CHAPTER LII.

INSTRUCTIONS FOR MEDICAL OFFICERS.

I. - Inspectors-General and Deputy Inspectors-General of Hospitals and fleets.
II. - Staff-Surgeons and Surgeons.
III. - Assistant Acting-Assistant Surgeons.

§ I. - INSPECTORS-GENERAL, AND DEPUTY INSPECTORS-GENERAL, OF HOSPITALS AND FLEETS.

1.

When an Inspector-General or Deputy Inspector-General of Hospitals and Fleets shall receive au appointment for service afloat, he is to be attentive to perform such duties in the Medical Department as may be required of him by the Commander-in-chief of the Fleet, or by the Captain of the Ship in which he may be placed, or by other his superior Officer, as well as to comply with all such directions as he may from time to time receive from the Admiralty, or from the Director-General of the Medical Department of the Navy. He is to inform the Secretary of the Admiralty of the day on which he shall have joined the Fleet or Hospital Ship to which he has been appointed.

2.

He is to visit all the patients on board the Hospital Ship in which he may be serving, regularly morning and evening, or oftener when the nature and urgency of their complaints render it necessary, and to direct such modes of practice, whether medical or surgical, as he deems proper. In Hospital Ships, all arrangements relating to the part of the Ship appropriated for the reception of the sick and wounded are to be under his orders and directions; he is therefore to propose to the Captain any measure which he may think likely to be of service to the sick, either for increasing their comforts or accelerating their cure.

3.

He is, with the sanction of the Commander-in-chief or senior Officer, to visit the Ships of the Fleet from time to time, to inquire into the health of the respective Ships' Companies and the treatment of the sick, - to ensure the most diligent attention to their professional duties on the part of the Surgeons and Assistant Surgeons, - to examine with care the Journals of Medical practice, - to correct the errors of inexperience by instruction to those who require it, - and, in general, to enforce the observance and execution of the established rules and regulations of the Service. Where he finds unusual sickness prevailing on board he is to ascertain, if possible, the cause thereof and to recommend measures for its removal; and, whenever he may consider it proper, he is to call upon the Surgeon of the Ship for a written statement respecting any disease that may be prevalent, or of any particular case. He is also to make himself acquainted with the conduct and abilities of the Assistant Surgeons, to enable him, if called upon to point out to the Commander-in-chief on the station, or to the Director-General, those who may be best qualified for any particular service or for promotion.

4.

He is to examine the instruments, medicines, and necessaries on board any Ship; and if he should find them bad in quality, or deficient in quantity, he is to report the same to the Commander-in-chief, and suggest such measures as may be required.

5.

He is, once every week at least, if the weather and other circumstances will admit of it, to report in the Form No. 1, to the Commander-in-chief, the state of the sick in the Hospital Ship, if there be one with the Fleet, and oftener, if the Commander-in-chief should require it; reporting also to him the general condition of the sick of the Fleet, in the Form No. 2, as far as he shall have been able to obtain information thereof, always sending a duplicate to the Director-General. In his annual report of the health of the Fleet, he will enter, at full length, into the state of the Crews as regards effectiveness in every particular, and into the medical topography of the Station, giving an ample account of any epidemic that may have occurred, or of any disease that may have been unusually prevalent, stating his opinion of its cause. He is to mention in his reports those Ships which, from the unhealthiness of their crews, appear to be least fit for active service, and most in want of refreshments; pointing out to the Commander-in-chief whatever measures he may think necessary for preserving the health of the Fleet, or improving the health of any particularly sickly Ship's Company; and in order that he may be fully informed on these subjects, the Surgeons of the respective Ships are required to furnish him, quarterly, with duplicates of the Nosological Reports forwarded to the Director-General.

6.

He is, when on a Foreign Station, to visit, as frequently as opportunities offer, the Naval Hospitals or Sick Quarters (when not in charge of a Medical Officer senior to himself); and he is to examine particularly into the detail of the following points:-

Treatment, Diet, Comfort of the Patients, and the General Economy of the Establishment. He is also to inquire into the expenditure and condition of the Stores, and the efficiency of the Officers and other persons employed.

He is also, when directed, to attend at any survey which maybe held there on men supposed to be unlit for the service, and assist the Surveying Officers with his opinion. He is likewise to examine the Agent's accounts, particularly with regard to his Contingent Disbursements, and to transmit to the commanding Officer, and also to the Director-General, a report of the result of each visitation, with such observations thereon as may guide the Admiralty in the adoption of any measures which may be deemed expedient.

7.

He is frequently to communicate with the Director-General on the health of the Fleet, and to state to him every circumstance relating to the Medical Department of which it may be proper that he should be informed. Although detailed accounts are only enjoined to be forwarded yearly, he will, nevertheless, consider it his especial duty to submit all observations and suggestions that may occur from time to time in any way relating to the health of the Ships' crews, for the Commander-in-chief's information, transmitting a copy to the Director-General.

8.

When embarked in any of Her Majesty's Ships, a suitable servant shall be assigned to him by the commanding Officer, but no special rating will be created for the purpose.

§ II. - STAFF-SURGEON AND SURGEON.

1.

