hours. They broke out in widely separated parts of the cantonment and in no one of them could infection be traced to previous cases. Mass quarantine of regiment or even companies was concluded to be necessary. Quarantine was made selective and included, first, all tent mates of the sick man; second, his close associates; third, occupants of neighboring tents. These contacts were removed to a quarantine camp, together with their tents and effects. No contacts developed the disease. Later, men in neighboring tents were not quarantined. The outstanding feature of meningitis outbreaks in this camp is that they invariably occurred after dust storms. They have not followed winter rains. All contacts and a great number of other individuals were examined and repeated post nasal smears were made. Even in those found to be carriers of the meningococcus the disease has not manifested itself. The cases were nearly always diagnosed at an early stage. This fact, together with prompt intraspinal treatment at the base hospital is accountable, it is thought, for the comparatively low death rate.

III. BASE HOSPITALS AND SPECIAL SERVICES."

At each cantonment an extensive base hospital was built, usually with a capacity for about 1,200 patients. In some camps there was a delay in completing the base hospital until the middle of winter. and this prevented the proper treatment of the sick. In other cases epidemics of unanticipated dimensions showed that the space provided was entirely inadequate. Thus at Camp Pike, with a normal capacity of 1,250, there were on January 14, 1918, 1,785 patients. and there have been as many as 1,850. In this case there was a severe epidemic of measles; and as fast as cases became convalescent they were treated in barracks.

A good picture of the surgical service at a base hospital is afforded by the report from Camp Pike.

From November 1, 1917, to December 1, 1917, operative surgery was carried on in a room of the receiving barracks with but five officers on duty in that service. There were two wards available for surgical patients. Weekly meetings of the surgical staff were held, with a view of putting in force a definite system as soon as the operating pavilion should be opened. This system devised and carried out during the remainder of the year was as follows: The main operating room cared for clean surgery only, and the two operating rooms in this pavilion were labeled "A" and "B." Wards 9, 10, 11, and 12, immediately adjacent, were set aside to take care of the patients on this service. The operating room of the ear. nose, and throat section was denominated "C," with wards 17, 18. and 19 to receive patients on this service. Operating room "D" was to take care of pus cases, with wards 23, 25, and 26; separate operating teams work in each service. The sterilization of dressings required for whole surgical service was finally done in the sterilization room of the operating pavilion. Each ward obtains its own dressings material from the supply officer, cuts and folds them as desired. places them in a clean, labeled pillow slip, and leaves them at the entrance of the operating pavilion at 1 p. m. daily.

The dressings are sterilized and returned to the wards. Each ward then does its own dressings without further assistance from the operating room service. This procedure has greatly simplified and made for efficiency in the dressing of surgical cases. Accident cases

were immediately attended to by ward surgeons, and anti-tetanic serum used in all cases. X-ray pictures are made as soon as practicable. Cement floors are in all operating rooms. A satisfactory System for delivery of sterile water was devised by the chief of the surgical service, which meets all requirements. The surgical service has met with the refusal of soldiers with acute appendicitis to submit to operation. Recent orders on the subject of refusal of operation do not meet this condition. Should a patient die without operation his friends can criticize the service for lack of proper treatment. Should operation be performed without the patient's consent and without the proceedings of the board required by recent order, the service would also be open to criticism. It may very well happen that immediate operation is necessary to save life, and there will be no time to convene a board of officers as contemplated. The commanding officer has ordered, in a specific case, that operation should be performed without the patient's consent, it having been decided by consultation that this measure was necessary to preserve the patient's life. Confirmation of this position in similar cases is desired. There were upward of 500 surgical operations of varying nature performed by the surgical service up to January 1, 1918.

BASE HOSPITAL, CAMP PIKE, ARK.-EYE, EAR, NOSE, AND THROAT SERVICE.

The work of this service was at first almost entirely taken up with the examination of malingering. The latter part of October many cases of measles were admitted and ear complications were treated. Up to January 1, 1918, 30 operations for acute mastoiditis were performed, two of these cases being bilateral. The department has treated many cases of tonsilar and paratonsilar abscesses and many cases of laryngitis. It has been realized that probably the most valuable work opened to this department of the surgical service is the seeking out and removing of chronically infected tonsils and the performance of operation for chronic nasal conditions. The limited personnel and the pressure of other work prevented systematic entrance into this field. September 27, 1917, there were two medical officers on duty at this service; October 17, one medical officer; December 5, three medical officers. The equipment was finally all that could be desired, but its arrival was slow.

BASE HOSPITAL, CAMP PIKE, ARK.-MEDICAL SERVICE.

There were many men at work in the hospital when it first opened. Notwithstanding, it was possible to operate all the wards but three. From the opening of the hospital until the end of the year practically all the beds were occupied, and many times it was necessary to place rows of cots in the corridors. There were as many as 1,700 in the hospital at one time. Commissioned personnel in the medical service was insufficient at this time, and sometimes one officer had to see as many as 300 patients. The same was true of the nurses, who worked efficiently and without complaint under adverse conditions. At that time there was no hot water in the wards, and it was a difficult matter to bathe patients.

In the medical service there is a standing order that all serious or Houbtful cases must have a consultation with the chief of sevice, and if he snot available then the next senior officer, and so on down the line, but the consultation must be held, and is an imperative rule in all such cases.