Spanish - American War

160

REPORT OF LIEUT. COL. CHARLES SMART, DEPUTY SURGEON-GENERAL, UNITED

STATES ARMY, ON SANITARY CONDITIONS AT CAMP ALGER, VA

Dated July 13, 1898

I have the honor to report that, in accordance with paragraph 33, Special Order 157, Adjutant-General*s Office, Washington, July 6, 1898, I proceeded, on July 8, to Camp Alger, Va., and inspected the camps of the First Division, and on the 11th the camps of the Second Division, Second Army Corps, having meanwhile investigated the condition and clinical histories of the cases of typhoid fever that had been removed from these camps to the general hospital at Fort Myer, Va.

I found two troops of New York cavalry encamped in conical wall tents on the slope on which the headquarters of the corps are established. These had ample

---

161

camping ground, which was well drained, but had no shade. Their water supply was derived from the same source as that of the headquarters.

The striking characteristics of the camps of the First Division were overcrowding of tents on the camp site, overcrowding of men in the tents, dust, sun glare, and fetid odors. The Eighth, Twelfth, and Thirteenth Pennsylvania were packed closely together, with scarcely an interval between the regiments, the company streets hardly wider than the intervals between adjacent companies should have been, tents of the same companies in contact with each other on the sides and of adjoining companies in contact by the ends. The double row of tents between the narrow company streets thus made a continuous canvas covering with double partitions dividing it up into small sections, under which it was impossible for the 5, 6, or 7 men in each section to get a breath of fresh air. The Eighth Pennsylvania had their common or wedge-wall tents floored with boards, but so close to the ground that there was no air space beneath the flooring. These tents had a ground area of about 56 feet. In addition to wedge tents the Twelfth and Thirteenth Pennsylvania had some conical wall tents, which also were overcrowded. In many there was no flooring, the men lying on the ground, their blankets and clothing matted with dust. The kitchens were close up against the company tents, with uncovered cesspools for kitchen slops and garbage, and the sinks also were so close that, although some care was given to cover the deposits with earth, the sink odor pervaded the company streets. The sinks were too small for the accommodation of the regiments, so that they were in constant use and always contained reeking and uncovered excreta. The streets and the open ground in the neighborhood of the camps were kept clean and free from excremental or garbage contamination. Under such conditions of overcrowding on a dusty site it was impossible for men to keep themselves clean or free from body vermin, if the latter were introduced, while typhoid fever or any other infectious disease might be expected to spread quickly. That serious consequences have not been developed is due to the heat of the weather, which has led the men to seek as much as possible for ventilation.

The walled wedge tents of the First New Jersey were similarly crowded on each other, but only four men occupied each tent. The streets were only about 13 or 14 feet wide. The sinks were manifestly cared for, but were so near that the odor pervaded the camp. The men slept on their dust-matted blankets on the ground, and nothing in the line of spare underclothing in the blanket roll could be kept clean under these conditions. Adjoining tents of the same company in the Seventh Ohio were separated from each other by about 3 feet, insufficient to give a passageway between the guy ropes, and there was no passageway between the tents of adjoining companies, these being pitched end to end in contact. The streets in this command were wider than those heretofore mentioned, and the men were building low bunks about 8 or 10 inches from the ground to keep themselves out of the dust. All these camps were on open ground, originally grass-covered, but now trampled under foot into a garish and dusty surface. A slight incline gave good surface drainage to the westward. No brush awnings or fences had been erected, and the sinks in most instances were protected merely by a strip of canvas. Practically the only sign of the existence of available wood and brush-wood in the neighborhood of the camps was the building of the low bunks in the last-mentioned command. The Sixty-fifth New York had more space. It was camped in a grove of young trees, which, while giving little shade, lessened the garishness by their greenery. Its conical wall tents were separated from each other and well trenched, but no bunks had been built; its sinks were well kept, and so far out that there was no taint in camp. The camps of the Sixth Illinois, Sixth Massachusetts, and Eighth Ohio, on a rising ground north of the hospital of the First Division, were evacuated on the day before my inspection by the departure of these regiments for the front.

The regimental camps of the Second Division were generally more expanded than those of the First Division. In none was the odor of the sinks perceptible in the company areas. The streets and surroundings were clean in all, with the exception of the Seventh Illinois, where filth was deposited by the side of the pathways to the sinks. The Sixth Pennsylvania was camped in an open space in walled wedge tents 7 by 8 feet, with a height of about 7 feet to the ridge, 18 inches of which was constituted by the wall. Four and 5 men were in each of these. Some had bunks of forked uprights supporting a platform of saplings, but many were lying on the dusty ground. The Second Tennessee was similarly situated, but in conical wall tents. The First Rhode Island, also on open ground, was in small wall tents, 6 men in each, all on bunks raised about 18 inches from the ground, except a  few who had bunks of evergreens on a bark-covered floor. Care was evidently exercised here to have the men clean and comfortable. The Twenty-second Kansas had the same kind of tents as the Rhode Island regiment,

