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SECTION II.
CHAPTER VIII.
DIVISION OF SANITATION.
FUNCTIONS
For many years the Division of Sanitation has been one of the permanent divisions of the Surgeon General`s Office; 1 consequently there was no occasion to create a division in this case during the World War. In fact, many of the basic activities of the Division of Sanitation have been well defined and maintained during almost the entire history of the Medical Department of the Army. Included among these are the physical examination of officers and enlisted men, the selection of the recruit, the collection and compilation of statistical data of morbidity and mortality, and many other matters having to do with sanitation. Then, too, long before the World War, with the recognition and development of preventive medicine as a distinct branch of medical science, the functions of this division had become greatly amplified.
For many years before the war the Division of Sanitation had been rather the catch-all of the Surgeon General`s Office. The reason for this was that, save the Record, Correspondence, and Examining Division, which was not equipped to handle anything outside its own work and which had no medical officer in charge, the only other divisions actually in being in the Surgeon General`s Office itself were the Personnel and the Supply Division It was, of course, perfectly easy to determine what subjects logically fell to them, and, save for records and hospital construction, everything else was handled by the Sanitation Division. It will be noted later that even during the war it was not freed from all extraneous business, yet primarily its function, both before and during the war, was to preserve the health of the Army.
The Division of Sanitation during the war was the responsible center in the Surgeon General`s Office for the initiation, coordination, and direction, in an administrative sense, of measures of sanitation and disease prevention for all troops within the United States. The points of contact with outlying camps and stations were through camp, division, port, and department surgeons direct, on technical and professional subjects, and through military channels to commanding officers, where military or administrative questions were involved. When sanitary defects or deficiencies were brought to the attention of the Surgeon General`s Office, immediate steps were taken to correct them, either by instructions sent to the camp surgeon, if the correction lay within his power, or by correspondence with the higher authorities of the War Department when such action was necessary. Ultimate reports as to action taken and results obtained were received and filed in this division.
Close cooperation with many of the other divisions in the Surgeon General`s Office was insured by frequent formal and informal conferences. This was particularly the case in respect to the Division of Infectious Diseases and Laboratories.
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In this connection it should be noted here that the Division of Sanitation, to a much greater extent than was the case in any other division of the Surgeon General`s Office, dealt with the administration of the Army as a whole rather than with that of the Medical Department exclusively. This, of course, is due to the fact that the good health of troops enters into every military problem, and that in the last analysis local commanders are responsible for the sanitation of their commands equally with other matters pertaining thereto. On the other hand, as already indicated, the Medical Department is responsible for technical matters having to do with sanitation and the Division of Sanitation controlled here.
Within the limits of this chapter no detailed discussion is made relative to sanitary measures applied in the various camps and stations, which will be included in the volume on sanitation. The aim is to outline briefly the organization of the Division of Sanitation, as it functioned during the war period, and to review its activities within the Surgeon General`s Office alone and not as reflected in the administrative and sanitary organizations in camps, cantonments, and other stations.
EARLY ORGANIZATION.
On April 6, 1917, upon our entrance into the World War, the Division of Sanitation was functioning for the peace-time needs of a Regular Army of approximately 175,000 officers and enlisted men. Only two medical officers were on duty in the division when war was declared.2 A small permanent clerical force had been required and provided for some years, the larger number in connection with statistical and other work pertaining to medical records. The small pre-war organization, fortunately, was capable of expansion, and early in April, 1917, the Surgeon General, visualizing the immensity of the task confronting the Medical Department, and on recommendation of the chief of the division, brought into the office, as assistants to the latter, a group of four senior medical officers of the regular service, to each of whom was assigned the task of planning, organizing, and developing a special activity. 3 The previous training and experience of the officers so selected preeminently fitted them for the respective tasks assigned. This was the real beginning of the war-time expansion of the Surgeon General`s Office in an administrative sense. The four separate activities thus initiated within the Division of Sanitation early in the war were: Hospitalization, medical officers1 training camps, laboratory and infectious diseases, and field sanitation.
For some time during the early months of the war the foregoing activities were coordinated as regards policy and plans in the Division of Sanitation. Later, hospitalization, training camps, and laboratories and infectious diseases were placed in separate divisions, but the date when they began to function as independent divisions can not be fixed definitely, as no office orders are of record creating them. The chief of the division, having been ordered over-seas, was relieved from duty in the Surgeon General`s Office September 30,1917, and it is certain that on and after that date, and probably long before, the three special activities referred to (hospital, training camps, and laboratories and infectious diseases) had no direct relation with the Division of Sanitation. The Hospital and Laboratories and Infectious Diseases Divisions
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continued as such to the end of the war. Upon the signing of the armistice Medical Department training camps were ordered abandoned, and the personnel then under training in them was reassigned or discharged.
The Division of Medical Officers Training Camps I was discontinued on November 11, 1919,when its remaining functions were again taken over by the Division of Sanitation. 4
The Division of Field Sanitation 5 was intended to confine its activities chiefly to the supervision of hygiene and sanitation at camps and cantonments in the United States, and, incidentally, to the administration of the newly organized Medical Department units to be concentrated in them. At its inception it was a division within a division, concentrating its attention on these subjects within the limited objective of camps and cantonments, while sanitation and hygiene, in a broader sense, as applying to the Army at large, to permanent posts and stations in the United States and the insular possessions, as well as to cantonments and camps, to the selection of the recruit, to medical records and permanent statistics, and to many other problems, were still handled by the parent division. A few months` experience with this tentative organization demonstrated that it was impracticable and undesirable to attempt to handle questions relating to sanitation in the field apart from those of general sanitation, and by the latter part of 1917 the Division of Field Sanitation, in its evolution, had gradually absorbed a great part of the function of the old Division of Sanitation. Eventually all the remaining functions of the permanent Division of Sanitation were consolidated with those of Field Sanitation, and the latter division ceased to exist as such, although a good part of the organization and personnel of the Division of Field Sanitation was continued, and served as the foundation for the reorganized Division of Sanitation, which was to "carry on" during the remainder of the war.5
EARLY PROBLEMS.
Among the early problems in the summer of 1917 (they were handled by the Division of Field Sanitation for the reason stated above) were: The formulation of sanitary regulations and rules for the prevention of disease to govern the new armies about to be mobilized; the development of a service of sanitary inspections; the selection of qualified medical officers for duty at each camp and cantonment during the period of construction.
In order that the Army might take advantage of the best professional opinion in the country, a conference was forthwith held in the Surgeon General`s Office, attended by eminent sanitarians in civil life and by many experienced officers of the Medical Corps, in which was discussed and prepared a revision of the sanitary regulations then in force." This revision was designated "Sanitary Regulations and Notes on Control of Communicable Diseases." Upon recommendation of the Surgeon General, these were published to the Army on August 10, 1917, as Special Regulations No. 28. 7 Though several important additional paragraphs were added from time to time, including the subjects of louse infestation and disinfestation, the examination of permanent food handlers, and the fitting of shoes, these regulations continued in effect during the entire war period. A circular of information regarding venereal diseases was prepared
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in the division early in the summer of 1917, which was printed in sufficient numbers to permit the placing of a copy in the hands of each enlisted man.
A sanitary inspection service was established July 1, 1917. 8 Especially qualified senior medical officers of the regular service were selected as special inspectors, and before troops were mobilized sanitary inspections of all camps of the National Guard and National Army and many of the large aviation and other special stations had been completed. The technical inspections at this time were limited to drainage, housing plans, water supply, and sewerage con-ditions. More extensive reference is made to the sanitary inspection service later in the chapter. The medical officers selected as camp sanitary inspectors at this time were instructed during the period of construction of camps and cantonments to advise the quartermaster in regard to sanitary matters, to make a sanitary survey of the camp site and its surroundings, and to establish and maintain satisfactory sanitary conditions among the civilians and military artisans of the camp. These officers were advised also to establish relations with the local representatives of the Public Health Service, who were charged with the sanitation of the extra-cantonment zones, and to provide for an interchange with local health authorities of information in regard to communicable diseases. The Surgeon General required that a special report from these camp sanitary inspectors, submitted by telegraph on August 31, 1917, regarding the state of preparedness of each camp or cantonment for the reception of troops, the readiness of the hospital to receive patients, the degree of completion of the water supply, sewerage system, and arrangements for the disposal of other wastes, and the existing insanitary conditions, especially as to mosquito breeding, which could not be immediately corrected. In compliance with other instructions from the Surgeon General, each camp sanitary officer was required to forward on or after September 1, 1917, a monthly sanitary report describing in detail the conditions in the camp at the time the commanding general of the incoming division assumed command.8 The first contingents of selective-service men for the newly organized divisions were sent to camps on September 5, 1917. 9 The general sanitation of camp and cantonment areas was well advanced before the arrival of troops. Unfortunately, hospitals were not completed; in fact, in several camps they were scarcely begun. 10
For the divisions organized in September, 1917, division surgeons and sanitary inspectors had been selected by the Division of Field Sanitation and were already designated in the camps before the date set for the arrival of registrants under the first draft.
With few exceptions, the medical officers assigned to the higher administrative positions with the various divisions were selected from the Medical Corps of the Regular Army, as previous training and experience appeared to fit them best for these duties.
REORGANIZATION AND EXPANSION.
From January 1, 1918, to the date of the signing of the armistice (November 11, 1918), the expansion of the Division of Sanitation was continuous. Changes were made gradually, without interfering in any way with the smooth working of the machine. New sections were created and former sections were reorgan-
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zed from time to time, as changing administrative needs seemed to demand. The division, as organized at the height of its activities, comprised eight distinct administrative sections, some of which functioned more or less autonomously. The degree of expansion of the Division of Sanitation during the war is well indicated by comparing its growth in terms of personnel alone. In April, 1917,as already stated, only two medical officers, with a small group of civilian clerks, handled the world of the division for the small peace-time Army, while in November, 1918, there were required, and were actually on duty in the division, 52 commissioned officers and enlisted men and approximately 400 civilian clerks."A roster of all commissioned officers on duty in this division during the war is given at the end of the chapter. The organization chart (Chart VIII) gives the designation and functions of the various sections of the reorganized division.
The organization and work of the various sections and subsections of the division are summarized in the following pages.
SECTION OF SANITARY INSPECTION.
Sanitary inspectors first appeared in the United States Army 99 years before the World War. A general order, dated April 21, 1818, contained the following paragraph relating to them: "The Assistant Surgeon Generals will forthwith commence the inspection of the Medical Department in their respective divisions, agreeable to the instructions they may receive from the Surgeon General." In March, 1821, when an act of Congress for the reduction of the Army abolished the office of Assistant Surgeon General, the duty of sanitary inspection seems also to have lapsed.
Medical Department inspection did not reappear until the Civil War. Several acts of Congress creating the office of medical inspector and defining its duties were passed during the war. The best definition of these duties and the final one is to be found in General Order 308, W. D., A. G. O., September 12, 1863, which is quoted:
WAR DEPARTMENT,
GENERAL ORDERS,
ADJUTANT GENERAL`s OFFICE,
No. 308.
Washington, September 12, 1863.
The Medical Inspector General has, under the direction of the Surgeon General, the supervision of all that relates to the sanitary condition of the Army, whether in transports, quarters, or camps: the hygiene, police, discipline, and efficiency of field and general hospitals; and the assignment of duties to Medical Inspectors.
Medical Inspectors are charged with the duties of inspecting the sanitary condition of transports, quarters, and camps, of field and general hospitals, and will report to the Medical Inspector General all circumstances relating to the sanitary condition and wants of troops and of hospitals, and to the skill, efficiency, and conduct of the officers and attendants connected with the Medical Department. They are required to see that all regulations for protecting the health of troops and for the careful treatment of and attendance upon the sick and wounded are duly observed.
They will carefully examine into the quantity, quality, and condition of medical and hospital supplies, the correctness of all medical, sanitary, statistical, military, and property records and accounts pertaining to the Medical Department, and the punctuality with which reports and returns required by Regulations, have been forwarded to the Surgeon General.
They will ascertain the amount of disease and mortality among the troops, inquire into the causes, and the steps that may have been taken for its prevention or mitigation, indicating verbally or in writing to the medical officers, such additional measures or precautions as may he requisite. When sanitary reforms, requiring the sanction and cooperation of military authority. are urgently demanded, they will report at once in writing to the officer commanding Corps, Department or Division, the circumstances and necessities of the case, and the measures considered advisable for their relief, forwarding a duplicate of such reports to the Medical Inspector General.
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Chart VIII.--Division of Sanitation, Surgeon General`s Office, June, 1918.
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They will instruct and direct the medical officers in charge as to the proper measures to he adopted for the correction of errors and abuses, and in all cases of conflict of views, authority, or instructions with those of Medical Directors will report the circumstances fully and promptly to the Medical Inspector General for the Surgeon General`s orders.
Upon or near the beginning of each month, Medical Inspectors will make minute and thorough inspections of hospitals, barracks, camps, transports, etc., within the districts to which they are assigned, in conformity with these instructions and the forms for inspection reports furnished them.
