfection; None. 
2. Terminal disinfection; None. 
3. Tick and louse eradication. 
Rocky Mountain spot- 
ted fever. 
1. Recognition by symptoms and 
history of tick bite or exposure 
to ticks. A positive Weil-Felix 
reaction during the second week 
of illness is a valuable confirma- 
tory aid. 
2. Isolation: None. 
1. Quarantine; None—not com- 
municable from man. 
2. Immunization; Active artificial 
immunization by Spencer-Par- 
ker vaccine has given very en- 
couraging results. 
1. Concurrent disinfection; All 
ticks on the patient should be 
destroyed. 
2. Terminal disinfection: None. 
3. Tick infested areas should be 
avoided as far as feasible; ticks 
should be promptly removed 
from person; hands should be 
protected when removing ticks 
from animals. 170 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Sandfly fever (pappa- 
1. Recognition by symptoms and 
1. Quarantine: None. 
1. Concurrent disinfection: None. 
taci fever). 
history of exposure to bite of 
sandfly (genus phlebotomus). 
2. Isolation: No; but every effort 
should be made to prevent infec- 
tion of Pblebotomm by prevent- 
ing them from gaining access to 
the patient during the first day 
of the disease. 
2. Immunization; None. 
2. Terminal disinfection: None. 
3. Sandfly-infested areas should 
be avoided as far as possible. 
4. Electric fans placed at open- 
ings will aid in preventing 
entrance of the flies. Screens 
must be 45 mesh to the inch 
to be effective. 
5. Repellents may be helpful. 
Scabies 
1. Recognition by clinical'mani- 
festations. 
2. Isolation: Yes; until itch mites 
and eggs are destroyed. 
1. Quarantine: None. 
2. Search contacts for unrecog- 
nized cases. 
1. Concurrent disinfestation: Yes; 
of body clothing and bedding. 
2. Terminal disinfestation:Under- 
clothing and bedding to be so 
treated by dry heat or washing 
as to destroy the mites and the 
eggs. 
Scarlet fever 
1. Recognition by clinical symp- 
toms, Schultz-Charlton blanch- 
ing phenomenon may be helpful. 
2. Isolation: Yes; until all ab- 
1. Quarantine: No (exclusion of 
nonimmune food handlers from 
their work for period of 7 days 
from last day of exposure). 
1. Concurrent disinfection: All 
articles that have been in con- 
tact with patient and all 
articles soiled by discharges of 
normal discharges have ceased 
and all open sores on wounds 
healed (at least 21 days from on- 
set). 
3. Observation of all close contacts 
daily for week following last ex- 
posure with isolation of those 
with sore throat or upper res- 
piratory infection until their 
symptoms have cleared. 
2. Immunization: (Usually none. 
In very special cases passive im- 
munization by the injection of 
human convalescent serum or 
scarlet fever antitoxin in Dick- 
positive contacts). 
patient. 
' 2. Terminal disinfection: Thor- 
ough cleaning. 
3. Study of possible milk or food 
source. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE PREVENTION 
171 
Schistosomiasis. .. . 
1. Recognition on clinical mani- 
festations and if possible by 
microscopical examina tion of the 
stools or urine for ova. 
2. Isolation; None. 
3. Treatment with sodium anti- 
mony tartrate, fuadin or other 
trivalent antimony compounds 
should reduce communicability. 
1. Quarantine: None. 
2. Immunization: None. 
tary disposal of feces and urine. 
2. Terminal disinfection: None. 
3. Protect workers in polluted 
watexs with boots, gloves, and 
other waterproof garments. 
Septic sore throat 
1. Recognition by clinical mani- 
festations aided if possible by 
bacteriological examination of 
the lesions or discharges. 
2. Isolation: Yes, until cured (ex- 
clusion from food handling until 
throat cultures clear of helmo- 
lytic streptococci). 
1. Quarantine: None. 
2. Immunization: None. 
3. Observation of close contacts 
daily for period of 3 days from 
last exposure. 
1. Concurrent disinfection: Ar- 
ticles soiled with discharges 
from nose and throat of patient. 
2. Terminal disinfection; Clean- 
ing. 
3. Investigate milk supply.] 
Smallpox .......... 
1. Recognition by clinical mani- 
festations. 
2. Isolation: In screened quarters, 
free from vermin until patient 
has recovered and all scabs and 
crusts have disappeared. 
1. Immunization: Revaccination 
immediately of entire personnel 
of the ship. 
2. Quarantine, For those con- 
tacts vaccinated within 24 hours 
of first exposure, quarantine un- 
til height of reaction is passed. 
For those contacts not vacci- 
nated within 24 hours of first 
exposure, quarantine for 16 days 
from last exposure. 
3. Meticulous search fox prior case, 
particularly checking cases pre- 
viously diagnosed as chicken- 
pox. 
1. Concurrent disinfection: Of 
all discharges. No articles to 
leave the surroundings of the 
patient without boiling or 
equally effective disinfection. 
2. Terminal disinfection: Thor- 
ough cleaning and disinfection 
of quarters. 
516368—43 12 172 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Syphilis 
1. Recognition by clinical mani- 
festations confirmed by micro- 
scopical examinations of dis- 
charges and by serum reactions. 
2. Isolation: Placed on “venereal 
restricted list” and refused all 
shore leave until non-infectious. 
(Infectiousness is not to be pred- 
icated on a blood test result, 
but upon the total time of 
course, laboratory tests, physical 
inspection, and treatment sum- 
mation of the case). 
3. Education: Stressing (a) that 
continence is compatible with 
health and normal development; 
(b) that prophylaxis is available 
and advisable if self-control has 
failed and promiscuous sexual 
intercourse has occurred. 
1. Immunization: None. 
2. Quarantine: None. 
3. Search made for infected person 
from whom patient received in- 
fection. Report made to proper 
authorities to bring about con- 
trol and treatment of this 
spreader. 
1. Concurrent disinfection of all 
discharges and articles soiled 
therewith. 
2. Terminal disinfection: None. 
3. Check against common use of 
towels and toilet articles. 
Tetanus 
1. Recognition by clinical mani- 
festations confirmed if possible 
by bacteriological means. 
2. Isolation; None. 
1. Quarantine; None. 
2. Immunization: All wounded 
or tetanus - exposed persons 
should be given a “booster 
dose” of H cc. of alum-precipi- 
tated tetanus toxoid intra- 
muscularly. 
1. Concurrent disinfection; 
None. 
2. Terminal disinfection; None. 
Trachoma 
1, Recognition on clinical mani- 
festations. 
2. Isolation: Not necessary if pa- 
tient is receiving appropriate 
chemotherapy and is properly 
instructed regarding precau- 
tions against spread of secretions 
1. Quarantine: None. 
2. Immunization: None. 
3. Search contacts for previously 
unrecognized cases. 
4. For closest contacts the pro- 
phylactic use of suitable agents 
such as solution of zinc sulfate 
1. Concurrent disinfection: Of 
discharges and articles soiled 
therewith. 
2. Terminal disinfection: None. 
3. Check against common use of 
towels and toilet articles. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Continued DISEASE. PREVENTION 
173 
of the eye to others by common 
use of articles. 
(1 percent), or copper sulfate 
(0.5 percent) may be useful as an 
eye wash. 
Trench fever 
1. Recognition on clinical manifes- 
tations with history of exposure 
to the bite of the body louse. 
2. Isolation: In vermin-free quar- 
ters until clinical recovery (re- 
covered cases may remain infec- 
tive to lice for several months). 
1. Quarantine: None. 
2. Immunization: None. 
3. Through disinfestation 
contacts of patients. 
1. Concurrent disinfection: De- 
of all 
stroy all lice and louse eggs on 
hair, clothing, and bedding. 
Disinfection of urine and saliva 
and articles soiled therewith. 
2. Terminal disinfection: None. 
1. Recognition on clinical symp- 
toms and marked eosinophilia 
aided if possible by intradermal 
and precipitin tests. Confirma- 
tion by muscle biopsy after third 
week. 
2. Isolation: None. 
1. Quarantine: None. 
2. Immunization: None. 
1. Concurrent disinfection: 
None. 
2. Terminal disinfection: None. 
3. Every effort should be made 
to trace source of infection in 
pork and pork products. 
4. Check thorough cooking of 
meat. 
Tuberculosis (pulmo- 
nary) including: Tu- 
berculosis, skin. 
1. Recognition by clinical signs 
and symptoms confirmed by 
bacteriological examinations. 
2. Isolation; None (but patients 
with open lesions must be for- 
bidden to handle food). 
1. Quarantine; None. 
2. Immunization; None. 
3. Special search for possible origi- 
nal source. 
1. Concurrent disinfection; Dis- 
charges and articles freshly 
soiled with them. 
2. Terminal disinfection: Clean- 
ing. 
3. Special investigation of milk 
source. 
Tuberculosis (pulmo- 
nary) including: Tu- 
berculosis, general 
miliary. 
1. Recognition by use of x-ray fol- 
lowed by thorough physical ex- 
amination supplemented by 
tuberculin testing when neces- 
sary and confirmed by bacteri- 
ological examination of sputum 
and other materials. Physical 
examination alone can rarely 
diagnose incipient case. 
2. Isolation: Of “open” cases. 
1. Quarantine: None. 
2. Immunization: None. 
3. All contacts of an “open” ease 
should be examined roentgeno- 
logically. This should be re- 
peated after 6 months. 
1. Concurrent disinfection of 
sputum and articles soiled with 
it. 
2. Terminal disinfection; Clean- 
ing and renovation. 174 
MANUAL OF NAVAL HYGIENE 
Diseases (in alphabetic 
order) 
Measures applicable to patient 
Measures applicable to contacts 
Measures applicable to patients’ 
discharges and to environment 
Tularemia - 
1. Recognition by clinical mani- 
festations confirmed by bacteri- 
ological and serological means 
if possible (skin reaction less 
reliable). 
2. Isolation; None. 
1. Quarantine: None. 
2. Immunization: None. 
1. Concurrent disinfection of dis- 
charges from the ulcer, lymph 
nodes, or conjunctival sac. 
2. Terminal disinfection: None. 
3. Special investigation of prev- 
alence of blood-sucking flies 
and ticks, if possibility of use 
of raw drinking water, of the 
dressing of wild game without 
gloves. 
Typhoid fever— 
1. Recognition by clinical mani- 
festations confirmed if possible 
by specific agglutination test and 
bacteriological examinations. 
2. Isolation: In fly-proof quarters 
until 2 successive negative cul- 
tures of stool and urine (col- 
lected not less than 24 hours 
apart) are obtained. 
1. Quarantine: None. 
2. Immunization: Yes, of ship’s 
personnel with 0.1 cc. “booster 
dose” of triple typhoid vaccine 
intracutaneously. 
1. Concurrent disinfection: Dis- 
infection of all bowel and uri- 
nary discharges and articles 
soiled with them. 
2. Terminal disinfection: Clean- 
ing. 
3. Investigate water, milk, shell- 
fish, and food supply. 
Typhus fever 
1. Recognition by clinical mani- 
festations confirmed if possible 
by a Weil-Felix reaction in the 
second week. 
2. Isolation: In vermin-free quar- 
ters until the temperature has 
become normal and an addition- 
al 36 hours has elapsed (at- 
tendants should wear louse- 
proof clothing). 
1. Quarantine: In the presence of 
lice, exposed susceptibles should 
be quarantined for 14 days after 
last exposure. 
2. Observation: In the absence of 
lice, exposed susceptibles should 
not be quarantined but observed 
daily for 14 days after last ex- 
posure. 
3. Immunization: Reinoculation 
of ship’s personnel with 1 cc. 
typhus vaccine subcutaneously. 
1. Concurrent disinfection: De- 
stroy all lice and louse eggs on 
the clothing or in the hair of 
the patient. 
2. Terminal disinfection: None. 
3. Check methods for controlling 
lice, fleas and rats. 
SPECIFIC MEASURES FOR DISEASE PREVENTION ON BOARD SHIP—Contixmed 175 
DISEASE PREVENTION 
Undulant fever 
1. Recognition by clinical mani- 
festations supplemented by ag- 
glutination tests and bacterio- 
logical examinations, if possible, 
of the blood and urine for 
Brucella. 
2. Isolation; None. 
1. Quarantine: None. 
2. Immunization: None. 
1. Concurrent disinfection: Dis 
infection of urine and article 
contaminated by urine. 
2. Terminal disinfection; None 
3. Search for Brucella infection ir 
goats, swine, or cattle. 
4. Check on pasteurization o 
milk. 
Whooping cough . 
1. Recognition by clinical mani- 
festations supported by a dif- 
ferential leukocyte count show- 
ing a definite lymphocytosis. 
2. Isolation: Yes; for period of 3 
weeks from onset of paroxysmal 
coughing. 
1. Quarantine: None. 
2. All contacts instructed to report 
promptly to sickbay if they have 
any cough or cold within 16 days 
after last date contact. 
3. Immunization: Not advised. 
1. Concurrent disinfection: Dis 
charges from the nose ana 
throat and articles soiled there 
with. 
2. Terminal disinfection; Thor 
ough cleaning. 
Yaws (frambesia) 
1. Recognition by clinical mani- 
festations supplemented by sero- 
logical tests if possible. 
2. Isolation: Yes; in fly proof quar- 
ters, as long as there are open 
lesions or moist discharges. 
3. Treatment as for early syphilis 
should reduce communicability. 
1. Quarantine: None. 
2. All contacts who have open 
wounds should be instructed to 
report promptly any unusual 
development in or about their 
wound to their medical officer. 
3. Immunization: None. 
1. Concurrent disinfection: Dis 
infection of all soiled dressing, 
and linens. 
2. Terminal disinfection; None. 
3. Check fly control measures. 
Yellow Jever 
1. Recognition by clinical mani- 
festations. 
2. Isolation; Yes; in screened quar- 
ters (from which all mosquitoes 
have been eliminated by fumi- 
gation, trapping, etc.) for the 
first 4 days of fever. 
1. Immunization: Reinoculate 
ship’s personnel with 0.5 cc. of a 
1; 10 dilution of a concentrated 
vaccine subcutaneously. 
2. Quarantine; All those probably 
exposed, in quarters protected 
with 18-mesh screen for 10 days 
and inspect daily. 
1. Concurrent disinfection: None 
2. Terminal disinfection: Nona 
except to destroy any mosqui 
toes in the patient’s quarters. 176 
MANUAL OF NAVAL HYGIENE' 
Biologic 
Method of administration 
Expected immunity and repeat 
indications 
Comments 
Cholera 
Vaccine—suspension of 
8,000 million killed ehol- 
erajvdbrios per cc. 
Smallpox 
Two subcutaneous injections 
at 7- to: 0-day interval consist- 
ing of 0.5 cc. and 1 cc. doses 
of vaccine respectively. 
Apparently short duration of 
immunity. Stimulating dose 
of I cc. given every 4 to 6 
months following initial vac- 
cination as long as danger of 
infection exists. 
No severe reactions have been reported. 
Oiven only to personnel in or travel- 
ing to areas where there is danger of 
endemic or epidemic cholera. Should, 
where practical, be given one month 
prior to entering area. 
Vaccine—cowpox virus 
plain, glycerinated. 
Tetanus 
Multiple pressure (needle held 
parallel to skin) 6 to 12 
strokes in )k-ineh area pref- 
erably on arm deltoid 
region. 
No dressings used. 
Expose lesion to air. 
To be administered on enlist- 
ment. Revaccination upon 
re-enlistment or when doubt 
as to existing protection. 
Revaccinate whenever ex- 
posed and at intervals no 
greater than four years. 
Vaccination reactions: 
A. Immune reaction.—Usually no 
vesicle. Maximum diameter of 
erythema reached and passed in 8 
to 72 hours. Occurs in fully pro- 
tected individual. 
R. Accelerated reaction.—Means par- 
tial loss of protection gained from a 
previous vaccination or attack. 
Maximum erythema diameter 
reached in 3 to 7 days. Usually a 
vesicle. 
C. Primary reaction.—Observed in 
unprotected individuals and prev- 
ious unsuccessful vaccinations. 
Maximum erythema reached in 8 to 
14 days. Always a vesicle. 
Toxoid—alum precipi 
tated. 
Two 0.5 cc. injections intra- 
muscularly with interval not 
less than 4 or more than 8 
weeks. 
One year after initial immuni- 
zation give a single booster 
injection of 0.5 cc. of alum 
precipitated tetanus toxoid 
intramuscularly. Further 
booster of 0.5 cc. when going 
into combat zone irrespec- 
tive of time interval since 
previous injection. Should 
Tetanus toxoid may be given concur- 
rently with typhoid and smallpox. 
It is considered unnecessary to repeat 
the annual “booster.” 
IMMUNIZATION MEASURES USED IN NAVY IMMUNIZATION MEASURES 
177 
Triple (typhoid- 
paratyphoid) 
be given at least one 
month before entering com- 
bat zone. Upon being 
wounded or exposed to tet- 
anus infection a further 0.5 
cc. dose of toxoid is given ir- 
respective of the time inter- 
val since previous injection. 
Vaccine—1,000 million 
bacteria (typhoid) per 
cc.; 250 million each of 
paratyphoid “A” and 
“B” organisms. 
Typhus fever 
Subcutaneously 3 injections of 
0.5 cc., 1 ce. and 1 cc. at 
weekly intervals. This is 
considered the standard 
course. 
Intracutaneous injection of 0.1 
cc. triple (typhoid-para- 
typhoid A and B) vaccine 
annually as a booster dose 
after the standard course has 
been received. 
Tuberculin syringe should be used for 
the “booster” injection. 
Vaccine—a suspension of 
killed epidemic typhus 
Rickettsiae prepared by 
Cox yolk-sac culture 
method. 
Yellow fever 
Three subcutaneous injections 
of 1 cc. each at intervals of 7 
to 10 days. 
Stimulating dose of 1 ce. sub- 
cutaneously given every 4 to 
6 months following initial 
vaccination as long as there 
is danger of epidemic typhus 
fever. 
No severe reactions have been reported. 
Given to all personnel on active duty 
in areas where danger from epidemic 
typhus fever exists. 
Vaccine—strain of living 
yellow fever virus at- 
tenuated through pro- 
longed cultivation in tis- 
sue cultures (chick em- 
bryo). 
0.5 cc. of 1:10 dilution of con- 
centrated vaccine subcuta- 
neously (one dose only). 
All personnel routinely im- 
munized. 
Immunization is lifelong but 
in presence of an epidemic 
of yellow fever another dose 
shall be given to increase 
the titer of immune bodies. 
Vaccine must be kept at temperature 
not above 4° C. (39° F.). 
All diluted vaccine which remains un- 
used after 3 hours must be dis- 
carded. Use only diluted vaccine. 
A very mild febrile reaction may occur 
in 4 to 7 days. 
Yellow fever vaccine should not be 
given concurrently with smallpox. 
Give yellow fever vaccine first and 
at least 5 days later give smallpox. 
Yellow fever vaccine may be given 
with typhoid or tetanus. 
It has been suggested that personnel in extreme northern latitudes be given shots of antidiphtheria toxoid due to the fact that 
ummmunized persons are extremely susceptible to diphtheria the farther north they travel. This suggestion is under consideration 
by the Navy but is not yet a part of its immunization schedule. Chapter XV 
THE HOSPITAL SHIP 
Hospital ships have amply justified their existence 
as a component of naval forces in time of peace as well 
as of war. 
Since August 29, 1921, the basic administration of a 
hospital ship has been similar to that of any other ship 
in the U. S. Navy, “except insofar as departures there- 
from are made necessary, in time of war, by the non- 
combatant status of the ship and the provisions of the 
Hague Convention of October 18, 1907.” 
By the Hague Convention of 1907 the distinctive 
markings of a hospital ship were delineated as follows: 
A green band of about 6 feet wide horizontally about 
the ship slightly above the water line, a large red 
Geneva cross amidships on each side and, very recently, 
a large red Geneva cross painted on the superstructure 
so that it may be readily observed from the air. While 
red and green lights for night use were also specified, 
they have been found to be impossible to use and 
usually flood lights are rigged for night time so that 
the distinctive markings of the ship may be observed 
for some distance. A hospital ship may not carry 
combatant arms except in very limited quantities for 
protection against savage or semicivilized enemy. 
The ideal hospital ship is one which has been de- 
signed for that purpose, but experience has proved 
178 THE HOSPITAL SHIP 
179 
that many merchant ships can be converted into efficient 
hospital ships and serve this purpose admirably. The 
ideal size of a hospital ship is about 10,000 gross tons. 
Smaller ships cannot carry a sufficient number of pa- 
tients to warrant their maintenance, and it is difficult 
to maneuver larger ships into some of the more shal- 
low harbors, especially in the Pacific area. Speed 
is an important factor. The ideal hospital ship should 
have sufficient speed to maintain its place with the main 
body of the fieet under all conditions, but unfortunately 
high speed means vibration, and vibration must be 
reduced as much as possible on a ship of this type. 
Cruising radius is an important factor in that the hos- 
pital ship must be able to stay with the fleet on long, 
fast cruises. Steadiness of operating platform is of 
paramount importance, hence the hospital ship should 
be designed, or a liner for conversion chosen, with that 
object in mind. 
Ample provision must be made for the hoisting on 
board of patients when the ship is at sea where gang- 
ways cannot be used. Special jib-cranes of a simple 
design can readily be made and installed and it may 
turn out to be very practical to use boat davits for the 
same purpose. Nothing mechanical has yet been devel- 
oped which can replace manpower in raising or lower- 
ing patients from or to boats alongside. It is not 
unusual for hospital ships to receive patients while 
cruising in company with the fleet, as is witnessed by 
the fact that on one peacetime cruise from the West 
Coast to Panama the U. S. S. Relief received 17 pa- 
tients in 15 days. The ship must be provided with 
several four-legged bridles, each leg having a snap 
hook on the end so that they may be quickly and 180 
MANUAL OF NAVAL HYGIENE 
safely snapped onto the Stokes stretchers in which 
the patients will normally arrive. While in port the 
ship would normally have its entry ports open, one or 
more on each side, and the gangways should be a mini- 
mum of 60 inches wide so that stretcher patients may 
be carried on board with ease. Even if a moderate sea 
is running while at anchor it wTill probably prove more 
satisfactory to use the hoisting gear for patients rather 
than to subject them to the jarring which occurs in 
removing a stretcher from the boat to the gangway 
landing. 
The special mission of a hospital ship must be con- 
sidered in laying out storage spaces for food as well 
as medical department equipment and supplies. Re- 
frigerated spaces must be considerably in excess of 
those allowed other vessels of equal complement. It 
would be a wise provision to have on board a special 
refrigerator of sufficient capacity to carry an ample 
supply of the hard frozen food products such as meats, 
fowl, fish, and vegetables. On the U. S. S. Solace 
there is refrigerated storage space sufficient to carry 
10 months’ supply of perishable foods. Storage space 
for medical supplies and equipment is likewise an 
important problem and there again, sufficient space 
must be provided to carry at least 1 year’s supply even 
if it means sacrificing bed space. It will be found to 
be more efficient to have a few large storerooms rather 
than a multitude of small ones. 
Elevators must be provided for the handling of 
patients and stores, and the ideal situation would be a 
patient elevator at each end of the ship and a freight 
elevator serving storerooms and bag room. This neces- 
sitates careful design and assignment of spaces below THE HOSPITAL SHIP 
181 
decks. Automatic elevators have proven far superior 
to the manually operated type. 
Electric generating capacity should be considerably 
in excess of the immediate apparent needs and the type 
of current and voltage should be very carefully con- 
sidered. Electricity for the x-ray department should be 
provided from a separate generating unit of sufficiently 
ample capacity to absorb all demands for current 
without undue voltage drop. If the electricity for the 
x-ray is taken from a common generator it will fre- 
quently happen that an elevator motor or other pow- 
erful piece of equipment starts at the same time that 
the x-ray is taken, with resultant spoilage of the film. 
Almost daily, new and desirable pieces of electric 
equipment may be introduced aboard and unless this 
contingency is allowed for, in a very short time the ship 
will be undersupplied with electric power. The same 
applies to the distilling apparatus in which the fresh 
water is made. All persons on board a hospital ship 
must be educated on the subject of fresh water con- 
servation and yet it is necessary to have ample water 
for actual needs. Experience on the U. S, S. Solace 
has proved that an average of 60 gallons of water per 
day per person on board is sufficient to care for the 
fresh water needs of crew and patients. 
Because of the nature of its mission, a hospital ship 
must contain all of the medical and surgical depart- 
ments found in any well-equipped hospital ashore. 
The x-ray department should be in the immediate 
neighborhood of the surgical wards, particularly the 
traumatic surgical ward, and must have elevator service 
nearby. The clinical laboratory should be close to 
the operating rooms in order that the frozen section 182 
MANUAL OF NAVAL HYGIENE 
Figure 31.—U. S. Hospital Ship Solace. THE HOSPITAL SHIP 
183 
work may be expedited. The physical therapy depart- 
ment is the only one which can be curtailed. Generally 
speaking, patients are not retained on board a hospital 
ship for extended periods of time, hence there will not 
be need for prolonged physical therapy. The x-ray 
and laboratory equipment and personnel should be of 
the highest caliber, as it is usually impracticable if not 
impossible to obtain consultation from other institu- 
tions. The same applies to the equipment. Nothing 
should be eliminated with the thought of borrowing 
from someone else if needed. 
Sterilizing equipment, up to and including a large 
mattress sterilizer, must be of the best. With modern 
innerspring mattress construction now in general use, 
the mattress sterilizer must be provided with a formal- 
dehyde vapor attachment. 
An animal house must be provided and is best 
located on the wTeather deck aft so that the usual animal 
odors may not permeate the whole ship. Considering 
global war, the animal house must be provided with 
ample ventilation as well as heating arrangements and 
adequate insulation against tropical sun. 
An adequate incinerator must be provided to dispose 
of the large quantities of combustible rubbish and dress- 
ings, and in addition there must be oil-burning facilities 
for the complete incineration of amputated parts. 
Obviously this latter installation must be in the im- 
mediate vicinity of the ship’s smokestack for the ready 
disposal of noxious vapors. 
Contrary to common usage in hospitals ashore, the 
mortuary must be provided with refrigerating facilities 
for the preservation of the bodies of deceased personnel. 
An adequate autopsy room with proper hot- and cold- 184 
MANUAL OF NAVAL HYGIENE. 
water service and oversized deck drainage must be pro- 
vided, preferably immediately contiguous to the mor- 
tuary. A competent embalmer is an essential member 
of the medical personnel. 
The ward spaces must be located above the water 
line and should have large ports or windows open to 
the outside. A study of the records of the U. S. S. 
Relief for the past 16 years indicates that the follow- 
ing percentage distribution of beds in the different 
wards will prove the most satisfactory: 
Percent 
Officers 3 
Contagious and acute medicine 10 
General medicine 9 
Operative surgery 15 
Traumatic surgery 15 
Eye, ear, nose, and throat 7 
Insane 1 
Urological and skin 15 
Convalescent wards 25 
Total 100 
There is an approved design for the stanchions on 
which the bunks are supported. These are of angle 
iron or H-bar type, and are so designed that the bunks 
may be either single-banked or double-banked as the 
need arises. Provisions must be made so that if the 
bunks are single-banked, the upper bunk not in use is 
well up out of the way so that it will not interfere 
wuth nursing procedures. All bunks and stanchions 
must be so designed and made that there will be no 
holes or crevices in which vermin may live and breed. 
