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T/i e military s urgeon g v^ 



ition of Military Surgeons of the United States 



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THE 

MILITARY 

SURGEON 



JOURNAL OF THE 

ASSOCIATION OF MILITARY SURGEONS 

OF THE UNITED STATES 

EDITED BY 

JAMES EVELYN PILCHER, M.D., L.H.D., 

MAJOR AND BRIGADE SURGEON UNITED STATES VOLUNTEERS; 

CAPTAIN, RETIRED, IN THE UNITED STATES ARMY, 

PERMANENT SECRETARY OF THE ASSOCIATION. 



VOLUME XXIII. 



CARLISLE, PENNSYLVANIA, 

THE ASSOCIATION OF MILITARY SURGEONS. 

MDCCCCVIIL 



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Contributors. 




Major PERCY M. ASHBURN, U.S. Army. 

Surgeon H. W. AUSTIN, P.H.&M.H.S. 

Surgeon FREDERICK L. BENTON. U.S. Navy. 

Captain GUSTAVUS M. BLECH, Formerly Illinois Reserves. 

Captain CHARLES S. BUTLER. Massachusetts V.M. 

Lieutenant FRED JOHNCONZELMANN, Medical Reserve Corps. 

Captain CHARLES F. CRAIG, U.S. Army. 

Surgeon SHELDON G. EVANS, U.S. Navy. 

Major ED. LAVAL, French Army. 

Lieutenant Colonel J0S£ BARBOSA LEJo, Portuguese Army. 

Major EDWARD A. LeBEL, Canadian Army. 

Dr. C.A. F. LINDORME. 

Major EDWARD L. MUNSON, U.S. Army. 

Passed Assistant Surgeon PAUL E. McDONNOLD. U.S. Navy. 

Dr. ANITA NEWCOMB McGEE. Formerly U.S. Army. 

Captain ALEXIUS McGLANNAN. Maryland N. G. 

Lieutenant HENRY J. NICHOLS, U.S. Army. 

Captain GEORGE P. PEED, U.S. Army. 

Captain JAMES M. PHALEN, U.S. Army. 

Major JAMES EVELYN PILCHER, U.S. Volunteers. 

Major HENRY I. RAYMOND, U.S. Army. 

Lieutenant GEORGE H. RICHARDSON, Medical Reserve Corps. 

Surgeon General PRESLEY M. RIXEY, United States Navy. 

Passed Asst. Surgeon WILLIAM COLBY RUCKER, P.H.&M.H.S. 

Medical Director MANLY H. SIMONS, U.S. Navy. 

Stabsarzt Dr^ JOHANN S TEINER, Austro-Hungarian Army. 

Major PAUL F. STRAUB, U.S. Army. 

Captain GIDEON McD. VAN POOLE, U.S. Army. 

Dr. WILLIAM FRANCIS WAUGH, Formerly U.S. Army. 

Captain WILLIAM A. WICKLINE. U.S. Army. 

Surgeon LOUIS L. WILLIAMS, P.H.&M.H.S. 

Captain FRANK T. WOODBURY, U.S. Army. 

Lieutenant H. W. YEMANS, Medical Reserve Corps. 



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ASSOCIATION OF 

MILITARY SURGEONS 

OF THE UNITED STATES 

hicorporaffd b\' Arte/' (oi/^irsi. 



mfxtnB. 1908-1909* 

President, 
REAR ADMIRAL PRESLEY M. RIXEY, 

SURGEON GENERAL OF THE UNITED STATES NAVY. 

First Vice President, 
COLONEL JOSEPH K. WEAVER, 

SURGEON GENERAL OP PENNSYLVANIA. 

Second Vice President, 
COLONEL WILLIAM C. GORGAS, 

MEDICAL CORPS UNITED STATES ARMY. 

Third Vice President, 
SURGEON CHARLES P. WERTENBAKER, 

PUBLIC HEALTH AND MARINE HOSPITAL SERVICE. 

Secretary and Editor, 
MAJOR JAMES EVELYN PILCHER. 

CAPTAIN, RETIRED, UNITED STATES ARMY, 
RICHMOND, VIRGINIA. 

Treasurer, 
MAJOR HERBERT ALONZO ARNOLD, 

MEDICAL DEPARTMENT NATIONAL GUARD OF PENNSYLVANIA, 
ARDMORE, PENNSYLVANIA. 

Assistant Secretary, 
SURGEON WILLIAM HEMPHILL BELL, 

UNITED STATES NAVY. 



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A000riati0n of Itttlttarg gitrgMtt0 

of % littt^d »tUttB. 



Eighteenth Annual Meeting 

WASHINGTON, D. C, 

Date to Be Fixed. 



(HouimittrrB, 1000-191)0. 



ADVISORY BOARD. 

Hon. Q. B.CORTKLYOU, Sec'y of Treasury. Gen. Robert M. 0'Rbilly,U.8.A. 
Hon. LUKK Wright, Secretary of War. Rear Admiral P. M. Rixbt. U.S.N. 
Hon. V. H. Metcalf, Secretary ofNavy. Gen. Walter Wyman, P.H. A M.H.8. 



EXECUTIVE COUNCIL. 

The Officers of the Association, ez-offlclo, and 
Med. Dlr.GEORGB E.H. Harmon, U.S.N. Major Junius F. Lynch, Va. N.G. 
Major Jefferson R. Kban. U.S.A. Major J. 0. Minor, Ark. N.G. 

Colonel Charles Adams, III. N.G. P. A.Surg. John F.Anderson,P.H.AM.H.S. 

In conjunction with the Ex-Presldents, ex-offlcio, vis.: 
Brig. Qen. Geo. M. Sternberg. U.S.A. Asst. Surg. Gen. George T. Vaughan, 
Colonel John Van R. Hoff, U.S.A. P.H.&M.H.S. 

Colonel Valbry Havard, U.S.A. Brig. Gen. J. D. Griffith, N.G.Mo. 

Medical Director John 0. Wisb,U.S.N. Brig. Gen. A. J.Stone, Minn.N.G. 
Surg. G«n. Walter Wyman,P.H.AM.H.R. MaJ.Gen. Robert Allen Blood.M.V.M. 
Lt. Col. ALBERT H. Briggs, N.Q.N. Y. 



STANDING COMMITTEES. 

Literary O&mmiUee. 
Major Paul F. Straub. U.S.A., Lieutenant Nelson W.Wilson, M.RC. 

War Dept., Washington, 1). C. Major W. C. Lyle. Ga.N.G. 

Surgeon Frank L. Plkadwell, U.h.N. Major George S. Crampton. N.G.Pa. 
A8st.8nr?.Gen.J.M.EAGER,P.H.AM.H.S. MaJorTHOMAS J. Sullivan, Ill.N.G. 
Publication Commitl^e. 
Major Jambs Evelyn Pilcher, U.S.V., Richmond, Va. 
Surg. William C. Braisted, U.S.N. Major Charles Lynch, U.S.A. 

Necrology OommiUee. 

Major Samuel Cecil Stanton. Ill.N.G., 1040 Sheridan Road, Chicago. 111. 

Surgeon Robert M. Kennedy, U.S.N. P. A. Surg. L. L. Lumsdkn. P.H.AM. H.S. 



SPECIAL COMMITTEES. 

Committee tm Legislation. 
Medical Director J. C. Boyd, U.8.N., Naval Medical School. Washington, D. C. 
Major W. D. McCaw. TT.S.A. Lt (V>1. Wilbur S.Watson, Conn. N.G. 

Lieutenant Colonel E. C. Rru«h, O.N.G. MaJ<ir D. S. Burr, N.G.N.Y. 
Major T. E. H albert, Tenn.N.G. Brig. Gen. Charles C. Foster, M.V.M. 

Major David s. Fatrchild, Iowa N G. Captain J. V. Frazier, Mlch.N.G. 
Major James Evelyn Pilcher, U.S.V., Lieut. Col. Homer I. Jones, Ind.N.G. 
Richmond. Va. Brlsr. Gen. F. J. Lutz. N.G.Mo. 

A<)Slstant Surgeon General J. W. Kerr, P. H.AM.H.S. 
Oommittee on International Ctasttification of OatMes of DeatK 
AsslRtant Surgeon General J. M. Eager. P.H. & M.H.B., Washington, D.C. 
Major Charles F. Mason. U.S.A. Surgeon Frank L. Pleadwell, U.S.N. 
Lieutenant James A. Egan, M.RC. 
Oommittee on Arrangements, 
Medical Director J. C. Boyd, U.S.N., Naval Medictil School, Washington. D. C. 
Major Charles TiYNCH, U.S. A.. Passed Assistant Surgeon J. W. Trask, 

Captain Charles R. Rrynolds,U.S.A. P.H.AM. H.S. 

Passed Asst. Surg. Cary T. Grbason, Major Ororob Henderson, Surgeon 

U.S.N. General D.C.N.G. 

Asst^Surg.Gen.W.J.PETTUS, P.H.AM.H.S. Captain Clarence A. Wbaver,D.C.N.O. 
Lieutenant Romulus A. Foster. D.CN.G. 



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1^0 >- 

Vol. XXni, No 1 .--'' Jult^, 1008 



// 



^ridinal ^Demotes. 



AUTHORS ALONE ARE RESPONSIBLE FOR THE OPINIONS 
EXPRESSED IN THEIR CONTRIBUTIONS. 



THE GERMAN FIELD SANITARY REGULATIONS. 

By major PAUL F. STRAUB, 
MEDICAI, CORPS UNITED STATES ARMY. 

HE REVISED edition of the 
** German Field Sanitary Reg- 
itions" {Kriegs Saniidtsord" 
vg), the first since 1878, re- 
itly published, under date of 
ary 27, 1907, embodies the 
ges made necessary by the ad- 
ss in military and sanitary sci- 

It is quite evident that the Germans have endeavored to 
profit by their experience in South- West Africa and from that of 
the Japanese in their recent war. This latter experience was, 
perhaps, of more value to them than to any other foreign service, 
for the reason that the Japanese sanitary organization was an 
adaptation of the German system. The defects and weaknesses 

(1) 



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2 MAJOR PA UL F, STRA UB. 

of the old Regulations, as demonstrated in more recent cam- 
paigns, have presumably been corrected in this new edition; no- 
tably by an increase in the strength of sanitary organizations and 
in the materials and supplies furnished. 

Greater authority has been granted administrative sanitary 
officers, and while it still leaves something to be desired, it indi- 
cates a growing tendency to allow them an authority commensu- 
rate with the responsibilities of their offices. Sanitary officers 
are required to "conduct their department in the manner con- 
templated in Regulations and not to attempt to avoid responsi- 
bility when questions of sanitation or the welfare of the sick are 
concerned; they must not let administrative methods obstruct 
prompt action in emergencies, provided, however, that no mUi- 
tary principles are violated. ' ' ( Italics mine) . 

To one not thoroughly familiar with the German military 
system and organization, the Field Sanitary Regulations would 
convey the impression that the sanitary officers are charged with 
the fullest responsibility for the service of their respective de- 
partments without having been clearly given the corresponding 
authority. No sanitary officer who has the best interests of the 
service at heart would for a moment contend that his department 
should have any authority that could possibly conflict with the 
proper functions of the line; he only desires to have the neces- 
sary powers to direct the internal affairs of his department, which, 
on account, of their technical character, can only be fully com- 
prehended by medical men. It is only the very exceptional man 
who is able to rise above his experience and training and tempo- 
rarily assume unaccustomed responsibility under the most trying 
conditions of battle, and it is, therefore, believed to be contrary 
to the best interests of a military institution that an officer who 
has an intimate knowledge of certain technical duties assigned 
to special organizations should in matters pertaining to his de- 
partment alone and under ordinary circumstances be subordinated 
to others who have not the special qualifications, and, further- 
more that he should remain comparatively free from authority 
and responsibility until some great emergency arises and then be 
forced into a sphere of action quite foreign to his training. The 



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THE GERMAN FIELD REGULA TIONS. 3 

position of the sanitary department as regards responsibility and 
authority is quite clearly set forth in the regulation which at- 
tempts to define the relations between the senior sanitary oflScer 
and the commander of the sanitary company (who is not a med- 
ical man). It is quite evident that they were unable to draw a 
distinct line of demarkation between the authority of the com- 
pany commander, on the one hand, and the chief surgeon **at- 
tached** to the company, on the other, as shown by a paragraph, 
which states that '^regulations concerning the relations between 
the two, as far as the question of commanding is concerned, can 
only be formulated in a general way, and they shall work in har- 
mony and be of mutual aSvSistance/ ' Such indefinite and divided 
responsibility may be quite possible in the German army, but 
would lead to conflict in our service greatly detrimental to the 
interests of the sick and wounded. 

For the first time in the German service, a sanitary organi- 
zation (headed by a division surgeon) has been instituted for a 
cavalry division. Provision is made for a sanitary echelon (sani- 
tatsstaflfel) for the purpose of organizing a cavalry dressing sta- 
tion. When an engagement is imminent, the sanitary echelon 
is formed by taking two-thirds of the regimental sanitary per- 
sonnel (which has been increased), the divisional sanitary sup- 
ply wagon, and a regimental supply wagon from each regiment. 
The remaining personnel and transportation remain with their 
units. This temporary organization establishes a dressing sta- 
tion for the cavalry division and performs the functions of a san- 
itary company. 

ORGANIZATION. 

The administrative head of the sanitary service of the armies 
in the field is the Chief of the Field Sanitary Service (Chef des 
Feld Sanitatswesens). His authority extends over all the sani- 
tary personnel in the zone of operations and on the lines of com- 
munication; he is appointed by the Emperor, and is authorized 
to communicate direct with the War Department on all matters 
pertaining to the sanitary service. 

A table giving the personnel and equipment of all the sani- 
tary officers and of the various sanitary organizations is appended 
hereto. 



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4 MAJOR PAUL F. STRAUB, 

A chief surgeon is assigned to the headquarters of an army, 
a corps surgeon to an army corps, a division surgeon to a divis- 
ion, but no provision is made, as in our service, for a brigade sur- 
geon. The former conduct the sanitary service in their com- 
mands, under the direction of their respective commanding gen- 
erals, but in cases of emergency may issue orders affecting the 
sanitary personnel, reporting action to headquarters as soon as 
possible. 

A consulting surgeon, selected from among the eminent pro- 
fessional men of the country, upon the recommendation of the 
chief surgeon of the armj', is assigned to each army corps. His 
duties are purely professional and advisory and he has no ad- 
ministrative responsibility. The services of the consultant are 
at the disposition of the chief surgeon of the army and of the* 
corps surgeon; his sphere of action is limited almost entirely to 
the established hospitals of the army in the field, which he is to 
visit frequently, and to the dressing stations. 

The division surgeon of an infantry division is the adminis- 
trative head of the sanitary service of that organization. When 
an engagement is in prospect he must ascertain the best locali- 
ties for the dressing stations and field hospitals, with due regard 
to the instructions of the corps surgeon and to the special mili- 
tary situation, as communicated to him by the division com- 
mander. He is placed in a most responsible position being, per- 
haps, the most important administrative sanitary officer in the 
field. During battle his position is with the division staff, al- 
though he must take advantage of every opportunity to person- 
ally direct and regulate the service of any of the divisional sani- 
tary organizations. 

An infantry battalion (1,000 men) is allowed two medical 
officers, two sanitary soldiers, and sixteen bearers made non- 
combatants for the first time and wearing the Geneva Cross. 
The latter are instructed in first aid and bearer service and when 
troops go into action are assembled in rear of the battalion, where 
as soon as an aid station is established, they lay aside their packs 
and proceed to render first aid and transport wounded, for which 
purpose they are supplied with Hospital Corps pouches and lit- 



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THE GERMAN FIELD REGULA TIONS. 5 

ters. Provision is also made for the use of musicians as ''assist- 
ant bearers" — they, however, do not wear the red cross but simply 
a red brassard. 

A sanitary battalion of three companies, comprising 942 of- 
ficers and men, is attached to each army corps. It is to be noted 
that twenty- four of the twenty-seven sanitary officers of the bat- 
talion are attached to companies, but are not under the com- 
mand of the company commander. The chief surgeon attached 
to each sanitary company is not required to forward his reports 
and communications through the commanding officer of the com- 
pany, and the company commander is required to keep him in- 
formed "of the tactical situation and of all orders he may re- 
ceive that may affect the sanitary service." The battalion is di- 
rectly under corps headquarters, but companies may be assigned 
to a division and thus come under the direction of the division 
surgeon. Each companj^ is under the command of a captain 
(not a sanitary officer) and attached thereto, but not under the 
command of the captain, is a chief surgeon with seven assist- 
ants. When the company goes into action the chief surgeon be- 
comes responsible for the service, and the captain of the company 
is placed under his orders. During the intervals, however, it 
would seem that the captain is the responsible head. 

The various drills and courses of instruction for the company 
are conducted by the lieutenants (not sanitary officers), and the 
regulations demand that the chief surgeon shall be present thereat 
whenever, in his opinion, it is necessary, in order to supervise 
such instruction, but he is not permitted to make corrections or 
suggest alterations except through the medium of the company 
commander. Each company has 208 bearers, under charge of 
sixteen lance corporals (Gefreite,) and its function is to establish 
dressing stations and transport the wounded from the battlefield 
and aid stations to the dressing stations and field hospitals. 

Twelve field hospitals are allowed each army corps, each hos- 
pital having a capacity of 200 beds, which may be enlarged by 
taking advantage of the resources of the locality. Each is com- 
manded by a chief surgeon who has the disciplinary authority of 
a company commander over the hospital personnel and non-com- 



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6 MAJOR PAUL F. STRAUB, 

missioned officers and men under treatment therein ; and he is 
authorized to deal directly with the authorities on the lines of 
communication anent the evacuation of the sick and wounded. 

The chief surgeon of the lines of communication (Etappen- 
arzt) is held responsible for the sanitary service in his district, 
and performs his duties under the direction of the general com- 
manding the lines of communication and the chief surgeon of 
the army. He is responsible for the reception, care, and further 
transportation of the sick and wounded of the army in the field, 
the evacuation of field hospitals, the organization and service of 
the various sanitary institutions located on the lines of commu- 
nication, and the establishment of other institutions, such as hos- 
pitals for the insane and infectious diseases. He is also required 
to see that the troops of the sanitary organizations are properly 
resupplied. 

A consulting hygienist is added to the personnel of the etappe, 
for the service of the sanitation of the etappe zone, whose posi- 
tion, rank, and pay are similar to those of the consulting sur- 
geon. His duties are also purely professional and he has nothing 
to do with administrative matters. His principal function is in 
connection with the prevention of infectious diseases; he inves- 
tigates the origin and spread of epidemics and advises as to the 
proper course to pursue in regard to them. 

The war hospital director assists the etappe surgeon in the 
organization and control of the. hospitals, and the evacuation of 
the sick within his zone. One is allowed to each army corps, 
and he is especially charged with the duty of speedily evacuating 
the field hospitals, and with the distribution of the sick and 
wounded. The etappe surgeon is his immediate superior, and 
under him is all the sanitary personnel of the lines of communi- 
cation. He is also the head of the **war hospital detachment," 
consisting of 123 officers and men, of which nineteen are sanitary 
officers. This detachment corresponds to our stationary hospi- 
tal organization and practically performs the same duties. The 
sanitary officers are taken from the active or reserve list, and, if 
this is impracticable, civilian physicians under contract will be 



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THE GERMAN FIELD REGULA TIONS. , 7 

employed. The senior sanitary oflScer commands the detach- 
ment. The most important function of this organization is to 
relieve field hospitals, that the latter may speedily be put in 
readiness to again accompany their unit. 

A transport detachment (Kranken-transport Abtheilung) is 
allowed to each special line of communications (Etappe Inspec- 
tion) and is for the purpose of transporting patients by trains, 
boats, field railways, wagons, etc. , and to provide for their shel- 
ter, food, and other necessary care while they are in transit. A 
chief surgeon is in command of the detachment, and has the 
disciplinary authority of a company commander. From the 
railway etappe stations patients may be further transported by 
hospital and supplementary hospital trains and by **trains for 
the transportation of sick.*' The hospital trains proper are the 
only ones which have a fixed personnel. The supplementary 
hospital trains and the trains for the transportion of the sick are 
temporary institutions and the necessary personnel is taken from 
the transport detachments. 

The organization of the volunteer aid service in time of war 
is also given, and it is quite evident that they depend upon this 
organization for much of the hospital and medical service of the 
rear. Their units are organized in time of peace; every individ- 
ual instructed in the duties that will be expected of hirfi in active 
service, materials and supplies accumulated and stored, and the 
organization presumably is always in readiness for active service. 

SANITARY SERVICE WITH TROOPS. 

Patients whose sickness is expected to be of short duration 
are, if possible, carried along with the columns. Such as can 
not be taken along, those who will presumably continue ill for 
some time, or whose condition will not permit transportation, 
are turned over to the troops on the line of communications. 
Seriously sick are to be sent to the nearest military hospital, and 
if such institutions are not accessible, they are transferred to civil 
hospitals, or in case of extreme necessity, are turned over to the 
local civil authorities for cure and treatment. 

The ambulances of the sanitary organizations may be used 



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8 MAJOR PAUL F, STRAUB, 

to such an extent as, in the opinion of the commanding oflScer 
of the company or the chief surgeon of the field hospital, circum- 
stances permit. Sanitary organizations must, however, be ready 
at all times for immediate service when in the presence of the 
enemy. 

* 'Collecting stations" will be designated at points within the 
territory occupied, for the sick of large bodies of troops, who 
will be sent from their respective organizations at a designated 
time. Personnel and supplies from the regimental sanitary de- 
tachments will be assigned to such stations and, in case of neces- 
sity, a section of a sanitary company or of afield hospital may be 
detailed thereto. These stations are to be in operation for only 
a very short period — a few hours at a time — and are to be evacu- 
ated as soon as arrangements can be made for the transportation 
and care of the sick by the etappe authority. 

If troops remain in a locality any length of time, the sanitary 
service will approximate that of peace service. Cantonment in- 
firmaries (Ortskrankenstuben), for the care of sick in quarters, 
will be provided as may be necessary. Cantonment hospitals 
will also be established under similar conditions, for the treat- 
ment of the more serious cases. The personnel and material for 
such institutions will be taken from the regimental detachment 
and supplies. 

Aid stations will be established whenever considerable losses 
occur. Each battalion may establish its own station, but this is 
not considered advisable if the battalion is part of a large com- 
mand, as a large number of aid stations would embarrass the 
work of transporting wounded to dressing and collecting stations 
for slightly wounded and to field hospitals, and would increase 
the diflSculty of keeping in contact with their respective units. 
It is, therefore, desirable that each regiment should have only 
one aid station, and, if conditions permit, it would be of advant- 
age to unite the aid stations of several regiments. The possible 
combination of the aid station with the dressing station should 
always be kept in mind. The aid station should be protected from 
rifle fire, and if possible from artillery fire. It must be as near as 
practicable to the firing line and of convenient access thereto. 



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THE GERMAN FIELD REGULA TIONS. 9 

Before going into action the company bearers of each com- 
pany of infantry, and other foot troops, are assembled at the 
rear of the organization and ordered to proceed to the infantry 
sanitary supply wagon. As soon as an aid station is established 
they lay aside their packs and are furnished with litters and 
pouches that they may rapidly bring in the wounded. 

Wounded who are able to march will receive such simple 
protective dressings at the aid station as may be necessary, and 
will march in detachments under the senior present, to a collect- 
ing station for slightly wounded or, in exceptional cases, direct 
to the nearest etappe station. Wounded who are unable to 
march will be conveyed from the aid station as rapidly as possi- 
ble, find, if practicable, direct to the field hospital. 

A dressing station is established by order of the division 
commander, upon recommendation of the division surgeon. In 
case of emergency, the division surgeon will give the necessary 
orders and report action to his commander. Dressing stations 
will not as a rule be established until the engagement has devel- 
oped to such an extent that the work of the sanitary company 
can be carried on at not too great a distance from the field of 
losses. The dressing station will be protected from rifle and ar- 
tillery fire, and should be accessible from one or more roads- 
buildings; a good place for cook fires, and a water supply are de- 
sirable. 

It is for the commanding oflBcer of the sanitary company to 
decide if the ambulances shall proceed to the field of losses or if 
an ambulance station shall be established at the nearest point 
thereto. The chief surgeon of the sanitary company determines 
whether the personnel employed on the battlefield is sufficient for 
the service; he directs the service at the dressing station, makes 
provision for the nourishment, temporary shelter of patients, and 
for their ultimate evacuation to the rear. The dressing station 
is organized, under direction of the chief surgeon, as follows: 

1. Place for packs of bearers — which is placed in charge of a trump- 
eter. 

2. Entrance and exit for ambulances. 

3. Unloading place for wounded, and a place for their equipment — in 
charge of a sanitary non-commissioned officer. 



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10 MAJOR PAUL F. STRAUB, 

4. Receiving department— sanitary officer in charge. 

5. Dressing department— sanitary officer in charge. 

6. Waiting place for wounded that are able to march — in charge of 
the senior present among them. 

7. Waiting place for wounded able to bear transportation and whose 
wounds have been dressed— a sanitary non-comnussioned officer in charge, 

8. Waiting place for wounded not able to bear transportation and 
whose wounds have been dressed — a sanitary non-commissioned officer in 
charge. 

9. A place for the dying — a sanitary non-commissioned officer in 
charge. 

10. Place for the dead. 

11. Kitchen. 

12. Wagon park (wagons, horses and train personnel) where wagons 
will also be prepared for carrying wounded. 

13. Latrines. 

The wounded are classified as follows: 

1. Wounded who are able to march— distinguished by a white diagno- 
sis tag. 

2. Wounded who are able to bear transportation and who need hos- 
pital treatment— distinguished by a white diagnosis tag with a red border 
on one side. 

3. Wounded who can not stand transportation, such as patients with 
abdominal wounds who can be carried only a short distance at most, — 
distinguished by a white diagnosis tag with two red borders. 

Surgeons are cautioned that the examination of wounds is 
to be restricted as much as possible, and that the cleansing of 
the wound and the surrounding integument is to be limited to 
what is absolutely essential. It is also distinctly brought out 
that the character of the surgical aid will depend upon the num- 
ber of wounded, the distance of the field hospital destined to re- 
ceive them, the kind, character, and sufficiency of the transpor- 
tation and other conditions which may aflFect the service; and that 
the demands of the individual may have to be sacrificed to some 
extent to the necessity for dressing and sheltering all the wounded 
on the day of battle. The greater the number of wounded the 
less time can be devoted to the individual case. 

Provision is also made for the employment of the sanitary 
companies during the periods of inactivity, when there is no ap- 
parent possibility of their service being required on the battle- 



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THE GERMAN FIELD REGULA TIONS. \ \ 

field, by authorizing their assignment to hospital duty or in con- 
nection with the transportion of the sick to the rear, etc. 

"Collecting stations" for slightly wounded are for the pur- 
pose of relieving the dressing stations of the wounded that are 
able to march, and to serve as an intermediary station to the 
etappe station. They must be located far enough in the rear, 
but must still be within reach of all the troops at the front and 
so placed as not to interfere with the movements of troops and 
trains. It is also distinctly provided that the collecting stations 
for slightly wounded shall not be established near field hospitals 
—presumably to avoid the danger of the latter being overrun 
with slightly wounded who may clamor for admission, as after a 
severe engagement the capacity of the field hospitals will un- 
doubtedly be taxed to the utmost to provide temporary care and 
shelter for the severely wounded. From the collecting stations 
the wounded will be returned to their regiments or sent to the 
rear, as the character of their injuries may indicate. 

The field hospitals receive wounded that require transporta- 
tion from dressing stations or directly from the field of battle, 
and they will be treated in these institutions only so lodg as may 
be necessary to arrange for their further transportation to the 
rear, unless their condition precludes this. The personnel and 
supplies pertaining to the field hospitals which are not estab- 
lished may be temporarily assigned to reinforce aid, dressing, 
and slightly wounded stations, as it is not considered advisable 
to weaken the regimental detachments by withdrawing men for 
such service. 

SERVICE OF THE REAR. 

Ample provision is made on the lines of communication for 
sanitation and the important service of the care of the sick and 
wounded including their further transportation to the rear. 

War hospitals, which correspond to our stationary hospit- 
als, are under the direction of the chief surgeon, and it is their 
important function to receive the patients of established field 
hospitals that the latter may again be made ready to accompany 
their units, after having been resupplied f rom the etappe sanitary 
supply'depot. 



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12 MAJOR PAUL F. STRAUS. 

Etappe hospitals are established at the headquarters of the 
lines of communications, and at such other stations as may be 
necessary to receive patients from the etappe troops and other 
organizations passing through the zone. Such hospitals are of 
especial importance at points where large numbers of wounded 
may be expected should a very severe engagement take place and 
the capacity of the field hospitals with the troops be insuflScient. 
If necessary personnel is not available for such institutions, ap- 
plication to higher authority will be made for sanitary officers 
and civilian physicians. Other personnel, if it can not be sup- 
plied by the local population, will be taken from the volunteer 
aid organization. Only regular, ex- regular or reserve sanitary 
officers will be assigned as chief surgeons of these hospitals. 
Should none of the above mentioned classes be available a com- 
mission consisting of an officer and a civilian physician is put in 
charge. 

Infirmary sections are provided for the care of slightly sick 
and wounded and are usually established in connection with 
the etappe or other hospitals. From the regulations governing 
the service of the infirmary sections, it appears that they are for 
the purpose of taking care of that class of patients we are accus- 
tomed to treat in **quarters." 

Patients who have recovered, but who are not yet strong 
enough for duty at the front, will be organized in convalescent 
detachments and will be assigned such duty in the service of the 
rear as their physical condition will permit. 

The fact that the success of the sanitary service at the front 
depends very much upon the rapidity of the evacuation of the 
sick and wounded is strongly emphasized. The sick whose re- 
covery will presumably require considerable time will be sent 
home whenever their condition permits of transportation. 

The highly important transport service in the etappe zone is 
carried on by the '*sick transport detachment'* which makes the 
necessary preparations for the transfer of patients on roads, rail- 
roads, waterways, and field railways, and also provides shelter, 
care, and treatment while en route. "Bandaging, refreshment 
places" and '^collecting places for the sick" are selected at va- 



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THE GERMAN FIELD REGULA TIONS. 13 

rious points along tbe lines of communication, and the sanitary 
personnel thereof is supplied from the sick transportation de- 
tachments. At the bandaging and refreshment places the woun- 
ded will be classified in accordance with the kind of transporta- 
tion they may require. Those that cannot be transported will be 
turned over to the nearest hospital — the remainder to the col- 
lecting place for sick. This latter station is solely for the pur- 
pose of furnishing temporary shelter for patients who are to be 
sent to the rear, and for this purpose buildings will be provided 
and supplied with the necessary conveniences for quartering 
them. These places may also be used for the slightly sick of 
troops en route. Whenever the personnel of the sick transport 
detachments is insufficient for the service at these stations the 
volunteer aid societies will be drawn upon for additional men. 
As a rule the sick transport detachments will not be assigned 
to accompany patients on trains or ships, as this function pertains 
to the * 'escort sections" of the volunteer aid societies and 
hired civilians. Patients who are to be sent to the rear are to be 
assembled at etappe stations located on railroads or waterways 
and will be transported to such assembling points in the ambu- 
lances of the field hospitals and other available army wagons or 
by wagons collected in the district. Sanitary supply wagons, re- 
turning empty from the etappe sanitary supply department; are 
especially convenient for this purpose, and, by authority of the 
corps commander, the vehicles of the provision or baggage trains 
returning to the depot may be used, but they shall not be re- 
quired to proceed farther than their objective point; nor shall 
they be used to transport patients with infectious diseases. Pro- 
vision is also made for the use of wagons and ambulances fur- 
nished by volunteer aid societies. 

Hospital trains are formal organizations with a permanent 
personnel and are prepared and organized in time of peace. In 
case of mobilization the proper number of trains is put in readi- 
ness and reported to the chief of the sanitary service in the field 
who assigns them to etappe districts. 

Hospital and supplementary hospital ships and ' 'ships for 
the transportation of sick*' are provided for the transportation 



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14 MAJOR PAUL F. STRAUB. 

of sick on waterways. The first two are intended exclusively 
for the transportation of bed patients, but the latter require no 
special fitting up, the ordinary accommodations for passengers 
being considered sufficient. The hospital ships are equipped in 
accordance with prescribed plans and are considered permanent 
units. The supplementary hospital ships are only for tempo- 
rary use and at the conclusion of the trip are made ready for or- 
dinary service. Hospital ships or fleets of hospital ships are com- 
manded by a chief surgeon. 

With the exception of those in fortresses all garrisoned hos- 
pitals become **reserve hospitals*' when the army is mobilized. 
These correspond to our general hospitals and fulfill the same 
functions. In addition to the transformed garrison hospitals, 
others are established in suitable buildings, barracks, or in tents. 
The uecesssary preparations are made in time of peace, so that 
ten days after mobilization a part of them will be ready for the 
reception of patients. **Reserve hospitals" are under charge 
of a chief surgeon, but should a sanitary officer not be available 
a ''hospital commission,*' consisting of an officer and a civilian 
physician, is put in control. Two or three surgeons are allowed 
for every 100 patients, and one apothecary for every 200. If no 
sanitary officer of the reserve can be secured civilians will be 
employed under contract already made in time of peace. 

Advantage is taken of the opportunity in reserve hospitals 
for training male military nurses, and as soon as they become 
proficient all in excess of the needs of the hospitals are sent to 
the front. Government employment agencies ar^ established in 
the larger cities for the purpose of securing nurses, and if the 
number obtained in addition to those furnished by the aid soci- 
eties is not sufficient, the local authorities are empowered to 
employ help. 

The chief of the field sanitary service assigns patients, re- 
turning from the front, to the reserve hospitals, the number of 
vacant beds therein being reported to him from time to time. 

If a number of reserve hospitals are located in one place, a 
senior sanitary officer may be placed in charge as reserve hospi- 
tal director. 



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THE GERMAN FIELD REGULA TIONS. 15 

SUPPI^IES. 

An etappe sanitary supply depot is established on each spec- 
ial line of communications. These depots contain all materials 
and supplies for war, etappe, and infectious disease hospitals; for 
fitting up supplementary hospital trains, and the supplies for 
sanitary organizations serving with troops. Mobile x-ray appa- 
ratus, mobile water sterilizers, tents, etc. , are also kept on hand 
for use in the zone of operations and on the lines of communi- 
cation. 

Interesting chapters on military hygiene are also included 
in the Kriegs Sanitatsordnung, which contain the most advanced 
ideas on this very important subject in a most concise and prac- 
tical way. Special chapters are devoted to the subjects of food, 
drinks, clothing, personal hygiene, the hygiene of marches, camps, 
and the battlefield, and the prevention of the spread of infec- 
tious diseases. A special chapter is also devoted to the sub- 
ject of disinfection and disposal of wastes. It is not possible to 
give a synopsis of the above mentioned section of the Kriegs 
Sanitatsordnung and keep this paper within proper limits, and a 
discussion thereof is reserved for another article. 

The appendix to the Kriegs Sanitatsordnung forms by 
far the larger part of the publication. It gives supply ta- 
bles; directions for the chemical and bacteriological examina- 
tions of water; hygienic rules to be observed in the selection of 
hospital sites and for their management; forms for reports and 
returns; improvisation of apparatus and appliances; methods of 
accounting; purchase and distribution of supplies, etc., etc. 

A general plan showin^^ the relative locations of the various 
sanitary institutions in the zone of operations and on the lines of 
communication is appetided, and gives an idea of the highly or- 
ganized and complicated system. One is impressed with the fact 
that such intricate schemes could be carried out only with an ex- 
ceptionally well disciplined body of men. The general principles 
laid down are in conformity with those of all up-to-date armies 
but go more deeply into details, at the same time considerable 
latitude is allowed to administrative officers and no hard and fast 
lines are drawn that could interfere with the service in case of 



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16 MAJOR PAUL F. STRAUB. 

emergency. All in all, these Regulations present the most mod- 
ern and advanced ideas upon the operations of the sanitary de- 
partment of an army in war. 

PERSONNEL AND EQUIPMENT FOR THE SANITARY SERVICE 

IN THE FIELD. 

1. OFFICE OF THE CHIEF OF THE FIELD SANITARY SERVICE. 

1 chief of Field Sanitary Service (Generalstabsarzt) . 

2 sanitary officers (Oberstabsarzte) . 

1 sanitary officer (Stabsarzt). 

2 field intendant secretaries. 

4 sanitary non-commissioned officers. 
8 train soldiers. 
10 saddle and 2 draft horses. 
1 two-horse vehicle. 
1 operating case (Truppenbesteck). 
1 sanitary chest. 

2. HEADQUARTERS OF AN ARMY. 

1 chief surgeon (Genera larzt). 
1 staff surgeon. 

1 assistant surgeon. 

2 sanitary non-commissioned officers. 
4 train soldiers. 

4 saddle, 2 draft horses. 
1 two-horse vehicle. 

1 operating case (Truppenbesteck). 
1 sanitary chest. 

3. HEADQUARTERS OF AN ARMY CORPS. 

1 corps surgeon (Generalarzt) . 

1 hygienist (superior staff or staff surgeon). 

1 assistant surgeon. 

1 corps staff apothecary. 

2 sanitary non-commissioned officers. 

5 train soldiers. 

5 saddle and 2 draft animals. 
1 operating case (Truppenbesteck). 
"1 sanitary chest. 
1 microscope. 
1 bacteriological chest. 
1 large reagent chest. 



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1 8 THE GERMAN FIELD REGULA TIONS, 

4. OFFICE OF CONSULTING SURGEON. 

1 consulting surgeon (Generalarzt, Generaloberarzt, Oberstabarzt) . 

1 assistant surgeon. 

1 sanitary non-commissioned officer. 

3 train soldiers. 

8 saddle, 2 draft horses. 
1 two-horse vehicle. 

1 large operating case (Hauptbesteck) . 

5. HEADQUARTERS OF A DIVISION. 

1 division surgeon (Generaloberarzt). 
1 assistant surgeon. 

1 sanitary non-commissioned officer. 

2 train soldiers. 

3 saddle horses. 

6. HEADQUARTERS OF A CAVALRY DIVISION. 

1 division surgeon (Generaloberarzt). 

1 mounted sanitary non-commissioned officer. 

4 train soldiers. 

3 saddle, 6 draft horses. 

1 six-horse sanitary supply wagon. 

7. SANITARY BATTALION STAFF. 

1 battalion commander. 
1 adjutant (lieutenant). 
1 non-commissioned officer (clerk). 

5 lance corporals (Crefreite) (bicyclists, 3 orderlies). 

4 train soldiers. 

9 saddle, 2 draft horses. 

1 two-horse staff pack wagon. 

8. SANITARY COMPANY. 

1 commanding officer. 

2 lieutenants. 

1 assistant surgeon. 

1 apothecary. 

1 paymaster. 

1 first sergeant. 

1 vice first sergeant. 

4 sergeants. 

14 non-commissioned officers. 
16 lance corporals (Crefreite). 

[ 2 musicians, 



1 tailor, 



208 bearers— includes < 1 shoemaker, 
I 1 wheelwright, 
1 2 blacksmiths. 
1 lance corporal (Gefreiter, bicyclist). 



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THE GERMAN FIELD REGULA TIONS. 19 

2 sanitary vice first sergeants or sergeants. 

7 sanitary non-commissioned officers, including 1 mounted. 

8 military nurses. 

1 train sergeant. 

2 train non-commissioned officers. 

3 train lance corporals (Gefreite). 

28 train soldiers— 8 of whom as gpx>oms for horses of sanitary officers. 
12 saddle and 28 draft horses. 

8 two-horse ambulance wagons, each provided with 7 or 9 litters 

and dressing pouches. 
2 two-horse sanitary wagons. 
2 two-horse pack wagons, each with a tent. 
1 two-horse commissary wagon. | 

Attached— 

1 chief surgeon (Oberstabsarzt) . 

2 staff surgeons. 

5 assistant surgeons. 

9 saddle* horses. 

9. FIELD HOSPITAL AND RESERVE FIELD HOSPITAL. 

1 chief surgeon (Oberstabsarzt). 
1 staff surgeon. 

4 assistant surgeons. 

1 apothecary. 

2 field hospital inspectors. 

1 sergeant, for police duty. 

1 non-commissioned officer, as clerk. 

1 non-commissioned officer, in charge of quarters. 

1 lance corporal (Gefreiter, bicyclist). 

2 privates (kitchen and dispensary). 

3 sanitary vice first sergeants or sergeants (ward masters). 

6 sanitary non-commissioned officers. 
14 military nurses. 

1 train sergeant 
1 train musician. 

1 train lance corporal (Gefreiter). 
18 (19) train soldiers. 
9 saddle, 18 (20) draft horses. 

1 two-horse ambulance wagon, with 7 or 9 litters and pouches of 

dressings. 

2 two-horse sanitary wagons. 
1 two-horse sanitary wagon. 

4 two-horse wagons for hospital appliances. 
1 two-horse wagon for officials. 



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20 MAJOR PAUL F, STRAUB. 

10. THE ETAPPE. 

(For each etappe inspector's district). 
1 etappe surgeon (Generalarzt). 
1 assistant surgeon. 
1 corps apothecary. 
1 sanitary non-commissioned officer. 
4 train soldiers. 
3 saddle, 2 draft horses. 
1 two-horse vehicle. 
1 sanitary chest 
1 large reagent chest. 

11. OFFICE OF THE CONSULTING HYGIENIST. 

(One for each eteppe inspector's district). 
1 consulting hygienist (Generalarzt, Generaloberarzt, Oberstabsarzt) . 

1 sanitary non-commissioned officer. 

2 train soldiers. 

2 saddle, 2 draft horses. 

1 two-horse vehicle. 

2 microscopes. 

1 bacteriological chest. 

1 portable bacteriological laboratory. 

12. OFFICE OF THE WAR HOSPITAL. DIRECTORY. 

(Number according to the number of army corps). 
1 war hospital director (Generaloberarzt, Oberstabsarzt). 
1 assistant surgeon. 

1 sanitary non-commissioned officer. 

2 train soldiers. 

3 saddle horses. 

13. WAR HOSPITAL DETACHMENTS. 

(Number according to the number of army corps). 

4 superior staff surgeons. 
6 staff surgeons. 

9 assistant surgeons. 

1 dentist. 

3 apothecaries. 

6 field hospital inspectors. 

3 non-commissioned officers (clerks) . 

3 privates (cooks). 

9 sanitary vice first sergeants or sergeants (ward masters). 
18 sanitary non-commissioned officers. 
36 military nurses. 
26 train soldiers. 

1 dental chest 



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THE GERMAN FIELD REGULA TIONS. 21 

14. WAR HOSPITAL. 

1 chief surgeon (Oberstabsarzt, Stabsarzt). 

Ward and assistant surgeons (sanitary officers from war hospital 
detachments and civilian physicians under contract). 

Apothecaries, administrative officials (apothecaries and field hospital 
inspectors of the war hospital detachments, or civilians under 
contract). 

Inferior personnel (enlisted sanitary personnel, military nurses of 
the war hospital detachments, or hospital sections of volun- 
teer societies). 

Appliances are obtained at the place or supplied from etappe sani- 
tary supply depots. 

15. ETAPPE HOSPITALS. 

1 chief surgeon (reg^ular or ex-regnilai^^ reserve or ex-reserve sani- 
tary officer), or a Hospital Commission (1 officer and a civil- 
ian surgeon). 

Ward and assistant surgeons (civilians). 

Inferior personnel (from the hospital section of the volunteer aid 
service— civilians) . 

Appliances as in paragraph 14. 

16. INFIRMARY SECTIONS. 

1 chief surgeon (only when the section is not attached to a hospital) 
as provided in paragraph 15, but under certain conditions he 
may be taken from a war hospital detachment). 

Personnel (from war hospital detachments, hospital section of the 
volunteer aid or civilians). 

17. SICK TRANSPORT DETACHMENTS. 

(One for each etappe inspector's district). 
(Bandaging, refreshment, and collecting places for sick). 
1 chief suigeon (Oberstabsarzt) . 
1 staff surgeon. 
4 assistant surgeons. 
1 field hospital inspector. 

1 sergeant for police duty. 

2 sanitary vice first seigeants or sergeants (ward masters) . 
4 sanitary non-commissioned officers. 

8 military nurses. 

8 train soldiers. 

Appliances as in paragraph 14. 

18. HOSPITAL TRAIN. 

1 chief surgeon (Oberstabsarzt). 

3 assistant surgeons. 

1 field hospital inspector 



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22 MAJOR PAUL F. STRAUB, 

1 lance corporal (Gefreiter) artificer. 

4 privates (2 cooks and 2 cooks' police). 

5 sanitary vice first sergfeants or sergeants. 
11 sanitary non-commissioned officers. 

16 military nurses. 

5 train soldiers. 

Railway personnel (engineers, firemen, etc) . 
24 hospital cars, each 12 berths \ qq^ Ka^4.Uo 

1 hospital car for officers, 8 berths \ ^^ ^«ruis. 

1 car for chief surgeon. 

1 car for surgeons. 

2 cars for personnel. 

1 car for dispensary and offices. 

2 cars for kitchens. 

3 cars with boilers for heating. 
. 2 cars reserve supplies. 

1 car supplies. 
1 car baggage. 

19. HOSPITAL SHIP. 

(Fleet of Hospital Ships). 
1 chief surgeon. 
Other personnel and supplies as provided elsewhere. 

20. SUPPLEMENTARY HOSPITAL TRAIN, SUPPLEMENTARY HOSPITAL SHIPS, 
SUPPLEMENTARY HOSPITAL SHIP FLEET. 

1 surgeon in charge. 

Other personnel and supplies as needed. 

21. TRAIN FOR TRANSPORTATION OF SICK, SHIP FOR TRAN- 
SPORTATION OF SICK. 

1 military escort, including a non-commissioned officer as conductor. 

2 field police. 

Other personnel and appliances as needed. 

22. ETAPPE SANITARY SUPPLY DEPOT. 

(One for each etappe inspector's district) . 
1 commanding officer (lieutenant). 
1 lieutenant. 
1 staff apothecary. 

5 apothecaries. 

3 field hospital inspectors. 

4 non-commissioned officers (clerks). 

8 non-commissioned officers (overseers) . 

6 instrument makers (inferior officials), 
l^sergeant conductor. 



l.tram non-commissioned officer, 
32Atrain soldiers, 

2 saddle and 48 draft horses, 
24 two-horse supply wagons. 



> Train column. 



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THE GERMAN FIELD REGULA TIONS. 23 



For each field X-ray 
apparatus. 



1 mounted vice first sergeant sergeant 

or non-commissioned officer. 
1 sanitary lance corporal (Gefreiter). 

1 mechanic (inferior official). \ 

2 train soldiers. 
1 saddle horse. 
4 draft horses. 
1 private (machinist or artificer). ) 

1 train soldier. \ For each water sterilizer. 

2 draft horses. ) 

Four-horse field X-ray wagon, ) Number in accordance with number 
Two-horse water sterilizer. \ - of army corps. 

23. FREIGHT DEPOT AT THE ASSEMBLY POST. (Sammelstation). 

1 staff apothecary. 

2 field hospital inspectors. 

4 sanitary vice first sergeants or sergeants. 
10 non-commissioned officers. 

3 train soldiers. 
Equipment — 

24. ACTING CORPS SURGEON. 

(Sanitary Office.) 
As in time of peace. 
Supplies as needed. 

25. RESERVE HOSPITAL DIRECTOR. 

1 reserve hospital director (Generaloberarzt, Oberstabsarzt or 

civilian surgeon under contract). 
1 sanitary non-commissioned officer. 

26. RESERVE HOSPITAL. 

1 chief surgeon or a hospital commission (1 officer and 1 civilian 

surgeon). 
Other personnel and supplies as provided elsewhere. 

27. CENTRAL REGISTRY OFFICER OF THE PRUSSIAN WAR MINISTRY. 

1 chief of division (regimental commander). 

1 staff officer. 

2 captains. 

1 superior staff surgeon or 1 staff surgeon. 

2 staff surgeons. 
1 accountant official. 

1 captain, assistant to chief of division. 
37 secretaries. 

5 registrars. 
133 non-commissioned officers. { r«ipyUq 

2 sanitary non-commissioned officers. ) ^^^'^*^°' 
5 messengers. 
And in addition thereto two members of volunteer aid societies. 



^ Re^strars and As- 
sistant Registrars. 



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24 MAJOR PAUL F. STRAUB, 

SERVICE, DELEGATES, AND PERSONNEL OF THE VOLUNTEER 
AID SOCIETIES. 

28. THE IMPERIAL COMMISSIONER AND INSPECTOR OF THE VOLUNTEER 

AID SOCIETIES. 

1 delegate general, as his representative at a distant field of operations. 

29. DELEGATES AND PERSONNEL IN THE ETAPPE. 

1 etappe delegate (with the etappe inspector). 

1 delegate with the war hospital director (at the head of a hospital 
section.) 

Sub-delegates with the sick transport detachments at the etappe 
headquarters station and at the assembly post. (Sammel- 
station). 

1 depot section. (Dopottruppe) 28 men from the depots of the 
volunteer aid societies at assembly posts and etappe head- 
quarters stations, and, if needed, also at the etappe stations. 

1 Hospital Section (Lazarettrupp) . 

28 male nurses, 25 female nurses, 4 cooks. 

1 section assigned to oach war hospital detachment. 

1 Transport Section — 112 men are assigned to etappe sanitary sup- 
ply depot or to the sick transport detachments as may be 
needed, for the transfer of sick from the advanced war and 
etappe hospitals to the main etappe station and transfers 
within the etappe district. 

1 Escort Section— 112 male nurses, 20 female nurses, to care for 
sick en route by rail or water to the reserve hospitals; also to 
bandaging and refreshment places at the collecting place for 
sick. 



GUNSHOT FRACTURKS. 

IN Der Militaerarzt, Kerchenberger discusses observations of 
gunshot fractures. He made experiments with a Flobert's 
smooth bored gun and a Flobert rifle. He shot at green 
wood and at the diaphysis of various bones. His results were 
not uniform but he concludes that the guns produced number- 
less radial fissures. He illustrates the results of his experiments 
with several figures. — F. J. Conzelmann. 



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AN IMPROVISED UTTER ON HORSEBACK. 

By captain FRANK T. WOODBURY, 

MBDICAI, CORPS UNITED STATES ARMY. 

THE necessity of extemporising suitable apparatus out of 
materials as they may come lo hand is nowhere more 
evident than in the Hospital Corps serving with our 
army. At its best it is always dependent upon another depart- 
ment for its transportation and equipment, which in the knowl- 
edge of the writer have never in the history of the army been 
supplied as contemplated by existing regulations, and at its worst 
it must make bricks without straw, using anything obtainable and 
converting it to the uses of the care and comfort of the wounded 
and injured. 

The writer presents herewith a description and photographs 
of a litter on horse back made from three poles and the equip- 
ment of a mounted soldier. 

This litter won the prize at the Philippines Division Athletic 
Meet held in Manila from January 13th to 18th, 1908, being de- 
monstrated by a squad from Camp Joseman, Island of Guimaras, 
representing the Department of the Visayas. The litter pre- 
sents the following essential and fundamental features. It can 
be made anywhere that poles can be cut (the Hospital Soldier 
carries a heavy knife or bolo for chopping purposes) and requires 
no other materials than are to be found on a horse saddled for 
field service, as it is fastened by four coat straps and the stirrup 
leathers and braced by a stick between the front poles fastened 
by the surcingle, and the bed of the littenis the shelter tent half, 
secured by the shelter tent rope. It is absolutely secure, will 
not shake loose, shift out of the median line, tilt, slide nor bump 
the patient even at a trot which was demonstrated by a test made 
by the Division Chief Surgeon. It does not irritate the horse in 
any way which is an important feature especially with a nervous 
horse or a badly wounded man. 

(25) 



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26 CAPTAIN FRANK T. WOODBURY, 

The litter is made as follows: — Two poles six feet long, or 
for qt^ick measurement, five bolo lengths, and two short pieces 
twenty-eight inches or one and three-quarters bolo lengths. The 
two short poles are crossed like the letter "X" in the seat of the 
saddle. They are notched at the center where they cross and at 
the ends where they receive the side pieces, which are made se- 
cure by the four coat straps from the cantle and pommel of the 
saddle which are wrapped twice around and buckled tightly. 



. Fig* 1. EztemporUed Mounted Dtter for one Patient 

This makes the four pieces of wood into a stiff frame and secures 
it to the saddle. The stirrup straps are then unbuckled and 
pulled out of the keepers, the tongue end is then pavSsed through 
the cincha ring upward and wound twice around the side poles 
and buckled. In tightening these straps the framework is ad- 
justed to a level and it becomes part of the saddle being held to 
it by the cincha through the stirrup straps. To prevent the 
front poles from approaching, a third short piece is wedged be- 



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AN IMPRO VISED UTTER ON HORSE B A CK. 27 

tween them and secured by the surcingle wound about the poles 
and buckled. So far we have not used any of the soldier's 
equipment proper, and we have two coat straps to spare. This 
is shown in the first illustration. The soldier's pack is now un- 
rolled, the blanket folded and tucked in over the cross poles in 
the seat to make a padding. The shelter tent half is then 
stretched over the poles, the rope end forward. The comers in 



Fig* 2* Estemporized Mounted Litter with Patient placed Thereon. 

front are secured by the guy rope of the tent to the poles, and 
at the rear by two spur straps. The other articles may be then 
used for a pillow. The patient is then lifted by three bearers 
and placed on the litter when all should appear as in the second 
illustration. 

The winning squad consisting of Privates 1st class Huber, 
Karcher, and Newby and private Sumraerville, Hospital Corps, 
in charge of Sergeant McGann, Hospital Corps, competed in the 
following problem: Having secured the horse of a wounded 



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28 CAPTAIN FRANK T, WOODBURY, 

trooper they espy him lying helplessly wounded 100 yards away; 
they run to him, apply such first aid as may be required, make a 
litter from poles and the wounded trooper's equipment attached to 
saddle, place him upon it and returned 100 yards to the starting 
point. This team did this, applying first aid treatment for a * 'hy- 
pothetical*' gunshot wound of the abdomen in the space of six 
minutes and fifty-four and one-fifth seconds. When the 200 
yards run is eliminated this shows how quickly this litter can 
be made. Nos. 1 and 2 make the litter and Nos. 3 and 4 treat 
the patient. . 



Fig* 3* Extemporized Mounted Utter utilUed as a Travois. 

The third illustration shows the travois made of two poles 
and two cross pieces fastened by shelter tent straps and attached 
to the saddle of a horse. The litter is made by rolling a blanket 
on two poles without other fastening; the head handles are sus- 
pended by leather ^yaist belts and the foot handles on the lower 
cross piece. The same team lost this event for time because of a 
baulky horse. 



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A HISTORY OF THE TYPHOID CASES OCCURRING 
ON BOARD THE U.S.S. CONNECTICUT. 
By PAUL E. McDONNOLD, M.D., 
PASSBD ASSISTANT SURGEON IN THE UNITED STATES NAVY. 

BETWEEN January 27 and April 29, 1907, there occurred 
on board the U.S.S. Connectiait two epidemics of ty- 
phoid fever, the first being mild in character and en- 
tirely confined to the enlisted personnel and the second severe and 
limited to the ship's officers and their attendants. Whether these 
epidemics were distinct also as to origin can not definitely be 
stated, there being evidence both for and against such an hypoth- 
esis. 

I reported for duty on board the Connecticut on April 12, 
1907, just at the close of the first epidemic. I have, therefore, 
no personal knowledge of its history and have been compelled to 
rely entirely upon such records and reports as are available for 
my information in regard to it. 

In order that a clearer understanding may be had of the sub- 
ject I shall mention briefly a few facts which have more or less 
bearing upon the health of the ship's crew since the date of her 
being put in commission. As is probably known, the Connecticut 
is one of our largest and newest battleships. The ship was built 
at the Navy Yard, New York, and was put into commission at 
that yard on September 28, 1906. Until November 6, of that 
year, her crew was comparatively small but on that date 460 
men were added to her complement, bringing it up to a total of 
807 officers and men. From the latter date until December IS, 
1906, when the ship left the navy yard, her senior medical offi- 
cer reported the sanitary conditions on board as being bad, it be- 
ing impossible to maintain anything approaching normal in the 
cleanliness of the ship or crew. He stated that Wallabout, or 
harbor water, which is at all times very foul, was used in flush- 

(29) 



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30 PASSED ASSISTANT SURGEON PAUL E, McDONNOLD. 

ing down the upper decks, in scrubbing canvas, and was the 
only supply to the crew's showers. Brooklyn city water was 
used for drinking and cooking purposes, it being first run into 
the ship's gravity tank and from there distributed to the various 
parts of the vessel. 

On December IS, 1906, the ship left the New York yard for 
Hampton Roads, Va., where she arrived on December 18. 
When she left the yard, there was of necessity an entire change 
of water supply, the water used for drinking and cooking pur- 
poses being distilled and that used for the crew's showers, decks 
and canvas being clean salt water. The ship's water tanks hold 
little more than enough for a day's supply, so that the Brooklyn 
city water, in the ordinary course of events, would have become 
exhausted by the time the ship reached Hampton Roads. The 
senior medical officer stated, however, in his report, that owing 
to some unusual circumstance, several tanks of this water were 
on hand two weeks after this time. 

From December 18, 1906, to January 2, 1907, the ship was 
at Hampton Roads, with the exception of four days during which 
she lay oflF the Capes. On January 2, she sailed for Newport, 
R. I., where she remained one day, leaving there on January 4, 
to return to Hampton Roads where a stay was made until the 
8th. On the latter date, the ship sailed for Culebra, V. I., 
where she arrived on January 14. During the stay at Hampton 
Roads, fresh milk and oysters were received on board for the use 
of officers and men, and fresh meat and provisions taken onboard 
for the use of the crew. Supplies for the officers had been ob- 
tained at New York. 

From January 14 to 28, the ship was at or near Culebra 
where liberty was given. Culebra is a very small island and no 
typhoid fever, so far as known to the health officer there, a sur- 
geon in the navy, existed either among the Marine guard sta- 
tioned there or among the native inhabitants. 

On January 26, 1907, an epidemic of diarrhea appeared 
among the crew, nineteen cases being admitted to the sick list 
on that date, twenty-three cases on the day following, and four 
on January 28. Numerous other cases are said to have occur- 



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TYPHOID FEVER ON THE CONNECTICUT 31 

red during this period which were uot admitted to the sick list, 
the patients being able to attend to their duties. According to 
the ship's medical journal, these cases presented practically the 
same symptoms, viz: ''colicky pain, diarrheic evacuations, pale, 
flabby tongue; pains in back, about kidneys; headache and rise 
of temperature. ' ' No distinct dietetic cause was assigned for the 
outbreak by the senior medical officer, but he reported that he 
found it to be a custom among the ship's cooks at this time to 
take large sections of meat out of cold storage and to let them 
lie on deck to thaw out, sometimes for twenty-four hours, be- 
fore cooking them. This in a tropical climate permitted the 
outer portions of the meat to become more or less decomposed at 
times, and he thought it possible that poisoning from the meat 
might have been the cause of the epidemic. 

With the exception of four, all of the diarrhea cases were 
discharged to duty before February 1. Three of the remaining 
cases were discharged to duty on the latter date and one was car- 
ried on the list continuously until discharged to hospital with 
febris enterica on February 28. Including the latter case, six 
of the diarrhea cases then admitted to the sick list were after- 
wards admitted with febris enterica, the dates of admission, omit- 
ting the above case, being February 11, 16, 17, 18, and 22. 

Between January 27, and February 25, there was a total of 
thirty-four cas^s admitted with febris enterica, including two 
suspected cases. These cases were admitted in the following or- 
der, although a diagnosis of typhoid was not always made im- 
mediately upon admission. All of the cases were, however, 
carried continuously on the sick list from the date of admission 
until discharged to hospital, excepting the two suspected cases 
mentioned which were not diagnosed as typhoid and which were 
discharged to duty: 

1 case January 27. 2 cases February 17. 



2 




February 5. 


1 




6. 


2 




" 11. 


3 




" 12. 


1 




'* 13. 


4 




" 15. 


5 




" 16. 



4 






18. 


2 






19. 


3 






20. 


1 






21. 


1 






22. 


1 






24. 


1 






25. 



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32 PASSED ASSISTANT SURGEON PAUL E. McDONNOLD. 

The two suspected cases were admitted, one od the 12th 
and the other on the 15th. One of the cases admitted on Feb- 
ruary S, was a ship's cook who had just five days previously 
been discharged from the sick list where he had been under 
treatment for a lymphadenitis, due to a wound of the foot, from 
January 20 to 30, 1907. When admitted on February 5, he 
had*a temperature of 103.8 and it is evident that he was in the 
incubation period of typhoid when first on the sick list. The 
beginning of the disease in his case occurred apparently between 
January 30 and February S, while he was performing duty as 
ship's cook. The second case admitted on February 5, had been 
performing duty as a messman. He was admitted with a tem- 
perature of 105 and feeling **ill all over." It is very evident 
that the disease began here also several days prior to the date of 
admission. Not a single member of the mess for which he worked, 
however, contracted the disease. 

From February 1 to 23, 1907, the ship lay in Guantanamo 
Bay, Cuba, with the exception of about one week during which 
a cruise was made to St. Thomas, D. W. I., where two days 
(February 13 and 14) were spent. So far as known, there was no 
typhoid in epidemic form either at St. Thomas or in the vicinity 
of Guantanamo Bay at the time the ship visited these places. 

On February 23, the ship left Guantanamo Bay for New 
York, where, on February 28, all of the typhoid cases then on 
the sick list were transferred to hospital with all of their effects. 
After their departure, the sick bay, isolation ward and dispen- 
sary, .were washed down with bichloride solution and their con- 
tents disinfected; the men's head (water-closet) disinfected with 
live steam; and such other sanitary measures carried out as were 
deemed necessary to rid the ship of further danger from such 
sources. 

On March 6, 1907, the ship sailed from New York (Tomp- 
kinsville) for Cape Cruz, Cuba, to take part in the spring target 
practice. On the second day out, another case of continued fever 
appeared which, later, gave a positive Widal reaction. This was 
after an interval of nine days during which no new cases had 
developed and was the beginning of what might be called the 



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TYPHOID FEVER ON THE CONNECTICUT 33 

intermediate series of cases, six in number. The five other cases 
appeared, otie at a time, on March 9, 11, 15, 19, and 22. The 
first case was discharged to duty on April 10, (34 days) ; the 
second on March 15, (6 days); the third was transferred 
to hospital when the ship arrived at Hampton Roads on March 
23; and the fourth (which was not diagnosed as typhoid, but 
was suspicious), was discharged to duty on March 28 (13 days), 
the patient leaving the ship immediately on furlough. Of the 
last two cases, the first had no temperature at any time, so far as 
the records show, above ninety-nine, and he was discharged to 
duty on March 28, or eight days after admission. The re- 
maining case was admitted with a ''sore throat^', bones aching, 
and a temperature of 100. He was discharged to duty in three 
days, viz., on March 25. Both of these cases gave a positive 
Widal reaction, however. 

This was the end of the first epidemic, which, as previously 
mentioned, was entirely confined to the enlisted personnel. There 
was a total of forty cases, including the three suspicious cases 
noted, and the symptoms presented in many cases were exceed- 
ingly mild. So far as the available records show, headache was 
the most constant symptom upon admission, being noted in thirty- 
six cases. Coated tongue and malaise are mentioned as occur- 
ring in -thirty-four cases; muscular pains over body and limbs in 
twenty-nine; ** sore throat*' in five; abdominal pain and tender- 
ness in five; constipation in three; and diarrhea in six. The 
combination of headache, coated tongue, malaise and muscular 
pains over body and limbs, occurred in twenty-six cases and in 
three others there were arthritic pains and backache. Delirium 
more or less pronounced, occurred in two cases and bed-sores 
in one, prior to transfer to hospital. Fourteen cases were ad- 
mitted with a temperature of 103 or above, and seventeen below 
that point. In nine cases, the record of the temperature on ad- 
mission is not obtainable. Four cases ran a temperature between 
three and four weeks before transfer to hospital; six between two 
and three weeks; twenty between one and two weeks; and ten 
less than one week. 

During the first series of cases, circumstances rendered it 



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34 PASSED ASSISTANT SURGEON PA UL E, McDONNOLD. 

impossible to obtain a Widal reaction as an aid to diagnosis, there 
being no typhoid culture on board the ship at that time, and the 
absence of characteristic symptoms in many instances, taken to- 
gether with the seeming impossibility for an infection of this 
character to occur at the time, made a diagnosis exceedingly dif- 
ficult at first. Owing to the unusual symptoms presented in many 
cases and to the fact that no deaths occurred as a direct result of 
the epidemic, some doubt must necessarily be entertained even 
at the present time as to whether all of the cases can properly be 
regarded as typhoid or paratyphoid. In the twenty-seven cases 
of definite paratyphoid infection which I have been able to find 
in the literature upon the subject, there were two deaths, show- 
ing that the death rate in this disease is about the same as in 
true typhoid. 

Through the kindness of Surgeon E. G. Parker, and Sur- 
geon Philip Leach, U.S.N., I have been able to obtain certain 
additional facts in regard to the thirty-two cases transferred to 
hospital at New York. Thirteen of these cases gave a positive 
Widal reaction; fourteen gave what was termed a **pseudo*' re- 
action in which clumping of the bacilli occurred without com- 
plete loss of motion; and in five cases the reaction was negative. 
Rose-spots were observed in twenty-one cases; in ten these were 
absent; and in one the record is not obtainable. Rose-spots 
were present in eleven of the fourteen cases which presented the 
**pseudo" reaction and in two which gave a negative reaction, 
while they were unobserved in four of the cases in which the 
Widal reaction was positive. Three cases ran a temperature after 
transfer to hospital for more than four weeks; two between 
three and four weeks; eight between two and three weeks; 
nine between one and two weeks; nine less than one week; 
and in one case the record is not obtainable. Of the cases 
with the **pseudo" reaction, two ran a temperature at the 
hospital for more than three week^; three between two and 
three weeks; five between one and two weeks; and four less than 
one week. A number of the **pseudo'* cases had typical clin- 
ical signs of typhoid fever and must, I think, be regarded as 
such. 



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TYPHOID FEVER ON THE CONNECTICUT 35 

Of the intermediate series mentioned, four cases presented 
positive Widal reactions, while in two the results of examination 
are not known. 

Thus far no officer had contracted the disease. One had 
been admitted to the sick list for two days during the epidemic 
of diarrhea in January and, prior to this, viz., on January 7, 
another had been admitted for one day with headache, malaise, 
muscular soreness and slight fever, but no after effects were no- 
ticed in either case. There is now an entire shift of scene to the 
wardroom and warrant oflScers' messes. To properly appreciate 
this change it must be understood that the oflBcers' quarters on 
the Connecticut are entirely separated from the crew's quarters 
and confined to the after part of the ship. No members of the 
crew, other than compartment cleaners, stewards, mess attend- 
ants, and orderlies, ever enter these quarters except for a few 
moments at a time on special occasions. The officers are divided 
into five messes which are absolutely distinct in regard to living 
space, cooks and attendants. These are first, that of the com- 
mander-in-chief of the fleet and his personal staff; second, that of 
the commanding officer of the ship; third, the wardroom, which 
includes all other commissioned officers above the rank of mid- 
shipmen; fourth, t)ie steerage, or midshipmen's mess; and, fifth, 
the warrant officers* mess. The wardroom is on the berth deck, 
immediately beneath the quarters of the commander-in-chief and 
commanding officer, and just»aft of the steerage quarters on the 
starboard side and the warrant officers* quarters on the port side. 
Two of the wardroom officers, however, both of whom contracted 
typhoid, had staterooms just forward of the commanding officer's 
quarters on the gun deck. 

On April 11, 1907, one of the officers just mentioned was 
admitted to the sick list with * 'headache, pains in the limbs and 
back, muscular soreness, bowels constipated" and a temperature 
of 101. On April 14, a warrant officer, who had quarters on 
the deck below, was admitted with similar symptoms. Repeated 
examinations gave negative Widal reactions. A positive diazo- 
reaction, however, was obtained in both cases on April 19. In 
the first case some gurgling and tympanites was present on the 



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36 PASSED ASSISTANT SURGEON PAUL E. McDONNOLD 

latter date and the temperature had gradually risen to 10.42. 
The warrant officer had been absent from the ship on leave in 
Washington, D. C, from March 30 until April 8. Both cases 
were transferred to hospital on April 20. 

On April 25, a third officer was admitted with a temperature 
of 104.4, severe headache and backache, tongue coated, bowels 
constipated and breath foul. He stated that he had been feeling 
badly for several days but did not wish to give up. An exami- 
nation of his blood gave a negative Widal reaction. He was 
transferred to hospital on the following day. 

On the same day on which this officer was admitted (April 
25) , a wardroom mess attendant was put on the sick list with 
malaise, headache, temperature 101.4, and a history of having 
felt feverish for several days. Here, also, all examinations proved 
negative. He was transferred to hospital on April 30. 

On April 29, the last officer to be admitted was put on the 
sick list with a heavily coated tongue, malaise and a temperature 
of 103.6. This officer had been on leave from about the first of 
the month until the 15th. He gave a history of having at- 
tended a dinner just before his return to the ship where he was 
taken suddenly ill with nausea and vomiting. Since then he 
had been feeling badly and had been constipated. For several 
days prior to his admission he had been feeling feverish in the 
evening but he thought it would pass off. When he was exam- 
ined, rose spots were found and a 4)ositive Widal reaction was 
obtained in five minutes (1:50, sterile), showing rather conclus- 
ively that the attack had begun at least a week before. He was 
transferred to hospital on April 30. 

This was a total of five cases, four from the wardroom and 
one from the warrant officer's mess. One other case properly 
belongs in this group, however. On April 2, 1907, a medical 
officer, who had been attached to the Connecticut, was transfer- 
red to another vessel. About April 20 this officer was taken 
ill with what proved to be a mild case of typhoid, diagnosed 
practically by Widal reaction alone. He was confined to his bed 
for a few days only. The mess attendant spoken of had attended 
this officer while he was attached to the ship. 



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TYPHOID FEVER ON THE CONNECTICUT 37 

This, briefly, is the history of the cases occurring in the two 
epidemics. Let us now look at the possible sources of infection. 
As water has heretofore been regarded as the principal medium 
through which the bacillus of Eberth and other members of the 
typhoid group gain entrance to the system, it seems proper to 
look first at the water supply of the Connecticut before and during 
the epidemics. As previously stated, Brooklyn city water was 
used for drinking and cooking purposes prior to December 15, 
1906, and for a short time thereafter. The fact that no epidemic 
of typhoid fever existed in Brooklyn or at the navy yard, and 
that no case of the disease occurred on board ship during the 
time spent at the yard (nearly three months), seems almost suf- 
ficient evidence in itself to pfove that this water was not at fault. 
The further fact that the first epidemic did not begin, so far as 
the records show, for nearly a month after the use of Brooklyn 
water had been discontinued, is additional proof of its innocence. 
There is a theoretical possibility for this water to have been con- 
taminated while being run into the ship's gravity tank, but there 
is no evidence that this ever actually occurred. This possibility 
lay in the use of a hose that had been used in flushing down 
decks with harbor water. The hose ordinarily used for fresh 
water, however, was distinctly marked and there is no good rea- 
son for believing that it was ever exchanged, accidentally or 
otherwise, for a salt water hose. Another possible source of 
contamination existed in the double faucets in use for a time in 
the officers' bathrooms and pantries. These faucets were so con- 
structed that by turning a handle in one direction fresh water 
would flow and turning it in the opposite direction allowed salt 
water to run. These faucets were only in use for a short time 
and the water ,so contaminated was that used by the officers who 
were not afEected during the first epidemic. 

In regard to the distilled water used on board, there are, 
theoretically, two ways by which this water might have been 
contaminated. The ship's tanks are so constructed that it is 
necessary for a man to go inside of them when they are cleaned 
out, which is done every few weeks. The man whose duty it 
was to attend to this work, I found from observation, was in the 



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38 PASSED ASSISTANT SURGEON PAUL E. McDONNOLD 

habit of wearing an old dirty suit of dungarees, without boots or 
shoes, when he performed this duty, and, on one occasion, I 
found him about to go into the tanks while he was suffering from 
an attack of diarrhea. He was on the sick list with diarrhea 
from January 27, to February 1, 1907, during the epidemic of this 
disease, but he cannot remember whether or not he went into the 
tanks just before or after this attack. Another possible source 
of contamination existed in the evaporator room where the 
freshly distilled water is tested for salt. I found it was the habit 
of the man on watch here to dip a tumbler, hand and all, into 
the tank whenever he tested the water, which was many times a 
day. Six difEerent men were on watch during the twenty-four 
hours, so that, had any of them had a mild attack of typhoid, 
the disease might have been spread in this way. One water tender 
was admitted with just this type of the disease during the latter 
part of the epidemic (March 22 to 25). 

If the ship's water tanks were infected, however, all trace of 
it had disappeared by the middle of April when a bacteriological 
examination of the water from every tank in the ship was made. 
The fact that none of the ship's oflBcers or their attendants who 
used water from the same tanks, were affected at this time, and 
that the epidemic was not more universal and extended among 
the crew, argues against this origin. 

As stated elsewhere, harbor water was used in scrubbing 
down upper decks and washing canvas while the ship lay at the 
New York Navy Yard. This has been thought to be a possible 
source of infection, but drying and exposure to the sun would, 
alone, I think, have prevented any infection of the ship itself in 
this way from continuing for any length of time, and there is no 
material that can be discovered which might have been washed 
in this water, stowed away, and, later, broken out, thus acting 
as an infective agent. The danger from the use of this water 
was an immediate one only it is believed, and lay in the possi- 
bility of its infecting the men who came in contact with it at the 
time it was used. 

The origin of the epidemic from an ambulatory case among 
the crew must be considered. While fitting out for sea at the 



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TYPHOID FEVER ON THE CONNECTICUT 39 

New York yard, many of the navy yard workmen were daily 
employed throughout every part of the ship. It was, of course, 
possible for one of these workmen to have infected some member 
of the crew, or one of the crew might have contracted a mild 
case in the city of Brooklyn, the distribution taking place on 
board by contact or otherwise. While at Hampton Roads on 
January 6, 7, and 8, 1907, oysters, milk, and fresh vegetables 
were obtained from shore and freely partaken of by the officers 
and men. Some of the crew might have been infected here, al- 
though it must be stated that an investigation made by myself 
at a later date (April) failed to disclose the presence of typhoid 
fever in epidemic form at Old Point, Norfolk, Phoebus, or vicin- 
ity. Several cases were found at Norfolk and Hampton, how- 
ever, and the fact that the disease is commonly called ''the 
fever*' around Hampton, shows the extent of its prevalence there. 
The ship's cook who was admitted to the sick list on February 
5, may have contracted the disease in this way and acted as a 
distributing agent on board ship. As previously noted, it seems 
probable that he performed his duties in the galley for several days 
after his attack began. Here he could easily have infected the 
whole ship's company, with the exception of the oflScers whose 
food was prepared in a separate galley. This would have been 
especially easy at this time as the epidemic of diarrhea had just 
been prevailing and the digestive apparatus of about half the 
crew inflamed and prepared to receive infection. Such a theory 
would leave unaccounted for as to origin three cases, viz., those 
admitted on January 27, February 5 and February 6, but it is 
not diflficult to suppose that these cases might have contracted 
the disease from the same source as the cook. It is rather re- 
markable that the messman admitted on the same day as the 
cook (February 5), did not infect some member of his mess, but 
such is the fact, all of the members of this mess being bandsmen 
and none of them contracting the disease. This goes to show 
that even probabilities are sometimes very unreliable data upon 
which to base opinions in the consideration of the source of epi- 
demics. 

Finally, the infection may have occurred through some arti- 



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40 PASSED ASSISTANT SURGEON PAUL E, McDONNOLD 

cle of diet kept in cold storage or elsewhere, and this theory is 
a very plausible one. The cold storage rooms on the Connec- 
ticut are very large and fresh meat, fruit, milk, butter and other 
perishable articles, are kept there for long periods of time. As 
has been mentioned, the meat and provisions used by the crew 
had been obtained at Hampton Roads, while that used by the 
oflScers had been taken on board in New York. This might ac- 
count for the fact that none of the officers were involved at this 
time. What the infected article of diet might have been it is 
impossible at this time to slate. As the meat was cooked before 
being served, the only possible danger from this source would 
seem to have been to those only who handled it raw. No vegetables 
are known to have been served raw, or any fresh milk issued to 
the crew after the first two or three days out fron^ Hampton 
Roads. Fresh butter could have been the article at fault. 

It is not improbable that the same article of diet which 
caused the epidemic of diarrhea, was also the source of infection 
with typhoid. Although only six of the diarrhea cases admitted 
to the sick list contracted typhoid, many of the typhoid cases 
were aflFected with diarrhea during the epidemic of the latter 
disease. As previously stated, a large portion of the ship's com- 
pany was involved during the diarrhea epidemic but only forty- 
six were put on the sick list. As many of the typhoid cases 
have not yet been returned to the ship, it is impossible to deter- 
mine definitely how many of them were afiFected. Out of twenty 
who have returned, however, thirteen state positively that they 
had diarrhea at that time and one cannot remember. Adding 
the six cases above mentioned, we have a total of nineteen out of 
a possible twenty-six who had diarrhea during the epidemic of 
that disease, there being fourteen cases which have not been 
questioned about the matter. 

Typhoid fever, so far as we know at the present time, has 
an incubation period varying from eight to twenty-one days. 
While a number of writers on the subject are inclined to bfelieve 
that the period is longer at times, and while it is evident that our 
ideas on this point are likely soon to be <!hanged, owing to the 
fact that the disease is being recognized more and more as pro- 



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TYPHOID FEVER ON THE CONNECTICUT 41 

tean in origin, so far as the infecting microorganism is concerned, 
sufficient proof seems lacking as yet to establish a period at vari- 
ance with this. It must certainly be said, I think, that the ma- 
jority of cases, at least, come within this period. This being so, 
it seems probable that at least thirty-one of the forty cases ap- 
pearing during the first epidemic were infected at the same time, 
viz., during the latter part of January, 1907. By extending the 
incubation period to twenty-five days, it is possible for the whole 
forty cases, excepting the intermediate series of six, to have con- 
tracted the disease at the same time. 

The possibility of the dispensary being a factor in the dis- 
tribution of the disease must be mentioned, though there is no 
evidence that such is the case. The cook mentioned was on the 
sick list during the height of the epidemic of diarrhea when a 
large portion of the ship's company was getting treatment at the 
dispensary, but so far as the records show, he received only local 
treatment and had no opportunity to infect the medicine glasses, 
which offered the only apparent means for transmission of the 
disease, as he was confined to the sick bay which is separate from 
the dispensary. From November 14, 1906, to February 1, 1907, 
seventeen of the forty cases of typhoid had been on the sick list 
for other causes, but, with the exception of nine, none of them 
had been on the list within a month of the time of their admis- 
sion with typhoid. Six of these nine were diarrhea cases 
which have been mentioned as later developing typhoid. 

Of the forty members of the crew aflEected in the first epi- 
demic, there were thirty belonging to the deck force; six be- 
longing to the fire-room force; one carpenter's mate; one private 
marine; one ship's cook and one water tender. Why such a large 
percentage of the deck force, which represents less than one-half 
of the ship's crew, was affected, is somewhat hard to explain. 
If the theory could be accepted that the harbor water used in 
scrubbing decks and canvas while in New York was the source 
of infection, this might account for it, as the deck force is prin- 
cipally concen\^d in the performance of this duty. The mem- 
bers of this force however are all much younger than the mem- 
bers of any other division of the ship's crew and many of them 



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42 PASSED ASSISTANT SURGEON PAUL E. McDONNOLD 

are boys. This fact might explain, and, it is believed, does ex- 
plain, the large percentage of cases which occurred in this force. 
The thirty cases mentioned were scattered throughout the entire 
seven divisions into which the seaman's branch is divided. They 
were employed all over the ship, particularly on deck, and ate at 
seven separate messes. 

The intermediate series of cases is hard to account for ex- 
cept by the theory of contact, either director indirect. It should 
be mentioned that conditions on board a battleship are entirely 
dissimilar from those in camps and opportunities for infection by 
indirect contact are small in comparison. The Connecliad, when 
I reported on board for duty on April 12, 1907, was as clean as 
soap and water, sand holystone and fresh paint could make her, 
and I was reliably informed that she had been so since she left 
the New York Navy Yard. There is hardly any part of the 
ship that is not thoroughly cleaned by the means mentioned at 
least once a week in the ordinary course of events, and the more 
frequently used parts are gone over daily. The crew's head, or 
water-closet, may have been the point of distribution. Certainly 
after its disinfection with live steam about March 1, only six 
other cases appeared among the crew and these could have been 
previously infected. 

In regard to the second epidemic, every effort was made to 
trace it to the original infection. The cases which had been dis- 
charged to duty on board ship were all examined and ques- 
tioned as to their duties and as to whether or not they had at any 
time entered the oflScers' quarters; the oJQScers' cooks and at- 
tendants, only one of whom had been admitted to the sick list, 
were all examined as to their health past and present; and the 
victims of the epidemic were questioned as to the likelihood of 
their having come in contact with any of the typhoid patients or 
convalescents. All of the evidence so obtained was negative. 

The last case of typhoid among the crew was only discharged 
to duty on the day before the first officer was affected and a possible 
source of infection by indirect contact was through the two med- 
ical officers, both of whom were members of the wardroom mess, 
but the evidence here is incomplete. As previously mentioned, 



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TYPHOID FEVER ON THE CONNECTICUT 43 

one of these officers was taken ill about April 20, with what 
proved to be a mild case of t3'phoid (diagnosed by Widal reac- 
tian). He apparently contracted the disease about the same 
time as the other officers. He was certainly well when he left 
the ship and for some time thereafter. The mess attendant who 
was admitted on April 25, had attended this officer, when he 
was attached to the ship, but this case was proven to be one of 
paratyphoid fever. A number of the cases in the first epidemic 
were probably paratyphoid and the mess attendant may possibly 
have been infected by indirect contact through the medical offi- 
cer. The warrant machinist who was the second to be taken ill, 
did not, so far as can be discovered, come in contact at any time 
prior to his illness with either of the medical officers, the mess 
attendant or any of the officers who contracted the disease. So 
far as can be learned, the medical officer mentioned was not inti- 
mate with, or likely to have come in contact with the officer ad- 
mitted on April 11, who had quarters on the deck above the 
wardroom. The officer admitted on April 25 was fond at 
times of bridge whist, as were both the doctors, and his infection 
might have occurred in this way. Neither this officer nor any of 
the others affected, however, took part regularly, in the evening 
game of bridge which was usually played by the two doctors and 
two other officers, neither of whom contracted the disease. 

The incubation period of all of the cases in the second epi- 
demic lies apparently between March 23, when the ship arrived at 
Hampton Roads, and April 2, when the medical officer who con- 
tracted the disease was detached from the ship. The incubation 
period of the first two cases is evident from their dates of ad- 
mission, there being no reason to believe that the disease in either 
case began prior to this time. The third and fourth cases which 
were admitted on April 25, gave histories indicating that their 
attacks began several days before. So with the fifth case which 
was admitted on April 29 and which gave a positive Widal re- 
action and exhibited rose-spots. This case gave a history which 
would indicate infection while away from the ship but, under 
the circumstances, such a supposition can hardly be entertained. 
The possibility of this case having been infected after his return 
from leave (on April 15), must be admitted, but the incubation 
period in such case would be extremely short. 



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TYPHOID FEVER ON THE CONNECTICUT 45 

During the period from March 23 to April 2, raw oysters, 
milk and salads, bought at Old Point, were served at the ward- 
room and warrant oflScers* messes. Some of the oysters were 
said to have been so dark, soft and unpalatable looking that 
many of the officers refused to partake of them. The coincidence 
of the appearance of two epidemics on board after visiting Hamp- 
ton Roads, both within the incubation period of typhoid from 
the time of the stay at this port, seems worthy of note. While 
the disease could not be found in epidemic form in this vicinity 
during April, it is a matter of common knowledge that typhoid 
is usually plentiful in this section and I am personally of the 
opinion that both epidemics originated here. 

With the transfer to hospital of the two cases on April 30, 
the disease disappeared from the ship in epidemic form. There 
was one death in the last epidemic and all of the cases, with the 
exception of the medical officer and mess attendant, were un- 
usually severe. 

One sporadic case occurred after April 30 in the person of a 
chief yeoman who joined the ship from the U.S.S. Hancock Anr- 
ing the early part of May. This man was taken suddenly ill at 
his home in Jersey City, N. J., on May 25 with symptoms of 
general peritonitis. He was transferred to hospital immediately 
and an operation performed, as a result of which it was discov- 
ered that his attack was due to the perforation of a typhoid ulcer. 
He did not survive the operation. 

This case had been going about doing his duty on board 
ship up to the day before his death when he went to his home on 
leave. It was learned afterwards that he had spoken to several 
people of not feeling well but he had not complained to any of 
the medical officers or asked for medicine. The man was 
employed in the office of the commander-in-chief and ate at the 
chief petty officers* mess. He was not associated in any way 
with any of the wardroom or warrant officers, their attendants, 
or members of the crew, outside of the employees in the office 
where he was on duty and the members of the chief petty 
officers' mess, none of whom had been affected with typhoid. 
The employees in the office of the commander-in-chief had in 



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46 PASSED ASSISTANT SURGEON PAUL E, AfcDONNOLD. 

fact only joined the ship on April 16, 1907. The man did not 
use the men*s head and so had no opportunity to have become 
infected in that way. He is believed to have been infected while 
on the U. S. S. Hancock where all of the typhoid cases in the 
first epidemic which were transferred to hospital in New York, 
were discharged as soon as they were able to leave the hospital. 
Or he may have contracted the disease at his home in Jersey 
City. As about half of the cases of perforation in typhoid fever 
occur during the third and fourth week of the disease, the chances 
are that this man had been ill since he first joined the ship. 

In conclusion, I wish to express my regret that I have been 
unable to present evidence more definite in character in the 
consideration of the origin of these epidemics. I have tried, 
however, to bring out all of the facts in the case so far as they 
are obtainable and from these facts I leave you to draw your 
own conclusions. 



PROPHYI.AXIS. 

BERI-BERI {Roths Jahresbericht) a disease which develops 
especially in people who live mostly on rice and non- 
nitrogenous food, was remarkably well subdued in the 
Russian-Japanese war with dietetic measures, — a remarkable ad- 
vance in hygiene as compared with the Japanese-Chinese war. 
Cholera nearly disappeared entirely; typhoid was 9. 26 per cent 
against 37,14 per cent in the Chinese war; dysentery 10.50 per 
cent as against 108.96 per cent; malaria was 1.96 per cent as 
against 102.58 per cent; Deaths were 2.68 per cent instead of. 
15.72 per cent. The Japanese used as a prophylactic, creasote 
pills, and every man received one pill daily. Water, and apparatus 
to boil it, were carried with the army. Apparatus for disinfection 
were also carried and whenever indicated, the clothing was dis- 
infected. Prophylaxis in the army against smallpox, yellow fever, 
plague, typhoid fever and dysentery has greatly reduced the mor- 
bidity. Military surgeons should especially be trained in bacter- 
iological work; how much such surgeons are capable of doing, by 
examination of the quarters, grounds, water conditions and re- 
moval of garbage and excreta, to prevent epidemics, has been 
amply shown in the Russian-Japanese war. — Freu J. Conzkl- 

MANN. 



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A METHOD OF TRANSPORTING DISABLED SOLDIERS 

IN THE FIELD, ON A REGULATION LITTER, 

ATTACHED TO A SADDLE, USING ONLY 

A MOUNTED SOLDIER'S EQUIPMENT. 

By CAPTAIN GEORGE P. PEED, 
MEDICAL CORPS UNITED STATES ARMY. 

DURING the Division Meet at Pasay, February 1907, the 
following event was open to squads of the Hospital 
Corps. 

For squads of four: first No. 2 in charge. 

1st squad No. 1, mounted. 

No. 2, with litter at the "shoulder." 

2nd squad at the "carry." 

Run 200 paces to a designated "patient," render 
first aid for an injury noted on the diagnosis tag 
attached to the man, improvise a means, fas- 
ten to the saddle, for carrying the patient lying 
flat on his back, load the patient thereon and bring 
him at a walk to a designated point fund unload him. 

The squad from the Division Hospital demonstrated the 
method to be described in this paper and was awarded first place. 

PREPARATION OF THE SADDLE. 

Stirrups and stirrup straps are removed from the saddle. 
The surcingle is then passed under the saddle-bags and over the 
saddle, between the cantle and the stud, and cinched tight 
around the horse. The lariat is uncoiled and the picket pin de- 
tached. The blanket roll is strapped to the cantle as tightly as 
possible. 

FASTENING THE LITTER TO THE SADDLE. 

The litter is opened, both braces being extended and placed 
on the saddle, with the middle of the front brace in front of the 
pommel, and resting on the ledge over which the quarter-strap 
passes. The two poles of the litter rest on the blanket-roll. 

(47) 



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48 



CAPTAIN GEORGE P. PEED, 



The center of the picket pin is placed under the center of 
the front brace, and both are secured to the pommel by the mid- 
dle coat strap. The picket pin is used to add security to the 
brace and lift the canvas from the pommel. Each side popimel 
coat strap is used to secure the litter to the pommel by passing 
it through the front litter stirrup of its respective side, and 
buckled tight. The litter should be perfectly level, over the 
center of the saddle and parallel to the back of the horse. One 
of the stirrup straps is then passed under the blanket roll, over 
the litter and buckled tight. 

The lariat 
is grasped 
near one end, 
and a bight 
passed 
through one 
of the stirrup 
loops of the 
saddle ; the 
bight isdrawn 
through until 
the knot in 
the end of the 
lariat is snug 
against the 
stirrup loop; 

Fig. K Showing bight in larUt binding the front litteff itirrup the bight is 
on the off side to tlie saddle* then passed 

around the 
front litter stirrup on the same side, drawn tight, and made fast 
by a half hitch at the stirrup loop. The free end of the lariat is 
then passed across the seat of the saddle, and a bight passed 
through the opposite stirrup loop, around the front litter stirrup 
on the opposite side, and made fast. 

A bight in the lariat is then passed through the cincha ring 
on the same side, and the free end of the lariat passed through 
the bight and tightened. The bights described above should be 



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A METHOD OF MOUNTING THE REGULA TION LITTER, 49 



made as near the attached end of the lariat as possible. The 

rope is then carried back and a hitch thrown around the rear 

litter stirrup 

on the same 

side and 

drawn tight, 

while the rear 

handles are 

pulled down. 

The rope is 

then passed 

over the lit- 

t e r , hitched 

around the 

opposite litter 

St i r r u p and 

carried to the 

cincha ring 

on the corresponding side, and made fast. 



Fig* 2* Showing the litter feady to be loadedU 



pommel. 



The litter is then 
ready for the 
patient. 

The patient 
is loaded with 
his head in 
the direction 
of the head 
of the horse, 
and a coat or 
some other 
suitable arti- 
cle should 
be used as a 
pillow, e X - 
tending over 
that part of 
the litter 
above the 
The litter sling in front is passed through the litter 



Fig. 3* Loaded Litter* 



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50 CAPTAIN GEORGE P. PEED, 

stirrup of the same side, across the patient's chest, under 
his arms and fastened to the opposite stirrup. The other sling 
should be fastened in the same way over his legs. 

The transportation of disabled soldiers in the field, has al- 
ways been, and ever will be, a problem to be worked out with 
the facilities at hand. 

The greatest objection to this form of transportation is that 
the motion of the horse's back is transmitted to the patient, 
causing more or less jolting, depending on the gait of the horse, 
yet it is believed that the method will be of advantage at times, 
as a^e the Iravois, cacolet, dooly, etc. 

It has been repeatedly demon.strated that it is possible to trot, 
gallop and run without much inconvenience to the man on the 
litter. 

The advantages are, viz: 

The center of gravity of the loaded litter is as near the sad- 
dle as practicable. 

The litter is quite securely attached, and the saddle pre- 
vented from shifting by the addition of the surcingle. 

The litter can be pttpare^a ifr»4ew minutes, and nothing 
but the equipment gf d mounted sbldi^- m required. 



SUDDfEW DEATH FROM ORCHITIS. 

AN epidemic of paf^^lfttfattkAcd iw^nty -eight men(Bonnette, 
/^W^ Deutsche M Hilar arztliche Zeitschrifi) . Nine of them de- 
veloped simultaneously a severe orchitis. Especially se- 
vere were the subjective symptoms in an infantry soldier, nineteen 
years of age, formerly always well and strong. On the fourth 
day of the disease the temperature was 39.5, pulse 130, heart 
sounds rough and weak. On the evening of the following day 
sudden death resulted without any preliminary symptoms. Au- 
topsy not allowed. The author considers that death was due to 
embolism following infectious endocarditis. — Fred J. Conzel- 

MANN. 



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Contempotatie Comment 



MILITARY MEDICAL NEEDS IN AUSTRIA. 

IN the Deutsche Miliiaerztl. Zeitschrift^ Dr. Hueppe makes 
an interesting communication concerning the necessity of a 
reform in the medical corps of the Austrian Army. The 
lack of candidates for army surgeons and the increased number 
of resignations owing to insufficient advancement have reached 
the point of calamity. The problem does not only concern the 
army that seeks medical aid, but also the whole state to which 
the army with its excellent military sanitation has become a 
necessity for public sanitation. The sanitary service in Austria 
is only in its incipiency, whereas in Germany and other nations 
the medical men of the army in combating epidemics in peace 
and war, have added valuable contributions for the benefit of the 
nation. Organization and reorganization must develop from the 
circumstances within, in order to become efficient. Austrian 
authorities must rid themselves of the idea that medical officers 
are not combatants. For the medical officer, in his effort to 
prevent epidemics and striving against the smallest yet most dan- 
gerous enemies, is continuously a combatant, often risking his 
own life in order to save others from disease and death. The 
line officer is a combatant in actual warfare but in jtimes of peace 
he is not. The military surgeon as hygienist and sanitary offi- 
cer is a combatant in war and peace. Statistics of campaigns 
show, in very simple language, that in times of war the medical 
officer is in more danger than the line officer. The medical 
corps, as sanitary officers of the army or navy, is a technical 
body of men and must, as such, have the same rank and authority 
as other officers. Then, intelligent, ambitious young medical 
men will be attracted to the military service just as other intelli- 
gent men are attracted to the duties of the line. Our times ^nd 

(51) 



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52 CONTEMPORARY COMMENT. 

associations do not allow young men of academic education to be 
set back of other men. The danger of an inadequate medical 
corps in a campaign is very great. Many campaigns have been 
lost purely from lack of adequate military hygiene. Bismark 
and the German authorities fully appreciated the danger of epi- 
demics to an army in times of war. France lost a whole army 
corps for lack of protective vaccination, a means which the Ger- 
man military surgeons had thoroughly carried out. The mili- 
tary medical school should have a two years course so that mili- 
tary surgeons may be thoroughly prepared for their duties. 
Sanitation in war, to be successful, must be supervised by men 
who had experience in times of peace. — F. J. Conzelmann. 



MILITARY MEDICAL SERVICE IN FRANCE. 

IN France {Roths fahresbericht) military surgeons fall into 
two classes, one class is too much, the other too little de- 
veloped in military affairs. The latter usually possesses a 
better knowledge of science and medicine but have not the re- 
quired authority with the soldiers. Good horsemanship is con- 
sidered a better qualification for military surgeons by the lead- 
ing authorities in France than a knowledge of medicine and 
surgery. A reform in the sanitary corps is undoubtedly neces- 
sary. According to the military law of 1905 men found unfit 
for military service on account of some trivial defect are enlisted 
in the future in the service corps (Service auxiliare) to serve 
without weapons. Formerly these men were only required to 
serve in time of war as storekeepers, horse tenders, etc. It is 
calculated to enlist 8,000 men annually in the service corps. 
The men consist of mechanics, shoe makers, tailors, harness 
makers, book keepers, clerks, laborers, etc., and constitute the 
working soldier. The plan originated with the Japanese who 
were very successful with the service corps in their recent war. 
— Fred J. Conzei^mann. 



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rt!yeblco=flDlUtatie Unbei. 



MEDICO MILITARY ADMINISTRATION. 

American National Red Cross. Resolutions adopted by the Executive 
Committee of the * * * [Wash., 1907.] 2 1. 4°. 

Great Britain. Army Medical Department. Handbook of the medi- 
cal services of foreign armies. Pt. i, France, Lond., 1908, Harrison & Sons* 
107 p. 16°. 

Bachmann (R* A«) The hospital arrangements of a man-of-war. /. 
Am. M. Ass., Chicago, 1907, xlix, 1 771-1773. 

Bartbelemy and Morinon. [Improvisation of a litter and operating table 
for an aid post] ArcA. de mfd, et pharm. mil,. Par., 1907, 353362. 

Bonnctte* [The portable measure of recruiting sergeants.] Caducte, 
Par., 1907, vii, 288. 

Bowie (S« C) A criticism of schemes and a new scheme for the dental 
treatment of British troops in India. /. Roy, Army Med, Corps, Lond.* 
1907, ix, 584-598. 

Cramer (H.) [The medico-military regulation of Jan. 27, 1907, with the 
proposal for voluntary nursing of March 12, 1907.] Ztschr,f, Krankenpjl., 
Bcrl., 1908, xxxi, 1-8. 

de Larra (A.) [Military occupations and the medical corps.] Rev. 
san, mil.y, med, mil. espah,, Madrid, 1907, i, 593-600. 

de Pradel (E.) [Maneuvers of the medical service of the 8th Corps 
around Dijon.] Presse mkd.. Par., 1907, xv, annexes 697. 

Ferraton. [Wound-dressing in military surgery.] Rev. mid,. Par., 
1907, xvi, 747-755- 

Finot [A study of the service of the medical corps of the first line in 
the field in a division equipped for a siege.] Arch, de mid et pharm. mil., 
Par., 1907, i, 338-353. 

Oder (P. A.) [Desirable alteration of army medical institutions in 
time of war, on the basis of experience during the recent war.] Voyenno- 
fned.J., St. Petersb., 1907, ccxx, med. spec. pt. 398-405. 

Grenier. [Dental service in the regiment] Caducee, Par., 1908, viii, 20. 

Herkt. [Railway transportation of the sick.] Ztschr.f. Bahn.-u, Bahn- 
kassendrzte, Leipz., 1908, iii, 1-7. 

Macphecson (W* G«) The rdle of the Red Cross Societies in peace and 
in war. /. Roy, U, Service Inst., Lond., 1907, li, 1 345-1 363, i pi. Also, Re- 
print. 

(53) 



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54 MEDICaMILITARY INDEX, 

— The rOle of the Red Cross Societies in peace and in war. Ix)nd., 
19071 J- J- Keliher & Co., 19 p. i map. 8**, 

Momose* [The prophylaxis of typhoid fever in the navy.] Saikiugaku 
Zasshiy Tokyo, 1907, 520-528. 

Morris (W* A*) Incinerators in cantonments. Indian Af, Gas,, Cal- 
cutta, 1907, xlii, 374, I pi. 

Moa (E. L«) Report on inefficiency caused by pustular skin eruptions 
and their association with the regulation flannel shirt /. Roy. Army Med. 
Corps, Lond., 1907, ix, 500. 

Nibon (G») [Vehicles for the sanitary service.] Tidskr. i mil. Hdlsov., 
Stockholm, 1907, xxxii, 262-272. 

Rodri^es Braga (A.) [Duties of the Medical Corps in Naval Combats]. 
Arch, de hyg, et path, exotic, Lisb., 1905-6, i, 133-152, i pi. 

Rudeoschdid (T*) [Some principles for the Swedish volunteer sanitary 
service in the field.] Tidskr.imil. Hdlsov., Stockholm, 1907, xxxii, 241-252. 

Sarmeato (A*) [Prevention of malaria and yellow fever on board ships]. 
Arch, de hyg. et path, exotic, Lisb., 1905-6, i, 109-128. 

Schaefer* [The modern armament and the medical corps in the field.] 
Rev. san. mil.y med. mil. espan,, Madrid, 1907, i, 483; 504. 

Schddl (H.) [Sidelights on military surgery.] Militdrarzt, Wien, 
1907, xli, 113-117. 

SchilL [Remarks on transportation of the sick.] Deutsche mil. drztL 
Ztschr,, Berl., 1907, xxxvi, 961-977. 

Shaikeyich (M* O*) [Mental diseases in the army in connection with 
the Russo-Japanese war.] Voyenno M. /., St. Petersb., 1907, ccxix, med. 
spec, pt., 270; 445; 629; ccxix, med. spec. pt. 81-94, 

Sluchevoski (A* M.) [Ophthalmic aid in Quantung peninsula and in be- 
sieged Port Arthur during the war.] Vestnik oftamoL, Mosk., 1907, xxiv, 
643-648. 

Violin (Ya A*) [Dwellings of our soldiers in Manchuria during the 
Russo-Japanese war.] Voyenno med. /., St. Petersb., 1907, ccxx, med. 
spec. pt. 68; 236. 

Yasujioia (S.) and Vamaxaki (S.) The killed and wounded of the field 
artillery regiment at the siege of Port Arthur. Sei-i-Kwai M./., Tokyo, 
1907, xxvi, 167; 179. 

MEDICO MILITARY HISTORY AND DESCRIPTION. 

Bennecke (K*) [Paralysis in non-commissioned officers.] Monatschr. 
f. Psychiat. u. Neurol., Berl., 1907, xxii, Ergngshft., 5-13. 

Beryodn (V.L) [Epidemic of gastro-enteritis in the 112th Ural regi 
ment] Voyenno med. J., St. Petersb., 1907, ccxx, med. spec. pt. 378-387. 

Boldt (K*) [Significance of hysteria in the army.] Monatschr, f. 
Psychiat. u, Neurol., Berl., 1907, xxii, Ergnschft., 25-34. 

Bonoette [La Meltrie, physiologist and pamphleteer, an army surgeon 
of the French guards.] Bull, med,. Par., 1908, xxv, 60. 



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MEDICO-MILITARY INDEX. 55 

Graajux. [Tuberculosis In soldiers and the responsibility of the State.] 
Bull, med.^ Par., 1907, xxi, 1039. 

Harriion (W* S«) Enteric fever in war. /. Ray, Army Mtd. Corps, ^ 
Lond., 1907, ix, 547-557- 

Hyades. [The Red Cross Conference of 1907 in its relation to the 
navy.] Arch, de mPd. nav., Par., 1907, Ixxxviii, 161; 241. 

Leerand (M.) [The Red Cross in Morocco.] Presse m^d,^ Par., 1907, 
XV, annexes, 745-747- 

Mann (A*) [Hysteria in soldiers.] Militararxt^ Wien, 1907, xli, 197; 
219. 

Martin. [The half-insane and irresponsible from the military point of 
view.] Arch, mPd. beiges^ Brux, 1907, 4. s., xx, 217-233. 

Reder (B.) [Care of the wounded on the battlefield in modern warfare 
in the Austro-Hungarian Army.] Militdrarzty Wien, 1907, xli; 263-269. 

Schiits* [Dubious cardiac conditions and their estimation from a 
medico-military viewpoint.] Militdrarxt^ Wien,'^907, xli, 270. 

Tlkhomiroff (V. W.) [General outbreak of Gastroenteritis in the 4th 
Infantry Regiment.] Voyenno med.J,^ St. Petersb., 1907, ccxx, med. spec. 
Pt-, 387-390- 

Vladiminkl (A. V.) [Paranvia on the theater of war.] Ohozr,psichiat,^ 
neural, [clc,"] St. Peterb., 1907, xii, 449-466. 

Zazik* [Military service and insanity.] Militdrarzt^ Wien, 1907, 26; 
40; 60; 74; 92; 109; 124; 155- 

MILITARY HYGIENE. 

Bcoca (A*) and Polack* [Naval regulations as to vision of right signals.] 
Campt, rend. Acad, d. sc.^ Par., 1907, cxxv, 828-830. 

Davldoff (N* N.) [Sanitary measures for the army.] Vayenna med. 
y., St. Petersb., 1907, ccxx, med. spec. pt. 391-397. 

DelmeUe (J*) [Dental hygiene in the barracks.] Odontologie, Par., 
1908, xxxix, 24-28. 

Freund (H,) [Public hygiene and fighting capacity.] Militdrarzt, 
Wien, 1907, xli, 140; 150. 

Joseph (E.) [Technique and hygiene of the ambulance.] Arztl, Sach- 
verst Ztg,y Berl., 1907, xiii, 465-469. 

K# [Water supply of the army in the field.] Riv. di i gegner^ san.y 
Torino, 1907, iii, 246-249. 

K06 (WL) [Visual disorders in recruits.] Milttdrarzt, Wien, 1907, xli, 
211; 230. 

Levering (P. A*) The alcohol question in the Navy; with suggestions 
as to its restriction. /. Am. M. Ass., Chicago, 1907, xlviii, 591-594. 

McGill (H. S.) The sanitation of transports. /. Ray, Army Med. 
Corps, Lond., 1906, vii, 472-484. 

BSarabail (Capitaine) [Psychology of the colonial soldier.] Rev. d. 
troupes colon. Par., 1906, ii, 787-801. 

Matignon (J. J*) [Hygiene of the Japanese army, apropos of the in- 
dividual manual of hygiene of the soldier.] Re7>. d^ hyg., Par., 1906, xxviii, 
1043-1058. 

Niedda (A») [Diseases of the ear incompatible with military service.] 
Gior, med, d, r, esercito, Roma, 1906, liv, 783-802. 



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56 MEDICO-MILITARY INDEX, 

Noack (Max) [The nutrition of soldiers in the garrison.] Leipzig, iqo6, 
B. George, 54 p. 8°. 

Pearse (A.) Preventive medicine in the army. /. Roy. Army Med. 
Corfis^ Lond., 1906, vii, 584-588. 

Smithaon (A* £•) Some remarks on the prevention of infectious dis- 
ease on board troop ships. /. Roy. Army Med. Corps ^ Lend., 1907, ix, 604. 

Spooner (W») Sailors' food. Brit. M.J., Lond., 1906, ii, 862-864. 

Stade (Carl Wilhdm) [The present condition of the hygienic arrange- 
ments on board His Majesty's ships.] Halle a, j., 1906, S. R. I. Nietsch- 
mann, 78 p. 8°. 

Stappenbeck* [Two cases of self-mutilation in Russian recruits.] Deutsche 
7nil.'drztL Ztschr.y 1907, xxxvi, 107-111.' 

Szillftky* [Extempore military hygiene.] Honvedorvos, Budapest} 

1906, xix. 43-46. 

Takaki {Baron K*) An address on sanitation in the Japanese Navy 
and Army. (fniv. Penn, M, Bull., Phila., 1906-7, xix, 246-263, 

MILITARY MEDICINE. 

Ventilation (The) and drainage of the Mauretania. Lattcet, Lond., 

1907, ii, 1482. 

desQIIenls (JO [Military medicine in the past; a reformer of military 
hygiene under the old regime: J. Colomoier, general inspector of military 
hospital 1736-89. Caducee, Par., 1907, vii, 285. 

Doche* [The medical corps in time of peace, maneuvers of the 
medical division of the i8th Corps.] Caducie, Par., 1907, vii, 301-304. 

Franck (FO [Military surgery a hundred years ago.] Med. Klin,^ Berl., 
1907, iii, 1431. 

Granjux* [Military medicine in France.] CaducU, Par., 1907, vii, 286. 

—[The Sanitary Dog Club (National Society for the development of 
the sanitary dog idea in France).] Deutsche med. Wchnschr., Leipz. u. 
Berl., 1907, xxxiii, 1955-1957- 

von Notthafft* [Attempts at venereal prophylaxis in the army in the 
17th Century.] Ztschr.f. Bekdmpf. d. Geschlechtskr ., Leipz., 1907, vi, 333. 

Ravartt (G.) fOn the wounded at Liitzen (June 13-19, 1S13) and the 
rOle of Larrey.] Chron. mtd.^ Par., 1907, xiv, 756-760. 

Sestiai (L.) [Criteria for determining physical aptitude for military 
service in the Italian Army.] Ann. di med. nav.^ Roma, 1907, ii, 14, i ch. 

Steiner (J*) [Military medicine and the International Exhibition in 
Milan, 1906.]^ Militdrarzt, Wien, 1907, xlii, 193; 215; 234, 257. 

Wiadycrko ($•) [Mental troubles during the seige of Port Arthur.] 
N. iconog. de la Saipctri^re^ Par., 1907, xx, 340353. 

Weacott (S*) A plan of campaign against malaria. /. Roy. Army Med, 
Corps, Lond., 1907, ix, 623-625. 

The teeth of the soldier. J. Roy. Army Med. Corps, Lond., 

1907, viii, 141-150. 

Werner. [Losses in war once and now.] Rothe Kreuz, Berl., 1906, 
xxiv, 682. 

Woodruff (C. E.) The army canteen as a hieans of reducing intemper- 
ance. /. Am. M. Asso.y Chicago, 1907, xlviii, 594-597. 



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THE ARMY MEDICAL CORPS. 

THE Act of April 23, 1908, reorganizing the Medical De- 
ical Department of the Army, gives an increase in the 
medical corps of six colonels, twelve lieutenant colo- 
nels, forty-five majors and sixty captains or first lieutenants. 
Under this recent Act, the lieutenants of the Medical Corps are 
promoted to captain after three years service instead of five, and 
the increase in the higher grades insures promotion at a reason- 
able rate all through an officer's military career. Furthermore, 
applicants who are found qualified in the preliminary examina- 
tion are appointed first lieutenants of the Medical Reserve 
Corps, and ordered to the Army Medical School in Washington, 
D. C, for eight months instruction. 

Preliminary examination for appointment in the Medical 
Corps will be held on August 3, 1908, and formal applications 
should be in possession of the War Department prior to July ist. 
This modification of the Army Medical Service is so mate- 
rial that practically the entire circular of information for those 
who desire to enter the service is reprinted herewith. 

The Medical Corps now consists of a Surgeon General with the rank 
of brigadier general, fourteen colonels, twenty-four lieutenant colonels, 
one hundred and five majors, and three hundred captains or first lieuten- 
ants with rank, pay, and allowances of corresponding grades in cavalry 
arm of the service. 

Section 4 of the act of Congress referred to above provides: 'That 
no person shall receive an appointment as first lieutenant in the Medical 
Corps unless he shall have been examined and approved by an army med- 
ical board consisting of not less than three officers of the Medical Corps 
designated by the Secretary of War." 

Vacancies in the Medical Corps are filled by appointment to the jun- 
ior grade (first lieutenant). After three years service lieutenants, upon 
passing an examination to determine their fitness, are promoted to the 
g^ade of captain. 

(57) 



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58 EDITORIAL EXPRESSION. 

Promotions to the grades of major, lieutenant colonel, and colonel is by 
seniority, but there is an examination for that of major and another for 
that of lieutenant colonel. Advancement to the grade of colonel takes 
place without further examination. The surgeon general is selected by 
the President from among the officers of the corps. 

PAY AND EMOLUMENTS. 
To each rank is attached a fixed annual salary, which is received in 
monthly payments, and this is increased by ten per cent for each period 
of five years service until a maximum of forty per cent is reached. A 
first lieutenant receives $2,000 per annum, or $166.66 monthly. At the 
end of three years he is promoted to captain and receives $2,400 a year. 
In two years more he receives an increase of ten per cent for five years 
service, making $2,640 or $220.00 per month. After ten years service 
the pay would be $2,880 annually, or $240.00 per month. The pay at- 
tached to the rank of major is $3,000 a year, which, with ten per cent 
added for each five years service, becomes $3,600 after ten years ser- 
vice, $3,900.00 after fifteen years service, and $4,000 after twenty years. 
The monthly pay of lieutenant colonel, colonel, and brigadier general is 
$375, $416.66, and $500, respectively. Officers in addition to their pay 
proper are furnished with a liberal allowance of quarters according to 
rank, either in kind, or, where no suitable Government building is avail- 
able, by commutation; fuel and light therefor are also provided. When 
traveling on duty an officer receives mileage for the distance traveled, in- 
cluding the travel performed in joining first station after appointment as 
first lieutenant; the amount allowed is usually sufficient to cover all ex- 
penses of journey. On change of station he is entitled to transportation 
for professional books and papers and a reasonable amount of baggage 
at government expense. Mounted officers, including all officers of the 
Medical Corps, are provided with forage, stabling, and transportation 
for horses owned and actually kept by them, not exceeding two for all 
ranks below that of brigadier. Horses and horse equipments are fur- 
nished by the Government for all mounted officers below the grade of 
major. Groceries and other articles may be purchased from the Com- 
missary at about wholesale cost price. Instruments and appliances are 
liberally supplied for the use of medical officers in the performance of their 
duties. Well selected professional libraries are supplied to each hospital 
and standard modem publications on medical and suigical subjects are 
added from time to time; current issues of a number of representative 
medical journals are also furnished for use of medical officers. 

DUTIES AND PRIVII<KGES. 

Leave of absence on full pay may be allowed at the discretion of 
the proper authority at the rate of one month per year, and this when 
not taken may accumulate to a maximum of four months, which at the 



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THE ARMY MEDICAL CORPS. 59 

end of four years is then available as one continuous leave. Beyond this 
an officer may still be absent with permission on half pay. Absence 
from duty on account of sickness involves no loss of pay. 

Medical officers are entitled to the privilege of retirement after forty 
years service, or at any time for disability incurred in the line of duty. 
On attaining the age of sixty-four they are placed upon the retired list 
by virtue of law. Retired officers receive three-fourths of the pay of 
their grade (salary and increase) at the time of retirement. 

When medical officers with the rank of captain approach the period 
of their examination for promotion to a majority they are usually as- 
signed to duty as attending surgeons at or near the principal medical 
centers of the United States, to enable them to become familiar with the 
practice of the leading physicians and surgeons of this country, and to 
attend medical lectures, meetings of medical societies, etc These as- 
signments are made for one year only, in order that as many medical of- 
ficers as possible may be enabled to avail themselves of the advantages 
thereby afforded. At the end of this tour of duty they are required to 
make a detailed report to the Surgeon General showing how much of 
their time has been occupied by their official duties and to what extent 
they have availed themselves of the advantages offered for professional 
advancement. 

APPOINTMENTS. 

Appointments to the Medical Corps of the Army are made by the 
President after the applicant has passed a successful examination before 
the Army Medical Examining Board and has been recommended by the 
Surgeon General. Due notice of the meeting of the board is published 
in the medical journals. 

Permission to appear before the board is obtained by letter to The 
Adjutant General of the Army, which must be in the handwriting of the 
applicant, giving the date and place of his birth and the place and State 
of which he is a permanent resident, and enclosing certificates, based on 
personal acquaintance, from at least two reputable persons as to his citi- 
zenship, character, and habits. 

QUALIFICATIONS. 

An applicant for appointment in the Medical Corps of the Army must 
be between twenty-two and thirty years of age, a citizen of the United 
States, and a graduate of a reputable medical school legally authorized to 
confer the degree of doctor of medicine, in evidence of which his diploma 
will be submitted to the board at the time of his preliminary examina- 
tion. 

Hospital training and practical experience in the practice of medicine, 
surgery and obstetrics are essential, and an applicant will be expected to 



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60 EDITORIAL EXPRESSION. 

present evidence that he has had at least one year's hospital experience, 
or the equivalent of this in practice. 

EXAMINATION. 

The examination will consist of two parts — a preliminary examina- 
tion and a final or qualifying examination, as hereinafter described, with 
a course of instruction at the Army Medical School intervening. 