Monthly inspection reports, in addition to remarks under the several heads, will also convey the fullest information in regard to the medical and surgical treatment adopted; the advantages or disadvantages of location, construction, general arrangement, and administration of hospitals, camps, and barracks; the necessity for improvement, alteration, or repair, with such recommendations as will most certainly conduce to the health and comfort of the troops, and the proper care and treatment of the sick and wounded. When alterations, improvements, or repairs requiring the action of Heads of Bureaus are considered essential, special reports, accompanied by plans and approximate estimates of quantities or cost, will be made.
Medical Inspectors will make themselves fully conversant with the regulations of the Subsistence Department in all that relates to issues to hospitals, whether general, field, division, or regimental, and will satisfy themselves, by rigid examination of accounts and expenditures, that the fund accruing from retained rations is judiciously applied and not diverted from its proper purposes through the ignorance or inattention of medical officers, giving such information and instruction on this subject as may be required. They will also give close attention to the supervision of cooking by the medical officers, whose duty it is, under the act of Congress of March 3, 1863, and General Orders, No. 247, of 1863, to "submit his suggestions for improving the cooking, in writing, to the commanding officer," and to accompany him in frequent inspections of the kitchens and messes.
They will exercise sound discrimination in reporting "an officer of the Medical Corps as dis- qualified, by age or otherwise, for promotion to a higher grade, or unfitted for the performance of his professional duties," and be prepared to submit evidence of its correctness to the Medical Board by whom the charge will be investigated.
Medical Inspectors are also charged with the duty of designating, to the surgeon in charge of general hospitals and convalescent camps, all soldiers who are in their opinion fit subjects for discharge on surgeon `s certificate of disability, or sufficiently recovered to be able for duty. In all such cases they will direct the surgeon to discharge from the service, in accordance with existing orders and regulations, or return to duty those so designated.
* * * * * * *
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It is expected that all commanding officers will afford every facility to Medical Inspectors in the execution of their important duties, giving such orders as may be necessary to carry into effect their suggestions and recommendations; and it is enjoined upon all medical officers, and others connected with the Medical Department of the United States Army, to yield prompt compliance with the instructions they may receive from Medical Inspectors on duty in the Army, Department, or District in which they are serving, on all matters relating to the sanitary condition of the troops, and of the hygiene, police, discipline, and efficiency of hospitals.
By order of the Secretary of War:
E. D. TOWNSEND,
Assistant Adjutant General.
With the end of the Civil War Medical Department inspectors disappeared, not to reappear in the Spanish-American War or until 1913. (A medical inspector was appointed in the latter part of 1898 and made at least one report of inspections to the Surgeon General, which covered both sanitary conditions and medical department operations, but this officer was then detailed as chief surgeon, Division of the Philippines, and ceased to act as an inspector).
The duties of the sanitary inspector of a department are defined in the Manual for the Medical Department (1913) as follows:
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(a) To serve as assistant to the department surgeon and to assume the duties of that officer when the latter is absent.
(b) To have charge, under the direction of the department surgeon, of all matters relating to the sanitary care of troops.
(c) To scrutinize the sanitary reports rendered by medical officers conformably to Army Regulations.
(d) To recommend the issue, at proper times, of orders containing specific instructions regarding hygienic and sanitary matters.
(e) To proceed, when authorized, to points threatened by seriously insanitary conditions for the purpose of studying such conditions and of recommending and supervising measures for their correction.
(f) To make himself thoroughly familiar with the sanitary conditions at and near each point within the jurisdiction of the department commander where troops are stationed.
(g) To make himself thoroughly familiar with the amount and character of field equipment and supplies pertaining to the sanitary service at each post in the department, and to assist the depart-ment surgeon in formulating such plans for mobilization as will result in the sanitary troops arriving at their concentration camps equipped as prescribed in regulations.
(h) To make annual inspections at such garrisoned stations as the department commander shall designate.
It should be noted that this was the first time in peace since 1818 that we had had any sanitary inspection service. Sanitary inspections from 1913operated at department headquarters and not from a central office, that of the Surgeon General.
Though there was no change in the new status of the sanitary inspectors from this time until the World War, actual shortage of mileage funds operated year by year, and sometimes wholly, to prevent them from making extended sanitary inspection of the departments to which they were assigned. Occasional visits were made to permanent military posts by the Surgeon General or by one or another of the department surgeons. Occasionally, too, a specially selected medical officer was sent to a particular station to investigate and report on some medical matter. Neither of these nebulous plans constituted anything remotely resembling a sanitary inspection service. Progress in the way of organization, however, should be noted as having taken place, for the sanitary inspector was provided for in the organization tables of 1913.
With the mobilization of troops on the Mexican border in 1916, seven experienced officers of the regular service were designated by the War Department as "general sanitary inspectors," and were assigned by the commanding general of the Southern Department to the various districts along the border, 12 where, by frequent inspections, supplemented by instruction, they assisted materially in maintaining the forces in excellent health. Their duties at this time were actually almost entirely in the strictly sanitary line rather than hav-ing to do largely with medical department administration.
With the beginning of the World War, it immediately became apparent to the Surgeon General`s Office that a corps of sanitary inspectors operating from that office was essential for the maintenance of good health conditions among the vast armies which were being raised. Like many other activities at the outbreak of the war, the sanitary inspection service grew up without formal orders, having had its inception early in July, 1917, with the detail to the Division of Field Sanitation of two experienced medical officers. 13 They at once devised the original inspection questionnaire forms and began the inspection of the large cantonment sites where building operations were then begin-
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ing. These officers reported for duty on July 18 and August 9, respectively, and remained in the Surgeon General`s Office on inspection work until their departure for France on December 27, 1917. On August 21, 1917, the officer, who after December 27, 1917, became chief of this section, was assigned to duty for inspection service. 13 On January 1, 1918, the inspection service was definitely organized as a section of the expanded Division of Sanitation, the same officer remaining at its head until after the end of the war.
An important early administrative accomplishment of the Sanitary Inspection Section was devising an adequate form of questionnaire for obtaining information at the stations inspected and for making report thereof to the Surgeon General. The original questionnaire covered relatively few points, these pertaining strictly to military sanitation. As the work of the section was gradually extended to include not only purely sanitary investigations, but also matters pertaining to other divisions of the Surgeon General`s Office, it became necessary to provide a more complicated form of questionnaire. The questionnaire forms were modified from time to time to suit changing conditions and to satisfy the increasing needs of other divisions. At the height of our military activities four forms were in use, one for camps and cantonments, one for base and general hospitals, one for development battalions, and one for Students` Army Training Corps units. The forms of these questionnaires are shown in the chapter on the " Section of Sanitary Inspection " in the volume on Sanitation. For the smaller commands the questionnaire was appropriately modified.
The general method of procedure for sanitary inspectors was as follows: The Chief of the Inspection Section requested of the Personnel Division that orders be issued for a given inspector to proceed to places named for the purpose of making sanitary inspections, and on completion of that duty to return to his proper station. On receipt of information that he was to visit certain stations, the inspector dispatched a standard mimeographed letter to the camp surgeon of the camp or to the commanding officer of the hospital which was to be inspected, requesting him to have ready, in letter form, on the inspector`s arrival, certain information indicated in the mimeographed letter. This information covered many of the points which were subsequently to be reported on in the questionnaire, amplifying the subjects discussed therein. On arrival at the station the inspector reported to the commanding officer, visited all parts of the camp or hospitals, and investigated thoroughly all conditions therein, checking his observations against the statements made in the letter to him from the camp surgeon or the commanding officer of the hospital. Before leaving the camp the inspector reported in writing to the commanding general of the camp or to the commanding officer of the hospital the sanitary defects found in the camp and the recommendations for the correction of any of these defects which it appeared that the local commander would be able to remedy without action of higher authorities. In the case of a general hospital the inspector, in the name of the Surgeon General, directed the commanding officer of the hospital to report in writing to the Surgeon General, attention Division of Sanitation, what action had been taken to correct the deficiencies or irregularities noted. In the case of stations other than general hospitals, the recommendations of the inspector, on submission of his report to the Sur-
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geon General, were referred by the Surgeon General to The Adjutant General of the Army, with request that they be transmitted to the commanding general of the camp with instructions that he report regarding the action taken to correct the defects noted by the inspector.
On the basis of his own observations, supplemented by the replies of the camp surgeon or hospital commander to the questions contained in the mimeographed letter referred to above, the inspector prepared his report on the condition of the station, and on returning to Washington submitted the same to the head of the Division of Sanitation for action. The recommendations which the inspector made were then referred to the different administrative divisions of the Surgeon General`s Office, or to the proper administrative bureaus of the War Department, with a view to accomplishing the prompt correction of the defects in question. The inspector personally saw to the institution of the necessary corrective measures with regard to important defects. It was found that the latter procedure often resulted in obtaining much more rapid corrective action than would have been possible by routine military correspondence.
At the outset, in the summer and fall of 1917, sanitary inspections were chiefly confined to National Army and National Guard camps. 14 As the great base hospitals at the camps took shape, these were also included in the camp inspections, a special hospital questionnaire being at this time devised for use at these institutions. As the war progressed it so happened that more and more commands, directly under the control of the War Department, were either established de novo or were developed by the expansion of previously existing military agencies. Such were the aviation fields, the arsenals, the ordnance proving grounds, the special camps, the recruit depots, the disciplinary barracks, the prison camps, the Students` Army Training Corps units, and the general hospitals. The Inspection Section undertook the inspection of all these stations as rapidly as they were organized.14 It was planned that the Inspection Section should visit about once every two months all commands which were directly under the jurisdiction of the War Department and that in addition special or more frequent inspections should be undertaken when complaints, epidemics, or other unusual events rendered them expedient. Owing to the difficulty in obtaining a sufficient corps of experienced regular officers for the Inspection Section it was impossible to make routine inspections of these stations as frequently as was desirable or as was originally contemplated. Usually three and sometimes four months intervened between inspections of important stations, and often a longer period in the case of smaller commands. It should be made clear at this point that the sanitary inspection service of the Surgeon General`s Office was extended only to commands directly under the War Department. The territorial departments, as a matter of fact, were maintained during the war, 15 and within them, as in peace times, a sanitary inspector operated, though shortage of mileage funds did not obtain during hostilities; his activities, therefore, were not restricted from this cause. 15
With the development of the great base hospitals of 1,000 to 2,000 beds, and with the establishment of many large general hospitals for the specialized care of the overseas cases, a new problem was introduced into the inspection situation so far as the Surgeon General`s Office was concerned. Each profes-
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sional division in that office, as well as many of the technical sections of these divisions, wished to have inspectors for investigating exclusively the handling of its particular line of professional work in these hospitals, with a view to standardizing procedures and detecting deficiencies. Yet it was apparent that the practice of making independent inspection for every specialty of medicine was bound to result in duplication of travel, effort, and expense, in a lack of centralized knowledge regarding conditions at these hospitals, and in confusion due to diverse recommendations by different inspectors who were inclined to view a hospital chiefly in the light of their own specialties. To obviate this difficulty it was decided that all inspection work should be centralized in the Inspection Section, and this policy was put into force. 16
This centralization of professional and technical inspections of hospitals, as distinguished from general sanitary inspections, continued in force for a time, but the desire for independent inspection by each professional division or section in the Surgeon General`s Office remained, and ultimately resulted in the appointment of "consultants," who visited the hospitals officially to consult regarding the cases pertaining to their specialties; in reality they acted as inspectors of their respective services. (See histories of Professional Divisions.) The consultants were not under the control of the Inspection Section. The inspectors of this section, however, continued to inspect the professional services at all hospitals, but this inspection was less detailed and technical than that made by the consultants.
The Inspection Section enabled the Surgeon General to keep in close touch with conditions at all camps and hospitals, not only by means of the written reports furnished him, but also by conversations between him and the inspectors. The inspectors on their return to Washington were in a position to answer by first-hand information any complaints regarding sanitary conditions or care of patients at the points visited by them. All the inspectors were stationed in Washington, with the exception of the inspector assigned to duty at San Antonio, Tex., who inspected stations in southern California, Arizona, New Mexico, Texas, Oklahoma, and Louisiana. He was from time to time ordered to Washington for conference and consultation regarding conditions in his inspection area.
The scope of the sanitary inspections as carried on from the Surgeon General`s Office differed materially from that of the Inspector General`s Department. With the former, less stress was laid on details of a purely military nature, while much more stress was laid on matters largely professional or technical. such as general camp sanitation; general administration of hospitals, hospital trains, and hospital ships; nursing and professional care of the sick; compe- tency of medical officers; the handling of infectious diseases; the prevention of venereal disease; the management of quarantine and detention camps; extra-cantonment health activities; medical supplies; hospital construction: laboratories; special diets; the instruction of medical personnel; mosquito and fly eradication; delousing plants; water purification; sewage disposal; physical examinations for entry into the service and for demobilization; development battalions; and convalescent centers.
