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HISTORY OF THE OFFICE OF MEDICAL HISTORY
PORT OF EMBARKATION, NEWPORT NEWS, VA.a
The choice of Newport News as a port of embarkation was obviously made on account of its geographical location, sheltered roadstead, extensive rail and water connections, and open climate. The facilities for docking and coaling ships, loading troops, animals, and supplies, and repairing and dry-docking vessels combined to make it a logical port from which to conduct military embarkation and debarkation. Its contiguity to the Norfolk Navy Yard and naval base made cooperation with the naval forces easier of accomplishment. Above all, the large areas of open country afforded building sites for the various camps and warehouses which were necessary for the men, animals, and supplies which were destined overseas.
Investigations made it evident that the port activities could not properly be confined to either Newport News or Norfolk. Therefore, Norfolk, the adjoining municipalities of Portsmouth and Berkley, and the coast-line section due north to Sewall's Point and westerly to Pig Point, all on the south side of the James River, were included. On the northern bank of the James, the port included the territory beginning at the soldiers' home and ending about 2 miles north of Lee Hall. Later, the Richmond and West Hampton College, at Richmond, Va., was taken over as Debarkation Hospital No. 52.
In this large area it was necessary to construct roads, to lay railway tracks, to build vast warehouses, corrals, barracks, kitchens, hospitals, laundries, officers' quarters, and office buildings, to run telephone, telegraph, and electric light wires, and to provide water supplies, the instrumentalities for police and fire protection and the disposal of wastes.
The many activities ultimately included in the port of embarkation and with which the port surgeon was concerned are listed here not only to facilitate orientation but also to show the territorial scope of the port surgeon's responsibilities. The first 12 activities were located on the Newport News side of Hampton Roads; the remainder were on the Norfolk side.
1. Debarkation Hospital No. 52 (near Richmond, Va.).
2. Camp Alexander (stevedore and labor battalions).
3. Camp Morrison (aviation camp).
4. Animal Embarkation Depot No. 301.
5. Camp Hill.
6. Motor Truck Corps.
7. Quartermaster General supply depot (brewery units).
8. Camp Stuart.
9. Embarkation hospital.
10. Port administration headquarters.
11. Debarkation Hospital No. 51 (near Hampton, Va.).
12. Miscellaneous activities: Skiff's Creek water project (near Lee Hall); fire and guard (near Lee Hall); pipe-line water project (near Harwood Mills); Harwood Mills water project; Big Bethel water project; military police (Newport News and Hampton); fire and guard (Newport News).
13. Army supply base (near Tanner's Point).
14. Norfolk Engineers' depot (near Lambert's Point).
15. General Ordnance supply depot (Pig Point).
16. Miscellaneous activities: Portlock classification yards; Gilmerton lumber yards.
Headquarters and accommodations for staff officers were secured in 15 rooms in a building in Newport News, a study was made of the developments necessary for the creation of docks, storehouses, railroads and switching facilities, wagon roads, water supplies, drainage, sites for depots, corrals, warehouses, hospitals, and camps; plans were drawn; contracts were let; and ground was broken for the first building on July 30, just 19 days after the commanding general's arrival.
It was necessary that construction operations be carried on at high speed in order that completed projects be occupied as rapidly as possible. The work was accomplished under most unfavorable conditions by reason of scarcity of material, transportation difficulties, shipping embargoes, and labor shortage. The housing facilities of Newport News speedily reached their limit of expansion, and many civilian employees could secure neither board nor lodging. Temporary barracks for workmen were rapidly erected; roads were constructed; sewer and water mains were laid; spur tracks were run from the main line
and, after a series of exasperating delays and several necessary changes of plans, the first shipment of lumber was received on the evening of September 1 and the actual work of constructing Camp Stuart, at Newport News, began. In the meantime, detachments of stevedores arrived and were placed under canvas at Camp Alexander, and several detachments of Cavalry and Artillery were similarly quartered at Camp Stuart.
The function, from the military point of view, of the collection of activities which constituted the port of embarkation was the shipment of supplies and the embarkation of men and animals for service abroad, together with storage, protection, and housing of the same prior to actual shipment; the inspection of men and animals so that no defectives be sent forward; the reception, classification, and shipment of men returning from overseas; and all the multitude of details which the collection and shipment of men, animals, and military stores entail. From the viewpoint of the Medical Department, it embraced everything which had to do with the prevention, detection, diagnosis, cure, and amelioration of wounds and sickness; the sanitation of the environment, the safeguarding of food and water supplies, the maintenance of cleanliness, the destruction and prevention of dangerous insects, the isolation of the infected, the disinfection of clothing and buildings; the administration of hospitals and dispensaries; the elimination of the physically and mentally unfit;
the sanitation of ships and trains; the transportation of the sick and wounded; and the physical examination of officers and men prior to discharge. To accomplish this, a well conceived, carefully organized and well administered agency was necessary.
THE PORT SURGEON
The functions of the surgeon of the port of embarkation, in a measure, combined those of the surgeon of a territorial department and of a division. He was responsible to the commanding general for the planning and proper administration of all the medical, surgical, and sanitary activities of a series of camps and hospitals; the physical examination of embarkation troops; the sanitation of transports; the medical and surgical care of troops en voyage; the reception, treatment, classification, entrainment, and care of returning sick and wounded; the discipline and training of medical and sanitary personnel; the maintenance of records, and the making of inspections and reports of various sorts. He was the medical, surgical, and sanitary advisor of the commanding general, and the outpost of the Surgeon General's Office. He was the advisor and coordinating focus of a large number of civilian activities having a direct relation to the mental, moral, and physical health of troops. He was called upon to solve all of the detail problems which confront a division surgeon, multiplied many times; he was vested with all of the responsibilities of a department surgeon.
ORGANIZATION OF PORT SURGEON'S OFFICE
The organization of the office of the surgeon was a matter of gradual growth and expansion. It began in two small rooms having a total floor space of 550 square feet. It finally occupied about seven times that area. At one time, the entire medical personnel of the port did not exceed 10; at the close of 1918, it was more than 5,000. The basic thought in the organization plan was the creation of an elastic but well coordinated machinery which would efficiently meet emergencies as they arose with due economy of personnel and matériel. Thus the needs of the situation were met promptly and without undue expenditure of funds or effort, while at the same time there was no idleness on the part of medical personnel or equipment.
THE EXECUTIVE OFFICER
The functions of the executive officer were to act as an understudy to the surgeon, to discharge his duties during his absence, and to relieve him of routine work and minor details. Theoretically, he was the liaison between the surgeon and the heads of the various divisions in the surgeon's office. Practically, many administrative perplexities found their way directly to the surgeon's desk, and, in the interest of prompt, aggressive business methods, it was better that the surgeon receive this knowledge at first hand. Nevertheless, the executive officer discharged many duties which left the surgeon time and strength
to attack special problems or decide matters of policy. In a measure, he performed many of the functions which, according to the Manual for the Medical
Department, vest in the sanitary inspector. This proved a valuable change, since it permitted the sanitary inspector to devote his entire attention to the protection of the troops against disease.
The first executive officer of the surgeon's office was detailed on January 15, 1919. Prior to this time the functions assigned to this office were performed either by the surgeon himself or by the sanitary inspector. The creation of this office in the organization scheme proved a valuable change. On account of the general character of his duties, however, it is impossible to render any adequate report on what he accomplished.
The adjutant performed all of the duties which ordinarily appertained to that office. He conducted all correspondence, was in charge of the files, prepared and issued orders under the direction of the surgeon, and attended to the details of assignments, promotions, etc. In addition, he commanded the headquarters medical detachment and was in charge of the civilian employees of the surgeon's office. He was assisted by two medical officers, one of whom was responsible for the property of the surgeon's office and the other conducted the transmission of telegraphic and telephonic communications.
In the early days of the port the operations of the surgeon's office were not large enough to require the appointment of an adjutant. By September, 1917, however, they had grown to such a size that the proper administration of the clerical work demanded the services of such an assistant. During the period from September 1 to November 1, 1917, the office force consisted of 2 civilian employees as stenographers and typists, and 2 noncommissioned officers and 4 privates of the Medical Department for handling the general office routine. Two additional civilians were employed as typists during the month of November, 1917, and one enlisted man was added to the office staff and placed in charge of the filing system. These additions were made necessary by the increased correspondence and clerical work incident to the growth of the port of embarkation, which was then assuming large proportions and becoming definitely established.
The office was moved to the newly completed administration building on River Road, Newport News, Va., on December 12, 1917, one room being assigned to the port surgeon and a portion of another being allotted to the enlisted personnel and civilian staff. The office was then reorganized and a more systematic program put in force. Prior to this time, the clerical duties of the adjutant's office and of the medical supply office had practically been combined and were discharged by the entire office staff, but 1 civilian employee, 1 non-commissioned officer, and 2 privates were then assigned exclusively to the medical supply officer. Incidentally, an addition of three enlisted men was made to the adjutant's office staff, and the office routine was arranged so that separate and distinct divisions were established to achieve specialization and greater efficiency. The position of chief clerk was created and a noncommissioned officer so assigned. Through him passed all incoming and outgoing correspondence for distribution as required, the incoming mail passing to the adjutant for action and the outgoing mail returning to the chief clerk for disposition.
The chief clerk, furthermore, assumed direction, under the command of the adjutant, of the entire clerical force.
Three divisions were organized, namely, a sick and wounded division, a personnel division, and a filing division, each with a competent noncommissioned officer at the head who, together with the three civilian typists and three enlisted men as utility clerks, comprised the office force.
The sick and wounded division handled all monthly reports from the various infirmaries and hospitals throughout the port. These were thoroughly checked and corrected before transmission to the Surgeon General. A complete record of all surgeons' certificates of disability and other data pertaining thereto was also compiled by this division. The officer on duty as hospital inspector acted as supervisor of this branch.
The personnel division kept an accurate record of all officers and enlisted men of the Medical Department on duty at the port, a directory being opened and all changes promptly recorded. This division likewise prepared and was responsible for the rendition of all personnel reports and returns to the office of the Surgeon General.
The filing division had by this time grown to large proportions and this important cog in the office machine was conducted in a most efficient manner.
Thus organized, the office routine moved with precision and expedition. The period between December, 1917, and April, 1918, gave evidence of continuous development throughout the port, and a coincident increase in the operations of the Medical Department.
A preembarkation medical examining board having been established, a noncommissioned officer was assigned to it for duty. It was found necessary to assign another enlisted man to the sick and wounded division. He took over the records of surgeons' certificates of disability and inaugurated an index of all port and War Department general orders, bulletins, etc., a system being devised whereby each circular was brought to the attention of all officers on duty in the office of the surgeon, each officer being required to initial the order after reading.
The month of April, 1918, revealed the need of further clerical assistance, the work fast outgrowing the office force. New infirmaries were opened from time to time in the port and adjacent camps and the several hospitals were constantly enlarging, coupled with which was the increased movement of troops overseas. An officer joined at this time as personnel officer and assistant to the adjutant. Several additions were made in the enlisted force, 4 men joining, 1 being assigned to the filing division, 1 to the personnel division, and 2 as typists and utility clerks. The volume of work handled by the office continued to increase rapidly and three further additions were made to the enlisted force during May, 1918. A system for recording the names of all sick and wounded returning from France through both ports of embarkation was devised during this month. Duplicate lists of all men arriving at Newport News were forwarded to the office of the surgeon, port of embarkation, Hoboken, N. J., and
in return, duplicate lists were received of all men reaching the latter port. A card was instituted for every sick or wounded man debarking in this country. On
this card appeared all data concerning him and showing his final disposition. The preparation of these cards was included as a part of the duties of the filing division.
A fourth civilian stenographer was engaged in June, 1918, the steadily increasing movement of troops through the port entailing a corresponding increase in the reports, records, correspondence, and other data handled by the adjutant. A noncommissioned officer was appointed assistant chief clerk; and additional floor space being required for desk room for officers and enlisted men, permission was granted to take over a further portion of the second room in use. From time to time during the months of June, July, and August, 1918, additional enlisted personnel was detailed to meet the greater office needs and
to replace several enlisted men who were commissioned or transferred. The month of September found the numbers of returning sick and wounded increasing to such an extent that a separate division was established to meet the situation. All questions relating to service records and other matters in connection with returning men were referred to this division.
The latter part of September and the first half of October saw the adjutant's office taxed to its utmost. This was due to the influenza epidemic then prevailing in the port, at one time more than half of the enlisted and civilian personnel being absent from duty.
The end of October, 1918, found the office force augmented and divided as follows: Chief clerk and assistant chief clerk; sick and wounded division-noncommissioned officer and assistant; filing division-noncommissioned officer and two assistants; property and supplies division-noncommissioned officer and assistant; personnel division-noncommissioned officer and assistant; transport and returning sick and wounded division-noncommissioned officer and two assistants; Surgeon's Certificate Disability and orders division-one noncommissioned officer; four utility clerks and orderlies, and four civilian typists.
The signing of the armistice, and the ensuing demobilization plans, applications for discharge, and still greater number of returning sick and wounded from overseas, brought a further increase in correspondence and clerical operations, calling for the employment of an additional civilian typist and several enlisted men to assist in the filing and returning sick and wounded division. The medical supply offices having been consolidated with the port storage division, more office space was available. This was much needed to meet the expansion of the adjutant's office force, which was greatly handicapped by
crowded conditions. At the same time, a third room was vacated by the ordnance officer and assigned to the statistical and historical division.
The following table, which was compiled from the consolidated morning report of the first day of each month, shows the gradual increase in the commissioned and enlisted personnel of the port.
These figures do not include the detachments of enlisted men of the Quartermaster Corps, labor companies, fire and guard, etc, and civilians, which were on duty at the hospitals.
MEDICAL SUPPLY OFFICER
The first organization for medical supply issues and overseas shipping at Newport News was planned by the medical officers who supervised the installation of the medical supply organizations at camps and ports throughout the country during July and August, 1917. Regular Army officers of the Medical Corps were chosen to start the work and were to have assistants to be commissioned in the Sanitary Corps, either from noncommissioned officers of the Medical Department or from men in civil life who were qualified in certain lines. An officer, after a short period of instruction at the New York Medical
Supply Depot, was sent to Newport News about August 1, 1917, as medical supply officer, under the direction of the port surgeon. A civilian was shortly afterwards commissioned first lieutenant in the Sanitary Corps and detailed as assistant. A retired noncommissioned officer of the Hospital Corps was detailed as chief clerk. He was soon commissioned in the Sanitary Corps and retained in charge of records.
The port of embarkation was still in its infancy. Camp Stuart and Camp Hill existed only as blue prints in the office of the constructing quartermaster. Requisitions were immediately made for a quantity of office furniture and for the equipment of the attending surgeon's office. This was followed by a requisition for medical equipment to outfit 24 troop transports. These supplies were never used for that purpose, but formed the nucleus for the medical supply depot that was started on the upper floor of a warehouse.
The first supplies for overseas shipment were veterinary medicines, which arrived the first week in September, 1917, and were stored at Pier 5 awaiting the arrival of the first transport. They were assigned in the cargo of the steamship Panaman, which loaded on September 26, 1917. Due to a breakdown, she was put into the shipyard and held for a month after loading.
The medical supply depot was moved during October, 1917, to the upper floor of the brewery building, later known as warehouse 1, group 1, where active issuing was begun in order to supply the organizations beginning to occupy the new camps. The operations at the depot and supervision of the medical supplies handled at the piers had both been assigned to one officer, but with the rapidly increasing quantity of supplies arriving at the piers it was found necessary to request the detail of another officer who could devote his entire time to that work. Since the Army transport service checking had been found to be very unreliable, the port commander directed that each corps put details of their own men on the piers to check all shipments.
The medical supply depot had outgrown its quarters and was moved to warehouse 3, group 1, about December 1, 1917, where better facilities were installed and a much larger stock was carried. The piers and railroad yards had become so badly congested with overseas freight at about this time, due to the unusually severe winter, the shortage of ships, and the lack of a proper system for releasing shipments consigned to Atlantic ports, that a complete embargo was put on the port, and the months of January and February, 1918, were spent in clearing out the supplies on hand. The medical supply depot was
forced out of warehouse 3 during the first week in February by the growing need for space by the clothing section of the depot quartermaster's office, and was moved to more permanent quarters in the warehouse group at the west side of Camp Stuart.
The overseas warehouse groups near Camp Hill were nearing completion and space was assigned to the different supply branches, requiring another officer to take charge there. Warehouses 9, 10, and 11, were first assigned to the use of overseas medical supplies. The assignment was later changed to warehouses 22, 23, and 24. An office to supervise this work was established in the new warehouse administration building. The congestion of freight became much relieved by spring and the tonnage shipped per month increased rapidly. The commissioned and enlisted personnel increased in proportion to handle the growing work.
The medical supply organization was authorized to induct suitable men for training in medical supply work, and approximately 400 men were obtained in this manner during April and May, 1918. Some of these men were trained only a short time before being sent to other camps. A regular course of instruction was followed, supplemented by lectures five evenings a week for the men who desired to take the examinations for commissions. The instructors were officers of the medical supply organization who were assigned to this work in addition to their own duties. This school was continued, with several different
classes, until August, 1918. The first examination for commissions among the candidates in the medical supply school was held in May. Thirteen men qualified and were commissioned as second lieutenants in the Sanitary Corps, being the first men to be commissioned in this branch with that rank. They were called into active service as needed from June 15 to July 15. Other examinations were held during the following months and a total of 35 men commissioned as second lieutenants from this school.
The field medical supply depot company, having been authorized by the War Department, the medical supply organization at Newport News was directed to assemble and equip these units. The commanding officers for the units were ordered to Newport News by the Surgeon General, but the details of organization were left to the medical supply officer. Field Medical Supply Company No. 1 was organized about April 15, 1918, but did not leave Newport News until June. Units Nos. 2 and 3 were organized shortly after No. 1 and they were all sent overseas about the same time. Other companies were organized as these were sent out, so that at least two units were in training at all times. Thirteen companies were organized, but the last four did not get overseas.
The shipping of motor ambulances was turned over to the newly organized Motor Transport Corps in August, 1918. This item had been a large one, and it was believed that the loss would reduce the medical tonnage considerably, but this proved to be incorrect. The lost tonnage was made up the first month by the increased quantity of other medical supplies, and the following months showed an increase. The peak of the shipping was reached in October, 1918, when 5,380 tons were shipped.
A consolidation of all the supply branches took place in October, 1918, to be operated under one central organization. Previous to this time, each branch of the Army had handled its supply work independently under the supervision of the commanding general of the port. The medical supply organization had received all medical shipments, checked and stored them, secured cargo allocation from the shipping control committee, and made the shipments to the piers. Under the new plan, this work was pooled with the similar work of other supply branches. The first step was the organization called for under General Order No. 54, War Department, under which port supply officers were to be appointed for each corps, with a port storage officer to supervise the entire organization.
No further consolidation was undertaken for a time. Active consolidation started in October. This reorganization took considerable time and was not put into actual operation until after the armistice was signed.
The medical supply officer and his office organization moved from the port of embarkation headquarters building on November 16 and consolidated with the medical warehouse office, where the port storage office was opened. The medical supply depot remained a separate unit for local issues until January 1, 1919, when it was taken into the port supply depot organization as part of the division of purchase, storage, and traffic, of the General Staff.
The medical supply depot, as a local issue organization, had furnished medical supplies to all the camps under the port of Newport News for the period of the war. This not only involved the permanent personnel but also all organizations sent through the port. It also furnished the necessary medical supplies for troop and animal transports. The veterinary medicines and disinfectants for the animal embarkation depot were large items in themselves. For several months all organizations going overseas were required to take their entire impedimenta. Inspection was made here and shortages in equipment had to be secured before embarking. This made it necessary for the medical supply depot to carry a large stock to meet emergencies.
Since the organization of the port storage office was not effected until after the close of hostilities, to the medical supply organization, as part of the port surgeon's office, was alone due the credit for the handling of all overseas medical supplies at Newport News during the period of the war. The total quantity for the 15 months of active operations amounted to nearly 30,000 tons. A conservative estimate of the value of medical items handled is $25,000,000. The largest individual item was 112 evacuation hospitals which were valued at approximately $5,000,000. The 856 motor ambulances cost nearly $1,500,000. Another large item was 12,370,000 packets, each containing 2½-yard lengths of sublimated gauze, and each packet costing 10 cents. Over 150,000 folding hospital beds were shipped, and a corresponding quantity of cotton felt mattresses or pads.
One hundred and seventy-five different shipments were made on transports. Only two of the ships with medical cargo were sunk, to wit, the steamship Dora and the steamship Ticonderoga. The largest medical item on the Dora was the complete equipment for Base Hospital No. 41, valued at approximately $80,000.
Red Cross dressings and hospital supplies which were invoiced to the Army were shipped through the medical supply organization at this port. The total Red Cross shipments, exclusive of base hospitals, amounted to 437 tons. The principal items were: 1,278,000 unsterile dressing pads, 1,633,800 gauze rolls, 564,200 gauze sponges, 3,881,540 gauze wipes, 155,206 pajama suits and 79,600 operating gowns.
The following tabulations on total shipments of medical supplies are noteworthy:
aOther items are chiefly drugs or replenishments of different kinds whose value may be assumed to be higher than that of the items listed, due to the large percentage of expensive medicines.
American Red cross supplies shipped by medical supply organization, Newport News, Va.
THE SANITARY INSPECTOR
An officer was detailed as sanitary inspector of the port on August 21, 1917. The sanitary inspector was responsible to the port surgeon for the preparation and execution of all general sanitary orders; for the health of both the permanent garrison and the transient troops. The discharge of these functions comprehended the sanitation of the entire environment-the inspection of foods, beverages, mess halls, bakeries, exchanges, and other places where articles of diet or drink were stored, prepared, served or sold; the control of insects and vermin; the sanitation of laundries; the prevention, control, and eradication of the communicable infections, including isolation, quarantine, and disinfection; the collection and tabulation of morbidity and mortality data; the search for chronic carriers of disease, and the study of problems related to fatigue, exposure, and other debilitating influences.
The sanitary inspector directed the work of the nutrition officer, whose functions covered an important field in the proper rationing of troops and were both advisory and administrative.
Under direction of the sanitary inspector was the epidemiologist, who collected the statistical data bearing on mortality and morbidity and prepared graphs and charts therefrom, conducted intensive studies relative to the occurrence of communicable diseases, and made special sanitary inspections when necessary. He was assisted by an officer of the Sanitary Corps and a sergeant.
The sanitary engineer was detailed by the Surgeon General for special duty in connection with the water-supply developments which were undertaken by the Army on account of the inadequacy of the local supply. He acted as a general advisor on sanitary questions involving a knowledge of sanitary engineering.
The chief of the division of insect control reported to the sanitary inspector. Under his direction were the malarial detachments at Camp Stuart, Camp Hill, Camp Morrison, Camp Lee Hall, Camp Pig Point, and the Army supply base, and the fly-control detachment of the animal embarkation depot, and special inspectors of garbage, latrines, and mess halls. He was also responsible for louse-control operations at Camp Stuart, Camp Hill, and Camp Alexander for well troops, and at the embarkation hospital and debarkation Hospitals Nos. 51 and 52. In addition, he directed miscellaneous insect-control operations
for the prevention and destruction of cockroaches and bedbugs.
The administration of the sanitation of the port was extremely difficult, particularly during the construction period. To properly safeguard the health of the military forces, it was necessary to maintain the strictly military areas
in a sanitary condition and to secure the same hygienic results in the civilian locale. This latter function vested in the Public Health Service and the Newport News Health Department. The situation would have been greatly simplified had there been a sharp geographical line between the civilian and the military jurisdictions, but there were various small detachments located in camps and buildings throughout the city while the larger camps were located in the outskirts of the city. The city health authorities were overwhelmed by the magnitude of the problem which confronted them. The pre-war sanitation of Newport News was never good-the city abounded with insanitary privies; the garbage collection and disposal service was archaic; the terrain was low, with many mosquito-breeding, swampy areas; the streets were filthy and poorly drained; and the restaurants were grossly insanitary. The city health authorities were reduced to the apathy of despair when such a defective sanitary organization was subjected to the stress of increased population. The surgeon, early realizing the importance of placing and maintaining the civilian area in a safe sanitary condition, wrote the following letter on July 19, 1917:
From: Surgeon, port of embarkation, Newport News, Va.
1. In view of the prospect of a large military institution being established at this place, I request that the Public Health Service be asked to furnish me with such information as is on file concerning the health and sanitation of this city and vicinity.
2. It is believed that a sanitary expert from the Public Health Service should be sent to this city with a view of suggesting to the city authorities measures for improving the sanitation of the city and the surrounding territories.
The Public Health Service undertook a sanitary survey of the situation and later detailed officers for the conduct of an active sanitary campaign in cooperation with the Army, State, and local health authorities. Lack of funds and absolute authority on the part of the Public Health Service made the speedy accomplishment of the desired results exceedingly difficult and slow, and a visiting medical officer, after a thorough inspection of the situation (June 11-13, 1918), recommended that the sanitation of the peninsula, including the city of Newport News, be placed under the surgeon of the port. This was not done, but, by the constant labors of the Public Health Service, the majority of the insanitary privies were abolished and the general sanitation of the city was greatly improved. There was harmonious cooperation
between the surgeon and the Public Health Service, and the military authorities were able to lend great assistance in the sanitation of restaurants and the abolition of the fly-breeding garbage dumps.
The part of the city drained by the west branch of Newport News Creek was frequently inundated and constituted a serious menace because it favored the breeding of malaria-carrying mosquitoes. This condition resulted from the failure to keep the creek and the culverts free from refuse. This danger was abolished after this material had been removed and free drainage established. Similarly, the sewer catch basins were clogged with street detritus, but were incompletely cleaned after a number of protests from the sanitary inspector and the Public Health Service. The streets were never satisfactorily
clean except immediately after a heavy shower, but they had improved markedly toward the end of the occupation of the port by the Army. Cans for the reception of waste paper and trash were installed by the city authorities on each street corner and in the center of the long blocks, and this aided very much in improving the sanitary condition of the streets. This resulted, in part, from the psychological fact that the public will unconsciously aid in keeping a street clean but will just as unconsciously make a dirty street dirtier. The city abounded in pigpens at one time. A few of these were gradually removed, with a resultant decrease in the number of flies.
The sanitation of restaurants in the civilian locale was under the jurisdiction of the Public Health Service. This organization inspected all places handling or preparing food for public sale and issued orders for the rectification of insanitary conditions. Copies of these orders were furnished the sanitary inspector and, in case of failure to comply therewith, a military policeman was stationed in front of the restaurant and soldiers were forbidden to enter. This resulted in a very satisfactory clean-up of these places and was an aid in protecting the health of the troops.
The control of the manufactories of soft drinks was not a problem of great magnitude since the bulk of the bottling works supplying the port was situated elsewhere. Places located in the immediate vicinity were carefully inspected and all insanitary conditions noted and brought to the forceful attention of the management. Exchanges were forbidden to purchase the products of any bottling works which failed to comply with the recommendations of the sanitary inspector. Bacteriological examinations of imported soft drinks were made at frequent intervals.
The most vexatious problem during the earlier days of the port was connected with the sanitation of the stevedore regiments, then stationed at Camp Hill, Va. These men were overcrowded in insanitary, floorless tents, without cots or mattresses. There were no bathhouses, there was much lousiness and measles; cerebrospinal meningitis and pneumonia were prevalent. Recruits were often received without advance notice in lots of 5 to 35, wearing worn-out civilian clothing, the men having been instructed to wear such clothes as the Government would issue uniforms at once. At other times, 100 to 500, and
in one case 1,000, recruits were received at one time on 24 to 36 hours' notice. Recruits were received who apparently had not received a physical examination. In some instances these men had fractured limbs, defective joints, flat feet, or were suffering from contagious diseases such as pneumonia, tuberculosis, cerebrospinal meningitis in advanced stages. Blankets and clothing were seldom on hand in sufficient quantity to properly equip these men. Frequently men were in camp from four to six weeks without receiving an issue of clothing. Only a few additional cases of communicable diseases occurred so long as the weather remained mild, but, with the first severe days of winter, the condition became so acute that on November 24, 1917, a letter was addressed by the surgeon to the commanding general, inviting his attention to the large amount of respiratory diseases in the stevedore regiments and requesting that additional tentage be provided to correct the great overcrowding which then existed. A report
was made on January 9, 1918, after about a week of investigation by the sanitary
inspector, showing that the tents of the stevedore regiments were greatly overcrowded, that many men had no cots, and that they were not sufficiently provided with bedding. There occurred in these
organizations during the months of November and December, 1917, and January, 1918, 222 cases of measles, with no deaths; 18 cases of bronchopneumonia, with 7 deaths; 139 cases of lobar pneumonia, 25 deaths; 46 cases of cerebrospinal meningitis, with 16 deaths; and 57 cases of bronchitis, with no deaths; a total of 482 cases, with 42 deaths.
The sanitary situation was attacked with vigor late in January, 1918, and on February 11 a general inspector made the following report of his investigation of February 4-8:
The present condition of the camp, while evidently improved, is still quite unsatisfactory. * * * The tents in which the members of the command are housed have all received makeshift floors of extra lumber and other materials picked up in various places, and the mess shacks have been constructed of odds and ends, including tin cans and old canvas. The present commanding officer of the camp has been making strenuous efforts to obtain bathing facilities for the men. After the time of inspection he completed a building with about 24 showers, with hot-water connections, and was hoping to be able to provide a bath for all members of the command within the next few days. They have had no opportunity to bathe during the freezing weather which has been prevalent of late, none having bathed for at least a month. He stated that request had been made for the immediate provision of more showers, and for tubs in which the men could wash their clothes, a thing which most of them had been unable to do since their arrival in camp. All the men are now provided with three blankets, cot, bed sack, uniform, heavy underwear, socks, two pairs of shoes, and overcoat. Most of them have also received Red Cross sweaters, gloves, and helmets. * * * The commanding general, port of embarkation, has finally assumed complete control of this camp. * * * It was understood, when this camp was first established that it would be entirely independent of the port of embarkation, excepting that the latter should furnish subsistence. The commander of the stevedore and labor organizations was to have charge of all other matters relating to this camp and was responsible for proper housing and equipment. He reported directly to the chief of embarkation service.
From that time forward there was a steady improvement in the sanitary condition of the stevedore camp, and later, when a new camp was constructed on the bank of the James River to the north of the village of North Newport News, it was one of the most sightly and sanitary camps in the entire port.
A nutrition officer reported December 1, 1918. The work of his office was conducted under the direction of the sanitary inspector, and began with a detailed study of the mess system of the embarkation hospital. The procedures of investigation and assistance in mess improvement which were followed in his subsequent work were formulated during the period of this study. Since the results accomplished depended largely upon the methods put in force, these are described in detail.
With a few exceptions, the nutrition officer followed the practice of working successively with groups of three or four messes. One or two weeks were spent with each group, the length of time depending upon the conditions found. The first two or three days of each study were devoted entirely to the group. Thereafter, three or four routine inspections were made daily of messes which had previously been studied in detail. Fifteen to 30 minutes were required for each of these routing inspections.
The necessary arrangements were made with the commanding officer of the group and the individual organization commanders before beginning work with a group of messes. The function of the nutrition officer was explained and any special authority which the commanding officer wished to confer was arranged. With few exceptions, all suggestions for improvement of the messes were welcomed by organization commanders, and mess sergeants were instructed to follow the directions of the nutrition officer.
It was possible to obtain detailed and reliable information concerning all phases of management and operation by keeping in close touch with a limited number of messes for one or two weeks, and thus to discover the fundamental difficulties. This made possible more effective recommendations and gave an opportunity to assist in carrying them out. These recommendations were made verbally and by memoranda to organization commanders and mess officers and to the surgeon through reports. The nutrition officer was able to bring about many improvements in mess organizations after gaining familiarity
with the problem. The activities of the nutrition officer in relation to individual messes were entirely investigative and advisory, and dealt particularly with the matters which follow.
MESS ORGANIZATION AND PERSONNEL
A lack of organization of the mess force was frequently found to be the cause of insanitary conditions and excessive waste. Recommendations looking to a more definite correlation of administration, assignment of routine duties, and more systematic methods of work were made in such cases. The manner in which the mess officer and the mess sergeant performed their duties was noted, and when either of these was found lacking in interest, the most suitable means of correction were adopted. Reference handbooks were suggested and specific instructions were given when sergeants or cooks were found to be lacking in knowledge or experience.
PURCHASING AND ACCOUNTS
The nutrition officer was able to assist in coordinating the purchase of supplies with dietary requirements and the available mess funds by keeping in touch with the subsistence division and the outside markets. To stimulate economical purchasing, mess sergeants were informed of commissary contract prices with local dealers, and were put in touch with the 12th Infantry regimental store, from which they were able to secure many items of selected produce at a reduced price.
The failure to keep systematic current accounts and properly to correlate these with menus and purchases was found to be a contributing factor to an unsatisfactory diet in a number of organizations. Marked improvement was noted in such instances when accounts were kept up to date and purchases were more carefully planned. Less experienced mess sergeants utilized the ration more uniformly and satisfactorily after they were required to calculate the cost of each meal and the ration saving or deficit for each day. The practice of accumulating large funds at the expense of the regular mess, to be spent
lavishly on special affairs, was discouraged.
SUPPLIES AND STORAGE
The food supplies in the hands of organizations were inspected with reference to their nutritive value and deterioration from spoilage or other causes, the source of any difficulties on this score being determined and adequate corrective measures instituted. Misunderstandings as to the quality of supplies purchased from the subsistence quartermaster were prevented by cooperation with the Subsistence Division. This applied particularly to good coffee improperly made, frozen meats not properly handled, and sound canned goods in cans which had an unsatisfactory appearance. Mess sergeants and cooks
were instructed in the detection of questionable canned goods and were informed of the ruling of the Quartermaster General relative to their disposition.
The nutrition officer visited most of the establishments selling foods to the messes, and also consulted with the local food division of the United States Public Health Service concerning the sanitary condition of these places. No serious objections on this score were found.
In spite of the vital importance of storing food under the best possible conditions, this phase of mess management was found to be the one most often neglected and was the most frequent reason for the presence of unsatisfactory supplies. An additional reason was the attempt to keep meats and produce for too long a time and the failure to keep fruits and vegetables properly culled. Recommendations were made for improved conditions of storage in nearly every mess visited. The relation of the care of supplies to proper feeding and mess economy was repeatedly emphasized. The condition, use, and care
of refrigerators was closely observed in connection with the storage of meats and dairy products. Neglect of minor repairs to hasps, hinges, doors, inner drain pipes, and metal linings was frequently found to interfere seriously with the maintenance of proper temperature and sanitary condition of the box.
The storerooms of mess halls in Camp Stuart and Camp Hill were originally constructed without bins, platforms, or shelving. Plans were suggested which would make it possible to keep all food supplies off the floor in messes where such facilities were still lacking or unsatisfactory makeshifts were in use. New bread boxes were recommended and plans were furnished for these where merely screened-in spaces or airtight bins were used for storing bread. On account of excessive temperatures and high humidity in the summer months, the most satisfactory type of bread box for the vicinity of Newport News was
one furnishing complete protection from flies and maximum ventilation compatible with adequate protection from dust. The ventilation was best secured by means of screened openings in the sides and doors. The shelving was slatted, loose, and spaced to accommodate the loaves on end, and the box was raised about 30 inches from the floor.
SANITARY CONDITIONS OF MESSES
Messes were studied to detect and correct habitual insanitary practices rather than to determine the state of affairs at any particular time. Improvements were brought about in methods of washing dishes and mess kits, particularly in the matter of providing sufficient boiling water to sterilize them. Where company dishes were used or the mess kits were washed by a special
detail, the most satisfactory method was to wash the dishes thoroughly in hot, soapy water frequently changed, then to pile them loosely in a galvanized-iron can of boiling water on the stove or fire trench and to boil them 5 or 10 minutes. This process was greatly facilitated by the use of wire baskets with handles. While one basket of dishes was being sterilized, another was filled. The use of towels for drying plates was discontinued, since it was found that, when the dishes were properly washed, rinsed, and sterilized, the water quickly evaporated when they were spread on tables. Meat blocks, tables, and shelves with insanitary cracks or spaces were reconstructed or discarded. Particular attention was paid to the care of refrigerators, bread boxes, meat blocks, and kitchen utensils, especially knives and meat saws.
Other sanitary matters which were improved were: Practices with respect to the care of shelves, tables, and floors, particularly methods and frequency of cleaning; elimination of rodents, cockroaches, and flies; general cleanliness of storerooms, and precautions for keeping all foods properly covered.
With few exceptions, the nutrition officer found that the mess sergeants were almost entirely responsible for the feeding of the men. Many of these sergeants had never been cooks and were lacking in experience in the proper knowledge of nutritional requirements and of the composition and function of the various types of food materials. These deficiencies were evidenced by poorly planned menus and lack of balance in the diet over extended periods. Whenever menus were kept on file, the nutrition officer tabulated these for the two or three weeks preceding his visit to the mess, making a careful, qualitative study of the diet for the period with respect to a balance of carbohydrate, fat, protein (complete and incomplete), salts, acid and base producing components, antiscorbutic properties, crude fiber and other laxative properties, variety in methods or preparation, and of condiments, flavors, and food materials used and the agreeability of combinations for individual meals. The results of these studies were used as a basis for the instruction of mess sergeants.
Many dietary errors were corrected by increasing the amounts of fruits, vegetables, and milk used. It was found that the different factors of the diet could be satisfactorily controlled by careful planning of menus and purchases, in spite of the fact that prices in the local market were very high and the choice of produce somewhat limited during the winter months. Money was saved for the purchase of fresh fruit by partially replacing fresh beef, pork, and mutton with a reasonable portion of cheaper substitutes, such as liver, frankfurters, link sausage, lima beans, split peas, macaroni and cheese, etc. Sweet potatoes,
cabbage, spinach, carrots, beets, turnips, and parsnips could be obtained in the local market all winter and usually could be purchased at a lower price than canned vegetables. The successful use of these vegetables required special attention as to variety and methods of preparation. Excessive fat, protein, and acid residues were reduced by these additions and substitutions, essential vitamins and crude fiber were increased, and the diet was made more satisfactory to the men. Some of the most poorly balanced diets were encountered in certain negro labor battalions where the men were fed according to their own
notions of a satisfactory diet. These diets were exceedingly high in protein and fat. Vegetables were limited almost entirely to navy beans, potatoes, canned corn, peas, and tomatoes, and even these were served only at intervals. Potatoes were omitted from as many as five successive meals in one mess. It was noted that in these organizations the men were very lazy and had little resistance to cold and minor throat infections, and it was believed that their diet was a contributing factor to these conditions.
Monotony of diet was found to be a frequent source of complaint in messes when the food was really well prepared and properly balanced. It was easy for mess sergeants to get into the habit of repeating a limited list of menus with only slight variations. The nutrition officer corrected such mistakes in many instances by recommending certain variations in food material, methods of preparation, and seasonings used. Menus were planned in periods of one or two weeks in a tabulated form, showing each type of food in a single column, under such headings as meat dishes, potatoes, canned vegetables, cereals,
fruits, soups, etc. Printed blank forms of this type were furnished to mess sergeants for this purpose.
Soups were served in only a few messes, the excuse being offered that the men would not eat soup. With few exceptions, this was found to be due to the manner in which they were prepared, and that they were usually relished if made thick and well seasoned. Soup reduced the amount of coffee consumed and was quite nutritious when thick. It was therefore an important economic factor in the diet and its inclusion in menus was frequently recommended.
