21. FOOD, BY DEPARTMENTAL SURGEON OF SOUTHERN DEPARTMENT.

Kitchen and mess management has been under constant inspection and systematic supervision. Faults in sanitary arrangement were corrected as promptly as possible. While not included within the period covered by this report, it may be of interest to note that careful investigation of the physical condition and personal hygiene. including investigation to determine the presence of disease carriers, has been instituted for all cooks and others handling food. Food has been satisfactory in character and sufficient in amount; no complaints as to preparation are reported.

A vigorous campaign against flies has been kept up throughout the year. The short winter of these Southern States allows a long fly-breeding season and, in reality, flies are to be found on occasional warm days even in the coldest season of the year. Thorough screening of all kitchen and mess facilities has been maintained and active methods of extermination with traps, poison, and swatters have been early instituted.

22. WATER SUPPLY, BY DEPARTMENTAL SURGEONS.

A. SOUTHERN DEPARTMENT.

Notwithstanding, the severe drought conditions which prevailed throughout this territory, water supply in general gave no great trouble and was sufficient. In no case was epidemic reported attributable to water supply.

At Leon Springs the shortage of water was most acutely felt for the Artillery troops and training camp located there. Special studies of the water situation at this point have been made the subject of a special report. The maximum available supply of 450,000 gallons per 24 hours is not sufficient for the almost 10,000 men at times located there with the accompanying animal equipment of artillery of Cavalry organizations.

B. FORT OGLETHORPE, GA.

Under the heading "Water," the surgeon in charge stated that "through the labora• tory much of the early work of sanitation was accomplished. The water supply as delivered to the hospital was found to contain B. coli. The supply was investigated and found to be made up of two sources, one the City Water Co. of Chattanooga and the other deep wells on the post. The former supplies about 2,000,000 gallons, the latter 500,000 gallons per day. This is inadequate. Frequently the hospital is without water, which causes great inconvenience and results in insanitary conditions in the toilets, which become clogged, much to the discomfort of the patients. Personal inspection and laboratory studies showed the Chattanooga supply to be Tennessee River water, which is sedimented, sand-filtered, and chlorinated. This was found excellent. The post supply is made up of deep wells averaging 450 feet in depth, and all contain B. coli. Contaminated wells were closed where possible and placarded."

23. CLOTHING, BY DEPARTMENTAL SURGEONS.

A. EASTERN DEPARTMENT.

Fort Hamilton, N. Y.-The surgeon reports that the shoes of the men wore out before those sent in for repairs were returned, thus causing a constant lack of proper shoes and subsequent increase of sickness.

B. CENTRAL DEPARTMENT.

The inability to obtain winter clothing, especially the olive-drab woolen clothing, for men has contributed materially to respiratory afflictions. Requisitions have been promptly made and approved for clothing, but the greater part of the Tenth Infantry has not as yet been supplied with heavy clothing.

C. SOUTHERN DEPARTMENT.

Proper clothing was not especially lacking till late in the fall of 1917 and in the early months of 1918, when the winter developed into the most severe for cold weather on record. The lack of warm clothing then became acute and applies to not only woolen uniforms, breeches, and blouses, but also to overcoats and blankets, and it was not surprising that the men crowded together in badly ventilated rooms in order to keep warm when their outer clothing consisted of cotton khaki and their bedding of but

two thin blankets.

24. HOSPITALS, BY DEPARTMENTAL SURGEONS.

A. SOUTHEASTERN DEPARTMENT.

Constant reminders were sent to the Surgeon General's Office that the necessary Medical Department construction was not being carried out in compliance with original orders on the subject. To partially offset this delay in preparation for reception of the sick, it was necessary to request the commanding generals of the Northeastern, Eastern and Central Departments to have field hospitals and ambulance companies precede the other troops, to immobilize as temporary hospitals until the delayed medical construction was completed. At the National Army cantonments, where no sanitary unit was scheduled to be assembled, a complete field hospital was shipped.

