0. MENINGITIS.

This disease has appeared in every camp during the six winter months of 1917–18. However, it has been epidemic only in three camps, Jackson, Beauregard, and Funston Indeed, it has been epidemic only in those camps where soldiers have been drawn from areas in which this disease has been endemic.

Meningitis, next to pneumonia, primary or secondary to measles, has been the most serious disease that the Medical Corps of the Army has had to contend with. It is serious by reason of its high fatality, and also because this of all diseases shows the greatest excess over its prevalence in civilian communities. It is estimated that meningitis has been more prevalent among the soldiers than it has been in any part of the United States during the same period, and taking the average in the Army and the average in the civilian communities, meningitis has been 45 times as prevalent in the Army as in civilian life. This disease is widely scattered over our country, and the draft acts as a dragnet, bringing those who have been exposed and those who are car riers to our camps where they come in contact with highly susceptible individuals, thus spreading the disease. It is unfortunate that drafted men from localities in which meningitis is known to exist can not be kept at home until shown to be free from infection.

D. SCARLET FEVER.

This disease has been most manifest at Camps Pike, Lewis, Kearney, Sherman, Dodge, and Grant. However, its great prevalence at Camp Pike stands out distinctly The rate at this camp is nearly twice that of the second camp. Scarlet fever was more prevalent in the National Army than in the National Guard camps. It seems probable that this fact is attributable to the presence of the disease in the particular localities from which troops have been drawn. This accounts for the disease in both Camp Kearney and Camp Lewis, which receives men from the same general localities. The greater prevalence of scarlet fever in the National Army as compared with the Nationa. Guard may be explained by the later assembly of the National Army and by the continual additions to these camps from civilian life.

E. DIPHTHERIA.

This disease occurred in only 7 out of 29 camps. Here, again, Camp Pike, which has a bad reputation in many things, leads the list. Camps Funston, Dodge, Cody, and Custer come next in order. On account of the specific treatment, diphtheria has not caused a large number of deaths.

16. DIVISION OF MEDICAL RECORDS.

Attached to the Sanitary Division for administrative purposes is also the Division of Medical Records. This division, as its name implies, handles all the medical records of enlisted men and officers serving either in this country or abroad. As was to be expected, it has been expanded very greatly during the present year. All the medical records are filed as promptly as possible, so that all inquiries for information coming through the authorized channels may be answered with as little delay as possible.

After the Civil War there was a great deal of confusion and delay in settling claims, for the medical records were imperfect and it was difficult to obtain information from them. Untold millions of dollars will be involved in the settlement of the various claims that will be made against the Government, all of which must be settled by the evidence from these records.

This office receives also the daily reports of hospitals from "over there." This daily report is a recent innovation. They are arranged as soon as received, so that fairly prompt information can be furnished to all relatives and friends regarding the character of wounds or causes of the deaths in the American Expeditionary Force.

The daily cablegrams of casualties are also carded and from these are prepared weekly statements for the Chief of Staff. It is from

these statements that the current information relative to all casualties is furnished to the Secretary of War and other officials.

During the past few months it was found necessary on account of the greatly enlarged Army to change the entire system of tabulating statistics in this division. The old method of tabulating by hand has now been replaced by a modern system of perforated cards, which are sorted and tabulated by electric machines. It will thus be possible to publish from year to year the health statistics of the Army in the annual report.

The work has been so arranged that after the war is concluded the work of preparing the statistics for the "Medical and Surgical History of the War" will be a continuation of the work that is being carried on for the preparation of the statistical tables for the Surgeon General's report. Thus it will be possible to complete the statistical work for the "Medical and Surgical History of the War" within a comparatively short time, instead of after a number of years as was the case after the Civil War. Few publications have been of greater value to the medical profession in this country and abroad than the "Medical and Surgical History of the War." It is especially desirable that the valuable medical and surgical material of this war should be available for the use of the entire medical profession as soon as practicable.

17. GENERAL REMARKS ON SANITATION BY DEPARTMENT SURGEONS.

(Extracts from reports.)

A. SOUTHEASTERN DEPARTMENT.

During the period May 1 to July 20 the nine National Guard divisional camps and the three National Army cantonments within the geographical limits of this department were subject to the authority of the department commander. General Orders No. 96, War Department, July 20, divorced these camps from departmental authority in all matters save supply. This condition continued until General Orders No. 96 were modified on October 15, at which time the divisional camps and cantonments were made entirely independent of these headquarters.

