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REPORT OF LIEUT. COL. A. A. WOODHULL, DEPUTY SURGEON-GENERAL UNITED STATES ARMY,
ON CONDITIONS IN CAMP GEORGE H. THOMAS, CHICKAMAUGA PARK, GA
Dated August 7, 1898
In compliance with a War Department order (Special Orders, No. 162, July 12, Adjutant-General*s Office, current series) I have made a sanitary inspection of the various camps and field hospitals at Camp Thomas, Ga., and of the Leiter General Hospital, and report as follows:
I personally examined every regiment in camp, excepting one or two that arrived during my visit and were assigned to brigades already inspected, and those that were ordered from the camp before I reached them in regular course. I also inspected all places where the sick are cared for.
The latest return gave 43,723 officers and men present, and 2,988 of these sick, exclusive of those sent to general hospital and those who have died or have been discharged for disability. This represents 6.83 per cent present sick, of which at least 4 per cent is grave, and both the rate and the gravity are increasing.
The determining conditions are (1) site, (2) water supply, (3) character of troops, (4) climate, (5) shelter and occupancy of camp, and (6) employment and control. These are not independent, but are conjoined factors treated separately in this report for convenience, but exerting their influence together.
(1) Site.-The camp includes an irregular area 10 by 12 miles square, or about 70,000 acres, bounded on the west by the Chickamauga Creek. The surface is both rolling and level, partly wooded and partly entirely cleared. The greater part has sufficient grade to carry the surface water into natural channels, that are dry except after rainfall. The timber is not dense and is free from undergrowth, so that the sun reaches the ground in nearly all places. There are no distinct swamps or morasses, but what are known locally as the "flat woods" should not be occupied, although some were camped in. The whole region is underlaid with magnesian limestone, which in some places crops out at the surface and in others is covered with dense and tenacious clay, varying in depth from a few inches to many feet. There are a few hillocks of gravel, I am told, but I saw none opened. The rock is irregular in density as well as in disposition. A part requires blasting and a part is fragile. Borings show different strata of varying degrees of hardness, with intermediate layers of dense clay. Communicating rifts may be expected in such limestone, permitting contamination of water over considerable distances. It is claimed, however, that no such rifts have been recognized in boring more than 30 wells. Their occurrence large enough to allow a free flow of water is nevertheless possible. These wells go to a gravel from which water rises near to the surface, but the engineer does not know whether the same bed is always reached. There are "sink holes" in various places that are not filled by any waste flowing into them, and some wells are roily after rain. It is manifest, therefore, that there is, at least, occasional intercommunication. When clay is encountered, and most of the camps are over clay, it holds water almost as cement would, making the construction and care of the sinks very difficult. In other cases the nearness of the rock to the surface makes them very shallow. The camps that are in low ground are consequently wet and very imperfectly drained. Since the middle or 20th of July a good deal of rain has fallen; previously the dust was spoken of as intense. There is a good deal of local feeling in favor of vacating the woods altogether and encamping entirely in the open. I think no camp should be in the "flat" or "low" woods, but the high woods are dry and are too sparse to interfere seriously with the sunlight.
(2) Water supply.-(a) From the Chickamauga Creek, which runs through an alluvial bottom, an extensive pipe system has been introduced from which water may be drawn by frequent taps. At the time of inspection this water was very muddy from repeated rain. In other respects there was no gross contamination, as far as recognized, except such as would naturally be found in a sparsely settled agricultural and somewhat malarious region. The sewage from the Leiter Hospital does not flow into the Chickamauga, as has been charged.
(b) There are numerous surface "springs," the most of which should not be used, but from which the men have drunk freely. The park commission has filled the more objectionable of these.
(c) More than thirty driven wells have been bored to water-bearing gravel. Four of these are less than 50 feet deep; the others range from 64 to 156 feet in depth-fourteen of them being more than 100 feet. The construction of the wells themselves is very good; the casing is iron hammered into a tight joint running down 15 feet, and the pump is placed on a tight cap elevated above the surface. I think no surface contamination need be feared, but it is probable that some are directly polluted through neighboring sink holes. Several have been condemned
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on suspicion, of which a part at least is well founded. In one instance (the Jay*s Mill well) the pump has been placed in a so-called spring that receives a great deal of objectionable waste, and after a heavy rain the wash runs into the top as is shown by the flood mark.
(d) There are also on the grounds, and within a few miles of the park, very large springs having a prodigious flow, from which some regiments haul their water in barrels or tanks for their immediate supply. I was unable to examine the springs that are beyond the park limits. One large spring a few hundred yards from its camp, from which the First Mississippi is drawing water, seemed liable to be hurtful unless the water is boiled.
The effort has been to limit the drinking water to the wells and the safe springs, and, after precautions, to the pipe line; but there is no doubt that water from all sources-from the pipes and from the surface springs-has been freely used without preparation. This occurred repeatedly within my personal observation; and, before the supply was as general as now, doubtless was much more common.