The cimices are particularly prone to get into pipes or 
hollow stanchions where they breed at will and are 
almost impossible to eradicate. THE HOSPITAL SHIP 
185 
Figure 32.—Hospital ship ward. 186 
MANUAL OF NAVAL HYGIENE 
Open deck space, partly glassed in, will prove to be 
of the utmost value for airing and sunning both ambula- 
tory and bed patients. Better still is a large sun deck 
on the top superstructure, preferably with elevator 
service, so that, weather permitting, the patients may 
be taken outside. This happy condition exists on both 
the U. S. S. Relief and the U. S. S. Solace. In order to 
take advantage of these open deck spaces, door combings 
should be kept as low as consistent with the safety of 
the ship, and ramps should be provided to permit wheel- 
ing stretchers and beds through the doors. 
With modern air-conditioning units so readily avail- 
able, the old accepted standards of a certain number 
of cubic feet of air space per patient no longer apply. 
The problem should be attacked from the angle of com- 
plete air change in the compartment per time limit. 
Ventilating units designed to give a complete change 
of air every three minutes have been found to be entirely 
satisfactory for use on board hospital ships. The units 
should be so constructed as to provide for warming, 
humidifying and cooling the air, all of which advantages 
will be found in the most modern units. The location 
of the ventilating outlets in the ward spaces must be 
carefully chosen, otherwise it will be found that certain 
beds will receive an overabundance of air and other beds 
will be undersupplied. The most efficient system is a 
combined supply and exhaust installation which will 
provide for a free circulation of air without undue draft 
on any one patient. (See chapter II, Ventilation). 
Each ward should be provided with a small service 
pantry from which trays to bed patients can be served. 
The iood very properly and efficiently can be brought 
from the galley to these ward pantries in electrically THE' HOSPITAL SHIP 
187 
heated food carts. The pantries should be equipped 
with accessory cooking equipment so that between-meal 
nourishment can readily be provided. A central scullery 
and dishwashing department will be found to be the 
most efficient. A garbage grinding and disposal unit 
has been developed and is now in use on one of our 
hospital ships (U. S. S. Solace). In this unit all gar- 
bage, except possibly some of the larger bones of a beef 
skeleton, is ground up, mixed with water and discharged 
overboard, thus doing away with the handling of large 
quantities of garbage. These units have been approved 
for use by the health authorities and port commissions 
of practically all of the larger ports in the United 
States. Obviously, separate scullery and dish washing 
machinery must be provided for the contagious and iso- 
lation wards of the ship. Deep compartmented trays 
composed of corrosion resisting metal—steel or dural- 
umin—make for better service, ease of handling and 
prevent a great breakage of crockery, and they lend 
themselves perfectly to sterilization. They have been 
used with excellent success on hospital ships. Messing 
facilities for ship’s company and ambulatory patients 
are best handled by the cafeteria system, and with 
proper installation it is practicable to serve up to 400 
persons in 1 hour. 
As female nurses are an accepted part of the ship’s 
complement, consideration must be given to the nurses’ 
quarters. While their presence on board a hospital 
ship is a definite asset, they nevertheless introduce prob- 
lems that do not occur on other ships of the Navy. 
Indoor passageways from the nurses’ quarters to all 
sick spaces must be provided; ample lounging space and 
recreation space are absolute essentials. While pri- 
51 6368—43——] 3 188 
MANUAL OF NAVAL HYGIENE 
vacy is usually a negligible feature in the life of a man, 
to most women it is of paramount importance, hence 
it will be best if the quarters can be so designed as to 
permit individual occupancy of rooms. A small, effi- 
cient laundry for the nurses should be provided in 
their quarters. 
Laundry facilities should be designed considerably 
in excess of the apparent load. Ten pounds of laundry 
per day per patient should be the very minimum pro- 
vided for, with an additional allowance of 2 pounds 
per day for the ship’s company. An expert laundryman 
must be provided, both for the efficient operation of 
the laundry and the proper conservation of fresh water, 
as inexperienced help usually prove more of a liability 
than an asset. 
Deck covering is of great importance. Operating 
rooms, scrub-up rooms, pantries, toilets, autopsy room 
and other spaces in which the deck is usually wet, are 
best covered with a nonslip tile. The conventional 
wooden gratings in baths can and should be eliminated 
by the use of such nonslip tile, which can be sterilized 
readily either by boiling water or chemical means. 
AVooden gratings have been found to be a prolific source 
of fungus infection in the feet and have no place on 
board modern ships. The deck coverings in the wards 
must be fireproof, somewhat resilient and not too slip- 
pery. It has been found that magnesite compounds 
properly laid satisfy all these requirements. Linoleum 
may be a very definite and serious fire hazard, in that 
it is moderately inflammable and when burning throws 
off a dense suffocating smoke. 
One of the difficulties in the design of a hospital ship 
is to isolate noise-making machinery. Such installation 189 
THE HOSPITAL SHIP 
as boat and cargo-hoisting winches, ventilating blowers, 
pumps and other noise-making machinery must be very 
carefully considered with a view towards obtaining 
units as nearly noiseless as possible and, even so, it may 
be necessary to locate them in such places as to prevent 
the transmission of noise through the metal structure 
of the ship to ward spaces. One has but to consider 
how irritating these noises can be to a well person, to 
appreciate the importance that they will assume to a 
sick one. Elevator shafts should be completely enclosed 
and soundproofed. Winches may have to be installed 
on vibration dampers with soundproofing between the 
winch bed and the decking. The same applies to the 
ventilating blowers. 
The psychopathic ward should be located as far away 
from the other ward spaces as possible, probably on 
the superstructure well aft so that possible noise from 
this department may not keep other patients awake 
day and night. Chapter XVI 
THE DENTAL OFFICER ABOARD SHIP 
Surprise is often expressed that the naval dental officer 
serves afloat as well as ashore. Before discussing his 
duties while at sea, it might be well to describe the dental 
office, its personnel and various types of dental equip- 
ment found aboard ship. 
In accordance with the desire of the Navy to improve 
the physical condition of its fighting men, dental facil- 
ilies aboard ship have expanded and improved rapidly 
both as to the amount of office space allotted and extent 
of treatment administered. For instance, the larger 
combatant ships, such as the new battleships and aircraft 
carriers usually have three dental offices; cruisers have 
sufficient space for one. Destroyers and submarines are 
dependent upon their tenders for dental care. These 
offices are equipped with the most modern dental operat- 
ing units, operating chairs, instrument cabinets, steri- 
lizers, roentgenographic equipment and instruments so 
that routine operative and minor oral surgical proced- 
ures may be carried out efficiently. 
Hospital ships and certain others acting as tenders are 
equipped with prosthetic laboratories as well as the 
standard dental office. These laboratories permit the 
construction of oral prosthetic appliances to replace 
missing teeth. Materials available for such treatment 
include acrylic resins, precious and nonprecious metals, 
100 THE DENTAL OFFICER 
191 
porcelains and all materials and equipment incident to 
partial and full denture impression-taking and process- 
ing. In addition, hospital ships offer oral surgical facil- 
ities for more advanced and extensive treatment. 
A dental technician holding the rating of pharmacist’s 
mate is assigned to assist each dental officer. He has 
Figure 33.-—Portable dental landing outfit. 
received adequate training in carrying out routine denta 1 
procedures. The technician scales and polishes teeth 
and in general carries out duties similar to those per- 
formed by a dental assistant in private practice. The 
dental technician and other hospital corpsmen must also 
assist in the battle-dressing stations under the direction 
of medical and dental officers. When roentgenographic 
examination of the extremities is required by the medical 192 
MANUAL OF NAVAL HYGIENE 
officer, the dental technician, under the supervision of 
the dental officer, makes the necessary roentgenogram. 
The dental x-ray unit is the only equipment of this type 
located aboard combatant ships. 
As to specific duties, the dental officer directs his 
efforts toward several main goals which are taken up 
separately. 
Preventive dentistry.—This includes education of the 
ship’s personnel in proper oral hygienic measures. 
Figure 34.—Portable dental landing outfit installed. 
This may be accomplished by visual education, by talks 
to individuals or groups and by the adoption of certain 
definite sanitary precautions. Proper methods of daily 
oral hygiene are continuously stressed. 
Great emphasis is placed on the necessity for proper 
diet. Aboard some ships, medical, dental, and supply THE DENTAL OFFICER 
193 
officers collaborate in planning correct menus for daily 
rations. The inclusion of fresh fruits, vegetables, and 
dairy products is stressed. Ingestion of proper foods 
cannot be emphasized too thoroughly since common 
gingival disturbances, particularly noticeable when at 
sea for extended periods, can be attributed in many 
cases to improper food intake. 
The danger of infecting oral tissues by the use of 
improperly sterilized drinking cups, glasses, and uten- 
sils is repeatedly impressed upon the ship’s personnel, 
particularly when visiting places ashore where ade- 
quate precautionary measures are not rigidly enforced. 
Routine examination of ship’s company both clini- 
cally and by the use of bite-wing roentgenograms aids 
in detection of carious lesions. Prompt treatment of 
the personnel’s dental needs lessens the degree of tooth 
destruction and prevents to a great extent apical in- 
volvement which might act as a focus of infection. 
Routine clinical 'procedures.—Dental treatment avail- 
able to ship’s personnel includes restorations of amal- 
gam or porcelain, simple extractions, elimination of 
oral infections and minor oral surgery. Since hospital 
ships are not always in the vicinity, it is necessary for 
dental officers to be thoroughly acquainted with routine 
oral surgical procedures. These include removal of 
impacted teeth, alveolectomy, apicoectomy, excision of 
cysts, and treatment of jaw fractures. 
The dental officer must be thoroughly familiar with 
oral lesions, particularly those which are manifesta- 
tions of systemic disorders. These cases may then be 
referred to the medical officer for treatment. 
The dental officer must check the health records of 
all personnel periodically in order to keep the dental 194 
MANUAL OF NAVAL HYGIENE 
record up to date. In many instances, this record, 
which contains a detailed diagram of all restorations 
present in the teeth, is the only means of identification 
of the dead. 
Special clinical procedures.—During battle, the den- 
tal officer is in charge of one of the battle-dressing sta- 
tions with corpsmen and other enlisted personnel as 
Figure 35.—Dental office at a naval dispensary. 
assistants. These men must be instructed in various 
duties pertaining to first aid, handling of casualties, 
identification of dead and in maintaining communica- 
tions with “Central.” The dental officer must have a 
complete understanding of the ship’s plans involving 
damage control procedure with reference to the com- 
partment in which the dressing station is established. 
This is necessary in order to maintain watertight integ- THE, DENTAL OFFICER 
195 
rity and to protect and evacuate the wounded for whose 
safety he is responsible. The dental officer must also 
check dressings, drugs and supplies at his station. 
As to professional duties, the dental officer assists the 
medical officer in emergency treatment of battle casual- 
ties. He must be thoroughly familiar with first-aid 
measures such as arresting hemorrhage, treatment of 
burns, proper bandaging, alleviation of pain and use 
of splints. He must understand wound debridement, 
particularly in regard to facial wounds in order to save 
as much tissue and attached bone fragments as possible 
for purposes of regeneration and repair. Administra- 
tion of plasma in the treatment of shock and burns and 
application of sulfonamide drugs must be understood. 
He must be familiar with clearing and maintaining air 
passages in mandibular wounds where tongue control is 
lost. 
The dental officer must also aid in sorting of wounded 
for immediate treatment or transfer. Aboard some 
ships, he is in charge of evacuating the sick from the 
sickbay. For this duty, he is given the services of sev- 
eral corpsmen. In this capacity, he must be sure that life 
jackets are properly adjusted on all patients, that they 
are correctly tagged and evacuated to proper stations 
as soon as possible with the least additional injury. 
Dental officers attached to units engaging in landing 
operations must set up proper dressing stations for 
treatment of casualties. The portable dental supplies 
and other medical stores and equipment are placed 
aboard ship where quick removal is possible. In such 
operations, the dental officer and his assistants must 
be prepared to protect their wounded by force if neces- 
sary. This requires carrying of small arms and a 196 
MANUAL OF NAVAL HYGIENE 
Figure 36. Dental office on a carrier. 197 
THE DENTAL OFFICER 
knowledge of their use so far as is permitted by 
international agreement. 
General duties.—There are times when the dental 
officer must assume other duties not related to his pro- 
fessional training. He may be elected mess treasurer 
or assigned to the auditing board. He may also serve 
as a member of a naval courts-martial. 
By nature of his profession, the dental officer comes in 
close contact with most of the ship’s company. During 
their professional visits to the dental office, he may often 
have the opportunity to exert some influence on the 
morale and mental attitude of the personnel as well as 
to care for their dental needs. Chapter XVII 
SUBMARINE MEDICINE 
A submarine is a vessel so constructed that it can 
either cruise on the surface or submerge and proceed be- 
low the surface. This type of ship has a cigar-shaped 
hull, built to withstand great pressure, and a free-flood- 
ing superstructure which forms the weather deck. 
When on the surface these vessels are propelled either 
by direct-drive Diesel engines or Diesel-electric combi- 
nations. When submerged they operate on electric 
motors driven by current from storage batteries made 
up of 120 to 252 1-ton lead-acid cells. These batteries 
are charged by Diesel operated generators. When sub- 
merged visual contact with the surface is maintained 
(to a keel-depth of about 60 feet) by means of peri- 
scopes. On the surface communication is accomplished 
either by visual or radio signals. While submerged 
radio reception is possible. Compartmentation by 
watertight, thwart-ship bulkheads divides the pressure 
hull into several sections. In the later type of sub- 
marines these are: The forward torpedo room, the for- 
ward battery room or officers' quarters; the control 
room; the after battery or crew’s quarters; the engine 
rooms; the maneuvering room; and the after torpedo 
room. Intercompartment passage is possible through 
small, quick-closing doors. 
Submarines have main ballast tanks which are car- 
ried “dry” for surface operations and are flooded upon 
198 SUBMARINE! MEDICINE 
199 
and during submergence. These tanks are so designed 
that their volume is exactly equal to the displacement 
of that part of the ship which is above the water line. 
When these tanks are flooded, the over-all weight of 
the ship exactly equals the over all displacement and 
thus the ship is in neutral buoyancy. Depth control is 
effected by means of the forward motion of the ship 
and the use of bow and stern planes. Minor variations 
in weight caused by the addition or use of stores, fuel, 
etc., are compensated for by flooding or pumping the 
variable tanks. These tanks are: Forward trim, lo- 
cated in the forward part of the ship; auxiliary, at the 
center of gravity of the ship; after trim, at the after 
end of the ship. A trim pump and water manifold are 
installed for transfer of water between this group of 
tanks and the sea. 
The submarine is brought to the surface by blowing 
the water from the main ballast tanks with compressed 
air. 
Because of the unusual construction and function of 
these vessels there are numerous problems of a medical 
nature which need emphasis, particularly air condi- 
tioning, diet, maintenance of health and sanitation, and 
selection of personnel. (See also section on Ventila- 
tion of Submarines in Chapter II.) 
Ventilation. 
Proper ventilation on submarines is of primary im- 
portance. In a sealed compartment such as a subma- 
rine the air is vitiated by the consumption of oxygen 
and the production of carbon dioxide and moisture by 
the ship’s company, by the production of heat from the 
machinery, gases from the cooking, the batteries and 
the lubricants, etc,; and during the charging of the bat- 200 
MANUAL OF NAVAL HYGIENE. 
teries, by hydrogen and under unusual circumstances, 
by chlorine gas. 
The habitability of a submarine from the standpoint 
of atmospheric conditions depends upon such factors 
as pressure, movement, temperature, humidity, and con- 
stituents of the air. 
(1) Air pressure.—The air in a submarine is nor- 
mally under the same pressure as that of the outside 
air. During a dive the pressure increases slightly due 
to compression of the hull and to venting of the tanks 
inboard. However should an escape with the sub- 
marine escape appliance (the “lung”) be necessary, the 
air pressure within the compartment which is being 
flooded must be permitted to increase until it equals the 
pressure of the sea water for the depth at which the 
submarine is submerged (which allows the opening of 
the escape hatch). 
(2) Air movement.—While a submarine is operating 
on the surface in a calm sea, its ventilation may be 
accomplished naturally through the hatches. How- 
ever it is often necessary to close all the hatches except 
the conning tower hatch and in that case air is taken 
through this hatch and the main induction system. 
Forced draft blowers take air through the main induc- 
tion and distribute it into the various compartments of 
the ship. An exhaust system is provided which takes 
air from the various compartments and delivers it to 
the engine room where it is discharged through the 
engines. 
When the vessel is submerged the air movement is 
controlled by the same system, except that air is no 
longer exhausted through the engines but is returned 
to the. supply system through the air-conditioning unit, SUBMARINE; MEDICINE 
201 
which cools and dehnmidifies it. These methods of air 
movement are supplemented by use of compartment 
electric fans and portable blowers. 
(3) Air temperature.—The temperature within a 
submarine is often extremely high, especially in the 
Tropics. Running submerged some cooling is obtained 
by conduction through the hull on account of its con- 
tact with the cooler sea water. The newer type sub- 
marines are equipped with an air-conditioning plant. 
When the air-conditioning unit is functioning it effec- 
tively lowers the temperature and humidity. Subma- 
rines on extended patrols in tropical waters have re- 
ported that air conditioning makes a vital difference 
in the staying power of the crew. 
(4) Air humidity.—The relative humidity of the 
air in a submarine can be determined by wet and dry 
bulb (psychrometer) reading (see table 7). This 
often approaches the saturation point, particularly 
during an extended submerged run. Moisture is given 
off from the skin and lungs at the rate of approxi- 
mately one ounce per hour per man at rest. This 
amount is greatly increased by bodily activity. Mois- 
ture is also given off from the food in cooking and 
from the batteries by evaporation. High relative 
humidity with high temperature causes considerable 
discomfort to the crew. It causes the bulkheads to drip 
moisture, and makes all clothing, mattresses, etc., con- 
tinually damp, thus adding to the health hazards 
among the crew. 
(5) Air constituents.—Normally the air within a 
submarine operating on the surface does not vary 
greatly from outside air, but during extended sub- 
mergence the composition of the air may become so 202 
MANUAL OK NAVAL HYGIEiNlE 
li 
a a 
Hg 
Difference Between the 
Drv and Wet Thermometers 
I. 
< 
0 
1 
2 
3 
4 
5 
6 
7 
8 
9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
20 
27 
28 
29 
30 
3 
30 
100 
89 
78 
67 
57 
47 
36 
26 
17 
7 
30 
35 
100 
91 
82 
73 
65 
54 
45 
37 
28 
19 
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3 
35 
40 
100 
92 
84 
76 
68 
60 
53 
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38 
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58 
51 
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50 
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93 
87 
80 
74 
67 
61 
55 
.50 
44 
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27 
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83 
82 
76 
70 
65 
59 
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60 
100 
94 
89 
84 
78 
73 
68 
63 
58 
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44 
39 
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GO 
65 
100 
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90 
85 
80 
75 
70 
C5 
61 
56 
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39 
35 
31 
28 
24 
20 
17 
13 
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3 
65 
70 
100 
95 
90 
86 
81 
77 
72 
68 
64 
60 
.55 
52 
43 
44 
40 
36 
33 
29 
26 
23 
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16 
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7 
4 
1 
70 
75 
100 
95 
91 
87 
82 
78 
74 
70 
66 
62 
•58 
55 
51 
47 
44 
40 
37 
34 
31 
27 
24 
21 
19 
16 
13 
10 
7 
5 
2 
75 
80 
100 
96 
92 
87 
83 
79 
75 
72 
68 
64 
61 
57 
54 
51 
47 
44 
41 
38 
35 
32 
29 
26 
23 
20 
18 
15 
13 
10 
8 
6 
3 
80 
85 
100 
96 
92 
88 
84 
80 
77 
73 
70 
66 
63 
60 
56 
53 
50 
47 
44 
41 
38 
36 
33 
30 
28 
25 
22 
20 
17 
15 
13 
11 
9 
85 
90 
100 
96 
92 
88 
85 
81 
78 
75 
71 
68 
65 
62 
59 
56 
53 
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47 
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41 
39 
36 
34 
32 
29 
26 
24 
22 
20 
17 
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90 
95 
100 
96 
93 
89 
86 
82 
79 
76 
72 
69 
66 
63 
60 
58 
65 
52 
49 
47 
44 
42 
39 
37 
35 
32 
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28 
25 
23 
21 
19 
17 
95 
100 
100 
97 
93 
90 
86 
83 
80 
77 
74 
71 
68 
65 
62 
59 
57 
,54 
51 
49 
47 
44 
42 
39 
37 
35 
33 
31 
29 
27 
25 
23 
21 
100 
105 
100 
97 
93 
90 
87 
84 
81 
78 
75 
72 
69 
66 
64 
61 
58 
■56 
63 
51 
49 
46 
44 
42 
40 
38 
35 
33 
31 
30 
> 
26 
24 
105 
no 
100 
97 
94 
90 
87 
84 
81 
78 
76 
73 
70 
67 
6.5 
62 
60 
57 
55 
53 
50 
48 
46 
44 
42 
40 
38 
36 
34 
32 
30 
28 
27 
no 
115 
100 
97 
94 
91 
88 
85 
82 
79 
7G 
74 
71 
69 
66 
64 
61 
59 
57 
54 
62 
so 
48 
46 
44 
42 
40 
38 
36 
34 
33 
31 
29 
115 
120 
100 
97 
94 
91 
88 
85 
83 
SO 
77 
75 
72 
70 
67 
65 
62 
60 
58 
56- 
54 
51 
49 
47 
45 
44 
42 
40 
38 
36 
35 
33 
31 
120 
125 
100 
97 
£4 
91 
88 
86 
83 
80 
76 
75 
73 
70 
68 
66 
64 
62 
59 
57 
55 
53 
51 
49 
47 
45 
43 
42 
40 
38 
37 
35 
33 
125 
130 
100 
97 
94 
91 
89 
86 
83 
81 
78 
76 
74 
71 
69. 
67 
65 
62 
60 
58 
56 
54 
52 
50 
49 
47 
45 
43 
42 
40 
38 
37 
35 
130 
135 
100 
97 
94 
92 
89 
88 
84 
81 
79 
77 
74 
72 
70 
68 
65 
C3 
61 
59 
57 
55 
53 
51 
50 
48 
46 
45 
43 
41 
40 
38 
37 
135 
140 
100 
97 
95 
92 
89 
87 
84 
82 
79 
77 
75 
73 
71 
68 
66 
64 
62 
60 
58 
56 
55 
53 
51 
49 
48 
46 
44 
43 
41 
40 
38 
140 
0 
i 
2 
3 
4 
5 
6 
7 
8 
9 
10 
ii 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
Relative Humidity Table. 
Table 7. SUBMARINE) MEDICINE 
203 
altered by vitiation and contamination as to be danger- 
ous. The gases important in this connection are 
discussed below. 
Carbon dioxide.—This gas is formed continuously 
in the body by oxidation of carbohydrates in the tissues. 
Increasing the oxygen tension has no beneficial effect 
unless the excess carbon dioxide is removed. The 
R. Q., or respiratory quotient, is given by the fraction 
C02 produced 
. t or normal use this ratio of volume ol 
Oo consumed 
carbon dioxide produced to volume of oxygen con- 
sumed averages 0.82. The normal oxygen consump- 
tion per man aboard submarines has been determined 
to be 0.9 cubic foot per hour, thus the carbon dioxide 
produced per man per hour may be calculated by 
0.9X0.82 or 0.T4 cubic foot. Thus a submarine of 
about 26,000 cubic feet of air space, such as a large 
S-boat with a crew of 50 men, may safely operate 
submerged for about 20 hours without releasing 
oxygen or absorbing carbon dioxide. This may be 
C 
calculated by the formula X=0.04-y where X is num 
her of hours submerged; C is net air space in cubic 
foot; N is number of men in crew. Further informa- 
tion on the habitability from this point of view may 
be found in chapter 27, section I, of the Manual of the 
Bureau of Ships. 
Each submarine is equipped with a Higgins-Merriott 
colorimetric alkaline-phenolphthalein carbon-dioxide 
indicator. This is very simple to use and all submarine 
personnel are required to be familiar with its operation. 
There are individual variations in tolerance of car- 
bon dioxide, but in general, tensions below 8 percent 
516368—43 14 204 
MANUAL OF NAVAL HYGIENE 
cause mild symptoms; between 3 percent and 6 percent 
cause headache, discomfort, and deep breathing; between 
6 and 9 percent cause extreme distress, panting, and 
collapse; above 9 percent is rapidly fatal. Particularly 
if flooding for escape is contemplated, it is of vital 
importance that as much carbon dioxide as possible be 
eliminated from the atmosphere. For, as is the case 
with oxygen, the 'physiologic effect of the carbon dioxide 
is in direct proportion to its partial pressure (which 
is a function of the percentage and the pressure in 
terms of atmosphere). 
The removal of carbon dioxide is accomplished by 
the use of the “CO, absorbent,” which is spread in 
mattress covers when necessary. The complete descrip- 
tion of the method of testing for carbon dioxide and 
the use of the absorbent also is contained in the Manual 
of the Bureau of Ships. 
Oxygen.—Oxygen is a colorless, odorless gas which 
constitutes 20.93 percent of the atmosphere. It is phys- 
iologically necessary for life and should not be allowed 
to fall below IT percent. Inasmuch as carbon dioxide 
is produced as oxygen is consumed, there is usually 
ample warning of oxygen lack, simply by evidence of 
the increase of carbon dioxide. The classical symp- 
toms of anoxemia are weakness, vertigo, cyanosis, nau- 
sea, and collapse. However, oxygen deficiency usually 
gives no warning, and collapse may be the first symptom, 
noted. No test for oxygen tension is provided in sub- 
marines. However, the approximate oxygen percent- 
age of the air in any given compartment, as altered 
by respiration, can be found by multiplying the carbon 
dioxide content by 1.22 and subtracting this figure 
from 20.93. A practical indication of the amount of SUBMARINE MEDICINE 
205 
oxygen in the air is obtained by striking a match. If 
the wooden part of the match will not burn, lack of 
oxygen is at or beyond the danger limit. Oxygen cyl- 
inders are provided in each compartment on board a 
submarine and oxygen is “bled” into the boat as follows: 
Sufficient oxygen is released from the cylinder to cause 
a drop in the gage pressure of the cylinder in pounds 
per man equal to 13.23 divided by the net capacity of 
the cylinder in cubic feet. This is repeated every hour. 
Thus, if the volume of the cylinder is 1.53 cubic feet and 
initial pressure at 1,800 pounds, for “S” class sub- 
marines with a crew of 43 men, oxygen should be 
released until the pressure in the cylinder drops 
13 93 
43 = 372 pounds, or until the gage reads 1,428 
pounds. If the new type oxygen-reducer valves are 
installed, the low-pressure valve should be adjusted so 
that the hand on the metering gage is set at the number 
of men for which oxygen is being supplied. 
During the flooding of a compartment preparatory to 
a “lung” escape, the partial pressure of gases will in- 
crease, i. e., at a depth of 165 feet, or 6 atmospheres ab- 
solute, the oxygen content by volume would still be about 
20 percent, but the partial pressure would be increased 
six times, thereby exerting the physiological effect on 
the body of 1y5 atmospheres of pure oxygen. The pro- 
longed breathing of this concentration may be danger- 
ous, therefore the oxygen content before flooding should 
not be greater than 20 percent. 
Hydrogen.—Hydrogen is a colorless, odorless, physi- 
ologically harmless, but chemically active gas. An air 
mixture containing 4.1 percent of hydrogen is inflam- 
mable, percentages higher than this may be explosive. 206 
MANUAL OF NAVAL HYGIENE 
Hydrogen in a submarine is produced by electrolysis 
within the storage batteries, particularly during 
charging. 