The use of too many fried dishes and too many soupy dishes was discouraged. It was recommended that certain foods which had become distasteful to the men of casual companies, such as canned salmon, canned corned beef, and corned-beef hash, be eliminated.
The palatability and other properties of food as determined by the methods of cooking, seasoning, and serving were important factors in its wholesomeness and were closely observed. While no pretense was made of training cooks, the lack of well-trained and experienced cooks in the various organizations of the port was so frequently encountered that instructions often were given in some of the elementary principles of cooking, particularly in relation to the preparation of tea, coffee, and cocoa, the cooking and most efficient utilization of meats, the preparation and cooking of vegetables, the use of seasonings, the preparation of sauces and gravies, palatable soups, salads, and special desserts, and the manner of preparing many types of dishes with reference to their appearance.
Food which was otherwise wholesome and properly cooked was often found to be rendered unpalatable by allowing it to stand too long a time after cooking (especially certain meats and most fried dishes), or by allowing it to become cold before serving. By explaining and emphasizing the importance of esthetic factors in feeding, much was done to improve the appearance of the food and the manner in which it was served by cooks and kitchen police. Bread, water, and sugar were placed on the tables, and line service in some instances was replaced by table service.
In reducing the waste of edible food, the nutrition officer determined the sources of such waste in each mess studied and instituted corrective measures by means of suggestions and reports.
Table waste.-Excessive table waste was corrected usually by improved cooking, improved menus, and closer attention to the size of portions served. Disciplinary measures to correct carelessness or indifference of the men in serving themselves to excessive quantities of food were sometimes necessary. Waste of bread was materially reduced by cutting thinner slices and by cutting these into half slices; also by placing bread so cut on the tables rather than by serving it in line. The amount of sugar wasted in discarded tea and coffee was materially reduced by placing the containers on the tables. It was found that the plate waste was much less with table service than with line service, with few exceptions.
Kitchen waste.-This was reduced by directing closer attention to the proper quantities of food to be cooked, the methods of preparing vegetables for cooking, the efficient and early use of left-overs, bones, and fat, and the use of the stock pot. The nutrition officer observed that waste involved in the preparation of food was usually higher where kitchen police duty was assigned as a form of punishment or as a one or two day detail. Sanitary conditions were also found to be less satisfactory under this arrangement, and the nutrition officer advised against the practice. The proper care of supplies and the correlation of menus and purchases were found to bear a close relation to the contents of garbage cans.
In addition to furnishing plans and making recommendations for better provisions for storage, the nutrition officer assisted in improving the adequacy and condition of all equipment used in the preparation of food. Stoves were examined with respect to the condition of grates, linings, stacks, and general heating efficiency, and necessary repairs were made. The nutrition officer cooperated with the port utilities division in these matters and arranged for the instruction of mess sergeants in the proper care of their stoves. The recommendations of the nutrition officer as to the most convenient kitchen, storeroom,
and mess hall arrangements, and as to the selection and arrangement of certain equipment, were formulated in a mess hall and kitchen plan and submitted to the sanitary inspector.
It became evident early in the occupation of the port that, unless every effort was made to conserve water and to expand the existing water plant, an acute water famine would result. This water shortage was so grave as to excite the fear of fire from incendiary and other causes, since the pressure was sometimes nil and fire engines had to be used to pump fresh water aboard ships so that they could make their voyage.
The original plant of the Newport News Water Co. consisted of a dam, filter plant, and pumping station. This plant supplied Newport News, Hampton, Phoebus, and Fortress Monroe with water previous to the war. The
supply was surface water which ran off from a catchment area of about 10,000 acres near Lee Hall, Va. The impounded water was pumped into a sedimentation basin, alum being added before entering. Next the water ran into gravity rapid sand filters, after which it was sterilized with liquid chlorine.
The filtered and chlorinated water was then pumped to Morrison through two cast-iron pipes, one 24-inch and one 18-inch; from Morrison to Newport News by a 20-inch wood-stave line and an 18-inch cast-iron pipe line. A booster station at Newport News repumped the water to Hampton and Phoebus. Fortress Monroe maintained a pumping station at Hampton which again pumped the water into that military reservation, and Langley Field maintained still another pumping station at Hampton which pumped the supply over to the field. There were equalization tanks at three points along the line; one high
tank at the reservoir, two wells or tanks at Newport News, and one at Hampton. All of these were open except one of the wells at Newport News.
The watershed was near Lee Hall, Va., and was about 10,000 acres in extent. It was almost entirely owned by the Newport News Light & Water Co. It was uninhabitated but had several sources of contamination. The Chesapeake & Ohio Railroad passed through the area and did not always take care to close the toilets of trains as they went through; the main road to Richmond crossed the dam and bordered the drainage area on the west, surface wash from parts of this road entering the reservoir; the village of Lee Hall lay on the edge of the area and it was possible for the surface wash from it to enter
the reservoir at times. However, all of these sources of contamination were of small consequence, inasmuch as the water was sedimented, filtered, and sterilized before using. The watershed was almost entirely covered with a dense forest of pines and hardwoods, thus retarding and equalizing the run-off; the soil was sandy clay and had a very small area of swamp land.
The reservoir lay along the valley of the Warwick River, and was formed by a dam 17½ feet high to the crest of the spillway. It was a shallow pond not over 18 feet deep, and 440 acres in extent when full. There was little weed growth, but microscopic organisms grew in large numbers, at times. The water was soft and clear. It was not subjected to violent changes, thus making the filter operations comparatively easy.
In April, 1917, the filter plant consisted of a set of pressure sand filters. Alum was added and the water was settled before filtration. The chlorine was added in the form of hypochlorite of lime. The pressure filters were done away with entirely on January 13, 1918, and the alum feed was discontinued the same day. The chlorine dose was continued at much the same rate. On May 5, 1918, the alum feed was started again, but only a small dose was added and this was again stopped on June 28. A modern gravity rapid sand filter plant of 8,000,000 gallons daily capacity was put in operation on July 27, and a liquid chlorine plant was started the same day.
In general, the water was excellent in quality. It was very muddy and contained considerable anabæna for a time during the summer of 1918. Copper sulphate was added to the reservoir to correct this. The chief difficulty, however, resulted from the paucity of the supply. This became so serious that the following general order was issued:
HEADQUARTERS PORT OF EMBARKATION,
Newport News, Va., June 23, 1918.
General Orders, No. 183.
1. The matter of water supply for this command is one of gravest concern. Of equal gravity is the waste of water. Provision has been made to give each part of the command an ample and good water supply. Carelessness or neglect on the part of those entrusted with its care, upkeep, and use will not only result in loss to the Government, but will seriously affect the training, health, comfort, and discipline of the command, as well as add to the fire hazards.
2. The supply of water is ample for every legitimate use.
3. The waste of water through leaks and misuses is already excessive and will increase as the weather grows warmer. The present consumption is enormous, and unless prompt steps are taken to economize, the supply during the coming summer may prove insufficient.
4. Commanding officers are hereby directed to take every precaution to stop waste and misuse, and to this end the following instructions will be carried out:
(a) All plumbing will be inspected daily, leaks stopped as fast as they are discovered, and repairs made immediately. The arrangement of the plumbing fixtures in the lavatories makes it possible to inspect 60 or 70 outlets, including showers, faucets, and closets, in four or five minutes, so that these inspections can be conducted in the minimum of time.
(b) Placards urging the men to economize water will be kept posted in conspicuous places in every lavatory.
(c) It is absolutely necessary that the men be trained never to leave a faucet or shower running except when it is actually needed. Faces and hands will not be washed in water running from a faucet, but from water in a basin. All fixtures will be shut off when not in actual use. The washing of clothes at the showers or at the lavatory faucets is prohibited.
(d) In the case of fire, every fixture except those from which water may be drawn for the purpose of fighting fire will, as soon as the fire alarm is sounded, be shut off except those necessary for cooking purposes.
(e) The use of water for sprinkling roadways, grounds, and for animals will be so timed as not to coincide with the heavy load on the water system resulting from the use of the showers. Sprinkling of roadways will be done from water wagons only.
(f) The peak of the load on the water system occurs from 7 a. m. to 12 noon, and from 1 p. m. to 6 p. m. If practicable, bathing, sprinkling, and filling of water wagons should be done before or after these hours.
(g) Sentries will be instructed to see that all fixtures on their beats are shut off when not in use.
5. Prompt disciplinary measures will be taken in the case of any member of this command-officer, enlisted man, or civilian-who may be found responsible for wasting water.
6. The purport of this order will be conveyed orally to each unit by its commanding officer at one formation weekly until October 1.
7. Camp commanders will report to these headquarters on June 28, 1918, the action taken by them to carry out the provisions of this order, and will report on the last day of each month, July to September, inclusive, the actual results accomplished.
By command of Brigadier General Hutcheson:
DANIEL VAN VOORHIS,
Lieutenant Colonel, Chief of Staff.
In spite of the water conservation which resulted, the long dry summer so increased evaporation from the reservoir and the draft on the supply was so heavy that a second near shortage occurred in November, 1918. The water company used all of its pumps, all of its filter plant, and the entire capacity of its pipe line for 24 hours a day in an endeavor to supply Newport News and vicinity. Thus, the margin of safety was reduced to zero.
The following report was made in January, 1919:
More water is going into the Lee Hall Reservoir daily than is being pumped out. The water company stopped the pumping of deep well water from Skiff's Creek into the reservoir on or about January 3, 1919, due to the fact that the chlorine content of reservoir water has
been raised about 10 parts per million since the beginning of pumping well water. The iron content has increased also. In addition to this, it has cost the water company about 6 cents per 1,000 gallons to pump this water, which makes the cost of water to the water company when delivered to Newport News considerably more than the rate at which it is sold. The pumping of water from Harwood's mill by means of the steam pump was also costly, due to the difficulty of transporting coal to the pumping station over the bad roads, hence the water company has discontinued the use of the steam pump. One of the new engines and pumps, however, is being operated at Harwood's mill, pumping 2½ or 3 millions of gallons daily into the Lee Hall Reservoir.
Some agitation is on foot to pump all possible water into the Lee Hall Reservoir now. It is the opinion of the writer that most of the water which is being pumped over now will be wasted over the Lee Hall spillway before summer. However, if the Lee Hall Reservoir should not fill before summer and another shortage should be imminent, 3,000,000 gallons daily can be pumped from Harwood's mill under present conditions for a period of at least three months; 2,000,000 gallons daily can in all probability be pumped from Skiffs Creek for an indefinite period beginning next spring; and as the Lee Hall watershed can produce easily 3,000,000 gallons daily, there will be all of the water that the filter plant can filter, or that the pipe lines can carry, or that the pumps can pump to Newport News.
Considerable danger of the pollution of the water supply by the town of Lee Hall became apparent in July, 1918. The following file of correspondence shows the conditions which existed and the way in which they were corrected:
OFFICE OF THE SURGEON,
Camp Eustis, Va., July 6, 1918.
From: Maj. D. W. McEnery, M. C.
To: Commanding officer, Camp Eustis, Va.
Subject: Unsanitary conditions at Lee Hall, Va.
1. As outlined in the sanitary report for June, I think that the sanitary conditions at Lee Hall should be remedied at once in order to protect the water supply of the port of embarkation and Camps Stuart, Hill, and Morrison. This camp is in such close relation to Lee Hall and the reservoir, it is imperative that immediate measures be taken to remedy these defects. There is no doubt in my mind that a great majority of the nuisances committed are performed by the employees of this camp. Later on we may expect the same defects from the soldiers. Toilet facilities at Lee Hall are extremely poor, and the men go to the outskirts of the town, practically on the watershed, to defecate. As the Army is the main offender in committing these nuisances, we should attempt to remedy them. There is an 8-inch sewer and small septic tank put in by the constructing quartermaster to care for some houses occupied by employees. This sewer will be large enough to accommodate toilets from the station. Mr. Curtis, a resident of Lee Hall, has offered the use of his water tank, provided the Government has the water pumped from the wells to the tank, so that he will not suffer from lack of water. Mr. Curtis also has a sewer system on his property. The sewer flows into Skiff's Creek and on into the James River.
2. In my opinion this is of such an emergency that the constructing quartermaster should be authorized to put in modern toilets and connect them with the sewer. The location should be the same as the public toilets at present; that is, in the rear of the railway station. It should consist of two buildings; 20 seats for men, and 8 for women. These should be constructed so that it will divide the colored from the white; that is, 10 seats for white men and 10 for colored men. The women's toilet should be divided similarly. They should be cared for by the sanitary squad of this camp. When these toilets are installed, a sanitary guard should police the watershed.
3. I urgently recommend that this work be done by the constructing quartermaster as an emergency. It is not a question of who should do it, as delay is dangerous. The water from the reservoir is very heavily contaminated, and every means to make it pure should be taken at once.
D. W. MCENERY,
Major, M. C., Surgeon.
COAST ARTILLERY SCHOOL,
Fort Monroe, Va., July 7, 1918.
TO COMMANDING GENERAL, PORT OF EMBARKATION,
Newport News, Va.:
1. The conditions reported as unsatisfactory exist on areas outside the Camp Eustis reservation, on all area under control (it is understood) of the commanding general, port of embarkation. The undersigned wishes to cooperate in the fullest extent in any measures which may be necessary or desirable to correct the conditions complained of in the foregoing report.
F. K. FERGUSSON,
Colonel, C. A. C., Commandant.
HEADQUARTERS, PORT OF EMBARKATION,
Newport News, Va., July 10, 1918.
To the SURGEON, PORT OF EMBARKATION:
By command of Brigadier General Hutcheson:
O. W. BELL,
Colonel, Adjutant General, Adjutant.
SURGEON'S OFFICE, PORT OF EMBARKATION,
Newport News, Va., July 18, 1918.
TO COMMANDING GENERAL, PORT OF EMBARKATION:
1. Returned. Additional men have been provided to guard that portion of the watershed in the neighborhood of Lee Hall, and measures have been instituted through both the United States Public Health Service and the State board of health to immediately provide adequate toilet facilities at Lee Hall station and a modern sewage system for the village.
2. How quickly this can be accomplished is problematical, however. This being the case, it is believed the Camp Eustis authorities should make provision in the way of toilets for their own men to prevent fouling the water supply. The Navy also is concerned, and if practicable it is suggested that an arrangement be made by the Camp Eustis authorities with the Navy people at Yorktown so both commands may provide the toilet facilities needed.
Colonel, M. C., United States Army.
GUARD AND FIRE COMPANY, No. 327, Q. M. C.,
Reservoir, Lee Hall, Va., October 28, 1918.
1. The following rules and regulations governing sanitation and police are recommended by the camp surgeon.
2. The camp will be inspected between 9 a. m. and 9.30 a. m.
3. General police.-Company streets and parade ground will be free from litter, papers, match sticks, and cigarette stumps at all times. All packing cases and boxes will be in neat, orderly piles. The interior of barracks buildings will be free from litter at all times. The beds will be in order and equipment disposed of properly. Screens will not be allowed out of windows. Screen doors will be kept closed.
4. Kitchens.-The kitchen will be kept clean and in order at all times. Screens will be kept in the windows, and in case the wire has been loosened this defect will be repaired. Screen doors will be kept closed. Kitchen floors will be scrubbed, as well as meat blocks and serving tables. The tops of tables will be scrubbed after each meal, the center boards removed and thoroughly cleaned. Refrigerators will be cleaned and scalded with boiling water daily. They will be kept clean and covered. Particles of bread, meat, and other food must not be scattered around. Areas around the mess hall and kitchen must present a neat and orderly appearance
at all times. All dishes used at mess must be washed and boiled after each meal. Soapy water must not be thrown on the ground.
5. Latrines.-These will be clean and properly policed at all times. Paper will not be thrown nor scattered about the building. Soap will be gathered and placed in proper receptacles. Urinals will be cleaned daily, or oftener if necessary. Cigarettes, paper, and other articles will not be thrown in either stools or urinals. Newspaper will not be used for toilet purposes. Shower baths will be kept clean and particles of soap will be kept off the floor.
6. Corral.-This will be kept clean and swept daily. Accumulation of manure will not be tolerated. Low places where water accumulates will be filled with dirt. Picket line will be burned over weekly. All hay and grain will be kept in a neat and orderly manner at all times.
7. Flies.-A relentless warfare will be waged on this pest at all times. Traps, fly paper, and poison will be used. Poison may be obtained of the surgeon daily.
8. Canteen.-This must be kept clean at all times, and free from all litter and refuse. All boxes and crates kept neatly piled in an orderly manner. Area around canteen must be kept clean and oiled daily.
C. B. LIVINGSTON,
First Lieutenant, M. C., Camp Surgeon.
In the report of the survey of Newport News, made in August, 1917, by representatives of the United States Public Health Service, and which was referred to earlier in this chapter, there are abundant references to the widespread and prolific occurrence of Anopheles quadrimaculatus, Anopheles crucians, and Anopheles punctipennis (in order of abundance), and to the prevalence of malaria. In the midst of these malarial conditions were located Camp Stuart, Camp Hill, and Camp Alexander, and, in spite of the difficult drainage problems, it was possible to report a year later that not a single case of malaria had originated in these camps. The necessity for the antimosquito work which followed as a consequence of the survey referred to is emphasized by the following paragraph from a letter dated November 27, 1917, from the surgeon of the port of embarkation, to the Surgeon General.
I regard the proper drainage of these swamps as the most important sanitary work that we have to do in this vicinity, as, if it is not done properly, troops stopping here while waiting overseas transportation during the mosquito season between July and October will unquestionably become infected with malaria in spite of netting and mosquito bars.
An officer of the Sanitary Corps was assigned to duty October 13, 1917, as assistant to the sanitary inspector, with instructions to make a survey of drainage conditions at the port of embarkation camps. Another officer of the same corps was later assigned temporarily in command of the engineering party making surveys and plans and estimating costs. The survey began about February 1, 1918. A detail of 200 colored troops arrived April 8 and was organized as a malarial drainage detachment (Medical Department), and shortly thereafter the officer in charge of the mosquito-control work was given the
supervision of insect control in general. Assistants were placed in charge of the mosquito-control work in two of the outlying sections of the port area in May, 1918.
Twelve white enlisted men, Medical Department, were used as inspectors and noncommissioned officers in the work of the malarial drainage detachment. Forty-seven colored enlisted men, Medical Department, and 50 colored stevedores
were added to the organization, the latter, temporarily, making a maximum of 300. Detachment headquarters was maintained at Camp Stuart. Smaller detachments were stationed at Camp Hill and Camp Morrison, and emergency details at Nansemond ordnance depot (Pig Point), reservoir guard (near Lee Hall), the rifle range, and elsewhere, as needed. The detachments at Camp Stuart, Camp Hill, and Camp Morrison each maintained its own mess and exchange. A spirit of friendly rivalry in work and sports was promoted.
The drainage problem at once becomes obvious in the light of the following extract from a letter dated March 29, 1918, by the surgeon of the port of embarkation to the Surgeon General:
Briefly, the camps constituting this port of embarkation are in swamps or so near that to all intents and purposes, so far as the mosquito menace is concerned, they might as well be swamps. Mosquitos breed by the million in the swamps in question. These mosquitos are of the malaria-carrying variety. Plenty of people in the vicinity suffer from malaria. * * *
The following example will serve to illustrate the difficulties concretely. Newmarket Creek, really only a wooded watercourse draining an area of 700 acres, originated about 6 miles beyond the northern boundary of Camp Alexander and formed a typical fresh-water swamp immediately east of Camp Morrison, Camp Alexander, and Camp Hill, including several miles of swamp both northerly and southeasterly from that point. The natural grade near its upper reaches was about 2.3 feet per mile, reducing rapidly to 12 inches per mile, thus producing at swamp. This meager fall made drainage operations
difficult in nearly every part of the lower peninsula.
Camp Hill and Camp Alexander were also affected by Beaver Creek swamp partly tide water and partly fresh water, including about 20 acres between the two camps and draining in a southwesterly direction, with an outlet in the James River. Drainage of this swamp presented no extraordinary difficulty. Camp Stuart comprised nearly 300 acres, of which 25 acres consisted of tidal swamp. Salters Creek swamp was located on the northern and eastern boundaries of the reservation and the Ivy Avenue swamp in the extreme southwestern corner of the reservation. Ivy Avenue swamp presented no
difficult control problem, but Salters Creek swamp, in addition to being very low (only 0.5 foot above high tide), received a part of the city sewage and the effluent from a number of private sewers.
In addition to the drainage and mosquito-control work at the camps mentioned, more or less extensive control operations were carried out at the Army supply base near Norfolk, the Nansemond ordnance depot at Pig Point, the rifle range and the Lee Hall Reservoir, and much extra-cantonment work was done in the vicinity of the camps mentioned and in Newport News in cooperation with the United States Public Health Service.
Drainage and grading work within the actual confines of the camps was largely done by contract under the supervision of the construction quartermaster and the Government supervising engineer. This work, while fundamental in the building of a camp, may not affect the mosquito question materially, this portion of the work being, as a rule, merely incidental.
Ditching by the Sanitary Corps began April 15, 1918, at Camp Stuart, a small amount having been done for about a month prior to that date at Camp
Hill by details from colored labor battalions. Salters Creek swamp was systematically ditched so as to concentrate the water, and a 36-inch tide gate was put in place at the point where the channel crossed Chestnut Avenue. The Ivy Street marsh was also properly ditched, the outlet into the James River being left open, thus allowing the tides to flood the ditches. Although a tide gate was planned for this point, it was deemed unnecessary after the ditching was completed, and considerable progress was made in filling the marsh with refuse, incinerated as far as possible, from the camps.
At Camp Hill, the Beaver Creek swamp was channeled, diked, and sumped from Virginia Avenue to its outlet in the James. Aside from small local mosquito-breeding places dependent on the seasonal rains and careless disposition of water containers, Beaver Creek and Newmarket Creek were responsible for practically the entire mosquito population of Camps Hill and Alexander.
Newmarket Swamp, as already explained, presented a problem of considerable proportion owing to its extent and scant grade. As originally planned, a cut-off ditch was begun under contract about October 1, 1918, extending from the eastern end of Beaver Creek to Newmarket Creek in order to divert the upper waters from the latter to the former and thence into the James River. The length of this cut-off (open-ditch canal) to Beaver Creek at Virginia Avenue was about 4,000 feet, with a maximum cut of 16 feet, a minimum of 3 feet at the junction with Newmarket Creek, average width at the top about 18 feet and at the bottom about 3 feet and a grade of 1 foot to 1,000 feet, and representing an excavation of about 20,000 cubic yards.
Very slow progress was made on this ditch, with little prospect of its completion before April 1, 1919. In the meantime, all of the water from Newmarket Creek was being carried through a new canal paralleling the old watercourse and constructed by the Sanitary Corps from the junction of the cutoff canal to the Sconesdam Road, a distance of 4,000 feet. The original survey called for a ditch following the general course of Newmarket Creek through the swamp. This plan was discarded in favor of a ditch paralleling the swamp on comparatively dry ground and tapping the swamp at frequent intervals
with laterals. This plan rendered the work much easier and made possible a much better ditch, giving just as good results. This new canal, 4,000 feet in length, with a maximum cut of 7 feet, a minimum of 2 feet, side-sloped 1 to 1, and a width of about 6 feet at the top, represented an excavation of 4,396 cubic yards. The work on this ditch was started September 12, 1918, and completed December 1, 1918. Carried under the Sconesdam Road through a culvert, the water poured into a ditch constructed by the United States Public Health Service and thence through an old canal about 1½ miles in length, 10
feet deep, and 25 feet wide at the top, built, according to old negroes living in the neighborhood, from 50 to 60 years before, apparently as a part of an old drainage project, and then abandoned.
With the completion of work on Newmarket swamp, which included considerable channeling north of the cut-off by the United States Public Health Service, many acres of land on both sides were reclaimed for agricultural purposes, malaria was very materially reduced, and a serious manace to the adjacent camps placed under control.
Camp Morrison, though in the midst of a swamp, rapidly became a well-drained camp, largely due to effective and extensive drainage operations by the camp personnel. The work of the malarial drainage detachment there, though intensive, was against odds, due to the proximity of Newmarket swamp and the malaria-ridden town of Morrison. Soldiers from Camp Morrison not only frequented the village but found rendezvous in and about eating houses for several miles along the Richmond road toward Lee Hall. In spite of these odds, there occurred only 10 malaria infections which were contracted locally.
In April, 1918, a company of the 48th Infantry was stationed about a mile south of the town of Lee Hall to act as a guard for the reservoirs at Lee Hall and at Harwood's Mill. The morbidity rate from malaria among the surrounding civil population was estimated by the United States Public Health Service at well over 90 per cent for the previous season, and Anopheles quadrimaculatus was the predominating and abundant species. Control work directed against the mosquitoes consisted of temporary canalization of the portion of the swamp adjacent to the camp on the west. This swamp was formed by the backwaters of the Warwick River, which originates at this point. At the time of the ditching, it was only hoped to concentrate the waters, but the operations so changed the ecological conditions that anopheline breeding was entirely inhibited in that portion of the swamp where the ditching was completed.
Weekly oiling of the pools, water barrels, and other possible mosquito-breeding places in the immediate vicinity failed to eliminate the abundant supply of mosquitoes infesting the camp until it was decided to oil the borders of the cut-off portion of the reservoir located about 400 yards from the camp site. This impounded water had a slight current, due to the fact that its overflow was carried away by a spillway located at the end of the pond nearest the camp. This flow brought down large masses of floatage always infested with larvæ and pupæ. By oiling the borders of the pond, already covered with
floatage, the additional masses that floated down were well covered with oil. The treatment of this source caused an immediate decrease in the number of mosquitoes infesting the camp. The United States Public Health Service, although operating in this district, was primarily interested in the protection of Camp Eustis and the town of Lee Hall and was not able to do much work in the vicinity of the guard camp. The nature of the work done by the troops at this camp (guard duty among the civil population and at some distance from points where control work was done) rendered them especially liable to infection. Head nets, repellents for the hands and wrists, mosquito bars, and a biweekly dose of 30 grains of quinine were the additional precautions exercised. In addition, a daily collection of mosquitoes was made in tents and barracks throughout the camp. The tabulation of these captures is noteworthy, since the records were begun at the time when mosquitoes were normally the most abundant in that section.
Despite these precautions, 25 cases originated among troops stationed at this camp during the nine months from April to December, 1918. These cases were more than half the total incidence of malaria in the port. A comparison of this morbidity rate of 5.3 per cent among these troops as compared with the high rate among the civilian residents (certainly over 90 per cent and actually 100 per cent in 1917 for eight families living within a few yards of the camp) throws a more favorable light on the results of the mosquito-control efforts at that station. That cases occurred at all was due to the inability to enforce
rigidly the wearing of head nets and the use of repellents. Numerous social entertainments were given for the men in the neighborhood, baseball games often continued through the dangerous period of dusk, and men on guard, unless constantly watched, were likely to become lax, particularly when the mosquitoes were not extremely abundant. The quinine treatment in many cases masked a latent infection which manifested itself when the drug was discontinued through the man's transfer to another station or to the hospital for treatment of some disease other than malaria.
Nansemond ordnance depot, located at Pig Point, opposite Newport News, on the James River, was seriously menaced by mosquito-producing swamps of both salt and fresh water. Except for guards of the 48th Infantry and, later, guard and fire companies, very few soldiers were stationed at this depot during the building operations, which were carried on by civilian contractors. For this reason, no extensive draining operations were undertaken and routine inspection and oiling for mosquitoes was in the hands of the sanitary engineer stationed at the Army supply base near Norfolk. Inspections made August 3,
1918, showed an abundance of Anopheles quadrimaculatus in the civilian barracks and tents. Immediate arrangements were made to attack this problem. An officer and a detail of 28 men from the malarial drainage detachment began work on this project about August 10. An intensive campaign, which included an extensive ditching program, embracing a large amount of extra-cantonment work, oiling, protection with head nets, bamber oil, collection of mosquitoes in tents and barracks, and quinine prophylaxis for both soldiers and civilian laborers, was instituted over a period of four weeks. The result was most gratifying in that but 4 cases of malaria developed during late August and 5 in early September in a military population numbering 725. Thirty cases occurred in 1,500 civilian employees not under military control.
The Army supply base near Norfolk embraced a large acreage of swamp, much of which was permanently eliminated by the use of hydraulic dredges. Necessary mosquito-control work, consisting of some ditching, the installation of two automatic drainage gates, and the systematic oiling of sundry pools, was carried on by the camp sanitary engineer with the aid of a small detail of enlisted men. All extra-cantonment work was carried on by the United States Public Health Service. Although a few anophelines (A. quadrimaculatus) were found at the base hospital, no cases of malaria originated at this camp and there was little complaint about mosquitoes in general.
The city of Newport News presented numerous drainage problems affecting the many military organizations located within its limits. The city was inadequately sewered and the existing storm sewers presented clogged catch basins
much of the time during the summer. Gutters and ditches in many parts of the city, originally designed to carry away water, became stagnant pools swarming with mosquito larvæ. Little or no attempt was made by the city authorities to correct these conditions, so the United States Public Health Service concentrated its efforts on the destruction and prevention of anophelines. At times during the summer, mosquitoes became abundant enough to be the cause of numerous complaints, and anopheline adults were taken in the heart of the city at frequent intervals. As a matter of protection to the military population, the malarial drainage detachment was instructed to carry out control measures in various parts of the city during August and September, 1918. This work included the maintenance, regrading, and cleaning of a mile and a quarter of ditches (6,920 feet), construction of a few new ditches (total 500 feet), and the application of 450 gallons of oil to mosquito-breeding pools.
Inspection for mosquitoes was divided into two phases: The inspection of all possible breeding places with the collection of samples for laboratory breeding; the collection of adult mosquitoes in and about the quarters and buildings as a prophylactic measure and for laboratory purposes. This work was done by both white and colored enlisted men who had been trained by their officers in this special line of work. Inspections were made at least weekly of each subdivision of the territory covered by the particular detachment. The presence of larvæ was reported to the detachment commander daily and oiling by a
special detail formed for this purpose followed. The oiling was immediately followed by another inspection.
The cost of inspection and oiling totaled 28 per cent of the entire cost of the work done by the malarial drainage detachment. The oil used was a half-and-half combination of Mexican crude oil and kerosene. Three hundred and ninety-nine barrels were sprayed during the season, the cost of spraying per barrel being $14.37. This apparently excessive cost of application was due to the intensive character of the spraying and the long hauls necessary to carry out some of the work. There was very little opportunity or necessity for spraying large areas in which the pumps would be emptied quickly and the cost of application per barrel decidedly reduced. The oil was delivered to the detachment camps by tank trucks and stored in open-top barrels until used. Knapsack spray pumps were used for the work. The first oiling for the season was done during the week ending November 2, 1917. Applications during the height of the season were made about once every 10 days. However, considerable variation in time intervals was necessary, depending on the weather conditions; for example, oiling was repeated several times at intervals of five or six days when the weather was excessively hot, dry and windy,
and, during cooler weather, two weeks might elapse between oilings. Careful inspections and a good knowledge of mosquitoes proved essential to the proper conduct of this work.
Each detachment was assigned a given area, for which it was responsible. These areas were in turn subdivided into plots to which letters were given in order to facilitate the giving of directions and the tabulation of collections. Each detachment made a weekly report of the mosquitoes, both larval and adult, that were taken during the week, designating the subdivision in which
they were taken. In this way, the port surgeon's office was able to exercise a fairly accurate check on the effectiveness of the control measures under way. A large blue-print spot map in the port surgeon's office, showing by appropriate map tacks the occurrence of the different anopheline species, the occurrence of cases of malaria, and the location of ditching and oiling operations, was kept up to date. Weekly reports were submitted to the port surgeon covering the activities of the detachments for the previous week, such as the number of feet of ditch built or maintained, barrels of oil sprayed, and acres
of brush cleared. These records were consolidated from time to time and curves were prepared to show the relation of the work to the set program. Special problems were covered by extra reports accompanied by maps and drawings.
SPECIES OF ANOPHELINES
Three species of anophelines were found in the tide water region: A. quadrimaculatus, A. crucians and A. punctipennis, in order of their abundance. Their local distribution seemed to depend entirely on a given set of ecological factors, A. crucians occurring in the neighborhood of slightly brackish water and A. quadrimaculatus in the so-called typical anopheline breeding places, such as wayside pools, neglected ditches, and the borders of impounded water, while A. punctipennis was found in wooded areas.
With these factors in view, it is noteworthy that collections at Camp Stuart showed A. crucians almost exclusively; Camp Hill and Camp Alexander, A. crucians and A. quadrimaculatus; Nansemond ordnance depot, Pig Point, A. quadrimaculatus greatly predominating, and A. crucians, while at Camp Morrison, which was farther removed from the tide water and in the midst of a wooded area, A. quadrimaculatus existed to the extent of 50 per cent for all collections and A. crucians and A. punctipennis in about equal proportions. At Lee Hall, when the nearby wooded marsh was controlled, A. punctipennis practically disappeared and A. quadrimaculatus, breeding in the nearby impounded water of the reservoir, became the dominant species.
The first anopheline larvæ for the season of 1918 were seen May 11, 1918, at Camp Stuart, and were all very young. These were discovered, together with culicine larvæ, in water barrels piled near a warehouse. Mosquito collections made at this time embraced only culicine species, larvæ and pupæ of these being encountered in abundance during the last week of April, 1918. Anopheline adults began appearing in the collections about May 15, 1918, when A. crucians began to be taken under the wards at the embarkation hospital, where they appeared in increasing numbers for about two weeks. It is believed they originated in a portion of Salters Creek marsh 300 or 400 yards distant. Great numbers of anopheline larvæ were found in this marsh, and this species (crucians) was hatched out. The number of anophelines in the collections became very low, with the correction of this location by ditching and oiling during June, 1918, ranging from 140 at the beginning of the month to zero during the first week in July. Weekly collections for this area thereafter included anopheles (all crucians) as follows: 8, 1, 11, 2, 1, 3, 3, 2, 5, 5, which indicates in a very fair manner the degree of control exercised in the vicinity
of the embarkation hospital. While A. crucians and A. punctipennis were
the first to appear and persisted in greater or less numbers during the entire summer in a given locality, A. quadrimaculatus, appearing somewhat later, rapidly became the dominant species for the region.
Anopheline larvæ, ranging in size from very small to practically full grown, were seen in large numbers in impounded waters in Newmarket swamp as late as the second week in November, 1918. About 50 of these in various sizes were transplanted to a pool that was screened and observations were made to determine their fate. These larvæ grew slowly, and, favored by occasional warm periods, the older ones pupated one by one, and the imagoes emerged. An examination made on December 26 showed one full-sized larva remaining on the surface, but careful search in the mud therein where it was thought hibernation might possibly take place until spring, when further development would be continued, failed to reveal a single hidden larva.
OCCURRENCE OF MALARIA
One hundred and forty-four cases of malaria were treated at the embarkation hospital, to which all cases and suspects were sent during the malarial season of 1918, the first case reporting April 8, 1918, and the last December 12, 1918. This is a fairly accurate statement of all the cases actually occurring, as all suspects were hospitalized at once, and cases were diagnosed only on the basis of a positive blood smear.
Complete histories of the cases were made whenever possible, and in every instance data were secured in an adequate amount to determine whether the case was of local origin or was imported. A tabulation of this information showed that 44 cases were contracted within the zone of this port, while 100 were contracted elsewhere, although treated at the embarkation hospital. In this connection, a rather striking point is that no cases originated at the large camps-Stuart, Hill, and Alexander-where the great majority of the troops were quartered. All cases of local origin became infected at the outlying camps at
Morrison, Lee Hall, and Pig Point, where the extra-cantonment conditions were so extensive that perfect mosquito control was not possible of accomplishment by the Army authorities.
Accurate histories of 60 per cent of the imported cases showed that 40 per cent of the infections were contracted at home before entering the service, while Camp Johnston, Fla., and Camp Eustis, Va., contributed 20 per cent and 13.3 per cent, respectively, the remainder being scattered. The infections were all of the tertian variety, except three cases of æstivo-autumnal (all imported), one of which, the only fatal case, was a mixed infection of tertian and æstivo-autumnal.
A more direct comparison of the degree of protection afforded men at the port of embarkation is found in a consideration of the local morbidity rate of 0.28 per 1,000 and the admission rate from malaria for troops in the United States for 1917 of 7.46 per 1,000, and the incidence of malaria in the Southern Department for 1917 of 6.8 per 1,000. The comparison of these figures, although relatively accurate, should be tempered by a consideration of the difficulties of determining a mean strength at the port of embarkation. This was particularly difficult owing to the constant flow of men through the port which rendered
the final results not strictly comparable with fixed stations or populations. The question may be raised as to whether men quartered here for a few days did not become infected and manifest symptoms only after they had embarked for overseas. It seems fairly safe to assume that this was not the case, for practically all the troops for overseas were quartered at Camp Stuart, Camp Hill, and Camp Alexander before embarkation, at which camps none of the troops permanently stationed became infected; furthermore, no reports of malarial admissions of overseas troops were received at this office from transports.
CONTROL OF FLIES
Flies were noticeably abundant in the vicinity of the port by May 1, 1918, and, for the week ending May 25, it was reported that the restaurants of Newport News were seriously infested with them and they were numerous in all the camps. To understand the difficulties which had to be met in the matter of fly control the following facts are cited: Camp Stuart was well within the range of flies originating in the city, and the latter was no doubt affected by flies bred in corrals occupied by horses awaiting overseas shipment; however, the principal animal embarkation depot was located rather too far (about a mile and a half) from the business section of the city to have played an important role in this connection, particularly with Camp Hill between. The British corrals were quite close enough, in part, to have been of some consequence, though the number of horses was not large (about 1,800 in early June) and the nearest corrals were fairly well kept. On the other hand, within a distance of a half mile from Camp Stuart in the vicinity of Boat Harbor, the city of Newport News maintained a series of garbage dumps comprising an area of about 5 acres. The dump in the vicinity of the gas tanks extended for the distance of about one long city block on both sides of the street, nearly blocking the same at several points. Besides receiving quantities of dead fish and all manner of perishable garbage, this dump received all the night soil from city privies, estimated by the United States Public Health Service to be 900 in number. Jefferson Avenue, near Boat Harbor, one-fourth mile from Camp Stuart, was strewn with garbage to the car track in the middle of the street, and the stench was indescribable. Flies fairly swarmed over all and maggots beyond number pervaded the mass. Numerous pig pens, mostly just outside the corporate limits of the city, but easily within a half mile of Camp Stuart, added to the fly-breeding menace. Over 50 pens were counted within a distance of about two city blocks at the north end of Wickham Avenue, in addition to a group on Salters Creek opposite the embarkation hospital. These pens were in an indescribably filthy condition and literally alive with flies and maggots, as were many of the slop barrels. The matter of correcting the serious condition of the dump fell to the Army, owing to the scarcity of civilian labor and partly because a portion of the refuse from Army camps was added.
The tremendous problem of manure disposition can be partly conceived when it is known that the animal embarkation depot had in its corrals alone a daily average of 7,000 horses and mules, which produced approximately 1,000 tons of manure a month. There were hundreds of horses and mules in corrals at the various camps in addition to those passing through the animal embarkation depot.
The problem where 7,000 to 10,000 horses and mules were congregated was not a simple one, even under the most favorable climatic conditions for fly control. It was much more complicated to handle a situation of this magnitude in a moist, warm climate with limited railroad service to haul manure, no large open areas (except swamps) on which to spread, dry, and burn the same, and with a very limited agricultural demand. Owing to these limitations, it was found necessary to begin dumping the manure in a shallow swamp in the immediate vicinity of the animal embarkation depot corrals. This, of course,
served to fill the swamp but resulted in breeding numerous flies in the superficial layer, although the manure became more and more compact, due to pressure from the dump carts and horses' feet. The exposed sides of the manure fill made during the winter and spring, while of small consequence in breeding houseflies because of old manure, became literally packed with larvæ of the biting fly (Stomoxys calcitrans), which became very troublesome to the animals during the latter part of May and early June, 1918.