B. EASTERN DEPARTMENT.

Fort Jay, N. Y.-The surgeon reports that the old hospital building is in a dilapidated state, being an old frame building with unsanitary plumbing, and that it has outlived its usefulness as a hospital. A new heating plant has been installed in the cellar of the building.

Four new buildings, each containing 32 beds, have been almost completed in addition to a mess hall. Buildings are lighted by electricity.

The capacity of the prison ward is for 10 beds. On account of the crowded condition of this ward, it has often been necessary to put convicts in the same wards with enlisted patients, a procedure which is unjust to the latter but which, under the circumstances, could not be avoided.

Fort Hamilton, N. Y.-The surgeon reports that the new hospital building can not be used for hospital purposes because the steam-heating plant is not yet completed. The building is being temporarily heated by the Quartermaster Corps, and is at present being used to house some of the drafted men recently received at the post.

Fort Monroe, Va.-The surgeon, Fort Monroe, Va., reports that the hospital there has acted as a base hospital for the surrounding territory, receiving patients from Camp Stuart and Camp Hill at Newport News, Va., Langley Field, Hampton, Va., Richmond and Norfolk, Va., and quite a number from merchant ships, United States and foreign naval vessels, there being 150 patients in hospital at times. Two new wards are about completed, which will increase the hospital capacity to 220 beds without crowding. New buildings have been asked for to house the increased number of enlisted men, Medical Department, needed for the increased capacity of the hospital. There are 8 female nurses, Army Nurse Corps, on duty at this post, and the surgeon expects that it will be necessary to increase this number to 14 within the next few months. The erection of a building to house the Army Nurse Corps has been requested.

25. MEASLES, BY DEPARTMENTAL SURGEONS.

A. CENTRAL DEPARTMENT.

There were several epidemics of measles, the larger number of cases being at Fort Riley, Kans., which had 247 cases. There were also 156 cases at Fort Benjamin Harrison, Ind., 121 cases at Fort Omaha, Nebr., 72 cases at Fort Leavenworth, Kans.; 37 cases at Fort Sheridan, Ill.; 35 cases at Fort Des Moines, Iowa; 34 cases at Fort Snelling, Minn.; 14 cases at Fort Wayne, Mich.; 10 cases at Fort Crook, Nebr.; and 3 cases at Fort Brady, Mich.

B. SOUTHERN DEPARTMENT.

These two diseases have continued to be very prevalent throughout the year. Many of the men claim to have had the diseases in childhood. Whether or not our future knowledge will show that different strains of the causative organisms of these diseases exist, as the several types of pneumonia, is of course.only a matter of specula tion at the present time; it might account for the absence of immunity in well authenticated cases of previous attack. As mentioned later, when discussing the presence of hookworm, another cause of the recurrent cases seems to be the lowering of physical standard by reason of the anemia incident to anchylostomiasis and malaria.

Complications of broncho-pneumonia were especially common following measles. In fact, probably the majority of these cases started in that manner. Not a few of the deaths reported as broncho-pneumonia undoubtedly were due primarily to measles.

26. VENEREAL DISEASES, BY DEPARTMENTAL SURGEONS.

A. CENTRAL DEPARTMENT.

Prophylaxis is promptly observed when required and all stations fully equipped and intelligent enlisted men designated for instruction and record keepers. Much of the success of prevention of venereal diseases is the result of proper "plain talk upon venereal diseases" by medical officers detailed for this purpose. At one time a lecture was given to the Tenth Infantry, the regiment being divided into battalions Instruction was given to the men upon the dangers of gonorrhea, syphilis, etc., calling attention to the prophylaxis required, the personal danger of contamination, and it results. Attention was especially directed to Army Regulations, and to the Manual for the Medical Department in relation to immoral conduct. The efficient and hearty cooperation of the post commander with city authorities in controlling the vice con ditions in the city of Indianapolis and its environment has mitigated in a large measure the spread of venereal diseases.