Filters of two varieties, both of which require to be used with the same water, have been introduced, but only recently. There is general complaint, which I think is well founded, that under the conditions the apparatus is insufficient and inefficient. It was repeatedly reported that time Berkefeld filter would require cleansing after preparing half a bucket of water, and many have been broken in the very act of filtering. In very few regiments are all the Berkefeld filters in operation, and in some they were distinctly abandoned after a few days* use. Practically, as already remarked, a great many men drink without discrimination any water they find. Without doubt, the best arrangement is that of the Third Tennessee, where all the 11 filters supplied to the regiment are concentrated into one battery under the charge of an officer; but even here, where extreme care appears to be taken, four bougies were broken already. The supply of water is insufficient, and has been more so. Where the filters are depended on the flow is not adequate. The very best showing is that of the Third Tennessee, just quoted, which gives 1 barrel and 4 buckets, or, at the outside, 66 gallons per company of more than 100 for twenty-four hours for all potable and culinary purposes. Including unavoidable waste, that does not allow more than 5 pints per man. This is a probable maximum, and from this it dwindles to a zero of filtered water, and a very small amount of that which has been boiled. There are general instructions to boil all the water, whether filtered or not. In the only regiment where I could be sure that order was actually enforced (Eighth Massachusetts) no typhoid has yet been recognized, and although the camp is very low and wet and remittent fever has occurred within the last fortnight the general sick rate is only 2.56 per cent. As will appear later I do not think the water is solely at fault in the spread of typhoid, but the more copiously and the purer it can be furnished the better will be time general health.
There is a general complaint of the difficulty of getting barrels for the storage of water, and, where it is hauled from springs, for its transportation. Some regiments have bought their own barrels, amid occasionally a tank has been procured. Barrels are not particularly costly, and it is recommended that the Quartermaster*s Department be authorized amid required to supply these freely, and that those necessarily abandoned be expended.
(3) Character of troops.-As is well understood, the regiments at Camp Thomas have all been newly raised. Some of them contain many immature men; others have an undue proportion of men positively unfit for service from preexisting disability; the most come from very different climates; for some the food is unusual and difficult of assimilation; the most of those who have had field experience have been in military camps of short duration, where there was no occasion to take especial care of themselves. As a consequence, in everything pertaining to field hygiene, the mass are sadly deficient. Not only are the most of the officers practically as ignorant as the men, but the regimental discipline varies very much, and in many cases appears still extremely lax. This is important in its bearing upon the apparently little things that in the aggregate make up the foundation of camp sanitation. The dirty camps are the sickly camps here as elsewhere. But discipline and intelligence have their reward also. Without specifying instances low in the scale, attention is invited to the Eighth Massachusetts, already cited, where the positive enforcement of orders by punitive measures when necessary has resulted in the actual use of only boiled water for drinking, with exemption from typhoid fever and a low sick rate as a probable consequence. Again, in the case of the Fifth Missouri, I was informed by the colonel that especial pains had been taken to exclude lads, and that the average of his men was 28 years. In this command, whose surroundings were extraordinarily bad, where 1,300 men had been confined since May 27 on an area 320 by 230 yards, shut in by other regiments
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with sinks immediately about them and constantly encroaching nearer and nearer, with necessarily narrowed and crowded streets, although typhoid fever has appeared, the actual sick list was relatively low, being 3.2 per cent. This I attribute to the greater resisting power of these full-grown men. An immature regiment must have been badly shattered under such conditions.
(4) Climate.-The heat and humidity at Camp Thomas are very great now. Early in the season the weather was dry, with occasional showers. Since the 20th of July, and perhaps earlier, copious rains have fallen. At first there were clouds of dust; later, the heavy rain has run off by the natural channels, except in the "flat woods," but has made the sinks still more difficult to take care of, has rendered the tents damp, and doubtless is increasing the causes of malarial disease.
(5) Shelter, occupancy, and arrangement of camps.-All the troops are under canvas and nearly all the canvas is overcrowded. The tents are of many patterns- a few shelter, more conical and conical wall; some State tents of various sizes, the most of which are so-called "flood" tents of the Mississippi Valley, very old and nearly all leaky, and the greater part the improved common or A-wall tent. The occupants vary from 2 in the shelter to 4 and 5 in the A, 6 or 8 in the "flood," and 15 or 16 in the conical.
Many of the regimental sites are precisely the same as those occupied from the beginning. A few of the regiments have been moved, amid it is probable that more are now being changed, but at the time of my observation many of the commands had been in absolutely the same position for two months or more. Not only were the camp sites the same, but in the most instances the tents themselves stood where they had first been placed. In scarcely any instance was fresh ground available, as it should be, upon which the tents might be moved laterally every week or ten days. Consequently the ground itself is being poisoned imperceptibly, but persistently, by the human body without the disinfectant and redeeming action of direct sunlight upon it. The contents of the tents, such as blankets, straw, and the like, have been irregularly removed into the open air, but, as a rule, not often enough. Direct touch showed in many instances that these articles and the ground were damp. The camps, speaking generally, were crowded not merely as to inhabitants but as to neighborhood. There was abundant room between divisions and generally between brigades, but many of the brigade camps were too compressed, and with some of the regiments the compression was extreme and in defiance of all sanitary laws; this in addition to the tents themselves having too many occupants. The difficulty probably arose originally from the expectation that many more troops would be sent into the park, for whom space must be reserved. In some cases higher authority arbitrarily established time regimental lines. Whatever the reason, the effect is clear-the tents are overcrowded and without sufficient adjoining space, the streets are narrow, and time soil is becoming more and more charged with filth. Owing to reasons previously explained, competent sinks were made with difficulty and were multiplied on account of their shallowness and the rapidity with which they filled with water. They thus encroached more and more upon the open space and intruded toward the camps. For instance, in the Second Arkansas, Second Brigade, Second Division, Third Army Corps, the men*s sinks were within 30 yards of the kitchens, and were very offensive. The kitchen sinks were intermediate and so full and so foul that maggots were abundant on the surface. In the Fifth Pennsylvania the camp site was lower than the sinks, and during recent rains they overflowed and flooded the camp. The sick report of that regiment was 11 per cent, including 25 cases recognized as typhoid and 15 supposed to be of that disease, with the sick rate increasing.