The manure was hauled direct from the corrals to the cars on a spur track at the animal embarkation depot when cars were available; however, the slowness with which these cars were finally moved is shown in the fact that during the period from August 23 to 31, 1918, inclusive, there were 46 carloads on the sidetrack (practically in the heart of Newport News) with an average of over three days retention each, and 8 remained for the entire period of nine days.
Much of the camp refuse was incinerated. Perishable garbage was collected on contract by civilians. In order to assist in filling at the dumps, as much as 50 loads of refuse daily (perishable matter not permitted) were added, under supervision, to the city garbage for a time. This was discontinued in July and thereafter used for filling purposes at Ivy swamp in Camp Stuart. The dump was kept in good condition by constant supervision, burning over, and grading.
Work on the city dumps was started by the Army with 50 colored stevedores May 15, 1918, several barrels of crude oil having been applied to the night soil and the worst fly-breeding portions, and burned over on May 11 and 12. As soon as work on the dumps was begun, an order was issued directing that all garbage be dumped in one or the other (alternating) of two large swamp holes near Boat Harbor, on Jefferson Avenue. Between four and five weeks of continuous labor were spent in getting the dumps in order, clearing the streets, leveling and burning refuse. A system of night soil disposal was instituted
through the efforts of the United States Public Health Service, and the method of surface disposal at the city dump was permanently discontinued during the week ending May 18, 1918, thus eliminating a very dangerous practice. It is a matter worthy of note that of 1,295 privies reported for Newport News in January, 1919, 1,278 were of the sanitary bucket type installed under the direction of the United States Public Health Service.
A marked decrease in the number of flies, both house flies and biting flies, followed in a little more than a week after the thorough spraying of the manure with crude oil, which was applied with spray pumps as for mosquito control. Myriad dead larvæ were seen in the thin coating of oil. Just why so many of these larvæ came to the surface in this manner is a matter of interest, since it is contact with oil which destroys them.
A matter of some interest to sanitary officers is that septic tanks may be the source of numerous flies of several species, mainly house flies. This was brought to the attention of the sanitary inspector by an invasion by flies of a ward in the immediate vicinity of a septic tank. Careful inspection in the vicinity failed to reveal the source until an inspection of the tank showed two or three 6 or 7 inch circular openings which had been left by workmen in making recent changes. Numerous flies were coming and going through these apertures, and examination of the sludge mat revealed numerous maggots, with pupæ on top where there was little moisture. Oiling the contents (in spots only, as a matter of precaution) and closing the apertures ended the trouble. Inspection of other tanks showed similar conditions where battens were omitted over crevices between boards used in building the superstructure.
The usual methods were employed for the destruction of adult flies, covered by the following extract from General Orders, No. 144, headquarters port of embarkation, Newport News, Va., dated May 31, 1918:
(a) Fly papers.-The "sticky fly paper" is best. It is to be used liberally wherever needed.
Fly-paper boards have been found serviceable. They are made as follows: Boards 10 to 14 inches are used. Along one of the 14-inch edges is nailed a strip of 2-inch light board, so that it extends for a short distance on either side. Viewed from the end, the large board and the strip make an inverted letter T.
One-half inch from the upper edge of the board, near each end, there is bored a hole. Sheets of sticky fly paper are tacked on both sides of the board, which is suspended from the ceiling or rafters by means of strings passed through the holes. The strip along the lower edge catches any drip which there may be from the fly paper.
Fly-paper boards prepared in this way are convenient. They are not in the way of cooks and do not litter up the mess tables. Inasmuch as flies have a tendency to alight, particularly in the later hours of the day, in the upper part of rooms and on ceilings, the boards, which are suspended, afford a lighting place to which the flies are attracted.
(b) Fly poisons.-There are many kinds of fly poison in use. The kind which has been used with most success in camps has been a mixture of formalin with milk and water.
It is used as follows: A thin slice of bread is placed on a plate. Over it is poured a cupful of the fly-poison mixture, about a half pint. There should be enough to saturate the bread and leave some of the liquid about it in the plate. The plate is then placed where there are the most flies. Cheap tin plates are used, and plenty of them.
As the formalin evaporates in the course of a few hours, the plates must be freshly baited two or three times daily. Flies which drink this mixture are killed in the course of a few minutes. The dead flies may not be seen in the plates or on the bait, but will be found scattered about on the ground. The poison is very effective.
(c) Flytraps.-Each company or equivalent organization should be supplied with three large flytraps. Two of these should be kept at the kitchen and mess hall, one of these outside near the entrance, the other in the mess hall. The third one at the latrine or other place where flies are attracted.
Flytraps, to be of use, must be kept baited and must be placed where flies come. They can not be neglected or set aside in some place out of the way and be expected to catch flies. Cooks and others in charge must be required to pay suitable attention to the care of flytraps.
Bait for flytraps commonly used is a mixture of sugar, vinegar, and water. An excellent fly bait may be made by mixing bran, mashed boiled potatoes, sugar, yeast, and water. This is mixed to the consistency of a thin mush and allowed to ferment for 24 hours.
Swatting the fly is even more necessary in camp than elsewhere. Swatters may be made from small waste pieces of fly screening, the handles being made out of laths and the like. By their use the mess halls and kitchens are cleared of flies which get in through the doors.
CONTROL OF BEDBUGS, COCKROACHES, AND FLEAS
Control measures were instituted, from time to time, against bedbugs, cockroaches, and fleas, which were not generally prevalent. Bedbugs were destroyed in one of three ways: First, by sulphur fumigation, using 4 pounds of sulphur per 1,000 cubic feet. This was done in one instance only in which a large brick house was to be used as a detention home and was reported to be infested with bedbugs. Second, quarters infested with bedbugs were liberally treated with kerosene. Third, at Debarkation Hospital No. 51, formerly used as a soldiers' home and badly infested with bedbugs, the iron beds were flamed
with a plumber's torch, the bedding steam sterilized, and wall crevices washed with a solution of bichloride of mercury, 1 to 500. The control of cockroaches was largely accomplished by the use of sodium fluoride diluted one-half with gypsum or flour and dusted in places frequented by the insects. An infestation of fleas at the local railroad depot was controlled by mopping floors and baseboards with kerosene.
CONTROL OF LICE
In anticipation of the danger of the spread of disease by lice, steps were taken early in the occupation of the port for their detection and destruction. Early in 1918, one 30 by 42 by 60 inch sterilizer was received and installed at the embarkation hospital, and on April 20, 1918, the Surgeon General wrote the surgeon as follows:
It is desired that you submit as promptly as practicable such detailed recommendations as you may be able to make regarding the establishment at your port of sufficient delousing plants to provide for the needs of outgoing troops. Recommendations are also desired as to the steps needful to provide for the disinfection of such ships as are under the control of the War Department. Information is desired as to the facilities you now have available for either of these purposes. Early action is requested.
The desired information was immediately sent forward, and on May 17, 1918, after considerable correspondence and several telephonic conversations on the subject, the following letter was written by the port surgeon to the Surgeon General:
1. Regarding your communication of April 20 on the subject of delousing plants, and the several telephonic conversations we have held on this subject since that time, I feel a preliminary report can now be made.
2. You explained to me over the telephone this morning that your office did not desire at the present time to go into the subject of an elaborate plant, but proposed to provide facilities at the various camps so that men might come to the port of embarkation free from lice. This, of course, would much reduce what we would have to do here, though with the pressure for space during the coming summer it is very probable that this port will be used for a mobilization point as has been the case in the past. However, so far as this is concerned, we can meet the situation fairly well if the two steam sterilizers, which I understood from you had been shipped, are provided.
3. I am not wholly in agreement with a point which I understood you to make over the telephone. It was very difficult to hear this morning, and I may not have heard you aright. It is my understanding that picking out men, who are actually lousy, never proves a success. Medical Director Pleadwell of the Navy told me that this was his experience in Europe and is equally so on the Mexican border. Therefore, if a lousy man is found in any organization, it will, in my opinion, be necessary to delouse all men of that organization, with their clothing. We can, in my opinion, do this here with the steam sterilizers mentioned above.
4. So far as the disinfection of ships is concerned, nearly all of these ships are now run by the Navy. We have only a few cargo ships and horse boats. I think, therefore, that all this work should properly be done by the Navy. It would hardly be worth while to duplicate the necessary plant. In return, it might be arranged that we provide for the disinfection of the crews and their bedding, clothing, etc. Possibly we could do this without any addition to our equipment.
5. You now know the facilities we have here for delousing troops, and also that we have no equipment for the ships. From what I have said, it should not be understood that we are not active in the matter of delousing, so far as this can be done with the inadequate supply of steam sterilizers. Careful instructions have been issued on this subject, and are being carried out.
6. One other point-the expert from the American Sterilizer Co. reported yesterday, and our portable sterilizers, and also the one in the laundry, are now in good working condition. They will be useful for the embarkation hospital, but can hardly be made of use for troops except to a limited extent.
7. We have done a great deal of work on the preparation of plans for an elaborate delousing plant, as I explained to you over the telephone. This work will be completed so that you may have it, even though you have no use for it at the present time.
The reply to this letter, from the Surgeon General, is as follows:
MAY 22, 1918.
From: The Surgeon General.
To: The surgeon, port of embarkation, Newport News.
Subject: Delousing plant.
1. Referring to your letter of May 17 on the above subject, you are right in assuming that you misunderstood me in our conversation over the telephone in regard to the inadequacy of picking out the individual man who is lousy and delousing him without giving the necessary attention to the rest of the company. What I intended you should understand was this-that it is not the intention to require general delousing of all commands at ports of embarkation; that delousing plants would be established in all camps and cantonments and that troops were supposed to come to ports of embarkation clean.
I have sent you advance copy of regulations which this office has recommended to The Adjutant General of the Army for publication to the Army on this subject. You will note that daily examinations will be required of all commands under orders for overseas service prior to their departure from camp. This daily examination will be continued while awaiting transportation at ports of embarkation, and also while en route overseas. If this procedure is carried out, it is believed that ship disinfection will be unnecessary. This latter question, however, is now up for consideration and will not be finally settled until the return from Europe of certain expert observers who are about making a round trip on transports to observe and report conditions in relation to louse infection aboard ship.
2. Capt. Harry Plotz, M. R. C., who has had a great deal of experience in delousing, has been relieved from station at one of our southern camps and ordered to this office for a conference. His report, with blue-print plan of a simple delousing plant, was sent you a few days ago. It is the intention to send Captain Plotz to Newport News to advise and assist you in carrying out your plans for delousing troops. When you have no further need for his services, if you will telephone this office (Colonel Howard), Captain Plotz will be relieved and then sent to Hoboken for similar duty.
3. The supply division informs me that two portable sterilizers have been shipped to you under priority orders. They should be available shortly.
By direction of the Surgeon General:
D. C. HOWARD, Colonel, Medical Corps.
Meanwhile, the following circular letters were promulgated by the port surgeon:
Circular Letter No. 23.
OFFICE OF THE SURGEON, PORT OF EMBARKATION,
Newport News, Va., April 21, 1918.
To all Medical Officers:
1. It is reported that lice are being carried by troops overseas. The destruction of lice in this port is a most important matter, to which all medical officers will give their careful attention.
2. The following methods have been found efficacious:
(a) To kill both adults and ova, hot ironing of the seams of clothing.
(b) To kill the adults forthwith, smear all the interior seams of clothing with grease, which will asphyxiate the young as they hatch from the ova. It is obvious that by this means cure will only be complete when the last batch of eggs is hatched, which may not occur for six weeks. Meanwhile, however, comfort is assured, and the laying of eggs is prevented.
The adults are best killed by powders, of which the following have been proved effective, in conjunction with grease on the seams of clothing, in the following order:
(1) N. C. I. powder consisting of 2 per cent each of iodoform and creosote, with 96 per cent of naphthaline. One ounce per man should be dusted on the interior of all clothing once a week. It is most effectual if the men dust their clothes freely and roll themselves and their clothing tightly in blankets for the night. Few, if any, lice will be found alive on the following morning.
(2) Zinc oxide and French chalk (magnesium silicate), 25 per cent of each, with 50 per cent of ammoniated mercury.
(3) Keating's powder (pyrethrum).
For asphyxiating the young as they hatch the most suitable grease is a jelly of crude mineral oil 9 parts, soft soap 5 parts, and water 1 part. This compound is known as "vermijelli." One ounce per man smeared once a week on all interior seams of the clothing has been found effective in conjunction with the above dusting powders.
3. When troops are found to be infected with lice, immediate report will be made to this office.
By direction of the Surgeon:
A. J. COLCORD, Captain, M. R. C.
Circular Letter No. 27.
OFFICE OF THE SURGEON, PORT OF EMBARKATION,
Newport News, Va., May 3, 1918.
From: The surgeon, port of embarkation.
To: The transport surgeons.
Subject: Procedure for the destruction of lice.
1. Recent reports show that lice are being carried by troops overseas. Medical officers in charge of troops will give strict attention to the destruction of vermin and will report infested men to their commanding officers, who will direct that the man and his quarters be freed of the infestation without delay.
2. One of the following methods may be followed:
(a) One ounce of naphthaline powder should be dusted on the interior of all clothing once a week. This is most effectual if men dust their clothes freely and roll themselves and their clothing tightly in blankets for the night.
(b) The man is stripped and while he is taking a full lather bath, his clothes are treated with gasoline. This is best done by applying the gasoline to his clothes with a sponge or old cloth. Each garment and blanket should be gone over in this manner, using from a pint to a quart of gasoline. Clothes and blankets so treated should be immediately rolled into a tight bundle and left for 30 minutes. They can then be shaken out in the open and returned to the man. Precautions should be taken against fire or explosion.
(c) Neither of these methods destroys the eggs-nits-but only the adults, so it is necessary to repeat either method in about a week in order to destroy the young lice after they are hatched.
(d) Quarters may be treated with kerosene.
Colonel, Medical Corps.
Plans for an adequate delousing station were prepared and submitted during the week ending May 11, 1918, and revised plans were further submitted to the office of the Surgeon General by the surgeon of the port of embarkation, with explanations of same, about June 12, 1918. These plans were not adopted, however, and it was not until October 28, 1918, that the construction of delousing plants (one for Camp Stuart and one for Camp Hill) was approved. Construction of the plant at Camp Stuart was begun shortly thereafter and was completed March 11, 1919. Approval for the Camp Hill plant was finally withdrawn by the War Department and directions were given to improvise for the purpose an existing building. This was done and equipment was installed as for Camp Stuart, the plant being ready for use on April 1, 1919. In the meantime, while negotiations relative to the erection of permanent delousing stations were in progress, the emergency had to be met and delousing was accomplished in other ways. Delousing on a much larger scale was begun with the installation of portable steam sterilizers at certain latrines with showers, one at Camp Stuart, June 24, 1918, and one at Camp Alexander, June 21, 1918. Prior to this time, cases of louse infestation found by the preembarkation physical inspectors were sent either to the embarkation hospital or the camp infirmary for treatment.
In order to determine the degree of lousiness of troops arriving at this port from mobilization camps, examinations were made in cooperation with an officer detailed by the Surgeon General for that purpose. Each man was carefully examined, as well as his clothing, with the following results:
Directions were then given for delousing all colored troops before embarking, which was done as follows: All reported by organization at a designated latrine (and bathhouse) adjacent to which stood the sterilizer; each man had his hair clipped, took a thorough bath with warm water and soap, and finally rubbed himself all over with kerosene; his clothing was sterilized during this time and was turned over to him when he was ready to leave. All were examined before embarking by the preembarkation physical inspectors to determine their freedom from lice. General delousing was not practiced in the case of white troops, only those receiving treatment who were found to be lousy by the preembarkation inspectors. This inspection required freedom from nits as well as lice, the presence of even one nit disqualifying a soldier from embarking with his organization until deloused. This was done by the camp surgeon concerned.
The time element made control measures especially difficult, as all the accepted insecticides required considerable time and continued application to insure successful results. In a majority of cases that came to the camp surgeon for delousing, it was necessary to return them to their organizations ready for
reexamination or embarkation within 24 hours. This debarred any form of treatment except shaving the body, a hot-water shower, and an application of kerosene. This process was slow and painstaking. The system worked out consisted in the report of infested men at a designated latrine with soap, towels, and safety razors. The men shaved themselves to the extent possible, the process being completed by Medical Department men. Five of these were able to shave satisfactorily from 15 to 20 men in an hour. A medical or sanitary officer was always on duty when the process was under way to inspect the men as they were finished. In the case of head lice, the hair was clipped close and kerosene applied to the scalp. The clipped hair was burned.
The following data, taken from reports of the preembarkation inspector, give additional information as to the degree of lousiness in troops, bearing in mind, however, the fact that the colored troops had been deloused before this inspection and that the white troops had not.
Comparing the above table with that previously given, it is seen that the average percentage of lousiness among white troops remained low; i. e., for 11,575 men there were 123 cases, or 1.06 per cent, as compared with 0.6 per cent in the former table. In the case of colored troops, who invariably came with a high percentage of louse infestation (42 per cent in one group examined), there was a very marked reduction indicated in the latter table; i. e., in 4,491 men there were 51 cases, or 1.1 per cent. This low percentage at preembarkation inspection must be attributed to the effects of the primary delousing treatment. The remaining cases were given a final treatment and were entirely freed from lice before embarking.
The delousing of troops returning from overseas was supplementary to that carried out prior to embarkation abroad, and on transports en route.
Patients.-All patients returning from overseas were examined for lice and bathed, and their clothing was sterilized at the hospital sterilizers or at the camp delousing stations. All patients debarking at the port were taken to either Debarkation Hospital No. 51 (Hampton) or the embarkation hospital (Camp Stuart) or Debarkation Hospital No. 52 (Richmond), where they were examined and deloused. While there was considerable variation in the percentage of lousiness in the various shipments, the average for December, 1918, for example, was about 10 per cent for a total of 5,896 patients received. For the first 10 days of January, 1919, 5,214 patients were received and 12 per cent were lousy, while for the week following, of 432, only 6.3 per cent were lousy.
Troops.-In the absence of permanent delousing stations as explained above, 7 temporary delousing stations were improvised at latrines-4 at Camp Stuart and 3 at Camp Hill. At Camp Stuart, where the latrines were double, a 30-foot extension of the roof was built to shelter the portable sterilizers and thus permit operation during inclement weather, a door being put into this end to provide direct communication with the latrine. At Camp Hill, where the latrines were single, opposite, and close together, a roof extension was built connecting two of these, thus affording proper shelter, and a convenient passageway was provided by new end doors.
The portable sterilizers were used in pairs, one for blankets and underwear and the other for clothing, and were of standard size. Operating the sterilizers in pairs made it possible to handle the blankets and clothing of about 35 men per load and a load every 30 to 35 minutes. Thus the seven stations could handle approximately 5,000 men daily. With lighting facilities provided, work proceeded at night when necessary, greatly increasing the capacity. These stations were put in operation December 16, 1918. Each station was in charge of a commissioned officer with five or six enlisted men as assistants.
Civilian employees.-Male civilian Government employees were handled in the ordinary manner, while females (nurses and others) were cared for under the supervision of the chief nurse, embarkation hospital, Camp Stuart.
Upon the arrival of a transport, the troop movement officer notified the port surgeon, who notified the camp surgeon concerned, giving the number of men and the time of arrival at camp. Having been assigned to quarters, the commanding officers of the returning units were ordered to report to the camp surgeon for instructions. The latter informed them where their men were to report and the manner of handling the men during the process.
The troops, after being instructed, reported at the designated latrines with their blankets and extra clothes tied in a bundle, to which one of their identification tags was attached. They then passed into the latrine (25 to 30 in each), undressed, placed uniforms over clothes hangers as carefully as possible, and attached to this their second identification tag. These clothes were carried from the latrine by a detail and placed in the sterilizer. Their property was sterilized while the men were bathing, and was finally returned to them. Another group in the meantime, had entered the other latrines of the station and their
property was started as soon as the others' was taken from the machines. The bath included a thorough soap lather from head to foot and, in the case of pubic and head lice, special treatment was prescribed. The sterilization of clothing and blankets was carried out as follows: After loading and closing the door, a vacuum of about 15 inches was produced, followed by steam sterilization at 15 to 20 pounds for about five minutes. A vacuum was then again produced. The preliminary vacuum was absolutely essential in the destruction of lice, and the terminal vacuum rendered the clothing dry on coming in contact with the air after being unloaded.
When the delousing was completed, the commanding officer of the organization signed a certificate that his entire command, stating number of officers
and men, had been deloused. This was executed in duplicate, one copy was retained by the camp surgeon and one was forwarded to the port surgeon. The estimated average percentage of louse infestation of all kinds for all troops, numbering 3,704, returning between December 16 and 21, 1918, inclusive, was placed at 1 per cent, while for the period January 1 to 11, 1919, inclusive, covering 22,702, it was found to be slightly less than 0.5 per cent. However, here again, we find some variation, depending on organizations; for example, the week ending January 18 showed 12.2 per cent lousiness for 4,009 men, due largely to the fact that one organization alone, consisting of 738 men, showed a louse infestation aggregating 44 per cent. The percentage for all troops arriving in February was 1.19 per cent, and for March, 1.04 per cent.
MORBIDITY AND MORTALITY DATA
The collection of the morbidity and mortality data for a constantly shifting population is an exceedingly difficult matter, even though that population be under military administration. In a port of embarkation where all operations are carried on at top speed, where the bulk of the personnel is busily engaged in outfitting for overseas service, where men are being inspected and otherwise prepared for embarkation, the difficulties surrounding the acquisition of reliable statistics are increased manyfold. The confusion and attendant difficulties are still further increased if large building operations are taking place coincidentally with the disorder which results from the detrainment, embarkation, and debarkation of troops. This explanation is made to account for an occasional hiatus in the statistics which follow. These statistics mainly cover the period from the beginning of the port to January 1, 1919. It will be noted that the data for the period prior to April 1, 1918, are incomplete. A careful search of the files failed to discover the material with which to bridge this gap.
Since all mortality and morbidity rates are of necessity dependent upon the strength of the command, it will be necessary to preface the statistical data of this report by a consideration of this intricate and puzzling question. There was a considerable daily fluctuation in the strength of the port, owing to the importation and exportation of troops. This produced the paradox that the greater the number of troops passing through the port, the less was the average strength. In other words, the strength of the port was determined by the relation between the rates of inflow and outflow of troops. Since the number
of troops passing through the port influenced the number of cases and deaths, especially from communicable diseases, a further distortion of the rates occurred, for as the average strength falls the factor per thousand rises. In order to equalize these errors, an attempt was made to compute the number of men-days of the port for the period in question. This figure, divided by the number of days of the period, would equal the yearly strength. Thus, if S equals the strength and T equals the length of time in days that the strength obtains, the product of S and T divided by 365 gives the yearly strength of YS. This
would give the formula ST/365=YS. Unfortunately, it did not prove practical to determine the exact length of time each unit remained in the port, and it was found that, even in the units themselves, there was a daily fluctuation of
the strength. The average monthly strength has therefore been used in the tables that follow as the basis of computation. This was obtained by dividing the sum of the daily strength for the month in question by the number of days in the month. Yearly rates are based on the results of dividing the sum of the monthly strength by 12. There is an element of error in this method, but it is believed that the rates as given furnish a fairly accurate picture of the sanitary results obtained. It should be pointed out, however, that morbidity and mortality data for a port of embarkation are not comparable with those of a
fixed post or cantonment in which a constant movement of entrance and exit of troops does not occur. The condition in a port of embarkation is that of a constantly rising and falling fluid from which cases and deaths are continually being precipitated.
The extent of troop movement at this port of embarkation from the commencement of operations in 1917 until August 22, 1919, is shown in the following table:
Troop movements through port of embarkation, Newport News, Va., August 1, 1917, to August 22, 1919, by years
aRemaining Aug. 22, 1919.
The following table shows the average strength of the port by month and by color:
Average strength, port of embarkation, Newport News, Va., September 1, 1917, to August 31, 1919
The foregoing data regarding strengths and the movements of troops were supplied by The Adjutant General's Office. The mortality and morbidity data which follow were received from two main sources; i. e., the reports of the embarkation, debarkation, and camp hospitals and the reports of the camp
surgeons. The following daily telephonic reports were received from hospitals: (1) Number of patients under treatment; (2) number of vacant beds; (3) admissions by specific causes by name and organization; (4) admissions from influenza, pneumonia, meningitis, and empyema; (5) deaths from pneumonia and from other causes; (6) field report on sanitary personnel and transportation. All telephonic reports were verified by written reports except (4) and (5).
A sick and wounded report was received on each Friday from all hospitals. This report included admissions to hospitals by total and by certain specific diseases, deaths by cause, disposals of patients, and the number of patients remaining at the close of the week. In addition, the embarkation hospital reported weekly on venereal admissions by causes, venereal disposals by causes and complications, and the number of venereal cases remaining by causes.
All hospitals and camps submitted monthly reports of sick and wounded. These included: (1) Register card for each admission, showing name, rank, etc. of the patient, diagnosis, complications, disposition, days of treatment, etc. (the item "disposition" included deaths); (2) report sheet, showing average make-up of the command for the reported month, with numerical report for the month of admissions from the command, completed cases and patients remaining; (3) nominal check list of admissions as taken up on the report. Daily telephonic reports were rendered by camp surgeons on the incidence of communicable diseases in the command by name, rank, organization, and specific disease. Written daily reports were made on the number sick from all causes, with dispositions and an analysis of remaining cases, and on sanitary personnel and transportation. Each command submitted on Friday the data for the weekly telegraphic report to the Surgeon General. This report included sick and wounded admitted to quarters, with dispositions and number remaining, venereal admissions, and total under treatment.
A monthly venereal disease report was made by each camp surgeon. This report was based on the results of the semimonthly physical examinations and contained data on prophylaxis, neglect of duty, etc. All infirmaries and hospitals submitted a report on the social history of each new case of acute venereal disease. These reports were submitted at the time of identification of the disease or of admission to hospital.
All morbidity data were assembled daily by organization and disease. From this card, which was a permanent record, the data were assembled by camp, and these, in turn, were consolidated upon a single card. Mortality data were filed by card for each organization, for each camp, and for the entire port. This enabled the port surgeon to have accurate information available at all times as to the incidence of disease and deaths and to apply corrective measures promptly. Complete morbidity data for the period prior to April 1, 1918, are not available, and the statistics for that calendar year are therefore
incomplete. It will be noted that practically all cases recorded were of the sputum-borne class, if venereal diseases are excluded.
This disease was present throughout the nine months for which data are obtainable. A severe epidemic occurred in late September, 1918, which continued at a high incidence rate throughout mid-October and slightly recrudesced in December. The following table shows the monthly incidence of the disease.
The daily incidence of influenza is of interest, in that it shows that this disease was present throughout the entire period for which statistics are obtainable, and that, beginning with September 20, 1918, there was a sharp rise which reached its peak on October 7, 1918. It then fell sharply and continued on about the same level, with slight daily variations, for several days, when a secondary fall took place. From this point there was a gradual fall, followed by a short recrudescence on December 6, 1918. This is shown in the following table:
Influenza, daily morbidity rate per thousand, 1918
From a study of statistics alone, it would appear that the white troops were far more susceptible to influenza than were the colored troops. The maximum daily rate at Camp Alexander, where the troops were almost exclusively colored, 9.12 per thousand, a low rate when it is considered that a fairly large number of infected men were introduced from interior camps. The following table shows the comparison between the maximum daily rates per thousand of the various camps:
In considering these data, however, it should be borne in mind that many of the colored troops had been in the port for a considerable time and had accustomed themselves to the environment; that they had had an opportunity to build up a series of sanitary safeguards, such as sanitary messing and housing; that they had not, for the most part, been exposed to the debilitation of travel and to the opportunities for contact with infected persons incident therto; that, on account of working in detachments, they did not come in contact with large groups of persons, as did the white troops. When they did become
infected, they seemed to show less resistance to pneumonia than did the whites, as shown in the table below.
Weekly admissions, pneumonia, all forms, absolute numbers and rates per thousand, by color, for the 20-week period from August 15, 1918, to January 3, 1919
It is difficult to set an arbitrary date at which the epidemic of influenza began, since, as is shown by the foregoing data, the disease was reported as present almost every day for which statistics are available. It is well-nigh impossible
to draw a sharp line of demarkation in all cases in all absence of a proved causal agent. Undoubtedly there have been included in the cases reported above many which, in the light of future knowledge, would not have been diagnosed as influenza vera, but which medical officers were unable to classify in any other way. On the assumption that the epidemic began on September 26 and ended October 20, 1918, it consisted of 5,370 cases, 719 of which, or 13.9 per cent, developed pneumonia. Of these 719 in which pneumonia occurred, 201, or 27.5 per cent, died. The death rate for the entire 5,370 cases was
3.74 per cent. But some of the cases which became ill before October 20 developed pneumonia or died after that date, and it is therefore not accurate to consider the epidemic closed on October 20. Since a slight recrudescence occurred subsequent to that date, it would seem more correct to consider the epidemic as certainly over by December 31, 1918, and to consider all cases after that date as between epidemics. On this basis, the epidemic consisted of 6,036 cases, 927 of which, or 15.3 per cent, developed pneumonia. Of the pneumonia cases, 250 died, or 26.8 per cent. The death rate of all cases was
then 4.1 per cent. It is more than probable that the truth lies between the two sets of figures, a pneumonia rate of 14 per cent with a fatality rate of 27 per cent, and an influenza fatality rate of 4 per cent being fairly accurate.
It would seem as though a more accurate picture could be obtained when the incidence of the disease is studied by camps. Such was not always the case, however, since the importation and embarkation of troops was not discontinued on account of the epidemic. Hence, there was a constant change in the personnel of the various camps; cases were constantly imported, and the fluctuations in the daily strengths very greatly distorted the rates. For example, the strength at Camp Alexander was 10,146 on September 28, 1918, the day the first case occurred in that camp. The strength was 5,167 on October 20,
the day that the epidemic was practically concluded there. The average strength for the 23-day period was 7,620. The incidence of the disease in this camp was greatly augmented by the introduction of a considerable number of men already ill with influenza. An attempt to overcome the distortion has been made in the tables which follow by figuring the daily rate per thousand on the daily strength rather than on the maximum or the average strength.
Daily incidence of influenza, Camp Morrison, fall of 1918, rate per thousand
In the consideration of the above table, it should be borne in mind that there was a considerable variation in the strength of Camp Morrison, fluctuating between 3,000 and 3,400 in the period prior to November 11, 1918, after which date a gradual decline to 875 occurred. It should also be noted that the boiling of mess kit wash water was instituted on October 5 and maintained at a high standard until late in October, when its efficiency was impaired through a misinterpretation of orders. It was reinstituted in mid-November, after which practically all cases reported were imported. A total of 1,448 cases occurred during the period shown.
Daily incidence of influenza, Camp Alexander, fall of 1918, rate per thousand
The personnel of this camp was entirely colored, with the exception of the commissioned officers and the noncommissioned staff. The colored strength was variable, being about 9,500 at the beginning of the epidemic and 2,645 on December 31, 1918. Part of the command was under canvas, part in hutments, and part in barracks. Some of the command had entered the Army in the August draft; some had served over a year. Part of the command consisted of reserve labor battalions, the men of which were unfitted for overseas duty for some physical reason, usually venereal disease. The great bulk of the command was engaged in stevedore and labor operations. Overcrowding did not exist. A total of 520 cases occurred in this camp during the period under consideration. That the disease was introduced in ample quantity is shown by the following incident:
A detachment of the 328th Labor Battalion, 239 men, entrained at 4 p. m., September 26, 1918, at Camp Beauregard, La., and arrived at Camp Alexander, Va., at 2 p. m., September 29, 1918. Twelve of the men, or 5.02 per cent, had shown symptoms of influenza prior to entrainment; 120, or 42.67 per cent, developed the disease en route; 61, or 29.7 per cent, developed the disease subsequent to detrainment but prior to October 2. The evolution of the outbreak took place in an almost arithmetical progression, which is shown by the following table of daily incidence. The data for this table were secured in part from the patients and in part from the camp surgeon.
It may be noted that the rate was at the peak during and immediately following the journey.
Each of the sick was carefully interrogated on the following points: Name, rank, organization (including company at Camp Beauregard), date of induction into the service, previous occupation, date of onset, symptoms, exposure to weather, common vessels used, exposure to other cases, roller towels used, debilitating factors, fatigue, overcrowding, untoward incidents of the journey, food, clothing, bedding, and the probable source of infection. After carefully sifting all data obtained in this way, the following facts of epidemiological importance remained. No debilitating factors prior to entrainment could be elicited by the most careful and patient questioning. There was no exposure to inclement weather, no history of fatigue. The food was uniformily satisfactory. The outer and under clothing and the bedding were
adequate. There was no marked exposure to other cases at Camp Beauregard. One or two men said that the disease existed there among the white troops. A few said that there had been much sneezing and coughing in their company, but no one remembered contact with men presenting the influenza complex until just before entrainment. Nothing was discovered which directly incriminated food or drink as the vehicle of infection. A common cup was used on one car during the first part of the journey.
This organization did no work for two or three days preceding departure from Camp Beauregard, save the orderlies, cooks, and kitchen police, since the command was "standing by" awaiting orders for entrainment. The organization was practically in quarantine during that time, no passes being granted. This would rule out mass infection from exterior sources. Overcrowding at Camp Beauregard seems to have existed to a certain extent, as shown by the following table:
1Average per tent, 8.18.
The journey was begun with 12 men, or 5.02 per cent of the command, already in the active stages of the disease. Still others were presumably infected,
as 4 were taken sick on the afternoon of the entrainment and 48 more were actively ill by the time the journey had continued 48 hours. Tourist cars were used, and all the windows were closely shut in the evening of the first day, causing the cars to become rather warm. This occasioned much discomfort, as the men had become habituated to open-air sleeping during their two months of service. Twenty-four new cases appeared on the following morning and the same number sickened in the afternoon; i. e., 52 cases occurred in the first 24 hours of the journey.
The men were drilled for 20 minutes on the platform at Memphis and for 30 minutes at Knoxville; otherwise they spent their entire time in intimate contact in the hot, unventilated cars. It was not possible to check the statements of the men against those of their officers, since the latter returned to Camp Beauregard as soon as they had delivered their commands to Camp Alexander, but it would seem that the receipt of the infection from exterior sources in transit could be excluded.
It was difficult to separate the cases of this detachment from those of the remainder of the battalion after the former arrived in Camp Alexander, the latter having arrived from Camp Gordon on the day previous. The battalion then consisted of 768 men, 528 of whom were from Camp Gordon. The following table shows the incidence of the disease while this battalion was at Camp Alexander:
Incidence of influenza in the 328th Labor Battalion
This organization furnished 50.7 per cent of the cases occurring in this camp. The following table gives the pneumonia fatalities (all forms) in this group of 264 men during a period in October, 27 in all:
The strength of this battalion was increased to 1,042, and the organization embarked for France on October 13, 1918, in company with the 701st Stevedore Engineers, 3 field remount squadrons, and 40 casual officers. The following table shows the incidence of influenza in the 328th Labor Battalion en voyage:
It is interesting to make a comparison between the influenza rates in the 328th Labor Battalion and the 701st Stevedore Engineer Regiment. The latter was formed on September 23, 1918, at Camp Alexander, from the 304th Stevedore Regiment and a few casuals. Its average strength was 958. The following table shows the incidence of influenza in this organization:
It may prove of value to compare the foregoing tables with those of other reserve labor battalions, as shown below.
Incidence of influenza, reserve labor battalions
The following table shows the number of cases of pneumonia occurring during 1918 and a part of 1919, by months, the average strength, the rate each month per thousand of strength, the number of deaths from pneumonia, and the percentage fatality each month.
Average monthly rate per thousand--- 5.05
Annual rate per thousand--- 60.60
Percentage fatality of pneumonia cases-- 18.71
The incidences of mumps and measles may be taken as indices of the degree of sputum commerce among nonimmunes. The following table shows the incidence of these and other diseases:
aThe monthly rate per thousand for tuberculosis is not included because all cases were among troops sent to the port for embarkation or were returned from overseas.
The following table shows the gross deaths by total and by color, and the rate per thousand by total and by color. The strengths for the year 1919 on which to base the rate by color are not available:
An analysis of the gross deaths shows that, of the 540 deaths from all causes that occurred in the port from November, 1917, to December, 1918, inclusive, 389, or 72 per cent, resulted from pneumonia. Of the 493 deaths in 1918, 367, or 74 per cent, were due to pneumonia. The data for this disease will therefore be analyzed first.
The following table shows the number and rate per thousand of deaths from all forms of pneumonia by month and by color.
The following table is an analysis of the total pneumonia deaths occurring during 1917 and 1918 by bronchopneumonia and lobar pneumonia, and the monthly rates per thousand of each.
Of the total of 389 deaths from pneumonia which occurred in the above noted 14 months of 1917-18, 179, or 46 per cent, were bronchopneumonia and 210, or 54 per cent, were lobar pneumonia. Not included in the foregoing statistics are 3 cases of bronchopneumonia secondary to pulmonary tuberculosis, 1 of lobar pneumonia secondary to pulmonary tuberculosis, 1 bronchopneumonia secondary to tuberculous meningitis, and 2 bronchopneumonias secondary to cerebrospinal meningitis. Pneumonia included in the above statistics was reported as secondary to influenza in 99 instances. This figure is, without doubt, greatly below the actual number.
The following table shows the monthly occurrence and rate per thousand of cerebrospinal meningitis deaths by total and by color. Of the total deaths from this disease from November, 1917, to December, 1918, inclusive, 24 were in colored and 8 in white troops; i. e., 75 per cent colored and 25 per cent white. The same ratio was maintained in the 10 deaths occurring in 1919 prior to August 23.
aMonthly figures for 1919 not available.
TUBERCULOSIS, ALL FORMS
During the 14-month period before mentioned, 42 deaths from tuberculosis in its various forms were recorded. Of these, 14, or 33.3 per cent, were in white troops and 28, or 66.7 per cent, were in colored troops. The rate per thousand for 1917 was 3.16; it was 1.34 for 1918. There was a total of 38 deaths from tuberculosis in 1919, prior to August 23.
MISCELLANEOUS CAUSES OF DEATHb
No deaths occurred from typhoid or paratyphoid fevers. Of the 675 deaths for the entire period, 424 were due to pneumonia, 42 to cerebrospinal meningitis, and 80 to tuberculosis. In other words, 546, or 80.1 per cent, were due to sputum-borne diseases. On the contrary, the only deaths from fecal-borne organisms were 2 from dysentery, less than 0 4 per cent. Only 1 death occurred from a mosquito-borne disease, 0.15 per cent.
It was early recognized that morbidity reports were quite as necessary to the successful prosecution of the control of venereal disease as of any other communicable disease, but it proved exceedingly difficult to secure accurate and continuous reports on the venereal infections. This resulted, in part, from the congestion and hurry which existed during the construction period, a time when troops, animals, and supplies were constantly pouring through a port in which building operations were still going on. A greater factor was the failure of medical officers to realize that it was quite as necessary to report a case of gonorrhea as to notify the port surgeon of the occurrence of a case of smallpox. Furthermore, the intense public interest in the control of these diseases created a new situation for the administration of which no precedents existed; add to this the unexpected magnitude of the problem and the well-nigh universal distaste for statistical collection on the part of medical men, and it is seen why the accumulation of accurate data for the entire period of the war is almost impossible.
