was contracted at Prospect, Ohio, and the man had received no typhoid prophylaxis. All cases of typhoid fever were transferred to Columbus Barracks, Ohio, for treatment.

Cerebrospinal meningitis. Of this disease there were 16 cases and 4 deaths, a mortality of 25 per cent. On November 10 a case of meningitis developed in Company M, Three hundred and twenty-ninth Infantry. At this time equipment was not on hand to do carrier work, but all members of this company were treated by regimenta surgeons. On November 8 another case developed in this company. Fifty-four men in the same squad room were examined but no carrier found. On November 8 a case developed in Company A, Three hundred and twenty-ninth Infantry. All men in this organization were examined and two carriers were found, one of whom occupied a bed immedi ately adjacent to the one occupied by the men who developed meningitis On November 13 another case developed in this organization. All members of the organization were examined and one carrier found. The remaining 10 cases were all isolated, no 2 of them occurring in the same organization or squad room. All cases of meningitis were placed in isolation to search for carriers. During November, four carriers were found, representing 1.2 per cent of the men examined. During December three carriers were found, representing two-tenths of 1 per cent of the men examined. Four known carriers of meningococcus have been rid of that organism in six days by one treatment per day. There were 10 companies from which cases of meningitis arose, and in these companies no subsequent cases devel oped after treatment was instituted.

The base hospital service is well organized, manned, and equipped. Up to December 31, 288 operations had been performed of a general surgical character.

Surgery of the eye, ear, nose, and throat, and dental work each had its own out-patient service in a separate pavilion designated as the "head house." This building was eventually very thoroughly equipped with the necessary instruments and appliances for carrying on the work of the different subsections, including a perfectly appointed operating room for eye surgery, and another for nose and throat, and five dental operating rooms, all having access to common waiting rooms for the use of convalescents coming from the various wards, as well as for out-patients.

In the section of ophthalmology the total number of cases examined and treated was 578. The average daily number was 23. Fifty-one of these were treated in hospital, on whom 31 operations were per⚫ formed. Refractions, 168; glasses ordered, 123. In the section of oto-laryngology 2,789 treatments were given and 140 operations performed. In the subsection of genito-urinary diseases six wards were in use with an out-patient department on three days weekly, treating from 80 to 100 cases per day. Over 1,000 doses of salvarsan were given and an average of about 800 out-patient treatments were given per month. This section was well equipped with the necessary instruments and apparatus incidental to diagnosis and treatment in accordance with the most modern methods, including electrocystos copy and ureteral catheterizations.

8. CAMP CUSTER, MICH.

Camp Custer is located about 5 miles south of Battle Creek, Mich., a manufacturing city of nearly 30,000 inhabitants. The site of the camp is a rolling plateau at the headwaters of certain streams flowing into the Kalamazoo River, and incloses several lakes. Ground was broken for construction June 27, 1917.

The temperature of the last three months of the year was below the average. A temperature of 16° F. below zero was reached on the 15th of December. November and December had less precipitation than usual. There was a total snowfall of 9 inches during December, and only nine clear days.

Camp Custer is supplied with water from eight wells, driven through terminal glacial deposits into sandstone. These wells have a capacity of 4,800,000 gallons in 24 hours, and the water is of excellent quality. The sewerage disposal system is of the Imhoff type, of which the affluent, after being treated with chlorine, is allowed to flow into the river.

To Camp Custer were called from civil life the following contingents:

Polygon of weekly strength of Camp Custer measured by scale on the left. {Increments are indicated by dotted rectangles of which the unit, 1,000 men, is represented by the smal rectangle above the polygon.]

40.000

-1000 Men

-30,000

-20,000

-10.000

7 14 21 28 5 12 19 26 2 9 16 23 30 7 14 21 28

Sept. Oct.

Nov.

CAMP CUSTER

CHART NO. 17.

Dec.

These men came from Michigan and the eastern rows of counties of Wisconsin, including especially the city of Milwaukee, 440,000 inhabitants. The chief Michigan cities are: Detroit, about 600,000

inhabitants; Grand Rapids, about 130,000; Saginaw, about 55,000; Flint, 55,000; and Bay City and Kalamazoo, each about 50,000. Of the whole territory from which the camp drew, the percentage of urbanity is about 53.

The strength of the camp at different dates is shown in Chart 17, from its first increment of 1,800 early in September to the end of the year. It rose quickly to 18,000 by the end of September; then gradually declined until the large increments of November 19 to 24 of nearly 11,000 brought the strength to its maximum for the year of 26,000. There were about 380 colored troops in the camp during December.

The leading diseases at Camp Custer are shown in Table 25:

TABLE NO. 25.-Admissions and deaths, infectious diseases, Camp Custer, 1917.

1 Figures in parentheses indicate number of colored troops in venereal diseases only.

Most of the 29 cases of lobar pneumonia treated were severe, with two or more lobes involved. As early as laboratory facilities were available, pneumococcus types were determined. In the eight cases so studied up to December 31, 1917, type II was found in four, type IV in four. Thus far, no case of type I was found.

