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CHAPTER I

Contents

CHAPTER I

MOBILIZATION CAMPS

For purposes of orientation it is necessary to explain here that, for the World War Army, two classes of camps were used, divisional and miscellaneous. The divisional camps comprised the tent group, for the National Guard divisions, and the cantonment group, for the National Army divisions. The reasons for having these two kinds of shelter, as well as the details connected with the selection of the sites for the camps and cantonments, are adequately set forth elsewhere.a The miscellaneous group comprised the special camps, usually of semipermanent construction, that were intended for mobilizing and training

special troops, such as the Quartermaster Department camp, Camp Joseph E. Johnston, Jacksonville, Fla., or for embarkation purposes, as for example, Camp Merritt, N. J.

With the exception of the camps used for embarkation purposes, this volume is concerned only with the camps and cantonments that were used for mobilizing and training combat divisions. No attempt is made to consider, in this chapter, camps and cantonments separately, because most of the topics discussed pertain as well to National Guard camps as to National Army cantonments. Where local differentiation is necessary, this is made.

PREMOBILIZATION PERIOD

Aside from its interest in the character of shelter to be provided, the interest of the Medical Department in the mobilization camps, during the period of their construction, was twofold, for it was necessary not only that suitable medical attention be afforded Army personnel, directly or indirectly concerned with construction, but it was essential also that the sanitation of each military reservation be adequately supervised pending the time of its occupation by divisional troops.

On each of these projects, thousands of laborers (in the cantonments where a greater amount of construction was to be done than in the tent camps, the laborers numbered from 10,000 to 14,000) were employed under the supervision of a constructing quartermaster and his corps of assistants.1 Furthermore, a military guard was essential. To supervise the sanitation of the area and act as camp surgeon during this period of construction, a junior medical officer of the Regular Army was assigned to each camp and cantonment at the time work was begun.2

The contract of the constructor bound him to comply with basic sanitary measures in the area of construction. Therefore, employees of the contractor were assigned to such sanitary work as policing, removal of garbage, and the construction and care of latrines that were provided for the laborers.

    aVol. VI, Sanitation, Sec. I, Chaps. IV and V.


With the presence of so many civilian laborers, it was inevitable that people who had all manner of edibles would flock to the camp area and establish stands for the sale of their wares. Since it was practically impossible to have these hucksters maintain their stands in a satisfactory manner it was necessary to forcibly remove most of them.

The camp surgeon frequently assumed the professional care of the contractor's employees, when they were suffering from minor illness or injury, and for this purpose a dispensary was established in one of the buildings, the completion of which was expedited by the contractor.

A campaign to effect the voluntary vaccination, against both typhoid fever and smallpox, of as many as possible of the civilian employees was carried out by the camp surgeon. The object of this was to have the camp free of these diseases when the time for mobilization arrived. Efforts along these lines were highly successful.

MOBILIZATION AND TRAINING PERIOD

(August 25, 1917, to November 11, 1918)

The first move toward actual mobilization in the camps was the arrival, in each case, of the major general who was to be in command, and his staff.3 This took place on or about August 25, 1917, in the majority of the camps, and was the official date of organization of the various divisions, although there were only small numbers of troops in the camps at that time.3 The prescribed strength of a division, in September, 1917, was approximately 28,000 officers and men, but various nondivisional organizations, casuals, etc., brought the total population of the camps to considerably higher figures.

In addition to organizing his division, the commanding general of each of the 16 National Army cantonmentsb was to organize a depot brigade, each brigade to consist of brigade headquarters and such number of training battalions as could be formed from the personnel available.4 The ultimate purpose of these brigades was to receive and train men for the tactical divisions. They were not a part of the division, but so long as the commanding general maintained dual jurisdiction over the division and camp, they were under his control. As will be seen below the depot brigade became a highly important part

of the camp organization, from the Medical Department viewpoint, particularly as regards the physical examination of personnel.

The division commander was also the camp commander prior to the time of departure of the first division to occupy the camp. Subsequently, though a new division was organized in a majority of the camps, there was a separation of the offices of camp and division commander, each with its incumbent and his staff.3

Though it is not the present purpose to consider in detail the tables of organization of a division, such details being more appropriately given elsewhere,c it is essential for a proper understanding of what follows to appreciate what organizations comprised an Infantry combat division. Therefore the following tabulation has been prepared to show, on the one hand, the divisional organiza-

bNational Guard camps had no depot brigade.
cConsult appendix, p. 1054 et seq., Volume VIII, of this history.


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tion, as of August, 1917, and on the other, the attached Medical Department personnel. It should be added that certain changes later were made in the table upon which the tabulation is based but only in minor degree.

Divisional headquarters, Infantry division, maximum strength

 

Attached Medical Department personnel

Commissioned

Enlisted

Division headquarters (including headquarters troops)

3

8

Two Infantry brigades (4 regiments of Infantry, 2 machine gun battalions)

30

404

One Field Artillery brigade (3 regiments, 1 trench mortar battery)

16

83

One machine gun battalion

1

13

One regiment of Engineers

3

28

One field signal battalion

1

7

Train headquarters

3

12

Sanitary train

47

900


 MEDICAL DEPARTMENT PERSONNEL

The Medical Department personnel of a camp, during this period, fell into two main groups, depending on whether it was assigned to divisional or camp organizations.3 As a general rule, and particularly until the spring of 1918, this separation had no significance as regards medical administration, the camp surgeon and the division surgeon being one and the same individual; but there were two camp organizations which, for a time, operated semi-independently-the base hospital and the auxiliary remount depot. Army Regulations gave to territorial department commanders the command of all military forces within the

limits of their respective commands, except such as were exempted by the Secretary of War.6 The War Department, in the summer of 1917, included divisions to be organized among forces to be exempted from departmental command;7 and in October of the same year, added troops "attached thereto," to the exempted list,8 thus placing the latter under the jurisdiction of camp and division commanders. This latter provision made the base hospital and the auxiliary remount depot dependent parts of a camp, and, in effect, gave to the division surgeon supervisory control over sanitation in these two units. Prior to this time, the division surgeon was forced to depend largely on the inherent good sense of the organization commanders of these two organizations and on his own diplomacy in securing concerted action throughout the camp area.

Aside from these two organizations, practically all of the Medical Department personnel in a camp was on duty with divisional organizations during the early period of the camps.3 This personnel was again of two classes, those serving with Medical Department units (sanitary train) and those serving with other units, principally combat.5 There were approximately 950 of the former and 600 of the latter.

COMMISSIONED

The commissioned medical personnel of the Regular Army was represented mainly by the division surgeon, the division sanitary inspector, the division veterinarian, and the division dental officer.3 This was not invariably true, as the first two of these positions were occupied in some camps by officers from the


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National Guard or the Medical Reserve Corps. There were 7 medical officers with each regiment of Infantry, 1 with a machine gun battalion, 3 or 4 medical and 2 veterinary with a regiment of Field Artillery, 3 medical with a regiment of Engineers, 1 medical with a Signal Corps battalion, and 3 medical and 2 veterinary with the divisional trains.9 Each ambulance company had 5 medical officers, each field hospital company had 6, and 4 additional medical officers and 1 veterinarian were with section headquarters of the sanitary train.10 The totals were 49 officers with the sanitary troops and 55 with other divisional troops, a divisional total of 104. The original allowance for division headquarters was 3 medical officers. The allowance of dental officers was 1 for each 1,000 troops.11

ENLISTED

Though a number of Regular Army enlisted men of the Medical Department were assigned to each division (usually 17 for an Infantry regiment),3 the bulk of the medical force obviously had to come from the draft. As regards the drafted men, efforts were made in the various divisions to select men with experience in lines of work which would be of assistance to them in the positions they would hold, as nurses, pharmacists, laboratory technicians, stenographers, supply men, etc.3 No general provision was made at first to allot such specially qualified men to organizations of the Medical Department, and it was only

after the lapse of some time that there was a realization among division commanders in general that the care of the sick and wounded could not be delegated to such men as remained of a draft increment after combat organizations had chosen those whom they particularly desired.3 This failure to appreciate the technical nature of the work of sanitary troops was further evidenced, in some instances, for example, Camp Lee, Va.,12 by the assignment to them of "conscientious objectors," who refused to do any work. In so far as the wishes of the selective service men were concerned, in December, 1917, the War Department gave authority for registrants, who so desired, to be inducted from local draft boards directly into any particular branch of the Army, but this required action through the War Department.13

In order to fill promptly the noncommissioned grades, promotion in these grades was gradually simplified and expedited as follows: By no longer requiring written examinations, or the 12 months' service in lower grades;14 division surgeons were given authority to appoint sergeants, first class, and sergeants and to reduce the former to at lower grade, in November, 1917;15 camp surgeons, after they were provided for, were given authority to appoint to and reduce from all noncommissioned grades.16 These special authorities, being war-time measures, were rescinded in 1919.17

MEDICAL DEPARTMENT ORGANIZATIONS

DIVISION SURGEON'S OFFICE

As stated above, the original allowance of officers for the division surgeon's office was 3, thus providing a sanitary inspector and 1 other assistant to the division surgeon.d The enlisted force of the office was 8, only 2 of whom were

dSpecialist assistants were provided later for the division surgeon, but the assistants (a neuropsychiatrist, an orthopedist, a urologist, and a gas medical officer) did not form a part of his office personnel; they were assigned to the sanitary train.


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noncommissioned officers.5 18 That this enlisted force soon became insufficient in numbers as the work increased is evidenced by the detail, in practically all divisions, of members of other organizations for temporary duty in this office.3

The division surgeon is both an advisory and an administrative officer.19 In his advisory capacity he makes recommendations concerning all matters pertaining to the sanitary welfare of the command and concerning matters pertaining to the personnel and equipment of the sanitary service under organization commanders. In his administrative capacity he is in command of the Medical Department personnel of the division.

To assist division surgeons in quickly mastering the details connected with their offices, the Surgeon General promulgated the following memorandum on the subject just prior to the time for the mobilization of troops in the fall of 1917.20

ON DUTIES OF DIVISION SURGEONS AT NATIONAL ARMY CANTONMENTS

1. The inclosed regulations, circulars, letters memoranda, etc., are transmitted to the division surgeon for his information. Certain of them have been officially authorized; others are in the form of memoranda from this office intended as suggestions as to ways and means. Before laying out his campaign, the division surgeon should carefully digest these papers and adapt the ideas contained in them to his special problems.

2. In the absence of definite orders from the Chief of Staff of the Army regarding various matters pertaining to the administration of his department, he should be governed by Army Regulations, by the Manual for the Medical Department, by authorized circulars, etc., from this office, and by the suggestions contained in the inclosed communications, remembering always to keep in touch with the division chief of staff and the other departments in order that the work of the Medical Department may be coordinated with theirs.

3. The duties of the division surgeon, in the opinion of this office, may be broadly considered in their order of importance as follows:

      (a) Prevention of the introduction and spread of communicable diseases in the cantonment area.

      (b) Administration of prophylactic inoculations.

      (c) Sanitation of the cantonment area.

      (d) Physical examination of drafted men.

      (e) Organization and equipment of sanitary units.

      (f) Instruction and training of Medical Department personnel.

GENERAL CONSIDERATIONS

4. Immediately upon arrival the division surgeon should report to the division commander for instructions.

5. The division surgeon should carefully study his prescribed duties as outlined in the Manual for the Medical Department, consulting the index upon these subjects. In addition, his duties are those prescribed for the senior surgeons of the concentration camp, as outlined in paragraph 599, Manual for the Medical Department.

ORGANIZATION

6. Tables of Organization, 1917, provide for a sanitary inspector and other medical officer as assistant to the division surgeon. They also authorize 1 sergeant first class, 1 sergeant, 4 privates first class, and 3 privates.

7. The division surgeon and the sanitary inspector of the division having been assigned, the division surgeon should promptly select the other personnel and so organize his office that the sanitary duty pertaining to the Medical Department are completely equipped.

8. He will consult with the division quartermaster relative to office space and equipment. Medical supplies of the division surgeon's office (par. 884. Manual for the Medical Department) are being furnished without requisition.


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9. Orders have been requested sending to the cantonment sufficient personnel to provide each regiment with 4 medical officers, 3 noncommissioned officers, and 14 enlisted men.

10. The division surgeon should supervise the organization of the various sanitary units. He should arrange with the division quartermaster for the formation and care of the sanitary trains.

EQUIPMENT

11. The division surgeon will make sure that all individuals and organizations are equipped with such articles of Medical Department property as are required by existing orders, and that all individuals and organizations pertaining to the Medical Department are completely equipped.

