rhea, dysentery, gastrointestinal and other diseases of the digestive organs. This condition is evidently due to excellent quality of food and extremely favorable sanitary condition of post. Military control of restaurants, lunch stands, etc., contiguous to post has contributed greatly to this result. There were a few cases of smallpox (mild type) during the early part of the year, but these cases occurred only among those who were recently enlisted and before a successful vaccination could be effected. There have been only a few cases of cerebrospinal meningitis. Sporadic cases of diphtheria have occurred, but they were promptly brought under control by locating the carriers and immediately isolating and immunizing them with antitoxin. A mild epidemic of measles has prevailed with practical elimination of pneumonia as a complication. A mild epidemic of scarlet fever at one time threatened the Tenth Infantry by infection of 10 or 12 men. Prompt isolation of Company B and the maintaining of a most successful quarantine promptly brought the threatened epidemic to an end.

Fort Leavenworth, Kans.-There were several outbreaks of infectious diseases but the active cases have been effectively isolated and the threatened epidemic killed in the shell. The civil population of the post has been singularly free from diseases, no case worthy of note being on record. The inundation of transient units and individuals comprising the training camps for officers and provisional officers and recruits for depot companies contributed largely to the percentage of sick and to the variety of diseases.

Measles and mumps have existed continuously since July and are at present on the decline. Meningitis, diphtheria, and scarlet fever existed sporadically, a few cases being constantly present, and nearly all contracted before arrival at post. A few cases of smallpox in nonvaccinated cases, contracted from outside sources and prior to arrival in post, developed; also one case of typhoid fever that had received first dose only toward immunization prior to attack.

Fort Snelling, Minn.-There has not been a single failure in enteroenterostomies, herniotomies, appendectomies, gall bladder and kidney operations, bladder and genito-urinary work, bone and joint surgery, head and mouth work, and in plastic surgery. There have been 233 operations performed since June 16, 1917. The department of nose, ear, and throat and that of internist have a record of 31 pneumonias and only 1 death; 4 meningitis cases and but 1 death, due in this case to other causes. The various organizations, aggregating 17,000 men, have been examined exhaustively for psychoneuroses and tuberculosis, and the hospital at this station has attended to the sick and to the military medical training of the troops in Wisconsin, North Dakota, and Iowa, with an average constant sick of about 132. The prevailing diseases have been for the summer months; mild gastrointestinal disorders, with occasional ptomaine attacks which were attributed largely to ice cream, hence this commodity was cut out entirely and not allowed to be brought upon the post, with certainly marked diminution of autointoxication ailments. Venereal diseases steadily ncreased, but were held in check to a moderate extent by an effort only partially effective in enforcing the usual methods of prophylaxis and the provisions of general order 17, 1912.

With the advance of cold weather pulmonary affections, mumps, and measles apeared more and more frequently on the sick report, with occasional diphtheria and neningitis cases. To control these diseases more effectually effort was made to pick out carriers from the companies and isolate them within the barracks. When the pidemic of mumps, measles, and pneumonia assumed alarming proportions, the baracks being badly overcrowded, a vigorous effort was made, with the hearty cooperaion of the commanding officer, to have the company officers daily pick out, and call ut, all men showing or complaining of any symptoms of colds or other affections, emove them from among the well men and segregate them in one part of the baracks. These so isolated were then removed, the ones who recovered (this without ospital treatment), with the result that soon all new cases originated in these separated ections only, and there wes a rapid reduction of all these affections and the complete radication of measles and pneumonia from the troops' barracks.

From this time on sporadic cases of mumps only have occurred. With this diminuion of increment to the sick report the cases received were held in the hospital beyond he time that their condition would seem to require, in order to further reduce the hance of infection. As a consequence marked temporary rise in noneffective rate o almost 60 per 1,000 in December ensued. Prior to this the noneffective rate had ever exceeded 11 or 12 per 1,000, the rate for the year reaching 15 plus. To prevent outh-to-mouth infection every bed in the barracks had its mosquito-bar rods in place, nd from the left side of these rods each man suspended his shelter half so that it hung long the side of his bed. Thus was there placed between each sleeping man a susended screen to act as a mechanical barrier to droplet infections. This has not been 1 effect long enough to demonstrate results. In the hospital suspended sheets eplaced the shelter halves of the barracks.

C. EASTERN DEPARTMENT.

Fort Jay, N. Y.-During the fall of 1917 an epidemic of measles occurred at this post. The admission rate during the period was 337.28 per 1,000 per year. There has been a marked decrease of venereal diseases for the past year. Most of these cases were contracted prior to arrival at the post.

