The spectacle of the traditional “Annual Physical Examination” is familiar to all officers—certainly those with pre-war service. Then, if ever, the medical officer had his field day. Everything else about the ship and its routines was relegated to insignificance in order that the practice might be completed and the ship chalk up another “annual” accomplishment.
It was an all-hands evolution. The officers to be examined cut out a few cups of coffee, reduced their nicotine intake, applied themselves with more than usual vigor to their morning monkey drill, and everybody was “physical conscious.” Pervading the whole picture was the medical organization. This was the time that the medical officer had his day in court.
The Executive Officer was besieged by the medical officer to prepare a schedule of examinations in accordance with the hours available. Individual officers wanted their examinations at certain times. The Gunnery Officer pointed out the utter futility of maintaining a consistent schedule of training if everything was subjugated to this whim of the medico. How could the Damage Control Officer train his parties if, every day or so, the key officer had to lay up to the Sick Bay for his annual?
In the Sick Bay country everything was hustle and bustle. Unusual compartments were rigged with eye charts and scales. Special tables were broken out to carry the load of health records and check-off lists. Syringes were washed and oiled for shots. The Hospital Corpsmen were drilled in their specific tasks. Specimen bottles were washed and sterilized. Sick Call, sanitary inspections and other routines were postponed.
At the crack of the dawn of December the action was joined. First salvos had to be spotted for timing of the schedule. Bottle necks appeared but in a few days everything was running smoothly. In turn the officers checked off the list, left their specimens, stripped to their skivvies, got weighed and measured. The medico looked in their throats and noses (and other apertures), listened to their hearts, dabbed across their chests with a stethoscope, often listening to three positions during one inspiration. Shots were administered and in true American mass-production, conveyor-belt fashion the practice proceeded. The dead line was Christmas. The examinations had to be completed during December and the last week was neither convenient nor available. Even during the first three weeks some officers had the hideous temerity to want to be excused so that they might have an afternoon ashore for Christmas shopping or to take the kids to see Santa Claus.
Finally, on Christmas Eve, it was finished. All laboratory tests were ended—the last few by the “sink test.” Forms Y were all neatly typed and ready to be forwarded to the Bureau. The officers who again had passed the hurdle had an extra snort ashore celebrating the fact that they were fit for another year. The medico slumped in an easy chair with a prodigious sigh of relief. He had accomplished his task and mission. Now there was nothing to worry about except the multitudinous annual reports.
This distorted picture has been deliberately exaggerated for emphasis. This degree of stilted formality was, of course, never attained. Nevertheless, there was implicit in the procedure an emphasis on accomplishing a mission by a certain time in which the correct clerical details had to be given priority over every other consideration.
But, did the officers of the ship get physical examinations in the spirit of the directive requiring them? Was there time for the medical officer to utilize all diagnostic procedures to elicit any and all slight variations from the usual physiological adjustments which should be viewed (a) as leading to the termination of a naval career or, infinitely more in keeping with the idea of routine examinations, (b) as subject to correction or elimination by moderate treatment, advice, or counsel?
Another aspect, not always given adequate consideration, is the fact that the procedure cheated the officers out of availing themselves of the most important function that the medical officer can perform. During the year little things had happened that would prompt an officer to consult the surgeon. After a strenuous period—or spontaneously without apparent cause—-there had been an occasional little catch under the sternum. After exertion there had been a feeling of heaviness in the lower abdomen. Weight had been dropping off and the customary cough syrup had not stopped that cough that constantly annoyed. Certainly those repeated and increasingly frequent little misunderstandings with the wife didn’t mean a thing, but, maybe, a little talk with Doc might bring a better mental slant on things.
He would talk it over some time. Not now. It didn’t amount to much anyway and Doc did enjoy his bridge and cribbage in the wardroom. He would bring it up at the time of his Annual Physical when he would have his own individual turn at him. But when he lined up for the furious pre-Christmas scramble and saw the “rats’ race” in the Sick Bay, it was silly to think of mentioning it then. Well, it didn’t bother him so much now anyway. He would find another opportunity or just skip it. He certainly didn’t want to get his name on the Sick List before the Selection Board met and after that he would get a chance to take it up.
This practice, repeated over a few years, has undoubtedly resulted in the extension and progression of minor disabilities, which at their inception were easily eradicable, to a stage where they were beyond correction. Careers have been prematurely terminated or lives have been sacrificed before the span of deserved useful years.