A separate ventilating system is provided for the bat- 
teries and the air is discharged outboard during surface 
runs and inboard during submerged runs. Each bat- 
tery compartment contains a hydrogen detector for 
determining the percentage of hydrogen in the air of the 
system. Three percent is the greatest amount of hydro- 
gen permissible in the battery ventilating system. 
Chlorine.—This gas is produced in a submarine when 
sea water comes in contact with the sulfuric acid in the 
batteries. It is two and a half times heavier than air 
and remains close to the deck unless disturbed by air 
currents. It is highly toxic. A concentration of 1 part 
per million causes coughing; 10 parts per million is dan- 
gerous if breathed for half an hour; and 100 parts per 
million may be fatal if breathed even for a few minutes. 
The submarine escape appliance, if properly used, will 
protect against chlorine. 
Carbon monoxide.—This gas results from the incom- 
plete combustion of any kind of fuel and is a constituent 
of the exhaust gases of engines. It is also found after 
fires or explosions in closed compartments where there is 
an insufficient supply of oxygen to afford complete com- 
bustion. This gas, even if present in concentrations of 
only 1 part in 10,000, combines with the hemoglobin of 
the blood to form a stable compound, which will not 
carry oxygen to the tissues. Carbon monoxide is par- 
ticularly dangerous because it is odorless, and those 
exposed to it are often unaware of any ill effects until 
they collapse. If the presence of this gas is suspected 
in a compartment, no one should enter unless wearing 207 
SUBMARINEi MEDICINE 
the. “lung” provided with a hopcalite canister filter. 
Complete discussion of this procedure is beyond the 
scope of this volume, but additional information is con- 
tained in the Bureau of Ships pamphlet entitled, “Sub- 
marine Safety—Respiration and Rescue Devices,” which 
is available to all submarines. 
Ozone.—This gas, present in minute amounts around 
all electrical machines in operation, is generated in ap- 
preciable amounts by ultraviolet lamps. Thus if ultra- 
violet bacteriological lamps are added to the present 
ventilative installation of any submarine, due precau- 
tions should be observed. Ozone is toxic even in a con- 
centration of 0.04 part per million, causing respiratory 
irritation and pulmonary edema. The presence of 
ozone can usually be detected by its characteristics odor. 
Fortunately, recent tests have shown that it does not 
constitute a hazard in submarines because it is very 
active chemically, oxidizing metals, rubber, paint, etc., 
and thus becoming rapidly decomposed. 
Tobacco smoke.—This presents a real hazard in the 
submerged submarine. The effects are those due to the 
nicotine absorbed by the body; to odor, particularly of 
stale smoke; and to irritation of the eyes and respiratory 
tract. The presence of appreciable amounts of carbon 
monoxide accompanying the smoke has been under in- 
vestigation. Without discussing the familiar toxic 
symptoms of salivation, nausea, impending sweat, and a 
feeling of exhaustion and palpitation, it should be 
pointed out that tolerance for tobacco varies greatly, and 
the young individuals are more susceptible than adults. 
Some individuals appear to be allergic to tobacco smoke. 
Although the acquisition of tolerance protects against 
unpleasant symptoms within limits, it is certain that the 208 
MANUAL OF NAVAL HYGIENE 
smoke in the rebreathed air of the enclosed space will 
exert its full harmful effect upon personnel not habitu- 
ated to the usage of tobacco. It follows that under these 
conditions the usage of tobacco should be forbidden. 
Submarine experience indicates that habitual smokers 
may be somewhat distressed for a day or two, but that 
they can adapt themselves without hardship to a routine 
that permits smoking only where ventilation is adequate. 
Apart from its inherently toxic effect tobacco smoke, 
by virtue of its accelerative influence on pulse rate, acts 
as a complicating variable to confuse estimates of car- 
diovascular fitness and response to deleterious environ- 
ment expressed in terms of pulse rate. 
Bacteriology of the Air. 
Due to the confined living quarters and the peculiar 
ventilating problems of submarines necessitating re- 
breathing of the air, contact and air-borne infections 
may become significant. 
Studies on the bacteriology of submarine air reveal 
bacteria in considerable numbers. Staphylococcus albus 
is the predominant organism, originating probably in 
large part from human skin and hair. Streptococcal 
forms from the throat and respiratory tract are also 
found, as are gram-negative bacilli, molds, and other 
forms in small numbers. These bacteria are apparently 
not present in greater amount than in the living quar- 
ters of surface craft such as destroyers. Prolonged 
periods of submergence do not seem to cause an ac- 
cumulation of bacteria in the air in greater numbers 
than are found while operating on the surface. Dust 
counts are apt to be low but the same organisms have 
been recovered from sweepings as from cultures of air 
samples. Comparisons of dust and bacterial counts SUBMARINE; MEDICINE 
209 
suggest that most air bacteria are present on dust par- 
ticles stirred up by air currents caused by human 
activity. The relative humidity of submarine air is 
usually high enough to cause dampness on the decks 
and uninsulated surfaces. This may have the effect 
of laying dust particles and thereby reducing bacterial 
counts. The presence of numerous oil droplets in the 
air of certain compartments may also assist in this 
process. Analysis of the water of condensation col- 
lected from the coils of the dehumidifier reveals a nearly 
sterile water, which would tend to exclude the washing- 
out effect of dehumidification as a possible mechanism 
in reducing the number of bacteria in submarine air. 
The effect of battery gases on air-borne bacteria is as 
yet undecided, but there appears to be no lowering 
of bacterial counts during the time batteries are being- 
charged. Records of extended war patrols reveal that 
outbreaks of colds and other respiratory infections are 
apt to occur early in a cruise, with relatively good health 
in the ensuing weeks. This indicates the prompt spread 
of the introduced infection and its subsidence after 
equilibrium is established with the infecting organism, 
since no new infecting agents are introduced. How- 
ever otitis externa and trichophytosis, caused by fungi, 
may persist because of the high temperature and hu- 
midity, Control measures under consideration for the 
prevention of the spread of respiratory infection on sub- 
marines include ultraviolet irradiation of the air, the 
use of germicidal vapors or “aerosols,” such as propylene 
glycol, and detention periods for the crew before em- 
barking on patrol. This last method might prove im- 
practical, but throat cultures a few days before sailing 
would prevent trouble by providing for the elimina- 210 
MANUAL OF NAVAL HYGIEiNIE 
tion of carriers of group A streptococci, diphtheria 
bacilli, and epidemic types of meningococci. 
Diet. 
Because of the unusual living condit ions on a subma- 
mariue, the limited food storage space available, and 
the length of wartime patrols, careful selection and 
preparation of the food for submarine crews assumes 
special importance. Fresh fruit and vegetables in suf- 
ficient quantity to last longer than a few weeks cannot 
be carried; therefore, canned fruit, fruit juices, and 
vegetables, as well as various dehydrated products, must 
be included in the supplies. Because they conserve 
space, dehydrated foods are highly desirable and have 
recently been made very palatable. In all cases it is 
best to carry boned meat to reduce the weight and stor- 
age space required. The major part of this should be 
beef. A good supply of powdered milk should always 
be on hand. 
In addition to the regular diet, all submarines are 
provided with multiple-vitamin capsules, each capsule 
containing one-half the daily vitamin requirement (see 
p. 50). The pharmacist’s mate is directed to issue these 
vitamin capsules to the crew during patrols at the rate 
of one capsule per man per day. 
Associated with the problem of diet is the ever- 
present one of constipation among the submarine crew. 
Improper eating habits, the small amount of roughage 
available in the diet, insufficiency of fresh fruits, move- 
ment of the ship, and the irregularity of meals and sleep 
all contribute to this difficulty. In addition, the “head” 
is difficult to operate. A new type that flushes into 
:i central tank rather than overboard with each opera- SUBMARINE, MEDICINE 
211 
tion lias been installed on some of the larger sub- 
marines. It is desirable that the intake of starchy 
foods such as bread, potatoes, rice, cornbread, biscuits, 
and hominy grits be reduced and some of the following 
be served and eaten at least once daily: Prunes, apri- 
cots, apples, figs, raisins, fruit salad, or high roughage 
vegetables. 
Noise. 
It has been demonstrated that long-continued ex- 
posure to the noise of Diesel engines leads to permanent 
loss of auditory acuity. In addition to such actual 
loss, the noise and confinement have a deleterious effect 
on the nervous system and general well-being of the 
men, increasing nervous tension and fatigue. Further 
quieting of submarine engines is desirable and the 
wearing of ear defenders is being investigated. 
Mkdical Department. 
Since the maintenance of the health and well-being 
of submarine crews is a specialized problem, the medical 
department representative charged with this responsi- 
bility should be an especially qualified man. The 
pharmacist’s mate assigned to a submarine is a picked 
'•independent duty” man and his duties are manifold. 
He not only takes care of the general medical depart- 
ment activities, i. e., care of the sick, first aid, and care 
of the injured, transfer of those beyond the scope of 
his care to shore or tender activities, but he also has 
numerous routine ship’s company duties assigned to 
him. He issues the vitamins and stimulants (as, for 
example, to the lookouts exposed to inclement weather 
for long periods) and supervises the daily treatment 212 
MANUAL OF NAVAL HYGIENE 
of all of the crew and officers with the ultraviolet “sun 
lamp carried in submarines. 
Personnel Selection. 
In view of the foregoing considerations, the mechani- 
cal complexity of the submarine, the cramped living 
conditions which necessitate close personal contact 
among the crew, and the fact that each member of the 
crew must be able to handle more than one job, it be- 
comes obvious that careful selection is necessary to 
make sure that the men entering the submarine service 
are in good health and are temperamentally fit for this 
special duty. The physical standards set forth in para- 
graph 1535 of the Manual of the Medical Department 
of the U. S. Navy are high and their purpose is to 
eliminate all those individuals with any chronic disease 
(upper respiratory infections, gastritis, venereal dis- 
ease, etc.) or who are otherwise physically unfit for 
this duty. In addition to fundamentally good health, 
it is necessary that the men be qualified on the basis 
of their level of intelligence and emotional stability. 
This is accomplished by administering mental tests for 
the determination of intelligence quotient and by con 
ducting neuropsychiatric examinations. These tests 
have been found to furnish valuable data to supple- 
ment the purely physical picture. In cramped quarters, 
in overheated, damp air, away from natural daylight 
and sunshine, the close contact for long periods of time 
makes intolerable those mental and emotional defects 
which would otherwise cause no trouble. 
Supplemental examinations are employed to deter- 
mine physical and mental ability to operate special 
submarine devices, particularly soundgear. Chapter XVIII 
DEEP-SEA DIVING 
The prevention of compressed-air illness depends 
upon the elimination of nitrogen absorbed during ex- 
Figure 37.—Solid line shows nitrogen elimination from a young lean 
man weighing about 60 kilograms. The nitrogen in the body is sole 
ble in fat and fluids. The elimination or absorption of this nitro- 
gen with changes in barometric pressure is represented by the hypo- 
thetical, broken-line curves on the graph. (Am. J. Physiol., 114; 
138, 1935.) 
posure to increased barometric pressure without allow- 
ing it to cause excessive bubble formation in the blood 
stream. 
From figure 37 it is observed that about 75 percent 
of the total body nitrogen is eliminated at a compara- 
213 214 
MANUAL OF NAVAL HYGIENE 
tively rapid rate and hence does not usually contribute 
to the formation of bends. There appears to be, how- 
ever, a relatively small amount of gas in the fatty 
bone marrow that requires many hours for proper 
elimination. 
At a depth of 90 feet, for example, 10.5 hours of air 
decompression were required following a 9-hour ex- 
posure (probable saturation). Ou the other hand, a 
2-hour exposure (75 percent saturation) at the same 
depth required only 59 minutes for decompression 
(table 8). Nine and one-half hours were therefore re- 
quired for the dissipation of the remaining excess gas 
amounting to but 25 percent of the total present in the 
body tissues. 
Tarle 8.—Chamber decompression following prolonged 
exposure in compressed air 
Simulated 
depth 
(feet) 
Exposure 
time 
(hours) 
Decompres- 
sion time 
(minutes) 
Remarks 
30 
12 
1 
No symptoms. 
38 
5 
1.5 
Do. 
38 
7 
1.5 
Do. 
38 .... 
9 
1.5 
Bends 3 hours following decompression. 
38 
9 
1.5 
No symptoms. Oxygen 6 hours at surface. 
12 
1.5 
Bends 2.5 hours following decompression. 
38 . 
12 
1.5 
No symptoms. Oxygen 6 hours at surface. 
60 . 
6 
(air) 69 
No symptoms. 
60 
12 
(air) 237 
Bends 10.5 hours following decompression. 
60 
12 
(air) 311 
No symptoms. 
Diver C. 
60 . . ... 
12 
(02) 79 
Oxygen 2.2 hours at surface. No symptoms. 
60 
12 
(02) 79 
Oxvgen 4.3 hours at surface, bonds 5 hours follow- 
Diver S. 
ing decompression. 
90 .. 
2 
(air) 59 
No symptoms. 
90 
6 
(air) 310 
Do. 
90 . 
9 
(air) 458 
Bends 2 hours following decompression. 
90.... 
9 
(air) 583 
Bends 1 hour following decompression. 
90 _ 
9 
(air) 638 
No symptoms. 
From our point of view the body may be compared 
with a mixture of water and fatty material contained 
in a beaker. Of the fat an important fraction is sur- DEEP-SEA DIVING 
215 
rounded by bone representing marrow and spinal cord 
substance. This bone-contained fat may be considered 
as lying in the bottom of the beaker. 
If the contents of the beaker are now exposed to a 
high nitrogen pressure for a short period of time and 
then quickly returned to atmospheric pressure, diffusion 
of the nitrogen will take place from the water into the 
surrounding air and also into the unsaturated water 
and fat. Following short exposures the partially satu- 
rated fat appears to act as a butter against bubble 
evolution. By contrast, after long exposures the large 
reservoir of nitrogen in the saturated fat constitutes 
the predisposing cause to embolism. The nitrogen with- 
in the bone, moreover, will require many hours for 
removal. 
With reference to the matter of tolerance for abrupt 
reductions in pressure, the body may be exposed to a 
compression of 4 atmospheres for a period of 27 minutes 
followed by a rapid decompression to the normal level 
in 2 minutes. A period of 90 minutes, however, at the 
same pressure and followed by the same period of de- 
compression would prove fatal. 
The nitrogen absorbed in the early part of decompres- 
sion and presumably dissolved in the body fluids is 
therefore readily eliminated by any method of decom- 
pression. In the rapid drop from 4 to 1 atmosphere, a 
degree of supersaturation appears to be tolerated by 
the body approaching a ratio of 4 to I. By contrast, 
when the body is saturated at a pressure of 4 atmos- 
pheres, requiring a saturation period of 9 to 12 hours, 
a ratio indicative of supersaturation of only 1.2 to 1 will 
not hold throughout the whole period of decompression. 
Furthermore, during rapid decompression in the low- 216 
MANUAL OF NAVAL HYGIENE 
pressure chamber, apparent ratios between the pressure 
of gas in the body and the ambient pressure of 3 to 1 or 
even 4 to 1 exist, i. e., 1 atmosphere to 0.33 atmosphere 
or to 0.25 atmosphere. 
On the basis of these facts the degree to which the 
body appears to hold gas in a state of supersaturation is 
relative and depends not only upon the degree of satura- 
tion but also upon the pressure level. 
Application of physiologic principles.—The impor- 
tant consideration is not mastery of a method of com- 
puting the decompression table on the basis of a ratio 
but rather the acquisition of an understanding of the 
basic physiologic principles, of which one of the most 
important is the realization of the difficulty in getting 
excess nitrogen out of fatty tissue, especially bone 
marrow. 
From the point of view of field practice this difficulty 
has been overcome by progressively limiting the time 
of exposure in compressed air as the working pressure 
is increased. The New York State tables (table 9) 
represent the culmination of this type of experience. 
Table 9.—Pressure shifts and intervals of work for each 2) 
hour period (New York State tables) 
Pressure 
Hours 
Column 1 
Column 2 
Column 3 
Column 4 
Column 5 
Column 6 
Minimum 
number of 
pounds 
Maximum 
number of 
pounds 
Maximum 
total 
M aximum 
first shift 
in com- 
pressed air 
Minimum 
rest inter- 
val in 
open air 
Maximum 
second 
shift in 
com- 
pressed air 
Normal 
18 
8 
4 
H 
4 
18 
26 
6 
3 
1 
3 
26 
33 
4 
2 
2 
2 
33 
38 
3 
1H 
3 
iH 
38 
43 
2 
i 
4 
1 
43 
48 
1H 
H 
5 
H 
48 
60 
i 
H 
6 
H 217 
DEEP-SEA DIVING 
Value of helium-oxygen mixtures.—Since the objec- 
tion to long exposures lies in the difficulty of eliminating 
the gas dissolved in fatty substance, the employment of 
helium with its low solubility-coefficient in fat would 
appear to be ideal. 
In diving tests, following short exposures in the 
compressed helium-oxygen or air atmosphere, the body 
fluids are well saturated with either gas and no par- 
ticular advantage in decompression accrues from the 
use of helium (table 10). Following long exposures, 
decompression time may be reduced as much as 75 per- 
cent. Part of the reduction in decompression time is 
brought about by the inhalation of oxygen at the lower 
decompression stops, but the important factor is the 
lessened uptake of helium by fat. 
Table 10.—Comparison of total decompression time following 
exposure in compressed air and exposure in a helium-oxygen 
atmosphere. 
Depth 
(feet) 
Exposure 
(minutes) 
Decom 
(min 
Air 
pression 
utes) 
Helium- 
oxygen 
90 
100 
50 
75 
90 
180 
77 
90 
360 
79 
90 
540 
638 
79 
150 
80 
141 
121 
150 
180 
126 
150 
360 
128 
200 
65 
217 
154 
200 
90 
164 
In altitude-test runs oxygen inhalation for a period 
of 5 hours is required under certain conditions to 
prevent aero-embolism. If the body nitrogen be re- 
moved and helium substituted, the time for oxygen 218 
MANUAL OF NAVAL HYGIENE 
inhalation can be reduced to at least 90 minutes or a 
reduction of 70 percent. 
In deep-sea diving, exposures are usually short and 
(he advantage derived from helium is that it renders 
unimportant the narcotic effect of nitrogen as demon- 
strated in the U. S. S. S qualm salvage operations. 
Value of oxygen.—Essentially oxygen inhalation 
permits the elimination of an inert gas at a maximum 
pressure head as shown by the graph (fig. 37), and at 
a pressure level sufficiently high to prevent injury from 
massive bubble evolution. 
During the past 3 years the Navy has used oxygen 
routinely in helium-oxygen diving during the latter 
part of the decompression period, beginning at the 60- 
foot level. 
In air diving the British have had a great deal of 
experience with oxygen inhalation and the reader is 
referred to the book, “Deep Diving and Submarine 
Operations,” by Robert H. Davis. A reduction in 
decompression time of about 40 percent is effected by 
the employment of oxygen according to British experi- 
ence. 
The data in table 8 demonstrate the value of oxygen 
inhalation following decompression at the surface level. 
Thus the depth could be increased from 33 to 38 feet 
provided that oxygen was inhaled following abrupt 
decompression to the surface. 
The conclusions drawn from these tests are that a con- 
siderable reduction in decompression time is brought 
about by oxygen. On the other hand, the occurrence of 
bends following a period of oxygen inhalation of 90 
minutes during the initial stage of decompression dem- 
onstrates again the difficulty in getting rid of the com- DEEP-SEA DIVING 
219 
paratively small residual fraction of nitrogen in slowly 
desaturating tissue (bone marrow). 
Oxygen inhalation undoubtedly serves its best purpose 
in preventing the serious symptoms of compressed air 
illness, and its chief value lies in clearing the blood 
stream and body fluids of the excess nitrogen. 
Danger of too rapid ascent to the first stop.—The 
tendency in diving is to bring men too rapidly to the 
first stop, which usually is at one-half the depth com- 
pared with the original level. This procedure leads to 
the initiation of the bubble state in the early part of 
decompression when the pressure head of gas in the 
tissues is highest. 
Symptoms indicative of embolism have appeared 
during helium-oxygen diving at depths of 180 and 90 
feet on two occasions following too rapid ascent from 
depths in excess of 300 feet. At present for helium- 
oxygen diving the rate of ascent is limited to 25 feet per 
minute and an arbitrary period of 7 minutes is taken at 
the first stop in order to permit the blood to transport 
tc the lungs the large amounts of helium diffusing into 
the blood stream. 
It has been possible to show by actual measurements 
that too rapid decompression in the early stages leads 
to an accumulation of gas probably in bubble form so 
that equal quantities of gas are eliminated during each 
of the first twTo 30-minute periods; if the blood stream is 
not overloaded, about two and one-half times more gas 
is given off during the first 30-minute period compared 
with that eliminated during the second period (fig. 37). 
In air diving the reduction in rate of ascent to the first 
stop from 50 to 25 feet per minute greatly reduced the 
516368—43 15 220 
MANUAL OF NAVAL HYGIENE 
incidence of embolism as manifested by the occurrence 
of pruritus and rash. 
Selection of 'personnel.—A routine physical examina- 
tion may not be adequate to determine those individuals 
who are qualified for work in compressed air. One 
should therefore employ specific pressure tests for the 
selection of fitted men. 
With reference to patency of auditory tubes and pre- 
sumably freedom from infection of the upper portion 
of the respiratory tract, the immediate application of a 
pressure of 50 pounds in the chamber will serve to select 
the qualified men. The assumption is made that the 
men have previously been instructed in the matter of 
“clearing their ears.” Inspection of the tympanic mem- 
brane following the application of pressure reveals the 
degree of ability to accommodate to excess pressure. 
Two tests with an interval of several days intervening 
should be accorded an applicant who is otherwise in 
good physical condition. 
With reference to susceptibility to bends, it follows 
from a consideration of the physiologic data that the 
elimination of excess nitrogen without the development 
of manifest air embolism depends upon effective blood 
flow through tissues and the absence of excess fat. The 
desirable type of man is therefore young and lean. Yet 
among such individuals the variation in susceptibility 
to compressed air illness makes necessary a specific de- 
compression test for the selection of deep-sea divers. 
This test consists in reducing the pressure from 1 
atmosphere to 0.20 atmosphere during a period of 7 
minutes. Oxygen is inhaled at the start of pressure 
reduction. The duration of stay in the rarefied atmos- DEEP-SEA DIVING 
221 
phere is for a period of 4 hours. Under these condi- 
tions susceptible men develop bends while those men 
who are comparatively immune remain free from symp- 
toms. Six to ten successive daily tests accurately define 
susceptibility status. 
Too much stress cannot be laid on the necessity for the 
maintenance of good physical condition by men who 
work in compressed air. Empirical data indicate that 
any condition tending to impair cardiovascular tone 
renders men susceptible to the development of decom- 
pression embolism. Indulgence in alcohol should be 
specifically interdicted. Fatigue, infection, hot atmos- 
pheres, and excess carbon dioxide in the air are all 
factors associated with increased incidence of bends. 
Our deep-sea divers, therefore, maintain a system of 
training similar to that followed by the athlete. 
Summary of 'principles.—The following principles 
underlie the prevention of compressed air illness: 
1. Limitation of time of exposure in compressed air or the 
employment of helium-oxygen mixtures for saturation exposures. 
2. Reduced rate of ascent in the early stages of decompres- 
sion. 
3. Slow decompression following long exposures and the in- 
halation of oxygen at the lower decompression levels. 
4. Careful selection and the maintenance of personnel in 
good physical condition. 
Treatment of compressed air illness.—The prime 
requirement in treatment is the rapid restoration of 
normal blood supply by compression and absorption of 
the obstructing gas emboli. Behnke and Shaw form- 
ulated a procedure of recompression utilizing oxygen, 
based on laboratory experiments, and later Yarbrough 
and Behnke applied the principles to field practice. 222 
MANUAL OF NAVAL HYGIENE' 
Recompression.—Essentially the basis of treatment 
is prompt recompression and the inhalation of oxygen. 
Figure 38.—Guide for treatment of compressed-air illness (after Behnke 
and Shaw, Yarbrough and Behnke). 
A—For “bends.” 
B—For “bends”—asphyxia. 
C—For asphyxia/paralysis. 
At maximum pressure patient inhales air, or helium-oxygen of 
about (70 : 30 ratio) mixture. 
At 60-foot level or below, patient inhales oxygen for 90-minute 
period. Attendant inhales oxygen for 30-minute period. 
For prolonged recompression at or below 60 feet, air is inhaled. 
Figure 38 serves as a guide in the recompression pro- 
cedure. It is emphasized that the condition of the DEEP-SEA DIVING 
223 
patient governs the detailed mode of therapy rather 
than rigid adherence to a system of tables. 
Perhaps there is no therapeutic procedure more effec- 
tive than recompression as applied to the asphyxiated, 
pulseless, cyanotic patient whose blood stream is filled 
with multiple gas emboli. Even patients presenting 
incipient lesions of the spinal cord have made complete 
recovery under immediate and prolonged recompression. 
In the mild cases of compressed air illness charac- 
terized by bends, the minimum pressure applied in 
recompression is 45 pounds per square inch (gage) 
equivalent to a diving depth of 100 feet. Relief of 
symptoms may occur at greatly reduced pressures but 
the additional compression reduces the size of the 
bubble 75 percent compared with surface volume, and 
ensures against the initiation of lesions in the spinal 
cord. 
For the serious cases characterized by asphyxia, 
probable involvement of the nervous system, or both 
conditions, recompression is limited to a pressure of 
75 pounds (gage) equivalent to a depth of 165 feet. At 
this pressure the surface size of the bubble has been 
reduced 83 percent; higher pressures can do little to 
improve circulation and would unduly delay the pres- 
sure at which oxygen could be breathed. 
The next stage is the maintenance of the maximum 
pressure for a period of 30 minutes. Usually this 
period of time is sufficient to ensure apparently com- 
plete recovery, but should paralysis be present or sus- 
pected, or if the patient remains unconscious, the max- 
imum pressure is maintained for an additional 90 
minutes. 224 
MANUAL OF NAVAL HYGIENE 
At the maximum pressure, air, or if available, a mix- 
ture of helium-oxygen in the ratio of 70 to 30 volumes 
percent, is inhaled. At the end of the 30-minute 
period the pressure is decreased uniformly for 40 minutes 
until the 60-foot level (27 pounds gage) is reached 
(fig. 38B). If a pressure of 45 pounds has been used 
(fig. 38A) a period of 10 minutes is sufficient for de- 
compression to the 60-foot level. 
Oxygen inhalation is begun at the 60-foot level and 
continued for a period of 90 minutes until the 30-foot 
level is attained. If the patient exhibits an idiosyncrasy 
for oxygen, the usual symptom being nausea, oxygen 
inhalation is postponed until the 45- or 30-foot levels are 
attained. Air or the helium-oxygen mixture is inhaled 
for the period of time at the 60- or 50-foot levels that 
would otherwise have been devoted to the inhalation 
of oxygen. 
It is unlikely that intolerance for oxygen will exist 
at the 45- or 30-foot levels and a period of 90 minutes 
for oxygen inhalation should be feasible for all patients 
prior to the termination of decompression. 
Decompression 1 is then terminated from the 30-foot 
level by a uniform drop to the normal atmosphere over 
a period of 5 minutes. 
For mild cases of compressed air illness this type of 
treatment usually affords permanent relief. Should 
symptoms recur in more seriously injured patients, 
recompression is again effected to a level between 30 
and 60 feet for a period of 12 to 24 hours followed by 
a gradual return from the 30-foot level to the normal 
atmosphere during a period of 4 hours. 