Preliminary examination will be required as follows: 

(a) Physical. The physical examination must be thorough. Candi- 
dates who fall below sixty-five inches in height will be rejected. Each 
candidate is also required to certify that he labors under no physical in- 
firmity or disability which can interfere with the efficient discharge of 
any duty which may be required. Errors of refraction, if vision is not 
below 20/40 in either eye, are not causes for rejection, provided they are 
not accompanied by ocular disease and are entirely corrected by appro- 
priate glasses. 

(6) Written examination on the following subjects: Mathematics 
(arithmetic, algebra, and plane geometry), geography, history, (espec- 
ially of the United States), general literature, Latin grammar, and the 
reading of easy Latin prose, English grammar, orthography, and com- 
position will be determined from the applicant's examination papers. 

This examination may be omitted in the case of applicants holding 
diplomas or certificates from reputable literary or scientific colleges, 
normal schools or high schools, or of graduates of medical schools which 
require an entrance examination satisfactory to the faculty of the Army 
Medical School. 

(c) Written examination in the following subjects: Anatomy, physi- 
ology, and histology, chemistry and physics, materia medica and thera- 
peutics, surgery, practice of medicine, obstetrics and gynecology. 

The preliminary examinations will be conducted by boards of medical 
officers at the large military stations in the United States; the questions 
in the several subjects being sent from the Surgeon General's office. 
Formal invitations will be extended to eligible applicants to appear at the 
most convenient points at which boards are convened and a date fixed for 
such appearance, which will be uniform throughout the country. No al- 
lowances can be made for the expense of applicants undergoing prelimi- 
nary examinations. 

Applicants who attain a general average of not less than eighty per 
cent in the preliminary examinations will be appointed to the Medical 
Reserve Corps with the rank of first lieutenant and ordered to the Army 
Medical School, Washington, D. C, for instruction as candidates for ad- 
mission to the Medical Corps of the Army. If, however, a greater num- 
ber of applicants attain the required average than can be accommodated 
at the school the requisite number will be selected according to relativ 



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THE ARMY MEDICAL CORPS. 61 

standing in the examination. An applicant thus selected will, before 
entering the school, be required to make an agreement to accept a com- 
mission in the Medical Corps if found qualified in the final examination 
and that he will serve at least five years thereafter, unless sooner dis- 
charged. Candidates undergoing instruction at the Army Medical School 
will receive the pay and allowances of first lieutenants including travel 
pay from their homes to Washington. 

An applicant failing in one preliminary examination may be allowed 
another after the expiration of one year but not a third; withdrawal from 
examination during its progress, except because of sickness, will be 
deemed a failure. 

The course of instruction at the Army Medical School will be of eight 
months duration, commencing on the first of October next succeeding 
the preliminary examination; it will consist of lectures and practical 
work in such subjects as are peculiarly appropriate to the duties which a 
medical officer of the Army is ordinarily called upon to perform. During 
this course of instruction the candidates will be held under military dis- 
cipline, and character, habits, and general deportment closely observed; 
if for any reason a candidate should be deemed undesirable he may at 
any time, on the recommendation of the Surgeon General, be honorably 
discharged by the President. 

The final examinations shall comprise the subjects taught in the 
school, namely: Duties of medical officers. Medical Department adminis- 
tration and customs of the service, military hygiene, clinical microscopy 
and bacteriology, military surgery, military and tropical medicine, sani- 
itary chemistry, Hospital Corps drill, operative surgery, ophthalmology, 
and optometry, x-ray work. It will be preceded by a thorough physical 
examination. 

Candidates who, in their final examination, obtain a general average 
of eighty per cent and upward shall be given certificates of graduation at 
the school, and those whose aptitude, as determined by the faculty, is 
deemed satisfactory and who, in addition to their final examination, pass 
a successful clinical examination, will be selected for commission in the 
Medical Corps. Candidates claiming a knowledge of ancient or modern 
languages, higher mathamatics, or scientific branches, other than medical, 
may be given a special examination therein. 

The relative standing of the candidates thus selected for commission 
will be determined by the total number of points obtained in the profes- 
sional subjects of the preliminary examination as well as in the final, 
clinical, and special examinations, and for aptitude. 

Candidates who fail to receive commissions because of lack of vacan- 
cies in the Medical Corps at the time of graduation may receive them in 
the order of their standing as vacancies occur before the graduation of 
the next class. The remaining qualified candidates, if any, will be 



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62 EDITORIAL EXPRESSION. 

preferred for selection for volunteer commissions and for assignment on 
active duty in the Medical Reserve Corps. 

Any candidate who, at his final examination, fails to qualify men- 
tally shall not be entitled to a reexamination. Any candidate who quali- 
fies mentally but fails physically shall, upon the recommendation of the 
Surgeon General of the Army, be given an opportunity to be reexamined 
physically with the next class, and if then found qualified may be com- 
missioned without further mental examination, his standing in the class 
being determined by the aggregate of the marks obtained in the exami- 
nations already passed by him. 

The rapid promotion together with the liberal pay now given all 
officers of the Army ofl^rs such manifest advantages to young physi- 
cians that the very best and most representative graduates of our medi- 
cal schools should be attracted thereby. As accepted candidates for the 
Medical Corps are appointed first lieutenants of the Medical Reserve 
Corps during their service and instruction at the Army Medical School 
there is no delay in receiving the pay of lieutenant, and no final loss of 
relative rank in the corps to those who successfully pass through the 
school, as no appointments are made to the Medical Corps except from 
the successive graduating classes from the school. 

The period of instruction at the school, although an anxious time 
for the candidate, is looked back upon by the graduates as a most pleas- 
ant and profitable part of their service. The time of all students is fully 
occupied, but those who work steadily and faithfully and are well grounded 
in medicine need not fear failure at the end. 

The large number of vacancies created by recent legislation makes 
it certain that all successful candidates will be recommended for com- 
mission for several years to come. 

It will be to the advantage of the candidate to pass the required ex- 
amination and secure a commission at as early a date as possible. 

Applications for permission to appear for examination, prepared in 
accordance with requirements before mentioned, should be sent to The 
Adjutant General of the Army, and when completed will be filed in the 
Surgeon General's office until the next succeeding preliminary examination 
shall have been decided upon, when formal invitations to appear before a 
board will be issued. Applicants are advised to file the necessary papers 
as early as practicable, in order that the places of examination may be 
arranged most conveniently to applicants, due regard being had to the 
interests and necessities of the service. 

To illustrate the general character of written questions submitted, 
a few examples from the records of an Army Medical Examining Board 
recently convened are hereto appended. 



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THE ARMY MEDICAL CORPS. 



63 



EXAMPLES OF WRITTEN QUESTIONS. 
Preliminary EoMiminationa, 

MATHEMATICS. 

Note.— In each case give a concise explanation of the method by which 
the result is obtained. 

A. Arithmetic. 

1. What is the weight (metric) of 8.17 liters of alcohol of a specific 
gravity of 0.83? 

2. Find the greatest common divisor of the following: 

84, 262, 168, 210. 

3. What is the interest of $475.05 for 1 year, 9 months, and 14 days, 
at 7.3 per cent? 

4. What is the area of a circle the diameter of which is 24 meters? 

B. Algebra. 

5. Find the value of x, y, and z in the following: 

5 X + 2 y - 20 z=20. 
3x — 6y + 7z=^51. 
4x + 8y-9z = 53. 

6. Find the value of x and y in the following: 

5 6 
-+-=2. 
X y 
15 3 

=2.5. 

X y 

7. Find the value of x and y in the following: 

x» -f xy = 24. 
xy + y' = 40. 

C. Creomstry. 

8. (a) Define the following terms: "Circle"; "Radius"; "Secant"; 
"Chord^'. 

(6) Show by demonstration that the sum of the three angles of a 
triangle is eoual to two right angles. 

9. Show by demonstration that the area of a triangle is equal to half 
the product of its base by its altitude. 

10. Construct a square equivalent in area to the sum of the squares a 
and b. 




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64 EDITORIAL EXPRESSION. 

GEOGRAPHY. 

1. Where is the Strait of Juan de Fuca? The Strait of Magellan? 
The Strait of Belleisle? 

2. Where is the Island of Malta? The Island of Jersey? 

3. What territory is embraced in the watershed of the Ohio River? 

4. What countries, towns, and principal points are on or near the 
fortieth parallel of north latitude? 

5. Where are the Humboldt Mountains? The Ural Mountains? 

6. Where is Pike's Peak? Mount Rainier? 

7. Upon what bodies of water would a vessel pass between Phila- 
delphia and Copenhagen? 

HISTORY. 

1. When, where and by whom was the first settlement made within 
the present boundaries of the United States? 

2. Give a brief account of the French and Indian war. 

3. Describe the siege of York town. 

When were the States of Oregon and Washington admitted to the 
Union? 

What were the respective claims of the United States and Eng- 
land to the territory? 

Describe the principal naval battles of 1812? 

What was the Missouri compromise? 

4. Relate some of the events leading up to and occurring during the 
French Revolution. 

5. Who was the first king of the house of Tudor? 
Why was Mary Queen of Scots put to death? 

GENERAL LITERATURE. 

1. Mention four (4) of the literary men of the "Elizabethan period.*' 

2. Name three (3) well known German poets. 

3. Who were the best known literary men of the reign of Queen 
Anne? 

4. Name three (3) of the Latin poets of the time of Augustus. 

5. Who was Dr. Samuel Johnson? What was his most important 
work? 

6. Name three (3) of the novels of Thackeray, and some of the prin- 
cipal characters in them. 

7. Who was Sir Francis Bacon? When did he live? 

8. Name four (4) of the books of Nathaniel Hawthorne. 

9. Name three (3) well known American historians, and two (2) of 
the works of each. 

10. Who was Thomas Carlyle? Name three (3) of his more impor- 
tant works. 

LATIN. 

1. Translate literally into English the following: 

Recipe Potassii lodidi semiunciam, Liquoris Potassii Arsenitis guttas 
duodecim. Aquae Cinnamomi uncias duas. Misce. 
Signetur: una drachma ter in die. 

2. Write the following in the form of a prescription. Do not abbre- 
viate the Latin words, giving them in full. The quantities should be 
stated in terms of the metric system : 

Mix and make an emulsion of 250 parts of cod liver oil; water, 375 

Barts; simple syrup, 125 parts; sugar 750 parts; gum arabic, 156 parts, 
^ose: 15 to 30 grams daily. 



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THE ARMY MEDICAL CORPS. 65 

3. Translate literally into English the following anatomical terms: 

1. Flexor profundus digitorum. 

2. Triceps. 

3. Chorda Tympani. 

4. Scapulae. 

5. Linea media. 

4. Translate freely the following, which speaks of the German war- 
riors and their families on the battlefield: 

"Hi (infantes) cuique sanctissimi testes, hi maximi laudatores. Ad 
matres, ad conjuges vulnera ferunt; nee illae numerare aut exigere 
plagas pavent. Cibosque et hortamina pugnantibus gestant." 

5. In the quotation of question 4: 

1. What verb is understood in the first sentence? 

2. What part of speech is * 'cuique?'* 

3. Name the nouns and their cases in the last sentence. 

4. The word ''bellatores'' is understood before "ferunt, *' what is 

the meaning of the word? 

6. What nominative pronoun is understood before "gestanf in the 
last sentence? 

ANATOMY. 

1. Give the names and relations of bones entered in the formation of 
the skull. 

2. Describe the hip joint. 

3. Give the origin, insertion, and surgical anatomy of the superficial 
abdominal muscles. 

4. Describe the lobes and convolutions of the brain with especial 
reference to cerebral localization. 

5. Discuss the anatomy, descriptive and surgical, of the male peri- 
neum. 

PHYSIOLOGY AND HISTOLOGY. 

1. Trace the course of sensory and motor impressions between the 
brain and foot. 

2. What are the causes of the sounds of the heart? 

To what is arterial pressure due? How is it regulated? 

3. Describe the mucous membrane of the small intestine, and give 
the process of absorption of the products of digestion. 

4. Describe the corpuscles found in human blood, and discuss their 
origin and functions. 

5. Give the composition of urine and trace the course of each sub- 
stance through the body. 

CHEMISTRY AND PHYSICS. 

1. Define the terms: "momentum;** "gravitation;** "gravity;** 
* 'weight : ' * * 'specific gravity. * * 

2. What velocity will a freely falling body attain in five seconds? 

3. What is the principle of the hydrostatic press? Of the siphon? 
Of the lifting pump? 

4. What is a voltaic battery?** What is the source of its energy? 

5. What is the "solar spectrum?" Explain the phenomenon. 

6. Define the following terms: "Acid;" "base;** "salt;** "valence.** 
"radical.** 

7. Give the chemical properties of "mercury,** Describe a reliable 
test for it. Mention compounds of mercury used in medicine. 

8. Name three (3) metals of the "iron group.** 

9. Write equations showing the reaction taking place when sodium 



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66 EDITORIAL EXPRESSION. 

hvdroxid is added to each of the following acids: Hydrochloric; sul- 
phuric; acetic. 

10. Describe in detail a reliable method for determining the quantity 
of sugar in diabetic urine. 

MATERIA MEDICA AND THERAPEUTICS. 

1. What do you understand by specific medicines? 

Name five (5) that are so considered, the diseases in which they are 
effectual, their doses and how given? 

2. Mention all the methods bv which medication is directed through 
the skin, examples of each, and the object of each example. 

3. Tabulate any classification of medicines. 

4. Write a prescription which you are sure to be curative of round 
worms in a child. Use both apothecaries and metric weights and meas- 
ures. 

5. From surgical point of view what articles of the materia medica 
should you have always on hand? 

SURGERY. 

1. Discuss the etiolo^, symptoms, diagnosis, and treatment of 
strangulated inguinal hernia. 

2. What are the suture materials used in surgery and how are they 
sterilized? 

3. Discuss the etiology, symptoms, diagnosis, and treatment of 
malignant pustule. 

4. Give the surfi;ical treatment of stone in the pelvis of the kidney. 

5. Describe in detail the conservative treatment of a compound frac- 
ture of the head of the tibia opening into the knee joint? 

PRACTICE OF MEDICINE. 

1. Give the symptoms and physical signs of aortic insufficiency. 

2. Give the differential diagnosis between gastric ulcer and gastric 
cancer. 

3. Give the symptoms and diagnosis of typhoid fever in the first week. 

4. Give the symptoms of small-pox. 

5. Give the symptoms and physical signs of acute miliary tubercu- 
losis of the lungs. 

6. Give the symptoms and differential diagnosis of locomotor ataxia 
in the preataxic stage. 

OBSTETRICS AND GYNECOLOGY. 

1. Discuss the changes which take place in the organs of the mother 
during normal pregnancy. 

2. Discuss the causes and treatment of difficult labor. 

3. Give the etiology, pathology, symptoms and treatment of puerperal 
eclampsia. 

4. Give the etiology, symptoms, and treatment of cervical endome- 
tritis. 

5. Give the etiology, symptoms, and treatment of retrofiection of the 
uterus. 



THE MEDICAL RESERVE CORPS. 

THE Medical Reserve Corps, provided for in Sections 7, 8 
and 9 of the Army Medical Reorganization Act, recently 
passed by Congress and quoted in full in the last num- 
ber of The Mii^itary Surgkon, is now in course of organiza- 



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THE MEDICAL RESER VE CORPS, 67 

tion and we are glad to give as wide publicity as possible to the 
official announcement of the requirements for admission to the 
Corps. 

PAY AND EMOLUMENTS. 

Officers of the Medical Reserve Corps have the rank of first lieuten- 
ant, mounted, and, when on active duty, receive the pay of that grade, 
namely $2,000 per annum, or $166.66 per month. 

At the end of five years active service an increase of ten per cent is 
received, making $2,200 annually, or $183.33 per month. This ten per 
cent increase is given for each period of five years active service, until 
at the end of twenty years the maximum increase of forty per cent is 
received, making $2,800 per year, or $233.33 per month. 

Officers of the Medical Reserve Corps on active duty, in addition to 
their pay are furnished with quarters either in kind or by commutation 
at the rate of $36 per month. Fuel and light are also provided. When 
traveling on duty mileage is allowed, the amount usually being sufficient 
to cover all expenses of the journey. 

On changing station they are entitled to transportation for profes- 
sional books and papers, and baggage, including household effects. 

Being mounted officers, they are provided with horses and horse 
equipments when necessary. Groceries and other articles may be pur- 
chased from the commissary. Instruments and appliances and profes- 
sional books and journals are liberally supplied for the use of all medical 
officers in the performance of their duties. 

Leave of absence on full pay may be allowed at the discretion of the 
proper superior authority at the rate of one month per year. Absence 
from duty on account of sickness involves no loss of pay. 

In addition to a limited number of officers of the Medical Reserve 
Corps who are on active duty with the Army in time of peace, it is de- 
sired to maintain a list of qualified men all over the country who are will- 
ing to serve as medical officers in time of emergency. To such men the 
President is authorized to issue commissions, and it is expected that, as 
long as they are under commission, they may be relied upon to give ser- 
vice when called. Officers of the Medical Reserve Corps can not be com- 
pelled to accept active service, but should it be declined when offered, 
the commission will be vacated. Nothing prevents Medical Reserve 
Corps officers serving with the militia, or with the volunteer troops of 
the United States, or in the service of the United States in any other 
capacity, and when so serving or employed they are not subject to call 
for active duty with the Army. Officers of the Medical Reserve Corps 
who make application for active service may receive such assignment 
when the necessity exists. 



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68 EDITORIAL EXPRESSION. 

Approved candidates for the Medical Corps who have fulfilled the 
entrance requirements, will be temporarily commissioned as first lieuten- 
ants of the Medical Reserve Corps until they have passed through the 
Army Medical School and their fitness for the Medical Corps has been 
finally determined. (See article upon the Army Medical Corps.) 

APPOINTMENTS. 

Appointment to the Medical Reserve Corps of the Army is made by 
the President after the applicant has passed a successful examination be- 
fore an examining board detailed from the Medical Corps of the Army 
and has been recommended by the Surgeon General. 

Permission to appear before the board is obtained by letter to The 
Adjutant General of the Army, which must be in the handwriting of the 
applicant, giving the date and place of his birth and the place and State 
of which he is a permanent resident. He must also furnish certificates, 
based on personal acquaintanceship, from at least two reputable persons 
as to his citizenship, character and habits. 

QUALIFICATIONS. 

An applicant for appointment in the Medical Reserve Corps must be 
between twenty-two and forty-five years of age, a citizen of the United 
States, a graduate of a reputable medical school legally authorized to 
confer the degree of doctor of medicine, and must have qualified to prac- 
tice medicine in the State in which he resides. 

EXAMINATION. 

The examinations for appointment in the Medical Reserve Corps will 
be held from time to time at convenient places throughout the country 
and will embrace the following: 

1. Physical examination. This will be thorough and will conform to 
that required for officers of the Army in general. 

2. Examination of diplomas, certificates from state examining 
boards, certificates of membership in medical societies and any other 
certificates or testihionials which the applicant may wish to submit. 

3. An examination on the following practical subjects: 

(a) Practice of medicine, including etiology, clinical description, 
pathology, and treatment of diseases. 
(6) Surgery— principles and practice. 

(c) Obstetrics and gynecology. 

(d) Hygiene — personal and general, especially as to the prophylaxis 
of the more prevalent epidemic diseases. 

This examination will be oral and sufficiently comprehensive to deter- 
mine whether, in the opinion of the board, the applicant is (or is not) 
qualified to practice his profession under the usual conditions of the mili- 
tary service. 



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THE MEDICAL RESERVE CORPS, 69 

Should the oral examination in any subject be unsatisfactory the ap- 
plicant may be required to take a written examination on that subject. 

Successful candidates will be recommended to the President for com- 
mission. 

It is recognized that except for the limited number of Medical Re- 
serve Corps officers who are (»n active duty in the Army in time of peace 
there are few material inducements for representative physicians to ap- 
ply for appointment in the corps. The possession of a commission from 
the President of the United States, setting forth his confidence in the 
patriotism, fidelity and abilities of the holder is, however, something that 
anyone might be proud of, and the contact that the War Department will 
be able to maintain with the best class of young medical men throughout 
the land will, it is expected, be of great value in emergency. 

It is especially hoped that medical officers of the militia of the va- 
rious States may be sufficiently interested to secure positions on the Med- 
ical Reserve Corps list. 

Officers of the Medical Reserve Corps who may desire to enter the 
Medical Corps of the Army must be between twenty-two and thirty years 
of age (except in the case of former contract surgeons who entered the 
service as such before the age of twenty-seven and who were in the ser- 
vice at the time of the passage of the act of April 23, 1908) ; they must 
fulfill all requirements for appointment in the Medical Corps that are im- 
posed upon applicants who are not members of the Medical Reserve 
Corps. Full information in this regard is contained in the preceding 
article which includes the ''Circular of Information in relation to ap- 
pointment in the Medical Corps of the United States Army, the requi- 
site qualifications, examination of applicants, etc." 

The examinations will be held at an early date at a time 
which will be announced in Thk MitiTARY Surgeon and mean- 
while those who desire to enter the Corps should make applica- 
tion at once. 



INSANITY FOLLOWING GUNSHOT INJURY OF THE 

HEAD 

IN the Deutsche MilitaerztL Ztschr. . Dr. Kirsch reports four 
cases of insanity following gunshot injury of the head. In 
one the brain was injured, in the others only peripheral injury 
took place. The case with the injury of the brain had a profuse 
hemorrhage and develops a quarter of an hour later a severe 
maniacal attack which lasted several hours. Two other cases de- 
veloped a typical melancholia; both committed suicide. One case 
developed a marked stupor which lasted three weeks. — F. J. 
C0NZEI.MANN, 



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flevp8 of the Services* 



Assistant Surgeon A. H. Allen, U.S.N., ordered from duty in con- 
nection with the Cape Cruz-Casilda Survey Expedition to duty with Ma- 
rines at Havana. 

Assistant Surgeon D. G. Allen, U.S.N., appointed from June 15, 1908. 

Dr. E. A. Anderson, U.S.A., granted two months leave and ordered 
from Fort Wingate to Fort Sam Houston for temporary duty with troops 
in the field. 

Lieutenant Colonel Daniel M. Appel, U.S.A., left San Francisco for 
witness duty in Washington. 

Captain Bailey K. Ashford, U.S.A., ordered from Hattiesburg, Miss., 
to Washington Barracks. 

Dr. Edward Bailey, U.S.A., ordered to Dyea, Alaska, for annulment 
of contract. 

Assistant Surgeon M. C. Baker, U.S.N., ordered from the Mare Is- 
and Navy Yard to the Ohio, 

Passed Assistant Surgeon M. W. Baker, U.S.N., ordered from the 
Colorado to the Nebraska, 

Captain Howard H. Baily, U.S.A., ordered from Hattiesburg, Miss., 
to Washingfton Barracks; returned to Fort Myer from detached service 
at Hattiesburg, Miss. 

Lieutenant Colonel John M. Banister, U.S.A., appointed member of 
a board to meet at Washington, D. C, to review proceedings and find- 
ings of medical examining boards in the case of medical officers found 
disqualified for promotion. 

Surgeon G. H. Barber, U.S.N., ordered from the Naval Medical 
School to the Boston Naval Hospital. 

Dr. F. M. Barney, U.S.A., ordered to accompany troops from Fort 
Myer to the maneuver camp, Pine Camp, N. Y. 

Assistant Surgeon J. A. Biello, U.S.N., ordered from the Portsmouth 
Naval Hospital to the Solace. 

Passed Assistant Surgeon L. W. Bishop, U.S.N., ordered from the 
Hancock to the Indianapolis Naval Recruiting Station. 

Passed Assistant Surgeon E. M. Blackwell, U.S.N., ordered fronb 
the Naval Medical School before the Nav|il Medical Examining Board, 
then to wait orders. 

Surgeon E. S. Bogert, U.S.N., ordered from the Naval Medical 
School to the Newport Naval War College. 

(70) 



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NEWS OF THE SERVICES. 71 

Passed Assistant Surgeon J. M. Brister, U.S.N., detached from the 
Puget Sound Naval Hospital and ordered to continue other duties. 

Surgeon B. W. Brown, P.H.&M.H.S., granted one month and six 
days leave. 

Passed Assistant Surgeon E. M. Brown, U.S.N., granted three 
months extension of sick leave. 

Assistant Surgeon E. W. Brown, U.S.N., ordered from the Naval 
Medical School to the Norfolk Naval Hospital. 

Assistant Surgeon C. W. O. Bunker, U.S.N., ordered from the Na- 
val Academy to the Arkansas. 

Passed Assistant Surgeon J. T. Burkhalter, P.H.&M.H.S., granted 
one month's leave. 

Dr. D. P. Card, U.S.A., ordered to accompany troops from Fort Jay 
to the maneuver camp. Pine Camp, N. Y. 

Assistant Surgeon D. H. Casto, U.S.N., ordered from the Maine to 
Guam Naval Station. 

Passed Assistant Surgeon D. C. Cather, U.S.N., commissioned from 
July 9, 1907, and ordered from the Lancaster to the Kansas City Naval 
Recruiting Station. 

Captain Weston P. Chamberlain, U.S.A., granted twenty days ex- 
tension of leave. 

Dr. A. M. Chase, U.S.A., ordered to accompany troops from Fort 
Sam Houston to Chickamauga Park, Ga. 

Captain James R. Church, U.S.A., granted one month's leave. 

Acting Assistant Surgeon G. F. Clark, U.S.N., appointed from June 
6, 1908. 

Lieutenant Clarence L. Cole, U.S.A., ordered from Fort Thomas to 
Fort Benjamin Harrison. 

Assistant Surgeon H. W. Cole, Jr., U.S.N., ordered home from the 
Naval Medical School and granted one month's leave. 

Surgeon F. C. Cook, U.S.N., ordered from the Naval Academy to 
the North Carolina. 

Passed Assistant Surgeon G. M. Corput, P.H.&M.H.S., granted ten 
days leave. 

Colonel Louis W. Crampton, U.S.A., appointed member of a board 
to meet at Washington, D. C, to review proceedings and findings of 
medical examining boards in the case of medical officers found disquali- 
fied for promotion. 

Dr. W. O. Cutliffe, U.S.A., ordered from the Philippines to San 
Francisco to wait orders. 

Dr. W. H. Dade, U.S.A., ordered to accompany escort to Ute Indians 
from South Dakota to Utah, and return to Fort D. A. Russell. 

Major Carl R. Darnall, U.S.A., granted two months leave. 

Assistant Surgeon M. Donelson, U.S.N., ordered from the Porter to 
the Biddle. 



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72 NEWS OF THE SERVICES. 

Assistant Surgeon J. T. Duhigg, U.S.N., ordered to the Los Angeles 
Naval Recruiting Station. 

Passed Assistant Surgeon H. A. Dunn, U.S.N., ordered from the 
Nebraska to the Colorado, 

Major Basil H. Dutcher, U.S.A., ordered from the Philippines to the 
United States about July 15; granted two months leave. 

Major Rudolph G. Ebert, U.S.A., arrived at San Francisco from tour 
of Philippine service, and ordered to Vancouver Barracks for duty as 
Chief Surgeon, Department of the Columbia. 

Acting Assistant SuiTgeonW. W. Eichelberger, P.H.&M.H.S., granted 
fifteen days leave. 

Acting Assistant Surgeon E. W. Fahey, P.H.&M.H.S., granted ten 
days leave. 

Surgeon A. Fahrenholt, U.S.N., ordered from the Independence to the 
Maryland. 

Passed Assistant Surgeon W. G. Farwell, U.S.N., ordered from the 
Lancaster to Camp Elliott, Isthmian Canal Zone. 

Passed Assistant Surgeon A. M. Fauntleroy, U.S.N., ordered from 
the Naval Medical School to the Naval Medical School Hospital. 

Captain Peter C. Field, U.S.A., ordered to accompany troops to the 
maneuver camp at Chickamauga Park, Ga. 

Acting Assistant Surgeon C. E. Fisher, P.H.&M.H.S., granted ten 
days leave. 

Acting Assistant Sui^geon C. M. Frissell, P.H.&M.H.S., granted 
twenty days leave. 

Passed Assistant Suiigeon G. F. Freeman, U.S.N., ordered from the 
Naval Medical School to the Boston Navy Yard. 

Passed Assistant Surgeon C. H. Gardner, P.H.&M.H.S., granted one 
month's leave. 

Lieutenant Fletcher Gardner, late Contract Surgeon U.S.A., has 
been appointed Assistant Surgeon in the Indiana National Guard. 

Assistant Surgeon H. A. Garrison, U.S.N., ordered from the Phila- 
delphia Naval Hospital to the Guam Naval Station about July 5. 

Dr. W. R. S. George, U.S.A., granted ten days extension of leave; 
returned to Fort Greble from leave; ordered from Fort Greble to Fort 
Schuyler for temporary duty. 

Captain Robert B. Grubbs, U.S.A., ordered to Fort Mcintosh. 

Colonel Philip F. Harvey, U.S.A., appointed delegate to the meeting 
of the American Medical Association at Chicago. 

Dr. H. E. Hasseltine, U.S.A., ordered to accompany troops from 
Fort Thomas to Camp Perry, Ohio. 

Assistant Surgeon A. B. Haywood, U.S.N., ordered from the Chicago 
Naval Recruiting Station to Camp Elliott, Isthmian Canal Zone. 



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NEfVS OF THE SERVICES. 73 

Dr. O. F. Henning, U.S.A., ordered from Fort Sheridan to accom- 
pany troops from Chicago, 111., to San Francisco, Cal. 

Assistant Surgeon R. A. Herring, P.H.&M.H.S., ordered from Ellis 
Island to the Reedy Island Quarantine Station. 

Dr. D. D. Hogan, U.S.A., granted two months leave. 

Assistant Surgeon C. J. Holeman, U.S.N., ordered from the San 
Francisco Naval Training Station to the Charleston; and later to the 
Arethuaa, 

Passed Assistant Surgeon J. M. Holt, P.H.&M.H.S., appointed del- 
egate to the meeting of the Oregon State Medical Association at Port- 
land, Oregon. 

Captain Paul C. Hutton, U.S.A., ordered to return to Fort William 
H. Seward from Fort Benjamin Harrison. 

Major Merritte W. Ireland, U.S.A., appointed delegate to the meet- 
ing of the American Medical Association at Chicago, 111. 

Major William P. Kendall, U.S.A., ordered to accompany troops 
from Fort Ethan Allen to the maneuver camp, Pine Camp, N.Y. 

Surgeon J. T. Kennedy, U.S.N., ordered from the Dallas Naval re- 
cruiting Station to the Independence. 

Assistant Surgeon General J. W. Kerr, P.H.&M.H.S., granted fif- 
teen days leave to be taken between Chicago and Washington. 

Acting Assistant Surgeon W. M. Kerr, U.S.N., appointed from June 
12, 1908. 

Passed Assistant Suigeon W. W. King, P.H.&M.H.S., ordered from 
the San Francisco Quarantine Station to the San Francisco Marine Hos- 
pital. 

Dr. C. C. Kress, U.S.A., ordered to accompany troops from Fort 
Bliss to Leon Springs, Texas. 

Lieutenant Colonel Louis A. LaGarde, U.S.A., appointed member of 
a board to meet at Washington, D. C, to review proceedings and findings 
of medical examining boards in the case of medical officers found dis- 
qualified for promotion, and granted an extension of leave. 

Assistant Surgeon H. H. Lane, U.S.N., appointed from May 5, 1908, 
and ordered to duty in the department of government and sanitation, 
Canal Zone, Panama. 

Assistant Sui^geon A. J. Lanza, P.H.&M.H.S., ordered from the 
Manning to the Rush. 

Lieutenant Colonel Jose Barbosa Leao, detailed by the Portuguese 
government to represent it at the Atlanta meeting of the Association of 
Military Surgeons. 

Major William F. Lewis, U.S.A., ordered from Fort Sill to Leon 
Springs, Texas. 

Major Charles Lynch, U.S.A., granted one month's leave; ordered to 
temporary duty in the Surgeon General's office, and on its completion to 
revert to status of leave. 



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74 NEWS OF THE SERVICES. 

Passed Assistant Surgeon W. N. McDonell, U.S.N., ordered from 
the Buffalo Naval Recruiting Station to the Severn for duty in connection 
with the Naval Rifie Team. 

Assistant Surgeon R. W. McDowell, U.S.N., ordered to the Phila- 
delphia Naval Hospital. 

Acting Assistant Surgeon A. A. McLarty, P.H.&M.H.S., granted 
fourteen days leave. 

Acting Assistant Surgeon H. B. McMurdo, U.S.N., ordered to the 
San Francisco Naval Training Station. 

Surgeon G. M. Magruder, P.H.&M.H.S., granted one month's leave. 

Dr. M. F. Marvin, U.S.A., returned to Fort Mansfield from two 
months leave. 

Passed Assistant Surgeon H. S. Mathewson, P.H.&M.H.S., granted 
one month's leave; granted fifteen days leave. 

Passed Assistant Surgeon G. M. Mayers, U.S.N., ordered to the 
Mare Island Navy Yard, and to continue treatment at the Mare Island 
Naval Hospital; ordered to the Naval Medical School Hospital for treat- 
ment, t 

Assistant Surgeon K. C. Melhom, U.S.N., ordered from the Wabash 
to the Yankee, 

Captain Reuben B. Miller, U.S.A., gnranted two months leave in the 
United States. 

Passed Assistant Surgeon O. J. Mink, U.S.N., ordered from the 
Naval Medical School to the Chicago Naval Recruiting Station. 

Assistant Surgeon C. L. Moran, U.S.N., ordered from the Norfolk 
Naval Hospital to the Dallas Naval Recruiting Station. 

Assistant Surgeon C. B. Munger, U.S.N., ordered from the Supply 
to the Maine, 

Major Edward L. Munson, U.S.A., appointed delegate to the Amer- 
ican Medical Association at Chicago, and granted one month's leave. 

Assistant Surgeon E. H. H. Old, U.S.N., ordered from the Canacao 
Naval Hospital to Washington for examination for promotion and then 
to wait orders. 

Acting Assistant Surgeon H. E. Pearse, P. H.&M.H.S., granted 
three months leave without pay. 

Passed Assistant Surgeon A. E. Peck, U.S.N., ordered home from 
the Cavite Naval Station. 

Captain George P. Peed, U.S.A., ordered to accompany troops from 
Fort Ontario to the maneuver camp, Pine Camp, N.Y. 

Lieutenant Colonel Harry 0. Perley, U.S.A., ordered from the Phil- 
ippines to the United States about October 15. 

Captain Robert H. Pierson, U.S.A., ordered to accompany troops 
from Fort Niagara to the maneuver camp. Pine Camp, N. Y. 

Captain William A. Powell, U.S.A., ordered from Jefferson Barracks 
to the Philippines about July 5. 



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NEWS OF THE SERVICES. 75 

Passed Assistant Surgeon C. Ramus, P.H.&M.H.S., ordered from 
Honolulu to Ellis Island, N. Y. 

Major Henry I. Raymond, U.S.A., ordered to return from treatment 
at Washington to Columbus Barracks. 

Major Thomas U. Raymond, U.S.A., ordered to duty as Chief Sur- 
geon, Department of the Colorado, during the absence on leave of Lieu- 
tenant Colonel L. A. LaGarde, in addition to duty as Surgeon at Fort 
Logan. 

Assistant Surgeon E. U. Reed, U.S.N., ordered from the Charleston 
to the Mare Island Navy Yard. 

Acting Assistant Surgeon H. B. C. Reimer, P.H.&M.H.S., ordered 
from Boston to New York for special temporary duty and return. 

Captain Charles R. Reynolds, U.S.A., arrived in New York from the 
Philippines on leave. 

Assistant Surgeon Norman Roberts, P.H.&M.H.S., granted one 
month's leave. 

Surgeon M. J. Rosenau, P.H.&M.H.S., appointed delegate to the 
meeting of the Section of Pathology and Bacteriology of the American 
Medical Association at Chicago, 111., and granted one month's leave. 

Captain Frederick F. Russell, U.S.A., ordered to London, England, 
for a course of study in the British Army Medical School upon treatment 
of typhoid fever. 

Assistant Surgeon W. F. Schaller, U.S.N., resignation accepted 
June 1, 1908. 

Captain Edward R. Schreiner, U.S.A., assigned to temporary charge 
of the San Francisco Medical Supply Depot. 

Assistant Surgeon F. E. Sellers, U.S.N., ordered from the Naval 
Academy to the Nevada. 

Passed Assistant Surgeon H. O. Shiffert, U.S. N., ordered to the 
LawMster. ^ 

Surgeon E. M. Shipp, U.S.N., ordered from the Illinois to the Penn- 
sylvania. 

Captain Joseph F. Siler, U.S.A., ordered from Fort Des Moines to 
Fort Slocum. 

Dr. Nathaniel L. A. K. Slamberg, P.H.&M.H.S., appointed as Acting 
Assistant Surgeon, for duty at Eastport, Idaho. 

Dr. E. F. Slater, U.S.A., arrived at Madison Barracks from leave. 

Surgeon A. C. Smith, P.H.&M.H.S., granted one month and fifteen 
days leave. 

Passed Assistant Surgeon C. G. Smith, U.S.N., ordered to the Ports- 
mouth Naval Hospital. 

Assistant Surgeon C. W. Smith, U.S.N., appointed from June 15, 1908. 

Surgeon G. T. Smith, U.S.N., ordered from the Naval Medical School 
to the New York Naval Hospital. 



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76 NEWS OF THE SERVICES. 

Passed Assistant Surgeon J. J. Snyder, U.S.N. , ordered from the 
Naval Medical School before the Naval Medical Examining Board, then 
to wait orders; ordered to the New Hampshire, 

Dr. F. H. Sparrenberger, U. S. A., granted one month and twenty 
days leave. 

Assistant Surgeon P. R. Stalnaker, U.S.N., ordered from the Naval 
Medical School before the Naval Medical Examining Board, then to wait 
orders. 

Surgeon W. G. Stimpson, P.H.&M.H.S., granted eleven days leave. 

Major John H. Stone, U.S.A., ordered from duty with the Army of 
Cuban Pacification to Newport News for further orders. 

Major Paul F. Straub, U.S.A., ordered to report to the President of 
the Army War College for duty pertaining to the staff ride over the" bat- 
tlefields of Virginia. 

Dr. Frank Suggs, U.S.A., returned to Fort Niagara from Madison 
Barracks. 

Assistant Surgeon J. L. Taylor, U.S.N., ordered from the Naval 
Medical School before the Naval Medical Examining Board, then to wait 
orderis. 

Assistant Surgeon G. C. Thomas, U.S.N., appointed from June 15, 
1908. 

Acting Assistant Suiigeon, M. J. Thornton, P.H.&M.H.S., granted 
one month's leave. 

Colonel George H. Torney, U.S.A., granted fifteen days leave. 

Captain Albert E. Truby, U.S.A., ordered to accompany one-half of 
Co. B., Hospital Corps, from San Francisco, Cal., to Murray, Wash., for 
camp duty. 

Dr. G. T. Tyler, U.S.A., ordered to accompany troops from Fort 
Porter to the maneuver camp, Pine Camp, N.Y. 

Surgeon J. F. Urie, U.S.N., ordered from the Pennsylvania to the 
Illinois, 

Passed Assistant Surgeon W. W. Verner, U.S.N., resignation ac- 
cepted from June 10, 1908. 

Passed Assistant Surgeon C. W. Vogel, P.H.&M.H.S., ordered from 
temporary duty at San Francisco to San Juan and other quarantine sta- 
tions in the Island of Porto Rico, and also to certain points in Venezuela, 
for special temporary duty. 

Captain William E. Vose, U.S.A., ordered from Fort Slocum to Fort 
Des Moines. 

Acting Assistant Surgeon W. S. Walkley, P.H.&M.H.S., granted 
ten days leave. 

Passed Assistant Surgeon R. A. Warner, U.S.N., commissioned from 
May 3, 1908. 

Passed Assistant Surgeon B. S. Warren, P.H.&M.H.S., granted two 
months leave. 



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NEWS OF THE SERVICES. 77 

Captain Frank W. Weed, U.S.A., ordered to accompany troops from 
Plattsburgh Barracks to the maneuver camp, Pine Camp, N.Y. 

Contract Surgeon Samuel T. Weirick, U.S. Army, who has been on 
duty at Alcatraz Island, Cal., has been examined at the Presidio of San 
Francisco with a view to his appointment as a first lieutenant in the Army 
medical department. Surgeon Weirick is 65 years of age and upon quali- 
fying for appointment will be commissioned as a junior officer in the reg- 
ular medical department and at once transferred to the retired list. 
This is in the line of the decision of the War Department based on the 
opinion of the judge advocate general that a contract surgeon of the 
Army who received his original appointment as such before he was tWenty- 
seven years of age may be considered as eligible to appointment to the 
Army medical department. 

Dr. H. R. Weston, U.S.A., ordered to accompany troops from Fort 
Ethan Allen to the Maneuver camp. Pine Camp, N.Y. 

Captain Arthur M. Whaley, U.S.A., ordered from Jackson Barracks, 
La., to Fort Sam Houston, and granted three months leave. 

Dr. J. M. Wheate, U.S.A., granted twelve days leave. 

Assistant Surgeon E. C. White, U.S.N., ordered from duty with 
Marines in Havana home to wait orders. 

Surgeon J. H. White, P.H.&M.H.S., appointed delegate to the meet- 
ing of the Section of Hygiene and Sanitary Science of the American 
Medical Association at Chicago, 111. 

Passed Assistant Surgeon M. J. White, P. H.&M.H.S., granted one 
month's leave. 

Assistant Surgeon L. C. Whiteside, U.S.N., appointed from June 15, 
1908. 

Surgeon G. B. Wilson, U.S.N., ordered from the Naval Medical 
School to the Wabash, 

Surgeon G. B. Young, P.H.&M.H.S., appointed delegate to the 
meetings of the American Medical Association at Chicago, III., and the 
Lake Michigan Water Commission at Grand Rapids, Mich. 

Acting Assistant Surgeon J. C. Zeigler, U.S.N., ordered from the 
Portsmouth Naval Hospital to the Pensacola Naval Hospital. 

The New Manual for the Army Medical Department.— The new 
manual for the Medical Department of the Army is in course of comple- 
tion, but cannot be finished until after the publication of the new Army 
Regulations. It is impossible to say how long it will be, but presum- 
ably several months will elapse before the manual will be ready for dis- 
tribution. 

Army Medical Pack Saddle.— The board on transportation for the 
Medical Corps of the Army has adopted a modification of the Pullman 
pack saddle. The new arrangement makes use of the leather pannier, 
but it is to be cut open at each side and enlarged so as to take in the 



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78 NE WS OF THE SER VICES, 

army medical chest, which the old one would not do. The fastenings 
are also to be strengthened to hold the chest in place. The drawings 
have been sent to the St. Louis depot to have six specimen saddles and 
panniers made for trial use. 

Low Typhoid Sick Rate in the Army.— The Army Medical De- 
partment has again broken a health record in this country. Reports re- 
ceived at the office of the surgeon general of the army indicate that the 
rate for typhoid fever in the army for the past year was less than one- 
half that of the civilian population of military age in this country. This 
result is a direct proof of the efficacy of the measures taken by the 
army medical department in camp and garrison sanitation. It shows 
what is possible by unremitting compliance with the rules of sanitation 
on the part of officers of the line. 

Hygienic Appliances for Summer Maneuver Camps. —The War 
Department has purchased some sixteen incinerators for distribution to 
the various maneuver camps for use during the joint exercises of the 
regular army and militia during the coming summer. There will also 
be distributed to these camps twenty-five DamaH filters, which will be 
subjected to further trial under the practical conditions which are pos- 
sible. The large portable Forbes water sterilizer now at the Washing- 
ton Barracks will be shipped to the maneuver camp at Chickamauga 
Park, Ga., where there will be additional opportunity for the employ- 
ment of that method of purifying drinking water. 

Chief Surgeons of Maneuver Camps.— The following officers of 
the Army Medical Corps are detailed as Chief Surgeons at the respective 
maneuver camps. The Chief Surgeon, Department of California, at 
Atascadero Ranch, Cal.; The Chief Surgeon, Department of Colorado, 
at American Lake, Wash. ; The Chief Surgeon, Department of the East, 
at Pine Camp, N.Y.; The Chief Surgeon, Department of the Gulf,' at 
Chickamauga Park, Ga. ; The Chief Surgeon, Department of the Lakes, 
at Fort Benjamin Harrison; Lieutenant Colonel John M. Banister, at 
Fort Riley; Lieutenant Colonel Aaron H. Appel, at Fort D. A. Russell; 
The Chief Surgeon, Department of. Texas, at Leon Springs, Texas. 

Reorganization of the Medical Department of the Russian 
Army.— The Bulletin du Service de Sg^nte Militaire informs us that there 
are more than five hundred vacancies in the medical corps of the Russian 
army and last spring it was necessary to call in retired medical officers 
and to employ the services of civilian physicians. 

The proposed changes in the medical department are as follows: 

(a) Medical officers are no longer regarded as employes but are to be 
organized into a special corps. 

(b) Medical officers will have disciplinary authority. 

(c) Their pay will be increased and their right to a pension is the 
same as other officers. 



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NEWS OF THE SERVICES, 79 

(d) Upon retirement they will be promoted one grade. 

(e) They will periodically receive a special course of instruction and 
will be given an opportunity for service in large hospitals. 

(f) Boards for the examination of medical officers will be convened 
under the direction of the chief surgeon of each district. 

(g) Medical officers will have command of sanitary organizations, 
(h) They will wear the same insignia of rank as the officers of the 

line. 

(i) A weekly medico-military journal will be published for the infor- 
mation and instruction of medical officers. 

Female Nurse Corps for the Navy.— The Senate added to the 
Naval Appropriation Bill a provision for a female nurse corps as follows: 

The nurse corps (female) of the U.S. Navy is hereby established, 
and shall consist of one superintendent, to be appointed by the Secretary 
of the Navy, who shall be a gnraduate of a hospital training school having 
a course of instruction of not less than two years, whose term of office 
may be terminated at his discretion, and of as many chief nurses, nurses 
and reserve nurses as may be needed; Provided: TTiat all nurses in the 
nurse corps shall be appointed or removed by the Surgeon General, with 
the approval of the Secretary of the Navy; and that they shall be grad- 
uates of hospital training schools having a course of instruction not less 
than two years. The appointment of superintendent, chief nurses, 
nurses and reserve nurses shall be subject to an examination as to their 
professional, moral, mental and physical fitness, and they shall be eli- 
gible for duty at naval hospitals, and on board of hospital and ambulance 
ships and for such special duty as may be deemed necessary by the Sur- 
geon General of the Navy. Reserve nurses may be assigned to active 
duty when the necessities of the service demand, and when on such duty 
shall receive the pay and allowances of nurses: Provided, That they shall 
receive no compensation except when on active duty. The superin- 
tendent, chief nurses and nurses shall respectively receive the same 
pay, allowances, emoluments and privileges as are now or may hereafter 
be provided by or in pursuance of law for the nurse corps (female) of 
the army. 

Legislation on Rank and Pay in the Public Health and Ma- 
rine Hospital Service.— The Senate on May 15 passed S. 6101, to pro- 
mote the efficiency of the Public Health and Marine Hospital Service, 
which provides: 

That hereafter the pay and allowances, including longevity, of the 
commissioned medical officers of the Public Health and Marine Hospital 
Service shall be the same as the pay and allowances, including longevity 
and excepting forage, of the commissioned officers of the Medical De- 
partment of the Army, as follows: Surgeon general, that of the surgeon 
general of the Army; assistant surgeons general, that of assistant sur- 



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80 NE WS OF THE SER VICES. 

geons general or colonel of the Army; ten medical directors, that of dep- 
uty surgeons general or lieutenant colonel of the Army; surgeons, that of 
surgeons or major of the Army. Provided, That the total number of 
the commissioned medical officers of the Public Health and Marine Hos- 
pital Service shall not exceed 150. 

Sec. 2. That when any officer of the Public Health and Marine Hos- 
pital Service shall be detailed for duty with the military or naval forces 
of the United States, under the provision of Section 4 of the Act of July 
1, 1902, entitled ''An act to increase the efficiency and change the name of 
the United States Marine Hospital Service," he shall when on such duty 
be subject to the Rules and Articles of War. 

Sec. 3. That when any commissioned medical officer in the Public 
Health and Marine Hospital Service has reached the age of sixty-four 
years he shall, upon his own application or in the discretion of the Presi- 
dent, be retired and his place qn the active list shall be filled by promo- 
tion according to seniority. 

Sec. 4. That the officers in charge of the divisions of zoology, 
pharmacology, and chemistry, in the hygienic laboratory shall be en- 
titled to leave of absence and waiting orders as now allowed by law and 
regulations to commissioned officers of the Service, and their pay and al^ 
lowances of longevity and commutation shall be the same as those re- 
ceived by professors of the Military Academy at West Point. The divi- 
sion of pathology and bacteriology shall be in charge of a commissioned 
medical officer, as now provided by regulation. 

The National Volunteer Emergency Service.— This Service, in- 
stituted in New York City in 1900, has recently taken on a new lease of 
life under the direction of Major James Evelyn Pilcher, Secretary of the 
Association of Military Surgeons, who has been elected Director General. 
The Service is designed to meet the emergencies of peace and war, and is 
formed upon a military basis. Its work is distributed particularly in 
three corps: (1). A First Aid Corps, consisting of physicians and lay- 
men and designed for the extension and propagation of first aid in illness 
and injury throughout the country. (2) . A Public Health Corps, intend- 
ed to promulgate a familiarity with the essentials of hgyiene and sanita- 
tion among the general public and to secure the correction of insanitary 
conditions throughout the country. (3) . A Medical Corps, the purpose 
of which is to combine into a compact organization all medical men who 
are willing to meet and instruct the public in the measures necessarv to 
cope with emergencies relative to health and life. In this Corps phar- 
macists and dentists also find a place, as do medical students. In the 
several corps the relative position of the members is determined by mil- 
itary titles and in the Medical Corps an officer may, by continued mem- 
bership, attain the rank of Colonel in the Corps. It is believed that this 
organization satisfactorily solves the problem as to the organization of a 
national aid society. Applications for membership are being received 
from all over the country and many valuable features are continually 
being added. Any one desirous of further information should address the 
Adjutant General, Brigadier General F. Elbert Davis, The New York 
Press Club, 120 Nassau St, New York, N. Y. 



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Current Xtteratute. 



THE SCOPE OF TEACHING THAT SHOULD BE FOL- 
LOWED IN THE NEWLY ESTABLISHED CHAIR 
OF HYGIENE AND SANITATION IN OUR 
MILITARY AND NAVAL SCHOOLS.* 

BRIGADIER General A. A. Woodhull, United States Army, 
Retired, lately Colonel, Army Medical Corps, is to be 
congratulated on his valuable **Seaman Prize Essay*' in 
\\i^ Journal of the Military Service Institution for March, on 
^'The scope of teaching that should be followed in the newly es- 
tablished chair of hygiene and sanitation in our military and 
7iaval schools, and the practical results to be expected therefrom.''^ 
The public services, for their part, are fortunate in that General 
Woodhull still continues to give his country the benefit of his 
broad technical knowledge and long military experience, and is 
a conspicuous exception to the too prevalent idea that, with re- 
tirement, an oflScer's usefulness must necessarily cease. 

It was only to be expected that General Woodhull's essay 
would be the best one submitted, for the subject was one which 
he, of all others, is best fitted to discuss. His manual of hy- 
giene has for many years been the guide for line officers in the 
care of troops; and his service as instructor in hygiene in the 
school at Fort Leavenworth marked the beginning of the teach- 
ing of this subject to the army on a dignified and practical basis. 
Since retirement, he has continued his activities along the same 
lines by establishing and conducting a course in personal hy- 
giene for the students of Princeton University. 

*The Scope of Teaching that should be Followed In the Newly Established 
Chair of Hygiene and Sanitation In our Military and Naval Schools and the 
Practical Results to be Expected Therefrom.— By Brigadier General Alfred 
A. Woodhull, U.S.A., (Retired). The Seaman Prize Essaj;, 1908. 
Journal of the Military Service Institution, New York, March-April, 1908. 
8 vo. ; pp. 36. 

(81) 



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82 CURRENT LITER A TURE, 

The essay itself, as would necessarily be the case, consists of 
a general outline of the subject, with specific mention of the 
more important points. If it is to be criticized at all, it must be 
on the ground that there is not enough of it. The latter fault, 
however, is necessarily imposed by the limitations of the terms 
of competition, and it is manifestly impossible, in an article of 
this character, to set forth in their relative importance all the 
points which in practice must receive mention. However, the 
essay contains a vast amount of suggestive material, which is 
commended to the earnest consideration of all in the military and 
naval services, and especially to those who now or in the future 
shall be responsible for the sanitary instruction of our coming 
generations of army and naval officers. The essay is elegantly 
written in an instructive and entertaining style. — E.L.M. 



STATE BOARD QUESTIONS AND ANSWERS* 

WITH the modern development of the state boards of ex- 
aminers for license to practice medicine in our several 
commonwealths, a demand has naturally arisen for a 
discussion of the examinations as conducted by the various 
boards. This feeling made itself apparent at one time in the 
publication of a journal devoted to the subject, which, however, 
failed for lack of adequate support. The need for information 
upon the subject of these examinations is now however excel- 
lently met in the extensive and comprehensive work of Dr. 
Goepp. The work is a very large one and the questions are so 
many in number that a reading of the book would seem to fur- 
nish in brief outline an excellent conspectus of the practice of 
the art of medicine at the present day. It will undoubtedly 
find a very wide sale among medical students and possibly among 
some medical examiners whose work may be materially assisted 
by it. 

*SUte Board Questions and Answers.— By R. Max Goepp, M.D. 8 vo; 
pp. 684. Philadelphia and London, W. B. Saunders Co., 1908. Cloth 
$4.00, net. 



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Vox* XXTIT, N'o 2 • AiTOOsa?, 1008. 



®rtdinal ^BDemoirs* 



AUTHORS ALONE ARE RESPONSIBLE FOR THE OPINIONS 
EXPRESSED IN THEIR CONTRIBUTIONS. 



OBSERVATIONS UPON TREPONEMA PERTENUIS (CAS- 

TELLANI) OF YAWS AND THE EXPERIMENAL 

PRODUCTION OF THE DISEASE IN MONKEYS. 

By captain PERCY M. ASHBURN, 
MEDICAL CORPS UNITED STATES ARMY, 

AND CAPTAIN CHARLES F. CRAIG, 

MEDICAL CORPS UNITED STATES ARMY, 

CONSTITUTING THE UNITED STATES ARMY BOARD FOR THE STUDY OF 
TROPICAL DISEASES AS THEY OCCUR IN THE PHILIPPINE ISLANDS. 

part !• 

HISTORICAL. 

HEIR discovery of a spiral 
shaped parasite in the les- 
ions of syphilis, which they 
named Spirochete pallida 
was announced in May 1905 
by Schaudinn and Hoffman. 
(1). Ks Sptrochaete,Qo\m, 
1872, is an amended spell- 
ing of Spirochaeta, Ehren- 
berg, 1834, the name Spirochaete pallida became Spirocheta 
pallida. In the same year Vuillemin (2) selected Spirochaeta 



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84 CAPTAIN^P. M. A SHB URN— CAPTAIN C, F, CRAIG. 

pallida as the type of a new genus which he called Spironema^ 
the organism found in syphilis thus becoming Spironema pal- 
lidufn, a classification accepted by Schaudinn in 1905. Further 
investigation developed the fact that the name Spironema had 
been previously used to designate a genus of moUusks, and ac- 
cordingly could not be used in this connection. Stiles and 
Pfender (3) proposed the name Microspitonema pallidum iorihi^ 
organism but before their publication appeared Schaudinn (4) 
had proposed the generic term Treponema and the specific name 
Treponema pallidum, Schaudinn, which is the correct name of 
the parasite of syphilis. 

In February, 1905, Castellani, (5) while investigating the 
etiology of yaws at Colombo, Ceylon, discovered spirochaetae in 
the serum of yaws lesions, one of which resembled very closely 
Treponema pallidum in its morphology. In the announcement 
of this discovery, which appeared in the Journal of the Ceylon 
Branch of the British Medical Association, June 17, 1905, he 
named the organism Spirochaeta pertenuis, but as it undoubtedly 
belongs to the genus Treponema, the correct name is Treponema 
pertenuis (Castellani). Several papers by this investigator have 
since appeared (6, 7, 8, 9, 10), dealing with the etiology of 
yaws and a few confirmatory reports of the presence in yaws les- 
ions of Treponema pertenuis. 

Wellman (11), in South Angola, Africa, was the first to 
confirm Castellani^s observations, finding the organism in scrap- 
ings from yaws lesions in one case. He was not aware of Cas- 
tellani's discovery at the time, July 1905, so that his observa- 
tions amount to an independent discovery of Treponema per^ 
tenuis, although the organism was first seen and described by 
Castellani. In a supplementary note regarding the spirochaetae 
found in yaws Wellman says (12): **It is significant that this 
observation which has been spoken of as *one of the most im- 
portant discoveries of recent times, considering the fact that 
the Spirochaetk pallida has been found by Schaudinn in syphilis, 
and considering the relation said to exist between yaws and 
syphilis, (13), should have been made almost simultaneously in 
two such widely separated countries as Ceylon and West Africa.*' 



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TREPONEMA PERTENlfIS IN YAWS. 85 

Further confirmation of the presence of Treponema pet" 
tenuis (Castellani) in the lesions of yaws have been published by 
Powell (14), Borne (15), and MacLennan (16). Powell and 
MacLennan fouud the organism in but one case but Borne found 
the treponema in nine of eleven cases examined, and the latter 
wrote Castellani (ITJ that he had found them in forty-nine out 
of fifty-nine cases. Connor (18) was unable to demonstrate 
Treponema pertenuis in two cases of yaws occurring in Manipur 
State, India, using Irishman's stain, the method advocated by 
Castellani. 

DESCRIPTION. 

The following resume is compiled from the published de- 
scriptions of the organism by Castellani. The treponema were 
found by him in the serum from the non ulcerated lesions and 
in smaller numbers in the ulcerated lesions of yaws. The major- 
ity of the organisms are extremely delicate, though some indi- 
viduals are thicker and stain more intensely, but all are thinner 
than ''refringens^' or other spirochaetae with the exception of 
Treponema pallidum (Schaudinn) . The length varies from a few 
microns to eighteen or twenty or more. Both extremities are often 
Xx>inted, but forms are met with presenting blunt extremities or 
one extremity blunt and the other pointed. Rarely one extrem- 
ity may , show a pear shaped expansion or a loop- like formation. 
The organisms are spiriliform the number of waves in the spiral 
varying, but generally being numerous, uniform, and of small 
dimensions; sometimes an organism is observed having uniform 
narrow waves for a portion of its length, the remainder being 
almost or quite straight. Two organisms may be attached together 
end to end or twisted about one another. Castellani has seen forms 
indicating longitudinal division, two organisms lying parallel, 
close together and united at one end; he has also observed a few 
chromatoid points scattered irregularly in some organisms. With 
Irishman's or Giemsa's stain the organism takes a pale reddish 
tint. Castellani also found, in very rare instances, a few oval or 
roundish bodies, five to eight microns in length, and four to six 
microns broad, staining purplish or bluish with Leishman's stain, 
containing chromatin, collected at one point or scattered through- 



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86 CAPTAIN P. M. ASHBURN— CAPTAIN C F. CRAIG, 

out the bodies. He suggests that these bodies may be a develop- 
mental stage of the Treponema pertenuis. In the open ulcer- 
ative sores of framboesia Castellani found, along with Trepon- 
ema pertenuis, three varieties of spirochaetae, as follows: 

1. A thick, easily stained form, identical morphologically 
with kS*. refringens, Scbaudinn. 

2. A thin, delicate form, with waves varying in size and 
number, and blunt at both ends. He named this organism S. 
obiusa, 

3. A thin, delicate form, tapering at both ends, which he 
named S. acuminaia, 

Castellani found Treponema pertenuis present in the lesions 
of yaws in eleven of fourteen cases. Regarding its morpholog- 
ical resemblance and its relation to Treponema pallidum he 
stated in 1906 (19): **The spirochaetae found in the non-open les- 
ions and some of those found in open sores of yaws are, in my 
opinion, morphologically identical with thcS. pallida of Schau- 
dinn. This is also the opinion of Schaudinn himself who very 
kindly has examined several of my specimens 'but* that if 
future investigation will prove that yaws is a spirochaetae disease, 
the yaws spirochaetae will have to be considered to be biologically 
different from the spirochaetae of syphilis." 

Careful and frequent inquiries among the medical officers of 
the army and civilian practitioners in Manila, during a period of 
almost a year, had but confirmed the impression gained from 
the literature, that yaws is a rare disease in the Philippine 
Islands, when we were shown some cases at Paranaque, through 
the courtesy of Dr. Luis Guerrero. At the time of our first 
visit there we saw four cases and at subsequent visits four other 
cases, while we were informed by the patients and their friends 
that the disease is very common throughout all the region about 
Paranaque; and we have since heard of it as common in certain 
towns of Tarlac province, Luzon, in the neighborhood of Parang- 
Parang, Mindanao^ and it is quite probable that it is frequently 
seen and well known by the natives in most parts of the Archi- 
pelago. That it is not more familiar to qualified physicans is 
doubtless largely owing to the fact that it occurs principally in 



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TREPONEMA PERTENUIS IN YA WS. 87 

the very poor class of persons who as a rule speak neither English 
nor Spanish and who do not consult physicans, except on very 
rare occasions of necessity which happen to coincide with almost 
equally unusual opportunities. 

Yaws is usually regarded by these people as a mild and 
self limited disease and an ordinary attack of it would probably not 
be considered a justification for seeking qualified medical aid. 

Then too, natives of the class being considered are rather 
fearful of Americans and apt to refuse rather than seek their 
medical assistance. We have offered free treatment and main- 
tenance to patients if they would come to Manila and enter the 
hospital, but no one has yet accepted the offer. 

We have also seen five cases in San Lazaro Hospital, Manila, 
all in lepers. We have not had an opportunity to treat any 
case that we have seen but we have examined all cases and in 
ten we have examined for Treponema pertenuis, finding it in all 
of them. 

Our examinations of yaws cases have been made at relatively 
infrequent intervals for the reason that we had no cases under 
our immediate control and supervision, but they embraced inquir- 
ies into the clinical manifestations of the disease. In this regard 
they brought nothing new that is important and the description 
that we might give of the clinical appearence of the disease 
would not differ greatly from the description given by most 
recent authors and even from those given a century ago by 
Winterbottom and Bateman (20), except we think the large 
ulcerative lesions are probably due to secondary infections and 
should not be credited to pure yaws any more than suppuration 
in syphilitic lesions should be attributed to Treponema pallidum. 

The observations that we shall discuss herein consist princi- 
pally, then, of studies of the fresh and stained serous exudate 
from yaws lesions, which contained the Treponema pertenuis, 
as described by Castellani and others. As the serum presented 
nothing peculiar or characteristic of yaws except the treponema, 
the great bulk of our work consisted in observations on that 
parasite. These observations were made on three varieties of 
preparations of the serum. 



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88 CAPTAIN P. M, ASHBURN— CAPTAIN C, F. CRAIG, 
METHODS OF EXAMINATION 

A, Stained smears. These were prepared by removing the 
yellowish, bees wax like tops from the papillomatous lesions, 
either by pulling them off entire or by washing them off by friction 
with wet gauze, and taking on the end of the slide a bit of the clear 
serum which then exudes from the lesion and making a very 
thin smear of it across a throughly cleaned slide. Preparations 
so made were then stained with either Wright's or Giemsa's stain, 
preferably the latter. 

A more profuse flow of serum is obtained if the crust or cap 
of the swelling be washed away as the friction necessary in this 
process probably causes an increased flow of blood to the lesion. 
At any rate, a remarkably profuse flow is so obtained. On the oth- 
er hand, if the cap be merel)' pulled off the serous flow may be very 
slight and it only becomes profuse when the papilloma is rubbed 
with the end of a slide or a piece of gauze, and even then it is 
not so abundant and so free from cells as the serum obtained by 
the first method. 

It is remarkable how clean and how free from body cells 
and bacteria the slides thus made may be found. 

B, Fresh Serum, This was obtained in the same way as 
that for staining except that it was generally allowed to flow 
into capillary tubes, whence it was blown out on to slides and 
diluted or not, as seemed desirable, with a small amount of nor- 
mal saline solution. It was then covered with a thin cover glass, 
the glass ringed with vaseline and examination made with a 
high power. 

C, Capillary tube preparations were made as indicated 
above, the tubes being sealed when filled and kept at room temp- 
erature (usually about 85° and upward) for variable lengths of 
time, when they were broken, the contents blown out and ex- 
amined stained or unstained, or both. 

In addition to the examinations made of the serum, in the 
ways just indicated, we excised two papillomata and sectioned 
and stained them by Levaditi's method. Examination of such 
preparations shows the Treponema in great numbers, lying 
among the epithelial cells, but less numerous among the deeper 



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TREPONEMA PERTENUrS IN YAWS, 89 

layers of these. The organisms are in many instances aggre- 
gated into clamps similar to those obtained in the capillary 
tubes. 

The cells among which the organisms are found always 
show signs of degeneration, loss of outline, indistinctness of 
nuclei, and vacuolation. Such areas are localized and present 
the appearance of lacunas of degeneration. 

DESCRIPTION OF TREPONEMA PERTENUIS. (CASTELLANi) . 

a. Morphology, The morphology of the treponema may be 
very briefly described by the statement that it is indistinguish- 
able, so far as we can determine, from that of Treponema palli- 
dum. In shape, size, staining reactions, appearance of ends, 
etc., the two are similar, and neither we nor the medical men 
and investigators, to whom we have shown the organisms and 
whose opinion we have sought, are able to differentiate them. 

In length Treponema pertenuis varies considerably, some 
short forms not being longer than about four microns. It is pos- 
sible that other forms may be even shorter than this but if so 
they are not recognizable as treponema. More commonly they 
are about ten to twelve microns in length while individuals are 
even longer. Occasionally very long forms are seen, twenty and 
twenty-five or very rarely even thirty microns, but whether these 
be single individuals or multiplying or agglutinating forms in 
which two individuals are joined end to end we cannot yet de- 
termine. 

The width of the organism is so very slight that we are un- 
able to measure it with exactness. We estimate its width as 
probably varying from one-sixth to one-half of a micron. If the 
line of a filar micrometer be brought as near to one side of a loop 
of the treponema as is possible without covering the latter and 
the line of the instrument be moved one-sixth or one-fourth of a 
micron toward the treponema, the side of the loop will be hid- 
den in most instances. Whether it will be completely covered, 
or more than covered by\he line we cannot say. We cannot be 
more definite than to say that in our opinion the width of the or- 
ganism is not far from one-fourth micron, but it may be either 
greater or less. The length of the spiral turns averages very 



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90 CAPTAIN P, M. ASH BURN— CAPTAIN C F. CRAIG. 

close to 1.5 microns, measured from crest to crest. When we 
first began to study it we thought that Treponema perienuis was 
probably a trifle wider and a trifle more open in its curves than 
Treponema pallidum, and we yet think that this may possibly 
be true for the average of large numbers, but our average meas- 
urements are the same for both, and there is no form that we 
have seen that we feel justified in designating as either pallidum 
or pertenuiSy one and not the other, unless we knew the source 
from which it was derived. 

The curves of both species of treponema vary somewhat in 
width and regularity but these variations are not peculiar to or 
even much more common for, either species. In general the 
curves are fine, about 1 to 1.2 microns in depth, regular and 
rather rigid. The last named character is especially noticeable 
in unstained fluid preparations. Here the organisms are seen as 
fine and fairly rigid spirals, usually straight or almost so. The 
appearance is the miniature of that produced by a long spiral 
wire spring. Such a spring may be bent by slight pressures but 
it at once resumes its straight form when the pressure is re- 
lieved, and in either the straight or the bent form it retains its 
spiral turns. 

This description applies particularly to fluid preparations from 
a few hours to a few days old. In quite fresh preparations the 
treponema can not usually be seen, or if seen, recognized. 
Plashes of very motile organisms may be seen, and it is a fair 
presumption that some or all of them may be treponema, but 
the motion is so rapid and the glimpse of the organism so fleet- 
ing that no deductions can be drawn as to morphological char- 
acteristics. 

It is important to note that in fluid preparations the mor- 
phology of the organisms is much more regular than in stained 
ones, and it is therefore probable that many of the variations in 
the latter class may be due to the drying and staining process. 
This statement applies to our experience«with both pallidum and 
perienuis and we think that it lessens the value of deductions 
based solely on the morphology of stained specimens. 

However, since the described morphology of both Trepo- 



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TREPONEMA PERTENUIS IN YAWS, 91 

nema pallidum and Treponema pertenuis heretofore rested al- 
most entirely on the descriptions of stained specimens, it is Well 
to consider such specimens here. It should be borne in mind, 
thougfi, that no matter how many shapes, sizes and forms the 
stained organisms may show, there is not one of them that can 
not be produced with the spiral wire spring to which we likened 
the forms in the wet preparations, if the spring be subjected to 
forces analogous to those acting on the treponema during the 
making and drying of the smear. 

The stained forms, presenting many variations as to size and 
shape, may be most conveniently described by dividing them into 
types or classes. While the length and number of curves vary 
greatly, the examination of a large number of Treponema perte- 
nuis shows the average number of curves to be about eight. 
Seventeen is the greatest number counted on one organism, two 
the smallest number. Many individuals show only four or five 
turns, only a few show more than twelve. All types, shapes and 
sizes, stain with diflSculty, showing best with Giemsa*s stain, 
which gives them a pinkish violet color. 

Type A (see drawing) , is probably the most common stained 
type of Treponema pertenuis, as it is of Treponema pallidum. 
This may be said to be the classical type of the latter, but the 
other forms to be described for pertenuis may also be found for 
it. 

This type is usually straight or but slightly bent, shows reg- 
ular and even curves which are very fine, and terminates in nar- 
row pointed ends which have been interpreted as flagella. It 
stains evenly throughout, though the finely pointed ends show less 
distinctly than the main part, probably because of their size. 

Type B is likewise very common, and differs from type A 
in having a straight and usually thin portion in some part in 
its course, frequently near the middle. This appearance has 
been variously interpreted by different obser\'ers; principally as 
a union of two organisms by their flagella in beginning aggluti- 
nation, as an incomplete separation of individuals resulting from 
longitudinal division, or as beginning or incomplete transverse 
division. 



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92 CAPTAIN P, M, ASHBURN^CAPTAIN C. F, CRAIG. 

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Diagrammatic views of the types exhibited by treponema pertenuis in stained 

preparations* 



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TREPONEMA PERTENUIS IN YAWS. 93 

A spiral wire spring may be made to present a similar ap- 
pearance if one or more of its coils be straightened out by trac- 
tion and pressure. 

Type C corresponds most closely with what we consider the 
unaltered form as seen in wet preparations. It corresponds to 
type A except that instead of terminating in finely pointed ends 
it shows a dot or little knob at one end or often one at each end. 
This is the appearance seen almost uniformly in wet prepara- 
tions and we think that it is due to a tight curling of the ends, 
such as is seen on the shoots of many young plants. This curl 
may straighten out under the influence of age or drying, and the 
end then appear as a finely attenuated point or flagellum. 

Typf, D is also a common type and differs from A and C in 
that one or both ends, instead of showing a finely attenuated 
point or blunt dot, shows a ring. 

This ring frequently appears thicker and heavier than the 
main part of the body. With the spiral wire we may obtain a 
similar picture if we turn up an end or the ends of the spiral 
so as to look down through part of it and view another part 
from the side. That such bends should frequently be caused by 
the spreading and drying of the serum is readily believed for 
the reason that we often see the same thing entirely in profile, i. 
e., the spiral turns still preserved but the whole spiral so bent 
as to form two or three sides of a quadrangle. 

Type E may present the terminal features of any of the 
above types, but it also presents in its continuity a complete 
circular loop, or more than one. The spirial wire assumes a 
similiar appearance if one turn be pressed down or back. 

Type F represents a short loosely curved organism at- 
tachM to a ring or two rings, one at either end. This, we think, 
differfe from D only in the proportions of the spiral viewed from 
the end, and in the fact that the part viewed in profile has the reg- 
ularity of its curves more altered by pressure or drying. 

Type G represents various irregular forms which differ 
from the more characteristic individuals in form only, not in 
size or staining. It is possible to produce all of them by press- 
ure or traction applied in various ways to the wire spiral. 



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94 CAPTAIN P, M, ASHBURN—CAPTAIN C. F. CRAIG, 

Type H embraces the individuals which show dots in some 
part of their continuity. These dots have been referred to by vari- 
ous writers as chromatin dots, as representing nucleus, blepharo- 
plast, etc. Whether or not they be such or are merely kinks or 
twists in the organism we do not know. We are unable to deter- 
mine any constancy in the frequency, number, or localization of 
their occurrence, and an analogous appearance may be caused in 
the wire coil by kinking or twisting it. 

These various types may be found pure or in a great variety 
of combinations, such as B C, C D, C D H, H G, A H, etc. 

Types A, B, and C are seen in the wet preparations, and of 
the three types C is by far the most common. It is unusual to 
see in such preparations any individuals which do not show the 
knob like ends and the regular curves throughout their length. 
The other forms D, E, F, G and H we have rarely or never 
seen. Occasionally we have seen individuals in wet prepara- 
tions, particularly old ones, which presented a somewhat beaded 
appearance that might represent type H of the stained speci- 
mens. 

MOTII^ITY 

In neither fresh or stained specimens have we seen anything 
that we interpreted as an undulating membrane, nor anything 
that was differentiated as a flagellum in the distinct manner in 
which flagella are differentiated on certain bacteria or trypano- 
somes. The motility of the organisms as seen in the wet prepa- 
rations probably varies from the extremely active motion already 
mentioned, which permits one to see a flash of glancing light 
but no more, to a very sluggish motion which so closely simu- 
lates entire passivity as to leave the observer in serious doubt as 
to whether any motion is present, other than that due to currents 
in the serum. 

When motion has ceased to a sufficient degree to permit of 
the organism being well seen and clearly identified, it is always 
slow. It consists of slight rotation on the axis of the spiral, a 
sort of cork screw motion, and a mild and gentle waving and 
bending of the entire organism. These two varieties of motion 
combined cause the organism to pass across the field, to rise and 



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TREPONEMA PERTENUIS IN YAWS, 95 

Sink, necessitating much change of focus, or, if one end of the 
treponema be attached to the cover glass, or to foreign matter 
in the field, as is frequently the case, to lash or to swing in an 
indolent manner from this fixed point. 

This motion and what we consider the common form of the 
organism may best be observed in capillary tube preparations 
about one day old. In that length of time the accompanying 
bacteria have not usually multiplied so greatly as to occupy the 
large part of the field that they do later, while the treponema 
have ceased to move actively but have usually increased in num- 
ber and are readily found. In these preparations, or stained ones 
made from them, what are most commonly called the dividing 
forms are more frequently seen. 

DIVIDING FORMS. 

For ease of description we may constitute of these forms 
a4ditional types I, K, L and M. 

Type I is fairly common and as indicated by the drawings, 
shows some variety in the arrangement of its component parts. 
Essentially it consists of two or more spirals which are attached 
one to another by their ends. In some this attachment is such 
as to be almost or quite indistinguishable from type B. 

Type K is also quite common and differs from I in that the 
attachment is more firm and involves a greater part of the length 
of the parasites. It is as though the wire of the spiral had 
been split throughout a quarter, a half, or three quarters of its 
length, the turns being preserved. However, the two sections 
of the split part are frequently unequal in length. The appear- 
ance presented in such cases has been figured by Siedlecki and 
Krystalowicz (21) as representing conjugation. 

Type L is probably the most striking and pretty form to 
be seen. In this type the two component parts are intertwined 
throughout their length, the two euds at one extremity, however, 
being free. Occasionally all four ends are free but more com- 
monly those at one extremity are fused or they take their origin 
from a common dot or knob. 

These typeii, I, K and L, have usually been considered 
indicative of longitudinal division, and they so appear to us. 



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96 CAPTAIN P. Af. ASHBUkN-^CAPTAIN C. /^ CRAIG. 

Some writers, however, particularly Novy and Knapp (22), 
have considered it possible that division of Treponema may be 
by transverse fission and type M, which is very rare, points that 
way. In this type we see what looks like one organism but it 
shows a break in its continuity. Rarely more than one break 
occurs. Whether these apparent breaks are really such, or are 
merely artefacts, we do not know. They usually look like the 
latter. We have seen the appearance indicated both in stained 
preparations and in photomicrographs but not in wet specimens. 

VIABILITY. 

We have found treponema which showed slight motion and 
preserved their forms in a capillary tube preparation of serum 
made thirty-four days prior to the time of its examination. Ap- 
parently the organisms were alive but we made no inoculations 
with them. The bacteria which had been very numerous in 
other preparations made at the time but not kept so long, had 
apparently all died out leaving a pure culture of Treponema per- 
tenuis. 

Undoubted motion is preserved by organisms in tube prepa- 
rations for a period of several days, though it is always sluggish 
after a few hours and often after one hour or less. 

CULTIVATION. 

At the suggestion of Dr. Miyajima we tried making capil- 
lary tube preparations of the serum from yaws lesions, in the 
hope of obtaining agglutination of the treponema, as Dr. Miya- 
jima said that he had obtained it in similar preparations from 
chancres. Our hopes in that direction were speedily realized, 
as we obtained marked clumping in the first tube preparation 
that we made. These tubes were examined on the second, third 
and fourth days. 

We have not since had an opportunity to discuss the matter 
with Dr. Miyajima, and therefore are not quite sdre as to what 
he meant by the term **agglutination." If he used it as mean- 
ing merely the aggregation into clumps of already existing or- 
ganisms we think that his statement was not sufl&ciently broad, 
as it is our opinion that the numbers of organisms in such prep- 
arations are greatly increased after one day to a week. 



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TREPONEMA PERTENUIS IN YA WS. 97 

Usually the increase is manifest within twenty-four hours. 
At times, however, it takes place more slowly and may only be- 
come well marked after several days. The increase in numbers and 
the clumping are both almost, but not quite, constant. Of the 
two the increase is, in our opinion, the more constant. 

In the two cases of syphilis in which we made the same ex- 
X)eriment with serum from the chancre, we obtained a similar re- 
sult from one. 

It is hard to say and still harder to prove that one smear 
preparation containing the treponema scattered, has as many or- 
ganisms as another preparation in which they are in clumps: 
Novy and Knapp, who described agglutination of Spirillufn 
obermeieri say that in the case of that organism there is no in- 
crease in number. Counts being out of the question, the observ- 
ers' estimate must be relied upon. Our estimate, based on many 
examinations of the serum made on the first, second, third, days 
etc. , is that in most instances Treponema pertenuis increases 
greatly in numbers when kept in the serum in capillary tubes, 
and in some instances the fncrease seems to occur without the 
agglutination. Our opinion that the organisms multiply in such 
preparations is based not only on the greater number of them 
found in the tube preparations as compared with smears made at 
the same time, but also on the appearance of the clumps and 
and the great preponderance of what we consider dividing forms 
as described under types I, K and L. The appearances of some 
such clumps and dividing forms will be shown in photo-micro- 
graphs accompanying part II. 

Exceptionally neither multiplication nor agglutination de- 
veloped in the tubes, and the failures, while infrequent, are some- 
what irregular and do not admit of what we consider a thor- 
oughly satisfactory explanation. In general terms, however, 
we are of the opinion that they are due to one or both of the 
following reasons: 

1st. Variability in the immunity of the yaws patient and 
in the amount of antibodies contained in the serum; possibly the 
variability of immunity may even be local, or toxins elaborated 



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98 CAPTAIN P. M. ASHBURN--CAPTAIN C. P. CRAIG. 

by bacteria may be present locally to inhibit the growth. An 
interesting observation which may bear on this point was made 
on a case of syphilis. 

Serum from a chancre was taken up in tubes on Monday. 
The chancre was then washed with bichloride solution and dressed 
with calomel. On Tuesday it was thoroughly cleaned and more 
serum tubed. The tubes of Monday showed marked increase 
and clumping of treponema, those of Tuesday showed neither. 
The patient was not taking any general treatment. 

2nd. Variability in the bacterial content of the tubes and 
consequently in their content of soluble toxins. 

While it is readily possible to make fresh smear preparations 
of yaws serum which show very few or no bacteria, it has not 
been possible, in our experience, to obtain a serum really free 
from bacteria, and in the sealed tubes these multiply enormously. 
However, the fact that both multiplication and clumping occur 
in the great majority of tubes encouraged us in the idea that we 
might cultivate the organisms indefinitely, and as the favorable 
medium seemed to be the serum of susceptible persons or ani- 
mals, we endeavored to obtain growth on monkey blood and on 
ascitic fluid from a patient who was suffering from cirrhosis of 
the liver and who gave a history of syphilis. The ascitic fluid 
was used in two ways, plain and heated to 60°C. for thirty min- 
utes to destroy complement. In none of these media did we ob- 
tain any growth of the treponema, though bacteria grew in all. 
We did not have the opportunity to repeat these experiments, 
however, and we are not at all convinced that cultivation of the 
treponema is impossible. 

PATHOGENESIS. 

It has been stated by different authors that yaws is inocula- 
ble on lower animals, notably cats and monkeys, and that it is 
iuoculable from person to person. We have made no inocula- 
tion experiments on persons, and none on lower animals other 
than monkeys Cynofiiolgous pkilippinensts (Geoffroy). Of 
these we inoculated five, using serum from the yaws of three 
different patients. All five of the monkeys developed yaws les- 



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TREPONEMA PERTENUIS IN YA IVS. 99 

ions of a sa£Bciently characteristic appearance to permit of diag- 
nosis based on that alone. 

In addition to this typical appearance we found Treponema 
pertenuis in all of the lesions. The organisms did not differ in any 
demonstrable way from those seen in serum from human lesions. 
In numbers, measurements, staining reactions, shape and motion 
they were similar. 

The monkeys, however, did not show the secondary lesions 
of a generalized infection, nor could we, in the instance in which 
we tried it, induce yaws in other monkeys by inoculating them 
with the blood or splenic juice of an infected animal. The yaws 
lesion did spread and in that way give rise to what might be 
termed secondary lesions, but the spreading was always by con- 
tinuity and we observed no evidence to make us think that it was 
ever through a general blood or lymph infection. 

BIOI«OGICAI< POSITION OF TREPONEMA PERTENUIS 

We see no reason to doubt that the biological position of 
Treponema pertenuis is as close to that of Treponema pallidum as 
one species may be to another. The almost overwhelming weight 
of scientific opinion at the present time seems to leave the latter 
organism where Schaudinn placed it, among the Protozoa. 

Its protozoal nature is not universally accepted, however, 
and probably will not be for some time to come. Our opinion is 
that both organisms are protozoal, but while so eminent a zoolo- 
gist as Stiles (23) concedes to others the right to regard^aZ/iV/e/m 
as of vegetable nature, we feel that we may safely grant the 
same latitude as regards Troponema Pertenuis, What we re- 
gard as more easily determinable are the following propositions: 

ist. That Treponema Pertenuis is constantly found in the 
serum from yaws lesions. 

2nd, That it can at the present time be differentiated from 
Treponema pallidmn only by the consideration of the lesion 
from which it is obtained, or by inoculation of certain animals. 

3rd, That its many forms in stained preparations are all 
explainable on the supposition that it is a regular spiral, often 
deformed by the forces or processes concerned in the spreading, 
drying and staining of the smears. 



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100 CAPTAIN P. M. ASHBURN— CAPTAIN C. F. CRAIG. 

4th, That, as will be shown more fully in Part II of this 
paper, the inoculation of serum containing this organism causes 
yaws in monkeys, and that the organism is again found in the 
lesions of the inoculated animals. 

Sth. That Treponema Pertenuis is the cause of yaws. 

BIBLIOGRAPHY. 
7. ScHAUDiNN, F. and Hoffmann, Ernst. Arb. a. d. k. Gesundheitsamie, 
Berlin, Vol. XXII, (2) 1905, pp. 527-534. 

2. Vuillemin, Paul. Compt, rend. Acad, de Set., Paris, Vol. cxi (23), 

June 5, 1905, pp, 1 567-1 568. 

3. Stiles, C. W. and Pfender, C. A. American Medicine, Vol. x (23), 

December 2, 1905, p. 936. 

4. ScHAUDiNN, F., Deutsche Med. Wochenschr.y Vol. 31 (43) October 28, 

1905, p. 1728. 

5. Castellan I, Aldo, /<7wr«^i/ Ceylon Bratuh Brit. Med. Asso., ]Miit 17, 

1905. 

6. Ibid. Brit. Med. Jour., November 18 and 24, 1905, pp. 1 280-1 330. 

7. Ibid. Jour, of Trop. Med., Vol. VIII (16), August 15, 1905, p. 253. 

8. Ibid. Jour, of Trop. Med., Vol. 9(1) January i, 1906, p. 1-4. 

9. Ibid. Deutsche med. IVochenschr., Vol. 32 (3) January 21, 1906, p. 132 — 

134. 

10. Ibid. Archivf. Schisffund Tr open-Hygiene, Vol XI (i) January i, 1907. 

p. 19. 

11. Wellman, F. C.,Jour. Trop. Med., Vol. VIII (23) December i, 1905, 

P, 345- 

12. Ibid. Boston Med. and Surg. Jour., Vol. CLIV (18) May 1906, p. 490. 

13. Editorial, Brit. Med. Jour., August 5, 1905, p. 822. 

14. Powell, Proceedings Pathological Soc. of London, Vol. 56. 
75. Borne, Geneskundig Tydschrift, igod. 

\6. MacLennan, a. Brit. Med. Jour. No. 2390, Oct. 20, 1906, p. 995. 

17. Castellani, Aldo. Archiv f. SchiffS' und Tropen-Hygiene. Vol. XI 

(i) January i, 1907, p. 19. 

18. Connor. Indian Med. Gazette, Vol. XL I (8) August, 1906, p. 327. 

ig. Castellani, Aldo. Jour, of Trop. Med. Vol. IX (i) January i, 1906. 

P-3. 

20. Winterbottom and Bateman. Reported in Indian Med. Gazette, 

Vol. XLI (12) April, 1906, p. 156. 

21. Seidlecki and Krystalowicz, Prezegl. lek. Krakow. Vol. XLV, 

1906, pp. 303—307. 

22. NovY, F. G., and Knapp, R. E., The Jour, of Infec. Diseases. Vol. 3, 
(3) May 1906, p. 291—393. 

2j. Stiles,*C. W. Jour. Am. Med. Assoc. Vol. 48(16), April 20, 1907, p. 
1309- 



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A REPORT OF FOUR OPERATIONS ON THE STOMACH. 
By LOUIS L. WILLIAMS, M. D., 

SURGEON IN THE UNITED STATES PUBLIC HEALTH AND MARINE HOS- 
PITAL SERVICE. 

THE cases here reported have occurred in my service at 
the United States Marine Hospital at Baltimore during 
the past two years. 

Case i. — Carcinoma of Esophagus— Gastrostomy. J. P.; aged 55 
years; native of Scotland; was admitted January 22, 1905. Family history 
negative. Has always enjoyed good health. 

Previous Medical History, In 1871 he fell from a loft and fractured 
the sternum but suffered no subsequent inconvenience. A year and a half 
ago he began to cough and had a '^tickling in his throat." Three months 
ago he began to sufiFer from difficulty in swallowing. At date of admis- 
sion is able to swallow only liquids and soft solids. Food is sometimes 
regurgitated. Has occasional attacks of dyspnea. 

Physical Examination; Patient fairly well nourished; chest barrel 
shaped; lungs emphysematous; manubrium depressed at site of old frac- 
ture; abdominal organs apparently normal. A number 22 soft catheter can 
be passed through esophagus; a number 29 catheter meets with obstruct- 
ions at a distance of eleven and one-half inches from the incisor teeth. 

Patient was advised to grind up his food, to use liquid nourishment 
freely and to return for operation when difficulty of swallowing increased 
and nutrition began to sufiFer. 

Readmitted August 21, 1905. Since the last examination dysphagia 
has steadily increased, patient has lost flesh and is anxious for surgical 
relief. 

Gastrostomy performed September 2nd. The abdomen was opened 
through the left rectus muscle, a portion of the anterior wall of the stom- 
ach delivered, a rubber tube inserted through a puncture and the stomach 
wall invaginated around it by two purse-string sutures reinforced by a 
double row of Lembert sutures. The stomach wall was stitched to the 
peritoneum and transversalis fascia and the muscle, fascia and skin closed 
by layer sutures, leaving room for exit of tube. Healing by primary union. 

Patient was fed regularly through the gastric fistula and enjoyed com- 
parative comfort. Control of the fistula was difficult, however, and regur- 
gitation frequent, especially during fits of coughing. During October 
difficulty in breathing increased. Death occured November 24, 1905, dur- 
ing an attack of dyspnea. 

(101) 



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102 SURGEON LOUIS L. WILUAMS. 

At the necropsy a carcinoma of the esophagus was found just below 
the bifurcation of the' trachea. The lumen of esophagus was practically 
occluded and the primary bronchi were involved in the growth and greatly 
flattened. The fistulous communication between skin and stomach was 
direct and not valvular, the invagination of the stomach wall having ap- 
parendy been flattened out. 

Case 2.— Carcinoma of Esophagus.— Gastrostomy. J. L.; aged 57; 
native of Germany; admitted May 21, 1907. Family history negative. 
Previous health good. 

Clinical History. He began to have dysphagia about two months ago. 
Since then he has lost twenty-two pouAds. Two weeks ago his voice 
became weak and husky and he has since had several prolonged attacks of 
coughing. Has been unable to swallow food or drink of any kind for past 
four days. 

Physical Examination-. Small and frail physique ; marked emaciation; 
cachectic appearance; small area of dullness in second intercostal space 
near right border of sternum; a Arm, slightly moveable mass can be felt 
behind right sterno-clavicular joint by deep pressure in the root of the 
neck; a similar deeply placed mass can be felt by pressure between the 
insertions of the sterno-mastoid and trapezius muscles. A blowing mui^ 
mur, systolic in time, is heard at the apex of the heart. 

The vital indication being urgent, gastrostomy was done the next day. 
May 22nd. Abdomen opened by a small incision through the outer border 
of the left rectus muscle, and the anterior wall of the stomach drawn out 
through the incision so as to form a cone about three inches long. Two 
strong silk ligatures, placed close together, were passed through the apex 
of the cone in order to control it. An incision three-fourths of an inch long 
was made through- the skin only over the cartilage of the left seventh rib 
and made to communicate with the abdominal wound by tunneling under 
the skin. The cone of stomach wall was then drawn into the second wound 
by traction on tlie silk ligatures, and its apex sutured to the skin. The peri- 
toneum was sutured to the base of the cone, the rectus and fascia sutured 
snugly around it and the skin sutured over all. The ligatures in the apex 
were left in. Two days later the apex of the cone was opened between the 
two ligatures, the latter were removed and a tube inserted into the stomach. 

Primary healing: The resulting flstula was eminently satisfactory, 
and owing to its valvular nature control by an abdominal belt and pad was 
perfect. 

Patient died August 26, 1907, as a result of abscess of the right lung. 
The abscess cavity was evidently located at the site of the area of dullness 
noted above. No necropsy. 

Case 3.— Carcinoma of Pylorus. — Posterior Gastro-jejunos- 
TOMY. J. N.; negro; male; native of Indiana; aged 52; admitted Novembier 
6, 1906. 



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OPERATIONS ON THE STOMACH, 103 

Family history and previous medical history unimportant. 

Clinical History, For past three months has suffered from soreness in 
abdomen, anorexia, debility, coYistipation and loss of weight. During the 
past three weeks has vomited at irregular intervals, always about an hour 
after eating. Vomitus very acid. Has no pain after eating but occasionally 
after vomiting. ' 

Physical Examination: "QtAy emaciated; heart and lungs negative; 
liver dullness slightly diminished; no tenderness on pressure in any part of 
abdomen; no tumor can be detected; sense of resistance on pressure in 
epigastrium to right of median line; slight relative fullness in this region 
on inspection by oblique light. Stomach washed out and test breakfast 
given. 

Examination of filtered Stomach Contents: Showed absence of free 
HCl, diminution of combined HCl, presence of lactic acid, presence of 
Oppler-Boas bacillus. These tests were repeated at intervals with practic- 
ally the same result. Salol, one gram, was administered and the urine tested 
with ferric chloride seventy-five minutes later; reaction negative.. Urine 
tested at end of thirty hours showed marked reaction with ferric chloride. 
Motility of stomach apparently defective. 

Exploratory operation October 21. Median incision above umbilicus. 
Adense cancerous growth of the pylorus was found extending toward the 
Iteser curvature to a moderate degree and involving most of the first por- 
tion of the duodenum. On account of the extensive involvement of the 
duodenum, an attempt at extirpation seemed unwise. The transverse 
mesocolon was therefore torn through, the posterior wall of the stomach 
delivered and a gastro -enterostomy done by uniting the most dependent 
portion of the greater curvature to the first portion of the jejunum without 
forming a loop. 

Recovery from operation was uneventful. 

November 12. Salol test repeated. Urine shows reaction with ferric 
chloride at expiration of seventy-five minutes. No reaction at end of 
twenty-seven hours. The passage of food from the stomach to the duode- 
num appears, therefore, to be unimpeded. 

December 30. Test meal given. Examination of stomach contents 
showed no change except a distinct diminution in the amount of lactic 
acid. Free HCl absent. Combined HCl diminished. 

Patient was discharged from observation January 22, 1907. He had 
vomited but once since the operation, all subjective symptoms had im- 
proved and he had gained eleven pounds in weight. 

Case 4.— Ulcer of Duodenum.— Posterior Gastro-jejunostomy. 
W. M.; white male; native of Germany; aged 21; entered hospital May 15, 
1907, to secure treatment for chancroid and bubo. 

Family history negative. 

Previous Medical History. Three years ago he had a prolonged attack 



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104 SURGEON LOUIS L, WILLIAMS, 

of epigastric pain during which he vomited a large quantity of blood. He 
had two subsequent attacks, the last occurring in February of the present 
year. Vomited small quantities of blood-stained mucus during these later 
attacks. Ten days ago contracted chancroid followed by suppurating 
bubo. 

Physical Examination: Well nourished. Chancroid on prepuce and 
suppurating bubo in left groin. Examination otherwise negative. 

May i6. Has sharp pain in epigastriu^i, with tenderness and vomit- 
ing. Vomitus contains mucus but no blood. Tenderness most marked 
in epigastrium and right hypochondrium. No muscular rigidity. This 
attack lasted three days. 

On May 25th abdominal symptoms returned; on the 26th they increased 
in intensity and blood appeared in the vomitus. Complained of some pain 
to the left of epigastrium. 29th. Passed blood-stained stool. On the 30th 
pain was greatest just below right costal border. Vomiting of bloody 
mucus continued. All symptoms declined June ist to reappear June 6th. 
Vomitus containing bile, mucus and blood. During these attacks stom- 
ach feeding was suspended and nutrient enemata given. During the 
intervals peptonized milk was given by mouth. 

June 7. Patient's condition serious and strength failing. Immediate 
exploratory operation decided upon. After opening the abdomen palpa- 
tion of stomach and duodenum failed to disclose any induration and the 
peritoneal coat of the stomach was normal. The duodenum and pylorus 
were bound down by adhesions. Marked* engorgement of the vessels on 
the anterior surface of the duodenum and pylorous was noted, contrasting 
well with the normal peritoneal coat of the stomach. In order to divert the 
food stream from the probably ulcerated mucosa of the duodenum, a post- 
erior gastro-jejunostomy was done, and the abdomen closed. Post opera- 
tive history was uneventful, excepting the vomiting of mucus and bile on 
the 12th, and an attack of epigastric pain on the 14th. After this date recovery 
was rapid. Discharged apparently well, July 6, 1907. 

The diagnosis of duodenal ulcer, while not absolutely demonstrated, 
seems to be warranted by the history of the case and the findings at opera- 
tion. 

REMARKS 

In Case 1 the fistula established by direct implantation of 
the tube and invagination of the stomach wall (Kader's Method), 
was very unsatisfactory and leaky, especially during fits of 
coughing. 

In Case 2, operated on by the Ssabanajaw-Pranck method, 
the resulting fistula left nothing to be desired. 

This operation can be rapidly done and all danger of con- 



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OPERATIONS ON THE STOMACH. 105 

taminating the peritoneum can be eliminated by opening the 
apex of the stomach cone two days after the operation. A 
point of value in connection with this operation has been 
brought to my attention by Dr. J. M. T. Finney, of Baltimore, 
viz., taking up the cone of stomach as near the cardiac orifice 
as may be practicable without undue tension, in order that the 
normal conditions may be imitated as closely as possible. 

Cases 3 and 4 are examples of the conditions for which 
gastro-intestinal anastomosis is most commonly done; in the one 
case to prolong life and relieve distress in gastric cancers which 
are not susceptible of removal, in the other as a curative measure 
in chronic ulcer of the stomach and duodenum, short-circuiting 
the digestive tract and permitting the ulcerated area to heal by 
diverting the food stream and eliminating spasm of the pyloric 
end of the stomach. 

During the past five or six years much has been written by 
surgeons of wide experience upon the surgical treatment of 
gastric disorders, and much difference of opinion will be found 
among them. Certain points, however, may be said to be fairly 
well established. It may not be amiss to briefly summarize 
them. 

The work of Cuneo has shown that the lymph drainage of 
the pyloric end of the stomach is distinct from that of the fun- 
dus and the major portion of the greater curvature. For this 
reason a cancer of the pylorus or lesser curvature may be re- 
moved in the earlier stages with a fair prospect of permanent re- 
lief. If therefore the tumor is located, as it usually is, in this 
portion of the stomach, if it is limited in extent, if the stomach 
is fairly moveable, and there are no secondary growths in the 
neighboring organs, partial gastrectomy should be done. If the 
stomach is very adherent or secondary growths are present, 
gastro-enterostomy gives the best prospect for prolongation of 
life in the cases in which the pylorus is involved. In cases of 
stricture of the pylorus following ulceration and in which the 
pyloric end of the stomach shows marked and extensive indura- 
tion, excision of the diseased area seems to be the operation of 
choice inasmuch as it has been shown that these indurated areas 



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106 SURGEON LOUIS L, WILLIAMS, 

are especially liable to cancerous degeneration. In the majority 
of the cases of benign stricture of the pylorus with secondary 
dilatation of the stomach, the choice will lie between the pylorQ- 
plasty of Finney and a gastro-enterostomy. The former, it 
appears to me, more nearly aproximates the normal conditions. 
Both operations have given excellent results. 

In chronic ulcer of the stomach or duodenum posterior gastro- 
enterostomy gives dependent drainage and permits the diseased 
area to heal bv providing physiological rest. In acute ulcer 
results have not been encouraging, except in cases of perforation. 
In chronic ulceration it is advisable to refrain from interference 
while active hemorrhage is going on. 

In these operations on the upper digestive tract there is less 
chance of peritoneal infection than in similar interference with 
the lower bowel. The stomach and duodenum are sterile under 
ordinary conditions, especially while fasting, and accidental soil- 
ing of the peritoneum is consequently less dangerous. 



THE MORAL INFLUENCE OF THE ARMY. 

A DISCUSSION by Captain Scarano, of the Italian Sanitary 
Corps, calls attention to the fact that criminal statistics 
show that in 1884, 3,339 soldiers were convicted by court 
martial and in the decade from 1884 to 1894, 2,000 were convicted 
and from 1894 to 1904 only 1,436 were convicted, 228 were tried 
twice and 172 committed their ofiFense before joining their regi- 
ment. These figures indicate that the army exercises a very good 
moral influence. Scarano emphasizes, and justly too, that it would 
be a great injustice to reject every recruit with a neurotic or 
vesanic taint. Observation in the service will tell whether these 
men are fit or unfit for service. Military surgeons are capable of 
doing their duty in this branch of medical science. The moral 
development of the soldier does not lag behind the physical in 
the army.— Fred J. Conzelmann. 



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THE DISABLED FOOT IN THE MILITARY SERVICE 

AND ITS DIAGNOSIS BY THE USE OF 

THE SKIAGRAPH. 

By lieutenant GEORGE H, RICHARDSON, 

MBDICAI* RESERVE CORPS UNITED STATES ARMY. 

WHEN one is called upon to determine whether or not an 
applicant for enlistment has deformed feet there at 
once arises a question where the personal experience 
of the examining surgeon and his ability to weigh all the appa- 
parent symptoms is of the greatest importance. 

A superficial examination would naturally reject all exces- 
ive conditions, yet there are many cases of a lesser degree of de- 
formity which particularly need careful scrutiny, as it is from 
this class we get the great number of candidates for discharge 
on certificates of disability. 

The usual method employed in the examination of the re- 
cruit is to ask him to raise himself on the toes which any one can 
readily do by a sudden spring no matter how weak the muscles 
or the arch of the foot may be. This should be modified by re- 
questing the applicant to raise the body slowly and repeatedly, 
allowing the heel to remain some time from the floor. The 
mobility of the ankle joint for inversion and e version should 
also be determined and a rigid inspection made for callosities or 
bunions for these show a tendency on the applicant's part to se- 
lect poorly fitting shoes or a departure from the ordinary shape 
which the average shoe will not supply. The plantar surface of 
the feet will often show callosities particularly if the applicant 
sufFers from a slight hyperidrosis. 

The study of orthopedic surgery is recognized by most phy- 
sicians to be a special branch of medicine requiring a mechanical 
temperament for its proper understanding, and is often neglected 
for other branches that do not demand this particular accomp- 
lishment. Perhaps it is for this reason that the average practi- 

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108 LIEUTENANT GEORGE H, RICHARDSON 

tioner drifts away from this class of patients, treating indifiFer- 
ently the minor cases, smiling at the one who consults him for 
corns, and referring the chronic, almost incurable sufiFerer to a 
specialist for proper care. 

Digressing from my subject it would seem that some form 
of special attention similar to that used in the British army, 
might with benefit be instituted among our troops, whereby the 
soldiers' feet could be watched and carefully treated by a qualified 
enlisted man who should receive '*extra duty pay" for his ser- 
vices. This plan could include the selection of proper fitting 
shoes for those who through ignorance select sizes unfit for the 
shape of their feet and would anticipate the production of corns 
and bunions. The importance of this procedure was impressed 
upon me in reading an article '*The care of the soldier's feet'* 
by Lieutenant Bradley, R. A.M. C. in the March, 1907 number 
of Wi^ Journal of the Royal Army Medical Corps, 

In looking at the Surgeon, General's report for the fiscal 
year ending June 30th, 1906, we find that 177 applicants, or two 
and one-half per cent of those seeking admission into the service 
were rejected owing to their having flat feet, and that nineteen 
men, one per cent of those discharged on surgeon's certificate of 
disability had a similar defect, while' thirty-five men or about 
three per cent were discharged for bunions and corns. Over 
four per cent, therefore, of all men discharged had some form of 
disabled feet. In how many of these the disability existed prior 
to enlistment I am unable to determine, yet I am satisfied, from 
the cases I have examined, that fully one-half could have been 
discovered at the time of their acceptance had the defect been 
more carefully investigated and appreciated. 

An epidemic of * 'flatf ootedness" occurred in this post, Pre- 
sidio of San Francisco, California, in the fall of 1906 and several 
men were discharged the service on account of this trouble. As 
four of these men came from one company the question of mal- 
ingering should not be overlooked, it being a significant fact 
that soldiers will often assume similar disabilities if they find a 
discharge easy to obtain, and as many men are comparatively 
flatfooted, particularly the colored troops, and some are not above 



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DISABLED FOOT IN THE MILITARY SERVICE. 109 

falsification when giving their subjective symptoms, one should 
be extremely careful before expressing an opinion or even sug- 
gesting the likelihood that the applicant has any defect whatso- 
ever. 

The recent appearance of three soldiers on sick report at this 
post complaining of pain in their feet while walking or drilling has 
brought to my mind the question whether a skiagraph » showing 
the exact relation of the bones of the foot, would be of benefit in 
the diagnosis of these cases with the idea that we could accu- 
rately measure the arch and make apparent the nature of the 
afiFection. I realize that a study of many cases will be neces- 
sary in order to arrive at a positive conclusion, and I submit this 
article with the hope that some one, better informed than I, in 
this branch of medicine, may be sufficiently interested to make 
this question the subject of a more extensive investigation than 
the limited material at my command will permit. 

The histories of the three cases are herewith submitted to- 
gether with the skiagraph of the right foot of each man taken 
when standing. It would be but just to state that two of these 
men had endeavored to obtain their discharge from the service 
by other methods before appearing on sick report with disabled 
feet. How far this fact has modified their subjective symptoms 
one can only surmise, yet it argues more strongly for some defi- 
nite means of recognizing the deformity either before these men 
are enlisted or at the recruiting depot before they are sent to 
permanent station. 

Case No, /.— B. E. J. private, 38th Company Coast Artillery, age 23, born 
in Davis County, Indiana, where malaria is very prevalent and where as a 
child he had several severe attacks. Has three brothers one of whom has 
trouble with his feet. Began manual labor early in life as a teamster in a 
logging camp which line of work he followed until his enlistment, January 
1906. He was first sent to Jefferson Barracks, Mo., where he was em- 
ployed on Mextra duty** as teamster for two months. Upon his arrival at 
this post was placed in the recruit squad and noticed at once that his feet 
were sore and painful after each exercise. He remained however on duty 
thinking that his feet would improve as he became accustomed to the work^ 
Finding that he could no longer do duty without limping on account of the 
pain he came on sick report April 2i8t, 1907. He complained also of his 
feet perspiring excessively requiring a daily change of socks and that they 



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110 LIEUTENANT GEORGE H, RICHARDSON 

felt numb. Examination shows a turning out of the feet with a promU 
nence of the internal malleoli. The arches of the feet seem completely ob- 
literated and the range of motion, particularly voluntary adduction, very 
limited. The skiagraph marked Fig. i shows a distance of 6.5 c. m. from 
the top of the astragalo-scaphoid junction to the floor and of i.i cm. from 
the calcaneo-cuboid articulation to a base line running from the os-calcis to 
the first matatarsal. 



Fig* {* Skiagraph In case of flat foot 

Case No. 2, — L. M. N., private, 65th Company Coast Artillery, born in 
Idaho, twenty-three years ago. Ever since boyhood has been engaged on 
the range caring for cattle and riding horseback constantly. About two 1 
weeks prior to his enlistment was employed at manual labor requiring him 
to be on his feet several hours a day and he found he was unable to keep 
the position owing to the pain in his feet. His father has similar trouble 
and he says that it is recognized and called "stirrup foot" among men em. 
ployed as cowboys. He enlisted July 17th, 1906, in Denver, Colorado, and 
was sent to this post in August. He was placed in the recruit squad at 
once and given daily drills.. He noticed during the first week that after 
drilling he had pain at the base of both great toes and his feet were tired 
and aching. This painful condition gradually increased until January 22, 

X7, when he was sent to the U.S.A. General Hospital for an operation for 
icocele. He was returned to duty on April 28th, 1907, and two days 
later came on sick report claiming that he was unable to perform his duties 
owing to pain in the feet. Examination shows a peculiarly shaped foot as 



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DISABLED FOOT IN THE MILITARY SERVICE, \\\ 

follows: The arch of the foot is exaggerated especially on the inner border. 
The balls of both great toes seem enlarged and he claims are painful to 
pressure. All the toes are in a condition of dorsi-flexation and none of 
them touch the floor when he is standing. He is unable to raise himself on 
his toes without great effort and in doing so says that it gives him 
pain in the first metatarso-phalangeal joint and in the arch of the foot. 
The measurements as noted in Fig. 2, show a distance of 7.8 cm from 
the astragalo-scaphoid junction to the floor, and a distance of 1.8 cm. from 
the calcaneo-cuboid junction to the base line. 



Fig. 2. Skiagraph fn case of flat foot. 

Case No, 3, — R. C. B., private, 65th Company, Coast Artillery, aged 
twenty-three years. Left school at sixteen and worked on a farm until he 
enlisted. About three years ago sprained his left ankle and was lame for 
about ten days. Enlisted January 22nd, 1906, at St. Joseph, Mo., and was at 
Jefferson Barracks Recruiting Depot for one month, arriving at Presidio of 
San Francisco, California, in March 1906. Was admitted on sick leport 
April 17th, 1906, and sent with a diagnosis of "sprain, right foot, incurred 
in gymnasium at Jefferson Barracks in January 1906*' to the General Hospital 
where he remained about two pnonths. Was returned again to hospital in 
June 1906 with the same diagnosis, and again on April 29th, 1907. He 
complains of pain in the arches of both feet and in both ankles. This pain 
he says is worse at night and that he is often unable to sleep on account of 
it He limps on walking and forced extension of the feet he states is 
painful. 

Examination:— inspection is practically negative there being a seem- 
ingly well formed arch and no external evidence of any deformity. A ski- 



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112 LIEUTENANT GEORGE H. RICHARDSON. 

agraph marked Fig. 3 shows a measurement of 6.8 cm. from the astragalo- 
scaphoid junction to the floor. It will be noted in this picture (Fig. 3) that 
the os-calcis reaches the floor, while in Fig. i it is .6 cm. from the same. 
This would make a difference of about .5 cm. in its favor as against the 
measurement in Fig. i showing the relative relations of 6 cm., 8 cm., and 
7.8 cm. in the different cases. The line connecting the calcaneo-cuboid ar- 
ticulation to the base line measures 1.5 cm. 



Fig. 3. Sklagraplf in case of flat foot 

The skiagraphs in these cases were taken at the United 
States Army General Hospital, Presidio of San Francisco, Cal., 
by Sergeant 1st Class Silverthorne, Hospital Corps, United States 
Army. 



PROGNOSIS IN GUNSHOT WOUNDS OF THE 
ABDOMEN. 

WE learn from an article by von Oettingen that the prog- 
nosis in gunshot wounds of the abdomen in any given 
case must be made with consideration of the following 
factors: 1. Anatomical relations of the wound; 2. Condition 
before transport; 3. Manner of transport; 4. Treatment. 



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AUTOINTOXICATION. 
By WILLIAM FRANCIS WAUGH, M.D., 

CHICAGO, ILLINOIS. 
FORMERLY ASSISTANT SURGEON IN THE UNITED STATES NAVY. 

WHILE visiting the late meeting of the Association of 
Military Surgeons at the Jamestown Exposition, I 
listened with deep interest to several papers which de- 
scribed the methods being devised, for the disposal of sewage 
and garbage, by these fine sanitarians in the Army, Navy and 
Marine Hospital Service. It is no longer possible for the modern 
army to bury its sewage, or to attempt to disinfect it. Nothing 
satisfies the modern army sanitarian now but absolute destruc- 
tion of these substances by burning; and this applies to urine as 
well as to fecal matter. So important is this now considered, 
that the remark was made at the public meeting, that if a suit- 
able provision was made for the destruction of the discharges, 
the army sanitarian would enable the commander of the forces to 
encamp them wherever he thought desirable for military reasons, 
up to the very gates of hell. 

The lesson to be learned from this matter is the tremendous 
importance of the urine and feces, as related to the health and 
eflScacy of the army. All the other causes of deterioration put 
together, including wounds in battle, the effects of alcoholism 
and of venereal disease, become insignificant as compared to 
those which follow the ingestion of fecal matter by the soldier, 
or infection transferred from it to him by means of flies. 

As I noted these things, the thought came to me — when will 
it occur to these scientific gentlemen that the peril emanating 
from fecal discharges outside of the body, may possibly in some 
degree be incurred by the soldier while this material is still in- 
side of his body ? 

The ideal conditions contemplate the complete digestion of 
each day's meals during that day, and the evacuation of the dis- 

(118) 



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114 DR, WILLIAM FRANCIS WAUGH, 

charges completely within the twenty-four hours; but under many 
conditions this does not occur. 

As men grow older, or their lives become sedentary, peris- 
talsis grows weaker, and feces may be retained for greater or less 
intervals along the entire course of the colon. Fecal impaction 
is not necessarily attended by obstruction or even by constipa- 
tion. There may be one or two daily stools and yet fecal masses 
may lie for weeks or months in the bowel. During this time, as 
a matter of course, decomposition must go on. 

This matter is simply reeking with micro-organisms of in- 
numerable varieties. It is beyond the reach of disinfection by 
the bile, the gastric juice and the other intestinal secretions. It 
is beyond the sphere of those active operations which go on in the 
small intestine, and which are believed to neutralize the effect of 
micro-organisms and hinder the absorption of fecal toxins, at least 
during the period of health. The colon is not looked upon now as 
an absorbent organ, or as anything more than a receptacle for 
fecal collections; and it is even quite freely said of late that it is an 
unnecessary organ, a relic of previous stages of development, and 
might with impunity or even advantage be entirely removed. 

Many persons who exist under the comfortable impression 
that their digestion is perfect, have this delusion rudely shaken 
by the appearance, after some accidental cathartic, of the debris 
of food which had been taken some months previously. 

We ask if it is possible that such putrescible material can lie 
so long in the bowels, and no harm result ? It is our belief that 
this is not the case; but that, instead of this, the manufacture of 
toxins through bacterial agencies is constantly going on, and the 
fluid portion of the feces is absorbed into the blood and the 
toxins with it; and that to this cause especially may be traced 
many disorders whose causation has been hitherto obscure. 

We will first consider this matter as it occurs during the 
progress of fever. During any fever, specific or non-specific, we 
know that the secretion of the digestive fluids is largely decreased 
or even stopped altogether. The radiation of fluid from the sur- 
face of the body, however, is so great that the blood grows thick, 
inducing thirst, and also greatly favoring the absorption of 



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AUTOINTOXICATION. US 

liquid matter from the bowels into the blood. The natural safe- 
guards of the body are therefore removed, and the absorption is 
increased; while under the influence of the increased heat and an 
abundant supply of putrescible material, micro-organisms multiply 
and become more active. Some of those which under ordinary 
conditions are harmless, become virulent; consequently there is 
an increase in the amount of the toxins and in their virulence, 
as well as of their absorption into the blood. 

For these reasons we firmly believe that the action of toxins, 
absorbed from fecal matter in the alimentary canal, forms a very 
large proportion of the symptomatology of every case of fever, 
of any description whatsoever. We are not now speaking of 
such infections as cholera infantum, or typhoid fever, where the 
alimentary canal itself is believed to be infected with specific 
micro-organisms. We are speaking of fever in general, and our 
remarks apply as well to pneumonia, or to traumatic fever, the 
fever of tuberculosis, scarlet fever, measles or smallpox, as to 
that of typhoid fever. We have been in the habit of roughly 
estimating the sum of the symptomatology which is due to this 
cause, at about thirty to forty per cent of the total presented by 
a case; and we believe that, by completely emptying and disin- 
fecting the alimentary canal, this proportion of the symptoms is 
subtracted from a case, reducing it in the vast majority of in- 
stances to the category of simple, benignant or even abortive 
forms. 

This conclusion did not come to us as the result of laboratory 
experiment, but from clinical observations. We applied this 
simply as a working hypothesis, on which to apply our thera- 
peutics; and the results of more than a quarter of a century of 
close observation have justified us. In fact, we have learned 
that when an apparent exception occurs, it is not a real excep- 
tion, but shows that the conditions have not been fulfilled. 

One clinical instance will illustrate this point: A physician 
informed us that he had employed the method of cleaning out 
and disinfecting the alimentary canal, in a case of typhoid fever, 
but that it had failed. The patient was in the fourth week of 
the fever, the temp^r?^t^^'^ itself continuing at or ^bgve 104°, 



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116 DR. WILLIAM FRANCIS WAUGH, 

The patient was a girl about fourteen years old, of an illiterate 
emigrant family, and the house in which they lived was situated 
in the middle of a barnyard, which also contained the family 
well, into which the surface drainage from the well-populated 
barnyard flowed. 