More than half of the men slept on the ground. In some regiments the tents were floored, in others cots and field bedsteads were arranged, but always at private or regimental expense. The motive in many instances doubtless was comfort, but in one regiment (Third Tennessee) the men bought the cots because they had learned by experience in civil life that it was harmful to sleep on the ground in that climate. In a very sickly regiment (Ninth Pennsylvania) the medical officer pointed out a very high three-story bunk, whose tenants he declared the healthiest in the command. A group of three is too small to reason from, but is significant that among much sickness these men escaped. The sanitary advantage of being off the ground is freedom from dampness, and especially escape from the immediate influence of the ground air, which, under the conditions described, must be peculiarly deleterious. It is recommended that in all camps of position in southern climates the tents be floored, with a considerable space beneath, and that the floors be portable, so that they may be moved (within the camp) when necessary for change of site or for police. The expenditure of a few feet of lumber
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when the regiment departs is well balanced by the greater physical efficiency of the men.
Quite independently of any specific contamination of the water supply (and were the general water supply thus contaminated the typhoid fever would also be general, which it is not as yet) , the pollution of the soil by fecal discharges, specifically diseased or healthful, leads to the occurrence of diarrhea, to general physical depression, moderate fever, and undermining the man*s health, and whether an imported case or not is necessary to fire the train, it is the universal experience of armies that outbreaks of typhoid fever will occur under just such circumstances. This is perfectly understood and always anticipated by sanitarians where precautionary measures are not carried into effect. In this case, besides having a congenial soil fertilized day by day for such seed, the seed itself was introduced directly by various regiments, as Thirty-first Michigan, First South Carolina (as reported, regiment has left the park), Fifty-second Iowa, which brought no acute case but was infected before arrival, and Ninth Pennsylvania, which has had nearly 100 cases in all. Besides which, certain regiments (Fourteenth Minnesota, Second Ohio, Third United States Volunteer Cavalry) have treated cases for considerable periods in the camps themselves. It can not be necessary to enlarge on the facilities for the spread of this disease that are afforded by fatigue, heat, moisture, overcrowding, dust, and flies; and all these are present.
(6) Employment and control.-The physical and the moral influences of occupation are factors that, speaking generally, do not seem to be thoroughly appreciated in this camp. I received the impression-it is only an impression and may be erroneous-that the most of the men were over drilled. Nearly constant occupation or amusement is the best antidote for the ennui that extinguishes some soldierly vitality, and idle men are likely to be sickly men, but monotonous drills in hot climates have their limits, and should be arranged with discretion. In at least one command drill was from 6 to 8 a. m., and with parades from 3.30 p. m. until dusk. So far as temperature is concerned, the hours were well suited, but to fall in at 6 o*clock implies for the majority of men, where the sinks are few to a regiment, extreme discomfort in the matter of physical relief. The afternoon cessation of such exercises leaves the clothing drenched with perspiration and the men without opportunity to dry it or themselves before sleeping. I was told, but did not verify it, that some drills had been held at 1 o*clock, but that seems hardly credible. As far as I could learn, no attempt has been made to carry out practice marches or to move the commands from the park itself, but those battalions that have moved out for two or three days* target practice always return in much better health. In my judgment systematic military excursions should be utilized for the health, to say nothing of the efficiency, of the men. The discipline of the several regiments varies greatly, but where it is intelligently exercised time condition of the men is the better, as shown by their camp police, their personal appearance, and especially their abstinence from unauthorized water supply.
The refuse from the thousands of animals and the other insoluble debris of the camp add to the aerial and indirectly to the aqueous pollution. A few of the regiments attempt to burn their kitchen garbage in extemporized furnaces, but there has been no systematic arrangement, as might easily have been made, for formal crematories.
Some officers attribute much of the sickness to the sale by numerous venders of milk, pastry, fruit, and vegetables, a considerable part of which is supposed to be not in the best condition. It is probable that some of these comestibles lead to moderate diarrheas, as in fact the natural water does, and predispose to other intestinal troubles. With a fair inspection I believe that these peddlers add to contentment of the men, to many of whom the ration is not yet perfectly satisfactory. (I verified occasional complaints of unsound beef and spoiled bacon, but they were not numerous.)
This outline, which might be filled with very copious detail, for which I have the notes made on the spot for every regiment, should suffice to account for the serious and increasing sickness in that part of the army.