1 For the attendant a 30-minute period of oxygen inhalation should 
ensure adequate decompression. DEEP-SEA DIVING 
225 
This practice of prolonged immersion in compressed 
air colloquially termed “the overnight soak” has proved 
to be the conclusive method of terminating treatment. 
The patient is permitted to sleep and the bubbles have 
adequate time for absorption. Should there be any 
question of involvement of the central nervous system, 
the prolonged immersion treatment is routinely put 
into effect. 
For the moribund patient, the pressure level follow- 
ing the 2-hour treatment at a depth equivalent to 165 
feet, is decreased to 60 feet during a period of 45 min- 
utes. Oxygen is then administered for 90 minutes, and 
air inhalation is continued for a period of 24 hours 
or longer. There should be no hesitancy in continuing 
treatment at the 60-foot level for a period of days. 
The increased partial pressure of oxygen at this level 
is also an effective therapeutic measure in treating the 
incipient or manifest pulmonary edema, anticipated as 
a complication of extensive embolism of the pulmonary 
bed (see fig. 38C). 
Adjuncts in treatment are the judicious injection of 
glucose and saline solutions, or plasma in the severely 
injured patients in order to counteract the effect of 
hemoconcentration. The use of epinephrine and the 
application of warmth (not heat) are additional meas- 
ures if the shock syndrome is present. 
The position of the patient’s body should be recum- 
bent since the site of bubble accumulation is influenced 
by gravity. 
Errors in treatment have been: 
1. Failure to apply the pressure test in doubtful 
cases, “It can’t be compressed air illness.” 226 
MANUAL OF NAVAL HYGIENE 
2. Delayed recompression. The potential patient 
avoids the doctor. 
3. Failure to keep the moribund patient at the 60- 
foot level. 
4. Failure to keep the “treated” patient near the 
recompression chamber for a 24-hour period. Chapter XIX 
HYGIENE IN AVIATION 
Naval hygiene as it relates to naval flying personnel 
deal's principally with the physical maintenance of of- 
ficers and men subject to the hazards and physical 
stresses inherent in their occupation and peculiar to the 
environment of flying. 
Man is by nature a terrestrial animal and whenever 
he ventures to ascend into the atmospheric envelope sur- 
rounding the earth, he finds himself in an environment 
unfavorable to the carrying on of his normal physiolog- 
ical functions. In the case of the aviator, physiological 
adjustments must be made to rapidly changing baro- 
metric pressures and to extreme ranges of temperature. 
Changes in barometric pressure do not alter the com- 
position of the air he breathes, but do alter partial pres- 
sures of its constituent gases, and hence the availability 
of oxygen, and oxygen in sufficient amount is required 
for all cell life. Above 5,000 feet altitude anoxia begins. 
Oxygen 21 percent 1 
Nitrogen 78 percent 
Bare (inert) gases 1 percent] 
The composition of atmospheric air is: 
►By volume, 
and is uniform up to an altitude of 70,000 feet. At sea 
level, air exerts a pressure (weight) of 760 mm. of mer- 
227 228 
MANUAL OF NAVAL HYGIENE 
cury. Twenty-one percent of this pressure is exerted 
by oxygen. 
Atmospheric pressure (sea level) =760 mm. Hg. 
Partial pressure (oxygen) =159 mm. Hg. 
Atmospheric pressure (10,000 feet) =506 mm. Hg. 
Partial pressure (oxygen) =105 mm. Hg. 
Atmospheric pressure (18,000 feet) =380 mm. Hg. 
Partial pressure (oxygen) = 79.5 mm. Hg. 
Atmospheric pressure (28,000 feet) =253 mm. Hg. 
Partial pressure (oxygen) = 53 mm. Hg. 
The above partial pressures exist only in dry air. 
They do not exist in the lungs. 
Dry air 
Lungs 
Oxygen 
100 mm. Hg. 
Nitrogen 
600 mm. Hg. 
570 mm. Hg. 
Carbon dioxide 
Trace 
43 mm. Hg. 
Water vapor 
None 
47 mm. Hg. 
760 
760 
The partial pressures of water vapor and of carbon 
dioxide remain constant at altitudes considered so far. 
llegardless of partial pressure of oxygen available in 
inhaled air, the partial pressures of both carbon di- 
oxide and water vapor must be subtracted in figuring 
partial pressure of oxygen available to the lungs. Car- 
bon dioxide exists in alveolar sacs in 4 to 6 percent 
volume and exerts a constant pressure of from 36 to 40 
mm. of mercury. Water vapor remains constant at 
47 mm. 
Increase of altitude (decrease of atmospheric pres- 
sure) requires the following considerations: 
1. Altitude sickness due to lack of oxygen (anoxia). 
2. Effects due to decreased pressures: HYGIENE INI AVIATION 
229 
{a) Decompression sickness (“bends” or “aero- 
embolism”) . 
(b) Expansion of gases in middle ear and sinuses. 
(c) Oxygen indoctrination and classification. 
(d) Oxygen apparatus. 
3. Effects of temperature. 
Contributory stresses in flying are: 
1. Blackout—effects of high centrifugal forces due to 
sudden changes in direction of the plane. 
2. Carbon-monoxide intoxication due to exhaust 
gases from engines or machine guns. 
3. The special organs in flying. 
4. Conflicting visual and equilibratory stimuli caus- 
ing “vertigo,” sometimes extreme in degree. 
5. Unusual motion of plane due to bumpiness and 
maneuvers causing “motion sickness.” 
6. Flying fatigue, which is due probably to a sum- 
mation of all the above stresses plus long hours of in- 
tense concentration, working or sitting in constricted 
spaces, and the continual awareness of hazard. 
Aviation hygiene, therefore, must concern itself with 
these hazards and stresses, their prophylaxis and pre- 
vention or amelioration. 
Anoxemia (anoxia) arises from a lack of oxygen in 
the inspired air. The brain is affected before other 
tissues, with resultant defective judgment, lack of self- 
criticism, inaccuracy, euphoria, dimming of alertness 
and impairment of mental processes. Visual acuity is 
reduced with severe anoxia, and at night the ability to 
discern dimly illuminated objects is impaired with any 
degree of oxygen lack. Sensation of weakness in the 
legs and arms, unsteady gait, inability to coordinate 230 
MANUAL OF NAVAL HYGIENE' 
movements, and finally uncontrollable tremors and 
twitchings develop with progressive anoxia. This may 
end in convulsive seizures or simple coma. Lack of 
oxygen makes the hands and feet cold and may dispose 
to airsickness. Dizziness, rapid beating of the heart 
and alternating rapid and slower respirations are fre- 
quently seen. The mental changes in the earlier stages 
are not appreciated by the individual and may prove 
fatal. Never risk being short of oxygen under war 
conditions! 
Oxygen should be used as follows: 
1. All flights above 10,000 feet of more than 4 hours’ 
duration. 
2. All flights above 12,000 feet of more than 2 hours’ 
duration. 
3. All flights above 15,000 feet regardless of the 
duration. 
4. All flights above 23,000 feet at a rapid rate of 
climb. Undiluted oxygen from the ground up. 
5. Pilots are urged to use oxygen equipment when- 
ever practicable, even at low altitudes, in the interests 
of familiarization and increased efficiency. 
At ambient temperature and pressure, gases are in 
solution in the blood in proportion to their respective 
absorption coefficients and partial pressures. With 
slow ascents gases have time to diffuse out through the 
lungs; but where the ascent is rapid, to gread heights 
and diminished pressure, gases will come out of the 
blood with the formation of bubbles in vessels and 
tissues. Considerable variation in susceptibility is 
noted among flying personnel. In general, slim, phys- 
ically fit and young individuals appear the least 
susceptible. Prevention at present consists of classifi- HYGIENE IN AVIATION 
231 
cation of personnel for altitude tolerance by low-pres- 
sure chamber tests. 
1. Itching and paresthesias of the skin, 
2. Pain in the limbs (muscles and joints) especially 
in the shoulders and knees. Pain may be mild and 
relieved by rubbing or movement, or it may become 
progressively more severe, and even lead to collapse. 
Characteristic symptoms of aero-embolism: 
3. Abdominal discomfort may be severe from gaseous 
distention. 
4. A vaguely defined generalized discomfort associ- 
ated with sweating, chilliness and dizziness which may 
progress to pallor and sudden collapse. 
5. Pain behind the sternum and coughing (chokes) 
occur with less frequency. 
All symptoms tend to disappear rapidly when per- 
sonnel are brought down to the 20,000-25,000 foot lev- 
els. Initial symptoms rarely occur below 30,000 feet 
altitude pressure. 
All flying personnel under training should be in- 
structed in the use and functioning of current types 
of oxygen-breathing equipment and supply. The pro- 
gram of indoctrination should consist briefly of the 
following: 
1. Lectures on atmospheric physics. 
2. Demonstration of oxygen supply in low-pressure 
chamber, proper fitting of oxygen masks and adjust- 
ment of service type apparatus. 
3. Chamber run: 
(a) To 18,000 feet without oxygen for 20 min- 
utes. After 15 minutes at this level, a simple 
pencil and paper code test is given and subjects 232 
MANUAL OF NAVAL HYGIENE' 
are asked to write a brief statement describing 
how they feel. 
(&) Oxygen masks are adjusted and ascent made 
to 28,000 feet at the rate of 5,000 feet per minute. 
Subjects are held at this level for 30 minutes. 
(c) Descent at rate of 5,000 feet per minute. 
(d) Subjects are taught how to clear the eusta- 
chian tubes to equalize pressure in the ears, and 
are impressed with the necessity for slow, regular, 
normal breathing. 
4. Lectures should be given in the chamber by a loud- 
speaker system during ascents and during stays at the 
prescribed levels for the purpose of demonstrating the 
effects of anoxia and the maintenance of efficiency while 
using oxygen. Lectures can be supplemented by train- 
ing films during classroom lecture periods. 
N. B.—At 25,000 feet individuals last only a few 
minutes without oxygen; at 20,000 feet from 10 to 20 
minutes; at 18,000 feet from 45 to 75 minutes; at 15,000 
feet an estimated 5 or 6 hours; at 10,000 feet some 
pilots can last all day, though with severe after-symp- 
toms of chronic oxygen starvation. 
Oxygen Breathing Apparatus. 
Rebreather equipment.—Figure 40 illustrates dia- 
grammatically the component parts and functioning 
of the M, S. A. individual oxygen supply type of 
rebreather. 
Figure 41 diagrammatically illustrates the com- 
ponent parts and functioning of the M. S. A. central 
oxygen supply type of rebreather. 233 
HYGIENE IN AVIATION 
REFERENCE CHART FOR OXYGEN REQUIREMENT AT VARIOUS ALTITUDES 
Figure 39. 234 
MANUAL OF NAVAL HYGIENE 
INDIVIDUAL OXYGEN 
SUPPLY SYSTEM 
FLOW DIAGRAM 
Figure 40 HYGIENE IN AVIATION 
235 
Figure 42 illustrates the component parts and 
method of installation of the central oxygen supply 
type of rebreather in two-place aircraft. 
Demand equipment.—Figure 43 illustrates the com- 
ponent parts and functioning of the M. S. A. demand 
oxygen supply equipment. 
Detailed instructions regarding the installation and 
operation of both rebreather and demand types of 
equipment are contained in a manual supplied by the 
manufacturer. 
Temperature.—With ascent, the temperature falls 
approximately 2° C. for every 1,000 feet until 35,000 
feet is reached. Then it remains nearly constant at 
— 55° C. Local variations of temperature do occur. 
Protection against cold.—The temperature of the 
body is maintained by a balance between the heat pro- 
duced by muscular activity and the heat lost from the 
skin by conduction, convection and evaporation of 
sweat, and moisture lost from the lungs. Factors af- 
fecting the heat lost from the skin are temperature of 
the air, wind, and moisture in the air. 
The effects of cold on personnel may be briefly stated 
to be discomfort, marked loss of efficiency due to grad- 
ual numbing of physical and mental activity. In the 
case of severe and prolonged cold, this terminates in 
an uncontrollable desire to go to sleep. 
Local intense cold may cause frostbite. Cold may 
produce spasms of the small arteries leading to reduc- 
tion of the blood flow and pain. The blood flow may 
fall below that necessary to keep the tissues alive, es- 
pecially where there is a concurrent lack of oxygen. 
When vessel walls are damaged through oxygen lack, 
serum passes into the tissues and the part becomes 
516368—43 16 236 
MANUAL OF NAVAL HYGIENE 
Figure 41. 
SBD 3 SHOWING CANISTER 
DETACHED FROM REBREATHERS HYGIENE. INI AVIATION 
237 
FLOW DIAGRAM 
Fiqdeb 42. 238 
MANUAL OF NAVAL HYGIENE 
swollen, blue, and may have blister formation. This 
may lead to tissue destruction (ulceration and gan- 
grene). 
The imminence of frostbite is indicated when the 
part feels cold. This is usually followed by pain and 
finally by the loss of sensation (numbness). 
Various protective and preventive measures may be 
adopted to increase the comfort and thereby the effi- 
ciency of personnel: 
1. Much progress has been made in providing closed 
aircraft free from draughts, insulated against cold, and 
with heating arrangement. In general the bow, dorsal 
turret, belly turret and tail turret are the locations in 
which subjective cold is most apt to be complained of in 
larger aircraft. Pilots, co-pilots and radio operators 
are affected to a lesser degree. There is little evidence 
that fighter pilots suffer to any degree, and the incidence 
of frostbite in this group is low. 
2. Clothing (see chapter VI). 
{a) Flying clothing should be windproof, made of 
material that will absorb moisture from the skin, and 
that will contain as much air as possible. Efficient fly- 
ing clothing takes into consideration the fact that sta- 
tionary dry air is a poor conductor of heat and that 
application of this fact can be brought about by the use 
of multiple layers or by furs. 
(h) Clothing should be loose fitting, especially socks 
and gloves; otherwise tightness impairs circulation and 
predisposes to frostbite. Gloves are particularly im- 
portant to gunners, since some of their tasks require 
considerable manual dexterity and sense of touch, i. e., 
reloading guns and ammunition, or changing the bulb HYGIENE INI AVIATION 
239 
iu the reflector sight. Silk gloves may be used if such 
work is not too prolonged. 
(c) The importance of dry clothing cannot be over- 
stated. Moist clothing will not only conduct the heat 
away from the skin readily, but may freeze and become 
hard and uncomfortable. The body constantly gives 
off moisture in the form of perspiration; hence it is 
important that flying clothing should be worn only 
while flying, and that adequate arangements should be 
made for thorough drying after wearing. Personnel 
should not be permitted to spend long periods standing 
by in ready rooms wearing full flight equipment. 
(d) The hands and feet should be thoroughly dried 
before donning socks and gloves. Moist, clammy hands 
and feet are rapidly affected by cold. The use of oint- 
ments to protect against frostbite is not advised. They 
do afford some protection against heat loss, but are 
messy, spoil the clothes, and prevent the absorption of 
moisture. 
(e) Lack of oxygen is a factor in the production of 
frostbite. The early symptom is a feeling of cold in 
the hands and feet; accordingly it is wise always to 
take oxygen at 10,000 feet or above. 
(/) The personnel should always be furnished with 
a hot meal and hot drinks before a long flight. Fre- 
quent small amounts of sugary foods and drinks help 
ward off effects of cold and promote maximum efficiency. 
Prevention entails the above-noted precautions; in 
addition, air crews should wear two pairs of gloves 
(inner pair silk) and keep numb parts moving. It is 
reemphasized that personnel should have thoroughly 
dry, warm socks and gloves, and dry hards and feet 240 
MANUAL OF NAVAL HYGIENE 
before taking off in operational work exposing them 
to cold. 
Treatment of frostbite. 
1. Do not put part near any heat. 
2. Restore circulation by gentle rubbing. (Do not 
rub with snow.) 
3. Give extra oxygen at ground level. 
4. If severe— 
(a) Elevate the part to avoid venous congestion 
and to put at rest. 
(b) Aseptic dressings loosely bandaged. 
(c) Use oxygen. (Suggested 8 liters per min- 
ute for 1 hour every 2 hours.) 
5. Never use vigorous massage or rubbing. Such 
treatment further damages the part and is dangerous. 
Acceleration.—Blackout. The most severe effects of 
linear acceleration are experienced under the follow- 
ing conditions; 
1. Catapult shots. 
2. Crashes or crash landings. 
3. Rapid deceleration caused by engaging arresting 
gear in carrier landings. 
These forces act on the pilot in one direction, and 
in the catapult and carrier landings are of the order 
of from 2 to 4 G (centrifugal force) acting through 2 to 
3 seconds. These forces do not cause any great physio- 
logical disturbance because they occur in the trans- 
verse axis of the body and have little effect on the 
column of circulating blood. Where crashes through 
the barriers erected on carriers occur, the forces exerted 
on the plane and pilot probably do not in most cases HYGIENE IN AVIATION 
241 
exceed 10 to 12 G. If occupants of planes have proper 
belt and shoulder harness support, injuries to head and 
face are in a degree prevented. 
In the action of centrifugal force on aircraft and 
pilots, any aircraft flying along any curve of a circle, 
whether produced by pulling out of a dive, a tight 
turn, a diving spiral or any combination of fighter 
aerobatics, has acting upon it from the center of the 
circle a centrifugal acceleration which varies directly 
as the square of the linear velocity and inversely as 
the radius of the circle. Weight is a force, and is ex- 
pressed as the product of mass times acceleration due 
to gravity. Hence when a pilot has acting upon him 
an acceleration of several times that of gravity, his 
weight increases in the same proportion. At a cen- 
trifugal acceleration of 6 G, a pilot weighing normally 
150 pounds would weigh 900 pounds. 
The production of blackout is caused by centrifugal 
forces acting in the direction of the long axis of the 
body. If these forces are large (over 3.5 G), they are 
capable of causing pooling or accumulation of the cir- 
culating blood in the veins and capillary beds of depend- 
ent portions of the body, particularly in the vascular 
beds of the upper and lower extremities. This acts to 
prevent sufficient return flow by the venous system to 
permit adequate filling of the heart chambers. Hydro- 
static pressures of the blood column ascending to supply 
the brain, retinal membrane of the eye, etc., falls to a 
level at which adequate blood supply to these struc- 
tures can no longer be maintained. This is due to: 
1. Direct effect of “G” on the column of blood from 
the left ventricle to the head. 242 
MANUAL OF NAVAL HYGIENE 
2. Inefficiency of the heart as a pumping mechanism 
due to pooling of blood in the extremities, with result- 
ant inadequate venous return flow to the heart. 
When the effects of these circulatory changes reach 
a given value for the individual pilot, failure of vision 
or “blackout” occurs. The time taken to reach this 
point is a function of the individual’s physiological 
mechanism. (A pilot may not blackout when pulling 
out of a dive if 6 G be applied for 1 second; but would 
blackout in a tight turn in which 6 G maintained 
for 5 seconds.) 
For each individual, in order to produce blackout, 
the minimum centrifugal force exerted for a minimum 
period of time appears to be 4.5 to 5.0 G acting for 4 
seconds. 
Unconsciousness is more readily induced by tight and 
inefficient abdominal belts, by compression of the veins 
of the neck in a mistaken effort to obstruct the drainage 
of blood from the brain, by severe degrees of anoxia, 
and by the after-effects of illness, alcohol or nicotine 
poisoning. Consciousness returns when the centrifugal 
force (G) is removed, but the pilot may still have visual 
loss for 1 to 2 seconds, and may still be markedly con- 
fused, with some loss of orientation in space. The best 
means at present available for the prevention of black- 
out from high acceleration have been adopted by for- 
eign nations, i.e., Great Britain and Germany. The 
method essentially consists of the assumption by the 
pilot of a crouching position which reduces the height 
of the blood column between the brain and the heart. 
At the same time the legs are raised as far as possible 
by auxiliary rudder pedals which elevate the feet about 
6 inches, thereby decreasing the venous level between HYGIENE, IN AVIATION 
243 
the legs and heart. Assumption of this attitude causes 
tensing of the abdominal muscles, which can be further 
accentuated by shouting or straining to increase intra- 
abdominal pressure and help to prevent pooling of 
blood in abdominal organs. 
All flying personnel should keep physicaly fit, prac- 
tice exercises to increase abdominal muscular tone, avoid 
excesses in the use of alcohol and tobacco and refrain 
from aerobatics until an hour after a meal. Experience 
has indicated that a full stomach lowers resistance to 
blackout. 
Mechanical equipment designed to assist the venous 
return flow to the heart has been under study for a con- 
siderable period of time. This procedure shows some 
promise of allowing pilots to withstand higher G values 
without blackout while in the normally assumed pos- 
ture in the cockpit. 
Toxic gases—Carbon monoxide is considered the 
most dangerous of all the gases likely to be encountered 
in aircraft. In flight, the air stream along the fuselage 
often produces decreased pressures within so that gases 
tend to be sucked in. An aircraft engine gives off about 
34 cubic feet of exhaust gas per second with high carbon- 
monoxide content, and it should be remembered that 
higher concentrations are produced when engines are 
cold and when there is incomplete combustion operating 
at altitudes. The known affinity of hemoglobin for car- 
bon monoxide and the resulting stable compound carbon 
monoxide-hemoglobin seriously lowers the ceiling of 
personnel even though the percentages of carbon monox- 
ide breathed may appear relatively small. As an exam- 
ple, at 12,000 feet blood oxygen saturation is about 85 
percent; breathing 0.02 percent carbon monoxide for an 244 
MANUAL OF NAVAL HYGIENE 
hour reduces oxygen saturation to 77 percent and in four 
hours to 65 percent. Such a decrease in oxygen satura- 
ScN£p?Ar/c Flow J>/ag*asv 
Few and TVpe OxrSSN Fcsulatok 
Figure 43. 
tion may lead to severe altitude sickness at this level. 
This danger is lessened but not entirely eliminated while HYGIENE, IN, AVIATION 
245 
wearing oxygen masks. Up to 20,000 feet there is danger 
of carbon-monoxide absorption, particularly in those 
systems using air diluter demand. 
Permissible levels of carbon monoxide in aircraft are : 
Percent 
United States (Navy specification) - 1.01 
British — . 005 
German . 0025 
The symptoms shown on figure 44 are exaggerated 
with altitude because of lowered oxygen partial pres- 
sures. 
Oil vapors from the engines may produce nausea 
and gastric irritation. Potentially, the lead content in 
exhaust gas may cause lead poisoning, but the danger 
is negligible compared with the effects and dangers of 
carbon monoxide. 
The Special Sense Organs in Flight.—The most 
important of the special sense organs for flying per- 
sonnel is the eye. Good vision is essential to recogni- 
tion of objectives from great heights, recognition of 
opponents in the air at a distance, and in the estima- 
tion of the possibility of landing on unprepared fields. 
While flying in sight of the earth, use of the eyes 
allows correct orientation in space, and while blind 
flying observation of instruments gives correct objec- 
tive estimation of the position in the air, the ability 
to make good landings depends, in part, on ocular 
muscle balance which can be disturbed temporarily 
by fatigue or illness. Color perception is essential as 
long as navigation lights are red and green. Color 
defectives show diminished perception when fatigued 
or when anoxic, and under decreased illumination. 246 
MANUAL OF NAVAL HYGIENE' 
Coma, death 
Collapse, unconsciousness, convulsions 
Cheyne-Stokes breathing 
Severity of symptoms increase, 
pulse rapid 
Marked headache, weakness, dizziness, blur- 
ring of vision, sweating, nausea, vomiting 
Headache, throbbing at temples 
Tight feeling across forehead, headache 
Dilatation of blood vessels of skin 
Figure 44.—Symptoms accompanying varying carbon monoxide levels. HYGIENIC IN AVIATION 
247 
Night Vision.—One of the most important functions 
of the eye in war time is the ability to “see” at night. 
The cones are primarily concerned with day vision, 
while the rods, on the other hand, are concerned largely 
with seeing under dim illumination. 
This function is brought into play by retinal 
adaptive process which in the main consists of a 
chemical change occurring in the rods increasing their 
sensitivity. Ordinarily this change requires about 30 
minutes in complete darkness until the rods reach 
near maximum sensitivity. The rods are most sensi- 
tive at about 510 millimicrons, i. e., to light which 
appears blue-green to the cones; however, they are 
relatively insensitive to waves longer than 600 millimi- 
crons. At this point the cones see red and the rods 
are in the dark up to certain intensities of illumina- 
tion. Taking advantage of this latter fact, goggles 
are used which transmit light at the 600-millimicron 
level and permit visual tasks to be carried out, while at 
the same time allowing the rods to become almost com- 
pletely dark adapted (3 to 6 minutes for complete 
adaptation). 
The subject is of such importance that the funda- 
mental rules which aid in securing maximal night 
visual efficiency are quoted: 
1. Do not attempt night duties until dark adapted— 
avoid short cuts. 
2. Maintain maximum dark adaptation by avoiding 
all possible light, except red light of low intensity. 
3. For instrument lighting use dim red light, and 
do not stare at lighted instruments. 
4. Keep windshield and goggles spotless and un- 
scratched. 248 
MANUAL OF NAVAL HYGIEfN® 
5. Practice using the “corners of the eyes”—night tar- 
gets are better seen by not looking directly at them, 
6. Move the eyes frequently; practice systematic scan- 
ning; be alert for moving objects. 
7. Know the tactical value of low light contrast in 
night missions, 
8. Use night binoculars when possible. 
9. Observe technical orders in use of oxygen—be over- 
conscientious at night, not overconfident. 
10. Don’t “break training,” the stakes are too high. 
11. Learn location of instruments and controls in air- 
craft by sense of touch. This blindfold drill will pay 
dividends. 
Glare and use of goggles.—The use of goggles is 
important in maintaining the efficiency of flying per- 
sonnel, particularly when used to reduce glare, to pro- 
tect the eyes from irritation by draughts and dust, and 
to prevent fire or flash injuries. Glare coming from the 
sun, reflected from water or clouds or from searchlights, 
induces ocular fatigue and markedly impairs efficiency. 
Tinted lenses in goggles or spectacles are of great help 
in reducing glare. The wearing of polarized lenses is 
not advised, since high velocity air pressure sets up in- 
visible lines of stress in plastics used in windshields 
which become visible and disturbing when viewed 
through such lenses. 
Effects of altitude on ears and sinuses.—Changes 
in pressure set up differentials between the middle ear 
and the external atmosphere which are equalized nor- 
mally by way of the eustachian tube. With sudden 
pressure changes, any blockage of this tube, either by 
mechanical means or inflammatory processes, gives rise HYGIENE IK, AVIATION 
249 
to discomfort or severe pain, or even rupture of the 
tympanum. 
Prevention of discomfort or pain can be avoided by— 
Figure 45.—Diagram to indicate how the static organ in the ear is 
affected by changes in the position of the head. 
1. Swallowing repeatedly, yawning, or by pinch- 
ing the nostrils closed and attempting to blow 
through the nose. 
2. If no relief is obtained, ascent of 1,000 or 2,000 
feet and repetition of the methods given above. 
Figure 46.—Diagram to show the action of a semicircular canal 
3, Flights to altitude and descents should not be 
attempted by personnel suffering from sore throat, 
head cold, or catarrh, unless required by opera- 
tional necessity. 250 
MANUAL OF NAVAL HYGIENE 
4. Temporary loss of auditory acuity may be 
noted after descent, but with equalization of pres- 
sure, this soon disappears. 
The frontal and maxillary sinuses may occasion se- 
vere discomfort if their ducts become blocked. Pressure 
within these sinuses usually equalizes readily with that 
of the outside air unless there is mechanical block- 
ade (fractures), or blockage from acute or chronic 
inflammation. 