The port was visited from time to time by experts from the Surgeon General's Office. These advised with the port surgeon on the various phases of the problem, but even the most optimistic admitted the almost insurmountable difficulties in its solution, particularly as applied to colored troops. At least 20 per cent of the colored troops arriving at the port were found to be suffering from obstinate chronic venereal infection of several years' duration.
In the great majority of cases, this had not materially interfered with the earning of a livelihood in civil life, neither did it prevent the performance of work at the port. Yet these men could not be embarked so long as they were suffering from a venereal disease. Here arose the difficulty of defining accurately when a man once infected ceased to have the disease. The Wassermann reaction furnished a reliable standard in the case of syphilis, chancroids offered a visible evidence of cure, but gonorrhea, which supplied the bulk of the cases, proved much more difficult. The presence or absence of an urethral discharge offered no reliable index since many of the discharges were intermittent or very scant, while at few were apparently not due to gonorrhea. Also, it was discovered that malingerers simulated gonorrhea through the aid of an urethral syringe and a can of condensed milk. It was finally determined that the solution lay in whether or not the discharge was infectious. This resulted in the preparation of a certificate by the Surgeon General's Office (April 12, 1918) based on miscropical examination of superficial and deep smears. This was excellent in many ways, but inasmuch as the certificate was not made a part of the soldier's service record, much of the usefulness of the scheme was lost so far as relieving the port from the burdensome duty of treating noninfectious venerals was concerned. The certificate issued by the surgeon's office was used for about six months, but little benefit resulted from the plan, for the certificate and the man almost invariably became separated. A record form to accompany the service record was finally evolved and put into use. The results were extremely satisfactory, in that much useless labor was obviated and an accurate trace was kept of a series of urethral catarrhs which were
noninfectious. This served to relieve the situation very materially.
Until the incidence of venereal disease became recognized as an acute problem, little attention was paid to the accuracy or continuity of reports from surgeons of the several camps or station to the port surgeon. Thus, during 1917, when at no time were there probably more than 800 or 900 venereals in the port, the records of them were very meager and no attempts were made at classification. Occasional informal reports were made, the earliest noted being for a period of seven weeks from the middle of October to the middle of December, 1917. But where such reports occur there follows a break of a month or more, and thus data lose all continuity and considerable value. Reports were occasionally made showing the number of venereals in organizations arriving at the port of embarkation, yet it appears that such reports were prompted only by a dangerous situation rather than by any definite idea of keeping continuous records.
Such a state of affairs existed with little improvement until April, 1918. The first authorized weekly reports on venereal diseases were received at the office of the port surgeon for the week ending April 13, 1918. Each post within the port of embarkation forwarded the same report the same day each week. Such reports showed the strength of the organization, the number of acute and chronic cases of syphilis, gonorrhea, and chancroid identified during the reported week, and the number of prophylactics administrated to the men in the command. Thus a relatively accurate record could be kept of the venereal situation of the port, week by week. At the same time it was urged that
sources of infection should be discovered where possible and reported to the Tidewater Health Department (United States Public Health Service), which in turn attempted to apprehend the carrier for treatment.
These weekly reports were officially continued until September, 1918. During the same period, the weekly report on sick and wounded was established in the port. This entailed a report from each camp on men in quarters. Such a report also included a report of venereal cases under treatment; showed the number of new acute and chronic cases (though no attempt was made at dividing into specific diseases) and the number of cases disposed of. It was from these reports that the first accurate record of the number of cases of venereal diseases treated at the camps was obtained, and the weekly report on sick
and wounded became the most accurate and continuous data available. The weekly venereal report (April 13 to August 30, 1918) was discontinued primarily because it was obviously incomplete.
Beginning with September, 1918, a new report was submitted by the several posts under the port of embarkation. This was in the form of a monthly report in considerable detail. The report was divided into two periods, each period determined by the dates of the semimonthly physical examinations. All cases of acute and chronic venereal diseases identified at such inspections were reported. The report included the strength of the command, the number present at inspection, the number of failures to take prohylaxis, and the number tried by court-martial. In fact, it was a complete report on the venereal situation at each post, month by month. In addition, commanding officers of each organization reported, separately from the medical officers on the absentees from physical examination.
This form of monthly report furnished the surgeon all necessary data wherewith it would be possible to note, definitely, changes in the venereal situation. At first, considerable difficulty was experienced in obtaining complete reports, and the data were not really useful until November, 1918.
Systematic reporting by the embarkation hospital was begun with the week ending September 6, 1918. The weekly sick and wounded reports, Form 86, M. D., were the only ones received, as a routine, prior to that date. Such reports were essentially generalizations, and no data as to specific diseases were available. The new reports showed admissions by specific diseases, disposals by method and cause, and those remaining under treatment at the end of each week, by specific disease. Such reports were accurate, but unfortunately could not be used as a criterion for the venereal situation of the port,
week by week, since they included only those venereal cases which demanded hospitalization.
It was always urged that sources of infection should be discovered, and special forms were prepared in the port surgeon's office for the use of the medical officers in fulfilling this purpose. These special forms were called social history sheets. During December, 1918, 26 cases of acute venereal diseases were reported on the social history sheets, and in January, 1919, it was felt that all new cases were thus being reported. While it was not anticipated that more than 10 per cent of such reports would disclose anything of value for the
law enforcement work on repression, at least this percentage was constantly discovered. These social history sheets formed a further check on the other reports.
Thus reporting had been established on a relatively firm basis by January, 1919. The reports received at that time included: Weekly venereal report, embarkation hospital; weekly reports on sick and wounded, all hospitals; weekly report on men in quarters, including venereal cases under treatment not carried on sick report; monthly venereal reports from all commands, and consolidated for each post; social case histories on all cases of acute infections. Thus several means were at hand to assist in determining the venereal situation at the port of embarkation, and the relatively accurate data could be assembled.
It is obvious from the foregoing description of the status of venereal data prior to April, 1918, that it can be expected that only an occasional glimpse into the venereal situation during 1917 can be obtained, and then only during the last three months of the year.
The first reported general survey of venereal diseases in the port was made on December 21, 1917. The figures presented are not accurate in many cases, some organizations being only partly examined, and in others no record had been kept of cure, discharge, or transfer. The time covered by this report is October, November, and the first half of December, 1917. It is obvious that, if records were partially kept, it was difficult to obtain accurate data for the one or two months preceding the making out of the report. Furthermore, certain organizations had been at their camps for only a short period, and the
reports of such organizations were included with those whose station at the port covered a longer period.
Consolidating the several items of this report, it is found that there existed at that time among approximately 12,000 troops, 628 cases of chronic venereal disease, or 5.2 per cent. The actual figures probable exceeded this, since, at the time of report, six labor companies (colored) had not been examined. Over the reported period, 329 prophylactics had been administered and 60 cases of acute venereal disease had been reported. It is difficult to estimate how many of these acute diseases were contracted through exposure in or about Newport News, but probably not more than 80 per cent, judging from the time certain of the organizations had been at the port.
It was reported on January 25, 1918, that over 300 men from the stevedore regiments had been discharged during the previous month because of physical disability "not in line of duty." It was further reported that there were 445 cases of venereal diseases in the stevedore regiments at that time, divided as follows: Gonorrhea, 322; syphilis, 72; chancroid, 41. These figures are probably accurate as far as they go, but it is evident that they are not complete, since on the day prior to this report it was ordered that all men in the stevedore regiments suffering from venereal diseases be put under treatment by the regimental surgeon at once. Yet the figures do show that, up to the time of report, approximately 745 cases of venereal disease had been identified among the colored soldiers. These 745 cases had existed among 22 labor companies with a strength of about 4,000 men, representing an incidence of approximately 18 per cent. Later reports indicate that this figure is probably too low.
In March, 1918, 619 colored soldiers were discharged on surgeon's certificate of disability. In April, 1918, 23 more were so discharged and 1,100 cases of venereal diseases from the colored organizations remained under treatment. Thus from January to April, 1918, colored venereal cases were found to the approximate total of 2,000, some 900 of which had been discharged and 1,100 remained under treatment. These figures show that, during this three-month period, nearly 1,300 cases had been detected among organizations arriving at the port of embarkation. No account is taken of discharges on surgeons' certificates of disability for January or February, of which there is no record. Venereally diseased colored troops continued to arrive at the port of embarkation during the summer and fall of 1918, until, in spite of constant discharging and of other means of disposal, the number of colored men under treatment in the camps, alone, reached approximately 332 men in December, 1918, and there were some 500 additional cases in the hospital.
Specific instances of the degree of infection existing in any one organization are rare. Of three labor battalions arriving on August 10, 1918, venereal diseases were found among 8, 16, and 15 per cent of the troops, respectively, thus averaging 13 per cent, or 390 cases, in about 3,000 men.. In contrast to this, 21,309 white troops picked at random, only 0.6 per cent, or 127 cases, were found infected. The proportionate number of cases for 21,309 colored troops, estimated on the foregoing basis of 13 per cent, would be 2,770. That this percentage is actually too low for colored troops is indicated by the fact that about 12,000 cases were reported during 1918 among colored troops sent to this port; from available records, it appears that some 59,000 colored troops were detrained, either for embarkation or permanent duty; thus approximately 20 per cent of all colored troops were venereally diseased.
CHRONIC VENEREAL DISEASES
While, on the one hand, the incidence of chronic venereal disease (cases contracted prior to enlistment) among the white troops stationed at or passing through the port was low, on the other, the incidence was very high among colored troops. This difference was largely due, in all probability, to the fact that it was not disorganizing to keep back the few cases of chronic diseases among white troops at their several interior posts; but it was tremendously disorganizing to keep back cases among colored troops, since, in some instances, it would have removed 50 per cent of the organization. Hence, despite War
Department instructions which prohibited sending such cases to ports of embarkation, colored organizations arrived at the port with many cases of chronic gonorrhea and syphilis among them. The diseased were separated from the sound men after arrival and formed into definite organizations for local labor duty while they underwent treatment. Thousands of negro troops passed through the infirmaries attached to their organizations.
The most representative figures over any considerable period of time are furnished by the weekly telegraphic reports from the several posts and the weekly report of sick and wounded from the hospitals. In the former reports are included the number of cases of chronic disease, not demanding hospitalization, treated in the camps. These men were not carried on sick report and
were on duty during their treatment. The latter reports furnish data on cases of chronic and acute diseases which demanded hospitalization. It is admitted that there are probably duplications, but they are not sufficiently numerous to seriously alter the totals. Complete figures for the weekly telegraphic reports are shown by the accompanying table.
Weekly telegraphic reports, all troops, May 25, 1918, to August 22, 1919
It has seemed advisable, in order to arrive at the more representative figure, to consider the number disposed of each week by the infirmaries rather than the number admitted, in order that the admissions to the infirmaries might not be duplicated with admissions to hospitals. To the total thus acquired, the number remaining under treatment in the posts at the time of this report must be added.
It will be noted that the disposals among cases under treatment at the several posts increased considerably during a period after December 13, 1918. On December 8, 1918, a port order directed that all cases of venereal disease which were shown by microscopic examination to be noninfectious should be discharged to duty and treatment discontinued. The effect of this order was to reduce the number of cases under treatment at the several camps from over 3,000 for the week ending December 13, 1918, to 24 for the week ending February 21, 1919. Those cases which proved infectious were transferred to the hospitals. A total of 6,183 such patients were admitted to hospitals during this reported period, not including 478 acute cases. Eight thousand three hundred and eighty-two cases were disposed of in the several camps. These men were not entered on the sick report. The total reported by the camps agrees, within 8, of the total as determined by hospital reports alone. It is significant that Camp Alexander, which at all times had from 2,500 to 6,000 colored troops, reported only 6 cases as acute.
In order to estimate the relative proportion of white and colored troops infected with chronic venereal diseases, hospital admissions from this cause were studied, covering a period of 12 weeks, November 29, 1918, to February 14, 1919. This showed that, of the 1,378 admissions, 1,169 were colored patients and 209 were white patients; that is, the colored patients represented about 90 per cent of the total. Applying this percentage to the total number of hospital admissions as given in the preceding table, it is found that, of the total of 4,426 admissions, 3,983 were colored and 443 were white patients.
In a somewhat similar manner, the relative proportion of white and colored troops treated in the camps is obtained. Weekly reports on sick and injured, among colored troops only, were received from the week ending August 2, 1918. During the period of August 2, 1918, to February 14, 1919, 5,758 cases of chronic venereal diseases among colored troops were disposed of at the several camps.
It is shown in the above table that there was a total of 6,101 disposals during this same period. Thus it can be estimated that the number of cases among negro troops greatly exceeded the number among white troops, in the ratio of 17 to 1; that is, 94 per cent of such cases were among negro troops. Applying this figure to the total cases reported for the entire period, it appears that, of 7,340 chronic cases passing through the camp infirmaries, 420 were cases among white troops and 6,920 were cases among colored troops. Adding to these figures cases of chronic diseases which demanded hospitalization, there is obtained a total of approximately 863 chronic cases among white troops and 10,903 among negro troops. There are also some 900 discharged "not in line of duty. " Thus a grand total of 12,660 chronic cases is obtained.
During 1918, 291,000 men detrained at the port. From the above estimate it would appear that 4.3 per cent of these troops were venereally diseased.
Two hundred and thirty-two thousand of these troops were white, with a venereal incidence of 0.37 per cent. Of the 59,000 colored troops, the venereal incidence was 20 per cent.
ACUTE VENEREAL DISEASES
The only reliable index of the efficacy of the antivenereal disease measures carried out in the community and among troops is the current incidence of acute venereal diseases. Reports for the port of embarkation indicate that over relatively long periods of time-a month or more-pertinent data are reliable, but it is impossible to draw conclusions concerning the incidence from daily or weekly returns, since the rise and fall curve over these shorter periods is too magnified.
No attempt is made to divide the incidence of acute venereal diseases among the white and negro troops. It is true, however, that these cases recorded here refer practically in their entirety to white troops. Colored soldiers were themselves so greatly infected in the beginning, particularly those among the labor organizations retained at the port, that the diagnosis of an acute case was most difficult and little attempt at differentiation of chronic and acute cases was made. Considering the large negro population of Newport News, it would seem probable that many cases of acute infection among the negro soldiers were not identified as such, and were treated among the thousands of chronic cases.
The incidence of acute venereal diseases by weeks at the several stations comprising the port is shown in the following table. Since these cases eventually were taken up by the hospitals, it is the hospital report which logically forms the basis for the estimate on the current incidence of acute venereal diseases. Reports, other than weekly telegraphic reports, indicate that, from time to time, more cases occurred than were reported by the hospitals. Thus to arrive at the more nearly correct figure for acute venereal disease incidence, all reports have been studied, and the following data obtained.
Incidence of acute venereal diseases, June, 1918, to August, 1919
aFigures are for 3 weeks.
The rate of infection per year, therefore, was 11.6 per thousand troops. A sharp decrease is to be noted in the figures for August, 1918. Many factors doubtless combined to produce this decided diminution in the number of such cases at this time, but it would seem that the chief of these was the commence-
ment of the law enforcement program on July 15, 1918, conducted under the auspices of the War Department. In December, 1918, a decided increase in the incidence of such cases was noted. Probably the cause underlying this change is more complex than in the first case. Attention is invited, however, to two factors: The abolition of the law enforcement program, as originally conceived, on December 15, 1918; the signing of the armistice, with the resultant relaxation among troops; loss of morale; return of overseas troops; and the illogical idea prevailing in the community that, since the emergency was over
in respect to the war, the emergency was over in respect to safeguarding health and morals.
RELATIVE INCIDENCE OF SYPHILIS, GONORRHEA, AND CHANCROIDS
It is difficult to draw any satisfactory conclusions as to the percentage of specific venereal diseases to those of the total venereal diseases, since the data on this point are meager and the data which are available cover only the period subsequent to September, 1918. It is safe to say that most of the cases among the thousands of colored troops under treatment throughout the year were of chronic gonorrhea. The single basis upon which to estimate the relative prevalence of each specific infection among 7,500 cases which underwent treatment in the camps is the report from Camp Alexander, previously quoted, covering some 4,000 cases from August 22 to December 31, 1918. Here it appears that the percentage of each specific disease to the total was 1.7 for syphilis, 89.2 for gonorrhea, and 9.1 for chancroids. It should be borne in mind that these cases were all chronic, and did not require hospitalization. The table of hospital admissions given below shows a different relation.
It was not to be expected that the various venereal diseases would occur in the same proportions as among the colored troops. All troops were inspected before entraining for the port and all of the more obvious cases of venereal infection were held back, the more or less obscure being sent forward with their organizations. Syphilis being more difficult of detection than is gonorrhea the port statistics show an increased proportion of syphilis. Relatively few white soldiers underwent treatment in the camps of the port, therefore the hospital statistics furnish the only reliable indication of the relative proportion of the venereal infections in white troops.
The following data were obtained from a study of the hospital admissions over a period of 13 weeks:
Hospital admissions for the venereal diseases, November 29, 1918, to February 21, 1919
In the case of acute infections the only source of data available relative to the proportionate distribution of syphilis, gonorrhea, and chancroids, prior
to September, 1918, is the weekly venereal report instituted in April, 1918, and discontinued September 1, 1918. While it is true that these data are not complete, it is believed that they furnish a fairly accurate picture of the relative proportion in which the specific venereal infections occurred. In all, from June 1, 1918, to February 7, 1919, 189 acute cases were reported. The proportionate occurrence of the three infections is shown in the following table:
It is not felt that the foregoing data warrant any general conclusions. Nor does it seem advisable to compare data shown above with like figures from other localities, since conditions prevailing at a port of embarkation are necessarily of a different nature than those prevailing elsewhere.
Statistics are not available relative to the occurrence of complications of syphilis and chancroid. From available data relative to complications following gonorrheal infection it is indicated that their number among colored patients greatly exceeded that among white patients. Among 871 hospital admissions for acute and chronic gonorrhea the following conditions obtained:
Of 115 white patients admitted, 17.4 per cent showed complications, chief of which was epididymitis. Of 756 colored patients admitted, 33.3 per cent showed complications, chief of which was prostatitis.
DISPOSAL OF CASES
With regard to disposal, venereal cases may be divided into three main classes: Cured, returned to duty; declared noninfectious, returned to duty; discharged on surgeon's certificate of disability. There was a fourth group for which no data of value are available-men under treatment at the camps transferred to the hospitals, and men transferred from hospitals to camp for continuance of treatment. How great a factor this fourth group might be can not be estimated.
The percentage of cures can be estimated only by assuming the proportions contained in the report from Camp Alexander (previously quoted). On that basis, the cured amounted to 27 per cent of the gonorrheas, 57 per cent of the chancroids, none of the syphilitics, and 29.5 per cent of all cases. Thus, of 4,770 cases of venereal diseases (many of long standing), 29.5 per cent were reported cured. It is impossible to state whether or not this figure can be applied to all cases treated. It would seem likely that treatment was discontinued in the majority of these chronic cases, not because the case could be
declared cured, but that the disease could be declared noninfectious.
Detailed data are available for cases disposed of at the embarkation hospital, but, unfortunately, these data cover only a very limited period, namely, the period of 13 weeks, from November 29, 1918, to February 21, 1919, mentioned above. The following classification of disposals covers 1,484 cases, 294 of which were white patients and 1,190 colored patients:
As with other data, the records relative to prophylaxis among troops stationed at the port of embarkation are not complete, and it would seem that figures which are at hand are lower than the actual number administered. The weekly venereal reports from individual camps and posts were the only source for these data prior to September, 1918. As stated previously, these reports were far from reliable because of irregularity in submitting them by certain organizations.
The estimation of the prophylaxis figures was further complicated by the fact that, particularly after September, 1918, it was urged, in certain colored organizations, that soldiers who left camp take prophylaxis upon their return, regardless of admitted exposure, and this procedure was made practically mandatory for February, 1918. It is readily seen that, with possibly 20 per cent of an organization on leave in an evening, all taking prophylaxis upon their return, the prophylaxis figure was bound to exceed the actual number of exposures. If there were included all prophylactics administered, there would be
obtained a figure which in no way would indicate the number of exposures to infection, since it does not seem probable that every time a negro left camp he
would indulge in sexual intercourse. On the contrary, the prophylaxis figures for the white troops probably fell below the number of exposures. Each prophylactic administered to a white soldier represented an exposure and would therefore be a gauge upon the existing opportunities for sexual intercourse. Division has been made as far as practicable. Fortunately, the weekly reports from May, 1918, until September, 1918, do not include figures for the negro troops, and monthly reports from September, 1918, through February, 1919, may be divided into figures for white and colored troops.
Annual rate per 1,000, white, 226.4 (based on figures for 11 months); negro, 1,570 (based on figures for 6 months).
These figures indicate little of importance except that it would appear that social conditions in Newport News had passed through a complete cycle, the conditions obtaining in February, 1919, being comparable to those of April, 1918. There is certainly a tendency for the prophylactic rate to increase, a decided increase being noted for both January and February, 1919. It does not seem justifiable to attempt to explain any fluctuations from month to month, since the data at hand prior to October, 1918, are incomplete.
PORT VENEREAL OFFICER
The port venereal officer, under the instructions of the port surgeon, was charged with the prevention of new infections, establishment and equipment of venereal infirmaries in the various camps, and the supervision of treatment.
On January 30, 1918, port headquarters issued General Orders, No. 1, which provided for the control and prevention of venereal disease through the following means: First, the diversion of athletics. Second, instruction of the soldiers in the methods of prevention and control of venereal disease. Officers of each regiment were required to meet as often as necessary to receive instructions, and they were held responsible for the instruction of the men under their immediate commands. Third, the prompt reporting of all new infections detected by medical officers and trial by court-martial of all men who failed to
Meanwhile (on January 1, 1918), the United States Public Health Service announced that it was prepared to place in hospitals all prostitutes who were found to be carriers of venereal infection. This information was furnished to all medical officers by the port surgeon through a circular letter, inclosing social history blanks on which to obtain from the infected soldier the names and addresses of women and such other information as was necessary in order to locate and place them under treatment.
Prophylactic stations were established in all organization infirmaries. A central station was established at the attending surgeon's office in Newport News. Each station was supplied with proper equipment, and enlisted personnel who had been carefully instructed. Records were kept according to the Manual for the Medical Department, and were inspected regularly by the port hospital inspector.
There was little improvement in the situation until June 5, 1918, when port instructions were issued, calling attention to the existing conditions as to venereal diseases and as to public and clandestine prostitutes, and directing that this fact be forcefully placed before the enlisted personnel by their immediate commanders. A marked decrease was noted in the number of new infections from this time on, and this continued until the signing of the armistice, after which the number of new infections rapidly increased.
During the early period of the war, owing to the lack of hospital facilities all cases of acute and chronic gonorrhea, and syphilis not having open lesions, were treated in their regimental infirmaries. Open lesions and the complications of gonorrhea were sent to the embarkation hospital. All troops passing through the port for overseas were carefully examined before embarking and those found with venereal disease were left behind and placed under intensive treatment. Reserve labor battalions were formed from the negro troops found physically unfit for overseas service. Fully 75 per cent of these were suffering from gonorrhea, late syphilis, and old suppurating buboes. They were quartered at Camp Alexander, with a small tent in use for a venereal infirmary. With 3,800 patients, it was impossible for one medical officer to handle the situation and give these men proper treatment, so a small building was equipped and occupied in August, 1918. The patients were divided into four groups, each group reporting every fourth day for treatment. These soldiers invariably had to be transported several miles from the camp to their duties, and it was found to be impossible to give them treatment during the day on which they were to report, as they were not returned to camp until late in the afternoon. This condition continued until after the armistice was signed, when a larger building was equipped and arrangements were made to treat at night men who were on duty during the day.
Few venereal cases were handled at Camp Hill and Camp Morrison. Prior to April 28, 1918, all cases of acute and chronic gonorrhea were treated in the regimental infirmaries, syphilis and the complications of gonorrhea being sent to the embarkation hospital. After the above date, they were sent to the venereal camp, embarkation hospital, for treatment.
At Camp Stuart, prior to April 28, 1918, all cases of chronic and acute gonorrhea and inactive syphilis were treated in the regimental infirmaries. But on that date venereal camp No. 1 was opened and all cases of acute and
active gonorrhea of the port, excepting those from Camp Alexander and Camp Morrison, were sent to this venereal camp for treatment. This camp consisted of 100 tents, each tent being equipped with 6 beds, and 1 building, which was used for a treatment and office building. This building was divided into six treatment rooms, a laboratory room and an office. Each treatment room was equipped with all necessary supplies for the treatment of gonorrhea and chancroids, and the laboratory was equipped with a dark-field illuminator and stains for making all venereal smears. The average number of patients treated daily at this infirmary was about 400. All patients found infected with syphilis were sent to a special ward in the hospital for treatment and further disposition. This ward was also used for dermatological cases.
Much trouble was experienced in getting the men to return for further syphilitic treatment after they had been discharged from the hospital, so a general order was issued in September, 1918, which placed upon company commanders the responsibility of returning syphilitics for further treatment. Each patient on leaving the hospital was returned to duty with a notice to his commander which listed the dates on which he should be returned for further treatment or serological examination.
On the Norfolk side of the river, cases of chronic gonorrhea and inactive syphilis were treated in the camp infirmaries. Cases of acute gonorrhea and open lesions were sent to the embarkation hospital. Later the Army supply base hospital was opened and cases of acute gonorrhea and open lesions were sent there for treatment.
DEMONSTRATION IN COMMUNITY VENEREAL DISEASE CONTROL
The general program of action of the American Social Hygiene Association proposed to combat venereal disease by reducing the number of infective contacts through the discovery of persons already infected and preventing their sexual contact with uninfected persons. Concretely it was proposed: (1) To render prostitutes and other antisocial venereal carriers inaccessible through law enforcement or quarantine. (2) To provide adequate proper treatment of those already infected. (3) To diminish the number of potential vectors of venereal disease by protecting weak girls, attempting rehabilitation of delinquent girls and women, and by providing permanent custodial care for the weak minded. (4) To provide adequate social and recreational facilities for soldiers and for civilians of both sexes. (5) To conduct a nation-wide campaign of education regarding social hygiene and the dangers of the venereal infections.
The Rockefeller Foundation made a grant of $35,000 to the American Social Hygiene Association to carry out such a demonstration in a war camp community. This demonstration was designed to develop and report the best methods for combatting venereal diseases and venereal moral hazards in a city which presented typical military, naval, industrial, and civil conditions and problems. This was, in effect, an intensive disease control experiment in which the community was to be utilized as a laboratory in which the various organizations interested in the venereal problem were to be stimulated and assisted and the whole situation of vice suppression and the prevention and cure of gonorrhea, syphilis, and chancroid studied actively.
Newport News seemed to be the ideal community in which to carry on such a demonstration. It was one of the primary ports of embarkation, with coincident concentration of military, naval and industrial activities; it was sufficiently large to furnish adequacy of data but small enough to keep the expense of the demonstration within the appropriation; it was readily accessible to Washington; it included a large colored population; its statute books contained most of the essential ordinances; while its institutional facilities were meager and therefore required upbuilding rather than reorganization. Newport News
was chosen, therefore, as the scene of the demonstration, which had its initiation on June 7, 1918.
When the port was occupied as a military base, there existed a de facto "red-light" district. The restricted district had been abolished by an act of the State legislature in 1916, but in its place there had sprung up a series of restaurants, coffee houses, and dance halls which were thinly disguised houses of prostitution. The attitude of the city administration and the local courts at this time was one of tolerance, and the solicitation of men in uniform was well known and notorious. Late in September, 1917, an officer of the Sanitary Corps was detailed by the Surgeon General to cooperate with the local representative of the United States Public Health Service in venereal-disease control, and, a little later, another officer of the Sanitary Corps was ordered to Newport News as the representative of the Commission on Training Camp Activities in charge of the law enforcement program. This officer, with the assistance of another, made a thorough investigation of vice conditions, which emphasized the necessity for immediate energetic action. It. was recommended by him that an order be issued forbidding soldiers to enter the section of the town just east of the Chesapeake & Ohio Railroad tracks between Twentieth and Twenty-
eighth Streets, and a general order to this effect was promulgated. The Navy followed with a similar order, and, through newspaper interviews and otherwise, it was made apparent to the general public that, unless there was an immediate improvement in the vice situation, it would be necessary to forbid the entrance of men in uniform to the city except on official business. A storm of protest and indignation followed; mass meetings were held; there was a demand that the grand jury fix the responsibility for the situation. But wise council prevailed and the citizens realized that the welfare of the troops and the
good name of Newport News were at stake. The result was a wholesome stimulation of public opinion. A committee was appointed to confer with the Government's representatives in the formulation of a program for the control of prostitution and its resultant evils, the improvement and augmentation of the police force, the lighting of the dark corners of the city, and the creation and maintenance of a prison farm. There was an activation of the police department and the courts, and between November 10 and 23, 1917, 90 cases involving sexual turpitude were tried. On November 30, 1917, the local board of health adopted a resolution directing the health officer to detain, under a quarantine, in the city jail, all convicted prostitutes who proved to be infected with a communicable venereal disease. The jail was old, dilapidated, filthy, vermin-ridden, insanitary, and ramshackled, and was soon overcrowded. There was a vigorous protest from the jail physician, who refused the admission of any more women
until conditions were remedied, and for a time the whole law enforcement program was threatened with distribution. It was saved from complete annihilation by the prompt action of the United States Public Health Service, which came forward with the offer of the contagious disease hospital, which had been created on the outskirts of the city, as a place for the confinement of venereal patients. The offer was accepted by the common council and the Newport News Board of Health, which resolved, on December 6, 1917, "That all persons not of good fame in the city jail and all persons who may be found in the city suffering with or having a venereal disease shall be sent to and cared for at such hospital of other suitable place as may be designated by the board of health, and there kept in quarantine for such period as the health officer may deem best."
The property thus placed at the disposal of the city consisted of a 10-room farmhouse about a mile and a half east of the city. A hasty campaign raised $750 by voluntary subscription and $300 by a grant from the city council to supply the necessary additional beds, bedding, stoves, furniture, and provisions and to install plumbing and sanitary privies. The provost marshal of the port detailed a guard to prevent the escape of the patients, and, within a few days, the institution opened with eight patients under the immediate charge of a Red Cross nurse.
The stimulation of the public conscience of Newport News reacted in a similar quickening of the entire State, and the State legislature passed no less than five acts looking to the direct and indirect control of venereal disease.
Little further progress was made in the local field, however, as the venereal disease control situation was found to be in a deplorably chaotic condition by May, 1918, the failure of the various agencies to actively cooperate in their endeavors having resulted in antagonisms and apathy.
It was evident that, unless there was such a rejuvenation of public opinion that the city administration would meet and discharge its venereal control functions in no half-hearted manner, there would occur a retrogression which would produce a condition worse than that which existed before any steps were taken. Therefore the city officials, the retail merchants' association, the chamber of commerce, the Rotary Club, the ministerial union, the medical society, the Red Cross, the Young Men's Christian Association, the local labor unions, and all other recognized civic and social groups were invited to meet with the
law enforcement officer and the surgeon of the port in the corporation court on the evening of June 7, 1918. Conferences were held on the morning of the same day and on the day following. The first conference agreed that the discussion of the police system should be delayed until after a mass meeting in the evening had cleared the atmosphere. With regard to the detention system, it was decided that the Tidewater Hospital should be increased from 22 beds to 52 beds, with a corresponding increase in personnel, but that this institution should be regarded as an exigency to be discontinued as a venereal disease place of detention as soon as the building on the jail farm was ready for occupancy.
The evening meeting was well attended and permitted a free expression of beliefs and grievances. This resulted in a better understanding between the champions of the demonstration and the city officials, and when the meeting
broke up it was with the agreement that a small group of municipal and Federal officers would assemble the next day to discuss the details of the plan. This meeting was held and the city accepted the Government's proposition for the formation of a joint civil and military vice squad, and agreed to appropriate $5,000 to pay the salaries of the civil members of the squad.
The commanding general recognized the fact that the demonstration would be more effective if it was linked in some definite way with the various social activities which were being conducted in the port by a number of non-military organizations. It was decided, therefore, to vest in the same officer the duties of director of venereal disease demonstration and of supervisor of nonmilitary activities. This was done, and a medical officer with wide experience and tact in the administration of public health problems was detailed to undertake these duties. His office was announced by the commanding general of the port of embarkation in the following general order:
General Orders, No. 193 HEADQUARTERS PORT OF EMBARKATION,
Newport News, Va., June 27, 1918.
Maj. Wilber A. Sawyer, Medical Reserve Corps, having reported for duty in compliance with paragraph 63, Special Orders, No. 136, War Department, Washington, June 11, 1918, is hereby announced as on the staff of the commanding general as his representative in the direct supervision of all nonmilitary activities connected with the administration of the port of embarkation, as follows:
1. War Department Commission on Training Camp Activities.
2. War camp community service.
3. War work council of the Young Men's Christian Association.
4. War work council of the Young Women's Christian Association.
5. National Catholic war council.
6. Christian Science camp welfare committee.
7. Hebrew Welfare Association.
8. Knights of Columbus
9. Hostess house of the Young Women's Christian Association.
10. City Young Men's Christian Association.
11. Ministerial union.
12. Camp pastors' association.
13. All churches.
14. Lutheran Soldiers and Sailors Club.
15. All fraternal orders.
16. National League for Women's Service.
17. American Library Association.
18. Rotary Club.
19. Visiting Nurse Association.
20. Chamber of commerce.
21. Army song leader.
22. Army athletic director.
23. United States Public Health Service.
24. American Red Cross.
25. Commercial amusements.
26. All other philanthropic, social, and civic organizations.
By command of Brigadier General Hutcheson:
DANIEL VAN VOORHIS,
Lieutenant Colonel, Chief of Staff.
O. W. BELL,
Colonel, Adjutant General,
The law enforcement officer was a second member of the demonstration staff. Another person working in immediate relationship to the demonstration was a woman who came to Newport News to take charge of the work of the section on women and girls of the Commission on Training Camp Activities, first as the local post worker, and later as the district supervisor, with a district covering the entire State of Virginia. She continued to make Newport News her headquarters, even after she had become State supervisor, but relinquished the local work. An officer of the Sanitary Corps was sent to Newport News, at the instance of the demonstration, to take charge of social hygiene educational work among the troops of the port and to develop and systematize a training course for enlisted social hygiene instructors. Another officer of the Sanitary Corps was attached to the demonstration staff for statistical and research work. The demonstration contributed the services of the matron of the detention house, and, later, of the matron of the city jail farm. An enlisted man of the Medical Department was the assistant to the director from the early days of the demonstration until its close.
It was for a long time impossible to find suitable office space for the demonstration on account of the crowded conditions in the city. Persistent search finally discovered a suite of four rooms. One office was set aside as a reception and stenographic room and the remaining offices were assigned to the director of the demonstration and his assistant, to the law enforcement officer and his staff, and to the representatives of the section on women and girls, respectively. Later on, when the demonstration outgrew its accommodations, two offices in another building were taken over for the educational work. The gathering together of the local workers in one group of offices proved to be of the greatest advantage in the development of the law enforcement program and in relating it to the broader program of the demonstration.
Every woman who was committed to the detention house because of sexual immorality was given a physical examination to determine the presence or absence of venereal disease and a psychological examination to ascertain her mental condition, as an aid to the court and to the protective worker in arriving at such a disposition of her case as would best serve the welfare of the individual and of the community.
In considering the observations which follow it should be borne in mind that few of the women were professional prostitutes. Most of the white women were clandestines, operating in hotels and lodging houses; all of the colored women were casual inmates of the low-grade entertainment houses on the east side. Very few women of either race had ever been inmates of houses of prostitution.
The work of examining mentally the women held at the detention house for prostitution and similar offenses was voluntarily undertaken early in July, 1918, by an officer of the port surgeon's office. Unfortunately, there are no satisfactory statistics on the prevalence of venereal disease among convicted prostitutes at Newport News. The United States Public Health Service, which made the clinical examinations, failed to keep a record of coerced patients who were sent for examination unless the result of the examination proved to be positive. Its records, therefore, offer no basis for estimating the prev-
alence of venereal infection among sexually delinquent Women in Newport News. The only index of such infection is offered by the case records prepared by the protective worker. In compiling data from the case records it has been assumed that a woman was free from infection unless it was specifically stated otherwise, in spite of the fact that a notation of infection is known to have been omitted in a great many cases merely through inadvertence.
The following table gives the distribution of 306 sexually delinquent women of Newport News according to infection with venereal disease as was noted upon their case records:
Distribution of 306 cases according to venereal infection
The figures for gonorrhea are believed to approximate correctness, but the figures for syphilis are known to be far below the true facts, inasmuch as no Wassernmann tests were made by the public-health clinic for an extended period, and the presence of syphilis was not ascertained unless it happened to be apparent in open lesions. The Wassermann test was used later on, but the result of the test frequently failed to be noted upon the case records, especially in cases which had already been found positive for gonorrhea.
The women who were sent to the Tidewater Hospital were, of course, infected with a communicable venereal disease in every case. The table below indicates the distribution of the several venereal diseases:
Distribution of venereal diseases in 132 infected prostitutes
The following table gives the distribution of 314 female delinquents according to the cause of their detention:
Distribution of 314 cases according to cause for detention
"Ill fame " is an old common law phrase covering a multitude of sins which might more properly perhaps have been specified on the police docket. It includes cases of prostitution, illicit cohabitation, lewd and lascivious conduct, and, in some cases, keeping a house of ill fame. The words "health warrant" indicate the procedure under which the health officer summons a suspected venereal carrier to appear before him for examination and, if necessary, for quarantine, under the authority of the health regulations.
That the demonstration, through the continued pressure of its several operations, did have a noticeable effect on vice conditions in the city is indicated by the continuous falling off of the venereal morbidity rate. From a per thousand rate of 24.8 in June, 1918, the rate dropped consistently to the low mark of 4.5 per thousand in November. 1918. There is reason to believe that there was a comparable reduction in the incidence of venereal disease among the civil population, it belief substantiated by the statement of several leading physicians.
However, beginning in September, 1918, certain political and civic antagonisms to the antivice program frankly demonstrated themselves. The situation was further complicated by the signing of the armistice, with the resultant let-down in morale and extensive changes in the personnel of the port of embarkation and of this demonstration. The end result was the disruption of both the city's vice squad and the antivice squad operating under the office of the law enforcement officer. Thus, with the disorganization of the law enforcement system through this unforeseen turn in local sentiment, the obstacles to
the demonstration became so formidable that continuance of the vice-control operations along the program of this demonstration, as first conceived, was not warranted. Newport News, which had at first appeared an ideal type of city in which to carry on such a social experiment, fulfilled the conditions of such a type no longer, either physically or politically. The demonstration closed its operations in the middle of November, 1918. Of the $35,000 appropriated for its use by the Rockefeller Foundation, barely a fifth of it had been expended. In applications, the program of the demonstration, mainly through its law
enforcement division, materially aided in the reduction of venereal morbidity. As an experiment, it clarified existing theories in the operations of vice-control measures and formed a practicable basis for the development of the national policy into a national program.
An interesting corollary to the cessation of the demonstration was the venereal morbidity for subsequent months: From the low rate of 4.5 per 1,000 in November, 1918, the rate increased for several months, then dropped abruptly in March, 1919, as shown in the table on page 403. The city had succeeded in controlling its vice just as long as it desired; but just as soon as an opportunity presented itself it had permitted vice interests to return and an immediate rise in venereal incidence resulted. Explanation of the terminal depression in the rate is not available.