We felt tempted at first to say that this was the cause of 
the continuance of the fever, knowing full well that bad hygienic 
environment will render a simple case of fever malignant under 
ordinary circumstances. Nevertheless the girl had been brought 
up with these surroundings, and must have secured a certain 
degree of immunity against them; therefore we expressed our be- 
lief that while the ordinary means had been taken to empty the 
alimentary canal this had not been complete; and cited instances, 
not occurring during typhoid fever but in ordinary cases, non- 
febrile, in which the use of cathartics and even of colonic flush- 
ing had yet failed to completely empty the bowels. We had 
been even compelled in some cases to use enemas of kerosene oil 
for this purpose, the oil having the property of permeating and 
softening the fecal masses better than any other agent with which 
we had experimented. 

The physician went home, and the following week we re- 
ceived a letter from him, stating that on his return he had ad- 
ministered to his patient an enema of kerosene oil, and that the 
results had amply justified our views, the discharge it had oc- 
casioned being something phenomenal in size and offensiveness. 
The evacuation was followed at once by a drop in the fever to 
almost normal, and the patient rapidly became convalescent. 

This was emphatically one of the exceptions which prove a 
rule. 

During the past year several remarkable papers have ap- 
peared on the causation of diseases of the eye, the ear, the nose 
and throat, and even of mental affections, which have been 
traced to the influence of fecal toxemia. Years ago Sir Lauder 
Brunton said that the cause not only of locomotor ataxia but of 
all chronic affections of the spinal cord, would ultimately prove 
to be fecal toxemia. Acting on this suggestion, we have made 
in all such cases a routine procedure of completely and absolutely 



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A UTOINTOXICA TION. \ 17 

emptying the alimentary canal and disinfecting it, as a part of 
our regular treatment, not only at the beginning but during the 
course of the case, and we must say that we have never had as 
marked success in the treatment of the specific maladies under 
consideration as before we added this to our previous thera- 
peutics. 

But it is not necessarily the spinal cord alone which is af- 
fected in this manner. We start with the primary consideration 
that we have from this cause the circulation of certain toxic 
matters in the blood. These matters are not necessarily the 
same in all individuals, in fact, while we know perhaps a scanty 
half dozen of the toxins which are generated in the alimentaty 
canal under these circumstances, it is probable there are many 
more which will yet be discovered, and that the effects of these 
vary. This prevents us picking out a certain specific set of 
symptoms and saying that these are due to auto-foxemia, and 
these alone. 

Besides this, the impressibility of various parts of the human 
body varies. We are compelled to adopt the theory of points of 
lowest vital resistance. The human body is not uniformly cap- 
able of resisting noxious influences, but in every one of us there 
are certain points, or certain tissues or cells, which are more 
easily affected by evil influences than the rest of the body. We 
may have toxins circulating universally throughout the system; 
the effects will be manifested at the points of lowest vital resist- 
ance, in the shape of local disease. 

A homely illustration of this is perhaps the ''cold'' which 
follows a Christmas or Thanksgiving dinner. We all know how 
frequently it is the case, that after the dinners characterizing 
such holiddiys we have a number of acute colds to treat. What 
do these mean? We know that every part of our body is in- 
fested with a waiting horde of micro-organisms, ready to start in 
and effect a lodgment whenever the vital resistance of that part 
is below par. Quite frequently it is the nasal mucous membrane. 
To the ordinary toxemia, always existing, an enormous increase 
is added, by the huge quantity of nitrogenous matter which is 
thrown into the digestive system at such a dinner. This is suffi- 
cient to depress the vital resistance of the nasal membrane below 
the point at which successful opposition may be made to the in- 



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118 DR, WILLIAM FRANCIS WAUGH, 

vasion. The ever-ready micro-organisms at once seize upon it, 
and the result is an acute infection, in other words, a **cold." A 
succession of such instances still further weakens the vital force 
of that part,- and the cold gradually becomes chronic, with sub- 
acute attacks of frequent occurrence. 

We see, therefore, that this hypothesis of fecal toxemia har- 
monizes with our studies in bacteriology, and with the older 
studies of cellular pathology. The system seems perfect in all 
respects. At any rate, as a working hypothesis it offers greater 
advantages for the application of our therapeutics than any other 
that has been devised. If we accept it, we will say that in all 
cases that come to us, with few if any exceptions, our first duty 
is to attend to the complete emptying and disinfecting of the ali- 
mentary canal, and henceforth we will see that this is kept up. 
By this means the toxins in the blood are reduced to those nor- 
mally afforded by the vital operation of the cells of the body. 

Our next duty is to see that the eliminant doors are kept 
widely open, so that these toxins may be passed out of the body 
at the normal rate; and with these two principles properly, in- 
telligently and successfully applied, so much of our duties as 
physicians has been done that in a vast number of cases there is 
nothing left for us to do. 

However, we are by no means ready to undervalue other 
methods. The regulation of the personal and domestic hygiene 
is of vital importance, and must never be neglected. The appli- 
cation of such remedies as are specific or valuable in each dis- 
ease is no less important. We do not wish to be understood as 
discouraging in any way the search for and the application of 
the sera and other such means of specific treatment of disease. 
But we do protest against the profession going to extremes over 
such matters, neglecting everything else and submitting to the 
dictum that the serum, and nothing but the serum, comprises 
our whole duty as therapeutists. 

We are not ready to lay down the results of the experience 
of the profession for the ages, to simply accept the latest new 
fad which is out, even before it has had time to be fairly tested 
and the limits of its applicability placed. We try to hold our 
minds always ready, always open for the acceptance of the new. 
We are ready to give it fair trial; but we cannot desert old and 
well-tried remedies and principles of practice, even in the name 
of progress. 



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AN IMPROVISED HORSE-UTTER FOR TWO PATIENTS. 
By captain GIDEON McD. VAN POOLE, 
MEDICAL CORPS UNITED STATES ARMY. 

THE following is a description of an improvised borse-lit- 
ter originated by Mora E. Smith, chief packmastey 
Philippines Division. 
The following articles are necessary to construct a litter for 
two men: 

Two poles 5 ft. long. One manta 72 in. square. 

Two poles 6 1/2 ft. long. Two hay pads. 

One pole 6 ft. long. Four sling or layer ropes. 

Two cross poles 4 ft. 4 in. long. One small rope. 



Fig. )• Impfovtsed ttttcf for two patieotB. 

The canvas, hay pads and ropes are always carried by the 
pack train. 



(119) 



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120 CAPTAIN GIDEON M,D. VAN POOLE, 

To construct the litter: The two cross poles are placed on 
the ground about four feet six inches apart, parallel to each 
other. The two five feet poles are placed vertically over and 
about six inches each from the center of the cross poles, making 
the five feet poles twelve inches apart. They are lashed in this 
position by a sling or layer rope. The litter is then turned over 
and the six feet pole placed vertically over the middle of the cross 
poles and lashed. This pole acts merely as a division between 
the two patients. (See Fig. 1). The two six and one-half 



Fig. 2. Improvlied hofae littef for two patients showing Utter turned over and 
placed upon the manta. 

feet poles are placed vertically over and near the ends of the 
cross poles and lashed securely. The manta is next spread upon 
the ground and the litter turned over and placed upon it, as 
shown in Fig. 2. (In Fig. 2, the ends of the cross poles should 
be sawn off up near the lashing). 

The small rope is passed through the eyelets on either side of the 



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AN IMPRO VISED HORSE LITTER FOR TWO PA TIENTS, 121 



Fig. 3« Improvised hone litter for two patientst showing manner of ladng 

the manta. 



i^« 4* Improvised horse litter for two patients, with cincha passed over and 

fastened* 



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122 CAPTAIN GIDEON M,D. VAN POOLE. 

manta alternately, similar to lacing a shoe, and drawn very tight. 
(See Fig. 3). This completes the litter. 

The common aparejo, used by the pack train, is placed upon 
a pack mule, and one of the hay pads used by the pack train is 
placed longitudinally over the aparejo extending back upon the 
mule's croup. Another is placed across the aparejo as shown in 
Fig. 3. 

The litter is placed upon the mule and the cincha passed 
over the two five feet poles and fastened. (See Fig. 4). Two 



Fig* 5. Improvised hofse Utter for two patteots lashed to the aparejo* 

layer or lash ropes, one on each side, are next applied, begin- 
ning at the front ends of the five feet poles, and passing beneath 
the comers of the flaps of the aparejo back and over the back 
ends of the five feet poles; again beneath the flaps of the aparejo 
and over the front ends, etc., until the litter is securely fastened. 
(See Fig. 5). These ropes should be adjusted on both sides at 
the same time. By them the litter can be made to tilt to either 



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AN IMPRO VISED HORSE-LITTER FOR TWO PA TIE NTS, \ 23 



Fig. 6* Improvised hofse litter for two patieots constructed from two hand litters. 



Fig. 7. Improyiied florae litter for two patients constructed from two hand litters 
with patients in place. 



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124 CAPTAIN GIDEON M. D. VAN POOLE. 

side to make it level, or either end can be raised or lowered, as 
circumstances may demand. 

The above is a description of a litter for two men, and has 
proved practical when tried by the Hospital Corps at Camp Mc- 
Grath, Batangas, P. I. A similar litter can be constri;icted for 
one man by making the cross poles shorter and leaving the di- 
vision pole out. A litter of this kind^was used in removing the 
wounded after the Mount Dajo fight in Mindinao, and was found 
to be practical and serviceable. 

This litter is intended for use only when it is impossible or 
impracticable to procure the litters now furnished the Medical 
Department. If the regular litters can be had, then a similar 
litter can be prepared for two patients by simply running the 
cross poles through the stirrup of two litters and lashing the 
litters together and to the cross poles, as shown in Pigs. 6 and 7. 



RIFLE BULLET, SHRAPNEL, AND SHELL WOUNDS IN 
THE RUSSO-JAPANESE WAR. 

AMONG the statistics of special interest (M. I. GlagoliefF, 
The Lancet) is the statement that 25 per cent of the 
wounds treated were made by shrapnel. This is a much 
larger percentage than was anticipated before the war and is a 
great increase over the 4 per cent of the Russo-Turkish war. 
As shrapnel wounds are usually more severe than small arm 
wounds, this notable increase in their proportion is of much 
practical importance as indicating at least the need of larger 
preparation for their proper treatment. Many more cases of sup- 
puration occured among them; there w^ere more penetrating 
wounds with lodgement of projectile; and a longer time was 
required for convalescence. Glagolieff agrees fully with the 
modern teaching of simply applying a first aid bandage in the 
field, reserving almost all operative work for a later time when 
surroundings are satisfactor3^ 



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THE MILITARY MEDICAL SERVICE OF THE SOVER- 
EIGN ORDER OF THE KNIGHTS OF MALTA 
IN THE AUSTRO-HUNGARIAN ARMY. 
By STABSARZT Dr JOHANN STEINER. 
IMPERIAL AND ROYAL WAR MINISTRY. 

IN like manner as the Teutonic Order* The Sovereign Order 
of the Knights of Malta through its Grand Priory of Bo- 
hemia and Austria participates in the voluntary medical 
service of the Austro-Hungarian army. 

The Sovereign Order of the Knights of Malta — originally 
called Order of The Hospital of St. John of Jerusalem — boasts 
of a splendid career of many centuries. Founded as a monastic 
order it was sanctioned by the Pope in 1113 and transformed 
into a clerical Order of Knights in 1119 which in a comparatively 
short time rose to considerable power. After the fall of Akka 
(1291) the Order resorted to Cyprus and later (1309) to Rhodes 
which 213 years later (1522) fell into the hands of the Mussul- 
mans. The Emperor Charles V. now granted the knights the 
occupation of the Isle of Malta, where they remained till it was 
captured by Napoleon I, in 1798. Since 1827 the Order has had 
its seat in Rome where the Grand Master resides. It is divided 
into several Grand Priories and Knight- Associations and consists 
of the Grand Master, the Grand Priors, the Baliffs, the Com- 
manders, the Knights of Justice, the Knights of Grace, the 
Honorary Knights and the Donates of the Order. 

For the more efficient practice of its cardinal virtue * 'charity' * 
the Grand Priory of Bohemia and Austria decided in the year 
1875 to establish hospital trains. This beneficent instituion was 
organized by the famous philanthropist Jaromir Baron Mundy at 
that time Chief Surgeon General of the Maltese Order. 

A revision of the regulations for the hospital trains of the 
Order, made in 1906, became necessary on account of the pro- 
gress in medical science and railroad technics as well as in the or- 
ganizatory changes of the sanitary service of the array. 

•Sec The Military Surgeon, Vol XX No. 2, page 131. 

(125) 



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126 STABSARZT DR, JOHANN STEINER, 

According to these new regulations the Maltese Order is able 
to put into service six, and in case of emergency, twelve hospital 
trains which are destined to carry the seriously wounded and 
sick directly home from the place of war. 

Each train consists of ten ambulances and six special wag- 
ons, i. e. for surgeons, kitchen, food, baggage, equipment of 
the sick and mess. The ambulance wagons are covered lug- 
gage-vans, already specially adapted in time of peace with 
double doors in the front walls, platforms on either side and 
three windows on the roof for the purpose of illumination and 
ventilation. The ten stretchers of each wagon being fixed on 
four iron frames have iron poles and wire nets as resting places 
for the mattresses. 

The personnel of a train is composed of one knight as com- 
mander, two surgeons, one accountant, ten male nurses and two 
cooks. One train can transport one hundred sick or wounded 
soldiers, each wagon offering room for ten men. The whole 
personnel as well as the necessary medical and hospital material 
is to be supplied by the Maltese Order. The furnishing of wag- 
ons is by mutual consent regulated between the Order and 
the railroad authorities. 

The Order possesses in time of peace a complete school 
train serving for the drill of the personnel. 

The entire sanitary service of the Maltese Order is super- 
vised by the Grand Prior — at present Prince Henry von und zu 
Liechtenstein who is assisted by a medical expert in the person 
of the Chief-Surgeon-General of the Order. As to their use the 
Maltese trains are perfectly under the charge of the military 
authorities so that the service is exclusively directed and con- 
trolled by the chief medical officers of the military staffs. 
The personnel of a Maltese train, though a civilian body, is sub- 
ject to military discipline. They wear special uniforms with the 
Geneve brassard and an extra red brassard with the white 
Maltese cross. 

The Maltese trains have most successfully performed active 
services in war, as is proven by their excellent work in 1878 
during the occupation of Bosnia and in 1885 to 1886 in the Serbo- 
Bulgarian war. They are quite satisfactory in regard to organi- 
zation and equipment; and there is no doubt, that they will form 
in case of a future war an inestimable constituent of the volun- 
tary medical service of the Austro-Hungarian army. 



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Contemporary Comment 



MANTEUFFEL'S CONDUCT OF THE MEDICAL DE- 
PARTMENT UPON THE BATTLEFIELD 
AND IN THE FRONT,* 

IN a comniuuication to the German Surgical Congress, Prof- 
essor von Manteuffel discusses the workings of the medical 
department on the battlefield and at the front in the Russo- 
Japanese War, which is reviewed by the Archives de Midecme 
et de Pharmacie MilitaireSy as follows: 

The author demonstrates that the vast amount of material 
furnished by the Russo-Japanese War is far from being exactly 
focused. The authors who have written in regard to this war 
have viewed it from their own particular standpoints. A suflB- 
ciently trustworthy work, embracing it in its entirety, is still 
awaited. 

The war surprised Russia in the midst of her preparations 
before her sanitary service was completely organized; this yv*as 
still further retarded by the length of the lines of evacuation, 
the slowness of the returning trains, etc. 

The formations which the sanitary service had stationed at 
the front were closely bound to the troops; a poor arrangement 
which was hastily remedied. The Red Cross formations, on the 
contrary, were distinguished for their mobility. A new type of 
field hospital and **flying lazaret" carried by horses, and so re- 
markable for its mobility, enabled the Red Cross to take a part in 
this war which it had never taken in any other. The personnel 
essential for it was from three to five surgeons, a certain number of 
medical students and in the neighborhood of thirty hospital at- 
tendants. The material (medicines, about a thousand dressings, 
instruments, thirty litters, kitchen utensils, tents) were distrib- 

•TraDBlated onder the direction of the Military InformatioD DIvIbIod of the 
United States Army General Staff. 

(127) 



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128 CONTEMPORARY COMMENT. 

uted on the horses. The field hospital of the Empress Marie, 
to which the author was attached, was the most complete of the 
kind. In addition it had at its command four two- wheeled Pin- 
nish wagons and a rolling kitchen. It could thus be used as a 
field hospital, a flying lazaret (by making use of available houses) 
and as a dressing station. It could be divided into sections. 
The personnel, with the exception of some of the attendants, 
was mounted. 

At the outbreak of the war, the regulation transport col- 
umns were lacking. The want was suflBciently made up for by 
means of Finnish spring wagons, supplied with litters, and drawn 
by two mules. 

Other wagons used were also of service in the second part 
of the campaign. The seriously wounded were transported on 
litters carried by mules or coolies. Wagons upset in the ploughed 
fields. Four-wheeled wagons could not be used upon the roads 
of Manchuria. 

From a surgical standpoint, the Russo-Japanese war taught 
us nothing new that we had not learned from the Boer War, and 
the works of Bergmann, Bruns, Beyer, Beck, Pawlow. There 
are still, however, some points to be elucidated, in what relates, 
for example, to cranial trauma, to lesions of the bladder, and of 
the thigh. There is reason, moreover, to consider whether the 
rules laid down by von Bergmann, Berck, Biittner, Bruns and 
others, should not be modified, by reason of the new teachings 
resultant from a great war, and especially from the employment 
of modern arms, which are responsible for a vast number of 
wounded. 

Without dwelling upon the position to be occupied by the 
dressing station, which should, upon level ground, be withdrawn 
to a distance of from three to four kilometers, upon the functions of 
the field hospital, the number of the wounded, varying accord- 
ing to the nature of the terrain, the projectiles employed, etc., 
attention may be invited to multiple wounds upon the same per- 
son. Six wounds were not unusual. At Shwangsho a Japanese 
with sixty-four bayonet wounds was taken to the dressing sta- 
tion and lived for twenty-four hours. 



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CONTEMPORARY COMMENT. 129 

As to what concerns the tfeatment of the wounded upon the 
advanced lines in the field hospital, the author sets forth the 
following considerations: 

Those wounded in the soft parts by conical bullets (Japan- 
ese), should be, as in the past, considered as constituting a class 
of **noli me tangere.*' This rule was not always observed. 

The question of wounds of the cranium has given rise to 
innumerable controversies. The German school, with Berg- 
mann at its head, advocates the expectant method. The author, 
basing his theory upon the English practice during the Boer war, 
and upon his own, recognizes the two following categories : 

(a). Wounds perpendicular to the surface should, as in the 
past, be treated expectantly. In the greater number of cases, 
they heal without any delirium or disorganization of the func- 
tion^. The autopsy of cases which have succumbed to serious 
injuries to centers, to meningitis or inflammation of the brain show 
no fragments. The prognosis of wounds from shrapnel is of the 
worst character. If the projectile has remained in the wound 
the expectant method is to be employed until special symptoms 
develop or until a radio-photograph shall have demonstrated the 
possibility of reaching the projectile. By this means the author 
was able to extract a Japanese bullet from the occiput of a Russian 
soldier wounded at Sandepu. It was in the covering of the cere- 
bellum, near the upper half of the skull, causing vertigo which 
prevented walking, and producing fever on the seventh day. 

(b) . Wounds at a tangent, which are of very frequent oc- 
currence, require, on the contrary, to be taken in hand without 
loss of time. Treated in the beginning expectantly, they yielded 
very bad results; suppuration, fever, meningitis, inflammation 
of the brain. It was found necessary to have recourse to opera- 
tion, though without much hope of success. Some cases, which 
were not infected, called for immediate surgical intervention be- 
cause of the appearance of symptoms indicating the destruction 
of a part of the nervous system. In these cases fragments were 
found to have penetrated from four to six centimeters in a per- 
pendicular direction to the tangent. 

The prognosis of wounds of the cranium was of a graver 



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130 CONTEMPORARY COMMENT. 

character in winter, as, indeed, was that of other wounds. Bits 
of the heavy wadded skin head-coverings have been found deeply 
imbedded in the brain. 

The principle of operating without loss of time is', however, 
wholly a theoretical one. Practically, it will very rarely be pos* 
sible to trepan at a dressing station, but the operation must be 
deferred until the first etape at the rear is reached, that is, for a 
period of eight or ten hours at the outside. Each day's delay 
makes the prognosis more doubtful. 

Wounds of the spine were as fatal in this war as in preceding 
ones. Operation is improper for bullet wounds ; this is shown 
by ^me anatomical specimens of the author's, in which cicatri- 
zation was obtained, though the cord was penetrated and severed. 

The course to be followed is entirely difiFerent if the projec- 
tile (such as a shrapnel) has lodged in the wound or has splint- 
ered the bone, causing compression of the cord. Some observa- 
tions go to prove that, in these latter cases, good results may be 
obtained by operation, but, naturally, only at the zone of the 
rear. 

These cases, should, moreover, be transferred when there is 
no hemorrhage. An examination should, therefore, be made at 
the first etape to ascertain its existence or non-existence. Where 
this condition is found, transportation by rail is not feasible. 
The wounded suffering from hemorrhage should, therefore, be 
kept within the zone of the etape. The author cites the case of 
a secondary hemorrhage at the end of a month, and the return 
of a paralytic condition which had disappeared at the time of 
the transportation of patients from Gunshulin to Harbin. 

Among the wounds of the lungs those in which there is 
hemorrhage into the pleura from the lungs or heart are of great 
interest. Both forms of hemorrhage strongly contra-indicate 
evacuation of the wounded, who should be cared for on the spot. 
Tapping the effusion will only be undertaken later. Any other 
mode of procedure would expose to secondary hemorrhage, and 
to the penetration of germs from the lung into the pleura. 

Of seven wounded in the heart, two recovered. The other 
five exhibited no dangerous symptoms for four or five days after 



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CONTEMPORARY COMMENT, 131 

the infliction of the wound. One should be content to establish 
the diagnosis, without operating or transferring to the rear. 

There is still much room for discussion in regard to abdom- 
inal wounds. Since the Boer War, wounds of the bladder are 
considered as imperatively demanding operation. Bergmann 
classes operations of this nature as emergency operations, such 
as tracheotomy, amputation, ligature. This practice, a good one, 
perhaps, for wounds inflicted by shrapnel, is not proper for bul- 
let wounds. The latter heal very readily, in spite of fistulas of 
all kinds. It is often necessary to enlarge fistulas, and to open 
abscesses. Wounds of the bladder should not be touched at the 
dressing station nor even at the first station of the etape. 

In wounds of the neck, it has sometimes been necessary to 
have recourse to tracheotomy and ligature of the vessels. The 
healing of transverse wounds of the trachea and esophagus has 
at times been attended with aneurism; at times no such compli- 
cation has occurred. * 

Wounds of the limbs were of special interest, particularly 
fractures and lesions of the vessels. The author declines to draw 
a conclusion in regard to fractures ; he began by treating frac- 
tures of the thigh conservatively, then, because of the bad re- 
sults obtained, resorted to resection of the fragments and even 
to amputation, without arriving at a satisfactory method of 
dealing with the question. One of his associates, a partisan of 
resection in the first instance, became, later on, a partisan of 
conservative treatment. 

By the application of a plaster cast it was possible to convey 
the wounded as far as Harbin, or even beyond, without difficulty. 
Bergmann's rule in these cases, the application of plaster with- 
out splints, is still the one to be followed. 

Suture after amputation is not admissable for the following 
reasons: 

Where the suture has been resorted to, and the wound is, or 
should become infected (and such was the casein most instances) 
it will be necessary to loosen the sutures and then the flaps will 
usually prove to be too short. Suture has been the cause of 
death at times. The author was held responsible at St. Peters- 
burg for conical stumps resulting from not having employed the 
suture. In his opinion sutures should be resolutely avoided (he 



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132 CONTEMPORARY COMMENT, 

would even be glad to see their use forbidden); but in case they 
are used the flaps should be made longer to allow for retraction. 

For the present he will say nothing in regard to injuries to 
the vessels^ but will invite attention to the numerous cases of 
phlegmon which he was called upon to open in the field hospital, 
that had become apparent from five to eight hours subsequent to 
the infliction of the wound, in the case of men who had lain a 
long time without assistance, or in that of those who l\ad come 
in of themselves for treatment. 

He advocates the use of rubber gloves, which he has always 
worn while operating(upon more than 1,000 wounded at Shaho). 
He would be glad to see the sanitary service in their field organi- 
zation supplied with these gloves, which save much time(a quarter 
of an hour for each operation) and insure perfect safety. 

This recent **epidemic of trauma," the author says, was the 
bloodiest that humanity has had to record since the battle of the 
Catalonian plains. It brought into singular relief the grave duties 
incumbent upon the medical service in our day, principally in 
the matter of the evacuation of the wounded, upon a scale unknown 
up to the present time. The newspapers protested against the 
inhuman suffering imposed upon those undergoing evacuation, 
but I cannot refrain from recalling the fact that the object of 
war is the infliction, not the cure, of wounds; that to the com- 
mander of the army a wounded man has no further interest 
because of his wound; and that to us, of the medical profession, 
ought to be reserved the obligation of caring for the wounded 
at the front. 

Two questions remain to be settled; one concerns the organi- 
zation of the medical service, the other the Geneva Convention. 

The first is this: How to transfer the wounded from the field 
of battle without paralysing the efficiency of an entire regiment. 

The second question admits of the establishment of a rule. 
The gravely wounded should be left upon the field to fall into 
the hands of the enemy. Those suffering from wounds of the 
abdomen or heart cannot be moved. Moreover, whether a wounded 
man be a prisoner of war or not. is a matter of no consequence. 
If, then, we decide to abandon him we shall be very close to 
having reached a solution of the first problem: the necessity of 
conducting military operations without paralysing action by the 
necessity of supplying bearers. 



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/■^ebtco-nDtUtar^ 1 nbei. 



MEDICO-MIUTARY ADMINISTRATION. 

Medicine and the law; the case of a trooper in the yeomanry suffering 
from chronic urticaria. Lancet^ Lond., 1907, ii, 728. 

de Mooy (O [The steel litter.] Nederl. Tidschr. v, Geneesk,^ Amst., 
1907, ii, 615-622. 

Dubnslle Le Bardes (A*) [The Medical Corps in war in mountainous 
regions.] Prov. Med.^ Par., 1907, xx, 307-309. 

Dtims. [The transportation of our sick soldiers in time of peace.] 
Deutsche miL drztl, Ztschr.^ Berl., 1907, xxxvi, 529-537. 

dies (P* B») The position of the volunteer stretcher-bearer. Brit. M, 
y., Lond., 1907, ii, 516. 

Harvey (P.F*) Evolution of medical education in the army. /. Am. 
Af. Ass.y Chicago, 1907, xlix, 573-575. 

Korchagin (V* V.) [Organization of military railroad disinfecting di- 
visions.] Vrach, Gas.^ S. Feterb., 1907, xiv, 773-776. 

Le Gtselinel de Llgnerolles* [Dismountable awning for litters.] Arch. 
de mid. et pharm. mil. Par. 1907, xlix, 423-427. 

Maftioet (J«) [Medical military instructions.] Rev. san, miL y Med. 
mil. espah.^ Madrid, 1907, i, 449-454. 

Nofd ()•) [International litter wagon; Nord system]. Mil.-geneesk 
Tijdschr.^ Haarlem, 1907, xi, 184, i pi. 

Norrli (H*L») Wirele.ss telegraphy and hospital ships. Brit. M.J.^ Lond., 
1907, ii, 512. 

Sassaparel (I*V*) [On frontal positions.] Voyenno-med. J.^^\..YtX.^x^.y 
1907, ccxix, med. spec. 89-94. 

Schafen [Modem armament and medical corps in the field]. Arch . de 
med. et pharm. mil.,. Par., 1907, i, 131-139. 

Schmidt (Go [Order for litter bearers of date May 15, 1907]. Deutsche 
mil. drxtl Ztschr.y Berl., 1907, xxxvi, 481-484. 

[Progress in caring for the sick in peace and war.] Deutsche mil. 

arztl. Ztschr.y Berl. 1907, xxxvi, 625-627. 

Troussaint [The medical corps of the rear guard.] Re^f. med.^ Par., 
1907, xvi, 523-529, 3 tab. 

Tsvtetayeff (A») [The medico statistical bureau at the theater of war 
existing from Nov. 30, 1904, to June 16, 1905; quality of the statistical ma. 
terial, summary.] Russk. Vrach.,, S. Peterb., 1907, vi, 450, 486, 614, 754. 

(133) 



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134 MEDICO-MILITAR Y INDEX, 

Violin (Y. A») [Connection of frontal dressing stations with their 
parts of troops.] Voyenno-med./^ St. Petersb., 1907, ccxix, med. spec. pt. 

Vbbecq (F.) [Army nurses in Great Britain and the United States.] 
Arch, de med. etpharm. inil,^ Par., 1907, xlix, 474-480. 

Von Brum (W.) [What should the soldier in the field know of mili- 
itary surgery.] Ztschr,/. Krankenpflg.^ Berl., 1907, xxix, 39; 73. 

Welge (OO [Use of Medico^mlHtary investigations in carrying out pre- 
ventive methods in nursing and treatment.] Soziale med. u. Hyg,^ Hamb., 

1907. "*, 350-352. 

Wilson (E» MJ The necessity for trained male personnel in the med- 
ical services on mobilization for war. Brit. Af-J.^ 1907, ii, 520. 

Woodhull (A» A.) Army medical organization. Month. Cyci. Pract. 
Med.y Phila., 1907, xxi, 352-355. 

MEDICO-MILITARY HISTORY AND DESCRIPTION. 

Boij^ey* [The death of Surgeon-Major Arcetin.] Caducve^ Par., 1907, 
vii, 163. 

Boman (E.) [The sanitary material of the Swedish army.] Tidskr^ 
i. mil. Hdlsov.^ Stockholm, 1907, xxxii, 114-127. 

Bonnette* [Accidents handled at the post of aid at Vibraye during the 
circuit of the sarthe; prevention.] Caducte^ Par., 1907, vii, 159. 

Botkin (Yc« S.) [The Red Cross in the Russo-Japanese war in 1904-5, 
in the region of the active armies,] Isviest. Imp. Voyenfw. med. Akad.^ S. 
Peterb., 1907, xiv, 374-402. 

ChafneL [Naval hygiene on board the Montcalm.] Arch, de med. nav. 
Par. 1907, Ixxxvii, 414-421. 

Chezln (P*) [The siege of Port Arthur.] Russk. /r/i^A., S. Peterb., 
1907, vi, 905. 

Goddard (G» H.) The King Edward vii Sanatorium. /. Roy. Army 
Med. Corps ^ Lond., 1907, ix, 202-210. 

Ho (C) [A statistical review of the dental patients in the Tokyo Mil- 
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1907, xii, No. 5, 15-21. 

Korting. [Military medicine, in the Southwest African expedition.] 
Rothe Kreuz, Herl., 1907, xxv, 371-373- 

Lefevre. [The Preparatory School of the Medical Corps of the Italian 
Army.] Caducfe, Par., 1907, vii, 177. 

Lyubarski (A. V.) [Insane department in the hospital of Nikolsk-Uss- 
uriysk during the Russo-Japanese war. Obofr. prichiat, Nevrol, etc.] S. 
Peterb., 1907, xii, 77-85. 

Marolx« [Notice of the Dutch East Indian Army.] Rev. d. troupes 
colon.. Par., 1907, i, 452; 530. 

Matlgnon (J. ]•) [Souvenirs of war in Manchuria; evacuation ot the 
wounded en route, by rail and water.] Med. mod., Par., 1907, xviii ,195-197. 



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MEDICO-MILITARY INDEX. 135 

Mine (N«) [Experiences undergone during the Russo-Japanese War of 
1904-5 in the Reserve Hospital at Hiroshima]. Arck.f, Schiffs-au-Tropen- 
Hyg.y Leipz., 1907, xi, 890-402. 

Myrdacz* [Sanitary statistics of the Austrian Army for the year 1905.] 
Militdrarzt^ Wien, 1907, xli, 209-211. 

Podlevski (L* V.) [Army medical affairs in Japan during the war of 
1904-5.] Voyettno-med, /,^ St. Petersb., 1907, ^cxviii, med. spec, pt., 67; 272; 
637 ; ccxix, 58. 

Ravn (E») [Military medicine in Denmark.] Deutsche med. Wchnschr. 
Leipz. u. Ber)., 1907, xxxiii, 1052. 

R£|[nter« [R^sumd of medical statistics of troops stationed in the col- 
onies during the year 1905.] Am. d^ hyg, et de med.^ colon.. Par., 1907, x, 
393-398. 

Senn (N.) Ancient military surgery. Surg. Gynec. and Obst., Chicago, 
1907, iv, 690-700. 

Sobotta (K) [Military hygiene in Spain.] Deutsche med. Wchnschr., 
Liepz. u. Berl., xxxiii, 1339. 

MILITARY HYGIENE. 

Blackham (R* J.) The teaching of hygiene in army schools. /. Roy. 
Army med. Corps, Lond., 1907, ix, 17-20. 

Bourgeois* [Spectacles in the army.] Caduch, Par., 1907, vii, 146. 

Cambrooero (S*) [Inconvenience and defects of the regimental filter, 
and description of a new model which obviates them.] Rev. san. mil. 
y. med. mil. espan., Madrid, 1907, ii, 257-269. 

Falchole (N*) Water supply in camps, on the line of march and in 
battle. Brit. M.J., Lond., 1907, ii, 517-520. 

Giks (P*B.) The disposal of the excreta in camp and upon the line of 
march. Brit. M.J., Lond., 1907, ii, 517. 

Kriloff (D* D.) [Nutritive value of the food regime of patients of the 
army medical institutions.] /. russk. Obsh. okhran.narod. zdrdv. St. Petersb., 
1907, xvii, 293-331. 

Lamberg (C) [Things desirable in military sanitation.] Tidskr. i. 
mil. Hdlsov., Stockholm, 1907, xxxii, 1 09-1 14. 

Lavmtyeff (A. GO [Influence of orange-yellow (Medviedeff's) glasses 
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Petersb., 1907, ccxix, med. spec, pt., 95-108. 

Makaroff (T. A«) [Hygienic principles of modern warships as gathered 
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narod. zdrav., St. Petersb., 1907, xvii, 331-336. 

Muikat (G*) [Avoidance of flatfoot, with special reference to fighting 
capacity.] Deutsche mil. arztl. Ztschr., Berl., 1907, xxxvi, 673-690. 

Nagel (W.) [Tests for color-blindness in the German mercantile ma- 
rine.] Aeretl. Sachverst. Ztg., Berl., 1907, xiii, 229-231. 



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136 MEDICO-MILITARY INDEX, 

VavUM (N*S.) [Advantages and desiderata as to recruits whose eyes 
are being tested under the new instructions.] Voyenno-med, J, St. Petersb., 
1907, ccxix, med. spec. pt. 109: 293. 

Porter ()•) Preventive medicine in the navy and army. Brii. Med. /., 
Lond., 1907, ii, 503. 

Schill* [Simulation in soldiers.] Deutsche med. Wchnschr., Leipz. u. Berl., 
1907, xxxiii, 973. 

MILITARY MEDICINE. 

Awtokratow (P* M.) [Insanity in the Russian Army during the Japa- 
nese war.] Allg. Ztschr.f. Psyckiat, etc.^ Berl., 1907, Ixiv, 286-319. 

dldwell ^R*) On enteric fever during active service. Brit. M.J.^ Lond., 
1907,11,513-516. 

G>nor. [Hysteria in the Army.] Arch, de med. etpharm. mil.^ Par., 
1907, xlix, 364; 448. 

Yemukoif (L DO [Mental diseases in the Russo-Japanese war after 
personal observations.] J. Nevropat ipsikhiat * * * Korsakova, Mosk., 
1907, vii, 388-399. 

. MILITARY SURGERY. 

Betbexe (R») [Frequency of venereal affections in the army.] Prov. 
m^.. Par., 1907, xx, 238. 

Boolsfield (L) Operative work in the Egyptian Military Hospital 
Khartoum, Soudan, during the year 1906. /. Roy. Army Med. Corps^ Lond., 
1907, ix, 21-31. 

Campo (P*) [Morbid troubles and accidents produced by spontaneous 
combustion of balistite on the Royal vessel, Marco Polo^ [Transl.] Arch, 
de mkd.nav.,, Par. 1907, Ixxxvii, 471-477. 

Cheatle (A* H*) Gun deafness and its prevention. /. Roy, United Ser- 
vice Inst.^ Lond., 1907, li, 840-853. 

Demmler (A*) [Surgery on the field of battle; its limitations.] Med. 
Mod., Par., 1907, xviii, 187. 

Dettling* [Appendicitis in the German Army from 1880 to 1900.] Arch, 
demed. et pharm. mil.. Par., 1907, i, 64-78. 

Gaskell (A*) Treatment of wounded in fleet actions. Brit. M. J., Lond., 
1907, ii, 504. 

Gateau* [Intoxication by deleterious gases in a tower during target 
practice.] Arch, de mid. nav.. Par., 1907, Ixxvii, 443. 

Ke!L [Treatment of gonorrhea in .military hospitals.) Deutsche med. 
Presse, Berl., 1907, xi, 83; 89. 

Lucas-Championnlefe (J*) [Surgery on the field of battle and ambu- 
lances; asepsis and antisepsis.] /. de med, et chir. prat.. Par., 1907, Ixxyiii, 
64 1-649. 

Manasein (M* P«) [Venereal diseases in the Russian army, and their 
significance to the nation.] Russ,/. Kozhn. i. Ven. Bolitzn, Kharkov, 1907, 
xiii, 279; 343; 398. 

Valence (A*) [Alopecia in the navy.] Arch, de mhi. nav. Par. 1907, 
Ixxxviii, 5-13. 

Van den Steen.van Ommerea (L*) [More on balsam of Peru in military 
surgery.] Mil.-Geneesk, Tijdschr., Haarlem, 1907, xi, 166- 171. 



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Ebitodal Bxpresston. 



CHANGE OF DATE OF THE ATLANTA MEETING. 

AT its recent quarterly ballot the Executive Council unani- 
mously determined to place the date of the Seventeenth 
Annual Meeting of the Association of Military Surgeons 
of the United State3 one week later than had originally been con- 
templated. The days for the meeting are now October 13, 14, 15, 
and 16, The prospects for a very successful meeting are most 
promising. Portugal, Ecuador and Turkey will be represented 
by delegates for the first time. From England we are to have 
Colonel .W G. Macpherson and from Mexico we have the prom- 
ise of Colonel Alejandro Ross, who were so popular at the Buffalo 
meeting. The beautiful city of Atlanta will be at its best at 
the time of the meeting and promises to extend to us a bountiful 
exhibition of good old fashioned southern hospitality. 



THE MILITARY ATTITUDE AND THE SOLDIER'S 
HEALTH. 

IN an interesting paper in the Journal of the Royal Army 
Medical Corps^ Dr. M. S. Pembrey, Civilian Member of 
the British Army Medical Advisory Board, remarks that 
during the first month of service they require plenty of food and 
light exercise. Unusual movements in gymnastic postures are 
not the most suitable, for they produce an amount of fatigue and 
an expenditure of nervous and muscular energy which are dis- 
proportionate to the work done. The co-ordinated and econom- 
ical working of the muscles in any form of exercise can only be 
learnt by frequent practice; in walking, the recruit has had such 
practice, but before he enters the gymnasium he has probably 
not once assumed the postures involved in some of the exercises. 

(137) 



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138 EDITORIAL EXPRESSION. 

Marching without a load is, for these reasons, a suitable exer- 
cise for the young recruit. 

Many of the exercises found in systems of physical training 
are based upon the idea that all the muscles must be uniformly 
developed, and with this end in view postures which are never 
used in ordinary life are constantly assumed. The uniform de- 
velopment of all the muscles of the body is unnecessary and un- 
economical. Muscles hypertrophied by unusual or acrobatic ex- 
ercises will become smaller unless the exercise is repeated fre- 
quently. The maintenance of all the muscles in a highly de- 
veloped condition, necessitates daily exercise of each muscle and 
the expenditure of much energy. The normal condition is di- 
vision of labour and differentiation. Marching and digging are 
exercises in which infantry soldiers require progressive training, 
it is essential that a soldier should be able 'to march carrying a 
load and to dig entrenchments without undue fatigue; both of 
these forms of work can produce over-strain of the 'heart if the 
man has not been trained by progressive and frequent practice. 
Digging has not received the attention which it deserves, and it 
has even been decried as an exercise on the ground that it makes 
men round-shouldered. Here again there is a danger that effi- 
ciency may be sacrificed to the ideal of a military figure. The 
strength and endurance of the English navvy are proverbial, and 
he does not possess the square shoulders desired by the drill- 
instructor. 

It has been stated in official manuals that the * ^strictly mili- 
tary position assists greatly in the free and full action of the 
heart and lungs, and the consequent development of the whole 
body.*' If this position has such a beneficial effect, it is sur- 
prising that it has been especially reserved for the private sold- 
ier, and has never been adopted by sailors or athletes. The con- 
strained military attitude with distended and rigid chest, hinders 
the action of the heart by restricting the free movement of the 
chest, whereby the passage of the blood from one side of the 
heart to the other is aided. It is, moreover, wasteful of ner- 
vous and muscblar energy. The position of "attention* ' is an 
abnormal one which can be defended only as a discipline. 



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flews of tbe Services* 



THE following officers of the several services were elected to mem- 
bership in the Association of Military Surgeons upon the last 
ballot of the Executive Council: 
Major Paul Allen Adams, N.G. California. 
Colonel Albert 8. Bower, N.G. Utah. 

Lieutenant Edward Albert Cunningham, Massachusetts V.M. 
Assistant Hurgeon Charles M.Fauntleroy, P.il.&M.H.S. 
Acting Assistant Surgeon John Nlvison Force, P.H.t&M.H.S. 
Acting Assistant Burgeon Herbert Gunn, P.H.&M.H.S. 
Acting Assistant Burgeon Howard H. Hopkins, P.H.&M.H.S. 
Acting Assistant Burgeon Joseph Louis Howard, P.H.i&M.H.S. 
Captain Elmer Edgar Keiser, N.G. Pennsylvania. 
Captain George Wlnlock Lee, N.G. Indiana. 
Colonel Frank Salter Nicholson, Nebraska N.G. 
Assistant Surgeon George M. Olson, U.S.Navy. 
Passed Assistant Burgeon Harry Bhaw, U.S.Navy. 
Acting Assistant Surgeon Gustavus Adolphus Weyer, P.H.dkM.H.8. 
Captain Clarence H. Willis, N.G. Georgia. 

Acting Assistant Surgeon Chester Howard Woolsey, P.H.&M.H.S. 
Assistant Surgeon A. H. Allen, U.S.N., ordered from Camp Columbia, 
Cuba, to Sancti Spiritus, Cuba. 

Assistant Surgeon D. G. Allen, U.S.N., ordered to the Naval Medical 
School. 

M. Ambiel, Physician in Chief of the First Class of the Navy and 
member of the Superior Health Council has been designated by the French 
Minister of the Marine to represent the French navy at the Atlanta meeting 
of the Association of Military Surgeons of the United States. 

Lieutenant Colonel and Mrs. Aaron Hirst Appel, U.S.A., announce the 
marriage of their daughter Miss Marjorie Appel to Dr. George Lewis 
Wickes, U.S.N., at Cheyenne, Wyo., on Wednesday, July 8. 

Dr. J. K. Ashburn, U.S.A., ordered to accompany troops from Fort 
Assinniboine to American Lake, Wash. 

Captain Percy M. Ashburn, U.S.A., ordered before the Washington 
Promotion Board. 

Major Bailey K. Ashford, U.S.A., promoted from Captain April 23, 1908. 
Captain Howard H. Bailey, U.S.A., ordered to Fort Wayne for tem- 
porary duty and return. 

Major Pavid Baker, U.S.A., promoted from Captain April 23, 1908. 
Assistant Surgeon J. A. Biello, U.S.N., ordered from the Solace to 
the Pacific Torpedo Fleet * 



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140 NEiys OF THE SERVICES. 

Captain Frank C. Baker, U.S.A., ordered from Fort Oglethorpe to 
Chickamauga Park, Ga. 

Passed Assistant Surgeon T. D. Berry, P. H.&M.H.S., placed on "wait- 
ing orders" from June i, 1908. 

Captain Ernest C. Bingham, U.S.A., ordered from the San Francisco 
General Hospital to Fort Porter. 

Passed Assistant Surgeon L. W. Bishop, U.S.N., ordered from the In- 
dianapolis Naval Recruiting Station to the Denver Naval Recruiting Sta- 
tion. 

Surgeon E. M, Blackwell, U.S.N., commissioned from March 4, 1908, 
and ordered to the Naval Academy. 

Passed Assistant Surgeon F. M. Bogan, U.S.N., ordered from the 
Minneapolis Naval Recruiting Station to the Wisconsin. 

Major William C. Borden, U.S.A., ordered before the Washington 
Promotion Board. 

Captain John R. Bosley, U.S.A., ordered to duty with the ist Infantry, 
en route to and at camp at American Lake, Wash. 

Passed Assistant Surgeon H. L. Brown, U.S.N., ordered from the Cav- 
ite Naval Station to the Cleveland. 

Captain Henry L. Brown, U.S.A., ordered before the Washington Pro- 
motion Board. 

Captain Orvil G. Brown, U.S.A., ordered before the Washington Pro- 
motion Board. 

Acting Assistant Surgeon Silas E. Brown, P.H.&M.H,S., granted 
twenty-one days leave. 

Lieutenant Earl H. Bruns, U.S.A., ordered before the Washington 
Promotion Board. 

Dr. G. F. Campbell, U.S.A., ordered from the Philippines to the United 
States. 

Dr. D. P. Card, U.S.A., granted one month's leave. 

Lieutenant Colonel Edward C. Carter, U.S.A., ordered from Fort 
Leavenworth to Fort Sheridan upon expiration of leave. 

Dr. C. A. Cattermole, U.S.A., ordered from San Francisco to Man- 
hattan, Nev., for annulment of contract. 

Major Weston P. Chamberlain, U.S.A., promoted from Captain April 
23, 1908. 

Acting Assistant Surgeon E. S. Clark, P.H.&M.H.S., granted ten days 
leave. 

Assistant Surgeon G. F. Clark, U.S.N., ordered to the Lancaster, 

Captain John A. Clark, U.S.A., ordered from Fort Oglethorpe and 
temporary duty at Madison Barracks to Fort Liscum. 

Passed Assistant Surgeon Taliaferro Clark, P.H.&M.H.S., ordered to 
Ellis Island for special temporary duty and return to Philadelphia, Pa. 

Major Jere B. Clayton, U.S.A., promoted from Captain April 23, 1908. 



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NEvVS OF THE SERVICES. 141 

Assistant Surgeon G. L. Collins, P.H.&M.H.S., ordered before the 
Washington Promotion Board for examination. 

Lieutenant Clarence L. Cole, U.S.A., ordered before the Washington 
Promotion Board. 

Assistant Surgeon F. X. Coltes, U.S.N., ordered from the Connecticut 
to report to the Commander, Third Squadron, Pacific Fleet. 

Lieutenant C. D. Cowles, Jr., U.S.A., ordered to accompany fifty men 
of Co. C, Hospital Corps, from the Washington General Hospital to Chick- 
amauga Park, Ga. 

Passed Assistant Surgeon R. H. Creel, P.H.&M.H.S., granted two 
months leave. 

Major William D. Crosby, U.S.A., ordered before the Washington 
Promotion Board. 

Captain Robert M. Culler, U.S.A., ordered before the Washington 
Promotion Board. 

Captain Frederick A. Dale, U.S.A., ordered to accompany troops from 
Fort Lincoln to American Lake, Wash. 

Captain Matthew A. DeLaney, U.S.A., ordered to Philadelphia, Pa., 
until further orders, to examine applicants for the Medical Reserve Corps. 

Dr. J. C. Dough terty, U.S.A., arrived at San Francisco on leave from 
the Philippines. 

Acting Assistant Surgeon A. D. Drew, P.H.&M.H.S., granted one 
month^s leave without pay. 

Major Douglas F. Duval, U.S.A., promoted from Captain April 23, 1908. 

Assistant Surgeon General J. M. Eager, P.H.&M.H.S., granted one 
month's leave. 

Dr. A. H. Eber, U.S.A., arrived in San Francisco on leave from the 
Philippines. 

Assistant Surgeon H. G. Ebert, P.H.&M.H.S., ordered before the San 
Francisco Promotion Board for Examination. 

Major Guy L. Edie, U.S.A., ordered before the Washington Promotion 
Board. 

Major Charles B. Ewing, U.S.A., ordered before the Washington Pro- 
motion Board. 

Assistant Surgeon E. O. J. Eytinge, U.S.N., ordered from the Concord 
to the Illinois^ thence to the Ranger. 

Passed Assistant Surgeon C. N. Fiske, U.S.N. , ordered to the Boston 
Naval Recruiting Station and to additional duty in attendance upon officers 
of the Navy and Marine Corps residing in Boston. 

Assistant Surgeon J. Flint, U.S.N., ordered from the Wilmington to 
the Connecticut. 

Captain Joseph H.. Ford, U.S.A., ordered to accompany troops from 
Fort William Henry Harrison to American Lake, Wash. 

Passed Assistant Surgeon G. F. Freeman, U.S.N., ordered from the 
Boston Navy Yard to the Montana. 



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1 42 NEWS OF THE SER VICES. 

Captain Paul L. Freeman, U.S.A. ordered before the Washington 
Promotion Board. 

Acting Assistant Surgeon H. M. Friedman, P.H.&M.H.S., granted 
twenty-eight days leave. 

Major Charles M. Gandy, U.S.A., ordered before the Washington Pro- 
motion Board. 

Passed Assistant Surgeon C. H. Gardner, P.H.&M.H.S., ordered from 
San Francisco to command the Service at Wilmington, N. C. 

Surgeon). M.Gassaway, P.H.&M.H.S., ordered to the Reedy Island 
Quarantine Station for special temporary duty and return to Philadelphia, 
Penna. 

Assistant Surgeon General H. D. Geddings, P.H.&M.H.S., ordered to 
Philadelphia, Pa., and the Reedy Island Quarantine Station for special 
temporary duty and return to Washington, D. C. 

Captain Harry L. Gilchrist, U.S.A., ordered before the Washington 
Promotion Board. 

Passed Assistant Surgeon Joseph Goldberger, P.H.&M.H.S., ordered 
to Baltimore, Md., for special temporary duty and return to the Hygienic 
Laboratory; granted one month's leave. 

Colonel William C. Gorgas, U.S.A., elected President of the American 
Medical Association at the recent meeting in Chicago, and appointed by 
the President one of the delegates to the Pan-American Scientific Congress 
to be held in Santiago, Chili, in December of this year. 

Dr. L. K. Graves, U.S.A., ordered from the Philippines to Whipple 
Barracks. 

Captain Henry S. Greenleaf, U.S.A.. ordered before the Washington 
Promotion Board. 

Captain Jay W. Grissinger, U.S.A., ordered from Fort Ethan Allen to 
Fort Egbert; granted an extension of leave to July 24. 

Captain Robert B. Grubbs, U.S.A., ordered from Fort Mcintosh to 
Leon Springs, Tex. 

Surgeon G. M. Guiteras, P.H.&M.H.S., appointed delegate to the 
Fifth Pan-American Medical Congress at Guatemala. 

Dr. A. M. Guittard, U.S.A., ordered from the Philippines to the United 
States. 

Lieutenant Louis H. Hanson, U.S.A., ordered from Fort Liscum to 
Seattle to wait orders. 

Medical Director G. E. H. Harmon, U.S.N., ordered from the Naval 
Academy to temporary duty in command of the Naval Medical School 
Hospital. 

Major Henry S. T. Harris, U.S.A., granted one month's extension of 
leave, ordered to Port Leavenworth. 

Dr. W. L. Hart, U.S.A., ordered to temporary duty at Washington 
Barracks in addition to his duties at the Washington General Hospital. 



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NEIVS OF THE SERVICES. 143 

Assistant Surf^eon L. Hart; P.H.&M.H.S., ordered from Stapleton. 
N. Y., to temporary duty at the Hygenic Laboratory. 

Major Frederick M. Hartsock, U.S.A., promoted from Captain April 
23, 1908. 

Brigadier General Albert Hartsuff, U.S.A., retired, well known as Chief 
Surgeon of the forces at Chickamauga in the early part of the Spanish- 
American War, died June 22, at Detroit, Mich. 

Captain Louis T. Hess, U.S.A., ordered before the Washington Pro- 
motion Board. 

Captain James D. Heysinger, U.S.A., ordered from Key West Bar- 
racks to Chickamauga Park, Ga., and ordered before the Washington Pro- 
motion Board. 

Assistant Surgeon M. E. Higgins, U.S.N,, ordered from the Illinois to 
report to the Commander, Third Squadron, Pacific Fleet. 

Passed Assistant Surgeon W. C. Hobdy. P. H. & M. H. S., relieved 
from duty on the San Francisco Examining Board. 

Passed Assistant Surgeon W. S. Hoen, U.S.N., ordered from the 
California to continue treatment at the Mare Island Naval Hospital. 

Passed Assistant Surgeon John M. Holt, P. H. & M. H. S., granted 
one month's leave. 

Lieutenant E. G. Huber, U.S.A., ordered to accompany fifty men of 
Co. C. Hospital Corps, from the Washington General Hospital to Chick- 
amauga Park, Ga. 

Dr. A. R. Hull, U.S.A., granted one month's leave. 

Captain Harry G. Humphreys, U.S.A., ordered before the Washington 
Promotion Board. 

Major Philip W. Huntington, U.S.A., granted three months leave from 
Fort Rosecrans. 

Dr. C. W. Johnson, U.S.A., ordered from Fort Des Moines to field 
duty in South Dakota. 

Dr. G. B. Jones, U.S.A., ordered from San Francisco to Fort George 
Wright 

Major Jefferson R. Kean, U.S.A., ordered before the Washinton Pro- 
nnotion Board. 

Acting Assistant Surgeon W. M. Kerr, U.S.N., ordered to the New 
York Naval Hospital, thence to the Norfolk Naval Hospital. 

Major Charles F. Kieffer, U.S.A., retired from active service June 24, 
1968. 

Passed Assistant Surgeon W. W. King, P.H.&M.H.S., detailed as re- 
corder of the San Francisco Examining Board. 

Major Thomas J. Kirkpatrick, U.S.A., ordered from Fort Moultrie to 
Chickamauga Park, Ga. 

Dr. F. T, Koylc, U.S.A., ordered from the Philippines to the United 
States. 



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144 NEWS OF THE SERVICES. 

Assistant Surgeon £. Krulish, P.H.&M.H.S., granted twenty days 
leave. 

Lieutenant J. S. Lambie, Jr., U.S.A., ordered to accompany fifty men 
of Co. C, Hospital Corps, from the Washington General Hospital to Chick- 
amauga Park, Ga. 

Captain Theodore Lamson, U.S.A., granted two months leave with 
permission to apply for one month's extension. 

Assistant Surgeon M. £. Lando, U.S.N., ordered to the Minneapolis 
Naval Recruiting Station. 

Lieutenant Colonel Louis A. LaGarde, U.S.A., returned to the Chief 
Surgeon's Office, Denver, Colo., from leave; assigned to duty as Attending 
Surgeon at Denver, Colo., in addition to duties as Chief Surgeon, Depart- 
ment of Colorado. 

Dr. F. V. Langenderfer, U.S.A., ordered from the Philippines to the 
United States. 

Passed Assistant Surgeon C. H. Lavinder, P.H.&.M.H.S., ordered 
from Wilmington, N. C, to Stapleton, N. Y. 

Assistant Surgeon A. £. Lee, U.S.N., ordered from the Canacao 
Naval Hospital to the Concord. 

Major William F. Lewis, U.S.A., ordered to accompany troops from 
Fort Sill to Leon Springs, Tex. 

Captain Robert C. Loving, U.S.A., ordered before the Washington 
Promotion Board. 

Dr. T. S. Lowe, U.S.A., ordered from the Philippines to Vancouver 
Barracks for duty in the Department of the Columbia. 

Captain Theodore C. Lyster, U.S.A., ordered before the Washington 
Promotion Board. 

Major Walter D. McCaw, U.S.A., ordered before the Washington Pro- 
motion Board. 

Medical Director W. A. McClurg, U.S.N., retired on thirty years ser- 
vice, September, i, iqo8. 

Passed Assistant Surgeon W. N. McDonnell, U.S. A., ordered from the 
Severn to Camp Perry, Ohio. 

Passed Assistant Surgeon John McMuUen, P.H.&M.H.S., granted one 
month and ten days leave. 

Lieutenant Colonel W. G. Macpherson, C.M.G., R.A.M.C, named as 
delegate from the British Army to the Atlanta meeting of the Association. 

Major Clarence J. Manly, U.S.A., promoted from Captain April 23, 
1908, granted leave in the United States from July 12, to September 15, 1908. 

Acting Assistant Surgeon W. L. Mann, Jr., U.S.N., appointed from 
July I, 1908. 

Assistant Surgeon H. M. Manning, P.H.&M.H.S., ordered before the 



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NEWS OF THE SERVICES, 145 

Washington Promotion Board, and to the Columbia River Quarantine 
Station for special temporary duty. 

Captain Charles E. Marrow, U.S.A., ordered before the Washington 
Promotion Board. 

Major Edgar A. Mearos, U.S.A., ordered before the Washington Pro- 
motion Board. 

Captain Edgar W. Miller, U.S.A., ordered before the Washington Pro- 
motion Board. 

Captain Samuel J. Morris, U.S.A., granted two months extension of 
leave about August 15. 

Major Edward L. Munson, U.S.A., ordered from Fort Sheridan to 
duty as instructor in the care of troops at the Fort Leavenworth Army Staff 
College. 

Dr. George Newlove, U.S.A., arrived at San Francisco on leave from 
the Philippines. 

Assistant Surgeon E. H. H. Old, U.S.N., ordered from the Cavite 
Naval Hospital to Washington for examination for promotion and then to 
wait orders. 

Captain Leartus J. Owen, U.S.A., ordered before the Washington 
Promotion Board. 

Major Henry Page, U S.A., promoted from Captain April 23, 1908. 

Dr. W. E. Parkman, U.S.A., ordered to accompany troops from Fort 
Assinniboine to American Lake, Wash. 

Passed Assistant Surgeon J. H. Payne, Jr., U.S.N., ordered from the 
Cleveland Naval Recruiting Station to the Boston Navy Yard and to ad- 
ditional duty in connection with the fitting out the Salem. 

Assistant Surgeon General W. J. Peltus, P.H.&M.H.S, ordered to ' 
Philadelphia, Pa., for special temporary duty and return to Washington, 
D. C. 

Major John L. Phillips, U.S.A., ordered before the Washington Pro- 
motion Board. 

Captain Robert H. Pierson, U.S.A., ordered before the Washington 
Promotion Board. 

Dr. E. H. Porter, U.S.A., ordered from Fort Worden to Fort Casey for 
temporary duty. 

Passed Assistant Surgeon J. A. Randall, U.S.N., ordered from the 
Denver to the Rainbow. 

Assistant Surgeon R. C. Randall, U.S.N., ordered from the Second 
Torpedo Flotilla to the Solace. 

Major Thomas U. Raymond, U.S.A., ordered to accompany the 21st 
Infantry from Fort Logan to camp near Fort D, A. Russell. 

Captain Charles R. Reynolds, U.S.A., ordered to duty as Command- 
ing OflSccr of Co. C, Hospital Corps, at the Washington Barracks Gen- 



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146 J\rElVS OF THE SERVICES. 

eral Hospital, and to accompany fifty men of Co. C. Hospital Corps, from 
the Washington General Hospital to Chickamauga Park, Ga. 

Acting Assistant Surgeon Henry C. Richter, P.H.&M.H.S., appointed 
July 7, 1908, and ordered to Calexico, Cal. 

Assistant Surgeon Norman Roberts, P.H.&M.H.S., ordered before the 
Washington Promotion Board. 

Passed Assistant Surgeon S. S. Rodman, U.S.N., ordered home 
from the Rainbow, 

Acting Assistant Surgeon J. O. Rush, P.H.&M.H.S., granted fourteen 
days leave. 

Acting Assistant Surgeon M. V. SafFord, P.H.&M.H.S., ordered to 
Ellis Island for special temporary duty and return to Boston, Mass. 

Passed Assistant Surgeon J. W. Schereschew.sky, P.H.&M.H.S., 
ordered to Ellis Island for special temporary duty and return to Baltimore 
Md. 

Captain Ferdinand Schmitter, U.S.A., ordered from Fort Egbert to Se- 
attle to wait orders. 

Major Edward R. Schreiner, U.S.A., promoted from Captain April 23, 
1908. 

Major Ira A. Shimer, U.S.A., promoted from Captain April 23, 1908. 

Captain Joseph F. Siler, U.S.A., ordered before the Washington Pro- 
motion Board. 

Acting Assistant Surgeon H.Slade, P.H.&M.H.S., granted one month's 
leave. 

Assistant Surgeon C. W. Smith, U.S.N., ordered to the Portsmouth 
Naval Hospital and to additional duty at the Naval Prison at that Yard. 

Assistant Surgeon F. W. Smith, U.S.N., ordered from the Wisconsin 
to report to the Commander, Third Squadron, Pacific Fleet. 

Captain Lloyd L. Smith, U.S.A., ordered before the Washington Pro- 
motion Board. 

Captain Cary A. Snoddy, U.S.A., ordered before the Washington Pro- 
motion Board. 

Lieutenant H. McC. Snyder, U.S.A., ordered from the San Francisco 
General Hospital to Fort Rosecrans for temporary duty. 

Surgeon J. J. Snyder, U.S.N. , commissioned from March 4, 1908, and 
ordered from the New Hampshire to the Franklin, 

Assistant Surgeon D. A. Spear, U.S.N., convicted by general court 
martial of forgery and sentenced to dismissal from the service 2nd two years 
imprisonment, the latter portion of which, upon recommendation of thecourt 
was migitated to one year. 

Passed Assistant Surgeon P. R. Stalnacker, U.S.N., commissioned 
from May 3, 1908. 

Medical Inspector J. M. Steele, U.S.N., retired after thirty years ser- 
vice. 



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NEWS OF THE SERVICE^. 147 

Major William Stephenson, U.S.A., ordered before the Washington 
Promotion Board. 

Acting Assistant Surgeon J. W. Stevenson, P.H.&M.H.S.» granted 
twenty days leave and two months leave without pay. 

Acting Assistant Surgeon C. S. Stoddard, P.H.&M.H.S.,granted one 
month^s leave. 

Acting Assistant Surgeon H. C. Story, P.H.&M.H.S., granted one 
month *s leave. 

Passed Assistant Surgeon J. L. Taylor, U.S.N., commissioned from 
December 17, 1907, and ordered to the New Fort Lyon Naval Hospital. 

Captain William H. Tefft, U.S.A., ordered before the Washington 
Promotion Board. 

Acting Assistant Surgeon W. Townsend, P.H.&M.H.S., granted one 
month's leave. 

Assistant Surgeon G. B. Trible, U.S.N., ordered from the Mare Island 
Naval Hospital to the Relief. 

Captain Willard F. Truby, U.S.A., ordered before the Washington 
Promotion Board. 

Surgeon J. F. Urie, U.S.N., ordered from the Pennsylvania before the 
Mare Island Naval Retiring Board, and then to the Naval Hospital at that 
place for treatment. 

Captain James W. Van Dusen, U.S.A., granted one month's leave about 
October i. 

Captain William E. Vose, U.S.A., ordered from Fort Des Moines to 
Fort Mackenzie. 

Dr. F. M. Wall, U.S.A., ordered from Fort Oglethorpe to Chickamauga 
Park, Ga. 

Passed Assistant Surgeon W, K. Ward, P.H.&M.H.S., ordered from 
Kllis Island to Manila. 

Captain Walter D. Webb, U.S.A., ordered before the Washington Pro- 
motion Board. 

Major Henry A. Webber, U.S.A., promoted frorti Captain April 23, 
igo8. 

Captain Frank W. Weed, U.S.A., ordered before the Washington Pro 
motion Board. 

Dr. H. R. Weston, U.S.A., ordered from Fort Ethan Allen to the Phil- 
ippines. 

Captain Arthur M. Whaley, U.S.A., ordered from Fort Sam Houston 
to Leon Springs, Tex. 

Surgeon W, M. Wheeler, U.S.N., ordered home from the Cavite Naval 
Station. 

Assistant Surgeon E. C. White, U.S.N., relieved from further duty in 
Cuba, and ordered to the Cleveland Naval Recruiting Station. 

Dr. J. S. White, U.S.A., arrived in San Francisco on leave from the 
Philippines. 



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148 NEWS OF THE SERVICES, 

Passed Assistant Surgeon M. J. White, P.H.&M.H.S., granted fifteen 
days leave. 

Dr. G. L. Wickes, U.S.N., married Miss Marjorie Appel, daughter of 
Lieutenant Colonel and Mrs. Aaron Hirst Appel, at Cheyenne, Wyoming, 
Wednesday, July 8. 

Captain William A. Wickline, U.S.A., ordered to accompany one-half 
of Co. B, Hospital Corps, from the San Francisco General Hospital to Leon 
Springs, Texas. 

Surgeon L. L. Williams, P.H.&M.H.S. granted one month's leave. 

Assistant Surgeon C. K. Winn, U.S.N., ordered from the Villalobos to 
the Missouri. 

Captain Robert N. Winn, U.S.A., ordered before the Washington Pro- 
motion Board. 

Captain Edwin P. Wolfe, U.S.A., ordered before the Washington Pro- 
motion Board. 

Lieutenant Colonel Frederick J. J. Wood, N.GN.Y,, desires to state 
that the information in the June Military Surgeon that he personally 
reported in favor of the Hospital Corps of one of the Regiments in his 
command is incorrect and that he made no such statement. 

Captain Frank T. Woodbury, U.S.A., granted two months leave from 
the Philippines. 

Major Marlborough C. Wyeth, U.S.A., ordered before the Washington 
Promotion Board. 

Dr. H. W. Yemans, U.S.A., ordered, upon expiration of leave, to Fort 
Wayne. 

Captain Stanley G. Zinke, U.S.A., ordered to accompany troops from 
Fort Leavenworth to Fort D. A. Russell, and before the Washington Pro- 
motion Board. 

A Military Hot Springs Hospital in the Philippines.— The 
military hospital at Camp Eldridge, Laguna, has been officially designated 
as a sanitarium in the Philippines for the special treatment of diseases ap- 
propriate to the form of hydro-therapeutics furnished by thermal springs. 

The New Drill Regulations for the Army Hospital Corps. — 
The new Drill Regulations, edition of igoS, have been issued. The book 
is materially larger than previous editions and is noteworthy for the substi- 
tution of half tone engravings for the outline illustrations formerly used. 
A more detailed review of the book will appear in the next number of The 
Military Surgeon. 

Army Cooking Schools at Maneuver Camps.— An interesting and 
valuable feature of the summer maneuver camps this year is the presence 
of the army cooking schools. Although not under the direct command of 
the Medical Department they form a most important feature of military 
hygiene and will prove of much advantage and interest to medical officers 
and the Hospital Corps. 

The Sixteenth International Medical Congress, — This Con- 
gress, which is to meet at Budapest, August 26th to September 4th, 1909, is 
already well organized and requests representation by delegates from the 



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NEIVS OF THE SERVICES, 149 

Association of Military Surgeons of the United States. Any member de- 
siring to attend the congress may receive credentials in official form from 
the Secretary of the Association upon application. 

Probationary Course at the Naval Medical ScHOOL.~The 
Medical Department of the Navy has adopted the plan followed for so 
many years by the Army Medical Department of appointing candidates for 
the Medical Corps Acting Assistant Surgeons and ordering them to a pro- 
bationary course at the Naval Medical School, at the successful termin- 
ation of which they are to be graded according to the standing of their 
final examinations and duly commissioned. 

Army Medical School Graduates. — The first officers to enter the 
reorganized Army Medical Corps graduated last month from the Army 
Medical School and have received commissions in the Corps in the follow- 
ing order: Mahlon Ashford, Washington, D. C, John R. Barber, Shetidan, 
Oreg., Calvin D. Cowles, Jr., at large, Edward G. Huber, Martinsburg, 
Mo., John S. Lambie, Jr., Blairsville, Pa., Garfield L. McKinney, South 
Canaan, Pa., Hiram A. Phillips, Monticello, Ky., Howard McC. Snyder, 
Cheyenne, Wyo., Arthur N, Tasker, Washington, D. C, Joseph A. Worth- 
ington, Harrison, Ark. 

Successful Candidates for the Army Medical Corps.— At the 
last examination for admission to the Army Medical Corps seventy-two 
candidates presented themselves and of this number but nine were success- 
ful, viz., Dr. Rozier Claggett Bayley, of Virginia; Contract Surgeon Daniel 
Parker Card, of New York; Dr. William Richard Dear, of District of 
Columbia*, Contract Surgeon Leon Connallis Garcia, of Missouri; Dr. £ben 
Clayton Hill, of Maryland; Contract Surgeon James Carre Magee, of 
Pennsylvania; Dr. Arm in Mueller, of Wisconsin; Contract Surgeon Syl- 
vester F. O'Day, of New York; Contract Surgeon Arnold Dwignt Tutlle, 
of New York. Physical defect was the chief element in producing so large 
a number of rejections, although the mental examination also found its 
victims. 

Examination for Admission to the Public Health and Marine 
Hospital Service. — An examination for appointment as Assistant Sur- 
geon in the Public Health and Marine Hospital Service will be held at the 
Bureau opposite the house wing of the capitol in Washington on Septem- 
ber *4, 1908. The Service is continually becoming more desirable and 
pending legislation will make it still more so. Those desiring admission 
should address the Surgeon General of the Public Health and Marine Hos- 
pital Service, 3 B St., S. E., Washington, D. C, requesting permission to 
appear for examination. 

Materialization of the Army Medical Reserve Corps.— Com- 
missions were issued last month to 160 active officers of the Army Medical 
Reserve Corps, embracing former contract surgeons who are eligible under 
the new medical law to appointment as first lieutenants of the reserve. The 
list embraces some who served in the Civil War, many who saw active ser- 
vice in the Spanish War and in the Philippines during the insurrection, both 
in the volunteers and as auxiliaries of the Regular service. No small diffi- 
culty has been encountered in determining the relative rank of the various 
candidates for appointment, as their service has been so varied and ex-- 
tended in some cases. The law is that relative rank must be settled by 
length of service in the Regular Army or since April 19, 1861, in the volun- 
teer forces, and when periods of service are equal, rank is determined by 



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150 NEIVS OF THE SERVICES, 

the standing in competitive examinations, by rank in service when appointed, 
and by lot. Practically all these methods have come into play in settling 
the numerous- knotty questions that have appeared in the appointments in 
question. Dr. S. T. Weirick, for many years a contract surgeon has been 
commissioned as a first lieutenant of this corps. Dr. Weirick is one of the 
oldest medical officers in the country, having had service in the ranks dur- 
ing the Civil War and for nearly two score years in the Medical Depart- 
ment. 

Many applications are being received from civilian physicians for ap- 
pointment to the corps under the terms of the circular published in the last 
Military Surgeon and twelve commissions have been issued. It is hoped 
to obtain leading members of the profession in the principal cities, that 
the new corps may have the benefit of their names and influence. Boards 
will be detailed to meet in various places as medical officers are available 
for the duty, with a view to conducting the examination upon which ap- 
pointments to the reserve corps are based. The first of these boards has 
been ordered to meet in Washington, and is composed of Major Charles 
Lynch, who will have charge of the reserve corps affairs in the surgeon 
generaPs office, and Captains W. B.Webb and J. B. Hugginsof the medical 
corps. In the meantime, consideration is being given to the designs of an 
insignia to be worn on the collars of the uniform of the commissioned per- 
sonnel of this branch of the Army medical department. It has been sug- 
gested that in addition to the letters "U.S." there be a combination of em- 
blem and letters made up of the caduceus and the letters "R. C." It is a 
question whether in the manufacture of such a combined design sufficient 
distinctness may be gained. 

Army Medical Preparations for War.— The assemblying of 
field equipment by the American Army Medical Department against the 
time it may be needed for the emergency of war was begun in a small way 
in 1901. At that time there was a small Field Medical Supply Depot in 
the cellar of the Army Medical Museum. After the present Chief of the 
Medical Corps came in more room was acquired in a building on 20th St., 
and last year authority was fortunately obtained to rent for a Field Medi- 
cal Supply Depot the Globe Building on Pennsylvania Ave.; this building 
is admirably adapted for use as a supply depot and is in charge of Major 
Carl R. Darnall. A bill appropriating ^200,000.00 for this purpose was ap- 
proved by the President on May 11, 1908, and bids have already been re- 
ceived for something like $192,000.00 worth of field supplies. The con- 
tracts for these expenditures were completed early in July and the expendi- 
ture of the remaining amount will be provided for during the summer. The 
supplies take the form of a certain number of completely assembled regi- 
mental, field, stationary and base* hospitals so that when an emergency 
comes again the medical department can ship these hospitals to camp and 
be immediately prepared to take care of the sick. 

The Army Medical Department will by this measure be relieved of 
much embarrassment due to the failure of Congress hitherto to provide for 
a field equipment. The special apparatus and supplies for field medical 
equipment are not in the general market and cannot be improvised. To 
assemble them takes months. In view of the celerity of modern military 
movements a prudent government must provide them beforehand. Some 
progress had been made in this direction, as already noted but the stock 
was constantly depleted by issues to the militia, and it was still far from • 
adequate. Moreover a large reserve of medical supplies in store at San 
Francisco was destroyed in the burning of that city. The estimated value 
of the stores destroyed was $357,391.62 and the appropriation to replace 
them was only $100,000.00. Those who have made a study of the situation 
have no hesitation in describing as one of the vital needs of the medical 
department in the future as stated in the report of the Dodge Commission, a 
year's supply for an army of at least four times the actual strength of all 
such medicines, hospital furniture and stores as are not materially damaged 
by keeping, to be held constantly on hand in the medical supply depots. 



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Current Xiterature. 



HISTORY OF THE FRENCH ARMY MEDICAL CORPS.* 

NO history of the French Army Medical Corps has appeared 
since that of Gama and Bdgin issued in 1840, so that it 
may ahnost be said that French military medicine was 
without a historian, its real life being a creature of later years. 
Uplike so many works of similar pretensions, this book is not the 
outcrop of a recent war, but a philosophical survey of the subject 
extending throughout the history of France. 

After an introduction covering the early general history of 
medical aid in war, the authors enter into a consideration of the 
monarchy and the military hospitals during the period from 1708 
to 1792, thence passing into the swift campaigns of the Grand 
Army, followed by the Restoration, the Franco-German cam- 
paigns, the colonial operations, and closing with a consideration 
of the progress of the service under the act of 1882 by which the 
medical department was endowed with autonomy. 

The uniforms of the service are touched upon with a special 
vividness, and their fashion brought out particularly clearly by a 
series of color plates from aquarelles by M. A.-L. La Gault of 
the Sabretache. 



INTERNATIONAL CLINICS.f. 

THE International Clinics for 1908 open up with a hand- 
some volume, maintaining the high character and com- 
prehensive scope which we have learned to expect from 
this publication. 

*Le Corps de Sante Militaire en France; son Evolution^ ses Campaignes, 
}708-1882» par M. le Docleur Bkice et M. le Captaine Bottet. 8vo; pp. 
462, Paris, Berger-Levrault ei Cie, 1908. Paper, 25 fr. 

tintematlonal Clinics* Eighteenth Series. Vol. I. Edited by W. T. 
LONGCOPE, M.D. 8 vo; pp. 309, with 75 illustrations. Philadelphia and 
London, J. B. Lippincott Co., 1908. 

(151) 



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1 52 CURRENT LITER A TURE. 

SURGICAL ANATOMY.* 

IN this excellent work the author has made medical practice 
to take a distinct step in advance, for the work is a material 
improvement upon all treatises upon the subject hitherto 
issued. The clinical aspect of the subjects considered is in every 
instance the prime motive of the discussion of the several parts. 
With this feature in the foreground the other elements of the 
work fall into position iq due proportion and proper perspective. 
Both clinically and anatomically the book is complete and up to 
date and will find for itself a broad field in the needs of the pro- 
fession. 

YEAR BOOKS OF GENERAL MEDICINE AND 
GENERAL SURGERY, f 

THE first two volumes of the Practical Medicine Series for 
1908 are cTevoted to the subjects of General Medicine 
and General Surgery and continue under the editorship, 
respectively, of Frank Billings, M.JD. and J. H. Salisbury, M.D., 
for the former, and John B. Murphy, M.D., for the latter, the 
whole series continuing under the chief editorship of Gustavus 
P. Head, M.D. We have already expressed our high opinion of 
this series and are glad to note that the series for 1908 promises 
to sustain the reputation already acquired. 

ADENOMYOMA OF THE UTERUS. t 

THIS work is a fine example of the modern exhaustive 
monograph which has been so highly and so frequently 
discussed with approval in the pages of The Military 
Surgeon. It originated in a study of a case of diffuse uterine 
adenomyoraa which indeed is in this work for the first time es- 
pecially worked out. The book is well arranged, finely illus- 
trated and sumptuously printed. 

*A Textbook of Surgical Anatomy.-By William Francis Campbell, 
M.D. 8 YD ; pp. 675, with 319 original illustrations. Philadelphia and 
London, W. B. Saunders Co., 1908. Cloth $5.00, net. 

tPractical Medicine Series.— Edited by GuSTAVUS P. HEAD, M.D. Vol. 
I. General Medicine, Edited by Frank Billings, M.D. and J. H. 
Salisbury, M.D. 12 rao; pp. 408. Cloth $1.50. Vol. II. General Sur- 
gery. Edited by John B. Murphy, M.D. 12 mo; pp. 614. Chicago, 
The Year Book Publishers. 1908. Cloth $2.00. 

tAdcnomyoma of the Uteru8«-By THOMAS S. CULLIN, M.D. Imp. 8 
vo; pp. 270, with 68 illustrations. Philadelphia and London, W. B. 
Saunders Co., 1908. Cloth $5.00, net. 



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Vox- atXIU, No. 3. Skptbmbbr, 1008. 



OviQinnl d^tnoiu. 



WHAT IS THE MOST EFFECTIVE ORGANIZATION 
OF THE AMERICAN NATIONAL RED CROSS FOR 
WAR, AND WHAT SHOULD BE' ITS RELA- 
TIONS TO THE MEDICAL DEPART- 
MENTS OF THE ARMY 
AND NAVY?* 

By major HENRY I. RAYMOND, 
MKDICAI^ CORPS UNITED STATES ARMY. 

PRELIMINARY REMARKS. 

HE fact that all human knowledge 
is derived from experience, either 
from one's own or from that of others 
is undeniable. *'Experientia opti- 
mus magister est*' is a familiar 
phrase of our academic days and tho 
it may sound scholastic, the fact re- 
mains that * 'history is philosophy 
teaching by example. ' * Those facts 
derived from past experiences and on 
which is founded all human knowl- 
edge, constitute, when classified and 
arranged in a complete series, the 
surest foundation for an abiding su- 
perstructure. Is it not then the part 
of wisdom in seeking a solution of 
'*the most effective organization of the American National Red 

*Tbe essay which received tint honorable mention In the Enno Bander Prize 
Bnay CompeUtlon for 19Q7. 

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1 54 MAJOR HENR Y /. RA YMOND. 

Cross for War" to study philosophy teaching by example upon 
the world's battlefields, and especially in that greatest and yet 
most recent war in the annals of history — the Russo-Japanese — 
and to adapt to the genius of the American people the exploita- 
tion of those principles which underlie the causes that are the 
prime essentials to success, and in comparison with which causes, 
mere resiilts are at most but necessary sequences ? 

Scarcely fifty years ago an American admiral opened up Japan 
to the civilization of the world. Today Nippon has given to the 
world the most perfect exemplification of an organized Red Cross 
for war — a spectacle seen from the time of Henri Dunant upon 
the battlefield of Solferino through a glass darkly, but now seen 
face to face. 

This greatest contribution to humanity in war was an off- 
spring of paganism: not Christianity but the teaching of Confucius 
that what ye would that others should not do unto you do ye not 
to them was the motive power. The underlying principle was 
reciprocity. It was however a living burning faith— one that 
opened the pocketbook — and today the poor and pagan Nippon 
is contributing three million yen annually in preparation toward 
the prevention and amelioration of the ravages of a possible war. 
Her budget toward practicable philanthropy vies with that for 
machine guns, just as her growth in ethical culture and altruism 
keeps pace with her advancment in the destructive arts of war- 
fare. The membership of her Red Cross today numbers over 
one million out of a population of forty-five million and the great 
bulk of her Red Cross fund is contributed in driblets by the peo- 
ple themselves, who pay their debt to their country by providing 
for the prevention of camp diseases, and for the care of their sick 
and wounded soldiery. It may injure our pride to take example 
from a pagan nation, but pride goeth before a fall and tends to 
paresis of that receptivity of mind which characterizes all honest 
men. 

The practical utility of the Japanese Red Cross for War in 
war is due in part to its universal popularity — it is the only thing 
in Japan without caste — its loyal supporters range from royalty to 
peasantry, and this very popularity insures an ample treasury. 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR, 1S5 

When a man sets his heart upon anything — especially a ^n^orthy 
object — he is usually willing to pay the price. Are we not too prone 
to cut our coat according to the cloth ? The Red Cross of Japan 
is no paper organization: its great popularity gives it member- 
ship and funds — two essential elements of success. International 
arbitration propaganda, while seeking the restriction or the re- 
duction of armaments and the cessation of warfare, should (how- 
ever paradoxical it may sound) encourage, in an inverse ratio, a 
liberality in preparation for the care of the sick and wounded in 
a possible future conflict, "opposing the arms of charity to the 
arms of violence' ' and making war against the ravages of war 
itself. This provision at least should be arranged well nigh on 
a war footing, irrespective of peace armaments and not left a poor 
pensioner upon the bounties of an hour. The humanitarian phase 
of the subject should appeal to all — alike to those possessed of the 
most conservative military spirit and to those most bitter in their 
denunciations of the righteousness or necessity of war. 

When the dogs of war are let slip, then the American people 
are most lavish with their money and open wide the National 
treasury, but '*then" is too late to enter. To those who will not 
accept the dictum that the price of peace, at leasts is prepared- 
ness for war, we make this appeal that the price of an e£Bcient 
medical and hospital corps service in war is its full anticipation 
and complete preparedness in time of peace. It is said of Napo- 
leon that he won his victories before his battles were fought — so 
perfect was his strategy so vast his generalizations: So with fore- 
sight and preparedness it has come to pass that the Red Cross 
of Japan has become the greatest organizer of victory on the 
battlefield against our invisible foe that, since the dawn of history, 
with but two exceptions, the Franco- Prussian and the Russo- 
Japanese wars, has engulfed in its enormous maw fourfold more 
victims than the actual causalties of battle alone. 

The foregoing may bring to the student's attention certain 
essential elements of organization that can not themselves be for- 
mulated between lines and crossbars but which bear to the com- 
pleted whole the relation of foundation to superstructure. The 
organization of the American National Red Cross for War must 



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156 . MAJOR HEf^RY II^AYMOND. 

therefore be federal in its governmental attribute; of universal 
popularity in its breadth of comprehensiveness; business-like and 
resourceful in its fiscal relations under a federal accountant and 
must have for her motto "semper paratus'* to insure the winning 
of her greatest victories before the first tocsin is sounded. 

The enemy in warfare is twofold, the visible and the invis- 
ible foes. Until the Russo-Japanese war, with one exception, 
the mortality record was one death from wounds to four deaths 
from disease, but Japan has transposed the numerals — four deaths 
now from wounds to one death from disease— or eight hundred 
per cent better than the average of history against an unseen foe. 
"God of battles! was ever a battle like this in the world .before?*' 

The Spanish- American war, waged in the name of altruism, 
gave us a ratio of one killed by bullets to more than ten who suc- 
cumbed to preventable diseases. The American arms were vic- 
torious but another such victory would undo us quite. The Jap- 
anese rightly conceived that in the oncoming war with Russia, 
according to the average of history, out of one hundred thousand 
deaths in war eighty thousand would be attributable to prevent- 
able causes and only twenty thousand to the legitimate and reason- 
able mortality of armed interference. She was willing to offer up 
this inevitable sacrifice as an immolation upon thexsountry's altar, 
but she must needs eliminate the slaughter of the eighty thousand 
by an unseen foe. This she did, giving her commanders against 
this Utter foe equal rank and opportunity and autonomy in their 
respective spheres of action with those commanding against the 
visible enemy who unavoidably destroyed but twenty thousand. 

Never is money so well invested as for prevention of dis- 
ease, nothing is more costly than disease; and two hundred and 
fifty thousand dollars spent in preparation of the medical person- 
nel and equipment for war would save the country ten million 
dollars in treatment and pensions. The lesson is one of prepar- 
edness for the inevitable. This is the price of victory oVer our 
unseen foe and if we are willing to pay the price then let us add 
(lest we forget!) that the American National Red Cross never 
will be prepared for war unless she is Blwsiys geiiing ready. 

In every way the most perfect humanitarian organization in 



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ORGANIZATlOt^ OF AMERICAN RED CROSS FOR WAR. 157 

the world is the Japanese Red Cross service. She leads the world 
in practical philanthropy. Her staff and Appliances available for 
war consist of: 

320 Doctors, - ' . 

160 Apothecaries, 
1,920 Nurses, 

770 Sick attendants (male)^ 
457 Probationary nurses, 

2 Hospital ships complete and two under construction, 
398 Cases of medical appliances, 
1,774 Cases of surgical instruments, 
496 Stretchers, 
52,438 Articles of patientsVplothing and bedding, 
27,199 Articles of nurses' clothing and bedding, 
2,060 Miscellaneous articles, 
1,035,000 names inscribed under the white banner of her Red Cross and 
3,000,000 yen contributed annually. ^ 

May we not suspect ourselves of some folly when our ratio 
of one to ten or more in the Spanish- American war shows three 
hundr^ per cent worse than the average of history while Japan 
went eight hundred per cent better than the historical average ? 
In which of the four great principles— centralization, preparation, 
impartiality, and solidarity — embraced in the solemn compact 
between the National Red Cross societies, as set forth by that in- 
comparable Red Cross American pioneer— Clara Barton— did we 
fall short of in oiir observance ? Did centralization on which de- 
pends unity of directiot^^ tail us? Did our preparation insure 
calmness and efficiency in 4be hour of trial and forestall hasty 
and disconcerted action in the bewilderment of excitement ? We 
need not enquire regarding impartiality which extends a helping 
hand alike to friend and foe nor regarding solidarity, which per- 
mits* strangers to the dispute to tender succor and assistance to 
the sick and wounded of the belligerent forces without affecting 
any principle of non-interference. This principle of solidarity 
alone is sufficient warrant for a highly organized American Na- 
tional Red Cross — tho our isolated geographical position renders 
improbable our own participation in a conflict of arms for the rest 
of the century. Such an aim would be truly humane and purely 
Christian with no taint of pagan reciprocity. 



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158 MAJOR HENR Y I. RA YMOND. 

Every constitution or world organization is a product of 
evolution — none ever sprung full panoplied into existence as did 
the fabled Juno who sprung full-armed from the breast of Jove. 
The discovery of a scientific fact is never a fortuitous circum- 
stance but rather is the capping stone of a long series of scienti- 
fic collateral findings precedent to the final crowning glory of the 
work in hand. So in sociology, no one can sit down and, disre- 
garding the history of constructive events in social evolution, 
map out in originality a plan of organization that will contain 
the Promethean spark of assured vitality. The military strate- 
gist studies the campaigns of the greater military commanders 
from Epaminondas to Von Moltke and deduces from their experi- 
ences the art of occupying specific points by specific forces in 
specific times. The strategist in mimic warfare upon the chess 
board studies the processes of the greater captains of the chessic 
art from Philidor to Morphy and deduces from their experiences 
the art of occupying specific points with specific chess forces in 
specific times. The lamp of experience furnishes a safe and steady 
light in the forecast of the future. In this spirit, then, let us ap- 
proach the task before us and enquire into the history of the 
greatest Red Cross organization— with no parallel precedent since 
the dawn of creation — the National Red Cross of Japan. 

PART I. 

HISTORY OP THE JAPANESE RED CROSS FOR WAR. 

The most complete and lucid exposition of the origin, growth, 
development and purposes of this organization is set forth in 
the French by Ariga upon whom the essayist will freely draw in 
this narration, vouching thus for its historical accuracy. In 1900 
in the farthest East, a development of the work of the Red Cross 
was being accomplished for which there had been, up to that 
date, no precedent in any other part of the world. Whence comes 
then the wonderful development of this society? Unquestion- 
ably from its special and individual character. The principle of the 
Geneva Convention of 1864 was humanity but in a broad sense 
humanity is opposed to nationality. Not humanity, but ''Dette 
a la patrie et secours aux soldats" was the actuating principle 
that gave to the Japanese Red Cross its special and individual 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 159 

character. On this principle of reciprocity. the society developed 
with a rapidity so prodigious that for one of the countries the 
most distant f romChristian civilization there had never before been 
seen a parallel precedent. 

The founders of the society called Hakuaisha — meaning Be- 
nevolence Unlimited— memorialized the throne in these memorable 
words — in free translation: * 'Our gratitude toward the country 
is immense and in order to pay a feeble part of what devolves 
upon us we have formed a society called Hakuaisha of which the 
end is to send its members upon the field of battle to care, under 
orders of the surgeons of the Army and Navy, for the wounded 
soldiers of the Imperial army. As to the wounded insurgents 
(civil war of Kagoshima, 1877), their number is much greater 
than that of the wounded of the Imperial Army and moreover 
their medical service is defective. Their wounded are abandoned 
in the fields and upon the mountains and remain for a long time 
exposed to the sun and rain. They are, it is true, rebels against 
the authority of the Kmperor and their fault is unpardonable 
but they are nevertheless subjects of the Empire and children of 
the Emperor and Empress. We cannot be so cruel as to abandon 
them to their ill fortune and we pray that we be also empowered 
to care for them. In according us this authorization, the mag- 
nanimity of our august sovereign will not only be manifested thru 
and thru but this magnanimity will also be the most certain means 
of recalling the insurgents to their duty." His Imperial High- 
ness, Prince Komatsu, then accepted the title of honorary pres- 
ident. An appeal was made to the public for funds. Gifts in 
money and kind flowed in like a swollen river. His Imperial 
Majesty came himself and gave 1,000 yen as a personal subscrip- 
tion, not as a functionary. Agents were sent to the theater of 
war to gather up the wounded and to scatter lavish care for all, 
without distinction between federal troops and insurgents. 

Thus was established the Society of the Red Cross of Japan. 
Let us now determine how the character of this Red Cross So- 
ciety has manifested itself in its development, its organization, 
its relations with the Imperial Household and with the military 
authorities in its different labors in the course of the war of 



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160 " MAJOR HENRY /. RA YMOND, 

1894-5, and how its character is manifested again today in its prep- 
aration for a possible war in the future. The origin of the so- 
ciety makes memorable the year 1867 when Count Sano, later on 
its president, was sent by the government of the Shogun to the 
universal exposition at Paris to study the organization and meth- 
ods of the Red Cross societies of the world powers. Again in 
1873, as Minister to the Court of Vienna, he devoted himself to 
a study of the progress made since the Franco-Prussian war of 
1870-1. The salutary effects of these missions upon the civil war 
of Kagoshima (1877) already have been recounted. Adhesion 
of Japan to the Geneva Convention followed in due course and 
then it was in order to undertake the reorganization of the so- 
ciety. The new organization was put into operation in May, 1887. 
She entered then upon a period of growth of her resources. The 
society estimated carefully the cost of the getting ready — how 
much cloth would be needful for the service coat— and looked 
about for the money. Sano sought new means of exciting a health- 
ful rivalry among the departments. He caused to be calculated 
upon the basis of the inhabitants of each department the per- 
centage of adherents; printed tables of statistics were sent to the 
chiefs of local sections and committees. The impartiality of this 
system and the question of amour propre of each department- 
each wishing not to make the worst showing or to be behind — 
naturally developed a favorable result. 

The effects of the Chino-Japanese war upon the development 
of the society were immediate and far reaching. The war demon- 
strated to the nation how precious and priceless had been the ser- 
vice rendered by the society. This war brought Japan face to 
face with the world and augmented her resourcs, while it in- 
creased her dangers. Before the war she had but one hospital in 
which to instruct her infirmary nurses, and tho she had an abund- 
ance of material and also a sum of money especially set apart for 
the expense of preparing in advance her material and personnel, 
she did not yet have an organizaaion sufficiently definitive for ser- 
vice in time of war. The great number of experiences gained in 
the course of the war and the rapid augmentation of resources 
and of members during and after the war however permitted the 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 161 

society to commence preparations on a grander scale and on a 
better determined plan. The military authority which then re- 
organized the different services of the army, profited by the re- 
form of the field sanitary service to study the mode of utilization 
of the personnel and materiel of the Red Cross Society. 

On his return from the sixth International Conference of the 
Red Cross, Dr. Koike was named Director of the Medical Ser- 
vice of the Army, and under his direction were completed the 
rules for the Service of Succor of the Red Cross Society in time 
of war. The plans of these preparations having been made in 
concert with the military authorities, it remained only for the 
society to put them into execution. As war may come at any 
time, surely within thirty or forty years, for the great fact of all 
history is war, but as no one can foretell the hour, the society 
resolved to put an end to the incertitude and fixed upon the year 
1902— the twenty-fifth anniversary of Kagoshima — as the year 
in which should be brought to fruition the new fruit of the tree 
of knowledge whose root was experience. The relation of the 
activity of the society to its acknowledged obligation to the sov- 
ereign, resulted in the high patronage which His Imperial Majesty 
extended over the society. This relation demanded the realiza- 
tion of the three following points: 

1. To have the honor of the high patronage of Their Imperial 
Majesties: 

2. To see that the nomination of the President and Vice Pres- 
ident of the Society meets the approval of the Emperor and Em- 
press: 

3. To place the Society under the control, and subject to the 
mandates of His Imperial Majesty. 

The principal means which the society employed to set forth 
to the people this relation between the Throne and the Red Cross 
were as follows: 

1. Publication and advertisment. 

2. Utilization of governors of departments. 

3. The insignia of the society. 

4. General assemblies of the local sections. 

5. Popularization by the mag^c lantern. 



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162 MAJOR HENR Y I. RA YMOND, 

The publications and advertisements consisted of manifestoes 
and a monthly magazine called "The Red Cross of Japan.*' In 
these publications were set forth the best methods of paying this 
debt to the country in the succor of her soldiers. The second 
manifesto explained how to aid wounded soldiers on the battle- 
field — all in language understood by the common people and placed 
in their hands. 

Another mode of propagandisra was manifested at the meet- 
ing of the governors of departments. The Honorary president, 
Komatsu in '80 and '83, invited them to Tokio, and at these 
annual reunions begged them to make every effort to recruit the 
society and to encourage donations. At one of these reunions 
Marquis Ito and the Ministers of War and of the Navy were pres- 
ent. Marquis Ito explained to them the intention of the Crown 
in placing the society under its high patronage, spoke of the 
flourishing condition of the Red Cross societies of Europe and 
showed how useful and necessary it had proven to be to obtai^ the 
assistance and co-operation of the entire people. The governors 
responded heartily, and from that day dales the identification of 
the administrative organs of the state with those of the local Red 
Cross societies. 

The Red Cross insignia were employed as a very effective 
means of propagandism. The Insignia were distinguished from 
the medals of other societies by their great value and the 
distinctive honor conferred by them. They differed in three 
essentials: 

1. They were created by special sanction of the Emperor on 
June 2, 1888, while those of the other societies had never received 
special sanction or ratification. 

2. They were bestowed on members with solemn ceremony; 
the Honorary President gave the names to the Minister of the Im- 
perial Palace, who conveyed them to His Majesty the Emperor. 
It follows that the insignia are in this respect accorded by the 
Emperor himself, after the manner of according certain other dec- 
orations and medals of the empire. 

3. These insignia could be worn by the members in their pub- 
lic reunions with equal right to that accorded other decorations 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 163 

or medals of state. By an ordinance of 1805, the wearing of the 
insignia of the Red Cross in public was confirmed, and, on the 
other hand, the wearing of the insignia of private societies in pub- 
lic was forbidden. Besides the insignia of membership there was 
a special decoration of merit which was created to recompense 
those who should render conspicuous service to the society. This 
decoration was likewise accorded by the Emperor himself. 

General assemblies of the local sections of each department 
were held annually and were presided over by the Governor; an 
address by the Honorary President was read or, as often hap- 
pened, was delivered by himself in person, and this was followed 
by exercises or maneuvers by the Sanitary Corps. This annual 
event or fete, being the great social event of the department, was 
productive of new adherents and enriched the treasury beyond the 
expenses of the occasion. 

Another method of propagandism was to assemble the inhabit- 
ants of the villages in a certain locality for the purpose of ex- 
plaining to them the origin of the Red Cross and the necessity of 
its existence, by means of pictures projected on a screen by the 
magic lantern. The idea of popularizing this society by this means 
was certainly novel. The Baron Ishiguro, medical inspector 
general, came himself with his lantern to the General Assembly 
at Tokio, and this report having reached the ears of Her Imperial 
Majesty, she ordered the Baron to give a representation of the 
magic lantern views before herself and the Crown Prince. 
This patronage insured its popularity. Among the views pre- 
sented were the portraits of Florence Nightingale and Henri 
Dunant; the national and Red Cross flags; wounded soldiers aban- 
doned on the field of battle: His Majesty visiting the wounded 
soldiers in the hospital at Osaka, and the Empress donating band- 
dages made by her own hands. 

We are now prepared to study more specifically the organi- 
zation of the Red Cross of Japan. The members of the Society 
are of three classes: 

1. Honorary. 

2. Special. 

3. Titular. 



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164 MAJOR HENRY I. RAYMOND, 

The permanent council has power to confer upon persons of 
dignity the title of honorary member. As a matter of fact this 
title is conferred only upon members of the Imperial Household. 

Those who have rendered notable service to the society in war 
or in peace and without compensation, may be made special mem- 
bers and, as such, are exempt from payment of annual dues. 

The titular members are those who pay annual dues of three 
to twelve yen. 

The Control is placed under the Minister of the Imperial 
Palace and the Minister of War and Navy, on whom it devolves 
to carry out the desires of His Imperial Majesty who is their High 
Protector; and they are also charged with the organization of the 
sanitary service of the army. All the principal rules of the so- 
ciety are subject to the authorization of these Ministers. The 
successive Surgeons General of the army have decided all questions 
that came up under the respective Ministers of War. These di- 
rectors of the medical service of the army were such men as Baron 
Hashimota, Baron Ishiguro, and Dr. Ishishaka who have always 
been warm partisans of the society and have personally contri- 
buted to its means. Without these personages the society never 
could have reached the stage of development in which we find it 
today. 

In order to render the control of the director of the sanitary 
service of the army more facile and efficient, there were actually 
attached to the Director of the Army Medical Service an officer 
of the general staff and an army surgeon who were representatives 
of the society in the capacity of military advisors. Thanks to 
these councilors, the society was held in close relation with the 
military authorities. On questions relating to preparedness for 
war, the heart of the army and the heart of the society beat as 
one. 

The most remarkable point in the constitution of the Japan- 
ese Red Cross is the powerful centralization of its many corps. 
This results from the history of its growth and is quite in con- 
trast with what existed in the development of the European so- 
cieties. In most of the countries of Europe the societies were 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 165 

first. founded in the different villages or provinces with the pres- 
ident, administrative board and finance committee, — all local. 
Necessity for these kindred but disconnected units to unite with 
each other soon manifested itself to the end that a more efficient 
service might be rendered to the Army. Unity is the soul of organic 
strength. A central committee was also founded whose function 
it was to manaf^e the affairs of all. In Japan, on the contrary, 
there has existed from the first but one single society which was 
established at Tokio. The power to authorize even the creation 
of a local society in a department lies with this central committee 
also and, as the establishment of local sections only conduces to 
the rapid dispersion of capital, no authorization to establish them 
is given them unless the departments are posessed of an annual 
revenue of 3,000 yen or of a membership of 1,000 souls. Until one 
or other of these requirements is fulfilled, the departmental com- 
mittee cannot exercise any administrative power; it can exercise 
itself only in facilitating communications of the central committee 
with the departments. These things being so, a strict centrali- 
zation of power is assured in the establishment of the regulations 
concerning administration, finances and the service of succor in 
time of war. 

The power of the society always rests centralized at Tokio 
and is composed of a Permanent Council and Executive Com- 
mittee. 

The Permanent Council is composed of thirty members 
elected by the General Assembly, consisting of the titular mem- 
bers resident at Tokio; its members hold office for three years and 
are eligible for re-election. It is this council that deliberates and 
decides upon the important affairs of the society. It convenes 
whenever an important subject-matter is presented that falls under 
the control of the central committee, and its members are required 
to assemble at least once every three months. Questious are de- 
cided by a majority vote; in case of a tie the president casts the 
deciding vote. The council cannot deliberate unless fifteen mem- 
bers are present. If a quorum be not present it is re-convened at 
the end of a fortnight and may then deliberate and act irrespec- 
tive of the presence of a quorum. 



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166 MAJOR HENRY I, RA YMOND. 

The Executive Commitlee is composed of a president, two 
vice-presidents and seven directors or administrators, who are 
elected by the permanent council and taken from among its mem- 
bets. The honorary president makes known to the Emperor the 
names of the members elected. The president and the vice- 
presidents cannot however enter upon the functions of office, 
until the election has been confirmed by Their Imperial Majesties. 
The president has the chief direction of the affairs of the society; 
he represents it; he makes the regulations and provides for the 
necessary detai^is for carrying its statutes into execution and 
presides over the General Assembly and the Permanent Council. 
The vice-president assists the president and replaces him when 
he cannot be present. The administrators regulate the affairs 
of the society under direction of the president. 

The services of the members of the Permanent Council and 
of the Executive Committee are gratuitous. The president con- 
vokes the General Assembly once a year or in extraordinary ses- 
sion whenever he deems it necessary. At these conventions re- 
ports of committees are read and questions of high import are 
brought under discussion. At the General Assembly of 1898 more 
than 30,000 members were present, so that it was possible only 
for the Empress herself to make an address, and the reports on 
administration, finance and new propositions that required the 
sanction of the assembly were presented in printed form. It is 
evident then that the real directing power resides in the President 
and in the Permanent Council. In time of war the Permanent 
Council is transformed into a Council Extraordinary in order to 
expedite the transaction of its affairs, and the president can, as 
a matter of utility, augment provisionally the number of members 
of the Council. 

The local sections of the society are presided over by sub- 
chiefs under the persouel supervision of the governor of the res- 
pective departments. 

It was through the perseverance of Prince Komatsu and 
Count Ito that the Governors finally took active control of the 
local sections, and as a result they became familiar with the local 
conditions and were able to exercise a salutary influence and give 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 167 

prestige to the local membership. The Ministers of War and Navy 
being in control of the Society of the Red Cross were invested 
with authority to give orders to the governors of the departments 
in a double capacity, as officials of the states and as chiefs of sec- 
tions. It was customary in Japan for all governors of depart- 
ments to meet once a year in Tokio to discuss questions of state. 
The Society of the Red Cross profits by this custom, as it pro- 
vides for a reassembling of its chiefs of sections and thus gives 
them an opportunity to receive instructions and to air their opin- 
ions. We do not know of any such convenient system existing in 
any other country. 

Centralization has a special importance with respect to fi- 
nances. The great inconvenience of having so many little inde- 
pendent local societies is that many with small capital will be 
found to be of little utility either in time of peace or in time of 
war. Inthe Red Cross of Japan throughout the empire there is but 
one strong box. All monies and gifts sent to the society come the- 
oretically to the central committee and all expenditures are made 
through it. The resources of the society come from the Imperial 
grants, the dues of the members, voluntary donations, sundry re- 
ceipts derived from its work and interest on its invested capital. 
The ordinary management of the fund is confided to the execu- 
tive committee who must render an account every three months 
to the Rermanent Council. The local sections are divided into 
two categories on the question of finances. The departments in 
the cities of Kioto and Osaka and the five large maritime ports, 
Yokohama, Kobe, Niigata, Nagasaki and Hakodate and the eight 
other departments in which are located the headquarters of the 
army divisions are authorized to withhold one-third of their local 
revenue; the other local sections are authorized to reserve only 
one- fourth of their revenue; all the rest of tha revenue of each 
section is sent to the central seat at Tokio. The one-third or one- 
fourth part of the revenue conserved by the local sections can 
not be expended by them on their own initiative, but the greater 
part of the resources must be employed for the preparation of the 
personnel and material for time of war after the schedule or scale 
has been established by the central committee. 



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168 MAJOR HENRY /. RA YMOND, 

The founding of the hospital ''Hakuaisha" of the Red Cross 
Society, the only one of its kind in the far east, was due to 
Baron Hashimoto, the medical inspector general. The public 
ceremony of inauguration took place with great pomp and eclat. 
The Emperor and Empress, all the Princes and Princesses of the 
realm, and the grand dignitaries of court and state were present. 

The Hospital had for its Object: 

1. Instruction of the personnel of the relief corps. 

2. .Utilization in time of war as a reserve hospital for the 
army. 

3. Treatment of the diseases and wounds of the populace for 
the purpose of the instruction of the personnel. The well-to-do 
were required to pay a certain price for medicines and subsis- 
tence; the poor on the other hand, were treated gratuitously. None 
of the attending physicians was recompensed. The total annual 
expenditures were limited in amount. The name was changed to 
''Hospital for the Society of the Red Cross.'' If humanity had 
been made the point of departure of their work, they would have 
been able to consecrate their hospital in time of peace entirely to 
the works of charity, but this was not the case. In this society 
everything was done with a view to the service in war and to this 
end it had to economize. The hospital established several classes 
of pay patients. Those who paid dearly were in the first class. 
It admitted persons from the lower class only when its funds for 
that purpose permitted. 

The object of the hospital being to facilitate the preparation 
for the service in war, it was divided into three parts each under 
a special regulation. 

1. Education of physicians, commenced in July 1889. 

2. Instruction of female nurses, commenced in January 1890. 

3. Instruction of male nurses, commenced after the war. 
The hospital had also two extraordinary functions: 

1. In time of peace to send succor in public calamities. 

2. In time of war to functionate as a reserve hospital for the 
army. 

This hospital was the organ through which all the technical 
questions of the Red Cross service were studied: — the difiEerent 



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ORGANIZATION OF AMERICAN REn CROSS FOR WAR. 169 

kinds of medicines to be employed; the indispensable dressing 
materials; the conveniences and perfecting of arrangements for 
surgical operations; the mode of instructing female nurses; the 
manner of caring for the sick,— in a word, all that has to do with 
the science and art of medicine was made the subject of profound 
studies in this hospital. 

At the beginning of the war of 1894-S the work of the Red 
Cross in its relations to the military authority had hardly been 
determined. Shortly however the Director of the Field Sanitary 
Service issued the following instructions. The Society of the 
Red Cross is authorized to extend its work only within the lines 
of communication, where it will be utilized in the service of evac- 
uation of hospitals and infirmaries and in the reserve hospitals of 
the interior and on the sick transports: 

The different services of the Red Cross in the war of 1894-5 
may be grouped under four headings: 

1. Service of the detachments of relief. 

2. Service on board military transports. 

3. Service of aid to the military reserve hospitals and to sick 
prisoners. 

4. Service at the way stations. 

Many defects in this working system became apparent when 
put to a practical test of real war. These deficiencies consisted 
chiefly in the following particulars: 

1. The personnel and materials had been pre-arranged for hos- 
pital purposes — but the war coming on, these units had to be 
subdivided and sent to different regions. 

2. Although female trained nurses were plentiful, the mil- 
itary authority thought it expedient not to send them without 
the lines of communication and ordered the employment of male 
nurses only, and these had to be newly recruited and were with- 
out previous ipst ruction. 

3. Neither the military authority nor the Red Cross had been 
prepared for evacuation of the field hospitals up to the head of 
the lines of communications, across regions withput railways, and 
almost without any sort pf fo^ds. 



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170 MAJOR HENRY /. RA YMOND, 

4. The Red Cross owned no boats for evacuation by sea, and 
so had to employ their relief personnel on the military transports. 

5. The society had no medical supply depots. 

At the close of this war, the society had to begin to prepare 
for the sanitary field service in time of war on a much more solid 
basis, by utilizing the experiences which they had acquired in the 
course of the war, as well as the experiences of the National Red 
Cross societies, strangers to the dispute. It was decided by new 
regulations to fill the gaps indicated in the foregoing resume of 
defects in the sanitary service of the Chino-Japanese war. Ac- 
cordingly it was agreed: 

1. To make the detachments of personnel and material of 
smaller numerical strength than those for an entire hospital, and 
in such fashion that it would be possible to divide them up or 
group them as desired. 

2. To instruct male as well as female nurses. 

3. To provide transport columns for the evacuation of the 
sick and wounded by land. 

4. To construct hospital ships of the Society of the Red Cross 
for the service of evacuation by sea from the headquarters of the 
Btape to the mother country. 

5. To organize medical supply depots for the purpose of re- 
ceiving and transporting material in the event of war. 

The service of aid in time of war according to the new regu- 
lations ratified by the Minister of War in 1898, comprises five 
subdivisions: 

1. Service of relief detachments. 

2. Service of transport columns. 

3. Service upon boats of evacuation. 

4. Service of resting stations. 

5. Service of medical supply depots. 

The president of the society is required to submit to the 
Minister of the Imperial Palace and to the Minister of War on 
October 31 of each year a succinct statement of the preparation 
for service in time of war for the ensuing year commencing April 
1. Even plans and specifications for the erection of temporary 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 171 

hospitals in time of war, are drawn up and contracts let for their 
fulfillment on sight draft, as it were. 

Delegates or deputies of the Red Cross Society of Japan are 
of thr(pe kinds: , 

:. 1. G^iieral delegates. 

2, , Delegates7in-chief.. 

3, Delegates ordinary. 

The general delegate represents the president at the princi- 
pal headquarters; he directs and controls the delegates sent to the 
theater of war and assures himself that there will be no hindrance 
to the relief service. If the president judges necessary, he pre- 
sents himself at the principal military headquarters and disposes 
of all questions without appointing a general delegate. 

The delegate-in-chief is placed under the direction of the 
Ktapes; he directs and controls the delegates and the physicians 
under his orders. The delegate-in-chief is under the orders of 
the inspector of the lines of communication, and on questions 
of relief he obeys the orders of the chief of the sanitary service 
of the lines of communication. 

One delegate ordinary is appointed to control the physicians 
and other members of the personnel; he regulates also the differ- 
ent questions of relief. The delegates-ordinary obey the orders 
of the military authorities under whom they are placed and as to 
questions of relief receive the orders of competent military surg- 
eons. 

The object of the relief detachments is to aid in the service 
of the military hospitals and in the service of escort to the sick 
as well as other works of relief confided to the military authori- 
ties. A relief detachment is organized as follows: 

Physicians 2 

Assistant pharmacist i 

Chief nurse (male or female) i 

Nurses (male or female) 10 

Adminstrator i 

Coolies „ 2 

.1 . , ' 

Total 17 



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172 MAJOR HENRY I. RA YMOND. 

Twenty relief detatchments are assigned to each division 
(German Army Corps) and each detachment is competent to care 
for 100 sick. 

The object of the transport columns is to render aid to the 
Sanitary Service of the Army by the evacuation of the sick and 
wounded by land. The organization of a transport colnmn for 
the evacuation of 200 sick is composed of the following personnel: 

Physician s i 

Male attendants 2 

Adminstrator .^ i 

Chief porter i 

Carriers 60 

Coolies 2 



Total 67 

Two transport columns are assigned to each division (German 
Army Corps). 

The boats of evacuation are for the pnrpose of coming to the 
aid of the Sanitary Service of the Array in evacuation of the sick 
and wounded by sea. They are divided into two classes "A" and 

The boats of the first class (A) are for the evacuation of 200 
sick or under and are composed of the following personnel: 

Delegate i 

Chief Physician i 

Physicians 3 

Pharmacist i 

Secretary i 

Pharmacy Assistants 2 

Male nurses (of whom four are chief nurses) 40 

Instrument repairer i 

Total 50 

The boats of evacuation of the second class (B) are for the 
transportation of 100 sick or under and are composed pf the fol^ 
lowing personnel: 



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ORGANIZATION OF AMERTCAN RED CROSS FOR WAR^ 173 

Delegate i 

Chief Physician i 

Physicians 2 

Pharmacist i 

Secretary i 

PbarmaciBt^s Assistant 1 

Chief nurse.. 1 

Male nurses 20 

Instrument repairer i 

Total 29 

Two of each class of boats of evacuation are furnished to the 
whole army. These boats are painted white on the exterior and 
carry the flag of the Geneva Convention and when cases of con^ 
tagious diseases are on board, a yellow flag is added. 

The object of the resting stations is to give nourishment and 
stimulants to the sick and wounded en route, for the purpose of 
assuaging their sufferings and recuperating their strength. These 
stations are established, after previous authorization by competent 
military authority, at ports of disembarkation or at railway 
stations. 

This, then is the general plan by which the Red Cross of 
Japan comes to the aid of the Army Medical Service in time of 
war; it remains now to show how this personnel is recruited and 
instructed. 

There are two methods in use for assuring a supply of physi- 
cians for the Red Cross; by engagement of students of medicine 
whose instruction is confined to its university at Tokio and by 
employment of physicians who have already obtained their di- 
plomas. Regulations ate minute and explicit for recruitment in 
this branch of the service, and the system is productive of an 
adequate supply of men. 

As has been said above, relative to the hospital of the so- 
ciety, one of the principal objects of the establishment consists in 
the instruction of female nurses. The undergraduate nurses go 
there and receive their instruction, ahd are exercised in the prac- 
tice of their art. The reserve female nurses pledge themselves, 
for a t)eriod of fifteen years, to take pdrt in the service of relief 
in response to an appeal by the society in the time of war or in 



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174 MAJOR H£JVR Y /. RA YMOND: 

case qf public calamity. In the local sections of the departments, 
instruction is given to female nurses in the local public and pri- 
vate hospitals, and the departments reserve the right to send some 
undergraduate nurses to the Hospital of the Red Cross at Tokio. 
These finally receive the designation of "infirmiferes normales,'* 
since on their return to their departments they serve as models 
to their local sister nurses. 

The reserve departmental nurses are bound to respond to an 
appeal from the society for service in war, during a period of ten 
instead of fifteen years. 

The male nurses receive their instruction in the military 
hospitals. In time of war, these nurses are often sent to the 
front and are considered as part of the personnel of the military 
ho.spitals. 

Two points in their instruction are made prominent; to suit- 
ably and skilfully handle wounded soldiers; and to learn to sub- 
mit to military control. The course of instruction is divided into 
two periods of five months each; during the first period, theoret- 
ical instruction is given in the hospital of the society or under 
direction of departmental instructors; during the second period, 
practical instruction is given in the military hospitals at the same 
time that this is given to the army nurses. 

The instruction of the 1,560 personnel of the transport 
columns of the society in time of peace is not practicable inas- 
much as this service is required only in time of war and has no peace 
function. Hence instruction in peace times is limited to chiefs 
of transport columns. On the breaking out of war, an instri^ted 
nurse assigned to each column assists the chief in instructing re- 
cruits for this service in great haste. 

The Red Cross charges the Nippon Kaisha Company with 
the construction of its boats of evacuation specially designed for 
that purpose. In time of peace these boats are in the employ of 
that company but must be surrendered on seven days notice in 
the event of war. . 