12. He should see that the standard supplies and equipment pertaining to organizations be maintained intact for active service in combat. To this end additional supplies should be issued from the hospital for routine use, for sick call, and for the treatment of trivial cases at infirmaries. The compressed surgical dressing materials of the field supplies are very expensive and should be used only to equip pouches, belts, and chests. Articles of post supplies should be utilized wherever practicable. (See par. 601, M. M. D., and supply letter No. 17.)

13. It is understood that at least 10 automobiles will be assigned to the quartermaster for routine use at the cantonment. In order to perform his duties efficiently, the sanitary inspector will require automobile transportation, and it is believed that sufficient automobiles have been allowed to enable this provision.

SUPPLIES

14. The initial stock of the medical and veterinary supplies for a divisional supply depot are being furnished without requisition, and the medical supply officer has been designated. Blank forms of the Medical Department and a stock of combined typhoid and paratyphoid vaccine have also been ordered to the depot. The division surgeon should see that the medical supply officer of his cantonment has sufficient assistance to organize his depot. He will have regimental surgeons draw their equipment and be prepared to examine and care for recruits upon their arrival. Supplies for the cantonment medical supply depot are being shipped as rapidly as possible.

15. Attention is invited to the copy of a letter from the Surgeon General's Office upon the duties of the supply officer at the cantonment, sent to each medical supply officer, and also to supply letter No. 17, copies inclosed.

16. An initial stock is being sent to the divisional supply depot without requisition. Thereafter maintenance supplies will be kept up by requisition from the camp supply depot, forwarded to the department surgeon for issue from the department depot. (See G. O. 96-E.)

17. The division surgeon may approve requisitions from organizations within his division for articles on the supply table. (See supply letter No. 17.)

18. Requisitions for articles not upon the supply table should be forwarded to the department surgeon for action. All requests should be scrutinized closely, to the end that issues may be economized as much as possible, compatible with the prompt and efficient service of organization.

19. Owing to the great demand for supplies which will occur with the mobilization of the National Guard and the National Army and the difficulties which are being experienced in obtaining them, requisitions should be limited at first to the quantities necessary for one month.

20. Any undue delay in delivery of supplies should be promptly reported to the Surgeon General's Office, that the defect may be corrected and that the supplies may be issued from other depots.

21. An initial supply for the base hospital of 500 beds and essential equipment is being sent without requisition. Additional supplies should be requested as needed.

22. At the beginning it will be practicable to issue for the cantonment two portable dental outfits. These should be stationed at the base hospital. As soon as more adequate supplies become available they may be issued, the first one to a brigade and later one to each


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regiment, as may be deemed in your judgment most expedient. Requisitions for replenishment of dental supplies should be forwarded to the department surgeon.

23. Steps should be taken to secure from  the divisional supply depot the blank forms, "Division surgeon's emergency supplies," paragraph 885, Manual for the Medical Department.

SANITARY SERVICE

24. The sanitary service of the cantonment is under the direction of the division surgeon. He should familiarize himself with the War Department sanitary order, and see that its provisions are carefully observed.

HOSPITALS

25. The plan for the cantonment contemplates the provision of a base hospital of 1,000 beds and of a small infirmary for each regiment. The infirmaries will have from 6 to 10 beds to provide temporary care for patients until they can be sent to the base hospital. A sheet showing the allowance of medical supplies at the camp infirmary is inclosed herewith.

26. The medical supplies of a field hospital have been sent to the cantonment for use should it be necessary in case of emergency before the supplies for the base hospital arrive. This will afford sufficient material to enable resourceful surgeons to meet any ordinary emergency. It should be preserved as nearly intact as possible for issue to a field hospital organization later on as soon as it can be spared. It is essential that adequate, even if small, hospital accommodations should be provided to be available upon the arrival of the men, some of whom may need immediate attention.

PROTECTIVE INOCULATION

27. The division surgeon will see that smallpox, typhoid, and paratyphoid vaccines are properly administered, and the proper notation made upon the vaccination register (Form 81, M. D.). Information should be furnished company and detachment commanders of the date and result of the last vaccination against smallpox and the date when the typhoid and paratyphoid vaccination was completed.

28. The department surgeon has been directed to have his departmental supply officer provide vaccine virus and sufficient vaccination registers (Form 81, M. D.).

29. It is especially enjoined that all men be thoroughly protected against smallpox. Every officer and man must be vaccinated upon entering into the service. If the first vaccination is ineffective, it will be repeated at the end of eight days.

CONTAGIOUS DISEASES

30. The division surgeon must have the drafted men examined promptly upon arrival to ascertain their freedom from contagious diseases. Any such case found will be promptly isolated.

INSTRUCTION

31. The division surgeon is responsible for the instruction of all individuals and organizations in personal and camp hygiene, and of the Medical Department personnel, commissioned and enlisted, in the routine work of the Medical Department in the field. An important factor in instruction will be the object lesson afforded by the administration of the camp and the measures inaugurated for the maintenance of sanitary conditions therein.

PHYSICAL EXAMINATION OF DRAFTED MEN

32. A detailed scheme for the physical examination is inclosed (Memo. No. 3).

THE DIVISION SANITARY INSPECTOR

The division sanitary inspector, as an assistant to the division surgeon, is primarily an advisory officer, but may in addition be assigned certain executive duties.21


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The sanitary inspector is charged especially with the supervision of the sanitation of the command to which he is assigned. In this connection he inspects and reports upon the sanitary condition within the command, upon the occurrence of preventable diseases arid the sufficiency of the measures taken for their prevention, and in general upon all matters affecting the sanitary care of troops.

CAMP SURGEON'S OFFICE

Medical Department activities which concerned the camp proper, as distinguished from activities of the division occupying the camp, were divorced from the division surgeon's office some time in the spring of 1918, dependent upon when the divisions originally formed left the camps. To insure a continuity of administrative activities, instructions were issued by the Surgeon General which required the departing division surgeon to leave behind a complete file of orders and communications pertaining to the camp, and personnel, both commissioned and enlisted, sufficient to meet the immediate needs of the command

remaining.22 A medical officer ordinarily was ordered to each camp in time to assume the duties of camp surgeon. The instructions referred to were not complied with in many instances, particularly in the matter of leaving records behind, thereby creating much confusion and necessitating a rebuilding of the local organization.

The organization of the camp surgeon's office varied with the populations of the various camps and with the primary functions of the camps, the number of commissioned officers in the office ranging from 5 to 12.3 The following positions formed the basis of the organization, the number of assistants and their assignments varying somewhat:3 Camp surgeon, camp sanitary inspector, camp dental surgeon, camp epidemiologist, camp nutrition officer, camp sanitary engineer. The nutrition officer and the sanitary engineer were officers of the Sanitary Corps, who assumed duties formerly performed by assistants to the

sanitary inspector.3

THE DEPOT BRIGADE

In the National Army cantonments, the depot brigade occupied a position of prime importance, from the medical viewpoint. It comprised the greater part of the camp not occupied by the division in training, and it was a reservoir for all casuals and a replacement training center for all organizations within the camp limits.3 An office organization that was highly effective at one of the camps divided the medical work in the depot brigade into seven services-examination of recruits, remedial defects (later development battalion), venereal diseases, detention camp, quarantine camps, infirmaries, dental-and the seven

specialist boards.23 This organization required from 73 to 82 medical officers, depending upon the number of battalions in training.

THE SANITARY TRAIN

During the war the sanitary train was composed of camp infirmaries, ambulance companies, and field hospitals.24 The sanitary trains that were formed when the first divisions were mobilized comprised 4 ambulance companies and 4 field hospital companies.25 The ambulance company group and


9

the field hospital group were each under a director, the whole, as stated above, commanded by the division surgeon.

THE DIRECTOR OF AMBULANCE COMPANIES

For each division a medical officer of the grade of major was to be designated as director of ambulance companies.24 The relationship of the director of ambulance companies to the division surgeon on the one hand, and to the ambulance companies on the other, was similar to that of a major of the line to the colonel of his regiment and to the companies of his battalion. He was to maintain no office of record but communications from the division surgeon to the ambulance companies and vice versa were to be sent through him for his information.

The director of ambulance companies was to make frequent inspections to ascertain whether all the companies possessed their regulation allowances of personnel and equipment, whether the personnel had been properly instructed, and whether the equipment was in good condition, and he was to take the necessary measures to correct any deficiencies found.

THE DIRECTOR OF FIELD HOSPITALS

For each division (except Cavalry) there was to be designated as director of field hospitals one medical officer of the grade of major.26 The director of the field hospitals, like the director of ambulance companies, was to be immediately under the division surgeon and was to be the latter's executive in respect to the field hospitals of the division.

COMMANDING OFFICER, SANITARY TRAIN

On April 17, 1918, a headquarters sanitary train was provided for by Tables of Organization, so that now, in addition to a headquarters of the ambulance company section and of the field hospital section, each commanded by a major, Medical Corps, there was a headquarters, sanitary train, commanded by a lieutenant colonel, Medical Corps.10 This provision relieved the division surgeon of the immediate direction of the activities of the sanitary train.

INFIRMARIES

An infirmary was intended to be the center of the medical activities of all organization rather than of a camp area, and each organization to which a medical detachment was assigned had its infirmary.3 Those of the regimental organizations were housed in buildings planned and constructed for the purpose, while those of the smaller organizations were often located in such space as was available.27 One standard infirmary building sometimes served two or more of the smaller organizations.

These standard buildings were planned when Tables of Organization prescribed 33 men in the medical detachment of an Infantry regiment. Construction had proceeded too far to permit of changes in the infirmaries when the strength of the medical detachments was increased to 48 men, in the early


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fall of 1917, and the buildings were therefore too small to provide all facilities originally intended. To meet these conditions, it was necessary to assign a portion of the detachments to quarters in other buildings; however, additions to infirmaries were later constructed in many instances to house personnel.3 The approximate doubling of the strength of the Infantry regiments also, of course, increased the size of the area they occupied, and resulted in the area now occupied by two regiments. The third infirmary was seldom so located that it could be used to advantage as an infirmary, and thus usually resulted

in so placing some of the smaller organizations as to leave them with no infirmary building available for their use.3

The infirmary building contained one 10-bed ward. The less severe cases of injury and illness were retained in the infirmaries in a few camps, and this plan often obtained temporarily in all during times of stress at the base hospital. It was usually necessary to bring patients' food from the companies to which they belonged and it was almost invariably cold when it arrived. Quite frequently, it did not arrive at all.3 These conditions were obviated by the establishment of messes in the infirmaries in 1918.3

Dental offices, at first, were located in the medical infirmaries. This proved so unsatisfactory that later separate dental infirmaries were established.3

MEDICAL SUPPLY DEPOTS

There was one medical supply depot in each camp, and this served the division, the base hospital, and the remainder of the camp.3 It was generally situated within the confines of the hospital area, the bulk of its work being concerned with the base hospital. It was a common experience of the first medical supply officer to have medical supplies arrive in carload lots (the initial stock was sent without requisitions) before his own warehouses were erected. It then became necessary to borrow personnel and transportation wherever available and to arrange for temporary storage space. Farm buildings not yet removed were occasionally available, but portions of various quartermaster warehouses were usually used. These spaces were required for other purposes within a few days, necessitating several shiftings of the

medical supplies before the medical storehouses were sufficiently constructed to be occupied. They eventually consisted of four warehouses, with a total storage capacity of about 130,000 cubic feet.3

There was originally one medical supply officer for the entire camp. He was accountable for all medical supplies issued to the division, the base hospital and elsewhere. Divisional medical supply officers were authorized in the fall of 1917, but they were not to act officially as such prior to arrival overseas.28 The enlisted personnel of the medical supply depot originally was drawn from the base hospital on a temporary duty status.29 These men later were made a part of the permanent personnel of the depot, others from both the division and the base hospital were attached for instruction purposes, and a number of men were inducted directly for medical supply work.29 Commissioned officers of the Dental Corps30 and Veterinary Corps31 were assigned as assistants to the camp medical supply officer to supervise the supplies of their respective corps.


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MEDICAL DEPARTMENT ADMINISTRATION

The training camps conducted for medical officers furnished each mobilization camp with a considerable number of both officers and enlisted men, so selected and grouped as to fill the key positions in the medical service of the division and to provide a surplus for other assignments.32 The division surgeon thereby had a skeletonized medical service placed under his command, with the necessity only for distribution of the individuals. Others coming directly from civil life were assigned tentatively to such vacant positions as they seemed best qualified to fill.3

The medical work in mobilization camps had two primary objectives, the training of medical department personnel, and the conservation of the health of all troops,3 including the care of those already ill. In addition to subjects which have a direct bearing on these two major divisions of medical work, there were numerous others having an indirect bearing. The physical examination of individuals before admission to or discharge from the military service constituted the greatest of these secondary problems.