CHIEF MEDICAL EXAMINER
Upon the office of the chief medical examiner, under the direction of the port surgeon, devolved the final physical examination of all troops entering or leaving the port, regardless of destination. Thus this office was required to examine troops on detrainment, during their stay at the port, and prior to embarkation, entrainment, or demobilization. The great bulk of this work was performed at Newport News, but about 50,000 men were examined at Camp Lee, Va., by examiners detailed from the port. These important operations were organized early, a captain of the Medical Corps being placed in direct charge.
The first chief medical examiner was not assigned until November, 1917, and he continued to exercise the duties of this office until he was honorably discharged from the service in April, 1919.
In the early days of the port, there were no precedents to follow in the conduct of the examination of such large numbers of men prior to a prolonged sea voyage. It was essential that no man be shipped to Europe who would not be able to do full duty immediately on debarkation. This required elimination of all physical nonefficients, all cases of communicable diseases, and all men presumably in the incubation period of an infectious disease.
The work was well organized by June, 1918, when the staff of the chief medical examiner consisted of 10 medical officers especially selected and trained for the work. These were mostly genitourinary and dermatological specialists of the rank of captain and lieutenant. They were assisted by orthopedists and neuropsychiatrists.
The method of procedure was as follows: All men were placed in quarantine immediately upon their arrival in camp. They were then given the preliminary physical examination, which resulted in the immediate elimination of the great bulk of the nonefficients. As a rule, these examinations were conducted by the surgeon of the camp in which the men were quartered, under the direction of the chief medical examiner and with the assistance of members of his staff. The remaining men were subjected to a daily physical inspection which was designed especially for the detection of cases of communicable disease before
they could infect others.
The prescribed period of preembarkation quarantine was 10 days. Its length, of necessity, was subject to great variation, but it served a very useful purpose, in that it permitted the prompt removal of all cases of communicable disease and the contacts thereto and gave opportunity for a complete check on vaccinations and inoculations, in addition to a very thorough preliminary culling out of men who were not physically or mentally fit for full duty overseas. Theoretically all nonefficients, excepting those who fell ill on the journey to the port, had been removed prior to entrainment. Practically, many men arrived
at the port who never should have been accepted by the draft boards. The number of nonefficients arriving gradually decreased as the war progressed. This may be taken as an indication that there was a coincident improvement in the preentrainment physical examinations, which may have been stimulated by the lists of nonefficients forwarded by the surgeon to the commanding officers of camps from which they came.
The final preembarkation physical examinations of troops were made 24 hours prior to embarkation. If, from any cause, embarkation was delayed over 48 hours, a complete reexamination was made. Appointments for final examination were made in writing with the commanding officers of the organizations to be examined, the following form being used:
OFFICE OF THE SURGEON, PORT OF EMBARKATION,
Newport News, Va., (date) ---1918.
APPOINTMENT WITH COMMANDING OFFICERS FOR PREEMBARKATION INSPECTION OF TROOPS.
Name of organization --Number of men to be inspected --. Officer in command - Phone --- Location Block Barrack-- Date of inspection 1918. Hour--
HENRY SMITH BARTHOLOMEW,
Major, Medical Reserve Corps,
Preembarkation Physical Inspector of Troops.
Phone, 166 Embarkation.
Commanding officers were directed to collect all absent men prior to the examination. Men who had broken quarantine were not permitted to embark. Prior to the preembarkation physical examinations, the following form was executed by the commanding officer and the surgeon of the organization to be examined:
PREEMBARKATION REPORT OF PHYSICAL EXAMINATION OF TROOPS
HEADQUARTERS PORT OF EMBARKATION,
Newport News, Va., --- 191-.
PREEMBARKATION REPORT OF STATUS OF VACCINATIONS
I certify that vaccinations against smallpox, typhoid and paratyphoid fever are complete, or will be completed at the time of debarkation, among members of the above organizations about to embark for overseas and same recorded on service records, in accordance with paragraph 14, G. O. No. 31, 1917, port of embarkation, Newport News, Va.
That preembarkation quarantine began on -, 191--.
Med. Dept. P. of E. Form No. 5,
Approved C. G., P. of E., Jan. 28, 1918.
PREEMBARKATION REPORT OF INFECTIOUS DISEASES AND CONTACTS
I certify that to the best of my knowledge there are no infectious diseases or contacts among the members of the above organizations about to embark for overseas. That G. O. No. 2, P. of E., has been complied with.
Med. Dept. P. of E., Form No. 6,
Approved C. G., P. of E., Jan. 28, 1918.
Organization surgeons or medical officers other than those under the direction of the chief medical officer were not permitted to certify as to the fitness of officers and men for overseas services. Orders covering this point were issued as follows:
Memorandum from the chief of staff to commanding officers.
PREEMBARKATION PHYSICAL INSPECTION OF TROOPS
JUNE 6, 1918.
1. The final physical preembarkation inspection of troops about to embark for overseas will be made under the direct supervision of the surgeon, port of embarkation.
2. At the appointed time for inspection you will have the entire personnel of your command present, officers, enlisted men, and others, at the designated place, under their company, troop, battery, or detachment commanders.
3. No man will be allowed to embark without this inspection.
4. All officers will be inspected with their commands unless other arrangements have been made.
5. Men who are absent without leave or otherwise and returned to their command during the prescribed 10-day period preembarkation quarantine will not be allowed to embark.
6. Rosters: A duplicate roster made on forms furnished by preembarkation inspectors or camp surgeons (as per instructions on back) will be furnished by organization commanders.
7. The medical officer who has been taking sick call for each organization must be present at the time of inspection.
8. The medical officer making the inspection will call upon the surgeon of the regiment, or other organization, for such assistance as he may require.
9. Men will file by the inspector in roster formation, stripped to the waist, with breeches unbuttoned and clothing of the upper part of the body carried over the left arm.
10. A suitable building, affording adequate light and protection to the men is required; barracks are preferable. Under no circumstances will men be allowed to undress in the open.
11. Men will not be permitted to use latrines just previous to this inspection.
12. As soon as practicable upon completion of this inspection, a list of rejections at this inspection will be furnished organization commanders.
13. It involves upon commanding officers and organization surgeons to maintain the strength of their commands while at this port awaiting overseas service.
By command of Brigadier General Hutcheson:
DANIEL VAN VOORHIS,
Lieutenant Colonel., General Staff,
Chief of Staff.
After the completion of the final preembarkation examination-that is, every man's name on the roster being accounted for-five copies of the list of rejections were made; one copy was given to the commanding officer of the troops, one to the camp surgeon, one to the casual officer, one to the transport department (through the chief of staff), and one copy was retained by the examining board. These lists were in the form of a certificate as follows:
PREEMBARKATION REPORT OF PHYSICAL EXAMINATION OF TROOPS FOR OVERSEAS SERVICE
HEADQUARTERS PORT OF EMBARKATION,
NEWPORT NEWS, VA.,
Camp ----, 191--.
To The COMMANDING OFFICER:
I certify that the individual members of the above organizations have this day been physically examined and found free from communicable diseases, with the following exceptions as herein noted below. These men will not be allowed to embark, in accordance with provisions of G. O. No. 2, port of embarkation, Newport News, Va.
HENRY SMITH BARTHOLOMEW,
Major, Medical Corps
(For the surgeon, port of embarkation).
Med. Dept., P. of E., Form No. 6,
Approved, C. G., Jan. 28, 1918.
The same disposition was made of these retained men as at the preliminary examination-they were sent to hospital for correction of the disqualifying cause. Contacts were held in quarantine and when released were sent to the casual companies. The same disposition was made of hospital cases released after their organization had embarked.
During the interim between the final examination and the boarding of transports, troops were kept under close observation to prevent the embarkation of cases of contagious disease. Not infrequently a case of contagious disease would be found within an hour of troops leaving camp for the transport. Contacts were determined and not allowed to depart. This entailed considerable trouble, as baggage and equipment were already aboard, sailing rosters made out, and other arrangements for sailing completed. In spite of orders to the effect that rejected men would not be allowed to embark, many made the attempt and, in several instances, succeeded in getting aboard the transport. At times this was apparently facilitated by the immediate commanding officers, but was easily controlled by rigid gangplank inspections.
Measles depleted the ranks more than any other cause, particularly through the detention of contacts. The method of determining measles contacts at first included all men quartered in the room or tent where the disease occurred. Each barrack was separated into two rooms, so the contents of a room, or 32 men, were held. Contacts were later designated as being the men sleeping on either side of the case and all others in the room who had not had the disease. This reduced the number of contacts materially.
Venereal diseases probably contributed the largest aggregate cause of rejections. It certainly was the most troublesome condition with which the Medical Department had to contend. At the beginning of embarkation, gonorrhea was designated as a cause for disqualifying a man for overseas service. On April 4, 1918, the War Department stated that both acute and chronic gonorrhea were communicable diseases. While it was comparatively easy to detect acute gonorrhea at the examinations, it was not so with chronic gonorrhea. There was no end of trouble in attempting to eliminate chronic gonorrhea in
colored troops. They were given a two-hour march, preceding the examination for overseas service and ending at the appointed place and time of examination. This was most effective in bringing out urethral discharges otherwise dormant, and prevented men from using the latrines before examination. It also insured all men being present at the examination.
While these preliminary marches were of material assistance in determining whether or not a man had an urethral discharge, they did not decide whether or not the discharge was due to acute or chronic gonorrhea. The decision was not difficult in the frank case of acute gonorrhea, but was an exceedingly vexatious problem when a chronic discharge was concerned. In many of the latter cases the discharge had had its origin as a gonorrheal infection, but the gonococcus had long since ceased to be demonstrable. The rejection for overseas service of all men having an urethral discharge of any sort would result in the retention of many physically competent men. This, however, was the practice during the war, though decision on the basis of a microscopic examination was contemplated.
Louse infestation in troops did not exist to any great extent, but a careful search was made for these parasites. The reports of the chief medical examiner show 11 cases of body lice in white troops and 3 cases in colored troops. Crab lice were very much in evidence from July, 1918, to the close of the embarkation period, 658 cases being reported in white troops and 91 in colored troops. No men having lice were permitted to embark.
Cases of scabies were held and sent to the hospital for treatment.
Records were kept showing the name and disposition of every soldier arriving at the port. Printed forms were used for this purpose, on which was written a complete roster of every organization upon its arrival. This included the name of the organization, strength, race, date of arrival, and camp or place from which the organization came. The form was ruled so as to allow notations to be made opposite each man's name at the preliminary and final examinations. Spaces were also ruled for recording the status of vaccinations and inoculations, for the dates of examinations, and for the signatures of examiners. This form is shown below.
OFFICE OF THE SURGEON,
PORT OF EMBARKATION, NEWPORT NEWS, VA.
PHYSICAL INSPECTION OF TROOPS
Organization -- Co., Batry. or Det ---, Div Date of arrival -- From --Total personnel
Date camp surg. insp --- Date preemb. insp
Vaccinations - Quarantine (date begun) --
Name of inspector -- Name of inspector
These rosters were made in duplicate, the organization retaining the carbon copy and being instructed to line up the men according to the roster for all examinations. The same roster was used for both preliminary and final examinations. After the final examinations these rosters, together with the certificates and rejection lists, were bound together by organization and filed by date. These bound rosters were often of value to other departments in serving to locate or show disposition of men whose records had been lost or misplaced.
Certificates on a printed form (vide supra) were obtained from organization commanders and surgeons stating that vaccinations and inoculations were complete or would be completed before debarkation; also, that no known contagious diseases existed in the command. These certificates were filed with the rosters. Lists of all men rejected, with rank, company, and cause of rejection, were also filed with the rosters.
Consolidated records were made showing organizations examined, with strengths of commands and dates of arrival and departure. Various causes of rejections were kept and tabulated, thus:
Record, preembarkation inspection of troops Newport News, Va.
Reports of men rejected at the examinations were made on printed forms which were of the nature of orders to organization commanders stating that "the members of the following-named organizations have been examined and found free from communicable diseases with the following exceptions, herein noted, who shall not embark" (vida supra). The copy of this report, which had been sent to the transport department, was used by the checker of sailing rosters at the gangplank. This proved to be very effective in preventing rejected men from boarding transports. It was also of great value to the casual officer,
camp surgeons, and others.
Reports were submitted whereby the Chief of Staff was kept constantly informed of the immediate overseas strength of organizations. This was extremely essential to all concerned relative to arranging for transportation, etc. The chief medical examiner was prepared at all times to give the status of organizations relative to strengths of overseas fitness.
Reports were made to camp commanders of camps from which troops came relative to any cause of communicable disease or of men unfit for overseas service arriving at the port. Reports were made to the War Department relative to the incidence of lice found in the examination of troops as shown below.
Report of physical condition of troops arriving at port of embarkation, Newport News, Va., for embarkation
From --- Date
After the signing of the armistice, it became apparent that there would be a reversal of direction in troop movements, changing the port from one of embarkation to one of debarkation, through which the troops would pass on their way to demobilization camps. Accordingly, the preembarkation examining staff was perpetuated, with slight modifications, for the purpose of examining troops as to fitness for transfer as outlined in Circular No. 162, War Department, December 18, 1918. Troops arriving from overseas were quartered at the various camps under the jurisdiction of the port until they were deloused, and equipped with clothing. They were then split up into detachments or casual companies corresponding to certain geographical areas, and sent for discharge to the demobilization camps nearest their places of induction. Rosters of the complete personnel of organizations were obtained. Men found physically unfit for transfer were sent to hospitals through camp surgeons, who were furnished with a list of rejections.
Troops arriving at the port from overseas were found to be in exceptionally good condition physically.
With the signing of the armistice and the consequent demobilization of the Army, steps were immediately taken to provide for the medical examination of such troops as should be locally discharged from the service. It was seen at once that, since the surgeon of the port was responsible for the procedure of medical examinations, as contemplated in Circular No. 73, War Department, November 18, 1918, it would be imperative to have all of these medical examinations made under one control. Accordingly, a port order was issued designating a chief medical examiner. This prohibited examinations being made by medical officers other than members of the medical board. A check was made, by agreement with the port personnel officer, whereby no report of examination was allowed to go through unless it bore the stamp of the board. The personnel office also returned to it for reexamination any officer or man whose report bore date of examination more than five days old.
In the formation of the medical board, the suggestions of Circular No. 73 were kept in mind, together with the nature of the work which would be encountered in this port. It was determined that the best combination would be an examining team consisting of a principal medical examiner who should also do the general examining, assisted by one medical officer for each of the following specialties: Dentistry; eye, ear, nose, and throat; orthopedics; neuropsychiatry; tuberculosis; diseases of the heart; and diseases of the lungs. Any number of examining teams could, of course, be created as circumstances required. A permanent board of review was designated, consisting of two medical officers from the staff of the embarkation hospital. The examinations in Camp Morrison were conducted by a team working under the camp surgeon of that camp, but under the direct control and supervision of the chief medical examiner of the port.
The examining board established offices in the administration building, Newport News, where a permanent board sat daily for the examination of casuals and small detachments. When an organization, or detachment of 100 men or more, was to be examined, an examining team was sent out and the men were examined in their companies. Each member of an examining team was responsible to, and under the supervision of, the principal medical examiner of the team, who, in turn, was responsible to the chief medical examiner for the work of his team.
The printed form shown below was adopted, on which each specialist in turn made notations of conditions found, with opinions as to how incurred and as to degree of disability, if any. This form was used as a guide by the principal medical examiner, who thereby, and by his personal examination of the soldier, determined the nature and decided upon the degree of disability or of the sum total of several disabilities. The principal medical examiner then completed and signed the report of examination.
PHYSICAL EXAMINATION, PORT OF EMBARKATION, NEWPORT NEWS
[Surname] [Christian name] [Serial No.] [Race]
[Rank-Grade] [Organization] [Co., det., Dept.]
Before enlistment --
Eye, ear, nose, and throat:*
Before enlistment -
After enlistment ---
Before enlistment -
Before enlistment -
After enlistment ---
Tuberculosis, heart, lung:*
Before enlistment -
After enlistment ---
Before enlistment ---
After enlistment -
--, M . C.,
Principal Medical Examiner.
*State degree of disability incurred in service only.
The completed form was then filed and constituted the record of the soldier's examination. In the cases of an officer or soldier referred to the hospital or to quarters for any reason, the form was filed separately for reference at the future reexamination. Obscure conditions requiring X-ray or laboratory examination or observation for diagnosis were referred to the hospital, the examiner interested following the case directly. Patients who were acutely ill or who were suffering from a communicable disease were sent to the hospital, as were those with diseases or injuries which could be cured or improved by a short period of hospital care before discharge.
The prime purpose of the work was to determine any disabilities incurred as a result of military service and the degree of disability in relation to the occupation previously followed in civil life. Notations were made, however, on the report of examination, of all abnormal conditions found, irrespective of origin of degree of disability.
Special mention should be made of the examination of guard and fire companies. These organizations were composed almost exclusively of limited service men, all of whom had from one to six different disabilities upon entrance into the service. The examination of these men was slow and tedious, since all of the abnormalities were to be examined and recorded and an estimate made of percentages, if any, of exaggerations, as the result of service, of disabilities which existed prior to enlistment.
The examinations for demobilization conducted at the port were largely confined to the permanent personnel of the port; guard and fire companies; portions of some organizations destined for overseas service who had reached the port at the time when embarkation ceased; portions of the 12th Infantry, which was sent to the port for guard duty after that time; and such casuals as were discharged from the port for various reasons. Examinations were also conducted for the colored officers' training camp located at the Hampton Institute, Hampton, Va. With the exception of casuals, these organizations
had not been overseas and therefore presented a relatively small number of disabilities incurred in the service.
The first of these local demobilization examinations was made November 25, 1918. From that time on, the number of daily examinations made in the office gradually increased until the latter part of December, when an average of about 80 a day was reached, with a high-water mark of 143.
MEDICAL SUPERINTENDENT OF TRANSPORT SERVICE AND DIRECTOR OF HOSPITAL TRAINS
In organizing the office of the surgeon of the port of embarkation, provision had to be made for the medical care and sanitary inspection of troops embarking for Europe and, later, for the debarkation and hospitalization of the returning sick and wounded from overseas and the transportation of men by hospital trains to hospitals in the interior. To this end, there was established the office of the medical superintendent of transport service and director of hospital trains, a dual function combined in one office.
The first few months were devoted almost exclusively to the work connected with the embarkation of troops for overseas service. Under this office was appointed a sanitary inspector of transports with the necessary number of assistants. It was the duty of these officers to meet the ships arriving at the port for use either as troop or animal transports, and to inspect and report on the condition of each. In addition, during the early days of the port, this office furnished the Medical Department personnel and obtained the medical and surgical supplies required on the transports. All medical personnel required on troop transports was later supplied by the Navy. Medical officers were detailed to merchant ships acting as Army transports and, on occasion, as during the influenza epidemic of 1918, to Navy transports, in order to augment their medical force. The final medical inspection of all embarking troops was made at the gangplank. This was a cursory examination, but gave the trained medical officer the opportunity to recognize men frankly sick and to exclude from going aboard many men in the early stages of communicable or other diseases.
The general duties of the office consisted of embarkation work as follows: Sanitary inspection of transports; assignment of transport surgeons and enlisted medical personnel on all troop ships; requisitioning all medical and surgical supplies and matériel required for use on troop-carrying ships; final medical inspection and the debarkation of all cases of beginning communicable diseases prior to sailing; and membership on a board of officers appointed to determine the fitness of freight ships for conversion into troop ships.
The sanitary inspection of transport and cargo ships covered the following: Ventilation of troop compartments; sanitary condition of all troop compartments; ventilation of quarters for officers; sanitary condition of quarters for officers; inspection of latrines and shower baths as to their sanitary condition and whether or not they were in proportion to the number of troops carried; suitability of sick bays (it was necessary to enlarge them in many instances); capacity and sanitary condition of cold-storage plants; equipment and sanitary condition of mess rooms and galleys; and the bacteriological examination of
the drinking water on the first voyage of a ship, any tank showing the presence of colon bacilli being cleaned and cemented.
Medical personnel for duty on transports, converted commercial liners, and ships operated by the British Ministry of Shipping were assigned from among individuals who had been detailed to duty at the port. Transport surgeons so assigned were given the following instructions prior to sailing:
INSTRUCTIONS TO TRANSPORT SURGEONS
1. Every effort will be made to deliver troops on board free from contagious or active venereal diseases. A medical officer from the list of preembarkation inspectors will be on duty on each ship from the time troops begin to go on board and will remain until sailing. He will keep in touch with the transport surgeon and medical officers with troops and assist in the removal of any man who may have developed contagious or active venereal disease after boarding or who may be otherwise too sick to travel. This officer can be identified by a Red Cross brassard on left arm.
2. Sanitary inspection of the ship will be made each morning at 10.30 by the transport surgeon and senior medical officer with troops. This inspection will include particularly galleys, mess decks, latrines, shower baths, and living spaces devoted to troops, including equipage. Irregularities and deficiencies noted on these inspections will be promptly reported to the proper authority for immediate correction.
3. Venereal inspection on shipboard will be held twice a week. Cases of venereal disease discovered will at once be given vigorous treatment.
4. Recent reports show that lice are being carried by troops overseas. At each venereal inspection twice a week, a careful examination of the men, including also an examination of the clothing, for the detection of lice will be carried out. Any cases discovered will be promptly deloused. A supply of naphthaline powder is provided on each ship for this purpose. One ounce of this powder should be dusted on the interior of all clothing once a week. This is most effectual if the men dust their clothing freely and roll themselves and their clothing tightly in blankets for the night. This method does not destroy the egg but only the adult, so it is necessary to repeat the procedure in a week in order to destroy the young lice after they are hatched. Sleeping quarters and standees that may become infested are to be treated with kerosene.
5. The hospital is under the charge of the transport surgeon, who is responsible for the proper care and use of the hospital equipment and property and for the discipline and instruction of the hospital attendants. The hospital will not be used for other purposes than for the accommodation of the sick, except in cases of emergency, and then not without the approval of the medical superintendent, if the vessel is at home port, or of the transport surgeon if at sea. (Par. 176, Medical Dept., A. T. C. Reg.)
6. Ample bathing facilities have been provided on each ship, and men should be made to bathe twice a week.
7. Records will be kept of all venereal cases developing en route, as well as all cases of lousiness; these will be reported by the transport surgeon, who will submit a report to the surgeon, port of embarkation, upon return of ship to this port; otherwise, this will be mailed.
8. Whenever practicable, weather and other circumstances permitting, the troop spaces will be vacated twice a day for aeration by opening all available ports and hatches. During at least one of these periods the men will take their blankets on deck for airing.
9. Troop decks should be thoroughly sprinkled before being swept and mopped. This procedure should be carried out while troops are on deck.
10. The use of tobacco, either smoking or chewing, will be prohibited at all times in troop berthing spaces and, during the serving of food, in mess spaces.
11. No food will be served outside of mess spaces for officers, troops, or crew, except upon recommendation of the transport surgeon. No food will be permitted in troop berthing spaces.
12. Sleeping and lying upon hatches is prohibited. The main source of fresh air is through the hatches and any blocking of this space seriously interferes with the proper ventilation of compartments below.
13. A supply of hot water should be on hand after each meal, and as many containers as necessary, for washing mess gear.
14. A sufficient number of enlisted men of the Medical Department should be detailed to look after sanitary conditions in quarters, latrines, and showers. Any failure on the part of the flushing system should be reported at once. Latrine seats should be scrubbed thoroughly with soap or lye once daily.
15. In order that sanitary regulations may be properly carried out, the transport surgeon should confer with the medical officers with organizations on board and certain details be made and a definite program be mapped out for the voyage.
16. Before disembarkation, all troop spaces, mess decks, latrines, and shower baths will be inspected to see that they are left in a clean and orderly condition.
17. Careful examination will be made of patients and casual passengers returning for the detection of lice. Any cases will be deloused on shipboard.
18. Head-to-foot berthing: Sleeping compartments will be inspected each night after troops have retired to insure head-to-foot sleeping.
REPORTS TO BE MADE BY TRANSPORT SURGEONS
1. Report of infectious diseases, including venereal diseases and lousiness developing en route.
Infectious and venereal report will include (a) name of patient, (b) rank and organization, (c) type of disease, (d) acute or chronic, (e) date of development.
Report of lousiness will include (a) name of patient, (b) rank and organization, (c) parts affected (head, body, or pubic), (d) probable source, (e) whether or not deloused on board.
All cases of venereal disease will be given vigorous treatment on shipboard.
All cases of lousiness will be promptly deloused on shipboard.
Surgeons with the organized military forces on board are instructed to furnish the transport surgeon with report of venereal disease and lousiness.
2. Sanitary reports of voyage on Form 50 will be filled out and handed in to the general superintendent, Army Transport Service.
3. Return of enlisted personnel, Medical Department (Form 47a), will be made monthly and forwarded through military channels to the Surgeon General, as provided in Manual for the Medical Department, paragraph 50.
4. A full record of sick and wounded will be kept in conformity with Manual for the Medical Department, paragraphs #427 to 465. Report of sick and wounded will be completed and handed in to the medical superintendent, Army Transport Service, upon arrival in port. (Forms 51, 51a, 51b, and 52.)
5. If sick and wounded are brought back, three lists, giving (a) name, (b) rank and organization, (c) diagnosis, should be ready upon arrival in port and transfer cards made for each patient to be transferred to the hospital.
6. Requisition for medical supplies needed for next voyage (Form 35 and blank forms, Form 37). Transport surgeons will be held responsible that they have sufficient medical supplies and blank forms.
Medical officers attached to and embarking with troops were given the following instructions in addition to those of general application given to transport surgeons:
GENERAL INSTRUCTIONS FOR MEDICAL OFFICERS EMBARKING WITH TROOPS
1. As soon as practicable after arrival on board transport, the senior medical officer of the organized military forces embarking will confer with the senior transport surgeon so that he may familiarize himself with sanitary regulations of the transport and have places assigned for holding sick call.
* * * * * * *
5. A written report giving the required information concerning the incidence of venereal disease and lousiness will be handed over to the senior transport surgeon upon arrival on the other side, same to be transmitted to the surgeon, port of embarkation, Newport News, Va.
RELATIONS OF ARMY AND NAVY SURGEONS ON TRANSPORTS
Extracts from consolidated General Order No. 1, headquarters, port of embarkation, Newport News, Va.
179. The senior medical officer of the military forces, upon embarkation and disembarkation, shall submit to the commanding and medical officers of the ship a statement to the effect that the command is clean, harbors no communicable diseases, and all individuals have been vaccinated against smallpox and typhoid fever. He will take care to prevent the embarkation of infected persons and property.
183. The ship's medical officer will be responsible for the care and treatment of the sick and injured among the ship's crew, casual passengers, those not attached to any military force on board, and for all patients in hospital.
184. When there are medical officers on duty with troops on board, the medical officer of the ship will provide hospital accommodations, supplies, and attendants in the sick bay for the sick of the command, sick call of the troops being held by the medical officers attached thereto. Patients requiring rest in bed or hospital treatment will be transferred to the ship's sick bay and the care of the medical officer of the ship, the same as to a hospital.
185. The commanding and medical officers of the ship will see to it that a suitable place is set aside where the medical officers on duty with the troops on board may hold sick call, and the medical officer of the ship will issue to the medical officers of the troops such stores as are necessary to render medical relief in quarters. The medical officers on duty with troops holding daily sick call shall utilize, to assist them, the Medical Department enlisted men attached to the troops, the Hospital Corps men attached to the ship being under charge of the medical officer of the ship for duty in the ship's sick bay (hospital).
188. A copy of all reports concerning the health of all forces, together or individually, that may be on board, will be furnished the medical officer of the ship for cognizance.
THE WASHING OF TABLEWARE AND MESS KITS
1. Wash water for both tableware and mess kits is, in many instances, not sufficiently hot to kill disease germs nor sufficient in amount to cleanse eating utensils. Men with mild, unrecognized cases of influenza, measles, pneumonia, etc., contaminate the wash water; if it is only tepid, the germs are not killed but spread to the hands and eating utensils of other men, who develop the disease.
2. It has been found that the number of cases of influenza in a command can be reduced about 75 per cent by the use of boiling water for washing utensils. It is believed that this holds true for many diseases, such as measles, scarlet fever, mumps, and pneumonia.
3. Most diseases are "hand-to-mouth" infections. The man with a mild, unrecognized case of influenza or measles soils his hands with disease-laden saliva and, through his contact with things which he, as well as others, handle, the disease germs spread to the hands of others; hence they are carried into the mouth, particularly at mealtimes.
4. It is, therefore, directed that all eating utensils be washed in boiling water and that all men wash their hands thoroughly with soap and water before each meal and after visiting the toilet.
5. Commanding officers with organized military forces embarking will detail one officer to act as mess officer for each mess. Mess officers will be responsible for the sanitary messing of troops and will see to it that mess kits are washed in scalding hot water after each meal; at no time will tepid or cold water be used. The mess officer will also be instructed to take such measures as may be necessary to insure that all men wash their hands thoroughly with soap and water before meals.
DEBARKATION OF SICK AND WOUNDED FROM OVERSEAS
This work was handled by appointing two or more medical officers as medical debarkation officers. They met all incoming transports and arranged with the ship's surgeon for the debarkation of the sick and wounded. Many large ships were met before the ship docked, a gasoline launch having been secured for this purpose and for inspecting ships at various places in the harbor. This launch was operated by the Medical Department.
The National Home for Volunteer Soldiers at Hampton, Va., having been procured by the Army, was designated as a debarkation hospital. All sick and wounded arriving at this point from overseas were to be sent to this hospital and the embarkation hospital. Since the long ambulance haul from Newport News to Hampton offered serious difficulties in the transportation of large numbers of sick and wounded, the steamship Montauk was leased, overhauled, equipped, and operated by the Medical Department as a hospital ship, plying with sick and wounded from the transports to the hospital dock at Hampton. This made a comfortable and excellent method of removing patients from transports, the Montauk being able to come alongside the ship and unload patients without interference with the discharge of cargo or troops from the opposite side.
The movement of troops overseas having been suspended after the armistice was signed, the large hospital at Camp Stuart previously used for embarkation purposes was used for debarkation work. The capacity of all hospitals available being under 6,000, it was necessary to organize an efficient system for evacuating patients from hospitals by train into hospitals situated in the interior. This was the second major function of this office. Hospital Train No. 3 was assigned to the port for this purpose. The train was stationed at Camp Stuart. Sufficient officers and men of the Medical Department were assigned to duty at this camp to furnish medical personnel for each trip of the train, this averaging in patients about 70 officers and 300 enlisted men.
A sufficient number of patients having accumulated in the debarkation hospitals to warrant an evacuation, the hospital commander communicated directly with the Surgeon General's Office, requesting authority to send a designated number of patients to certain hospitals. A list of the patients to be sent to designated hospitals was transmitted to the port surgeon when the authority had been received. A train sheet was then made up in the surgeon's
office which showed the designated number of patients, listed by rank, whether litter or ambulant, and the number requiring medical care en route. This list was submitted to the troop movement office of the port and to the railroad representative, and a schedule and time of movement was worked out. The commanding officer of the train was given ample notice so as to cover the movement of the medical personnel by proper orders and to prepare and stock the kitchen cars. The Motor Transport Corps, having charge of the ambulances, was notified to have a sufficient number ready to convoy the cases from
the hospital to the train.
As there was not a sufficient number of hospital trains to handle all evacuations, trains were made up, consisting of standard Pullman or tourist cars with one medical car containing a kitchen. There was also a shortage of kitchen cars, so the United States Railroad Administration supplied baggage cars fitted with cooking ranges, and these served admirably in place of the usual kitchen car. Cars used in hospital trains were of the following classes: (a) Cars owned by the Medical Department of the Army, represented by Hospital Train No. 3; cars Nos. 1 to 10 were received from Chicago, Ill., January 20, 1919, but Nos. 6 and 7 were sent to the port of embarkation, Hoboken, N. J., on February 27, 1919, by direction of the Surgeon General; (b) cars leased from the Railroad Administration, 3 Pullman, and 4 tourist cars; (c) cars rented for the trip only. Classes (a) and (b) returned to the port, class (c) were released to the railroad after discharge of the patients, the medical personnel returning on regular passenger trains.
Kitchen cars, under the command of a medical officer, were attached to each hospital train and accompanied the larger number of cars if the train was eventually divided. Arrangements then had to be made to feed the patients and personnel in the detached cars. For this purpose and to provide proper inspection of hospital trains, medical officers were stationed at the following points as junction inspectors: Richmond, Washington, Baltimore, Philadelphia, New York, Chicago, Cincinnati, St. Louis, Salisbury, N. C., and, temporarily, at Kansas City. The duties of the junction inspectors included investigations as to the cleanliness, discipline, food supplies, general comfort of the patients, and, when required, the arrangements for rationing patients on detached cars. Train commanders wired to junction inspectors the time of arrival, number of meals required, if any, or for any help required. Junction inspectors submitted written reports to the port surgeon, Newport News, for each inspection made.
Special care was exercised by the hospitals to entrain only cases able to travel. Any case requiring special attention or care en route was marked with a red tag, and instructions were furnished for his care. Trained attendants were provided to accompany mental and nervous cases to their destination. Prior to arrival at the destination, the train commander, or the commanding officer of separated cars, wired to the commanding officer of the receiving hospital the expected time of arrival and the number of patients, classified, in ample time to enable the hospital authorities to provide ambulance service and attendants for unloading the train.
The general administration of the command of a hospital train was that of a detachment. The necessity of preparing lists of names of medical officers and attendants, the usual records, reports, and correspondence covering train movements, the refunding of ration money to patients, when necessary, and the requisitioning and supplying of rations, created a great deal of paper work at train headquarters.
The general scheme of organization for debarkation of sick and wounded, the hospitalization and, later, evacuation by train to interior hospitals, worked very satisfactorily and allowed the steady flow of the stream of sick and wounded arriving from overseas to be diverted to designated interior hospitals with great comfort to the patients and with the least possible delay at the port and en route.
The numbers and classes of sick and wounded disembarked are as follows:
Prior to October 1, 1917, the work in connection with the identification office was conducted by three civilian employees, one of whom was a photographer. The function of this office was to prepare and issue certificates of identification to civilian employees of the Government engaged in the United States Army Transport Service. Each certificate was prepared in duplicate and contained a brief description of the man, together with a 2 by 3 inch photograph of the holder and both thumb prints.
A medical officer was designated as identification officer of the port about October 1, 1917, with headquarters in the office of the port surgeon. Two enlisted men were assigned to him for duty as assistants, replacing civilians. The services of the civilian photographer were retained. All Army transports arriving in the port were boarded and the necessary photographs taken aboard ship, a copy of his certificate being delivered to each man before sailing, one
copy being retained in the office files. A new form of certificate was adopted to cover civilians about December 1, 1917, and also individual forms for casual officers departing for overseas on a detached service status, and for Army and quartermaster field clerks. The routine of the office having greatly increased, another enlisted man was added to the staff and the office was removed to the newly completed administration building.
Two small rooms in the recently completed building assigned to the attending surgeon were allotted to the identification officer on January 10, 1918. A photographer was inducted into the service at this time, and the services of the civilian photographer were dispensed with. The necessary equipment had meanwhile been requisitioned to carry on the photographic work and, by March 1, 1918, one room was fully equipped as a dark room and the second room was used as an office. A noncommissioned officer directed the work, assisted by three privates. There was a constant increase in the number of certificates issued, not only to civilian crews but to large numbers of casual officers transported overseas. A detailed list of the certificates issued was forwarded to the State Department, Washington, D. C., every 10 days, through The Adjutant General of the Army. A fifth enlisted man was added to the force in June, 1918, the duties of the office having been further increased by a port order which required every officer, enlisted man, and civilian employee on the piers under Government operation to be provided with a pass issued by the provost marshal of the port. Each pass contained a photograph of the holder, taken by the identification office. The work of the office was well organized and moved very smoothly during the remainder of the year.
The signing of the armistice greatly reduced the amount of work passing through the office, and 3 enlisted men were assigned to other duties, 2 remaining to care for whatever further identification work was necessary. The building occupied was destroyed by fire on January 7, 1919, and all equipment was lost. The requirement of photographs on passes was discontinued at this time, and a civilian photographer was engaged to handle any future requirements relative to identification certificates. From about December 1, 1917, to December 31, 1918, 5,909 certificates were issued, and 6,514 pass photographs
were taken between the dates of June 1, 1918, and January 7, 1919.
THE ATTENDING SURGEON
The attending surgeon's office was established on August 15, 1917, in Newport News, with a captain of the Medical Corps in charge. This officer, in addition to conducting the regular duties of an attending surgeon, held sick call for four companies at the quartermaster depot and for one troop of Cavalry at the Casino grounds. He was assisted by two officers. The office was transferred to a special building on December 12, 1917. This building was well fitted and equipped as an office, dispensary, and emergency hospital, and was occupied until it and its contents were destroyed by fire on the evening of January 7, 1919. As all records were burned, it is impossible to give any statistics relative to the operation of this important adjunct of the port. The office was reestablished in a frame building on January 9, 1919. This was speedily remodeled and contained an office for the attending surgeon, a consul-
tation room, a prophylaxis station, a dispensary, a dental office, and an emergency ward. This building was partially destroyed by fire on the morning of March 29, 1919, but was repaired and continued in use.
The attending surgeon acted as recruiting officer and made all records and reports pertaining thereto; made physical examinations of officers and enlisted men and recorded the same; administered vaccinations against smallpox and typhoid fever, and made the necessary records; held daily sick call, and prepared sick and wounded records of the same for headquarters detachment, 323d Fire and Guard Company, Company K of the 12th Infantry, 304th Stevedore Regiment, Engineer Corps, and the 404th Reserve Labor Battalion; made provisions for emergency treatment at any time during the day or night;
provided medical treatment for officers, enlisted men, their families and dependents, and emergency treatment for civilians employed at the port; and maintained a prophylaxis station.
The inspection of hospitals began February 8, 1918, the results being reported verbally to the port surgeon, who in turn made written reports to the commanding general. The eventual duties of the hospital inspector may be summarized as follows: (1) The inspection of all hospitals and infirmaries in the port area. (2) The checking of all sick and wounded cards received, their preparation and forwarding to the Surgeon General. (3) The preparation of weekly telegraphic reports of sick and injured to the Surgeon General. (4) Coordinating and assisting in the proper carrying out of venereal work. (5) Keeping records relative to infectious diseases, etc. (6) The investigation of discrepancies in recommendations made to the Surgeon General relative to hospitals, infirmaries, etc., with recommendations regarding the same.
The inspection of all hospitals in a systematic manner gave the hospital inspector an almost continuous routine to perform. The following hospitals and infirmaries were inspected: Embarkation hospital, Camp Stuart; camp hospitals, Camp Morrison and Camp Hill; Army supply base in Norfolk, and Nansemond ordnance depot at Pig Point; Water-front Emergency Hospital, Newport News; and infirmaries. These latter varied in number from time to time, but averaged approximately 10 to 12 at all times, located in Camp Hill and Camp Stuart, and in Norfolk and Newport News.
A critical inspection was made. All departments of each hospital, from the administrative to the mess and the enlisted personnel, were required to perform their functions in strict accordance with hospital regulations and the Manual for the Medical Department. Rapid transportation was necessary, as many of these places were located at a considerable distance from headquarters. This was accomplished by automobile and, at times, a Government launch, the latter being necessary to get rapidly to such places as Pig Point and Norfolk. These inspections were made, not only to determine if the duties of these places were being properly performed, but also to acquire information on which suggestions for improvements might be based. Wards were inspected minutely; the care of the sick was observed, including their messing; general sanitation and care of the hospital grounds were considered.