It now remains only to indicate how the Society of the Red 
Cross exercises its organized personnel in peace maneuvers in 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 175 

preparation for the actual service of war. The principle is now 
well established that all national volunteer medical organizations 
shall be excluded from service on the front, and shall be confined 
to service on the Etape and thence to the home base, at resting 
stations and on hospital transports or boats of evacuation. Con- 
sequently it is of the highest importance in the peace exercises 
or maneuvers of the Red Cross, that uo^nstruction be given upon 
matters relating to rescue of the wounded on the field of battle, 
or their care at first aid stations or in the field military hospitals, 
and that the members of the Red Cross organization be brought 
to clearly comprehend the precise sphere of action assigned to 
the personnel of that organization and to each member of the 
personnel. On this proposition the National Red Cross of Japan 
is entirely in accord with the military authorities. 

This being settled in advance as a vital principle of coope- 
ration of the military forces and the volunteer aid association, 
all concerned have rid themselves of a false notion and one that 
has hitherto worked a real injury to the Red Cross thru disap- 
pointment of its expectations, thus resulting in relaxations of 
its efforts thru false pride. Under the new understanding, the 
Red Cross, at the annual military maneuvers, concerns itself 
profitably in its own sphere by establishing hospitals and resting 
stations on the lines of communication and at railway depots to 
which centers dummy wounded or the actual sick and injured 
are transported by means of transport columns or by trains, and 
expeditiously detrained and cared for — everything being done 
with system and dispatch. 

The Red Cross of Japan has gracefully accepted the limita- 
tions or restrictions of its work. The personnel of this society 
differs from the military in that the state makes no provision for 
pensioning the families of those members who might be wounded 
or killed in service in the front, and hence it is not just that the 
state should require such persons to risk their lives on the fight- 
ing line; moreover the state itself has a specially organized san- 
itary corps of officers and men whose duty is to render succor in 
this part of the field of operations. Here, too, the situation 
requires that discipline and calmness of mind which character- 



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176 MAJOR HENRY L RA YAfOND. - 

ize for the most part those only who have long been under mili- 
tary training and control. 

A review of the history and organization of the German Red 
Cross for War would be instructive in the extreme, but lack of 
space forbids, and this omission may be condoned by the reflec- 
tion that the Japanese Red Cross was laid out along the lines of 
the older German Red Cross organisation, and has been selected 
as our examplat, because Japan has most recently undergone the 
refining process of her Red Cross in the crucible of the greatest 
conflict of arms of which history affords any record; and has rid 
herself of much dross of theory in the actualities of war. 

PART II. 

THE HISTORY AND THE PRESENT ORGANIZATION OF THE AMER- 
ICAN NATIONAL REP CROSS. 

Space will permit of only a brief r6sum6 of this part of our 
subject. The final accession of the United States to the articles 
of the Geneva Convention of 1864 and to those of the conven- 
tion of 1868 at Paris, the signing of the treaty by the President, 
its ratification by the Senate and its proclamation by the Presi- 
dent to the people of the United States, signalized the year 1882 
as the great jubilee year of a nation's awakening from its Nico- 
demian slumber. The nation took its place, being signatory 
No. 32 to the Articles of the Geneva Convention, as the young- 
est entered apprentice. 

On being legally constituted by act of Congress, the yoting 
Samaritan was christened **The American Association of the 
Red Cross." This association was dissolved and reincorporated 
by act of Congress in 1893 under the title of •*The American 
National Red Cross*' which in turn was dissolved and reincor- 
porated in 1900. Owing to the growing importance of the work, 
the act of 1900 was repealed and the organization created thereby 
dissolved in 1905, and the same year by act of Congress, the 
present American National Red Cross was incorporated, suc- 
ceeding to all the rights and property which had been hitherto 



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ORGANIZATION OF AMERiCAN RED CROSS FOR WAR. 177 

held, and to all the duties which had been performed by the 
tintecedent corporation. 

According to the charter, the governing body shall consist 
ot a central committee numbering eighteen persons, six to be 
appointed by the incorporators and twelve by the President of 
the United States, one of whom shall be designated by the Pres- 
ident to act as chairman. '*When six or more State or Territo- 
rial Societies have been form^, the Central Committee shall be 
formed as follows: Six to be appointed by the incorporators, 
six by the representatives of the State and Territorial Societies 
at the annual meeting of the incorporators and societies, and six 
by the President of the United States, one of whom shall be 
designated by him as chairman and one to be named by him from 
the Departments of State, War, Navy, Treasury, and Justice. 

"The central committee shall have power to appoint from 
its own members an executive committee of seven persons, five 
of Whom shall be a quorum. 

'•The American National Red Cross shall, on the first day 
of January of each year, make and transmit to the Secretary of 
War a report of the proceedings for the preceding year, includ- 
ing a full, complete and itemized report of receipts and expendi- 
tures of whatever kind, which report shall be duly audited by 
the War Department and a copy of said report shall be trans- 
mitted to Congress by the War Department.'* 

State and Territorial Societies including the District of Co- 
lumbia, the Philippines, Hawaii and Porto Rico have been organ- 
ized as branch societies of the present organization. 

The membership of the Red Cross has increased from three 
hundred at the time of its reorganization in 1905 to more than 
nine thousand in 1906 and far beyond that number at the pres- 
ent date, each member paying dues of $1.00 except life members 
who have paid life membership dues of $25.00. 

Such, then, is a sketch of The American National Red Cross, 
its aims and purposes being to furnish volunteer aid to the sick 
and wounded of armies in time of war and to carry on a system 
of national and international relief in time of peace in the event of 



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178 MAJOR HENR Y /. RA YAfOND. 

great nationar calamities. The former is directly pertinent to 
the object of our enquiry, the latter only indirectly so, tho 
vitally concerned in the self-evident proposition that an or- 
ganization to be efficient at any indeterminate period must be 
more or less active all the time. 

PART III. 

WHAT SftOULD BE THE RELATIONS OP THE AMERICAN NATIONAL 
RED CROSS FOR WAR TO THE MEDICAL DEPARTMENTS ' 
OF THE ARMY AND NAVY? 

The existing vagueness and want of definitiveness in the re- 
lationship between The National Red Cross and the Army and 
Navy has been a stumbling block for many years to the growth 
and efficiency of the Red Cross as an organization for war. This 
question must be settled once and forever before any healthful co- 
ordination can take place between the members of a voluntary and 
of a military aid organization. The school of experience is hard 
but when its lessons are heeded by both parties earnestly seeking 
for more light in the search for truth, not more surely will the 
magnetic needle point to the north than will the directing finger 
of experience indicate the basis not only of a theory, but of the 
true theory of co-ordination, leading us to the deduction of princi- 
ples whose truth and applicability must be universally obvious 
at all times and in all circumstances of practice. 

The waning light of the nineteenth century revealed to our 
astonished eyes the futility of a two-headed monster directing a 
work that required an organic solidarity, with fine adjustment of 
all its parts, and a correlation of all its forces, to maneuver strat- 
egically and to operate efiFectively in the actualities of war. 

Fortunately, there has resulted from our past experiences a 
unanimity of sentiment on the part of the Red Cross and of the 
Army and Navy administrations to the effect that the former must 
be subordinate to the latter, not however in any sense of subser- 
viency, as tho the eye should say to the hand *'I have no need of 
thee," but rather in that military sense in which each unit of or- 
ganization is subordinate to a higher unit while itself subordinates 
a lower unit in the military economy. * 'Unity is the soul of 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR, 179 

strategy'' no lessin deeds of mercy than in acts of carnage. Thus 
it was that the Society called Hakuaisha sent its members upon the 
field of battle lo care for the wounded soldiers of the Imperial 
army under the orders of the surgeons of the Army and Navy, 
Thus it was that Dr. Koike upon his return from the sixth In- 
ternational Conference of the Red Cross was named Director of the 
Medical Service of the Army and under his direction were com- 
pleted the rules for the service of succor of the Red Cross in time 
of war. Thus it was that the successive Surgeons General of the 
Imperial Army decided all questions of relief that came up under 
the respective Minister of War. Thus it was that the Director 
of the Field Sanitary Service issued instructions bearing upon the 
work of the Japanese Red Cross in its relations to the military 
authority-;-a matter that had hardly been determined at the be- 
ginning of the war of 1894-5. 

Thus it was that the delegates ordinary were required to 
obey the orders of the military authorities under whom they were 
placed, and to receive the orders of competent military surgeons 
as to questions of relief. Thus it was that the Red Cross of 
Japan was brought clearly to comprehend the exact sphere of 
action assigned to the personnel of that organization and to each 
member of that personnel. 

On this principle of military subordination of the voluntary 
organization, the Red Cross of Japan brought itself into entire 
accord with the military authorities, iand, this vital principle of 
co-operalion of the military forces and the voluntary aid associa- 
ation being settled in advance, the situation rid itself of a false 
notion of duplex responsibility and one which had up to that time 
worked a real injury to the Red Cross thru disappointment of the 
expectations of many of its adherents. 

Thus, finally, has it come to pass, as we are happy to record, 
that The American National Red Cross has gracefully accepted 
thi teaching of experience— that greatest school of masters — and 
has made an avowed declaration of its purpose to co-operate with 
the Army and Navy in strict conformity with the laws and usages 
of warfare on land and sea, yielding to the officers of the Army 
and Navy in their respective grades precedence in military rank 



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1 80 MAJOR HENR Y L RA YMOND. 

which is defined as ''that character or quality bestowed npon 
military persons which marks their station and confets elig])[>i]ity 
to exercise command or authority in the military service within 
the limits prescribed by law." 

So stands the Red Cross today in its true light as the great 
reserve voluntary aid organisation incorporated into, and ad in- 
tregal part of, the military and naval medical departments for 
war, — the official auxiliary instrumentality for applying volun- 
tary aid to the sick and wounded soldiers and sailors of the con- 
tending forces, taking up its service in the rear and along the 
lines of communication where it relieves the army persbnnel for 
service at the front. 

PART IV. 

WHAT IS THE MOST EFFECTIVE ORGANIZATION OF THE AMER- 
ICAN NATIONAL RED CROSS FOR WAR ? 

As essential to the consideration of this question we lay down 
the. following postulates. 

1. A voluntary aid organization to be truly effective in war 
must have a large membership and ample funds. To this end it 
must secure universal popularity. The Red Cross must become 
an institution of the people by the people for the people. How can 
this end best be obtained ? Is not Philanthropy closely related 
to Independence ( July 4th. ) ? Is not Philanthropy the peer of 
thanksgiving for blessings received? Is not Philanthropy the 
twin sister of Commemoration of our dead soldiers and sailors ? 
Why not assign then to the Red Cross a national holiday or com- 
memorate alike on the thirtieth day of May the memory of those 
who **gave the last full measure of devotion** to their country's 
cau.se, and our love for those who may be willing to risk as much 
as they ? 

2. Other methods of arousing public interest and of extend- 
ing propaganda with a view to increasing the membership and 
funds of the Red Cross are by personal solicitation, by public ad- 
dresses, by enlisting the co-operation of the great democratic 
agency for the dispersion of knowledge and the moulding of 
opinion — the public press, by exhortation and agitation from the 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR. 181 

pulpit, from the college ptatform and in the public schools, and 
by discussion in our Boards of Trade by the businessmen of the 
country who have a right sense of proportion and a just dis- 
crimination of the fitness of things. The history of the Red 
Cross with its beneficent aims and purposes should be taught to 
the youth of our land thru ocular demonstration by means of 
moviiig pictures — the Kinetoscope — or by any means that will 
excite a child's interest, for to the rising generation ^ye must look 
for recruitment in that coming army of The American National 
Red Gross when one out of every hundred of eighty-five mil- 
lions or more will be enrolled under her white banner. 

i. The lack of racial homogeneity in this nation due to its 
being "conceived in liberty and dedicated to the proposition that 
all mkVL are created equal'' demands as a guaranty of popularity 
of any national organization that on its Central Committee shall 
find representation, alike the Jew, the Hibernian, the Teuton — 
all cl^uises upon whom has been conferred American citizenship, 
to the end that its governing power may stand for the widest 
catholicity of race and religion. 

4. This Central Committee representing as it does the states, 
territories, and dependencies of a nation of eighty-five millions 
should itself be numerically large. This principle applies to all 
deliberative assemblies. On the other hand the executive Com- 
mittee, from the nature of its functions, should be numerically 
small. The Central Committee should be numerically not less 
than half as large as the United States Senate— each politically 
governing body having one or more representatives. It should 
have an Honorary President — appointed by the President of the 
United States — who by his name alone would lend prestige to 
the organization and whose appeal for a generous endowment 
fund by public announcement would be responded to cheerfully 
by America's multi-millionaire philanthropists until the active 
members of the Red Cross assisted by a full treasury in their in- 
struction and education toward a state of preparedness for their 
humane functions in war, would give to the nation an earnest of 
fulfillment of the great humanitarian mission of the Red Cross 
for War. 



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182 MAJOR HENRY LJ^AYAfOND 

In time of war the Central Committee should be tran^fon^cdf 
into a Council Extraordinary in order to. expedite the transact 
tion of its affairs, and its president should be .empowered to aug- 
ment provisionally the number of its members. . r; u 

The Executive Committee, chosen from membelk^ of the 
Central Committee, should number seven and its chairman as 
well as the Honorary President of the Central Committee should 
be appointed by the Chief Executive of the land and the ap-' 
pointment confirmed by the United States Senate. Of the othef 
members of the Central Committee one-sixth should be appoih^ee^ 
at large by the President of the United States including 6ne' ap- 
pointee each for the Departments of State, War, Navy; Treas- 
ury, and Justice, and the rest of the appointments apportioned 
to the politically governing bodies of the several states, territorite 
and dependencies of the nation. These latter should be elected 
from among its members by a popular vote of the ebtire state 
section. The Governor of the State should beex-ofiicio thechitf 
of the state section and should exercise a personal jurisdictiotl^ 
over the subchiefs of the* local subsections. The Central CoiSi- 
mittee alone should have the power to authorize the creation of 
a local society and as the establishment of local sections, not Iself- 
sustaining and life-giving, only conduces to the rapid dispersion 
of capital, no authorization to establish and to endow them with' 
administrative power should be given unless the section in ques- 
tion is possessed of an annual revenue of $200 or a membei^hip 
of one hundred persons. 

Until one or other of these requirements be fulfilled let the 
embryo organization act only as a medium for facilitating cohi- 
munication between the Central Committee and its local int^r^sts. 

5. The membership of the Red Cross should be of three 
classes: 

(a) Honorary^ to ht conferred by the Central Co^nmit^eepn. 
distinguished personages of state and upon the most; cqn$j)icuou$. 
and altruistic exponents of world-wide philanthropy. As vyas 
said by Mirabeau before the National Assembly, of ,^Jpr,apce, 
speaking of the Nation, so may it be said of the Red Crossr^hat 



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ORGANIZATION OF AMERICAN RED. CROSS FOR WAR, 183 . 

she "should honor as her heroes only those who have been her 
real benefactors.'' This class should be limited in membership 
to one hundred and the high honor conferred should be an ear- 
nest of most faithful and efficient stewardship in the vineyard of 
the Red Cross. 

(b) Special, to be conferred by the Central Committee on 
persons who have rendered notable service to the Red Cross and 
without compensation.. The membership of this class should be 
limited to one thousand and the members should be exempt from 
annual dues. It should constitute, as it were, a waiting list 
from' which selections should be made to fill vacancies in the 
honorary membership. 

(c) Titular^ or those who pay annual dues and who belong 
to the commonalty of the nation— those whom Mr. Lincoln al- 
ways eulogized as the •'common people''— the muscle and sinew 
and common sense of the Red Cross. These are those who bear 
the brunt of the battle, of whom it is expected that every man 
will do his duty. This is the class most numerous in the annual 
general assemblies of the departments, and represents in the as- 
semblies the vox populi, and they should here make known thru 
delegates or by direct vote their election of members of the great 
Central Committee. 

The insignia of membership should be distinctive or as the 
Grerman expresses it in the phrase **selbst eigenthtimlich." The 
design or composition of th^ insig^iia should difiFerentiate the 
classes of membership. The insignia of the honorary and special 
classes should be paid for by the recipient; insignia for the titu- 
lar members should be furnished by the Red Cross gratis upon 
payment of the first annual dues and in cost or value should not be 
less than the amount so paid. The insignia should be accorded 
by no less a personage than the Commander in Chief of the Army 
and Navy of the United. States— the great High Protector of the 
Red Cross: — and should be conferred by the chiefs of sections 
with becoming ceremony. It will thus become a badge of •*spec- 
ial trust reposed in the Vecipient*' who is sent — commissioned as 
it were— ^by the Commander-in-Chief to work worthily in the 
national volunteer army for practical philanthropy. 



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184 MAJOR HENRY I, RAYMOND. 

6. In this day of federalism and centralized military con- 
trol, it goes almost without saying that there should be a power- 
ful concentration of the many army corps of The American Na- 
tional Red Cross to the end that there may be a perfect cohesion 
in the regulations concerning administration, finance and the 
service of aid in time of war. The power of the Red Cross 
should rest centralized at Washington. Its Central Cdnimittee 
should convene once a year, and should be called in extraordi- 
nary session at the call of its president whenever an important 
subject-matter of urgency presents itself ; fifteen members should 
constitute a quorum and in an emergency the Executive Com- 
mittee should be authorized to act provisionally. 

The president of the Central Committee should convoke a 
National General Assembly once every three years or in extra- 
ordinary session whenever he deems it necessary. At these 
general assemblies, questions of high import should be brought 
under discussion by previous arrangement. The Executive 
Committee of the Red Cross should be the recipient and custo- 
dian of all monies and gifts, and all expenditures should be made 
thru this committee, and its fiscal representative should be a fed- 
eral accountant for the War Department. 

The local sections should be authorized to withhold one- 
fourth part of their local revenue (except the payment of first 
annual dues) , and the revenue so conserved should be for the 
most part employed for the preparation of its personnel and ma- 
terial for time of war. 

7. The Red Cross should own and operate a hospital at one 
of the large medical centers and this hospital should be affiliated 
with a medical school such as Rush, JefiFerson, Johns Hopkins, 
the University of New York or that of Georgetown. This hos- 
pital should have for its object the instruction of undergraduates 
in medicine, the training and instruction of male and female nurses 
and the members of the Relief Detachments as well as the Chiefs 
of the Transport Columns. 

The trained personnel of this Natiolial Red Cross Hospital 
should be sent to the State Sections to instruct and train local 
Red Cross nurses in the public and private hospitals of the corn- 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR, 185 

mtinity. The Chief Administrative officer and the Executive 
officer of the Central Hospital should be medical officers of the 
Army, Navy, or Public Health and Marine-Hospital Service. 

In time of peace the hospital should be nearly or quite self 
supporting from its several classes of pay patients, furnishing, 
however, medical attendance, nursing, medicines and subsistence 
gratis to the poor as far as its means permit. It should furnish 
aid in public calamities. 

In time of war the hospital should be utilized as a reserve 
hospital for the army. Here should be studied and worked out 
all the technical questions of the Red Cross Service — in short all 
that has to do with the application of medical science in the mili- 
tary practice. 

8. The limitations of the Red Cross Service in War having 
been clearly defined in part 1, it follows as a corollary that its 
sanitary formations will be utilized in the service of evacuation 
of hospitals by land and by sea, in the reserve hospitals of the 
interior, at the resting stations on the lines of communication and 
at railway stations and ports of disembarkation. The service of 
aid in time of war, then, should comprise five subdivisions: 

1. Service of detachments of relief. 

2. Service of transport columns. 

3. Service of boats of evacuation. 

4. Service of resting stations. 

5. Service of medical supply depots. 

The object of the detachments of relief being to aid in the 
service of the military hospitals and in the service of escort to the 
sick, its organized personnel should be of such numerical strength 
as to make it competent to care for lOOsick and wounded. A de- 
tachment of relief should be organized as follows: 

Medical Captains or Lieutenants 2 

Sergeant ist class Hospital Corps i 

Sergeant Hospital Corps i 

Privates ist class Hospital Corps (or female nurses).... 10 
Privates Hospital Corps 2 

Total 16 



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186 MAJOR HENRY I. RA YMOND. 

Twenty detachments of relief should be assigned to each 
army corps. 

The object of the transport columns being to render aid in 
the evacuation of the sick and wounded by land, its organized 
unit for the evacuation of 200 sick should be composed of the 
following personnel: 

Medical Captains or Lieutenants 2 

Sergeant Hospital Corps i 

Privates ist class Hospital Corps 10 

Privates Hospital Corps $0 

Total 63 

Two transport columns should be assigned to each army corps. 

The boats oiF evacuation are for the purpose of coming to the 
aid of the Sanitary Service of the Army in evacuation of the sick 
and wounded by sea. The Sanitary Formation for the evacuation 
by sea of 200 sick should be composed of the following personnel: 

Medical Major i 

Medical Captains or Lieutenants 3 

Sergeant ist class Hospital Corps i 

Sergeants Hospital Corps 5 

Privates ist class Hospital Corps 8 1 i Privates Hospital Corps... S 
Privates Hospital Corps 32 i ^"^ I Female nurses 32 



Total so 

Two boats of this capacity and two of capacity for 100 sick 
with a proportional personnel should be furnished to the whole 
army. 

The resting stations are for the purpose of affording nour- 
ishment, stimulants and encoiiragement to the sick and wounded, 
en route, with a view to recuperation of their strength. The 
stationary personnel need not be large, as it may be supple- 
mented by the attendants en route. 

The establishment of supply depots may properly follow the 
lines laid down for the Army Medical Service. 

Such then is the general plan by which The American Na- 
tional Red Cross should come to the aid of the Army and Navy 
medical service in time of war. It remains only to add that on 



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ORGANIZATION OF AMERICAN RED CROSS FOR WAR, 187 

the principle laid down in this essay, the relief detachments of 
the Red Cross should be excluded from service on the battle • 
ships of our navy for the reas6n that each ship in action is 
within the zone of fire and every man on her is literally on the 
firing line. The Red Cross should provide for the construction 
of her own boats of evacuation and their ready adaptation for 
service in war, by some such project as that so ingeniously de- 
vised and carried out by Japan as hereinbefore related. 
BIBLIOGRAPHY. 

The Sei'i'kwai Medical Journal^ February, 1906. 

Les Conferences International des Societies de la Croix- 
Ratine, par Gustave Moynier, Geneve, 1901. 

The American National Red Cross Bulletins, 1906-7. 

History of the Red Cross, American Association of the Red 
Cross, 1883. 

La Croix Rouge en extreme Orient, par Ariga^ ipoo, Paris. 
Numerous Magazine Articles. 

Grand Tactics and Chess St rategetics Illustrated, Young. 



OPERATIVE PROCEDURES IN GUNSHOT WOUNDS OF 
THE NERVES. 

IN connection with a series of cases of gunshot wounds of the 
nerves, Henle remarks that suture was made with fine silk. 
Twice the line of suture was incased with flaps of fatty 
tissue, once with a portion of injured and resected brachial artery 
(method of Formatti). The distance between severed nerve-ends 
proved too great in many cases to admit of any operative union. 
Grafting of one nerve into another gave three results in six cases. 
These graftings consisted in suturing about one-third of the one 
nerve into a flap cut from one-third of the other. Twenty opera- 
tions were performed on nineteen patients presenting paralyses;— 
nine cases improved, eleven cases without result. Of all but two 
cured, in tlfe rest the missing functions were but partially re- 
stored. Too short a time was permitted to await final results. 
Most probably some of these cases regained better and greater 
functional powers of the muscles involved, after they had been 
dismissed. Stress is laid upon the importance of rapid transport 
of all cases of injury to peripheral nerves, to a point where exact 
surpcal treatment can be administered. 



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THE MEDICAL SERVICE OF THE UNITED STATES 

MARINE CORPS. 

By FREDERICK L. BENTON, M. D., 

SURGEON IN THE UNITED STATES NAVY. 

THE recent critical political condition in Cuba, which for a 
time threatened to assume serious proportions involving 
loss of life, destruction of property and general paraly- 
zation of trade and commercial life in the Island, caused interest 
for a time to be centered upon the movements of the organization 
officially known as the * 'United States Marine Corps"; for upon 
them at this time, devolved the duty of hastening to the disturbed 
area, to assume control of the military situation on shore, prevent 
the loss of life and destruction of property and to use such methods 
as were necessary to preserve the balance of power until the ar- 
rival of larger forces or until conditions were settled by more 
peaceful methods. A brief history of this corps, its methods of 
work, duty and organization, with a description of its medical 
service under its varied conditions of duty, both at sea on the 
warships of the navy, on landing forces from the ships, expedi- 
tionary duty with the army, such as has lately arisen in Cuba, 
in the past in China, Africa, the Philippines and numerous times 
in Central and South America, and in fact almost everywhere 
where the vessels of the navy have been stationed, might be 
of some interest to those who have heard of this organization, of 
how warships have proceeded to some out-of-the-way place and 
have landed marines; how the situation was controlled at the time 
or settled by more peaceful methods of diplomacy. ^ 

This briefly has been the routine of duty as performed by the 
marines, as far as is known by the public at large, but a short 
history of this organization, will not, I hope, be out of place at 
this time before this Association of Military Surgeons, for closely 
interwoven with the military achievements of the Marine Corps 

(188) 



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MEDICAL SERVICE OF THE MARINE CORPS. 189 

performed afloat and ashore in many corners of the globe, in 
civilized and savage warfare, the history of the Medical Corps of 
the Navy is closely allied, for at all times and at all conditions of 
service, such as no other military organization has ever been called 
upon to perform, the medical oflScer of the navy has been present 
and has always performed his duties with credit, therefore a 
brief history of the Marine Corps and its medical service is briefly 
traced. 

The first authentic record of the Marine Corps in this coun- 
try that we have, dates back to 1740, when three regiments of 
Colonial Marines were established by act of Parliament. The 
Commanding Officer, Field^and Staff OflBcers, were appointed by 
the Crown; the Company Commanders and Lieutenants were 
nominated by the Provincial Government. There is no record 
of this organization having its own Medical Corps, for then its 
Medical Corps was obtained from the Royal Navy as at present 
from our own. 

The original Marine Corps of the United States was estab- 
lished by act of Continental Congress, October 9, 1775, and num- 
bered 1,000 men. It was composed of men who were all good sea- 
men, were acquainted with maritime affairs and so could perform 
equally well the duty of the sailor as well as that of the soldier 
as the emergency required. 

Their history showed that they performed valuable services 
during the Revolutionary War; notably around Philadelphia, in 
the attack upon New Providence and upon vessels of the new navy. 

During this period their medical service was rendered by the 
medical oflBcers of the navy who were known as surgeons and 
surgeons' mates. They were not commissioned officers although 
classed as such, and were often employed from civil life for the 
cruise. These medical officers doubtless performed their duties 
in much the same manner and under the conditions custom and 
tradition have handed down to us today. They had no Hospital 
Corps and worked under the disadvantage of being provided with 
such assistants as could be provided from the deck force, from 
men who were untrained and incapable above, to be transferred 
below to the surgeons* division during action. 



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190 SURGEON FREDERICK L. BENTON, 

It is worthy of note that this condition still existed in our 
own naval medical service until the outbreak of the Spanish- 
American war in 1898, when the United States Navy Hospital 
Corps was established. 

As quoted from Cullom*sHistory of the Marine Corps, **at 
no period of the history is it probable that the Marines were 
more important than during the War of the Revolution.'* In 
many cases they preserved the vessels to the country in suppress- 
ing the turbulence of their ill assorted crews and the effect of 
their fire not only then, but in all subsequent conflicts, under 
those circumstances in which it could be resorted to, has been 
singularly creditable to the steadiness'and discipline. The history 
of the navy even at that early date, as well as in these latter 
times, abounds with instances of their gallantry. 

The Marine incurs the same risks of disease and tempests, 
undergoes the same privations, suflFers the same hardships and 
sheds his blood in the same battles as the seamen and the nation 
owes him the same rewards, and the writer might add, gets 
them. These statements are all true and much more could be 
added, but time and space do not permit. There is little to say 
about them and their medical service during this period, but to 
note that at the close of the war, the Marine Corps was disbanded 
and like the army and navy passed from existence. 

In April 1798 the present Navy Department was established 
and in July of the same year the United States Marine Corps was 
created. The Commissioned Officers were appointed by the Pres- 
ident and he was empowered in case the Marines were ordered 
ashore, to appoint the necessary Staff Officers with the exception 
of the Medical Officers, who were assigned then as now, from the 
Medical Corps of the Navy in cases where the Marines were serv- 
ing on warships, or from them were sent as landing forces or ex- 
peditionary duty with the ships acting as a base, or with the 
army. 

In cases where it was impossible to secure the medical offi- 
cer from the navy the Commanding Officer of the Marines was 
authorized to hire a civilian physician by contract, which arrange- 
ment still exists and is utilized in emergencies. 



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MEDICAL SERVICE OF THE MARINE CORPS, 191 

This period following^ the reestablishing of the Marine Corps 
in 1798, was one of the most useful and active of its existence, 
for from that period until the present day the service of the Mar- 
ines has been closely allied with that of the Navy Medical Corps 
and during their service with the brief war with France, they 
shared equally the honors that came to the navy. 

The war with Tripoli added to their achievements both at^ 
sea, and in the interior of Africa. Service in the war of 1812, 
on the Great Lakes, at sea, on duty with the army on several oc- 
casions notably at the capture of Washington, and in the attack 
ou Baltimore and New Orleans. 

The service of the Corps during the campaign against the 
Creek Indians in Florida in 1836 was also a subject of favorable 
commendation. 

Here it is of interest to note that the medical oflScers on this 
expedition were detailed both from the Army and the Navy Med- 
ical Corps to serve with the Marine Regiment during that cam- 
paign, and the hospital corps detachment secured, being detailed 
from the line of the army and a few of them from the navy and 
Marines, for at this time no Hospital Corps existed in either 
branch of the service, the Hospital Corps of the army being es- 
tablished first in 1887, while that of the navy still later in 1898, 
although it had been agitated and legislation for its establishment 
had been asked for from time to time. 

The Mexican War again called th*e Marines and the medical 
officers of the navy to be associated together in active service 
under General Scott. Later on Perry's memorable expedition to 
Japan which partook of the nature of active expeditionary duty, 
upon the attacks of the Chinese pirates, when both the Americans 
and English served together, and which the Navy Medical Corps 
were present to render its service to both nations. 

From this period followed active expeditionary duty in the 
insurrection of Montevideo, against the savages in Washington 
Territory, against the pirates in China, against the savages in 
Waya, expeditionary work in Paraguay, John Brown's insurrec- 
tion and numerous occasions until the outbreak of the Civil War 
in which the Marines and the naval medical officers were associated 



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192 SURGEON FREDERICK L, BENTON. 

both on shipboard and landing forces, and on shore with the army. 
It is but a repetition at best of their previous duty as is the case 
also in the Spanish- American War and in the Philippine insur- 
rection, in the Boxer campaign and expeditionary duty still later 
in Central America and last of all in Cuba. 

As this brief narration of the duty performed by the Marine 
Corps under the many varied conditions is an attempt to show 
'^that although it has no distinctive Medical Corps, its medical 
service has always been efficiently done by the Medical Corps of 
the Navy and will show to those who visit our warships as they 
lie at anchor before us in the harbor, that the duty of the Ma- 
rines and the medical officers of the navy does not entirely con- 
sist in pacing the decks or taking their afternoon tea under pleas- 
ant surroundings. 

With a military history of such a varied and extensive na- 
ture, naturally the next question to -interest us as medical men 
relates to its medical service. 

Strictly speaking it has none, for while the Marine Corps 
has its other StaflF Officers and departments, such as its Adjutant 
and Inspector, Paymaster and Quartermaster Departments, it 
has no medic£^l service of its own, depending entirely upon the 
Medical Corps of the Navy for its service so that the description 
of its medical service is but that of the medical organization of 
the navy with Marines such as has been rendered since the ear- 
liest date of its establishment. 

A description of the medical service as is rendered the Ma- 
rines while on board one of the. warships of the navy is hardly 
necessary at this time, except to state that the Marines who 
number from ten to eighty men are considered by the Medical 
Officer as a part of the. ship's crew to receive medical treatment, 
while officially the Marine guard is considered a distinct de- 
partment, they not being considered as a part of the ship's com- 
plement. As the most important duty rendered by the Marine 
Corps is performed ashore as an expeditionary force from the 
fleet or with the army in varying sized detachments, the scheme 
of organization of the medical service must of a necessity be a 
flexible, or sliding scale which must obviously change its char- 



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MEDICAL SERVICE OF THE MARINE CORPS. 163 

acter by nnmber solely. It must meet the character o£ the ser- 
vice required for which the Marines are ordered, must be mobile, 
compact, easily handled, complete as possible and in every de- 
tail, assist in the military necessity and not hamper the working 
of the organization which essentially is of an expeditionary 
character and whose mobility is its strong point; therefore any 
medical service but that of the simplest character commensurate 
with eflBciency is the medical service required for service with 
the Marines. 

To this end the following organization has been established 
by the medical department of the navy in its service on shore 
with sailors and Marines in landing forces from the ships, and 
has proven itself satisfactory for its simplicity and eflBciency in 
conditions such as have arisen in the past. 

Marines are landed for expeditionary work from naval sta« 
tions, yards or ships; are made up of detachments of varying 
size and organized into expeditionary brigades or provisional 
regiments or from a part of the fleet or ship's landing force. It 
labors under the disadvantage of having no defined military 
unit; no company organization nor yet the regimental unit of the 
army, therefore the medical organization must of a necessity 
adapt itself to this temporary arrangement:— 

The medical service on shore in time of action is divided 
into the Service of the Front and the Service of the Rear. 

The service of the front includes the firing line, dressing 
station, and field hospital. 

The service of the front is rendered by the ambulance party, 
which cocresponds to the unit known in the army as the Ambu- 
lance Company and aims to provide not less than a ratio of four 
per cent of medical assistance for those engaged. 

The service of the rear includes the base hospital, or hos- 
pital ship of the navy, the medical supply depot and the trans- 
portation arrangements for the sick to the hospitals in the 
United States. 

The ambulance party which provides the personnel of the 
firing line, dressing station and field hospital is distributed as 
follows: — ^As nearly as possible, one hospital steward, one hos 



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194 SURGEON FREDERICK L, BENTON, 

pital apprentice, 1st class, and one hospital apprentice are as- 
signed to each section composed of one commissioned officer, 
three non-commissioned officers and twenty-four men as a unit, 
two such sections composing a company. 

As this proportion is a liberal one the ambulance party of a 
company of about fifty-six is seen to consist of two hospital 
stewards, two hospital apprentices, 1st class, and two hospital 
apprentices as a minimum, with four stretchermen and extra 
Hospital Corps men as circumstances demand and permit of. 

The above arrangement is that which is laid down by the 
United States Navy Regulations for landing forces from ships 
of the navy and is applied also to the Marines when on shore 
duty from the ships at the same time, but on detached service from 
the ships of the navy and when serving with the army, this 
proportion of Hospital Corps men is rarely obtainable. 

From this unit are detailed such hospital stewards and ap- 
prentices as are considered necessary for duty at the dressing 
stations and the field hospital. 

First aid is rendered on the firing line by the hospital ap- 
prentice, 1st class, under the direction of a junior medical officer 
or a hospital steward, who do little but apply the first aid dress- 
ings, control hemorrhage and direct the removal of the wounded 
by the stretcherman to the dressing stations in the rear of the 
firing line. 

The dressing stations are located about three hundred yards 
in the rear of the firing line, where the wounded may be readily 
removed by the stretchermen, under cover as is protected from 
the rifle fire as the natural contour of the ground or as a tempo- 
rary earthworks will permit. 

One or more medical officers with hospital stewards and 
hospital apprentices here render the first systematic surgical aid; 
the first aid dressings are readjusted if necessary, splints ap- 
plied, hemorrhage controlled and diagnosis tags attached and the 
patient placed in as favorable a position as possible for trans- 
portation, by litter, ambulance or other wheeled transportation, 
to the field hospital. 

The ambulance station or point nearest to the dressing sta* 



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MEDICAL SERVICE OF THE MARINE CORPS. 195 

tions to which ambulances can safely approach is not a recog- 
nized station in the service of the front of the navy or Marines 
when serving independently or together on shore in landing for- 
ces but there is no doubt that its usefulness and necessity are 
very apparent when landing forces from the ships are acting at a 
distance from their field hospital in which event such wagons, 
carts, animals and native carriers are hired or impressed into ser- 
vice as has been done in the past for similar emergencies. It be- 
comes doubly necessary, due to the locations of the dressing sta- 
tions, these being located but three hundred yards in the rear of 
the firing line at which point it would not be feasible to drive the 
ambulances when the troops are engaged, to this end there is little 
doubt but that in the future this ambulance station will be adopted 
when possible for the medical department of the navy when on 
shore duty with landing forces. 

The Field Hospital, the last station of the service of the front, 
is in naval and marine expeditionary duty a flexible unit, depend- 
ing entirely upon the nature of the service as to its size and or- 
ganization; varying in capacity from the regulation twelve bed 
regimental hospital such as the army use on detached service 
and is also issued by the navy for detached expeditionary duty 
with Marines, to one which would be suflSciently large to act as 
a Bas* Hospital to accommodate at least fifteen per cent of the com- 
mand in the absence of the base hospital or the hospital ship of 
the Navy. . 

The Field Hospital is in command of the senior medical 
officer on shore, who selects his assistants from among those 
known to be most proficient in special lines and Hospital Corps 
men from those belonging to the ambulance party. As a general 
thing the personnel and material of the Field Hospital is 
secured from the Flagship. 

The service of the rear includes the Base Hospital or Ship, 
the medical supply depots, and transportion arrangements of sick, 
wounded and convalescents to the Naval Hospitals in the United 
States. 

The service is efficiently rendered in the larger and newer 
vessels of the battleship and cruiser type which have the advau- 



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1% SURGEON FREDERICK L. BENTON, 

tage of each ship providing in itself a complcfte service of the rear^ 
including that of a complete section of a field hospital. Medical 
supply depot, transportation with systematic and complete fac- 
ilities where satisfactory medical and surgical aid under the ex- 
cellent aseptic conditions, with an abundant. supply of ice, sterili- 
zed and hot water at hand. 

This briefly expressed is a synopsis of the medical organ 
zation of the Navy when serving on shore duty with the Marines 
but as the Marines are frequently serving with the army on de- 
tached and expeditionary duty, this medical organization is 
altered to correspond to the changed conditions of the service. 

When ordered to dntyVith the army, the entire Marine or- 
ganization of whatever unit it may happen to be, all staff depart- 
ments, including the medical officers and Hospital Corps of the 
navy attached, being directly under the Commanding General 
of the Brigade, Division or Corps to which the Marines may be 
assigned, the Marines being organized into Provisional Regiments 
for such duty. 

The status of the Medical Department of the Navy on duty 
with the Marines serving with the army is not fixed by regula- 
tion as is that of the Marines. They are both still working 
under Navy Regulations, coming under the Articles of War of 
the Army so far as discipline is concerned; the routine of duty 
and drill, customs of the service etc. , being altered only to the 
extent to make them correspond to that of a unit of the same 
strength belonging to the army, this being understood. The 
medical service as is rendered to the Marines by the Medical 
Department of the Navy when serving with the army, resolves 
itself, but to that of only the service of the front and corresponds 
exactly to that which is provided by a unit of the same size of 
the army. 

The personnel of the Medical Department of a provisional 
regiment of Marines is not laid down in the Navy or Army Reg- 
ulations but the following subjoined tables represent a minimum 
of what is provided for a provisional regiment of a thousand Ma- 
rines while serving with the Army. 



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MEDICAL SERVICE OF THE MARINE CORPS, 197 

1. Regimental Surgeon. (Lieutenant Commander). 

4-8 Regimental Assistant Surgeons. (Lieutenants, or 
Lieutenants Junior grade). 

2-6 Hospital Stewards. 

10-15 Hospital Apprentices 1st class or Hosp. Apprentices. 

One Regimental Field Hospital equipment complete for a 
regiment of 1,200 men provided by the navy, which requires:— 

1 Escort wagon for transportation. 

3 Ambulances when serving on detached duty; or one to each 
battalion which are provided by the Quartermaster of Marines. 

It will be seen that the number of medical officers assigned 
to 1,200 men is greatly in excess of that laid down in the Field 
Service Regulations of the Army. The reason of this is evident 
when it is understood that the Marines rarely actually serve to- 
gether in units larger than the battalion but are divided into 
posts and subposts on detached service, and as they are called to 
duty with the army splely in emergencies, the necessity for more 
medical officers becomes evident. 

For such detached service for a company or smaller detach- 
ment of Marines the medical equipment as far as possible con* 
sists of: 

1 Medical Officer (Lieutenant, or Lieutenant Jr. grade). 

2 Hospital Corps men of the Navy. 

1 Expeditionary Medical case, provided by the Navy. 

1 Expeditionary Surgical case, provided by the Navy. 

1 Ambulance, provided by the Quartermaster, or other 
wheeled transportation provided by the Marines. In addition 
the Commanding Officer is requested to provide two men to act 
as bearers and to assist the medical officer of the detachment. 

This Regimental Field Equipment is held in readiness for 
expeditionary duty at each of the Navy Medical Supply Depots 
in the United States and .additional outfits in the Philippines. 
They are packed and prepared for immediate shipment and upon 
notification by the Secretary of the Navy that an expeditionary 
force of Marines is to be organized for active service the Surgeon 
Genera] directs the disposition of such field equipment, assigns 
such medical officers and Hospital Corps men as are necessary. 



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198 SUlfGEON FREDERICK Z. BENTON, 

arranges for subsisteuce and additional supplies not supplied by 
the Medical Department, including ambulances, transportation 
facilities, animals, forage and special details are provided by the 
Quartermaster of Marines. 

Transportation en route and subsistence is furnished by reg- 
ularly furnished naval vessels acting as transports and also the 
accommodations on board during the voyage, the Marines are re- 
examined for inefiFectives, instruction in first aid is given and 
those found physically unable to perform active duty are either 
left on shipboard or assigned to light duty or special duty. Asa 
matter of fact, few such are found, as they are previously ex- 
amined when the detail is being made up and those found physi- 
cally unable to perform active field service remain at home with 
the detail to guard the yards, stations or property left in their 
charge. 

The Marines rarely serve as an independent military or- 
ganization for any prolonged period. They are however self sup- 
porting, carrying pay, commissary and provisional medical sup- 
plies with them and as such can render efficient service in these 
departments for an extended period, but as their duty is emer- 
gency duty, intended to cover the interval until the army can 
arrive when the Marine organization in its entirety becomes a 
part of the army of invasion or occupation, including all staff 
departments. 

In this manner the Medical Department becomes to all intents 
and purposes a part of the army, so far as character of duty and 
command can make it so. Its organization however remains un- 
altered, personnel and material unchanged and its own methods 
of performance of duty is continued, altered only to the extent 
to have it correspond to the army routine. 

Medical supplies, ambulances and everything necessary for 
future service of the front, are in this event, supplied from the 
Army Supply Depots. 

In a permanent camp with the army, there is no Regimental 
Hospital. Each Regiment has a small infirmary in a suitable 
building or one hospital tent in which minor cases are treated 
and an A wall tent to serve as surgeon's office and dispensary. 



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AfEDICAL SERVICE OF THE MARINE CORPS. 199 

All cases requiring hospital treatment are immediately sent to the 
Brigade or Division Field Hospital. 

After all has been said of the Medical Service of the Marine 
Corps and its close relation to the navy and army, one cannot 
help but remark that as long as efficiency and preparedness which 
has been and still are the ever present aims of all our government 
services there is no reason to doubt but that the Medical and 
Hospital Corps of the Navy will continue to render its best ser- 
vice to the Marines as it has so many times in the past with 
efficiency to the Marines and credit to itself. 



ENURESIS IN SOLDIERS. 

ON the average twenty-one per cent of soldiers {Roths 
Jahresbcrichf) were discharged from the French army 
for enuresis during 1895 to 1901. The number of cases 
steadily increased from 105 in 1895 to 243 in 1900. A careful 
observation and investigation showed that the majority of the 
cases were suffering from a slight polyuria which at times devel- 
oped into a real diabetes insipidus. In all of CarePs cases an in- 
crease of Na CI was discovered in the urine. Sometimes as high as 
• 40 G, of Na CI were excreted per day. He considers the inconti- 
nence and polyuria a sign of general degeneration. Perrin is of 
the opinion that enuresis is not due to a weakness of the bladder, 
for that would show itself also during the day. In nine cases 
out of ten it is due to profound sleep. Cold weather favors the 
condition while warm weather causes it to disappear, probably 
due to the increased perspiration of the skin. Punishment and 
suggestion are of no avail in the treatment. Remedies may have 
a reflex actipn on the brain causing the patient to awaken or may 
favorably influence the tolerance and capacity of the bladder. 
Local applications may act by exciting the reflexes, creating a 
desire to urinate and possibly awaken the patient for that pur- 
pose. Perrin has found the faradic current an excellent local 
application in these cases. — Fred J. Conzelmann. 



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OBSERVATIONS UPON TREPONEMA PERTENUIS(CAS- 
TELLANI) OF YAWS AND THE EXPERI- 
MENTAL PRODUCTION OF THE 
DISEASE IN MONKEYS. 

By CAPTAIN PERCY M. ASHBURN, 
MEDICAL CORPS UNITED STATES ARMY, 

AND CAPTAIN CHARLES F. CRAIG, 

MEDICAL CORPS UNITED STATES ARMY, 

CONSTITUTING THE UNITED STATES ARMY BOARD FOR THE STUDY OF 
TROPICAL DISEASES AS THEY OCCUR IN THE PHILIPPINE ISLANDS. 

part 11 

THE EXPERMENTAL PRODUCTION OP YAWS IN MONKEYS. 

Historical, —The literature relating to the production of f ram- 
boesia in monkeys by the inoculation of material from the lesions 
of the disease is very limited and so far as we have been able to 
determine Neisser, Baerman and Halberstadter, working together 
in Batavia, Java, and Castellani, in Colombo, Ceylon, have been • 
the only investigators to produce the disease in these animals. 
To Castellani belongs the credit of demonstrating Treponema 
perUnuis in the experimental lesions in monkeys, the other in- 
vestigators mentioned not searching for the organism although 
in their report, they mention Castellani's discovery of a spiro- 
cheta in the lesions in man. 

Neisser, Baerman and Halberstadter (24) inoculated seven 
monkeys with serum from yaws papules, the inoculation being 
made upon the breast and over the eyebrow, by rubbing the in- 
fective material into small abrasions in the regions mentioned. 
Pramboesia developed in all of the animals, the incubation period 
varying from 13 to 14 days in two Gibbons to 96 days in Macac- 
cus. In the latter, five in all, the incubation period was 22, 31, 
65, 91, and 96 days respectively. So-called secondary lesions devel- 

(200) 



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TREPONEMA PERTENUIS IN YAWS. 201 

oped in three of the animals, 40, 49 and 70 days after the primary 
lesions had appeared, the authors stating that the secondary les- 
ions always appeared upon the site of the initial lesion and ex- 
tended in a serpiginous manner into the surrounding skin. They 
did not observe a generalized eruption in any of the animals. 
They also inoculated seven monkeys {Mac. nemestrin, Mac. 
niger and Mac. cynomolgous) with material from yaws papules 
in monkeys suffering from the disease. In only one of these 
animals, a Mac. ;//*^(?r inoculated from a Mac. nemesirin, did the 
disease develop after an incubation period of 34 days. 

The authors then endeavored to produce the disease in mon- 
keys by subcutaneous inoculation of a mixture of splenic juice, 
bone, marrow and lymph 
glands from a Gibbon suffer- 
ing from yaws. They inocu- 
lated three Mac. cynomolgous, 
with negative results in all. 
Inoculation of three monkeys 
of the same species with splenic 
pulp and three with the bone 
marrow from an infected Mac. 
cynomolgous, resulted in one 
of the three inoculated with 
bone marrow developing f ram- 

boesia after an incubation pe- pjg^ j^ t. pertenufs from human yaws 
riod of 44 days. lesion, x J500 (about). 

These investigators also demonstrated that monkeys sucess- 
fully inoculated with syphilis developed framboesia upon inocu- 
lation. In one instance a Mac. niger was inoculated upon April 
17th with syphilis and developed the primary syphilitic lesion 
upon May 13th. On May 28th the same monkey was inoculated 
with framboesia and the typical yaws papule developed at the 
site of inoculation upon August 1st. Another monkey, a Mac. 
cynomolgous, was inoculated September 23rd with framboesia, 
and on October 25th with syphilis. Upon November 8th a typi- 
cal yaws papule appeared at the site of inoculation,, while on 
November 15th the characteristic syphilitic lesion appeared. 



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202 CAPTAIN P. M. ASHBURN— CAPTAIN C. F, CRAIG, 

From their experiments the authors mentioned draw the fol- 
lowing conclusions: 

1. Framboesiaisinoculablefrom man tohigher and lower apes. 

2. Framboesia is inoculable from ape to ape. 

3. Infection in monkeys following inoculation of the bone 
marrow proves that framboesia is a general and not a local disease. 

4. Apes infected with syphilis are susceptible to fromboesia. 
Castellani (25) inoculated four Ceylon monkeys (species not 

given) with framboesia but one of which developed the disease, 
after an incubation period of 19 days. A small papule, which en- 
larged slowly and became covered with a crust, developed at the 
site of inoculation. Two months later, the original papule be- 
ing still present, four other 
papules appeared, two upon 
the forehead near the first 
lesion, and two upon the upp- 
er lip; one of these papules 
disappeared in a few days, 
but the other three enlarged 
slightly, became moist, and a 
yellowish crust formed over 
each. At the end of three 
months all of the lesions had 
healed. In the scrapings from 

„, ^ -, , " , , the lesions Treponema perle- i 

Fig. 2. T. pertenuis from human yaws , -^ % 

lesion, X J500 (about). nuis was demonstrated re- 

peatedly. 

Six weeks after the disappearance of the yaws lesions this 
monkey was inoculated with syphilis, and sixteen days later a 
typical syphilitic lesion developed, accompanied by general gland- 
ular enlargement. 

The positive results obtained by the investigators whose work 
we have briefly reviewed lead us to partially repeat their experi- 
ment with a view to determining if the native monkey of the 
Philippines Cynomolgous philippinensis, GeoflFroy, could be in- 
fected with framboesia, and of adding, if possible, something to 
our knowledge concerning the disease as observed in these 



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TREPONEMA PERTENUIS IN YAWS, 203 

animals and the relation of Treponema pertenuis to the lesions 
prodtfced by experimental inoculation. While our observations 
cannot be considered as completed we believe the results so far 
obtained are of interest and should be put upon record. In the 
main our work has confirmed the results of the above mentioned 
investigators and we believe that we are justified in asserting 
that framboesia is easily inoculable from man to monkeys and 
that Treponema pertenuis is constantly present in the active 
experimental lesions and stands in a causal relationship to them. 

Material and methods. — The monkeys used in our experi- 
ments were all Cyno?nolgous phiiippinefisis, O^o^roy, the common 
native monkey of the Philippine Islands. We have experimented 
with eleven monkeys, the inoculations in such animals being both 
by the subcutaneous pocket 
method and by vaccination, 
i.e., rubbing a little of the 
yaws serum into slight abra- 
sions upon the skin. The site 
of inoculation was generally 
the skin of the abdomen and 
forehead, but the inside of the 
thigh was used in inoculating 
with syphilitic serum. The 
method by vaccination prov- 
ed, in our experience, slightly 

more successful than the sub- F4g» 3» T. pertenuis from human yaws 
cutaneous pocket method but ^"**'°' "^ ^^ ^*^*^- 

it is probable that if a larger number of the animals were used 
there would be found to be no difference in the results ob- 
tained. In every instance of successful inoculations the slight 
inoculation wounds healed rapidly and the site of inoculation 
appeared normal until the development of the yaws papules 
at periods varying from 16 to 35 to 42 days after the inoculation. 
The serum used in making the inoculations was obtained in the 
manner already described for securing smears for staining. 

In searching for Trepone^na pertenuis in the lesions in mon- 
keys the 3am^ methods of securing specimens of the scrum and 



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204 CAPTAIN P. M, ASHBURN— CAPTAIN C, F. CRAIG, 

staining them were used as have been already described in Part 
I of this report. 

We also endeavored to secure cultures of Treponema perien- 
uis from the lesions in monkeys, using methods similiar to those 
employed in our endeavors to cultivate the organism from human 
lesions. 

In considering the experimental production of framboesia in 
these animals we were desirous of investigating many problems in- 
timately connected with the subject aside from the mere successful 
result of inoculation, and while we have attempted to solve some 
of them, we do not feel justified, as yet, in expressing an opinion 
regarding our results in certain directions. This is especially 

true of our experiments re- 
garding re-infection and the 
local or general, nature of the 
disease as it is observed in 
monkeys in general, for our 
I experiments in these direc- 
I tions are too few to be 
f ofdefinite value, although they 
are suggestive. The following 
protocols of our inoculations 
include those already complet- 
ed and those in which it is too 

^ _, early, as yet, to predicate the 

Fig. 4. T. pertenuis from human yaws . ,. 
lesion, X J500 (about) result. 

PROTOCOLS OF THE EXPERIMENTS. 

Monkey No. i. (3070). This monkey was inoculated on February 16, 
*o7, with serum from a typical yaws papule in a young Filipino girl. A sub- 
cutaneous pocket inoculation was made in the skin of the abdomen, and 
some of the serum was rubbed into a scarified area over the left eye- 
brow. Smears of the serum prepared at the time of the inoculation 
were made showed numerous examples of Treponema pertenuis. The 
inoculation wound healed rapidly and the animal appeared normal until 
March 4th, when a small papule covered with a yellowish crust was noticed 
at the point of the inoculation upon the abdomen; the crust was removed 
and smears made from the serum which exuded from the minute granu- 
lations. An examination of these smears demonstrated the presence of 



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TREPONEMA PERTENUIS IN YAWS. 205 

Treponema pertenuis in large numbers. The period of incubation was about 
sixteen days. Upon March 8th, a small crusted papule had appeared at the 
point of inoculation over the left eyebrow and smears of serum from this 
lesion also showed Treponema pertenuis. Both the lesions enlarged slowly, 
especially the abdominal lesion, and healing in the center, extended in a 
circular manner into the surrounding healthy skin. The lesion upon the head 
had disappeared by May 14th but the abdominallesion persisted until May 
28th. Duration of the disease, eighty-four days. Upon May 15th, this animal 
still showing yaws papilloma apon the abdomen was inoculated with serum 
from a chancre which contained numerous Treponema Pallidum, A sub- 
cutaneous pocket inoculation was made in the skin of the abdomen and in 
addition some of the serum from the chancre was rubbed into an abrasion 
upon the inside of the left thigh. 
No results have followed these 
inoculalations to date, June 30th, 
1907. 

Monkey No, 2, (3071). Upon 
February 16, 1907, this animal was 
inoculated subcutaneously on the 
abdomen and through an abrasion 
over the left eyebrow with serum 
from a yaws tubercle from the 
same caseas Monkey No. i (3070). 
Upon March 8th a small crusted 
papule was observed at the site 
of inoculation on the head, which 

gradually enlarged until it reached „ ^ — . , 

the size of a s.ai. hazel nut; a i',;, iwC^^iiS^tSTl'S'^t 
typical yellowish crust developed, able longitudinal divWon,x J500 (about), 
which upon removal, disclosed the Note comparative size of treponema and 
characteristic pink granulating sur- coed. 

face of a yaws papilloma. Examination of the serum from the lesion demon- 
strated repeatedly the presence of Treponema pertenuis. The incubation 
period in this case was twenty days. The lesion had entirely disappeared 
upon May 2nd, thus making the duration of the disease fifty-seven days. 
Upon May i6th this animal was re-inoculated with yaws serum through a 
subcutaneous pocket upon the abdomen and an abrasion over the right eye 
brow. No lesion has appeared to date, June 30th, upon the abdomen but 
the inoculation wound over the right eyebrow suppurated and a deeply 
excavated ulcer resulted. Repeated examinations of the material from the 
ulcer have always resulted negatively for Trepone?Na pertenuis. 

Monkey i\^. ^.(3072). This animal was inoculated February 26th, 1907, 
with serum from a yaws tubercle in a native woman, the inoculation being 
made upon the abdomen and over the left eyebrow in the manner described. 



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206 CAPTAIN P. Af. ASHBURN— CAPTAIN C. F, CRAIG. 



The serum used contained many examples of Treponema pertenuis. Upon 
March 8th after an incubation period of twenty days, a small crusted papule 
was noticed at the site of inoculation upon both the abdomen and the head. 
Both lesions enlarged, became covered with a typical crust, and the exam- 
inations which were made repeatedly, were always positive for Trepo- 
nema pertenuis. This monkey did not stand close confinement well, be- 
came weaker and weaker and was chloroformed on March i8th, ten days 
after the appearance of the yaws lesion. At autopsy the viscera appeared 
normal but the cervical and inguinal glands were slightly enlarged. The 
yaws tubercle upon the abdomen measured i x % cm., was considerably 
raised above the surrounding skin and covered with a yellowish crust. The 
lesion upon the head measured 1.5 x i cm., and was very typical of the 
yaws papilloma as seen in man. The pathological material was handed 

to Dr. H. T Marshall, Pathologist of the Bu- 
reau of Science, for examination. 

Monkey No. 4. (3073) was inoculated Feb- 
ruary 26, 1907 upon the abdomen and over the 
left eyebrow in the manner described, with 
serum from a yaws tubercle in a native woman. 
Upon March 8th, twenty days after inocula- 
tion, a typical yaws papule developed at the 
site of vaccination upon the head. This lesion 
enlarged slightly, became covered with the 
characteristic crust, and the examination of the 
serum from the granulation tissue revealed 
upon the removal of the crusts showed the 
presence, repeatedly, of a few Treponema per- 
tenuis. By April i6th the lesion had healed, the 
duration of the disease being about thirty-nine 
days. Upon May 15 this animal was inoculated 
upon the abdomen and right thigh with serum 
from a chancre showing many examples of Treponema pallidum. No re- 
sults have been obtained from this experiment to date, June 30, 1907. 

Monkey No. 3. (A). This animal was inoculated April/ loth, 1907, upon 
the abdomen and right eyebrow, with serum from a yaws tubercle in a 
leper woman, the inoculation upon the head being subcutaneous, upon the 
abdomen by rubbing the serum into a slight abrasion. No lesion appeared 
upon this monkey until May 29th, when a well developed papule, about 
I cm. in diameter, and covered with a thick yellowish crust was observed. 
This lesion had evidently existed for several days, so that the incubation 
period is uncertain, probably between thirty-five and forty-five days. Upon 
removal of the crust the typical pink raspberry like growth was wellmarked 
and examination of the serum from the lesion demonstrated Treponema 
pertenuis. In this case the lesion enlarged but slightly and by June 12th 
had disappeared, the duration ol the disease being about two weeks. 



Fig. 6. T. pertenuis from 
captllary tube culturet show- 
ing agglutination and prob- 
able longitudinal division^ x 
J500 (about). Note com- 
parative size of treponema 
and coed. 



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TREPONEMA PERTENUIS IN YA WS, 207 

Monkey No, 6, (3109). This monkey upon March i8th was inoculated 
by the subcutaneous pocket method upon the abdomen, and through an 
abrasion upon the forehead, with blood from the heart of Monkey No. 3, 
(3072), obtained at the time of the autopsy. No lesions have developed 
in this animal to date, June 30th, 1907. 

Monkey No, 7. (31 10). Was inoculated March i8th, 1907, in the same 
manner as monkey No. 6. (3109) with splenic juice from monkey No. 3, (3072) 
obtained at autopsy. No lesions have developed in this animal to date, June 
30, 1907, but there is a marked enlargement of the inguinal lymphatic 
glands. 

Monkey No. 8. (311 1). Inoculated as above with serum from a yaws lesion 
upon head of Monkey No. 3 (3072) obtained at the time of autopsy March 
iSth. This animal was in a weakened condition from continued con- 
finement at the time of inoculation and died upon April 6th, nineteen 
days after the inoculation. No lesions 
of yaws bad appeared at the time of 
death and the autopsy did not show any- 
thing of interest beyond enlargement of 
the spleen, liver, kidneys, and lympha- 
tics of the abdomen. 

Monkey No, g, (B). This animal was 
inoculated April 13, 1907, in the manner 
already described with yaws serum from 
a leper woman, the serum having been 
kept in a glass capillary tube for three 
days. No lesions have appeared in this 
monkey to date, June 30, 1907. p, ^^ ^^ pcrtenuls ffom capll- 

Monkiy No. 10. (C). Inoculated Ury tube culture, showing aggltiti- 
th rough a subcutaneous pocket upon the nation and probable longitudinal 
abdomen May 15th, 1907, and through division x JSOO (about). Note 
an abrasion upon the inside of left thigh, ^parativesizeof treponema and 
with serum from a chancre, showing very 

numerous examples of Treponema pallidum. No lesions have appeared 
to date, June 30, 1907. 

Monkey No. II. {T>). Inoculated May 15, 1907 in the same manner 
as Monkey No. 10 (C) with serum from a chancre showing the presence 
of Treponema pallidum. No lesions have appeared in this monkey to 
date, June 30, 1907. 

The two latter animals were used as controls to our inoculation of 
syphilis in yaws monkeys No. i (3070) and No. 4 (3073). 

SUMMARY 

The protocols given show that in all eleven monkeys have 
been used in our experimental work. Of these five were in- 



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208 CAPTAIN P. M. ASH BURN—CAP TAIN C. F. CRAIG. 

oculated directly with serum from human yaws lesions; one with 
serum from a human lesion, the serum having been kept in a 
glass capillary tube for three days; one with blood from the 
heart of a monkey that had developed yaws; one with' splenic 
juice from the same monkey; one with serum from a yaws 
papilloma in a monkey and two with serum from a primary 
syphilitic lesion. In addition one monkey after recovery from 
yaws was re-inoculated with human yaws serum, and two 
after recovery were inoculated with syphilis. As regards results, 
of the five monkeys inoculated with yaws serum taken immedi- 
ately from the human lesions all developed typical yaws tuber- 
cles, the animal inoculated with serum from a yaws lesion in a 
monkey died before the period of incubation, as shown by our 
experiments, had expired; the animal re-inoculated with yaws 
after recovery has developed no lesions. Lastly, in not one of 
the four monkeys inoculated with syphilis have any lesions de- 
veloped. 

PERIOD OF INCUBATION. 

As will be seen upon referring to the protocols the period of 
incubation of yaws in the monkeys we experimented with va- 
ried from 16 to 35 or 45 days, but it should be understood that 
the period as given is only approximate, as owing to the distance 
and pressure of work, the animals were not inspected every 
day and thus the lesions may have existed a short time before 
they were noticed. However the limit of error in this respect is 
small and of no practical importance. The approximate period of 
incubation in our five successful inoculations was as follows: 

Monkey No 1. (3070) 16 days. 

*' 2. (3071) 20 ** . 

*• 3. (3072) 20 ** . 

'' 4. (3075) 20 '* , 

'• 5. (A) 35 to 45 days. 

In the case of monkey No S (A), the yaws lesion, when first 
noticed, was about the size of a small pea and had obviously been 
present for a number of days. 

Comparing our results with those of Neisser, Baermann and 



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TREPONEMA PERTENUIS IN YAWS, 209 

Halberstadter (26), it is noticeable that in our monkeys the pe- 
riod of incubation was much shorter, as a rule, although the 
same low type of animal was used. Indeed the incubation period 
of yaws in Cynomolgous philippinensis, Geoflfroy, approaches 
more nearly that of Gibbons as shown by the investigators men- 
tioned. Thus in the lower types of monkeys used by them, the 
incubation period in five animals was found to be 22, 31, 65, 91 
and 96 days respectively, while in only one of our five animals 
did the incubation period probably exceed 20 days. If we add 
to this result the probability that the lesions in all of our cases 
may have existed for a day or two before they were noticed, thus 
shortening the period of incuba- 
tion still further, the difference 
in our results and those of 
the German commission becomes 
more noticeable. The regularity 
of the period of incubation in 
our animals is also worthy of 
notice, four of the animals devel- 
oping the disease between the 
fifteenth and twentieth day af- 
ter inoculation. 
Duration of the Disease, —In 

the five monkeys in which we -. « ^ _^ , . , . ^ 
, . , , Fig. 8. T. pertenuis from Inoctslated 

produced famboesia by inocula- yaws in monkey^ x J500 (about). 

tion the duration of the lesion was as follows: 

Monkey No 1. (3070) 84 days. 

•* *' 2. (3071) 57 days. 

" *' 3.(3072) 10 days. 

(This animal was chloroformed while the lesions were still active.) 

Monkey No. 4. (3073) 39 days. 

'* '* 5. (A) 14 to 21 days. 

It was invariably our experience that in the more severe cases 
the primary lesion tended to spread into the surrounding skin, 
and the more marked this tendency was, the longer the disease 
lasted. We failed to observe any general glandular enlargement 
or any symptoms pointing to a general infection. 



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210 CAPTAIN P, M, ASHBURN-CAPTAIN C. F, CRAIG. 
THE LESIONS OF FRAMBOESIA AS OBSERVED IN MONKEYS. 

The lesions produced by the experimental inoculation of 
framboesia in monkeys do not differ essentially, in their morpho- 
logy, from those occurring in the disease in man, but we have 
never observed the secondary or generalized eruption, which, 
according to most authors, follows the primary lesion in the hu- 
man subject. Neisser, Baermann and Halberstadter regard as 
secondary eruptions the extension of the infection from the site 
of the original lesion, and in one of our animals. Monkey No 1. 
(3070), such an extension occurred. However, we do not regard 
the new lesions so produced as a secondary eruption but simply 
as an invasion of the contiguous healthy tissue by the organism 
causing the disease, i. e., the trepouema. Castellani appears to 

have secured true secondary lesions, 
situated at a distance from the orig- 
inal papule, in his one successful 
inoculation, and in this case a gener- 
al infection might be supposed to 
exist. 

The evidence obtained from our 
experiments would appear to indi- 
cate that experimental framboesia 
in the monkey, at least in Cynom- 
Fig. 9, T. pertenul. from Jnocu- "^^ous philippinensis, GeofiFroy. is 
Uted yaws in monkey, x 1500 a purely local infection that readily 
(about). heals after a period of time vary- 

ing from a few days to several weeks. 

As we have stated, a few days after inoculation, the wounds 
so made had completely healed, although when the inoculation 
was made by means of a subcutaneous pocket a slight thickening 
about the site of inoculation persisted for a short time, finally 
disappearing before the appearance of the yaws papule. 

In all of our animals the yaws lesion appeared at the site of 
inoculation and when first diagnosed consisted of a small papule, 
very slightly elevated above the surrounding skin, and covered 
by a yellowish cap or crust. In size the papules varied from 
that of a large pin head to a small pea. The epidermis had been 



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TREPONEMA PERTENUIS IN YA WS. 211 

replaced by the yellowish crust, which upon removal revealed a 
moist surface composed of minute, closely aggregated, but sepa- 
rate pinkish points, from which a thin, slightly milky fluid ex- 
uded. 

The initial papule gradually enlarged, became in most in- 
stances elevated, and the crust, formed of the exuded serum, 
became thicker and more noticeable. The lesions were circular 
in shape and firm upon pressure. Even when fully developed 
they were not greatly elevated, as is so frequently the case in 
human yaws tubercules, and in only one of our animals did the 
lesion project markedly above the surrounding surface. While the 
crust covering the lesion al- 
ways projected more or less, 
it would almost invariably be 
found upon its removal that 
the granulating surface was 
but slightly elevated, although 
very distinctly demarcated 
from the healthy skin sur- 
rounding it. 

The crust covering the fully 
developed yaws lesion, in the 
monkey was perfectly charac- 
teristic of that covering simi- 
lar lesions in man, varying in Fig. 10. T.palllduin from human syph- 
thickness, easily removed, and *"»' ^ ^^ ^*^'^>- 

yellowish or yellowish brown in color, sometimes streaked with 
reddish brown due to admixture with blood. 

The surface of the fully developed yaws papule in the mon- 
key, after the removal of the crust, was typical of that observed 
in human lesions. The color varied from a light pink to a bright 
red and a colorless or slightly whitish serum oozed from the raw 
surface which consisted of minute, closely aggregated papillae, 
situated upon a slightly raised base and surrounded by appa- 
rently healthy skin. In some of our animals the typical '•rasp- 
berry'* appearance so characteristic of human yaws tubercle was 
well illustrated. When fully developed the papules averaged 



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212 CAPTAIN P. Af. ASHBURN—CAPTAIN C. F. CRAIG. 

1 cm. in diameter. In one of our animals, Monkey No. 1 (3070) 
the lesion both upon the head and the abdomen was typical of 
that variety of the disease described bj Pierez (27), Scheube (28), 
Manson (29) and others as * 'ringworm yaws.'* The first lesion 
appeared upon the abdomen and presented the appearance al- 
ready described. After a few days it was observed that in both 
the abdominal and head lesion, which had meanwhile appeared, 
healing was occurring at the center while the edges of the lesion 
were covered with an elevated crust. At this time the lesion 
resembled a ring worm infection so closely that we made an ex- 
amination for the fungus with negative results. 

The lesion upon the head, when fully developed, measured 

2 cm. in diameter and consisted of a perfect ring of raised gran- 
lating tissue covered with the characteristic yellowish crust, 
and enclosing the original site of the yaws papule, which had 
healed without scar formation and but little pigmentation. Re- 
moval of the crust disclosed the usual moist pink surface and an 
examination of the serum exuding from it demonstrated the 
presence of Treponema pertenuis in large numbers. A slight 
extension of this lesion occurred in the form of a small charac- 
teristic papule developing at its lower portion and slightly in- 
volving the eyelid. 

The abdominal lesion enlarged rapidly and for some time 
presented the appearance of a large yaws tubercle, markedly ele- 
vated and covered with a mammilated yellow crust. Healing 
began at the center of the tubercle and soon atypical **ring- 
worm* ' appearance was assumed by the lesion but here a very 
considerable invasion of the surrounding skin occurred, new pap- 
ules appeared at the periphery of the original lesion, so that 
eventually nearly one-half of the surface of the abdomen was in- 
volved in the process. The new lesions were easily demonstrated 
to be extensions in direct continuity with pre-existing lesions and 
sound skin was never found separating them while in the active 
stage. 

The progress of these lesions answered perfectly to the so 
called secondary lesions described by Neisser, Baermann, and Hal- 
berstadter but, as we have stated, we cannot regard them as an 



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TREPONEMA PERTENUIS IN YAWS, 213 

evidence of a general infection and therefore as * 'secondary" in 
the sense in which the term is used in connection with syphilis. 

After persisting for a varying period of time the lesions of 
framboesia heal in the same manner as those occurring in man, 
the hypertrophied papilla atrophy, the crust covering the pap- 
illoma shrivels up and falls oflF. and a slightly discolored but ap- 
parently sound area of skin, devoid of hair, marks the site of 
the lesion. After a few days the hair again grows and it be- 
comes practically impossible to discover the site of the inocula- 
tion. As it is now nearly three months since our animals have 
recovered from the infection, and as we have seen no evidence of 
a generalized secondary 
eruption, we believe we 
are justified in asserting 
that in the species of mon- 
key we used, a general 
eruption of yaws does not 
occur after experimental 
inoculation. While the 
lesions of framboesia are 
undoubte dly modified 
somewhat in the monkeys 
of the low type used in our 

work, they are yet so char- «.» ** ^ ^ . • j *j 

.*.*', ^ , ,. Fig* U. T. pertenuiB m degenerated 

acteristic that we believe area of epithelium of human yaws 

that from their appearance ^^^^* Levaditi method, 

alone a clinical diagnosis could be made, even in the mildest 
case of infection that we observed, while in the more severe in- 
fections, such as Monkey No. 1 (3070), the nature of the lesion 
was apparent at a glance. It is probable that if higher species 
of apes were used the lesions would be much more pronounced 
and a generalized eruption of yaws tubercles might occur, 

EXAMINATION FOR TREPONEMA PERTENUIS. 

We have examined the lesions in all our successfully inocu- 
lated animals for Treponema pertenuis zxiA have repeatedly dem- 
onstrated its presence in every case, without any special difiS- 



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214 CAPTAIN P. Af. ASHBURN-CAPTAIN C, F, CRAIG. 

culty. The organism occurred usually in the very earliest stage 
of growth of the yaws papule and persisted until the lesion had 
nearly healed, being most numerous during the active growth of 
the papule and decreasing in number as the healing process ad- 
vanced. As we have stated the treponema occurring in the les- 
ions in monkeys did not differ in any particular from those found 
in the serum from the lesions in man. In most instances no 
other spirochaetae were observed in the preparation, although 
in one or two instances, organism corresponding to the type of 
S. refringens were observed, but these were very rare. As in 
man the lesions covered with crust showed the treponema un- 
mixed with other spirochaetae, while in those in which the crust 
had been removed, as by scratching, thus allowing of secondary 
infectious, organisms corresponding to the types described by Cas- 
tellaui were infrequently observed. 

Serum from the lesions in some of our inoculated animals 
was collected in capillary tubes and kept for varying periods of 
time. Apparent multiplication of Treponema pertenuisoooxiXxtA 
in some of the tubes and the organisms remained motile for sev- 
eral days. In the serum from the tubes the organisms occurred 
singly, in pairs, or in clumps. Agglutination and apparent lon- 
gitudinal division was also observed in the serum from the lesions 
in these animals. 

We consider that the constant presence of Treponema -per- 
tenuis in the experimental lesions of yaws in monkeys, produced 
by the inoculation of serum containing them from the lesions in 
man, and their absence in other conditions, is conclusive proof of 
their etiological relationship to framboesia. If we add to this the 
fact that as the lesions heal the treponema gradually disappear 
and the further fact, as proven by the case of Monkey No 2 
(3071), that the organisms can not be found in pyogenic ulcera- 
tions even when inoculated, unless framboesia be induced, it 
appears to us that the evidence is complete. Treponema per- 
tenuis is found constantly and only in the lesions of framboesia 
whether such lesions be natural, as in human infection, or exper- 
imental, as in the infection of animals^. 



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TREPONEMA PERTENUIS IN YAWS, 215 

Reinfection. — In only one instance [Monkey No. 2 (3071)] 
have we attempted to reinfect a monkey that had recovered from 
framboesia, and in this animal the re-inoculation of human yaws 
serum resulted negatively. 

Inoculation from Monkey to Monkey, — In one instance 
[Monkey No. 
3.(3111)] we 
attempted to 
inocu late a 
monkey with 
the serum 
from a well 
marked le- 
sion occurr- 
ing in another 
animal of the 
same species, 
but unfortu- 
nately the in- 
oculated ani- 
mal died in 
19 days, be- 
fore the prob- 
able per i o d 
of incubation 
had expired. 
In view of 
the results of 
N e i s s e r , 
Bae rmann 
and Halber- 
stadter who ^*^' ^^* Example of yaws lesions as seen in FiUplnoe* 

obtained only one successful result from the inoculation of 
seven monkeys with the serum of infected animals, it is obvious 
that no conclusions can be drawn from our single experiment. 

Inoculation of Blood and Splenic Pulp,— -In order to deter- 
mine whether f ramboesia, as observed in infected animals, was a 



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216 CAPTAIN P, M, ASHBURN— CAPTAIN C. F. CRAIG, 

general or local disease we inoculated one monkey [No. 6 (3109) ] 
with blood from the heart of an animal infected with yaws, and 
another [No. 7 (3110) ] with splenic pulp from the same animal. 
No results followed these inoculations but we do not consider that 
the experiments prove anything, as Neisser, Baermann and Hal- 
berstadter obtained only negative results in six monkeys inocu- 
lated with vSplenic pulp and with a mixture of splenic juice, bone 
marrow and mesenteric glands, and only one positive result in 
three animals inoculated with bone marrow. We did not try the 
inoculation of bone marrow but in view of the fact that of the 
nine animals inoculated by the investigators mentioned, the only 
positive result was obtained by the inoculation of this substance, 
we feel that our negative result with the blood and splenic pulp 
does not justify us in drawing a definite conclusion as to the 
production of the disease in this manner. 

Inoculation of Taws and Syphilis, — Both Castellani (30) 
and Neisser and his co-workers appear to have proven conclu- 
sively that monkeys which have recovered from yaws are sus- 
ceptible to syphilis. We have endeavored to repeat their exper- 
iments but have failed to produce syphilis in either monkeys re- 
covered from yaws or those that have never sujBFered from the 
disease. 

As shown in the protocols of our experiments we inoculated 
two animals. Monkey No. 1 (3070) and Monkey No. 4 (3073), 
both of which had recovered from well marked yaws lesions, 
with serum from a chancre containing at the time of inoculation 
numerous examples of Treponema pallidum. As controls we 
inoculated two healthy animals with serum from the same case. 
At the present time, two months after inoculation, none of these 
monkeys have developed syphilitic lesions, and we are forced to 
the conclusion that it is extremely difficult, if not impossible, to 
inoculate syphilis in the species of monkeys used in our experi- 
ments. ( Cynomolgous philippinensis, GeoflF roy ) . This difficulty, 
compared with the ease with which framboesia is transmitted to 
the same species, speaks very strongly against the identity of the 
two diseases. 



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TREPONEMA PERTENUIS IN YAWS, 217 

Taws and Syphilis. — As is well known the question of the 
relation of yaws and syphilis has always excited much contro- 
versy, and Hutchinson's theory, that yaws is the original form of 
syphilis, the latter disease, as we observe it to-day, being fram- 
boesia modified by passagfe through the Caucasian race, still has 
man y sup- 
porters. The 
discovery of 
au organism 
in yaws lesion 
indistinguish- 
able morpho- 
logically from 
Trepo neina 
pallidum a t 
first sight ap- 
peared to lend 
additional ev- 
dence to the 
claim that 
yaws and 
syphilis are 
identical but 
the experi- 
mental e v i - 
dence already 
at hand dem- 
onstrates that 
the lesions 
produced by 

Treponema ptg. J3- Example of yaws lesions as seen In FlUpinos. 
pertenuis diff- 
er greatly from those produced by Treponema pallidum, and 
that infection with one of these organisms does not produce 
immunity against the other. Treponema fertenuifjsA Trepo- 
nema pallidum are, therefore, distinct species, and the lesions 
produced by each are characteristic and easily distinguished 
clinically, in uncomplicated cases. 



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218 CAPTAIN P, Af, ASHBURN— CAPTAIN C. F. CRAIG, 

There is no room for doubt in our minds, after consulting 
the work of other authors and investigators, and our own clinical 
and experimental experience, that yaws and syphilis are distinct 
diseases, our belief being based upon the following facts: 

a. The pleomorphism of the lesions of syphilis, the unifor- 
mity of those of yaws. 

b. The granulomata (yaws papules) are the primary lesions 

of yaws; such lesions, if syph- 
ilitic, could only be secondary 
or tertiary, 

c. The presence of the very 
peculiar and typical yellow 
cap, or crust, covering the 
yaws lesions. 

d. In infected regions every 
uncomplicated case of yaws, 
whether in children or adults, 
presents the same character- 
istic lesion (the papule cover- 
ed with a yellow crust). If 
the disease were syphilitic a 
wider variation in the type of 
the lesion would be obser%'ed. 

e. The epidemic occurrence 
of yaws, especially among 
young children, and the great- 
er prevalence of the disease in 
children. 

!,.,.« t f , , /. The absence of genital 

Ffg. M« Examples of yaws leaions as seen . ' . . , 

in Filipinos* infections in any case observ- 

ed by us. 

g. The absence in yaws of such striking symptoms as loss of 
hair and iritis. 

h. The auto-inoculability of yaws even when a general erup- 
tion is present. 

/. The ready inoculability of yaws into such a low type of 
monkey as Cynomolgous philippinensis^ GeofiFroy, and the nega- 



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TREPONEMA PERTENUIS IN YAWS, 219 

tive r«6ult of the inoculation of syphilis in this species of monkey. 

j. The fact, as proven by Neisser, Baermann and Halber- 
stadter, and Castellani, that monkeys susceptible to both yaws and 
syphilis can 
be infected 
with both, no 
immunity be- 
ing conferred 
against the 
one by an at- 
tack of the 
other. 

k. The 
fact, as prov- 
en by Char- 
louis (31) and 
Powell (32), 
that patients 
sufiF e r i n g 
from yaws 
can be infect- 
ed with syph- 
ilis. 

GENERAL 
CONCLUSIONS. 

As a result 
of our obser- 
vations, both 
clinical and 
experimental, 
we believe 
that we are 
justified in 
drawing the 

following Fig. J5* Case of Yaws In Fllfplxio. 

conclusi]o n s : 

1. That Treponema pertenuis is the cause of yaws. 

2. That Treponema pertenuis is constantly present in the 
serum from yaws lesions. 



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220 CAPTAIN P. M. A SHB URN— CAPTAIN C. F. CRAIG. 

3. That the variations in the morphology of Treponema 
perteniiis are explainable by the deformities produced during the 
preparation of the serum for examination. 

4. That Trepone^na pertenuis 2XiA Treponema pallidum Q2m 
be differentiated by the results obtained from the inoculation of 
monkeys. 

5. That the inoculation of the serum from human yaws les- 
ions containing Trepone}na perlemiis causes yaws in monkeys and 
that the organism can be easily demonstrated in the lesions of 
the infected animals. 

6. That the length of the period of incubation in Cynoinol- 
gous philippineusis, Geoffroy, is approximately twenty days. 

7. That the duration of the inoculated disease in this species 
of monkey varies from 21 to 84 days. 

8. That yaws and syphilis are distinct diseases. 

9. That Trepon&tna pcrtenuis can be demonstrated in sec- 
tions of yaws papillomata by the Levediti method. 

BIBLIOGRAPHY. 

24. Neisser, Baermann, and Halberstadter, Munch, med. 
Wochenschr. Vol. 53, (28), 10 July, 1906, p.l337. . . 

25. Castellani, Aldo, Archiv. f. Schiffs-und Tropen-Hygiene. 
Vol. xi (1) 1 January, 1907, pp, 19-38. 

26. NeisSer, Baermann, and Halberstadter. Loc. cit. 

27. Pierez, Proceedings Pan-American Med. Congress. Vol. 
iii, 1906, p. 1764. 

28. Sclieube, B., Diseases of Warm Countries. Eng. Trans., 
1.902, p. 295. 

29. Maiison, Sir P. Tropical Diseases, 1903. p. 524. 

. 30* Castellani, Aldo, Archiv.f. Schiffs-und Tropen-Hygiene, 
Vol; xi (1) 1 January, 1907, pp. 19-38. 

31. Charlouis, M. Vjsch. f. Derm. u. Syph. Vol. viii (2-3). 
1881. 

32. Powell, A. The British Jour, of Dermatology, 1898. 



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Contemporary Comment- 



A NEW HEAT STROKE THEORY. 

UNDER the subject of Military Medicine (^Deutsche Milit- 
a^r^//. i??5^A.) Dr. Hiller discusses Oberstabsarzt Dr. Seii- 
ftleben's recent theory, of heat stroke which may be 
briefly stated as follows: In consequence of the continual perspi- 
ration of the soldiers on the march, the red blood corpuscles 
undergo dissolution. The hemoglobin of the red blood cells, dis- 
solved in the blood plasma, destroys the white blood corpuscles, 
and liberates, from the protoplasm of the white cells, the fibrin fer- 
ment, which calls forth an active rise in temperature and coagu- 
lation of the blood, especially in the venous system, and by ob- 
structing the pulmonary artery and its branches leads to death 
with lightning rapidity. The severity of the attacks of heat 
stroke depends upon the amount of fibrin ferment produced and 
the varied intensity of coagulation. The experimental support 
of Senftleben*s theory are the experiments of Maas; "Influence 
of the rapid withdrawal of water from the organism," and three 
dissertations of Koehler, Sachsendahl, and Maissurianz; * 'Fibrin 
ferment and hemoglobin intoxication" from Schmidt's laboratory 
in Dorpat. Hiller made a thorough study of the investigations 
of Maas and the dissertations from Schmidt's laboratory and 
comes to a widely different conclusion. He cannot see how the 
perspiring of soldiers on the march can be compared to the with- 
drawal of water caused by exposing in a room of warm dry air 
the contents of the abdominal cavity of a narcotised rabbit, nor 
do the injections of a concentrated sugar solution into the peri- 
toneal cavity of a rabbit or dog confirm Senftleben's theory to 
him. The experiments of Koehler, Sachsendahl and Maissur- 
ianz were made to explain blood transfusion. They found that 
dissolved hemoglobin, prepared from the blood of an animal, when 
injected in the jugular vein of the same or any other animal, lead 
to a rapid disintegration of the colorless blood cells and a sudden 
accumulation of a large amount of fibrin ferment, which caused 

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222 CONTEMPORAR Y COMMENT. 

coagulation of the venous blood in the lesser circulation and pro- 
duced sudden death by asphyxiation. Since Senftleben's theor)' 
requires coagulation of the venous blood in the lesser circulation, 
then one should find clots in the pulmonary artery and its branches 
in a patient dead from heat stroke. No such findings have as 
yet been reported. Senftleben's explanation that the fibrin fer- 
ment has been used up does not explain the absence of a coag- 

Ulm. — F. J. CONZELMANN. 



PARA-TYPHOID. 

IN the Deutsche Militaerztl, Zeitsch., Oberarzt Sacks- Mueke 
reports an interesting case of para-typhoid, the history of 
which is as follows: Patient Z. complains on the morning of 
July 15, 1906, of a feeling of weakness and dizziness. Took to his 
bed. Severe abdominal pains, frequent vomiting and diarrhea 
later in the day. Admitted to hospital July 17. Physical con- 
dition poor. Eyes and cheeks sunken. Tongue dry and thickly 
coated. Pulse small and rapid, not dicrotic. Temperature 36.1. 
Forearm and legs ice cold. Heart and lungs regular. Scaphoid 
abdomen, sensitive to touch in the upper parts. Stools have a 
pea soup appearance. Mentally clear. July 18, pulse better. 
Vomiting of bile. Stools, pea soup appearance. July 19, stupor. 
Temperature still low. Albumin in urine. July 20, pulse 90. 
Albumin in urine. Marked typhoid state. Spleen enlarged. 
Para-typhoid bacilli in the blood. Widal negative. July 21 
condition critical. Infusion of saline solution. Extremities 
warm. Temperature 35. 8. July 22, vomited. Mentally clear. 
General condition improved. Urine continued to contain albumin 
and not until July 27 did his temperature rise to 37. 0. During 
the last few days a measly eruption occurred over the whole body. 
No other signs of measles. Desquamation followed a few days 
later. August 31, Widal for typhoid negative, for para-typhoid 
positive. Urine cloudy, contains albumin and para-typhoid ba- 
cilli, no typhoid bacilli. No typhoid or para-typhoid bacilli could 
be found in the stools. September 21, patient went to duty. 
The case shows many of the clinical symptoms which Leutz con- 
siders characteristic for para-typhoid, as vomiting, enlargement of 
the spleen, rapid agglutination in a 1-250 dilution and the skin 
eruption. The subnormal temperature suggests cholera. The case 
demonstrates the importance of making a bacteriological exam- 
ination of the blood. — Frkd J. Conzblmann. 



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ni^ebico-ilMlitari^ f nbei. 



MEDICO-MILITARY ADMINISTRATION. 

[InterDational convention for the amelioration of the condition of the 
wounded and sick in armies in the field. Signed at Geneva, July 6, 1906. 
Lond., 1906, Harrison & Sons, 52 p. 8°. 

Baketd (H* L.) The medical man afloat. N, York M.J. [etc.], 1907, 
Ixxxv, 1 1 29. 

— — Some facts anent the personnel of the Army Medical Depart- 
ment N. York M.J. [etc.], 1907, Ixxxvi, 770-772. 

Blackham (R. J.) A note on the service water cart. /. Roy. Ar?ny 
Med. Corps y Lond., 1907, ix, 516. 

Cron* [Example of transportation of the sick on the water. Aug- 
mented by a review of the theory of transportation of the sick upon navig- 
able rivers by Dr. Raschofszky.] Wien, 1907,/. Safdr^ 45 p. i tab. 8°. 

de Lafra (A.) [Military duties and the Medical Corps.] Rev. san. 
mil.y med. mil. esfiaH.^ Madrid, 1907, i. 545-551. 

Hafhaway (H«) The disposal of the wounded of mounted troops. 
/. Roy. Army Med. Corps, Lond., 1907, ix, 485. 

Keogh (Sir A*) The medical service of the territorial force. Brit. 
M.J,^ Lond., 1907, ii, 1243-1252; also. Lancet, Lond., 1907, ii, 1265-1271. 

Kortin||[ (G») [The training of voluntary relief corps in the light of new 
opinions on military hygiene in the field.] Rothe Kreuz, Berl., 1907, xxv, 

599; 634. 

Kfoath (Fraiu.) [Contribution to medico-military methods in the 
open.] Wien, 1907,/. Saf&r, 67 p. 8°. 

Laval (E*) [Individual first-aid package of the Belgian Army.] 
CaducUt Par., 1907, vii, 204. 

[Individual first-aid package of the Swiss Army.] Caducde, 

Par., 1907, vii, 190. 

Lynch (C) Practice of medicine and surgery in Russo-Japanese 
war. Interstate M, /., St. Louis, xiv, 928-938. 

Macphenon (W* G*) Notes on staff work as applied to the medical 
services. /. Roy. Army Med. Corps, Lond., 1907, ix, 350-363. 

Redondo (J.) [Sanitary instruction in the personnel of the Armada 
(Spanish Navy).] Rev. ml'd. de Sevilla, 1907, xlviii, 361-371. 

Satdemann (E.) [Life insurance in war cases.] Deutsche med. 
Wchnschr., Leipz., u. Berl., 1907, xxxiii, 1460; 1500. 

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224 MEDICO MILTTAR Y INDEX. 

SchiU. [Simple device for a litter.] Deutsche miliidrdrztL Ztschr,^ 
Berl., 1907, xxxvi, 855-S58. 

Tate (R. G. H») The water-bottle: a suggestion. /. Roy. Army 
Med. CorpSf Lond., 1907, ix, 294. 

von Hocn (MazimflUo) Ritter« [Operative and tactical medico-mili- 
tary service.] Wien, 1907,/. Safdr, 173 p. 6 ch. 4 maps, 8°. 

Whe (J. C.) Should protected hospitals be built in ships of war. 
CI. States Nav, M. Bull.^ Wash., 1907, i, 102-104. 

MEDICO-MILITARY HISTORY AND DESCRIPTION. 

Amiis (T. BO Experiences as soldier and sui^geon. South. Pract.^ 
Nashville, xxix, 599-603. 

BlUafd (M») [The wounded of the Grand Army in 1813.] Chron. 
med.^ Par., 1907, xiv, 621-624. 

Blackham (R« J.) The statistics of Military Families' Hospitals. /. 
Roy. Army M. CorpSy Lond., 1907, ix, 296. 

Ellis (Sir H«) United Service Medical Society address by the Presi- 
dent. J. Roy. Army Med. Corps^ Lond., 1907, ix, 449-459. 

Grady (R.) The dentist in the United States Navy. /. Am. M. 
Asso.y Chicago, 1907, xlix, 1515-1520. 

Hoorn (Friedrich). [Medico-military experiences in the Russo-Japa- 
nese War.] Wien, 1907, /. Safdr , 79 p., 8°. 

-jeffrryi (H* B.) The native races of South Africa from a military 
point of view.] /. Roy. United Serv. Inst.y Lond., 1907, li, 1 107-11 23. 

Legfand* [The action at Morocco; medical notes.] Caducke^ Par., 
1907, vii, 257. 

M» D. The bad physical condition of West Point Cadets. Med. 
Rec.y N. Y., 1907, Ixxii, 193. 

Mac Auleppe (LJ [Letter to a future colonel.] Cliniquey Par., 1907, 
"', 497. 

Matignon (J. J.) [Medical data about the Russo-Japanese War.] Par., 
1907, A. Maloine, 448 p., i tab., i map, 8°. 

[On losses from the Medical Corps in Manchuria; should army 

surgeons be considered as combatants or non-combatants?] Mid. Mod., 
Par., 1907, xviii, 227. 

[Military hygiene in the Middle Ages as described in Fros- 

sart's Chronicles.] CaducPe^ Par., 1907, xii, 207. 

Policard* [Recruiting and status of surgeons in the English Army.] 
Caducee^ Par., 1907, vii, 206. 

Saktiral (Tadayoshi) Human bullets: a soldier's story of Port 
Arthur. With an introduction by Count Okuma. Transl. by Masujiro 
Honda. Edited by Alice Mabel Bacon. Boston and N. Y., 1907, 
Houghton, Mifflin & Co., 286 p., i, pi. 12°. 



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MEDICO'MILITAR Y INDEX. 225 

Sarmento (A.) [Tuberculosis in the Portuguese Navy.] Arch, de hyg, 
i path, exotic. y Lisb., 1905-6, i, 129-132. 

Tsvtetayeff (A* A«) [Sanitary-statistical bureau' on the theatre of the 
Russo-Japanese war.] /, Obsh, Russk. Vrach. y pani^ Pirogova Mosk,^ 
1907, xiii, 144-160. 

Westcott (SO The organization of recruiting in the Northern Com- 
mand. /. Roy, Army Med, CorpSy Lond., 1907, i», 7 ; 156. 

Wyman (H»C) Remarks on the surgery of the war of 1812. Physi- 
cian and Surg, ^ Detroit and Ann Arbor, 1907, xxix, 203-209. 

MILITARY HYGIENE. 

Bergemann* [Hygiene of military foot-gear.] Vrtljschr. f. gerichtl. 
med,^ Berl., 1907, xxxiv, 363-403. 

Bombarda (M*) [Military crimes and alcoholism.] Med, contemps.y 
Lisb., 1907, XXV, 318-320. 

Guitan (H. T«) Physical training and its advantages. /. Roy. United 
Serv, Inst,^ Lond., 1907, li, 949-983, i pi. 

Davy (F, A.) The blot in recruit training. J.Roy, United Serv, 
Inst.<, Lond., 1907, li, 1076-1106. 

Edwards (A. M,) The proposed garrison ration. /. Mil, Serv. Inst, 
U. S. Governor's Island, N. Y. H., 1907, xli, 327-336. 

Fefencty (A*) [Prophylactic measures against venereal diseases in 
general and in particular in the Barracks at Temesvar.] Allg, mil. drztl, 
Ztschr,^ Wien, 1907, xlviii, 81-86. 

Fernindet VIctorfo (A*) [Feigned insanity.] Rev. san, mil, y Med. 
mil. espafi,y Madrid, 1907, i, 473-479. 

Gffeco (GJ [Military hygiene in Italy.] Deutsche med, Wchnschr,^ 
Leipz. u., Berl., 1907, xxxiii, 1641-1643. 

Grasvenor (J. W«) The soldier as a total abstainer from alcoholic bev- 
erages. Bull, Am, Acad. M.y Easton, Pa., 1907, viii. 353-369. 

M. (N*) Thedepot, the recruit and the Swedish drill. /. Roy, Army 
Med, CorpSy Lond., 1907, ix, 502-504. 

B/Iason (C F.) Contagion as a factor in the spread of typhoid fever in 
the military service. /. Am. M, Asso., Chicago, 1907, xlix, 1592. 

Matignon (J. J.) [An original method of sanitation on the field of battle 
(Robespierre as a military hygienist).] Caducfe, Par., 1907, vii, 188. 

Mikhailoff (N. NO [On marching equipment.] Voyenno-med, /., St. 
Petersb., 1907, ccxix, med. spec, pt., 265-434. 

MoU-Wda (Augusta.) [Nutrition in the barracks.] Par., 1907, A. Ma- 
loine, 16 p. 8°. Reprint from La Revue^ Par., 1907, No. 6. 

Nichols (F. ?•) Some recruiting reflections. /. Roy, Army Med. 
Corps, Lond., 1907, ix, 272-275. 

Pelper (£.) [Infantile mortality and availability for military service.] 
Deutsche mil, cirztl, Ztschr., Berl., 1907, xxxvi, 605-620. 



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226 MEDICO-MILITARY INDEX, 

Rouget (J«) [Rations and water-supply for an army in the field.] 
Hygiene ^n. et apfiliq.y Par., 1907, ii, 525-541. 

SImoo. [The sanitary record (dossier) of the soldier.] Caducke^ Par., 
1907, vii, 243-245. 

Steuber. [On the availability of European troops in tropical colonies 
from a hygienic standpoint.] Berl., 1907, E. S. Mettler & Sohn, 38 p., 
roy. 8**. 

Stier (E.) [Acute inebriety and its legal estimation, with special refer- 
ence to military relations.] Jena, 1907, G. Fischer, 159 p. 8°. 

von Oetttn^ef (Walter). [Studies in military hygiene from the Russo- 
Japanese War.] herl., 1907, A. Hirschwald, 258 p. roy. 8°. 

MILITARY MEDICINE. 

Bcjsca^lino (A«) [Early diagnosis of phthisis in soldiers.] Gior, med, 
d. r. esercito^ Roma, 1907; Iv, 660-665. 

Gotten (R* J. G.) Heart disease and the service. /. Roy. Army 
Med, Corps y Lond., 1907, ix, 460-475. 

Mark (S* AJ [Struggle with phthisis in the army (apropos of phthis- 
ical young soldiers) ]. Voyenno-ined.J.^ St. Petersb., 1907, ccxix, med. spec, 
pt. 408; 590: ccxx, med. spec. pt. 32-46. 

Miranda (G«) [Modern explosives ; phenomena of poisoning by explo- 
sive gases.] Arch, de med. nav,^ Par., 1907, Ixxxvii, 444-470. 

Sukhanoff (S« A.) [Mental diseases in connection with the Russo-Jap- 
anese War.] Vrach. Gaz,^ St. Petersb., 1907, xiv, 969. 

MILITARY SURGERY. 

Demmler (AO [Surgery on the field of battle (methods of dressing 
and emergency interventions after modern instruction)]. Par., [1907], 
Massons & Cie, 168 p. 12°. 

Kolchin (?♦ F,) [Wounds in the Russo-Japanese War, according to 
data of the First-Barrack of the Ninth Kharbin hospital.] Khirurgia^ 
Mosk., 1907, xxii, 245.277. 

Kusaka (S») [Some cases of concussion of the internal ear occurring 
during the Russo-Japanese War.] Sei-i-Kwai M. /., Tokyo, 1907, xxvi, 
No. 306, pt. 2, 10-25. 

RIchter (Maximilian). [Ear and eye diseases in the Imperial Austrian 
Army. A critical study, based upon statistical data.] Wien, 1907. /. 
Safdr, 43 p. 8°. 

Shtseherbakoff (A.) [General review of the wounds in the Japanese 
war.] Prakt, Vrach.^ St. Petersb,, 1907, vi, 592-594. 



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fibitodal fitpresdion. 



ADVANTAGES OF ESPERANTO IN MILITARY 
MEDICAL SERVICE. 

IN connection with the recent detail of Major P. F. Straub, 
Medical Corps, U.S. Army, to attend the Esperanto Con- 
gress at Dresden, Germany, August 16-22, we may make a 
few comments on the ivteniacia hclpatingoo. 

During the months of February, March, April, and May the 
writer made the voyage from Manila, P.I., to the United States, 
visiting, en route, Straits Settlements, Ceylon, Aden, Egypt, 
Malta, Gibraltar, Spain, France, Switzerland, Germany, and Eng- 
land, and everywhere found that he might have gotten along, 
linguistically, by the aid of Esperanto alone. In all of the coun- 
tries and places mentioned he found Ksperantists, and most enthu- 
siastic they are. Many of these were medical men, and they all 
testified to the great benefit which Esperanto is to them, especially 
now that we have a medical gazette, bocho de Kuracistoj, printed 
in Esperanto at Lwow, Austria Gallicia. 

In the United States the writer found Esperanto had not 
spread as it has in most other countries, but the official recogni- 
tion by our Government of the language will attract widespread 
attention to it. To two of its great advantages we would call 
especial attention. 

Firstly: By means of translations into Esperanto, the world's 
literature maybe made accessible to all, at, comparatively speak- 
ing, a modicum of cost. Think what this means to medical and 
all other scientific men. 

Secondly: As a basis for the acquirement of other foreign 
languages, it can not be over estimated, for the word-meanings are 
so precise, and the grammar so logical, that its study affords an 

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228 EDITORIAL EXPRESSION, 

insight into language and grammar which few obtain, even through 
most arduous study. 

Esperantists have founded and maintain in Geneva. Switzer- 
land, an International ScientiBc Bureau, under the charge of that 
most competent and accomplished. man and scientist, Dr. Ren6 
de Saussure, where are being compiled lists of scientific words 
and phrases in Esperanto, which will soon be published. These 
vortaroi Qov^r every branch of science and human knowledge, 
and are most complete. Think of the great advantage to the 
world were all names of objects and things to be alike in all 
languages. 

Esperanto literature, and full information about the language, 
may be obtained from the following named persons or institu- 
tions: 

Fleming H. Revell Co., 158 Fifth Ave., New York. 

Centra Esperanta Oficejo, 51 rue de Clichy, Paris. 

Internacia Scienca Oficejo, 8 rue Bory Lysberg, Geneva, 
Switzerland. 

American Esperanto Association, Boston, Mass. 

The following periodicals, out of many, are recom- 
mended. 

Internacia Scienca Revuo, 8 rue Bory Lysberg, Geneva, 
Switzerland. 

Vocho de Kuracistoj, Lwow, Austria-Gallicia. 

La Revuo (literary), chez Hachette et cie., Paris. 

Ira la Mondo, Pundon (S. et O.) France. 

Amerika Esperantisto, Chicago, 111.— H. W. Yemans. 

SEPTIC INTOXICATION FROM MEAT DIET. 

THE article of our esteemed friend. Dr. W. F. Waugh, in 
our last issue, is pretty exhaustive. Yet we can infer 
from it an argument which he does not suspect, and 
which would not be admitted by a carnivore dyed in the wool 
and brought up to the manners. The argument is afforded by 
the illustration he pricks from a *'cold'* through a Christmas or 
Thanksgiving dinner. If one repast conveys to the alimentar}' 



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EDITORIAL EXPRESSION. 229 

canal such a huge mass of nitrogenous matter, injurious to the 
body, how much more must a habit be dangerous which is liable 
to lead to excess every day, nay, three times a day? 

Vegetarianism has an occasion to exclaim with Wallenstein, 
* 'The Lord protect me from my friends; of my enemies I will take 
care myself.'* It has made itself ridiculous by its esthetical ex- 
travagance, its butcher's shop horror leads to the fantastic ultima- 
tum of East Indian lice culture, for fear of killing an animal. But 
that does not make carnivorism good; meat-diet is only one de- 
gree removed from cannibalism ; there is in nature a progressing and 
a retrogressing metamorphosis, and a climax of the progressive 
metamorphosis is in the meat-fiber. Thence decomposition sets in. 
Therefore the carnivore eats more his like than the vegetarian, the 
vegetarian in avoiding meat aliment, gives to nature something to 
work over, and this creates better, firmer, tissue than the fiber 
formed by the meat fiber. And this holds more forcibly owing to 
the indulgence in condiments, the depravation of taste, and the 
temptation to overeat oneself. As a matter of fact, moreover, there 
is in a carnivore population less resistance against epidemics than in 
vegetarians, and there is in vegetables a less quick decomposition 
than in meat-flesh, and a less horrible putrefaction. Successful bac- 
terial cultures are made in broth, not of vegetable infusion. We 
know of an institution, a bridewell, of two hundred inmates, in 
which vegetarianism was strictly observed; two days in the year 
only meat was given, and the state of health was most exem- 
plary. Vegetable nitrogen shares in all the good qualities of 
animal nitrogen, without sharing in its bad qualities. For twenty- 
nine years the writer has observed vegetarianism, and does not 
miss the meat fiber in his hygiene. 

Among the military a trial should be made. It is merely 
a matter of habit. What with good Graham bread, the taste is 
reformed in six months. As has been said before, carnivorism 
is only one degree removed from cannibalism. — C. A. F. Lind- 

ORME. 



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Georgia State Capitol. 

Zbc Htlanta (V^cctitiQ. 



PRELIMINARY PROGRAM OF THE SEVENTEENTH 

ANNUAL MEETING OF THE ASSOCIATION 

OF MILITARY SURGEONS OF THE 

UNITED STATES. 

THE prospects for the Seventeenth Annual Meeting of the 
Association of Military Surgeons of the United States 
are particularly alluring. Atlanta is famous for its 
effective entertainment of conventions. The military element is 
strong: in Georgia and the presence at its capital of the head- 
quarters of the Army Department of the Gulf, with the great 
post of Fort McPherson on its borders, adds still more to its ap- 
propriateness as a location for the meeting of a military society. 

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PROGRAM OF THE A TLANTA MEETING. 231 

The state government, headed by the commander-in-chief of 
the Georgia National Guard, with his staff, will a£Ford an addi- 
tional element of attractiveness. The month of October is a par- 
ticularly agreeable season in Georgia and the environments of the 
meeting cannot but prove a delightful setting to a most interest- 
ing occasion. The military, naval, and marine-hospital surgeons 
of the United States have continued in active professional work 
during the year and a program will be presented bringing out 
many of the more important features of the army, navy and 
public health medical work. 

The meetings will be held in the Assembly Room of the 
magnificent Piedmont Hotel, which will also be the social head- 
quarters of the meeting, so that all of the sessions of the conven- 
tion will be held under one roof, an advantage which experience 
has shown to be very great. 

Amon^ the papers which will be presented at the meeting 
are the following: 

Suture of Wounds of the Heart. By Assistant Surgeon 
General George TuUy Vaughan, P.H.&M.H.S. 
The President's annual address. 

The Development and Maintenance of a Militia Hospital 
Corps. By Captain J. Carlisle DeVries, N.G.N. Y. 

A National Guard Practice March. By Major Buell S. 
Rogers, Illinois N.G. 

A Plea for Specialism. By Captian Edward B. Vedder, U.S.A. 
The necessity of specializing is pointed out, both from the point of view 
of obtaining the best resuhs in army medical practice, and in case orig- 
inal work or research is carried on, the desirability of the latter and a 
brief plan for providing for specialists in the Medical Corps. 

A Simple Method of Transporting Drugs, Surgical Instru- 
ments, and Dressings into the Field for a Few Day's March. By 
Lieutenant Harold G. Goldberg, N.G. Pa. 

A Mexican Litter Especially Adapted to Transportation from 
the First Line to the Dressing Station. By Lieutenant Colonel 
Alejandro Ross, Mexican Army. 

A description of a litter devised by a Mexican army surgeon who calls 
it "the Mexican Wheeler Stretcher," 

Sanitary Service in the Field. By Colonel H. Nimier, 
French Army. 



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232 ASSOC! A TION OF MILITAR Y SURGEONS. 

The Situation of the Medical Corps in the Austrian Army. 
By Major George E. Bushnell, U.S.A. 

Sanitary Service of the Swiss Army. By Captain Louis C. 
Duncan, U.S.A. 



North Pryor Street in AtlanU* 

The New Sanitary Regulations of the Swedish Army. By 
Captain Robert L. Richards, U.S.A. 

The Sanitary Service in the Third Japanese Army, the Be- 
sieging Army at Port Arthur. By Captain Edward B. Vedder, 
U.S.A. 



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PROGRAM OF THE A TLANTA MEETING, 233 

The Steel Frame in the Transportation of the Disabled. By 
Colonel C. de Mooy, Retired, Netherlands Army. 

A description of the author's adaptation of steel to th^ formation of 
litters for transportation of the disabled in military service. 

Some Recent Scandinavian Military Medical Literature. 
By Major Hans Daae, Norwegian Army. 

An interesting review of the subject by the editor of the Norsktids- 
skriftfor Militar Medecin, 

The Medical Log of the U.S.S. Virginia on the Cruise to 
the Pacific. By Surgeon Charles Henry Tilgham Lowndes, 
U.S.N. 



AtlanU DenUl College* 

Reason for the article; general description of the Virginia] the cruise, 
the health of the ship; a few practical conclusions. 

Sanatorium Management. By Surgeon Paul M. Carrington, 
P.H.&M.H.S. 

A description of the routine at Fort Stanton, New Mexico. 

The Remote Effects of Exposure to fhe Direct Rays of the 
Sun. By Lieutenant Colonel Edward Champe Carter, U.S.A. 

Change of Climate not Essential in Treatment of Pulmonary 
Tuberculosis. By Former Acting Assistant Surgeon Melville 
A. Hays, U.S.A. 



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234 ASSOCIA TION OF MIUTARY SURGEONS. 

PulmoQary tuberculosis can be treated successfully at sealevelas well 
as in high altitudes. Essentials of treatment are plentiful supply oi fresh 
air, good, nourishing food, and medicinal treatment to meet indications. 
Synopsis of cases showing results in treatment of cases in a variety of alti- 
tudes from sea level to 2,000 feet above sea level. ^ 

A Plea for the Early Diagnosis of Pulmonary Tuberculosis. 
By Surgeon Barton Lisle Wright, U.S.N. 

Our fundamental dependence on the early diagnosis of pulmonary 
tuberculosis and the widespread failure to recognize or neglect to accord 
full import to the physical signs of the incipient stage of the disease. Cases 
in illustration are presented and a plea is made for better training in and 
more attention to physical diagnosis, to the end that phthisis may be 
brought under treatment more often before microscopical confirmation is 
available. 

Researches upon the Cultivation of the Plasmodia of Mala- 
ria. By Captain Charles F. Craig, U.S.A. 

The paper gives the results obtaii\ed in attempts to cultivate the ma- 
laria Plasmodia upon hitherto untried culture media which have been used 
successfully in cultivating other protozoan organisms. 

Public Health and Military Medical Department of the 
United States. By Surgeon lyloyd W. Curtis, U.S.N. 

The object of this paper is to suggest to the Association a tentative 
plan for the creation of a comprehensive national health organization, 
•which shall embrace the Medical Departments of the Army, Navy, and Pub- 
lic fiealth and Marine Hospital Service, having as its official head a physi- 
cian and sanitarian of national reputation, who would be a cabinet officer. 
The paper will attempt to show some of the advantages such an organization 
would possess in dealing with the public health in its federal relations, by 
fixing responsibility and authority in the hands of a personnel trained for 
the purpose and no other. Should the subject of this paper prove of stimu- 
lating interest to the Association a suitable medal might (and would) be 
offered for competing essays, the subject of which should deal with the 
practical development and organization of such a department of the federal 
government. 

Camp Sanitation. By Major Thomas J. Kirkpatrick, U.S.A. 

Gives r^sumd of recent literature bearing on the subject, more espe- 
cially the part played by the contagion and ''bacillus carriers" in spread of 
typhoid fever, and new' prophylatic measures suggested by these advances 
in knowledge of the subject. 

The Disposal of All Liquid Refuse of the Otis Excavators 
and of the Sanitary Carts in a Maneuver Camp, by Evaporation 
on Heated Rocks. By Major Henry I. Raymond, U.S.A. 



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PROGRAM OF THE A TLANTA MEETING. 235 

An ideal sanitary encampment leaves nothing to mark its site, under- 
ground or above, except a monumental mound of ashes with which the fall- 
ing rains will enrich the earth. The scheme involves no innovation as to 
mechanicaldevices,but simply the adaptation of a primitive and well-known 
earth and masonry construction to a new end. Principles of construction 
and operation of a pit for evaporation of liquid in the field as evolved 
through observation and experiment at the Maneuver Camp, Leon Springs 
Reservation, Texas. *'If any one can recommend a method for the disposal 



Carnegie Library* 

of liquid waste in a camp where the subsoil is a closely packed clay, he 
will confer a lasting blessing, etc." (Major Ferrel, Journal of the Associa- 
tion of Military Surgeons ^ July, 1906). 

Favus as Observed in the Inspection of Immigrants. By Sur- 
geon J. B. Stoner, P.H.&M.H.S. 

Don*t Swallow the Enemy, Don*t Touch the Enemy, Don't 
Breathe the Enemy. By Captain Frank T. Woodbury, U.S.A. 
A simply worded manual designed for the use of officers and soldiers 
of the line and containing much of interest upon the subjects considered. 



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236 ASSOCIA TION OF MILITARY SURGEONS, 

The Administration of a Plague Campaign. By Passed 
Assistant Surgeon Rupert Blue, P.H.&M.H.S., Commanding 
plague supressive measures in San Francisco, Cal. 

The Executive Work of a Plague Campaign. By Passed As- 
sistant Surgeon W. C. Rucker, P.H.&M.H.S., Executive Offi- 
cer plague suppressive measures in San Francisco, Cal. 

The Flea and Its Relation to Plague, with a synopsis of the 
Rat Fleas. By Passed Assistant Surgeon Carroll Fox, P.H & 
M.H.S., Pathologist plague suppressive measures, San Francisco, 
Cal. 

The Clinical and Post Mortem Diagnosis of Plague. By 
Passed Assistant Surgeon Carroll Fox, P.H.&M.H.S. 

The Examination of Rats and the Practical Bacteriology of 
Plague. By Passed Assistant Surgeon G. W. McCoy, P.H.& 
M.H.S., Bacteriologist plague suppressive measures, San Fran- 
cisco, Cal. 

Rat Destruction. By Passed Assistant Surgeon C. W. Vogel, 
P.H.&M.H.S., Commanding the Sth Provisional Plague District, 
San Francisco, Cal. 

Practical Rat-Proofing as an Anti-Plague Measure. By 
Passed Assistant Surgeon R. H. Creel, Commanding 6th Provis- 
ional Plague District, San Francisco, Cal. 

The Conduct of an Anti-Plague District. By Assistant Sur- 
geon J. R. Hurley, P.H.&M.H.S., Commanding 11th Provisional 
Plague District, San Francisco, Cal. 

Method of Making Sanitary Surveys in a Plague Campaign. 
By Acting Assistant Surgeon C. H.Woolsey, P.H.&M.H.S., Com- 
manding 3rd Provisional Plague District, San Francisco, Cal. 

Cleaning and Disinfection as Plague Suppressive Measures. 
By Acting Assistant Surgeon G. M. Converse, P.H.&M.H.S., 
Commanding 1st Provisional Plague District, San Francisco, Cal. 

District Organization. By Acting Assistant Surgeon L. S. 
Schmitt, P.H.&M.H.S., Commanding 4th Provisional Plague 
District, San Francisco, Cal. 

Medical versus Surgical Treatment of Amebic Dysentery. 
By Passed Assistant Surgeon John Milton Holt, P.H.&M.H.S. 

Consideration of this relatively new disease can not be too frequent, 
for a time, at least. Published accounts of alleged cures by internal medi- 



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PROGRAM OF THE A TLANTA AfEETING, 237 

cation often fail to mention how long thereafter ameba colt were absent 
from stools, and whether microscopical examination was systematically made 
to determine the presence or absence of ameba. After some of these ap- 
parent recoveries, subsequent attacks have been reported concerning which 
it has been said that perhaps they might have been new infections. It is 
believed medical treatment should be limited to the acute cases, and when 
the cases become chronic, they are exclusively surgical. 

Disease, — A Conservative Instrument of Nature. By Sur- 
geon P. C. Kalloch, P.H.&M.H.S. 

The writer undertakes to frame a hypothesis which may account for 
the occurrence of disease in man and the hypothesis offered presents the 



CaplUl Qty Oub* 

following factors: (i) That disease attacks only persons who are either 
permanently or temporarily enfeebled and that the tendency in such cases 
is their removal as active members of the race. (2) That susceptibility to 
disease depends upon the infraction of natural laws. (3) That such infrac- 
tion consists in the neglect of certain functions or their performance under 
unnatural circumstances. (4) That the remedy lies in the instruction of the 
public as to the proper apportionment of time to the different functions and 
as to the importance of living under sanitary or natural laws. 

Battleship Neurasthenia (?). By Surgeon Sheldon Guth- 
rie Evans, U.S.N. 