On May 1 the department surgeon's office made contact with sanitary detachments, Regular and National Guards, throughout the entire department, and a schedule of intensive instruction for sanitary troops was prepared and issued. Tentative selection of main and subsidiary medical supply depots and a department laboratory was made. Correspondence was entered into with the Surgeon General's Office over the proposed location of camps and cantonments, and the form and number of medical establishments to be constructed therein. Numerous Red Cross companies and base hospitals were organized and enlisted in the Medical Enlisted Reserve Corps to await the pleasure of the War Department for assignment.

B. EASTERN DEPARTMENT.

The surgeon reports that since the declaration of war the hospital has performed many functions not required in peace times. Over 2,000 candidates for training camps were examined. From 1,000 to 2,000 protective inoculations have been given monthly. For two months an overseas casual camp was administered. Men of special qualifications were furnished units and promptly replaced by searching out recruits from New York or by training men already in the detachment. The hospital acted as a clearing office for the militia and casual offices. It was an unofficial consultant and advisor for medical men, organizations, and civilians on all sorts of topics. The surgeon was called upon for lectures to college students, special courses in military hygiene to senior classes of medical schools, medical societies, and an association of medical reserve officers. In addition, militia organizations were examined for muster in, and work was continued in the office on many occasions until after midnight. On the whole, officers and men worked loyally and uncomplainingly and exhibited the proper spirit and morale under the trying and unusual conditions imposed.

Allentown, Pa., United States Army Ambulance Service.-This camp is under the direction of Col. Elbert E. Persons, Army Ambulance Service. It began on June 1. 1917. The average number of men in the command was approximately 3,200. The commanding officer reports that so far as known this is the only camp in the United States in which the men are not messed by organizations. On account e local conditions a general mess was adopted at this camp on July 1, 1917. There has been no sickness of a considerable number of men at one time, which may be attrib uted to improper food or insanitary preparation of food. The men have been well fed and the mess saved and declared a dividend from the company fund aggregating $1 per capita for the period covered. The health of the command has been excellent

C. WESTERN DEPARTMENT.

The hasty and superficial examinations given by inexperienced and indifferent medical examiners to applicants for enlistment, immediately following the declara tion of war, is reflected in the enormous increase in discharges for disability existing prior to enlistment. These do not include the large number of men of Nation Guard regiments who were discharged for disabilities detected by the medical examiners at the time of muster of their organizations into Federal service. Under War Department instructions mustering officers were authorized to discharge, witho prior reference to these headquarters, cases of physical disability detected by them at muster-in examinations. The number so discharged indicated that recruits en listed in the State National Guard regiments were not required to come up to the standard exacted for the Regular service. As a result many National Guard organi zations had an actual effectiveness of only about 75 per cent of their paper strength, During the past three months boards, consisting of specialists in tuberculosis and cardiovascular diseases, have been sent to the majority of posts in the department for the examination of troops for these diseases. These boards are still engaged on this duty and the result of their work already accomplished has been submitted to the Surgeon General of the Army in the shape of a report from each post examined. The prompt elimination of these physical defectives, and particularly the tubercular subjects, will doubtless result in the saving to the Government of millions for pensions and for days lost in hospital, had these defective soldiers not been promptly discovered and eliminated. At the outset it appeared to be the intention of the War Department to examine only those troops at stations known as "organization camps Shortly after my arrival at these headquarters, however, I became convinced that these examinations should not be limited to the several large stations, but should be general throughout the entire department, as the majority of the troops were men who had enlisted subsequent to the declaration of war, and had received a most hasty and superficial examination. The result obtained has confirmed my opinion. and the comparatively small expense for mileage is more than offset by the assurance that the men in organizations have been given a thorough physical examination and found qualified for actual field service, without the liability of breakdown. During the calendar year there were 1,399 discharges for disability, of which 195 were in line of duty and 1,204 not in line of duty.

The United States becomes responsible for the medical attendance and supplies of the National Guard organizations from the date on which they report at their com pany rendezvous. No sooner had these organizations so reported than there appeared to develop a mania for purchase of drugs, hire of civilian physicians, and treatment of officers and soldiers in civilian hospitals. To a certain extent this procedure was necessary and permissible under paragraph 1476, Army Regulations, particularly for those organizations guarding tunnels, bridges, and public utilities, frequently scattered in small detachments. The idea seemed to prevail among the National Guard officers, medical and line, that as the United States was responsible for the bills there need be no limit to the expenditures.