TRAINING

Another volume of this history (Vol. VII) is devoted to the subject of Medical Department training; however, it is deemed appropriate here to reiterate the salient facts in connection with preparing, with the least possible loss of time, the divisional Medical Department personnel for their new duties. It is true many medical officers had received a course of basic training at one or the other of the medical officers' training camps prior to their assignment to divisions, but a great deal of additional training was essential after their arrival in the divisional camps. Furthermore, many medical officers arrived directly from civil life at the camps. The same statements apply to the enlisted personnel. It was highly desirable, therefore, to begin the training as soon as possible, but the necessity of examining the members of the frequently

arriving increments of the draft largely limited training during the first few weeks to practical instruction through the actual performance of duty.3 Equipment and supplies were incomplete at first, so this enforced inactivity in organized training was not altogether without its advantages, giving the force an opportunity to become familiar with routine duties before the intensive training was inaugurated and before there were any considerable numbers of sick to require attention.3 Since dental equipment was practically nonexistent during this period, the dental officers were used largely on other work, particularly

as assistants in the examination of drafted men.33

The influx of recruits decreased in rate and volume after about November 1, 1917, and organized training was then taken up with vigor along both military and professional lines.34 Night classes were much in vogue.3 There were two aspects to the professional training, the strictly professional and the application of military necessities to professional work.35 The reserve officers included individuals with various degrees of medical education, experience, and ability, and it was necessary to organize classes which would tend to equalize individual professional ability by increasing the professional knowledge of


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those lower in the scale. It was also necessary to so instruct all medical officers that they would perform professional duties in a manner that would accord with the military necessities. These necessities required a considerable amount of clinical work and the reduction of professional work to a routine, with a high degree of cooperation.3 Realization of the absolute necessity for these requirements was one of the most difficult impressions to make upon the average medical reserve officers.3

The training schedule for medical officers comprised the following list of subjects:35 Setting-up-exercises, taken by medical officers daily with the troops to which they were attached; drills-marching, litter, ambulance, other means of transport; inspections-personnel and environment; equitation-saddling, bridling, care of animals; tent pitching; personal equipment of the soldier, its care; first-aid-using soldiers' equipment; examination of recruits, with papers and finger prints; general organization of the military forces of the United States; general organization of the Medical Department for war; relation of

the Medical Department to the rest of the Army; paper work relating to the Medical Department; paper work relating to the Quartermaster's Department; paper work relating to the Ordance Department; customs of the service; duties of the soldier; Army Regulations; Manual for the Medical Department; Field Service Regulations; military hygiene and applied camp sanitation, including sanitary inspections, map reading, use of compass, orientation; elementary road and position sketching; the regimental detachment-its use, equipment, and administration; the field hospital-its use, equipment, and administration;

the Medical Department in campaign; the principles of sanitary tactics; the tactical use of Field Artillery (lecture by line officer); the tactical use of Cavalry (lecture by line officer); the uses of Engineer and Signal Corps troops (lectures by officers of service concerned); the service and mechanism of quartermaster supply in the field (lecture by quartermaster officer); map problems; war games; tactical walks and rides; practice marches and bivouacs; practical field maneuvers, including brigade and divisional problems, with not less than three night problems, utilizing regimental detachments, ambulance companies, and field hospitals in coordination; problems including the attack, retreat, planned defense, and re-encounter with all arms, as far as possible, carried out in actual conjunction with problems by line troops; handling of the ration, food economy, and mess management; courts-martial, and military law; the Articles of War; the Geneva and Hague Conventions; the rules of land warfare; military surgery; poison gasese-protection against, and their effects; liquid fire; trench foot, war psychoses and neuroses; diseases common on the Western Front; malingering; cantonment, evacuation, base, and general hospitals, including their organization, administration, records, and management; sanitary service of the line of communications; contagious-disease hospitals, casual camps, convalescent camps, camps for prisoners of war; organizations, functions, and limitations of the American Red Cross; the civil sanitary function of the Army Medical Department in occupied territory.

eGas defense, and instruction concerning it, ceased to be a function of the Medical Department upon the organization of the Chemical Warfare Service, in June, 1918.-Ed.


13

All medical officers of the division were required to qualify in the entire course.35 In addition, officers devoted three evenings a week to various conferences and lectures, the enlisted men were given an equally thorough training in their duties, and special schools were provided for enlisted specialists and for candidates for promotion.35

CONSERVATION OF HEALTH

Every activity of the Medical Department had a more or less direct bearing on the health of the troops, but only preventive sanitary measures and the care of the sick will be considered here.

GENERAL SANITARY MEASURESf

Water supply.-The majority of the camps and cantonments were sufficiently close to large cities to utilize their water systems, but the development of independent sources of supply from either wells or neighboring streams was necessary at a number of the camps. While the water thus obtained from wells was usually of good quality, the ultimate decision was to chlorinate all supplies.3 That obtained from streams usually required sedimentation treatment, as a preliminary measure.3 The main line of supply for camps in the Western States was constructed of wooden staves.36 Storage reservoirs or tanks were

constructed to provide a reserve supply.36

The quantity of water per day that was actually used exceeded the original estimate in nearly every camp.3 Where the supply was derived from a city system, it was frequently difficult to keep the city purification plant up to the standard desired by the Army, and the placing of an Army officer in charge of the plant was sometimes necessary.37

Disposal of garbage and waste.-The Quartermaster Corps was responsible for the disposal of all wastes, and instructions governing this matter in cantonments were issued by the Quartermaster General on August 31, 1917.38 These instructions provided for the separation of garbage, its removal to a garbage-transfer station, the cleaning of garbage cans, and the salvage of bottles, tin cans, and waste paper by a contractor.

Incineration of a large proportion of the garbage and manure was necessary after the arrival of troops, and this remained as the standard method of disposal of rubbish. The disposal of rubbish usually was accomplished at a dump rather than in an incinerator, all ashes and dirt being used to cover tin cans, unburnable refuse, etc.3 The site selected for the dump was preferably a low area where filling would be advantageous, or a steep slope which would assist in the distribution of the refuse.

As previously stated, disposal by contract did not become effective until about October 1, 1917, and these instructions were not generally in force in tent camps until a considerably later date.3 The adoption of other methods of disposal was necessary in certain camps where no one was found to undertake the contract. Until late in 1918 the disposal of liquid kitchen wastes in the tent camps was accomplished by evaporation in pans over incinerators, no sewerage system being available. Guthrie and Conley incinerators, or modifications of

fFor greater details concerning the subjects treated under this caption, consult Vol. VI, Sanitation.-Ed.


14

these, were the types commonly used. The consumption of fuel by this method was so great, however, that it was estimated that the fuel cost for a few months would be greater than the cost of installation of a complete sewerage system.39 This method was also most unsatisfactory in results.40 The evaporating capacity of the incinerators being limited, the kitchen police were so economical in the use of water in washing mess tables and mess equipment that the desirable degree of cleanliness was not attained.40

To comply with the terms of the waste-disposal contracts, all refuse was separated by the organizations under the following headings: Strained garbage for hog food; bones; meats and fats; coffee grounds, tea leaves, fish heads, citrus-fruit rinds, dirty paper, and other combustible rubbish; tin cans and unbroken bottles; clean paper and cardboard; ashes, sand, dirt, and broken glass.3  A later requirement was the separation of all dry bread.3 The cans containing the garbage were at first kept inside the kitchens, but were later placed outside on a fly-proof stand. These receptacles were daily taken to the garbage-transfer station by the organizations, where the cans were emptied and cleaned by the personnel of the station.

The original idea of heating the can-washing water by means of coils from the incinerator and using the same water for the coils was not successful, as foreign material gained access to the coils and caused stoppages.3 The incinerator was not always in use when hot water was needed, and it ultimately was used only for incineration and was therefore expensive.3 Provision was made for the treatment of the wash water by a combined grease trap and settling tank where sewer connections were not available.38

Sanitation of the transfer-station area was difficult in nearly every camp.3 In few instances were impervious surfaces provided surrounding the stations until well along in 1918. This area was consequently badly cut up by vehicles during wet weather, and garbage once spilled on the ground could not be recovered. At the worst, this resulted in a fly-breeding area of considerable size.

The two-can system was used, the filled cans received from organizations being replaced by clean, empty ones at the time of collection.3 To be successful, this demanded cans of a uniform diameter; otherwise there was extreme difficulty in matching cans and lids. The contractors generally removed the garbage from the transfer station in tank wagons or tank trucks, sometimes in barrels by train. When these receptacles leaked, as occasionally was the case, the resulting trail of liquid waste created a decided nuisance.

Either incineration or disposal by sale was satisfactory, from the medical point of view, for both garbage and manure. Incineration was ideal, but the question of cost and practicability was to be considered. Neither garbage nor manure burns readily; therefore a considerable outlay for incinerators, fuel, etc., is required when incineration is adopted, particularly during periods of heavy rainfall. The quantities of these wastes produced in large camps were enormous, amounting, for example, to 982,500 pounds of garbage in July, 1918, at Camp Sherman, Ohio,41 and an average of about 120 tons of manure per day

when there were approximately 12,000 animals in camp.42 The necessary incidental expense, therefore, might be the deciding factor against the adoption of incineration.


15

Disposal of human excreta.-Both pit latrines and sewerage systems were employed in the mobilization camps.43 Pit latrines were used generally in the tent camps and, to some extent, in the cantonments.3

Each of the latter was furnished with a sewerage system, as were some of the tent camps late in 1918.43 These methods, therefore, will be discussed under the types of camps most generally concerned.

More or less complete sewerage systems were provided in the original plans for each cantonment.43 Sewerage systems are the most desirable form of excreta disposal in camps when original cost and rapidity of installation are not determining factors. They possess additional value in serving as a convenient and satisfactory avenue for the disposal of liquid wastes from kitchens and bath houses, but, for satisfactory action of disposal plants, grease traps must then be installed between the sources of this liquid waste and the disposal plants.

The systems as first installed did not include a treatment plant when it was practicable to discharge raw sewage into neighboring streams.44 Where treatment was required, single-story septic tanks without grit chambers were constructed.44 Sprinkling filters were planned for use where the effluent could not be discharged into large streams, and automatic chlorinating apparatus was provided for in all cases except the few where sand filtration was to be used. Sludge beds were not constructed until the winter of 1917-18.45 The installation of an 18-inch grease trap on each kitchen line was included in the original

plans.46

These systems were almost universally the source of much trouble in 1918. Complaints were received from civilian sources when sewage was discharged into small streams, either treated or untreated.41 Some faults of the septic tanks were, they proved to be too small in capacity and soon acted merely as settling tanks and were rapidly filled; the sewage was of an unexpected quality, and the entirely too-small grease traps were so ineffective that the presence of grease in the septic tanks removed all chance of effective septic decomposition. Furthermore, the stone used in the sprinkling filters was often not properly graded as to size. The scarcity of experienced personnel excluded the possibility of these handicapped plants producing satisfactory results.

Correction of these faults was inaugurated in 1918, but had not been completely effected when construction was generally stopped by the signing of the armistice.45 A single large grease trap on the main sewer line was rather generally tried, but the grease collected was so mixed with fecal material as to have no value and the trap merely acted as another settling tank to be cleaned. Large grease traps were then installed on each kitchen line, late in 1918, and served their purpose well when properly cared for. In this connection, it proved necessary to padlock them in order to prevent improper treatment by

organizations, such as washing them thoroughly with hot water. Additional septic tanks were added to the disposal plant, as were sprinkling filters in some instances.45

The removal and disposition of sludge and scum from the septic tanks was a major problem.45 At few camps were sludge beds available as soon as needed, and recourse was had to disposal by burying. This involved great labor and


16

exposure of the sludge to flies before it was covered. Available space was often limited, and the distance necessary to transport the sludge increased as the closer areas were filled. Attempts to lighten the labor by using pumps was often unsuccessful owing to failure of the pumps to handle the sludge. It was necessary to cut and remove the scum by hand when the accumulation was particularly thick.