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More than 1,400 inspections were made by inspectors from this section, and practically every station not under control of a department commander was visited. All large camps and hospitals were inspected many times. 17
The inspections resulted in the alleviation of numberless local sanitary defects and paved the way for general recommendations looking toward the improvement of sanitary conditions in the Army as a whole.
SECTION OF MEDICAL RECORDS.
The first report of the Surgeon General of the Army to the Secretary of War was made in the year 1819. From that year until the present time at least one report has been made to the Secretary each year. During the early period the report was submitted quarterly. The first statistical report of any consequence, published in 1840, covered the period from January, 1818, to January, 1839. After this time statistical tables were included in the annual reports to the Secretary of War. A second special statistical volume was published in the year 1856, covering the period from 1839 to 1855. Such statistics as were prepared during these early years were consolidations of quarterly numerical reports submitted by the various surgeons of the military posts and other commands.
During the Civil War, beginning with 1861, the regulations prescribed that the senior medical officer of each hospital, post, regiment, or detachment should make a monthly report to the medical director and a quarterly report to the Surgeon General, showing the number of sick and wounded and the number of deaths and of discharges on surgeon`s certificate of disability. The medical director by whom the monthly reports were received was required to consolidate them and to forward the consolidated returns to the Surgeon General. From January 1, 1884, when a change was made from numerical to nominal reports, until December 31, 1904, nominal lists of all cases of sickness, deaths, and discharges occurring at military posts were forwarded to the Office of the Surgeon General by the responsible medical officer.
It was in 1883 that the first modern statistical tables for the service were published in an annual report. As time has gone on the data contained in these tables have been continued and amplified, and for many years have formed a vast and exceedingly valuable collection of health statistics applying to many diverse conditions of climate, habitation, race, and service. They are available for the use of the medical profession in the annual reports of the Surgeon General of the Army.
At the outbreak of the World War a method of reporting each case of sickness, death, or discharge on an individual report card was in vogue, having been inaugurated on January 1, 1905. From the time that this system was adopted until the fall of 1917, the cards were filed by posts in the Surgeon General`s Office as received, with a nominal check list and a report sheet in each case. This was done each month, vertical filing boxes being used. In common with that of the rest of the Surgeon General`s Office, the correspondence of this section was indexed in a correspondence book and filed in vertical files. Later the individual report cards, after being numbered according to a table of diagnostic terms, were sorted and counted by hand. The results were then entered in the designated places on sheets that had been prepared for the
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purpose. From these data statistical tables for the annual reports of the Surgeon General were compiled.
From what has been said it is apparent that the compilation of medical records had long been an important function of the Office of the Surgeon General. Before the World War the Record Section, as a matter of fact, constituted a good part of the Division of Sanitation. Yet upon our entry into the war, it became evident at once that an enormous expansion would be necessary. As an indication of the increase of its work, it may be well to point out immediately that while before the war the personnel of this section was 1officer (part time) and 14 clerks, at the height of its activities during the war, 6 officers and approximately350 clerks were needed. 11
After it was decided that the United States was to put a large armed force in the field, it became obvious that the old system of handling the sick and wounded records would be inadequate. The filing system for all correspondence was at once changed from a vertical system to a flat-filing system with self-evident indices. (See Administrative Division.) This system, so far as this section is concerned, consisted, in brief, of filing all correspondence by posts and organizations under the name of the respective post or organization. The nominal check lists and numerical reports were separated from the report cards and filed in a flat-filing system by posts or commands. The cards themselves were arranged in one general alphabetical file. It was clearly evident that this was necessary on account of the frequent changes of soldiers from one command to another, as well as from one country to another, conditions which did not obtain to any great extent in peace times.
The Hollerith tabulating machines were adopted and a coding book was prepared. In the preparation of the statistical material free use was made of the system employed by the Bureau of Medicine and Surgery of the Navy Department, as well as of the system which had been instituted in the Office of the Surgeon General of the Army. Each professional division or section of the latter submitted a list of the diagnostic terms which were preferred for its spe-cialty. These were then arranged in one alphabetical file.
Whereas the Navy and the French were using one statistical card for both medical and traumatic cases, it was decided to use one card for medical cases and one for traumatic cases. In this way it was possible to obtain much more detail.
It soon become apparent that if the statistical part of our medical history of the war was to be complete, some data must be obtained showing the physical condition of the men upon their entrance into the military service. Consequently, negotiations were opened with the office of the Provost Marshal General, through whose assistance it was possible to obtain from the local examining boards a copy of the physical examination record, Form P. M. G. O., for each registrant who was rejected by the local boards as physically disqualified. The Provost Marshal General joined with the Surgeon General in a letter to The Adjutant General of the Army requesting that the physical examination forms for the men who were inducted into the military service, and who had been examined at camps, be temporarily loaned to the Surgeon General`s Office for the purpose of preparing statistical cards. This request was approved. 18
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Subsequently, approximately 2,000,000 statistical cards for men who had been inducted, and who had been examined at military camps, were prepared. In addition to this number, 549,099 reports of physical examinations were received in the case of men who were rejected by the local board; statistical cards were also prepared for these cases. From this great number of cards, supplemented in many cases by the information obtainable from the sick and wounded cards, it was possible to secure a more complete survey regarding the physical condition of men of military age than has ever before been practicable in this country.
In addition to the 2,500,000 cards which were prepared to show the results of the physical examinations, approximately 3,500,000 cards were made from the reports of sick and wounded for the years 1917 and 1918.Furthermore, about 300,000 additional cards were made, based on casualty cablegrams.
In compliance with a request from the Office of the Chief of Staff that the Surgeon General`s Office furnish weekly reports showing the casualties occurring by weeks in the various branches of the service in France, such a plan was put into effect during the latter part of the summer of 1918 and continued until February 1, 1919. 19 On the latter date, the weekly report by branches of the service was discontinued and a weekly report substituted, showing the con- solidated figures. This was the only office in the War Department where figures showing the loss by arms of service and by weeks were available and the only place in which there existed the necessary organization and machinery to furnish them.
It was anticipated in the spring of 1918 that it would be desirable to have early information relative to men invalided home from Europe. Consequently a letter was prepared and sent through The Adjutant General to the ports and to various military posts and commands. 20 This letter directed that the field medical cards, or the report cards (Form 52, M. D.), whichever might be sent with cases invalided to the United States, be stamped with the name of the debarkation hospital receiving the patients and the date; and that from the debarkation hospital each card be sent to the hospital in the interior to which the patient was transferred; and that on arrival at this receiving hospital the name of the hospital and the date be stamped on each such card and the card forwarded to the Surgeon General`s Office as promptly as possible. From the cards received an alphabetical index was prepared. For a number of weeks this index was the only source of information available in Washington regarding the whereabouts of the patients in question. Of course many purposes were served by this index, mainly in the way of answering inquiries; it was also found of value by The Adjutant General`s Office for directing mail addressed to soldiers who had already been invalided home from Europe.
The report cards received by this section rendered it possible to answer thousands of inquiries from relatives and friends in regard to details of sickness and deaths. It was possible also in a large number of cases to furnish information to the Pension Bureau and to the Bureau of War Risk Insurance.
The statistical data collected by this section may be found in the statistical tables, Part Two, Volume XV, Statistics, and in annual reports of the Surgeon General.
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SUBSECTION OF ANTHROPOLOGY.
A subsection of Anthropology in the Section of Medical Records was created. 21 Its function was to secure the highest possible degree of perfection in the measurement of recruits and in the preparation of the identification records, and to provide for the analysis and synthesis of statistics on the subject of anthropology. The results of this work are published in Part One, Volume XV, of this history.
SECTION OFCURRENT STATISTICS.
With the outbreak of war and the mobilization of vast armies it became necessary that the Surgeon General be kept currently informed as to the amount of sickness among troops, in order that he might have at all times an up-to-date measure of the practical effect of efforts to combat epidemics. Of course the true index of success or failure of sanitary measures is the number of soldiers on sick report. In other words, as compared with the total strength the successor failure of the Medical Department in its efforts to promote healthful living conditions among troops is indicated by the relative incidence of disease among troops. It was necessary, then, that the Division of Sanitation be kept posted in this respect through current information on the health conditions among troops everywhere. Monthly sanitary reports and reports of inspectors were too infrequent to serve this purpose. To solve the problem department sur-geons and the senior medical officer of each divisional camp and cantonment were instructed on September 19, 1917, 22 to forward by telegraph, in code, on Friday night of each week, a report regarding the numbers admitted to hospital and quarters for diseases and injuries, the number of new cases of certain communicable diseases appearing during the week, and the number remaining sick at the end of the week. In addition, the strength of the command and the detailed causes of all deaths during the week were to be included in the report. The form of the weekly report as rendered and as it appeared when transcribed in this office for records as follows:
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The current statistics service was initiated at the beginning of the war in the Division of Field Sanitation, but its functions were greatly amplified in January, 1918, when weekly and sometimes daily telegraphic reports were called for from all general hospitals. ports of embarkation, and independent stations, in addition to those from department surgeons and from the camps and cantonments which, as has been explained, were previously required. Weekly cabled reports were likewise received from the chief surgeon, American Expeditionary Forces, France and Siberia. In the reorganization of the Division of Sanitation the current statistics branch became a separate section, 23 and continued so to function during the remainder of the war.
This section compiled statistics from the weekly telegraphic reports as soon as they were received. Daily reports were used for the same purpose during the influenza epidemic. From these data the Surgeon General was able to see at a glance the morbidity and mortality rates of the previous week for each home command and for the home Army as a whole. Naturally, too, these current statistics enabled him to take very prompt action to better health conditions. During the period of mobilization of the National Army these current statistics were the best available source of information on the health of the Army. Later during the measles-meningitis epidemic of November,1917, and the influenza-pneumonia pandemic of September and October,1918, the Section of Current Statistics furnished the only up-to-the-minute information relative to the progress or abatement of disease conditions in the camps. At these times this information was vitally necessary to the Surgeon General`s Office in order to determine at what points help was most urgently needed for checking the ravages of the epidemics; to what place, and at what time, it would be safe to move healthy troops; and in what localities amore rigid system of quarantine should be established in order to halt the further spread of contagion.
It should be explained that the statistics compiled by this section were not absolutely accurate. This was due to the fact that it was impossible, in the short time in which the weekly reports were prepared and sent in by the various surgeons, to have them accurate. Some errors were inevitable, due to haste; for example, a common one was dependent on the fact that final diagnosis in a given case sometimes could not be determined promptly. A patient reporting sick might be considered on first examination to have a certain ailment, and it would be so reported, whereas more thorough examination ultimately would show that something entirely different was the trouble. Nor was time available for carefully checking the figures. The statistics of the section were sufficiently accurate, however, to answer their purpose, although they should never be permitted to serve as a source of information on which to base permanent statistics. They actually proved of the greatest value at the time in giving the Division of Sanitation a fairly reliable measure of current health conditions among troops, thereby helping it to meet the various and peculiar health problems which arose from time to time among our forces in home territory. The figures are not useful for any historical purpose and should not be so used.
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This section compiled and published during the war period weekly bulletins on Disease Conditions among Troops, 24 which were widely distributed among medical and line officers and to health officers in civil communities. Special quarterly, semiannual, and annual consolidated reports were also prepared and similarly distributed. A summary of health conditions based upon the weekly bulletin was given to the press each week for publication.
In view of the criticisms which were being made relative to conditions at Army camps in November and December, 1917, the Surgeon General, accompanied by several of his advisers, made a personal inspection of a large number of stations where epidemics were then prevailing, and submitted reports to the Chief of Staff from each place visited. 25 The unsatisfactory and insanitary conditions found were fully set forth in these reports, with recommendations for their correction. This series of records gives a complete picture as to conditions found at the places visited; as a matter of fact, similar conditions obtained to a greater or less extent at all camps and cantonments at that time. Overcrowding was found to be general and often extreme. Hospitals were in process of construction and were not prepared to function properly. Medical personnel was new to the service and untrained. Not infrequently the sick were being accommodated in extemporized buildings and tents.
It became evident to the Surgeon General from his observations that the communicability of pneumonia was not being properly appreciated by medical officers, and that cross infections were occurring in hospitals too frequently, due to overcrowding of the sick and failure to take proper precautions for limiting contact. Overcrowding in tents, assembly halls, and barracks was also believed to be responsible to a large extent for the spread of infections at that time. It was recognized, also, that the authorized personnel for each camp surgeon`s office was inadequate properly to handle the large medico- military problems constantly present in a large camp, especially when extensive epidemics were prevailing, and that there was urgent need for the full-time service of an additional assistant to the camp surgeon and sanitary inspector who should be especially trained in epidemiology, and who, working under the sanitary inspector, could devote his energies exclusively to intensive studies of means for the prevention of communicable diseases. 26
These conclusions of the Surgeon General led to the establishment on January 1, 1918, of the Section of Communicable Diseases as part of the Division of Sanitation. 27
SECTION OF COMMUNICABLE DISEASES.