These results are diametrically opposed to the basic, fundamental philosophy of Naval Medicine. They are certainly opposed to the principles of the development of an increasingly fit and accomplished corps of officers. Any directive that stipulates that “all officers shall be given a complete physical examination during December” must be condemned as militating against the best interests of the service.
Nevertheless, there must be provision for routine physical examinations. The alternative of no routine examinations is equally untenable. This is one feature of our Navy for which we are envied by medical departments of many other navies. And they should be made at regular intervals. To leave the time of examination to the whim of the officer concerned or the medical officer would inexorably result in extending gaps and defeating the intended purpose. But the routine should not be restricted to a limited period which does not provide for adequate, comprehensive, and careful examination. It should be evenly distributed throughout the year.
There is in the life of each of us a historical landmark which recurs at an annual interval and which is not dependent upon any other calendar high light. That is the birthday. With varying degrees of emphasis, depending largely upon family background, every man is annually brought up with a round turn to the realization that another year has passed and he is a year older. The date of birth is significant to officers in many respects. It is the subject of an essential column in the Navy Register. It recurs on every page of the Health Record. John Smith’s record and jacket can’t be found in the Navy Department without knowing the date of his birth. In any event, the date of birth—certainly the birth month—is well known to the individual concerned and appears in many official records.
Although physiological age is only remotely parallel to chronological age, many physical findings are interpreted in terms of chronological age. This is attested by the old disproven generalization that blood pressure should be 100 plus the age. The Manual of the Medical Department, paragraph 21104.2, specifically requires that “medical examiners shall carefully consider the age and grade of the officer concerned.” But this is essentially beside the point in the thesis being developed. The point for emphasis is the fact that the birth month is a poignant annual episode on the basis of which an officer may be scheduled for his annual physical examination. An examination during the birth month can be just as routine and just as “annual” as “during December.”
The distribution of birthdays among the months of the year is surprisingly uniform. In general it can be assumed that, in a representative ship, the distribution of the birthdays of the officers will permit an even scheduling of physical examinations throughout the year. The larger the command the more even the distribution, and consequently, the greater ease of scheduling.
Under a schedule in which officers would be examined during their birth months, the examinations could be arranged so that, at times mutually convenient to the medical officer and the officer concerned, the examination could be leisurely, complete, and thorough. When indicated, special examinations for which the ship does not have the facilities could be arranged when berthed in company with hospital ships or in port near naval hospitals. There would be opportunity for a quiet man-to-man “huddle” to talk things over, understand and appreciate situations and points of view, and, generally, establish that close association which is the sine qua non of correct relationship between the medical officer and the officers of his ship.
To begin with, the schedule would serve to insure that examinations would be made at regular intervals and there would be records of findings at intervals of not longer than a year. This is in conformity with the most firmly established interval in the history of man. With experience and practice and as the service would become more and more familiar with the procedure, it would lose its stiltedness. The formality would be replaced by a growing tradition of closer relationship between the medical officer and the officers of his ship. From the status of a formalized, stated “practice” in which the primary objectives are meeting a dead line and getting the papers signed, sealed, and delivered, the Annual Physical Examination would become a practicable, working arrangement by which the cardinal principles of Naval Medicine would be attained and there would be increased preservation of fitness of all officers. Can there be any doubt about the end results?
This is not purely a hypothetical thesis. It has been done. During recent years the phraseology of directives requiring annual examinations has shifted from the traditional “during December” to requiring that all officers be given a careful and complete examination “during the calendar year.” This has permitted the establishment of schedules for examinations on the basis of each officer being examined during his birth month. Parenthetically, in one command the directive was simplified by stipulating that each officer report on his birthday. This degree of specificity might not be practicable in all instances. The rare officer born on February 29 would lose out on three successive years.
Scheduling on the basis of birth month is simple. It can be done without the slightest encroachment upon other schedules involving the individual officer, gunnery years, holidays, etc. In all cases in which it has been practiced there has been universal endorsement. The lists get smaller toward the end of the calendar year. More officers have had complete examinations for promotion or for other reasons. As the holiday season approaches and as other annual reports and returns require attention, the Annual Physical Examinations become a matter of historical recollections.
The implementation of the procedure is equally simple. It is necessary only to replace in directive—either General Order or ALNAV—the phrase “during December” by wording that requires that “each officer will be given a complete physical examination during the month of his birth.”