Pit latrines were used in the cantonments as an accessory to the sewerage system for outlying areas, or for areas not originally expected to be occupied by troops and for which no sewerage connections had been provided.3

The deep-pit latrine system was the disposal method chosen for all camps, where the period of occupancy was expected to be short, including the 16 National Guard camps.43 Latrines had received their share of attention in the development of sanitation subsequent to 1898. The first improvement over the open pit in use during the Spanish-American War was the development, by the board which investigated the typhoid fever epidemics of that war,47 48 of the sanitary trough latrine. This consisted of a metallic trough covered with a wooden seat and emptied by means of an excavator tank wagon. The next

development was the Havard box and its modifications, a box seat with self-closing covers placed over the deep pit. This was first used extensively in the camp at San Antonio, Tex., in 1911, with a urinal trough at one end discharging into the pit.49 The last improvement of importance was the spraying of the inside of the pit and box with a mixture of kerosene (or crude oil) and lamp-black, substituted for the procedure of the daily burning out of the pit.50 The blackness and oily odor were much more efficacious in repelling flies, the process was cheaper, and it avoided the breakage and charring of the box so common when burning was used. This method was introduced in the camps on the Mexican border in 1916 by troops of the New York National Guard, and was adopted by the War Department in 1917 as the standard treatment for latrine pits and their urinal troughs.50 51 This method was the first one employed which would wholly prevent fly breeding in latrine pits not absolutely fly-tight. The only later improvement of importance was the erection of overhead cover over the latrine shelters.3

Pit latrines, having the undesirable characteristic of tending to pollute the ground water supplies of adjacent areas, were the basis of many complaints from localities in which tent camps were established.52 A fault in construction occasionally found was the cutting of square and octagonal holes in the seat, probably because this shape was easier to cut than a circle or oval.3 Sometimes the holes were too small. Another inherent fault in the latrine system, when the camp was occupied for more than a few months, was the additional space required for new pits. Pits would serve for a period of several months

 when carried to a depth of 8 feet or more in a porous soil, and provided that a sufficient seating capacity was available. The period of use was much shorter in impervious soil, so to overcome this the use of excavator wagons to remove the liquid contents was resorted to in some camps.3 In still other camps, to avoid the digging of pits at too frequent intervals, each pit was made much larger in area than the box and the excess opening was roofed over with timbers covered with earth.


17

Disposal of animal excreta.-The problem of the disposal of manure concerned two areas, that of the camp proper and that of the auxiliary remount depot.3 While the ultimate disposition from both areas was ordinarily the same, the greater number of men available in the camp area permitted a dispersion of the labor required and a certainty of disposal in emergencies by measures other than those in routine use. The one point of interest in the camp area was the necessity for using receptacles impervious to fly larvŠ or a ground area puddled with crude oil as storage space for the accumulated manure pending its daily removal.3 This discussion will therefore be confined to the auxiliary remount depot, where the removal of manure produced by thousands of animals over a comparatively large area was attempted by a relatively small number of men.3

The removal of manure from the corrals was an almost insurmountable task. At first, attempts at removal were made by hand loading into wagons, until the winter of 1917-18 resulted in such a mixture of mud and manure, with alternate freezing and thawing, that, what with the increase in animal sickness and the labor resulting therefrom, cleaning of corrals became impractical.3 Efforts were resumed as the fly-breeding season of 1918 approached, and facilities were increased. Animal-drawn scrapers were used in the corrals and details of several hundred men were obtained from the labor battalions.3 The majority

 of the depots succeeded in completing the cleaning by early fall, but, in a few instances, a portion of the old accumulation remained through the following winter.3 Experiences of the year 1919 were largely repetitions of those of 1918, the decrease in the number of animals present being counterbalanced by the difficulty in retaining personnel during the demobilization period.3

After its removal from the corrals, the disposition of this vast accumulation of waste product was still a problem.3 The method of disposition first employed was to spread it on neighboring farms with the understanding that it would be plowed under at once. Plowing under, however, was not always done, thus being sometimes responsible for fly breeding which affected the camp.3 This method of disposal was in common use during the winter of 1917-18 when the contractors could not obtain a sufficient number of cars for removal by rail.3 However, the roads in some sections of the country were so nearly impassable that drivers who had started to deliver loads to farms were forced to dump them before reaching their destinations, and the formation of large dump piles in the immediate neighborhood of the depot sometimes became unavoidable.3 Other camps attempted to burn all manure, but this was practically impossible where rainfall or snowfall was heavy, without a large expenditure for incinerators and fuel. Incineration in windrows was accomplished in a few places by the use of considerable quantities of kerosene or crude oil.3

The standard method of disposal of manure by the contractors was to ship it by rail for sale to farms.3 The organizations delivered it to a loading platform, usually in the general neighborhood of the auxiliary remount depot, where it was loaded into freight cars, the preferable open, or gondola type, not being commonly available. The original construction of these loading points, like the garbage transfer stations, did not include a concrete base, but this was ultimately obtained by a few camps.3 This base was needed not under the plat-


18

form itself but covering the adjacent area where the manure would be spilled in transferring loads, and including the area occupied by the track. Sufficiently extended markets for the manure were often obtained only through the effort of the State agricultural schools in organizing the farmers over considerable areas for its reception in bulk and its distribution.

The difficulties encountered in the disposal of manure resulted often in the more or less forced use of compost piles.3 This method had been adopted by the British Army as a standard method,53 and was authorized and gradually adopted in our camps in 1918, usually as an emergency method, pending removal by the contractors.54 The British depended upon thorough packing of the surface of

 the pile, either with or without a covering of earth, to retain sufficient heat to prevent fly breeding in the outer few inches of the pile, the heat generated in the internal portions being amply sufficient to accomplish this.32 In our camps, reliance was placed on a careful dressing of the sides and margins and the application of borax or cresol solutions,3 although the regulations contemplated

covering with packed earth.54

The compost pile method possessed several advantages-it required only a short haul, it was available under all conditions, and it provided a disposition for manure that had been so mixed with earth or sand as to be unacceptable as fertilizer. Under only one condition was its use contraindicated, that being the presence of such a communicable disease as glanders. The manure then was completely incinerated.3 A number of adverse reports on this method were received, based on the finding of fly larva in the pile.3 In the most definite of these instances, the statement was made that the larvŠ were present in the manure before its removal from the corrals and therefore did not constitute a valid objection to the method.55 The method was perfectly satisfactory when properly carried out.

Supervision of foods.-This subject was covered by the representatives of three different departments. The regulation of food supplies in the extra-cantonment zone was supervised by the members of the United States Public Health Service, in the camp (for meats and dairy products) by the veterinarian, and in the messes by the camp nutrition officer.3 56 The supervision of foods in the extra-cantonment zone, and in the camp by the veterinarian is discussed below. The camp nutrition officer was interested primarily in the efficiency of the messes as regards a well-prepared and well-balanced diet and the avoidance of unnecessary wastage.57 His best line of approach was through the camp school of bakers and cooks, as this school prepared men to serve as cooks and mess sergeants throughout the camp and maintained an inspection service of messes. Best results were obtained by working in cooperation with these inspectors and company commanders and through mess sergeant graduates of the school. This work assumed its fullest operation in the fall of 1918, when a generalized campaign for economy in the use of foodstuffs resulted in an immense reduction in the garbage sales in camps.

Epidemiology.-The major problems relative to prevention of disease and the care of the sick in a military camp concern communicable diseases. Since the treatment of these diseases is discussed in another volume of this history (Vol. IX), the present discussion is confined to the aspects of the problems with which the camp epidemiologist had to deal.


19

The duties of a camp epidemiologist were performed by the sanitary inspector to about January 1, 1918, when the office of camp epidemiologist was established.58 The primary duty of the epidemiologist was to prevent the introduction and spread of communicable diseases.59 This included the provision of proper hygienic surroundings for troops, the inspection of arriving troops, investigation of the source of infection, and the nature of the causative agent, investigation of the care of men sick with communicable diseases, detention and quarantine measures, and the preparation of reports and charts.

In the prevention of infectious diseases effort was directed toward those infections which came about by close association and by direct contact, and to the prevention of their spread by the detention of all new arrivals for two weeks, by the isolation of contacts and carriers, and by quarantine in hospital of patients with communicable diseases.

The relationship of close association and the rapid spread of infectious diseases, especially the respiratory infectious diseases, was well known before the World War, and was adequately demonstrated in our camps on the Mexican border in 1916; however, when the plans for the tent and barrack camps for the World War Army first were formulated, considerations of economy were paramount, and overcrowding in both kinds of camps was sanctioned,60 in the belief that a liberal supply of fresh air would more than counterbalance the bad effects of the close proximity of the men. How the overcrowding eventually was remedied is more appropriately told elsewhere,g and it is sufficient to say here that, in so far as the tent camps were concerned, the man capacity of each tent was established at 8,61 then at 5 in certain camps (Camps Beauregard, Bowie, and Wheeler) and 8 in others,62 and finally at 6, in the summer and in the absence of sickness, otherwise at 5.63 As regards the cantonments, overcrowding existed

 there also, particularly during the winter of 1917-18, but eventually the allowance of dormitory floor space was established at not less than 50 square feet per man.3

In addition to increasing the tent and dormitory floor space per man, other measures were adopted that were calculated to counteract the deleterious effects of close association in sleeping quarters.3 Whereas double-deck bunks at first were considered as most highly undesirable because they cut the air space in half, and thus were prohibited, with the weight of opinion swinging to the relative greater importance of separation of sleeping men's heads over cubic air space, their use was approved by the Surgeon General under the condition that the bunks be not grouped in close proximity to each other.64

Two means of guarding against the droplet transmission of respiratory diseases became standard throughout the camps-increasing the distance between the heads of bunks and the partial cubicling of bunks.3 Increasing the distance between the heads of bunks was accomplished by reversing the position of alternate ones, so that the head of one was opposite the foot of each contiguous bunk. Draping a shelter tent half on its pole at one side of the head of each bunk answered the purpose of cubicling.

At many camps it was found that the men ineffectually washed their mess kits; that is to say, the water in which the kits were washed was neither suffi-

gConsult Vol. VI, Chap. V of Sec. I, of this history.


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ciently hot nor of adequate soap content. Under such conditions it was believed that the transmission of acute respiratory diseases from man to man was favored. To correct this, general instructions were issued by the War Department65 which required that when dishes and mess equipment were washed they were to be thoroughly rinsed in boiling water.

Since the introduction of communicable diseases into a camp was unavoidable, it being impractical to refuse entrance to an inducted man because he was suffering from one of these diseases, it was necessary to adopt means of preventing the transference of infection from him to others. The only practical method was to prevent the association of infected with uninfected persons during the period of infectivity of the former. The same was true when infectious diseases occurred among individuals already in the camp. The prevention of this association was accomplished by the use of the following measures:3 Inspection of troops upon arrival; detention of all arrivals in a state of mass isolation; isolation of contacts and carriers; quarantine of developed cases of the diseases in hospital.

Incoming troop trains were met by details of officers and enlisted men which included representatives of the Medical Department.3 The medical officers inspected the men at the detraining point and sent cases of sickness directly to the hospital. The remainder of the arriving group were then conducted to barracks reserved for their use in the depot brigade area, where they were kept in detention for a period of two weeks.3

These barracks were in a subarea which had been designated for this particular purpose.3 This system was built up gradually, and was not so definite in all camps, the principal variation being that these detention barracks were not always grouped in a definite area.3 Detention camps under canvas sometimes replaced the use of barracks, this possessing the distinct advantage of minimizing the number of secondary contacts of each new case.3

A further refinement carried out in a few camps, particularly when measles was concerned, was the separation of arrivals into two groups, immune and nonimmune, the classification being determined by the history as to previous attacks of the disease.3 The immunes were not held in detention.

Men held in detention were given all instruction and drill in groups separate from other troops during the detention period.3 The training cadre, cooks, etc., assigned to these groups were immunes, so far as practicable.

Contacts were the men who had been definitely exposed to a communicable disease or who had been closely associated with cases. The term at first included only those definitely exposed; however, it was soon amplified to include men who were probably exposed and even those who might have been exposed; but was ultimately confined, as a general rule, to known direct contacts and the men occupying the adjacent bunks.3 This was not true when dealing with epidemic cerebrospinal meningitis, when all men occupying the barrack involved, or even the entire company, were considered to be contacts.3

The most efficient method of handling the question from the housing point of view was to separate the contacts into small groups in order to limit the number of secondary contacts arising from succeeding cases. This was most practical when tentage was used, and tent camps for carriers and contacts were


21

established in the majority of camps and designated as "quarantine camps."3 Contacts were held until the period of incubation had passed, or until negative cultures were obtained in diseases demanding this method of determination of freedom from infection.

The standard procedure in the majority of the camps was to send all cases of communicable disease to the base hospital, but it was universally necessary to depart from this procedure during epidemic periods.3 At such times, the total capacity of the base hospital was frequently insufficient to accommodate the cases arising from one disease alone, and the establishment of secondary hospitals became mandatory. These were occasionally organized as regimental or brigade hospitals, but usually were operated as camp hospitals; they were manned by personnel from the sanitary train, supplemented from the regimental medical detachments when necessary. Personnel from the line was frequently necessary also during the influenza epidemic of 1918.3 Some, or all, of these camp hospitals were sometimes used as convalescent hospitals to supplement the base-hospital service, to enable the latter to evacuate its convalescents at an early date and thus increase the number of acute cases which it could handle during a given period.