The inspection of the hospitals and of the sick lists of the regiments shows a complementary condition. My orders did not cover any question of supply or of administration, but it was absolutely necessary to touch these subjects at certain points in order to obtain an intelligent view of the situation.
Under the general plan of field administration all the sick who may not properly he cared for in their own tents, the "quarters" of garrison, are expected to be treated in the hospitals of their appropriate divisions, which are conveniently situated for access by ambulance. These division hospitals are in turn subdivided in theory into brigade hospitals, both as to personnel and material, so that if necessary
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its proper allowance of men and supplies can accompany such a detached command. At the time of my inspection there were four intact divisions in the camp, a cavalry brigade, an artillery brigade, and a headquarters escort, provost guard and employees. When the First Division, First Corps, left Camp Thomas about the 23d of July, it left 153 cases in the division hospital, doubtless because the general hospital could not receive them. The hospital was placed under Major Brechemin, United States Volunteers (captain, Medical Department, United States Army), with four contract surgeons as assistants. At the date of inspection, August 3, 88 cases remained, 60 of which were typhoid fever. There had been 17 deaths at the hospital in all, and several of those remaining were critically ill. When the change of ad ministration was made the general condition of the hospital and of the patients must have been deplorable, judging from special reports in the office of the chief surgeon Third Corps, that I had the opportunity to read. From those reports some of the patients had bed sores, and the general administration lacked order and care.
At the time of my inspection there were six beds to a tent, including the typhoid cases. The general police of wards and grounds was fair and evidently improving. The natural drainage was good, but the site was bordered by low ground on three sides and any considerable enlargement would have been impossible. Of 33 privates of the Hospital Corps 20 were on duty as nurses in reliefs of twelve hours each. Originally there were no sheets, but these had been supplied by the Red Cross. There was no hospital fund. There was extreme difficulty in obtaining medical supplies, a week being named as the ordinary limit. For two days there was no corrosive sublimate to disinfect the bedding. No strychnia at all was obtainable. The hospital then needed both strychnia and whisky. Water was formerly obtained from a large spring, but now from a well. There is no filter, but it is supposed to be boiled. It is doubtful whether it all is boiled. The sinks which the patients are able to use are bad. A detail of 50 men sent by the Second Division from a Minnesota regiment the previous day to dig sinks declined to do so under the alleged orders of the division adjutant-general and merely policed the grounds. As no more patients were likely to be received, the condition of this hospital will improve, and under Major Brechemin*s intelligent energy the confused records will be made more plain. In my judgement there should be hospital accommodation to which all the remaining cases might have been transferred when the division moved, but there was none. There were 5 cases of venereal disease awaiting discharge, although the command had actually left the park ten days previously.
Hospital, First Division, Third Corps-At the time of my inspection, July 27, the hospital control was just being assumed by a newly-arrived officer, who could not be regarded as responsible for its defects nor be credited with its advantages. The staff consists of 5 medical officers, and the enlisted force was 95 noncommissioned officers and privates of the Hospital Corps. The hospital consists of 30 hospital tents for all purposes, containing at this date 179 patients. The tents are too crowded, containing 8 patients apiece, and they have had 10. There is insufficient space between the wards, the grounds are not adequately ditched, and the approach to the patients* sinks is very poor. The sinks themselves are very bad. The hospital is not divided into brigades. The Red Cross supplies about one-half of the clothing and the bedding. The floors that have been supplied the tents were furnished by regimental means. The hospital fund started with $50, and there was $48 at the end of the month, but considerable expenditures had been made by emergency funds supplied by the regiments. Very serious complaints are made as to the inadequacy of the medical supplies. No atropine is on hand, and the salol has been bought by private means. The chloroform supplied 1st-10th of June was regarded as inert, although this might depend on the inexperience of the administrator in open-air work, but the bottles contained a small part of the marked contents. Chocolate-coated quinine tablets in stock, Parke, Davis & Co., tablet 125 (563360 in red), are insoluble and found in the stools. I am informed in Washington that this is not supplied by the medical department. It was evidently regarded there as part of the regular supplies. The food as a whole is good, and the special diet kitchen was very neat and appeared excellent. Two of a case of 12 sides of bacon then on hand were bad, and I personally observed the maggots in them. There was only one very small coffee mill, apparently belonging to a mess chest, for the whole hospital and one man was employed all day in grinding coffee. The average duration of treatment, excluding the typhoid cases, is stated at three or four days. Cases are transferred to Leiter and to McPherson general hospitals. Fifty men are employed as nurses and are on duty from twelve to eighteen hours continuously, day by day. As far as observed, all the hospital cases of this division were taken into the hospital.
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Second Division, Third Corps-Nearly if not all of the regiments in this division maintain regimental hospitals. For instance, the Ninth New York has from 6 to 8 men in a local hospital out of 60 supposed to be in quarters. In the division hospital are 33. The regiment has had about 30 cases of typhoid, but the proportion of malarial cases is now large. First Arkansas has 37 in hospital and 85 in quarters. When examined there was a small regimental hospital maintained by individual subscription, in which were 3 cases of dysentery alleged to have been returned from the division hospital. First Maine has 7 men in the regimental hospital. Of the 42 officers, 7, or 16.67 per cent, are sick-all with typhoid fever.