When a Staff-Surgeon or Surgeon shall be appointed to any one of Her Majesty's Ships, he in to comply with the following Instructions, and to obey such orders as he may receive from his Captain, the Director-General of the Medical Department of the Navy, the Inspector or Deputy-Inspector General of the Fleet in which he may be serving, or from any other his superior Officer. As soon as the requisite accommodations are completed for the security and safe custody of the stores which are to be in his charge, he is to make applications to the respective Officers at the Hospital or Depot, for the established supplies of Medicines, Necessaries, Bedding, Clothing, &c., referred to in Scales A and B, affording such information as he may possess relative to the Station for which his Ship is fitting, so that the issues may be regulated agreeably to the established scales. Tea, Sugar, Soap, and Lemon-juice, being in the charge of the Paymaster, are to be demanded from him, with the approval of the Captain, as required; for these and all other supplies not contemplated by Article 21 of this section the Surgeon is to grant receipts quarterly, and to obtain from the Paymaster counterparts, or issue-notes, with his signature thereto, charging himself with all such articles in his account, and transmitting therewith the Paymaster's issue-notes as vouchers, observing that he is not (except on extraordinary occasions, which are to be particularly stated), to exceed the proportions allowed by the Scale, for which there can seldom be necessity, since the establishment of the Sick-Mess, as explained in Article 21.

2.

He is to provide and keep in proper repair, at his own expense, a complete set of Surgical Instruments, according to the List No. 3; and on proceeding to the Hospital or Depôt, with the requisition for his stores, he is to deliver them to the Surgeon in charge of the Medicines, that he may furnish him with a certificate as to their number and condition; and this certificate he is to transmit with his first annual account. He is frequently to examine the Surgical Instruments of his Assistants, to see that they are in good repair, and in conformity with the established List No. 4, giving a certificate of such inspection, as also of the conduct of the Assistant at the end of every year, or when he may quit the Ship; but should he see any reasons for withholding such certificate, he is, without fail, to state them fully to his Captain and to the Director-General.

3.

When a Surgeon shall be superseded, he is to deliver the whole of the stores in his charge to his successor, by survey, in the Form No. 5, which is to be made out in triplicate, and signed by himself, his successor, and the surveying Officers. One copy is to be transmitted as a voucher to the remains in his final account, another is to be forwarded by his successor with his Annual Account as a voucher to the first charge therein, and the third is to be delivered to the Captain for transmission to the Commander-in-chief, or senior Officer on the Station; observing that the account is always to be closed, when practicable, at the expiration of twelve mouths, by a survey on the remains, which is also to be made out, and properly signed, in triplicate; one copy of which is to accompany the closed account, one to be delivered to the Captain for the Commander-in-chief, or senior Officer, and the other to be sent with the succeeding account. But should the Ship be paid off, then the whole of the stores are to be returned, the account closed, and the receipts for the quantities returned into Store are to be transmitted with the account, together with the Captain's certificate of conduct, for the period, and the other documents referred to in Article 5.

4.

Dispensaries for the reception of Medicines and Medical Stores being fitted up in all classes of Her Majesty's Ships, the Surgeon will, on application at the Hospital or Depôt, at the Port where the Ship fits out, be supplied with the proper chests, observing that to vessels below the Sloops' rate one chest only in to be supplied; but to those of and above that rate as follows, viz.:-

1st Rates... ... ... ... ... ... ... ... ... ... ... ... ....	3 Chests each.
2nd, 3rd, 4th, 5th, and 6th Rates, and Sloops...	2 Ditto ditto.

From one of the chests the contents are to be immediately removed into the dispensary, and the chest itself returned into store, together with the packing cases in which the necessaries were sent on board. The Surgeon will be held responsible for the due care and preservation, not only of the bottles, jars, medicines, and stores in the dispensary, but also for the safety of the chests and their contents, which are to be properly secured in the cockpit, or other safe place, so that he may have ready access to them at any time. The medicine chests are not to be struck down in the hold, or spirit room, nor placed in any situation where they may sustain injury. When the medicines in the dispensary are expended, they are to he replaced from the chests, and the empty bottles and jars returned into the spaces from whence the full ones were taken. Annually, or oftener if necessary, he is to make out demands in the Forms Nos. 6 and 7, showing the quantities remaining, and the quantities required to complete the established proportions according to the scales. These demands when approved by the Captain, are to be taken with the medicine chests, to the Hospital or Depôt, in order that the requisite supplies may be obtained; and to prevent inconvenience or delay, demands are to be presented there, if possible, before three o'clock in the afternoon, and stores are not to be returned after that hour. demands are not to be repeated for medicines, utensils, or necessaries within a year, nor for groceries within six months, unless the Ship be ordered on detached service, or extraordinary circumstances have caused an unusual expenditure, which are to be reported to the Director-General. Trusses, however are to be completed as often as necessary, and the receipts for those issued are to be transmitted in the Form No. 13, with the annual account. Should any articles of medicine, utensils, bedding, clothing, or necessaries become unfit for use, they are not to be taken credit for, nor returned into store, until a survey, in the Form No. 8, shall have been held upon them, and a report made out In triplicate, specifying the probable cause of their becoming unserviceable. One of these reports is to accompany the articles when returned into store, one is to be delivered to the Captain for the Commander-in-chief, and the other, with the receiving Officer's receipt, is to be transmitted as a voucher to the account in which credit is taken for the articles. Credit will not be allowed for any bedding or utensil lost or expended, or any breakage of the bottles or jars belonging to the medicine chest, unless under unavoidable circumstances, which must be satisfactorily explained to the Director-General.

5.