Madison Barracks, N. Y.-The surgeon reported that during September, October, and November there were 123 cases of measles, 75 mumps, and 11 diphtheria at the post, and that it is probable that the crowded conditions of the barracks had much to do with the extension of the epidemics of measles and mumps. He reports one case of spinal meningitis occurring on September 29, the patient dying within 24 hours. Fort Monroe, Va.-The surgeon reports 19 cases of pneumonia at the post during the year, one being acute lobar pneumonia and 5 acute pneumonic tuberculosis in negroes. There were 3 deaths and 1 case of permanent blindness from wood-alcohol poisoning.

Plattsburg Barracks, N. Y.-The surgeon reports no epidemic disease occurring during the year with the exception of acute epidemic conjunctivitis (pink eye), caused by the Koch-Weeks bacillus. A very large number of cases of this disease occurred during the first officers' training camp, which was ascribed to the use of the common washbasin. On the discontinuation of the use of the common basin for washing the epidemic gradually disappeared.

One case of acute anterior poliomyelitis was also reported as occurring in October during the second officers' training camp, in a candidate 25 years of age who had been exposed to severe weather conditions by being in the trenches all night. He was evidently a carrier of the disease, and owing to exposure his resistance to development of the disease was lowered. He had not been away from his station and the disease was nonexistent in this locality.

Allentown, Pa., United States Army Ambulance Service.-The commanding officer, United States Army Ambulance Service, reports that the work of the camp hospital was conducted in tents through the months of June, July, August, September, and October, and the more serious operative cases were treated at the Allentown Hospital. This hospital is reported to have a splendid management, excellent facilities and plumbing, and on account of its proximity to the camp has rendered very valuable service.

During November and December sick call, dispensary, surgical dressings, and infirmary have occupied temporary quarters in the basement of the Allentown Hospital, while premanent infirmary building was being erected. The sick rate of the camp has been comparatively low, namely 17.52 per 1,000 of strength constantly noneffective.

19. SANITATION, BY DEPARTMENTAL SURGEONS.

A. SOUTHEASTERN DEPARTMENT.

During the period May 1 to June 30 no morbidity of moment arose, the main movement of sick being malaria, arising from detachments guarding public utilities, due to inadequate housing facilities. To relieve this condition, due to lack of screening, quining prophylaxis was directed and carried out, with marked result.

The following activities were of note: Inspection of proposed camp sites Savannah, Ga., and Charlotte, N. C., and recommendation for rejection of the first and acceptance of the second. Publication and issue of General Sanitary Code to all troops within the department. The selection of a large main medical supply depot at Atlanta, Ga. Due to an epidemic of typhoid in the States of North Carolina and Tennessee intensive inoculation of all National Guard troops in those States. Upon muster into Federal service of National Guard organizations immediate preparation for their sanitary supplies and organizations of detachments and units in conformity with existing tables of organization. Organization and supply of new Regular regiments in this department. Plans were entered into with the Surgeon General's Office and with the authority of the department commander for the use of the post hospitals, certain barracks and buildings of the posts of Forts McPherson, Oglethorpe, and Logan H. Roots, as a nucleus for a base hospital at each of these points.

In compliance with General Orders 96, War Department, divisional medical supply officers were assigned by the Surgeon General to each of the 12 divisional camps, and without requisition a complete base hospital and initial medical equipment for all troops, for three months in advance, ordered issued and sent by express. Sanitary inspectors were assigned to each camp during the period of construction, with orders to make a complete survey of the camp site and maneuver terrain and eradicate all

unsanitary conditions. With the exception of the cantonment at Camp Pike and Camp Jackson, little of moment was found requiring attention from a sanitary standpoint.

The large number of workmen gathered at the camps and cantonments from all sections of the country would naturally have given rise to typhoid and smallpox, and to obviate these dangers the sanitary inspectors at such points were ordered to complete vaccination of all men. The results have fully met expectations.

On May 14 a circular was issued directing the administration of oil of chenopodium for the eradication of hookworm, the procedure suggested being the administration of one 5-minim globule at 7 a. m. on a fasting stomach, a second at 10 a. m., and a purgative of Epsom salts or castor oil at noon.

B. SOUTHERN DEPARTMENT.

Fort Sam Houston, Tex.-Sanitary inspections of camps was maintained throughout the year and in general conditions have been satisfactory.

C. CENTRAL DEPARTMENT.

With the calling into the Federal service of the National Guard and organization of officers' training camps it became necessary to expand many of the military posts in this department to several times their normal capacity and to lay out many new camp sites. In connection with these expansions the question of water supply, disposal of sewage, garbage, bathing facilities, etc., all had to be solved, while at the same time the task of conducting the physical examination of all troops entering the Federal service and their immunization against small pox and typhoid fever were thrust upon the medical personnel.