The hospital of this division (Major Bradbury, First Maine, in charge) consists of 37 hospital, 8 conical, and 6 common tents, containing 285 cots and 250 patients. Eight medical officers are present for duty, with 6 stewards and 138 privates. Or the latter, 45 were men of the line detailed from regiments. To this date 1,190 patients had passed through the hospital, and 56 typhoid cases were present. Were all the men in the division who should be in hospital present it would be overcrowded, as it has been when men were at times literally upon the ground, and at other times medical officers have given up their own accommodations to them. Sometimes typhoid patients are returned to their regiments for convalescence in order to make room. Speaking generally, the condition of the hospital is very good. The streets are broad and well policed; the general police is excellent; the ordinary wards are very good, but the typhoid ward is too crowded, and formerly was still more so, when the cots touched each other. There is great difficulty in disinfecting the bedding. The hospital is brigaded, but not the attendants, and there would be difficulty were the command suddenly broken up. There are several brigade surgeons at this hospital, and it is plain that they do not regard that as their proper sphere. The records are well kept, but great difficulty is experienced in obtaining supplies. This seems to be partly technical and partly from insufficient stores. I examined the record of a requisition made on the 1st, acted on on the 13th, 17th, and 19th, and on the 22d filled in part. I saw another where two articles were supplied out of seventeen authorized. The hospital finds it practically impossible to get intestinal antiseptics, such as salol, or strychnia, or subgallate of bismuth. It is very largely dependent upon regimental and Red Cross funds, and a case of boxes to hold regimental supplies has been arranged to stimulate regimental interest, which is quite foreign to the principle of these organizations. The Red Cross supplies 1,500 pounds of ice daily; milk, food, comforts, and some absolute necessities, as medicines, themselves.
Second Division, First Corps-Brigadier-General Poland, since deceased, particularly requested me to recommend that the water which is being drawn for his command from the spring of the Rev. Mr. Park, outside of the public grounds, should be paid for. He made this request with much earnestness, and it has proved to be one of time latest of his official acts. I heartily commend his request.
The hospital cases of the First Brigade doubled in July. The Second Ohio has 13 men in the regimental hospital regularly cared for by 2 men permanently and 4 men detailed day by day. The Fourteenth Minnesota has 5 in its regimental hospital, several of whom are quite ill, 1 being a typhoid fever case which there is no pretense of sending to the division hospital. In the Thirty-first Michigan 10 cases are being treated in the regimental hospital, which is evidently a fixed arrangement, and there is great unwillingness to send men to the division hospital. On the other hand, I questioned a man (Private Dyer, Company F) who had been sent to the division hospital 29th of July, but was not admitted. There was serious complaint as to the detaching of medical officers and noncommissioned officers and the employment of such men of high social and scholastic standing on menial duty-for example C. O. Ryan, I Company.
Regimental hospital, First Georgia, was equipped at Griffin partly by the Surgeon-General and partly by private means. The Fifth Illinois claims great difficulty in discharging men for disability, and has now a dangerous epileptic (David D. Edwards, Company A), who is a menace, but whose discharge has long been delayed.
Hospital Second Division, First Corps-This contains 150 beds, but has 172 patients present. More cots have been sent for. There are 6 medical officers, 1 line officer as quartermaster and acting commissary subsistence, 5 stewards, and 39 privates. Occasionally individual nurses are sent for special cases from the regiment. The tents are too crowded-8 men each-and the tent police is not good. There were 20 cases there fit for a general hospital which could not be sent without orders. A greater capacity is much needed. There were 11 tents in possession not erected. The washing is done by contract, and the clothing disinfected, but not boiled. The hospital fund is $33. There is no money from private funds. The Red Cross sends daily 200 pounds of ice, 10 gallons of milk; 4 chickens
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weekly; eggs and lemons irregularly. Pajamas and night shirts are furnished by benevolent societies. There have been 586 patients all told, with 4 deaths (1 accidental, 1 from cerebral hemorrhage, 1 when a patient had been under treatment for typhoid fever for ten days in his regiment). Forty-two cases have been sent to the general hospital. There was serious complaint that the supplies were defective in strychnia, nux vomica, belladonna, opium (except camphor and opium and dovers powder), and the liquid preparations of opium and deodorized opium are much desired. There was no opthalmoscope or no rectal speculum available. The diagnoses were not well kept in the register, little correction being made in the original ones sent from the regiments; but a distinction was drawn between "enteric" and "typhoid" fevers, with the claim that they are distinct.