Accounts were sent to this office which indicated that an earnest effort had been made to purchase at least one item of the varied stock of drug stores, or to place men of every organization in some civilian hospital, or under the care of a civilian physi cian. Needless to say, not only these but all accounts have been closely scrutinized and nothing left undone to safeguard the interests of the Government. In spite numerous letters on the subject, settlement of these accounts has been considerably delayed and has caused an almost interminable correspondence by reason of the failure of the officers responsible for the purchase or service to render vouchers immedi ately on the conclusion of such purchase or service. The accounts, even when redered, are habitually in such form as to render it necessary for this office to prepare the voucher for signature of the creditor and certificate of the officer responsible, the latter by that time being in France or at some eastern embarkation point.

D. CENTRAL DEPARTMENT.

The mean strength of command for the year, as reported on returns of the Medical Department, was 19,899.67. The total admissions to sick report from disease and jury numbered 14,567, with a ratio of 732.022 per 1,000. A total of 131,723 days were lost by sickness, making a daily noneffective from all causes of 18.135 per 1,000. On May 8, when the first officers' training camp was to be opened at Fort Snelling, Minn., the Medical Department personnel consisted of two officers, Medical Corps, one lieutenant, Medical Reserve Corps, one master hospital sergeant, eight privates and privates, first class, Medical Department, a shell of a hospital, with buildings, n only fair condition.

A partial regiment of National Guard was camped on the reservation at Fort Snellng. On May 15 enough candidates had been examined physically to start in trainng 2,500 students of the officers' training school. A hospital had been put into unning capacity, requisitions submitted for 300 beds, barrack, kitchen, and adminisrative features prepared for a recruit company of 200 hospital department men, and sanitary management completed for a command of a training camp and four regiments of Infantry and a regiment of Artillery.

One of the first and most successful acquisitions to effective work in meeting the emergency of sudden expansion with only new and untrained men to work with, was 16 trained nurses (female) under a head nurse, Miss Sophia Burns, of the Army Nurse Corps.

New medical men direct from civil practice found their places as best they could under Army conditions strange to them, and soon came to appreciate the advantages to be derived from a practical course of schooling. This was instituted in accordance with circular letter, Surgeon General's Office, dated May 14, 1917, and was carried through in every detail with great credit to all concerned.

Considering the frequent changes in both the commissioned and enlisted medical personnel, the fact that this personnel was largely composed of men new to the service and the vast amount of work thrust upon them, their services have been most grati fying. This degree of efficiency has been due to the schedule of intensive training prescribed by the Surgeon General May 14, 1917, which has been carried out in this department, to the similar schedule of instructions in force in the medical officers' raining camps, and the intellectual caliber of the men entering this branch of the service.

E. SOUTHERN DEPARTMENT.

In considering the operations of the Medical Department of the Southern Departnent for the calendar year 1917, the special condition that pertained during the ear will first be briefly enumerated in order that a proper understanding of the ituation be called to mind.

During 1916 practically the entire available military force of the United States, ncluding the militia of practically all the States, had been mobilized in this departnent in connection with the Mexican border troubles. These forces, numbering Itogether 160,000 men in December, 1916, were gradually moved out of the departnent, the main homeward-bound movement of the militia beginning January 2, 1917. At the end of the month there were 50,000 Regular troops and 70,000 State troops of he States comprising the department. The Regular troops in this department maintained a fairly constant strength throughout the year, the average being 57,408. In April 5, 1917, just prior to the declaration of war, the State troops were again alled into the Federal service and at the end of April those troops in the Southern Department numbered 5,740. This was about the average number for the remainder f the time during which the militia was under department control with the excepion of the month of August, when the number increased to 17,664. This increase is xplained by the fact that the State troops were assembling in Southern Department rritory for the National Guard divisional camps which opened during September nd October, after which time the militia passed out of the department control by he organization of divisions. There are five National Guard divisional training amps within the territory comprising the Southern Department.