Fort Benjamin Harrison, Ind.-The sanitary conditions have at all times been excellent. This is no doubt due to the efficient administration of the medical officers in charge of the medical officers' training camp, the sanitation of the post being in charge of selected officers for this work for the period of about three months. Their work has been thoroughly efficient and it has been the endeavor to maintain a high standard of sanitation. Unsanitary conditions resulting from overcrowding in quarters, personal uncleanliness from neglect of bathing, improperly cooked food, etc., have been promptly corrected through action taken on reports of inspection. In the summer, examination of various swimming pools, proper analyses of water, noting the quantity, quality, drainage, and source of supply, number of bathers, care of pools, etc., and report of conditions in general were made to the post commander. This precaution evidently prevented many diseases and especially those of microbic origin, affecting the eyes and ears. General sanitation of post excellent, disposal of sewage, stable manure, kitchen garbage, etc., ample. The installation of septic tanks, and provisions for an adequate water and milk supply have been noted in previous sanitary reports.

D. EASTERN DEPARTMENT.

Fort Hamilton, N. Y.-An active campaign was carried on at this post during the year against the breeding of flies.

Fort Totten, N. Y.-Measures taken to decrease the number of mosquitoes have only been partially successful. This post is situated on a point jutting into Little Neck Bay on Long Island Sound, an area of about 30 acres being between it and the mainland. This area is salt marsh and stagnant water and always has been a source of trouble with regard to the breeding of mosquitoes. Drainage seems to be impossible.

A new system of sewerage and sewage disposal is about completed. The plumbing throughout the post is old and frequent repairs are necessary. The guardhouse is inadequate under present conditions and recommendations have been made to enlarge it. The incinerator used for the disposal of waste is old, out of date in design, and practically unserviceable. The surgeon has recommended that a new incinerator be installed.

20. HOUSING AND VENTILATION, BY DEPARTMENTAL SURGEONS.

A. EASTERN DEPARTMENT.

Camp American University, Washington, D. C.-The camp commander reports that there are 400 more men in the camp than the maximum allowance for the space available. He stated that the Chief of Engineers was requested to make further efforts to get money for building an engineer cantonment, that such efforts were being

continually made, but so far without success. However, the number of troops in this camp varies on account of the departure of troops for overseas.

Fort Hamilton, N. Y.-Lack of suitable accommodations for the National Guard troops which arrived in August was a troublesome factor which has been remedied by the construction of cantonments for mess halls.

Camp A. L. Mills, N. Y.-The commanding general, Forty-first Division reported that eight men were sleeping in each pyramidal tent, which did not permit of 500 cubic feet of air space for each man, nor of the separation of 5 feet between the heads of occupants of bunks, and that orders had been put in effect that the top of half the door space of tents be open all the time except during rainfall.

Fort Terry, N. Y.-Overcrowding in barracks is reported. In December, with the formation of the batteries here for overseas duty, and the influx of draft men sent to fill up these batteries, the barracks originally built for 109 men were crowded to hold 235 men forming these batteries. The cantonments ordered to be erected at this post were started in December. When these are completed it will relieve the overcrowding.

Fort Washington, Md. The surgeon reports that owing to the number of recruits and drafted men received at the post, there are not sufficient barracks to house them properly it having been necessary to use the gymnasium as sleeping quarters for the troops. He recommends that additional cantonments be built at once. The commanding officer, Coast Defenses of the Potomac, has been directed to take the neces sary steps to secure adequate sleeping accommodations for the troops at Fort Washington.

Fort Wood, N. Y.-The present barracks are reported to be greatly overcrowded, men sleeping in the schoolroom, gymnasium, and basement of the barracks. The construction of cantonments to accommodate 500 men had been recommended and the Quartermaster General has recently had a representative of his office at Fort Wood to investigate and report on the matter.

B. SOUTHERN DEPARTMENT.

Fort Sam Houston, Tex.-Tents are gradually being replaced by barracks or tent frames erected with board sides. These are warmer for winter use than barracks unless the frame structure of such barracks is covered with some sort of sheathing material. In this case the question of ventilation of both requires the same attention Without such sheathing the problem of heating barracks is extremely difficult, and the quantity of fuel required is excessive and does not accomplish its purposes. Patients in hospitals so constructed, who could otherwise be up and around, must stay in bed to keep warm.

In some of the border stations, adobe houses have been constructed by the men and make most comfortable quarters for the climate where dust storms are a frequent cause of great annoyance.