The purpose of this section was to make a more intensive study infectious diseases and their control from an administrative standpoint and to secure more prompt action on measures of disease prevention, many of which were then most pressing. At that time epidemics of measles, pneumonia, and meningitis were raging extensively in the various camps and cantonments. Special interest attached to the relationship existing between pneumonia and measles which then appeared of primary importance, although at a later date this relationship became less marked. As camp surgeons, sanitary inspectors, and sanitary engineers were selected and directed in their activities by the Division of Sanitation, it was considered only logical and in the interest of
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efficiency that epidemiologists should be chosen and their activities controlled by the same division.
The Section on Communicable Diseases came into being to meet an emergency. It fulfilled its mission and justified its organization by its effective work in disease prevention during the war period. On November 1, 1918, it was transferred to the Division of Laboratories and Infectious Diseases as a result of the reorganization of the Surgeon General`s Office. 28 With the organization of this section an epidemiologist was assigned at each of the larger commands as an additional assistant to the camp surgeon. The first assignments were to stations where serious epidemics were then prevailing. An outline of what it was intended that epidemiologists should (10 was promulgated in a memorandum to division surgeons issued under date of January 8,1918: 29
1. It is contemplated that an officer of the Medical Department, with special training as an epidemiologist, will be assigned to each camp and cantonment where serious epidemic disease exists. While not an officer of the division, he will be under your jurisdiction in your capacity as camp surgeon, acting under the immediate control of the sanitary inspector as his assistant. Where the amount of sickness warrants such action, it is desired that in each brigade a suitable medical officer be selected who will be assigned as whole or part time assistant to the epidemiologist; one of these should be trained as an understudy with a view of having him serve as an assistant to the sanitary inspector in communicable disease problems when the division leaves camp. The epidemiologist should make such reports to you as you deem necessary.
2. It is expected that the epidemiologist will be given free access to the wards of the base hospital and that the commanding officer and staff of the hospital will cooperate with him in every way. The facilities of the laboratory should be at his disposal in so far as the study of epidemics may render this desirable. In the event of serious epidemics prompt request should be made to this office for additional bacteriologists if needed.
3. The epidemiologist should personally, or through one of his assistants, visit the tent or barrack in which each case of infectious disease originates, and observe, as far as possible, everything pertaining to that case from an epidemiological standpoint. He should assure himself that the necessary quarantine measures and the daily inspections for incipient cases are promptly inaugurated and carefully carried out, and that proper disinfection of contaminated articles is practiced. In all these steps he should act through and in cooperation with the regimental commander and regimental surgeon.
4. He should trace the connection, if any, between cases, and observe where the sick man came from, how long he has been in the camp and in the service, where he has been, and what associates he has had, if any, outside his present company.
5. He should investigate the air space per man, the arrangement of beds, the ventilation and the heating in infected barracks, and also the clothing of the soldiers concerned, in so far as these factors pertain to the prevalence of disease.
6. He should give special attention to the adequacy of the prescribed examinations of out-going and incoming troops for the detection of incipient communicable disease.
7. He should keep spot maps of infectious diseases in the camp. In this connection special attention must le given to the frequent movement of whole organizations from one barrack to another, to the change in personnel within organizations and from one organization to another, and to the constant arrival of new men from outside the camp.
8. Under your supervision he should give to the medical officers of the camp special in-structions by lectures and practical demonstrations regarding the most approved methods of handling communicable diseases.
9. The attached extracts indicate the character of detention camps and quarantine camps which will probably be constructed at each cantonment and camp. The epidemiologist should supervise the management of both camps. At the detention camps the following points should especially be emphasized. The camps will consist of huts holding eight men, or tents holding five. These hut or tent units must be kept separate. Drills must be by these units only. In the vaccination, the physical examination, and the issuing of clothing, great care should be taken to
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prevent one squad of eight, or group of five, from being in a room at the same time as another squad or group. Messing should be outdoors, or, during inclement weather, in the hutsor tents.
10. The following points should receive special attention in view of the prevalence in our
camps at present of the diseases named. The particular details to be emphasized in caring for these diseases while in hospitals are covered by memorandum, S. G. O., dated January 1, 1918, and sent to all division surgeons and base hospitals.
(a) Measles.-This disease should be regarded as one having a high mortality, not directly, but through its complications and sequelae. Experience has shown that patients sick with measles often carry most virulent pneumococci, influenza bacilli, meningococci, and possibly other dangerous organisms. Patients with measles should be treated with every possible provision for the protection of one patient from another, and of the physicians, nurses, and male attendants from the patients. Convalescent cases should be carefully guarded for a long period in well-warmed quarters.
The period of infectivity lasts as long as the abnormal discharges from the mucous membranes persist. All such discharges should be disinfected.
Contacts should be quarantined in barracks, or preferably in a quarantine camp, and be inspected twice daily by a medical officer. Special attention should be given to detecting Koplik spots, and early rises in temperature up to 1000 should be isolated. Daily airing of barracks and sunning of bedding should be practiced in "contact" barracks for measles, and also for all of the below-mentioned infections diseases.
Closure of assembly halls, exchanges, etc., may be necessary in severe epidemics of measles and other serious infections diseases.
(b) German measles.-The same precautions should be taken as for measles. Every effort should be made to correctly diagnose German measles with a view to preventing cross infection with measles.
(c) Pneumonia.-This disease is to be regarded as communicable. It should be determined in every case whether the disease is primary or secondary to measles or scarlet fever, and records should be classified accordingly. Careful cleansing of the floors should be practiced in a barrack where pneumonia has developed. Special attention should be given to sunning the patients` bedding and clothing. Ample ventilation and the widest possible separation of the heads of adjacent sleepers should be insisted on.
(d) Diphtheria.-Early culture of suspicious throat conditions seen by regimental surgeons should be insisted on. Contacts with a case of diphtheria should be quarantined until it is shown by both nose and throat cultures that they are not carriers. All close contacts shown by the Shick test to be nonimmune should be promptly immunized by means of antitoxin. Articles which have been in contact with the patient and articles soiled by discharges should be disinfected.
(e) Mumps.-Cases should be isolated and special care taken to detect incipient cases. No quarantine is recommended, but immediate contacts may be segregated if deemed necessary.
(f) Scarlet fever.-Contacts should be quarantined for seven days and examined twice daily by a medical officer, particular attention being directed to the throat. All articles which have been in contact with the patient in barracks or tent, or
(g) Smallpox.-The virus is believed to be present in all body discharges including the feces and urine. It may be carried by flies. It probably persists till all crusts have disappeared. Prompt and widespread revaccination of contacts, including at least the entire company, should be practiced. Quarantine of contacts is unnecessary, except in case of new troops when there is doubt as regards successful original vaccination, but all contacts should be inspected twice daily for a period of two weeks, special attention being given to the mouth and to rises of temperature.
(h) Cerebrospinal meningitis.-For purposes of carrier examinations to be made after the occurence of a case of epidemic cerebrospinal meningitis the word "group" should be taken to mean--
First. Other members of the same squad or tent.
Second. All other men in the same room.
Third. All other men in the same building or company.
In other words, the examinations should be extended in increasing circles about a case rapidly as time and laboratory facilities permit. While such examinations are being made on the smaller group, the largest group should be treated as potential carriers. All men in the largest group should be quarantined and prevented from mingling, as individuals, with others within or without the camp; they may, however, be permitted to attend drills and other formations as a unit. In the meantime, sprays and gargles may be used. Whenever it is impracticable to culture the
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larger units at once, the inauguration of spraying need not he delayed. If spraying is employed it should be timed so that it falls as closely as possible to the hour of retiring, thereby diminishing the chance for droplet infection during the night. When practicable a second culturing of the largest group is advisable, this to be carried out after the removal of any contacts found at the primary culture.
All carriers, as rapidly as detected, are to be removed from the building and isolated in a quarantine camp until free from meningococci on three consecutive examinations. with intervals of from three to six days between examinations. On completion of the examinations, and removal of the carriers, the quarantine may be raised.
11. From time to time the epidemiologist may report to this office. through the division surgeon, such observations as are of interest in regard to the prevention and spread of communicable diseases. Among the points of particular interest to this office may be mentioned the following:
(a) Relationship between bronchitis and pneumonia, measles and pneumonia, and septic sore throat and pneumonia.
(b)Influence of exposure to cold on incidence of pneumonia, especially during convalescence from measles.
(c)Influence of length of convalescence in measles on subsequent incidence of pneumonia.
(d) The best methods of limiting the spread of pneumonia in camps.
(e) Is the raw recruit specially susceptible to meningitis and pneumonia; and, if so, why?
(f)Influence, if any, of gas masks, on spread of infectious diseases.
(g) Influence of housing conditions, on incidence of measles, pneumonia, and meningitis.
(h) Influence of rural and urban residence on development of measles, pneumonia, and meningitis.
(i) To what extent is epidemic disease due to transfer of troops from one camp to another.
(j) Recommendations which may be of use in preventing the development and spread of communicable diseases among men in future assemblies of troops.
12. The above instructions in no wise relieve the division surgeon from the responsibility of prescribing such other measures as in his opinion are necessary to limit the development and spread of communicable diseases.
The epidemiologists had no official status in the Tables of Organization, but, as already explained, they served as additional officers on the staffs of camp surgeons, specializing along definite lines and making effective their recommendations through the authority of the sanitary inspector. The smaller camps were not supplied with epidemiologists as the sanitary inspector was able to perform all the duties of his position without assistance. As epidemics subsided in one camp, the trained epidemiologist was available for transfer and was sometimes sent to another camp where there was special need for his services. In effect, the epidemiologist during the war took over a part of the functions laid down in Army Regulations for the sanitary inspector. 30 This permitted more intensive study and better handling of epidemiologic problems than was possible when the sanitary inspector was unassisted in his work. In September, 1918, the War Department formally authorized the assignment of an additional officer to each of the larger camps as epidemiological assistant to the camp surgeon. 31
In the fall of 1918, the severe epidemic of influenza, with a succeeding high incidence of pneumonia, claimed first attention of the section. Both before and during the influenza epidemic the section was particularly impressed with the importance of contact and droplet infections in the spreading of sputum-borne diseases and with the necessity of treating pneumonia as in infectious disease. The Division of Sanitation took steps to prevent overcrowding in barracks and tents, and to minimize in the hospitals the danger of droplet infection by requiring the use of cubicles for the patients and masks and gowns
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for the attendants. 29 Later the importance of careful dishwashing in the prevention of respiratory disease received particular attention. 32
The Medical Department early came to the conclusion that for the control of communicable diseases, it was essential that incoming drafted men should be received in detention camps and kept in small groups during the first two weeks of their service, instead of being domiciled in barracks accommodating several score of individuals in a single room. No such detention camps were provided in the original plan of the cantonments, but these, and also quarantine camps, were improvised at several stations. Ultimately, authority was obtained from the War Department to construct permanent detention and quarantine camps, consisting of frame huts each of which would hold eight men with an allowance of 50 square feet of floor space per man. These detention and quarantine camps were nearing completion when the signing of the armistice put a stop to this work. No actual experience with them can therefore be recorded.
SECTION OF SANITARY ENGINEERING.
The organization of the Sanitary Corps (q. v.) in June, 1917, was a matter of basic importance to the Section of Sanitary Engineering, which derived its personnel from this corps. The Sanitary Corps comprised officers who were not graduates in medicine but who possessed certain other technical qualifications which made them of special value to the Medical Department. Sanitary engineering, which was but one of the many professions represented in the Sanitary Corps, is the only one of interest in the present connection. On August 13,1917, a sanitary engineer was appointed in the Sanitary Corps and assigned to duty in the Division of Field Sanitation as technical adviser on problems pertaining to sanitary engineering. 33 On January 1, 1918, a Section of Sanitary Engineering was established in the expanded Division of Sanitation. 34
The sanitary engineers on duty in the Division of Sanitation acted as advisers and consultants on various matters concerned with the physical sanitation of military stations. Among the features to which their attention was especially directed were the following: Water supply and water purification; sewerage, sewage treatment and disposal; the collection and disposal of garbage, manure, and other camp wastes; drainage and mosquito-control operations; the control of flies and fly breeding; housing and ventilation. These sanitary engineering officers represented the Surgeon General`s Office in conference on these and similar problems with the Construction Division and with other bureaus of the War Department. To them were referred for action or comment all papers passing through the Office of the Surgeon General which related especially to engineering or to problems of physical sanitation. Such papers comprised routine monthly sanitary reports of camp and post surgeons; reports of camp sanitary inspectors and camp sanitary engineers; special reports of medical and engineering inspectors; various technical papers prepared for publication; reports and papers dealing with laboratory procedure in relation to the examination of water, sewage, etc.; and miscellaneous letters of complaint in regard to matters pertaining to sanitary engineering.
Many field inspections and office studies were made by the sanitary engineers. For the most part such inspections dealt with problems of water supply,
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sewage treatment, and drainage for the purpose of mosquito control. The officers making these inspections were attached to the Section of Sanitary Inspection for the time being.