Third Division, First Corps-The Twelfth Minnesota, with a constant sick rate of 13 per cent, claims great difficulty in getting lime and vessels for boiling water. The Fifth Pennsylvania has a sick report of 11 per cent, with many typhoid cases. The police is not good and sickness is increasing. It is said that the quartermaster department declined to supply vessels and barrels for water, but boiling has begun lately. The sinks were infected and no disinfectant allowed. (This is the regiment already reported as being overflowed by its sinks.) Medicines have been very difficult to procure. It was supposed that they were "held in reserve." Consequently they have been purchased, and strychnia, which could not be had on requisition, was finally bought by direct authority of the Surgeon-General. The Eighth Massachusetts, whose discipline is good and which boils its water, has a sick rate of 2.56 although its camp site is bad. The Twelfth New York, in the same brigade, has a rate of 8.5, rapidly increasing, of which 95 per cent is believed to be typhoid. The regimental hospital has 19 cases. The regimental fund equipped the hospital and the medicine and food are supplied by charity. The Ninth Pennsylvania has a sick rate of 13 per cent. It brought 2 cases of typhoid fever into camp and has had nearly 100 altogether. It has 80 cases in general hospital and 30 in division hospital, which declines to receive more. In the regimental hospital are 28 men with detailed nurses, and there are reported by the surgeon a number of cases in the camp in quarters (tents) with high temperature. The Second Missouri has no field desk, and its reports of sick and wounded have been returned for quite unnecessary corrections. There are 15 men in the regimental hospital, which is floored and furnished by private means. There is the perfectly just complaint that no whisky and other necessary medicines can be had for the men who have been permitted, whether necessary or not, to be treated in camp. The First New Hampshire has more than 70 men under treatment in quarters, besides 25 on sick report on light duty amid 25 in the division hospital. It has 20 typhoid cases, the first occurring about six weeks ago. The regimental surgeon reports 18 or 20 fit for the division hospital and many men in camp unable to attend sick call and who must be visited. There is also time repeated complaint of the difficulty of obtaining discharges.
Hospital, Third Division, First Corps-This has 5 medical officers, 1 line officer, 8 regimental stewards, 89 privates, including 18 sick. Forty of these men are employed as nurses, but as they are untrained their value is small. Twenty-four of time detachment were transferred voluntarily and are good, but the Hospital Corps recruits are very poor as received. The nurses go on in two reliefs of twelve hours each, and special nurses are also obtained from the regiments for particular cases as required. There is also a daily regimental detail of 15 men. The capacity of the hospital is 30 tents with 206 beds, leaving 7 tents and 50 beds not pitched. The hospital is not brigaded. To the 10th of July there were 658 cases, and 26 deaths, chiefly from typhoid. Some cases appear to be delayed in reaching hospital, and the Second Missouri was cited as a regiment that preferred to treat its sick in camp. Some of the tents were crowded with 8-beds and others contained 6. The typhoid cases are not kept in distinct wards, but are mingled among the others. The police is fair, and time patients* clothing, wrapped in a poncho, is kept under their respective beds. The stools are disinfected with the bichloride and the clothing is washed by a woman living near, after chemical disinfection. The clothing is not boiled in camp. The hospital ground is small but the drainage is good. Fifteen barrels of water from the park spring are received daily. The water is boiled and partly filtered. Major Clark, Twelfth Minnesota, is in charge, and all the medical officers are regimental, who desire to rejoin their regiments when the command moves. Their present detached condition is resented by the line officers. It was not thus noted on the spot, but it is believed that this hospital, in common with time others, is largely dependent on time Red Cross and similar voluntary associations for support. The defects reported by the officers concerned are as follows: The Myers stove is inferior to the Buzzacott oven,
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because it soon fills with ashes and requires specially short wood. But a single coffee mill was available, and it ground badly. Salol and other necessary medicines require to be bought. The medical field supply was pronounced insufficient and inappropriate for the climate. Some articles were in excess, but the most are deficient. The quinine is insufficient for the conditions, and there should be more condensed food, as beef and milk; and malted milk, which was spoken of very highly, was desired. It was charged that the needle holder broke the curved needles very easily, so that four were destroyed in an operation recently.
Besides these organized hospitals there are four others necessarily required. The cavalry and artillery brigades, each practically independent commands, have no reserve hospital, but care for their sick regimentally-namely, the Third United States Volunteer Cavalry, the First Illinois Cavalry, and the various batteries together. There is also a small hospital for the troops and others directly attached to headquarters.
Third United States Volunteer Cavalry has a sick report of 16.47 per cent., which is increasing. The first recognized typhoid fever case occurred in the previous week, and five were sent to the general hospital. There is reason to suppose, however, that a case now convalescent is actually one of that disease. There were 375 cases to July, but the July record was not yet entered. There are now 20 in the regimental hospital, chiefly remittent, and 139 in quarters. This regiment had just changed its camp to a new site, but its old one from want of police had been an offense to all who observed it.
The First Illinois Cavalry lying by the side of the last, also having just changed camp, has a sick report of 3.8 per cent. The regiment has been in the park since the 1st of June, and typhoid fever commenced about eighteen days ago, since which time there have been 5 cases. There were 19 cases in hospital, chiefly remittent and 29 in quarters. The hospital, which is regimental property of a unique pattern given by friends, was very neat and well kept.
The artillery brigade of seven batteries has a sick rate of 8 percent, but unequally distributed, the most of the cases being in the Georgians. The hospital tents are of a somewhat larger pattern than the present regulation, but are neatly floored and contain six beds each. All the hospital water is boiled and filtered, but this is difficult of general application. It was complained that the Myers quinine was insoluble.
The headquarters sick report showed a rate of 2.8 percent. The hospital was neat and the patients few.