Medicines and Medical Stores supplied from a regular establishment arc to be accompanied by invoices, on the Hospital Forms Nos. 58 and 59, by which the Surgeon is to examine the several quantities, and, if correct, they are to be entered in the proper columns of his Annual Account (No. 9), which is to be sent to the Director-General, at the expiration of twelve months from the date of the Officer taking charge, or at the time he may be superseded, or when the ship be paid off. The articles supplied are to be administered for the relief of the sick and wounded, and no part of them is to be either wasted or applied to any other purpose than that for which they are intended. On closing the said account, he is to execute the declaration attached thereto, and transmit it with the documents recapitulated in the list at the back thereof, and the necessary receipts for supplies of medicines or stores which he may have been authorized by his Captain to make to other Ships, or to expend on any emergency. If, from unforeseen causes, the medicines or stores should be expended at a time when he cannot have recourse to a Naval Hospital or Medical Depôt, nor procure a sufficiency from another Ship, he is to represent the same to the Captain, who will obtain from the senior Officer present an order, in writing, to purchase such articles as may be necessary, and cannot be supplied from the Ship's stores.

6.

On receiving the order to make the necessary purchases, the Surgeon is to procure the same on just and reasonable terms, seeing that they are good and fit for Her Majesty's Service; and he is to assist the Paymaster in obtaining vouchers, in duplicate, for the quantities purchased, taking care to have all the particulars correctly inserted.

The medicines so purchased, are, if circumstances will permit, to be examined by the Inspector or Deputy Inspector-General of the Fleet,- should neither be present, by himself and his Assistants, who are to sign a certificate of such examination on the voucher.

Necessaries, or other articles than medicines, are to be examined by the Master and Paymaster, who are to certify on the voucher to the quality and quantity of the several articles so purchased.

Payment of the Medicines, Medical Stores, or Necessaries above referred to will be made by the Paymaster, under the directions of the Captain; and the Surgeon is to send an attested copy of the purchase voucher with his annual account to the Director-General.

7.

The Paymasters of all Ships proceeding to Foreign Stations are supplied with Preserved Meats, to be issued to such of the sick and convalescents on board as may, in the Surgeon's opinion, stand in need of such refreshment. The Surgeon is, therefore, with the approval of the Captain, to demand of the Paymaster such quantities as he may from time to time require, as in the case of other medical necessaries.

8.

Whenever a part of the Ship's company is ordered away in boats on detached Service, or on shore, where they are likely to be exposed to wet or night air, he is to endeavour, by timely representation to the Captain or commanding Officer, to prevent any men from being sent on such duty who may have recently recovered from illness, returned from Hospital, or who from impaired health may be unfit for that service.

9.

Sickness and mortality among Seamen in tropical climates being frequently caused by the nature of their occasional duties on shore, and quinine having been found of great utility as a preventive, the Surgeon is, on all such occasions, to request of the Captain a list of the men who are to be sent on shore to procure wood or water, or on other laborious duty; and should he consider it advisable, he is to recommend for each man, previously to his leaving the Ship in the morning, and on his return to the Ship in the evening, 4 grs. of quinine dissolved in water (see Formula in Appendix), which he is to keep ready. Should any men remain on shore during the night, he is to furnish the Officer commanding them with a sufficient quantity of quinine, mixed in the same proportions, for their use both night and morning; and should he consider it necessary to administer the quinine in an allowance of wine, or spirits, in lieu of water, he will explain this to the Captain, who will give the Paymaster the requisite order for the supply. He is not to give any receipt to the Paymaster, nor to be in any manner accountable for the quantities of wine or spirits so issued, as the Captain will grant the necessary certificate; and he is to observe attentively the subsequent state of health of the men to whom the quinine shall have been thus administered, and to report very fully to the Director-General his opinion of its effects, noting the total quantity of wine or spirits so issued, and under what circumstances, at the conclusion of his remarks at the end of the Journal.

10.

When from bad weather, or any other cause, the lower deck ports of Ships of the line cannot he opened, and the space between decks becomes replete with moisture and noxious effluvia, he is to apply to the Captain to cause hanging stoves with burning cinders to be distributed between decks, and in the well, or any other of the lower parts of the Ship in which they can be placed with safety, taking care that there is sufficient, ventilation to carry off the gas evolved.

When any infectious disease breaks out, or there shall be cause to : suspect its existence, he is to adopt, with the Captain's permission, every possible measure for checking its spread, bearing in mind that dryness, cleanliness, and ventilation are the most effectual means for preventing and destroying contagion; and, when it exists, he is to recommend that the bedding and clothes of the men be frequently opened and spread loose in the fresh air, that they may be completely purified; and all persons whose illness he may suspect to be infectious are to be stripped on their entry into the Sick Berth, and if practicable washed with soap and warm water, and supplied with clean linen. The bedding, and the clothes they have recently worn, are to be immersed in boiling water, and washed before they are returned to them. The mattresses, blankets, sheets, &c., appropriated to the use of the sick, are to be kept perfectly clean, and occasionally hung up separately on lines for the purpose of being purified by ventilation.

11.

Hair mattresses, sheets, linen caps, pillows, clothing, and utensils for patients confined to bed, being allowed, together with soap for washing the persons of the sick, the Surgeon is to see that the patients are kept in a state of perfect cleanliness; and he is not to allow articles supplied for their use to be injured or destroyed. He is to visit the sick at least twice each day, or as much oftener as the respective cases may require; his Assistants are also to visit them from time to time; and he is to leave orders with his Assistants, and with the Nurses, that in the event of any alteration taking place in the state of patients labouring under dangerous diseases, he is to be immediately acquainted therewith, by day or night, in order that no time may be lost in affording the necessary assistance.

12.