All prophylactic stations were inspected as to their equipment and method of administration, together with the preparation of records. Another function of the inspector was to assist in the coordinating of venereal treatments by hospitals and infirmaries and to observe that all existing orders relative to the treatment of venereal diseases were carried out. Again, as in the inspection of hospitals, every effort was made to improve methods of treatment, especially by insuring that patients reported for treatment as ordered.
The checking of all sick and wounded cards, numbering many thousands, at the beginning of each month, their preparation for return to organizations for corrections, and their forwarding to the Surgeon General in a way relieved the routine of the hospital inspector. A telegraphic report tabulating the various types of diseases, injuries, deaths, and transfers of all patients in hospitals and infirmaries was prepared on Friday of each week. This demanded extreme accuracy and furnished information as to the progress of diseases in the port. Many other records were kept, principally those of local interest
to the port surgeon.
No officer was regularly detailed as hospital inspector during the period from October 1 to 23, 1918, the duties being performed by the adjutant and his assistant. The functions of the office were somewhat altered in January, 1919, when the preparation of records was turned over to the statistical officer and the coordinating venereal work was transferred to the officer in charge of the genitourinary work of the port.
THE NEUROPSYCHIATRIC SERVICE
A port of embarkation and debarkation is, so to speak, the neck of a double bottle through which pass two currents of men, the one outward bound to the theater of war and the other returning from the front. Theoretically, the outward-bound stream has been so carefully examined that no person of physical or mental unfitness is brought to the port of embarkation. As a matter of fact, this condition did not obtain in actual practice, and, as has been shown in other pages, it was necessary to maintain a large force of special examiners at ports of embarkation to weed out the physically and mentally unfit who
may have escaped examination at interior points, or whose mental or physical disability had been made apparent by the fatigues and excitement of travel toward the zone of operations. These facts were emphasized by the results obtained by the neuropsychiatrists at the port. Theoretically, they should have acted as reviewing officers, not as examiners, and this would have been possible had the work of the neuropsychiatrists at the interior points been more highly developed. That this could be accomplished was shown by the facts that some organizations arrived at the port without a single nervous or mental
case, while others, which had been less carefully examined, contained many. Since it was obviously impossible to discriminate between the well examined and the poorly examined organizations, it was necessary to examine all. Much the same condition of affairs obtained in the inward-bound stream. Theoretically, the abundant time of the sea voyage was occupied in the classification of all patients on board the transport and, when the vessel docked, all data upon which to determine ultimate destination were completed. Practically,
such was not the case with neuropsychiatric cases, chiefly by reason of the fact that neuropsychiatrists were not a part of the permanent transport personnel. Had they been, it would have been possible for the neuropsychiatric operations at the port to have resolved themselves into review and consultation, since, obviously, a port of embarkation is not the place to initiate a large neuropsychiatric classification scheme.
Before June, 1918, the embarkation hospital had installed adequate beds and secured a force of officers to handle the nervous and mental cases that came to it through its functioning as a general hospital. The port had a succession of neuropsychiatric officers who examined outgoing troops, but none of these officers remained long enough to build up an organization. A neuropsychiatrist was permanently assigned to the port in June, 1918, with the result that a system of neuropsychiatric examination, consultation, and review was built up under the surgeon and with the help of the division of neuropsychiatry.
The functions of this organization were to examine outgoing troops; to care for incoming patients; to furnish consultants for port personnel; to examine recruits; to examine soldiers demobilizing; to coordinate neuropsychiatric activities with other port activities.
The chief work prior to the signing of the armistice was the prevention of sending unfit men overseas. Conditions favoring this work were the nearness of the camps and good transportation, advance information concerning the movements of troops, and the cooperation of the other port authorities. Conditions that hindered were the limited number of days available for troops to outfit and undergo the numerous inspections, and the fact that only one neuropsychiatrist was available at the time when the greatest number of troops was embarking.
An effort was made to deal with companies as units. It was usually possible to secure from the organization commander a list of dull, queer, or nervous men in the company. The men so designated were individually examined. While such examinations indicated clearly enough that certain soldiers were unfit, the hurry in which it was usually performed left the impression that many men remained with the company who should have been rejected.
The worst conditions mentally were found in organizations whose quotas had been completed with large numbers of men just before leaving camp. Though few cases of insanity were found, many cases of feeble-mindedness were discovered which should never have gotten as far as the port. Mental instability was frequent, and it was reasonable, even after the most careful weeding-out process, to expect this to first become evident at a port, under the strain of traveling and of waiting to embark.
Prompt action in these cases facilitated operations very greatly. The soldier was separated from his organization and on the road to final disposition a few hours after recommendation for his rejection had been made. The only form used gave the soldier's identification, diagnosis, and disposition recommended; of the three copies, one went to the casual officer, one to the camp surgeon, and one was kept for the port surgeon's file.
CARE AND DISPOSITION OF PATIENTS FROM OVERSEAS
After November 11 emphasis naturally was placed upon the reception of neuropsychiatric cases from France. This had long been a function of the embarkation hospital, where patients were received in small groups; of 100 admissions to the neuropsychiatric ward in August, 1918, for instance, 30 were from overseas. By September 4 the accommodations at this hospital, for 38 insane and 60 nervous patients, were manifestly insufficient, even for the immediate future. At this time it was recommended to the port surgeon that 180 more beds be provided, this special need to be merged in the general need of a
large debarkation hospital. Debarkation Hospital No. 51, which was opened on November 17, 1918, included 30 beds for the care of acute psychoses and 110 beds for neuroses. In January, 1919, accommodations for 30 more psychoses were provided and 2 wards of 40 beds each were nearly ready.
Before these new accommodations were available the U. S. S. Aeolus docked on October 13 with 243 cases, divided as follows: 127 psychoses, 18 feeble-minded, 55 epileptics, 39 neuroses, and 3 cases of organic disease of the nervous system. No warning had been received, the force of attendants at the embarkation hospital was crippled by the influenza epidemic, and other ships were due. Under these circumstances special trains were requested to carry these patients directly inland, and, after a day's wait, the psychoses and feeble-minded were sent to General Hospital No. 6, Fort McPherson, Ga., and the others to General Hospital No. 31, Plattsburg, N. Y. Two patients hung themselves on the ship, one on the last day of the voyage and one while the transfer from boat to train was going on. The ship, of necessity, carried these patients between decks without lights from sunset to sunrise. The trains trips were made without incident.
When Debarkation Hospital No. 51 was opened, its first large group of patients was one of 300 nervous and mental cases received from overseas. Upon receipt of advance information as to the arrival of this transport a psychiatrist went out to meet the ship and classify the patients, but, unfortunately, the ship did not stop to take on a pilot, so the classification could not be made. A hospital boat was brought alongside at the pier, received the patients and landed them at a dock inside the hospital grounds. Here one man dived overboard but was rescued unharmed. These patients were successfully transferred
to interior hospitals, although wards were in charge of new men and lock and keys were unobtainable. Subsequently, other ships, each carrying 200 or 300 mental cases, were unloaded, and a procedure was developed which gave very satisfactory results in the transfer of these patients from ship to hospital wards: On advance information, the neuropsychiatrist, with a detail of experienced men, reported at the pier as advisers of the medical superintendent of transports. The medical officer and the noncommissioned officer in charge of the detail boarded the ship and secured from the ship's surgeon and the attendants
all possible information regarding the behavior of the patients. Quarters on the hospital boat or the routes to the ambulances were inspected and attendants placed at strategic points-gangways, ports, stairways. Patients from whom trouble could be expected were each placed in charge of an attendant and
landed first. The milder mental cases were grouped and taken next, with several attendants. At the receiving hospital patients were taken off in the same order; thus the more disturbed could be placed in the most protected ward, and the patients who needed no special care could, when necessary, be admitted to the general medical wards.
The customs of the hospitals with regard to diagnosis of general cases were followed. This meant the filling in before midnight on the day of admission of a "classification for distribution" form, of which the following is a synopsis: (1) and (2) Name and identification. (3) Diagnosis. (4) Classed as psychoneurosis, peripheral nerve injury, epilepsy, psychosis, mental defect, convalescent, other medical groups, other surgical groups. (5) Ambulatory or bed patients. (6) Individual attendant, special care or litter.
It is obvious that the future care of patients was dependent, to a considerable extent, upon the accuracy with which the diagnosis was made prior to entrainment for an interior hospital. The ratio of accuracy would be lowered if conditions were such as to limit the time which the neuropsychiatrist might expend in making the diagnosis. After numerous experiences, the neuropsychiatrists of the port arrived at the conclusion that, while theoretically the good of the patient and the service alike would be best served by allowing more time for making the investigations upon which an accurate diagnosis must rest, it was
impracticable to secure more time without greatly interfering with general evacuation. In other words, a port of debarkation, by its very nature, could not become a place for scientific niceties of diagnosis. Therefore, an endeavor was made to combine speed with accuracy. That this succeeded in a great measure is well illustrated by the experience and experiments described below.
A large group, 300, was landed at the hospital dock at 6 p. m., where they were enrolled and sent to the ward with Form 55a made out. The ward surgeons assigned each man to a bed and entered the number of the bed on the 55a slip. Supper was then served. Then four men at a time were taken from each of the five wards for delousing. Field cards from overseas arrived at the wards and were matched with the 55a forms, always with some discrepancies which took time to adjust. A neuropsychiatrist stationed himself at the door of each ward, called a patient, read the field card, entered a diagnosis, and checked the appropriate class.
Many diagnoses could be confirmed in a few seconds; epilepsy, for instance, by a history of convulsions antedating Army service, or undiagnosed psychosis by the presence of any delusional remnant or behavior disorder. It should be remembered that such a diagnosis had little of the significance that it had in civil life, merely meaning at the port that the psychotic individual was being sent to a hospital with the proper specialists to care for or discharge him. Therefore, when epilepsy was the term used to describe a disease characterized by convulsions which first appeared under shell fire, a change was made to psychoneurosis in order to make sure that the patient should receive specialized treatment. The diagnosis "constitutional psychopathic state" covered such varied conditions that at first it seemed best to change it; later it was retained and its constituents separated by checking under classification "psychosis, epilepsy, psychoneurosis, mental defect," according to the treatment the patient required.
In questions involving mental defect, patients would remain for a psychologist to examine individually.
When diagnosis and classification had been made by a specialist, the patient took his papers to the ward surgeon, who completed them. The distribution sheets were then ready with the sheets from other medical and surgical wards for early action the next day; from them were made up the travel orders which caught the patient in a system which landed him at an interior hospital. At times a patient would remain several days before entraining and many valuable clinical notes could be entered on his field card. It was found best not to alter his diagnosis, since this meant disarranging complicated travel orders, unless an injustice was being done to a soldier.
Hospital trains formed a medical unit separate from the hospitals. For mental patients, however, the hospitals were asked to furnish additional neuropsychiatric attendants. The 35 trained enlisted men sent to the port at the instance of the Surgeon General "to escort nervous and mental cases from the port to the general hospitals" were used here as well as in the transfer from ship to ward and ward to train. Berths were made without curtains and toilet rooms were specially guarded.
Efforts were made to improve the above-described routine. Attention was first centered on the short time allowed for diagnosis in these difficult cases. As has been stated above, careful consideration made the neuropsychiatrists feel that no increase in time should be asked if such an increase would give mental patients second place in travel arrangements.
The question of discharging patients at the port was raised in an effort to clear beds in interior hospitals. Certificates of disability for discharge were made out for 30 epileptics whose convulsions clearly antedated their enlistment and where treatment could not be expected to improve their conditions. No difficulty was experienced in getting convincing histories. The result was that these patients were held about a month and then sent under escort to widely separated homes, a procedure which resulted in a multiplication of travel orders and a tying up of many Medical Department enlisted men in travel. The
scheme was abandoned as having no advantages over immediate distribution to hospitals near their homes.
SUPERVISION AND COORDINATION OF ACTIVITIES
The function of the neuropsychiatric member of the port surgeon's staff was determined by the fact that the port surgeon's office was the first unifying control of independent organizations containing neuropsychiatric officers. The work in all these organizations tended to pile up at intervals, with slack times between. Some central officer was required to move men toward the accumulating work and as promptly get them away when the work was over. The port surgeon acted as spokesman for neuropsychiatric matters to the Surgeon General and to the different organizations under him at the port.
The neuropsychiatric organization came in close contact with and was serviceable to the following officers: Chief medical examiner, in the preembarkation inspection, examination for discharge, examination of permanent personnel; medical superintendent of transports, in the transfer of patients from
ship to hospital, transfer of patients from hospital to train; commanding officers and chiefs of medical service of hospitals, in the assignments of neuropsychiatric officers and enlisted men, and correlations between hospitals; camp surgeon, in preembarkation inspection; attending surgeon, in consultation.
THE PSYCHOLOGICAL SERVICE
Unfortunately, it was not possible to make much use of psychology at the port of embarkation until after the signing of the armistice. A port of embarkation and debarkation, with its constant movement of population, was not an ideal place in which to carry on psychological investigations. While psychological examinations at such ports, because of the nature of the environment in which they are conducted, can not reach the perfection and usefulness which they attain in the relative quiet of interior posts and cantonments; they act to increase very greatly the margin of safety. They were of great assistance in the classification and consequent distribution of sick and wounded from overseas.
No psychological examinations were made at the port prior to December 1, 1918, except as incidental to other examinations. The return of mental and nervous cases from overseas in considerable number then made it necessary to undertake examinations by neuropsychiatrists familiar with psychological methods. As a matter of experiment, it was desirable to apply group methods of examinations to these patients, and two officers of the Sanitary Corps were assigned to this duty on December 1, 1918.
The functions of these officers were: (1) To assist the neuropsychiatrists in the classification of nervous and mental patients by the group application of a brief neuropsychiatric questionnaire; (2) the reexamination of patients returning from overseas with a diagnosis of mental deficiency; (3) the psychological reexamination of patients returning from overseas with a diagnosis of mental or nervous condition other than mental deficiency. Other duties were the group mental examination of the medical detachments of the embarkation hospital and of Debarkation Hospital No. 51, with the view of eliminating
men of low-grade mental efficiency; and the individual mental examination of women detained for examination by the United States Public Health Service at the Newport News Detention Home.
THE GROUP METHOD
The first opportunity to attempt the group method of psychological examination with a large number of mental cases from overseas presented itself on the arrival of the U. S. S. Zealandia on December 21, 1918.
It was hoped that the group method would permit a more rapid classification of the patients upon arrival by a more rapid and accurate selection of the mentally deficient; by using a neuropsychiatric questionnaire to indicate those who might be epileptic or paranoid, and by utilizing the patients themselves in filling part of the forms used.
The Zealandia docked at 6.30 p. m., December 21, 1918, and the patients were unloaded the following morning. All the examining material and mimeo-
graphed blanks were assembled in a ward of the embarkation hospital. The patients were admitted to the ward at 2 p. m., and by 3 p. m. had been assigned to beds, clothed in pajamas and bath robes, and were ready for examination. The 77 patients were assembled in one-half of the ward on the second floor. Pencils and information blanks were distributed and the patients instructed in the filling of the blanks. Those who were relatively illiterate were assisted by their brighter neighbors. The information blanks were filled out very satisfactorily within five minutes, and were then given to the ward nurse and
ward master, who immediately filled out the other forms required.
The Beta examinationc for foreigners and illiterates was then given, in order that those who were illiterate might not fail because of that fact. Upon completion of this examination, the neuropsychiatric questionnaire was filled out by the patient, and the patients were returned to their beds by 4 p. m.
The Beta papers and questionnaire were then scored. As soon as a paper was found scoring below D (inferior intelligence) one of the examiners called for that patient and gave him a brief individual examination. Five of the 77 patients scored less than 19 points (D), and were therefore given individual examinations. Of these five, one was of such low mentality as to warrant a diagnosis of mental deficiency, assuming that no other cause of low mental age was operative. This patient, Case I, had an overseas diagnosis of psychopathic state; Beta rating, D; mental age on Stanford-Binet examination, 8.8. The result of this examination was given to the psychiatrist and a diagnosis of mental deficiency was made by him. From the above facts, it can be seen that only one overseas diagnosis was changed; i. e., from psychopathic state to mental deficiency.
This method of detecting mentally deficient men did not yield positive results of any great significance. The following table indicates that the conditions for examining patients in hospital wards are so unfavorable as to make the group examination less reliable than when used under other conditions; e. g., in examining draft quotas in the cantonments:
The greatest discrepancy occurred in Case V, who rated D in the group examination and had a mental age of 6.6. In this case it was discovered that the patient had copied from a neighbor. This indicates that the group method needs close supervision. Of the 7 patients who were diagnosed as mentally deficient, 4 would have been referred to the psychiatrists by the psychological examiners on the basis of individual examination. It is
doubtful if Case VII (mental age, 10), Case VI (mental age, 9.3), and Case III (mental age, 12) would have been diagnosed as mentally deficient by the psychiatrist had the mental-age data been in his hands at the time he made his diagnosis. Case III seems to have had unusual ability for one diagnosed as mentally deficient, having been within two classes of graduation from a parochial school and having later been employed as a machinist's helper. The psychological examination showed him to have a good knowledge of abstract words, to be able to detect absurdities, to be able to form good sentences using
three given words as a basis, and to have good ability in putting dissected sentences together. In fact, he was able to pass some adult tests. Another case where it seemed the mental age would have aided the psychiatrist at the time of his brief interview with the patient was that of Case VI. A psychiatrist from the port surgeon's office picked out this man as an apparent defective. And so he seemed on first impression. The patient was partially deaf, had a thick speech suggesting feeble-mindedness, and was slow in movement. He had been reared in an isolated community and had attended school for only one
year. He had been employed as a teamster for the greater portion of his life. His mental age of 10 years was surprising, in view of his appearance and lack of education. The psychiatrist who called attention to this man was convinced, after listening to the psychological examination, that the man was not definitely feeble-minded but that his apparent feeble-mindedness was due to a lack of a favorable environment in childhood and to his defective hearing. This illustrates the value of the individual psychological examination in differentiating a congenital defect and one due to accident or lack of schooling.
From this experiment it seemed that the group method was of little value in examining overseas patients because of the inherent difficulties of conducting such examinations under the conditions existing in debarkation hospitals, and also because the method entailed the needless examination of 90 per cent of the patients. On the other hand, the individual examination of all cases of suspected mental deficiency was of value because it permitted accuracy of diagnosis. Cooperation between psychiatrist and psychologist was thus developed without delaying the important work of rapidly classifying the patients. As the psychiatrist interviewed the patients, he could refer to the psychologist for a determination of their mental age those who appeared mentally deficient. With this information in hand, the psychiatrist could arrive at an accurate diagnosis more quickly. In this plan of cooperation the psychologist performed a function for the psychiatrist similar to that rendered by the bacteriologist for the internist.
In the examination of the patients from the Zealandia, inspection of the neuropsychiatric questionnaires revealed only two patients who claimed to have had fits, fainting spells, or convulsions prior to entering the Army. This information was given to the psychiatrist by the psychologist prior to the former's interview with the patients, but proved of no value. Three patients of this group stated that they "had not been treated right in the Army. " On the whole, the questionnaire was barren of results. This was due, perhaps, to the fact that the experiment was undertaken in the debarkation hospital
where there was always a rapid movement of patients to interior hospitals. Under other conditions, it might have been possible to devise a group test which would have differentiated roughly the various types of psychiatric cases.
The information blanks filled out by the patients proved workable but not valuable. The nurses and the ward master were able to fill out the forms from the information given by the patients, but it is doubtful if the group method of securing this information was sufficiently economical to warrant its adoption. The nurse who used the information blanks seemed to think that the information could have been secured in the same length of time from the patients when they were lined up preparatory to bathing. If it were necessary to secure this information from two or three hundred patients, it is obvious that a group method would be economical of time. This was rarely the case, the number rarely exceeding 80 in any one ward; therefore, little time would be gained by having the patients fill out the information sheet in groups.
THE INDIVIDUAL METHOD
On January 1, 1919, the next large contingent of nervous and mental cases arrived at the port of embarkation from overseas on the U. S. S. Princess Matoika. It was decided to employ individual methods of examination, both by neuropsychiatrists and the psychologist. The success of the method, with certain limitations, was indicated in a report to the Surgeon General, to the following effect:
The Princess Matoika docked at 11 a. m. January 1, 1919, and the patients were taken off between the hours of 2 and 10 p. m. The 204 nervous and mental cases were transferred to the steamer Smithfield, which carried them to Debarkation Hospital No. 51, Hampton, Va. All cases were placed in wards by 6.30 p. m. No psychological examination of the 91 insane patients was attempted because of their obvious mental condition, although 6 of these cases were diagnosed overseas as mentally deficient. The others were at their beds by 7.45 p. m., having eaten and disrobed. While the chief of the neuropsychiatric service and his assistants checked up overseas diagnoses on the field hospital cards of the men, the psychological examiner passed from bed to bed and, by brief interview, selected nine men for psychological examination who gave evidence of low mentality. A complete canvass was impossible owing to some confusion incident to bathing. It was later found that three cases whom the psychologist would undoubtedly have selected for examination were missed in this way.
Examination of these nine men, without reference to their overseas diagnoses, was begun at 9.45 p. m. It was possible to examine only three patients, because by 11.30 p. m. the remaining 6 patients had gone to sleep. It seemed unwise to continue the examination at such a late hour. The psychological examiner continued the examination the next day, even though the diagnoses had been filed by the neuropsychiatric chief in accordance with the usual procedure. The results were as follows:
The examination was discontinued as soon as any patient rated over 10. Three other patients selected for examination were not examined, on the advice of the ward psychiatrist, who believed that their mental deficiency was complicated with other nervous and mental symptoms and that they were therefore in need of further hospital treatment. In addition to the foregoing, Case X was examined at the request of the port neuropsychiatrist because of undiagnosed mental condition. He was not found to be mentally deficient (12 Standford-Binet).
From the above, it can be seen that at least four patients with a diagnosis of psychoneurosis from overseas should possibly have been diagnosed mentally deficient. The chief of the hospital's psychiatric service concurred in this opinion. However, the time allotted to the neuropsychiatric officers for submitting a classification of the patients was so short as to prevent the utilization of these data. The result was that the diagnosis on the field medical card constituted the basis of classification.
After examining the above cases, the 11 overseas diagnoses of mental deficiency were checked up. By comparison of the names with the list of men examined, it was discovered that only one of the overseas deficiency cases had been uncovered by a personal canvass (Case IV, mental age 9). The overseas mental deficiency patients were then examined with the appended results:
From the above, it can be seen that the mental ages of five men diagnosed overseas as mentally deficient were so high as to render the correctness of the diagnoses questionable, which accounts for the failure of the psychological examiner to select these particular cases for examination at the time of the individual interview.
Case XV, mental age 11, was a French-Canadian by descent who had had little schooling, but who had taught himself to read and write English, although
French was his mother tongue. He was a bright-looking young man, and would probably have scored even higher than 11 had time permitted the completion of this particular examination.
Case XVI, mental age 11.8, a Kentucky farm lad with education to the fourth grade, was found to be well oriented, able to make change accurately, to repeat five digits backward and seven digits forward, able to do "clock" problems, and to show a fair degree of practical judgment.
Case XVII, mental age 12.7, was only slightly below the average soldier in mental ability and by no means to be considered deficient. Had reached the fifth grade in the schools of Baltimore, Md., read and wrote well; employed prior to Army service as a box maker at $15 a week. He was not very prepossessing in appearance but would not be considered a defective from his appearance.
Case XVIII, mental age 13.2, diagnosed overseas as an imbecile, was an illiterate but self-supporting Alabama cottonmill hand, who had excellent mental power for one without an education and was by no means to be considered an imbecile. He performed all of year 10 tests, 4 out of 5 tests in year 12, and 3 out of 4 in year 14. His only failures up to year 16 were inability to repeat five digits backwards and seven digits forward.
Case XIX, mental age 14; was a normally intelligent man with a slight congenital speech defect which might easily have given a wrong impression as to his mentality; schooling to the fourth grade; worked in civil life at embalming and at driving an undertaker's wagon. His mental age indicated a mentality higher than that of 40 per cent of the general run of draft as judged by tabulated results of psychological examinations. He was able to repeat six digits backward and able to differentiate abstract terms, such as idleness and laziness, character and reputation, with fair judgment.
The chief of the neuropsychiatric service concurred in the belief that the overseas diagnosis of mental deficiency could not be sustained in these particular cases. The psychological examination of the remaining six overseas mental deficiency cases confirmed the diagnosis made. The psychologist had selected one of these in his individual interview, leaving five cases that he had apparently missed. It was found that three of these had been at their baths, and consequently only two who should have been selected had been missed in the individual interview: Case XI (8.3), a negro, and Case X (8.5). The reasons
for the failure to select Case X for examination can be found in the fact that he had schooling to the sixth grade and two years of trade school, and the possibility of mental deterioration.
PSYCHOLOGICAL RATING OF MEDICAL DETACHMENTS
The entire medical detachment of Debarkation Hospital No. 51 and a portion of the detachment at the embarkation hospital, Newport News, were given the Alpha examination during December, 1918, by groups of 100 to 200. The purpose of the examination was to classify the men according to their mental ability, to discover men of unusual mental ability who were serving in low-grade types of work, and to facilitate the discharge of incompetents who might be shown to be such by reason of low mentality. The results of the
examination showed rather a high percentage of low-grade men in both hospitals. In order to improve the service a number of these were given their discharges and their work was taken up by higher grade men.
The value of psychological ratings in the selection and promotion of men for more responsible positions is indicated in the results of the examination of a group of 99 unselected enlisted men taking the Alpha examination at the embarkation hospital. The men were requested to write their actual kind of duty in the hospital on the blank. The results are as follows:
Computing the average score by points and letter rating, the occupations are arranged in order of score made:
The number of cases was not large enough to warrant far-reaching conclusions, but there were sufficient data to show a relationship between the mentality of the men and the kind of work they were doing. The intelligence rating in the above list decreased in proportion to the degree of mental ability needed in the doing of the work satisfactorily. The above data indicate the value of psychological ratings in assigning or promoting men to more responsible duties, especially when little other information is available concerning the relative ability of the men. The data are further indicative of the fact that men in a detachment can be classified for suitable duty within one or two hours with almost the same degree of certainty as by the longer method of assigning and reassigning, extending through a long period of intimacy with the men in question.
The necessity for final orthopedic examinations became increasingly apparent in connection with the various medical examinations which took place prior to the embarkation of troops. Immediately upon the arrival of troops destined for overseas service, arrangements were made with the organization commanders for an orthopedic examination of their commands. This consisted chiefly in the determination of previous or existing disabilities of the
feet and joints as well as the liability of recurrence of conditions which would render the soldier unfit for overseas duty. As a result of these examinations made in connection with the preliminary medical examination, officers and men were recommended for overseas duty, for domestic service, or for discharge on surgeon's certificate of disability.
A course of lectures was conducted by members of the orthopedic board for officers and enlisted men of arriving organizations. Special stress was laid on the importance and necessity of maintaining the feet in perfect condition while on active campaign. Instructions in the prevention and treatment of minor foot injuries were given. This included the distribution, to each officer and noncommissioned officer, of the booklet entitled "Minor Foot Ailments," issued at the instance of the Surgeon General.
An orthopedic board was established at the port in March, 1918. The functions of the board were as follows: (1) The examination of soldiers prior to embarkation; (2) the classification of the unfit in the casual detachments for limited service, domestic service, or domestic interior service; (3) consultations on special cases, both in the camps and at the embarkation hospital.
By the end of April, 1918, the orthopedic work included the examination of troops at Camp Stuart, Camp Hill, Camp Morrison, and Camp Alexander, with consultation at these camps and at the embarkation hospital. It was found necessary to increase the number of orthopedic surgeons in order to maintain a high degree of efficiency in this work and properly to conduct the preembarkation examinations of the rapidly increasing number of troops arriving for overseas duty. The orthopedic board then consisted of three members, a major, a captain, and a lieutenant. The number of arriving troops continued to increase rapidly and it became necessary to request a second augmentation of the board by the close of May, 1918.
The examinations were conducted in the mess halls of the various companies, each officer examining one company at a time. Shoes and socks were removed and the feet examined manually and by the use of selected exercises. The following classification table was prepared with a number assigned to each condition, in order to systematize the recording of the pathological and physical defects discovered by the examinations:
1. Weak feet.
(a) With subjective symptoms.
(b) Without subjective symptoms.
2. Flat feet.
3. Loss of transverse arch.
6. Hallux varus.
8. Hallux rigidus.
11. Overriding toes.
12. Amputated toes
24. Inflamed heel
Preembarkation physical examinations practically ceased with the signing of the armistice and demobilization examinations began immediately. Boards of demobilization examiners were formed for this purpose, which included members of the orthopedic board. The inspection and examination of orthopedic cases debarking from overseas necessitated a change in the operations of the orthopedic board. Such cases began to arrive in considerable numbers within a week after the signing of the armistice, and were first inspected on board arriving tranports prior to landing. A second examination was made at the hospital to which they were transferred, and a third just preceding entrainment. Splints, traction apparatus, and plaster work were carefully examined at these inspections and corrected when necessary. Faulty positions, pathological changes, and physical disabilities were carefully studied and appropriate treatment was instituted.
About 90 per cent of men examined were found without listed orthopedic conditions. Corns, bunion, hallux valgus, hyperidrosis, horn nail, weak feet, ingrown nail, and overriding toes, in the order mentioned, were the commoner conditions noted.
Laboratory service for the port of embarkation was furnished by the laboratory at the embarkation hospital, Camp Stuart. This laboratory was inaugurated early in December, 1917, in the temporary hospital, with an equipment consisting of a microscope, a few stains, and a meager amount of glassware. The hospital was moved to its later site in January, 1918, and two small rooms were assigned for the use of the laboratory. As there was no gas supply, and no bacteriological equipment had been received, it was necessary to borrow media and incubator room from the United States Public Health Service. The
personnel then consisted of one officer and one enlisted man. During the latter part of March, 1918, the laboratory was expanded by the addition of two rooms, and its personnel was augmented by an officer and three enlisted men. Gas from the city mains was installed at about this time.
An officer arrived in April, 1918, to study the laboratory situation. Proper incubator space, an additional room, and better cooperation between the clinical services and the laboratory were secured through his efforts. Supplies, which up to this time had been very slow in arriving, were received promptly. Studies on the respiratory diseases then prevalent in the port were inaugurated a short time later. There were three officers and five enlisted men in the laboratory at that time, and it was able to meet practically all of the demands made upon it. Ten enlisted men were on duty in the laboratory by June, 1918, and an
animal house was built which gave adequate housing to the supply of animals on hand.
An ever-increasing number of demands was made on the laboratory with the beginning of the summer season and the increase in overseas troop movements. The appearance of malaria was the occasion for the inauguration of a system of reporting positive cases and of close cooperation with the malarial drainage detachment. The occasional cases of meningitis and diphtheria among troops bound overseas necessitated arrangements for the quick determination of carriers. Accordingly, upon the discovery of a positive case by the laboratory,
the camp surgeon concerned was notified and he at once quarantined all contacts with the case, and an officer from the laboratory then proceeded to culture these contacts. It was thus possible to release from quarantine the next morning all negative contacts and to arrange promptly for the disposition of positive or questionable carriers. It was deemed advisable to examine the stools of all civilian food handlers in the port for typhoid and dysentery on account of the occurence of a number of cases of enteric disturbance in the permanent garrison. This was done and resulted in the finding of one carrier of bacillary dysentery, Flexner type. Close cooperation was maintained between the laboratory and the sanitary officials of the port in the control of the water and sewage situation.
A temporary branch laboratory was established at Camp Alexander during the months of September and October, 1918, to assist in the campaign against hookworm and gonorrhea. Two officers and one enlisted man were assigned from the main laboratory and took with them such supplies as were necessary to inaugurate the work. These officers made routine examinations of the stools of several labor battalions for intestinal parasites. Examinations of routine smears from cases of gonorrhea were also carried out in conjunction with the clinicians, in an effort to coordinate treatment with the results of treatment as shown by the microscope.
The increasing work and the scarcity of laboratory officers made the question of skilled technical assistance an acute one. As there were 3 women technicians and 5 officers on duty in the laboratory, the question of training competent enlisted men for commission in the Sanitary Corps was considered. Enlisted men who were college men or who had had technical training were secured and a regular course of instruction was carried out. Under this plan, the men spent a certain definite time in each department, learning the routine bacteriological and clinical microscopic work under the officer in charge or under the women technicians doing the work. By giving the women fixed posts, it was thus possible to transfer and train the men without having the routine work suffer. It usually meant a double check on each specimen. The men were encouraged to study and were to be found in the laboratory almost every evening, busy with the various textbooks. Three enlisted men were thus prepared for commissions
in the Sanitary Corps by the time the armistice was signed, and the other men were making such progress that two would have been ready every two months had the war continued. The good effect upon the morale of the enlisted personnel was marked. Each man saw the possibility of a commission dependent upon his efforts and worked accordingly.
The work of the women technicians was accurate and reliable, on the whole, but the large amount of emergency work and frequent demands for long hours constituted too heavy a tax upon them. They frequently lacked initiative and adaptability to the unusual conditions which, of necessity, obtained at the laboratory, and their feeling of superiority to the enlisted personnel constituted a source of friction. This militated against the achievement of the highest degree of success in their work and, in all probability, would not have occurred in a laboratory devoted entirely to research or to routine operations.
The building occupied by the laboratory soon proved entirely inadequate for the character and the amount of work. It was at first thought that it would be
possible to enlarge the old building and thus provide the additional room needed. It was found, however, that sufficient room could not be had on account of fire regulations, and that the additional room that could be made could not be coordinated with the rest of the laboratory without a great deal of lost space. An entirely new structure was deemed advisable, and plans for a two-story tile building were prepared and forwarded to the Surgeon General for approval. These were approved and construction was begun. The construction progressed irregularly on account of labor troubles, and the building was finally occupied on January 7, 1919. Even then, there was much minor work to be finished. In spite of the inconvenience caused by workmen in the building, it became possible to organize and coordinate the work of the laboratory in a way never possible in the old building. The plan of the new building made it possible to so arrange the departments as to cause a minimum of disturbance in the work.
The new building, with the consequent broadening of the work, required an increase of personnel to 12 officers and 34 enlisted men. The laboratory was equipped and manned to do any work asked of a department laboratory and served the whole port in that capacity. In order to give the hospitals of the port the benefits of the laboratory, a daily courier service was inaugurated to Debarkation Hospital No. 51 and Camp Morrison hospital. These couriers delivered reports and such materials as had been requested the previous day and brought back to the laboratory specimens for examinations.
It was the policy of the laboratory to encourage such research as it was possible to carry on in conjunction with the routine work. It was possible to make a study of the bacteriology of the 1918 epidemic of influenza in the port, in spite of the sickness of half of the officers in the laboratory. Studies were made of the bacillary dysentery organisms isolated from cases of dysentery. Investigations were carried on to determine the possibility of indirect transmission of sputum-borne diseases.
THE DENTAL SERVICE
The Dental Corps began operations at the port, August 22, 1917, when one dental officer and two enlisted assistants established an office in the Western Union Building in Newport News, there being no Government building available. The equipment in use was purchased from the dental officer on duty. Two more dental officers reported for duty on October 27, 1917, and a portable dental outfit was then installed. The dental office was removed to the temporary embarkation hospital at Camp Stuart on November 20, 1917, and remained there until the permanent hospital was completed in January, 1918.
Nine dental officers were assigned to the hospital at this time, and, pending the arrival of base equipment, the dental services were conducted in conjunction with the laboratory department. Space was finally provided in storeroom No. 1, which later was remodeled to suit the dental and the eye, ear, nose, and throat clinics. The dental clinic building was occupied July 13, 1918, and had 10 separate operating rooms, a prosthetic laboratory, a record room, and a waiting room. The equipment was all of the base type and complete in all details. When headquarters building of the port was completed
in the city, a dental clinic was established in the attending surgeon's office to care for the staff at headquarters and the officers' families.
Twenty-seven dental officers were on duty on September 24, 1918, stationed as follows: 10 at the embarkation hospital; 3 at Camp Stuart; 6 at Camp Hill; 5 at Camp Alexander; 1 at the attending surgeon's office; 1 at the engineer depot; 1 at the ordnance depot. The equipment at this time consisted of 11 base and 16 field outfits, with 1 laboratory equipment at the embarkation hospital. A request had been made for the construction of three unit buildings capable of accommodating approximately 20 operators each. The plan was to place one building in each of the larger camps and one in the port, and to equip them with the base type of equipment, complete in all respects. Prospects for the fulfillment of this need were bright, but the signing of the armistice caused the plans to be dropped.
Geographical conditions of the port necessarily spread the dental activities over a considerable area on both sides of the James River. Stationed at the port were 17 fire and guard companies of approximately 250 men each, all limited service men presenting many varieties of dental conditions. Many dental mechanical restorations were necessary for the members of these companies, and the construction of same was accomplished at the embarkation hospital laboratory by experienced men. Excellent results were obtained in this branch of the work.
Three more dental officers reported for duty during October, 1918, making at total of 30 on duty.
The Air Service station, Camp Morrison, Va., was made a part of the port on October 17, 1918. An excellent dental clinic had been established in its camp hospital, with three complete base equipments. Plans were completed at this time whereby the soldiers' home at Hampton, Va., was converted into a debarkation hospital. Two dental officers and complete base equipments were assigned to this hospital. Fourteen dental officers reported for duty during November, 1918, making a strength of 44 officers at the port. This number slightly exceeded the equipments in use in the available space. The camp hospital, army supply base, Norfolk, Va., was completed during this month and two dental officers were assigned there for duty.
The average weekly strength of the port had been approximately 30,000 men. As the population was mostly of a temporary character, inasmuch as it consisted chiefly of troops for embarkation, their stay being for a period of 4 to 10 days, the character of the dental work varied. Efforts were made to treat as many men as possible yet render the maximum amount of service to each man. Special effort was made to remove all unserviceable teeth and to repair all simple carious conditions of the teeth, with other necessary prophylaxis, before dismissing the patient. From September, 1918, to August 30,
1919, the following conditions were cared for:
Total patients treated --21,132
Total sittings given 33,125
Permanent fillings inserted ---19,759
Unserviceable teeth extracted 7,057
Prosthetic restorations 914
Root canal fillings 1,437
In respect to the number of patients treated and the number of sittings given, the conditions existing at the port should be taken into consideration.
As stated, the object was to cover as much individually as was possible considering the short period the troops remained in the port. This accounts for the fact that root canal fillings were not relatively great in number.
No expense was spared in material, and the effort resulting in the use of the material and equipment was in direct ratio to the ability and care of the operator. Efforts were successfully made to standardize amalgam and root canal technique. The resin-chloroform method of filling root canals was most adaptable and proved very acceptable. The element of time was the greatest handicap to the dental operator. Many men accepted for the service were dentally deficient. With the men's time so fully occupied with varied sorts of military training under pressure, many were not brought to a point of dental fitness. This fact often left the dental surgeon to choose between extraction and an attempt to restore the tooth. Considering the after results of root canal work when improperly or too quickly completed, extraction was frequently preferable.
The permanent fillings consisted of gold, amalgam, amalgam combinations, oxyphosphate, and synthetic porcelain. The gold fillings were largely performed upon officers and at their personal expense, as regulations forbade the use of gold or other precious metals upon enlisted men except in certain authorized cases. All anterior teeth were restored with synthetic porcelain fillings or porcelain crowns. The mechanical prosthetic restorations consisted chiefly of vulcanite dentures, mostly of a partial type.