Concerned in the work of the section were Sanitary Corps officers who had had special training and experience in sanitary engineering and public-health administration in civil life, and an enlisted force composed of men with qualifications which fitted them to assist the officers in their work. Broadly stated, the service to which these officers and men were assigned was of three general types, as follows: Duty within the Surgeon General`s Office as members of the Section of Sanitary Engineering in the Division of Sanitation; duty at camps, cantonments, ports, posts, arsenals, and other military stations in the United States where special sanitary engineering problems in connection with sanitation arose; and duty overseas for special details, or with water-supply companies with divisional or other sanitary squads, and with water-tank trains.
The total number of sanitary engineering officers commissioned in the Sanitary Corps was 181.35 Of this group 59 were assigned to duty overseas. The distribution of the commissioned personnel with reference to assigned duties is shown below :36
[table]
No complete record is available with respect to the enlisted personnel assigned to duty in the engineering service. Enlisted men specially qualified in chemistry, bacteriology, and sanitary engineering were assigned to various camps and posts in the United States to assist in operating water and sewage-treatment plants, to perform laboratory work, to make engineering surveys, and to act as noncommissioned officers in Sanitary Corps detachments. Other men qualified particularly in laboratory technique were assigned to special duty overseas, mainly for water-supply control work.
It should be pointed out that the officers and enlisted men of the sanitary engineering service were selected with great care, the training and experience which they possessed and the duties which they would be required to perform being held in view. A high standard was maintained for appointment in this service. Approximately 2,000 applications were reviewed in selecting a group, containing not over250 officers and men. 37
Immediately on being commissioned over half of the sanitary engineering officers were assigned to the Medical Officers` Training Camp, Camp Greenleaf, Chickamauga Park, Ga. Prior to March, 1918, their instructional work was given in the School of Applied Hygiene and Sanitation intended primarily for medical officers, in order to equip them for the duties of sanitary inspection. In March a School of Sanitary Engineering 38 was organized within the School of
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Applied Hygiene and Sanitation, and later, in May, 1918, the two schools became mutually independent. The purpose of the School of Sanitary Engineering was to furnish newly appointed officers with instruction in military forms and methods of procedure, and to focus their general knowledge of engineering and sanitation upon sanitary problems incident to military conditions. This training, usually extending over a period of from four to six weeks, proved markedly advantageous to the service and very beneficial to the officers personally.
This section gradually introduced sanitary engineers into various stations as assistants to camp and post surgeons. The officers assigned to points in the United States served as camp sanitary engineers, is officers commanding detachments of soldier or civilian labor engaged in mosquito and fly control work, as officers in charge of drainage survey parties, and as operators of water and sewage treatment plants. Several officers having special training in public-health work, in addition to their engineering training, were detailed as camp sanitary inspectors. Approximately 20 sanitary detachments, each consisting of from 50 to 200 colored enlisted men of the Sanitary Corps, were developed for mosquito and fly control work in southern stations.39 In some cities supplying water to camps or large posts, and in certain camps having water-purification and sewage-treatment plants, sanitary engineers of the Sanitary Corps were placed in direct charge of the operation of these utilities. 40 In several instances officers of this section conducted classes for the instruction of medical officers in sanitary engineering problems.
The authority for placing sanitary engineering officers of the Sanitary Corps at military stations, and a preliminary definition of their duties, was contained in a letter from The Adjutant General of the Army to the Surgeon General, under date of July 5, 1918, from which the following is quoted: 41
4. The sanitary engineers grouped under section B, of Table (E. L.) 2 (sanitary engineers for sanitary inspectors of camps and cantonments; inspectors of sewage and garbage disposal and water-purification plants; in charge of drainage and other work for the extermination of mosquitoes, flies, etc.; survey parties) are available for all of the duties to which such officers may be assigned and may be transferred from one of such duties to another as the needs of the service may require.
5.You are authorized to assign to each camp and cantonment where sewage and garbage disposal plants or water-purification plants have been installed a sanitary engineer whose duty it shall be to inspect such plants and supervise their operation in order that he may advise the quarter master as to the operation thereof under the varying(conditions of flood, drainage, and temperatures.
The status and duties of camp sanitary engineers were still further defined as follows: 42
1. An officer of the Sanitary Corps may be assigned as sanitary engineer to each camp or other large military stations where water-purification or sewage and garbage disposal systems
ave been installed.
2. The sanitary engineer is an assistant to the (amp surgeon and his duties ordinarily shall be---
(a) To inspect and supervise the operation of water supply, or sewage and garbage disposal systems, and to advise the utilities officer and subdepot quartermaster with reference thereto; to recommend such suitable standards of performance of these systems as will properly conserve the interests of health and sanitation in the camp and its environment.
(b) To have immediate charge, under the camp surgeon, of drainage, oiling, and other preventive measures for the extermination of mosquitoes and flies.
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(c) To act as consultant and adviser to the camp surgeon on all the engineering or structural phases of the camp or station which bear a definite relation to health and sanitation.
(d) To perform such other sanitary duties as may be designated by competent authority.
(e) To render a monthly report to the Surgeon General of the Army, through military channels, covering such subjects as may be prescribed by the Surgeon General of the Army (322.02 A. G. 0.).
It should be noted that the Sanitary Corps was not authorized until after the general policies regarding the design and construction of the camps had been adopted, consequently no sanitary engineers belonging to the Medical Department were available at that time. This fact, it is believed, seriously interfered with efficiency.
The nature and extent of the results obtained by the Section of Sanitary Engineering varied in importance with the conditions encountered at each camp or other station. The work accomplished may be set forth under the following general headings:
(a) Assisted in securing both better design and better construction of works for the treatment and distribution of water, for the collection and treatment of sewage, and for the disposal of garbage, refuse, and other camp wastes. The results were obtained during the enlargement and reconstruction which was found necessary at certain camps after the organization of the Sanitary Corps, and at the stations which were originally established after that date.
Investigations were made of camp utilities by the officers of this section and, where necessary, recommendations for their improvement were made. The actual work was carried out, either in whole or in part, by the Construction Division of the War Department. One of the first important difficulties which developed at the camps was in respect to the sewage-disposal plants. These failed to operate properly as originally designed.43 A thorough study of the first plant constructed in conformity with the general type adopted for all of the camps was made by officers of the engineering section. This installation was at Fort Myer, Va., and as a result of the investigation and a later study of the plant at Camp Meade all septic tanks subsequently con- structed were designed on the basis of more than double the capacity provided originally.
Investigations by officers of this section first gave definite information as to the relatively large quantities of grease present in camp sewage, as compared with municipal sewage, and its deleterious effect upon the operation of the sewage-disposal plants. In the light of this information a study was made of the quantity and of the value of the grease in the sewage at Fort Myer, and experiments were conducted on grease removal. The result of this study was partially responsible for the adoption by the Construction Division of a vastly improved type of grease trap at all camps.
Likewise, routine investigations by officers of the sanitary engineering service with respect to methods in use for the collection, handling, and disposal of garbage, manure, and other camp wastes were in part responsible for the abandonment of the expensive incinerators of miscellaneous types which had been adopted at many of the larger camps and for the designing of a new and efficient type of incinerator by the Construction Division, and for many improvements in methods of handling other camp wastes.
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(b) Assisted in securing better operation of the plants for the treatment and distribution of water, for the collection and treatment of sewage, and for the disposal of garbage, refuse, and other camp wastes.
In July, 1918, the Maintenance and Repair Branch of the Construction Division was established and the operation of camp utilities in general was then taken over by that organization.44 The operation of camp utilities was closely supervised by officers of the sanitary engineering service, and at many stations a program for their operation was laid out by them. In several other instances the actual operation of the water and sewerage utilities was carried on as a part of the routine duties of the local sanitary engineer officer.
(c) Under the general supervision of camp surgeons, sanitary engineer officers usually assumed complete immediate charge of drainage and mosquito control in camps requiring it. A great amount of work of this character was done at the more than 70 military stations where it was found necessary. As a result, malaria was practically eliminated from reservations on which the disease would otherwise have been prevalent, and in many localities where mosquitoes were normally an almost unbearable nuisance it became difficult to collect even single specimens for identification and study.
(d) Assisted in putting into operation proper and standardized laboratory procedures, in both base hospital and departmental laboratories, for the examination of water, sewage, milk, and soft drinks. The examinations in question were actually made under the direction of the medical officers in charge of the laboratories.
SECTION OFF OOD AND NUTRITION.
The Secretary of War on October 16, 1917, approved the organization of a Food Division in the office of the Surgeon General.45 This division was composed of officers and enlisted men from the Sanitary Corps of the Medical Department. The status and functions of this division are given in full in the administrative history of the Division of Food and Nutrition (p. 307).
STUDENTS`ARMY TRAINING CORPS SECTION.
This corps was organized under the authority of the act of Congress, approved May 18, 1917, commonly known as the selective-service act, as amended by the act of August 21, 1918, and under War Department orders 46 of August 24, 1918. The date fixed for the induction of the students was October 1, 1918. Five hundred and sixty units of this corps were organized in various colleges and technical schools throughout the country, with a total enrollment of about 180,000 men. 47 Units varied in size from 50 to 3,200 and were administered by the War Department Committee on Education and Special Training, on which was an officer of the Medical Corps. This medical officer had to do primarily with the educational program at the various medical schools, but apparently it was the original intention of the War Department that he also handle the Medical Department administrative duties pertaining to all the Students` Army Training Corps. The corps was developed very rapidly and without definite information being given to the Office of the Surgeon General as to what was contemplated. In a short time after the courses of instruction were begun the Medical Department activities at the various colleges and schools involved were found to have fallen into a chaotic state and it became
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apparent that the medical officer on the committee would be unable to handle the administrative side of the question. This was due to the fact that the work pertained to many divisions in the Surgeon General`s Office and required some agency on the spot to coordinate it. To solve the difficulties the Acting Surgeon General on October 15, 1918, created a Students` Army Training Corps Section in the Division of Sanitation. Its activities included (a) selection and assignment of Medical Department personnel (medical and dental officers, contract surgeons, enlisted men of the Medical Department, and female nurses);(b) hospitalization; provision of medical equipment and supplies; (c) examination of accounts for professional services rendered; and (d) the meeting of the many administrative emergencies which were certain to arise from time to time. Most of these matters were handled by liaison between this section and the various other divisions and sections of the Surgeon General`s Office to which they properly pertained.
Physical examination for induction into the Students` Army Training Corps began the latter part of September, 1918. The original plan was to complete this work by October 15, but on account of the epidemic of influenza at this time the period was extended to October 21. 48 These physical examinations were made by medical officers and contract surgeons. At the various colleges and technical schools candidates who were found to be physically qualified were inducted by the local commanding officers, who notified local draft boards of the fact so that they could account for the men accepted.
The problem of obtaining medical attendance for the Students` Army Training Corps was a difficult and pressing one. As it chanced, 196 medical officers were found on duty with training detachments at colleges, and these passed into the Students` Army Training Corps when that corps absorbed the training detachments which had previously existed. This helped out greatly, but on account of the shortage of medical officers in the Army no more could be assigned to the Students` Army Training Corps. Therefore it was necessary to obtain authority from the War Department to employ not to exceed 1,000contract surgeons for this work.49 Telegrams were then sent to presidents of the colleges and schools asking for names of local physicians who would accept contracts, and also to deans of leading medical schools requesting the names of prominent graduates living in the vicinities of the training corps units. From the lists secured from these two sources 755 physicians were appointed contract surgeons. Contracts were made for full time or for half time. The former carried a salary of $150 and the latter $75 per month. Medical enlisted personnel was allotted as follows: To colleges and schools under 500 inducted population, none; to those over 500 and under 1,000, one sergeant and two privates; to those over 1,000 and under 2,000, one sergeant first class, five privates; to those over 2,000, one sergeant first class, one sergeant, and six privates.
The contract physicians working alone were of course considerably hampered by their unfamiliarity with medico-military procedures. The work consisted of physical examination of students before induction, medical attendance to all students in the various corps, local sanitary supervision, and usually administrative duties similar to those of a post surgeon. The few available commissioned medical officers were assigned as surgeons to the larger units,
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where they were assisted by contract surgeons. Yet, although the units were organized during the epidemic of influenza and although the situation at a number of institutions was a difficult one, the medical service in general was efficiently administered in a manner which demonstrated the earnestness, adaptability, and professional ability of the civilian physicians concerned.
One hundred and fifteen dental officers were on duty with training detachments when these detachments became a part of the Students` Army Training Corps. 50 It was planned to assign dentists to all units having over 500 men, but this plan was not carried out on account of the abandonment of the whole enterprise after the signing of the armistice. No contracts with local dentists were made. Students needing emergency dental treatment were sent to a local dentist, if a dental officer was not available, and the account was settled on Form 355, W. D. Surgeons were cautioned to refer to local dentists only cases requiring emergency work, and by emergency work was meant dental treatment necessary for the relief of pain.