Quarantine in hospital was conducted along familiar lines, its rigidity, as regards the medical personnel in attendance depending upon the disease concerned, the question of immunity, etc.3 The use of separate wards for specific diseases was not always possible during epidemic periods. Under such conditions, the cubicling of beds was of material benefit. The use of gauze masks over the mouth and nose of all attendants was an innovation used particularly in the care of influenza and pneumonia cases.3

PHYSICAL EXAMINATION OF DRAFTED MEN

This was the greatest single task imposed upon the Medical Department during the early period of the camps, and it practically excluded detailed attention to other matters not fundamental.3 The examination of the 482,000 men called during September and October of 1917 required a vast amount of work made doubly difficult by the necessity of accomplishment within a short period of time and with a force of medical personnel which largely reported only a short while before the arrival of the draft contingents.3 34 This personnel was also largely without experience in the physical examination of men

other than as individuals. The Surgeon General had directed that the examinations be conducted at the regimental infirmaries, and that they consist of two phases, a preliminary and a final examination.66 The final examination was conducted by boards of specialists, and concerned only such men as were referred by the preliminary examiners; the preliminary examiners could not definitely reject them.66 Since the men were being mustered into the service before they were given the preliminary physical examination at the camps, the action of the disability board was required before a rejected man could be

discharged from the Army.67

The special examiners consisted of experts in the lines of tuberculosis, orthopedics, cardiovascular diseases, neuropsychiatry, dentistry, and eye, ear, nose, and throat conditions. Only the first four were generally considered under the terms "special examiners" or "special examining boards."68


22

The examining system was gradually improved until one examining board came into general use early in 1918.69 This was a combination of the preliminary examiners and the special examiners into one unit which completed the examination of each individual in one day.69 The boards used existing buildings, which were generally altered to a greater or less extent in their interior arrangement, adjacent buildings being sometimes connected by canvas or wooden closed corridors.3 In the more highly developed units the interior of the buildings was rearranged in order to meet with the requirements of rapid, complete, and accurate examinations of large numbers of men. Two-story barracks were used in the majority of instances, but infirmaries and mess halls were also used.

The whole system for the reception of recruits, including the physical examining board, was concentrated in the depot brigade when large draft increments were again received in the spring of 1918.3 This made possible a systematization and coordination of the functions of the various branches of the Army concerned, which had not been attained before. The work of the quartermaster and personnel officers was combined with the medical work in a few instances, so that an individual entering the physical examining station left it either on his way back to civil life as rejected or else completely uniformed and sworn into the Army.3 A special building for such combined services was authorized in October, 1918, but its construction, along with most new construction, was prevented by the signing of the armistice.70

While minor differences existed in the physical examining systems used in the various camps, the general plans came ultimately to be the same.3 The system finally developed was to combine all examining personnel into one unit, but this unit consisted of a varying number of subunits.3 In general, there were two main divisions of each team, general examiners and special examiners. Over the whole was one officer responsible for its coordination. All recruits were now being examined before they were mustered into the service, but as they had been accepted by their local boards action by a physical disability board continued to be necessary. This latter board, while not officially a part of the physical examining board, was so closely associated with it as to constitute a subdivision of the examining board for all practical purposes.

The general plan of the system was to have a definite number of men report for examination at stated intervals. These were admitted in groups, and orderlies and railings were so placed as to guide the men from one examining station to another with no possibility of going astray. Traffic lines were so planned as to avoid crossing, if possible. Undressing stations were generally placed first on the route, but such steps in the examination as did not require the removal of clothing, as record taking, dental and neuropsychiatric examinations, sometimes preceded the undressing. Vaccination stations for smallpox were also placed near the beginning of the route to allow the vaccine to dry before the clothing was resumed. The typhoid inoculation was occasionally given at a station placed near the end of the route, particularly when transactions with the quartermaster and personnel departments followed, in order that the men might leave the examining station before the reaction to the inoculation became mainfest. Each man to be examined carried his printed forms throughout the route, clerks making the necessary entries thereon at each station.


23

The general examining team was composed of medical officers experienced in conditions affecting the special senses, the heart, the lungs, and in orthopedics, neuropsychiatry, and surgery.3 Men whose condition was definitely within the limits for acceptance were finally accepted by the general examining team; doubtful cases and all marked for rejection were referred to the special examiners

for final decision. These special examiners were the special boards who formerly conducted the final examination, and were generally given separate examining rooms where noise could be more or less excluded.3

The total personnel of the examining board was about 34 officers and 60 enlisted men. Usually, there were 3 orthopedic, 3 neuropsychiatric, 4 cardiovascular, and 10 tuberculosis examiners, the last working in two shifts. The number of men that could be examined daily depended mainly upon the number of medical officers available who were qualified to act in the capacity of special examiners, as officers to fill the other positions were sufficiently numerous to increase the examining board to any desired size.3 Each heart and lung examiner could accurately handle a maximum of 80 to 100 men per day, while each neuropsychiatrist could examine 250 daily.71 The maximum capacity of the average board was 400 men per day; frequently, however, from 800 to 1,000 were passed through daily.3

Numerous administrative features required careful attention. Lists of absentees were prepared daily, their commanding officers notified, and their forms placed in an "absentee" file. Men held for reexamination were particularly difficult to locate during the fall of 1917 for then they were scattered through all organizations, and transfers were frequent. This difficulty was largely avoided later by the retention of all newly arrived men in the depot brigade. Company commanders of all men found to have venereal disease were notified to have them report for treatment. Shoe sizes were determined with the aid of a mechanical measuring device and actual trial of sample shoes, and sizes were entered on slips which were later pasted in the service records. Printed forms and rubber stamps were used freely.3

SPECIALIST EXAMINERS

The work of the special examiners, sent in 1917 to the camps for the physical examination of draft troops, developed to much greater proportions than was originally contemplated, particularly those concerned with tuberculosis, nervous and mental diseases, cardiovascular disorders, and orthopedic conditions.72 Additions were made to the plans of operation and to personnel until the developments sometimes overshadowed the original objective of the specialists.72 The work thus became gradually divided into two sections, the "specialist" boards for physical examination and consultant work, and additional specialists of less experience for conducting the remedial efforts for the camp.72 The senior member of each specialty acted as consultant assistant to the division surgeon.

The consultant was often assigned to the base hospital for duty during the early stages of this development.72 He was thus incompletely subordinate to the division surgeon, although designated as consultant for the whole camp, and this condition interfered to some extent with the administrative efforts of the division surgeon.


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The tuberculosis boards were first in the field with general surveys, but the nature of the disease with which they were concerned prevented the possibility of fitting tuberculous men for active military service within a reasonable time.73 These efforts to remedy certain physical defects were at first conducted as a divisional function for those cases not requiring hospital treatment. The activities were later included in those of the development battalion,74 and still later were transferred to the convalescent center.75

The consolidation of the earlier separate general and special physical examinations into one process in the spring of 1918 removed the necessity for the specialist boards, and they were officially dissolved August 22, 1918.76 Their members were then available primarily for duty as members of the physical examining boards, but the consultant could still be retained as such.

DISABILITY BOARDS

One board for discharge from the military service on surgeon's certificate of disability was convened at each camp early in the fall of 1917,77 and provision was made for as many additional disability boards of tuberculosis examiners as might be necessary. The camp surgeon had no power of revision over the findings of these tuberculosis boards.

An increase in the number of disability boards for general work later became advisable, usually to 3-1 for the camp proper, 1 for the base hospital, and 1 for the development battalion.3 Because of the almost universal complaint that these boards functioned too slowly and that men were retained in the service who should have been discharged,3 investigations were made that developed that the avoidable delays in action were frequently due to the necessity of returning the form used to organization commanders for correction, and that improper retentions in the service were based on differences of opinion.3

Differences of opinion between the members of the disability board and the members of the various specialty boards also arose.3

The disability boards functioned best when they were most intimately connected with the physical examining system and were practically a part of it.3 The great bulk of their work was derived from this source, and when functioning as a part of the general examining board, all information available was at hand and everything could usually be completed at once except the part prepared by the organization commander.

DEVELOPMENT BATTALIONS

Development battalions were the culmination of a sequence of steps taken to fit for military duty those men who had remediable defects and to place to advantage those with minor defects which were not remediable. Eventually, their functions included the teaching of illiterates, physical exercises for convalescents, medical treatments for various types of ambulatory cases, the discharge of ineffectives, and the placement of men whose low mentality made them ineligible for general military duty.3

The necessity for some such organization was realized in 1917, particularly by the orthopedists in developing men with minor physical defects and by the neuropsychiatrists in placing men who were so undeveloped mentally that


25

they were fit for duty only as laborers.78 79 Special orthopedic classes were organized, and these functioned as separate detachments in some instances. Occasionally special organizations, larger in size and   broader in scope, were formed, to which were assigned practically the same classes of men as later composed the development battalion, such as the "provisional regiment" of some 3,000 men organized in Camp Logan, Tex.80 Companies or detachments of venereal cases were sometimes formed.81

Some form of special training organization had become quite general in the camps by the spring of 1918.3 Some of these were operated as convalescent detachments in the base hospitals, others were a part of the depot brigade or were independent organizations, commanded by line officers with medical officers to supervise the medical activities. These generally provided only for the building up of convalescent patients recently discharged from hospital, and the formation of such organizations was ordered by the War Department in March, 1918.82 The formation of special training organizations for other classes than

convalescents was stimulated principally by the orthopedists. About half of the camps had orthopedic training organizations in May, 1918, and woodworking tools had made their appearance as part of the equipment.

These various experiences led to the formation of a development battalion in nearly every mobilization camp and the more or less prompt transference to it of the activities conducted in the special training detachments.83 This transfer was generally made early in July, 1918.84 The functions of the development battalion, much wider in range than those of the special training detachments, were to receive all unfit men and either to train them so as to make them fit for some military duty or to eliminate them from the service.83 There were transferred to the battalions, therefore, men inapt for military service, drug

addicts, those with criminal tendencies, morons, alien enemies, conscientious objectors, illiterates, venereal cases, convalescents and others with physical disabilities not warranting immediate discharge on surgeon's certificate of disability. Company commanders also availed themselves of the opportunity and transferred men whose names appeared on their rosters but who were not present, causing much confusion in the development battalions.84 Many of these men never were located and their names were ultimately dropped from the lists.84

Development battalions were part of the depot brigades, where such brigades existed.83 Each had its permanent training cadre consisting of officers and enlisted men from both the line and the Medical Department,84 the latter amounting to 2 officers and 19 enlisted men.85 Additional medical officers were assigned or attached for duty as occasion demanded. The enlisted cadres were drawn largely from men transferred to the battalions for physical disabilities. Medical officers ordinarily took no direct part in the general administration, being concerned only with medical treatment and the supervision of physical

exercises.84

As regards the physical exercises, there were two methods in vogue, one in which the medical officers merely supervised the exercises and another in which they actually conducted them.84 Medical officers made periodic physical


26

examinations of all men assigned to the development battalion,84 and classified them according to their physical ability to perform military services, as follows:86 Class A, fit for general military service; class B, potentially fit for general military service when treatment of their curable condition was completed; class C-1, fit for general military service in the Services of Supply overseas or any service in the United States; class C-2, fit only for special limited service in the United States; class D, unfit for any military service. Classification was made first within about 24 hours after arrival;84 approximately 90 per cent

could be permanently classified during that time. The specialists on the physical examining boards ordinarily examined all men before transfer to the development battalions, and, in some instances, were also in charge of all physical examinations within the battalions and supervised the medical treatments.84

These periodic physical classifications of the men and their other qualifications together formed the basis on which a "rating" was made as to their actual ability to perform military duty.84

The individual records in battalion headquarters consisted of Form No. 88, M. D., as used in the physical examination of recruits and various card indices. As the rating was subject to change with improvement in physical condition or education, this was usually determined only when a man's service in the battalion was to be terminated.

The various types of disabilities represented were more or less segregated by companies or battalions, and by color.84 Two specialist activities, orthopedic and venereal, were largely concentrated in the development battalions by the transfer to them of the bulk of those cases present in a camp, and their camp clinics became parts of the development battalion.84 The proportion of men in battalions as represented by the different classes of medical cases varied widely, but that of venereal cases was almost invariably highest, as much as 50 per cent in some instances. Orthopedic cases composed approximately 25 per cent, cardiovascular about 7 per cent, and neuropsychiatric usually less than 5 per cent. Venereal cases were divided and segregated by disease; syphilitics were further divided according to infectivity. The physical classifications were often so divided that the classification indicated the kind and duration of physical exercise to be taken, thus largely avoiding the necessity

for special exercise classes in such types of cases as the cardiovascular, where graduated exercise was indicated.