Venereal diseases figure conspicuously among the causes of admittance to the hos pital, but have by no means advanced in volume in proportion to the increase of size of command. Adequate provisions for prophylactic treatment was provided at the beginning of the influx of troops, and the number of treatments taken indicate that a very negligible percentage of the admissions for venereal diseases had failed to avail themselves of prophylactic treatment.

Fort Riley, Kans.-On account of the great influx of new troops in newly formed organizations, it was difficult to carry out such prophylaxis in detail at various times. The number of venereal diseases, however, has been a good deal below normal.

Fort Robinson, Nebr.-A conspicuously small number of venereal cases originated at this post, one syphilis and four gonorrhea. The system of inspection has been efficient in reducing the cases to a minimum.

B. SOUTHERN DEPARTMENT.

Grouping the three venereal diseases together, syphilis, chancroid, and gonorrhea the Regular Army shows 5,394 cases, or 94 per 1,000, while the militia shows 1,048 cases, or 58 per 1,000, a higher ratio for the militia than a year ago but still markedly below the rate for the Regular Army. That figure, however, shows an improvement over a year ago when the rate was 140 per 1,000. It is believed that many cases of venereal disease are unreported in militia organizations.

27. MALARIA, SOUTHERN DEPARTMENT.

The incidence of malaria shows a decided decrease over the figures of a year ago. The combined rate for Regulars and Militia is 6.8 per 1,000, or exactly 10 less per 1,000 than for the year 1916.

28. PHILIPPINE DEPARTMENT, MANILA, P. I.

(Extracts from department surgeon report.)

The general condition of this department is that of peace, and as a matter of fact it is more peaceful than it ever has been before since American troops were sent to these islands.

Four stations have been abandoned during the year: Regan Barracks, Warwick Barracks, Fort San Pedro, and Ludlow Barracks.

The troops were stationed at 13 posts and one subpost. No new posts were established. Three more posts are scheduled to be abandoned early in 1918.

The food and clothing provided for the troops has been excellent. The water supply generally, although somewhat expensive as far as that for drinking and cooking is concerned, has been excellent in quality and abundant. Distilled water has been furnished for drinking and cooking purposes at many of the stations; others are supplied with artesian water which is of an excellent quality.

A. HOSPITALS.

The department hospital is in a very good state of repair at the present time. It has been repainted during the past year and an excellent X-ray clinic has been provided.

There were 1,807 cases transferred to the department hospital for treatment, namely 1,698 American white, 71 American colored, and 38 Philippine Scouts. An average of 109 patients was in hospital during the year, of which enlisted men and officers were 63 and civilians 46.

The hospital at Fort Mills is a large concrete building, sufficient in size to provide for all the demands made upon it, with the exception of quarters for the enlisted personnel. The hospital at Fort McKinley is a large concrete structure, which is much larger than is needed for the present garrisons, there generally being about 140 or 150 vacant beds.

The hospital at Camp Stotsenburg, which was an old dilapidated wooden structure, has been rebuilt, and while not as large or of as good construction as is desirable for this station, yet it was the best that could be done under the present restrictions, which do not permit of permanent construction at this station.

The hospital at Camp John Hay, which is at Baguio, in the mountains, is an attractive building, and is used to a limited extent as a convalescent hospital for cases arising in other posts of the department.

B. DENTAL SANITATION.

Considerable attention has been given to the work of the dental surgeons. In this connection the condition of the teeth of enlisted men is looked upon as an unsanitary condition that should be corrected if possible with the limited means at hand. As an unsanitary condition it becomes a matter of personal concern of each post surgeon. The dental clinic is considered to be a department of the hospital the same as the eye or ear department, or the laboratory. The initiative in directing the work of improving the unsanitary condition belongs to the surgeon the same as in any other unsanitary condition, instead of the initiative being taken by the patient as contemplated by Army Regulations. It needs the teamwork of the organization commanding officers, the surgeon, and the dentist to be most effective. The treatment of the unsanitary dental conditions of the enlisted men has the first call for consideration. At the same time the facilities of the dental clinic are apportioned between the needs of officers, their families, and emergency dentistry, and the correction of the unsanitary condition of the soldiers' teeth.