The use of a benzedrine inhaler (not more than once 
in an hour) or of a mild vasoconstrictor nasal spray will 
do much to prevent symptoms. 
Equilibrium.—Vertigo, defined as “dizziness or 
swimming of the head, giddiness; a disturbance in 
which objects, though stationary, appear to move in 
various directions, and the person affected finds it 
difficult to maintain correct posture,” is of considerable 
importance to flying personnel. It is vitally important 
that the physical and psychological reactions resulting 
from these sensory illusions be recognized and 
understood. 
The organs of equilibrium are located in the inner 
ear and consist of— 
1. The static organs, for perception of the direction 
of the pull of gravity and probably of acceleration. 
2. The semicircular canals for the perception of 
movements of rotation. 
When the force of gravity and centrifugal force 
come into play during flight, it is the resultant of these 
two forces which affects the sensory hairs of the static HYGIENE, IN, AVIATION 
251 
organ. This may deceive the pilot as to his relative 
position in space during instrument flight. 
1. At the commencement of rotation, the fluid lags, 
the sensory hairs are bent back and the brain senses 
a turning movement. 
2. The rotation continues at the same speed and the 
fluid is now moving as rapidly as the canals; the sen- 
sory hairs are upright and no turning movement is felt, 
although a turn is being made. 
3. The rotation has ceased, but the fluid continues 
moving in the same direction for a time; the hairs 
are bent in this direction and the brain senses a false 
turning movement. 
Man, with his eyes closed, has no means of sensing 
a uniform turning movement; but can only sense accel- 
eration or deceleration of the movement. It is there- 
fore possible to rotate a person slowly without his 
being aware of it. 
The organs of equilibrium are closely connected to 
the eyes by nerve paths. This gives rise to false con- 
ceptions in flight due to the fact that the ear organs 
react to the resultant of gravitational and centrifugal 
forces, while the eyes react to what they see as well as to 
nerve impulses from the ear. Consequently, it fre- 
quently happens, in flying, that sensations sent by the 
ear are in opposition to those sent by the eyes and to 
those sensibilities located in the skin, muscles, tendons, 
and joints. These opposed impulses received by the 
brain, and the confused and contradictory directions 
sent from the brain to the body are considered to be 
the chief cause of vertigo. 
516368—43 17 252 
MANUAL OF NAVAL HYGIENE 
Blind flying and sensory illusions.—The following 
are some of the sensory illusions which may be noted 
during instrument flying: 
1. During a steep turn centrifugal force may pro- 
duce a sensation of ascent. (Pilot’s reaction—push 
controls forward.) 
2. Returning to level flight from a steep turn, the 
removal of the strain of centrifugal force from the body 
leads to a feeling of less than normal weight and a 
sensation that the aircraft is falling (Pilot’s reaction— 
pull back on the controls). 
3. Where an aircraft skids in a turn, the sensation is 
that of a tilt opposed to the direction of the true turn. 
4. In instrument flying a false sensation of turning 
often occurs in straight and level flight. This may be 
due to— 
(a) The eyes working in conjunction with the 
ears and receiving false sensations from the latter. 
(b) False sensation of rotation produced in the 
inner ear when motions caused by turbulent air are 
recorded. 
(c) Correction of the course for propeller torque 
by the rudder, which frequently gives a sense of 
turning. 
5. During a sharp turn, movement of the head often 
leads to the feeling that the aircraft is diving or tip- 
ping ; and during a spin the sensation of going beyond 
the vertical. (Pilot reaction—pull back on controls). 
6. Pilots are apparently more subject to vertigo when 
nervous, tired, or tense. Occurrence among wing men in 
formation flying is common under conditions of reduced 
visibility. It is caused possibly by the lack of horizon HYGIENE IN AVIATION 
253 
or plane of reference, or the skidding and maneuvering 
necessary to maintain position. The most common 
sensations are of diving, approaching a stall, or flying 
in some unusual position, and the pilot’s reaction is to 
recover from whatever attitude he feels he may be in, 
correction usually resulting in a vertical spin or dive, 
and often in a fatal crash. 
A good general rule for flying personnel to remember 
is: “The sensations will deceive, but the instruments 
tell the truth.” 
DIRECTION OF ACCELERATIONS OF AIRPLANE DURING 
LEVEL FLIGHT 
Figure 47. 
Airsickness (Motion Sickness).—Airsickness in per- 
sonnel is due to an abnormal individual susceptibility 
to the following factors: 
1. Overstimulation of the mechanism of equilibrium 
with reflex involvement of the vegetative nerve centers 
of the body. 
2. Vertical, rotary, and lateral motion caused by air 
turbulence and aerodynamic qualities of aircraft. 
The primary activating factor in the production of 
airsickness is vertical linear acceleration, and of lesser 254 
MANUAL OF NAVAL HYGIENE 
importance, the rotary acceleration around the trans- 
verse axis of the aircraft. 
The factors causing airsickness, in the order of their 
importance are: 
1. Motion. 
2. Loss of visual reference. 
3. Odors, vibration, and noise. 
4. Cold. 
5. Fear or anxiety. 
The symptoms chiefly affecting personnel are nausea, 
vomiting, cold perspiration, weakness, dizziness, and, in 
extreme cases, marked prostration. 
These factors are of importance in that they detract 
considerably from the efficiency of air crews on war 
missions. Airsickness may be of extreme importance 
when flights of air-borne troops either in aircraft or 
gliders are assigned missions requiring maximum 
efficiency. 
Treatment.—Taking into consideration the causative 
factors, the best treatment is prevention. The use of 
drugs to prevent airsickness is not recommended. 
There is considerable evidence that air crews adapt 
themselves in some measure as flying experience in- 
creases. This factor should be stressed. 
Flying Fatigue.—Flying fatigue is a condition re- 
sulting from abnormal strain or stresses being placed 
upon a normal individual. It is found particularly 
in members of combat crews engaged in combat mis- 
sions, and affects pilots and air crews alike. 
The characteristics of flying fatigue are various and 
variable, but in every case there are sufficient signs or 
symptoms which are likely to be spotted by a good HYGIENE IN’ AVIATION 
255 
squadron commander or flight surgeon. If the condi- 
tion is not recognized early, irreparable harm may be 
done to the individual, and he may be permanently 
lost as a member of the combat unit. It is of prime 
importance that there be close liaison between flight 
and squadron commanders and squadron medical 
officers in order that early recognition of the condition 
may be facilitated. 
There are stresses peculiar to flying in peacetime 
which are both physiological and psychological. The 
former are connected with many conditions including 
oxygen shortage at altitudes, exposure to cold and 
fatigue on long flights, and the effects of G involved in 
certain maneuvers. The psychological strains are 
those inherent in the pursuit of any duty carrying with 
it risks which call for constant care and concentration 
in their avoidance. In peacetime the majority of per- 
sonnel adapt themselves satisfactorily to these forms 
of stress. 
In time of war the stresses become enormously in- 
creased in both intensity and duration, and the effects 
become cumulative, owing to lack of opportunity for 
adequate recuperation. Once the individual has reached 
the limits of his endurance, his deterioration is rapid. 
Physiological and psychological strains react upon one 
another to establish a vicious circle, which, if not broken 
early, will inevitably lead to accident or breakdown. 
The importance of avoiding wastage of personnel by 
extra vigilance in watching for signs of deterioration 
and by the application of appropriate countermeasures 
is obvious. The development of even minor indications 
of fatigue or stress should be regarded as a danger 256 
MANUAL OF NAVAL HYGIENE 
signal which warrants close attention and investiga- 
tion. 
The warning signals which are of importance are: 
1. Falling off in flying efficiency. 
2. Markedly increased liability to fatigue, both 
mental and physical. 
3 Loss of interest, disinclination for effort. 
4. Increased indulgence in alcohol and/or tobacco. 
5. A tendency to become unsociable or irritable. 
6. Emotional crises, loss of self control. 
T. Physical symptoms such as loss of appetite, inabil- 
ity to sleep properly (nightmares frequent), loss of 
weight, the presence of tremors, tachycardia, and typi- 
cal anxiety facies. 
The occurrence of the symptoms may be the only 
evidence of what may be termed a “preneurotic state” 
for which a period of rest, leave, or change of duty is 
indicated. 
Prevention is of primary fundamental importance 
in handling the problem. Briefly outlined below are 
some of the methods which may be applied in order to 
avoid personnel wastage. 
1. Institution as far as possible of recreational facili- 
ties aboard operating stations. This should include 
aircraft carriers insofar as practicable, the attempt 
being to provide some degree of relaxation and relief 
from constant routine. 
2. Every effort should be made to provide as great 
an amount of comfortable sleep as possible for per- 
sonnel who are required to fly. 
3. Leave should be granted freely whenever possible, 
consistent with operational requirements. 257 
HYGIENE IN’ AVIATION 
(a) For shore-based operational squadrons, a 24- 
hour leave in each week or after any major operation; 
at least 8 days every 6 weeks or 14 days leave in any 
given 3-month period. 
(b) Carriers—It is difficult, if not impossible, to 
stipulate any definite program of leave for carrier- 
based squadrons. Where possible, personnel should 
always be granted leave to the fullest extent when the 
carrier is at anchor. This leave should be clear of the 
ship and not on the basis of a 1- or 2-hour recall. Such 
leave on a restricted standby status defeats its own 
purpose. 
4. There is no apparent necessity to set arbitrary 
operational flying limits for personnel. However, for- 
eign experience has indicated that signs of incipient 
fatigue among personnel are first noted around 100- 
125 hours for fighter personnel and 125-150 hours for 
bomber personnel. Patrol personnel average about 250- 
300 hours. The above noted hours refer to combat 
operational flying only. These limits should not be set 
up arbitrarily as limits for pilot or air-crew efficiency, 
but rather as a guide to medical officers in their estima- 
tions of peak personnel efficiency. 
5. Handling of cases of incipient fatigue: Prevention 
should be as far as possible an administrative problem 
effected by close cooperation between commanding offi- 
cers and medical officers. The following factors should 
be considered: 
(a) Placing individuals (with incipient fatigue 
or stress) on the sick list has a deleterious effect 
upon individual and squadron morale. 258 
MANUAL OF NAVAL HYGIENE 
(b) Hospitalization under medical care reacts 
unfavorably as far as the restoration of the indi- 
vidual to peak operational efficiency is concerned. 
(c) It is unwise to mix cases of incipient fatigue 
(those presenting more or less intangible evidence 
of staleness—war weariness) and those cases which 
have developed well-marked symptomatology with 
predominant psychogenic aspects. Intermingling 
the two has a distinctly unfavorable reaction on the 
incipient cases indicated by a gradual loss of “edge” 
and desire to return to a full operational status. 
(■d) Rehabilitation should be chiefly recreational 
or by a change of duty status, either to nonflying 
duties or by transfer to flying training activities. 
(e) Do not whip a “tired horse” with drugs. 
Such a procedure is physiologically unsound and 
leads to eventual exaggeration of the condition. 
Fatigue in high altitude flying.—Flights over 25,000 
feet, and especially over 30,000 feet, often produce an 
exhaustion out of proportion to the duration of the 
flight or the effort involved. This fatigue appears to be 
much greater than that experienced in flights of 20,000 
feet or below, irrespective of whether the mission in- 
volves combat or patrol. 
The condition manifests itself in the following 
manner; 
1. A brief period of exhilaration. 
2. Loss of interest in surroundings. 
3. Feeling of exhaustion. This fatigue tends to be 
progressive with repeated exposure. Flying efficiency 
is diminished. Physical findings show little except a 
slight to moderate diminution of red cell count and 
hemoglobin. HYGIENE IN; AVIATION 
259 
When pilots or air crews exhibit the signs of fatigue 
accompanying high altitude flights, they should be 
granted a short period of leave (6 to 10 days). This 
will usually restore them to full operational efficiency. 
Aircraft accidents.—Advances in military aviation 
have contributed more to performance and design than 
to safety factors of aircraft. With this increase in the 
requirements from the human, there has arisen a cor- 
respondingly greater number of accidents' which are 
attributed to personnel failure. 
A number of factors may enter into the causes of avia- 
tion accidents. Chief of these are— 
1. Technical failure (structural, power plant). 
2. Personnel failure (pilot error, carelessness, negli- 
gence). 
3. Weather and terrain (low visibility, storms, icing, 
rough landing spaces). 
By far the greater number of accidents are attributed 
to personnel failure. The factors contributing to this 
are briefly outlined below. 
1. Anoxia. 
(a) Failure of oxygen apparatus due to cold, 
faulty mechanism. 
(b) Faulty functioning due to unfamiliarity 
with apparatus or lack of knowledge concerning 
the effects of altitude. 
(<?) Anoxia due to carbon-monoxide poisoning. 
(This may be due to technical deficiency of the 
aircraft or personnel carelessness.) 
2. The accentuation of disease or constitutional de- 
fects under conditions of high altitude flying (flying 
following an illness). Also of importance is continued 260 
MANUAL OF NAVAL HYGIENE 
flying by “stale” or fatigued personnel. These lat- 
ter factors lead to gross errors of judgment and di- 
minished efficiency. 
3. Effects of acceleration: Blackout, particularly in 
low level dive bombing or in torpedo plane attack 
may be a fruitful source of accidents with serious in- 
jury or fatal termination, . 
4. Training in all phases of flying and in physio- 
logical factors producing reactions in air crews is most 
important in the prevention of accidents. From the 
medical standpoint, physiological factors in particular 
should be stressed. It is insufficient to give prelimi- 
nary lectures and instruction to personnel while in the 
training phase only. Indoctrination and instruction 
should be carried out without interruption in opera- 
tional units. 
Safety appliances.—Apparently it is not possible to 
avoid injury in those crashes in which the aircraft is 
completely destroyed, demolished or burned. How- 
ever, there are a number of accidents in which struc- 
tural peculiarities or failure to use safety devices 
contribute to injury. Personnel should be thoroughly 
indoctrinated in the wisdom of using the shoulder 
harness, and where that is not available, the thigh 
straps. 
Industrial hazards.—There are numerous toxic 
substances to which ground personnel may be subjected. 
Chief among these are airplane dopes, cleaning ma- 
terials, aviation gasoline, fire-extinguishing compounds, 
engine exhaust gases, and oil fumes. 
Airplane dope.—The hazards from doping are well 
controlled and personnel engaged in this type of work 
should suffer no ill consequences if existing regulations HYGIENE IN AVIATION 
261 
are carried out. From a preventive standpoint, atten- 
tion to ventilation of workrooms, careful personal 
hygiene, protective clothing, adequate fresh air and 
sunshine, careful tire precautions and monthly medical 
checkups are the most important factors. 
The chief danger from cleaning materials is from 
caustic burns or from fire. Carbon tetrachloride is a 
possible exception. The fumes and liquid of this com- 
pound are toxic, and if allowed to come in contact with 
heated metal, phosgene is formed. Preventive precau- 
tions should include the avoidance of breathing vapors 
or spilling liquid on clothing, keeping material in closed 
containers, and good ventilation. 
Aviation gasoline contains tetraethyl lead, a toxic 
compound. Precautions shoidd include avoidance of di- 
rect contact with the skin or clothing, and of breath- 
ing fumes. Where the skin has been contaminated, soap 
and water will provide adequate cleansing. While 
handling the fluid, rubber gloves should be worn. 
The chief fire-extinguishing compounds are carbon 
dioxide and carbon tetrachloride. Carbon dioxide 
spray may cause severe burns if blown on the exposed 
skin, and it is possible that dangerous concentrations 
may be encountered in small closed spaces. The dangers 
of carbon tetrachloride have already been noted under 
cleaning solvents. 
Engine exhaust gases are chiefly important from the 
possibility of carbon-monoxide poisoning. (See pre- 
vious description.) The main precaution is adequate 
ventilation when working in enclosed spaces. 
Breathing hot oil fumes in inadequately ventilated 
spaces may give rise to upper respiratory irritation, 
headache, nausea, and vomiting. Very little difficulty 262 
MANUAL OF NAVAL HYGIEiME 
should be experienced if adequate ventilation is 
provided. 
Aircraft emergency ration.—The present author- 
ized emergency aircraft ration consists of the following: 
Pemmican. 
Malted milk tablets. 
Sweet chocolate. 
Pemmican is packaged in one-foiirth-poimd cans and 
consists of the following ingredients: 
1. Rendered kidney fat. 
2. Prime oleo oil. 
3. Seedless raisins. 
4. Evapox-ated apples. 
5. Crisp bacon. 
6. Peanuts. 
7. Dextrose. 
8. Shredded coconut. 
9. Vanilla extract. 
10. Salt. 
Three types are furnished: Class I lacks the bacon 
and peanuts; class II lacks the evaporated apples and 
peanuts, and class III lacks the evaporated apples and 
bacon. 
The malted milk tablets are supplied in a glass con- 
tainer holding 3 ounces (about 40 tablets). 
The sweet chocolate one-fourth-pound bar contains 
chocolate, sugar, oat flour, milk, vanillin, vitamin B. 
Caloric value of the cake is 600 calories. 
Total caloric content of the ration is 4,000 calories. 
Emergency water is supplied in cans, 8 ounces to 
each can, 3 cans per person. 
First-aid kits.—First-aid kits for pneumatic life 
rafts are furnished as a single-unit package. Contents 
of this six-unit package are as follows: HYGIENE INI AVIATION 
263 
1. Six Syrettes (morphine tartrate). 
2. One iodine applicator (bottle type, 10 cc.). 
3. Two tubes of burn ointment (tannic acid). 
4. Two one-half-inch bandage compresses. 
5. Sulfanilamide (for topical application, 5 gm. per packet, 
5 packets). 
This first-aid kit is supplied for all one-, two-, and three- 
place aircraft. 
A large 10-unit first-aid kit is supplied for long range 
patrol aircraft carrying larger crews. Contents of this 
package are: 
1. Six morphine Syrettes (morphine tartrate). 
2. One iodine applicator (bottle type, 10 cc.). 
3. Two tubes burn ointment (tannic acid). 
4. One package sulfanilamide powder, five 5-gm. packets. 
5. Sulfadiazine (twenty-four 1-gm. tablets). 
6. Four 1-inch compresses. 
7. One triangular bandage. 
8. One web tourniquet. 
9. One battle dressing, small. 
10. One package scissors, safety pins. 
It is quite evident that the contents of the two first- 
aid kits will not meet all the needs of personnel operat- 
ing under unusual conditions. However, it is expected 
that local medical establishments, after determining the 
needs, will provide supplemental supplies as required. 
Duties or medical officers attached to aviation 
activities.—It is fundamental that a medical officer 
should thoroughly acquaint himself with the person- 
nel and material of the station or ship to which he is 
attached. He should know the type or types of aircraft, 
the number and duties of the crew, seating arrange- 
ments, type of heating, endurance, range, ceiling and 
types of oxygen equipment installed. He should estab- 264 
MANUAL OF NAVAL HYGIENE 
lish himself as a part of the squadron (or squadrons) 
and become a part of its administration. He must iden- 
tify himself with all aspects of squadron life, whether 
in the crew room, on the sports field, or in opera- 
tional phases, and he should be available at all times 
for interview and for requests requiring his special 
attention. In addition it is necessary that medical 
officers take part in routine medical duties, including 
sickbay duties, and in every way assist in cooperation 
between the Medical Department and commanding 
officer. 
Rest, relaxation and sport.—Recreational activities 
are highly important as a means of maintaining morale 
and efficiency. All efforts should be made to secure, 
as far as possible, 8 hours’ sleep out of 24 for operating 
personnel. During periods of rest (stand-off from 
operations), idleness or slackness should not be toler- 
ated, The most beneficial form of relaxation from re- 
stricted and emotionally toned effort is to be found in 
exercise of the body and mind in play, and every effort 
should be made ashore and afloat to provide sports for 
personnel. Such sports as wrestling, boxing, handball, 
shuffleboard, etc., are readily adaptable on board ship 
and allow a considerable range of personal preference 
to supplement the more diverse activities that can be 
indulged in ashore. Chapter XX 
FIELD HYGIENE AND SANITATION 
It has long been recognized and is an axiom of com- 
bat that health of the fighting personnel is essential in 
war. Preservation and promotion of health of the 
forces in the field requires attention to a number of 
details, each trivial in itself. 
The Medical Department’s authority over field 
hygiene and sanitation is largely advisory. The quan- 
tity and quality of medical care is contingent upon the 
military situation. Military requirements take pre- 
cedence over medical care and humanitarian needs. 
The naval service does not furnish funds, installations 
or labor for field sanitation, hence care of the health 
of the individual is largely left to the local command. 
Food ix the field.—Troops in the field, as a general 
rule, have limited opportunity to supplement their 
military rations by purchase from outside sources and 
thus are unable to supply any deficiencies existing in 
their food allowance. Hence it is particularly impor- 
tant that the field ration be well balanced as regards 
to fats, proteins, carbohydrates, and mineral elements 
and have the required vitamin content. 
The daily menu should be prepared at least 24 hours 
in advance. On the march, or when otherwise engaged 
in heavy work, troops will have a craving for sweets 
265 266 
MANUAL OF NAVAL HYGIEiME 
and a liberal amount of jam should be provided to 
satisfy this craving. 
The mess gear should be washed in boiling soapy 
water and rinsed in boiling clear water. Surplus and 
reserve food supplies should be protected from such 
insects as flies and roaches, dust, dirt, and rodents. 
The weight of vitamin-containing foods of an exclu- 
sive military ration should be at least 30 percent of the 
total. 
The field kitchen should be located on the side of 
the camp opposite the latrines and urinals. Every 
precaution should be made to protect the food from 
dust and dirt and, if practicable, the field kitchen 
should be screened. 
If the kitchen has a dirt floor it may be oiled with 
motor oil to control dust. 
The food handlers should be instructed and trained 
in personal hygiene and cleanliness and should be 
given a physical examination at regular intervals. 
The mess halls, screened if possible, should be located 
near the kitchen. The mess tables should be cleansed 
and sunned at regular intervals and care must be taken 
to prevent the collection of food particles in the cracks 
of the table. This is usually accomplished by construc- 
tion of a table with a removable center board. 
Care should be taken not to cook the food too long 
as this tends to destroy some of the vitamins. During 
the World War I, scurvy broke out in one organiza- 
tion, and without any alteration in the diet the out- 
break was arrested immediately by reducing the period 
of cooking from 6 hours to 45 minutes. 
In Mesopotamia, during the World War I, British 
troops eating white bread suffered from beriberi while FIELD HYGIENE AND SANITATION 
267 
the Indian troops eating bread made of unmilled wheat 
were unaffected. During the siege of Kut the reverse 
was the case, the British lived largely on fresh meat 
while the vegetarian Indians lived largely on white 
bread. 
Water in the field.—As a result of the policy of im- 
munizing naval personnel with the enteric antigens, 
water-borne diseases have been more or less eliminated. 
However it is important that water sources be in- 
spected and that sterilization be employed before per- 
mitting the drinking of any water from sources that, 
potentially, may be contaminated. Boiling is the 
simplest method; however chlorination is the usual 
method employed. 
In the absence of chlorinated lime, tincture of iodine 
can be used to sterilize wnater in the canteen or the water 
sterilizing bag. Two and one-half teaspoonfuls (10 cc.) 
of 7 percent tincture added to a sterilizing bag (36-gal- 
lon capacity) of water will purify it in 80 minutes. 
Two drops of the tincture added to one canteen of water 
and allowed to stand for 30 minutes will sterilize the 
contents. 
Chlorinated lime (bleaching powder, calcium hypo- 
chlorite) is prepared by saturating slaked lime with 
chlorine gas. When freshly prepared, chlorinated lime 
contains about 35 percent of available chlorine. 
Grade A calcium hypochlorite includes such prepara- 
tions as “H.T.H.” (high test hypo) and “Perchloron.” 
These compounds are more stable and contain about 
twice the available chlorine that ordinary calcium hypo- 
chlorite contains. 
516368—43 18 268 
MANUAL OF NAVAL HYGIEflSHE 
When added to a bagful of water 1 gram of calcium 
hypochlorite or one-half gram of “H.T.H.” will yield 
2.5 parts of free chlorine per million. 
The responsibility for the water supply is usually 
delegated as follows: 
(a) The Marine Corps quartermaster or Nary supply 
officer.—Procurement of water rights and delivery of 
water to the camp site. 
(I)) Medical officer.—In advisory capacity, for quan- 
tity and quality of water supply. 
(c) The unit commander.—For the proper distribu- 
tion of the water within the command. 
Hygiene of the march,—Care of troops on the march 
is of paramount importance. The men should be 
trained in marching by gradually increasing the length 
of the hike and weight of the pack. The most suitable 
time to start the day’s march is 1 hour after break of 
day. Night marching should be practiced only when 
military necessity demands, in which case it should 
begin soon after sunset. Before leaving camp elimina- 
tion of the sick and physically unfit is necessary. A 
sanitary detail must see that the camp site is left in a 
clean condition and, during the march, see that the road 
rules of sanitation are obeyed. 
The men should start the day’s march at a slow pace 
in order to warm up, and the end of the march should be 
at a similar slow pace in order to enable the men to cool 
off gradually. 
When marches are of considerable length and forced, 
singing and whistling of popular tunes should be en- 
couraged. Such stimulation tends to prevent exhaus- 
tion by distracting the men from their fatigued state. FIELD HYGIENE AND SANITATION 
269 
Straggling must be avoided. Straggling casualties 
are due largely to preventable foot disorders and their 
occurrence creates a nail-foot-sock-shoe problem that 
requires constant attention. The development of losses, 
organization difficulty, packing of ambulances and 
futile employment of medical personnel while on the 
march can be overcome by rigid adherence to sound 
rules of foot care. Feet should be inspected before and 
after every march and all minor disorders should be 
attended to promptly. 
March fracture is a fracture of the second or third 
metatarsal bone at the junction of the anterior and 
middle thirds. It occurs in marching with heavy load, 
especially in double time. 
New shoes should not be worn on the march unless 
they have been broken in. 
Physics and physiology of the makch.2—Compared 
to the steam engine the human mechanism is a bit more 
efficient. The engine is capable of utilizing only 13 
percent for useful work from its fuel, whereas our body 
utilizes 20 percent of the energy value of a consumed 
diet. The 80-percent balance goes into the production 
of heat which must be dissipated in order to keep the 
body temperature constant. 
A soldier marching 15 miles carrying full equipment, 
performs 353 foot-tons of work. 
According to Haughton, as quoted by Harrington, 
this labor, in walking over a level surface, is determined 
by the following formula: 
(W+W^XD 
multiplied by C equals number of foot-tons 
1 After LeLean, P. S., Sanitation in War. P. Blackiston’s Son & Co., 
Philadelphia, Pa. 27U 
MANUAL OF NAVAL HYGIENE 
Where: W equals weight of person. 
W' equals weight carried. 
D equals distance in feet. 
2240 equals number of pounds in long ton. 
G equals coefficient of traction. 
The coefficient of traction varies for different rates 
of speed. For 2, 3, 4, and 5 miles per hour, it is ap- 
proximately ■/26? /4o? He and M.4? respectively. Thus a 
man weighing 160 pounds, carrying 40 pounds and 
walking 15 miles at the rate of 3 miles per hour, will 
perform an amount of work equivalent to 353.57 foot- 
tons. 
(160 -f- 40) X 792°° muUipUed by equa]s 353 57 
or, if at the rate of 2.5 miles per hour, 307.45 foot-tons. 
As we know from physics, one kilogram-calorie equals 
3,087 foot-pounds or 1.38 foot-tons. 