There was a very general inclination on the part of camp commanders to invalidate the basic purpose of these organizations, the rapid development of unfit men, by interfering with instruction and treatments through using the battalions as a source for special details required for work throughout the camp.84 However, reports made prior to the time of the signing of the armistice indicate that about 68 per cent of men transferred to development battalions were reclaimed for some kind of military service.87

Demobilization ended the usefulness of the battalions except for some medical cases.88 These, except venereals, were transferred to the newly formed convalescent centers. The development battalions were reduced to "development companies" in May, 1919, and formed a unit of the development group.89 They were entirely dissolved soon afterwards.


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SPECIAL DEPARTMENTS AND AREAS

DENTAL CORPS

A senior dental officer was sent to each mobilization camp early in September, 1917.90 At first he was "the dental officer in charge";33 later however, he was given the title of "the dental surgeon."91 Since tables of organization made no provision for this officer at division headquarters, he was given space in the office of the division surgeon.33 92 Members of the Dental Officers' Reserve Corps reported at about the same time as the division dental surgeon and eventually numbered about 35 in each camp.33 Dental equipment available at first consisted of one or two field dental outfits, and pending the receipt

of equipment and supplies requisitioned it was necessary to gather articles from any source available in order to provide emergency dental treatment for the troops.33 In some instances purchases were made in the open market of such individual articles as were available, and dental furniture was improvised. Some of the dental officers had brought a number of their personal instruments with them, and these were purchased by authority of the Surgeon General.93 Requisitions for field dental outfits were filled in October, 1917, and base outfits were received in numbers two or three months later.33

During the early period of enforced professional inactivity dental officers were temporarily assigned to various positions and both professional and military instruction were taken up.33 To further professional instruction, a camp dental society was organized and papers were presented, particularly on the more recent progress made in dentistry.33 The enlisted dental assistants were very largely men with a dental education.33

Divisional dental officers were at first attached to regiments. In October, 1917, however, instructions were issued by the Surgeon General to organize the divisional dental service into brigade units of 1 supervising and 10 other dental officers each.94 Each unit was to occupy a dental dispensary building eventually, but meanwhile it was to be housed in regimental medical infirmaries and base hospitals pending the necessary construction. The dental offices in nearly all divisions remained in the infirmaries until the special buildingsh were completed, about May, 1918.33 Dental officers and their assistants

remained attached to organizations and under the administrative control of the division surgeon during the period prior to their arrival in France.95 Thirty-one dental officers and 32 dental assistants were assigned to each division for overseas service.95

A dental survey of each tactical division was undertaken in the fall of 1917.33 When completed, men having conditions liable to produce focal infections were given priority in treatment. The most common condition in this class was infected roots, so a great proportion of the dental work performed during the following months consisted of extractions. Recruits were thereafter examined and classified before being transferred from the depot brigade, although this was not the case in all camps.33 In a total of approximately 50,000 men surveyed in one group, about one-half required dental treatment

hSee Vol. V, p. 108, fig. 63, for plans of dental infirmary building.-Ed.


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of some kind; approximately 10,000 were examined in the spring of 1918, about two-thirds of whom were white and one-third colored; 22 per cent of the whites were found to have peridental infections and 19 per cent had focal infections; among the colored men, 15 per cent had peridental infections and 30 per cent had focal infections.96

Certain general rules of procedure were established, by direction of the Surgeon General, in conducting the dental service of the camp.33 These general rules were: Only those dental assistants who were graduates in dentistry were to be allowed to operate at the chair; the conservation of all teeth which probably would not provide a source for focal infection was to be practiced; all dental operations which were of sufficient importance to be classed as oral surgery were to be referred to the base hospital. Dental supplies were requisitioned from the medical supply depot, where a dental officer was usually

stationed as an assistant medical supply officer.33

Reports of general inspectors were first rendered in the spring of 1918.33 These inspectors were of great assistance in obtaining the high standard of dental service so general in the camps, particularly through the transmission of the general policies of the Surgeon General's Office and by introducing measures found of value from experience in other camps.

Authorization was given in September, 1918, for 1 dental officer to each 500 men in training, and for 3 dental officers for each 1,000 beds in a camp hospital.97 Three dental mechanics were also authorized for each camp and one additional for each camp hospital. Graduate dental assistants were authorized to apply for commissions in the Dental Corps.

One or two improvised dental infirmaries were added to the one of standard type in each camp during the summer of 1918.33 These were of smaller capacity than the dental infirmaries and located in such buildings as were available. Arrangements were sometimes made for quarters for both officers and enlisted men in the vicinity, either in buildings or in tents, and the entire dental personnel of the camp was organized as a separate detachment.33

VETERINARY CORPS

The veterinary service in the mobilization camps was furnished by the small and newly created Veterinary Corps of the Medical Department.98 This corps was expanded by commissioning enlisted graduates in veterinary medicine, by calling to active duty members of the Veterinary Reserve Corps, and by the enlistment, assignment from the draft and transfer of enlisted men. Officers were few in number in the camps during the early fall of 1917, and there was no enlisted personnel in the corps until October, 1917.98 No enlisted personnel was assigned to the camps proper, as differentiated from the division and the auxiliary remount depot, until about June, 1918.

The veterinary service operated as two quite separate sections, the division or camp service and the auxiliary remount depot.99

Camp service.-Organization of the veterinary service of the division was accomplished shortly after regulations governing the Army Veterinary Service were issued late in 1917.56 The status of the division veterinarian in his relation to the division surgeon was a tentative one prior to that time.31 Precedent


29

placed him as subordinate to the division surgeon, but Special Regulations, No. 70, W. D., gave him an independent status under the division commander. This was so unusual in Army custom when two officers concerned were members of the same department that considerable discussion, generally friendly, was aroused. The question was definitely settled by instructions from the Surgeon General which reiterated and amplified the statements of the special regulations referred to.100

The divisional organization consisted of a division veterinarian, a division meat and dairy inspector, an evacuating section and a number of "veterinary units," a total of 12 officers and 51 enlisted men."56 101 Each veterinary unit consisted of 1 officer and 3 enlisted men, and the units were attached to Infantry brigades, Artillery regiments, and the divisional trains."'101 102

The two main divisions of veterinary work in the camp service were the care of animals and food inspection. In addition to these, the veterinary officers attended to the necessary administration and to the training of the veterinary enlisted personnel. Hospital facilities were provided by the veterinary hospital located in each auxiliary remount depot.99

The care of animals included diversified lines of work, such as forage inspection, medical care, sanitation of stables and picket lines, and the instruction of line personnel in feeding, watering, shoeing, and the care and use of harness.99 Serious cases of sickness and injury were sent to the hospital, while minor cases were treated at improvised dispensaries in the camp.99 The animal ambulance which was furnished each camp, was seldom used.99

A camp veterinarian was designated when the original division left the camp, generally about June, 1918.99 He was provided with an assistant who was the meat and dairy inspector. The enlisted personnel consisted of 6 men, 2 of whom were designated as assistants to the meat and dairy inspector.103

Meat and dairy inspection.-Meat and dairy inspection of the camps was largely performed by lay inspectors until taken over by the Veterinary Corps rather late in 1918.104 These lay inspectors were representatives of the Bureau of Animal Industry assigned, through the efforts of the Quartermaster Corps, to inspect all meat purchased by that corps.104 Inspection of the milk supplies was performed by the camp sanitary inspector or by an officer of the United States Public Health Service during the earlier period of the war.104 These officers also generally supervised the local sources of meats and meat products, to some extent, at least, but instances are recorded where all supervision was lacking and in which it was badly needed.104 Inspections of locally purchased meats and meat products, if made at all prior to June, 1918, were not systematized and therefore were ineffective.99 The procedure usually employed during this ineffective period was to designate a point in the camp where local dealers

were to present their products for inspection before delivery to the purchaser, but no check was provided to insure that they did so. The well-organized service later established by the Veterinary Corps required that the dealer's sales slips be stamped in duplicate at the time of inspection, one copy being retained at the inspection station. Periodic reports from organizations or presentation of their retained sales slips then provided a check on the reliability of the dealers and organizations. Organizations were not allowed to accept


30

deliveries accompanied by unstamped slips, and the dealer was barred from the camp if he failed to comply with the requirements. The inspecting station was conducted by enlisted men experienced in this work.

Storage provision for meat in quantities was not made in the camps until the summer of 1918, when cold-storage plants were completed.99 Meanwhile, the refrigerator cars in which the meat was shipped were retained on sidetracks and issues were made directly from them as required.

The later developments of the dairy inspection service were handicapped by the wide separation of the large number of dairies necessary to supply a camp and by a lack of transportation and personnel.99 This service was furnished by the United States Public Health Service throughout the camp period in some instances.99 In others, dairies were scattered over such a large area that inspection was impracticable, and the pasteurization required for all camp milk was judged to afford sufficient protection against disease transmission through this medium.

Auxiliary remount depot.-With the new construction incident to mobilization, a remount depot was built at each divisional cantonment.105 A remount depot had an official capacity of 5,000 animals and included barracks and shops. It was the function of these depots to receive and condition newly purchased animals and to turn them over to the divisions as required.

Construction of the auxiliary remount depots was begun early in the fall of 1917 and completed about the end of the year.99 In many instances, unfortunately, the plant was laid out with regard to compactness rather than to the geographical features of the terrain, resulting in the location of corrals on low ground, placing the veterinary hospital on the slope above messes and quarters for personnel, etc.99

The camp commander had control for the purpose of discipline and supply, and this was interpreted, in some instances, to include control of sanitation.3 This duality of responsibility naturally resulted in many difficulties for the senior veterinarian in the depot.99

A troop of Cavalry was stationed at a number of the depots of southern camps early in the fall of 1917, but the Quartermaster Corps furnished the main portion of the personnel of the depots.99 This corps also furnished personnel to conduct the veterinary activities until enlisted men from the Veterinary Corps were supplied late in 1917.99 The veterinary personnel of a depot of standard size was eventually 6 officers and 75 enlisted men.106 The Medical Department furnished a small detachment with one medical officer.107

The duties of the veterinary personnel, aside from hospital duties, consisted in supervision of animal sanitation, daily inspection of all animals in corrals, the conduction of a horseshoer's school, and the supervision of animals en route when a shipment was made.99

The corrals at remount depots were universally too large, from the veterinary point of view, and frequently were overcrowded.99 Their size, and the omission of double fencing between them, made the control of communicable diseases among animals there very difficult, and for this reason they were later subdivided at some camps.99 The fencing was usually of 2-inch plank top and bottom with 1-inch boards between, but the heavier material was used



31

throughout in some instances.99 A long shed was provided in each corral for shelter. Sheds in the southern camps were closed on the north side, while those in the northern camps were closed on both ends as well as on the north side. Feeding racks consisted of V-shaped, slatted hay racks, with shallow feeding troughs on both sides at the bottom of the V and about 4 feet above the ground. Watering troughs were originally constructed of wood, with no protection against freezing;99 however, concrete troughs were provided in the northern camps before the winter of 1918-19. These troughs were so shaped that they would not be damaged by freezing, and were provided with self-draining cut-offs on the inlet water pipe.99 The overflow was removed by drainage ditches, with rock filling immediately surrounding the trough. Dipping vats were provided in 1918, but these were usually reported as faulty in dimensions.99

When the auxiliary remount depots were constructed, stables were set aside for sick animals, in each instance and were designated veterinary hospitals. Little was done, however, toward providing accessory utilities essential to the operation of complete hospitals.107

The veterinary hospital consisted of 4 or 8 stables, depending upon their size, 4 smaller buildings with concrete floors, 4 forage buildings, and corrals. The stables were of the double-stall type, with a number of box stalls in one end, and were used as wards. The buildings with concrete floors were for use as dressing and operating rooms. The capacity of a hospital was about 400 animals.

These meager accommodations were often overcrowded with the sick, whose presence, in the midst of great numbers of sound animals normally occupying the depots, rendered the handling of communicable diseases highly unsatisfactory. Estimates and plans eventually were prepared by the Surgeon General for the establishment of camp veterinary hospitals outside the remount depot areas, but further action was stopped by the signing of the armistice.107

The highest animal disability rate occurred in the winter of 1917-18 and the early part of the following spring, when the bulk of the shipments of newly purchased animals was received.99 This was due to several basic conditions-the large proportion of animals not immune to shipping fever, exposure to inclement weather after receipt, the absence of dry standings in the corrals, the opportunities for injury from loose or protruding nails and from stumps, and the infection of slight wounds from contamination with the mixture of mud and manure in the corrals. Pneumonia and strangles were particularly widespread and fatal. Dermatitis gangrenosa became common from infection of minor wounds when the spring rains converted the corrals into seas of mud. Picked-up nail was the most common cause of disability from injury.