In arranging hospital facilities for members of the Students` Army Training Corps, the institutions concerned were classified as follows:51 Class A, colleges so situated that it was practicable to send members of the Students` Army Training Corps to an Army hospital; class B, colleges which had adequate hospitals or infirmaries of their own and were not accessible to any Army hospital; class C, colleges which had no adequate hospitals or infirmaries of their own and which were not accessible to an Army hospital, but which were accessible to a satisfactory civil hospital; class D, colleges which had no adequate hospitals or infirmaries of their own and which were not near by an Army or a civil hospital.
Colleges in class A were directed to use the military hospital. Those in class B were directed to send patients to their own hospitals and were paid on a per diem-capita basis for hospital treatment rendered. Those in class were directed to use the near-by civil hospital and the bill was paid in the usual manner on Form 355, W. D. Those in class D, if small (less than 300), were directed to treat cases of minor sickness in quarters and to transfer serious cases to the nearest hospital, either civil or military. Patients too sick to be moved were to be treated in quarters, a special nurse being hired if necessary. It was planned for larger colleges in class D (over 300) to have the school establish a college hospital, if possible, otherwise a military hospital would have been established by the Medical Department. On November 1, 1918, a circular letter 51 was sent to all units requesting a statement of their hospital facilities. Three hundred and two replies were received to the following effect: Class A, 50; class B, 80; class C, 148; class D, 24; no reply, 258. The average rate charged per man per day at class B schools was $2.06. The average rate per man per day at class C schools was $2.05.
Surgeons were directed in a memorandum 52 from this office dated October 22, 1918, to established dispensaries for sick call purposes and for the treatment of mild ambulant cases. They were also directed to purchase locally medicines and dressings required for these dispensaries. No requisitions for medical supplies were honored from units except for those having Army hospital facilities.
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The armistice having been signed, the War Department ordered the Students` Army Training Corps demobilized.53 Their demobilization began December 2 and ended December 21. Surgeons were directed to ship medical property to the nearest Army camp or post.
Retained medical records were disposed of in accordance with the provisions of the Manual for the Medical Department (par. 425). Enlisted men, Medical Department, were reported to department commanders for transfer. Medical officers were likewise reported to department commanders for dis-charge or transfer. Contracts with contract surgeons were annulled as rapidly as their services could be dispensed with.
MISCELLANEOUS SECTION.
This section was established in July, 1918, 54 to bring together under a common head, for convenience in administration, various special activities having no logical relation with any other section of the Division of Sanitation or to each other. Some of these activities were of long standing in the division, others of recent development. The Miscellaneous Section as then organ-ized comprised five subsections, as follows: (a) Personnel; (b) Physical Standards and Examinations; (c) Vermin Infestation and Disinfestation; (d) Correspondence Relating to the Physical Conditions of Individual Officers and Enlisted Men; and (e) Development Battalions. In addition, from time to time during the war, the Miscellaneous Section handled other important problems which pertained to none of these subsections.
SUBSECTION OF PERSONNEL.
The Subsection of Personnel was organized early in 1918. Its function was to supply administrative Medical Department personnel for divisions camps, cantonments, ports of embarkation, aviation fields, and other large in dependent stations. The personnel selected included camp and division surgeons and sanitary inspectors, camp epidemiologists, sanitary engineers, and members of physical examination boards.
To provide a reserve of administrative officers, especially sanitary officers, this section selected men who had had previous training in public-health work and had them ordered to the Medical Officers` Training Camp at Fort Riley, Kans., or to Camp Greenleaf, Fort Oglethorpe, Ga., where schools of applied hygiene and sanitation had been established. 55 After an intensive course of instruction at one of these schools, the officers recommended by the respective commandants of the schools were assigned to one or another of the larger camps for practical instruction under the camp surgeon. After a proper period the section called for a special report on the efficiency and adaptability of each such officer. Based on these reports permanent assign-ments were made as sanitary inspectors, assistant sanitary inspectors, epidemiologists, and in some cases as division or camp surgeons.
In order to understand just what was done in the way of securing qualified officers for the more important medical administrative positions in the large camps, it should be explained that while the original divisions, those organized late in 1917, remained in camps in the United States, in each camp the division medical staff administered all Medical Department affairs for the entire camp.
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These divisions began to be transferred overseas in the early spring of 1918, and the movement continued throughout the summer. After the departure its division, each camp or cantonment still continued to function to full capacity, new men from the draft being brought in immediately, and so it as necessary to assemble an entirely new staff for each camp medical organization. In anticipation of this situation understudies for such Medical Department administrative positions had been placed in the large camps. New camp surgeons with all their necessary assistants were thus immediately available, without embarrassment or delay, to take over the camp duties from the medical staffs of the departing divisions. Again, as soon as a new camp surgeons` organization began to work smoothly a new group of medical officers was ordered to the station for instruction and training as understudies.
It is clear from what has been said that the plan pursued was to develops and maintain a gradually increasing reserve of selected medical officers qualified by special training in medico-military administration, sanitation, and disease prevention. This was essential in order to meet the continually increasing demands due to enlargements of the military program which continued until the armistice. It is believed that the method followed met with success, for it enabled the section to meet all requests for this class of personnel, and in most instances the right man was picked for the place.
The section also supplied Medical Department personnel for medical examining boards for all camps and cantonments, and controlled assignments and reassignments of such personnel from station to station to meet changing demands. This was an especially prominent activity of the section during the demobilization period.
SUBSECTION OF PHYSICAL STANDARDS AND EXAMINATIONS.
For many years prior to the World War the Division of Sanitation handled all medical questions relating to physical standards, physical examinations of officers and enlisted men, individual waivers of physical defects, discharges on certificate of disability for enlisted men, and discharges and retirements on physical grounds for officers. With the small peace-time Regular Army no special machinery was necessary for the activities enumerated, these being handled by the division chief; but with the tremendously expanded Military Establishment incident to the war the volume and scope of this special work were increased to such an extent that it became necessary to establish a separate subsection within the Miscellaneous Section of the division.
Physical standards.-The physical standards of the pre-war period 56 were relatively severe, and wisely so, as it was possible to maintain the authorized strength of the small Regular Army by voluntary enlistments without being driven to the necessity of accepting physically substandard and otherwise physically undesirable men. But with the passage of the selective-service act it was at once app-rent that pre-war physical standards must be materially lowered if soldiers in sufficient numbers to prosecute the war successfully were to be secured from the age groups of the male population liable to the draft under the provisions of the act in question. The first war revision of physical standards was prepared in the Sanitation Division in the early summer of 1917. This was
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published by the Provost Marshal General on July 2,1917 (Form 11, P. M. G. O.) 57 as Regulations Governing Physical Examinations under the Selective-Service Act. It should be noted that these revised standards related to registrants under the draft act only, the higher pre-war requirements still governing among those applying for voluntary enlistment. A few weeks later a pamphlet, 58 Instructions for the Physical Examination of Drafted Men at National Army Cantonments, was prepared in the Sanitation Division and furnished all medical officers in camps for their information and guidance. This pamphlet brought together under one cover various memoranda which had been previously issued by the Surgeon General from time to time in explanation and interpretation of the published physical standards for the draft, and also included certain instructions and details of procedure to be carried out in the physical examinations at camps and other military stations.
Another revision of the physical standards for drafted men was called for by the Provost Marshal General in October, 1917. This was also prepared in the Division of Sanitation. It was published as Part VIII of Selective-Service Regulations on November 8, 1917. Very few fundamental changes characterized this revision, but in it there were included all modifications and changes in Form No. 11, P. M. O., which had been made since the original publication of July 2, 1917. Furthermore, certain physical requirements were more clearly defined and made more specific. Herein appeared, for the first time, reference to the class of substandard men later to be taken into the Army for "limited service." This revision was in force for only a short period.
There followed a revision with which the Division of Sanitation had nothing to do. This revision was called "Changes in Selective-Service Regulations No. 3," 59 and was formulated by a board of medical officers appointed for the purpose by the Surgeon General.60 This revision was not considered a success. One of the outstanding features provided for the unconditional acceptance for general military service of registrants having "remediabled effects."
Hospital facilities and personnel were totally inadequate to accomplish the whole sale reclamation of unfit men in the midst of war activities. 62
This third revision was soon abandoned, and again the Surgeon General convened a board of medical officers for the purpose of making a revision. 63 Many changes were made, and a thorough, practicable, and remarkable revision resulted, which immediately was put into operation. Registrants with medical defects were now classified in a "deferred remediable group" eligible for call when wanted. By this revision, and for the first time, the same standards were fixed for draft and for voluntary enlistments. A few minor modifications and changes in the standards now set were made from time to time during the summer of 1918, but in general it may be said that this latest revision stood the test in the induction of new men during the .months of greatest war activity. A later revision, which was prepared in the Division of Sanitation in September,1918, 64 remained in effect during the remainder of the war.
One important change may be noted in the last revision, namely, that the "deferred remediable group " was greatly restricted and in effect eliminated as an important class. About midsummer, 1918, it was decided to induct registrants who previously had been placed in "deferred remediable group," 65 for
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special and limited service, when qualified for such service, without holding them further awaiting operation or other corrective measures to fit them for full military service. This decision resulted in making immediately available for limited service many thousands of registrants who were physically qualified for such service and who otherwise would never had been called upon for service during the war.
Physical examinations for induction.-For a time during the first year of the war there was no central coordination or supervision in the Surgeon General`s Office of physical examinations or of medical examining boards in camps. Under instructions governing physical examinations of registrants published in1917, 66 there were prescribed two distinct examinations: (a) Preliminary examination made immediately following arrival in camp, usually by regimental or battalion medical officers; (b) final examination made by various boards of specialists, i. e.,tuberculosis, cardiovascular, orthopedic, psychiatric, etc.
Under this scheme of examination, each board of specialists for conducting the final examination was designated by the professional division of the Surgeon General`s Office concerned, and each operated independently of the others and independently of the camp surgeon himself. The camp surgeon was held responsible for the prompt making of the preliminary examination in his camp, and there was no serious criticism relative to the manner in which this part of the examination was conducted. With respect to the final examination, many months often elapsed before the various special boards were able to complete their physical surveys in a camp. In some instances men were actually ordered overseas before complete special final examinations had been made. In certain camps when orders were received to prepare for overseas service there was a hurried effort to complete the special final examinations, this action necessarily resulting in the elimination of men as physically unfit after they had been in training for a considerable period and were otherwise ready for overseas service. Such late elimination necessitated filling the gaps with untrained men at the last moment. Many complaints and criticisms were made by commanding officers relative to this method of procedure, and it was obvious that it was a failure." Early in April, 1918, upon the recommendation of the Sanitation Division, a change was made and it was provided that the "preliminary" and "final" examinations should be combined in a single examination by a board of medical officers, including all necessary specialists. This examination was to be made immediately after arrival of the registrants in camp. Telegraphic instructions to this effect were sent to all camp surgeons by this office on April29, 1918, under authority from the War Department.68 This plan was continued during the remainder of the war and operated very satisfactorily. All special camp examining boards were at once dissolved and their personnel made available for the single examining board prescribed. Thus each camp examining board contained specialists from all branches of medicine and surgery and every soldier in the course of his examination was required to pass, unclothed, before the different specialists in order to receive a critical examination of every part of the body. A chief medical examiner was designated for coordinating and maintaining the general efficiency of the full examining board. In anticipation of demobilization, new forms for recording the results of physical examinations preceding separation from the service were prepared in
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the Subsection of Physical Standards and Examinations. This was accomplished several days before the signing of the armistice, and the forms were approved by the War Department, printed and ready for distribution at the time demobilization was ordered. 69 A comprehensive scheme for conducting the physical examination was worked out, the basic instructions on the subject being circularized by the War Department.70 The Medical Department sent additional instructions to camp surgeons and other senior medical officers relative to the procedure of conducting examinations preceding demobilization.
In camps the machinery for the examination of registrants was made use of in conducting the examination for demobilization, the same type of examining board being employed and the same careful physical survey being given as was required for entrance into the service.
The subject of reports was also an important one. Reports were required at the end of each month from all stations in the United States, these covering the composition of examining boards and the details of the work during the month. So far as the latter were concerned, separate reports were required for examination preceding separation from the service, for voluntary enlistment, and for soldiers discharged on surgeon`s certificate of disability, and until the signing of the armistice such reports were also required for the examination of registrants entering the service. The monthly reports were consolidated and tabulated in the section and detailed information was thus always available concerning the status of physical examination at all stations.
Much difficulty was experienced because of the lack of proper buildings in which to conduct physical examinations.72 Sketches were prepared by the Surgeon General, and repeated recommendations to the War Department were made for the construction of a special building for this purpose in every large camp and cantonment. Finally, just before the armistice was signed, plans were approved for a building designed to accommodate all the activities con-nected with induction, namely, physical examination, vaccination, furnishing clothing and equipment, writing insurance, and the clerical work pertaining to the personnel officer. The basic design of the portion of this building intended for physical examination was initiated in this section, and if the construction had been completed, which was not the case, the work of examination would have been greatly facilitated.