Then 350 foot-tons would require 254 calories or 
energy as work, but only 20 percent of the calories 
can be utilized as work, hence the 254 must be in- 
creased by 80 percent which will total 1,270 calories. 
But the soldier in 8 hours normally expends 1,000 
calories, so 1,000 plus 1,270 equals 2,270 calories, which 
will be the food requirements for a man hiking 15 miles 
in 8 hours, (fig. 48). 
Heat dissipation.—The evaporation of water acts in 
dissipating heat of the body in a fashion analogous to 
the action of the radiator of the automobile in main- 
taining the motor near a constant temperature. 
The evaporation of 1 cc. of water requires 0.5 calorie, 
consequently the evaporation of a quart of water FIELD HYGIENE AND SANITATION 
271 
(1,182.52 cc.) from the body’s surface will dissipate 
600 calories of heat generated by a marching soldier. 
Heat equilibrium.—The human mechanism—similar 
to the automobile motor—must be warmed up before 
it can function at its best in marching. 
CALORIES OF HEAT PRODUCED 
2270 Calories used 
in 8 hours marching 
15 miles 
WORK 
20 % 
CALORIES 
470 
Actual work 
470 Calories 
600 Calories loss 
in convection, conduc- 
tion, radiation, etc 
1000 Calories used in 
8 hours at rest 
WORK 
20% 
CALORIES 
200 
HEAT 
LOSS 
80% 
CALORIES 
800 
Actual work 200 
Calories 
1200 Calories re- 
quired for evaporation 
of 2 quarts of water 
lost from body. 
HEAT 
LOSS 
80% 
CALORIES 
1800 
500 Colones loss in 
convection, conduction, 
radiation, etc 
300 Colones required 
for evoporotion of 0 5 
quart of water lost 
from body 
SOLDIER AT REST 
FOR EIGHT HOURS 
SOLDIER MARCHING 15 
MILES IN EIGHT HOURS 
ENERGY BALANCE SHEET PER 8 HOURS AT REST AND ON MARCH OF 15 MILES 
(After LeLean) 
FlGUEE 48. 
The physiological best temperature for the body in 
marching is 100.5° F., and 102° F. is the maximum tem- 
perature before serious symptoms become noticeable 
such as swaying, tremor, nervousness, etc. 272 
MANUAL OF NAVAL HYGIENE 
Thus there is only 1.5° range between the optimum 
body temperature and danger body temperature “and 
this narrow safety margin indicates alike the delicacy 
of the adjustment mechanism and the importance of 
every means of aiding that adjustment.” 
If the soldier expends 2,270 calories in 8 hours march- 
ing 15 miles, 80 percent (1,816 calories) must be lost 
in dissipating heat. 
Of the 1,816 calories, 30 percent is disposed of by 
radiation, conduction, and convection, while the re- 
maining 70 percent must be disposed of by evapora- 
tion of fluids. Since the evaporation of 1 quart of 
water takes 600 calories, then the total water which 
must be lost in this 8-hour march is approximately 
2 quarts. 
Conservancy in the field.—Conservancy is a tech- 
nical name for the collection, removal, and disposal of 
waste products. As a general rule, while on the march 
and in temporary camps, burial is the usual method 
of disposal of waste products; in camps of more or less 
permanent nature incineration is preferred. In the 
field, trench latrines, soakage pits, field incinerators, 
etc., must replace the functions of sewage disposal 
plants and water-carriage sewage system. 
Manure can be taken care of by incineration, chem- 
ical treatment, spreading and close-packing (compost- 
ing or biothermic method). 
In the biothermic method, the wetted manure is 
closely packed in a pile. The fermenting manure will 
generate a heat of 140° F. to 160° F., while a tempera- 
ture of 115° is sufficient to destroy the larvae of flies 
within a few minutes. 273 
FIELD HYGIENE AND SANITATION 
At camp sites near the shore on rocky terrain, espe- 
cially small coral islands, where the surface soil is too 
shallow to permit trench latrines, short low piers ex- 
tending into the sea have been satisfactorily used as 
latrines by military forces. Garbage and refuse are 
placed in barges, hauled out to sea and dumped. 
Camp and bivouac sites.—Before determining the 
location of a camp or bivouac site a number of military 
and sanitary factors must be considered. Available 
sites or areas, in the line of march are investigated and 
reported on by quartering or reconnoitering parties of 
which a responsible medical department representative 
is a member. The final decision as to the site to be 
used is made by organization commanding officers. In 
the selection of camp and bivouac sites the medical 
department representative serves as a sanitation expert 
and in that capacity makes pertinent reports. Such a 
sanitary survey is an analysis of the conditions existing 
in a prospective camp or bivouac site which are con- 
sidered to influence, favorably or unfavorably, the 
health of the men expected to be quartered there. 
The sanitary aspects of a proposed camp site can be 
given very little, if any, consideration when an organ- 
ization is moving into combat. All activities devoted 
to the preservation of the health of the force must 
then be governed by the military situation. 
The method employed in the moving of troops (by 
foot, mounted, trucks, tractors, planes, etc.) and the 
nature of the terrain and “road net” over which they 
are to pass will limit the number of available camp 
sites. The physical strain which troops might have 
to undergo to reach a more distant site may be the 
cause of eliminating an otherwise desirable location. 274 
MANUAL OF NAVAL HYGIENE 
Because of greater mobility, mounted, mechanized, and 
air-borne troops may greatly lengthen the daily dis- 
tance, thereby increasing the number of satisfactory 
sites, some of which would not be accessible to foot 
troops. 
On the other hand, motorized troops may be confined 
to the use of highways while foot and mounted troops 
can be moved over both good and bad roads, over fields 
and across country. When this occurs foot and 
mounted troops, although limited by distance, are per- 
mitted a. wider selection of sites than is available to 
motorized troops. 
The conditions which would be likely to cause and 
transmit disease among troops must be carefully con- 
sidered in the selection of a camp site. Taking into 
careful consideration the sanitary and health condi- 
tions of local civil communities, a prospective camp 
site should be investigated as regards to the following 
sanitary features; 
1. Water supply.—An adequate supply of potable 
water must be available from sources that can be 
reached, either by the men directly or by animal or 
motor drawn water carts. All local water used for 
drinking purposes should be sterilized by boiling or 
by the use of one of the acceptable chemical methods. 
2. Terrain.—Ideally, the terrain should be one that 
permits good drainage during and following rainfall. 
Therefore flat country overlaid with clay should be 
avoided. The topography should be rolling and the 
vegetation, soil, subsoil and first impervious layers of 
a character that wdll permit drainage, disposal evacua- 
tions and shade conducive to the utmost health and 
comfort of the men. Troops should not be camped FIELD HYGIENE AND SANITATION 
275 
in the neighborhood of swamps or other water-collect- 
ing sites or near rank vegetation, all of which are 
potential breeding-grounds for insects. 
In this connection it is of interest that during field 
maneuvers in the past, one body of troops selected a 
camp site near a spring-fed, fresh-water basin in order 
to be near a good water supply. Within a few weeks 
60 percent had reported sick with malaria. Another 
military force that chose to camp only 2 miles away 
had a negligible incidence of malaria. It is better to 
transport water and avoid proximity to anopheles- 
breeding areas whenever possible. 
3. Civil inhabitants.—When practicable, a camp site 
should be located a reasonable distance from a populated 
area. The necessity of billeting troops, for short or 
long stays, in the homes and buildings of a community 
is likely to occur during war. Every effort must be 
made by the quartering medical representative to obtain 
full medical intelligence on the public health condi- 
tion of the population and community in which the 
troops are to be billeted, and every safeguard must be 
taken to protect the troops from infectious disease. 
In general, the factors to be considered when select- 
ing a suitable camp or bivouac site are: 
(a) A rolling, well-drained area having a sandy loam 
or gravel soil for drainage. 
(b) Availability of an adequate supply of good water 
and fuel. 
(<?) Grass and shade trees as wind-breaks in cold 
weather and protection from the sun’s rays in summer. 
1. Avoid clay or alluvial soil, marshes and insect- 
breeding places. 
2. Avoid base of hill, ravine or dry river bed. 276 
MANUAL OF NAVAL HYGIENE 
3. Avoid site of recent camp. 
Sanitary orders.—In camp or billets, the sanitary and 
hygienic measures required to protect the health of 
troops are stipulated in sanitary orders prepared by the 
senior medical officer and signed by the unit commander. 
Such orders apply equally to all elements of the force 
and designate the duties and responsibilities of all per- 
sonnel. Specifically, a sanitary order applies to the 
establishment, use, and maintenance of— 
1. Food, mess halls, and kitchens. 
2. Water supply. 
3. Quarters (tents, billets, or barracks). 
4. Personnel hygiene (scrub and wash clothes—bath- 
ing). 
5. Waste disposal (excreta and refuse). 
6. Insect control. 
7. Sick call (time, location, hospitalization, and evac- 
uation). 
8. Venereal disease control. 
9. Physical inspection. 
10. Civil community. 
11. Special measures. Chapter XXI 
ARMORED UNITS 
The armored units in the United States Marine Corps 
consist of tanks and armored amphibian tractors. Duty 
in these types of vehicles is extremely arduous in that 
personnel must operate in a confined space with limited 
visibility, be constantly jolted about, exposed to gaseous 
fumes and extremes of temperature and humidity. In 
view of the above conditions it is essential that as- 
signed personnel meet the highest physical standards. 
The tactical employment of armored units will fre- 
quently result in individual armored vehicles being sep- 
arated from trained medical personnel. The confined 
spaces in which the crews of armored vehicles operate 
make it difficult for medical personnel, even if avail- 
able, to render first aid promptly. For these reasons 
the personnel of armored forces should be thoroughly 
trained in administering first aid. 
In many instances injured personnel are required to 
evacuate a disabled tank without delay. In such cases 
the first-aid kits are frequently left behind because of 
the haste with which the tank is evacuated, and are 
thereafter unavailable for use. By training, and by 
properly placing the first-aid kit in an easily accessible 
spot, personnel can be taught to remove the kit auto- 
matically during evacuation. 
Evacuation or Wounded. 
After considerable study by the Armored Force Sur- 
geon and the Armored Force Medical Research Lab- 
277 278 
MANUAL OF NAVAL HYGIENE 
oratory, the Armored Force Board at Fort Knox, Ky., 
has adopted certain methods of casualty handling. 
These methods are adaptable to the existing types of 
Figure 49.—Front and rear views of pistol belt-suspender method 
equipment, using one pistol belt and one suspender belt. 
armored vehicles in the United States Marine Corps 
and are as follows: 
1. Pistol belt—suspender method. 
2. Inversion (feet first) method. 
3. Floor hatch method. 
The pistol belt-suspender method. 
This method requires either one pistol belt and one 
suspender belt, or three pistol belts. The two modifica- 
tions of this method are described as follows: 279 
ARMORED UNITS 
{a) Use of one pistol belt and one suspender belt.— 
The pistol belt is placed around the waist of the cas- 
ualty, then the suspender belt is fastened to the pistol 
belt in the normal manner. If necessary the arms or 
feet may be securely fastened by means of additional 
Figuee 50.—-Front and rear views of pistol belt-suspender method 
equipment using three pistol belts. 
pistol belts. The casualty is then hoisted through any 
appropriate opening in the vehicle by two men. Sus- 
penders are issued to armored units on the basis of one 
per individual. 
C&) Use of three pistol belts.—If a suspender belt 
is not immediately available, one can be improvised 
from pistol belts. Two pistol belts are adjusted in 280 
MANUAL OF NAVAL HYGIENE 
such a manner that a loop, of sufficient size to permit a 
third pistol belt to be threaded through it, is formed 
Figure 51.—Showing casualty being supported by pistol belt-suspender 
method. Note use of an additional pistol belt threaded under shoulder 
straps to provide better mechanical advantage for hoisting crew. 
on each end of both belts. This is accomplished by 
sliding the keeper until a loop of the proper size is ARMORED UNITS 
281 
obtained on one end of the belt; the loop at the other 
end is produced by fastening the small hook normally 
used to adjust the length of the belt, to the appropriate 
center eyelet of the belt. A third pistol belt, to be worn 
Figure 52.—Removing injured from tanks. Showing removal of assist- 
ant driver (M4 medium tank) by means of suspender strap-pistol 
belt method. 
around the waist, is threaded through the four loops 
of the other two belts in such a manner as to produce 
a belt with suspenders (not crossed). The waist belt 
is fastened and the casualty then hoisted out through 
any appropriate opening. 282 
MANUAL OF NAVAL HYGIENE' 
The advantages are: No special equipment is re- 
quired ; it is satisfactory for all types of injuries below 
the hip joint; the method can be used by tank crews 
without assistance. 
The disadvantage is that it is not satisfactory for 
serious wounds of the chest or abdomen. 
The inversion (feet first) method. 
This method consists of lifting the man through the 
nearest hatch or turret opening feet first. A pistol 
belt, trouser belt or seat safety belt is attached tightly 
around both ankles below the shoe tops. The man is 
then laid flat on his back and the feet well elevated 
toward the opening through which he is to be evacu- 
ated. The man standing above grasps the strap and 
slowly lifts the evacuee out through the hatch, being 
aided and guided by one man from below who sees to 
it that the evacuee is not injured as he is lifted upward. 
Having been removed from the hatch, the evacuee is 
carefully laid across the bow of the tank until a litter- 
bearer can assist in removing him to the ground. When 
the wounded man is in the driver’s or bow gunner’s 
seat the transmission housing should be padded by 
blankets, combat jackets, a couple of gas masks or simi- 
lar articles to provide a relatively soft bed upon which 
the man may be laid without danger of burning before 
the evacuation is completed. In the turret, the man 
is simply laid flat on the floor and made comfortable 
with available duffle. With practice, a complete evacu- 
tion can be accomplished in less than 2 minutes. 
Its advantages are: No special equipment is re- 
quired; it is applicable to all hatches of all existing 
tank models; it tends to decrease rather than to in- ARMORED UNITS 
283 
Figure 53.—Showing driver of M4 medium tank in position preparatory 
to being hoisted through hatch by the inversion method. 
516368—43 19 284 
MANUAL OF NAVAL HYGIENE 
crease shock; it has no undesirable effects on major 
wounds of the head, neck, spine, chest, abdomen, and 
Figure 54.—Showing driver being hoisted through hatch of M4 medium 
tank by the inversion method. 
pelvis; it can be used in all types of wounds except 
those involving fractures of both legs; it can be done 
by the crew members or by medical personnel with ARMORED UNITS 
285 
Figure 55.—Showing driver of M4 medium tank being laid across bow 
of lank preparatory to transferring him to a litter. 286 
MANUAL OF NAVAL HYGIENE 
Figure 56.—Showing driver of M4 medium tank being placed on litter. ARMORED UNITS 
287 
equal facility; and it can be done with a minimum of 
two men; three are preferable. 
Its disadvantage is that this method should not be 
used when there are fractures of both legs. It is dif- 
ficult to use when there are fractures of both arms re- 
quiring splinting of the arms prior to evacuation. This 
circumstance prevents evacuation through the bow 
hatches of modern tanks by any method yet devised. 
Such personnel should be moved into the turret before 
evacuation or else should be removed through the floor 
hatch. 
The floor hatch method. 
In all newer tanks a floor escape is being provided. 
In most instances it is under and behind the bow gun- 
ner’s seat. It is approached by removing the bow 
gunner’s seat and then dropping the plate onto the 
ground. 
Evacuation from the bow seats is accomplished feet 
first by simply lowering the man through the floor 
hatch, having one man underneath the tank to assist 
in pulling him out. A litter may be placed beneath 
the floor hatch and the man evacuated directly onto it. 
In order to evacuate a man from the turret compart- 
ment through the floor hatch, it is necessary to rotate 
the turret until its major opening is directly above the 
floor escape hatch. A litter is then placed under the 
escape hatch. The evacuee is lowered, preferably head 
first, from the turret opening down through the floor 
hatch onto the litter. To accomplish this maneuver 
without danger of increasing injury three men are 
required; one in the turret, one in the driver’s compart- 
ment, and one underneath, to aid in handling the 
evacuee. 288 
MANUAL OF NAVAL HYGIENE 
The chief advantage of this method is that it can be 
done under gunfire without unduly exposing personnel 
Piguee 57.—Showing floor hatch method of evacuation in which casualty 
is lowered head first from the turret of M4 medium tank to a litter 
located under the tank. 
to its danger. It also decreases the physical effort re- 
quired on the part of evacuation personnel. ARMORED UMTS 
289 
It has the disadvantage that a considerable amount of 
manhandling is required to complete the evacuation. 
Figure 58.—Showing evacuation by floor hatch method in which casualty 
is lowered head first from the turret of M4 medium tank to a litter 
located under the tank. The casualty is “fed” onto the litter which 
is slowly being pulled along by one or two men under the tank. 
In the presence of gunfire this disadvantage is not suf- 
ficiently great to make evacuation impracticable. 290 
MANUAL OF NAVAL HYGIENE 
Fumes from any gun contain ammonia and carbon 
monoxide. If there are enough fumes in the air to be 
GUN FUMES IN TANKS 
Figuhb 59.—Showing floor hatch method of evacuation in which casualty 
is lowered onto a litter placed under the tank. 
seen, then men are exposed to carbon monoxide. Am- 
monia fumes will be very apparent by their effect on the ARMORED UNITS 
291 
Figure 60.—Showing floor hatch method of evacuation in which casualty 
is lowered feet first onto a litter placed under the tank. 292 
MANUAL OF NAVAL HYGIENIE 
eyes. After five rounds of 75-mm. rapid fire there may 
be enough ammonia in the air to cause irritation of the 
eyes which will interfere with gunnery. Fumes are 
very much the same from 75 mm., 37 mm., and machine 
guns, but the 75 mm. is more dangerous. 
From the tactical point of view ammonia fumes are 
very important because they cause tears. Even though 
the eyes are not irritated it is not safe to assume that 
carbon monoxide is not present as it is tasteless and 
odorless. Carbon monoxide accumulates and gradually 
lowers efficiency. 
Normally there is enough cool air swTept through the 
bulkhead oil coolers to keep the air in the tank safe 
when firing at a slow rate. When tiring is rapid or 
when more than one gun is being fired, then it will be 
necessary to gun the engine to 1,000 or 1,200 r. p. m. 
for 15 to 20 seconds or until the air is clear. 
If the tank is fought as a pill box, hatch covers should 
be left open when possible. Ventilation can be in- 
creased by cracking the overhead hatches and opening 
the floor hatches, thereby creating a draft. Chapter XXII 
RECRUIT SELECTION 
The process of selecting recruits for the naval service 
begins at the recruiting stations and is continued 
(hrough the training period of those who are accepted 
for enlistment. 
The mission of the recruiting service is to insure by 
careful selection of applicants that those accepted as 
enlisted men are individuals of high quality. The 
minimum standards require they should be of good 
repute in their home communities, possess at least 
normal intelligence and a reasonably sound education, 
be physically fit to perform any of the duties to which 
they may be assigned and possess the mental capacity 
to assimilate instruction in those duties. The success 
of this program depends upon the character and ef- 
ficiency of the recruiting personnel, upon a continuing 
policy of establishing and maintaining contacts whereby 
prospects with the desired characteristics will be ob- 
tained, and upon thorough investigation and careful 
physical examination of all applicants prior to 
acceptance. 
The results of the selective recruiting program have 
been evident to the general public in the high quality of 
the men who compose the enlisted force of the Navy, 
and to the service in increased efficiency of enlisted per- 
sonnel, a higher percentage of reenlistments and a lower- 
incidence of avoidable losses such as by desertion and 
by discharge for reasons other than expiration of en- 
298 294 
MANUAL OF NAVAL HYGIENE 
listment. The recruit who can be trained over a period 
of years to perform the duties and accept the respon- 
sibilities of a petty officer is worth two or three who 
leave after the minimum period of service or who must 
be discharged for unsuitability. The misfits who must 
be separated from the service during the first months 
after enlistment constitute a nuisance, and a hindrance. 
The time and effort expended in trying to train them 
has been lost. This could be used better in developing 
more promising candidates rather than in attempting 
to correct the errors or in effecting the discharge of 
those who are readily recognized as inapt for the service. 
In addition to meeting the minimum requirements of 
intelligence, education, and physical fitness, the recruit 
must possess the constitutional qualities and tempera- 
ment necessary to adjust himself to service life. He will 
be called upon to serve under various conditions any- 
where the Navy may operate and it will be his duty to 
assist in the operation and maintenance of the largest 
and most intricate engineering organization in the 
world. In time of national emergency the enlisted per- 
sonnel of the regular Navy who have been well trained 
in their duties constitute a nucleus upon which the naval 
forces can be expanded. Under such conditions they 
will have to assume increased responsibilities and many 
of them will be advanced to warrant and commissioned 
rank. It is obvious therefore why the standards for 
peacetime enlistment must be high and because of this, 
emphasis is placed on quality rather than on a numerical 
quota. The general public is acquainted with the high 
character of the men who compose the enlisted force 
and it is well known that only the specially qualified are 
accepted. Through emphasizing that a career in the RECRUIT SELECTION 
295 
service offers specialized technical training, medical 
care, certain financial return, and retirement benefits 
after a definite period of service, no difficulty is ordi- 
narily encountered in obtaining the required quota. 
There has been no definite educational standard estab- 
lished for recruits although the regulations require that 
a candidate shall be able to read and write and that 
he possess a reasonably quick and clear understanding 
and be able to do a certain amount of elementary arith- 
metic. The applicants for enlistment are given a modi- 
fied intelligence test in an endeavor to determine their 
general mental qualifications for service, to indicate in 
a broad way what special aptitude they may present and 
to eliminate the mentally defective. This procedure is 
known as the group classification test and was first 
used at the naval training stations where it was in- 
troduced in 1923 by the Training Division of the Bureau 
of Naval Personnel. It proved so valuable in eliminat- 
ing mental defectives and providing a means for group 
classification that in 1931 it was introduced at recruit- 
ing stations. During peacetime all of the applicants for 
enlistment are given this test. No man with a mark 
below 50 can be enlisted as an apprentice seaman al- 
though otherwise desirable candidates of this group 
may be enlisted as steward’s mates. The routine use 
of the test at recruiting stations, during wartime, is im- 
practical because of the greatly increased number of 
enlistments. Its use under such conditions in the re- 
cruiting of enlisted personnel is limited to the study of 
borderline cases, the major portion of the classification 
and psychiatric selection of the recruits being carried 
out at the training stations. 296 
m:anual of naval hygiene- 
The physical qualifications required to meet enlist- 
ment standards have been established in detail and are 
based on the principles of sound medical judgment as 
tempered by previous naval experience. As a basic 
requirement an individual must be free of organic 
disease, mental illness, and psychopathic traits. The 
qualifications may be modified from time to time par- 
ticularly in relation to dental, visual, and height-weight 
standards as necessitated by the manpower needs of the 
service. Those men who have defects which are likely 
to become aggravated during active duty in the Navy, 
or which are of such nature that they may later be 
used as the basis for a claim against the Government 
are not accepted. This policy is dictated by existing 
legal provisions whereby a person in active naval 
service who develops aggravation of a disability which 
existed prior to enlistment then becomes eligible for 
certain Government benefits. Furthermore it is very 
important that medical examiners enter all defects 
(deformities, and sequelae of injuries, operations, or 
diseases) which are noted at the time of enlistment, on 
the descriptive sheet and medical history sheets of the 
health record. This is important because it is gener- 
ally held that once a member of the naval service has 
passed the required physical examinations for enlist- 
ment, he must thereafter be considered as having been 
in sound mental and physical condition when accepted, 
excepting where positive facts are presented showing 
the disability complained of existed prior to his en- 
trance into the naval service. Thus in the event an 
individual while in the service becomes disabled be- 
cause of a condition which would appear to have existed 
prior to enlistment, it is necessary that actual facts be 297 
RECRUIT SELECTION 
presented in order to rebut the legal presumption of 
soundness at the time of acceptance. It frequently 
happens that applicants for enlistment are found to 
present minor defects which are disqualifying for ac- 
ceptance according to existing standards. The medica I 
officers do not have the authority to either ignore or 
waive these defects. However, a recommendation may 
be submitted to the Navy Department for waiver pro- 
viding the defects are considered not sufficient to dis- 
qualify for the performance of duty and are not of a 
progressive nature or likely to become aggravated 
by service. The Navy Department policy regarding 
waiver of such defects is influenced by the fact that 
certain conditions which may appear insufficient to 
disqualify for enlistment often become aggravated by 
service; whereas others are of such nature that the indi- 
vidual may complain of symptoms therefrom in order 
to avoid undesirable assignments. There are other 
applicants who present disqualifying defects which are 
amenable to surgical correction. The medical officers 
can assume no responsibility, either for themselves or 
for the Navy, in fitting such applicants for enlistment 
and are not permitted to operate with a view to qualify- 
ing them. Furthermore, no assurance can be given a 
prospective recruit that he will be enlisted once he 
has obtained correction of an otherwise disqualifying 
defect. 
There should be no doubt as to the physical fitness 
of recruits. They must be free from any defect or 
pathological condition which would interfere with the 
performance of the duty expected of them in the serv- 
ice, or which would as a result of service be especially 
liable to undergo progressive change or to become the 298 
MANUAL OF NAVAL HYGIENE 
basis of a claim against the Government. The exam- 
ining surgeon must remember that all candidates ex- 
amined are, unless specifically excepted, enlisted for 
the performance of all duties pertaining to the naval 
service ashore or afloat. The individual’s condition 
must be carefully weighed in relation to the duties he 
may have to perform, inasmuch as candidates for 
special ratings need not possess the physique and en- 
durance of those actively engaged in strictly military 
duties. The presence of slight defects in those who 
have matured or in those who have had previous mili- 
tary or seafaring experience has less significance than 
in the cases of youthful applicants who have been 
adjusted to occupations of a more confining and less 
rigorous character. It is recognized that regardless of 
the thoroughness of the enlistment examination, some 
cases with conditions such as asthma, peptic ulcer, 
glycosuria, so-called orthostatic albuminuria, psoriasis, 
and the like, because of the periodicity or seasonal 
nature of such conditions, will be enlisted while symp- 
tom-free. These individuals either constitute a poten- 
tial liability to the Government from a pension or 
compensation viewpoint or are not physically qualified 
to perform all of their duties and therefore must be 
discharged by medical survey at such time as their dis- 
abilities are recognized. 
It is desirable that the character of the applicant for 
enlistment be studied carefully and his antecedents and 
general reputation in the neighborhood inquired into 
insofar as possible prior to his acceptance. The exist- 
ence of certain constitutional conditions or of latent 
mental illness may not be detected because of lack of 
trained personnel, proper facilities, and the necessary RECRUIT SELECTION 
299 
time to make a complete analysis of the individual’s 
inherent constitutional characteristics and the influence 
of his past environment and previous training. The 
formulation of an opinion, however, as to character, 
personality, ability, and desirability will be greatly 
aided by a review of the applicant’s past history, and 
school and occupational record obtained from his rela- 
tives, neighbors, family physician, and former em- 
ployers. 
At such time as the foregoing procedure has been 
completed and the applicant’s enlistment effected, ar- 
rangements are made for his transfer to a training sta- 
tion where he will undergo the regular recruit training 
program. While such an individual is a potential unit 
of the service, experience has proved it necessary that 
he receive detailed clinical, laboratory, and neuro- 
psychiatric study upon arrival at the training station. 