As previously stated, the strength of command in the Southern Department for the ear 1917 has fluctuated widely, from a maximum of 119,178, January 31, 1917, to a inimum of 51,096, March 31, 1917; again reaching a high figure of 85,242, August 31, 17. These figures include both Regular Army and National Guard officers and listed men.

For the Regular Army troops, the number in the department averaged 57,408 ficers and enlisted men, the figures ranging from 48,492 in May to 67,578 in August. hese figures omit the large number of men of the aviation section, Signal Corps, in

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training at Kelly Field. Since October 5, when the number of men at this station was 11,000 and had in December increased to approximately 32,000, reports of sick and wounded from this station have not been forwarded through this department. Attention is called to this for the reason that a large part of the work at Base Hospital No. 1, Fort Sam Houston, Tex., is received from this aviation station. At Kelly Field itself, there is only a small camp hospital, not equipped for handling serious

cases.

Again, during the latter part of the year a considerable number of cases, about 2,200, were treated at Base Hospital No. 1, Fort Sam Houston, belonging to the National Army cantonment at Camp Travis. This was due to the fact that the base hospital at that camp was not ready for two months after the camp itself was put into service. These cases were reported direct to Camp Travis for transmission to the Surgeon General and do not appear on the weekly reports of this department, but during October, November, and December they occasioned a very material part of the work of that hospital. Figures are not available to show the number of men in this territory contributing to Base Hospital No. 1, but besides the department proper there is, as above mentioned, Kelly Field, Camp Travis, and the officers' training camp at Leon Springs, Tex., which at times numbered 4,000 men.

F. FORT OGLETHORPE, GA.

The middle of May marked the beginning of the expansion of military activities in Chickamauga Park, Ga., the personnel of troops representing about two-thirds recruits and one-third seasoned soldiers. Until the advent of cold weather, clothing was sufficient, but since then a lack of sufficient woolen clothing was felt. This condition has now been remedied except for the pressing need for heavy woolen blouses and breeches.

In the formative period of the camp, tents served as shelter until rough, unceiled, wooden one-story buildings were constructed. As cold weather approached, these buildings were double floored, side walls were ceiled inside and a layer of beaver board made to form a ceiling overhead and an adequate number of stoves installed. An insufficient supply of coal has made the use of wood necessary for heating purposes, which latter for the most part has been green and of poor quality.

The health of the experienced soldiers has been very good. As might have been expected among so many recruits from rural districts, measles, mumps, pneumonia, a few cases of scarlet fever, and diphtheria appeared. Fourteen cases of cerebrospinal meningitis occurred, with 3 deaths. The outbreak of mumps reached its highest point about the middle of December, when 420 cases were under treatment.

18. GENERAL MEDICAL SERVICE BY DEPARTMENT SURGEONS.

A. SOUTHERN DEPARTMENT.

In the case of the Regular Army the incidence of disease for the first three months of 1917 averaged between 22 and 30 per week per 1,000. During April and May this figure increased to about 40 per 1,000, owing to the numerous enlistments, but since the middle of June, when the weekly rate was 36 per 1,000, the rate has gradually decreased till the end of the year, when rates of 15 to 18 per 1,000 have been maintained. These favorable rates, however, unfortunately have not continued into the present year, owing to the epidemics of measles, pneumonia, etc.

With a total strength of command fluctuating widely from week to week, and month to month, as has been the case with the National Guard troops in this department, it is difficult if not impossible to determine reliable morbidity rates. However, there seems to be a tendency to a rate which is slightly higher than in the regular forces. Including measles with the respiratory disease and taking the total of such diseases with influenza, pneumonia, and tonsillitis, we have a group of diseases which comprises one-third of all the admissions on sick report of the Regular Army and National Army for the year and over one-half of similar cases of the militia.

B. CENTRAL DEPARTMENT.

Tuberculosis cases were very prevalent, there being 71 cases at Fort Benjamin Harrison, Ind.; 44 cases at Fort Riley, Kans.; 43 cases at Fort Des Moines, Iowa; 24 cases at Fort Sheridan, Ill.; 13 cases at Fort Crook, Nebr.; 11 cases at Fort Snelling, Minn.; 10 cases at Fort Leavenworth, Kans.; 3 cases at Fort Brady, Mich.; and 1 case at Fort Wayne, Mich.

Fort Benjamin Harrison, Ind.-The amount of sickness has been unusually small and the mortality extremely low. There has been remarkable immunity from disr