Figurative tabulation of the above conditions would not give a balanced comparison, due to the fact that the system of recording cases was not as comprehensive as it might have been. Variance in diagnosis in the individual operator to a great extent retarded the proper completion of the register cards. It was believed that a system of charting should have been used whereby the man's dental condition at the time of entrance into the service and each subsequent operation would have been charted. This would have furnished a basis on which progress could have been determined. His dental condition at all times should have been made a part of his service record, thereby enabling his commanding officer to determine the dental fitness of his men at any time, and also to act as an aid in identification.
Oral surgery wits limited to minor conditions, due to the fact that the sick and wounded from overseas were retained at the port only for a period of classification and were then transferred to general hospitals. This fact contributed to the condition of unsatisfactory results to a great degree, as the follow-up results of the cases could not be recorded.
THE VETERINARY SERVICEd
The one port veterinary service developed by the Army during the World War was that of the port of embarkation, Newport News, Va. This service consisted of two main divisions, that of the port of embarkation proper and the animal embarkation depot.
The senior veterinary officer was an assistant to the port surgeon from the time of the organization of the port until Special Regulations, No. 70, War Department, was published early in 1918, which placed him under the port commander. His relation to the port surgeon then became that of consulting veterinarian, and his assistance was of particular value in the matter of meat and dairy inspection. His other duties were the supervision of veterinary sanitation, meat and dairy inspection, sanitary inspection of animal transports, assignment of veterinary officers and enlisted personnel, supervision of the loading of animals, supervision of medical supplies, forage, grain, and animal equipment for all transports, etc. He maintained an office in the administration building, and was a member of the transport inspection
board, which conducted a general inspection of all Army transports entering the port of Norfolk, Va. This board was composed of one officer of the Inspector General's Department, one assistant to the surgeon, the port veterinarian, and a representative of the Shipping Board. A quarantine station for animals returned from overseas, established after the armistice was signed, under the supervision of the port veterinarian, had facilities for caring for 200 officers' private mounts. The veterinary personnel consisted of an officer, in charge, and 98 enlisted men of the Veterinary Corps.
ACTIVITIES CONNECTED WITH THE SHIPMENT OF ANIMALS
The shipment of animals overseas was inaugurated October 15, 1917, and continued until March 22, 1918, when it was temporarily discontinued. Shipments were resumed August 12, 1918, and finally discontinued November 30, 1918. Twenty-five veterinary officers were designated at an early date to act as transport veterinarians, each permanently detailed to a ship. Casual veterinary officers were used as transport veterinarians when necessary. Veterinary units ready for overseas service were sent to Newport News and their personnel assigned to duty on animal transports for the trip. This often scattered the personnel, that of one unit being divided among several ships. It furnished veterinary attendance on the transports, but at the expense of the efficiency of the units. Other casual troops were used for the purpose when veterinary personnel was not available. This use of casuals insured a new and inexperienced detachment of attendants each trip, with consequent confusion and loss.
The unsatisfactory conditions arising from the lack of a permanent enlisted force led to a recommendation from the remount division of the Quartermaster General's Office that permanent detachments of enlisted Veterinary Corps men be assigned to each boat to provide for the care of animals. The recommendation was not concurred in for the reason that the enlisted Veterinary Corps was for the purpose of caring for sick animals and it seemed improper to assign them as caretakers of animals in transit. At the same time the necessity of a small veterinary detachment to assist the transport veterinarian in caring for the sick was freely admitted.
The use of civilian employees was suggested and failed, by reason of the difficulty in securing suitable men. Eventually, authorization was received
for the addition of 300 enlisted men to the veterinary detachment at the animal embarkation depot, Newport News, where they were trained as a part of the permanent detachment which was drawn on to furnish a detachment of 20 men for each horse transport. The actual care of the animals continued to be rendered by casual troops.
The veterinary detachment was intended to assist the transport veterinarian in treating the sick and for general supervision in caring for the animals. On the return trip the cleaning and disinfecting of the ship was done under veterinary supervision. This arrangement proved satisfactory.
All animals were given a thorough examination, such as being mallein tested and their temperatures taken, as well as being thoroughly examined otherwise at the animal embarkation depot. They were then haltered, tied together in groups of 4 and led a distance of about 3½ miles and placed in what were designated as Pier No. 5 corrals. This was done the day previous to embarkation. They were fed the usual grain allowance in the afternoon and were allowed hay in an unrestricted quantity during the night, drinking water being available at all times.
On the day of loading, they were put through the chute and there examined by a veterinary officer for overnight developments, such as nasal discharge, injuries, contused, lacerated, and penetrating wounds. All those passing this inspection were led to the pier to be loaded. They were again examined by the transport veterinarian at the pier gate; membranes were examined, pulse noted, respirations counted, mouth examined, submaxillary and parotid glands palpated. Any animals showing symptoms of coryza, even to the slightest extent, were at once rejected. All animals rejected by him were reported in writing to the port veterinarian, with a statement as to the number and cause of rejections.
Previous to loading animals, all stall-division boards were removed in each compartment and set aside in a convenient place where they could be reached in the least possible time to expedite loading.
The brow, in the meantime, had been attached to the ship. The closed-side brow was the type used at this port and proved very satisfactory.
The animals were then led to the entrance of the brow and were led aboard ship or were turned loose in the brow and driven aboard. The lower decks were loaded first. The animals were led to the farthest stall in the compartments and tied to the breast board.
When the desired number of animals had been placed in each stall, division boards were put in place. Stalls in which it was desired to load no animals were placarded with a printed placard, "NO STALL."
All transports, before being loaded, were inspected by the port veterinarian in regard to the suitability of the fixtures and the water supply, and the forage as to quantity, quality, and place of storage. This inspection also included stable utensils, such as forks, brooms, shovels, buckets, and feed pans. All animals were led aboard ship by employees of the company which had the contract for placing animals aboard. This could have been done more economically by enlisted men, as the men employed by the firm were largely inexperienced in handling animals and were constantly being changed to other
duties, and it was only on rare occasions that an experienced crew was available. This naturally retarded the loading. An enlisted personnel of 50 men could have done the work better and in a much shorter space of time.
The port veterinarian requisitioned for the necessary veterinary medical supplies and instruments.
All inspections of transports, when possible, were made in ample time so that recommendations for the correction of irregularities could be made to the commanding general and corrected as per his command prior to loading animals.
The remount officers cooperated with veterinary officers in every way possible and rendered as much assistance as they could at times of loading. They supervised the haltering of animals and the leading of same to the piers and aboard ship.
Transports used in the first shipping period were equipped much better than those in service during the following period. The superstructure and stalls on the weather deck were more securely anchored. The breast boards were held in place by strong iron cleats, one breast board to each stall, and could therefore be removed in sections. Those in the transports used in the latter period were bolted on and provided a removable board at 30-foot intervals only, thereby often necessitating the removal of an 18 or 20 foot board which was secured to the stanchion by bolts in order to remove one animal from a stall. This greatly interfered with the proper policing of the ship, and was a great inconvenience in case it was desired to move the animals.
The stalls were generally 8 feet in depth and 10 feet in width, accommodating four animals. Some transports were fitted with individual stalls during the latter period. These proved to be entirely unsatisfactory for the following reasons: They gave the animal less freedom than the 4-animal stalls; they were not as accessible to police; the dividing boards were not fastened securely and the animals were continually knocking them down.
All transports were equipped with bell-mouth funnel ventilators and wind sails, and a great many with the blower-fan system. The allowance of air space was decidedly deficient, averaging about 338 cubic feet per animal, when the allowance for ordinary conditions should have been 1,500. It is apparent that the ventilation should have been as nearly perfect as possible. The blower-fan system gave a great deal of trouble, due mainly to the improper installation of the electric motors. These were usually installed on the decks and would short-circuit and fail to operate when wet by surplus water on the decks. While the ventilating system would appear inadequate upon casual observation, it really functioned in a quite efficient manner, as was proved by the large percentage of animals which were debarked in excellent condition. Animals were often sent to active duty within a week after their arrival overseas. On the other hand, there were 13 deaths from influenza and pneumonia on a transport which put in to New York and was held six days for repairs without unloading the animals. These deaths were attributed largely to the lowered powers of resistance of the animals as a result of the poor ventilation while the ship was lying at anchor.
The ships used in animal transportation were not built for that purpose, consequently the drainage system was entirely inadequate. The drainage
or scupper pipes were about 3 inches in diameter, and it required the constant attention of one person in each compartment to maintain a proper drainage.
The water supply was adequate and the quality good, as a whole. It was stored in tanks in the hold and pumped to the different horse compartments. Barrels were placed about 50 feet apart along the water-pipe line and the animals were watered with buckets.
Following are the specifications for horse fixtures on animal transports.
Preparation.-All compartments selected for accommodation of animals to be thoroughly cleaned out and washed down, as necessary, and placed in proper condition for the erection of stalls.
Deck covering.-'Tween deck to be sheathed in horse stalls and in passageways only and to be of 2-inch spruce or yellow pine. Sheathing of sectional flooring taken from other vessels to be used as far as practicable. If there is not sufficient sheathing to cover the decks as required, new and similar sheathing will be furnished and installed by the contractor.
On the main and upper decks, instead of sheathing there will be footlocks 2 by 4 inches thoroughly secured to wood decks by 4½-inch nails, with suitable openings for drainage. The first footlock will be placed 16 inches inside of foot board and the other spaced as follows: 14, 26, and 14 inches between.
Stalls.-All stalls for animals will be arranged with animals standing athwartship, facing fore-and-aft passages. Stalls to be arranged to accommodate one horse, allowing 30 inches in width for each horse. Length in clear 7 feet 6 inches to 8 feet where possible. Passages between stalls to be not less than 4 feet, but may be reduced to 3 feet 6 inches abreast of hatches, if necessary. Where mules are to be carried 5 mules will be placed in the space occupied by 4 horses; that is, the mules will be placed in pens of 5, using the space of 4 horses.
Front stanchions.-To be spaced 5 feet center to center and to be of 6 by 4 inch yellow pine dressed on all sides, corners rounded and made smooth. All stanchions will have a 2 by 4 inch tenon to receive athwartship beams, this tenon to be 4 inches high.
In the way of horses heads, the front stanchions to be covered with galvanized iron, with the edge of sheets well nailed.
Heels of stanchions to rest on deck and to be thoroughly braced in position with 3 by 4 inch yellow pine or spruce.
Rear stanchions.-To be 6 by 4 inch by 7 feet 6 inches high from deck to shoulder and spaced to suit front stanchions. Rear stanchions will have a 2 by 4 inch tenon to receive athwartship beams, this tenon to be 4 inches high.
The rear stanchions to be set against rail and secured by means of hook bolts. Back of stanchions to be filled flush with outside of rail to admit of the outside sheathing being properly secured thereto. The filling piece and outside piece to be through-and-through bolted to rear stanchions by 5/8-inch screw bolts.
Heels of these stanchions to be secured by bracing same as the front stanchions.
Beams.-Beams must be of good sound spruce or hard-pine lumber 4 by 6 inches, to run clear across the ship's beam where practicable. Should any horse or deck fittings be in the way, the beams should butt up closely to same. These beams shall have a 2 by 4 inch mortise to receive the tenon of each and every stanchion and to take the same crown as deck of ship by springing down to shoulder of outside stanchion and to be properly pinned or nailed to tenon and wedged tightly afterwards. Diagonal braces on each stanchion on both sides of same running to top beam, secured by well nailing to both stanchions and beams. The mortises shall be cut not less than 6 inches from outside ends of beams.
Roof.-To be 1½ inch or 2 inch tongued-and-grooved yellow pine, as obtainable, and carried over 2 feet in front beyond line of front stanchions. This roofing shall be laid close and driven tight.
Back sheathing.-To be 1½ inch or 2 inch thick yellow pine, as obtainable, on outside of stanchions, extending from deck to roof. Where there are no obstructions, similar sheathing will be worked on the inside of outboard stanchions to a height of 5 inches above deck. Where obstructions occur, such as stanchions, braces, rigging, etc., 3 by 4 inch stanchions shall be set clear of all obstructions and receive sheathing.
Breast boards.-To be 9¾ by 2¾ inch yellow pine or spruce dressed and fitted with galvanized iron on rounded top edge. Breast rails to be filled with iron cleats and toggle pins, the fittings removed from other ships to be used in this instance. Footboards, 3 by 9 inches to be installed on the outside of stanchions in passageways, fastened with 4½-inch nails.
Parting boards.-To consist of one board 2 by 9 inches dressed on both sides and rounded on top edge, the stanchions to be cleated to receive these parting boards. Midway between all stanchions there will be installed a 2 by 6 inch pine upright secured to headboard and to footboard and cleated in a similar manner to the stanchions to receive the parting boards.
Fittings.-A screw ringbolt for hitching purposes to be installed on each stanchion. A hole to be drilled in breast board in the way of each stall, about 1 inch in diameter.
Fittings on 'tween-decks for horse stalls are to be similar to those on upper deck in every respect, except that that roof is to be omitted.
'Tween-deck stanchions to be secured by bracing at heels and head of stanchions, across the ship. These braces shall be 2 by 3 inch yellow pine. A piece of 2 by 3 inch pine shall be driven tight between the beams and secured by nailing to the head of front board stanchions.
Scuppers.-All scuppers throughout the ship to be cleaned, thoroughly repaired, and put in good working condition and to be fitted with proper strainers and means for washing down.
A passageway of at least 18 inches to be left in way of scuppers.
Brows.-Brows to be provided for hatchways to Nos. 2 and 3, to enable animals to be led to the compartments from the upper deck. These brows to be strongly made of 3 inch timber for the bottom and 2 inch for the sides, the sides to be dressed smooth on one side. Brows to be well cleated with 3 by 4 inch pine spaced 4-inch center to center. Protection rails to be suitably built of 2-inch material; side rails also be be 2-inch material carried on stanchions 4 by 4-inch spaced about 5 feet apart.
Lighting.-Animal compartments will be properly wired to provide a sufficient equipment of electric lights throughout, in number, about as follows: Main deck, 50; 'tween-deck, forward, 17; 'tween-deck, aft, 17.
All wires to be run in conduit; suitable panel boards and switches for controlling these lights to be furnished. All light sockets in all compartments to be of the snap-switch type. Conduits to be carefully run for protection and properly supported.
Water service.-A permanent water service of not less than 2-inch diameter galvanized-iron pipe to be fitted in main and 'tween decks carried fore and aft, with cross sections to opposite sides. A cock to be fitted at convenient distances, say, 50 feet apart, with a hose connection 5 feet long. A hose connection to be run from pipe line below up through hatchway to upper deck. Spigots to have male hose outlet connections.
Barrels to be placed on all decks in the way of taps specified above, from which buckets for watering the animals can be filled.
Ventilation.-These will be 6 cowl ventilators, 4 forward and 2 aft, as per blue print attached, and as specified below, installed where directed to ventilate the main deck, and 6 aft to ventilate 'tween-decks.
Ventilation will be made in accordance with the blue print, details and dimensions to conform to type of standard 18-inch cowl ventilator specified. Cowl head to be made in four pieces, using No. 14 United States standard gauge galvanized sheet iron. Lower course to be made of same material, lapped 1 inch, with rivets spaced 2 inches on center line, driven flush outside. All courses of ventilation above weather deck to be No. 18 United States standard gauge galvanized sheet iron, lapped 1 inch and similarly riveted. All courses below weather deck to be of No. 20 United States standard gauge galvanized sheet iron, let through decks and secured in place as shown.
Ventilation will be provided with two ¾-inch wrought-iron trimming handles, riveted to cowl. Cowls to be portable and to have sufficient working clearance so as to be capable of being easily trimmed at all times.
Flanges on weather deck to be of 3 by 3 by ¼ inch angle iron riveted to vent and welded continuous. Angle flanges to be set down on 4 by 4 inch circular yellow pine margin pieces, where decks are not sheathed with wood. Butts of margin pieces to be properly calked and payed. Tarred felt liberally coated with white lead will be laid on deck before margin pieces are fitted in place, and again between angle-iron flanges and margin pieces. Bolts used to
hold angle flange down to be ⅝ inch through bolts, 12 in number, fitted with galvanized-iron extra-heavy grommets. Flanges and margin pieces to be similarly fitted on between decks, except that margin pieces will be 2¼ by 4 inches. Wood to be properly leveled so as to allow ventilator to set plumb.
All bare iron to receive one coat of first-quality red lead.
Contractor will submit a separate price in quintuplicate:
a. For each portable cowl, including wrought-iron band and trimming handles, furnished and installed.
b. For each deck flange furnished and installed.
c. Per foot of ventilator courses furnished and installed above and below decks. (As special specifications may require for individual ships.)
It is agreed that any fittings or appliances temporarily removed to facilitate the installation of any of the ventilators will be reinstalled upon the completion of said installation by the contractor.
The contractor will also submit a separate price, quintuple, to cover the cost of items a, b, c, exclusive of installation on ship. (Six separate prices in all to be submitted.)
Workmanship.-All workmanship, material, and general arrangements of the stalls to pass the inspector appointed, who may make any reasonable alterations in this specification while the work is in progress. Workmanship to be carried out in first-class manner.
NOTE.-All stalls in way of cargo hatches on upper deck to be made portable.
To accompany plan of ventilation.-This plan is merely a typical one, and is intended to illustrate the wishes of the director of shipping, outports, as to the approximate location and arrangement of cowl-head ventilators to be installed in animal transports when animals are carried on one or more underdecks. It is understood that any ventilators of this type found in the ship are to be, as far as possible, utilized. The locating of the new ones will have to be governed by the structural and operating details found. At the time of locating it is important not to use any more animal space than is absolutely necessary and to avoid, in arranging uptake or exhaust groups, exhausting into the supply groups of different compartments. The general rule to be guided by is that each underdeck compartment used for animals must have at least four bell-mouth ventilators of not less than 18 inches diameter, running without break from the deck to be ventilated to the open, the under edge of the cowl to be not less than 7 feet above the deck. In compartments exceeding 75 feet in length or decks without bulkheads two additional (one in each wing) ventilators will be necessary for every 75 feet of length.
In urging this method of ventilation the director of shipping, outports, does not wish to be understood as disapproving the fan system heretofore employed, but, on the contrary, will be glad to see both systems employed in the majority of cases and especially in the warmer months.
Years of experience have demonstrated, however, that no ship can carry a large number of animals comfortably and successfully without the above method of air supply and exhaust, which is independent of electric or steam power or the running of machinery for its efficiency.
Breast boards.-Breast boards shall be of 2¾ by 9¾ inch spruce or hard pine, dressed on both sides and upper edge rounded galvanized iron covering, as before mentioned.
Breast boards will be secured to stanchions with ⅝-inch bolts with washer under nuts.
Portable sections of breast boards will be formed at distances of 30 feet to admit of horses being moved into or out of stalls. These portable sections to be secured by iron cleats bolted through stanchions, with toggle set on stanchions above breast boards to hold same in place.
At least one portable section of breast board must be in each section of stalls.
Flooring.-Flooring to be laid fore and aft, built in sections of about 32 inches wide. Three sections to cover the 8-foot depth of stalls. Sections to be 15 to 16 feet in length, where possible. Sections will be of 2-inch spruce or hard pine with 2 by 3 inch cleats well nailed to underside of sections. Cleats to be placed not more than 3 feet between centers.
Fore-and-aft footlocks 2 by 4 inches will be laid on top of sections leaving openings each 10 feet for waterway. Athwartship cleats 2 by 3 inches will be well nailed to sections
of flooring at center line of each stanchion and between fore-and-aft footlocks to outer end of stalls. A 2-inch opening will be at outer end of athwartship cleats to allow water to run.
On exposed decks 2 by 3 inch batten will be placed at heels of stanchions to run athwartship over flooring and footlocks, nailed to footlocks, and secured at either end by cleat set on top of same and nailed to stanchions at front and rear of stalls, or to inner sheathing in rear of stalls.
The number of stalls reserved for sick animals was generally about 5 per cent of the total. In some compartments the percentage of vacant stalls was somewhat in excess of this percentage, this being due to the arrangements of the stalls in these particular compartments.
Transport veterinarians were instructed as to the importance of maintaining, as nearly as possible, perfect sanitation of the transports en route. The manner in which the breast boards were bolted to the stanchions prohibited the removal of one animal from each stall while the stall was being policed. This method was permissible on transports having the breast boards fastened to the stanchions by means of iron cleats.
Forage was stored in respective holds, the other cargo being loaded first and the forage last so as to render it available for immediate use when desired.
Veterinary supplies were ample and consisted of such drugs and instruments as could be obtained by requisition per veterinary supplies table.
Forks, shovels, hoes, rakes, water buckets, feed measures, etc., constituted the veterinary utensils used on animal transports. Feed boxes were of the standardized galvanized-iron transport feed boxes, having two hooks to hang them on the breast boards.
Little or no attempt was made to groom animals. Exercising them was practically out of the question owing to the manner in which the breast boards were attached.
The more common injuries received by animals en route were those inflicted by other animals, such as bites and kicks. When a vicious animal was discovered and his nearness to other animals was considered dangerous, he was immediately placed in one of the vacant stalls.
The most common cause of death was pneumonia. It occurred among animals stabled in the remote corners of the animal compartment where the ventilation was not functioning properly.
Transport veterinarians were fully instructed in the following subjects: The sanitation of transports; disinfecting of same; care of veterinary supplies; feeding and watering of animals; assignment of enlisted personnel to duties.
In view of the fact that, as nearly as possible, perfect sanitation was the predominant factor in the successful transportation of animals overseas, it was of the utmost importance that the transport should be kept in a clean and sanitary condition at all times. To accomplish this, unceasing efforts for the removal of manure and débris were enforced during the daylight hours.
After thoroughly policing the ship, the free use of disinfectant was recommended. Solution of liquor cresolis compositus in strengths of from 2 per cent to 5 per cent was freely used in the animal compartments. Grain sacks saturated with 10 per cent formaldehyde solution were hung in different-sections of the animal compartments, likewise grain sacks saturated in a solution
of chloride of lime were utilized. This was found to be of great advantage to combat foul odor and purify the atmosphere of the respective compartments.
All officers were instructed to keep all veterinary supplies locked in the room which was furnished for that purpose, and to see that too free use of medicines was not indulged in. Animals, as a rule, requiring the attention of a veterinarian (excepting those injured) were more in need of fresh air than medicines, with the exception of medicinal stimulants.
All animals were fed hay as soon as possible after being placed aboard ship. No grain was fed for 48 hours after embarking, preferably 72, and then the daily allowance did not exceed 2 pounds for the first three days, thereafter gradually increased until, at the time of debarking, the animal was receiving full rations. These hours of feeding were those used after the transport began to function without being convoyed. Previous to the armistice, it having been declared that no lights were permissible in any part of the transport after dark, all feeding and watering of the animals was done in daylight.
During the first period of shipping animals, no permanent personnel was assigned to the transports, the attendants being secured from casual detachments at this port awaiting transportation overseas. This method proved unsatisfactory, as the majority of the animal attendants were either inexperienced in the care of animals or were very indifferent in the performance of their duties. The result was that the transports arrived overseas and returned to this port in a filthy condition, which necessarily delayed shipments, the transport having to be policed and disinfected after arrival at this port.
It was then recommended that a permanent personnel be assigned to each transport. The Surgeon General was requested to assign 300 members of the enlisted personnel, Veterinary Corps, to this port to be utilized as a permanent personnel on the different transports. In compliance with this request, 100 enlisted men, Veterinary Corps, from Camp Lee, Va., reported for duty September 15, 1918, and 200 from Camp Devens, Mass., reported October 24, 1918. These men were assigned to duty on the different transports in numbers of from 5 to 20 men to each transport, depending on the number of animals the transport carried. Additional attendants were selected from casuals awaiting passage overseas and were generally remount, veterinary, or quartermaster detachments.
The accommodations for troops on board animal transports were generally sufficient for 1 attendant for every 10 animals, including the veterinary detachment, which was assigned as a permanent personnel. The troop quarters were inspected by the port veterinarian and an officer from the office of the port surgeon in regard to sanitation, etc., and were generally satisfactory.
The port veterinarian always informed the commanding officers of transports as to the status of the transport veterinarians. They were advised that the latter had full charge of all animals aboard ship; had direct supervision over the feeding, watering, stabling, grooming, and exercising of the animals; the ventilation, lighting, and cleaning of their quarters; the handling and storage of forage; and the direct supervision of methods of artificial ventilation. The commanders, as a whole, thoroughly recognized the duties of the transport veterinarians and
cooperated to the fullest extent in the performance of such duties. Recommendations made by the transport veterinarians usually received favorable action.
Shipping statistics are shown in the following table:
DISTRIBUTION OF DEATHS
MEAT AND DAIRY INSPECTION
In the early days of the port, meat was delivered direct from the contractor to the different organizations. A veterinary officer acting as meat inspector was permanently stationed at the delivery point. An adequate refrigeration plant was installed at the quartermaster depot in June, 1918, where all beef and meat products were thereafter inspected at the time of receipt and issue. An order was issued and enforced requiring all vehicles used in the transportation of meats from point of issue to the different organizations to be kept in a thoroughly sanitary condition at all times; in addition, paulins were required to be used both under and over meats, the paulins to be clean at all times. Line and medical officers were instructed in the treatment of refrigerated quartered beef to avoid its condemnation on account of appearance.
In the heat of the summer months, cargo beef in many instances arrived at the port in a more or less softened condition, due to the long time in transit from western points and the failure to re-ice the cars at frequent intervals. It was deemed necessary, therefore, to have all beef refrozen at Richmond, Va., and relayed to this port. A veterinary officer was eventually stationed at Richmond as supervisor of operations of the cold-storage plant used there in connection with the shipment of beef overseas. Conditions improved greatly as a result.
Meat inspection at the port was conducted as follows: Upon receipt of a car of meat, each piece was inspected and, if accepted, was stamped with the date of its receipt, as passed. Each inspector had a number assigned to him. The meat was so arranged in the cooler that the first received was available for first issue. The refrigerator was inspected daily as to cleanliness and proper sanitary conditions; also to see that a proper temperature was maintained at all times. Meat and meat products, when purchased locally (which was done only on rare occasions), were thoroughly and rigidly inspected. The refrigerator as well as the meats were inspected at the place of purchase. Trucks with
meat and dairy products intended for delivery to organizations reported at a designated point for an inspection of such products. The organization bill and the dray receipt were there stamped if the products passed inspection.
The inspection of cargo frozen beef intended for shipment overseas was an important duty and was conducted as follows: Cargo beef for consumption by the American Expeditionary Forces was inspected at the time of transfer from refrigerator cars to transports, cars being unloaded immediately upon arrival. All beef not thoroughly frozen was rejected and placed in cold storage to be issued at this port, providing the meat was free from decomposition and bad bruises.
The meat and dairy inspection work was performed by various veterinary officers prior to August, 1918. One who had received special training in this line was assigned at that time, and marked improvement in the meat and dairy inspections was immediately noticeable. A meat-inspection service was gradually developed until it took in the local supply, including abattoirs and butcher shops.
No post-mortem examinations were made for Army-purchased beef, although several inspections were made at the request of the United States Public Health Service. The animals thus posted were milk cows which had reacted to the tuberculin test. They were inspected for disease only, as they were not for Army consumption.
No camps (with one exception) or organizations at the port used any fresh milk purchased at local dairies, evaporated milk supplied by the quartermaster being the only milk used. The milk used at the embarkation hospital, Camp Stuart, and Debarkation Hospital No. 51, at Hampton, was purchased from Washington, D. C. The dairies supplying this milk were not inspected by a representative of the port, owing to the distance from the port. A private dairy consisting of 36 cows supplied Camp Morrison with 15 gallons of milk daily. This herd and dairy were frequently inspected by the dairy and meat
inspector. A firm in Newport News manufactured and supplied ice cream to some of the organizations of the port. The milk used was purchased from some 19 dairies in the vicinity of Waynesboro, Va. These dairies were inspected on several occasions. The meat and dairy inspector rendered valuable assistance in correcting insanitary conditions existing in the Pasteurization plants of this company, thus greatly reducing the former high bacterial count and improving sanitary conditions in general.
All condemned meat, meat products, and dairy products were immediately denatured with coal oil and sent to the salvage division. The inspector made four copies of an affidavit stating the place inspected, reason for condemning, the amount condemned, inspection numbers or other marks of identification, and the disposition recommended. Affidavits were sent through the port veterinarian and the depot supply officer, the inspector swearing to the report of survey.
ANIMAL EMBARKATION DEPOT NO. 301
This depot was located 3 miles north of Newport News, in Warwick County, Va., where the soil was a sandy loam and the drainage inadequate. Apparently, no effort was made to install a proper drainage system when the corrals
were built. The personnel assigned for policing the corrals was insufficient, and the system of policing was not such as to accomplish proper sanitation. As a result, in February, 1918, the veterinary hospital contained over 2,000 patients, 90 per cent of which were affected with dermatitis in its various forms. An effort was made to drain the corrals during March, 1918. Lateral box drains were installed along the roadways, connecting with others which emptied into the river. The corrals were plowed and graded so that they would drain into the lateral box drains. This system was fairly successful where the corrals
were policed daily; when not, the corrals soon became very insanitary.
There were 30 corrals, each 200 by 400 feet in dimensions, and having a capacity of 300 animals. Six were located on the east side of Virginia Avenue and were known as receiving or quarantine corrals. Arriving animals were placed in these corrals for a period of 21 days and were carefully observed twice daily for contagious infections or other diseases. They were mallein tested for glanders, and were moved to what were known as the duty corrals on the west side of Virginia Avenue when found to be free from any disease. Each corral had a shelter shed inclosed on both ends and on the north side.
These sheds extended from east to west, the southern exposure being open. They were 23 by 300 feet in dimensions.
The forage was ample and, as a rule, good. The grain was ample, 8 to 10 pounds daily being fed each animal. The animals were fed twice daily, 7 a. m. and 4 p. m. Hay was fed from open racks and the grain ration from grain troughs built in the open. No provision was made for feeding animals in any of the shelters.
The source of the water supply was the Newport News city waterworks. the quantity was ample at all times and the quality excellent. The animals were watered from troughs which were kept in an excellent sanitary condition, being drained and scrubbed twice daily.
It was contemplated that animals would be held for a short time while awaiting overseas shipment, but the shortage of bottoms interfered with shipments and the depot became filled and largely remained so. It was impossible to keep the crowded corrals free from mud and accumulated manure, and the sick rate was high, with infections and injuries of the foot predominating.
The veterinary hospital first constructed could not be called a hospital in any sense of the word. It consisted of five sheds similar in type and construction to those in the other corrals. There were no operating rooms, no properly equipped dressing rooms; in fact, the lack of equipment was a serious handicap in rendering efficient veterinary service. Two thousand animals were receiving treatment at this hospital in February, 1918, and necessarily in the open air under more or less insanitary conditions. Authority was therefore requested and obtained for the construction of a modern veterinary hospital.
This hospital was erected on a bluff overlooking the James River and was completely separated from the corrals of the animal embarkation depot. The hospital proper consisted of a building 30 by 196 feet, with two wings extending from each end 30 by 65 feet in dimensions. It had sewer connections, hot and cold water throughout, steam heat, electric lights, and good lighting ventilation. The operating room measured 30 by 64 feet, was well lighted and ventilated,
and was equipped with modern operating table, casting mat, and modern instrument sterilizer. Immediately adjoining and communicating with it were two recovery rooms, 15 by 15 feet, for anesthetic patients. There was an office, a pharmacy, a surgical dressing room, a diet kitchen, an animal equipment room, a supply room, a disinfecting room, a bacteriological laboratory, a boiler room,
a feed room, shower baths, and water-closets. The hospital building and court had concrete floors. In the court were 16 stalls having concrete floors. These were used for surgical cases. In addition to the hospital proper, there were four wards. These were 100 by 100 feet and were wooden shedlike stables with dirt floors. Each ward accommodated about 60 patients. On the west, at a distance of about 1,000 feet, were five more wards having a total capacity of 600 patients.
The total number of animals handled at the depot was 57,944. The total number of deaths from disease was 1,140. The death rate per thousand was 19.68.
The armistice reversed the main functions of ports of embarkation as they concerned animals as well as men. The volume of the reversed function for animals was comparatively insignificant; it was of immense importance, however, for it constituted the national defense against Army importation of diseased stock from Europe. The veterinary activities in the port proper and in the animal embarkation depot were those of any of the large camps, with the exception of such as concerned animals returned from Europe. In this connection The Adjutant General issued the following instructions:
THE ADJUTANT GENERAL'S OFFICE,
Washington, January 30, 1919.
From: The Adjutant General of the Army.
To: Commanding general, port of embarkation, Newport News, Va.
Subject: Danger of returning Army animals from foreign service.
In accordance with telegram from this office of January 30, 1919, relative to above subject, a receiving and quarantine station will be established at the port of embarkation, Newport News, Va., for all private mounts returning from France.
You will take the necessary steps to establish such a station after consultation with the port veterinarian and the representative of the Bureau of Animal Industry stationed at Newport News. One veterinary officer to be designated by the port veterinarian and the necessary Veterinary Corps enlisted personnel will be detailed for duty in connection with this station.
The following regulations will govern until further orders:
All private mounts received from Europe will be segregated immediately in a designated place at Newport News apart from all other animals and placed under the personal charge of a veterinary officer and the necessary attendants to be recommended by the port veterinarian. The place of quarantine is to be mutually satisfactory to the Surgeon General and Chief of the Bureau of Animal Industry.
Any equipment which accompanies the animals will remain with them until the quarantine is raised.
This quarantine will be maintained for a period of six months from the date of its establishment, during which time these animals shall not come in direct contact with any other animals nor be allowed to feed or water away from the place of quarantine.
They will not be removed from the place of quarantine for exercise except under veterinary supervision. In case any one of them develops a serious communicable disease, it may be necessary to extend the quarantine period six months additional, as the Surgeon General may recommend.
During the quarantine period necessary instructions will be issued from the office of the Surgeon General to the port veterinarian regarding details of quarantine regulations, laboratory and other examinations, and treatment deemed necessary. On the appearance of any symptoms of serious communicable disease, especially mange, glanders, equine trypanosomiasis, epizootic lymphangitis, ulcerative lymphangitis, or piroplasmosis, the Office of the Surgeon General will be informed by telegraph.
The Surgeon General will direct the release from quarantine of any of these animals after suitable recommendations from the port veterinarian. When so released the owners of the mounts, on proper notification, will take prompt steps to remove them. Newly imported animals will be kept wholly isolated from those in quarantine, otherwise the six months' quarantine of all animals coming in contact with the newly imported animals will be extended to cover a six months' quarantine from the date of contact.
By order of the Secretary of War:
These instructions referred to private mounts only, but it developed later that the return of a number of public animals was also desired. For example, General Pershing requested the return of 100 such animals. He did not desire any quarantine in this instance, but arrangements were made with the Bureau of Animal Industry by which the quarantine period was divided into 30 days in France and 150 days at Newport News. This permitted the Army to return certain valuable stock while protecting the livestock interests of the country. Arrangements were also made by which dogs and other organization mascots might be returned.
The quarantine regulations of January 30, 1919, were amended as follows:
OFFICE OF THE SURGEON GENERAL,
Washington, July 23, 1919.
From: The Surgeon General of the Army.
To: Port veterinarian, port of embarkation, Newport News, Va.
Subject: Quarantine regulations.
1. You are informed that the following quarantine regulations, amending those under date of January 30, 1919, will govern for all Army animals which have been or which may be in future imported from France.
2. This quarantine will be in charge of a competent veterinary officer, to be selected by yourself subject to the approval of this office, and assisted by the necessary veterinary officers and noncommissioned officers and sufficient enlisted men to insure one attendant (personal) for each animal. Should a shortage of attendants render it impossible to provide one for each animal, several animals, not to exceed five, may be placed in charge of an attendant under the following conditions: All the animals of a group given in charge of an attendant shall have been in quarantine at Newport News at least 30 days. All preferably shall have been in quarantine the same length of time; none of them shall have presented symptoms or other signs of communicable disease at any time since they entered quarantine in France; the attendant for a group shall be selected for his trustworthiness and efficiency and shall not be changed unless absolutely necessary during the remainder of the quarantine and the principle of separate stall, equipment, individual grooming kit, water bucket, etc., and freedom from direct contact between any two animals shall be as strictly observed as where each animal has an individual attendant.
3. Should any animal of a group develop symptoms of serious communicable disease, the group in question will be broken up by assigning an individual attendant to each animal; the usual procedures governing the control of communicable disease, including the weekly report, will be carried out and the circumstances reported to this office by telegraph. With this exception, there shall be no shifting of animals between groups nor adding or subtracting from groups after they are once formed. In other words, if five or less animals are turned over to one attendant, the latter retains the absolute and undivided care of these animals and of no other during the remainder of the quarantine period.
4. The officer in charge, under your supervision, will have entire control of the animals. He will inspect each animal at least once daily at the place of quarantine and will be responsible for their veterinary examinations and treatment and for their proper care and condition all the time. He will be responsible that the equipment which accompanies each animal is kept separate, is properly cared for, cleaned and disinfected, and that there is no interchange of grooming or other untensils, etc.
5. He will make a thorough physical examination of all animals on every Wednesday. A report of this examination and of any unusual occurrence during the preceding week, including results of all laboratory examinations will be forwarded through your office to the Surgeon General.
6. A veterinary officer will be on duty at the place of quarantine at all times. The enlisted force should be quartered at the place of quarantine and, under the supervision of the veterinarian in charge, will perform all duties in connection with the proper and necessary care of the animals, such as feeding, watering, grooming, exercising, etc.
7. Each animal shall be provided with shelter, dry standing, and a separate stall to permit of carrying out of the principle of isolation. All manure, bedding, and refuse from manger and feed box will be collected daily and stored in a water-tight covered container and will be disposed of by burning.
8. The animals will invariably be fed, watered, and groomed at the place of quarantine, and their feeding or watering elsewhere is strictly prohibited. They will be exercised at the place of quarantine, and they will not be allowed to use any road or other place to which outside animals have access. They will not be exercised by any other person than the attendant assigned and only when authorized by the officer in charge. They will be shod at the place of quarantine.
9. It is contemplated these animals not only shall be kept apart from all others except as provided in paragraph 2, but each animal shall be isolated and have its separate grooming kit, blankets, watering buckets, stable utensils, feeding place, etc., and every precaution will be taken to keep these articles permanently separate.
10. All animals will be kept securely tagged. The tags will contain the necessary descriptive data for the purpose of identification, also the date of arrival and, in case of private mounts, the name of the owner.
11. Animals will arrive in different shipments. Should any animal of a later shipment come in contact with one already in quarantine except as provided in paragraph 2, the quarantine of the latter will be regarded as broken and said animal will be subjected to the full quarantine period from the date of such contact irrespective of any time which has already elapsed.
12. The quarantine period for animals imported from France will normally comprise 180 days, 30 of which shall be in France and 150 days in Newport News, Va., including the time while enroute. No animal should be accepted for quarantine at Newport News unless satisfactory evidence is submitted to you that it has undergone the required 30 days' bona fide quarantine in France.
13. All animals received at quarantine will receive as a minimum a mallein test within 21 days of the date of arrival and again within 21 days of release from quarantine. All doubtful or positive reactors to the mallein test and all animals showing suspicious symptoms of glanders at any time will be handled as directed in Circular Letters Nos. 28 and 30, Surgeon General's Office, Veterinary Division.