SUBSECTION ON VERMIN INFESTATION AND DISINFESTATION.
The eradication of vermin with a view to preventing louse-borne diseases was one of the important sanitary problems during the war. The conditions existing abroad resulted in a prevalence of lice among soldiers which had probably never been equaled before. No army abroad was spared from this pest or from the diseases conveyed by lice. In April, 1918, it was reported from the American Expeditionary Forces that about 50 per cent of all troops arriving from the United States were vermin infested.73
Later investigations showed that these estimates were excessive and that such troops as were infested consisted almost exclusively of colored labor battalions, hastily organized and sent overseas.74 On June 18, 1918, a circular letter was sent to all camps, cantonments, and posts requesting information on the degree of lice infestation present and the methods employed for its control. 75
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At this time a paragraph dealing with this question was added to Special Regulations No. 28, which governed sanitation and the control of communicable diseases. 76
Early in June, 1918, a subsection on vermin infestation was organized in the Division of Sanitation with a medical officer in charge.77Somewhat later an officer of the United States Public Health Service was attached to the Army and ordered to France to study conditions regarding louse infestation on transports and at foreign ports, while the chief of the subsection was ordered to Newport News to make similar studies there. The results of these investigations indicated that vermin infestation was more common in the United States than had previously been supposed. At Newport News 0.6 per cent of a certain group of white soldiers and 42 per cent of a certain group of colored soldiers were found infested, mostly with pubic lice.78 Of the crews of three transports 2.1 per cent were found louse-infested. 79Investigations carried on at Camp Meade showed that 3.5 per cent of white and 26 per cent of negro recruits arriving in camp at one period were infested. 80 Vermin infestation was not found among troops on transports at that time, but the degree of infestation at base ports and rest camps in France and England was very high. As a result of this investigation universal delousing of all troops before embarking for Europe was recommended. 81
The problem of excluding vermin infestation and louse-borne diseases from the United States was deemed of great importance, and a program of inspection and delousing with this in view was put into effect.
An important feature of the administrative work of this subsection was the designing, in conjunction with the Construction Division in the War Department, of delousing plants, known in some stations as "sanitary process plants." 82 These plants were designed in three sizes, capable of disinfesting 130, 40, and24 men, respectively, per half hour. Plans had been approved for constructing such plants in 45 camps, at a cost of about $1,800,000, when the signing of the armistice put an end to this work. However, nine of the large-size plants and one medium-size plant, together with several non standardized improvised plants, were built, equipped, and satisfactorily operated at ports and camps of debarkation for the purpose of handling troops returning from France.
Among other activities of the subsection may be mentioned various inspections of the debarkation camps and ports of embarkation with a view to determining the efficiency of the methods of disinfestation employed. An educational campaign was started, of which the most important feature was the making of a motion picture called "Fighting the Cootie." This was used for the instruction of enlisted men. Likewise, various memoranda and publications on the louse problem were issued. Research work consisted in examining various substances reputed to be lethal for vermin, experimenting with gases used for fumigation, investigating methods for the impregnation of underwear, studying various soaps and powders, and testing laundry appliances, dry-cleaning machinery, and other apparatus recommended for deverminizing purposes.
The various tables dealing with the degrees of infestation of troops in camp, embarking and debarking, and also pertaining to the degree of infesta-
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tion found in troops arriving from England and France, are included in the chapter on vermin infestation in the volume on Sanitation.
Over 2,000,000 troops were returned to the United States and, so far as known, not a single case of louse-borne disease was introduced, nor was vermin infestation carried into the civil communities by discharged soldiers. 83 Of the same number of men examined for discharge from the service only five in a hundred thousand were found with any of the three types of lice. These results may be regarded as conclusive evidence of the success of the methods in vogue abroad, at home ports, and in transit, since about 90 per cent of the troops arriving at the base ports in France, immediately following the signing of the armistice, were reported to be infested, 84 though later on this percentage was much reduced.
SUBSECTION OF CORRESPONDENCE.
Correspondence relating to the physical condition of individual officers and enlisted men had long been one of the functions of this division and was so continued during the war. On November 3, 1918, the officer in charge of this subsection was temporarily detached and assigned to the Personnel Branch of the General Staff as the representative of the Surgeon General, with the object of expediting action on matters relating to the physical condition of individual officers and candidates for commission. The work of this officer in the Personnel Branch continued a part of the Division of Sanitation, since all action taken by him on official papers was in the name of the Surgeon General and appeared of record in the files of this office.
Official and unofficial papers relating to individuals and requiring the action of this subsection multiplied many times during the war. The work also increased steadily following the signing of the armistice and during the months of demobilization. While much of the correspondence was more or less routine, many questions arose in individual cases requiring on the part of the officer in charge great familiarity with existing orders, decisions, precedents, and procedures relating to Army administration.
SUBSECTION OF DEVELOPMENT BATTALIONS.
War Department orders were issued on May 9, 1918, directing that one or more development battalions be organized in each of the divisional camps of the National Army, the National Guard, and the Regular Army, and in other camps when so directed by the Secretary of War. In the order in question, the functions of development battalions were specified as follows: 85
(a) To relieve divisions, replacement organizations, etc., of all unfit men.
(b) To conduct intensive training with a view of developing unfit men for duty with combatant or noncombatant forces either within the United States or for service abroad.
(c) To promptly rid the service of all men who, after thorough trial and examination, are found physically, mentally, or morally incapable of performing the duties of a soldier.
A board, consisting of a medical officer attached to the Division of Physical Reconstruction of the Surgeon General`s Office, a member of the General Staff, and a civilian, was appointed by the Secretary of War on June 10, 1918, "for the purpose of coordinating the work in connection with the establishment of development battalions." 86 The early plans for the medical phases of the
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work were entirely in the hands of this medical officer from the date of establishment of development battalions up to September 9, 1918.
The medical and administrative problems arising in connection with the establishment and operation of these organizations were numerous and often involved questions of policy in which several divisions of the Surgeon General`s Office were immediately concerned. This complicated matters, and in their earlier stages development battalion activities in the Surgeon General`s Office were not so well coordinated as might have been desired. The Acting Surgeon General, therefore, on September 9, 1918, ordered the transfer of the officer in charge of this work in the Division of Physical Reconstruction to the Division of Sanitation "for the purpose of assuming the duty in connection with the activities of development battalions, the work of which is placed under the direction of the officer in charge of the Division of Sanitation." Subsequent to this order, all medical activities relating to development battalions were coordinated and directed by the officer in charge of the Division of Sanitation through the officer in immediate charge of the work.
When the development battalions were transferred to the Division of Sanitation, immediate steps were taken to organize a group of inspector-instructors 87 composed of specially selected medical officers who were more or less familiar with problems of physical training and reconstruction. Several of these officers were brought together in the Surgeon General`s Office, where they were familiarized with all published orders relating to development battalions and with previous plans for these organizations. Solutions were worked out to meet such defects in organization and administration as had already appeared. Information relative to the defects in question was based chiefly upon reports from medical officers in the various camps where battalions had already been formed. The inspector-instructors were then ordered to Camp Meade, Md., where a very efficient organization had been developed. They remained there several days under intensive instruction with the development battalion in that camp. Having been thus familiarized with the work at Camp Meade, they were then ordered to other camps, where they gave instruction using the development battalion at Camp Meade as a model. 88 Each inspector-instructor was required to remain at a camp until satisfied that the development battalion was properly organized and equipped and was functioning as intended. Upon the completion of this work, he rendered a report to the Surgeon General covering in detail the conditions found by him within the battalion, in so far as this concerned Medical Department activities, and the results of his efforts to improve matters. Twenty-seven camps were visited by these inspector-instructors and in all of them the foundations were laid for efficient development battalions. Methods of physical training and medical administration were standardized in the camps visited.
Chiefly through the efforts of medical inspector-instructors, about 15 camps developed very efficient systems in their development battalions before the signing of the armistice on November 11, 1918. The men were more rapidly classified and disposed of than was the case at first, and better cooperation between line and medical officers was secured. Physical develop- ment work was established on a proper basis and carried out systematically under the immediate supervision of medical officers. Segregation of the
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ambulant venereal cases from the remainder of the men in the battalions was accomplished whenever possible. In a number of camps schools for instruction in English were established for the benefit of illiterates and non-English-speaking soldiers, as well as other schools for special training in occupations useful to the Army. Recreation, games, and other amusements tending to improve morale were promoted and proved of great value.
Unfortunately, immediately after the signing of the armistice, as a result of the interpretation placed upon certain War Department circulars, the rumor became general in the camps that all men in development battalions were to be demobilized at once regardless of their physical condition. The morale of these organizations then went down to a very low ebb and in most places it became increasingly difficult to continue any of the real work prescribed for these battalions.
The following figures were obtained from the consolidated reports submitted to the Surgeon General`s Office by the several camps. They cover operations from the organization of the developmental battalions toNovember13, 1918, and, so far as they go, indicate approximately the results attained. As some of the camps failed to submit final reports, and as the reports from a few camps have been disregarded because in them the development battalions were not organized according to War Department orders, these figures are not complete. It is believed, however, that they represent a close approximation, so far as percentages are concerned, for all camps having development battalions.
The total number of men in development battalions was approximately 224,717. Classified by condition, the results are as follows: 89
|
(a) Venereals |
77, 456 (34.4 per cent of total). |
|
(b) Orthopedic cases |
28, 823 (12. 7 per cent of total). |
|
(c) Mental conditions |
4,798 ( 2. 1 per cent of total). |
|
(d) Functional heart conditions |
10, 917 ( 4. 8 per cent of total). |
|
(e) Miscellaneous |
3, 540 (23. 8 per cent of total). |
|
(f) Non-English-speaking, illiterates, morally unfit, conscientious objectors, draft evaders, enemy aliens, etc |
49, 183 (21.4 per cent ot total). |
Figures showing the method of disposition are available for 168,583 men.
|
Transferred to class A (full duty) |
41, 450 (25 per cent). |
|
Transferred to class C-1 (limited overseas duty) |
46, 054 (27 per cent). |
|
Transferred to class C-2 (limited domestic duties only) |
42, 530 (25 per cent). |
|
Discharged from service |
36, 274 (21 per cent). |
|
Deserted |
919 (0. 5 per cent) |
|
Died |
1.356 (0. 8 per cent). |
|
|
168,583 |
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PERSONNEL. d
(April, 1917, to December, 1919.)
Birmingham, H. P., Brig. Gen., M. D)., chief.
Howard, Deane C., Col., M. C., chief.
Reynolds, Frederick P., Col., M. C., chief.
Ashburn, Percy M., Col., M. C.
Chamberlain, Weston P., Col., M. C.
Church, James R., Col., M. C.
Clayton, Jere B., Col., M. C.
Conner, Lewis A., Col., M. C.
Fisher, Henry C., Col., M. C.
Hutton, P. C., Col., M. C.
Lewis, William F., Col., M. C.
Mock, Harry E., Col., M. C.
Morris, Samuel J., Col., M. C.
Schreiner, Edward R., Col., M. C.
Shaw, Henry A., Col., M. C.
Truby, Albert E., Col., M. C.
Truby, Willard F., Col., M. C.
Van Dusen, James W., Col., M. C.
Vaughan, Victor C., Col., M. C.
Weed, Frank W., Col., M. C.
Welch, William H., Col., M. C.
Wrightson, William D., Col., S. C.
Bowles, James T. B., Lieut. Col., S. C.
Davis, Charles E., Lieut. Col., M. C.
Fulton, John S., Lieut. Col., M. C.
Hoad, William S., Lieut. Col., S. C.
Hopwood, L. L., Lieut. Col., M. C.
Hume, Edgar E., Lieut. Col., M. C.
Kremers, Edward D., Lieut. Col., M. C.
Love, Albert G., Lieut. Col., M. C.
McIntyre, Henry B., Licut. Col., M. C.
Register, Edward C., Lieut. Col., M. C.
Sherwood, John W., Lieut. Col., M. C.
Shields, William S., Lieut. Col., M. C.
Whitmore, Eugene R., Lieut. Col., M. C.
Williams, Linsley, Lieut. Col., M. C.
Balderston, S. V., Maj., M. C.
Barney, Joseph N., Maj., M. C.
Bascom, George R., Maj., S. C.
Bolling, Robert II., Maj., M. C.
Castlen, C. R., Maj., M. C.
d In this list have been included the names of those who at one time or another were assigned to the division during the period April 6, 1917, to December 31, 1919.
There are two primary groups-the chiefs of the division and the assistants. In each group names have been arranged alphabetically, by grades, irrespective of chronological sequence of service.
282
Cleave, John W., Maj., S. C.
Cornell, Walter S., Maj., M. C.
Cox, Samuel C., Maj., M. C.
Davenport, Charles B., Maj., S. C.
Delafield, Robert H., Maj., S. C.
Doyle, Luke C., Maj., S. C.
