physical condition is such as to interfere with the proper performance of their duty to hospitals for observation. If in the opinion of the medical officer at the hospital these men are unsuited for the naval service, they will be returned to their stations with notation in their health record, but without medical survey. The commanding officer will then be authorized to discharge such men with an undesirable or inaptitude discharge.

THOS. WASHINGTON.

29372-161.

[Second indorsement.]

128586 (41)

DEPARTMENT OF THE NAVY,
Washington, 27 April, 1923.

From: The Secretary of the Navy.

To: The Chief of the Bureau of Navigation.

Via: The Chief of the Bureau of Medicine and Surgery.

Subject: The elimination of the unfit, inapt, undesirable, enlisted personnel. 1. Returned.

2. The department approves the recommendations of the Bureau of Medicine and Surgery and Bureau of Navigation as follows:

66

(a) That the commanding officers of training stations be authorized to discharge for "inaptitude or as undesirable" recruits obviously inapt or undesirable.

(b) That where there is a question as to the inaptitude or undesirability of recruits for service in the Navy they be transferred to the hospital with diagnosis "No disease" for a period of observation.

(c) That after observation and determination of the physical condition in each case those recruits who may be found to be inapt or undesirable but not suffering from any disease be returned to the training station for discharge. (d) That those recruits who are found after observation to be suffering from some disease be treated in the same manner as other patients.

EDWIN DENBY.

The following correspondence has resulted in a change in article 1196, United States Navy Regulations, which will require that when an entry "not in the line of duty" is made in a patient's health record or other medical record and the patient does not desire to submit a statement in rebuttal, he shall sign a statement to that effect in the record:

WEE: EGP: R&PD-127551 (51).

To: The Judge Advocate General.

Subject: Article 1196, Navy Regulations.

APRIL 28, 1923.

1. The following change is recommended either as an amendment of article 1196, Navy Regulations, or as paragraphs of instruction in the Manual of the Medical Department.

2. Article 1196 of the regulations requires that when the medical officer enters on the health record that any disability was not received in the line of duty or was the result of misconduct it shall be the duty of the medical officer to inform the patient, in which event the patient has the right to file a statement in rebuttal.

3. The medical officer makes the record of the entire transaction; and if no rebuttal is made by the patient, the entry to this effect also is recorded solely by the medical officer. This record being of an official character is supposedly final but the credibility of the record is placed upon the medical officer alone. 4. It is, however, possible and instances are already on file in which the patient has averred facts in denial of this record long after the events and at a time when the several parties concerned are distantly separated or out of the service. The statement of the patient has been sustained, the authentic records made at the time of disability notwithstanding. Nevertheless the record as made stands on the books and it has been held by the Judge Advocate General that "In the event that the facts in a particular case show that the entry in question is erroneous, said entry may not be stricken from the record, but an additional entry should be made showing wherein and to what extent the original entry is in error. An entry in a public record whether correct or erroneous thereby becomes a fact which may not be destroyed, but if in error such additional entry or entries may be made, and in fact should be made, as are necessary to show the nature of the error sought to be corrected." Whatever may arise to induce the patient to become interested in changing the record may not be known to the department nor does it seem reasonable that such statements should receive such extraordinary consideration in defiance of the records.

5. The bureau considers that the present practice of dealing with this matter is conducive to fraud and to distortion of facts and records. It is therefore recommended that each patient, in whose health record entries of not in line of duty and/or of misconduct are made, be required to sign a statement something like the following in his medical record:

"In accordance with article 1196, United States Navy Regulations, 1920, you [name] are informed that you are admitted to the sick list with [diagnosis], the origin of which is considered not in the line of duty and (is) or (is not) the result of your own misconduct.

(Medical officer.)

"I acknowledge having been informed that the origin of the diseases or condition [diagnosis] with which I am suffering is not in the line of duty and (is) or (is not) the result of my own misconduct and I have a tent to offer nothing

in rebuttal."

6. It is therefore recommended that the regulations be amended to carry such requirements as to the above statements as are necessary and legal.

E. R. STITT.

[First indorsement.]

DEPARTMENT OF THE NAVY,

OFFICE OF THE JUDGE ADVOCATE GENERAL,

Washington, 7 May, 1923.

From: The Judge Advocate General.

To: The Chief of the Bureau of Medicine and Surgery. Subject: Navy Regulations, proposed change in article 1196 relative to entry "not in the line of duty" in medical record.

1. Returned.

2. This office believes that the change in article 1196 of the Navy Regulations which you propose to recommend, for the purpose of putting the patient on record at the time as to whether or not he desires to make any statement in rebuttal to an entry of "not line of duty" in his medical record, is desirable.