Besides these conditions, chiefly physical, affecting the men, there are others that disturb the medical officers and are discouraging them. Excepting a very few regulars scattered among them, all of these volunteer officers, although filled with a laudable desire to do their best, are in an unaccustomed atmosphere, and what is plain to men of long experience is obscure to them. The stated reports, the requisitions, the certificates for discharge have given great trouble and have consumed time, often ineffectually, that might be otherwise occupied. Until very recently there have been two heads of corps and a chief surgeon superior to both, and the methods used do not appear to be uniform. One of the effects has been to cause great delay in the distribution of supplies, and, wherever the fault, there has certainly been great inconvenience to all concerned. There has been also not only delay, but, regardless of theory, deficiency which has been real and prejudicial. This matter of supply I touch with diffidence, as not coming strictly within the scope of my orders, and yet both it and administration have a marked bearing on the sanitary condition of the men. It is clear to me that filters, if they were to be used, were withheld too long and are insufficient in number; that the field desks for convenience of administration, and in view of their contents necessary for it, were not supplied in time (all have not yet been issued); the field chests have reached the most of the regiments only very recently; the standard allowance for a "brigade or division field hospital," one of which is normally three times the size of the other, is grossly inadequate under the conditions of a permanent camp such as this, that contains numerous and very serious fever cases; and, however it may come about, the hospital supplies are not replenished with freedom and dispatch.
Stated briefly, the troops at Camp Thomas are suffering not from special infection of water or from peculiarly malarious conditions of locality, although the latter will increase with the advancing season, but with the inevitable results of crowd poisoning, soil pollution, insufficient water, insufficient and imperfect shelter, a very great lack of facilities for the disposal of refuse, and the indirect consequences of ignorance in camp sanitation on the part of practically all the men and nearly all the officers. The regiments are very large and the medical staff, besides being almost entirely inexperienced, is too small in numbers. Much
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of the time of all of them is occupied with preparing, correcting, revising, and completing papers with which very few are familiar. The methods of getting supplies, of discharging the unfit, of accounting for persons are strange, and they naturally are discouraged. I think every medical officer in the camp is overworked, and some of them severely.
Added to all this, the hospital accommodation has been exceedingly inadequate. For a camp of more than 40,000 new troops-I exclude those that have been detached-there are four division hospitals, with an aggregate capacity of 850 beds in which to treat every case not fit to remain in his own tent, or about 2 per cent of the gross amount. Added to this is a neighboring general hospital of nominally 255 beds, whose normal capacity is not more than 130, which has been overcrowded from its opening. The consequence has been that the camps are dotted all over with a vicious system of regimental hospitals not recognized, and properly not recognized, by orders, but tolerated as a makeshift. In a camp of this kind, filled with raw, poorly selected troops, 300 should have been the minimum for each division hospital, with the ability to increase to twice that number without delay, or large, well-appointed, easily accessible general hospitals should have been at hand. The eruptive diseases always ravage new rural commands, diarrheal diseases of varying intensity furnish their contingent for hospitals, typhoid fever should constantly be apprehended, and the malarious diseases, as the season advances, will add to the cases. For these reasons there should be a surplus rather than a deficiency of canvas.
My orders do not call for recommendations, but, under the verbal instructions of the Secretary of War to make such immediately on the more pressing points, which I have done already in a brief preliminary paper, I add, to complete this section of this report, that in my judgment rules to this effect should be applied to the troops at Chickamauga Park, and, mutatis mutandis, the same applies to all similar large commands:
(1) Every regiment (of new troops) that has occupied its present site more than thirty days should be moved.
(2) Wooden floors, to be movable within camp limits and to stand at least 4 inches above the ground, should be supplied all tents.
(3) All leaky canvas should be replaced.
(4) In a camp of this kind the occupancy of a common tent should be limited to 3 and of a conical wall tent to 10 men.
(5) All tents should have an area equal to their own base of free ground between them and the adjacent tents, and to and from this fresh ground they should be moved every week or ten days.
(6) At Camp Thomas quicklime should be very freely furnished for disinfection, although the rainy weather will make storage and transportation difficult.
(7) Facilities for boiling the drinking water and for storing it in barrels should be given each regiment at Camp Thomas.
(8) Crematories for all combustible refuse should always be supplied to each division of a permanent camp when such refuse can not be otherwise consumed. Much of the existing waste at Chickamauga should be burned by the park commission.
(9) Practice marches over short distances and of short duration should be put into operation for the Camp Thomas troops. These can not be made too long, because nearly all the regiments are charged with typhoid fever, and for the next ten days or fortnight new cases already infected will appear.
(10) It would probably be better to remove the Third United States Volunteer Cavalry (Grigsby*s) altogether, although arrangements must be made to care for its present sick and those taken on the way.
(11) The division hospitals should be increased by one-half at least; the camp hospital about to be established be put into immediate operation, and the regimental hospitals be absolutely and incontinently abolished as soon as this new canvas is ready.