As he has charge of the health of so many persons, who, from crowded] accommodations, the nature of their diet, the variation of the weather and climate, and numerous other circumstances, are liable to infectious fevers, and various other diseases, as well as to wounds or injuries incidental to their mode of life, the guarding against and counteracting the attendant evils will depend very materially on his own resources and promptitude in applying the most speedy remedies according to circumstances; and as sickness, which in the most favourable situation on shore must in some degree depress the spirits, cannot fail to have similar effects on board ship, it will become his duty to soothe and cheer the minds of his patients by the most humane attention, and all possible consolatory kindness; to listen with patience to all their complaints or grievances, whether real or imaginary, and to show every disposition to redress them; as this conduct will materially tend to create confidence. to exhilarate the spirits, and thus add to the hope of recovery.

13.

The patients are to be removed, when the Surgeon shall judge it necessary, into the Sick-birth, which, as well as all persons appointed to attend it, is to be under his immediate direction; and it is to be kept at all times as clean and dry as possible, for which latter purpose, as well as for the comfortable warmth of the patients, a stove, with clear burning cinders is to be placed therein as often as he may think it needful; and, on his request, the Captain will cause him to be supplied with all requisite conveniences, and allow such a number of the Ship's Company as may be proper to attend the sick night and day as Nurses in addition to the established Attendant; and he is to report any negligence or want of attention in the performance of their duty. He is to direct that medicines and proper drink be provided every evening in sufficient quantities to serve until morning; and as drink to the sick, particularly in fevers, is essential to their comfort and recovery, he is to give the most positive directions that the Nurses and Attendants offer it occasionally, when the patients are not asleep, and gently press it upon them according to circumstances.

14.

Should sloughing ulcer make its appearance on board, the persons so affected are to be kept apart from the rest of the Ship's Company, and as much as possible from each other, in a well ventilated part of the ship; and the strictest attention is to be observed that all removed dressings be thrown overboard, and the foul bandages are immediately to be put into boiling water, for the purpose of destroying contagious or infectious matter, and afterwards properly washed. Every ulcerated patient is to have a sponge to himself, which is daily to be purified in boiling water.

15.

He is not to confine his attention exclusively to patients in the Sick-Berth, or to those who may be actually sick, but to watch attentively every circumstance that may in any degree tend to affect the general health of the Ship's Company, which he is at all times carefully to observe; and should he suspect the presence of disease or indisposition in any man, he is to examine him minutely, although he may not have made any complaint; and on finding his suspicion well founded, he is immediately to take such steps as may be necessary, in order that the disease may be more speedily arrested, and the communication of it to others be prevented. Upon long cruizes or voyages, when there is not a sufficiency of lemon-juice on board for the whole Ship's Company, he is to ascertain, by inspection, whether any of the men have symptoms of scurvy; and should he discover any who show the slightest symptom of that disease, he is to demand lemon-juice and sugar from the Paymaster for their use, as directed in Article 1.

16.

He is to see that every preparation be made for the accommodation and treatment of wounded men; and, therefore, whenever the Ship be cleared for action, he is, with his Assistants and others appointed to attend him, to repair to the cockpit, or such other place as the Captain shall direct, where a platform and other conveniences are to be provided. He is to instruct all those stationed with him in the use of the tourniquet, causing a sufficient number of temporary substitutes for that article to be made and distributed to the different quarters, and into each of the tops, to be applied as occasion may require; so that the wounded men may suffer as little as possible from the loss of blood, while waiting until he shall be able to attend to them.

17.

When any dangerous or infectious disease appears, he is immediately to apprise the Captain, for the purpose of its being reported to the Commander-in-chief or senior Officer present; and to communicate with the Inspector or Deputy Inspector-General of the Fleet, if there be either present, on this subject, and on all other points, relative to the health of the Ship's Company, transmitting detailed statements thereof to the Director-General in the Nosological Returns.

18.

It having frequently occurred that the Crews of Ships returning from Foreign Stations, have, on their arrival in Northern Latitudes, particularly in the winter season, being afflicted with Pulmonary and Rheumatic complaints, and other dangerous diseases, usually occasioned by a sudden change of temperature and deficiency of clothing, the Surgeon is, whenever he learns that the ship is destined to proceed from a warm to a cold climate, to submit the matter to the Captain, and recommend, should it be necessary, the issue of additional clothing, to provide against such contingencies.

19.

Every death which occurs on board, on detached service, or of men on leave, is to be reported by the earliest opportunity to the Director-General, and to the Inspector or Deputy Inspector-General of the Fleet, with a particular detail of the circumstances; and in all cases of sudden death, where there has not been any previous indisposition, he is, with the sanction of the commanding Officer, to examine the body, with a view to ascertain the cause of dissolution, a full and explicit report of which is also to be transmitted.

20.

For the better accommodation and comfort of the sick and wounded on board Her Majesty's Ships, a Sick-Mess is to be formed, under the superintendence of the Surgeon; and that he may be enabled to procure the first supplies for that mess in Ships fitting out, a sum of money, according to the rate of the Ship, as specified in the following scale, will be placed at his disposal from the "Sick-Mess Fund," viz.:-

£ s. d.
1st Rate ...............	24 0 0
2nd " ....................	22 0 0
3rd " ....................	20 0 0
4th " ....................	18 0 0
5th " ....................	15 0 0
6th " ....................	12 0 0
Sloops ...................	8 0 0
Other vessels ..........	6 0 0

On the ship being commissioned, the sum allowed, according to the foregoing scale, for the formation of a Sick-Mess, will be advanced to the Surgeon, by the Paymaster, under the direction of the Captain.