---

162

but each was made to accommodate 8 men. All lay on the ground; a few with pine twigs under them to keep them from the dust. The One hundred and fifty-ninth Indiana was in walled wedge tents, 4 men in each; some having shelter tent extensions to lessen crowding. The tents were pitched too closely, and the men lay on the ground, dusty and dirty. The Third Missouri had 5 men in each walled wedge tent, and no flooring nor bunks. The Third New York had its streets narrow, its conical wall-tents set too closely; the men lay on the ground on their dusty blankets. The Fourth Missouri had the advantage of shade by being camped in a wood. The wall tents were well spaced and the streets comparatively wide. All were furnished with raised bunks; and the regiment would have had a model camp had care been given to the policing of the interior of the tents. The Seventh Illinois also was favorably camped in the edge of a wood with every facility at hand to have made a model camp, but the conical wall-tents, instead of being furnished with well raised bunks, were littered with dirty straw.

The chief surgeons of division and the regimental surgeons in each instance accompanied me in my inspection.

The great faults in all the camps were the tendency to crowding the tents on each other, the overcrowding of the individual tents, and the want of care for the comfort, cleanliness, and health of the men in failing to have them build bunks, fences, and awnings, when the materials for these purposes were at hand.

The natural drainage in all the camps was good, but in some lying near the margins of a run the sub soil water is too near the surface for health later in the season when heavy rains fall. A thick stratum of clay underlies a few feet of pervious surface soil, and in some of the camps cesspools for kitchen slops consist of basins in this clay, which retain the liquid contents, fermenting in the heat and infecting the neighborhood with bad odors and flies.

The water supply obtained by the Engineer Department is from a series of about 28 driven wells over 100 feet deep, all furnishing a soft and organically pure water. Prior to the sinking of these tubes water from springs of uncertain quality was used by some regiments, while others used water from the sluggish runs, which is manifestly impure, and would undoubtedly have occasioned disease if used without boiling.

These camps, notwithstanding their many insanitary features, are unusually free from disease. Vaccinia, measles, a few venereal cases from proximity to Washington, and some diarrheas from irregularities in diet, or from chill after perspiration, and the difficulty of attending to personal comfort in the crowded tents, constitute the sick list. In addition to these, I found that since the camp was established, in May, 39 cases of typhoid fever have been reported and sent to hospital for treatment. Of these 39 cases, 4 have died- 2 from the incidence of the fever and 2 from intercurrent pneumonia. Although not verified in any of these cases by post mortem observation, there is no doubt of the diagnosis, for the clinical features were well marked, and Widal`s test has given positive reactions. Abdominal, not cerebral, symptoms have characterized the cases. Four occurred during the month of May, 23 in June, and 12 up to the date of my inspection in July. Taking the month of June as the second month of the aggregation of troops after the call of the President, and rating the strength at Camp Alger during that month at 20,000, the fever rate for the month would be 1.15 cases per thousand men. When we compare this with the July and August record of typhoid among the troops gathered around Washington in 1861, 2.2 in the one month and 6.14 per thousand in the other, we have reason to feel satisfied that the efforts to reduce the typhoid fever rate at the present time has been so successful. The 39 cases were distributed as follows:

---

163

The regiments which have not as yet been affected with typhoid fever are the First Rhode Island, Twenty-second Kansas, Seventh Illinois, Seventh Ohio, First New Jersey, and to these must be added the Sixty-fifth New York, for this regiment brought one case of fever with it to Camp Alger, but has had no case since then. It is evident that the crowding on the camp sites, in the tents, and the dusty condition of the men from sleeping on the hard-trampled ground, are not factors in the causation of the typhoid cases that have occurred, for, although the First Rhode Island, which was tolerably free from these insanitary conditions, had no case, the First New Jersey, which had all of these conditions in an aggravated form, also had none. From the manner in which the cases are scattered through the camps, it seems clear that the infection is due to causes which are not general, but which operate on the individual or on two or three closely related individuals in the same command. This excludes all emanations from the camp site or its surroundings, and all matters relating to the subsistence of the troops, including the general water supply. We know now that the great prevalence of typhoid fever in the camps around Washing-ton in 1861 was due to the use of surface water in runs and creeks contaminated with infected excreta from the carelessly policed camps of those days, and the more closely the present cases are investigated the more evident does it appear that the sporadic cases that have occurred are due to the occasional use of surface or farmhouse well waters that have not been sterilized by boiling. Before the deep-well-water general supply was obtained, many of the regiments made use of waters from springs of uncertain quality and from surface streams of certainly bad quality, and that this was not followed by widespread evil consequences is due to the care taken that such waters should be boiled before use. The largest number of cases occurred among the troops of the New York cavalry, the members of which on orderly duty are frequently away from camp, and while on such duty are in the habit of drinking from the most available source of supply, irrespective of quality. I feel confident that with the present general water supply and the prompt removal of sporadic cases to general hospital there need be no fear of any epidemic visitation of typhoid fever in the Second Army Corps. I would suggest, however, that due care be given to the removal of the insanitary conditions which I have pointed out, as these would be very apt to promote the spread of the disease were many sporadic cases to appear.