It has been found advisable to concentrate here the 
trained personnel, special equipment, and observation 
wards necessary to detect obscure disease, latent or pre- 
clinical mental illness, personality defects, and abnor- 
malities of temperament. The medical examination is 
rigid and thorough and includes x-ray chest study as 
an aid in eliminating those with pulmonary tubercu- 
losis or other conditions of such nature as may be of 
present or future clinical significance; and blood sero- 
logical study to eliminate those with syphilis. Any 
physical conditions or defects which may have been over- 
looked at the recruiting office are searched for and, 
if found, are recorded. If the disability is of a minor 
nature its presence is simply noted in the health record, 
but if it is more serious in nature and not necessarily 
a cause for rejection, a request for waiver is submitted 
516368—43 20 300 
MANUAL OF NAVAL HYGIENE- 
by despatch or letter to the Navy Department. When 
such conditions are probable or possible causes for 
rejection the recruit is either kept under observation 
in a duty status or transferred to a naval hospital for 
further study and disposition. Those who are obvi- 
ously disqualified are immediately brought before a 
Board of Medical Survey with a view to discharge. 
It is recognized that incident to enlistment certain 
military ineffectuals consisting largely of the constitu- 
tionally inadequate, some of the borderline mental de- 
fectives, and a few preclinical psychotics will escape 
detection or be able to conceal their condition. This is 
true because it is often difficult to determine during the 
time an applicant is under observation in a recruiting 
office, whether he presents a personality defect or is 
suffering from or is predisposed to mental disease. The 
number of such cases enlisted during peacetime recruit- 
ing is negligible compared to the number accepted dur- 
ing wartime mobilization. This is understandable 
when it is realized that peacetime recruiting is con- 
ducted by medical officers of the regular Navy who have 
had long naval experience, are thoroughly familiar with 
the required standards and cognizant of the difficulty 
those individuals with psychopathic personalities ex- 
perience in adjusting to service situations. Further- 
more, in peacetime recruiting there are long waiting lists 
of applicants for enlistment, and only a small percent- 
age, consisting of the most desirable candidates, need be 
taken. The situation during wartime mobilization is 
quite different. Much of the recruiting must be carried 
out by medical personnel only recently called to active 
duty from civilian life, many of whom have from the RECRUIT SELECTION 
301 
nature of their former occupation had little or no previ- 
ous naval experience. Furthermore a much higher per- 
centage of applicants must necessarily be accepted, and, 
as noted previously, it is not practicable under these con- 
ditions to give all accepted applicants the group classi- 
fication test prior to enlistment. Thus during wartime 
mobilization it has been found necessary to establish 
special units to detect those who would be a continual 
handicap through chronic inaptitude and inefficiency or 
who by breaking down at some critical moment might 
seriously disrupt the functioning of their entire unit. 
To meet this need the Navy Department has set up a 
special organization at each training station. The in- 
coming recruits receive special psychiatric study as a 
part of their medical examination. This is conducted 
by a psychiatric unit composed of qualified psychiatrists 
who are aided by well trained psychologists. Such psy- 
chological tests as modern science has shown practicable 
are used in order to reduce to a minimum the number of 
unsuitable, inapt, and undesirable individuals intro- 
duced into the service. A high percentage of these 
individuals can be detected by trained personnel in the 
course of a 3-minute examination, but with borderline 
cases a period of observation on the psychiatric ward is 
often necessary, and some require a period of observa- 
tion under training conditions. At any time during the 
training period the company commanders may refer 
backward, poorly adjusted, or seemingly maladapted 
individuals to this unit for further study and investiga- 
tion. By analyzing the inherent capacity of the recruits 
it can be determined whether the material is sufficiently 
good to work with and also whether there are present, 302 
MANUAL OF NAVAL HYGIENE' 
traits which will make certain phases of naval life diffi- 
cult or impossible. Such cases as are considered unfit 
for continuation in the service are referred to a special 
board for review and recommendation as to disposition. 
This is known as an aptitude board and functions di- 
rectly under the commanding officer of the training 
station. It is composed of line and medical officers of 
long naval experience, medical officers who are qualified 
psychiatrists, and a psychologist. The boards are 
guided by the knowledge that under all-out wartime 
mobilization a certain percentage of all recruits arriv- 
ing at naval training stations will prove unsuitable 
service material. They recognize that the waging of 
war places a tremendous stress on combat personnel 
and that those personalities already heavily burdened 
by anxiety are apt to break under this stress and become 
disabled by acute anxiety states, confusion, or panic. 
The prevention of these acute disturbances is important 
because of their “psychic contagiousness,” their tend- 
ency to spread through the unit, and the rapidity with 
which they tend to disable others whose feelings of per- 
sonal security are threatened from within. This is 
costly to combat efficiency and precautionary measures 
are vital. With this in view, therefore, and a detailed 
psychiatric analysis of such cases available, the aptitude 
board interviews them and makes appropriate recom- 
mendations to the commanding officer of the training 
station who is authorized to effect the discharge of those 
individuals considered unsuitable for retention in the 
naval service. 
At such time as those recruits who have been found 
qualified have completed their regular recruit training RECRUIT SELECTION 
303 
they are transferred to technical schools for vocational 
training, to the fleet, or to other assignments in the 
service. It is expected that these individuals when 
placed in this new environment will be called upon 
to make certain adjustments. For the most part they 
have been accustomed in civil life to an existence where 
strenuous or prolonged physical exertion, emotional 
stresses and life’s complexities are at a minimum. 
They are called upon suddenly to enter upon a strenuous 
physical hardening process, an altered mode of living, 
and to break home ties and make new friends. There is 
no way of determining whether many of these cases 
are suitable service material except to give them a trial 
on active duty. Having completed their preliminary 
period of basic training they may be assigned to situa- 
tions requiring considerable responsibility and technical 
skill. A number of these men fail, not because they are 
physically defective or lacking in the intellectual equip- 
ment with which to cope with their problems, but be- 
cause they are temperamentally and emotionally inade- 
quate to meet the situation. Under such conditions the 
psychopath has more difficulty in adjusting himself 
than has any other type of individual. A man with 
such a personality usually lacks the perseverance neces- 
sary for constant application and continued persistent 
effort, is not likely to be amenable to discipline, and 
ordinarily cannot comfortably be assimilated in any 
part of the service without having a detrimental influ- 
ence on morale. During peacetime recruiting when a 
well-trained potential nucleus is the goal, it is question- 
able if even the constitutionally inferior types are to be 
accepted, although under all-out wartime mobilization 304 
MANUAL OF NAVAL HYGIENE 
such individuals and the medium-grade intellectual 
types may be acceptable if properly classified and 
utilized in certain assignments within the organization. 
However, those individuals who lack the stamina, the re- 
sourcefulness, or the ability to adjust, whether it be 
physical, mental, or temperamental must of necessity 
be separated from the service. These latent defects 
usually become clinically manifest within from 3 to 6 
months under service conditions and disposition can be 
determined then by bringing the individual concerned 
before a Board of Medical Survey. In this way those 
persons who have demonstrated their unfitness for con- 
tinuation in the service by reason of physical defects, 
or latent, previously unrecognized illness, are dis- 
charged by reason of physical disability whereas those 
who are maladjusted and inapt by reason of personality 
defects are discharged because of unsuitability. 
This review of the recruit selection system in use by 
the United States Navy indicates the care with which 
the enlisted personnel are chosen. The process begins 
in the civilian communities with selective recruiting 
under the jurisdiction of the navy recruiting service. 
It is continued during a conditioning period at the 
naval training stations where highly trained personnel 
endeavor to eliminate the unsuitable recruits through 
careful study and detailed analj-sis of each individual. 
Thereafter these men are observed under actual service 
conditions where those who prove unable to adjust can 
be detected and removed with a view to returning them 
to a civilian status. Thus as a result of repeated exam- 
inations,* thorough study and prolonged observation, 
only the physically and mentally fit are selected. These RECRUIT SELECTION 
305 
individuals possess the qualities which enable them, to 
carry on under adverse conditions of many types. 
They possess the perserverance to continue through 
long weeks and months of training practice and under 
actual war conditions. Most important of all when 
the ship which they man meets the supreme test of 
battle the members of the crew will not be found want- 
ing. Chapter XXIII 
MENTAL HYGIENE 
Mental hygiene in the Navy may be defined as that 
branch of psychiatry which is concerned primarily with 
the prevention of mental disease, and the maintenance 
of the personnel, both afloat and ashore, at the peak 
of mental health at all times. 
Prevention of Mental Disease 
The prevention of mental disease in the Navy may be 
conveniently discussed under the following headings: 
(A) Screening Methods; (B) Detection of Mental 
Disorders; (C) Elimination of the Mentally Unfit; 
and (D) Special Prophylactic Measures. 
(A) Screening Methods. 
Recruiting office.—Any program for excluding the 
mentally unfit at the recruiting office should always 
include: {a) Careful selection of personnel assigned to 
recruiting duty; (b) rigid qualifications for enlistment 
as far as the nervous system is concerned; (c) use of 
a general classification test; (d) appraisal of the per- 
sonal traits of each applicant, and an investigation of 
his moral character; (e) utilization of the records avail- 
able through the police, schools, employment agencies, 
hospitals, and mental hygiene clinics in this weeding- 
out process; and (/) assistance of the Red Cross Social 
Service in obtaining histories and other data. 
306 307 
MENTAL HYGIENE 
Training stations.—Screening methods in use at the 
training station are the following; (a) Preliminary 
psychiatric survey of all incoming recruits; (b) de- 
tailed study by the psychiatric unit of all recruits sus- 
pected of having neurological or mental handicaps; 
(c) psychological examination of recruits by a psychol- 
ogist whenever indicated to evaluate their abilities and 
determine their emotional characteristics; and (d) 
inaptitude discharge from the service of all recruits 
found to be mentally unfit for retention therein. 
(B) Detection of Mental Disorders. 
Mental deficiency.—Low-grade defectives constitute 
no particular problem in the recruiting office. The de- 
tection of borderline feeblemindedness, however, is 
often quite difficult. Appropriate questions should be 
put to the applicant to determine his intellectual capac- 
ity. If he has a poor school record, with failure to be 
promoted in several grades, some degree of mental 
deficiency should he suspected, and psychometric 
studies are indicated. The feebleminded recruit is soon 
spotted at the training station by his to under- 
stand orders and comply with instructions. 
Psychopathic states.—The diagnosis of the psycho- 
pathic states in the recruiting office is based on the social 
history, which is usually not available. An endeavor 
should be made, therefore, to obtain from the applicant 
himself any evidence of family conflicts, irregular work 
record, nomadism, hoboism, traffic accidents, and fre- 
quent arrests, all of which are highly suggestive of 
psychopathy. A few characteristics of the psychopath, 
such as smugness, evasion, lying, arrogance, a marked 308 
MANUAL OF NAVAL HYGIENE 
gift of gab, and a tendency to brag over his escapades, 
may be revealed during the examination. At the 
training station, the regimentation and rigid discipline 
tend to bring out latent psychopathic traits which be- 
fore were not apparent. 
Psychoneuroses.—In order to detect the psychoneu- 
roses in the recruiting office, the applicant should be 
questioned concerning nervous traits and symptoms, 
past and present. The hysteric is apt to overdramatize, 
but he usually reacts fairly well to the examination 
because it is a distinct novelty to him. The obsessive 
individual may insist upon performing some act in a 
certain way, or he may answer questions in an inde- 
cisive fashion. Anxiety neurosis will reveal itself by 
unusual sweating, rapid pulse, apprehensive expres- 
sion, and coarse tremors. Neurasthenia should be sus- 
pected if the applicant appears thin and undernour- 
ished, weak and fatigued, speaks with an effort, and 
has a hypotension. The routine at the training sta- 
tion soon produces all sorts of bizarre complaints in 
recruits with no organic basis, which stamps them as 
being psychoneurotic. 
Schizophrenia.—When we attempt to detect the pre- 
schizoid personalities in the recruiting office, we run 
into difficulty. Very characteristic is a tendency of the 
applicant to preoccupation with little or no affective 
response during the entire examination. He may be 
calm or nervous, show extraordinary reserve, or volun- 
teer unexpected information. Perhaps the most im- 
portant point in the diagnosis is the sensation of queer- 
ness or strangeness which he creates in the examiner. 
The preschizoid applicant with paranoid trends should 
also be borne in mind. He is apt to watch closely every MENTAL HYGIENE 
309 
move the medical officer makes, and may reveal his sus- 
picious nature by demanding to know the reason for 
certain steps in the routine. Physical examination 
often reveals muscular tensions, mannerisms, cyanotic 
extremities, dermographia, and hyperactive reflexes. 
At the training station, the preschizoid recruit is easily 
detected because of his unusual and erratic behavior. 
I n addition, the social history may reveal a personality 
change or previous institutional care. 
Manic-depressive psychosis.—The future victim of 
this disorder may possibly show some suggestive clues 
in the recruiting office which might lead to his exclu- 
sion. If in the manic phase, his speech and mode of 
expression are apt to be jerky and flighty. Distracti- 
bility is often evidenced by his interest in irrelevant 
matters not connected with the examination. Irrita- 
bility over delays in routine procedures is character- 
istic, although he will be friendly and jovial most of 
the time. An applicant in the depressed phase appears 
solemn and morose, volunteers little information, and 
answers questions in monosyllables. Physical examina- 
tion is usually negative. Mood swings and cyclothymic 
disturbances are quickly brought to the surface at the 
training station and are not difficult to diagnose. 
Epilepsies.—The epilepsies are often overlooked in 
the recruiting office. The applicant should always be 
questioned in detail concerning fits, convulsive seizures, 
spasms, or attacks of unconsciousness. In all proba- 
bility they will be denied, but the desired information 
may be obtained in some cases. The classical epileptic 
is morose, irritable, suspicious, hypochondriacal, ego- 
centric, and hyperreligious. Physical examination 
may show evidences of old injuries or tongue biting 310 
MANUAL OF NAVAL HYGIENE 
from previous spells. At the training station, the re- 
cruit may have a frank seizure, or his perverse make-up 
and periods of transitory ill humor will bring him to 
the attention of the psychiatrist. 
(C) Elimination or the Mentally Unfit. 
Medical officers, both afloat and ashore, should be 
constantly on the alert for the appearance of nervous 
and mental disorders in the personnel of the Navy. 
These cases can be detected in their incipiency if every 
medical officer will take the trouble to acquaint himself 
with the prodromal signs, the early symptoms, and the 
diagnostic criteria of the neuroses, psychoses, and 
psycho-somatic conditions. The medical officer aboard 
ship can often spot those who are maladjusted and 
likely to break down, by paying particular attention to 
the frequent visitors to the sickhay, by checking up on 
the men who are repeatedly up to mast for infractions 
of discipline, and by talking over personnel problems 
with chief petty officers and division officers. As soon 
as a mental disorder is discovered in anyone in the serv- 
ice, he should be evacuated at once to a hospital, and 
there disposed of in accordance with instructions in the 
Manual for the Medical Department. 
(D) Special Prophylactic Measures, 
Heredity.—There has been a tendency to exaggerate 
the importance of heredity in the cause of mental 
disease. More often than not when a correct evalua- 
tion of the causative factors in the breakdown of an 
individual has been made, the fault has been found to 
be in the environment and not in the antecedents. 
Many measures have been suggested for preventing 
mental disease by controlling heredity. These include MENTAL HYGIENE 
311 
strict marriage laws, segregation of the mentally in- 
capacitated, birth control, and sterilization. Such 
methods as these cannot, of course, be applied in the 
Navy. In connection with this subject, the question 
often arises as to whether or not a history of insanity 
in the family is a sufficient cause for rejecting an appli- 
cant for enlistment. Generally speaking, if he is 
normal in every other way, he should be accepted, de- 
spite the hereditary taint. On the other hand, if one 
or both of his parents and several close relatives have 
been insane, it is wise to reject him even though he is 
physically perfect. 
Childhood.—Perhaps the most important causative 
factor in the development of mental disease is faulty 
hygiene during childhood. This is particularly true 
in schizophrenia, manic-depressive psychosis, and the 
psychoneuroses. Preventive measures consist in the 
early recognition of abnormal trends in children, as 
well as vicious parental attitudes and environmental 
influences, and in correcting them immediately. This 
involves a knowledge of child guidance, the psycho- 
pathology of childhood, and the problems of adoles- 
cence, which we cannot go into here. Very little can 
be done in the Navy, therefore, to prevent the occur- 
rence of the conditions named above, since prophylaxis 
to be effective must be instituted before the individual 
enters the service. 
Syphilis.—The prevention of the syphilitic psychoses, 
notably dementia paralytica and tabo-paresis, de- 
pends primarily upon the complete stamping out of 
ilues. Despite personal prophylaxis and the efforts 
being put forth by various agencies to control venereal 
infection, the chances are that syphilis will always be 312 
MANUAL OF NAVAL HYGIENE 
more or less prevalent. Much can be done, however, 
towards lessening the incidence of its after-effects by 
early diagnosis, repeated spinal fluid examinations, and 
adequate treatment in the primary and secondary 
stages, including malaria combined with chemotherapy. 
Alcohol.—Prophylactic measures, as far as the alco- 
holic psychoses are concerned, consist in the reduction 
of the amount of alcohol habitually consumed, strict 
requirements as to the quality of liquor produced and 
sold, proper diet fortified by vitamins when drinking, 
and psychotherapy. Much more can be accomplished 
by a nation-wide educational program than by legisla- 
tion, In the Navy, it might be helpful for medical 
officers to give periodic lectures to all hands on the 
psychological and organic damages resulting from ex- 
cessive indulgence in alcohol. 
Avitaminoses.—No definite correlation has been made 
between avitaminosis A, C, I), and K, and mental 
disease in general. Associated with vitamin E de- 
ficiency, which produces sterility, there may be feelings 
of inferiority, symptoms of anxiety, and neurasthenic 
states. Lack of vitamin Bx gives rise to a central and 
peripheral neuronitis, beriberi and Wernicke’s disease, 
with their accompanying mental symptoms. Deficiency 
in vitamin B2 causes the psychotic manifestations of 
pellagra. Measures for the prevention of these con- 
ditions, which are rare in the Navy, are simple and 
obvious. 
Trauma.—Neither the traumatic psychoses nor the 
so-called traumatic neuroses are particularly prevalent 
in the Navy. These disorders are preventable. Every 
possible safeguard should be provided for the elimina- 
tion of accidents and injuries on board ship, at shore MENTAL HYGIENE 
313 
stations, and wherever the men are engaged in hazardous 
work. Important also is the attitude of the medical 
officer when treating a patient suffering from a trauma. 
He should be perfectly frank, and avoid any suggestion 
that may determine the development of nervous or 
mental symptoms. 
Infections.—M e n t a 1 disturbances, characterized 
mainly by delirium, disorientation, motor excitement, 
and hallucinations, often arise in the course of pneumo- 
nia, influenza, malaria, erysipelas, septicemia, cerebro- 
spinal meningitis, and many other febrile diseases. In 
addition, asthenic and exhaustive states frequently fol- 
low in their wake. Prophylaxis depends upon the pre- 
vention of the underlying infection, and the proper 
treatment of the patient, both in the acute stages and 
during convalescence. 
Drugs.—Certain drugs, such as morphine, cocaine, 
bromides, barbiturates, marihuana, cannabis indica, and 
others, are apt to cause psychotic manifestations when 
taken excessively over a long period of time. The 
habitue undergoes a moral rather than an intellectual 
deterioration, and he is usually regarded as a degenerate 
by the community instead of a person who is mentally 
ill. The only feasible hope for prevention lies in rigid 
Government supervision and restriction of the habit- 
forming drugs to the amounts actually needed by 
physicians. Medical officers in the Navy should be 
particularly careful in handling and accounting for all 
narcotics in their custody. 
Fatigue.—The true nature of fatigue has not been 
discovered or elucidated. Its exact relationship to men- 
tal illness, which still remains obscure, is a psychiatric 
problem worthy of intensive study. No matter how 314 
MANUAL OF NAVAL HYGIENE 
much men may be forced, or how willing they may be 
to carry on, they become inefficient when subjected to 
more than a certain amount of fatigue. In fact, as a 
result of physical and mental exhaustion, they may de- 
velop signs of anxiety, insomnia, irritability, loss of 
appetite, and exaggerated fears. It must be remembered 
however, that fatigability is a common symptom of 
practically all the psychoses and neuroses, and not neces- 
sarily the cause. The prevention of fatigue is very im- 
portant. Fighting men must be relieved from their 
duties, if they are particularly strenuous, at periodic in- 
tervals, provided it does not interfere with the military 
requirements. It is a good plan to remove them from 
the combat area, if possible, and give them opportunity 
for relaxation in camps provided for the purpose or else- 
where. It should be emphasized, however, that recrea- 
tion, diversion, exercise, and psychotherapy are often 
more effective in combating fatigue than prolonged rest, 
which is not the panacea it is generally supposed to be. 
In discussing measures for maintaining the person 
nel, both ashore and afloat, at the peak of mental health 
we must consider (a) the Navy as a, whole, (b) the in- 
dividual. 
Maintenance of Mental Health 
(A) The navy as a whole. 
The possibilities of maintaining the mental health 
of the Navy at a high level are legion. Lessening the 
strain on the personnel can be accomplished by con- 
stantly improving the surroundings and conditions 
under which the men must live and fight. In other 
words, all possible physical comforts should be provided 
and irritating influences removed. Fitness of the 315 
MENTAL HYGIENE 
body likewise tends to insure efficiency of the mind. 
Good food also conditions mental health. In addi- 
tion, an attempt should be made to place each man in 
the job which he likes and is best suited for. The 
psychology of self-preservation and herd instincts, and 
the various ways of controlling fear, should be ex- 
plained to the personnel by circulars and lectures sys- 
tematically prepared. A thorough knowledge of the 
objectives and principles for which we are fighting, and 
a firm belief in their attainability, are important aids to 
the mental health of a fighting Navy. As far as pos- 
sible, the men should be kept informed about what is 
going on, the mission of the ship or force, and the plan 
of battle. This helps to produce a healthy state of 
mind and esprit de corps in the personnel. Increased 
facilities for taking care of the families of officers and 
enlisted men in naval hospitals and dispensaries, ex- 
pansion of the activities of the Navy Relief Society, 
frequent and regular deliveries of mail to the fleet and 
outlying stations, and periodic leave whenever practi- 
cable, are all measures that contribute to the morale, 
and hence the mental health, of all hands. 
(B) The individual. 
The individual in the Navy can improve and main- 
tain his mental health himself by cultivating those 
habits and thoughts which enable him to make an ade- 
quate adjustment to service life. A few suggestions 
will suffice. The emotions should not be suppressed 
indefinitely. A natural outlet must be found for them, 
and they should be controlled by use of the intellect. 
The many annoying and irritating situations which are 
constantly arising should be pushed aside without wor- 316 
MANUAL OF NAVAL HYGIENE 
rying or brooding over them. One of the attributes of 
a healthy mind is tolerance of the opinions of others. 
We must also approach the problems that confront us 
with courage and confidence. This will enable us to 
solve them easily. To keep the mind in optimum 
health, one must work and be active. Every person, 
however, no matter how much he may be absorbed in 
what he is doing, should have interests outside of his 
occupation. Recreation and hobbies serve as a mental 
tonic. Finally, a sense of humor, combined with a 
cheerful and amiable disposition, dispels distressing 
thoughts, relieves tension, and keeps us from taking 
ourselves and life too seriously. Chapter XXIV 
QUARANTINE RULES AND REGULATIONS 
It is unlawful for any merchant ship or other vessel 
from any foreign port or place to enter any port of 
the United States except in accordance with the 
provisions of the quarantine laws and the rules and 
regidations of state and municipal health authorities. 
Every vessel subject to quarantine inspection, enter- 
ing a port of the United States, its possessions or de- 
pendencies, is considered to be in quarantine until given 
free pratique. Such vessel must fly a yellow flag at 
the fore and observe all the other requirements of ves- 
sels actually quarantined. 
No person, except the quarantine officer, quarantine 
employees, or pilots, will be permitted to board any 
vessel subject to quarantine inspection until after the 
vessel has been inspected by the quarantine officer and 
granted free pratique, except with the permission of 
the quarantine officer, and any person boarding such 
vessel may, in the discretion of the quarantine officer, 
be subject to the same restrictions as those imposed 
on the personnel of the vessel. 
Pratique is that freedom of the port which is ex- 
tended by a certificate, signed by the quarantine officer, 
to the effect that a vessel has, in all respects, complied 
with the quarantine laws, and that all on board are free 
from quarantinable diseases or the danger of conveying 
the same. 
317 318 
MANUAL OF NAVAL HYGIENE 
The quarantine laws and regulations of the United 
States designate the following as quarantinable dis- 
eases : 
(1) Cholera, period of incubation 1 to 5, usually 3 days. 
(2) Yellow fever, period of incubation 3 to 6 days. 
(3) Smallpox, period of incubation 8 to 16 days. 
(4) Typhus fever, period of incubation 5 to 20 days. 
(5) Leprosy; alien lepers are not permitted to land; if a 
citizen, the case is dealt with according to the State 
laws of the port of entry. 
(6) Plague, period of incubation 3 to 7 days. 
(7) Anthrax, period of incubation 7 days. 
A ship arriving in the United States with any of these 
diseases on board will be placed in quarantine. 
A hill of health is an official document issued by the 
proper port official at a port of departure concerning 
principally the sanitary and health conditions in and 
adjacent to the port. United States bills of health 
are usually issued by United States consular officers 
or United States Public Health Service medical officers. 
Any vessel clearing from a foreign port for any port 
or place in the United States must obtain from the 
consul, vice consul, or other consular officer of the 
United States at the port of departure, or from the 
medical officer where such officer has been detailed by 
the President for that purpose, a bill of health in 
duplicate, setting forth the sanitary history and condi- 
tion of the vessel, and that it has in all respects com- 
plied with the rules and regulations prescribed for 
securing the best sanitary condition of the vessel, its 
cargo, passengers, and crew. 
The President, in his discretion, is authorized to de- 
tail any medical officer of the Government to the office QUARANTINE RULES AND REGULATIONS 
319 
of the consul at any foreign port for the purpose of 
furnishing information and making the inspection and 
giving the above-mentioned bills of health. 
Under the quarantine laws and regulations of the 
United States every vessel departing from a port in 
the insular possessions or dependencies of the United 
States for a port in the United States, is required to 
take out an American bill of health in duplicate. In- 
asmuch as there are no American consuls stationed in 
ports in the insular possessions and dependencies of the 
United States such bills of health are issued by the 
quarantine officer on duty in such ports. 
The issuance of American bills of health by such 
quarantine officers is conditioned upon the proper 
observance of the outbound quarantine requirements 
prescribed in the quarantine regulations issued by the 
Public Health Service. Vessels will be given bills of 
health by the quarantine officer only when such appro- 
priate provisions have been properly observed. 
If the quarantine officer is not satisfied that such 
requirements have been properly observed, and that a 
vessel may safely enter any port in the United States, 
its possessions or dependencies, without danger of in- 
troducing quarantinable disease, he may refuse to issue 
a bill of health and in event of departure of the vessel 
without the required bill of health, may report by cable 
to the quarantine officer at the port of destination that 
the vessel has been refused a bill of health and the 
reasons therefor. 
Collectors of customs may refuse entry to vessels 
from ports in the possessions and dependencies of the 
United States which fail to present a bill of health, 320 
MANUAL OF NAVAL HYGIENE 
and remand such vessels to the quarantine station for 
quarantine inspection and such treatment as may be 
necessary prior to entry. 
These instructions must be observed in the Virgin 
Islands, Puerto Rico, the Panama Canal Zone, the 
Hawaiian Islands, and other insular possessions or 
dependencies of the United States. 