21.

Upon any patient being entered on the Sick-list, for whom a change of diet may be necessary, the Surgeon is to give immediate information to the Paymaster by a note, who is thereupon to stop such person's regular allowance of provisions, and proper diet is to be assigned him on such of the scales in the following scheme as the Surgeon may deem advisable; for which purpose he is to demand from the Paymaster such articles of provisions, &c., as he may consider necessary, including wine or spirits, should the state of the sick require the use of either medicinally; and that Officer is, at the end of each Quarter of a Year, to pay into the hands of the Surgeon such sums as the portion of provisions so stopped from the patients may amount to, at the established prices for savings, except fresh meat, which is to be paid for at "fourpence per pound ;" and the quantities of the various articles, with the value so paid, he is to include in the usual List of Savings, as made by the Sick-Mess.

Whilst amply providing for the comfort and subsistence of those to whom the ordinary naval ration is unsuitable, Surgeons are required to guard against any profuse expenditure, or unnecessary indulgence, and to adhere, as closely as practicable, to the Scale of Hospital diet.

A Scheme of Diet for the Sick on board Her Majesty's Ships (daily), viz.:-

	Full Diet.	Half Diet.	Low Diet.
Soft Bread (when procurable) ......	l lb	12 oz	8 oz.
Beef ... ............	1 "	8 "	none.
Vegetables (when procurable) ......	1 "	8 "	none.
Broth ... ... ... ... ...	1 pint	1 pint	1/2 pint.
Barley for ditto ....... ......	12 drachms	12 drachms	6 drachms.
Or Rice, in lieu of Barley ......	10 "	10 "	5 "
Pot Herbs (when procurable) ......	24 "	24 "	24 "
Salt ...............	8 "	8 "	8 "
Vinegar ...............	16 "	16 "	none.
Tea ...............	3 "	3 "	3 drachms
Sugar ...............	14 "	14 "	14 "
Milk (when procurable) ... ... ...	1/2 of a pint	1/2 of a pint	1 pint.
Wine ...............	at the discretion of the Surgeon.
Cocoa (as a substitute for Tea)......	1 oz	l oz	1 oz.

N.B. - Preserved Meat, referred to in Article 7, and such articles of the men's daily allowance as the Surgeon may deem advisable, are to form part of the Diet for the Sick.

22.

The Surgeon is to charge himself with all sums of money which he may receive, whether from the Sick-Mess Fund, from the Paymaster for stoppages, or otherwise, and with which he is to purchase such stock and extra articles as he may consider necessary for the comfort and cure of the sick, and as are not supplied from other sources, taking care that the expenditure be limited to the amount in hand; and as there is a prescribed allowance of medicines for each Ship, which is found, under ordinary circumstances, to be sufficient, other medicines than those included in the established scale are only to be purchased out of the fund when really necessary. He is to observe that no issues of tea, sugar, or other articles in the Scale B, will be allowed beyond the proportions therein specified, except under very particular circumstances, a detailed statement of which is to accompany the account in which credit is taken for the expenditure. In all rates in which they are allowed, he is to select (subject to the Captain's approval), proper men, of good character, for the rating of Sick-Berth Steward, Sick-Berth Attendant, and Assistant Sick Berth Attendant, whose duties will be to attend exclusively on the sick, without being called away at any time by the other ordinary duties of the Ship, unless by the order of his Captain or commanding Officer, in case of emergency. If the Surgeon be satisfied with the way in which the Sick-Berth Steward and. Attendants have performed their duties, he may grant them certificates' to that effect, approved by the Captain.

23.

The Surgeon is to deliver to the Captain a Quarterly Statement of his receipts and disbursements of Sick-Mess Fund money, checked and countersigned by the Paymaster, with vouchers for his payments, and the balance in hand is to be carried to the debit of the next quarter's account, or paid over by the Surgeon to his successor, as the case may be. If the Ship should be paid off, the balance is to be invariably delivered by the Surgeon, with the certificate of the amount, into the hands of the Paymaster, who will give a receipt for the same, and debit himself therewith in his Cash Account; but should there not be any balance for the Paymaster to receive, he will make a notation to that effect at the foot of the Account, and produce a certificate from the Surgeon in support thereof. At the end of every annual or final account, the Surgeon is to forward to the Director-General an abstract, in the Form No. 14, together with Vouchers, to show the amount received and expended, and the articles purchased by him for the Sick-Mess in each quarter, together with the receipt of his successor, or, should it be a final account, of the Paymaster, for the balance; and all articles purchased, excepting provisions, are to be taken on charge, - and those that are serviceable on the Ship being paid off, are to be delivered into store, for future use. It is expected that not less a sum will be returned on the paying-off of the Ship than was advanced on the Ship being commissioned, unless anything extraordinary should occur, which is to be reported.

24.

When Fish are caught for the Ship's Company, the Surgeon is to give the Captain a list of the men who stand most in need of it, that they may be first supplied; and when convalescents belonging to other Ships are sent on board from a Hospital, or otherwise, they are to be treated by the Surgeon in the same manner as the sick belonging to his own Ship, and to be put upon such diet as he shall judge proper.

25.