A simple plea for the recognition of the intestinal origin of neurasthe- 
nia and outlining a successful plan of treatment. 



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238 ASSOCIA TION OF MIL/TAR Y SURGEONS. 

Perforation of the Intestines in Typhoid Fever — A Brief Re- 
view with a Report of Three Cases. By Passed Assistant Surgeon 
C. H. Lavinder. P.H.&M.H.S. 

Tropical Diseases in the Philippines. By Captain James M. 
Phalen, U.S.A., and Lieutenant Henry J. Nichols, U.S.A. 

A report upon the work of the board for research upon tropical dis- 
eases in the Philippine Islands. 

Iron-Aristol for Chronic Skin Ulcers. By Passed Assistant 
Surgeon M. J. White, P.H.&M.H.S. 

The Sanguinary Assault by United States forces upon the 
Moros at Bud-Dajo, Island of Jolo, P. I., as Observed by the 



Eatfance to Fort McPhenon, near Atlanta^ Ga. 

Surgeon. Illustrated by Maps and Weapons. By Major Charles 
B. Ewing, U.S.A. 

Cocaine, Its Relations to the Military Surgeon. By Passed 
Assistant Surgeon William Dunlop Owens, U.S.N. 

Necessity for laws regulating the sale of cocaine. The environment 
of a military organization and its relation to cocaine. Certain attractive 
advantages which cocaine offers to a possible military habitue. The 
effects, agreeable and otherwise. The malignant type when taken in 
poisonous doses. Two frequent conditions which have come under obser- 
vation. The different state laws relating to the sale of cocaine. Massa- 
chusetts' more advanced law. Note. 

Hypodermic Anesthesia (Historical). By Former Acting 
Assistant Surgeon William Thomas Thackeray, U.S.A. 

A paper, the title to be announced. By Colonel William C. 
Gorgas, U.S.A. 



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flews of the Services* 



Acting Assistant Surgeon G. H. Altrec, P.H.&M.H.S., granted two 
months leave without pay. 

Lieutenant E. H. Anderson, U.S.A., ordered to Fort Wingate. 

Assistant Surgeon F. A. Ashford, P.H.&M.H.S., ordered before the 
San Juan Promotion Board. 

Assistant Surgeon S. Bacon, U.S.N., ordered from the New Fort Lyon 
Naval Hospital to the South Dakota. 

Surgeon C. E. Banks, P.H.&M.H.S., granted twenty days leave. 

Passed Assistant Surgeon L. P. H. Bahrenburg, P.H.&M.H.S., ordered 
to Point Pleasant, N. J., to examine keepers and surfmen of the Life- 
Saving Service and return to Ellis Island, N. Y. 

Acting Assistant Surgeon W. O. Baird, P.H.&M.H.S., granted sixteen 
days leave. 

Lieutenant R. C. Bayly, U.S.A., ordered to Fort D. A. Russell, thence 
to Camp Emmett Crawford. 

Medical Inspector C. Biddle, U.S.N. , ordered home from the Phila- 
delphia Marine Recruiting Station and granted two months leave. 

Lieutenant Colonel H. P. Birmingham, U.S.A., appointedmember of the 
medical examining board vice Colonel Charles B. Byrne. 

Assistant Surgeon L. W. Bishop, U.S.N., ordered from the Indian- 
apolis Naval Recruiting Station to the New York Naval Hospital for treat- 
ment and observation. 

Captain Robert M. Blanchard, U.S.A., granted twenty instead of ten 
days leave. 

Passed Assistant Surgeon Rupert Blue, P.H.&M.H.S., appointed a 
member of the San Francisco Revenue-Cutter Service Retiring Board. 

Captain James Bourke, U.S.A.; ordered from Fort Leavenworth to camp 
near Fort Riley. 

Medical Director J. C. Boyd, U.S.N., ordered from command of the 
Naval Medical School Hospital to continue duty as president of the Naval 
and Medical Examining Boards at that school. 

Major Thomas S. Bratton, U.S.A., ordered with troops from Fort Des 
Moines to camp near Fort Riley. 

Assistant Surgeon H. Butts, U.S. N., ordered from the Cavite Naval 
Station to the Canacao Naval Hospital. 

Surge6n D. N. Carpenter, U.S.N., ordered from the Cavite Naval Sta- 
tion home to wait orders. 

(239) 



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240 NEWS OF THE SERVICES. 

« 

Surgeon P. M. Carrington, P.H.&M.H.S., granted sixteen days sick 
leave, and appointed delegate to the meeting of the International Congress 
on Tuberculosis. 

Major W. Fitzhugh Carter, U.S.A., granted one month*s leave. 

Assistant Surgeon A. L. Chilton, U.S.N., ordered to the Philadelphia 
Naval Hospital. 

Passed Assistant Surgeon Taliaferro Clark, P.H.&M.H.S., ordered to 
Lebanon, Pa., for special temporary duty and return to Philadelphia, Pa. 

Acting Assistant Surgeon F. H. Cleaves, P.H.&M.H.S., granted 
twelve days leave. 

Assistant Surgeon A. L. Clifton, U.S.N., commissioned from July 15, 
1908. 

Surgeon J. O. Cobb, P.H. & M.H.S., ordered to Chicago, III., for 
special temporary duty and return to Milwaukee, Wis. 

Assistant Surgeon I. F. Cohn, U.S.N., ordered to the Mare Island 
Naval Hospital. 

Assistant Surgeon H. W. Cole, Jr., U.S.N., ordered to the Charleston 
Navy Yard. 

Captain George H. Crabtree, U.S.A., granted fifty-four days leave from 
Ancon, Canal Zone. 

Assistant Surgeon G. B. Crow, U.S.N., commissioned from July 15, 
1908, and ordered to the Norfolk Naval Hospital. 

Lieutenant W. R. Dear, U.S.A., ordered to the Washington General 
Hospital. 

Captain William A. Duncan, U.S. A., granted fifteen days leave. 

Acting Assistant Surgeon James Dunn, P.H. & M.H.S., granted one 
month's leave. 

Assistant Surgeon H. G. Ebert, P.H.&M.H.S., ordered from special 
temporary duty at San Francisco to the San Francisco Quarantine Station. 

Passed Assistant Surgeon W. G. Farwell, U.S.N., ordered from Camp 
Ellicott, Isthmus of Panama to the Philadelphia Naval Recruiting Station. 

Lieutenant Herbert L. Freeland, U.S.A., ordered to Camp Emmett 
Crawford; granted twenty days leave about October i. 

Colonel Joseph B. Girard, U.S.A., appointed delegate to the Fifth 
Pan-American Medical Congress at Guatemala. 

Acting Assistant Surgeon C. M. Gleason, P.H.&M.H.S., granted twenty 
days leave. 

Assistant Surgeon General A. H. Glennan, P.H.&M.H.S., granted 
twenty-eight days leave. 

Passed Assistant Surgeon J. Goldberger, P. H. & M. H. S., appointed 
delegate to the meeting of the International Fishery Congress, Washing- 
ton. D. C. . 

Medical Director G. E. H. Harmon, U.S.N., ordered to command the 
Naval Medical School Hospital. 



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NEWS OF THE SERVICES. 241 

Lieutenant Herbert I. Harris, U.S.A., granted sixteen days leave. 

Major H. S. T. Harris, U.S.A., granted ten days extension of leave, and 
ordered before the Medical Examining Board for examination for promo- 
tion. 

Colonel Valery Havard, U.S.A., appointed president of the medical ex- 
amining board vice Colonel Charles B. Byrne. 

Assistant Surgeon A. B. Haywood, U.S.N., ordered from Camp Elli- 
cott, Isthmian Canal Zone, Panama, to the Pittsburg Naval Recruiting 
Station. 

Assistant Surgeon H. R. Hermesch, U.S.N., ordered from the Cincin- 
nati Naval Recruiting Station to the California. 

Captain James D. Heysinger, U.S.A., granted fourteen days leave. 

Acting Assistant Surgeon B. I. Hicks, P. H. & M. H. S., granted 
twenty-three days leave. 

Lieutenant Eben C. Hill, U.S.A., ordered to Fort Porter. 

Passed Assistant Surgeon W. S. Hoen,U.S.N., ordered from treatment 
at the Mare Island Naval Hospital to the Bureau of Medicine and Surgery 
for further orders. 

Acting Assistant Surgeon M. VV. Houghton, P. H. & M. H. S., granted 
fifteen days leave. 

Captain Park Howell, U.S.A., ordered from the Fort Leavenworth 
Military Prison to the Fort Bayard General Hospital. 

Lieutenant Edward G. Huber, U.S.A., ordered from Chickaroauga Park 
to Fort Riley. 

Major R. W.Johnson, U.S.A., granted one month's leave in the United 
States. 

Assistant Surgeon H. L. Kelly, U.S.N., ordered from the Canacao 
Naval Hospital to the Cavite Naval Station. 

Major William P. Kendall, U.S.A., ordered from Fort Ethan Allen to 
Fort Ontario for temporary duty, and then before the Medical Examining 
Board for examination for promotion. 

Acting Assistant Surgeon S. R. Kennedy, P. H.&M.H.S., granted one 
month's leave. 

Lieutenant Edgar King, U.S.A., ordered from the Philippines to San 
Francisco. 

Passed Assistant Surgeon W. W. King, P.H.&M.H.S., appointed a 
member of the San Francisco Revenue-Cutter Service Retiring Board. 

Major Thomas J. Kirkpatrick, U.S.A., granted one month's leave. 

Captain C. E. Koerper, U.S.A., granted twenty-seven days leave from 
Cuba with permission to visit the United States. 

Lieutenant John S. Lambie, Jr., U.S.A., ordered from Chickamauga 
Park to Fort Riley. 

Captain James I. Mabee, U.S.A., ordered from the Sherman to Jef- 
ferson Barracks; granted two months leave. 



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242 NEWS OF THE SERVICES. 

Acting Assistant Surgeon R. H. McGinnis, P.H.&M.H.S., granted fif- 
teen days leave ; leave revoked. 

Assistant Surgeon L. W. McGuire, U.S.N., ordered from the Charles- 
ton Navy Yard to the Montana. 

Surgeon W. P Mcintosh, P.H.&M.H.S., granted one month's leave. 

Assistant Surgeon F. H. McKeon, P.H.&M.H.S., ordered before the 
Manila Promotion Board. 

Acting Assistant Surgeon W. L. Mann, Jr., U.S.N., ordered to the 
Newport Naval Hospital. 

Assistant Surgeon H. M. Manning, P.H.&M.H.S., ordered to the 
Hygienic Laboratory for temporary duty. 

Major Charles F. Mason, U.S.A., appointed delegate to the meeting of 
the American Public Health Association, Winnepeg, Manitoba, Canada. 

Surgeon F. W. Mead, P.H.&M.H.S., ordered to Tuckerton and Atlan- 
tic City, N. J., to examine keepers and surfmen of the Life-Saving Service 
and return to Savannah, Ga., and granted one month's leave. 

Assistant Surgeon J. M. Minter, U.S.N., ordered from the Mare Island 
Naval Hospital to the Cincinnati Naval Recruiting Station. 

Captain William H. Moncrief, U.S.A., granted two months leave with 
permission to apply for one month's extension. 

Major Edward R. Morris, U.S.A., ordered before the Medical Examin- 
ing Board for examination for promotion. 

Surgeon L. Morris, U.S.N., ordered from the Newport Naval Torpedo 
Station to the Cavite Naval Station. 

Lieutenant Armin Mueller, U.S.A., ordered from Milwaukee, Wis., to 
Jefferson Barracks. 

Acting Assistant Surgeon A. J. Nute, P.H.&M.H.S., granted sixteen 
days leave. 

Captain Fred W. Palmer, U.S.A., ordered from the Fort Bayard Gen- 
eral Hospital to Fort Benjamin Harrison. 

Passed Assistant Surgeon H. B. Parker, P.H.&M.H.S., granted one 
month's leave. 

Passed Assistant Surgeon J. H. Payne, U.S.N., ordered from the Bos- 
ton Navy Yard to the Salem. 

Passed Assistant Surgeon A. E. Peck, U.S.N., ordered to the Newport 
Naval Torpedo Station. 

Assistant Surgeon General W. J. Pettus, P.H.&M.H.S., granted 
one month and fifteen days leave with permission to go beyond the sea. 

Assistant Surgeon Joseph Pettyjohn, P.H.&M.H.S., ordered before the 
Manila Promotion Board. 

Assistant Surgeon J. R. Phelps, U.S.N.. commissioned from July 15, 
1908. 

Major Henry I. Raymond, U.S.A., ordered before the Medical Exam- 
ining Board for examination for promotion. 



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NEWS OF THE SERVICES. 243 

Dr. James Reagles, U.S.A., granted twenty days sick leave. 

Captain Charles R. Reynolds, U.S.A., ordered from Chickamauga 
Park to Fort Riley. 

Assistant Surgeon G. C. Rhoades, U.S.N., ordered from the Franklin 
to the Scorpion. 

Surgeon General Presley M. Rixey, US N., has returned from a west- 
ern tour of inspection. He will, in a few weeks, make a visit of inspection 
to Newport, where land has been secured lor a new hospital and the site 
and plans for the new building are to be worked out with a view to be- 
ginning construction early in the fall. The hospitals to be built at Boston 
and Portsmouth will be the next to be taken up. 

Assistant Surgeon T. W. Salmon, P.H.&M.H.S., ordered before the 
Washington Promotion Board. 

Acting Assistant Surgeon Walter L. Savage, P.H.&M.H.S., granted one 
month's leave. 

Passed Assistant Surgeon J. W. Schereschewsky, P.H.&M,H.S., 
ordered to Ocean City, Md., and Chincoteague, Wachapreague, and Cape 
Charles City, Va., to examine keepers and surf men of the Life-Saving Ser- 
vice and return to Baltimore, Md. 

Captain George H. Scott, U.S.A., granted one month's leave. 

Acting Assistant Surgeon L. T. Seavey, P.H.&M.H.S., granted twenty- 
one days leave. 

Major Henry A. Shaw, U.S.A., granted one month's leave. 

Assistant Surgeon G, W. Shepard, U.S.N., ordered from the Mare 
Island Naval Hospital to the Naval Medical School for instruction. 

Acting Assistant Surgeon A. E. Spohn, P.H.&M.H.S., granted one 
month's leave and one month's leave without pay. 

Assistant. Surgeon R. D. Spratt, P.H.&M.H.S., ordered before the 
Washington Promotion Board.. 

Assistant Surgeon P. R. Stalnaker, U.S.N., ordered to the Annapolis 
Naval Hospital. 

Captain Chester J. Stedman, U.S.A., granted three months leave. 

Passed Assistant Surgeon A. M. Stimson, P.H.&M.H.S., granted one 
month and fifteen days leave. 

Major John H. Stone, U.S.A., ordered from Newport News to the 
Fort Leavenworth Military Prison. 

Assistant Surgeon G. E. Strite, U.S.N., ordered from the Franklin to 
the Norfolk Naval Hospital. 

Assistant Surgeon D. G. Sutton, U.S.N., ordered from the Newport 
Naval Hospital to the Franklin. 

Assistant Surgeon E. A. Sweet, P.H.&M.H.S., ordered before the San 
Francisco Promotion Board, and granted two months leave. 

Lieutenant Frank Suggs, U.S.A., ordered from Fort Niagara to Fort 
Washington for temporary duty. 



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244 NEWS OF THE SERVICES. 

Acting Assistant Surgeon J. W. Tappan, P.H.&M.H.S., granted twenty 
days leave. 

Acting Assistant Surgeon B. C. Tarbell, P.H&M.H.S., granted one 
nnonth's leave without pay. 

Passed Assistant Surgeon J. W. Trask, P.H.&M.H.S., granted twenty- 
seven days leave. 

Lieutenant George Trotter-Tyler, U.S.A., ordered from Fort Adams to 
Fort Monroe for temporary duty. 

Assistant Surgeon H. W. B. Turner, U.S.N., appointed July 20, 1908. . 

Acting Assistant Surgeon Jay Tuttle, P.H.&M.H.S., granted one 
month's leave. 

Surgeon J. F. Urie, U.S.N., retired August 1, 1908, and ordered home 
when discharged from treatment at the Mare Island Naval Hospital. 

Acting Assistant Surgeon P. Villodo, P.H.&M.H.S., ordered to Cien- 
fuegos, Cuba, for temporary duty and return to Havana. 

Passed Assistant Surgeon C. W. Vogel, P.H.&M.H.S., ordered from 
special temporary duty at San Juan, P. R., to Washington, D. C. 

Acting Assistant Surgeon H. C. Wakefield, P.H.&M.H.S., granted 
twelve days leave. 

Surgeon Eugene Wasdin, P.H.&M.H.S., granted one month's leave. 

Acting Assistant Surgeon W. A. Weldon, P.H.&M.H.S., granted one 
month's leave. 

Surgeon C. P. Wertenbaker, P.H.&M.H.S., ordered to Wachapreague 
and Cape Charles City, Va., to examine keepers and surf men of the Life- 
Saving Service, and granted one month's leave. 

Passed Assistant Surgeon H. W. Wickes, P.H.&M.H.S.. ordered to 
the Brunswick Quarantine Station for special temporary duty and return to 
station. 

Captain William A. Wickline, U.S.A., ordered to accompany troops 
from Leon Springs, Texas, to Camp Emmett Crawford. 

Captain Frank T. Woodbury, U.S.A., ordered to Fort Assinniboine 
upon expiration of leave. 

Surgeon R. M. Woodward, P.H.&M.H.S., granted thirteen days leave. 

Screens at Army Posts. — An allotment of $40,000.00 has been made 
for screening buildings at army posts and camps in the Philippine Archi- 
pelago. Installation wiil begin at the hospitals, quarters and barracks 
coming later. 

Dengue a Mosquito Borne Disease.— The Medical Department in 
the Philippines after patient investigation has come to the conclusion that 
dengue fever is carried by mosquitoes and is not contagious. Recommenda- 
tion has been made to Washington that anti-mosquito measures be adopted 
at Fort William McKinley, P. L, where the fever was prevalent some 



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J^EiVS OF THE SERVICES. 245 

months ago, and wherever else there is danger of an outbreak of the dis- 
ease. 

The Uniform of the Army Medical Reserve Corps. — General 
Orders No. 125 from the War Department prescribes that the uniform 
for officers of the Medical Reserve Corps will be the same as that pres- 
cribed for officers of the Medical Corps, except the insignia, which will be 
the caduceus of gold or gilt, superimposed in the center by a monogram of 
dull finish bronze, bearing the letters "R. C", five-eighths (\) of aji inch 
high, for the full dress, dress, and white coats. For the service coat and 
overcoat, the caduceus will be of dull finish bronze metal, superimposed in 
the center by. the monogram in gold or gilt. 

New Army Shoes.— An improved Army shoe will be tried at Fort 
Sheridan, 111., to which post have been sent seventy-five pairs of new russet 
shoes and a like number of black dress shoes, consisting of a full set of 
sizes and widths. A board of officers will be convened at Fort Sheridan to 
have these shoes tried by members of the garrison under the observation, 
also, of the chief shoe inspector from Boston. The board will criticise the 
shoesand make suggestions of changes. The russet shoe embodies improve- 
ments which have been recommended hitherto, the tops being not so high 
as the old shoe and there being fewer lacing holes and those of large size. 
The russet shoe is on the orthopedic last, while the the black shoe is on the 
standard commercial last. 

The Next Surgeon General of the Army.— In view of the fact that 
Surgeon General O'Reilly of the Army must be retired by age in January' 
next, considerable agitation has already begun in official circles as to his 
successor. Among the Colonels of the Army Medical Department may be 
found material of the very highest character, so that the President's selec- 
tion need not be embarrassed by the lack of a suitable man. Among 
those mentioned are Colonel Valery Havard, President of the Army Med- 
ical School ; Colonel John Van Rensselaer HofiF, Chief Surgeon of the 
Philippines ; Colonel Louis M. Maus, Chief Surgeon of the Department of 
the Luzon/ Colonel George H. Torney, Commandant of the Presidio Gen- 
eral Hospital; and Colonel William C. Gorgas, of the Isthmian Canal 
Commission. 

Testimonial to General Sternberg.— In recognition of his emi- 
nent services to the public a complimentary banquet was tendered to 
General George M. Sternberg, U.S.A., a member of the Executive Council 
of the Association of Military Surgeons, by the medical profession and cit- 
izens of Washington, D. C, June 8, the occasion being the celebration of 
his seventieth birthday. Honorable John W. Foster presided. Addresses 
were delivered by Major Walter D. McCaw, U.S.A., on " Sternberg, the 
Medical Officer;" Dr. George M. Kober, on "Sternberg, the Scientist and 
Author;" Mr. Justice David J. Brewer, on " Sternberg, the Philanthro- 
pist;" Commissioner Henry B. F. MacFarland, on "Sternberg, the Cit- 



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246 NEWS OF THE SERVICES. 

izen;" and Honorable Simon Wolf, on "Our Guest," while a beautiful 
silver cup was presented to General Sternberg as a permanent memorial of 
the occasion. 

Military Surgeons in the First Rank of Esperantistoj.— The 
military surgeons of the United States are forging ahead in their interest' 
and work for the international language, which they believe will do an im- 
mense amount of good for the science of medicine as well as for commer- 
cialism and universal peace. 

At the First American Esperanto Congress, recently held at Chau- 
tauqua, N. Y., Major Walker, Surgeon U.S A., was one of the leaders, and 
little Miss Winifred Sackville Stoner, Jr., daughter of Lieutenant-Colonel 
J. B. Stoner, Surgeon P.H.&M.H.S., was the youngest Esperantist holding 
a diploma from the International Esperanto Institute for being able to 
read, write and converse in the wonderful tongue. Little Miss Stoner is 
but five years of age, but having heard her father and mother talking 
Esperanto for the past year she could not help imbibing it. Dr. Stoner is 
now busy trying to bring his brother officers into the fold of "universal 
peacedom," and hopes to organize The P.H.&M.H.S. Esperanto Asso- 
ciation. 

Promotion of Army Medical Field Officers.— The terms of 
the recentiy enacted statute for the reorganization of the Medical Corps 
have been complied with in the case of the majors of the corps who failed 
to pass the examination for promotion to the grade of lieutenant colonel. 
The law provides that in the matter of the physical examination the officer 
who fails may ask for a second examination, but in no other respect can 
he have a second trial on failure. He may, however, ask for the appoint- 
ment of a board of review to go over the conditions of the examination 
and report whether in the judgement of the board any injustice has been 
done the candidate for promotion. Three majors who have not passed for pro- 
motion to the higher grade will remain majors until the expiration of their 
service. All are regarded as capable surgeons and officers who have a good 
record of service to their credit; but a light estimate of the requirements of 
the examination and the unexpected stiffness of the test to which they were 
put no doubt caught them off their guard. One of the severest parts of the 
test was an administration problem for which several days of the time al- 
lotted was given, and it is understood that it was this feature of the ex- 
amination that proved the stumbling stone over which the officers in ques- 
tion fell down. Nothing short of the compassion of Congress in special 
legislation can come to their relief, and they are destined to remain on the 
list of majors, while other officers in their grade will be examined, and as 
they demonstrate their fitness for advancement will be promoted. The in- 
cident has caused no little commotion in the Medical Corps. A second list 
of majors for examination for promotion has been made up. This was 
made necessary by the fact that the three officers who were ordered before 
a board in June failed to pass mentally. It is expected that with the example 



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NEWS OF THE SERVICES. 247 

of those who failed before them the second draft of candidates will contain 
no causalties. The conditions with reference to promotion from Captain to 
Major and from Lieutenant to Captain are that the candidate who fails 
after the results of the examination have been confirmed by a board of re- 
view shall be honorably discharged with a year's pay. This has been done 
with one officer who failed in his examinaiion for promotion from Lieu- 
tenant to Captain. 

Officers of the Army Medical Reserve Corps.— The following 
former Contract Surgeons of the Army have been appointed Lieutenants 
in the new Medical Reserve Corps and assigned to duty at their former 
stations: G. F. Adair, E. A. Anderson, William M. Archer, Frank E. 
Artaud, J. K. Ashburn, L. P. Ball, F. M. Barney, Joseph E. Bastion, Ed- 
mund W. Bayley, H. C. Bierbower, L W. Brewer, L C. Brown, P. D. 
Brown, W. E. Brown, G. F. Campbell, D. P. Card, A. M. Chase, C. L. 
Chase, G. R. Clayton, Albion McD. Coffey, Harold L. Coffin, F. J. Conzel- 
mann, G. W. Cook, C. W. Cullen, W. O. Cutliffe, Waller H. Dade, O. F. 
Davis, George W. Daywalt, S. C. DeKrafft, A. C. Delacroix, W. F. de 
Niedmann, Luis G. de Quevedo, Clarence F. Dickenson, P. G. Drake, C. 
T. Dulin, L. R. Dunbar, H. W. Eliot, W. F. Enders, J. A. Escobar, E. J. 
Farrow, H. L. Frecland, L. C. Garcia, W. R. S. George, L. K. Graves, F. 
C. Griffis, W. C. Griswold, Frederick Hadra, W. E. Hall, C. H. Halliday, 
F. A. Halliday, J. W. Hard, D. W. Harmon, H. L Harris. W. L. Hart, H. 

E. Hasseltine, O. F. Henning, J. R. Hereford, John M. Hewitt, David D. 
Hogan, T. G. Holmes, Alva R. Hull, Leonard S. Hughes, M, E. Hughes, . 
T. W. Jackson, A. R. Jarrett, F. E. Jenkins, C. W. Johnson, E. K. John- 
stone, E. C. Jones, G. B. Jones, Edward H. Jordan, P. S. Kellogg, John P. 
Kelly, J. S. Kennedy, H. Newton Kierulff, Clarence C. Kress, J. F. Leeper, J. 
C. LeHardy, Robert Lemmon, Henry F. Lincoln, J. W. Love,Thomas S. Lowe, 

F. M. McCallum, D. P. McCord, C. E. McDonald, H. C. McLeod, Clemens 
W. McMillan, S. B. McPheeters, J. C. Magee, M. F. Marvin, J. N. Merrick, 
A. L. Miller, F. H. Mills, J. R. Mount, W. H. Myers, S. F. O'Day, Wallace, 

E. Parkman, J. B. Pascoe,E. W. Patterson, L. B. Peck, Henry duR. Phelan, 
Joseph Pinquard, Elias H. Porter, Howard Priest, James Reagles, G. H. 
Henderson, E. E. Roberts, W. E. Sabin, J. L. Sanford, J. M. Shepherd, 
R. E. Sievers, E. F. Slater, J. T. H. Slayter, R. D. Smith, W. H. Smith, 

F. H. Sparrenberger, S. A. Springwater,G. P. Stallman, C. H. Sterns, A. V. 
Stephenson, J. K. Stockard, H. W. Sluckey, Frank Suggs, E. S. Tenney, C. 
A. Tetrault, J. L Thorne, C. A. Treuholtz, George Trotter-Tyler, Tesse P. 
Truax, W. H. Tukey, A. D. Tuttle, George B. Tuttle, G. T. Tyler, Henry 
H. Van Kirk, T. C. Walker, F. M. Wall, George S. Wallace, Benjamin B. 
Warriner, V. E. Watkins, C. L Wertenbaker, H. R. Weston, J. M. Wheate, 
Walter Whitney, D. C. Wiggin, Elsworth Wilson, H. C. Woolley, R. J. 
Wren. H. W. Ycmans. 



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KELLY'S MEDICAL GYNECOLOGY.* 

THIS is a work which appeals particularly to the general 
practitioner, and practically all American military med- 
ical officers are of this class. The comparatively limited 
amount of gynecological practice which pushes on to the terrain 
of the military medical officer renders a work of consultation, so 
thorough, so exact and so complete as the present book, an 
adjuvant of the highest value. There is no part of medical 
gynecology which Dr. Kelly has failed to discuss most intelli- 
gently and luminously. To especially n^ntion any one subject 
where all are so well treated would be an invidious discrimina- 
tion. All of the progress made during the quarter of a century, 
during which gynecology has arisen from obscurity to promi- 
nence, finds its place in this essentially modern text-book. 



HANDLER'S MEDICAL GYNECOLOGY.t 

THE frequent occurrence of simultaneous recognition of 
facts and the conditions of the medical profession as 
manifested by the almost simultaneous production of 
works upon the same subject is well marked in connection with 
medical gynecology. The work of Dr. Kelly which we notice 
above is followed almost directly by this notable work of Dr.' 
Handler. It is an outgrowth of the author's clinical lectures in 
the New York Post-Graduate School, and is consequently emin- 
ently practical in character. The arrangement of the book is good 
and its teachings are conservative and yet progressive. 

♦Medical Gynecology.— By Howard A. Kelly, M.D. 8 vo: pp. 662, 
with 163 illustrations. New York and London, D. Appleton & Co., 1908. 
Cloth $6.00. 

tMedical Gynecology. By S. Willis Bandler, M. D. Svo; pp. 675, with 
135 illustrations. Philaaelphia and London, W.B. Saunders Co., 1908. Cloth 
;^*5.oo net. 

(248) 



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Vol- 3t3K MII, Wo. 4. OCJTOBBR. 1008. 



®ddinal ^l^emoirs* 



AUTHORS ALONE ARE RESPONSIBLE FOR THE OPINIONS 
EXPRESSED IN THEIR CONTRIBUTIONS. 



THE INDIVIDUAI. FIRST AID PACKETS OF THE 

PRINCIPAI. ARMIES OF THE WORLD. 

By major ED. LAVAL, 

SURGEON IN THE FRENCH ARMY. 

Translated by CAPTAIN CHARLES 8. BUTLBR, 

ASSISTANT SURGEON IN THE MASSACHUSETTS VOLUNTEER MILITIA. 

individual first aid packet 
has taken on new im- 
' portance within the past 
few years. Our former 
1 place to new ones; at 
Its of the packet being 
re was taken about the 
be dressing was subjected 
)ugh to enclose in com- 
tnpresses on the one hand, 
ith two safety-pins on the 

as come to be the chief 
he object has been to put 
packets whose contents 
east handling in the ap- 
dressing; on account of 
ethods more or less in- 
genious have appeared, making it possible to unfold and 

(249) 



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250 MAJOR ED, LA VAL. 

to apply the cx)mpresses to the wound without touching them 
with the hands. At the same time, it is most ipiportant to make 
the dressing aseptic. But, asepsis being a quality easily lost if 
its protection is not perfect and constant, we are obliged, on ac- 
count of circumstances to put the dressing in a soldered metal 
box. 

As the accompanying table shows, the packets of the sev- 
eral armies differ considerably. To take up their study according 
to the principal characters — 



¥\g. U The Austrian First Aid Packet 

Natural size 2 1/8 by 2 7/8 Inches. 

Shape, — Except the Dutch and the Italian, which are nearly 
square, the packets have an oblong shape, which seems a more 
advantageous arrangement for the contents, as well as for car- 
rying in a pocket of the clothing. 

Size,— Th^ largest are the Belgian and the Roumanian, 
which are respectively 13 by 9.5 cm., and 12 by 7 cm. The 
smallest is the Italian 6 cm. square. It is of interest to note 
that the new Swiss packets of 1906 and those of the United 
States, 1906, are sizes halfway between these extremes. They 
are both about 10 cm. long by a little more than half that wide; 
or 6.5 cm. for the former and 5.7 cm. for the latter. 



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FIRST AID PACKETS OF THE PRINCIPAL ARMIES. 



251 




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252 MAJOR ED. LA VAL. 

The thickness is from 2 to 3 cm., more usually 2. This is 
as much projection as packets can stand in a soldier's pocket 
without being troublesome . 

Weif^ht. — The old packets are light enough; the lightest in 
weight is the Norwegian, which weighs only twenty-one grams. 
On the other hand, the heaviest are the Swiss, 100 grams, and 
that of the United States, 130 grams, both of which weights are 
easily understood when we take account of the metal case. 



Figs* 2 and 3* Elements of the Austrian Packet in Reduced Proportion* 

Covering, — In general, the dressing itself is covered with a 
water-proof paper, then further covered with a water-proof cloth 
or not, kept closed either by a string, so completing the whole, 
for example the Dutch; or tied on all sides, as in the German; 
or by sewing together the edges, as in the French, Spanish and 
Belgian; or by other joining together of the edges of the water- 
proof covering, as in the Roumanian. To open the packets, it 
is only necessary to cut the string or to pull on the thread, or to 
tear apart the edges of the covering, according to the conditions. 

With the new packets in metal cases, however, made by the 
apposition of two hollowed halves, it is only necessary to pull on 



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FIRST AID PA CKETS OF THE PRINCIPAL ARMIES. 253 

a ring which draws apart a soldered band, this making the whole 
of the fastening. 

Cb«/tf«/s.— The old model packets contained one or two com- 
presses enclosed in a water-proof paper, with one bandage rolled 
separately or one sling, 
and one or more pins; for 
example Spanish, Nor- 
wegian, Belgian, Rou- 
manian, and Swedish. 
But the more recent 
models comprise a band- 
age to which is attach- 
ed one or two compress- 
es; in a word, the dress- 
ing and bandage are in 
one piece. In the case 
of several countries, i 

Germany and Austria 

^r.'T ^vo«,*>i^ ♦i.o /./A«i Ftg»4^ The Italian First Aid Packet* 

for example, the com- « Naturalize 2 5/8 by 8 inches. 

press is sewed along the 

bandage, at one extremity. In the United States model, the com- 



Figs. 5, 6 and 7* Elements of the Italian Packet In Reduced Proportion* 
press is sewed on, but at the middle of the bandage, which be- 



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254 



MAJOR ED. LA VAL. 



comes a divided bandage with two free ends. Finally, in Holl- 
and the meth- 
od, patented 
under the 
name* of 
Utermohlen 
consists in 
this that the 
com press , 
sewed to the 
middle of the 
bandage 
making two 
Fig. 8. The Norwegian First Aid Packet. portions is 

Natural size 8 1/2 by 2 Inches. ^ 

folded several 
times on itself and therefore as it were automatically unfolds. 



Figs« 9 and 10* G)mpre8ses of the Norwegian Packet in Reduced Proportion* 



Fig* \\. G)tton Bandage of the Norwegian Packet in Reduced Proportion* 
* After M. Utermdhlen, who origiDated It. 



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FIRST AID PA CKETS OF THE PRINCIPAL ARMIES. 255 

From these last packets, safety-pins have disappeared, a fortu- 
nate simplification. 



Fig. M. The Roumanian First Aid Packet* 

Natural size 5 by 2 3/4 inches. 

Sterilization. — A large number of the packets, in fact, the 
uiajorily, are rendered afitiseptic with corrosive sublimate. 



Fig. 13* Roumanian G>mpress Fig* 14* Diagnosis Tag of the 

Reduced. Roumanian Packet Reduced* 

Some are made aseptic, as the Dutch, by steam under pressure. 
Finally, some, as the Swiss, are made aseptic, as well as anti- 
septic with vioform. 



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256 MAJOR ED, LA VAL, 

Method of Application, — If we omit from consideration the 
old models, where first, the compress is put on the wound, then 
the bandage, to consider only the recent models, where compress 
and bandage are in one piece, we shall see that there are two 



Fig. 15* Roumaniaa Compress Reduced. Fig* 16* Bandage of the Roumanian 

Packet Reduced. 

methods of application according to whether the compress is at- 
tached to one extremity or to the middle of the bandage. . 

In the first case, the soldier, applying the dressing, unrolls 
the first few centimeters of the bandage near the compress, ap- 



¥\gAl. The Russian First Aid Packet. 

Nataral size 4 by 2 1/2 inches. 

plies the compress to the wound and then continues to unroll the 
rest of the bandage round about the compress. But we may 
criticize this method in that it exposes the wound to the risk of 
infection by the fingers because the end of the bandage next the 



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FITST AID PA CKETS OF THE PRINCIPAL ARMIES, 257 

compress must have been touched by the fingers in the applica- 
tion. 

Much more satisfactory however, is the practice in the first 
aid packet of the United States or of Holland, where the soldier 



Fig. 18* Compresses and Baodage of the Russiaa Packet in Reduced Proportion. 

takes in each hand one of the two parts of the bandage in one 
set, spreads the hands apart and the compress is thus opened; it 
only remains 
to wind the 
bandage 
about the 
wound, with- 
out having so 
much as 
touched the 
compress. 
The superi- 
ority of the 
Dutch packet 
consists in 
this, that al- 
though of 

^ ^^ ^ ^ -^ r ^* ^2- ^9- '^^ Swedish First Aid Packet, 

and with a Natural size 3 1/2 by 2 3/4 inches. 

rather nar- 
row bandage, the compress can be spread over a considerable 
area, thanks to a most ingenious manner of folding, and so can 



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258 MAJOR ED, LAVAL, 

cover an extensive wound. The ends of the bandages are tied 
over the dressing, making pins unnecessary. 

Several countries, as Germany and Austria, have only one 
compress in their packets; this however seems to us insufBcient. 



Figs* 20 and 2U Gnnpresses of the Swedish Packet la Reduced Froportlon* 

It is truly said that then it would be suflBcient to supply the men 
with two packets; but this is impracticable. It is necessary that 
each packet should have two sets of bandage-compresses. 



Fig. 22. Bandage of the Swedish Packet In Redticed Proportion* 

Position for the first aid Packet, — In all armies the packet 
is carried in a coat pocket, or in an inside pocket. The United 
States, however, has inaugurated a new model, provided with 
two hooks, allowing the men to carry it on their belt. 



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FIRST AID PA CKETS OF THE PRINCIPAL ARMIES. 259 

Is this an advisable change? It seems certain that this is 
advantageous in showing the soldiers that they should consider 
the first aid packet just as useful as other parts of their lesser 
equipment. But these other objects are already so many that we 
may ask ourselves whether it seems wise to add to the impedi- 
menta. In any case, the model which we have examined has two 
rather weak hooks, badly fastened. It is to be presumed, how- 
ever, that some modifications will be introduced. 

CONCLUSIONS. 

The ideal first aid packet, meeting the exigencies of the 
surgery of the battlefield, seems to have been realized, in great 
measure, in the model adopted by the United States. The metal 
case seems necessary but we should prefer it aluminum, because 
the two halves make a dead weight which should be reduced as 
much as possible. 

The contents should be made up of two sets of bandage, 
with compress fixed to the middle of the bandage. But we 
criticize the bandage in the United States packet as being too 
wide:* five to six cm. would be quite enough. 

Of course, no pins.t 

The contents should be both aseptic and antiseptic. 

Finally, it seems best to us to continue to carry the packet 
in some pocket of the soldier's uniform. 



TREATMENT OF GUNSHOT WOUNDS OF THE 
ABDOMEN. 

IN a contribution to the last German Surg-ical Congress, von 
Oettingen remarks that, theoretically, no abdominal wound 
from a modern bullet should be primarily laparotomized, 
with exception of those cases presenting signs of continued hem- 
orrhage into the abdominal cavity. Conservative treatment is 
indicated. 

*The United States 1906 model has bandage about 9.5 cm. wide. 

fThe United Htates 1906 model (Bauer and Black) has fonr safety pins. 



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FACTS ABOUT THE ARMY CANTEEN. 

By dr. ANITA NEWCOMB McGEE, 

FORMERLY ACTING ASSISTANT SURGEON IN THE UNITED STATES 

ARMY. 

EARLY in 1907 I was asked to take an active interest in the 
restoration of the army canteen. With the intention of 
SO doing, I went to the War Department to obtain official 
facts and reports on the subject. I spent many days in examin- 
ing these documents, and, finally, to my very great surprise, I 
was obliged to change completely my former opinion, for I be- 
came convinced by the evidence furnished by the army itself 
that the results of the abolition of the canteen had, on the whole, 
been good. The most important facts which I discovered were 
the following: 

1. There has been somewhat less drunkenness in the army 
since the canteen was abolished than there was in the years when 
it flourished. 

The facts are shown primarily by the reports of the Surgeon 
General on the number of cases admitted to hospital for Alcohol- 
ism per thousand of strength. These admissions are practical 
proof of the extent to which drunkenness prevails in the army, 
and their comparison from year to year enables one to reach 
conclusions which are impossible when memory alone is relied 
upon. In Munson's Military Hygiene are given fig'ures prior to 
1897 which show the following: 

The percentage of admissions of the whole army in 1870 
was 38.20, from which it rose to 58.10 in 1874 and to 68 in 1875. 
(An enormous increase, the cause of which I have not inquired 
into). Then it dropped by steps to 57.60 in 1881, rising next 
year again to 68.70. From that time until 1898 there was a 
steady fall in this percentage, showing some influence at work 
throughout the whole army. The canteen (which word I use 
throughout in its popular restriction to the beer-drinking feature 

(280) 



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r 



FACTS ABOUT THE ARMY CANTEEN. 261 

only), was officially established February 1, 1889, but I under- 
stand that it was already in operation at some posts before that, 
while it did not begin at others until later. The following are 
the figures for each year from 1887 to 1907: 

1887 46.70 1897 27.80 

1888 40.20 1898 15.95 

1889 41.40 1899 '8.35 

1890 40.70 1900 22.43 

1891 40.00 1901 26.25 

1892 37.20 1902 24<44 

• 1893 33.80 1903 26.72 

1894 3090 '904 25.42 

1S95 30.10 1905 30.22 

1896 28.80 1906 32.27 

For 1897, and later, figures are quoted from the .Surgeon 
General's Report for 1897 (page 52). 

These figures relate to the whole army in the United States 
proper, thus eliminating the small difference due to conditions 
outside of the United States which did not obtain before the 
Spanish War. From this we see — (a) great fluctuations prior 
to establishment of canteen; (b) a steady fall, beginning with 
the years before the canteen was established, but commonly con- 
sidered to be the effect thereof; (c) an abrupt fall in 1898 fol- 
lowed by a rise during the re-establishment of peace conditions; 
(d) a sudden stop to the rise and a practical level for four years 
following the abolition of the canteen, during which time it did 
not reach even the lowest figure before the Spanish War; (e) a 
rise in 190S and 1906, coming too long after February 1, 1901 to 
be attributed to a law passed on that date; (f) the average of 
the nine canteen years prior to the Spanish War is 34.52; the 
average of the six non-canteen years is 27.72. 

In making this most important comparison, I eliminate the 
war-years, because it is self-evident that the canteen had nothing 
whatever to do with the conditions obtaining then and the ab- 
rupt fall in alcoholism in 1898. Herein lies the source of most 
of the errors on this subject, and even in the report of the Chief 
of Staff for 1907 (page 19), he speaks of the canteen period as 
the years 1891 to 1900, thus giving to the canteen all the credit 



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262 DR, ANITA NEWCOMB McGEE, 

of the war conditions in his comparisons. (I could learn nothing 
at the War Department about the details of comparisons, etc., 
referred to by the Chief of Staff). 

The chart iti which the above figures are put in diagrammatic 
form, on page 52 of the report of the Surgeon Gkineral of the 
Army for 1906 and same page of report for 1907, shows very 
clearly that normal conditions were not reestablished until 1901, 
though the figure then and for some time afterward was, as above 
stated, lower than any of the canteen years previous to the Span- 
ish War. To what should be attributed the relatively small rise 
of 1905 and 1906 cannot be stated without a thorough investi- 
gation, though what follows throws some light on it. 

II. The difference in amount of Alcoholism during the 
canteen years {be/ore i8^) and that during the post canteen 
years is so slight as to show in conjunction with other facts that 
the presence or absence of the canteen has a decidedly minor ef- 
fect on drunkenness in comparison with other influences. 

Among the tables in the Surgeon General's reports is one 
showing **Most Important Diseases by Arms of Service.'* The 
following figures are taken from these tables: 

ALKOHOLISMUS. 



1903 


1904 


1905 


1906 


Infantry { 
Cavalry ' 
Coast Artillery 
Field Artillery 
Whole Army 


25.92 
14.17 

24.69 


24.94 
16.17 
42.62 

9-43 
27.61 


46.52 

'0-53 
29.65 


30- 15 
16.06 

1 46.52 
IO-53 
3122 



It is beyond all question that the causes which produce forty- 
six cases of Alcoholism per thousand in one arm of the service 
when an allied arm has only ten cases, must be most powerful 
and these differences throw into insignificance the trifling fiuctu- 
ations attributed to the canteen. 

III. There was an enormous increase in venereal diseases 
in iSqq^ coincident with tropical service; there was no increase 
in the United States in the four years following the abolition of 
the canteen^ as compared with the two years preceding it. In 
the Philippine Inlands there was an absolutely regular increase 
from 18^ to 1 90s, 



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FACTS ABOUT THE ARMY CANTEEN, 263 

Charts showing the above appear in the Surgeon General's 

Report for 1906, pages 50 and 90. The figures for the United 
States proper are as foUows: 

1897 84.59 1902 161. 14. 

i8g8 81.49 1903 135.84 

1899 148.43* 1904 163.42 

1900 155-39 ^905 17S.72 

1901 .*.. 149.96 1906 158.91 

The chart for the whole army (Surgeon Generars Report, 
1907, page 14) is similar to that for the United States proper, 
and both show a distinctly different character from the chart for 
Alcoholism. In the former the high level was reached in 1899, 
and no effect of the abolition of the canteen can be discovered. 
The greater prevalence of these diseases as compared with that 
before 1898 is clearly due to causes acting in 1899, and presum- 
ably to the tropical service, especially that in the Philippine Is- 
lands. I have not examined the figures prior to 1897. The 
disassociation of disease with Alcoholism and its relation to the 
tropics is further shown by adding the percentage of two vene- 
real diseases in the four largest arms of the service, as shown in 
the international table, Surgeon General's Report for 1907, page 
180. He also reports (p. 22) that the coast artillery, with the 
highest Alcoholism, has the lowest venereal disease, while the 
field artillery, with scarcely one-fourth of the former, has a much 
higher rate of disease. Note that the former is stationed entirely 
in the United States, and the latter is largely in the Philippine 
Islands. The cavalry runs higher than the artillery, and 
sometimes lower than the infantry, though the last named has 
twice its alcoholism. Furthermore, in the last report of the 
Surgeon General (1907, page 15) is a chart showing that the 
proportion of venereal diseases in the United States proper is 
158.91, while in the Philippine Islands it is 310.34. 

IV. The increase of saloons outside Army posts, which 
was so generally predicted to follow an anti-canteen law, did not 
occur at all. 

'('Showing insignificant effect of Spanish War in reducing amount of 
disease and effect of troops returning home from tropics. 



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264 DR. ANITA NEWCOMB AfcGEE. 

I make this statement with assurance but^with great hesita- 
tion, because in the voluminous document sent to Congress by 
the Acting Secretary of War, January 8, 1903 (House Docu- 
ment, No. 252) is stated on page 15: 

''Number of saloons within one mile of posts according to last 

reports 1,896 

Number of saloons within one mile of posts February 2, 190 1, 1,555 

Number of saloons established since abolition of canteen 341" 

On pages 16 and 17, the posts in the United States are speci- 
fied, each name being followed by the number of "additional 
saloons established within one mile of military posts since Feb- 
ruary 1, 1902.** I add the figures for each post in the United 
States and' find the total to be 271 and not 341 at all. I have 
carefully read a considerable part of the volume which contains 
the reports on which the above figures are based, but nowhere 
have I found any warrant for them. Further; the table on page 
18 claims the ''number of places at which intoxicants are sold" 
"established since abolition of canteen,** in the Philippine Is- 
lands to have been 371, whereas the sum of those established at 
each separate post in the Islands (pages 19 to 21), gives only 131. 

It will amply show the character of the summaries given, if 
sample posts are taken somewhat at random, and the reports 
therefrom compared with the figures given in the table. I specify 
here as examples the two having the largest reported increase; 
the first five on the alphabetical list; and three posts near Wash- 
ington. 

The post in the United States reporting the largest increase 
according to the table, is Whipple Barracks, Arizona, with twen- 
ty-eight additional saloons in consequence of the passage of the 
anti-canteen law. On page 351 is printed what the commanding 
officer there actually reported, which was that there were no 
troops at that post until April 29, 1902 (over a year after the 
enactment of the anti-canteen law) ; that the whole of Prescott 
is within, a mile of the post, and that Prescott contains twenty- 
eight saloons! 

The second largest increase in the table is Fort Leavenworth, 
22. The actual reports are (pages 112 to 145) on August 28, 



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FACTS ABOUt THE ARMY CANTEEN, 265 

1901: **The city of Leavenworth lies south of the reservation, 
and within about three miles of the post proper, and being in a 
Prohibition State, it was impracticable to procure an accurate 
list of the saloons and other places where intoxicants could be 
obtained. So far as known, there are about 118 saloons near 
the city limits, and of these about eighty are within one mile of 
the reservation. During the past six months, i. e., following 
the anti-canteen law there has been no increase in this number. 
West of the reservation, within about one mile, there have been 
for years, three small saloons. * * * During the last year 
there has been a decrease of one saloon in that vicinity.'* Au- 
gust 18, 1902, a different officer commanding a different regi- 
ment, reported: **The number of saloons within one mile of the 
reservation is 102, with three gambling places. ' * It is evident 
that no comparison can properly be made between these reports, 
and, since the first officer said there has been no increase follow- 
ing the anti-canteen law, but, on the other hand, a decrease of 
one, this statement seems in the absence of anything to contra- 
dict it, the only acceptable one. To arbitrarily take the cautious 
•'about 80'' of the first officer and subtract it from the *'102'' of 
the second officer's report and so obtain an "increase" of twenty- 
two is a remarkable use of figures! 

Of the five posts standing first in the alphabetical list, three 
are reported as no increase. Two are reported with increase of 
two each, and I find in the first instance the two new saloons were 
thirty miles away from the post, not * 'within one mile," as 
stated (a second officer reported no increase at this post); and 
in the second instance, the post was a new one which never had 
had a canteen ! 

Washington Barracks is credited with sixteen new saloons. 
The reports (pages 341 to 349) , show these facts: The post ex- 
change officer reported thirty-four saloons within one mile before 
the anti-canteen law, and the 'same officer reported exactly the 
same saloons by name six months later; no increase. There is 
printed with this, statements of the Excise Board of the District 
of Columbia, naming fifty saloons before the passage of the Act, 
and stating that there bad been no increase since. The reader 



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266 DR, ANITA NEWCOMB McGEE. 

would naturally conclude that the post exchange officer had not 
counted all the saloons, but the tabular statement sub^acts the 
report of the one man from the report of the other man, and so 
manufactures an increase of sixteen! 

Fort Myer, Va., appears in the table with eight new saloons 
to its credit, and on page 198 is an extract from the Washington 
Post of September 22, 1902, saying: '* After the abolition of the 
army canteen — brought about by a great moral revolution a 
year or so ago— Fort Myer at once became the center of a cir- 
cumference of grog shops, deadfalls, palaces of pleasure — ^the 
usual thing,*' etc. The official report of August 27, 1901 says: 
"The liquor saloons within one mile of the post (three in num- 
ber) have not increased, but one that had closed for want of 
patronage immediately reopened, and now does a flourishing 
business." Reference is made to other saloons in Rosslyn, about 
one and one-half miles from the post, but the number is not given. 
The report of September 15, 1902, by a different officer, com- 
manding a different regiment, says: **There are eleven saloons 
and drinking places within one mile of the reservation limits 
* * * all in operation at the time of arrival of the Second 
Cavalry troops at this post, January 23, 1902; no others since 
having been established.'* He names the saloon keepers, and 
from names which I recognize, I judge that he includes the Ross- 
lyn saloons, especially as he mentions only two as located at the 
entrance to the post, so as to leave it quite in doubt as to what 
the true comparison is. 

Fort Monroe, Va., figures in the table merely as having no 
increase. Reports (pages 182-186) show at passage of the law^ 
fifty-one; six months later, forty-six; in 1902, forty, a total flfe- 
crease of eleven saloons! The above are fair samples of this re- 
port of a former Secretary of War. Secretary Taft has carefully 
refrained from any expression ^of conviction on this sub- 
ject. 

V. Desertions, courts-martial, etc., are due to so many 
causes I have not considered them -worthy of thorough analysis^ 
but so far as I examined^ I could find no pro-canteen evidence* 



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FACTS ABOUT THE ARMY CANTEEN. 267 

I have noted a number of minor questions of interest re- 
garding the canteen, but as they are not essential to the main 
issue, they are omitted here. 

VI. The statement that *'The Army from the lowest rank 
up is [1907] practically unanimous in its desire to have the can- 
teen re-established/' is an opinion, the proof of which I could 
not obtain. 

Opinions expressed, as requested by the Department in 1899, 
before the passage of the anti-canteen law, can scarcely show 
opinions held in 1907, and even then only 582 officers out of 
2,248 regulars and 1,524 volunteers reported; and but (500 non- 
commissioned officers), out of 171,646 enlisted were asked to re- 
port. (Report of the Secretary of War, 1899). Opinions of a 
certain number of officers were obtained in 1901 and 1902 in 
connection with the report on * increase*' of saloons and printed 
in the same volume, and summaries (?) in the same table. I 
have shown so fully the character of this table in its saloon col- 
umn, that the other columns can hardly be given serious con- 
sideration. So far as I can learn, no general inquiry has been 
made since that time. These reports of 1901 and 1902 are those 
which the then Secretary of War sent to Congress as the proof 
of his statement in his annual report for 1902, that '*! am con- 
vinced that the general effect of prohibiting the use of beer and 
light wines within the limited area of the Army post is to lead 
the enlisted men to go out of the post, to frequent vile resorts 
which cluster in the neighborhood, to drink bad whiskey to ex- 
cess, and to associate intimately with abandoned men and more 
abandoned women; and that the operation of the law is to in- 
crease drunkenness, disease of the most loathsome kind, insubor- 
dination and devsertion, and moral and physical degeneration." 
Certainly the Secretary who signed this did not himself read 
these reports in detail and analyze the tables prepared from (sic) 
them, nor did he examine the reports of facts about Alcoholism, 
disease, etc. , made by the army surgeons, before he authorized 
such an extreme statement. 

Before I gave up expectation of finding evidence in favor of 
the canteen; I visited several of the officers in the War Depart-. 



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268 DR, ANITA NEWCOMB McGEE. 

ment who were most likely, to be informed on the subject, and 
only one of these outside tlje Surgeon General's o£5ce had ex- 
amined the medical reports from which the actual results of the 
law might have been seen; none had any idea of the difiPerence 
in the amount of Alcoholism in the different arms of the service, 
and every one regretted his inability to supply me with any pro- 
canteen evidence from his office. 

Conversation with many oflScers at different posts and read- 
ing from their printed opinions has shown me — (a) a large 
amount of indifference, because the canteen was regarded as un- 
important, or now as a dead issue; (b) a small proportion will- 
ing to explain in confidence their decided opposition to the can- 
teen, but unwilling to say anything publicly, for obvi6us reasons; 
(c) those who had been so confident of evil results to follow the 
anti-canteen law that they naturally never thought of question- 
ing whether these results had actually followed. The older of- 
ficers remembered the great improvement in conditions during 
the canteen years (and attributed to it) and they also noted that 
the years after the anti-canteen law were worse than those im- 
mediately preceding it, but they failed to notice that the condi- 
tions of 1898 to 1900 were due to the Spanish War, Philippine in- 
surrection, Boxer Campaign, etc., and therefore form no basis 
of comparison; and no man's recollection can be relied on to 
compare accurately a series of recent years with a series of pre- 
war j'ears some time before. One man's personal experience is 
limited, and he necessarily relies mainly on hearsay in forming a 
particular opinion on a subject affecting the entire army. (As 
did I, also, when I expressed a pro-canteen opinion before inves- 
tigation of facts!). 

VII. Quite apart from the canteen y the subject of drunk- 
enness and immorality in the Army demands attention. Inter- 
national medical statistics show that the admission rates of Al- 
coholism, for Gonorrhea, and, {^British Army excepted^ for 
Syphilis, '^ were much higher than in any other army,'*' {^Sur- 
geon General's Report, 1907, pages 2j and 26: for ipo6^ pages 
22 and 2^), 



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FACTS ABOUT THE ARMY CANTEEN 269 

It is explained that the comparison of the different armies 
is not wholly fair, but the difference in both admission and 
death rates between the American and all other armies except 
the British, is so great that it must have some meaning. For 
example, one report (1906) gives regarding Alcoholism the rate 
of admission of enlisted American troops as 27.72, while the 
highest of any other army was 0.26; American rate of death as 
0.17, while the only other armies with any such deaths are Brit- 
ish, 0.07, and Russian, 0.001. Ours is the only army reporting 
any deaths from Gonorrhea — .02. 

VIII. Conclusions : 

It is evident that I have only scratched the surface of a mine 
of actual fact. But the great difference shown to exist in the 
different arms of the service leads me to believe that if army of- 
ficers would make a careful study of the facts much could be 
done to reduce the amount of alcoholism, and it is for this reason 
that I have yielded to repeated urgings to set forth the main facts 
which I have learned. I have become convinced that the pro- 
hibition sentiment of the country makes the restoration of the 
canteen impossible. The sooner we forget it and adopt other 
methods for diminishing alcoholism, the better it will be for the 
army. 

DISCUSSION, 

Colonel Valery Havard, U.S.A. — My objection to the present policy 
of excluding wine and beer from the canteen is that it renders the life of the 
soldier less pleasant, more irksome; it violates his personal liberty, that is 
those rights to which all men are reasonably entitled. In regard to his 
eating and drinking he ought to enjoy the usual privileges of any citizen, 
so long as he is not guilty of any excess which, in the opinion ot his supe- 
riors, might be detrimental to his health or morals. 

Lieutenant Colonel Albert H. Briggs,N.G.N.Y.— I am interested in 
the comparative statistics given by the reader of the paper. Drunkenness 
might be called a comparative condition, and what one authority might 
call drunkenness another might not consider in that category. Many of 
you remember the anecdote related by Surgeon Arthur Gaskell of the 
British Navy, at our last meeting, wherein a petty officer was represented 
as denying that a certain inebriated tar was "drunk" because he could 
"move his thumb." The wide difference between this view and that of the 
prohibitionist who regards a man slightly elevated by alcoholic stimulants 



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270 DR, ANITA NEWCOMB McGEE. 

as '*drunk" would account for the equally wide difference in statistics; and 
to this difference I attribute much of the variation in statistics to which this 
question is subject. 

Colonel Joseph K. Weaver, N.G.Pa.— I am against the canteen and 
I think I voice the sentiments of the National Guard of Pennsylvania when 
I make this statement. You speak of personal liberty— *'lf they are re- 
strained too much in their liberty we cannot get recruits." I think that if 
we could restrain beer to a reasonable amount it would not be so bad. I 
think the principle is wrong. The habit of drinking intoxicants is bad. It 
makes the guard more susceptible to discipline and disobedience; they are 
therefore not as good soldiers when they get beer. It renders the standing 
of regiments a great deal lower. We have regiments that use beer and 
others that do not. In our last encampment the three regiments which 
used beer received the lowest markings. It would be better for the army 
and national guard if intoxicants were not permitted, or if they are per- 
mitted, do so under great restraint. 

Major Charles E. Woodruff, U.S.A.— The sick report does not 
show the amount of drunkenness as we get very few cases in the hospitals, 
though since the abolition of the canteen they are more numerous and more 
violent. The saloons around the post which had not flourished during the 
days of the canteen are rich now if not more numerous. The number of 
courts martial for drunkenness has increased in the last fifteen years, though 
the general courts have diminished. There is a vast change also in the 
soldier. It has gone on in all the armies of the world. A man who had 
served a great many years in the army was formerly expected to be a heavy 
drinker. Drunkenness and drinking were universal 150 years ago. When 
I entered the army twenty years ago I found many old soldiers who got 
drunk as regularly as pay day came, and stayed drunk until their money was 
gone. I have seen a gradual improvement and the number of total ab- 
stainers in the army is now exceedingly high. There is a change also in 
the character of the men who now make up our army; we have a higher 
grade than ever before and the canteen has no effect upon this fact one way 
or the other. Many now save their money and quite a big percentage de- 
posit it with the paymaster. They are now mere boys between twenty and 
twenty-six who have not had time to acquire habits of drinking. I know 
that the abolition of the canteen has increased drunkenness and the drink- 
ing is done outside. 

Medical Director John C. Wise, U.S.N.— The paper by Dr. McGee is 
a most interesting and informing one. The facts she has collected are con- 
vincing and show that there is a wide spread interest in the subject of the 
Canteen. We see the influence of the Canteen in the Pennsylvania Guard 
and I think the judgment of the Medical Ofiicers of the Guard is that it is 
not conducive to discipline or efficiency, but that those who indulge in it 
are more susceptible to the sun's rays and to digestive disturbances. .1 



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FACTS ABOUT THE ARMY CANTEEN 271 

should be glad if the Canteen would never be restored to the Army and that 
its use become less and less in all the Guards of the States. Dr. McGee is 
to be congratulated on the informing address which she has just prtsented. 

Dr. McGee, closing. — Please note that I have strictly limited this pa- 
per to Xht facts. No opinions were given and I have eliminated the per- 
sonal factor absolutely. The international figures are not wholly compara- 
ble, though they certainly have an important significance. As for beer 
against whiskey and other drinks, I am told by Dr. Wiley that whiskey is 
less harmful than beer. The general temperance of the country is im- 
proving all along as Colonel Woodruff says. The essential point I make is 
this. The official facts published by the War Department show that the 
Canteen is a factor of insignificant importance as compared to the other 
factors which affect drunkenness and disease in the army. 



YEAST THERAPEUTICS IN GONORRHEA. 

IN the Muenchener Med. Wochenschrift, Kehrer recommends 
yeast highly as a remedy in gonorrheal colpitis. The dis- 
trust which has been awakened recently as to the treat- 
ment of vaginitis with yeast is unfounded and is due to the im- 
proper use of the yeast crayon in acute gonorrhea of the uterus. 
Vaginitis and the inflamatory erosions are very often favorably 
influenced by yeast. Good results are often observed from its 
use in three or four days in the acute form of gonorrheal vagini- 
tis. The best bactericidal actions of yeast preparations are those 
which do not contain any living yeast cells as the sterile zymin 
yeast of Albert. This preparation should only be used in the 
acute vaginal gonorrhea and never in the cervical form. The 
vaginal treatment is a good prophylactic to prevent the gonor- 
rhea from attacking the parts higher up. The author considers 
the following as the simplest treatment: The vagina is first irri- 
gated with sterile water and then sponged dry. The yeast is 
then injected and the patient kept in the dorsal decubitis with 
the foot of the bed raised. In six to seven hours the treatment 
is repeated. In this connection it may be stated that Captain T. 
B. Grant reported some excellent results with the use of yeast in 
genito-urinary work and gynecology in The Military Surgeon 
of May, 1907.— Fred J. Conzei^mann. 



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PROPOSAL FOR A NATIONAL MEDICAL SERVICE OR 

DEPARTMENT OF PUBLIC HEALTH. 

By SHELDON G. EVANS. M.D., 

SURGEON IN THE UNITED STATES NAVY. 

THE world has but recently witnessed, probably in many 
ways the greatest war of all times. Even now the air 
is full of war and rumors of war; it is war, war every- 
where and if not at war all nations are busily engaged in that 
surest preventative of war and preserver of peace, preparation. 

We have witnessed an epidemic of battleship construction, 
all nations are increasing their armies as if distrustful of every 
action of their neighbors, until one anticipates with a shudder 
the enormous task that will fall to the only humanitarians in war, 
the medical departments of the governments concerned. 

We say that we have refined the so-called art of war. Cen- 
turies ago the order was ''to smite them hip and thigh and let no 
living thing escape;'' now we shoot and then we succor, make 
frantic efforts to destroy life and then to save it, and it is to us, 
gentlemen, that the world looks to the accomplishment of the 
latter noble end. 

Are we prepared ? I fear not, and it is with the hope of 
making us better prepared to meet the terrible responsibilities 
that devolve upon us in war that I present this paper. 

In the late Russo-Japanese war the Medical Departments of 
both the Army and the Navy came in for a great deal of well 
earned consideration. 

In our own country numerous plans are being considered 
and bills introduced in Congress, looking to the almost complete 
reorganization of the Medical Departments of both services, and 
so I thought this an opportune time, the psychological moment, 
as it were, to present to this Association a far reaching plan to 
that end. 

The question that I am about to bring before you gentle- 
men, is one that has occupied my attention for many years and 

(272) 



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PROPOSED NATIONAL MEDICAL SERVICE. 273 

it is with a view to the free and honest discussion of the subject 
that it is now presented. It is a proposition that has been 
broached before, in part, on many occasions, but never in a form 
to involve the radical changes that are about to be suggested. 

In a nut-shell the plan is the absolute consolidation of the 
Medical Departments of the Army, Navy and Public Health and 
Marine Hospital Service and all strictly medical positions com- 
ing under Federal control into one body, to be known as the De- 
partment of Health, or other suitable name, to be headed and 
controlled by a Secretary of Health a member of the President's 
Cabinet. 

It is only a short while ago that the President appointed a 
board composed of medical officers of the Army and Na\^ to 
consider the question of uniformity of equipment for the Medi- 
cal Departments of both services. If uniformity of equipment is 
necessary and advisable, why not uniformity of personnel ? 

I might say that I firmly believe that all quarantine matters 
should be under Federal control and included in this department. 
This would greatly increase the number of required medical 
men over the numbers about to be suggested and add import- 
ance to their work and to the department, a great advantage as 
every one connected with the government service knows. 

Dr. Sexton, of Tulane University, says **as to whether na- 
tional quarantine should be under the supervision of the Marine 
. Hospital Service or under control of the Army or Navy medical 
service or under a cabinet health officer, we leave others to argue, 
but that maritime quarantine should be in the hands of the Na- 
tional Government we are thoroughly convinced. 

We have under the National Government today a Depart- 
ment of Commerce and Labor, a Department of Agriculture and 
many others advocated and even a Department of Public Health 
has often been advised but never as far as I know to include the 
Army and Navy medical departments. 

This seems a vast change from present conditions and is sure 
to meet with strenuous opposition, but when it is considered 
from all standpoints I am convinced that the majority of you 



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274 SURGEON SHELDON G, EVANS. 

will recognize the great benefits to be derived not only for the 
National Government but for the medical men in the various ser- 
vices as they now stand. 

The saving to the government would be considerable. One 
has only to look at the various hospitals of the services, side by 
side (as in Boston, Naval and Marine) each fully equipped for 
all kinds of work, with from three to six medical oflScers, where 
were the two combined the work could be done with a slight in- 
crease in the force of one. Or note the number of recruiting 
stations of the Army and Navy, often in the same building, where 
the work of the two is hardly suflScient to keep one medical officer 
decently busy and yet the Navy owing to shortage of officers is 
unable to send regular medical officers on recruiting duty for 
the Marine Corps in spite of the fact that it is fully realized that 
men of experience are required for this kind of work. 

Many will probably exclaim that the duties of the medical 
officers in the three services are too diversified and differ in too 
many essential features to be united; that one man could hardly 
master the details of all of the work. This is a great mistake. 
Surgeon Stokes, U.S. Navy, in his able article recently published 
in our journal says ''we can readily see that service conditions 
are really much alike in ships and in forts— we may expect the 
same horrible infected and mutilating wounds— the transporta- 
tion problems are both difficult and hazardous— we all meet the 
same peace and war conditions of sanitation ashore — while on 
the surface our duties appear todiffer widely they are really much 
the same." In my humble opinion we hear too much nowadays 
of the medical officer and too little of the physician or surgeon. 
We are all too prone to forget that we are disciples of Aesculapius 
and to lay too much stress upon the fact that we are officers in 
a military service. 

Far be it from me to detract from the dignity of the position 
of a medical officer in any honorable service, but I am one of 
the old style medical men who look upon the title of Doctor of 
Medicine as the highest in the gift of any university or college, 
and upon the practice of medicine, the healing of the sick, suc- 



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PROPOSED NATIONAL MEDICAL SERVICE. 27 S 

coring the helpless and relieving the sufferings of overburdened 
humanity as the noblest profession under God's blue canopy, and 
this all ought to admit is the first and most important duty of a 
medical man in either or any service. To be a doctor first and a 
medical officer afterwards. 

There is of course avast amount of work, outside the purely 
professional that must be done, disagreeable as it is to most of 
us, but this scheme of consolidation will reduce that to a mini- 
mum and also place us in a position of independence not now 
attainable in any service. Of the intricacies and official details 
of the work in the Public Health and Marine Hospital Service I 
cannot speak, but having been brought up in the Army I was 
able to observe many of the difficulties encountered by the med- 
ical men in that service and seventeen years experience in the 
Navy has convinced me that there is room for vast changes in 
our own official work and position and the earnest efiPorts now 
being constantly made in our service in this direction, certainly 
verify that conviction. 

The work in the three services may differ in many respects 
but the foundation is the same, medical and surgical skill, a 
knowledge of hygiene and a large share of common sense. The 
latter cannot be taught or acquired but the three former we can 
teach in a National Medical School and a homogeneous body cre- 
ated capable of grasping and treating in its own way the prob- 
lems presented. 

In what way does or should the medical officer differ 
from his professional brother in civil life? In order to satisfy 
one's self in regard to this matter it is only necessary to read care- 
fully the Instructions for Medical Officers of the Army and of 
the Navy and the various books and pamphlets issued for the in- 
struction of medical officers in the Public Health and Marine 
Hospital Service. 

You will find page after page in each book devoted to the 
multitudinous duties of the medical officer and unfortunately, 
as I think we all admit, you will find a great part of it devoted 
to the administrative, executive or purely clerical work. Admin- 



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276 SC/RGEON SHELDON G, EVANS. 

istrative ability comes from years of experience, executive ability 
is congenital and certainly clerical ability can be easily acquired. 

In any government service a large amount of clerical work 
in the form of record keeping, etc., is of course necessary, but 
with the consolidation of the three services this could be reduced 
to a minimum by adopting a system of returns applicable to all. 
Thus not only would a great amount of work be saved the med- 
ical oflScer but the saving to the Government in pay of clerical 
force would be considerable. 

Reams have been written in our medical journals about the 
duties of medical oflScers, but outside the three requisites men- 
tioned the duties of a medical ofiBcer do not differ from those of 
his civil confrere. 

With a large Medical School under the national govern- 
ment and supported as those at West Point and Annapolis we 
could yearly turn out a class of medical men fully capable of 
performing all the duties of a medical officer in either the Army, 
Navy or Public Health and Marine Hospital Service. 

By a government school I do not mean a post-graduate 
school as we now have both in the Army and Navy but one to 
take young men and teach them medicine and surgery and hy- 
giene as now taught and all that pertains to the practice of 
medicine, granting them the degree of Doctor of Medicine 
and launching them upon their career as fully equipped for 
their duties as are the graduates of our government institutions 
today. It is often said that an institution of this character would 
meet with strenuous opposition from outside medical schools as 
tending to compete with them. There is no more room for such 
objection than there is to West Point or Annapolis on the part 
of other colleges. 

The purely official duties of a medical officer in the services 
today are easily learned and if the young officer is well grounded 
in his profession, with a little application and the exercise of a 
little tact he need have no fear of difficulty. If he attends to 
the professional side of his work with care and zeal he has no 
cause for alarm in regard to the official and will have very little 
of the common trouble with his commanding officer of the line. 



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PROPOSED NATIONAL MEDICAL SERVICE. 277 

It is true that some instruction in purely military and naval 
subjects as stated is necessary. This could be readily given at 
the National Medical School as it is at the two service schools 
today. In this connection and while speaking of schools of med- 
icine under the Government, permit me to quote from a recent 
article in one of the service papers ''while the instructions at the 
two schools (the Army and Navy Medical Schools) is devoted 
primarily to military medicine and surgery, military diseases, 
chemistry, sanitation, hygiene and related subjects, it necessa- 
rily embraces a course in military and international law, ad- 
ministrative duties, tactics and signals,,etc. These schools hav- 
ing limited facilities (the italics are mine) for clinical work and 
practical instruction, may prove inadequate to the requirements 
that will arise from an increase. It is suggested students be 
sent to the service schools and then to the large hospitals in the 
great cities for practical training." Why is this so? Because 
under the present system of division of labor and too numerous 
hospitals we have not the material nor the facilities in any one 
place for instruction clinically. With combined hospitals and 
combined corps we would have more than enough material to in- 
struct any class of men thoroughly in all branches of medicine 
and surgery in addition to their official duties. 

Another fact that must not be lost sight of is that the young 
medical men would be brought up in an atmosphere filled with 
* 'esprit de corps,*' a fact so evidently beneficial at the Military 
and Naval Academies. Again I quote Surgeon Stokes "if the 
graduates of these schools (meaning the Army and Navy Medi- 
cal Schools) acquired nothing more than an 'esprit de corps* 
and a unified conception of the duties required of them in their 
respective corps, the existence of the schools would be justified.'* 
What a large amount of this necessary sentiment would be in- 
stilled into the 3'oung men at the National Medical School. 

The graduates of this institution could be then detailed for 
duty with the Army, the Navy or the Public Health and Marine 
Hospital Service and be transferred from one to the other at any 
time. Thus would the duties not only be performed in a more 
efficient manner but every officer would have opportunities for 



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278 SURGEON SHELDON G. EVANS. 

varied kinds of work and would not be compelled to suffer from 
professional dry rot so often the case now where a man serves 
for years at a one company post or for years on a small gun-boat 
drifting around on the broad ocean away from all contact with 
his professional brothers treating perhaps one or two cases a 
week and these the same old venereal. 

Variety is the spice o( life, why not give it to us of the ser- 
vices professionally as well as in other ways. Duty with troops, 
on board ship, at quarantine, inspection duty or in a hospital? 

Simplify the method of keeping records or rather combine 
all the systems into one ttseful one and the various duties can 
easily be mastered by any man. 

Let the Secretary of War call upon the Secretary of Public 
Health for a medical officer as brigade surgeon, let the Secre- 
tary of the Navy, call for a medical officer for a battleship or 
cruiser, the Secretary of the Treasury for an officer to command 
the Marine Hospital at Boston or to do inspection duty in Naples. 
How simple. Just as now the Secretary of the Navy calls upon 
the Commandant of the Marine Corps for an officer of certain 
rank to command the Marine Guard of a ship. 

I have had called to my mind by officers, in connection with 
this matter the difference in the methods of handling the wounded 
in the Army and the Navy, transportation, etc. The methods are 
perhaps different but are any of them so intricate or difficult that 
they are beyond the ken of any man who knows medicine and 
surgery as he should? No; it is with us as President Roosevelt 
has said ''the man who meets the conditions as they arise and 
with the materials at hand in the most efficient manner," that is 
the man we want and that man will be a good medical officer in 
any service and under all conditions. 

At the present time we have in the Army 323 medical offi- 
cers with twenty-three vacancies, in the Navy an authorized 
number of 350 with forty vacancies and an increase allowed for 
next year which will increase the number of vacancies by twenty- 
five, and in the Public Health and Marine Hospital 130 officers 
with twenty-two vacancies. In addition to the above there are in 



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PROPOSED NATIONAL MEDICAL SERVICE, 279 

the Army 183 Contract Surgeons,* in the Navy eighteen Acting 
Assistant Surgeons and in the Public Health and Marine Hos- 
pital Service 237 Acting Assistant Surgeons and in the latter 
Service about twenty-two vacancies in the regular establishment. 

Under existing conditions it is almost impossible to get 
young men, to enter any of the services, and in spite of the most 
strenuous efforts the number of vacancies increases each year. 

Here we have a total of about 900 medical oflScers not count- 
ing the Acting Assistant Surgeons and Contract Surgeons of 
which there a great number now employed as shown above. All 
services are crying loudly for an increase, showing that all are 
very short-handed, so, let us say that there are required for the 
service of the Government at least 1,200 medical men which I 
think you will all admit is a very small estimate. 

The latest Navy Register shows but 983 commissioned line 
officers on the active list and yet the United States Government 
maintains a large school at enormous expense for the education 
of these officers and graduates large classes each year. 

Why should not the same be done to keep a corps of twelve 
hundred or so medical officers proficient in their profesaonal call- 
ing and thoroughly well posted in all the routine military and 
naval duties required of them? 

It seems to me that the consolidation could be easily effected 
of the various corps as they now stand having in the new depart- 
ment the grades of Surgeon General, Assistant Surgeons Gen- 
eral, Deputy Surgeons General, Surgeons Captain or Colonel, 
Surgeons Commander or Lieut- Colonel, Surgeons Lieutenant 
Commander or Major, Surgeons Lieutenant or Captain and Sur- 
geons Lieutenant (J. G. ) or Lieutenant. All to have positive 
rank assimilated with that of the line of the Army and Navy, 
the same being true of pay and allowances. 

The question of titles I leave for future consideration merely 
suggesting that the title change with the branch of the service 

« The Medical Keserve Corps, since the writlDg of this paper, has supplanted 
the body of Contract SurgeonH and in other respects the flgares are somewhat 
changed by legislation and other caases, bat these flacts do not affect the author's 
argument— Editor. 



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280 SURGEON SHELDON G. E VANS. 

with which the officer may be serving, for instance if with the 
Navy, Surgeon Lieutenant Commander, or if with the Army, 
Surgeon Major, etc. 

Simply as a basis I have taken the number in each grade 
about as follows: 

Surgeon General, 1, rank of Vice Admiral or Lieutenant Gen- 
eral. 
Surgeon (R. A. or M. J.) 3, rank of Rear Admiral or Major 

General. 
Surgeon (Com. or B. G.) 8, rank of Brigadier General or Com- 
modore. 
Surgeon (Col. or Capt.) 25, rank of Colonel or Captain. 
Surgeon (Lt. Col. or Comdr.) 35, rank of Lieutenant Colonel or 

Commander. 
Surgeon (Maj. or Lt. Col.) 250, rank of Major or Lieutenant 

Commander. 
Surgeon (Capt. or Lt.) 900, rank of Captain or Lieutenant after 
three years service, with rank of 1st Lieut, or Lt. J. G. 
The number in each grade could be changed at any time by 
act of Congress as the conditions of the service might require 
but I have made the numbers correspond so far as x>ossible to 
the ratio proposed in the various bills recently introduced in 
• Congress for the increase in the line of the Army and 
Navy. 

A plan should be devised for a regular and steady flow of 
promotion a **sine qua non*' in any military service. 

This body of medical men should be entirely independent 
of any other department and self sustaining. By the latter I 
mean that it should be capable of performing all the duties de- 
volving upon it, under all conditions without assistance from 
other departments. 

The cause of a great deal of friction in the army to-day is 
the lack of its own transportation facilities in the Medical De- 
partment. This department should clothe and feed itself, trans- 
port itself and be prepared to feed and transport all patients 
without assistance. I do not mean that it should always do so 



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PROPOSED NATIONAL MEDICAL SERVICE, 281 

though this might be very desirable, but it should be able to do 
so. When a patient is fed his ration should be credited to the 
Department of Health. 

The status of the medical ofl&cer on board ship would be 
then one of independence and positive position and with the 
Army in the field the medical oflficer would not have to go on 
his knees to get a cart and horse from the Quartermaster to 
transport supplies or even patients. All would run smoothly 
and I fully believe to the greater satisfaction of all parties con- 
cerned and certainly to the patients, the first consideration. 

This then. Gentlemen, is the question that I submit for 
your consideration trusting that my efforts may at some future 
day bear fruit in the emancipation of the Medical Departments 
of the Federal Government from many of the burdens of red tape 
and dissatisfaction ; making us a homogeneous and powerful body 
of medico- military men upon whom so much devolves in time of 
war and of peace too for that matter. 

I speak to the great majority, the large body of medical 
officers in all services who are proud of the distinction of their 
degree, whose life interest is the succoring the maimed, the halt 
and the blind, whose home is by the bedside of the suffering, 
whose noble deeds and self sacrifice in peace- and in war will go 
unrecorded in the newspapers and in the congressional record 
and who may go to their graves unsung, but not unwept or un- 
bonored. 

THE REDUCTION OF MORTALITY IN ABDOMINAL 
GUNSHOT WOUNDS. 

AMONG the conclusions reached by von Oettingen in a 
paper read before the last German Surgical Congress 
was the opinion that proper instructions to the individ- 
ual soldier, and special training of personnel of the medical corps 
in the field, together with improvements in the methods of trans- 
port of the wounded, will be the chief means of reducing mortal- 
ities in the future. 



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THE EFFECTS OF TROPICAL CLIMATE ON THE 
WHITE RACE. 

By captain WILLIAM A. WICKLINE, 
MKDICAL CORPS UNITED STATES ARMY. 

THE Chief Surgeon, Philippines Division, Colonel Charles 
B. Byrne, in order to ascertain if possible any and what 
changes the usual tour of tropical service produces on 
the physical condition of officers and enlisted men of the army, 
and to further the study of **the effects of the tropical climate 
on the white race,'* instituted a series of examinations; the first 
to be made as soon as practicable after their arrival in the Philip- 
pines Division, and one every six months thereafter during their 
stay. 

The Seventh United States Cavalry arrived in this Division 
from the United States in June 1905, and was stationed at Camp 
McGrath, Philippine Islands, This post is well situated and is 
one of the most healthful in the islands. Free from epidemic 
diseases, and with scarcely any malarial fevers, or other debili- 
tating diseases, it presents an ideal location to study the effects 
of the climate. 

There were 104 men (including twenty-two officers) of this 
regiment selected, upon their arrival, for observation,— forty - 
three were blondes, fifty-nine brunettes, and two American In- 
dians. Thirty-six show previous tropical service. All types 
were selected, and examinations were fully made as outlined on 
the blank forms used for record. There were four examinations 
in all made, the results of which are given in this report. 

The first regular examination was made by Captain Edwin 
P. Wolfe, Medical Corps, United States Army, and com- 
pleted in February 1906. There had been a preliminary exam- 
ination made in September 1905, which was not very complete 

(282) 



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EFFECTS OF TROI^ICAL CLIMA TE ON THE WHITE RACE. 283 

and included only a part of the men, afterwards selected by 
Captain Wolfe. 

Particular care has been given to the technique in doing the 
blood work and in examining the lungs, heart, liver, spleen and 
nervous system. Any illness at the time or since the last exam- 
ination, the use of alcohol and the duties performed, have been 
noted on the progress charts. The working method adopted by 
Captain Wolfe, with a very few exceptions, has been followed. 
The von Fleischl apparatus for determining the hemoglobin has 
been used, and the Thoma Zies for counting the red and white 
cells. The number of leucocytes has been based on the count of 
1,600 squares; the erythrocytes on 400 squares, and the differ- 
ential count on 500 cells per man. 

On account of transfer and the expiration of term of ser- 
vice, some of the men were not present at the last two examina- 
tions. The number of men at each of the examinations is given 
in the tabulated results. 

The examinations show a reduction in the percentage of 
hemoglobin. The highest recorded is 110 per cent, the lowest 
sixty-three per cent, giving an average at the first examination 
of ninety-four per cent, at the second eighty-nine per cent, at the 
third eighty-six per cent., and at the last eighty-three per cent. 
Comparing the first examination with the last, about eighty-six 
per cent show a decrease in the percentage of hemoglobin, about 
five per cent showing a gain, the remainder showing no change. 

The change in body weight corresponds very closely to the 
hemoglobin index. Comparing the weight as shown in the first 
examinations with that as shown in the last about eighty per 
cent show a loss of weight, with an average loss per man of 
8.1 pounds; whereas only about fifteen per cent show a gain in 
weight with an average gain per man of about six pounds. 
Eighty-two men show loss, and fifteen show gain. 

The study of the nervous system has been based largely 
upon the individual's statement as to increased irritability, loss 
of memory, loss of power of application, loss of initiative, occular 



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284 CAPTAIN WILUAM A, WICKUNE, 

pain, insomnia, palpitation of the heart, etc. , etc. The number 
complaining of these symptoms has increased with each exami- 
nation, and it is believed that a sufficient amount of evidence 
has been produced to conclude that unquestionably the nervous 
system of the majority of white troops, serving in these islands, 
is more or less afiPected, producing and exaggerating the tendency 
to neurasthenia and mental irritability, and to develop other ner- 
vous diseases in those who possess a predisposition. At the 
second examination eighteen per cent complain of these symp- 
toms, at the third examination thirty-three per cent, and at the 
the fourth forty-seven per cent. The duties performed by these 
men were not more arduous than at posts in the United States. 

I^he high erythrocyte count in tropical countries, noticed by 
different observers, has been verified by these examinations. The 
highest count made was 6,800,000, the lowest 4,200,000, with an 
average of 5,640,000. In studying the pulse and circulation, 
there has been no loss in the volume of blood perceptible. It 
has been explained that the high count is due to excessive per- 
spiration, thereby concentrating the amount of blood in the body 
by the loss of fluid, in that, the increased number of red cells is 
shown to exist in all seasons, without particular relation to the 
amount of fluid lost or ingested. It was suggested by Captain 
Wolfe, and would seem to me to be more logical, to account for 
the difference by the effect of light and heat, stimulating the 
blood regenerating centers, or, as the oxygen carrying power of 
the blood is reduced by the loss of hemoglobin, and if, as is 
claimed, the oxygen is relatively less in the atmosphere of the 
tropics, it would appear that this might be an effort on the part 
of nature to regulate the supply of oxygen, demanded for the 
process of body metabolism, by a numerical increase in the indi- 
vidual oxygen carriers. 

The number of respirations shows an increase, giving an av- 
erage of 19.6 per minute, which may be accounted for in the 
same way. 

The most notable changes in the examinations of the blood 
occur in the differential leucocyte count. A chaotic condition 



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EFFECTS OF TROPICAL CUM A TE ON THE WHITE RACE, 285 

exists in the nomenclattire of the different leucocytes with especial 
reference to the large mononuclears. In these examinations, the 
classification outlined on the blank form for record, has been 
adopted and is as follows: 

Small mononuclears, Lar^e mononuclears, Polymorphonuclears. 

Eosinophiles, Mast cells. 

Under small mononuclears all lymphocytes of about the di- 
ameter of ten microns or less have been included, as defined by 
Cabot, and under large mononuclears have been included the 
transitionals, the lymphocytes and mononuclears of a diameter 
greater than ten microns. 

It is to be hoped that some definite standard will soon be 
worked out, whereby the results of different observers may be 
strictly comparable. It will be seen by referring to the follow- 
ing table of results, that there is a continuous decrease in the 
number of polymorphonuclears with a relative increase in the 
lymphocytes. The second examination shows an average of 
sixty-four per cent polymorphonuclears, the third shows sixty 
per cent and the last fifty-four per cent. 

Cabot, in his clinical examination of the blood, says: ''It 
would appear that the degree of health in persons not organically 
diseased, might perhaps prove to vary directly with the percent- 
age of polymorphonuclear cells in the blood. '* 

There is found an increase in the number of eosinophiles; in 
some cases running up to forty per cent. 

The hook-worm and other intestinal parasites have been 
demonstrated in some of these cases, and it is believed that this 
increase in the percentage of eosinophiles may be caused by para- 
sitic skin diseases and intestinal parasites. 

Attention is attracted to a number of cardiac disturbances, 
such as palpitation, functional and organic murmurs, and cardiac 
irritability. I believe that the majority of the cases other than 
organic, is perhaps due to the irritability of the nervous system. 
While there has not been observed any material increase in the 
organic lesions of the heart or any change in the structure of the 



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286 



CAPTAIN WILLIAM A. WICKLINE, 



arteries, yet it seems probable that a long period of service might 
increase the tendency in that direction. 

The numerous intestinal parasites together with a lack of 
variety in the dietary, may help to explain the growth in number 
of those complaining of indigestion and constipation. 

In the comparative study of the blonde and brunette types, I 
have not been able to find any marked difference in their physical 
condition. It would seem that both types are about equally sus- 
ceptible to the climatic influences met with in these islands. A 
comparative study of these types in those who have been in the 
tropics for a longer period would be interesting. 

In summing up the conclusions, which I believe may be 
fairly and logically drawn from these observations, there are a 
number of factors to be necessarily considered, such as, a changed 
and modified dietary, a change in the environment, the suscepti- 
bility to tropical diseases, the mental effect on the individual, of 
being a long distance from his home, and the change in military 
duties incident to foreign tropical service. The effect that any 
or all of these factors may have on the health of those serving in 
the tropics is not wholly apparent. 

It is to be observed that of the thirty-six who show previous 
tropical service in Cuba, Porto Rico and the Philippines, only in 
those showing continuous tropical service, is there any appre- 
ciable difference in their physical condition noticeable. 



OFFICERS AND ENLISTED MEN. 
Number Examined I 70 104 97 



I Prelim. Exam 
. (Sept. 1905) 

Hemoglobin | 94 percent 

Erythrocytes 1 4,9^0,555 

Leucocytes | 6,943 

Small mononuclearfl..' 

Large mononuclears..' 

Polymorphonuclears 

Eosinophiles 

Mast cells 

Nervous system (dis-i 

orders) ' 



ist. Exam. 
(Dec. 1905) 
89 per cent 

5»343.595 
6,699 
2 1.80 per cent 

9.44 " " 
64.43 " " 

4.10 " " 



18 



2nd Exam. 
(Aug. 1906) 

86 per cent 1 

5,429,960 
6,624 
26.61 percent 

8.77 " " 
60.04 *' *' 

4.39 " " 



.19 



81 



33 



3rd Exam. 
(April 1907) 
83 per cent 
5,330,888 
6,831 
33.38 percent 
6.15 " " 
54.87 " " 
5.14 " " 
.47 " " 

47 " " 



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EFFECTS OF TROPICAL CUM A TE ON THE WHITE RA CE. 287 

WEIGHT. 

1 1 No Change 
No. 



I 



Loss 



No. 



I 



\~ 



82 



Average 



8.1 lbs. 



Gain 



No. 



Average 



'5 ! 



6 lbs. 



BLONDES. 



Number Examined 



^ 



1st. Exam. 



42 



2nd Exam. 



Polymorphonuclears....! 67.70 



I 61.51 



BRUNETTES. 



»8 



Small mononuclears j 18.85 per cent 1 25.20 per cent 



3rd Exam. I 
33.25 per cent , 

54.30 « " i 



Number Examined 



69 



ist Exam. 

Small mononuclears 23.28 per cent 

Polymorphonuclears..., 60.28 " " 



62 

2nd Exam. 
27.81 per cent 
56.65 " " 



46 



3rd Exam. 
33.58 per cent 
53.12 " " 



OFFICERS. 



Number Examined 



Hemoglobin 

Erythrocytes 

Leucocytes 

Small mononuclears.. 

Large mononuclears. 

Poljrmorphonuclears. 

Eosinopniles 

Mast cells 

Liver (diameter in 
mammary line) 

Nervous system (dis- 
orders) 



Prelim. Exam. 

96 percent 

5,800,000. 



22 

istExam. > 
94 per cent 

5,832,600 
6,508 
27.57 percent! 

7.75 " " 

60.10 " " 

4.08 " *' I 

.50 " " ' 

.104 m 



I 



19 

2nd Exam. 
91 percent 
5,556,200 
5,642 I 
28,48 per cent, 
8.93 '• " 
58.35 " " 
3.74 " " ' 

.55 " " : 

.112 m I 



3rd Exam. 

87 per cent 

5,512,600 

6,391 
35.81 percent 

5.75 " " 

5371 " " 

4.10 " " 

.59 " " 
.114 m 



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288 



CAPTAIN WILLIAM A. WICKLINE, 



1.1O88 



No. 



13 
59.09 per cent 



Average 

6 lbs 



WEIGHT. 

Gain No. Chanf^ 

No. Average No. 

8 9.5 lbs I 

36.36 per cent 4.55 per cent 



ENLISTED MEN. 



Number F^xamlned 



50 



K2 



7« 



Prelim.Exam. 1st Exam. 2nd Exam. 

Hemoglobin 91 percent 87 per cent 84 percent 

Erythrocytes *4,820,ooo 5.209,106 5,383,820 

Leucocytes 6,493 ■ ^^75© 6.863 

Small mononuclears I 20.23percent 26,i5percent 

Large mononuclears 1 9.89 " " 8.73 ** " 

Polymorphonuclears ' 65.64 " ** 60.49 " ** 

Eosinophiles 4.10 '* '* 4.55 " " 

' Mast cells 15 *» " .12 ** " 

Liver (diameter in 

mammary line 109 m .104 m 

Nervous system (dis 

orders 18 23 



3rd Exam. 
82 per cent 

5,282,625 
6,948 
12.71 percent 

6.25 " " 
55.24 " " 

5.42 " " 

.44 " " 

.109 m 

25 



WEIGHT. 





I.0B8 
cent 


Average 
8.5 lbs 


Gain 
No. 


Average 
2 lbs 


No Change 


NO. 


No, 


^ 
87.34 per 


7 
8.86 per cent 


3 80 per cent 



OFFICERS AND ENLISTED MEN. 

Blondes {41). 



Loss 



Hemoglobin 

(lain No Change l^oss 



Weight 
Gain No Change 



38 3 

92.6S 7.32 

per cent per cent 



3- 7 2 

78.05 17.07 4.88 

per cent per cent per cent 



'Hematokrlt used In preliminary examination would probably help toaccount 
for the reduced count of erythrocytes 



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EFFECTS OF TROPICAL CUM A TE ON THE WHITE RACE, 289 

Brunettes (jS). 



Loss 



Hemoglobin 
I Qatn 



No Change 



51 

87.93 

per cent 



5 
3-45 



Loss 



48 
82.76 



Weight 

Gain 

8 
13-79 



No Change 



percent | percent percent 



American Indians (^), light brown 
Hemoglobin Wnlght 



Loss 



Gain 



No Change 



Loss 



Gain No Change I 



50 per cent 



50 percent 100 per cent 



SOME PECULIAR MILITARY MEDICAL CASES. 

IN Roths Jahresbericht, attention is called to two disease 
• pictures observed by Freund in recruits. 1. The recruits 
take suddenly sick with all the manifestations of a severe 
pneumonia. Chill, tympanic sounds over one lung, wheezing 
and rales over both lungs, muco- purulent, blood tinged sputum, 
not, however, the characteristic prune juice sputum of pneu- 
monia. The symptoms disappear in a few days. Some observers 
consider this the engorgment stage of pneumonia and believe its 
early disappearance due to the powerful resistance of the youth- 
ful patient. Freund believes it is only a sign of congestion in 
the lesser circulation, brought about by respiratory exercises, re- 
sulting in a hyperemia and consecutive moistening of the lung 
tissue with relative heart weakness. The absence of the char- 
acteristic sputum and the pneumo-cocci speaks in favor of 
Freund*s view. 2. After severe physical exercises, recruits often 
become sick with fever, general lassitude and severe muscular 
pains. Objective symptoms are absent. In one or two days the 
patient is well. Freund considers this an auto-intoxication, 
caused by the absorption of toxins produced by excessive mus- 
cular exercise. E. del Vecchio reported a case of neuropathic 
recurrent hematemesis, the cause of which he does not find in the 
mouth or stomach but in the esophagus, in the region of the 
heart, where the hematemesis results through the cardiac im- 
pulse in nervous persons with hemophilic tendency, not with 
emesis but with singultus. — Frkd J. Conzelmann. 



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THE TEACHING OF TROPICAL MEDICINE. 

By captain JAMES M. PHALEN, 

MEDICAL CORPS UNITED STATES ARMY. 

AS the desirability of special courses of instruction in the dis- 
/~\ eases of tropical countries is becoming more and more 
apparent and as this want must one day be supplied in 
our own country, I will say something of the history, scope and 
work of a school which was one of the first to be established for 
the exclusive teaching of tropical medicine, in the hope of being 
helpful to those who are looking forward to the creation of such 
a school in America. 

To show how short the time has been within which this 
specialty has been deemed of sufficient importance to warrant 
special instruction, I need only say that this pioneer of schools 
of Tropical Medicine with this month begins its tenth year of in- 
struction. Previous to that time tropical medicine had but a 
small place in the ordinary curriculum; a few lectures at most 
and these given because of their academic interest rather than 
because they were considered of practical importance. 

It was in 1897 that Sir Patrick Manson, but recently re- 
turned from a long residence in southern China, was appointed 
physician to the branch hospital of the Seaman's Hospital So- 
ciety at the Albert Docks in London. Though the hospital was 
small, a great variety of important tropical diseases was to be 
seen there, and to utilize this material to some extent, visiting 
medical men from the tropics and others interested in this line of 
work, were invited to the hospital and for them were demon- 
strated some of the. more important parasites then known to cause 
disease. In this way a small group of enthusiasts was brought 
together, and interest in tropical medicine stimulated to the ex- 
tent that during the following year a course of lectures embracing 
the more common of tropical diseases was given at the Charing 
Cross Hospital. 

(290) 



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THE TEACHING OF TROPICAL MEDICINE, 291 

The work being done at the Seaman's Hospital and at the 
(!^haring Cross Hospital coming to the attention of the Hon. 
Joseph Chamberlain, then Secretary of State for the Colonies, 
attracted him with a peculiar interest, as it had long been rec- 
ognized at the Colonial office that many of the tropical diseases 
were preventable but that little had been done because of a lack 
of that special knowledge necessary to carry on the work. The 
outcome was that Mr. Chamberlain suggested to the Seaman's 
Hospital Society the establishment of a school of tropical medi- 
cine in connection with its hospitals, and the acceptance of the 
suggestion by that organization. 

The hospital at the Albert Docks was decided upon as the 
proper location for the school, but before it could be put into 
operation increased accommodations for patients had to be pro- 
vided and laboratories to be built. The London School of Trop- 
ical Medicine was formally opened on October 2, 1899 with ac- 
commodations for twenty students, but this modest estimate of 
the needs of the school was early found to be inadequate and in 
1903, the buildings were enlarged so as to accommodate about 
forty students. 

Mr. Chamberlain's object in the establishment of the school, 
was that the medical officers of the Colonial Service, alid more 
particularly the recent appointees to that service, should be pro- 
vided with a course of instruction which should make them ac- 
quainted with the diseases peculiar to the tropical countries in 
which most of their work would be found, but also to better pre- 
pare them to cope with these diseases, and to enable them to in- 
vestigate intelligently the causation of those still of unknown or- 
igin. It was early recognized however that the usefulness of 
the school would be greatly impaired if its advantages were de- 
nied to others than the Colonial medical officers, and its courses 
were therefore thrown open to all practitioners. 

The location of the school at first thought appears to be un- 
fortunate, located as it is at a distance requiring nearly thirty 
minutes travel by the suburban trains of the Great Eastern Rail- 
road, and in a section of the unsavory East End inhabited ex- 
clusively by dock laborers. But it is this section that provides the 



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292 CAPTAIN JAMES M, PHALEN, 

peculiar clientage of the hospital, and these people, Lascars, 
Chinese, Negroes, and others have the strongest prejudice against 
being taken away from the neighborhood of the docks, and of the 
ship which is the link connecting them with their distant homes. 

The hospital has accommodations for fifty patients and at 
all times is nearly full. The wards are large, clean and well 
ventilated, furnished with the most modern furniture and eqjuip- 
ment. To the hospital are assigned all cases of disease that are 
peculiar to or that are more frequent in tropical climates. The 
more common maladies, as dysentery, malaria and beri-beri may 
be seen at all times, while patients suffering from plague, leprosy, 
relapsing fever, kala-azar, trypanosomiasis, filarial and Guinea- 
worm disease are not very uncommon. 

The ward clinics are conducted by Sir Patrick Manson and 
Dr. Andrew Duncan, each holding two hourly clinics a week dur- 
ing the school session. During these hours of bedside instruc- 
tion, and at other times the student is permitted to make exami- 
nations of the patients, and to become acquainted with the vari- 
ous clinical manifestations of their maladies. 

Of special interest are the clinics of Sir Patrick Manson, 
who has been appropriately styled "the Brahma and Vishnu— 
the creator and sustainer"— of the school, and whose individu- 
ality is impressed upon every department. A man of the widest 
clinical experience in tropical diseases, and possessed of a most 
attractive presence and a fine voice and delivery, his lectures and 
clinical demonstrations are examples of the highest development 
of the teaching art. 

The school building proper is a modern three story brick 
building situated in the same enclosure as the hospital, to which 
it is connected by a covered passage. It contains the laborato- 
ries, lecture amphitheatre, museum, library and out-patients dis- 
pensary, together with accommodations for the housing of twelve 
students who are thus in position to devote their entire time to 
study and work in the laboratories. The dining room also affords 
opportunity for other than resident students to obtain lunch 
without leaving the building. 



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THE TEACHING OF TROPICAL MEDICINE, 293 

Three sessions of the school are held each year, beginning 
on January 15th, May 1st, and October 1st, and extending over 
a period of twelve weeks. The instruction is divided between 
practical work in the laboratory occupying four hours each day 
and two hours devoted to didactic lectures or clinics. 

In the laboratory course the student is first instructed in the 
use and care of the microscope and its accessories including in- 
struction in the use of the micrometer and the Camera Lucida. 
Then the study of normal blood is taken up, and the methods of 
making suitable films and the use of the different stains be- 
comes familiarized. After sufficient practice has been given in 
the differential counting of the leucocytes, blood films illustrative 
of the primary anemias are given around, followed by those 
secondary anemias due to the malarial organisms, Ankylostoma 
and the Bothriocephalus latus. 

The parasites of the blood are next taken up, beginning 
with the malarial organism. The wards at the hospital at al- 
most any time furnish specimens of the benign and malignant 
tertian organisms for study, and frequently the quartan also may 
be found. Considerable time is given to the study of these para- 
sites, so that their different phases may be readily recognized, 
both in fresh films, and after staining. There is almost always 
within reach of the instructors, either in the hospital or else- 
where, some individual whose blood contains the filarial embryos, 
and these are likewise shown, together with other filarial em- 
bryos of lower animals. 

Cases of human trypanosomiasis are not very infrequently 
seen in London, but the infrequency of this parasite in the blood 
makes it quite difficult of demonstration. Nevertheless this par- 
asite is seen occasionally, while the more common trympanosomes 
of cattle, birds and fishes are readily found in the blood of these 
animals, and being almost identical in appearance gives the stu- 
• dent a correct idea of the aspect of the parasites in man. 

Representatives of the class of parasites known as spiro- 
chaetae or spirilla are studied from cases of relapsing fever, while 
the dried specimens are shown of the parasite causing the re- 
cently discovered disease known as African spirillosis. The 



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294 CAPTAIN JAMES M, PHALEN. 

Donovan-Leisbman body, tbe specific cause of Kala-Azar can 
bardly be called a parasite of tbe blood certainly not a parasite 
of tbe circulating blood. Nevertbeless it is intensely interest- 
ing, and of tbe greatest importance, and tbe opportunity tbe 
student bas to become acquainted witb its appearances is one of 
tbe great advantages of sucb a scbool and bospital. 

Practical acquaintance is also obtained witb several classes 
of blood parasites of lower animals, patbogenic and otberwise, 
wbose members are not as yet known to cause disease in man, 
but wbicb may at any time be discovered to be of tbe greatest 
importance as causes of disease. Sucb parasites are tbe Piro- 
plasma of cattle, tbe Halteridia and Proteosoma of birds, and 
tbe Hemogregarines of certain cold blooded animals, as fisb, 
frogs and lizards. 

Tbe close relation of blood parasites and insects as tbeir 
carriers, leads naturally to tbe study of sucb insects as are of im- 
portance in tbe transmission of disease. After a classification of 
tbese members of tl;e Animal King["dom, instruction is given in 
tbeir collection, mounting, preservation and transportation. Tbe 
first class to be taken up is tbe mosquito and tbe anatomy of its 
several pbases, egg, larva, pupa and imago are carefully studied, 
so tbat tbe classification of tbe family of tbe Culicedae wbicb 
follows may be readily understood. Tbe museum of tbe scbool 
furnisbes examples of nearly all of tbe more important genera, 
wbicb are utilized for study, witb tbe idea of familiarizing tbe 
student witb tbeir appearances. 

Tbe life cycle of tbe malarial parasite and tbe filarial em- 
bryo witbin tbe body of tbe mosquito are sbown in serial sections 
and in fresb specimens, and the student is taugbt tbe metbod of 
preparing sections and of dissections of tbe mosquito for tbis 
study. 

Biting flies bave witbin recent years assumed importance on 
account of tbeir activity in spreading Trypanosomiasis and per- 
baps some otber disease. Tbe known offenders of tbis class are 
tbe tsetse flies,, belonging to tbe genus Glossiua, tbe carriers of 
tbe Trypanosoma Brucei of domestic animals, and some mem- 
bers of tbe Stomoxys and Tabanidae. Otber small animal life 



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THE TEACHING OF TROPICAL MEDICINE, 295 

that claim importance in this connection are the ticks, distrib- 
utors of Texas fever in cattle, and of African spirillosis in man, 
and the fleas, under grave suspicion at least, as the carriers of 
plague. . 

Helminthology is one of the most important branches of 
tropical medicine, and the classification and study of intestinal 
parasites is given the attention their importance demands. Ex- 
cellent opportunity is given for becoming familiar with the in- 
testinal worms, the flukes, and also with the protozoa, pathogenic 
and otherwise which inhabit the alimentary tract. No less im- 
portant than the study of these parasites is the recognition of 
their eggs, and here the wards of the hospital at all times furnish 
an excellent variety for study. Two disease conditions which on 
account of their wide distribution and economic importance are 
given particular attention are Bilharziosis, an invasion of the 
veins of the bladder and rectum by the Schistosoma hematobium, 
and Ankylostomiasis. 

A short period of instruction in bacteriology completes the 
practical course, but this work only emphasizes the fact that in es- 
sentially tropical disease, bacteria play but a small part and that 
the leading role is taken by animal parasites. In fact protozoa 
may be said to bear the same relation to disease in hot countries 
that bacteria do to those of temperate regions. And this is due 
not so much to favorable conditions of the tropics for the parasite 
itself as for the mosquito, biting fly, or other intermediate host 
which is a necessity in the life of many of these parasites. The 
recognition of the importance of protozoa as a cause of disease 
has been one of the greatest advances in medicine in recent years, 
and much of future investigation must be in working out the 
problems incident to this discovery. 

A valuable feature of the laboratory work is a weekly prac- 
tical examination, at which twenty to thirty specimens, gross and 
microscopical, are set out for identification. This laboratory 
course is without doubt a most excellent one, and the practical 
work is supplemented by clear, concise lectures at intervals dur- 
ing the laboratory hours by Dr. C. W. Daniels who is in charge 
of this part of the course. 

Dr. Daniels, like a majority of the teaching staff has seen 



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296 CAPTAIN JAMES M. PHALEN. 

service in the tropics, he having been for several years in the 
Colonial Medical Service at Demarara in British Guiana. Dr. 
Daniels holds the position of Medical Superintendent of the hos- 
pital and together with his assistant instructor lives in the school 
building and devotes his entire time to the school and to research 
work. 

The lecture course is carried on by ten lecturers upon as 
many subjects, embracing the whole field of tropical medicine 
and surgery, hygiene, special diseases of the skin, eye, ear and 
mouth, bacteriology and protozoology. These instructors are 
mostly men of considerable experience in tropical practice, and 
notably the lectures of Sir Patrick Manson, Drs. Hewlett, Sand- 
with, Cantlie are of great interest and value. The lecture course 
as a whole however, leaves something to be desired; with the 
large number of teachers the courses overlap so that a subject 
may be presented by two or even more lecturers, while the so 
called special branches, probably on account of the short time 
allotted to them are poorly presented. It seems that a consoli- 
dation of subjects, with a reduction in the number of lecturers 
would be to the advantage of the student. 

A feature of this lecture course that is worthy of emulation 
is the great use that is made of the stereopticon. By its use typ- 
ical examples of disease are illustrated, bacteriological and path- 
ological specimens are shown, and the teaching of medical zool- 
ology, to use an all-embracing term, is greatly simplified. To 
be sure the idea is not new, but it is here carried out to a much 
greater extent than I have ever seen elsewhere. 

Nine years have elapsed since the opening of the school, and 
during that time over seven hundred students have been in at- 
tendance. Of these by far the larger number belong to the Col- 
lonial Medical Service, but the Army and Navy services have 
furnished many students while nearly all of the governments of 
Europe and America have been represented by their medical offi- 
cers. Another source from which such a school draws a large 
patronage is the medical missionary service, which has furnished 
nearly one hundred students, either attending on their own initi- 
ative or at the expense of the various mission boards. Nearly 
one-third of the students have been physicians who have intended 
going into private practice in the tropics. 



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THE TEACHING OF TROPICAL MEDICINE. 297 

That special instruction in tropical medicine is not withotit 
results, we have only to mention the names of Low, Daniels, Cas- 
tellani, Bentley, Balfour, and Philip Ross; names familiar to 
those conversant with the recent literature of tropical medicine. 
It was a former student of the school, working on the Gambia in 
Africa, that first found the Trypanosoma gambiense in man, 
while another student first demonstrated that sleeping sickness 
was due to this parasite. African tick fever was shown by an- 
other student to be due to a spirillum similar to that which 
causes relapsing fever, while many investigations of lesser im- 
portance have been carried out. 

In the early days of the school, Drs. Sambon and Low faced 
the fevers of the Roman Campagna in their efforts to make cer- 
tain the relationship between mosquitoes and malaria, and since 
that time, several expeditions have been sent out for the investi- 
gation of special diseases. Laboratories for the study of tropi- 
cal diseases have been recently established by the different Colo- 
nial governments throughout tropical Asia and Africa, and among 
those in charge of these laboratories, the London School of Trop- 
ical Medicine and its Liverpool rival are well represented. 

The only government aid the school obtains is from the fees 
for the Colonial oflBcers, and a portion of a research fund con- 
tributed by the different Colonies and apportioned by the Colo- 
nial office. A few quite liberal benefactions have been received 
but these have been used in equipment, and the school has there- 
fore no endowment for teaching or research. The fees are there- 
fore necessarily high, amounting to about one hundred dollars 
for a course. 

The importance of tropical medicine has been recognized by 
Cambridge University which has granted to those completing a 
course at either the London or Liverpool schools the privilege of 
taking the examination for its Diploma of Tropical Medicine and 
Hygiene. 

The London school has recently been strengthened by affili- 
ation with the University of London, and the admission of trop- 
ical medicine as an alternative subject for the M. D. of that Uni- 
versity. At the Christmas holiday distribution of honors of last 
year, the King conferred an order of knighthood on P. Mitchelli, 
secretary of the institution, in recognition of his services to the 
school, and through the school to the country. 



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THE BOARD FOR THE STUDY OF TROPICAL 

DISEASES AS THEY OCCUR IN THE 

PHILIPPINE ISLANDS. 

By captain PERCY M. ASHBURN, 

MEDICAL CORPS UNITED STATES ARMY. 

BY the terms of G.O. 16, W.D., 1906, the Secretary of War 
appointed a board of medical officers for the study of 
tropical diseases as they occur in the Philippine Islands. 
In his annual report for the year 1906, the Surgeon General re- 
fers to the board as one of a permanent character and the letter 
of instructions sent from his office to the board affords corrobora- 
tive evidence that he regarded it as such, for the board was in- 
structed to elucidate most of the dark spots in tropical medicine. 

If the permanent character of the board be conceded there 
should be an opportunity for every medical officer in the army 
who has desires in that direction to serve on it. The field of 
work is so broad that the probability of the board ceasing to exist 
because of any lack of unsolved problems need not be considered. 

Since any and every officer who so desires may at some time 
be appointed on the board, it behooves all such to take an es- 
pecial interest in its work for that reason, as well as for numerous 
others. And, in case not enough officers desire to serve on the 
board, I may stimulate interest by saying that it is most in- 
teresting, pleasant and instructive work, and that the authorities 
have done all in their power to promote its success. The mem- 
bers of the board are freed from other duties, work under in- 
structions so broad and general as to leave them free to choose 
their own subjects for investigation and to investigate in such 
manner, time and place as they see fit. Cordial and generous 
assistance has been forthcoming whenever requested, from the 
Commanding General of the Philippines Division, the Surgeon 
General, the Chief Surgeons of the Division and several depart- 

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THE BOARD ON TROPICAL DISEASES IN PHILIPPINES. 299 

ments, while various bureaus of the insular government, those of 
Science, Health and Agriculture, have been cheerfully helpful 
whenever it lay in their power. 

The organization of the board was simplicity itself, the Senior 
member being the president, the Junior recorder; no further or- 
ganization being considered necessary. 

The plan of work was almost as simple. As stated at the 
beginning of this article, the board worked under instructions 
from the Surgeon Generars office. When first examined those 
instructions were discouraging, as they seemed to demand an 
impossible amount of work. Considering it impossible, we set in 
to do such work as we could, selecting first that which was near- 
est to hand. Any subject in tropical medicine can be selected 
without violating the spirit or the letter of the instructions. 

Following this plan and working at the subjects presenting 
themselves, we started many investigations, most of which, for 
one reason or another, did not lead far, but all of which were in- 
teresting and instructive to the investigators; and some of them 
were deemed worth recording in separate papers. The work was 
not divided, i. e., one subject was not studied by one member and 
another subject by the other, but any subject taken up was in- 
vestigated by both members, each criticizing and controlling the 
work of the other, and thus working to agreement on demon- 
strable facts and obvious deductions, and eliminating as uncer- 
tain those on which agreement could not be reached. Another 
board might find a division of work more satisfactory, though 
we found our plan thoroughly so. 

For the greatest success in its work it is essential that the 
board should enjoy the friendship and co-operation of as large a 
body as possible of practicing physicians, in both military and 
civil life. These we enjoyed in a high degree and through 
them we obtained valuable help. It is our opinion, how- 
ever, that our successors will have a greater degree of assistance 
from the medical men of the army itself, when means are per- 
fected by which the officers outside of Manila can be kept in- 
formed of the work the board is doing, and so can take up 



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300 CAPTAIN PERCY M, ASHBURN, 

parallel work if they desire, or can be enabled to send to the 
board cases, specimens or reports throwing light on the sub- 
jects. 

With this object in view we suggested to the Surgeon 
General that the quarterly reports of the board, which are merely 
reports of work undertaken, regardless of the value of the re- 
sults, should be published in a journal which all the medical 
officers see, and as the reports are those of an army board, we 
thought Thb M11.1TARY Surgeon a fitting medium for publi- 
cation. 

The Philippines Medical Association and former Army con- 
nections served to get many private practitioners interested, 
while the officials of the Government were most helpful, both 
in their official and their personal relations with us. 

As the Surgeon General did not deem it wise or expedient 
to go to large expense in fitting up a laboratory for us we 
used our office room, the laboratory of the Division Hospital or 
the laboratory of the Bureau of Science, Philippines Civil Gov- 
ernment as was most convenient. 

With the last named institution we stood in the relation of 
•'assistants without pay. ' ' This relationship conferred on us the 
right to use the instruments, apparatus, library, etc., of the 
Bureau, in return for which we were under no obligation further 
than to publish first in the Philippines Journal of Science any 
paper which might grow out of our work. Our relations with the 
Bureau were most cordial and quite helpful to us. 

We made certain efforts to get in closer touch with 
officers stationed in the various posts in the provinces, notably 
by the distribution of reprints and of a circular from the office of 
the Chief Surgeon, in which the organization of the board was 
announced and the assistance and co-operation of medical officers 
requested. As a result of these measures we received some 
very valuable assistance from such officers, some particular in- 
stances being as follows: 

Dr. Albert ly. Miller, stationed at Imus, sent us four of the 
five cases of infection with Filaria Philippine?! sis ^ which we had 
an opportunity to study. 



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THE BOARD ON TROPICAL DISEASES IN PHILIPPINES. 301 

Captain Edward B. Vedder, Medical Corps, U. S. Army, 
permitted us to use in an article on dengue the results of the im- 
portant and valuable blood work that he had done in that disease. 

Captain Thomburgh, Captain Schreiner and Captain Gosman 
also sent us interesting cases. 

As showing that such co-operation was not so general and so 
valuable as it should be I may mention that we have thus far re- 
ceived for transmission to Washington but one specimen from a 
medical officer outside of Manila, a specimen illustrating intes- 
tinal myiasis, sent by Dr. John M. Hewitt. 

