o supply the names of men with the necessary qualifications who had lready been drafted and were at the cantonments. This was folwed up by a ready response and a great many names were obtained nly to find out later that almost all of these men had already been ssigned to duties that prevented their being available. The banks ere then requested to furnish lists of the men who were about to be alled, and by induction and regular enlistments the desired number as obtained. From first to last, 7 officers (including the comander) and 135 men were brought to France. Many of the latter, owever, were intended as clerical help in the office of the chief sureon, supply depots, division surgeons, etc.

In November a temporary office was established at the New York fedical Supply Depot, where the work of organizing was done. Recruits were examined as to qualifications and sent to Fort Jay, overnor's Island, for physical examination and were there staoned until the date of sailing. While at Fort Jay the detachment as thoroughly drilled, and classes were held in such subjects as ould likely be involved in their work in France. Here, also, suplies were collected and plans made for the procedure and work of he detachment abroad.

* * *

The first section of the detachment, consisting of the commander, lieutenants, and 100 men, left the United States on January 4, 1918, rriving at January 17. They remained at the rest camp t this place until January 24, when they entrained for * *. In his town, while awaiting orders to their permanent destination, the rganization of the detachment was worked out and the members ssigned to definite duties when the work of the unit should begin; lans of procedure were charted, and suggestions worked out for the mprovement of the methods of handling money and property acounts of the Medical Department. While at * 25 memers of the detachment were sent to the Intermediate Medical Suply Depot No. 3 at and 5 to the Advance Medical Supply epot No. 1 at On February 13, the remainder of the etachment was sent to * * * their permanent stations. The reliminary work of establishing an office was immediately begun, ad about the 15th of March actual work was started in the room ovided in Barracks No. 66.

* * * *

* *

The second section, consisting of 2 lieutenants and 35 men, arrived France on the 9th of February, was promptly broken up, and ly 2 members and the 2 officers were later assembled with the iginal unit.

With numerous transfers to medical supply depots and other MediDepartment organizations the enlisted force was reduced to 37 embers. One of the officers was sent to Paris for duty with the reau of accounts, and one to the office of the purchasing board. April 1 the unit was attached to the office of the chief surgeon, d has since operated as the finance and accounting division of at office. Then on May 1 the personnel of the chief surgeon's ice and that of the finance and accounting division were conidated.

Regarding the report of money and property operations of the dical Department above mentioned, it is interesting to note that timony has been received from the bureau of accounts, the AssistAuditor for the War Department, and the Comptroller of the

Treasury that the Medical Department is the first department to submit such a report. The chief of the bureau of accounts desired to show the report to the chiefs of the various departments as a sam ple of what was possible along this line. It should also be noted that the Medical Department is the first of the departments to at tempt to coordinate the financial and property operations in the United States and those of the American Expeditionary Force. The question is often raised as to the value of accounting work to the actual prosecution of the war. Regarding this question two ver important points have been clearly brought out in the work of this division. (1) The work is of great importance to those actually en gaged in the prosecution of the war as making it possible for them to render an account to the people of the United States for the vast sums of money they have expended, as well as to assist in the economical expenditure of the same; (2) but, of far more importance than this, the accounting division is actually aiding in the efficient prose cution of the war as far as it concerns the Medical Department by helping to put the business dealings of the department with the French and English on a sound and equitable foundation. Many instances might be cited to show how intricate problems of business relation between the French and Americans have been tactfully adjusted, so that while amicable relations might continue, it would become clear that efficient service was demanded.

II. DIVISION OF SANITATION.

1. INTRODUCTION.

The mobilization of the National Guard, the concentration of the Regular Army into large camps, the hurried recruiting of the regular forces, the mobilization of the National Army, the great force of drafted men suddenly called from home life to a new environment, all these conditions have required the application of the total professional knowledge of the country to the vast and relatively new sanitary prob lems involved. The sudden call for shelter, food, clothing, conserv ancy, medical attendance, and the other things necessary to the health of the soldier could not be met at once in a manner wholly perfect.