Commanding officers of naval vessels, on entering 
a port, foreign or domestic, are required to comply 
strictly with all its quarantine regulations. They 
should afford every facility to visiting health officers 
and furnish any information they may require. If 
doubt exists as to the regulations of the port, no com- 
munication should be held with the shore, with boats, or 
with other ships, until a sufficient time has elapsed to 
allow for the visit of the health officer. 
Upon arrival of the ship in port the medical officer 
should be prepared to receive the health officer and 
exhibit to him the bill of health; also to answer any 
questions that may be asked concerning the sanitary 
condition of the ship. 
If a naval vessel arrives in port with a quarantinable 
disease on board, or such a disease breaks out while 
lying in port, the fact must be reported at once to the 
commander in chief or senior officer present. The com- 
manding officer should hoist the quarantine flag and 
prevent all communication likely to spread the disease 
elsewhere until pratique is received. In order to check 
the spread of the disease on board ship, arrangements 
should be made with the authorities of the port for the 
care and treatment of the patients on shore or on board QUARANTINE RULES AND REGULATIONS 
321 
a hulk. If at sea in company with other ships and a 
quarantinable disease exists or appears on board, the 
quarantine flag should be kept flying as long as the 
disease lasts. 
By arrangement with the Treasury Department, 
ships of the Navy to which medical officers are attached 
are ordinarily exempt from quarantine inspection. A 
certificate furnished by the ship’s medical officer as to 
the sanitary condition of the vessel and record of com- 
municable diseases may be accepted by the quarantine 
officer in lieu of actual inspection. In case pratique is 
granted by radio communication the medical officer 
upon arrival in port must forward the bill of health in 
duplicate to the quarantine officer, together with a state- 
ment as to sanitary condition, including number of 
cases of any communicable disease on board. A vessel 
of the Navy without a medical officer is subject to the 
provisions of quarantine regulations as they apply to 
merchant vessels. 
Vessels of the United States Navy which carry a 
medical officer upon entering the United States ports 
from foreign ports or from ports in the possessions or 
dependencies of the United States are exempt from 
quarantine inspection provided that such vessels have 
not sailed from a port infected with cholera, yellow 
fever, plague, typhus or smallpox and further provided 
that no case of these quarantinable diseases has occurred 
on board en route. 
Naval vessels coming within the above provisions 
will radio to the naval authorities at the port of 
destination for relay to the quarantine officer, or will 
radio direct to the quarantine officer, a report of the 322 
MANUAL OF NAVAL HYGIENIE 
pertinent facts, including a statement to the effect that 
no cases of these quarantinable diseases have occurred 
on board during the voyage. The radio quarantine 
message should include an enumeration of the port of 
departure and all subsequent ports of call on the home- 
ward-bound voyage, together with a statement as to the 
reported presence or absence of quarantinable diseases 
in those ports. 
Immediately following the arrival of the vessel at 
the first United States port, the commanding officer 
should address a letter to the quarantine officer report- 
ing the pertinent facts, including a statement by the 
ship’s medical officer to the effect that no case of the 
above-mentioned quarantinable diseases occurred on 
board during the voyage, giving the name and rank of 
the ship’s medical officer, and enclosing duplicate copies 
of the American bills of health taken out by the vessel 
at the port of departure and each subsequent port of 
call on the homeward-bound voyage. 
When two or more vessels of the smaller type, such 
as destroyers, only one of which carries a medical of- 
ficer, are cruising together, one certificate will be ac- 
cepted for the quarantine clearance of the group. 
These provisions do not apply to vessels which do not 
carry a medical officer or are not certified for by a medical 
officer as provided in the preceding paragraphs. 
Vessels of the United States Navy having entered the 
harbors of infected ports, but having held no com- 
munication which is liable to convey infection, may 
be exempted from the disinfection and detention im- 
posed on merchant vessels from such ports. 
Naval vessels clearing from one United States port 
for another United States port do not ordinarily pro- QUARANTINE RULES AND REGULATIONS 
323 
cure a bill of health for presentation at the port of arri- 
val. Local or State authorities at the port of arrival 
may, however, require the exhibition of a bill of health 
under special circumstances, such as when some epidemic 
disease exists at the port of departure, and under such 
circumstances it is advisable for the medical officer to 
procure a bill of health. 
A naval vessel departing from a port in the con- 
tinental United States for a port in the Canal Zone 
or United States possessions is not required to procure 
a bill of health or port sanitary statement at such port 
of departure, except when plague, cholera, or yellow 
fever exist, or typhus fever or smallpox prevail in 
epidemic form, in the port of departure. 
A naval vessel departing from a port in the posses- 
sions or dependencies of the United States for a port 
in the Canal Zone or other United States possessions 
is required to procure a bill of health in duplicate at 
each port of departure. 
Naval vessels sailing from a United States port to 
a foreign port should always procure a bill of health 
from the proper authorities and have it visaed by the 
consular or other representative of the country or 
countries of ports of call, if such ports can be de- 
termined upon prior to sailing. A naval vessel sailing 
from a foreign port to another foreign port shall like- 
wise procure and have visaed a bill of health. 
The following measures are observed in connection 
with quarantine inspection and treatment of aircraft 
of the military forces of the United States: 
Glass I. In the absence of quarantinable diseases or epidemic 
conditions at any port of departure or call, flights of military air- 324 
MANUAL OF NAVAL HYGIENE 
craft of the United States may be made nonstop to and from the 
following areas without quarantine restrictions: 
United States. 
Puerto Rico. 
Canal Zone. 
Virgin Islands. 
Alaska. 
Canada. 
Cuba and Bahama Islands. 
(All other islands of the Car- 
ibbean area where United 
States air bases may be es- 
tablished are included.) 
Class II. Flights having contact with all other areas.—The 
officer in charge of the flight should communicate with the quar- 
antine authority in the area where landing is contemplated in 
ample time to permit this official to be on the field and carry 
out such procedures as may be indicated. 
All personnel on the flight must be confined to the landing field, 
or to such area as may be designated by the quarantine officer, 
until released by the quarantine officer. 
For the period of the existing national emergency, 
the Surgeon General of the United States Public Health 
Service may in his discretion, when requested by the 
competent military authorities, designate the senior 
medical officer of an Army or a Navy air base to serve 
as quarantine officer for the inspection and treatment 
of military aircraft, carrying only military personnel, 
which may be proceeding on confidential missions. This 
delegation of quarantine authority will convey to the 
military service concerned full responsibility for pre- 
venting the introduction into the United States of dan- 
gerous communicable diseases and of insect vectors of 
disease. 
Further instructions relative to the quarantine in- 
spection and treatment of aircraft of the military forces 
of the United States are included in United States 
Public Health Service Foreign Quarantine Division 
Circular No. 71, revised December 20, 1941. Due to 
lack of space it is not possible to include all of these QUARANTINE RULES AND REGULATIONS 
325 
instructions in this section. Furthermore, some of the 
instructions apply to wartime measures and are of a 
temporary nature. 
For further information relative to the laws, rules 
and regulations relating to quarantine and bills of 
health, attention is invited to chapter 2, title 42, U. S. 
Code; Code of Federal Regulations and Circulars issued 
by the Public Health Service; section 1, chapter 40, 
U. S. Navy Regulations; chapter 18, Manual of the 
Medical Department, U. S. Navy; and General Orders 
Nos. 42, 157, and 162. Chapter XXV 
IDENTIFICATION RECORDS 
Means of identification are essential. Identification 
records constitute integral facets in naval service and 
operation. The advantages of the record system need 
not be emphasized. By its means identification is 
prompt, inevitable, and accurate. 
To establish beyond a doubt is the purpose of the 
naval identification system. The identity of the re- 
mains of service personnel may hinge on an apparently 
trivial and insignificant mark noted at the time of en- 
listment. Consequently instructions for processing the 
record are minute, and separate directives are issued 
for the more difficult procedures narrating their proper 
execution. 
Identification records in the naval service consist 
principally of the general descriptive list and the iden- 
tification record in the service record, the physical 
examination record and the health chart, the dental 
record, the identification card for naval reserves and 
for civilians, the photo pass card, the identification 
fingerprint record, the personal identification and en- 
listment fingerprint card, and the identification tag. 
Each of these has a specific purpose and the composite 
picture that may be garnered from them will describe 
the general character of the individual and will lead to 
320 327 
IDENTIFICATION RECORDS 
his identity either from the summation of parts or from 
the peculiar characteristic of a part. 
Illustrative of this fact, from the dental record alone 
it may be possible to recognize a service personnel 
whose remains might have been recovered from the sea 
or who had been killed in a burning airplane or mu- 
tilated by some disfiguring accident. 
The forms are prepared for the most part at the time 
of enlistment or reeinlistment. Some are renewed at 
enrollment, commission or promotion. Others are 
added to from time to time with the inclusion of modi- 
fying marks or scars, or any change that might alter 
the description of the service personnel, as for example 
the extraction of teeth since the last physical ex- 
amination. 
Owing to the urgency of the war, some of the forms 
are modified as well as parts of their subject matter 
deleted. For example, it is no longer required to have 
the identification tags restricted to Monel metal or the 
fingerprint etched thereon. These directives have been 
superseded by other instructions more appropriate to 
the circumstances of war. Any noncorrosive metal may 
now be substituted for the specific Monel plate. 
It is said that Purkinje, the physiologist, was one of 
the first to call attention to the value of the fingerprint 
as an identifying record. Unfortunately his suggestion 
went unheeded until the time of Galton. Now this 
method is universal. 
So important does the Navy look on this means of 
establishing the identity of its service personnel that a 
special instruction manual is issued describing the 
proper technic for making perfect prints. A smuggy, 
blurred print defeats its purpose, making it difficult or 328 
MANUAL OF NAVAL HYGIENE 
nearly impossible to discern the characteristics of an 
impression. 
Occasionally circumstances prevail that of their na- 
ture make the deciphering of fingerprints a most diffi- 
cult operation. Bodies for instance lost at sea and 
recovered will have the skin of the fingertips macerated 
or greatly shriveled and wrinkled. Treatment must be 
necessary before satisfactory prints can be made. 
Water therefore is injected beneath the skin of the 
fingertips by means of a hypodermic needle smoothing 
out the skin. Impressions taken in this manner may 
readily be compared. A blurred original will only add 
to the complication. Hence the regulation insisting on 
as nearly perfect fingerprints as possible. 
The following are the identifying steps which carry 
a man into and through the naval service: 
1. The descriptive list and identification record in his 
service record. 
2. The physical examination sheet on his health rec- 
ord. This carries a complete record of physical exam- 
ination on entry, enlistment, or reenlistment, with all 
identifying marks; and an impression of the right index 
finger. 
3. The dental record. This is another sheet in his 
health record, carrying all details of condition of teeth 
as to number, repairs, and replacements. 
4. Fingerprint record (identification). This is a 
Bureau of Naval Personnel form; on one side are spaces 
for individual and grouped fingers; on the other space 
for brief data as to name, date, birth, etc., and outlined 
figure for marking of scars, tattooing, moles, etc. 
5. The personal identification and enlistment finger- 
print card. This is designed for the purpose of check- 329 
IDENTIFICATION RECORDS 
ing on the criminal record of an individual desirous of 
entering the Navy or Marine Corps. Each applicant 
for enlistment or reenlistment in the naval service has 
one of these forms prepared. It is then forwarded to 
the Federal Bureau of Investigation and not infre- 
quently it leads to the identification and apprehension 
of individuals with criminal records and others who are 
undesirable for naval service. 
6. Identification tag. This is a small disk of Monel 
or other corrosion-resistant metal, carrying name, des- 
ignating number, blood group, and date of last tetanus 
toxoid inoculation. This is worn in duplicate on the 
body with a fire-resistant chain or wire. Chapter XXVI 
PROCUREMENT OF MEDICAL AND DENTAL 
SUPPLIES 
The Naval Medical Supply Depot under this title was 
authorized by Secretary of the Navy Morton, on May 
26, 1905, and a building located on Flushing Avenue, 
Brooklyn, N. Y., within the naval hospital reservation 
was erected for the purpose. This building was evacu- 
ated upon the completion of the present building, the 
third, at Sands and Pearl Streets, October 15, 1918. 
The Naval Medical Supply Depot at San Francisco. 
Calif., is a development of a small depot formerly 
located in the Mare Island Navy Yard. During the 
period 1929 to 1939 this depot’s function consisted 
chiefly of replenishment issues to ships and minor shore 
stations. With the growth of the Navy the depot stor- 
age was expanded but the two-ocean navy soon demon- 
strated that a large depot and a better location was 
required. The permanent depot is under construction 
at Oakland, Calif. In the meantime, the San Francisco 
depot is in rented facilities. 
While the emergency has modified the routine some- 
what, the basic function of the Brooklyn Medical Sup- 
ply Depot is as follows to: 
(1) Provide standard medical stores (a) for the fleet 
and outlying shore stations, and (6) for shore stations 
within the United States. 
3B0 PROCUREMENT OF MEDICAL AND DENTAL SUPPLIES 
331 
(2) Maintain on hand, in accordance with approved 
naval policy, such medical stores as may he designated 
by the Bureau. 
(3) Provide facilities for salvage and for repair of 
medical equipment. 
(4) Provide laboratory facilities for examination 
and testing of medical stores. 
(5) Develop and revise material specifications for 
medical stores and initiate recommendation for revision 
of Federal, Navy Department, and Bureau specifications 
when indicated. 
(6) Develop logistic data relative to medical stores. 
(7) Develop and revise commissioning-outfit lists of 
material for ships and shore stations. 
(8) Recommend modifications in the Supply and 
Supplementary Supply Tables, annually, October 1. 
At San Francisco, Calif.: 
(1) Maintain on hand a minimum quantity of each 
supply-catalog item of medical stores, except perish- 
ables, equal to the average annual issues plus such 
quantities of reserve stores as may be designated by the 
Bureau. 
(2) Establish a maximum quantity of each supply- 
catalog item of medical stores, except perishables, equal 
to twice the average annual issues (par. 3148), plus such 
quantities of reserve stores as may be designated by the 
Bureau. 
(3) Establish a replenishment order point for each 
supply-catalog item of medical stores, except perish- 
ables ; the replenishment order point is a quantity con- 
sisting of minimum quantity plus a quantity sufficient 
to meet average issues for the number of months nor- 
mally required to obtain replenishments. 
516368 —43 22 332 
MANUAL OF NAVAL HYGIENE 
(4) Submit normal replenishment requisitions four 
times annually (following the beginning of each quar- 
ter) . This procedure should result in replenishment of 
approximately one-fourth of the items carried, to the 
maximum quantity, each quarter, and, except for fluc- 
tuations in current issues, the replenishment quantities 
requisitioned should approximate 1 year’s average is- 
sues. Replenishment quantities shall be adjusted to the 
nearest case unit, except when such adjustment would 
exceed 2 months’ average issues. 
(5) Suitable modification of the foregoing procedure 
should be made in the case of stores subject to rapid 
deterioration. 
Both the medical supply depots have by reason of the 
emergency been expanded by adding medical supply 
storehouses to their existing facilities. 
At Brooklyn, they operate subsidiary storehouses at 
Newport, R. I.; Norfolk, Va.,; Charleston, S. C.; and 
New Orleans, La. 
San Francisco depot operates storehouses at Seattle, 
Wash.; Long Beach, Calif.; and San Diego, Calif. 
The Manual of the Medical Department prescribes 
the routine for requisitioning material from depots. 
This is basic. For the emergency certain modifications 
of the prescribed routine are in effect. Briefly, practi- 
cally all overseas activities, ashore and afloat, are replen- 
ished through the storehouse system and under regula- 
tions and routines as prescribed by area commanders. 
Within the United States, activities ashore and afloat 
use the NMS Form 4 requisition (7 copies) system, sub- 
mitting requisitions direct to Brooklyn or San Fran- 
cisco as location dictates, except in emergencies when 
local storehouse if existing, may be utilized. PROCUREMENT OF MEDICAL AND DENTAL SUPPLIES 
333 
ORGANIZATION 
U.S. NAVAL MEDICAL SUPPLY DEPOT, BROOKLYN, N.Y. 
CHARGING 
SECTION 
PUBLIC VOUCHER 
SECTION 
ACCOUNTING 
DIVISION 
OFFICE SERVICE 
SECTION 
GENERAL LEDGER 
SECTION 
PAYROLL ( 
TI HEKEEPING 
SECTION 
STOCK 
SECTION 
SHIPPING 
SECTION 
Command i ng 
Officer 
of Depot 
ExecutIve 
Officer 
OPERATING 
DIVISION 
)Building $ equip- 
MENT HAINTElfflcE 
SECTION 
Figure 61 
R|ENSMCnON 
SECTION 
ASSEMBLY i 
SECTION 
TALLY 
SECTION 
PURCHASE 
SECTION 
PROCUREMENT 
DIVISION 
FLAMING 
SECTION 
SPEC If 1C AT I ON 
SECTION 
STOCK CONTROL 
SECTION 334 
MANUAL OK NAVAL HYGIENE' 
Wartime expansion may ’severely tax the capacities of 
all] procurement agencies. Delays in delivery of mate- 
rials to the depots, even when high priority ratings are 
assigned, can frequently necessitate (a) reduction in 
quantities requisitioned or (h) “transfer requisitions.” 
The failure or inability of some contractors to meet spe- 
cifications may result in rejection of materials and 
another waiting period results. 
At all times medical department units ashore and 
afloat can lessen the interval between the date of a 
requisition and that of receipt of items by careful ob- 
servance of the following points: 
(a) By preparing S. D. requisitions in accordance 
with the references listed above. 
(h) By paying attention to the necessity of indi- 
cating the type and voltage of electric current, proper 
identification of parts (when required) and the identi- 
fication of the unit or apparatus, serial numbers, etc., 
for which the parts are required. 
(tf) By limiting “emergency” requisitions to items 
and quantities required immediately to meet needs until 
regular or replenishment S. D. requisitions are sub- 
mitted, particularly when air mail, air express, railway 
express or other costly method of shipment is required. 
{d) Bearing in mind transportation difficulties, con- 
gestion, and delays, whenever possible units should sub- 
mit S. D. requisitions well in advance of overhaul or 
“in port ” periods. 
(e) When possible, replenishment S. D. requisitions 
should be submitted not less than 2 months in advance 
of the time material is required, due allowance being 
made for transit time. If at the time the requisitions 
are prepared, certain items are desired at an early date, PROCUREMENT OF MEDICAL AND DENTAL SUPPLIES 
335 
those items should be listed in a separate requisition 
and an appropriate comment made under “remarks.” 
(/) Requisitions for material such as beds, chairs, 
bedside lockers, mattresses} overbed tables, x-ray units, 
and similar major items required to outfit or expand 
shore stations should be submitted at the earliest pos- 
sible date and bear a statement as to the tentative date 
material is desired or can he received. 
{(/) Despatch or letter inquiry relative to prospective 
shipment of material should be limited to 'urgently 
necessary items. When such communication cannot be 
avoided, care should be observed to accurately identify 
the proper name of the ship or station, the S. D. requi- 
sition number and date, the item number, stock number, 
and the name of the material. INDEX 
Abandon ship, 122 
Acceleration, black-out, 229, 240, 
241 
Accident prevention afloat, 152 
Aero-embolism, symptoms of, 231 
Air conditioning, 4, 186 
constituents, 201 
humidity, 201 
movement in submarine, 200 
pressure, 200 
sickness (motion sickness), 253 
temperature, 201 
vitiation of, 21 
Air conditions, adverse, 12 
desirable, 11 
endurable, 11 
Air cooling, 16 
Aircraft, accidents, 259 
Aircraft, quarantine inspection of, 
323 
Airplane dope, 250 
Alarms, 122 
Alcohol, 312 
Altitude, effects on ears and si- 
nuses, 248 
Animals, diseases of, 52 
Anoxemia, 229 
Anoxia, 259 
Armored units, 277 
Ascent, in diving, 219 
Aviation gasoline, 261 
Avitaminoses, 312 
Bacteria in air, 23, 208 
Bacteriological laboratory afloat, 
111 
Balance, body heat, 65 
Battle dressing station, 115, i 27 
casualty collecting, 133 
lockers, 128 
burn, 133 
Bill of health, 318 
Black-out, 229, 240, 241 
Blind flying, 252 
Boxes, first-aid, 131 
boat, 134 
Camp and bivouac sites, 273 
Carbon dioxide, accumulation, 22, 
203, 228, 261 
Carbon monoxide, 22, 206, 229, 213. 
261 
Carbon tetrachloride, 261 
Childhood, faulty mental hygiene 
in, 311 
Chlorine gas, 36, 206 
Cleaning materials, 261 
Climate, influence of, 69 
Clothing, aviation, 77, 238 
dry, 239 
fitting of, 238 
flying, 77, 238 
influence of climate, 69 
insulation of,.75 
naval, 65 
protection against cold, 73 
flame, 88 
flash, 88 
gas, 88 
heat, 88 
special problems of, 85 
water resistance of, 75 
wind resistance of, 75 
Cold, effects of, 17 
protection against, 20, 73 
Collision drill, 121 
Compressed air illness, 213, 214 
treatment, 221 
errors in treatment, 225 
Condition A, 124 
B, 124 
Conservancy in the field, 272 
Constipation on a submarine, 210 
Cooling, spot, 17 
radiant, 37 
Decompression, 215 
chamber, 214, 229 
Deep sea diving, 213 
Dental officer afloat, 135, 190 
treatment, routine, 193 
special, 194 
Dentistry, preventive, 192 
337 338 
INDEX 
Detection of mental disorders, 307 
Disease, mental, prevention of, 306 
prevention afloat, 156, 160 
Dispensary aboard ship, 111 
Doctor’s office afloat, 114 
Drugs, psychosis producing, 313 
Elimination of mentally unfit, 310 
Emergencies afloat other than bat- 
tle, 116 
during battle, 125 
Emergency rations, aircraft, 262 
Epilepsies, 309 
Equilibrium, 250 
Equipment, basic, battle dressing 
station, 135 
special, 135 
Evacuation, tank, 277 
Evacuation of wounded, 277 
Examining room (aviation), 113 
Fabrics, 70 
Fatigue, high altitude, 258 
Fire and rescue party, 122 
bill, 121 
extinguish ng compounds, 261 
First-aid kits, 262 
Floor hatch method, tank evacua- 
tion, 287 
Fluid requirements, 15 
Flying efficiency, falling off, 256 
fatigue, 229, 254, 813 
Food. 46 
fresh, 99 
in field, 265 
inspection, 46, 51, 52 
Fresh fruits, defects of, 54 
Frostbite, treatment of, 235, 240 
Galley, lighting in, 60 
Gas-decontamination lockers, 131 
Gases, toxic, 22 
noxious, 36. 243 
Glare, 56, 248 
direct, 56 
reflected, 57 
Gun bags, 131 
Gun fumes in tank, 290 
Hazards, industrial, 260 
Health, mental, maintenance of. 
314 
Heart in black-out, 242 
Heat cramps, 15 
dissipation, 270 
effects of, 12, 71 
equilibrium, 271 
exhaustion, 14 
protection from, 71 
stroke, 14 
Helium-oxygen mixtures, 217 
Heredity in mental conditions, 310 
Hospital corpsmen, 135 
basic equ pment, 135 
special equipment, 135 
ship. 109, 178 
space afloat, 108 
Humidity aboard ship, C 
submarine, 201 
Hydrogen, 36, 205 
Hygiene, field, 265 
in aviation, 227 
on the march, 268 
Identification records, 326 
Infections, 313 
Inhabitants, civil, 275 
Insane ward, 111 
Inspection, food handlers, 100 
sanitary, afloat, 98 
Instrument carrier (Broaddus), 137 
Insulation, 75 
Inversion (feet first) method in 
tank evacuation, 282 
Isolation ward, 110 
Light, color of, 58 
diffusion, 57 
distribution, 57 
sources, 62 
Lighting fixtures, 59 
of ships, 55 
surround ngs, color of, 59 
working areas, 59 
Lockers, burn, 133 
gas decontamination. 131 
Man overboard, 124 
Manic depressive psychosis, 309 
March fracture, 269 
physics and physiology of, 269 
hygiene, 268 
Measures, prophylactic, special, 310 INDEX 
339 
Medical: 
department, essential reports, 92 
in battle, 125 
in emergencies, 116 
officer, duties, general, 92 
in aviation, 263 
personnel in battle, 135 
in deep-sea diving, 220 
submarine, 212 
storerooms, destroyers, 115 
Medicine, submarine, 198 
Mental disease, prevention of, 306 
health, maintenance of, 314 
hygiene, 306 
Mentally unfit, elimination of, 310 
Night vision, 247 
Nitrogen, absorption, 213, 215, 228 
Nurses, female, 187 
Odors, 23 
Oil fumes, 261 
Operating room afloat, 112 
Orders, sanitary, 276 
Output, urine, 29 
Oxygen. 204 
breathing apparatus, 232 
deficiency of in closed spaces, 21 
demand, 235 
in aviation, 230, 239 
in deep sea living, 218 
in submarines, 204, 218 
value of, 218, 228, 229 
Ozone, 207 
Personnel selection (submarine), 
212 
diving, 220 
Perspiration, 67 
Pistol belt-suspender method in 
tank evacuation, 278 
Pratique, 317 
Procurement of dental supplies, 330 
medical supplies, 330 
Psychoneurosis, 308 
Psychopathic states, 307 
Psychosis, manic depressive, 309 
Pulse rate, 26 
Quarantine rules and regulations, 
317 
Quiet room, 110 
Haft kit, 134 
first-aid (aviation), 262 
Recompressiou, 222 
Recreational activities, 264 
Recruits, minimum requirements 
of, 294 
physical qualifications, 296 
selection, 293 
Safety appliances, 260 
Salt requirements, 15 
Sanitary inspection of ship, 98 
Schizophrenia, 308 
Screening, 306 
Sensory illusions (flying), 252 
Ship as living space, 1 
berthing spaces of, 110 
spaces, dry and wet, 6 
Sickbay space afloat, 108 
Sick ward, 110 
Spaces afloat: 
doctor’s office, 114 
laundry, 188 
main storeroom, 134 
utility room, 114 
living, 61 
crew, 61 
hot (dry and wet), 6 
sick berthing. 110 
sanitary standards, 111 
Special sense organs in flight, 245 
Spot cooling, 16 
Stations, battle dressing, 115 
casualty collecting, 133 
Sterilizing equipment, 138 
room, 112 
Storeroom, main, 134 
Stretcher : 
Army litter, 137, 141 
bearers, 187 
canvas (Davis), 143 
hammock (Farrar), 143 
(German), 143 
Neil Robertson, 143 
pole, 141 
Stokes, 141 
Totsuka (Japanese), 143 
zipper (Weber), 137, 141 
Studies aboard ship, method of, 24 340 
INDEX 
Submarine medicine, 198 
Superdehydration, 15 
Supplies, dental, procurement of, 
330 
medical, procurement of, 330 
Surgeon’s division, duties of, 121 
Surgical dressing room afloat, 111 
Syphilis, 311 
Temperature, effective, 7 
limitations of, 9 
envelope, 24 
foot-shoe, 25 
oral, 24 
Terrain, 274 
Textiles, theraldynamics of, 70 
Tobacco smoke, 36, 207 
Transportation of sick and injured, 
141 
Trauma, 312 
Vapors, toxic, 22 
Vegetables, defects of, 54 
Venereal treatment room afloat, 
113 
Ventilation, 4 
aircraft, 37 
submarine, 31, 199 
Vitamins, 15, 48, 210 
Ward, psychopathic. 189 
Water in the field, 267 
on shipboard, 38 
on shore, 41, 267 
supply, field, 274 
vapor, 228 
Working areas, 59 
X-ray darkroom, 113 
Zones, comfort, 9