The necessity for system in this matter is shown by a survey of a detachment of the Medical Department of 90, which showed that 70 per cent needed some dental treatment, extending from filling 1 or 2 cavities in one, to the extraction of 17 teeth in another. A survey of one company of Engineers showed that there were 525 cavities. It is believed that about 70 per cent of the enlisted men of the line need some dental treatment.

C. HOUSING OF THE TROOPS.

The troops in this department are, as a general rule, well housed except as to the China expedition. At present there exists there a serious overcrowding. The troops are quartered in rented buildings owned by a Chinese corporation which in constructing the new buildings made no provision for ventilation and has thus far refused to provide any. The crowded condition at present allows less than 500 cubic feet in the dormitories, and at times about 300 feet to the prisoners in the guardhouse. This close confinement shows itself in the high rate for tuberculosis and pulmonary disease. Recommendation has been made to reduce the forces so as to allow 700 cubic feet per man, or secure other quarters. This matter is still under consideration.

The screening of the barracks at Camp Stotsenburg has been completed during the past year. This screening was first recommended 12 years ago.

D. HEALTH OF THE TROOPS.

The increase in both the admission rate and constantly noneffective was due to alcoholism, dengue, and venereal diseases: the admission rate for disentery was reduced from 8.8 in 1916 to 5.0, malaria from 54.8 to 51.7, and tuberculosis from 5.0 to 4.9 per 1,000.

As compared with 1916 alcoholism shows an increase among white and colored Americans, and a decrease among Philippine scouts; dengue and venereal diseases a general increase all around; dysentery a general decrease; malaria a decrease in American white, the increase being in American colored and Philippine scouts, while tuberculosis has decreased in American white and Philippine scouts and increased among American colored.

The comparative admission rates for the posts in the Department for the years 1916 and 1917 are given below:

TABLE NO. 149.—Admission rates, posts, Philippine Islands (absolute numbers).

Malaria. The malarial situation continues to show great improvement, the admissign rate being 51.7 per 1,000 against 54.8 per 1,000 in 1916; 65.6 in 1915, 93.9 in 1914, 125.4 in 1913, and 188 in 1912. The rate per 1,000 in 1917 was the lowest since American occupation.

TABLE NO. 150.-Admission rates per 1,000, posts, Philippine Islands.

The increase at Pettit Barracks was largely due to disease being epidemic at that station during the month of May, in which there were 49 cases admitted (total cases for the year, 87).

Dengue. The admission rate for this disease was 55.6 against 11.3 per 1,000 in 1916. The increase was largely due to dengue being prevalent during May, June, and July at Cuartel de Espana and at Augur Barracks during April, May, and June.

Dysentery amoebic and bacillary.-Thet otal admissions in the department for 1917 were 93 as against 170 in 1916, a decrease of 77 cases, or 5 per 1,000, as against 8.8 in 1916. Most of the cases of dysentary were probably due to contact with natives who had this disease. A muchacho at Camp Stotsenburg, working for bachelor officers, infected several of them.

Smallpox.-Seven cases of smallpox occurred, one among Americans and six among Philippine scouts; all recovered. Cases occurred at the following stations: Augur Barracks, 1 scout in January; Camp McGrath, 1 scout in February, and 2 scouts in December; China, 1 American in May; Warwick Barracks, 2 scouts in November. Typhoid fever.-No case reported during the year.

Leprosy. Two cases were discovered among the Philippine scouts, one at Augur Barracks and one at Ludlow Barracks. Both were discharged on certificate of disability and turned over to the civil authorities.

Beriberi.-There were two cases of beriberi at Augur Barracks in August. Both were Philippine scouts.

Cholera. No case reported during the year.