It is a matter of history that all campaigns have been accompanied by epidemics of those diseases more or less peculiar to great aggrega tions of men. in the light of modern accomplishments in preventive medicine we expect that these Army diseases will be kept at the min mum, though not absolutely prevented. The mobilization, concen tration, and movement of troops during the past year have been no exception to the general rule. Some epidemics have occurred, and the morbidity and mortality rates in the camps and cantonments have been higher than the minimum desired. These minimum rates hav by no means been reached, but the present handling of a constant stream of men in the camps and cantonments will result in the formu lation of improved laws of military hygiene, the application of which it is expected, will allow large numbers of men to be brought int camp and to live there, with the minimum dissemination of the camp diseases.

The old Army scourge, typhoid, together with the paratyphoid group, has been practically eliminated by prophylactic inoculation with triple vaccine. The other intestinal infections have been controlled by general sanitary methods. The class of diseases now of importance throughout the Army is that group in which the method of spread is by means of secretions from the respiratory tract, viz, meningitis, pneumonia, measles, diphtheria, scarlet fever, and mumps. With the experience of the past year as a guide and with the aid of the best medical talent of the country, it may be confidently expected that the study of these diseases will yield new facts regarding the modes of infection and the methods of prevention which will prove of immense benefit not only to the soldiers during the present war, but also to the entire population of the country thereafter.

2. THE WORK OF THE DIVISION OF SANITATION.

Organization.-A division of field sanitation was informally established on May 24, 1917, by the assignment of an experienced sanitarian from the Medical Corps of the Army. Additional personnel has been added from time to time and the functions of the division have gradually expanded to embrace the whole subject of general military sanitation. For administrative purposes, the division is subdivided into sections which are indicated below:

(a) Section of inspection.-A group of specially trained medical officers of long service is constantly engaged in making routine and special inspections of all large camps, cantonments, hospitals, and other stations. Their duties originally pertained chiefly to sanitary and administrative matters within camps and cantonments. As the service of hospitals developed, their duties were extended to include hospital inspections also. One of these inspectors is stationed at San Antonio, Tex., and visits the large stations in the Southern Department. The other officers are stationed in Washington and return to that city after their inspection tours, spending about half their time in office duty. This system enables the Surgeon General to keep in close personal touch with the sanitary situation at all stations. The officers making inspections, upon their return to Washington, confer personally with the departments and divisions concerned in the correction of sanitary deficiencies and take a personal interest in following up such matters and obtaining such remedial action as is practicable. It has been found that in most instances this procedure secures far more rapid and satisfactory results than can be obtained by the usual written report emanating from the command where the defect exists. At the conclusion of an inspection the sanitary inspector makes a report to the commanding officer regarding the defects he has found, and submits recommendations for such remedial action as lies within the power of local authorities.

The scope of the sanitary inspection differs materially from that made by the Inspector General's department. Less stress is laid on details of a purely military nature and much more stress is laid on matters largely technical, such as general camp sanitation, nursing and professional care of the sick, competency of medical officers, handling of infectious diseases, prevention of venereal disease, management of quarantine and detention camps, extra cantonment

87894-18-18

health activities, medical supplies, hospital construction, laboratories, special diets, training of sanitary trains, mosquito eradication. water purification, sewage disposal, etc. A medical officer who has expert knowledge of the louse problem makes inspections with a view to determining the prevalence of lice and the steps necessary for their eradication. Inspections relating especially to technical sanitary engineering problems are made by officers belonging to the sanitary engineering section of this division.

(b) Section of communicable diseases.-This section is composed of officers who are specially trained in the study and control of communicable diseases. The work of the section includes the preparation graphic charts and reports for the use of the Surgeon General and for general dissemination. The activities of this section are indicated by the report on communicable diseases appearing under Paragraph 14. (c) Section of sanitary engineering. This section, consisting of officers of the Sanitary Corps with training as sanitary engineers. advises on questions of water supply, sewage disposal, drainage, and mosquito control in all camps, cantonments, and other stations. Every large camp has one or more officers of the Sanitary Corps on duty as assistant to the camp surgeon. These officers supervise drainage and mosquito work, and in some camps have charge of the operation of water purification and sewage-disposal plants and the handling of garbage.