When any of the Officers or Men, from the general state of their health, or the particular nature of their hurts or diseases, maybe considered no longer fit to serve in Her Majesty's Navy, the Surgeon is to report them to the Captain that they may be surveyed; but he is to be very careful not to suffer himself to be deceived by any who may feign complaints for the purpose of obtaining their discharge from the Service. When invalids are sent to a Hospital, to await a conveyance, or when they are sent direct on board a Ship for a passage to England, a concise statement of each case, detailing the medical treatment to the period of their being discharged, is to be delivered to the Surgeon of the Hospital, or of the Ship in which they are embarked, that it may be given to the Officer of the Hospital or the Surgeon of the Flag or other Ship into which such invalids shall be finally discharged. When Officers are invalided from Foreign Stations, the Surgeon of the Ship in which they served is to deliver to each a detailed statement, sealed up, of the commencement and progress of his complaint, where it can be done, or he may send it by the first opportunity to the Secretary of the Admiralty, noting on the cover, "For the Director-General, Medical Department."

Cases of disease or hurts which may constitute a claim hereafter for a pension, are to be specially reported, noting particularly whether the disease or injury originated in the line of actual duty which is indispensable for the proper adjustment of those claims, and a timely attention to which will save much trouble and correspondence.

26.

The necessaries and other articles supplied for the use of invalids embarked for passage home, to the amount specified in the following scale, according to the Station, are to be exclusively appropriated to their use; and if any remain unexpended when the invalids are discharged, they are, with the empty packages, bottles, and jars, to be returned into store. A receipt for these stores, together with a statement showing the total quantity of the several articles received, expended, and returned (distinct from his annual account of medicines, &c.), and a list of the invalids originally embarked in the Form No. 15, he is immediately to transmit to the Director-general; and, should any have died during the passage, he is also to transmit the original cases received with them, accompanied by a detail of the symptoms and mode of treatment while under his care.

Scale of Allowance for Necessaries to Invalids on their Embarking from Foreign Hospitals and Stations for England.

£ s. d.
China Station .................	per Man 3 3 0
East India Station ..............	2 2 0
Cape of Good Hope, South America, West Indies and Halifax ....	1 1 0
Gibraltar and the Mediterranean .....	0 10 6

27.

When men can be conveniently cured on board, they are not to be sent either to a Hospital, Hospital Ship, or Sick Quarters; but if labouring under infectious diseases, or if the nature of their wounds or coin-plaints render their retention on board dangerous to others or injurious to themselves, or if the number of the sick and wounded be so great as to prevent their receiving proper attendance, they are to be sent to Hospital as soon as possible. Whenever, therefore, it becomes necessary to send patients out of the Ship to a Hospital, the Surgeon is to inform the Captain or commanding Officer, who will, without delay, give the requisite orders for preparing their pay and sick vouchers, noting upon the latter whether the patient had been victualled on board for that day or not, and inserting in both an inventory of each man's effects. The effects are to be carefully tied up, and marked with the name of the Ship and the owner, in readiness to be put into the boat with him, observing particularly that the arms and accoutrements of Marines are not to be sent with them to Hospitals on Foreign Stations. The Surgeon is also to give as early information as possible to the Resident Superintendent, or to the Chief Medical Officer, of the number of patients intended to be sent to the Hospital, and the probable time at which they will be disembarked, in order that due preparation may be made for their reception. An Officer, accompanied by the Surgeon, or one of his Assistants, is to be sent with the patients to see that they are properly received at the Hospital or Sick Quarters, and that they are conveyed thither with as little inconvenience as possible; and should two boats be required, the Medical Officer is to be in the one with the worst cases, in order to afford ready relief on the passage. A detailed statement, sealed up, is to be delivered with the men at the Hospital, showing the manner in which they were first seized, the nature and progress of their disorders, the means used for their cure, and stating if there be reason for suspecting any of their complaints to be feigned.

28.

Every Surgeon from whose Ship any men shall have been sent to a Hospital is, during his stay at the port, to visit them as frequently as the Captain may direct, previously ascertaining from the Medical Officer under whose care the patients may be, the propriety of doing so, in order to determine whether any of them be so far recovered as to return to their Ship; in which case, he is to inform his Captain.

29.

By a standing regulation at the Naval Hospitals, a signal is to be made whenever an operation is about to be performed. The Surgeons of Her Majesty's Ships at the Port will therefore observe, that they are, with the Captain's permission, to attend at every such operation when the Service will admit; and to take with them such of their Assistants as can be spared from the duties of the Ship.

30.

He is to keep a daily Sick-Book, to contain the names of all the sick on board, which he is to submit to the Captain or commanding Officer, every morning; and he is to suggest any measures he may consider necessary for the comfort and accommodation of his patients. He is also to report particularly if there be any whose diseases are infectious, in order that they may he sent out of the Ship; or if that cannot be done, that they may be separated from the other patients, and from the Ship's Company; and every possible precaution is to he taken to prevent the progress of the disease. Whenever the name of any person is inserted in the Sick-Book for a wound or injury, the part of the body injured is to be stated, and, if possible, how the wound or injury was occasioned.

When the Journal is completed he is to copy his Sick-Book into the Form provided at the end of the Journal, arranging it alphabetically, according to specimen given in the Appendix to these Instructions.

31.