(12) A medical officer of experience, discretion, and energy should be attached temporarily to those headquarters, whose sole duty it should be to examine men presented for discharge, to prepare the certificates, and get them before the commanding general with the least possible delay. He should visit the various regiments and hospitals for this purpose, act independently of existing boards, and trouble the chief surgeon of the camp with them only for the purposes of record. There are many such cases to be acted on whose consideration occupies much time of the chief surgeon that might be more profitably employed, and the presence of the unfit men in the commands is harmful.
I also inspected the sanitary condition of the Leiter general hospital, as required by my orders. The building is that formerly known as the Park Hotel, and at
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the time of my visit, July 31, its capacity was reckoned as for 255 patients. On that date there were 19 vacant beds. The hospital is commanded by Maj. E. C. Carter, who is his own executive officer, quartermaster, and subsistence officer. His medical staff consists of Major Bayne, United States Volunteers, and 5 Contract surgeons. He has 2 stewards, 1 acting steward, and 30 privates, Hospital Corps, including 2 absent and 3 present sick. There are 30 female contract nurses, 10 Red Cross nurses, and 2 excellent volunteer nurses. Half of the Hospital Corps are on nursing duty. There are 10 authorized civil laborers, among whom are 4 vacancies. There are three large rooms on the lower floor, formerly the dining, reading, and billiard rooms, and a detached dancing pavilion in the grounds. There are also a number of small chambers on the second floor, a number of beds not occupied at the time stand in the second story hall, and 30 convalescents sleep on the veranda. Two wards of 16 tents in all, each to contain 5 beds, a total of 80 beds, are in time grounds as yet unequipped.
All the large rooms are greatly overcrowded, the detached pavilion alone giving no odor. It has abundant eaves ventilation and tolerable cubic capacity. The floor space in these rooms is 46.5, 58, 69, and 65 square feet, respectively, and all but the reading room have four rows of beds, the ends of those in the central rows being in contact. There is very little working space, the floors in the nature of the case can not be kept clean, and, in general terms, these rooms contain twice as many patients as they should, for there are practically no vacant beds and the cases are all serious. None of these rooms has immediate closet facilities, and the discharges from the dining room and reading room have to be carried through the lower part of the building to the closets adjacent to the billiard room. The floor of this ward is below the level of the surrounding earth. There is a basement water-closet now undergoing repair, in which 4 closets and 2 urinals were about to be introduced. The walls of the first floor are dirty throughout and require kalsomining. In the upper story the rooms have too many patients, considering their character. The walls here are clean. There are water-closets on the halls of this floor.
I was told that when the hospital was first occupied the sewer was occluded for a considerable distance, that the sewage debouched so that ultimately it might have polluted the Chickamauga Creek, and that the closets within the house were untrapped. Manholes have since been introduced, a masonry basin, discharging the fluid contents automatically, and from which the solid residuum is removed by hand, receives the sewage and protects the river. The closets are now all trapped, and the building appears to be properly protected in that direction. In one outhouse closet, when inspected, insoluble waste was found in the bowl, and the apparatus was temporarily disarranged. The rain-water leaders discharge into the sewer, and the pipe for flushing the sewer proceeds from the base of the tank that supplies the house with water.
The water is drawn from the adjacent Crawfish Spring, whose flow is estimated at 60,000,000 gallons per diem. To the eye that seems an exaggeration. The tank and the engine belonging to the hotel proved insufficient, and a 30-horsepower engine, furnishing 3,000 gallons an hour, has been in operation since June 25, and a new tank of sufficient capacity is in process of erection. The spring is essentially a pond, somewhat liable to contamination, although there is no direct evidence thereof. Distilled water has been offered by a trustworthy company in Chattanooga at 21-cents per gallon.
Besides the hospital fund there has been spontaneously sent $240 from private sources, which has been spent chiefly for cows and food. Many gifts have been sent and offered, including one of a carload of much cows from some one in Chicago. The slowness by which certain wants are supplied through the regular channels has made such extraneous aid very acceptable.
The hospital corps is not only ill disciplined, but is very poorly clothed. The female nurses are said to be efficient.
To the end of July there had been 350 admissions to the hospital, all from the neighboring camp, and 80 per cent of the cases were of typhoid fever. It had happened that the place has been overstocked, as when 30 patients were sent to fill 20 vacancies.
There is no guard for the public property, such an application having been refused. One noncommissioned officer permanently detailed and 1 private by roster act as watchmen. There is no stable for 10 head of stock that are herded.
The commanding officer expresses a desire for a line officer to act as quartermaster and commissary; he wishes more and better clerks; he desires an executive officer; he would prefer half of his contract surgeons to be more experienced men.
According to my observation the hospital is well managed. It is, however, sadly overcrowded. In my judgment time buildings should not contain more than
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130 beds. It is possible to put up in the grounds 4 more groups of 40-bed wards, making 240 under canvas, or 370 beds in all. Perhaps room could be found for 400, but the kitchen and other administrative facilities would be strained. The lower story should be thoroughly kalsomined, the floors carefully cleaned, and in the unventilated large rooms some of the simpler forms of ventilation by tubes be introduced. In one of those rooms there are electric fans, but their chief value is to stir up the air, not to replace it.
As a whole, the sanitary condition about Chickamauga Park is not good, owing to preventable conditions, and I believe that measures similar to those herein suggested should be carried out.