At several of the southern camps where there was a probability that malaria might occur, enlisted men of the Sanitary Corps have been assigned in detachments varying from 50 to 200 men for the purpose of furnishing the actual labor required in connection with drainage and oiling operations. This has been necessary in view of shortage of civilian labor in many localities. These enlisted men are colored. White men of the Medical Department have also been assigned as overseers of enlisted laborers from labor battalions. This force is under the immediate control of an officer of the Sanitary Corps.

(d) Section of current vital statistics. This section receives and compiles current statistics relating to morbidity and mortality rates, based on daily and weekly telegraphic reports from camps and stations in the United States and the weekly cable from forces overseas. Publication and general distribution of the "Weekly Bulletin on Disease Conditions among Troops in the United States" has been carried out and the mailing list numbers about 300. The statistics compiled by this section are used as the basis of a weekly summary of health conditions which is prepared by the chief of the division and given to the press for publication. These statistics are also used by the section of communicable diseases for the preparation of graphic charts and tables. Although not mathematically correct, mistakes and corrections being inevitable, these figures are sufficiently accurate for all practical current purposes in the current medical administration of the Army stations. The weekly report to the Secretary of War and the Chief of Staff and the system of compilation have been the subject of much favorable comment, and the report made use of by other bureaus of the War Department in compiling current statistics.

(e) Section of personnel. This section is engaged in the mobilization of trained medical personnel for the camps, for mobile divisions, and

or other stations and organizations; the changes in their distribution; and the recording and listing the medical staffs of the camps. The hief medical officers, division surgeons, camp surgeons, sanitary inpectors of divisions and camps, depot brigade surgeons, epidemilogists, and assistants of special importance are selected by the ivision of sanitation and are held to account for the proper performnce of their duties. There has already developed an acute shortge of trained medical officers for the important administrative uties, but by a process of gradual training of subordinates for higher ositions it is fully expected that satisfactory personnel will ultinately be fitted into all of these positions.

The following subjects with which the division of sanitation has een concerned have been of especial importance and are separately iscussed:

CAMPS AND CANTONMENTS; ACCOMMODATIONS FOR ENLISTED MEN, AIR SPACE AND VENTILATION; OVERCROWDING AND ITS EFFECT UPON THE TRANSMISSION OF DISEASE.

The original plans for the concentration of the Army were for 32 rge stations. Sixteen were for National Guard divisions. These ere camps with floored and framed tents and wooden mess halls, itchens, and regimental infirmaries. Sixteen were for National rmy divisions, to be composed of drafted men housed in frame

antonments.

The cantonments to be built for the new divisions were needed at nce and plans were drawn by the construction division of the uartermaster General's Office. The barrack plans were objected to y the Surgeon General, and a "board to examine the housing plans" as appointed by the Secretary of War. This was composed of the urgeon General and three eminent officers of the Medical Reserve orps.

The board found two grave sanitary defects in the plans: "First, vercrowding, i. e., the men in the dormitories are too close together; id, second, there are too many men in each dormitory. The amount cubic space allowed to each man averages about 338 cubic feet. his is altogether too small." The board recommended that the bic air space per man be increased to 500 cubic feet; that the unit be housed in each barrack be reduced to 30; that changes be made the plans to secure increased space and ventilation; and that ditional barracks be built to lessen the crowding.

When the drafted men were accommodated in the barracks of ese cantonments it was found that, as a result of military necesy, overcrowding was the rule and that new cases of pneumonia d meningitis were becoming so frequent as to occasion alarm. It is therefore recommended that the cubic space and the square or space per man be immediately increased so as to provide a nimum of 500 cubic feet and 45 square feet, respectively, in each uad room; that in all barracks the men be required to sleep with e feet of one man opposite the heads of the two adjacent men, this allow of at least 5 feet separation between the heads and so dease the chances of spreading respiratory diseases by droplet infecn; that the placing of bunks in groups of twos or fours should be hibited; and that where double-deck bunks were used, the cubic