He is to forward to the Director-General, a Nosological Return, Form No. 10, of the state of the sick, properly filled up and signed by himself, subjoining thereto, under the head of Remarks, a full and comprehensive account of the several diseases, the state of the weather and climate, and the average height of the thermometer, and he is also to detail every other circumstance that may have had an influence in promoting health or generating sickness in the Ship's company; these returns are to terminate on the 31st March, 30th June, 30th September, and 31st December; and, before being transmitted to the Director-General, they are to be submitted to the Captain for his information. In each return a list is to be given of men to whom pension-certificates may have been granted during the period; or should there not have been any granted, a notation to that effect is to be made thereon. In the event of a continuance of any prevailing sickness when abroad, whether of an endemic, or epidemic nature, or whether originating from contagion, or peculiar constitution of the atmosphere, the return is to be sent monthly, or as, often as opportunities may offer. If there should be an Inspector or Deputy Inspector-General of the Fleet on the Station, a copy of every Nosological Return is to be transmitted to him; and upon the arrival of the Ship in England from abroad, or from a cruize, a return is to be immediately transmitted to the Director-General, which is not to supersede or in any manner interfere with the returns ordered to be made at the regular stated periods. The Surgeon is also to furnish the Captain, or commanding Officer, weekly, and at such other periods as he may direct, with a return of the sick on board, in the Form No. 16.

32.

He is to keep a rough and a fair journal of his practice, in the Form No. 11, transmitting the latter to the Director-General, made up to the 31st of December of each year; but should the Medical Officer take charge within three mouths of the expiration of the year, he is to transmit his Journal completed to the 31st December of the following year, taking care that the Nosological Tables at the end of the Journal are drawn up as follows: - Table No. 2, is to contain all cases of sickness occurring previously to the 31st of December of the first year; Table 3, is to include all cases occurring during the subsequent year. In the event of the Medical Officer being superseded, or the Ship being paid off, the Table No. 3, is to contain all cases occurring between the 1st of January and the date of his giving up charge.

In his Journal he is to give the daily symptoms of particular cases, including all those sent to Hospital, as well as cases of death and invalids, and under the head of General Remarks, a history of the complaints that prevailed in the Ship during the period of the Journal. If any malignant or infectious diseases shall have made their appearance, he is to endeavour to trace them to their source, to account for their introduction, and explain the means used for destroying the infection and preventing their re-appearance.

In Table No. 1, he is to insert the names of persons who have received wounds or hurts which may partly or wholly disqualify them for the Public Service, or subsequently, in any way, interfere with their earning a livelihood, specifying those to whom pension certificates have been given.

He is further enjoined, at all times, to keep his fair Journal in such a state of forwardness, that, in the event of any sudden accident to himself, it may be sent as above directed.

33.

He is to advise all the men who have not had small-pox, or who have not been satisfactorily vaccinated, to be vaccinated; and the progress and effect of vaccination, and the prevalence of small-pox ought to constitute prominent topics of remark. Directions have been given that a column shall be appropriated in the Description-Books for the purpose of noting against every man, whether he has had the small-pox, or been vaccinated ; he is to make a corresponding note on the cases sent to the Hospital, with the men referred to in Articles 25 and 27 of this section.

34.

When directed by the Captain or commanding Officer to inspect men newly received, he is not only to examine their persons very carefully, to ascertain whether they are fit for the Service, but he is also to inquire very particularly as to the circumstances in which they may have recently been, for the purpose of judging whether there be any risk of their bringing an infectious disorder into the Ship. He is also to ascertain whether they are pensioned on Greenwich Hospital, and if so, to represent it to the Captain. When men are received on board from a Rendezvous or Receiving-Ship, who are unfit for the Service, he is to report, in writing, to the Captain, his reasons for deeming them so, in order that he may adopt the measures directed by his instructions. The following are the directions for examining Men and Boys for the Navy:-

1st. The external characters of a sound constitution and efficient limbs may be briefly stated, viz., a tolerably just proportion between the Trunk and the different members of the Body - a Countenance expressive of Health, with a lively Eye - Skin firm and elastic - Lips red -Teeth in good condition - Voice strong - Chest capacious and well formed - Belly lank -Limbs muscular - feet arched, and of a moderate length - Hands rather large than small.

The reverse of these marks of a good constitution and efficiency, may be considered to indicate infirm health or inefficiency.

2nd. Every Man or Boy is to be undressed before inspection; und the following enumeration of the more common causes for which a man or boy should be rejected, when any of them exist to such a degree, as will immediately, or in all probability may at no very distant period, impair his efficiency, is to be most particularly attended to by the Surgeon who makes the inspection:-

i.	A feeble Constitution arising from imperfect development, or weakness of the Physical powers of the body, or from Chronic Disease, Wounds, or Injuries.
ii.	Disordered Intellect, or Mental Imbecility; Epilepsy.
iii.	Defective Vision of both Eyes, from whatever cause, and Fistula Lachrymalis. (The loss of one Eye, if the Man be otherwise sound, is not to be considered an objection.)
iv.	Deafness, or purulent Discharge from the Ears.
v.	The loss of so many Teeth as will materially interfere with mastication.
vi.	Purulent Expectoration, severe Cough, or other well-marked symptoms of Consumption; -Asthma, and Chronic Bronchitis.
vii.	Organic disease of the Heart, or Aneurism.
viii.	Distortion of the Spine, from Injury; but slight deviation from the mesial line, from natural causes, is not to be considered as an objection, unless there be considerable deformity.
ix.	Paralysis, either partial or general; Fractures (if they materially impair the strength of the Limb); Permanent contraction, or Rigidity of the larger Joints; Mutilation, especially of the Hands; Deformity, or Lameness, from Gout or Rheumatism, Fractures received in the Service, which have united, without much shortening of the Limb, (not more than an inch,) are not to disqualify a man, if he be otherwise serviceable.
x.	Rupture; Stricture of the Urethra, (but Instruments are not to be introduced unless Stricture be suspected;) Chronic enlargement of the Testicles ; Hemorrhoidal Tumours.
xi.	Varicose Veins, if they are large and impair the strength of the Limbs, require bandaging, or interfere with the free motion of any part of the Body.
xii.	Old Ulcers, or large unsound Cicatrices; Scrofulous enlargement of the Glands of the Neck.
xiii.	Chronic Eruptions of the Skin, or Scalp; Simple Cutaneous Eruptions, such as Psora, are not to be considered as objections, though they are to be reported, and the men are to be placed under Medical Treatment.