Measles became epidemic in November and German measles acquired important figures. The division surgeon reports:

The cubical system, using suspended sheets, was put in use in the measles wards, December, 1917. Complications in measles were rare up to the latter part of Decem ber, 1917. Three cases developed otitis media, in one of which a mastoid required operation. There were no deaths. With the advent of colds, acute bronchitis, pharyngitis, and tonsillitis in the cantonment, a number of more serious compli cations have appeared in measles patients since January 1, 1918. The clinical course of these cases resembles that described in "measles pneumonia" in southern camps The first case was a soldier three weeks after measles, with onset while he was being held sick in quarters after discharge from the hospital. The onset resembled a pneumonia, and pus was discovered by exploratory puncture after several days of illness. Operation was attempted, but the patient died. Autopsy showed that the entire process was not in any case a true lobar pneumonia but began as a streptococcus pleurisy, with an immediate empyema. Since this case all patients have been studied with the special object of detecting empyema early and instituting drainage by operation. At the date of this report (January 15) empyema has been found in 10 such cases, of which 8 were drained, 1 died, and 7 remained under treatment.

In three autopsies with empyema, the findings have been essentially the same, with hemolyticus streptococcus as the bacteriological cause in one case, and purulent peritonitis accompanying the empyema. It seemed possible that the peritonitis was simultaneous with, and not consecutive to, the empyema. The clinical course and pathology of these cases resemble that of certain cases seen in the severe epidemics of septic sore throat which occurred in several of our larger cities during the past winter. These cases have not been confined to patients suffering with measles, but have occurred in other soldiers, following tonsillar abscess or apparently beginning as a primary pleurisy with the pharynx and throat as possible infection atria. It is believed that the forms of measles and pneumonia hardly express the sequence of events as a whole and that the large number of such cases of measles patients represent rather the development of an independent streptococcus infection quite general in distribution in camps, in a group of patients whose resistance has been depressed by measles.

9. CAMP GRANT, ILL.

Α

The site of Camp Grant is an attractive one. It lies on a plain 20 to 30 feet above the Rock River, from 1 to 4 miles south of Rockford, Ill., a city of about 50,000 inhabitants, the third manufacturing city in the State. The altitude is about 72 feet above the sea. A broad flood plain at the junction of the Kishwaukee and Rock Rivers forms a fine ground for maneuvers. The upland is well drained; nevertheless, there are many small ponds, in some of which mosquito larvæ of the genus Anopheles have been found breeding. The average July temperature is 73° F. with a maximum of 100° F. or more; that of January about 21° F. The month of December, 1917, was the coldest in many years, the thermometer falling to 15° below zero on the 15th of the month. The snowfall was somewhat above the average; there were 17 clear days.

Camp Grant is supplied with water from six wells at the flood plain of the river, west of the northern part of the camp. These wells reach a depth of about 153 to 185 feet. They yield pure water from below 140 feet. They have supplied over 2,000,000 gallons of water per day.

To Camp Grant were called from civil life the following contingents:

These men came largely from the 86 local boards of the city of Chicago; and also from the three northern tiers of counties of Illinois and from all the counties of Wisconsin, except those bordering on Lake Michigan. This territory includes in Illinois, besides Chicago (a city of about 2,000,000 whites and 59,000 colored), also Aurora, 35,000, and Rockford. 50,000. In Wisconsin it includes Superior, 45,000; Oshkosh, La Crosse, and Madison, each between 40,000 and 30,000; and smaller cities of about 10,000 inhabitants each. Of the 26,000 men called to Camp Grant about 75 per cent were from cities of over 10,000 inhabitants and about 64 per cent of all from Chicago proper or 71 per cent from Cook County, Ill. Thus the camp population was of prevailingly urban origin.

Polygon of weekly strength of Camp Grant measured by scale on the left.

[Increments are indicated by dotted rectangles of which the unit, 1,000 men, is represented by the small rectangle above the polygon.]

-40.000

[1-1000 Men

-30,000

7 14 21 28 5 12 19 26 2 9 16 23 30 7 14 21 28

Sept.

CAMP GRANT

The strength of the camp at different dates is shown in Chart 18. From its first increment of 2,000 on September 10, it rose to 22,000 by September 28, and to a maximum of about 30,000 by October 19. Since the Provost Marshal General called only 25,000 men, it is clear that a few troops were transferred from elsewhere. Chiefly through transfers and discharges the strength of the camp fell to about 21,000 near the end of the year. About 1,000 colored soldiers were inducted into the camp in November.

The leading diseases at Camp Grant had the following frequency: TABLE NO. 26.-Admissions and deaths, infectious diseases, Camp Grant, 1917.

1 Figures in parenthesis indicate number of colored troops in venereal disease only.