With general co-operation on the part of medical officers in 
the islands, the board should be able, in a relatively short time, 
to send to the Army Medical Museum a collection of pathologi- 
cal specimens, blood smears, intestinal parasites, etc., such as 
would well illustrate the diseases of the islands and be of great 
value to the Museum and the Army Medical School. 

Another instance may be related in which a general interest 
on the part of officers in the provinces would probably have been 
of great value. In June 1906 the Commanding General directed 
the board to undertake at as early a date as possible a series of 
experiments to determine whether the surra which so seriously 
affects the horses in these islands is carried by carabaosand, if so, 
what is the method of transmission. A screened stable was built 
for the necessary experiments and the needed horses promised. 

Trypanosomiasis of carabaos is reputed fairly common, a 
government report stating that in the year ending August 1905 
almost nine per cent of the carabaos in Manila had trypanosomes 
in their blood. Yet after June 1906 we were ready and 
desirous but unable to perform the experiments requested be- 
cause we were not able to obtain the infected carabao. We 
did twice locate infected animals, and one of them we bought, 
but it developed rinderpest the day it arrived in Manila and died. 
The other was killed and sold for food as soon as the owner 
learned of its infection and our offer to purchase arrived too late. 

It does not seem improbable that we might have found other 
infected cattle had the medical officers throughout the islands 
been on the lookout for them. 



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302 CAPTAIN PERCY M, ASHBURN, 

The letter of instructions from the Surgeon General's oflBce 
set forth the objects to be sought by the board as follows : 

1. Investigation of diseases. 

2. Application of knowledge to prevention and cure of disease. 

3. Collection of specimens for Army Medical School and Army Medical 
Museum. 

To these we think a fourth object might well be added viz. : 
The correlation of the work of investigation of such medical 
officers as have the time and inclination to co-operate with the 
board. 

The board would have welcomed such co-operation at any time 
and always given due credit for it. It also stood ready to 
help at any time, and to the full extent of its ability, in investiga- 
tions that other medical officers requested, either to initiate them 
or to carry them on. It was, however, a great saving of time that 
most of the board's work was done in Manila, and, when prac- 
ticable, cases to be studied should be sent there for the purpose. 
The board made a few trips to outside posts but usually 
found them unprofitable, as the time consumed in such trips was 
out of all proportion to the part of it that could be spent in actual 
work; and it would be easily possible for the board to spend all 
of its time in trips, which might be pleasant but would lead to no 
useful results. 

A summary of the work of the board during its first year of 
service may serve to show that its tastes were catholic and that no 
man need think that his ca.ses would not interest it. The sub- 
jects investigated embrace the following: 

1. Examination of feces, 

a. Of 107 healthy men, to determine the percentage of them har- 
boring harmless ameba, 71 per cent positive. 

b. Of 28 insane, to determine the kind of parasitic infection from 

which they might suffer, with particular reference to infection 
with HymenoUpis nana. 10 had Entameha coli. All negative 
for Hymenolepis. 

c. Examination of stools of various sick persons for diagnostic and 

other purposes. 

2, Examination of blood, 

A. Human. I. All types of malarial infection. 



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THE BOARD ON TROPICAL DISEASES IN PHILIPPINES, 303 

II. For filaria, resulting in identification of Filaria phil- 
ippirunsis^ also blood pictures in filariasis. 

III. In non.malarial splenomegalia all resulting negatively 
as regards the finding of causative organisms and 
Leishmania donovatii. 

IV. For the organism of dengue, always negative as to 
visible or cultivable organisms. 

V. For the white cell picture of dengue. 
VI. For the Treponema pallidum. Always negative in 

blood smears. 
VII. For Treponema per tenuis. Negative. 
VIII. For the cause of certain undetermined fevers. Neg- 
ative. 
IX. Numerous examinations for diagnostic purposes; e.g., 
blood counts, hemoglobin estimations, etc. Aggluti- 
nation tests. 9 Malta fever cases found. 

B. Horse. For trypanosomes. Positive and negative in different 

cases. 

C. Carabaos For trypanosomes, 112 examinations. Always nega- 
and Cattle, tive in our personal experience in Manila. Twice 

found in the provinces, for us, by veterinarians. 

D. Monkeys, rabbits, guinea pigs, etc., for various things. Usually 

negative. 

3. Blood Cultures, 

In dengue, malaria, undetermined fevers, syphilis, yaws, splenome- 
galia, etc. Results almost uniformly negative except for frequent 
contaminations. 

4, Examination of urine. 
Usually routine matters. 

J. Examination of skin lesions, 

a. Tropical ulcers. Negative for protozoa and Wright's bodies in 
smears and sections, except certain cases showing spirochaetae. 

b. Ring worms of various kinds. Fungi usually found. 

c. Blastomycosis. Lesions studied and treated. Blastomyces iso- 
lated and cultivated. Inoculations failed on guinea pig. 

d. Yaws. Studied and Treponema pertenuis always found. 

e. Syphilis. Treponema pallidum rarely demonstrated in skin. 

f. Other and unknown conditions, including cases of suspected my- 

cetoma. Results negative. 

6, Staining Experiments. 

a. Attempt to differentiate between B. tuberculosis and B, lepra by 
staining. Negative. 

b. Various experiments in staining protozoa. 

7. Mosquito work. 



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304 CAPTAIN PERCY M. ASHBURN, 

a. Experiments on transmission of dengue by mosquitoes. 

b. Observations on life cycle of Filar ia philippinensis in the mos- 
quitoes. 

c. Attempts to infect Myzomyia ludlowii with malaria for studying 
mosquito phase. Negative. 

d. Collection and classification (by Mr. Banks) of mosquitoes at Fort 
William McKinley. 

Anophlina. 4 genera and 8 species. 
Culicina, 5 genera and 8 species determined. 
5 species as yet unidentified. 

8, Collection of specimens. 

a. For Army Medical Museum. 

1. Leprosy, 70 specimens. 

2. Cholera, 1 5 specimens, 

3. Plague, I specimen. 

4. Trematode infection. Specimens from cases. (Dr. Musgrave.) 

5. Pernicious malaria. Specimens from 1 case. (Captain Peed.) 

6. Intestinal myiasis. Specimens from i case. (Dr. J. M. Hewitt.) 

7. Other unusual intestinal lesions. 2 specimens. 

b. For Army Medical School. 

1. Blood smears, illustrating the different types and stages of ma- 
larial infection. 

2. Blood smears showing Filaria philippinensis. 

3. Slides showing numerous Balantidium coli. 

4. Smears showing Treponema pertenuis. 

9. special reports, 

1. A New Blood Filaria of Man: Filaria Philippinensis. 

2. Observations on Filaria Philippinensis and its Development in 
the Mosquito. 

3. Experimental Investigation regarding the Etiology of Dengue 
Fever, with a General Consideration of the Disease. 



INDICATIONS FOR OPERATION ON PERIPHERAL 

NERVES. 

FROM the observation of a series of cases in two German 
Red Cross hospitals at Tokyo, Henle concludes that in 
such cases operative interference is indicated to release 
the nerves or nerve-ends f rora scar tissues. 



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Contemporary Comment 



COMPARATIVE CONDITIONS IN THE RUSSO- 
JAPANESE WAR. 

IN Roths Jahresbericht^ Dr. Koerting reviews a masterly ar- 
ticle of Follenfant, a military observer during the war. 
Both armies accomplished extraordinary results in hygiene, 
the Russians excelling the Japanese, according to Follenfant's 
and Koerting*s opinion. Their general health was better and 
the death of the wounded less. The Russian surgeons were 
better than the Japanese. Follenfant found, toward the end of 
1904, among the Manchurian army, a dozen cases of typhus, 
about forty cases of anthrax, several hundred cases of typhoid 
fever, but no dysentery, cholera, plague or wound diseases. 
This was confirmed by Colonel Hoff of the American army and 
Dr. Schaefer, from Germany, companions of Follenfant. The 
maximum strength of the Russian army was 1,262,000. Of such 
an army one would estimate, in times of peace, to have 600,000 
sick, with 30,000 deaths. The Russians, however, had only 
287,000 sick, and 5,000 deaths, so that the health of their com- 
mand was better than in times of peace. Of 113,800 wounded, 
2.64 per cent died. In some of the hospitals the percentage was 
still lower. The Russians lost in battle 34,000, or one to every 
3.5 wounded. Twenty-one surgeons were killed, twenty-one 
wounded and twenty-eight taken prisoners. The sanitary corps 
had 193 killed, 297 wounded and 47 taken as prisoners. The 
artillery wounds were all .infected, fifty per cent of the gunshot 
were infected in summer and eighty per cent in winter. 56,717 
cases of epidemic disease occurred: of these there were 25,800 
intestinal catarrh, 15,800 typhoid, 8,970 dysentery and 4,500 
malarial cases. Ten per cent of the typhoid fever cases died. 
The disease ran a mild course and disappeared completely in the 

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306 CONTEMPORARY COMMENT. 

winter. This remarkable result was influenced by : 1. The favor- 
able climate. 2. The excellent selection of the soldiers. 3. The 
long winter. 4. Geographical location. 5. The excellent nurs- 
ing. 6. Proper clothing. 7. Rest after engagements. 8. Pro- 
hibition of the sale of liquor to soldiers. In the matter of nurs- 
ing, Pollenfant especially emphasizes that preserves were not 
known, the nourishment being as a rule fresh food. Large bak- 
eries, meat markets and merchants of cities provided for that. 
The value of tea as a drink can not be overestimated and hot 
water and sugar were never wanting for its preparation. The 
Russians never ate raw fruit. The transportable kitchen sup- 
plied a meat soup of the best quality. The kitchen is an excel- 
lent addition for the maintenance of health with troops in the 
field. In summer, 1905, when Pollenfant left the Russian army 
the health was better than in 1904. Of an army of 1,000.000 
men, only 2.4 per cent were in the hospitals. In no European 
war could the health conditions have been better than with the 
Russians in 1904-1905. The same impression that Pollenfant 
has pictured, Koerting received, from other literature, and es- 
pecially from the writings of German observers and Colonel HofiF 
of the American army, who can not have come to the Russians 
with a preconceived notion. — Prkd J. Conzei^mann. 



BALSAM OF PERU IN THE TREATMENT OP 
WOUNDS. 

IN the treatment (Dr. Gebele, Muenchener Med, Wochen- 
schriff) of contused and lacerated wounds, especially of 
the fingers and toes, balsam of peru has proven to be an 
excellent remedy. It has three distinct actions: 1. Bactericidal; 
2. Chemotactic; 3. It envelops the bacteria. Through its in- 
fluence necrosis of the contused tissue is prevented and it is es- 
pecially applicable in the conservative treatment of wounds of 
the fingers and hands. It is indicated in fresh wounds, and all the 
cavities should be filled with it. Gebele did not observe nephritis 
in his cases. However, in long continued use of balsam, urine 
examination should be made in all cases. The combination of 
Bier's hyperemic method with the balsam treatment gave excel- 
lent results.— Prkd J. Conzki,mann. 



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CONTEMPORARY COMMENT, 307 

CEREBRO-SPINAL MENINGITIS. 

IN February, 1906 {^Roths Jahresbericht) an epidemic of 
cerebro-spinal meningitis occurred in the Bavarian First 
Train Battalion. Six men were attacked by the disease, one 
of whom died. The meningococci of Weichselbaum was found 
in each case. The isolated cocci showed the characteristic mor- 
phological, staining, cultural and sero- diagnostic signs of the 
diplococci of Weichselbaum. In four patients the germs were 
found in the pharynx. The microscopical examination of the 
secretion of the naso-pharynx does not suffice and a culture is 
required. In five cases the meningococci could be cultivated 
from the blood. The serum of the patients agglutinated the dis- 
ease producers in adilution of one-sixtieth and one one-hundredth. 
Of thirty-nine well men examined, five were found to carry the 
germ. Of twenty-nine men suflFering from catarrh of the upper 
air passages, four carried the germ. The germ carriers play an 
important part in the spread of the disease. Of twenty men of 
the 1st Infantry Regiment, who had in no way been in contact 
with cases of cerebro-spinal meningitis, not one of them carried 
the meningococci in the nasal or pharyngeal secretions. Ac- 
cording to WestenhoeflFer, infection occurs through the respira- 
tory tract. Children first complain of ear disease, from here the 
infection of the cranial cavity follows. In adults the infection 
takes place through the sphenoid bone. The hypophysis be- 
comes the seat of the disease at first, and it is a fact that one al- 
ways finds a perihypophseal infection. Infection may also take 
place from the pharynx along the course of a nerve. Pus in the 
nerve sheaths could, however, only be followed to the pharyngeal 
wall. Acute inflammation of the tonsils is always present. 
Lymph and blood channels are possible avenues of infection.— 

FrKD J. CONZKI,MANN. 



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flDebtco-flDtlttari? 1 nbei. 



MEDICO-MILITARY ADMINISTRATION. 

de Mooy (C) [New manner of transporting patients without lifting 
them in the arms or permitting them to be enveloped and immobilized in the 
stretcher.] Caducie^ Par., 1908, viii, 35-38. 

Ekeroth (C C*) [On the question of a reorganization of the Swedish 
field corps.] Wien klin. Rundschau^ 1908, xxii, 99. 

Graajux* [Effects of military surgeons.] Caducke^ Par., 1908, viii, 33. 

Hafvey (P. F.) Some present and prospective needs of the army med- 
ical service. /. Mil. Serv. Inst, U.S. Governor's Island, N.Y.H., 1908, 
xliii, 112-118. 

Kowalk* [Medico-military instruction for one year volunteer officers 
and non-commissioned officers as also for reserve medical officers;] Berl., 
1908, E. S. Mittler, 398 p., 8°. 

Lion (H*) [The new field ambulance of the English Army.] Caducte 
Par., 1908, viii, 21. 

Mobefly (H» J. R») A new pattern bed-rest. /. Roy. Army Med, Corps ^ 
Lond., 1908, X, 182. 

Muhlschlei^eL [The new German army medical regulation. Militdrarzt^ 
Wien, 1908, xii, 7-10. 

OlMeiU ( J« S») A new method of carrying the wounded off the field on 
service. Indian M, Gas,^ Calcutta, 1908, xliii, 52, 2 pi. 

Phelan (PL du R.) A plea for U.S. Army contract surgeons. Calif. 
State J. M,^ San Fran., 1908, vi, 9 5-97 • 

Philippe (H*) [The first aid and emergency care of victims of accidents, 
of sudden illness or of poisoning.] Par., 1908, A Maloine, 530 p., 12®. 

Pttisais. [Utilisation of dogs in the field for the transportation of the 
wounded.] Arch de mid et pharm, miL^ Par., 1908, li, 72-76. 

Prost-MarechaL [A study of the organization of dental service in the 
Army.] Odontologie, Par., 1907, xxxviii, 547-561. 

Reder (B*) [The care of wounded on the field in modern warfare in the 
German Army.] Militdrarzt^ Wien, 1907, xli, 276. 

Rizey (P. M.) The relation of the Navy to the study of tropical dis- 
eases. /. Cutan. Dis, incl.^, Syfih.^ N.Y., 1908, xxvi, 63-66. 

Sabatie (R») [For invalid soldiers.] Cadude, Par., 1907, viii, 50. 

Sahatier* [Infirmary for invalid soldiers.] Arch, de med, et pharm, 
mil., Par., 1908, li, 159-176. 

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MEDICO-MIUTARY INDEX, 309 

Schmklt (G*) [The new organization of dental service in war.] Deutsche 
mil, drztl,^ Ztschr., Berl., 1908, xxxvii, 49-S4- 

Schwleoing (H.) [International medico-military statistics.] Deutsche 
mil, dratl, Ztschr.^ Berl., 1908, xxxvii, 58-70. 

Secheyrofi* [Lighting of medical forces in the field, lighting after the 
combat] Arch.firov. de chir.^ Par., 1908, xvii, 7-15. 

Treilku [Effective strength of the medical corps: I. In America. 
President Roosevelt and the army surgeons.] Caduchy Par., 1908, viii, 33. 

'VanhlU (C F*) Comment on a method of drying clothes on active ser- 
vice as tried during the last Scottish manoeuvres. /. Roy, Army Med, 
Corps ^ Lond., 1908, x, 68. 

MEDICO-MILITARY HISTORY AND DESCRIPTION. 

[Red Cross nursing in Switzerland.] Ztschr. F. Krankenpflge^ Berl., 
1907, xxix, 356-359- I 

Ateodt [The Marine Hospital Kiel-wik.] Berl., 1907, £. S. Mittler, 
Sohn, 27 p. 8 pi. 9 diag., 8°. 

Crawfofd (D« G*) The medical services in the Mutiny. Indian M, 
Gaz,y Calcutta, 1908, xliii, 1-5. 

Japan {Minister of War,) [Report upon military quarantine in the 
war of 1904-5 (37-38 Meiji.) Issued by the Minister of War, Tokio.] 
Tokio, 1907, 174 p., 27 pi., I port roy. 8°. 

LaNlcca (R*) [Military medicine in Switzerland.] Deutsche med, 
JVchnschr,, Leipz. u. Berl., 1907, xxxiii, 2094-2096. 

Laval (K) [Material for the medical service in the field; the Japanese 
individual package of dressing.] CaducU^ Par., 1908, viii, 49* 

Prealich CV*) [A day in a station for the sick on a line of march.] 
Militdrarzty Wien, 1908, xlii, 17-25. 

Purdy (J* S*) Experiences of a medical officer with the New Zealanders 
in South Africa. /. Roy. Army Med, Corps^ Lond., 1908, x, 191-199. 

Scfaintinger (Frldolln.) [The hospitals of the War of Liberation in 
Breisgawjwith special description of the Hospital inHennebach atEmmen- 
dingen.] Freib. i B., 1907, 83 p., 8°. 

Seaman (L* L*) Some of the triumphs of scientific medicine in peace 
and war in foreign lands, with suggestions upon the necessity of important 
changes in the organization of the Medical Department of the United 
States Army. N,Y. M,J. (etc.), 1908, Ixxxvii, 335-343. 

▼on F08S (GO [Experiences and thoughts of a Russian military sur- 
geon, 1904-1905.] Leipz. [1908], G. Schlemminger, 102 p., 8^. 

MILITARY HYGIENE. 

Lusitania (The); a vast experiment in ventilation: an example that 
may serve on shore as at sea. Lancet, Lond., 1908, i, 54-57. 

Sanitation at sea: the ventilation and drainage of some Liverpool pas- 
senger ships. Lancet^ Lond., 1908, i, 457. 



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310 MEDICO MILI TAR Y INDEX, 

BUu* [Feigning of defects and injuries among recruits in the difiEerent 
armies.] Deutsche mil, arztl, Ztschr,^ Berl., 1908, xxxvii, 97-128. 

Brown (R*T*) Camp sanitation. /. Roy. Army Med, CcrpSy Lond., 
1908, X, 226-237. 

Dleudoone. [The removal of sewage in military camps and fields.J 
Gesund'Ingenieur^ Miinchen, 1908, xxxi, 81. 

Hullman* [On the ventilation of war-ships.] Gesundh, Infftnieur^ 
Miinchen, 1908, xxxi, 101-105. 

Lcafd (L. E. JO [Contribution to the results obtained from physical 
education in the Army.] Arch, de mkd, et pharm, miL^ Par., 1908, li, 24-34. 

Mtinson (E* L«) The military shoe and the military foot /. Mil, Serv, 
Inst, [/^., Governor's Island, N.Y.H., 1908, xlii, 275-293. 

Myrdact* [Weights of the personnel of the 4th Army Corps.] Mili- 
tararzt, Wien, 1908, xlii, 4. 

Obon (G* M*) Vaccination on board ship in the Orient C/, States 
Nav, M, Bull,, Wash., 1908, ii, 44-46. 

Pembrey (M* S«) and Parker (L* E* L.) The composition and energy 
value of the food of the soldier. Proc, Physiol, Soc, Lond., 1907-8, p. xlix. 

MILITARY MEDICINE. 

Cummins (S* L«) Tuberculosis in the Egyptian Army. Brit, J, Tuber c.^ 
Lond., 1908, ii, 35-46. 

Johnston (C A*) Tuberculosis in the Indian Army; its incidence as 
a£Eected by locality, racial proclivity, and service generally. Brit, J, Tuberc.^ 
Lond., 1908, ii, 20-23. 

Melvflle (C H*) Tuberculosis in the Army 1860-1906: its influence on 
invaliding and the death rate. Brit, J, Tuberc,^ Lond., 1908, ii, 10-15. 

Simpson (R* J« S.) Tuberculosis in the British Army on foreign service. 
Brit. J, Tuberc, Lond., 1908, ii, 16-20. 

Sticf* [Later psychiatric work and data from armies other than the 
German.] Deutsche mil, arztl, Ztschr., Berl., 1907, xxxi, 985; 1908, xxxii, 

159. 

Magnet (L*) [The significance of psychiatric investigation in the 
Army.] ^/j^rAr., Berl., 1908, xxxvii, 145-159. 

MILITARY SURGERY. 

Cornelius* [What significance has massage for the military surgery.] 
Deutsche Mil, drztl, Ztschr,, Berl., 1908, xxxvii, 215-218. 

Holt (M* P. C) The advisability of operation for recurrence of hernia 
in the services. /. Ray, Army Med, Corps, Lond., 1908, x, 11 5-123. 

Johnson (A* K) Appendicitis at sea with remarks on the surgical 
equipment of the mercantile marine. Brit, M,J,, Lond., 1908, i, 442. 

ScfaoU (F.) [Ear and eye diseases in the Austro-Hungarian army and 
in our army.] Deutsche mil. drztl. Ztschr., Berl., 1908, xxxvii, 1 31-133. 



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Ebitotial fixpresston. 



A RUSSIAN MEDICAL OFFICER ON RUSSIAN ARMY 
SHORTCOMINGS. 

IN spite of the great advances made by medical sciences, in 
spite of the great life-preserving and life-saving achieve- 
ments of sanitary measures undertaken by sanitarians, hy- 
gienists, bacteriologists and surgeons, in civil as well as in military 
life , t he medical officer is as yet looked upon as a * * non -combatant , ' * 
and as a comparatively insignificant part of a g^'^at fighting 
machine, in short as a sort of * 'necessary evil" required by 
fashion. 

Undoubtedly highly-cultured and humane governments 
have begun to realize the value of a well-organized sanitary ser- 
vice for troops in garrison and in the field and have accorded the 
representatives of that service the rank and emoluments of 
officers of the line. This holds especially good for the United 
States and it is gratifying to us to know that our colleagues in 
other, less enlightened countries of the*old world, have held up 
the medical department of the United States army as an ideal 
service for those in it as well as for those it serves, an ideal well 
worthy of emulation. 

While it must be admitted that in this country medical offi- 
cers are better off in every respect than those in almost all Euro- 
pean armies, we cannot truthfully assert, however, that we are 
accorded all the privileges and emoluments which we deserve. 
A real autonomy of the medical department does not exist in 
praxi. 

In this respect we learn by sad experience. When a war is 
in progress and more men die of diseases that can be prevented, 
than from the enemies' missiles, then something is wrong some- 
where; either the medical department is inefficient or the com- 

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312 EDITORIAL EXPRESSION. 

manding officers are to be blamed because they have hampered 
that service. For whatever shortcomiDgs and blunders occurred 
during the Spanish- American war, for example, the medical de- 
partment is blameless. It \& hoped that the American govern- 
ment has learned a lesson it is not likely to forget, and the 
present reorganization of the army medical corps seems to be- 
speak a brilliant future for an activity that shall be looked upon 
by all concerned as a godsend. 

Since the Spanish- American war a great nation with practi- 
cally the largest standing, well-disciplined army in the world, 
commanded by men of excellent reputation as field marshals, has 
engaged in a war with a nation of an Oriental race, which here- 
tofore had been looked upon as greatly inferior to the Caucasian 
race. The disastrous outcome for the ** white Christians" is too 
well known. Of course all sorts of explanations of this disas- 
trous result are offered by those who are led by sympathy rather 
than reason and science. 

If we study the reports of the officers of the general staff we 
get no satisfaction. There is much talk about **heroism," * 'irre- 
sistible forces," ''overwhelming numbers," "climatic condi- 
tions,'* "topographical hindrances," etc., etc. Once in a while 
we read of a complaint of lack of harmony among the higher 
officers, in other words one commandertrying to throw the blame 
on a comrade's shoulders. 

And now we come to the main subject of this article: The 
truth of the late Russo-Japanese war can be heard only from 
Russian medical officers. Astounding as this may appear it is an 
absolute fact nevertheless. 

As an example let us briefly cite from a report of the well- 
known Russian syphilographer Dr. B. Ph. Deniick, who for 
some time was in charge of "general hospital No. 4, "at Harbin. 

A few explanatory notes may not be amiss. In Russia the 
common soldier and the subaltern officer knows of but one thing 
as representing all that is expected of him, viz., his body and 
soul belong to the Emperor and, therefore, blind obedience to 
superiors is the sine qua non. What more ideal army can an 
efficient general and staff ask for? And why was such an army 



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EDITORIAL EXPRESSION. 313 

defeated? Let us hear what Demick has to say. For frankness 
his article, which appeared last year iu the Voyenno Medizinsky 
Journal, a leading medico- military monthly published in St. 
Petersburg, it probably stands supreme in Russian official litera- 
ture. It is indeed a sign of the times when in such a country, 
ridden by official red-tape and white- washing, a medical man is 
permitted to raise his thundering voice, accusing the proper 
authorities, nay the very nation of its defeat. 

In his introductory remarks he says: '*The unsuccessful war 
revealed numerous shortcomings in all departments of the million 
army of Russia. These shortcomings were principally due to our 
unpreparedness for war, to lack of familiarity with the local condi- 
tions of the theater of war, to deficient specialistic knowledge 
and, in general, to our low culture." The author sharply re- 
bukes the system of bureaucracy which boisterously issued thous- 
ands of documents from the *'field" and **base" offices, to the just 
dissatisfaction of the real workers. He boldly says that the 
chiefs of the sanitary service were suflFering from lack of harmony 
and solidity. 

But the mute statistics issued by this fearless observer speak 
a language that can be heard and understood by all those who 
want to hear. 

The hospital under his charge was open from May 26, 1904, 
to July 22, 1906, that is to say a little over two years. During 
that period 28.154 patients were treated, 2,396 of whom were 
commissioned officers. 

As regards the nature of the diseases the following table is 
remarkable: 

Gunshot wounds 225 

Typhoid fever 616 

Venereal Diseases 26,316 

Skin diseases 202 

Diverse 795 

In reporting interesting case histories especially deaths due 
to lues, the author ascribes the bad results to the inability to 
completely cure most gonorrheics to the habitual drunkenness of 
both ofiBcers and soldiers. He takes to task the higher officers 



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314 EDITORIAL EXPRESSION. 

who permitted in Harbin the existence of caf 6s which were noth- 
ing but brothels of the lowest and most degenerate type. 

Had the Russian government been wise enough to so pre- 
pare herself for war as to avail herself of the sound advice which 
men of the stamp of a Demick could have givefl her — who knoivs 
but what she would have been able to defeat a race of physically 
inferior men. But even the most heroic soldiers avail little when 
confined in military hospitals suffering from the ravages due to 
overindulgence at the shrines of Venus and Bacchus. 

But even in such armies where a personal sense of honor and 
preference for moral and physical ' 'cleanliness' ' is characteristic 
of the officers and most men, hospitals are unnecessarily filled, a 
circumstance that could be avoided if the medical department 
had sufficient authority to see to it that any order emanating 
from it would be obeyed implicitly. 

That time must soon come. Humanity and self-preservation 
demand it.— G. M. B. 



APPENDECTOMY AND MILITARY SERVICE. 

IN the Deutsche MilitaerztL Ztschr,y Stabsarzt Dr. Braun 
discusses in detail the number of patients returned to duty 
as fit for military service after operation for appendicitis. 
The percentage of patients discharged for disability after suc- 
cessful appendectomy is very high. The author tries to ascer- 
tain the cause of this high percentage. He concludes that if the 
following rules are observed the percentage of disability will be 
lowered : 1. The soldier should at once report sick if he notices 
pain in the right abdominal region. 2. Immediate transfer of 
the patient to the base hospital. 3. Diagnosis made, operate at 
once. 4. Zig-zag incision. 5. Correction of the scar tissue after 
healing in cases in which drainage was employed and separate 
returning of the layers of the abdominal walls. — Fred. J. 

CONZKLMANN. 



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Georgia State Capitol* 

Zbc Htlanta ObcctinQ. 



SUPPLEMENTARY PROGRAM OF THE SEVENTEENTH 

ANNUAL MEETING OF THE ASSOCIATION 

OF MILITARY SURGEONS OF THE 

UNITED STATES. 

THE fine prospects for a successful meeting of the Associ- 
ation of Military Surgeons at Atlanta continue to be 
brilliant and attractive. The foreig£ delegation is 
steadily increasing in number. The Indian Medical Service will 
be represented this year by Lieutenant Colonel W. H. W. El- 
liot, who will be remembered pleasantly by those who attended 

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316 ASSOCIA TION OF MILITAR Y SURGEONS, 

the Buffalo meeting. The Spanish government has issued or- 
ders authorizing all medical officers who desire to attend to ap- 
ply for permission. 

The hospitality of our Atlanta friends involves a reception 
at the Piedmont Driving Club under the auspices of the Fulton 
County Medical Association, an automobile trip about the beau- 
tiful city and suburbs and closes with a good old fashioned bar- 
becue, together with many other lesser entertainments character- 
istic of southern hospitality. 

The affair will open with the usual informal reception at the 
Piedmont Hotel on the evening of the 12th, on which evening 
there will also be the regular meeting of the Executive Council. 

The first day's proceedings will open at 10:30 o'clock which 
will give ample time for all to arrive and the following program 
will be carried out: 

Reports of the work of the Association during the year 1907- 
1908. By the Officers and Committees of the Association. 

1. Report of the Executive Council. 

2. Report of the Treasurer. * 

3. Report of the Secretary and Editor. 

4. Report of the Literary Committee. 

5. Report of the Public Service Medical School Committee. 

6. Report of the Committee on Legislation. 

7. Report of the Committee of Arrangements. 

8. Report of the Necrology Committee. 

9. Report of the Enno Sander Prize Medal Board of Award. 

The relation of the Military and Naval Forces of the United 
States to Public Health. By the successful competitor for the 
Bnno Sander Prize. 

The usual public meeting will occur on Tuesday evening, 
the 13th, and the following is a tentative program for the occasion. 



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PROGRAM OF THE A TLANTA MEETING. 317 

TUESDAY, OCTOBER 13, 1908. 
8:oo o'clock p. m. 

Vat public nDeeting. 

The general public invited. 
The Chairman of the Committee of Arrangements in the chair. 
Overture ........ Orchestra 

Invocation 

Music .-...-.-- Orchestra 
The State of Georgia. - - - By the Governor of Georgia 

Music -----...- Orchestra 

The Georgia State Forces. - By the Adjutant General of Georgia 

Music --------- Orchestra 

The Medical Profession of Georgia. By the President of tlie State Medical 

Society. 
Music - • . - - - - - - - Orchestra 

The Annual Address of the President on "The Suture of Wounds of the 

Heart" By Colonel George Tully Vaughan. 
Music --------- Orchestra 

Installation of Foreign Delegates. By Major James Evelyn Pilcher^ Sec- 
retary of the Association. 
March - - - - - "■ - - - Orchestra 

Ip addition to the papers contained in the preliminary pro- 
. gram published in the last number of The Military Surgeon, 
the following will be presented: 

Method for Recording the Surgeon's Orders in Hospital. 
By Former Acting Assistant Surgeon Harold D. Corbusier, 
U.S.A. 

The Card System as Adapted to Property Accounts. By 
Brigadier General Charles C. Foster, M.V.M. 

A description of an admirable solution of the question as worked out 
in the Medical Department of the Massachusetts Volunteer Militia. 

The Organization and Training of the First Aid Corps of 
^ the Philadelphia and Reading Coal and Iron Company and A 
New Model Mine Ambulance. By Major George H. Halberstadt, 
N.G.Pa. 

A New Detached Service Medical Outfit. By Captain Je.*se 
R. Harris, U.S.A. 

Service Schools for the Militia. By Captain G. Morgan 
Muren, N.G.N. Y. 



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318 ASSOCIA TION OF MILITARY SURGEONS, 

The Civilian Aid Society in its Relation to the Military 
Service. By Major James Evelyn Pilcher, late U.S.V. 

A review of the work of civilians in aiding the ill and injured in mili- 
tary operations, followed by a discussion of the place of such organizations 
in peace as well as in war and of the best methods of developing their work, 
by the Director General of the National Volunteer Emergency Service. 

The Organization and Initial Work of the Medical Depart- 
ment when Volunteers are Called into Service. By Major Fred- 
erick P. Reynolds, U.S.A. 

A Diagram of the Medical Organization, U.S. Army, for 
Service with a Division; Designed for the Purpose of Instruct- 
ing the Hospital Corps and to Show Where the American 
National Red Cross Can be of Assistance in Time of War. By 
Lieutenant G. H. Richardson, U.S.M.R.C. 

Retrospect of Cooperative Work of the Medical Services of 
the Government. By Surgeon H. W. Austin, P.H.&M.H.S. 

A Method of Disposing of Excrementitious Matters, Suita- 
ble forTemporary Camps. By Major Herbert A. Arnold, N.G.Pa. 
Can be installed the instant camp is established, is sanitary, fly proof 
and readily portable. 

Military Sanitary Problems in the Philippine Islands. By 
Colonel Louis Mervin Maus, U.S.A. 

Brief outline of the physical and climatic conditions of the Philippine 
Islands. Origin and sociological conditions of the natives. Domestic and 
municipal sanitation among the Filipinos. Number of troops in the Phil- 
ippines and nature of service. Barracks, food, clothing and general sani- 
tation. Effects of climate, alcohol, habits and nostalgia on troops serving 
in the Philippines. Prevailing diseases. Vital and mortuary statistics and 
their comparison between those of troops serving in the Philippines and at 
home. Health of native and colored troops as compared with that of white 
troops. Sanitary measures necessary to secure best results. Ideal bar- 
racks for American troops serving in the tropics. 

The Field Hospital of the Austrian Red Cross. By Stab- 
sarzt Dr. Johann Steiner, Austro-Hungarian Army. 

A sketch of the Red Cross Hospital arrangements in Austria-Hungary 
by an officer of the War Ministry. 

The Origin and Condition of the Peoples who make up the 
Bulk of our Immigrants and the Probable Effect of their Ab- 



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PROGRAM OF THE A TLANTA MEETING. 319 

sorption upon our Population. By Medical Director Manly 
Hale Simons, U.S.N. 

Man was evolved from a simian stem in a now sunken continent. The 
white race arose in Northern Africa. The races should not be crossed, but 
the crossing of varieties within the race is necessary for its intellectual and 
physical advancement. Degradation and extinction are inherent and cer- 
tain in a bad environment. Mental, moral and physical training must be 
insisted upon to combat th^se tendencies. The military efficiency and moral 
force of our population are decreasing. It is the duty of medical men to 
impress this upon the public and to recommend means to combat the evil. 

The Study of Military Hygiene for the National Guard Of- 
ficer. By Dr. Robert Smart, Former Assistant Surgeon, U.S.A. 
Efficiency of an army depends upon efficiency of each department but 
more particularly upon the Medical Department. The study of hygiene 
should begin with the unit, hence the importance of physical examination 
of recruits which is too frequently perfunctory in character. The prevent- 
able diseases, necessity of line officers and enlisted men recognizing the care 
to be taken to prevent them. The study of hygiene should begin with 
thorough instruction of Hospital Corps, then with officers of the line by 
whom the enlisted personnel should be instructed. The value of the Army 
Medical School. A method of practical teaching nf hygienic duties to the 
state officer by the regular when both are encamped together outlined. 

Variola Hemorrhagica. By Passed Assistant Surgeon R. 
E. Ebersole,P.H.&M.H.S. 

An account of two cases of this form of smallpox, with deductions as 
to diagnosis and treatment. 

Felon or Whitlow. By Former Acting Assistant Surgeon 
John Hudson Grant, U.S.A. 

We have in felon an infectious inflammation of palmar surface of fingers 
and thumb, and owing to perpendicular arrangement of the fibers pus readily 
extends in the finger, that of the little finger and thumb likely to extend to 
palm and forearm. Apparently of spontaneous origin, but resulting from, 
perhaps, trivial injury, frequent among men in army service. Diagnosis 
not easily mistaken ; symptoms are locally characteristic and in severe 
cases constitutional disturbance. Those opening spontaneously not desira- 
ble cases; treatment prompt deep incisions, neglect of this for abortive 
measures lead to loss of function or of hand. Refers to new method of 
therapy, the opinions of Wright and Douglas and the production of an im- 
munizing substance^— protective vaccine. 

Papers are also promised by: 

Major T. E. Carmody, N.G.Colo. 

Major John Adams Metzger, U.S. V. 



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flews of the Services* 



Passed Assistant Surgeon J. F. Anderson, P.H.&M.H.S., ordered to 
Arundel-on-the-Bay, Md., for special temporary duty. 

Lieutenant Colonel W. H. Arthur, U.S.A., appointed member of the 
Washington Promotion Board. 

Lieutenant M. Ashford, U.S.A., ordered from Washington Barracks 
to the camp of instruction at Fort Benjamin Harrison, to rejoin Co. C, 
Hospital Corps. 

Passed Assistant Surgeon L. P. H. Bahrenburg, P. H. &M. H. S., 
granted one month's leave. 

Lieutenant Edward Bailey, M.R.C., ordered to active duty in the ser- 
vice of the United States and assigned to Fort George Wright. 

Surgeon P. H. Bailhache, P.H.&M.H.S., granted twenty days leave. ^ 

Captain H. H. Baily, U.S.A., ordered in addition to his present 
duties at Fort Myer, to make the necessary sanitary inspection of the 
rooms occupied by the clerical force of the War Department during the 
absence of Major Paul F. Straub, and appointed member of the board on 
the horsemanship test of field officers. 

Lieutenant Charles L. Baker, M.R.C., assigned to active duty at his 
present station. 

Surgeon C. E. Banks, P.H.&M.H.S., granted twenty days leave. 

Lieutenant Fred M. Barney, M.R.C., granted one month's leave. 

Captain C. J. Bartlett, U.S.A., granted leave of absence to visit the 
United States to take effect upon the arrival of the transport Kilpatrick 
and ending September 15. 

Assistant Surgeon J. A. Biello, U.S.N., ordered from duty with the 
Pacific Torpedo Fleet to the Mare Island Naval Hospital. 

Lieutenant Colonel H. P. Birmingham, U.S.A., relieved from duty 
as a member of the Washington Promotion Board. 

Passed Assistant Surgeon L. W. Bishop, U.S.N., ordered to the 
New York Naval Hospital, and to temporary duty at the New York 
Naval Recruiting Station. 

Captain R. M. Blanchard, U.S.A., granted one month's extension of 
leave. 

Captain H. D. Bloombergh, U.S.A., granted twenty days leave. 

Surgeon E. S. Bogert, U.S.N., ordered from the Newport Naval 
War College to the New York Naval Recruiting Station. 

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NEWS OF THE SERVICES. 321 

Lieutenant M. H. Bowman, M.R.C., ordered to active duty in the 
service of the United States. 

Medical Director J. C. Boyd, U.S.N., ordered to additional duty in 
command of the Naval Medical School Hospital. 

Lieutenant L W. Brewer, M.R.C., granted thirteen days leave. 

Assistant Surgeon F. H. Brooke, U.S.N., ordered from the J/<7«/- 
gomery to the Boston Naval Hospital. 

Passed Assistant Surgeon E. M. Brown, U.S.N., unexpired portion 
of sick leave revoked; ordered to the Los Angeles Naval Recruiting 
Station. 

Captain 0. G. Brown, U.S.A., granted ten days leave. 

Lieutenant Earl H. Bruns, U.S.A., ordered to Fort Monroe upon ex- 
piration of leave; ordered from Fort Monroe to Fort Bayard. 

Assistant Surgeon C. W. O. Bunker, U.S.N. , ordered from the y^r- 
kansas to the Montgomery. 

Captain W. E. Butler of the Field Hospital, N.G.N.Y., recently met 
with a severe accident by a collision with an automobile but is now im- 
proving. 

Lieutenant Daniel P. Card, M.R.C., ordered to active duty in the 
service of the United States. 

Major W. F. Carter, U.S.A., grantedone month's extension of leave; 
ordered to Fort Myer September 16, for the purpose of undergoing the 
physical examination and testing his skill and endurance in horseman- 
ship. 

Lieutenant G. E. Chamberlain, M.R.C., ordered to active duty in 
the service of the United States. 

Passed Assistant Surgeon Taliaferro Clark, P.H.&M.H.S., ordered 
to Lebanon, Pa., for special temporary duty. 

Captain J. M. Coffin, U.S.A., g^ranted one month's extension of 
. leave. 

Passed Assistant Surgeon G. L. Collins, P.H.&M.H.S., commissioned 
from July 9, 1908. 

Captain C. F. Craig, U.S.A., appointed member of the Fort Leaven- 
worth Examining Board vice Captain Bloombergh. 

Captain R. M. Culler, U.S.A., ordered from Fort Monroe to Fort 
Ontario instead of to Fort Logan H. Roots. 

Lieutenant W. O. Cutliffe, M.R.C., ordered to Fort Mcintosh. 

Lieutenant W. H. Dade, M.R.C., granted two months and fifteen 
days leave. 

Lieutenant G. W. Daywalt, M.R.C., ordered from the Depot of Re- 
cruits and Casuals, Angel Island, to the Presidio of San Francisco for 
temporary duty. 

Captain M. A. DeLaney, U.S.A., detailed to act as judge at the third 
annual contest of the First Aid Corps of the Pennsylvania Coal Co. and 



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322 NEiVS OF THE SERVICES. 

the Hillside Coal & Iron Co., to be held on October 3, at Inkerman, near 
Scranton, Pa. 

Acting Assistant Surgeon J. M. Delgado, P.H.&M.H.S., granted 
twenty-nine days leave. 

Passed Assistant Surgeon P. T. Dessez, U.S.N., unexpired portion 
of leave revoked ; ordered from the Chicago to the Las Animas Naval 
Hospital. 

Brigadier General Calvin DeWitt, U.S.A., a distinguished retired 
medical officer of the Army, died at the home of his son, Captain Wallace 
DeWitt, Medical Corps U.S.A., September 3, 1908. 

Surgeon O. Diehl, U.S.N., ordered from the Philadelphia Navy Yard 
to the Charleston and to additional duty as fleet surgeon of the Third 
Squadron, Pacific Fleet 

Dr. C. E. Doerr, U.S.A., ordered from Cincinnati to Fort Thomas 
for temporary duty. 

Assistant Surgeon H. L. Dollard, U.S.N., ordered from the Rhode 
Island io the Albatross. 

Dr. Pascal M. Dowd, U.S.A., ordered from Fort Ontario home to 
Oswego, N. Y., and report to the Surgeon General for annulment of 
contract. 

Assistant Surgeon J. T. Duhigg, U.S.N., ordered from the Los 
Angeles Naval Recruiting Station to duty with the Pacific Torpedo Fleet. 

Lieutenant C. T. Dulin, M.R.C., ordered to active duty in the ser- 
vice of the United States. 

Captain L. C. Duncan, U.S.A., appointed member of a board to 
examine officers of the Medical Reserve Corps at Fort William H. Har- 
rison. 

Acting Assistant Surgeon N. J. Dynan, P.H.&M.H.S., granted one 
month's leave. 

Lieutenant A. H. Eber, M.R.C., relieved from further duty in the 
Philippines and upon expiration of present leave ordered to Fort De Soto. 

Passed Assistant Surgeon Harvey G. Ebert, P.H&M.H.S., commis- 
sioned from July 9, 1908. 

Lieutenant Colonel W. H. W. Elliot, LM.S., who was the delegate 
of the Indian Medical Service at the Buffalo meeting, has been detailed 
by the government of India to represent it at the Atlanta meeting. 

Passed Assistant Surgeon C. F. Ely, U.S.N., ordered from the 
Hartford to the Charleston. 

Acting Assistant Surgeon G. D. Fairbanks, P.H.&M.H.S., granted 
twenty days leave. 

Assistant Surgeon C. M. Fauntleroy, P.H.&M.H.S., ordered to 
Mobile, Ala., for special temporary duty and return to New Orleans, La. 

Captain Peter C. Field, U.S.A., ordered to Fort Benjamin Harrison 
for temporary duty. 



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NEIVS OF THE SERVICES. 323 

Captain J. H. Ford, U.S.A., appointed member of a board of med- 
ical officers for the examination of officers of the Medical Reserve Corps 
at Fort William H. Harrison. 

Passed Assistant Surgeon M. H. Foster, P.H.&M.H.S., granted 
twenty-one days leave. 

Assistant Surgeon T. G. Foster, U.S.N., ordered from the Newport 
Naval Training Station to the Newport Naval Hospital. 

Acting Assistant Suigeon C. M. Frissell, P.H.&M.H.S., granted ten 
days leave and eight days leave without pay. 

Surgeon M. F. Gates, U.S.N., ordered from the Charleston to the 
Philadelphia Navy Yard. 

Lieutenant W. R. S. George, M.R.C., ordered from Fort Greble to 
Fort Totten. 

Assistant Surgeon H. A. Giltner, U.S.N., appointed from September 
10, 1908. 

Passed Assistant Surgeon M. W. Glover, P.H.&M.H.S., appointed 
delegate to the meeting of the Washington State Medical Association at 
Walla Walla, Wash. 

Captain G. H. R. Gosman, U.S.A., ordered from Fort Morgan to 
Fort Barrancas. 

Lieutenant Frank C. Griffis, M.R.C., order to Fort Benjamin Har- 
rison revoked. 

Dr. A. M. Guittard, U.S.A., ordered home to Alliance, Ohio, for an- 
nulment of contract. 

Assistant Surgeon M. C. Guthrie, P.H.&M.H.S., granted one month's 
leave. 

Lieutenant C. H. Halliday, M.R.C., ordered from Fort Sam Houston 
to Fort Fremont. 

Lieutenant Francis A. Halliday, M.R.C., ordered before the Wash- 
ington Examining Board for examination; retired from active service 
September 13, 1908. 

Lieutenant L. H. Hanson, U.S.A., ordered to Fort Sam Houston. 

Acting Assistant Surgeon G. G. Hart, U.S.N., ordered from the 
Albatross home to wait orders. 

Lieutenant H. E. Hasseltine, M.R.C., granted two months 
leave. 

Assistant Surgeon G. S. Hathaway, U.S.N., ordered from the Bos- 
ton Naval Hospital to Washington for examination for promotion and 
then to wait orders; ordered to duty in connection with fitting out the 
Wyoming and to duty on board that vessel when commissioned. , 

Assistant Surgeon A. B. Hayward, U.S.N., ordered irom the Pitts- 
burg Marine Recruiting Station to the Dallas Naval Recruiting Station. 

Medical Director L. G. Heneberger, U.S.N., commissioned from Sep- 
tember 2, 1908. 



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1 



324 NEWS OF THE SERVICES. 

Lieutenant 0. F. Henning, M.R^C.,ordered to accompany the command 
at Fort Sheridan to Fort Benjamin Harrison. 

Assistant Surgeon R. B. Henry, U.S.N., appointed from September 
10, 1908. 

Passed Assistant Surgeon W. C. Hobdy, P.H.&M.H.S., granted 
fourteen days leave and ordered to the Mare Island Naval Station for 
special temporary duty. 

Passed Assistant Surgeon W. S. Hoen, U.S.N., ordered from duty 
as assistant to the Inspector in charge of the 3rd Lighthouse District, 
Tompkinsville, N.Y., to the New York Naval Hospital for treatment; or- 
dered to duty with flotilla of Lighthouse vessels en route to Pacific 
Coast. 

Passed Assistant Surgeon John M. Holt, P.H.&M.H.S., appointed 
delegate to the meeting of the Washington State Medical Association at 
Walla Walla, Wash. ; granted sixteen days leave. 

Lieutenant G. B. Jones, M.R.C., ordered from Fort George Wright 
to Fort Benjamin Harrison. 

Lieutenant H. W. Jones, U.S.A., granted three months leave to 
take effect about January 16, 1909, upon the arrival of the transport 
Buford at Manila; he is authorized to return to the United States via 
Asia and Europe. 

Surgeon P. C. Kalloch, P.H.&M.H.S., ordered to the Portland, Me., 
Marine Hospital for special temporary duty and return to the Portland, 
Maine, Quarantine Station. • 

Acting Assistant Surgeon H. W. Keatley, P.H.&M.H.S., granted 
twenty-seven days sick leave. 

Major F. R. Keefer, U.S.A., ordered from the Presidio of Monterey 
to San Francisco on or before September 10, for duty as acting chief sur- 
geon of the Department of California during the absence of Colonel 
George H. Torney. 

Acting Assistant Surgeon William Keiller, P.H.&M.H.S., granted 
twenty-three days leave. 

Captain E. D. Kilboume, U.S.A., ordered from Fort Brady to San 
Francisco, thence to the Philippines November 5, 1908. 

Major Thomas J. Kirkpatrick, U.S.A., granted fourteen days leave. 

Lieutenant F. T. Koyle, M.R.C., ordered to active duty in the ser- 
vice of the United States. 

Assistant Surgeon M. E. Lando, U.S.N., ordered from the Minne- 
apolis Naval Recruiting Station to Washington for examination for pro- 
motion and then to wait orders. 

Assistant Surgeon H. H. Lane, U.S.N., ordered from duty in the de- 
partment of government and sanitation, Isthmian Canal Zone, Panama, 
to the Naval Medical School for instruction. 

Captain Leon T. LeWald, U.S.A., granted twenty-five days leave. 



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NEWS OF THE SERVICES. 325 

Passed Assistant Surgeon J. D. Long, P.H.&M.H.S., ordered to Los 
Angeles, Cal. , for special temporary duty. 

Passed Assistant Surgeon L. L. Lumsden, P.H.&M.H.S., appointed 
member of a promotion board vice Passed Assistant Surgeon A. M. 
Stimson. 

Major Charles Lynch, U.S.A., detailed to act as judge at the third 
annual contest of the First Aid Corps of the Pennsylvania Coal Co. and 
the Hillside Coal & Iron Co., to be held on October 3, at Inkernian, near 
Scranton, Pa. 

Medical Director W. A. McClurg, U.S.N., ordered home from duty 
as a member of the Washington Medical Examining Board. 

Surgeon A. M. D. McCormick, U.S.N., ordered from the Naval 
Academy to the Baltimore Naval Recruiting Station. 

Lieutenant Thomas B. McCown, M.R.C., assigned to active duty at 
his present station. 

Passed Assistant Surgeon W. N. McDonnell, U.S.N., ordered from 
Camp Perry, Ohio, to the Minneapolis Naval Recruiting Station. 

Assistant Surgeon E. G. Mackenzie, U.S.N., ordered from the New 
York Naval Hospital to the Naval Medical School for instruction. 

Passed Assistant Surgeon N. T. McLean, U.S.N., unexpired portion 
of leave revoked ; ordered from the New Orleans Naval Station to the 
Dolphin, 

Acting Assistant Surgeon H. B. McMurdo, U.S.N., ordered from the 
San Francisco Naval Training Station to the Naval Medical School for 
instruction. 

Passed Assistant Surgeon Herbert M. Manning, P.H.&M.H.S., com- 
missioned from July 9, 1908. 

Surgeon E. H. Marsteller, U.S.N., retired upon his own application 
after thirty years service, September 15. 

Major C. F. Mason, U.S.A., appointed member of a Pittsburg, Pa,, 
examining board for the purpose of examining the plant for the purifica- 
tion of water by ozone now in operation at the Homeopathic Hospital in 
that city. 

Colonel Louis M. Maus, U.S.A., is proposed for appointment again 
as Commissioner of Public Health of the Philippines by the Manila 
Cabelenews- American which refers in most complimentary manner to his 
former administration of that department. 

Passed Assistant Surgeon H. A. May, U.S.N., ordered from the Nor- 
folk Naval Hospital to duty with light-house vessels en route to the 
Pacific coast. 

Passed Assistant Surgeon G. M. Mayers, U.S.N., granted three 
months sick leave when discharged from treatment at the Naval Medical 
School Hospital. 

Lieutenant A. L. Miller, M.R.C., granted twenty days leave. 



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326 NEWS OF THE SERVICES. 

Passed Assistant Surgeon O. J. Mink, U.S.N., ordered from the 
Chicago Naval Recruiting Station to the Naval Medical School. 

Assistant Surgeon C. L. Moran, U.S.N., ordered from the Dallas 
Naval Recruiting Station to the Naval Medical School for instruction. 

Surgeon J. A. Murphy, U.S.N., ordered to temporary duty on board 
the Franklin ; ordered from the Dolphin home to wait orders. 

Assistant Suigeon W. M. Nickerson, U.S.N., retired, died at Fort 
Collins, Colo., August 19, 1908. He was a member of the Association of 
Military Surgeons. 

Passed Assistant Surgeon J. H. Oakley, P.H.&M.H.S., ordered to 
take temporary charge of the Port Townsend Marine Hospital. 

Assistant Surgeon E. H. H. Old, U.S.N., ordered to the Norfolk 
Naval Hospital. 

Captain R. U. Patterson, U.S.A., granted leave of absence to visit 
the United States to take effect upon the arrival of the transport Kit- 
Patrick and ending October 15. 

Captain G. P. Peed, U.S.A., ordered from Fort Ontario to Fort 
Monroe. 

Medical Inspector H. T. Percy, U.S.N., commissioned from Septem- 
ber 2, 1908. 

Assistant Surgeon J. R. Phelps, U.S.N., ordered from the Boston 
Naval Hospital to the Naval Medical School for instruction. 

Captain W. W. Quinton, U.S.A., granted one month's sick leave. 

Lieutenant M. A. Reasoner, U.S.A., granted twenty-four days leave. 

Assistant Surgeon E. U. Reed, U.S.N., ordered from the Mare 
Island Navy Yard to the San Francisco Naval Training Station. 

Lieutenant Colonel Charles Richard, U.S.A., ordered to Fort Myer 
September 16, for the purpose of undergoing the physical examination 
and testing his skill and endurance in horsemanship. 

Acting Assistant Surgeon H. B. C. Rinmer, P.H.&M.H.S., granted 
fourteen days leave. 

Captain T. L. Rhoads, U.S.A., orders for examination forpromption 
at Manila revoked. 

Lieutenant E. E. Roberts, M.R.C., ordered from Fort Logan H. 
Roots to Fort Sill. 

Passed Assistant Surgeon Norman Roberts, P.H.&M.H.S., commis- 
sioned from July 9, 1908. 

Passed Assistant Surgeon S. S. Rodman, U.S.N., unexpired portion 
of leave revoked; ordered to the Chicago Naval Recruiting Station. 

Passed Assistant Surgeon T. W. Salmon, P.H.&M.H.S., commis- 
sioned from July 9, 1908. 

Passed Assistant Surgeon J. W. Schereschewsky, P.H.&M.H.S., 
granted one month's leave; granted one month's extension of leave. 



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NEWS OF THE SERVICES. 327 

Lieutenant Ferdinand Schmitter, U.S.A., ordered to Fort Logan H. 
Roots. 

Acting Assistant Surgeon Louis Schwartz, P.H.&M.H.S., granted 
twenty-one days leave. 

Acting Assistant Surgeon J. T. Scott, P.H.&M.H.S., granted one 
month's leave. 

Assistant Surgeon F. E. Sellers, U.S.N., ordered from the Nevada 
to the Texas. 

Major H. A. Shaw, U.S.A., ordered to Fort Myer, September 16, for 
the purpose of undergoing the physical examination and testing his skill 
and endurance in horsemanship. 

Lieutenant J. M. Shepherd, M.R.C., granted one month's leave. 

Captain E. D. Shortlidge, U.S.A., granted fifteen days leave; resig- 
nation accepted September 15, 1908. 

Captain J. F. Siler, U.S.A., detailed to act as judge at the third an- 
nual contest of the First Aid Corps of the Pennsylvania Coal Co. and the 
Hillside Coal & Iron Co., to be held on October 3, at Inkerman, near 
Scranton, Pa. 

Acting Assistant Surgeon A. N. Sinclair, P.H.&M.H.S., granted 
twenty-five days leave. 

Passed Assistant Surgeon Frederick C. Smith, P.H.&M.H.S., com- 
missioned from July 9, 1908. 

Acting Assistant Surgeon F. E. Smith, P.H.&M.H.S., granted one 
month's leave. 

Captain Cary A. Snoddy, M.R.C., honorably discharged from the ser- 
vice of the United States. 

Lieutenant H. McC. Snyder, M.R.C., ordered from temporary duty 
at Fort Rosecrans to the San Francisco General Hospital. 

Medical Inspector J. M. Steele, U.S.N., ordered home from the 
Portsmouth Navy Yard. 

Assistant Surgeon C. F. Sterne, U.S.N., ordered from the New York 
Naval Hospital to the Naval Medical School for instruction. 

Surgeon W. G. Stimpson, P.H.&M.H.S., ordered to Tatoosh Island, 
Wash., for special temporary duty and return to Port To¥m8end, and 
granted ten days leave. 

Passed Assistant Surgeon A. M. Stimson, P.H.&M.H.S., ordered to 
Los Angeles, Cal., for special temporary duty. 

Surgeon G. W. Stoner, P.H.&M.H.S., ordered to Gowanda, Black 
Rock, Niagara Falls, N.Y., and Detroit, Mich., for special temporary duty. 

Passed Assistant Surgeon Ernest A. Sweet, P.H.&M.H.S., commis- 
sioned from July 28, 1908. 

Captain William H. Tefft, U.S.A., ordered from Washington to Cuba. 

Acting Assistant Surgeon M. C. Terry, P.H.&M.H.S., granted one 
month's leave. 



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328 NEWS OF THE SERVICES, 

Colonel George H. Tomey, U.S.A., ordered from San Francisco to 
Atascadero Ranch, Cal., for duty in connection with laying out camp and 
sanitation of same. 

Dr. C. A. Treuholtz, U.S.A., granted one month's extension of leave. 

Lieutenant George Trotter-Tyler, M.R.C., ordered from Fort Monroe 
to Fort Fremont for temporary duty. 

Assistant Surgeon H. W. B. Turner, U.S.N., ordered to the Naval 
Medical School Hospital. 

Passed Assistant Surgeon C. W. Vogel, P.H.&M.H.S., granted one 
month's leave and ordered to the Hygienic Laboratory for temporary 
duty. 

Acting Assistant Surgeon M. L. Volk, P.H.&M.H.S., appointed Sep- 
tember, 2, 1908, and ordered to the Reedy Island Quarantine Station. 

Acting Assistant Surgeon T. D. Walker, P.H.&M.H.S., granted six- 
teen days leave and twenty-six days leave without pay. 

Acting Assistant Surgeon W. S. Walkley, P.H.&M.H.S., granted 
eleven days leave. 

Surgeon E. Wasdin, P.H.&M.H.S.. granted fifteen days extension 
of leave. 

Acting Assistant Surgeon Harvey J. Watson, P.H.&M.H.S., granted 
one month's leave. 

Captain W. D. Webb, U.S.A., granted four months leave. 

Captain Frank W. Weed, U.S.A., granted one month's leave. 

Lieutenant Frank M. Wells, M.R.C., ordered to active duty in the 
service of the United States. 

Medical Director H. Wells, U.S.N., ordered from the New York 
Naval Recruiting Station to the Portsmouth Navy Yard and to additional 
duty in command of the Naval Hospital at that yard. 

Lieutenant C. I. Wertenbaker, M.R.C., ordered from Madison Bar- 
racks to Fort Wadsworth. 

Surgeon C. P. Wertenbaker, P.H.&M.H.S., granted fourteen days 
instead of one month's leave, and ordered to New York for special tem- 
porary duty; appointed delegate to the meeting of the International Con- 
gress on Tuberculosis. 

Surgeon W. M.Wheeler, U.S.N., ordered to the New York Navy Yard. 

Dr. Joseph H. Whiteley, U.S.A., granted eighteen days leave. 

Acting Assistant Surgeon L. C. Whitside, U.S.N., ordered from the 
Newport Naval Hospital to the Naval Medical School for instruction. 

Lieutenant Els worth Wilson, M.R.C., ordered from the Department 
Rifle Range, Cal., to Fort Rosecrans for temporary duty. 

Acting Assistant Surgeon J. G. Wilson, P.H.&M.H.S., granted ten 
days leave. 

Acting Assistant Surgeon Richard Wilson, P.H.&M.H.S., granted 
one month's leave and fifteen days leave without pay. 



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NEWS OF THE SERVICES, 329 

Major W. H. Wilson, U.S.A., ordered to Fort Myer, September 16, 
for the purpose of undei^ingf the physical examination and testing his 
skill and endurance in horsemanship. 

Major F. A. Winter, U.S.A., ordered to Fort Myer, September 
15, for the purpose of undei^going the physical examination and testing 
his skill and endurance in horsemanship ; appointed member of the board 
on the horsemanship test of field officers. 

Medical Director J. C. Wise, U.S.N., ordered from command of the 
Naval Medical School to duty as a member of the Washington Naval 
E2xamining and the Washington Naval Medical Ebcamining Boards. 

Captain Frank T. Woodbury, U.S.A., granted fifteen days extension 
of leave. 

Major Charles E. Woodruff, U.S.A., granted three months leave. 

Surgeon G. B. Young, P.H.&M.H.S., ordered to Milwaukee, Wis., 
for special temporary duty. 

The Naval General Hospital at Las Animas.— The name of the 
naval hospital for tuberculosis hitherto known as New Fort Lyon, Colo., 
has been changed to read the naval general hospital at Las Animas, 
the military title being unsuited for a naval institution. 

The EIxamination of Candidates for the Army Medical Corps.— 
All the twenty-eight boards before whom candidates for appointment to 
the Medical Corps of the Army appeared Aug. 3 in the various large 
posts throughout the country have reported to the Surgeon General. The 
total number of applicants was 151, of whom three withdrew before the 
invitations to take the examination were sent out The whole number of 
sets of questions forwarded was 150 and the number of candidates in- 
vited to take the examination was 149, Twelve declined; eight failed to 
appear, and 128 were examined. The physical examination threw out 
forty-one and four withdrew from the professional examination, so that 
the number that actually took the examination finally was eighty-three 
and of these twenty were successful. The examination on the whole was 
a notable one, being the largest in many years. 

Status of Officers of the Army Medical Reserve Corps.— A 
contract surgeon of the Army who accepts a position as first lieutenant 
in the medical reserve corps has his status completely changed, and, it 
18 held, he has severed any connection with* his early status as a contract 
surgeon. Any leave that he may have obtained as a contract surgeon 
ceases since that leave appertained to his status as a contract surgeon 
and he has voided that status and assumed another. It is held that from 
the moment a lieutenant of the medical reserve corps accepts active 
duty, his status is that of an officer appointed to the Army who has ac- 
cepted his appointment and that the question of leave or delays in join- 
ing would be the same as is the case with an officer of any other position 
in the regular establishment. 



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330 NEWS OF THE SERVICES. 

American Sanitation in the Philippines. —The Manila Times 
thinks that it is only by reason of the great distance of the Philippines 
from the United States that the great sanitary work of the American 
health officers in the archipelago does not figure as prominently in the 
home papers as does the commendable work of the force under Colonel 
William C. Gorgas in the Catial Zone. Says the Times : ** When the actual 
record of accomplishment is considered, the people of the United States 
have as much if not more right to feel proud about what has been wrought 
in their farthest outpost. Thus this last year, 1907, the general mortality 
in Panama was 41.24 per 1,000, while in Manila it was only 36.91. The 
same year, also, the death rate among Americans in Panama was 16.71 
per 1,000, while here it was only 9 and the year preceding it was only 
slightly over 5. When i^ is considered that much larger sums are being 
spent in health work in Panama and that greater facilities are put at the 
disposal of the board of health, and further, that the conditions sur- 
rounding Americans are practically the same in that they frequently re- 
turn to the United States for recuperation or when affected by. some 
serious but not immediately dangerous ailment, the advantage seems to 
lie altogether with the Philippines." 

Examining Boards for the Army Medical Reserve Corps.— The 
following boards have been appointed for the examination of candidates 
for the Army Medical Reserve Corps at the locations specified. New 
York City: Lieutenant Colonel Charles Richard, Major W. H. Wilson, 
Captain E. P. Wolfe ; Washington, D. C. : Major W. D. McGaw, Cap- 
tain J. B. Huggins, Lieutenant J. R. Barber ; Columbus Barracks: Major 
H. C. Fisher, Captain S. M. DeLoffre, Captain L. J. Owen ; Jefferson 
Barracks: Major A. E. Bradley, Captain R. N. Winn; Omaha, Neb.: 
Lieutenant Colonel W. B. Davis : Fort Leavenworth : Major E. L. Mun- 
son ; Fort McKinley: Captain C. W. Farr ; Key West Barracks: Captain 
J. D. Hey singer ; New Orleans, La. : Major W. P. Chamberlain ; Fort 
Ontario : Captain G. P. Peed ; St. Paul, Minn. : Major F. P. Reynolds ; 
Fort Meade : Major J. S. Kulp; Fort Sill: Major W. F. Lewis ; Presidio 
General Hospital, San Francisco : Major E. R. Schreiner ; Presidio of 
Monterey : Major F. R. Keefer ; Vancouver Barracks : Major A. N. 
Stark ; Ancon, Canal Zone, Panama : Major C. C. McCulloch, Jr. 

The Pay op the Hospital Corps. —An officer of the Army Medical 
Corps writes to the Army and Navy Journal a valuable suggestion as to 
the pay of the Hospital Corps, which embodies also a still more valuable 
suggestion as to that body. The absurdity of an Army Staff Corps with 
no commissioned officers, such as is the Hospital Corps, must have struck 
many officers. The propriety of making the Hospital Corps simply the 
enlisted portion of the Medical Corps is equally apparent. In connection 
with this might also be remarked the cumbersomeness of the present 
titles of the Hospital Corps such as * 'Sergeant, First Class, Ebeiiezer 



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NEWS OF THE SERVICES. 331 

Hiscock, Hospital Corps." The communication is: "I have been in 
hopes that some one would evidence a desire to put a quietus upon the 
nefarious scheme recently seen in print to reduce the pay of the privates 
of the Hospital Corps. The desirability of establishing a superior or 
warrant grade in the Hospital Corps is evident to all, but to do so at the 
expense of the already unfortunate private is heartless and is like taking 
milk away from sick kittens. The Hospital Corps has already received 
its death blow by the recent pay schedule, and while a dollar a month 
less may not be much, it is over six per cent of the pay of a private, and 
should not be handed out to pay a seventy-five-dollar-a-month man. I 
would suggest the following rates of pay: Private Medical Corps, $18; 
private, first class, $20; corporal, $24; sergeant, $36; sergeant, first class, 
$50; sergeant major, $75. The latter grade to be appointive by severe 
examination and not purely by seniority among the sergeants, first class. " 

Delegates TO the Seventeenth Annual Meeting.— Up to the 
date of the publication of this issue of The Military Surgeon the fol- 
lowing nations and states have named delegates to the Atlanta meeting 
of the Association : 

Great Britain : Colonel W. G. Macpherson, R.A.M.C. 

India : Lieutenant Colonel W. H. W. Elliot, I. M.S. 

Mexico : Colonel Alejandro Ross, Mexican Army. 

Portugal : Lieutenant Colonel Jose Barbosa Leao. 

Arkansas : Major J. C. Minor. 

Mississippi : Dr. Charles Le Barron, Dr. H. C. Kent, Dr. John M. 
Stanley, Dr. J. T. McLean. 

Missouri : General Frank J. Lutz, Colonel Daniel Morton, Major C. 

E. Wilson, Major E. R. Churchill, Major Harry E. Ferrell, Major Henry 
L. Walker, Major Oliver C. Gebhart, Captain W. E. Montoomeiy, Cap- 
tain Arthur C. Kimball, Captain Emmett Ballard, Captain £. E. Holtzen, 
Captain J. B. Luten, Lieutenant E. W. Slusher, Lieutenant Floyd E. 
Spencer, Lieutenant Louis H. Dandurant, Lieutenant A. V. McArthur, 
Lieutenant Henry M. Moore, Lieutenant B. W. Hays, Lieutenant J. H. 
McCoy, Lieutenant Vincil C. Williams, Lieutenant Thomas Redmond, 
Lieutenant Louis T. Pim. 

New Mexico : Dr. James A. Massie, Dr. John F. Pearce. Dr. H. M. 
Smith, Dr. S. A. Milliken. 

Oregon: Dr. Charles T. Chamberlain, Dr. Joseph D. Sternberg, Dr. 

F. C. Brosius, Dr. W. L. Cheshire, Dr. W. E. Carll, Dr. M. B. Marcell- 
lus, Dr. William H. Byrd, Dr. C. C. McCornack, Dr. R. E. L. Holt. 

Vermont : Dr. G. C. Berkley, Dr. G. R. Anderson, Dr. J. H. Dodds, 
Dr. W. E. Putnam. 

Virginia : Major Junius F. Lynch, Major James W. Henson, Major 
W. L. Old, Major A. T. Finch, Major Truman A. Parker, Captain J. 
Fulmer Bright. 

West Virginia : Major C. C. Hogg, Major Z. T. Kalbaugh, Captain 
Alonzo Andrews, Captain Victor H. Dye, Captain William A. McMillan, 
Captain A. J. Lyons, Captain J. E. Robins, Lieutenant V. A. Selby. 

Wyoming : Colonel William A. Burgess. 

In addition to the foregoing, the governments of Ecuador, San Sal- 
vador and Turkey have indicated their intention of sending delegates, but 
have not as yet announced their names. 



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Current Xtteratuie. 



THE JAPANESE NAVY IN 1905.* 

THE annual report of the Imperial Japanese Navy for 1905 
appears in English as heretofore and again excites ad- 
miration of the enterprise of our neighbors across the 
Pacific in making their work known in this manner throughout 
the English speaking world. The statistical information fur- 
nished is very complete, comprising an enormous mass of tabu- 
lation expressed in great detail with much evident accuracy and 
comprehending all phases of the medical work of their service., 

INTERNATIONAL CLINICS.t 

IN the second volume of the eighteenth series the Interna- 
tional Clinics, already so highly regarded for its sterling 
merit, continues its successful career in the presentation of 
interesting articles upon treatment, medicine, surgery, gynecol- 
ogy, ophthalmology, dermatology, orthopedics, pediatrics and 
pathology. All of its contributions are authorative, valuable, 
interesting and creditable. 

BORDERLAND STUDIES. J 

THIS interesting collection of professional papers includes 
fourteen of the most interesting and attractive addresses 
and communications for which their author is so well 
known. As a book of entertainment, as well as information, it 
should meet with widespread acceptance. 

*AimtsaI Report of the Health of the Imperial Navy for the Year 1905* 8vo; 
pp. 177. Tokyo, 1908. 

tlntematfonal Qliiics* Eighteenth Series, Vol, 11, Edited by W. T. 
LoNGCOPE, M. D. 8vo; pp. 304. Philadelphia, J. B. Lippincott Co., 1908. 

tBorderlaod Studies* Vol. II. By George M. Gould, M. I)., 8vo. pp. 
311. Philadelphia, P. Blakiston's Son & Co., 1908. 

(332) 



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VOZj. '^^ill , VO» 6. N'OVSMBKR, 1908. 



iBnno Sanber pxi^c iBesa)? 



AUTHORS ALONE ARE RESPONSIBLE FOR THE OPINIONS 
EXPRESSED IN THKIR CONTRIBUTIONS. 



THE RELATION OF THE MILITARY AND NAVAL 

FORCES OF THE UNITED STATES 

TO PUBLIC HEALTH. 

By WILLIAM COLBY RUCKER, M. A., M. D., 

PASSED ASSIST^ANT SURGEON IN THE PUBLIC HEALTH AND 
MARINE HOSPITAL SERVICE. 

HE last half century has been 
the scene of tremendous 
progress in medicine ; sur- 
gery has ceased to be a bar- 
ber craft ; internal medicine 
has been established on the 
firm foundation of modern 
pathology ; bacteriology has 
taken its position among 
the sciences ; and the product of this unparalleled advance, pre- 
ventive medicine, has been born. The part which has been 
played by the medical men of the military and naval forces in 
this stirring drama is too little Recognized, partly because of 
their own modesty and also because of the fact that too often 

(J«8) 



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334 PASSED ASSISTANT SURGEON IV. C RUCKER. 

military and naval association has been quite covered by their 
position in the medical world. 

The foundation of Darwin's great work was laid while he 
was a naval surgeon, and had he not refused a second tour of sea 
duty after his first two years' cruise, he would probably have 
remained a naval surgeon all his days. That first, and for him 
the last, cruise was the beginning of marine biology as we now 
know it, and not only paved the way for his great accomplish- 
ments of later years, but also added an impetus to histology and 
indirectly to cellular pathology. 

Koch, the father of modern bacteriology, discovered the 
cause of anthrax while an obscure surgeon in the German army 
stationed in the remote town of Wollenstein and thus made the 
beginning of that wonderful work which was to crown his later 
years. His accomplishments did more to advance the cause of 
public health than those of perhaps any man now living, and 
these saw their first fulfillment in the sanitary reforms which he 
worked in the German army. When he devised new means of 
bacterial staining and cultivation and made the announcement 
in 1882 of the finding of the bacillus tuberculosis, he made the 
first really great advance in the study and the control of the 
great white plague. His discovery of the cholera vibrio placed 
another weapon in the hand of sanitary science. 

While stationed in Constantina, Laveran saw, on the 6th of 
November, in 1880, spherical pigmented bodies in the blood of 
a patient suffering with malaria. These he believed were the 
cause of the disease, and though several years of tenacious labor 
on his part were necessary to convince a scoffing scientific world, 
he at last won his battle and proved absolutely the etiological re- 
lation of the hematazoa malariae to that disease. Not only was 
this a world victory in that it made the diagnosis of the disease 
accurate, but it also opened up a new field of biology and gave 
new hope to preventive medicine. 

This work, however, was not completed until another army 
surgeon, Ross, working on the mosquito theory evolved by 
Manzon, followed the life cycle in the body of the mosquito. 

It is a loss to military medicine that it cannot claim Don 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 335 

Carlos Finlay, whose brilliant hypothesis of the mosquito as the 
infecting vehicle of yellow fever formed the basis of Reed's great 
work. It is, however, to the lasting glory of our craft, if such 
our profession may be called, that it was one of our number 
who, by a series of careful yet dramatic experiments, placed 
what had before been theorj- only, in the category of fact. 

These are but a few of the pioneers who have blazed new 
trails to a better national health, to a higher standard of physical 
eflSciency for the nation. What shall we say of those who have 
applied these basic principles and by their thorough trial on a 
large scale proved their worth both as eradicative and preventive 
measures? The work of Wood, Gorgas, Glennan, Carter, 
White, Keen and Blue have not only rid whole cities and coun- 
tries of '' the pestilence that walketh in darkness and striketh at 
noonday," but they have awakened in the mind of the general 
public the belief that epidemics are not a visitation from God, 
but are wholly unnecessary oflFerings on the altar of ignorance 
and perhaps commercial greed. The day is not far ofiF when 
wealth will no longer be placed before health and when a cam- 
paign such as that of Ashford and King in Porto Rico and of 
White in New Orleans will arouse the plaudits of the nation like 
a great military or naval victory in human warfare. Perry, 
Strong and Reiser and a thousand other medical officers did 
more to safeguard the public health in the Philippine Islands 
and to advance the study of tropical medicine than had been done 
in the previous hundred years. It should be remembered, how- 
ever, that in the Philippine Islands the work was begun with a 
clean slate. While the native prejudices were extreme, they did 
not enter materially into the problem, because at the time of the 
beginning of public health work in the Islands they were under 
military control, and it was possible to enforce sanitary measures 
until the people should become sufficiently educated so that they 
might be left to the argument of reason rather than that of 
force. In the United States, however, the problem is a very dif- 
ferent one and must be approached in a difiFerent way. 

The recitation of the great accomplishments of our guild is 
unnecessary save to bring out the fact that all of the really great 



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336 PASSED ASSISTANT SURGEON W. C. RUCKER, 

discoveries in sanitary science and all of the far reaching appli- 
cations of the basic principles derived from these discoveries have 
been made by medico-military men. In other words, these deeds 
have been accomplished under the direction and with the assist- 
ance of the Federal Government. At first glance it would seem 
as though the Military and Naval forces of the United States, ex- 
isting for the purpose of the protection of the nation from for- 
eign foe, would not be concerned with the preservation of the 
health of the nation from its enemies in the form of disease. 
When we consider, however, the debt which preventive medi- 
cine owes to the military medical men of the world, we are 
struck with the fact that many of the most important discoveries 
with regard to epidemic diseases and their prevention have been 
made by medical officers. The work of Laveran and Reed alone 
is sufficient to establish this fact. The relation of the military 
and naval forces of the United States to public health is therefore 
of the utmost importance, not only because of the achievements 
of the past, but also because of the gigantic possibilities of the 
future. 

The last census shows that the annual death rate in the 
United States is one million five hundred thousand, in other 
words, one eightieth of the population die every year. In a re- 
cent address Dr. William H. Welch, professor of Pathology in 
Johns Hopkins University, made the statement that, ** the death 
rate can probably be cut in two if adequate measures, which are 
well within the possibilities of realization are inaugurated." 
That is to say, three quarters of a million of citizens may be 
saved every year if adequate measures be inaugurated, and con- 
versely, just so long as the inauguration of these measures is de- 
layed, seven hundred and fifty thousand lives are being wantonly 
sacrificed annually. 

What are these measures ? Is their inauguration practical 
at the present time ? To whom should be intrusted the task of 
tneir administration ? 

The first question finds its answer in a resolution passed by 
the Ohio State Legislature at its last session, proposing to vest 
in the Federal Government the right to perform the duty of safe- 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 337 

guarding and improving our national health and urging Con- 
gress * * to create and establish a National Bureau of Health and 
endow it with power and funds commensurate with the highly 
important duties with which it will be entrusted.'* 

We have seen in the foregoing brief resume of the discover- 
ies and achievements of preventive medipine that those workers 
who succeeded in the fullest measures were those who received the 
moral and financial assistance of their national governments. At no 
time has any great progress come from any individual working 
solely in his individual capacity. Finlay, the great prophet of yel- 
low fever, worked alone for twenty years and failed to convince the 
world of the correctness of his brilliant theory. Koch achieved 
success from the beginning— he was a German army surgeon and 
was subsequently subsidized by the Reichstag; Ross, of the Royal 
Army Medical Corps of England succeeded; Reed, Gorgfis, and 
Keen, all of our army, were successful; and Carter, White and 
Blue, of the United States Public Health and Marine Hospital 
Service, each fought and won his battle against a scourge. 
These victories are national achievements, yes, world achieve- 
ments, but they were accomplished as only such great acts can 
be, with the backing of the national government. 

The first measure then is the placing of the right to combat 
disease in the hands of the Federal Government. The stumbling 
block which has heretofore and still impedes progress in this di- 
rection is the doctrine that health powers are a part of the rights 
of a state and must be respected as such and preserved inviolate. 
It was only after years of tedious legislation that the present 
quarantine service has been organized, and even now several im- 
portant states on the Atlantic seaboard cling with childish 
tenacity to their quarantine rights. When the United States 
made its first definite attempt to enact a quarantine law violent 
objections were opposed. The colonies since 1700 had adopted 
acts looking to the prevention of the introduction of epidemic 
diseases, but a jealous regard for the rights of the individual 
state, fostered by the same spirit of g-rasping commercialism 
which exists to-day, prevented the enactment of laws placing 
the quarantine powers in the hands of the general government. 



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338 PASSED ASSISTANT SURGEON W. C, RUCKER, 

It was found that the port which applied the minimum quaran- 
tine restrictions and was thereby willing to stake its health 
against commercial prosperity by lax administration of its bar- 
riers against disease, got the business, and attracted shipping in- 
terests. Should a pestilence be introduced through this mis- 
guided practice, the disease was carefully concealed. In fact, in 
many places a health officer's ability to hide infection was often 
his chief qualification for office. Unfortunately, this habit has 
not altogether gone out of fashion, and the fearless health officer 
who conscientiously reports the occurrence of epidemic disease 
in his community is bitterly opposed by the commercial interests 
and the public press. It was not until 1893 that the quaran- 
tines of this country were placed on a working basis, and then 
only after one hundred and ninety-three years of outbreaks 
or threatened outbreaks of exotic diseases. Repeated 
epidemics of yellow fever brought forth repeated calls 
for a national quarantine service, only to be checked by a 
selfish regard for the vested rights of the state. The ter- 
rific outburst of yellow fever which so disastrously afflicted our 
Southern States in 1878 resulted in the introduction of a bill em- 
powering the general government to assume control of epidemics 
as an emergency measure only, but failed of passage by the Con- 
gress. In fact every attempt that has been made to confer on 
the Federal Government any power to oversee the health of the 
nation has fallen before that phrase in the Constitution which 
delegates to the states all powers not specifically granted to the 
United States. 

It needs no argument to prove that the protection of our 
coasts from invasion by exotic disease is as much a national duty 
as their protection against a human foe. The principles which 
served a loosely connected bundle of colonies do not find their 
application to a world power, yet, by a strange omission from 
the Constitution, the health of a state is held paramount to that 
of the nation of which it is a part. That sacred document does 
not contain a single phrase from which legal ingenuity can 
evolve any delegation to the nation of the right to assume any 
public health power whatsoever. 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 339 

The means then of inaugurating this first measure lie either 
in an amendment to the Constitution or in the ceding of the 
health powers of the various states to the Federal Government 
by their respective Legislatures. He would indeed be a bold 
man who would undertake such a campaign as the latter. 

There remains, therefore, but one practical measure, an 
amendment to the Constitution. Such legislation is not the 
work of a day. When we consider that about two centuries were 
consumed in securing a reasonable and necessary national quar- 
antine, we see why so little progress has been made toward the 
goal of a central health authority. It has never been proposed 
that the nation should meddle with the internal administration 
of a state, yet since **the regulation of the national public health 
was not delegated to Congress, the right to be a national nui- 
sance was reserved to the states. * ' The road to a constitutional 
amendment will be long and thorny. A nation which expends 
millions annually to promote great crops and to suppress sheep 
scab and swine cholera yet appropriates almost nothing to study 
and to prevent the diseases of man will be slow to see the need 
of caring for human health. The medical profession and the 
general public must be educated to the necessity of such an 
amendment, and while the American Medical Association and 
the Committee of One Hundred of the American Association for 
the Advancement of Science have such a movement on foot, it 
will be years before their labors will bear fruit. When we have 
aroused an educated public sentiment in health matters we can 
hope for an amendment to the Constitution. Until then we 
must work and make the best of what we now have. Public ed- 
ucation is a matter of slow growth, but properly conducted will 
achieve results. The American citizen does his own thinking. 
He does not take kindly to cheap leaflets and predigested tracts, 
but if he is shown "why," he can be interested ; and, being in- 
terested, he will co-operate in any movement for the public 
good. Time, however, is required before this can be accom- 
plished. 

In the interim, if we are to accept Prof. Welch's statement, 
the annual sacrifice of three quarters of a million of liumaA lives 



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340 PASSED ASSISTANT SURGEON W. C, RUCKER, 

must continue. What can be done in the way of an emergency 
measure to relieve this useless waste of the nation's greatest 
asset? 

At present we have three great bodies in the national line of 
defense against disease, the Public Health and Marine-Hospital 
service and the Medical Corps of the Army and of the Navy. 
The first conducts our quarantines, examines all alien immi- 
grants, and directs all epidemic campaigns. The Army Medical 
Corps not only cares* for the health of its fighting units, but also 
by its work in our insular possessions and in the Canal Zone 
does much for the national health, both by precept and practice. 
Both the army and the navy send back into civil life each year 
many men who by their training in both personal and military 
hygiene are able to do much to further the education of the gen- 
eral public in these matters. The sanatoria maintained by the 
Army, the Navy and the Public Health and Marine-Hospital 
Service remove from contact with the general public thousands 
of persons suffering with tuberculosis. Those who are cured re- 
turn to their homes, there to spread the doctrine of the cure of 
the disease by proper living and hygienic precautions. 

The Army and the Navy, however, find their great relation 
to the public health in the discoveries which come from tlie un- 
biased minds of their medical officers who have unusual ad- 
vantages for studying diseases and the measures to be adopted 
for their eradication. Their time is too occupied in caring for 
the physical condition of the fighting machine to permit their at- 
tacking those great problems of sanitation as they affect the civ- 
ilian population. 

The National Guard finds its place of usefulness in the 
thousands of young men who are annually trained in the basic 
principles of camp sanitation and personal hygiene. This should 
be made the subject of a course of lectures to be delivered by 
their medical officers. It would be perfectly proper and advisa- 
ble to include in this course a lecture on public health and to 
point out their duties to the community, not only as members of 
the National Guard, but also as citizens. Instruction of this 
character would be especially valuable and would do much to 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 34I 

improve public health conditions in this country, reaching as it 
would the younger generations of the better class ; but unfor- 
tunately it would affect only a small percentage of the popula- 
tion. The National Guard then can no more carry on national 
public health work than can the Army of which it is the proto- 
type. 

The preservation of the public health therefore must be left 
to the Public Health and Marine- Hospital Service until such time 
as a constitutional amendment which will establish a great De- 
partment of Public Health can be secured. 

This is the aim of a widespread and growing movement ex- 
tending throughout the United States and supported by Amer- 
ica's most active workers for public good ; the end being to cen- 
tralize under a Federal head all means of prolonging and saving 
so far as possible the health and lives of American citizens ; to in- 
vest in that head facilities for carrying out such work as may be 
found necessary to preserve what President Roosevelt has termed 
our ''national eflficiency." The movement now in progress for 
the establishment of national control of public health is no new 
thing. So long ago as 1871 the American Medical Association 
seriously considered the matter and passed resolutions to the 
effect that a national health council should be formed. A year 
later the definite plan to inaugurate a National Department of 
Health was presented, but met with objection. The following 
year the matter was again placed before the Association, but 
the resolution was tabled. From time to time this movement 
has presented acute exacerbations, but, save for the founding of 
the short lived National Board of Health in 1878, the end seems 
no nearer of attainment, and almost every resolution or motion 
on the subject has met an ignominious end in the pigeon-hole. 
The present movement, however, may hope for success. The 
profession and the general public have awakened to a realization 
of the need and the possibilities of a National Department of 
Health, and endeavors in this direction will meet with more 
hearty approval than in 1871. The fruition of these plans will 
crown the marvelous advance which the science of medicine has 
made during the last three decades, the advance into the domain 



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342 PASSED ASSISTANT SLTRGEON W. C. RUCKER. 

of preventive medicine. Remedial medicine has occupied the 
medical stage for centuries; to-day it must give place to pro- 
phylaxis. Before this millenium can be reached, however, 
thousands must perish while we are devising a means for their 
salvation. 

Just exactly what is being done to render disease impossi- 
ble in the United States to-day ? 

The first line of defense is the City Health Officer. In the 
larger cities and towns there are often very talented men as phy- 
sicians or surgeons. Usually they are the most prominent med- 
ical men of the community. Unfortunately they are almost 
almost "rule of thumb*' sanitarians and have no great theoret- 
ical or practical training in the duties which they are to per- 
form. It should be said in justice to them, however, that this 
is not their fault. There is but one medical college in this 
country offering a course leading to the degree of Doctor of 
Public Health. Many years ago a course in State Medicine 
was offered by Rush Medical College, but was abandoned for 
want of applicants. Few medical colleges teach anything of 
the duties of public health officers, and for the most part lec- 
tures on hygiene are perfunctorily delivered and laxly attended. 
Too often the City Health Officer has such a large private prac- 
tice that it is impossible for him to attend to his public duties. 
He must therefore intrust the discharge of these important 
functions to underlings whose sole qualification for the positions 
they occupy is the number of votes they can control, and who 
have little knowledge or interest in the work they are supposed 
to perform. Frequently the City Health Officer receives no sal- 
ary or perhaps only a small annual stipend. None of these 
things tend to make efficiency. 

What has been said of city health officers applies equally to 
county health officials. In some instances they are not even 
medical men, a local undertaker or veterinarian discharging 
those important functions. Usually they are honest, hardwork- 
ing, underpaid physicians who discharge their duties as well as 
their defective sanitary education will allow. 

The state health work is usually done almost entirely by the 
Secretary and the President of the State Board of Health, too 



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MIUTAR YAND NA VAL FORCES AND PUBLIC HEALTH 343 

often the other members of which are **swivel chair** sanitarians 
who attend the meetingsof the Board and that is all. The whole 
system is hampered by lack of educational advantages. If there 
was any opportunity for study along the lines of their work, 
many health officers would avail themselves of it. As it is, 
there is but one such course offered in the United States. 

The cure for this evil lies evidently in better education. Ed- 
ucation for city, county and state health officers must be pro- 
vided. It must take the form of a short practical course, and it 
should be free to any health officer. We cannot expect men to 
accept positions in which the execution of their duty will make 
for them life long enemies unless we offer some inducement. 
Many good men are withheld from public health positions by 
their own feelings of unfitness for the place; more because of 
the small salary usually attached to the positions. Local health 
officers must therefore be better paid. They should also receive 
training in the duties pertaining to their position. Congress has 
now under consideration a bill creating such a course in the Hy- 
gienic Laboratory in Washington. This bill should be made a 
law. The section relating to the founding of the school of hy- 
giene reads as follows: 

'*That to facilitate co-operation between State and Terri- 
torial Boards of Health or departments of health including the 
District of Columbia, and the Public Health and Marine-Hos- 
pital Service, there shall be established a school of hygiene for 
which the facilities of the hygienic laboratory shall be available. 
Regulations for admission to and for the conduct of said school 
shall be made by the Surgeon- General with the approval of the 
Secretary of the Treasury. There shall be received in this 
school, with such limitations as may be deemed necessary. State, 
county and municipal health officials, on application by the Board 
of Health or Health Department of any State, Territory or the Dis- 
trict of Columbia; Provided, That satisfactory assurance is given 
with the application and by the health officer himself that the 
special instruction desired is to be utilized in the performance of 
official health duties. Officers of the Public Health and Marine 
Hospital Ser\ace shall be detailed as instructors in said school* 



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344. PASSED ASSISTANT SURGEON W, C. RUCKER, 

and officers of said Service may also be detailed to receive in- 
struction. An official, upon satisfactory completion of the course 
of study in sanitary science as prescribed in the regulations, 
shall be entitled to a certificate to that effect.'* 

The second part of the cure is covered by the oft repeated 
phrase **the education of the general public.** Local health offi- 
cers should receive higher renumeration. Some incentive should 
be offered to induce men of ability to make public health posi- 
tions a life work and sufficient salary should be paid to make 
it worth while for a physician to devote his entire time to the 
discharge of his official duties. An underpaid official is either 
going to perform his duties in a perfunctory manner or neglect 
them altogether. 

The general public must be taught to hold its public health 
officer responsible for the occurrence of epidemics of measles, 
diphtheria and scarlet fever. They must be informed that these 
are wholly preventable diseases, the occurrence of which is a 
reflection on the sanitary organization and intelligence of the 
community. If they have these views on this important subject 
there will be no objection on the part of the taxpayer to sending 
the health officer on full salary and expenses to Washington for 
the purpose of attending the School of Hygiene. Municipal 
garbage collection and disposal will become the rule instead of 
the slipshod methods which now too often prevail, and the 
frightful pollution of the streams of our country with animal ex- 
crement will no longer be tolerated. 

By whom should this instruction be given? It has already 
been shown that the American public does its own thinking; 
that it simply requires of a teacher that he furnish demonstra- 
tion and proof of the statements which he makes, that it is prac- 
tical and will make no changes unless the practical side of the 
question is clearly shown. Who is in a better position to direct 
this education than the medical profession, but it should not be 
given by us alone. Happily there is work enough to go round 
and we will find that the solution of any economic or social 
question will be greatly facilitated if we invite the assistance of 
those lay workers who have done so much in carrying forward 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 345 

the tuberculosis fight, the movement for park systems and the 
better housing of the poor. Harrington points out that *'it was 
a lay commission who paved the way to the establishment of the 
first State board of health in America by pointing out that the 
average length of human life was too short, that the annual 
waste of life could be largely reduced, that much unnecessary 
sickness was preventable and that the thousands of unnecessary 
deaths, the millions of days of unnecessary sickness and the vast 
amount of unnecessarily impaired health and physical debility 
meant an enormous pecuniary and social burden which might be 
avoided; in short, that preventive medicine is a most compre- 
hensive social and economic problem. It is very largely to phil- 
anthropic laymen and to students of economics that the credit 
for the worldwide movement against tuberculosis belongs. To 
undervalue the importance of the lay readers and teachers in 
creating a public sentiment in favor of state medicine, is as 
short-sighted as to overrate that of a medical man who may have 
no adequate conception of the real functions of a public health 
office.*' 

Part of this education must come from the Federal Health 
Service, but the great bulk of this work must be done by the 
medical profession as a whole. First we must educate ourselves. 
Then we can teach others. '*The average medical man has no 
very clear conception of the value of a good system of sanitary 
bookkeeping or of the methods of applying the knowledge ob- 
tained by studying a mass of statistical data, and yet it is upon 
the registration of vital statistics that we must depend to deter- 
mine the actual results of public health measures. In order to 
become an effective part of the educational force, he should ac- 
quaint himself with the importance of a great central registra- 
tion office so as to be able clearly to demonstrate it." How few 
states have anything like an accurate system of keeping vital 
statistics and how many of our professional brothers in civilian 
life pay no attention whatever to the registration of the facts 
going to make up those statistics. It is offered in extenuation 
that it takes time and after all is a useless piece of red tape, and 
in those few states in which no certificates of death, no inter- 



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346 PASSED ASSISTANT SURGEON W. C. RUCKER. 

ment permits and no returns of death are required, it is urged 
that clerks cost money. First then must come the education of 
the medical profession itself. This is being undertaken by the 
American Medical Association and is already bearing fruit. The 
Society for the Study and the Prevention of Tuberculosis, while 
attacking only a single phase of the problem, is endeavoring to 
reach the whole public and indirectly is doing much to plant in 
the lay mind the seeds of sanitary reform. 

We must realize that in this campaign of education we have 
more to fear in our own ranks than from the layman. This 
does not apply to the medical oflScers of the Army, Navy, 
Public Health and Marine-Hospital Service or of the National 
Guard. These are picked men, trained in sanitation and fully 
alive to their duties both as officers and citizens. It is the pro- 
mulgator of half truths and unscientific statements, and the 
assinine skeptic who decries modern prophylaxis who will do 
most to hurt the cause. The dogmatically ignorant attracts at- 
tention and is followed. The modevSt and conservative voice of 
science has no chance with the layman against these blatant ut- 
terances. 

The education of the public of San Francisco during the re- 
cent epidemic of bubonic plague affords an excellent example of 
what may be done if the problem is approached tactfully. When 
Passed Assistant Surgeon Rupert Blue took command of the 
plague suppressive measures in September, 1907, there was a 
widespread feeling of apathy, in some parts even of open antago- 
nism, in that city. The people and press utterly disregarded 
the awful situation which faced them. Quietly and with great 
care lest a too sudden awakening should bring about an exodus, 
the campaign of education was begun. Reaching its full swing 
in January, 1908, the Citizens Health Committee was organized, 
$165,000 was raised, meetings of every tradesunion, labor coun- 
cils, commercial, social and religious organizations were held. 
Dr. Blue and his officers going from meeting place to meeting 
place, teaching the people of the danger that confronted them. 
Instantly they set to work to assist in the cleaning of the city and 
the extermination of the rat; homes, stores, markets and vacant 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 347 

lots were cleared of rat food, the city was bonded to build new 
sewers, a new garbage crematory, and the plague was stayed. 
More than that, the number of deaths from other contagious dis- 
eases has been reduced thirty-three and one third per cent and 
typhoid fever reduced by more than half. The city has not been 
so clean in years and the lesson of sanitation learned in the harsh 
school of terror of plague will do much to further the public 
health movement in other directions on the Pacific Coast. Had 
the people been approached less tactfully, or by one in whom 
they had no confidence this could not have been accomplished. 

In the same city there are delivered each year in the Cooper 
Medical College a series of lectures to which the general public is 
invited. These deal with the great public health problems which 
are now confronting us. They are well attended and have pro- 
ven a most gratifying success. They have resulted in a wide- 
spread interest in public hygiene and a better mutual under- 
standing between the profession and the general public. 

During the New Orleans yellow fever epidemics of 1905, 
Surgeon J. H. White inaugurated a series of popular lectures 
on yellow fever. These have been continued by the State Board 
of Health and there are now few persons in the State of Louis- 
iana who are not familiar with Finlay's hypothesis or Reed's 
heroic work. This is the right sort of public health work and 
one of the most important relations of the military and naval 
forces of the United States to public health. We can do much 
as educators, for the utterances of a Federal officer carry great 
weight with the thinking public. 

The last link in the chain is the Federal Health Service, 
the Public Health and Marine-Hospital Service. This is an 
underofficered and overworked corps covering a large field of 
responsibilities. Its activities may be divided into two parts, its 
military and naval duties and its public health functions. In the 
first category fall the Marine Hospitals, in which sixty thou- 
sand sailors are treated annually, its service on board the ves- 
sels of the Revenue Cutter service, and its liability to duty with 
either the Army or the Navy in time of war. In the second 
group are the Hygienic Laboratory, the Immigration Service, the 



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348 PASSED ASSISTANT SURGEON W, C, RUCKER, 

Quarantine Stations and the epidemic suppressive campaigrns. 
It is therefore both a military and naval service of the United 
States, having a most important relation to the public health. 
By its quarantines both at home and abroad and the careful med- 
ical examination of alien immigrants, this corps reduces to the 
minimum the entry of epidemic disease into our ports. By its ep- 
idemic suppressive work it has been able, when given the oppor- 
tunity, to eradicate epidemics breaking out within our borders. 
The first application of the mosquito dogma to a large epidemic 
of yellow fever in this country was made by this corps and the 
only campaigns against bubonic plague in America have been con- 
ducted under its direction. This Service also collects data con- 
cerning the incidence of the various diseases dangerous to the 
public health in all parts of the world, examines all establish- 
ments engaged in the interstate commerce in vaccines, serums 
and antitoxins, conducts researches in medical zoology, biologi- 
cal chemistry, pharmacology, bacterology and other fields of 
sanitary science, and engages in other miscellaneous investigations. 
It conducted the examinatibn of federal employees and the pub- 
lic buildings in which they worked in the District of Columbia 
to determine the amount of tuberculosis among them and the 
bearing which the sanitary condition of the workshops might 
have on the disease. Its report on typhoid fever in the District 
of Columbia and the bulletin on the Relation of Milk to Public 
Health form valuable additions to these subjects and are a no- 
table advance toward the national assumption of the typhoid fe- 
ver and milk problem. 

Once each year, and oftener if requested by the health offi- 
cers of not less than five states, the Surgeon General is required 
by law to call the Conference of State and Territorial Boards of 
Health for the consideration of matters pertaining to the public 
health. The government assumes none of the expenses of these 
annual conferences either for travel or subsistence. A barrier 
is thus placed to the frequent consultations which should take 
place between the head of the Federal Health Service and the 
State health authorities by reason of the expense which the State 
or the individual health officer must bear and the fact that the 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 349 

call for the meeting must come from the States and not from the 
Surgeon General. These meetings are of national importance 
and return good to the nation as a whole. The necessary travelling 
expenses of the delegates should tlierefore be borne by the general 
government and they should in addition receive a compensation 
for their time including the days of travel to and from Washing- 
ton. If the states have the right to request a meeting, the same 
power should be given to the Surgeon General. These meetings 
occurring oftener than they now do would increase and cement 
the friendship now existing between the Federal and State Boards 
of Health and would be of mutual benefit. 

A bill was passed by the Senate at the last session of the 
Congress authorizing such additional conferences. The House of 
Representatives still has the measure under consideration. That 
portion of the bill referred to reads as follows: 

**Sec. 5. That in addition to the conferences now au- 
thorized by law to be held between the Surgeon General of the 
Public Health and Marine-Hospital Service and the health au- 
thorities of the States, Territories and the District of Columbia, 
when in the opinion of the Surgeon General it is in the interest 
of the public health to call a special conference to be held in 
Washington, of said health authorities of not more than five 
States and one only from each State, the delegates shall receive 
a compensation of ten dollars a day, including the days of travel 
to and from Washington and necessary traveling expenses: Pro- 
vided, That not more than five such conferences shall be held in 
any one year and the duration of such conference in Washing- 
ton shall not exceed three days.'* It is to be hoped that there 
will be an enactment of this law early in the next session. The 
Public Health and Marine-Hospital Service is the nearest ap- 
proach to a Department of Public Health which we have at pres- 
ent. If it is to best discharge its functions it should be enlarged 
and strengthened in every possible way. This body has proven 
its ability to undertake large public health measures and has 
shown that it is prudent to entrust it with the discharge of those 
even more important public health duties which aflEect both the 
mass and the individual, 



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350 PASSED ASSISTANT SURGEON W. C. Rl/CKER. 

The eradication of epidemics has fallen on the Federal 
Government as an emergency measure, not because the Govern- 
ment could under the Constitution take an active interest in the 
health of the people, but because epidemics interfere with com- 
merce and must be suppressed because they represent a loss 
which can be estimated in dollars and cents. This is the same 
principle which actuates the expenditure of large sums each 
year in investigating the diseases of swine and cattle and denies 
the passage of exactly similar legislation calling for an investi- 
gation of some of the more common diseases of man. Millions 
for hogs but not a cent for man ! The health of the people at 
large is held as unimportant as compared with that of wheat, 
cotton, poultry, swine, cattle and sheep because it cannot be 
measured by dollars and cents. Human health and human dis- 
eases are not considered as an asset or a debit and, therefore 
phylloxera in grapes and the erysipelas of swine are held to need 
more attention than typhoid fever and tuberculosis in man. 
Were it not for the terror which the strangeness of an exotic disease 
excites, they would soon be treated with the silent contempt ac- 
corded those commoner, but in the aggregate, far more fatal ill- 
nesses such as tuberculosis, typhoid fever, whooping cough and 
the whole category of so called unavoidable diseases of child- 
hood. These are the disease foes we have to fear and these are 
the ones with which the Federal Government must concern it- 
self if the health of the nation is to be maintained. We can by 
our efficient quarantine service turn from our shores alien dis- 
eases but it is the insidious gnawing of the canlfer worm of "ac- 
cepted diseases" which strikes at the root of public health. 
Disease can be and is barred from entry to our ports without un- 
necessary inconvenience to traffic; the great point is to prevent 
those diseases which have come to be regarded as inevitable. 
This is not an emergency duty— it is a permanent duty affecting 
both the physical and the financial welfare of the entire nation. 
It is therefore a Federal duty— the duty of the Federal Health 
Service to undertake the study of these heretofore disregarded 
foes we have at home. This spells two things, law and 
money. 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 351 

If it is incumbent on this service to undertake the study of 
these scourges, it is equally its duty to evolve and supply the meas- 
ures looking to their extermination. In the case of the great epi- 
demics which this corps has fought so well it has been hampered by 
many things, chief among which are a lack of funds and the ab- 
sence of a trained and well organized enlisted ^personnel. A 
most important and far-reaching precedent has been made by the 
general government in the case of the San Francisco epidemic of 
plague. It will be remembered that just a year before that city 
was stricken by plague it suffered terrific losses from fire and 
earthquake, and, after going through one of the most trying 
periods that can be imagined, rose phoenix-like from its ashes. 
When the visitation by plague came, not only was the sanitary 
condition of the city, which was only just dragging itself from 
its ashes, awful, but by reason of a term of graft and misrule the 
city treasury was depleted, the city's immediately available 
assets almost run dry. In spite of this lack of funds, San Fran- 
cisco did her best to stagger under the additional load which the 
incidence of plague entailed, but seeing that it was impossible to 
combat the plague with one hand and rebuild herself with the 
other, she called upon the Federal Government for aid. This 
was freely, even generously afforded, the government first bear- 
ing the expense of oflBcers only, next paying the salaries of the 
men, an item of about one thousand dollars per diem, and finally 
taking over practically the entire expense of the campaign, 
officers, men, transportation and supplies. Thus an important 
precedent has been created which cannot help but have its bear- 
ing on future epidemics. And this is as it should be. An epi- 
demic of any disease which will cause death or suffering or re- 
duce the wage earning capacity of a certain percentage of our 
population is not a local affair, but a matter of grave national 
import. The Pacific States should not be obliged to bear the 
expense of preventing the passage of a local disease into other 
states simply because of the geographical situation. If this be 
true of plague in California, it is equally true of small-pox in 
Maine, yellow fever in Louisiana, or dengue in Texas. And if 
these states are to be relieved of the expense of protecting their 



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352 PASSED ASSISTANT SURGEON IV, C, RUCKER, 

neighbors and the country at large, should not the cost of the 
combat with typhoid fever in Pennsylvania or uncinariasis in 
our Southern States be borne by the central government ? It 
may be safely assumed that hereafter there will be little difl5- 
culty in securing federal money with which to fight epidemics of 
high mortality. It is also to be hoped that this precedent may 
be extended so as to include the funds which should be avail- 
able for combating tuberculosis, and those commoner diseases 
which are, in their final analysis, far more dangerous. We may 
then consider the question of money as practically assured. 

What shall we say, however, regarding a trained and well 
organized enlisted personnel with which to do the heavy work 
required in epidemic campaigns ? At present the Public Health 
and Marine- Hospital Service has no enlisted personnel. It has, 
however, civil service employees, in the persons of its pharma- 
cists, clerks, nurses, hospital and quarantine attendants. With 
the exception of the pharmacists, these are not available for ep- 
idemic suppressive work. The first thing this corps has to do on 
taking the field is to employ and train a large number of men. 
These have to be gathered from every available source, and 
many of the men who present themselves for employment are 
the nondescript debris of the epidemic or the dregs of the com- 
munity. Men who are to be employed in sanitary wor£ must be 
honest. That is the first qualification, for a single case of theft 
by a member of the sanitary force would ruin utterly all the good 
impression which may have been made before, because the 
householders would be afraid to admit the members of the sani- 
tary force to the premises. These men have to be picked over 
carefully and much valuable time has to be wasted in sorting the 
wheat from the chaff. At best this is largely guess work, and it 
is wonderful that in both the New Orleans and the San Fran- 
cisco campaigns not one case of theft occurred. Granted that 
the employee is honest, he is of no value in the sanitary cam- 
paign until he has been trained. This requires time during 
which the scourge must be stayed in its march. This means 
that men of imperfect training must be put on important work 
and while the medical officers concerned with the different parts 



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MILITARY AI^D NA VAL FORCES AND PUBLIC HEALTH 353 

of the problem may endeavor to oversee the work, it is impossi- 
ble for them to check and correct the many mistakes which are 
sure to be made by men who have zeal without training. During 
the San Francisco campaign, schools of instruction for all classes 
were organized and the District Commanders already worn out 
by the work of the day, were obliged to use the time which 
should have been spent in rest, in teaching their men the prin- 
ciples on which the fight was based. This yielded good results, 
but it took at least sixty days before really good, effective team 
work was secured. This time was lost when the pestilence 
was at its height, time which might have translated it- 
self into great loss of human life and commercial pros- 
perity. It was found that at least two months were re- 
quired to produce a good rat catcher, that an inspector did not 
really reach his maximum of usefulness in that time and that 
considerable time was required for the rat-skinners and other 
laboratory employees to become expert or even proficient. 
There is at present in San Francisco as good a sanitary Corps as 
the world has ever seen, men who for one year have fought un- 
ceasingly to stay a plague and cleanse a city. When the cam- 
paign is ended these men will go back to their ordinary voca- 
tions and save for the small interest in hygiene which they may 
be able to impart to their neighbors, this valuable training which 
has been produced at the cost of so much time and painstaking 
labor, will be absolutely lost. Men who have become expert in 
the practical application of the fundamental principles of sanita- 
tion will go back to their lives as artists and artisans and their 
intricate knowledge which might be employed in a field of more 
benefit to mankind will have been thrown away, so far as the 
future is concerned. There should be some way in which to 
retain a part of these men in the service of the United States. 
There would always be work enough for them to do, for we have 
never had a time of sanitary peace since the first settlement in 
America. This would form the basis of a standing sanitary 
army, a mobile organization which would never be idle and 
would pay for its cost of maintenance many times over in human 
lives and the prevention of commercially disastrous quarantines. 



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354 PASSED ASSISTANT SURGEON W, C, RUCKER, 

Think what such an organization could accomplish in a campaign 
against typhoid fever or uncinariasis, and the time which could 
be saved in controlling those more fulminant epidemic maladies 
which run their rapid, devastating course through a season's 
frightful mortality. 

The sanitary force in San Francisco has been organized on 
military lines and discipline and esprit de corps of a high order 
maintained. Should the future ever see the founding of a per- 
manent corps of this character it is suggested that such an or- 
ganization should be formed along similar lines. The corps 
might be at first a skeleton formation from which nucleus might 
be built a larger body by the addition of recruits in time of na- 
tional sanitary danger. The permanent force would be the 
leaven for the whole loaf, and could furnish the non-comnjis- 
sioned officers, i. e. inspectors, assistant inspectors and foremen, 
while the laboring positions could be filled by recruits. Such a 
corps should be made a part of the Public Health and Marine 
Hospital Service by whom this little sanitary army should be 
officered. Train and uniform such a body of men, let their pay 
be commensurate with the highly important and dangerous duties 
they will have to perform and the results will more than justify 
the expenses entailed. 

At present such an organization could not work in any State 
unless requested by the Government of that State, unless an 
epidemic disease threatening interstate commerce existed therein. 
National legislation is therefore necessary to permit a certain 
freedom of action on the part of this much needed flying sani- 
tary squadron. Before attempting to secure this it is necessary 
to examine the .sanitary code to determine what laws are not 
effective and upon what principles they are based. 

What is the condition of the statutes regarding the law as it 
affects sanitation? The fact that we are a commercial nation \s 
in no way better exemplified than by the laws under which the 
public health work of this country is now carried on. All of 
these laws are at the bottom, regulations of interstate commerce. 
The act of August 30, 1890 prohibiting the importation of adul- 
terated foods and beverages, was a law for the protection of 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 355 

American manufacturers, as was also the act of March 2, 1897, 
which authorized the Customs Service to deliver to the Depart- 
ment of Agriculture samples of consignments of tea for the purpose 
of analysis and the law of March 3, 1903 subjecting imported foods 
to a similar test. Even the so called national pure food law, the 
Food and Drugs Act of June 30, 1906 and the Act to regulate 
the manufacture and sale of antitoxin and virus are only indi- 
rectly health measures, being in reality simply regulations of in- 
terstate commerce. 

We have then national laws under which the public health 
may be safeguarded which are not health laws at all and while 
we can under the guise of seeking to protect and foster com- 
merce, prevent the introduction of noxious or adulterated food- 
stuffs from without, or the shipment of sophisticated foods from 
one State into another state, we have no national law which pro- 
hibits the manufacture and sale of impure or contaminated foods 
within the borders of a state. We have a law requiring that 
meats which are to be shipped beyond the borders of a state must 
conform to a certain standard of excellence, but the national 
government cannot prevent the sale of cattle or meats which 
have been refused by the government inspector within the bound- 
aries of that state. There is no national law at all governing 
the interstate traffic in that most important article of diet, milk, 
and while there is a heavy penalty for mislabeling oleomargarine 
and cheese, there is no Federal regulation prohibiting the sale of 
the dairy products of diseased cattle. 

There is another article of daily consumption of which the 
Federal law takes no cognizance. Any state can interfere with 
and prohibit the pollution of the water supplies in its domain, 
but neither one state or the entire collection of States can prevent 
any single state from pouring its sewage into interstate waters, 
even though the stream may have its origin in one state and be 
the water supply of another. It would therefore seem just 
that the prevention of the pollution of streams should be placed 
under the jurisdiction of a central health authority. The wide- 
spread disregard of our people for the most rudimentary con- 
ceptions of sanitation finds no better example than in the way the 



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356 PASSED ASSISTANT SURGEON W, C RUCKER, 

beaatif ul streams of our country have been turned into cloacae by 
the emptying of sewage into them. Injurious alike to the health 
and commerce of the community, this frightful pollution of the 
rivers with excrement and ofiFal has received the sanction of the 
people and their lawmakers until it has become an evil of national 
urgency, requiring the earliest and most serious attention. 
While the national Government has no sanitary supervision what- 
ever over inland waters, it controls'^absolutely the navigation of 
these streams. Each year millions are spent in dredging harbors 
and deepening channels but no measures are taken to prevent 
these harbors from becoming cesspools or the channels from be- 
coming sewers. After the primary deepening much money must 
be spent annually to remove the solid sewage which the munici- 
palities of the state are allowed to empty into the stream or haven. 
We are thus spending millions uselessly each year in removing 
accumulations which might be prevented were proper attention 
paid to sewage disposal. It is a serious offence for anyone to in- 
terfere in any way with the navigation of a stream, and since the 
pollution of interstate waters cannot be prevented by a health 
measure, it would seem logical to secure a national law prohibiting 
the emptying of sewage into interstate streams as a measure affect- 
ing commerce. Purity of interstate waters can be conserved only 
by such a law or by the co-operation of the states concerned, and 
Federal control as a health measure can be granted only by a 
constitutional amendment requiring years of concerted endeavor 
on the part of the people. The great etiological relationship 
which polluted water bears to enteric fever and possibly to many 
of our other common diseases raises the hope that some day we 
may see the protection of our water supplies under the control of 
the central Government. 

When we examine the laws of the states whose health pow- 
ers must be so sacredly guarded, we find a woeful lack of uni- 
formity. Some, the minority, have a sensible sanitary code deal- 
ing specifically with the matters to be governed. Others have a 
sweeping set of sanitary laws as full of flaws as a sieve is full 
holes, the easy prey of the acute legal mind and so full of glitter- 
ing generalities that a case cannot be taken into court on them 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 357 

for fear that their constitutionality will be questioned and the law 
found useless. In a few states there is also no sanitary code 
whatever. 

In the cities and towns conditions are even worse. ^ The san- 
itarv law is a part of the police code and the enforcement thereof 
a duty of the Chief of Police. Sometimes a zealous health oflScer 
insists on the application of these ordinances and on one occasion 
at least, such an one has been told by the very Board of Aldermen 
who passed the law that it was intended as a ''warning** ordi- 
nance only and was not meant to be enforced. It has been the 
experience of those Federal Health officers who have been en- 
gaged in the suppression of epidemics that one of their first duties 
was to secure the passage of suitable ordinances under which to 
carry out their work and even then nine tenths of the results at- 
tained are achieved by a judicious use of blufiF and cajolery. 

The sanitary laws of this country then, should be revised and 
placed on the solid basis of modern science. We have seen that 
little can be done in the way of national legislation save to im- 
pose additional duties on an already overworked and underoffi- 
cered corps until such time as an amendment to the Constitution 
can be secured. The revision then must begin in the towns and 
cities and from them spread to the state. It is here that the 
National Guard can perform a most important service. The 
citizen soldiery represents votes and a willing voter attracteth 
the hungry politician. If in the course of lectures mentioned 
above it is pointed out that a careful revision of the sanitary code 
is a consummation devoutly to be desired, a company of guards- 
men can secure such revision not only in their home town, but 
also throughout the state. 

If the American Public Health Association were to appoint 
a committee to draw up a sample sanitary code for towns and 
cities, and a copy be placed in the hands of every medical officer, 
physician and national guardsmen in the United States, unified 
action could be secured and the sanitary laws of this country put 
on a uniform basis so that adulterated milk which could not be 
sold in Massachusetts could not be disposed of in Rhode Island 
or Connecticut. Public health officials of the Federal Govern- 



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358 PASSED ASSISTAAT SURGEON W. C. RUCKEIL 

raent would not then have to make a new set of laws in order to 
secure the best results in combatting an epidemic disease within 
the bprders of a state. 