The most dreaded disease was glanders, on account of its endemic and incurable nature and its communicability. While a few cases were discovered among contractors' animals in 1917, it was not generally reported until the spring of 1918.99 Reports from the various camps indicate that general mallein testing was first adopted when divisions turned in their animals to the auxiliary remount depots, and that cases of glanders were then generally discovered. All animals in the camp and remount depots were then mallein tested by the


32

ophthalmic method; positive cases were destroyed and suspicious cases were isolated and retested later. Animals that were destroyed were autopsied and the carcasses incinerated.

All this involved the entire personnel of the depots in an immense amount of work. One corral at a time was thoroughly cleaned and disinfected, whereupon  it could be used to contain animals which showed a negative reaction to the test. Double fences were constructed in order to prevent contact of these animals with others, and the corrals were sometimes subdivided in order to facilitate the work. The depot being quarantined and its activities thereby limited, the exercise of many animals was necessary which otherwise would not have been required. The serological test was used as a confirmation of other tests, and all animals were again tested after an interval. The intradermal mallein test was later adopted for routine use.

EXTRA-CANTONMENT AREAS

The territory contiguous to the mobilization camps generally included cities and towns in which sanitation not infrequently had been neglected.108 By statutory provisions administrative matters in this connection were charged to local authorities, municipal or State, under the supervisory control of the United States Public Health Service. Since these communities were sources of danger to the health of commands unless brought up to the same standards of health as was required for the camps, the United States Public Health Service stationed officers of that service in the extra-cantonment area of each of the large mobilization camps, where they acted in conjunction with the local authorities in the education of the local public and the initiation and maintenance of proper health activities. Frequently, these Public Health Service officers were appointed deputy health officers, and were given authority to enforce the local regulations, which, in turn, were often drawn by themselves. Such a system, by which the local health officials, representatives of the United States Public Health Service and the Medical Department cooperated in the prevention of disease in both camps and the surrounding territory, resulted in the prompt

notification of unusual health conditions, the control of epidemics, the hygienic regulation of eating and drinking places, public water, milk and other food supplies and their handlers, the prevention of fly and mosquito breeding, the disposal of waste and excreta, the care of ice plants, the control of prostitution, the treatment of the venereally diseased, and the prevention of illicit liquor dealing.

DEMOBILIZATION PERIOD

(November 11, 1918, to December 31, 1919)

PHYSICAL EXAMINATIONS

It was the duty of the Medical Department, in connection with demobilization, to examine physically all men before discharge and to make of record the results of each individual examination.109 In accomplishing this use was made of the machinery for the physical examination of recruits with certain modifications.3 The main factor making this a difficult task, aside from the enormous numbers of men to be examined, was the fact that medical personnel had to be demobilized at the same time.


33

Various administrative difficulties led to the formation, early in 1919, of a "demobilization group" in each camp designated as a demobilization center.99 These groups consisted, for all practical purposes, of the depot brigade converted into a plant to provide the means for handling large numbers of men rapidly and accurately during the process of discharge from the service.3 After demobilization of the troops that had been occupying a camp at the beginning of the armistice, a demobilization center constituted a great casual camp in which men were received by thousands, passed through the complicated business of

physical examination, final record making, settling of accounts and discharge, all in the course of a day or two.3 The intricacy of this process required the close cooperation of all agencies concerned, and the physical examining board was therefore made a part of the demobilization group.89

This board retained the general characteristics, during the early part of the demobilization period, under which it had functioned in examining men entering the service, and these characteristics varied somewhat in the different camps. Circumstances dictated certain changes in order to hasten the work, and definite standards were issued November 18, 1918. The board functioned under a chief medical examiner, and each team had a principal medical examiner. A well-balanced team consisted of 3 general; 1 dental; 3 orthopedic; 1 eye; 1 ear, nose, and throat; 3 cardiovascular; 6 tuberculosis; and 3 neuropsychiatric examiners. Such a team required the assistance of about 74 enlisted clerks and orderlies.3 A board of review was provided as a final authority.89 No maximum limit was placed on the number of teams that might be employed in a camp.

The boards functioned approximately on this basis throughout the period, with minor changes as new conditions arose.3 In general, the later tendency was to reduce the number of teams and the number of officers in a team, detailing extra personnel to assist during periods when large numbers of men were arriving, and to increase the floor space available and the clerical force. The number of medical examiners varied, depending upon the number of men to be examined daily, from examining officers and 10 enlisted men, at a camp handling 200 men daily, to 16 officers and 35 enlisted men for a camp handling 800 men. These numbers were necessarily increased at times by the addition of personnel from other sources, owing to the requirement that demobilization be completed within 48 hours after the arrival of men in the demobilization center.110 There was no other allowance of medical personnel made to attend to the routine medical duties of the demobilization group. The examining team, the board of review, the disability board and the chief medical examiner were brought together in one or more buildings reserved for their exclusive use, in order to expedite the work. Cooperation with the remainder of the demobilization group assured that the men would be presented promptly in the numbers desired and with the necessary papers. Mimeographed forms, rubbers stamps, and other equipment were used freely. Detailed findings of the physical examination of an individual were entered on Form 88 M. D., as used in the physical examination of recruits, and the final report for enlisted men was entered on Form 135-3, A. G. O. This final report included a statement as to any decrease during service of the individual's earning capacity in view of his occupation in civil life, expressed in percentage.111 Men requiring hospital treatment, including all with active venereal


34

disease, were sent to the base hospital and were not discharged until their physical condition had reached the maximum to be expected. Permanently disabled men were discharged by the disability board.

Some regulation of the thoroughness of the physical examinations was necessary in the spring of 1919, but ultimately all examining boards made most complete examinations, including the eversion of eyelids, the use of specula for the ear, nose, and throat, and vision and hearing tests, in all cases.3

The majority of the men in our emergency army had been discharged before the end of September, 1919, and the demobilization groups were then dissolved.3 The few men remaining to be demobilized were thereafter examined by the small medical personnel remaining, usually by the recruiting officer.3

CONVALESCENT CENTER

The necessity for demobilizing the World War Army within a comparatively short period of time, together with the policy of returning to civil life men who had been sick or injured but no longer required treatment, in the best physical condition possible, prompted the formation of convalescent centers. The convalescent center was an outcome of the development battalion, wherein men were placed as not being fit for full military duty, and to undergo a course of graduated work. The return of disabled men from overseas emphasized the necessity for the continuance of this work for convalescents, and "overseas convalescent detachments" were ordered formed in each camp where there were convalescent soldiers returned from overseas.112 Provision was soon made changing the designation of these organizations to "convalescents centers" and for admitting to them, in addition to overseas convalescents, such domestic convalescents as required to be built up physically before discharge.88

The training cadres of the centers were obtained mainly from those of the development battalions,88 and the administrative formation resembled that of the latter.75 It was originally intended that all convalescents in the centers would be on a duty status, reporting to the base hospitals for such treatment as was necessary.113 This plan did not work out well, generally, as the center was usually at some distance from the hospital, and resulted in the division of the center into two departments-the center proper, and that portion represented by the convalescents requiring treatment, the latter being carried as

 "sick in hospital" and being actually retained there.75 As the larger workshops available in a camp were usually likewise at a distance from the hospital, the curative work was also in two divisions.75 The result of these conditions was that the center proper was composed of men who were about ready for discharge, hospital patients being retained in hospital until the hardening process was practically complete. The center proper therefore functioned mainly as a discharge center, and the men did not remain there long enough for any definite accomplishments in the workshops.75 The curative work schedule of the base

hospital was therefore the one which could be of any considerable value. 

Graded physical exercise was the main reliance of the convalescent center, and the men were grouped in platoons or companies according to their physical ability to participate in the exercises.75 Exercises of all kinds were usually given by line officers, or civilian physical directors from the Young Men's


35

Christian Association, but under medical supervision.75 The actual supervision of exercises was not of much importance ordinarily, the principal medical function being to examine and classify the men for assignment to exercise classes.75

The centers contained from 300 to 800 men each about March, 1919, then decreased in population until their function was taken over by the base hospitals, usually about June, 1919.75 The center was a part of the development group during the latter part of its existence.

MEDICAL DEPARTMENT PERSONNEL

Emergency personnel of the Medical Department being as anxious for discharge as that of other branches of the service, and the remaining sick still  requiring attendance, it became necessary by June, 1919, to adopt special recruiting measures in an effort to obtain a sufficient number of men to perform the duties imposed upon the Medical Department.114 Special recruiting campaigns were ordered conducted in each camp, a medical officer was ordered to be detailed as assistant to the camp recruiting officer for this purpose, and all demobilization centers were authorized to send recruiting parties through the

 neighboring country.115 All emergency men desiring discharge were to be demobilized by the end of 1919, and this required the reduction of the medical enlisted personnel in camps to the absolute minimum necessary to perform the duties required.116

CLOSING OF CAMPS

Generally speaking, the National Guard camps were closed in the spring of 1919, and the cantonments were occupied until the following fall or later.3 Several of the National Guard camps were turned over to the United States Public Health Service, in whole or in part, for use for hospital purposes.3 117

REFERENCES

(1) Annual Report of the Chief of the Construction Division, 1918.

(2) File of special orders, W. D., 1917. On file, Record Room, S. G. O.

(3) Reports of special sanitary inspectors detailed from the Surgeon General's Office. On file, Record Room, S. G. O., 721.1 (camp concerned). Also, Medical histories of the camps prepared by the various camp surgeons. On file, Historical Division, S. G. O., and Record Room, S. G. O., 314.7 (Medical History (camp concerned)) D. Also, Annual reports of division and camp surgeons. On file, Record Room, S. G. O., 721.5 (Sanitary Report (camp concerned)) D.

(4) G. O. No. 109, W. D., August 16, 1917.

(5) Tables of Organization, W. D., Series A, August 27, 1917, Table 1.

(6) Army Regulations 91, 1913.

(7) G. O. No. 96, W. D. July 20, 1917.

(8) G. O. No. 137, W. D., October 30, 1917.

(9) Tables of Organization, W. D., Series A, August 27, 1917, No. 30.

(10) Tables of Organization, W. D., Series A, August 27, 1917, No. 28.

(11) Bulletin No. 61, W. D, October 23, 1917.

(12) Sanitary Report for the month of May, 1918, Camp Lee, Va., by David N. W. Grant, Maj., M. C., Camp Sanitary Inspector. On file, Record Room, S. G. O., 721 (Camp Lee) D.

(13) G. O. No. 161, W. D., December 22, 1917.

(14) G. O. No. 70, W. D., June 2, 1917; also, G. O. No. 102, W. D., August 4, 1917.

(15) G. O. No. 139, W. D., November 1, 1917.


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(16) G. O. No. 66, W. D., July 12, 1918.p

(17) G. O. No. 120, October 28, 1918: also, G. O. No. 125, November 8, 1919.

(18) Cir. Memo. from the Surgeon General, August 22, 1917.

(19) Manual for the Medical Department, U. S. Army, 1916, par. 743.

(20) Cir. Memo. from the Surgeon General, August 22, 1917.

(21) Manual for the Medical Department, U. S. Army, 1916, par. 746.

(22) Cir. letter from the Surgeon General to division surgeons, May 21, 1918.

(23) Cir. memo. from the Surgeon General to Camp Surgeons, May 27, 1918.

(24) Manual for the Medical Department, U. S. Army, 1916, par. 651-2.

(25) Tables of Organization, W. D., Series A, August 27, 1917, No. 36.

(26) Manual for the Medical Department, U. S. Army, 1916, par. 691.

(27) Based on medical histories of the divisions, U. S. Army, prepared under the direction of the various division surgeons. On file, Historical Division, S. G. O.

(28) Letter from the Surgeon General, U. S. Army, to Lieut. Col. Louis C. Duncan, M. C., Hdqrs., 34th Division, Camp Wheeler, Ga., October 2, 1917. Subject: Medical personnel. Copy on file, Historical Division, S. G. O.

(29) Correspondence on file, Record Room, S. G. O., 327.3 (Induction, camp concerned) D.

(30) Reports of special dental inspectors assigned from the Surgeon General's Office. On file, Record Room, S. G. O., 333 (Dental (camp concerned)) D.

(31) Veterinary histories of various camps. On file, Record Room, S. G. O., 314.7 (camp concerned) D.

(32) Cir. letter from the Surgeon General, September 5, 1917.

(33) Dental histories of various camps. On file, Record Room, S. G. O., 703 (camp concerned) D.

(34) Annual Report of the Surgeon General, 1918, 47.

(35) Circular letter, Surgeon General's Office, October 3, 1917.

(36) War Department Annual Reports, 1918, I, 1290.

(37) Letter from Capt. John H. O'Neil, S. C., to the Surgeon General, U. S. Army, June 25, 1918, and attached papers. Subject: Report on water supply and waste disposal at Camp Sheridan, Ala. On file, Record Room, S. G. O., 720.6-1 (Camp Sheridan) D. Storage 1918.