3. Numerous cases have come to the attention of this office where the individual affected has subsequently contended that he had not been informed at the time relative to the entry of "not in line of duty." In some instances this situation has rendered it impossible to get at the facts existing at the time the entry was made. It is believed that any injustice arising from this situation would be cured by requiring the patient to make a statement at the time the entry is made or as soon thereafter as his physical or mental condition permits. 4. The following wording of the acknowledgment to be signed by the patient is submitted in lieu of the wording contained in your recommendation:

"Having been duly informed of the finding that my present disability [diagnosis was not incurred in the line of duty and is not the result of my own misconduct I do not desire to submit a statement in rebuttal."

J. L. LATIMER.

THE DIVISION OF PREVENTIVE MEDICINE.

Lieut. Commander J. R. PHELPS, Medical Corps, United States Navy, in charge.

Notes on Preventive Medicine for Medical Officers, United States Navy.

INSTRUCTIONS TO MEDICAL OFFICERS.

FOOD POISONING ON THE U. S. S. "IDAHO."

While at anchor off Panama, March 25, 1923, a rather serious outbreak of food poisoning developed. From 10.30 a. m. to 1 p. m. 90 cases of sufficient severity to require bed treatment were admitted. Two hundred and five cases with less severe symptoms occurred.

The outbreak occurred on Monday, liberty having been granted the two days previous. Investigation showed that approximately half of those affected had remained on board over the week end. The outbreak occurred so suddenly and such a large number of men were attacked that an accurate record was not made. No doubt quite a number of men with symptoms of poisoning failed to report at sick quarters. The first cases appeared about 10.30 a. m. and within two hours about 100 cases developed.

The first symptom complained of was pain in the abdomen, followed by nausea, with severe and persistent vomiting. In some instances the vomitus contained blood. Following this there was marked prostration, feeble pulse, severe muscular cramps, and headache. Later diarrhea occurred. Only in a few cases was there a rise in temperature.

On account of the large number of cases no attempt was made to care for any except the most severe in the sick bay. The forward section of the forecastle was roped off, hammocks were spread on the deck, and the waterways were used to receive the vomited material. Hospital corpsmen were placed on watch, and rounds were made by the medical officers at frequent intervals.

Treatment consisted in washing out the stomach with water containing sodium bicarbonate. This being accomplished by having all cases drink copious quantities of sodium bicarbonate solution immediately on reporting. The nausea was so severe and persistent.

that no other medication was attempted until later in the day, when a castor-oil cocktail containing two drams camphorated tincture of opium was given each case. Twenty-five patients with severe vomiting, marked prostration, and cramps, were cared for in the sick bay and were treated symptomatically. Anodynes were given, heat was applied, and the muscles of the legs were massaged. By 7 o'clock in the evening of the same day vomiting had stopped, and all cases showed marked improvement. At sick call the following morning, only six cases showed any symptoms or serious enough effects from the attack to be retained on the sick list.

Investigation as to the cause of the outbreak took into consideration what food had been served during the preceding 24 hours. In view of the fact that approximately 50 per cent of those affected had been on liberty the day before and had taken no meals on board, the food served at breakfast on the morning of March 26 was considered responsible. Breakfast consisted of boiled rice, milk, and sugar, fried-meat hash, hot biscuits, bread, butter, and coffee. An accurate check was made and all patients stated that they had eaten breakfast and had eaten hash. No cases occurred in the wardroom, junior officers', warrant officers', and chief petty officers' messes. On account of the fact that no cases developed during the night of March 25 and also that 50 per cent of those affected had not eaten supper on board March 24, the food served at supper was not considered at fault. It consisted of cold meats, head cheese, cold beans, potato salad, coconut layer cake, bread, jam, and coco.

The meat used in preparing the hash was beef received from the U. S. S. Arctic on March 8 and was inspected and found frozen and in excellent condition when received on board. It was placed in cold storage, and when broken out on March 24 steak was served to the general mess for dinner. All other messes also obtained meat from the quarters of the beef referred to above, which was cooked and eaten on March 25. No symptoms developed in any member of these messes. The trimmings from the steak served on Sunday, together with two other quarters of beef, was cooked after dinner on the same day. After cooling it was ground up and placed in galvanized tubs.

On the morning of March 25 potatoes (cooked that morning), ground onions, and condiments were added to the meat and the whole put in pans and baked. The other articles served at breakfast could not be considered responsible, as they were the same as regularly served each meal and of a standard make and quality.

A sample of the hash was submitted to the Ancon Hospital for examination, but the only report received was to the effect that the sample was in a state of decomposition. It was not examined until March 27, 48 hours later, and had not been kept in a refrigerator.