The general government recognizes the importance of its 
public school by creating a National Bureau of Education, but 
the commissioner at the head of it has no power to introduce into 
the public schools courses of instruction in the elements of per- 
sonal and public hygiene, to cause the physical examination of 
school children or to inaugurate means of preventing the spread 
of contagious diseases among them. If we are to educate the 
general public to the end that we may secure their co-operation 
in public health work we must commence with the rising genera- 
tion. Beginning with the child upon whose plastic mind is in- 
eff aceably impressed the lesson that a proper regard for the public 
health is the highest order of citizenship, we may carry the work 
by gradations to the adult whose mature mind may more fully 
grasp the underlying principles of hygiene. There is the greatest 
need for instruction of this kind in the United States. If the 
interest in hygiene were more widespread we would not have the 
spectacle of newly raised regiment of volunteers in time of war, 
most of whom consider an order relative to the places of urina- 
tion and defecation as an infringement on their free born rights. 
A campaign for the education of our future volunteers would be 
most profitable, not only because a body of men trained from 
childhood in the principles of sanitation would be able to take 
better care of themselves on the field than those not so trained, but 
they would also be a tremendous asset to the public health of the 
community. The public school is the place in which to give in- 
struction of this sort, and it is the duty of those who are work- 
ing to establish and maintain a better public health to urge upon 
their Commissioners of Education the initiation of such a course 
into all institutions of learning from the grammar school to the 
college. 

There is another educational matter of which the general 
government takes no official account, that is the education and 
the subsequent licensing of physicians, masters, mates and pi- 
lots on vessels plying in United States waters or upon vessels flying 



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MILITARY AND NA VAL FORCES AND PUBLIC HEALTH 359 

the flag, who are obliged to satisfy the appointed representatives 
of the central government as to their fitness for their vocations 
and once having passed such an examination, no further such 
tests are required no matter in what state they pursue their occu- 
pation. The physician who is responsible for the safe pilotage 
of the frail craft of human life through the troubled waters of 
disease is not allowed the privilege of a national license but is 
obliged to submit to vexatious penalties of pocket and of mind 
at the hands of each of the various states and territories. 
Further, a registered practitioner of one state cannot go to another 
state and take up his life work without additional payments and 
penalties. The American Medical Association and the Associa- 
tion of American Medical Colleges have done much to raise the 
standard of and to secure uniformity in medical education, 
and some states have arranged partial terms of reciprocity of 
license, but in the great majority this manifest injustice imposed 
on the medical profession by itself still continues. Even the 
medical oflScers of the Federal Government are exempt from ex- 
amination only so long as they are engaged in their official duties 
and are legally obliged to undergo an examination at the hands 
of the State Board of Medical Examiners in order to do private 
practice. From what has been said regarding the Constitutional 
public health hiatus it is evident that no legal steps can be 
taken by the general government to force uniformity of examina- 
tion or reciprocity of licenses. It is evident then that for the 
present our hope in this direction must lie in reciprocity of med- 
ical license by the states. This movement has not brought forth 
the uniformity for which its originators hoped because of the in- 
tricate complications which arise in the execution of the plan. 
Illinois may reciprocate with North Dakota but not with Georgia 
though the latter may have established reciprocity with North 
Dakota. Hence the whole is hopelessly muddled because there 
is no one person to set the standard by which the right to re- 
ciprocate must stand or fall. Who could better discharge this 
function than the head of the national health service? There 
seems also to be a very simple plan by which the constitutional 
objections could be circumvented. 



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360 PASSED ASSISTANT SURGEON W, C, RUCKER, 

A law could be passed directing the Surgeon General of the 
Public Health and Marine Hospital Service to investigate the 
various medical colleges of the United States to determine if 
their graduates receive training of a standard and uniform char- 
acter. Upon this information he could admit to examination 
graduates of medical colleges whose course of instructfon reaches 
the standard which he shall set. Those passing this examination 
are given a license authorizing the holder thereof to practice medi- 
cine in the District of Columbia and those states whose Boards 
of Medical Examiners will accept the license. Here then we 
have a standard of reciprocity interfering in no way with the 
prerogatives of any state. The State Boards of Medical Exam- 
iners may accept or refuse the license as they see fit, but it is 
safe to assume that most of them would grant a ready acceptance 
on account of the high standard such a license would represent. 
It would be fair to the state, just to the medical profession as a 
whole, would save the physician so registered endless bother 
and worry and would react to the lasting benefit of the public 
health. 

Throughout this essay the endeavor has been to show the 
importance of the relationship existing between public health 
and the military and naval forces of the United States ; the 
ways in which this relationship may be turned to better account 
and the obstacles in the way of the execution of these plans. 
The redemption of the Panama Canal Zone from preventable dis- 
eases, the sanitary record of the Japanese in their war with Rus- 
sia, the brilliant victory of White over yellow fever in New Or- 
leans, and Blue's accurate application of the basics of preventive 
medicine to the eradication of plague in San Francisco demon- 
strate the weapons which modern civilization posesses against 
pestilence and disease. They all show that the warfare against 
disease, like the warfare against a human foe, can best be con- 
ducted by the general government. Let us hope that the future 
holds in store the time when such campaigns may be waged 
whenever necessary by the government which is ** by the peo- 
ple, of the people, and for the people,** to the end that human 
suffering maybe prevented and life prolonged. 



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0rtdtnal ^l>emotrs. 



THE WORK OF THE BOARD FOR THE STUDY OF 
TROPICAL DISEASES IN THE PHILIPPINES. 

Bv CAPTAIN HENRY J. NICHOLS, 

MEDICAL CORPS UNITED STATES ARMY, 

AND 

CAPTAIN J. M. PHALEN, 

MEDICAL CORPS UNITED STATES ARMY. 

THE Board for the Study of Tropical Diseases as They 
Exist in the Philippine Islands, submits the following 
' report of its work during the quarter ending March 
31, 1908: 

PARAGONOMIASIS. 

No new cases have been found since those noted in the last 
report. Inquiries concerning this disease were sent out to 
thirty-two Scout Stations, but only four replies were received, 
and these were negative. All of the cases mentioned in the last 
report are now out of the service, five by expiration of term of 
service and one on certificate of disability. The disposition of 
these cases raises a question, but in view of our ignorance con- 
cerning the life cycle of the parasite, and the mode of infection, 
it appears inadvisable to retain them in the military service. In 
this connection we have learned from Dr. Ryley, R.A.M.C, a 
delegate to the recent meeting of the Philippine Islands Medical 
Association, that in the English Army it was formerly the cus- 
tom to discharge all cases of Bilharziosis as soon as discovered, 
but that this has been discontinued, and now no attention is paid 
to the disease from the point of view of prophylaxis. 

After several failures to hatch the eggs, using sea water, 
tap-water and distilled water at room and body temperatures, we 
have succeeded in hatching a considerable number in tap-water 

(361) 



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362 CAPT. HENRY J, NICHOLS— C APT J. M. PHALEN 

at ordinary temperature. The eggs came from the sputum of 
the first case found. It was collected in a larg'e jar for two 
weeks, then highly diluted with tap-water, the eggs allowed to 
settle, and the fluid poured off. This was repeated until the 
fluid was perfectly clear. In about six weeks active ciliated em— 
bryos were seen, at first within the eggs, later after having es- 
caped, and many empty eggs were also observed. Excel- 
lent photomicrographs have been obtained of the embryos within 
the egg and just after having escaped therefrom. 

We have exposed monkeys to infection with the parasite at 
this stage, by way of the skin, by the mouth, and by intraper- 
itoneal injection. At this time it is too early to determine 
whether infection has taken place. In regard to the snail as an 
intermediate host it is evident that if such is the case, the em- 
bryo must leave its host later. Snails are cooked until the mus- 
cle is loosened and they are sucked out of the shell. This re- 
quires boiling for two or three minutes, and infection by any 
contained parasite would be impossible after such treatment. 

SCHISTOSOMIASIS. 

A case of infection by the schistosomum japonicum was oY>- 
served at the Division Hospital recently. The patient, a mem- 
ber of a Visayan Scout company, came to the hospital on January 
16, 1908, and was assigned to the service of Captain E. L. Riiiff- 
ner, and died the following morning. When he came to t.Vi^ 
hospital he was suffering from diarrhea and abdominal cratr&I>^» 
and had a weak, irregular heart-action. The autopsy was x^^^^" 
formed by Captain E. R. Whitmore, a few hours after the d^^-^^ 
of the patient. The most pronounced gross abnormality to ^^ 
observed was a moderate enlargement of the liver and spl^^° 
with a number of adhesions binding down the latter organ. 'Tl'e 
liver was not cirrhotic in appearance, but presented a numb^^' ^^ 
yellowish patches over its surface, and in addition the wb^'^ 
surface was studded with small white spots up to the size of ^ 
pin head. On section, small nodules corresponding to the sp^^^ 
on the surface were found scattered uniformly throughout: tt*^ 
organ. One of these nodules was excised and crushed 0|^ g 



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TROPICAL DISEASES IN THE PHILIPPINES, 363 

cover-glass and was found to contain eggs of approximately sixty 
by forty microns. Recognizing it as a probable case of schis- 
tosomum infection, a search was instituted for the adult parasite 
in the blood vessels of the mesocolon, but without success. Tis- 
sues were taken from the liver, lung, kidney, small and large in- 
testines which were sectioned and stained for study. The 
nodules in the liver were found to occupy a lobule or two lobules 
fused together, the normal tissue replaced by a necrotic mass 
which was being replaced by connective tissue. Eggs in vary- 
ing numbers were found in these nodules. It was evident that 
a cirrhotic condition was being produced in the liver; due either 
to the mechanical action of the ova, or, as has been suggested, 
to a toxin produced by the adult parasite. The large intestine 
showed misc^oscopically one area low down in the bowel that 
was swollen and congested, and microscopically eggs were found 
scattered through the mucosa and submucosa, though in rather 
small numbers. No eggs were found in the other organs. 

It is unfortunate that we were unable to observe the clinical 
course of this case, and no history of the man's previous illness 
was obtainable. In Japan, where infections with the schistoso- 
mum japonicum are seen quite frequently, the patients are said 
to suffer from a chronic diarrhea, resembling dysentery in that 
the stool contains mucus and small amounts of blood, enlarge- 
ment of the liver and spleen, ascites and anemia. From the 
pathological findings it will be reasonable to expect a similar 
line of symptoms in this case. 

The personal history of this patient is of importance, as it 
shows an almost continuous residence in the Visayas since birth, 
the first twenty-four years of his life being spent in Samar, and 
the last six years, while in the military service, on the Islands of 
Panay, Cebu, Leyte and Samar. It is evident then that the in- 
fection was incurred somewhere in the Visayas. In the only 
previously reported case from the Philippines, that of Dr. 
Wooley, of the Bureau of Science, Manila, the patient had never 
been out of the Philippine Islands. In this case the large intes- 
tine was greatly affected, though as the patient was suffering 



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364 CAPT. HENRY J. NICHOLS— CAPT. /. J/. PHALEN 

from a coincident amebic dysentery, it is hard to say which 
element had most to do with the condition. 

It is evident then, that in the diagnosis of chronic bowel 
troubles, in these islands, the possibility of infection with the 
schistosomum japonicum must not be overlooked. Diagnosis 
will rest upon finding the characteristic ^%% in the stools. The 
eggs are oval, variable in size, averaging about fifty by seventy- 
five microns, smooth in outline, and when passed in the stools 
frequently containing a ciliated embryo, though the ones ob- 
served by us, being taken from the bowel contents at autopsy, 
did not show them. Photomicrographs were obtained showing 
the ova in the liver and the microscopic appearance of a section 
of nodule. 

In regard to trematode infection in general, statistics re- 
cently reported covering examinations of over 4,000 Bilibid pris- 
oners shows a great preponderance of these infections from the 
islands of Samar and Leyte, and this result is in harmony with 
our observations. 

FILARIASIS. 

Through the courtesy of Dr. Shattuck, of Bilibid prison, 
we had the opportunity of studying a case of this disease which 
is of unusual interest. The patient is a male Filipino, thirty- 
five years of age, a native of the province of Union, but has been 
in Manila about ten years, being employed as a laborer. He 
was sentenced to Bilibid in January of this year and immediately 
came under Dr. Shattuck 's care on account of hydrocele. This 
was operated upon January 29th, and about 250 c. c. of a milky 
fluid was obtained. This fluid was sent to us, and upon exami- 
nation was found to contain microfilaria in large numbers, which 
morphologically answered to the description of the Filaria philip- 
pinensis as described by Drs. Ashburn and Craig. This man's blood 
was then examined systematically and microfilaria were found, 
always very infrequent, but apparently as numerous by day as by 
night. So infrequent were the parasites that as many as ten to 
fifteen slides had to be examined before a single one was found, 
and frequently none were found even in such a number of slides. 
The man gave a history of a gradual swelling of the right side 



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TROPICAL DISEASES IN THE PHILIPPINES, 365 

of the scrotum for about one year, but experienced no other 
symptoms. Upon examination the right calf and the right in- 
guinal glands were found to be enlarged, the former but slightly. 
Dr. Shattuck has shown us another patient upon whom he had 
operated for simple hydrocele, and in whose blood a microfilaria 
was found. This patient was a native of the province of Albay, 
male, single, thirty-five years of age. He had lived in Albay all 
his life until committed to Bilibid prison. He gave a history of 
having what he describes as a swelling of the left leg and ab- 
domen ten years ago. This lasted five months and then broke 
in the groin and over the saphenous opening and about a pint 
of white fluid was discharged. From the man's description we 
conclude that this was probably chylous fluid and not pus. 

Filaria have several times been found in the man's blood 
during the day by Dr. Shattuck, but were not especially studied 
to determine the species. 

The peculiar interest in these cases is that the microfilaria 
nocturna has always been regarded as the only one that pro- 
duced pathological lesions. In the first case here recorded we 
have an undoubted chylocele produced by the microfilaria phil- 
ippinensis with probably a beginning varicose groin glands and 
elephantiasis of the right leg. During a trip to the province of 
Sorsogon, which a member of the board made with the Director 
of Health, for the purpose of collecting lepers, eleven cases of 
elephantiasis were observed among those brought in as suspects. 
These cases showed a variety of lesions, one or both legs being 
affected in ten cases, lymph scrotum was present in three cases, 
varicose groin glands in one case and in one the left arm alone was 
involved. The short time spent at each town and the fact that it 
rained almost continuously during the trip rendered it difficult 
to study these cases to much advantage, but nevertheless photo- 
graphs were taken of a number of them, some of which turned 
out very well. Blood smears were taken from all of the cases, 
but no parasites were found. We hope to be able to make another 
and longer trip to this section of the islands and study these cases 
more in detail and establish the identity of the filaria causing the 
elephantiasis. 



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366 CAPT, HENRY J, NICHOLS-CAPT,J, M. PHALEN. 

Another case observed at the Division Hospital is of interest 
as a probable infection with the microfilaria philippinensis show- 
ing nocturnal periodicity with a question as to the locality where 
the infection was obtained. The patient, a colored soldier of 
the 25th Infantry, was transferred from Parang, Mindanao, to 
the Division Hospital by Captain I. W. Rand. He is twenty- 
two years of age, a native of Charleston, S. C, where he lived 
until he entered the military service early in 1907. After seven 
months service in the United States at Columbus Barracks, Ohio, 
and at Fort Reno, Okla., he came to the Philippines in Sep- 
tember, 1907, and went to Parang. On February 12th, 1908, 
he went to the hospital suffering from headache and fever, his 
blood was examined and a microfilaria was found. At the hos- 
pital here we have had the opportunity of examining the patient's 
blood at all times during the day and night, and of studying the 
parasite under the most favorable circumstances. As to the 
periodicity the following table shows the number of parasites 
found in two slides at each hour of the day and indicates decided 
nocturnal periodicity for the parasite : 



|Nam-l Num- 

Hour. ber ' Hour. ber | Hour. 

found I fouDd 



12.00 ui. I \ 8.00 p.m. 82- I 4.00a.m. 

' ' " I " 

1.00 p.m. I \ 9.00 p.m. 141* ^ 5.00a.m. 

I 

2.00 p.m. I ! 10.00 p.m. 33 

I : 

3.00 p.m. : I 11.00 p.m. i 68 



--- -- i , , 

4.00 p.m. I 1 j 12.00 p.m. ; 72 

I - I - 
I 

5.00 p.m. I I 1.00 a.m. , 48 

fi.00p.m. I 6 2.00a.m.' 7« 



7.00 p.m. 



15 3.00 a.m. 47 



Hour. 


dum- 
ber 
found 


4.00a.m. 


38 


5.00 a.m. 


16 


6.00 a.m. 


7 


7.00 a.m. 


1 


8.00 a.m. 





9.00 a.m. 





10.00 a.m. 





11.00 a.m. 


1 

I I 

i 



Larger drops. 



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TROPICAL DISEASES IN THE PHILIPPINES, 367 

The microfilaria measures about .280-.300 mm. in length 
and .0075 mm. in diameter, is enclosed in a sheath which while 
apparently tightly approximating the body laterally extends well 
beyond the head and tail, the latter especially, this excess of 
sheath being fully one-third the length of the parasite. No 
movement of the worm within the sheath was observed. The 
head is rounded, showing a spot which has been described as like 
an eosinophilic granule at the anterior extremity, and from this 
spot a delicate spicule was observed to be protruded. No lips 
could be observed. The tail tapered to a fine point. 

Anterior and posterior '*V" spots were present, the former 
about eighty-five to ninety microns from the anterior extremity. 
The central viscus shows a spiral appearance. Movement of 
the parasite was both lashing and progressive. Dispite some 
minor discrepancies this parasite is seen to answer quite well the 
description of the microfilaria philippinensis, though the peri- 
odicity is against that view. The question whether this infec- 
tion was obtained here or in the United States must remain in 
abeyance until more is known of the variety and distribution of 
filaria in both countries, and then the atiswer may only be by 
inference. Captain E. R. Whitmore has been doing some work 
with this case to trace the development of the microfilaria in the 
mosquito. Taking the Culex fatigans for the purpose, he in- 
duced them to bite the patient at times when the parasites were 
numerous in the blood. Since then mosquitoes have been dis- 
sected at frequent intervals and the course of development in the 
mosquito followed out as far as it goes. After about two weeks 
an attempt was made to infect monkeys with the parasite by in- 
ducing mosquitoes to bite them, but for some reason the mos- 
quitoes refused to bite. An incision was then made in the back 
of the neck of a monkey and an infected mosquito, recently 
killed was broken up and imbedded in the tissues by .«ewing up 
the wound over it. Any developments from these experiments 
will be reported later. 

AMEBAS. 

Considerable attention has been devoted during the quarter 
to the observation of amebas and to their cultivation. Using 



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368 CAPT, HENRY J, NICHOLS^CAPT, J. Af. PHALEN, 

the amoeba media recommended by Dr. Musgrave of the Bureau 
of Science, we have been able to grow amebas from a v^ariety of 
sources such as surface waters, washing of vegetables, and 
dysenteric and apparently healthy stools, and three times we 
have succeeded in growing them from liver abscess pus obtained 
at operation. These cultures have been studied with great care 
in connection with amebas found in stools, with the result that 
we were unable in either case to find constant characteristics to 
at all warrant a differentiation into species. Still less do we 
feel that the appearance of an ameba can be relied upon to de- 
termine its pathogenicity. We do not doubt the probability of 
a multiplicity of species, but their differentiation is work for the 
the expert zoologist, and until such work has been done and the 
contrary established, it is our opinion that all amebas should 
be regarded as potentially pathogenic. 

We have made a number of experiments with a view to in- 
fecting monkeys with amebas but with little success. These 
animals have been fed upon cultures from liver pus, from dysen- 
teric stool and from tap-water, and encysted forms recovered in 
the stools, but without producing any appreciable effect. Salt 
solution containing a culture from liver pus, and salt solution 
with a tap-water culture were injected into the livers of monkeys 
but without producing lesion. Rectal injections of amebas from 
the same sources were also unproductive of results. It is inter- 
esting to note however that a monkey that was associated with 
those upon whom these experiments were tried, spontaneously 
developed dysentery with amebas in the stools. 

OIDIOMYCOSIS. 

This title is a term suggested by Ricketts to embrace a va- 
riety of pathological conditions due to infection by blostomyces 
and allied organisms. Infections of this class appear to be quite 
frequent in the Philippines, in both man and domestic animals, 
producing lesions of the skin, glandular tissue and the lungs. 
As it is our hope to be able soon to bring out a special report 
upon this subject, we will only refer in this report to two cases 
of skin infections that have recently come under our observation. 



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TROPICAL DISEASES IN THE PHILIPPINES, 369 

Case /. The patient, a sergeant in the Twenty-sixth In- 
fantry, came to the Philippine Islands first in 1904, and took 
station at Camp Jossman, island of Guimaras. In the spring of 
1905, while cutting a clump of bamboo at that post, he cut his 
right wrist on a thorn. The cut bled a little and he sucked it. 
A little later the spot became reddened and itched greatly, grad- 
ually spreading around the wrist. A similar spot appeared upon 
the palm of the right hand. These spots were treated with 
ointments of diflFerent kinds for nearly two years, until while at 
Mt. Gretna, Pa., in 1906, they were healed by applications of 
bichloride of mercury and alcohol. Shortly after small spots of 
a similar character appeared upon the left wrist and left leg, 
which have continued to spread ever since, more rapidly since 
coming again to the Philippines. The lesions now present are 
situated on the outer side of the left leg near the knee, and on 
the back of the left wrist. These spots are each several inches 
in diameter, slightly raised, have a well defined edge and are cov- 
ered with dry .scales, which when removed, leave a pink glisten- 
ing surface. The lesions feel rough and indurated. The scales, 
when removed, treated with potassium hydrate solution and ex- 
amined under a high power lens show the presence of large 
numbers of round bodies, three to five microns in diameter, with 
a double contour and showing many budding forms. We will 
leave to a future report a more detailed account of this organism, 
together with the experiments we have undertaken with it. 

Case II, This patient is an officer in a scout organization 
and gives the following history. In 1904, while stationed at 
Camp Council, Samar, he noticed a small papule near the middle 
of his left cheek. He does not remember much about it except 
that it itched, and that from it the present eruption extended, at 
first downward, then backward and upward parallel to the lower 
jaw. He does not recollect any injury or abrasion of the face 
previously. At first the lesion was quite superficial, and the 
earlier places were healed by the application of nitrate of silver. 

There is now present on the left cheek a large crescentic 
patch extending parallel to lower jaw, presenting an indurated 
ridge along the convexity of the patch, and induration of a less 



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370 CAPT. HENRY J. NICHOLS^CAPT, /. M, PHALEN. 

degree inside. The whole is red and shining, except where cov- 
ered by dry scales. Along the ridge, a number of more indu- 
rated spots exist, lighter in color, which upon opening exude a 
drop of white pus. There are some few scabs covering small 
white cavities also containing pus. Examination of the scales 
in this case shows the same round, double contoured, budding or- 
ganisms as in the previous case. 

These cases coincide both in appearance and in microscopic 
findings with the case of Blastomycotic dermatitis reported by 
the former Board in 1906. 

YAWS. 

One case of yaws in a Scout has been under our observation 
at the Division Hospital and several cases were seen by one of 
us on a recent trip to Sorsogon and Culion. The Scout was a 
member of the Twenty-ninth Company stationed at Imus, Cavite, 
twenty-six years old, with six years in the service. About a 
year ago a yaw developed on the neck following a cut by a razor 
and about a month later a general eruption occurred affecting 
the forehead, neck, back and legs. He was treated with mer- 
cury and iodides at the Hospital at Camp Ward Cheney by Con- 
tract Surgeon Farrow, and in about two months was sent to 
duty apparently cured. Four months later he had another 
milder outbreak of yaws and was again treated for two weeks in 
Hospital. We saw the patient at the end of this attack and at 
this time he had only one active yaw on the elbow. Treponema 
pertenuis was easily demonstrated with Giemsa's stain. The 
yaw was excised and sent in formalin to the Curator of the Army 
Medical Museum to be stained by Levaditi's method and we have 
since received from the Curator a number of fine sections. For 
some reason it is difficult to stain by the Levaditi method here, 
no satisfactory stains have been made either at the Bureau of 
Science or the Naval Station. We have had partial success in 
one instance. We secured some Atoxyl with the intention of 
trying it on the patient but he showed no more yaws. 



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XCbe Seventeenth Hnnual flDeetino 

atlanta, (Seoraia, October 13^16, 1908. 

MINUTES OF THE MEETING. 



T 



^HE citj of Atlanta, 
Ga., was the scene 
of the Seventeenth 
Annual Meeting of the As- 
sociation of Military Sur- 
geons of the United States, 
which convened at the 
Piedmont Hotel, Tuesday 
morning, October 13, 1908, 
and continued in scientific 
session during the ensuing 
two days, with one day 
additional devoted to the 
cultivation of mutual ac- 
quaintance, the following 
officers, members and dele- 
I>.G«)fgeT«UypV^tuj^ gates being present. 

OFFICERS. 
^AssisUnt Surgeon General George Tully Vaughan, Public Health 

and Marine Hospital Service, President, 
Rear Admiral Presley M. Rixey, Surgeon General U.S. Navy, First 

Via PrisuUnt, 
Colonel Joseph K. Weaver, National Guard of Pennsylvania, Second 

Vice President, 
♦Major Jambs Evelyn Pilcher, United SUtes Volunteers, Secretary and 

Editor. 
Major Herbert A. Arnold, National Guard of Pennsylvania, Treasurer, 
Captain J. Carlisle DeVries, N.G. New York, Assistant Secretary, 

*Not now In active service as such. 

(871) 



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372 ASSOC! A TION OF MILITAR Y SURGEONS, 

MEMBERS. 

Captain M. Burnwell Abcrnethy, North Carolina N.G. 

Major Henry AUers, N.G. New Jersey. 

*CaptaiQ Gustavus M. Blech, Illinois Res. Troops. 

♦Major Bial F. Bradbury, U.S. Volunteers. 

Captain J. Fulmer Bright, Virginia Volunteers. 

*Colonel George Brown, N.G. Georgia. 

♦Acting Assistant Surgeon O. H. Buford, U.S. Army. 

Colonel M. A. Burgess, Wyoming N.G. 

Major Daniel S. Burr, N.G. New York. 

Captain P. F. Butler, Massachusetts V. M. 

Surgeon Paul M. Carrington, P.H.&M.H.S. 

Lieutenant Charles D. Center, Illinois N.G. 

Major George S. Crampton, N.G. Pennsylvania. 

♦Captain F. Elbert Davis, N.G. New York. 

Major Howard S. Dearing, Massachusetts V.M. 

Lieutenant Thomas F. Duhigg, U.S. Army. 

Captain J. W. Duncan, N.G. Georgia. 

Colonel John F. Edwards, Wisconsin N.G. 

Major Theodore W. Evans, Wisconsin N.G. 

Major Charles B. Ewing, U.S. Army. 

Major D. S. Fairchild, Jr., Iowa N.G. 

Brigadier General Charles C. Foster, Massachusetts V.M. 

Captain John Vernon Frasier, Michigan N.G. 

Major Edwin M. Fuller, Maine V.M. 

Captain G. H. Green, N.G. Georgia. 

Major Thomas E. Halbert, Tennessee N.G. 

Major G. H. Halberstadt, N.G. Pennsylvania. 

Colonel Valery Havard, U.S. Army. 

Lieutenant Harry A. Haze, Michigan N.G. 

Captain George N. Hidershide, Wisconsin N.G. 

Acting Assistant Surgeon Montafix W. Houghton, P.H.&M.H.S. 

Major Arthur R. Jarrett, N.G. New York, 

Major William Jepson, Iowa N.G. 

Major Henry Aaron Jones, Rhode Island M. 

Major Jefferson R. Kean, U.S. Army. 

Lieutenant A. H. Lindorme, N.G. Georgia. 

Major W. C. Lyle, N.G. Georgia. 

Lieutenant William D. Lyman, Michigan N.G. 

Major Charles Lynch, U.S. Army. 

Major Junius F. Lynch, Virginia Volunteers. 

Lieutenant Colonel George Paull Marquis, Illinois N.G. 



* Not DOW in active service as such. 



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MINUTES OF THE SEVENTEENTH ANNUAL MEETING, 373 

Acting Assistant Surgeon William Hertry Marsh, P.H.&M.H.S . 

Major E. A. Martindale, Iowa N.G. ' 

Major James C, Minor, Ark. N.G. 

Captain George Morgan Muren, N.G. New York. 

Captain James R. Nankivell, Tennessee N.G. 

Colonel F. S. Nicholson, Nebraska N.G. 

Colonel John B. O'Neill, Maine V.M. 

Colonel Matt R. Root, N.G. Colorado. 

Lieutenant William G. Schauffler, N.G. New Jersey. 

Medical Director Minly H. Simons, U.S. Navy. 

Lieutenant Colonel Andrew S. Stayer, N.G. Pa. 

Brigadier General Alexander J. Stone, Minn. N. G. 

Major Thomas J. Sullivan, Illinois N.G. 

Coloqel Blair D. Taylor, U.S. Army. 

♦Acting Assistant Surgeon W. T. Thackeray, U.S.Army. 

Major H. H. Tuttle, Illinois N. G. 

Captain C. Bruce Walls, Illinois N. G. 

Surgeon C. P. Wertenbaker, P.H.&M.H.S. 

Passed Assistant Surgeon Mark J. White, P.H.&M.H.S. 

Captain B. J. Witherspoon, North Carolina N.G. 

Medical Director John C. Wise, U. S. Navy. ^ 

REPRESENTATIVE OF FOREIGN NATIONS. 

Lieutenant Colonel W. H. W. Elliot, Indian Medical Service. 
Lieutenant Colonel Jos^ Barbosa Leao, Portuguese Army. 
Major Ernest A. LeBel, Canadian A. M. ^. 
Lieutenant Colonel Alejandro Ross, Mexican Army. 
Lieutenant Colonel M. W. H. Russell, British R.A.M.C. 

In addition to the foreign delegates mentioned above, many 
of the members present were officially delegated by their states 
and services, all of the three national services being represented 
by three delegates each, while many of the states sent more and 
some less in number. 

The meetings of the Association were attended not only by 
the foregoing members and delegates but also by a considerable 
number of physicians of Atlanta and vicinity and a number of 
subscribers to The Military Surgeon, who, though not eligi- 
ble for membership in the Association, are greatly interested in 
military medical matters. 

* Not now in active Hervlce as such. 



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374 ASSOCIA TION OF MILITARY SURGEONS. 

FIRST SESSION, TUESDAY MORNING, OCTOBER 13, 1908. 

THE meeting was called to order in the Assembly Room of 
the Piedmont Hotel, the President, Former Assistant 
Surgeon General George Tully Vaughan,P.H.&M.H.S. , 
in the chair and the other officers in their respective places. 

The report of the Executive Council was then read by the 
Assistant Secretary. It stated that in addition to the annual 
meeting held on the previous evening six mail ballots had been 
held during the year and that seventy-eight new Active and As- 
sociate Members had been elected, recommended the election to 
Corresponding Membership of Colonel Rafael Caraza, Mexican 
Army, Colonel Francisco deP. Echeverria, Mexican Army, Lieu- 
tenant Colonel M. W. H. Russell, R.A.M.C., Lieutenant Colonel 
Jose Barbosa Leao, Portuguese Army, Major Ernest A. LaBel, 
Canadian Army, and recommended the amendment of Section 3, 
Article III of the Constitution to read as follows: 

Section 3. Active Membership is limited to commissioned medical of- 
ficers of — 

1. The United States Army; 

2. The United States Navy; 

3. The United States Public Health & Marine Hospital Service; 

4. The United States Volunteers; anfl 

5. The National Guard and other state troops. 

Active members may retain their membership, should they be honor- 
ably discharged from the service in which they have been commissioned. 

Reference to the Publication Committee of all papers read 
by title without motion and the adoption of the usual time limit 
of twenty minutes for papers was recommended. 

After discussion by Surgeon C. P. Wertenbaker, P.H.& 
M.H.S., Medical Director John C. Wise, U.S.N,, Major Charles 
Lynch, U.S.A., and Colonel Joseph K. Weaver, N.G.Pa., the 
report was adopted. 

The Treasurer read a summary showing a balance of 
S6,539. 32 from the last report, receipts of $3,787.70 during the 
year, making a total of $10,327.02, expenditures of $3,592.21 and 
exhibited a certified check for $6,734.81 balance on hand, an in- 
crease notwithstanding the hard times of $195.49 during the year. 



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MINUTES OF THE SE VENTEENTH ANNUAL MEETING. 375 

The report was received and referred to an Auditing Com- 
mittee consisting of Medical Director John C. Wise, U.S.N. , 
Major JeflFerson R. Kean, U.S.A. and Captain George Morgan 
Muren, N.G.N. Y. 

The Secretary and Editor then reported that during the 
Association year of 1907-1908, the work of his office had been 
pursued without cessation. With the growth of the Association 
and the further development of the journal, the time and labor 
involved in conducting his work had continued to progressively 
increase, although every measure tending to economy in labor, 
as well as in money, had been employed. 

He mentioned the active efforts for recruiting the member- 
ship of the Association which had resulted in the addition of 
seventy-eight new members. 

He commented upon the development of the journal and 
complimented the Association on having in The Military Sur- 
geon the most useful as welJ as the most attractive military med- 
ical journal in exi.stence. 

He referred to the effect upon the advertising department of 
the hard times and stated that for the first time since the allow- 
ance was made in 1906 it had been necessary to draw upon the 
treasury for the full amount of $600.00 authorized at that time, 
a draft which he was glad to learn had in no way prevented the 
added accumulation of the surplus. The receipts of his office 
were $4,085.07, the expenditures were $3,922.01 and a balance of 
$163.06 remained. A detailed and minute account of all neceipts 
and expenditures, together with duplicate vouchers for the latter 
was submitted. On motion the report was accepted and the ac- 
counts referred to an Auditing Committee consisting of Medical 
Director Manly H. Simons, U.S.N., Colonel Joseph K. Weaver, 
N.G.Pa. and Acting Assistant Surgeon William H. Marsh, 
P.H.&M.H.S. 

The Liter AKV Committee reported through Captain J. C. 
DeVries, N.G.N.Y., that a large amount of work had been done 
during the year and presented the program as the result of its 
efforts. The report was adopted with thanks. 



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376 



ASSOCIA TION OF MILITARY SURGEONS. 



The Committee of Arrangements reported through Col- 
onel George Brown, N.G.Ga., concerning the preparations which 
had been made for the entertainment of the Association. These 
events and the manner in which they were carried out are de- 
scribed in the department of Editorial Expression under the 
caption of '*the accessories at Atlanta." On motion the 
thanks of the Association were tendered to the committee and 
the opening hour for the afternoon session was deferred until 
four o'clock in order to permit the members to engage in an au- 
tomobile excursion tendered by citizens of Atlanta. 

The Necrology Committee presented a report which was 
read by Lieutenant Colonel George Paull Marquis, Ill.N.G., for 
the chairman, Major Samuel C. Stanton, who was unavoidably 
detained ; the report announced the deaths during the year of 
fourteen members as follows: 



Lieutenant Colonel Georg^e Wheaton Carr, R.LM. 

Colonel Henry O'Donnell, Kans.N.G. 

Major Julian LaPierre, Conn.N.G. 

Medical Director John Hosea Babin, U.S.N. 

Captain William Nathan Belcher, N.G.N.Y. 

Lieutenant William Alexander Gordon, Jr., Wis.N.G. 

Colonel Nicholas Senn, Ill.N.G. 

Colonel Henry Lippincott, U.S.A. 

Lieutenant Stacy D wight Williamson, N.G.N.Y. 

Major William Rudolph Steinmetz, U.S.A. 

Generalarzt Friederich von Esmarch, Prussian Army. 

Major Carlton E. Starrett, Ill.N.G. 

Lieutenant Colonel H. Bryon Baguley, W.Va.N.G. 

Assistant Surgeon William Mavel Nickerson, U.S.N. 



Upon motion, the report was accepted and the dead honored 
by a rising vote. 

The Enno Sander Prize Medal Board of Award re- 
ported in the absence of any of the board through the Secre- 
tary, who stated that a majority of the board had voted to 
award the prize to the author of an essay presented under the 
nom de plume of " Sanitas ; " one member of the board, Gen- 
eral A. A. Woodhull, U, S. A., voting in the negative because 



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D 



MINUTES OF THE SEVENTEENTH ANNUAL MEETING. 377 

in his opinion 
the essay was 
not sufficiently 
military in char- 
acter. The Pres- 
ident then open- 
ed the envelope 

containing the > 

card of the sue- f 

cessful compet- I* 

itor and an- \ 

nounced that •«• 

the medal had ^ 

been awarded to ^ 

Passed Assistant 3 

Surgeon W i 1 - 8 

Ham Colby | 

Rucker. P.H.& J 

M.H.S.. which g 

was received S 

with applause. S 

The Assistant | 

Secretary in the ^ 

absence of the ^ 

author then read S 

a twenty min- £• 

ute abstract of § 

the essay, the 8* 

whole of which ? 

appears in this ^ 

issue of The ^ 

Military Sur- I^ 

OEON. £ 

A paper upon 8 

Iron Aristol for 53 

Chronic Skin £ 



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378 ASSOCIA TION OF MILITARY SURGEONS. 

Ulcers was then read by Passed Assistant Surgeon M* J. White, 

P.H.&M.H.S. 

A description of the Card System as Adapted to Property 

Accounts was then read by Brigadier General Charles C. Foster, 

Surgeon General of 
Massachusetts, and 
discussed by Lieu- 
tenant Colonel G. P. 
Marquis, lU.N.G., 
Lieutenant William 
Gray Schauffler, 
N.G.N. J., Colonel 
Valery Havard, U.S. 
A., Major Henry 
Aaron Jones, R.LM., 
and Major Herbert 
A. Arnold, N.G.Pa. 

It was moved and 
carried that the 
medical profession of 
Georgia and any vis- 
iting physicians be 
tendered the privi- 
leges of this meeting. 
There being no 
further business, the 

Lieutenant A. H. Lindorme, N.G. Ga., meeting adjourned at 

Chairman Committee of Arrangements* 1 1 >< c ^ ^ 

■* li;4o a. m. 

SECOND SESSION, TUESDAY AFTERNOON, OCTOBER 13, 1908 

THE afternoon session was called to order by the Second 
Vice President, Colonel Joseph K. Weaver, N.G.Pa., 
at 4 p. m., Tuesday, October 13,. 1908. 

The first paper on the program was upon Hypodermic An- 
esthesia (Historical), by Former Acting Assistant Surgeon 
William Thomas Thackeray, U.S.A., which was discussed by 



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MINUTES OF THE SE VENTEENTH ANNUAL MEE TING, 379 

Major Thomas J. Sullivan, 111. N.G.. and Captain G. Morgan 
Muren, N.G.N. Y. 

Invitations extending the privileges of the Atlanta Athletic 
Club and the East Lake Country Club were accepted with thanks. 

The following papers were read by title. 

The Treatment of Fracture of the Jaw. By Major T. E. 
Carmody, Colorado National Guard. 

Favus as Observed in the Inspection of Immigrants. By Sur- 
geon J. B. Stoner, P.H.&M.H.S. 

Cocaine, Its Relations to the Military Surgeon. By Passed 
Assistant Surgeon William Dunlop Owens, U.S.N. 

Felon or Whitlow. By Former Acting Assistant Surgeon 
John Hudson Grant, U.S.A. 

The meeting then adjourned. 

PUBLIC MEETING, TUESDAY EVENING, OCTOBER 13, 1908. 

THE Public Meeting was called to order in the Legislative 
Hall of the State Capitol, Tuesday evening, October 
13, at 8:20 p. m. by Lieutenant A. H. Lindorme, N.G. 
Ga. , Chairman of the Committee of Arrangements. 

The music was furnished by the orchestra of the Fifth Reg- 
iment of the Georgia National Guard. 

The usual invocation was delivered by Captain C. B. Wii.- 
MER, chaplain of the Fifth Georgia Regiment. 

Lieutenant Lindorme then introduced Judge Marcus Beck 
who welcomed the visitors to the state of Georgia in the absence 
of Governor Hoke Smith. 

Judge Beck*s remarks were both eloquent and humorous and 
showed an appreciation of the position of the military surgeon in 
military experience only to be gained by actual service such as had 
been his own lot during the Spanish-American War. 

An address on behalf of '*The Medical Profession of Georgia" 
was then delivered by Dr. J. S. Todd whose professional exper- 
ience compassed two wars to which an empty sleeve eloquently 
testified. He spoke of Long, of Battey and a host of other sons 
of Georgia whose deeds arc memorable in the history of medicine. 



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380 ASSOCIA TION OF MILITAR Y SURGEONS. 

His address was extempore and it is to be regretted that it could 
not havfe been published in full. 

The annual address of the President was then delivered by 
Former Assistant Surgeon General George TuUy Vaughan, 
P.H.&M.H.S., who took for his subject ''Suture of Wounds of 
the Heart.'* This address will be published in full in an early 
number of The Military Surgeon. 

INSTALLATION OF FOREIGN DELEGATES. 

Major James Evelyn Pilcher, in installing the foreign 
delegates remarked in part that this is a red letter evening in the 
history of the Association. Never have we been so warmly wel- 
comed and never have the glories of medical military men been so 
well characterized. If there were others to speak on behalf of 
the Association, I should not take upon myself that which I feel 
would be the wish of every member, to thank the good people 
who have so cordially received us. 

For years military medicine has been aided by this Associa- 
tion which has many features of interest and value to the world. 
It has grown from a small organization to a large body including 
the four principal medical services of our nation. It has been 
one of the most important instruments in enabling the military 
medicine of the United States to accomplish the great results 
which are now a matter of history. But we have gone further 
and have developed an international feature. Each year there 
come to our meeting members of the medical corps of the armies 
of the other great nations. Japan and Russia, and China over 
and over again, have honored us with the presence of members of 
their medical corps. England never fails to be with us. France 
has brought the fleur de lys to us many times and oft; and so 
our sister nations are always friendly to us, and in this friendship 
represent that feeling of international comity in which military 
medicine hopes to be a great factor. 

We have in our midst Colonel Alejandro Ross, a representa- 
tive from Mexico, who has been with us twice before, and conse- 
quently will not be decorated tonight, as this was done four years 
ago. India also has seat us a representative in the person of 



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MINUTES OF THE SE VENTEENTH ANNUAL MEE TING. 381 

Lieutenant Colonel W. H. W. Elliot who was decorated two 
years ago. 

I hardly know what to say of that great nation from which 
we are largely an outcrop. I speak of that nation which has 
given us our life, our form of government which was brought 
here when the Pilgrims came to the rock bound coast of the east. 
I speak of that great country of which we are perhaps the great- 
est oflFspring nation, by whose wonderful colonization power the 
crosses of St. Andrew and St. George dot the world. We have 
with us tonight, Lieutenant Colonel M. W. H. Russell, 
R.A.M.C., a distinguished officer of the British service. We are 
proud that his government has seen fit to send an officer of so 
much distinction. Colonel Russell, in the name of the Associa- 
tion of Military Surgeons, I have the honor to inform you that 
you have been elected a Corresponding Member and in testimony 
thereof to pin this decoration upon your breast. In honoring 
you the Association not only honors itself but evidences the pro- 
found appreciation which it has of the great nation which you 
represent. 

I said we had with us tonight one of our neighbors. We have 
a representative of Our Lady of Snows who reposes constantly 
in the arms of the United States formed by Alaska on the one 
side and New England on the other, so that the United States 
always feels toward Canada something of that interest which an 
admirer feels toward the lady of his affections. We are tonight 
honored by one who has been a member of the association since 
it was possible for officers of his service to enter our membership. 
We are glad that we have with us tonight a representative not only 
of the Gallic race but a Canadian of the Canadians. We are 
proud, Major LeBel, that you are with us and that your coun- 
try has honored us by sending you to us. We are also glad that 
we can change you from an Associate to a Corresponding Mem- 
ber, and in placing this insignia upon your breast we know 
we are placing it where it will be worn with honor and 
credit. 

Now I come to the last decoration of the evening, which 
is to be conferred upon Lieutenant Colonel Jose Barbosa 



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382 ASSOC! A TION OF MILITARY Sl/RGEONS. 

Le&o, an officer of that small country which for so 
many years has faced the storms of the Atlantic, but 
is more scientific and progressive than most of us under- 
stand. The ^reat debt which the western hemisphere owes 
to early Portuguese navigators is brought to mind by this the 
first entrance of Portugal into the work of the Association of 
Military Surgeons of the United States and we trust that the re- 
sults which came to the world of nations through the voyages of 
Vasco de Gama and his compatriots may be paralleled in the 
future of military medicine by the mutual relations now estab- 
lished between the military medicine of Portugal and of America. 
Colonel Leao, we are proud and glad to receive you and trust 
that the government of Portugal will permit you to wear this 
decoration and remembering the work which the medical 
corps of your army is doing, we honor ourselves in honoring 
you. 

In closing Major Pilcher again adverted to the hearty ap- 
preciation with which the Association regarded the courteous 
reception which the members had received from the citizens of 
Atlanta. 

Surgeon Charles Poindexter Wertenbaker, P.H.& 
M.H.S., regretted that the Reflectoscope with which he had de- 
signed to demonstrate some remarks upon "The Use of the Re- 
flectoscope in Teaching Sanitary Results and for the Amusement 
of Men and Officers" had not arrived. He described it however 
as a combination of mirrors and lenses by which an enlarged re- 
production of any picture or printed matter could be thrown upon 
a screen similar to that used for stereopticon purposes. Surgeon 
Wertenbaker enlarged upon the value of such an appliance in 
the instruction of the troops in sanitary matters and dwelt upon 
its advantage as a means of providing for the men in garrison or 
on board ship that relief from monotony and ennui which is so 
important an element in military hygiene. 

Lieutenant Lindorme then in a few appropriate words dis- 
missed the audience which passed out accompanied by the strains 
of a closing march by the orchestra. 



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MINUTES OF THE SEVENTEENTH ANNUAL MEETING. 383 



« 



FOURTHSESSION,WEDNESDAYMORNING,OCTOBERi4,i9o8. 

THE meeting was called to order by the President, Assistant 
Surgeon General George Tully Vaughan,P.H.&M.H.S., 
at 10:15 a. m. 

Lieutenant Colonel Jose Barbosa Leao, of Portugal, made a 
brief congratulatory address to the Association, extending the 
felicitations of his country and comrades, and expressing appreci- 
tion of the honor done him on the preceding evening in making 
him a Corresponding Member of the Association. 

On motion a vote of thanks was tendered to the delegate 
from Portugal for his interesting remarks. 

Major Jefferson R. Kean, U.S.A., moved that the Associa- 
tion go into executive session at 2 p. m. , which was carried. 

A paper upon The Sanguinary Assault by United States 
forces upon the Moros at Bud-Dajo. Island of Jolo, P. I., as 
Observed by the Surgeon, illustrated by Maps and Weapons, 
was then read by Major Charles B. Ewing, U.S.A. 

Some Hygienic Maxims for the Soldier in Camp and Field, 
were then presented by Colonel Joseph K. Weaver, N.G. Pa. 

The paper was discussed by Major Charles Lynch, U.S.A., 
Major George H. Halberstadt, N.G. Pa., Lieutenant Colonel M. 
W. H. Russell, R.A.M.C, Major Ernest A. Le Bel, Canadian 
A.M.C.. and Brigadier General Charles C. Foster, M.V.M. 

A Segregating Latrine for Temporary and Semipermanent 
Military Camps was then demonstrated and described by Major 
Greorge Sumner Crampton, N.G. Pa., and discussed by Major 
Herbert A. Arnold, N.G.Pa., Colonel Valery Havard, U.S.A., 
Captain C. Bruce Walls, 111. N.G., Dr. Thomas D. Coleman, 
President of the Georgia State Medical Society, Major Thomas 
J. Sullivan, 111. N. G., and Major Charles B. Ewing, U.S.A. 

The following Nominating Committee was appointed: 
Army, Colonel Havard. Minnesota, General Stone. 

Navy, Medical Director Wise. Nebraska, Colonel Nicholson. 

P.H.&M.H.S., Surgeon Carnngton. New Jersey, Lieutenant Schauffler. 
Arkansas, Major Minor. New York, Captain DeVries. 

Colorado, Colonel Root. North Carolina, Major Holmes. 

Georgia, Major Lyle. Pennsylvania, Major Halberstadt. 

Illinois, Captain Walls. Rhode Island, Major Jones. 

Iowa, Major Fairchild. Tennessee, Captain Nankivell. 

Maine, Colonel O'Neill. Virginia, Major Lynch, 

Maryland, Act. Asst. Surg. Marsh. Wisconsin, Colonel Edwards. 
MsLssachusetts, General Foster. Wyoming, Colonel Burgess. 

Michigan, Captain Frazier. 



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384 ASSOC! A TiON OF MILITARY SURGEONS, 



\ 



The meeting of the nominating committee was announced to 
take place immediately after the close of the afternoon session. 
The following papers were then read by title. 

A Method of Disposing of Excrementitious Matter, Suita- 
ble for Temporary Camps. By Major Herbert A. Arnold, 
N.G.Pa. 

Camp Sanitation. By Major Thomas J. Kirkpatrick, U.S.A. 

The Study of Military Hygiene for the National Guard Of- 
ficer. By Dr. Robert Smart, Former Assistant Surgeon, U.S.A. 

Don*t Swallow the Enemy, Don't Touch the Enemy, Don't 
Breathe the Enemy. By Captain Frank T. Woodbury, 
U,S.A. 

The Administration of a Plague Campaign. By Passed As- 
sistant Surgeon Rupert Blue, P.H.&M.H.S., Commanding plague 
suppressive measures in San Francisco, Cal. 

The Executive Work of a Plague Campaign. By Passed 
Assistant Surgeon W. C. Rucker, P.H.&M.H.S., Executive 
Oflficer plague suppressive measures in San Francisco, Cal. 

The Flea and Its Relation to Plague, with a synopsis of the 
Rat Fleas. By Passed Assistant Surgeon Carroll Fox, P.H.& 
M.H.S. , Pathologist plague suppressive measures, San Francisco, 
Cal. 

The Clinical and Post Mortem Diagnosis of Plague. By 
Passed Assistant Surgeon Carroll Fox, P.H.&M.H.S. 

The Examination of Rats and the Practical Bacteriology of 
Plague. By Passed Assistant Surgeon G. W* McCoy, P.H.& 
M.H.S. , Bacteriologist plague suppressive measures, San Fran- 
cisco, Cal. 

Rat Destruction. By Passed Assistant Surgeon C. W. Vogel, 
P.H.&M.H.S., Commanding the 5th Provisional Plague District, 
San Francisco, Cal. 

Practical Rat-Proofing as an Anti-Plague Measure. . By 
Passed Assistant Surgeon R. H. Creel, Commanding 6th Provis- 
ional Plague District, San Francisco, Cal. 

The Conduct of an Anti-Plague District. By Assistant Sur- 
geon J. R. Hurley, P.H.&M.H.S., Commanding 11th Provisional 
Plague District, San Francisco, Cal. 



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MINUTES OF THE SEVENTEENTH ANNUAL MEETING. 385 

Method of Making Sanitary Surveys in a Plague Campaign. 
By Acting Assistant Surgeon C. H. Woolsey, P.H.&M.H.S., 
Commanding 3rd Provisional Plague District, San Francisco, Cal. 

Cleaning and Disinfection as Plague Suppressive Measures. 
By Acting Assistant Surgeon G. M. Converse, P.H.&M.H.S., 
Commanding 1st Provisional Plague District, San Francisco, Cal. 

District Organization. By Acting Assistant Surgeon L. S. 
Schmitt, P.H.&M.H.S., Commanding 4th Provisional Plague 
District, San Francisco, Cal. 

FIFTH SESSION, WEDNESDAY AFTERNOON, OCT. 14, 1908. 

THE meeting was called to order at 2 p. m. in Executive 
Session, the President, Assistant Surgeon General 
George Tully Vaughan, P.H. &M.H.S., in the chair. 
During the session the following business was transacted. 
The presentation of insignia to foreign delegates at this and at 
future meetings was authorized; the attire to be worn at the 
meeting limited to uniforms of the services by virtue of which 
admission was gained to the Association, or to civilian clothing; 
directing the Secretary to publish and issue to each member a 
copy of the Constitution and By-Laws wit^a list of the members 
showing the date and source of membership in each case; refer- 
ring the report of the auditing committee on the Treasurer's 
accounts to the auditing committee of the Secretary's accounts 
for the verification of expenditures and vouchers, and endorsing 
the following Resolutions adopted by the Executive Committee 
of the American •National Red Cross, October 18, 1907: 

JVhereaSj By international agreement in the Treaty of Geneva, 1864, 
and the revised Treaty of Geneva, 1906, "the emblem of the Red Cross on 
a white ground and the words Red Cross or Geneva Cross" were adopted 
to designate the personnel protected by this Convention, and 

IVhtreaSj The Treaty further provides (Article 23) that "the emblem 
of the Red Cross on a white ground and the words Red Cross or Geneva 
Cross can only be used whether in time of peace or war, to protect or des- 
ignate sanitary formations and establishments, the personnel and material 
protected by this convention," and 

Whereas^ The American National Red Cross comes under the regula- 
tions of this Treaty according to Article 10, ^'volunteer aid societies, duly 
recognized and authorized by their respective governments," such recogni- 



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386 ASSOCIA TION OF MILITAR Y SURGEONS, 

tion and authority having been conferred upon the American National Red 
Cross in the Charter granted by Congress, January 5, 1905, Sec. 2, "The 
corporation hereby created is designated as the organization which is 
authorized to act in matters of relief under said Treaty," and furthermore. 

Whereas^ In the Revised Treaty of Geneva, 1906, in Article 27, it is 
provided that "the signatory powers whose legislation should not now be 
adequate, engage to take or recommend to their legislatures such measures 
as may be necessary to prevent the use by private persons or by societies 
other than those upon which this Convention confers the right thereto of 
the emblem or name of the Red Cross or Geneva Cross," 

Be it Resolvedy That the Executive Committee of the American Na- 
tional Red Cross requests that all hospitals, health departments and like 
institutions kindly desist from the use of the Red Cross created for the 
special purpose mentioned above, and suggests that for it should be substi- 
tuted some other insignia, such as a green St. Andrew's cross on a white 
ground, to be named the ^'Hospital Cross", and used to designate all hos- 
pitals (save such as are under the Medical Departments of the Army and 
Navy and the authorized volunteer aid society of the Government), all 
health departments and like institutions, and, further, 

Be it Resolved^ That the Executive Committee of the American Na- 
tional Red Cross likewise requests that all individuals or business firms 
and corporations who employ the Geneva Red Cross for business purposes, 
kindly desist from such use, gradually withdrawing its employment and 
substituting some other distinguishing mark. 

The Executive Session adjourned at 3.15 p. m. and the open 
sessions were resumed. 

A paper upon Service Schools for the Militia was read by 
Captain G. Morgan Muren, N.G.N.Y., and discussed by Lieu- 
tenant Colonel George P. Marquis, Ill.N.G., Brigadier General 
Charles C. Foster, M.V.M., Major W. C. Lyle, Ga.N.G., and 
Colonel Valery Havard, U.S.A. 

The Organization and Training of the First Aid Corps of 
the Philadelphia and Reading Coal and Iron Company and A 
New Model Mine Ambulance were then described by Major George 
H. Halberstadt, N.G.Pa. 

This was followed by a paper upon The Origin and Condi- 
tion of the Peoples who make up the Bulk of our Immigrants 
and the Probable Effect of their Absorption upon our Popula- 
tion, by Medical Director Manly Hale Simons, U.S.N. 

The following papers were then read by title. 



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MINUTES OF THE SEVENTEENTH ANNUAL MEETING. 387 

A National Guard Practice March. By Major Buell S. 
Rogers, Illinois N.G. 

Method for Recording the Surgeon's Orders in Hospital. 
By Former Acting Assistant Surgeon Harold D. Corbusier, 
U.S.A. 

Researches upon the Cultivation of the Plasmodia of Mala- 
ria. By Captain Charles F. Craig, U.S.A. 

Battleship Neurasthenia (?). By Surgeon Sheldon Guth- 
rie Evans, U.S.N. 

Change of Climate not Essential in Treatment of Pulmonary 
Tuberculosis. By Former Acting Assistant Surgeon Melville 
A. Hays, U.S.A. 

Disease, — A Conservative Instrument of Nature. By Sur- 
geon P. C. Kalloch, P.H.&M.H.S. 

Perforation of the Intestines in Typhoid Fever — A Brief Re- 
view with a Report of Three Cases. By Passed Assistant Surgeon 
C. H. Lavinder, P.H.&M.H.S. 

The Medical Log of the U.S.S. Virgitiia on the Cruise to 
the Pacific. By Surgeon Charles Henry Tilgham Lowndes, 
U.S.N. 

A Plea for the Early Diagnosis of Pulmonary Tuberculosis. 
By Surgeon Barton Lisle Wright, U.S.N. 

The meeting then at 5 p. m. adjourned. 

SIXTH SESSION, THURSDAY MORNING. OCTOBER 15, 1908. 

THE meeting was called to order by the Second Vice Pres- 
ident, Colonel Joseph K. Weaver, N.G. Pa. at 10 a. m. 
in executive session. 
During the executive session the following actions were 
taken: The Auditing Committee on the Secretary's accounts 
reported that the books of the Secretary and Editor were complete, 
minutely itemized, and invariably vouched, and that the items 
referred to it from the Committee on Treasurer's Accounts were 
uniformly accounted for as received and the amounts fully 
accounted for as expended, and the report was thereupon adopted. 
The report of the Auditing Committee on the Treasurer's Ac- 
counts specifying that in future all funds received except Journal 



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3 88 ASSOC! A TION OF MIUTAR Y SURGEONS, 

receipts should be paid to the Treasurer, and that all expendi- 
tures on the part of that oflScer should be upon vouchers approved 
by the President was also adopted. An appropriation of $1 ,200. 6o 
for the work of the Secretary and Editor was made, and a vote 
of confidence in that officer was adopted. 

The Association then resumed its open session at 10.45 a.m. 

A paper upon Sanatorium Management was read by Surgeon 
Paul M. Carrington, P.H.&M.H.S. 

The reading of a paper upon A Mexican Litter Especially 
Adapted to Transportation from the First Line to the Dressing 
Station, by Lieutenant Colonel Alejandro Ross, Mexican Army, 
then followed. 

The next event of the afternoon was the customary ad- 
dresses by the representatives of foreign nations. 

Lieutenant Colonel Russei^l, R.A.M.C— Mr. President and 
Members : I think that the eminence and value of this associa- 
tion and the work that is done is sufficiently proven by the 
fact that foreign governments send representatives to watch and 
learn from your proceedings. I had heard before I came from 
predecessors who have attended meetings how warmly they have 
been received and what profit and pleasure they have derived 
from your sessions. I was, therefore, not unprepared for a cor- 
dial welcome, but I think I can say that the realization has out- 
stripped my anticipations. I must thank you all for your broth- 
erly greeting. You have made me feel at home, than which I 
can give no higher commendation of your hospitality. I knew 
practically nobody, but I may now say that there are no states in 
which I could not find a friend whom I have made. I will not 
detain you, but I have thoroughly enjoyed my stay with you, 
and I have derived keen pleasure from my visit, but when I have 
been able to think over and digest the work, I feel that the 
profit I shall have derived will not be inconsiderable. 

Lieutenant Colonel W. H. W. Elliot, I. M.S.— I want to 
say a word of thanks for the pleasant time I have had here. I 
was with you at Buffalo two years ago. I never dreamt I would 
get another nomination, and I was most agreeably surprised and 



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MINUTES OF THE SE VENTEENTH ANNUAL MEE TING, 389 

jumped at the ofifer. I fear that under the circumstances it 
would be too much to expect a third nomination, but it is not 
altogether impossible. In any case I shall always have the most 
pleasant recollections of my two visits and always feel a satis- 
faction in expressing the privilege of being a corresponding 
member. 

Lieutenant Colonel Alejandro Ross, Mexican Army.— Ev- 
ery time that I come to the states I have much pleasure to see 
this country, and I am also satisfied to be among the military 
surgeons, my friends and fellows, from whom I have learned 
much and will learn more. I have always presented some models 
of Mexican equipments, and have had the satisfaction of seeing 
that my words have been accepted. I ammuch obliged to this asso- 
ciation for these meetings. One of my great pleasures is to show 
upon my breast the insignia of the Association. I keep this 
decoration with a deep sense of gratitude, and I consider it an 
emblem of the good fellowship and friendship of the military 
surgeons of Mexico and the United States. Having elected as 
corresponding members the Chief of the Medical Department and 
the Director of the Military Medical School of the Mexican 
Army, I declare that both oflScers are worthy this distinction 
as they have worked very much. I give the most expressive 
thanks in their names. 

Lieutenant Colonel Josft Barbosa LeIo of Portugal. — Mr. 
President and illustrious colleagues: How sorry I have been 
lately for being unable to speak English well enough to express 
fully my great pleasure and gratification in being present at your 
congress. But T am sure, you will excuse me and accept kindly 
my badly translated expressions which testify sincerely the high 
consideration and admiration of all my countrymen towards the 
immensely great people of the United States of North America, 
that beginning yesterday, as it were, to walk, are already seen 
running today in full speed on the van-guard of progress, and 
towards this astonishing people that do not know the impossible 
and have surprised the world with the incredible boldness of 
their mental conceptions. The Portuguese Government being 
highly obliged to the Government of the United States for the 



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390 ASSOCIA TION OF MILITARY SURGEONS. 

honor of their invitation to be represented in this Congress, 
charged me with the commission as honorable as difficult, as 
thorny as pleasant, to come here and thank heartily your 
Government for the invitation extended by them to my 
country. 

The military physicians in that little country of Europe 
called Portugal are also greedy for progress and animated by the 
legitimate ambition to accompany their colleagues in this enor- 
mous nation through the way of science and its practical appli- 
cations. 

Here I am then among you in this modern American 
Athens invested with the honor to salute the Government of this 
great people in the name of the Government of Portugal, in the 
name of the Portuguese military physicians and in my own. I 
was charged at the same time with the mission to transmit the 
most sincere protestations of wishes of my country for the suc- 
cess and splendor of the work of this meeting, from which, no 
doubt, a great benefit shall derive for the army and for the inter- 
ests of humanity the world over. 

I rejoice to think that the military physician everywhere 
lives in a higher atmosphere than that which is apt to be dis- 
turbed in the dusty arena of politics and by the various phases 
of international strife and competition. We are all cultivators 
of a science that has no native country, that has no home. We 
are all apostles of the most holy religion, that of charity. When 
we unite, we can but do work of a great value and practical in- 
terest. Our efforts are always for the best interests of soldiers 
and humanity the world over. The illustrious representatives of 
military medicine join here, assured of attention to their indubi- 
table scientific authority. I trust then I shall carry from here 
to my country the most pleasant remembrances of this town an 
and important contribution of sound erudition. 

I accept with pride the honor as great as unmerited you 
have conferred upon me in making me a corresponding member. I 
am sorry I cannot return the greatness of the offer with a visible 
profitableness of a scientific work, but I do assure you that I 
will endeavor to follow you, at least at a distance and I will never 



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MINUTES OF THE SEVENTEENTH ANNUAL MEETING. 391 

forget your civilities. Now I cannot say more than, Thank 
you very much. 

Major Ernest A. LeBel, of Canada. — I am extremely 
thankful to you, Mr. President, for offering me the privilege of 
making a few remarks to your Association at its seventeenth con- 
gress, and have no doubt that such meetings will cement the 
friendly relations already existing between the people of Can- 
ada and your country, and will tend to draw closer the ties 
which bind together the medical faculties of both countries. 

We Canadians have just founded also an Association of Mili- 
tary Surgeons and sincerely hope that it will work in harmony 
with yours in a near future. 

For two obvious reasons am I happy to have responded to 
your kind invitation, first because of the great pleasure it affords 
me to meet old friends, since I have attended your congress in 
Boston in 1903; and next because I am the bearer of the best 
wishes of the Canadian Militia for - the success of the present 
congress. 

Now, Mr. President, may I be permitted to throw out the 
suggestion that the rules of our Association be so amended or 
modified as to allow the latter to hold its sittings occasionally 
in Canada, and, in the premises, may I express the wish that 
you meet next year or in a near future in Quebec, the Old Rock 
City of Champlain where both citizens and municipal authorities, 
will endeavor to keep up the standard of their repute for un- 
bounded hospitality and courteousness, and where you will be 
afforded all the facilities for visiting and studying the most his- 
toric city and environs on the Continent. 

In conclusion I desire to express my personal wish for the 
entire success of this Congress which is called upon to work in 
the interests of military surgery and hygiene the world over 
and so apt to develop amicable relations between all the nations 
whose distinguished representatives honor us by their presence 
on this solemn occasion, and whose aim is to work together not 
only for the progress of military medical service, but as well for 
the general welfare of humanity. 



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392 ASSOCIA TION OF MILITAR Y SURGEONS, 

On motion, the Association, while regretting its inability to 
meet on Canadian soil, voted to send a delegate to the next meet- 
ing of the Canadian Military Medical Association. 

The following resolutions were proposed by Major James 
Evelyn Pilcher and unanimously adopted: 

Resolved, that in view of the courteous treatment received by the mem- 
bers of the Association during the Seventeenth Annual Meeting, the hearty 
and cordial thanks of the Association be extended 

1. To Lieutenant A. H. Lindorme, N.G.Ga., Chairman of the Com- 
mittee of Arrangements, Colonel George Brown, N.G.Ga., Chairman of 
the Committee on Entertainment, and the citizens of Atlanta for the work 
which has been done in connection with our social entertainment. 

2. To Judge Marcus Beck and Dr. J. S. Todd, whose interesting ad- 
dresses formed so valuable a feature of the public meeting. 

3. To the Fulton County Medical Society for the delightful reception 
given the Association and to the authorities of the Georgia State Fair for 
opening the gates of that institution to our members. 

4. To the officers of the National Guard of Georgia and the ladies asso- 
ciated with them in the conduct of the barbecue and accompanying festiv- 
ities at Oakland City. 

5. To the Capital City Club, the Transportation Club, the AtlanU 
Athletic Club and the East Lake Country Club for extending the courte- 
sies of their houses to the Association. 

6. To the managers of the Piedmont Hotel for the uniform civility and 
hospitality which they have displayed. 

General A. J. Stone then moved the following resolution 
which was seconded and adopted : 

Resolved, that the thanks of the Association be extended to the officers 
who have conducted its affairs so successfully during the present 
year. 

Colonel Valery Havard, Chairman of the Nominating Com- 
mittee then presented the following report. 

The Nominating Committee has the honor to report the following 
nominations for officers during the Association year 1908-1909. 

President, Rear Admiral Presley M. Rixey, U.S.N. 

First Vice President, Colonel Joseph K. Weaver, N.G.Pa. 

Second Vice President^ Colonel William C. Gorgas, U.S.A. 

Third Vice President, Surgeon C. P. Wertenbakbr, P.H.&M.H.S. 

Treasurer, Major Herbert A. Arnold, N.G.Pa. 



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MINUTES OF THE SEVENTEENTH ANNUAL MEETING. 393 

The Secretary^ Major James Evelyn Pilcher, being, under the Con- 
stitution, a permanent official, no nomination is made for that office. 
Place of meeting for 1909— Washington, D. C. 
Time of meeting to be fixed by the Executive Council. 

The report was adopted and the Secretary by unanimous 
vote instructed to cast the ballot of the Association for the nom- 
inees presented, which was done, and the election thereby com- 
pleted. 

General A. J. Stone and Colonel Valery Havard were ap- 
pointed a committee to escort the President-elect Surgeon Gen- 
eral Presley Marion Rixey, U.S.N. , to the chair. 

Surgeon General Presley Marion Rixey, President-elect, 
then addressed the Association as follows: 

Fellow Colleagues. — In accepting the presidency of this 
organization for the ensuing year, I wish, as the representative 
of the Medical Corps of the Navy, to thank you for the honor 
conferred upon that branch of the service and to express my ap- 
preciation of the personal compliment. I deeply regret that I 
have been unable in the past to take as active a part in the work 
of the Association as I should have liked, but it has been my 
pleasure as far as possible to see that the Navy was furnishing 
its quota towards its success. 

I am deeply sensible of the responsibilities devolving upon 
the incumbent of this oflSce, and in that consciousness I assure 
you that, so far as lies within my power, I shall, in the future 
as I have in the past, endeavor to do everything to promote the 
interest and welfare of this growing and important Association of 
Military Surgeons. 

No one who has intelligently watched the trend of the times 
and given serious thought to the full meaning of medical advance 
— both within its own scientific sphere of activity and in relation 
to human enterprise the world over, particularly the develop- 
ment of the art of war on land and sea and the growing complexity 
of life— can fail to realize the incalculable value of such an asso- 
ciation. The power for greatest benefit from the truths which 
medical science has given and is daily giving us rests upon the 



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394 ASSOCIA TION OF MILITARY SURGEONS. 

condition of co-operation in their application, and in no field of 
endeavor is this requirement more urgent than in the medico- 
military service, in which the first duty of those charged with 
the supervision of health conditions in the land and sea forces is 
that of the hygienist. Problems of preventive medicine, though 
the same in principle everywhere, diflFer in many respects, as be- 
tween civil and military life, in their practical applicability, 
and the dictates of sanitary science must be adapted to the vary- 
ing circumstances and inalienable conditions of special services? 
What more essential provision, therefore, than this annual gath- 
ering of representative medical men who have a common interest 
in medico-military matters. A conflict of interests should in the 
very nature of things be impossible, for no matter what the pe- 
culiar interests of the various factors of this organization may 
be, the very foundation upon which we have builded is com- 
munity of interest and a greater or less interdependence, and we 
should be growing closer together as time passes. The reserve 
force which the National Guard has always constituted in rela- 
tion to the Army has now been brought into closer affiliation 
with that arm of the government service. It is hoped that, in 
the near future, the Naval Militia may participate in a similarly 
improved relation as the reserve force of the Navy. We have 
long realized the value of the Naval Militia organizations of the 
various states as a reserve source of surgeons, trained in naval 
service conditions, for purposes of medical department expansion 
in time of national need, and every means within the limits of 
the law looking to the establishment and continuance of a 
closer relation has been employed. Effort was made last year to 
give the medical officers of the Naval Militia a national status, 
and effort will be continued in this direction, but until Congress 
recognizes the need to provide for this desirable change by lib- 
eral legislation, we must depend solely upon the opportunities 
which these meetings offer for a better acquaintance and a clearer 
understanding of our mutual aims. Here, and through the 
agency of the Association journal, new ideas are presented and 
pertinent problems are discussed so that, besides the pleasure and 
refreshment of professional and social intercourse, there is the 



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MINUTES OFTHE SEVENTEENTH ANNUAL MEETING. 395 

salient feature of individual intellectual profit by which each ser- 
vice and the Government as a whole benefits immeasurably. 
The Association of Military Surgeons today wields a potent in- 
fluence for the nation's welfare, and it is rapidly developing 
toward the realization of its destiny as a co-ordinating institution 
of all state and national medico-military organizations, and as a 
universal school of military medicine and hygiene. It has a 
splendid future if we will work together in unity of aim for its 
best possibility, and I entertain the ambition that, during my 
administration, progress will be no less marked than under the 
guidance of my esteemed predecessors. 

After the presentation of the following papers by title, the 
Association adjourned sine die. 

The Development and Maintenance of a Militia Hospital 
Corps. By Captain J. Carlisle DeVries, N.G.N.Y. 

The Care of the Refugees from the Chelsea fire, by Captain 
P. F. Butler, M.V.M. 

A Diagram of the Medical Organization, U.S. Army, for 
Service with a Division; Designed for the Purpose of Instruct- 
ing the Hospital Corps and to Show Where the American 
National Red Cross Can be of Assistance in Time of War. By 
Lieutenant G. H. Richardson, U.S.M.R.C. 

The Remote Effects of Exposure to the Direct Rays of 
the Sun. By Lieutenant Colonel Edward Champe Carter, 
U.S.A. 

Medical versus Surgical Treatment of Amebic Dysentery. 
By Passed Assistant Surgeon John Milton Holt, P.H.&M.H.S. 

Military Sanitary Problems in the Philippine Islands. By 
Colonel Louis Mervin Maus, U.S.A. 

Retrospect of Cooperative Work of the Medical Services of 
the Government. By Surgeon H. W. Austin, P.H.&M.H.S. 

The Situation of the Medical Corps in the Austrian Army. 
By Major George E. Bushnell. U.S.A. 

Public Health and Military Medical Department of the 
United States. By Surgeon Lloyd W. Curtis, U.S.N. 



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396 ASSOCIA TION OF MILITARY SURGEONS. 

Some Recent Scandinavian Military Medical Literature. 
By Major Hans Daae, Norwegian Army. 

The Steel Frame in the Transportation of the Disabled. By 
Colonel C. de Mooy, Retired, Netherlands Army. 

Variola Hemorrhagica. By Passed Assistant Surgeon R. 
E. Ebersole, P.H.&M.H.S. 

A New Detached Service Medical Outfit. By Captain Je?se 
R. Harris, U.S.A. 

The Disposal of All Liquid Refuse of the Otis Excavators 
and of the Sanitary Carts in a Maneuver Camp, by Evaporation 
on Heated Rocks. By Major Henry L Raymond, U.S.A. 

Sanitary Service of the Swiss Army. By Captain Louis C. 
Duncan, U.S.A. 

A Simple Method of Transporting Drugs, Surgical Instru- 
ments, and Dressings into the Field for a Pew Day's March. By 
Lieutenant Harold G. Goldberg, N.G.Pa. 

Sanitary Service in the Field. By Colonel H. Nimier, 
French Army. 

The Civilian Aid Society in its Relation to the Military 
Service. By Major James Evelyn Pilcher, late U.S.V. 

The Organization and Initial Work of the Medical Depart- 
ment when Volunteers are Called into Service. By Major Fred- 
erick P. Reynolds, U.S.A. 

The New Sanitary Regulations of the Swedish Army. By 
Captain Robert L. Richards, U.S.A. 

The Field Hospital of the Austrian Red Cross. By Stab- 
sarzt Dr. Johann Steiner, Austro-Hungarian Army. 

A Plea for Specialism. By Captain Edward B. Vedder, 
U.S.A. 

The Sanitary Service in the Third Japanese Army, the Be- 
sieging Army at Port Arthur. By Captain Edward B. Vedder, 
U.S.A. 



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Contemporary Comment 



PROPHYLAXIS IN VENEREAL DISEASES. 

IN a lecture (^Allgemeine MilitaerztL ZtgS) before the scien- 
tific association in Temesar, Dr. Ferenezy treats this im- 
portant question in detail. That venereal diseases were con- 
tagious was known in ancient times. The earliest known pro- 
tective measures consisted in washing the penis after coitus, or 
urinating shortly after intercourse. The still popular method of 
washing the penis with freshly passed urine as a prophylaxis 
against venereal diseases was recommended by Fallopius. The 
cundom introduced by a physician in the middle of the last cen- 
tury is most frequently used at the present time. The discovery 
of. this method of preventing venereal infection received little 
credit, yet its usefulness cannot be denied. Crede's two percent 
silver nitrate solution for blennorhea of the eyes of the new- 
born and Neisser's protargol were soon popular anti-gonorrheal 
remedies. The writer has used prophylactic measures in two 
artillery regiments for one year and succeeded in reducing the 
venereal diseases one half of those of the preceding year. In the 
Artillery Regiment No. 20, eighty-four men had venereal dis- 
eases in 1905; forty- three in 1906 when prophylaxis was resorted 
to. In the Artillery Regiment No. 7, 102 men had venereal dis- 
eases in 1905 and sixty-five in 1906. The figures forty-three and 
sixty-five do not indicate any inefiBciency of the prophylactic 
measures as it was impossible to treat some of these cases on 
account of maneuvers, target practice and furloughs, and 
some willfully neglected to take the proper precautions. A 
convenient systematic plan to carry out prophylaxis in the 
•barracks is of prime importance. The remedy used is second- 
ary. The soldiers must be made acquainted with the danger 
and consequences of gonorrhea. It is especially important to 
win their confidence and cooperation in the matter. The author's 
method is most useful and caused no difficulties. A box, con- 
taining the necessary solutions and cotton, with directions was 
placed in the bath room. The soldier, coming to the barracks 

(8W) 



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398 CONTEMPORAR Y COMMENT. 

after coitus goes to the bath room, gets his bichloride solution 
and thoroughly washes his penis, then injects, with a medicine 
dropper, a 1 per cent solution of nitrate of silver. The medicine 
droppers are kept in a 3 percent boric acid solution in which tbey 
are placed after they have been cleaned with cotton. Kor 
prophylaxis during maneuvers, the writer had prepared small 
rods consisting of silver nitrate ichthyol and cocoa-butter. 
Each man received ten or twelve of these and was told to place 
one in the fossa navicularis after coitus and by gentle stroking^ 
cause it to melt. This is a very simple, quick and easy method. 
If the rods are introduced shortly after intercourse they may 
exert their bactericidal action at a time when the germs have 
not yet passed into the cells. Cleanliness in sexual intercourse 
does much in preventing venereal diseases. In the eflFort to 
eliminate venereal diseases every remedy should be welcome. A 
recent order from the War Department makes venereal prophy- 
laxis obligatory. — F. J. Conzelmann. 



TREATMENT OF SYPHILIS BY ARYLARSONATES. 

IN The British Medical journal Colonel F. J. Lambkin, R. 
A.M.C., arrives at the following conclusions with regard to 
the use of arylarsonates in syphilis: 

1. That there is strong reason to believe that, given early 
and in suflScient quantities, they can be looked on as prophylac- 
tic in the majority of cases against any further development 
of the disease. 

2. That they undoubtedly delay and modify very remark- 
ably the secondary symptoms. 

3. That they appear to exert a marked beneficial effect on 
all syphilitic ulcerations. 

4. Finally, without entering into the question as to whether 
the treatment of syphilis by arylarsonates is as efiBcacious or 
likely to become more so than that by mercury, which time and 
further experience can alone tell us, I consider that one import- 
ant fact has been established — that is, that in these salts we are 
now in possession of a second specific for syphilis and need not 
add that the importance of this can not be well exaggerated. 
With regard to the therapeutic action of arylarsonates on syphi- 
litic lesions, the work of several observers has indicated that 
they do not kilf the germ (as mercury is supposed to do), but 
exert their influence in strengthening the phagocytic defence of 
the host. 



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flDebtco-flDtlttar^ f nbei. 



MEDICO-MILITARY ADMINISTRATION. 

[Ambulance wagon drawn by dogs.] Caducie^ Par., 1908, viii, 78. 

Bell (W. H.) Medical department battle stations. U, States Nav. 
Med, BulL^ Wash., 1907, i, 171. 

D-ff (AO [A regimental bandaging point during battle in the late war; 
from the reminiscences of a senior physician.] Voyenno-med, /., St. 
Petersb., 1908, ccxxi, med. spec. pt. 53 ; 244. 

Donegaa (J. D. F«) Notes on the new Geneva Convention. /. Roy. 
Army Med, Corps^ Lond., 1908, x, 520-526. 

MEDICO-MILITARY HISTORY AND DESCRIPTIOIt. 

Bofgey. [Campaign against the Beni-Snassen.] Caducte^ Par., viii, 
105-108. 

DesBnienles (J.) [Military hygiene in the i8th Century.] Bull, mkd,. 
Par., 1908. xxii, 408. 

Franck (E«) [^Military surgery a hundred years ago.] Med, Klin,^ 
Berl., 1907, iii, 1461; 1495- 

MILITARY HYGIENE. 

Andrzheyevski (A« JO [Toothless soldiers and their radical dental aid.] 
Voyenno-med,^ spec. pt. 199-205. 

Barthelemy and Varenne (Georges)* [Manual of naval hygiene for the 
usage of captains, officers and students of the merchant marine.] Paris, 
1907, A. Challamel, 373 p. 8°. 

Bonjean (£♦) [Surveillance of the water supply of the army.] Rev. 
prat, dhyg, municip. [etc.] Par., 1908, iv. Bulletin technique 42-44. 

MILITARY MEDICINE. 

Braua (A.) [Functional troubles of the heart and tuberculosis in the 
soldier.] Arch,de mid. etpharm, miL^ Par., 1908, li, 273-297. 

Gazean* [Tuberculosis on board the Desairs.^ Arch, de mkd, nav.y 
Par., 1908, Ixxxix, 222-225. 

MILITARY SURGERY. 

Braun (A.) [Appendicitis operations and military availability.] 
Deutsche, miL-drztl. Ztschr.^ Berl , 1908, xxxvii, 369-383. 

Imbrtaco (P*) [Statistical report of the surgical operations performed 
in the medico military establishments during the year 1906.] Gior. med. 
d, r. esercitOy Roma, 1907, Ivi, 801-843. 

(899) 



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, Georgia^SUte Capitol* 

Ebttotial Expression. 



THE ACCESSORIES AT ATLANTA. 

AS had been anticipated Atlanta proved to be a most delight- 
/■^ ful location for the meeting of the Association of Mili- 
tary Surgeons. The beautiful city and its delightful 
climate appeared to the best advantage. All of the entertain- 
ments which had been planned passed off smoothly and delight- 
fully. 

The automobile ride through the city and its suburbs, which 
was scheduled for Tuesday afternoon, was a most agreeable 
affair. But one serious accident occurred to mar the complete 
enjoyment of the event, an accident which narrowly escaped 
being a tragedy but which in its finality became a comedy. • On 

(400) 



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IHE ACCESSORIES AT A TLANTA. 401 

the way from the hotel out through the city and suburbs the 
entire party was stopped at the State Capitol where was taken 
one of the finest group pictures the writer has ever seen. This, 
in very greatly reduced form, is reproduced herewith, but the 
original should be seen to be appreciated. After the evening 
entertainment many of the members were escorted to the Capitol 
City Club where the doors were opened wide to them with a 
hospitality which never failed during the remainder of the week. 
On Wednesday evening the reception at the supurb Piedmont 
Driving Club was a scene long to be remembered by those who 
had the good fortune to be present. Every accessory which 



Capital City Club* 

might prove of effect in entertaining the guests was present. 
The beautiful ballroom was in unsurpassed condition and those 
members of the Association in whom the youthful fires still bum 
enjoyed the fine music and finer floor to the full. 

By the adoption of the unusual plan of advancing papers 
from time to time it came about that the scientific work was 
completed on Thursday morning, which left Thursday after- 
noon free for a visit to the Georgia State Fair, which was in ses- 



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403 EDITORIAL EXPRESSION. 



sion at the time of the 
meeting. The Associa- 
2 tion were guests of the 
^ State Pair authorities and 
S received from them every 
a courtesy. The Grand 
i* stand and all the other 
8 attractions of the Fair 



H 



^^ 



were free to the members 
and a great deal of inter- 
est was felt in this feat- 
ure of the visit— a feature 
entirely unlike ^anything 
else which had ever been 
experienced at the Asso- 
ciation meetings. 

Thursday evening was 
left open for the personal 
entertainment of the 
various members by citi- 
zens of Atlanta and to af- 
ford an opportunity for 
the indulgence of personal 
tastes upon the part of the 
members. This was a 
feature most heartily wel- 
comed and most cordially 
enjoyed. 

The climax of the social 
accessories however cul- 
minated in the barbecue 
at Oakland City. A spe- 
cial trolley was provided 
for the members of the 
Association whichbrought 
them within a few yards 



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THE ACCESSORIES^A T A TLANTA, 4O3 

of the rustic park in which they found mutton and pork roasting 
whole over an old fashioned wood fire, a process which had been 
going on for many hours in order to bring out the exact shade of 
delicacy which was essential to the full development of the 
proper flavor. Here a large number of physicians and military 
men gathered to participate in the function and when the Bruns- 
wick stew — a most delicious concoction of almost everything 
culinary— was served, the loiig tables were filled with hosts and 
guests. The view shown herewith exhibits but one side of a 
part of one of the tables, which it is rejrretted could 



teated, tne secretary 
of the Association took the chair by request and presented the 
foreign delegates to the assembled company. These gentlemen 
came to the front nobly and responded to the occasion in gal- 
lant and eloquent terms. Particular mention must be made of 
Lieutenant Colonel I^eao of Portugal who displayed to an em- 
inent degree that preparation so essential to efiBciency in a 
soldier and whose well worded phrases and eloquent diction 
already prepared in manuscript found a most enthusiastic re- 
ception. Indeed all of the foreign representatives commended 
themselves most heartily to the Association and the citizens of 
Atlanta alike. 



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404 EDITORIAL EXPRESSION. 

As the day wore on the party diminished in numbers until 
in the latter part of the afternoon it was sufficiently reduced to 
be accommodated in two tally-hoes, which had been provided 
through the courtesy of one of the officers of the Georgia state 
forces and upon which the party coached to Fort McPherson and 
through many beautiful streets and charming drives, a most 
fitting termination to a most memorable series of entertainments. 

The Association was very fortunate in the location of all its 
sessions. The Piedmont Hotel was a beautiful structure and the 
courtesy of its employees and the perfection of its service was 



Entrance to Fort McPherson, near Atlantat Ga« 

everything that could be desired. The Convention Hall on the 
tenth floor was a most excellent place for the meeting and could 
have accommodated three times the attendance at its sessions. 

The Legislative Hall, in the State Capitol, in which the 
Public Meeting was held, was of course peculiarly adapted to the 
occasion and the Capitol itself, which was thrown open to the 
guests, excited much interest, being probably the only State 
Capitol which presents in its rotunda the portrait of a country 
doctor as one of the most distinguished heroes of the state — Dr. 
Crawford W. Long, one of the discoverers of anesthesia by sul- 
phuric ether. 



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THE A CCESSORIES AT A TLANTA . 405 

Many of the southern states wer^ represented, although, as 
a whole the Association was disappointed in not having a larger 
attendance from the south. The north and west were well rep- 
resented as usual and the most northern, as well as the most 
eastern state, had an unusually large delegation. 

A plan much discussed and with great approval for future 
meetings was that the Association should convene on alternate 
years in Washington and that at those meetings the presidency 



Piedmont Hotel. 

should be held in rotation by medical oflBcers of the national ser- 
vices, while on the other years the presidency should be held by 
an officer of the national guard in whose state the meeting should 
be held. This of course could not be embodied in the Constitu- 
tion nor was any attempt made to officially adopt it by the Asso- 
ciation, but the suggestion that it become an unwritten law, like 
that which requires a President of the Association to be present 
at the meeting at which he is elected to the presidency, as well 
as the one at which he presides, was regarded with great favor. 



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406 EDITORIAL EXPRESSION. 

THE OFFICERS OF THE ASSOCIATION, 1908-1909. 

THE inevitable change consequent upon the progress of 
time has brought to the head of the Association one of 
its most distinguished and capable members in the per- 
son of Rear Admiral Presley Marion Rixey, who was appointed 
Surgeon General of the Navy on the tenth of February, 1902. 
Admiral Rixey was b6m in Culpeper county, Virginia, on the 
fourteenth of July, 1852, and received his early education at 
schools in Culpeper and Warrenton. His family identified itself 
with the Confederate cause during the civil war which brought 
financial ruin upon its members in company with so large a pro- 
portion of our old southern families. Undaunted by difficulties, 
however, he sought and achieved an education, both general and 
professional, receiving the doctorate in medicine from the Uni- 
versity of Virginia in 1873. He then undertook to extend his 
practical acquaintance with his profession by attendance upon 
clinics and hospitals in Philadelphia during the remainder of the 
year, presenting himself before the naval examining board early 
in 1874 as a candidate for appointment in the medical corps of the 
Navy. 

He was commissioned Assistant Surgeon in the navy on the 
twenty-eighth of January, 1874, and set out upon that long 
period of service which has been crowned with the highest 
honors attainable in his corps and in the Association of Military 
Surgeons. He was first assigned to duty on the Receiving Ship 
Sabine, but soon transferred to the Congress, then on the Eu- 
ropean^ station and later at the Centennial Exposition at Phil- 
adelphia, where she represented the navy. He was detached in 
1876 and ordered to the Philadelphia Naval Hospital, where he 
remained until he passed his examination for promotion to the 
grade of Passed Assistant Surgeon in 1877. He then took sta- 
tion at the Norfolk (Va.) Navy Yard as attending surgeon, 
where he served until assigned to a three years tour of special 
duty on the Tallepoosa in 1879. He was on the flagship Lan- 
caster from 1884 lo 1887 on the European and South Atlantic 
Stations, and on the Dolphin from 1893 to 1896. During the 
Spanish war he applied for active sea duty, but his services were 



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OFFICERS OF THE ASSOCIA TION 407 

deemed so essential in Washington that he could be spared only 
to make a brief voyage to Cuba on the ambulance ship Solace. 
The twelve years of service not enumerated above were passed 
on special duty as attending surgeon at Washington. In 1888 
he was promoted to the grade of Surgeon and in 1900 to that of 
Medical Inspector and since his detail as Surgeon General to that 
of Medical Director. 

During his long service in Washington he was honored with 
the confidence of many of the most prominent men of the coun- 
try, and for the last nine years has been physician to the Exec- 
utive Mansion. It was in special recognition of the value of his 
distinguished services in the latter capacity that President Mc- 
Kinley promised him the surgeon-generalcy of the navy when 
the next vacancy should occur, a promise which President 
Roosevelt fulfilled. In connection with his duty at the Execu- 
tive Mansion, it became necessary for him to accompany the 
President upon all journeys taken by the Chief Executive, and 
thus it happened that he was in Buffalo when President McKin- 
ley was assassinated. He had been detailed by the President 
to accompany Mrs. McKinley to the Milburn house, whilst he 
received the people, so that he was not immediately at hand 
when the President was shot, but was promptly summoned so 
that he was present and assisted with the operation, and took 
oflScial charge of the case. Here he displayed in the highest de- 
gree those qualities which evidenced not only professional ac- 
quirements of an entensive range, but executive ability and di- 
plomatic faculties of a remarkable character. The skill and 
devotion which he displayed in the management of the case of 
the President and the almost equally exacting case of the Presi- 
dent's invalid wife won for him the admiration and affection of 
the entire country. 

Admiral Rixey is a member of the American Medical Asso- 
ciation and a member by invitation of the Washington (D. C. ) 
Medical Society. He has been an active member of the Associa- 
tion of Military Surgeons since 1895, and served successively 
through the various vice presidential chairs prior to his election 
as President at Atlanta. 



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408 kDITORIAL EXPRESSION. 

On the occasion of an explosion on the Spanish Caravel 
Santa Maria in the harbor of New York in 1893 he rendered 
prompt and generous assistance to the officers and crew of the 
vessel, a courtesy which the King of Spain, Alfonso XIII, 
recognized by decorating him with the Order of Naval 
Merit. 

His thorough understanding of the needs of the service was 
evidenced by his prompt application to Congress for a material 
increase in the number of his corps. His request was accom- 
panied by evidence of the necessity for the desired action so con- 
vincing that the proposed legislation was promptly enacted. He 
has also added greatly to the efficiency of the Hospital Corps, 
developed the Naval Medical School, and established a female 
nurse corps for his service. But perhaps the most important 
achievement of his administration is the recognition of the right of 
the medical officer to command, a prerogative which had been 
jealously monopolized during the previous history of the Navy 
by officers of the line. Now, however, medical officers not only 
command in the naval hospitals and other institutions pertaining 
to the medical department, but such authority has been granted 
to them, notwithstanding tremendous opposition, on hospital 
ships. The accession of Admiral Rixey to the Presidency of the 
Association augurs good fortune for the organization, which is 
sure to be developed and advanced by the sagacity, tact and 
ability which has characterized all the official acts of his suc- 
eessful career. 

Much is expected of Admiral Rixey and there is no doubt 
in the minds of his friends but that he will justify their hopes in 
the administration of the affairs of the Association as he has 
already done in the conduct of the affairs of his Bureau. 

Colonel Joseph K. Weaver, Surgeon General of Pennsyl- 
vania, who was advanced to the First Vice Presidency, is one of 
the oldest and most faithful members of the Association whose 
loyalty to military surgery and whose distinguished administra- 
tive ability have been widely recognized by the organization which 
he has served so long and so efficiently. Under his guidance the 
Medical Corps of the Pennsylvania National Guard has never 



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Surgeon General Presley Marion Rizey» U.S*Nv President 



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410 



EDITORIAL EXPRESSION, 



Colonel Jofq)h K* Weavett N.G*Pa*» 
Pint Vice Prettdent. 



failed to present a large del- 
egation of active workers 
at each meeting. He has 
often presented papers him- 
self and has never failed to 
provide one or two num- 
bers on the annual program 
from the Keystone State. 
Colonel Weaver ranks high 
among the medical profession 
of Pennsylvania and in his 
own community. He is a 
trustee of Bucknell Univer- 
sity and holds many other 
honorable and responsible po- 
sitions, all of which have com- 
bined to create in him quali- 
ties which will go far toward 
making him one of the ablest 
and most accomplished of- 
ficers of the Association. 



Colonel William C. Gor- 
GAS of the Army Medical 
Corps, was advanced to the 
Second Vice Presidency. His 
work as one of the Commis- 
sioners of the Panama Canal 
has given him a world-wide 
reputation, which manifested 
itself during the past year 
in his election to the Presi- 
dency of the American Medi- 
cal Association. A rare com- 
bination of modesty, and in- 
itiative, geniality and force. 
Colonel Gorgas' position in 
the world has been won by 
supreme merit without ad- 
ventitious assistance. The 
Association is glad to recog- 



Colooel William C Gof^gast U«S.A*t 
Seoond Vice Pfoldent. 



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OFFICERS OF THE ASSOCIATION, 



411 



SufifeoQ C. P* Wertenbakeff 
Third Vice President 



nize the value of his work and to join the profession in its ad- 
miration of his accomplishments. 
Surgeon Chari.es Poindex- 

TER WeRTENBAKER, P. H. & 

M.H.S., the new Third Vice 
President, has been a member of 
the Association of Military Sur- 
geons since the meeting of| 
1893, at which the doors of the 
organization were first opened | 
to officers of the regular ser- 
vices. He has been very active 
in Association work, having 
been present at most of the an- 
nual meetings since that time, 
in the majority of instances as 
an official representative of his 
service. Surgeon Wertenbaker 
was prior to his entry into the 
service for thirteen years a member of the Virginia state forces 

where he gained an amount of 
military experience that created 
in him a degree of military en- 
thusiasm which has never been 
allowed to diminish. His work 
has been largely of a public 
health character, involving ser- 
vice in Cuba and Canada. He 
has administered successfully 
important quarantines, among 
which may be especially men- 
] tioned that at Atlanta in 1905 
where his discreet and efficient 
conduct of the work commended 
him warmly to the citizens of the 
city in which he was afterwards 
honored by election to the office 
which he now holds in the Asso- 
ciation. 
Of the Secretary and the Treasurer much might be said be-^ 



Major James Evelyn Pilchert 
Secretary and Editor. 



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412 EDITORIAL EXPRESSION. 

cause they are the officers whose work continues throughout the 

r. The many hours of daily 
3r required to conduct the 
interim affairs of the Associa- 
1 no one who has not at* 
ipted it can understand. 
e inquiry of one correspond- 
**do you never slumber nor 
ip?*' is right appropriate to 
situation, for the work re- 
res constant care, watchful- 
s and labor. All these quali- 
; have been exercised con 
ore during the past and no 
linution in the zeal and 
nestness with which they 

Major Herbert A. Arnold, °^^^ ^^^° ^^^"^^^ ^^^^^^ 

Treasurer. during the past years will be 

permitted during the coming year. 

ARMY MEDICAL CORPS EXAMINATIONS. 

THE Surgeon General of the Army announces that the 
first of the preliminary examinations for the appoint- 
ment of first lieutenants in the Army Medical Corps 
for the year 1909 will be.held on January 11, 1909, at points to 
be hereafter designated. 

Full information concerning the examination can be pro- 
cured upon application to the **Surgeon General, United States 
Army, Washington, D.C." The essential requirements to se- 
curing an invitation are that the applicant shall be a citizen of 
the United States, shall be between twenty-two and thirty years 
of age, a graduate of a medical school legally authorized to confer 
the degree of doctor of medicine, shall be of good moral char- 
acter and habits, and shall have had at least one year's hospital 
training or its equivalent in practice. The examinations will be 
held concurrently throughout the country at points where boards 
cau be convened. Due consideration will be given to localities 



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EDITORIAL EXPRESSION. 413 

from which applications are received, in order to lessen the travel- 
ing expenses of applicants as much as possible. 

The examination in subjects of general education (mathe- 
matics, geography, history, general literature and Latin) may be 
omitted in the case of applicants holding diplomas from reputable 
literary or scientific colleges, normal schools or high schools, or 
graduates of medical schools which require an entrance exami- 
nation satisfactory to the faculty of the Army Medical School, 

In order to perfect all necessary arrangements for the ex- 
amination, applications must be complete and in possession of 
the Adjutant General on or before December 10, 1908. Early 
attention is therefore enjoined upon all intending applicants. 
There are at present fifty-seven vacancies in tlie Medical Corps 
of the Army, 



HEATSTROKE. 

DURING a period of ten. years Steinhausen {Roths Jahres- 
bericht), studied in 443 cases the psychical and nervous 
conditions following heatstroke. Among the psychical 
diseases coma and delirium were frequently observed. During 
the convalescing period characteristic disturbances of ill humor 
and depression, crying spells, feeling of oppression in the chest, 
tremor, tonic and clonic twitching of certain groups of muscles, 
swelling of muscles, unilateral perspiration of the body and 
other vaso-motor disturbances occurred. Increased suggest abil- 
ity, deficiency of will power and now and then a stuporous be- 
havior was observed. Hysteria is one of the most common ner- 
vous diseases following heatstroke. Neurasthenia is often ac- 
companied by marked features of hysteria. The character of 
the psychical and nervous conditions following heatstroke point 
to an intoxication, rather than a simple exhaustion.— Fred J. 
C0NZKI.MANN. 



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flews of tbe Setpices* 



T 



HE following officers were elected to membership in the Asso- 
ciation of Military Surgeons of the United States at the last 
regular quarterly ballot. 

ACTIVE. 

Lieutenant Charles W. Decker, California N.G. 

Captain Frank W. Foxwortby, Indiana N.O. 

Acting Assistant Surgeon Morton R. Qlbbons, P.H. A M.H.8, 

Lieutenant Howard H. Johnson, United States Army. 

Lieutenant Lloyd L. Jones, Ohio N.O. 

Passed Assistant Surgeon, Wm. Dunlop Owens, United States Navy. 

Acting Assistant Surgeon Herman J. Schlageter, P.H.<fcM.H.S. 

Captain John W. Sluss, Indiana N.G. 

Lieutenant Charles H. Stearns, Medical Reserve Corps. 

Assistant Surgeon George €arrol Thomas, United States Navy. 

Captain F. M. C. Usher, United States Army. 

ASSOCIATE. 
Captain Gustavus Maximilian Blech, formerly Illinois Reserye Troops. 
Captain Herman A. Haubold, formerly United States Volunteers. 
Acting Assistant Surgeon George E. Maurer, formerly United States Army. 

The following officers were elected to membership at the Atlanta 
Meeting. 

ACTIVE. 

Captain M. Burwell Abernethy, North Carolina N.G. 
MDjor J. W. Duncan, Georgia N.G. 
Captain Jesse R. Harris, United States Army. 
Lieutenant Harry A. Haze, Michigan N.G. 
Lieutenant Wm. D. Lyman, Michigan N.G. 
Captain Benjamin £. Pearce, Georgia N.G. 
Captain M. Toland SI me, N.G. Pennsylvania. 
Captain Herman H. Tuttle, Illinois N.G. 
Captain B. J. Wlther8po<m, North Carolina N.G. 
Lieutenant Ira C. Young, Missouri N.G. 

CORRESPONDING. 
Colonel Rafttel Caraza, Mexican Army. 
Colonel Francisco deP. Echeverrla, Mexican Army. 
Lieutenant Colonel Jos^ Barbosa Le&o, Portuguese Army. 
Major Ernest A. LeBel, Canadian Army. 
Lieutenant Colonel M. W. H. Russel, British Army. 

Assistant Surgeon W. H. Abbott, P.H.&M.H.S., granted 15 days leave. 
Colonel G. W. Adair, U.S. A., granted one month's leave. 

(414) 



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NEiVS OF THE SERVICES. 415 

Colonel Charles Adams, formerly Secretary of the Association of Mil- 
itary Surgeons of the United States, has been appointed Surgeon General 
of Illinois in place of the late Colonel Nicholas Senn, his intimate friend. 
Assistant Surgeon D. G. Allen, U.S.N., ordered from duty to instruc- 
tion at the Naval Medical School. 

Captain J. H. Allen, U.S.A., granted one month's leave in the United 
States. 

Passed Assistant Surgeon L. H. P. Bahrenberg, P.H.&At.H.S., granted 
14 days extension of leave. 

Surgeon P. H. Bailhache, P.H.&M.H.S., granted 15 days leave. 

Lieut. J. C. Ballard, M.R.C., ordered to active duty at Fort Sam Hous- 
ton, Texas. 

Lieutenant Fred M. Barney, M.RC, ordered from Fort Myer, Va. to 
temporary duty at Fort McHenry, Md. 

Lieutenant Edmund W. Bayley, M.R.C., granted one month's leaw. 

Lieutenant R. C. Bayly, M.R.C., ordered to the Army Medical School 
for instruction. 

Passed Assistant Surgeon L. W. Bishop, U.S.N., ordered from the New 
York Naval Hospital to the Omaha Navy Recruiting Station. 

Captain R.M.Blanchard, U.S.A., orderded from Fort Wingate to Whip- 
ple Barracks, Arizona, for duty with troops on a 21 days practice march. 

Captain Horace D. Bloombergh, U.S.A., married, October 7, 1908, at 
Atchison, Kansas, Miss Helen Howard. 

Assistant Surgeon M. Boland, U.S.N., ordered from the Detroit .Vaval 
Recruiting Station to the Castine, 

Major W. C. Borden, U.SA., having been found physically incapac- 
itated for active service ordered to his home to wait retirement. 

Acting Assistant Surgeon P. E. Bowers, P.H.&M.H.S., granted 11 days 
extension of sick leave. 

Lieutenant Madison M. Bowman, M.R.C., ordered from the Philippines 
to the United States for station. 

Lieutenant Colonel Louis Brechemin, U.S. A., ordered from the New 
York Medical Supply Depot to the Philippines. 

lieutenant I. W. Brewer, M.R.C., granted 13 days leave from Fort 
Warren. 

Assistant Surgeon E. M. Brown, U.S.N., granted three months sick 
leave from the Norfolk Naval Hospital. 

Assistant Surgeon W. M. Bryan, P.H.&M.H.S., granted 30 days leave. 

Lieutenant G. F. Campbell, M.R.C., arrived at San Francisco from the 
Philippines and ordered to Alcatraz Island, Cal., for duty, at the Pacific 
Branch, U.S. Military Prison. 

Lieutenant D. P. Card, M.R.C., ordered to the Army Medical School 
for instruction. 



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416 ATEPVS OF THE SERVICES. 

Surgeon P. M. Carrington, P.H.&M.H.S., directed to report at the 
Bureau for special temporary duty; relieved from temporary duty at 
Washington, and detailed to represent the Service at the Association of 
Military Surgeons at Atlanta, Ga., October 13-16, 1908. 

Major William Fitzhugh Carter, U.S.A., retired upon his own applica- 
tion after thirty years service, July 8, 1908, a step which he has been con- 
templating for some years. 

Assistant Surgeon W. Chambers, U.S.N., ordered from the Buffalo 
Naval Recruiting Station to the Naval Medical School for instruction. 

Acting Assistant Surgeon G. F. Clark, U.S.N., ordered from the Lan- 
caster to the Naval Medical School for instruction. 

Major J. T. Clarke, U.S.A., granted one month's leave in the United 
States. 

Lieutenant H. C. Coburn, M.R.C., ordered to active duty and instruc- 
tion at the Army Medical School. 

Lieutenant H. L. Coffin, M.R.C., granted four months leave. 

Captain C. LeR. Cole. U.S.A., granted ten days leave. 

Assistant Surgeon C. F. Cottie, U.S.N., appointed Oct. 3, 1908^ and 
ordered to instruction at the Naval Medical School. 

Assistant Surgeon G. B. Crow, U.S.N., ordered from the Norfolk Navy 
Yard to the Naval Medical School for instruction. 

Assistant Surgeon R. Cuthbertson, U.S.N., appointed October 12, 1908. 

Lieutenant A. D. Davis,M.R.C., ordered to the Army Medical School 
for instruction. 

Captain W. R. Davis, U.S.A., ordered to accompany troops from Fort 
Mason to Atascadero, Cal. 

Lieutenant G. W. Daywalt, M.R.C., ordered from San Francisco to 
the Philippines. 

Lieutenant W. R. Dear, M.R.C., ordered to the Army Medical School 
for instruction. 

Acting Assistant Surgeon J. M. Delgado, P.H.&M.H.S., granted three 
months extension of leave without pay. 

Passed Assistant Surgeon P. T. Dessez, U.S.N., ordered from the Las 
Animas Naval Hospital to the South Dakota. 

Medical Inspector S. H. Dickson, U.S.N., and Mrs. Dickson have 
taken a house, 1739 Corcoran St., Washington, D. C, for the winter. 

Medical Inspector O. H. Diehl, U.S.N., commissioned October 11, 1908. 

Assistant Surgeon A. H. Dodge, U.S.N., appointed Oct. 3, 1908, and 
ordered to instruction at the Naval Medical School. 

Lieutenant C. E. Doerr, M.R.C., ordered to the Army Medical S?booI 
for instruction. 

Lieutenant L. R. Dunbar, M.R.C., ordered to the Army Medical School 
for instruction. 



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NEWS OF THE SERVICES. 417 

Major Basil H. Dutcher, Medical Corps, U.S.A., ordered to Plattsbtirg 
Barracks, N.Y. 

Assistant Surgeon General J. M. Eager, P.H.&M.H.S., ordered to 
Philadelphia for spedal temporary duty and returned to the Bureau. 

Lieutenant A. H. Eber, M.R.C., ordered from Fort DcSoto, Fla,, to tem- 
porary duty at Key West Barracks, Florida. 

Passed Assistant Surgeon H. G. Ebert, P.H.&M.H.S., ordered from 
San Francisco to Manila, P. I. 

Surgeon S. G. Evans, U.S.N., ordered from the Washington Naval 
Hospital to the Pennsylvania. 

Passed Assistant Surgeon W. G. Farwell, U.S.N., ordered from the 
Marine Recruiting Station to the Philadelphia Naval Hospital. 

Passed Assistant Surgeon Wrey G. Farwell, U.S.N., married Miss Vir- 
ginia Davis Schaefer at Baltimore, Md., October 22, 1908. 

Lieutenant J. B. Ferguson, M. R. C, recently appointed from Contract 
Surgeon, U.SA., ordered to active duty. 

Acting Assistant Surgeon P. A. de Ficaniere, U.S.N., appointed Ort 
3, 1908, and ordered to instruction at the Naval Medical School. 

Passed Assistant Surgeon C. N. Fiske, U.S.N., ordered from the Bos- 
ton Naval Recruiting Station to the Minneapolis Naval Recruiting Station. 

Lieutenant Thomas M. Foley, M.R.C., ordered to active duty at Fort 
Moultrie, S. C. 

Captain Clyde S, Ford, U.S.A., ordered from duty in the Philippines to 
the United States, and granted six months leave with permission to go 
beyond the sea. 

Acting Assistant Surgeon J. P. C Foster, P.H.&M.H.S., granted IG 
days leave from Sept. 23, 1906. 

Surgeon G. F. Freeman, U.S.N., commissioned August 2, 1908. 

Captain Paul L. Freeman, U.S.A., granted ten days leave. 

Lieutenant C. E. Fronk, M.R.C., ordered to the Army Medical School 
for instruction. 

Lieutenant L. C. Garcia, M.R.C., ordered to the Army Medical School 
for instruction. 

Medical Inspector J. E. Gardner, U.S.N., ordered to additional duty at 
the Boston Naval Recruiting Station and to duty in attendance upon officers 
of the Navy and Marine Corps residing in Boston not otherwise provided 
with medical aid. 

Medical Inspector J. D. Gatewood, U.S.N., commissioned September 
18, 1908. 

Lieutenant R. H. Goldwaithe, M.R.C., ordered to the Army Medical 
School for instruction. 

Assistant Surgeon Q, D, Hale, U.S.N., ordered from the Idaho to the 
New Hampshire, 



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418 NEWS OF THE SERVICES, 

Acting Assistant Surgeon T. Harlan, U.S.N., appointed from Septem- 
ber 17, 1908, and ordered to the Naval Medical School for instruction- 

Dr. Joseph Randolph Harmer, for many years an Acting Assistant Sur- 
geon in the Army and for a considerable time after the resumption of the 
employment of civik physicians in the service a Contract Surgeon, died 
April 15, 1908, at the home of his daughter at Opelika, Ala. 

Lieutenant D. W. Harmon, M.R.C., ordered to the Army Medical 
School for instruction. 

Captain Jesse R. Harris, Medical Corps, U.S.A., eranted twelve liys 
extension of leave. 

Captain E. H. Hartnett, U.S.A., ordered from the Philippines to San 
Francisco. 

Passed Assistant Surgeon G. S. Hathaway, U.S.N., commissioned from 
August 1, 1908. 

Colonel Valery Havard, Medical Corps, U.S.A., detailed to represent 
the Medical Department of the Army at the meeting of the Association of 
Military Surgeons, at Atlanta, Ga., Oct. 13-16, 1908. 

Lieutenant G. D. Heath, Jr., M.R.C., ordered to the Anny Medical 
School for instruction. 

Passed Assistant Surgeon V. G. Heiser, P.H.&M.H.S., granted 30 days 
leave while en route to join station at Manila. 

Lieutenant Z. L. Henry, M.R.C., ordered to active duty at Fort 
ThoH'as, Ky. 

Assistant Surgeon M. E. Higgins, U.S.N., ordered from the Illinois to 
the Naval Hospital, Canacao. 

Lieutenant R C. Hill, M.R.C., ordered to the Army Medical School for 
instruction. 

Colonel John Van R. Hoff, U.S.A., ordered from the Philippines to re- 
port at San Francisco. 

Passed Assistant Surgeon J. M. Holt, P.H.&M.H.S., ordered to Boise, 
Idaho, upon special temporary duty. 

Acting Assistant Surgeon M. W. Houghton, P.H.&M.H.S., granted 
nine days leave. 

Captain P. W. Huntington, U.S.A., granted one month's extension of 
leave, and ordered to the Philippines. 

Lieutenant T. W. Jackson, M.R.C., granted one month's leave from the 
Philippines. ' 

Lieutenant C. W. Johnson, M.R.C., ordered from Fort Des Moines, 
Iowa, to the tournament at Louisville, Kentucky. 

Assistant Surgeon L. W. Johnson, U.S.N., appointed from September 
17, 1908, and ordered to the Naval Medical School for instruction. 

Major Jefferson R. Kean, U.S.A., was in Washington D. C, in attend- 
ance upon the Tuberculosis Congress last month, and at the same time 
appeared before the Promotion Board for examination, and later was 



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NtlVS OP THE SERVICES. 41^ 

ordered to represent the Medical Department of the Army at the meeting 
of the Association of Military Surgeons, at Atlanta, Ga., Oct. 13 to 16, 1908^ 
and then to his station in Havana. 

Lieutenant R. A. Kearney, M.R.C., ordered to active duty and instruc- 
tion at the Army Medical School. 

Major F. R. Keefer, U.S.A., ordered from San Francisco to the 
Presidio of Monterey, thence to Atascadero, Cal. 

Lieutenant R. W. Kerr, M.R.C.,' ordered to the Army Medical School 
for instruction. 

Acting Assistant Surgeon W. M. Kerr, U.S.N., ordered from the Nor- 
folk Naval Hospital to the Naval Medical School for instruction. 

Acting Assistant Surgeon W. A. Kimmet, P.H.&M.H.S., granted SO 
days leave. 

Lieutenant H. A. Knox, M.R.C., ordered to active duty at Fort Michie, 
N, Y. 

Assistant Surgeon F. X. Koltes, U.S.N., ordered from the Connecticut 
to the Wilmington, 

Lieutenant J. S. Lambie, Jr., U.S.A., ordered from duty with Co. C, 
H. C, at Washington Barracks to Fort Monroe, Va. 

Assistant Surgeon M. E. Lando, U.S.N., ordered to the Buffalo Naval 
Recruiting Station. 

Lieutenant T. J. Leary, M.R.C., ordered to the Army Medical School 
for instruction. 

Lieutenant W. F. Leech, M.R.C., ordered to active duty at Jefferson 
Barracks, Mo. 

Acting Assistant Surgeon F. S. Lewis, P.H.&M.H.S., granted six 
weeks leave. 

Passed Assistant Surgeon J. D. Long, P.H.&M.H.S., assignment to 
Los Angeles revoked. 

Lieutenant L. W. Lord, M.R.C.,ordered to active duty at Fort Riley, 
Kans. 

Lieutenant A. G. Love, U.S. A., ordered from the Philippines to San 
Francisco. 

Surgeon C. H. T. Lowndes, U.S.N., ordered from the South Dakota 
home to await orders. 

Major Charles Lynch, Medical Corps, U.S.A., detailed to represent the 
Medical Department of the Army at the meeting of the Association of Mil- 
itary Surgeons, at Atlanta, Ga., Oct. 13 to 16, 1908. 

Captain James I. Mabee, Medical Corps, U.S.A., granted two months 
extension of leave. 

Lieutenant N. L. McDermid, M.R.C., ordered to the Army Medical 
School. for instruction. 

Passed Assistant Surgeon W. N. McDonell, U.S.N., ordered from the 
Minneapolis Naval Recruiting Station to Washington, D.C., to report to 



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420 NEWS OF THE SERVICES. 

the Surgeon General of the Navy for temporary duty, and thence to the 
Naval Academy. 

Lieutenant G. H. McLellan, M.R.C., ordered to the Army Medical 
School for instruction. 

Lieutenant J. C. Magee, M.R.C., ordered to the Army Medical School 
for instruction. 

Lieutenant J. E. Maloney, M.R.C., ordered to active duty at Fort 
Hancock. 

Assistant Surgeon W. L. Mann, U.S.N., appointed Oct. 3, 1908, and 
ordered to instruction at the Naval Medical School. 

Acting Assistant Surgeon W. H. Marsh, P.H.&M.H.S., granted 13 
days^ leave to enable him to attend the meeting of the Association of Mili- 
tary Surgeons at Atlanta, Ga., and to pay a visit to Lieutenant Colonel 
Leonard B. Ahny at Norwich, Conn. 

Acting Assistant Surgeon C. J. Marsillan, P.H.&M.H.S'., granted two 
months sick leave. 

Colonel Louis M. Maus, U.S.A., is enjoying a trip through China and 
Japan. 

Surgeon F. W. Mead, P.H.&M.H.S., granted 27 days leave from 
Aug. 26, 1908. 

Major Edgar A. Mearns, U.S. A., has been found physically disqualified 
for promotion to Lieutenant Colonel and will be retired with that rank 
when reached in the course of promotion. 

Lieutenant D. Miner, M.R.C., ordered to the Army Medical School for 
instruction. 

Captain W. H. Moncrief, U.S.A., relieved from present duty and or- 
dered to the Philippines. 

Major Edward R. Morris, U.S.A., has been found physically disquali- 
fied for promotion to Lieutenant Colonel and will be retired with that rank 
when reached in the course of promotion. 

Lieutenant A. Mueller, M.R.C., ordered to the Army Medical School 
for instruction. 