14. Blood examinations for piroplasmosis, trypanosomiasis, and for any other suspected communicable disease will be made normally at three different times during quarantine and
at any other time deemed necessary. Specimens for the regular examinations will be taken immediately after arrival, on the 21st day after arrival, and on the 21st day from the date of expiration of the quarantine period. In addition to the specimens which will always be forwarded to the Philadelphia laboratory under standing orders, a duplicate will be forwarded to the Department of Agriculture, Washington, D. C. See Circular Letters Nos. 24 and 30, Section III and IV, Surgeon General's Office, Veterinary Division, regarding collection and shipment of specimens.
15. On the discovery of any evidence of mange, glanders, epizootic lymphangitis, ulcerative lymphangitis, piroplasmosis, equine trypanosomiasis, or other communicable disease, or on the occurrence of any other serious sickness or accident, the officer in charge will at once notify you and you will transmit full particulars by wire to this office.
16. A complete clinical record of each animal will be kept on Form 115, M. D., during the entire time it is in quarantine, and you will inspect these records as to accuracy and completeness from time to time. The temperature of each animal will be taken daily throughout the entire quarantine period and made a part of the clinical record.
17. You will arrange with the port authorities to receive timely notification of the arrival of an Army animal at this port, and will require the officer in charge of the quarantine to board the transport and take over all such animals after proper release and under such regulations as the Department of Agriculture may require, together with the equipment pertaining. The veterinary officer, at this visit, will make a careful physical examination of the animal. Should evidence of any serious communicable disease be discovered, the animal should be prohibited from landing pending instructions from this office, and the accredited representative of the Department of Agriculture and the port veterinarian will be promptly notified. You will at once make a personal inspection of the animal in such case and verify the findings.
18. You will notify this office by wire on the day of arrival of any animal or animals from France, giving the name of its owner if a private mount, its physical condition on arrival, whether the 30-day quarantine period in France was complied with, and whether the papers hereinafter described were complete and, if not, wherein they were incomplete. If the animal presents symptoms of serious communicable disease, full particulars and suitable recommendations as to its disposal will be furnished. The following papers should accompany each animal and copies thereof turned over to you, namely:
(a) A certificate of the officer owning the mount, in case of private mounts, that he is the bona fide owner and that it was acquired for his personal and official use as an officer of the Army.
(b) A certificate of a veterinary officer, in case of private mounts, that the animal is suitable as an officer's mount under existing regulations.
(c) A certificate of the veterinary officer in charge of the quarantine in Europe to the effect that the animal is free from all evidence of communicable disease, stating the length of time in quarantine; that the animal has passed a negative test for glanders, dourine, piroplasmosis, and trypanosomiasis while in quarantine and that all the quarantine and other requirements of these regulations have been complied with.
(d) A clinical history of the animal during the entire quarantine period showing what, if any, symptoms of disease manifested, the nature and results of all laboratory or other examinations, and treatment applied. Copies of laboratory reports will be inclosed. This record will be signed by the veterinary officer in charge of the quarantine.
(e) A certificate or affidavit, properly executed, by the officer or noncommissioned officer who accompanied the mount to the port of embarkation to the effect that the animal, while en route to the port, did not come in contact with any others or use a public watering trough or feeding place.
19. The veterinary officer in charge will accompany the animal from the transport to the place of quarantine and will be held personally responsible that it does not come in contact with any other animal nor use any public watering trough or feeding place or frequented roads. If a vehicle of any kind is used for its transportation, said vehicle will be cleaned and disinfected before and after use.
20. The Surgeon General will authorize the release from quarantine of any animal on receipt of your recommendations and statement that all requirements of these regulations have been complied with; and when so authorized, the owner of the mount, or other authority on proper notification, should take prompt steps to remove the animal and its equipment from the place of quarantine.
21. This quarantine will be conducted in full accord with the requirements of the Department of Agriculture and will be subject to the inspection and approval of its authorized representative. He should be allowed to inspect the place of quarantine whenever he desires. Steps will be taken to comply promptly with any suggestions which he may make, and should the officer in charge deem such suggestions impracticable, he will report the circumstances to you. Should you be unable to adjust matters to the satisfaction of both parties, you will at once report the facts to this office for further instructions.
22. You are directed to prepare a list of instructions based on these regulations to be posted in prominent places at the place of quarantine for the guidance of all concerned. Before posting, these instructions will be submitted to this office for approval.
23. This letter supersedes instructions forwarded you from this office dated January 30, 1919.
By direction of the Surgeon General:
C. F. MORSE,
Colonel, Medical Corps, Director Veterinary Corps.
Rules and regulations to the following effect governing the care of animals in quarantine were compiled by the port veterinarian and approved by the Surgeon General. These regulations were thoroughly complied with during the entire quarantine period.
1. Animals, upon arrival at the quarantine station, shall be assigned to their respective stalls by the veterinary officer in charge. They shall remain in the stalls assigned to them. There shall be no interchanging of stalls.
2. In the event of any contagious disease developing which, in the opinion of the veterinary officer in charge, endangers the other animals, they may be removed to the more isolated stalls when so ordered by him.
3. Each stall shall be numbered and all animals securely tagged.
4. Each feed box, water bucket, grooming utensil, and other utensil used shall be numbered to correspond with the number on the stall.
5. All grooming utensils shall be kept in each animal's stall in the locker provided for that purpose. Under no circumstances shall there be an interchanging of grooming utensils. The same caution must he exercised that there shall be no interchange of feed boxes or water buckets and other utensils.
6. Attendants assigned to the care of an animal are strictly forbidden to assist in the care of any other animal unless so ordered by the veterinary officer in charge. Each animal shall be kept in a clean condition at all times. Especial attention shall be paid to the careful cleaning of all animals' feet daily.
7. Each stall shall be kept in a thoroughly clean condition at all times. The litter shall be thoroughly shaken each morning, all soiled litter and manure removed, stall floors swept, and air-slaked lime sprinkled on damp spots. The clean litter to be placed in one corner of stall until after the exercise hours (10 to 11 a. m.). The litter is then to be shaken out evenly, covering the floor of stall, and allowed to remain until the following morning. Droppings promptly removed as soon as made and placed in cans.
8. Urine-soaked litter shall be removed from stalls at least twice daily and placed in cans. Positively no soiled straw shall be allowed to remain in small piles, but will be placed in cans by the animal attendant. Cans shall be emptied once daily and the contents burned.
9. Animal attendants will be responsible for the covers being kept on cans at all times, and they will be required to perform the proper policing of corrals. No baling wire shall be thrown about; the grounds must be kept free from débris.
10. The feed boxes and buckets, as well as the woodwork in each stall, shall be kept clean at all times and scrubbed as often as is necessary to keep same thoroughly clean.
11. The animals in quarantine shall be exercised one hour daily. They shall be led by the halter or leading bridle. They shall be watered, fed, and exercised regularly at hours designated by the veterinary officer in charge.
12. No animals shall leave the confines of the quarantine at any time.
13. Attendants of animals will promptly report the sickness of any animal to the veterinary officer in charge; in his absence, the noncommissioned officer on duty shall be notified. All guards on duty at night are instructed, when an animal is discovered sick, to report the same immediately to the corporal of the guard, who, in turn, shall notify the veterinary officer in charge without delay.
14. No person other than those assigned to duty at the quarantine station shall be admitted to the station.
15. No dogs shall be permitted to enter the station inclosure.
16. Smoking is positively forbidden within the station corrals.
17. Any violations of the above instructions will be dealt with by disciplinary measures.
MEDICAL DEPARTMENT ACTIVITIES IN THE CAMPS OF THE PORT
The port of embarkation in addition to its headquarters and embarkation and debarkation hospitals, embraced seven organized camps and a number of smaller posts, chiefly water projects. The camps included Camps Stuart, Hill, Alexander, and Morrison on the east, or Newport News, side of the James River; and the Army supply base (quartermaster terminal), camp of United States troops (engineering depot), and the Pig Point, general ordnance supply depot on the west, or Norfolk, side of the river.
The medical activities of each of these camps were directed by a camp surgeon, who, in turn, was responsible to the port surgeon. The field medical organization of the port may be closely compared with that of a base, the port surgeon comparable to the base surgeon, the camp surgeons comparable to the division surgeons, though their sphere of work was more extensive in most cases, not in so far as basic administration was concerned but in the size of the personnel and in the number of troops under their command. Under the camp surgeons were sanitary inspectors and the regimental and battalion infirmaries.
Medical Department troops arriving at the camps for overseas duty automatically came under the supervision of the respective camp surgeons. All reports from the various units in the camp came through the camp surgeon's office, and these were incorporated in the morning and other reports of the camp to the port surgeon's office.
General policies of administration and special sanitary measures were outlined by the port surgeon through the medium of circular letters and memoranda. The camp surgeons were responsible for the proper interpretation and carrying out of such measures. Considerable latitude was allowed the camp surgeons in the arrangement of details of sanitary policy, and interference by the port surgeon was prompted only when exigency demanded it.
Sufficient elasticity to meet all emergencies was allowed in the camp Medical Department organizations. The adaptability of such organizations to meet a peak load was well demonstrated in the influenza epidemic of October, 1918, when, though taxed to the utmost, all possible attention was given the many sick and no organization broke down under the strain. A high standard of health and cleanliness prevailed throughout the camps of the port, almost without exception.
It is true that, in 1917, the negro soldiers at Camp Alexander lived under relatively insanitary conditions, being insufficiently clothed and quartered, and with insufficient medical personnel. These conditions were due to the confusion existing at that time and to the delay in receiving supplies and personnel. The medical and line officers at this camp worked through long, tedious hours under the most trying conditions, and the low mortality at this camp may be directly attributed to their ceaseless endeavor to make the best of a bad condition and to their spirit of unselfish service.
Camp Hill, Va., was exceptionally well located on the east bank of the James River, in Warwick County, Va. The camp was constructed on terrain which was decidedly flat. The soil was sandy in its composition. The camp was relatively free from high-flying dust because of its close proximity to the river and free from mud because of the sandy soil, the latter being conducive to a rapid drying of the surface, even after days of repeated rain. The climate of this locality in general was of a moderate temperature, but the winter of 1917-18 proved an exception and was unusually severe. During the warm weather of the summer months, the temperature was moderated by the breeze from the James River on the west of the camp.
The construction of Camp Hill began in the early part of August, 1917, and proceeded with precision and dispatch. The camp extended from Fiftieth Street, Newport News, Va., on the south, to Camp Alexander on the north. In the beginning, Camp Hill also included what was later known as Camp Alexander. The camp was approximately 1 mile long. From west to east the camp extended from the James River to a point 200 yards east of the Chesapeake & Ohio Railroad tracks. There were sections of barracks located at both the northern and southern ends of the camp. All told, this area had within its
limits approximately 400 buildings. Flanking the central section of the camp on the east was a series of large, spacious warehouses, used for the storage of all types of war material, while on the north this section was bordered by the animal embarkation depot corrals. These were an integral part of Camp Hill and had a capacity of some 20,000 animals. Approximately 10,000 troops could be accommodated in this camp.
The last building, additions to the camp were the Young Men's Christian Association building, the hostess house, and a complete bakery unit.
The water supply was the same as for the rest of the port. Sewage disposal from the camp was good. All sewage passed through a standard septic tank and the effluent was chlorinated before final disposition in the James River. Latrines were conveniently located and of sufficient number, 1 being provided for every 3 or 4 barracks. A combination type of latrine building was used containing 8 or 9 shower baths grouped in one end of the latrine, while flush toilets and hot-water boilers, etc., occupied the other end. All garbage of the camp was disposed of by reclamation and by incineration. The usual
sanitary methods of garbage collection were in use.
All parts of the camp were illuminated by electricity. The barracks were heated by coal furnaces. Officers' quarters and hospital buildings were steam heated, each building having a complete heating unit.
The development of Camp Hill represents an interesting evolution from the medical and sanitary standpoints. The swampy area immediately northwest of the camp, an exceptionally fertile place for the breeding of mosquitoes, was successfully drained by ditching and the construction of wooden conduits. All parts where drainage was exceptionally difficult and where the water showed a tendency to remain were repeatedly oiled. Mosquitoes were considerably reduced by these methods. From a very insanitary beginning, the camp progressed until it had an excellent sewerage system, was well drained, was clean, and presented a neat appearance throughout. Good macadamized roads connected all parts of the camp.
When the camp was first occupied, the sick and injured were, for the most part, treated at the regimental or field infirmaries. Cases requiring hospital treatment were transferred by ambulance over almost impassable roads to the post hospital at Fortress Monroe, Va., a distance of approximately 12 miles. It was not until the latter part of October, 1917, that a hospital with a capacity of 30 beds was constructed. This was the first hospital erected and operated in the port of embarkation. The need for a contagious disease hospital became apparent a month or so after its completion, and an additional hospital building, similar to the original, was constructed at the northwestern corner of the camp. Both buildings were then brought under one administrative head and were collectively known as the camp hospital. Practically all the communicable diseases of the port were treated in the contagious part of the hospital, and, at times, its capacity was sorely taxed until the stress was relieved by establishing
the embarkation hospital at Camp Stuart.
The camp then made progressive strides in the care of its sick and wounded. It had three well-established infirmaries-the animal embarkation depot infirmary, the camp infirmary, and the motor truck group infirmary. These, together with the camp hospital, provided all the ordinary attention for the sick and injured of the camp. All patients who required special surgical treatment or hospital care were sent to the embarkation hospital or to the Camp Morrison hospital.
Both sanitation and medical administration of this camp were given an impetus when, in March, 1918, the position of camp surgeon was created. The infirmaries became better organized and equipped and excellent ambulance service was established, the work of all medical officers in the camp was coordinated and a dental infirmary with standard equipment was established.
The Medical Department personnel of the camp on October 1, 1918, consisted of 12 medical officers, 8 dental officers, and 28 enlisted men.
During the latter part of September, 1918, the influenza became epidemic in the camp and, because of its rapidity of onset and the great number of cases occurring daily, hospitals of the entire port became crowded, with the result that temporary hospitals had to be established. The emergency was met in Camp Hill by converting 13 barrack buildings into temporary hospitals. Medical personnel to man all these could not be obtained, and it was necessary to use enlisted personnel from the line for this purpose. In all, approximately 800 cases of influenza developed in this camp. Of this number, 91 cases were
so serious as to require treatment at the embarkation hospital, and 23 of these died.
Measles developed in Camp Hill during the early part of November, 1918, as a result of the arrival in this camp of the draft troops from Camp Jackson, S. C. Measles cases were found among them before they left their troop train. As a result, over 125 cases of measles developed, principally in this organization, causing a resultant quarantine of 600 contacts, or 15 per cent of the command.
Three stations were established for delousing troops returning from overseas. The delousing stations consisted of batteries of two sterilizers each, located in convenient parts of the camp. These were operated by a personnel of 1 officer and 15 enlisted men, under the supervision of the camp surgeon. All men arriving were deloused systematically. These units were able to delouse 1,500 troops a day.
Camp Alexander was located on the east bank of the James River, immediately north of Camp Hill. The camp began with three lines of tents for the colored soldiers on one side of the main road, with the officers' tents on the opposite side. A large hospital tent for headquarters was at the north end of the latter. The camp quickly enlarged through the addition of more tents. Even up to January, 1918, no stoves were provided for these tents, and fires had to be built on the floors of the tents to insure warmth to the inmates. During December, 1917, an officer generously donated $500 for the purchase and equipment of a hospital tent. A pyramidal tent accommodating 12 cots was erected. A stove and sufficient blankets were supplied. A small kitchen was erected beside this tent to prepare food for the patients. This little hospital served to afford hospital facilities for the severely sick before they were transferred to a proper hospital. Construction was begun in June, 1918, at the new camp site, north of the old one, on barracks and bathhouses supplied with electric lights and hot and cold water. A delousing station was opened in July, 1918, in order that all troops going overseas might go clean. It was not until November, 1918, that the new camp site was ready for occupancy.
Thus the camp was a camp of tents for a period of more than a year; tents for quarters, for infirmaries, for hospitals, for headquarters. No wooden buildings belonged to the camp except the post exchange, the Young Men's Christian Association, the messes, and an occasional shanty hastily constructed.
The medical and line officers had to deal here with ignorant negroes of the poorest class, both physically and mentally. Thousands of negroes, first recruited, then drafted, came to this camp with scarcely any rudimentary education. Personal hygiene meant nothing to them; and if it had, living conditions were so poor that it would have been impractical to expect it.
From these men organizations were formed, and the best of them embarked for overseas duty clothed in the brass buttoned blues of the old Regular Army. Many others were discharged because of physical disability. The rest, and they were many, were formed into organizations for local labor duty. The cause of the greatest number of disabilities was chronic gonorrhea. Fully 20 per cent of all these negroes had venereal diseases, and of those who stayed at the port for local labor duty, approximately 70 per cent were thus diseased. Bronchitis
was rife throughout the camp at all times, but, because it was usually uncomplicated, a low mortality was maintained.
The medical personnel underwent constant change, for medical officers would be assigned to organizations as they reported and would subsequently proceed overseas with them.
One of the first sanitary problems was that of the kitchens. At the head of each company street was the kitchen, comprising two field ranges, roofed by shelter tentage and often without sides. Besides each kitchen was a single faucet which supplied the water for all purposes-cooking, washing, and bathing. Since the kitchen personnel knew nothing relative to cleanliness in the preparation of food or in its preservation, it was with great difficulty and through the use of tact and diplomacy that the kitchen and messing environment was finally made satisfactory.
Another problem was to keep the tent floors dry, particularly during the autumn and the early winter of 1917-18. No stoves were available at that time and dryness had to be accomplished by drainage. A ditch was dug around each tent, and these led into two deeper ditches which bordered the company street. Ventilation within the tents was accomplished largely through the agency of the fires built on the tent floors, sparks from which made the necessary holes in the tentage. Policing of the camp occupied considerable time. The most notable achievement of this work was the clearing up of the swampy
hollow in the middle of the camp, which had become a dump for all sorts of refuse. The dump was cleaned up, the hollow properly drained and satisfactorily oiled during the proper season.
The latrines at first used were of the ordinary pit type. These were replaced by latrine incinerators in February, 1918. All police and sanitary work was done by the sanitary squad. Great difficulty at first arose because too few men could be spared from stevedore duties to work on such a detail, but this matter was eventually arranged satisfactorily.
White noncommissioned officers and white troops for guard duty were sent to this camp early in 1918, and the commissioned personnel was increased. Sanitary conditions constantly improved with the increased discipline and better organization. The noneffectives were weeded out, and the whole camp gradually underwent a distinct change for the better.
A steady flow of stevedore regiments for overseas duty occurred in the spring of 1918. This camp accommodated some 5,000 men and over 50,000 negro soldiers passed through it prior to the signing of the armistice. The medical officers at this camp were worked to the utmost with medical inspection, quarantine, enforcement of sanitary regulations, delousing, and ordinary regimental medical work. An average morning sick call for a battalion numbered 125 to 500, and about 15 cases were sent to the hospital each day with the object of discharge for disability.
Sickness and mortality was kept down to an unexpectedly low figure during the occupancy of this camp. There was a serious epidemic of cerebrospinal meningitis in November, 1917. No other serious epidemic occurred at this camp except the influenza epidemic of October, 1918, and a high incidence of mumps during the early part of 1919. Over 500 cases of influenza
occurred during that epidemic, giving a lower rate per 1,000 men than at any other camp, though the rate for pneumonia with resulting death was greater than among white troops. Eight barrack buildings in the new camp were turned into emergency hospitals, and all patients were receiving systematic treatment within 24 hours after the onset of the epidemic. It usually was the case with the colored patients that a rise in temperature after 48 hours portended bronchopneumonia, and the patient was forthwith transferred to the embarkation hospital.
As stated before, chronic gonorrhea was the greatest single cause for disability among the negro troops. Thousands of such cases passed through the infirmaries of this camp for treatment. Individual study of cases could not take place, due to the great number, and the method of treatment developed was that which did the greatest good to the greatest number. Thousands of cases were discharged for disability, yet several thousand cases remained to be treated. It was decided in December, 1918, that cases of chronic gonorrhea which would not yield to continued treatment and which were declared to be
noninfectious by microscopical diagnosis should be returned to duty with treatment discontinued. This resulted in a decrease in the number of cases under treatment among these troops from several thousand to a few hundred. As a safeguard, however, it was urged that all men who went on pass from the camp should take prophylaxis upon return.
Thus the sanitary history of this camp was a continued effort to enforce all the sanitary regulations designed to keep the camp and men clean; to administer to their many minor ailments; to discharge for disability those men who who were physically incapable of performing useful service; and, in the case of the seriously sick, to transfer them to hospitals for proper treatment. All this was done with energy and kindness, and the end result of such a spirit of service was to so discount the uncomfortable, and often insanitary, living conditions that the health record was a worthy example of applied principles of
field sanitation and medical administration.
Camp Morrison was located about 5 miles north of Newport News, Va., and 1 mile east of the James River. It was about 1⅛ miles long and three-eights mile wide. The camp site was about 10 feet above the sea level, on swampy and wooded ground.
Though the camp was occupied in October, 1917, construction was not completed until April, 1918. Barracks were available during this period, but sanitary facilities were most limited. The large construction force had little regard for sanitary and medical obligations-picket lines were neglected, fecal matter was dumped on piles but not treated, and urine was carried across the camp in cans without covers to a pit where the urine was emptied and treated with crude oil. This pit emptied through a traverse for about a mile along a public road to the James River. The construction force had a small first-aid hospital, badly equipped. There was no Government infirmary or hospital in the camp for the 750 soldiers. Sick call was held in the company barracks
and the sick were transferred to hospitals in Newport News. The company latrines consisted of a Havard box over galvanized-iron cans. There were practically no bathing facilities. Waste water discharged into open ditches.
Sanitation improved with the arrival of the medical personnel, not through any better facilities but through efficient policing and proper enforcement of sanitary regulations. Additional Medical Department enlisted personnel arrived from Fort Riley in December, 1917, and the camp medical organization was established at that time, with four commissioned officers. Barracks No. 8, still uncompleted, was used for a temporary hospital. There were no running water or other facilities, but it was scrubbed clean and cots were set up.
The one-story barracks of this camp stood lengthwise east to west, were lighted by electricity, and ventilated by windows and seven ventilators upon the roof. They were divided into two sections and heated by a poor hot-air system. These sections were planned for 75 men each, but as many as 100 had to be placed in them at times. Despite the constant opposition to such procedure, these sections were changed, beginning with April 20, 1918, by dividing each into six squad rooms and utilizing the porches, thereby giving the proper number of square feet of floor space and cubic feet of air space for 25 men.
A narrow-gauge railroad track was placed upon the street adjacent to the barracks in January, 1918, for the purpose of carrying crushed stone for the building of the macadam road, and this was used in the mornings for carrying urine and fecal matter from the barracks. The urine was carried out each morning in galvanized-iron cans and placed upon flat cars, then taken away to the end of the camp. There it was loaded upon carts and carried to a pit and treated with crude oil. The fecal matter was collected in small galvanized-iron cans which were placed in the improvised Havard boxes situated in the latrines
of the barracks. These cans were carried out by a detail from each barracks to the railway, thence to the end of the camp. The contents were emptied into pits and treated with crude oil. The cans were burned out, treated with oil, and returned to the camp ready for use the next day.
Bathing facilities were installed in the latrines about January 15, 1918, the waste water passing into open ditches.
The mess halls were large but poorly arranged, being separated in the center by the kitchen, thus crowding the kitchen and having room to spare at either side. This condition was changed in September, 1918. The water supply was good and generally adequate. Ice of fair quality was obtained from different sources, but the demand in warm weather was greater than the supply.
The sewerage system was completed about March 15, 1918, and included septic tanks. The effluent passed into the James River. This sewerage system proved to be inadequate, becoming clogged. A larger sewer was then installed, gasoline pumps working meanwhile to discharge the sewage into a large open ditch which flowed the length of the camp to the septic tanks. The ditch was treated with crude oil. This procedure continued well into the month of May, 1918, before the new sewer line was completed. The septic tank proved to be too small and a larger one had to be constructed.
The construction division of the Air Service in the meantime, had begun to do valuable work in ditching the camp to get rid of the surface water, and
sanitary conditions in general had improved. Garbage was incinerated, where before it had been hauled away by farmers. The picket lines were better cared for and manure was hauled out of camp and disposed of to farmers. Latrines in each barracks emptied into the sewerage system. There were shower baths and white enameled lavatories in each barracks. Laundry work was sent outside the camp, being done mostly by colored residents. A 40-bed hospital was at first planned, to be constructed at the south end of the camp. It was recommended that this location be changed and that plans be made for a 250-bed hospital, but this capacity was reduced to 120 beds. During the time construction was in progress for this hospital, from January to April, 1918, vacant mess halls, the guardhouse, shanties, and tents were used in conjunction with the temporary hospital for the isolation of infectious diseases, of which there was a great number, mostly mumps, scarlet fever, and measles. The porch of No. 8 barracks, the hospital at that time, was used for convalescent pneumonias, with great success. Canned milk exclusively was used, at first, but milk was received from a dairy later on. The idea of cleanliness had to be instilled into the cooks' minds, especially that of personal cleanliness. All cooks were examined for carriers.
A plot of land lying at the south end of the camp was reserved for stables and supplies for the same. The stables were well policed. There were no remount stations at this camp. The clothing was sufficient, as a general rule; the quality of the clothing was good. There were no infirmaries at this camp, sick call for the whole camp being held at the hospital, with better results than if held by each company, for sufficient medical officers were present and proper attention was given to each man presenting himself. The nursing personnel consisted entirely of enlisted men of the Medical Department prior to September, 1918, when female nurses arrived. Two Ford motor ambulances and three animal-drawn ambulances were furnished the hospital. The Ford ambulances, received some time in January, 1918, were not covered. The mule-drawn ambulances arrived some time in April, 1918. The general character of the service given with this transportation was not as efficient as it would have been had more powerful ambulances been available. A Ford touring car was assigned for the use of the commanding officer of the camp hospital.
There was no medical supply depot at this camp, the nearest being at Newport News. Requisitions were made monthly to a general supply depot, but in case of emergency, supplies were received from the port of embarkation, Newport News.
Venereal inspections were held semimonthly for the local personnel and semiweekly for troops proceeding overseas. Prophylaxis was administered at the infirmary, attendants being on duty day and night. There were prophylactic stations in near-by towns and lectures were given on venereal disease and its associated problems. All venereal cases were confined to camp and al failing to take prophylaxis were reported for trial, a large number of conviction resulting.
During the spring and summer of 1918, there were but three cases of malaria. Inside the camp and within one-half mile around it, mosquito extermination was carried on by an Army sanitary squad.
The dental work was first done in barracks No. 8, in January, 1918, with field equipment. One base hospital outfit was installed in the dental infirmary in May, 1918. Two more base units were later installed, and three dental officers were kept constantly at work.
The office of the camp surgeon was established in this camp March 23, 1918. Prior to that date, the regimental surgeon of the 48th Infantry acted as senior medical officer of the camp. This organization was on permanent guard duty for the port of embarkation, with their regimental headquarters at this camp.
Nothing of great importance in the way of medical history occurred with the exception of the epidemic of influenza, which first appeared on September 25, 1918. The camp had been remarkably free from any epidemic disorders prior to that time. Influenza was brought into this camp by replacement troops from Camp Jackson, S. C., the epidemic lasting about six weeks. Approximately 1,500 cases occurred during that time. These cases were cared for at the embarkation hospital for the first few days, but that institution was soon filled and subsequent cases were treated in a temporary hospital established in this camp in blocks 13 and 14. Approximately 1,000 cases were cared for in this manner. Only the milder cases were allowed to continue treatment in the temporary hospital, the severer ones being immediately transferred to the embarkation hospital where they could be adequately cared for. The physical inspection of troops was a large factor in the routine work of this camp. A camp infirmary was established under the camp surgeon's office. The personnel of the office was 5 medical officers, 3 dental officers, and 17 enlisted men.
ARMY SUPPLY BASE
The Army supply base was located in Norfolk County, Va., about 5½ miles north of the city of Norfolk. The terrain immediately adjacent to the hospital was very slightly rolling, with natural drainage toward the west into a small branch leading to an arm of Boush Creek, and toward the northeast and east into another depression leading to Boush Creek; both of these branches were bordered with a growth of timber. The ground to the west formerly was used as golf links and was covered with a growth of grass. The soil was a sandy loam, which, while soft with a certain degree of stickiness, immediately after a rain was permeable and dried very quickly. But little dust was noticeable, except in the roads during dry weather. The hospital site was particularly sheltered from coastal winds by its inland situation and
the fringes of timber which bordered the area in every direction. A newly constructed macadam road connected the hospital with the camp and with the Jamestown Boulevard leading from Norfolk to the naval operating base. The hospital grounds were included in an angle formed by two branches of Boush Creek, both of which were tidewater streams with sluggish flow and bordered by an extent of flat grass-grown marsh. Filling-in processes were carried out at the Army base camp and modified this condition. Ditching
work in the neighboring areas carried out by the United States Public Health Service remedied defective drainage. With the exception of two or three negro dwellings on adjoining farms, there were no other particularly objectionable insanitary surroundings.
There were approximately 10,000 civilian laborers in this camp during 1917 and 1918, and the medical and surgical cases occurring among them were cared for by a civilian medical and surgical force, employed indirectly by the construction contractors. The building designated for an infirmary, among the buildings erected for two guard battalions, was assigned to them for this purpose by the Army. This infirmary building was of two stories, having a hall and reception, dispensary, operating and store rooms, with kitchen and dining hall, below; the upper floor contained ward room sufficient for 12 or 15 patients. An additional one-story ward, 29 by 64 feet, added about October 1, 1917, connected to the main building with a covered corridor. Sufficient and convenient toilet and lavatory facilities were provided. Serious cases of illness or surgical cases allowing selective operation were sent to the Protestant Hospital in Norfolk.
One room in the officers' quarters was occupied August 12, 1918, as the combined office of the commanding officer of the hospital and camp surgeon. There were five additional officers on the medical staff of the camp, two of whom were assigned to duty with the construction quartermaster. Two others were assigned to duty with military companies doing guard duty. The personnel of the hospital consisted of 9 officers and 39 enlisted men.
Sewage from this camp and the hospital flowed through septic tanks into Boush Creek. Approximately 800,000 gallons of sewage was pumped each day. Sewage disposal was unsatisfactory, the existing system proving insufficient. Tanks became clogged by large collections of scum, and it was difficult to effect its removal. Because of the bulk of sewage, the retention period of sewage was less than an hour and a quarter, thus allowing no solvent action. Satisfactory results were eventually secured in this connection by causing chemical disintegration of the sludge by adding quicklime and water. Plans were also proposed to extend this pipe line from the tanks to the Elizabeth River. The tidewater flats about the outlet of the sewage pipes were filled in.
The water supply of the base was that of Norfolk and of Norfolk County, furnished through a 10-inch main, and was derived from both the Norfolk City Water Co. and the Norfolk County Water Co., in mains from both sources passing through the reservation.
All refuse was incinerated. Kitchen waste, manure, etc., were sold in considerable quantities to farmers, who were required to remove it at least four miles from the base.
All kitchens and mess halls were carefully screened. Messing conditions among the civilian laborers were bad, but improved with the substitution of white for colored help.
Little sickness developed here. One case of typhoid fever occurred among the civilians and an effort was made to have these laborers immunized through inoculation. One case of malaria developed in the local command.
On September 17, 1918, 259 colored enlisted men arrived in camp from Camp Alexander, and were given quarters in the stevedore barracks section of the camp. On the 19th, there occurred nine cases of what apparently was influenza, the first seen in camp. These were immediately reported, and the infirmary building in that section was at once put in order for the reception of patients. Each patient brought his own bedding, but this was later supplemented by supplies of sheets, pillows, pajamas, etc., furnished by the American Red Cross chapter of Norfolk. Emergency equipment of medical supplies was
requisitioned from the medical supply officer at Newport News. The infirmary thoroughly cleaned and the floors oiled, was ready on September 20 and patients were moved in on that day. Five other cases developed, 24 in all, on each of three successive days, then no more. All immediate contacts were isolated, the company was inspected twice daily, barrack floors were mopped, mess cans and utensils were scalded, and no member of the company was permitted outside the environs of company barracks. Armed guards enforced these restrictions.
Twenty cases of sudden illness were reported on September 23, originating in four different barracks occupied by civilian workman. It was at first doubted if these were cases of true influenza, as all these men had recently come from Texas and Oklahoma, and had been working in the rain on the 20th and 21st. Cases of similar character, however, continued to occur until 50 cases were under treatment. One of the regulation barracks in the stevedore section, where most of the first cases occurred, was turned over for use as a hospital. The civilian medical personnel having care of all civilian sick and injured under the employ of an insurance company, consisted of 1 consulting surgeon, 1 physician living at the hospital, 1 orderly in charge of property and records, 2 female day nurses, and 1 female night nurse. These were severely taxed and additional medical assistants and nurses were furnished. But few of the cases appeared at all serious, although a majority had very high temperatures with severe aching and the prostration of influenza. Many cases began with severe, obstinate vomiting; a marked hemorrhagic tendency was noted, and some alarming epistaxis occurred.
Two cases of influenza developed in Guard and Fire Company No. 312 on September 25; also 4 cases in the motor transport company. These were properly isolated in a barrack used as an infirmary. Supplemental Red Cross supplies were procured for these men, as noted in connection with the labor battalion. None presented any serious symptoms.
General quarantine measures and the restriction of all soldiers to the limits of the camp were instituted. Quarantine measures with reference to civilian employees were considered impracticable and were not attempted.
The epidemic soon raged disastrously among civilian employees at the base. Approximately 600 cases occurred, with 15 reported deaths. Three additional barracks were thoroughly cleaned and taken over as hospital wards. Two adjoining mess halls and kitchens were later used as adjuncts. The contractors and the agent for the insurance company were brought together and arrangements made to purchase the full supplies of sheets, pillows, pajamas, and hospital furniture necessary properly to care for the large number of patients under treatment.
Arrangements were also made, by consent of the constructing quartermaster, to use three of the complete general wards, the isolation ward, and the kitchen at the new base hospital for the reception of the more severe cases. A temporary heating plant was installed by connecting the system already placed in the wards with a small upright boiler, located near the site of the future heating plant. Occupation of these wards was begun about October 3, practically all of the equipment being furnished by the insurance company except bedsteads and kitchen fixtures.
Later cases occurring in the guard and fire companies and the motor transport company numbered approximately 100, practically all of which were of a very mild type. Six cases were considered serious and were transferred to the embarkation hospital. The epidemic subsided by October 12, 1918, though troops were quarantined during the entire month of October.
The Engineer depot, in the county of Norfolk, Va., was situated about 1½ miles from the center of the city of Norfolk and occupied two city blocks within the city limits. The camp was located almost on the shores of the Elizabeth River. The terrain was flat and open and had formerly been cultivated land. The soil was mostly red clay and therefore very dusty in dry weather and extremely muddy and sticky in wet weather. The climate was moderate. The roads in the camp, with the exception of company streets, were city thoroughfares, the one on which the infirmary faced being of unrolled, crushed stone, spread over a mixture of clay and gravel.
Two small swamps about one-eighth mile from the camp constituted the only sanitary menace. These were drained, and tide gates served to carry away the tide water and thus greatly relieved the situation. The water supply and sewage of the entire camp was that of the city of Norfolk.
This post was first occupied by soldiers, August 14, 1917, when Troop B, 11th Cavalry, arrived. The medical detachment then consisted of 1 medical officer and 2 enlisted men, the latter being attached to the Engineer depot for first aid and emergency work for the civilian employees. The troop was attached to the depot for sick call and medical service. It was relieved on November 2, 1917, by Companies I and K of the 48th Infantry. The accompanying medical detachment consisted of 1 medical officer and 6 enlisted men, and the original detachment of 1 officer and 2 enlisted men was transferred to Pig Point.
A small building of two rooms, located near the center of the depot, was used as an infirmary from the time of the inauguration of medical service at this post until the completion of the permanent building, which was occupied July 15, 1918. The permanent infirmary building was not entirely completed until about August 1, 1918. It was of one story, well ventilated, and screened. The dimensions were 80 by 14 feet, on the plan of a center hall with all rooms opening from this. The infirmary comprised 10 rooms in all, viz, ward, squad room, dining room, office, dispensary, operating room, treatment room, dental
operating room, lavatory, and bath. The ward was located on the south side and the squad room on the north. The heating plant, consisting of one boiler and a hot-water heater, was installed in a cement outbuilding at the north side.
It was entirely adequate and filled every requirement, under the weather conditions which prevailed after the opening of the building. The bathroom consisted of 1 porcelain tub and 1 shower. The lavatory had 2 flush toilets, 2 urinals, 2 wash bowls, and 1 sink. Power for the lighting system was furnished by a Norfolk power company. Because of unusual conditions created by the great influx of people into the city and community, the power had to be distributed to many more points and the service was occasionally poor. There were times during the month of September when there would be no lights for
from one to two hours early in the evenings. The service was greatly improved later.
While provision was made in the infirmary building for a mess hall and kitchen, it was not deemed advisable to start a mess, the enlisted personnel being only 12 men and the ward capacity 5. The enlisted men of the medical detachment were rationed first with Company K, 48th Infantry, and later with Fire and Guard Company No. 313, the meals for the patients being obtained from their respective companies.
The medical service was regimental, the daily sick call being at 7.45 a. m., when as critical examinations as were practical at that time were given to all who appeared. Those cases not easily diagnosed were detained and further examination given before rendering the surgeon's morning report of sick. The cases of a mild and not infectious type were treated at the infirmary; all others were transferred to the embarkation hospital, Camp Stuart.
PIG POINT GENERAL ORDNANCE SUPPLY DEPOT
This depot was situated in Nansemond County, Va., about 11 miles northwest of the cities of Norfolk and Portsmouth. The surrounding country was flat and partly wooded with pines. The soil was mostly sand and there was considerable high-flying dust during dry seasons.
The roads in the camp proper were made of concrete and were very good, but the road to the nearest city was mostly dirt and in some places nearly impassable.
The post was bounded on the north by Hampton Roads, on the west by the Nansemond River, on the east by Streeters Creek, and on the south by three plantations. The sanitary conditions were very poor, the surrounding neighborhood being mostly very poorly drained swamps and marshes.
An infirmary was established on December 24, 1917, in the corner of a barracks. The camp hospital was organized February 12, 1918, with a personnel of 1 medical officer and 10 enlisted men. It was officially opened February 19, 1918, and the first patient to be admitted was a case of mumps, on March 5, 1918. The hospital was situated on one of the highest points in the camp, a small bluff overlooking Hampton Roads, and about 100 yards from the water front.
The water was derived from wells driven about 90 feet deep and located about one-fourth mile from the hospital. It was pumped by electricity into two large tanks, each having a capacity of 100,000 gallons. Water was chlorinated by means of an automatic chlorinator and then piped to the various buildings. The water supply at the hospital was identical with that of the rest of the camp.
The only disease that could have been classed as epidemic was influenza, which became epidemic in September, 1918. The first case developed the last day of August and the last case was discharged October 8, 1918. As the hospital was equipped for not more than 40 patients, the entire personnel was taxed to its utmost in caring for the 300 patients who were admitted during September. Various buildings were utilized and made into temporary hospitals. Enlisted personnel was insufficient to care for the number of patients, which necessitated requesting men from the various organizations in the post to assist.
There were no physical examinations of drafted men at this post. All uncompleted vaccinations were completed and new vaccination registers started when necessary.