Fuller, Harry N., Maj., S. C.
Hubbard, Roscoe C., Maj., M. C.
Hyde, Charles G., Maj., S. C.
Luckie, Lorenzo F., Maj., M. C.
Morehouse, Arthur, Maj., S. C.
Neff, E. B., Maj., S. C.
Plotz, Harry, Maj., M. C.
Rasmussen, Nels, Maj., S. C.
Ross, F. A., Maj., S. C.
Sledge, Edwin S., Maj., M. C.
Sprague, John T., Maj., M. C.
Telfair, John H., Maj., M. C.
Tucker, Edward J., Maj., S. C.
Yost, John D., Maj., M. C.
Brown, Robert H., Capt., S. C.
Craig, R. H., Capt., S. C.
Follin, James, Capt., S. C.
Haskins, Charles A., Capt., S. C.
Hammon, Charles C., Capt., S. C.
Lipsett, J., Capt., M. C.
Andrew, H. H., First Lieut., M. C.
Cavanagh, Arthur L., First Lieut., S. C.
Donobe, Fitz W., First Lieut., S. C.
Frey, C. N., First Lieut., S. C.
Hulse, Fernand E., First Lieut., S. C.
Sharp, John P., First Lieut., M. C.
Armstrong, Glendon H., Second Lieut., S.C.
Donaghy, Robert J., Second Lieut., S. C.
Erbe, Ernest A., Second Lieut., S. C.
McClure, J. L., Second Lieut., S. C.
Sullivan, L. R., Second Lieut., S. C.
Dunlap, Fayette, contract surgeon.
White, J. H., senior surgeon, U. S. Public Health Service.
REFERENCES.
(1) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1015.
(2) Personal records of Col. H. P. Birmingham, M. C., and Col. George E. Bushnell, M. C. On file, Commissioned Personnel Division, S. G. O.
(3) Annual Report of the Surgeon General, United States Army, 1918, 273; 1919, Vol. II, 1015. (4) Office order No. 97, S. G. 0. Organization Chart, December 1, 1918. On file, Record Room, S. G. O., Confidential Files.
(5) Annual Report of the Surgeon General, United States Army, 1918, 273.
(6) G. O., No. 45, W. D., September 11, 1916.
283
(7) Sanitary Regulations No. 28. Sanitary Regulations and Control of Communicable Diseases, August 10, 1917.
(8) Annual Report of the Surgeon General, United States Army, 1918, 273. Sanitary Inspection Reports. On file, Division of Sanitation, S. G. O., and Record Room, S. G. O., 721.1.
(9) File of calls from various States, selective-service men, filed by date of issue. On file, Office of the Provost Marshal General, Washington, D. C.
(10) "Complete Reports." On file, Construction Division, Office of the Quartermaster General.
(11) Personal records. On file, Commissioned Personnel Division, and chief clerk`s office, S. G. O.
(12) S. O., No. 153, pars. 9 and 10, W. D., July 1, 1916.
(13) S. O., No. 156, par. 23, W. D., July 6, 1917; office orders, S. G. O., August 9, 1917; S. O., No. 188, W. D., August 14, 1917, par. 40.
(14) Quarterly report, Division of Sanitation, January to March, 1918. On file, Record Room, S. G. O.,024.13.
(15) List of sanitary inspections made by officers of the Inspection Section luring the period of the World War. On file, Record Room, S. G. O., 721.1 (Sanitary Inspections).
(16) Office order, S. G. O., No. 7, February20, 1918. On file, Record Room, S. G. O., 721.1 (Sanitary Inspections).
(17) Sanitary inspection reports. On file, Record Room, S. G. O., 721.1 (Sanitary Inspections).
(18) Memo. from the Provost Marshal General and the Surgeon General for The Adjutant General, January 9, 1918. Subject: Installation of Tabulating Card System in the Surgeon General`s Office of the War Department to Tabulate the Records of Men Rejected for Physical Defects-authorization contained in memo. from The Adjutant General to the Provost Marshal General and the Surgeon General, United States Army, on the same subject, January 28, 1918 On file, Record Room, S. G.O., 413.5 (Tabulating Machines).
(19) Memo. from Maj. A. G. Love, M. C., to the executive officer, S. G. O., June 20, 1921. On file, Record Room, S. G. O., 721.6-2.
(20) Letter from Adjutant General to commanding officers of ports and other commands, May 27, 1918. On file, Mail and Record Division, A. G. O., 700 (Miscellaneous Division) (EE).
(21) Office order, No. 68, S. G. O., July 23,1918. On file, Record Room, 024.13 (Medical Record Division).
(22) Instructions. On file, Record Room, S.G. O., 188799 (Old Files).
(23) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1020.
(24) Weekly bulletin. On file, Record Room, S. G. O., 710-1 (Diseases).
(25) Reports to the Chief of Staff. On file, Record Room, S. G. O., 333 (Individual Camps) (C)
(26) Correspondence. On file, Record Room, S.G. O., 210.31-1 (General).
(27) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1021.
(28) Office order, No. 91, S. G. O., November2, 1918.
(29) Memo. from Surgeon General to division surgeons, January 1, 1918; memo. from Surgeon General to division surgeons, January 8, 1918. On file, Historical Division, S. G.O.
(30) Manual for the Medical Department, 1916,pars. 371-374; 626.
(31) Second indorsement, W. D., Adjutant General, October 31, 1918, to the Acting Surge General, United States Army. On file, Record Room, S. G. O., 210.31-1 (Assignment, Epidemiologists).
(32) Special Regulations No. 28 (Sanitary Regulations and Control of Communicable Diseases) (33) S. O., No. 170,par. 32, W. D., July 31, 1917.
(34) Memo., S. G. O., January 17, 1918. On file, Record Room, S. G. O., 201 (Wrightson, William D.).
(35) Reports of Section of Sanitary Engineering. On file, Record Room, S. G. O., 322.3 (Sanitary Corps).
(36) Table, June 12, 1918. On file, Record Room, S. G. O., 322.3 (Sanitary Corps).
(37! Applications for Sanitary Engineering Service. On file, Record Room, S. G. O., 201.
(38) Report on School of Sanitary Engineers. On file, Record Room, S. G. O., 322.3 (Camp Greenleaf) (C).
(39) Reports fly and mosquito control. On file, Record Room, S. G. O., 725.1-1.
(40) Plans for water-supply, sewage-disposal, and waste-disposal plants. On file, Record Room, S. G. O., 720.2(General).
(41) Letter from The Adjutant General to the Surgeon General, July 5, 1918. On file, Record Room, S. G. O.,322.2 (Sanitary Corps).
284
(42) Bull., No. 66, W. D., December 31, 1918.
(43) Reports from Capt. E. J. Tucker, S. C., to the Surgeon General, United States Army. Sub- ject: Sewage Disposal at Cantonments (Fort Myer, Va., and Camp Meade, Md.). On file, Record Room, S. G. O., 672 (Fort Myer, Va.) (N): 620.6 (Camp Meade) (1).
(44) First indorsement, W. D., A. G. O., August 30, 1918. Through chief of the Construction Division to the Surgeon General. On file, Record Room, S. G. O., 720.2 (General).
(45) G. O., No. 67, par. 5, W. D., July 15,1918.
(46) G. O., No. 79, W. D., August 24, 1918.
(47) Reports of colleges (Students` Army Training Corps units). On file, Sanitation Division, S. G. O.
(48) Letter from the Provost Marshal General to the commanding officer, Students` Army Training Corps, September 9, 1918. Subject: Individual Induction of Registrants into Students` Army Training Corps. On file, Record Room, S. G. O., 322.021 (Students` Army Training Corps).
(49) Letter from The Adjutant General to the Surgeon General, September 21, 1918. On file, Record Room, S.G. O., 211 (Contract Surgeons).
(50) Records of assignments of dentists. On file, Record Room, S. G. O., 211 (Dentists).
(51) Circular letter from the Surgeon General, United States Army, to the surgeons of all Students` Army Training Corps units on hospital facilities, November 1, 1918. On file, Sanitation Division, S. G. O.
(52) Memo. from Surgeon General to surgeons of units, October 22, 1918. On file, Record Room, S. G. O.,322.021 (Students` Army Training Corps).
(53) Circular No. 124, W. D., December, 1918.
(54) Annual report of the Surgeon General, United States Army, 1919, Vol. II, 1030.
(55) Instruction reports. On file, Record Room, S. G. O., 353 (Sanitation, Camp Greenleaf) (C). (56) G. O., No. 66,W. D., 1910.
(57) Compiled Rules, Provost Marshal General`s Office, Nos. 6, 8, and 10. On file, Record Room, S. G. O., Document File.
(58) Instructions for the Physical Examination of Drafted Men at National Army Cantonments. Issued by the War Department, S. G. O., August 25, 1917. On file, Sanitation Division, S.G. O.
(59) Changes in Selective-Service Regulations No. 3, January 25, 1918 (Bloodgood Revision). On file, Law Library, Office of the Judge Advocate General.
(60) S. O., No. 303, par. 272, W. D., December 29, 1917.
(61) Annual Report of the Surgeon General,. United States Army, 1918, 278.
(62) Extracts and Quotations from Reports of Sanitary Inspectors made during the World War. On file, Sanitation Division, S. G. O.
(63) S. O., No. 55, par. 51, W. D., March 7,1918.
(64) Special Regulations No. 65, W. D., June5, 1918; revised November 8, 1918.
(65) Form No. 75, Provost Marshal General`s Office, revised September 27, 1918.
(66) Memo. No. 3. Subject: Instructions Governing Physical Examinations, S. G. O., August 22, 1917. On file, Sanitation Division, S. G. O.
(67) Correspondence. On file, Record Room, S. G. O., 327.2 (Examinations, Name of Camps)(C)
(68) Telegram from Surgeon General, United States Army, to camp surgeons, April 29, 1918. On file, Record Room, S. G. O., 327.2 (Examinations).
(69) Forms 135-3 and 395-1, Adjutant General`s Office. On file, Record Room, A. G. 0., 702.1 (Examinations, enlisted men); 702.2 (Examinations, Officers).
(70) Circular, No. 73, W. D., November 18,1918.
(71) Circular Letter, S. G. O., November 21,1918. On file, Record Room, S. G. O., 370 (De- mobilization).
(72) Memo. for Assistant Secretary of War from Assistant Chief of Staff, September 24, 1918, recommending approval for recruit examining building (approved October, 1918). On file, Mail and Record Division, A. G. O.,652 (Misc. Div.).
(73) Memo. for Lieut. Col. James A. Logan, General Staff, from Col. Henry C. Fisher, M. C., general medical inspector, A. E. F., France, April 8, 1918; first indorsement, W. D., S. G. O., May 1, 1918, to surgeon at port of embarkation, Hoboken, N. J. On file, Record Room, S. G. O., 729.5(Lice, port of embarkation, Hoboken, N. J.) (N).
285
(74) Fifth indorsement, W. D., S. G. O., July 22, 1918, to The Adjutant General of the Army. On file, Record Room, S. G. O., 729.5 (Lice).
(75) Letter from The Adjutant General of the Army to all departments, divisions, ports of embarkation commanders, bureaus of War Department, and all excepted places, June 18, 1918. Subject: Estimates for Delousing Plants. Letter from Surgeon General, United States Army, to camp surgeons, July 25, 1918. Subject: Vermin Infestation. On file, Division of Sanitation, Surgeon General`s Office (Louse Infestation).
(76) Special Regulations No. 28, W. D., Changes No. 2, June 17, 1918, par. 18 1/2.
(77) S. O., No. 143, W. D., June 19, 1918,par. 150.
(78) Report on Louse Investigations, Office of the Surgeon, Newport News, Va., June 18, 1918. On file, Record Room, S. G. O., 729.5 (Vermin, Newport News, Va.) (N).
(79) Correspondence. On file, Record Room,729.5 (Lice, Ships) (BB).
(80) Reports. On file, Record Room, S. G. O.,729.5 (Vermin, Camp Meade) (D).
(81) Telegram from General March to General Pershing, November23, 1918. On file, Record Room, S. G. O., Cablegram File.
(82) Letter from the Surgeon General to The Adjutant General, August 9, 1918. Subject: Delous- ing Plants. On file, Record Room, S. G. O., 679 (Delousing Plants).
(83) Annual Report of the Surgeon General, United States Army, 1919, Vol. II, 1031.
(84) Ibid., 1030.
(85) G. O., No. 45, W. D., May 9, 1918.
(86) S. O., No. 1:35, par. 239, W. D., June10, 1918.
(87) Letter from the Acting Surgeon General to camp surgeon, Camp Meade, September 21, 1918. Subject: Medical Personnel for Development Battalions. On file, Record Room, S. G. O.,210.3 (Camp Meade) (D).
(88) Report of sanitary inspection, Camp Meade, Md. On file, Record Room, S. G. O., 721.5 (Sanitary Report).
(89) Annual Report of the Surgeon General, United States Army, 1919, Vol. 11, 1031.