Where tents are in use for quarters, overcrowding and lack of ventilation are the most constant cause of trouble. The importance of this danger is now especially emphasized by recent investigation into the etiology of the respiratory diseases including, in this group, measles and tonsillitis. Frame barracks except for over crowding are not in most cases such great offenders in this regard, as the cracks between the boards allow almost too free ventilation in windy weather, but with tents the tendency to close all ventilating openings is ever present and required constant watchfulness on the part of the sanitary officers.

In November orders were issued restricting the number of men in barracks and tents so that not less than 500 cubic feet of air space and 40 square feet of floor space was provided for each man with at least 5 feet between bunks. Later instructions were issued to alternate the heads and feet of men as they slept, so that an even greater distance separated their heads and less danger of "droplet" infection existed.

C. FORT M'PHERSON, GA.

Remarks of post surgeon, Fort McPherson, Ga.:

When the plans for the cantonment barracks were first received at this post. I carefully examined them and informed the commanding officer that the allowance of cubic air space was entirely too small, and recommended that before the building were put up he communicate my objections to the War Department. The com manding officer did not approve of this recommendation, on the ground that the plane were sent from Washington and that he had no other recourse but to put the building

up. I informed him that I would make a sanitary report immediately when they were occupied.

On opening up the training camp (reserve officers of the line) and before many of the candidates had arrived I made a thorough inspection of these buildings and their contents, and made the following special report to the commanding officer:

* * * "The examination of the first two or three barracks now occupied by applicants for the officers' training camp shows a very unsanitary condition of affairs. Without exception, all beds are touching each other. Aside from the lack of initial air space. such a condition of affairs, in which this close and intimate association of large bodies of men occur, can not but end disastrously in an epidemic of various infectious diseases, if our experience in the past is of any value. I recommend that sufficient additional barracks be built at once, in such quantity as to permit at least the space of a bunk between each occupied bunk. This, it seems to me, on sanitary grounds should be the minimum of floor space.'

The department surgeon was able to obtain from the department commander additional buildings, and in the meantime all candidates over and above one for every 600 cubic feet were put in tents. The wisdom of this was manifested in the fact that the training camp at Fort McPherson was exceptionally free from contagious diseases, nothing more than a few cases of conjunctivitis having occurred. The sewage disposal plant was much overworked when the training camp was in full swing, resulting in foulness. Although recommendations for the abatement of the nuisance were made, the matter was not taken up until after the arrival of a special sanitary inspector from the Surgeon General's Office in August. An allotment has now been made which it is believed will correct all deficiencies. United States Hospital No. 6 is excellently equipped.

D. SOUTHEASTERN DEPARTMENT.

On September 13 recommendation was made to the Surgeon General for the instal lation of the Sayville water heater, or equivalent, for camps and cantonments, reminding the Surgeon General that by the middle of October the change of temperature would be such that southern troops would refrain from using cold-water showers, and that to insure physical comfort and cleanliness of these troops, the necessity for installation of such water heaters was essential, at the rate of one to each thousand men. Paragraph 4 of that recommendation stated that "this recommendation is made at this time in view of the difficulty the Quartermaster's Department has encountered in securing plumbing facilities, and as each of these heaters can be made in the course of a day by local talent, by the use of one 30-gallon boiler and several strings of pipe and knuckles, it would appear more satisfactory to have camp quartermasters procure the necessary articles and construct one for each 1,000 men, so that they will be available when the demand arises, and a long wait will not have to be made on the pleasure of congested railways."

The following letter to The Adjutant General of the Army, with reference to the advisability of providing tent floors at all National Guard divisional camps, was written by the department surgeon:

"It is recommended that the decision not to provide tent floors for the National Guard divisional camps be reconsidered. and that authority for the purchase of the necessary lumber be granted to constructing quartermasters.

"The labor of constructing tent floors can be performed in part by troops of the advance detachments, and completed when the organizations arrive. The total cost per tent should not exceed $4 to $5, or approximately 50 cents per man, and the saving to equipment and clothing and the certainty of a neat and orderly arrangement within tents would, it is believed, amply justify the expense, even without taking into consideration the comfort and contentment and physical well-being of the troops. "I wish to invite attention, also, to the evident fact that the saving made on material for tent floors will be more than counterbalanced by the increase in sick rate, with a corresponding reduction in efficiency. As the deficiency in canvas will cause necessary overcrowding, it is thought the part of wisdom to take every precaution to minimize the danger of communicable diseases, and tent floors being susceptible to mechanical cleaning, will go far toward the reduction of such diseases as can be acquired from men in close contact who can not be so disciplined that they will not expectorate on the floor, as they invariably do in unfloored tents.

"In addition to the above reasons, the possession of a tent floor in a camp invariably adds to pride in appearance, and it is an indisputable fact that a soldier may not keep his clothing and equipment in even a reasonably correct condition if he is forced to be housed on bare soil.'