(38) Memorandum from Col. I. W. Littell, Q. M. C., in charge of cantonment construction, to Construction and Camp Quartermasters, August 31, 1917. Subject: The disposal of waste material at cantonments. On file, Record Room, S. G. O., 721 (Camp Lewis) D.

(39) Letter from Lieut. Col. R. E. Noble, M. C., U. S. Army, to the Surgeon General, U. S. Army, October 12, 1917. Subject: Inspection of Camp Logan, Houston, Tex. On file, Record Room, S. G. O., 721.4 (Camp Logan) D.

(40) Letter from W. T. Wood, Acting Inspector General of the Army, to The Adjutant General, January 14, 1918. Subject: Sanitation. On file, Record Room, S. G. O., 333.3 (Camp Wadsworth) D.

(41) Medical History for 1918, Camp Sherman, Ohio, by Wm. W. Pretts, Maj., M. C., Camp Sanitary Inspector, On file, Historical Division, S. G. O.

(42) War Department Annual Reports, 1918, I, 1299.

(43) War Department Annual Reports, 1918, I, 1292.

(44) War Department Annual Reports, 1919, I, 1293.

(45) Reports of camp sanitary engineers and correspondence. On file, Record Room, S. G. O., 720-1 and 721 (camp concerned) D.

(46) Annual Report of the Chief of the Construction Division to the Secretary of War, 1919. Washington, Government Printing Office, 1919, 261.

(47) Based on Report on the Origin and Spread of Typhoid Fever in U. S. Military Camps During the Spanish War of 1898, by Walter Reed, major and surgeon, U. S. Army, Victor C. Vaughan, major and division surgeon, U. S. Volunteers, and Edward O. Shakespeare, major and brigade surgeon, U. S. Volunteers. Washington, Government Printing Office, 1904, I.

(48) Havard, Valery: Manual of Military Hygiene. New York, William Wood & Co. 1917, 653-5.


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(49) Ibid., 642-647.

(50) Letter from the sanitary inspector, 27th Division, N. G., Camp Wadsworth, S. C., to the division surgeon, 27th Division, September 14, 1917, and attached papers. Subject: Latrines, oil for spraying same. On file, Record Room, S. G. O., 463.8-1 (Crude oil, distillate, Camp Wadsworth) D.

(51) Special Regulations No. 28, W. D., 1917, 11.

(52) Based on correspondence on file, Record Room, S. G. O., 672-2 (camp concerned) D.

(53) Lelean, Major P. S.: Sanitation in War. Philadelphia, P. Blakiston's Sons & Co., Second Edition, 117.

(54) Special Regulations No. 77, W. D., 1918, 34.

(55) Letter from the Surgeon General, U. S. Army, to the Director of Purchase and Storage, August 12, 1919, and attached papers. Subject: Report of sanitary inspection, Camp Pike. On file, Record Room, S. G. O., 721- (Camp Pike) D.

(56) Special Regulations No. 70, W. D., 1917.

(57) Cir. memo. from Surgeon General to camp surgeons, August 30, 1918; also, reports and correspondence from various camps. On file, Record Room, S. G. O., 720.1-1 (camp concerned) D.

(58) Cir. memo. from the Surgeon General, January 8, 1918.

(59) Cir. letter from the Surgeon General, October 13, 1918.

(60) 1st ind., Surgeon General's Office, August 27, 1917, to Adjutant General. Indorsement to letter from the department surgeon, Southeastern Department, to the Surgeon General, August 22, 1917. Subject: Tent floors. On file, Record Room, S. G. O., Correspondence File, 411.2 (Flooring, etc.).

(61) Letter from The Adjutant General to the Quartermaster General, September 18, 1917. Subject: Tent floors for National Guard camps. On file, Record Room, S. G. O., Correspondence File, 424.1 (Misc. Div.).

(62) Telegram from Surgeon General to division surgeons, December 5, 1917. On file, Record Room, S. G. O., Correspondence File, 424 (Tentage, Camps Bowie, Wheeler, Beauregard) D.

(63) Memorandum from the Assistant Chief of Staff to The Adjutant General, June 25, 1918. Copy on file, Record Room, S. G. O., Correspondence File, 424 (Tentage).

(64) 5th ind., War Department, Surgeon General's Office, January 19, 1918, to Adjutant General. Subject: Withdrawal opposition double-deck bunks. On file, Record Room, S. G. O., Correspondence File, 724.9 (General).

(65) Bulletin No. 66, W. D., December 31, 1918.

(66) Memorandum No. 3, Surgeon General's Office, August 22, 1917.

(67) Letter from Capt. Thomas J. Heldt, M. R. C., to Lieut. Col. Pearce Bailey, Surgeon General's Office, May 22, 1918. On file, Record Room, S. G. O., 702-3 (Camp Sevier) D.

(68) Correspondence on file, Record Room, S. G. O., 702-3 (camp concerned) D.

(69) Telegraphic instructions to all division and camp surgeons, surgeon of recruit depots and depot posts, from Surgeon General's Office, April 29, 1918.

(70) Memorandum for Assistant Secretary of War from Assistant Chief of Staff, September 24, 1918, recommending approval for recruit examining building (Approved October, 1918). On file, Record Room, A. G. O., 652 (Misc. Div.).

(71) Letter from the president, Camp Examining Board, Camp Dix, N. J., to the Acting Surgeon General of U. S. Army, November 2, 1918. Subject: Draft examinations. On file, Record Room, S. G. O., 327.2 (Examinations, Camp Dix) D.

(72) Based on correspondence on file, Record Room, S. G. O., 702 and 730 (camp concerned) D.

(73) Correspondence on file, Record Room, S. G. O., 702 and 730 (Tuberculosis (camp concerned)) D.

(74) Correspondence on file, Record Room, S. G. O., 322.171-1 and 322.052 (camp concerned) D.

(75) Correspondence on file, Record Room, S. G. O., 704.2-1 (Convalescent Center (camp concerned)) D.


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(76) Letter from The Adjutant General to all department commanders, commanding generals of all divisions and ports of embarkation, and commanding officers of all camps, recruit depots, and excepted places, August 22, 1918. Subject: Special examiners. On file, Mail and Record Division, A. G. O., 342.15 (Miscellaneous Division).

 (77) Circular, unnumbered, W. D., July 16, 1917.

(78) Correspondence on file, Record Room, S. G. O., 730 (Orthopedic (camp concerned)) D.

(79) Report of Neurological and Psychiatrical Service, Camp Lee, Va., November and December, 1917, by Maj. James Ross Moore, M. R. C. On file, Record Room, S. G. O., 702-3 (Camp Lee) D.

(80) Memorandum from Capt. George G. Shor, U. S. N. G., Assistant Division adjutant to the division surgeon, March 21, 1918. Attached to 3d ind., Office of Division Surgeon, 33d Division, Camp Logan, Tex., March 21, 1918, to the Surgeon General of the Army. On file, Record Room, S. G. O., 327.2 (Examination, Camp Logan) D.

(81) Correspondence on file, Record Room, S. G. O., 322.052 (Development Battalion, Camp Meade) D.

(82) Letter from The Adjutant General of the Army to the commanding generals of all Regular Army, National Army, and National Guard Divisions, March 8, 1918, and attached papers. Subject: Rehabilitation of the physically unfit. On file, Record Room, S. G. O., 353.91-1.

(83) G. O. No. 45, W. D., May 9, 1918.

(84) Correspondence on file, Record Room, S. G. O., 322.052 (Development Battalion (camp concerned)) D, and 721-1 (camp concerned) D.

(85) Tables of Organization, W. D., Series "D," corrected to March 19, 1918, Table No. 401, Training Battalion, Infantry, Maximum Strength.

(86) Circular No. 7, W. D., October 8, 1918.

(87) Report on Development Battalions and Limited Service, by Harry E. Mock, M. D., undated. On file, Historical Division, S. G. O.

(88) Circular No. 188, W. D., December 31, 1918.

(89) Letter from The Adjutant General to the commanding generals of all demobilization centers, May 28, 1919. Subject: Instruction creating at each demobilization center a demobilization group and directing demobilization at each such center, as soon as practicable, of depot brigade, convalescent center, and development battalion. Table of organization incorporated in letter. On file, Record Room, A. G. O., 324.122 (Misc. Div.).

(90) Annual Report of the Surgeon General, U. S. Army, 1918, 390.

(91) Instruction Letter No. 1, Dental Division, Surgeon General's Office, September 11, 1917.

(92) Letter from the division surgeon, Hdqrs., 76th Div., Camp Devens, Mass., to the Surgeon General, U. S. Army, February 25, 1918. Subject: Report required by paragraph 370, M. M. D. (annual report). On file, Record Room, S. G. O., 319.1 (Report, Camp Devens) D.

(93) Circular Letter No. 106, W. D., Office of the Surgeon General, February 25, 1919. Subject: History of dental service. On file, Record Room, S. G. O., 703 (Camp Shelby) D.

(94) Instruction Letter No. 2, Dental Division, Surgeon General's Office, October 16, 1917.

(95) 4th ind., W. D., Adjutant General's Office, May 14, 1918. Indorsement to letter from the division dental surgeon, Camp Hancock, Ga., to the Surgeon General, U. S. Army, April 16, 1918. Subject: Dental surgeons and dental assistants. On file, Record Room, S. G. O. 322.3 (Dental Corps, Camp Hancock) D.

(96) Letter from Capt. Robert F. Mille, M. R. C., plastic and oral surgeon, Camp Travis, Tex., to the Surgeon General, U. S. Army, May 6, 1918. Subject: Report of oral survey in compliance with S. G. O. No. 201, 1917, and Camp G. O. No. 32, c. s. On file, Record Room, S. G. O., 730 (Oral and plastic surgery, Camp Travis) D.

(97) Telegram from Gorgas to camp surgeon, Camp Wadsworth, S. C., October 3, 1918. Copy on file, Record Room, S. G. O., 322.3 (Dental Corps, Camp Wadsworth) D.

 

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(98) Eakins, Horace S., Capt., V. C.: History of the Veterinary Service, U. S. Army. Veterinary Bulletin, Veterinary Division, Office of the Surgeon General, Washington, 1925, XV, No. 5, 199-206.

(99) Based on veterinary histories of the various camps. On file, Record Room, S. G. O., 314.7 (Veterinary (camp concerned)) D; also, veterinary histories of various auxiliary remount depots. On file, Record Room, S. G. O., 314.7 (Auxiliary Remount Depot, (camp concerned)) R.

(100) Circular Letter No. 16, Veterinary Division, Surgeon General's Office, February 20, 1918.

(101) Tables of Organization, W. D., Series "A," January 14, 1918, Table No. 43, Veterinary Service.

(102) Eakins, op. cit. XV, No. 6, 244.

(103) Letter from First Lieut. Rosser Lane, V. C., Hdqrs. Camp Custer, Mich., to the Director, Veterinary Corps, February 20, 1919. Subject: Veterinary history of the war. On file, Record Room, S. G. O., 314.7 (Veterinary, Camp Custer) D.

(104) Annual Report of the Surgeon General, U. S. Army, 1919, II, 1206.

(105) War Department annual reports, 1918, 1296.

(106) Eakins, op. cit., XV, No. 6, 248.

(107) Annual Report of the Surgeon General, U. S. Army, 1919, Vol. II, 1204.

(108) Annual Report of the Surgeon General, U. S. Army, 1918, 279.

(109) Circular No. 73, W. D., November 18, 1918.

(110) Memorandum from Maj. Gen. Henry Jervey, U. S. A., Assistant Chief of Staff, Director of operations, for The Adjutant General, April 5, 1919. Subject: Information for demobilization centers as to the daily numerical capacity for discharge. On file, Record Room, S. G. O., 370.01-2.

(111) Cir. Memo., Surgeon General's Office, November 21, 1918.

(112) Cir. No. 90, W. D., November 25, 1919.

(113) Cir. No. 33, Office of the Surgeon General, Jan. 18, 1919.

(114) Correspondence on file, Record Room, S. G. O., 341-1 (camp concerned) D.

(115) Cir. Letter No. 257, Surgeon General's Office, July 15, 1919.

(116) Cir. Letter No. 358, Surgeon General's Office November 28, 1917.

(117) Letter from Surgeon General Rupert Blue, (U. S. P. H. S.), to the Director of Operations, U. S. Army, Office of Chief of Staff, March 11, 1919. Copy attached to memorandum from Col. F. G. Kellond, G. S., Equipment Branch, Army Operations Division, for the Surgeon General, U. S. Army, March 13, 1919. On file, Record Room, S. G. O., 323.7 (General).

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