Assistant Surgeon E. H. MuUan, P.H.&M.H.S., ordered from Ellis 
Island, N.Y., to Montreal, Canada. 

Surgeon J. A. Murphy, U.S.N., ordered to the Franklin. 

Assistant Surgeon D. H. Noble, U.S.N., appointed October 12, 1908. 

Acting Assistant Surgeon C. W. Nulty, Jr., P.H.&M.H.S., granted 
15 days leave. 

Passed Assistant Surgeon J. A. Nydegger, P.H.&M.H.S., granted 22 
days leave, and 23 days extension. 

Lieutenant S. F. O'Day, M.R.C., ordered to the Army Medical School 
for instruction. 

Major John F. O'Farrel, Mississippi N.G., has been detailed by his 
state to attend the present session of the Army Medical School. 



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NEWS OF THE SERVICES. 421 

Lieutenant A. D. Parce, M.R.C., ordered to the Army Medical School 
for instruction. 

Lieutenant Edwin W. Patterson, M.R.C., ordered from the Philippines 
to the United States for station. 

Lieutenant H. F. Phillips,, M.R.C., ordered to active duty and instruc- 
tion at the Army Medical School. 

Major John L. Phillips, Medical Corps, U.S.A., ordered from exami- 
nation at Washington, D. C, to return to his station. 

Captain H. F. Pipes, U.S.A., ordered from duty with Co. C, H. C, to 
the Washington General Hospital. 

Assistant Surgeon J. P. Pollard, U.S.N., appointed Oct. 3, 1908, and 
ordered to instruction at the Naval Medical School. 

Passed Assistant Surgeon F. E. Porter, U.S.N., ordered from the 
Washington Navy Yard to the Detroit Naval Recruiting Station. 

Captain H. S. Purnell, U.S.A., granted two months leave about No- 
vember Ist 

Captain C. A. Ragan, U.S.A., ordered to return to Fort Monroe from 
treatment at Washington, D. C. 

Major L W. Rand, U.SA., ordered from the Philippines to report 
from San Francisco. 

Acting Assistant Surgeon S. A. Ransom, P.H.&M.H.S., appointed for 
duty at Shanghai, China. 

Captain William W. Reno, U.S.A., married Miss Ruth Steere, daughter 
of Captain and Mrs. Henry Steere, in Washington, D. C, on October 9, 
1908. 

Acting Assistant Surgeon J. R. Ridlon, P.H.&M.H.S., appointed for 
duty at Stapleton, N. Y. 

Assistant Surgeon M. E. Rose, U.S.N., ordered from the Omaha Naval 
Recruiting Station to the Hist 

Passed Assistant Surgeon T. W. Salmon, P.H.&M.H.S., ordered to the 
revenue cutter Gresham for temporary duty, and to Stapleton, N. Y. for 
temporary duty. 

Passed Assistant Surgeon J. W. Schereschewsky, P.H.&M.H.S., or- 
dered to the Bureau upon special temporary duty. 

Lieutenant Anton R. Schier, M.R.C., honorably discharged from the 
service of the United States. 

Assistant Surgeon L. N. Schmidt, U.S.N., ordered from the Annapolis 
Naval Hospital to the Naval Medical School for instruction. 

Captain G. H. Scott, U.S.A.,granted an extension of leave to include 
October 31st, and ordered from Fort Logan to the Philippines at expiration 
of leave. 

Lieutenant J. M. Shepherd, M.R.C., granted one month's extension of 
leave. 



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422 NEWS OP THE SkRVICES. 

lieutenant W. S. Shields, M Ji.C., ordered to the Army Medical School 
for instruction. 

Surgeon E. M. Shipp, U.S.N. , ordered from the Pennsylvania home to 
wait orders. 

Assistant Surgeon L. P. Shippen, U.S.N., appointed from September 
17, 1908, and ordered to the Naval Medical School for instruction. 

Assistant Surgeon J. A. B. Sinclair, U.S.N., appointed October 12, 1908. 

Lieutenant K F. Slater, M.R.C., ordered from Madison Barracks, N.Y., 
to temporary duty at Plattsburg Barracks, N. Y. 

Lieutenant J. T. Slater, M.R.C., granted ten days leave and ordered 
from Fort William Henry Harrison, Montana, to his home, Cambridge, 
Mass., to await orders. 

Assistant Surgeon C W. Smith, U.S.N., ordered from the Portsmouth 
Naval Hospital to the Naval Medical School for instruction. 

Passed Assistant Surgeon F. C. Smith, P.H.&M.H.S., granted a month's 
leave, and 17 days extension. 

Assistant Surgeon H. L. Smith, U.S.N., ordered from the Missouri to 
the Villalobos, 

Lieutenant W. H. Smith, M.R.C., ordered to the Army Medical School 
for instruction. 

Lieutenant C. G. Snow, M.R.C., ordered to the Army Medical School 
for instruction. 

Captain Craig R. Snyder, U.S.A., granted one month's leave. 

Lieutenant H. M. Snyder, U.S.A., relieved from present duty and or- 
dered to the Philippines. 

Surgeon J. J. Snyder, U.S.N., ordered from the Franklin to the Phila- 
delphia Marine Recruiting Station. 

Assistant Surgeon A. C. Stanley, U.S.N., ordered from the Naval 
Medical School Hospital to the Naval Medical School for instruction. 

Major A. N. Stark, U.S.A., granted a month's leave from Dec. 15, with 
permission to apply for 15 days extension. 

Lieutenant M. C. Stayer, M.R.C., ordered to the Army Medical School 
for instruction. 

Captain C. J. Stedman, U.S.A., ordered to return to Fort Stevens 
from American Lake, Wash. 

Major William Stephenson, Medical Corps, U.S.A., ordered from ex- 
amination at Washington, D.C., to return to his station. 

Passed Assistant Surgeon A. M. Stimson, P.H.&M.H.S., unexpired 
portion of leave revoked, and ordered to special temporary duty at Santa 
Ana and points in vicinity of Los Angeles. 

Surgeon G. W. Stoner, P.H.&M.H.S., granted 15 days leave. 

Major Paul F. Straub, U.S.A., who has been the official delegate of the 



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NEIVS OF THE SERVICES. 423 

United States to the Esperanto Congress, arrived in New York on his re- 
turn journey on Oct. 1st. 

Lieutenant. Frank Suggs, M.R.C., granted one month's leave. 

Brigadier General John E. Summers, U.S.A., retired, formerly colonel. 
Medical Department, died in Atlantic City, October 1, 1908. 

Assistant Surgeon D. G. Sutton, U.S.N., ordered from the Franklin to 
the Naval Medical School for instruction. 

Colonel George H. Torney, U.S. A., has been announced by the Presi- 
dent as the successor to Brigadier General Robert M. O'Reilly, U.S.A., as 
Surgeon General of the Army. 

Assistant Surgeon A. J. Toulon, U.S.N., ordered from the Boston 
Naval Hospital to the Naval Medical School for instruction. 

Lieutenant C. A. Treuholtz, M.R.C., recently appointed from Contract 
Surgeon, U.S A., ordered tO' active duty, and to the Army Medical School 
for instruction. 

Major Charles S. TurnbuU, N.G.P., announces the engagement of his 
daughter Edith Somers Turnbull to Paymaster Magill R. Goldborough, 
U.S.N. Miss Turnbull is the third of Dr. TurnbuU's daughters to marry in 
the service. Paymaster Goldsborough is the son of Pay Director and Mrs. 
Worthington Goldsborough, of Cambridge, Md. He is stationed at League 
Island. 

Assistant Surgeon H. W. B. Turner, U.S.N., ordered from the Naval 
Medical School Hospital to the Naval Medical School for instruction. 

Lieutenant A. D. Tuttle, M.R.C., ordered to the Army Medical School 
for instruction. 

Lieutenant G. T. Tyler, M.R.C., ordered from Fort Porter, N. Y., to 
Fort Jay, N. Y., for teniporary duty. 

Captain James W. Van Dusen, U.S.A., married Miss Bessie Evelyn 
Haines, at Elyria, Ohio, October 20, 1908. 

Captain G. M. Van Poole, U.S.A., granted four months leave when his 
services can be spared. 

Captain E. B. Vedder, U.S.A., arrived at Fort Walla Walla from four 
months leave. 

Lieutenant J. B. H. Waring, M.R.C., ordered to the Army Medical 
School for instruction. 

Captain F. W. Weed, U.S.A., granted one month's leave from Platts- 
burg Barracks. 

Colonel E.A Weimer, formerly Surgeon General of South Dakota, 
moved from Pekin, 111., to Peoria, 111. 

Lieutenant F. M. Wells, M.R.C., ordered from Fort Robinson, Nebras- 
ka, to duty with U. S. troops at St. Joseph, Missouri. 

Surgeon C. P. Wertenbaker, P.H.&M.H.S., detailed to represent the 
Service at the Association of Military Surgeons at Atlanta, Ga., October 
13-16,1908. 

Surgeon J. H. White.P.H.&M.H.S., detailed to represent the Service at 



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424 NEIVS OF THE SERVICES. - 

the meeting of the Southern Medical Association at Atlantic Ga^ Not. 
10-12. 1908. 

Passed AssisUnt Surgeon M. J. White, P.H.&M.H.S., detailed to repre- 
sent the Service at the Association of Military Surgeons at Atlanta, Ga., 
October 13-16. 1908. 

Dr. J. H. Whitely, U.S.A., relieved from duty at Fort De Soto and 
ordered, upon expiration of present leave, to his home in Chicago. IlL. for 
annulment of contract. 

Assistant Surgeon G. B. Whitmore. U.S.N.. appointed October 12. 1908. 

Lieutenant J. A. Wilson, M.R.C.. ordered to the Army Medical School 
for instruction. 

Lieutenant F. S. Wright, M.R.C., ordered to the Army Medical School 
for instruction. 

Lieutenant Colonel M. C. Wyeth, U.S.A.. having been found physically 
disqualified for duties of that grade in the Medical Corps, by reason of 
disability incident to the service, his retirement from active service as a 
Lieutenant Colonel is announced to date from May 1. 1908. 

Acting Assistant Surgeon J. G. Ziegler, U.S.N., ordered from the New- • 
port Naval Hospital to the Naval Medical School for instruction. 

The Army Medical School. — The Army Medical School opened on 
October 1. with 34 officers in attendance whose names appear in that con- 
nection in alphabetical order in this department of The Mhjtasy Surgeon. 
This is the largest class ever matriculated. 

Military Medical Pedestrians. — Colonel Valery Havard. Major 
Charles F. Mason, and Major Charles Lynch, on duty in the Surgeon Gen- 
eral's office, War Department, and Major William D. Crosby on duty at the 
Soldier's Home completed the fifty mile walking test recently. Their 
route was over the Rockville pike. 

The Foot of the Soldier. — Major Edward L. Munson. U.SArmy. has 
submitted to the War Department a report on the care of the foot of the 
soldier. He entertains the opinion that there is such a thing as a military 
foot which, as a distinction, exists by reason of much marching in the case 
of the infantrymen. He suggests there may also be a difference in the foot 
of the men of the artillery and of the cavalry on account of the character 
of the duties of those respective branches of the Army. It is this report 
and the suggestions which have been made by Major Munson which led 
the quartermaster general to make the practical trial of the new russet shoe 
and the black dress shoe, for which a large contract has been recently made. 
Sets of the shoes of both types have been sent to Fort Sheridan and will be 
tried by he enlisted men at that post under the observation of a board 
of officers and the civilian expert in shoes employed by the quartermaster 
general's office. Major Munson has given considerable attention to the 
question of foot apparel as he has to other features which promote mili- 
tary sanitation and personal hygiene. The new shoes are of a pattern 
which take advantage of the criticisms that have hitherto been made of the 
shoes issued to the soldier and it is expected that the new shoes will be as 



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NEWS OF THE SERVICES. 425 

nearly perfect as it is possible to have anything in leather. Major Mun- 
son has also called attention to the need of having shoes which fit issued to 
the enlisted men and special care will be exercised hereafter in attending to 
this detail, the observance of which is bound to be not only a contribution 
to individual comfort, which is a consideration by no means to be despiv;^!, 
but will also add to the efficiency of troops in the field. 

The Army as a Sanitahy Corps.— Prof. C. Otto Schoenrich, oi the 
Baltimore City College, has just returned from Cuba with nothing but 
praise for the system of sanitation introduced by the United States Army. 
The professor is a son of Jugde Otto Schoenrich, secretary of the provi- 
sional government in Cuba, and a member of the Cuban Law Commission. 
"Havana is entirely free from mosquitoes and flies," said the returned 
educator to a reporter of the Baltimore American, "This condition is 
brought about by the American Army system of sanitation, the most per- 
fect in the world. Rain pools are rendered harmless by the pouring of oil 
over them. Then there are men constantly engaged in cleaning the streets. 
It is the cleanest city imaginable. Garbage is collected in Havana until ten 
o'clock at night. These endeavors to avoid filth have resulted in clearing 
the city of almost allinsects. I could sit in my room in the hotel al night, 
with a bright light burning, and, although there are no glass windows in 
Havana and everything is open, not an insect of any kind would be at- 
tracted. This was so in spite of the fact that the hotel faces a grove of 
palm trees. 

"If any one had predicted ten years ago that Havana would be an in- 
sectless, feverless, dirtless city in less than a decade he would have been 
put down as non compos mentis. Without any wish to draw invidious 
distinctions, it may be asked, in view of the insect plague? in American 
cities like New York, how long it would have taken a purely civil, politically 
administered municipal government to do what the Army medical men 
have so quickly accomplished. In northern cities in the United States 
everything in the climate works to make insect extermination easy; still 
year after year the pests continue to endanger the public health by trans- 
mitting disease. As a result of Army administration Havana has become 
an example to the whole civilized world as to what can be achieved by 
scientific sanitation in the face of every drawback of climate and native* in- 
difference. When one comes to calculate the great addition made to pop- 
ular knowledge on the yellow fever question by the victories won by our 
Army doctors in the disease-breeding localities of Havana, it may not seem 
idle to assert that these triumphs in wresting the scepter from one of the 
deadliest of diseases were worth far more than it cost in lives and money 
to fight the Cuban war. Havana afforded the first instance when trained 
medical men could begin in the seat, in the very cradle, of a scourge, 
a systematic plan to master it, and could proceed unhampered by civilian 
embarrassment to carry their scheme to complete fruition. Army admini- 
stration is producing a similar condition of things in the Panama Isthmus, 
and to lesser extent, because military control is less complete, in the Phil- 
ippines." 



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Current Xlteratuie. 



SURGICAL THERAPEU^riCS.* 

ONE of the most useful and meaty books that has come to 
the editorial desk is the little work on non-operative 
surgery which Dr. Lanphear has just given to the pro- 
fession. It is useful because it contains so many facts that most 
practitioners are obliged to learn by sad experience and for the 
teaching of which many patients have to suffer. A careful 
reading of this book persuades one to anticipate with great in- 
terest the appearance of the more complete treatise on surgery, 
which is one of the surgical suggestions thrown out by the 
author, one which will be greeted with much interest by the pro- 
fession. 

OPHTHALMIC SURGERY.f 

THIS work is an account of the surgical procedures in vogue 
at the Clinic of Professor Fuchs in Vienna, together 
with the original views and practices of the author who 
has been for many years first assistant in the Vienna Clinic. It 
is a faithful picture of German methods and practices and well 
worthy a hearty reception at the hands of the American ophthal- 
mological profession. 

THE* EXPERIMENTAL PROPHYLAXIS OF SYPHILIS.^ 

THIS little book contains an account of the work of Met- 
chnikofF and Maisonneuve upon this most important sub- 
ject, idiomatically translated by Dr. Verteuil. 

♦Surgical Therapeutics*— By Emory Lanphear, M.D. 8vo; pp. 396. 
Chicago, The Clinic Publishing Co., 1907. 

tOphthalmic Surgerv. By Dr. Josef Meller. 8vo; pp.262, with 118 
illustrations. Philadelphia, P. Blakiston's Son & Co., 1908. Cloth I3.00 net. 

tThc Experimental Prophylaxis of Syphilis* By Dr. Paul Maisonneuve. 
Translated from the French by Dr. Fernand L. de Verteuil. i2mo; pp. 
102. New York, William Wood & Co., 1908. 

(428) 



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Vor. XXUI, No. 6. DBxngiCBiJR, 1908 



®ddtnal ^l^emoirs. 



AUTHORS ALONE ARE RESPONSIBLE FOR THE OPINIONS 
EXPRESSED IN THEIR CONTRIBUTIONS. 



THE ORIGIN AND CONDITION OF THE PEOPLES WHO 
MAKE UP THE BULK OF OUR IMMIGRANTS 
AT THE PRESENT TIME AND THE PROB- 
ABLE EFFECT OF THEIR ABSORPTION 
UPON OUR POPULATION. 
By manly H. SIMONS, M. D., 
MEDICAL DIRECTOR IN THE UNITED STATES NAVY. 

HIS subject is too long and im- 
portant to be treated fully in 
the time allotted, so I shall 
not cite authorities or go into 
statistics, but trust that my 
statements can be verified by 
anyone who desires to do so. 
My aim in this paper is to 
assist in the agitation of a 
subject which concerns us 
nearly as Americans, as med- 
ical men and as military sur- 
geons, for only by medical 

men can these matters be properly considered in their total effect 

upon the complex;; human organism. 



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428 MEDICAL DIRECTOR MANLY H. SIMONS, 

Of the theories which are put forward to account for the 
origin of man the most plausible is that there was a gradual evo- 
lution from a simian stem of which the chimpanzee, orang- 
outan and gorilla are retrograde variants and the monkey-like 
man, Anthropithecus erectus, of which Dr. DuBois found a 
skull and long-bone in Java, is an example of the ascending scale 
which has eventuated in the military surgeon who appears in 
session today. 

If the average capacity of the human skull be taken as 1,500 
C.C. that of the pliocene man, will be about 1,250 c.c. of the Java 
skull 1,000 c.c. and those of the above named monkeys 350 c.c. 
to 500 c.c. It is quite generally accepted that the early anthro- 
poids developed into early man in a continent in the Indian 
ocean, Lemuria, so-called, of which the remains are the islands 
scattered through those waters. The continent was connected 
with Africa and Asia and the anthropoid apes and ape-like men 
wandered to both continents and remains of these early men are 
found in Java and Burma, in the Pliocene period, the last stage 
of the Tertiary period of geologists. It is impossible to give, 
except approximately, the number of years that man has been 
wandering upon the earth as a reasoning and thinking being. The 
evidence accepted appears to depend very much upon whether the 
theorist adheres to the ordinary interpretation of the account of 
creation given in Genesis or to the interpretation by geologists 
and paleontologists of that other book of God written in the 
stratifications of the earth and illustrated by the remains of God's 
creatures buried therein, but it now seems most probable that 
man lived in the Pliocene period and that he had been developed 
to such an extent as to make rude stone weapons and ornaments, 
and these, with his bones, have been found in the strata of this 
period. In the Pleistocene, the first stage of the Quartenary, 
there is very positive evidence of his presence in Europe, and 
Asia, in caves in Brazil, and, as claimed by Dr. Abbott, in glacial 
deposits in New Jersey. It is probable that these evidences 
point to a period of over a million years of development as man. 
When the Ice age began in the Pleistocene, the ice advanced, 
then retreated and after many thousand years advanced again. 



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ORIGIN AND CONDITION OF AMERICAN IMMIGRANTS. 429 

and man evidently advanced and retreated with the ice-cap. 
When you consider the thickness of the deposits, the changes in 
level which they imply, the changes in the animal and vegetable 
world as pictured in the earth, you must allow for immense 
periods of time, especially as the evidence shows that the ordinary 
leisurely proces^s of natural law have been followed; the 
processes were not hastened by general cataclysms. Great periods 
also must have elapsed to permit of such world-wide wanderings 
of rude men who were impelled only by the desire of food and of 
a moderate degree of warmth. No doubt local disturbances such 
as earthquakes, volcanic eruptions, drouths and floods and the 
consequent scarcity of his usual food drove man from one section 
to another and these migrations and variations in environment 
increased his knowledge, his comprehension and his adaptability. 
There are geological evidences to show that his wanderings were 
made possible by a landbridge by way of England and the Faroe 
islands to Greenland and America from Europe, and the pres- 
'ence of the fossil trunks of redwood trees show that a climate 
not colder than the present one of California then prevailed in 
Greenland. The Esquimaux are supposed to have come from 
France to their present habitat by this landbridge. They are 
the aboriginal French; they have lost much of the polish and all 
remembrance of *'Gay Paree," but they prove that energy, 
adaptability and bravery characterized the early as well as the 
later Frenchman. Land once joined America and Asia across 
Bering Sea, and the island of Yesso shows evidence in its flora 
and fauna that it was joined to this continent by way of an early 
Aleutian chain. It is however quite certain that, after the ar- 
rival of paleolithic man on this continent, land communication 
was cut oflF by subsidence and there were no subsequent invasions 
of any moment. The semi-civilization found here by the whites 
therefore, was indigenous, not the result of transfer of any old 
world culture, and the color, mental qualities, physique, ad- 
vancement etc., showed the inherent capacity for improvement 
of these first migrants from the primal cenler. It must be re- 
membered that when they left Lemuria they were probably still 
ape-like men and that they prove that the tendency to higher 



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430 MEDICAL DIRECTOR MANL Y H. SIMONS. 

development had already shaped itself to proceed along nearly 
similar lines in all branches from the original stem. There is no 
other section of the world in which it is probable that the de-. 
scendants of paleolithic man can be found unmixed with other 
types which had themselves been modified by long residence in 
the same environment and mixture with invading varieties as was 
the case in the old world. 

These first wanderers from the original habitat are known 
as paleolithic men, from the rude and rough character of their 
stone weapons and tools; the next arrivals are called neolithic 
and are characterized by more highly finished utensils and other 
evidences of greater skill and advancement. The land of origin 
was large and probably diversified by mountains, uplands and 
lowlands so that the in habit ants were exposed to varying climatic 
and food conditions. These may account, in part at least , for 
the differences in the races of man, and these differences, physical 
and mental, together with the tendencies to advancement, re- 
tardation and degradation may have been impressed upon the 
early forms before the actual evolvement of man, in other words 
there may have been varieties of the anthropoids. It seems evi- 
dent also that the progenitors of the white race left the original 
habitat at or near its western end, the mongols near its eastern 
and that the blacks were more general, but did not wander so far 
north. 

I have adopted for convenience the classification of Keene 
which divides man into four races. Homo caucasicus, Homo 
americanus, Homo mongolicus, and. Homo aethiopicus. These 
are supposed virtually to have proceeded from the same anthro- 
poid stem and their differences are supposed to have developed or 
become accentuated since. The Caucasic race includes the 
Hamites or Berbers, Semites, Persians, Slavs, Germans, Anglo- 
Saxons, in other words the white races which vary from florid to 
black in India, brown in Polynesia, the hairy and brown Ainu, 
etc., and the other races are shown by the name. 

The early men then wandered from their original habitat 
over the world: Some settled in North Africa and there developed 
into white or light men; the Hamites, the type of these is sup- 



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ORIGIN AND CONDITION OF AMERICAN IMMIGRANTS. 431 

posed to be the Berber of the present time. North Africa in- 
cluding the Sahara, Soudan and Egypt, was then a pleasant well- 
watered land several hundred feet higher than now, three land- 
bridges across the Mediterranean, one to Gibraltar, one to Italy 
and one to Greece connected it with Europe. In Egypt the 
Hamite developed a high degree of civilization and in its soil are 
found the evidences of this from its beginnings in the rude flints 
of paleolithic man, in the more polished ones of neolithic man 
and so on to the pottery, bronze and iron of later ages. From 
northern Africa the Hamites spread over the landbridges and 
around the Mediterranean shores and were called Iberians in 
Spain, lyigurians in Italy, Palasgians in Greece; they invaded 
northern Europe, and passed around eastward into Persia; those 
that settled in the Steppes on both sides of the Urals developed 
into the tribes from which have descended our present Germans, 
Anglo-Saxon, and other Europeans. These blond tribes pressed 
west, mingling with the darker peoples and eventually produc- 
ing the present types. The Semitic family may have developed 
from the Hamitic, or it may have come from migrants direct to 
Arabia from Lemuria, but it eventually mingled with the Hamites 
and negroes producing the Abyssinians and many other black 
tribes which have formed kingdoms in Africa from early days 
down to quite late times, and under the stimulus of Moham- 
medanism, it over-ran in later times a large portion of the world. 

With the American aborigines we have little to do; they 
are too few to influence our development. 

The Mongol race varies from yellow and brown to white in 
color and at one time apparently was a leader in civilization as in 
ancient Babylonia which was Mongol. This race pressed west 
in the height of its power but the Turks and the Huns have 
mingled so with western peoples that only the language remains 
to show the Mongol origin. 

The negro was left as the aborigine on the islands of the 
Indian Ocean, and spread into Africa, India, Australia and many 
islands of the Pacific, as Papuans, Negritos, etc. In Africa the 
now extinct Strandloopers, the fading Bushmen and Pigmies are 
probably remnants of the early forms. 



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432 MEDICAL DIRECTOR MANLY H. SIMONS. 

Three of these races, the white, the yellow and the black, 
show well-marked physical differences in their extreme types, as 
in the proportions of the limbs, the capacity of the skull, the 
third eyelid of the Mongol, the tendency to early ossification of 
the skull in the black, the shape of the pelvis and long bones, 
differences in the glottis, etc. It is pretty evident however that 
no one or two characters can be depended upon as a means of 
differentiation, there has been so much admixture that one shades 
into the other. 

If the field be scanned broadly it will be seen that with the 
tendency to improvement, there exists also in man a tendency to 
retardation, degradation and extinction. The earth is full of the 
monuments of mighty nations who made the world of their day 
bow to the force of their intellect and the might of their arms, 
and of them now live, among the remains of their glory, a few 
rude barbarians or half-civilized tribes. Perhaps of all the 
mighty kingdoms of the past, only Egypt retains a large number 
of her people, and the Fellaheen certainly have retrograded. It 
is stated that the skulls of the present day Egyptians are smaller 
than those found in the tombs. The Greeks and the Romans 
have held the stage and have retired, their numbers have di- 
minished, their force has decayed. The French and the Span- 
ish have lost their aggressiveness and the former are said to be 
losing in population from lack of fertility. The list could be 
extended for several pages. Now the German and Anglo-Saxon 
in the west and the Mongoloid Japanese in the East are showing 
the greatest progress and aggressiveness. The negroes, it is 
said, in Africa tend to degradation of type unless the proportion 
of foreign blood is constantly renewed and the pure blacks, the 
aborigines, are fast disappearing. The South Italian, the type 
of the ancient Ligurian, is the shortest of the white people and 
is apparently retrograding mentally and physically. Travelers' 
descriptions of the people of the mountain regions of Poland, of 
Austro-Hungary, Italy and other back countries of Europe read 
like tales of the early days when tribes and clans held the hills 
and valleys and warred upon each other, and such of these people 
as come to this country show by their poorly developed reasoning 



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ORIGIN AND CONDITION OF AMERICAN IMMIGRANTS, 433 

faculties, their habits of personal revenge, their treatment of 
women and children and their anarchistic and lawless tendencies 
that they have retrograded to the semi-civilized stage. Of the 
great Semitic family only the Jews concern us particularly. 
These people have, in theory, but only partly in fact, refrained 
from intermarriage with alien peoples but the type has been pre- 
served in noticeable distinctness since the destruction of their 
power as a nation over 1800 years ago. Since that time they 
have lived in groups or communities in all of the cities of the 
western world. They have been confined to limited and unsan- 
itary sections which have ultimately become greatly crowded. 
The poorer classes of Jews are very unsanitary; they work and 
live in dirty and badly ventilated quarters. Though special 
virtue is claimed for the Jewish method of killing the animals 
they use for food this is offset by the dirtiness of the shops in 
which the meat is sold. The Jew is very tuberculous, he has 
been so for so long, that he exhibits great tolerance of the effects 
of the disease; he is also prone to pneumonia, bronchitis, etc. 
The upper class Jew is healthier, his surroundings are the same as 
other wealthy individuals, but as a type Jews are beginning to 
show mental and physical degradation, as evidenced by the great 
variability of development, great brilliancy, idiocy, moral per- 
versity, epilepsy, physical deformity, anarchistic and lawless 
tendencies. The percentage of rejection at the Philadelphia 
naval recruiting office among young Jews and other foreigners 
and their descendants of the first generation is so great that 
barely one in ten is accepted. The Jewish quarter in New York 
is said to be the most thickly settled section in the world and 
the death rate is enormous. It is from these quarters that our 
hospitals, sanatoria, epileptic wards and colonies are filled. From 
these densely packed districts come the great proportion of the 
distorted forms and minds, the beggars, tramps, burglars and 
other perverts who make life burdensome and fill our prisons 
with criminals, our asylums with insane, 

The causes which lead to degradation, retardation and ex- 
tinction may be briery summarized: They may be inherent, 
hereditary, or extraneous, belonging to the environment, acquired. 



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434 MEDICAL DIRECTOR MANLY H, SIMONS. 

or the result of circumstances over which the nation or individual 
has no control. The line between these is not always distinctly 
drawn. It seems evident by the consideration of nature gener- 
ally that there is an inherent tendency to degradation and ex- 
tinction which favoring environment may cause to become pre- 
dominant. A type reaches the heifjht of its perfection, rests for a 
time and then slowly fades. Intermarriage or crossing between 
members of the same family, tribe or type, tends to accentuate 
and increase undesirable physical, nervous and mental character- 
istics. The race qualities are hereditary and, as seen in the 
negro, they sometimes tend to extinction of the race or type by 
limiting their adaptability especially where they are reenforced 
by marriage within the variety. There are what Prof. Ray- 
mond calls * 'family diseases" or abnormal types which tend to 
early death or sterility. There is not time to dwell on these 
points. Other causes, producing poverty and extinction, are 
barrenness of the soil from elevation, subsidence, deforestation 
and washing, flooding, drouth, incursion of sand, overcropping, 
war, pestilence and famine, the presence of malaria, sleeping 
sickness, uncinariasis, etc. The effect of general and long-con- 
tinued use of alcohol is said to be sterility; maladministration, 
luxury, and vice promote sterility and decay. The wars of Al- 
exander and the Caesars killed off the young men and exhausted 
their people. The list might be extended for several pages. 
Tuberculosis has now become a strong factor. One of the most 
potent of the peoples who have entered into the composition of 
the American type is the Irish, and of late they have begun to 
develop a strong tendency to tuberculosis; one cause of this may 
be that they are deserting the manual labor and out-of-door life 
of former times and flocking to the city to crowded quarters and 
in-door occupations. 

It is evident that environment under which may be grouped 
all extraneous circumstances, or things affecting us from with- 
out, is stronger for our hurt or our betterment than heredity. Im- 
munity to disease is not transmitted but adaptation to an environ- 
ment is, though it acts very slowly and many perish before it is 
perfected. It would seem that long dwelling in a locality and 



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ORIGIN AND CONDITION OF AMERICAN IMMIGRANTS. 435 

in-breeding tend to produce a variety almost as well marked as 
one of the four races, and there is a disposition thus to explain 
the numerous well-marked varieties of the different races. 

Twenty-five or thirty thousand years ago villages existed 
built on piles or rafts in the Swiss lakes and their state and the 
advance they made toward civilization are shown by the relics 
obtained. These were a roundheaded people, the Homo Al- 
pinus. There were also longheaded people, the Homo Mediter- 
ranensis and Homo Europus, but all three came from the long- 
headed Hamites, the Berbers of today. The range of color of 
the whites is through all shades from white to black. Each 
shade, as a ruie though, is found within certain latitudes show- 
ing that climate and environment had a great deal to do with its 
formation and perpetuation, but other factors such as sexual and 
natural selection must also be mentioned. It is claimed that the 
blond color and the longhead (dolichocephalism), tend to disap- 
pear and be replaced by a medium color, neither light nor dark, 
and the roundhead (brachyccphalism). 

From causes now unknown but of which we can imagine 
many plausible, in ancient times there were innumerable petty 
tribes and each one had its dialect, or its language. The world 
was then a panorama of shifting tribes and peoples. Impelled 
by many motives one horde invaded the territory of another and 
reduced it to slavery or was itself extinguished. Sometimes a 
whole people was extinguished as when Moses ordered the killing 
of certain tribes; under these circumstances there was a great 
confusion of dialects and types. It is said that a new language 
is rarely or never evolved by the mixture of different tongues, 
but that one side will drop its own and adopt the language of 
the other. Thus the Teutonic tribes which occupied France, 
Spain and part of, Italy adopted Latin, and the Norsemen 
adopted the French of the day and afterwards those who came 
to England dropped it and adopted the English. The Aryan 
tongue was taken by many peoples and the people who evolved 
it can not now be found. We have numerous examples in our 
own country and in Spanish America to the same effect. Though 
the language may be unaffected the physique and mental qual- 



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436 MEDICAL DIRECTOR MAINLY H. SIMONS. 

ities are decidedly modified. With this aspect we are also famil- 
iar. 

The cross between races, that is, the primary divisions of 
Homo sapiens, is not favorable to longevity or to desirable mental 
qnalities; thus it is an axiom that the cross between the black 
and the white, the white and the yellow, the yellow and the 
black, the black and the red inherits the bad qnalities of both 
sides and few of the good; of course this is not true to such an 
extent, but it is true that the vitality of the cross is generally 
less than that of either parent, and the susceptibility to disease 
seems to be increased. It is as if a new form were introduced 
and had to start afresh to adapt itself to strange environment 
and new diseases. Now it is my opinion that this will be found 
to apply strongly, though perhaps to a less extent than between 
the races, to the crosses between well-marked varieties. 

In Europe the varieties are found to be more closely con- 
nected and to have greater resemblance along certain lines from 
East to West; the lighter types along northerly lines, medium 
along a central, dark along a southern. We find the same to a 
less extent here. The New Englander goes West and is found 
in greater numbers in about the latitude of New England; 
Swedes and Norwegians are found more commonly in the North- 
ern part of the country. This, of course, is being rapidly changed 
and overcome by the pressure of commerce, but in ancient times, 
when means of travel were poor, the condition was marked and 
thus strongly marked varieties, with almost the weight of a race, 
were made. 

We face the problem of uniting these varieties as they gather 
here into an American type which shall continue our system of 
Government, develop the energy and force to perfect and de- 
fend it and insure for our people the greatest amount of liberty 
and happiness. 

To do this successfully wje should first insure that those 
coming in are desirable physically and mentally, secondly that 
their habits, methods of thought and state of civilization are 
such that they will readily assimilate with us. 

Though there is no danger of the adoption of any other 



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ORIGIN AND CONDITION OF AMERICAN IMMIGRANTS. 437 

than the English language, there is danger of our losing the 
hitherto distinguishing physical and mental characteristics which, 
we pride ourselves, enabled our forefathers to conquer this 
country and found the Republic, to fight a great civil war over 
principlfss and ideals dear to both sides, and, when the matter 
was settled, to go to work in amity side by side for the public 
good; for the daily tale of the happenings in our great land seems 
to show that we are losing the self-restraint, the broad sense of 
justice and obedience to law, the mental poise and depth, the 
great moral force which distinguished our ancestors and which 
would enable us to face danger and defeat calmly and recover 
quickly. We boast loudly of our strength, our wealth and our 
bravery, one day, and the next we are in a hysteria of fear over 
the shadow of a danger; mob violence, dynamiting, defiance of 
authority, murder, robbery, commercial dishonor and disregard 
of the obligations of public and private trust occupy too large 
portions of the daily papers to enable us to make claim without 
question to a high and ever advancing plane of moral and intel- 
lectual development. It is noticeable in the City of New York 
and probably in other large cities, that the preponderance of the 
people met on the streets are of a new type, which is without 
marked characteristics of the Anglo-Saxon, and, if an English 
dialect did not appear to be the common language, it would seem 
to be a foreign community. New York is a most prominent ex- 
ample of the tendency of foreigners to flock to the cities, to form 
communities in which their own customs and language are prac- 
ticed and outside of which their religion, and their prejudices too 
often forbid them to niarry. 

A survey of the history of nations and peoples proves to my 
mind that a mixture of varieties of a race, not of races, is neces- 
sary for the preservation and stimulation of the mental and 
physical qualities which insure the steady advancement of a 
people. 

As before stated crosses between well marked varieties are 
specially susceptible to disease and though there may be increased 
mental capacity, there are also likely to be irritability, insta- 
bility and lack of moral force. This is not entirely a misfor- 



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438 MEDICAL DIRECTOR MANL Y H, SIMONS, 

tune, for receptivity, imitation, a capacity for training and proper 
moulding of character are greater and ready for the teacher. It 
is therefore necessary that a proper environment and system of 
instruction be provided for ^hem. Too much emphasis can not 
be laid upon instruction in general and personal sanitation and 
in a high degree of morality, self-restraint and high thinking. 
It is a pity that the legal assumption of the duties and responsi- 
bilities of manhood are not now marked by some such ceremonies 
as those practiced by the candidates for knighthood in olden 
times, or for admission to the warrior class among our Indians. 
The fasting, watching, praying and considering of the lives of 
illustrious persons were especially for the fostering of the moral 
forces, self-restraint, tenacity of purpose, devotion to a high 
ideal of conduct, etc. , all qualities characteristic of the best type 
of citizen. 

As the white race is all in one division and has the same gen- 
eral conformation and capacity for advancement, there is everj'^ 
reason that the varieties should blend to form a uniform type of 
high order, but to insure this the mentally and morally defective 
and perverted, and the physically defective, those who are liable 
to transmit disease, a lower vital capacity and resistance, should 
not be permitted to marry and should be placed under careful 
supervision and training. Man is said to be the sum of his ances- 
tors, and this is true to a certain extent, as in racial characteris- 
tics, temperament, etc., but the man is also the product of his en- 
vironment in so far as his relation to the community is to a very 
great extent concerned; his business qualities, his probity, his 
moral standing, his honor, are to a very great extent, or almost 
entirely due to his bringing up, his moral training. A man may 
be naturally brave, but he can not be relied upon as a soldier un- 
til he has been properly trained, and it has been said that even 
cowards can be given the courage to make good soldiers by train- 
ing physically and morally, and this is likely true. We all know 
how much the course of any disease can be affected by the mental 
condition of the patient. 

The admission of immigrants to the overcrowded tenement 
districts is a danger to themselves and others. They should be 



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ORIGIN AND CONDITION OF AMERICAN IMMIGRANTS. 439 

diverted to the country, or to districts which are sanitarily fitted 
to receive them. Many of them are non-producers by which is 
meant that they do not add to the products of the country; they 
are parasitic. In the crowded tenements flourish as in a hot- 
bed the disease and vices, which, aided by the unsanitary en- 
vironment, lower the vital powers and pervert the moral forces. 
The immigrant, fresh from the small villages and farms of his 
own land, will not long remain healthy in such surroundings. 
He falls an easy prey to tuberculosis and diseases of the digestive 
and respiratory tracts, and contagious diseases generally. There 
is evidence to prove that intoxication, or it may be better to say, 
saturation, of the paternal organism with poison will produce a 
vitiated progeny. Then aside from the effect of disease, an im- 
paired vitality in the parent, upon the offspring, there is the 
effect upon the offspring itself, of unhealthful surroundings. 
Healthy bodies and minds can not be expected from such 
surroundings, but a greatly increased number of those with 
unstable nervous systems, perverted morals and an im- 
paired nutrition. The more the matter is studied the more con- 
vincing becomes the evidence that environment is greater than 
heredity in determining the health of the offspring; therefore 
sanitary measures must be enforced rigidly and generally. It 
must not be forgotten that it is not suflScient to provide measures 
but that they must be enforced, for the immigrant is generally 
entirely ignorant of the necessity. The mentally and physically 
diseased must be cared for separately, the perverted and vicious 
confined and given proper training. 

In Holy Writ it is doubted that man can, by taking 
thought, add to his stature but it is physiologicallj' certain that 
man can by proper thought and training add to the mental, moral 
and physical stature of his descendants and raise to himself a 
heritage that will be a glory to his country and to his name. • 

Mens Sana in corpore sano is a proper ideal. It is better 
that we should carry this before us than that we should strive 
for a huge population, a blind unthinking mass ever ready to 
follow a specious leader, a mob ferocious and cruel at one mo- 
ment, cowardly and hysterical at another. It should be remem. 



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440 MEDICAL DIRECTOR MANLY H. SIMONS. 

bered that mental and physical training must be harmonious to 
be eflFective; that is that one part must not be developed at the 
expense of the other. A sound mind in a sound body and the 
whole directed by a thoroughly cultivated moral nature will give 
the ideal citizen. Training must be practical and intere^ing so 
as to fit the student for an avocation as well as to give him a 
knowledge of military drill and of the benefit of the bearing and 
prompt obedience of a soldier, and it must show the general re- 
lation of his avocation and of his actions to the welfare of the 
community at large. The result of his omissions and commis- 
sions upon himself, his descendants and others must be accen- 
tuated so that he may not act in ignorance. 

In all this work the medical man is vitally interested, in 
fact it can not be carried out, its principles can not even be laid 
down, without his broad knowledge of physiology and sanitation 
and of the nature of man. The rules should not be so rigid as 
to be irksome, nor so lax as as to be useless; the specialist is apt 
to lay too much stress upon a part whereas success depends upon 
the cultivation of the whole. The aim should be to inculcate a 
sound elementary knowledge, but the application and enforce- 
ment in a community should be placed in the hands of those who 
have been trained for it. 

To the military surgeon the subject is interesting and vital, 
for he will have to deal with all types of men in camp and field 
and his attention has been more closely drawn to the ever increas- 
ing number of defectives who under the stress of active service 
fall from the ranks either as sick or as deserters and to the ever 
increasing difficulty of getting recruits who conform to the 
physical requirements. It is especially difficult to find men who 
are fitted for the Navy; only the strongest and healthiest will 
do. In the old days when the old sailor lived practically in the 
open air the life was a healthy one; now he lives in a steel fort- 
ress artificially lighted and ventilated and much overheated; it is 
overcrowded also and the ventilation is not so good but that the 
compartments are often surcharged with the emanations from 
the lungs of the men. It is then no wonder that tuberculosis and 
other infectious diseases are common in the Navy now. I con- 



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ORIGIN AND CONDITION OF AMERICAN IMMIGRANTS. 441 

sider the crime of desertion to be due principally to two causes; 
first, — a low or perverted mental development which makes the 
person unable to appreciate the enormity of the ofiFense; second, 
an undeveloped or perverted moral sense which equally prevents 
the realization of the enormity of the offense, but is susceptible 
of cultivation by training to the normal healthy standard. Those 
cases in which men are forced to desert by the other men of the 
company generally come under the second class, for their un- 
popularity is most commonly due to moral obliquity. The pro- 
portion of deserters therefore is an index of the mental and moral 
condition of a people which can not be neglected in any calcula- 
tion. 

It must not be forgotten that, by neglect of proper sanitary 
rules and of the laws of nature, we have made sewers of many of 
our streams and rivers of which the waters can not be drank 
without great risk, and have materially lessened the productive- 
ness of our land, so for our own welfare the work of sanitation 
and of restoring the fertility of our soil must be begun soon and 
done thoroughly. 

In our efforts to exterminate tuberculosis, it must not be 
forgotten that we should take into consideration all preventable 
diseases and everything which tends to depress vitality. In other 
words the means of prevention must, to be complete, cover the 
broad field so faintly indicated in this paper; many particular 
points will suggest themselves to the scientific observer, in this 
connection. Nothing radical should be undertaken without the 
most thorough discussion and consideration. Too often has the 
welfare of a people been affected by a disturbance of the balance 
of nature from the hasty action of some enthusiast who has seen 
only one side of a question. We must not sheer so violently 
from the shoal on one hand as to run into the rocks on the other. 



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A DIAGRAM OF THE MEDICAL ORGANIZATION, 

UNITED STATES ARMY. FOR SERVICE 

WITH A DIVISION.* 

By lieutenant GEORGE H. RICHARDSON, 
MEDICAL RESERVE CORPS, UNITED STATES ARMY. 

IN connection with a diagram of the medical organization for 
service with a division designed for the purpose of instruct- 
ing the Hospital Corps, and to show where the American 
National Red Cross can be of assistance in time of war, it would 
seem that an explanation, if the diagram were sufficiently ex- 
plicit, would be reiteration, but I find an excuse for submitting 
this article in the fact that I have failed to embody in it all the 
details which it should contain. 

I have endeavored to make the diagram as simple as the 
subject would allow, for I realize that in order to be of service it 
must appeal to the most inexperienced recruit and also to those 
who have but a limited knowledge of what an army division con- 
sists. 

The '*War Strength" of the various organizations composing 
the division is given, as enumerated in the Field Service Regu- 
lations, and for any information concerning the medical personnel, 
I have followed closely the Manual for the Medical Department. 
In stating the quota for the Army Nurse Corps, I have used my 
own judgment as to the number who could be utilized at the 
stations designated. In this, I can naturally conceive a differ- 
ence of opinion which however is of no material consequence. 

I will, first of all, explain wherein I feel that the diagram 
can assist in the instruction of the Hospital Corps. 

The training of every enlisted man is primarily for the pur- 



*Note: — Owing to contemplated changes in the Field Service Regulations, the 
diagram can be used only in a general wny for purposes of inntruction. It* usefulneas 
in showing where the services of the American National Red Cross can be utilized 
will not be impaired. Upon the publication of these changes the diagram will be 
revised accordingly. 

(442) 



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A DIVISION MEDICAL ORGANIZA TION, 443 

pose of developing in him those qualities which shall make him 
useful in time of war. Unless he can be made to appreciate this 
fact he will not develop that enthusiasm which will create a de- 
sire for study, and his efforts, particularly in the Courses of In- 
struction as they are now authorized, will be prefunctory in 
character and necessarily superficial. Every effort should be 
made to show that the daily routine to which he is subjected in 
garrison or hospital work is only the means of fitting him for the 
more important duties of active military service, when such ser- 
vices shall be required. 

I believe that, if in the teaching of the subjects comprised 
in the Course of Instruction, he could be shown by reference to 
the diagram, the various positions where his knowledge could be 
utilized in time of war, he would take hold of his daily studies 
and exercises with more zeal and in the direct ratio that he can 
be impressed with this importance. 

For instance, the necessity of being well versed in all that 
pertains to the first aid treatment of gun-shot wounds, would be 
evident to the man who desires' to be on duty at the "Dressing 
Stations" as he could readily see that this qualification would be 
absolutely essential if he were assigned here for duty. 

The man whose special qualification is '^Care of Animals'' 
should be made to feel that his services are just as necessary as 
those of a licensed druggist and that as one of the 308 members 
of the "Ambulance Stations" he is a very useful member in mak- 
ing complete the eflSciency of his corps. 

Those on duty at the field hospital will be men as capable of 
nursing and have special training in this branch of medical 
work. They will also be associated with some who are drug- 
gists and others who will have charge of property and the hos- 
pital records. 

These men, by a study of the diagram, will appreciate the 
necessity of quick, efficient work and that while they may not be 
immediately on the "firing line*' they are as much a part of the 
"Service of the front" as if they were directly attending to the 
wounded where they fell. 

The location of the various stations, while necessarily di- 



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444 LIEUTENANT GEORGE H, RICHARDSON. 

agramatic, will be understood by every man and the interde- 
pendence of one upon the other made clear and distinct. 

I am also of the opinion that it will be of value in proving 
that the prompt rendering of all military reports is necessary^ 
even from the smallest component part of the division, in order 
that the senior medical officer may be in touch with every detail 
that might aid him in obtaining from his subordinates the expe- 
ditious return of all papers, which I have heard is, on some oc- 
casions, a difficult task. 

I can conceive where it might assist the surgeons of the 
various State Militia in explaining to those in authority the im- 
portance of procuring an adequate equipment of medical supplies 
in order that they might be in a position to take the field at a 
moment's notice and form an integral part of a division or at 
least of a brigade. 

The American temperament is eminently practical in its 
composition; one must prove definitely to each person that he 
wishes to interest, the value of his arguments. It very seldom, 
if ever, will voluntarily subscribe funds or influence to a new 
idea. 

We have not in this country a king or an emperor, who by 
becoming the Honorary President of an organization, so attracts 
the public mind that it hastens to take an active part in the en- 
terprise. We must appeal directly to the* intelligence of each 
individual in order to arrest them in their hurried struggle for 
advancement. 

The American National Red Cross was reincorporated in 
1905 and under a new administration, which is in direct relation 
with the War Department, is endeavoring to interest the people 
of this country in its organization. One of its claims for their 
support is that, if sufficiently assisted by the representative men 
of the various states, it will be in a position to augment the 
medical department of the Army and Navy in time of war and 
will be so well managed that it would be selected as the dis- 
tributor of the voluntary offerings of the public to the soldiers 
and sailors. As I have said before, no matter how worthy the 
object, the average American will not of his own volition become 



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446 LIEUTENANT GEORGE H. RICHARDSON. 

a member of this society. He is by temperament and education 
independent in his nature and must decide for himself. The Red 
Cross must therefore show a reason for its existence and some 
authority for its statement before it can expect the encourage- 
ment it desires. 

In the lower half of the diagram I think I have made clear 
the necessity of having a trained personnel in order to properly 
care for those sick and wounded of a division, whose injuries or 
illness are of such a character that they are unable to return to 
the front. I have endeavored to show how the organized Red 
Cross Society, working in harmony with the Army Medical De- 
partment can be of great assistance. 

One is surprised to find how little the average person knows 
of the strength of the Army and the relation which the Medical 
Department bears to it. They little realize that to care for a 
division of 20,000 men, 1,200 Hospital Corps are necessary. If 
we multiply these figures by ten we can see at once the terrible 
limitations of our present force, and we find a rational basis for 
the society's statement and the intense interest which the War 
Department evidences in its growth and development. We know 
that it takes time and training to make medical aid effective 
in time of war, so we should begin immediately to formulate 
plans for the future even though the necessity for such aid may 
seem extremely remote. 

I have purposely limited the scope of the Red Cross to **Ser- 
vice of the Rear*' for I am insistent upon this point and it is 
only the exceptional circumstance which would make justifiable 
it being employed elsewhere. Its right to recognition by the 
military authorities depends upon its being willing to be a part 
of the general military scheme and to be able to render help and 
assistance, when called upon to do so. I shall try and give in 
detail those arguments which I think the Red Cross should em- 
phasize in order that it may more clearly present its case. 

An army in active campaign must have two so-called **Field 
Hospitals;" one of these must be mobile in character and capable 
of following the advance movements, while the other is sta- 
tionary, yet in direct communication with the other. It is prac- 



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A DIVISION MEDICAL ORGANIZATION. 447 

tically dependent on the mobile hospital for its patients, as the 
sick and wounded are a hindrance to the combatant forces and 
should be.rapidly sent from the field of active operations. 

In this stationary hospital we first find the Red Cross phy- 
sicians and nurses of service. Here is an excellent field for our 
surgical specialists and for all forms of scientific investigation, 
such as the x-ray work. The sick may be compelled to remain 
for some time in its ward before they are recovered suflBciently 
to be transferred to their commands in case of recovery or if per- 
manently disabled back to the Base or Convalescent Hospital. 

The Army Nurse Corps can be here employed to advantage, 
as everything necessary for good work will be furnished, which 
cannot be available in the mobile hospital. 

This hospital, if we were in conflict with a nation which is 
a member of the Geneva Convention, would be recognized by 
the belligerents. Its personnel, if they were members of the 
Red Cross, would be ranked as non-combatants and as such 
would be free from capture and would not be disturbed in their 
duties. 

If I may be allowed to divert, 1 consider this one of the best 
arguments in favor of the fact that all members of the Associa- 
tion of Military Surgeons should become a unit in working for 
the interests of the National Society, for there is a likelihood that 
independent organizations might not be recognized and would 
consequently fail in their efforts, becoming a hindrance rather 
than an assistance to the Army. 

The sick and wounded in the Stationary Hospital must soon 
be removed, for it has but a limited capacity, as will be seen by 
the diagram. To do this, Hospital Ships and Hospital Trains 
ar€ necessary, which I have embodied in the chart and connect- 
ing the stationary hospital with the base or convalescent hos- 
pital. 

It is needless for me to say that these ships and trains must 
be specially constructed in order to properly care for the sick, re- 
quiring operating rooms, wards and equipment, such as it takes 
considerable time to collect and furnish. 

These cannot be had at a moment's notice, and as wars are 



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448 LIEUTENANT GEORGE H. RICHARDSON 

seldom expected, the Red Cross contemplates procuring the sup- 
plies necessary and having them in readiness. The Base or Con- 
valescent Hospital could practically be equipped and manned by 
the Red Cross Society, for it would be in the home territory. 

The rest stations, four of which are indicated on the dia- 
gram, should be entirely under the direction of the Red Cross 
Society. They should be established at intervals of about six 
hours on the route over which the troops are passing, and should 
consist of two departments, one of which should minister to the 
temporal needs of the soldier by supplying them with fresh 
water, food, fruit and other supplies, while the second depart- 
ment should contain physicians and nurses with suitable equip- 
ment to care for any sick that might need temporary help. 

This all looks very easy on paper, yet it is a procedure 
which requires very careful centralization and management in 
order that a surplus may not be accumulated in one place and a 
deficit be found in another. 

It requires the services of men and women who are trained 
to their duties and who have made a study of the conditions as 
they existed in former wars, whose executive abilities have been 
tested, and whose mental and moral worth is such that they are 
beyond reproach. 

The unpreparedness of this country, in so far as its Volun- 
teer Aid Societies was concerned, was proven during the Spanish 
American War. It should be a lesson to those of us who are 
interested in military matters from a medical standpoint. I will 
not go into details and tell you my own exeperiences during 
1898-1899 in the Philippines for many of you have had the same 
conditions to contend with and the recital of my narrative would 
be but "another story.'* 

Much is being done to develop among our people a recog- 
nition of the claims of the society for their support. Legions of 
the Red Cross have been starte4 in New York and California, 
made up of young men who are taught by regularly appointed 
physicians, the elements of first aid and hospital corps drill. 

Nurses' Auxiliary Branches have been formed in many 
states and they are receiving instructions which will make them 



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A DIVISION MEDICAL ORGANIZATION. 449 

competent to replete and augment the ranks of the Nurse Corps 
of the Army and Navy. 

Many well known physicians and surgeons are joining and 
volunteering their services in case of need. All these members 
receive the Red Cross Quarterly Bulletin which keeps them in 
touch with Red Cross work all over the world. 

The Society is severely handicapped by having but a limited 
membership, which I believe is due to the fact that its claims 
have not been sufficiently presented; I personally feel it my duty 
as a physician and a citizen of this country to do all in my power 
to increase its efficiency and it was with that intention that this 
diagram was conceived. 

Should any present feel that it would be of some personal 
assistance in aiding to advance the cause of the Red Cross or to 
interest his hospital corps detachment, I shall be only too glad to 
furnish him a copy at a price which shall cover the cost of the 
paper, postage and mailing tube. 

The blue-prints are made for me in the office of the District 
Artillery Engineers, Presidio of San Francisco, by enlisted men 
of the best army in the world, and they do it because they feel 
that perhaps it may be of some service in keeping alive that pa- 
triotism which ^ * 'government of the people, by the people and 
for the people" must have in order to exist. 



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RETROSPECT OF CO-OPERATIVE WORK pF THE 

MEDICAL SERVICES OF THE GOVERNMENT. 

By H. W. AUSTIN. M. D., 

SURGEON IN THE UNITED STATES PUBLIC HEALTH AND 
MARINE HOSPITAL SERVICE. 

EACH medical service of the Government is, by the organic 
law of its establishment and by subsequent acts of Con- 
gress, charged with certain specific duties which, under 
Department regulations, constitute the usual duties of the med- 
ical officer in the different services. 

Under these acts of Congress, and the regulations made 
pursuant thereto, the several medical services of the Govern- 
ment have on various occasions been required or authorized to 
perform the same duty, or to aid or co-operate with each other 
in some special duty. Again, under special acts of Congress and 
by Executive order, mixed boards have been created from the 
several services for scientific investigation or for the carrying out 
of sanitary measures, etc. Co-operative work by the services 
has not been infrequent in time of peace as well as in time of 
war. The assignment of officers of the Army and Navy to some 
special duty in other departments of the government is not 
limited to the Medical Corps. There are naval inspectors of 
light-houses along the coasts and rivers, Army engineers are en- 
gaged in the same service and also frequently assigned to en- 
gineering work (not military) under other departments of the 
government. 

Co-operation between the several departments of the gov- 
ernment in furnishing relief to the sick and injured in any great 
disaster to the people, such as floods, fires, epidemics and earth- 
quakes has been the policy of the government from early times. 
Notable instances of co-operative relief work between the three 
medical services of the government may be mentioned : The 

(460) 



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CO-OPERA TIVE WORK OF THE MEDICAL SERVICES, 451 

Johnstown flood, the Chicago fire, various epidemics of yellow 
fever and the San Francisco earthquake and fire. 

In every war in which the United States has been enfj^aged, 
from 1812 to the present, the medical officers of the Public 
Health and Marine-Hospital Service have cared for the sick and 
wounded soldier, sailor or marine,in hospital, aboard United States 
revenue cutters and army transports, in camps or aboard sanitation 
ships. During the war of 1812 all of the wounded naval sailors 
of the frigates Constitution and Guerriere after their memor- 
able action were treated in the United States Marine Hospital at 
Boston, as were also many naval seamen and marines from the 
frigates Chesapeake^ Congress, and United States and the brigs 
Syren and Hornet. 

During the civil war 648 United States soldiers, sailors and 
marines were treated at this same hospital and in many other 
United States Marine Hospitals they were received, but of the 
number in each I have no authentic record. Several of the 
hospitals were temporarily turned over to the War Department. 

During the Spanish-American war, by order of the Presi- 
dent, the United States Marine Hospitals were again open for the 
reception of United States soldiers, sailors and marines and 547 
were admitted and given medical and surgical relief by the 
officers of the Marine Hospital Service. 

The detention camp at Egmont Key, Fla., was virtually a 
hospital camp built for the reception of troops returning from 
Cuba to the United States. In this camp were received six hun- 
dred and eighty officers and soldiers of the United States Army. Of 
these there were 303 cases of malarial fever, 9 cases of typhoid 
fever and 101 cases of dysentery. Many of these troops were 
from the army hospital at Siboney and barely convalescent from 
yellow fever. It was a camp of invalids. The medical officer in 
command reported that nearly all were in a condition of pitiable 
prostration. They were given medical relief by this service and 
cared for until they were able to travel, when their baggage was 
disinfected and all were sent to New York by vSteamer, except 
thirty-two commissioned officers who proceeded north by train. 

In the transfer of Shafter's army from Santiago to the 



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452 SURGEON H, IV. AUSTIN. 

United States the recommendations of the Surgeons-General of 
the Army and Marine Hospital Service were, by order of the 
Secretary of War, put into effect, and upon request of the Sec- 
retary of War a National Quarantine was established by the Ma- 
rine Hospital Service at Montauk Point for the returning troops. 

The United States quarantine steamer Protector, which was 
under construction at Philadelphia, was rapidly completed and at 
great expense equipped with steam chambers, sulphur furnaces, 
bichloride tanks, pumps, shower baths, beds, bedding, medical 
and other supplies and was dispatched to Montauk Point, ar- 
riving there in time for the first transport. 

Six medical oiBcers of the Marine Hospital Service, two 
hospital stewards and twenty-one attendants were engaged in 
this work. 

Thirty-two transports arrived between August 13 and Sep- 
tember 13, 1898, bringing about 17,000 troops, of which number 
2,200 were reported sick. There were fifty deaths from various 
diseases en route but only four cases of yellow fever arrived at 
Montauk Point. This war emergency quarantine which was es- 
tablished on very short notice was most successful and received 
the hearty support and cooperation of the medical officers of the 
army. 

In 1899 one hundred United States troops from the military 
hospital at Santiago, were by request of General Wood, placed 
aboard a vessel at Santiago under the supervision of a medical 
officer of the Marine Hospital Service where they were cared for 
about one month when they were able for duty. 

A commissioned officer of the Marine Hospital Service was 
by authority of the President temporarily transferred and ap- 
pointed Brigade Surgeon, United States Volunteers, during the 
Spanish-American War. 

By Executive order dated January 4,1900, the * 'National 
Quarantine Act" of February 15, 1893, and all regulations made 
pursuant thereof were given full force and effect in the Philip- 
pine Islands. All the maritime quarantine stations were turned 
over to the United States Marine Hospital Service and a number 
of officers of this service were assigned to duty there under the 



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CO-OPERA TIVE WORK OF THE MEDICAL SERVICES. 453 

direction of one of them, designated the Chief Quarantine Officer 
of the Philippines. The Chief Quarantine Officer was also ap- 
pointed Director of Public Health of the Philippines and still 
holds this office. 

During the military government of the isilands, the Chief 
Quarantine Officer was, by Executive order, made ex-officio a 
member of the Military Governor's Staff, then General Mac- 
Arthur. The sanitary supervision over all incoming and out- 
going government vessels including army transports and naval 
vessels (non-combatant) requiring cooperative work between the 
services made this appointment essential. 

In 1902 and 1903, a large number of medical officers of the 
army serving at military posts in small coast towns of the Phil- 
ippines were by request of the Chief Quarantine Officer detailed 
by the General in Command of the Philippines Division to 
act as quarantine officers at these posts to carry out the quaran- 
tine regulations of the Treasury Department and there are two 
medical officers of the army still performing this duty. For sev- 
eral years a medical officer of the navy has been detailed to en- 
force the National Quarantine regulations at Cavite, Philippine^ 
Islands, by request of the Chief Quarantine Officer of the Is- 
lands. All army transports and naval supply vessels are disin- 
fected at Marivales before leaving that port for the United States. 

By request of the Commanding Officers and upon recom- 
mendation of the Naval Medical Officer, United States battle- 
ships and cruisers have at different times been given sanitary 
treatment at the National Quarantine Stations under the direc- 
tion of officers of the Public Health and Marine Hospital Ser- 
vice. A recent instance of this was in the battleship Nebraska 
on which scarlet fever developed among the sailors just prior to 
the date appointed for the fleet to leave San Francisco for their 
voyage around the world. 

From six to eight officers of the Public Health and Marine 
Hospital Service are each year detailed on United States revenue 
steamers cruising in the Arctic Ocean or Behring Sea or off the 
coasts of Porto Rico or Hawaii. 

In time of war the Cutter Service becomes a part of the 



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454 SURGEON H. IV, AUSTIN, 

naval establishment and, as in the Spanish- American War, these 
medical officers would be performing similar duty to that of the 
medical officers of the navy. The officers and crews from these 
vessels and also the officers and crews of the army transports are 
treated at the United States Marine Hospitals. 

The State Department in its Consular Service furnishes in- 
formation to the Public Health and Marine Hospital Service of 
the prevalence of epidemic diseases and of the sanitary condition 
of the cities in which they are stationed. They also furnish bills 
of health to vessels bound for American ports under regulations 
furnished by the Surgeon General of the Public Health and 
Marine Hospital Service. 

The Medical Corps of the Army and Navy have at different 
times taken part in the preventive measures in times of epidemics 
in the United States and in our insular possessions. 

By an act of Congress approved March 24, 1874, a commis- 
sion of medical officers, one from the United States Army and 
one from the Marine Hospital Service was appointed by the 
President to investigate and obtain all information possible re- 
garding the epidemic of cholera that prevailed in the United 
States in 1873, and to make a detailed report to the President to 
be submitted to Congress. In this epidemic there were 7,356 
cases and 3^800 deaths and the work involved in obtaining infor- 
mation and making a full report of this great epidemic -which 
prevailed so extensively was a difficult and laborious task. The 
published report of the Commission, a volume of 1,025 pages, is a 
valuable record of the history of that epidemic. 

In the epidemics of yellow fever in the United States in 1878, 
and at later dates the medical officers of the Army, Navy and 
Marine Hospital Service worked together in relief work and also 
took part in the preventive measures adopted by the state 
authorities. 

The Government Medical Services have achieved much in 
the field of preventive medicine and for many years officers from 
each service have devoted much time in the investigation of the 
etiology of, and in preventive measures against yellow fever, and 
the lives of many officers of the Public Health and Marine Hos- 



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CO-OPERA TJVE WORK OF THE MEDICAL SERVICES. 455 

pital Service have been sacrificed in this work. Six medical offi- 
cers of the Public Health and Marine Hospital Service have died 
of yellow fever in these investigations, and in the execution 
of quarantine measures adopted by the Government; and four 
officers of this service died of other diseases due to exposure 
in this same work. I have no data of the mortality due to this 
cause in the other government services. 

The crowning event of the work in the investigation of yel- 
low fever was the discovery made by the commission of army 
medical officers, Reed, Agramonte, Carroll and Lazear, that the 
disease is transmitted by the mosquito and by the mosquito only. 

In this work Lazear sacrificed his life and other members of 
the commission contracted the disease but recovered. 

The remarkable scientific observations made by Surgeon 
Carter, Public Health and Marine Hospital Service, that the yel- 
low fever infection was extrinsic, that the place did not become 
infected for some days after the disease occurred, together with 
Finley's early contention that the mosquito could transmit the 
disease, the commission stated, influenced them to investigate 
along this line. These earlier investigations no doubt helped in 
clearing the way and pointed the direction. 

This discovery rendered possible some of the most brilliant 
achievements in modem preventive medicine. The eradication 
of yellow fever from Havana by the medical officers of the army 
in 1901, under Colonel Grorgas, and the successful campaign 
waged against yellow fever in New Orleans by the medical 
officers of the Public Health and Marine Hospital Service under 
Surgeon White, in which a great epidemic was at once con- 
trolled and was extinguished long before frost in 1905. 

When the government undertook the work of building the 
Isthmian Canal, one of the greatest difficulties to be overcome 
was to make the Canal Zone safe for the men to live there who 
were to engage in this stupendous operation. 

A number of medical officers from each government ser- 
vice, Army, Navy and Public Health and Marine-Hospital Ser- 
vice were detailed for this work under the Isthmian Canal Com- 
mission and they are still engaged in it. These officers were 



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456 SURGEON H. W, AUSTIN. 

selected by reason of their experience in work of this character. 
The Chief Sanitary Officer is from the army, the Director of 
Hospitals in the Canal Zone is from the Public Health and 
Marine Hospital Service, the Chief Quarantine Officer of the 
Canal Zone and the Quarantine Officer at Christobal are from the 
Public Health and Marine Hospital Service. Numerous other 
army medical officers are also there. The sanitary work which 
has been in progress four or five years is one of the triumphs of 
preventive medicine. 

During the great epidemic of small-pox which occurred in 
Montreal and throughout the Province of Quebec in 1885 and 
1886, valuable assistance was given by some of the medical of- 
ficers of state troops in the preventive measures taken by the 
Marine Hospital Service along the Canadian border. This work, 
which lasted about six months, was a practical demonstration on 
a grand scale of the value of railroad inspection and sanitation 
and vaccination. Small-pox was kept out of the United States 
with but little interference with travel between Montreal and 
other points in Quebec and the United States. 

By virtue of an act of the Legislative Assembly of Porto 
Rico, the Governor of Porto Rico appointed a commission of 
medical officers, one from the United States Army, one from the 
Public Health and Marine Hospital Service and the health 
officer of Bayamon, for the study and treatment of anemia. Con- 
firmation of the appointments was made by the Secretaries of the 
Treasury and War. The work of the commission covering a 
period of several years in the investigation of the prevalence of 
uncinariasis throughout the island and in the demonstration of 
its successful treatment was of immense value to the inhabitants 
of Porto Rico. This report was published by the Government 
of Porto Rico and widely distributed to the medical profession. 

The line of duty of the medical officers in the Army, Navy 
and Public Health and Marine Hospital Service affords oppor- 
tunities to each corps to stndy tropical diseases and many other 
diseases not indigenous in the United States. They are serving 
in the Philippines, in Japan, in China, in Cuba, in South Amer- 
ica, in Panama, in Porto Rico, in Hawaii, in Alaska, at quaran- 



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CO-OPERATIVE WORK OF THE MEDICAL SERVICES. 457 

tine and immigration stations and at Army, Navy and Marine 
Hospitals in the United States and aboard naval vessels. 

In this broad field they obtain a knowledge of tropical and 
other diseases not common in the United States. However it is 
not my purpose to mention in detail the work of the services but 
rather to show the close relation of duties performed by each in 
which co-operative work has been or may be required. It is in 
that greater field of preventive medicine where the close relation 
of duties exists. History repeats the fact that the greatest in- 
jury to the people of a -nation on account of war is not the loss 
of life or limb in battle but rather to disease. 

The ravages of war are not all upon the battlefield. X^e 
ravages of disease which begin in camps, and in foreign climates, 
are brought home by the returning troops. Epidemics, most 
appaling, have at difiFerent times resulted from the return of an 
army, and many diseases unknown before have been introduced. 

The Public Health and Marine Hospital Service is charged 
by law with the prevention of the introduction and spread of 
contagious or infectious diseases in the United States and in our 
insular possessions. By an act of Congress, the oflScers of this 
service are also made available for duty in times of actuator 
threatened war in such manner as the President may direct. 

In the event of war, co-operation between the medical ser- 
vices would be necessarily frequent, mainly in the field of pre- 
ventive medicine. 

War with any eastern power would necessitate the frequent 
transfer of large bodies of troops to the seat of war or to our insular 
possessions and their return from the field. There would be 
constant communication between the United States and the seat 
of war by the fleets of the Navy, the United States Army 
Transports and other vessels brought into the service of the 
United States. 

The officers of the Public Health and Marine Hospital Ser- 
vice stationed in the Philippine and Hawaian Islands as Direc- 
tors of Public Health of the Islands or the officers at the various 
National Quarantine Stations in the Philippine and Hawaian 
Islands and Porto Rico as well as those in the United States are 



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458 SURGEON H. W. AUSTIN, 

in a position to be of great service to the military and naval 
forces of the United States. The stations are in commission at 
all times and equipped fully for the sanitation of vessels and the 
care of their sick. Their anchorages are safe for naval vessels 
and their wharves ample. These oflficers are expert in ship san- 
itation and understand the handling of men. Troops or sailors 
can be put in barracks, the vessels given complete sanitation, 
the sick isolated in hospital, and the troops returned with the 
least possible detention. Should cholera, plague or yellow fever 
occur aboard a battleship or army transport in the Philippines 
the great importance of these stations would be manifest. 

• Each service has its hospital where the young officer may 
acquire a practical knowledge of the treatment of medical and 
surgical diseases, hospital management and discipline, and each 
officer must be a competent physician and surgeon ; but as he 
advances in his grades and his experience broadens he becomes 
more and more convinced that his primary duty is that of a 
health or sanitary officer. 

In this day of the universal awakening of the people to the 
fact that a very large percentage of the mortality from disease is 
due' to preventable diseases, the medical officer must be learned 
in sanitary science, familiar with "the sanitary laws and regula- 
tions, and have the savoir faire and courage to put them into 
effect, frequently against strong opposition. His success in pre- 
ventive medicine will often depend upon his skill in diplomacy, 
his ability to educate the layman or public, in the subject of san- 
itation, and convince them of the necessity of the preventive 
measures he would adopt, and to obtain their confidence and 
active support. 

ILLUSTRATIVE ORDERS. 

Adjutant-General's Office, 
Washington, August ii. 
Commanding General United States Forces, 

Santiago de Cuba. 
The Secretary of War directs that the following instructions be sent you:— 
That medical officers of the United States Marine Hospital Service be 
immediately detailed for duty at Santiago, and subsequently at other Cuban 



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CO-OPERATIVE WORK OF THE MEDICAL SERVICES. 459 

or Porto Rican ports under control of the United States forces, to carry 
out the requirements of the quarantine law of 1893; such officers to issue 
certificates and perform other duties of sanitary or other port inspectors. 

That all sanitary matters pertaining to the condition of transports and 
crews be placed under the jurisdiction of the medical officers of the Marine 
Hospital Service. Every vessel engaged in the transport service between 
the United States and Cuban or Porto Rican ports to carry a medical 
officer of the Army or of the Marine Hospital Service, whose duty shall be 
that of sanitary inspector of the vessel and who shall see that in every for- 
eign port no material or person is taken aboard liable to convey yellow 
fever; to keep the crews of the transports under surveillance, and on the 
return voyage act as sanitary inspector. 

That there be placed at Santiago and every chief port where practi- 
cable a receiving ship for the reception of those who take passage for ports 
in the United States. This ship would practically be a detention camp and 
quarantine station, and passengers seeking homeward voyage would then 
be taken from this vessel after they had undergone a period of observation 
and disinfection of their effects. 

Surgeon Carter, United States Marine Hospital Service, has been ap- 
pointed sanitary inspector at Santiago. 

H. C. CORBIN, 

Adjutant General. 

Headquarters of the Army, 
Adjutant General's Office, 
Washington, D.C., January 20, 1899. 
By direction of the Secretary of War, the following orders of the Pres- 
ident are published for the information and guidance of all concerned: 

Executive Mansion, 
Washington, D.C., January 17, 1899. 
To prevent the introduction of epidemic diseases, it is ordered that the 
provisions of the act of Congress approved February 15, 1893, entitled an 
"act granting additional quarantine powers and imposing additional duties 
upon the Marine Hospital Service," and all rules and regulations hereto- 
fore prescribed by the Secretary of the Treasury under that act are to be 
given full force and effect in the islands of Cuba and Porto Rico, and the 
following additional rules and -regulations are hereby promulgated. 

The examination in ports of the islands of Cuba and Porto Rico of in- 
coming and outgoing vessels and the necessary surveillance over their sani- 
tary condition as well as of cargo, passengers, crew, and of all personal 
effects, is vested in and will be conducted by the Marine Hospital Service, 
and medical oflficers of that Service will be detailed by the Secretary of 



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460 SURGEON H, W. AUSTIN. 

the Treasury as quarantine officers at the ports of Habana, Matanzas, 
Cienfuegos, and Santiago immediately, and at other ports in the islands of 
Cuba and Porto Rico as soon as practicable or necessary. Quarantine 
officers shall have authority over vessels, their wharfage and anchorage in 
infected seaports, in so far as is necessary to prevent the infection of ves- 
sels or their personnel, and all vessels including vessels of the army trans- 
port service and merchant and coastwise vessels, leaving ports in the is- 
lands of Cuba or Porto Rico for the United States or for other ports in the 
islands of Cuba or Porto Rico, vessels of the United States Navy ex- 
cepted. Quarantine officers will enforce necessary measures on incoming 
vessels through collectors of customs at ports of entry, who will not permit 
entry without quarantine certificates, and bill of health will not be given to 
an outgoing vessel unless all quarantine regulations have been complied 
with. All officers of the army transport service and medical officers of the 
Army and Marine Hospital Service on duty on army transports will use 
every precaution to prevent danger of exposure to infection of crews while 
in the ports in the islands of Cuba or Porto Rico. 

Since the quarantine service herein provided for is for the protection 
of the islands of Cuba and Porto Rico as well as the protection of the 
United States against both, the expenses arising therefrom will be charged 
at present both against the revenues of these islands and the epidemic fund; 
said expenses will be divided equally against both, payments, however, to 
be made out of the epidemic fund and reimbursement made thereto from 
the revenues of the islands of Cuba and Porto Rico. 

William McKinley. 
By Command of Maior General Miles: 
H. C. CoRBiN, Adjutant General. 

(Executive Order) 

Executive Mansion, 
Washington, D.C., October lo, 1900. 

On and after October 15, 1900, there shall be detailed on the staff of 
the military Governor of the Philippine Archipelago,aschief of the quaran- 
tine service established by Exectuive order of January 3, 1900, a commis- 
sioned officer of the Marine Hospital Service, who shall on the first day of 
the month, or at such other periods as may be directed by the military gov- 
ernor, submit to the military governor a detailed estimate of the quarantine 
expenses of the said islands of the Philippine Archipelago. After approval 
of such estimate by the military governor the chief quarantine officer shall 
malce requisition for the funds required in favor of the disbursing officer or 
agent of the Treasury Department, who shall pay the bills and vouchers on 
account of the quarantine service upon the certificate of an officer detailed 
under executive order of January 3, 1900 (said order being still in force 
except as herein amended), and after approval by the chief quarantine 



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CO-OPERA TIVE WORK OF THE MEDICAL SER VICES, 461 

officer. The disbursing officer or ageat shall be appointed by the Secretary 
of the Treasury as soon as practicable, and shall render his accounts of 
such disbursements in accordance with the rules and instructions to carry 
into effect the Executive order of May 8, 1899, relative to the military gov- 
ernment of the United States in the islands of the Philippine Archipelago 
during the maintenance of such government. 

William McKinley. 

Treasury Department 

Office of the 

Supervising Surgeon General 

Marine Hospital Service, 

Washington, D.C., May 2, 1898. 

To Medical Officers of the Marine Hospital Service: 

The United States Marine Hospitals are hereby made available for the 
the reception of the sick and wounded of either the United States Army or 
the United States Navy, and you are hereby directed, upon a written re- 
quest of the proper military or naval authority, to receive and care for said 
patients; the Marine Hospital Service to be reimbursed the actual cost of 
maintenance. 

Walter Wyman, 
Supervising Surgeon General, M.H.S. 
Approved: 

L. J. Gage, 
Secretary. 
Executive Mansion, May 2, 1898. 
Approved: 

William McKinlby. 



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TROPICAL DISEASES IN THE PHIUPPINES. 

By captain JAMES M. PHALEN, 
MEDICAL CORPS UNITED STATES ARMY. 
AND LIEUTENANT HENRY J. NICHOLS, 
MEDICAL CORPS UNITED STATES ARMY. 

THE Board for the Study of Tropical Diseases as they 
exist in the Philippine Islands submits the following 
report of its work during the quarter ending June 
30, 1908: 

FILARIASIS. 

As was noted in the last report a ^ase of filariasis was 
found by Captain Eastman, Medical Corps, United States 
Army, in a colored soldier, Private Rivers, Twenty-fifth In- 
fantry, stationed at Parang, Mindanao, and was sent to the 
Division Hospital, Manila, by the Surgeon of that post, Captain 
Rand. This soldier came from Charleston, South Carolina, and 
had been in the Philippine Islands but five months when the in- 
fection was discovered. This filaria was of a nocturnal variety, 
but the question of its identity was in doubt. It was therefore 
considered advisable that one of us should go to Parang to ex- 
amine the other soldiers at that post and natives of the section. 

All of the enlisted men at Parang, 420 in number, were ex- 
amined for nocturnal filariae and one other case was found in the 
same company as the first case. This man, Private Vives, a 
Porto Rican age twenty-three, left Porto Rico in August 1906 
for the United States and enlisted in October 1906 in the Twenty- 
fifth Infantry. As he was in Rivers' company for nearly two years, 
it seems probable that he was the source of infection of the latter. 

With the assistance of Lieutenant Wiegenstein, Twenty- 
fifth Infantry, Quartermaster, and Lieutenant Bugbee, Twenty- 
fifth Infantry, Presidente of Parang, 266 persons living in 
Parang, Bacolod, and near the dock at Parang were examined. 
Five infections with filaria nocturna were found; two in Fili- 
pinos, two in Moros, and one in a Japanese. Both Filipinos had 
been muchachos in oflficers' families in near-by posts for several 
years. One was born in Misamis and one in Cotabato, but both 

{402) 



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TROPICAL DISEASES IN THE PHILIPPINES. 463 

had lived in various places in the southern islands. Both Moros 
were Quartermaster employees, born near Cotabato, and have 
lived all their lives near that place. The Japanese had been in 
the Philippines five years, of which the first three years had been 
spent on the island of Luzon and the last two years at Parang. 
Captain Rand later found another case in a muchacho of one of 
the companies, who had evaded our examination. None of those 
affected showed any symptoms whatever. 

A trip was then made to Cotabato, where eighty-five men of 
the Eighth Company, Philippine Scouts, Macabebees, were ex- 
amined with negative results. One case was discovered among 
thirty Moro prisoners, a man who had lived in the vicinity of 
Cotabato all his life. He too showed no symptoms due to the 
malady. 

By the exercise of a good deal of diplomacy and persistence 
on the part of Lieutenant Glass and Dr. Delacroix, Datto Piang 
was persuaded to allow some of his men at Duluan to be ex- 
amined. No case was found in sixty men examined. Among 
ninety-two members of the forty-fifth Company of Philip- 
pine Scouts at Cudarangan, across the river from Duluan, four 
cases were found and two more cases among twenty-three women 
of the company. All four Scouts, however, were recruits of less 
than one year's service, and had been in the Cotabato valley less 
than six months. They had spent most of their time in their 
home towns, Ivisan, Panay, Initao and Mambogao, Mindanao 
and Cebu. The two women had come a short time previously 
from Davao. These results are interesting as they show that 
the natives of the Cotobato valley have very little filariasis, while 
in Davao, the next district to the eastward, according to reliable 
reports, cases of elephantiasis are frequent and filariasis probably 
also. 

Out of 104 native Quartermaster employees at Camp Over- 
ton, Mindanao, one case, was found. This man had lived thir- 
teen years at Tacloban, Leyte, one year at Manila, and the last 
five years at Camp Overton. 

Of 203 residents of Cebu, who were examined with the as- 
sistance of Major Dutcher, Medical Corps, United States Army, 
two were infected. One was the wife of a man who had a lymph 
scrotum, but whose blood showed no parasites. Both of this 



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464 CAPTAIN J, M. PHALEN—LIEUTENANT H. /. NICHOLS. 



couple were young and had lived all their lives near Linao, six 
miles from Cebu. The other case was a Cebu policeman, a native 
of Zamboan, Cebu, who had lived, however, in difiPerent parts 
of the island. 

A total of 863 persons were examined in Mindanao and Cebu, 
of whom fifteen or one and seven-tenths per cent were infected . 
The case of lymph scrotum found in Cebu and noted above, was 
the only one which showed symptoms which might be referred 
to a filarial infection. 

The following table shows the result of these examinations, 
by towns and by nationalities: 



Place. 



Number 
examined. 



Cases. 



Parang... 




266 


Ootobato. 




115 • 


Cudarangan . 


list 


Duluan . . 




60t 


Overton.. 


— 


104 


Cebu 




208 


Total 


fl6S 


Per cent 
fected... 


In- 


1.7 



Filipinos. I MoroB Japanese. Chinese. 





113 


96 


89 


19 




86 


28 








115 











... 


60 








104 






" 


2 


20S 








15 


621 


184 


89 


19 


•• 


1.8 


1.6 


2.6 






Of seventy-four women examined three and four-tenths per 
cent were found to be infected. 

The other member of the Board in the meantime made a 
trip to Camp Daraga, Albay, for the purpose of investigating 
the presence of filariasis and elephantiasis in this section of 
southern Luzon. The existence of a large number of these 
maladies was suspected from cases seen previously in Sorsogon 
province, these cases being brought in as suspect lepers during 
the segregation of the lepers in that section. Through the good 
offices of the Governor of Albay province, and with the assist- 
ance of Captain Collins, Medical Corps, United States Army, 
thirty-four cases of elephantiasis were found, together with 
fourteen cases of filariasis. As these fourteen cases were found 
among 114 persons examined, a percentage of twelve and three- 
tenths, the indications are that this section of southern Luzon is 



\ 



85 Philippine Scouts. 
92 Philippine Scouts. 
Datto Plang's men. 



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TROPICAL DISEASES IN THE PHILIPPINES, 465 

one of the most heavily infected sections of the islands, and the 
fact that seven out of nine previously reported cases among the 
native population were natives of this section, bears out that 
view. 

Altogether thirty cases of filariasis have been seen by the 
members of the Board during the quarter. The parasites pres- 
ent in all these cases have been apparently of one species. The 
accompanying table shows the periodicity of a number of the 
parasites observed. 



Cases. 


No.1 


No.2 


12.00 m 




.. 


LUOp.m 







1 


2L0Op.m 


.. 




8.00 p. m 





1 


4.00 p. m 


.. 




5.00 p. m.. 





1 


6.00 p. m 




1 .. 


7.00 p. m 


8 


> 8 


8.00 p. m 


• . 




0.00 p. m 


6 


' 4 

1 


10.00 p. m 


ILOOp. m 


11 


' 5 

1 .. 


12.00 p. m 


LOO a. m 


8 


; 8 


2.00 a. m 


8.00 a. m 


10 


' 1 

1 


4.00 a. m 


6.00 a. m 


6 


1 8 


e.00a. m 


7.00 a. m 


8 


1 


aoOa. m 


9.00 a. m 








10.00 a. m 






11.00 a. m 





' 





No.8 


No.4 


















2 




1 


10 


4 


12 


1 






I 



No.5 


No.6 


No.7 


No.8 


No.9 


No. 10' 

1 


1 














1 

.. i 


1 


1 











1 


2 


1 


•■ 








2 

1 


2 


8 


12 








1 
8 





2 






2 


12 1 






18 


1 




21 ' 


1 


6 




8 





28 
46 





10 


41 


5 


4 


82 


1 




19 








89 ' 





8 


6 


2 


5 


42 


1 


1 


18 





2 


18 


8 


1 


6 








2 


8 





.. 







: 














.. ! 



Remark. — Cases Nos. i, 2, 3, 4 and 5 were from Parang, 6 from Cota- 
bato, 7 from Cudarangan, 8 from Overton, 9 from Cebu and 10 from Albay. 



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466 CAPTAIN J, M. PHALEN--UEUTENANT H. /. NICHOLS. 

It will be seen that case number 5 is the only one that failed 
to show a nocturnal periodicity. The series of slides in this 
case, however were not very uniform, and when an attempt was 
made to secure another series, the patient, a Moro at Parang 
had taken to the hills. The morphology of the filarial embryo 
in this case agreed with that of the others. The lack of peri- 
odicity may have been due to a slight or to a beginning or ending 
infection. We are of the opinion that all of the filarial embryos 
seen by us during the quarter, together with those that we have 
seen heretofore, were those of the Filaria Bancrojti, 

In our last report we spoke of the efforts of Captain E. E. 
Whitmore and ourselves to infect monkeys with this parasite. 
Monkeys were exposed to the bites of mosquitoes which two 
weeks before had fed upon a filaria patient, and one was given an 
intravenous injection of blood, in which it was estimated there 
were six thousand embryos. Captain Whitmore also imbedded 
an infected mosquito under the skin of a monkey, the mosquito 
being recently killed and broken up before being imbedded. Up 
to the present no filarial embryos have been recovered from the 
blood of this animal. 

BILHARZIOSIS. 

Through the courtesy of Dr. T. W. Jackson, United States 
Army, we were permitted to. observe a case of Intestinal Bil- 
harziosis, which was found by him at Fort William McKinley. 
The patient, a white soldier in the Engineer battalion, went to 
Porto Rico with a Volunteer regiment in 1898. After having 
been there about two months he acquired an attack of diarrhea 
which necessitated his being sent home about one month later. 
He recovered from this trouble shortly after arriving in the 
United States. He has since served in various posts in the United 
States and for two years served in Alaska. Previous to his com- 
ing to the Philippines, in August 1907, he has had no return of 
the bowel trouble. Since coming here he has served at Grande 
Island, Camp Stotsenburg and Fort William McKinley. While 
at Camp Stotsenburg, in November 1907, he was on sick report 
with acute dysentery, which kept him in the hospital for two 
months. After one month's duty, he returned to sick report, 
this time at Fort William McKinley. While examining his 
stools for amebae, Dr. Jackson found Bilharzia eggs having a 



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TROPICAL DISEASES IN THE PHILIPPINES, At^^J 

lateral spine. The eggs are never numerous and are found only 
when the stools contain a small amount of blood. We have been 
able to make permanent mounts of a few of the eggs, and a good 
photomicrograph of them has been obtained. 

Careful examination of this patient's stools have failed to 
locate any motile amebae, but what were thought to be vege- 
tative forms were found and a culture of amebae was obtained. 
As infections with the Bilharzia trematode having lateral spined 
eggs are frequent in the West Indies, it is likely that this in- 
fection was acquired while the patient was in Porto Rico. The 
fact that he has sufiFered from no bowel trouble during the sub- 
sequent nine years, indicates that his present complaint is due to 
amebae rather than to the trematode infection. 

PARAGONOMIASIS. 

No new cases have been observed during the past quarter. 
In our last report we spoke of having hatched out a ciliated 
embryo from the eggs, and of having made efforts to infect 
monkeys by immersing the shaved skin of a monkey in water 
containing the free embryos; also by introducing eggs contain- 
ing the embryos into the peritoneal cavity, and into the stomach 
by means of a stomach tube. After an interval of three months, 
autopsies upon these monkeys disclosed no evidence of infection 
having taken place. These experiments support the theory that 
development in an intermediate host is a necessary preparation 
for these embryos to become infective. 

AMEBAE. 

Advantage has been taken of every opportunity for the ob- 
servation of amebae in fresh specimens, and for their cultiva- 
tion. Quite a number of cultures have been obtained, though 
during the absence from Manila of both members of the Board, 
some of them died out from being overgrown by the symbiotic 
bacteria, and from lack of transplantation. Our further obser- 
vations only confirm our previous views upon the unreliability 
of accepting the morphological character of an ameba as an in- 
dex to its pathogenic powers. If there is a distinction to be 
drawn between a pathogenic and a non-pathogenic ameba, 
which we are not prepared to admit, it is too obscure for the 



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468 CAPTAIN J. M, PHALEN—UEUTENANT H. /. NICHOLS. 

average laboratory worker, and therefore of no practical value as 
an aid to diagnosis. 

CUTANEOUS BLASTOMYCOSIS. 

A number of new cases of this interesting and important 
skin disease, have come under our observation during the quarter, 
mainly through the kindness of Dr. Saleeby of St. Luke's dis- 
pensary, Manila. One case now under observation is apparently 
of a similar character to those reported in the United States by 
Drs. Hyde and Montgomery, and others. Many of the other 
cases are of a milder character, and clinically resemble the skin 
infections with the ordinary fungi. A study is being made of 
the blastomyces in cultures and in sections, as well as in fresh 
preparations, and it is expected that a special report upon this 
subject can be made in the near future. 

TINEA IMBRICATA. 

Foreman says ** Apparently a large majority (perhaps sev- 
enty per cent) of the Parang-Parang Moros have a loathsome 
skin disease.*' This is tinea imbricata which afiFects about 
twenty per cent of the Moros at- Parang, Cotabato and Duluan. 
The entire body is covered with scales which form figures on the 
chest and back. The skin is greatly thickened. One Dattowas 
anxious to have his son cured, but most Moros are indifferent to 
the disease saying that if cured it would come back and makes 
no difference anyway. A man affected is popularly known as 
"pescado." 

YAWS, 

Yaws is very common in the Cotabato district. Landor 
speaks of seeing **many children all suffering from terrible ulcers 
all over the body and face, caused by the worst of venereal com- 
plaints, the existence of which I had noticed in most Moham- 
medan settlements I had visited on Mindanao.*' ' Cases were 
seen, especially in Moro children at Parang, Cotabato and 
Cudarangan. At Datto Piang's place it was said that all the 
children had it at one time or another. A common location was 
on the sole of the foot where the skin cracked over the yaw; 
circinate forms were also seen. At Jolo Major Snyder had a 
case from Cagayande Jolo; Captain Shimer observed a case on 
the island of Pilas, near Zamboanga, and a case was seen in a 
prostitute at Iligan. 



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LACERATION OF THE BRAIN AND SUB-DURAL 
HEMORRHAGE — REPORT OF A CASE SUC- 
CESSFULLY TREATED BY MEANS OF 
BI-LATERAL INTERMUSCULO-TEM- 
PORAL DECOMPRESSION. 
By captain ALEXIUS McGLANNAN, 
MEDICAL DEPARTMENT, MARYLAND NATIONAL GUARD. 

OUR knowledge of the effects of increased intra-cranial 
pressure is largely the result of study of tumors of the 
brain and its appendages. Physiologists, neurologists, 
and surgeons have all contributed information. Recently the 
surgeon neurologists, notably Cushing, have applied this knowl- 
edge to the treatment of traumatic lesions of the skull and its 
contents. A number of valuable articles have been published. 
Although the work is still in its beginning, enough experi- 
mental and clinical evidence has been recorded to justify opera- 
tion for the relief of pathological tension of the cranial contents 
and to allow us to recognize the condition in most cases. 

Increased intra-cranial tension from injury is the result of 
hemorrhage and is always an acute compression. The eflFect of 
this compression is chiefly on the blood vessels with venous stasis 
as an early result, and later arterial compression with an inqrease 
of pressure. The increase in tension may be local or general. 
The distinction between local and general increase is important, 
because it is possible to have a great degree of local pressure 
without serious general symptoms, while even a less severe gen- 
eral pressure will be fatal because of implication of the vital 
centers of the medulla in the general anemia. 

The danger of increased intra- cranial tension is compression 
anemia of the vital centers of the medulla, but nature has pro- 
vided physiological methods for their protection. The falx 
cerebri, tentorium, and other membranes so separate the different 
parts of the brain, that it is possible to have a high degree of 

(469) 



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470 ^ CAPTAIN ALEXIUS McGLANNAN. 

local pressure at a distance from the medulla without serious 
vital disturbance. The membranes protect the vital region, and 
the free circulatory anastomoses quickly balance the blood supply. 
On the other hand, when there is general increased tension the 
protection must be vascular alone. Here we see a most elabo- 
rate system of pressure balance developed by the circulation of 
the cerebro-spinal fluid, and local and general variations in blood 
pressure progressively coming forth to protect the medulla. Of 
course an injury involving the medulla may at once destroy the 
vital centers, or an injury may be so severe that all the powers 
of compensation are unable to balance the pressure, and coma 
and death quickly follow. 

Kocher (Nothnagel's Specielle Path, und Therapie, 1901) , 
has divided the effects of increased tension into four stages, rep- 
resenting progressive increase of tension. Clinically it is com- 
mon to have the symptoms bridge these stages. Occasionally 
the process is arrested at one or the other stage, or it may pass 
directly on to the last almost immediately, depending on the 
severity of the lesion. The stages of general increased tension, 
as described by Kocher, are : 

First. The stage of compensation in which the escape of 
cerebro-spinal fluid and the narrowing of the veins makes the 
disturbance slight and without severe symptoms. 

Second. Failing compensation. Here the pressure is sufli- 
cient to lessen the amount of blood flowing through a consider- 
able part of the capillary field, but without serious alteration in 
the nutrition of the vital centers. 

Third. General circulatory involvement. Here the tension 
is sufl&cient to involve the medulla and call forth the general vaso- 
motor regulation for compensatory action. 

Fourth. Failing general compensation. , 

The symptoms of compression vary with the stages and 
progress in a like manner. Serious cases pass rapidly on to the 
late stages. At first the symptoms may be mild and insignifi- 
cant. Headache is practically always present, and with it there 
may be some mental dullness. Later, in progressive cases, or 
early in the more serious injuries, in addition to pronounced 



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DECOMPRESSION FOR BRAIN PRESSURE. 471 

headache we note vertigo, restlessness, excitement or delirium. 
Now certain objective symptoms become apparent. Of these the 
rise in blood pressure and the state of the eye grounds are most 
important. The ophthalmoscope reveals dilation of the veins 
which are also tortuous, and often a beginning edema of the 
nerve. The external veins of the head, especially the venules of 
the eye lids, are dilated and the face is usually cyanosed.* 

In the third stage there is a marked rise in blood pressure ; 
the respiration approaches the Cheyne-Stokes type ; the pulse is 
slowed to 40-50 per minute and is bounding in character, of the 
vegal quality. Examination of the retina shows choked disk. 
As the fourth stage is approached there is gradual failure of the 
compensatory action of the general circulation, the blood pres- 
sure falls, the pulse becomes rapid, the heart's action and the 
respiratory movements become irregular, and the patient passes 
into coma and dies from respiratory paralysis. 

The treatment is at once apparent. If ^he progressive in- 
crease of intra-cranial pressure leads to this final wearing out of 
compensation, or if the tension has already worn it out, the 
proper procedure is to relieve the pressure. This is best done by 
the intermusculo-temporal decompression operation (H. Gush- 
ing, Surg, Gyn. and ObsL, March, 1908). 

The advantages of this particular method are many. It un- 
covers the middle meningeal artery and the tips of the temporal 
lobes, the structures most often damaged in head injuries. The 
resulting bone defect is covered by strong muscle which controls 
the tendency to hernia of the brain. The operation can be per- 
formed rapidly and with safety. 

Technique of operation. {Surg. Gyn, and Obst,^ March, 
1908; Annals of Surgery , May, 1908). The patient's head is 
carefully prepared by shaving and scrubbing. It is not necessary 
to shave the entire scalp, a point of importance when operating 
on women. The shaved area can be so mapped out that after 
recovery the remaining hair may be arranged to hide the defect. 
The scrubbing must be very thorough and the scalp further 
cleaned by ether, alcohol and bichloride. The incision is made 
in either of two ways — a crescentic incision about an inch above 



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472 CAPTAIN ALEXIUS McGLANNAN. 

the ear, the points of the incision coming about an inch in front 
of and an inch behind the tip of the ear. The scalp is reflected 
down uncovering the temporal fascia. Or a straight incision 
may be made over the temporal region down to the fascia. With 
either method of exposure the fascia is divided perpendicularly, 
the muscle fibers separated bluntly and retracted. The skull is 
exposed at the bottom of the wound and a button of bone re- 
moved by the trephine. If the bony opening requires enlarge- 
ment, this is done by flat rongeur forceps. With sub-dural 
lesions the dura bulges into the wound and is opened after it has 
been picked up with forceps and transfixed by fine silk retraction 
sutures. In opening the dura care must be taken to avoid 
wounding the pia. After the dura is open, the clot, if any is 
found, is gently removed by salt sponging, etc., and any 
breeding point is ligated. In closing the wound the dura is 
not sutured, the muscle and fascia are brought together with 
fine catgut and the scalp sutured with interrupted fine silk. In 
traumatic cases with sub-dural hemorrhage it is necessary to 
drain, because of the oozing which we can not stop. A small 
piece of protective is brought out from the brain through the 
lower angle of the wound. This drain and the silk sutures are 
' removed at the end of forty-eight hours. Whenever the unilat- 
eral decompression does not relieve the pressure symptoms a 
similar opening should be made on the other side. 

The following is the report of my case of laceration of the 
brain and sub-dural hemorrhage cured after the decompression 
operation : 

Laceration of brain, sub-dural hematoma, cerebral compression. Bi- 
lateral intermusculo-temporal decompression. Recovery. 

The patient, a white man, age 26, was admitted to the City Hospital 
May 31, suffering from an injury to the skull. He had fallen from a tower, 
about eighteen feet, striking on his head. He was unconscious and had a 
scalp wound. When admitted he came under the care of Dr. A. C, Har- 
rison, to whom I am indebted for the opportunity of treating the patient 
and reporting this case. On June 4th Dr. Harrison was called out of town 
and left the patient in my charge. At that time the patient bad rallied 
somewhat. Consciousness had not been fully restored, although he seemed 
to understand commands. He was quite restless and rather incoherent in 
his speech. The pulse and respiration had been for the most part about 



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DECOMPRESSION FOR BRAIN PRESSURE, 473 

80 and 24, occasionally dropping to 68 and 18 respectively. On June 4th 
there was no cyanosis, the circulation and respiration were undisturbed, 
and the condition seemed to be that of the second stage of compression, 
with local compensation. There was a gradual change* in the condition 
until the eighth day, when there were fairly distinct evidences of increasing 
tension. The pupils were evenly dilated and reacted normally. The pulse 
became slower and the respirations a little stertorous, with cyanosis of the 
face and some superficial venous engorgement. On this account I had Dr. 
Herring, the neurologist of the hospital, see the patient and give his opin- 
ion concerning operation. Dr. Herring noted among other conditions, 
double choked disk more marked on the right side. Considering this in con- 
nection with evident failure of local compensation, and the absence of any 
focal symptoms, we decided that a sub-temporal decompression should be 
done on the right side. 

Operation June 8th, 1908. Intermusculo-temporal decompression of 
the right side. 

Under ether anesthesia I opened the skull through the split temporal 
muscle. There was no extra-dural lesion, and the dura bulged through the 
bone opening under considerable tension. When the dura was incised 
about 5 cc. Qf straw-colored fluid spurted out. The tip of the temporal lobe 
was badly lacerated and softened, but no distinct clot was found. A 
searcher passed down under the temporal lobe allowed the evacuation of a 
considerable quantity of blood-stained fluid. A protective drain was 
brought out from the brain through the lower angle of the wound and the 
wound closed in the usual manner. 

There was no shock and the patient recovered from the anesthetic 
without any trouble. There was immediate relief of the general circulatory 
disturbance, but the patient remained unconscious and the eye grounds on 
both sides continued to show choked disk. At the flrst dressing on the 
fourth day after operation, the stitches and the drain were removed. The 
wound had healed per priniam except at the drainage opening. There was 
distinct bulging of the temporal area and a slight flow of bloody fluid fol- 
lowed the removal of the drain. The wound went on to final healing with- 
out complications. 

There was no further change in the condition of the patient, the choked 
disk and the unconsciousness persisted. The bulging of the decompressed 
area was constant. About the tenth day after the operation occasional ev- 
idences of failing general compensation began to occur. There would be 
periods of cyanosis, with stertor and slow bounding pulse, associated with 
periods of fluctuation in blood pressure and approach to the Cheyne-Stokes 
type of respiration. A second decompression on the other side was strongly 
advised, but the patient's friends objected to further operation. On June 
24th, after consultation with Dr. Charles Magill, the family physician, con- 
sent was obtained and I decompressed on the left side. 



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474 CAPTAIN ALEXIUS McGLANNAN. 

Operation June 24th, 1908. Intermusculo-temporal decompression of 
left side. 

The skull was opened as in the first operation and the dura incised. A 
lenticular clot was found under the dura, extending forward over the tem- 
poral lobe. The bone opening was enlarged to allow the complete removal 
of the clot by wet salt sponges. No bleeding point was found and the 
wound was closed with a drain in the usual way. The patient showed con- 
siderable mental improvement soon after the operation. The stitches and 
drain were removed on the fourth day after the operation and the wound 
healed without complications. The eye grounds cleared up. Then fol- 
lowed a period of no change that lasted for several weeks. The patient 
was more or less unconscious, would obey orders, but took no interest in 
his surroundings. This period was followed by one of gradual improve- 
ment, ending in recovery. 

On October ist the patient reported at the hospital and was examined 
by Dr. Schmitz, the resident surgeon,who reports him completely recovered. 



STAB WOUNDS OF THE ABDOMEN. 

IN the Muenchener Med. Wochenschrift, Dr. Hartleib reports 
an interesting case of a young boy who received a stab 
wound in the abdomen, inflicted by his comrade with a 
pocket knife. Operation seventy-three hours later with recov- 
ery. The author received the patient for treatment fifty-three 
hours after the injury. At this time there were no signs of 
perforation ; temperature was normal ; pulse 104. The follow- 
ing morning the pulse was 84; temperature normal ; in the 
afternoon vomiting occurred, temperature 38, pulse 104; abdo- 
men tympanitic. Laparotomy in the evening; on opening the ab- 
domen two small cuts of about one cm. in size were found in the 
intestines. Gas escaped through the cuts. Peritoneum inflamed 
in the immediate neighborhood of the cuts. Milko asserts that 
in most cases of abdominal injury it is easy to decide whether 
operative measures are necessary or not, and cites as a constant 
symptom the reflex contraction of the muscles of the abdominal 
wall. The author's case, as well as many others reported in 
medical literature, proves the contrary. The time limit at 
which the patient is out of danger can not be fixed within the 
first week of the abdominal injury. — Fred. J. Conzelmann. 



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Contemporary Comment 



TYPHOID FEVER. 

IN five years Chantemesse (^Roths Jahresbericht) has treated 
712 typhoid fever patients with his serum with a mortality 
rate of 3.7 per cent. In the hospitals with the usual treat- 
ment of typhoid the mortality rate was 17.3 per cent. From a 
large clinical material one may judge the results of his treatment 
from the death rate, the lower the death fate the better the treat- 
ment. Favorable results with Chantemesse's serum were also 
obtained by other observers. The War Department has adopted 
the treatment for the army. The dose consists, as a rule, of an 
injection of one c. c. per forty Kg. body weight. The reaction 
lasts usually five days, showing enlargement of the spleen, a 
marked leucocytosis and a slight increase in temperature. The 
temperature begins to fall suddenly ; the earlier the treatment 
is begun the quicker the fever disappears. In very severe cases 
a second injection of one-half the previous dose may be necessary. 
Complications were few. Recovery took place in all patients in 
whom the serum was used in the first week of the disease. Har- 
rison reports the results of the protective inoculation in an epi- 
demic of typhoid fever among the men of the 17th Lancers with 
a new preparation. The dose was one and two c. c. containing, 
respectively, 500 and 1,000 million bacteria. The second dose is 
absolutely necessary and it is to be administered at an interval of 
ten days. The only case of typhoid fever that occurred among 
the inoculated was one who had refused the second dose. Seven 
hours after the injection there is « rise of temperature and a 
moderate general disturbance. After thirty hours all manifes- 
tations have disappeared apart from the sensibility to pressure at 
the point of injection. A revaccination after two years is at 
present essential. The vaccine can be kept one year. The ad- 
dition of an antiseptic makes it possible to keep the vaccine for 

(476) 



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476 CONTEMPORARY COMMENT. 

further use even if part of the contents of a flask has been used. 
The Roux syringe containing 5 c. c. appears to be the best. The 
vaccination is voluntary. The men are instructed about pro- 
tective vaccination. The number of men vaccinated depends 
entirely how the matter is presented to them. It varies between 
and 50 per cent. — Fred J. CoNZEiyMANN. 



SUTURE OF LUNG AFTER GUNSHOT INJURY, 

IN the Muenchener Med. Wochenschrift, Dr. Schuette re- 
marks that if one considers the great advances that surgery 
has made in the last decades one is astonished to find that 
rarely surgical measures are employed for traumatic hemorrhage 
of the lungs. This is especially surprising as the results of the con- 
servative treatment are far from being satisfactory. G. Garres' 
statistics of 700 cases of traumatic hemorrhage of the lungs with 
conservative treatment show a mortality rate of 40 per cent. 
Richter found in thirty-seven cases of subcutaneous rupture of 
the lungs a total mortality rate of 63 per cent ; in 100 stab 
wounds a mortality rate of 38 per cent, and in 535 gunshot in- 
juries of the lungs a mortality rate of 30 per cent. Until now 
only twelve cases of traumatic hemoptysis have been reported in 
medical literature. In three of these cases a tampon was used 
and in the other nine, suture was employed. Three of the latter 
died. The author reports an interesting case of attempted sui- 
cide. The patient had shot himself in the third left intercostal 
space. The symptoms indicated that a severe hemorrhage was 
taking place in the lungs. The author decided to operate. On 
opening the thoracic cavity, the technic of it is given in detail, 
blood was spurting freely from the upper lobe. The lung tissue 
was sutured. Resection of the seventh rib was also performed in 
order to provide proper drainage. The author concludes that in 
all cases with severe hemorrhage where life is in immediate dan- 
ger, operative procedure is imperative. Patients who have lost 
much blood should, after the bleeding points have been sutured, 
receive a large infusion of normal salt solution. As a prophy- 
lactic measure to avoid empyema the resection of the seventh 
rib in the posterior axillary line is advised. — Frkd J. Conzei,- 

MANN. 



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flDebico-rt&ilitar^ f nbei. 



MEDICO-MILITARY ADMINISTRATION. 

Isambert. [Employment of draught-dogs in ambulances in the field.] 
Caduch, Par., 1908, viii, 63-66. 

Preacott (J* J* W.) A new method of carrying wounded off the field on 
service. /. Roy. Army Med, Corfis, Lond., 1908, x, 569. 

Pttisais. [Draught-dogs.] CaducUy Par., 1908, viii, 90. 

Reboul (HO [R61e of the surgeon in cantonment. Experiences during 
the manoeuvres of 1902.] Caducie^ Par,, 1908, viii, 89. 

Renault* [Organization of a dental service among the colonial troops.] 
Caduch, Par., 1908, viii, 91. 

Sch5ppler (H*) [Norren*s field chest as an example of medical equip- 
ment in the field in the i8th Century.] Deutsche mtl.drztl, Ztschr., Berl., 
1908, xxxvii, 391-396. 
MEDICO-MILITARY HISTORY AND DESCRIPTION. 

Epaulard (A,) [The Medical Corps in a combat in Morocco.] Presse 
mkd.y Par., 1908, xvii, 153-155. 

Kilbouroe (E. D*) The Medical Corps United States Army. Quart. 
Bull. Northwest Univ. Med. Sch.^ Chicago, 1907-8, ix, 388-396. 

Legrand (G*) [On removal of the wounded (Morocco campaign).] 
Caducke^ Par., 1908, viii, 75. 

huzzait' [The Army Medical Museum in Washington.] Ann. di 
med. nav.y Rome, 1908, i, 265-271. 

Newburger. [The Queen Alexandra Corps of Sisters in the English 
Army.] Ztschr.^ Berl., 1908, xxxvii, 321-329. 

Potlralovskl (P. P*) [Manoeuvers of the army medical department] 
Voyennomed.J.^ St. Petersb., 1908, ccxxi, med. spec, pt. 253-264. 

Steiner (JO The Medical Department of the British Army. /. Roy. 
Army Med. Corps ^ Lond., 1908, x, 547-552. 

MILITARY HYGIENE. 

Champeauz (M.) [Physiology of the soldier.] Presse mtd.^ Par., 1908, 
xvi, 209; 265. 

CouUaod (HO and Giaestous (E.) [Conditions of visual aptitude required 
in the French and foreign armies.] Bull, mid.^ Par., 1908, xxii, 367 ; 391. 

(477) 



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478 MEDICaMIUTARY INDEX. 

Defresslae. [Report on disiafection with the fumigator at the Mari- 
time Hospital of the Orient] Arch, de mkd. nav.y Par., 1908, Ixxxix, 207- 

222. 

Enidne (W» D.) Washing-up arrangements in barrack rooms. /. Roy. 
Army Med. Corfis, Lond., 1908, x, 532-534. 

GaUtn (IL) [On the subject of the item in military nosology : pied 
forc^.] Caduch^ Par., 1908, viii, 80. 

GtflUea (Eugene Theodofe)* [Duties in social hygiene of the soldier and 
sailor.] Bordeaux, 1907, 133 p. 8°. 

GttiUon (AO [Teaching of dietetics in the schools of application for 
the Medical Corps.] CaducUy Par., 1908, viii, 123. 

Lengfellner (K*) [Scientific principles in making shoes with special 
reference to shoes for youths and soldiers. Ztschr.f, orthop. Chir. Stuttg.^ 
1908, XX, 278-291. 

Medlredeff (L L) [Apropos of the report concerning the use of specta- 
cles with yellow orange and yellow green glasses in the array.] Voyenno- 
med. /., St. Petersb., 1908, ccxxi., med. spec, pt., 332-342. 

Mueller (F. L.) Field cooking and the travel ration. /. MtL Serv, 
Inst.y Governor's Island^ N. Y. H.^ 1908, xlii, 444-460. 

[Prophylaxis of typhoid fever in the army.] Bull, m^d.^ Par., 1908. 
xxii, 225-228. 

Tate (R« G. H.) Notes on the new field latrine. /. Roy. Army Med. 
Corps ^ Lond., 1908, x, 536-538. 

MILITARY MEDICINE. 

Hof&nan and Sirunk* [Observation on the use of autan in military 
medicine.] Deutsche, mil.-drstl. Ztschr.^ Berl., 1908, xxxvii, 384-391. 

Kalfiitratoff (?• M.) [Typhoid fever epidemic of the 5th Reserve Ar- 
tillery Brigade.] Voyentuhmed. J.y St. Petersb., 1908, ccxi, med. spec, pt 
228-243. 

Ottvi (G*) [Fatigue in the soldier and the marine.] Milano, 1908, 144 
0. 8**, 

MILITARY SURGERY. 

Senn (N») The dawn of modern military surgery. Surg, Gymc. ObsLy 
Chicago, 1908, vi, 477-482. 

StrauflB. [Diseases and wounds of the pancreas in the army from 1894 
to 1904.] Deutsche, mil.-drztl. Ztsch.^ Berl., 1908, xxxvii, 329-338. 



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Ebitorial Bipressiom 



'*ON TO RICHMOND'*— 

THE CHANGE OF ADDRESS OF THE SECRETARY 

AND THE MIUTARY SURGEON. 

IT is announced that on and after the first of December, 1908, 
the office of the Secretary will be located at Richmond, 
Virginia, where Thb Military Surgkon will also here- > 
after be published. The increasing membership of the Associa- 
tion renders a more central and accessible location desirable for 
the more efficient conduct of its work, which will also bfe ma- 
terially advanced by the facilities of a larger city. These reasons, 
together with certain personal considerations, have been the 
compelling factors which have brought about this movement. 
The Secretary believes that the transfer bodes well for the fu- 
ture of the Association. 



THE PURIFICATION OF WATER FOR MILITARY 
PURPOSES. 

WATER forms so important an item in military hygiene 
that even when nothing new or startling is advanced 
it is worth while to consider the views held in other 
countries. This comment is applicable to an interesting paper 
by Dr. E. Ravenezin Der Mililaeraerzt, the enterprising Austro- 
Hungarian military medical bi-weekly. He emphasizes the fact 
that as harmlessness is the essential requirement for potable 
water it follows that the hygienic condition of the water must be 
known before it is used for drinking purposes. To determine 
this in the field it is necessary that a chemical and bacteriological 
examination be made with portable apparatus, unless it is pos- 
sible to refrain entirely from using it. In case the employment 
of water from an impure source is unavoidable, the problem of 

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480 EDITORIAL EXPRESSION. 

rendering it potable is readily solved by the use of a proper 
method of purifying the water supply. 

He catalogues the different methods of purifying water as: 

1. Mechanical (filtration through porcelain and sand filters), 

2. Physical (sterilization by heat and ozone), 3. Chemical 
(bromine, iodine, etc.). 

If these methods are carefully carried out, pure water in a 
bacteriological sense may beobtained. Theoretically the methods 
are highly recommended but practically they are not always 
suitable for the purpose. The best results will be obtained by a 
careful consideration of the indications for purifying the water 
and also of the advantages and disadvantages of the various 
methods. Certain methods for purification which give good re- 
sults for troops stationed for some time in the field would be out 
of the question for troops on the march and the method used for 
a large body of soldiers would not be applicable to a small number 
stationed at an isolated post. The circumstances and surround- 
ings would have to decide the method which should be used and 
which would most effectually satisfy the requirements at the 
moment. The chemical method would be most satisfactory for 
troops on the march as it is simple and consumes but little time. 
The easy transportable sterilization apparatus which may be sent 
ahead of the troops to prepare the required amount of water 
needed, have proven very efficient. These methods have also 
proven their value in garrisons, but here it will be more advan- 
tageous to put up more lasting establishments instead. 



PUBUC HEALTH AND MARINE HOSPITAL 
EXAMINATIONS. 

ABOARD of commissioned medical officers will be con- 
vened to meet at the Bureau of Public Health and Ma- 
rine Hospital Service, 3 B street S.E., Washington, 
D.C., Monday, January 11, 1909, at 10 o'clock a.m., for the 
purpose of examining candidates for admission to the grade of 
assistant surgeon in the Public Health and Marine Hospital Ser- 
vice. 

Candidates must be between twenty-two and thirty years of 
age, graduates of a reputable medical college, and must furnish 
testimonials from responsible persons as to their professional and 
moral character. 



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EDITORIAL EXPRESSION. 481 

The following is the usual order of the examinations: 1. 
physical; 2. oral; 3. written; 4. clinical. 

In addition to the physical examination, candidates are re- 
quired to certify that they believe themselves free from any ail- 
ment which would disqualify them for service in any climate. 

The examinations are chiefly in writing- and begin with a 
short autobiography of the candidate. The remainder of the 
written exercise consists in examination in the various branches 
of medicine, surgery and hygiene. 

The oral examination