35.

By the Regulations for Her Majesty's Service at Sea, it is directed that Subordinate and Warrant Officers, Petty Officers, Seamen, Marines, and others on Sea-Pay, shall be entitled to Pensions or Gratuities when Wounded or Hurt in the Service so as to disable them from continuing therein; when, therefore, any one of the above-named persons shall receive an injury which unfits him for the Service, the Surgeon is, without delay, to acquaint his commanding Officer with all the particulars, in order that a Pension Certificate may be made out, which, when it is signed by the commanding Officer, a Lieutenant, the Master, the Surgeon, and the Paymaster, is to be delivered to the person, before he is discharged from the Ship. The Surgeon is to mention in the Certificate (Form No. 12) the nature of the injury, and the manner in which it happened. certificates are not to be granted for Rupture unless the man shall make application to him, or his Assistant, immediately after the accident; and in that case the circumstances by which the Rupture was occasioned are to be accurately stated, with the date on which it occurred; and, in addition to the usual signatures, the certificate is to bear that of any Officer who may have witnessed the accident, and is to be dated on the day, or at latest the day after, it shall have been reported.

36.

Every Surgeon or Assistant-Surgeon serving on board any of Her Majesty's Ships is, previously to his sending any letter or communication relative to his public duty to the Admiralty, or to the Director-General, to submit the same to the Captain of his Ship, who is to note thereon his approval, or such observations as he may think necessary, observing that all letters for the Director-General are to be sent under cover to the Secretary of the Admiralty with the words "Director-General of Medical Department," written in the left-hand corner.

37.

Every Surgeon and Assistant-Surgeon is to give immediate information to the Secretary of the Admiralty of the day on which he shall have joined or quitted any Ship; and every such Officer being unemployed is, during peace, to report his address on the 31st December; and in time of war, on 31st March, 30th June, 30th September, and 31st December in each year, and also as often as he shall change his abode, in order that his residence may be known; and should he at any time be in London for the purpose of taking up an appointment, or, on being superseded, or paid off from a Ship, he is without fail to report himself personally to the Director-General.

38.

Whenever any unusual expenditure of medicines or stores, or departure from the regulations, orders, or instructions, or, in short, whenever | anything out of the common course shall occur, he is to attach an explanation thereof to the account for the period during which the same may occur, otherwise when the proper period arrives his name will not be placed on the Half-Pay List.

39.

He is to obey all directions which he may at any time receive from the Director-General, or the Inspector or Deputy Inspector-General of the Fleet, relating to the administration of medicines or the treatment of the sick; and to furnish such information, as may from time to time be required respecting the patients under his care, and the means adopted for their cure. He is also to communicate his observations upon any points that he may consider beneficial to the Service, and to propose such measures as he may think likely to conduce to the health and comfort of those under his immediate care, as well as of Seamen in general.

40.

As many favourable opportunities are afforded to the Surgeons of Her Majesty's Ships on Foreign Stations for obtaining a knowledge of the medical topography and course of the seasons of the Ports and Countries which they visit, of the most prevalent diseases, and the general method of treating them, together with the history, properties, preparations, and uses of the medicinal plants or productions, their particular attention is required for the attainment of competent information on these interesting points, to which it is expected that their most zealous exertions will be devoted, as well for the purpose of benefiting the scientific branches of the profession, as for exhibiting a laudable example to their Assistants, to whom this injunction is likewise directed, and from whom an equal degree of attention will be expected.

41.

It being an essential part of the Surgeon's duty to represent to his commanding Officer whatever may be likely to prove detrimental to the health of the crew, and thereby impair the efficiency of the Ship, - he is, should there be any disease prevalent at the place where the Ship may be to acquaint the Captain thereof, so that measures may be adopted to guard against its introduction amongst the Ship's company.

§ III. - ASSISTANT AND ACTING ASSISTANT-SURGEON.

1.

Assistant and Acting Assistant-Surgeons on board Her Majesty's Ships are to make themselves acquainted with the foregoing Instructions for Surgeons, and to comply therewith at all times in so far as may relate to their duties.

2.

An Assistant or Acting Assistant-Surgeon is to send to the Director-General at the end of every year's service, and also on quitting a Ship, a certificate of conduct signed by the Captain; and a certificate to the same effect from the Surgeon, stating also that he has furnished himself with the instruments required, and that they are in complete order: and he in to observe that if ho do not regularly transmit such certificates, in original, at the periods required, the omission will be regarded as an objection to his promotion, and to his being placed on the Half-Pay List when paid-off.

3.

Acting Assistant-Surgeons are not confirmed to the rank of Assistant-Surgeon until they produce satisfactory certificates after serving one year.

4.

In the absence of the Surgeon, or in Ships where no Surgeon is borne, the senior Assistant Surgeon on board is to observe and follow the instructions for that Officer.

NOTE. - Specimens of the Forms referred to in this chapter, are given in the Appendix to these Instructions, issued in a separate volume for the Medical Officers of the Navy.